Medicine and Health Sciences Commons^™

Heart Failure Transition Of Care Program: The Pharmacist’S Role In Reducing Readmissions, Joseph Favatella, Pharmd Candidate 2013, Joanne Heil, Pharmd, Bcps

College of Pharmacy Faculty Papers

Presented at: ASHP Mid-Year Clinical Meeting in Las Vegas.

Introduction & Background

Current Trends¹

•Approximately 19.6% of Medicare patients are readmitted to the hospital within 30 days

•These readmissions accounted for $15 billion of Medicare spending in 2009

Changes Coming

•As part of the Affordable Care Act, Medicare will not be reimbursing hospitals for patients readmitted within 30 days of discharge

•Hospitals have already begun improving discharge protocols to provide a greater continuity of care and minimize the financial loss of future readmissions

A Model²

•Boston University Medical Center's Re-Engineered Discharge (RED) was the first program to improve …

The Use Of Glucarpidase In An Open-Label Treatment Protocol As Adjunctive Treatment For A Patient With Delayed Methotrexate Elimination, Cheryl A. Abbas, Pharmd, Anne Marie Valorie-Oberle, Bs, Pharmd, Bcop

College of Pharmacy Faculty Papers

Presented at: ASHP Clinical MidYear Meeting in Las Vegas.

Background

Methotrexate (MTX)

• Cytotoxic agent that competitively inhibits dihydrofolate reductase (DHFR), the intracellular enzyme responsible for converting folic acid to reduced folate inhibitors, necessary for DNA synthesis
• Used since 1948 in the treatment of various malignancies and as a disease-modifying agent in rheumatoid arthritis and psoriasis
• High-dose mexthotrexate (HDMTX) began in 1960s solely or in combination with other chemotherapeutic agents

Methotrexate Toxicity

• Almost exclusively cleared through the kidneys
  • Precipitation of drug occurs in the renal tubules
  • Prolonged elevations of systemic MTX concentrations results in potential serious toxicity
• Increased use of HDMTX …

Limited Sampling Estimates Of Epigallocatechin Gallate Exposures In Cirrhotic And Noncirrhotic Patients With Hepatitis C After Single Oral Doses Of Green Tea Extract., Dina Halegoua-De Marzio, Walter K. Kraft, Constantine Daskalakis, Xie Ying, Roy L Hawke, Victor J. Navarro

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Epigallocatechin-3-gallate (EGCG) has antiangiogenic, antioxidant, and antifibrotic properties that may have therapeutic potential for the treatment of cirrhosis induced by hepatitis C virus (HCV). However, cirrhosis might affect EGCG disposition and augment its reported dose-dependent hepatotoxic potential.

OBJECTIVE: The safety, tolerability, and disposition of a single oral dose of EGCG in cirrhotic patients with HCV were examined in an exploratory fashion.

METHODS: Eleven patients with hepatitis C and detectable viremia were enrolled. Four had Child-Pugh (CP) class A cirrhosis, 4 had Child-Pugh class B cirrhosis, and 3 were noncirrhotic. After a single oral dose of green tea extract 400 …

The Fear Factor In Takotsubo Cardiomyopathy: A Retrospective Cohort Study, Lex Denysenko, Md, Robin Hanson, Md, Jessica Mosier, Md, Ethan J. Halpern, Md

Department of Psychiatry and Human Behavior Faculty Papers

Presented at: Academy of Psychosomatic Medicine in Atlanta Georgia.

BACKGROUND

•Takotsubo cardiomyopathy (TCM) is a transient, reversible acute cardiac syndrome that mimics acute MI

•Reportedly frequently precipitated by an emotionally stressful event

•Excessive catecholamine release is a possible pathophysiologic mechanism¹

•Prevalence of anxiety and mood disorders in TCM patients varies among studies, ranging from 21-40%^2,3

Takotsubo Cardiomyopathy And Catatonia: An Acute Stress Connection?, Lex Denysenko, Md, Rachel Shmuts, Do, Adam Trenton, Do, Ethan J. Halpern, Md, Madeleine Becker, Md

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND

•Takotsubo cardiomyopathy (TCM):

•transient left ventricular dysfunction

•ECG changes and symptoms mimicking acute MI

•often precipitated by emotional stressor

•Catatonia is a psychomotor syndrome most commonly seen in mood disorders

•This is the first known reported case of TCM co-occurring with catatonia in the setting of acute psychological trauma and bereavement

Interprofessional Education In Didactic And Experiential Settings At The Jefferson School Of Pharmacy, Elena M. Umland, Cynthia A. Sanoski, Emily R. Hajjar, Bhavik Shah

College of Pharmacy Faculty Papers

Presented at: 2012 Annual Meeting of the American Association of Colleges of Pharmacy in Kissimmee, Florida.

