Medical Specialties Commons^™

Steamn Spin, Kathryn Sommer, Christina Stiebris, Kelley Yuan, Morgan Hutchinson, Md, Aaron Herl, Rachel Smith, Jessica Gaulton, Md, Mph, Eddie Chang, Md, Mba

Phase 1

Sanitize and dry your breast pump parts within minutes.

Adverse Events Following Screening Eye Examinations For Retinopathy Of Prematurity In Premature Infants, Aditi Kale, Pedro Urday, Zubair H. Aghai

Phase 1

Introduction: The retinopathy of prematurity (ROP) examination is recommended for high-risk preterm infants to prevent its complications but may be associated with adverse events. The goal of this study is to determine whether the ROP examination increases the incidence of adverse events in premature infants.

Design/Methods: This was a retrospective study on all preterm infants (32 weeks gestation) born between 03/2017 and 12/2019 who survived until the first eye examination. The number of episodes of apnea (A), bradycardia (B), desaturation (D), number of infants on mechanical ventilation, and number of infants requiring sepsis evaluation were compared before and …

Peri-Operative Urodynamic Assessment Has Poor Predictive Value For Developing Post-Operative Urinary Retention, Baylor Wickes, Robert Pivec, Md, Mathew S. Austin, Md

Phase 1

Introduction: Post-operative urinary retention (POUR) following primary total joint arthroplasty (TJA) has a reported prevalence up to 35%. Risk factors for developing POUR have traditionally included surrogate markers such as the presence or absence of urologic disease. However, dynamic measurement of the renal system with post-void residual volumes (PVR) has not been investigated as a tool for assessing POUR risk.

Methods: All male TJA patients underwent an pre-operative screen for POUR, including PVR measurements, patient-derived subjective urinary retention scores, and assessment of urologic disease. This was combined with a post-operative monitoring and catheterization protocol developed in partnership with a …

The Impact Of Patient Characteristics On Quality Of Life In Keloid Patients, Jonathan Wang, Romsin Zaya, Rachel Zachian, Mary Metkus, Neda Nikbakht

Phase 1

Introduction: Quality of life (QoL) is an important metric in assessing dermatological diseases such as keloids. This study evaluated the effects of patient characteristics on QoL in keloid patients.

Methods: This was a cross-sectional study. 36 patients presenting to the keloid clinic at TJUH were surveyed. QoL subscale scores for emotion, symptom, and function were calculated in addition to a total score for each patient using a keloid-specific questionnaire. The association between the QoL scores and patient characteristics of sex, ethnicity, as well as keloid location, duration, visibility, size, number, pain score, and pruritis score were evaluated using t-tests. …

The Prevalence Of Orally Administered Glucocorticoids, Generalized Pustular Psoriasis And Erythrodermic Psoriasis In The Treatment Of Adult Plaque Psoriasis Provided By U.S. Dermatologists, Katherine Awh, Kumar Nasham, Christian Albornoz, Steven Feldman, Anthony Albornoz

Phase 1

Introduction: Orally administered glucocorticoids (OAG) are not recommended for the management of plaque psoriasis (PsO) due to the classically feared outcomes of generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP). Given their widespread anecdotal use, we hypothesize that the use of OAG is not infrequent among US dermatologists and is rarely complicated by GPP or EP.

Methods: Anonymous electronic survey of 50 US dermatologists. Primary outcomes of interest were the prevalence of OAG in the management of PsO and the prevalence of GPP and EP in the context of OAG tapering.

Results: Overall, 9 out of 50 (18%) respondents …

An Assessment Of Quality Improvement Strategies For The Implementation Of Certified Recovery Specialists In Treating Opioid Use Disorder At The Emergency Department At Jefferson, A. Cosmo Annese, Rickie Brawer, Phd, Mph, Ches

Phase 1

Introduction: Opioid overdose mortality rate in the U.S. has seen a staggering upward trend lately, more than tripling between the years 2000-2017. Although the use of Certified Recovery Specialists (CRSs) has been shown to improve overdose rates, relapse rates, and treatment completion rates for people with opioid use disorder (OUD), the optimal specialization of CRSs in healthcare settings has yet to be clearly defined. This project seeks the perspectives of CRSs and healthcare workers to gain insight into how CRSs can be most effectively implemented in the ED at Jefferson to treat OUD.

