Medicine and Health Sciences Commons^™

Easy Identification Of Missed Dvt Prophylaxis-A Chance For Intervention, Kinjal Parikh, Md, Shuwei Wang, Md, Kimberly Conway, Rn, Rebecca C. Jaffe, Md

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

Goal:

"To minimize the number of missed or refused medications for inpatients so that adverse patient events such as PE or DVT are prevented"

SMART AIM: Within 3 months of initiating an EMR based electronic identification system for refused and missed medications, we will decrease the rate at which DVT prophylaxis was ordered however not eventually administered by 50%.

Improving Influenza Vaccination Rates And Understanding Reasons For Patient Refusal At Jefferson Hospital Ambulatory Practice, Daniel Brandt, Md, Ashley Butland, Md, Kevin Kwak, Md, Joseph Yoo, Md, Albert Lee, Md, Susan West, Md

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

AIM:

Improve influenza vaccination rates for eligible patients at the Jefferson Hospital Ambulatory Practice to levels above the national average of 43.6% between October 2015 and March 2016 with universal screening and improved documentation.

To characterize reasons for patients who did not receive vaccination.

Using A Swift Score Guided Time Out To Reduce Medical Icu Readmission Rates, Justin Herman, Md, Andrew Dargan, Md, John Madara, Md, Michael Baram, Md, Bharat K. Awsare, M.D., Fccp

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

AIM:

For patients admitted to the medical ICU over an additional period of 17 months, our goal is to reduce the rate of ICU readmissions within 72 hours of transfer out of the ICU to less than 2%. This will as a result reduce the costs of care, length of stay, and in-hospital mortality rates for these patients.

Understanding And Improving Patient Arrival Rates At An Urban Ambulatory Medicine Resident Clinic, Teresa Lee, Md, Shuwei Wang, Md, Susan Truong, Md, Albert Lee, Md

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

AIMS:

To improve the arrival rate of patients at the Jefferson Hospital Ambulatory Practice (JHAP) by 10% over a 10-month period from July-April 2016 using a combination of additional reminder calls and targeted summaries from physicians.

Improving Influenza Vaccination Rates In The Hiv Population At An Academic Clinic, Anusha G. Govinda, Md, Anita Modi, Md, Emma Biegacki, Bryan Hess, Md

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

AIM:

Performance measure: Percentage of HIV-infected patients with documentation of influenza vaccination in Allscripts.

Numerator: Number of HIV-infected patients who have obtained an influenza vaccine during influenza season.

Denominator: Total number of HIV-infected patients at the Jefferson Infectious Disease (ID) Clinic

Patient exclusions: Those who are allergic to eggs or have had allergic reactions to the influenza vaccine in the past

Goal: "75% of HIV-infected patients at the Jefferson ID clinic will be vaccinated against influenza and documented in Allscripts during influenza season"

Medication Errors And Hospital Admissions, A Tale Of Woe, Allison Greco, Md, René Daniel, Md, Raymond Janowski, Md, Bracken Babula, Md

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

Goal for Improvement:

To improve proper medication regimens for patients as they transition between healthcare settings

So that patients achieve improved outcomes and reduced hospital admissions caused by medication errors

SMART aim is to decrease teh number of discrepancies between discharge medication lists and pill bottles or blister packs produced at one-week follow up with Jefferson PCP by 10% within six months.

Prolonged Morphine Exposure Induces Increased Firm Adhesion In An In Vitro Model Of The Blood-Brain Barrier., Marianne Strazza, Vanessa Pirrone, Brian Wigdahl, Will Dampier, Wei Lin, Rui Feng, Monique E Maubert, Babette Weksler, Ignacio A Romero, Pierre-Olivier Couraud, Michael R Nonnemacher

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

The blood-brain barrier (BBB) has been defined as a critically important protective barrier that is involved in providing essential biologic, physiologic, and immunologic separation between the central nervous system (CNS) and the periphery. Insults to the BBB can cause overall barrier damage or deregulation of the careful homeostasis maintained between the periphery and the CNS. These insults can, therefore, yield numerous phenotypes including increased overall permeability, interendothelial gap formation, alterations in cytokine and chemokine secretion, and accelerated cellular passage. The current studies expose the human brain microvascular endothelial cell line, hCMEC/D3, to prolonged morphine exposure and aim to uncover the …

Medical Student And Resident Foley Catheterization Training Program To Decrease Post-Operative Catheter Associated Urinary Tract Infections, Peter J. Altshuler, Adam P. Johnson, Md, Mph, Danica Giugliano, Md, Gerald A. Isenberg, Md, Scott W. Cowan, Md

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

Objective:

Determine whether a more comprehensive medical student urinary catherer training curriculum can be successful in decreasing post-operative CAUTI rates in general and vascular surgery patient populations.

