Medicine and Health Sciences Commons^™

Treatment Outcomes In Gram Negative Periprosthetic Joint Infection, Irene Kalbian, Ba, Karan Goswami, Md, Carol Foltz, Phd, Nathan John, Bs, William Arnold, Md, Javad Parvizi, Md, Fcrs

Phase 1

Introduction: Outcomes associated with periprosthetic joint infection (PJI) involving Gram negative (GN) organisms are poorly understood. While prevailing beliefs indicate that GN PJI cases have poorer prognoses than Gram positive (GP) cases, the current literature is sparse and inconsistent.

Objective: The purpose of this study is to systematically compare the treatment outcomes for GN PJI versus GP PJI.

Methods: A retrospective review of 1189 PJI cases between 2007 and 2017 was performed using an institutional PJI database. Treatment failure defined by the Delphi criteria was compared between cases with only GN organisms (n=45) and only …

Long Term Effects Of Ovum Donation On Donors, Danielle Garfunkel, Andrea Braverman

Phase 1

Introduction: As infertility affects 17% of couples, IVF has become a key, increasingly prevalent option for couples with oocyte donors providing eggs to infertile women in ~13.7% of IVF cycles. Despite the growing prevalence of donation, there are no long-term follow up studies on the emotional and health effects of donation. We cannot appropriately counsel patients regarding the risks of the donation procedure without understanding its effects.

Objective: This study sets out to identify the long-term effects of oocyte donation on donors’ mental state and physical health and how the attitudes and concerns of oocyte donors regarding their donation …

Does Concomitant Cabg Influence The Outcomes Of Post-Myocardial Infarction Ventricular Septal Defect Repair?, Dylan P. Horan, Jae Hwan Choi, Matthew P. Weber, Elizabeth Maynes, Sinal Patel, Jothika Challapalli, Jessica G.Y. Luc, John W. Entwistle, H. Todd Massey, Rohinton J. Morris, Vakhtang Tchantchaleishvili

Phase 1

Introduction: Ventricular septal defect (VSD) following myocardial infarction (MI) is a relatively infrequent complication with high mortality. Over time, understanding of the pathology and its management has resulted in improved outcomes; however, controversies remain.

Objective: We sought to investigate the effect of concomitant coronary artery bypass graft (CABG) on outcomes following post-MI VSD repair.

Methods: Electronic search was performed to identify all relevant studies published from 2000 to 2018. After assessment for inclusion and exclusion criteria, 66 studies were selected for the analysis. Data were extracted and pooled for systematic review and meta-analysis.

Results: Average age was 68.7 years …

Assessing The Operative Log Data Of Traditional (5+2) Vs. Integrated (0+5) Vascular Training Programs, Ernest Gillan, Bs, Anthony Feghali, Md, Tuong Nguyen, Md, Dawn Salvatore, Md, Paul Dimuzio, Md, Babak Abai, Md

Phase 1

Introduction: In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved an integrated 5 year vascular surgery residency program. Operative experience can be used as a surrogate marker for success in the evolving field of vascular surgery training.

Objective: The purpose of this study is to compare the operative experience of those graduating from the traditional (5+2) vascular training program with the integrated (0+5) program.

Methods: National operative case log data supplied by the ACGME was gathered and organized for vascular surgery residents graduating between 2013 and 2018. Mean case numbers were compared between integrated vascular residents and traditional …

Bova Is Superior To Spesi In Identification Of High Risk Pulmonary Embolism Patients, J. Dibello, P. Khaing, E. Gupta, C. Au, T. Chengsupanimit, B. K. Awsare, M. Baram, F. M. West, G. C. Kane

Phase 1

Introduction: Prognostic models exist for the purpose of stratifying patients with acute pulmonary embolism. Of these, the Pulmonary Embolism Severity Index (PESI) and the simplified PESI (sPESI) are the most well-known, although more recent composite models, like the BOVA score, are now being studied and implemented. Comparative efficacy of these scores to predict long term mortality is not well established.

Methods: We performed a retrospective analysis of all consecutive patients diagnosed with PE using computed tomography scan from 2014-2016 at an urban tertiary-referral medical center. Cox proportional hazard analyses were performed to compare the performance of two prognostic …

Comparing Treatment Efficacy Of Upper Airway Stimulation To Cpap For Obstructive Sleep Apnea, Alec Furstenberg, Colin Huntley, Md, Adam Vasconcellos, Md, Ayan Kumar, Karl Doghramji, Md, Maurits Boon, Md

Phase 1

Introduction

Upper airway stimulation (UAS) is newer treatment option for the management of Obstructive Sleep Apnea (OSA) and presents an alternative to the traditional Continuous Positive Airway Pressure (CPAP). Previously published data has shown good control of disease severity utilizing UAS with high patient tolerance and compliance. We aim to compare a cohort of patients treated with UAS and CPAP and evaluate therapy usage and disease control through use of the mean disease alleviation concept.

