Medicine and Health Sciences Commons^™

Menstrual Management In Adolescent Transgender Males, Julia Eisenberg, Sarah Felleman, Benjamin Bear, Mph, Arielle Effron, Md, Anne Kazak, Phd, Abpp, Anthony Alioto, Phd, Evan Graber, Do, Vanessa Short, Phd, Mph, Meghan Gannon, Phd, Msph, Beth Schwartz, Md

Phase 1

Introduction: Gender dysphoria is associated with increased rates of anxiety, depression, and suicidal ideation in adolescents. There is anecdotal evidence that menstruation increases the occurrence of gender dysphoria in adolescent transgender males. We hypothesize that menses are distressing to transgender males and this population would benefit from menstrual management.

Methods: We conducted a retrospective chart review of all transgender male patients seen in the Nemours Gender Wellness Program (GWP) and limited our population to those who have reached menarche. Data was extracted from the encounters at the GWP clinic and recorded in REDCap. We compared self-reported symptoms of gender dysphoria …

Diabetes Distress, Daily Functioning, And Hemoglobin A1c In Older Black Individuals With Diabetes And Mild Cognitive Impairment, Navajyoti R. Barman, Robin J. Casten, Phd, Barry W. Rovner, Md

Phase 1

Objective: The purpose of the cross-sectional study was to identify associations between diabetes distress, physical functioning, and cognition with hemoglobin A1c in older Black individuals with diabetes and mild cognitive impairment.

Methods: The investigators analyzed previously collected data from 101 older Black individuals with diabetes and mild cognitive impairment. Participants were administered surveys at baseline to assess diabetes distress, physical functioning, and cognitive functioning, and had hemoglobin A1c testing.

Results: Participants with higher hemoglobin A1c showed worse self-reported daily function (r = -0.279, p < .01). Three of four diabetes distress factors were positively correlated with hemoglobin A1c – emotional (r = .276, p < .01), regimen-related (r = .330, p < .01), and interpersonal distress (r = 0.266, p <.01). In a multivariate regression with hemoglobin A1c as the dependent variable, only regimen-related diabetes distress (beta = .282, p = .012) and self-reported daily function (beta = -0.294, p = .027) were significant.

Conclusion: The main finding of this study is that regimen-related diabetes distress and self-reported daily …

Racial Discrepancies In Interpregnancy Intervals And Postpartum Contraception Receipt In Centering Pregnancy Prenatal Care, Amulya Raju, Ms, Dennis Hand, Phd

Phase 1

Non-Hispanic black women are disproportionately affected by higher rates of shorter interpregnancy intervals. The purpose of this study is to identify whether the Centering Pregnancy model of group prenatal care (GPC) can reduce this health disparity by increasing postpartum contraception receipt.

This retrospective chart analysis measures consistency in contraception intent versus actual postpartum receipt in populations of women who received either individual or GPC. The main predictors were: race, insurance type (public or private), marital status, and type of prenatal care. The main outcomes were: type of contraception received, consistency with contraception intent, and presence of a short interpregnancy interval. …

The Number And Types Of Procedures Performed At Jeffhope Clinics, Jeremy Heard, James Plumb

Phase 1

Introduction: Procedures performed as part of the urgent care medical services provided at JeffHOPE Clinics (JHCs) are common in daily operations, but the number and types of procedures performed at each JHC have not yet been reported. The goal of this research was to provide JHCs the data needed to ensure clinic-specific evidence-based training for incoming procedures committee members, and thus ensure the highest quality patient care. The inquiry question was what are the number and types of procedures performed at each JHC?