Primary target:

Reduce post-operative UTI rates by 0.5% over 6 months

Secondary targets:

Achieve 100% medical student confidence in Foley catheter placement, understanding indications and contraindications to urinary catheterization.

Improve objective performance of urinary catheterization skills as determined by objective clinical skills exam (OSCE) scores.

Screening For Venous Thromboembolism In Asymptomatic Trauma Patients: Effective In High Risk Patients, Seth Stake, Bs, Adam Wallace, Bs, Deepika Koganti, Md, Pgy-4, Adam P. Johnson, Md, Mph, Joshua A. Marks, Md, Scott W. Cowan, Md, Murray Cohen, Md

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

Hypothesis:

Through data analysis of a large cohort of trauma patients, a clinically applicable protocol can be developed based on various predisposing factors for VTE in asymptomatic patients. By isolating the factors that make these patients high risk for VTE, we can effectively lower the incidence of PE in hospitalized trauma patients.

Analyzing Patient Satisfaction And Improved Physician-Patient Communication Using Introductory Brochures, Raza A. Hasan, Md, Lily Ackermann, Md

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

AIM:

Assess how the use of introductory brochures added to patient satisfaction at time of discharge. Also, assess whether the brochure helped foster improved physician-patient communication.

Barriers To Anticoagulation In Atrial Fibrillation Among Cardiologists, Internists And Family Physicians, Jad Al Danaf, Md, Mph, Mitul Kanzaria, Md, John U. Doherty, Md

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

Current Performance:

The rates of AC in patients 18 years or older who visited general internists & family physicians not seen by cardiologists from 4/30/2013 to 4/30/2015, cardiologists from 11/29/2012 to 11/29/2014 and all 3 specialties from 1/30/2014 to 1/30/2016 were derived from the EHR.

A 12-question survey was shared using RedCap with these physicians to examine potential reasons for not prescribing AC.

Safety Of Lobar Hepatic Arterial Embolization In Metastatic Uveal Melanoma Patients With Underlying Gilbert's Disease, David C. Feldstein, Md, Robert D. Adamo, Md, Carin F. Gonsalves, Md, Fsir, David J. Eschelman, Ms, Fsir, Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pa, Takami Sato, Md, Phd

Department of Medical Oncology Posters

Introduction

❖ Uveal melanoma is the most common primary intraocular malignant tumor in adults.

❖ Up to half of all patients develop systemic metastases, with liver involvement in >90% of patients.¹

❖ Various liver-directed, locoregional therapies (i.e. chemoembolization, immunoembolization, radioembolization, and ablation) have played a significant role in prolonging the lives of patients with metastatic uveal melanoma.²

❖ Elevated bilirubin levels are typically considered a relative contraindication for lobar hepatic arterial embolization treatment, given mainly the increased risk of precipitating hepatic failure.

❖ Gilbert's syndrome, also known as benign unconjugated hyperbilirubinemia, is a hereditary disorder of bilirubin conjugation. …

3d Dynamic Motion Planning For Robot-Assisted Cannula Flexible Needle Insertion Into Soft Tissue, Yanjiang Zhao, Wenqiang Wu, Yongde Zhang, Ruixue Wang, Jingchun Peng, Yan Yu

Department of Radiation Oncology Faculty Papers

In robot-assisted needle-based medical procedures, insertion motion planning is a crucial aspect. 3D dynamic motion planning for a cannula flexible needle is challenging with regard to the nonholonomic motion of the needle tip, the presence of anatomic obstacles or sensitive organs in the needle path, as well as uncertainties due to the dynamic environment caused by the movements and deformations of the organs. The kinematics of the cannula flexible needle is calculated in this paper. Based on a rapid and robust static motion planning algorithm, referred to as greedy heuristic and reachability-guided rapidly-exploring random trees, a 3D dynamic motion planner …

Hepatocellular Carcinoma After Locoregional Therapy: Magnetic Resonance Imaging Findings In Falsely Negative Exams., David Becker-Weidman, Jesse M. Civan, Sandeep P. Deshmukh, Christopher G. Roth, Steven K. Herrine, Laurence Parker, Donald G. Mitchell

Division of Gastroenterology and Hepatology Faculty Papers

AIM: To elucidate causes for false negative magnetic resonance imaging (MRI) exams by identifying imaging characteristics that predict viable hepatocellular carcinoma (HCC) in lesions previously treated with locoregional therapy when obvious findings of recurrence are absent.

