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Health Care Reform: Current Updates And Future Initiatives For Ambulatory Care Nursing, Beth Ann Swan, Phd, Crnp, Faan, Sheila A. Haas, Phd, Np, Faan

College of Nursing Faculty Papers & Presentations

Executive Summary:

• While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing.
• Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives.
• RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes' and accountable care organizations'quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach.
• RNs are …

Saddle Pulmonary Embolism: Is It As Bad As It Looks? A Community Hospital Experience., Alejandro Sardi, Jill Gluskin, Adam Guttentag, Morris N Kotler, Leonard E Braitman, Michael Lippmann

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

BACKGROUND: Saddle pulmonary embolism represents a large clot and a risk for sudden hemodynamic collapse. However, the clinical presentation and outcomes vary widely. On the basis of the findings of right heart dysfunction on echocardiograms, computed tomography angiography, or cardiac enzyme elevation, some argue for the use of thrombolytics or catheter thrombectomy even for hemodynamically stable patients.

OBJECTIVE: To investigate the outcomes and management of patients with saddle pulmonary embolism, including radiographic appearance (estimate of clot burden) and echocardiographic features.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: This study is a retrospective evaluation of all patients with computed tomography angiography positive …

Participatory Research At Pathways To Housing-Pa: A Consumer Perspective, Patways To Housing Consumer Health Research Team And Department Of Family And Community Medicine

Department of Family & Community Medicine Presentations and Grand Rounds

Research Question: How does housing affect healthcare decision making?

Methods: 11 Clients took part in a 9-week project focused on health. Using qualitative methodology, weekly meetings were recorded, transcribed, then analyzed resulting in the development of thematic findings.

Baseline Monitoring Of Standard Health Indicators In A Formerly Homeless Population, Lara Carson Weinstein, Md, Mph, Marianna Lanoue, Phd, Elizabeth Collins, Bs

Department of Family & Community Medicine Presentations and Grand Rounds

Research Question: What are the rates of baseline health status indicators recording at Pathways to Housing (PTH) using select recommended measures from the National Association of State Mental Health Program Directors (NASMHPD) and the Healthcare Effectiveness Data Information Set (HEDIS)?

How do health indicators compare between clients receiving direct clinical care in the integrated care program vs non-integrated care clients?

Cervical Cancer Screening Outcomes In A Refugee Population, Sarah Pickle, Md, Marc Altshuler, Md, Kevin Scott, Md, Christina Hillson, Md, R. Patrick Mcmanus, Md, Mazvita Nyamukapa, Michael Walker

Department of Family & Community Medicine Presentations and Grand Rounds

The purpose of our study was to determine the prevalence of abnormal Pap smears and high-risk HPV genotypes within our refugee population.

The Prevalence And Risk Factors Of Acute Myocardial Infarction (Ami) After Acute Ischemic Stroke (Ais) In The United States, Ali Seifi, Md, Fred Rincon, Md, Msc, Michael Moussouttas, Md, Mitchell Maltenfort, Phd, Matthew Vibbert, Md, Rodney Bell, Md, Maria Carissa Pineda, Md, Diana Tzeng, Md, Jacqueline Urtecho, Md, Anish Koka, Md, William Mcbride, Md

Department of Neurology Faculty Papers

Objectives: To determine the prevalence and risk factors for, and the association with in-hospital mortality of, AMI after AIS, and to study the effect of intravenous recombinant tissue plasminogen activator (r-tPA) in this setting. We hypothesized that AMI would be associated with lower survival rate at hospital discharge but that intravenous r-tPA would be associated with lower risk of AMI.

Expression Of Cancer Stem Cell Biomarkers In Male Breast Cancer, Ping Gong, Md, Juan P. Palazzo, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Male breast cancer is an uncommon disease, representing <1% of all breast cancer diagnoses. The prognostic factors and expression of molecular markers in male breast carcinomas are similar to female cancer. Cancer stem cell (CSC)s have been associated with tumor aggressiveness and drug resistance. CSCs are characterized by CD44 and/or ALDH1 expression. We investigated their expression in male breast cancer.

