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Progress In Controlling Healthcare Associated Infections: A Historical Perspective, Richard Wenzel, Md

Building the Chain of Safety: Stakeholders Summit

Richard P. Wenzel, MD, MSc, is professor and former chairman of the Department of Internal Medicine at the Medical College of Virginia, Virginia Commonwealth University, in Richmond, Virginia (1995-2009).  From 2003-2008, he was President of MCV Physicians, the clinical practice plan for over 600 physicians, and Senior Associate Dean for Clinical Affairs.

For eight years (1992 to 2000), he was a member of the editorial board of The New England Journal of Medicine, and, in September 2001, became the journal’s first Editor-at-Large, a position he still holds.  He is the prolific author of over 500 publications, the editor of …

Download Entire Pdf: The Medicine Forum, Vol 5, Winter 2003

The Medicine Forum

Download entire PDF: The Medine Forum, (The Journal of Thomas Jefferson University Hospital, Department of Internal Medicine), Vol 5, Winter 2003.

Training Residents In Acls/Code Response Using A Computerized Medical Simulator: Improving Resident Comfort And Preparedness, Elisabeth Dial, Md, Henry Schairer, Md, Steven Silver, Md, Jennifer Claves, Md, David Gardiner, Md, John Caruso Md, Salvatore Mangione, Md, Gregory C. Kane, Md

The Medicine Forum

Internal Medicine residents are responsible for leading the
code response team at most teaching hospitals, yet many
graduating interns (PGY1s) may feel unprepared to run
codes. Currently, the only formal training for house staff
is the two-day American Heart Association’s Advanced
Cardiac Life Support (ACLS) course, generally required at
the beginning of internship, with recertification necessary
every two years. This course does not address leadership
skills or a resident’s self-reported sense of comfort with
leading a code team within a teaching hospital. Prior
investigations have highlighted the deterioration in
knowledge of important ACLS protocols, with knowledge
levels at or near …

A Male With Chills And Arthralgias, Lo-Ku Chiang, Md, Ambrish Ojha, Md

The Medicine Forum

A 53-year old man presented to the ED with complaints
of fevers and chills for 5 days. Two days prior, he started
having generalized arthralgias and a painfully numb left
index finger. Similar symptoms had also begun on his
left great toe (See Figures D and E, Color Plates page
19). The patient denied recent trauma, although he was
unsure if he had sustained an insect bite on the dorsal
aspect of his left hand 8 hours prior to the onset of
symptoms. Three sets of blood cultures obtained prior
to admission were positive for methacillin-sensitive
Staphylococcus aureus. The patient …

A Man With A Soft Tissue Lesion Of The Hand, Susan Masonis Md

The Medicine Forum

A fifty year old male presents with a lesion on his right
hand. Approximately 2 months prior to presentation, the
patient, who is a dentist and avid boater, first noted the
lesion after hitting his hand when working in his boat’s
engine room. Initially he had a 1 cm erythematous
macular lesion on the dorsum of his right hand at the
5th metacarpal. He believed the lesion was present prior
to the time he struck his hand, and the injury brought it
to his attention.

Microarray-Based Analysis Of Differential Gene Expression Between Infective And Noninfective Larvae Of Strongyloides Stercoralis., Roshan Ramanathan, Sudhir Varma, José M C Ribeiro, Timothy G Myers, Thomas J Nolan, David Abraham, James B Lok, Thomas B Nutman

Department of Microbiology and Immunology Faculty Papers

BACKGROUND: Differences between noninfective first-stage (L1) and infective third-stage (L3i) larvae of parasitic nematode Strongyloides stercoralis at the molecular level are relatively uncharacterized. DNA microarrays were developed and utilized for this purpose.

