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Download Entire Issue-The Jefferson Medicine Forum, Volume 6, Winter 2004

The Medicine Forum

Download entire issue-The Jefferson Medicine Forum, Volume 6, Winter 2004.

The Use Of Non-Primed Peripheral And Central Iv Tubing For Nesiritide Infusion Is Reliable And Cost-Effective, Duygu Onat Phd, John Stathopoulos Md, Andrew B. Rose Md, Karel Newman Phd, Ulrich P. Jorde Md, Paolo C. Colombo Md

The Medicine Forum

Background

Prescribing information of nesiritide mandates priming

of intravenous tubing with 25 mL of nesiritide prior to

connecting the intravenous (IV) line to the patient, since

the drug may partially absorb to the line. Thus, 10% of

a reconstituted vial is wasted, with a cost of $40-50 per

line used. No study has quantified the binding effect of

nesiritide to intravenous tubing, tested binding

properties of different materials, or analyzed binding

effect of central lines, where priming cannot occur.

Furthermore, prescribing information states that

nesiritide must not be administered through a central

heparin-coated catheter, since it may bind to heparin. …

Resident And Faculty Feedback: The Student’S Perspective, Daniel J. Rubin Md, Pgy-2, Kyle E. Rarey Phd

The Medicine Forum

Background

Feedback from faculty members and residents is a critical component

of undergraduate medical education. Little is known about how

students assess the adequacy of feedback from faculty and residents.

Purpose

To report medical students’ evaluations of clinical teacher feedback

and to determine if students assess feedback given by residents

differently than they assess feedback given by faculty.

Methods

Data were retrospectively collected from medical students’ responses

to end-of-clerkship questionnaire items that evaluated feedback from

residents and attending physicians. The mean ratings of faculty

feedback in four clerkships were compared with the mean ratings of

resident feedback within each academic …

Effect Of Endogenous Noradenaline Release On Peak Exercise Heart Rate In Subjects With Chronic Heart Failure Receiving Carvedilol Versus Metoprolol, Timothy J. Vittorio, Duygu Onat, Paolo C. Colombo, John Stathopoulos, Cselaj Sulejman, Andrew B. Rose, Gillian Miller, Joshua Trufant, Rochelle Goldsmith, Ulrich P. Jorde

The Medicine Forum

Background

Dose equivalency of metoprolol and carvedilol for beta-

1 blockade remains subject of ongoing debate. The

degree of beta-1 blockade is best assessed in vivo by

blunting of the exercise induced heart rate. Accordingly,

we examined baseline and peak exercise heart rate in

subjects with chronic heart failure (CHF) treated with

carvedilol or metoprolol. To correct for possible

differences in norepinephrine (NE) release due to beta-2

blockade, we also measured NE levels at baseline and

peak exercise.

Pulse: Ekg-Man With Syncope, Emily Lai Md, Pgy-2, Anita Mehrotra Md, Pgy-1

The Medicine Forum

Mr. K, a 57 year-old Caucasian male with a history of

coronary artery disease, dilated ischemic cardiomyopathy,

ventricular fibrillation arrest status post

implantable cardioverter defibrillator (ICD) placement

was admitted to telemetry for two syncopal episodes. The

patient described multiple episodes of dizziness with

fatigue over the week prior to admission, the last two

episodes resulting in loss of consciousness with bladder

incontinence. He was home alone when these episodes

occurred and was unsure of how long he had been

unconscious. Mr. K was not aware of any recent firing of

his ICD. He denied any shortness of breath, chest pain, …

Pulse: Ekg-Ventricular Fibrillation Or Not?, Parmatma Parmatma Greeley Md, Pgy-3

The Medicine Forum

Mr. B is an 84 year-old African-American male veteran

with a history of type 2 diabetes and hypertension who was

admitted to the VA hospital for hypertensive urgency. In

the ICU, he became unresponsive and pulseless. Telemetry

showed “ventricular fibrillation” which spontaneously

converted to sinus rhythm. An echocardiogram showed an

ejection fraction of 60%. An ECG performed prior to the

ventricular arrhythmia is shown below.

