Medical Specialties Commons^™

Implementation Of Standardized Discharge Instructions, Caitlin Hodge, Md, Quyngdiem Lam, Md, Luis A. Mejia, Md, Orlando C. Kirton, Md, Facs, Mccm, Fccp, Mba, Robert Josloff, Md, Kristin Noonan, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Introduction

Previously, same-day surgical discharge instructions were handwritten by residents on generic fill-in-the-blank forms leading to inconsistent discharge instructions. Residents started an initiative to create these standardized discharge instructions. These instructions were designed to improve documentation for post-operative instructions as well as enhance overall patient safety in an attempt to eliminate miscommunications with patients.

Improving Screening For Diabetic Retinopathy In An Ambulatory Resident Clinic, R. Benson Jones, Guy Katz, Jon Zaid, Navdeep Sangha, Rebecca Davis

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Introduction

While 60% of Americans with diabetes are screened for diabetic retinopathy, the residents in the Jefferson Internal Medicine Associates (JIMA) ambulatory clinic had a lower screening rate (roughly 50%).(1) Our project aimed to increase that screening rate.

Scanning For Qi: Resident And Sonographer Driven Improvement Of Radiology Resident Ultrasound Technique, Brian Blumhof, Md, Corinne Wessner, Bs, Rdms, Rvt, Kristen Mcclure, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objective

The aim of this structural QI project is to improve the educational ultrasound curriculum , thus improving overall resident confidence and technical ability in acquiring diagnostic quality sonographic images.

Comparing resident confidence levels and performance against their initial benchmarks as well as against yearly cohorts, we plan to create a long standing addition to the radiology residency at Jefferson, with plans to include additional ultrasound examinations as the curriculum becomes more robust.

Stakeholders include not only the radiology residency, which would benefit from improved resident education and knowledge, but also the hospital and ultimately patients, who stand to benefit …

Getting Rid Of Stupid Stuff (Gross) Committee: Residents Dedicated To Streamlining Epic-Related Workflow, Nkosi H. Alvarez, Md, Christina L. Jacovides, Md, Brian M. Till, Md, Walker Lyons, Md, Keyur Patel, Md, Richard Zheng, Md, Adam Johnson, Md, John Kairys, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

• Identify specific mechanisms for submitting and implementing improvements to the Epic environment
• Standardize high-use order sets
• Incorporate high-value modular components into existing order sets
• Create new order sets to streamline resident workflows
• Improve communication between stakeholders

Optimizing Resident Clinic Efficiency Through Process Flow Analysis, Michael Abendroth, Md, Mba, Saumya Copparam, Md, Qiang Zhang, Phd, Rose Costello, Ma, Tara Uhler, Md, Robert Bailey, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Abstract

Introduction: Clinic process inefficiencies cause lengthy visit and wait times, which frustrate patients and providers and limit clinic capacity

Objective: To identify process inefficiencies and assess process flow interventions

Methods: Prospective, consecutive series of resident clinic visits over a 3-week period after transferring refraction from tech to resident. Personnel recorded the time spent waiting for and undergoing each clinic process. The clinic also piloted a “Fast Track” from registration to resident for appropriate established patients.

Results: Patients spent 53% of the visit waiting, primarily for the tech. Transferring refraction from tech to resident decreased the wait for tech …

Reducing Double Chest Ct And Unnecesary Radiation: A Quality Improvement Project, Stephan S. Leung, Md, Mansi R. Parekh, Md, Achala Donuru, Md, Paras C. Lakhani, Md, Christopher G. Roth, Md, Baskaran Sundaram, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

To analyze the variables resulting in double chest CTs being ordered and performed, with the aim to reduce the amount of ordered double chest CTs at Thomas Jefferson University Hospital.

Getting To The Source: Safety Findings In Cervical Cancer Screening Using External Lab Databases, Miranda Aragon, Md, Sunny Lai, Md, Mph, Geoffrey Mills, Md, Phd

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objective

To investigate the feasibility of using external lab databases to locate Pap smear results completed at outside clinics.

