Medicine and Health Sciences Commons^™

Avoid, Accommodate, Confront Or Collaborate: Using Simulation To Teach Conflict Resolution Skills, E. Adel Herge, Otd, Otr/L, Deborah A. Hopkins, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Objective:

• Interprofessional education competencies include understanding roles & responsibilities of team members, and demonstrating effective communication and team building skills (Pardue, 2013).
• Team conflict impacts patient safety and outcomes (Knickle & McNaughton, 2009; Wagner, Liston & Miller, 2011) so effective team communication and conflict resolution in an important skill for students to develop (Greer et al., 2012; Levi, 2014).
• Simulation is effective in teaching interprofessional communication skills to health profession students (Velde, 2009).

Implementation Of A Four Year Rehabilitation Curriculum For Medical Students, Nethra S. Ankam, Md

Department of Rehabilitation Medicine Faculty Papers

In 2009 the Vice-Dean of Undergraduate Medical Education modified the 4th year curriculum by eliminating the required clerkship in Rehabilitation Medicine, and the Department was tasked with the creation of a four year curricular thread. While disappointing, this was a blessing in disguise. For years, we attempted to fit a great deal of content into an ever decreasing timespan, to increasingly disinterested students. Our teachers were also burned out with the sheer volume of students.

Through collaboration with other course directors, we inserted content where it fit the developmental needs of the students. We were also able to introduce students …

Bridging The Evidence Gap: The Role Of Fieldwork Students, Tracey Vause-Earland, Ms, Otr/L, E. Adel Herge, Otd, Otr/L, Faota

Department of Occupational Therapy Posters and Presentations

Introduction

Understanding and using evidence in practice improves health care delivery (Lugtenberg, Burgers, & Westert, 2009), reduces errors, and increases professional identity. Despite the call for increased use of evidence in occupational therapy decision making and positive attitudes of therapists toward use of evidence in practice), evidence based practice (EBP) is perceived by clinicians as time consuming and difficult due to lack of knowledge and/or resources (Humphries, et al, 2000; Bennett et al, 2003).

Evaluating The Effects Of Grasp Patterns And Grip Strength On Handwriting Skills, Jennifer Bebey, Ots, Kelsey Engelstad, Ots, Audrey Zapletal, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Background Information

• Handwriting is a critical and complex skill that school aged children acquire over time.
• When a child demonstrates handwriting difficulties, he or she may have challenges with:

Completing written school assignments in a timely fashion,

Taking notes,

Finishing homework,

Completing exams, especially short answer.

• 80% to 85% of occupational therapy referrals in schools are due to atypical grasp pattern, fine motor and handwriting concerns that affect a child’s educational performance.

Jefferson Digital Commons Quarterly Report: Jan-Mar 2014, Daniel G. Kipnis, Msi, Kelsey Duinkerken, Msi

Jefferson Digital Commons Reports

The Jefferson Digital Commons has 184 new deposits this quarter. Ending this quarter brings the total number of assets to 8,811 and a total of 1,765,509 downloads.

The most downloaded asset this quarter was: Multi-nutrient supplement improves hormone ratio associated with cancer risk. with 86 downloads registered from Jan 6, 2014 to April 1st.

In this Issue:

• Reminders
• Assorted Highlights
• New Methods for providing feedback
• Exploring the JDC Visually
• New from the Archives
• What People are Saying
• Announcements

Entire inventory of newly added assets spreadsheet located at bottom of page.

The Effect Of Breathable Under Pads To Decrease Hospital Acquired Pressure Ulcers: A Nurse Resident Project, Sara Meshino, Bsn, Rn, Bridget Trefz, Bsn, Rn

Department of Nursing papers and presentations

PURPOSE

To reduce the rate of hospital acquired pressure ulcers (HAPU), in June 2013, a large urban academic medical center switched from non-breathable to breathable under pads for incontinent patients lying on either a standard bed (low risk patients) or low-air-loss mattress (high risk patients). Standard pressure ulcer prevention measures were maintained. Staff on two oncology units sought to determine the effectiveness of breathable vs. non-breathable under pads in reducing the rate of HAPU and UAPU.

