Medical Specialties Commons^™

2019 Overview, Cesario Borlongan, Frederic Dorandeu, Giuseppe Di Giovanni, Jian-Sheng Lin, Gang Hu, Johannes Boltze, Jie Wu, Xiaoming Hu, Yumin Luo

Neurosurgery and Brain Repair Faculty Publications

No abstract provided.

Potential Of Mesenchymal Stem Cells Alone, Or In Combination, To Treat Traumatic Brain Injury, Alison E. Willing, Mahasweta Das, Mark Howell, Shyam S. Mohapatra, Subhra Mohapatra

Neurosurgery and Brain Repair Faculty Publications

Traumatic brain injury (TBI) causes death and disability in the United States and around the world. The traumatic insult causes the mechanical injury of the brain and primary cellular death. While a comprehensive pathological mechanism of TBI is still lacking, the focus of the TBI research is concentrated on understanding the pathophysiology and developing suitable therapeutic approaches. Given the complexities in pathophysiology involving interconnected immunologic, inflammatory, and neurological cascades occurring after TBI, the therapies directed to a single mechanism fail in the clinical trials. This has led to the development of the paradigm of a combination therapeutic approach against TBI. …

Eagle Syndrome Masquerading As A Chicken Bone, Jason E. Cohn, Sammy Othman, Karima Sajadi-Ernazarova

Otolaryngology (ENT) Resident Research

This is a brief report of a 17-year-old male who presented to the emergency department with odynophagia and a foreign body sensation in the throat after choking on a chicken wing. A soft tissue neck radiograph was performed which revealed a 4.6-cm linear object in the vallecula read by the radiology department as a chicken bone. The otolaryngology team was consulted and performed a nasopharyngeal laryngoscopy which did not reveal a foreign body in the upper aerodigestive tract. On physical examination, the right tonsillar fossa was tender to palpation. Upon further review of the radiograph, the right stylohyoid ligament was …

Development Of A Robust Treatment Delivery Framework For Stereotactic Body Radiotherapy (Sbrt) Of Synchronous Multiple Lung Lesions, Lana Catherine Critchfield

Theses and Dissertations--Radiation Medicine

Stereotactic body radiation therapy (SBRT) of lung tumors uses high doses of radiation to deliver high biological effective doses (BED) in very few fractions (1-5). With the use of highly conformal fields to cover the tumor without depositing large doses to non-cancerous structures, this technique has proven time and again to be successful at achieving high local control. However, frequently patients receiving SBRT are elderly with multiple medical comorbidities who may not tolerate long treatment times. Furthermore, many patients present with oligometastatic or multiple primary lung tumors. The success of SBRT on oligometastatic lung disease relies on physician experience with …

Functional Neuroimaging In Psychiatry-Aiding In Diagnosis And Guiding Treatment. What The American Psychiatric Association Does Not Know., Theodore A Henderson, Muriel J Van Lierop, Mary Mclean, John Michael Uszler, John F Thornton, Yin-Hui Siow, Dan G Pavel, Joe Cardaci, Phil Cohen

Articles, Abstracts, and Reports

While early efforts in psychiatry were focused on uncovering the neurobiological basis of psychiatric symptoms, they made little progress due to limited ability to observe the living brain. Today, we know a great deal about the workings of the brain; yet, none of this neurobiological awareness has translated into the practice of psychiatry. The categorical system which dominates psychiatric diagnosis and thinking fails to match up to the real world of genetics, sophisticated psychological testing, and neuroimaging. Nevertheless, the American Psychiatric Association (APA) recently published a position paper stating that neuroimaging provided no benefit to the diagnosis and treatment of …

Will "Social Distancing" Lead To Future "Research Distancing": A Reflection On Covid-19 Impacts On Alzheimer's Disease Research, Shoshana H. Bardach, Allison K. Gibson, Elizabeth K. Rhodus, Gregory A. Jicha

Sanders-Brown Center on Aging Faculty Publications

Coronavirus disease 19 (COVID-19) has dramatically altered everyday life, including the field of Alzheimer's disease (AD) research. This perspective article explores some of the ways in which COVID-19 has already impacted the field, anticipates some of the long-lasting effects, and explores strategies for addressing current and future needs. Areas of impact include study integrity, regulatory and industry issues, and participant engagement. Proposed strategies for addressing these challenges include analytic methods to deal with large degrees of missing data and development of patient-centered, user-friendly, remote data collection tools and assessments. We also highlight the importance of maintaining participant well-being as a …

