Medicine and Health Sciences Commons^™

Rescue Stenting For Failed Mechanical Thrombectomy Procedures, Joseph Schaefer, Ahmad Sweid, Md, M. Reid Gooch, Md, Pascal Jabbour, Md

Phase 1

Background: Mechanical thrombectomy (MT) has dramatically changed the natural history of acute ischemic stroke. The disease that was associated with high morbidity, mortality, and significant cost on the health care system became a treatable disease. One of the most important variables to improve outcomes is time to revascularize the ischemic tissue. Rescue stenting (RS) is an option for patients who fail MT.

Methods: A retrospective chart review for patients who underwent a MT procedure and either failed (defined as TICI 0-2a) or required a RS from 2015 – 2019 composed the study population. IRB approval was obtained and the consent …

Static Vs. Expandable Peek Interbody Cages: A Comparison Of One-Year Clinical And Radiographic Outcomes For One-Level Tlif, Ryan Nachwalter, Parthik Patel, Md, Alexander R. Vaccaro, Md, Phd

Phase 1

Introduction: Degenerative spine disease is a disabling condition affecting many worldwide. Transoforaminal lumbar interbody fusion (TLIF) procedures help stabilize the spine, while improving back and/or leg pain. With the introduction of new implant designs and modifications, focus has shifted to optimizing spinopelvic alignment, fusion rates, and more. This study aims to explore the effect of static versus expandable polyetheretherketone (PEEK) cages on patient-reported outcomes (PROMs) and radiographic outcomes (subsidence, disk height, and alignment parameters).

Materials/Methods: A retrospective cohort study was conducted using a database of patients in a single, high volume academic center. Patient outcomes were obtained from charts and …

Hepatocellular Carcinoma Treated With Microwave Ablation Prior To Liver Transplantation, Nicole Wagner, Amanda Smolock, Michael Markovitz, Varun Danda, Christopher Neely, Warren Maley, Jesse Civan, Colette Shaw

Phase 1

Introduction: Ablation is a minimally invasive procedure that limits local liver tumor progression and prolongs patients’ transplantation eligibility. Microwave ablation (MWA) utilizes higher temperatures than the standard of care, radiofrequency ablation (RFA), which increases efficiency. Meta-analyses compared MWA with RFA for the treatment of HCC and showed similar efficacy and safety between these modalities. However, limited pathologic data exists determining whether explanted tumors remained viable after MWA.

Methods: Our database was reviewed retrospectively for patients with HCC who underwent MWA prior to liver transplantation between 2013 and 2019. Patient demographics, etiology of disease, tumor size, procedure details, bilirubin, MELD, …

Retrospective Review Of Fluoroscopic Swallowing Studies And Outcomes At An Academic Health Center, Rachel Strock, Priyha Mahesh, Baskaran Sundaram, Md, Gregory C. Kane, Md

Phase 1

Introduction: Aspiration is often associated with underlying medical conditions and can cause pneumonia or death. Aspiration risk can be assessed via video fluoroscopic swallowing study (VFSS) or barium swallow (BaSw). We aimed to assess the diagnoses and clinical course of patients who were evaluated for potential aspiration through VFSS or BaSw to determine if there is a degree of aspiration that increases the risk of developing pneumonia and/or death.

Methods: We conducted a retrospective chart review of 374 patients in TJUH who were evaluated via VFSS or BaSw from January 1 to June 30, 2017. We recorded the degree and …

The Use Of Wearable Technology In The Detection Of Operator Fatigue, James O'Shea, Stanton Miller, Md, Mph

Phase 1

Introduction: Operator fatigue is a prevalent cause of injury and death. Many studies have proven reliable ways of determining operator fatigue through the use of engineering and technological advances including blink rate, lid lag, respiratory rate, cardiac rate, chest expansion, etc. However the implementation of these advances has yet to be utilized. This systematic literature review seeks to elucidate the need for implementation of wearable technology for those who suffer from operator fatigue.

