Medicine and Health Sciences Commons^™

Comparison Of Endovascular Therapy Versus Medical Therapy In The Management Of Descending Thoracic Aortic Dissection, Eli Cehelyk, Babak Abai, Md

Phase 1

Introduction: This retrospective review aimed to compare clinical outcomes between patients with descending aortic dissections, with and without organ malperfusion, who were managed with thoracic endovascular aortic repair (TEVAR) or best medical therapy (BMT).

Methods: Thirty-eight patients diagnosed with descending aortic dissections between 2013 and 2020 were identified for analysis. Patients with dissection secondary to trauma and death unrelated to cardiothoracic pathology were excluded. Participants were divided into three groups based on their management: TEVAR (without side branch stenting), TEVAR+ (with additional branch stenting) and BMT. The primary outcome measure was length of hospital stay (LOS) and statistics were analyzed …

Otologic Opioid Usage And Pain Control In The Postoperative Period, Matthew Stewart, Eric Mastrolonardo, Joann Butkus, Raphael Banoub, Md, Tingting Zhan, Phd, Sophia Dang, Md, David Cognetti, Md, Rebecca Chiffer, Md, Thomas Wilcox, Md

Phase 1

Introduction: Patients’ unused prescription opioids can be diverted and increase the overall opioid burden on society. Therefore, otolaryngologists can reduce opioid influx by minimizing excess tablets in opioid prescriptions. We hypothesize that otology patients at TJUH receive more opioid tablets than needed to effectively manage postoperative pain.

Methods: Patients ages ≥18 years old who received otologic surgery at TJUH were included in this prospective observational study between November 2019 and August 2020. Patients were provided a survey for recording pain on postoperative days 0, 1, 3, and 7 and the amount of remaining opioids from their prescription. Opioid amounts were …

Postoperative Opioid-Prescribing Practices In Nasal Surgery: A Prospective Study, Brian M. Yan, S. Hamad Sagheer, Cory D. Bovenzi, Uche Nwagu, David Cognetti, Howard Krein, Ryan Heffelfinger

Phase 1

Introduction: Within facial plastic and reconstructive surgery (FPRS), prescription practices have trended toward prescribing larger amounts of perioperative opioids. However, there is limited literature regarding the postoperative pain experience and opioid consumption for FPRS. The purpose of our study was to investigate opioid prescription and consumption following procedures of the nose, with the aim of developing evidence-based guidelines for postoperative pain management.

Methods: In this prospective single center study, morphine milligram equivalents (MME) consumption and pain scores were collected in 72 patients who underwent nasal surgery. Patient demographics, MME use, and pain scores were examined. MME use was compared …

Differences In Clinical And Functional Outcomes Between Osteochondral Allograft Transplantation And Autologous Chondrocyte Implantation When Used In The Treatment Of Focal Grade 3 And Grade 4 Articular Cartilage Defects, Daniel Abraham, Joseph Brutico, Kashyap Chauhan, Anant Dixit, Fotios Tjoumakaris, Brad Tucker, Kevin Freedman

Phase 1

Introduction:

Grade 3 and 4 articular cartilage defects involve 50% of cartilage thickness without involvement of the underlying bone. There are several available options for the surgical repair of articular cartilage lesions including osteochondral allograft transplantation (OCA), a well-established procedure, and autologous chondrocyte implantation (ACI), an alternative developed more recently. Although there are studies examining ACI outcomes, there hasn’t been significant comparison of ACI outcomes to other procedures, including OCA. The inquiry question of this study was: how do clinical and functional outcomes differ between patients with focal articular cartilage defects treated with ACI and patients treated with OCA? …

Total Knee Arthroplasty In Patients With Prior Meniscus Surgery: A Matched Case Control Study, Lasya Rangavajjula, Steven B. Cohen, Md, Meghan E. Bishop, Md, Shyam Brahmabhatt, Md, Michael G. Ciccotti, Md, Ashley Bassett, Md, Christopher Hadley

Phase 1

Introduction: Meniscus surgery is one of the most commonly performed orthopedic surgical procedures in the United States. However, outcomes following a Total Knee Arthroplasty (TKA) in patients with a history of prior knee arthroscopy are varied with small patient cohorts, warranting further research. The research question investigates how the clinical outcomes of TKA compare between patients with and without prior meniscectomy history. It is hypothesized that there will be no significant difference in clinical outcomes between the two cohorts.

