Medicine and Health Sciences Commons^™

An Overview Of The Healthcare System In Argentina, Derya Arkonac

CwiC-PH

Poster outlines:

1. The Health Care System
2. The Population
3. The Politics
4. Conclusion

Role Of Traditional Chinese Medicine In Modern Healthcare, Gealina Dun

CwiC-PH

Theories of Traditional Chinese Medicine (TCM)

Traditional Chinese Medicine (TCM), a form of complementary and alternative medicine (CAM), has been practiced for over 2500 years, and approaches health as an interrelated and holistic state of being. Using multiple methods, the theories of TCM aim to balance:

• Qi
• Yin and Yang (Fig. 1)
• The Five Elements
• ZangFu Organs

A Place For Mindfulness In Successful Addiction Recovery, Susannah Eckman

CwiC-PH

The difficulties that women face during substance abuse recovery and re-integration into society after incarceration are staggering in number and combined severity. Over the last several decades, a substantial body of research has investigated the psychological, neurobiological, and public health aspects of the actual experience – as well as the sustained perception of – resource depletion that everyday life in low-income communities creates. The tide of research is now headed towards evaluating new treatment strategies that respond to the understanding gained from this research. Mindfulness Training (MT) is one strategy that promises particular efficacy in addressing the root of these …

Successful Aging In Philadelphia: Examining The Needs Of The Geriatric Community, Mollie Woehling

CwiC-PH

INTRODUCTION

• As more adults continue to live until older ages they will have a greater reliance on the formal aging care system and continue to use a large proportion of healthcare resources
• From 2000 to 2010, the US 65+ population grew 15.1% compared to the total population that grew 9.7%¹
• CDC estimates that adults who make it to 65 can expect to live for 19 more years, 14 of those in relatively good health²
• Adults 65 years and older comprise over 12% of the population of Philadelphia¹
• In 2002, 19% of Philadelphia’s seniors 65+ lived in poverty, …

Decision-Making In Accessing The Emergency Department Versus Primary Care, Lev Malevanchik, Rickie Brawer, Mph, Phd, Priya Mammen, Md, Mph, Bernard Lopez, Md, Ms

CwiC-PH

• 95% of emergency department (ED) visits from patients living in Jefferson’s (TJUH) community benefit area (CBA) were for conditions with lower priority

Emergency Severity Index (ESI) numbers of 3, 4, or 5 in FY 2011 & 2012.

– Many of these visits were non-emergent.

• The aim of this study was to document how community members chose between going to the ED or their primary care physician (PCP).

The State Of Healthcare For Bhutanese Refugees In South Philadelphia: Challenges & Progress, Sarah Wells

CwiC-PH

Who the Bhutanese Refugees Are ^[1]

• Mid-19^th Century: Nepalese farmers recruited to work farmlands of Southern Bhutan (called Lhotshampa, or “southerners”)
• Lhotshampa retained Nepali and Hindu customs, but lived in peace with the Drukpa (Buddhist elite) majority for many years
• 1989: “One Nation, One People” policy of ethnic cleansing: Drukpa culture imposed on all Bhutanese
• Torture, sexual assault and murder forced over 130,000 Lhotshampa to flee Bhutan
• These refugees spent decades of their lives in camps in Nepal (many still remain there)
• Over 68,000 have resettled to the USA, many coming to South Philadelphia ^[2]

An Assessment Of Food Insecurity In A Lower North Philadelphia Community Health Center, Carly Sedlock, James D. Plumb, Md, Mph, Rickie Brawer, Mph, Phd

CwiC-PH

Food insecurity describes the inability to access enough food at all times to lead an active, healthy life. While food insecurity is associated with several negative health outcomes, screening for food insecurity in the clinical setting is not consistently performed. The goals of this pilot study were to: explore the prevalence of food insecurity among patients attending St. Elizabeth's Wellness Center in Lower North Philadelphia, explore the impact of food insecurity on health and disease management, and assess how to better address food insecurity in the primary care setting.

Women’S Perspective: The Underlying Factors Leading To Malnutrition In Poor Women In India, Tanuja Devaraj

CwiC-PH

AIM

A qualitative pilot study aimed to understand the socioeconomic aspects leading to malnutrition in urban poor women in Bangalore, India.

