Medicine and Health Sciences Commons^™

Improving Response To Non-Traumatic Dental Pain In The Ed Through A Novel Task Trainer For Dental Blocks, Dylan Selbst, Alanna O'Connell, Tracy Brader

Phase 1

Purpose:

Dental nerve blocks are a vital skill for physicians to have when treating non-traumatic dental pain; however, there is yet to be a simple, practical, and effective way to educate residents in performing this task. The purpose of this project is to explore the efficacy of a low-fidelity dental model task-trainer in teaching emergency medicine residents to perform dental blocks.

Methods:

In this study, 29 EM residents at TJUH were surveyed regarding their knowledge and attitudes regarding performing dental blocks using a brief Likert-scale questionnaire. Next, they were given 15 minutes to practice performing dental blocks on a low-fidelity …

Analyzing The Effect Of Interview Time And Day On Emergency Medicine Residency Interview Scores, Sean Greco, Alanna O'Connell, Do, Tingting Zhan, Phd, Tracy Brader, Md, Megan Crossman, Do, Megan Stobart Gallagher, Do, Anthony Sielicki, Md, Peter Tomaselli, Md, Robin Naples, Md, Dimitrios Papanagnou, Md, Mph

Phase 1

Purpose: Each year, medical students go through the residency application process and are faced with the decision of where to apply. If they receive an interview offer at an institution, they are faced with another decision, when to schedule their interview. Studies have examined the possible effect of interview date on matching and on match rank. However, other variables such as examination scores, letters of recommendation, and class rank also effect match outcome. There have been no studies investigating the possible role the time of day in which the interview takes place can affect the residency interview process. The purpose …

Assessing The Educational Impact Of 3d Printed Models On Fellow, Resident, And Patient Education For Partial Nephrectomies, E. Reilly Scott, Samuel Morano, Andrea Quinn, Erica Mann, Kaitlyn Boyd, Michelle Ho, Alice Karp, Abhay Singh, Thenappan Chandrasekar, Mark Mann, Edouard Trabulsi, Vishal Desai, Costas Lallas

Phase 1

Purpose:

3D printing is a growing tool in surgical education with the ability to visualize and teach complex procedures from multiple angles. Previous studies demonstrated 3D models as useful teaching tools for partial nephrectomy for patient and trainee education. We aim to create a cheaper and simpler 3D model to encourage these learning opportunities.

Methods:

Patient-specific, cost-effective ($35) 3D models of the affected urologic structures were created using preoperative imaging of 17 patients undergoing partial nephrectomies at Thomas Jefferson University Hospital between July and December 2020.

Patients receiving the surgery filled out two surveys about their understanding of …

Understanding Clinical Staff Attitudes Towards Patients Presenting To The Emergency Department With Opioid Use Disorder, Benjamin Finard, Joseph Arciprete, Madalene Zale, Mph, Carissa Walkosak, Benjamin Slovis, Md, Ma, Dimitrios Papanagnou, Md, Hannah Smith, Phd

Phase 1

Purpose: Significant stigma surrounds patients with opioid use disorder (OUD). This stigma repeatedly follows patients into the ED and negatively influences care. All ED staff impact the patient journey in the ED and the success with which OUD patients receive a warm handoff to a recovery organization. What is the current attitude of Jefferson’s clinical staff towards patients with OUD?

Methods: The authors developed and deployed a survey to Jefferson’s ED clinical staff members through Qualtrics. The survey was informed by the validated Medical Condition Regard Scale (MCRS) to capture staff sentiments towards patients with OUD. Respondents job category, job …

The Use Of Integra Dermal Regeneration Templates And Cortical Bone Fenestrations Over Exposed Tibia., Liam P Hughes, Steven Forman, James C Krieg, William Hughes

Department of Surgery Faculty Papers

We present the case of an 86-year-old woman who suffered full-thickness soft tissue loss secondary to degloving injury to the lower left limb, resulting in an exposed tibia. This patient underwent drilling to create artificial fenestrations in the cortical bone followed by placement of Integra dermal regeneration template. The technique of drilling fenestrations to expose underlying vasculature of cortical bone has not previously been described in its relationship with Integra dermal regeneration templates in large degloving injuries of the lower limb. This technique enabled us to perform earlier skin grafting and ultimately resulted in complete and timely wound closure. We …

Levonorgestrel Intrauterine Device Use For Medical Indications In Nulliparous Adolescents And Young Adults., Beth I Schwartz, Morgan Alexander, Lesley L Breech

Department of Obstetrics and Gynecology Faculty Papers

PURPOSE: Intrauterine devices (IUDs) are highly effective at preventing pregnancy. Levonorgestrel (LNG) IUDs also have beneficial effects on menstrual bleeding and abdominal and pelvic pain. Although there are increasing data on use of IUDs for contraception in adolescents and for medical indications in adults, there are extremely limited data on LNG IUD use for medical indications in adolescents. Our objective is to describe the characteristics and experiences of LNG IUD use in nulliparous adolescents and young women using IUDs for medical indications.

