Medicine and Health Sciences Commons^™

Confrontations With Death: Psychological Responses During Internship, Michael Miller, M.D.

Jefferson Journal of Psychiatry

During internship, the daily confrontation with the consequences of disease contributes much to the distress which young physicians experience (I). Not only are interns responsible for first line medical care, they must also provide emotional support for their patients struggling with pain, disability and impending death. This paper seeks to examine some of the factors responsible for the turmoil involved in caring for these dying patients.

Our conceptions of death and dying are determined to a large extent by the cultural context in which we live. Compared with other times in which death was not so ego alien, we presently …

Identity Formation And Reformation In First And Second Career Psychiatric Residents, Steven J. Kingsbury, M.D., Ph.D.

Jefferson Journal of Psychiatry

Although all residents seek to acquire competence, those entering psychiatry as a first career appear to use different strategies for the early protection of self esteem than do those entering psychiatry as a second career. These differences and their ramifications for the resident and the residency are discussed.

Differences appear in the formation of a professional identity as a psychiatrist when that career is the second career as opposed to the formation of that identity when the career is the first. For most older psychiatric residents, a first career typically precedes the entrance into psychiatry. In my case, I was …

On Becoming A Psychiatrist: A Resident's Perspective, Phebe M. Tucker, M.D.

Jefferson Journal of Psychiatry

Developing an identity as a psychiatrist is a process which has been seen by many to span an individual's career; from the first decision of choice of a career, through residency training and beyond, into the years of practice. As part of a "Residents' Day Paper," psychiatrists in the Oklahoma City area were surveyed in order to look at their perceptions of the growth of their professional identities. Despite the limitations of a small sample population, limited to one metropolitan area, some interesting common patterns emerged: the psychiatrists surveyed had diverse educational and cultural back grounds, similar practical and unconscious …

Telephone Associated Pathology: Clinical Case Studies And Discussion, Mark Servis, M.D.

Jefferson Journal of Psychiatry

The advancement of modern technology shapes and develops new expressions of psychopathology and accompanying treatments. This is most apparent with the telephone, an instrument of contact and communication for the patient, and assessment and intervention for the therapist. The telephone both constrains and creates unique constellations of patient symptomatology. This paper will examine one such telephone symptom complex-the habitual over use of the telephone by non-bipolar patients. The frequent monopolization of the phone seen in some bipolar patients will not be considered, though the elements of intrusion and aggression discussed in this paper are probably shared by manic patients.

A …

A Pilot Study Of Brief Group Therapies For Preschool Children: Parent Training Vs Group Play Therapy Vs Project Group, William S. Evans, Jr., M.D., Susan A. Black, M.D.

Jefferson Journal of Psychiatry

The optimum modality for treating preschool age children with behavioral and emotional problems is uncertain. One study showed that children with good ego strength respond to psychotherapy independent of whether it is group or individual psychotherapy, provided that a minimum period of psychotherapy occurs (ovick, 1965). The literature has demonstrated that parent training, individual play therapy, and group therapy are all effective modes of treatment with children (Axline, 1969; Moreland, et ai, 1983; Pesco solido & Petrella, 1986). Due to the limited psychiatric resources in the military setting and increasing demand for service, the option for individual therapy may be …

The In-Hospital Suicide: A Psychological Autopsy Of A System Involving Borderline Dynamics, Kathleen A. Hughes, Md, Al Santos, Md

Jefferson Journal of Psychiatry

This manuscript reviews principles of hospital management in the care of severe borderline patients with concomitant affective syndromes. The case presented highlights a process of experiential learning in a novice clinician (a beginning psychiatric resident) and illustrates several critical areas of concern with these patients. The following four facets of clinical management are discussed: 1) Failed attempts to understand borderline dynamics and subsequent countertransference reactions; 2) Staff resistance to consistent, honest and open acknowledgement of suicide potential; 3) Special risks when borderline dynamics are combined with affective syndromes; and 4) Possible suicide preventive measures and their relative effectiveness.

Conversion Hallucinations In A Patient With Pseudohypoparathyroidism, John Kasckow, Md, Ph.D., Allan Maltbie, Md

Jefferson Journal of Psychiatry

There are few case reports in the literature which discuss psychiatric disturbances in patients with pseudohypoparathyroidism (PH P) (1,2). PHP is a disease characterized by an inadequate response to parathyroid hormone . Often these patients are obese with a short, stocky build and moon-shaped face. Mental retardation is present in as many as 10% of these patients; a reversible dementialike syndrome can also occur (2,3). In addition, Capgras' syndrome has been observed in pseudohypoparathyroid patients (1,2). In these last two reports the authors concluded that the psychosis was probably organically-based. Hay et al (I) noted in their case report that …

What Supports Supportive Therapy?, Peter N. Novalis, M.D., Ph.D.

