Medicine and Health Sciences Commons^™

Navigating The Digital Divide: A Teaching-Learning Initiative With The Ipad2, Beth Ann Swan, Kathryn Shaffer, Kellie Smith, Anthony J. Frisby, Mary Hanson-Zalot

College of Nursing Faculty Papers & Presentations

Background/ Rationale: It has been established that Interprofessional Education (IPE) offers a solution to foster teamwork and improve patient care and should be implemented early in professional role development. Thomas Jefferson University has been providing IPE to interprofessional healthcare students for over 5 years. A long term strategic goal was identified to “create innovative learning environments that support interprofessional education including state-of-the-art technologies”. In actualizing this goal, the curriculum was enhanced with technology supported collaborative learning techniques to assist in group processing and reflection. Combining traditional IPE activities with technology supported components incorporated the advantages of both delivery methods, …

Clinical Care Plan: Interdisciplinary Course (Ccpic), Marcia Levinson, Pt, Phd, Mft, Amy M Egras, Pharm.D, Bcps, E. Adel Herge, Otd, Otr/L, Kathryn Shaffer, Rn, Msn

Department of Physical Therapy Faculty Papers

Background/Rationale:

Interprofessional collaborative practice significantly improves patient outcomes, reduces mortality and enhances quality-of-life.

Person-focused care demands collaboration among professions in a team approach to address multiple issues including illness, prevention, and health promotion activities.

Key elements of successful implementation of interprofessional education supported by Clinical Care Plan, Interprofessional Course (CCPIC):

-Increasing knowledge of the roles, responsibilities, and competencies of multiple health professions.

-Collaborating in teams

-Recognizing the patient as the expert

-Communicating effectively

Course Statistics:

-176 students from various disciplines completed course (2008-2011).

Disciplines include:

-Medicine, Nursing, Occupational Therapy, Physical Therapy, Pharmacy

The Characteristics Of Borrelia Hermsii Infection In Human Hematopoeitic Stem Cell-Engrafted Mice Mirror Those Of Human Relapsing Fever, Raja Vuyyuru, Hongqi Liu, Tim Manser, Kishore Alugupalli

Department of Microbiology and Immunology Faculty Papers

Rodents are natural reservoirs for a variety of species of Borrelia that cause relapsing fevers in humans. The murine model of this disease recapitulates many of the clinical manifestations of the human disease and has revealed that T cell-independent antibody responses are required to resolve the bacteremic episodes. However, it is not clear whether such protective humoral responses are mounted in humans.

Second Floor Pilot For Group Learning Tools, Aisr, Education Services

Library Posters

Poster promoting collaborative learning tools including whiteboards and Teamspot.

Macrophages And Neutrophils From Humans And Mice Kill Larval Strongyloides Stercoralis During Innate Immunity, Sandra Bonne-Annee, Laura A. Kerepesi, Jessica A. Hess Ligas, David Abraham, Phd

Department of Microbiology and Immunology Faculty Papers

The parasitic nematode Strongyloides stercoralis (Ss) infects 30-100 million people worldwide, yet little is known about the immune response in humans. Previous studies on innate immunity to Ss in mice have demonstrated a role for eosinophils, neutrophils (PMN) and complement activation in the protective immune response.

Health Information Technology (Hit) And Chemotherapy Management, Diane Abisaleh, Rn, Bsn, Msn

Department of Nursing papers and presentations

• Cancer is the 2nd most common cause of death, accounting for 26% of all deaths.
• Chemotherapy errors can potentially lead to significant harm or death
• 1 out of every 50 chemotherapy orders, results in serious death
• Lack of HIT support for workflow increases error

Partnership Between University Clnical Skills/Simulation Center And Nursing Staff Development-New Products, Mary Bent Mangano, Msn, Rn, Cns, John J. Duffy, Rn, Msn, Ccrn, Cnrn

