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Reducing Benzodiazepine Use For The Treatment Of Insomnia And Supporting Nonpharmacological Therapies, UnChan Pyon 2019 University of Vermont

Reducing Benzodiazepine Use For The Treatment Of Insomnia And Supporting Nonpharmacological Therapies, Unchan Pyon

Family Medicine Clerkship Student Projects

Most medical organizations recommend against the use of benzodiazepine use for the treatment of insomnia, especially in the elderly. However, the percentage of the adult population on benzos increase with age: 7.5% in adults ages 51-64; 9% in adults over 65. Alternative therapies for insomnia, including online CBT, require more commitment than taking a medication so many patients opt for medication. This project aims to increase awareness of benzodiazepine use for insomnia and provide support for nonpharmacological therapies.


Letter To The Editor: Digital Dementia-Is Smart Technology Making Us Dumb?, Sanaa Moledina, Adeel Khoja 2018 Jinnah Sindh Medical University, Karachi, Pakistan.

Letter To The Editor: Digital Dementia-Is Smart Technology Making Us Dumb?, Sanaa Moledina, Adeel Khoja

Department of Medicine

No abstract provided.


Linking Hostile/Helpless Maternal Representations In Pregnancy And Later Child Protection Involvement: A Pilot Study, Madeleine Terry 2018 The Graduate Center, City University of New York

Linking Hostile/Helpless Maternal Representations In Pregnancy And Later Child Protection Involvement: A Pilot Study, Madeleine Terry

All Dissertations, Theses, and Capstone Projects

The present pilot study examined whether there are reliable indices in the narratives of pregnant women that can be used to identify child abuse and neglect potential before the birth of the child. The Hostile/Helpless (HH) Classification system (Lyons-Ruth et al., 1995-2005), which detects mental states associated with trauma, disturbances in early attachment, and severe pathology, was adapted for use with the Pregnancy Interview (PI), a semi-structured clinical interview (Slade, 2003) that assesses a woman's emotional experience of pregnancy, and quality of her developing relationship with her baby. The study sample was drawn from a replication study of ...


Guidance For Switching From Off-Label Antipsychotics To Pimavanserin For Parkinson’S Disease Psychosis: An Expert Consensus, Kevin J. Black, Henry Nasrallah, Stuart Isaacson, Mark Stacy, Rajesh Pahwa, Charles H. Adler, Gustavo Alva, Jeffrey W. Cooney, Daniel Kremens, Matthew A. Menza, Jonathan M. Meyer, Ashwin A. Patkar, Tanya Simuni, Debbi A. Morrissette, Stephen Stahl 2018 Washington University in St. Louis

Guidance For Switching From Off-Label Antipsychotics To Pimavanserin For Parkinson’S Disease Psychosis: An Expert Consensus, Kevin J. Black, Henry Nasrallah, Stuart Isaacson, Mark Stacy, Rajesh Pahwa, Charles H. Adler, Gustavo Alva, Jeffrey W. Cooney, Daniel Kremens, Matthew A. Menza, Jonathan M. Meyer, Ashwin A. Patkar, Tanya Simuni, Debbi A. Morrissette, Stephen Stahl

Kevin J. Black, MD

Patients with Parkinson’s disease psychosis (PDP) are often treated with an atypical antipsychotic, especially quetiapine or clozapine, but side effects, lack of sufficient efficacy, or both may motivate a switch to pimavanserin, the first medication approved for management of PDP. How best to implement a switch to pimavanserin has not been clear, as there are no controlled trials or case series in the literature to provide guidance. An abrupt switch may interrupt partially effective treatment or potentially trigger rebound effects from antipsychotic withdrawal, whereas cross-taper involves potential drug interactions. A panel of experts drew from published data, their experience ...


Resident Reflection: A Missed Date, Timothy Kuchera, MD 2018 Thomas Jefferson University

Resident Reflection: A Missed Date, Timothy Kuchera, Md

The Medicine Forum

Resident Reflection: A Missed Date


The Opioid Epidemic – Addressing Provider Roles And Responsibilities, Anita Modi, MD, Debbie Chen, MD, Neha Bansal Etherington, MD, Brianna Shinn, MD, Colin Thomas, MD 2018 Thomas Jefferson University

The Opioid Epidemic – Addressing Provider Roles And Responsibilities, Anita Modi, Md, Debbie Chen, Md, Neha Bansal Etherington, Md, Brianna Shinn, Md, Colin Thomas, Md

The Medicine Forum

INTRODUCTION

This year marks the 19th volume of Jefferson’s annual publication spearheaded by Internal Medicine residents and supported by its fellows. Our Editorial Board includes Neha, Debbie, Anita, Brianna, and myself. Our mission is to further medical knowledge by sharing each other’s observations and studies both through our publication, which you can find online, as well as through annual discussion at Grand Rounds.