Methods: The study design is a retrospective case-control study. The study population included patients from Rothman Institute with TKA and …

Establishing The Relationship Between Mendelian Nafld And Skin Pathology, Anthony Medvedev, Hassan Vahidnezhad, Phd, Leila Youssefian, Phd, Jouni Uitto, Md, Phd

Phase 1

Introduction:

It is estimated that 25% of the world’s population has some form of Nonalcoholic Fatty Liver Disease (NAFLD), a pathology associated with the development of cirrhosis, varices, and hepatocellular carcinoma. The discovery of a biallelic mutation in ABHD5 established the link between NAFLD and Chanarin-Dorfman syndrome. Consequently, it was hypothesized that additional NAFLD-inducing mutations could be associated with dermatologic manifestations.

Methods:

International NAFLD patients from consanguineous families underwent whole exome sequencing. These results were then filtered by frequency and pathogenicity prediction algorithms (e.g. Mutation Taster, Polyphen, CADD) to yield novel mutations. Concurrently, a literature review via PubMed identified …

Risk Factors And Effect Of Acute Kidney Injury On Outcomes Following Total Hip And Knee Arthroplasty, Zachary S. Aman, Michael Yayac, Alexander J. Rondon, Timothy L. Tan, P. Maxwell Courtney, James J. Purtill

Phase 1

Introduction: Development of acute kidney injury (AKI) following primary total joint arthroplasty (TJA) is a potentially avoidable complication associated with negative outcomes including increased length of stay and mortality. The purpose of this study was to determine the effect of AKI on short-term outcomes and identify risk factors for developing AKI following either total hip or total knee arthroplasty. It was hypothesized that AKI has significant adverse effects on short-term outcomes metrics.

Methods: Patients undergoing primary TJA at a single hospital from 2005 to 2017 were identified and patient demographics, comorbidities, short-term outcomes, and perioperative laboratory results were recorded. …

A Single Academic Center's Experience With Direct Access Colonoscopy, Rachel Israilevich, Mary White, Sophia Lam, Benjamin Chipkin, David Kastenberg, Md

Phase 1

Introduction: Direct Access Colonoscopy (DAC) does not require pre-colonoscopy consultation and may improve access for patients needing screening and surveillance. DAC eligibility criteria vary widely, and we developed a novel, DAC program using EMR patient data to assess appropriateness for inclusion. This study aimed to evaluate the efficacy and quality of our DAC program and compare to traditional, Office-Scheduled Colonoscopy (OSC).

Methods: We conducted a retrospective, single-center study of OSC and DAC patients ages 45-75 with a screening or surveillance indication over 13 months. Primary outcome was Complete Colonoscopy (CC): to cecum/ileum/anastomosis, adequate prep, < 90 days from gastroenterology contact. Patients not meeting CC criteria were classified as Incomplete Colonoscopy (IC). Secondary endpoints: time to CC, adenoma detection rate (ADR).

Results: 2,651 patients met …

Success Of Preoperative Radiotherapy In Inflammatory Breast Cancer With Inadequate Response To Taxane-Based Chemotherapies, Paul Forrest, Christian Fernandez, Md, Ayesha Ali, Md, Ryan C. Miller, Md, Rebecca J. Jaslow, Md, Melissa A. Lazar, Md, Pramila R. Anne, Md, Adam C. Berger, Md, Massimo Cristofanilli, Md, Nicole L Simone, Md

Phase 1

Inflammatory breast cancer is a locally-aggressive and highly malignant cancer which often carries a poor prognosis for afflicted patients. Multi-modality treatment is often required, and taxane-based chemotherapy has shown improved outcomes and allowed for the pursuit of mastectomies, which are critical to disease control. Inadequate response to taxane-based chemotherapy indicates aggressive disease, and the role of preoperative radiotherapy for treatment in this patient group and its effects on patient outcomes and toxicity has not been studied. This study evaluates the effectiveness of preoperative radiotherapy on this patient group. Inflammatory breast cancer patients between 2012-2018 who were not deemed appropriate for …