Methods: The target population includes anyone who operates a vehicle including drivers, aviation pilots, train conductors/engineers, marine pilots, operators of heavy machinery, fishermen and professional/overnight drivers. All …

Characteristics And Outcomes Of Patients Discharged Directly Home From A Medical Intensive Care Unit, Preeyal M. Patel, Michele Fiorella, Ms, Ann Zheng, Erika J. Yoo, Md

Phase 1

Introduction: Discharging patients directly home from the ICU is becoming increasingly common, largely driven by decreased ward bed availability. We evaluated readmission patterns of ICU patients discharged directly home.

Methods: Retrospective review was conducted of direct discharges from the ICU to home between June 2017 and June 2019. The primary outcome of interest was 30-day hospital readmission. Patients were dichotomized by “wait-time” between transfer order and hospital discharge (<24 hours or ≥24 hours). Outcomes were compared using t-test, Fisher exact, and chi-squared. Risk-adjustment was performed using the Mortality Probability Model (MPM₀-III). ICU workload was estimated using the nine equivalents of nursing manpower use score (NEMS).

Results: 331 patients were identified, with a mean time of 0.72 [0 - 5.84] …

What Is The Effect Of Iodine Contrast Agents On The Subharmonic Signal Generated From Ultrasound Contrast Agents?, Neal Kalantri, Cara Esposito, Jaydev Dave

Phase 1

Subharmonic-aided pressure estimation (SHAPE) is a technique utilizing subharmonic signals from microbubble-based ultrasound contrast agents (UCA’s) to noninvasively record pressures. Cardiac applications of SHAPE have been demonstrated in canines where low errors (0.19-2.5mmHg) were observed in canine ventricle pressures between the SHAPE technique and pressure catheter measurements. Validation of SHAPE involves simultaneous measurements by a pressure catheter (iodine contrast is used to guide catheter placement) and by SHAPE using UCAs. The goal of this experiment is to determine if mixing Visipaque (iodine contrast, GE Healthcare, Oslo, Norway) and UCAs effects the subharmonic signal.

The study was performed in an in …

Effects Of Neonatal Abstinence Syndrome On Long-Term Growth Parameters, Ayoung Kim, Anastasiya Latushko, Md, Zubair H. Aghai, Md

Phase 1

Introduction: Past studies have shown that babies with Neonatal Abstinence Syndrome (NAS) have lower weight, head circumference, and height at birth. This study aims to compare their growth at 9 and 18 months of age, and to compare growth parameter of NAS infants below 10th percentile to those above 10th percentile at birth.

Methods: In this retrospective review, 260 infants admitted to Jefferson Neonatal Intensive Care Unit between 2006 and 2018 were included. The weight, height, and head circumference at birth, 9 months, and 18 months were collected and correlated by Pearson correlation. The growth parameters of infants below …

Renal Mass Ablation In The Octogenarian And Nonagenarian Population, Callum Hamilton, Amanda Smolock, Md, Colette Shaw, Md, Conor Mckee, Md

Phase 1

Introduction: The gold standard for the management of T1a and T1b renal tumors is partial nephrectomy. This study aims to analyze the outcomes of renal mass thermal ablations as an alternative therapy in the octogenarian and nonagenarian patient population, specifically.

Methods: Departmental database of all percutaneous renal ablations performed between February 2008 and August 2019 was reviewed. 34 tumors were ablated in 19 males and 15 females with a mean age of 84.1 ± 3.1 years (range 80-92 years). Patient demographics, procedural and postprocedural data were evaluated.

Results: Ten microwave and 24 cryoablations were performed, all ablations …

Primary Care Obstructive Sleep Apnea Screening (Pcosa), Alyssa Givens, Risa Goldberg, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a largely underdiagnosed disorder of upper airway collapse during sleep. Primary care providers do not routinely screen for OSA. This project aims to determine the yield of using the STOP-BANG questionnaire to identify previously undiagnosed OSA in a primary care population.