Objective:

To evaluate the various IPE offerings at a new school of pharmacy at a large academic medical center.

Visual Function After Correction Of Distance Refractive Error With Ready-Made And Custom Spectacles: A Randomized Clinical Trial., Christopher J. Brady, Andrea C Villanti, Monica Gandhi, David S Friedman, Lisa Keay

Wills Eye Hospital Papers

PURPOSE: To evaluate patient-reported outcome measures with the use of ready-made spectacles (RMS) and custom spectacles (CS) in an adult population in India with uncorrected refractive error (URE).

DESIGN: Prospective, double-masked, randomized trial with 1-month follow-up.

PARTICIPANTS: A total of 363 adults aged 18 to 45 years with ≥1 diopter (D) of URE (RMS, n = 183; CS, n = 180).

INTERVENTION: All participants received complete refraction and were randomized to receive CS (full sphero-cylindrical correction) or RMS based on the spherical equivalent for the eye with lower refractive error but limited to the powers in the RMS inventory.

MAIN …

A Teaching-Learning Initiative With Tablet Computing, Beth Ann Swan, Phd, Crnp, Faan, Kellie Smith, Edd, Rn, Anthony J. Frisby, Phd, Kathryn Shaffer, Msn, Rn, Cne, Mary Hanson-Zalot, Msn, Rn

College of Nursing Faculty Papers & Presentations

Mobile computing and electronic books are the top emerging technologies to impact higher education.¹ The rapid expansion of technology in the health care setting has created a growing recognition that there is a need for adoption of a sound set of innovative teaching-learning strategies related to information management and technology applications in undergraduate nursing curriculum. Success in these technology-related strategies will rest on the degree to which schools comprehensively integrate technology with teaching-learning strategies in the undergraduate nursing curriculum.

Tablet computing has the potential to enhance educational experiences by providing a delivery option for teaching and learning practices that …

Development Of Dna Vaccination Approach For Tumor Immunotargeting, Nathaniel Sangster

Summer Training Program in Cancer Immunotherapy

The emergence of immunotherapy as a prominent modality to treat cancer is a crucial advancement in the fight against this devastating disease. Although DNA vaccines against cancer have not been effective in treating pre-existing tumors, this approach holds much promise particularly for the activation of immune responses to specific mutant antigens responsible for tumorigenesis. Recent studies demonstrated that Q209L point mutation in the GNAQ (and GNA11) is responsible for the development of more than 70% of uveal melanomas and pre-malignant cutaneous blue nevus in humans. Based on the epitope prediction, we hypothesized that DNA vaccination with mutant GNAQ may result …

Jefferson Digital Commons Celebrates One Million Downloads And Over 5,000 Items Archived, Education Services

Library Posters

Poster celebrating 1 million downloads in the Jefferson Digital Commons (JDC).

A Thermoplastic Vest To Prevent Self Mutilation In Experimental Flap Surgery In Rats, Eli A. Gordin, Md, Sarah M. Drejet, Md, Ryan N. Heffelfinger, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Poster presented at: 8th International Conference on Head and Neck Cancer in Toronto, Canada.

Introduction:

Rats are frequently utilized for both research and training related to reconstructive head and neck surgery. The femoral neurovascular complex represents a useful mode for microvascular anastomosis, both for the purposes of testing adjuncts designed to improve anastomotic patency rates, as well as for residents and students to gain experience in microvascular surgery outside the operating room. Additionally, the rat proves useful in investigations examining the survivability of both random and axial pattern skin flaps.

Aisr Connections Fall 2012 (2012-2013 Orientation Issue), Aisr

The AC's Research Support Newsletter (Formerly AISR Connections)

Yearly publication of AISR Connections for 2012-2013.

Issue includes:

• Scott Library renovations
• New library catalog
• Clinical Resources Support
• Jefferson Digital Commons

The mission of Academic & Instructional Support & Resources (AISR) is to strengthen the educational, research and clinical activities of the Jefferson community by providing knowledge-based information, developing and managing instructional technologies and content, supporting and managing campus classroom technologies, and providing leadership in scholarly communication and publishing.

