Medicine and Health Sciences Commons^™

Manipulation Of Genome Integrity Signaling Axes Contributing To Prostate Cancer Aggressiveness, Frank Duan, Veronica Rodriguez-Bravo, Phd

Phase 1

Introduction: Prostate cancer (PC) is one of the leading causes of death in men, and despite current treatment options patients can develop aggressive disease that spreads to other parts of the body. Little research has focused to date on the effect of centrosome biology in the pathogenesis of PC.

Methods: Two metastatic PC cell lines, DU145 and 22Rv1, as well as highly aggressive derivatives generated in Dr. Rodriguez-Bravo lab (docetaxel-resistant; (DR) variants) were compared through various experiments to determine differences in centrosome proteins expression and functionality. All cells (DU145 /DR and 22Rv1 /DR) underwent electroporations with siRNAs to knockout …

Microbial Keratitis After Penetrating And Endothelial Keratoplasty, Nicolas Dohse, Turner D. Wibbelsman, Sara Rapuano, Kristin Hammersmith, Parveen Nagra, Christopher Rapuano, Zeba A. Syed

Phase 1

Introduction: The purpose of this study is to review the incidence, risk factors, and outcomes of bacterial and fungal keratitis after penetrating keratoplasty (PK) and endothelial keratoplasty (EK).

Methods: The medical records at Wills Eye Hospital were reviewed for all cases of confirmed microbial keratitis following PK or EK performed between May 1, 2007 and September 1, 2018. Charts were examined to obtain demographic information, past ocular history, details of the microbial keratitis, and graft outcomes.

Results:A total of 2100 transplants (1269 PK and 831 EK) were performed in 1864 eyes of 1601 patients. The incidence of microbial …

Functional Outcomes After Lumbar Fusion In Opioid-Tolerant Patients, Max Detweiler, Noah Levy, Dhruv K.C. Goyal, Ariana Reyes, Alex R. Vaccaro, Md, Phd, Mba

Phase 1

Introduction: Prolonged opioid use after lumbar fusion surgery is implicated with increased hospital readmissions, higher postoperative pain scores, and longer return to work time. There are several non-modifiable risk factors for postoperative opioid use including socioeconomic status and gender. The purpose of this study was to determine the effects of opioid-tolerance on PROMs and to determine risk factors for prolonged opioid use after lumbar spine surgery.

Method: Using retrospective cohort analysis, patients who underwent lumbar spinal fusion at TJUH were identified and determined to be either opioid-naïve or opioid-tolerant using the Pennsylvania PDMP. Outcomes included number of opioid tablets consumed, …

Ethnic Differences In Germline Genetic Testing For Breast Cancer, Kathryn Dent, Rebecca J. Jaslow, Md

Phase 1

Introduction: Ethnic variations in uptake of genetic testing and differences in findings of germline mutations within ethnic groups, are not well understood. The goal of this research is to assess for any such differences or similarities within a genetic counseling and testing program at an urban Cancer Center.

Methods: This is a non-comparative, descriptive epidemiology study assessing individuals with a diagnosis of breast cancer undergoing genetic counseling at the TJUH Sidney Kimmel Cancer Center in Philadelphia between 2014 and 2019. Data were compiled onto Research Electronic Data Capture (REDCAP) and analyzed statistically.

Results: Patients with Breast Cancer (n=1075) were included …

Transdermal Lidocaine For Perioperative Pain: A Systematic Review Of The Literature, Alexa Cohen, Jordan Smoker, Mohammad R. Rasouli, Eric S. Schwenk

Phase 1

Introduction: Recent data have shown that the risk of taking chronic opioids after surgery increases after about 5 days of postoperative opioid therapy. Alternatives to opioids are desirable, and transdermal lidocaine is one such perioperative multimodal agent. This review provides a summary of the perioperative studies that have examined transdermal lidocaine as an analgesic in the perioperative period.

Methods: We conducted searches of PubMed and Scopus databases. Studies involving patients who were undergoing surgery and were given either transdermal lidocaine, placebo, or active comparator in the perioperative period with the primary endpoint of improvement in pain were included in …

Utility Of Point Of Care Ultrasound For Identifying Dental Abscesses In Emergency Department Patients Presenting With Dental Pain, Matthew Cervantes, Kelly Goodsell, Md, Arthur Au, Md

Phase 1

Introduction: Computed tomography (CT) is the current gold standard for diagnosing dental abscesses in the Emergency Department (ED). There are limitations to using CT, including high cost, radiation exposure, and lengthy time to diagnosis. Point of Care Ultrasound (POCUS) is an alternative imaging modality that does not have these limitations, and is already used to diagnose other soft tissue abscesses. The efficacy of POCUS for diagnosing suspected dental abscesses has never been investigated. The purpose of this project is to compare the utility of POCUS to CT in diagnosing suspected dental abscesses in the ED.