Methods: The study population includes CRSs and …

Focal St-Segment Elevation Without Coronary Occlusion: Myocardial Infarction With No Obstructive Coronary Atherosclerosis Associated With Covid-19-A Case Report, Casey Meizinger, Bruce D. Klugherz

Division of Cardiology Faculty Papers

Background: While it is understood that coronavirus disease 2019 (COVID-19) is primarily complicated by respiratory failure, more data are emerging on the cardiovascular complications of this disease. A subset of COVID-19 patients present with ST-elevations on electrocardiogram (ECG) yet normal coronary angiography, a presentation that can fit criteria for myocardial infarction with no obstructive coronary atherosclerosis (MINOCA). There is little known about non-coronary myocardial injury observed in patients with COVID-19, and we present a case that should encourage further conversation and study of this clinical challenge.

Case summary: An 86-year-old man presented to our institution with acute hypoxic respiratory failure …

Levonorgestrel Intrauterine Device Use For Medical Indications In Nulliparous Adolescents And Young Adults., Beth I Schwartz, Morgan Alexander, Lesley L Breech

Department of Obstetrics and Gynecology Faculty Papers

PURPOSE: Intrauterine devices (IUDs) are highly effective at preventing pregnancy. Levonorgestrel (LNG) IUDs also have beneficial effects on menstrual bleeding and abdominal and pelvic pain. Although there are increasing data on use of IUDs for contraception in adolescents and for medical indications in adults, there are extremely limited data on LNG IUD use for medical indications in adolescents. Our objective is to describe the characteristics and experiences of LNG IUD use in nulliparous adolescents and young women using IUDs for medical indications.

METHODS: We conducted a retrospective chart review of all nulliparous patients aged 22 years and younger who underwent …

The Reflection On The Management Of Toxic Epidermal Necrolysis In The Community Setting: An Internist's Perspective, Qian Zhang, Ali Raza Shaikh, Thomas Yoon, Shreeja Shah Shah, James W. Mahoney

Abington Jefferson Health Papers

Toxic epidermal necrolysis (TEN) is a dermatological emergency that is often associated with high mortality. It is differentiated from Stevens-Johnson syndrome (SJS) based on the percentage of the total body surface area affected. There has been an established correlation with certain medications that could trigger the development of such a devastating disease. Despite numerous research studies conducted on aspects of this disease entity, TEN remains foreign to many general Internists situated in a community setting due to the extremely low disease prevalence that leads to a lack of overall experience and medical resources in dealing with this medical condition. Thus, …

Fat Graft For Parotidectomy Defect Reconstruction In The Setting Of Malignant Disease, S. Hamad Sagheer, Bs, Alexander Knops, Ba, Kurren Gill, Md, Vivian Xu, Bs, Howard Krein, Md, Phd, Ryan Heffelfinger, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Objectives: Currently, limited data examines the safety of utilizing fat transfers in the setting of malignant parotid disease. Here we evaluate the safety of fat graft reconstruction of parotidectomy defects in the setting of malignant disease.

Study Design: Retrospective cohort study

Methods: Electronic chart review of patients who underwent parotidectomy from 2012-2020 were reviewed.

Results: Three hundred and sixty-one patients were identified at a single institution who underwent parotidectomy, and 113 (31.3%) were for malignancy. One hundred and thirty-two patients underwent fat graft reconstruction (49.2%, n=65 for umbilical, 50.8%, n=67 for dermal). One-third of patients had malignant pathology (34.8%, n=46). …

Intraoperative Evaluation Of Nasal Valve Repair Interventions: A Prospective Analysis, Kurren Gill, Md, S. Hamad Sagheer, Bs, Cory Bovenzi, Md, Brian Yan, Ba, Howard Krein, Md, Phd, Ryan Heffelfinger, Md

Department of Otolaryngology - Head and Neck Surgery Posters

Objectives: To allow for early identification and treatment of inadequate nasal valve repair interventions in the intraoperative setting, based on degree of nasal valve collapse quantified by suction-assisted pressure readings. Patient outcomes were measured by comparison of pre- and post-operative Nasal Obstruction Symptom Evaluation (NOSE) surveys.

Study Design: Prospective study.

