Digital Commons Network^™

Adaptive Statistical Iterative Reconstruction-V For Lung Nodule Analysis, Cherry Au, Zhenteng Li, Md, Eric Gingold, Md, Ethan Halpern, Md, Baskaran Sundaram, Md

Phase 1

Introduction: Low-dose CT in lung cancer screening has demonstrated benefits in select patients. As the traditional filtered back projection (FBP) technique is limited by poor image quality, adaptive statistical iterative reconstruction-V (ASIR-V) algorithm has been developed to achieve higher image quality with processing efficiency.

Objective: To investigate the impact of various CT scan parameters on the semi-automated measurement of lung nodules using a Computer Aided Detection (CAD) program.

Methods: This IRB-exempt phantom experiment was conducted with a CT scanner capable of ASIR-V algorithm. Eight lung nodules sized 5-12 mm, of solid or ground glass type, were placed inside a multipurpose …

Diagnostic Accuracy Of Home Sleep Apnea Testing (Hsat) Based On Recording Duration, Angela Alnemri, Theodora Fynn, Prakash Vasudevan, Ritu Grewa, Karl Doghramji

Phase 1

Introduction: Obstructive Sleep Apnea (OSA) is a chronic sleeping disorder with serious health consequences. Currently, standard diagnosis is through in-lab polysomnography; however, there has been a shift to greater use of Home Sleep Apnea Testing (HSAT) for patients with a high pre-test probability of having OSA.

Objective: To investigate the minimum recording time needed during HSAT to accurately diagnose the presence and severity of OSA.

Methods: A retrospective review was conducted of HSATs done from January-October 2017. Each study was divided into 1-, 2-,3-,4-,5-, 6-, and 7 hour intervals beginning at the recording start time. The respiratory event index (REI) …

Network Influence Of The Cerebellum For Predicting Dbs Response In Patients With Advanced Parkinson’S Disease, Lucy Li, Jennifer Muller, Sara Thalheimer, Mackenzie D. Silverman, Mahdi Alizadeh, Tsao-Wei Liang, Kelly Layton, Daniel Kremens, Victor Romo, Feroze Mohamed, Chengyuan Wu

Phase 1

Introduction: Deep brain stimulation (DBS) is a treatment option for reducing motor symptoms in patients with Parkinson’s Disease (PD) when first-line medication becomes ineffective. Existing literature has hypothesized that the clinical outcome of DBS may depend on brain connectivity profiles of the stimulation site to distant brain regions. However, the potential of brain connectivity profiles to predict response to DBS in PD remains unclear.

Objective: This study aimed to investigate how changes in structural and functional connectivity may relate to patient response to DBS, through the examination of brain network changes using graph theory.

Methods: Ten patients with advanced PD …

Identifying Refractory Aml Patients Using Rate Of Wbc Decline In Order To Reduce Length Of Stay, Kyle Itri, Thomas Klumpp

Phase 1

Introduction: Acute Myeloid Leukemia (AML) is the most common acute leukemia in the United States. At diagnosis, these patients are admitted to begin induction chemotherapy and remain in the hospital throughout treatment. Response to therapy is assessed with bone marrow biopsy one month later. However, rate of white blood cell (WBC) and absolute blast count (ABC) decline can be useful in predicting bone marrow blast clearance and complete remission.

Objective: Therefore, our goal is to identify AML patients refractory to induction therapy using rate of WBC, ABC, and ANC decline as prognostic markers in order to reduce length of stay. …

Acute Pancreatitis In The Emergency Department, Gregory J. Lopez, Bs, Matt Hall, Md, Matthew Babineau, Md, Darshan Kothari, Md, Ryan C. Burke, Phd, Mph, Richard E. Wolfe, Md, Sunil G. Sheth, Md, Stephen Freedman, Md, Nathan I. Shapiro, Md, Carrie Tibbles, Md

Phase 1

Introduction: Acute pancreatitis (AP) is a common emergency department (ED) presentation with a variety of outcomes. Stratifying AP severity with scoring systems can allow physicians to effectively manage patient disposition.

