Medicine and Health Sciences Commons^™

The Combination Of Platelet Rich Plasma And Corticosteroids In Musculoskeletal And Musculotendinous Pathologies, Mikayla Stoudt

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

- 126 million Americans reported to have a musculoskeletal or musculotendinous pathology in 2012¹

- Combined direct and indirect cost of these injuries in 2015 was $874 billion¹

- Corticosteroid injections have been the mainstay of invasive management after conservative methods fail
Long-term effects of corticosteroids

• Intra-articular injections for knee osteoarthritis resulted in cartilage volume loss¹⁰
• Harm to flexor tendons, neurovascular structures, and compromised integrity^{7, 11}

- Platelet Rich Plasma

• Sample patient blood --> Centrifuge --> Separate plasma and platelets from other blood products --> Reconcentrate the platelets into the plasma
• Platelets release growth factor …

A Comparison Of Bleeding Risk In Patients With Cardiovascular Disease Treated With Aspirin Versus Clopidogrel, Laboy Alyssa

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

Cardiovascular disease is the leading cause of death for men and women in the United States.⁷­­

There are four main types of CVD:

1. Coronary heart disease
2. Strokes & TIAs
3. Peripheral arterial disease
4. Aortic disease

Coronary artery disease (CAD) is the most prevalent and most common cause of atherosclerosis

Antiplatelet medications remain the cornerstone of medical therapy for primary and secondary atherosclerotic CAD prevention.

Aspirin is prescribed for:

• Individuals with a history of MI or ischemic stroke to prevent a recurrence.
• When a myocardial infarction (MI) is suspected to avoid further infarction.
• Thromboembolism prevention after hip surgeries, transient …

The Impact Of Police Transport Of Patients With Penetrating Traumas On Mortality, Breanne Grove

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

• 2020: For people aged 1 to 44 in the U.S., firearm-related injuries ranked in the top five leading causes of death.¹
• 2022: 44,343 total gun violence deaths, 38,593 gun injuries & 646 mass shootings²
• 1987: Philadelphia became first U.S. municipality to allow police personnel to follow a “scoop and run” policy.^3,4 Necessity for police transport came from the lack of EMS availability when firearm homicide rates rose by 123%.⁵

Mobile Health As A Potential Tool To Treat Children In Obesity, Olivia Carey

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

• Pediatric obesity prevalence is estimated to be 22% in 2020 of all children in the US³
• Obesity is defined as greater or equal to the 95th percentile for age and sex⁴
• Childhood obesity leads to adulthood hypertension, hyperlipidemia, respiratory complications, and reduced quality of life⁴⁴
• The AAP released new 2023 guidelines that define the standard of care as a multi-modal, chronic-care treatment plan that prescribes healthy eating choices, an increase in physical activity, and mental health support.⁵
• Mobile health is the use of mobile phones and wireless technology in healthcare³
• A meta analysis of …

Trauma-Informed Care Pa-S Pilot Program Evaluation, Karyn Furcolo, Raya Patel, Mihail Petrov, Leslie Rowland

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

Trauma stimulates the sympathetic nervous system, creates a fight-or-flight response through the hypothalamic-pituitary-adrenal axis, release of cortisol.¹ Repeated stress leads to dysregulation of this response, which can lead to altered stress susceptibility and the inability to cope with stress.² A trauma-informed approach encourages the provision of care to be based on knowledge and understanding of trauma and its widespread implications on patients lives.³

- Rather than asking "what is wrong with you," trauma-informed care encourages providers to ask "what happened to you?"⁵

Pocus Use For Emergency Airway Management In Rural Emergency Departments, Margaret Downing

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

- Preparation and accurate prediction of difficult airways in emergent situations is necessary for successful first pass intubation

- Current methods for airway assessments require patient cooperation and may vary by provider

• Mallampati score: open mouth, protrude tongue, see what structures are visible³
• LEMON criteria: look externally, evaluate 3-3-2 rule, Mallampati score, obstruction, neck mobility
• Thyromental distance: measure thyroid cartilage to tip of chin with neck extended³

- Difficult airways have successful first pass intubation only 82.2% of the time (vs 92.4% for non-difficult airways)⁶