Mir-17/20 Sensitization Of Breast Cancer Cells To Chemotherapy-Induced Apoptosis Requires Akt1., Zuoren Yu, Zengguang Xu, Gabriele Disante, Jennifer Wright, Min Wang, Yuan Li, Qian Zhao, Tao Ren, Xiaoming Ju, Ellen Gutman, Guangxue Wang, Sankar Addya, Tieyan Li, Zhendong Xiang, Chenguang Wang, Xiongfei Yang, Xiaolai Yang, Richard Pestell

Department of Cancer Biology Faculty Papers

The serine threonine kinase Akt1 has been implicated in the control of cellular metabolism, survival and growth. Herein, disruption of the ubiquitously expressed member of the Akt family of genes, Akt1, in the mouse, demonstrates a requirement for Akt1 in miRNA-mediated cellular apoptosis. The miR-17/20 cluster is known to inhibit breast cancer cellular proliferation through G1/S cell cycle arrest via binding to the cyclin D1 3'UTR. Here we show that miR-17/20 overexpression sensitizes cells to apoptosis induced by either Doxorubicin or UV irradiation in MCF-7 cells via Akt1. miR-17/20 mediates apoptosis via increased p53 expression which promotes Akt degradation. Akt1-/- …

A Long-Term Study Of The Effects Of Antiviral Therapy On Survival Of Patients With Hbv-Associated Hepatocellular Carcinoma (Hcc) Following Local Tumor Ablation., Hie-Won Hann, Robert Coben, Daniel Brown, Laurence Needleman, Ernest Rosato, Albert Min, Richard Hann, Kyong Bin Park, Stephen Dunn, Anthony J. Dimarino

Department of Medicine Faculty Papers

The ultimate goal of antiviral therapy for chronic hepatitis B (CHB) is prevention of hepatocellular carcinoma (HCC). Earlier we reported favorable effects of antiviral therapy on survival of HCC patients following curative tumor ablation (Int J Cancer online 14 April 2010; doi: 10.1002/ijc.25382). It was the first observation made in the United States. We now report 12 year follow-up of this patient group. CHB patients with no prior antiviral therapy with a single HCC (≤ 7 cm) were studied. All patients underwent local tumor ablation as their first option. Patients diagnosed before 1999 received no antiviral treatment while those diagnosed …

Interleukin-7-Dependent B Lymphocytes Are Required For The Anti-Pneumococcal Polysaccharide Response And Protective Immunity To Streptococcus Pneumoniae, Gregory S. Dickinson, Phd, Raja Vuyyuru, Timothy L. Manser, Phd, John F. Kerney, Kishore Alugupalli, Phd

Department of Microbiology and Immunology Faculty Papers

Unlike human adults or adult mice, young children or young mice respond poorly to pneumococcal polysaccharides (PPS). In mice, B1b lymphocytes are the major responders to a variety of bacterial polysaccharides including PPS. Despite having B1b cells, young mice are severely impaired in responding to PPS, suggesting that B cells in the young are distinct from those in adults. Since B lymphopoeisis early in life is largely Interleukin-7 (IL-7)-independent, while in adults it is IL-7-dependent, we hypothesize that B cells developed in the presence of IL-7 are required for generating anti-PPS antibody responses. In support of this, we found that …

Implementation Of A Residency Twitter Account To Provide Curricular Enrichment, Bryan Lebude, Md, Subhashini Appulingam Sellers, Md, Gretchen Diemer, Md, Facp

Department of Medicine Faculty Papers

Background

_{The Problem}

_{With the goals of improving patient safety and resident well-being, the ACGME’s 2011 revision of duty-hour requirements included a 16-hour limit on continuous duty hours for postgraduate year 1 (PGY-1) trainees, increased supervision for junior trainees, as well as mandated rest periods between duty hours.1 These rules place limitations on the ability of trainees to attend scheduled educational activities during standard work hours; a recent study showed a decrease in resident availability for teaching conferences compared with the 2003 duty hour regulations.2 Residency training programs must develop alternative avenues for education and encouraging inquiry outside of traditional …}

