Medicine and Health Sciences Commons^™

An Old Problem With A New Therapy: Gi Bleeding In Vad Patients And Deep Bowel Enteroscopy (Double Balloon. Spiral Enteroscopy)., Hitoshi Hirose, Konrad Sarosiek, Linda Bogar, Pitcher Harrison, Barbara Ebert, Nicholas Cavarocchi

Nicholas C Cavarocchi MDJ

An old problem with a new therapy: GI Bleeding in VAD patients and deep bowel enteroscopy (Spiral and Double Balloon Enteroscopy) Purpose: Evidence suggests that patients treated with non-pulsatile ventricular assist devices (VAD) are at an increased risk for gastrointestinal bleeding (GIB) beyond what is expected from routine anticoagulation. Diagnostic and treatment algorithms are currently undefined. We reviewed our experience of GIB in VAD patients and propose a new algorithm utilizing deep bowel enteroscopy (DBE) aimed to speed diagnosis and limit transfusions. (471) Methods & Procedures From 2004 to 2011, we studied 62 patients who received a non-pulsatile VAD at …

Efficacy Of Miniaturized Imacor Trans-Esophageal Echocardiografm (Tee) Prove In Mechanical Circulatory Support., Hitoshi Hirose, Christopher Y. Kang, Joshua K. Wong, Harrison T. Pitcher, Caitlyn M. Johnson, Konrad Sarosiek, Linda J Bogar, Nicholas C. Cavarocchi

Nicholas C Cavarocchi MDJ

Application of the miniaturized ImaCor Trans-Esophageal Echocardiogram (TEE) probe in Heart Transplant/Mechanical Cardiac Support Patients In the surgical cardiac care unit (SCCU), therapeutic interventions often need to be done at the bedside, necessitating the need for a rapidly employable diagnostic tool for the cardiac intensivist. We report the clinical utility of the miniature ImaCor TEE-probe in guiding management of post heart transplant (H-Txp) and mechanical cardiac support patients (MCS) and describe the economic benefit of such a device. This is an IRB approved retrospective review of MCS/H-Txp patients who had ImaCor TEE monitoring in the SCCU of our institution in …

Novel Approach To Monitoring Renal Perfusion With The Use Of Continuous Renal Oximetery In The Setting Of Aortic Dissection, Hitoshi Hirose, Philip Batista, Nicholas C. Cavarocchi

Nicholas C Cavarocchi MDJ

INTRODUCTION: Aortic dissections commonly extend beyond the renal arteries with varying effects ranging from asymptomatic to renal failure. We report a case of aortic dissection with initial renal compromise, which was continuously monitored utilizing direct renal oximetry for evaluation of real-time renal perfusion and function. CASE PRESENTATION: A 65 year-old female with a long history of uncontrolled hypertension presented with acute retrosternal chest pain radiating to the back for 12 hours. She was in stable condition except for a serum creatinine of 1.6mg/dl. Magnetic resonance angiography (MRA) demonstrated a type A dissection extending from the aortic root to the left …

Venoarterial Extracorporeal Membrane Oxygenation (Ecmo) For Support During Whole Lung Lavage For Pulmonary Alveolar Proteinosis., Hitoshi Hirose, Julie Monteagudo, Nicholas C. Cavarocchi, Boyd Hehn, Naveed Hasan

Nicholas C Cavarocchi MDJ

INTRODUCTION ECMO as support during whole lung lavage (WLL) for pulmonary alveolar proteinosis is reserved for severe cases where oxygenation is inadequate to support the patient using the ventilator alone. While most publications describe a venovenous cannulation with variable results we present a successful case using venoarterial cannulation and discuss the potential benefits of this mode of ECMO support. CASE PRESENTATION We present the case of a 44 year old female with a past medical history of Behcets disease and a BMI of 37 who was diagnosed with pulmonary alveolar proteinosis (PAP) on a lung biopsy after presenting with dyspnea. …

Successful Liver Failure Management Using Molecular Adsorbents Recirculating System During Complicated Veno-Arterial Extracorporeal Membrane Oxygenation As A Bridge To A Left Ventricular Assist Device Placement, Hitoshi Hirose, Shigeki Tabata, Nicholas Cavarocchi

