Digital Commons Network^™

A Cost Analysis Of Carpal Tunnel Release Surgery Performed Wide Awake Versus Under Sedation., Todd H. Alter, William J. Warrender, Frederic E. Liss, Asif M. Ilyas

Rothman Institute Papers

BACKGROUND: Hand surgery under local anesthesia only has been used more frequently in recent years. The purpose of this study was to compare perioperative time and cost for carpal tunnel release performed under local anesthesia ("wide-awake local anesthesia no tourniquet," or WALANT) only to carpal tunnel release performed under intravenous sedation.

METHODS: A retrospective comparison of intraoperative (operating room) surgical time and postoperative (postanesthesia care unit) time for consecutive carpal tunnel release procedures performed under both intravenous sedation and wide-awake local anesthesia was undertaken. All operations were performed by the same surgeon using the same mini-open surgical technique. A cost …

Perioperative Aspirin And Long-Term Survival In Patients Undergoing Coronary Artery Bypass Graft., Qian Ding, Hong Liu, Zugui Zhang, Jordan E. Goldhammer, Eric Yuen, Zhongmin Li, Linong Yao, Nilas Young, Douglas Boyd, William Weintraub, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Faculty Papers

This study aimed to examine association between perioperative uses of aspirin and long-term survival in patients undergoing CABG. A retrospective cohort study was performed in 9,584 consecutive patients receiving cardiac surgery from three tertiary hospitals. Of all the patients, 4,132 patients undergoing CABG met inclusion criteria and were divided into four groups: with or without preoperative or postoperative aspirin respectively. 30-day postoperative and long-term mortality were compared with the use of propensity scores and inverse probability weighting adjustment to reduce the treatment-selection bias. The patients taking preoperative aspirin presented significantly more with comorbidities. However, the results of this study showed …

Care Of Adult Cancer Survivors, Kelsey Kloosterman

Doctoral Projects

As innovative cancer treatments emerge, more people are surviving cancer. Cancer survivors have multiple and unique healthcare needs due to their cancer and cancer treatments. Communication among those treating the cancer, primary care providers, and cancer survivors is necessary to coordinate care once treatment is finished. The development of a survivorship care plan that is reviewed with the cancer survivor is intended to facilitate communication among all stakeholders. This quality improvement project examined current practice in a survivorship clinic in a Midwestern health system cancer center that cares for a variety of types of cancer patients. By reviewing evidence in …

Levels Of Par-1 Kinase Determine The Localization Of Bruchpilot At The Drosophila Neuromuscular Junction Synapses., Kara R. Barber, Martin Hruska, Keegan M. Bush, Jade A. Martinez, Hong Fei, Irwin B. Levitan, Matthew B. Dalva, Yogesh P. Wairkar

Farber Institute for Neuroscience Faculty Papers

Functional synaptic networks are compromised in many neurodevelopmental and neurodegenerative diseases. While the mechanisms of axonal transport and localization of synaptic vesicles and mitochondria are relatively well studied, little is known about the mechanisms that regulate the localization of proteins that localize to active zones. Recent finding suggests that mechanisms involved in transporting proteins destined to active zones are distinct from those that transport synaptic vesicles or mitochondria. Here we report that localization of BRP-an essential active zone scaffolding protein in Drosophila, depends on the precise balance of neuronal Par-1 kinase. Disruption of Par-1 levels leads to excess accumulation of …

Traumatic Complications Of Inpatient Massage Therapy: Case Report And Literature Review, Ishna Sharma, D'Andrea Joseph, Orlando Kirton

Abington Jefferson Health Papers

No abstract provided.

The Hungry Cancer Patient: A Case Of Money Ill Spent., Allison Zibelli

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

No abstract provided.

Uptake Of Three Doses Of Hpv Vaccine By Primary School Girls In Eldoret, Kenya; A Prospective Cohort Study In A Malaria Endemic Setting, Hillary Mabeya, Sonia Menon, Steven Weyers, Violet Naanyu, Emily Mwaliko, Elijah Kirop, Elkanah Omenge, Heleen Vermandere, Davy Vanden Broeck

Obstetrics and Gynaecology, East Africa

Background: All women are potentially at risk of developing cervical cancer at some point in their life, yet it is avoidable cause of death among women in Sub- Saharan Africa with a world incidence of 530,000 every year. It is the 4th commonest cancer affecting women worldwide with over 260,000 deaths reported in 2012. Low resource settings account for over 75% of the global cervical cancer burden. Uptake of HPV vaccination is limited in the developing world. WHO recommended that 2 doses of HPV vaccine could be given to young girls, based on studies in developed countries. However in Africa …

Early Identification Of Depression In Patients With Pediatric Epilepsy, Erin Fecske, Paul Glasier, Lines Vargas Collado, Elizabeth Rende

Posters

Describes the use of the Neurological Disorders Depression Inventory-Epilepsy-Youth (NDDI-E-Y) in adolescent patients in a comprehensive epilepsy center to identify patients who need referral for mental health care.

