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From The Editors

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

Happy New Year and welcome to JCIPE's fall 2019/winter 2020 edition of Collaborative Healthcare! The past six months have been an especially busy time for us. We offered all our major IPE programs while welcoming several new full-time JCIPE staff members. These include two new program coordinators and two program assistants. The growth in human capital is essential for the continued growth (both in number and size!) of our core and advanced IPE/CP programs. We also welcomed a full-time staff member to oversee development and marketing of the Jefferson Teamwork Observation Guide (JTOG) - soon to be available as …

Collaborative Healthcare: Interprofessional Practice, Education And Evaluation (Jcipe), Volume 10, Number 2, Fall 2019/Winter 2020

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

In this Issue

1 - From the Editors

2 - Collaboration is a "Work of Art"

4 - Developing Interprofessional Preceptors to Promote Intentional Interprofessional Education in Practice Settings: Reflections from the Preceptors in the Nexus Workshop

6 - Stranger No More: A Reflective Conversation

7 - Using the Interprofessional Education Collaborative (IPEC) Core Competencies to Build a Microcredentialing Framework for Interprofessional Curriculum Development

8 - Meet an IPE Faculty Champion from Thomas Jefferson University

9 - Meet an IPE Student Champion from Thomas Jefferson University

9 - Dr. John Gilbert visits the JCIPE Team

Robotic Adrenalectomy For Functional Adenoma In Second Trimester Treats Worsening Hypertension, Courtney Capella, Bs, Joseph Godovchik, Bs, May Jean Counsilman, Md, Thenappan Chandrasekar, Md, Costas D. Lallas, Md, Huda B. Al-Kouatly, Md

Department of Obstetrics and Gynecology Posters

Robotic adrenalectomy is a feasible surgical alternative in the second trimester and can reverse the hypertensive disease and its associated maternal-fetal complications

Improving Utilization Of Aspirin For Prevention Of Preeclampsia In A High Risk Urban Cohort, Rupsa C. Boelig, Md, Mariam Wanees, Ba, Vincenzo Berghella, Md, Amanda Roman, Md

Department of Obstetrics and Gynecology Posters

High risk women without a history of preeclampsia were less likely to be recommended aspirin for preeclampsia prevention. A simple screening tool at 1st trimester ultrasound can significantly improve aspirin utilization for preeclampsia prevention

Association Between Abo Blood Type And Postpartum Hemorrhage By Mode Of Delivery: A Retrospective Cohort Study, Julia Burd, Md, Johanna Quist-Nelson, Md, Sara Edwards, Md, Anju Suhag, Md, Vincenzo Berghella, Md, J. Biba Nijjar, Md

Department of Obstetrics and Gynecology Posters

Background

Patients with type O blood have been reported to have more bleeding complication than those of other pooled blood groups (OR 1.33)

Prior studies on postpartum hemorrhage by blood type

• Yielded mixed results
• Did not separate by mode of delivery

The Effect Of Transvaginal Ultrasound, Vaginal Examination, Or Coitus On Fetal Fibronectin Results: A Systematic Review, Ariel Levy, Md, Johanna Quist-Nelson, Md, Vincenzo Berghella, Md

Department of Obstetrics and Gynecology Posters

Cervical manipulation via transvaginal ultrasound or sterile vaginal examination does not significantly affect fetal fibronectin results; therefore its use after these exposures is clinically acceptable. Conversely, fFN use in the setting of recent coitus should continue to be discouraged.

Return To Sport And Athletic Function In An Active Population After Primary Arthroscopic Labral Reconstruction Of The Hip, David R. Maldonado, Sarah L. Chen, Mitchell J. Yelton, Philip J. Rosinsky, Rafael Walker-Santiago, Jacob Shapira, Ajay C. Lall, Benjamin G. Domb

Student Papers, Posters & Projects

Background: Labral reconstruction has been advocated as an alternative to debridement for the treatment of irreparable labral tears, showing favorable short-term results. However, literature is scarce regarding outcomes and return to sport in the nonelite athletic population.

Purpose: To report minimum 1-year clinical outcomes and the rate of return to sport in athletic patients who underwent primary hip arthroscopy with labral reconstruction in the setting of femoroacetabular impingement syndrome and irreparable labral tears.