Methods

We evaluated demographic, pre and post-treatment sleep study, and therapy utilization data of cohorts of patients with OSA treated with CPAP and UAS. We …

Cellular Milieu Imparts Distinct Pathological Α-Synuclein Strains In Α-Synucleinopathies, Ronald Gathagan, Chao Peng, Dustin Covell, Coraima Medellin, Anna Stieber, John L. Robinson, Bin Zhang, Rose M. Pitkin, Modupe F. Olufemi, Kelvin C. Luk, John Q. Trojanowski, Virginia M.Y. Lee

Phase 1

Introduction: In Lewy body diseases-including Parkinson's disease, without or with dementia, dementia with Lewy bodies, and Alzheimer's disease with Lewy body co-pathology -α-synuclein (α-Syn) aggregates in neurons as Lewy bodies and Lewy neurites. By contrast, in multiple system atrophy α-Syn accumulates mainly in oligodendrocytes as glial cytoplasmic inclusions (GCIs)

Objective: Our objective was to determine the conformational and biological profiles of a-Syn strains.

Methods: The following methods were used to collect and analyze data: Recombinant α-Syn purification and in vitro fibrillization. Preparation of sarkosyl-insoluble fractions from disease and control brains. Sandwich ELISA. Cell cultures. Stereotaxic injection of sarkosyl-insoluble fraction of …

Sociodemographic Background Characteristics Of Patients Who Participate In A Lung Cancer Screening Program, Amber Zhang, Marcella Pimpinelli, Brooke Ruane, Russell K. Mcintire, Julie Barta, Md, Hee-Soon Juon, Bridget Jackson

Phase 1

Introduction: Despite decreasing lung cancer incidence and mortality rates, disparities in prevalence and outcomes persist between Black and White patients. Secondary analysis of the National Lung Screening Trial found screening with low-dose CT (LDCT) reduced lung cancer mortality more in Blacks than Whites. However, it is unknown if racial disparities exist in screening results, and the involved sociodemographic factors.

Objective: The study aims to analyze characteristics that may predict screening outcomes (Lung-RADS category) in patients who received LDCT through the Jefferson Lung Cancer Screening Program (LCSP).

Methods: Retrospective data (n=733, May 2015 to July 2017) were merged with prospective …

Post-Operative Outcomes Of Surgical Treatment For Trigeminal Neuralgia, Daniel Tzou

Phase 1

Introduction: Trigeminal Neuralgia causes severe paroxysmal facial pain that leads to debilitating quality of life. Pharmacologic management often becomes insufficient, and the microvascular decompression (MVD) procedure is the mainstay surgical intervention. Internal neurolysis (IN) is a novel addition to the MVD procedure to treat trigeminal neuralgia, and its efficacy has not been well tested.

Objective: The objectives of the study are to understand appropriate surgical treatments for trigeminal neuralgia and to determine the efficacy of the additional IN compared to MVD.

Methods: A retrospective cohort study on patients undergoing surgical intervention for trigeminal neuralgia at TJUH was conducted. Surgical treatment …

Technology Use And Wellness Maintenance In A Medical Student Population, Lillian Flashner

Phase 1

Introduction: Burnout now affects more than half of U.S. medical students, causing decreased resilience and coping ability. When these students become physicians, they are more likely to commit medical error and have decreased patient satisfaction. Studies in college students have shown that technology use may improve wellness and deter burnout; however, heretofore no studies have been conducted to understand if medical students use the same practices.

Objective: Our specific aims were to survey medical students to identify whether they use technology to maintain their wellness, and to identify which technologies are the most effective for this purpose.

Methods: We distributed …

Acute Pancreatitis In The Emergency Department, Gregory J. Lopez, Bs, Matt Hall, Md, Matthew Babineau, Md, Darshan Kothari, Md, Ryan C. Burke, Phd, Mph, Richard E. Wolfe, Md, Sunil G. Sheth, Md, Stephen Freedman, Md, Nathan I. Shapiro, Md, Carrie Tibbles, Md

Phase 1

Introduction: Acute pancreatitis (AP) is a common emergency department (ED) presentation with a variety of outcomes. Stratifying AP severity with scoring systems can allow physicians to effectively manage patient disposition.