Department of Nursing papers and presentations

There is a growing evidence in the nursing literature about the effectiveness of clinical simulation as a powerful teaching/learning strategy. This wealth of research attributes simulation's effectiveness to its design that creates an environment where "students become active learners, abandoning memorization for accessing knowledge, and thinking and applying learning in context rather than providing answers to fact-based test" (Jeffries, 2007). A simulation suite provides a "safe, supportive environment that allows students to learn a variety of complex skills in a stress-free environment" (Ghiglieri, Ruiz, & Vasudevan, 2007). Creating this environment requires meticulous planning to details. The learner must have a …

Expression Of Cancer Stem Cell Biomarkers In Male Breast Cancer, Ping Gong, Md, Juan P. Palazzo, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Male breast cancer is an uncommon disease, representing <1% of all breast cancer diagnoses. The prognostic factors and expression of molecular markers in male breast carcinomas are similar to female cancer. Cancer stem cell (CSC)s have been associated with tumor aggressiveness and drug resistance. CSCs are characterized by CD44 and/or ALDH1 expression. We investigated their expression in male breast cancer.

Baseline Monitoring Of Standard Health Indicators In A Formerly Homeless Population, Lara Carson Weinstein, Md, Mph, Marianna Lanoue, Phd, Elizabeth Collins, Bs

Department of Family & Community Medicine Presentations and Grand Rounds

Research Question: What are the rates of baseline health status indicators recording at Pathways to Housing (PTH) using select recommended measures from the National Association of State Mental Health Program Directors (NASMHPD) and the Healthcare Effectiveness Data Information Set (HEDIS)?

How do health indicators compare between clients receiving direct clinical care in the integrated care program vs non-integrated care clients?

Individual Agency, Community Capacity Building, And Chronic Illness Care: Using Participatory Methods To Implement The Stanford Chronic Disease Self Management Program In A Housing First Program, Lara Carson Weinstein, Md, Mph, Abbie Santana, Msph, Carolyn Armour, Cornelius Crossan, James Lawson, Karen Webb

Department of Family & Community Medicine Presentations and Grand Rounds

Research questions:

Is a standardized chronic disease self management program (CDSMP) experienced as a valuable intervention by Pathways' consumers?

What is the impact of collaborative inquiry into health program development on participant's critical agency?

Predictors Of Appropriate Defibrillator Therapies- A Single Center Analysis, Rina R. Shah, Ratika Gupta, Carrie Stackhouse, Robin Ward, Behzad B. Pavri

Division of Cardiology Faculty Papers

Discussion:

• Although differences in HR and the JT interval were statistically significant in patients who received appropriate shock vs. those who did not, these differences are not clinically meaningful
• We did not identify any clinical predictors of early vs. late ICD shocks
• These data suggest that we may not be able to improve on current guidelines for patient selection for ICD implantation.

Characterization Of The Drosophila Slowpoke Binding Protein (Slob) Promoter, Amanda L. Sheldon, Lauren Manderfield, Irwin B. Levitan

Farber Institute for Neuroscience Faculty Papers

Drosophila SLOWPOKE (SLO) is a voltage and calcium dependent, large conductance potassium channel important for action potential repolarization, neuronal excitability, neurotransmitter release, and hormone secretion. SLO binding protein (SLOB) binds to and modulates SLO activity. We have shown previously that modulation of SLO by SLOB has profound effects on SLO channel currents, synaptic transmisison, and metabolism. Multiple isoforms of SLOB exist and are encoded by multiple transcripts; the isoforms are named based on their predicted protein molecular weights, in kilodaltons. In the Drosophila brain, SLOB57/51 proteins are expressed especially prominently in insulin producing neurons of the pars intercerebralis, while SLOB71/65 …

Postoperative Glycemic Variability In Diabetic And Non Diabetic Patients, Boris Mraovic, Md, Brian Hipszer, Md, Zvi Grunwald, Md, David Gratch, Do, Charles J. Yeo, Md, Jennifer Lessin, Rn, Kathleen O'Malley, Rn, Angela Gulino, Md, Peter Simpson, Meng, Jeffrey Joseph

Department of Anesthesiology Faculty Papers

Objectives: Glycemic variability increases oxidative stress and may trigger the inflammation and coagulation cascades. Variability may be associated with increase morbidity and mortality in ICU patients. We analyzed glycemic variability after major surgery in diabetic (DM) and non-diabetic (NDM) patients using an automated intravenous blood glucose monitor (IVBG).