Study Design: Case series; Level of evidence, 4.

Methods: Data were prospectively collected and retrospectively analyzed for patients who underwent an arthroscopic labral reconstruction between August 2012 …

Gibbon Surgical Society

Gibbon Surgical Review

The John H. Gibbon, Jr. Surgical Society (GSS) at Sidney Kimmel Medical College (SKMC) at Thomas Jefferson University is a unique student interest group that has been working hard to increase interest in the field of surgery among medical students for the last 37 years. The society has over 400 total active members on a year to year basis, spread across the four-year curriculum. The GSS increases exposure and interest to the surgical field through a unique blend of episodic and longitudinal programming that helps bring together students, residents, and faculty in an educational setting.

Interview With Dr. Geoffrey Krampitz, Colin Yost

Gibbon Surgical Review

Geoffrey Krampitz, MD, PhD is a hepatopancreaticobiliary surgeon with an extensive background in surgical oncology, stem cell science, and cancer immunotherapy research who recently joined the faculty here at Thomas Jefferson University as an Assistant Professor of Surgery. After earning his BSE in biomedical engineering at Johns Hopkins University and before starting medical training, Dr. Krampitz worked in consulting in the San Francisco Bay Area and eventually helped launch two internet startup companies in Silicon Valley. He then went to UC San Francisco for his Master’s degree, where he investigated the role of HIF1-alpha in stem cell differentiation. Dr. Krampitz …

Primum Non Nocere: Surgeons And The Politics Of Firearm Trauma, Kaushal Desai

Gibbon Surgical Review

The crisis of firearm violence in America continues to worsen and the call to action cannot be ignored. If we are to make a real impact, we must be just as skilled policy makers as proceduralists. We must wield the pen as well as we wield the scalpel. All the clinical knowledge and surgical skills in the world will make no difference if we do not reduce the number of firearm injuries. The skillset we need is policy analysis and lobbying, which can only be developed through political activism and engagement, not more practice questions and Online MedEd.

General Surgery 101: Nissen Fundoplication, Kelley Yuan, Tyler Bauer

Gibbon Surgical Review

The first time that medical students enter the OR can be a jarring experience. Successfully maintaining sterility is hard enough, but remembering relevant patient history, answering “pimp” questions, and performing basic suturing skills can make the third year medical student experience difficult. In this article we describe a common surgery performed by both general and thoracic surgeons with a specific focus on “medical student level” understanding. This piece is the product of a collaboration between an MS1 and MS4, both of whom are interested in a career in surgery. We hope you find it helpful!

Interview With Dr. Dawn Salvatore, Preeyal Patel

Gibbon Surgical Review

A medical student’s path to surgery is notoriously long and arduous. Traditionally, students who are interested in the field begin to prepare their qualifications from day one, especially given the competitive nature of acceptance into surgical programs. For students who develop an interest in surgery during their later years of medical school, it can be a daunting task to pursue a track in which they already feel behind. Often times, these students are discouraged from applying to surgical residencies, worrying that their non-traditional path may hinder their success. However, Dr. Dawn Salvatore can reassure students that a non-traditional path to …

The Utility Of Surgical Simulation In Student Education, Jared Raikin

Gibbon Surgical Review

The use of simulation in the field of surgery has become a heavily researched topic over the last few decades, but it is by no means a new concept. The first recorded use of surgical simulation dates back 2,500 years with evidence of nasal models for flap reconstruction made of leaf and clay.1 But simulation as we know it today did not take shape until the 1980s with the invention of the Comprehensive Anesthesia Simulation Environment (CASE) mannequins. The use of nonorganic simulation tools revolutionized the field and continues to play a large role in medical education. These modalities have …

Bedside To Bench: Basic Science Research During General Surgery Residency, Signe Caksa

Gibbon Surgical Review

Clinical, basic science, and quality improvement research is becoming increasingly integrated into general surgery residency programs, providing aspiring surgeons with an avenue to engage with academia and improve patient care early on in their careers. For example, as an essential part of their training, general surgery residents at Thomas Jefferson University Hospital (TJUH) complete one to two years of research, usually between their PGY3 and PGY4 years. The goal of this protected research time is for residents to gain hands-on surgical research skills and work on translational research projects that correlate with clinical cases, while also becoming more competitive for …