Jefferson Journal of Psychiatry

Think of 1896, the year Jacob Freud died, kindling a depression in his son Sigmund which led to The Interpretation of Dreams. To a raucous convention in Chicago, William Jennings Bryan declaimed against the gold monetary standard: "You shall not press down upon the brow of labor this crown of thorns, you shall not crucify mankind upon a cross of gold" (I). Years later the monetary gold standard was abandoned during the New Deal, but Freud's newly mined "pure gold of analysis" continued to be an object of adulation and emulation, despite Freud's prediction that its …

Pharmacologic Treatments Of Cocaine Dependence, Michael B. Knable, D.O.

Jefferson Journal of Psychiatry

The rapid escalation of cocaine abuse in the United States in the 1980's has generated a host of interesting hypotheses on various aspects of this problem. After a succinct discussion of epidemiologic, clinical, and neuro-pharmacologic aspects of cocaine abuse, a survey of the current literature on psychopharmacologic management of dependence is offered. While several agents have emerged as useful adjunctive treatments for abstinence syndromes it is important for the clinician to remember that there is not official approval for such treatments. Additionally, psychotherapeutic maneuvers, which remain the major tools in treatment of addicts, should not be overlooked when an experimental …

Mead Johnson Award

Jefferson Journal of Psychiatry

The Mead Johnson Award has been established to honor the best paper submitted to The Jefferson Journal of Psychiatry: A Resident Publication during each calendar year. An award of one thousand dollars is given to the chosen author, with an additional one thousand dollars to be given to the residency program or fellowship in which the author is enrolled.

Editor's Column, Elizabeth Trefzger, Md

Jefferson Journal of Psychiatry

On my recent holiday I noted an interesting pattern. The island I visited was frequented by many different people from a variety of nations. The island itself had a history of being uninhabited and hence its present natives were rather modern in thought. The native language was English but of course it was spoken quite differently from English as we speak it. This was no surprise.

Resident Editorial Board

Jefferson Journal of Psychiatry

Resident Editorial Board for Volume 7, Number 2, 1989 for the Jefferson Journal of Psychiatry

Early Exposure To Paraquat Sensitizes Dopaminergic Neurons To Subsequent Silencing Of Pink1 Gene Expression In Mice., Hongxia Zhou, Cao Huang, Jianbin Tong, Xugang Xia

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Environmental exposure, genetic modification, and aging are considered risky for Parkinson's disease (PD). How these risk factors cooperate to induce progressive neurodegeneration in PD remains largely unknown. Paraquat is an herbicide commonly used for weed and grass control. Exposure to paraquat is associated with the increased incidence of PD. In contrast to familial PD, most sporadic PD cases do not have genetic mutation, but may suffer from partial dysfunction of neuron-protective genes as aging. Using conditional transgenic RNAi, we showed that temporal silencing of PINK1 expression in adult mice increased striatal dopamine, the phenotype that could not be induced by …

Creating The Health Care Workforce For The 21st Century: Regional Economic Impact, Michael Strazzella

Creating the Health Care Workforce for the 21st Century

Audio begins at 1 hour, 10 minutes and 46 seconds.

The Need For Transformational Change In The Education Of Health Care Professionals, Joanne Conroy, Md

Creating the Health Care Workforce for the 21st Century

Audio file is attached at bottom of page.

Cultivating Collaborative And Coordinated Care, Susan Dentzer

Creating the Health Care Workforce for the 21st Century

Audio starts at 28 minutes and 25 seconds and ends at 1 hour, 27 minutes and 20 seconds.

An Organ Culture System To Model Early Degenerative Changes Of The Intervertebral Disc., Ravi K Ponnappan, Dessislava Z Markova, Paul Jd Antonio, Hallie B Murray, Alexander R Vaccaro, Irving M Shapiro, D Greg Anderson, Todd J Albert, Makarand V Risbud

Department of Orthopaedic Surgery Faculty Papers

ABSTRACT: INTRODUCTION: Back pain, a significant source of morbidity in our society, is related to the degenerative changes of the intervertebral disc. At present, the treatment of disc disease consists of therapies that are aimed at symptomatic relief. This shortcoming stems in large part from our lack of understanding of the biochemical and molecular events that drive the disease process. The goal of this study is to develop a model of early disc degeneration using an organ culture. This approach is based on our previous studies that indicate that organ culture closely models molecular events that occur in vivo in …

Download The Full Pdf Of Jefferson Surgical Solutions Fall 2011, Volume 6, Number 2

Jefferson Surgical Solutions

Download the full PDF of Jefferson Surgical Solutions Fall 2011, Volume 6, Number 2.

