Medicine and Health Sciences Commons^™

Introduction To Direct Oral Anticoagulants And Rationale For Specific Reversal Agents., Charles V. Pollack

Department of Emergency Medicine Faculty Papers

No abstract provided.

Aging-Associated Changes In Microrna Expression Profile Of Internal Anal Sphincter Smooth Muscle: Role Of Microrna-133a., Jagmohan Singh, Boopathi Ettickan, Sankar Addya, Benjamin Philllips, Isidore Rigoutsos, Raymond B. Penn, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

A comprehensive genomic and proteomic, computational, and physiological approach was employed to examine the (previously unexplored) role of microRNAs (miRNAs) as regulators of internal anal sphincter (IAS) smooth muscle contractile phenotype and basal tone. miRNA profiling, genome-wide expression, validation, and network analyses were employed to assess changes in mRNA and miRNA expression in IAS smooth muscles from young vs. aging rats. Multiple miRNAs, including rno-miR-1, rno-miR-340-5p, rno-miR-185, rno-miR-199a-3p, rno-miR-200c, rno-miR-200b, rno-miR-31, rno-miR-133a, and rno-miR-206, were found to be upregulated in aging IAS. qPCR confirmed the upregulated expression of these miRNAs and downregulation of multiple, predicted targets (Eln, Col3a1, Col1a1, Zeb2, …

A Word From The Writing Center (November 2016), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

November 2016 issue includes:

• Writing Tip
• Learning Opportunity
• Writing Café

Head And Neck Manifestations Of Eosinophilic Granulomatosis With Polyangiitis: A Systematic Review., Jared M. Goldfarb, Mindy R. Rabinowitz, Shristi Basnyat, Gurston G. Nyquist, Marc R. Rosen

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To conduct the first and only systematic review of the existing literature on head and neck manifestations of eosinophilic granulomatosis with polyangiitis to guide clinical decision making for the otolaryngologist.

DATA SOURCES: PubMed, Cochrane Library, Scopus, and LILACS.

REVIEW METHODS: A systematic review of the aforementioned sources was conducted per the PRISMA guidelines.

RESULTS: From an initial 574 studies, 28 trials and reports were included, accounting for a total of 1175 patients with eosinophilic granulomatosis with polyangiitis. Among clinical and cohort studies, 48.0% to 96.0% of all included patients presented with head and neck manifestations. In a distinct group …

Clinical Influences In The Multidisciplinary Management Of Small Renal Masses At A Tertiary Referral Center, Costas D. Lallas, Kymora Scotland, Michael Zhang, Daisey Schaeffer, Anne Calvaresi, Leonard G. Gomella, Daniel Brown, Colette Shaw, Edouard J. Trabulsi

Department of Urology Faculty Papers

Introduction We designed a multidisciplinary Small Renal Mass Center to help patients decide among treatment options and individualize therapy for small renal masses. In this model physicians and support staff from multiple specialties work as a team to evaluate and devise a treatment plan for patients at the same organized visit. Methods We retrospectively reviewed the records of 263 patients seen from 2009 to 2014. Monitored patient characteristics included age, Charlson comorbidity index, body mass index, nephrometry score, tumor size and estimated glomerular filtration rate. Univariate and multivariate analyses were performed to identify patient characteristics associated with each treatment choice. …

The Development Of A Universally Accepted Sacral Fracture Classification: A Survey Of Aospine And Aotrauma Members., Gregory D. Schroeder, Mark Kurd, Christopher K. Kepler, James C. Krieg, Jefferson R. Wilson, Conor P. Kleweno, Reza Firoozabadi, Carlo Bellabarba, Frank Kandizoria, Klause J. Schnake, S. Rajesekaran, Marcel F. Dvorak, Jens R. Chapman, Luiz R. Vialle, F. C. Oner, Alex R. Vaccaro

