Translational Medical Research Commons^™

The Prevalence Of Orally Administered Glucocorticoids, Generalized Pustular Psoriasis And Erythrodermic Psoriasis In The Treatment Of Adult Plaque Psoriasis Provided By U.S. Dermatologists, Katherine Awh, Kumar Nasham, Christian Albornoz, Steven Feldman, Anthony Albornoz

Phase 1

Introduction: Orally administered glucocorticoids (OAG) are not recommended for the management of plaque psoriasis (PsO) due to the classically feared outcomes of generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP). Given their widespread anecdotal use, we hypothesize that the use of OAG is not infrequent among US dermatologists and is rarely complicated by GPP or EP.

Methods: Anonymous electronic survey of 50 US dermatologists. Primary outcomes of interest were the prevalence of OAG in the management of PsO and the prevalence of GPP and EP in the context of OAG tapering.

Results: Overall, 9 out of 50 (18%) respondents …

Evaluation Of Arthroscopic Repair To Pan-Labral Lesions Of The Glenoid: A Retrospective Review Of Patient Outcomes Over A Ten-Year Period And Matched Cohort Analysis, Julien Aoyama, Joseph Schmitz, Christopher Hadley, Meghan Bishop, Md, Brandon Erickson, Md, Sommer Hammoud, Md

Phase 1

Introduction:

Most shoulder labral tears are partial and treated with surgery, but rarely they are “panlabral” around the entire shoulder. Due to infrequency panlabral tears aren’t well understood, and thus this study compares outcomes between panlabral and more common SLAP tears. We hypothesize no difference in outcomes based on surgeon experiences.

Methods:

This is a retrospective cohort study of shoulder labrum repairs at Rothman Institute from 2006-2016. All patients received arthroscopic repair and were categorized to compare panlabral to SLAP tears. The primary outcome is return-to-activity rate at six months post-surgery and secondary outcomes include post-operative range of motion, …

Antithrombotic Choice And Timing In Patients Presenting With Symptomatic Hemorrhagic Conversion Of Ischemic Stroke, Joshua Margolis, Robin Dharia, Md, Judy Diep, Md

Phase 1

The primary aim of this research project is to determine the optimal time for antithrombotic agent initiation post ischemic stroke without resulting hemorrhagic conversion. We hypothesize that not only is hemorrhagic conversion risk often inaccurately estimated, but also that antiplatelet agents and anticoagulants may pose similar risk of hemorrhagic conversion, particularly when initiated seven days post ischemic stroke. This risk potentially outweighs their protective effects against recurrent stroke. We are in the process of identifying patients with hemorrhagic conversion of ischemic stroke at Thomas Jefferson University Hospital and will analyze the type and timing of antithrombotic agents. Additional risk factors …

Factors Influencing General Surgeons To Involve Urologists In Bladder Trauma Management, Joseph Schultz, Paul Chung, Md

Phase 1

Introduction: Bladder trauma injuries, which are graded by severity, often require immediate care and surgical management by General Surgeons (GS) or Urologists. This study seeks to understand the inconsistencies that exist in collaboration between GS and Urologists in bladder trauma management. We hypothesize that the decision for GS to involve Urologists in bladder trauma management is a multifactorial decision with severity of bladder trauma being the primary determining factor as opposed to other factors like provider experience or hospital setting.

Methods: This cross-sectional descriptive study surveyed GS to determine how likely they were to involve Urologists in bladder trauma …

Effect Of Palmitic Acid On B2 Receptor Expression In Airway Smooth Muscle Cells, John Magagna, Deepak A. Deshpande, Ajay P. Nayak

Phase 1

Introduction: People with asthma and obesity struggle to control asthma flares. B2 agonists are often the acute treatment of choice during these flares, so the decreased asthma control in this population may be due to a decrease in B2 receptor activity. We tested the hypothesis that B2 receptor expression will decrease in airway smooth muscle cells exposed to Palmitic Acid, a saturated fatty acid, compared to Oleic Acid and untreated cells.