METHODS AND FINDINGS: Oligonucleotide hybridization probes for the array were designed to bind 3,571 putative mRNA transcripts predicted by analysis of 11,335 expressed sequence tags (ESTs) obtained as part of the Nematode EST project. RNA obtained from S. stercoralis L3i and L1 was co-hybridized to each array after labeling the individual samples with different fluorescent tags. Bioinformatic predictions of gene function were developed using a novel cDNA Annotation …

Comparison Of Human Memory Cd8 T Cell Responses To Adenoviral Early And Late Proteins In Peripheral Blood And Lymphoid Tissue., Amita Joshi, Biwei Zhao, Cara Romanowski, David Rosen, Phyllis Flomenberg

Department of Microbiology and Immunology Faculty Papers

Treatment of invasive adenovirus (Ad) disease in hematopoietic stem cell transplant (SCT) recipients with capsid protein hexon-specific donor T cells is under investigation. We propose that cytotoxic T cells (CTLs) targeted to the late protein hexon may be inefficient in vivo because the early Ad protein E3-19K downregulates HLA class I antigens in infected cells. In this study, CD8+ T cells targeted to highly conserved HLA A2-restricted epitopes from the early regulatory protein DNA polymerase (P-977) and late protein hexon (H-892) were compared in peripheral blood (PB) and tonsils of naturally infected adults. In tonsils, epitope-specific pentamers detected a significantly …

Multimethod Teaching Strategies To Integrate Selected Qsen Competencies In A Doctor Of Nursing Practice Distance Education Program, Mary Lou Manning, Phd, Crnp, Anthony J. Frisby, Phd

College of Nursing Faculty Papers & Presentations

The Quality and Safety Education for Nurses (QSEN) initiative identified 6 competencies for the education of nurses (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics) and the related knowledge, skills, and attitudes (KSAs) for each competency. The initial QSEN focus was on competency development during prelicensure nursing education, with subsequent attention on adapting the KSAs for graduate programs that prepare advanced practice nurses for clinical roles. Description of successful QSEN competency integration in Doctor of Nursing Practice (DNP) programs is limited. Although the ultimate goal is executing DNP programs where quality and safety is thoroughly integrated …

Health Needs Of Hiv-Infected Women In The United States: Insights From The Women Living Positive Survey., Kathleen E Squires, Sally L Hodder, Judith Feinberg, Dawn Averitt Bridge, Staats Abrams, Stephen P Storfer, Judith A Aberg

Department of Medicine Faculty Papers

The objective of this study was to describe attitudes, opinions, and perceived health needs of HIV-infected women in the United States. In this cross-sectional study, women were invited to participate in the Women Living Positive survey, a structured interview instrument with 45 questions. Collected data were deidentified and the margin of error was calculated as four percentage points. Incoming toll-free phone interviews were conducted from December 21, 2006, through March 14, 2007 among subjects recruited from a U.S. national network of AIDS counseling centers. Seven hundred HIV-infected women (43% African American, 28.5% Hispanic, 28.5% Caucasian; median age, 42.5 years) receiving …

Periodic Fever, Aphthous Stomatitis, Pharyngitis, And Adenitis (Pfapa) Is A Disorder Of Innate Immunity And Th1 Activation Responsive To Il-1 Blockade., Silvia Stojanov, Sivia Lapidus, Puja Chitkara, Henry Feder, Juan C Salazar, Thomas A Fleisher, Margaret R Brown, Kathryn M Edwards, Michael M Ward, Robert A Colbert, Hong-Wei Sun, Geryl M Wood, Beverly K Barham, Anne Jones, Ivona Aksentijevich, Raphaela Goldbach-Mansky, Balu Athreya, Karyl S Barron, Daniel L Kastner

