Digital Commons Network^™

Use Of Theory To Plan Or Evaluate Guideline Implementation Among Physicians: A Scoping Review., Laurel Liang, Susanne Bernhardsson, Robin W.M. Vernooij, Melissa J. Armstrong, André Bussières, Melissa C. Brouwers, Anna R. Gagliardi, Samia Alhabib, Margot A.H. Fleuren, Margie Fortino, Daniele Mazza, Niamh O'Rourke, Melina L. Willson

Jefferson Hospital Staff Papers and Presentations

BACKGROUND: Guidelines support health care decision-making and high quality care and outcomes. However, their implementation is sub-optimal. Theory-informed, tailored implementation is associated with guideline use. Few guideline implementation studies published up to 1998 employed theory. This study aimed to describe if and how theory is now used to plan or evaluate guideline implementation among physicians.

METHODS: A scoping review was conducted. MEDLINE, EMBASE, and The Cochrane Library were searched from 2006 to April 2016. English language studies that planned or evaluated guideline implementation targeted to physicians based on explicitly named theory were eligible. Screening and data extraction were done in …

Mechanisms Of Modulation Of Brain Microvascular Endothelial Cells Function By Thrombin., Eugen Brailoiu, Megan M. Shipsky, Guang Yan, Mary E. Abood, G. Cristina Brailoiu

College of Pharmacy Faculty Papers

Brain microvascular endothelial cells are a critical component of the blood-brain barrier. They form a tight monolayer which is essential for maintaining the brain homeostasis. Blood-derived proteases such as thrombin may enter the brain during pathological conditions like trauma, stroke, and inflammation and further disrupts the permeability of the blood-brain barrier, via incompletely characterized mechanisms. We examined the underlying mechanisms evoked by thrombin in rat brain microvascular endothelial cells (RBMVEC). Our results indicate that thrombin, acting on protease-activated receptor 1 (PAR1) increases cytosolic Ca

Map7 Regulates Axon Collateral Branch Development In Dorsal Root Ganglion Neurons., Stephen R Tymanskyj, Benjamin Yang, Aditi Falnikar, Angelo C Lepore, Le Ma

Department of Neuroscience Faculty Papers

Collateral branches from axons are key components of functional neural circuits that allow neurons to connect with multiple synaptic targets. Like axon growth and guidance, formation of collateral branches depends on the regulation of microtubules, but how such regulation is coordinated to ensure proper circuit development is not known. Based on microarray analysis, we have identified a role for microtubule-associated protein 7 (MAP7) during collateral branch development of dorsal root ganglion (DRG) sensory neurons. We show that MAP7 is expressed at the onset of collateral branch formation. Perturbation of its expression by overexpression or shRNA knockdown alters axon branching in …

Strategic Leadership Newsletter: Volume 3, Number 1, Larry M. Starr Phd

Leadership Doctorates Newsletter (Formerly Strategic Leadership Newsletter)

Strategic Leadership Newsletter reports information relevant to the Philadelphia University Doctor of Management in Strategic Leadership program including personal and professional events and accomplishments, new practices, research and opportunities, and suggestions. You are encouraged to forward the Newsletter to friends and colleagues to expand awareness and to brand yourself as a community member. You are also invited to recommend people or organizations to be added to the mailing list. Contact Strategic Leadership Newsletter by emailing the Editor [email protected]

Telemedicine Coverage For Post-Operative Icu Patients., Tara Ann Collins, Matthew P. Robertson, Corinna P. Sicoutris, Michael A. Pisa, Daniel N. Holena, Patrick M. Reilly, Benjamin A. Kohl

Department of Anesthesiology Faculty Papers

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical …

Associations Of Emergency Department Length Of Stay With Publicly Reported Quality-Of-Care Measures., Anna Marie Chang, Amber Lin, Rongwei Fu, K. John Mcconnell, Benjamin Sun

Department of Emergency Medicine Faculty Papers

OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals.

METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of …

A Word From The Writing Center (February 2017), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

This issue includes:

• Writing tip
• Publishing news
• Writing Café

Department Integration Of A Community Hospital With A Large Urban Teaching Hospital: A Case Report, Jessica Shank, Pt

Jefferson Hospital Staff Papers and Presentations

Purpose/Background

Healthcare is rapidly changing and community hospitals are no longer able to keep up. Accountable Care Organizations (ACOs) are absorbing many of these hospitals. Rehab departments within these facilities are afforded the opportunity to impact the financial bottom line by removing inefficiencies and promoting higher quality patient care. The purpose of this quality improvement initiative was to develop a process to integrate departments focusing on efficiency, patient care, and employee engagement.

Endothelium In The Pharyngeal Arches 3, 4 And 6 Is Derived From The Second Heart Field., Xia Wang, Dongying Chen, Kelley Chen, Ali Jubran, Annjosette Ramirez, Sophie Astrof

Center for Translational Medicine Faculty Papers

Oxygenated blood from the heart is directed into the systemic circulation through the aortic arch arteries (AAAs). The AAAs arise by remodeling of three symmetrical pairs of pharyngeal arch arteries (PAAs), which connect the heart with the paired dorsal aortae at mid-gestation. Aberrant PAA formation results in defects frequently observed in patients with lethal congenital heart disease. How the PAAs form in mammals is not understood. The work presented in this manuscript shows that the second heart field (SHF) is the major source of progenitors giving rise to the endothelium of the pharyngeal arches 3 - 6, while the endothelium …

Small Rna Zippers Lock Mirna Molecules And Block Mirna Function In Mammalian Cells., Lingyu Meng, Cuicui Liu, Jinhui Lü, Qian Zhao, Shengqiong Deng, Guangxue Wang, Jing Qiao, Chuyi Zhang, Lixiao Zhen, Ying Lu, Wenshu Li, Yuzhen Zhang, Richard G. Pestell, Huiming Fan, Yi-Han Chen, Zhongmin Liu, Zuoren Yu

Department of Cancer Biology Faculty Papers

MicroRNAs (miRNAs) loss-of-function phenotypes are mainly induced by chemically modified antisense oligonucleotides. Here we develop an alternative inhibitor for miRNAs, termed 'small RNA zipper'. It is designed to connect miRNA molecules end to end, forming a DNA-RNA duplex through a complementary interaction with high affinity, high specificity and high stability. Two miRNAs, miR-221 and miR-17, are tested in human breast cancer cell lines, demonstrating the 70∼90% knockdown of miRNA levels by 30-50 nM small RNA zippers. The miR-221 zipper shows capability in rescuing the expression of target genes of miR-221 and reversing the oncogenic function of miR-221 in breast cancer …

2017 Clinic Yearbook, Danielle Levine, Ryan Mcclintock, Katherine Pleet, Mai Tsukikawa

Sidney Kimmel Medical College Yearbooks

The Clinic is the yearbook of the Sidney Kimmel Medical College at Thomas Jefferson University.

Harnessing The Power Of Cell Transplantation To Target Respiratory Dysfunction Following Spinal Cord Injury., Brittany A. Charsar, Mark W. Urban, Angelo C. Lepore

Department of Neuroscience Faculty Papers

The therapeutic benefit of cell transplantation has been assessed in a host of central nervous system (CNS) diseases, including disorders of the spinal cord such as traumatic spinal cord injury (SCI). The promise of cell transplantation to preserve and/or restore normal function can be aimed at a variety of therapeutic mechanisms, including replacement of lost or damaged CNS cell types, promotion of axonal regeneration or sprouting, neuroprotection, immune response modulation, and delivery of gene products such as neurotrophic factors, amongst other possibilities. Despite significant work in the field of transplantation in models of SCI, limited attention has been directed at …

Program In Faculty Development 2017-2018

Program in Faculty Development

Welcome to a new academic year and to opportunities to improve your skills as an educator, scholar and leader at Thomas Jefferson University! This booklet will provide you with information on the TJU Faculty Development Program for the 2017-2018 academic year, including course listings, registration information, and general program information. This booklet features two “At-A-Glance” outlines of faculty development offerings: a course outline for each of the three faculty development program focus areas (education, research/scholarship, and professional development and leadership) and a month-by-month calendar of activities. Detailed program information for each focus area follows. Faculty development programs scheduled for the …

