Medicine and Health Sciences Commons^™

Impact Of Long-Term Doula Services On Maternal And Fetal Health Outcomes In Women In Treatment For Opioid Use Disorder, Saloni Parikh, Meghan Gannon, Phd, Msph

Phase 1

This study analyzed the impact of doula services on maternal and fetal health outcomes in pregnant women seeking treatment for opioid use disorder. Understanding the impact of doula services is critical in reducing inequities in health outcomes experienced by this vulnerable population. Retrospective and prospective data was collected from surveys, focus groups, and maternal and infant birth data from 100 women in treatment for opioid use disorder, with fifty utilizing doulas and fifty not utilizing doulas. Standardized data abstraction of quantitative and qualitative measures were collected into an SPSS database and Nvivo, respectively, and analyzed using SPSS. Measures of importance …

Conexo, Joseph Leone, Anjali Patel, Heli Patel, Gigi Geary, Lauren Huggler, Stephanie Szymanski, J. Matthew Fields

Phase 1

Helping healthcare workers keep IV lines clean in order to reduce preventable bloodstream infections.

The Wic Program: Background, Trends And Factors Associated With Participation Among Wic Eligible Families, Peace Nosa-Omorogiuwa, Cheryl Bettigole

Phase 1

Introduction

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides access to supplemental foods, nutrition education etc. to low-income pregnant women, infants and children under 5. Despite being a safety net for nutritionally at-risk individuals, the coverage rates for WIC eligible individuals are far lower than the eligibility rates. This study seeks to understand the history of the WIC program, analyze current trends and discuss factors affecting participation in the WIC program.

Methods

The target population are populations that are eligible for the WIC program. A narrative review of journal articles was conducted. Databases searched were EBSCO …

Maternal Stress And Breastfeeding Intention In Pregnant Women With Opioid Use Disorder, Yassamin Jamshidian, Vanessa Short, Phd, Mph, Diane J. Abatemarco

Phase 1

Introduction: Breastfeeding rates are low among women in treatment for opioid use disorder (OUD). Information on determinants of breastfeeding intention can help inform the design of breastfeeding promotion interventions for this population. The objective of the study was to examine associations between maternal characteristics, including stress, and breastfeeding intention among pregnant women in treatment for OUD.

Methods: Fifty-six pregnant women who were receiving treatment for OUD at Thomas Jefferson University’s Maternal Addiction Treatment Education & Research (MATER) program completed a survey, which included questions on demographics, psychosocial characteristics, breastfeeding history, and breastfeeding intention. Maternal stress was measured using the Perceived …

The Integration Of Transgender Health Into Jeffmd, Jacob Nair, Bernard Lopez, Md

Phase 1

Purpose: One way to address healthcare disparities experienced by the transgender community is by educating medical students on trans health. Currently, there is not a universal LGBTQ+ curriculum in medical schools, which has resulted in students feeling incompetent and uncomfortable when treating transgender patients. The purpose of this study was to evaluate the current trans health content in JeffMD and remedy any curricular gaps with trans specific content.

Methods: The trans content in JeffMD was identified using a Keyword Search tool, One45 and lecture notes. A survey distributed to all Thomas Jefferson healthcare students regarding their attitudes and knowledge surrounding …

Needs Analysis For Breastfeeding Education At Thomas Jefferson University Hospital, Michal Norry, Julia Switzer, Md

Phase 1

Purpose: There are currently gaps in breastfeeding education for OB/GYN and Family Medicine residents, consequently affecting their confidence in this area of patient care. To address this issue, we are conducting an analysis of the efficacy of the current curriculum to highlight areas for future improvement.

