Medicine and Health Sciences Commons^™

Acute Aseptic Meningoencephalitis Due To Covid-19 In An Otherwise Healthy Patient: A Case Report, Shyama Appareddy, Norma Moncayo, Ronkino T. Mccoy, Jared Sperling, George Huddleston, Raza L. Kahn

Research Colloquium

Several studies have shown the extrapulmonary manifestations of COVID-19 disease caused by the SARS-CoV2 virus. Although extrapulmonary manifestation to the heart, kidney, blood, and skin are common, neurological and cerebrovascular manifestations are rare with most of these cases being described in patients who also have the pulmonary manifestation of the disease. Here we present the case of an 18 year-old male with no prior history of respiratory symptoms who presented to the emergency department with altered mental status. Neurology was consulted and the patient was started empirical on ceftriaxone, vancomycin, dexamethasone, and acyclovir for meningoencephalitis. Urine drug screen, head CT, …

Multisystem Inflammatory Syndrome In Children (Mis-C): Is There A Relationship To Typhus?, Juliana Hager, Juliana Hager, Jacob Smith

Research Colloquium

The United Kingdom first reported in April 2020 a group of eight previously healthy children with a link to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that presented with systemic inflammation and multi-organ involvement, now named multisystem inflammatory syndrome in children (MIS-C). The Centers of Disease Control and Prevention (CDC) have reported over 1000 cases since the primary discovery as of October 2020 with 20 total deaths. [1] The clinical features of MIS-C have been previously compared to inflammatory syndromes including Kawasaki disease (KD) and toxic shock syndrome (TSS). We describe the clinical presentation and management for 3 pediatric cases with …

Catheter-Associated Urinary Tract Infections: Patient Characteristics, Treatment, And Clinical Outcomes In One South Texas Acute Care Hospital, Kimberly A. Ambrosini, Jose Campo Maldonado

Research Colloquium

Background: Catheter-associated urinary tract infections (CA-UTIs) account for 40 percent of nosocomial infections worldwide. Their elimination is at the forefront of quality improvement in one South Texas acute care hospital.

Methods: Over a period of 6 months, five CA-UTIs occurred in one South Texas acute care hospital. These cases were identified via regular surveillance by Infection Prevention staff and the Laboratory Department of the hospital. This research reviews patient age, sex, length of stay, bacteria contracted, appropriate antibiotic use, patient characteristics, and overall outcomes.

Results: Between the months of July and December 2021, 5 CAUTIs were contracted. Patients ranged in …

A Simple Case Of Viral Myopericarditis Or A Complication Of Monoclonal Antibody Infusion?, Jose A. Rivera, Michael Menowsky

Research Colloquium

Background: Myocarditis has been a rare, but well-documented side effect of the mRNA-based vaccines against SARS-CoV-2 as well as a complication of viral infections including SARS-CoV-2. However, myopericarditis as a complication of monoclonal antibody infusion or as complication of allergic reaction to antibody infusions might be and underreported.

Case presentation: In this case, we report a 30-year-old man with a previous diagnosis of COVID infection 1 week prior to presentation, unvaccinated for SARS-CoV-2 who was referred from a monoclonal infusion center where he received casirivimab and imdevimab and 15 minutes after infusion began to complain of chills, chest pain, shortness …

Pediatric Covid-19 Encephalitis, Nelson D. Gonzalez, Dustin Paul, Ana Almeda, Samuel Serna, Linette Linsangan

Research Symposium

Background: Neurologic complications of COVID-19 in the pediatric population have been reported in a limited number of reports. There have been reports of COVID-19-associated encephalitis in pediatric cases along with neuroimaging findings revealing involvement of some parts of the nervous system. We present the first case of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - associated encephalitis targeting the parietal lobes.

