Medicine and Health Sciences Commons^™

The Effect Of Cpap Treatment On T2dm In Moderate To Severe Osa Subjects, Dani Yellanki, Amy He, Grace Severance, Peter Zhang, Zach Feuer, Natali Salinas, Olivia Taylor, Rani Patel, Hannah Kostan, Carl Sun, Catherine Liu, Humaal Khan, Katie Keck, Mikayla Cochrane, Ronak Ahir, Sammy Alfonsi, Will Connolly, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a significant risk factor for type 2 diabetes mellitus (T2DM). CPAP treatment can potentially improve glycemic control in such subjects. However, the exact effects of CPAP treatment on diabetes are uncertain. The objective of this study is to examine the effect of CPAP treatment on HbA1c levels in subjects with moderate to severe OSA and T2DM.

Methods: This is a combined retrospective and prospective study collecting data through EPIC medical record reviews. We are collecting HbA1c levels (primary outcome variable) before and after CPAP treatment in subjects with moderate to severe OSA and T2DM. …

Evaluating The Accuracy And Use Of Continuous Glucose Monitoring In Hospitalized Patients: A Systematic Review And Meta-Analysis, Caroline Purcell, Jeffrey I. Joseph, Do

Phase 1

Introduction:

Glycemic variability in hospitalized patients is associated with poor clinical outcomes, longer length of stay, and increased cost. Advances in subcutaneous continuous glucose monitoring (CGM) technology may reduce glycemic excursions and improve clinical outcomes in hospitalized patients, yet CGM is not used due to a lack of evidence on accuracy. The objective of this study was to review and summarize the evidence on the accuracy of CGM in hospitalized, diabetic patients.

Methods:

A search was conducted for literature evaluating CGM accuracy in hospitalized, diabetic patients. Relevant studies were identified through full-text review and data was extracted for analysis. …

The Effect Of Medical Nutrition Therapy On Weight Loss, Ayesha Baig, Hannah Kostan, Cynthia Cheng

Phase 1

Introduction: In this retrospective study, we evaluated the effects of Jefferson’s medical nutrition therapy (MNT) program on weight loss. We anticipate that participation in the MNT program will lead to an improvement in weight and metabolic syndrome parameters.

Methods: We selected a convenience sample of 10 participants with BMI > 25 for this pilot retrospective chart review. Subjects were screened for various exclusion criteria such as past bariatric surgery, heart failure, malignancy, renal dialysis, and uncontrolled conditions such as hypothyroidism, anemia, or B12 deficiency. Weight measurements were collected from EPIC records starting from baseline, defined as 3 months prior to initiation …

Outcomes Following Open Reduction And Internal Fixation For Distal Humerus Fracture: Does Handedness Matter?, Charlotte N. Shields, Joseph R. Johnson, Jack M. Haglin, Sanjit R. Konda, Md, Kenneth A. Egol, Md

Phase 1

Introduction: No studies have assessed the relationship between extremity dominance and distal humerus fractures. This study sought to compare post-operative outcomes between patients with distal humerus fractures treated by open reduction and internal fixation (ORIF) of their non-dominant vs dominant arm.

Methods: A retrospective review of patients who sustained a distal humerus fracture treated with ORIF at one hospital between 2011-2015 was performed. Data collection included demographics, hand dominance, injury information, and surgical management. Post-operative outcomes included complications, time to fracture union, painful hardware, removal of hardware, Mayo Elbow Performance Index (MEPI), and range of motion.

Results: Of the …

Primary Care Obstructive Sleep Apnea Screening, Benjamin Espenhorst, Grant Gillan, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA), a disorder characterized by upper airway collapse during sleep, is currently underdiagnosed and undertreated. The goal of this project is to evaluate the efficacy of utilizing a targeted screening protocol to identify previously undiagnosed OSA in an adult primary care population.

Methods: This prospective quality improvement project included 210 patients in the Jefferson Department of Family Medicine not previously diagnosed with OSA. These patients were targeted based on 3 STOP-BANG criteria: hypertension, age >50 years, and BMI >35 kg/m2. Patients were initially contacted by mail, followed by 3 weekly phone calls. Patients were screened …

Chronic Kidney Disease Is Associated With Mortality From Covid-19 During Hospitalization In Male Vs. Female Adults, Katherine Senter, Jingjing Zhang

Phase 1

No abstract provided.

