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Changes To Echocardiography-Derived Left Ventricular Filling Pressures And Cardiac Output In Response To Fluid Boluses In Elderly Patients With Left Ventricular Diastolic Dysfunction Undergoing Vascular Surgery, Sasha K. Shillcutt 2016 University of Nebraska Medical Center

Changes To Echocardiography-Derived Left Ventricular Filling Pressures And Cardiac Output In Response To Fluid Boluses In Elderly Patients With Left Ventricular Diastolic Dysfunction Undergoing Vascular Surgery, Sasha K. Shillcutt

Theses & Dissertations

Left ventricular diastolic dysfunction (LVDD) of the heart is a condition where the heart does not relax properly. This condition is important during times of stress, as LVDD is associated with significant morbidity of elderly surgical patients. LVDD is often asymptomatic and unrecognized as many of these patients have normal ejection fractions. However, LVDD may lead to heart failure in patients with preserved systolic function, with the incidence being as high as 50% in hospitalized elderly patients. The diagnosis of LVDD is an independent risk factor for postoperative major adverse cardiac events (MACE) and negatively impacts post-surgery readmission rates. Anesthesiologists ...


Restriction Therapy In Acute Heart Failure Is Not Shown To Be Effective, Amrit K. Basi, Colleen W. Harkreader, Nicholus H. Yee M.D., Shadia A. Yeihey M.D., Suraiya K. Azom M.D. 2016 Wayne State University School of Medicine

Restriction Therapy In Acute Heart Failure Is Not Shown To Be Effective, Amrit K. Basi, Colleen W. Harkreader, Nicholus H. Yee M.D., Shadia A. Yeihey M.D., Suraiya K. Azom M.D.

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Travers B, O’Loughlin C, Murphy NF, et al. Fluid restriction in the management of decompensated heart failure: no impact on time to clinical stability. J Card Fail. 2007;13(2):128-132. doi: 10.1016/j.cardfail.2006.10.012


It Is Reasonable To Treat Patients With Type 1 Hepatorenal Syndrome With Midodrine And Octreotide, William Kane 2016 Wayne State University

It Is Reasonable To Treat Patients With Type 1 Hepatorenal Syndrome With Midodrine And Octreotide, William Kane

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Esrailian E, Pantangco ER, Kyulo NL, Hu KQ, Runyon BA. Octreotide/midodrine therapy significantly improves renal function and 30-day survival in patients with type 1 hepatorenal syndrome. Dig Dis Sci. 2007;52(3):742-748. doi: 10.1007/s10620-006-9312-0


Salvage Therapy For Non-Acetaminophen-Induced Acute Liver Failure Includes N-Acetylcysteine, David Robinson 2016 Wayne State University School of Medicine

Salvage Therapy For Non-Acetaminophen-Induced Acute Liver Failure Includes N-Acetylcysteine, David Robinson

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Lee WM, Hynan LS, Rossaro L, et al. Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology. 2009;137(3):856-864. doi: 10.1053/j.gastro.2009.06.006


Novel Collaborative Cardiology And Maternal Fetal Medicine Practice – Continued Experience At The Heart And Pregnancy Program, Joanne Quiñones MD, MSCE, Margaret Bettin, Irena B. Cabrera MD, Adetola Louis-Jacques MD, Amy M. Ahnert MD, Ronald S. Freudenberger MD 2016 Lehigh Valley Health Network

Novel Collaborative Cardiology And Maternal Fetal Medicine Practice – Continued Experience At The Heart And Pregnancy Program, Joanne Quiñones Md, Msce, Margaret Bettin, Irena B. Cabrera Md, Adetola Louis-Jacques Md, Amy M. Ahnert Md, Ronald S. Freudenberger Md

Ronald S Freudenberger MD

No abstract provided.


Research Professionals’ Experience And Perspectives On Women’S Participation In Clinical Research, Anita Kurt PhD, RN, Lauren Semler MS, Matthew Meyers BS, Bernadette Gl-Porter BS, Samantha Myles BS, Stephen Dusza DrPH, Jeanne L. Jacoby MD, John C. Smulian MD, MPH 2016 Lehigh Valley Health Network

Research Professionals’ Experience And Perspectives On Women’S Participation In Clinical Research, Anita Kurt Phd, Rn, Lauren Semler Ms, Matthew Meyers Bs, Bernadette Gl-Porter Bs, Samantha Myles Bs, Stephen Dusza Drph, Jeanne L. Jacoby Md, John C. Smulian Md, Mph

John C Smulian MD, MPH

No abstract provided.


