Medicine and Health Sciences Commons^™

Steamn Spin, Kathryn Sommer, Christina Stiebris, Kelley Yuan, Morgan Hutchinson, Md, Aaron Herl, Rachel Smith, Jessica Gaulton, Md, Mph, Eddie Chang, Md, Mba

Phase 1

Sanitize and dry your breast pump parts within minutes.

Adverse Events Following Screening Eye Examinations For Retinopathy Of Prematurity In Premature Infants, Aditi Kale, Pedro Urday, Zubair H. Aghai

Phase 1

Introduction: The retinopathy of prematurity (ROP) examination is recommended for high-risk preterm infants to prevent its complications but may be associated with adverse events. The goal of this study is to determine whether the ROP examination increases the incidence of adverse events in premature infants.

Design/Methods: This was a retrospective study on all preterm infants (32 weeks gestation) born between 03/2017 and 12/2019 who survived until the first eye examination. The number of episodes of apnea (A), bradycardia (B), desaturation (D), number of infants on mechanical ventilation, and number of infants requiring sepsis evaluation were compared before and …

Outcomes Of Surgical Treatment For Carcinoid Heart Disease: A Systematic Review And Meta-Analysis, Diana C. Jiminez, Thomas J. O'Malley, Md, Abhiraj Saxena, Matthew P. Weber, Louis E. Samuels, John W. Entwistle, T. Sloane Guy, H. Todd Massey, Rohinton Morris, Vakhtang Tchantchaleishvili

Phase 1

Introduction and Objective: Carcinoid Heart Disease (CaHD) develops from vasoactive substances released by neuroendocrine tumors causing significant patient morbidity and mortality necessitating surgical intervention. We performed a systematic review and meta-analysis to elucidate granular perioperative details and long-term outcomes in these patients.

Methods: Electronic search of Ovid, Scopus, Cumulative Index of Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed. Nine articles comprising 416 patients who received surgery were selected. Primary outcomes investigated included patient characteristics, surgical characteristics and survival data. Study-level data were extracted and pooled for meta-analysis.

Results: Primary outcomes consisted of …

Characterizing The Anesthetic Management Of Patients Undergoing Transradial Cardiac And Cerebrovascular Interventions: A Single-Institution Study, Steven Bieser, Somnath Das, Lohit Velagapudi, Heli Patel, Joshua Weinberg, Lisa Moss, Marguerite Davis, Nicholas Ruggiero, Pascal Jabbour, Victor Romo

Phase 1

Introduction:

Transradial approaches are shown to reduce mortality, morbidity, access-site complications, hospital stay and costs when compared to the transfemoral approach in multiple cardiac trials. Use of the antispasmotic cocktail for these interventions poses challenges for anesthetic management. Differing practices between fields may need to be consolidated. This study aims to characterize the safety profile of cardiac and neuroanesthetic management protocols for transradial interventions, hypothesizing that the cocktail is safe from an anesthetic perspective.

Methods:

We performed a retrospective chart review of patients undergoing transradial diagnostic cardiac and cerebrovascular interventions. Data collected included age, sex, comorbidities, prior antihypertensive medications, dose …

Development Of A Method Using Retrograde Neuronal Tracers To Neuroanatomically Characterize Respiratory Neural Circuitry, Samantha Thomas, Angelo Lepore

Phase 1

Introduction:

Loss of respiratory function is one of the leading causes of death following spinal cord injury (SCI). Existing studies have demonstrated that pre-phrenic interneurons (PPIN’s) can be recruited into the phrenic motor neuron (PhMN) pathway following cervical SCI and may contribute to respiratory recovery, but there is still a lack of information detailing the nature of these changes and the extent they may improve diaphragm function. This project aims to validate a method of utilizing neuronal tracers to further characterize the intact respiratory circuitry.