Images In Medicine-Clostridial Myonecrosis, Jaime Chin Md, Pgy-3

The Medicine Forum

A 48 year-old male with a past medical history of gout,

degenerative disc disease, and T cell lymphoma treated

with chemotherapy and autologous peripheral blood

stem cell transplant, currently in remission, presented

seven days status-post a non-myeloablative allogeneic

transplant with an acute onset of excruciating left hip

and groin pain and a low-grade fever. The physical exam

did not reveal any obvious cause of his extreme pain.

Images In Medicine-Bronchiectasis, Jane Luu, 4th Year Medical Student

The Medicine Forum

A 43 year-old Chinese woman who

immigrated to the United States in

1994 was seen because of several years

of chronic, intermittent coughing

that was productive of voluminous,

thick, green sputum with occasional

blood streaking. The cough was

accompanied by right anterior

pleuritic chest pain. She had no

fevers, chills, or night sweats. Her

medical history included childhood

pneumonia at the age of 18 months,

a prior right pneumothorax that

required chest tube placement, and a

positive PPD. She was a nonsmoker.

Despite her symptoms, she was fully

functional with activities of daily

living but unable to tolerate exercise.

She …

Images In Medicine-Small Bowel Varices Without Esophago-Gastric Varices: A Cause Of Massive Gastrointestinal Hemorrhage, Sivakumar Srinivasan Md, Pgy-3, Kuntal Thaker Md, Pgy-6, Gastroenterology Fellow

The Medicine Forum

The following case demonstrates small bowel varices

without esophago-gastric varices as an unusual cause

of gastrointestinal bleeding in a patient with chronic

liver disease.

The patient is a 47 year-old man who presented to the

hospital with several days of back pain and weakness.

The work-up of his symptoms revealed a L3-L4

phlegmon on MRI of the lumbar spine. A biopsy of this

lesion yielded focal nonviable bone.

Images In Medicine-Pseudomyxoma Peritonei, Erev E. Tubb Md, Pgy-3

The Medicine Forum

The patient is a 78 year-old male with

a past medical history of

hypertension and duodenal ulcer

presenting with 2 months of

increasing abdominal girth. The

patient reports 1 month of loose

bowel movements and a 2 week

history of early satiety. He notes that

in the last week he has been nauseous

at the smell and thought of food. He

denies fevers, chills, excessive alcohol

intake, history of blood transfusions,

intravenous drug use, melena or

bright red blood per rectum. The

patient states he has never undergone

a colonoscopy and to his knowledge

there is no family history of …

What's Your Diagnosis? Hematology Slide Review, Jane Choi Md, Pgy-2

The Medicine Forum

A 23 year-old Caucasian female with no past medical

history presents with one week of easy bruising and

increasing “red spots” on her arms and chest. She does

not recall any history of trauma that may have lead to

the bruises. She denies any fever or chills. She has no

history of bleeding problems and underwent dental

procedures last year without any complications. On

review of systems, she had vague left abdominal pain over

the past week and 3 days of right ear pain that was

recently treated with cefuroxamine as directed by her

primary care doctor. Family history is …

What's Your Diagnosis? Lung Cavitary Lesion, Bassem Elgohary Md, Pgy-3, Betty Lim Md, Pgy-2

The Medicine Forum

A 35 year-old Caucasian woman with history of Systemic
Lupus Erythematous (SLE) complicated by Lupus
glomerulonephritis presented to the Emergency
Department complaining of worsening bilateral lower
extremity rash and leg pain. The rash had been present
for over a month and a recent biopsy of the lesion
revealed leukocytoclastic vasculitis. Her usual dose of
prednisone 120mg every other day had been increased
to 60mg daily over the past few weeks with the worsening
rash. In addition to the rash and leg pain, she also
reported some right-sided pleuritic chest pain.
Otherwise, the patient noted no shortness of breath,
cough, fevers, …