Case: A 14-year-old morbidly obese Hispanic male with no past medical history presented to the hospital for new onset seizures. Family reported exposure to his COVID-19 positive mother, a one-week history of fever, and a three-month history of …

The Impact Of Covid-19 On Post-Recovery Memory, Chelsea Mcnamara, Alison Mancuso

Rowan-Virtua Research Day

The SARS-CoV-2 virus, responsible for the covid-19 pandemic, has had profound effects on countries worldwide. As the pandemic progressed, clinical and patient data continued to mount. A subset of symptoms named “Long Covid Syndrome” persisted in patients after recovering from infection. One commonly reported but understudied symptom was a deficit in memory function. Although commonly reported, prevalence of ‘brain fog’ has yet to be characterized using patient data. Using Rowan Medicine electronic patient data, we were able to collect information on patients before and after the emergence of the coronavirus. Data was collected on reported memory-related symptoms as well as …

Whole Body Cryotherapy As A Novel Treatment For Long Covid Syndrome Associated Brain Fog, James Mack, Brandon Goodwin, Paras Patel, Kyra Herman, Daniel Casal, Emily Levenson

Rowan-Virtua Research Day

SARS-CoV-2, which causes coronavirus disease 2019 (COVID-19), was first discovered in December 2019 in Wuhan, China when adults began presenting with severe pneumonia of an unknown cause. SARS-CoV-2 can cause a wide range of clinical manifestations. SARS-CoV-2 can penetrate the olfactory mucosa and may enter the brain through the cribriform plate along the olfactory tract, through vagal or trigeminal pathways, or pass through the blood-brain barrier. Once inside the brain, levels of inflammatory cytokines are increased and can lead to altered learning, memory, neuroplasticity, hallucinations, nightmares, cognitive and attention deficits, new-onset anxiety and depression, and psychosis. A theoretical treatment for …

Factors That Influence The Decision To Get Vaccinated Against Covid-19, Rhea Bhargava, Meghan H. Foos, Brandy M. Gotti, Alexandra L. Mulvenna, Taylor O. Smith, Danielle Cooley, Venkateswar Venkataman

Rowan-Virtua Research Day

Since the start of the COVID-19 pandemic and the launch of the vaccine, healthcare workers have been encouraging people to get vaccinated to prevent the spread of the virus. However, there is a significant number of people who are vaccine hesitant, or uncertain about receiving the COVID-19 vaccine and its booster. Vaccine hesitancy represents a state of opportunity to make positive change; therefore, it is crucial for healthcare workers to identify those who are in this population. When factors contributing to the vaccine hesitancy, including gender, age, ethnicity, education level, and income were studied, it was found that women, those …

Case Report: Covid Arm (Covid Vaccine Arm), Joseph Pagano, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

We report the case of a 38-year-old male physician who was vaccinated with the Pfizer vaccine. He experienced arm pain and swelling on the vaccinated arm as well as systemic symptoms, including fever, chills, headache and weakness. The systemic symptoms improved after the use of oral prednisone. A review of the literature on the COVID vaccine is presented.

Case Report: Covid-19 Associated Guillain-Barre Syndrome, Matthew Aharonov, Neelesh Parikh, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 72-year-old female who presented to the emergency department with a complaint of generalized weakness. The patient was found to have ascending muscle weakness and subsequently diagnosed with Covid-19 related Guillain-Barre Syndrome. Our patient was negative for Campylobacter jejuni. It is noteworthy that the patient did not have fever, respiratory symptoms or loss of the sensation of taste.

Jefferson Internal Medicine Associates (Jima) Patient Triage Initiative, Mary White, Alexandra Leto, Barry Ziring, Md

Health Equity and Quality Improvement (HEQI) Summit

HOW MIGHT WE:

1. Contact patients to triage them for in-person versus virtual visits and teach them to use telehealth quickly?
2. How might we screen patients who are coming to the office for COVID-19 symptoms and exposures?

Intelligence Reporting In The Face Of Covid-19: Informing Our Response Efforts, Jamie D. Garden

Health Equity and Quality Improvement (HEQI) Summit

How might we provide successful intelligence?

1. Gather all relevant information from all possible sources available (academia, news, social media, human intelligence, etc.)
2. Sort intelligence based on relevance and credibility.
3. Identify trends, indicators, vulnerabilities, and warnings.
4. Assess opportunity analysis.

