Medicine and Health Sciences Commons^™

Implementation Of Standardized Discharge Instructions, Caitlin Hodge, Md, Quyngdiem Lam, Md, Luis A. Mejia, Md, Orlando C. Kirton, Md, Facs, Mccm, Fccp, Mba, Robert Josloff, Md, Kristin Noonan, Md

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

Introduction

Previously, same-day surgical discharge instructions were handwritten by residents on generic fill-in-the-blank forms leading to inconsistent discharge instructions. Residents started an initiative to create these standardized discharge instructions. These instructions were designed to improve documentation for post-operative instructions as well as enhance overall patient safety in an attempt to eliminate miscommunications with patients.

Improving Screening For Diabetic Retinopathy In An Ambulatory Resident Clinic, R. Benson Jones, Guy Katz, Jon Zaid, Navdeep Sangha, Rebecca Davis

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

Introduction

While 60% of Americans with diabetes are screened for diabetic retinopathy, the residents in the Jefferson Internal Medicine Associates (JIMA) ambulatory clinic had a lower screening rate (roughly 50%).(1) Our project aimed to increase that screening rate.

Scanning For Qi: Resident And Sonographer Driven Improvement Of Radiology Resident Ultrasound Technique, Brian Blumhof, Md, Corinne Wessner, Bs, Rdms, Rvt, Kristen Mcclure, Md

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

Objective

The aim of this structural QI project is to improve the educational ultrasound curriculum , thus improving overall resident confidence and technical ability in acquiring diagnostic quality sonographic images.

Comparing resident confidence levels and performance against their initial benchmarks as well as against yearly cohorts, we plan to create a long standing addition to the radiology residency at Jefferson, with plans to include additional ultrasound examinations as the curriculum becomes more robust.

Stakeholders include not only the radiology residency, which would benefit from improved resident education and knowledge, but also the hospital and ultimately patients, who stand to benefit …

Evaluation Of A Text-Based Event Reporting Process On Resident Event Reporting Rates, R. B. Jones, C. L. Devin, D. Chalikonda, B. Menachem, R. Kanesa-Thasan, K. Klinger, B. Babula, R. Jaffe

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

Background

Voluntary event reporting is crucial to identify problem areas in healthcare. At TJUH, resident reporting from July to February during FY19 represented 2% of all report, compared to nursing who accounted for 77% of reports. Resident physicians witness events but do not report them due to cumbersome reporting platform, absence of feedback about reports, lack of reinforcement on how and what to report, and a mindset of not wanting to cause trouble (1,2). Our project aimed to lower the barrier of high administrative reporting burden for residents to report events by creating a HIPAA-compliant, mobile event reporting system.

Getting Rid Of Stupid Stuff (Gross) Committee: Residents Dedicated To Streamlining Epic-Related Workflow, Nkosi H. Alvarez, Md, Christina L. Jacovides, Md, Brian M. Till, Md, Walker Lyons, Md, Keyur Patel, Md, Richard Zheng, Md, Adam Johnson, Md, John Kairys, Md

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

Objectives

• Identify specific mechanisms for submitting and implementing improvements to the Epic environment
• Standardize high-use order sets
• Incorporate high-value modular components into existing order sets
• Create new order sets to streamline resident workflows
• Improve communication between stakeholders

Optimizing Resident Clinic Efficiency Through Process Flow Analysis, Michael Abendroth, Md, Mba, Saumya Copparam, Md, Qiang Zhang, Phd, Rose Costello, Ma, Tara Uhler, Md, Robert Bailey, Md

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

Abstract

Introduction: Clinic process inefficiencies cause lengthy visit and wait times, which frustrate patients and providers and limit clinic capacity

Objective: To identify process inefficiencies and assess process flow interventions

Methods: Prospective, consecutive series of resident clinic visits over a 3-week period after transferring refraction from tech to resident. Personnel recorded the time spent waiting for and undergoing each clinic process. The clinic also piloted a “Fast Track” from registration to resident for appropriate established patients.