Nicholas C Cavarocchi MDJ

Successful liver failure management using molecular adsorbents recirculating system during complicated veno-arterial extracorporeal membrane oxygenation as a bridge to a left ventricular assist device placement. SHIGEKI TABATA, MD, Nicholas Cavarocchi, MD, Hitoshi Hirose, MD. Department of Surgery, Division of Cardiothoracic Surgery Thomas Jefferson University Hospital, Philadelphia, PA Introduction: Extracorporeal membrane oxygenation (ECMO) is a well-established therapy for the patients with cardiogenic shock. We present a patient who developed severe complications while on ECMO. Case presentation: A 49-year-old female presented with severe heart failure and was placed on veno-arterial ECMO for bridge to decision. While on ECMO, the patient developed massive …

Chronic Malnutrition In Guatemala, Nicholas Bishop, Susan Mcilvaine

CwiC-PH

Poster includes:

• What is chronic malnutrition and what causes it?
• Why address malnutrition?
• Addressing the problem

Role Of Traditional Chinese Medicine In Modern Healthcare, Gealina Dun

CwiC-PH

Theories of Traditional Chinese Medicine (TCM)

Traditional Chinese Medicine (TCM), a form of complementary and alternative medicine (CAM), has been practiced for over 2500 years, and approaches health as an interrelated and holistic state of being. Using multiple methods, the theories of TCM aim to balance:

• Qi
• Yin and Yang (Fig. 1)
• The Five Elements
• ZangFu Organs

Women’S Perspective: The Underlying Factors Leading To Malnutrition In Poor Women In India, Tanuja Devaraj

CwiC-PH

AIM

A qualitative pilot study aimed to understand the socioeconomic aspects leading to malnutrition in urban poor women in Bangalore, India.

Social And Structural Barriers Faced By Gender And Sexual Minorities In Obtaining Female Reproductive, Montida Fleming

CwiC-PH

The Problem

• Lesbian women are less likely to have health insurance and less likely to receive routine Pap tests compared their heterosexual counterparts.¹
• Transgendered males were found to be less likely to receive preventative health services such as pap tests due to both lack of insurance and discrimination by healthcare providers.²
• Barriers may include:

Stigma and discrimination

Lack of compassion, sensitivity, and gender literacy by healthcare workers

Lack of health insurance

Misconceptions about risk in female bodied people who do not have sex with males

Language used by public health advocates regarding preventative care for female reproductive organs

Successful Aging In Philadelphia: Examining The Needs Of The Geriatric Community, Mollie Woehling

CwiC-PH

INTRODUCTION

• As more adults continue to live until older ages they will have a greater reliance on the formal aging care system and continue to use a large proportion of healthcare resources
• From 2000 to 2010, the US 65+ population grew 15.1% compared to the total population that grew 9.7%¹
• CDC estimates that adults who make it to 65 can expect to live for 19 more years, 14 of those in relatively good health²
• Adults 65 years and older comprise over 12% of the population of Philadelphia¹
• In 2002, 19% of Philadelphia’s seniors 65+ lived in poverty, …

The State Of Healthcare For Bhutanese Refugees In South Philadelphia: Challenges & Progress, Sarah Wells

CwiC-PH

Who the Bhutanese Refugees Are ^[1]

• Mid-19^th Century: Nepalese farmers recruited to work farmlands of Southern Bhutan (called Lhotshampa, or “southerners”)
• Lhotshampa retained Nepali and Hindu customs, but lived in peace with the Drukpa (Buddhist elite) majority for many years
• 1989: “One Nation, One People” policy of ethnic cleansing: Drukpa culture imposed on all Bhutanese
• Torture, sexual assault and murder forced over 130,000 Lhotshampa to flee Bhutan
• These refugees spent decades of their lives in camps in Nepal (many still remain there)
• Over 68,000 have resettled to the USA, many coming to South Philadelphia ^[2]

Decision-Making In Accessing The Emergency Department Versus Primary Care, Lev Malevanchik, Rickie Brawer, Mph, Phd, Priya Mammen, Md, Mph, Bernard Lopez, Md, Ms

CwiC-PH

• 95% of emergency department (ED) visits from patients living in Jefferson’s (TJUH) community benefit area (CBA) were for conditions with lower priority

Emergency Severity Index (ESI) numbers of 3, 4, or 5 in FY 2011 & 2012.

– Many of these visits were non-emergent.

• The aim of this study was to document how community members chose between going to the ED or their primary care physician (PCP).