Methods: PGY1-4 residents in the departments of Family Medicine (FM) and Obstetrics and Gynecology (OB/GYN) completed a pre-test before their required annual breastfeeding education on August 6, 2020. We used a validated pre-test from the American Academy of Pediatrics (AAP) which included items assessing the training. Learners self-selected one of two didactic sessions: in …

Assessing Sentiment Towards Opioid Use Disorder At Jefferson: Characterizing Non-Clinical Emergency Department Staff, Joseph Arciprete, Benjamin Finard, Madalene Zale, Mph, Benjamin Slovis, Md, Hannah Smith

Phase 1

Purpose: To characterize emergency department (ED) staff regard toward opioid use disorder (OUD) and analyze variation based on job category. The closure of Hahnemann Hospital, in combination with the increasing prevalence of OUD, is exacerbating the previously inadequate network of resources for these patients. Jefferson is strategically positioned to improve the care provided to this patient population, especially in an ED setting, and ultimately increase linkage to long-term recovery programs.

Methods: Sentiment toward this patient population was measured utilizing the Medical Condition Regard Survey (MCRS). This questionnaire was previously validated to subjectively, but quantitatively, assess regard toward a defined patient …

Efficacy Of Articulate Module: Tracheostomy And Laryngectomy Pearls For The Health Care Providers, Sruti Tekumalla, Andrew Piacitelli, Vanessa Christopher, Dimitri Papanagnou, David Cognetti

Phase 1

Purpose: Anatomy, general care and emergency management knowledge of tracheostomies and laryngectomies is crucial in preventing significant morbidity and mortality within the surgical airway population. An Articulate module was made to address and refresh learners on pertinent surgical airway knowledge. Our goal was to assess the efficacy of the new Articulate module, measuring airway knowledge and attitude treating the surgical airway population.

Methods: Residents in anesthesia, emergency medicine, and internal medicine were eligible and consented to participate. Half of participants were given the Articulate module and half were not. All participants were asked to take a follow-up test. The test …

Demographic Backgrounds And Career Goals Of First-Generation Medical Students, Brianna Kunes, Ricky Burns, Allison Casola, Phd, Mph

Phase 1

Purpose: Little research is available on the demographics and career goals of first-generation medical students. Undergraduate research suggests first-generation students are more likely to come from lower-income households, speak English as a second language, and experience higher drop-out rates. These diverse experiences could make first-generation medical students valuable members of the healthcare team. However, without more information, it is difficult for medical schools to identify and support them. Therefore, the purpose of this study is to define the following inquiry statements: What are the demographic backgrounds and intended career goals of first-generation medical students; How do they differ from non-first-generation …

The Psychosocial Impact Of Penile Implant Treatment, Taylor Tidwell, Paul Chung, Md

Phase 1

Introduction: Erectile dysfunction affects nearly 2/3rds of men age 50 or older worldwide and involves multiple hormonal, neurologic, psychological and environmental etiologies. Although contemporary research suggests that ED causes increased anxiety and depressive symptoms, there is relatively little information on how specific treatments impact mental health.

The purpose of this study is to answer the question: How do penile implants influence the psychosocial and emotional wellbeing of patients with ED compared to those without implants?

Methods: Our study uses a free-listing technique to interview via phone 50 patients with erectile dysfunction (25 with implant treatment, 25 without) regarding their emotional, …

Expanding The Whipple Accelerated Recovery Pathway (Warp) To All Patients Undergoing Pancreaticoduodenectomy (Pd), Taylor R. Kavanagh, Clifford Yudkoff, Ava Torjani, Geoffrey W. Krampitz, Wilbur Bowne, Hamza Rshaidat, Cyrus J. Sholevar, Alexandra C. Leto, William Preston, Elwin Tham, Mandeep Shergill, Shawnna Cannaday, Theresa Yeo, Harish Lavu, Charles J. Yeo

Phase 1

Introduction:

Pancreaticoduodenectomy (PD) is a complex abdominal procedure with high rates of perioperative morbidity. The Whipple Accelerated Recovery Pathway (WARP) was developed for highly selected patients undergoing PD to reduce hospital length of stay (LOS) and time to adjuvant therapy (TTAT), without increasing post-operative complications (POC) or readmission rates (RR). The purpose of this study was to determine if WARP could be implemented for all-risk patients undergoing PD.