Results: Patients spent 53% of the visit waiting, primarily for the tech. Transferring refraction from tech to resident decreased the wait for tech …

Reducing Double Chest Ct And Unnecesary Radiation: A Quality Improvement Project, Stephan S. Leung, Md, Mansi R. Parekh, Md, Achala Donuru, Md, Paras C. Lakhani, Md, Christopher G. Roth, Md, Baskaran Sundaram, Md

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

Objectives

To analyze the variables resulting in double chest CTs being ordered and performed, with the aim to reduce the amount of ordered double chest CTs at Thomas Jefferson University Hospital.

Getting To The Source: Safety Findings In Cervical Cancer Screening Using External Lab Databases, Miranda Aragon, Md, Sunny Lai, Md, Mph, Geoffrey Mills, Md, Phd

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

Objective

To investigate the feasibility of using external lab databases to locate Pap smear results completed at outside clinics.

The Validity, Reliability, Measurement Error, And Minimum Detectable Change Of The 30‐Second Fast‐Paced Walk Test In Persons With Knee Osteoarthritis: A Novel Test Of Short‐Distance Walking Ability, Lisa T. Hoglund, Phd, Erik Folkins, Dpt, Laura Pontiggia, Phd, Michael W. Knapp, Dpt

Department of Physical Therapy Faculty Papers

Objective

To develop and establish the reliability, validity, measurement error, and minimum detectable change of a novel 30‐second fast‐paced walk test (30SFW) in persons with knee osteoarthritis (OA) that is easy to administer and can quantify walking performance in persons of all abilities.

Methods

Twenty females with symptomatic knee OA (mean age [SD] 58.30 [8.05] years) and 20 age‐ and sex‐matched asymptomatic controls (57.25 [8.71] years) participated in the study. Participants completed questionnaires of demographic and clinical data, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the 36‐item Short Form Health Survey (SF‐36) followed by 30SFW performance. Participants returned …

Generation Of Oligodendrocyte Progenitor Cells From Mouse Bone Marrow Cells., Yuan Zhang, Xin-Yu Lu, Giacomo Casella, Jing Tian, Ze-Qing Ye, Ting Yang, Juan-Juan Han, Ling-Yu Jia, A. M. Rostami, Xing Li

Department of Neurology Faculty Papers

Oligodendrocyte progenitor cells (OPCs) are a subtype of glial cells responsible for myelin regeneration. Oligodendrocytes (OLGs) originate from OPCs and are the myelinating cells in the central nervous system (CNS). OLGs play an important role in the context of lesions in which myelin loss occurs. Even though many protocols for isolating OPCs have been published, their cellular yield remains a limit for clinical application. The protocol proposed here is novel and has practical value; in fact, OPCs can be generated from a source of autologous cells without gene manipulation. Our method represents a rapid, and high-efficiency differentiation protocol for generating …

A Community Pharmacy Elective Course Utilizing A Service Development Project To Foster Innovation And Creative Thinking, Danielle Mayer, Pharmd, Bcacp

College of Pharmacy Posters

Course Description

Innovations in Community Pharmacy Practice is a 2-credit hour course offered to pharmacy students in the spring of the third professional year.

Teaching methods

• Group discussions
• Case study activity
• Self-reflection
• Group project

The focus of this course is the evolving role of the community pharmacist in delivering direct patient care services. Students learn the basics of creating a business plan and utilize these principles to create their own business plan for a new or enhanced service that could be implemented at a community pharmacy site. This is a hands-on, project- based course, designed to foster innovation, entrepreneurship, and …

Client Centered Simulation: Practicing Interprofessional Teamwork With Standardized Patients, E. Adel Herge, Otd, Otr/L, Faota, Sarah Libros, Ba, Courtney Newsome, Ba, Richard Hass, Phd, Caitlin Cadematori, Ots, Abegale Nelson, Bs, Neal Geosits, Ba

Department of Occupational Therapy Posters and Presentations

Background

Interprofessional education (IPE) prepares students to work in collaborative teams (Burin et al., 2009). Educators use a variety of methods to develop and enhance teamwork skills (Fox et al., 2018).

Standardized patient (SP) simulations allow students to practice skills in safe environments (Herge et al., 2013) and respond to situations as they would under natural conditions (McGaghie, 1999). As an active learning experience, SP simulations help students break through the “illusion of understanding” (Syinicki & McKeachie, 2001 p. 190).