Usefulness Of Highly Sensitive Afp-L3 And Dcp In Surveillance For Hepatocellular Carcinoma In Patients With A Normal Alpha-Fetoprotein, Hie-Won Hann, Dave Li, Hiroyuki Yamada, Shinji Satomura, Robert Coben, Anthony J. Dimarino

Department of Medicine Faculty Papers

Background and aims: Early detection of Hepatocellular Carcinoma (HCC) is crucial for effective management. Incidence of HCC has increased in the United States largely attributed to hepatitis B and C virus. Lens culinaris agglutinin-reactive Alpha-Fetoprotein (AFP-L3) and Des-Gamma-Carboxy Prothrombin (DCP) are being recognized specific biomarkers for HCC.

Methods: We measured AFP-L3 and DCP in serial serum specimens of a cohort of chronic hepatitis patients on HCC surveillance and compared these markers to abdominal imaging. Among fifty patients who developed HCC during surveillance, 30 were included in the study with available sera 1-2 years before, at diagnosis and post ablation of …

Exploration And Confirmation Of The Latent Variable Structure Of The Jefferson Scale Of Empathy., Mohammadreza Hojat, Marianna Lanoue

Department of Psychiatry and Human Behavior Faculty Papers

OBJECTIVE: To reaffirm the underlying components of the JSE by using exploratory factor analysis (EFA), and to confirm its latent variable structure by using confirmatory factor analysis (CFA).

METHODS: Research participants included 2,612 medical students who entered Jefferson Medical College between 2002 and 2012. This sample was divided into two groups: Matriculants between 2002 and 2007 (n=1,380) and be-tween 2008 and 2012 (n=1,232). Data for 2002-2007 matriculants were subjected to EFA (principal component factor extraction), and data for matriculants of 2008-2012 were used for CFA (structural equation modeling, and root mean square error for approximation.

RESULTS: The EFA resulted in …

Wandering Acute Myocardial Infarction., Kamal R. Joshi, D Lynn Morris, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Incorrect electrode placement or cable connection during electrocardiographic (ECG) recording can significantly alter the ECG morphology. We report a case of ST-segment elevation myocardial infarction causing a diagnostic dilemma due to cable interchange.

Metformin Inhibits Androgen-Induced Igf-Ir Up-Regulation In Prostate Cancer Cells By Disrupting Membrane-Initiated Androgen Signaling., Roberta Malaguarnera, Antonella Sacco, Alaide Morcavallo, Sebastiano Squatrito, Antimo Migliaccio, Andrea Morrione, Marcello Maggiolini, Antonino Belfiore

Department of Urology Faculty Papers

We have previously demonstrated that, in prostate cancer cells, androgens up-regulate IGF-I receptor (IGF-IR) by inducing cAMP-response element-binding protein (CREB) activation and CREB-dependent IGF-IR gene transcription through androgen receptor (AR)-dependent membrane-initiated effects. This IGF-IR up-regulation is not blocked by classical antiandrogens and sensitizes cells to IGF-I-induced biological effects. Metformin exerts complex antitumoral functions in various models and may inhibit CREB activation in hepatocytes. We, therefore, evaluated whether metformin may affect androgen-dependent IGF-IR up-regulation. In the AR(+) LNCaP prostate cancer cells, we found that metformin inhibits androgen-induced CRE activity and IGF-IR gene transcription. CRE activity requires the formation of a CREB-CREB …

Tumor Radiation Therapy Creates Therapeutic Vaccine Responses To The Colorectal Cancer Antigen Gucy2c., Matthew Witek, Erik S Blomain, Michael Sullivan Magee, Bo Xiang, Scott A Waldman, Adam E. Snook

Department of Pharmacology and Experimental Therapeutics Faculty Papers

PURPOSE: Radiation therapy (RT) is thought to produce clinical responses in cancer patients, not only through direct toxicity to cancer cells and supporting tumor stroma cells, but also through activation of immunologic effectors. More recently, RT has potentiated the local and systemic effects of cancer immunotherapy (IT). However, combination regimens that maximize immunologic and clinical efficacy remain undefined.