METHODS: This retrospective institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study included patients who underwent liver transplantation at our center between 1/1/2000 and 12/31/2012 after being treated for HCC with locoregional therapy. All selected patients had a contrast-enhanced MRI after locoregional therapy within 90 d of transplant that was prospectively interpreted as without evidence of residual or recurrent tumor. Retrospectively, 2 …

Genome-Wide Redistribution Of Mecp2 In Dorsal Root Ganglia After Peripheral Nerve Injury., Melissa T. Manners, Adam Ertel, Yuzhen Tian, Seena K. Ajit

Department of Cancer Biology Faculty Papers

BACKGROUND: Methyl-CpG-binding protein 2 (MeCP2), a protein with affinity for methylated cytosines, is crucial for neuronal development and function. MeCP2 regulates gene expression through activation, repression and chromatin remodeling. Mutations in MeCP2 cause Rett syndrome, and these patients display impaired nociception. We observed an increase in MeCP2 expression in mouse dorsal root ganglia (DRG) after peripheral nerve injury. The functional implication of increased MeCP2 is largely unknown. To identify regions of the genome bound by MeCP2 in the DRG and the changes induced by nerve injury, a chromatin immunoprecipitation of MeCP2 followed by sequencing (ChIP-seq) was performed 4 weeks after …

Repurposing Atovaquone: Targeting Mitochondrial Complex Iii And Oxphos To Eradicate Cancer Stem Cells., Marco Fiorillo, Rebecca Lamb, Herbert B Tanowitz, Luciano Mutti, Marija Krstic-Demonacos, Anna Rita Cappello, Ubaldo E. Martinez-Outshoorn, Federica Sotgia, Michael P Lisanti

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Atovaquone is an FDA-approved anti-malarial drug, which first became clinically available in the year 2000. Currently, its main usage is for the treatment of pneumocystis pneumonia (PCP) and/or toxoplasmosis in immune-compromised patients. Atovaquone is a hydroxy-1,4-naphthoquinone analogue of ubiquinone, also known as Co-enzyme Q10 (CoQ10). It is a well-tolerated drug that does not cause myelo-suppression. Mechanistically, it is thought to act as a potent and selective OXPHOS inhibitor, by targeting the CoQ10-dependence of mitochondrial complex III. Here, we show for the first time that atovaquone also has anti-cancer activity, directed against Cancer Stem-like Cells (CSCs). More specifically, we demonstrate that …

Thomas Jefferson University Department Of Surgery Resident Research Day 2016, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

Fourth year residents in the Department of Surgery held their annual Resident Research Day on June 2nd and this is the 3rd year that the Research Day presentations have been archived in the Jefferson Digital Commons. View the 7 new presentations.

Benefits Of A Surgical Safety Checklist For Otolaryngology Patients, Lindsay A. Goodstein, Md, Nadia K. Mostovych, Md, Michael B. Hall, Md, David Hsu, Md, David Cognetti, Md, Maurits S. Boon, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Introduction

The volume and complexity of knowledge today has exceeded any single individual's ability to manage it consistently without error despite advances in technology, years of training, and specialization of functions and responsibilities. Checklists have been employed since the 1930s in aviation and high-risk industries to prevent accidents caused by human error. Only recently has their use been introduced to surgery after the World Health Organization (WHO) heightened awareness of the significant number of deaths, about a half million worldwide, that occur each year as a result of avoidable surgical error.¹ With over 275,000 surgical procedures performed daily, an …

The Effects Of Formalized Team Training On Key Patient Outcomes In An Otolaryngology- Head And Neck Surgery Residency, Natalie Vercillo, Md, Adam Vasconcellos, Md, David Cognetti, Md, Maurits Boon, Md

Department of Otolaryngology - Head and Neck Surgery Posters

BACKGROUND

• Errors in medical care have consistently been linked to communication failures among team members. TeamSTEPPS^® is a team training system which was co-developed by the Department of Defense and the Agency for Healthcare Research and Quality (AHRQ) which provides a full curriculum of ways to improve patient safety through four main skills: communication, mutual support, leadership and situation monitoring¹.
• Training in these skills through TeamSTEPPS^® has been shown to improve patient safety and outcomes by reducing destructive barriers within the healthcare field such as poor communication, conflicts, ambiguous responsibilities of each team member, hierarchical constraints …

Jdc Passes 11,000 Asset Mark, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

The Jefferson Digital Commons now archives more than 11,000 assets and it continues to showcase Jefferson scholarship. Recent additions include: 32 conference posters and 3 newsletters.