Methods: This prospective quality improvement pilot project included 181 patients of the Jefferson Department of Family Medicine identified as high-risk for OSA based on 3 EMR-based search criteria taken from STOP-BANG: hypertension, age >50 years, and BMI >35 kg/m². We attempted contact with patients by mail, followed by up to …

Predictors Of Functional Outcomes Following Operative Treatment Of Acute Achilles Tendon Ruptures, Andrew Fisher, Ryan Rogero, Joseph O'Neil, Md, Daniel Fuchs, Md, Steven Raikin, Md

Phase 1

Introduction: Previous studies involving operative management of Achilles tendon ruptures have attempted to determine if patient factors influence outcomes. No previous study has attempted to identify outcome predictors in patients exclusively undergoing surgical repair. The purpose of this study is to determine if any injury or patient variables were predictive of outcomes following operative management of Achilles ruptures.

Methods: Patient demographics including age, sex, body mass index (BMI), comorbidities (diabetes mellitus, depression, anxiety), mechanism of injury (sports, non-sports), and date of injury were collected. Postoperative notes were reviewed to determine compliance. Patients completed the Foot & Ankle Ability Measure (FAAM)-Activities …

Impact Of Smartphone Usage On Children’S Horizontal Fusional Amplitudes, Jordan Hamburger, Judith Lavrich, Md, Kammi Gunton, Md

Phase 1

Introduction: Cell phone usage has increased in pediatric patients and little research has been done on its effects on patients’ fusional vergence amplitudes. We aim to study the impact of smartphone usage on healthy pediatric patients’ fusional vergence amplitudes and report findings that may lead to future eye problems.

Methods: This is a prospective randomized study. We are currently recruiting healthy patients between the ages of 8-17 years old with no ocular problems. Data collected include refractive error, ocular alignment in the distance and at near, divergence amplitudes at near and in distance, convergence amplitudes at near and in distance, …

Determining The Role Of Surgery In Diagnosis And Treatment Of Primary Cns Lymphoma, Tyler Fox, Michael Baldassari, Lohit Velagapudi, Karim Hafazalla, Christopher J. Farrell, Md, James J. Evans, Md, David W. Andrews, Md, Kevin Judy, Md, Donald Ye, Md

Phase 1

Introduction: Primary central nervous system lymphoma (PCNSL) is a rare entity typically treated with a combination of chemotherapy and radiation. The role of surgery is controversial, and biopsy may be non-definitive or injurious. We review our series of stereotactic and excisional biopsy as well as surgical debulking of PCNSL to quantify overall risk and benefits.

Methods: Patients with biopsy-confirmed intracranial PCNSL were identified from a large singlecenter academic institution between 2012-2018. Preoperative factors and perioperative outcomes were retrospectively reviewed.

Results: A total of 61 cases of PCNSL were identified. Most patients presented with confusion (23.0%), weakness/paralysis (19.7%), and gait disturbance …

Effects Of Medications On Cognitive Function And Falls In Older African Americans With Diabetes, Diana Alnemri, Robin J. Casten

Phase 1

Introduction: Potentially-inappropriate medications (PIMs) are medications that have increased rates of adverse drug events in older adults. Medications with anticholinergic activity are classified as PIMs since they can lead to cognitive dysfunction and increased fall risk. PIM use is higher among African Americans (AA) than Whites.

