Medicine and Health Sciences Commons^™

Improving The Quality Of Internal Medicine Discharge Summaries Via Accurate Admission Medication Reconciliation, Natasa Kostic, Md, Tammy Tran, Md, Kenneth Meserole, Md, Jon Zaid, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Transitions of care are a time of vulnerability for patients.
• Nearly 20% of patients experience an adverse event within 3 weeks of hospital discharge, with adverse drug events being the most common.
• Discharge (DC) summaries serve to provide safe transition of care by describing hospital course and medication changes for review by outpatient providers.
• At TJUH, DC summaries are completed by internal medicine (IM) senior residents, but there is variability in quality of hospital course and thoroughness of medication reconciliation.
• Inaccurate admission medication reconciliation may lead to inaccurate reporting of discharge medication lists, causing confusion for both patients and …

Project Proposal: The Impact Of The Septa Zero Fare Program On Healthcare Access Among Philadelphia's Refugee And Migrant Population, Emily Hashem, Bs, Paranshu Shah, Mitchell Kaminski, Md, Mba

Health Equity and Quality Improvement (HEQI) Summit

Background

Since the 1960s, private, state sponsored, and charitable programs have attempted to increase transportation programs to improve healthcare access. Among these are the Centers for Medicare and Medicaid Services' Non-Emergency Medical Transportation (NEMT) program, Pennsylvania’s Medical Assistance Transportation Program (MATP) benefiting Medicaid recipients, Southeastern Pennsylvania Transit Association’s (SEPTA) SEPTA Access (formerly known as CCT connect) for disabled and elderly people, and ModivCare, a social services corporation that offers non-emergency medical transportation for qualifying people with low incomes. The importance of these programs is emphasized by the body of evidence surrounding healthcare metrics and transportation access. A Robert Wood Johnson …

Readmission For Picc Line Placement In Spine Surgery, Joseph Schaefer, Md, Joshua Heller, Md, James Harrop, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Pseudoarthrosis is failure of adequate bony fusion after a spinal fusion
• Prior literature has implicated occult C. acnes infection in cases of pseudoarthrosis
• Intraoperative cultures are often sent in cases of pseudoarthrosis at Jefferson
• C. acnes cultures often result after discharge requiring readmission

Medical Assistance In Dying In A Profit-Driven Health System: Ethical And Equity Challenges In The U.S. Vs. Canada, Joseph A. Zwillenberg, Eric M. Teichner, Jacob Schwell, Cameron Haghshenas, Joseph F. Majdan, Md, Facp, Fcpp

Health Equity and Quality Improvement (HEQI) Summit

Introduction

Medical Assistance in Dying (MAID), legalized in Canada in 2016, now accounts for 4.1% of all deaths nationwide and 6.6% in Quebec as of 2022(1). In Canada’s single-payer system, MAID is integrated as a publicly funded medical service. In contrast, the U.S.’s fragmented, market-driven system is defined by profit maximization, inequitable access, and insurer- driven decision-making. While MAID aims to promote autonomy and compassion, introducing it into the American context raises profound ethical concerns, particularly regarding nonmaleficence and systemic coercion. This poster evaluates the unique risks MAID poses within the U.S. healthcare system, particularly for vulnerable populations.

Instituting A New Traumatic Ich Algorithm At Jefferson, Michael Baldassari, Md, Matthews Lan, Md, Caitlin Ritz, Md, Tyler Alexander, Bs, Richard Schmidt, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Traumatic brain injury (TBI) is a high-incidence condition causing substantial economic burden on trauma centers worldwide. Many institutions have begun using validated algorithms for safe management, such as the Modified Brain Injury Guidelines (BIG) Criteria. At Jefferson, tICH have not historically been treated algorithmically, and therefore, tICH patients are often subject to excessive imaging surveillance and admission lengths.

Aim Statement: To institute a new algorithm modeled off mBIG criteria for the management of tICH patient at Jefferson to streamline treatment and safely reduce the number of surveillance HCTs obtained, as well as length of stay in this …

Incorporation Of The 4ms, With A Focus On Mentation, Into The H&P For Older Adults Hospitalized With A Hip Fracture And Its Effect On Delirium Documentation, Emily Custer, Do, Kristine Swartz, Md, Lily Ackermann, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Delirium affects 15% to over 50% of patients with hip fractures during their hospital stay (1) and is associated with increased mortality, increased length of hospital stay, poorer functional outcomes, and higher risk of nursing home placement (1,2). However, at Thomas Jefferson University Hospital, the prevalence of documented delirium post-hip fracture is only 5.22%, suggesting potential under recognition. Additionally, at the end of 2025, a new CMS inpatient quality metric will require public reporting on a hospital's capability to provide age-appropriate care for older adults, which can be done by utilizing the 4M framework of age-friendly health care. The …

