Digital Commons Network^™

Stimulant Medication Use In Children/Adolescent Athletes With Adhd Reduce The Recovery Time Of Concussions And Traumatic Brain Injury, Matthew Lee

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

• Concussions and TBIs are well-known injuries occurring 30-50 million times a year worldwide and are commonly seen in sports.¹ The majority of TBIs are mild yet still have the potential to cause lifelong detrimental effects.
• Short- and long-term complications include difficulty thinking, difficulty concentrating, changes in emotions and personality, decreased memory and sensation, and may lead to depression and dementia.²
• Especially in children and adolescents who are undergoing brain development.
• There are no known prophylactic medications, however, some studies have indicated that sympathomimetic drugs, MPH, may be neuroprotective in the setting of TBIs.
• The purpose of this …

Impact Of Mental Health Boarding In The Emergency Department And Recommendations On How We Can Improve, Kyra Buettner

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

Every year in the United States there is an estimated 2 million adolescents who experience suicidal ideation or attempt suicide.¹ The shortage of behavioral and mental health professionals has led to an increase in emergency department (ED) visits. “Boarding” is defined as “the practice of holding patients in the ED or another temporary location after the decision to admit or transfer has been made.²” The purpose of this study is to evaluate the following question - in adolescent patients with suicide attempt or mental health crisis, does boarding in the ED result in poorer mental health …

Role Of Suction-Based Airway Clearance Devices In Pediatric Foreign Body Airway Obstruction, Rebecca Braver

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

• Foreign body airway obstruction (FBAO) represents a significant cause of morbidity and mortality in the pediatric population. Factors including pediatric anatomy, chewing and swallowing difficulties, developmental stages, habits and behaviors, and children’s toys and foods increase risk of FBAO in children.^1,2
• BLS guidelines for FBAO management in responsive children ages 1-8 call for a series of subdiaphragmatic abdominal thrusts, which increase intrathoracic pressure to force air and the foreign body out of the airway.^3,4 Abdominal thrusts have higher reports of injury compared to all other FBAO interventions, with risk of thoracic, vascular, and gastro-esophageal injury.^5-7
• Novel …

Electric Field Navigated 1-Hz Rtms For Poststroke Motor Recovery: The E-Fit Randomized Controlled Trial, Dylan J. Edwards, Charle Y. Liu, Kari Dunning, Felipe Fregni, Jarmo Laine, Benjamin E. Leiby, Lynn M. Rogers, Richard L. Harvey

Moss-Magee Rehabilitation Papers

BACKGROUND: To determine if low-frequency repetitive transcranial magnetic stimulation targeting the primary motor cortex contralateral (M1_CL) to the affected corticospinal tract in patients with hemiparetic stroke augments intensive training–related clinical improvement; an extension of the NICHE trial (Navigated Inhibitory rTMS to Contralesional Hemisphere Trial) using an alternative sham coil.

METHODS: The present E-FIT trial (Electric Field Navigated 1Hz rTMS for Post-stroke Motor Recovery Trial) included 5 of 12 NICHE trial outpatient US rehabilitation centers. The stimulation protocol remained identical (1 Hz repetitive transcranial magnetic stimulation, M1_CL, preceding 60-minute therapy, 18 sessions/6 wks; parallel arm randomized clinical …

The Role Of Repetitive Transcranial Magnetic Stimulation (Rtms) V. Electroconvulsive Therapy (Ect) In Geriatric Depression Treatment: Efficacy & Tolerability, Madeleine Sarro

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

• Geriatric depression, or depression in a population over the age of 60, is a highly debilitating mental health condition with a prevalence of 25% versus 10% in the general population.^{1, 2} Increasing prevalence is expected in the next 30 years with a rise in the population size for adults over 60 from 12% to 22%.³
• Limiting variables in the treatment of geriatric depression include polypharmacy, intolerable adverse effects, medical comorbidities, drug resistance and atypical symptom presentation.^2-7
• Due to uniformity in underlying pathophysiology, current treatment guidelines for geriatric depression are the same as for the general population. …

The Impact Of Intralesional 5-Fluorouracil In The Treatment Of Keloid Scars, Madeline Derham

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

- The American Academy of Dermatology (AAD) defines a keloid scar as a type of raised scar extending past the initial area of injury¹

- Approximately 10% of the general population affected - significant risk factors include +family history, darker skin tones, mechanism of injury (burn, surgical)³

