Medical Specialties Commons^™

Induction Techniques That Reduce Redistribution Hypothermia: A Prospective, Randomized, Controlled, Single Blind Effectiveness Study., Jonathan V. Roth, Leonard E. Braitman, Lacy H. Hunt

Student Papers, Posters & Projects

BACKGROUND: While much effort has been devoted to correcting intraoperative hypothermia, less attention has been directed to preventing redistribution hypothermia. In this study, we compared three different anesthetic induction techniques to standard IV propofol inductions (control) in their effect on reducing redistribution hypothermia.

METHODS: Elective, afebrile patients, age 18 to 55 years, were randomly assigned to one of four groups (n = 50 each). Group "INH/100" was induced with 8% sevoflurane in 100% oxygen, Group "INH/50" with 8% sevoflurane in 50% oxygen and 50% nitrous oxide, Group "PROP" with 2.2 mg/kg propofol, and Group "Phnl/PROP" with 2.2 mg/kg propofol immediately …

Progression-Free But No Overall Survival Benefit For Adult Patients With Bevacizumab Therapy For The Treatment Of Newly Diagnosed Glioblastoma: A Systematic Review And Meta-Analysis., Nagham Kaka, Karim Hafazalla, Haider Samawi, Andrew Simpkin, James Perry, Arjun Sahgal, Sunit Das

Department of Neurosurgery Faculty Papers

Glioblastoma (GBM) is the most common high-grade primary brain tumor in adults. Standard multi-modality treatment of glioblastoma with surgery, temozolomide chemotherapy, and radiation results in transient tumor control but inevitably gives way to disease progression. The need for additional therapeutic avenues for patients with GBM led to interest in anti-angiogenic therapies, and in particular, bevacizumab. We sought to determine the efficacy of bevacizumab as a treatment for newly diagnosed GBM. We conducted a literature search using the PubMed database and Google Scholar to identify randomized controlled trials (RCTs) since 2014 investigating the safety and efficacy of bevacizumab in the treatment …

Pediatric Moyamoya Presenting As A Subarachnoid Hemorrhage From A Ruptured Anterior Cerebral Artery Aneurysm., Mohammad Hassan A. Noureldine, Ibrahim Saikali, Anis Nassif, Rita Chahinian, Ahmad Sweid, Raghid Kikano, Michel Mawad

Department of Neurosurgery Faculty Papers

BACKGROUND: The incidence of Moyamoya disease (MMD)-associated intracranial aneurysms ranges from 3% to 14% in adult patients, whereas this complication has rarely been reported in children.

CASE DESCRIPTION: We herein report the first case, to our knowledge, of an extremely rare subarachnoid hemorrhage presentation of a child with a ruptured anterior cerebral artery dissecting aneurysm secondary to a newly discovered, unilateral Moyamoya-like pathology.

CONCLUSIONS: MMD-associated aneurysms are extremely rare in children, and hemorrhage may be the initial presentation of the disease. Prompt intervention is essential to exclude the ruptured aneurysm that is at risk of rebleeding because of persistent hemodynamic …

Why Medical (And Dermatologic) Practice Has Become So Convoluted: The Complexity/Convolutional/Obfuscatory Kleptocracies., W. Clark Lambert, Jennifer L. Parish, Lawrence Charles Parish, Shreya Patel, Loka Thangamathesvaran, Amer Ali Almosshen

Department of Dermatology and Cutaneous Biology Faculty Papers

Consider dermatology (or medical) practice from the aspect of those who manage, and seek to glean a profit from, medical management corporations, including but not limited to third party payers. Although much of the complexity burden thrust upon doctors’ offices is borne by the offices and doctors, there is also much that is borne by the companies, and the entire process appears to make no sense whatsoever. How can the business professionals who run these outfits make such blunders? Let us approach this question by examining another industry: fast food franchising.

