Medicine and Health Sciences Commons^™

Antibiotics For Operative Vaginal Delivery: Practice-Changing Data., Vincenzo Berghella, Federica Bellussi

Department of Obstetrics and Gynecology Faculty Papers

No abstract provided.

Obstetrical Providers’ Comfort And Knowledge Of Screening, Brief Intervention, And Referral To Treatment, Dennis J. Hand, Aasta Mehta, Emily Rosenthal, Alice C. Fischer, Tamara Tatevosian, Carrie Malanga, Laura Hart, Debra Dalessandro, Kristin Walker

Department of Obstetrics and Gynecology Posters

Background

Rates of substance use during pregnancy have continued to rise through 2017. It is likely that obstetrical providers are encountering many pregnant persons who use substances either during prenatal care or postpartum. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based model that has been successfully implemented in some obstetrical settings, but its implementation has been sporadic. The objective of this study was to determine the baseline level of familiarity and use of SBIRT elements among obstetrical providers to identify needs for future SBIRT implementation efforts.

Methods

Participants were physicians, medical students, nurses, and other staff attending …

An Innovative Interprofessional Team To Enhance Refugee Resettlement Into U.S. Daily Life, Stephen Kern, Phd, Otr/L, Faota, Christina Kubica, Msw

Department of Occupational Therapy Posters and Presentations

The world continues to see dramatic increases in the numbers of refugees as new humanitarian crises emerge. Once approved by a host nation, the resettlement process begins. To facilitate successful resettlement, a collaborative partnership between a refugee resettlement agency and a university occupational therapy program has continued to successfully serve the needs of the partnership’s three key stakeholders; the organization; the individual refugee or family; and the clinical training of occupational therapy students. Through ongoing program development and enhancements, an innovative interprofessional team approach to resettlement has emerged.

Together, with the individuals and families served, a clientcentered, interprofessional approach was …

Patient And Student Experience On An Interprofessional Hotspotting Team, Steven Elsesser, Md, Elizabeth Feeney, Bsn, Katherine Petty, Spt, Kevin Shaloo, Spt, Nancy Tang, Pharmd

JCIPE Posters

The purpose of the Student Hotspotting initiative is to identify these individuals, understand their barriers and intervene by:

• Connecting them with community resources
• Improving coordination and communication between both providers and the patient
• Empowering these individuals to better manage their health

Our patient (DW) lives in a close-knit, 4-generation household that just welcomed their newest member: a black-and-white kitten

DW is a 61 year-old female who recently received orthotopic heart transplant. Her comorbidities include sleep apnea, GERD, OA, chronic pain syndrome, COPD and a history of a CVA

We identified 3 main barriers to address with DW

• Transportation difficulties
• Management …

Bridging The Gaps: Team 6 Hotspotting Experience, Sean O'Sullivan, Rebecca Schuck, Sean Tonnesen, Gabrielle Sallade, Emily Osisek, Avninder Ubhi

JCIPE Posters

Healthcare spending in the U.S. reached $3.5 trillion in 20171. Half of this spending was due to only 5% of patients. Hotspotting is the practice of identifying high-utilizing patients and providing them ancillary care. Supporting such patients with nutrition information, care coordination, clinician communication, health education, and treatment adherence coaching benefits the patients, clinicians, and healthcare system. The Jefferson Interprofessional Student Hotspotting Program places students of different educational programs into teams to identify high-utilizing patients and provide them individualized and holistic care. It is an intimate longitudinal clinical experience for students and an opportunity to improve the health of complex …

Interprofessional Student Hotspotting: Impact Of Federally Qualified Health Centers (Fqhc) On Complex Patients, Alexis Amendola, Pallavi Chary, Andrew Day, Graziella Holland, Michelle Murray, Jesse Simpson

JCIPE Posters

Individuals with complex health and social needs drive much of the total cost of care, accounting for nearly 50% of annual costs. Studies show that patients’ use of community health centers is associated with lower health care costs, less frequent use of emergency departments, and fewer preventable hospitalizations, compared to patients who do not use the health centers. Federally qualified health centers (FQHCs) provide patients with medical homes where they can build ongoing, personal relationships with treatment teams, resulting in continuous, comprehensive and integrated care.

Additionally, addressing these individuals' needs and decreasing costs requires interprofessional teams to engage with communities …

Interprofessional Student Hotspotting Learning Collaborative: A Student Initiative To Together Help Patients In Tangible And Intangible Ways, Kristin Brannon, Saskia Levy-Sheon, Michael Murphy, Megan Rankel, Caroline Christianson, Carly Alexander, Tejash Patel, Mariana Kuperman, Md, Leigh Ann Hewston, Pt, Dpt, Med, Ceeaa

JCIPE Posters

The Interprofessional Student Hotspotting Learning Collaborative brings together a team of students who work closely with individual patients with complex medical histories who are “super-utilizers” of health care resources.

