Medicine and Health Sciences Commons^™

Quality Management Across The Continuum Of Care In Orthopedics, James F. Pelegano Md, Ms

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Amsa Patient Safety And Quality Symposium, Preyanka Makadia Do Candidate, Class Of 2013

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Impact Of Culture And A Performance Improvement Framework On The "Superior Care Experience" At Main Line Health System, Denise M. Murphy Rn, Mph, Cic, Jessica Lampley Mha

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Innovation And Collaboration In The New Health Care Ecosystem, David B. Nash Md, Mba, Alexis Skoufalos Edd

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Metabolic Syndrome And Migraine., Amit Sachdev, Michael J Marmura

Department of Jefferson Headache Center Papers and Presentations

Migraine and metabolic syndrome are highly prevalent and costly conditions. The two conditions coexist, but it is unclear what relationship may exist between the two processes. Metabolic syndrome involves a number of findings, including insulin resistance, systemic hypertension, obesity, a proinflammatory state, and a prothrombotic state. Only one study addresses migraine in metabolic syndrome, finding significant differences in the presentation of metabolic syndrome in migraineurs. However, controversy exists regarding the contribution of each individual risk factor to migraine pathogenesis and prevalence. It is unclear what treatment implications, if any, exist as a result of the concomitant diagnosis of migraine and …

The Fear Factor In Takotsubo Cardiomyopathy: A Retrospective Cohort Study, Lex Denysenko, Md, Robin Hanson, Md, Jessica Mosier, Md, Ethan J. Halpern, Md

Department of Psychiatry and Human Behavior Faculty Papers

Presented at: Academy of Psychosomatic Medicine in Atlanta Georgia.

BACKGROUND

•Takotsubo cardiomyopathy (TCM) is a transient, reversible acute cardiac syndrome that mimics acute MI

•Reportedly frequently precipitated by an emotionally stressful event

•Excessive catecholamine release is a possible pathophysiologic mechanism¹

•Prevalence of anxiety and mood disorders in TCM patients varies among studies, ranging from 21-40%^2,3

Exploring The Depths Of Health Literacy Are We Teaching This And Why Does It Matter?, Susan Toth-Cohen, Phd, Otr/L, Tracey Vause-Earland, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Background: Why does Health Literacy Matter?

• Healthcare practitioners often work with older persons with low health literacy without realizing that this issues limiting the success of their interventions. They may also lack awareness of the serious impact that low health literacy can have, since it is associated with lower reported health status, increased hospitalizations, and increased morbidity (Levasseur & Carrier, 2011).
• The current US healthcare system places increase demands on consumers to manage their own health (Smith & Gutman, 2011).
• Educators in the health professions must instill a sense of responsibility in future practitioners to understand the important role they …

Venoarterial Extracorporeal Membrane Oxygenation (Ecmo) For Support During Whole Lung Lavage For Pulmonary Alveolar Proteinosis., Hitoshi Hirose, Julie Monteagudo, Nicholas C. Cavarocchi, Boyd Hehn, Naveed Hasan

Department of Surgery Faculty Papers

INTRODUCTION ECMO as support during whole lung lavage (WLL) for pulmonary alveolar proteinosis is reserved for severe cases where oxygenation is inadequate to support the patient using the ventilator alone. While most publications describe a venovenous cannulation with variable results we present a successful case using venoarterial cannulation and discuss the potential benefits of this mode of ECMO support. CASE PRESENTATION We present the case of a 44 year old female with a past medical history of Behcets disease and a BMI of 37 who was diagnosed with pulmonary alveolar proteinosis (PAP) on a lung biopsy after presenting with dyspnea. …

Novel Approach To Monitoring Renal Perfusion With The Use Of Continuous Renal Oximetery In The Setting Of Aortic Dissection, Hitoshi Hirose, Philip Batista, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

INTRODUCTION: Aortic dissections commonly extend beyond the renal arteries with varying effects ranging from asymptomatic to renal failure. We report a case of aortic dissection with initial renal compromise, which was continuously monitored utilizing direct renal oximetry for evaluation of real-time renal perfusion and function. CASE PRESENTATION: A 65 year-old female with a long history of uncontrolled hypertension presented with acute retrosternal chest pain radiating to the back for 12 hours. She was in stable condition except for a serum creatinine of 1.6mg/dl. Magnetic resonance angiography (MRA) demonstrated a type A dissection extending from the aortic root to the left …

