Medicine and Health Sciences Commons^™

An Historical Review Of Electroconvulsive Therapy, Bruce A. Wright, M.D.

Jefferson Journal of Psychiatry

The initial clinical trial of electroconvulsive therapy (ECT) was performed by Ugo Cerletti and Lucino Bini at the University of Rome in 1938. The following paper will examine both the developments which led to the first trial of ECT, and the use of ECT over th e subsequent fifty years. Hopefully, by investigating the historical aspects of the development and progression of ECT, a better understanding of this treatment modality can be attained.

Working With Homeless Women And Children: Opportunities For Training, Lance D. Clawson, M.D., Ronald J. Koshes, M.D.

Jefferson Journal of Psychiatry

The diversity of the homeless population allows for unique training opportunities in psychiatry, especially for child and adolescent psychiatry fellows. The prevalence of psychopathology both existing in and as a result of displacement and disenfranchisement requires a specialized knowledge of this population and provides an extraordinary education in community outreach, emergency psychiatry and social service delivery systems. The authors review their experience of working with homeless women and children in the community. Possibilities for more comprehensive training and research are also presented.

The Real Mother-Issues In Adoption, Penelope J. Hooks, M.D.

Jefferson Journal of Psychiatry

Our society has deemed adoption a desirable alternative method of creating a family. It satisifies the need of a child for parents, it gratifies the desire of adults who yearn to provide a home and love for a child, and it gracefully solves the dilemma for the one who cannot or will not raise the child. In addition to the usual developmental conflicts, families involved in adoption will encounter a variety of fears, fantasies, resentments, and misconceptions which may adversely affect identity formation in the child. Here I will attempt to explore some of the psychodynamic issues which will be …

Cognitive Information Processing In Borderline Personality Disorder: A Neuropsychiatric Hypothesis, J.Wesley Burgess, Ph.D., M.D.

Jefferson Journal of Psychiatry

Neurocognitive information processing was compared in 18 borderline subjects and 14 controls of similar age and gender. An 11-item screening examination significantly differentiated the two groups (P < 0.001). Significant differences were found on Delayed Memory, Serial Sevens, Rhythm Reproduction, and Perseveration subtests (P < 0.05). The results are interpreted as evidence for mild frontotemporal brain deficits. The findings support a developmental model of borderline disorder where early stress/injury during the childhood period of frontotemporal vulnerability results in failure to negotiate developmental landmarks and adult deficits in cognition, emotion/behavior modulation, and insight.

A Sexually And Physically Abused Child: His Inner World, Carmen Mayugba-Sugai, M.D.

Jefferson Journal of Psychiatry

This paper describes how a sexually abused 8 year old boy's internal dynamics correlated with and influenced his behavior while he was on an inpatient unit. Through play therapy and unit staff's observation, the psychopathological sequelae to the abuse unfolded in a very interesting way. This process of correlating play material with observations of behavior on the unit, helped the treatment team in understanding the child's inner world.

Neurodevelopmental Disorders Associated With Chromosome 15, Karl G. Sieg, M.D.

Jefferson Journal of Psychiatry

Chromosome 15 is a focus of increasing interest to both psychiatry and neurology. Several neurodevelopmental disorders are genetically associated with this autosome, including Prader-Willi syndrome, Angelman syndrome, Dyslexia, Autism, Hyperlexia, Ring 15 Chromosome syndrome, and Trisomy 15 syndrome. This report provides a review of the molecular biology of chromosome 15 and these associated disorders.

Therapeutic Alliance And Involuntary Commitment Of A Minor, Karen Dineen Wagner, M.D., Ph.D, Sharon R. Weinstein, M.D., Richard F. Wagner, Jr., M.D.

Jefferson Journal of Psychiatry

Children are legally entitled to be present throughout the commitment hearing for continued hospitalization. The effect of this process on the therapeutic alliance between the child and the psychiatrist warrants examination. A case study of a 14 year-old boy who participated in the court proceedings is presented. The outcome of the hearing resulted in a disruption of the therapeutic alliance. Alter natives to current commitment procedures for minors are discussed.

Editor's Column, Edward Kim, M.D.

Jefferson Journal of Psychiatry

This issue of the Jefferson Journal of Psychiatry impressively reflects current trends in the American Psychiatric Association. Past President Herb Pardes took as his theme "The Research Alliance: Road to Clinical Excellence." Current President Elissa Benedek has adopted the theme "Our Children, Our Future" for the 1991 annual meeting. Adjusting to the responsibilities of chief editorship (under the watchful eye of my predecessor, Dr. Trefzger), I am impressed by the evolution of the Journal and the manuscripts submitted for review.

