Medical Specialties Commons^™

Cognitive Control In Health And Disease: A Dynamic Approach To Mapping Oscillatory Activity Across The Lifespan, Mikki Schantell

Theses & Dissertations

Cognitive control is critical for flexibly adapting goal-directed behaviors to meet the demands of dynamically changing environments. The neural oscillatory dynamics serving cognitive control undergo changes across the lifespan, both in health and disease, with impairments in cognitive control functions being broadly implicated across a multitude of psychiatric disorders. Despite this, the trajectory of the population-level neural oscillatory dynamics supporting cognitive control across the lifespan remain poorly characterized, presenting challenges in fully understanding perturbations to these systems relative to one’s stage in neuronal maturation. Herein, we used the Eriksen flanker task during magnetoencephalographic (MEG) recording to map the neural oscillatory …

Cis-Regulatory Mechanisms Through Stages Of Erythroid Regenration, Yichao Zhou

Theses & Dissertations

Produced by steady state erythropoiesis, erythrocytes serve as vital regulators of metabolism and life by delivering oxygen to all the cells and tissues. Under acute anemia, steady state erythropoiesis is not sufficient to produce enough erythrocytes, leading to distinct mechanisms needed to regenerate large numbers of mature erythrocytes rapidly. Erythroid regeneration occurs in four stages: activation, expansion and differentiation, resolution, and post-resolution, according to the dynamics of erythrocyte numbers and progenitor activity. Erythroid regeneration throughout this timeline requires some critical extracellular cues, but the intrinsic molecular mechanisms needed to accelerate and decelerate the activity of erythroid progenitors in anemia and …

From Survivors To Care Providers: A Multi-Dimensional Study On Physical Activity In Cancer Care, Gaurav Kumar

Theses & Dissertations

As the population of cancer survivors grows, understanding the dynamics of physical activity (PA) engagement is critical due to its potential benefits in reducing adverse health outcomes and mortality associated with cancer. Despite known benefits, both adherence to and promotion of PA among cancer survivors face significant challenges. This comprehensive study examines PA levels, barriers, facilitators, and perceptions among cancer survivors and oncology care providers over a ten-year period. The objectives are to assess adherence levels to PA among cancer survivors, explore the perceived barriers and facilitators to PA engagement from the survivors' perspectives, and understand the barriers, facilitators, and …

Accuracy Of Machine Learning To Predict The Outcomes Of Shoulder Arthroplasty: A Systematic Review, Amir H. Karimi, Joshua Langberg, Ajith Malige, Omar Rahman, Joseph A. Abboud, Michael A. Stone

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Artificial intelligence (AI) uses computer systems to simulate cognitive capacities to accomplish goals like problem-solving and decision-making. Machine learning (ML), a branch of AI, makes algorithms find connections between preset variables, thereby producing prediction models. ML can aid shoulder surgeons in determining which patients may be susceptible to worse outcomes and complications following shoulder arthroplasty (SA) and align patient expectations following SA. However, limited literature is available on ML utilization in total shoulder arthroplasty (TSA) and reverse TSA.

METHODS: A systematic literature review in accordance with PRISMA guidelines was performed to identify primary research articles evaluating ML's ability to …

Assessment Of In-Vitro And In-Vivo Pre-Clinical Pharmacokinetics Of Epz015666; A Novel Small Molecule For Medulloblastoma Treatment, Pratiksha U. Kshirsagar

Theses & Dissertations

Group 3 medulloblastoma (MB) has the worst prognosis of the MB subgroups associated with elevated MYC expression and a 5-year survival rate of

Quantitation of EPZ was performed on a Shimadzu LC-MS/MS system utilizing electrospray ionization operated in positive mode. The validated assay was linear from 0.2 to 500 ng/mL. Metabolic stability studies demonstrated slow intrinsic clearance of EPZ in mouse and human liver microsomes, suggesting no CYP-mediated metabolism. Additionally, EPZ exhibited low binding affinity to plasma and brain proteins and high apparent permeability across artificial membranes, indicating efficient membrane penetration. Drug transporter studies identified EPZ as a substrate of …