The Tjuh Hospital Medicine Covid19 Emergency Taskforce: A Guiding Light During The Surge Of Spring 2020, Rebecca Jaffe, Md, Alan Kubey, Md, Gretchen Diemer, Md, Michele Decastro, Lily Ackermann, Md, Christopher Haines, Md, Jesse Edwards, Md, René Daniel, Catriona Harrop, Md, Jonathan Woo, Md, Jack Stewart, Md

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

In mid March 2020 a highly infectious and deadly disease appeared in Philadelphia that no American physician had ever treated before. The challenge of disseminating reliable and relevant information about a novel and dangerous pathogen across practice areas cannot be understated.

Usual practices for communication and leadership are not designed to manage this kind of challenge.

A Web-Based Application To Simulate Manual Bag-Valve-Tube Ventilation, Robert Ries, Erin Jennings, Dylan Kenna, Logan May, Robert Pugliese, Pharmd, Matt Fields, Md

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

• The COVID-19 pandemic has threatened ventilator capacity in many locations which has led to alternative solutions to meet surge ventilator capacity including a strategy for deploying large-scale volunteer continuous bag-valve-tube (BVT) ventilation
• While an online training module may teach the manual ventilation volunteer force requisite knowledge, evidence suggests technology enhanced simulation training in health professions training is associated with improved outcomes for desired knowledge, skills and behaviors

Qr-Code Based Just-In-Time Platform For Perioperative Covid Guidelines, David F. Nelson, Md, Mba, Anna L. Rabinowitz, Md

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

When the COVID-19 Pandemic arrived in Philadelphia in March 2020, leadership at Thomas Jefferson University Hospital began a process of quickly authoring and updating a multitude of clinical guidelines, PPE (personal protective equipment) usage protocols, and surgical care standards in rapid succession.

The scope and scale of perioperative care at TJUH, which is made up of the Departments of Anesthesiology, Surgery, and Perioperative Nursing, means that a large and diverse number of individuals need timely access to a curated collection of resources that are specifically relevant to emergency airway management, urgent surgical care, testing, and recovery.

Large …

Maintaining Powered Air-Purifying Respirator (Papr) Supply Through Repair Of Damaged Hose Units By 3d Printing, Dante Varotsis, Robert Ries, Michelle Ho, Kathryn Linder, Jordan Kurzum, Robert Pugliese, Pharmd, Bon Ku, Md, Mpp, Matt Fields, Md, Morgan Hutchinson, Md

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

• Powered air-purifying respirators (PAPRs) are a type of Personal Protective Equipment (PPE) that serves an essential line of defense against the spread of COVID-19 and other airborne pathogens.
• Demand for PAPRs are at a premium during a time where supply chains have been disrupted.
• The hose component of the 3M™ Air-Mate™ PAPR has a fragile interface with the hood, leading to damage and rendering the PAPR unit unsafe for continued use.
• PAPR units are on backorder, as are their components.
• Given the acute need for functional PAPRs other approaches for repair were explored.

Home Telemonitoring Of Covid Patients By Medical Students At The Christiana Care Virtual Practice, Thomas Marconi, Jr, Chelsea Richards

Health Equity and Quality Improvement (HEQI) Summit

SARS-Cov2 arrived in Delaware on March 11, 2020. By March 22, 2020, stay at home orders were in place1. During this time, CareVio, a subsidiary of ChristianaCare, was tasked with developing a strategy to monitor the Delaware community. CareVio repurposed Twistle – a telemonitoring application utilized to distribute symptom related surveys and conduct text message conversations for follow up. This service had the capability to act as a virtual information desk and triage patients to be seen by virtual practice providers or the emergency department. Patient monitoring via Twistle was initiated on March 18, 2020 and medical students from Sidney …

A Telehealth Clinical Workflow For Academic Radiation Oncology Programs During The Covid19 Pandemic, Gregor Manukian, Md, Phd, Christian Fernandez, Md, Paul Forrest, Adam Dicker, Md, Phd, Mark D. Hurwitz, Md

Health Equity and Quality Improvement (HEQI) Summit

• COVID19 has resulted in drastic measures to decrease exposure risks within healthcare systems, with cancer patients at increased risk of infection and death (Liang. Lancet Oncol. 2020).
• Telehealth is the delivery of medical care via interactive audio and/or video telecommunication services.
• Telehealth was previously used sparingly within the department of radiation oncology but has suddenly become the preferred method of contact.
• In order to maintain quality of care, patient satisfaction, resident learning, and reimbursement, a robust telehealth clinical workflow is critical.
• Our department engaged various stakeholder to quickly develop a clinical workflow.