Weakness In A Young Man, Steve C. Tsai Md, Pgy-3

The Medicine Forum

A 39 year-old African-American male with past medical
history significant for uncontrolled hypertension presents
with a sudden onset of weakness and numbness on the
left side of his face, left arm, left leg, and right leg while
watching television twenty hours prior to presentation.
At that time, the patient did have a mild headache. The
patient initially thought that it was positional, but soon
realized that he could not move the affected extremities
at all. He also began to have some difficulty swallowing
and minor difficulties with speech as well.

Cambodian Monk With Malaise, Aditi Satti Md, Pgy-3

The Medicine Forum

A 26 year-old Cambodian monk presents with complaints
of a three week history of fatigue and malaise. The patient
reports that four days prior to presentation he developed
fevers to 103F, chills and a severe headache. The patient
reports that he had returned from Cambodia one week
prior to initiation of symptoms. He denies any sick
contacts and denies any neck stiffness, photophobia,
visual changes or abdominal pain. The patient does report
diarrhea for one week with approximately 8-10 bowel
movements per day. The patient denies any risk factors
for HIV. The patient had been seen in the Emergency
Department …

Woman With A Bleeding Diathesis, Bo Kim Md, Pgy-3

The Medicine Forum

61 year-old Indian female with history of hypercholesterolemia
presents to an outside hospital (OSH) with
worsening vaginal bleeding, hematochezia, nausea, and
vomiting starting three days prior to admission. Patient
also had a global persistent headache for approximately
24 hours at the time of admission. Otherwise, the patient
denied any fever, chills, abdominal pain, or trauma. The
patient noted no previous episodes of bleeding or easy
bruising in her past. She notes that her menstrual periods
were always regular and not subjectively heavy. Last
menstrual period was 10 years ago. Patient has had two
pregnancies in her obstetric history for which …

Woman With Post-Partum Kidney And Liver Failure, Joshua Gibbs Md, Pgy-3

The Medicine Forum

The patient is a 34 year-old G1P1 Caucasian female with
no medical history who was transferred from an outside
hospital after an emergent Cesarean section for increasing
jaundice with elevated liver enzymes, abnormal
coagulation times and acute renal failure. The patient
was healthy until 33 weeks gestation when she noted
dizziness, headache and visual changes. Blood pressure at
that time was elevated at 140/90 and she had trace lower
extremity edema. No proteinuria was detected. The
clinical picture was consistent with mild pre-eclampsia.
The patient was followed until 35 weeks gestation when
she developed vaginal bleeding and abdominal pain. At …

Woman With Mental Status Change, Vanita Treat Md, Pgy-3

The Medicine Forum

An 83 year-old African-American female with a history
of hypertension, frequent urinary tract infections, atrial
fibrillation, and a cerebrovascular accident (CVA) on
Coumadin presented two days after a fall. A family
member stated she was walking normally and tripped on
uneven concrete, hitting her chin on a fence. Two days
after the incident, the patient was found at home
slumped over in a chair with blood oozing from her chin
wound. The patient was brought to the emergency
department where she was lethargic but responsive. The
patient denied any chest pain, shortness of breath,
lightheadedness, dizziness, blurry vision, weakness or …

Table Of Contents-The Medicine Forum, Volume 6, Winter 2004

The Medicine Forum

Table of Contents-The Medicine Forum, Volume 6, Winter 2004

Welcome To The 6th Edition Of The Jefferson Medicine Forum, Nicole Weinberg Md, Betty Lim Md

The Medicine Forum

We are very excited to bring you this
new and improved volume of the Forum
because it exhibits the talents of the
Internal Medicine Residents. This
edition showcases many of the residents’
strengths in writing scholarly projects,
creating research studies, and interpreting
modern diagnostic imaging.