Virtual Support For Bereaved Parents: Acceptability, Feasibility, And Preliminary Efficacy Of Hope Group, Emma Archer, Bs, Amelia Hayes, Mpg Ccls, Kristin Drouin, Lcsw, Elissa G. Millier, Md, Aimee Hildenbrand, Phd

Health Equity and Quality Improvement (HEQI) Summit

Background

• Bereaved parents demonstrate increased risk for long-term psychological problems and poorer overall quality of life. Bereavement support programs can promote improved coping and are positively received by parents but remain underutilized.
• Virtual programs may help address barriers to accessing bereavement resources, such as families’ physical distance to the hospital and trauma reactions when exposed to a setting where the child received care.
• The objective of this quality improvement study is to examine caregivers’ bereavement experiences and perspectives on HOPE Group, a virtual group program for bereaved caregivers administered by the palliative care team at Nemours Children's Hospital, Delaware.

Identification And Management Of Exposure Keratopathy In The Critical Care Setting, Susanna Betti, Harrison Bell, Erika Yoo, David Oxman

Health Equity and Quality Improvement (HEQI) Summit

Background

- Exposure keratopathy (EK) refers to corneal damage and ocular epithelial breakdown.

- It can result from prolonged exposure of the eye to the outside environment, often from incomplete eyelid closure or tear film defect.

- Increasingly common in critical care settings, up to 60%

• Mechanical ventilation, sedation, paralysis
• Medications (neuromuscular blockade)
• Impaired blink reflex, reduced tear production
• Fluid imbalance, increased vascular permeability

- Complications include corneal scarring, perforation, and blindness.

- Current recommendations: scheduled artificial tears with nightly lubricating ointment, tarsorrhaphy to close lids

Assessment Of Obgyn Department Research Collaboration And Satisfaction, Anne Bocage, Md, Melanie Hotz, Md, Julia Switzer, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• There are many simultaneous and similar research projects ongoing within the OB-GYN department, but with little collaboration. Additionally, it can be difficult to identify faculty, residents, and students with similar research interests.
• Collaboration between residents is shown to improve research productivity (1) and co-residents serve as effective research mentors (2).
• This project is aimed to assess the department's satisfaction with ongoing research and collaboration and to purpose an intervention for improvement.

Effect Of Education Level On Adequacy Of Bowel Preparation Prior To Colonoscopy, Anna Chen, Md, Michael Dimarino, Md, Akash Patel, Do, Katherine Duffey, Md, Gregory Habig, Md, Aaron Martin, Md, Cuckoo Choudhary, Md, Stephanie Moleski, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Adequate bowel preparation is crucial for obtaining a high-quality colonoscopy.
• Inadequate preparation leads to impaired visualization, which can lower adenoma detection rate, increase the risk of complications and potentially necessitate repeating the procedure.¹
• Patients with higher health literacy and a higher level of education have been associated with better bowel preparation quality.^2,3,4,5

The Utility Of The Pap Nap For Increasing Patient Utilization Of Positive Airway Pressure Therapy, Erin Creighton, Md, Nicole Molin, Md, Dimitri Markov, Md, Ritu Grewal, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• An estimated 9-38% of adults have obstructive sleep apnea (OSA), and about 80% is undiagnosed.
• OSA has been linked to excessive sleepiness, neurocognitive impairments, reduced quality of life, diabetes, heart disease, stroke, hypertension, and motor vehicle and workplace accidents
• Approximately85% of people with diagnosed OSA receive PAP and only 35-60% remain compliant long term
• Many factors impact CPAP use: disease and patient characteristics, titration procedures, device factors, side effects, psychological and social factors

Project AIM: Evaluate whether a daytime, abbreviated cardio-respiratory sleep study (AKA the PAP NAP -developed to help improve adherence in patients with OSA and …

Health Outcomes Of Hispanic Clients In A Community-Based Medically Tailored Meal Program, Victor Diaz, Jule Anne Henstenberg, Adrian Crafford