Immunization With The Recombinant Antigen Ss-Ir Induces Protective Immunity To Infection With Strongyloides Stercoralis In Mice., David Abraham, Jessica A. Hess, Rojelio Mejia, Thomas J. Nolan, James B. Lok, Sara Lustigman, Thomas B. Nutman

Department of Microbiology and Immunology Faculty Papers

Human intestinal infections with the nematode Strongyloides stercoralis remain a significant problem worldwide and a vaccine would be a useful addition to the tools available to prevent and control this infection. The goal of this study was to test single antigens for their efficacy in a vaccine against S. stercoralis larvae in mice. Alum was used as the adjuvant in these studies and antigens selected for analysis were either recognized by protective human IgG (Ss-TMY-1, Ss-EAT-6, and Ss-LEC-5) or were known to be highly immunogenic in humans (Ss-NIE-1 and Ss-IR). Only mice immunized with the Ss-IR antigen demonstrated a significant …

Duration Of Symptoms Resulting From Lumbar Disc Herniation: Effect On Treatment Outcomes: Analysis Of The Spine Patient Outcomes Research Trial (Sport)., Jeffrey A Rihn, Alan Hilibrand, Kristen Radcliff, Mark Kurd, Jon Lurie, Emily Blood, Todd J Albert, James N Weinstein

Rothman Institute Papers

BACKGROUND: The purpose of the present study was to determine if the duration of symptoms affects outcomes following the treatment of intervertebral lumbar disc herniation.

METHODS: An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of intervertebral lumbar disc herniation. Randomized and observational cohorts were combined. A comparison was made between patients who had had symptoms for six months or less (n = 927) and those who had had symptoms for more than six months (n = 265). Primary and secondary outcomes were measured at baseline and at regular follow-up …

Duration Of Symptoms Resulting From Lumbar Disc Herniation: Effect On Treatment Outcomes: Analysis Of The Spine Patient Outcomes Research Trial (Sport)., Jeffrey A Rihn, Alan S Hilibrand, Kristen Radcliff, Mark Kurd, Jon Lurie, Emily Blood, Todd J Albert, James N Weinstein

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The purpose of the present study was to determine if the duration of symptoms affects outcomes following the treatment of intervertebral lumbar disc herniation.

METHODS: An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of intervertebral lumbar disc herniation. Randomized and observational cohorts were combined. A comparison was made between patients who had had symptoms for six months or less (n = 927) and those who had had symptoms for more than six months (n = 265). Primary and secondary outcomes were measured at baseline and at regular follow-up …

Proliferating Cell Nuclear Antigen Is Required For Loading Of The Smcx/Kmd5c Histone Demethylase Onto Chromatin., Zhihui Liang, Marc Diamond, Johanna A Smith, Matthias Schnell, René Daniel

Department of Medicine Faculty Papers

UNLABELLED: ABSTRACT:

BACKGROUND: Histone methylation is regulated by a large number of histone methyltransferases and demethylases. The recently discovered SMCX/KMD5C demethylase has been shown to remove methyl residues from lysine 4 of histone H3 (H3K4), and constitutes an important component of the regulatory element-1-silencing transcription factor (REST) protein complex. However, little is known about the cellular mechanisms that control SMCX activity and intracellular trafficking.

RESULTS: In this study, we found that small interfering RNA-mediated knockdown of proliferating cell nuclear antigen (PCNA) resulted in the reduction of the chromatin-bound SMCX fraction. We identified a PCNA-interaction protein motif (PIP box) in the …

New Insights Into The Androgen-Targeted Therapies And Epigenetic Therapies In Prostate Cancer., Abhijit M Godbole, Vincent C O Njar

Kimmel Cancer Center Faculty Papers

Prostate cancer is the most common cancer in men in the United States, and it is the second leading cause of cancer-related death in American men. The androgen receptor (AR), a receptor of nuclear family and a transcription factor, is the most important target in this disease. While most efforts in the clinic are currently directed at lowering levels of androgens that activate AR, resistance to androgen deprivation eventually develops. Most prostate cancer deaths are attributable to this castration-resistant form of prostate cancer (CRPC). Recent work has shed light on the importance of epigenetic events including facilitation of AR signaling …

Koniaris Heads Expanding Multi-Disciplinary Surgical Program At Methodist Hospital