Methods:

This study was carried out using a rat model. A fluorophore-conjugated retrograde neuronal …

Effectiveness Of Nutritional Counseling And Vlcd (Very Low Calorie Diet) For Weight Loss And Metabolic Syndromeketav., Ketav Patel, Ayesha Baig, Connor Mcelwee, Jessica Vitale, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obesity and Diabetes are highly prevalent conditions worldwide. Morbidity and mortality stemming from these conditions has critical implications on the health and day to day lives of patients. A Very Low- Calorie Diet (VLCD) may be an effective tool to aid in lowering weight for both obese and diabetic patients, but has not been well studied. Thus, the efficacy of a VLCD on lowering weight, BMI, blood pressure, HbA1c, Lipid levels, and blood glucose was explored in this pilot study.

Methods: The study’s population is taken from an MNT (medical nutrition therapy) program at Jefferson. Patients who had prior …

Role Of Il-6 In Uremia-Induced Muscle Dysfunction, Taylor Penzel, Maria P. Martinez Cantarin

Phase 1

Introduction: Defects in mitochondrial function and increased circulating interleukin-6 (IL-6) caused by uremia of chronic kidney disease (CKD) are significant contributors to skeletal muscle atrophy and weakness, and to increased mortality. This study evaluated the effect of abrogation of IL-6 on markers of muscle and mitochondrial dysfunction.

Methods: Adenine supplementation was used to induce uremia in wild-type (WT) and IL-6-knockout (KO) mice, which were compared to control diet WT and IL-6-KO mice, respectively. Body weight, individual muscle weights, quantity and diameter of extensor digitorum longus (EDL) fibers by type (1, 2A, 2B and 2X), optical density of mitochondrial complexes …

The Use Of Advanced Ultrasound Techniques For The Evaluation Of Uterine Fibroids Pre And Post Uterine Artery Embolization, Kathleen Gillmore, Priscilla Machado, Alison Tan, Carin F Gonsalves, Flemming Forsberg

Phase 1

Introduction: Uterine fibroids are the most common benign tumor in females of reproductive age. Uterine artery embolization (UAE) is a less-invasive alternative to hysterectomy. Our objective is to assess the ability of superb microvascular imaging (SMI) to characterize fibroid microvascularity before and after UAE compared to conventional Doppler modes using contrast-enhanced ultrasound (CEUS) and clinical outcomes as reference standards.

Methods: Participants will be 40 adult females who are scheduled for UAE. Participants receive three transabdominal ultrasounds at day 0, day 14 and day 90 post-UAE using an Aplio i800 scanner. Subjects undergo examination with four non-contrast ultrasound modalities— color doppler …

Clinical Outcomes Following Lumbar Fusion In Patients With And Without A History Of Spinal Cord Stimulation Therapy, Jake Budlow, Ellina Hattar, Heli Patel, Thiago S. Montenegro, Glenn A. Gonzalez, Garrett Largoza, Christopher Elia, Caio M. Matias, Chengyuan Wu, Ashwini D. Sharan, James S. Harrop

Phase 1

Introduction:

The treatment of chronic back pain is a challenging and costly issue faced by patients across the United States. Spinal cord stimulators (SCS) or lumbar fusion surgery can be utilized in cases of intractable pain. This study aims to determine if a history of a thoracic SCS influences patient recorded outcomes measures (PROMs) of lumbar fusions at six months.

Methods:

This retrospective cohort study includes patients who underwent elective lumbar fusions at Thomas Jefferson University Hospital between January 2018 and December 2019. PROMs were measured, specifically the Oswestry Disability Index (ODI), preoperatively and 6 months postoperatively. Clinical outcomes …

Evaluating The Effect Of Telestroke Intervention On Patient Treatment And Outcomes, Charles Morse, Daniel Moylan, Daniel Joffe, Michael Knapp, Ahmad Sweid

Phase 1

Acute ischemic strokes (AIS) are a prominent cause of death and have the potential to cause lifelong neurological deficits. We hypothesize that through telestroke intervention, patients will receive treatment more rapidly and therefore have reduced complications as a result of AIS. To analyze the efficacy of telestroke intervention, we completed a retrospective chart review of suspected AIS patients at hospitals in the greater Philadelphia region from 2015-2019. We then assessed whether a patient received a telestroke consultation and any subsequent care. Several variables were then used to determine the effectiveness of this intervention, such as the promptness of treatment, length …

Assessment Of Treatment Response Of Keloid Patients, Mary Metkus, Rachel Zachian, John Bruckbauer, Neda Nikbakht, Md, Phd

Phase 1

Introduction: Keloids are benign skin overgrowths, often accompanied by pain and pruritis. Despite many modalities, treatment of keloids is difficult due to variable response and high recurrence rates. This study evaluated the efficacy of surgical excision compared to intralesional triamcinolone in the treatment of keloids.