Using A Checklist To Guide Discussion In Level Of Care Meetings At The Hill At Whitemarsh, Grant Schultheis, Nicholas Safian, Sopuru Ezeonu, Austin Klein, Danielle Snyderman, Md

Phase 1

Background: The Hill at Whitemarsh is a retirement facility in Lafayette Hill, Pennsylvania which has three bundles of services for residents termed levels of care (LOC). Meeting are held routinely by medical and administrative staff to determine if an individual needs to move to a different LOC to improve her/his quality of life and safety. These meetings require integration of medical, functional, cognitive, social, and subjective factors often requiring input from several staff members. In this project, we seek a checklist for staff members at the Hill to use at the LOC meetings to ensure important points of discussion for …

3d Printed Liver Models As A Tool To Improve Pre-Surgical Consultation And Enhance Patient Consent, Miranda Sill, Nathan Ott, Robert S. Pugliese, Pharmd, Bcps

Phase 1

Background: 3D printing has recently emerged as an effective, cost-efficient tool for healthcare innovation. We propose the fabrication of 3D printed, patient-specific liver models as a pre-surgical planning and communication tool for liver resection surgery.

Methods: Creation of the model began with the segmentation of the patient's abdominal CT scan, where specific sections of their anatomy, including the blood vessels (portal and hepatic systems), gallbladder, and tumor (when applicable), were digitally segmented. Each structure was then printed in a unique color using polylactic acid (PLA) plastic filament on an Ultimaker 5s printer. Once printed the components were arranged anatomically and …

Improving The Inhaler, Alex Reibstein, Jesse Evensky, Bradley Freid, Kabir Malkani, Gregory C. Kane, Md

Phase 1

Background: Inhalers used to dispense various pharmacological agents play an important role in the care of patients with pulmonary disease. These pharmacological agents can be very effective, however, many patients that use inhalers often deliver these drugs incorrectly or in a sub-optimal manner. Our project aims to improve the design of the inhaler in order to increase the effectiveness of drug delivery and also ease of patient use.

Methods: We interviewed a critical care pulmonologist regarding patient inhaler use and compliance. This physician offered information about proper inhaler use and described common errors that patients encounter when attempting to dispense …

Patient-Specific 3d Printed Liver Models For Pre-Operative Planning And Improved Patient Adherence, Nathan Ott, Miranda Sill, Robert S. Pugliese, Pharmd, Bcps, Ashesh P. Shah, Md

Phase 1

Project Background: 3D anatomical relationships in the liver are not always visually accessible for surgeons performing resections even with advanced imaging options. Firm understanding of these relationships is essential for timely procedures, which can improve patient outcomes and lower hospital expenses. Patient-specific 3D modeling has existed for some time, though it is costly. New cost-effective techniques have surfaced which may yield opportunities for more effective preoperative planning in liver surgery and improved patient adherence.

Methods: Digital patient-specific 3D reconstruction of a liver was completed by interpolating data from MRI scans using 3D Slicer, a segmenting program. The liver model was …

Improvements On The Inhaler, Jesse Evensky, Bradley Freid, Kabir Malkani, Alex Reibstein, Gregory C. Kane, Md

Phase 1

Background: Inhalers are a commonplace in American health care and deliver crucial drugs to patients with COPD and asthma. Inhaler use has been shown to be unsatisfactory among patients resulting in ineffective medication delivery. The goal of this project was to improve the inhaler design for increased effectiveness and ease of use.

Methods: Our team first interviewed a Pulmonologist regarding patient inhaler use. Dr. Harry Kane demonstrated the proper use of an inhaler as well and described errors in inhaler use are due to patient technique. A variety of inhalers currently available were examined and were compared for ease of …

Sound Dampening Headband For Infants, Alexandra A. Mccullough, Mohammad Rasool, Alison Romisher, Robert S. Pugliese, Pharmd, Bcps, Bon Ku, Md, Mpp

Phase 1

Background: Noise in the Intensive Care Nursery (ICN) has been linked to sleep disruption, vital sign destabilization, abnormal development, and stress response induction in infants. Specifically, a sound level ≥60 decibels (dB) was linked to sleep disruption in infants, and the American Academy of Pediatrics (AAP) set a maximum recommended sound level of 45dB in ICNs. The present work was conducted to confirm that the Jefferson ICN exceeds the 60dB and 45dB levels, like most hospitals do, and to conduct preliminary testing on materials for a wearable intervention to reduce infants’ exposure to noise.