James Mann, M.D. (1759-1832): Military Surgeon For The "Second War Of Independence"., Eliza C. Anderson, Md, Scott W. Cowan, Md, Charles J. Yeo, Md

Department of Surgery Gibbon Society Historical Profiles

The War of 1812 is remembered for the Burning of Washington, and Francis Scott Key’s “The Star Spangled Banner,” but little else. It was a poorly funded war of relatively short duration and nebulous resolution. Under such circumstances, it is understandable that the “Second War of Independence” failed to produce many notable military or medical advancements. However, one surgeon took it upon himself to recount his experiences in the field. For his dedication to the art and science of medicine, James Mann deserves recognition.

Reversibility Of Apixaban Anticoagulation With A Four-Factor Prothrombin Complex Concentrate In Healthy Volunteers., S Nagalla, Lynda Thomson, Y Oppong, B Bachman, I Chervoneva, Walter K. Kraft

Department of Pharmacology and Experimental Therapeutics Faculty Papers

It was hypothesized that the four-factor prothrombin complex concentrate (4F-PCC) Kcentra 25 unit/kg would reverse impairment of thrombin generation in healthy volunteers dosed with apixaban to steady state. In this randomized, two-period crossover, assessor-blinded trial, 12 healthy subjects received 5 mg apixaban every 12 h. Three h after the fifth dose, four-factor prothrombin complex concentrate (4F-PCC) 25 unit/kg or saline were infused. Serial blood samples were assessed for thrombin generation using PPP-reagent and PPP-reagent low, anti-Xa, PT, and PTT assays. Geometric mean ratio was calculated at 30 min postinfusion, and at 24, 48, and 72 h. Peak thrombin generation was …

Postoperative Intussusception In 10-Year-Old Presenting As Decreased Intestinal Motility, Arielle Spellun, Loren Berman, Stephen Murphy

Department of Medicine Faculty Papers

No abstract provided.

Ictal Crying, Ali Akbar Asadi-Pooya, Dale Wyeth, Michael R. Sperling

Department of Neurology Faculty Papers

PURPOSE: The purpose of this study was to describe a series of patients with ictal crying to estimate its occurrence and characterize the clinical features and the 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 terms "cry" or "sob" or "weep" in the text body. All the extracted reports were reviewed, and patients with at least one episode of documented ictal crying at the epilepsy monitoring unit (EMU) were included in the study.

RESULTS: During the study period, 5133 patients were investigated …

Comparison Of The Lonidamine Potentiated Effect Of Nitrogen Mustard Alkylating Agents On The Systemic Treatment Of Db-1 Human Melanoma Xenografts In Mice., Kavindra Nath, David S. Nelson, Mary E. Putt, Dennis B. Leeper, Bradley Garman, Katherine L. Nathanson, Jerry D. Glickson

Department of Radiation Oncology Faculty Papers

Previous NMR studies demonstrated that lonidamine (LND) selectively diminishes the intracellular pH (pHi) of DB-1 melanoma and mouse xenografts of a variety of other prevalent human cancers while decreasing their bioenergetic status (tumor βNTP/Pi ratio) and enhancing the activities of melphalan and doxorubicin in these cancer models. Since melphalan and doxorubicin are highly toxic agents, we have examined three other nitrogen (N)-mustards, chlorambucil, cyclophosphamide and bendamustine, to determine if they exhibit similar potentiation by LND. As single agents LND, melphalan and these N-mustards exhibited the following activities in DB-1 melanoma xenografts; LND: 100% tumor surviving fraction (SF); chlorambucil: 100% SF; …

Bh3 Mimetic Abt-737 Sensitizes Colorectal Cancer Cells To Ixazomib Through Mcl-1 Downregulation And Autophagy Inhibition., Lifeng Yang, Juefeng Wan, Sheng Xiao, Darryll Barkhouse, Ji Zhu, Guichao Li, Bo Lu, Zhen Zhang