Methods: An IRB waiver of authorization was obtained. A chart review of patients 18 years or older …

Net Therapy Effect On Chronic Pain Patients: An Fmri/Pet Imaging Study, Layla Annous, Andrew Newberg

Phase 1

Chronic pain is pain that lasts longer than 3 months or lasts longer than tissue healing should naturally take, which can limit patients’ daily activities. Chronic pain impacts 20% of people worldwide, preferentially affecting vulnerable and marginalized populations. We aimed to use fMRI/PET imaging of the brain to determine the efficacy and therapeutic use of Neuro-emotional Technique (NET) therapy for chronic pain patients. We anticipated that NET Therapy would result in decreased activity in areas of the brain associated with pain and decreased perception of pain. Patients who have been suffering chronic pain conditions were used as the experimental group …

Primary Care Obstructive Sleep Apnea Screening, Grant Gillan, Ben Espenhorst, Cynthia Cheng

Phase 1

Obstructive Sleep Apnea (OSA) is a common sleep disorder characterized by long pauses in breathing over the course of a night’s sleep, leading to significant daytime fatigue and long-term pathologies if left untreated. While a sleep study is the diagnostic tool of choice for OSA, this test is costly. To maximize cost effectiveness, we developed a screening protocol to identify patients at high risk for OSA for referral for a sleep study.

To identify high risk individuals, we screen patients identified in the EMR with pre-existing risk factors of OSA. We contact them to complete the full screening test: the …

Assessing Sentiment Towards Opioid Use Disorder At Jefferson: Characterizing Non-Clinical Emergency Department Staff, Joseph Arciprete, Benjamin Finard, Madalene Zale, Mph, Benjamin Slovis, Md, Hannah Smith

Phase 1

Purpose: To characterize emergency department (ED) staff regard toward opioid use disorder (OUD) and analyze variation based on job category. The closure of Hahnemann Hospital, in combination with the increasing prevalence of OUD, is exacerbating the previously inadequate network of resources for these patients. Jefferson is strategically positioned to improve the care provided to this patient population, especially in an ED setting, and ultimately increase linkage to long-term recovery programs.

Methods: Sentiment toward this patient population was measured utilizing the Medical Condition Regard Survey (MCRS). This questionnaire was previously validated to subjectively, but quantitatively, assess regard toward a defined patient …

Improving Response To Non-Traumatic Dental Pain In The Ed Through A Novel Task Trainer For Dental Blocks, Dylan Selbst, Alanna O'Connell, Tracy Brader

Phase 1

Purpose:

Dental nerve blocks are a vital skill for physicians to have when treating non-traumatic dental pain; however, there is yet to be a simple, practical, and effective way to educate residents in performing this task. The purpose of this project is to explore the efficacy of a low-fidelity dental model task-trainer in teaching emergency medicine residents to perform dental blocks.

Methods:

In this study, 29 EM residents at TJUH were surveyed regarding their knowledge and attitudes regarding performing dental blocks using a brief Likert-scale questionnaire. Next, they were given 15 minutes to practice performing dental blocks on a low-fidelity …

Analyzing The Effect Of Interview Time And Day On Emergency Medicine Residency Interview Scores, Sean Greco, Alanna O'Connell, Do, Tingting Zhan, Phd, Tracy Brader, Md, Megan Crossman, Do, Megan Stobart Gallagher, Do, Anthony Sielicki, Md, Peter Tomaselli, Md, Robin Naples, Md, Dimitrios Papanagnou, Md, Mph

Phase 1

Purpose: Each year, medical students go through the residency application process and are faced with the decision of where to apply. If they receive an interview offer at an institution, they are faced with another decision, when to schedule their interview. Studies have examined the possible effect of interview date on matching and on match rank. However, other variables such as examination scores, letters of recommendation, and class rank also effect match outcome. There have been no studies investigating the possible role the time of day in which the interview takes place can affect the residency interview process. The purpose …

Assessing The Educational Impact Of 3d Printed Models On Fellow, Resident, And Patient Education For Partial Nephrectomies, E. Reilly Scott, Samuel Morano, Andrea Quinn, Erica Mann, Kaitlyn Boyd, Michelle Ho, Alice Karp, Abhay Singh, Thenappan Chandrasekar, Mark Mann, Edouard Trabulsi, Vishal Desai, Costas Lallas

Phase 1

Purpose:

3D printing is a growing tool in surgical education with the ability to visualize and teach complex procedures from multiple angles. Previous studies demonstrated 3D models as useful teaching tools for partial nephrectomy for patient and trainee education. We aim to create a cheaper and simpler 3D model to encourage these learning opportunities.