Case Series On Veno - Venous Extracorporeal Membrane Oxygenation (Vv-Ecmo) As A Bridge To Complete Recovery In Influenza Type A Related Refractory Ards, Renganaden Sooppan, Md, Nicholas C. Cavarocchi, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Michael Baram, Md, Hitoshi Hirose, Md, Phd

Department of Surgery Faculty Papers

Introduction:

Influenza A sequelae range from mild symptoms to acute respiratory distress syndrome (ARDS), which can be refractory to conventional ventilator therapy. We present a case series of three non-H1N1 Influenza patients with ARDS, who completely recovered after VV-ECMO.

Case Presentation:

In January and February 2013, we experienced three cases of Influenza A induced ARDS that failed conventional ARDS ventilator therapy. All three patients presented with typical flu-like symptoms, which deteriorated over several days, requiring intubation. They were all treated with oseltamivir. They had bilateral chest infiltrates on chest x-rays. After a few days of failing conventional treatment these patients …

Efficacy And Safety Of Infliximab In Older Inflammatory Bowel Disease Patients, Christina Cress Lindenmeyer, Md, Stephanie M. Moleski, Md, Maureen P. Whitsett, Med., Patricia L. Kozuch, Md

Division of Gastroenterology and Hepatology Faculty Papers

Background:

The limited data regarding treatment of inflammatory bowel disease (IBD) with anti-tumor necrosis factor antibodies in older patients suggest equal efficacy but higher morbidity and mortality compared to younger patients. This retrospective case control study aims to clarify the efficacy and safety of infliximab (IFX) in older IBD patients.

A Preliminary Report Of Percutaneous Craniofacial Osteoplasty In A Rat Calvarium., William Parkes, Jewel Greywoode, Brian J O'Hara, Ryan N. Heffelfinger, Howard Krein

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To evaluate the potential for injectable, permanent bone augmentation by assessing the biocompatability and bioactivity of subperiosteal hydroxylapatite (Radiesse) deposition in a rat model.

STUDY DESIGN: Randomized controlled animal model METHODS: Fourteen adult Sprague Dawley rats were injected in the parietal skull with 0.2 ml of hydroxylapatite (10 animals) or a carrier gel control (4 animals), using a subperiosteal injection technique on the right and a subcutaneous injection technique on the left. At 1, 3, and 6 months, 3 rats (1 negative control, 2 variables) were sacrificed and calvaria were harvested. At 12 months, the remaining 5 rats were …

Giving Back: Physiatry, Program & Patients, Seyed Amir Tahaei, Md, John F. Ditunno, Jr, Md, Frank Naso, Md, John L. Melvin, Md

Department of Rehabilitation Medicine Faculty Papers

“Giving Back” is a Jefferson tradition beginning with Dr. William Schmidt (JMCF1917-1959), who together with Dr. Frank Krusen (JMC 1921) served as Presidents of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) in 1943 and 1941 respectively. Other Jefferson graduates and faculty have also served as President of the Academy including Drs. Bender (1973), Ditunno (1981), Reinstein (1993), Melvin (1998) and recent presidents in 2009-2013, Betsy Sandel (JRR 1984), Mike Lupinacci (Jefferson Resident teaching faculty) and Alberto Esquenazi (JMCF 2000). Both Krusen and Schmidt were founding members of the American Board of PM&R in 1947. Over the years many …

Igf-Ir Promotes Prostate Cancer Growth By Stabilizing Α5Β1 Integrin Protein Levels., Aejaz Sayeed, Carmine Fedele, Marco Trerotola, Kirat K Ganguly, Lucia R Languino

Department of Cancer Biology Faculty Papers

Dynamic crosstalk between growth factor receptors, cell adhesion molecules and extracellular matrix is essential for cancer cell migration and invasion. Integrins are transmembrane receptors that bind extracellular matrix proteins and enable cell adhesion and cytoskeletal organization. They also mediate signal transduction to regulate cell proliferation and survival. The type 1 insulin-like growth factor receptor (IGF-IR) mediates tumor cell growth, adhesion and inhibition of apoptosis in several types of cancer. We have previously demonstrated that β1 integrins regulate anchorage-independent growth of prostate cancer (PrCa) cells by regulating IGF-IR expression and androgen receptor-mediated transcriptional functions. Furthermore, we have recently reported that IGF-IR …

The Fieldwork Planning Matrix – Maximizing The Learning Environment In Non-Traditional Community Based Settings, Arlene Lorch, Otd, Otr/L, Ches, Tina Angelis, Edd, Otr/L

Department of Occupational Therapy Posters and Presentations

OBJECTIVES

•Learn about a matrix guided tool utilized to plan and structure unique fieldwork experiences.