METHODS: We conducted a retrospective chart review of all nulliparous patients aged 22 years and younger who underwent …

White Paper On Ophthalmic Imaging For Choroidal Nevus Identification And Transformation Into Melanoma, Carol Shields, Sara E. Lally, Lauren Dalvin, Mandeep Sagoo, Marco Pellegrini, Swathi Kaliki, Ahmet Kaan Gündüz, Minoru Furuta, Prithvi Mruthyunjaya, Adrian T. Fung, Jay S. Duker, Sara M. Selig, Antonio Yaghy, Sandor R. Ferenczy, Malvina B. Eydelman, Mark S. Blumenkranz

Wills Eye Hospital Papers

Purpose: To discuss the evolution of noninvasive diagnostic methods in the identification of choroidal nevus and determination of risk factors for malignant transformation as well as introduce the novel role that artificial intelligence (AI) can play in the diagnostic process. Methods: White paper. Results: Longstanding diagnostic methods to stratify benign choroidal nevus from choroidal melanoma and to further determine the risk for nevus transformation into melanoma have been dependent on recognition of key clinical features by ophthalmic examination. These risk factors have been derived from multiple large cohort research studies over the past several decades and have garnered widespread use …

Voxelotor Modulates The Analgesic Effect Of Certain Opioids., Samir K. Ballas

Cardeza Foundation for Hematologic Research

No abstract provided.

A Game Of Triage: Developing A Game To Teach Medical Students Triage Tagging In The Setting Of A Mass Casualty Event, Luke Egan, Alanna O'Connell

Phase 1

Purpose: Triage tagging during a mass casualty event (MCE) is an essential skill when it comes to being able to distribute limited resources to those most critical out in the field. Medical students do not receive any formal training on this. This project set out to design a game that would effectively teach students how to use the Simple Triage and Rapid Treatment (START) algorithm in the event they ever find themselves assisting in an MCE.

Methods: This project was aimed towards MS-4’s during their EM rotation. Due to COVID-19, the game design was adjusted to an online platform for …

Identifying The Roadblocks To Successful Pediatric Imaging Without Sedation Or Anesthesia, Iman Soliman, Ammie M. White, Md, J. Christopher Edgar, Phd, Laura Cadge, Ccls, Margaret Hamel-Daymon, Crnp, Sandra Saade-Lemus, Md, Rochelle Bagatell, Md, Elizabeth T. Drum, Md, Lisa States, Md

Phase 1

Background: Modern imaging modalities allow for assessment of a wide array of medical conditions. Because it is difficult for young children to remain still during lengthy imaging studies, there is a need for sedation and general anesthesia (GA). A growing literature, however, suggests that there may be deleterious neurocognitive effects of sedation/GA in young children. As such, it is in our patients’ best interest to critically evaluate the use of sedation/GA.

Objective: To identify the roadblocks to obtaining clinical pediatric magnetic resonance imaging (MRI) exams without sedation/GA.

Materials and Methods: Participants included 63 parents/guardians of 5- to 9-year-old patients who …

Health Disparities Among Pregnant Women Diagnosed With Covid-19 In Philadelphia, Vasundhara Acharya, Emily Oliver, Mbbs, Danielle Tsevat, Md, Guillermo Gurza, Md, Rupsa Boelig, Md

Phase 1

Introduction:

The CDC has cited language barriers and racial discrimination as some of the social determinants of health during the COVID-19 pandemic. This study aims to investigate the socioeconomic factors that affect COVID-19 diagnosis and outcomes in pregnant women. We hypothesize that women whose primary language is not English will have higher rates of COVID-19 compared to women whose primary language is English.

Methods:

This is a retrospective cohort study of women who delivered at TJUH between 04/13/2020 and 06/31/2020. Data on demographics, SARS-CoV-2 PCR, maternal, fetal, neonatal outcomes were collected. The primary outcome was the proportion of English …

Cryo Vs Rf P-Wave Characteristics Comparative Analysis, Waleed Khan, Behzad Pavri, John Schanz

Phase 1

Introduction:

Atrial fibrillation is one of the leading causes of heart failure and stroke in the US, meaning that optimizing treatment is essential. There are two catheter based PVI techniques used to treat drug-refractory AF patients: radiofrequency and cryo-balloon ablation. The goal of this study is to determine if there is a difference in efficacy between these two procedures.