Methods:

A single-institution, retrospective analysis of 281 patients implemented on the WARP between 2017-2020 was performed. 119 patients were categorized as WARP-eligible (WEPs) according to original inclusion criteria, and 162 were …

A Single Academic Center's Experience With Direct Access Colonoscopy, Rachel Israilevich, Mary White, Sophia Lam, Benjamin Chipkin, David Kastenberg, Md

Phase 1

Introduction: Direct Access Colonoscopy (DAC) does not require pre-colonoscopy consultation and may improve access for patients needing screening and surveillance. DAC eligibility criteria vary widely, and we developed a novel, DAC program using EMR patient data to assess appropriateness for inclusion. This study aimed to evaluate the efficacy and quality of our DAC program and compare to traditional, Office-Scheduled Colonoscopy (OSC).

Methods: We conducted a retrospective, single-center study of OSC and DAC patients ages 45-75 with a screening or surveillance indication over 13 months. Primary outcome was Complete Colonoscopy (CC): to cecum/ileum/anastomosis, adequate prep, < 90 days from gastroenterology contact. Patients not meeting CC criteria were classified as Incomplete Colonoscopy (IC). Secondary endpoints: time to CC, adenoma detection rate (ADR).

Results: 2,651 patients met …

Assessing Patient Satisfaction And Confidence After Use Of Educational Video To Augment Surgical Consent For Thyroid Surgery, Michelle Schafer, Katie Holland, Alexander Duffy, Kelley Yuan, Marisa Wu, Raphael Banoub, Elizabeth Cottrill

Phase 1

Introduction: Informed consent is a crucial aspect of ethical patient care, yet the increase in surgical complexity presents a challenge in achieve this properly. This study explores the use of an educational video to help standardize the consent process, increase patient retention of information, and promote patient understanding by allowing patients to replay the information remotely as often as needed.

Methods: This is a perspective, survey-based study of adult patients undergoing thyroid surgery. A novel video detailing thyroid surgery containing the standard contents of informed consent was shown to patients after traditional informed consent followed by a survey on …

Likelihood Of Germline Mutation With Solitary Unilateral Retinoblastoma Based On Patient Age At Presentation. A Real-World Analysis Of 482 Consecutive Patients., Martin Calotti, Carol L. Shields, Md, Philip Dockery, Md, Mph, Megan Ruben, Antonio Yaghy, Md, Madalyne A. Sunday, Emily R. Duffner, Hannah J. Levin, Olivia S. Taylor, Sara E. Lally, Md, Jerry A. Shields, Md

Phase 1

Introduction: Retinoblastoma due to germline mutation has a greater risk of bilateral presentation, and multifocal or extraocular involvement. In solitary unilateral retinoblastoma, the inheritance pattern is less understood and assumed to be somatic. We assessed the likelihood of germline inheritance in children with unilateral retinoblastoma and whether it varies based on age at presentation.

Methods: This was a retrospective case study assessing 482 consecutive patients with solitary unilateral retinoblastoma at Wills Eye Hospital between 1972 and 2020 for the likelihood of germline inheritance based on age at presentation (≤1 year vs. >1 year). Germline inheritance was deemed likely if …

Factors Influencing General Surgeons To Involve Urologists In Bladder Trauma Management, Joseph Schultz, Paul Chung, Md

Phase 1

Introduction: Bladder trauma injuries, which are graded by severity, often require immediate care and surgical management by General Surgeons (GS) or Urologists. This study seeks to understand the inconsistencies that exist in collaboration between GS and Urologists in bladder trauma management. We hypothesize that the decision for GS to involve Urologists in bladder trauma management is a multifactorial decision with severity of bladder trauma being the primary determining factor as opposed to other factors like provider experience or hospital setting.