Our goals:

• Provide a targeted, patient-centered approach to patient care
• Learn about our patient’s health from their perspective and develop a plan based on the patient’s goals and perceived needs
• Minimize misuse and miscommunication that had previously hindered the patient healthcare experience.
• Bring unique perspectives from each of our respective disciplines to improve upon inefficiencies in care
• Our team consisted of students from the colleges of Occupational Therapy, Physical Therapy, Nursing, …

Interprofessional Perspectives: Challenges & Lessons Learned From Participation In The Student Hotspotting Program, Alex Faus, Bs, Jennifer Newman, Ba, Stephanie Quist, Bm, John Ra, Bs, Madeline Runyen, Ba, Kelsie Wilhelm, Bsfs

JCIPE Posters

By participating in the Student Hotspotting Program, students learned that:

• Coordinating the care of a complex patient requires an interprofessional team
• Hotspotting interventions can often be complicated by uncontrollable circumstances
• Building trust is key to working with patients who may be hesitant to engage with the healthcare system
• Successful interprofessional healthcare teams are characterized by specific attributes
• As future healthcare practitioners, we can apply these lessons into our own interprofessional interactions to optimize our treatment plans for complex patients

An Overview And An Experience Of Hotspotting, Adam Myer, Allyson Psillos, Brianna Brown, Anne Bono, Stephen Kern, Phd, Otr/L, Faota, Jamie Smith, Michele Zawora, Md

JCIPE Posters

United States Healthcare Dilemma

In the United States, a large proportion of healthcare resources and costs are utilized by a small percentage of the population.

• Approximately 25% of the United States healthcare costs are incurred by 1 percent of the population, while 5% are of healthcare costs are incurred by 50% of the population. The small percentage of the individuals who consume large amounts of resources has led to the term “super-utilizers.”
• These patients usually have complex and hard-to-manage conditions, as well as socioeconomic barriers to care, which frequently lead to potentially avoidable emergency department and hospital admissions and complications. …

Student Hotspotting: A Novel Dynamic For Learners And Patients, Richard Jeffries, Lydia Glick, Katherine O'Rourke, Mi Bui, Jennifer Morelli, Katherine Cambareri, Florencia Campbell, Miranda Aragon, Tracey Vause-Earland

JCIPE Posters

About the Student Hotspotting Program:

A team of interdisciplinary students working with patients with complex medical and social needs

Identify "super-utilizers" of the healthcare system

• These patients frequently use the Emergency Department as primary source of medical care
• A "super-utilizer" of the ED is costly to the patient and system

Goals:

• Build relationships
• Identify needs and goals
• Provide support to navigate healthcare system and increase independence

Extreme Peripheral Blood Plasmacytosis Mimicking Plasma Cell Leukemia As A Presenting Feature Of Angioimmunoblastic T-Cell Lymphoma (Aitl)., Kelsey Sokol, Saritha Kartan, William T. Johnson, Onder Alpdogan, Neda Nikbakht, Bradley M. Haverkos, Jerald Z. Gong, Pierluigi Porcu

Department of Medical Oncology Faculty Papers

Angioimmunoblastic T-cell lymphoma (AITL) is one of four major subtypes of nodal peripheral T cell lymphoma, characterized by its cell of origin, the follicular helper T-cell (TFH). Patients typically present with prominent constitutional (B) symptoms, generalized lymphadenopathy, hepatosplenomegaly, cytopenias, and rash. Here we present a case of a 62-year-old male with progressive cervical adenopathy, fevers and weight loss presenting with extreme polyclonal plasmacytosis and high plasma EBV viral load. While the initial presentation appeared to mimic plasma cell leukemia or severe infection, lymph node biopsy and bone marrow biopsy confirmed a diagnosis of AITL. This case highlights the heterogeneity of …

A New Era For Real-World Evidence, Neal J. Meropol, Md

College of Population Health Forum

This presentation will use cancer therapeutic development as a use case for exploring the emerging role of real-world evidence. The current availability of electronic health records with rich information about patients gathered during their routine care is rapidly changing the landscape of evidence generation in medicine. Recent advances have accelerated the introduction of new diagnostics and treatments into clinical practice.