Sternal Pain After Rigid Fixation: A Pilot Study Of Randomization Rigid Vs Conventional Wire Closure., Hitoshi Hirose, Hong Mun Kong, Shigeki Tabata, Kentaro Yamane, Margaret Lusardi, Linda J. Bogar, James Diehl

Department of Surgery Faculty Papers

Objective: Rigid sternal fixation may provide better sternal closure than conventional sternal wire closure. We performed a prospective randomized study to investigate if rigid closure reduces postoperative sternal pain. Methods: Patients undergoing CABG ± valve surgery between July 2011 and January 2012 were prospectively randomized into conventional wire closure (group C) or rigid fixation using sternal plates (group R). Pain scores were determined at 6 AM using a numeric rating scale (0 no pain, 5 moderate pain, 10 worst possible pain). Narcotic pain medication requirement from day 1 to 5 was collected and converted into intravenous morphine equivalent. Results: Among …

Fate Of The Lower Extremity In Patients With Va-Ecmo Via Femoral Cannulation, Hitoshi Hirose, Kathleen Lamb, Neil Moudgill, Paul Dimuzio, Megan Mccullough, Pawel Karbowski, Atul Rao, Nicholas Cavarocchi, Joshua Eisenberg

Department of Surgery Faculty Papers

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a salvage therapy in patients with severe cardiopulmonary failure. Femoral cannulation is associated with limb complications including ischemia, limb loss, arterial infections and wound infections. This study aims to evaluate these complications and management related to successful outcomes. Methods: A retrospective review was conducted in 17 patients requiring VA- ECMO support via femoral cannulation from 1/ 2010 till 4/2012. After cannulation, all patients had near infared spectroscopy (NIRS) monitoring after cannula placement and most had placement of distal arterial perfusion catheters (DPC). At decannulation, all patients had femoral cutdown with closure of arteriotomies …

Percutaneous Gastrostomy (Peg) Tube Placement In Patients With Continuous Flow Left Ventricular Assist Device. (Lvad)., Hitoshi Hirose, Chris Rizzi, Linda Bogar, Jay S. Jenoff, Nicholas Cavarocchi

Department of Surgery Faculty Papers

Percutaneous gastrostomy (PEG) tube placement in patients with continuous flow left ventricular assist device. (LVAD). CHRIS RIZZI, BS, Linda Bogar, MD, Jay Jenoff, MD, Nicholas Cavarocchi, MD, Hitoshi Hirose, MD. Department of Surgery, Thomas Jefferson University, Philadelphia, PA. Introduction: Inadequate nutritional support after LVAD placement is known to increase postoperative infections and to decrease survival. The LVAD patients with complicated postoperative recovery requiring prolonged mechanical ventilation may require long-term tube feedings. Placement of a PEG requires knowledge of the location of the LVAD pocket and driveline to avoid device infection and injury. Methods: Between August 2008 and December 2011, 39 …

Successful Liver Failure Management Using Molecular Adsorbents Recirculating System During Complicated Veno-Arterial Extracorporeal Membrane Oxygenation As A Bridge To A Left Ventricular Assist Device Placement, Hitoshi Hirose, Shigeki Tabata, Nicholas Cavarocchi

Department of Surgery Faculty Papers

Successful liver failure management using molecular adsorbents recirculating system during complicated veno-arterial extracorporeal membrane oxygenation as a bridge to a left ventricular assist device placement. SHIGEKI TABATA, MD, Nicholas Cavarocchi, MD, Hitoshi Hirose, MD. Department of Surgery, Division of Cardiothoracic Surgery Thomas Jefferson University Hospital, Philadelphia, PA Introduction: Extracorporeal membrane oxygenation (ECMO) is a well-established therapy for the patients with cardiogenic shock. We present a patient who developed severe complications while on ECMO. Case presentation: A 49-year-old female presented with severe heart failure and was placed on veno-arterial ECMO for bridge to decision. While on ECMO, the patient developed massive …

Recovery Of End-Organs And Improved Mortality In Adult Patient On Ecmo., Hitoshi Hirose, Joshua Wong, Vei Shaun Siow, Thomas N. Smith, Harrsion Pitcher, Linda Bogar, Nicholas C. Carvarocchi

