Medicine and Health Sciences Commons^™

Potential Roles Of Extracellular Vesicles In The Pathophysiology, Diagnosis, And Treatment Of Autoimmune Diseases., Jing Tian, Giacomo Casella, Yuan Zhang, Abdolmohamad Rostami, Xing Li

Department of Neurology Faculty Papers

Since extracellular vesicles (EVs) were discovered in 1983 in sheep reticulocytes samples, they have gradually attracted scientific attention and become a topic of great interest in the life sciences field. EVs are small membrane particles, released by virtually every cell that carries a variety of functional molecules. Their main function is to deliver messages to the surrounding area in both physiological and pathological conditions. Initially, they were thought to be either cell debris, signs of cell death, or unspecific structures. However, accumulating evidence support a theory that EVs are a universal mechanism of communication. Thanks to their biological characteristics and …

Investigating The Effects Of Brainstem Neuronal Adaptation On Cardiovascular Homeostasis., James H Park, Jonathan Gorky, Babatunde Ogunnaike, Rajanikanth Vadigepalli, James S Schwaber

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Central coordination of cardiovascular function is accomplished, in part, by the baroreceptor reflex, a multi-input multi-output physiological control system that regulates the activity of the parasympathetic and sympathetic nervous systems via interactions among multiple brainstem nuclei. Recent single-cell analyses within the brain revealed that individual neurons within and across brain nuclei exhibit distinct transcriptional states contributing to neuronal function. Such transcriptional heterogeneity complicates the task of understanding how neurons within and across brain nuclei organize and function to process multiple inputs and coordinate cardiovascular functions within the larger context of the baroreceptor reflex. However, prior analysis of brainstem neurons revealed …

Use Of The Progestin Challenge Test In Diagnosing Amenorrhea: The Time Has Come To Say Goodbye., William D. Schlaff, Charles C. Coddington

Department of Obstetrics and Gynecology Faculty Papers

No abstract provided.

Targeting Homologous Recombination Addicted Tumors: Challenges And Opportunities, Talia Golan, Jonathan Brody, Md

Kimmel Cancer Center Faculty Papers

Recent advances in next generation sequencing (NGS) and molecular subtyping of tumors have opened the door to clinically available targeted therapies. Although the treatment of many solid tumors still rely on a steady regimen of non-targeted chemotherapeutic agents, it is becoming increasingly more apparent that certain tumors with defects in DNA damage repair (DDR) genes may be exquisitely sensitive to DNA damaging agents or therapies targeting key elements of this pathway such PARP1, ATR, or ATM. Still, for tumors with DDR defects the challenges are multi-fold including: (I) identifying these tumors in patients in time for a window of opportunity …

The Evolving Pharmacotherapeutic Landscape For The Treatment Of Sickle Cell Disease., Samir K Ballas

Cardeza Foundation for Hematologic Research

Sickle cell disease (SCD) is an extremely heterogeneous disease that has been associated with global morbidity and early mortality. More effective and inexpensive therapies are needed. During the last five years, the landscape of the pharmacotherapy of SCD has changed dramatically. Currently, 54 drugs have been used or under consideration to use for the treatment of SCD. These fall into 3 categories: the first category includes the four drugs (Hydroxyurea, L-Glutamine, Crizanlizumab tmca and Voxelotor) that have been approved by the United States Food and Drug Administration (FDA) based on successful clinical trials. The second category includes 22 drugs that …

A Brief History Of Quality Improvement In Health Care And Spinal Surgery., Kevin Hines, Nikolaos Mouchtouris, John J Knightly, James Harrop

Department of Neurosurgery Faculty Papers

While medical and technological advances continue to shape and advance health care, there has been growing emphasis on translating these advances into improvement in overall health care quality outcomes in the United States. Innovators such as Abraham Flexner and Ernest Codman engaged in rigorous reviews of systems and patient outcomes igniting wider spread interest in quality improvement in health care. Codman's efforts even contributed to the founding of the American College of Surgeons. This society catalyzed a quality improvement initiative across the United States and the formation of the Joint Commission on Accreditation of Hospitals. Since that time, those such …

Implementation Of A Spine-Centered Care Pathway At A Regional Academic Spine Center., George M Ghobrial, Jefferson Wilson, Daniel Franco, Kristen Vogl, Alexander R Vaccaro, James S Harrop

Department of Neurosurgery Faculty Papers

Study Design: Retrospective case series.