Department Of Radiology-Annual Executive Summary Report-July 1, 2011 To June 30, 2012, Vijay M. Rao, Md

Department of Radiology Administrative Documents and Reports

93 page Department of Radiology Annual Executive Summary Report, July 1, 2011 to June 30, 2012, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.

Table of Contents

Chairman, Vice Chairmen 1

Divisions and Directors 1

Committees and Chairmen 1

Radiology Department Faculty Rank 2

Faculty with Secondary Appointments 3

Clinical Divisions 4

Radiology Residents and Fellows 5

Department Organizational Chart 6

Department Administration Chart 7

State of the Department 8

Appendix I: Publications

Journal Articles 23

Books and Book Chapters 31

Abstracts 35

Appendix II: Formal Scientific Presentations 50

Appendix III: Honors, Editorial Activities, Service to Regional or National Organizations …

Phosphorylation Of Vasodilator-Stimulated Phosphoprotein Ser239 Suppresses Filopodia And Invadopodia In Colon Cancer., David S Zuzga, Joshua Pelta-Heller, Peng Li, Alessandro Bombonati, Scott A Waldman, Giovanni Mario Pitari

Department of Pharmacology and Experimental Therapeutics Faculty Papers

In colorectal cancer, the antitumorigenic guanylyl cyclase C (GCC) signalome is defective reflecting ligand deprivation from downregulation of endogenous hormone expression. Although the proximal intracellular mediators of that signal transduction system, including cyclic guanosine monophosphate (cGMP) and cGMP-dependent protein kinase (PKG), are well characterized, the functional significance of its distal effectors remain vague. Dysregulation of ligand-dependent GCC signaling through vasodilator-stimulated phosphoprotein (VASP), an actin-binding protein implicated in membrane protrusion dynamics, drastically reduced cGMP-dependent VASP phosphorylation levels in colorectal tumors from patients. Restoration of cGMP-dependent VASP phosphorylation by GCC agonists suppressed the number and length of locomotory (filopodia) and invasive (invadopodia) …

Ranking Library Tasks For Redesigning A Medical Academic Health Center And University Mobile Web Site, Daniel G. Kipnis, Msi, Gary Kaplan, Mslis, Ann Koopman, Am, Brian Kysela, Joseph Zavorski

Academic Commons and Scott Memorial Library Staff Papers and Presentations

Objectives:

(1) To determine what library-related tasks users most want to be able to perform on their mobile devices (smartphones, iPads,etc.), using a modified Likert scale, freetext and multiple choice questions to rank the most common tasks.

(2) To redesign our existing Library mobile site.

How Will Comparative Effectiveness Research Influence Clinical Decision Making?, Nicholas Zaorsky, Md, Timothy Showalter, Md

The Medicine Forum

Most health care recommendations in the United States have come from trials designed to measure efficacy of medical interventions, with randomized controlled trials considered the gold standard for evidence-based medicine. Comparative effectiveness research has become an essential component of research to help define the benefits, risks, and effectiveness of different interventions for a particular illness. Comparative effectiveness research is informally defined as an assessment of all available options for a specific medical condition, with intent to estimate effectiveness in specific subpopulations. In this article, we contrast efficacy-based healthcare research and recommendations in the United States, under the model of evidencebased …

An American On Rotation In Switzerland, Jennifer Alloo Hong, Md

The Medicine Forum

It wasn’t easy getting to Switzerland. My husband started work at CERN at the end of 2009 when I was a 3rd year medical student and I was there helping him find an apartment during my winter break. In the back of my mind, I wondered if I could do an away rotation at les Hopitaux Universitaires de Genève (HUG) the following year. So I walked into the front entrance of the medical school associated with HUG. Bonjour! Do you have a program for students like me? Is it allowed for foreigners? Would I have to take a test in …

Quality Improvement Of Diabetic Care At A Resident Clinic, Carmi Santos Punzalan, Md, Sarah Rutherford, Md, Andrew Lerner, Md, Tasha Kouvatsos, Md, Sneha Thakkar, Md, Melissa Klein, Md, David Manoff, Md, Cecilia Kelly, Md, Dina Halegoua, Md, Gregory Kane, Md

The Medicine Forum

Our objective was to develop a quality improvement project on diabetes mellitus at our internal medicine residency clinic. Residents developed projects aimed at improving an aspect of diabetic care. Continuity of care, achievement of clinical targets, no-show rates, patient knowledge of diabetes, and preventive care were evaluated. Our data was obtained with a questionnaire and a retrospective review of medical records. A different provider was scheduled about every 1.78 visit. The no-show rate was 25.4%. About half of patients identified goal hgbA1c and BPs, and 35% and 60% achieved their hgbA1c and SBP goals respectively. Nearly all of the charts …

