Medicine and Health Sciences Commons^™

From The Editors, Colin Thomas, Md, Eitan Frankel, Md, Guy Katz, Md, Michael Weintraub, Md, Brianna Shinn, Md, Navdeep Sangha, Md, Rachel Redfield, Md, Mario Caldararo, Md

The Medicine Forum

We are delighted to present you with the 20th annual edition of The Medicine Forum. Here in the birthplace of our nation, we like to think of The Medicine Forum as being of the housestaff, by the housestaff and for the housestaff. Undeniably, this publication would not be possible without the countless hours dedicated by our residents, students, fellows and faculty.

From The Desk Of The Residency Program Director, Emily Stewart, Md

The Medicine Forum

It has been another wonderful year in the Jefferson Internal Medicine Residency Program. Our program continues to train the best and brightest residents in the country. This publication is just one example of the passion, dedication and creativity our residents continue to provide to the Jefferson Community. The residents are not just outstanding clinicians but excel in all aspects of medicine including: research, humanities and medical education.

The Medicine Forum: Volume 20

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 20, 2018-2019

TABLE OF CONTENTS

Clinical Images

Case Reports

• Cardiology
• Endocrinology
• Gastroenterology and Hepatology
• Hematology and Oncology
• Infectious Disease
• Pulmonary Medicine
• Rheumatology

Original Article

Editorial

Literature Review

Creative Writing

Gender Competence And Quality Of Care, Mary E. Losacco

Grace Peterson Nursing Research Colloquium

Gender Competence and Quality of Care:

What is the Role of Healthcare Providers in Transgender Healthcare Disparities?

An Integrative Literature Review

Mary Losacco

Faculty Sponsor: Elizabeth P. Anderson RN, PhD

Background: Unlike cisgender individuals, whose gender identities match the sexes they were given at birth, transgender individuals exhibit gender incongruence, because their gender identities differ from the sexes they were assigned at birth. Transgender individuals are still underrepresented in research and reporting, leading to obstacles in understanding possible health disparities within the community due to lack of recognition and knowledge of these issues. Early recognition by health care providers …

Coping Mechanisms Commonly Used In Asian-American Patients Diagnosed With Breast Cancer: An Integrative Review Of The Literature, Kathy Hoi-Yan Leung

Grace Peterson Nursing Research Colloquium

Coping Mechanisms Commonly Used in Asian-American

Patients Diagnosed with Breast Cancer:

An Integrative Review of the Literature

Kathy Leung

Background: Having breast cancer can be a difficult experience to navigate through. Ethnic minorities can encounter many challenges physically and psychologically.

Objective: To explore the different coping mechanisms of Asian Americans with breast cancer or are breast cancer survivors.

Method: An integrative literature review design was conducted using the framework constructed by Whittemore and Knafl (2005), was conducted. A computerized search was used using Cumulative Index to Nursing and Health Literature (CINAHL), Nursing & Allied Health Database, Health Source: Nursing/Academic Edition, …

Comparing Evidence-Based Emergency Interventions For Seizure Management In The Pediatric Populatin, Samantha Lieven

Grace Peterson Nursing Research Colloquium

Epilepsy affects approximately 470,000 children nation wide. Some of the emergency treatments of an epileptic episode include: rectal diazepam, intranasal midazolam, and vagus nerve stimulation. It is essential to evaluate and research the most effective, cost effective, and accessible treatments in order to provide pediatric patients with optimum quality of life and caregivers with ease of treatment interventions. The purpose of this literature review was to compare evidence-based emergency seizure interventions in children with epilepsy. Evidence reviewed assessed the efficacy, accessibility, and user friendliness of rectal diazepam, intranasal midazolam, and vagus nerve stimulation as emergency seizure interventions. This literature …

Anaerobic Exercise’S Effects On Depression And Depressive Symptoms: An Integrated Literature Review, Peter Douglas Ryckbosch

Grace Peterson Nursing Research Colloquium

Anaerobic Exercise’s Effects on Depression and Depressive Symptoms:

An Integrated Literature Review

Peter Ryckbosch

Research Sponsor Roxanne Spurlark DNP, MSN, FNP, RN

Introduction: This data depicts a startling picture; depression affects a large portion of the population at some point in their life. Pharmacology and psychotherapy are the treatments of choice for the depressed. Half of the depressed clients do not respond well enough to conventional treatments to reach remission from their symptoms (Danielsson et al., 2014; Halter, 2014). Studies have found that exercise for as little as 10 days can help alleviate symptoms. Aerobic exercise has been studied heavily …

School Nursing Interventions To Prevent Childhood Obesity: Integrative Literature Review, Sara Blythe Hewitt

Grace Peterson Nursing Research Colloquium

SCHOOL NURSING INTERVENTIONS TO PREVENT CHILDHOOD OBESITY: Integrative Literature Review

Sara Hewitt

Faculty Sponsor: Elizabeth P. Anderson RN, PhD

Background: Childhood obesity is a serious public health crisis. Obese children are more likely to become obese adults, and are at a higher risk for developing heart disease, type 2 diabetes, and cancer. To date, schools have been the primary target setting to implement obesity prevention programs. While there has been considerable research on these school-based obesity prevention programs, most overlook the school nurse as a potential resource. School nurses can lead BMI screening programs, nutrition and physical education lessons, …

Examination Of The Impact Of Team Sport Participation On Adolescent Male Mental Health: An Integrative Literature Review Proposal, Alicia Ann Foster

Grace Peterson Nursing Research Colloquium

Examination of the Impact of Team Sport Participation on Adolescent Male Mental Health: An Integrative Literature Review Proposal

Alicia Foster

Background: In 2018, the U.S. Department of Health and Human Services (HHS) found that depression impacts almost one in eight adolescents and young adults yearly. They further sited that the number of adolescents who experienced major depressive episodes increased nearly a third from 2005-2014. Also in 2018, the World Health Organization cited that suicide is the third largest cause of death in older adolescents, ages 15-19 years old.

Objectives: The purpose of this integrative literature review is to evaluate the …

Multiracial Health Behaviors And Disparities: An Integrated Literature Review, Elsa Chiyo Alexandra Iwai

Grace Peterson Nursing Research Colloquium

Multiracial Health Behaviors and Disparities:

An Integrated Literature Review

Elsa Chiyo Iwai

Faculty Sponsor: Elizabeth P. Anderson RN, PhD

Background: The year 2000 was a pivotal year for multiracial individuals. Changes to the U.S. Census Bureau included acknowledging multiracial individuals. However, where multiracial individuals and healthcare intersect, the research is relatively new and limited. Multiracial individuals confound many assumptions about race. Uncertainty exists between socially constructed racial categories and populations that have evolved genetic patterns independently over time but fail to fit perfectly within categorical lines. Although social changes has raised awareness on mixed race and multiracial individuals, a deeper …

The Influence Of Significant Screen Time On Mental Health Among Adolescents An Integrative Literature Review, Stephanie Marie Patrick, Caryn Lynn Connors

Grace Peterson Nursing Research Colloquium

The Influence of Significant Screen Time on Mental Health Among Adolescents

Caryn Connors and Stephanie Patrick

Faculty Sponsor: Elizabeth P. Anderson RN, PhD

Background: The adolescent brain is impressionable and not fully developed, in a time when habits and possibly irreversible lifestyles has its origins. This is a crucial period in the adolescent life when educational performance and behavior can influence future promise for success and mental well-being. Anxiety and depression that is ever-present can lead to mortality and morbidity for this age group (Centers for Disease Control and Prevention [CDC], 2012). Increased screen time >2 hours a day (tablet, …

The Efficacy Of Incentive Spirometry In Postoperative Pulmonary Complication Prevention: An Integrative Review, Ziyad Zuhair Thalji

Grace Peterson Nursing Research Colloquium

The Efficacy of Incentive Spirometry in Postoperative Pulmonary Complication Prevention:

An Integrative Review

Ziyad Thalji

Background: Both the postoperative pulmonary complications (PPC) of atelectasis and pneumonia increase risk of fatality among postoperative patients. Pulmonary stasis, as the result of surgery, promotes along with the inability to expel secretions and ventilate the parenchyma the potential for multi-drug resistant pathogens for compromised host entry. Post-operative atelectasis risk occurs when there is reduced respiratory muscle activity and strength for inspiration and expiration. The resultant pooling of secretions can promote the growth of pathogens to a common form known as pneumonia. The incentive spirometer …

Diabetes Distress Differentiation From Depression An Integrated Review Of Literature, Anthony Joseph Warpecha

Grace Peterson Nursing Research Colloquium

Diabetes Distress Differentiation from Depression

An Integrated Review of Literature

Anthony Warpecha

Background and Significance: According to Bennetter, Clench-Aas, and Raanaas (2016), people with diabetes have a higher probability of developing depression. These rates were found to be about 2-3 times as likely for individuals with diabetes to have depression compared to individuals who do not have diabetes (Bennetter et al., 2016). This has profound effects on an individual such as decreased quality of life, complications increase, and a lowered life expectancy (Dieter & Lauerer, 2017). There is also the increase in hospital stays, admissions, and health expenditure. However, more …

Cardiovascular Disease And Rotating Shift Nurses, Rachel Elizabeth Wilschke

Grace Peterson Nursing Research Colloquium

CARDIOVASCULAR DISEASE AND ROTATING SHIFT NURSES

Rachel Wilschke

Faculty Sponsor: Elizabeth Aquino, PhD, RN

Background: Cardiovascular disease is the leading cause of death in the United States. The implications for cardiovascular disease from working rotating shifts requires further review.

Objectives: To determine how working rotating shifts impacts nurses’ cardiovascular health.

Method: An integrative literature review was conducted, searching for peer-reviewed articles published between 2008 and 2018 in the following databases: CINAHL, PubMed and ProQuest. Using the outline from Gray, Grove and Sutherland (2017), data was categorized, analyzed and synthesized in a data matrix table to organize the review.

Results: A …

Sepsis Screening And Morbidity Of Seriously Infected Adult Patients: An Integrative Literature Review, Elizabeth Jeanne Placek

Grace Peterson Nursing Research Colloquium

Sepsis Screening and Morbidity of Seriously Infected Adult Patients:

An Integrative Literature Review

Elizabeth Placek

Faculty Sponsor: Elizabeth P. Anderson PhD, RN

Background: Despite the necessary guidelines that require hospitals and healthcare institutions to adopt a sepsis screening and protocol system, institutions are not required to follow a universal protocol for sepsis management. The quandary this presents to evidenced based practice is that the difference of interpretation by healthcare institutions may not be therapeutic or conducive. There may be a variance and difference in how protocols are followed by healthcare institutions that may be ineffective in preventing untoward outcomes and …

Beneficial Effects Of Mindfulness Based Interventions Used With Spinal Cord Injury Patients; Integrative Literature Review, Sharif Ahmed Rahim

Grace Peterson Nursing Research Colloquium

Beneficial Effects of Mindfulness Based Interventions Used with Spinal Cord Injury Patients An Integrated Review of Literature

Sharif Rahim

Background and Significance: The major psychiatric complication of 20 to 45% after the injury is related to depression (North, 1999). This population has 4 to 5 times of higher rates of suicide which is the leading cause of death. Seventy-five percent of suicides occur within the first 5 years of the injury. High levels of pain and lack of support further increases their status of being at high risk. This population faces a difficult transition filled with stress from the trauma …

Efficacy Of Pain Management Among Opioid-Tolerant Individuals: An Integrative Review Of The Literature, Jeannie Sikich

Grace Peterson Nursing Research Colloquium

Abstract

Background: Opioids are among the most effective drugs for pain management. However, the course of pain management in opioid-tolerant individuals is complicated. An integrative literature review was conducted.

Objectives: The purpose of this integrative literature review is to establish the efficacy of using opioids to treat opioid-tolerant patients and the perspectives of patients and healthcare professionals.

Method: An integrative literature review was used along with Kolcaba’s comfort theory to determine common themes in the literature.