Initiatives In Anesthesia Workspace Hygiene During Covid-19: The Gray Airway Basin And The Epic Hand Hygiene Event, Anna Rabinowitz, Kent Berg, Daniel Casey, Dietrich Gravenstein

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

The COVID-19 Pandemic has highlighted the need for anesthesia providers to decrease workspace contamination, particularly during and after airway management.

Delineation of “clean” and “dirty” spaces in the anesthesia workplace has been historically challenging, but the heightened awareness of microbial contamination presents a new opportunity to effect behavioral change among staff.

Irradiation Of N95 Masks For Their Sterilization And Reuse During The Covid19 Pandemic, Tara Tyson, Phd, Alex Kubli, Ms, Matthew Mistro, Ms, Karen Mooney, Phd, Amy Harrison, Phd, Adam Dicker, Md, Phd

Health Equity and Quality Improvement (HEQI) Summit

Research Objective

We sought to investigate the feasibility of irradiation for N95 mask sterilization.

A Strategy For Deploying Large-Scale Volunteer Continuous Bag Valve Tube (Bvt) Ventilation, Robert Ries, Erin Jennings, Michael Velez, Caroline Komlo, Morgan Hutchinson, Md, Robert Pugliese, Pharmd, Bon Ku, Md, Mpp, Matt Fields, Md

Health Equity and Quality Improvement (HEQI) Summit

Part 1: Hospital Guide

The hospital guide outlines steps and considerations for the healthcare system to successfully implement a manual ventilation strategy

Part 2: Online BVT Training Module

We created an online articulate evidence based training module for safe and effective Bag-Valve-Tube (BVT) ventilation for medical and nonmedical providers.

Nursing And Provider Safety Checklist For Covid-19 Patients, Michele Decastro, Msn, Crnp, Jennifer Zak, Bs, Rn, Pccn, Andrew Thum, Msn, Ml, Rn-Cc, Ccctm, Kristine Meagher, Rn, Msn, Acns-Bc

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

As increasing numbers of Covid-19 patients were admitted to the hospital, multiple Med-Surg and Telemetry units were needed to provide care. All healthcare providers noted difficulty in communicating patient plans of care across multiple units and multiple teams. Providers, Clinical Nurses, and Nursing leadership all noted differences in processes for care and communication among units and teams.

Covid: Decoded - A Website, Blog, And Social Media Page With Resources And Information For The Public, Jessica Smith, Taylor Jones, Madeline Norris, Benjamin Meyers, Christopher Haines, Md

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

Information about COVID19 in the news and on social media platforms is overwhelming, confusing, riddled with jargon and sometimes straight up wrong. Makig it easy for the public to misinterpret facts or simply accept headlines and infographics at facevalue without checking with primary and/or reputable sources.

The nature of social media also allows for a perpetuation of this misinformation without recourse. Recall the one article floating around Facebook reporting that gargling salt/vinegar water could help prevent COVID19. We needede a source of simplified, reliable information about the pandemic for people outside of the health professions.

Medical students …

Expansion And Conversion Of Family Medicine And Neurohospitalist Services Into Covid-19 Services, Zachary Klock, Md, Aimee Mcmullin, Md, Jesse Edwards, Md, Christopher Haines, Md

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

• During the COVID-19 pandemic, there was an anticipated increase in the number of patients admitted with COVID-19.
• To meet the increased number of admitted patients, additional providers and teams were needed to care for hospitalized patients during the pandemic.
• Pre-existing teams needed to find ways to expand (in the case of the Family Medicine service) and repurpose (in the case of the Neurohospitalist service) in order to care for an increased number of patients.