The Role Of Mer In Apoptotic Cell Clearance In The Germinal Center, Tahsin N. Khan, Eric B. Wong, Ziaur S.M. Rahman, Phd

Department of Microbiology and Immunology Faculty Papers

Germinal centers (GCs) are specialized micro-environments that generate high affinity Ab-forming cells (AFCs) and memory B cells. Many B cells undergo apoptosis during clonal selection in GCs. The TAM (Tyro-3, Axl, and Mer) family receptor tyrosine kinases, including Mer, facilitate macrophage clearance of apoptotic cells. We previously showed that tingible body macrophages (TBMφs) in GCs express Mer. We observed that apoptotic cells (ACs) accumulated in GCs of mice deficient in Mer (Mer-/-), after immunization with T-dependent Ag. Accumulation of ACs in GCs of Mer-/- mice resulted in significantly increased AFCs, GCs, and Th1-skewed IgG2c Ab responses. We report here that …

Participatory Research At Pathways To Housing-Pa: A Consumer Perspective, Patways To Housing Consumer Health Research Team And Department Of Family And Community Medicine

Department of Family & Community Medicine Presentations and Grand Rounds

Research Question: How does housing affect healthcare decision making?

Methods: 11 Clients took part in a 9-week project focused on health. Using qualitative methodology, weekly meetings were recorded, transcribed, then analyzed resulting in the development of thematic findings.

The Prevalence Of Cervico-Arterial Dissection In Sub-Arachnoid Hemorrhage In The United States, Ali Seifi, Md, Fred Rincon, Md, Msc, Mitchell Maltenfort, Phd, Pascal Jabbour, Md, Rodney Bell, Md, Michael Moussouttas, Md

Department of Neurology Faculty Papers

Objectives: In this study, we sought to determine the prevalence of cervico-arterial dissection in aubarachnoid hemorrhage (SAH) using a large administrative database.

The Prevalence And Risk Factors Of Acute Myocardial Infarction (Ami) After Acute Ischemic Stroke (Ais) In The United States, Ali Seifi, Md, Fred Rincon, Md, Msc, Michael Moussouttas, Md, Mitchell Maltenfort, Phd, Matthew Vibbert, Md, Rodney Bell, Md, Maria Carissa Pineda, Md, Diana Tzeng, Md, Jacqueline Urtecho, Md, Anish Koka, Md, William Mcbride, Md

Department of Neurology Faculty Papers

Objectives: To determine the prevalence and risk factors for, and the association with in-hospital mortality of, AMI after AIS, and to study the effect of intravenous recombinant tissue plasminogen activator (r-tPA) in this setting. We hypothesized that AMI would be associated with lower survival rate at hospital discharge but that intravenous r-tPA would be associated with lower risk of AMI.

International Evidence On Medical Spending., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

The 46th Actuarial Research Conference, Poster session I, University of Connecticut, Storrs, CT. August 11, 2011.

Poster conclusions:

• U.S. spending is high.
• Long tailed medical linked insurance may be easier to write in the U.S.
• U.S. healthcare cost curve is not outrageous.
• Average spending
• Low volatility

Poster is associated with this paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/

Leah Lowenstein, Md Nation's First Female Dean Of A Co-Ed Medical School (1981), Michael Angelo, Matt Varrato

50 and Forward: Posters

Poster highlighting Leah Lowenstein, MD the nation's first female Dean of a co-ed medical school. Though last to admit female students, Jefferson Medical College was the first co-educational medical school to appoint a woman as dean.

First Female Students Admitted To Jefferson Medical College, Michael Angelo, Matt Varrato

50 and Forward: Posters

Poster highlighting the first female students admitted to Jefferson Medical College in 1961. On June 6, 1960, the Board of Trustees voted to admit women to Jefferson Medical College. The first woman accepted was 21-year-old Nancy Szwec who also won a scholarship.

