Medicine and Health Sciences Commons^™

Provider Perceptions Of Virtual Reality As A Therapeutic Tool, Margaret Eberts, Christine Vincent, Tejal U. Naik, Md, Virginia O'Hayer

Phase 1

Introduction: Virtual reality (VR) shows significant potential as a healthcare tool, especially in the management of anxiety disorders and pain. However, despite recent studies demonstrating the effectiveness of VR, there continues to be limited use among providers. A lack of resources and understanding of the feasibility of clinical VR use may present a significant barrier for VR implementation. Through studying the perceptions of providers using VR clinically, this study aims to understand the achievability of VR as a standardized therapy.

Methods: Researchers distributed an online, self-administered questionnaire to healthcare providers identified on VR application websites. The questionnaire consisted of five …

Cryo Vs Rf P-Wave Characteristics Comparative Analysis, John Schanz, Waleed Khan, Behzad B. Pavri

Phase 1

Introduction: Atrial fibrillation (AF) is the leading cause of stroke. Patients with drug-refractory AF are managed with Radiofrequency (RF) or Cryoballoon (Cryo) pulmonary vein isolation (PVI). Approximately 30% of PVIs result in AF recurrences. There is clinical utility in identifying patients at higher risk of AF recurrence with readily available ECG parameters.

Methods: This retrospective study analyzed the ECG characteristics and AF recurrence of 86 paroxysmal AF patients who underwent PVI. Baseline characteristics were collected by chart review and p-wave parameters were measured with electronic calipers in the MUSE (GE) ECG database. AF recurrence was defined as any documented atrial …

Impact Of Algorithmic Bias On Hospital Risk Stratification Scores Among Insurance Recipients, Andrew Zeiger, Victoria Gulick, Tejal U. Naik

Phase 1

Introduction: Although medical schools are implementing programs to promote student scholarship, few programs exist to informally promote inter-student collaboration. Considering many medical students are early in the process of deciding what they want to spend their lives pursuing, and high levels of social connection and engagement may reduce burnout, we sought to evaluate medical students’ attitudes about inter-student collaboration.

Methods: Approximately 1000 medical students in all classes at Sidney Kimmel Medical College (SKMC) were invited to complete a questionnaire. Data collection remains active. Survey questions included a rank order choice on how respondents would use a tool to learn about …

Readmission Risk Assessment Tool For Stroke Patients, Simran Rahi, Sasha Mitts, Dominick Battistini, Tiffany D’Souza, Bryan Sadler, Krista Mar, Maureen Deprince, Deborah Murphy, Diana Tzeng, Md

Phase 1

Introduction: Strokes are one of the leading causes of morbidity and mortality in the world and its cost of management has vastly increased; an effective prediction tool that utilizes artificial intelligence to lower the rate of stroke-related readmissions has the potential to lower healthcare costs and increase the quality of provider care. We hypothesize that machine learning techniques are superior to traditional statistics when determining the likelihood of 30-day readmission for Jefferson’s stroke patients.

Methods: Jefferson’s existing data on stroke patients were cleaned, aggregated, and prepared to be split into train and test sets. Using the train sets, machine learning …

Machine Learning Models For 6-Month Survival Prediction After Surgical Resection Of Glioblastoma, Jeffrey Gray, Lohit Velagapudi, Michael Baldassari, Bryan Sadler, David Vuong

Phase 1

Introduction: The role of surgical resection for the treatment of glioblastoma multiforme is well established. Survival analysis after resective surgery in the literature comprises mostly of traditional statistical models. Machine learning models offer powerful predictive and analytical capability for varied datasets and offer improved generalizability and scalability. We analyzed survival data of patients with glioblastoma with various machine learning algorithms and compared it to binary logistic regression.

Methods: We retrospectively identified cases of glioblastoma treated with surgical resection at our institution from 2012-2018. Feature scaling and one-hot encoding was used to better fit the models to the data and used …

Patient Tolerance To Virtual Reality-Based Vestibular Rehabilitation: A Scoping Review, Michael Knapp, Tejal Naik

Phase 1

Introduction: Virtual reality-based therapy (VRBT) using head-mounted devices (HMDs) is being explored as a novel treatment modality for rehabilitation of vestibular disorders. We hypothesize there may exist unique risks and side effects to VRBT using HMDs in the vestibular patient population which no previous studies have directly explored. This scoping review compiles all currently published data concerning vestibular patient tolerance to this treatment modality and provides preliminary interpretation of overall risks.