This year, we’ve chosen to focus on our roles as providers in the midst of the National Opioid Epidemic. The National Institute on Drug Abuse has reported that the number of opioid-related overdose deaths ...


White Paper: Improving Handoff Culture In Intensive Care Unit To Floor Handoffs, Grant Turner, MD, Kristin Lohr, MD, Andrew Brown, MD, Allison Greco, MD, Rebecca C. Jaffe, MD 2018 Thomas Jefferson University

White Paper: Improving Handoff Culture In Intensive Care Unit To Floor Handoffs, Grant Turner, Md, Kristin Lohr, Md, Andrew Brown, Md, Allison Greco, Md, Rebecca C. Jaffe, Md

The Medicine Forum

The frequency of handoffs between providers has increased since the 2011 Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions, generating concerns over the quality of these handoffs and their impact on patient safety. At Thomas Jefferson University Hospital (TJUH), the 2016 Safety Culture Survey revealed that across all specialties, many residents felt that “things fall through the cracks” when transferring patients from one unit to another. The interdepartmental Housestaff Quality and Safety Leadership Council (HQSLC) at TJUH sought to improve handoffs at our institution and identified two areas of focus: (1) standardizing the language of handoffs with a ...


Syncope Diagnosed By Inducible Sustained Ventricular Tachycardia, Amit Vira, MD 2018 Thomas Jefferson University

Syncope Diagnosed By Inducible Sustained Ventricular Tachycardia, Amit Vira, Md

The Medicine Forum

INTRODUCTION

Syncope is a common complaint in the emergency department (ED), accounting for approximately 3% of all ED visits.1 Although most causes of syncope are benign and self-limited, others are associated with significant morbidity and mortality.


Sclerosing Mesenteritis: Clinical Presentation, Imaging Findings, And Treatment, Jennifer Nauheim, BSc, Rose Onyeali, MD 2018 Thomas Jefferson University

Sclerosing Mesenteritis: Clinical Presentation, Imaging Findings, And Treatment, Jennifer Nauheim, Bsc, Rose Onyeali, Md

The Medicine Forum

CASE PRESENTATION

A 67-year old male with a history of myocardial infarction status post percutaneous coronary intervention and stage IV bladder cancer status post radical cystoprostatectomy with ileal neobladder reconstruction and chemotherapy (cisplatin and gemcitabine) presented with progressive, severe epigastric and lower abdominal pain associated with nausea. The pain had intensified over the previous week and was associated with a recent fifteen pound weight loss in the setting of poor oral intake. He denied nausea or diarrhea. His physical exam was notable for abdominal tympany and tenderness. His labs were notable for mild hyperkalemia (potassium 5.0 mmol/L), normal ...


Adverse Effects Of Checkpoint Inhibitor Immunotherapy In Medical Oncology, Michael Brister, MD, Colin Thomas, MD 2018 Thomas Jefferson University

Adverse Effects Of Checkpoint Inhibitor Immunotherapy In Medical Oncology, Michael Brister, Md, Colin Thomas, Md

The Medicine Forum

No abstract provided.


Amyotrophic Lateral Sclerosis Presenting As Chronic Cough, Marjorie Friedman, MD 2018 Thomas Jefferson University

Amyotrophic Lateral Sclerosis Presenting As Chronic Cough, Marjorie Friedman, Md

The Medicine Forum

INTRODUCTION

Amyotrophic Lateral Sclerosis (ALS) is a debilitating, uniformly fatal disease. While it most commonly presents with limb weakness, patients may also present with neurocognitive, respiratory, or bulbar symptoms. Despite its poor prognosis, an early diagnosis can save patients from unnecessary and expensive testing, lead to interventions that improve quality of life, and give patients and family time for advanced planning.1 This case highlights an unusual presentation of ALS.

KEY POINTS

  • Our patient presented with chronic cough and restrictive lung disease and after extensive workup was diagnosed with ALS.
  • Bulbar and respiratory symptoms are uncommon initial presentations of ALS ...