Evaluation Of Arthroscopic Repair To Pan-Labral Lesions Of The Glenoid: A Retrospective Review Of Patient Outcomes Over A Ten-Year Period And Matched Cohort Analysis, Julien Aoyama, Joseph Schmitz, Christopher Hadley, Meghan Bishop, Md, Brandon Erickson, Md, Sommer Hammoud, Md

Phase 1

Introduction:

Most shoulder labral tears are partial and treated with surgery, but rarely they are “panlabral” around the entire shoulder. Due to infrequency panlabral tears aren’t well understood, and thus this study compares outcomes between panlabral and more common SLAP tears. We hypothesize no difference in outcomes based on surgeon experiences.

Methods:

This is a retrospective cohort study of shoulder labrum repairs at Rothman Institute from 2006-2016. All patients received arthroscopic repair and were categorized to compare panlabral to SLAP tears. The primary outcome is return-to-activity rate at six months post-surgery and secondary outcomes include post-operative range of motion, …

Callicore, Cole Miller, Galen Ogg, Jasmine Phun, Yajnesh Vedanaparti, Morgan Hutchinson, Md

Phase 1

Transporting children in SPICA casts in a safe, comfortable, and convenient manner so that the parents can feel more at ease.

Expanding The Whipple Accelerated Recovery Pathway (Warp) To All Patients Undergoing Pancreaticoduodenectomy (Pd), Ava Torjani, Clifford Yudkoff, Taylor R. Kavanagh, Wilbur Bowne, Geoffrey Krampitz, Hamza Rshaidat, Cyrus J. Sholevar, Alexandra C. Leto, William Preston, Elwin Tham, Mandeep Shergill, Shawnna Cannaday, Theresa Yeo, Harish Lavu, Charles J. Yeo

Phase 1

Introduction

Enhanced recovery after surgery constitutes a multi-disciplinary approach to reduce length of stay (LOS), post-operative complications (POCs), and readmission rate (RR). This not only improves patient outcomes, but also reduces hospital costs. The Whipple Accelerated Recovery Pathway (WARP) trial successfully reduced LOS without increasing the rate of POCs and RR in patients undergoing pancreaticoduodenectomy (PD). However, the study was limited to a highly selective group of patients. This study aimed to determine if WARP could be expanded to all patients undergoing PD.

Methods

A single-institution retrospective review of 281 patients who underwent PD between 2017-2020 was conducted. Patients were …

Assessment For Simulation Training For Prehospital Ems Providers In Bermuda, David Duperreault, Roger Band, Md, Amy Gutman, Md, Dimitri Papanagnou, Md

Phase 1

Introduction

The island of Bermuda is 21 sq miles and located approximately 650 miles east of North Carolina, US. ^[1] There is only one hospital to serve the population of approximately 65,000. There are approximately 95 registered EMTs (Emergency Medical Technician) and AEMTs (Advanced Emergency Medical Technician) currently serving the island. ^[2] It is hypothesized that due to the remote/isolated nature of the island, low ratio of 911 call volume to population, and limited access to continuing education, there is difficulties for EMTs and AEMTs to maintain their skill and knowledge base. ^{[3, 4, 5, 6]} The Goal of this …

Effects Of Intravenous Iron Versus Oral Iron For Treatment Of Anemia In Pregnancy On Maternal And Fetal Outcomes: A Systematic Review And Meta-Analysis, Sarah Chen, Julia Burd, Md, Rupsa Boelig, Md

Phase 1

Introduction: Anemia during pregnancy can lead to preterm birth, low fetal birthweight, and poorer neonatal neurological outcomes. The purpose of this study was to compare maternal and fetal outcomes following intravenous (IV) versus oral iron supplementation for iron-deficiency anemia during pregnancy.