Rothman Institute Papers

Study Design Survey study. Objective To determine the global perspective on controversial aspects of sacral fracture classifications. Methods While developing the AOSpine Sacral Injury Classification System, a survey was sent to all members of AOSpine and AOTrauma. The survey asked four yes-or-no questions to help determine the best way to handle controversial aspects of sacral fractures in future classifications. Chi-square tests were initially used to compare surgeons' answers to the four key questions of the survey, and then the data was modeled through multivariable logistic regression analysis. Results A total of 474 surgeons answered all questions in the survey. Overall …

Ictal Verbal Help-Seeking: Occurrence And The Underlying Etiology., Ali Akbar Asadi-Pooya, Marjan Asadollahi, Krzysztof Bujarski, Amin H. Rabiei, Narsis Aminian, Dale Wyeth, Michael R. Sperling

Department of Neurology Faculty Papers

PURPOSE: Ictal verbal help-seeking has never been systematically studied before. In this study, we evaluated a series of patients with ictal verbal help-seeking to characterize its frequency and underlying etiology.

METHODS: We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term "help" in the text body. All the extracted reports were reviewed and patients with at least one episode of documented ictal verbal help-seeking in epilepsy monitoring unit (EMU) were studied. For each patient, the data were reviewed from the electronic medical records, EMU report, and …

E-Cigarette Use Among Women Of Reproductive Age: Impulsivity, Cigarette Smoking Status, And Other Risk Factors., Laura L. Chivers, Dennis J. Hand, Jeff S. Priest, Stephen T. Higgins

Department of Pediatrics Faculty Papers

INTRODUCTION: The study aim was to examine impulsivity and other risk factors for e-cigarette use among women of reproductive age comparing current daily cigarette smokers to never cigarette smokers. Women of reproductive age are of special interest because of the additional risk that tobacco and nicotine use represents should they become pregnant.

METHOD: Survey data were collected anonymously online using Amazon Mechanical Turk in 2014. Participants were 800 women ages 24-44years from the US. Half (n=400) reported current, daily smoking and half (n=400) reported smokingsociodemographics, tobacco/nicotine use, and impulsivity (i.e., delay discounting & Barratt Impulsiveness Scale). Predictors of smoking and …

Jeffhope News-Fall 2016

JeffHOPE News

This issue includes:

• Updates: HCV Testing
• From the Project Director
• New Position: Triage Director
• Clinic at a Glance
• Advocacy Spotlight
• Research at JEFFHope
• Eye screening in an urban homeless shelter
• Contraception
• Self-Reported Indicators for Hepatitis C Virus Screening in JEFFHope Patients
• EKG Study
• Assessing the Need for Dermatological Care and Prevalence of Dermatologic conditions in an urban homeless shelter
• Spotlight on the John Bell Center
• If you had to describe JEFFHope in one word...
• Reflections by Committee Members and Directors
• 2016-2017 JEFFHope Volunteers

A Randomized Placebo-Controlled Pilot Study Of The Efficacy And Safety Of D-Cycloserine In People With Chronic Back Pain., Thomas J. Schnitzer, Souraya Torbey, Kristi Herrmann, Gagan Kaushal, Renita Yeasted, A. Vania Apkarian

College of Pharmacy Faculty Papers

BACKGROUND: Few effective pharmacological treatment options exist for chronic back pain, the leading cause of disability in the US, and all are associated with significant adverse effects.

OBJECTIVE: To determine the efficacy and safety of D-cycloserine, a partial agonist to the N-methyl-D-aspartate receptor, in the treatment of chronic low back pain.

METHODS: A total of 41 participants with chronic back pain who met all inclusion and exclusion criteria were enrolled in a double-blind, placebo-controlled randomized pilot trial of D-cycloserine. Treatment was administered orally for six weeks at escalating daily doses of 100 mg, 200 mg, and 400 mg, each for …

Duration Of Posttraumatic Amnesia Predicts Neuropsychological And Global Outcome In Complicated Mild Traumatic Brain Injury., Tessa Hart, Thomas A. Novack, Nancy Temkin, Jason Barber, Sureyya S. Dikmen, Ramon Diaz-Arrastia, Joseph Ricker, Dale C. Hesdorffer, Jack Jallo, Nancy H. Hsu, Ross Zafonte

Department of Neurosurgery Faculty Papers

OBJECTIVES: Examine the effects of posttraumatic amnesia (PTA) duration on neuropsychological and global recovery from 1 to 6 months after complicated mild traumatic brain injury (cmTBI).

