Medicine and Health Sciences Commons^™

The Population Health Template: A Roadmap For Successful Health Improvement Initiatives, Michael Kobernick, Md, Ms-Hsa, Ms-Poph, Faafp

Population Health Leadership Series: PopTalk Webinars

Learning Objectives

• Describe the population health template as a tool to achieve and report on Quintuple Aim objectives of health improvement initiatives
• Identify gaps in current health initiatives illustrating the needs for the template's more organized approach
• Apply the template to health improvement opportunities in health improvement initiatives
• Understand the role of social determinants of health in health improvement initiatives

Presentation: 50:31

A Closer Look At Arsa Activity In A Patient With Metachromatic Leukodystrophy., Kathleen Doherty, S. Barron Frazier, Matthew Clark, Anna Childers, Sumit Pruthi, David A. Wenger, Jessica Duis

Department of Neurology Faculty Papers

Metachromatic leukodystrophy (MLD) is an autosomal recessive lysosomal storage disease mainly caused by a deficiency of arylsulfatase A activity. The typical clinical course of patients with the late infantile form includes a regression in motor skills with progression to dysphagia, seizures, hypotonia and death. We present a case of a 4-year-old female with rapidly progressive developmental regression with loss of motor milestones, spasticity and dysphagia. MRI showed volume loss and markedly abnormal deep white matter. Enzymatic testing in one laboratory showed arylsulfatase A activity in their normal range. However, extraction of urine showed a large increase in sulfatide excretion in …

Early Progression Of Krabbe Disease In Patients With Symptom Onset Between 0 And 5 Months., Maria L. Beltran-Quintero, Nicholas A. Bascou, Michele D. Poe, David A. Wenger, Carlos A. Saavedra-Matiz, Matthew J. Nichols, Maria L. Escolar

Department of Neurology Faculty Papers

BACKGROUND: Krabbe disease is a rare neurological disorder caused by a deficiency in the lysosomal enzyme, β-galactocerebrosidase, resulting in demyelination of the central and peripheral nervous systems. If left without treatment, Krabbe disease results in progressive neurodegeneration with reduced quality of life and early death. The purpose of this prospective study was to describe the natural progression of early onset Krabbe disease in a large cohort of patients.

METHODS: Patients with early onset Krabbe disease were prospectively evaluated between 1999 and 2018. Data sources included diagnostic testing, parent questionnaires, standardized multidisciplinary neurodevelopmental assessments, and neuroradiological and neurophysiological tests.

RESULTS: We …

The Voices Of Graduates: Informing Faculty Practices To Establish Best Practices For Readying Nclex-Rn Applicants, Mary Hanson-Zalot, Angela Gerolamo, Julia Ward

College of Nursing Faculty Papers & Presentations

Changes in the National Council of State Boards of Nursing along with other factors influence graduates’ successful completion of a nursing program and the licensing examination. Literature is scarce in the area of examining stu-dent perceptions of preparing for and taking the NCLEX-RN examination. Our study sought to fill this gap in knowledge by conducting a focus group and interviews with individuals who passed the NCLEX-RN on their first at-tempt and those who did not. This was a descriptive qualitative study which used semi-structured interviews and a focus group to examine graduates’ perceptions related to preparing for and taking the …

A Novel Handheld Robotic-Assisted System For Unicompartmental Knee Arthroplasty: Surgical Technique And Early Survivorship., Andrew K. Battenberg, Nathan A. Netravali, Jess H. Lonner

Department of Orthopaedic Surgery Faculty Papers

Technology, including robotics, has been developed for use in unicompartmental knee arthroplasty (UKA) to improve accuracy and precision of bone preparation, implant positioning, and soft tissue balance. The NAVIO™ System (Smith and Nephew, Pittsburgh, PA, United States) is a handheld robotic system that assists surgeons in planning implant positioning based on an individual patient's anatomy and then preparing the bone surface to accurately achieve the plan. The surgical technique is presented herein. In addition, initial results are presented for 128 patients (mean age 64.7 years; 57.8% male) undergoing UKA with NAVIO. After a mean of follow-up period of 2.3 years, …

Evaluation Of Cranial Base Repair Techniques Utilizing A Novel Cadaveric Cpap Model., Chandala Chitguppi, Ryan A. Rimmer, Hermes G. Garcia, Ian J. Koszewski, Judd H. Fastenberg, Gurston G. Nyquist, Marc R. Rosen, Colin Huntley, Mindy R. Rabinowitz, James J. Evans

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: Although recent guidelines for obstructive sleep apnea recommend early postoperative use of continuous positive airway pressure (CPAP) after endonasal skull base surgery, the time of initiation of CPAP is unclear. In this study we used a novel, previously validated cadaveric model to analyze the pressures delivered to the cranial base and evaluate the effectiveness of various repair techniques to withstand positive pressure.