Methods: This study explored relationships among cognitive function, falls, and PIMs in AAs with diabetes. This study recruited AAs with diabetes (n=99, age ≥60yrs) who were seen in the Emergency Department (ED), and were enrolled in a trial of a behavioral intervention to improve diabetes management. PIMs were based on the Beer’s criteria …

Outcomes In Knot Vs Knotless Surgery In Labrum Tears, Zachary Howell, Benjamin Hendy, Md

Phase 1

A Bankart lesion is a tear of the anterior and inferior glenoid labrum. The primary method of repairing this lesion is to sew the detached part back to the joint, however there is a relatively newer method of doing so that does not involve tying a knot in the joint which may cause less joint irritation. The question our research project attempted to answer was: How do the long-term outcomes associated with knotless Bankart labrum repairs compare with the knot repairs? A retrospective cohort study was done with Rothman Institute Bankart lesion patients from 2010-2016. Data was gathered over phone …

Vaccination Exemptions For School-Aged Children In Delaware, Anna Melnick, Mph, Meghan Gannon, Phd

Phase 1

Background: Current awareness around childhood vaccinations and associated requirements for school entry has been heightened both nationally and internationally as governments work to find a balance between protecting their residents’ health and personal freedoms. Scant research exists examining the characteristics of these vaccine exemptors, but as the percentage of students seeking these exemptions increases yearly, this yields an opportunity to identify trends and inform future policy.

Question: What are the associations between reason for exemption from mandated vaccinations and the demographics of race and gender for school-aged children in the state of Delaware?

Results: Drawing from school nurse vaccine exemption …

Using Electrolyte Repletion Guidelines To Improve The Rate Of Oral Potassium And Magnesium Delivery, Joshua Riley, Alan Kubey, Md

Phase 1

Introduction: Evidence-based guidelines for electrolyte replacement that safely encourage oral (PO) and/or intravenous (IV) dosing more successfully attain goal levels than standard care. However, the Thomas Jefferson University Hospital (TJUH) electrolyte replacement guidelines (JG 11-1296), approved in 2002 and last updated in 2008, provide guidance for IV repletion not PO. Between 5/2017-11/2017, TJUH dosed potassium and magnesium in a 2.30 and 4.24 IV:PO ratio, respectively. If 50% of doses were given PO, we anticipate ~$800,000 annual TJUH savings.

Methods: We created a multidisciplinary team and completed a literature review to inform the creation of updated TJUH guidelines for …

Characteristics Of A Food Insecure Population In North Philadelphia, Galicano Kai Inguito, James Gardner, Laura Layer, Karen Fritz

Phase 1

Introduction: A 2018 report by Hunger Free America showed that food insecurity increased in Philadelphia by 22%, even though it decreased nationally. The objectives of this study were to perform food insecurity screens, and to describe the demographic characteristics in terms of age, gender, primary language, body mass index (BMI), and zip code. We hypothesized that older, overweight, Hispanic females would be more likely to be food insecure.

Methods: After obtaining consent, the validated Hunger Vital Sign screening tool was used in the Summer of 2019 in North Philadelphia by teams of trained students in the Summer Medical Institute program. …

Needs Assessment: Northeast Philly Opioid Epidemic, Davis Witt, Ms, Christopher Chambers, Md

Phase 1

Introduction: Philadelphia has the 3rd highest rate of opioid-related overdoses in the nation. This crisis is worsening in Northeast Philadelphia and the Department of Public Health lacks necessary information to intervene in an informed manner.

Objective: This study aims to better understand the crisis in this community and to provide key information to guide future harm reduction interventions in the Northeast Philadelphia region.

Methods: Using a designed discussion guide, qualitative interviews were completed with key stakeholders and community members. Information regarding personal experiences and opinions about the epidemic was gathered and interviews were analyzed using narrative analysis. In addition, needle …

Adolescent Hiv Pre-Exposure Prophylaxis Prescribing Practices Among Family Medicine Physicians: Limited Immediate Uptake, Emma T. Cooper, Steven A. Elsesser, Md, Amy Cunningham, Phd, Mph, Marshal Miller, Md

Phase 1

Introduction: In the United States, individuals aged 13-24 made up 21% of new HIV infections in 2016. In 2018, the FDA approved tenofovir/emtricitabine as HIV pre-exposure prophylaxis (PrEP) for adolescents aged 15-17. In 2019, we examined adolescent PrEP prescribing practices among family medicine physicians at an academic family medicine practice.