Incidence Of Marginal Ulceration Following Primary Versus Revisional Roux-En-Y Gastric Bypass Surgery: A Multi-Center Retrospective, Brigitte Anderson, Talar Tatarian, Md, Alec Beekley, Md

Phase 1

No abstract provided.

Think Twice Before Prescribing Antibiotics For That Swollen Knee: The Influence Of Antibiotics On The Diagnosis Of Periprosthetic Joint Infection., Graham S Goh, Javad Parvizi Md

Rothman Institute Papers

Periprosthetic joint infection (PJI) is a rare but devastating complication after total joint arthroplasty. An estimated 7-12% of patients have negative cultures despite clear clinical evidence of infection. One oft-cited reason for this occurrence is the administration of antibiotics in the weeks prior to obtaining cultures. This article reviews the influence of antibiotics on the diagnosis of PJI. Specifically, we examine the effect of prophylactic and therapeutic antibiotic administration on the diagnostic accuracy of microbiological cultures as well as serum and synovial biomarkers. We also explore the potential of molecular techniques in overcoming these limitations in patients who have received …

Racial Disparities In Occupational Risks And Lung Cancer Incidence: Analysis Of The National Lung Screening Trial., Hee-Soon Juon, Alicia Hong, Marcella Pimpinelli, Madhuwani Rojulpote, Russell Mcintire, Julie A. Barta

College of Population Health Faculty Papers

The relationship between racial disparities in occupational risk and lung cancer diagnosis is not well defined. We examined occupational exposure to asbestos, silica, and other workplace chemicals, fumes, or dusts as reported in the National Lung Screening Trial (NLST). Descriptive analyses and multivariate logistic regression models were performed. Among the NLST study cohort, 3.9% were diagnosed with lung cancer. African-Americans had a higher rate of lung cancer diagnosis than White individuals (4.3% vs. 3.9%). About 28% reported at least one occupational exposure, including 6.5% exposed to silica and 4.7% to asbestos. African-Americans reported occupational exposure more frequently than White participants, …

The Quest For Conquering Covid-19: Updates From The Laboratory, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

Disparities In Sars-Cov-2 Positivity Rates: Associations With Race And Ethnicity, Harvey W Kaufman, Justin K Niles, David B. Nash

College of Population Health Faculty Papers

Numerous reports indicate that African Americans and Latinos are being affected disproportionately by coronavirus disease 2019 (COVID-19). Positivity rates have not been analyzed on scale because only 4 states report race/ethnicity as part of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Previous studies also have had little ability to control for many known risk factors to better identify the effects of COVID-19 on racial and ethnic communities. Using test results from a large national reference laboratory database that included patients from all 50 states and the District of Columbia, this study compared positivity rates for SARS-CoV-2 nucleic acid amplification …

Machine Learning Approaches Identify Genes Containing Spatial Information From Single-Cell Transcriptomics Data., Phillipe Loher, Nestoras Karathanasis

Computational Medicine Center Faculty Papers

The development of single-cell sequencing technologies has allowed researchers to gain important new knowledge about the expression profile of genes in thousands of individual cells of a model organism or tissue. A common disadvantage of this technology is the loss of the three-dimensional (3-D) structure of the cells. Consequently, the Dialogue on Reverse Engineering Assessment and Methods (DREAM) organized the Single-Cell Transcriptomics Challenge, in which we participated, with the aim to address the following two problems: (a) to identify the top 60, 40, and 20 genes of the Drosophila melanogaster embryo that contain the most spatial information and (b) to …

Primary Care In A Pandemic: A Qualitative Study On The Impact Of Covid-19 On Workplace Wellness, Oriana Pando, Amy Cunningham, Erin Kelley, Randa Sifri, Kelsey Smith

Phase 1

Introduction:

On March 16, 2020, the city of Philadelphia announced a state of emergency due to the COVID-19 global pandemic. The Primary Care Department of Thomas Jefferson Hospital had to alter operations to protect patients, providers and staff. These changes included an increase in telehealth, personal protective equipment (PPE), spacing in-person visits, and working from home. This study was designed to qualitatively assess how these changes have impacted providers and staff in Jefferson’s primary care settings.