Objective: To describe the early implementation of an inpatient spinal surgery unit and measure the impact on cost and length of stay (LOS).

Methods: A retrospective case review was performed for frequent spine-related diagnosis-related groups (DRGs) cared for by a dedicated multidisciplinary team: combined anterior/posterior (AP) spinal fusion with major complicating or comorbid condition (MCC), combined (AP) spinal fusion with CC, combined (AP) spinal fusion without complicating or comorbid (CC)/MCC, cervical spinal fusion with MCC, cervical spinal fusion with CC, and cervical spinal fusion without CC/MCC. Four time periods were compared: historical control, initial pathway …

Early Surgery For Traumatic Spinal Cord Injury: Where Are We Now?, Jefferson R. Wilson, Christopher D. Witiw, Jetan Badhiwala, Brian K. Kwon, Michael G. Fehlings, James Harrop

Department of Neurosurgery Faculty Papers

Study Design: Narrative review.

Objective: There is a strong biological rationale to perform early decompression after traumatic spinal cord injury (SCI). With an enlarging clinical evidence base, most spine surgeons internationally now favor early decompression for the majority of SCI patients; however, a number of pertinent questions remain surrounding this therapy.

Methods: A narrative review evaluating the status of early surgery for SCI. In particular, we addressed the following questions: (1) Which patients stand to benefit most from early surgery? 2) What is the most appropriate time threshold defining early surgery?

Results: Although heterogeneity exists, the evidence generally seems to …

3d Printing Of Bone Spurs Before Surgical Removal During Total Knee Arthroplasty, Chris Li, Jeffrey Henstenburg, Md, Katelyn Koons, John Paul Prodoehl, Matthew Chadwick, Lauren Schlegel

Phase 1

Background: In the United States, total knee arthroplasty (TKA) is the most common performed orthopedic surgery, with over 700,000 cases per year. Overall, 21-25% underwent revision due to instability. Incorrect soft tissue balancing during the procedure can lead to improper alignment, flexion, and extension. Visualization of osteophytes in a 3D manner prior to removal is difficult and poses significant risks for improper balancing on TKA. The purpose of the study is to determine whether the utilization of 3D osteophyte models is beneficial to Orthopaedic surgeons in the course of care, specifically with regard to improving outcomes, decreasing complication rates, and …

Anxiety And Depressive Symptoms Pre-Trauma As A Predictor Of Dissociative Symptoms Post-Trauma – An Aurora Study, Vishal Swaminathan

Phase 1

Introduction: Increased states of anxiety or depression may lead to increased occurrences of dissociative behavior, justifying the need to validate pre-traumatic cognitive states as a predictor of dissociation post-trauma. Early prediction can lead to medical intervention for high-risk patients and prevent potential adverse sequalae. The AURORA Study evaluates biomarkers and neuropsychological sequelae in patients immediately following traumatic events. We predict patients who suffered from depressive symptoms and anxiety prior to the traumatic event will experience increased dissociative symptoms post-trauma.

Methods: This study includes survey data collected at ED’s from survivors (n = 666) of traumatic motorized vehicle collisions (MVC) at …

Dual Mobility Bearing Articulations Result In Lower Rates Of Dislocation After Revision Total Hip Arthroplasty., Zachary Kozick, William Li, Matthew Sherman, Camilo Restrepo, Md, Eric B. Smith, Md, P. Maxwell Courtney, Md

Phase 1

Introduction: The purpose of our study is to directly compare the rates of instability after revision total hip arthroplasty (THA) between a modular dual mobility (DM) and a conventional polyethylene single-bearing surface.