Methods: A convenience …

The Financial And Psychosocial Impact Of Medicinal Cannabis, Chris Ahmed, Andrew Lee, Amanda Campbell, Gregory Garber, Msw, Lcsw, Neil D. Palmisiano, Md, Brooke Worster, Md

Phase 1

Introduction: Therapeutic utilization of medicinal cannabis for symptom management in oncology patients is a burgeoning area of research focus. We hypothesize that medicinal cannabis use can result in subjective improvements in quality of life (QOL) metrics for cancer patients.

Methods: Adult palliative care patients at a medical oncology clinic are consented to the study after being certified to access medicinal cannabis. After three months, subjective changes in QOL, including well-being, financial burden, pain, chemotherapy induced nausea and vomiting (CINV), and other categories are recorded via telephone interview. Responses are documented with a numerical Likert scale (from 1-5, with a score …

Falls And Traumatic Brain Injury In The Elderly On Aspirin Or Anticoagulant Therapy, Jonathan Bassig, David Nauheim, Stanton Miller, Patricia Williams, Tingting Zhan

Phase 1

Introduction: Traumatic brain injury (TBI) after a fall in individuals aged 65 and older is a leading cause of morbidity and mortality, but the effect of aspirin and anticoagulant therapy on TBI severity is not fully understood. This study evaluated whether the severity of TBI is associated with use of aspirin or anticoagulant therapy or in combination.

Methods: Using retrospective chart review, we identified patients age 65 or older who fell and sustained head trauma that were admitted to Thomas Jefferson University Hospital trauma service from 2017-2018. Based on final diagnosis, patients were classified into three groups of TBI …

State-Level Cpr Education Legislation Associated With Higher Survival After Out-Of-Hospital Cardiac Arrest In Older Adults, Megan Barnes, David G. Buckler, Tyler D. Alexander, Marissa Lang, Alexis Zebrowski, Douglas J. Wiebe, Benjamin S. Abella, Brendan G. Carr

Phase 1

Introduction: State-level legislation requiring CPR education prior to high school graduation is associated with an increased likelihood of community-level CPR training. CPR Legislation has also been shown to be associated with increased bystander CPR. We hypothesized that states with CPR Legislation would be associated with higher survival following out-of-hospital cardiac arrest (OHCA).

Methods: Utilizing 2014 Medicare Claims data for emergency department visits and inpatient stays, we identified OHCA via ICD-9-CM code. CPR Legislation data was collected through online statute review. Exposure to CPR Legislation was assessed using the patient state of residence. All disposition categories were considered survival to discharge …

Evaluating The Utility Of Diagnostic Workups For Biliary Atresia In Neonates With Cholestatic Jaundice Following Prolonged Tpn, Melissa Austin, Zubair H. Aghai

Phase 1

Introduction: Parenteral nutrition associated cholestasis (PNAC) develops in 40-60% of premature infants following TPN for 2-4+ weeks. The incidence of biliary atresia is low and there is a 60-day, post-term window for corrective surgery. There is limited data on both the natural history of PNAC in premature infants following prolonged TPN, as well as the utility of diagnostic tools investigating biliary atresia in these patients.

Methods: A retrospective chart review using EMR data from the Intensive Care Nursey was performed with the following criteria: premature babies diagnosed with cholestasis, born at <1500 grams, and received TPN for 14 days. Ultimately 61 babies met criteria and data was collected and pooled to produce descriptive statistics and graphs describing laboratory trends.

Results: Median gestational age was 26 [IQR 25, …

Creating A Noise-Reducing, Wearable Intervention For Newborns In The Nicu, Mohammad Rasool, Alexandra A. Mccullough, Alison Romisher, Robert S. Pugliese, Pharmd, Bcps, Bon Ku, Md, Mpp

Phase 1

Background: Excessive auditory stimulation can have negative effects on the growth and development of newborn babies. The American Academy of Pediatrics states that newborns should not be exposed to sounds in excess of 45dB while they are in the hospital, however noise levels in NICUs across the country are often between 50-100dB. A design project was conducted to develop an intervention that could reduce infant exposure to excessive noise.