Methods: A group of …

3d Printing Of Bone Spurs Before Surgical Removal, Katelyn Koons, John Paul Prodoehl, Matthew Chadwick, Chris Li, Lauren Schlegel, Jeffrey Henstenburg, Md

Phase 1

Project Background: In the United States, 2% of the population will experience bone spurs, which will not resolve on their own.¹ Of people over 60 who experience a bone spur, 40% will require medical attention.² The soft tissue visualization appears to be difficult with imaging, leaving increased chance of poor balancing of the knee replacement. Osteophyte structure continues to be difficult to visualize in a 3D way and without their proper removal, can lead to increased rate of revision surgery. Having a 3D model of the bone spur may decrease risk of complication and enhance soft tissue modification …

Improving The Inhaler, Bradley Freid, Jesse Evensky, Kabir Malkani, Alex Reibstein, Gregory C. Kane, Md

Phase 1

Background: Inhaled drugs play a critical role in caring for patients with respiratory disease such as COPD and asthma. It is understood that many of the patients that use inhalers to deliver these drugs to their lungs use them entirely improperly or in a sub-optimal manner. Improving the inhaler design for increased effectiveness and ease of use was the focus of this project.

Methods: A pulmonary critical care attending was interviewed regarding patient inhaler use. The attending provided information about proper inhaler use and also described patient errors in using the inhaler that were observed. Inhalers that are currently in …

Scavenger Of Waste Anesthetic, Cary Hess, Jonathan Karp, Delara Kiani, Corey Jameson, Michael E. Mahla, Mary Herman, Dietrich Gravenstein, Robert S. Pugliese

Phase 1

Waste anesthetic gases (WAGs) are associated with spontaneous miscarriages in pregnant persons, an increased risk of congenital abnormalities, hepatotoxicity, neurotoxicity, and cognitive impairment. Through monitoring anesthesiologists we found levels of WAGs to be 5-10x the current standard inside the OR. Currently, no solutions exist for the mitigation of WAG release. Remora is a solution to removing WAGs that fits on top of existing anesthesia masks. A flexible skirt is joined to a rigid ring, which deforms under hand pressure to facilitate effective hand-to-mask placement. The suction system is plugged into an unused suction port to create an area under the …

Color-Changing Device To Improve Adherence To Foley Catheter Replacement Protocols And Reduce Urinary Tract Infection Frequency, Kurt Hill, Alexander Straus, Ms, Bryn Cross, Jason M. Fields, Md

Phase 1

Background: Foley catheter-associated UTI’s (CAUTI’s) represent a driving cause of cystitis, bacteremia and sepsis in the hospital setting. Accordingly, the CDC has identified prolonged indwelling time as the foremost risk factor for CAUTI’s. However, the fundamental design of the Foley has remained unchanged for over eighty years. Hospital-specific protocols do currently exist for the removal of infection-prone catheters; however, in practice it remains commonplace for catheters to be ignored, increasing the risk of life-threatening infection. Our design process addressed this by creating a color-changing alarm device that would alert providers when a catheter has been left in beyond protocol, is …

Automated Assessment Of Cardiothoracic Ratios On Chest Radiographs Using Deep Learning, Varun Danda, Paras Lakhani, Md

Phase 1

Introduction: The cardiothoracic ratio (CTR) is a quantitative measure of cardiac size that can measured from chest radiography (CXR). Although radiologists using digital workstations possess the ability to calculate CTR, clinical demands prevent calculation for every case. In this study, the efficacy of a deep convolutional neural network (dCNN) to assess CTR was evaluated.

Methods: 611 HIPAA-compliant de-identified CXRs were obtained from [institution blinded] and public databases. Using ImageJ, a board-certified radiologist (reader #1) and a medical student (reader #2), measured the CTR by marking four pixels on all CXRs: the right- and left-most chest wall, the right- and left-most …

Evaluating The Impact Of Kardiamobile On Healthcare Expenditures, Christopher Gerace, Mph, Daniel Frisch, Md

Phase 1

Background: KardiaMobile is a mobile ECG device, with smartphone connectivity, that is able to detect atrial fibrillation (a-fib). The device captures a 30 second reading and an algorithm differentiates a-fib from sinus rhythm. The mobile application can alert the user to an a-fib reading and also send the ECG output to their personal physician. By monitoring a-fib without accessing traditional care, KardiaMobile has the potential to reduce healthcare costs for patients with a-fib. This study looked to evaluate the effect of KardiaMobile on healthcare utilization for patients with suspected or diagnosed a-fib and who see a clinical cardiac electrophysiologist.