Methods:

The study consisted of a retrospective chart review and ECG analysis of approximately 130 patients. The criteria for involvement is patients diagnosed with drug-refractory paroxysmal AF and who have undergone an ablation procedure in the past two years. Baseline characteristics …

Public Perceptions Of Opioid Use Disorder (Oud) In Rural Pennsylvania: Opportunities, Challenges, And Barriers, Josiah Miller, Duane Donmoyer, Md, James Plumb, Md, Mph

Phase 1

Introduction:

Opioid Use Disorder (OUD) has significantly impacted rural communities nation-wide. This study adds information to what is currently known about OUD and its effects on small towns through examining how OUD has, and is currently, affecting a rural community (~7,000 population) in central Pennsylvania. The main aim of this study was to better understand how OUD affects this small town through interviewing individuals involved in local public health.

Methods:

This qualitative study consisted of key stakeholder interviews with ten individuals involved in local government, law enforcement, or healthcare. Questions centered around how OUD affects the local area, how current …

Prevalence And Risk Factors For Abnormal M-Tics, Maëlys Yepes, Michael Chang, Cynthia Cheng, Md, Phd

Phase 1

Introduction: The lack of effective treatments for Alzheimer’s Disease (AD) underscores the importance of prevention and early detection of amnestic mild cognitive impairment (aMCI), its prodromal state. While studies have proposed a number of potential mechanisms underlying the pathogenesis of AD, such as hypoxia and neuropsychiatric symptoms, little research has been done to evaluate predictive risk factors.

Objective: The objective of this pilot study is to assess the prevalence and risk factors for aMCI.

Methods: This cross-sectional study was performed using data from patients screened for Memories 2, a clinical trial evaluating the effect of CPAP usage in patients with …

A Systematic Review Of Effective Waste Management In Hospitals, Adam Uppendahl, Shane Noreen

Phase 1

Introduction: Climate change is one of the most pressing issues facing society today. Hospitals have substantial carbon footprints and are one of the most significant contributors to waste production, yet environmental sustainability is woefully overlooked in healthcare. Understanding the state of environmental sustainability in healthcare is critical to improving the sustainability of medical practice.

Methods: A systematic review of the current literature regarding environmental sustainability in hospitals was conducted in the PubMed research database. In addition to the systematic search, reference sections of included papers were searched to identify additional papers. Studies needed to be focused on research related to …

Improving The Implementation Of Home Blood Pressure Monitoring, Joshua Mairose, Geoffrey Mills, Md

Phase 1

Introduction: Home blood pressure monitoring (HBPM) has been shown to outperform traditional office readings in its association with cardiovascular disease (CVD) risk and ability to identify patients with white coat or masked hypertension. For these reasons, the 2017 ACC/AHA Guidelines included HBPM as part of its recommendations for hypertension management. Our project focused on improving the implementation of HBPM in an urban primary care practice with an end goal of increasing the number of patients that actively use home blood pressure cuffs and have access to them for future telemedicine visits.

Methods: A patient outreach process to increase HBPM uptake …

Medicaid Expansion’S Importance To Mental Health Care, Cameron Blazoski, Vittorio Maio, Pharmd, Ms, Msph

Phase 1

Introduction: The 2010 Patient Protection and Affordable Care Act established the Medicaid expansion, which incentivized states to expand their Medicaid programs to include individuals with incomes up to 138% of the federal poverty level. A significant population that stood to benefit from this health care expansion were Americans who suffer from a mental health disorder. This study was conducted to analyze the impact of Medicaid expansion on individuals with mental health and substance abuse disorders.

Methods: This political commentary was based on statistics on mental health in the United States derived from research studies and publications from federal …

Lgbtq-Related Material In Undergraduate Medical Education In The Mid-Atlantic Region Of The United States, Margaret Pearce, Bernard Lopez, Md

Phase 1

Purpose

This study describes the current state of formal lesbian, gay, bisexual, transgender and queer (LGBTQ)-related education at undergraduate medical schools in the Mid-Atlantic region of the United States. A review of literature shows the last time a similar study was conducted was in 2011 by Obedin-Maliver et al and was a survey that included all medical schools of the United States and Canada. Given the changes over time for both the LGBTQ and medical community , it is likely that the state of LGBTQ-related education in undergraduate medical education has changed greatly.

