Medicine and Health Sciences Commons^™

Mir126-5p Downregulation Facilitates Axon Degeneration And Nmj Disruption Via A Non-Cell-Autonomous Mechanism In Als., Roy Maimon, Ariel Ionescu, Avichai Bonnie, Sahar Sweetat, Shane Wald-Altman, Shani Inbar, Tal Gradus, Davide Trotti, Miguel Weil, Oded Behar, Eran Perlson

Farber Institute for Neuroscience Faculty Papers

Axon degeneration and disruption of neuromuscular junctions (NMJs) are key events in amyotrophic lateral sclerosis (ALS) pathology. Although the disease's etiology is not fully understood, it is thought to involve a non-cell-autonomous mechanism and alterations in RNA metabolism. Here, we identified reduced levels of miR126-5p in presymptomatic ALS male mice models, and an increase in its targets: axon destabilizing Type 3 Semaphorins and their coreceptor Neuropilins. Using compartmentalized

Posterior Reversible Encephalopathy Syndrome (Pres) After Bevacizumab Therapy For Metastatic Colorectal Cancer., Mohsin Hamid, Ali Ghani, Ida Micaily, Usman Sarwar, Md, Bilal Lashari, Md, Faizan Malik

Abington Jefferson Health Papers

Posterior reversible encephalopathy syndrome (PRES) is an increasingly recognizable neuro-clinical syndrome. Clinical and neurological manifestations of PRES include hypertension, headache, encephalopathy, seizures, and symmetrical white matter changes on brain MRI. Most common precipitants of PRES are acute medical illness, hypertensive crisis, eclampsia, immunosuppressive therapy, and chemotherapy. Bevacizumab is a monoclonal antibody that halts angiogenesis by inhibiting vascular endothelial growth factor. It has gained widespread popularity in oncology world especially for metastatic and recurrent cancers due to its inherent ability to stop angiogenesis; a vital step for tumor growth. Bevacizumab has also been implicated as the cause of PRES due to …

Epidermodysplasia Verruciformis: Inborn Errors Of Immunity To Human Beta-Papillomaviruses, Sarah J. De Jong, Elias Imahorn, Peter Itin, Jouni Uitto, Gerard Orth, Emmanuelle Jouanguy, Jean-Laurent Casanova, Bettina Burger

Department of Dermatology and Cutaneous Biology Faculty Papers

Epidermodysplasia verruciformis (EV) is an autosomal recessive skin disorder with a phenotype conditional on human beta-papillomavirus (beta-HPV) infection. Such infections are common and asymptomatic in the general population, but in individuals with EV, they lead to the development of plane wart-like and red or brownish papules or pityriasis versicolor-like skin lesions, from childhood onwards. Most patients develop non-melanoma skin cancer (NMSC), mostly on areas of UV-exposed skin, from the twenties or thirties onwards. At least half of the cases of typical EV are caused by biallelic loss-of-function mutations of TMC6/EVER1 or TMC8/EVER2. The cellular and molecular basis of disease in …

A Deadly Prescription: Combination Of Methotrexate And Trimethoprim-Sulfamethoxazole., Mohsin Hamid, Bilal Lashari, Irfan Ahsan, Ida Micaily, Usman Sarwar, Joseph Crocetti

Abington Jefferson Health Papers

Methotrexate (MTX) is a chemotherapeutic synthetic(s) phase cell cycle inhibitor, and its role has evolved as an immunological agent in autoimmune diseases like rheumatoid arthritis, psoriasis, and systemic lupus erythematosus, etc. Trimethoprim-sulfamethoxazole (TS) is one of the most widely prescribed antibiotics commonly used for urinary tract infections, exacerbations of chronic bronchitis, traveler's diarrhea, and pneumocystis pneumonia. Both MTX and TS can have significantly overlapping side effects involving dermatologic, renal, and hematological systems, and the combination of these can be deadly. Our case is about the combination of MTX and TS that leads to mucocutaneous ulceration, leukopenia, and renal insufficiency. The …