Mis Posterior Cervical Spine Surgery: Five-Level Fusion Through A Novel Cervical Tube, Ashwini Sharan Md, Mitchell A. Hardenbrook, Md, John K. Ratliff Md, James Harrop, Md

JHN Journal

Minimally invasive surgical (MIS) techniques to the spine have focused mainly on the lumbar region. Many reports exist on the ability to decompress the neural structures in the lumbar and thoracic spine both via an anterior and posterior approach. Familiarity with these techniques now allows one or two level interbody and pedicle fusions, and treatment of trauma through MIS approaches. Controversy exists as to the efficacy of these techniques because direct studies comparing MIS approaches with open techniques are lacking. However, proponents of these techniques site smaller incision, less muscle retraction, less blood loss, shorter length of stay and better …

Second Floor Pilot For Group Learning Tools, Aisr, Education Services

Library Posters

Poster promoting collaborative learning tools including whiteboards and Teamspot.

Challenges And Opportunities For Medical Institutional Repositories, Dan Kipnis, Msi, Ann E. Koopman, Am, Lisa Palmer, Msls, Ahip

Academic Commons and Scott Memorial Library Staff Papers and Presentations

Description

Thomas Jefferson University Library and University of Massachusetts Medical School Library have two important things in common: successful institutional repositories and experienced library leaders that developed them.

Please join Dan Kipnis and Ann Koopman of Thomas Jefferson University, and Lisa Palmer of University of Massachusetts Medical School for a free webinar on institutional repositories (IRs) at medical schools.

Speakers will explore how each organization decided to start an IR, how the IRs have evolved, unique IR collections, successful partnerships, challenges and opportunities, and the future of medical IRs.

Functional Recovery Of Untreated Human Immunodeficiency Virus-Associated Guillain-Barré Syndrome: A Case Report, Adam L. Schreiber, John W. Norbury Iii, Eduardo A. De Sousa

Department of Rehabilitation Medicine Faculty Papers

HIV-associated Guillain-Barré Syndrome is a well-documented phenomenon, typically occurring at seroconversion. GBS may result in functional impairment treated with a combination of medications, plasmapheresis, and rehabilitation. The quantified functional recovery of HIV-associated GBS with or without HIV treatment is not well-described. Utilizing serial FIM scoring, we describe a patient’s recovery from HIV-associated GBS after treatment with IVIg and acute inpatient rehabilitation without HIV treatment.

Clinical Care Plan: Interdisciplinary Course (Ccpic), Marcia Levinson, Pt, Phd, Mft, Amy M Egras, Pharm.D, Bcps, E. Adel Herge, Otd, Otr/L, Kathryn Shaffer, Rn, Msn

Department of Physical Therapy Faculty Papers

Background/Rationale:

Interprofessional collaborative practice significantly improves patient outcomes, reduces mortality and enhances quality-of-life.

Person-focused care demands collaboration among professions in a team approach to address multiple issues including illness, prevention, and health promotion activities.

Key elements of successful implementation of interprofessional education supported by Clinical Care Plan, Interprofessional Course (CCPIC):

-Increasing knowledge of the roles, responsibilities, and competencies of multiple health professions.

-Collaborating in teams

-Recognizing the patient as the expert

-Communicating effectively

Course Statistics:

-176 students from various disciplines completed course (2008-2011).

Disciplines include:

-Medicine, Nursing, Occupational Therapy, Physical Therapy, Pharmacy

Health Information Technology (Hit) And Chemotherapy Management, Diane Abisaleh, Rn, Bsn, Msn

Department of Nursing papers and presentations

• Cancer is the 2nd most common cause of death, accounting for 26% of all deaths.
• Chemotherapy errors can potentially lead to significant harm or death
• 1 out of every 50 chemotherapy orders, results in serious death
• Lack of HIT support for workflow increases error

Partnership Between University Clnical Skills/Simulation Center And Nursing Staff Development-New Products, Mary Bent Mangano, Msn, Rn, Cns, John J. Duffy, Rn, Msn, Ccrn, Cnrn

Department of Nursing papers and presentations

There is a growing evidence in the nursing literature about the effectiveness of clinical simulation as a powerful teaching/learning strategy. This wealth of research attributes simulation's effectiveness to its design that creates an environment where "students become active learners, abandoning memorization for accessing knowledge, and thinking and applying learning in context rather than providing answers to fact-based test" (Jeffries, 2007). A simulation suite provides a "safe, supportive environment that allows students to learn a variety of complex skills in a stress-free environment" (Ghiglieri, Ruiz, & Vasudevan, 2007). Creating this environment requires meticulous planning to details. The learner must have a …

The Characteristics Of Borrelia Hermsii Infection In Human Hematopoeitic Stem Cell-Engrafted Mice Mirror Those Of Human Relapsing Fever, Raja Vuyyuru, Hongqi Liu, Tim Manser, Kishore Alugupalli

Department of Microbiology and Immunology Faculty Papers

Rodents are natural reservoirs for a variety of species of Borrelia that cause relapsing fevers in humans. The murine model of this disease recapitulates many of the clinical manifestations of the human disease and has revealed that T cell-independent antibody responses are required to resolve the bacteremic episodes. However, it is not clear whether such protective humoral responses are mounted in humans.