Methods: An exhaustive list of search terms covering virtual reality, HMDs, vestibular disorders, side effects, and adverse events were submitted to six different databases. Returned papers were uploaded to …

Provider Perceptions Of Virtual Reality As A Therapeutic Tool, Christine Vincent, Margaret Eberts, Tejal U. Naik, C. Virginia O'Hayer

Phase 1

Introduction: Virtual reality (VR) can be an effective healthcare tool, particularly applied to anxiety and pain management. Despite significant interest in VR, lack of resources and knowledge regarding feasibility are barriers to implementation. This study aims to understand the current clinical usage of VR and the achievability of VR as a standardized therapy, by assessing VR healthcare providers.

Methods: An online, self-administered questionnaire with five sections—respondent demographics, VR value, onboarding, billing, and clinical use—was distributed. Providers, identified on VR application websites, were contacted via email. Inclusion criteria was providers in the United States using VR actively or in the past …

Detecting Anterior Cruciate Ligament Tears And Posterolateral Corner Injuries On Magnetic Resonance Imaging, Paul Woloszyn, Vishal Desai, Md, Simukayi Mutasa, Md, Tiffany D’Souza, Dominick Battistini, Sasha Mitts, Bryan Sadler

Phase 1

Introduction: Anterior Cruciate Ligament (ACL) tears are an extremely common orthopedic injury, with an incidence ranging from 39-52 per 100,000. Knee Magnetic Resonance Imaging (MRI) scans are the gold standard for diagnosing ACL tears and their comorbidities, such as posterolateral corner injuries; the results of these scans determine the appropriate treatment needed for patients. There is evidence that machine learning can be used to automate the detection of pathology on MRI, and we hypothesize that we can train a neural network machine learning model to accurately interpret ACL injuries and posterolateral corner injuries.

Methods: We will be analyzing over 1000 …

Creation Of A Web-Based Tool To Facilitate Community Connectivity, Peter Zdunek, Sarah Reed, Saima Anis, J. Alex Wrem

Phase 1

Introduction: Artificial intelligence-based modelling has created an opportunity to improve upon existing hospital readmission risk score systems by redefining priority and uncovering new criteria, but inherent systematic errors known as algorithmic bias can impact applicability. This study evaluated whether there is racial bias for unplanned readmission risk scores in a novel model prepared for the CMS AI challenge.

Methods: The study population provided by the CMS challenge included Medicare recipients from 2012 (unique beneficiaries n=1,667,362, total claims n=34,233,260). Risk scores for unplanned hospital readmissions were projected on the basis of clinical and demographic criteria, including age, sex, comorbidities, and prior …

Uncalibrated Chronotypes: Circadian Clocks In The Wake Of Covid-19, Nicolas Nelson, Zachary Highley-Gergel, Nicole Simone, Nikolaos Mouchtouris, Adam Dicker

Phase 1

Background: All life is attuned to Earth’s light–dark cycle. In humans, the hypothalamus calibrates the body to circadian cycles of homeostatic activity. The mechanism responsible may run shorter or longer than 24 hours, which is thought to be the basis of chronotype—an intrinsic preference for mornings or evenings. Circadian rhythms can be recalibrated by environmental cues (lighting, temperature, mealtimes) to keep the body aligned with societal time; however, chronic disruptions produce a range of adverse cognitive effects. Early COVID-19 stay-at-home conditions were unique for students because their cues no longer adhered to strict scheduling. Our objective was to determine how …

Paging: A Collection Of Short Stories, Shruthi Deivasigamani, Katherine Hubbard, Ma

Phase 1

Introduction: Paging is a series of thematically interconnected short stories that take place at a single fictional urban hospital center. The guiding questions that the stories explore are twofold: other than doctors and patients, what kinds of people spend their time in a hospital? And, what kind of place is the hospital for these people?

Methods: The background research for Paging began by exploring written works of fiction, nonfiction, and memoir set in hospitals. After I had developed a set of guiding research questions, I spent the summer at a major hospital in New York City, where I was able …

The Experience Of Intimate Partner Violence Among Pregnant Women Seeking Treatment For Opioid Use Disorder, Julia Dewey, Diane Abatemarco, Phd, Msw

Phase 1

Introduction: Intimate partner violence (IPV) is a major health issue among those with substance use disorder. A history of partner violence is associated with increased health problems and less improvement in treatment. The perinatal period is a time of increased risk of IPV for women, as well as a key opportunity for opioid use disorder treatment intervention. The purpose of this study is to characterize the experience of partner violence and evaluate the typology of sequelae associated with it in a population of pregnant women seeking medication assisted treatment for opioid use disorder.