Deprescribing Type 2 Diabetes Mellitus Medications In Older Adults In An Urban Primary Care Setting, Katelyn Koons, Md, Eugenie Hughes, Md, Eunice Choe, Md, Julio Garcia, Md, Munifa King, Md, Emily Lavell, Md, Michael Danielewicz, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Adults 65+ take on average five medications daily
• Polypharmacy increases risks of drug interactions and adverse events
• About 29% adults 65+ in developed countries have type 2 diabetes mellitus (T2DM) and the number of older adults living with these conditions is expected to increase rapidly in the coming decades
• Over-treatment of DM in older adults is common and increases risks of serios adverse outcomes including hypoglycemia
• Older adults with T2DM should have higher A1c goal consistent with ADA guidelines: [See Table on Poster]

Evaluation Of Immediate Postpartum Long-Acting Reversible Contraception For Reducing Short Interval Pregnancies, Andrew Grover, Md, Molly Haas, Bs, Amanda Ricard, Do, Heather Cunningham, Md, Joanne N. Quiñones, Amanda Flicker, Md

Health Equity and Quality Improvement (HEQI) Summit

Objective

• Short interval pregnancy (SIP): any pregnancy that occurs within 18 months of a previous delivery or pregnancy loss.
• SIP is associated with increased risk of gestational diabetes, placenta accreta spectrum,1preterm birth, low birth weight, and small size for gestational age.²
• Long-acting reversible contraceptive (LARC) methods such as intrauterine devices (IUDs) and subdermal implants offer solutions to the limitations of daily oral contraception. Despite these options, 45% of U.S. pregnancies in 2011 were unintentional.³

While immediate postpartum LARC has been shown to be effective for mitigating unintended pregnancy, implementation of programs providing access to this contraceptive option have …

The N-Alternative Optional Choice Experiment, Benjamin T. Backus, James J. Blaha, Thaddeus B. Czuba

MODVIS Workshop

When testing visual function in clinical settings, one encounters test-takers who have difficulty following a forced-choice instruction when stimulus intensity is low. “I didn’t see anything, why do I have to guess?” An optional-choice paradigm makes it easier for these test-takers to provide data. Here we describe a theory of signal detection for N-alternative optional-choice (N-AOC) psychophysical tasks. The theory generalizes two well-known paradigms into a single framework: the theory for yes-no tasks is a degenerate case in which N=1, and the theory for N-alternative forced choice tasks (N-AFC) is a degenerate case in which the decision criterion is liberal. …

Agenda (Pdf), Department Of Surgery

Surgery Research Symposium

Agenda for the 3rd Annual Surgery Research Symposium held May 15, 2025.

Recommendations For Telesupervision: Promoting Ethical, Legal, And Effective University And Clinical Supervision Using Technology, Madeleine M. Stevens, Yegan Pillay, Edisa Music, Elena Shahen

Journal of Counselor Preparation and Supervision

The expansion of the use of technology in counseling has implicated counseling professionals in considering how to legally and ethically incorporate it into all facets of practice, including university and clinical supervision settings. In this article, we provide scholarship-backed recommendations for doing so as well as provide suggestions for incorporating psychodynamic and cognitive-behavioral (CBT) supervision models into telesupervision.

Exploring Race In Addiction Treatment And The Need For An Anti-Racist Approach, Jackie D. Dell, Mei Tang

Journal of Counselor Preparation and Supervision

Extensive literature documents that Black people, Indigenous people, and People of Color (BIPOC) have been historically and systematically discriminated in addiction and substance use disorder treatment and services. This systemic oppression is the result of the creation and intersection of multiple systems that are rooted in White supremacy, which continue to fail to recognize racism as a critical factor in health disparities. The complexities of the structural factors that contribute to these racial health disparities, and opportunities to better address these disparities were reviewed to discuss their impact on BIPOC clients and the necessity for anti-racist approaches to addressing addiction …

Applying Supervision To Animal Assisted Therapy: Using The Integrative Development Model, Rachel W. Rachlinski, Kelli A. Mcfarland