•Identify key elements associated with “matrix” implementation.

•Understand multi-faceted uses of the manual.

BACKGROUND - NONTRADITIONAL FW

•More community-based sites are needed to meet FW placement demand

•Typically, these FW sites rely upon non-traditional, distant supervision.

•These learning environments require high degree of structure to support experiential self-directed learning

•High structure requires detailed planning

•A planning matrix method to maximize the learning environment is proposed.

The Decision Counseling Program© And Shared Decision Making, Ronald E. Myers, Phd, Dsw

Division of Pulmonary, Allergy, and Critical Care Medicine Presentations and Grand Rounds

Objectives:

1. Participants will be able to define patient-centered care.

2. Participants will be able to identify components of the Decision Counseling Program©

3. Participants will be able to determine outcomes of exposure to decision counseling and shared decision making

PowerPoint slides only. No Audio.

Care In Columbia: What We Can Glean From South American Medicine, Neil Flannery Haidorfer, Robert Simmons, Drph, Mph, Mches, Cph

CwiC-PH

The information presented is the product of a two month international rotation at Medellin General Hospital and the non-profit pediatric clinic, Santa Ana through an academic affiliation with La Universidad CES in Medellin, Antioquia. The goal of the rotation was to obtain an understanding of healthcare in Columbia and identify potential practices that could be utilized in the U.S.

New Phenotype Of Parsonage-Turner Syndrome Involving Radial And Proximal Median Nerve: A Case Report, Matthew Mcauliffe, Md, Nancy Vuong, Md, Adam L. Schreiber, Do

Department of Rehabilitation Medicine Faculty Papers

History

A 74-year-old woman developed sudden severe left shoulder, arm, and forearm pain that suddenly developed. This pain lasted approximately 2 months. Approximately 1-2 months after the resolution of the first pain she developed a different type of pain which she described as a tingling, burning, pins and needle sensation that radiated from her shoulder past her elbow into the dorsal and palmar aspect of her hand in the thumb, index, and long fingers. Additionally, she developed numbness in her hand along the palmar thumb, index, and long fingers. Two months following the onset of the initial type of pain, …

Jefferson Digital Commons Quarterly Report: July-September 2013, Daniel G. Kipnis, Msi

Jefferson Digital Commons Reports

Jefferson Digital Commons quarterly report. Includes new assets added to the JDC and statistics.

Trans-Sacrococcygeal Joint Ganglion Impar Injection For Treatment Of Pudendal Neuralgia (3 Cases Report), Matthew Mcauliffe, Md, Linqiu Zhou, Md

Department of Rehabilitation Medicine Faculty Papers

History

Three patients, 2 male and 1 female were diagnosed with pudendal neuralgia. The female patient developed pudendal neuralgia secondary to post-herpetic neuralgia. The two male patients were caused from likely repetitive sitting injury. One patient was a truck driver causing him to sit for long periods of time and the other patient was a professional writer. The three patient initially all attempted conservative therapies, however their pain persisted. They elected to undergo Trans-sacrococcygeal joint ganglion impar injection for treatment of pudendal neuralgia.

The Impact Of A New Ecmo Program On Clinical Outcomes Of Patients With Acute Myocardial Infarction Complicated By Cardiogenic Shock., Shinya Unai, Md, Harrsion Pitcher, Md, Qiong Yang, Md, Nicholas Ruggiero, Md, Hitoshi Hirose, Md, Phd, Nicholas C. Cavarocchi, Md

Department of Surgery Faculty Papers

Objective:

To investigate if a new ECMO program will improve the outcome of patients who had acute myocardial infarction complicated with cardiogenic shock.

Presented 24th Annual ELSO Conference. Philadelphia, PA. Sep 19-21, 2013.

