Medicine and Health Sciences Commons^™

Effectiveness Of A Clinical Decision Support System To Identify Heparin Induced Thrombocytopenia., Jeffrey M. Riggio, Md, Msc, Mandelin K. Cooper, Pharmd, Benjamin E. Leiby, Phd, Jeanine M. Walenga, Phd, Geno J. Merli, Md, Jonathan E. Gottlieb, Md

Department of Medicine Faculty Papers

BACKGROUND: Subtle decreases in platelet count may impede timely recognition of heparin-induced thrombocytopenia (HIT), placing the patient at increased risk of thrombotic events.

OBJECTIVE: A clinical decision support system (CDSS) was developed to alert physicians using computerized provider order entry when a patient with an active order for heparin experienced platelet count decreases consistent with HIT.

METHODS: Comparisons for timeliness of HIT identification and treatment were evaluated for the year preceding and year following implementation of the CDSS in patients with laboratory confirmation of HIT.

RESULTS: During the intervention time period, the CDSS alert occurred 41,922 times identifying 2,036 patients …

Cardioprotective Effect Of Adiponectin Is Partially Mediated By Its Ampk-Independent Antinitrative Action., Yajing Wang, Ling Tao, Yuexing Yuan, Wayne Bond Lau, Rong Li, Bernard L. Lopez, Theodore A. Christopher, Rong Tian, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

Adiponectin (APN) exerts its metabolic regulation largely through AMP-dependent protein kinase (AMPK). However, the role of AMPK in APN's antiapoptotic effect in ischemic-reperfused (I/R) adult cardiomyocytes remains incompletely understood. The present study was designed to determine the involvement of AMPK in the antiapoptotic signaling of APN. Cardiomyocytes from adult male mice overexpressing a dominant-negative alpha(2)-subunit of AMPK (AMPK-DN) or wild-type (WT) littermates were subjected to simulated I/R (SI/R) and pretreated with 2 microg/ml globular domain of APN (gAPN) or vehicle. SI/R-induced cardiomyocyte apoptosis was modestly increased in AMPK-DN cardiomyocytes (P < 0.05). Treatment with gAPN significantly reduced SI/R-induced apoptosis in WT cardiomyocytes as well as in AMPK-DN cardiomyocytes, indicating that the antiapoptotic effect of gAPN is partially AMPK independent. Furthermore, gAPN-induced endothelial nitric oxide synthase (eNOS) phosphorylation was significantly reduced in AMPK-DN cardiomyocytes, suggesting that the APN-eNOS signaling axis is impaired in AMPK-DN cardiomyocytes. Additional experiments demonstrated that treatment of AMPK-DN cardiomyocytes with gAPN reduced SI/R-induced NADPH oxidase overexpression, decreased superoxide generation, and blocked peroxynitrite formation to the same extent as that observed in WT cardiomyocytes. Collectively, our present study demonstrated that although the metabolic and eNOS activation effect of APN is largely mediated by AMPK, the superoxide-suppressing effect of APN is not mediated by AMPK, and this AMPK-independent antioxidant property of APN increased nitric oxide bioavailability and exerted significant antiapoptotic effect.

Shoulder Arthroscopy Positioning: Lateral Decubitus Versus Beach Chair., Christina M. Peruto, Md, Michael G. Ciccotti, Md, Steven B. Cohen, Md

Department of Orthopaedic Surgery Faculty Papers

Since the introduction of the beach chair position for shoulder arthroscopy, orthopaedic surgeons have debated whether the beach chair or lateral decubitus is superior. Most surgeons use the same patient position to perform all of their arthroscopic shoulder procedures, regardless of the pathology. Each position has its advantages and disadvantages. The evidence regarding the efficiency, efficacy, and risks of the lateral decubitus and the beach chair positions for shoulder arthroscopy does not show one position to be superior. This review presents a comparison of these positions with regard to setup, surgical visualization, access, and patient risk.

The Time Has Come For Physicians To Take Notice: The Impact Of Psychosocial Stressors On The Heart., Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

A rapidly growing body of evidence supports a relationship between psychosocial factors and cardiovascular disease. In this article, a review of the epidemiologic and clinical research investigating this relationship concludes that psychosocial stressors can be both a cause and a consequence of cardiovascular disease events. Furthermore, recent data have shown that stress management might reduce future cardiac events in patients with cardiovascular disease. Unfortunately, the influence of psychosocial risk factors on cardiovascular disease remains underrecognized compared with traditional cardiac risk factors. Physicians and their associates should screen for psychosocial stressors and recognize potential symptoms. Consideration should be given to developing …

Intra-Tumor Heterogeneity Of Mlh1 Promoter Methylation Revealed By Deep Single Molecule Bisulfite Sequencing., Katherine E Varley, David G Mutch, Tina B Edmonston, Paul J Goodfellow, Robi D Mitra