Methods: All enrolled patients undergo suction-assisted evaluation of nasal valve collapse before surgical intervention. Patients randomized into the experimental group underwent repeat assessment after various nasal valve interventions, compared to a control group where adequacy of interventions was assessed by palpation of the nasal ala.

Results: 20 patients who underwent …

Management Of Gliomas In Patients With Lynch Syndrome., Iyad Alnahhas, Appaji Rayi, Shirley Ong, Pierre Giglio, Vinay Puduvalli

Department of Neurology Faculty Papers

No abstract provided.

Printing The Pathway Forward In Bone Metastatic Cancer Research: Applications Of 3d Engineered Models And Bioprinted Scaffolds To Recapitulate The Bone-Tumor Niche., Anne M. Hughes, Alexus D. Kolb, Alison B. Shupp, Kristy M. Shine, Karen M. Bussard

Department of Cancer Biology Faculty Papers

Breast cancer commonly metastasizes to bone, resulting in osteolytic lesions and poor patient quality of life. The bone extracellular matrix (ECM) plays a critical role in cancer cell metastasis by means of the physical and biochemical cues it provides to support cellular crosstalk. Current two-dimensional in-vitro models lack the spatial and biochemical complexities of the native ECM and do not fully recapitulate crosstalk that occurs between the tumor and endogenous stromal cells. Engineered models such as bone-on-a-chip, extramedullary bone, and bioreactors are presently used to model cellular crosstalk and bone-tumor cell interactions, but fall short of providing a bone-biomimetic microenvironment. …

Early Hemodynamic Assessment Using Nicom In Patients At Risk Of Developing Sepsis Immediately After Emergency Department Triage., Steve B Chukwulebe, David F. Gaieski, Abhishek Bhardwaj, Lakeisha Mulugeta-Gordon, Frances S Shofer, Anthony J Dean

Department of Emergency Medicine Faculty Papers

BACKGROUND: One factor leading to the high mortality rate seen in sepsis is the subtle, dynamic nature of the disease, which can lead to delayed detection and under-resuscitation. This study investigated whether serial hemodynamic parameters obtained from a non-invasive cardiac output monitor (NICOM) predicts disease severity in patients at risk for sepsis.

METHODS: Prospective clinical trial of the NICOM device in a convenience sample of adult ED patients at risk for sepsis who did not have obvious organ dysfunction at the time of triage. Hemodynamic data were collected immediately following triage and 2 hours after initial measurement and compared in …

Algorithm For Cavo-Tricuspid Isthmus Flutter On Surface Ecgs: The Actions Study., Daniel Frisch, Eitan Frankel, Deanna Gill, Jad Al Danaf

Division of Cardiology Faculty Papers

OBJECTIVE: Cavo-tricuspid isthmus atrial flutter (CTI-AFL) is an important arrhythmia to recognise because there is a highly effective and relatively low-risk ablation strategy. However, clinical experience has demonstrated that providers often have difficulty distinguishing AFL from atrial fibrillation.

METHODS: We developed a novel ECG-based three-step algorithm to identify CTI-AFL based on established CTI flutter characteristics and verified on consecutive ablation cases of typical flutter, atypical flutter and atrial fibrillation. The algorithm assesses V1/inferior lead F-wave concordance, consistency of P-wave morphology and the presence of isoelectric intervals in the inferior leads. In this observation study, the algorithm was validated on a …

What We Learned In The Development Of A Third-Year Medical Student Curricular Project., Maria Syl D. De La Cruz, Rashida S Smith, Alexis E Silverio, Allison R Casola, Erin L Kelly

Department of Family & Community Medicine Faculty Papers

The application of continuous systems improvement in medical education can provide actionable information for curriculum development, improvement, and future planning (as reported by Bowe and Armstrong, Acad Med 92:585-92, 2017). After receiving a medical education grant, we developed a curriculum to teach medical students how to use quality improvement (QI) to address health disparities in vulnerable populations. During the process of developing and implementing this curriculum, we learned several lessons.One of the major surprises was that our proposed project work took much longer to complete than anticipated. This was mainly because we did not have the right team assembled from …