METHODS: Skull base defects were surgically created in 3 fresh human cadaver heads and repaired using 3 commonly used repair techniques: (1) Surgicel™ onlay; (2) dural substitute underlay with dural sealant onlay; and (3) dural substitute underlay …

Endoscopic Laser-Ablation For The Treatment Of Orthotopic And Ectopic Ureteroceles In Dogs: 13 Cases (2008-2017)., Cleo P. Rogatko, Allyson C. Berent, Larry G. Adams, Chick W. Weisse, Demetrius H. Bagley

Department of Urology Faculty Papers

BACKGROUND: Ureteroceles are a rare condition in dogs in which conventional treatments can result in substantial morbidity. Cystoscopic and fluoroscopic-guided laser ablation (CLA) of ureteroceles can successfully relieve obstruction.

OBJECTIVES: To describe the technique and outcomes of attempting CLA for treatment of ureteroceles in dogs.

ANIMALS: Thirteen client-owned dogs that underwent CLA for treatment of ureteroceles.

METHODS: Retrospective multicentered study. Medical records were reviewed in all dogs that underwent CLA for ureterocele(s). A laser was used to extend the opening of the ureteral orifice (UO) unless surgical conversion was necessary. Data collected included signalment, clinicopathologic data, imaging, procedural findings, complications, …

Tradd Regulates Perinatal Development And Adulthood Survival In Mice Lacking Ripk1 And Ripk3., John P. Dowling, Mohamed Alsabbagh, Christina Del Casale, Zheng-Gang Liu, Jianke Zhang

Department of Microbiology and Immunology Faculty Papers

TRADD is an adaptor for TNFR1-induced apoptosis and NFκB activation. However, TRADD-deficient mice undergo normal development and contain normal lymphoid populations, which contrasts with an embryonic defect in mice lacking FADD, the shared adaptor mediating apoptosis. Recent studies indicate FADD suppresses embryonic necroptosis mediated by RIPK1. TRADD was suggested to also mediate necroptosis. Here we report that targeting TRADD fails to rescue Fadd ^−/− embryos from necroptosis, and ablation of TRADD rescues Ripk1 ^−/− mice from perinatal lethality when RIPK3-mediated necroptosis is disabled. The resulting Ripk1 ^−/− Ripk3 ^−/− Tradd ^−/− mice survive until early adulthood, but die thereafter. A …

Is Retinal Metabolic Dysfunction At The Center Of The Pathogenesis Of Age-Related Macular Degeneration?, Thierry Léveillard, Nancy J. Philp, Florian Sennlaub

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The retinal pigment epithelium (RPE) forms the outer blood⁻retina barrier and facilitates the transepithelial transport of glucose into the outer retina via GLUT1. Glucose is metabolized in photoreceptors via the tricarboxylic acid cycle (TCA) and oxidative phosphorylation (OXPHOS) but also by aerobic glycolysis to generate glycerol for the synthesis of phospholipids for the renewal of their outer segments. Aerobic glycolysis in the photoreceptors also leads to a high rate of production of lactate which is transported out of the subretinal space to the choroidal circulation by the RPE. Lactate taken up by the RPE is converted to pyruvate and metabolized …

Hemi-Eses Associated With Agenesis Of The Corpus Callosum And Normal Cognition., Mahmoud Mohammadi, Safoura Kowkabi, Ali Akbar Asadi-Pooya, Reza Azizi Malamiri, Reza Shervin Badv

Department of Neurology Faculty Papers

• Corpus callosum plays the important role in bilateral synchronous expression of focal discharges of ESES.
• Sparing dominant hemisphere form continuous spike and slow waves during sleep accounts for normal cognitive scores.
• Early detection and treatment of ESES have a great impact on cognitive and language scores and final prognosis.