Methods: This was a retrospective study. Through a medical chart review, patients with keloids treated in the Jefferson Health System from 2018-2020 were identified and included. Participants were surveyed via telephone to assess change in size, pain and pruritis of their keloid in response to treatment. Participants ranked pain and pruritis severity from 1-10 before …

Assessment Of The Diagnostic Accuracy Of Core Needle Biopsies In The Diagnosis Of Lymphoma, Austin Redilla, George Ye, Catherine Tucker, Md, Christopher Gardner, Guldeep Uppal, Md, Adam F. Binder, Md

Phase 1

Introduction: Excisional biopsy remains the gold standard in the diagnosis of lymphomas. However, recent studies have shown that core needle biopsy (CNB) may have similar accuracy. CNB offers several advantages over excisional biopsy, including reduced cost and morbidity, thus we set out to determine the diagnostic accuracy of CNB at Thomas Jefferson University Hospital (TJUH) to understand if this approach should be utilized more in our system.

Methods: We performed a retrospective chart review of all suspected new diagnosis of lymphoma at TJUH from January 1^st, 2016 to December 31^st, 2019. All CNB and excisional …

Peri-Operative Urodynamic Assessment Has Poor Predictive Value For Developing Post-Operative Urinary Retention, Baylor Wickes, Robert Pivec, Md, Mathew S. Austin, Md

Phase 1

Introduction: Post-operative urinary retention (POUR) following primary total joint arthroplasty (TJA) has a reported prevalence up to 35%. Risk factors for developing POUR have traditionally included surrogate markers such as the presence or absence of urologic disease. However, dynamic measurement of the renal system with post-void residual volumes (PVR) has not been investigated as a tool for assessing POUR risk.

Methods: All male TJA patients underwent an pre-operative screen for POUR, including PVR measurements, patient-derived subjective urinary retention scores, and assessment of urologic disease. This was combined with a post-operative monitoring and catheterization protocol developed in partnership with a …

The Impact Of Patient Characteristics On Quality Of Life In Keloid Patients, Jonathan Wang, Romsin Zaya, Rachel Zachian, Mary Metkus, Neda Nikbakht

Phase 1

Introduction: Quality of life (QoL) is an important metric in assessing dermatological diseases such as keloids. This study evaluated the effects of patient characteristics on QoL in keloid patients.

Methods: This was a cross-sectional study. 36 patients presenting to the keloid clinic at TJUH were surveyed. QoL subscale scores for emotion, symptom, and function were calculated in addition to a total score for each patient using a keloid-specific questionnaire. The association between the QoL scores and patient characteristics of sex, ethnicity, as well as keloid location, duration, visibility, size, number, pain score, and pruritis score were evaluated using t-tests. …

The Psychosocial Impact Of Penile Implant Treatment, Taylor Tidwell, Paul Chung, Md

Phase 1

Introduction: Erectile dysfunction affects nearly 2/3rds of men age 50 or older worldwide and involves multiple hormonal, neurologic, psychological and environmental etiologies. Although contemporary research suggests that ED causes increased anxiety and depressive symptoms, there is relatively little information on how specific treatments impact mental health.

The purpose of this study is to answer the question: How do penile implants influence the psychosocial and emotional wellbeing of patients with ED compared to those without implants?

Methods: Our study uses a free-listing technique to interview via phone 50 patients with erectile dysfunction (25 with implant treatment, 25 without) regarding their emotional, …

The Impact Of Doula-Supported Care On Stress Levels Of Women Receiving Opioid Addiction Treatment, Mariel Becker, Meghan Gannon, Phd, Msph

Phase 1

Introduction: Mothers suffering from opioid addiction are at high risk for experiencing extreme stress levels which prevents them from providing a healthy and nurturing environment for their family. The aim of this project is to explore if a doula-supported care team alleviates the parenting stress of new mothers participating in opioid addiction rehabilitation.