METHODS AND MATERIALS: We evaluated the impact of local RT on adenoviral-mediated vaccination against the colorectal cancer antigen GUCY2C (Ad5-GUCY2C) in a murine subcutaneous tumor model using mouse CT26 colon cancer cells (CT26-GUCY2C). Immune responses were assessed by ELISpot, and clinical responses …

Jeffhope News-Summer 2014

JeffHOPE News

Issue includes:

• Question of the Day
• Creating an Education Program at Mercy
• The Impact of a Simple Intervention
• Reevaluating Our Population's Needs
• JeffHOPE Goes Electronic EMR at Clinic

Architecture Of Viral Genome-Delivery Molecular Machines., Anshul Bhardwaj, Adam S. Olia, Gino Cingolani

Department of Biochemistry and Molecular Biology Faculty Papers

From the abyss of the ocean to the human gut, bacterial viruses (or bacteriophages) have colonized all ecosystems of the planet earth and evolved in sync with their bacterial hosts. Over 95% of bacteriophages have a tail that varies greatly in length and complexity. The tail complex interrupts the icosahedral capsid symmetry and provides both an entry for viral genome-packaging during replication and an exit for genome-ejection during infection. Here, we review recent progress in deciphering the structure, assembly and conformational dynamics of viral genome-delivery tail machines. We focus on the bacteriophages P22 and T7, two well-studied members of the …

Hematopoietic Cell Transplant Co-Morbidity Index (Hct-Ci): Ability To Predict Outcomes In Haploidentical (Hi) Hematopoietic Stem Cell Transplantation (Hsct), Neil D. Palmisiano, Md, Sameh Gaballa, Md, Onder Alpdogan, Matthew Carabasi, Md, Joanne Filicko-O'Hara, Md, Margaret Kasner, Md, Ubaldo E. Martinez-Outshoorn, Md, John L. Wagner, Md, Mark Weiss, Md, Neal Flomenberg, Md, Dolores Grosso, Dnp

Department of Medical Oncology Faculty Papers

Introduction

We developed a 2 step approach to HI HSCT in which a fixed dose of allogeneic T cells are infused after reduced intensity (RIC) or myeloablative conditioning (HSCT step 1). After 2-3 days, cyclophosphamide (CY) 60 mg/kg/d x 2 is given to establish bidirectional tolerance. One day after the CY, a CD 34 selected stem cell product is infused (HSCT step 2).

This approach has been associated with a low incidence of non-relapse mortality (NRM) resulting in a significant improvement in overall survival (OS) in patients (pts) undergoing HI HSCT at our institution. This abstract examined the predictability of …

Outcomes Of Older Patients Undergoing 2-Step Approach To Haploidentical And Matched Related Peripheral Blood Hematopoietic Stem Cell Transplantation (Hsct): A Single Institutional Experience, Sameh Gaballa, Md, Seyfettin Onder Alpdogan, Md, Matthew Carabasi, Md, Joanne Filicko-O'Hara, Md, Margaret Kasner, Md, Benjamin E Leiby, Phd, Ubaldo E. Martinez-Outshoorn, Md, Edward C Pequignot, Md, Sarah Rosado, Shannon Rudolph, Ms, John L Wagner, Md, Mark Weiss, Md, Neal Flomenberg, Md, Dolores Grosso, Dnp

Department of Medical Oncology Faculty Papers

Introduction:

HSCT is a curative option for many patients (pts) with hematological malignancies.

Significant advances in supportive care and conditioning regimens over the past decade have allowed the extension of this therapy to older individuals.

Information regarding the outcomes of this older subset of pts undergoing HSCT is limited, especially those undergoing haploidential (HI) HSCT.

Objectives:

To describe the outcomes of patients 60 years of age or older undergoing haploidential and matched related (MR) HSCT using the 2-step approach.