Gitelman Syndrome: A Rare Cause Of Seizure Disorder And A Systematic Review., Muhammad Asim Shahzad, Maryam Mukhtar, Asrar Ahmed, Waqas Ullah, Rehan Saeed, Mohsin Hamid

Abington Jefferson Health Papers

Gitelman syndrome is one of the few inherited causes of metabolic alkalosis due to salt losing tubulopathy. It is caused by tubular defects at the level of distal convoluted tubules, mimicking a thiazide-like tumor. It usually presents in late childhood or in teenage as nonspecific weakness, fatigability, polyuria, and polydipsia but very rarely with seizures. It is classically associated with hypokalemia, hypomagnesemia, hypocalciuria, hyperreninemia, and hyperaldosteronism. However, less frequently, it can present with normal magnesium levels. It is even rarer to find normomagnesemic patients of GS who develop seizures as the main complication since hypomagnesemia is considered the principal etiology …

Pharmacological And Non-Pharmacological Treatments For The Neonatal Abstinence Syndrome (Nas)., A. K. Mangat, G. M. Schmölzer, W. K. Kraft

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Neonatal abstinence syndrome is defined by signs and symptoms of withdrawal that infants develop after intrauterine maternal drug exposure. All infants with documented in utero opioid exposure, or a high pre-test probability of exposure should have monitoring with a standard assessment instrument such as a Finnegan Score. A Finnegan score of >8 is suggestive of opioid exposure, even in the absence of declared use during pregnancy. At least half of infants in most locales can be treated without the use of pharmacologic means. For this reason, symptom scores will drive the decision for pharmacologic therapy. Nevertheless, all infants, regardless of …

Combination Therapy With Fingolimod And Neural Stem Cells Promotes Functional Myelination, Yuan Zhang, Xin-Yu Lu, Ze-Qin Ye, Bogoljub Ciric, Cun-Gen Ma, A. M. Rostami, Xing Li, Guang-Xian Zhang

Department of Neurology Faculty Papers

Myelination, which occurs predominantly postnatally and continues throughout life, is important for proper neurologic function of the mammalian central nervous system (CNS). We have previously demonstrated that the combination therapy of fingolimod (FTY720) and transplanted neural stem cells (NSCs) had a significantly enhanced therapeutic effect on the chronic stage of experimental autoimmune encephalomyelitis, an animal model of CNS autoimmunity, compared to using either one of them alone. However, reduced disease severity may be secondary to the immunomodulatory effects of FTY720 and NSCs, while whether this therapy directly affects myelinogenesis remains unknown. To investigate this important question, we used three myelination …

Finding The 'Qr' To Patient Safety: Applying Gamification To Incorporate Patient Safety Priorities Through A Simulated 'Escape Room' Experience., Xiao Chi Zhang, Gretchen Diemer, Hyunjoo Lee, Rebecca Jaffe, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Medical errors are the eighth leading cause of mortality in the United States and contribute to over one million preventable injuries. In an effort to prevent medical errors, reporting systems serve as invaluable tools to detect patient safety events and quality problems longitudinally. Historically, trainees (i.e., students and residents) rarely submit incident reports for encountered patient safety threats. The authors propose an immersive learning experience utilizing gamification theory and leveraging the increasingly popular ‘escape room’ to help resident trainees identify reportable patient safety priorities. All 130 incoming intern physicians at the Thomas Jefferson University (Jefferson) were enrolled in the Patient …

Cyclin D1 Integrates G9a-Mediated Histone Methylation., Zhiping Li, Xuanmao Jiao, Gabriele Di Sante, Adam Ertel, Mathew C. Casimiro, Min Wang, Sanjay Katiyar, Xiaoming Ju, D. V. Klopfenstein, Aydin Tozeren, William Dampier, Iouri Chepelev, Albert Jeltsch, Richard G. Pestell

Department of Cancer Biology Faculty Papers

Lysine methylation of histones and non-histone substrates by the SET domain containing protein lysine methyltransferase (KMT) G9a/EHMT2 governs transcription contributing to apoptosis, aberrant cell growth, and pluripotency. The positioning of chromosomes within the nuclear three-dimensional space involves interactions between nuclear lamina (NL) and the lamina-associated domains (LAD). Contact of individual LADs with the NL are dependent upon H3K9me2 introduced by G9a. The mechanisms governing the recruitment of G9a to distinct subcellular sites, into chromatin or to LAD, is not known. The cyclin D1 gene product encodes the regulatory subunit of the holoenzyme that phosphorylates pRB and NRF1 thereby governing cell-cycle …