Methods:

We conducted 31 qualitative semi-structured interviews with employees of Jefferson Primary Care practices. Though, our population was heavily skewed toward clinical staff (N=9), …

Effectiveness Of Enrichment Programs Such As Step Up In Increasing The Matriculation Of Urim Students To Medical Schools, Jessica Amoako, Traci Trice, Md

Phase 1

Introduction: Diversity in healthcare can improve access to healthcare for racial/ethnic minorities. However, barriers such as lack of educational opportunities have hindered URiM (underrepresented in medicine) students from matriculation to medical school. Enrichment programs such as STEP UP Medicine seek to break down these barriers. It provides its participants with MCAT preparation, advising, medical skills sessions, clinical shadowing experiences, and networking opportunities. Thus, the goal of this project is to assess if this program is effective in improving the medical school matriculation rates of URiM students.

Methods: Data was collected through a self-administered online survey using Google forms. The link …

Retrospective Chart Review Of Metastatic Solid Tumor Discharges To Subacute Rehab, Sarah Svetec, Molly Hanson, Crnp, Brooke Worster, Md

Phase 1

Introduction: Regaining strength through rehabilitation as a mechanism to return cancer patients to therapy is poorly understood and therefore realistic advice cannot be given to patients when cancer-directed therapy must be stopped. This research examines what cancer patients are able to accomplish following referral to subacute rehabilitation (SAR). It was hypothesized that the majority of patients would not return to cancer-directed therapy following SAR and that a high functional status at discharge would be the best predictor of this return.

Methods: A retrospective chart review was completed for 112 metastatic solid tumor patients discharged to SAR (2018-2020). The primary outcome …

Training Toolkit For Caregivers At Residential Care Centers In Peru, Elizabeth Stratton, Stephen Didonato, Wayne Centrone

Phase 1

Introduction:

Health Bridges International (HBI) is developing a training toolkit for caregivers working with marginalized youth in residential care centers (RCCs) in Peru. The toolkit represents an amalgamation of best practices, evidence informed research, and the results of our QI survey tool. We predicted that current Peruvian caregivers will identify topics of interest that differ from current literature.

Methods:

Surveys were distributed to over 150 RCCs throughout Peru using email and WhatsApp messages in a snowball format, starting at the administration level. The survey required 20-30 minutes to complete and was completely voluntary. All preliminary data was de-identified and imputed …

Patient Evaluation Of Medication-Assisted Treatment For Opioid Dependency, Francesca Ciocco, Lara Weinstein, Md

Phase 1

Introduction: Although primary care settings are a promising setting for expansion of medication-assisted treatment (MAT) for opioid use disorder (OUD), currently there is not an established primary care model for MAT. While creating a primary care MAT model, traditional treatment success measures (TSMs), like abstinence, may not be effective for vulnerable populations. This study aims to identify patient-important TSMs and compare their relative importance to traditional TSMs.

Methods: Traditional TSMs for MAT programs were identified with a literature review, while potential patient-important TSMs were identified from qualitative analysis of intake interviews for a MAT program in Philadelphia. Traditional and …

Pattern Of Sexual Partner Violence And Health In Young Adult College Students Ages 18-24, Alice Renaud, Allison Casola, Phd

Phase 1

No abstract provided.

Identifying Health Topics For Elementary-Aged Children In Delaware, Kayla Morrell, Denise Hughes

Phase 1

Introduction: Health literacy involves understanding health-related information to make educated decisions regarding an individual’s needs. Low health literacy is associated with poorer health outcomes, which can be minimized by early introduction to accurate health information. Currently, elementary schools in Delaware have no health curriculum, leaving students at risk for low health literacy.

Methods: Interviews were conducted with Delaware elementary school teachers to identify a series of topics that would allow students to learn health information via incorporation into existing curriculum. Teachers were divided into focus groups by school and grade level. The resulting discussions were qualitatively analyzed by two independent …

Assessing The Role Of Virtual Social Networks In The Treatment Progress Of Mothers Recovering From Opiate Addiction, Marisa Wu, Meghan Gannon, Phd Msph, Diane Abatemarco, Phd, Msw

Phase 1

Introduction: Social engagement is a significant contributor to the treatment success of individuals with prior substance use. This project aims to determine if social engagement improves the progression through and experience of treatment of mothers with prior opioid use at an inpatient recovery facility. We hypothesize that increased social engagement will improve treatment progress and experience.