Objective: To identify ED pancreatitis patients who will likely be admitted to the ICU or be discharged within 48 hours, and to validate existing pancreatitis severity scores.

Methods: Patients with a final ED diagnosis of AP and/or lipase ≥ 3 times the upper limit of normal were enrolled in a prospective, observational chart review study. Parametric and non-parametric descriptive statistics were used to describe the patient population. Area under receiver …

Racial Disparities In Head And Neck Cancers In An Urban Hospital, Jessica Kraus-Lavy, Charnita Zeigler-Johnson, Scott W Keith, Frances Guiles, David Cognetti, Voichita Bar-Ad, Rita S. Axelrod, Md

Phase 1

Introduction: Head and neck cancer incidence rates are higher for white residents in Philadelphia, while related mortality rates are highest for black residents. It is unclear how risk factors like HPV and smoking contribute to these disparities. The goal of this study is to determine which factors are associated with head and neck cancers in a diverse patient population from a Philadelphia hospital.

Methods: Cancer registry data from Thomas Jefferson University was used to obtain records from 922 head and neck cancer patients. One patient of other race was excluded. Twenty in-situ cancer cases were excluded. Chi-square tests were used …

Retrospective Chart Review Assessing Factors That Contribute To Network Leakage In Postoperative Pancreatic Cancer Patients, Nazanin Sarpoulaki, Christian Fernandez, Md, Mark Hurwitz, Md

Phase 1

Introduction: Standard of care for resectable pancreatic cancer includes surgery, chemotherapy, with consideration of radiotherapy. Thomas Jefferson University Hospital (TJUH) is a large volume institution for pancreatectomy. Rate of subsequent in-network adjuvant treatment are far less which may impact outcomes. We will elucidate variables that influence coordinated patient care.

Objective: To evaluate variables that correlate with follow up and adjuvant treatment of pancreatic cancer patients at TJUH.

Methods: Retrospective medical chart reviews will be performed with data from patients with pancreatic cancer who have undergone resection at TJUH from April 2017 to March 2018. Patient demographics, clinical, and pathologic information …

High Density Of Tumor-Associated Macrophage Staining Correlates With Poor Clinicopathologic Markers In Head And Neck Squamous Cell Carcinoma: A Meta-Analysis, Alexander Knops, Ba, Ayan Kumar, Bs, Brian Swendseid, Md, Ubaldo E. Martinez-Outshoorn, Md, Larry Harshyne, Phd, Nancy Philp, Phd, Ulrich Rodeck, Md, Phd, Christopher Snyder, Adam Luginbuhl, Md, David Cognetti, Md, Jennifer Johnson, Md, Joseph Curry, Md

Phase 1

Background: Head and neck squamous cell carcinoma (HNSCC) develops within a complex cellular microenvironment that promotes tumor growth, but also represents many potential therapeutic targets. Macrophage presence within that environment has been implicated in the growth, aggression, and persistence of HNSCC. Current literature reports variable degrees of association between tumor-associated macrophage (TAMs) density and clinicopathologic markers of disease.Inconsistent findings may result from grouping of TAM subtypes, which include both M1 (pro-inflammatory) and M2 (immunosuppressive). Our aim is to define the prognostic significance of the phenotypes of tumor-associated macrophages in HNSCC.

Methods: We conducted a meta-analysis of the existing publications investigating …

Sociodemographic Background Characteristics Of Patients Who Participate In A Lung Cancer Screening Program, Amber Zhang, Marcella Pimpinelli, Brooke Ruane, Russell K. Mcintire, Julie Barta, Md, Hee-Soon Juon, Bridget Jackson

Phase 1

Introduction: Despite decreasing lung cancer incidence and mortality rates, disparities in prevalence and outcomes persist between Black and White patients. Secondary analysis of the National Lung Screening Trial found screening with low-dose CT (LDCT) reduced lung cancer mortality more in Blacks than Whites. However, it is unknown if racial disparities exist in screening results, and the involved sociodemographic factors.