Growth Inhibition Of Human Hepatocellular Carcinoma Cells By Overexpression Of G Protein-Coupled Receptor Kinase 2, Zhengyu Wei, Reginald Hurtt, Cataldo Doria

Department of Surgery Faculty Papers

Summary:

In this study, we investigated a novel approach for HCC treatment by inducing overexpression of GRK2 in human HCC cells. We found that overexpression of GRK2 through recombinant adenovirus transduction inhibits the growth of human HCC cells. BrdU incorporation assay showed that the growth inhibition caused by elevated GRK2 level was due tot he reduced cell proliferation but not apoptosis. To examine the anti-proliferative function of increased GRK2 level, we performed cell cycle analysis using propidium iodide staining. We found that the proliferation suppression was associated with G2/M phase cell cycle arrest by the wild type GRK2 but not …

Assessment Of Adherence To Guidelines For Hepatocellular Carcinoma Screening In Hiv/Hcv Coinfected Patients, Jonathan M. Fenkel, Md, Victor J. Navarro, Md

Division of Gastroenterology and Hepatology Faculty Papers

Conclusions:

1. Self-reported adherence with published guidelines for HCC screening is poor among primary providers for HIV/HCV coinfected patients, including HIV specialists and University-based providers.

2. Unnecessary imaging is also frequently ordered on non-cirrhotics, particularly by University-based providers.

3. Improved adherence to guidelines is needed among primary providers as over 50% of HCC's may be missed, and many patients many not be referred for subspecialty GI or Liver care, where screening practices may differ.

Utilizing Livers From Donors Older Than 65: A Single Center Experience, Krishnaraj Mahendraraj, Jorge H. Castro, Sean Devitt, Chad Gorn, Cataldo Doria, Adam Frank, Warren Maley, Carlo G. Ramirez

Department of Surgery Faculty Papers

Conclusions:

Use of liver grafts from older donors presents similar survival outcomes as grafts from younger donor age. Therefore, it offers a viable option to expand the donor pool and increase number of OLTs.

However, there is higher incidence of retransplantation due to primary graft non-function, and longer hospital length of stay observed in the older donor age group.

Further studies using larger patient populations are needed to validate our results.

Treatment Of Cerebrospinal Fluid Leak During Spinal Cord Stimulator Implantation With Epidural Blood Patches, Farid Kia, Md, Linqiu Zhou, Md, Jason Berk, Md

Department of Rehabilitation Medicine Faculty Papers

Conclusion:

Our data is consistent with prior studies in demonstrating that the incidence of dural puncture and CSF leak with SCS procedures is rare. Based on our experiences, performing an epidural blood patch intra-operatively on the contra-lateral side under fluoroscopy could prevent PDPH. This treatment should especially be considered in patients undergoing SCS trials in order to accurately assess the level of pain reduction. Patients with prior spine surgeries might pose higher risks for dural puncture and more extensive pre-operative assessment could be beneficial.

Performance Of Colorectal Cancer Screening Steps In Primary Care, Salini Mohanty, Mph, Mona Sarfaty, Md, Mph, Faafp, Randa Sifri, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Discussion:

This analysis revealed the differences in which physicians in primary care complete CRC screening steps. The approach and completion of screening steps varied greatly among practices.

There was a correlation between the quantitative data and the qualitative data. The analysis from both methodologies produced similar results and supports each other's assessment.

All of the practices analyzed possessed one of the essential elements (a physician recommendation) which is the foundation for increased screening. All of the practices have the potential to expand upon this foundation in order to ensure that all eligible patients are approached and screened for CRC.