An Overview Of The Healthcare System In Argentina, Derya Arkonac

CwiC-PH

Poster outlines:

1. The Health Care System
2. The Population
3. The Politics
4. Conclusion

A Place For Mindfulness In Successful Addiction Recovery, Susannah Eckman

CwiC-PH

The difficulties that women face during substance abuse recovery and re-integration into society after incarceration are staggering in number and combined severity. Over the last several decades, a substantial body of research has investigated the psychological, neurobiological, and public health aspects of the actual experience – as well as the sustained perception of – resource depletion that everyday life in low-income communities creates. The tide of research is now headed towards evaluating new treatment strategies that respond to the understanding gained from this research. Mindfulness Training (MT) is one strategy that promises particular efficacy in addressing the root of these …

An Assessment Of Food Insecurity In A Lower North Philadelphia Community Health Center, Carly Sedlock, James D. Plumb, Md, Mph, Rickie Brawer, Mph, Phd

CwiC-PH

Food insecurity describes the inability to access enough food at all times to lead an active, healthy life. While food insecurity is associated with several negative health outcomes, screening for food insecurity in the clinical setting is not consistently performed. The goals of this pilot study were to: explore the prevalence of food insecurity among patients attending St. Elizabeth's Wellness Center in Lower North Philadelphia, explore the impact of food insecurity on health and disease management, and assess how to better address food insecurity in the primary care setting.

Case Series On Veno - Venous Extracorporeal Membrane Oxygenation (Vv-Ecmo) As A Bridge To Complete Recovery In Influenza Type A Related Refractory Ards, Renganaden Sooppan, Md, Nicholas C. Cavarocchi, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Michael Baram, Md, Hitoshi Hirose, Md, Phd

Department of Surgery Faculty Papers

Introduction:

Influenza A sequelae range from mild symptoms to acute respiratory distress syndrome (ARDS), which can be refractory to conventional ventilator therapy. We present a case series of three non-H1N1 Influenza patients with ARDS, who completely recovered after VV-ECMO.

Case Presentation:

In January and February 2013, we experienced three cases of Influenza A induced ARDS that failed conventional ARDS ventilator therapy. All three patients presented with typical flu-like symptoms, which deteriorated over several days, requiring intubation. They were all treated with oseltamivir. They had bilateral chest infiltrates on chest x-rays. After a few days of failing conventional treatment these patients …

Does Skin Pigmentation Effect Readings Of Cerebral Oximeter Devices While On Cardiopulmonary Support?, Christine Feldmeier, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Nicholas C. Cavarocchi, Md, Hitoshi Hirose, Md, Phd

Department of Surgery Faculty Papers

Introduction:

Cerebral oximetry is utilized as a non-invasive method to ensure adequate cerebral perfusion. In a review of our clinical experience, it was noted that there were consistent inaccurate values from normal utilizing relative (INVOS, Covidien, Mansfield, MA) cerebral oximetry as opposed to absolute (FORESIGHT, CAS medical, Branford, CT) cerebral oximetry in darker skin patients.

Presented 24th Annual ELSO Conference. Philadelphia, PA. Sep 19-21, 2013.

Efficacy And Safety Of Infliximab In Older Inflammatory Bowel Disease Patients, Christina Cress Lindenmeyer, Md, Stephanie M. Moleski, Md, Maureen P. Whitsett, Med., Patricia L. Kozuch, Md

Division of Gastroenterology and Hepatology Faculty Papers

Background:

The limited data regarding treatment of inflammatory bowel disease (IBD) with anti-tumor necrosis factor antibodies in older patients suggest equal efficacy but higher morbidity and mortality compared to younger patients. This retrospective case control study aims to clarify the efficacy and safety of infliximab (IFX) in older IBD patients.

Giving Back: Physiatry, Program & Patients, Seyed Amir Tahaei, Md, John F. Ditunno, Jr, Md, Frank Naso, Md, John L. Melvin, Md

Department of Rehabilitation Medicine Faculty Papers

“Giving Back” is a Jefferson tradition beginning with Dr. William Schmidt (JMCF1917-1959), who together with Dr. Frank Krusen (JMC 1921) served as Presidents of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) in 1943 and 1941 respectively. Other Jefferson graduates and faculty have also served as President of the Academy including Drs. Bender (1973), Ditunno (1981), Reinstein (1993), Melvin (1998) and recent presidents in 2009-2013, Betsy Sandel (JRR 1984), Mike Lupinacci (Jefferson Resident teaching faculty) and Alberto Esquenazi (JMCF 2000). Both Krusen and Schmidt were founding members of the American Board of PM&R in 1947. Over the years many …

The Fieldwork Planning Matrix – Maximizing The Learning Environment In Non-Traditional Community Based Settings, Arlene Lorch, Otd, Otr/L, Ches, Tina Angelis, Edd, Otr/L

Department of Occupational Therapy Posters and Presentations

OBJECTIVES

•Learn about a matrix guided tool utilized to plan and structure unique fieldwork experiences.