Health Equity and Quality Improvement (HEQI) Summit

Introduction and Objectives

• The Philadelphia-based Metropolitan Area Neighborhood Nutrition Alliance (MANNA) is a community-based organization that home delivers medically tailored meals (MTM) to local residents with serious illness andnutritional risk.
• Previous research has shown that in the U.S., Hispanics bear a disproportionate burden of major pathologies such as kidney disease [1] and experience lower rates of healthcare utilization [2].
• The objective of this project is to describe health outcomes of 258 Hispanic clients (mean age 57, 50% women) enrolled in MANNA’s program for 3-6 months between 2020-2022.

Increasing Hpv Vaccination Rates In Residents' Primary Care Clinics, Normonique Dyer, Do, Amman Bhasin, Md, Abdul Ekiyoyo, Md, Umma Fatema, Md, Ilana Goldberg, Md, Chukwuemezie Mamanu, Md, Tamar Wolinsky, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• The human papillomavirus (HPV) vaccine was approved in 2014 for the prevention of anogenital, cervical, and oropharyngeal cancers in female and male adolescents up to 26 years of age^1,2
• Data compiled from multiple clinical trials performed between 2006 and 2018 sought to evaluate benefit from extending the vaccination age given the implications on improving quality of life, morbidity/mortality, and reducing overall healthcare costs for preventable diseases³
• Results showed that increasing the vaccination age up to 45 in both males and females could offer additional protections against high-risk oncogenic strains of the HPV virus3
• Current recommendations from the …

Timely Ambulatory Follow Up After Emergency Department Discharge, Kevin Endersby, Jackson Weber, Marisyl De La Cruz

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

Patients over the age of 65 lack timely ambulatory follow up after discharge from the ED, leading to increased return to the ED, resource utilization, and mortality.

Project AIM:

Within 6 months of intervention, 70% of patients over the age of 65 who were recently discharged from the ED will follow up with their PCP within 7 days of the timeline recommended by the ED provider.

Improving Site-Specific Sti Screening In A Philadelphia-Based Academic Family Medicine Office, Brittany Macdonald, Md, Marie Ezran, Md, Haley Smallwood, Md, Gisel Garcia, Md, Maia Mandel, Md, Amaka Amobi, Md, Marshal Miller, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• In the last decade, rates of sexually transmitted infections (STIs) are rising both in Philadelphia and across the United States^{1, 2}
• STIs are often asymptomatic³
• Site-specific screening for gonorrhea and chlamydia (GC/CT) infections may increase STI detection o Genitourinary (GU), pharyngeal, and rectal sites o GU is the most common site tested, but GU-only testing may lead to missed diagnoses⁴

Knowledge And Receptiveness Of Epidural Labor Analgesia By Parturients At Two Teaching Hospitals In Rwanda: A Cross-Sectional Study, Casey Fishman, Ba, Justin Do, Bs, Richita Bashyal, Mph, Fidele Hakorimana, Md

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• Pain during labor can result in lasting psychological and physiological effects.¹ Although epidural analgesia is a first line pain management treatment and is used to reduce birth complications in many western countries, it is not commonly used in much of the world including Rwanda. The literature shows that African women have some of the lowest rates of pharmacological pain relief usage.
• Barriers to accessibility include; availability of equipment, staff with sufficient skills and monitoring, or myths and controversies surrounding labor.² Studies have found that some women believe that crying is a sign of weakness.³
• The aim …

Procedural Realignment To Ensure Superb Hypertension Regulation: The Presher Study, Eleni Florakis, Md, Emily Khantses, Md, Bret Mccarty, Md, Jeffrey White, Md, Jason Ojeda, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition

Hypertension (HTN), defined by the American Heart Association as systolic blood pressure (SBP) over 130 mm Hg or diastolic blood pressure (DBP) over 80 mm Hg, remains a major health concern worldwideas it leads tocongestive heart failure, chronic kidney disease, and stroke. Blood pressure control is an important task for the primary care physician (PCP). However, adequate management remains suboptimal as nearly half of US adults have uncontrolled high blood pressure.