From The Residency Program Director, Gregory C. Kane Md

The Medicine Forum

The goal of a Residency Program in Internal Medicine is
to strive to train the next generation of practitioners and
academicians in Medicine who will become physiciansscholars,
scientists, teachers, and humanists.

We are excited that many of our residents are pursuing
research opportunities in the laboratory or clinic. Such
participation is a requirement for training at Jefferson. In
addition, this journal serves as an outlet for scholarly
work of a variety of types. We are pleased to support
another issue of the Jefferson Forum to continue to
highlight this work. This represents the sixth installment
of the Jefferson Forum, which …

Bapcap2-1 Does Preoperative Aspirin Improve Outcomes In Cardiac Surgery Patients?, Jian-Zhong Sun, L. Cao, H. Liu, W. Sun, S Silvestry, J. Diehl

Department of Anesthesiology Faculty Papers

Best Abstracts - Runner-up Session 2 presented at Euroanaesthesia 2011 in the Netherlands.

Background and Goal of Study: The effects of preoperative aspirin on major cardiocerebral and renal outcomes and mortality remain uncertain.

Research On Healthcare Worker Personal Protective Equipment: Minimum Requirements For Isolation Gowns, F.Selcen Kilinc-Balci, Phd

Building the Chain of Safety: Stakeholders Summit

F. Selcen Kilinc-Balci, PhD, is a Senior Service Fellow at the National Personal Protective Technology Laboratory (NPPTL) of Centers for Disease Control and Prevention (CDC)/National Institute for Occupational Safety and Health (NIOSH). She works in the area of protective clothing and ensembles, including personal protective equipment for healthcare workers, mine rescue ensembles, fire fighter turnout gear, and chemical protective garments. Prior to joining NIOSH in February 2010, she worked as a senior engineer at DuPont Protection Technologies. Her work at DuPont focused on product development, product testing and certification, and promotional claim validation in personal protective clothing. She has more …

Adoption Of Protective Uniforms, Thomas J. Walsh, Md, Facp, Fccp, Faam, Fidsa

Building the Chain of Safety: Stakeholders Summit

Thomas J. Walsh, MD, FACP, FCCP, FAAM, FISDA, is Professor of Medicine (appointment pending) and Director of the new Transplantation-Oncology Infectious Diseases Program at Weill Medical College of Cornell University. Following graduation from Johns Hopkins University School of Medicine, Dr. Walsh completed ten post-doctoral years of laboratory investigation, clinical research and patient care leading to boards in Medicine, Infectious Diseases and Oncology and laboratory expertise in pharmacology, innate host defenses, and medical mycology.

Following a distinguished career in the Pediatric Oncology Branch of the National Cancer Institute, Dr. Walsh was recruited to direct the new Transplantation-Oncology Infectious Diseases Program of …

Overcoming Barries To Compliance, Janine C. Jagger, Phd

Building the Chain of Safety: Stakeholders Summit

Janine Jagger, PhD, is an epidemiologist specializing in injury prevention and control.  Early in her career, her research and advocacy focused on brain trauma and motor vehicle safety.

Over the last 20 years, Dr. Jagger has devoted herself to reducing healthcare workplace transmission of bloodborne pathogens.  In 1988, Dr. Jagger and colleagues published a landmark study in the New England Journal of Medicine which detailed the characteristics of medical devices causing needlestick injuries, and criteria for protective needle designs.  This pioneering research provided the foundation for the development of a new generation of safer medical devices.