Longevity In Surgery: A Conversation With Two Temple Surgeons About How They Continually Find Joy In Their Careers, Kelsey Muir

Gibbon Surgical Review

Both Dr. Daly and Dr. Pontari describe the stress and pressure that comes with a long career in patient care, however intertwined with the stress is their overwhelming gratitude and joy for surgery. Maintaining that perspective for medicine and patient care has required two things: community and an outlet. Dr. Daly and Dr. Pontari expressed the need to be able to share their anxieties and struggles with someone to process the stress, the difficulties, and the demands of a surgical career.

Surgery Myths And Facts, Heli Patel

Gibbon Surgical Review

Throughout social media, television shows, movies, and “public perception”, surgical residents and attendings are often stereotyped into a personality that is most often incorrect. Unless you are a surgeon, it is often hard to understand what exactly the life entails. Add in some Hollywood drama and social media, and what you get is a wildly disproportionate picture of what surgeons’ personalities are like. As a medical student, it is often difficult to separate fact from fiction, so here are some of the most common myths debunked.

John H. Gibbon, Jr., Md

Gibbon Surgical Review

Dr. John Heysham Gibbon, Jr. graduated from Jefferson Medical College in 1927, and in a brief series of events, he was named Fellow at Massachusetts General Hospital. In 1930, he found himself assisting Dr. Edward Churchill in an emergency pulmonary embolectomy. At that time the procedure was one of desperation, as no patient in the U.S. had survived the removal of blood clots in open-heart surgery. As Dr. Gibbon recorded the patient’s waning vital signs prior to the procedure he thought, “If only we could remove the blood from her body by bypassing her lungs, and oxygenate it, then return …

Gibbon Surgical Review, Volume 3, Issue 1, 2020

Gibbon Surgical Review

Table of Contents

4 - Interview with Dr. Geoffrey Krampitz

8 - Primum Non Nocere: Surgeons and the Politics of Firearm Trauma

10 - General Surgery 101: Nissen Fundoplication

14 - Interview with Dr. Dawn Salvatore

16 - The Utility of Surgical Simulation in Student Education

18 - Bedside to Bench: Basic Science Research During General Surgery Residency

20 - Longevity in Surgery: A Conversation with Two Temple Surgeons About How They Continually Find Joy in Their Careers

22 - Surgery Myths and Facts

24 - Gibbon Surgical Society

25 - John H. Gibbon Jr., MD

26 - Editorial Board …

Anesthesia For The Patient With A Recently Diagnosed Concussion: Think About The Brain!, Mohammed R. Rasouli, Michelle Kavin, Stephen Stache, Michael E. Mahla, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

Some patients require emergent, urgent, or elective surgery in the time period immediately following diagnosis of concussion. However, changes in brain homeostatic mechanisms following a concussion and concern for secondary brain injury can complicate the decision as to whether or not a surgery should proceed or be postponed. Given the paucity of available evidence, further evaluation of the use of anesthesia in a patient with concussion is warranted. This article summarizes what is currently known about the relevant pathophysiology of concussion, intraoperative anesthesia considerations, and effects of anesthesia on concussion outcomes in an attempt to help providers understand the risks …

Linkage Between Poverty And Smoking In Philadelphia And Its Impact On Future Directions For Tobacco Control In The City., Christine S. Shusted, Gregory C. Kane

Department of Medicine Faculty Papers

Poverty is linked to negative health consequences and harmful health behaviors such as smoking. Despite this established correlation, few comparative studies have investigated the relationship between local poverty rates and smoking in urban settings through a Social Ecological Model framework. The authors sought to examine the linkage between local poverty rates in Philadelphia, Pennsylvania and adult smoking rates by scrutinizing existing patterns and potential mediating factors via publicly accessible data in established planning districts. The authors determined several individual, interpersonal, organizational, community, and environmental factors, varying across these districts, that impact smoking in Philadelphia. Poverty rates influence the resources, demographic …

Proton Pump Inhibitor Use Affects Pseudarthrosis Rates And Influences Patient-Reported Outcomes., John J. Mangan, Srikanth N. Divi, James Mckenzie, Justin D. Stull, William Conaway, David S. Casper, Dhruv K.C. Goyal, Kristen J. Nicholson, Matthew S. Galetta, Scott C. Wagner, I. David Kaye, Mark Kurd, Barrett I. Woods, Kristen E. Radcliff, Jeffrey A. Rihn, D. Greg Anderson, Alan S. Hilibrand, Alex R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler

Department of Orthopaedic Surgery Faculty Papers

Study Design: Retrospective cohort review.