Methods

This was a cross-sectional Internet-based survey, …

Capturing Initial Understanding And Impressions Of Surgical Therapy For Parkinson’S Disease To Enhance Patient Education, Samantha Katz, Julie Barbera, Chengyuan Wu, Tsao-Wei Liang

Phase 1

Purpose: Deep Brain Stimulation (DBS) is an underutilized surgical therapy for Parkinson’s Disease (PD). Both physician and patient hesitancies have been described as barriers to DBS, but specific perceptions of DBS have not been well characterized. To better understand DBS hesitancy, our objective is to pinpoint what specific concerns and fears our patient population have and use this information to enhance education for those contemplating DBS.

Methods: A 30-question survey assessing impressions of surgical therapy for PD was administered to PD patients seen at an urban movement-disorders clinic. Patients had not yet undergone DBS implantation or neurosurgeon consultation. Questions were …

Cbl Facilitation: A Survey Of Facilitators And Students With A Particular Interests In Team Building And Facilitation Improvement, Cecelia Sagona, Susan Truong, Md, Nethra Ankam, Md

Phase 1

Purpose: As the CBL cases have become more refined, there is a desire to continually improve the way cases are being facilitated, understand the methods that are working well, learn if there are practices that are detrimental to learning, and better understand how students are transitioning to teams. This project gathered information from both the from the Class of 2023 during their first year in the SKMC program and their CBL facilitators in order to improve the CBL facilitation. With the information gathered, there were two aims. First, to generate suggestions which were discussed at the CBL facilitators’ back to …

Use Of Active Comparator Tirals In Dermatology: A Repeated Cross-Sectional Analysis, John Miller, John Barbieri, Md, Arash Mostaghimi, Md, Sophia Ly

Phase 1

Introduction: Spending on medications is expected to grow to $420 billion in 2023, largely driven by introduction of new branded products. While new branded medications can transform how physicians care for patients, others may not offer meaningful benefit over existing less costly alternatives. As additional new products are approved, the need to include active comparators in dermatologic clinical trials is particularly important to guide clinical decision making.

Methods: To evaluate the trends in the use of active comparator trials designs, topical medications approved between January 2002 and December 2020 were identified through the 2020 Food and Drug Administration (FDA) …

Attitudes And Practices Of Providers Towards Continuity Of Care With Patients Prescribed Contraception, Jennifer Sachs, Grace Styklunas, Caroline King, Rebecca Mercier, Md

Phase 1

Introduction: The primary objective of this study is to evaluate provider attitudes and practices for follow-up counseling regarding patients prescribed contraception at women's health and primary care offices. As prescription contraception (oral contraceptive pills (OCPs), the patch, NuvaRing) are the most widely used reversible form of birth control in the United States, understanding provider practices and attitudes towards the necessity of follow-up for prescription contraception management is crucial.

Methods: An anonymous 16-item cross-sectional online Qualtrics survey queries providers for specialty and position, years in practice, as well as attitudes and practices regarding follow-up counseling for prescription contraception. The study cohort …

Differences In Hypertension And Obesity Levels Between High School Students In Philadelphia Urban And Suburban Areas, Joseph Gonnella, Jeremy Close, Md, Michael Bozzi, Md, Peri Levey, Kyle Prochno

Phase 1

Introduction: The prevalence of childhood obesity remains high, putting millions of children at risk of developing certain illnesses, such as diabetes and cardiovascular diseases. Therefore, it is vital to determine the true scope of the issue and reveal the risk factors associated with this condition. Since the objective of this study is to compare the obesity and hypertension levels between adolescents in Philadelphia urban and suburban high schools, these risk factors can be highlighted and analyzed.

Methods: Biometric and demographic data of Philadelphia urban students was collected from the Athlete Health Organization (AHO) pre-participation evaluations (PPEs) from 2016-2018. It was …

Comparing The Quality Of An In-Person Versus Virtual Diabetes Education Course Due To Covid 19 Pandemic, Allie Hamilton, Rickie Brawer, Phd

Phase 1

Introduction: Group diabetes education courses are proven to improve patients’ diabetes knowledge and metabolic control. Due to the COVID19 pandemic, Stephen Klein Wellness Center (SKWC) shifted their diabetes education course to an online format over Zoom. This study aimed to investigate difference in patient experience and course effectiveness between the in-person and online courses.

Methods: The population for this study includes 89 patients at SKWC that completed either the in-person or online diabetes education course. Participant satisfaction was measured with phone interviews and a survey. Course effectiveness was measured using surveys to assess the change in patients’ weight, amount of …

Steamn Spin, Kathryn Sommer, Christina Stiebris, Kelley Yuan, Morgan Hutchinson, Md, Aaron Herl, Rachel Smith, Jessica Gaulton, Md, Mph, Eddie Chang, Md, Mba

Phase 1

Sanitize and dry your breast pump parts within minutes.