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

A single tumor may contain cells with different somatic mutations. By characterizing this genetic heterogeneity within tumors, advances have been made in the prognosis, treatment and understanding of tumorigenesis. In contrast, the extent of epigenetic intra-tumor heterogeneity and how it influences tumor biology is under-explored. We have characterized epigenetic heterogeneity within individual tumors using next-generation sequencing. We used deep single molecule bisulfite sequencing and sample-specific DNA barcodes to determine the spectrum of MLH1 promoter methylation across an average of 1000 molecules in each of 33 individual samples in parallel, including endometrial cancer, matched blood and normal endometrium. This first glimpse, …

Hp Newsletter June 2009 Download Full Pdf

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Book Review: Global Health And Global Aging, Safiya Abouzaid Pharmd

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

The Impact Of Serious Medication Errors For Health Care Providers

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

The Public-Private Balance In Healthcare: Political And Economic Tipping Points

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Follow-On Biologics, Patient Safety And Policy Focus Of Jsph Program In Dc

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

The Patient Navigator Outreach And Chronic Disease Prevention Act Of 2005: A Bipartisan Approach To Improving Access To Care And Addressing Health Disparities, Natalia M. Urrea

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

The Impact Of Education On Health Care Quality: The 18th Annual Dr. Raymond C. Grandon Lecture

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Master Of Science In Healthcare Quality And Safety (Ms-Hqs), Susan Desharnais Phd, Mph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

The University Clinical Skills And Simulation Center: A Jefferson Gem Part Ii

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Jefferson Students' Improving Knowledge Of Issues In Health Policy, Daniel Z. Louis Ms

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

2009 Annual Quality/Risk Management Retreat

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Stimulus Money And Health Care Research And Investment, Eric Jutkowitz

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Losing My Dad, David B. Nash Md, Mba

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Persistent Lithium-Induced Neurotoxicity: Direct Effect Of Lithium And/Or Hypernatremia?, Ioana-Mihaela Popescu, James A. Bourgeois

Jefferson Journal of Psychiatry

Abstract Lithium has been used in the treatment of bipolar affective disorder (BAD) for more than 50 years. Features of lithium toxicity include drowsiness, slurred speech, ataxia, psychomotor slowing, polyneuropathy, impaired memory, seizures, coma and death. Lithium neurotoxicity is usually reversible on cessation of its administration, and irreversible toxicity is uncommon. However, persistent neurological sequelae may follow lithium intoxication. There may be a contribution to neurotoxicity from the SIADH associated with lithium toxicity in addition to the direct effects of lithium itself. We describe a case of lithium toxicity with persistent delirium in a patient with a brief period of …

Erosive Eosinophilic Esophagitis In Rumination Syndrome, Shawn S. Sidhu, James R. Rick

Jefferson Journal of Psychiatry

Rumination syndrome involves bringing up partially digested food into the pharynx voluntarily, followed by reswallowing or expelling. It was discovered in the 17th century; however, knowledge of the disorder has remained sparse until recently. Indeed, the first case of adult rumination in Japan was reported as recently as 2006. Due to this recent increase in awareness, notions about the disease have remained in a state of constant fluctuation. While first believed to be a disease of neurologically-impaired children between 3 and 8 months of age, it is now widely recognized as occurring in men and women of all ages and …

Tactile Hallucinations: Presenting Symptom Of Schizophrenia, Virgen M. Quinones

Jefferson Journal of Psychiatry

Although previous reports about tactile hallucinations of sexual content suggesting Schizophrenia are known2, this disorder has been characterized mostly by hallucinations of visual/auditory content. At Schizophrenia presentation these two types of hallucinations are the prominent features. This report describes a patient who had no previous psychiatric symptoms and for whom tactile hallucinations were the presenting symptom of Schizophrenia.

R992c (P.R1192c) Substitution In Collagen Ii Alters The Structure Of Mutant Molecules And Induces The Unfolded Protein Response., Hye Jin Chung, Deborah A. Jensen, Katarzyna Gawron, Andrzej Steplewski, Andrzej Fertala

Department of Dermatology and Cutaneous Biology Faculty Papers

We investigated the molecular bases of spondyloepiphyseal dysplasia (SED) associated with the R992C (p.R1192C) substitution in collagen II. At the protein level, we analyzed the structure and integrity of mutant molecules, and at the cellular level, we specifically studied the effects of the presence of the R992C collagen II on the biological processes taking place in host cells. Our studies demonstrated that mutant collagen II molecules were characterized by altered electrophoretic mobility, relatively low thermostability, the presence of atypical disulfide bonds, and slow rates of secretion into the extracellular space. Analyses of cellular responses to the presence of the mutant …

The Play And Learn Classroom, Therese Mcgurkin Rn, Msn, Janet Paul Rn, Msn, Terri Schwartz Rn, Msn