Generation Of Oligodendrocyte Progenitor Cells From Mouse Bone Marrow Cells., Yuan Zhang, Xin-Yu Lu, Giacomo Casella, Jing Tian, Ze-Qing Ye, Ting Yang, Juan-Juan Han, Ling-Yu Jia, A. M. Rostami, Xing Li

Department of Neurology Faculty Papers

Oligodendrocyte progenitor cells (OPCs) are a subtype of glial cells responsible for myelin regeneration. Oligodendrocytes (OLGs) originate from OPCs and are the myelinating cells in the central nervous system (CNS). OLGs play an important role in the context of lesions in which myelin loss occurs. Even though many protocols for isolating OPCs have been published, their cellular yield remains a limit for clinical application. The protocol proposed here is novel and has practical value; in fact, OPCs can be generated from a source of autologous cells without gene manipulation. Our method represents a rapid, and high-efficiency differentiation protocol for generating …

Quality Improvement: Enhancing Provider Screening Of Adolescent Substance Use With Crafft Questionnaire, Julia C. Durante Md, Emily Pollack Md, Richard J. Mazzaccaro Md, Phd, Rosa Gomez-Dejesus Md

Department of Pediatrics

No abstract provided.

Price Variance For Malaria Prophylaxis Among Northeastern Us Pharmacies, Marcelo Gareca Md, Mark Knouse Md

Department of Medicine

No abstract provided.

Using Entrustable Professional Activities To Improve Pediatric Residency Evaluations, Kelli N. Harajda Md, Kris Rooney Md

Department of Pediatrics

No abstract provided.

Early Rapid Decline In Kidney Function In Medically Managed Patients With Atherosclerotic Renal Artery Stenosis., Emily L Cooper, Yanmei Xie, Hanh Nguyen, Pamela S Brewster, Haden Sholl, Megan Sharrett, Kaili Ren, Tian Chen, Katherine Tuttle, Steven T Haller, Kenneth Jamerson, Timothy P Murphy, Ralph B D'Agostino, Joseph M Massaro, William Henrich, Christopher J Cooper, Donald E Cutlip, Lance D Dworkin, Joseph I Shapiro

Articles, Abstracts, and Reports

Background Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Methods and Results Patients enrolled in the medical therapy-only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline (RD) in estimated glomerular filtration rate (eGFR), defined as a ≥30% decrease from baseline to either 3 months, 6 months, or both. In the medical therapy-only cohort, eGFR was available in 359 subjects at all time points, the subjects were followed for a median of …

Peripheral Synucleinopathy In A Dj1 Patient With Parkinson Disease, Cataracts, And Hearing Loss, Derek P. Narendra, Risa Isonaka, Diana Nguyen, Alice B. Schindler, Angela D. Kokkinis, Debra Ehrlich, Tanya M. Bardakjian, David S. Goldstein, Tsao-Wei Liang, Pedro Gonzalez-Alegre

Department of Neurology Faculty Papers

No abstract provided.

Ileocecal Valve Tuberculosis In Setting Of Terminal Ileitis In Patient With Septic Shock And Pneumonia, Lisa Kurth Md, Daniel Latta Md, Giovanni Bonomo Md, John S. Park Md

Department of Surgery

No abstract provided.

Percutaneous Transhepatic Access With Liquid Sclerotherapy And Coil Embolization Of Peristomal Varices, Daniel Kuehler Md, Daniel Latta Md, Errin Hoffman Md, Sheridan A. Morgan Md, David S. Bub Md, John S. Park Md

Department of Surgery

No abstract provided.

Attitudes Toward Precision Treatment Of Smoking In The Southern Community Cohort Study, Nicole Senft, Maureen Sanderson, Rebecca Selove, William J. Blot, Stephen King, Karen Gilliam, Suman Kundu, Mark Steinwandel, Sarah J. Sternlieb, Shaneda Warren Andersen, Debra L. Friedman, Erin Connors, Mary Kay Fadden, Matthew Freiberg, Quinn S. Wells, Juan Canedo, Rachel F. Tyndale, Robert P. Young, Raewyn J. Hopkins, Hilary A. Tindle

Center for Prevention Research Publications

Background: Precision interventions using biological data may enhance smoking treatment, yet are understudied among smokers who are disproportionately burdened by smoking-related disease.

Methods: We surveyed smokers in the NCI-sponsored Southern Community Cohort Study, consisting primarily of African-American, low-income adults. Seven items assessed attitudes toward aspects of precision smoking treatment, from undergoing tests to acting on results. Items were dichotomized as favorable (5 = strongly agree/4 = agree) versus less favorable (1 = strongly disagree/2 = disagree/3 = neutral); a summary score reflecting generalized attitudes was also computed. Multivariable logistic regression tested independent associations of motivation (precontemplation, contemplation, and preparation) and …

Brainstem Atrophy In Focal Epilepsy Destabilizes Brainstem-Brain Interactions: Preliminary Findings., Susanne G. Mueller, Lisa M. Bateman, Maromi Nei, Alica M. Goldman, Kenneth D. Laxer

Department of Neurology Faculty Papers

BACKGROUND: MR Imaging has shown atrophy in brainstem regions that were linked to autonomic dysfunction in epilepsy patients. The brainstem projects to and modulates the activation state of several wide-spread cortical/subcortical regions. The goal was to investigate 1. Impact of brainstem atrophy on gray matter connectivity of cortical/subcortical structures and autonomic control. 2. Impact on the modulation of cortical/subcortical functional connectivity.