Hyperthermia And Immunotherapy: Clinical Opportunities., Mark D Hurwitz

Department of Radiation Oncology Faculty Papers

Hyperthermia holds great promise to advance immunotherapy in the treatment of cancer. Multiple trials have demonstrated benefit with the addition of hyperthermia to radiation or chemotherapy in the treatment of wide-ranging malignancies. Similarly, pre-clinical studies have demonstrated the ability of hyperthermia to enhance each of the 8 steps in the cancer-immunotherapy cycle including stimulation of tumor-specific immunity. While there has been an extensive recent focus on augmenting immunotherapy with radiation, surprisingly to date, there have been no clinical trials assessing the combination of hyperthermia with immunotherapy. The study of hyperthermia with immunotherapy is particularly compelling when considered in the context …

False In Name Only-Gastroduodenal Artery Pseudoaneurysm In A Recurrently Bleeding Patient: Case Report And Literature Review., M. Binetti, A. Lauro, R. Golfieri, S Vaccari, V D'Andrea, I. R. Marino, M. Cervellera, M. Renzulli, V. Tonini

Department of Surgery Faculty Papers

INTRODUCTION: Although the diagnosis of visceral pseudoaneurysm is unusual, it requires emergent attention due to the risk of rupture. We describe a 70-year old man with a gastroduodenal artery (GDA) pseudoaneurysm manifest as recurrent hæmorrhage.

AREAS COVERED: We highlight the possible ætiologies, clinical presentations, diagnostic tools and treatment options for this condition. In this instance, the patient was successfully treated by selective angio-embolization.

EXPERT COMMENTARY: A visceral pseudoaneurysm should be considered in patients with abdominal pain and GI hæmorrhage. At present, angio-embolization is first-line therapy.

A Physiologically-Based Pharmacokinetic Model For Targeting Calcitriol-Conjugated Quantum Dots To Inflammatory Breast Cancer Cells., James Forder, Mallory Smith, Margot Wagner, Rachel J. Schaefer, Jonathan Gorky, Kenneth L. Van Golen, Anja Nohe, Prasad Dhurjati

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Quantum dots (QDs) conjugated with 1,25 dihydroxyvitamin D3 (calcitriol) and Mucin-1 (MUC-1) antibodies (SM3) have been found to target inflammatory breast cancer (IBC) tumors and reduce proliferation, migration, and differentiation of these tumors in mice. A physiologically-based pharmacokinetic model has been constructed and optimized to match experimental data for multiple QDs: control QDs, QDs conjugated with calcitriol, and QDs conjugated with both calcitriol and SM3 MUC1 antibodies. The model predicts continuous QD concentration for key tissues in mice distinguished by IBC stage (healthy, early-stage, and late-stage). Experimental and clinical efforts in QD treatment of IBC can be augmented by in …

Hypotrichosis With Juvenile Macular Dystrophy: Combination Of Whole-Genome Sequencing And Genome-Wide Homozygosity Mapping Identifies A Large Deletion In Cdh3 Initially Undetected By Whole-Exome Sequencing-A Lesson From Next-Generation Sequencing., Amir Hossein Saeidian, Hassan Vahidnezhad, Leila Youssefian, Soheila Sotudeh, Meisam Sargazi, Sirous Zeinali, Jouni Uitto

Department of Dermatology and Cutaneous Biology Faculty Papers

BACKGROUND: Hypotrichosis with juvenile macular dystrophy (HJMD) is an autosomal recessive disorder characterized by abnormal growth of scalp hair and juvenile macular degeneration leading to blindness. We have explored the genetic basis of HJMD in a large consanguineous family with 12 affected patients, 1-76 years of age, with characteristic phenotypes.

METHODS: We first applied genome-wide homozygosity mapping to 10 affected individuals for linkage analysis to identify the genomic region of the defective gene. All affected individuals shared a 7.2 Mb region of homozygosity on chromosome 16q21-22.3, which harbored 298 genes, including CDH3, previously associated with HJMD. However, whole-exome sequencing (WES) …

Gilteritinib Or Chemotherapy For Relapsed Or Refractory Flt3-Mutated Aml, Alexander E. Perl, Giovanni Martinelli, Jorge E. Cortes, Andreas Neubauer, Ellin Berman, Stefania Paolini, Pau Montesinos, Maria R. Baer, Richard A. Larson, Celalettin Ustun, Francesco Fabbiano, Harry P. Erba, Antonio Di Stasi, Robert Stuart, Rebecca Olin, Margaret Kasner, Fabio Ciceri, Wen-Chien Chou, Nikolai Podoltsev, Christian Recher, Hisayuki Yokoyama, Naoko Hosono, Sung-Soo Yoon, Je-Hwan Lee, Timothy Pardee, Amir T. Fathi, Chaofeng Liu, Nahla Hasabou, Xuan Liu, Erkut Bahceci, Mark J. Levis

