Medicine and Health Sciences Commons^™

Multinational Comparative Cross-Sectional Survey Of Views Of Medical Students About Acceptable Terminology And Subgroups In Schizophrenia, Shanaya Rathod, Muhammad Irfan, Rachna Bhargava, Narsimha Pinninti, Joseph Scott, Haifa Mohammad Algahtani, Zhihua Guo, Rishab Gupta, Pallavi Nadkarni, Farooq Naeem, Fleur Howells, Katherine Sorsdahi, Kerensa Thorne, Victoria Osman-Hicks, Sasee Pallikadavath, Peter Phiri, Hannah Carr, Lizi Graves, David Kingdon

Rowan-Virtua School of Osteopathic Medicine Departmental Research

AIM: The aim of this study was to inform thinking around the terminology for 'schizophrenia' in different countries.

OBJECTIVES: The objective of this study was to investigate: (1) whether medical students view alternative terminology (psychosis subgroups), derived from vulnerability-stress models of schizophrenia, as acceptable and less stigmatising than the term schizophrenia; (2) if there are differences in attitudes to the different terminology across countries with different cultures and (3) whether clinical training has an impact in reducing stigma.

DESIGN: This is a cross-sectional survey that examined the attitudes of medical students towards schizophrenia and the alternative subgroups.

SETTING: The study …

Inactivation Of Hepatic Atrx In Atrx Foxg1cre Mice Prevents Reversal Of Aging‐Like Phenotypes By Thyroxine, Megan E Rowland, Yan Jiang, Frank Beier, Nathalie G Bérubé

Paediatrics Publications

ATRX is an ATP‐dependent chromatin remodeler required for the maintenance of genomic integrity. We previously reported that conditional Atrx ablation in the mouse embryonic forebrain and anterior pituitary using the Foxg1cre driver causes reduced health and lifespan. In these mice, premature aging‐like phenotypes were accompanied by low circulating levels of insulin‐like growth factor 1 (IGF‐1) and thyroxine (T4), hormones that maintain stem cell pools and normal metabolic profiles, respectively. Based on emerging evidence that T4 stimulates expression of IGF‐1 in pre‐pubertal mice, we tested whether T4 supplementation in Atrx Foxg1cre mice could restore IGF‐1 levels and ameliorate premature aging‐like phenotypes. …

An "Exercise" In Cardiac Metabolism, Stephen C. Kolwicz Jr.

Health Sciences Faculty Publications

Research has demonstrated that the high capacity requirements of the heart are satisfied by a preference for oxidation of fatty acids. However, it is well known that a stressed heart, as in pathological hypertrophy, deviates from its inherent profile and relies heavily on glucose metabolism, primarily achieved by an acceleration in glycolysis. Moreover, it has been suggested that the chronically lipid overloaded heart augments fatty acid oxidation and triglyceride synthesis to an even greater degree and, thus, develops a lipotoxic phenotype. In comparison, classic studies in exercise physiology have provided a basis for the acute metabolic changes that occur during …

Lung Cancer Risk And Low (≤50 Μg/L) Drinking Water Arsenic Levels For Us Counties (2009⁻2013)-A Negative Association., Steven H Lamm, Isabella J Boroje, Hamid Ferdosi, Jaeil Ahn

Pediatrics Faculty Publications

While epidemiologic studies clearly demonstrate drinking water with high levels of arsenic as a significant risk factor for lung cancer, the evidence at low levels (≤50 μg/L) is uncertain. Therefore, we have conducted an ecological analysis of recent lung cancer incidence for US counties with a groundwater supply of <50 μg/L, the historical limit for both the EPA and WHO. Data sources used included USGS for arsenic exposure, NCI for lung cancer outcome, and CDC and US Census Bureau forcovariates. Poisson log-linear models were conducted for male, female, and total populations using for exposure median county arsenic level, maximum arsenic level ≤50 μg/L, and ≥80% population groundwater dependency. Statistically significant negative associations were found in each of the six models in which the exposure was limited to those who had major exposure (≥80% dependency) to low-levels of arsenic (≤50 μg/L). This is the first large ecological study of lung cancer risk from drinking water arsenic levels that specifically examined the dose-response slope for populations whose exposure was below the historical limit of ≤50 μg/L. The models for each of the three populations (total; male; female) demonstrated an association that is both negative and statistically significant.