Department of Pediatrics Faculty Papers

The syndrome of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) is the most common periodic fever disease in children. However, the pathogenesis is unknown. Using a systems biology approach we analyzed blood samples from PFAPA patients whose genetic testing excluded hereditary periodic fevers (HPFs), and from healthy children and pediatric HPF patients. Gene expression profiling could clearly distinguish PFAPA flares from asymptomatic intervals, HPF flares, and healthy controls. During PFAPA attacks, complement (C1QB, C2, SERPING1), IL-1-related (IL-1B, IL-1RN, CASP1, IL18RAP), and IFN-induced (AIM2, IP-10/CXCL10) genes were significantly overexpressed, but T cell-associated transcripts (CD3, CD8B) were down-regulated. On the …

Health Policy Newsletter Spring 2011 Download Full Text Pdf

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Enhanced Neutralization Potency Of Botulinum Neurotoxin Antibodies Using A Red Blood Cell-Targeting Fusion Protein., Sharad P Adekar, Andrew T Segan, Cindy Chen, Rodney Bermudez, M D Elias, Bernard H Selling, B P Kapadnis, Lance L Simpson, Paul M Simon, Scott K Dessain

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Botulinum neurotoxin (BoNT) potently inhibits cholinergic signaling at the neuromuscular junction. The ideal countermeasures for BoNT exposure are monoclonal antibodies or BoNT antisera, which form BoNT-containing immune complexes that are rapidly cleared from the general circulation. Clearance of opsonized toxins may involve complement receptor-mediated immunoadherence to red blood cells (RBC) in primates or to platelets in rodents. Methods of enhancing immunoadherence of BoNT-specific antibodies may increase their potency in vivo. We designed a novel fusion protein (FP) to link biotinylated molecules to glycophorin A (GPA) on the RBC surface. The FP consists of an scFv specific for murine GPA fused …

Urological Involvement In Renal Transplantation., Daniel D Sackett, Pooja Singh, Costas D Lallas

Department of Urology Faculty Papers

Historically, urologists were the primary surgeons in renal transplantation. Specialization and increased complexity of the field of transplantation, coupled with a de-emphasis of vascular surgical training in urology, has created a situation where many renal transplants are carried out by surgeons with a general surgery background. Because of its genitourinary nature, however, urological input in renal transplantation is still vital. For living donors, a urologist should be involved to help evaluate and prepare certain patients for eventual donation. This could involve both medical and surgical intervention. Additionally, urologists who carry out living donor nephrectomy maintain a sense of ownership in …

Septic Shock: Current Management And New Therapeutic Frontiers, R. Phillip Dellinger, Md

Division of Pulmonary, Allergy, and Critical Care Medicine Presentations and Grand Rounds

No audio is available for this presentation.

Dr. R. Phillip Dellinger is a Professor of Medicine who holds a faculty appointment in the Division of Pulmonary and Critical Care Medicine at the Robert Wood Johnson School of Medicine, University of Medicine and Dentistry of New Jersey. He is also the Vice-Chair, Department of Medicine and the Director, Medical/Surgical/Cardiovascular Surgical Intensive Care Unit at the Cooper Medical Center in Camden New Jersey. In 2006-2007, he was selected as South Jersey Top Docs by South Jersey Magazine. Dr. Dellinger's interests are in the treatment and outcomes of septic shock.

Uganda And The Current Hiv Treatment Crisis - A Perspective, Ellen J. Plumb Md

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Hpn Winter 2011 Download Full Pdf

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Comparative Gender Analysis Of The Efficacy And Safety Of Atazanavir/Ritonavir And Lopinavir/Ritonavir At 96 Weeks In The Castle Study., Kathleen E Squires, Margaret Johnson, Rong Yang, Jonathan Uy, Louise Sheppard, Judith Absalon, Donnie Mcgrath

Department of Medicine Faculty Papers

OBJECTIVES: To examine whether the overall results of the CASTLE study pertain to both genders, we analysed the efficacy and safety of atazanavir/ritonavir and lopinavir/ritonavir in 277 female and 606 male patients in the open-label, multinational trial over 96 weeks. The trial is registered with ClinicalTrials.gov, number NCT00272779.

