Medicine and Health Sciences Commons^™

One Jefferson News September 2017, Performance Excellence

One Jefferson News

Over the past three years, we have embarked on an exciting journey of reimagining a new model for health and education to create One Jefferson. Our first step was to bring together Thomas Jefferson University and Thomas Jefferson University Hospital. We continued along this journey by welcoming Abington Health and Aria Health, and combining Philadelphia University and Thomas Jefferson University. Recently, we also welcomed Kennedy Health to the Jefferson Health family.

As the process of coming together – becoming one – continues to produce a growing number of integration successes for the organization, we are expanding communication efforts with this …

Interprofessional Grand Rounds: Student Hotspotting Team 2016-2017, Caroline Komanecky, Peter Sacci, Danielle Mcfadden, Nuriya Neumann, Michaela Scotten, Melissa Murphy

Department of Occupational Therapy Posters and Presentations

No abstract provided.

Utilization Of Care By Infants With Neonatal Abstinence Syndrome In Delaware, Michele K. Savin, Msn, Nnp-Bc

College of Nursing Faculty Papers & Presentations

From 1999-2013, the nationwide incidence of neonatal abstinence syndrome (NAS) due to maternal drug use rose from 1.5/1000 to 6/1000 hospital births. There is a dearth of information regarding what happens to these children when they are discharged. The purpose of this Practice Inquiry Project is to utilize existing Delaware Medicaid data to retrospectively explore the utilization of services and gaps in care for the infant with NAS in the first year of life. Key findings include less than expected well child visits and immunizations along with higher hospital re-admission rates. This represents missed opportunities for care, also demonstrating the …

The Effect Of Undergraduate Exposure And Experience On Choosing To Pursue A Pharmacy Degree, Erica M. Mcgovern, Ms, Andrew Stacy, Bs, Elena Schmidt, Phd, Ma, Elena Umland, Pharmd

College of Pharmacy Posters

BACKGROUND

• Shortage of pharmacists identified by Department of Health and Human Services in 20001
• Despite investment of significant recruitment resources to achieve optimum enrollment, fewer applications are being submitted for consideration to pharmacy school, and the number of students pursuing pharmacy school continues to decline2
• American Association of Colleges of Pharmacy (AACP) Recruitment Admissions Task Force speculates that qualified candidates may be pursuing other healthcare professions due to lack of awareness of and limited exposure to the expanding role of the pharmacist2
• Limited studies have been conducted to evaluate the primary factors motivating students to pursue a career in pharmacy …

A Word From The Writing Center (July 2017), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

This issue includes:

• Grammar tip: affect vs effect
• Opportunity for online writing workshop for scientists

Jefferson Digital Commons Quarterly Report: April-June 2017, Daniel G. Kipnis, Msi, Kelsey Duinkerken, Msi, James Copeland, Libt

Jefferson Digital Commons Reports

For Full-Text access download report.

Jefferson Digital Commons Quarterly Report: April-June 2017

The Jefferson Digital Commons had another very busy quarter with assets being deposited from across the enterprise.

• Total number of assets deposited this quarter: 371
• Total downloads for this quarter: 113,261(April 10, 2017 highest download count: 1,763)
• 7,500 different institutions accessed content in the JDC Asset with the most downloads this quarter: 2017 issue of Inside Out
• Countries visiting the JDC this quarter: 196

Below are highlighted assets that were added to the inventory along with more feedback from researchers that continue to arrive from around the globe …

The Effects Of C5-Substituted 2,4-Diaminoquinazolines On Selected Transcript Expression In Spinal Muscular Atrophy Cells., Cinsley Gentillon, Andrew J Connell, Ryan W Kirk, Matthew E R Butchbach

Department of Pediatrics Faculty Papers

C5-substituted 2,4-diaminoquinazolines (2,4-DAQs) ameliorate disease severity in SMA mice. It is uncertain, however, that these compounds increase SMN protein levels in vivo even though they were identified as activators of the SMN2 promoter. These compounds also regulate the expression of other transcripts in neuroblastoma cells. In this study, we investigate the mechanism by which the 2,4-DAQs regulate the expression of SMN2 as well as other targets. D156844, D158872, D157161 and D157495 (RG3039) increased SMN2 promoter-driven reporter gene activity by at least 3-fold in NSC-34 cells. These compounds, however, did not significantly increase SMN2 mRNA levels in type II SMA fibroblasts …

Reduction Of Central Line Associated Bloodstream Infections In An Urban 40 Bed, Level Iii Neonatal Intensive Care Unit When New Practices Were Implemented, Roberta Glenn, Bsmt (Ascp) Cic

Department of Medicine Posters

BACKGROUND

• Central line-associated bloodstream infection (CLABSI) in the neonatal population is a major source of morbidity and mortality.
• The disruption of skin and mucus membranes by the use of invasive devices contributes to the susceptibility of this population.
• In our Neonatal Intensive Care Unit (NICU), the CLABSI rate was continually increasing.
• It became evident that new practice guidelines were necessary to reduce the CLABSI rate in this vulnerable population.