- Symptom presentation: pain, pruritus, burning, increased sensitivity³

- Varying existing treatment methods with high resistance and recurrence rates leading to no agreed upon standard approach⁵

• Most widely adopted method currently : intralesional (ILS) steroid ^injection5

Successful Return To Sport And Daily Activities After Suture Augmentation Of Both The Anterior Talofibular Ligament And Calcaneofibular Ligament, S Ali Ghasemi, Jetha Tallapaneni, Benjamin C Murray, Clark Yin, James Raphael, Zachary Vaupel, Allan Grant, Paul Fortin

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: To evaluate the return to sport and daily activities in addition to clinical outcomes after modification of the Brostöm repair, specifically using suture augmentation for concomitant fixation of both the anterior talofibular ligament and calcaneofibular ligament.

METHODS: Patients who had grade III ankle sprains and lateral ankle instability, all of whom failed supervised conservative management, were included. Patients underwent a modified Broström procedure consisting of suture augmentation for both the anterior talofibular ligament and calcaneofibular ligament. For clinical outcome evaluation, Foot and Ankle Ability Measure (FAAM) and Karlsson-Peterson Scoring System for Ankle Function questionnaires coupled with questions regarding time …

Addressing Inpatient Substance Use Stigma And Bias: An Examination To Support Training For Healthcare Professionals, Tara Flood, Dnp, Rn, Cbc

College of Nursing Posters

Background

The current opioid crisis is a significant public health issue in the United States, especially amongst women of reproductive age. In the last two decades, the rate of opioid use disorder (OUD) in pregnant women has quadrupled. Women with substance use disorders (SUD) experience more sociodemographic and health disadvantages, pre-existing health conditions, and co-morbid psychiatric diagnoses than their counterparts without SUDs. They are also more likely to experience emergency department visits and hospitalizations during the antenatal period and less likely to utilize prenatal healthcare services.

Acute Inpatient Stabilization Study Primary Stakeholders Evaluation, Tara Flood, Dnp, Rn, Cbc

College of Nursing Posters

Background

The current opioid crisis is a significant public health issue in the United States, especially amongst women of reproductive age. In the last two decades, the rate of opioid use disorder (OUD) in pregnant women has quadrupled. Women with substance use disorders (SUD) experience more sociodemographic and health disadvantages, pre-existing health conditions, and co-morbid psychiatric diagnoses than their counterparts without SUDs. They are also more likely to experience emergency department visits and hospitalizations during the antenatal period and less likely to utilize prenatal healthcare services.

Opioid Use Disorder (Oud) And Neonatal Abstinence Syndrome (Nas) Education In An Undergraduate Nursing Program, Tara Flood, Dnp, Rn, Cbc

College of Nursing Posters

Background

In 2018 the American Academy of Nursing urged all nursing schools to adopt curriculum to address the opioid epidemic, although few programs have begun this work.

Minimal background training in nursing school is focused on caring for patients with Opiate use disorder ( OUD) and Neonatal Abstinence Syndrome (NAS) leaving nurses to develop the necessary skills for optimal patient engagement to be formulated in practice. An undergraduate nursing program in an urban setting developed OUD and NAS education into their curriculum.

Undergraduate nursing students are increasingly encountering patients with opioid use disorder in the clinical setting. Previous research indicates …

Bimanual Movement Characteristics And Real-World Performance Following Hand-Arm Bimanual Intensive Therapy In Children With Unilateral Cerebral Palsy, Shailesh S. Gardas, Christine Lysaght, Amy Gross Mcmillan, Shailesh Kantak, John D. Willson, Charity G. Patterson, Swati M. Surkar

Department of Rehabilitation Medicine Faculty Papers

The purpose of this study was to quantify characteristics of bimanual movement intensity during 30 h of hand-arm bimanual intensive therapy (HABIT) and bimanual performance (activities and participation) in real-world settings using accelerometers in children with unilateral cerebral palsy (UCP). Twenty-five children with UCP participated in a 30 h HABIT program. Data were collected from bilateral wrist-worn accelerometers during 30 h of HABIT to quantify the movement intensity and three days pre- and post-HABIT to assess real-world performance gains. Movement intensity and performance gains were measured using six standard accelerometer-derived variables. Bimanual capacity (body function and activities) was assessed using …

Variant Characterization Of A Representative Large Pedigree Suggests “Variant Risk Clusters” Convey Varying Predisposition Of Risk To Lynch Syndrome, Mouadh Barbirou, Amanda A. Miller, Amel Mezlini, Balkiss Bouhaouala-Zahar, Peter J. Tonellato