Fructosamine Is A Valuable Marker For Glycemic Control And Predicting Adverse Outcomes Following Total Hip Arthroplasty: A Prospective Multi-Institutional Investigation, Noam Shohat, Karan Goswami, Leigham Breckenridge, Michael B Held, Arthur L Malkani, Roshan P Shah, Ran Schwarzkopf, Javad Parvizi

Rothman Institute Papers

Recently, fructosamine has shown promising results in predicting adverse outcomes following total knee arthroplasty. The purpose of this study was to assess the utility of fructosamine to predict adverse outcomes following total hip arthroplasty (THA). A prospective multi-center study involving four institutions was conducted. All primary THA were evaluated for glycemic control using fructosamine levels prior to surgery. Adverse outcomes were assessed at a minimum 1 year from surgery. Primary outcome of interest was periprosthetic joint infection (PJI) based on the International Consensus Meeting (ICM) criteria. Secondary outcomes assessed were superficial infections, readmissions and death. Based on previous studies on …

Manganese Exposure In Juvenile C57bl/6 Mice Increases Glial Inflammatory Responses In The Substantia Nigra Following Infection With H1n1 Influenza Virus., Collin M Bantle, C Tenley French, Jason E Cummings, Shankar Sadasivan, Kevin Tran, Richard A Slayden, Richard Jay Smeyne, Ronald B Tjalkens

Farber Institute for Neuroscience Faculty Papers

Infection with Influenza A virus can lead to the development of encephalitis and subsequent neurological deficits ranging from headaches to neurodegeneration. Post-encephalitic parkinsonism has been reported in surviving patients of H1N1 infections, but not all cases of encephalitic H1N1 infection present with these neurological symptoms, suggesting that interactions with an environmental neurotoxin could promote more severe neurological damage. The heavy metal, manganese (Mn), is a potential interacting factor with H1N1 because excessive exposure early in life can induce long-lasting effects on neurological function through inflammatory activation of glial cells. In the current study, we used a two-hit model of neurotoxin-pathogen …

"Trauma To The Eye"-A Low Fidelity Resident Teaching Module For Identifying And Treating A Retrobulbar Hematoma., Jared Raikin, R. Hall, Dimitrios Papanagnou, Md

Department of Emergency Medicine Faculty Papers

Introduction: A retrobulbar hematoma (RH) is a serious time-dependent diagnosis due to its potential for permanent damage of the optic nerve, resulting in blindness. Emergency medicine (EM) physicians face the challenge of recognizing this time-sensitive injury and treating it before irreversible damage occurs. Due to its relative infrequency in the emergency department, residents may not have adequate experience in recognizing and treating RH.

Methods: This educational intervention outlined a simulated scenario that we developed to educate EM residents to diagnose RH and perform an emergent lateral canthotomy and cantholysis (LCC). Participating residents were asked to obtain a history and perform …

Post-Partum Skin-To-Skin Care And Infant Safety: Results Of A State-Wide Hospital Survey, Eileen Tyrala, Md, Michael H. Goodstein, Md, Erich Batra, Md, Barbara Kelly, Md, Judy Bannon, Mba, Ted Bell, Ms

Department of Medicine Faculty Papers

Objectives: Survey current experience with Skin to Skin care (SSC) in Pennsylvania Maternity Centers.

Study Design: The nursing director of each Maternity Center in PA (n = 95) was sent an on-line confidential survey querying SSC practices. Responses were compared by delivery size, location, and nature of affiliation. Statistics analyzed by chi-square and student t-test.

Results: Of these 64/95 MCs (67%) responded. All allowed SSC after vaginal deliveries, 55% after C-section, 73% mother’s room. Monitoring included delivery room nurse (94%) with support from other providers (61%), family members (37%), and electronic monitoring (5%). If SSC occurred in mother’s …

Opioids And Sickle Cell Disease: From Opium To The Opioid Epidemic., Samir K. Ballas

Cardeza Foundation for Hematologic Research

Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure. The clinical effects of the sickle gene are pleiotropic in nature causing multiple phenotypic expressions associated with the various complications of the disease. The hallmark of the disease is pain that could be acute, chronic, nociceptive, or neuropathic that could occur singly or in various combinations. The acute vaso-occlusive painful crisis (VOC) is the most common cause of admissions to the Emergency Department and/or the hospital. Although progress has been made in understanding the pathophysiology of SCD as well as in developing preventive and curative therapies, effective pain management …