Clinician Perspectives On Factors Affecting Shared Decision Making About Lung Cancer Screening, Mohammad Abubaker-Sharif, Melissa Dicarlo, Mph, Ms, Ronald E. Myers, Phd, Dsw

Phase 1

Background/Objective. In 2015, the Centers for Medicare and Medicaid Services (CMS) announced coverage for annual lung cancer screening (LCS) with low dose computed tomography (LDCT) for individuals who are 55 to 77 years of age, have > 30 pack years of smoking history, and undergo shared decision making (SDM) prior to screening. Most referrals for LCS are initiated in primary care. Currently, little is known about how primary care physicians view SDM and barriers in practice to SDM about LCS. This study aimed to gather information to help fill these knowledge gaps.

Methods. I worked with senior leadership in …

Patient Perceptions And Expectations About Postoperative Analgesia, Carrie Mok, Nirmal Shah, Do, Stephen F. Goldberg, Md, Amir C. Dayan, Md, Marc Torjman, Phd, Jaime L. Baratta, Md

Phase 1

Introduction

Opioid overdose deaths have nearly quadrupled since 1999. Nearly 2 out of 3 persons being prescribed medications are prescribed an opioid. Physicians may be prescribing opioids for more than what is required for postoperative pain control, leading to increased risk for opioid abuse and addiction. Patient perceptions of perioperative pain medications are poorly understood.

Objective

This survey aims to understand patient expectations of perioperative analgesics.

Methods

Following IRB approval, patients 18 years of age or older, were given a 13-question survey prior to their surgery at Thomas Jefferson University Hospital, to evaluate the perception of pain medications, medication efficacy, …

A Comparison Of Screening, Prevention, And Management For Hepatitis B Patients Between The Us And Chinese Healthcare Systems, Thomas Chen, James D. Plumb, Md

Phase 1

Introduction: Hepatitis B (HBV) is a complex disease entity with potentially serious outcomes, including developing hepatocellular carcinoma (HCC). HBV is estimated to be responsible for about 50-80% of HCC cases worldwide, and 75-95% of HCC cases in HBV endemic regions.¹ HBV and HCC are great concerns especially in East Asian countries like China. In China, HCC ranks as the 2^nd most common cancer and 2^nd in cancer mortality, both behind only lung cancer.¹ China is considered an endemic HBV region, with about 100-150 million people infected. In comparison, only an estimated 550,000-2 million people are chronically …

Opioid-Prescribing Practices For Post-Operative Patients In Otolaryngology: A Multiphasic Quality Improvement Project In A Single Large Institution, Zachary Gandee, Sophia Dang, Alexander N. Duffy, Jonathan C. Li, Tanvi Rana, Brittany Gunville, Tingting Zhan, Elizabeth Cottrill, Md, David Cognetti, Md

Phase 1

Objectives:

In otolaryngology, postoperative pain management lacks evidence-based guidelines. We investigated opioid prescription and consumption for common procedures to develop prescribing guidelines at our institution.

Study Design:

Prospective, survey study.

Methods:

Patients who underwent surgery between July and September were given surveys upon discharge and at first follow-up visit. We assessed opioid usage and pain using the visual analog scale and opioid consumption throughout the postoperative period. Opioid prescriptions were converted to a standardized unit of 5 mg Oxycodone pills for reporting. Four procedures (transoral robotic surgery resection [TORS], sialendoscopy, parathyroidectomy/thyroidectomy, and parotidectomy) were selected for isolated analysis.

Results: …

The Impact Of Mental Health On Cancer Preventative Screenings, Chelsea Edirisuriya, Amy Leader, Phd

Phase 1

Among the mental health population of the United States, overall preventative health services, such as cancer screening rates, are remarkably low. Additionally, there is a significant 30% higher mortality rate due to cancer in psychiatric patients. This project established if there are disparities in cancer screening rates between the general population and the mental health population of Southeastern Pennsylvania. The project analyzed and compared the differences in cancer screenings for colorectal, breast, and cervical cancer among those currently diagnosed with a mental condition and the general population. Through p-value and Pearson chi-square statistical analysis of the Community Health Data Base …

Impact Of Sepsis And Non-Communicable Diseases On Prognostic Models To Predict The Outcome Of Hospitalized Chronic Liver Disease Patients, Fakhar Qazi, Shahab Abid, Preet Ayoub Shaikh, Safia Awan

Section of Gastroenterology

AIM: To evaluate the impact of sepsis and non-communicable diseases (NCDs) on the outcome of decompensated chronic liver disease(CLD) patients.