Methods: Physicians were invited to complete an online questionnaire assessing PrEP knowledge, attitudes, and prescribing practices. Differences in PrEP knowledge and attitudes among providers who prescribe PrEP to adolescents versus those who do not were examined using independent samples t-tests.

Results: 50 out of 99 surveys were completed. Respondents were …

What It’S Like To Study The Brain: A Creative Exploration, T. J. Cahanap, Katherine Hubbard, Ma

Phase 1

Introduction: In recent years, medicine and the humanities have evolved to be adopted synergistically in dual practice. Employing principles of narrative medicine, this multimodal piece explores the experience of hunger to draw parallels between creativity in art and creativity in medicine. By stimulating reading, writing, listening, and seeing, this account aims to represent these faculties as necessary to both art and medicine and to exemplify synergy between the two.

Methods: As codified by the field of narrative medicine, methods consisted of a repetitive practice of close reading, writing, and reflecting. In viewing medicine as interconnected provider-patient narrative, scholars of narrative …

The Clicker Study, Alex Brady, Daniel Mirsch, Do, Xiao C. Zhang, Md, Ms, Rishi Kalwani, Md, Phd, Zachary Risler, Md, Mph, Mark Magee, Md, Kelly Goodsell, Md, Resa E. Lewiss, Md, Arthur Au, Md, Dimitrios Papanagnou, Md

Phase 1

Purpose: A recent study in orthopedics showed that clicker-based learning was more effective than traditional feedback when teaching procedures. We sought to determine whether this principle is applicable to ultrasound skills.

Methods: Our prospective randomized control trial used a population of new ultrasound learners. Exclusion criteria included previous ultrasound experience of more than one hour. Students were shown an instructional video on the Focused Assessment with Sonography in Trauma (FAST) exam and randomized to receive clicker or scripted feedback. Each student performed the FAST exam once without feedback, then with either scripted or clicker-based feedback. They were timed and scored …

“Trauma To The Eye” – A Low Fidelity Module For Identifying Retrobulbar Hematoma And Practicing Lateral Canthotomy & Cantholysis, Jared Raikin, Dimitrios Papanagnou, Md, Ronald Hall, Md

Phase 1

Purpose: A retrobulbar hematoma (RH) can cause preventable blindness due to damage of the optic nerve. Due to its relative infrequency in the emergency department, Emergency Medecine (EM) residents have limited experience in recognizing and treating a RH. This paper outlines a simulated scenario that was developed to improve EM residents knowledge in diagnosing a RH and performing an emergent lateral canthotomy and cantholysis (LCC).

Methods: This module used a low fidelity task trainer and case vignette created for EM residents to practice recognizing a RH and perfroming a LCC. Participants took an assessment questionnaire before and after the teaching …

Perceptions Of Centering Pregnancy At Jefferson’S Maternal Addiction Treatment, Education & Research (Mater) Program, Lindsay Caldarone, Ms, Vanessa Short, Phd, Mph

Phase 1

Introduction: Opioid use and misuse, including during pregnancy, is prevalent across the United States. Many women with opioid use disorder (OUD) face multiple barriers to care, including prenatal care. Group prenatal care, as compared to individual prenatal care, may lead to beneficial outcomes such as reduced odds of preterm birth.

Objective: This study aimed to assess the perceptions of Centering Pregnancy (CP), a group prenatal care program, among women in treatment for OUD.

Methods: The target population included women who participated in the CP program at MATER. Participants (N=6) completed a survey after the last CP session. Survey questions assessed …

A Comparison Of Homemade Phantoms For Ultrasound Guided Peripheral Intravenous Catheter Insertion, Saami Zakaria, Liam Hughes, Lauren Selame, Kelly Kehm, Resa E. Lewiss, Arthur Au, Zachary Risler

Phase 1

Purpose: U/S guided peripheral intravenous catheter (PIV) placement is implemented in many clinical settings. Commercially available U/S phantoms are expensive and difficult to alter from stock. Non-commercial phantoms have been described in published literature without data showing which type is more efficacious. The primary objective of this study was to determine efficacy of various non-commercial phantoms for U/S guided PIV placement, while secondary objectives were to characterize the cost and ease of production.