About The Authors

Jefferson Journal of Psychiatry

List of authors for Jefferson Journal of Psychiatry, Volume 8, Number 1, 1990.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor for Jefferson Journal of Psychiatry, Volume 8, Number 1, 1990.

Book Review: Biologic Psychiatry For The Biologist, John P. Seibyl, M.D.

Jefferson Journal of Psychiatry

PSYCHOPHARMACOLOGY: THE THIRD GENERATION OF PROGRESS

Edited by Herbert Y. Meltzer, M.D .New York, Raven Press, 1987

1824 pages, $160.00

Book Review: Illness Or Person?, Beth Z. Mark, M.D.

Jefferson Journal of Psychiatry

Book Review of:

PSYCHOTHERAPY OF NEUROTIC CHARACTER

Dana Shapiro

New York, Basic Books, 1989

In Response: A Practical Approach To The Assessment And Management Of Psychiatric Emergencies, William R. Dubin, M.D.

Jefferson Journal of Psychiatry

I would like to respond to the article entitled "A Practical Approach to the Assessment and Management of Psychiatric Emergencies" (Jefferson Journal of Psychiatry, Vol. 7:8 I-9 1, 1989). The authors are to be congratulated for their concise distillation of the major clinical problems encountered in emergency psychiatry. However, there are several aspects of this review which require further amplification and clarification.

Psychiatrists' Knowledge And Attitudes About The Acquired Immune Deficiency Syndrome, Carol L. Alter, M.D., Ellen S. Dickinson, M.D., Greg Miller, M.D.

Jefferson Journal of Psychiatry

Since 1981 the Acquired Immune Deficiency Syndrome (AIDS) has become the primary health care issue in this nation. Psychiatrists have had a central role in caring for AIDS patients: they have been asked to evaluate and treat patients with neuropsychiatric manifestations of AIDS and emotional reactions to the illness itself, as well as to treat those who are fearful of acquiring AIDS. Numerous studies in the literature have explored the physician and lay population's knowledge and attitudes about AIDS. To date no study has addressed these issues in psychiatrists in specific (1- 9).

Most studies suggest that individuals who have …

The Homicide Witness And Victimization; Ptsd In Civilian Populations: A Literature Review, Gerald M. Streets, M.D.

Jefferson Journal of Psychiatry

People who witness the murder of an individual, whether a family member or acquaintance, often experience their loss as a psychic trauma. This described trauma is revealed by the symptom complex defined in the DSM-III-R as post -traumatic stress disorder (PTSD). Children, in particular, frequently suffer from debilitating grief, which hinders their emotional and cognitive development. This grief may masquerade as a learning disability, hyperactivity, or an attention deficit disorder. Witnessing murder and being victimized (i.e, rape, incest, and physical abuse) are equivalent experiences in their potential for generating massive intrapsychic conflict. Being poor is a predisposing factor which puts …

Exploring Frontal Lobe Dysfunction In Schizophrenia With Positron Emission Tomography, Donald P. Hall, Jr., M.D.

Jefferson Journal of Psychiatry

Frontal lobe dysfunction in schizophrenic pa tients has been highly suspected for many years. Many psychiatrists and patients, however, are awaiting solid proof of a biological manifestation of this disease. While positron emission tomography does not uniformly demonstrate such a manifestation, it does demonstrate a prefrontal cortex deficit in most reported studies. Further, a localization of the attention deficit of schizophrenia, in the prefrontal cortex, is strongly suggested by some studies.

INTRODUCTION

Positron emission tomography (PET) has enabled investigators in modern clinical psychiatry to demonstrate that schizophrenia is, at least in part, a frontal lobe disorder. PET studies of many …

A Case Of Conversion Catatonia Misdiagnosed For 24 Years, Pauline K. Wiener, M.D.

