Medical Specialties Commons^™

Kerlan-Jobe Orthopaedic Clinic Overhead Athlete Scores In Asymptomatic Professional Baseball Pitchers., Matthew J Kraeutler, Michael G Ciccotti, Christopher C Dodson, Robert W Frederick, Brian Cammarota, Steven B. Cohen

Rothman Institute Papers

BACKGROUND: The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score is a subjective questionnaire that has been validated and been shown to be more specific in overhead athletes than the American Shoulder and Elbow Surgeons scale. The purpose of this study was to determine a mean KJOC score and reasonable range of KJOC scores within which a healthy asymptomatic professional baseball pitcher will fall. It was hypothesized that healthy professional baseball pitchers would have very high KJOC scores.

MATERIALS AND METHODS: KJOC questionnaires were given to all healthy pitchers before the start of the season at all levels in 1 …

Optimizing Parametrial Aperture Design Utilizing Hdr Brachytherapy Isodose Distribution., Katherine L Chapman, Nitin Ohri, Timothy N Showalter, Laura A Doyle

Department of Radiation Oncology Faculty Papers

Treatment of cervical cancer includes combination of external beam radiation therapy (EBRT) and brachytherapy (BRT). Traditionally, coronal images displaying dose distribution from a ring and tandem (R&T) implant aid in construction of parametrial boost fields. This research aimed to evaluate a method of shaping parametrial fields utilizing contours created from the high-dose-rate (HDR) BRT dose distribution. Eleven patients receiving HDR-BRT via R&T were identified. The BRT and EBRT CT scans were sent to FocalSim (v4.62)(®) and fused based on bony anatomy. The contour of the HDR isodose line was transferred to the EBRT scan. The EBRT scan was sent to …

Clinician-Performed Beside Ultrasound For The Diagnosis Of Traumatic Pneumothorax., Bon S. Ku, Jason M. Fields, Brendan Carr, Worth W Everett, Vincent H Gracias, Anthony J Dean

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Prior studies have reported conflicting results regarding the utility of ultrasound in the diagnosis of traumatic pneumothorax (PTX) because they have used sonologists with extensive experience. This study evaluates the characteristics of ultrasound for PTX for a large cohort of trauma and emergency physicians.

METHODS: This was a prospective, observational study on a convenience sample of patients presenting to a trauma center who had a thoracic ultrasound (TUS) evaluation for PTX performed after the Focused Assessment with Sonography for Trauma exam. Sonologists recorded their findings prior to any other diagnostic studies. The results of TUS were compared to one …

Preparation And Technical Considerations For Percutaneous Cannulation For Veno-Arterial Extracorporeal Membrane Oxygenation., Kathleen Lamb, Hitoshi Hirose, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

BACKGROUND: The most frequent limb complications from peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are limb ischemia and localized bleeding. To minimize these risks, perfusion of the distal limb with peripheral percutaneous cannulation was done.

TECHNIQUE: Percutaneous cannulation with a distal perfusion port was performed in all patients. During the VA-ECMO, distal limb perfusion was monitored using near-infrared spectroscopy to assess tissue oxygenation. At the decannulation, patch angioplasty was performed to prevent the development of narrowing of the artery at the cannulation site.

CONCLUSIONS: Using our standard technique, we have not experienced any limb loss related to ischemia or bleeding.

Assessment Of Early Tumor Response To Cytotoxic Chemotherapy With Dynamic Contrast-Enhanced Ultrasound In Human Breast Cancer Xenografts., Jian-Wei Wang, Wei Zheng, Ji-Bin Liu, Yao Chen, Long-Hui Cao, Rong-Zhen Luo, An-Hua Li, Jian-Hua Zhou

Department of Radiology Faculty Papers

There is a strong need to assess early tumor response to chemotherapy in order to avoid adverse effects from unnecessary chemotherapy and allow early transition to second-line therapy. This study was to quantify tumor perfusion changes with dynamic contrast-enhanced ultrasound (CEUS) in the evaluation of early tumor response to cytotoxic chemotherapy. Sixty nude mice bearing with MCF-7 breast cancer were administrated with either adriamycin or sterile saline. CEUS was performed on days 0, 2, 4 and 6 of the treatment, in which time-signal intensity (SI) curves were obtained from the intratumoral and depth-matched liver parenchyma. Four perfusion parameters including peak …