Methods: …

Assessment Of A Wearable Device For Minute Ventilation In Detecting Different States Of Ventilation, Michael Morano, Yash Patel, Marc J. Torjman, Phd, Indupriya Eedara, Ms, Moeness Amin, Phd, Channy Loeum, Jeffrey Joseph, Do

Phase 1

Introduction: Minute ventilation (MV) and breathing status are valuable vital signs to measure in patients clinically such as in detecting opioid induced respiratory depression. However, there are few devices capable of continuously monitoring MV in an accurate fashion. RTM Vital Signs, LLC and TJU are developing a non-invasive wearable Tracheal Sound Sensor to determine if a device can accurately and continuously measure respiratory rate (RR), tidal volume (TV), MV, and changes in ventilation patterns based on sound recordings of breathing.

Methods: Tracheal breathing sounds were recorded in six researchers using a prototype sensor placed on the skin above the sternal …

Angiogenin Mrna Expression Levels In Prostate Cancer Tissue, Bowen Yao, Megumi Shigematsu, Phd, Kamlesh Ganesh Pawar, Phd, Venetia Pliatsika, Ms, Yohei Kirino, Phd

Phase 1

Introduction: Prostate cancer is the most commonly diagnosed cancer in men and second leading cause of cancer deaths. Studies have shown that tRNA fragments are upregulated in prostate cancers and play important roles in carcinogenesis. This project looks at how tRNA cleaving enzyme angiogenin expression is regulated in prostate cancer tissues.

Methods: Clinical data and mRNA expression levels of selected tRNA cleaving enzymes were extracted from the TCGA website. mRNAs were sequenced using IlluminaGA_RNASeqV2 at University of North Carolina.

Results: 546 samples from 494 patients, with normal tissue from 53 patients were collected. ANG mRNA levels were lower in patients …

Evaluation Of Ventricular Repolarization In Patients Undergoing Cardiac Resynchronization Therapy (Crt) Using Two Modalities: Conventional Biventricular Pacing Vs. His-Bundle Pacing, Anshul Gupta, Behzad B. Pavri, Md, Fhrs

Phase 1

Introduction:

Permanent His-bundle pacing (HBP) is being used as an alternative to biventricular pacing (BiVP) for CRT. HBP preserves the physiologic pattern of ventricular activation and markedly reduces ventricular dyssynchrony. While ventricular depolarization with HBP vs. BiVP has been studied, the effects of the 2 modalities on repolarization have not been compared. The purpose of this study was to compare ventricular repolarization in patients with HBP and BiVP. We hypothesize that HBP provides more physiologic repolarization as compared to BiVP.

Methods: ECG repolarization parameters were analyzed in patients who underwent HBP and BiVP using the first available ECG post implant. …

Comparison Of Patient Satisfaction With Telehealth And In-Clinic Post-Operative Visits, Lillian Matthews, Bryan Renslo, Deborah T. Glassman, Md

Phase 1

Introduction: Telehealth has grown rapidly in the healthcare industry as a time efficient, affordable, and accessible means to provide care. Jefferson’s Department of Urology currently employs telehealth for post-operative visits but its efficacy in post-nephrectomy patients has not been well studied. We aim to demonstrate that patient satisfaction is the same for telehealth versus in-clinic post-operative visits in nephrectomy patients. Secondarily we will examine distance saved for telehealth patients.

Methods: We will administer an IRB approved questionnaire to all nephrectomy patients via the EPIC^® EMR platform after their post-operative visit. Each questionnaire will be specific to telehealth or …

Cognitive Changes In Patients Treated For Obstructive Sleep Apnea With Upper Airway Stimulation, Maxillomandibular Advancement, Or Expansion Sphincter Pharyngoplasty, Nicolas Zingas, Colin Huntley, Matthew Stewart, Ramez Philips

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a prevalent diagnosis that has been shown to not only affect sleepiness, but daytime cognitive function — specifically attention, working memory, and executive function. CPAP treatment is troublesome for some patients and it is possible that superior treatment options, specifically novel surgical techniques, are available, though none have been evaluated for their long-term effects on neurocognition. We hypothesize that treating patients with upper airway stimulation surgery (UAS) UAS, maxillomandibular advancement surgery (MMA), and expansion sphincter pharyngoplasty surgery (ESP) for OSA produces a significant improvement in cognition from baseline.