Methods: A total of 35-40 women in treatment at the Montair program for substance use disorder rehabilitation were recruited to participate in the City of Philadelphia’s Community Doula project. The Parenting Stress Index Score (PSI) was recorded and compared to a control group composed of women …

Cns Derived Extracellular Vesicles As Biomarkers In Multiple Sclerosis (Ms), Anshel Kenkare, Abdolmohamad Rostami

Phase 1

This project aims to develop biomarkers for the diagnosis and treatment of multiple sclerosis (MS), a clinically heterogenous disease resulting from demyelination of the central nervous system. Extracellular vesicles (EVs) have shown potential as such a biomarker.

EVs were isolated from the plasma and cerebrospinal fluid (CSF) of patients with suspected MS and patients with headaches. Participants are recruited before starting treatment for their condition and controls were only included if the cause of headache was determined to be non-inflammatory. Proteomic analysis will be conducted on the plasma and CSF before isolating the EVs, as well as the isolated plasma …

Comparative Observational Study For Bifurcating Aneurysm Treatment; Open Versus Endovascular Approaches And Classical Versus New Techniques., Samuel Fallon, Ahmad Sweid, Md, Nikolaos Mouchtouris, Md, Michael Reid Gooch, Md, Pascal Jabbour, Md

Phase 1

Introduction: Aneurysm occur in approximately 3.2% of the population with a mean age of 50 years, a 1:1 gender ratio, and an estimate mortality rate of 70%. Aneurysms develop at branch points with elevated intravascular turbulence and vessel wall shear stress. we aim to compare the efficacy and safety of different surgical treatment modalities for bifurcating intracranial aneurysms.

Methods: A retrospective review of 398 patients who underwent surgical management of a bifurcating aneurysm at Thomas Jefferson University hospital from 2010 to 2020. Aneurysm size, location, modality of treatment, and treatment complications were assessed.

Results: Data analysis is expected to …

Assessing The Utilization And Effectiveness Of Pediatric Order Sets In Hpv Vaccine Administration In A Large Urban Family Medicine Practice, Lakshmi Narayanam, Krys Foster, Md, Mph

Phase 1

Introduction: Human papilloma virus (HPV) vaccination remains a controversial topic with low rates of vaccination completion. According to a 2017 National Immunization Survey, only 49% of adolescents were up to date (UTD) on their HPV vaccination, an alarming statistic given its importance in reducing HPV-related cancers. This project seeks to determine the effectiveness of pediatric order sets in affecting rates of HPV vaccine administration in a large urban family medicine practice.

Methods: A retrospective, qualitative chart review was conducted on patients nine years or older seen at Jefferson Family Medicine Associates in Philadelphia, PA from April 2019 to April …

The Prevalence Of Orally Administered Glucocorticoids, Generalized Pustular Psoriasis And Erythrodermic Psoriasis In The Treatment Of Adult Plaque Psoriasis Provided By U.S. Dermatologists, Katherine Awh, Kumar Nasham, Christian Albornoz, Steven Feldman, Anthony Albornoz

Phase 1

Introduction: Orally administered glucocorticoids (OAG) are not recommended for the management of plaque psoriasis (PsO) due to the classically feared outcomes of generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP). Given their widespread anecdotal use, we hypothesize that the use of OAG is not infrequent among US dermatologists and is rarely complicated by GPP or EP.

Methods: Anonymous electronic survey of 50 US dermatologists. Primary outcomes of interest were the prevalence of OAG in the management of PsO and the prevalence of GPP and EP in the context of OAG tapering.