Methods: Airway smooth muscle cells were plated and treated with Palmitic Acid and Oleic Acid at 100uM and 200uM concentrations while other untreated cells served as controls. Cells …

Otologic Opioid Usage And Pain Control In The Postoperative Period, Matthew Stewart, Eric Mastrolonardo, Joann Butkus, Raphael Banoub, Md, Tingting Zhan, Phd, Sophia Dang, Md, David Cognetti, Md, Rebecca Chiffer, Md, Thomas Wilcox, Md

Phase 1

Introduction: Patients’ unused prescription opioids can be diverted and increase the overall opioid burden on society. Therefore, otolaryngologists can reduce opioid influx by minimizing excess tablets in opioid prescriptions. We hypothesize that otology patients at TJUH receive more opioid tablets than needed to effectively manage postoperative pain.

Methods: Patients ages ≥18 years old who received otologic surgery at TJUH were included in this prospective observational study between November 2019 and August 2020. Patients were provided a survey for recording pain on postoperative days 0, 1, 3, and 7 and the amount of remaining opioids from their prescription. Opioid amounts were …

Radiographic Results Of Expandable Interbody Devices, Jonathan Ledesma, Mark Kurd, Md, Kris Radcliff, Md, D. Greg Anderson, Md

Phase 1

Introduction: Minimally invasive surgery for transforaminal lumbar interbody fusion (MIS-TLIF) has become a mainstay procedure in the treatment of degenerative conditions of the lumbar spine. Expandable interbody devices have gained popularity in recent times due to several well-cited advantages including greater correction of disc height and lordosis and decreased intraoperative disruption of neurologic structures. However, the clinical benefits offered by these devices compared to traditional static implants remain unclear. This study seeks to investigate differences in the radiographic and clinical outcomes between traditional static versus expandable interbody devices used in MIS-TLIF.

Methods: Patients who underwent MIS-TLIF performed by three …

Evaluating Barriers To Clinical Trial Enrollment In Head And Neck Surgical Oncology, Gregory Schneider, Emily Sagalow, Kealan Hobelmann, Md, Richard Goldman, Md, David Cognetti, Md, Joseph M. Curry, Md, Adam Luginbuhl, Md

Phase 1

Introduction and Objectives: Clinical trials are an important focus in academic otolaryngology practices, but busy practices may pose difficulty for identification and enrollment of patients eligible for trials. We will identify barriers to enrollment from the perspective of both head and neck surgical oncologists and their patients.

Methods: Patients who were eligible for any of the eight clinical trials offered at Jefferson between August and November 2020 were identified. We utilized an Epic EMR phrase to capture if a trial was offered or not and why, whether a patient refused enrollment and why, and patient wait time.

Results: During the …

A Virtual Educational Intervention Addressing Weight Bias In Medical Students, Gina Goldberg, Joseph Majdan, Md

Phase 1

Introduction:

Individuals with higher body weight experience severe and pervasive discrimination in nearly every walk of life. Stigmatizing treatment from healthcare providers increases anxiety, depression, body dissatisfaction and risk of weight gain while decreasing the likelihood that patients will seek preventative or emergency care. This study assessed whether a virtual session exploring obesity, which included the personal testimony of a Physician Professor with obesity, positively influenced the explicit attitudes and implicit biases of medical students towards people with higher body weight.

Methods:

SKMC medical students completed an Implicit Associations Test (IAT), a Universal Measure of Bias (UMB) and a …

Continuous Positive Airway Pressure Therapy Effects On Lipid And Hepatic Function Test Values, Grace Severance, Cynthia Cheng, Md, Phd, Amy He, Peter Zhang, Dani Yellanki, Zachary Feuer, Olivia Taylor, Natali Salinas

Phase 1

Introduction : Continuous positive airway pressure (CPAP) therapy is an established therapy for patients diagnosed with obstructive sleep apnea (OSA). The following study aims to measure the impact of CPAP therapy on lipid and liver profiles of patients diagnosed with OSA. We hypothesize that CPAP therapy will improve patient serum lipid and liver measures in this patient population compared to patient baseline prior to CPAP therapy. Furthermore, we also will examine differences in hepatic ultrasound results for OSA patients on CPAP therapy.