Learning Objectives:

1. Understand potential sources of real-world data for use in evidence generation to guide drug development and patient care.
2. Describe the opportunities and limitations of observational research using real-world data derived from electronic health records.
3. Review examples of real-world …

Solutions To Reduce Unnecessary Imaging., David C. Levin, Vijay M. Rao

Department of Radiology Faculty Papers

No abstract provided.

The Impact Of Cholesterol Deposits On The Fibrillar Architecture Of The Achilles Tendon In A Rabbit Model Of Hypercholesterolemia., Andrzej Steplewski, Jolanta Fertala, Ryan Tomlinson, Kevth'er Hoxha, Lin Han, Ocean Thakar, Jason Klein, Joseph A. Abboud, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Increased tendon pain and tendon damage is a significant complication related to hyperlipidemia. Unlike the well-established pathogenesis associated with increased serum concentrations of total cholesterol, triglycerides, and low-density lipoprotein in atherosclerotic cardiovascular disease, the role of hyperlipidemia in promoting tendon damage remains controversial and requires mechanistic clarity.

METHODS: In this study, we analyzed the consequences of hypercholesterolemia on the integrity of the collagen-based architecture of the Achilles tendon. The Achilles tendons from rabbits fed with normal-cholesterol (nCH) and high-cholesterol (hCH) diets were analyzed. We studied the morphology of tendons, distribution of lipids within their collagen-rich milieu, the relative amounts …

C1q/Tnf-Related Protein 3 (Ctrp3) And 9 (Ctrp9) Concentrations Are Decreased In Patients With Heart Failure And Are Associated With Increased Morbidity And Mortality., Chao Gao, Shasha Zhao, Kun Lian, Baibing Mi, Rui Si, Zhijun Tan, Feng Fu, Shuai Wang, Rutao Wang, Xin-Liang Ma, Ling Tao

Center for Translational Medicine Faculty Papers

BACKGROUND: Biochemical marker has revolutionized the approach to the diagnosis of heart failure. However, it remains difficult to assess stability of the patient. As such, novel means of stratifying disease severity are needed. C1q/TNF-Related Protein 3 (CTRP3) and C1q/TNF-Related Protein 9 (CTRP9) are novel adipokines that contribute to energy homeostasis with additional anti-inflammatory and anti-ischemic properties. The aim of our study is to evaluate concentrations of CTRP3 and CTRP9 in patients with HFrEF (heart failure with reduced ejection fraction) and whether associated with mortality.

METHODS: Clinical data and plasma were obtained from 176 healthy controls and 168 patients with HFrEF. …

Gm1 Ganglioside Modifies Α-Synuclein Toxicity And Is Neuroprotective In A Rat Α-Synuclein Model Of Parkinson's Disease., Jay S. Schneider, Radha Aras, Courtney K. Williams, James B. Koprich, Jonathan M. Brotchie, Vikrant Singh

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

While GM1 may interact with α-synuclein in vitro to inhibit aggregation, the ability of GM1 to protect against α-synuclein toxicity in vivo has not been investigated. We used targeted adeno-associated viral vector (AAV) overexpression of human mutant α-synuclein (A53T) in the rat substantia nigra (SN) to produce degeneration of SN dopamine neurons, loss of striatal dopamine levels, and behavioral impairment. Some animals received daily GM1 ganglioside administration for 6 weeks, beginning 24 hours after AAV-A53T administration or delayed start GM1 administration for 5 weeks beginning 3 weeks after AAV-A53T administration. Both types of GM1 administration protected against loss of SN …

Multi-Institutional Dosimetric Evaluation Of Modern Day Stereotactic Radiosurgery (Srs) Treatment Options For Multiple Brain Metastases., Irina Vergalasova, Haisong Lui, Michelle Alonso-Basanta, Lei Dong, Jun Li, Ke Nie, Wenyin Shi, Boon-Keng Kevin Teo, Yan Yu, Ning Jeff Yue, Wei Zou, Taoran Li

Department of Radiation Oncology Faculty Papers

Purpose/Objectives: There are several popular treatment options currently available for stereotactic radiosurgery (SRS) of multiple brain metastases: 60Co sources and cone collimators around a spherical geometry (GammaKnife), multi-aperture dynamic conformal arcs on a linac (BrainLab Elements™ v1.5), and volumetric arc therapy on a linac (VMAT) calculated with either the conventional optimizer or with the Varian HyperArc™ solution. This study aimed to dosimetrically compare and evaluate the differences among these treatment options in terms of dose conformity to the tumor as well as dose sparing to the surrounding normal tissues.