Pathogenic Determinants And Mechanisms Of Als/Ftd Linked To Hexanucleotide Repeat Expansions In The C9orf72 Gene., Xinmei Wen, Thomas Westergard, Piera Pasinelli, Davide Trotti

Department of Neuroscience Faculty Papers

Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are two apparently distinct neurodegenerative diseases, the former characterized by selective loss of motor neurons in the brain and spinal cord and the latter characterized by selective atrophy of frontal and temporal lobes. Over the years, however, growing evidence from clinical, pathological and genetic findings has suggested that ALS and FTD belong to the same clinic-pathological spectrum disorder. This concept has been further supported by the identification of the most common genetic cause for both diseases, an aberrantly expanded hexanucleotide repeat GGGGCC/ CCCCGG sequence located in a non-coding region of the gene …

New Horizons In Spine Research: Intervertebral Disc Repair And Regeneration., James C Iatridis, James Kang, Rita Kandel, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Design And Challenges Of A Randomized Clinical Trial Of Medical Expulsive Therapy (Tamsulosin) For Urolithiasis In The Emergency Department., Pamela K. Burrows, Judd E. Hollander, Allan B. Wolfson, Michael C. Kurz, Lorna Richards, Sara Difiore, Phillip Watts, Nivedita Patkar, Jeremy Brown, Stephen Jackman, Ziya Kirkali, John W. Kusek, Chloe Michel, Andrew C. Meltzer

Department of Emergency Medicine Faculty Papers

Urolithiasis or urinary stone disease has been estimated to affect about 1 in 11 Americans. Patients with urinary stone disease commonly present to the emergency department for management of their acute pain. In addition to providing analgesia, administration of drug (medical expulsive therapy) is often prescribed to assist passage of the urinary stone. In this methodology paper, we describe the design of a prospective, multi-center, randomized, double-blind placebo controlled clinical trial of the alpha-adrenergic blocker, tamsulosin, to evaluate its effectiveness as medical expulsive therapy. In addition, we describe the unique challenges of conducting a trial of this type within the …

Targeting The Nrf2-Heme Oxygenase-1 Axis After Intracerebral Hemorrhage., Jing Chen-Roetling, Raymond F. Regan

Department of Emergency Medicine Faculty Papers

BACKGROUND: Injury to cells adjacent to an intracerebral hemorrhage (ICH) is likely mediated at least in part by toxins released from the hematoma that initiate complex and interacting injury cascades. Pharmacotherapies targeting a single toxin or pathway, even if consistently effective in controlled experimental models, have a high likelihood of failure in a variable clinical setting. Nuclear factor erythroid-2 related factor 2 (Nrf2) regulates the expression of heme oxygenase-1 (HO-1) and multiple other proteins with antioxidant and antiinflammatory effects, and may be a target of interest after ICH.

METHODS: Studies that tested the effect of HO and Nrf2 in models …

Factors Associated With Post-Arrest Withdrawal Of Life-Sustaining Therapy., Anne V. Grossestreuer, David F. Gaieski, Benjamin S. Abella, Douglas J. Wiebe, Ari Moskowitz, Daniel J. Ikeda, Jason S. Haukoos, Sarah M. Perman

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Most successfully resuscitated cardiac arrest patients do not survive to hospital discharge. Many have withdrawal of life sustaining therapy (WLST) as a result of the perception of poor neurologic prognosis. The characteristics of these patients and differences in their post-arrest care are largely unknown.

METHODS: Utilizing the Penn Alliance for Therapeutic Hypothermia Registry, we identified a cohort of 1311 post-arrest patients from 26 hospitals from 2010 to 2014 who remained comatose after return of spontaneous circulation. We stratified patients by whether they had WLST post-arrest and analyzed demographic, arrest, and post-arrest variables.