Methods:

Patient-specific, cost-effective ($35) 3D models of the affected urologic structures were created using preoperative imaging of 17 patients undergoing partial nephrectomies at Thomas Jefferson University Hospital between July and December 2020.

Patients receiving the surgery filled out two surveys about their understanding of …

Understanding Clinical Staff Attitudes Towards Patients Presenting To The Emergency Department With Opioid Use Disorder, Benjamin Finard, Joseph Arciprete, Madalene Zale, Mph, Carissa Walkosak, Benjamin Slovis, Md, Ma, Dimitrios Papanagnou, Md, Hannah Smith, Phd

Phase 1

Purpose: Significant stigma surrounds patients with opioid use disorder (OUD). This stigma repeatedly follows patients into the ED and negatively influences care. All ED staff impact the patient journey in the ED and the success with which OUD patients receive a warm handoff to a recovery organization. What is the current attitude of Jefferson’s clinical staff towards patients with OUD?

Methods: The authors developed and deployed a survey to Jefferson’s ED clinical staff members through Qualtrics. The survey was informed by the validated Medical Condition Regard Scale (MCRS) to capture staff sentiments towards patients with OUD. Respondents job category, job …

Incomplete Bladder Emptying And Urinary Tract Infections After Onabotulinumtoxina Injection For Overactive Bladder In Men And Women: Multi-Institutional Collaboration From The Sufu Research Network, William Stuart Reynolds, Anne M. Suskind, Jennifer T. Anger, Benjamin M. Brucker, Anne Pelletier Cameron, Priya Padmanabhan

Conference Presentation Abstracts

Introduction: OnabotulinumtoxinA (BTX) is an effective third-line therapy for overactive bladder (OAB), however the potential for adverse events may prevent patients from initiating therapy. The objective of this study is to report rates of incomplete emptying and urinary tract infection (UTI) in men and women undergoing BTX for OAB and to identify potential risk factors for these adverse events. Methods: Eleven clinical sites performed an IRBapproved retrospective study of adult women and men undergoing first-time BTX injection (100 units) for non-neurogenic OAB in 2016. Exclusions included: post void residual (PVR) >150ml, prior BTX, pelvic radiation, or catheterization. Clinical data was …

Dean's Research Newsletter, February 2021, Jerry L. Nadler

SOM Dean's Research Newsletter

No abstract provided.

Breastfeeding Confidence, Alexandra Sciacca Rn, Amanda Morgan Rn, Chelsea Diorio Rn, Karleigh Williams Rn

Vizient/ AACN Nurse Residency Program™ EBP Projects

No abstract provided.

Short- And Long-Term Outcomes For Single-Port Risk-Reducing Salpingo-Oophorectomy With And Without Hysterectomy For Women At Risk For Gynecologic Cancer, Caitlin E. Carr, Laura Chambers, Amelia Marie Jernigan, Lindsey Freeman, Pedro F. Escobar, Chad M. Michener

School of Medicine Faculty Publications

Introduction Risk-reducing salpingo-oophorectomy has been established as one of the most effective strategies in risk reduction for ovarian and breast cancers among women at increased genetic risk. However, there are limited data regarding the single-port laparoscopic platform in the field of risk-reducing surgery. Our objective was to describe outcomes after single-port risk-reducing salpingo-oophorectomy with or without hysterectomy for reduction of ovarian, breast, or endometrial cancer risk. Methods A retrospective, single institution (Canadian Task Force Classification II.2) analysis was performed in women at high genetic or familial risk for ovarian/tubal/primary peritoneal cancer or with personal history of breast cancer who underwent …

Natural Family Planning And Marital Chastity: The Effects Of Periodic Abstinence On Marital Relationships, Richard J. Fehring, Michael D. Manhart