Methods and Materials: Sixteen patients and a total of 112 metastases …

Time Outs Take Teamwork Improving Patient Safety For Bedside Procedures, Thana Theofanis, Md, Adam Johnson, Md, Mph, Jennifer Harris, Md, Elly Fitzpatrick, Rn, Darlene Rosendale, Rn, Rebecca Jaffe, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aims for Improvement

Mission: Improve patient safety through increasing interprofessional collaboration and empowerment in the peri procedural time periods.

Aims

• Increase rate of high quality time outs performed prior to bedside procedures by 50%
• Increase rate of accurate and timely timeout documentation by 50%

Ephb-Ephrinb Cis Interaction Regulates Filopodial Movement, Yu-Ting Mao, Matthew B. Dalva

Department of Neuroscience Posters

Neural connections are initiated by motile dendritic and axonal protrusions, such as dendritic filopodia and axonal growth cones. Dendritic filopodia interview many axons and then choose the correct ones to make stable contacts. Specific rates of EphB activation in dendritic filopodia controls the decision of filopodia to reject or stabilize a synaptic contact onto an axon. However, it remains unknown how EphB activity in dendritic filopodia is modulated to regulate filopodial decisions. Here using an optogenetic approach, we find that photoactivation of a cis-interaction between EphB2 and ephrinB3 prevents filopodial retraction, likely driving filopodial stabilization. Using photoactivatable EphB2KD as a …

Increasing Awareness For The Opioid Aftercare Coordination Service (Oacs), Michael Weintraub, Md, Harry Wang, Md, Sean Dikdan, Md, Mph, Alexys Monoson, Md, Shalini Krishnasamy, Jillian Zavodnick, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

• The United States is in a crisis of opiate related adverse events. From 1999 2017, more than 700,000 people in the U.S. died from drug related overdose; 68% of those involved opioids
• Admissions at Jefferson Hospital for opioid abuse complications are common among the medicine services. Treating patients for their opiate addiction is essential to prevent future opioid overdoses and other complications
• Jefferson has initiated an Opioid Aftercare Coordination Service (OACS) consult system in response to this crisis in order to increase the number of patients who receive medications for opioid use disorder on discharge
• OACS serves both Jefferson …

Improving Residents’ Response Time To Inbox Results, Sean Hurt, Md, Rose Onyeali, Md, Jason Ojeda, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Study Aims

• We aimed to improve the response times to inbox results of the residents and interns at Jefferson Internal Medicine Associates. A standard measure in EPIC is the percentage of inbox results responded to within 24 hours. At the time of project initiation, 50% of all results assigned to resident and intern inboxes were being responded to in this time frame . We aimed to improve this number to 70%
• There is no expectation that residents and interns could respond to all results within 24 hours. Trainee schedules are very crowded, and not all inbox results need to be …

Moisture Chamber For Eye Care After Facial Nerve Injury, Ryan Rimmer, Md, Lauren Bogdan, Md, Gregory Epps, Md, Nikolaus Hjelm, Md, Erin Reilly, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Introduction

• Patients with various lesions of the head and neck may have compromise of facial nerve function.
• Facial nerve (CN VII) has various roles, including movement of facial muscles and, importantly, eye closure.
• When facial nerve is sacrificed or damaged during a surgical cases, steps are often taken intraop to surgically correct the deficit and allow eye closure. However, these patients may not immediately realize the benefit of these interventions.
• In the postop period, appropriate eye care is critical to prevent exposure keratopathy due to inability to close eye.
• Exposure keratopathy is damage to the cornea that occurs primarily due …

Creation Of An Institutional Toolkit For Evaluation Of Multidisciplinary Handoffs, Richard F. Schmidt, Md, Courtney Devin, Md, Nicholas Tarangelo, Md, Andrew Mendelson, Md, Bracken Babula, Md, Rebecca Jaffe, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

1. Create a method for analyzing different handoffs in a variety of clinical settings and scenarios at TJUH.
2. Develop a set of standardized survey tools using existing validated language to quantify the perceptions, quality, and needs for different patient care transitions.
3. Use results from these tools to cater focused handoff improvement interventions for specific patient care settings.

Improving Ed Door To Puncture Times For Endovascular Thrombectomy In Acute Ischemic Stroke, Richard F. Schmidt, Md, Nabeel Herial, Md, Robin D'Ambrosio, Bsn, Erin Simko, Bsn, Fred Rincon, Md, Maria Aini, Md, Pascal Jabbour, Md, Stavropoula Tjoumakaris, Md, M. Reid Gooch, Md, Robert H. Rosenwasswer, Md, Robin Dharia, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

• Optimize the management of patients presenting to TJUH with AIS who are candidates for ET.
• Enable continued process improvement through improved data collection methods and identification of new process metrics.