Methods: This cross-sectional descriptive study surveyed GS to determine how likely they were to involve Urologists in bladder trauma …

Effect Of Palmitic Acid On B2 Receptor Expression In Airway Smooth Muscle Cells, John Magagna, Deepak A. Deshpande, Ajay P. Nayak

Phase 1

Introduction: People with asthma and obesity struggle to control asthma flares. B2 agonists are often the acute treatment of choice during these flares, so the decreased asthma control in this population may be due to a decrease in B2 receptor activity. We tested the hypothesis that B2 receptor expression will decrease in airway smooth muscle cells exposed to Palmitic Acid, a saturated fatty acid, compared to Oleic Acid and untreated cells.

Methods: Airway smooth muscle cells were plated and treated with Palmitic Acid and Oleic Acid at 100uM and 200uM concentrations while other untreated cells served as controls. Cells …

A Virtual Educational Intervention Addressing Weight Bias In Medical Students, Gina Goldberg, Joseph Majdan, Md

Phase 1

Introduction:

Individuals with higher body weight experience severe and pervasive discrimination in nearly every walk of life. Stigmatizing treatment from healthcare providers increases anxiety, depression, body dissatisfaction and risk of weight gain while decreasing the likelihood that patients will seek preventative or emergency care. This study assessed whether a virtual session exploring obesity, which included the personal testimony of a Physician Professor with obesity, positively influenced the explicit attitudes and implicit biases of medical students towards people with higher body weight.

Methods:

SKMC medical students completed an Implicit Associations Test (IAT), a Universal Measure of Bias (UMB) and a …

Continuous Positive Airway Pressure Therapy Effects On Lipid And Hepatic Function Test Values, Grace Severance, Cynthia Cheng, Md, Phd, Amy He, Peter Zhang, Dani Yellanki, Zachary Feuer, Olivia Taylor, Natali Salinas

Phase 1

Introduction : Continuous positive airway pressure (CPAP) therapy is an established therapy for patients diagnosed with obstructive sleep apnea (OSA). The following study aims to measure the impact of CPAP therapy on lipid and liver profiles of patients diagnosed with OSA. We hypothesize that CPAP therapy will improve patient serum lipid and liver measures in this patient population compared to patient baseline prior to CPAP therapy. Furthermore, we also will examine differences in hepatic ultrasound results for OSA patients on CPAP therapy.

Methods: The target patient population has moderate-severe OSA, defined as an Apnea-Hypopnea Index greater than 15. The intervention …

Evaluating The Efficacy Of Telestroke Intervention In A Large Community Hospital Network, Daniel Moylan, Daniel Joffe, Charles Morse, Michael Knapp, Ahmad Sweid, Pascal Jabbour

Phase 1

Introduction: Telemedicine for acute ischemic stroke (Telestroke) allows live consultation between patients, remote stroke specialists, and providers to facilitate administration of IV tissue plasminogen activator (IV-tPA) within the 4.5 hour window. Small cohort studies have demonstrated thrombolytic therapy conveys significant benefit to stroke outcomes and yet is underutilized due to difficulties in recognition and delivery of medication. This study proposes that access to telestroke care across the Thomas Jefferson University Hospital network will result in increased thrombolytic reperfusion rates and improved patient outcomes for stroke.

Methods: A retrospective cohort study was designed to utilize a telestroke database collecting information from …

Peri-Operative Urodynamic Assessment Has Poor Predictive Value For Developing Post-Operative Urinary Retention, Baylor Wickes, Robert Pivec, Md, Mathew S. Austin, Md

Phase 1

Introduction: Post-operative urinary retention (POUR) following primary total joint arthroplasty (TJA) has a reported prevalence up to 35%. Risk factors for developing POUR have traditionally included surrogate markers such as the presence or absence of urologic disease. However, dynamic measurement of the renal system with post-void residual volumes (PVR) has not been investigated as a tool for assessing POUR risk.