Virtual Community Health Workers: Outreach Calls During Covid-19, Geoffrey Hayden, Md, Paula Ostroff, Rn, Ms, Emily Romano, Bs, Imani Gray-Taylor, Carl Johnson, Bs, Angelique Miller, Sharla Thomas, Ba, Gina Mccoy, Bs, Deborah Ziring, Md

Health Equity and Quality Improvement (HEQI) Summit

The “Clinical Experience” program at the Sidney Kimmel Medical College, established in 2017, provides pre-clerkship students with an opportunity to identify and address patients’ needs for social determinants of health (SDoH). The COVID-19 pandemic led to a suspension of the student program in the clinical environment, but the CHWs continued to address patients’ social needs from a remote setting. In the absence of established best practices regarding patient outreach calls from a remote setting, we sought to develop an effective workflow that would mask the CHWs’ personal cell phones while leading to fewer “unable to reach” scenarios and improved case …

Development And Implementation Of A Covid-19 Specific Peri-Operative Workflow For Anesthesia Providers, Alexander Olson, David Maguire, David Gratch, Dietrich Gravenstein, Michael Mahla, Anna Rabinowitz

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

• Needed to develop and clarify the use of PPE in the COVID-19 era
• New considerations for infection control in OR
• Unique airway equipment and filter placement considerations
• Potential shortages of equipment and medications, need for conservation
• Need to incorporate human factors principles into protocol release and procedural compliance

We realized that there was no standard protocol for these functions existing in a visually compelling graphic form for wide distribution throughout anesthesia care areas, and sought to create one.

Avoid, Delay, Shorten. Results Of Radiation Oncology’S Covid19 Patient Exposure Risk Mitigation Guidelines, Alex Kubli, Ms, Lilya Babinski, Bs, Angelia Landers, Phd, Christian Fernandez, Md, Amy Harrison, Phd

Health Equity and Quality Improvement (HEQI) Summit

We implemented evidence-based COVID19 guidelines on 3/16/20 to minimize patient exposure risks by avoiding, delaying, and shortening patient treatments when possible.

We analyzed the effectiveness of our COVID guidelines by comparing the number of new patient starts and number of treatments before and after implementation.

Our department successfully decreased patient exposure risk by reducing new prescription starts, rates of longer treatment courses, and overall number of treatment encounters in an evidence-based approach.

Expanding Care Coordination Scope To Support Covid-19 Population, Kate Behan, Cpho, Laura Gontz, Rn, Shawn Thurber, Rn, Christin Kyriss, Rn

Health Equity and Quality Improvement (HEQI) Summit

Covid-19 has caused overwhelming surges of cases in urban areas across the world. To assist with difficult discharges, as well as avoid unnecessary readmissions and ED visits, the care coordination team has created a comprehensive follow up care pathway across the enterprise to support our COVID-19 patients. This care pathway looks to assist Covid patients by reinforcing self-care management, providing education and supporting adherence with scheduled follow up with a primary care provider.

Technology was leveraged to interact virtually with patients who are quarantined at home. Jefferson Abington and Jefferson Northeast partnered with DinaCare to utilize their texting platform to …

Sars-Cov-2 Testing Guidelines For Patients Admitted To Mrh For Inpatient Rehabilitation, Deborah Cassidy, Do, Roger Liu, Do, Malav Shah, Md, Kyle Hummerston, Do, Jeanne Doherty, Md

Health Equity and Quality Improvement (HEQI) Summit

We implemented a clinical algorithmic approach with an emphasis on symptoms and risk to stratify patients into 3 groups:

• Acutely Ill COVID Rule Out/PUI
• Stable COVID Rule Out/PUI
• COVID OBS

Scrubs Tracking, Michael Saris

Health Equity and Quality Improvement (HEQI) Summit

The DICE Group repurposed an ID badge scanning app originally built for OIA to enable scrubs to be checked out then checked back in, therefore enforcing rationing limits.