Differential Expression Of Αvβ3 And Αvβ6 Integrins In Prostate Cancer Progression, Fabio Quaglia, Shiv Ram Krishn, Yanqing Wang, David W Goodrich, Peter Mccue, Andrew Kossenkov, Amy C Mandigo, Karen Knudsen, Paul H Weinreb, Eva Corey, William Kevin Kelly, Lucia R Languino

Department of Cancer Biology Faculty Papers

Neuroendocrine prostate cancer (NEPrCa) arises de novo or after accumulation of genomic alterations in pre-existing adenocarcinoma tumors in response to androgen deprivation therapies. We have provided evidence that small extracellular vesicles released by PrCa cells and containing the αVβ3 integrin promote neuroendocrine differentiation of PrCa in vivo and in vitro. Here, we examined αVβ3 integrin expression in three murine models carrying a deletion of PTEN (SKO), PTEN and RB1 (DKO), or PTEN, RB1 and TRP53 (TKO) genes in the prostatic epithelium; of these three models, the DKO and TKO tumors develop NEPrCa with a gene signature comparable to those of …

Development Of Optically Controlled "Living Electrodes" With Long-Projecting Axon Tracts For A Synaptic Brain-Machine Interface., Dayo O. Adewole, Laura A. Struzyna, Justin C. Burrell, James P. Harris, Ashley D. Nemes, Dmitriy Petrov, Reuben H. Kraft, H. Isaac Chen, Mijail D. Serruya, John A. Wolf, D. Kacy Cullen

Department of Neurology Faculty Papers

For implantable neural interfaces, functional/clinical outcomes are challenged by limitations in specificity and stability of inorganic microelectrodes. A biological intermediary between microelectrical devices and the brain may improve specificity and longevity through (i) natural synaptic integration with deep neural circuitry, (ii) accessibility on the brain surface, and (iii) optogenetic manipulation for targeted, light-based readout/control. Accordingly, we have developed implantable "living electrodes," living cortical neurons, and axonal tracts protected within soft hydrogel cylinders, for optobiological monitoring/modulation of brain activity. Here, we demonstrate fabrication, rapid axonal outgrowth, reproducible cytoarchitecture, and simultaneous optical stimulation and recording of these tissue engineered constructs in vitro. …

Clinical Performance Of The Point-Of-Care Cobas Liat For Detection Of Sars-Cov-2 In 20 Minutes: A Multicenter Study., Glen Hansen, Jamie Marino, Zi-Xuan Wang, Kathleen G Beavis, John Rodrigo, Kylie Labog, Lars F Westblade, Run Jin, Nedra Love, Karen Ding, Sachin Garg, Alan Huang, Joanna Sickler, Nam K Tran

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Highly accurate testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the point of care (POC) is an unmet diagnostic need in emergency care and time-sensitive outpatient care settings. Reverse transcription-PCR (RT-PCR) technology is the gold standard for SARS-CoV-2 diagnostics. We performed a multisite U.S. study comparing the clinical performance of the first U.S. Food and Drug Administration (FDA)-authorized POC RT-PCR for detection of SARS-CoV-2 in 20 min, the cobas Liat SARS-CoV-2 and influenza A/B nucleic acid test, to the most widely used RT-PCR laboratory test, the cobas 68/8800 SARS-CoV-2 test. Clinical nasopharyngeal swab specimens from 444 patients with …

A Systematic Review On Three Major Types Of Scleral-Fixated Intraocular Lens Implantation, Ho Ming Wong, Ka Wai Kam, Christopher J Rapuano, Alvin L Young

Wills Eye Hospital Papers

PURPOSE: We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and subjects with Marfan syndrome.

DESIGN: Systematic review.

METHODS: We performed a search in PubMed, Ovid MEDLINE, and Embase for English language articles with keywords "(sutured intraocular lens) OR (SFIOL) OR (sutureless intraocular lens) OR (glued intraocular lens) OR (intrascleral intraocular lens) OR (SFIOL)" through October 16, 2019. Articles reporting individual outcomes after SFIOL were included in this systematic review. Recorded outcome measures included intraoperative and postoperative complications, endothelial cell changes, and intraocular lens-related outcomes.