Methods: In this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were reviewed. Patients older than 18 years with decompensation of CLD (i.e., jaundice, ascites, encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged hospital …

Using The Engagedmd Multimedia Platform To Improve Informed Consent For Ovulation Induction, Intrauterine Insemination, And In Vitro Fertilization, Jody L. Madeira, Jennifer Rehbein, Mindy S. Christianson, Miryoung Lee, J. Preston Parry, Guido Pennings, Steven R. Lindheim Md

Articles by Maurer Faculty

Objective: To study patient and provider feedback on how a multimedia platform (EngagedMD) helps patients to understand the risks and consequences of in vitro fertilization (IVF), ovulation induction (OI), and intrauterine insemination (IUI) treatments and the impact of the informed consent process.

Design: Prospective survey study.

Setting: IVF units in the United States.

Patient(s): Six-thousand three-hundred and thirty-three patients who viewed the multimedia platform before IVF or OI-IUI treatment at 13 U.S. IVF centers and 128 providers.

Intervention(s): Quantitative survey with 17 questions.

Main Outcome Measure(s): Assessment of the impact of a multimedia platform on patient anxiety, comprehension, and satisfaction …

Medial Temporal Lobe Functional Connectivity Predicts Stimulation-Induced Theta Power., E. A. Solomon, J. E. Kragel, R. Gross, B. Lega, M. R. Sperling, G. Worrell, S. A. Sheth, K. A. Zaghloul, B. C. Jobst, J. M. Stein, S. Das, R. Gorniak, C. S. Inman, S. Seger, D. S. Rizzuto, M. J. Kahana

Department of Neurology Faculty Papers

Focal electrical stimulation of the brain incites a cascade of neural activity that propagates from the stimulated region to both nearby and remote areas, offering the potential to control the activity of brain networks. Understanding how exogenous electrical signals perturb such networks in humans is key to its clinical translation. To investigate this, we applied electrical stimulation to subregions of the medial temporal lobe in 26 neurosurgical patients fitted with indwelling electrodes. Networks of low-frequency (5-13 Hz) spectral coherence predicted stimulation-evoked increases in theta (5-8 Hz) power, particularly when stimulation was applied in or adjacent to white matter. Stimulation tended …

Implementing Evidence-Based Dietary Instruction Strategies In A Specialty Care Clinic, Jacobie Landers

Doctor of Nursing Practice

Cardiovascular disease is a significant health concern that increases risks for stroke, escalates the development of renal disease, and significantly increases morbidity and mortality risk. Dietary changes can significantly reduce complications in patients with heart and vascular disease. This project was designed to effectively implement and sustain provider and cardiovascular staff instructions on dietary modifications to improve hypertension control and lower cholesterol in patients with cardiac disease using staff support. The project facilitated provider evaluation of patients’ dietary habits to promote wellness in a patient population which was not receiving dietary education. Project interventions included establishing structured methods of providing …

Non-Neutralizing Antibodies Elicited By Recombinant Lassa-Rabies Vaccine Are Critical For Protection Against Lassa Fever., Tiago Abreu-Mota, Katie R. Hagen, Kurt Cooper, Peter B. Jahrling, Gene Tan, Christoph Wirblich, Reed F. Johnson, Matthias J. Schnell

Department of Microbiology and Immunology Faculty Papers

Lassa fever (LF), caused by Lassa virus (LASV), is a viral hemorrhagic fever for which no approved vaccine or potent antiviral treatment is available. LF is a WHO priority disease and, together with rabies, a major health burden in West Africa. Here we present the development and characterization of an inactivated recombinant LASV and rabies vaccine candidate (LASSARAB) that expresses a codon-optimized LASV glycoprotein (coGPC) and is adjuvanted by a TLR-4 agonist (GLA-SE). LASSARAB elicits lasting humoral response against LASV and RABV in both mouse and guinea pig models, and it protects both guinea pigs and mice against LF. We …

Development Of Onchocerca Volvulus In Humanized Nsg Mice And Detection Of Parasite Biomarkers In Urine And Serum., John B. Patton, Sasisekhar Bennuru, Mark L. Eberhard, Jessica A. Hess Ligas, April R. Torigian, Sara Lustigman, Thomas B. Nutman, David Abraham

Department of Microbiology and Immunology Faculty Papers

BACKGROUND: The study of Onchocerca volvulus has been limited by its host range, with only humans and non-human primates shown to be susceptible to the full life cycle infection. Small animal models that support the development of adult parasites have not been identified.