Methods: The target patient population has moderate-severe OSA, defined as an Apnea-Hypopnea Index greater than 15. The intervention …

Outcomes Of Surgical Treatment For Carcinoid Heart Disease: A Systematic Review And Meta-Analysis, Diana C. Jiminez, Thomas J. O'Malley, Md, Abhiraj Saxena, Matthew P. Weber, Louis E. Samuels, John W. Entwistle, T. Sloane Guy, H. Todd Massey, Rohinton Morris, Vakhtang Tchantchaleishvili

Phase 1

Introduction and Objective: Carcinoid Heart Disease (CaHD) develops from vasoactive substances released by neuroendocrine tumors causing significant patient morbidity and mortality necessitating surgical intervention. We performed a systematic review and meta-analysis to elucidate granular perioperative details and long-term outcomes in these patients.

Methods: Electronic search of Ovid, Scopus, Cumulative Index of Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed. Nine articles comprising 416 patients who received surgery were selected. Primary outcomes investigated included patient characteristics, surgical characteristics and survival data. Study-level data were extracted and pooled for meta-analysis.

Results: Primary outcomes consisted of …

Using Silac-Based Proteomics To Investigate Pathogenic Mechanisms In Spinal And Bulbar Muscular Atrophy, Debotri Chatterjee

Phase 1

Introduction: Spinal and bulbar muscular atrophy (SBMA) is a neurodegenerative disease caused by a polyglutamine (polyQ) expansion in the androgen receptor (AR). Instead of being exported out and degraded, mutant polyQ-AR remains in the nucleus, forming aggregates. We hypothesize that the cellular toxicity in SBMA is caused by aberrant intra-nuclear interactions (both gained and lost) of polyQ-AR aggregates.

Methods: We utilized SILAC proteomics on a cell model of SBMA to develop an AR interactome and investigate which intra-nuclear proteins and protein networks are affected through interaction with polyQ-AR (population C18) in comparison to wild type AR (C21). A candidate …

Translation Of Ephb2 In Pkcgamma And Calretinin Interneuron Subpopulations After Spinal Cord Injury, David A. Jaffe, Nicolette Heinsinger, Angelo Lepore

Phase 1

Introduction: Neuropathic pain is a common, debilitating occurrence after spinal cord injury (SCI). EphB signaling has been implicated in neuropathic pain, but different populations of neurons that upregulate EphB after SCI must be discovered. Understanding whether EphB2 is upregulated in specific subpopulations of dorsal horn interneurons (e.g. those expressing PKCgamma or calretinin) after injury would increase the understanding of SCI-induced neuropathic pain.

Methods: Mice were either given a contusion-type SCI (n=7) or a laminectomy-only (n=6) at cervical level 5/6. After two weeks of recovery, mRNA was labeled using RNAscope in the sectioned spinal cords. Four different targets were visualized …

Evaluating The Efficacy Of Telestroke Intervention In A Large Community Hospital Network, Daniel Moylan, Daniel Joffe, Charles Morse, Michael Knapp, Ahmad Sweid, Pascal Jabbour

Phase 1

Introduction: Telemedicine for acute ischemic stroke (Telestroke) allows live consultation between patients, remote stroke specialists, and providers to facilitate administration of IV tissue plasminogen activator (IV-tPA) within the 4.5 hour window. Small cohort studies have demonstrated thrombolytic therapy conveys significant benefit to stroke outcomes and yet is underutilized due to difficulties in recognition and delivery of medication. This study proposes that access to telestroke care across the Thomas Jefferson University Hospital network will result in increased thrombolytic reperfusion rates and improved patient outcomes for stroke.

Methods: A retrospective cohort study was designed to utilize a telestroke database collecting information from …

Evaluating The Efficacy Of Telestroke Intervention On Stroke Care In A Large Hospital Network, Daniel Joffe, Ahmad Sweid, Daniel Moylan, Charles Morse, Michael Knapp, Pascal Jabbour

Phase 1

Introduction: Telestroke medicine (TM) involves clinical stroke care by digitally connecting patients and their providers to neurovascular specialists to decrease the time to thrombolytic reperfusion during an acute ischemic stroke (AIS). Rapid administration of intravenous tissue plasminogen activator (iv-tPA) improves AIS outcomes yet no large scale research has evaluated the effectiveness of TM. This study proposes that TM utilization across the Jefferson University Hospital network will increase thrombolytic reperfusion rates and improve overall stroke outcomes.