Meeting The Challenge: Technological Advances In Stroke Rehabilitation, Peggy Seminara Rn, Ne-Bc, Mha, Bernadette R. Anderson Bsn, Rn, Alberto Esquenazi Md

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Roles And Mechanism Of Mir-199a And Mir-125b In Tumor Angiogenesis., Jun He, Yi Jing, Wei Li, Xu Qian, Qing Xu, Feng-Shan Li, Ling-Zhi Liu, Bing-Hua Jiang, Yue Jiang

Computational Medicine Center Faculty Papers

MicroRNAs (miRNAs) have been shown to be involved in different aspects of cancer biology including tumor angiogenesis. In this study, we identified that two miRNAs, miR-199a and miR-125b were downregulated in ovarian cancer tissues and cell lines. Overexpression of miR-199a and miR-125b inhibited tumor-induced angiogenesis associated with the decrease of HIF-1α and VEGF expression in ovarian cancer cells. Moreover, the levels of miR-199a and miR-125b were negatively correlated with VEGF mRNA levels in ovarian tissues. We further showed that direct targets of miR-199a and miR-125b HER2 and HER3 were functionally relevant. Forced expression of HER2 and HER3 rescued miR-199a- and …

A 2-Step Approach To Myeloablative Haploidentical Stem Cell Transplantation With Optimized T-Cell Dosing: Early Immune Reconstitution Leads To Better Outcomes, Sameh Gaballa, Onder Alpdogan, Matthew Carabasi, Joanne Filicko, Margaret Kasner, Ubaldo E. Martinez-Outshoorn, Md, John L Wagner, Mark Weiss, Neal Flomenberg, Delores Grosso

Department of Medical Oncology Faculty Papers

We developed a 2-step approach to myeloablative haploidentical HSCT in which patients receive a large fixed dose of cyclophosphamide (CY)-tolerized T cells separately frm the HSC infusion in the hopes of accelerating post HSCT immune reconstitution (IR). The uniformity of the T cell dosing facilitates comparison of patients without (low risk) and with (high risk) active malignancy at HSCT to ascertain the impact of disease status at HSCT on IR with fewer confounding effects from conditioning or T cell dosing.

Management Of Upper Aerodigestive Tract Bleeding On Extracorporeal Membrane Oxygenation., Hitoshi Hirose, Md, Phd

Department of Surgery Faculty Papers

Introduction: Bleeding complications on extracorporeal membrane oxygenation (ECMO) are often encountered. In a review of our own series, it was found that upper aero digestive tract bleeding was common and management was often difficult. We propose an algorithm to help manage upper aero digestive tract bleeding in the anticoagulated, ECMO patient.

Methods: A retrospective chart review was performed of the patients who underwent veno-venous or veno-arterial ECMO at our institution between July 2010 and July 2012. The patients that had upper aero digestive tract bleeding that required an otolaryngology consultation were identified. They were further investigated to determine location …

Continued Clinic Staff Education, Joseph S. Hong

CwiC-PH

Improving patient care by providing teaching sessions to hospital and clinic staff. The staff include medical assistants, technicians, and front office staff. The desired result would be to create an environment of scientific curiosity and improved understanding, for what the patients are dealing with. Thereby improving empathetic care when interacting with the patient.

Helping Refugees Navigate The Health Care Maze, Jenna Fox, Andy Kay

CwiC-PH

Jenna’s main focus during her Bridging the Gaps assignment at NSC was an outcomes assessment for use in grant applications. Her side projects included client service and education development

Analysis Of Importance Of Implementing Spiritual Assessment And Care Of Patients In Clinical Settings, You Na Park

CwiC-PH

Health professionals need to take care of patients’ spirituality, evaluate various spiritual approaches from both professional and public voices, and address concerns and potential conflicts in meeting the patients’ spiritual needs. There is a number of strategies and solutions to addressing the concerns of spiritual assessments and management of the patients in clinical setting.