Methods: Neonatologists, nurses, audiologists, music therapists, sound designers, soft materials experts, and medical device designers were interviewed and consulted throughout the design process. A 24-hour sound recording using a REED-SD-4023 meter …

3d Printing Of Bone Spurs Before Surgical Removal During Total Knee Arthroplasty, John Paul Prodoehl

Phase 1

Project Background: In the United States, total knee arthroplasty (TKA) is the most performed orthopaedic operation. Among the 700,00 patients who received TKA, 21-25% underwent revision due to knee instability. Proper stability of a TKA depends on soft tissue balance for proper alignment in flexion and extension, and improper soft tissue modification is the primary cause of early implant failure. Soft tissue balancing can be complicated by presence of osteophytes on the distal femur or proximal tibia, which may require removal. The three-dimensional structure of osteophytes is often difficult to visualize with imaging, which could cause incomplete removal. Utilizing 3D …

3d Printing Of Bone Spurs Before Surgical Removal, Matthew Chadwick, John Paul Prodoehl, Katelyn Koons, Chris Li, Lauren Schlegel, Jeffrey Henstenburg, Md

Phase 1

Project Background: In the US alone, total knee arthroplasty is the most common performed orthopedic surgery, with over 700,000 cases per year.1 Overall, 21-25% underwent revision due to instability.2 The stability of a TKA depends largely on soft tissue balance for proper alignment in flexion and extension. Soft tissue balancing in TKA depends on posterior femoral condylar osteophytes, which prevent full extension of the knee and increase tension posteriorly. Pre-operative soft tissue visualization is difficult and this leaves an increased chance for implant failure and revision surgery. Having a 3D model of the bone spur before and during the surgery …

Color Changing Device To Improve Adherence To Foley Catheter Replacement Protocols And Reduce Urinary Tract Infection Frequency, Bryn Cross, Kurt Hill, Alexander Straus, Ms, Jason M. Fields, Md

Phase 1

Background: Millions of hospital-acquired UTI’s are caused by indwelling urinary catheters. The longer a catheter is left in, the greater the risk for infection. Catheters are often left in longer than necessary because physicians are not aware of them or the original indications for placement are not reevaluated. We hypothesize our device will draw attention to indwelling catheters and prompt re-evaluation and removal if necessary.

Methods: We will design a light strip that can be attached to the catheter bag and will turn on to blue after 5 days of placement and purple after 8 days. This will call the …

Device For The Capture And Extraction Of Waste Anesthetic Gas, Jonathan Karp, Cary Hess, Delara Kiani, Corey Jameson, Robert S. Pugliese, Michael E. Mahla, Dietrich Gravenstein, Mary Herman

Phase 1

Background: Leaks occur often throughout the process of delivering inhaled anesthesia prior to and during surgery. Leaks typically occur around the patient’s mouth, nose, and eyes. Potent inhaled anesthetics (PIAs) include halothane, sevoflurane, desflurane, and isoflurane. All PIAs, to one degree or another, pose hazards to human health. PIAs are associated with reproductive toxicity, spontaneous miscarriages in pregnant persons as well as an increased risk of congenital abnormalities in offspring. In other words, PIAs are thought to be both abortifacients as well as teratogens. PIAs are also associated with hepatotoxicity, neurotoxicity, cognitive impairment, as well as increased incidence of malignancy. …

Race And Implicit Bias In The Jeffmd Case-Based Learning Curriculum, Abigail Wetzel, Denine Crittendon, Mph, Rosemary Frasso, Phd, Andres Fernandez, Md, Susan Truong, Md, Traci Trice, Md

Phase 1

Purpose: Race is related to health disparities, not to genetic predispositions, but race is often presented to medical students as a biological variable. At Sidney Kimmel Medical College, the curriculum has never been reviewed to analyze how race is presented to students. This Scholarly Inquiry project aims to analyze how the case-based learning (CBL) narratives presented to medical students perpetuate or challenge implicit biases in medicine, especially in regard to race. This paper will describe the methods of the project, which can serve as a model for other institutions to review their own curricula.

Methods: Thirty-nine CBL cases from the …

Basic Life Support And Opioid Overdose Management: Knowledge And Attitudes Among Students Matriculating Into Medical School - A Cross-Sectional Analysis To Inform Curricular Change, Nicholas Macdonald, Dimitrios Papanagnou, Md

Phase 1

Purpose: While Basic Life Support (BLS) skills are typically included in undergraduate medical education (UME) curricula, graduating students continue to demonstrate substandard skills retention. In the setting of the opioid epidemic, effective opioid overdose management (OOM) training should likewise take place during UME. To date, there is a paucity of literature that describes incoming medical students’ knowledge and attitudes on these topics prior to beginning their studies. The purpose of this study is to describe medical students’ knowledge and attitudes towards BLS and OOM prior to their medical training to inform curricular change in UME.

