Medicine and Health Sciences Commons^™

Jefferson Digital Commons Quarterly Report: October-December 2012, Daniel G. Kipnis, Msi

Jefferson Digital Commons Reports

Jefferson Digital Commons quarterly report includes statistics, top 10 most downloaded items and new assets added to the collection.

Patient Safety Symposium: Issues, Analyses, Prevention, Alan Forstater, Marcia Levinson, Jennifer Bellot, Mary Hess, John Spandorfer

Department of Medicine Presentations and Grand Rounds

Abstract Introduction: While learning the basics of patient safety, students can also learn about the contribution members of the various health professions can make to patient safety, which is why we stress the importance of interprofessional interactions in this Introduction to Patient Safety Symposium.

Methods: This 4-hour symposium is designed as an introduction to patient safety presented in a classroom setting, with students seated in groups made up of representatives of each health profession. The course revolves around a case scenario presentation of a hypothetical patient who has had his knee replaced and is the victim of a series of …

Periprosthetic Joint Infection Increases The Risk Of One-Year Mortality., Benjamin Zmistowski, Joseph A. Karam, M.D., Joel B Durinka, David S Casper, Md, Javad Parvizi Md

Rothman Institute Faculty Papers

BACKGROUND: Periprosthetic joint infection continues to potentially complicate an otherwise successful joint replacement. The treatment of this infection often requires multiple surgical procedures associated with increased complications and morbidity. This study examined the relationship between periprosthetic joint infection and mortality and aimed to determine the effect of periprosthetic joint infection on mortality and any predictors of mortality in patients with periprosthetic joint infection.

METHODS: Four hundred and thirty-six patients with at least one surgical intervention secondary to confirmed periprosthetic joint infection were compared with 2342 patients undergoing revision arthroplasty for aseptic failure. The incidence of mortality at thirty days, ninety …

Milestone: Over 100 Mph Capstones Archived In The Jefferson Digital Commons, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

Since 2009 the Jefferson School of Population Health (JSPH) has archived all capstone presentations in the Jefferson Digital Commons.

The Teaching Self-Reflection Tool And Skills Checklist, Arlene Lorch, Otd, Otr/L, Ches

Department of Occupational Therapy Faculty Papers

OBJECTIVE.

To provide occupational therapy faculty with a collaborative system to review and improve teaching skills within the educational program.

METHOD.

Six faculty members completed a self-assessment using self-reflection tools and feedback from an interview with a fellow faculty member serving as consultant. Surveys evaluated perceptions of the experience.

RESULTS.

Survey responses indicated strong approval of the peer review process as a valuable method for faculty development. Results identified aspects of the process that needed revision, specifically, the burden of time required to complete the process.

CONCLUSION.

Findings support the need for a peer review process because it benefits faculty, …

Adiponectin Inhibits Oxidative/Nitrative Stress During Myocardial Ischemia And Reperfusion Via Pka Signaling., Yanqing Zhang, Xiao-Liang Wang, Jianli Zhao, Ya-Jing Wang, Wayne Bond Lau, Yue-Xing Yuan, Er-He Gao, Walter J. Koch, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

The cardioprotective effects of adiponectin (APN) against myocardial ischemia/reperfusion (MI/R) injury are well known. However, comprehension of the mechanisms mediating intracellular APN signaling remains incomplete. We recently demonstrate the antioxidant/antinitrative effects of APN are not dependent on AMPK. Protein kinase A (PKA) has been previously shown to be activated by APN, with uncertain relevance to APN cardiac protection. The current study determined whether the antioxidative/antinitrative effect of APN is mediated by PKA. Administration of APN (2 μg/g) 10 min before reperfusion significantly enhanced cardiac PKA activity, reduced oxidative stress, and decreased infarct size. Knockdown of cardiac PKA expression (PKA-KD) by …

Sevoflurane Induces Cardioprotection Through Reactive Oxygen Species-Mediated Upregulation Of Autophagy In Isolated Guinea Pig Hearts., Mayumi Shiomi, Masami Miyamae, Genzou Takemura, Kazuhiro Kaneda, Yoshitaka Inamura, Anna Onishi, Shizuka Koshinuma, Yoshihiro Momota, Toshiaki Minami, Vincent M. Figueredo

Division of Cardiology Faculty Papers

PURPOSE: Sevoflurane increases reactive oxygen species (ROS), which mediate cardioprotection against myocardial ischemia-reperfusion injury. Emerging evidence suggests that autophagy is involved in cardioprotection. We examined whether reactive oxygen species mediate sevoflurane preconditioning through autophagy.