Methods: The population of interest in this …

Lgbt Elder Initiative Thrivers Program Evaluation, Darcy Curtis, David Griffiths

Phase 1

Introduction: Aging with HIV is a critical area of study, especially as the generation that was initially affected by the disease grows older. The LGBT Elder Initiative (LGBT EI) is an organization in Philadelphia that supports and advocates for older members in the LGBT community. The LGBT EI Thrivers program is a community group that meets monthly to discuss what it means to “thrive” with HIV. The purpose of this study is to evaluate the LGBT EI’s Thrivers program and determine what motivates older individual with HIV to become involved in this program and identify the impact of the program. …

A Photovoice Project With Latino Youth In Easten North Philadelphia, Maria F. Arisi, Vincent Pepe, John Mckeegan, Caleb Dafilou, Mph, Rickie Brawer, Mph, Phd

Phase 1

Introduction: Eastern North Philadelphia is home to both the highest density Latino population in Philadelphia and some of the poorest health measures of the city. This Latino population is known to face a multitude of barriers to health, such as high rates of poverty, low educational attainment, and language barriers. There is little data showing what the self-identified priority needs of these Latino populations are, and even less showing the needs of Latino youth. Understanding how youth perceive the impact of their social and built environments can bring attention to the issues that the community needs addressed.

Methods: We conducted …

Quality Improvement Study Of Behavioral Health Resources Access In 19121 And 19132, Courtney Kaye, Rickie Brawer, Mph, Phd, Mches, Jeanne Felter, Phd, Lpc

Phase 1

Introduction: Children who have experienced four or more ACES (adverse childhood events) are shown to have negative mental health outcomes. Adolescents living in the Philadelphia zip codes 19121 and 19132 have higher ACE scores. This makes it necessary for adolescent providers to screen for behavioral health issues in their patients and refer out to appropriate resources.

Objective: The purpose of this quality improvement study is to see what current barriers exist relating to physician referral and access to behavioral health resources for their patients.

Methods: A guide of behavioral health resources available to adolescents in 19121 and 19132 was …

Health Concerns In The Juvenile Justice System In Philadelphia: An Analysis, Sarah Humrich

Phase 1

Introduction: There are more than 40,000 minors nationwide that are incarcerated, and yet there remains to be no standardized way to offer this population health care. Time spent in prison offers a unique opportunity that could allow healthcare workers to intervene, providing needed health care to an otherwise neglected population. This research seeks to better understand the healthcare offered to youth in juvenile detention centers in Philadelphia and to determine the unique health concerns of this population.

Methods: The target population of this study is the incarcerated youth in the juvenile detention centers of Philadelphia. I intend to collect data …

Constructing And Implementing A Summer Wellness Curriculum: Bridging The Gaps At Yes, Lauren Lynch, Julia Gong, Tim Massaquoi, Ma

Phase 1

Introduction: Youth experiencing homelessness lack learning experiences during the summer months, potentially leading to delinquent activities and hazardous situations. The project created and implemented a summer wellness curriculum at Youth Emergency Service (YES) that aimed to identify gaps in and educate the youth on various health and wellness topics. Daily exercise actively promoted physical wellbeing.

Methods: The curriculum aimed at a mixed group of adolescents facing homelessness integrated various educational and/or physical activities with wellness activities by YES staff and Title I programming. Activity description, cost, location, time and date, and number of attendees were recorded in a logbook. Qualitative …

Investigating Chronic Illness In Pathways To Housing Clients, Joshua Malerich, Lara Weinstein, Md, Dph

Phase 1

Approximately 553,000 individuals were homeless in the US each night in 2017, each at significant risk for substance use disorder, severe mental illness, and untreated chronic disease. Housing First (HF) is an evidence-based model for reaching high risk homeless individuals by providing a personal home to clients without the requirement for abstinence. HF has been shown as effective as other frameworks in remission of substance use, connectedness in the community, and client perceived quality of life, but there is a gap in the literature regarding the impact of HF services on clinical measures of chronic health, which could help further …

A Report From The Grndad Multi-Site Registry For Sickle Cell Disease: Iron Overload Is Under-Recognized And Under-Managed, Matthew Sears, Phd, Sophie Lanzkron, Md, Mhs, Carolyn Hoope, Md, Joshua J. Field, Md, E. Leila Jerome Clay, Md, Mcts, Faap, Susan Padrino, Md, Payal C. Desai, Md, Lynne D. Neumayr, Deepa Manwani, Md, Jane Little, Md

Phase 1

Introduction: GRNDaD is a prospective registry for people with SCD that opened to enrollment in 2016. Nine comprehensive SCD centers from across the United States are currently enrolling patients. The registry includes iron status and management data, important in SCD because chronic transfusion therapy is a mainstay of prophylactic management. Each unit of transfused blood introduces approximately 250 mg of iron into the blood, which can lead to systemic iron deposition, and untreated may lead to organ dysfunction or death.