- Adverse effects occurred in 14.2% of patients with successful first …

In Stable Phase Copd Patients Does Oral Magnesium Supplementation Vs Nothing Decrease The Number Of Copd Related Hospitalizations?, Georgina Garvey

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

- Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that leads to significant morbidity and mortality. Magnesium deficiency is known to lead to increased risk of both respiratory and cardiovascular diseases1. This deficiency can lead to an inflammatory state and increased bronchoconstriction that would exacerbate a disease state like COPD.² Magnesium deficiency is seen in aging populations and those with chronic diseases³ and has also been seen in the population of patients coming into the emergency room with acute exacerbations of COPD.⁴

- Treatment with IV magnesium has been shown to be efficacious in …

Reminiscence Therapy For Prevention Of Post-Stroke Anxiety And Depression In Adults, Carly Porter

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

Anxiety and depression are prevalent after a stroke.^1,2 Peer support is a non-pharmacologic intervention utilized to manage post-stroke anxiety and depression with inconsistent results.³ Reminiscence therapy is an intervention that has been studied in the dementia population but is a relatively new intervention for the stroke population and has the potential to impact the psychological care provided to stroke patients.⁴

Tranexamic Use And Safety In Adult Trauma Patients, Drew Frankenfield

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Problem

• Trauma is one of the top leading causes of death worldwide with about 1.9 million deaths per year.
• Mortality due to hemorrhaging trauma, specifically, accounts for 30-40% of all trauma deaths.⁸
• Mortality is due in part to trauma-induced coagulopathy which has simultaneous bleeding and clotting

Anterior Shoulder Instability And Open Procedures: History, Indications, And Clinical Outcomes, Mohamad Y. Fares, Peter Boufadel, Mohammad Daher, Jonathan Koa, Akshay Khanna, Joseph A. Abboud

Rothman Institute Papers

The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still …

Protein-Energy Malnutrition Is Associated With Worse Outcomes In Patients With Atrial Fibrillation: A Nationwide Analysis, Favour Markson, Emmanuel Akuna, Iriagbonse Asemota, Gabriel Areoye, Anoz Shahi, Praise Nwachukwu, Kenneth Ong

Einstein Health Papers

Protein–energy malnutrition (PEM), which leads to a reduced ability of tissues to regenerate and repair themselves, may exacerbate many chronic diseases, including atrial fibrillation (AF), which occurs as a response of the heart to chronic inflammation. However, population-based studies examining the association between PEM and the prevalence and health care burden of AF are lacking. The aim of this retrospective cohort study was to estimate the impact of PEM on the prevalence and clinical outcomes of hospitalization for AF. The National Inpatient Sample (NIS) 2016 and 2017 datasets were searched for data on hospitalized adult patients with AF as a …

Stimulant Medication Use In Children/Adolescent Athletes With Adhd Reduce The Recovery Time Of Concussions And Traumatic Brain Injury, Matthew Lee

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

• Concussions and TBIs are well-known injuries occurring 30-50 million times a year worldwide and are commonly seen in sports.¹ The majority of TBIs are mild yet still have the potential to cause lifelong detrimental effects.
• Short- and long-term complications include difficulty thinking, difficulty concentrating, changes in emotions and personality, decreased memory and sensation, and may lead to depression and dementia.²
• Especially in children and adolescents who are undergoing brain development.
• There are no known prophylactic medications, however, some studies have indicated that sympathomimetic drugs, MPH, may be neuroprotective in the setting of TBIs.
• The purpose of this …

Impact Of Mental Health Boarding In The Emergency Department And Recommendations On How We Can Improve, Kyra Buettner

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

Every year in the United States there is an estimated 2 million adolescents who experience suicidal ideation or attempt suicide.¹ The shortage of behavioral and mental health professionals has led to an increase in emergency department (ED) visits. “Boarding” is defined as “the practice of holding patients in the ED or another temporary location after the decision to admit or transfer has been made.²” The purpose of this study is to evaluate the following question - in adolescent patients with suicide attempt or mental health crisis, does boarding in the ED result in poorer mental health …

Role Of Suction-Based Airway Clearance Devices In Pediatric Foreign Body Airway Obstruction, Rebecca Braver