Department of Medical Oncology Faculty Papers

Recently, worldwide incidences of young adult aggressive colorectal cancer (CRC) have rapidly increased. Of these incidences diagnosed as familial Lynch syndrome (LS) CRC, outcomes are extremely poor. In this study, we seek novel familial germline variants from a large pedigree Tunisian family with 12 LS-affected individuals to identify putative germline variants associated with varying risk of LS. Whole-genome sequencing analysis was performed to identify known and novel germline variants shared between affected and non-affected pedigree members. SNPs, indels, and structural variants (SVs) were computationally identified, and their oncological influence was predicted using the Genetic Association of Complex Diseases and Disorders, …

Tav-In-Tav And Beyond: How Far Can We Go?, Taramasso Maurizio, Ana Paula Tagliari, David L. Fischman

Division of Cardiology Faculty Papers

No abstract provided.

Expanding The Primary Care Interprofessional Team: Creating Space For Behavioral Health Consultants, Rachelle Rene, Phd, Bcb, Hsmi, Cgp, Mollie Cherson, Mphil, Lcsw

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Statement of issue or problem addressed

Despite a growing need for mental and behavioral health services, access to these services has been limited due to constraints in insurance coverage and location of services outside of medical care. As a result, mental and behavioral health needs have frequently fallen to the primary care system to support.

2023 James B. Erdmann Award Recipients

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

The Jefferson Center for lnterprofessional Practice & Education (JCIPE) congratulates this year's interprofessional education (IPE) and collaborative practice (CP) award winners and thanks them for all of their efforts to support and advance this work on campus and beyond. Their contributions are immeasurable!

Interview Of John E. Lewis, Jr., Md, Ms, Facep, John E. Lewis, Jr., Md, Ms, Facep, Ciera M. Osborne, Otd

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Dr. John E. Lewis, Jr., Assistant Professor of Emergency Medicine at the Emory University School of Medicine, presented the keynote at the 2022-23 J-SICCC Kick-Off event, exploring the systemic racism fueling the health disparities in our society in a raw, real, and electrifying way. I sat down with Dr. Lewis to continue the conversation. Through his sharing, Dr. Lewis helps us understand our own journeys, what drives us, and how we can improve our healthcare teams and patient interactions. This interview dives deeper into the roots of our disconnections to find the only treatment that will work to make the …

Spotlight On Interprofessional Clinical Teams, William F. Bucher, Bs, Rrt-Nps, Alicia Graf, Ma, Ccc-Slp, Margaret Lafferty, Md, Faap, Dot Mcelwee, Msn, Nnp-Bc, Elizabeth Przychowicz, Rn, Bsn, Cbc, Marie Snyder, Pt, Dpt, Pcs, Eileen Winter, Msw, Lsw

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Take a closer look at a clinical team at Thomas Jefferson University Hospital and how they practice interprofessionally every day!

The Jefferson Intensive Care Nursery (ICN) offers advanced care for infants who are born under critical circumstances or require specialized treatment for medical, surgical, or cardiac disorders. JCI PE interviewed the ICN team about several topics, including their roles, their interprofessional dynamic, and what they have learned from each other over the years. The team also reviewed the case of "Baby C during the interview. (Responses have been edited for length and clarity.)

Preparing The Healthcare Workforce Of Tomorrow Through Interprofessional Simulations: A Review Of Simulation Technologies Used At Jefferson Center For Interprofessional Practice & Education, Susan Toth-Cohen, Phd, Otr/L, E. Adel Herge, Otd, Otr/L, Faota, Amber King, Pharmd, Bcps, Fnap

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Interprofessional (IP) collaborative practice is believed to be an essential component of healthcare system transformation via the "Quadruple Aim" (IPEC. 2016) IP simulations provide invaluable opportunities for learners to practice, discuss, and improve teamwork and communication skills for clinical situations (Thistlethwaite, 2012). Furthermore, IP simulations help students gain a nuanced understanding of, and appreciation for, the roles and responsibilities of colleagues from different professions (Thistlethwaite, 2012). As a result, students increase their understanding of how practice is enhanced as they gain additional perspectives on care and improve their ability to engage in effective IP teamwork (IPEC, 2016). IP simulations allow …

Meet An Ipe/Cp Alumna Champion From Thomas Jefferson University, Kyra Shreeve, Bsn

