Medicine and Health Sciences Commons^™

Integrating Primary Care, Shared Decision Making, And Community Engagement To Facilitate Equitable Access To Multi-Cancer Early Detection Clinical Trials, Cheryl L. Thompson, Adam H. Buchanan, Ronald E. Myers, David S. Weinberg

Department of Medical Oncology Faculty Papers

Effective implementation of cancer screening programs can reduce disease-specific incidence and mortality. Screening is currently recommended for breast, cervical, colorectal and lung cancer. However, initial and repeat adherence to screening tests in accordance with current guidelines is sub-optimal, with the lowest rates observed in historically underserved groups. If used in concert with recommended cancer screening tests, new biospecimen-based multi-cancer early detection (MCED) tests could help to identify more cancers that may be amendable to effective treatment. Clinical trials designed to assess the safety and efficacy of MCED tests to assess their potential for reducing cancer mortality are needed and many …

Advanced-Stage Melanoma At Presentation Following The Peak Of The Pandemic: A Covid-19 Cancer Canary In A Coal Mine, Ryan Lamm, Md, Walker Lyons, Md, Winnie So, Rn, Alliric I. Willis, Md, Facs, Msph

Department of Surgery Faculty Papers

Background: For melanoma patients, timely identification and tumor thickness are directly correlated with outcomes. COVID-19 impacted both patients' ability and desire to see physicians. We sought to identify whether the pandemic correlated with changes in melanoma thickness at presentation and subsequent treatment timeline.

Methods: Retrospective chart review was performed on patients who underwent surgery for melanoma in an academic center surgical oncology practice from May 2019 to September 2021. Patients were split into two cohorts: "pre-pandemic" from May 2019 to May 2020 and "pandemic," after May 2020, representing when these patients received their initial diagnostic biopsy. Demographic and melanoma-specific variables …

Increasing Depression Screening And Treatment, Emma De Louw, Md, Michael Danielewicz, Md, Michael Haines, Md, Molly Allanoff, Md, Elizabeth Clark, Md, Michael Bozzi, Md, Natalie Antosh, Md, Catherine Guariglia, Md, Yael Horvath, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aims for Improvement

• Increase response to depression advisory in EHR from 39% (January 2021) to 60% or greater (March 2021)
• Increase referrals to behavioral health from baseline of 39/month (January 2021) by 25% (March 2021)

Improving Colon Cancer Screening Rates In An Ambulatory Resident Clinic, Ashima Oza, Md, Tina Boortalary, Md, Elizabeth Chin, Md, Tudor Sturzoiu, Md, John Wallis, Md, Sonia Bharel, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

In the US, colorectal cancer (CRC) is the third leading cause of cancer-related deaths. According to the 2018 CDC Behavioral Risk Factor Surveillance System survey, 68.8% of US adults between 50 and 75 were up to date on colorectal screening (CRCS) across all screening modalities. In light of the COVID-19 pandemic, screening has dropped even further and is still 50% below pre-pandemic levels. At Jefferson, our CRCS rate is below the national average at 55.4%. Given the importance of regular screening for CRC prevention, this is clearly inadequate. There are several barriers to completing an invasive screening modality like a …

Association Of Race With Lung Cancer Risk Among Adults Undergoing Lung Cancer Screening., Christine S Shusted, Nathaniel R Evans, Hee-Soon Juon, Gregory C Kane, Julie A Barta

Division of Pulmonary and Critical Care Medicine Faculty Papers

No abstract provided.

Molecular Landscape And Actionable Alterations In A Genomically Guided Cancer Clinical Trial: National Cancer Institute Molecular Analysis For Therapy Choice (Nci-Match)., Keith T Flaherty, Robert J Gray, Alice P Chen, Shuli Li, Lisa M Mcshane, David Patton, Stanley R Hamilton, P Mickey Williams, A John Iafrate, Jeffrey Sklar, Edith P Mitchell, Lyndsay N Harris, Naoko Takebe, David J Sims, Brent Coffey, Tony Fu, Mark Routbort, James A Zwiebel, Larry V Rubinstein, Richard F Little, Carlos L Arteaga, Robert Comis, Jeffrey S Abrams, Peter J O'Dwyer, Barbara A Conley

Department of Medical Oncology Faculty Papers

PURPOSE: Therapeutically actionable molecular alterations are widely distributed across cancer types. The National Cancer Institute Molecular Analysis for Therapy Choice (NCI-MATCH) trial was designed to evaluate targeted therapy antitumor activity in underexplored cancer types. Tumor biopsy specimens were analyzed centrally with next-generation sequencing (NGS) in a master screening protocol. Patients with a tumor molecular alteration addressed by a targeted treatment lacking established efficacy in that tumor type were assigned to 1 of 30 treatments in parallel, single-arm, phase II subprotocols.

PATIENTS AND METHODS: Tumor biopsy specimens from 5,954 patients with refractory malignancies at 1,117 accrual sites were analyzed centrally with …

Exercise Prescriptions In Primary Care, Caitlyn Haines, Pgy-2

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives:

●Review the health benefits of physical activity.