METHODOLOGY/PRINCIPAL FINDINGS: We hypothesized that highly immunodeficient NSG mice would support the survival and maturation of O. volvulus and alteration of the host microenvironment through the addition of various human cells and tissues would further enhance the level of parasite maturation. NSG mice were humanized with: (1) umbilical cord derived CD34+ stem cells, (2) fetal derived liver, …

Pilot Study Of The Physiological Effects Of An Integrative Medicine Approach In Irritable Bowel Syndrome, Gigi Constable, Eleanor Lewis, Andrew B. Newberg, Md

Phase 1

Introduction: Irritable Bowel Syndrome (IBS) is the most common GI functional disease in the US, affecting 10-25% of the population and costing ~$1.6B in annual healthcare spending. Defined by varied GI symptoms, IBS is associated with gut inflammation from many factors, including diet, microbiome imbalances, and stress. However, the disease lacks a treatment algorithm, especially within integrative medicine.

Objective: This research explores integrative medicine approaches to IBS, including diet and supplements, to identify microbiome and symptom patterns before and after intervention.

Methods: Patients first complete surveys on diet and symptoms, the Beck depression inventory, the SF-36 questionnaire, PET-MRI imaging, and …

Common Practice For Behavioral Health Screening In Pediatric Primary Care Settings, Joseph A. Menand, Mario Cruz, Md

Phase 1

Mental health disorders in the United States are highly prevalent, affecting 14-20% of children yearly. Only 25-35% receive treatment after on average a six-plus year delay from symptom onset. Current recommendations suggest primary care physicians/providers (PCP) manage mental health conditions, however, PCPs are wary, citing lack of time, training and resources.This study evaluated pediatric/adolescent PCPs using a self-report questionnaire assessing knowledge/skill, clinical practice (e.g. screening tool) and perceived barriers when managing attention deficit hyperactivity disorder (ADHD), anxiety and depression (N = 11). Self-reported knowledge/skill diagnosing, treating and referring each disorder were recorded on a 5-point Likert scale and evaluated using …

Total Body Skin Exams: Sensitivity, Specificity, And Number Needed To Screen, Shayan Waseh, Michael Bui, Audra Hugo, Alexander Sherban, Elizabeth Jones, Md

Phase 1

Introduction: Skin cancer, the most common form of cancer worldwide, has one of the highest cure rates among cancers if diagnosed and treated early in its course. The Total Body Skin Exam (TBSE) is the primary modality used to screen for skin cancers. Currently, few studies have characterized the effectiveness of the TBSE in contemporary populations.

Objective: Characterizing the number-needed-to-screen (NNS) to diagnose a case of skin cancer through TBSEs will make it possible to better understand its effectiveness as a screening modality and its utility in an increasingly population health-based healthcare system.

Methods: A retrospective chart review of 3155 …

Bilateral Mastectomy, Choroidal Mass: A Curve Ball., Phillip Gordon, Carol L. Shields

Wills Eye Hospital Papers

No abstract provided.

Challenges Faced By Pakistani Healthcare System: Clinician's Perspective, Faran Khalid, Ahmed Nadeem Abbasi

Department of Radiation Oncology

Abstract are not provided by the author/publisher

Loss-Of-Function Mutations In Atp6ap1 And Atp6ap2 In Granular Cell Tumors., Fresia Pareja, Alissa H. Brandes, Thais Basili, Pier Selenica, Felipe C. Geyer, Dan Fan, Arnaud Da Cruz Paula, Rahul Kumar, David N. Brown, Rodrigo Gularte-Mérida, Barbara Alemar, Rui Bi, Raymond S. Lim, Ino De Bruijn, Sho Fujisawa, Rui Gardner, Elvin Feng, Anqi Li, Edaise M. Da Silva, John R. Lozada, Pedro Blecua, Leona Cohen-Gould, Achim A. Jungbluth, Emad A. Rakha, Ian O. Ellis, Maria I.A. Edelweiss, Juan P. Palazzo, Larry Norton, Travis Hollmann, Marcia Edelweiss, Brian P. Rubin, Britta Weigelt, Jorge S. Reis-Filho