PARTICIPANTS: A total of 330 persons with cmTBI defined as Glasgow Coma Scale score of 13 to 15 in emergency department, with well-defined abnormalities on neuroimaging.

METHODS: Enrollment within 24 hours of injury with follow-up at 1, 3, and 6 months.

MEASURES: Glasgow Outcome Scale-Extended, California Verbal Learning Test II, and Controlled Oral Word Association Test. Duration of PTA was retrospectively measured with structured interview at 30 days postinjury.

RESULTS: Despite all having a …

Symptom Clusters., Andrea M. Barsevick

Department of Medical Oncology Faculty Papers

No abstract provided.

The Targetable Epigenetic Tumor Protein Ezh2 Is Enriched In Intraocular Medulloepithelioma., Sarah E. Avedschmidt, Anna M. Stagner, Ralph C Eagle, George J. Harocopos, Yali Dou, Rajesh C. Rao

Wills Eye Hospital Papers

Purpose: Intraocular medulloepithelioma (IM), the second most common primary neuroepithelial tumor of the eye, can lead to blindness in the affected eye and in rare cases, is deadly. Intraocular medulloepithelioma lacks targetable biomarkers for potential pharmacologic therapy. The purpose of this study was to identify actionable, tumor-specific proteins for potential diagnostic or therapeutic strategies. We hypothesize that the tumor-specific epigenetic enzyme EZH2 is selectively expressed in IM.

Methods: We conducted a retrospective case series study of five IM from five eyes of four children and one adult. Hematoxylin and eosin (H&E) stains of sections from formalin-fixed, paraffin-embedded blocks of IM …

Differential Item Functioning In The Patient Reported Outcomes Measurement Information System Pediatric Short Forms In A Sample Of Children And Adolescents With Cerebral Palsy., Wendy J. Coster, Pengsheng Ni, Mary D. Slavin, Pamela A. Kisala, Ratna Nandakumar, Mary Jane Mulcahey, David S. Tulsky, Alan M. Jette

Department of Occupational Therapy Faculty Papers

AIM: The present study examined the Patient Reported Outcomes Measurement Information System (PROMIS) Mobility, Fatigue, and Pain Interference Short Forms (SFs) in children and adolescents with cerebral palsy (CP) for the presence of differential item functioning (DIF) relative to the original calibration sample.

METHOD: Using the Graded Response Model we compared item parameter estimates generated from a sample of 303 children and adolescents with CP (175 males, 128 females; mean age 15y 5mo) to parameter estimates from the PROMIS calibration sample, which served as the reference group. DIF was assessed in a two-step process using the item response theory-likelihood ratio-differential …

Potent And Broad Inhibition Of Hiv-1 By A Peptide From The Gp41 Heptad Repeat-2 Domain Conjugated To The Cxcr4 Amino Terminus., George J. Leslie, Jianbin Wang, Max W. Richardson, Beth S. Haggarty, Kevin L. Hua, Jennifer Duong, Anthony J. Secreto, Andrea P.O. Jordon, Josephine Romano, Kritika E. Kumar, Joshua J. Declercq, Philip D. Gregory, Carl H. June, Michael J. Root, James L. Riley, Michael C. Holmes, James A. Hoxie

Department of Biochemistry and Molecular Biology Faculty Papers

HIV-1 entry can be inhibited by soluble peptides from the gp41 heptad repeat-2 (HR2) domain that interfere with formation of the 6-helix bundle during fusion. Inhibition has also been seen when these peptides are conjugated to anchoring molecules and over-expressed on the cell surface. We hypothesized that potent anti-HIV activity could be achieved if a 34 amino acid peptide from HR2 (C34) were brought to the site of virus-cell interactions by conjugation to the amino termini of HIV-1 coreceptors CCR5 or CXCR4. C34-conjugated coreceptors were expressed on the surface of T cell lines and primary CD4 T cells, retained the …

Should Family Presence Be Allowed During Cardiopulmonary Resuscitation?, Karen J. Brasel, John W. Entwistle Iii, Md, Phd, Robert M. Sade

Department of Surgery Faculty Papers

No abstract provided.