METHODS: Isolated guinea pigs hearts were subjected to 30 min ischemia followed by 120 min reperfusion (control). Anesthetic preconditioning was elicited with 2 % sevoflurane for 10 min before ischemia (SEVO). The ROS-scavenger, N-(2-mercaptopropionyl) glycine (MPG, 1 mmol/l), was administered starting 30 min before ischemia to sevoflurane-treated (SEVO + MPG) or non-sevoflurane-treated (MPG) hearts. Infarct size was determined by triphenyltetrazolium chloride stain. Tissue samples were obtained …

Defects In Synapse Structure And Function Precede Motor Neuron Degeneration In Drosophila Models Of Fus-Related Als., Mohammad Shahidullah, Sylvain J Le Marchand, Hong Fei, Jiaming Zhang, Udai Bhan Pandey, Matthew B. Dalva, Piera Pasinelli, Irwin B. Levitan

Department of Neuroscience Faculty Papers

Amyotrophic lateral sclerosis (ALS) is an adult-onset neurodegenerative disease that leads invariably to fatal paralysis associated with motor neuron degeneration and muscular atrophy. One gene associated with ALS encodes the DNA/RNA-binding protein Fused in Sarcoma (FUS). There now exist two Drosophila models of ALS. In one, human FUS with ALS-causing mutations is expressed in fly motor neurons; in the other, the gene cabeza (caz), the fly homolog of FUS, is ablated. These FUS-ALS flies exhibit larval locomotor defects indicative of neuromuscular dysfunction and early death. The locus and site of initiation of this neuromuscular dysfunction remain unclear. We show here …

Evaluation Of The Appropriate Weaning Of Neonatal Morphine Solution (Nms) In The Treatment Of Neonatal Abstinence Syndrome (Nas) And Its Effect On Length Of Stay (Los), Nicole Hollinger, Pharmd Candidate, Christopher Hvisdas, Pharmd Candidate, Maria Samohod, Md Candidate, Tara E. Decerbo, Pharmd, Janet Larson, Md, Kristin Mckenna, Md, Lindsey Roke, Pharmd

Pharmacy Presentations, Posters, and Grand Rounds

Purpose: Neonates suffering from NAS receive NMS to treat withdrawal symptoms associated with this disease. Frequent NMS dosing and close monitoring are required to ensure adequate symptom control and prevent adverse events. Maximum dose achieved, titration, severity of disease, and variance in in-utero exposure to addictive drugs all contribute to length of stay. The primary objective of this drug utilization evaluation is to assess adherence to current institutional guidelines for titrating neonates and infants off NMS and to identify opportunities for improvement to potentially decrease length of stay in this population.

Methods: A retrospective chart review of neonates …

Sociocultural Influences On Diabetes Self-Management Behaviors In Older African Americans, Barry W. Rovner, Robin J. Casten, Lynn Fields Harris

Department of Psychiatry and Human Behavior Faculty Papers

Objective. The purpose of this observational study was to describe the associations between cultural beliefs that are prevalent in older African Americans and adherence to diabetes self-management (DSM) behaviors.

Methods. In a community population of 110 older African Americans with type 2 diabetes, the investigators administered surveys that assess present time orientation (PTO), future time orientation (FTO), and religiosity, as well as exercising habits, reading food labels, and checking blood glucose.

Results. Participants who reported regularly exercising had significantly lower PTO scores and higher FTO and religiosity scores than participants who did not regularly exercise. Similarly, participants who reported reading …

Effects Of A Pneumonia Pathway On Hospital Readmission Rates, Melissa Ash, Brian Glynn, Silvana Romeo, Zenobia Black, Ashley Adams, Bridget Dutil, Raymond Malloy, Maribeth Kelly

Department of Nursing papers and presentations

There are inconsistencies in treating inpatients with community acquired pneumonia (CAP) and providing adequate post discharge follow-up contributing to significant hospital re-admission rates and increased healthcare costs. Will the use of a pneumonia pathway decrease hospital re-admissions and healthcare costs? Our null hypothesis for this study was that the use of a pneumonia care pathway will have no significant effect on hospital readmission rates.

Review Of Cerebral Aneurysm Formation, Growth, And Rupture., Nohra Chalouhi, Md, Brian L Hoh, David Hasan

Department of Neurosurgery Faculty Papers

No abstract provided.