Methods: The project is centered on mothers seeking treatment for opioid use at an urban inpatient treatment facility. The study obtains qualitative and quantitative data through interviews and therapy sessions. The data informs the extent and quality of social engagement and individual perspectives of …

Maternal Stress And Breastfeeding Intention In Pregnant Women With Opioid Use Disorder, Yassamin Jamshidian, Vanessa Short, Phd, Mph, Diane J. Abatemarco

Phase 1

Introduction: Breastfeeding rates are low among women in treatment for opioid use disorder (OUD). Information on determinants of breastfeeding intention can help inform the design of breastfeeding promotion interventions for this population. The objective of the study was to examine associations between maternal characteristics, including stress, and breastfeeding intention among pregnant women in treatment for OUD.

Methods: Fifty-six pregnant women who were receiving treatment for OUD at Thomas Jefferson University’s Maternal Addiction Treatment Education & Research (MATER) program completed a survey, which included questions on demographics, psychosocial characteristics, breastfeeding history, and breastfeeding intention. Maternal stress was measured using the Perceived …

Immigrant Health Literacy Initiative, Yuliya Goykhman, Kelsey Salazar, Mph

Phase 1

Introduction: Low health literacy in immigrant and refugee patients contributes to reduced health access and overall poorer quality of life in these patient populations. Community-Based Organizations (CBOs) provide necessary health navigation services for immigrant populations, but their role is often overlooked by large healthcare institutions. This project aims to illustrate the unique needs of both immigrant and refugee clients in navigating the healthcare system and CBO staff in assisting them with navigation, and to demonstrate to hospital partners how their services are crucial to adequate care of these communities.

Methods: As part of the Pennsylvania Health Literacy Coalition (PAHLC), four …

Nutritional Intervention In Concussion Treatment And Analysis Using Mri And Eeg, Jideofor Okafor, Namdi Nwasike, Andrew Newberg, Md

Phase 1

Traumatic brain injuries (TBI) occur in over one million Americans annually, leading to thousands of deaths, hospitalizations, and individuals with long term disability. The most common causes of TBI which result in hospitalization primarily affect middle-aged to older adults and contribute to the annual economic burden of billions of dollars. The goal of this study is to determine if baseline EEG scans predict responsiveness to supplemental treatment in TBI patients experiencing chronic symptoms, which could improve their care.

Subjects recruited from the greater Philadelphia area were randomly separated into 3 groups—Control, N-acetylcysteine (NAC), or Nutrition—and either received standard treatment for …

Menstrual Management In Adolescent Transgender Males, Julia Eisenberg, Sarah Felleman, Benjamin Bear, Mph, Arielle Effron, Md, Anne Kazak, Phd, Abpp, Anthony Alioto, Phd, Evan Graber, Do, Vanessa Short, Phd, Mph, Meghan Gannon, Phd, Msph, Beth Schwartz, Md

Phase 1

Introduction: Gender dysphoria is associated with increased rates of anxiety, depression, and suicidal ideation in adolescents. There is anecdotal evidence that menstruation increases the occurrence of gender dysphoria in adolescent transgender males. We hypothesize that menses are distressing to transgender males and this population would benefit from menstrual management.

Methods: We conducted a retrospective chart review of all transgender male patients seen in the Nemours Gender Wellness Program (GWP) and limited our population to those who have reached menarche. Data was extracted from the encounters at the GWP clinic and recorded in REDCap. We compared self-reported symptoms of gender dysphoria …

Diabetes Distress, Daily Functioning, And Hemoglobin A1c In Older Black Individuals With Diabetes And Mild Cognitive Impairment, Navajyoti R. Barman, Robin J. Casten, Phd, Barry W. Rovner, Md

Phase 1

Objective: The purpose of the cross-sectional study was to identify associations between diabetes distress, physical functioning, and cognition with hemoglobin A1c in older Black individuals with diabetes and mild cognitive impairment.

Methods: The investigators analyzed previously collected data from 101 older Black individuals with diabetes and mild cognitive impairment. Participants were administered surveys at baseline to assess diabetes distress, physical functioning, and cognitive functioning, and had hemoglobin A1c testing.