Methods: This prospective observational study trialed six unique phantom models: 1) Amini ballistics gel model, 2) Morrow ballistics gel model, 3) University of California San Diego (UCSD) …

Performance Improvement In Healthcare: Integrating Gilbert's Behavior Engineering Model Within A Just Culture, Candice Freeman, Jill Erin Stefaniak

STEMPS Faculty Publications

Healthcare leadership and department management personnel are tasked with the responsibility of ensuring safe, high-quality patient care delivered by competent and proficient staff. This responsibility often comes in the form of identification of discrepant and erroneous practices that result in subsequent employee disciplinary action process improvement discussions and implementation. This case study presents an example of a sentinel event and how Gilbert's Behavior Engineering Model (BEM) was utilized in the context of a Just Culture to ensure both processes and personnel were adequately supported to meet expected task outcomes.

Law, Structural Racism, And The Covid-19 Pandemic, Ruqaiijah Yearby, Seema Mohapatra

All Faculty Scholarship

Racial and ethnic minorities have always been the most impacted by pandemics because of: disparities in exposure to the virus; disparities in susceptibility to contracting the virus; and disparities in treatment. This article explains how structural racism, the ways in which laws are used to advantage the majority and disadvantage racial and ethnic minorities, has caused these disparities. Specifically, this article focuses on how employment, housing, health care, and COVID-19 relief laws have been manipulated to disadvantage racial and ethnic minorities, making minorities more susceptible to COVID-19 infection and death. This article uses Blumenshine’s 2008 framework to outline how structural …

Structural Discrimination In Covid-19 Workplace Protections, Ruqaiijah Yearby, Seema Mohapatra

All Faculty Scholarship

Workers, who are being asked to risk their health by working outside their homes during the COVID-19 pandemic, need adequate hazard compensation, safe workplace conditions, and personal protective equipment (PPE). Sadly, this is not happening for many essential workers, such as those working in home health care and in the meat processing industry. These workers are not only being unnecessarily exposed to the virus, but they are also not receiving paid sick leave, unemployment benefits, and affordable health care and childcare. The lack of these protections is due to structural discrimination and has disproportionately disadvantaged women of color and low-wage …

The Americans With Disabilities Act And Healthcare Employer-Mandated Vaccinations, Y. Tony Yang, Elizabeth Pendo, Dorit Rubinstein Reiss

All Faculty Scholarship

Battles around workplace vaccination policies often focus on the annual influenza vaccine, but many healthcare employers impose requirements for additional vaccines because of the increased likelihood that employees in this sector will interact with populations at increased risk of acquiring or experiencing harmful sequelae of vaccine-preventable diseases. The federal Centers for Disease Control and Prevention and many states recommend healthcare employees receive numerous vaccines, including measles, mumps, and rubella (“MMR”); tetanus, diphtheria, and pertussis (“Tdap”). However, recent outbreaks of once-eliminated diseases that are now resurgent and the rising antivaccination movement raise questions about how far employers can go to mandate …

The Problem With Relying On Profit-Driven Models To Produce Pandemic Drugs, Ana Santos Rutschman

All Faculty Scholarship

The longstanding problems of relying on a market response to a pandemic are becoming readily apparent in the United States, which has quickly become the epicenter of the COVID-19 outbreak. The problems are particularly pronounced in pharmaceutical markets, where we are pinning our hopes for both cures and vaccines. In previous work we have shown how characteristics of healthcare markets in the United States create a divergence between the private incentives of for-profit companies and public health needs, leading to sub-optimal health outcomes in what is a uniquely market-driven healthcare system. In this Essay, written as the COVID-19 pandemic unfolds, …