Methods: We searched MEDLINE, OVID, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) comparing IV versus oral iron supplementation for iron-deficiency anemia during pregnancy. Studies were included in this meta-analysis if they reported maternal and fetal hematologic outcomes. The relative risk (RR) or standard mean difference (SMD) of IV iron supplementation …

Sperm Donor Attitudes And Experiences On Direct-To-Consumer Genetic Testing, Sascha Wodoslawsky, Joy Fatunbi, Md, Andrea Braverman, Md

Phase 1

Introduction: Direct-to-consumer (DTC) genetic testing provides a way for genetically linked persons to connect, threatening the anonymity promised by sperm banks to past sperm donors. This study will assess whether these testing resources have changed attitudes of previous donors on donation and their likelihood to donate again.

Methods: A cross-sectional survey was distributed to sperm donors between 1980 and 2020 at Fairfax Cryobank, measuring variables including demographics and donor attitudes on DTC testing. The Qualtrics survey platform aggregated responses and descriptive statistics were used to report outcomes.

Results: Of the 364 responses, 72.8% of donors had not participated …

Effects Of Continuous Positive Airway Pressure (Cpap) Sleep Apnea Treatment On Mild Cognitive Impairment (Mci) And Cardiovascular Risk, Olivia Taylor, Cynthia Cheng, Md, Phd

Phase 1

There is a documented association between sleep apnea and earlier onset of cognitive impairment later in life. We hypothesize that nightly treatment with CPAP therapy will improve MCI status as estimated by a panel of neuropsychiatry tests in patients >55 with OSA and concomitant memory complaints. With a prospective cohort design, patients compliant with CPAP therapy are being compared to noncompliant patients and a non-OSA control group. My role in this multi-site project was to screen potential patients from Jefferson’s sleep clinic for eligibility for study enrollment. This study is still ongoing. OSA’s high prevalence makes it a worthwhile endeavor …

Characterizing The Timeline Of Drug Resistant Epilepsy Surgery., Nicole Belliard Martuscelli, Caio Matias, Ashwini Sharan

Phase 1

Introduction: Although early detection and surgery are crucial for positive outcomes in individuals with drug-resistant epilepsy (DRE), a minority of qualifying patients receive it in the US. This retrospective study investigates why some DRE patients who undergo complete pre-surgical assessment end up not receiving surgery.

Methods: We analyzed 211 EPIC charts from all of Jefferson Comprehensive Epilepsy Center's patients who underwent DRE surgical evaluation from 2017 through 2019. To that end, we characterized the DRE surgery timeline and collected data on age, onset of seizures and drug resistance, surgery dates, surgical modalities, and notes that elucidated the reasoning behind …

The Role Of Toll-Like Receptor 4 In The Progression Of Keloids, Madison Brandes, Nishi Srivastava, Neda Nikbakht

Phase 1

Keloids are highly prevalent in the population and their pathogenesis is largely unknown. T-cell lymphoma research shows that toll like receptor-4 (TLR-4) is highly expressed on CD206+ immunosuppressive macrophages and is implicated in maintaining the tumor microenvironment. Additionally, fibronectin, specifically extra domain A (EDA), is highly expressed and is associated with immunosuppression via the TLR-4 pathway. Assuming that keloids mimic the tumor microenvironment, we hypothesize that TLR-4 is implicated in the pathogenesis of keloids. Using keloid tissue samples and normal breast tissue as a control, immunohistochemistry was performed to observe the presence and co-localization of these markers. Three antibodies were …

Assessing Patient Satisfaction And Confidence After Use Of Educational Video To Augment Surgical Consent For Thyroid Surgery, Michelle Schafer, Katie Holland, Alexander Duffy, Kelley Yuan, Marisa Wu, Raphael Banoub, Elizabeth Cottrill

Phase 1

Introduction: Informed consent is a crucial aspect of ethical patient care, yet the increase in surgical complexity presents a challenge in achieve this properly. This study explores the use of an educational video to help standardize the consent process, increase patient retention of information, and promote patient understanding by allowing patients to replay the information remotely as often as needed.