Results: Participants with higher hemoglobin A1c showed worse self-reported daily function (r = -0.279, p < .01). Three of four diabetes distress factors were positively correlated with hemoglobin A1c – emotional (r = .276, p < .01), regimen-related (r = .330, p < .01), and interpersonal distress (r = 0.266, p <.01). In a multivariate regression with hemoglobin A1c as the dependent variable, only regimen-related diabetes distress (beta = .282, p = .012) and self-reported daily function (beta = -0.294, p = .027) were significant.

Conclusion: The main finding of this study is that regimen-related diabetes distress and self-reported daily …

Racial Discrepancies In Interpregnancy Intervals And Postpartum Contraception Receipt In Centering Pregnancy Prenatal Care, Amulya Raju, Ms, Dennis Hand, Phd

Phase 1

Non-Hispanic black women are disproportionately affected by higher rates of shorter interpregnancy intervals. The purpose of this study is to identify whether the Centering Pregnancy model of group prenatal care (GPC) can reduce this health disparity by increasing postpartum contraception receipt.

This retrospective chart analysis measures consistency in contraception intent versus actual postpartum receipt in populations of women who received either individual or GPC. The main predictors were: race, insurance type (public or private), marital status, and type of prenatal care. The main outcomes were: type of contraception received, consistency with contraception intent, and presence of a short interpregnancy interval. …

The Number And Types Of Procedures Performed At Jeffhope Clinics, Jeremy Heard, James Plumb

Phase 1

Introduction: Procedures performed as part of the urgent care medical services provided at JeffHOPE Clinics (JHCs) are common in daily operations, but the number and types of procedures performed at each JHC have not yet been reported. The goal of this research was to provide JHCs the data needed to ensure clinic-specific evidence-based training for incoming procedures committee members, and thus ensure the highest quality patient care. The inquiry question was what are the number and types of procedures performed at each JHC?

Methods: An IRB waiver of authorization was obtained. A chart review of patients 18 years or older …

Net Therapy Effect On Chronic Pain Patients: An Fmri/Pet Imaging Study, Layla Annous, Andrew Newberg

Phase 1

Chronic pain is pain that lasts longer than 3 months or lasts longer than tissue healing should naturally take, which can limit patients’ daily activities. Chronic pain impacts 20% of people worldwide, preferentially affecting vulnerable and marginalized populations. We aimed to use fMRI/PET imaging of the brain to determine the efficacy and therapeutic use of Neuro-emotional Technique (NET) therapy for chronic pain patients. We anticipated that NET Therapy would result in decreased activity in areas of the brain associated with pain and decreased perception of pain. Patients who have been suffering chronic pain conditions were used as the experimental group …

Primary Care Obstructive Sleep Apnea Screening, Grant Gillan, Ben Espenhorst, Cynthia Cheng

Phase 1

Obstructive Sleep Apnea (OSA) is a common sleep disorder characterized by long pauses in breathing over the course of a night’s sleep, leading to significant daytime fatigue and long-term pathologies if left untreated. While a sleep study is the diagnostic tool of choice for OSA, this test is costly. To maximize cost effectiveness, we developed a screening protocol to identify patients at high risk for OSA for referral for a sleep study.

To identify high risk individuals, we screen patients identified in the EMR with pre-existing risk factors of OSA. We contact them to complete the full screening test: the …

Assessing Sentiment Towards Opioid Use Disorder At Jefferson: Characterizing Non-Clinical Emergency Department Staff, Joseph Arciprete, Benjamin Finard, Madalene Zale, Mph, Benjamin Slovis, Md, Hannah Smith

Phase 1

Purpose: To characterize emergency department (ED) staff regard toward opioid use disorder (OUD) and analyze variation based on job category. The closure of Hahnemann Hospital, in combination with the increasing prevalence of OUD, is exacerbating the previously inadequate network of resources for these patients. Jefferson is strategically positioned to improve the care provided to this patient population, especially in an ED setting, and ultimately increase linkage to long-term recovery programs.

Methods: Sentiment toward this patient population was measured utilizing the Medical Condition Regard Survey (MCRS). This questionnaire was previously validated to subjectively, but quantitatively, assess regard toward a defined patient …