Findings/Results: The literature that was reviewed revealed that opioid-tolerant patients reported feeling as though their course of pain management was insufficient. Research has shown …

Formula And Milk Food Insecurity Amongst Infants And Children In Wic Families, Kristen Hench

Grace Peterson Nursing Research Colloquium

No abstract provided.

Compassion Fatigue And Coping Icu Nursing: An Integrative Review Of Literature, Kamila Barnak

Grace Peterson Nursing Research Colloquium

Abstract

Background: Compassion fatigue and burnout are significant issues among intensive care unit nurses. Many nurses leave their job in the ICU after a few years due to their negative experiences. This is an issue, as many baby boomers are aging and need to be cared for; at the same time many ICU nurses are retiring and need to be replaced. However, there are not a lot of young nurses willing to take their place and the ones who do, leave after a short period of working.

Objective: The purpose of this study is to identify the factors that contribute …

Barriers That Restrict Health Care Access For The Deaf Community And Interventions For Improved Patient Quality Care, Jacqueline Meraz

Grace Peterson Nursing Research Colloquium

Background: Deaf patients have lower levels of health literacy, given less health prevention, more likely to engage in harmful behaviors, and had higher rates of health disparities compared to the hearing population. Deaf people avoid healthcare because of their distrust of healthcare providers, and their previous negative experiences regarding communication issues. Barriers that restrict health care and proposed interventions were studied regarding the deaf patient population to account for these disparities.

Objectives: The purpose of this literature review is to identify barriers that deaf patients face when seeking healthcare and was framed using the Cultural Care Theory.

Method: An integrative …

Risk Factors For Central Line-Associated Bloodstream Infections (Clabsi) In Home Parenteral Nutrition (Hpn) Patients, Megan Ong

Grace Peterson Nursing Research Colloquium

CLABSI, home parenteral nutrition

Effects Of Prenatal Yoga On Labor Pain, Maternal And Newborn Outcomes: An Integrative Literature Review, Gaia Bagordo

Grace Peterson Nursing Research Colloquium

Background: Labor pain management in the U.S. is commonly accomplished with the use of pharmacological pain management. However, pharmacological pain management of labor pain is associated with several adverse effects. New studies suggest that labor pain can be managed using a nonpharmacologic approach. Complementary and Alternative Medicine (CAM) is an alternative method used during pregnancy and childbirth associated with innumerable benefits for mothers and the newborn, including the management of pain during labor.

Objectives: The purpose of this integrative literature review is to analyze the effects and benefits that prenatal yoga, a form of Complementary and Alternative Medicine, …

Healthcare Providers' Attitudes And Biases Regarding Chronic Pain And The Patient-Provider Relationship, Casey Clifford

Grace Peterson Nursing Research Colloquium

Background: Chronic pain affects millions of Americans, and is often underreported, underdiagnosed, and undertreated. The Institute of Medicine has called for a “cultural transformation” in how chronic pain is addressed.

Objectives: The purpose of this literature review was to explore the current research to identify some of the common attitudes and biases that healthcare providers possess toward patients presenting with chronic pain and to determine ways in which the patient-provider relationship can be strengthened in dealing with chronic pain.

Method: An integrative literature review was conducted. Data analysis was performed, and common themes throughout the literature were …

The Benefits Of Using Morbidity And Mortality Conferences In Nursing: An Integrative Literature Review, Kelly Chen

Grace Peterson Nursing Research Colloquium

Abstract

Background: Although morbidity and mortality conferences (MMCs) are well-documented in the physician arena, little has been published on the use of MMCs in nursing.

Objectives: The purpose of this integrative literature review is to determine the perceived benefits of using MMCs in nursing.

Method: An integrative literature review was conducted using the CINAHL Complete, PubMed, and ProQuest Nursing & Allied Health databases. The search terms included: morbidity mortality conferences, M&M conferences, M&M rounds, morbidity mortality rounds, case review conferences, case review meetings, nursing, nurses, safety, quality, errors, improvement, performance, and competence.