Racial Differences In Human Platelet Par4 Reactivity Reflect Expression Of Pctp And Mir-376c., Leonard Edelstein, Lukas M Simon, Raúl Teruel Montoya, Michael Holinstat, Edward S Chen, Angela Bergeron, Xianguo Kong, Srikanth Nagalla, Narla Mohandas, David E Cohen, Jing-Fei Dong, Chad Shaw, Paul Bray

Cardeza Foundation for Hematologic Research

Racial differences in the pathophysiology of atherothrombosis are poorly understood. We explored the function and transcriptome of platelets in healthy black (n = 70) and white (n = 84) subjects. Platelet aggregation and calcium mobilization induced by the PAR4 thrombin receptor were significantly greater in black subjects. Numerous differentially expressed RNAs were associated with both race and PAR4 reactivity, including PCTP (encoding phosphatidylcholine transfer protein), and platelets from black subjects expressed higher levels of PC-TP protein. PC-TP inhibition or depletion blocked PAR4- but not PAR1-mediated activation of platelets and megakaryocytic cell lines. miR-376c levels were differentially expressed by race and …

The Mir-17/92 Cluster: A Comprehensive Update On Its Genomics, Genetics, Functions And Increasingly Important And Numerous Roles In Health And Disease., Elena Mogilyansky, Isidore Rigoutsos

Computational Medicine Center Faculty Papers

The miR-17/92 cluster is among the best-studied microRNA clusters. Interest in the cluster and its members has been increasing steadily and the number of publications has grown exponentially since its discovery with more than 1000 articles published in 2012 alone. Originally found to be involved in tumorigenesis, research work in recent years has uncovered unexpected roles for its members in a wide variety of settings that include normal development, immune diseases, cardiovascular diseases, neurodegenerative diseases and aging. In light of its ever-increasing importance and ever-widening regulatory roles, we review here the latest body of knowledge on the cluster's involvement in …

Transfusion Medicine Illustrated: Transfusion Interference By Cold Agglutinins., Melissa R. George, Jay Herman

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

No abstract provided.

Periprosthetic Knee Infection: Ten Strategies That Work., Javad Parvizi, Md, Priscilla Ku Cavanaugh, Claudio Diaz-Ledezma

Department of Orthopaedic Surgery Faculty Papers

Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). The demand for TKA is rapidly increasing, resulting in a subsequent increase in infections involving knee prosthesis. Despite the existence of common management practices, the best approach for several aspects in the management of periprosthetic knee infection remains controversial. This review examines the current understanding in the management of the following aspects of PJI: preoperative risk stratification, preoperative antibiotics, preoperative skin preparation, outpatient diagnosis, assessing for infection in revision cases, improving culture utility, irrigation and debridement, one and two-stage revision, and patient prognostic information. …

Preoperative Spinal Tumor Embolization: An Institutional Experience With Onyx., George M. Ghobrial, Md, Nohra El-Chalouhi, Md, James Harrop, Md, Richard Dalyai, Md, Stavropoula Tjoumakaris, Md, L Fernando Gonzalez, Md, David Hasan, Md, Robert Rosenwasser, Md, Pascal Jabbour, Md

Department of Neurosurgery Faculty Papers

BACKGROUND: Preoperative embolization has the potential to decrease intraoperative blood loss and facilitate spinal cord decompression and tumor resection.

OBJECTIVE: We report our institutional experience with the embolization of hypervascular extradural spinal tumors with Onyx as well as earlier embolic agents in a series of 28 patients.

METHODS: A retrospective case review was conducted on patients undergoing preoperative transarterial embolization of a spinal tumor between 1995 and 2012 at our institution.

RESULTS: Twenty-eight patients met the inclusion criteria, with a mean age of 60.6 years. Twenty-eight patients had metastatic tumors. In 14 (50%) patients the metastases were from renal cell …

Smooth Muscle-Specific Myosin Phosphatase Target Subunit 1 (Mypt1): An Important Piece Of The Puzzle., Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

Dear Sir:

We have read with great interest a recent article by Dr. He et al. in the June issue of Gastroenterology.¹ The studies provide strong evidence in favor of the concept that smooth muscle–specific myosin phosphatase target subunit 1 (MYPT1) of myosin light chain phosphatase (MLCP) plays a critical role in the agonist-induced contraction/relaxation of the smooth muscle. This was shown in their studies using animals with knocked out MYPT1^-/-. The investigators employed the Cre-loxP system in which they used the promoter region and exon 1 of Mypt1 flanked by 2 loxP sites …