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

• Foreign body airway obstruction (FBAO) represents a significant cause of morbidity and mortality in the pediatric population. Factors including pediatric anatomy, chewing and swallowing difficulties, developmental stages, habits and behaviors, and children’s toys and foods increase risk of FBAO in children.^1,2
• BLS guidelines for FBAO management in responsive children ages 1-8 call for a series of subdiaphragmatic abdominal thrusts, which increase intrathoracic pressure to force air and the foreign body out of the airway.^3,4 Abdominal thrusts have higher reports of injury compared to all other FBAO interventions, with risk of thoracic, vascular, and gastro-esophageal injury.^5-7
• Novel …

Electric Field Navigated 1-Hz Rtms For Poststroke Motor Recovery: The E-Fit Randomized Controlled Trial, Dylan J. Edwards, Charle Y. Liu, Kari Dunning, Felipe Fregni, Jarmo Laine, Benjamin E. Leiby, Lynn M. Rogers, Richard L. Harvey

Moss-Magee Rehabilitation Papers

BACKGROUND: To determine if low-frequency repetitive transcranial magnetic stimulation targeting the primary motor cortex contralateral (M1_CL) to the affected corticospinal tract in patients with hemiparetic stroke augments intensive training–related clinical improvement; an extension of the NICHE trial (Navigated Inhibitory rTMS to Contralesional Hemisphere Trial) using an alternative sham coil.

METHODS: The present E-FIT trial (Electric Field Navigated 1Hz rTMS for Post-stroke Motor Recovery Trial) included 5 of 12 NICHE trial outpatient US rehabilitation centers. The stimulation protocol remained identical (1 Hz repetitive transcranial magnetic stimulation, M1_CL, preceding 60-minute therapy, 18 sessions/6 wks; parallel arm randomized clinical …

The Role Of Repetitive Transcranial Magnetic Stimulation (Rtms) V. Electroconvulsive Therapy (Ect) In Geriatric Depression Treatment: Efficacy & Tolerability, Madeleine Sarro

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

• Geriatric depression, or depression in a population over the age of 60, is a highly debilitating mental health condition with a prevalence of 25% versus 10% in the general population.^{1, 2} Increasing prevalence is expected in the next 30 years with a rise in the population size for adults over 60 from 12% to 22%.³
• Limiting variables in the treatment of geriatric depression include polypharmacy, intolerable adverse effects, medical comorbidities, drug resistance and atypical symptom presentation.^2-7
• Due to uniformity in underlying pathophysiology, current treatment guidelines for geriatric depression are the same as for the general population. …

The Impact Of Intralesional 5-Fluorouracil In The Treatment Of Keloid Scars, Madeline Derham

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background

- The American Academy of Dermatology (AAD) defines a keloid scar as a type of raised scar extending past the initial area of injury¹

- Approximately 10% of the general population affected - significant risk factors include +family history, darker skin tones, mechanism of injury (burn, surgical)³

- Symptom presentation: pain, pruritus, burning, increased sensitivity³

- Varying existing treatment methods with high resistance and recurrence rates leading to no agreed upon standard approach⁵

• Most widely adopted method currently : intralesional (ILS) steroid ^injection5

Successful Return To Sport And Daily Activities After Suture Augmentation Of Both The Anterior Talofibular Ligament And Calcaneofibular Ligament, S Ali Ghasemi, Jetha Tallapaneni, Benjamin C Murray, Clark Yin, James Raphael, Zachary Vaupel, Allan Grant, Paul Fortin

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: To evaluate the return to sport and daily activities in addition to clinical outcomes after modification of the Brostöm repair, specifically using suture augmentation for concomitant fixation of both the anterior talofibular ligament and calcaneofibular ligament.

METHODS: Patients who had grade III ankle sprains and lateral ankle instability, all of whom failed supervised conservative management, were included. Patients underwent a modified Broström procedure consisting of suture augmentation for both the anterior talofibular ligament and calcaneofibular ligament. For clinical outcome evaluation, Foot and Ankle Ability Measure (FAAM) and Karlsson-Peterson Scoring System for Ankle Function questionnaires coupled with questions regarding time …

Opioid Use Disorder (Oud) And Neonatal Abstinence Syndrome (Nas) Education In An Undergraduate Nursing Program, Tara Flood, Dnp, Rn, Cbc

College of Nursing Posters

Background

In 2018 the American Academy of Nursing urged all nursing schools to adopt curriculum to address the opioid epidemic, although few programs have begun this work.