Results: Ten studies met the inclusion and exclusion …

Medical Alert Animals For Anaphylaxis Prevention In Patient’S With Mast Cell Diseases: An Integrative Review Of Literature, Molly Gritt

Grace Peterson Nursing Research Colloquium

Medical Alert Animals for Anaphylaxis Prevention in Patients with Mast Cell Diseases:

An Integrated Literature Review

Molly Gritt

Faculty Sponsor: Elizabeth P. Anderson RN, PhD.

Background: Mast Cell Disease is a broad term that covers a variety of conditions that can cause many debilitating systemic symptoms. In severe cases, triggers or allergens can cause the patient to have a life-threatening reaction, anaphylaxis. Anaphylaxis is associated with poor health outcomes, including shock, hospitalizations, and expensive and sometimes invasive interventions. The current way clinicians deal with anaphylaxis is to promote the avoidance of known triggers and to pharmacologically treat the reaction when …

The Effects Of Rape Trauma And Ptsd On The Childbirth Process, Helena Kevorkian

Grace Peterson Nursing Research Colloquium

Abstract

Background: Sexual trauma, including rape and childhood sexual abuse, takes a toll on the survivor emotionally and physically. With the invasive procedures, physical exposure and feelings of loss of control related to childbirth, the survivor may become triggered and become retraumatized. Through an integrative literature review, the effects of rape trauma and PTSD on the childbirth process were identified.

Objective: The purpose of this integrative literature review was to determine the effects of rape trauma and PTSD on the childbirth process. Through determining the effects, a greater understanding will be gained on how to best approach a situation with …

An In Silico Study Of G Protein-Coupled-Receptor Activation, Specifically In The Corticotropin Releasing Factor Receptor And The Glucagon-Like Peptide Receptor, Nicolas Angelo Scorese

Theses and Dissertations

The drug discovery process is an extremely long and expensive process that modern computational methods help to alleviate. Through the use of computational methods, we provide information and insight into the activation methods of class B GPCRs so that future drugs can be developed to have less side effects. The first study focuses on the corticotropin releasing factor receptor, which is a good drug target for anxiety and depression. A mechanism of activation was theorized which focuses less on molecular switches (as has been the focus of several papers) and more on large scale conformation at the intracellular region of …

Effect Of Hyperoxia On Type-1 Diabetic Mouse Model, Samuel Ignatious Bolleddu

USF Tampa Graduate Theses and Dissertations

Administration of Hyperoxia (>90 % oxygen) is a pervasive intervention to supplement respiratory needs in patients admitted in ICU/critical care units. Current literature suggests that prolonged use of Hyperoxia therapy is directly associated with in-hospital mortality. The exact reason for this high mortality under Hyperoxia is unknown. Recent explorations in Dr. Panguluri lab identified that dysregulation of Kv channels plays a vital role in the pathophysiology of Hyperoxia-induced pulmonary and cardiac complications using animal models. The proposed research will focus on the part of Hyperoxia in generating cardiotoxicity and ventricular remodeling in the type-1 diabetes patients using the Akita, …

Associations Between Comorbid Tdp-43, Lewy Body Pathology And Neuropsychiatric Symptoms In Alzheimer's Disease, Ece Bayram, Guogen Shan, Jeffrey L. Cummings

School of Public Health Faculty Research

More than half of the patients with Alzheimer’s disease (AD) have comorbidities including TDP-43 and Lewy bodies, which are also associated with frontotemporal lobar degeneration and dementia with Lewy bodies, respectively. These comorbidities may help explain the overlapping neuropsychiatric symptoms between AD and other dementias. Data on 221 AD patients with Neuropsychiatric Inventory-Questionnaire were obtained from the National Alzheimer’s Coordinating Center. TDP-43 was associated with aberrant motor activity, whereas Lewy bodies were associated with anxiety, irritability, sleep behavior, and appetite problems. The associations between these comorbidities and neuropsychiatric symptoms were more significant for patients with sparse diffuse plaques.

Making Sure Your Voice Is Heard Lgbtqi Documentation For End Of Life, Kenneth J. Mangano Bhas, Mcm

Patient Care Services / Nursing

No abstract provided.