The Childhood Role In Development Of Primary Hypertension., Bonita Falkner

Department of Medicine Faculty Papers

Primary hypertension is not just an adult disorder. Current US population data on children and adolescents demonstrate a prevalence of elevated blood pressure (BP) and hypertension combined of over 10%. Recent reports from prospective cohort studies describe an association of high BP in childhood with hypertension in young adulthood. Excess adiposity is strongly associated with higher BP in childhood and increases risk for hypertension in adulthood. In addition to overweight/obesity, other exposures that raise the risk for high BP include low birthweight, dietary sodium, and stress. Using intermediate markers of cardiovascular injury, studies on hypertensive children report findings of cardiac …

Save The Date

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

Save the Date

Recognizing The Importance Of Materials: Embracing A Sociomaterial Perspective On Interprofessional Collaboration, Mark Goldszmidt, Md, Phd

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

Recognizing the Importance of Materials: Embracing a Sociomaterial Perspective on Interprofessional Collaboration

Health Mentors Program Reflection Essays, Jen Starrs, Rachel Fogley

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

Health Mentors Program Reflection Essays

Health Mentors Program: Student Key Takeaways, 2017-2018

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

Health Mentors Program: Student Key Takeaways, 2017-2018

Meet An Ipe Faculty Champion From Thomas Jefferson University: Angela Gerolamo, Phd, Rn, Angela Gerolamo, Phd, Rn

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

Meet an IPE Faculty Champion from Thomas Jefferson University: Angela Gerolamo, PhD, RN

Meet An Ipe Student Champion From Thomas Jefferson University: Gerald Gibbons - Md/Mph Student, Class Of 2018, Gerald Gibbons

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

Meet an IPE Student Champion from Thomas Jefferson University: Gerald Gibbons - MD/MPH Student, Class of 2018

Student Hotspotting: Reflections Of A Program Graduate, Kyle Bardet, Md

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

Student Hotspotting: Reflections of a Program Graduate

An Ounce Of Prevention: Interprofessional Education, Burnout Syndrome, And Healthy Work Environments: A Pilot Study, Mary Louanne Friend, Phd, Mn, Rn, Richard D. Friend, Md, Faafp

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

Background

Burnout syndrome (BOS), characterized by exhaustion, depersonalization, and reduced satisfaction in performance, has been associated with increased job turnover, reduced patient satisfaction, and decreased quality of care. It affects physicians and nurses alike, particularly in high acuity areas. In response to alarming rates of BOS, the Critical Care Societies Collaborative (CCSC), comprised of four U.S. professional and scientific societies, issued a call to action, advocating for healthy work environments (HWE), where mutal respect between team members occurs. HWE, supported by six evidence-based relationship focused standards of care, empower nurses and their colleagues to practice to their full potential. The …

From The Editors

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

From the Editors

Jcipe By The Numbers

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

Looking Back Over 10 Years

Availability to work with Interprofessional healthcare teams ranked 13 out of 28 most important reasons for choosing to attend Jefferson by incoming students in 2016.

Download Entire Issue: Collaborative Healthcare: Interprofessional Practice, Education And Evaluation (Jcipe), Volume 9, Number 1, Spring 2018

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

In This Issue

From the Editors.....1

An Ounce of Prevention: Interprofessional Education, Burnout Syndrome, and Healthy Work Environments: A Pilot Study.....2

JCIPE by the Numbers.....3

Student Hotspotting: Reflections of a Program Graduate.....4

Meet an IPE Student Champion from Thomas Jefferson University Gerald Gibbons.....5

Meet an IPE Faculty Champion from Thomas Jefferson University Angela Gerolamo.....5

Health Mentors Program Key Student Take Aways.....6

Health Mentors Program Reflection Essays.....7

Recognizing the Importance of Materials: Embracing a Sociomaterial Perspective on Interprofessional Collaboration.....8

Cox-2 Expression Mediated By Calcium-Tonebp Signaling Axis Under Hyperosmotic Conditions Serves Osmoprotective Function In Nucleus Pulposus Cells., Hyowon Choi, Weera Chaiyamongkol, Alexandra C. Doolittle, Zariel I. Johnson, Shilpa S. Gogate, Zachary R. Schoepflin, Irving M. Shapiro, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

The nucleus pulposus (NP) of intervertebral discs experiences dynamic changes in tissue osmolarity because of diurnal loading of the spine. TonEBP/NFAT5 is a transcription factor that is critical in osmoregulation as well as survival of NP cells in the hyperosmotic milieu. The goal of this study was to investigate whether cyclooxygenase-2 (COX-2) expression is osmoresponsive and dependent on TonEBP, and whether it serves an osmoprotective role. NP cells up-regulated COX-2 expression in hyperosmotic media. The induction of COX-2 depended on elevation of intracellular calcium levels and p38 MAPK pathway, but independent of calcineurin signaling as well as MEK/ERK and JNK …