Methods: This is a perspective, survey-based study of adult patients undergoing thyroid surgery. A novel video detailing thyroid surgery containing the standard contents of informed consent was shown to patients after traditional informed consent followed by a survey on …

Effect Of Palmitic Acid On B2 Receptor Expression In Airway Smooth Muscle Cells, John Magagna, Deepak A. Deshpande, Ajay P. Nayak

Phase 1

Introduction: People with asthma and obesity struggle to control asthma flares. B2 agonists are often the acute treatment of choice during these flares, so the decreased asthma control in this population may be due to a decrease in B2 receptor activity. We tested the hypothesis that B2 receptor expression will decrease in airway smooth muscle cells exposed to Palmitic Acid, a saturated fatty acid, compared to Oleic Acid and untreated cells.

Methods: Airway smooth muscle cells were plated and treated with Palmitic Acid and Oleic Acid at 100uM and 200uM concentrations while other untreated cells served as controls. Cells …

Reliability Of Surgical Margin Labels Using 3d Radiographic Software, Heather Ross, Raphael Banoub, Md, Brian Swendseid, Md, Joseph Curry, Md

Phase 1

Introduction: Surgical resection is a primary treatment for head and neck cancers that improves prognosis and quality of life for patients. Margin assessment is a critical component in this process as positive margins are associated with poor clinical outcomes. However, there is a lack of consensus on how surgical margins should be labeled for accurate origin identification. The objective of this project is to determine the difference in interpretation of surgical margin labels between and within Thomas Jefferson otolaryngologists and pathologists.

Methods: Adults with head and neck cancer who underwent surgical resection were identified. Pre-operative head and neck CT DICOM …

Evaluating The Efficacy Of Telestroke Intervention On Stroke Care In A Large Hospital Network, Daniel Joffe, Ahmad Sweid, Daniel Moylan, Charles Morse, Michael Knapp, Pascal Jabbour

Phase 1

Introduction: Telestroke medicine (TM) involves clinical stroke care by digitally connecting patients and their providers to neurovascular specialists to decrease the time to thrombolytic reperfusion during an acute ischemic stroke (AIS). Rapid administration of intravenous tissue plasminogen activator (iv-tPA) improves AIS outcomes yet no large scale research has evaluated the effectiveness of TM. This study proposes that TM utilization across the Jefferson University Hospital network will increase thrombolytic reperfusion rates and improve overall stroke outcomes.

Methods: A retrospective cohort study design with data from a Jefferson Telestroke database contained information for 9,702 patients across 36 hospital affiliates. These patients were …

Assessment Of The Diagnostic Accuracy Of Core Needle Biopsy In The Diagnosis Of Lymphoma, Christopher A. Gardner, Xiangyun Ye, Catherine Tucker, Md, Austin Redilla, Guldeep Uppal, Md, Adam F. Binder

Phase 1

Introduction: Excisional biopsy (EB) of lymph nodes is the gold standard for diagnosing lymphoma. Recent literature suggests that diagnostic techniques such as immunohistochemistry, flow cytometry and FISH/Cytogenetics yield similar diagnostic adequacy rates when paired with less invasive procedures, like Core Needle Biopsy (CNB). We were interested in comparing the diagnostic odds ratio and adequacy of patients suspected of lymphoma who underwent CNB to EB at Thomas Jefferson University Hospital (TJUH).

Methods: We performed a retrospective cohort study on biopsies collected from 01/01/2016 and 12/31/2019 at TJUH. Specimens were considered diagnostically inadequate if there was not enough lesional tissue for …

Timing Of Preoperative Surgical Antibiotic Prophylaxis Prior To One-To-Three Level Elective Lumbar Fusion, Akash Singh, Gregory Schroeder, Md, Jose Canseco, Md, Alexander Vaccaro, Md, Parthik Patel, Md, Ariana Reyes, Md

Phase 1

Introduction: Surgical site infections (SSIs) in patients who have undergone lumbar fusion surgery can be a devastating complication. The aim of this study was to examine the relationship between timing of preoperative antibiotic prophylaxis and adverse outcomes such as SSIs with subgroup analysis stratified by antibiotic type.