Minimal background training in nursing school is focused on caring for patients with Opiate use disorder ( OUD) and Neonatal Abstinence Syndrome (NAS) leaving nurses to develop the necessary skills for optimal patient engagement to be formulated in practice. An undergraduate nursing program in an urban setting developed OUD and NAS education into their curriculum.

Undergraduate nursing students are increasingly encountering patients with opioid use disorder in the clinical setting. Previous research indicates …

Addressing Inpatient Substance Use Stigma And Bias: An Examination To Support Training For Healthcare Professionals, Tara Flood, Dnp, Rn, Cbc

College of Nursing Posters

Background

The current opioid crisis is a significant public health issue in the United States, especially amongst women of reproductive age. In the last two decades, the rate of opioid use disorder (OUD) in pregnant women has quadrupled. Women with substance use disorders (SUD) experience more sociodemographic and health disadvantages, pre-existing health conditions, and co-morbid psychiatric diagnoses than their counterparts without SUDs. They are also more likely to experience emergency department visits and hospitalizations during the antenatal period and less likely to utilize prenatal healthcare services.

Acute Inpatient Stabilization Study Primary Stakeholders Evaluation, Tara Flood, Dnp, Rn, Cbc

College of Nursing Posters

Background

The current opioid crisis is a significant public health issue in the United States, especially amongst women of reproductive age. In the last two decades, the rate of opioid use disorder (OUD) in pregnant women has quadrupled. Women with substance use disorders (SUD) experience more sociodemographic and health disadvantages, pre-existing health conditions, and co-morbid psychiatric diagnoses than their counterparts without SUDs. They are also more likely to experience emergency department visits and hospitalizations during the antenatal period and less likely to utilize prenatal healthcare services.

Bimanual Movement Characteristics And Real-World Performance Following Hand-Arm Bimanual Intensive Therapy In Children With Unilateral Cerebral Palsy, Shailesh S. Gardas, Christine Lysaght, Amy Gross Mcmillan, Shailesh Kantak, John D. Willson, Charity G. Patterson, Swati M. Surkar

Department of Rehabilitation Medicine Faculty Papers

The purpose of this study was to quantify characteristics of bimanual movement intensity during 30 h of hand-arm bimanual intensive therapy (HABIT) and bimanual performance (activities and participation) in real-world settings using accelerometers in children with unilateral cerebral palsy (UCP). Twenty-five children with UCP participated in a 30 h HABIT program. Data were collected from bilateral wrist-worn accelerometers during 30 h of HABIT to quantify the movement intensity and three days pre- and post-HABIT to assess real-world performance gains. Movement intensity and performance gains were measured using six standard accelerometer-derived variables. Bimanual capacity (body function and activities) was assessed using …

Variant Characterization Of A Representative Large Pedigree Suggests “Variant Risk Clusters” Convey Varying Predisposition Of Risk To Lynch Syndrome, Mouadh Barbirou, Amanda A. Miller, Amel Mezlini, Balkiss Bouhaouala-Zahar, Peter J. Tonellato

Department of Medical Oncology Faculty Papers

Recently, worldwide incidences of young adult aggressive colorectal cancer (CRC) have rapidly increased. Of these incidences diagnosed as familial Lynch syndrome (LS) CRC, outcomes are extremely poor. In this study, we seek novel familial germline variants from a large pedigree Tunisian family with 12 LS-affected individuals to identify putative germline variants associated with varying risk of LS. Whole-genome sequencing analysis was performed to identify known and novel germline variants shared between affected and non-affected pedigree members. SNPs, indels, and structural variants (SVs) were computationally identified, and their oncological influence was predicted using the Genetic Association of Complex Diseases and Disorders, …

Tav-In-Tav And Beyond: How Far Can We Go?, Taramasso Maurizio, Ana Paula Tagliari, David L. Fischman

Division of Cardiology Faculty Papers

No abstract provided.

