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.

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, …

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 …

Invited Commentary On: Orthotopic Heart Transplantation In Patients With Metabolic Risk Factors, Nicholas Cavarocchi, Paul Mather

Nicholas C Cavarocchi MDJ

This is invited commentary to the following article: Kilic, A., Conte, J. V., Shah, A. S., & Yuh, D. D. (2012). Orthotopic heart transplantation in patients with metabolic risk factors. Annals of Thoracic Surgery, 93(3), 718-724.

Efficacy Of Miniaturized Imacor Trans-Esophageal Echocardiografm (Tee) Prove In Mechanical Circulatory Support., Hitoshi Hirose, Christopher Y. Kang, Joshua K. Wong, Harrison T. Pitcher, Caitlyn M. Johnson, Konrad Sarosiek, Linda J Bogar, Nicholas C. Cavarocchi

Nicholas C Cavarocchi MDJ

Application of the miniaturized ImaCor Trans-Esophageal Echocardiogram (TEE) probe in Heart Transplant/Mechanical Cardiac Support Patients In the surgical cardiac care unit (SCCU), therapeutic interventions often need to be done at the bedside, necessitating the need for a rapidly employable diagnostic tool for the cardiac intensivist. We report the clinical utility of the miniature ImaCor TEE-probe in guiding management of post heart transplant (H-Txp) and mechanical cardiac support patients (MCS) and describe the economic benefit of such a device. This is an IRB approved retrospective review of MCS/H-Txp patients who had ImaCor TEE monitoring in the SCCU of our institution in …

Vascular Site Hemostasis In Percutaneous Extracorporeal Membrane Oxygenation Therapy., Kathleen Lamb, Hitoshi Hirose, Harrsion Pitcher, Nicholas Cavarocchi

Nicholas C Cavarocchi MDJ

Bleeding is a well described complication of percutaneous extracorporeal membrane oxygenation support (ECMO). In an effort to prevent ongoing percutaneous-cannula blood loss, we tried multiple methods to achieve hemostasis and have obtained the best results with QuikClot® Combat Gauze TM (Z-Medica Corp, Wallingford, CT). This product is made of kaolin, white alumina silicate clay, which initiates activation of the intrinsic clotting cascade. We reviewed our experience in 21 ECMO patients and found 5 patients who required 17 applications of QuikClot® Combat Gauze TM to percutaneous catheter insertion sites and demonstrated a significant reduction in both localized bleeding complications and the …

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 …

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 …

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

Comparison Of Sternal Pain And Narcotic Requirement After Cardiac Surgery Between New Rigid Closure And Conventional Wire Closure: Follow-Up Results Of 50 Randomizations., Jeevan Kuman, Bs, James T. Diehl, Md, Hitoshi Hirose, Md, Phd

Department of Surgery Faculty Papers

To investigate if rigid closure reduces sternal pain.

Presented at Chest 2013.Chicago IL.October 26-31, 2013.

Two-Vessel Off-Pump Coronary Artery Bypass Grafting By Left Thoracotomy In A Complex Redo Case, Shinya Unai, Md, Hitoshi Hirose, Md, Phd, Gary A. Cook, Pa-C, Nicholas C. Cavarocchi, Md, John W..C. Entwistle Iii, Md, Phd

Department of Surgery Faculty Papers

Introduction:

The left thoracotomy approach is an alternative technique for coronary revascularization to avoid complications associated with re-sternotomy, such as injury to patent grafts, right ventricle, aorta, during re-sternotomy. Situations such as calcification of the ascending aorta and previous mediastinitis favor the use of the left thoracotomy approach. Revascularization of the circumflex territory via a lateral thoracotomy has been reported previously. However, reports of revascularization of the LAD combined with circumflex artery territory via left thoracotomy approach are rare. We successfully performed an off-pump CABG by left thoracotomy in a complex redo case to revascularize the LAD and obtuse marginal …