Methods: All male TJA patients underwent an pre-operative screen for POUR, including PVR measurements, patient-derived subjective urinary retention scores, and assessment of urologic disease. This was combined with a post-operative monitoring and catheterization protocol developed in partnership with a …

Evaluating The Accuracy And Use Of Continuous Glucose Monitoring In Hospitalized Patients: A Systematic Review And Meta-Analysis, Caroline Purcell, Jeffrey I. Joseph, Do

Phase 1

Introduction:

Glycemic variability in hospitalized patients is associated with poor clinical outcomes, longer length of stay, and increased cost. Advances in subcutaneous continuous glucose monitoring (CGM) technology may reduce glycemic excursions and improve clinical outcomes in hospitalized patients, yet CGM is not used due to a lack of evidence on accuracy. The objective of this study was to review and summarize the evidence on the accuracy of CGM in hospitalized, diabetic patients.

Methods:

A search was conducted for literature evaluating CGM accuracy in hospitalized, diabetic patients. Relevant studies were identified through full-text review and data was extracted for analysis. …

Effects Of Continuous Positive Airway Pressure On Blood Pressure In Obstructive Sleep Apnea, Amy He, Dani Yellanki, Grace Severance, Peter Zhang, Zachary Feuer, Natali Salinas, Cynthia Cheng, Md, Phd

Phase 1

Introduction:

Obstructive sleep apnea (OSA) has been previously linked to the development of hypertension, possibly through the proposed mechanism of recurrent episodes of intermittent hypoxia leading to endothelial dysfunction, inflammation, and metabolic dysregulation. This study aims to investigate continuous positive airway pressure (CPAP) therapy, a first-line therapy for OSA, and its effects on blood pressure in patients with moderate to severe OSA. We hypothesize that compliance to CPAP leads to a decrease in average annual systolic and diastolic blood pressure, compared to noncompliant and non-CPAP use.

Methods:

Our study is a combined retrospective and prospective EPIC chart review study. Moderate …

Short Term Response To Trigger Finger Injections, Neil Patel, Richard Mcentee, Daniel Seigerman

Phase 1

Introduction: Pain, clicking, and locking are common presentations in patients with hand conditions and more often than not, the cause is a trigger finger. The common practice to treat trigger fingers is a corticosteroid injection. The purpose of this study was to determine how these injections affect patients in the short term.

Methods: Patients who underwent corticosteroid injections from June 2019 to September 2019 was the population of study. Phone interviews were conducted with patients each week for 3 weeks following their injection. Patients were questioned about pain and triggering symptoms. Other demographic data was collected to be reviewed …

Prevalence And Risk Factors For Abnormal M-Tics, Maëlys Yepes, Michael Chang, Cynthia Cheng, Md, Phd

Phase 1

Introduction: The lack of effective treatments for Alzheimer’s Disease (AD) underscores the importance of prevention and early detection of amnestic mild cognitive impairment (aMCI), its prodromal state. While studies have proposed a number of potential mechanisms underlying the pathogenesis of AD, such as hypoxia and neuropsychiatric symptoms, little research has been done to evaluate predictive risk factors.

Objective: The objective of this pilot study is to assess the prevalence and risk factors for aMCI.

Methods: This cross-sectional study was performed using data from patients screened for Memories 2, a clinical trial evaluating the effect of CPAP usage in patients with …

Assessment Of Treatment Response Of Keloid Patients, Mary Metkus, Rachel Zachian, John Bruckbauer, Neda Nikbakht, Md, Phd

Phase 1

Introduction: Keloids are benign skin overgrowths, often accompanied by pain and pruritis. Despite many modalities, treatment of keloids is difficult due to variable response and high recurrence rates. This study evaluated the efficacy of surgical excision compared to intralesional triamcinolone in the treatment of keloids.

Methods: This was a retrospective study. Through a medical chart review, patients with keloids treated in the Jefferson Health System from 2018-2020 were identified and included. Participants were surveyed via telephone to assess change in size, pain and pruritis of their keloid in response to treatment. Participants ranked pain and pruritis severity from 1-10 before …

A Comparative Analysis Of Anterior & Lateral Cranial Base Csf Leaks, Rahul Alapati, Glen D. Souza, Md, Prachi Patel, Chandala Chitguppi, Md, Rashiqah Syed, Tawfiq Khoury, Md, Mindy R. Rabinowitz, Md, Christopher J. Farrell, Md, Elina Toskala, Md, Phd, Marc R. Rosen, Md, James J. Evans, Md, Gurston Nyquist, Md

Phase 1

Introduction

The optimal strategy for management of Idiopathic Intracranial Hypertension (IIH) in anterior and lateral cranial base meningoencephaloceles remains debated. The purpose of this study is to present a comparison of the surgical management of anterior and lateral cranial base meningoencephalocele and a treatment algorithm for the diagnosis and management of IIH in this patient population.