Effective Hepatitis C Screening In High Risk Populations, Aekata Shah, Do, Jennifer Seymour, Do

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

Purpose

The purpose of our study was to demonstrate how various quality improvement initiatives activated in selected Jefferson Northeast family medicine teaching offices have enabled effective HCV screening. Given the cost effectiveness of screening and early treatment versus treatment of the disease in the later stages of progression,8 we hope to encourage other primary care offices to implement quality initiatives to encourage appropriate HCV screening. This is especially important for the baby boomer generation, as well as for high risk individuals with a history for and/or current IV drug abuse or other high risk behaviors.

Improving Advanced Care Planning Documentation In The Outpatient Setting, Carly Sedlock, Md, Tatiana Bekker, Md, Tara Sunder, Md, Mario Caldararo, Md, Divya Chalikonda, Md, Newton Mei, Md

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

Aims

We aimed to increase Jefferson Hospital Ambulatory Practice (JHAP) electronic medical record documentation of advanced care planning discussion of 209 identified “high risk” patients via independently labeled ACP notes by 5% (from 1.4% to 6.4%) over a six-month period (October 1, 2017- April 1, 2018).9 We elected to focus this pilot project on high risk patients due to time constraints of the study period and we felt that these high risk patients would likely derive the most benefit from ACP planning in the outpatient setting.

Hey, What’S The Delay? An Evaluation Of Reporting Time For Pediatric Eegs, Aparna Polavarapu, Md, Rachit Patil, Md, Maromi Nei, Md

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

Aim

To determine if there is a reduction in time to EEG reporting after institution of the Pediatric Epilepsy fellowship track.

A Provider-Based Survey On Quality Of Care And Identification Of Quality Gaps In Inpatient Palliative Care, Adam Pennarola, Md, Mph, Matthew Murphy, Md, Elizabeth Collins, Md, Beth Wagner, Msn, Crnp, Achpn, John Liantonio, Md

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

Background

Inpatient Palliative Care Teams (IPCTs) are often called upon to provide multidisciplinary care across hospital settings at Jefferson. However, there is currently no mechanism in place wherein providers consulting the IPCT can provide feedback to specialty palliative care clinicians. Such input from providers could be used to elucidate those services provided by the team which are most appreciated and those which require further development in order to be truly effective. Furthermore, such input may also serve to identify completely new areas for inpatient palliative care needs.

Establishing Cost-Effective Management Of Postoperative Urinary Retention After Spine Surgery, Nikolaos Mouchtouris, Md, Catriona Harrop, Md, Edward Kloniecke, Md, Victoria English, Crnp, David Wyler, Md, Kamini Patel, Rn, Mba, Ashwini Sharan, Md, James Harrop, Md

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

Goal

Our goal is to develop evidence-based guidelines that:

1. streamline the order/timing of interventions in patients who develop PUR after spine surgery
2. identify those at high-risk of long-term urinary retention that require further workup
3. minimize the rate of PUR –goal is to reduce to 3.5% in FY 2019
4. and determine the cost savings from our intervention when applied to all surgeries

Improving Resident Confidence And Efficiency During Stroke Alerts Through Simulation Training, Megan Margiotta, Md, Danielle Wilhour, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Maria Carissa Pineda, Md, Fred Rincon, Md, Rodney Bell, Md, Diana Tzeng, Md

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

Objectives

• Teach incoming neurology residents how to respond efficiently and appropriately to stroke alerts
• Improve the confidence level of residents during stroke alerts

Standardized Discharge Instructions And Their Impact On Post Operative Patient Knowledge, Nikolaus Hjelm, Md, Gregory Epps, Md, Ryan Rimmer, Md, Lauren Bogdan, Md, Erin Reilly, Md

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

After every surgery, surgeons send their patients home with discharge instructions. The information is intended to educate the patients about their postoperative care and how to safely care for themselves upon returning home. Each surgeon reviews and approves the discharge instructions before they are given to their patients. This information is once again reviewed by the patient’s nurse before the patient leaves the hospital.