Objective: To identify ED pancreatitis patients who will likely be admitted to the ICU or be discharged within 48 hours, and to validate existing pancreatitis severity scores.

Methods: Patients with a final ED diagnosis of AP and/or lipase ≥ 3 times the upper limit of normal were enrolled in a prospective, observational chart review study. Parametric and non-parametric descriptive statistics were used to describe the patient population. Area under receiver …

Medice, Cura Te Ipsum (Physician, Heal Thyself): A Documentary Film Exploring How The Passions Of Medical Students Will Make Them Better And Healthier Physicians, Ryan Emhoff

Phase 1

It is a well documented, yet largely ignored fact that physicians, residents and medical students are experiencing a pandemic of depression, burnout, dissatisfaction, and suicide. The principal cause may be the institution of medicine, which is slow to change, abusive, and dismissive of these complaints. While interventions are necessary at all levels of training, medical students may be the most in need as their mental health is the poorest of these groups.

Emotion-focused coping activities focus on alleviating stress. The humanities can function as emotion-focused coping activities, and exposure to them in medical education has been correlated with higher empathy …

Improving Midstream Urine Collection For Urine Culture Through The Use Of A Novel Device, Flipcatch, Christopher Neely, Dante Varotsis, Helen Xu

Phase 1

Background : A midstream, clean-catch urine sample is the gold standard for diagnosing urinary tract infections and determining treatment. The current method of collection is not standardized, frustrating both patients and providers. The current method results in a high rate of contaminated samples (30-40%), which often need to be repeated in order to obtain a diagnosis and antibiotic susceptibility data. A design project was conducted in order to create a more effective urine collection device with the goals of decreasing contamination and improving patient and provider experience.

Methods : We conducted interviews of patients, allied health professionals, physicians, and clinical …

3d Printed Biliary Anatomy For Surgical Planning, Jason Core, Erik Massenzio, Tamar Wasserman, Kevin Xie

Phase 1

Background: Studies demonstrated that 3D-printed livers from CT or MRI data can be accurate models of actual patient anatomy. However, it has yet to be established if 3D printing offers improvements to clinical outcomes in surgery. This project seeks to optimize these applications for use at Jefferson by producing 3D-printed models from patient CT scans to guide liver resection surgeries.

Methods: A liver transplant attending was interviewed about challenges encountered during hepatectomies. A publicly available abdominal computed tomography scan was used to render a liver and its vasculature in 3DSlicer. The liver surface was cut into two halves in MeshMixer …

Portable Pelvic Exam Positioning Device For Enhanced Workflow And Patient Comfort, Hannah Levy, Elliott Perow, Sean Haynie

Phase 1

Background: Pelvic exams are often performed in settings other than designated obstetrics and gynecology suites. In these other settings, the equipment that is traditionally used to position the patient, such as a bed fitted with stirrups, may not be available. Therefore, physicians often improvise a solution to elevate the pelvis, such as using inverted bedpans, pillows or blankets. However, the lack of an appropriate device to position patients decreases patient and physician comfort, causes workflow inefficiency and leads to suboptimal examination due to inadequate provider visualization.

Methods: Over the course of five months, input from patients and providers alike was …

Theater Of Witness: The Patient Experience Of Dementia Shared Through Testimonial Performance, Salena Cui

Phase 1

Introduction: Dementia is a condition that modern medicine is ill-equipped to address, and to which art may have much to offer. This project combines reflective and creative processes in a theater collaboration between patients, caregivers, and healthcare students. The goal was to explore the ways in which theater can heal, and to better understand the patient experience of dementia.

Methods: I worked with Teya Sepinuck on this project. We met with participants individually to conduct interviews about personal stories and held group workshops to explore our collective story. We worked with a percussionist and composer to explore accompanying music. …

De-Stigmatizing Mental Illness Through Graphic Medicine, Megumi Tsuda

Phase 1

Graphic medicine - or the communication of health-related narratives through images and texts, such as comics - has been increasingly recognized as a powerful educational tool. My project investigates the value of integrating graphic medicine to medical education, specifically to improve mental health literacy and de-stigmatize mental illness. As a medical student, I have encountered several instances where fellow medical students and even doctors casually throw around diagnostic terminology, especially those used to describe mental health disorders, in a colloquial and insensitive manner that seem to indicate that they do not take mental illness seriously, or even ignorant of what …

Can Standardized Heuristics Reduce Bias And Preserve Clinical Creativity?, Daniela Fishbein, Ryan Long, Phd

Phase 1

Background: Heuristics, commonly known for introducing bias, are now being standardized to reduce biases in clinical decision-making (CDM). In a healthcare environment that recognizes the importance of clinical creativity, it remains unclear how standardized heuristics such as the fast-and-frugal model impact creative features of CDM. One framework of CDM, proposed by Engebresten et al., emphasizes the importance of uncertainty and creativity through four aspects: imagination, reflective questioning, understanding and critical judgment.