Adverse Events Following Screening Eye Examinations For Retinopathy Of Prematurity In Premature Infants, Aditi Kale, Pedro Urday, Zubair H. Aghai

Phase 1

Introduction: The retinopathy of prematurity (ROP) examination is recommended for high-risk preterm infants to prevent its complications but may be associated with adverse events. The goal of this study is to determine whether the ROP examination increases the incidence of adverse events in premature infants.

Design/Methods: This was a retrospective study on all preterm infants (32 weeks gestation) born between 03/2017 and 12/2019 who survived until the first eye examination. The number of episodes of apnea (A), bradycardia (B), desaturation (D), number of infants on mechanical ventilation, and number of infants requiring sepsis evaluation were compared before and …

Outcomes Of Surgical Treatment For Carcinoid Heart Disease: A Systematic Review And Meta-Analysis, Diana C. Jiminez, Thomas J. O'Malley, Md, Abhiraj Saxena, Matthew P. Weber, Louis E. Samuels, John W. Entwistle, T. Sloane Guy, H. Todd Massey, Rohinton Morris, Vakhtang Tchantchaleishvili

Phase 1

Introduction and Objective: Carcinoid Heart Disease (CaHD) develops from vasoactive substances released by neuroendocrine tumors causing significant patient morbidity and mortality necessitating surgical intervention. We performed a systematic review and meta-analysis to elucidate granular perioperative details and long-term outcomes in these patients.

Methods: Electronic search of Ovid, Scopus, Cumulative Index of Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed. Nine articles comprising 416 patients who received surgery were selected. Primary outcomes investigated included patient characteristics, surgical characteristics and survival data. Study-level data were extracted and pooled for meta-analysis.

Results: Primary outcomes consisted of …

Characterizing The Anesthetic Management Of Patients Undergoing Transradial Cardiac And Cerebrovascular Interventions: A Single-Institution Study, Steven Bieser, Somnath Das, Lohit Velagapudi, Heli Patel, Joshua Weinberg, Lisa Moss, Marguerite Davis, Nicholas Ruggiero, Pascal Jabbour, Victor Romo

Phase 1

Introduction:

Transradial approaches are shown to reduce mortality, morbidity, access-site complications, hospital stay and costs when compared to the transfemoral approach in multiple cardiac trials. Use of the antispasmotic cocktail for these interventions poses challenges for anesthetic management. Differing practices between fields may need to be consolidated. This study aims to characterize the safety profile of cardiac and neuroanesthetic management protocols for transradial interventions, hypothesizing that the cocktail is safe from an anesthetic perspective.

Methods:

We performed a retrospective chart review of patients undergoing transradial diagnostic cardiac and cerebrovascular interventions. Data collected included age, sex, comorbidities, prior antihypertensive medications, dose …

Development Of A Method Using Retrograde Neuronal Tracers To Neuroanatomically Characterize Respiratory Neural Circuitry, Samantha Thomas, Angelo Lepore

Phase 1

Introduction:

Loss of respiratory function is one of the leading causes of death following spinal cord injury (SCI). Existing studies have demonstrated that pre-phrenic interneurons (PPIN’s) can be recruited into the phrenic motor neuron (PhMN) pathway following cervical SCI and may contribute to respiratory recovery, but there is still a lack of information detailing the nature of these changes and the extent they may improve diaphragm function. This project aims to validate a method of utilizing neuronal tracers to further characterize the intact respiratory circuitry.

Methods:

This study was carried out using a rat model. A fluorophore-conjugated retrograde neuronal …

Effectiveness Of Nutritional Counseling And Vlcd (Very Low Calorie Diet) For Weight Loss And Metabolic Syndromeketav., Ketav Patel, Ayesha Baig, Connor Mcelwee, Jessica Vitale, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obesity and Diabetes are highly prevalent conditions worldwide. Morbidity and mortality stemming from these conditions has critical implications on the health and day to day lives of patients. A Very Low- Calorie Diet (VLCD) may be an effective tool to aid in lowering weight for both obese and diabetic patients, but has not been well studied. Thus, the efficacy of a VLCD on lowering weight, BMI, blood pressure, HbA1c, Lipid levels, and blood glucose was explored in this pilot study.

Methods: The study’s population is taken from an MNT (medical nutrition therapy) program at Jefferson. Patients who had prior …