Department of Surgery Faculty Papers

Title: Recovery of End-Organs and Improved Mortality in Adult Patients on ECMO Joshua K Wong, BS1, Vei Shaun Siow, BS1, Thomas N Smith, BS1, Harrison Pitcher, MD2, Linda Bogar, MD2, Hitoshi Hirose, MD2 and Nicholas C Cavarocchi, MD2. 1Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States, 19107 and 2Division of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States, 19107. Body: With increasing use of ECMO in adults, we seek to objectively measure End-Organ recovery and correlate intensive care mortality scores and complications with patient survival. This is a retrospective review of patients who were placed on …

Efficacy Of Miniaturized Imacor Trans-Esophageal Echocardiografm (Tee) Prove In Mechanical Circulatory Support., Hitoshi Hirose, Christopher Y. Kang, Joshua K. Wong, Harrison T. Pitcher, Caitlyn M. Johnson, Konrad Sarosiek, Linda J Bogar, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

Application of the miniaturized ImaCor Trans-Esophageal Echocardiogram (TEE) probe in Heart Transplant/Mechanical Cardiac Support Patients In the surgical cardiac care unit (SCCU), therapeutic interventions often need to be done at the bedside, necessitating the need for a rapidly employable diagnostic tool for the cardiac intensivist. We report the clinical utility of the miniature ImaCor TEE-probe in guiding management of post heart transplant (H-Txp) and mechanical cardiac support patients (MCS) and describe the economic benefit of such a device. This is an IRB approved retrospective review of MCS/H-Txp patients who had ImaCor TEE monitoring in the SCCU of our institution in …

An Old Problem With A New Therapy: Gi Bleeding In Vad Patients And Deep Bowel Enteroscopy (Double Balloon. Spiral Enteroscopy)., Hitoshi Hirose, Konrad Sarosiek, Linda Bogar, Pitcher Harrison, Barbara Ebert, Nicholas Cavarocchi

Department of Surgery Faculty Papers

An old problem with a new therapy: GI Bleeding in VAD patients and deep bowel enteroscopy (Spiral and Double Balloon Enteroscopy) Purpose: Evidence suggests that patients treated with non-pulsatile ventricular assist devices (VAD) are at an increased risk for gastrointestinal bleeding (GIB) beyond what is expected from routine anticoagulation. Diagnostic and treatment algorithms are currently undefined. We reviewed our experience of GIB in VAD patients and propose a new algorithm utilizing deep bowel enteroscopy (DBE) aimed to speed diagnosis and limit transfusions. (471) Methods & Procedures From 2004 to 2011, we studied 62 patients who received a non-pulsatile VAD at …

Correlation Between Adherence To A Ventilator Weaning Protocol And Successful Extubations In An Intensive Care Nursery, James Gibson, Bs, Rrt, Brian Glynn, Bs, Rrt, Ursula Nawab, Md, Erin Mcdermott

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

Presented at: American Association of Respiratory Care.

Background

Chronic lung disease (CLD) is a multi-factorial respiratory disease of the preterm neonate for which mechanical ventilation is a significant contributor. Mechanical ventilator weaning protocols have been shown to reduce the duration of mechanical ventilation. A ventilator weaning protocol (VWP) based on Level I-III evidence was instituted in 2004. Compliance with existing VWP is unknown. CLD rates in our unit have increased over the past 3 years. Assessment of and understanding protocol compliance is an important first step in identifying internal factors which may contribute to CLD. Based on increasing rates of …

Activating Healthcare Advocates: A Collaboration Between Npa And The Ihi Open School, Ashlee Goldsmith, Md, Valerie Pracilio, Mph, Cpps

Department of Rehabilitation Medicine Faculty Papers

Presented at: National Physician's Alliance National Conference in Alexandria Virginia.

AIM

To facilitate opportunities for interdisciplinary learning and aligning the missions of the two organizations, we organized an educational program for current and future healthcare professionals focused on the relationship between quality and cost using the Top 5 lists to promote good stewardship in clinical practice, initially developed by the NPA, as a tool to initiate collaboration.

Development Of A Competency-Based Transplant Hepatology Fellowship, Steven K. Herrine, Andrew P. Keaveny, Ayman Abdel-Latif Koteish, Richard K. Sterling, John R. Lake

Division of Gastroenterology and Hepatology Faculty Papers

Presented at 63rd annual meeting AASLD, The Liver Meeting, Boston MA, November 9-13, 2012.

Purpose: The Accreditation Council for Graduate Medical Education (ACGME) next accreditation system (NAS) provides incentive for medical educators to understand and implement competency-based medical education (CBME) training and assessment in their programs. Noting decreasing enrollees for the American Board of Internal Medicine (ABIM) Transplant Hepatology (TH) exam, workforce concerns in TH, and questionnaire data from Gastroenterology (GI) fellows and Program Directors (PDs), we developed an ABIM-approved one-year competency-based TH pilot program.