Where Are They Now? Understanding How Src Directorship Influences Medical Student Career Trajectories And Outcomes Post-Graduation, Anita Modi,, Ann Vale, James D. Plumb, Md, Mph

CwiC-PH

JeffHOPE, a student-run clinic (SRC) designed to empower and care for Philadelphia's underserved population, was established in 1991 by the students of Jefferson Medical College. Since its inception, the program has been led by over 100 student directors, who oversee each of the five JeffHOPE clinics staffed by fellow medical students every week. But where are the directors now, and how did their leadership experiences caring for the underserved influence their career trajectories? Through the administration of a 20-question survey, we aimed to explore the experiences and accomplishments of medical student directors throughout the 20-year history of JeffHOPE, as well …

Asthma Questionnaire For An Immigrant Chinese Population, Ho-Hin Choy, Whitney Shiau, Md, Audrey Lung Md, Faap

CwiC-PH

Asthma is a key public health problem for the pediatric population of the United States. 7 million children in the United States have been diagnosed with asthma at some point in their lives (1). Asthma remains a disease that occurs in higher rates among minority populations. Those living in inner-city environments are most at risk. A study performed in an inner-city area of Boston, MA showed that 16% of an Asian American school age population had previously diagnosed asthma with an additional 3% having possible undiagnosed asthma (2). Northeast Medical Services (NEMS), a federally qualified community health center (FQHC), serves …

Compliance For Latent Tuberculosis Infection Treatment Among Incoming Refugees At Jefferson Center For Refugee Health, Elizabeth Bates, Marc Altshuler, Md, Kevin Scott, Md

CwiC-PH

80% of active TB cases in the US originate from reactivation of Latent Tuberculosis Infection (LTBI), identifying treatment of LTBI as a public health imperative. All incoming refugees at the Jefferson Center for Refugee Health (JCRH) are screened for LTBI upon arrival. Incidence of LTBI and compliance rates were assessed using a retrospective chart review and analysis of prescription refill records. The study showed 23.1% of incoming refugees were diagnosed with LTBI. Once treatment was initiated, only 33.1% were completed, while 56.2% were lost to follow up. Nepali women showed the highest rates of adherence, while Iraqi women and Burmese …

The Contribution Of Schizophrenia To Homelessness: Analysis Of The Housing First Model And Possible Prevention Of Serious Mental Illness, Elijah Grillo

CwiC-PH

The Problem

• 2.6 million schizophrenics in the US accounting for more inpatient treatment days than any other medical illness (national cost: $62 billion/year).

• 6% (~160,000) are homeless or live in shelters

• Make up 36% of the 700,000 homeless individuals in the US.

Integrated Medical Pluralism To Sustain Health Care In The Indian Trans-Himalayas, Jane Babiarz

CwiC-PH

Inadequate health care delivery in the Indian trans-Himalayas arises from the harsh landscape and climate, poverty, the inaccessibility of health care centers, and a burden of chronic diseases and preventable acute illnesses that exceeds the number of traditional healers in the region. Systematizing a pluralistic healer network that integrates NGOs, international health organizations, mobile camps, district clinics, and traditional healers could address the issue of sustaining health care in this region. The backbone of this strategy would be a pre-existing resource relied upon by public and private health organizations: community health workers.

Supplementary Trainings On Non-Medical Topics For Community Health Workers In Mutsengo, Kenya, Steven Fox

CwiC-PH

• Assessed needs and looked for solutions that are
• Executed and maintained locally Income-generating
• Provided skills trainings to CHWs on these topics
• Help initiate projects using these skills
• These projects show some modest continuing success

The Current State Of Health Care In China, Jonathan Yadlosky

CwiC-PH

After decentralizing health management in the early 1980s, China’s health care system developed many of the problems that we in the United States are currently working to solve. Though China is literally on the other side of the world, I think we might learn a few very important lessons from a close look at their successes, failures, trends, and goals in health care administration and delivery.