Objective: The study aims to analyze characteristics that may predict screening outcomes (Lung-RADS category) in patients who received LDCT through the Jefferson Lung Cancer Screening Program (LCSP).

Methods: Retrospective data (n=733, May 2015 to July 2017) were merged with prospective …

Clinical And Pathologic Factors In Breast Cancer Patients With Bone Metastases Undergoing Surgery For Pathologic And Impending Fractures, Emily Bochner, Kerith Wang, Benjamin Leiby, Ayako Miura, William Kevin Kelly

Phase 1

Introduction: Metastatic lesions to bone carry a poor prognosis. Bone lesions can be responsible for significant morbidity in patients, including pathologic or impending fractures that may require emergent surgical evaluation.

Objective: We evaluated the clinical and pathologic features associated with breast cancer patients with bone metastases who underwent surgery for pathologic or impending fractures.

Methods: A retrospective chart review of 20 breast cancer patients with bone metastases who underwent surgery from the Bone Biorepository Bank at Sidney Kimmel Cancer Center was performed. We evaluated their clinical and pathologic characteristics and performed Fisher’s Exact Testing to explore potential associations.

Results: 90% …

Comparing Treatment Efficacy Of Upper Airway Stimulation To Cpap For Obstructive Sleep Apnea, Alec Furstenberg, Colin Huntley, Md, Adam Vasconcellos, Md, Ayan Kumar, Karl Doghramji, Md, Maurits Boon, Md

Phase 1

Introduction

Upper airway stimulation (UAS) is newer treatment option for the management of Obstructive Sleep Apnea (OSA) and presents an alternative to the traditional Continuous Positive Airway Pressure (CPAP). Previously published data has shown good control of disease severity utilizing UAS with high patient tolerance and compliance. We aim to compare a cohort of patients treated with UAS and CPAP and evaluate therapy usage and disease control through use of the mean disease alleviation concept.

Methods

We evaluated demographic, pre and post-treatment sleep study, and therapy utilization data of cohorts of patients with OSA treated with CPAP and UAS. We …

Predictors Of Ventriculostomy Infection In A Large Cohort, Christine Wamsley, Ba, Ahmad Sweid, Md, Stavropoula Tjoumakaris, Md, Erica J. Mann, Ba, Christopher Neely, Bs, Jeffrey Head, Ba, Michael R. Gooch, Md, Nabeel Herial, Md, Robert Rosenwasswer, Md, Pascal Jabbour, Md

Phase 1

Introduction: External ventricular drains (EVDs) are neurosurgical devices used to treat hydrocephalus and monitor intracranial pressure. Ventriculostomy-associated infections (VAIs) are a complication of EVD placement associated with increased morbidity and mortality, as well as cost. A previous study at Jefferson reported a decrease in VAI’s with the use of antibiotic-coated catheters.

Objective: The aim of this study was to assess the current rate of VAI’s and determine risk factors associated with infections.

Methods: Using Epic, the electronic medical records software, we conducted a retrospective review of patients who underwent EVD placement at Thomas Jefferson University Hospital and Jefferson Hospital for …

A Study Of Wellness Education As A Burnout Coping Strategy, Abhishek Surampudy, Allen Friedland, Md, Himani Divatia, Do, Tina Hu, Md

Phase 1

Introduction: The MedScape National Physician Burnout & Depression 2018 report states that over 40% of responding physicians reported burnout, with 12% reporting clinical depression. As such, there is a need to study burnout mitigation.

Objective: This study seeks to validate the hypothesis that intervention will prevent burnout and promote physician well-being.