Journal of Counselor Preparation and Supervision

A study conducted by Hartwig and Smelser (2018) reported 91.7% of clinicians being aware of animal assisted therapy (AAT) who agree it is a legitimate treatment model. However, 57% of respondents expressed interest in receiving AAT training. Although published standards and competencies published by ACA and IAHAIO indicate the requirement for clinical supervision when implementing AAT, research does not address supervision protocols for AAT. This manuscript suggests a protocol for supervising the implementation of AAT. The consequence of untrained supervisors is the potential harm to the well-being of the client as well as the clinician and the animal. As such, …

Culturally-Affirming Service-Learning For Counselors-In-Training: Child-Parent Relationship Therapy Training With Spanish-Speaking Families, Karen M. Roller, Szu-Yu Chen, Katrina Volante

Journal of Counselor Preparation and Supervision

The Spanish-speaking community is the largest underserved language group in the United States. To advance social justice advocacy and multicultural humility for this language group, the field of counselor education needs to create pedagogical scaffolding for non-Spanish-speaking counselors-in-training to work with interpreters to support Spanish-speaking families, while also enhancing language-concordant training for Spanish-English bilingual counselors-in-training. We utilized a critical race research design to explore six counselors-in-training’s experience participating in service-learning through online facilitation of Child-Parent Relationship Therapy with Spanish-speaking families. Interpretative phenomenological analysis of qualitative data yielded four major themes: (a) collaboration, (b) improved awareness, (c) growth and strength, and …

Pcsk-9 Inhibitors Treatment: The Cardiovascular Disparity, Julia Lees, Seana-Pierre Williams, Tahir Razzaq, Michael B. Roberts

The Journal of Integrated Primary Care

Introduction: According to the Center for Disease Control and Prevention (CDC) and American Heart Association (AHA), cardiovascular disease is the leading cause of death in the United States. This phenomenon disproportionally affects the African American population, who have a 31% higher mortality rate than non-Hispanic Caucasian individuals. A retrospective review of PCSK-9 medication use, specifically in a patient population that had minimal representation in the large, landmark clinical trials, can lead to better understanding about the therapeutic potential in cardiovascular disease reduction and patient outcomes attributed to medication use. Education regarding this novel drug class, medication access and patient support, …

Literature Review Of Stiff Person Syndrome, Mustafa Ansari, Adam Davis, Donald Penney

The Journal of Integrated Primary Care

Background: Stiff Person Syndrome (SPS) is a rare, debilitating autoimmune neurological disorder characterized by progressive muscle rigidity, painful spasms, and gait disturbances. It is strongly associated with autoantibodies against glutamic acid decarboxylase (GAD), leading to impaired GABAergic neurotransmission. SPS exists on a spectrum, with both classical and paraneoplastic variants, the latter often linked to malignancies such as breast cancer.

Methods: This review synthesizes current literature on the pathophysiology, clinical presentation, diagnostic criteria, and treatment modalities of SPS. We examine emerging therapies, including immunomodulatory approaches and antibody-targeted interventions, to address the heterogeneity of disease progression and treatment response.

Results: SPS remains …

Advancing Sports-Related Concussion Management: Integrating Evidence-Based Protocols, Emerging Diagnostics, And Personalized Care, Anvitha Kaguturu, Colin Rhoads, Donald Penney

The Journal of Integrated Primary Care

Background

Sports-related concussions (SRC) are a prevalent and complex public health issue, with 1.6-3.8 million cases annually in the United States. Increased awareness has led to higher rates of emergency and primary care consultations, yet many healthcare providers lack the resources or training to apply current evidence-based guidelines. The evolving understanding of concussion pathophysiology and long-term outcomes, including chronic traumatic encephalopathy (CTE), highlights the need for updated management strategies.

Objectives

This study aims to review current approaches to SRC management, from initial diagnosis to return-to-play, while exploring advances in biomarkers, neuroimaging, and genetic testing that could improve the prediction and …

A Pilot Study Of A Manualized Cognitive-Behavioral Intervention For Opioid Use Disorder Delivered In A Community-Based Public Health Organization, Michelle R. Lent, Denise Botcheos, Chad Gurdgiel, Hannah R. Callahan, Liam Gilroy

The Journal of Integrated Primary Care

This pilot study evaluated a previously untested cognitive-behavioral therapy (CBT) intervention designed specifically to treat opioid use disorder (OUD). Adults (N = 20) taking medication for OUD were recruited from a public health organization providing harm reduction and treatment services to people who use drugs in Philadelphia. Outcomes collected at baseline and 12 weeks included urinalysis-confirmed use of illicit drugs and surveys of mood (Patient Health Questionnaire-9; Generalized Anxiety Disorder-7), recovery capital (Brief Assessment of Recovery Capital-10), and cravings (Brief Substance Craving Scale). Feasibility and acceptability were assessed via retention rates, the Client Satisfaction Questionnaire-8, and the number of …