In 1991, Dr. Jagger …

Exposure Risks And The Chain Of Healthcare-Associated Infection, Amber Hogan Mitchell, Drph, Mph, Cph

Building the Chain of Safety: Stakeholders Summit

Amber Hogan Mitchell, DrPH(c), MPH, CPH is the Worldwide Director of Professional Education and Learning Solutions for Advanced Sterilization Products (ASP), a Johnson & Johnson Company located in Irvine, CA.  Amber is responsible for educational initiatives for ASP and its customers related to infection prevention, healthcare associated infections, sterilization, disinfection, environmental hygiene, and quality initiatives in healthcare related to safe care and quality patient outcomes.  Amber is a Doctor of Public Health Candidate (all but dissertation) in occupational and environmental health sciences at the University of Texas School of Public Health in Houston, TX.  She was a Centers for Disease …

Progress In Controlling Healthcare Associated Infections: A Historical Perspective, Richard Wenzel, Md

Building the Chain of Safety: Stakeholders Summit

Richard P. Wenzel, MD, MSc, is professor and former chairman of the Department of Internal Medicine at the Medical College of Virginia, Virginia Commonwealth University, in Richmond, Virginia (1995-2009).  From 2003-2008, he was President of MCV Physicians, the clinical practice plan for over 600 physicians, and Senior Associate Dean for Clinical Affairs.

For eight years (1992 to 2000), he was a member of the editorial board of The New England Journal of Medicine, and, in September 2001, became the journal’s first Editor-at-Large, a position he still holds.  He is the prolific author of over 500 publications, the editor of …

The State Of Safety, John Combes, Md

Building the Chain of Safety: Stakeholders Summit

John Combes, MD, is a Senior Vice President at the American Hospital Association (AHA) and the President of the Center for Healthcare Governance (CHG), an AHA affiliate organization. CHG is a dynamic community of board members, executives and thought leaders dedicated to advancing excellence, innovation and accountability in healthcare governance through education, tool development and research.  Dr. Combes also serves as Senior Fellow at the Hospital Research and Education Trust (HRET), and in that role focuses on quality and leadership issues in Patient Safety, End of Life Care and Clinical Performance Improvement.

Dr. Combes received his medical degree from Cornell …

International Evidence On Medical Spending., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the Casualty Actuarial Society 2011 Seminar on Reinsurance, Philadelphia, PA.

Handouts are also available at: http://www.casact.org/education/reinsure/2011/handouts/C17-Lieberthal.pdf

the audio is available at: http://www.casact.org/education/reinsure/2011/audio/C17.mp3

and it is associated with the paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/

23 PowerPoint slides.

Soluble Extract From The Nematode Strongyloides Stercoralis Induces Cxcr2 Dependent/Il-17 Independent Neutrophil Recruitment., Amy E. O'Connell, Kevin Redding, Jessica A. Hess, James B. Lok, Thomas J. Nolan, David Abraham

Department of Microbiology and Immunology Faculty Papers

Neutrophil recruitment via CXCR2 is required for innate and adaptive protective immunity to the larvae of Strongyloides stercoralis in mice. The goal of the present study was to determine the mechanism of CXCR2-mediated neutrophil recruitment to S. stercoralis. Mice deficient in the receptor for IL-17A and IL-17F, upstream mediators of CXCR2 ligand production, were infected with S. stercoralis larvae; there was no difference in larval survival, neutrophil recruitment, or production of CXCR2 ligands compared with wild type mice. In vivo and in vitro stimulation of neutrophils with S. stercoralis soluble extract resulted in significant neutrophil recruitment. In vitro assays demonstrated …

Chronic Diseases: The Emerging Pandemic., Andre Terzic, Scott A. Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

According to the 2011 World Health Organization Global Status Report, of the 57 million annual global deaths – a staggering 36 million or over 63% are due to chronic diseases.¹ Four noncommunicable diseases - namely cardiovascular, cancer, diabetes, and chronic respiratory diseases - emerge as the leading cause of mortality in the world, accounting respectively for 17, 7.6, 4.2, and 1.3 million deaths based on the latest available global epidemiology data. By 2020, global deaths due to chronic diseases are projected to worsen by at least 15 to 20%. It is estimated that the four major noncommunicable diseases will …