Poster presented at: APIC 2017 in Portland Oregon, United States.

Strategic Approach Of An Urban 900-Bed Academic Medical Center To Combat Clostridium Difficile Infection Transmission Using Staff Engagement, Courtney Mitchell, Mph, Kelly Zabriskie, Cic

Department of Medicine Posters

BACKGROUND

• Clostridium difficile infection (CDI) caused nearly 500,000 illnesses with 29,000 deaths in the United States
• Preventing hospital-associated Clostridium difficile infection (HA-CDI) is crucial to modern healthcare systems for reducing mortality, healthcare costs and length of stay
• There are multiple risk factors for CDI transmission in healthcare settings:
  • Failure to comply with hand hygiene
  • Ineffective equipment and surface cleaning
  • Diagnosis delays

Poster presented at: APIC 2017 in Portland Oregon, United States.

A Delayed H3k27me3 Accumulation After Dna Replication Of Embryonic Stem Cells Opens Chromatin For Lineage Specific Transcription Factors To Bind And Initiate Differentiation, Jingli Cai, Svetlana Petruk, Robyn Sussman, Sina K. Kovermann, Samantha Mariani, Bruno Calabretta, Steven B Mcmahon, Hugh W. Brock, Lorraine Iacovitti, Alexander Mazo

Department of Neuroscience Faculty Papers

Introduction

Pluripotent stem cells (PSCs) have been useful to generate differentiated progenies for cell replacement therapy, and disease models. The Parkinson’s Disease (PD) field was arguably one of the first to have embraced the promise of stem cells. However, regardless of the differentiation protocols used, cultures and grafts continue to contain multiple cell types with midbrain dopamine (mDA) neural progenitors (NPs) and neurons representing only a fraction of total cells in the dish or graft. During cell differentiation, recruitment of transcription factors (TFs) to repressed genes in euchromatin is essential to activate new transcriptional programs, which is impeded by condensed …

The Added Value Of Spect/Ct In Endocrinology: A Pictorial Essay, Cheryl Rickley, Cnmt, Michele Barasch, Cnmt, Charles Intenzo, Md, Sung Kim, Md

Department of Radiology Posters

Objective:

Dedicated radionuclide imaging of the spleen in useful in conditions such as accessory spleen and splenic trauma. Nuclear Medicine plays a key role in the diagnostic molecular SPECT/CT imaging of splenic disorders.

Poster presented at SNMMI Annual Conference in Denver Colorado, United States.

Optimal Radionuclide Imaging Of Splenic Disorders: The Value Of Spect/Ct, Cheryl Rickley, Cnmt, Michele Barasch, Cnmt, Charles Intenzo, Md, Sung Kim, Md

Department of Radiology Posters

Objective:

Dedicated radionuclide imaging of the spleen in useful in conditions such as accessory spleen and splenic trauma. Nuclear Medicine plays a key role in the diagnostic molecular SPECT/CT imaging of splenic disorders.

Poster presented at Society of Nuclear Medicine Molecular Imagining in Denver Colorado, United States.

A Word From The Writing Center (June 2017), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

This issue includes:

• Writing tip: Purpose of semicolons and colons
• Tips on preparing posters

Interdisciplinary Learning Project, Demetrius H. Bagley, Md, Maryann Sonzogni, Rn, Bsn, Bridget Weissinger, Cst, Kelly A. Healy, Md

Department of Urology Faculty Papers

Description

With a 20 year history, we have implemented a multifaceted IPE program for members of the urology team. These include urologists, both faculty and community, residents, medical students, nurses, nurse practitioners, physician assistants, medical technicians/assistants and administrative/ clerical personnel with patient contact. The program was designed with three components: a yearly symposium for all, and journal club(JC) and lectures for non-physicians. Participation is on a voluntary, noncompensatory basis. Outcome measures include routine anonymous participant feedback via questionnaire.

Results

The programs were very positively received. Limiting obstacles were also observed. Initially too many papers were assigned in the Journal club. …

“Step & Shoot” Cardiac Gated Ct For Detection Of Pulmonary Embolism: Technique And Advantages, Dinesh K. Sharma, Md

Department of Radiology Posters

Introduction

Pulmonary Embolism (PE) is a common condition with significant morbidity and mortality. Prompt recognition, diagnosis and management is important, as untreated PE complications are high; also treatment with long term anticoagulation has serious complications.