Results: Overall, 9 out of 50 (18%) respondents …

Correlates Of Rem Sleep Without Atonia In Dream Enactment Behavior Associated With Parkinson’S Disease, Nisha Bagchi, Ritu Grewal, Abigail Quintos, Rohin Saroya

Phase 1

Introduction: Parkinson’s Disease (PD), a common neurodegenerative disease worldwide, has few reliable biomarkers. PD has been linked to REM Behavioral Disorder (RBD), a condition where patients abnormally experience REM sleep without atonia (RSWA). We aim to determine whether chin movements, a feature of RSWA, could serve as a PD biomarker. We hypothesize that those with higher RSWA are more likely to have PD.

Methods: Our study examined patients who underwent polysomnograms from 2015 onwards at the Jefferson Sleep Disorders Center. We did a retrospective EPIC chart review and compared 2 groups, those with RBD and PD (n=12) versus RBD …

An Assessment Of Quality Improvement Strategies For The Implementation Of Certified Recovery Specialists In Treating Opioid Use Disorder At The Emergency Department At Jefferson, A. Cosmo Annese, Rickie Brawer, Phd, Mph, Ches

Phase 1

Introduction: Opioid overdose mortality rate in the U.S. has seen a staggering upward trend lately, more than tripling between the years 2000-2017. Although the use of Certified Recovery Specialists (CRSs) has been shown to improve overdose rates, relapse rates, and treatment completion rates for people with opioid use disorder (OUD), the optimal specialization of CRSs in healthcare settings has yet to be clearly defined. This project seeks the perspectives of CRSs and healthcare workers to gain insight into how CRSs can be most effectively implemented in the ED at Jefferson to treat OUD.

Methods: The study population includes CRSs and …

Pediatric Group Well Care Within The Maternal Treatment Education & Research (Mater) Program, Elizabeth Franko, Neera Goyal, Vanessa Short, Aditi Kale

Phase 1

Introduction:

This project aims to develop and implement group well care for mothers and infants receiving care for opioid use disorder (OUD). Groups would be composed of 5-7 mothers and infants of similar age with extension of sessions to allow group activities and parenting discussions. To evaluate acceptability and feasibility of this care model, we sought to examine attitudes and beliefs from these mothers, in particular the impacts of the COVID-19 pandemic.

Methods:

A qualitative interview study of women receiving treatment for OUD at Maternal Addiction Treatment Education and Research at Thomas Jefferson University from October – December 2020 was …

Impact Of Long-Term Doula Services On Maternal And Fetal Health Outcomes In Women In Treatment For Opioid Use Disorder, Saloni Parikh, Meghan Gannon, Phd, Msph

Phase 1

This study analyzed the impact of doula services on maternal and fetal health outcomes in pregnant women seeking treatment for opioid use disorder. Understanding the impact of doula services is critical in reducing inequities in health outcomes experienced by this vulnerable population. Retrospective and prospective data was collected from surveys, focus groups, and maternal and infant birth data from 100 women in treatment for opioid use disorder, with fifty utilizing doulas and fifty not utilizing doulas. Standardized data abstraction of quantitative and qualitative measures were collected into an SPSS database and Nvivo, respectively, and analyzed using SPSS. Measures of importance …

Medical Student Interest In Loan Forgiveness Programs, Ricky Burns, Brianna Kunes, Allison Casola, Phd, Mph

Phase 1

Purpose: Student debt from medical school rises every year and there is limited research on how early financial education affects career placement. Our purpose is to investigate the prevalence, demographics and motivations of 3^rd year medical students who intend to enter loan forgiveness programs (LFPs). The question we aim to answer is, what are the demographics of 3^rd-year students who intend to take part in LFPs and how can it be used to create better financial education for future students?

Methods: Data from a 31-item cross-sectional quality improvement and health disparities assessment was given to third year …

The Effect Of 3d Printed Models On Surgical Planning And Outcomes For Partial Nephrectomies, Samuel Morano, E. Reilly Scott, Andrea Quinn, Erica Mann, Adam Schneider, Connor Mcpartland, Kaitlyn Boyd, Alice Karp, Abhay Singh, Md, Thenappan Chandrasekar, Md, Mark Mann, Md, Edouard Trabulsi, Md, Vishal Desai, Md, Costas Lallas, Md

Phase 1

Purpose:

Partial nephrectomies to remove renal masses are kidney-sparing procedures that rely on anatomical comprehension. Prior research demonstrates complex and expensive 3D models (~$1000) increased surgeons’ confidence in selecting their operative plan. We aim to use simpler and cheaper 3D models to improve preoperative surgeon confidence and support operative management.