Improving The Quality Of Veteran Health Care By Optimizing Va Integrated Primary Care: 20 Years And Beyond Of The Center For Integrated Healthcare, Jennifer S. Funderburk, Robyn Shepardson, Gregory Beehler, Kyle Possemato, Kristen Perry, Christina Shook, Jessica Martin, Katherine Dollar

The Journal of Integrated Primary Care

Primary care patients often present with mental and behavioral health concerns, such as depression or insomnia, leaving medical teams scrambling. To help fill this gap and increase access to care while aligning with patient preferences, a new service delivery model of integrated care, characterized by embedding behavioral health providers within medical teams, was embraced in a grassroots effort, with the VA being one of the first healthcare systems to implement it throughout all primary care settings. A common challenge to grassroot efforts is the lack of research establishing effectiveness and identifying ways to optimize the innovation’s impact. Innovative VA leaders …

Community-Based Toolkit For Parents And Their Children With Severe Mental Illness, Adam Thai, Jo Loomis, Alicia Kletter

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Many adult children with severe mental illness (SMI) reside with their aging parents, who not only provide financial and housing support but often serve as the caretakers and care coordinators. Circumstances can change in an instant for this population with the loss of their parents.

Local Problem: Persons with SMI in San Mateo County that have been reliant on their parents throughout their lives would suddenly be unhoused, vulnerable and without support in the community, which can adversely affect health outcomes.

Methods: A Doctor of Nursing Practice (DNP) student-led pilot online community-based toolkit was designed …

Framing The Future: A Community Health Analysis Of The Pee Dee Region, Stephen Borders, Jean Anton, Rian Fontaine, Donielle Phillips, Treyton Ringer, Jessica Robinson, Caitlin Thompkins

Public Health

This report presents a comprehensive, data-driven analysis of community health across South Carolina’s Pee Dee region, encompassing Florence, Darlington, Chesterfield, Marlboro, Marion, and Dillon Counties. Using tract-level data from CDC PLACES, the U.S. Census, and the National Provider Identifier registry, it assesses chronic health conditions, health behaviors, and social determinants of health. The analysis incorporates the South Carolina Healthy Communities Index (SCHCI) and a Suitability Analysis to identify the region’s most disadvantaged communities. The findings highlight persistent disparities, particularly in rural counties, where high rates of poverty, chronic disease, and unmet basic needs intersect with limited access to care. Despite …

Trauma-Informed Care: A Therapeutic Communication - Executive Summary, Nicole Anne Leonce

Doctor of Nursing Practice (DNP) Projects

Background Effective therapeutic communication is essential for building strong patient relationships, yet bias, stigma, and judgment can exacerbate trauma and widen health disparities. Trauma-Informed Care (TIC) emphasizes respect, compassion, and empathy to mitigate these issues. Problem Although TIC is extensively studied in high-income regions such as the United States, Europe, and Australia, its application in developing countries remains limited. This gap impedes culturally sensitive healthcare practices that address unique social, cultural, and economic challenges, potentially deepening disparities. Methods A comprehensive literature review was conducted to assess current TIC training research among healthcare workers. The review aimed to underscore TIC's importance …

“Invisible Populations”: A Policy Brief Approach To Address Housing Data Needs In Vulnerable Communities, Kristin E. Moser

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Dependent adult children with severe mental illness (ASMI) living with aging parents have been an increasing population over decades due to lack of supportive housing and services in the community. ASMI living with aging parents is a high-risk group for housing instability and future homelessness. Local Problem: A limited amount of literature and data exist to determine the size and needs of the population of ASMI living with aging parents. A collaboration with University of San Francisco (USF) and non-profit, Solutions for Supportive Homes (S4SH) of San Mateo County (SMC) formed to disseminate information and quantify the “invisible …

Targeting The Beiging Of Muscle-Associated Adipose Tissue To Promote Muscle Regeneration, Jacob C. Parson

WUSM Theses and Dissertations – All Programs

The expansion of intra-muscular adipose tissue (IMAT) between myofibers and epi-muscular adipose tissue (EMAT) outside of the muscle boundary accompanies numerous pathologies including diabetes, muscular dystrophy, and aging. IMAT and EMAT are anatomically juxtaposed to myofibers. Some evidence supports that IMAT and EMAT impede muscle function. This is potentially due to paracrine factors that are secreted by IMAT/EMAT. Different adipose depots can be classified in numerous ways including where they are located anatomically as well as the factors in which they secrete. Unlike classical white fat, adipose depots classified as brown or beige, noted by the marker uncoupling protein-1 (UCP-1) …