Expanding Care Access For The Homeless Using Teledermatology, Elizabeth Schoenberg, Ba, Nicholas A. Ross, Md, Kathleen Mcguinn, Md, Rachelle Lacey, Md, Elizabeth Jones, Md, Matthew Keller, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aims for Improvement

Specific: Expand dermatology care access to men’s shelters using a teledermatology model enabling us to determine the efficiency, feasibility, and relevance of delivering telehealthcare to the homeless population

Measurable: Surveys to determine patient and provider needs enabling creation of practice guidelines, as well as surveys measuring feasibility and efficacy of the teledermatology intervention

Assignable: JeffHOPE precepting medicine residents, on-call JeffHOPE dermatology residents, dermatology research fellow

Realistic: Pilot two interventions: 1) a teledermatology program to determine feasibility, utility, and efficiency of this care modality in a homeless population 2) a patient-centered practice recommendation booklet to best serve this …

We Got The Beat: Improving Cpr Quality With Real-Time Metrics, Juergen Kloo, Md, Frances Mae West, Md, Michael Haviland, Rn, Bsn

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Introduction

High quality chest compressions have been linked to improved survival from sudden cardiac arrest.

The 2015 AHA guidelines recommend the following:

• Rate of compressions between 100 120 CPM
• Depth of compressions between 2 2.4 inches
• Allow full recoil between compressions
• Target CPR fraction at least 60% of the time, ideally 80%
• Avoid hyperventilation
• Collect and use data to improve performance

We set out to show that our clinicians would have a minimum 25% improvement in CPR quality with the use of real time feedback using the new R series ZOLL defibrillators.

Spinal Cord Injury Activation Alert: Revisiting And Revamping Protocols, Ritam Ghosh, Md, Ralph Marino, Md, Michael Wolf, Md, James S. Harrop, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objective

Our objective was to look at the current protocol for spinal cord injury activation alerts and to highlight deficiencies in the system. Currently, any physician at Jefferson can call this alert, which often leads to a misuse of resources and wrongful identification of true spinal cord injury.

In order to refine the protocol, we believe that the Cord System should be used for the following guidelines:

1. Identify patients w Spinal Cord Injury (SCI)
2. Identify patients for SCI research trials
3. Identify patients who require surgery

Analysis Of Alert Based Intervention On Management Of Hospital-Acquired Acute Kidney Injury: A Prospective Study, Amisha Ahuja, Md, Sonia Bharel, Md, Phil Durney, Md, Goni Katz, Md, Nicholas Tarangelo, Md, James Uricheck, Md, Randi Zukas, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Introduction

The development of acute kidney injury (AKI) during hospitalizations has become a widespread problem that leads to prolonged hospital stays and an increased risk of the development of renal failure. Several national prospective studies have been conducted to identify the most common causes of hospital acquired acute kidney injury (HAAKI) including contrast-induced, drug-induced, sepsis with hypotension, and comorbid organ dysfunction. To attempt to reduce HAAKI and its long-term consequences both to patients and the healthcare system, our study aimed to review creatinine changes among patients admitted to five general medicine teams. Our study goal was to see whether spreading …

The Implementation And Efficacy Of A Breast Cancer Wellness Group At Thomas Jefferson University Hospital, Steven Woodward, Md, Peter Altshuler, Md, Theodore N. Tsangaris, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Abstract

Introduction: Breast cancer is not only a physical disease but something that affects our patients’ mental, spiritual, emotional and social wellbeing. There has been literature that demonstrates the positive benefits of exercise, social support, and nonmedical adjuncts for breast cancer patients. There is currently a lack of wellness support within the Jefferson breast cancer community.

Methods: A wellness survey will be distributed throughout the breast surgery and breast oncology clinics to assess the current level of wellness and interest in a breast cancer wellness group at TJUH. This survey will be used both before and after implementation …

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

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Problem Statement

Neutropenic fever (NF) (defined as temperature of 101o F on one occasion, or 100.4o F sustained over 60 minutes in a patient with an absolute neutrophil count (ANC) less than 500, or suspected drop below 500 within 48 hours) is relatively common oncologic emergency, particularly in hematologic malignancy patients. Expert consensus is that anti-pseudomonas gram-negative antibiotics (abx) should be administered within 60 minutes of detecting neutropenic fever.

At Thomas Jefferson University Hospital (TJUH), internal guidelines for time to treatment in neutropenic fever are in line with expert consensus - 60 minutes. We found that from July 1st – …