The Role Of Mer In Apoptotic Cell Clearance In The Germinal Center, Tahsin N. Khan, Eric B. Wong, Ziaur S.M. Rahman, Phd

Department of Microbiology and Immunology Faculty Papers

Germinal centers (GCs) are specialized micro-environments that generate high affinity Ab-forming cells (AFCs) and memory B cells. Many B cells undergo apoptosis during clonal selection in GCs. The TAM (Tyro-3, Axl, and Mer) family receptor tyrosine kinases, including Mer, facilitate macrophage clearance of apoptotic cells. We previously showed that tingible body macrophages (TBMφs) in GCs express Mer. We observed that apoptotic cells (ACs) accumulated in GCs of mice deficient in Mer (Mer-/-), after immunization with T-dependent Ag. Accumulation of ACs in GCs of Mer-/- mice resulted in significantly increased AFCs, GCs, and Th1-skewed IgG2c Ab responses. We report here that …

Factors Influencing The Implementation Of A Point-Of-Care Screening Tool For Delirium, Beth Ann Swan, Phd, Crnp, Faan, Julie Becker, Phd, Mph, Rickie Brawer, Mph, Phd, Christopher N. Sciamanna, Md, Mph

College of Nursing Faculty Papers & Presentations

Given the ample evidence delirium in hospitalized older adults is under diagnosed and not recognized by nurses up to 85% of the time, interventions are needed at the point of care to assist nurses in recognizing delirium. In this qualitative study, factors that might influence the implementation of a point-of-care screening tool for delirium were examined.

Characterization Of The Drosophila Slowpoke Binding Protein (Slob) Promoter, Amanda L. Sheldon, Lauren Manderfield, Irwin B. Levitan

Farber Institute for Neuroscience Faculty Papers

Drosophila SLOWPOKE (SLO) is a voltage and calcium dependent, large conductance potassium channel important for action potential repolarization, neuronal excitability, neurotransmitter release, and hormone secretion. SLO binding protein (SLOB) binds to and modulates SLO activity. We have shown previously that modulation of SLO by SLOB has profound effects on SLO channel currents, synaptic transmisison, and metabolism. Multiple isoforms of SLOB exist and are encoded by multiple transcripts; the isoforms are named based on their predicted protein molecular weights, in kilodaltons. In the Drosophila brain, SLOB57/51 proteins are expressed especially prominently in insulin producing neurons of the pars intercerebralis, while SLOB71/65 …

Surgical Management Of Fungal Vertebral Osteomyelitis, Benjamin M. Zussman, Bs, David L. Penn, Ms, James S. Harrop, Md

JHN Journal

Fungal vertebral osteomyelitis (FVO) is an uncommon but aggressive disease that may cause spinal instability, neurological insult, and possible death. Little data about treatment strategies and patient outcomes exist. A retrospective review of medical and surgical management with follow-up of this disease was performed.

Bevacizumab: A Controversial Agent Against High-Grade Gliomas, Sussan Salas, Md, Miguel Guzman, Md, Kevin Judy, Md

JHN Journal

Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in adults. Despite the current regimen of surgical resection with subsequent external beam radiotherapy and temozolomide, mean survival is 14.6 months and 2-year survival is 26%. GBM is a highly vascular tumor, a result of its increased expression of vascular endothelial growth factor (VEGF) compared to other brain tumors. VEGF promotes endothelial cell proliferation, and is thought to have a pivotal role during tumor progression. Multiple treatment modalities have targeted VEGF and VEGF receptors (VEGFTs) due to their essential roles in the regulation of angiogenic processes. Bevacizumab is a …

Macrophages And Neutrophils From Humans And Mice Kill Larval Strongyloides Stercoralis During Innate Immunity, Sandra Bonne-Annee, Laura A. Kerepesi, Jessica A. Hess Ligas, David Abraham, Phd

Department of Microbiology and Immunology Faculty Papers

The parasitic nematode Strongyloides stercoralis (Ss) infects 30-100 million people worldwide, yet little is known about the immune response in humans. Previous studies on innate immunity to Ss in mice have demonstrated a role for eosinophils, neutrophils (PMN) and complement activation in the protective immune response.