Medical Marijuana-Induced Tacrolimus Toxicity., Daniel Moadel, Keira Chism

Department of Psychiatry and Human Behavior Faculty Papers

As both recreational and therapeutic marijuana use increases in the US, more attention is being paid to its direct medical and psychoactive effects. One crucial dimension is the potential for marijuana or marijuana-derived therapies to interact with other prescribed medications. Tacrolimus is an immunosuppressant medication prescribed to prevent rejection in patients receiving solid organ and bone marrow transplants. Clinically, it is characterized by a narrow therapeutic index and multiple drug-drug interactions. Constituents in marijuana are known to inhibit cytochrome P-450 3A, which is normally responsible for metabolizing tacrolimus, leading to the potential for a dangerous interaction. Though this phenomenon has …

Utilizing The Boston Syncope Observation Management Pathway To Reduce Hospital Admission And Decrease Adverse Outcomes, Oren J. Mechanic, Celine Y. Pascheles, Gregory J. Lopez, Alina M. Winans, Nathan I. Shapiro, Carrie Tibbles, Richard E. Wolfe, Shamai A. Grossman

Student Papers, Posters & Projects

Introduction: In an age of increasing scrutiny of each hospital admission, emergency department (ED) observation has been identified as a low-cost alternative. Prior studies have shown admission rates for syncope in the United States to be as high as 70%. However, the safety and utility of substituting ED observation unit (EDOU) syncope management has not been well studied. The objective of this study was to evaluate the safety of EDOU for the management of patients presenting to the ED with syncope and its efficacy in reducing hospital admissions.

Methods: This was a prospective before-and-after cohort study of consecutive patients presenting …

Eliciting Patient-Important Outcomes Through Group Brainstorming: When Is Saturation Reached?, Marianna Lanoue, Alexzandra Gentsch, Amy Cunningham, Geoffrey Mills, Amanda M.B. Doty, Judd E. Hollander, Brendan G. Carr, Larry Loebell, Gail Weingarten, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

PURPOSE: Group brainstorming is a technique for the elicitation of patient input that has many potential uses, however no data demonstrate concept saturation. In this study we explore concept saturation in group brainstorming performed in a single session as compared to two or three sessions.

METHODS: Fifty-two predominately African American adults patients with moderately to poorly controlled Diabetes Mellitus participated in three separate group brainstorming sessions as part of a PCORI-funded group concept mapping study examining comparing methods for the elicitation of patient important outcomes (PIOs). Brainstorming was unstructured, in response to a prompt designed to elicit PIOs in diabetes …

Association Between Hypertensive Disorders And Fetal Growth Abnormalities In Class Ii And Iii Obese Women, Mary Ferrante, Bs, Rebekah Mccurdy, Md, Mph

Phase 1

Introduction: Studies have shown that hypertension in pregnancy can lead to small for gestational age newborns while obesity can lead to large for gestational age newborns. However, little research has been done to study the influence of both disorders on birthweight.

Objective: To assess the effect of both maternal obesity and a hypertensive disorder on neonatal birthweight and to identify the specific growth abnormality(s) present if a discrepancy exists. We hypothesize that obese women diagnosed with hypertensive disorders are more likely to deliver neonates with growth abnormalities compared to obese women without hypertensive disorders.

Methods: This is a …

Bova Is Superior To Spesi In Identification Of High Risk Pulmonary Embolism Patients, J. Dibello, P. Khaing, E. Gupta, C. Au, T. Chengsupanimit, B. K. Awsare, M. Baram, F. M. West, G. C. Kane

Phase 1

Introduction: Prognostic models exist for the purpose of stratifying patients with acute pulmonary embolism. Of these, the Pulmonary Embolism Severity Index (PESI) and the simplified PESI (sPESI) are the most well-known, although more recent composite models, like the BOVA score, are now being studied and implemented. Comparative efficacy of these scores to predict long term mortality is not well established.

Methods: We performed a retrospective analysis of all consecutive patients diagnosed with PE using computed tomography scan from 2014-2016 at an urban tertiary-referral medical center. Cox proportional hazard analyses were performed to compare the performance of two prognostic …

Emergency Medicine Palliative Care Access (Empalla): Preliminary Data From A Multi-Center Randomized Controlled Trial, Abigail M. Schmucker, Ba, Deborah J. Shim, Bs, Corita R. Grudzen, Md, Mshs, Jeanne Cho, Mph, Keith Goldfeld, Drph

Phase 1

Introduction: Emergency department (ED)-initiated palliative care has been shown to improve patient-centered outcomes in older adults with serious illnesses, but the optimal modality for providing such interventions is unknown. The EMPallA trial compares nurse-led, telephonic case management with specialty, outpatient palliative care on: 1) patient quality of life (QOL); 2) healthcare utilization; 3) loneliness and symptom burden; and 4) caregiver strain, QOL, and bereavement.