Role Of Traditional Chinese Medicine In Modern Healthcare, Gealina Dun

CwiC-PH

Theories of Traditional Chinese Medicine (TCM)

Traditional Chinese Medicine (TCM), a form of complementary and alternative medicine (CAM), has been practiced for over 2500 years, and approaches health as an interrelated and holistic state of being. Using multiple methods, the theories of TCM aim to balance:

• Qi
• Yin and Yang (Fig. 1)
• The Five Elements
• ZangFu Organs

Women’S Perspective: The Underlying Factors Leading To Malnutrition In Poor Women In India, Tanuja Devaraj

CwiC-PH

AIM

A qualitative pilot study aimed to understand the socioeconomic aspects leading to malnutrition in urban poor women in Bangalore, India.

Social And Structural Barriers Faced By Gender And Sexual Minorities In Obtaining Female Reproductive, Montida Fleming

CwiC-PH

The Problem

• Lesbian women are less likely to have health insurance and less likely to receive routine Pap tests compared their heterosexual counterparts.¹
• Transgendered males were found to be less likely to receive preventative health services such as pap tests due to both lack of insurance and discrimination by healthcare providers.²
• Barriers may include:

Stigma and discrimination

Lack of compassion, sensitivity, and gender literacy by healthcare workers

Lack of health insurance

Misconceptions about risk in female bodied people who do not have sex with males

Language used by public health advocates regarding preventative care for female reproductive organs

Successful Aging In Philadelphia: Examining The Needs Of The Geriatric Community, Mollie Woehling

CwiC-PH

INTRODUCTION

• As more adults continue to live until older ages they will have a greater reliance on the formal aging care system and continue to use a large proportion of healthcare resources
• From 2000 to 2010, the US 65+ population grew 15.1% compared to the total population that grew 9.7%¹
• CDC estimates that adults who make it to 65 can expect to live for 19 more years, 14 of those in relatively good health²
• Adults 65 years and older comprise over 12% of the population of Philadelphia¹
• In 2002, 19% of Philadelphia’s seniors 65+ lived in poverty, …

The State Of Healthcare For Bhutanese Refugees In South Philadelphia: Challenges & Progress, Sarah Wells

CwiC-PH

Who the Bhutanese Refugees Are ^[1]

• Mid-19^th Century: Nepalese farmers recruited to work farmlands of Southern Bhutan (called Lhotshampa, or “southerners”)
• Lhotshampa retained Nepali and Hindu customs, but lived in peace with the Drukpa (Buddhist elite) majority for many years
• 1989: “One Nation, One People” policy of ethnic cleansing: Drukpa culture imposed on all Bhutanese
• Torture, sexual assault and murder forced over 130,000 Lhotshampa to flee Bhutan
• These refugees spent decades of their lives in camps in Nepal (many still remain there)
• Over 68,000 have resettled to the USA, many coming to South Philadelphia ^[2]

Decision-Making In Accessing The Emergency Department Versus Primary Care, Lev Malevanchik, Rickie Brawer, Mph, Phd, Priya Mammen, Md, Mph, Bernard Lopez, Md, Ms

CwiC-PH

• 95% of emergency department (ED) visits from patients living in Jefferson’s (TJUH) community benefit area (CBA) were for conditions with lower priority

Emergency Severity Index (ESI) numbers of 3, 4, or 5 in FY 2011 & 2012.

– Many of these visits were non-emergent.

• The aim of this study was to document how community members chose between going to the ED or their primary care physician (PCP).

Evidence Based Practice (Ebp) Literature Searching Skills-Part 1 And 2, Patricia Wynne, Bsn, Ms

Academic Commons and Scott Memorial Library Staff Papers and Presentations

Two PowerPoint presentations presented at 8th Annual Nursing Research Conference, Christiana Hospital, Newark Delaware.