Methods: A retrospective cohort study design with data from a Jefferson Telestroke database contained information for 9,702 patients across 36 hospital affiliates. These patients were …

The Effect Of Cpap Treatment On T2dm In Moderate To Severe Osa Subjects, Dani Yellanki, Amy He, Grace Severance, Peter Zhang, Zach Feuer, Natali Salinas, Olivia Taylor, Rani Patel, Hannah Kostan, Carl Sun, Catherine Liu, Humaal Khan, Katie Keck, Mikayla Cochrane, Ronak Ahir, Sammy Alfonsi, Will Connolly, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a significant risk factor for type 2 diabetes mellitus (T2DM). CPAP treatment can potentially improve glycemic control in such subjects. However, the exact effects of CPAP treatment on diabetes are uncertain. The objective of this study is to examine the effect of CPAP treatment on HbA1c levels in subjects with moderate to severe OSA and T2DM.

Methods: This is a combined retrospective and prospective study collecting data through EPIC medical record reviews. We are collecting HbA1c levels (primary outcome variable) before and after CPAP treatment in subjects with moderate to severe OSA and T2DM. …

Evaluating The Effect Of Telestroke Intervention On Patient Treatment And Outcomes, Charles Morse, Daniel Moylan, Daniel Joffe, Michael Knapp, Ahmad Sweid

Phase 1

Acute ischemic strokes (AIS) are a prominent cause of death and have the potential to cause lifelong neurological deficits. We hypothesize that through telestroke intervention, patients will receive treatment more rapidly and therefore have reduced complications as a result of AIS. To analyze the efficacy of telestroke intervention, we completed a retrospective chart review of suspected AIS patients at hospitals in the greater Philadelphia region from 2015-2019. We then assessed whether a patient received a telestroke consultation and any subsequent care. Several variables were then used to determine the effectiveness of this intervention, such as the promptness of treatment, length …

Peri-Operative Urodynamic Assessment Has Poor Predictive Value For Developing Post-Operative Urinary Retention, Baylor Wickes, Robert Pivec, Md, Mathew S. Austin, Md

Phase 1

Introduction: Post-operative urinary retention (POUR) following primary total joint arthroplasty (TJA) has a reported prevalence up to 35%. Risk factors for developing POUR have traditionally included surrogate markers such as the presence or absence of urologic disease. However, dynamic measurement of the renal system with post-void residual volumes (PVR) has not been investigated as a tool for assessing POUR risk.

Methods: All male TJA patients underwent an pre-operative screen for POUR, including PVR measurements, patient-derived subjective urinary retention scores, and assessment of urologic disease. This was combined with a post-operative monitoring and catheterization protocol developed in partnership with a …

Evaluating The Accuracy And Use Of Continuous Glucose Monitoring In Hospitalized Patients: A Systematic Review And Meta-Analysis, Caroline Purcell, Jeffrey I. Joseph, Do

Phase 1

Introduction:

Glycemic variability in hospitalized patients is associated with poor clinical outcomes, longer length of stay, and increased cost. Advances in subcutaneous continuous glucose monitoring (CGM) technology may reduce glycemic excursions and improve clinical outcomes in hospitalized patients, yet CGM is not used due to a lack of evidence on accuracy. The objective of this study was to review and summarize the evidence on the accuracy of CGM in hospitalized, diabetic patients.

Methods:

A search was conducted for literature evaluating CGM accuracy in hospitalized, diabetic patients. Relevant studies were identified through full-text review and data was extracted for analysis. …

Transradial Approach For Diagnostic Cerebral Angiograms In The Elderly: A Comparative Observational Study, Cannon Greco Hiranaka, Ahmad Sweid, Somnath Das, Joshua H. Weinberg, Kareem El Naamani, Julie Kim, Darcy Curtis, Daniel Joffe, Darshana Vijaywargiya, Chrissa Sioka, Mazen Oneissi, Abdel Hadi El Hajjar, Michael Reid Gooch, Nabeel Herial, Stavropoula I. Tjoumakaris, Robert H. Rosenwasswer, Pascal Jabbour

Phase 1

Introduction: The transradial approach (TRA) reduces mortality, morbidity, access site complications, hospital cost, and length of stay while maximizing patient satisfaction. We aimed to assess the technical success and safety of TRA for elderly patients (aged ≥75 years).