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Granular cell tumors (GCTs) are rare tumors that can arise in multiple anatomical locations, and are characterized by abundant intracytoplasmic granules. The genetic drivers of GCTs are currently unknown. Here, we apply whole-exome sequencing and targeted sequencing analysis to reveal mutually exclusive, clonal, inactivating somatic mutations in the endosomal pH regulators ATP6AP1 or ATP6AP2 in 72% of GCTs. Silencing of these genes in vitro results in impaired vesicle acidification, redistribution of endosomal compartments, and accumulation of intracytoplasmic granules, recapitulating the cardinal phenotypic characteristics of GCTs and providing a novel genotypic-phenotypic correlation. In addition, depletion of ATP6AP1 or ATP6AP2 results in …

Evaluation Of The Hiv Infant Tracking System (Hitsystem) To Optimise Quality And Efficiency Of Early Infant Diagnosis: A Cluster-Randomised Trial In Kenya., Sarah Finocchario-Kessler, Brad Gautney, Anlin Cheng, Catherine Wexler, May Maloba, Niaman Nazir, Samoel Khamadi, Raphael Lwembe, Melinda Brown, Thomas A. Odeny, Jacinda K. Dariotis, Matthew Sandbulte, Natabhona Mabachi, Kathy Goggin

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The HIV Infant Tracking System (HITSystem) is a web-based intervention linking providers of early infant diagnosis, laboratory technicians, and mothers and infants to improve outcomes for HIV-exposed infants. We aimed to evaluate the efficacy of the HITSystem on key outcomes of early infant diagnosis.

METHODS: We did a cluster-randomised trial at six hospitals in Kenya, which were matched on geographic region, resource level, and volume of patients (high, medium, and low). We randomly allocated hospitals within a matched pair to either the HITSystem (intervention; n=3) or standard of care (control; n=3). A random number generator was used to assign …

Spinal Infections: From Prevention To Cure, James Harrop

Department of Neurosurgery Faculty Papers

AOSpine North America (AOSNA) is honored to have the ability to present this focused issue on spinal infections. As we are all aware, spinal infections are a prevalent part of our daily treatment regimen as spine surgeons—whether these infections are in our elective practice or emergencies.

A Learning Community Approach To Identifying Interventions In Health Systems To Reduce Colorectal Cancer Screening Disparities., Lillian C. Man, Melissa Dicarlo, Emily Lambert, Randa Sifri, Martha Romney, Linda Fleisher, Ronald Myers

Department of Medical Oncology Faculty Papers

Although colorectal cancer (CRC) screening in the United States has been increasing, screening rates are not optimal, and there are persistent disparities in CRC screening and mortality, particularly among minority patients. As most CRC screening takes place in primary care, health systems are well-positioned to address this important population health problem. However, most health systems have not actively engaged in identifying and implementing effective evidence-based intervention strategies that can raise CRC screening rates and reduce disparities. Drawing on the Collective Impact Model and the Interactive Systems Framework for Dissemination and Implementation, our project team applied a learning community strategy to …

Multiple-Micronutrient Supplementation: Evidence From Large-Scale Prenatal Programmes On Coverage, Compliance And Impact, Cristiana Berti, Michelle F. Gaffey, Zulfiqar Ahmed Bhutta, Irene Cetin

Department of Paediatrics and Child Health

Micronutrient deficiencies during pregnancy pose important challenges for public-health, given the potential adverse outcomes not only during pregnancy but across the life-course. Provision of iron-folic acid (IFA) supplements is the strategy most commonly practiced and recommended globally. How to successfully implement IFA and multiple micronutrient supplementation interventions among pregnant women and to achieve sustainable/permanent solutions to prenatal micronutrient deficiencies remain unresolved issues in many countries. This paper aims to analyse available experiences of prenatal IFA and multiple micronutrient interventions to distil learning for their effective planning and large-scale implementation. Relevant articles and programme-documentation were comprehensively identified from electronic databases, websites …

The Dietary Intake And Practices Of Adolescent Girls In Low- And Middle-Income Countries: A Systematic Review, Emily C. Keats, Aviva I. Rappaport, Shailja Shah, Christina Oh, Reena Jain, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

In many low- and middle-income countries (LMICs) the double burden of malnutrition is high among adolescent girls, leading to poor health outcomes for the adolescent herself and sustained intergenerational effects. This underpins the importance of adequate dietary intake during this period of rapid biological development. The aim of this systematic review was to summarize the current dietary intake and practices among adolescent girls (10⁻19 years) in LMICs. We searched relevant databases and grey literature using MeSH terms and keywords. After applying specified inclusion and exclusion criteria, 227 articles were selected for data extraction, synthesis, and quality assessment. Of the included …