Methods: We retrospectively reviewed a consecutive series of patients who underwent revision THA from 2012 to 2016 at a single institution with a minimum of 2 years of follow-up. Rates of re-revision, dislocation, complications, and short-form (SF-12) scores were compared between the DM and single-bearing groups. To control for confounding variables, a multivariate logistic regression analysis was performed.

Results: Of the 267 revision THA patients, 94 patients …

Amelioration Of The Neuroinhibitory Local Environment After Ischemic Injury Through In Situ Astrocyte-To-Neuron Conversion, Abhinav K. Rao, Yu-Chen Chen, Ning-Xin Ma, Zi-Fei Pei, Susan Keefe, Emma Yellin, Miranda Chen, Fu-Han Yang, Xiao-Song He, Gong Chen

Phase 1

Ischemic injury in central nervous system (CNS) often causes severe neuronal loss and activates glial cells. We showed earlier that NeuroD1-mediated astrocyte-to-neuron (AtN) conversion can regenerate a substantial proportion of neurons (~40% of the total) and reconstruct the ischemic injured neural circuits. In this study, we focus on glial changes and blood vessel recovery following AtN conversion. Specifically, we found that ectopic expression of NeuroD1 in the reactive astrocytes after ischemic injury significantly reduced glial reactivity, as shown by less hypertrophic morphology, along with reduced secretion of neuroinhibitory factors such as CSPG and LCN2. As for microglia, we found less …

Is Facet Joint Distraction A Cause Of Postoperative Axial Neck Pain After Acdf Surgery?, Nathan Houlihan, Srikanth N. Divi, Md, Dhruv K.C. Goyal, John J. Mangan, Md, Justin D. Stull, Md, Matthew S. Galetta, Jeffrey A. Rihn, Mark F. Kurd, Md, D. Greg Anderson, Md, Alan S. Hilibrand, Md, Alexander R. Vaccaro, Md, Phd, Mba, Christopher K. Kepler, Md, Mba, Gregory D. Schroeder, Md, Joseph K. Lee, Md

Phase 1

Introduction: Intervertebral distraction in anterior cervical discectomy and fusion (ACDF) has been postulated to injure the degenerative facet joints posteriorly and increase postoperative pain and disability. This study aims to determine if there is a correlation between the amount of facet distraction and postoperative patient reported outcomes.

Methods: A retrospective cohort analysis of patients undergoing ACDF for degenerative pathologies was performed. Each patient received lateral cervical spine x-rays at the immediate postoperative time point and were split into groups based on the amount of facet distraction measured on these films: Group A: < 1.5 mm; Group B: 1.5-2.0 mm; and Group C: > 2.0 mm. Patients reported outcome measures were obtained …

Surgical Pulmonary Embolectomy Outcomes For Acute Pulmonary Embolism, Nicholas D. D'Antonio, Jae Hwan Choi, Md, Thomas J. O'Malley, Md, Elizabeth J. Maynes, Md, Matthew P. Weber, Ms, Martín Mellado, Md, Frances M. West, Md, Taki Galanis, Md, Carin F. Gonsalves, Md, Gregary D. Marhefka, Md, Bharat K. Awsare, Md, Geno J. Merli, Md, Vakhtang Tchantchaleishvili, Md

Phase 1

Introduction: Acute pulmonary embolism (PE) is associated with significant mortality. Surgical embolectomy is a viable treatment option; however, it remains controversial due to variable outcomes. This review investigates patient outcomes following surgical embolectomy for acute PE.

Methods: Electronic search was performed to identify articles reporting surgical embolectomy for treatment of PE. 32 studies were included comprising 936 patients. Demographic, perioperative, and outcome data were extracted and pooled for systematic review.

Results: Mean patient age was 56.3 [95% CI 52.5; 60.1] years and 50% [46; 55] were male. 82% had right ventricular dysfunction [62; 93], 80% [67; 89] had unstable …

The Effect Of Reflection Rounds On Medical Students’ Empathy, Erica Westlake, Jennifer Desantis, Med, Fred Markham, Md

Phase 1

Background: A decline in empathy has been noted in medical students in medical education and training. This decline raises concerns because empathic physician-patient interactions positively impact health outcomes and patient satisfaction. We tested the hypothesis that Reflection Rounds would increase empathy scores of third-year medical students.