Methods: A retrospective chart review and comparative analysis was performed for elderly patients undergoing a diagnostic cerebral angiogram performed via TRA versus transfemoral approach (TFA). Also, a second comparative analysis was performed among the TRA cohort between elderly patients and their younger counterparts.

Results: Comparative analysis in the elderly (TRA vs TFA) showed no significant differences for contrast dose per vessel, fluoroscopy …

Incidence Of Marginal Ulceration Following Primary Versus Revisional Roux-En-Y Gastric Bypass Surgery: A Multi-Center Retrospective, Brigitte Anderson, Talar Tatarian, Md, Alec Beekley, Md

Phase 1

No abstract provided.

The Effect Of Medical Nutrition Therapy On Weight Loss, Ayesha Baig, Hannah Kostan, Cynthia Cheng

Phase 1

Introduction: In this retrospective study, we evaluated the effects of Jefferson’s medical nutrition therapy (MNT) program on weight loss. We anticipate that participation in the MNT program will lead to an improvement in weight and metabolic syndrome parameters.

Methods: We selected a convenience sample of 10 participants with BMI > 25 for this pilot retrospective chart review. Subjects were screened for various exclusion criteria such as past bariatric surgery, heart failure, malignancy, renal dialysis, and uncontrolled conditions such as hypothyroidism, anemia, or B12 deficiency. Weight measurements were collected from EPIC records starting from baseline, defined as 3 months prior to initiation …

Primary Care Obstructive Sleep Apnea Screening, Benjamin Espenhorst, Grant Gillan, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA), a disorder characterized by upper airway collapse during sleep, is currently underdiagnosed and undertreated. The goal of this project is to evaluate the efficacy of utilizing a targeted screening protocol to identify previously undiagnosed OSA in an adult primary care population.

Methods: This prospective quality improvement project included 210 patients in the Jefferson Department of Family Medicine not previously diagnosed with OSA. These patients were targeted based on 3 STOP-BANG criteria: hypertension, age >50 years, and BMI >35 kg/m2. Patients were initially contacted by mail, followed by 3 weekly phone calls. Patients were screened …

Acute Depression And Anxiety Symptoms Following Concussion In An Adolescent Outpatient Population, Ari M. Fish, Julia Vanni, Kristy Arbogast, Phd, Catherine C. Mcdonald, Phd, Rn, Christina Master, Md, Caqsm

Phase 1

Introduction: Research has shown that concussed youth are at increased risk of developing psychiatric symptoms as compared to non-concussed youth. Few studies, however, have detailed the presence and severity of acute depression and anxiety symptoms following a concussion in adolescents, specifically. Thus, the current study aims to describe depression and anxiety symptoms in concussed and non-concussed adolescents using validated measures of depression and anxiety.

Methods: The current study includes 284 adolescents (114 cases, 170 controls), 13-18 years of age. Cases included concussed patients at the Children’s Hospital of Philadelphia, and controls were recruited from a local, Philadelphia high school. …

Cardiac Arrest Clinical Outcomes In Patients Presenting With Opioid Overdose, Andrew Toron, Morgan Hutchinson, Md, David Gaieski

Phase 1

Introduction: Understanding opioids and their potential to cause cardiac arrests is integral in learning how to lower mortality rates in patients who overdose on them. Few studies have specifically examined the association of out-of-hospital cardiac arrests with opioid overdoses. We hypothesized that cardiac arrests caused by opioid overdoses will result in longer hospital stays and a higher mortality rate than other cardiac arrests.