Methods: We conducted an observational, …

Simulating Status Epilepticus Management For Junior Neurology Trainees, Navya George, Pankhuri Jha, Frank Anzelmi, Md, Allyson Pickard, Md, Jeffrey Ratliff, Md

Phase 1

Purpose/Methods: Status Epilepticus (SE) represents a potentially fatal neurologic emergency. We aimed to create an educational simulation of SE for 9 PGY2 neurology residents. Scenarios included a patient with SE requiring adequate benzodiazepine dosing and another with seizures requiring IV anticonvulsant therapy. Subjects were dichotomized to groups who did and did not feel confident in clinical skills around SE. Knowledge was assessed with a multiple choice quiz. Confidence groups were analyzed with Fisher’s exact test. Quiz scores means were assessed with paired t-test.

Results: There was a trend towards significance in the proportion of residents expressing confidence in their ability …

Understanding The Attitudes And Perceptions Towards Lung Cancer Screening Amongst United States Veterans: A Qualitative Study, Shannon Nugent, Kristine Pham, Mph, Rickie Brawer, Mph, Phd, Mches

Phase 1

Introduction: Lung cancer is the leading cause of cancer mortality in the United States, with this rate disproportionately affecting the veteran population. Despite USPSTF recommendations, screening rates are low and underutilized. The purpose of this study is to understand veterans’ knowledge, attitudes and beliefs surrounding lung cancer and lung cancer screening to better address barriers to screening.

Methods: Five interviews were conducted with veteran community members, and three were conducted with key informants for a current total of eight interviews. Key informants included Philadelphia community leaders who work with veterans. Interviews explored lung cancer screening knowledge, motivating factors and barriers …

Medication Adherence In A Housing First Model, Lily Segal, Sharon Lyles

Phase 1

Introduction: Mental illness and chronic medical conditions are prevalent among those experiencing homelessness. Medication adherence has been very poor due to a variety of barriers, one of those being housing. For those who have previously experienced homelessness, does a Housing First model have a positive impact on medication adherence?

Methods: The target population was individuals on Team 1 at Pathways to Housing, PA. Medication adherence was measured through the use of blister packs, which contained 1 weeks’ worth of medication, therefore at the end of the month 4-empty blister packs should have been returned. Medication adherence, specifically for …

The Utility Of Performing Cervical Length Follow-Up In Lower Risk Singleton, Varsha Kripalu, Rupsa Boelig, Md

Phase 1

Introduction: Short cervical length (<25 mm) during pregnancy is known to be an increased risk factor for preterm birth (<37 weeks). While interventions exist for women who have had prior preterm births, it is important to investigate the cost effectiveness of screening low risk women with an intermediate cervical length (26-29 mm).

Objective: To quantify the association between change in cervical length on follow up and the incidence of preterm birth in otherwise low risk women with an initial intermediate cervical length.

Methods: A retrospective cohort study was conducted, reviewing 108 charts of women who had an initial screening between 26 and 29 mm. Charts were reviewed for whether or not a follow-up ultrasound was recommended, whether or not the follow-up was performed, and the outcome of their deliveries.

Results: 93.5% (N=101) of women were recommended to get a follow-up ultrasound and 84% (N=85) completed their follow-up. …

The Experience Of Intimate Partner Violence Among Pregnant Women Seeking Treatment For Opioid Use Disorder, Julia Dewey, Diane Abatemarco, Phd, Msw

Phase 1

Introduction: Intimate partner violence (IPV) is a major health issue among those with substance use disorder. A history of partner violence is associated with increased health problems and less improvement in treatment. The perinatal period is a time of increased risk of IPV for women, as well as a key opportunity for opioid use disorder treatment intervention. The purpose of this study is to characterize the experience of partner violence and evaluate the typology of sequelae associated with it in a population of pregnant women seeking medication assisted treatment for opioid use disorder.