Poster presented at The 11th Congress of Asian Society of Cardiovascular Imaging in Kyoto Japan.

Aboriginal Urban Design For Health, Kate Clark, Mpa, Kirby Broadnax, Antionette Carroll, Jonathan Cha, Naomi Doerner, Allie Kast, Matthew Kennedy, Michael Mendez, Pascale C. Annoual, Carrie Martin, Wendall Nicholas

College of Population Health Lectures, Presentations, Workshops

Montreal’s Aboriginal population is growing rapidly, yet the community lacks a culturally safe and holistic health service center that is accessible to all Aboriginal people. On Friday, June 2, 2017 The Montreal Urban Aboriginal Health Centre (MUAHC) joined forces with Next City & Concordia University to co-create a 7-minute pitch for a $7,000 prize through the Vangaurd Conference Big Idea Challenge. An interdisciplinary team of 8 conference attendees worked with MUAHC leadership to design a short-term solution that would be a step in the right direction towards MUAHC’s goal to build a fully functioning and independent health center dedicated …

Improving Blood Donor Diversity Through Focused Recruitment Interventions, Sarah Amanullah, Vandi Ly, Md, Amanda Pirilli, Md, Julie Karp, Md

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

Study Design:

Beginning in May 2016, the Jefferson Blood Donor Center began collecting donor self-identified race/ethnicity: White, Black or African American, Hispanic, Asian or Pacific Islander, American Indian or Alaskan Native, Multiracial, Other, Unknown (Figure 1).

We retrospectively quantified the racial/ethnic groups represented in each month’s donor population.

In January 2017,the following intervention strategies were implemented:

Emailing donors who self-identified as part of a racial/ethnic minority group

Contacting racially/ethnically-focused student groups to organize blood drives with the Jefferson Blood Donor Center

Partnering with the Jefferson Medical Oncology Society MarrowthonDrive to encourage blood donations

Presentation to the local chapter …

A Case Of Severe Insulin Resistance In A Diabetic Patient Being Treated For Acute Promyelocytic Leukemia With Arsenic And Glucocorticoids, Eric Shiffrin, Md, Intekhab Ahmed, Md, Serge Jabbour, Md, Facp, Face, Kevin Furlong, Do

Division of Endocrinology, Diabetes and Metabolic Diseases Posters

Objective:

To present a case of severe insulin resistance in a patient with a new diagnosis of acute promyelocytic leukemia (APML) treated with all-trans retinoic acid (ATRA), arsenic, and high-dose glucocorticoids.

Poster presented at Thomas Jefferson University House Staff Quality and Safety conference.

Vaginal Preparation With Povidone Iodine Prior To Cesarean Delivery, Laura Felder, Md, Amanda Paternostro, Md, Johanna Quist-Nelson, Md

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

Objectives: To reduce the rate of postoperative endometritis in patients undergoing cesarean delivery by implementing a new departmental guideline for vaginal preparation prior to cesarean sections, after labor or rupture of membranes

Utilization Of A Multimodal Preoperative Pain Regimen Prior To Gynecologic Oncology Exploratory Laparotomies, Lauren C. Hand, Md, Alison Vogell, Md, Talia Maas, Md, Kristina Masi, Md, Rebecca J. Mercier Md Mph, Norman G. Rosenblum, Md, Phd, Christine H. Kim, Md

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

Objective:

The aim of this study was to evaluate the use of a combination of non-opioid preoperative pain medications including Tylenol, Lyrica, and Celecoxib (TLC) in patients undergoing gynecologic oncologic exploratory laparotomies. We evaluated postoperative narcotic use in morphine equvalents (ME) as well as pain scores, anti-emetic use, and length of stay.

Quiet In The Operating Room! Team Stepps And Or Distractions, Zabecca S. Brinson, Md, Adam P. Johnson, Md, Mph, Rose Farmer, Rn, Tesa Leonard, Crna, Susan Cacciatore, Rn, Maritza Sanchez, Rn, Lorie Weikel, Rn, Paul Sammut, Rn, Francesco Palazzo, Md

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

Background and Objective:

From the moment that a patient enters the operating room to the time that they are brought to the post anesthesia care unit, a distraction has the potential to lead to an adverse outcome for the patient. During the critical portions of the surgery, it is even more important for all members of the operating staff to be focused and engaging in safe practices. Distractions in the operating room can hinder safe communication and potentially endanger patient safety. Team training has been shown to both improve team communication and reduce distractions.