The …

Knowledge And Perceived Barriers About Diabetic Retinopathy And Dilated Eye Exam In Patients With Diabetes, Manisha Verma, Md, Mph, Mona Sarfaty, Robert Simmons, Drph, Mph, Albert G. Crawford

College of Population Health Lectures, Presentations, Workshops

Conclusions:

• The results of this study suggest that 68% of the population from this primary care practice got a dilated eye exam within a year. Facilitators were awareness/knowledge about the DR and DFE, eye problems and information from their doctors.
• Almost 20% of the patients did not get an eye exam as recommended. Various barriers included cost, transportation issues, time constraint issues, lack of symptoms of the disease, and fear of the exam.
• There is a significance difference in getting an eye exam by the type of insurance with a smaller percentage of Medicaid recipients (60%) meeting the guidelines compared …

Primary Provider Beliefs And Practice Patterns Contribute To The Lack Of Hiv/Hcv Coinfected Patients Undergoing Liver Transplantation In The United States, Jonathan M. Fenkel, Md, Victor J. Navarro, Md

Division of Gastroenterology and Hepatology Faculty Papers

Conclusions:

1. The majority of primary providers were ambivalent toward or against LT for HIV/HCV coninfected patients.

2. Half of all respondents were unlikely to refer cirrhotic coinfected patients for LT evaluation.

3. HIV specialists were significantly more likely to believe transplant should be offered, but reported no difference in likelihood of LT referral.

4. These findings suggest that primary provider beliefs and self-reported practice patterns may partially explain the paucity of coinfected US liver transplant recipients.

Transplant Glomerulopathy In The Absence Of Donor Specific Antibodies, Mayuri Vijay-Sharma, Md, Pooja Singh, Md, Beth W. Colombe, Phd., Rakesh Gulati, Md, John L. Faber, Md, George Francos, Md

Department of Medicine Faculty Papers

Conclusions:

Half of our 50 patients with TG documented by EM had no DSAs or positive C4d staining in PTCs. Almost 70% of the patients evidenced PTC basement membrane multilayering. These patients were all diagnosed with chronic active CMR independently of the presence of TG. Cellular rejection mechanisms are likely the cause of the TG in this group. Patients with TG and DSAs are at greater risk for episodes of acute AMR and CMR. C4d staining of PTCs was evident in less than 40% and in the glomeruli in less than half. Interestingly, 25 of the 26 DSA+ patients were …

A Compact Guide To The Diagnosis And Management Of Neurofibromatosis Type 1, Timothy Beer, David Strayer, Md, Phd

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

Brief Introduction

Neurofibromatosis type 1 (NF-1) is a multisystem neurocutaneous disorder resulting from mutations in the NF-1 gene on chromosome 17 (q11.2). Mutations in NF-1 result in deficient activity of the tumor suppresor protein neurofibromin, allowing for uncontrolled constitutive activity of the proliferative Raspathway in several neural cell types, including neurons, oligodendrocytes, astrocytes and Schawnn cells. Half of NF-1 cases are inherited in autosomal dominant fashion, while half develop sporadically. The syndrome has 100% penetrance but highly variable expressivity. The prevalence of this syndrome is 1/3,000, making it common enough to warrant YOU, the physician, taking a moment to learn …

Ercc1 And Rrm1 As Predictors Of Survival And Response In Pancreatic Ductal Adenocarcinoma Treated With Gemcitabine-Based Chemotherapy, Thomas Holdbrook, Kathleen D. Danenberg, Suneeta Satti, Jessica Kline, Charles J. Yeo, Jonathan R. Brody, Peter Mccue, Agnieszka K. Witkiewicz

Department of Surgery Faculty Papers

Conclusion:

In this study, we used RT-PCR and IHC to analyze RRM1 and ERCC1 mRNA and protein expression in PDA specimens. PDA patients with low expression of RRM1 by IHC derived benefit from gemcitabine-based chemotherapy. Assessment of RRM1 mRNA expression was limited by the small sample size. Low ERCC1 expression by RT-PCR was associated with a 2.5 times higher risk of mortality than high expression (p=0.031). There was no association between ERCC1 expression by IHC and survival; however, agreement between mRNA and protein expression was poor for ERCC1. This study demonstrates the ERCC1 and RRM1 expression have an impact on …