The Prevalence Of Cervico-Arterial Dissection In Sub-Arachnoid Hemorrhage In The United States, Ali Seifi, Md, Fred Rincon, Md, Msc, Mitchell Maltenfort, Phd, Pascal Jabbour, Md, Rodney Bell, Md, Michael Moussouttas, Md

Department of Neurology Faculty Papers

Objectives: In this study, we sought to determine the prevalence of cervico-arterial dissection in aubarachnoid hemorrhage (SAH) using a large administrative database.

The Prevalence And Risk Factors Of Acute Myocardial Infarction (Ami) After Acute Ischemic Stroke (Ais) In The United States, Ali Seifi, Md, Fred Rincon, Md, Msc, Michael Moussouttas, Md, Mitchell Maltenfort, Phd, Matthew Vibbert, Md, Rodney Bell, Md, Maria Carissa Pineda, Md, Diana Tzeng, Md, Jacqueline Urtecho, Md, Anish Koka, Md, William Mcbride, Md

Department of Neurology Faculty Papers

Objectives: To determine the prevalence and risk factors for, and the association with in-hospital mortality of, AMI after AIS, and to study the effect of intravenous recombinant tissue plasminogen activator (r-tPA) in this setting. We hypothesized that AMI would be associated with lower survival rate at hospital discharge but that intravenous r-tPA would be associated with lower risk of AMI.

Expression Of Cancer Stem Cell Biomarkers In Male Breast Cancer, Ping Gong, Md, Juan P. Palazzo, Md

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Male breast cancer is an uncommon disease, representing <1% of all breast cancer diagnoses. The prognostic factors and expression of molecular markers in male breast carcinomas are similar to female cancer. Cancer stem cell (CSC)s have been associated with tumor aggressiveness and drug resistance. CSCs are characterized by CD44 and/or ALDH1 expression. We investigated their expression in male breast cancer.

Health Care Reform: Current Updates And Future Initiatives For Ambulatory Care Nursing, Beth Ann Swan, Phd, Crnp, Faan, Sheila A. Haas, Phd, Np, Faan

College of Nursing Faculty Papers & Presentations

Executive Summary:

• While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing.
• Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives.
• RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes' and accountable care organizations'quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach.
• RNs are …

Postoperative Glycemic Variability In Diabetic And Non Diabetic Patients, Boris Mraovic, Md, Brian Hipszer, Md, Zvi Grunwald, Md, David Gratch, Do, Charles J. Yeo, Md, Jennifer Lessin, Rn, Kathleen O'Malley, Rn, Angela Gulino, Md, Peter Simpson, Meng, Jeffrey Joseph

Department of Anesthesiology Faculty Papers

Objectives: Glycemic variability increases oxidative stress and may trigger the inflammation and coagulation cascades. Variability may be associated with increase morbidity and mortality in ICU patients. We analyzed glycemic variability after major surgery in diabetic (DM) and non-diabetic (NDM) patients using an automated intravenous blood glucose monitor (IVBG).

Predictors Of Appropriate Defibrillator Therapies- A Single Center Analysis, Rina R. Shah, Ratika Gupta, Carrie Stackhouse, Robin Ward, Behzad B. Pavri

Division of Cardiology Faculty Papers

Discussion:

• Although differences in HR and the JT interval were statistically significant in patients who received appropriate shock vs. those who did not, these differences are not clinically meaningful
• We did not identify any clinical predictors of early vs. late ICD shocks
• These data suggest that we may not be able to improve on current guidelines for patient selection for ICD implantation.

Baseline Monitoring Of Standard Health Indicators In A Formerly Homeless Population, Lara Carson Weinstein, Md, Mph, Marianna Lanoue, Phd, Elizabeth Collins, Bs

Department of Family & Community Medicine Presentations and Grand Rounds

Research Question: What are the rates of baseline health status indicators recording at Pathways to Housing (PTH) using select recommended measures from the National Association of State Mental Health Program Directors (NASMHPD) and the Healthcare Effectiveness Data Information Set (HEDIS)?

How do health indicators compare between clients receiving direct clinical care in the integrated care program vs non-integrated care clients?

Individual Agency, Community Capacity Building, And Chronic Illness Care: Using Participatory Methods To Implement The Stanford Chronic Disease Self Management Program In A Housing First Program, Lara Carson Weinstein, Md, Mph, Abbie Santana, Msph, Carolyn Armour, Cornelius Crossan, James Lawson, Karen Webb

Department of Family & Community Medicine Presentations and Grand Rounds

Research questions:

Is a standardized chronic disease self management program (CDSMP) experienced as a valuable intervention by Pathways' consumers?

What is the impact of collaborative inquiry into health program development on participant's critical agency?