Methods:

3D printed models (~$35) of the affected kidney, mass, and renal vasculature were created using preoperative CT or MRI imaging of 17 patients presenting for partial nephrectomies at Thomas Jefferson University (TJU) between July and December 2020. The models were created at TJU using Ultimaker technology.

Surgeons filled …

Race And Disordered Eating: A Narrative Review Of Current Literature, Casey Swann, Msed, Lee Pachter, Do, Elizabeth Liveright, Md, Meghan Gannon, Phd, Msph

Phase 1

Research Problem: Eating disorder literature has well-established a correlation between childhood trauma and development of eating disorder symptomology. One type of trauma that is often overlooked in eating disorder research is that of racial stress faced by ethnic minorities. The literature on racism and eating disorders tends to focus on the transdiagnostic construct of disordered eating behavior rather than specific DSM-5 diagnoses. As such, the current literature review examined the findings regarding associations between racial stressors and disordered eating behavior.

Methods: The current literature review between Nov 2007 and August 2020 searched 3 databases, PubMed, CINAHL, and PsycInfo for …

Parenteral Lipid Emulsions Induce Unique Ileal Fatty Acid And Metabolomic Profiles But Do Not Increase The Risk Of Necrotizing Enterocolitis In Preterm Pigs, William Yakah, Pratibha Singh, Joanne Brown, Barbara Stoll, Doug Burrin, Muralidhar H Premkumar, Hasan H Otu, Xuesong Gu, Simon T Dillon, Towia A Libermann, Steven D Freedman, Camilia R Martin

Children’s Nutrition Research Center Staff Publications

Necrotizing enterocolitis (NEC) is a manifestation of maladaptive intestinal responses in preterm infants centrally medicated by unattenuated inflammation. Early in the postnatal period, preterm infants develop a deficit in arachidonic and docosahexaenoic acid, both potent regulators of inflammation. We hypothesized that the fatty acid composition of parenteral lipid emulsions uniquely induces blood and intestinal fatty acid profiles which, in turn, modifies the risk of NEC development. Forty-two preterm pigs were randomized to receive one of three lipid emulsions containing 100% soybean oil (SO), 15% fish oil (MO15), or 100% fish oil (FO100) with enteral feedings over an 8-day protocol. Blood …

Fructan-Sensitive Children With Irritable Bowel Syndrome Have Distinct Gut Microbiome Signatures, Bruno P Chumpitazi, Kristi L Hoffman, Daniel P Smith, Ann R Mcmeans, Salma Musaad, James Versalovic, Joseph F Petrosino, Robert J Shulman

Children’s Nutrition Research Center Staff Publications

Background: Dietary fructans may worsen gastrointestinal symptoms in children with irritable bowel syndrome (IBS).

Aim: To determine whether gut microbiome composition and function are associated with childhood IBS fructan-induced symptoms.

Methods: Faecal samples were collected from 38 children aged 7-17 years with paediatric Rome III IBS, who previously completied a double-blind, randomised, placebo-controlled crossover (fructan vs maltodextrin) trial. Fructan sensitivity was defined as an increase of ≥30% in abdominal pain frequency during the fructan diet. Gut microbial composition was determined via 16Sv4 rDNA sequencing. LEfSe evaluated taxonomic composition differences. Tax4Fun2 predicted microbial fructan metabolic pathways.

Results: At baseline, 17 fructan-sensitive …

Overview Of Breath Testing In Clinical Practice In North America, Buford L Nichols, Robert D Baker, Susan S Baker

Children’s Nutrition Research Center Staff Publications

Human breath is an easily, noninvasively obtained substance. It offers insight into metabolism and is used to diagnose disaccharide malabsorption, infection, small bowel bacterial over growth, and transit times. Herein, we discuss the readily available clinical breath tests, how they function, how they are administered and interpreted and some pitfalls in their use.