Part 1: slides 1-30

Part 2: slides 31-47

An Overview Of The Healthcare System In Argentina, Derya Arkonac

CwiC-PH

Poster outlines:

1. The Health Care System
2. The Population
3. The Politics
4. Conclusion

A Place For Mindfulness In Successful Addiction Recovery, Susannah Eckman

CwiC-PH

The difficulties that women face during substance abuse recovery and re-integration into society after incarceration are staggering in number and combined severity. Over the last several decades, a substantial body of research has investigated the psychological, neurobiological, and public health aspects of the actual experience – as well as the sustained perception of – resource depletion that everyday life in low-income communities creates. The tide of research is now headed towards evaluating new treatment strategies that respond to the understanding gained from this research. Mindfulness Training (MT) is one strategy that promises particular efficacy in addressing the root of these …

An Assessment Of Food Insecurity In A Lower North Philadelphia Community Health Center, Carly Sedlock, James D. Plumb, Md, Mph, Rickie Brawer, Mph, Phd

CwiC-PH

Food insecurity describes the inability to access enough food at all times to lead an active, healthy life. While food insecurity is associated with several negative health outcomes, screening for food insecurity in the clinical setting is not consistently performed. The goals of this pilot study were to: explore the prevalence of food insecurity among patients attending St. Elizabeth's Wellness Center in Lower North Philadelphia, explore the impact of food insecurity on health and disease management, and assess how to better address food insecurity in the primary care setting.

Case Series On Veno - Venous Extracorporeal Membrane Oxygenation (Vv-Ecmo) As A Bridge To Complete Recovery In Influenza Type A Related Refractory Ards, Renganaden Sooppan, Md, Nicholas C. Cavarocchi, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Michael Baram, Md, Hitoshi Hirose, Md, Phd

Department of Surgery Faculty Papers

Introduction:

Influenza A sequelae range from mild symptoms to acute respiratory distress syndrome (ARDS), which can be refractory to conventional ventilator therapy. We present a case series of three non-H1N1 Influenza patients with ARDS, who completely recovered after VV-ECMO.

Case Presentation:

In January and February 2013, we experienced three cases of Influenza A induced ARDS that failed conventional ARDS ventilator therapy. All three patients presented with typical flu-like symptoms, which deteriorated over several days, requiring intubation. They were all treated with oseltamivir. They had bilateral chest infiltrates on chest x-rays. After a few days of failing conventional treatment these patients …

Neuropathy, Neuropathic Pain, And Sickle Cell Disease., Samir K. Ballas, Deepika S Darbari

Cardeza Foundation for Hematologic Research

No abstract provided.

Does Skin Pigmentation Effect Readings Of Cerebral Oximeter Devices While On Cardiopulmonary Support?, Christine Feldmeier, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Nicholas C. Cavarocchi, Md, Hitoshi Hirose, Md, Phd

Department of Surgery Faculty Papers

Introduction:

Cerebral oximetry is utilized as a non-invasive method to ensure adequate cerebral perfusion. In a review of our clinical experience, it was noted that there were consistent inaccurate values from normal utilizing relative (INVOS, Covidien, Mansfield, MA) cerebral oximetry as opposed to absolute (FORESIGHT, CAS medical, Branford, CT) cerebral oximetry in darker skin patients.

Presented 24th Annual ELSO Conference. Philadelphia, PA. Sep 19-21, 2013.

Efficacy And Safety Of Infliximab In Older Inflammatory Bowel Disease Patients, Christina Cress Lindenmeyer, Md, Stephanie M. Moleski, Md, Maureen P. Whitsett, Med., Patricia L. Kozuch, Md

Division of Gastroenterology and Hepatology Faculty Papers

Background:

The limited data regarding treatment of inflammatory bowel disease (IBD) with anti-tumor necrosis factor antibodies in older patients suggest equal efficacy but higher morbidity and mortality compared to younger patients. This retrospective case control study aims to clarify the efficacy and safety of infliximab (IFX) in older IBD patients.