METHODS: 11 controls and 18 patients with non-lesional focal epilepsy (FE) underwent heart rate variability (HRV) measurements and a 3 T MRI (T1 in all subjects, task-free fMRI in 7 controls/ 12 FE). The brainstem was extracted, and atrophy …

Solitary Brain Metastasis: A Rare Initial Presentation Of Prostate Carcinoma, Asim Hafiz, Muneeb Uddin Karim, Bilal Mazhar Qureshi, Adnan Jabbar, Zubair Ahmad

Department of Radiation Oncology

Cerebral metastasis as an initial clinical presentation of prostate carcinoma is extremely rare. Usually, patients have widespread metastasis in the body before presenting with brain metastasis. In the absence of extensive metastasis, especially without bony metastasis, only brain metastasis is an unusual presentation of the disease. We report a case of a 59-years-old patient who presented with a lack of concentration and decreased vision. Magnetic resonance imaging (MRI) of the brain revealed a large right parietal-occipital space-occupying lesion. He underwent surgery and the pathological diagnosis of the tumor turned out to be metastatic prostate carcinoma. Further evaluation by a whole-body …

Sternoclavicular Joint Arthropathy Mimicking Radiculopathy In A Patient With Concurrent C4-5 Disc Herniation, Prateek Agarwal, Ab, Nitin Agarwal, Md, David Hansberry, Md, Phd, Neil Majmundar, Md, Ira M. Goldstein, Md

Department of Radiology Faculty Papers

Background

Patients with sternoclavicular joint arthropathy, which can result from septic arthritis, often present with localized sternoclavicular pain as well as shoulder pain. Such pain may be similar to the presenting symptoms of cervical intervertebral disc herniation.

Clinical presentation

A 47-year-old female presented with 1 month of significant pain in the neck as well as right anterior chest and deltoid. The patient was found to have reduced strength in the right deltoid muscle on physical examination. MRI revealed a C4-C5 herniated nucleus pulposus. The patient underwent successful C4-C5 anterior cervical discectomy, but subsequently developed painful swelling in the region of …

Front Matter, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Robotic-Assisted Versus Video-Assisted And Open Thoracic Surgery: Outcomes, Advantages, And Costs, Ananth Thitte

Nurse Anesthesia Student Capstones

Thoracic surgery via video assisted thoracoscopic surgery (VATS) began in the early 1990s, as a minimally invasive alternative to open thoracotomy for performing lobectomies, wedge resections, and segmentectomies. It initially showed improved morbidity and mortality, decreased pain, and decreased length of stay when compared to traditional open thoracotomy (Zhang & Gao, 2015). To its detriment, VATS has a steep learning curve and manipulation of instruments has been described as non-intuitive. The video camera used provides a two-dimensional image, with limited depth perception compared to the naked eye in an open procedure. Due to these shortcomings, and in spite of its …

Vaping And Anesthesia, Wen Wang

Nurse Anesthesia Student Capstones

Electronic cigarettes (ECs) are a fast-growing class of Electronic Nicotine Delivery Systems (ENDS) which were first put on the market 15 years ago. These devices have been advertised as safer alternatives to conventional cigarettes and a tool for smoking cessation by their manufacturers regardless of inadequate safety data (Kalkhoran, 2016). Since ECs have only been on the market for one and half decades, data on short-term health effects from inhaling EC aerosols are inadequate, and data regarding long-term health effects are very limited. Despite insufficient safety data, the use of ECs has increased exponentially since they were put on the …

Amniotic Fluid Embolism In The Parturient Patient, Vanessa Pasquariello

Nurse Anesthesia Student Capstones

An amniotic fluid embolism (AFE) occurs when amniotic fluid enters maternal circulation, causing a physical obstruction or an anaphylactoid reaction, both of which are often detrimental to the parturient patient. This paper reviews a series of studies to examine the incidence, risk factors, presentation, and management of an AFE in the healthcare setting. Diagnosing an AFE remains difficult as a universal diagnostic criterion does not exist (aside from in reported research); thus, its identification is often made when another differential diagnosis fails to manifest. The presentation of the following biomarkers: squamous cell carcinoma antigen, CK13, and CK10/13 can aid in …