METHODS: Treatment-naive patients aged ≥ 18 years with HIV-1 RNA ≥ 5000 copies/mL were randomized to receive either atazanavir/ritonavir 300/100 mg once daily or lopinavir/ritonavir 400/100 mg twice daily, with fixed-dose tenofovir/emtricitabine 300/200 mg once daily.

RESULTS: At week 96, confirmed virological response rates (HIV RNA <50 copies>/mL; intent-to-treat analysis) were higher in …

Sci-Tech Book News Reviews, Susan Fingerman

Sci-Tech News

The following section consists of 100 book reviews selected from Sci-Tech Book News, reprinted with the permission of Book News Inc. This review journal is published four times a year, each issue reviewing over 2,000 new titles in the physical and biological sciences, mathematics, engineering, computer science, technology, and agriculture. For a sample issue and subscription information, contact Book News Inc. at 5739 NE Sumner Street, Portland, OR 97218. Phone: (503)281-9230; Fax: (503)287-4485; E-mail: [email protected].

The Role Of The Pediatrican In The Effort To Prevent Congenital Malformations, Robert L. Brent Dr.

The Selected Works of Robert Brent

No

The Intensivist, Ed Marchan, Jack Jallo, Fred Rincon, Matthew Vibbert

JHN Journal

The intensivist is the primary care physician of the ICU. Critically ill patients often have multiple acute and chronic illnesses requiring the careful integration of information and recommendations from multiple consultants. In addition to acting as a physician, intensivists commonly are administrators of an ICU. In 1992, the Society of Critical Care Medicine1 published its guidelines for the definition of an intensivist and the intensivist’s role in an ICU (Table 1).

Sci-Tech Book News Reviews, Susan Fingerman

Sci-Tech News

This section consists of 100 book reviews selected from Sci-Tech Book News, reprinted with the permission of Book News, Inc.

Surgical Site Infection: A Review, Olatilewa Awe, James Harrop

JHN Journal

Infection of the spine may occur spontaneously, by direct hematogenous or contiguous spread from an area of infection, or secondarily to an inciting event such as trauma or spine operation. The overall rate of spine surgery has increased steadily over the last decade. Medicare spending on inpatient spine surgery has doubled over the same period with lumbar fusion representing the greatest percentage of spending.1 Surgical site infection (SSI) after spinal surgery is not uncommon, leading to increased morbidity and mortality. The incidence of surgical site infection after spine surgery varies and depends on several factors including immune status of patient, …

Fever And Infection In The Neurosurgical Intensive Care Unit, Craig Laws, Jack Jallo

JHN Journal

Fever is an adaptive response to a variety of infectious, inflammatory, and foreign stimuli. The “febrile response” confers an immunological advantage to the host over invading microorganisms – bacterial, fungal and viral. Fever results from a cytokine-mediated reaction that results in the generation of acute phase reactants and controlled elevation of core body temperature. The anterior hypothalamus coordinates the “febrile response” in reaction to the release of endogenous pyrogenes and subsequent up-regulation of prostaglandin synthesis. An ensuing change in the hypothalamic set point for temperature regulation advances a synchronized physiologic response from CNS to periphery, on a microscopic and macroscopic …

Self-Protecting Bactericidal Titanium Alloy Surface Formed By Covalent Bonding Of Daptomycin Bisphosphonates., Chang-Po Chen, Eric Wickstrom

Department of Biochemistry and Molecular Biology Faculty Papers

Infections are a devastating complication of titanium alloy orthopedic implants. Current therapy includes antibiotic-impregnated bone cement and antibiotic-containing coatings. We hypothesized that daptomycin, a Gram-positive peptide antibiotic, could prevent bacterial colonization on titanium alloy surfaces if covalently bonded via a flexible, hydrophilic spacer. We designed and synthesized a series of daptomycin conjugates for bonding to the surface of 1.0 cm² Ti6Al4V foils through bisphosphonate groups, reaching a maximum yield of 180 pmol/cm². Daptomycin-bonded foils killed 53 ± 5% of a high challenge dose of 3 × 10⁵ cfu Staphylococcus aureus ATCC 29213.