Kirkpatrick posits a hierarchy of changes as a result of training/education (Kirkpatric, 1979). At the highest level is transfer of …

Electronic Notebooks To Facilitate Student Learning Within And Beyond The Classroom, Mary Muhlenhaupt, Otd, Otr/L, Faota, Mary Ann Wagner-Graham, Phd, Gary E. Kaplan, Mslis, Ahip

Thomas Jefferson University Faculty Days

Introduction

Electronic Research Notebooks (ERN), also called Electronic Lab Notebooks, are becoming standard in many industries and academic labs where documentation, reproducibility, online access, and collaboration tools are important (1,2, 3). Jefferson launched cloud-based LabArchives in 2018 as its ERN. The product includes a Classroom Edition for use with students. It offers instructors options to embed course readings, documents, assignments, images, videos, audio files and links to other online resources. Students can type and save notes in their electronic notebook, complete and submit assignments, draw and annotate images and illustrations. Instructors can update the students’ notebooks anytime, grade assignments, comment …

Engaging Students To Improve Research Competencies, Sam Bardarik, Mlis, Paul Hunter, Dmd, Mlis, Gary Kaplan, Mslis, Ahip

Thomas Jefferson University Faculty Days

By increasingly incorporating a variety of student engagement methods into instruction sessions, librarians will be able to build on basic skills (remembering, understanding, applying) and develop students’ higher order learning skills (analysis, evaluation, and creation). For example, a skill librarians have recently introduced is critical appraisal of the literature, one component that ensures students effectively incorporate evidence-based practice into patient care. Librarians also aim to assess student learning and make appropriate iterative modifications to ensure these methods effectively set up students for success. Together, librarians and faculty are laying the groundwork to facilitate lifelong learning in Jefferson students.

Jeffmd’S Wellness Thread: Lessons Learned, Nethra Ankam, Md

Thomas Jefferson University Faculty Days

Background

“Nearly half of U.S. medical students experience symptoms of burnout such as feeling emotionally exhausted, detached from patients, and that their efforts do not make a difference” –Dyrbye & Shanafelt 2011

Systems solutions must be pursued to promote wellness and reduce burnout. Per Shanafelt & Noseworthy 2017, when groups/organizations operate under the assumption that wellness and burnout are the sole responsibility of the individual, efforts to improve wellness are looked upon with skepticism by physicians and organizational factors are neglected. Individuals may pursue strategies to mitigate burnout that work for the individual, but not for the group/organization. Systems strategies …

Roles Of Gm-Csf In The Pathogenesis Of Autoimmune Diseases: An Update., Noushin Lotfi, Rodolfo Thome, Nahid Rezaei, Guang-Xian Zhang, Abbas Rezaei, A. M. Rostami, Nafiseh Esmaeil

Department of Neurology Faculty Papers

Granulocyte-macrophage colony-stimulating factor (GM-CSF) was first described as a growth factor that induces the differentiation and proliferation of myeloid progenitors in the bone marrow. GM-CSF also has an important cytokine effect in chronic inflammatory diseases by stimulating the activation and migration of myeloid cells to inflammation sites, promoting survival of target cells and stimulating the renewal of effector granulocytes and macrophages. Because of these pro-cellular effects, an imbalance in GM-CSF production/signaling may lead to harmful inflammatory conditions. In this context, GM-CSF has a pathogenic role in autoimmune diseases that are dependent on cellular immune responses such as multiple sclerosis (MS) …

Peripheral Synucleinopathy In A Dj1 Patient With Parkinson Disease, Cataracts, And Hearing Loss, Derek P. Narendra, Risa Isonaka, Diana Nguyen, Alice B. Schindler, Angela D. Kokkinis, Debra Ehrlich, Tanya M. Bardakjian, David S. Goldstein, Tsao-Wei Liang, Pedro Gonzalez-Alegre

Department of Neurology Faculty Papers

No abstract provided.