Jefferson Hospital Staff Papers and Presentations

Providing a consistent curriculum to educate and train more than 2,000 members of a nursing department and over 1000 nursing students in a tertiary care hospital on a complex clinical documentation system can be a challenge to the educator. Training new employees on an ongoing basis and an entire department when periodic system upgrades occur requires that the curriculum and methodology be consistent and made available at any time – day or night. In order to maintain consistency of the curriculum and provide the learner with ample opportunity to “play and learn” we use computer – based training video tutorials …

Graduate Nurse Residency Programs: Bridging The Knowledge – Practice Gap, Elissa Harmon Rn, Msn, Ccrn

Jefferson Hospital Staff Papers and Presentations

Nurse residency programs provide the foundation needed to address the unique needs of the graduate nurse by providing a means to bridge the knowledge practice gap. The evidence based program curriculum developed by University HealthSystem Consortium (UHC) is utilized at Thomas Jefferson University Hospital. The program blends the collaborative atmosphere of peer networking opportunities with the promotion of critical thinking skills and hands on activities. The additional support eases the transition period as the graduate nurse is nurtured from advanced beginner to competent professional nurse. The Nurse Residency program promotes autonomy and effective decision making skills through application based learning …

Lifeline Of New Products- Destination: The Patient's Bedside, Mary Bent Mangano, Msn, Rn New Products Coordinator, Department Of Nursing Education

Jefferson Hospital Staff Papers and Presentations

The lifeline of a new product begins with an innovative process driven by an on-line request through our academic medical center’s intranet system. The individual championing the new product completes the request. Staff nurses have a voice in the decision making process of the acceptance or the rejection of new product(s) being used in a hospital setting. All requested products are thoroughly investigated as the item relates to new technology, cost, reimbursement, medical evidence and evidence-based practice. These critical factors assist in the decision making process to improve the quality of patient care while ensuring cost-containment and standardization, thereby, translating …

Prescriptions For Excellence In Health Care Summer 2009 Download Full Pdf Issue 5

Prescriptions for Excellence in Health Care Newsletter Supplement

No abstract provided.

Genomic Biomarkers For Molecular Imaging: Predicting The Future., Mathew L. Thakur

Department of Radiation Oncology Faculty Papers

Over the past few decades, great strides have been made in anatomical imaging of disease that has led to their diagnosis with minimal invasion. Despite these advances, diseases such as cancer continue to take one human life every minute in the United States. Complimentary approaches that pertain directly to the genesis of the disease might contribute to its early diagnosis and subsequent management. In cancer, an array of molecular abnormalities leading to the modulations in expression of key proteins important in the cellular signaling pathways and cell proliferation has been identified. These specific disease fingerprints, biomarkers, are overexpressed on malignant …

Growing Ambulatory Care Nurse Leaders: Building Talent From The Primed Pipeline, Beth A. Swan, Janet P. Moye

College of Nursing Faculty Papers & Presentations

In this article, the first of two on this topic, the importance of leadership and succession planning will be defined, desired leadership competencies identified, different opportunities and approaches for succession planning identified, and organizational strategies identified, as well as personal strategies, that may be employed for leadership succession planning. In the second article, in an upcoming issue of Nursing Economic$, the role played by multiple generations in building talent and leadership succession planning will be described.

Persistent Nodular Rash In An Elderly Patient, Daniel Dejoseph, Md, James Studdiford, Md, Amber Stonehouse, Md, Beth Careyva, Md

Department of Family & Community Medicine Faculty Papers

A 62yo white male presented to same day clinic with an erythematous nodular rash. He was initially treated with antibiotics for a furunculosis, but the rash worsened and he was eventually found to have secondary syphilis. He is an MSM who had a prior history of syphilis, putting him at high risk for STI’s and HIV, and should have been undergoing annual screening. He was found to be HIV positive. The rates of STI’s and HIV are increasing in older Americans. Despite this, physicians do not regularly screen this population for unsafe sexual behavior. This case emphasizes the importance of …

Title: Student Readiness For Interprofessional Learning: Baseline And Midpoint In The Jefferson Health Mentor Program, Elena M. Umland, Cynthia A. Sanoski, Jon Veloski, Kevin Lyons, Carolyn Giordano, Christine Arenson, Molly Rose

College of Pharmacy Faculty Papers

Objectives: To measure pharmacy student readiness for interprofessional education (IPE) and compare the results to medical, nursing, occupational therapy (OT), and physical therapy (PT) student peers using the Readiness for Interprofessional Learning Scale (RIPLS).

Methods: First-year medical, nursing, OT, pharmacy, and PT students (n=544) participate in a 2-year longitudinal, interdisciplinary curriculum where they are assigned to a team including a Health Mentor (patient volunteer with chronic condition). Aims include understanding team roles and patient-centered care. All students complete the RIPLS at baseline and after completing years 1 and 2. RIPLS contains 3 subscales related to readiness for IPE: 1.)teamwork and …