A Case Of Cryptogenic Organizing Pneumonia Managed Without A Diagnostic Biopsy, Kamal Amer, MD, McKensie Walker, BSc, Vincent Yeung, MD 2018 Thomas Jefferson University

A Case Of Cryptogenic Organizing Pneumonia Managed Without A Diagnostic Biopsy, Kamal Amer, Md, Mckensie Walker, Bsc, Vincent Yeung, Md

The Medicine Forum

INTRODUCTION

Organizing pneumonia (OP) is a type of diffuse interstitial lung disease characterized by a specific histopathologic pattern of response to lung injury. When the etiology of the injury is unknown and in the absence of inflammatory or connective tissue disease, this entity is termed cryptogenic organizing pneumonia (COP) or primary organizing pneumonia (POP). Disease states in which the etiology of underlying injury is known is termed secondary organizing pneumonia (SOP). Causes of SOP include drug toxicity, chronic heart or renal failure, rheumatic disease, collagen vascular disease, infection, immunodeficiency, autoimmune disease, and interstitial lung disease.

OP is characterized by the ...


Fifty Shades Of Sarcoidosis: A Case Report Of Löfgren Syndrome, Arpana Parachuri, MD 2018 Thomas Jefferson University

Fifty Shades Of Sarcoidosis: A Case Report Of Löfgren Syndrome, Arpana Parachuri, Md

The Medicine Forum

INTRODUCTION

Sarcoidosis is a multi-organ disorder that is characterized by the presence of noncaseating granulomas in involved organs. It commonly affects young and middle-aged individuals of all races, but is 3-4 times more common in African Americans and typically presents earlier with more severe symptoms.1 The lungs are affected in 90% of patients and pulmonary disease accounts for the majority of the morbidity and mortality associated with this disease. However, approximately 30% of patients can present with extrapulmonary findings and can have involvement of other organs such as the skin and eyes.1 The various presentations of sarcoidosis can ...


Use Of Venovenous Extracorporeal Membranous Oxygenation Following Iatrogenic Tracheal Rupture, Rajiv Kabadi, MD 2018 Thomas Jefferson University

Use Of Venovenous Extracorporeal Membranous Oxygenation Following Iatrogenic Tracheal Rupture, Rajiv Kabadi, Md

The Medicine Forum

INTRODUCTION

Iatrogenic tracheal rupture is a rare complication of endotracheal intubation and has a high risk of morbidity and mortality. Risk factors include female gender, short stature (height less than 160-cm), difficult airway anatomy, underlying connective tissue disorder, chronic obstructive pulmonary disease, use of a rigid stylet, inadequate intubation tube size, cuff over-inflation, emergent intubation and intubation performed by non-anesthesiologists. 1 Early recognition is important and diagnosis requires bronchoscopic confirmation.2,3 We describe a case where emergent venovenous extra-corporeal membrane oxygenation (VV-ECMO) was utilized in the management of tracheal rupture.

KEY POINTS

  • Tracheal rupture is an uncommon but severe ...


A Case Of Eosinophilic Granulomatosis With Polyangiitis, Anita Modi, MD, Lily Ackermann, MD 2018 Thomas Jefferson University

A Case Of Eosinophilic Granulomatosis With Polyangiitis, Anita Modi, Md, Lily Ackermann, Md

The Medicine Forum

INTRODUCTION

Eosinophilic granulomatosis with polyangiitis (eGPA) is a small- and medium-sized-vessel vasculitis with multi-organ manifestations. Given the rarity of eGPA, patients are often misdiagnosed for decades and may initially present with life-threatening manifestations of late-stage disease. Therefore, it is important to raise awareness of this condition and its associated signs and symptoms. This case report serves to describe a classic presentation of a patient with eGPA, as well as to delineate the diagnostic workup, acute management, and early outpatient follow-up required.

KEY POINTS

Given the life-threatening complications of this rare condition, it is important to raise awareness about eGPA. This ...


Tenofovir Cons The Kidneys: A Case Of Acquired Fanconi, Ritu Nahar, MD, Emma Lundsmith, MD 2018 Thomas Jefferson University

Tenofovir Cons The Kidneys: A Case Of Acquired Fanconi, Ritu Nahar, Md, Emma Lundsmith, Md

The Medicine Forum

INTRODUCTION

Proximal (Type 2) renal tubular acidosis (RTA) is a relatively rare diagnosis, especially in adults. It is characterized by a reduction in proximal bicarbonate reabsorption resulting in urinary bicarbonate wasting. Proximal RTA can also be associated with additional defects in proximal tubular function including impaired reabsorption of phosphate, glucose, uric acid, and amino acids. Generalized proximal tubular dysfunction is termed Fanconi syndrome. While there are primary causes of Fanconi syndrome including sporadic and familial sources, this syndrome can also be acquired. Two major culprits include monoclonal gammopathies resulting in increased excretion of immunoglobulin light chains and drug-induced nephrotoxicity to ...