Methods: Third-year students entering their Family and Community Medicine (FCM) clerkship completed the Jefferson Physician Scale of Empathy – Student Version (JPSE-S) at the onset of their clerkship; students at the Jefferson Campus site were assigned to the experimental group and students at Affiliate Sites were assigned to the control group. The experimental group …

An Investigation Of Anki Flashcards As A Study Tool Among First Year Medical Students Learning Anatomy, Tanvi Rana, Chaiya Laoteppitaks, Md, Guiyan Zhang, Md, Phd, Gregory Troutman, Shruti Chandra, Md

Phase 1

Purpose: Anatomy is a challenging course in medical school, in part because of the vast number of facts that must be memorized. Current literature suggests the value of spaced repetition in the learning of factual information, and online tools such as Anki flashcards have been developed to facilitate it. The purpose of this study is to investigate the role of curriculum-specific Anki flashcards as a study tool for first year medical students learning anatomy.

Methods: A set of Anki flashcards was created for the anatomy thread of the first block (i.e. back, pectoral, shoulder, vertebral regions) of the JeffMD curriculum …

Developing An Online Critical Care Electroencephalography Curriculum For Epilepsy And Neurophysiology Fellows, Brooke Hancock, Anne Woehling, Nathanael Lee, Md, Connie Tang, Md, Allyson Pickard, Md, Andres Fernandez, Md

Phase 1

Purpose: This project aims to create an Electroencephalography (EEG) curriculum that synthesizes the teachings of current publications and faculty expertise within a single digital platform. The goal is to remedy the unmet need for a centralized resource for learners to use when learning EEG interpretation.

Methods: The target learner population is epilepsy and neurophysiology fellows. The platform will be accessible from any computer, tablet, or phone, allowing for mobile, self-paced learning to take place. To date, the curriculum outline has been designed with extensive literature review and collaboration from other institutions, and two pilot modules have been completed using the …

Helping Continuing Care Retirement Communities Determine The Best Level Of Care For Each Patient, Sopuru Ezeonu, Nicholas Safian, Grant Schultheis, Austin Klein, Danielle Snyderman, Md

Phase 1

Background: Continuing Care Retirement Communities (CCRCs) consists of various neighborhoods and care spaces for senior adults. The neighborhoods are organized and residents are housed based on “levels of care” (LOC), Independent, Assisted, and Nursing. During scheduled interprofessional meetings, the CCRC leadership has the critical task of understanding the residents’ needs and assigning them to the appropriate LOC. Currently, the process of completing this task lacks the necessary structure, which engenders challenges in making recommendations in a systematic way. This project seeks to offer the CCRC interprofessional team a structured approach to determine which LOC and its resources would best serve …

3d Printing Of Knee Models To Decrease Or Time And Reduce Revisional Surgery In Total Knee Arthroplasty (Tka), Lauren Schlegel, John Paul Prodoehl, Matthew Chadwick, Chris Li, Katelyn Koons, Jeffrey Henstenburg, Md

Phase 1

Project Background: Osteophytes are a common problem, affecting 2% of the United States population. For many elderly people, these osteophytes will cause them to seek medical attention. Due to the 2-D nature of MRIs and CT scans, it can be difficult to gain a complete understanding of the complicated soft tissue structures surrounding the joint when performing a Total Knee Arthroplasty(TKA). Without proper removal of osteophytes and correct soft tissue balancing, there is an increased rate of revisional surgery. By utilizing a 3-D model preoperatively and within the OR, surgeons can visualize various aspects of the knee to determine what …

Electronic Health Records: All That They’Re Chalked Up To Be?, Mac Williams, Meghan Gannon, Phd

Phase 1

Introduction. The United States faces a challenge: how to improve access to healthcare with an aging physician workforce. An aging baby boomer population prompts higher medical demands, further heightening this challenge. Although measures to increase the longevity of practice for older physicians could help address this challenge, the federal government has lacked to create such policy.