Methods: GRNDaD currently contains prospective baseline and annual update information on approximately 1000 people with SCD. We analyzed ferritin levels …

Housing First For People With Opioid Use Disorder (Oud) And Engagement With Medication-Assisted Treatment (Mat) And Harm Reduction Services, Husayn Siddiqui, Ashley Katzenstein, Lara Weinstein, Md, Drph

Phase 1

Intro: Opioid Use Disorder (OUD)is one of the most prevalent and deadly SUD’s in the country and many barriers exist for individuals living with homelessness and concurrent psychiatric illnesses when hoping to engage in Medication-Assisted-Recovery/Treatment (MAR/MAT). The current study evaluates the Pathways to Housing PA’s (PTHPA) Housing First(HF) model which provides scatter-site housing with social and maintenance services to individuals with a history of chronic homelessness and a diagnosis of OUD.

Methods: A retrospective chart analysis was completed for to assess factors relating to MAT engagement using PTHPA’s Credible BH recording system. MAT engagement prior to HF, psychiatric, homelessness, and …

Along A River In The Wilds: A Podcast, Rhianna Hibbler, Howard Rabinowitz, Bob Motley

Phase 1

Introduction: The American urban-rural divide has been further magnified by discourse surrounding the 2016 election. Through this project we aimed to uncover stories of people from three small towns in rural north central Pennsylvania who are identifying and overcoming challenges by harnessing their region’s strengths in order to improve local social, economic, educational, and health outcomes.

Methods: Interviews were recorded with 10 local change-makers. Core topics included Community Initiatives, Education, and Healthcare, within the communities of Lock Haven, Jersey Shore, and Renovo. Edited podcast episodes are released under “Along a River in the Wilds,” available on major platforms including Apple …

Improvements On The Inhaler, Jesse Evensky, Bradley Freid, Kabir Malkani, Alex Reibstein, Gregory C. Kane, Md

Phase 1

Background: Inhalers are a commonplace in American health care and deliver crucial drugs to patients with COPD and asthma. Inhaler use has been shown to be unsatisfactory among patients resulting in ineffective medication delivery. The goal of this project was to improve the inhaler design for increased effectiveness and ease of use.

Methods: Our team first interviewed a Pulmonologist regarding patient inhaler use. Dr. Harry Kane demonstrated the proper use of an inhaler as well and described errors in inhaler use are due to patient technique. A variety of inhalers currently available were examined and were compared for ease of …

Color-Changing Device To Improve Adherence To Foley Catheter Replacement Protocols And Reduce Urinary Tract Infection Frequency, Kurt Hill, Alexander Straus, Ms, Bryn Cross, Jason M. Fields, Md

Phase 1

Background: Foley catheter-associated UTI’s (CAUTI’s) represent a driving cause of cystitis, bacteremia and sepsis in the hospital setting. Accordingly, the CDC has identified prolonged indwelling time as the foremost risk factor for CAUTI’s. However, the fundamental design of the Foley has remained unchanged for over eighty years. Hospital-specific protocols do currently exist for the removal of infection-prone catheters; however, in practice it remains commonplace for catheters to be ignored, increasing the risk of life-threatening infection. Our design process addressed this by creating a color-changing alarm device that would alert providers when a catheter has been left in beyond protocol, is …

Helping Continuing Care Retirement Communities Determine The Best Level Of Care For Each Patient, Austin Klein, Nicholas Safian, Grant Schultheis, Sopuru Ezeonu, Danielle Snyderman, Md

Phase 1

Background: The vast majority of healthcare costs are spent on the last decade of life. Older patients often have complex medical histories complicated further by physical, mental and social limitations. High levels of hospital readmittance and nonadherence further complicate care for senior adult patients. Continuing Care Retirement Communities (CCRCs) are long term care facilities that attempt to support this diverse array of problematic patients. Residents can live in several different groupings called “Levels of Care” (LOC). To maximize safety, quality of care, and patient satisfaction, it is important to place residents in the right context. This project seeks to drive …

Creating A Noise-Reducing, Wearable Intervention For Newborns In The Nicu, Mohammad Rasool, Alexandra A. Mccullough, Alison Romisher, Robert S. Pugliese, Pharmd, Bcps, Bon Ku, Md, Mpp

Phase 1

Background: Excessive auditory stimulation can have negative effects on the growth and development of newborn babies. The American Academy of Pediatrics states that newborns should not be exposed to sounds in excess of 45dB while they are in the hospital, however noise levels in NICUs across the country are often between 50-100dB. A design project was conducted to develop an intervention that could reduce infant exposure to excessive noise.