Pulmonary Alveolar Microlithiasis Diagnosed With Radiography, Ct, And Bone Scintigraphy, Emad Alkankan, Hasan Yamin, Hazim Bukamur, Fadi Alkhankan, Yousef Shweihat, Fuad Zeid

Internal Medicine

Pulmonary alveolar microlithiasis is rare disease characterized by accumulation of calcium phosphate microlithis in the alveoli. The pathogenesis relates to mutation in the gene SLC34A2 (solute carrier family 34 member 2) located on chromosome 4p15.2, which produces a defective sodium-phosphate cotransporter in alveolar epithelial type-2 cells, making these cells unable to clear phosphorus released during recycling of surfactant.

Twelve Tips For Enhancing Student Engagement., Harm Peters, Marko Zdravkovic, Manuel João Costa, Antonio Celenza, Kulsoom Ghias, Debra Klamen, Liz Mossop, Michael Rieder, Vishna Devi Nadarajah, Danai Wangsaturaka, Martin Wohlin, Margot Weggemans

Paediatrics Publications

Student engagement refers to a broad range of activities where students participate in management, education, research, and community activities within their institutions. It is a mutually beneficial collaborative approach between students and their institutions. This article provides practical advice for the implementation or further development of student engagement at medical, dental, and veterinary schools. The tips provided are based on the experiences of a group of universities recently recognized for best practice in student engagement, and are supported by evidence from the literature. The tips cover overarching themes which include the creation of an institutional culture and formal framework for …

External Cold And Vibration For Pain Management Of Children Undergoing Needle-Related Procedures In The Emergency Department: A Randomised Controlled Non-Inferiority Trial Protocol., Ariane Ballard, Christelle Khadra, Samara Adler, Evelyne D Trottier, Benoit Bailey, Naveen Poonai, Jean Théroux, Sylvie Le May

Paediatrics Publications

INTRODUCTION: Needle-related procedures are considered as the most important source of pain and distress in children in hospital settings. Considering the physiological and psychological consequences that could result from these procedures, management of pain and distress through pharmacological and non-pharmacological methods is essential. Therefore, it is important to have interventions that are rapid, easy-to-use and likely to be translated into clinical practice for routine use. The aim of this study will be to determine whether a device combining cold and vibration (Buzzy) is non-inferior to a topical anaesthetic (liposomal lidocaine 4% cream) for pain management of children undergoing needle-related procedures …

Unanticipated Admissions To Paediatric Cardiac Critical Care After Cardiac Catheterisations., Erin Peebles, Michael R Miller, Lee N Benson, Tilman Humpl

Paediatrics Publications

OBJECTIVES: Cardiac catheterisation is commonly used for diagnosis and therapeutic interventions in paediatric cardiology. The inherent risk of the procedure can result in unanticipated admissions to critical care. Our goals were to provide a qualitative description of characteristics and evaluation of children admitted unexpectedly to the cardiac critical care unit (CCCU).

METHODS: A retrospective single centre review of cardiac catheterisation procedures was done between 1 January, 2003 and 30 April, 2013.

RESULTS: Of 9336 cardiac catheterisations performed, 146 (1.6%) were admitted from the catheterisation laboratory to the CCCU and met inclusion criteria. Of these 146 patients, 117 (1.3%) met criteria …

Use Of A Radial Artery ‘Slender’ Sheath For Facilitating Transfemoral Arterial Access For Neuroendovascular Embolization In A Very Young Infant, Timothy L. Miao, Enriqueta Lucar Figueroa, Khalid Bajunaid, Michael Mayich, Sandrine De Ribaupierre, Sachin K. Pandey

Paediatrics Publications

Pediatric neuroendovascular procedures are increasingly performed as several studies have shown the safety of these interventions. In the literature, an upper limit of 4 French catheter size is conventionally used for femoral access in neuroangiography of very young infants. However, this constraint in luminal size may not allow for more complex procedures. We present the previously unreported use of a radial 5 French slender catheter with ultrathin walls for femoral access for aneurysm embolization in a 3-month-old boy presenting with left M2 aneurysm rupture.

The University Of New Mexico Orthopaedics Research Journal 2019, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Malnutrition In The Elderly, Clodagh Corcoran, Craig Murphy, Eamonn P. Culligan, Janette Walton, Roy D. Sleator

Department of Biological Sciences Publications

Changes that occur naturally throughout the ageing process place the elderly population at greater risk of malnourishment. This review discusses the significance, causes, consequences and assessment of malnutrition in the elderly.