Aplastic Anemia Post Liver Transplant Due To Graft-Versus-Host Disease, Ping Gong, Md, Jerald Z. Gong, Md

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

Poster presented at: American society for clinical pathology (ASCP) conference 2012, Boston MA, USA.

Introduction:

The patient was a 64-year-old male presented with a 2 day history of increasing fevers and altered mental status. He underwent orthotopic liver transplant for cryptogenic cirrhosis, probably secondary to non-alcoholic steatohepatitis, 45 days before. The head and neck imaging showed pancytopenia with WBC 0.6 x 109 /L., hemoglobin 6.8 g/dl and platelet 29 x 109 /L.

Effects Of Scleroderma Antibodies And Pooled Human Immunoglobulin On Anal Sphincter And Colonic Smooth Muscle Function., Jagmohan Singh, Sidney Cohen, Vaibhav Mehendiratta, Fabian A. Mendoza, Sergio A. Jimenez, Anthony J. Dimarino, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND & AIMS: Patients with systemic sclerosis (SSc) have impairments in gastrointestinal smooth muscle function. The disorder has been associated with circulating antibodies to cholinergic muscarinic the type-3 receptor (M(3)-R). We investigated whether it is possible to neutralize these antibodies with pooled human IgGs (pooledhIgG).

METHODS: We studied the effects of IgGs purified from patients with SSc (SScIgGs) on cholinergic nerve stimulation in rat colon tissues. We also examined the effects of SScIgGs on M(3)-R activation by bethanechol (BeCh), M(3)-R occupancy, and receptor binding using immunofluorescence, immunoblot, and enzyme-linked immunosorbent analyses of human internal anal sphincter (IAS) smooth muscle cells, …

John Y. Templeton Iii: Pioneer Of Modern Cardiothoracic Surgery., Jing Li, B.S., Herbert E. Cohn, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

John Young Templeton III was born in 1917 in Portsmouth, Virginia, and graduated from Jefferson Medical College in 1941. He completed his residency training under Dr. John H. Gibbon, Jr., and was the first resident who worked on Gibbon's heart-lung machine. After his training, he remained at Jefferson as an American Cancer Society fellow and Damon Runyon fellow and went on to become the fourth Samuel D. Gross Professor and Chair of the Department of Surgery in 1967. Dr. Templeton was the recipient of numerous grants and published over 80 papers in the field of cardiothoracic surgery. As a teacher …

Initial Experience With Imacor Htee-Guided Management Of Patients Following Transplant And Mechanical Circulatory Support., Christopher Kang, Hitoshi Hirose, Harold Hasting

Department of Cancer Biology Faculty Papers

We reviewed an initial experience using a miniaturized transesophageal echocardiography (TEE) probe (ImaCor, Garden City, NY) with 3 patients in whom Imacor hTEE intervention was used as a point of care device to manage extracorporeal membrane oxygenation cannula placement, cardiac hemodynamics, and post-op cardiac pathophysiology. The management of transplant or mechanical circulatory support (MCS) patients is especially challenging: transplanted hearts pose unique pathophysiological challenges, and MCS significantly alters pressure-volume-flow relationships. Real-time “hemodynamic” TEE (hTEE) can help provide effective management by direct visualization of cardiac filling and function and help guide hemodynamic management. In our initial experience, hTEE can provide point-of-care …

Trop-2 Inhibits Prostate Cancer Cell Adhesion To Fibronectin Through The Β1 Integrin-Rack1 Axis., Marco Trerotola, Jing Li, Saverio Alberti, Lucia R. Languino

Department of Cancer Biology Faculty Papers

Trop-2 is a transmembrane glycoprotein upregulated in several human carcinomas, including prostate cancer (PrCa). Trop-2 has been suggested to regulate cell-cell adhesion, given its high homology with the other member of the Trop family, Trop-1/EpCAM, and its ability to bind the tight junction proteins claudin-1 and claudin-7. However, a role for Trop-2 in cell adhesion to the extracellular matrix has never been postulated. Here, we show for the first time that Trop-2 expression in PrCa cells correlates with their aggressiveness. Using either shRNA-mediated silencing of Trop-2 in cells that endogenously express it, or ectopic expression of Trop-2 in cells that …

Bandemia With Normal White Blood Cell Counts Associated With Infection., Marci Drees, Narrani Kanapathippillai, Marc T Zubrow

Department of Medicine Faculty Papers

OBJECTIVE: Measuring immature white blood cell forms ("bands") has been considered clinically unnecessary. We performed this study to determine whether elevated band counts, with normal total white blood cells on admission, were associated with infection or in-hospital death.