Persistent Severe Hyperkalemia In A Patient With Normal Renal Function, Michael L. Tobin, Md

The Medicine Forum

Case Report

A 75-year-old female with a past medical history significant for hypertension, hyperlipidemia, and colon cancer, status post colectomy with ileostomy, presented to the Methodist Hospital emergency room with muscular low back pain, which began a few hours prior, after abruptly bending over. Upon arrival to the hospital, she had no other complaints and noted that the back pain was starting to resolve without intervention.

In triage, her heart rate was measured at 38 beats per minute (BPM) with her other vital signs within normal limits. Her electrocardiogram (EKG) was read as a junctional rhythm with a rate of …

Sarcomatoid Mesothelioma In A Patient With Asbestos Exposure, Abhik Roy, Md, Merritt Brown, Md

The Medicine Forum

Case

A 76-year-old man with no significant past medical history presented with a two month history of progressive shortness of breath, 25-pound weight loss, and sharp right-sided chest, abdomen, and pelvic pain without radiation. The patient noted his dyspnea became more pronounced in recent weeks, notably worse with climbing stairs or performing work around the house. He described the pain as having a positional component, and exacerbated with deep-inspiration. On further questioning, the patient reported a 50-pack-year history of smoking and past exposure to asbestos while working with heating insulation. Physical examination revealed an age-appropriate, but cachectic appearing male with …

A 45-Year-Old Male With Hiv, Kaposi’S Sarcoma, And Squamous Cell Carcinoma Of The Skin, Jascha Rubin, Md, Hasan Bayat, Md

The Medicine Forum

Case

A 45-year-old male with a history of human immunodeficiency virus, (HIV), on highly active antiretroviral therapy (HAART), Kaposi’s sarcoma, and squamous cell carcinoma (SCC) of the right lower extremity complicated by chronic wound formation presented with worsening right leg pain and increasing wound drainage.

The patient described the pain as excruciating, with 10/10 intensity and exacerbated by movement. His wounds began draining purulent material and blood about two weeks prior to presentation. He has had several similar, though milder episodes in the past requiring hospitalization. When the wounds began to have a foul odor, he presented to the hospital. …

Thrombotic Thrombocytopenic Purpura Revisited: Upshaw Schulman Syndrome In A 20-Year-Old Male, Judy Wang, Md, Niluk Peiris, Md

The Medicine Forum

Case Report

A 20-year-old male with no significant past medical history presented to an outside hospital with a two-week history of progressive fatigue, malaise and decreased appetite. Prior to these events, he had been in his usual state of health with normal exercise tolerance and energy level. Upon development of his symptoms, the patient felt as though he had developed an upper respiratory infection (URI). The URI symptoms eventually resolved; however complaints of fatigue and malaise still remained. He then developed progressive dyspnea on exertion and tea-colored urine. The patient reported a singular febrile episode to 38.9˚C associated with nonbilious …

A Case Of Pyoderma Gangrenosum, Christopher T. Miller, Md

The Medicine Forum

Case Report

A 60-year-old man with past medical history of hypertension, post-traumatic stress disorder, major depression, hepatic steatosis, chronic kidney disease, and untreated hepatitis C virus (genotype 1b) initially presented to the outpatient primary care clinic with a chief complaint of an extremely painful right lower extremity ulcer that had developed and grown progressively larger after mild trauma against a metal corner 4 months prior to the appointment. He admitted to picking at the granulation tissue that would develop over the ulcer. He was treating the ulcer with antibiotic ointment. On initial exam, the ulcer was about 2x2 cm, located …

Two Cases Of Co-Infection With Babesiosis And Lyme Disease, Anthony Decicco, Md, B. Niluk Peiris, Md, Cecilia Kelly, Md, Michael Latreille, Md, Donald Jungkind, Phd

The Medicine Forum

Case 1

The patient is a 71-year-old female with past medical history significant for hypothyroidism and hyperlipidemia who presented to Thomas Jefferson University Hospital (TJUH) with complaints of myalgias for 6 weeks duration. The patient stated that she had begun an exercise program to lose weight and had subsequently noticed body aches and increased fatigue. She had presented to an outside hospital with these complaints, was told that the etiology was musculoskeletal, and was prescribed naproxen for pain relief. The pain did improve slightly with the naproxen but she noticed a rash and hives after starting the medication and stopped …