College of Nursing Faculty Research and Publications

Marital chastity is the practice of periodic abstinence with use of natural family planning (NFP). The purpose of this study was to determine the influence of the most common methods of contraception (female sterilization, oral contraceptive pills, and condoms) and NFP on divorce/separation and cohabitation rates among reproductive age women. The study involved an extensive review of the literature on the effects of practice of NFP on marital dynamics and a statistical analysis of 2,550 ever-married women in the (2015–2017) National Survey of Family Growth data set. Importance of religion and frequency of church attendance were included in the analysis. …

“Ecmo In A Bag”: Successful Adaptation And Implementation Of A Novel Conference Idea, Johanna I. Orrick, Debra E. Newton, Kari L. Davidson, Jenna Miller, Alyssa Stoner

Posters

INTRODUCTION: Extracorporeal Membrane Oxygenation (ECMO) is an ever-evolving technical landscape that requires an advanced level of education. At our institution, a 367-bed pediatric teaching and research facility, learners include registered nurses, registered respiratory therapists, advanced practice registered nurses, resident physicians, pediatric and neonatal intensive care physicians. A certification class followed by an advanced course covers ECMO diagnoses, complications, equipment, and management prior to providing care for ECMO patients in our institution. Educational strategies include high and low fidelity simulations, didactic learning, and clinical hours at the bedside. A desire to increase the experiential learning opportunities was identified as an ECMO …

The Use Of Integra Dermal Regeneration Templates And Cortical Bone Fenestrations Over Exposed Tibia., Liam P Hughes, Steven Forman, James C Krieg, William Hughes

Department of Surgery Faculty Papers

We present the case of an 86-year-old woman who suffered full-thickness soft tissue loss secondary to degloving injury to the lower left limb, resulting in an exposed tibia. This patient underwent drilling to create artificial fenestrations in the cortical bone followed by placement of Integra dermal regeneration template. The technique of drilling fenestrations to expose underlying vasculature of cortical bone has not previously been described in its relationship with Integra dermal regeneration templates in large degloving injuries of the lower limb. This technique enabled us to perform earlier skin grafting and ultimately resulted in complete and timely wound closure. We …

Delivering Maternal And Neonatal Health Interventions In Conflict Settings: A Systematic Review, Mariella Munyuzangabo, Michelle F. Gaffey, Dina S. Khalifa, Daina Als, Anushka Ataullahjan, Mahdis Kamali, Reena P. Jain, Sarah Meteke, Amruta Radhakrishnan, Shailja Shah, Fahad J. Siddiqui, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: While much progress was made throughout the Millennium Development Goals era in reducing maternal and neonatal mortality, both remain unacceptably high, especially in areas affected by humanitarian crises. While valuable guidance on interventions to improve maternal and neonatal health in both non-crisis and crisis settings exists, guidance on how best to deliver these interventions in crisis settings, and especially in conflict settings, is still limited. This systematic review aimed to synthesise the available literature on the delivery on maternal and neonatal health interventions in conflict settings.
Methods: We searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to …

Safety Of Daily Low-Dose Aspirin Use During Pregnancy In Low-Income And Middle-Income Countries, Vanessa L. Short, Matthew Hoffman, Mrityunjay Metgud, Avinash Kavi, Shivaprasad S. Goudar, Jean Okitawutshu, Antoinette Tshefu, Carl L. Bose, Saleem Jessani, Sarah Saleem

Community Health Sciences

Background: The daily use of low-dose aspirin may be a safe, widely available, and inexpensive intervention for reducing the risk of preterm birth. Data on the potential side effects of low-dose aspirin use during pregnancy in low- and middle-income countries are needed.
Objective: This study aimed to assess differences in unexpected emergency medical visits and potential maternal side effects from a randomized, double-blind, multicountry, placebo-controlled trial of low-dose aspirin use (81 mg daily, from 6 to 36 weeks' gestation).
Study design: This study was a secondary analysis of data from the Aspirin Supplementation for Pregnancy Indicated Risk Reduction In Nulliparas …

Encoding And Perception Of Voicing And Aspiration In Native And Non-Native Listeners In Quiet And In Background Noise, Reethee Antony

Dissertations, Theses, and Capstone Projects

The perception and encoding of voice cues in consonants have been well studied, whereas there has been relatively little research on aspiration. The current study examined the encoding and perception of aspiration and voicing in Hindi, American English, and Tamil listeners when relevant cues were and were not degraded by noise. This study is novel because of the inclusion of aspiration, the language groups, inclusion of noise masking, and inclusion of auditory evoked potentials (in addition to behavioral testing).