Expanding The Primary Care Interprofessional Team: Creating Space For Behavioral Health Consultants, Rachelle Rene, Phd, Bcb, Hsmi, Cgp, Mollie Cherson, Mphil, Lcsw

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Statement of issue or problem addressed

Despite a growing need for mental and behavioral health services, access to these services has been limited due to constraints in insurance coverage and location of services outside of medical care. As a result, mental and behavioral health needs have frequently fallen to the primary care system to support.

2023 James B. Erdmann Award Recipients

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

The Jefferson Center for lnterprofessional Practice & Education (JCIPE) congratulates this year's interprofessional education (IPE) and collaborative practice (CP) award winners and thanks them for all of their efforts to support and advance this work on campus and beyond. Their contributions are immeasurable!

Interview Of John E. Lewis, Jr., Md, Ms, Facep, John E. Lewis, Jr., Md, Ms, Facep, Ciera M. Osborne, Otd

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Dr. John E. Lewis, Jr., Assistant Professor of Emergency Medicine at the Emory University School of Medicine, presented the keynote at the 2022-23 J-SICCC Kick-Off event, exploring the systemic racism fueling the health disparities in our society in a raw, real, and electrifying way. I sat down with Dr. Lewis to continue the conversation. Through his sharing, Dr. Lewis helps us understand our own journeys, what drives us, and how we can improve our healthcare teams and patient interactions. This interview dives deeper into the roots of our disconnections to find the only treatment that will work to make the …

Spotlight On Interprofessional Clinical Teams, William F. Bucher, Bs, Rrt-Nps, Alicia Graf, Ma, Ccc-Slp, Margaret Lafferty, Md, Faap, Dot Mcelwee, Msn, Nnp-Bc, Elizabeth Przychowicz, Rn, Bsn, Cbc, Marie Snyder, Pt, Dpt, Pcs, Eileen Winter, Msw, Lsw

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Take a closer look at a clinical team at Thomas Jefferson University Hospital and how they practice interprofessionally every day!

The Jefferson Intensive Care Nursery (ICN) offers advanced care for infants who are born under critical circumstances or require specialized treatment for medical, surgical, or cardiac disorders. JCI PE interviewed the ICN team about several topics, including their roles, their interprofessional dynamic, and what they have learned from each other over the years. The team also reviewed the case of "Baby C during the interview. (Responses have been edited for length and clarity.)

Preparing The Healthcare Workforce Of Tomorrow Through Interprofessional Simulations: A Review Of Simulation Technologies Used At Jefferson Center For Interprofessional Practice & Education, Susan Toth-Cohen, Phd, Otr/L, E. Adel Herge, Otd, Otr/L, Faota, Amber King, Pharmd, Bcps, Fnap

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Interprofessional (IP) collaborative practice is believed to be an essential component of healthcare system transformation via the "Quadruple Aim" (IPEC. 2016) IP simulations provide invaluable opportunities for learners to practice, discuss, and improve teamwork and communication skills for clinical situations (Thistlethwaite, 2012). Furthermore, IP simulations help students gain a nuanced understanding of, and appreciation for, the roles and responsibilities of colleagues from different professions (Thistlethwaite, 2012). As a result, students increase their understanding of how practice is enhanced as they gain additional perspectives on care and improve their ability to engage in effective IP teamwork (IPEC, 2016). IP simulations allow …

Meet An Ipe/Cp Alumna Champion From Thomas Jefferson University, Kyra Shreeve, Bsn

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

As a Jefferson College of Nursing student (JCN), I had the opportunity to be involved in several JCIPE initiatives, including the Jefferson Student lnterprofessional Complex Care Collaborative program (J-SICCC, formerly Student Hotspotting) and Team Simulation & Fearlessness Education (TeamSAFE). As a member of J-SICCC, I worked with an interprofessional team of students to support a patient with complex social and healthcare needs. The TeamSAFE training was incorporated within the JCN curriculum, and after participating as a student I was able to volunteer as a co-facilitator. In addition, I had the chance to work with one of the JCN faculty members, …