Objectives: Using the fast-and-frugal model as an example, we investigate the role that standardized heuristics play in a CDM framework that emphasizes uncertainty and creativity over the standardization of …

“Who Am I Now?”: A Musical And Creative Case Study/Time Capsule, Alexander M. Olson

Phase 1

Background

Medical school is an immense undertaking, emotionally, intellectually, and physically. I heard it said that “medicine is the frontline seat to human condition, without the tools to process that...it becomes traumatic”. I entered this phase of my life with interests and passion outside of my professional aspirations, and I have found it a struggle to devote to them the energy and time that they deserve. I have chosen a project in the humanities track, focused on creating a musical time capsule of creative work.

Objective

To create a chronological record of my evolving musical tastes and influences that I …

Burnt: A Narrative Exploration Of Burnout In Medicine, Aaron Chambers

Phase 1

Burnout has become a central social issue within the culture of medicine. Estimates project that more than half of all physicians experience burnout in a given year. This results in lower job satisfaction among physicians as well as diminished patient outcomes. The topic’s literature suggests that burnout susceptibility is multifactorial, but includes extrinsic (debt, variable schedule, hierarchical workplace, EMR) as well as intrinsic (uncertainty, breaking difficult news, secondary trauma) contributors. To better understand this complicated topic, this project sought to synthesize competing factors within a narrative that explores the good and bad of contemporary medicine. The narrative is informed by …

Cross-Sectional Analysis Of Sound Levels In The Neonatal Intensive Care Unit (Nicu) At Thomas Jefferson University Hospital, Caroline Komlo, Martin Morris, Robert Ries, Michael Velez

Phase 1

Introduction . Infants in the NICU are considered at greater risk of developmental delay. It is now known that excessively loud noise can have a negative impact on parameters such as blood pressure, breathing, heart beat and oxygen saturation. Previous research has concluded that the optimal decibel (dB) level for proper growth of neonate hair cells rests around 45dB. Consequently, the American Academy of Pediatrics recommends that noise levels in the NICU be maintained to a maximum of 45dBA. However, little research has focused on designing new noise-altering products and their impact on neonatal outcomes.

Methods. This was a cross …

Useless Med School Notes; Medical Education Through Mnemonics, Aaron B. Miller

Phase 1

BACKGROUND: The volume of content required for synthesis by medical students is immense and continues to grow as more insight and information is added to the existing compendium of medical knowledge. Mnemonics, memory palaces, and other visual memory aids have been used throughout history for assisting students and scholars in recalling information; offering an alternative to the practice of rote memorization. While technology has advanced and a shift towards paid-subscription services that offer pre-made mnemonics has gained great popularity among medical students, studies have shown that the act of creating the mnemonic in of itself serves as a powerful memory …

The Healing Power Of Live Music, Brianna Casey

Phase 1

Music has long been recognized for its ability to promote healing and wellbeing in patients across the entire spectrum of healthcare settings. Thanks to recent research into its therapeutic effects, music is now widely accepted as an established part of a holistic healthcare regime. However, more work needs to be done in defining the aspects inherent to music that make it such an effective agent of healing. Notably, little research has been done on whether live musical performance is more effective than recorded music in bringing about therapeutic benefits. The current project sought to explore the differential perceptions of and …

The Sentiment, Alexander Thomas

Phase 1

The Sentiment is a work of prose poetry that crystallizes my understanding of fluid identity and the interrelation of all existences. It synthesizes my personal experiences with the words and actions of the many teachers who came before me, and serves as an existential reminder of the unique and universal nature of all things. This is a perception that has only grown through the writing of the work, and one which deeply affects my relationships with others. It is, in large part, my motivation for becoming a doctor. I see each suffering as my suffering, and each joy as my …

A Social Dance Intervention To Nourish Sustainable Quality Of Life Outlook In Geriatric Oncology Patients, Luis Alberto Aguilar Montalva

Phase 1

Importance: Social support is a major determinant of health for geriatric oncology patients. Nevertheless, no DMT program utilizes community building as an explicit focus of intervention.