RESULTS: Our …

Prevalence Of Malaria Parasite Infections Among U.S.-Bound Congolese Refugees With And Without Splenomegaly., Moses Mwesigwa, Jessica L. Webster, Sam Lubwama Nsobya, Alexander Rowan, Mukunda Singh Basnet, Christina R. Phares, Michelle Weinberg, Alexander Klosovsky, Marwan Naoum, Philip J. Rosenthal, William Stauffer

Student Papers, Posters & Projects

All U.S.-bound refugees from sub-Saharan Africa receive presumptive antimalarial treatment before departing for the United States. Among U.S.-bound Congolese refugees, breakthrough malaria cases and persistent splenomegaly have been reported. In response, an enhanced malaria diagnostic program was instituted. Here, we report the prevalence of plasmodial infection among 803 U.S.-bound Congolese refugees who received enhanced diagnostics. Infections by either rapid diagnostic test (RDT) or PCR were detected in 187 (23%) refugees, with 78 (10%) by RDT only, 35 (4%) by PCR only, and 74 (9%) by both. Infections identified by PCR included 103 monoinfections (87 Plasmodium falciparum, eight Plasmodium ovale, seven …

Myeloid-Derived Suppressor Cells In Gastrointestinal Cancers: A Systemic Review., Maham Farshidpour, Monjur Ahmed, Shilpa Junna, Juanita L. Merchant

Division of Internal Medicine Faculty Papers & Presentations

Gastrointestinal (GI) cancers are one of the most common malignancies worldwide, with high rates of morbidity and mortality. Myeloid-derived suppressor cells (MDSCs) are major components of the tumor microenvironment (TME). MDSCs facilitate the transformation of premalignant cells and play roles in tumor growth and metastasis. Moreover, in patients with GI malignancies, MDSCs can lead to the suppression of T cells and natural killer cells. Accordingly, a better understanding of the role and mechanism of action of MDSCs in the TME will aid in the development of novel immune-targeted therapies.

Caesarean Birth By Maternal Request: A Poorly Understood Phenomenon In Low- And Middle-Income Countries., Margo S. Harrison, Ana Garces, Lester Figueroa, Fabian Esamai, Sherri Bucher, Carl Bose, Shivaprasad Goudar, Richard Derman, Archana Patel, Patricia L. Hibberd, Elwyn Chomba, Miusaku Mwenechanya, Michael Hambidge, Nancy F. Krebs

Global Health Articles

BACKGROUND: While trends in caesarean birth by maternal request in low- and middle-income countries are unclear, age, education, multiple gestation and hypertensive disease appear associated with the indication when compared with caesarean birth performed for medical indications.

METHODS: We performed a secondary analysis of a prospectively collected population-based study of home and facility births using descriptive statistics, bivariate comparisons and multilevel mixed-effects logistic regression.

RESULTS: Of 28 751 patients who underwent caesarean birth and had a documented primary indication for the surgery, 655 (2%) were attributed to caesarean birth by maternal request. The remaining 98% were attributed to maternal and …

Biomolecules As Model Indicators Of In Vitro And In Vivo Cold Plasma Safety, Caitlin Heslin, Daniela Boehm, Julianne Megaw, Brendan F. Gilmore, Theresa A. Freeman, Noreen J. Hickok, P. J. Cullen, Paula Bourke

Department of Medicine Faculty Papers

No abstract provided.

Medical Oncology Professionals’ Perceptions Of Telehealth Video Visits, Arianna Heyer, Rachel E. Granberg, Kristin L. Rising, Adam F. Binder, Alexzandra T. Gentsch, Nathan R. Handley

Department of Medical Oncology Faculty Papers

IMPORTANCE: Telehealth has emerged as a means of improving access and reducing cost for medical oncology care; however, use by specialists prior to the coronavirus disease 2019 (COVID-19) pandemic still remained low. Medical oncology professionals’ perceptions of telehealth for cancer care are largely unknown, but are critical to telehealth utilization and expansion efforts.

OBJECTIVE: To identify medical oncology health professionals’ perceptions of the barriers to and benefits of telehealth video visits.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used interviews conducted from October 30, 2019, to March 5, 2020, of medical oncology health professionals at the Thomas Jefferson University Hospital, …