Methods: 200 medical professionals attending the November 2018 NMPRA conference in Orlando were administered a survey to assess attitudes and prevalence of burnout. Education about burnout was provided through an information booth, handouts, and discussions. A monthly newsletter about wellness will seek to inspire participants. Another survey after 6 …

Cellular Milieu Imparts Distinct Pathological Α-Synuclein Strains In Α-Synucleinopathies, Ronald Gathagan, Chao Peng, Dustin Covell, Coraima Medellin, Anna Stieber, John L. Robinson, Bin Zhang, Rose M. Pitkin, Modupe F. Olufemi, Kelvin C. Luk, John Q. Trojanowski, Virginia M.Y. Lee

Phase 1

Introduction: In Lewy body diseases-including Parkinson's disease, without or with dementia, dementia with Lewy bodies, and Alzheimer's disease with Lewy body co-pathology -α-synuclein (α-Syn) aggregates in neurons as Lewy bodies and Lewy neurites. By contrast, in multiple system atrophy α-Syn accumulates mainly in oligodendrocytes as glial cytoplasmic inclusions (GCIs)

Objective: Our objective was to determine the conformational and biological profiles of a-Syn strains.

Methods: The following methods were used to collect and analyze data: Recombinant α-Syn purification and in vitro fibrillization. Preparation of sarkosyl-insoluble fractions from disease and control brains. Sandwich ELISA. Cell cultures. Stereotaxic injection of sarkosyl-insoluble fraction of …

The American Academy Of Ambulatory Care Nursing's Invitational Summit On Care Coordination And Transition Management: An Overview, Sheila Haas, Beth Ann Swan

College of Nursing Faculty Papers & Presentations

The American Academy of Ambulatory Care Nursing convened an Invitational Summit of national leaders to assist with strategic planning for promulgation of the care coordination and transition management (CCTM™) model. The conference was devoted to CCTM and the roles of registered nurses (RNs) across the care continuum to ensure safety and quality health care. The specific emphasis was on embedding the CCTM RN in healthcare policy and payment reform, as well as integration into academic and ongoing education across all care settings and specialties.

Just Another Chalazion?, Jonathan Mclaughlin, Sara E. Lally, Carol L. Shields

Wills Eye Hospital Papers

No abstract provided.

Effect Of Tort Reform On Diagnostic Imaging Rates, Israel Ojalva, Ba, Arthur Hong, Md, Mph

Phase 1

Introduction: Defensive medicine, is defined as “order[ing] tests, procedures, or visits, or avoid certain high-risk patients or procedures, primarily (but not solely) because of concern about malpractice liability.” Nearly all physician who fear malpractice litigation have admitted to practicing some degree of defensive medicine. In response, many states have enacted policy reforms to lighten the threat of malpractice on physicians.

Objective: The most common defensive medicine behavior is ordering diagnostic imaging tests when it is potentially unwarranted. Many states have enacted non-economic damage caps from 2000-2010. We explored if these laws had an impact on the rates of diagnostic imaging …

Identifying The Causes Of Cancer Readmissions: A Patient Centered Approach, Katie Holland, Emily Wei, Allison Zibelli

Phase 1

While there are large efforts to decrease readmission rates in the United States, cancer patients represent a population that has been overlooked. Cancer patients are a vulnerable population who make up a large portion of hospital readmissions. Most of the current research on the causes of readmissions in cancer patients focuses on medical chart reviews and insurance claims. Many of these studies fail to incorporate patient input which could further the understanding of the complete burden associated with cancer readmissions. The goal of this study is to understand the personal reasons behind the decision of cancer patients to return to …

Enhancing Services For Homeless Populations: Impact Of A Virtual-Reality Training Tool On Health Professional Students’ Self-Efficacy In Working With Homeless Populations, Madeline Russell, Susan Toth-Cohen, Phd, Otr/L

Phase 1

INTRODUCTION

Despite the rising prevalence and unmet healthcare needs of homeless populations, most healthcare providers do not receive specific training on working with this population. The growth of simulation-based technology in the medical classroom offers new opportunities for such training. Virtual-reality tools have been shown to facilitate learning and minimize restraints such as time and travel. The Enhancing Service to Homeless Populations (ESHP) program was designed to provide health professions students at Thomas Jefferson University with training on how to interact with homeless populations using an interprofessional virtual-reality setting, with the ultimate goal of improving students’ self-efficacy.