The first aim was to determine whether language groups for whom aspiration and/or voicing is phonemically contrastive show better perception and …

Strategically Rational Risk Taking By Age In Covid-19, And The Heterogeneous Agent Behavioral Sir Model, Siamak Javadi, Elena Quercioli, Lones Smith

School of Economics and Finance Faculty Publications

Given the dramatic age variation in COVID death rates, we create a heterogeneous agent version of the Behavioral SIR contagion model of Engle et al. (2020). The Bayes Nash equilibrium of our infection avoidance game yields a simple new log-linear relationship between the case fatality rate (CFR) and COVID incidence: Everyone knows that everyone optimizes vigilance both for the prevalence and their CFR. We explain 2020 CDC incidence data for the USA north-east in terms of the CFR to age-specific COVID death data for Massachusetts. Our model is statistically significant: A 10% higher CFR reduces incidence by about 1%.

Sociodemographic, Clinical Characteristics, And Outcomes Of Influenza Pneumonia Patients Admitted In A Tertiary Care Hospital In Karachi, Pakistan: Findings From A Cross-Sectional Study, Fazal Ur Rehman, Muhammad Arslan Ahmed, Kashif Aziz, Mahmooda Jabeen Ashraf, Tazein Amber, Sumera Aziz Ali

Section of Internal Medicine

Objective: To determine the sociodemographic, clinical characteristics, and outcomes of influenza pneumonia patients in tertiary care hospital, Karachi Pakistan.
Study design: A cross-sectional study.
Place and duration of study: The Aga Khan University Hospital Karachi Pakistan from January 2013 to December 2018. Methodology: All adult patients who were older than 18 years and suspected to have viral pneumonia were included in the study. Data were abstracted on 105 patients and were entered on preformed proforma after reviewing the files of patients.
Results: Ninety-four (89.5%) patients were influenza positive and 15.2% (n=16) had been vaccinated. Around 92.4% (n=97), 81.9% (n=86) and …

Bilateral Systematised Epidermolytic Epidermal Nevus: A Case Report, Sabeika R. Kerawala, Najam-Us-Saher Rizvi, Saadia Tabassum

Section of Internal Medicine

Verrucous epidermal nevi (VEN) are benign congenital hamartomas consisting of keratinocytes. Histological examination mostly exhibits hyperkeratosis, acanthosis, papillomatosis and, rarely, the features of epidermolytic hyperkeratosis (EHK). We report a case of a 6-year-old boy who presented at Aga Khan University Hospital, Karachi, Pakistan with bilaterally symmetrical linear epidermal nevi following Blaschko's lines and showing epidermolytic hyperkeratosis on histology. The patient was treated with topical keratolytics and emolients which led to considerable improvement. To the best of the authors' knowledge, this is the first report of VEN from Pakistan.

Hyperlipasemia And Potential Pancreatic Injury Patterns In Covid-19: A Marker Of Severity Or Innocent Bystander?, Hemant Goyal, Sonali Sachdeva, Abhilash Perisetti Md, Rupinder Mann, Sumant Inamdar, Benjamin Tharian

Other Specialties

No abstract provided.

Prevalence Of Gastric Intestinal Metaplasia In A Multiethnic Us Veterans Population, Theresa H Nguyen, Mimi C Tan, Yan Liu, Massimo Rugge, Aaron P Thrift, Hashem B El-Serag

Faculty, Staff and Students Publications

BACKGROUND & AIMS: There is a need to identify individuals with gastric intestinal metaplasia, a precursor to gastric cancer, so they can be offered screening and surveillance. We examined the prevalence of gastric intestinal metaplasia, detected by upper endoscopy biopsy analysis, in different race and ethnic subgroups. We also investigated the extent to which Helicobacter pylori infection, with or without acute and chronic gastritis, accounts for observed associations between race or ethnicity and risk of gastric intestinal metaplasia.