Methods: The population of interest in this …

Lgbt Elder Initiative Thrivers Program Evaluation, Darcy Curtis, David Griffiths

Phase 1

Introduction: Aging with HIV is a critical area of study, especially as the generation that was initially affected by the disease grows older. The LGBT Elder Initiative (LGBT EI) is an organization in Philadelphia that supports and advocates for older members in the LGBT community. The LGBT EI Thrivers program is a community group that meets monthly to discuss what it means to “thrive” with HIV. The purpose of this study is to evaluate the LGBT EI’s Thrivers program and determine what motivates older individual with HIV to become involved in this program and identify the impact of the program. …

Assessment Of Dobhoff Tube Malposition On Radiographs Using Deep Learning, Kevin George, Paras Lakhani, Md

Phase 1

Introduction: Dobhoff tubes (DHT) are narrow-bore flexible devices that deliver enteral nutrition for critically ill patients. Tracheobronchial insertion of DHTs presents a significant risk for pulmonary complications. Thus, DHT insertion requires radiologist confirmation of correct placement with chest x-ray (CXR), increasing clinical delays. To address this, we demonstrate the novel application of Deep Convolutional Neural Networks (DCNNs) to automatically and accurately identify DHTs in CXRs in real time.

Methods: 141 de-identified HIPAA compliant frontal view chest radiographs containing DHTs in various positions were obtained. The DHTs were first manually segmented and verified by a board certified radiologist. Images were split …

3d Convolutional Neural Networks For The Diagnosis Of 6 Unique Pathologies On Head Ct, Travis Clarke, Paras Lakhani, Md

Phase 1

Introduction: Head CT scans are a standard first-line tool used by physicians in the diagnosis of neurological pathologies. Recently, the development of deep learning models such as convolutional neural networks (CNNs) has allowed the rapid identification of bleeds and other pathologies on CT scans. This study aims to show that by training 3D CNNs with a larger, curated dataset, a more comprehensive list of potential diagnoses can be included in the detailed model.

Methods: A retrospective study was performed using a dataset of 66,000 head CT studies from the Thomas Jefferson University health system. Studies were acquired using a natural …

Cost Savings And Patient Satisfaction Following Implementation Of An Online Blockchain-Based Healthcare Payment Portal, Zubin Hussain, Meghan Gannon, Phd, Constantine Daskalakis, Scd

Phase 1

Introduction. Although most patients prefer e-billing, many providers use paper. On average, over three paper bills are sent before payment is received. This means wasted time, money, energy, and decreased patient satisfaction. Could the implementation of an online, blockchain-based healthcare payment portal increase cost savings and patient satisfaction while maintaining confidentiality?

Methods. Transaction data was collected by MAPay through their portal system from about 100 providers in 50 locations in the NYC area, all through IntegraConnect. This study analyzes trends in how patients pay their medical bills and how much they pay.

Results. From March through September, all electronic methods …

We Was Somebody, Kyle Rodgers, Abigail Kay, Md

Phase 1

As the number of people who inject drugs (PWID) in Philadelphia increases, more healthcare professionals find themselves treating patients suffering from IV drug addictions. Unfortunately, many of these busy healthcare professionals have little education on the biochemistry of addiction and obstacles between people who inject drugs (PWID) and their recovery. We Was Somebody, a fictional play inspired by the stories of PWID in Kensington, Philadelphia, aims to promote understanding and empathy for the complexity of addiction and ultimately improve the quality of healthcare provided to the human beings affected by it.

The content of the play comes from peer-reviewed …

Along A River In The Wilds: A Podcast, Rhianna Hibbler, Howard Rabinowitz, Bob Motley

Phase 1

Introduction: The American urban-rural divide has been further magnified by discourse surrounding the 2016 election. Through this project we aimed to uncover stories of people from three small towns in rural north central Pennsylvania who are identifying and overcoming challenges by harnessing their region’s strengths in order to improve local social, economic, educational, and health outcomes.

Methods: Interviews were recorded with 10 local change-makers. Core topics included Community Initiatives, Education, and Healthcare, within the communities of Lock Haven, Jersey Shore, and Renovo. Edited podcast episodes are released under “Along a River in the Wilds,” available on major platforms including Apple …

Internal Medicine Consultation For Dentists, Nina Mingioni, Md

Clinical Education Teaching Tools

Learning Objectives:

• Recognize ubiquitous nature of common medical condition in general population
• Discuss implications of common medical conditions on dental care of patients
• Identify concerns affecting patients that would necessitate medical consultation prior to dental intervention

Jefferson Digital Commons Quarterly Report: October-December 2019, Kelsey Duinkerken, Msi, James Copeland, Libt, Larissa Gordon, Mslis, Med, Ma

Jefferson Digital Commons Reports

This quarterly report includes:

• Articles
• Dean's Research Development Lunch Conference
• Dissertations
• Educational Materials
• From the Archives
• Grand Rounds and Lectures
• Journals and Newsletters
• Population Health Presentation Materials
• Posters
• Reports
• Symposiums
• What People are Saying About the Jefferson Digital Commons