Methods. This study looked at the role of electronic health records and the American Recovery and Reinvestment Act in the ability of primary care physicians to continue practice through in-depth qualitative interviews. A total of N=5 interviews were conducted in-person and remotely using a …

A Quality Improvement Initiative To Reduce Time To Antibiotics In Oncologic Neutropenic Fever, Jordan Villars, Adam Binder

Phase 1

Introduction: This paper documents a Quality Improvement (QI) initiative using Plan-Do-Study-Act (PDSA) cycles to decrease time to antibiotics (TTA) in oncologic neutropenic fever (NF) patients in a large tertiary-care academic medical center to the national guideline target of 60 minutes.

Methods: We measured baseline NF TTA across hospital units in the summer of 2018 and analyzed factors underlying delays in antibiotic treatment. We then developed a multi-disciplinary team to implement four proposed interventions:

1. Ensure that oncology floors are appropriately stocked with antibiotics required for initial NF treatment
2. Implement a nursing based order set for treatment of new NF cases. …

Narrative Medicine: A Reflective Writing Workshop Series For Interprofessional Healthcare Students At Thomas Jefferson University, Carly S. Slater, Ma, Ms, Brooke Salzman, Md, Rosemary Frasso, Phd, Cph

Phase 1

Introduction: Narrative medicine (NM) teaches reflective writing and close reading to help healthcare professionals think critically about themselves and others in order to offer more effective, empathic care. Few reports of NM methods document its value to facilitating collaboration and communication across students of different professional backgrounds. This study examines the effects of NM workshops on Thomas Jefferson University interprofessional healthcare students, and their utility to achieving these aims: 1) supporting thoughtfulness, mindfulness, and curiosity; 2) supporting the development and use of narrative in understanding the lives/contexts for self and others; 3) improving interactions and communication with others in professional …

The Role Of The Uncinate Margin In Pancreaticoduodenectomy For Pancreatic Ductal Adenocarcinoma: A Survival Analysis, David Nauheim, Richard Zheng, Md, Jonathan Bassig, Matthew Chadwick, Christopher Schultz, Harish Lavu, Md, Facs, Jordan R. Winter, Md, Facs, Charles J. Yeo, Md, Facs, Adam C. Berger, Md, Facs

Phase 1

Introduction: Positive margins during pancreaticoduodenectomy for pancreatic cancer portend worse survival, but additional resection of the uncinate margin is typically unfeasible without major vascular reconstruction. The survival benefit of resecting additional neck or bile duct margins in the face of a positive uncinate is also unknown. We examined the impact of re-resection of these margins on survival.

Methods: Patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy from 2006-2015. Pancreatic neck, bile duct, uncinate, and duodenal frozen section margins were assessed before and after resection of positive margins. Kaplan-Meier survival curves were compared with log-rank tests. Multivariable Cox regression was used to …

A Module-Based Novel Approach To Electrocardiogram Interpretation For Emergency Medicine Residents, Alexandra Koutsoubis, Emily Fishbein, Jennifer White, Md

Phase 1

Purpose: In the Emergency Department, accurate ECG interpretation is essential as many conduction abnormalities are treatable and can lead to death if inaccurately diagnosed. Learning how to read a 12-lead ECG is part of medical education, taught through the following approach: rate, rhythm, axis. In the ED, this tedious approach doesn’t relay important information that should be garnered from the ECG with accuracy. Currently, resources for residents to improve ECG interpretation skills are limited. The purpose of the study was to design a module that teaches an accurate way of interpreting an ECG, that allows for pragmatic, pattern recognition of …

The Effect Of The Surgery Rotation Sequence On Surgery And Emergency Medicine Nbme Scores, Anna Lin, Gerald Isenberg, Md, Chaiya Laoteppitaks, Md