Length Of The Second Stage Of Labor And Risk Of Preterm Delivery In A Subsequent Pregnancy, Joanne Quiñones MD, MSCE, Daniel Gomez MD, Matthew Hoffman MD, Cande V. Ananth PhD, John C. Smulian MD, MPH, Lauren A. Plante MD, Daniel W. Skupsk MD, Karin M. Fuchs MD, William E. Scorza MD 2016 Lehigh Valley Health Network

Length Of The Second Stage Of Labor And Risk Of Preterm Delivery In A Subsequent Pregnancy, Joanne Quiñones Md, Msce, Daniel Gomez Md, Matthew Hoffman Md, Cande V. Ananth Phd, John C. Smulian Md, Mph, Lauren A. Plante Md, Daniel W. Skupsk Md, Karin M. Fuchs Md, William E. Scorza Md

John C Smulian MD, MPH

No abstract provided.


Growing Organizational Capacity To Facilitate The Streamlining Of Patients With Psychiatric Disorders In A Community Academic Health Network; An Eight Year Review, Edward R. Norris MD, FAPA, FAPM, Michael W. Kaufmann MD, David B. Burmeister DO, Muhamad Aly Rifai MD, Laurence P. Karper MD, Ralph A. Primelo MD 2016 Lehigh Valley Health Network

Growing Organizational Capacity To Facilitate The Streamlining Of Patients With Psychiatric Disorders In A Community Academic Health Network; An Eight Year Review, Edward R. Norris Md, Fapa, Fapm, Michael W. Kaufmann Md, David B. Burmeister Do, Muhamad Aly Rifai Md, Laurence P. Karper Md, Ralph A. Primelo Md

David Burmeister, DO, FACEP, CPE

No abstract provided.


Dietary Weight Loss Advice In Us Health Magazines And Its Relation To Ancestral Diet, Risa J. Stein, Marium A. Choudhry, Thomas J. Murray Jr. 2016 Rockhurst University

Dietary Weight Loss Advice In Us Health Magazines And Its Relation To Ancestral Diet, Risa J. Stein, Marium A. Choudhry, Thomas J. Murray Jr.

Journal of Evolution and Health

As rates of overweight and obesity have risen in the US, the public has sought effective strategies for weight loss through dietary modification. A proliferation of processed foods and changing governmental nutrition guidelines have both impacted dietary intake patterns. While physicians are considered respectable sources of weight-loss information, increasingly the public has turned to the media, particularly magazines, for weight loss advice. This study investigated the dietary recommendations found in the five leading US health-related magazines and compared those recommendations to ancestral diets. With a couple notable exceptions, leading health magazines present consistent recommendations for dietary modifications to promote weight ...


Synthetic Magnetic Resonance Imaging Revisited, Ranjan Maitra, John J. Riddles 2016 Iowa State University

Synthetic Magnetic Resonance Imaging Revisited, Ranjan Maitra, John J. Riddles

Ranjan Maitra

Synthetic magnetic resonance (MR) imaging is an approach suggested in the literature to predict MR images at different design parameter settings from at least three observed MR scans. However, performance is poor when no regularization is used in the estimation and otherwise computationally impractical to implement for three-dimensional imaging methods. We propose a method which accounts for spatial context in MR images by the imposition of a Gaussian Markov Random Field (MRF) structure on a transformation of the spin-lattice relaxation time, the spin-spin relaxation time and the proton density at each voxel. The MRF structure is specified through a Matrix ...


From The Editors, Anusha Govind, MD, Loheetha Ragupathi, MD, Jad Al Danaf, MD, MPH, Shuwei Wang, MD 2016 Thomas Jefferson University

From The Editors, Anusha Govind, Md, Loheetha Ragupathi, Md, Jad Al Danaf, Md, Mph, Shuwei Wang, Md

The Medicine Forum

Dear Students, Residents, Faculty, and Friends of the Forum,

We are excited to present you with the 17th annual edition of The Medicine Forum. This work reflects the talent, passion, creativity, and scientific inquisitiveness of Jefferson medical students, residents, fellows and faculty. It also celebrates the diverse patients who serve as the centerpiece for each story.