Objective: Summarize preliminary demographic and QOL data for the EMPallA cohort.

Methods: A pragmatic, parallel, two-arm randomized controlled trial is enrolling 1350 ED patients across 9 EDs over 3 years to compare the effectiveness of palliative …

Opioid Consumption After Orthopedic Surgery: Prospective Randomized Trial On The Effects Of Preoperative Counseling, Sage Vincent, Taylor Paskey, Elizabeth Critchlow, Erica Mann, Talia Chapman, Md, Kristin Sandrowski, Md, Asif Ilyas, Md

Phase 1

Introduction: Recently, there have been increases in morbidity and mortality associated with opioid medications. Physician overprescribing, particularly within orthopedics, contributes to large quantities of leftover opioids, leading to an increased risk of non-medical opioid use and abuse.

Objective: To understand the role of preoperative patient counseling on postoperative opioid consumption, a prospective randomized study was done, with the idea that patients receiving counseling would take fewer opioids than their control counterparts.

Methods: Patients undergoing elective outpatient orthopedic surgery at Jefferson affiliate hospitals were enrolled over a 3-month period. Patients were randomized to a control group or to receive preoperative counseling …

Direct Anterior Approach Utilizing A Bikini Incision Has Less Wound Related Complications In Patients With High Bmi, Taylor Paskey, Bs, Jorge Manrique, Md, Majd Tarabichi, Md, Camilo Restrepo, Md, Carol Foltz, Phd, William J. Hozack, Md

Phase 1

Introduction: Direct anterior approach (DAA) total hip arthroplasty (THA) can be performed through a traditional vertical skin incision, situating the proximal incision at the hip flexion crease, or a horizontal (bikini) skin incision, situating the incision slightly distal and parallel to the hip flexion crease. The dissection beyond the subcutaneous layer is identical for both methods.

Objective: The purpose of this study was to compare these approaches, performed by an experienced single surgeon, in terms of overall wound complications and patient-reported esthetics 6-months post-operatively. It was hypothesized that the bikini incision would result in less wound complications and …

Minimally Invasive Surgery In Neonates With Congenital Anomalies: Experience From The Nsqip-P, Emily Sagalow, Katerina Dukleska, Md, Courtney Devin, Md, Erin Teeple, Md, Scott W. Cowan, Md, Charles D. Vincour, Md, Loren Berman, Md

Phase 1

Background: Congenital diaphragmatic hernias (CDH) and tracheoesophageal fistulas (TEF) are managed with minimally invasive surgery (MIS) or open surgery. Little is known about the patient populations and outcomes for those treated by each approach. Hypothesis/Specific Aims: We expect that there will be fewer complications, better outcomes, and longer operative times for the MIS group versus the open group.

Methods: National Surgical Quality Improvement Program-Pediatric Participant Use Files (NSQIP-P PUFs) from 2012-2015 were used to identify neonates (up to 30 days old) who underwent CDH and TEF repair. The patient characteristics, post-operative complications, and 30-day mortality were analyzed using multivariable logistic …

Does Concomitant Cabg Influence The Outcomes Of Post-Myocardial Infarction Ventricular Septal Defect Repair?, Dylan P. Horan, Jae Hwan Choi, Matthew P. Weber, Elizabeth Maynes, Sinal Patel, Jothika Challapalli, Jessica G.Y. Luc, John W. Entwistle, H. Todd Massey, Rohinton J. Morris, Vakhtang Tchantchaleishvili

Phase 1

Introduction: Ventricular septal defect (VSD) following myocardial infarction (MI) is a relatively infrequent complication with high mortality. Over time, understanding of the pathology and its management has resulted in improved outcomes; however, controversies remain.

Objective: We sought to investigate the effect of concomitant coronary artery bypass graft (CABG) on outcomes following post-MI VSD repair.

Methods: Electronic search was performed to identify all relevant studies published from 2000 to 2018. After assessment for inclusion and exclusion criteria, 66 studies were selected for the analysis. Data were extracted and pooled for systematic review and meta-analysis.