Bleeding With Direct Oral Anticoagulants Vs Warfarin: Clinical Experience., John Eikelboom, Geno J. Merli

Department of Surgery Faculty Papers

The risk of bleeding in the setting of anticoagulant therapy continues to be re-evaluated following the introduction of a new generation of direct oral anticoagulants (DOACs). Interruption of DOAC therapy and supportive care may be sufficient for the management of patients who present with mild or moderate bleeding, but in those with life-threatening bleeding, a specific reversal agent is desirable. We review the phase 3 clinical studies of dabigatran, rivaroxaban, apixaban, and edoxaban in patients with nonvalvular atrial fibrillation, in the context of bleeding risk and management.

Haploinsufficiency Of The Myc Regulator Mtbp Extends Survival And Delays Tumor Development In Aging Mice., Brian C. Grieb, Kelli Boyd, Ramkrishna Mitra, Christine M. Eischen

Department of Cancer Biology Faculty Papers

Alterations of specific genes can modulate aging. Myc, a transcription factor that regulates the expression of many genes involved in critical cellular functions was shown to have a role in controlling longevity. Decreased expression of Myc inhibited many of the deleterious effects of aging and increased lifespan in mice. Without altering Myc expression, reduced levels of Mtbp, a recently identified regulator of Myc, limit Myc transcriptional activity and proliferation, while increased levels promote Myc-mediated effects. To determine the contribution of Mtbp to the effects of Myc on aging, we studied a large cohort of Mtbp heterozygous mice and littermate matched …

Overcoming Barriers To Interprofessional Education Through Legislative Reform: A Colorado Case Study, Kari L. Franson, Pharmd, Phd, Eric H. Gilliam, Pharmd

JCIPE Conference

Purpose: Allow pharmacy interns to participate fully in patient care activities when led by any member of the interprofessional health care team.

Background: Pharmacy is the only health profession requiring student licensure (intern). Colorado statute required a licensed pharmacist to supervise interns while engaging in the practice of pharmacy, thus necessitating one to be present for each Interprofessional (IP) clinical experience.

Description of Intervention: Between 2010-2012 we identified stakeholders and engaged potential collaborators (other pharmacy and health professions schools, state board of pharmacy, Colorado Pharmacists Society, practitioners, and the public) to establish the need to change the law to expand …

Bringing Brotherly Love To Interprofessional Education - Creating A Curriculum Of Simulation With Multidisciplinary Objectives, Dana Farabaugh, Md, Kymberlee Montgomery, Dnp, Crnp-Bc, Cne, Faanp, Owen Montgomery, Md, Daniel Guilfoil, Md, Lewis Bennett, Dnp, Nina Multak, Phd, Mpas, Pa-C, John Cornele, Msn, Rn, Cne, Emt-P, Alis Panzera, Drnp, Apn-C, Rn, Mary Gallagher Gordon, Phd, Msn, Rn, Cne

JCIPE Conference

Objectives:

Learners attending this presentation/workshop will:

1. Discuss the current trends in an interprofessional education curriculum
2. Explore the possible pinnacles and pitfalls in developing an IPE educational curriculum, including institutional support for IPE programs
3. Acquire the skills to develop simulation cases that foster interprofessional objectives

Interprofessional collaboration and teamwork among health care professionals is essential to provide safe, high quality patient care. Unfortunately, dismantling of the existing educational silos between disciplines is fraught with challenges. Success requires multidisciplinary commitment and leadership, and must occur early in each student’s educational training. Although gaining popularity, interprofessional education (IPE) and communication is not commonly …

Utilizing Teamstepps Resources Combined With A Simulated Grand Rounds Workshop: Signature Pedagogy For Interprofessional Practice And Education, Mick V. Kaminsky, Ms, Atc

JCIPE Conference

Purpose: To provide hospital professional staff with the opportunity for interprofessional standardized patient conferencing, through simulated bedside grand rounds.