Unique to this issue is the initiation of Grand Rounds Discussions focusing on controversial medical topics with inputs from an array of experts. This year we discussed perioperative management of anticoagulation and antiplatelet agents, and we had exciting viewpoints from experienced cardiologists, a hematologist ...


A Difficult Conversation, Shuwei Wang, MD 2016 Thomas Jefferson University

A Difficult Conversation, Shuwei Wang, Md

The Medicine Forum

I put on my isolation gown, knocked on his hospital room door, and entered to initiate the family meeting. I had been dreading this meeting all morning. It is never easy telling the loved ones of a thirty-seven year old that his disease is terminal, and he is actively dying.

I greeted Mr. M, his girlfriend and sister with the help of a Spanish translator. He smiled and had a twinkle in his jaundiced eyes. He was debilitated, bed bound with anasarca, his right thigh tightly bound by multiple blood stained pressure dressings. "Hola", I greeted them with the little ...


A Tribute To Our Nurses, Anusha Govind, MD 2016 Thomas Jefferson University

A Tribute To Our Nurses, Anusha Govind, Md

The Medicine Forum

I turned faint and weary as the page came through "Your patients heart rate is one hundred eighty" My legs shook as I ran up the stairs Thoughts racing a mile a minute, hoping someone more knowledgeable might be there first As I turned a corner, color draining from my face Then I spot my savior, the nurse, holding a syringe filled with the medication I knew now my patient and I were in good hands.


Grand Rounds Panel Discussion: Blood Thinners Peri-Operatively: What To Do?, Jad Al Danaf, MD, Anusha Govind, MD, Loheetha Ragupathi, MD, Shuwei Wang, MD 2016 Thomas Jefferson University

Grand Rounds Panel Discussion: Blood Thinners Peri-Operatively: What To Do?, Jad Al Danaf, Md, Anusha Govind, Md, Loheetha Ragupathi, Md, Shuwei Wang, Md

The Medicine Forum

PANELISTS

Mathew DeCaro, MD: Associate Professor of Cardiology, Director of the Coronary Cardiac Unit, Cardiology fellowship program director

John Doherty, MD: Professor of Cardiology

Gregary Markefka, MD: Associate Professor of Cardiology, Associate Director of the Coronary Cardiac Unit, Cardiology fellowship assistant program director

Geno Merli, MD: Professor of Vascular Medicine, Co-director of Jefferson Vascular Center

Srikanth Nagalla, MD, MS: Associate Professor of Medicine, Director, Clinical Hematology

Eric Schwenk, MD: Assistant Professor of Anesthesiology, Director of orthopedic anesthesia

Barry Ziring, MD: Clinical Associate Professor of Internal Medicine / Primary Care, Director of the division of Internal Medicine


The Financial Dialogue In The Development Of Medical Treatment Plans, Christopher D. Busack, MS3, Bethany Fox, MS3 2016 Thomas Jefferson University

The Financial Dialogue In The Development Of Medical Treatment Plans, Christopher D. Busack, Ms3, Bethany Fox, Ms3

The Medicine Forum

As patients face increasingly high out-of-pocket costs and difficulties navigating the healthcare system, failing to discuss available treatment options in financial terms can lead to grave consequences for patients. Medical bills are responsible for the majority of bankruptcies in the United States. Given the severe financial implications of medical bills, it is imperative that patients become more involved in discussions of their treatment plans and become aware of the costs of their decisions up front. Counseling about costs ensures that physicians avoid placing a debilitating financial burden on patients and maintain adherence to the ethical principle of non-maleficence. Various studies ...


Pemphigoid Gestationis: A Rare Dermatosis Of Pregnancy, Victoria Tran, MS3, Meghan Belamorich, MD 2016 Thomas Jefferson University

Pemphigoid Gestationis: A Rare Dermatosis Of Pregnancy, Victoria Tran, Ms3, Meghan Belamorich, Md

The Medicine Forum

INTRODUCTION

Pemphigoid gestationis is a rare dermatosis of pregnancy that often goes unrecognized or misdiagnosed. It can lead to adverse fetal outcomes including preterm delivery, low fetal birth weight, and even neonatal pemphigoid gestationis1. As such, proper diagnosis and management is critical in reducing fetal risk.