METHODS

Participants (n=15) …

Are We Doing It For The Money? A Salary Survey Of The United States Surgical Program Directors, Alexander Hoey, Ba, Brian Hoey, Md, Stanislaw Stawicki, Md

Phase 1

Compensation packages and job responsibilities for United States surgical program directors (PD) vary considerably from one institution to the next. With limited compensation data available for PD’s, this survey reassesses and compares the salaries, benefits, duties, and contract arrangements of all allopathic U.S. surgical PDs. Questionnaires regarding these areas of interest were mailed out electronically to all of the PDs and data was compared between the individuals’ responses using Chi-Squared and Fischer Exact Tests. Fifty-five percent of the PDs responded, revealing significant variation in total compensation packages, size of the dedicated stipend for the role, and time spent on clinical …

A Multicomponent Quality Improvement Project To Improve Sleep In Hospitalized Patients: A Single Center Pilot Experience, Michelle Konkoly, Alan Kubey, Md

Phase 1

No abstract provided.

A Qualitative Evaluation Of The Interprofessional Student Hotspotting Learning Collaborative: Perceptions Of Student And Faculty Advisor Participants, Ashley Traczuk, Bsn, Rn, Angela Gerolamo, Phd, Rn, Elena Umland, Pharmd

Phase 1

Introduction: Student participation in interprofessional education has proven beneficial in regards to students’ understanding of professional roles, team situational awareness¹,and appreciating the need for collaboration². The interprofessional student hotspotting learning collaborative enables students to work in teams to help serve patients categorized as health-system “super-users”, defined as those who overuse inpatient and/or emergency hospital services, over a period of six months’ time. This model will allow students to have real patient encounters and to begin utilizing their own roles within interdisciplinary teams.

Objective: This study aims to evaluate the impact of the interprofessional student hotspotting learning …

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

Phase 1

Introduction/Background: Skin cancer screening could impact mortality and morbidity in US adults; however, the effectiveness of widespread screening remains unclear. Further research is necessary to determine what age groups, with what risk factors, might benefit from routine total body skin exams (TBSE) in the US.

Objective: This study sought to determine, on average, the number of patients, per decade, needed to screen via TBSE to identify one person with skin cancer.

Methods: A retrospective review of Jefferson Dermatology outpatient data in Epic was conducted. All patient charts from 1/1/2017 - 1/1/2018 were reviewed if they received a TBSE. The type …

Outcomes Reporting In Regional Anesthesia Patients: A Comparison Of Manual Phone Calls Versus Automated Phone App Messaging, Gavyn Ooi, Mba, Eric Schwenk, Md, Fasa, Jeffrey Mojica, Do, Alexander Grant, Md, Max Shilling, Md, David Barnabei, Md, Jennifer Lessin, Ba, Rn, Ccrc, Marc Torjman, Phd, Kent Berg, Md, Mba

Phase 1

Automation of patient follow-up via mobile phone apps have the potential to save time for physicians, standardize responses from patients, and increase the patient response rate. Studies that assess the effectiveness of mobile phone-based surveys have been favorable, with completion rates of about 60% in the surgical population. The impact of mobile phone-based patient management in anesthesia deserves further study. This study examines the follow-up success rates of (1) manual phone calls (the current standard of care) vs. (2) automated patient outreach (APO) in patients who receive a regional anesthesia block procedure.

As part of normal follow up, anesthesia team …

Mindfulness-Based Stress Reduction Intervention For The Treatment Of Chronic Pain In The Elderly, Austin Roadarmel, Diane Reibel, Phd, Aleeze Moss, Phd, Andrew Newberg, Md

Phase 1

One of the most common complaints of adults in their 80s and above, a growing portion of our population, is chronic pain and it is often inadequately treated. A secular mindfulness-based stress reduction (MBSR) program was developed by Jon Kabat-Zinn in 1979 and has since shown measurable benefits to individuals in decreasing depression, pain, and anxiety. Considering the significant risk of side effects and age-associated changes of pharmacodynamics and pharmacokinetics in the traditional pharmacologic approach to chronic pain in the elderly, non-pharmacologic intervention such as MBSR may be particularly effective for the elderly population.