Implementation Of Attending-Supervised Ipass Handoff In The Neuro-Icu, Laura Cifrese, Md, Sonia Gill, Md, Megan Margiotta, Md, Muhammad Athar, Md, Rodney Bell, Md, Sara Hefton, Md, Fred Rincon, Md, Msc, Mbe, Syed Shah, Md, Mba, Jacqueline Urtecho, Md, Matthew Vibbert, Md, David Wyler, Md, Amandeep Dolla, Md

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

Background

• Duty hour restrictions, cross coverage, and the growing number of mid-level practitioners has led to an increased number of handoffs across medical specialties
• These handoffs are well-known points of communication breakdown which can lead to patient safety issues
• Factors contributing to an effective handoff include standardization of communication, appropriate training and supervision, ample time, a quiet environment, and a supportive culture
• We hypothesize that attending supervision of handoffs is feasible and can improve practitioner perception of transitions of care

Improving Transitions Of Care For Inpatients With An Egfr < 20ml/Min, Brianna Shinn, Md, Brandon Menachem, Md, Robert Park, Md, Sarah Houtmann, Md, Zachary Lee, Md, Thomas Holden, Md, Tomoyuki Hongo, Md, Vincent Yeung, Md, Goni Katz-Greenberg, Md, Peter Burke, Do, Mba

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

In this study we conducted an analysis of 22 inpatients with an eGFR<20 that revealed there was a greater prevalence of patients without permanent AV access for HD initiation when compared to national data. These findings demonstrated the need for improved transitions of care and timely creation of AV access for this patient population, thus we sought to improve this. This is the first inpatient initiative that our group is aware with the aim of improving timely AV access and transitions of care for an inpatient population (Figure 1).

Cross-Departmental Educational Program On Complex Airway And Epistaxis Management, Adam Vasconcellos, Md, Meghan Crawley, Md, Michael Topf, Md, Ryan Gerritsen, Md, Dominick Gadaleta, Md, Joseph Spiegel, Md

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

Internists, emergency medicine physicians, and intensivists routinely provide essential care for patients with complex airways (i.e. tracheostomy and laryngectomy) and patients with epistaxis. Any of these physicians may serve as first responder in a complex airway or epistaxis emergency situation. Therefore, a basic understanding of complex airway and epistaxis management is essential. The otolaryngology department aims to provide our colleagues with fundamental take-home points to improve crossdepartmental care of these patients.

Effective Hepatitis C Screening In High Risk Populations, Aekata Shah, Do, Jennifer Seymour, Do

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

Purpose

The purpose of our study was to demonstrate how various quality improvement initiatives activated in selected Jefferson Northeast family medicine teaching offices have enabled effective HCV screening. Given the cost effectiveness of screening and early treatment versus treatment of the disease in the later stages of progression,8 we hope to encourage other primary care offices to implement quality initiatives to encourage appropriate HCV screening. This is especially important for the baby boomer generation, as well as for high risk individuals with a history for and/or current IV drug abuse or other high risk behaviors.

Improving Advanced Care Planning Documentation In The Outpatient Setting, Carly Sedlock, Md, Tatiana Bekker, Md, Tara Sunder, Md, Mario Caldararo, Md, Divya Chalikonda, Md, Newton Mei, Md

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

Aims

We aimed to increase Jefferson Hospital Ambulatory Practice (JHAP) electronic medical record documentation of advanced care planning discussion of 209 identified “high risk” patients via independently labeled ACP notes by 5% (from 1.4% to 6.4%) over a six-month period (October 1, 2017- April 1, 2018).9 We elected to focus this pilot project on high risk patients due to time constraints of the study period and we felt that these high risk patients would likely derive the most benefit from ACP planning in the outpatient setting.

Hey, What’S The Delay? An Evaluation Of Reporting Time For Pediatric Eegs, Aparna Polavarapu, Md, Rachit Patil, Md, Maromi Nei, Md

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

Aim

To determine if there is a reduction in time to EEG reporting after institution of the Pediatric Epilepsy fellowship track.