Physician Care: Best Practices In Patient-Centered Care, Elisabeth Kunkel, Md, Susan Krekun, Md, Jennifer Jasmine Arfaa, Phd, Mhsa, Eleanor Gates, Msn, Rn, Mary Ann Mcginley, Phd, Rn, Leo Katz, Md, Andrew Miller, Md, Mph, Cynthia Line, Phd, Teresa Heavens

Department of Psychiatry and Human Behavior Faculty Papers

APPROACH TO PROBLEM SOLVING

During fiscal year 2013, TJUH targeted “communication with physicians” for improvement as this HCAHPS domain was at 76% (trended July to September, 2010). The primary challenge to improving this score was that of physician investment and buy-in.

Engagement of physicians was achieved through the creation of the Physician CARE (Communication, Attention, Respect, and Expertise) task force. Identified as essential for success were:

·Investment by physician specialty departments/stakeholders

·Strong support by hospital leadership and the engagement of physician stake holders and physician leaders

·Increasing physician understanding of and access to patient experience scores

Incidence And Management Of Rhinosinusitis After Complex Orbitofacial Reconstruction., William Parkes, Gurston G. Nyquist, Christopher Rizzi, Sarah Zhang, James J. Evans, Ryan N. Heffelfinger, Marc Rosen, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: To examine the sinus-related sequelae of free flap reconstruction for complex orbitofacial defects.

STUDY DESIGN: Retrospective chart review METHODS: Demographic, clinical, and radiographic data on a series of 55 patients who had undergone free tissue transfer for orbitofacial reconstruction was retrospectively reviewed. Follow-up of ≥ 3 months was available for 49 patients. Outcome measures studied included clinical or radiographic evidence of sinusitis and the need for sinus surgery.

RESULTS: The most commonly involved sinuses were the ethmoid (n=40) and maxillary (n=38) sinuses, and the anterolateral thigh was the most common flap used (n=41). Clinical and/or radiographic sinusitis was evident …

Left Ventricular Thrombus Found In A Patient With Ards And Stress-Induced Cardiomyopathy Requiring Veno-Arterial Ecmo., Shreya Gupta, Bs, Joseph Miessau, Ms, Harrsion Pitcher, Md, Michael Baram, Md, Nicholas C. Cavarocchi, Md, Hitoshi Hirose, Md, Phd

Department of Surgery Faculty Papers

Presentation:

68 year-old male with a history of acute leukemia with complete remission after bone marrow transplant 4 months ago, coronary disease s/p LAD stents about 14 years ago with no chronic anti-platelet medication, and repeated episode of DVT despite appropriate anti-coagulation, presented with viral pneumonia (rhinovirus).

Generating Hypotheses About Care Needs Of High Utilizers: Lessons From Patient Interviews., Dawn B Mautner, Hauchie Pang, Jeffrey C Brenner, Judy A Shea, Kennen S Gross, Rosemary Frasso, Carolyn C Cannuscio

Department of Family & Community Medicine Faculty Papers

Informed by a largely secondary and quantitative literature, efforts to improve care and outcomes for complex patients with high levels of emergency and hospital-based health care utilization have offered mixed results. This qualitative study identifies psychosocial factors and life experiences described by these patients that may be important to their care needs. Semi-structured interviews were conducted with 19 patients of the Camden Coalition of Healthcare Providers' Care Management Team. Investigators coded transcripts using a priori and inductively-derived codes, then identified 3 key themes: (1) Early-life instability and traumas, including parental loss, unstable or violent relationships, and transiency, informed many participants' …

Thioredoxin Reductase Was Nitrated In The Aging Heart After Myocardial Ischemia/Reperfusion., Ke Wang, Jie Zhang, Xiaoliang Wang, Xin Liu, Lin Zuo, Kehua Bai, Jianyu Shang, Lu Ma, Teng Liu, Li Wang, Wen Wang, Xin-Liang Ma, Huirong Liu

Department of Emergency Medicine Faculty Papers

The age-related loss of anti-oxidant defense reduces recovery from myocardial ischemia/reperfusion injury (MI/R) in aged people. Our previous data showed that inactivation of thioredoxin (Trx) was involved in enhanced aging MI/R injury. Thioredoxin reductase (TrxR), the enzyme known to regulate Trx, is less efficient with age. The aim of the current study was to determine why TrxR activity was reduced and whether reduced TrxR activity contributed to enhanced aging MI/R injury. Both Trx and TrxR activity were decreased in the aging heart, and this difference was further amplified after MI/R. However, MI/R injury did not change TrxR expression between young …