Full Issue: Vol. 64, Issue 3

Sci-Tech News

No abstract provided.

Relationship Between Maternal Methadone Dose At Delivery And Neonatal Abstinence Syndrome., Neil S., Seligman, Christopher V. Almario, Edward J. Hayes, Kevin C. Dysart, Vincenzo Berghella, Jason K. Baxter

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To estimate the relationship between maternal methadone dose and the incidence of neonatal abstinence syndrome (NAS).

STUDY DESIGN: We performed a retrospective cohort study of pregnant women treated with methadone for opiate addiction who delivered live-born neonates between 1996 and 2006. Four dose groups, on the basis of total daily methadone dose, were compared (160 mg/d). The primary outcome was treatment for NAS. Symptoms of NAS were objectively measured with the Finnegan scoring system, and treatment was initiated for a score>24 during the prior 24 hours.

RESULTS: A total of 330 women treated with methadone and their 388 …

A Role For The Histone Deacetylase Hdac4 In The Life-Cycle Of Hiv-1-Based Vectors., Johanna A Smith, Jennifer Yeung, Gary D Kao, René Daniel

Department of Medicine Faculty Papers

HIV-1 integration is mediated by the HIV-1 integrase protein, which joins 3'-ends of viral DNA to host cell DNA. To complete the integration process, HIV-1 DNA has to be joined to host cell DNA also at the 5'-ends. This process is called post-integration repair (PIR). Integration and PIR involve a number of cellular co-factors. These proteins exhibit different degrees of involvement in integration and/or PIR. Some are required for efficient integration or PIR. On the other hand, some reduce the efficiency of integration. Finally, some are involved in integration site selection. We have studied the role of the histone deacetylase …

Human Papillomavirus And Survival Of Patients With Oropharyngeal Cancer., K Kian Ang, Jonathan Harris, Richard Wheeler, Randal Weber, David I Rosenthal, Phuc Felix Nguyen-Tân, William H Westra, Christine H Chung, Richard C Jordan, Charles Lu, Harold Kim, Rita S. Axelrod, Md, C Craig Silverman, Kevin P Redmond, Maura L Gillison

Jefferson Hospital Staff Papers and Presentations

BACKGROUND: Oropharyngeal squamous-cell carcinomas caused by human papillomavirus (HPV) are associated with favorable survival, but the independent prognostic significance of tumor HPV status remains unknown.

METHODS: We performed a retrospective analysis of the association between tumor HPV status and survival among patients with stage III or IV oropharyngeal squamous-cell carcinoma who were enrolled in a randomized trial comparing accelerated-fractionation radiotherapy (with acceleration by means of concomitant boost radiotherapy) with standard-fractionation radiotherapy, each combined with cisplatin therapy, in patients with squamous-cell carcinoma of the head and neck. Proportional-hazards models were used to compare the risk of death among patients with HPV-positive …

Prescriptions For Excellence In Health Care Issue 9 Summer 2010 Download Full Pdf

Prescriptions for Excellence in Health Care Newsletter Supplement

No abstract provided.

Sizing Up Pharmacotherapy For Obesity., Michael A. Valentino, Andre Terzic, Scott A. Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Obesity has increased over the last 20 years, from a condition affecting only a small portion of populations in developed countries, into a global pandemic. The impact of obesity can be appreciated in the context of the populations at risk, and it is estimated that >1 billion adults worldwide are overweight (BMI >25 kg/m2), 300 million of whom are clinically obese (BMI >30 kg/m2). In the United States, 65% of adults are overweight, and 32.2% of them are obese, a prevalence that has doubled over 20 years. In industrialized countries, obesity rates have tripled, coinciding with adoption of a Western …