Jefferson Journal of Psychiatry

Catatonia is a syndrome whose etiology may be both diverse and difficult to substantiate. Ms. H. is a 45-year-old black female with 18 previous psychiatric hospitalizations beginning at age 21. A common characteristic to all hospitalizations was a catatonic presentation (i.e ., the patient was mute with marked muscular rigidity; she would refuse to eat or follow orders). In each of her previous 18 hospitalizations, the patient was thought to be psychotic.

It was found that each catatonic episode could be related to a severe psychological stressor. The patient's illness never involved delusions, hallucinations or disturbances in thought form. Upon …

Enhancing The Utility Of The Dexamethasone Suppression Test: A Chart Review And Application Of Bayes' Theorem, Scott B. Patten, M.D.

Jefferson Journal of Psychiatry

The dexamethasone suppression test (DST) is the most extensively studied biological test in psychiatry. Despite this, its role in the diagnostic assessment of psychiatric patients remains controversial. Shortcomings of the test include limited sensitivity (45%) and limited specificity (75-80%) (1). The DST has many proposed uses, including the differentiation of endogenous from non-endogenous depressions, helping to decide when maintenance medications may be withdrawn, and as a diagnostic test for major depression. This paper is concerned with the latter use only, that is, the ability of the DST to function as a useful diagnostic test for major depression.

The significance of …

Reliability Of Trainees' Endorsements On Standardized Psychiatric Interviews, Thomas E. Uttley, M.D.

Jefferson Journal of Psychiatry

This study investigated the utilization of standardized psychiatric interviews (SPI's) in psychiatric training programs. As the field of psychiatry, and the training of its' new members moves to conformits' principles to scientific models, the reliable use of SPI's is use ful in reaching that goal, in both research and diagnostic applications. This investigation contains two studies. In Study 1, a random survey of 20 percent of all psychiatric residency training programs was conducted to determine the prevailing level of training devoted to SPI's. The resulting findings are referred to as "training as usual" (TAU). Study 1 shows that residents are …

Imipramine In The Treatment Of Obsessive-Compulsive Symptoms In Schizophrenic Spectrum Illnesses: Three Case Reports, Ileana Zaharovits, M.D., Marvin H. Lipkowitz, M.D.

Jefferson Journal of Psychiatry

It has long been known that obsessions and compulsions occur during the course of a schizophrenic illness (1- 7). It is, therefore, of interest that there has been little systematic research into the treatment of these symptoms in patients suffering from schizophrenia.

It is possible that the meager research in this area is related both to the difficulty at times in differentiating signs of a psychotic decompensation in severe obsessive-compulsive disorder (OeD) from those of schizophrenia; and to the significant amount of controversy regarding the function of obsessive compulsive symptoms in patients suffering from schizophrenia and related diseases. For example, …

Postpartum Depression In A Caretaking Grandmother: Case Report, Valerie D. Raskin, M.D.

Jefferson Journal of Psychiatry

Postpartum depression has only recently been understood to affect individuals other than the biological mother (1). In such cases, postpartum depression has been attributed to the enormous psychological and social stress of the caretaking role, with its demands to nurture in the face of what may be the sense of having been insufficiently nurtured oneself (2). A growing number of grandparents, especially maternal grandmothers, are being asked to serve as primary caretakers for their grandchildren, due to circumstances which include adolescent childbearing, single parent families and substance abuse. A case report of a new grandmother with significant caretaking functions who …

Treating Dual Diagnosis Patients: Challenges And Opportunities, Robert H. Howland, M.D.

Jefferson Journal of Psychiatry

The use and abuse of drugs and alcohol have recently gained greater attention both from the public and the medical profession. Despite increasing cognizance of its unfortunate consequences, substance use has become a more pervasive element of contemporary society. As substance abuse has come to affect more segments of the population, it is not surprising that this problem also has affected the mentally ill. Awareness of the mentally ill substance abuser has grown, although this population has not been well studied or well served by the mental health system. These dually diagnosed patients often are depicted as the square pegs …

Special Article: One Resident's Perspective On A Different Style Of Psychopharmacological Practice, Michael Amiel, M.D., Docteur J.P. Blayac

Jefferson Journal of Psychiatry

This article provides a comparison of psychopharmacological practices in the U.S. and France. The prescription as well as proscription of various classes of psychotropic drugs are considered. Even though the general guidelines of psychopharmacological practice remain the same, the details vary considerably and are determined especially by commercial factors.