Methods: This retrospective cohort included patients having undergone a 1-3 level lumbar fusion who were allocated into 5 groups based on the time from antibiotic administration to incision (Group A = 0-15 min, Group B = 16-30 min, Group C = 31-45 min, Group D = 46 – 60 min, and Group …

The Integration Of Transgender Health Into Jeffmd, Jacob Nair, Bernard Lopez, Md

Phase 1

Purpose: One way to address healthcare disparities experienced by the transgender community is by educating medical students on trans health. Currently, there is not a universal LGBTQ+ curriculum in medical schools, which has resulted in students feeling incompetent and uncomfortable when treating transgender patients. The purpose of this study was to evaluate the current trans health content in JeffMD and remedy any curricular gaps with trans specific content.

Methods: The trans content in JeffMD was identified using a Keyword Search tool, One45 and lecture notes. A survey distributed to all Thomas Jefferson healthcare students regarding their attitudes and knowledge surrounding …

Efficacy Of Articulate Module: Tracheostomy And Laryngectomy Pearls For The Health Care Providers, Sruti Tekumalla, Andrew Piacitelli, Vanessa Christopher, Dimitri Papanagnou, David Cognetti

Phase 1

Purpose: Anatomy, general care and emergency management knowledge of tracheostomies and laryngectomies is crucial in preventing significant morbidity and mortality within the surgical airway population. An Articulate module was made to address and refresh learners on pertinent surgical airway knowledge. Our goal was to assess the efficacy of the new Articulate module, measuring airway knowledge and attitude treating the surgical airway population.

Methods: Residents in anesthesia, emergency medicine, and internal medicine were eligible and consented to participate. Half of participants were given the Articulate module and half were not. All participants were asked to take a follow-up test. The test …

Needs Analysis For Breastfeeding Education At Thomas Jefferson University Hospital, Michal Norry, Julia Switzer, Md

Phase 1

Purpose: There are currently gaps in breastfeeding education for OB/GYN and Family Medicine residents, consequently affecting their confidence in this area of patient care. To address this issue, we are conducting an analysis of the efficacy of the current curriculum to highlight areas for future improvement.

Methods: PGY1-4 residents in the departments of Family Medicine (FM) and Obstetrics and Gynecology (OB/GYN) completed a pre-test before their required annual breastfeeding education on August 6, 2020. We used a validated pre-test from the American Academy of Pediatrics (AAP) which included items assessing the training. Learners self-selected one of two didactic sessions: in …

Patient Characteristics Of A Primary Care-Based Medication-Assisted Treatment Program For Opioid Use Disorder In Philadelphia, Zoe Wong, Lara Weinstein, Md

Phase 1

Introduction: The opioid crisis is a persistent national public health concern, with Philadelphia at its epicenter. Medication-assisted treatment (MAT) programs for opioid use disorder in primary care settings afford greater access to marginalized groups and integration of healthcare services. This study describes patient characteristics of a low-threshold, primary care-based MAT program in Philadelphia.

Methods: 134 patient interviews between February 12, 2019 and March 14, 2020 were retrospectively analyzed. Key characteristic measures included drug and alcohol use history, co-occurring health conditions, history of violence or trauma, and quality of life. The results from the two program locations, Stephen Klein Wellness Center …

The Wic Program: Background, Trends And Factors Associated With Participation Among Wic Eligible Families, Peace Nosa-Omorogiuwa, Cheryl Bettigole

Phase 1

Introduction

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides access to supplemental foods, nutrition education etc. to low-income pregnant women, infants and children under 5. Despite being a safety net for nutritionally at-risk individuals, the coverage rates for WIC eligible individuals are far lower than the eligibility rates. This study seeks to understand the history of the WIC program, analyze current trends and discuss factors affecting participation in the WIC program.

Methods

The target population are populations that are eligible for the WIC program. A narrative review of journal articles was conducted. Databases searched were EBSCO …

Urosim, Robert Abishek, Bryan Nardone, Jasmine Wang, Christopher Wetzel, Rob Pugliese

Phase 1

Designing a more cost-efficient method for ureteroscopy simulation training that involves 3D printing an anatomically-accurate model of a patient’s renal pelvicalyceal system.