Underutilization Of Statins And Aspirin Following Coronary Artery Bypass Graft Surgery, Kevin M. Curl, Md, Bryan Lebude, Md, Nicholas Ruggiero, Md, D L Fischman, Md, Andrew Rose, Md, Sulay Patel, Md, J. David Ogilby, Md, Paul Walinsky, Md, Babu Jasti, Md, Michael P. Savage, Md

Division of Cardiology Faculty Papers

Introduction

Coronary artery bypass graft (CABG) surgery continues to be an important procedure for the treatment of coronary artery disease. However, clinically significant stenoses and complete bypass graft occlusion rates remain high, especially among saphenous vein grafts1. This is associated with significant morbidity and mortality. Both statin medications and aspirin have been shown in numerous clinical trials to play an important role in the medical management of coronary artery disease following CABG surgery. As per the ACC/AHA guidelines, both statin medications and aspirin have class I indications to support their use indefinitely following CABG, unless contraindication exists2. Long term studies …

Physiology And Advancements In Wound Healing, Adam Baker, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Outline of presentation:

Fundamentals

Advances

• -Growth Factors
• -Platelet Rich Plasma
• -Engineered skin
• -Hyperbaric Oxygen Therapy

Research

Inputs Drive Cell Phenotype Variability., James Park, Anthony Brureau, Kate Kernan, Alexandria Starks, Sonali Gulati, Babatunde Ogunnaike, James S. Schwaber, Rajanikanth Vadigepalli

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

What is the significance of the extensive variability observed in individual members of a single-cell phenotype? This question is particularly relevant to the highly differentiated organization of the brain. In this study, for the first time, we analyze the in vivo variability within a neuronal phenotype in terms of input type. We developed a large-scale gene-expression data set from several hundred single brainstem neurons selected on the basis of their specific synaptic input types. The results show a surprising organizational structure in which neuronal variability aligned with input type along a continuum of sub-phenotypes and corresponding gene regulatory modules. Correlations …

Current Pathophysiological Concepts In Cerebral Small Vessel Disease., Fred Rincon, Clinton B Wright

Department of Neurology Faculty Papers

The association between cerebral small vessel disease (SVD) - in the form of white matter lesions, infarctions, and hemorrhages - with vascular cognitive impairment (VCI), has mostly been deduced from observational studies. Pathological conditions affecting the small vessels of the brain and leading to SVD have suggested plausible molecular mechanisms involved in vascular damage and their impact on brain function. However, much still needs to be clarified in understanding the pathophysiology of VCI, the role of neurodegenerative processes such as Alzheimer's disease, and the impact of aging itself. In addition, both genetic predispositions and environmental exposures may potentiate the development …

Aging Aggravates Nitrate-Mediated Ros/Rns Changes., Qian Fan, Lifen Chen, Shujuan Cheng, Fang Li, Wayne Bond Lau, Le Feng Wang, Jing Hua Liu

Department of Emergency Medicine Faculty Papers

Nitrates are the most frequently prescribed and utilized drugs worldwide. The elderly are a major population receiving nitrate therapy. Both nitrates and aging can increase in vivo reactive oxygen species (ROS) and reactive nitrogen species (RNS). To date, the effects of aging upon nitrate-induced ROS/RNS alteration are unknown. The present study tested the effects of aging upon nitrate-induced ROS/RNS alteration in vivo. 32 adults and 43 elderly unstable angina (UA) patients were subjected to 48 hours of isosorbide dinitrate intravenous injection (50  μg/minutes) in this clinical study. Blood samples were obtained at baseline and conclusion. Outcome measures of oxidative stress …

Yoga Therapy For Irritable Bowl Syndrome: Integrative Medicine Grand Rounds, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

Please join us for Integrative Medicine Grand Rounds on Tuesday, April 1, 2014 in 925 Chestnut Street, 2nd floor conference room from 8:00-9:00 am. Please note the venue for this exciting program. Senthamil R. Selvan, Ph.D.. is presenting and the title of his presentation is: “Yoga Therapy for Irritable Bowl Syndrome: Interim Results of a Randomized Control Study.”