INTRODUCTION

Though a comparison of current clinical psychopharmacological practices in France and the U.S. is an unaddressed topic, these contrasts may be quite striking to an American-trained psychiatrist. The following observations are based on my two month inpatient experience as a fourth-year psychiatric resident at a public psychiatric institution located in …

Mead Johnson Award

Jefferson Journal of Psychiatry

The Mead Johnson Award has been established to honor the best paper submitted to The Jefferson Journal of Psychiatry: A Resident Publication during each calendar year. An award of one thousand dollars is given to the chosen author, with an additional one thousand dollars to be given to the residency program or fellowship in which the author is enrolled. The winning submission will be selected by the Journal's editorial board from manuscripts submitted on any subject related to psychiatric practice and/or research. We invite authors to review the Information for Contributors section of this issue. The board will announce …

Editor's Column, Elizabeth Trefzger, Md

Jefferson Journal of Psychiatry

In selecting articles for, and preparing this latest issue of the Jefferson Journal, I am impressed by the ongoing trend towards refinement that is present in the submissions which we receive. This has been both encouraging and exciting for everyone concerned with the production of the Journal. Much as any other piece of scientific literature, the value of criticism in the production of the work cannot be forgotten . While reflecting on the need for refined and worthwhile criticism I have been reminded of the value of criticism in education. It is through criticism, our own self evaluation, and that …

Resident Editorial Board

Jefferson Journal of Psychiatry

List of Resident Editorial Board for Jefferson Journal of Psychiatry, Volume 8, Number 1, 1990.

Trick Or Truth? Accessing Accurate Health Information On The Web, Gary Kaplan, Mslis, Ingrid Hilghman, Msn, Rn

Academic Commons and Scott Memorial Library Staff Papers and Presentations

Learning objectives:

* Identify 2 locations to access the internet

* Identify website resources that can be searched to locate reliable health information

* Describe 2 items that can be found on a website to analyze content

* Describe the purpose of a Personal Health Record

A 2-Step Approach To Myeloablative Haploidentical Stem Cell Transplantation: A Phase 1/2 Trial Performed With Optimized T-Cell Dosing., Dolores Gross, Matthew Carabasi, Joanne Filicko-O'Hara, Margaret Kasner, John L Wagner, Beth Colombe, Patricia Cornett Farley, William O'Hara, Phyllis Flomenberg, Maria Werner-Wasik, Janet Brunner, Bijoyesh Mookerjee, Terry Hyslop, Mark Weiss, Neal Flomenberg

Department of Medical Oncology Faculty Papers

Studies of haploidentical hematopoietic stem cell transplantation (HSCT) have identified threshold doses of T cells below which severe GVHD is usually absent. However, little is known regarding optimal T-cell dosing as it relates to engraftment, immune reconstitution, and relapse. To begin to address this question, we developed a 2-step myeloablative approach to haploidentical HSCT in which 27 patients conditioned with total body irradiation (TBI) were given a fixed dose of donor T cells (HSCT step 1), followed by cyclophosphamide (CY) for T-cell tolerization. A CD34-selected HSC product (HSCT step 2) was infused after CY. A dose of 2 × 10(8)/kg …

About The Authors

Jefferson Journal of Psychiatry

About the authors in the Jefferson Journal of Psychiatry, Volume 7, Number 2, 1989.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor to Jefferson Journal of Psychiatry, Volume 7, Number 2, 1989.

Book Review: Humanizing Freud, Edward Kim, M.D.

Jefferson Journal of Psychiatry

FREUD: A LIFE FOR OUR TIME

Peter Gay, Ph.D.

W.W. Norton & Company

New York, 1988 651 pages

$25.00