Jefferson Surgical Solutions

Leonidas Koniaris, MD, FACS, is the newly appointed Chief of Surgery at Methodist Hospital in South Philadelphia, an affiliate of Jefferson that now has the strongest presence of full-time Jefferson faculty surgeons to date. One of the oldest hospitals in the Philadelphia region, Methodist has been treating patients continuously since 1892. Professor of Surgery and Vice Chair of the Department of Surgery at Jefferson Medical College, Dr. Koniaris is leading the effort to help what he describes as “an already great local hospital become an even more essential and integral partof this vibrant community.” Dr. Koniaris replaces Melvin Moses, MD, …

The Surgeon Speaks: Leonidas Koniaris, Md, Facs

Jefferson Surgical Solutions

Leonidas Koniaris, MD, FACS Chief of Surgery, Methodist Hospital Vice Chair of Surgery, Jefferson Medical College

The professionalism and work ethic of the Methodist hospital staff are second-to none, and the dedication to superb patient care is a top priority. Over the next three to five years, our focus is to take this existing gem in the Jefferson brand and continue to develop it into a strong top-tier facility.

We have been fortunate to have the support of hospital leadership in meeting our goals and embracing change. Several initiatives – a new endovascular suite and multidisciplinary breast care clinic, coupled …

Overview

Jefferson Surgical Solutions

The academic year 2011/2012 is now four months old, and we are off to a splendid start! We (a) have welcomed several new faculty members and a bolus of categorical interns (see below), (b) had a leadership transition at our Methodist Hospital, (c) are in growth mode at Methodist with initiatives in General Surgery, Vascular Surgery, Wound Care and Surgical Oncology (see the cover story), and (d) with the leadership of Dr. Nicholas Cavarocchi have seen remarkable growth in our adult ECMO program with outstanding clinical results and several research projects brought to fruition. Exciting times again this year at …

Surgeon-Led Ecmo Treatment Improves Survival Rates In Surgical Cardiac Care Unit

Jefferson Surgical Solutions

The Jefferson Surgical Cardiac Care Unit (SCCU), reorganized in July 2010, delivers the best survival rates in Pennsylvania for patients plagued by serious lung and/or heart dysfunction. Nicholas Cavarocchi, MD, FACS, FCCP, the SCCU Director and Associate Professor of Surgery, leads a highly trained team that uses extracorporeal membrane oxygenation (an ECMO machine) to provide respiratory and cardiac support to patients whose lungs and/or hearts cannot function on their own. Because of the excellent outcomes – 70 to 80 percent survival rates for patients with life-threatening situations, up from a previous zero-based survival rate – Dr. Cavarocchi believes the Jefferson …

Meet Our Surgical Interns

Jefferson Surgical Solutions

We have welcomed an amazing new group of categorical interns, selected from over one thousand applicants to our program. These doctors, who recently matched with Jefferson Medical College (JMC), started on June 20, 2011. Just a few months into their Jefferson surgical residency, we have all noticed their dedication to patient care, their energy and their excitement in joining the Jefferson community.

Meet Our Surgical Interns

Please welcome (from left to right):

• Christine Feldmeier, MD, JMC
• James Crawford, MD, New York University
• Kate Holoyda, MD, University of Wisconsin
• Vishen Sooppan, MD, SUNY Upstate - Syracuse
• Caitlyn Johnson, MD, JMC
• Jonathan …

National Transplantation Pregnancy Registry Celebrates 20th Anniversary

Jefferson Surgical Solutions

This year marks the 20th anniversary of the National Transplantation Pregnancy Registry (NTPR). Established at Jefferson, this unique registry is a voluntary study, in which transplant recipients (both men and women) report their experiences with conception, pregnancy, childbirth, and the health of the recipient. The NTPR was founded by Principal Investigator Vincent Armenti, MD, PhD, a Jefferson alumnus and former transplant fellow with a dual faculty appointment as Professor in the Department of Surgery (Transplantation Division) and the Department of Pathology, Anatomy, and Cell Biology.

Dr. Armenti’s interest was sparked two decades ago when a transplant recipient told him she …

On The Job: Dr. Karen Chojnacki, Residency Program Director

Jefferson Surgical Solutions

Karen Chojnacki, MD, FACS, who has directed the General Surgery Residency Program for the past three years, was a resident at Jefferson from 1995 to 2000 – and loved it. Following a fellowship in minimally invasive surgery at the University of Southern California and a brief stint in private practice, she returned to Jefferson in early 2002, jumping at the chance to capture her “dream job” and buoyed by memories of the institution’s camaraderie and professionalism. “Whoever said ‘You can’t go home again’ didn’t have a home like Jefferson,” she says. “I lead the program that helped make me the …