Department of Medical Oncology Faculty Papers

BACKGROUND: Patients with relapsed or refractory acute myeloid leukemia (AML) with mutations in the FMS-like tyrosine kinase 3 gene (FLT3) infrequently have a response to salvage chemotherapy. Gilteritinib is an oral, potent, selective FLT3 inhibitor with single-agent activity in relapsed or refractory FLT3-mutated AML.

METHODS: In a phase 3 trial, we randomly assigned adults with relapsed or refractory FLT3-mutated AML in a 2:1 ratio to receive either gilteritinib (at a dose of 120 mg per day) or salvage chemotherapy. The two primary end points were overall survival and the percentage of patients who had complete remission …

Worldwide Inequality In Access To Full Text Scientific Articles: The Example Of Ophthalmology., Christophe Boudry, Patricio Alvarez-Muñoz, Ricardo Arencibia-Jorge, Didier Ayena, Niels J Brouwer, Zia Chaudhuri, Brenda Chawner, Emilienne Epee, Khalil Erraïs, Akbar Fotouhi, Almutez M Gharaibeh, Dina H Hassanein, Martina C Herwig-Carl, Katherine Howard, Dieudonne Kaimbo Wa Kaimbo, Patricia-Ann Laughrea, Fernando A Lopez, Juan D Machin-Mastromatteo, Fernando K Malerbi, Papa Amadou Ndiaye, Nina A Noor, Josmel Pacheco-Mendoza, Vasilios P Papastefanou, Mufarriq Shah, Carol L Shields, Ya Xing Wang, Vasily Yartsev, Frederic Mouriaux

Wills Eye Hospital Papers

Background: The problem of access to medical information, particularly in low-income countries, has been under discussion for many years. Although a number of developments have occurred in the last decade (e.g., the open access (OA) movement and the website Sci-Hub), everyone agrees that these difficulties still persist very widely, mainly due to the fact that paywalls still limit access to approximately 75% of scholarly documents. In this study, we compare the accessibility of recent full text articles in the field of ophthalmology in 27 established institutions located worldwide.

Methods: A total of 200 references from articles were retrieved using the …

Case-Based Asynchronous Interactive Modules In Undergraduate Medical Education., Tatiana Villatoro, Katherine Lackritz, Joanna S Y Chan

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Undergraduate medical education traditionally consists of 2 years of lecture-based courses followed by 2 years of clinical clerkships. However, over the past couple decades, undergraduate medical education has been evolving toward non-lecture-based integrated curriculums, requiring a collaborative curriculum. Additionally, e-learning platforms have become efficacious and essential to delivering education asynchronously to students. At Thomas Jefferson University, the Pathology and Obstetrics and Gynecology departments collaborated to create a pilot series of case-based asynchronous interactive modules to teach gynecologic pathology in a clinical context, while interweaving other educational components, such as evidence-based medicine, clinical skills, and basic sciences. The case-based asynchronous interactive …

Nucleus Pulposus Primary Cilia Alter Their Length In Response To Changes In Extracellular Osmolarity But Do Not Control Tonebp-Mediated Osmoregulation., Hyowon Choi, Vedavathi Madhu, Irving M. Shapiro, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

The nucleus pulposus (NP) cells adapt to their physiologically hyperosmotic microenvironment through Tonicity-responsive enhancer binding protein (TonEBP/nuclear factor of activated T-cell5 [NFAT5])-mediated osmoregulation. Primary cilia in different organs serve diverse roles including osmosensing, but its contribution to NP cell osmoadaptive response is unknown. A high percentage of cultured primary NP cells possessed primary cilia that changed length in response to osmotic stimuli. Stable silencing of Intraflagellar Transport 88 (Ift88) or Kinesin Family Member 3 A (Kif3a) to inhibit the formation of primary cilia did not affect hyperosmotic upregulation of TonEBP. While ShKif3a blocked hyperosmotic increase of TonEBP-Transactivation Domain (TAD) activity, …