●Recognize barriers on the part of the provider that limit our discussion of exercise with our patients.

●Understand the current recommendations for physical activity including: time per week, exercise intensity, and recommendations for pregnant patients and those with chronic disease.

●Understand the current recommendations for screening prior to exercise in patients with chronic medical conditions.

●Help patients devise strategies to introduce physical activity into their routine.

●Become familiar with resources to connect our patients with for exercise in their area.

Updates In Cervical Cancer Screening, Sarah Cokenakes (Hirsh), Md - Pgy 3

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives:

• To review the incidence of cervical cancer in the United States and the relationship between the HPV virus and invasive cervical cancer.
• To review the 2019 ASCCP guidelines and how they differ from 2012 guidelines.
• To discuss use of technology to aid in appropriate decision making and management.

Breast Cancer Screening, Nina Mingioni, Md, Facp

Clinical Education Teaching Tools

Learning Objectives:

• Assess patients for risk of breast cancer
• Name common breast cancer screening modalities
• Discuss the risks and benefits of breast cancer screening
• Recommend breast cancer screening in appropriate patients

Cancer Prevention And Therapeutics For The Primary Care Clinician, Richard C. Wender, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline

•Basics of cancer screening •Recommended options for colorectal cancer screening •Trends in incidence and mortality •The 80% in Every Community initiative

Implementation Of Family Psychosocial Risk Assessment In Pediatric Cancer With The Psychosocial Assessment Tool (Pat): Study Protocol For A Cluster-Randomized Comparative Effectiveness Trial, Anne E Kazak, Janet A Deatrick, Michele A Scialla, Eric Sandler, Rebecca E Madden, Lamia P Barakat

Department of Pediatrics Faculty Papers

BACKGROUND: Childhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g., economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation.

METHOD: The PAT will be implemented across a national sample …

Timely Diagnosis And Staging Of Non-Alcoholic Fatty Liver Disease Using Transient Elastography And Clinical Parameters., Christine Shieh, Dina L. Halegoua-De Marzio, Matthew L. Hung, Jonathan M. Fenkel, Steven K. Herrine

Division of Gastroenterology and Hepatology Faculty Papers

Background and Aim: There is no standardized guideline to screen, image, or refer patients with non-alcoholic fatty liver disease (NAFLD) to a specialist. In this study, we used transient elastography (TE) to examine the fibrosis stages at which patients are first diagnosed with NAFLD. Subsequently, we analyzed metabolic markers to establish cut-offs beyond which noninvasive imaging should be considered to confirm NAFLD/non-alcoholic steatohepatitis fibrosis in patients.

Methods: Charts spanning July 2015-April 2018 for 116 NAFLD patients who had TE performed were reviewed. Univariate and multivariate analysis of metabolic markers was conducted.

Results: At the first hepatology visit, TE showed 73% …

Development Of An Emergency Room Identification Tool To Aid In The Identification Of Victims Of Sex Trafficking, Misha Yakobi, Amy Leader

Phase 1

Despite the reality that the majority of victims of sex trafficking interact with the healthcare system, there is no uniformly implemented or agreed upon screening tool utilized by emergency departments to identify members of this population. In addition, there is no easily accessible composite of resources available to be distributed if these victims of sex trafficking are identified. This study aims to aid in the design and dissemination of such a screening tool and to create a composite of local and national resources that serve this population.

Using an interview guide, conversations were held with policy experts and healthcare professionals. …

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 …

Common Practice For Behavioral Health Screening In Pediatric Primary Care Settings, Joseph A. Menand, Mario Cruz, Md

Phase 1

Mental health disorders in the United States are highly prevalent, affecting 14-20% of children yearly. Only 25-35% receive treatment after on average a six-plus year delay from symptom onset. Current recommendations suggest primary care physicians/providers (PCP) manage mental health conditions, however, PCPs are wary, citing lack of time, training and resources.This study evaluated pediatric/adolescent PCPs using a self-report questionnaire assessing knowledge/skill, clinical practice (e.g. screening tool) and perceived barriers when managing attention deficit hyperactivity disorder (ADHD), anxiety and depression (N = 11). Self-reported knowledge/skill diagnosing, treating and referring each disorder were recorded on a 5-point Likert scale and evaluated using …

Clinician Perspectives On Factors Affecting Shared Decision Making About Lung Cancer Screening, Mohammad Abubaker-Sharif, Melissa Dicarlo, Mph, Ms, Ronald E. Myers, Phd, Dsw

Phase 1

Background/Objective. In 2015, the Centers for Medicare and Medicaid Services (CMS) announced coverage for annual lung cancer screening (LCS) with low dose computed tomography (LDCT) for individuals who are 55 to 77 years of age, have > 30 pack years of smoking history, and undergo shared decision making (SDM) prior to screening. Most referrals for LCS are initiated in primary care. Currently, little is known about how primary care physicians view SDM and barriers in practice to SDM about LCS. This study aimed to gather information to help fill these knowledge gaps.