Objective: To design a DMT that fosters a therapeutic approach which relies as much on the interpersonal relationships as on the intrapersonal journey. Design, setting, participants: 12 weeks observational trial of participants, from TJUH geriatric oncology patient population, as they progressed through two series of social dance workshops. The first series of six workshops happened on a weekly basis, with participants filling out a FACT-G survey pre and post involvement. The second series of …

The Impact Of Mental Health On Cancer Preventative Screenings, Chelsea Edirisuriya, Amy Leader, Phd

Phase 1

Among the mental health population of the United States, overall preventative health services, such as cancer screening rates, are remarkably low. Additionally, there is a significant 30% higher mortality rate due to cancer in psychiatric patients. This project established if there are disparities in cancer screening rates between the general population and the mental health population of Southeastern Pennsylvania. The project analyzed and compared the differences in cancer screenings for colorectal, breast, and cervical cancer among those currently diagnosed with a mental condition and the general population. Through p-value and Pearson chi-square statistical analysis of the Community Health Data Base …

Screening, Brief Intervention, And Referral To Treatment (Sbirt) For Substance Use Disorders In Title X Facilities: Assessing Barriers, Change Of Provider Behavior, And Patient Outcomes, Christian Iversen, Ms, Holly Ireland, Lcsw-C, Dickie Lynn Gronseth, Mph

Phase 1

Introduction: Substance use disorders, specifically opioids, are an increasing problem in the US. Screening, brief intervention, and referral to treatment (SBIRT) is a method to identify and treat patients at risk, or currently using illicit substances. Integrating SBIRT into Title X facilities, which provide reproductive healthcare to lower income populations, may allow identification and treatment of individuals that do not seek healthcare elsewhere. Objective: We aim to assess the efficacy of a longitudinal training program in Title X facilities. The program provides a structured approach to implementing new protocols, including an educational session on SBIRT and motivational interviewing (MI).

Methods: …

Demographics, Support Opportunities, And Self-Reported Well-Being Of Patients Presenting For Hepatitis C Treatment At A Federally Qualified Health Center In Philadelphia, Dina Zaret, C. Coleman, M. Dorshimer, J. Kostman, L. Magaldi, T. Preston, R. Rivera, S. Trooskin

Phase 1

Introduction: As the opioid epidemic develops and evolves, the number of people who inject drugs is rising. A growing number of new Hepatitis C Virus (HCV) infections have been identified in people who inject drugs.

Objective: This study aims to better understand the demographics, well-being, and satisfaction with medical care of patients presenting for HCV treatment at a Federally Qualified Health Center (FQHC) in an urban setting. The study also looks to assess the impact of continued connection to holistic medical care.

Methods: Surveys were administered to 51 unique patients at their first visit for HCV treatment. Along with demographic …

Opioid-Prescribing Practices For Post-Operative Patients In Otolaryngology: A Multiphasic Quality Improvement Project In A Single Large Institution, Zachary Gandee, Sophia Dang, Alexander N. Duffy, Jonathan C. Li, Tanvi Rana, Brittany Gunville, Tingting Zhan, Elizabeth Cottrill, Md, David Cognetti, Md

Phase 1

Objectives:

In otolaryngology, postoperative pain management lacks evidence-based guidelines. We investigated opioid prescription and consumption for common procedures to develop prescribing guidelines at our institution.

Study Design:

Prospective, survey study.

Methods:

Patients who underwent surgery between July and September were given surveys upon discharge and at first follow-up visit. We assessed opioid usage and pain using the visual analog scale and opioid consumption throughout the postoperative period. Opioid prescriptions were converted to a standardized unit of 5 mg Oxycodone pills for reporting. Four procedures (transoral robotic surgery resection [TORS], sialendoscopy, parathyroidectomy/thyroidectomy, and parotidectomy) were selected for isolated analysis.

Results: …

Knowledge And Awareness Of Std Risk Perception Of Msm In Philadelphia, Timothy Chou, Nancy Brisbon, Md

Phase 1

There has been a rise in incidence of sexually transmitted diseases (STDs), in particularly in men who have sex with men (MSM). MSM were 106x as likely to have primary or secondary syphilis as compared to men who exclusively had sex with women (MSW). MSM account for large portion of antimicrobial resistant gonorrhea diagnoses and saw a 151% increase in incidence while compared to a 31.7% increase in MSW. This study examines what MSM in Philadelphia know about transmission methods and outcomes of syphilis and gonorrhea to better understand MSM risk perception of these diseases. A multiple-choice test was distributed …