A Case Of A 32-Year-Old Female With Right-Sided Facial Droop And Numbness, Jason Schoenfeld, Msiii, Efstathia Andrikopoulou, Md

The Medicine Forum

Case Presentation

A 32-year-old Hispanic female with a past medical history of asthma, depression and insomnia presented to the emergency room with complaints of right-sided facial droop associated with ipsilateral facial numbness and diminished taste for the past three days. In addition, she reported a moderate to severe pulsatile headache for the past day. This headache was initially right-sided and frontal, but then became right-sided and occipital in location. She had a history of a similar headache episode four years ago. Additionally, she noted moderately severe intermittent chest pain described as sharp then dull occurring over the past day. On …

Mycobacterium Fortuitum Device Infection With Subsequent Endocarditis, Paurush Shah, Md, Alec Vishnevsky, Md

The Medicine Forum

Case

A 78-year-old female with a past medical history of mild dementia, hypertension, diabetes, coronary artery disease status post automatic implantable cardioverter defibrillator (AICD) for congestive heart failure presented with suspected bacterial endocarditis and AICD lead infection from an outside hospital (OSH). The patient initially presented to the OSH with chest wall tenderness, fevers up to 101° F, chills, decreased appetite, weakness and weight loss. She was diagnosed with a non-ST segment myocardial infarction based on elevated troponin levels without electrocardiogram changes. At the OSH, blood acid fast bacillus (AFB) cultures were checked after routine blood cultures and fungal cultures …

A 55-Year-Old Man With Rapid Onset Rectosigmoid Mass And Hepatic Metastases With An Afp Of > 3 Million Ng/Ml, Francis Kim, Md

The Medicine Forum

Case

A 55-year-old male with a past medical history of ulcerative colitis diagnosed in 1999, Barrett’s esophagus, hyperlipidemia, and diabetes mellitus presented with a 2-week duration of daily constant abdominal pain. He described the pain as a sharp, epigastric pain not worsened with food intake or bowel movements. He was unable to tolerate any oral intake for a week prior to admission secondary to increased epigastric pain. He stated an increase in bowel movements to 1 per day that was softer and less formed than usual. He also stated he had a near syncopal episode on the day of admission …

Not Your Typical Case Of Ascites: Pancreatic Ascites In A Patient With Cirrhosis And Pancreatic Duct Leak, Philip Montemuro, Md, Abhik Roy, Md

The Medicine Forum

Case

A 55-year-old male with a history of hepatic cirrhosis secondary to Hepatitis C and alcohol abuse presented to an outside hospital with progressive abdominal pain and distension. The patient initially complained of “punching” right upper quadrant and epigastric abdominal pain that was 10/10 in intensity and non-radiating. Although the pain had started one to two days prior to presentation, the patient had been experiencing several weeks of increasing abdominal distension. He reported drinking eight 40oz beers daily for over 40 years, and he felt that the abdominal pain improved slightly with cessation of alcohol use. The patient complained of …

Strongyloides Stercoralis Infection In A Patient With Aids, Abhik Roy, Md, Gregory Young, Md, Geoffrey Koff, Md, Tasha Kouvatsos, Md

The Medicine Forum

Case

A 46-year-old male with a past medical history significant for acquired immune deficiency syndrome (AIDS) presented with constant, non-radiating epigastric pain, nausea, non-bloody emesis, weakness, and lethargy. He had emigrated from Honduras twenty years prior. The patient denied fever, chills, recent travel, animal exposures, or sick contacts. His medications included efavirenz/emtricitabine/tenofovir, valganciclovir, trimethoprim/sulfamethoxazole, fluconazole, and iron.

Large, Solitary, High-Grade Duodenal Tubular Adenoma In A Patient Presenting With Gi Bleed, Paurush Shah, Md

The Medicine Forum

Case

A 71-year-old male with past medical history of hypertension, hyperlipidemia, aortic stenosis, and atrial flutter on warfarin presented to his primary care physician (PCP) a few days prior to admission with complaints of lethargy, lightheadedness, and mild shortness of breath (SOB) for about five days prior to admission. He stated that he had also been experiencing dark stools for one week while therapeutic on warfarin. His blood pressure in the office was slightly low, and he was told drink extra fluids as his symptoms were likely due to dehydration. The patient returned to his PCP a few days later …