Within a large hospital, there are often several surgeons within each specialty that perform the same surgeries. The department of Otolaryngology at Thomas Jefferson University Hospital is no exception. Within otolaryngology there are several subspecialties. At …

Optimizing Physical Therapy Sessions Among Patients Undergoing Elective Lumbar Surgery, Ellina Hattar, Md, Kelly Hufford, Dpt, Marie Wilson, Rn, James Harrop

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

Background

Physical therapy is imperative in achieving early mobilization, thereby reducing morbidity of immobility such as venous thrombolic events, improving postoperative pain, and facilitating appropriate disposition among patients who have recently undergone spine surgery. At TJUH, patients undergoing elective spine surgery are planned to engage in physical therapy (PT) twice a day. There are however several impediments that may limit the ability of patients to adequately participate in PT.

Order From Order Sets: Analysis Of Ordering Patterns And Patient Outcomes Before And After Order Set Changes On The Inpatient Psychiatry Units At Tjuh, David Halpern, Md

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

Aims

Short Term

To decrease the total number of times one-time orders were added for patients for Vistaril, Remeron, Melatonin, Colace, Senna, and MiraLAX. Increase number of times urine PCP and urine oxycodone added to the urine drug screen.

Long Term

To decrease overall length of stay and improve treatment outcomes

Adequate Patient Education - The Key To Improving Patient Experience While Being Under Contact Precautions?, Edosio Eloho, Md, Mary Naglak, Phd, Doron Schneider, Md, Hadiatou Barry, Md, Babatunde Ogunnaike, Md, Puneet Dhillon, Md, Neethu Gopisetti, Md

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

Objectives

To improve patient satisfaction with the quality of education provided about CP by at least 30% by the end of 7 months. Through the provision of a standardized patient education sheet to hospitalized patients placed on CP within their first 24 hours being placed under contact isolation.

Implementation Of A Volunteer-Based Hospital Program For Older Adults, Elizabeth Collins, Md, Kristine Swartz, Md

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

Background

• A multi-faceted, volunteer-led, hospital-based program1has been shown to: •Reduce the incidence of delirium •Decrease hospital length of stay •Reduce hospital costs.
• Implementation of such a program requires upfront investment.
• A smaller, volunteer-based visitation program for older adults may provide support for the allocation of more hospital resources in delirium prevention and establishment of a formal Hospital Elder Life Program1in this institution.
• This research aims to investigate: •If the implementation of a visitation program is feasible at this hospital •Volunteer experience with the program.

Improvement In Patient Safety Through “Irrigation Time-Outs” During Turp Procedures, B. L. Deiling, Do, E. Kilmartin, Md, T. L. Kennedy, Md

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

Objective

During any surgical procedure, clear and standardized communication among surgeons, anesthesiologists and operating room nursing staff is a necessity for all aspects of patient safety. During TURP procedures, the perioperative staff must alert team members of the signs and predictors for the potential of TURP syndrome or NSS overload. The goal of our quality improvement project is to increase communication and diagnostic actions based on irrigation fluid amounts among surgeons, anesthesiologists, and the operating room nurses in order to decrease complications in TURP patients at Jefferson over the next six months.

Handoff Training In Undergraduate Medical Education – Identifying And Closing The Gaps, Gregory Troutman, Jeffery Head, Andrew Day, John Hafycz, Lauren E. Grunenwald, Kelly Daniels, Kevin He, Rebecca Montana, Alexis Wickersham, Md

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

Objectives:

• Our study sought to assess differences in perceptions and the use of standardized handoff tools between medical students near completion of their third and fourth years of medical school at Sidney Kimmel Medical College.
• We hope to use this information to create targeted medical education interventions to better expose pre-clinical medical students to standardized handoff tools in the first and second years of medical school, before entering the wards.