The objective of this project was …

Transrectal Ultrasound Guided Prostate Biopsy Antibiotic Prophylaxis: Standard Vs. Augmented Antibiotic Regimens, And The Role For Pre-Biopsy Rectal Swab Cultures, Thomas Hardacker, Md, Mba, Danielle Squadrito, Rn, Christopher Caputo, Md, Mark Mann, Md

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

Objectives:

To evaluate peri-procedural antibiotic prophylaxis regimens based on pre-procedural rectal swab cultures.

To evaluate infection rates between transrectalbiopsy patients receiving FQs alone and those receiving ceftriaxone or gentamicin in addition to FQs.

Standardization Of Monofilament Use In A Resident-Run Clinic, Odunayo Banjoko, Md, Doron Schneider, Md

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

Study Aim:

The aim of this study was to improve incidence of regular foot exams among clinic diabetic patients.

Preventing Isolated Perioperative Reintubation: Who Is At Highest Risk?, Tyler M. Bauer, Md, Adam P. Johnson, Md, Chris Wirtalla, Md, Jordan E. Goldhammer, Md, Rachel R. Kelz, Md, Scott W. Cowan, Md

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

Objectives:

1. We aim to characterize IPR nationally through a retrospective review of the National Surgical Quality Improvement Program participant user file (NSQIP PUF).

2.Identify risk factors for IPR including analysis of procedure type and preoperative characteristics.

Echocardiography Role In Syncope Patients, Ali Raza Ghani, Md, Irfan Ahsan, Md, Wajahat Humayun, Md, Usman Sarwar, Md, Margot I. Boigon, Md, Mary Maglak, Phd

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

Methods: We did a retrospective chart review of 138 patients admitted to observation floor with diagnosis of syncope.

Improving Resulted Hemoglobin A1c Rates: A Feasibility Study For Point-Of-Care Hemoglobin A1c Testing At An Urban Family Medicine Office, Phoebe Askie, Md, Mph, Daniel Chung, Md, Laura Parente, Md, Yury Parra, Md, Grace Amadi, Md, Mariana R. Kuperman, Md, Mph, Bruce Reaves, Md, Miranda Aragon, Md, Kyle Bardet, Md, Sunny Lai, Md, Anna Woods, Md, Marc Altshuler, Md

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

Study Aims:

• Our practice’s goal is to increase the number of up to date hemoglobin A1c for diabetic patients seen at JFMA in order to help improve glycemic control
• The aim of this study is to see if point of care (POC) hemoglobin A1C is a feasible way to increase the number of up to date hemoglobin A1C. We looked at various factors including timing, training, and flow.

Analysis Of Clostridium Difficile Patterns At Thomas Jefferson University Hospital, Andrew Tseng, Kulvir Nandra, Md, Kelly Zabriskie, Phyllis Flomenberg, Md, Scott W. Cowan, Md

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

AIMS:

To analyze CDI patterns to TJUH, particularly in Opportunity Units

To visually examine the relationship between CDI cases within units

Provide data analysis to the CDI working group

Tracking And Improving Bedside Procedures Through Standardized Documentation, N. Sich, L. Gartner, J. Sternlieb, K. Noonan

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

Proposal and Goals:

We propose to create a standardized electronic procedure note that will replace all documentation for bedside procedures without sedation.

◦Makes notes legible and easily identified

◦Allows uniform tracking of metrics necessary to identify outcomes from a procedure (blood loss, specimens, post-procedure studies, complications)

2.The procedure note will be created in such a way as to allow specialized procedures to be added over time with minor customization to improve physician/nursing work flows and increase efficiency

◦Allows procedures to be sorted and tracked by type

◦Will be constructed to allow attaching CPT codes to patient charts via documentation

3. …

Filling The Void: A Low Cost, High-Yield Method To Addressing Incidental Findings In Trauma Patients, N. Sich, A. Rogers, D. Bertozzi, P. Sabapathi, L. Gartner, W. Alswealmeen, P. Lim, J. Sternlieb, J. Yuschak, O. Kirton, R. Shadis

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

In this study we:

Report the incidence of incidental findings in a suburban trauma center treating primarily blunt and elderly trauma

Propose simple solutions to increase the rate of disclosure to patients

Perioperative Glycemic Management, A. Rogers, T. Olszewski, N. Sich, K. Noonan

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

Proposals and Goals:

1. We propose creating a standard easy to use and safe protocol for glycemic management for same day/elective surgical patients.

2. Following implementation in same day and elective surgical procedures, we propose expanding the protocol to be effective in urgent and emergent inpatient surgical procedures.