Brainstem Atrophy In Focal Epilepsy Destabilizes Brainstem-Brain Interactions: Preliminary Findings., Susanne G. Mueller, Lisa M. Bateman, Maromi Nei, Alica M. Goldman, Kenneth D. Laxer

Department of Neurology Faculty Papers

BACKGROUND: MR Imaging has shown atrophy in brainstem regions that were linked to autonomic dysfunction in epilepsy patients. The brainstem projects to and modulates the activation state of several wide-spread cortical/subcortical regions. The goal was to investigate 1. Impact of brainstem atrophy on gray matter connectivity of cortical/subcortical structures and autonomic control. 2. Impact on the modulation of cortical/subcortical functional connectivity.

METHODS: 11 controls and 18 patients with non-lesional focal epilepsy (FE) underwent heart rate variability (HRV) measurements and a 3 T MRI (T1 in all subjects, task-free fMRI in 7 controls/ 12 FE). The brainstem was extracted, and atrophy …

Sternoclavicular Joint Arthropathy Mimicking Radiculopathy In A Patient With Concurrent C4-5 Disc Herniation, Prateek Agarwal, Ab, Nitin Agarwal, Md, David Hansberry, Md, Phd, Neil Majmundar, Md, Ira M. Goldstein, Md

Department of Radiology Faculty Papers

Background

Patients with sternoclavicular joint arthropathy, which can result from septic arthritis, often present with localized sternoclavicular pain as well as shoulder pain. Such pain may be similar to the presenting symptoms of cervical intervertebral disc herniation.

Clinical presentation

A 47-year-old female presented with 1 month of significant pain in the neck as well as right anterior chest and deltoid. The patient was found to have reduced strength in the right deltoid muscle on physical examination. MRI revealed a C4-C5 herniated nucleus pulposus. The patient underwent successful C4-C5 anterior cervical discectomy, but subsequently developed painful swelling in the region of …

Competency-Based Curriculum Development To Meet The Needs Of People With Disabilities: A Call To Action., Nethra S. Ankam, Md, Glendaliz Bosques, Carley Sauter, Steven Stiens, Maya Therattil, Faren H. Williams, Caleb C. Atkins, R. Samuel Mayer

Department of Rehabilitation Medicine Faculty Papers

People with disabilities constitute 22.2% of the population in the United States, and virtually all physicians have people with disabilities in their clinical practice across a wide range of diagnostic groups. However, studies demonstrate that people with disabilities are inadequately served by the health care system, leading to high costs and poor outcomes. The authors argue that one cause of this discrepancy is that medical students receive limited training in the care of people with disabilities and may therefore not be able to adequately meet the competencies that underlie the Core Entrustable Professional Activities for Entering Residency. To address these …

An Infection Control Journey In Hospital Based Practice Conversion, Cathleen Strzalka, Mph, Cph, Cic, Kelly Zabriskie, Cic

Division of Infectious Diseases and Environmental Medicine Posters

Objective

• Effectively bring physician based practices (PBPs) under hospital licensure
• Ensure safe delivery of care
• Produce successful regulatory surveys

Physician Based Practices And Instrument Sterilization - How Do You Do It?, Kelly Zabriskie, Cic, Cathleen Strzalka, Mph, Cph, Cic

Division of Infectious Diseases and Environmental Medicine Posters

Objective

To develop a process that allows the PBP to operate efficiently and effectively but still be compliant with proper instrument reprocessing rules and regulations.

Hand Hygiene Observations… Not So Secret Anymore, Mary Ehly, Bsn, Rn, Cic, Courtney Mitchell, Mph, Cic, Charlotte Sacksteder, Ba, Kelly Zabriskie, Bs, Cic

Division of Infectious Diseases and Environmental Medicine Posters

Objective

To create a hand hygiene surveillance program to reduce bias, be more reliable, yield a greater number of observations, and provide real time feedback

Promoting Adherence To Influenza Vaccination Recommendations In Pediatric Practice., Lloyd N. Werk, Maria Carmen Diaz, Adriana Cadilla, James P. Franciosi, Jobayer Hossain

Jefferson Health - Northeast Papers (formerly Aria Health Papers)

OBJECTIVES: In the United States, nonadherence to seasonal influenza vaccination guidelines for children and adolescents is common and results in unnecessary morbidity and mortality. We conducted a quality improvement project to improve vaccination rates and test effects of 2 interventions on vaccination guidelines adherence.