The Effects Of Office-Based Interventions To Increase Patient Enrollment In An Online Electronic Medical Record Portal, Lionel Mcintosh, Md, Allison Rague, Md, Claire Thesing, Md, Amy Lachewitz, Md, Gillian Love, Md, Daniel Sizemore, Md, Zachary Klock, Md, Aimee Mcmullin, Md, Zeynep Uzumcu, Md, Patrick Mcmanus, Md

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

We aimed to increase the number of JFMA patients signed up with MyChart by 50% over a 5 month time frame by educating providers and staff on ways to implement patient portal sign up into the office visit as well raising awareness of the portal for both providers and patients

Bad Out Of The Box: A Report On Pre-Operative Failure Rates Of Reusable Flexible Ureteroscopes At A Single Institution, Whitney R. Smith, Brian P. Calio, Scott G. Hubosky, Kelly A. Healy, Demetrius H. Bagley

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

Purpose: Single-use flexible ureteroscopes offer the advantage of being consistently functional and perfect for immediate clinical use right “out of the box.” Cost is the barrier to widespread acceptance of these instruments. Economic models have been put forth which compare the expense of acquiring and maintaining reusable flexible ureteroscopes to that of using single-use flexible ureteroscopes.However, one poorly defined variable in these models is the frequency of encountering an unsuitable reusable flexible ureteroscope at the beginning of a case. We sought to define this in a consecutive series of patients undergoing flexible ureteroscopy.

Patients and Methods: Prospective analysis of all …

Awareness During An Intensive Care Unit Procedure: A Root Cause Analysis And Creation Of The D5 Handoff Tool, Elise Strickler, Do, Bryan Lutman, Do

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

Objectives

The objectives of this study are to:

1. perform root cause analysis of the systemic causes of an incident of awareness that occurred during bedside EGD and
2. create a handoff tool that is easily remembered that conveys the essential information about ICU intubations.

Utilizing Feedback As A Mechanism To Improve Resident Event Reporting Rates, Grant Turner, Md, Kristin Lohr, Md, Ben Jones Jr., Md, Emma Lundsmith, Md, Megan Margiotta, Md, Riti Kanesa-Thasan, Md, Bracken Babula, Md, Rebecca C. Jaffe, Md

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

Objectives

• Provide feedback to 100% of residents entering a report between December 2017 and March 2018
• Evaluate the degree to which residents value the feedback we were able to provide
• Assess a pilot process for sustainability on a larger scale

Get With The Rhythm – Telemetry Education In Internal Medicine Residency, Rashesh Shah, Md, Hanna Sofie Ellingsen, Md, Molly Halloran, Md, Reetu Mukherji, Md, Juergen Kloo, Md, Yair Lev, Md

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

Aim

• Our aim was to design and implement cardiac monitoring education for medical residents in order to help residents feel more comfortable navigating and assessing telemetry.
• Our objective was to create and pilot a telemetry education video among Internal Medicine residents (from March to May 2018) resulting in a 75% increase in ability to demonstrate essential telemetry skills as determined by a pre and post video assessment.

Prevention And Screening Of Vte In Sci Patients At Thomas Jefferson University Hospital, Erika Dillard, Md, Phd, Yusef Mosley, Md, Joshua Marks, Md, Christina Jacovides, Md, Geoffrey Ouma, Md, James Harrop, Md

Department of Neurosurgery Posters

Currently no protocol exists for thromboprophylaxis (TPx) and screening in SCI patients at TJUH. As such, often patients are either not started on TPx or are started on an inappropriate regimen depending on admitting team preference. In addition, patients often receive an admission DUS then weekly thereafter as a screening mechanism for DVT even if asymptomatic.

Our goal is to determine the effectiveness of our current method for initiating pharmacological TPx as well as efficacy and cost of our current screening method compared to national guidelines by addressing these questions:

• What is the occurrence of VTE in SCI patients at …

Atrx Mutation In Pineal Parenchymal Tumor Of Intermediate Differentiation, Michelle Nagurney, Md, Christopher Farrell, Md, Zi-Xuan Wang, Phd, Mark T. Curtis, Md

Department of Pathology, Anatomy, and Cell Biology Posters

Objectives

Based on our identification of an ATRX mutation in a PPTID of a 22 year old female, we analyzed the frequency of ATRX loss in pineal parenchymal tumors using ATRX immunohistochemical staining.