Dysregulation Of Mitochondrial Ca2+ Uptake And Sarcolemma Repair Underlie Muscle Weakness And Wasting In Patients And Mice Lacking Micu1, Valentina Debattisti, Adam Horn, Raghavendra Singh, Erin L. Seifert, Marshall W. Hogarth, Davi A. Mazala, Kai Ting Huang, Rita Horvath, Jyoti K. Jaiswal, György Hajnóczky

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Muscle function is regulated by Ca²⁺, which mediates excitation-contraction coupling, energy metabolism, adaptation to exercise, and sarcolemmal repair. Several of these actions rely on Ca²⁺ delivery to the mitochondrial matrix via the mitochondrial Ca²⁺ uniporter, the pore of which is formed by mitochondrial calcium uniporter (MCU). MCU's gatekeeping and cooperative activation are controlled by MICU1. Loss-of-protein mutation in MICU1 causes a neuromuscular disease. To determine the mechanisms underlying the muscle impairments, we used MICU1 patient cells and skeletal muscle-specific MICU1 knockout mice. Both these models show a lower threshold for MCU-mediated Ca²⁺ uptake. Lack of …

Poem Perceptions: A Survey Of Gastroenterologists And The Treatment Of Achalasia In The Philadelphia Region, Rebecca Loh, Md, Alexander Schlachterman, Md

Department of Medicine Posters

Introduction

Peroral endoscopic myotomy (POEM) is a relatively new innovate technique that has been shown to be an effective treatment for achalasia. Despite studies demonstrating its effectiveness as a less invasive therapy, POEM is still not as widely implemented as the traditional Heller myotomy for the treatment of achalasia. We aimed to explore the barriers that may impact implementation of POEM and to assess the regional perception of POEM amongst gastroenterologists in an urban setting.

The Utility Of Impedance Cardiography In Hemodynamic Monitoring Of Patients With Sepsis, James Butz, Yizhi Shan, Andres Samayoa, Orlando C. Kirton, Thai Vu

Abington Jefferson Health Papers

BACKGROUND: Commonly used biochemical indicators and hemodynamic and physiologic parameters of sepsis vary with regard to their sensitivity and specificity to the diagnosis. The aim of this preliminary study was to evaluate non-invasive impedance cardiography as a monitoring tool of the hemodynamic status of patients with sepsis throughout their initial volume resuscitation to explore the possibility of identifying additional measurements to be used in the future treatment of sepsis.

METHODS: Nine patients who presented to the emergency room and received a surgical consultation during a 3-month period in 2016, meeting the clinical criteria of sepsis defined by systemic inflammatory response …

Effect Of Nutritional Intervention On Patients With Gastroparesis, Emily Rubin, Rd, Melissa Viscuso, Rd, Kamal Amer, Md, Joseph Yoo, Md, Anthony Dimarino, Md, Stephanie Moleski, Md

Division of Gastroenterology and Hepatology Posters

Study Aims

• Utilize the PAGI-SYM survey as an assessment tool in following clinical symptoms of patients with GP.
• Determine if a formal consultation with a Registered Dietitian (RD) provided benefit to patients documented gastroparesis.

Post-Stroke Recrudescence In The Setting Of Tramadol Overuse: A Case Report, Richard S. Zhang, Bs, Benjamin Larson, Md

Student Papers, Posters & Projects

This report promotes greater awareness of opioid-induced PSR, especially considering the tragic opioid crisis that has afflicted the US since the 1990s, and the contribution of synthetic prescription opioids to the crisis. This report also supports the establishment of care guidelines to limit PSR risk in people with major risk factors, such as MCA infarcts.

Case 22-2019: A 65-Year-Old Woman With Myopathy., Marinos C. Dalakas

Department of Neurology Faculty Papers

No abstract provided.