Methods

Retrospective study of 109 patients who underwent anterior or lateral CSF leak repair at TJU from 2004-2020. Epic & RedCap were utilized to record data. Patient demographics, presenting symptoms, imaging, Beta-2 Transferring testing, surgery, repair, and post-op data were collected. Two-sided Chi-squared tests …

Return To Play Criteria Following Operative Management Of Acromioclavicular Joint Separation: A Systematic Review, Richard J. Gawel, Taylor D'Amore, Md, Peters Otlans, Md, Somnath Rao, Steven B. Cohen, Md, Michael G. Ciccotti, Md

Phase 1

Introduction: Acromioclavicular (AC) joint separation is a leading cause of shoulder injury among athletes. High grade injuries may require operative fixation, and comprehensive return to play guidelines have not yet been established. The purpose of this investigation is to summarize return to play criteria following operative management of AC joint separation.

Methods: A systematic review of the literature was performed to evaluate clinical evidence regarding return to play following operative management of isolated AC joint separation. Studies satisfying inclusion criteria were analyzed for return to play timeline and other factors used to guide return to play following surgery.

Results: Sixty-three …

Anatomic Location And Mortality Of Pancreatic Adenocarcinoma: A Single Institution Study, Sophia Lam, Randi Zukas, Ida Micaily, Atrayee Basu Mallick

Phase 1

In pancreatic adenocarcinoma, it is believed that patients with proximal tumors (head) have earlier diagnosis and higher survival due to anatomic location compared to patients with distal tumors (body/tail). We hypothesized that differences in tumor biology would contribute to poorer survival in body/tail tumors compared to head tumors when diagnosed at the same stage.

We performed a retrospective chart review on 324 patients with pancreatic adenocarcinoma (236 head and 88 body/tail) diagnosed from 2011-2017. We gathered electronic health records from a single center with a high volume of pancreatic cancer directed surgery. We compared median patient survival from onset of …

Factors Influencing Efficacy And Satisfaction In Prenatal Counseling For Families With Single Ventricle Heart Disease, Taylor Hartzel Houlihan, Jack Rychik, Md

Phase 1

Introduction: The Fetal Heart Program at Children’s Hospital of Philadelphia offers prenatal counseling to families with congenital heart disease diagnoses. This center has yet to examine family satisfaction with counseling, especially those with complicated single ventricle diagnoses. While families may receive sufficient education about their child’s condition, better communication may be needed to prepare them for potential neurological and behavioral complications.

Methods: Through chart review, 355 patient families with single ventricle diagnoses who utilized CHOP prenatal counseling within the past 10 years were identified. Retrospective surveys including Likert scales and open-ended questions were distributed by email. 65 responses were …

Assessment Of Hyperfibrinolysis In Liver Transplantation Surgery As Measured By Rotational Thromboelastometry, Ryan Madsen, Uzung Yoon, Marc Torjman

Phase 1

Hyperfibrinolysis is a significant concern during liver transplantation surgeries. Rotational thromboelastometry (ROTEM) is a point of care device that is capable of intraoperatively measuring the clotting properties of whole blood samples, including the rate of fibrinolysis. The aim of this study was to use ROTEM to determine if improved surgical techniques have lowered rates of hyperfibrinolysis during liver transplantations. Blood samples were taken from 284 patients during liver transplantations that took place over five years from 2014-2019. The blood samples were drawn at various time points during the preanhepatic phase, anhepatic phase, and neohepatic phase of the surgery. Hyperfibrinolysis was …