Targeting Cell Cycle And Hormone Receptor Pathways In Cancer., C E S Comstock, M A Augello, J F Goodwin, R De Leeuw, M J Schiewer, W F Ostrander, R A Burkhart, A K Mcclendon, Peter Mccue, Edouard J. Trabulsi, Costas D. Lallas, Leonard G Gomella, Md, M M Centenera, Jonathan Brody, Md, L M Butler, W D Tilley, K E Knudsen, Phd

Department of Cancer Biology Faculty Papers

The cyclin/cyclin-dependent kinase (CDK)/retinoblastoma (RB)-axis is a critical modulator of cell cycle entry and is aberrant in many human cancers. New nodes of therapeutic intervention are needed that can delay or combat the onset of malignancies. The antitumor properties and mechanistic functions of PD-0332991 (PD; a potent and selective CDK4/6 inhibitor) were investigated using human prostate cancer (PCa) models and primary tumors. PD significantly impaired the capacity of PCa cells to proliferate by promoting a robust G1-arrest. Accordingly, key regulators of the G1-S cell cycle transition were modulated including G1 cyclins D, E and A. Subsequent investigation demonstrated the ability …

Comparing The Cumulative Pain Patients Experience Waiting For Knee Arthroplasty To Their Postoperative Pain, Eric S. Schwenk, Richard H. Epstein, Md, Cphims, Franklin Dexter

Department of Anesthesiology Faculty Papers

Introduction: Reduction of pain is a major goal of anesthesiologists treating patients undergoing knee arthroplasty. This has been achieved traditionally through the use of regional analgesia. Although these techniques decrease postoperative pain, they inherently do not affect the longstanding pain patients experience as they wait for surgery. Our objectives were to quantify: 1) the decrease in pain achieved by surgical joint replacement; and 2) the decrease in postoperative pain achievable through femoral nerve blocks versus opioids. From a systems-based perspective, we wanted to determine how much reduction in waiting time before surgery would be necessary to achieve an equal cumulative …

Toward A Unifying Taxonomy And Definition For Meditation., Jonathan D Nash, Andrew Newberg, Bhuvanesh Awasthi

Marcus Institute of Integrative Health Faculty Papers

One of the well-documented concerns confronting scholarly discourse about meditation is the plethora of semantic constructs and the lack of a unified definition and taxonomy. In recent years there have been several notable attempts to formulate new lexicons in order to define and categorize meditation methods. While these constructs have been useful and have encountered varying degrees of acceptance, they have also been subject to misinterpretation and debate, leaving the field devoid of a consensual paradigm. This paper attempts to influence this ongoing discussion by proposing two new models which hold the potential for enhanced scientific reliability and acceptance. Regarding …

Download Entire Issue- Jefferson Interprofessional Education And Care Newsletter, Fall, 2013, Volume 4, Issue 2

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Download entire issue- Jefferson Interprofessional Education and Care Newsletter, Fall, 2013, Volume 4, Issue 2.

Jefferson Makes A Major Contribution To Collaborating Across Borders, Iv Conference, Kevin Lyons, Phd

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

The fourth international Collaboration Across Borders conference (CAB IV) was held in Vancouver BC, Canada on June 12‐14, 2013. This conference, held every two years, attracts people involved in interprofessional education and care (IPEC) from across North America, and from other countries such as Japan, Australia and the European Union. The conference is a collaborative venture between the American Interprofessional Health Collaborative (AIHC) and the Canadian Interprofessional Health Collaborative (CIHC). The site of the conference alternates between the United States and Canada. As interest and involvement in interprofessional approaches to education and health care grows, so too does attendance at …

Award Corner, Julia M. Ward, Phd, Rn

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

My career in nursing began more than three decades ago. Healthcare education during that time was delivered in the familiar “silo” style. Having to navigate through clinical practice, learning along the way which disciplines were involved in the care of patients and how to work as a team developed over time.

Teamstepps Pilot Course, Alan T. Forstater, Md, Facep

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

A new and exciting course on TeamSTEPPS was introduced at Jefferson last Spring. JCIPE has embraced the concept of TeamSTEPPS, a program developed by the Department of Defense and now sponsored by AHRQ to train healthcare professionals to work together effectively as a team to ensure patient safety. The following team skills are emphasized: leadership, situational awareness, team support and communication skills. To introduce this to the campus JCIPE sponsored a pilot project in May, 2013 to train a cadre of students in the techniques of TeamSTEPPS.