•Identify key elements associated with “matrix” implementation.

•Understand multi-faceted uses of the manual.

BACKGROUND - NONTRADITIONAL FW

•More community-based sites are needed to meet FW placement demand

•Typically, these FW sites rely upon non-traditional, distant supervision.

•These learning environments require high degree of structure to support experiential self-directed learning

•High structure requires detailed planning

•A planning matrix method to maximize the learning environment is proposed.

Creating An Infrastructure To Support Faculty Outcomes Research On Teaching And Learning, Susan Toth-Cohen, Phd, Otr/L, Susan Wainwright, Phd, Pt

Department of Occupational Therapy Posters and Presentations

This presentation discusses the Teaching and Learning Initiative (TLI), a comprehensive program for building faculty capacity to design and implement educational research in a school of health professions. The TLI is a staged program based on Eade's (1997) approach to capacity building, which the authors apply to the academic environment. The TLI consisted of 4 stages:

1. Initial planning and data gathering.

2. Training faculty in educational outcomes research.

3. Faculty submission of educational outcomes research for intramural funding.

4. Participatory action research approach to further develop faculty capacity for the scholarship of teaching and learning, including educational outcomes …

Care In Columbia: What We Can Glean From South American Medicine, Neil Flannery Haidorfer, Robert Simmons, Drph, Mph, Mches, Cph

CwiC-PH

The information presented is the product of a two month international rotation at Medellin General Hospital and the non-profit pediatric clinic, Santa Ana through an academic affiliation with La Universidad CES in Medellin, Antioquia. The goal of the rotation was to obtain an understanding of healthcare in Columbia and identify potential practices that could be utilized in the U.S.

An Organization-Wide Service Improvement Approach, Jennifer Jasmine Arfaa, Phd, Mhsa, Cynthia Line, Phd, Nora Kramer, Msn, Rn, Karen Montoro, Rn, Richard D. Blob,, Maria Francesco, Jaime Stazi, Rn, Elisabeth Kunkel, Md, Susan Krekun, Md, Lizanne Mason, Rn, Kathy Evans, Rn, Lorraine Weikel, Rn, Ann D. Clark, Ms, Otr/L, Ray Wisniewski, Teresa Heavens

Department of Nursing papers and presentations

APPROACH TO PROBLEM SOLVING

High priority index questions from HCAHPS and Press Ganey surveys, including overall ratings, communication with RNs and MDs, hospital environment and response to concerns and complaints, were targeted for improvement. These high priority indices served as the basis for redesigning Patient Services using a multi-faceted approach to improve patients’ experiences.

At Thomas Jefferson University Hospital (TJUH), high performance on the Patient Experiences of Care Survey has been driven by a successful multi-tiered approach to patient services:

·Hospital leadership guided and implemented new approaches to ensure excellence in patient services is an ever-present and obtainable goal

·Physician …

Clevidipine For Acute Blood Pressure Management In The Neurological Intensive Care Unit, Dorota K. Szarlej, Pharmd, Jessica L. Mckeon, Pharmd, Akta S. Patel, Pharmd, Bcps, Amber King

College of Pharmacy Faculty Papers

Clevidipine is a third generation intravenous dihydropyridine calcium channel antagonist approved for treatment of acute hypertension when oral therapy is not feasible or desirable. It is an arterial vasodilator that is metabolized by plasma esterases; therefore, it is eliminated independently of the liver and kidney.1 Clevidipine has been studied for the control of perioperative hypertension2-5 as well as for the management of hyper-tensive crises6 when immediate blood pressure control is clinically necessary. Benefits include its tolerability, rapid onset and offset, and easy titration with predictable response. Other continuously infused intravenous antihypertensives used in the neurocritical care patient population include nicardipine, …

A Cost Reducing Ecmo Model: A Single Institutional Experience., En Yaw Hong, Suzanne Wallace, Amy Tropea, Jaime Byrne, Msn, Rn, Hitoshi Hirose, Md, Phd, Harrsion Pitcher, Md, Nicholas C. Cavarocchi, Md

Department of Surgery Faculty Papers

Background: The demand for ECMO support has grown. Its provision remains limited due to several factors (high cost, complicated technology, lack of expertise) which increase healthcare cost. Our goal was to assess if an ICU run ECMO model (without continuous bedside perfusion) would decrease costs while maintaining patient safety and outcomes.