Identifying Emergency Department Symptom-Based Diagnoses With The Unified Medical Language System., Benjamin H. Slovis, Danielle M. Mccarthy, Garrison Nord, Amanda Doty, Katherine Piserchia, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Many patients who are discharged from the emergency department (ED) with a symptom-based discharge diagnosis (SBD) have post-discharge challenges related to lack of a definitive discharge diagnosis and follow-up plan. There is no well-defined method for identifying patients with a SBD without individual chart review. We describe a method for automated identification of SBDs from ICD-10 codes using the Unified Medical Language System (UMLS) Metathesaurus.

METHODS: We mapped discharge diagnosis, with use of ICD-10 codes from a one-month period of ED discharges at an urban, academic ED to UMLS concepts and semantic types. Two physician reviewers independently manually identified …

Perturbed Mitochondria-Er Contacts In Live Neurons That Model The Amyloid Pathology Of Alzheimer's Disease., Pamela V. Martino Adami, Zuzana Nichtova, David B. Weaver, Adam Bartok Dr., Thomas Wisniewski, Drew R. Jones, Sonia Do Carmo, Eduardo M. Castaño, A. Claudio Cuello, György Hajnóczky, Laura Morelli

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The use of fixed fibroblasts from familial and sporadic Alzheimer's disease patients has previously indicated an upregulation of mitochondria-ER contacts (MERCs) as a hallmark of Alzheimer's disease. Despite its potential significance, the relevance of these results is limited because they were not extended to live neurons. Here we performed a dynamic in vivo analysis of MERCs in hippocampal neurons from McGill-R-Thy1-APP transgenic rats, a model of Alzheimer's disease-like amyloid pathology. Live FRET imaging of neurons from transgenic rats revealed perturbed 'lipid-MERCs' (gap width <10 nm), while 'Ca2+-MERCs' (10-20 nm gap width) were unchanged. In situ TEM showed no significant differences in the lipid-MERCs:total MERCs or lipid-MERCs:mitochondria ratios; however, the average length of lipid-MERCs was significantly decreased in neurons from transgenic rats as compared to controls. In accordance with FRET results, untargeted lipidomics showed significant decreases in levels of 12 lipids and bioenergetic analysis revealed respiratory dysfunction of mitochondria from transgenic rats. Thus, our results reveal changes in MERC structures coupled with impaired mitochondrial functions in Alzheimer's disease-related neurons.This article has an associated First Person interview with the first author of the paper.

Maternal Characteristics Affect Fetal Growth Response In The Women First Preconception Nutrition Trial., K Michael Hambidge, Carla M Bann, Elizabeth M Mcclure, Jamie E Westcott, Ana Garcés, Lester Figueroa, Shivaprasad S Goudar, Sangappa M Dhaded, Omrana Pasha, Sumera A Ali, Richard J Derman, Robert L Goldenberg, Marion Koso-Thomas, Manjunath S Somannavar, Veena Herekar, Umber Khan, Nancy F Krebs

Global Health Articles

The objective of this secondary analysis was to identify maternal characteristics that modified the effect of maternal supplements on newborn size. Participants included 1465 maternal-newborn dyads in Guatemala, India, and Pakistan. Supplementation commenced before conception (Arm 1) or late 1st trimester (Arm 2); Arm 3 received usual care. Characteristics included body mass index (BMI), stature, anemia, age, education, socio-economic status (SES), parity, and newborn sex. Newborn outcomes were z-scores for length (LAZ), weight (WAZ), and weight to length ratio-for-age (WLRAZ). Mixed-effect regression models included treatment arm, effect modifier, and arm * effect modifier interaction as predictors, controlling for site, …

Does Perioperative Use Of Renin-Angiotensin System Inhibitors Improve Patient Outcomes In Cardiac Surgery?, Qian Ding, Mark Berguson, Zugui Zhang, Hong Liu, Huang Nie, Jordan E. Goldhammer, Rohinton J. Morris, Jianzhong Sun

Department of Anesthesiology Posters

• 2011 ACCF/AHA Guidelines for CABG: Uncertain about the safety of the preoperative administration of ACE inhibitors or ARBs in patients on chronic therapy and the safety of initiating ACE inhibitors or ARBs before hospital discharge
• 2014 ESC Guidelines: ACE inhibitors might be stopped 1 to 2 days before CABG to avoid the potential deleterious consequences of perioperative hypotension
• Guidelines state that ACE inhibitors or ARBs should be initiated postoperatively in CABG patients who were not receiving them preoperatively if they have an LVEF ≤40%, hypertension, diabetes, or CKD (Level of Evidence: A)
• There is still a lack of large clinical …