Methods. I worked with senior leadership in …

Perspectives Of Asian/Pacific Islanders On Lung Cancer Screening In Philadelphia: A Qualitative Study, Melissa Chai, Kristine Pham, Mph, Rickie Brawer, Phd, Mph, Mches

Phase 1

Introduction: Even though rates of smoking, the leading cause of cancer, are lower in Asian/Pacific Islanders (API), the rates of lung cancer deaths are still one of the highest compared to those of other minority groups in the US. However, little is known about the beliefs and attitudes that influence lung cancer screening behaviors of APIs.

Objective: The objective of this study is to better understand the current beliefs, attitudes, and knowledge of APIs in Philadelphia towards lung cancer and lung cancer screening.

Methods: Six in-depth interviews were conducted with key informants, who all had extensive experience working with the …

Identifying And Addressing Hepatitis C Linkage Barriers Through An Institutional Screening Process, Madalene Zale, Mph, Priya Mammen, Md, Mph

Department of Emergency Medicine Posters

Aim

This study evaluates the impact of Act 87 on HCV screening in an urban, academic hospital system with particular attention to disparate care and barriers to linkage to specialty treatment

Effective Hepatitis C Screening In High Risk Populations, Aekata Shah, Do, Jennifer Seymour, Do

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Purpose

The purpose of our study was to demonstrate how various quality improvement initiatives activated in selected Jefferson Northeast family medicine teaching offices have enabled effective HCV screening. Given the cost effectiveness of screening and early treatment versus treatment of the disease in the later stages of progression,8 we hope to encourage other primary care offices to implement quality initiatives to encourage appropriate HCV screening. This is especially important for the baby boomer generation, as well as for high risk individuals with a history for and/or current IV drug abuse or other high risk behaviors.

Success And Limitations Of Hepatitis C Screening In The Inpatient Setting, Madalene Zale, Mphc, Priya Mammen, Md, Mph

College of Population Health Posters

This study evaluates the outcomes that a state level mandate for HCV screening with HCV-Antibody-only has on linkage to care and access to treatment, compared to a specific programmatic effort, which includes HCV confirmation.

Scientific Evidence For Different Options For Gdm Screening And Management: Controversies And Review Of The Literature., Claudia Caissutti, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

Background. Gestational diabetes (GDM) affects up to 7% of pregnant women and is associated with several maternal and perinatal morbidities. International organizations suggest several different recommendations regarding how to screen and to manage GDM. Objective. We aimed to analyze the most important and employed guidelines about screening and management of GDM and we investigated existing related literature. Results. We found several different criteria for screening for GDM, for monitoring GDM, and for starting pharmacological therapy. When using IADPSG criteria, GDM rate increased, perinatal outcomes improved, and screening became cost-effective. Compared to no treatment, treatment of women meeting criteria for GDM …

Integrated Guidance On The Care Of Familial Hypercholesterolaemia From The International Fh Foundation., Gerald F Watts, Samuel Gidding, Anthony S Wierzbicki, Peter P Toth, Rodrigo Alonso, W Virgil Brown, Eric Bruckert, Joep Defesche, Khoo Kah Lin, Michael Livingston, Pedro Mata, Klaus G Parhofer, Frederick J Raal, Raul D Santos, Eric J G Sijbrands, William G Simpson, David R Sullivan, Andrey V Susekov, Brian Tomlinson, Albert Wiegman, Shizuya Yamashita, John J P Kastelein

Division of Cardiology Faculty Papers

Familial hypercholesterolaemia (FH) is a dominantly inherited disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL) cholesterol and causes premature coronary heart disease. There are at least 20million people with FH worldwide, but the majority remain undetected and current treatment is often suboptimal. To address this major gap in coronary prevention we present, from an international perspective, consensus-based guidance on the care of FH. The guidance was generated from seminars and workshops held at an international symposium. The recommendations focus on the detection, diagnosis, assessment and management of FH in adults and children, and set guidelines for clinical …

Delirium Screening: From Research To Point Of Care, Beth Ann Swan, Phd, Crnp, Faan, Sheena Ahlawat, Mph, Christopher N. Sciamanna, Md, Phd

College of Nursing Faculty Papers & Presentations

Delirium is a serious public health problem among older adults and is one of the most common cognitive disorders affecting postoperative older adults. Delirium is a treatable illness that disproportionately places postoperative older adults at increased risk for functional and cognitive decline, as well as increased morbidity and mortality. More than 50 percent of postoperative patients develop delirium during hospitalization. Epidemiologic and clinical studies over the past two decades have provided ample evidence that delirium in hospitalized older adults is under-recognized by nurses and physicians, often leading to untoward events that the safety and well-being of hospitalized older adults.

Asthma Prevalence In The Philadelphia Public Schools, Elaine J. Yuen, Salvatore Mangione, Colin Cleary

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Decision Counseling In Prostate Cancer Screening, Ronald E. Myers, Jeffrey Riggio, Elisabeth Kunkel, Constantine Daskalakis, Lawrence Goldstein, Mark Capkin, Alan Braverman

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.