Identification And Management Of Cobalt Toxicity: A Case Report Of Rapidly Progressing Toxicity After Hip Arthroplasty Revision, Neena Mohan, MD, Eric Kasprowicz, MD 2016 Thomas Jefferson University Hospital

Identification And Management Of Cobalt Toxicity: A Case Report Of Rapidly Progressing Toxicity After Hip Arthroplasty Revision, Neena Mohan, Md, Eric Kasprowicz, Md

The Medicine Forum

INTRODUCTION

Patients undergoing total hip arthroplasty represent a growing portion of the population. More than 330,000 hip replacements are performed annually1, and more than 2.5 million Americans are living with a hip prosthesis2. Many hardware configurations utilize metal alloys for the femoral head and/or acetabulum. Although their use is decreasing due to safety concerns, cobalt-chromium femoral heads were still used in 51% of total hip arthroplasties in 20143. There is rising concern about the adverse effects of metal ions released from these joint replacements. However, little published evidence is available supporting specific interventions for the management of ...


Kikuchi Disease: Recognizing A Common Presentation Of An Uncommon Condition, Ramya Punati, MD 2016 Thomas Jefferson University

Kikuchi Disease: Recognizing A Common Presentation Of An Uncommon Condition, Ramya Punati, Md

The Medicine Forum

INTRODUCTION

Kikuchi disease, also known as histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease, is a rare condition that typically presents with fever and cervical lymphadenopathy in previously healthy young women. First described by Dr. Kikuchi and independently by Dr. Fujimoto in Japan in 1972, the disease is benign and usually self-limited. However, because it can present dramatically and mimic more serious conditions such as lymphoma and tuberculous adenitis, recognizing Kikuchi disease is crucial to avoid misdiagnosis and inappropriate treatment. This case describes a patient who presented with severe manifestations of Kikuchi disease that generated an extensive workup and differential diagnosis prior ...


A Case Report Of Multiple Aseptic Facial And Spinal Abscesses In A 45-Year-Old With Inflammatory Bowel Disease, Matthew Zheng, MD, Kristen Jackson, MD, Gloria Francis, MD, Bolin Niu, MD 2016 Thomas Jefferson University Hospital

A Case Report Of Multiple Aseptic Facial And Spinal Abscesses In A 45-Year-Old With Inflammatory Bowel Disease, Matthew Zheng, Md, Kristen Jackson, Md, Gloria Francis, Md, Bolin Niu, Md

The Medicine Forum

INTRODUCTION

Sterile abscess syndrome is a rarely described entity that is often associated with auto-inflammatory disorders. Although clinically similar to septic abscesses, sterile abscesses are known to be unaffected by antibiotic regimens and instead highly sensitive to steroids. The association of sterile abscesses with inflammatory bowel disease has been well-described. The majority of sterile abscess syndromes described in the literature are intraabdominal abscesses related to a primary gastrointestinal inflammatory disease. We describe a unique case of extra-abdominal sterile abscess syndrome associated with inflammatory bowel disease presenting as facial and paraspinal lesions.


Distal Renal Tubular Acidosis And Diabetes Insipidus Leading To The Diagnosis Of Sjögren's Syndrome, Loheetha Ragupathi, MD, Elijah Grillo, MD, Jonathan Yadlosky, MD, Ravi Sunderkrishnan, MD 2016 Thomas Jefferson University

Distal Renal Tubular Acidosis And Diabetes Insipidus Leading To The Diagnosis Of Sjögren's Syndrome, Loheetha Ragupathi, Md, Elijah Grillo, Md, Jonathan Yadlosky, Md, Ravi Sunderkrishnan, Md

The Medicine Forum

INTRODUCTION

Sjögren's syndrome is a chronic inflammatory disease characterized by the infiltration and progressive destruction of salivary and lacrimal glands. A common presentation involves the complaints of dry eyes and dry mouth, known as the “sicca complex.” Extra-glandular involvement is not uncommon, and is known to involve the lungs, vascular and peripheral nervous system, and kidney.1 The reported renal involvement ranges broadly from 2 – 67%,and is variably defined: the most commonly reported renal pathology is an a tubulo- interstitial nephritis resulting in tubular dysfunction and immune-mediated glomerular disease; however distal renal tubular acidosis (RTA) in particular can ...


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