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

As a Jefferson College of Nursing student (JCN), I had the opportunity to be involved in several JCIPE initiatives, including the Jefferson Student lnterprofessional Complex Care Collaborative program (J-SICCC, formerly Student Hotspotting) and Team Simulation & Fearlessness Education (TeamSAFE). As a member of J-SICCC, I worked with an interprofessional team of students to support a patient with complex social and healthcare needs. The TeamSAFE training was incorporated within the JCN curriculum, and after participating as a student I was able to volunteer as a co-facilitator. In addition, I had the chance to work with one of the JCN faculty members, …

Meet An Ipe/Cp Staff Champion From Thomas Jefferson University, Eileen Winter, Msw, Lsw

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

I became involved with JCIPE in 2016 as a faculty advisor to the one Jefferson Student lnterprofessional Complex Care Collaborative program (J-SICCC, formerly Student Hotspotting) team participating from Thomas Jefferson University. I found the students (medicine, nursing, OT, pharmacy, and two combined MD/PhDs) very engaged and enthusiastic. They took initiative and worked hard to establish connections with their patients. At some point during the year, they began meeting regularly at Scott Library at the end of the day. I joined them when I could, and provided them with direction as they tried to help their patients. It was rewarding to …

A Provocateur For Improvement, David B. Nash, Md, Mba

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

I like to think of myself as an internal champion for improving the quality and safety of medical care that we deliver at Jefferson. A central tenet of our work together at the bedside is that care can never be error free because we're working with people. Our goal should always be to make care harm free.

As a result of my dedication to this notion of harm free care, I would like to review some key milestones in my 30 years as a faculty member and connect the dots between my work and certain events. Here is the punch …

Jcipe Updates

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

JCIPE Updates

From The Editors

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

We are excited to share with you the summer 2023 edition of our newsletter! As the weather warms, and we celebrate commencements, we reflect upon our accomplishments in the face of many challenges. JCIPE is thankful for our 140 faculty, staff, resident, and student volunteer facilitators who made our student programming possible over the past year. We could not advance team-based care without their support. Additionally, after three years of largely virtual programming, we are thrilled to have brought all of our in-person simulations back to campus during the 2022-2023 academic year. JCIPE said goodbye to some longtime faculty and …

Collaborative Healthcare: Interprofessional Practice, Education And Evaluation (Jcipe), Volume 13, Number 1, Spring/Summer 2023

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

In this Issue:

• Letter from the Editors
• JCIPE Updates
• A Provocateur for Improvement
• Meet an IPE Faculty Champion
• Meet an IPE Student Champion
• Preparing the Healthcare Workforce of Tomorrow through Interprofessional Simulations: A Review of Simulation Technologies used at Jefferson Center for Interprofessional Practice & Education
• Spotlight on Interprofessional Clinical Teams
• Interview of John E. Lewis, Jr., MD, MS, FACEP
• 2023 James B. Erdmann Award Recipients
• Expanding the Primary Care Interprofessional Team: Creating Space for Behavioral Health Consultants

Deep Brain Stimulation For Substance Use Disorder: A Systematic Review And Meta-Analysis, Nour Shaheen, Ahmed Shaheen, Can Sarica, Arun Singh, Mario Zanaty, Karim Johari, Andrew Yang, Theresa Zesiewicz, Brian Dalm, Yarema Bezchlibnyk, Andres M Lozano, Oliver Flouty

Department of Neurosurgery Faculty Papers

OBJECTIVE: Substance use disorder (SUD) is a significant public health issue with a high mortality rate. Deep brain stimulation (DBS) has shown promising results in treating SUD in certain cases. In this study, we conducted a meta-analysis to evaluate the efficacy of DBS in the treatment of SUD and reduction of relapse rates.

METHODS: We performed a thorough and methodical search of the existing scientific literature, adhering to the PRISMA guidelines, to identify 16 original studies that fulfilled our inclusion criteria. We used the evidence levels recommended by the Oxford Centre for Evidence-Based Medicine to assess bias. The R version …

Leser-Trélat Sign As A Marker For Underlying Pancreatic Cancer, Kalpit Modi, Richard Chen, Layla Abubshait

Einstein Health Papers

Case Presentation: Early diagnosis and rapid treatment of cancer is essential for good clinical outcomes for patients. In this case, an 85-year-old man presented with failure to thrive and was noted to have rapid-onset, multiple seborrheic keratoses (Leser-Trélat sign) on his chest and back. He was ultimately diagnosed with pancreatic cancer using computed tomography.