Wellbody Alliance, Sierra Leone, Kevin Rurak

CwiC-PH

Pharmacy Project:

Inventory database development

• Streamlined tracking of daily and monthly drug dispensing
• New database to plan requisitions based on trends

Jeffhealth Soil-Transmitted Helminths, David Maniscalco

CwiC-PH

Soil-transmitted helminth (STH) infections are known to be a significant problem in Rwanda. The Ministry of Health and individual villages are aware of its impact on people’s health and well-being as well as its impact on the country’s economy. The goal of the JeffHEALTH project is to educate poor, rural villages in Rwanda so that village members can take the knowledge they gain, put it into practice and share this knowledge with generations to come.

Increasing Human Papillomavirus (Hpv) Vaccination Rate Among Adolescent And Young Adult Males In A Primary Care Setting, Michele Fascelli, Anna Marie Quinn, Amy Leader, Christopher Chambers

CwiC-PH

Study Purpose:

To increase HPV vaccination rates among adolescent males through the use of an informational aid designed to increase knowledge and favorable attitudes about HPV vaccination.

Evaluate the educational aid for feasibility of use in a primary care setting, interest among patients for participating, and increases in intentions to vaccinate among patient and providers.

Inflammatory Biomarker Changes And Their Correlation With Framingham Cardiovascular Risk And Lipid Changes In Antiretroviral-Naive Hiv-Infected Patients Treated For 144 Weeks With Abacavir/Lamivudine/Atazanavir With Or Without Ritonavir In Aries., Benjamin Young, Kathleen E Squires, Lisa L Ross, Lizette Santiago, Louis M Sloan, Henry H Zhao, Brian C Wine, Gary E Pakes, David A Margolis, Mark S Shaefer

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Propensity for developing coronary heart disease (CHD) is linked with Framingham-defined cardiovascular risk factors and elevated inflammatory biomarkers. Cardiovascular risk and inflammatory biomarkers were evaluated in ARIES, a Phase IIIb/IV clinical trial in which 515 antiretroviral-naive HIV-infected subjects initially received abacavir/lamivudine + atazanavir/ritonavir for 36 weeks. Subjects who were virologically suppressed by week 30 were randomized 1:1 at week 36 to either maintain or discontinue ritonavir for an additional 108 weeks. Framingham 10-year CHD risk scores (FRS) and risk category of

Management Of Upper Aerodigestive Tract Bleeding In Patients On Ecmo., Hitoshi Hirose, Md, Phd, Meredith Harrison, Md, Adam I. Baker, Md, Nicholas C. Cavarocchi, Md

Department of Surgery Faculty Papers

Introduction: Bleeding complications on Extracorporeal Membrane Oxygenation (ECMO) are often encountered. In a review of our own series, it was found that upper aero digestive tract bleeding was common and management was often difficult. We propose an algorithm to help manage upper aero digestive tract bleeding in the anticoagulated, ECMO patient. Hypothesis: Once an ECMO patient fails conservative management for upper aero digestive bleeding, more aggressive measures will prove successful, which will provide benefit to the patient. Methods: A retrospective chart review was performed of the patients who underwent venovenous or veno-arterial ECMO at our institution between July 2010 and …

Major Perioperative Morbidity Does Not Affect Long-Term Survival In Patients Undergoing Esophagectomy For Cancer Of The Esophagus Or Gastroesophageal Junction., Brent T Xia, Ernest L Rosato, Karen A Chojnacki, Albert G. Crawford, Benny Weksler, Adam C. Berger

Department of Surgery Faculty Papers

INTRODUCTION: The incidence of cancer of the esophagus/GE junction is dramatically increasing but continues to have a dismal prognosis. Esophagectomy provides the best opportunity for long-term cure but is hampered by increased rates of perioperative morbidity. We reviewed our large institutional experience to evaluate the impact of postoperative complications on the long-term survival of patients undergoing resection for curative intent.