Heat Shock Factor 1-Mediated Transcription Activation Of Omi/Htra2 Induces Myocardial Mitochondrial Apoptosis In The Aging Heart., Dan Liu, Linguo Wu, Ye Wu, Xin Wei, Wen Wang, Suli Zhang, Ming Yi, Jing Li, Huirong Liu, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

BACKGROUND: Increased cardiac apoptosis is a hallmark of the elderly, which in turn increases the risk for developing cardiac disease. The overexpression of Omi/HtrA2 mRNA and protein contributes to apoptosis in the aged heart. Heat shock factor 1 (HSF1) is a transcription factor that binds to the promoter of Omi/HtrA2 in the aging myocardium. However, whether HSF1 participates in cardiomyocyte apoptosis via transcriptional regulation of Omi/HtrA2 remains unclear. The present study was designed to investigate whether HSF1 plays a role in Omi/HtrA2 transcriptional regulation and myocardial apoptosis.

METHODS AND RESULTS: Assessment of the hearts of mice of different ages was …

Comparison Of Mri- And Trus-Informed Prostate Biopsy For Prostate Cancer Diagnosis In Biopsy-Naive Men: A Systematic Review And Meta-Analysis., Hanan Goldberg, Ardalan E. Ahmad, Thenappan Chandrasekar, Laurence Klotz, Mark Emberton, Masoom A. Haider, Samir S. Taneja, Karan Arora, Neil Fleshner, Antonio Finelli, Nathan Perlis, Mark D. Tyson, Zachary Klaassen, Christopher J.D. Wallis

Department of Urology Faculty Papers

PURPOSE: Multiparametric magnetic resonance imaging (mpMRI) with informed targeted biopsies (TGBX) has changed the paradigm of prostate cancer (PCa) diagnosis. Randomized studies have demonstrated a diagnostic benefit of Clinically significant (CS) for TGBX compared to standard systematic biopsies (SBX). We aimed to evaluate whether mpMRI-informed TGBX has superior diagnosis rates of any-, CS-, high-grade (HG)-, and clinically insignificant (CI)-PCa compared to SBX in biopsy-naive men.

METHODS: Data was searched in Medline, Embase, Web of Science, and Evidence-based medicine reviews-Cochrane Database of systematic reviews from database inception until 2019. Studies were selected by two authors independently, with disagreements resolved by consensus …

Incorporating Mpmri Biopsy Data Into Established Pre-Rp Nomograms: Potential Impact Of An Increasingly Common Clinical Scenario, Joon Yau Leong, Jaime O. Herrera-Caceres, Hanan Goldberg, Elwin Tham, Seth Teplitsky, Leonard G. Gomella, Neil E. Fleshner, Costas D. Lallas, Edouard J. Trabulsi, Thenappan Chandrasekar

Department of Urology Faculty Papers

Background: We examine the practical application of multiparametric MRI (mpMRI) prostate biopsy data using established pre-RP nomograms and its potential implications on RP intraoperative decision-making. We hypothesize that current nomograms are suboptimal in predicting outcomes with mpMRI targeted biopsy (TBx) data.

Materials and methods: Patients who underwent mpMRI-based TBx prior to RP were assessed using the MSKCC and Briganti nomograms with the following iterations: (1) Targeted (T) (targeted only), (2) Targeted and Systematic (TS) and (3) Targeted Augmented (TA) (targeted core data; assumed negative systematic cores for 12 total cores). Nomogram outcomes, lymph node involvement (LNI), extracapsular extension (ECE), organ-confined …

Mindfulness Based Stress Reduction Increases Pathology Resident Self Wellness, Kaitlin Collura, Md, Phd, Joanna Chan, Md