Background: There is a need for conferencing techniques, regarding matters of patient concern, that are capable of providing a particular level of collaboration between providers at hospital interprofessional (IP) rounds¹. This is due to the mortality attributed to preventable medical errors² along with an estimated 3.4 trillion dollars in wasteful healthcare costs/year owing to fragmented oversight.³ The AAMC’s Aligning and Educating for Quality Initiative recognizes the medical conference as a quality improvement endeavor within graduate …

Formative Debriefing In Team Observed Simulation Encounters To Promote Team Performance, Jan Odiaga, Dnp, Apn, Cpnp-Pc, Joanne Miller, Phd, Apn, Gnp-Bc, Beverly Robbin, Md, Chse, Kelli Covington, Pharmd, Bpcs, Theresa Gierlowski, Mpm, Uchita Davis, Ms

JCIPE Conference

To bridge the gap between interprofessional education (IPE) and interprofessional collaborative practice (IPCP), educators need to foster innovation in healthcare education. Students need opportunities and experiences to practice team skills prior to patient encounters. One innovation includes the use of high-fidelity interprofessional simulation in the form of Team Observed Structured Clinical Encounters (TOSCEs) with standardized patients (SP) and realistic case scenarios. The primary objective of this study was to demonstrate the impact of formative debriefing on team-based performance during TOSCEs.

At a large academic medical center, 49 health profession students from the College of Medicine, College of Nursing, College of …

Medical Case Studies Inspired By A Personal Experience Of Helping The Refugees On The Island Of Lesbos-Greece, Majeda Kardosh, Rn, Ma

JCIPE Conference

Purpose: Employ a personal experience to advance inter-professional education and collaborative practice made by a case studies lecture, which refine and refresh the profession principles and values with healthcare students, explaining and suggesting ways to deal with ethical dilemmas that medical team face in their daily work routine in the hospital departments.

Background: September-October 2015, the refugee crisis in Europe, thousands of refugees (70% from Syria) took the relatively short voyage from Turkey to Lesvos Island in Greece by flimsy rubber boats. I volunteered with IsraAid NGO as a nurse who has a specialty for being an Arab speaker. After …

From “Uni-Professional” To “Inter-Professional” – Strategies For Remodeling Curricula, Elizabeth K. Kachur, Phd, Lucy Bruell, Ms, Lisa Altshuler, Phd

JCIPE Conference

Up until recently, health professions education was very much focused on single disciplines. Training occurred in silos with little attention to teams or other integrative work situations. This workshop will help participants explore and share various strategies to activate and bring together learners from different fields and strengthen their current or future collaboration in patient care. Workshop leaders will briefly share their extensive experience helping multiple institutions move towards inter-professionalism training. The majority of the session participants will work individually or in small groups, exploring key features and instructional strategies useful for each of the four curriculum phases: Needs Assessment, …

Bringing The Patient's Voice Into Teamwork Assessment Using The Jefferson Teamwork Observation Guide (Jtog), Lauren Collins, Md, Elizabeth T. Speakman, Edd, Rn, Fnap, Anef, Shoshana Sicks, Med, Carolyn Giordano, Phd, Kevin J. Lyons, Phd, Marianna Lanoue, Phd, Abigail Sherburne, Bs, Alexis Silverio, Bs

JCIPE Conference

Purpose: To test the feasibility of using the Jefferson Teamwork Observation Guide (JTOG) as a mobile application with diverse patients to gather perceptions of team-based care delivery.

Background: A validated tool assessing IPE core competencies is a significant gap in the literature (IOM, 2015). Little research has demonstrated links between effective teamwork and improved patient outcomes. In 2015, a research team validated the JTOG tool to assess team function. This JTOG was then converted to a mobile application, and individual, patient, and caregiver versions were developed, allowing for 360° evaluation.