The Use Of Online Cbt-I At Jefferson Sleep Disorder Clinic: A Quality Improvement Study, Kathy Tran, Do, Ritu Grewal, Md

Department of Sleep Medicine Posters

Objectives

We propose to introduce online CBT-I into our patient practice by distributing flyers to patients who complain of insomnia. We have made flyers available in all the exam rooms and educated physicians, nurse practitioners and staff. We will then review charts after the intervention period to evaluate for an increase in recommendation for CBT-I as a treatment option and education for patients.

Improving Follow-Up For Family Medicine Patients After Hospital Discharge, Erica Li, Md, Rebecca Simon, Md, Michael Weissberger, Md, Angela Silverman, Md, Mpg, Bryan Botti, Md, Laura Emerson, Md, Zoe Agoos, Md, Rachel Ehrman-Dupre, Md, Jennifer Moyer, Md, Andrew Rabovsky, Md, Geoffrey Mills, Md, Phd

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

Aims

• Increase percentage of JFMA patients with follow-up appointment scheduled after discharge to 100% by March 2018
• Increase percentage of JFMA patients who show up to their follow up appointments after discharge to 80% by March 2018

The ‘Med History Note’: A Standardized Method Of Reducing Medication History Errors Among Internal Medicine Residents In A Teaching Hospital, Odunayo Banjoko, Md, Babatunde Ogunnaike, Md, Genene Amoia-Pigliacelli, Pharmd, Doron Schneider, Md

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

Problem Statement

According to the institute of medicine’s preventing medication errors report, the average hospitalized patient is subject to at least one medication error per day. Errors have been known to occur during admission, transfer and discharge of patients. An accurate medication history on admission is crucial and can go a long way in preventing medication reconciliation errors. Of note, more than 40% of medication errors occur from inadequate reconciliation, during admission, transfer and discharge of patients. Of these, 20% result in harm.

Improving Medical And Endovascular Management For Acute Ischemic Stroke Through Multidisciplinary Education And Simulation, Richard F. Schmidt, Md, Megan Margiotta, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Robin Dharia, Md, Maria Aini, Md, Diana Tzeng, Md, Fred Rincon, Md, Pascal Jabbour, Md, Nabeel Herial, Md

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

Primary goals:

1. Reduce door to treatment times (both DTN and DTP) to meet and exceed existing guidelines metrics.
2. Educate residents about acute stroke management, including national guidelines and new institutional protocols to improve efficiency during stroke alerts.

Central Line Cart: An Emergency Department Initiative To Improve Efficiency, M. Ahmed, Md

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

Background

• Critically ill patients that present to the emergency room often require time sensitive resuscitative measures, which often necessitates placement of a central venous catheter.
• Efficient placement of a central venous catheter is often limited by the time it takes to gather the number of supplies needed for the task.
• It is already known that central venous catheter procedure carts and kits decrease the incidence of central line associated bloodstream infections (CLABSIs)1 as well as reduce the incidence of procedural mistakes during central line insertion2
• However, there is a paucity of data in regards to the impact of central line …

Process Improvement For Endovascular Thrombectomy In Patients Presenting With Acute Ischemic Stroke, Richard F. Schmidt, Md, Michael J. Lang, Md, Robin Dharia, Md, Fred Rincon, Md, Thomas Zdanowski, Rn, Msn, Robin D'Ambrosio, Rn, Msn, Stavropoula Tjoumakaris, Md, M. Reid Gooch, Md, Pascal Jabbour, Md, Nabeel Herial, Md

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

Aims

1. Critically evaluate the existing stroke activation and ET protocols for compliance with new 2018 metrics and guidelines.
2. Review DTP times under the existing protocol to assess for potential inefficiencies or gaps in care delivery, specifically addressing differences between processes at JHN compared to ED/Gibbon.
3. Make changes to the existing stroke alert protocol to better reflect current guidelines, streamline care, and ultimately improve process metrics (DTP times).
4. Establish a system for recursive continuous analysis of AIS patients to identify protocol gaps, inefficiencies and areas for further intervention.