METHODS: We conducted a cluster randomized control trial with 11 primary care practices (PRACTICE) that provided care for 11 293 individual children and adolescents in a children's health care system from September 2015 through April 2016. Practice sites (with their clinicians) were randomly assigned to 4 arms (no intervention [Control], computerized clinical decision support system [CCDSS], …

Quantitative Sensory Testing In Children With Sickle Cell Disease: Additional Insights And Future Possibilities., Robin E. Miller, Dawn S. Brown, Scott W. Keith, Sarah E. Hegarty, Yamaja Setty, Claudia M. Campbell, Suzanne M. Mccahan, Suhita Gayen-Betal, Hal Byck, Marie Stuart

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Quantitative sensory testing (QST) is used in a variety of pain disorders to characterize pain and predict prognosis and response to specific therapies. In this study, we aimed to confirm results in the literature documenting altered QST thresholds in sickle cell disease (SCD) and assess the test-retest reliability of results over time. Fifty-seven SCD and 60 control subjects aged 8-20 years underwent heat and cold detection and pain threshold testing using a Medoc TSAII. Participants were tested at baseline and 3 months; SCD subjects were additionally tested at 6 months. An important facet of our study was the development and …

Which Osteotomy For Osteonecrosis Of The Femoral Head And Which Patient For The Osteotomy?, Young-Kyun Lee, Beomseok Lee, Javad Parvizi, Yong-Chan Ha, Kyung-Hoi Koo

Rothman Institute Papers

Transtrochanteric curved varus osteotomy (TCVO) and transtrochanteric rotational osteotomy (TRO) are joint-preserving procedures for osteonecrosis of the femoral head. The purpose of this review is to provide up-to-date guidelines for the osteotomies. One retrospective comparison revealed that TCVO has shorter operation time, less bleeding, lower incidence of osteophyte formation, and lower rate of secondary collapse. To obtain successful results of the osteotomy, the patient should be younger than 40 years and should have a body mass index of less than 24 kg/m². The osteotomy should be performed in early stages of femoral head osteonecrosis before marked collapse of …

Effect Of Motor Imagery On Children With Developmental Disabilities, J. Bonner, Ots, L. Finnegan, Ots, V. Leonard, Ots, M. Scuderi, Ots, A. Shacklett, Ots, J. Thiel, Ots, M.-C. Potvin, Phd, Otr/L

Student Papers, Posters & Projects

This systematic review provides a comprehensive summary of current research evidence with the intent to help OTs working in pediatric settings understand the potential outcomes of using MI with children with DD.

A Systematic Review: Light Therapy For Individuals With Dementia And Implications For Practice, E. Goodman, Ots, A. Milione, Ots, C. Mikus, Ots, E. Jacobs, Ms, Ots, A. Torres, Ots, V. Vu, Ots, L. Kaiser, Otd, Otr/L, M.-C. Potvin, Phd, Otr/L

Student Papers, Posters & Projects

This systematic review seeks to answer the question: is light therapy an effective intervention for sundowning symptoms experienced by individuals who have dementia?

Optimizing Clinical And Cost Outcomes For Patients On Enteral Nutrition Support For Treatment Of Exocrine Pancreatic Insufficiency: Proceedings From An Expert Advisory Board Meeting, Joseph I. Boullata, Janice L. Clarke, Archie Stone, Alexis Skoufalos, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

The Endocannabinoid System In Migraine: From Bench To Pharmacy And Back., Cristina Tassorelli, Rosaria Greco, Stephen D. Silberstein

Department of Neurology Faculty Papers

PURPOSE OF REVIEW: Migraine is a common, highly disabling disorder. Its treatment involves acute and preventive therapy. Many of available preventive medications are not well tolerated, which results in poor compliance and limited effectiveness. Cannabinoids have been proposed for the treatment of migraine but their efficacy and tolerability are controversial.

RECENT FINDINGS: Cannabinoids modulate functions and activity of signaling pathways that have a key role in pain control. Growing preclinical evidence and initial clinical findings suggest that modulation of the endocannabinoid system, via endogenous or exogenous cannabinoids may be relevant for migraine via multiple mechanisms.

SUMMARY: The endocannabinoid system qualifies …