Phase 1

Purpose: Within a school, the formerly fourth year emergency medicine clerkship was added to the third year curriculum in a sequence with general surgery and surgical subspecialty clerkships. Together, a student can be placed in any permutation of the three clerkships, but a student will take the Surgery and EM NBME exam after the completion of the respective clerkship regardless of the order of clerkships. The purpose of this project was to look to see if there was a significance difference in NBME scores between four different sequences of clerkships and to see if sequence of a third year student’s …

Investigating Chronic Illness In Pathways To Housing Clients, Joshua Malerich, Lara Weinstein, Md, Dph

Phase 1

Approximately 553,000 individuals were homeless in the US each night in 2017, each at significant risk for substance use disorder, severe mental illness, and untreated chronic disease. Housing First (HF) is an evidence-based model for reaching high risk homeless individuals by providing a personal home to clients without the requirement for abstinence. HF has been shown as effective as other frameworks in remission of substance use, connectedness in the community, and client perceived quality of life, but there is a gap in the literature regarding the impact of HF services on clinical measures of chronic health, which could help further …

An Educational Workshop To Improve Neurology Resident Knowledge And Understanding Of Burnout, Substance Abuse, And Mood Disorders, Shiori Tomatsu, Ryan Donaghy, Patrick Kerns, Md, Phd, Courtney White, Md

Phase 1

Problem: Many medical residents are at risk for burnout, mood disorders, and substance abuse. We created an educational activity composed of an online module (OM), an interactive role-playing session (AL), and a video practicum (VP) to inform neurology residents on the aforementioned risks and available support resources. This project evaluates the efficacy of these tools.

Methods: PGY2 and PGY3 neurology residents were given OM. In addition, the PGY2 residents participated in AL. Three surveys were given to assess their knowledge about burnout before completing the module (Sur1), after AL session (Sur2), and after watching VP(Sur3).

Outcomes: More PGY2 residents scored …

Motivational Interviewing For Cpap Adherence, Caitlin Green, Grayton Downing, Cindy Cheng, Md, Phd

Phase 1

Background: Continuous Positive Air Pressure (CPAP), is the gold standard for obstructive sleep apnea (OSA) treatment. If left untreated, patients with OSA can experience serious and potentially life-threatening consequences. However, patient CPAP adherence is an ongoing problem, as compliance rates are historically low (typically 30-60%). Engaging patients in motivational interviewing (MI) by trained providers could promote increased CPAP adherence.

Question/Purpose: Assess CPAP compliance in patients who receive motivational interviewing compared to a control attention intervention.

Methods: A team of medical students were trained in MI interviewing techniques through a novel training protocol. The training protocol includes reading articles and watching …

Assessing Student Opinion On Autopsy As A Supplement To Medical Education, Wing Fei Wong, Joanna Chan, Md

Phase 1

Purpose: Medical schools in the United States have decreased use of autopsy as a teaching tool in undergraduate medical education (UME). However, there are no recent data to understand how undergraduate medical students (UMS) value autopsies in their education, thus limiting suggestions for improving UME. This study aims to assess UMS opinion regarding autopsies as a supplement to their medical curriculum: is autopsy important and how?

Methods: This was a questionnaire study targeted to UMS at Sidney Kimmel Medical College. The questionnaire contained 51 closed- and open-ended questions (e.g. multiple choice, Likert scale, free response), and was distributed electronically. Data …

Examining The Associations Between Addiction Severity And Prior Adverse Childhood Experiences In Pregnant Women Receiving Treatment For Opioid Addiction, Julia Gong, Diane Abatemarco, Phd, Msw

Phase 1

Introduction: Opioid use during pregnancy poses risk to both the mother and fetus, including fetal loss and pre-term birth. Prior research suggests that adverse childhood experiences (ACEs) are a plausible antecedent to opioid abuse. However, there is insufficient understanding of the association between prior ACEs, familial history of substance use, and treatment outcomes in pregnant women receiving treatment for opioid addiction.

Methods: A retrospective chart review will be used to review data from 167 MATER patients who entered treatment between 1997 and 2017. Descriptive statistics will be utilized to characterize the study population. Regression and chi-square analyses will be conducted …