Objectives: Cervical pseudarthrosis is a frequent cause of need for revision anterior cervical discectomy and fusion (ACDF) and may lead to worse patient-reported outcomes. The effect of proton pump inhibitors on cervical fusion rates are unknown. The purpose of this study was to determine if patients taking PPIs have higher rates of nonunion after ACDF.

Methods: A retrospective cohort review was performed to compare patients who were taking PPIs preoperatively with those not taking PPIs prior to ACDF. Patients younger than 18 years of age, those with less than 1-year follow-up, and those undergoing surgery …

Contemporary Nstemi Management: The Role Of The Hospitalist., Charles V Pollack, Alpesh Amin, Tracy Wang, Steven Deitelzweig, Marc Cohen, David Slattery, John Fanikos, Christopher Dilascia, Regan Tuder, Scott Kaatz

Department of Emergency Medicine Faculty Papers

Non-ST-segment elevation myocardial infarction (NSTEMI) is defined as elevated cardiac biomarkers of necrosis in the absence of persistent ST-segment elevation in the setting of anginal symptoms or other acute event. It carries a poorer prognosis than most ST-segment elevation events, owing to the typical comorbidity burden of the older NSTEMI patients as well as diverse etiologies that add complexity to therapeutic decision-making. It may result from an acute atherothrombotic event ('Type 1') or as the result of other causes of mismatch of myocardial oxygen supply and demand ('Type 2'). Regardless of type and other clinical factors, the hospital medicine specialist …

Accepting Higher Morbidity In Exchange For Sacrificing Fewer Animals In Studies Developing Novel Infection-Control Strategies., Henk J. Busscher, Willem Woudstra, Theo G. Van Kooten, Paul Jutte, Linqi Shi, Jianfeng Liu, Wouter L.J. Hinrichs, Hendrik W. Frijlink, Rui Shi, Jian Liu, Javad Parvizi, Stephen Kates, Vincent M. Rotello, Thomas P. Schaer, Dustin Williams, David W. Grainger, Henny C. Van Der Mei

Rothman Institute Papers

Preventing bacterial infections from becoming the leading cause of death by the year 2050 requires the development of novel, infection-control strategies, building heavily on biomaterials science, including nanotechnology. Pre-clinical (animal) studies are indispensable for this development. Often, animal infection outcomes bear little relation to human clinical outcome. Here, we review conclusions from pathogen-inoculum dose-finding pilot studies for evaluation of novel infection-control strategies in murine models. Pathogen-inoculum doses are generally preferred that produce the largest differences in quantitative infection outcome parameters between a control and an experimental group, without death or termination of animals due to having reached an inhumane end-point …

Ultra-Fast Conductive Media For Rna Electrophoretic Mobility Shift Assays., Samantha Z Brown, Lebaron C Agostini, Henry L Thomsett, Jonathan R Brody

Department of Surgery Faculty Papers

The use of RNA electrophoretic mobility shift assays (REMSAs) for analysis of RNA-protein interactions have been limited to lengthy assay time and qualitative assessment. To vastly improve assay efficiency, feasibility and quality of data procured from REMSAs, we combine here some of the best-known labeling and electrophoretic techniques. Nucleic acid fragments are end-labeled with fluorescent tags, as opposed to the radioactive or biotin tags. The fluorescent probes may be detected directly from the electrophoresis gel, eliminating the need for cumbersome membrane transfer and immunoblotting. Modifying the REMSA protocol to include low-molarity, lithium borate conductive media and near-infrared-labeled probes allows for …

Appendix 10: Neurotechnology Descriptions, Namrata Grampurohit, Phd, Otr/L

Department of Occupational Therapy Faculty Papers

Neurotechnologies Covered:

• Electrical stimulation over the surface of the arm or hand
• Electrical stimulation over the surface of the spine
• Electrical stimulation over the surface of the head
• Magnetic stimulation over the surface of the head
• Braces that are powered to amplify movements
• Brain computer interface with a cap
• Baclofen pump

Paging: A Collection Of Short Stories, Shruthi Deivasigamani, Katherine Hubbard, Ma

Phase 1

Introduction: Paging is a series of thematically interconnected short stories that take place at a single fictional urban hospital center. The guiding questions that the stories explore are twofold: other than doctors and patients, what kinds of people spend their time in a hospital? And, what kind of place is the hospital for these people?

Methods: The background research for Paging began by exploring written works of fiction, nonfiction, and memoir set in hospitals. After I had developed a set of guiding research questions, I spent the summer at a major hospital in New York City, where I was able …

Diagnostic Accuracy Of Ceus Li-Rads For The Characterization Of Liver Nodules 20 Mm Or Smaller In Patients At Risk For Hepatocellular Carcinoma., Jia-Yan Huang, Jia-Wu Li, Qiang Lu, Yan Luo, Ling Lin, Yu-Jun Shi, Tao Li, Ji-Bin Liu, Andrej Lyshchik

Department of Radiology Faculty Papers

Background: American College of Radiology contrast agent–enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) was developed to improve the accuracy of hepatocellular carcinoma (HCC) diagnosis at contrast agent2enhanced US. However, to the knowledge of the authors, the diagnostic accuracy of the system in characterization of liver nodules 20 mm or smaller has not been fully evaluated.

Purpose: To evaluate the diagnostic accuracy of CEUS LI-RADS in diagnosing HCC in liver nodules 20 mm or smaller in patients at risk for HCC.

Materials and Methods: Between January 2015 and February 2018, consecutive patients at risk for HCC presenting with …

Acoustic Parameters For Optimal Ultrasound-Triggered Release From Novel Spinal Hardware Devices., Lauren J. Delaney, Cemile Basgul, Daniel W Macdonald, Keith Fitzgerald, Noreen J. Hickok, Steven M Kurtz, Flemming Forsberg

Department of Radiology Faculty Papers

Post-operative infection is a catastrophic complication of spinal fusion surgery, with rates as high as 10%, and existing preventative measures (i.e., peri-operative antibiotics) are only partially successful. To combat this clinical problem, we have designed a drug delivery system around polyether ether ketone clips to be used for prophylactic post-surgical release of antibiotics upon application of ultrasound. The overall hypothesis is that antimicrobial release from this system will aggressively combat post-surgical bacterial survival. This study investigated a set of acoustic parameters optimized for in vitro ultrasound-triggered coating rupture and subsequent release of encapsulated prophylactic antibiotics. We determined that a transducer …

Angioimmunoblastic T Cell Lymphoma: A Diagnostic Dilemma, Nishanth Thalambedu, Md, Seema Sethi, Do, Herbert Auerbach, Do

Abington Jefferson Health Posters

Angioimmunoblastic T cell lymphoma(AITL) is one of the rarest T cell lymphomas. Diagnosing the type of lymphoma is crucial, as the management differs depending on the type. We present a case of a sixty-one-year-old woman who presented with generalized lymphadenopathy and how we unfolded the diagnosis.

Evaluation Of The Effect Of Gm-Csf Blocking On The Phenotype And Function Of Human Monocytes., Noushin Lotfi, Guang-Xian Zhang, Nafiseh Esmaeil, Mohamad Rostami

Department of Neurology Faculty Papers

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a multipotent cytokine that prompts the proliferation of bone marrow-derived macrophages and granulocytes. In addition to its effects as a growth factor, GM-CSF plays an important role in chronic inflammatory autoimmune diseases such as multiple sclerosis and rheumatoid arthritis. Reports have identified monocytes as the primary target of GM-CSF; however, its effect on monocyte activation has been under-estimated. Here, using flow cytometry and ELISA we show that GM-CSF induces an inflammatory profile in human monocytes, which includes an upregulated expression of HLA-DR and CD86 molecules and increased production of TNF-α and IL-1β. Conversely, blockage of …