METHODS: We used data from a cross-sectional study of consecutively recruited patients at the Michael E. DeBakey Veterans Affairs Medical Center in …

Adherence To The Kidney Disease: Improving Global Outcomes Ckd Guideline In Nephrology Practice Across Countries, Bénédicte Stengel, Daniel Muenz, Charlotte Tu, Elodie Speyer, Natalia Alencar De Pinho, Christian Combe, Kunihiro Yamagata, Helmut Reichel, Danilo Fliser, Ziad A Massy, Antonio A Lopes, Michel Jadoul, Wolfgang C Winkelmayer, Ronald L Pisoni, Bruce M Robinson, Roberto Pecoits-Filho

Faculty, Staff and Students Publications

INTRODUCTION: The uptake of the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 chronic kidney disease (CKD) Guideline is not fully described in real-world nephrology practice across the world.

METHODS: We used baseline data from the CKD Outcomes and Practice Patterns Study (2013-2017), a 4-country cohort of patients with estimated glomerular filtration rate/min per 1.73 m

RESULTS: The mean age ranged from 65 years in Brazil to 72 years in Germany. Albuminuria (mostly proteinuria) was measured routinely in 36% to 43% of patients in Brazil, Germany, and the United States. Blood pressure control (≤140/90 mm Hg) ranged from 49% in France …

Bone Grafting History Affects Soft Tissue Healing Following Implant Placement, Vrisiis Kofina, Mutlu Demirer, Barbaros S. Erdal, Timothy D. Eubank, Vedat O. Yildiz, Dimitris N. Tatakis, Binnaz Leblebicioglu

School of Dentistry Faculty Research and Publications

Background

This study aimed to determine and compare soft tissue healing outcomes following implant placement in grafted (GG) and non-grafted bone (NGG).

Methods

Patients receiving single implant in a tooth-bound maxillary non-molar site were recruited. Clinical healing was documented. Volume and content of wound fluid (WF; at 3, 6, and 9 days) were compared with adjacent gingival crevicular fluid (GCF; at baseline, 1, and 4 months). Buccal flap blood perfusion recovery and changes in bone thickness were recorded. Linear mixed model regression analysis and generalized estimating equations with Bonferroni adjustments were conducted for repeated measures.

Results

Twenty-five patients (49 ± …

Fabrication Of Nanocrystalline Austenitic Stainless Steel With Superior Strength And Ductility Via Binder Assisted Extrusion Method, L. Heidari, M. J. Hadianfard, A. R. Khalifeh, Daryoosh Vashaee, Lobat Tayebi

School of Dentistry Faculty Research and Publications

Biomedical austenitic stainless steel (ASTM F2581) has been processed by the powder metallurgy technology using binder assisted extrusion method and aside a sintering aid. The resultant microstructure was examined by optical microscopy, field emission scanning electron microscopy, transmission electron microscopy and x-ray diffraction methods. The optical microscopy images indicate that using the binder and sintering aid considerably decreases the porosities of the sintered samples. The x-ray diffraction and transmission electron microscopy images reveal that the microstructure of the sintered alloy consists of austenite in nanocrystalline form and amorphous phases. The mechanical properties were measured through compressive tests. The mean yield …

Can Incline Treadmill Walking Protocol Be Augmented By Visual Perturbation For Physical Therapy Use?, Jie Hao, Ka-Chun Siu

Posters and Presentations: Physical Therapy

Purpose/Hypothesis: Incline treadmill walking (ITW) has been used in different patients receiving physical therapy. Given the critical role of visual information in human locomotion, integrating visual perturbation (VP) to treadmill training could induce the challenge to patients, magnifying the training effects. However, literature regarding how VP influences muscle activation during ITW is limited. Knowledge gaps exist in whether and how the muscle is modulated by the systematically manipulated visual information. We hypothesized that VP could increase muscle activation during ITW, and larger VP could elicit higher muscle activation. Number of subjects: 28 healthy young adults (20-33 years old). Experiment One …