Isoform- And Species-Specific Control Of Inositol 1,4,5-Trisphosphate (Ip3) Receptors By Reactive Oxygen Species., Száva Bánsághi, Tünde Golenár, Muniswamy Madesh, György Csordás, Satish P. Ramachandrarao, Kumar Sharma, David I Yule, Suresh K Joseph, György Hajnóczky

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Reactive oxygen species (ROS) stimulate cytoplasmic [Ca(2+)] ([Ca(2+)]c) signaling, but the exact role of the IP3 receptors (IP3R) in this process remains unclear. IP3Rs serve as a potential target of ROS produced by both ER and mitochondrial enzymes, which might locally expose IP3Rs at the ER-mitochondrial associations. Also, IP3Rs contain multiple reactive thiols, common molecular targets of ROS. Therefore, we have examined the effect of superoxide anion (O2) on IP3R-mediated Ca(2+) signaling. In human HepG2, rat RBL-2H3, and chicken DT40 cells, we observed [Ca(2+)]c spikes and frequency-modulated oscillations evoked by a O2 donor, xanthine (X) + xanthine oxidase (XO), dose-dependently. …

Common And Specific Impairments In Attention Functioning In Girls With Chromosome 22q11.2 Deletion, Fragile X Or Turner Syndromes., Andrea I Quintero, Elliott A Beaton, Danielle J Harvey, Judith L. Ross, Tony J Simon

Department of Pediatrics Faculty Papers

BACKGROUND: Chromosome 22q11.2 deletion syndrome (22q11.2DS), fragile X syndrome (FXS), and Turner syndrome (TS) are complex and variable developmental syndromes caused by different genetic abnormalities; yet, they share similar cognitive impairments in the domains of numbers, space, and time. The atypical development of foundational neural networks that underpin the attentional system is thought to result in further impairments in higher-order cognitive functions. The current study investigates whether children with similar higher-order cognitive impairments but different genetic disorders also show similar impairments in alerting, orienting, and executive control of attention.

METHODS: Girls with 22q11.2DS, FXS, or TS and typically developing (TD) …

Therapy Optimization In Multiple Sclerosis: A Prospective Observational Study Of Therapy Compliance And Outcomes., Patricia K Coyle, Bruce A Cohen, Thomas P. Leist, Clyde Markowitz, Merrikay Oleen-Burkey, Marc Schwartz, Mark J Tullman, Howard Zwibel

Department of Neurology Faculty Papers

BACKGROUND: Data sources for MS research are numerous but rarely provide an objective measure of drug therapy compliance coupled with patient-reported health outcomes. The objective of this paper is to describe the methods and baseline characteristics of the Therapy Optimization in MS (TOP MS) study designed to investigate the relationship between disease-modifying therapy compliance and health outcomes.

METHODS: TOP MS was designed as a prospective, observational, nationwide patient-focused study using an internet portal for data entry. The protocol was reviewed and approved by Sterling IRB. The study was registered with ClinicalTrials.gov. It captured structured survey data monthly from MS patients …

Empathy, Self-Reflection, And Curriculum Choice, Suely Grosseman, Mohammadreza Hojat, Pamela M. Duke, Stewart Mennin, Stephen Rosenzweig, Dennis Novack

Department of Psychiatry and Human Behavior Faculty Papers

We administered the Jefferson Scale of Empathy and the Groningen Reflection Ability Scale to 61 of 64 entering medical students who self-selected a problem-based learning curricular track and to 163 of 198 who self-selected a lecture-based track (response rates of 95.3% and 82.3%, respectively, with no statistically significant differences in mean age or sex). Mean empathy and self-reflection ability scores were significantly higher among students who chose problem-based learning. Women scored higher than men in empathy. Women choosing problem-based learning had the highest empathy scores. Studies comparing students’ performance and achievements in different curricular tracks should consider differences in personal …

Patient Characteristics And Predictors Of Mortality Associated With Pericardial Decompression Syndrome, Rajesh Pradhan, Md, Toshimasa Okabe, Md, Kazuki Yoshida, Md, Dimitrios Angouras, Md, Matthew Decaro, Md, Gregary D. Marhefka, Md

Division of Cardiology Faculty Papers

Pericardial decompression syndrome is a rare complication of pericardiocentesis and surgical drainage of pericardial effusion with a high morality rate. The minimum amount of drained effusion in our serious was 450 ml. Surgical drainage was associated with a higher mortality rate.