Methods: We conducted a 6 week, …

Comparison Of Visual Analog Pain Score Reported To Physician Vs Nurse In Nonoperatively Treated Foot And Ankle Patients, Trevor Mcbride, Bs, Maj Kevin D. Martin, Do, Cpt Jeffrey Wake, Do, Atc, Lt J. Preston Van Buren, Do, Cuyler Dewar, Bs

Phase 1

Background: Patient reported outcome measures (PROMs) are taking a more prominent role in Orthopedics as health care seeks to define treatment outcomes. The Visual Analogue Scale (VAS) is considered a reliable measure of acute pain. A previous study found that operative candidates’ VAS pain score was significantly higher when reported to the surgeon compared to the nurse. This study’s aim is to examine whether this phenomenon occurs in nonoperative patients. We hypothesize that patients’ VAS scores reported to the surgeon and a nurse will be the same

Methods: This study is a retrospective cohort of 201 consecutive nonoperative patients treated …

Impact Of Patient Safety Bundle For Management Of Morbidly Adherent Placenta On Estimated Blood Loss, Aislinn Crank, Johanna Quist-Nelson, Md, Arbor Quist, Msph

Phase 1

Introduction: Establishment of centers of excellence for care of patients with morbidly adherent placentas (MAP) has been described to improve patient outcomes. We compared maternal estimated blood loss (EBL) for patients with MAP delivered before and after the implementation of a protocol for management of MAP.

Objective: To assess the impact of a new protocol for management of MAP.

Methods: This is a retrospective cohort of patients at TJUH who had a MAP between 2007 and 2018. In 2015 our center developed a protocol as a patient safety bundle for the management of MAP. Pre-protocol and post-protocol groups were compared. …

Sickle Cell Disease And Variation In The Par4 Receptor, Matthew Lankiewicz, Steven E. Mckenzie, Leonard Edelstein, Stephanie Renna

Phase 1

Sickle cell disease disproportionately affects African Americans in the U.S. Much can still be learned regarding determinants of frequency and severity of painful vaso-occlusive episodes in these patients. It has been reported that a variant in PAR4 (protease-activated receptor 4) has a unique distribution among African Americans. One variant (Thr120) is hyperactive, while the other (Ala120) is hypoactive. This receptor is present on platelets, vascular cells, and nociceptors. We wish ultimately to test the hypothesis that sickle cell patients with the hyperactive PAR4 receptor have greater pain severity. A genotype-phenotype correlation would have prognostic value. An adequately powered study to …

Treatment Outcomes In Gram Negative Periprosthetic Joint Infection, Irene Kalbian, Ba, Karan Goswami, Md, Carol Foltz, Phd, Nathan John, Bs, William Arnold, Md, Javad Parvizi, Md, Fcrs

Phase 1

Introduction: Outcomes associated with periprosthetic joint infection (PJI) involving Gram negative (GN) organisms are poorly understood. While prevailing beliefs indicate that GN PJI cases have poorer prognoses than Gram positive (GP) cases, the current literature is sparse and inconsistent.

Objective: The purpose of this study is to systematically compare the treatment outcomes for GN PJI versus GP PJI.

Methods: A retrospective review of 1189 PJI cases between 2007 and 2017 was performed using an institutional PJI database. Treatment failure defined by the Delphi criteria was compared between cases with only GN organisms (n=45) and only …

Investigating Gαs Pepducin’S Effect On Β2ar Signaling For Chf Pharmacology, Nida Bajwa, Nathan Hopfinger, Charles Scott

Phase 1

Introduction: Congestive heart failure affects nearly six million Americans and significantly impairs their quality of life. New and better interventions are needed to improve HF patients’ survival and outcomes. Pharmacologics that bias β2AR signaling towards arrestin, which promotes cardiomyocyte survival and contractility, may offer advantages over traditional β-blockers.

Objective: It has been demonstrated that peptides mimicking the C-terminus of the Gα_s subunit block downstream signaling of GPCRs. The study’s objective is to determine if a pepducin derived from the C-terminus of the Gα_s subunit of the β2AR could block G_s signaling but maintain arrestin-recruitment, thereby producing a …