Description of Intervention or Program: A research …

The Patient's Perspective: A Qualitative Study Of Patient Perceptions Of Teamwork Competencies, April Smith, Mph, Shoshana Sicks, Med, Abigail Sherburne, Bs, Lauren Collins, Md, Elizabeth T. Speakman, Edd, Rn, Anef, Fnap, Carolyn Giordano, Phd

JCIPE Conference

Purpose: To examine patients’ ability to evaluate the interprofessional core competencies of their healthcare teams using the Jefferson Teamwork Observation Guide (JTOG).

Background: It is widely regarded that interprofessional team-based care improves patient outcomes and satisfaction.[i] To investigate that claim, the JTOG, a validated survey tool mapped to the Interprofessional Education Collaborative (IPEC) Core Competencies for Interprofessional Collaborative Practice (CP)[ii], was adapted to collect patients’ feedback on teamwork behaviors in the domains of: Communication, Values/Ethics, Roles/Responsibilities, and Teamwork.

Description of Intervention or Program: Trained research assistants surveyed inpatients and outpatients about their perceptions of their health care …

Implementing Ipe In Community College Health Professions Programs, Challenges And Rewards, Mary Kay Demarco, Phd, Rn, Cne, Judith Blum, Ms, Otr/L

JCIPE Conference

The health care literature is rich with Interprofessional Education (IPE) and collaborative learning research based in major universities, but similar evidence is limited at the associate degree level. National data indicate that graduates of associate degree allied health and nursing programs account for 49% of the total healthcare workforce (Brookings Institute, 2014)[1]. To improve education for students in its School of Health Professions, The Community College of Baltimore County (CCBC) embarked on a grant-funded mission to infuse interprofessional collaboration into nursing and allied health programs. Faculty attended immersion training programs to learn, evaluate, and adapt different IPE approaches …

A Partnership Model Of Clinical Interprofessional Education, Rebecca Mcgill, Edd, Rn, Karen M. Sames, Otd, Mba, Otr/L, Faota

JCIPE Conference

Purpose and Background: The University wanted to enhance students’ uniprofessional education by providing an interprofessional experience in a gerontology context in collaboration with a clinical education partner. The project goals were to improve students’ teamwork skills, improve the vitality of their elder teacher, and create a model of interprofessional education for undergraduate and graduate students which would also benefit the clinical partner.

Description of Intervention or program: Over three semesters, 44 students formed interprofessional teams of 4-5 students and worked with an elder teacher (resident) of the facility to learn with, from, and about each other. The student teams were …

“In All Of Our Differences We Are Humanly Similar”: International Service Learning (Isl) And Interprofessional Education (Ipe) In Ecuador, Audrey Johnson, Dpt, Dana Howell, Phd, Otd, Otr/L

JCIPE Conference

a. Purpose:

The purpose of this phenomenological qualitative study was to describe the shared experience of interprofessional health profession students participating in a service learning trip to Ecuador.

b. Background:

Few studies have examined interprofessional service learning (ISL) and interprofessional education (IPE) together. Students in short-term ISL/ IPE projects report an appreciation of the work of other health professions and respect for interprofessional teamwork. These results suggest that IPE occurring during ISL can contribute to development of interprofessional teamwork skills; however, further research examining the link between ISL and IPE is warranted.

c. Description of the Program:

The complexity of …

A Medical Student, Pharmacy Student And A Nurse Resident Walk Into A Room, Cinnamon Desgres, Rn, Msn, Chse, Michael Picchioni, Md, Jason Cross, Pharmd, Cara Chandler, Rn, Msn, Reva Kleppel, Msw, Mph

JCIPE Conference

Learning Objectives

Participants will:

1. Describe how an innovative interprofessional education project was designed and implemented in an academic clinical setting.

2. Demonstrate how simulation was employed to achieve specific Core Competencies of Interprofessional Collaborative Practice

a. The Purpose of our project was to develop, implement and evaluate an interprofessional simulation program to assist medical students, pharmacy students and nursing residents in achieving the competencies required for interprofessional practice (IP).

b. Background: Working as a part of an interprofessional team is an essential skill for healthcare providers. As such it has become a core competency among trainees in many …