Methods: Neonatologists, nurses, audiologists, music therapists, sound designers, soft materials experts, and medical device designers were interviewed and consulted throughout the design process. A 24-hour sound recording using a REED-SD-4023 meter …

Improving The Inhaler, Kabir Malkani, Jesse Evensky, Bradley Freid, Alex Reibstein, Gregory C. Kane, Md

Phase 1

Background: It is estimated that about 1 in 10 Americans use inhalers to deliver inhaled drugs for respiratory disease such as COPD and asthma. Some studies have shown that up to 84% of people use their inhaler incorrectly, which can cause long term problems and acute flareups. Therefore, improving the inhaler design to allow for ease of use was the main focus of our project.

Methods: We had a discussion with a pulmonary critical care attending who provided information on proper patient inhaler use and common user errors. He also gave us a sample of different inhalers on the market …

Applying Design Thinking For Community-Provider Collaboration: Designing A Culture- And User-Friendly Refugee Wellness Center, Oluwatoni Okuboyejo, Ellen Solomon, Shandon Coffman, Brandon Joa, Bon Ku, Md, Mpp

Phase 1

Background: Designing South Philadelphia’s first permanent healthcare facility dedicated to immigrant and refugee health presents a unique opportunity to integrate cultural sensitivity with principles of community health. Philadelphia is a city saturated with many medical institutions and hospitals, yet there are large health disparities within miles of each other. Bringing together healthcare providers with a common goal of improving community health needs from a cultural standpoint can be tasking, even when all are on the same page. Design thinking is an underexplored perspective that has the potential to address these concerns in an efficient way that improves both provider and …

3d Printed Liver Models As A Tool To Improve Pre-Surgical Consultation And Enhance Patient Consent, Miranda Sill, Nathan Ott, Robert S. Pugliese, Pharmd, Bcps

Phase 1

Background: 3D printing has recently emerged as an effective, cost-efficient tool for healthcare innovation. We propose the fabrication of 3D printed, patient-specific liver models as a pre-surgical planning and communication tool for liver resection surgery.

Methods: Creation of the model began with the segmentation of the patient's abdominal CT scan, where specific sections of their anatomy, including the blood vessels (portal and hepatic systems), gallbladder, and tumor (when applicable), were digitally segmented. Each structure was then printed in a unique color using polylactic acid (PLA) plastic filament on an Ultimaker 5s printer. Once printed the components were arranged anatomically and …

Simulation Of Status Epilepticus Is Effective Teaching For Junior Neurology Residents, Pankhuri Jha, Navya George, Jeffrey Ratliff

Phase 1

Purpose: Status Epilepticus (SE) represents a potentially fatal neurologic emergency. At Jefferson, acute management of SE falls to the inpatient neurologist, requiring early competency.

Methods: During a 2 week educational “bootcamp”, 9 PGY2 residents participated in a 2 hour simulation of acute SE with two clinical scenarios. Scenarios included a patient with SE requiring adequate benzodiazepine dosing and another with seizures requiring IV anticonvulsant therapy. Prior to and following the simulation, residents took a survey to gauge their knowledge and confidence in managing SE.

Results and Conclusions: There was an increase in the number of residents expressing confidence in their …

Patient Interview Simulator: An Innovative Tool To Learn And Practice Clinical Medicine, Daniel Habbal, Khaled Noueihed, Gretchen Diemer

Phase 1

Purpose: There is a lack of materials for simulating and testing the medical diagnostic procedure. Studies show that this is a trend nationwide, where not enough emphasis is put on clinical skills acquisition and assessments. We have designed a simulator to supplement the integration of medical knowledge in clinical scenarios. We designed this tool to be used as an add-on to medical school curricula.

Methods: Twenty second-year medical students participated in this innovative project, as they had the necessary foundations of medical knowledge, and have not had many patient interactions yet. During the pilot study, participants played four cases regarding …