Discussion: Leser-Trélat sign is a rare cutaneous marker for underlying malignancy. Identification of this sign can help guide diagnostic imaging and lab work to identify an occult internal malignancy, resulting in more rapid diagnosis, earlier treatment, and potentially better clinical outcomes.

A Hypothetical New Challenging Use For Indocyanine Green Fluorescence During Laparoscopic Appendectomy: A Mini-Series Of Our Experience And Literary Review, Noemi Zorzetti, Augusto Lauro, Manuela Cuoghi, Marco La Gatta, Ignazio R. Marino, Salvatore Sorrenti, Vito D'Andrea, Andrea Mingoli, Giuseppe Giovanni Navarra

Department of Surgery Faculty Papers

Laparoscopic appendectomy (LA) is a well-standardized surgical procedure, but there are still controversies about the different devices to be used for the appendiceal stump closure and the related postoperative complications. Indocyanine green (ICG) fluorescence angiography (FA) has already been shown to be helpful in elective and emergency surgery, providing intraoperative information on tissue and organ perfusion, thus guiding the surgical decisions and the technical strategies. According to these two aspects, we report a mini-series of the first five patients affected by gangrenous and flegmonous acute appendicitis intraoperatively evaluated with ICG-FA during LA. The patients were admitted to the Emergency Department …

Characteristics And Outcomes Of Patients Who Underwent Coronary Atherectomy In Centers With And Without On-Site Cardiac Surgery, Mohamed Dafaalla, Muhammad Rashid, Saadiq Moledina, Tim Kinnaird, Peter Ludman, Nick Curzen, Sarah Zaman, James Nolan, Mamas A. Mamas

Department of Medicine Faculty Papers

We aimed to describe the clinical characteristics and outcomes of patients who underwent atherectomy at the time of percutaneous coronary intervention in centers with on-site surgical centers (SCs) versus nonsurgical centers (NSCs). Patients treated with coronary atherectomy between January 1, 2006, to December 31, 2019, from the British Cardiovascular Society Intervention (BCIS) registry were included. Primary outcomes were in-hospital all-cause mortality and major adverse cardiovascular and cerebrovascular events. A total of 20,833 patients were treated with coronary atherectomy, of which 7,983 (38%) were performed at NSC. The proportion of coronary atherectomies performed in NSC increased from 12.5% in 2006 to …

Fan1 Removes Triplet Repeat Extrusions Via A Pcna- And Rfc-Dependent Mechanism, Ashutosh S. Phadte, Mayuri Bhatia, Hope Ebert, Haaris Abdullah, Essam Abed Elrazaq, Konstantin E. Komolov, Anna Pluciennik

Department of Biochemistry and Molecular Biology Faculty Papers

Human genome-wide association studies have identified FAN1 and several DNA mismatch repair (MMR) genes as modifiers of Huntington’s disease age of onset. In animal models, FAN1 prevents somatic expansion of CAG triplet repeats, whereas MMR proteins promote this process. To understand the molecular basis of these opposing effects, we evaluated FAN1 nuclease function on DNA extrahelical extrusions that represent key intermediates in triplet repeat expansion. Here, we describe a strand-directed, extrusion-provoked nuclease function of FAN1 that is activated by RFC, PCNA, and ATP at physiological ionic strength. Activation of FAN1 in this manner results in DNA cleavage in the vicinity …

A Biologic-Device Combination Product Delivering Tumor-Derived Antigens Elicits Immunogenic Cell Death-Associated Immune Responses Against Glioblastoma, Christopher Cultrara, Christopher Uhl, Kenneth Kirby, Essam Abed Elrazaq, Amelia Zellander, David W. Andrews, Charles B. Scott, Lorenzo Galluzzi, Mark A. Exley, Jenny Zilberberg

Department of Neurosurgery Faculty Papers

Background IGV-001 is a personalized, autologous cancer cell-based immunotherapy conceived to deliver a tumor-derived antigenic payload in the context of immunostimulatory signals to patients with glioblastoma (GBM). IGV-001 consists of patient-derived GBM cells treated with an antisense oligodeoxynucleotide against insulin-like growth factor 1 receptor (IGF1R) and placed in proprietary biodiffusion chambers (BDCs). The BDCs are then exposed to 5–6 Gy radiation and implanted at abdominal sites for ~48 hours. IGV-001 has previously been shown to be generally safe with promising clinical activity in newly diagnosed GBM patients.

Methods Mouse (m) or human (h) variants of IGV-001 …