METHODS: We performed a retrospective cohort study including all patients admitted to the Christiana Care Health System 2-hospital, 1100-bed community-based academic health system in 2009 with normal white blood cells (3800-10,800 per mm(3)) on admission who had manual differentials performed. We defined our band groups as normal (≤10% bands and other immature cells), moderate (11%-19%), or high (≥20%). Via chart review, we …

Advancing Pharmacometrics And Systems Pharmacology., Scott A. Waldman, Andre Terzic

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Pharmacometrics and systems pharmacology are emerging as principal quantitative sciences within drug development and experimental therapeutics. In recognition of the importance of pharmacometrics and systems pharmacology to the discipline of clinical pharmacology, the American Society for Clinical Pharmacology and Therapeutics (ASCPT), in collaboration with Nature Publishing Group and Clinical Pharmacology & Therapeutics, has established CPT: Pharmacometrics & Systems Pharmacology to inform the field and shape the discipline.

Takotsubo Cardiomyopathy And Catatonia: An Acute Stress Connection?, Lex Denysenko, Md, Rachel Shmuts, Do, Adam Trenton, Do, Ethan J. Halpern, Md, Madeleine Becker, Md

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND

•Takotsubo cardiomyopathy (TCM):

•transient left ventricular dysfunction

•ECG changes and symptoms mimicking acute MI

•often precipitated by emotional stressor

•Catatonia is a psychomotor syndrome most commonly seen in mood disorders

•This is the first known reported case of TCM co-occurring with catatonia in the setting of acute psychological trauma and bereavement

A Four Factor Model Of Systems-Based Practices In Psychiatry., Jules M. Ranz, Michael Weinberg, Melissa R. Arbuckle, Joanna Fried, Anthony Carino, Hunter L. Mcquistion, Glen Davis, Donovan Wong, Sosunmolu O. Shoyinka, Benjamin Brody, Kamala D. Sethi, Anna Skiandos, Wesley Sowers, David Stern, Anne Sullivan, Michael J. Vergare

Department of Psychiatry and Human Behavior Faculty Papers

No abstract provided.

Dysregulation Of Mir-31 And Mir-21 Induced By Zinc Deficiency Promotes Esophageal Cancer, Hansjuerg Alder, Cristian Taccioli, Hongping Chen, Yubao Jiang, Karl Smalley, Paolo Fadda, Hatice G. Ozer, Kay Huebner, John Farber, Carlo M. Croce, Louise Fong

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Presented at: Hallmarks and Cancer Conference, October 29-31 in San Francisco.

And AICR Annual Meeting, November 1-2, 2012.

Dietary zinc (Zn) deficiency (ZD) in rats induces an inflammatory gene signature that fuels esophageal squamous cell cancer (ESCC). Using nanoStringTM technology, we show that the inflammation is accompanied by altered expression of specific microRNAs in esophagus, as well as skin, lung, pancreas, liver, prostate, and PBMC, predictive of disease development. Particularly, the ZD esophagus has a microRNA signature resembling human ESCC/tongue SCC miRNAomes with overexpression of miR-31 and miR-21 and downregulation of their respective tumor suppressor targets PPP2R2A and …

Decrease In Central Venous Catheter Placement And Complications Due To Utilization Of Ultrasound-Guided Peripheral Intravenous Catheters, Arthur K Au, Masashi Rotte, Robert Grzybowski, Bon Ku, Jason M. Fields

Department of Emergency Medicine Faculty Papers

Poster presented at: American College of Emergency Physicians (ACEP) conference.

Introduction: -Up to 40% of ED visits include diagnostic blood tests and 26% result in administration of IV fluids necessitating successful peripheral intravenous (IV) catheter placement.1 -There is a subset of patients with difficult IV access (DIVA) in which traditional cannulation methods are unsuccessful resulting in central venous cannulation (CVC). -CVCs have a 5-15 percent complication rate2 and attributable costs per CVC related infection have been estimated at $34,508-$56,000.3 -Ultrasound-guided peripheral IV catheters (USGPIVs) provide a method of potentially decreasing the need for CVC placement, however due to poor durability …