From The Editors, Elizabeth Speakman, Edd, Rn, Cde, Anef, Christine A. Arenson, Md

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Welcome to the Fall 2013 edition of the Jefferson Interprofessional Education and Care newsletter. In this edition you will read about Collaborating Across Borders, IV, the largest IPE meeting to date, where the work of developing, integrating, and sustaining interprofessional education and collaborative practice was shared by over 700 participants. The clear message of CAB IV – interprofessional education is being recognized and adopted by health professions education programs in a way not seen before, but the work of clearly identifying optimum education strategies and documenting impact on patient care must be a high priority for all of us in …

Intestinal Gucy2c Prevents Tgf-Β Secretion Coordinating Desmoplasia And Hyperproliferation In Colorectal Cancer., Ahmara V Gibbons, Jieru Egeria Lin, Gilbert Won Kim, Glen P Marszalowicz, Peng Li, Brian Arthur Stoecker, Erik S Blomain, Satish Rattan, Adam E. Snook, Stephanie Schulz, Scott A Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Tumorigenesis is a multistep process that reflects intimate reciprocal interactions between epithelia and underlying stroma. However, tumor-initiating mechanisms coordinating transformation of both epithelial and stromal components are not defined. In humans and mice, initiation of colorectal cancer is universally associated with loss of guanylin and uroguanylin, the endogenous ligands for the tumor suppressor guanylyl cyclase C (GUCY2C), disrupting a network of homeostatic mechanisms along the crypt-surface axis. Here, we reveal that silencing GUCY2C in human colon cancer cells increases Akt-dependent TGF-β secretion, activating fibroblasts through TGF-β type I receptors and Smad3 phosphorylation. In turn, activating TGF-β signaling induces fibroblasts to …

Two Phase 3, Multicenter, Randomized, Placebo-Controlled Clinical Trials Of Fampridine-Sr For Treatment Of Spasticity In Chronic Spinal Cord Injury., D. D. Cardenas, J. F. Ditunno, V. Graziani, A. B. Mclain, D. P. Lammertse, P. J. Potter, M. S. Alexander, R. Cohen, A. R. Blight

Department of Rehabilitation Medicine Faculty Papers

STUDY DESIGN: Two randomized, double-blind, placebo-controlled trials.

OBJECTIVE: To evaluate the efficacy and safety of fampridine sustained-release tablets (fampridine-SR) 25 mg twice daily for moderate-to-severe spasticity in patients with chronic spinal cord injury (SCI).

SETTING: United States and Canada.

METHODS: Patients with incomplete chronic SCI were randomized to twice daily fampridine-SR 25 mg or placebo, with a 2-week single-blind placebo run-in, a 2-week titration, 12 weeks of stable dosing, 2 weeks of downward titration and 2 weeks of untreated follow-up. Co-primary end points were the change from baseline, averaged over the double-blind treatment period, for Ashworth score (bilateral knee flexors …

Chronic Malnutrition In Guatemala, Nicholas Bishop, Susan Mcilvaine

CwiC-PH

Poster includes:

• What is chronic malnutrition and what causes it?
• Why address malnutrition?
• Addressing the problem

Microrna-138 Regulates Hypoxia-Induced Endothelial Cell Dysfunction By Targeting S100a1., Anagha Sen, Shumei Ren, Carolin Lerchenmüller, Jianxin Sun, Norbert Weiss, Patrick Most, Karsten Peppel

Center for Translational Medicine Faculty Papers

The Ca(2+) sensor S100A1 is essential for proper endothelial cell (EC) nitric oxide (NO) synthase (eNOS) activation. S100A1 levels are greatly reduced in primary human microvascular ECs subjected to hypoxia, rendering them dysfunctional. However mechanisms that regulate S100A1 levels in ECs are unknown. Here we show that ECs transfected with a S100A1-3' untranslated region (UTR) luciferase reporter construct display significantly reduced gene expression when subjected to low oxygen levels or chemical hypoxia. Bioinformatic analysis suggested that microRNA -138 (MiR-138) could target the 3'UTR of S100A1. Patients with critical limb ischemia (CLI) or mice subjected to femoral artery resection (FAR) displayed …