A Provider-Based Survey On Quality Of Care And Identification Of Quality Gaps In Inpatient Palliative Care, Adam Pennarola, Md, Mph, Matthew Murphy, Md, Elizabeth Collins, Md, Beth Wagner, Msn, Crnp, Achpn, John Liantonio, Md

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

Background

Inpatient Palliative Care Teams (IPCTs) are often called upon to provide multidisciplinary care across hospital settings at Jefferson. However, there is currently no mechanism in place wherein providers consulting the IPCT can provide feedback to specialty palliative care clinicians. Such input from providers could be used to elucidate those services provided by the team which are most appreciated and those which require further development in order to be truly effective. Furthermore, such input may also serve to identify completely new areas for inpatient palliative care needs.

Establishing Cost-Effective Management Of Postoperative Urinary Retention After Spine Surgery, Nikolaos Mouchtouris, Md, Catriona Harrop, Md, Edward Kloniecke, Md, Victoria English, Crnp, David Wyler, Md, Kamini Patel, Rn, Mba, Ashwini Sharan, Md, James Harrop, Md

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

Goal

Our goal is to develop evidence-based guidelines that:

1. streamline the order/timing of interventions in patients who develop PUR after spine surgery
2. identify those at high-risk of long-term urinary retention that require further workup
3. minimize the rate of PUR –goal is to reduce to 3.5% in FY 2019
4. and determine the cost savings from our intervention when applied to all surgeries

Improving Resident Confidence And Efficiency During Stroke Alerts Through Simulation Training, Megan Margiotta, Md, Danielle Wilhour, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Maria Carissa Pineda, Md, Fred Rincon, Md, Rodney Bell, Md, Diana Tzeng, Md

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

Objectives

• Teach incoming neurology residents how to respond efficiently and appropriately to stroke alerts
• Improve the confidence level of residents during stroke alerts

Standardized Discharge Instructions And Their Impact On Post Operative Patient Knowledge, Nikolaus Hjelm, Md, Gregory Epps, Md, Ryan Rimmer, Md, Lauren Bogdan, Md, Erin Reilly, Md

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

After every surgery, surgeons send their patients home with discharge instructions. The information is intended to educate the patients about their postoperative care and how to safely care for themselves upon returning home. Each surgeon reviews and approves the discharge instructions before they are given to their patients. This information is once again reviewed by the patient’s nurse before the patient leaves the hospital.

Within a large hospital, there are often several surgeons within each specialty that perform the same surgeries. The department of Otolaryngology at Thomas Jefferson University Hospital is no exception. Within otolaryngology there are several subspecialties. At …

Optimizing Physical Therapy Sessions Among Patients Undergoing Elective Lumbar Surgery, Ellina Hattar, Md, Kelly Hufford, Dpt, Marie Wilson, Rn, James Harrop

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

Background

Physical therapy is imperative in achieving early mobilization, thereby reducing morbidity of immobility such as venous thrombolic events, improving postoperative pain, and facilitating appropriate disposition among patients who have recently undergone spine surgery. At TJUH, patients undergoing elective spine surgery are planned to engage in physical therapy (PT) twice a day. There are however several impediments that may limit the ability of patients to adequately participate in PT.

Order From Order Sets: Analysis Of Ordering Patterns And Patient Outcomes Before And After Order Set Changes On The Inpatient Psychiatry Units At Tjuh, David Halpern, Md

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

Aims

Short Term

To decrease the total number of times one-time orders were added for patients for Vistaril, Remeron, Melatonin, Colace, Senna, and MiraLAX. Increase number of times urine PCP and urine oxycodone added to the urine drug screen.

Long Term

To decrease overall length of stay and improve treatment outcomes

Adequate Patient Education - The Key To Improving Patient Experience While Being Under Contact Precautions?, Edosio Eloho, Md, Mary Naglak, Phd, Doron Schneider, Md, Hadiatou Barry, Md, Babatunde Ogunnaike, Md, Puneet Dhillon, Md, Neethu Gopisetti, Md

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

Objectives

To improve patient satisfaction with the quality of education provided about CP by at least 30% by the end of 7 months. Through the provision of a standardized patient education sheet to hospitalized patients placed on CP within their first 24 hours being placed under contact isolation.