Clevidipine For Acute Blood Pressure Management In The Neurological Intensive Care Unit, Dorota K. Szarlej, Pharmd, Jessica L. Mckeon, Pharmd, Akta S. Patel, Pharmd, Bcps, Amber King

College of Pharmacy Faculty Papers

Clevidipine is a third generation intravenous dihydropyridine calcium channel antagonist approved for treatment of acute hypertension when oral therapy is not feasible or desirable. It is an arterial vasodilator that is metabolized by plasma esterases; therefore, it is eliminated independently of the liver and kidney.1 Clevidipine has been studied for the control of perioperative hypertension2-5 as well as for the management of hyper-tensive crises6 when immediate blood pressure control is clinically necessary. Benefits include its tolerability, rapid onset and offset, and easy titration with predictable response. Other continuously infused intravenous antihypertensives used in the neurocritical care patient population include nicardipine, …

Analyzing The Health Care Cost Curve: A Case Study., Robert D. Lieberthal

College of Population Health Faculty Papers

This case study uses data from a self-insured employer plan to perform an analysis into the properties of the health care cost curve. The analysis shows that one statistical property of the health care cost curve is that costs rise continuously, not on an annual or monthly basis. Graphical analysis indicates that managed care techniques used to restrain costs can also smooth utilization, producing the continuously growing cost curve observed. The analysis further illustrates that there is no one "cost curve"-analysis must be segmented by population. Finally, the power of predictive models to fit the cost curve varies by population. …

Mrsa Sepsis And Acute Respiratory Distress Syndrome During Veno-Arterial Extracorporeal Membrane Oxygenation (Ecmo)., Philip Hsiao, Bs, Joseph Miessau, Bs, Harrsion Pitcher, Md, Qiong Yang, Md, Michael Baram, Md, Nicholas C. Cavarocchi, Md, Hitoshi Hirose, Md, Phd

Department of Surgery Faculty Papers

Presentation:

A 39 year old female African American presented with respiratory distress two days after ERCP for pancreatitis.

The patient quickly deteriorated, required intubation, and developed severe hypotension requiring vasopressors.

VA-ECMO was initiated for ARDS and SIRS due to on-going pancreatitis.

Pre ECMO ABG: PH 7.01, PaCO2 70, PaO2 70 with FiO2 100% with PEEP 15

Profound hypotension, required 2 pressors

Preliminary results of cultures were negative at the time of ECMO placement.

Presented 24th Annual ELSO Conference. Philadelphia, PA. Sep 19-21, 2013.

A Cost Reducing Ecmo Model: A Single Institutional Experience., En Yaw Hong, Suzanne Wallace, Amy Tropea, Jaime Byrne, Msn, Rn, Hitoshi Hirose, Md, Phd, Harrsion Pitcher, Md, Nicholas C. Cavarocchi, Md

Department of Surgery Faculty Papers

Background: The demand for ECMO support has grown. Its provision remains limited due to several factors (high cost, complicated technology, lack of expertise) which increase healthcare cost. Our goal was to assess if an ICU run ECMO model (without continuous bedside perfusion) would decrease costs while maintaining patient safety and outcomes.

Method: We performed a retrospective review that analyzed the cost and safety benefits of a newly implemented ICU-run ECMO unit from 2011-2012. The program consisted of a dedicated ICU involving multidisciplinary providers (ICU RN, mid-level providers and intensivists). In year one, we introduced an education platform, new technology and …

An Interdisciplinary Model To Improve Completion Of Latent Tuberculosis Infection Treatment In The Refugee Population, Christine O'Leary, Pharmd, Marc Altshuler, Md, Kevin Scott, Md, Karen Kitagawa-James, Rn, Bsn, Maria Hervada-Paige, Mss

Department of Family & Community Medicine Presentations and Grand Rounds

Background: Refugees are disproportionately affected by latent tuberculosis infection (LTBI) and active tuberculosis (TB) compared to the general US population. More than 50% of TB cases in the US occur in foreign-born persons. In addition, approximately 80% of TB cases in the US are a result of reactivation of LTBI. Treatment of LTBI is effective to prevent and control TB. Unfortunately, LTBI treatment completion rates in the foreign-born are less than 50%. Methods: After conducting a retrospective chart review to establish baseline rates of treatment completion in our LTBI refugee patients, we implemented a model of prospective chart review, initial …