Method: We performed a retrospective review that analyzed the cost and safety benefits of a newly implemented ICU-run ECMO unit from 2011-2012. The program consisted of a dedicated ICU involving multidisciplinary providers (ICU RN, mid-level providers and intensivists). In year one, we introduced an education platform, new technology and …

Physician Care: Best Practices In Patient-Centered Care, Elisabeth Kunkel, Md, Susan Krekun, Md, Jennifer Jasmine Arfaa, Phd, Mhsa, Eleanor Gates, Msn, Rn, Mary Ann Mcginley, Phd, Rn, Leo Katz, Md, Andrew Miller, Md, Mph, Cynthia Line, Phd, Teresa Heavens

Department of Psychiatry and Human Behavior Faculty Papers

APPROACH TO PROBLEM SOLVING

During fiscal year 2013, TJUH targeted “communication with physicians” for improvement as this HCAHPS domain was at 76% (trended July to September, 2010). The primary challenge to improving this score was that of physician investment and buy-in.

Engagement of physicians was achieved through the creation of the Physician CARE (Communication, Attention, Respect, and Expertise) task force. Identified as essential for success were:

·Investment by physician specialty departments/stakeholders

·Strong support by hospital leadership and the engagement of physician stake holders and physician leaders

·Increasing physician understanding of and access to patient experience scores

Trans-Sacrococcygeal Joint Ganglion Impar Injection For Treatment Of Pudendal Neuralgia (3 Cases Report), Matthew Mcauliffe, Md, Linqiu Zhou, Md

Department of Rehabilitation Medicine Faculty Papers

History

Three patients, 2 male and 1 female were diagnosed with pudendal neuralgia. The female patient developed pudendal neuralgia secondary to post-herpetic neuralgia. The two male patients were caused from likely repetitive sitting injury. One patient was a truck driver causing him to sit for long periods of time and the other patient was a professional writer. The three patient initially all attempted conservative therapies, however their pain persisted. They elected to undergo Trans-sacrococcygeal joint ganglion impar injection for treatment of pudendal neuralgia.

Left Ventricular Thrombus Found In A Patient With Ards And Stress-Induced Cardiomyopathy Requiring Veno-Arterial Ecmo., Shreya Gupta, Bs, Joseph Miessau, Ms, Harrsion Pitcher, Md, Michael Baram, Md, Nicholas C. Cavarocchi, Md, Hitoshi Hirose, Md, Phd

Department of Surgery Faculty Papers

Presentation:

68 year-old male with a history of acute leukemia with complete remission after bone marrow transplant 4 months ago, coronary disease s/p LAD stents about 14 years ago with no chronic anti-platelet medication, and repeated episode of DVT despite appropriate anti-coagulation, presented with viral pneumonia (rhinovirus).

New Phenotype Of Parsonage-Turner Syndrome Involving Radial And Proximal Median Nerve: A Case Report, Matthew Mcauliffe, Md, Nancy Vuong, Md, Adam L. Schreiber, Do

Department of Rehabilitation Medicine Faculty Papers

History

A 74-year-old woman developed sudden severe left shoulder, arm, and forearm pain that suddenly developed. This pain lasted approximately 2 months. Approximately 1-2 months after the resolution of the first pain she developed a different type of pain which she described as a tingling, burning, pins and needle sensation that radiated from her shoulder past her elbow into the dorsal and palmar aspect of her hand in the thumb, index, and long fingers. Additionally, she developed numbness in her hand along the palmar thumb, index, and long fingers. Two months following the onset of the initial type of pain, …

Using Nursing Knowledge To Improve Health Literacy, Michele K. Savin, Msn, Nnp-Bc

College of Nursing Faculty Papers & Presentations

Health Literacy: an ability to obtain and understand written, oral, and numerical health information, which allows people to make appropriate healthcare decisions for themselves and their family members.

The Problem:

*Low Health Literacy affects up to twenty percent of the adult population in the US and is not correlated with highest education achieved.

*Hospitals and healthcare professionals are increasingly being held accountable to create systems of care that address this issue with every patient encounter.

*AHRQ talks about implementing Universal Literacy Precautions.