Methods: This study is a secondary analysis of data from the Cardiac Arrest Registry to Enhance Survival. Data regarding 35 patients who presented to Jefferson and Methodist hospitals with out-of-hospital cardiac arrests due to opioid overdose …

Endovascular Intervention For Tracheo-Innominate Fistula: A Systematic Review And Meta-Analysis, Andrew M. Jordan, Thomas J. O'Malley, Kyle W. Prochno, Abhiraj Saxena, Elizabeth Maynes, Brandon Ferrell, T. Sloane Guy, John W. Entwistle, H. Todd Massey, Rohinton J. Morris, Babak Abai, Vakhtang Tchantchaleishvili

Phase 1

Introduction: Fistula formation between the trachea and the innominate artery is a life-threatening complication rarely seen with existing or previous tracheostomy. Fatal upon rupture, swift diagnosis and immediate intervention are paramount for survival. We aim to identify feasibility and outcomes of endovascular intervention for trachea-innominate fistula (TIF).

Methods: Patient-level data of reported individuals above the age of 14 that underwent endovascular intervention for TIF was extracted and analyzed. Identification of 25 patients from 27 studies was accomplished by electronic database search of Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, …

Effects Of Continuous Positive Airway Pressure On Blood Pressure In Obstructive Sleep Apnea, Amy He, Dani Yellanki, Grace Severance, Peter Zhang, Zachary Feuer, Natali Salinas, Cynthia Cheng, Md, Phd

Phase 1

Introduction:

Obstructive sleep apnea (OSA) has been previously linked to the development of hypertension, possibly through the proposed mechanism of recurrent episodes of intermittent hypoxia leading to endothelial dysfunction, inflammation, and metabolic dysregulation. This study aims to investigate continuous positive airway pressure (CPAP) therapy, a first-line therapy for OSA, and its effects on blood pressure in patients with moderate to severe OSA. We hypothesize that compliance to CPAP leads to a decrease in average annual systolic and diastolic blood pressure, compared to noncompliant and non-CPAP use.

Methods:

Our study is a combined retrospective and prospective EPIC chart review study. Moderate …

Adverse Events Following Screening Eye Examinations For Retinopathy Of Prematurity In Premature Infants, Aditi Kale, Pedro Urday, Zubair H. Aghai

Phase 1

Introduction: The retinopathy of prematurity (ROP) examination is recommended for high-risk preterm infants to prevent its complications but may be associated with adverse events. The goal of this study is to determine whether the ROP examination increases the incidence of adverse events in premature infants.

Design/Methods: This was a retrospective study on all preterm infants (32 weeks gestation) born between 03/2017 and 12/2019 who survived until the first eye examination. The number of episodes of apnea (A), bradycardia (B), desaturation (D), number of infants on mechanical ventilation, and number of infants requiring sepsis evaluation were compared before and …

Nccn Intermediate Risk Prostate Cancer- Long-Term Outcomes Of Active Surveillance Compared To Active Treatment, A Population-Based Analysis, Adam Schneider, Thenappan Chandrasekar, Nicholas Bowler, Hanan Goldberg, James R. Mark, Edouard J. Trabulsi, Costas D. Lallas, Leonard G. Gomella

Phase 1

Background: While active surveillance (AS) is an established standard of care for low-risk (LR) prostate cancer (PCa), its utility for intermediate risk (IR) PCa is less evident. Prior studies were limited by the inability to differentiate between AS and watchful waiting (WW). Using a recent update in the Surveillance, Epidemiology and End Results (SEER) Database that allows for enhanced distinction between AS and WW, we aimed to compare survival outcomes of men with LR and IR PCa treated with either AS, WW or active treatment (AT).

Methods: 166,244 men were initially identified by biopsy Gleason Grade Group (GG) alone – …

Impact Of Covid-19 On Individuals With Opioid Use Disorder’S Access To Services And Substance Use, Camryn Bernheimer, Lara Weinstein, Md

Phase 1

Introduction: The opioid epidemic has already devastated Philadelphia and COVID-19 has the potential to exacerbating this existing crisis. The goal of this study is to investigate how COVID-19 has impacted Medication Assisted Treatment (MAT) service utilization and substance use for individuals with opioid use disorder (OUD).

Methods: 170 participants with OUD in group-based MAT programs in Philadelphia were analyzed three months prior to and after COVID-19. The data provided participant age, gender, race/ethnicity, MAT visits, primary care physician (PCP) visits, behavioral health consult visits (BHC), and urine drug screen (UDS) results from health records. Pre-post COVID-19 relationships were examined …