RESULTS: In our cohort, 565 (43%) patients …

Adiponectin Partially Rescues High Glucose/High Fat-Induced Impairment Of Mitochondrial Biogenesis And Function In A Pgc-1Α Dependent Manner., H. Wang, W.-J. Yan, J.-L. Zhang, F.-Y. Zhang, C. Gao, Y.-J. Wang, W.B. Lau, L. Tao

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Plasma adiponectin (APN) levels are decreased in diabetic patients. Dysfunctional mitochondrial biogenesis is involved in type 2 diabetes (T2DM) pathogenesis, by unclear mechanisms. The present study determined (1) whether myocardial mitochondrial biogenesis was impaired in cardiomyocytes exposed to a high glucose/high fat (HGHF) medium (a T2DM in vitro model), (2) the effects of APN administration upon mitochondrial biogenesis in cardiomyocytes affected by HGHF incubation, and 3) the involved underlying mechanisms.

MATERIALS AND METHODS: Neonatal rat ventricular myocytes (NRVMs) were isolated and incubated in HGHF medium. Mitochondrial function was assessed by ATP content, and fluorescent microscopic analysis of myocardial apoptosis …

Proteoglycan Neofunctions: Regulation Of Inflammation And Autophagy In Cancer Biology., Liliana Schaefer, Claudia Tredup, Maria A. Gubbiotti, Renato V. Iozzo

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Inflammation and autophagy have emerged as prominent issues in the context of proteoglycan signaling. In particular, two small, leucine-rich proteoglycans, biglycan and decorin, play pivotal roles in the regulation of these vital cellular pathways and, as such, are intrinsically involved in cancer initiation and progression. In this minireview, we will address novel functions of biglycan and decorin in inflammation and autophagy, and analyze new emerging signaling events triggered by these proteoglycans, which directly or indirectly modulate these processes. We will critically discuss the dual role of proteoglycan-driven inflammation and autophagy in tumor biology, and delineate the potential mechanisms through which …

Promoting Environments That Measure Outcomes: Partnerships For Change, Roseann C. Schaaf, Amy P. Carroll, Susan Toth-Cohen, Janice P. Burke, Caryn Johnson, E. Adel Herge

Department of Occupational Therapy Faculty Papers

This paper describes the development of the PrEMO^© (Promoting Environments that Measure Outcomes) program. PrEMO^© is an innovative model promoting evidence-based practice (EBP) while developing capacity and quality of Level II fieldwork placements. The PrEMO^© program is described from initiation to completion, including development of site-specific learning objectives, the twelve week schedule and the role of faculty mentorship. Occupational therapy (OT) students, and university OT program faculty including academic fieldwork coordinators, partner with fieldwork educators at the site to implement EBP using a data-driven decision making (DDDM) process to guide the development of evidence-based practices. PrEMO^{© …}

Text Messaging In The Patient-Centered Medical Home To Improve Glucose Control And Retinopathy Screening., Janice M Miller, Ann G. Phalen, Albert Crawford, Anthony Frisby, Barry S. Ziring

College of Nursing Faculty Papers & Presentations

Purpose: To evaluate the effectiveness of a text messaging program (TMP) to improve glucose control, retinopathy screening (RS) rates, and self-care behaviors in patients with uncontrolled type 2 diabetes.

Methods: A single-group design with a quasi-systematic random sample (n=20) received educational/exhortational text messages on their cellular phones for 3 months. Subjects, 12 of whom identified as a minority ethnicity, were mostly male, aged 27-73 years.

Results: Glucose control and RS rates improved significantly. Subjects (>70%) reported changes in self-care behaviors.