Department of Radiation Oncology Faculty Papers

The proteasome inhibitor MLN9708 is an orally administered drug that is hydrolyzed into its active form, MLN2238 (ixazomib). Compared with Bortezomib, MLN2238 has a shorter proteasome dissociation half-life and a lower incidence and severity of peripheral neuropathy, which makes it an attractive candidate for colorectal cancer treatment. In the present study, we observed that MLN2238 induced autophagy, as evidenced by conversion of the autophagosomal marker LC3 from LC3I to LC3II, in colorectal cancer cell lines. Mcl-1, an anti-apoptotic Bcl-2 family protein, was markedly elevated after treating a colorectal cancer cell line with MLN2238. We proved that inhibiting Mcl-1 expression enhances …

Illness Cognitions And Coping Self-Efficacy In Depression Among Persons With Low Vision., Bonnie A Sturrock, Jing Xie, Edith E Holloway, Mark Hegel, Robin J. Casten, David Mellor, Eva Fenwick, Gwyneth Rees

Department of Psychiatry and Human Behavior Faculty Papers

PURPOSE: To investigate the mediating role of coping self-efficacy (CSE) between two types of illness cognitions (i.e., acceptance and helplessness) and depressive symptoms in persons with low vision.

METHODS: This was a single-group, cross-sectional study. Patients with visual acuity < 6/12 in the better eye and at least minimal depressive symptoms (≥5 on the Patient Health Questionnaire-9 [PHQ-9]) were recruited from vision rehabilitation services and participated in telephone-administered structured interviews at one time point. Measures were the PHQ-9, CSE Scale, and Illness Cognition Questionnaire. Structural equation modeling (SEM) devised the causal flow of illness cognitions and their observed indirect effects on depressive symptoms via the CSE mediators: problem focused, emotion focused, and social support.

RESULTS: The study comprised 163 patients (mean age 62 years; 61% female), most with age-related macular degeneration (26%) and moderate vision impairment (44%, <6/18-6/60). Structural equation modeling indices indicated a perfect fit (χ2 < 0.001, P = 1.00), accounting for 55% of the variance in depressive symptoms. Lower levels of acceptance and higher levels of helplessness illness cognitions were associated with lower self-efficacy in problem-focused coping (β = 0.38, P < 0.001, β = -0.28, P < 0.01, respectively), which in turn was associated with greater depressive symptom severity (β = -0.54, P < 0.001).

CONCLUSIONS: Lack of acceptance and greater helplessness relating to low vision led to a lack of perceived capability to engage in problem-focused coping, which in turn promoted depressive symptoms. Third-wave cognitive-behavioral treatments that focus on acceptance may be …

Radiotherapy For Iris Metastasis From Esophageal Carcinoma: A Series Of Three Cases., Chandana Das, Carol L Shields

Wills Eye Hospital Papers

BACKGROUND: Description of three cases of metastatic esophageal carcinoma to the iris and focus on management strategies.

METHODS: A 48-year-old man (Case 1) with previously treated stage IV esophageal carcinoma presented with blurred vision in the left eye (OS) for 3 weeks. Initial fine needle aspiration biopsy (FNAB) was negative for malignant cells, so incisional biopsy was performed and confirmed metastatic carcinoma. A 53-year-old man (Case 2) with previously treated stage III esophageal cancer experienced 2 months of pain and 1 month of blurred vision OS. Documented tumor growth suggested esophageal carcinoma metastasis. A 65-year-old man (Case 3) with previously …

Zinc Intake, Microrna Dysregulation, And Esophageal Cancer., Louise Y. Fong, John Farber, Carlo M. Croce

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

No abstract provided.

Managing Opioid-Tolerant Patients In The Perioperative Surgical Home., John T. Wenzel, Eric S. Schwenk, Jaime L. Baratta, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

Management of acute postoperative pain is important to decrease perioperative morbidity and improve patient satisfaction. Opioids are associated with potential adverse events that may lead to significant risk. Uncontrolled pain is a risk factor in the transformation of acute pain to chronic pain. Balancing these issues can be especially challenging in opioid-tolerant patients undergoing surgery, for whom rapidly escalating opioid doses in an effort to control pain can be associated with increased complications. In the perioperative surgical home model, anesthesiologists are positioned to coordinate a comprehensive perioperative analgesic plan that begins with the preoperative assessment and continues through discharge.