Trauma-Informed Family-Centered Care Training For Neonatal Intensive Care Nurses, Sonja A. Alli-Casella

Doctor of Nursing Practice (DNP) Projects

Background The neonatal intensive care unit (NICU) is a high-stress environment that can cause or exacerbate emotional trauma for parents of critically ill infants. While NICU nurses are trained in neonatal care and basic family-centered principles, they often receive limited education on supporting adults in acute emotional distress, leaving them unprepared to manage dysregulated behaviors. Local Problem At a Level IV NICU in a Southern California pediatric hospital, nurses may underestimate their influence on parental stress levels due to a lack of formal training in supporting emotionally distressed adults. Methods A comprehensive literature review informed an evidence-based practice (EBP) initiative …

A Retrospective Study Of Pulmonary Function Tests In Bronchiectasis: An Infectious Disease Of The Respiratory System, Vinod Mutkule, Mahesh Shinde, Vidya Bapmare, Sangramsingh Dixit, Atharva Sharma, Kshitij Sarwey, Yogeshwari Patil, Sanket Jethlia, Aayushi Dwivedi, Disha Pardeshi, Anmol Rai, Kunal Shah, Vidhi Kalwar

The University of Louisville Journal of Respiratory Infections

Introduction: Bronchiectasis, currently being recognized worldwide, is an abnormal dilatation of the bronchi and bronchioles brought on by recurrent cycles of inflammation and airway infection. Impaired pulmonary function has a predictive significance in bronchiectasis. When treating patients with suspected or confirmed respiratory diseases, pulmonary function tests (PFT) are useful examinations. Very few studies have been done on PFTs in bronchiectasis. The main aim of this study is to study PFTs in bronchiectasis.

Method: This is a retrospective observational study done on 50 patients over two years at the tertiary care center. The previous records of patients were collected from the …

Increasing Formation Of Advance Directives In Acute Care Through Staff Education, Piper E. Parres

Doctor of Nursing Practice Scholarly Project

In the acute care setting, the condition and stability of patients can change in an instant. Oftentimes, patients that were ambulatory, independent, and high functioning may be rendered critically ill and unable to communicate due to the rapid onset of an illness. When this happens, the care team must act quickly to stabilize the patient by any means necessary. With the wealth of medical knowledge and technology available in modern healthcare, life may be sustained indefinitely with the help of machinery such as ventilators, continuous renal replacement therapy, or extracorporeal membrane oxygenation. While some patients may welcome these interventions, others …

Toward An Understanding Of Loneliness And Social Participation In Serious Mental Illness, Samantha B. Randolph

WUSM Theses and Dissertations – All Programs

Loneliness is an immense challenge facing the majority of Americans with Serious Mental Illness. Loneliness is linked to negative outcomes, including heart disease, reduced quality of life, and early mortality. Current loneliness interventions (e.g., social skills training, social support) do not effectively address all the complex factors that lead to loneliness in this population. More work is needed, therefore, to better understand how to optimally research and prevent loneliness among individuals with Serious Mental Illness, who experience unique barriers to social integration/participation and dwell in complex settings, such as permanent supportive housing. The presented dissertation aims to address current gaps …

A Theory-Based Examination Of Factors Influencing Caregivers’ Intentions To Disclose Sickle Cell Trait Status To Their Children, Christine A. Chaba

WUSM Theses and Dissertations – All Programs

Sickle cell trait (SCT), the heterozygous form of sickle cell disease, has significant implications for health and reproductive decision-making. Timely disclosure of SCT status to children by their caregivers is critical for promoting genetic awareness and supporting informed reproductive choices. However, many caregivers delay or avoid this conversation. This study examined the psychosocial and behavioral factors influencing caregivers’ intentions to disclose SCT status to their children, guided by the Theory of Planned Behavior and the Theory of Regret Regulation. A descriptive, cross-sectional study was conducted with 78 caregivers of Children with SCT, who completed an online survey. The study addressed …

Identifying Key Factors Associated With Assistive Technology Availability For Dementia Care Using Machine Learning, Wai Hang Kwok, Syed Afaq Ali Shah, Guanjin Wang

Research outputs 2022 to 2026

This study explores the factors influencing the availability of assistive technology for people with dementia through the application of machine learning. The analysis identified key factors, including carer support, protective legislation, and access to reimbursable products from the WHO Global Health Observatory. A random forest model with high accuracy emphasises the importance of targeted resources and policies in improving dementia care infrastructure.