Methods: For inclusion in the study, …

Pilot Evaluation Of The Usability And Utility Of A Wearable Technology To Monitor And Evaluate Health Condition, Drew Nielsen, David Shipon, Md, Facc, Facp

Phase 1

Introduction: Cardiac rehabilitation programs have particularly poor attrition and rehospitalization from cardiac-related events is a large burden on the medical system, as 8.9% of patients who have acute MI are rehospitalized within one year. External barriers may exist that prevent patients from adequately completing in-house cardiac rehabilitation, which makes them strong candidates for a home-based rehab program (HBCR). Previous randomized trials have generated evidence that HBCR can achieve similar cardiac improvements in 3- 12-month clinical outcomes. With the large-scale adoption of wearable technologies, with an estimated 8.2 million devices owned by individuals over 55, we have an opportunity to incorporate …

Comparison Of Patient Satisfaction Between Telehealth And In-Clinic Post-Operative Visits, Bryan Renslo, Lillian Matthews, Deborah T. Glassman, Md

Phase 1

Introduction: Telehealth has the potential to be an efficient, affordable, and accessible means to give care. In the field of Urology, its use has large potential but has not been well studied. We hypothesize that the use of telehealth for post-op nephrectomy patients will maintain the same level of patient satisfaction. We also hypothesize that telehealth visits will take less time and save patients money by eliminating the need to travel.

Methods: From May through July 2019, post-nephrectomy patients who consented to the study were given either a telehealth or in-clinic post-operative visit. Outcome metrics and demographics information were obtained …

An Investigation Of Infectious Etiologies Of Sporadic Inclusion Body Myositis, Tyler Kennedy, Michele Meltzer, Md

Phase 1

Introduction: Sporadic inclusion body myositis (sIBM) is a rare, debilitating disease that can significantly lower one’s quality of life. Unfortunately, there are no current effective treatments, as the underlying causes are still unknown. We hypothesize that preceding infections do not cause sporadic inclusion body myositis.

Methods: The study investigated patients with a diagnosis of inclusion body myositis, with a concurrent or previously documented infection. Men represented a larger proportion of the population as they have an increased preponderance of those affected. The primary objective was to discern which infection, if any, could induce the inflammatory and degenerative changes in muscle …

Test–Retest Reliability Of The Friedreich’S Ataxia Rating Scale, Christian Rummey, Theresa A. Zesiewicz, Santiago Perez-Lloret, Jennifer M. Farmer, Massimo Pandolfo, David R. Lynch

Neurology Faculty Publications

The modified Friedreich Ataxia Rating Scale (mFARS) is a disease specific, exam-based neurological rating scale commonly used as a outcome measure in clinical trials. While extensive clinimetric testing indicates it’s validity in measuring disease progression, formal test–retest reliability was lacking. To fill this gap, we acquired results from screening and baseline visits of several large clinical trials and calculated intraclass correlation coefficients, coefficients of variance, standard error, and the minimally detectable changes. This study demonstrated excellent test–retest reliability of the mFARS, and it’s upright stability subscore.

Direct Oral Anticoagulant Failure In Stroke/Transient Ischaemic Attack: Neurologic And Pharmacokinetic Considerations, David Z. Rose, W. Scott Burgin

Neurology Faculty Publications

No abstract provided.

Marijuana Use And Mental Health Among Emergency Department Patients, Megan Hanna

Scholarship in Medicine - All Papers

Background: According to the Centers for Disease Control and Prevention (CDC), marijuana is the most commonly used illicit drug in the U.S. with an increasing number of users in recent years.

Objective: This study was undertaken to identify common reasons for marijuana use and any relationship between its use and mental health among Emergency Department (ED) patients. Methods: A total of 303 ED patients participated from the Miami Valley Hospital Emergency Department. Eligible participants included those with any marijuana use. Subjects were administered a survey which identified age of first use, reasons for use, and presence of anxiety and depression …

The Verbal Numeric Pain Scale: Ed Patient Understanding And Perspectives, Bracey Bayonnet

Scholarship in Medicine - All Papers

Objective: The objective of this study is to identify patient self-reported pain scores and understanding and perspectives of the Verbal Numeric Pain Scale. Methods: In this prospective survey study, eligible participants were interviewed by research assistants. Data collected included ED patients self-reported pain scores, previous painful experiences, and their understanding of the Verbal Numeric Pain Scale,

Results: Among 164 participants (92% response rate), the mean triage pain score was 6.4 (95% CI 6.0-6.9). Many participants had experienced significant painful experiences in the past, including major surgery (N = 113), broken bone (N = 102), childbirth (N = 89) and kidney …