Results: Average age was 68.7 years …

Pharmacokinetics Of Midazolam And Ketamine In Critically Ill Adults On Extracorporeal Membrane Oxygenation (Ecmo) Therapy, Julian Tanjuakio, Edwin Lam, Walter K. Kraft, Hitoshi Hirose, Nicholas C. Cavarocchi

Phase 1

Introduction: Extracorporeal Membrane Oxygenation (ECMO) is a form of life support for temporary mechanical cardiopulmonary support. Critically ill adults receiving ECMO support are often sedated using ketamine and benzodiazepines. Previous studies have showed altered connects of benzodiazepines and ketamine in ECMO patients compared to non-ECMO patients. However, no studies have shown prospective data regarding the pharmacokinetics of these drugs in vivo.

Objective: The primary purpose of this study is to characterize the pharmacokinetic parameters of Ketamine and Midazolam in adult patients on ECMO. As a secondary objective, we will develop a pharmacokinetic model of these drugs using various clinical endpoints. …

Repeat Neuro-Imaging In Patients Presenting With Traumatic Extra-Axial Intracranial Hemorrhage, Austin Saline, Anthony Stefanelli, Md, Omaditya Khanna, Md, Sol Feuerwerker, Somnath Das, Evan Selzer

Phase 1

Introduction: The management of extra-axial intracranial hemorrhage patients is complicated and lacks a systemic algorithm to determine the timing and necessity of head computed tomography (HCT). However, repeat HCTs weakly predict the need for an intervention after mild traumatic brain injury (TBI).

Objective: This study focused on assessing the safety, efficacy, and necessity of obtaining serial HCTs in patients presenting with subdural hemorrhages.

Methods: A retrospective chart review was conducted of patients with subdural hemorrhages and a GCS between 13-15 on admission (n=116). The total number of HCTs, time between repeat HCTs, duration of hospital stay, and factors necessitating surgery …

Is Excision Of Radial Scars Identified On Cnb Necessary?, K. Nimtz, K. Hookim, Md, A. Sevrukov, Md, T. Tsangaris, Md, A. Willis, Md, A. Berger, Md, M. Lazar, Md

Phase 1

Introduction: Quantifying the risk of upgrade to malignancy with radial scars has been an ongoing challenge, as the published upgrade rate varies widely from 0-40%, making management strategy controversial. The lack of consensus on optimal management highlights the need for further analysis. We sought to identify our institutional upgrade rate of radial scar identified on core needle biopsy (CNB).

Methods: A retrospective review of pathology and radiology databases was performed to identify radial scars found on CNB. We excluded patients with malignancy associated with radial scar and those who did not undergo surgical excision. The upgrade rates to …

The Accuracy Of Blood Pressure Measurement By Two Cuff-Less Wearable And Portable Health Devices, Dylan M. Bard, Noud Van Helmond, Christina Hahnen, Nilanjan Haldar, Cecilia Freeman, Jacquelyn N. Hamati, Vignesh Murali, Jeffrey I. Joseph

Phase 1

Introduction: Wearable and portable devices that claim to measure blood pressure without the need of a cuff are becoming increasingly popular among consumers. Given that hypertension is the leading cause for cardiovascular mortality worldwide, a portable technology that allows consumers to easily measure their BP several times a day would be of great value. However, the convenience that portable health technology provides is useless, and even dangerous, if the measurements are inaccurate.

Objective: Investigate the accuracy of two popular commercial cuff-less BP device, the Bodimetrics Performance Monitor and Everlast TR10 watch.

Methods: A sample of 127 ambulatory patients (>18y) …

17-Hydroxyprogesterone Caproate Does Not Prevent Preterm Birth In Women With A Twin Pregnancy And A Prior Singleton Spontaneous Preterm Birth, Breanna Valcarcel, Bs, Andrew Ward, Md, Huda Al-Kouatly, Md, Vincenzo Berghella, Md, Victoria Greenberg, Md

Phase 1

INTRODUCTION: Prior spontaneous preterm birth (sPTB) is a risk factor for recurrent sPTB. Weekly 17-hydroxyprogesterone caproate (17P) is used to prevent sPTB in singletons, but there is insufficient evidence on its benefit in twin pregnancies.

OBJECTIVE: We hypothesized that 17P weekly injections would reduce the likelihood of sPTB in women carrying a twin pregnancy with a history of singleton sPTB.

METHODS: We performed a retrospective case control study of women with a twin gestation and prior singleton sPTB between 2005 and 2016. The study group consisted of women with a twin gestation that received weekly 17P starting at 16 to …