Conclusion: Leveraging ubiquitous technology, a TMP for patients with limited access to healthcare education, holds promise

A Word From The Writing Center (January 2017), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

This issue includes:

• Writing tip
• Selecting the right journal
• Writing Café

Effect Of Pulse Shaping On Subharmonic Aided Pressure Estimation In Vitro And In Vivo., Ipshita Gupta, John R. Eisenbrey, Maria Stanczak, Anush Sridharan, Jaydev K. Dave, Ji-Bin Liu, Christopher Hazard, Xinghua Wang, Ping Wang, Huiwen Li, Kirk Wallace, Flemming Forsberg

Department of Radiology Faculty Papers

OBJECTIVES: Subharmonic imaging (SHI) is a technique that uses the nonlinear oscillations of microbubbles when exposed to ultrasound at high pressures transmitting at the fundamental frequency ie, f

METHODS: Eight waveforms with different envelopes were optimized with respect to acoustic power at which the SHAPE study is most sensitive. The study was run with four input transmit cycles, first in vitro and then in vivo in three canines to select the waveform that achieved the best sensitivity for detecting changes in portal pressures using SHAPE. A Logiq 9 scanner with a 4C curvi-linear array was used to acquire 2.5 MHz …

Outcomes Of An Evidence-Based, Data Driven-Model Fieldwork Experience For Occupational Therapy Students, Amy P. Carroll, E. Adel Herge, Lindsay Johnson, Roseann C. Schaaf

Department of Occupational Therapy Faculty Papers

Over the past decade, there has been an increased emphasis on evidence-based practice (EBP) and the use of outcome measurement in clinical practice, however, the implementation of evidence into practice remains challenging and irregular. During fieldwork, students often experience a disconnect between the emphasis on EBP in the classroom and lack of use in the clinic. Recognizing the need to develop high-quality, evidence-based and data-driven models of practice for student training, we partnered with local fieldwork educators to develop an innovative program that guides students and simultaneously trains fieldwork educators (FWE) in the use of a systematic data driven decision …

Effects Of Evidence-Based Fall Reduction Programing On The Functional Wellness Of Older Adults In A Senior Living Community: A Clinical Case Study., Andrew Harnish, William Dieter, Albert G. Crawford, Tiffany E E. Shubert

College of Population Health Faculty Papers

BACKGROUND: Older adults at a high risk of falls may be referred to a physical therapist. A physical therapy episode of care is designed for the transition of an older adult from a high fall risk to a moderate to low fall risk. However, these episodes of care are limited in time and duration. There is compelling evidence for the efficacy of group-based exercise classes to address risk, and transitioning an older adult from physical therapy to a group-based program may be an effective way to manage risk through the continuum of care.

OBJECTIVES: The purpose of this study was …

Role Of A Plausible Nuisance Contributor In The Declining Obesity-Mortality Risks Over Time., Tapan Mehta, Nicholas M. Pajewski, Scott W. Keith, Kevin Fontaine, David B. Allison

Department of Pharmacology and Experimental Therapeutics Faculty Papers

CONTEXT: Recent analyses of epidemiological data including the National Health and Nutrition Examination Survey (NHANES) have suggested that the harmful effects of obesity may have decreased over calendar time. The shifting BMI distribution over time coupled with the application of fixed broad BMI categories in these analyses could be a plausible "nuisance contributor" to this observed change in the obesity-associated mortality over calendar time.

OBJECTIVE: To evaluate the extent to which observed temporal changes in the obesity-mortality association may be due to a shifting population distribution for body mass index (BMI), coupled with analyses based on static, broad BMI categories. …

Joseph Albin Witkowski, Md (1925–2015), A Dermatologist For All Seasons, Lawrence Charles Parish

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

Applying Multiple Data Collection Tools To Quantify Human Papillomavirus Vaccine Communication On Twitter., Philip M. Massey, Amy Leader, Elad Yom-Tov, Alexandra Budenz, Kara Fisher, Ann C. Klassen

Department of Medical Oncology Faculty Papers

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. There are several vaccines that protect against strains of HPV most associated with cervical and other cancers. Thus, HPV vaccination has become an important component of adolescent preventive health care. As media evolves, more information about HPV vaccination is shifting to social media platforms such as Twitter. Health information consumed on social media may be especially influential for segments of society such as younger populations, as well as ethnic and racial minorities.

OBJECTIVE: The objectives of our study were to quantify HPV vaccine communication on …

Ot Department News- Issue #1

Department of Occupational Therapy Newsletter

No abstract provided.