Department of Pathology, Anatomy, and Cell Biology Posters

Stress during medical residency is a common, complex issue influenced by time demands, level of social support, and environmental factors. Increased stress levels can lead to resident burnout, and may contribute to the high rates of depression and suicide seen among physicians. In 2015, the ACGME began a campaign to promote resident wellness by calling on programs to implement strategies to develop resiliency, identify problems, and promote wellbeing. Mindfulness based stress reduction (MBSR) strategies have been shown to decrease burnout, improve mood, and increase compassion in healthcare providers. We implemented a wellness retreat to educate residents on the principles of …

Wellness Initiative Program And Effect On Pathology Resident Burnout Rate, Kaitlin Collura, Md, Phd, Michelle Nagurney, Md, Joanna Chan, Md

Department of Pathology, Anatomy, and Cell Biology Posters

Increasing rates of physician burnout are reported across many medical specialties, including Pathology. In 2014, 52.5% of pathologists experienced symptoms of burnout compared to 37.6% in 2011. Suicide and depression rates in physicians are also higher than the average population. As a result, the ACGME began a campaign, in 2015, to foster resident wellness. The campaign calls for strategies to develop resiliency, identify problems, and promote well-being. While wellness initiatives may not change underlying mental illness, they may mitigate environmental factors that can exacerbate mental illness or suicidal behavior. Here we report results from a recently implemented resident wellness initiative …

Targeted Epidural Blood Patches Under Fluoroscopic Guidance For Incidental Durotomies Related To Spine Surgeries: A Case Series., Andrew K. Wong, Mohammad Rasouli, Andrew Ng, Dajie Wang

Department of Anesthesiology Faculty Papers

Introduction: Incidental durotomies are usually managed conservatively. However, 1.8% of patients require surgical dural repair for CSF leak. There are limited data available regarding the use of epidural blood patches (EBP) for persistent CSF leaks secondary to incidental durotomies. This case series aims to evaluate the efficacy of targeted EBPs under fluoroscopic guidance in the treatment of incidental durotomies.

Methods: Four patients with incidental durotomies after spine surgeries (one cervical decompression, one revision of L5-S1 decompression and fusion, and two lumbar decompressions) were included in this series. These patients did not respond to conservative management and subsequently underwent EBPs. Magnetic …

Twitter And Academic Urology In The United States And Canada: A Comprehensive Assessment Of The Twitter-Verse In 2019., Thenappan Chandrasekar, Hanan Goldberg, Zachary Klaassen, Christopher J. Wallis, Joon Yau Leong, Spencer Liem, Seth Teplitsky, Rodrigo Noorani, Stacy Loeb

Department of Urology Faculty Papers

OBJECTIVE: To provide the first comprehensive analysis of the Twitter-verse amongst academic urologists and programs in North America.

METHODS: Using national accreditation and individual program websites, all active urology residency programs (USA & Canada) and academic Urology faculty at these programs were identified. Demographic data for each program (AUA section, resident class size) and physician (title, fellowship training, Scopus H-index and citations) were documented. Twitter metrics (Twitter handle, date joined, # tweets, # followers, # following, likes) for programs and physicians were catalogued (data capture: March-April 2019). Descriptive analyses and temporal trends in Twitter utilization amongst programs and physician were …

Recovery Priorities In Degenerative Cervical Myelopathy: A Cross-Sectional Survey Of An International, Online Community Of Patients., Benjamin Davies, Oliver Mowforth, Iwan Sadler, Bizhan Aarabi, Brian Kwon, Shekar Kurpad, James S Harrop, Jefferson R Wilson, Robert Grossman, Michael G Fehlings, Mark Kotter

Department of Neurosurgery Faculty Papers

OBJECTIVES: To establish the recovery priorities of individuals suffering with degenerative cervical myelopathy (DCM).

DESIGN: A cross-sectional, observational study.

SETTING: Patients from across the world with a diagnosis of DCM accessed the survey over an 18-month period on Myelopathy.org, an international myelopathy charity.

PARTICIPANTS: 481 individuals suffering from DCM completed the online survey fully.

MAIN OUTCOME MEASURES: Functional recovery domains were established through qualitative interviews and a consensus process. Individuals were asked about their disease characteristics, including limb pain (Visual Analogue Scale) and functional disability (patient-derived version of the modified Japanese Orthopaedic Association score). Individuals ranked recovery domains (arm and …