METHODS: We identified 237 patients who underwent esophagogastrectomy, with curative intent, for cancer between 1994 and 2008. Complications were graded using the previously published Clavien scale. Survival was calculated using Kaplan-Meier methodology and survival curves were compared using log-rank tests. …

Distribution Of Dyssynchrony In Subjects With No Known Cardiac Disease And Comparison Of Velocity Vector Imaging To Color-Coded Tissue Doppler Imaging., Anoop C Parameswaran, Bhaskar Purushottam, Aman Amanullah, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Data on the distribution of dyssynchrony in subjects with normal ejection fraction (EF) and normal QRS are scarce. We studied 100 subjects with no known cardiac disease (52% male, mean age 60 ± 17 years) using velocity vector imaging (VVI). Seventeen percent had septal to lateral (S-L) wall longitudinal delay >75 msec, 63% of subjects had S-L wall radial delay >75 msec, and 25% had a circumferential opposing wall delay >100 msec. Those with circumferential opposing wall delay of >100 msec had a lower EF (57 ± 5% vs. 62 ± 5%, P < 0.05). In an additional group of 33 patients, we compared the longitudinal dyssynchrony parameters as assessed by VVI and tissue Doppler imaging (TDI) and found them to be comparable. In conclusion, we find significant variation in time to peak velocities in subjects with no known cardiac disease, who had a normal left ventricular ejection fraction and QRS duration. VVI is comparable to TDI.

Assessment Of Nutritional Adequacy In Patients On Extracorporeal Membrane Oxygenation., Hitoshi Hirose, Md, Phd, Joseph Miessau, Pa-C, Evanthia Foliou, Rd, Pawel Karbowski, Pa-C, Ms, Melanie K. Sion, Md, Christine Feldmeier, Md

Department of Surgery Faculty Papers

Introduction: Nutrition is a key element of recovery from the state of critical illness. Little is known about nutritional adequacy in patients supported on extracorporeal membrane oxygenation (ECMO) for severe cardio-respiratory dysfunction. A study was performed whether or not early nutrition support improve outcomes of the patients on ECMO.

Methods: A retrospective IRB approved review was conducted of all patients supported on ECMO from 7/10 to 6/12. The patients were divided into 2 groups, survivors and non-survivors. Age, sex, preoperative comorbidities, type and duration of ECMO, day to initiation and goal feeding, caloric intake, weekly biomarkers (pre-albumin, albumin, …

Endoscopic Ultrasonic Dacryocystorhinostomy For Recurrent Dacryocystitis Following Rhinoplasty, Nadia Mostovych, Md, Mindy R. Rabinowitz, Md, Edmund A. Pribitkin, Md, Jurij R. Bilyk, Md

Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds

Abstract:

The lacrimal sac is the structure most vulnerable to injury when performing osteotomies for rhinoplasty. When performed in a low lateral position or along the frontal process of the frontal-maxillary suture, osteotomies have the potential to tear the medial canthal ligament and injure the underlying lacrimal sac resulting in dacryocystitis. We report a case of dacryocystitis in a 19 year old male who presented with recurrent episodes of pain, tearing, and discharge from his left eye following primary rhinoplasty. He was found to have obstruction of the lacrimal system secondary to a low lateral osteotomy with an impinging bone …

What's New In Adult Reconstructive Knee Surgery., Carl A Deirmengian, Jess H Lonner

Rothman Institute Papers

No abstract provided.

Acetabular Components In Total Hip Arthroplasty: Is There Evidence That Cementless Fixation Is Better?, Nader Toossi, Bahar Adeli, Andrew J Timperley, Fares S Haddad, Mitchell Maltenfort, Javad Parvizi

Rothman Institute Papers

BACKGROUND: The use of cementless acetabular components in total hip arthroplasty has gained popularity over the past decade. Most total hip arthroplasties being performed in North America currently use cementless acetabular components. The objective of this systematic review and meta-analysis was to compare the survivorship and revision rate of cemented and cementless acetabular components utilized in total hip arthroplasty.

METHODS: A primary literature search in PubMed identified 3488 articles, of which 3407 did not meet the inclusion criteria and were excluded. Only English-language articles on either the survivorship or revision rate of primary total hip arthroplasty at a minimum of …