Abdomen Actin’ Up: A Unique Presentation Of Disseminated Abdominal Actinomycosis, Arpana Parachuri, MD, Brianna Shinn, MD, Rino Sato, MD 2018 Thomas Jefferson University

Abdomen Actin’ Up: A Unique Presentation Of Disseminated Abdominal Actinomycosis, Arpana Parachuri, Md, Brianna Shinn, Md, Rino Sato, Md

The Medicine Forum

INTRODUCTION

Abdominal actinomycosis is a chronic, indolent disease characterized by nonspecific symptoms such as fatigue, weight loss, fever, and abdominal pain. Actinomyces is a genus of fastidious, gram-positive, non-acid-fast, branching filamentous bacilli characterized by sulfur granules that is normally found in oral flora and inhabits the gastrointestinal (GI) tract. Actinomyces infections are relatively rare, however when present, they have the ability to invade multiple organs and disseminate throughout multiple body cavities. Factors that increase the risk of developing actinomycosis include poor oral hygiene, alcoholism, and preexisting dental disease. Intrauterine devices (IUDs) also increase the risk of developing pelvic actinomycosis. Over ...


Resistant Raoultella Ornithinolytica Bacteremia In A Patient With New Acute Myeloid Leukemia, Mario Caldararo, MD 2018 Thomas Jefferson University

Resistant Raoultella Ornithinolytica Bacteremia In A Patient With New Acute Myeloid Leukemia, Mario Caldararo, Md

The Medicine Forum

INTRODUCTION

Members of the Raoultella genus were formerly considered to be Klebsiella species until they were differentiated based on phylogenetic Deoxyribonucleic acid (DNA) analysis.1 Since then, Raoultella ornithinolytica has been sparsely implicated in clinically-apparent disease, though more case reports are appearing as of late. Here we report the first documented instance of R. ornithinolytica bacteremia in a patient with new acute myeloid leukemia (AML).


A Case Of Secondary Hemophagocytic Lymphohistiocytosis In An Adult Patient Treated With Concurrent Dexamethasone And Interleukin-1 Receptor Blockade, Vikas Sunder, MD 2018 Thomas Jefferson University

A Case Of Secondary Hemophagocytic Lymphohistiocytosis In An Adult Patient Treated With Concurrent Dexamethasone And Interleukin-1 Receptor Blockade, Vikas Sunder, Md

The Medicine Forum

INTRODUCTION

Hemophagocytic Lymphohistiocytosis (HLH) is a rare, life-threatening syndrome of overwhelming inflammation caused by activation and proliferation of T-lymphocytes and hemophagocytic macrophages. This uncontrolled proliferation of macrophages creates a cytokine storm with resultant tissue damage. HLH is associated with clinical and laboratory findings which include fever, cytopenias, hepatic dysfunction, splenomegaly, and marked hyperferritinemia.1-3 There exists limited epidemiologic data on adult (age ≥ 18 years) cases of HLH, and its incidence is uncertain. HLH can be due to inherited mutations causing immune system dysregulation or secondary to underlying malignancy, infection, or rheumatologic condition. Macrophage activation syndrome (MAS) refers to HLH that ...


Death By Delirium: A 71-Year-Old Male With Poor Post-Operative Recovery, William Bradford, MD 2018 Thomas Jefferson University

Death By Delirium: A 71-Year-Old Male With Poor Post-Operative Recovery, William Bradford, Md

The Medicine Forum

INTRODUCTION

Delirium is an acute decline in attention and cognition not better explained by another medical condition.1 It is multifactorial in origin, with risk factors including advanced age, male sex, baseline decreased cognitive status, sensory impairment, poor baseline functional status, polypharmacy, and multiple comorbid conditions. Acute precipitants for delirium include administration of psychoactive medications (particularly benzodiazepines, narcotics, anticholinergic medications, and general anesthesia), sleep deprivation, major surgery, and new illness or worsening of current illness.Delirium accounts for some 49% of all hospital days in older patients, increases rates of mortality and morbidity, and is associated with lasting cognitive impairment ...


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