After reviewing selected patients in our primary care office and discussing with our stakeholders, we found that more than two-thirds (69%) of uncontrolled hypertensive patients from a …

Incidental Coronary Artery Calcification: A Low-Hanging Fruit With Life-Prolonging Potential, Ryan Gardner, Md, Youssef Elfatatry, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

Incidental coronary artery calcium (CAC) seen on ungated computerized tomography (CT) scans obtained for various clinical reasons can serve as an excellent opportunity for screening of patients with previously undiagnosed coronary artery disease (CAD). Despite this, studies have shown that these findings are rarely reported in final impressions of radiology reports.

Project AIM:

To propose the use of a natural language processing (NLP) algorithm to identify incidental CAC noted in radiology reports and an electronic alert to notify primary care clinicians of such findings.

Addressing The Rates Of Contaminated Blood Cultures In The Tjuh Ed, Marina Gonzalez, Md, Trishya Srinivasan, Md, Bertilia Tavárez, Md, Natasa Kostic, Md, Virginia Gonzalez, Md, Kathleen Quinn, Bsn Rn-Bc, Michael Dong, Md

Health Equity and Quality Improvement (HEQI) Summit

Background & Aim

Blood culture contamination is a common, yet underrecognized, adverse event within emergency departments (ED). Through root cause analysis, this project identified barriers to using standardized blood culture collection techniques in the TJUH (Thomas Jefferson University Hospital) ED.

After incorporating our proposed interventions, we aim to reduce the percentage of contaminated blood cultures to

Improving Time To Mri In The Emergency Room For Spinal Epidural Abscesses, Karim Hafazalla, Md, Angeleah Carreras, Ms, Sean Mcgann, Md, Scott Faro, Md, Adam Flanders, Md, Richard Schmidt, Md, James Harrop, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Magnetic resonance images (MRI) is integral in assessing pathology. This is especially true in the emergency room (ER), where delays in diagnosing emergent neurologic pathologies, including spinal epidural abscesses (EDAs), where the morbidity can be severe if not addressed in time. This study aims to implement an expedited imaging pathway for this urgent / emergent pathology.

Finding Ways To Decrease The Number Of Pediatric Type 1 Diabetes Patients With A Hba1c Over 8.5%, Abigayle Hoover, Bs, Ashley Medina, Dhsc, Kimberly Shoe Moyer, Apm, Evan G. Graber, Do, Patrick C. Hanley. Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

Hemoglobin A1c is the standard of care for monitoring the metabolic control of patients with Type 1 Diabetes.¹ Patients should have HbA1c checked every 3 months.

Higher HbA1cs are linked to higher morbidity and mortality in patients with diabetes.²

Project AIM:

Develop, implement, and evaluate different methods to engage patients with an

Improving Head Ct Utilization After Traumatic Intracranial Hemorrhage According To The Modified Brain Injury Guidelines (Mbig), Mathews Lan, Md, Michael Baldassari, Md, Caitlin Ritz, Md, Tyler Alexander, Bs, Richard Schmidt, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: There are subsets of patients with traumatic intracranial hemorrhage who are low-risk for clinically significant hemorrhage expansion and/or neurologic deterioration requiring procedural intervention, yet these patients often undergo multiple serial head CT’s requiring an extended length of stay that may not be necessary. The Brain Injury Guidelines^1,2 (BIG) and subsequent modified Brain Injury Guidelines³ (mBIG) sought to categorize these low-risk subsets and provide an algorithm for more efficient care for these patients.

Project AIM: For low-risk patients with traumatic intracranial hemorrhage (specifically mBIG 2), we aim to reduce the number of head CT’s during admission …

Evaluating Patient Satisfaction Of Medication Education In Oncology, Christina Lew, Pharmd, Bcps, Rose Dimarco, Pharmd, Bcps, Bcop, Maria Hafez, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Optimization of medication education is important in promoting patient adherence, improving outcomes, and managing toxicities.
• With the increasing complexities of cancer treatments and an aging population, patient understanding is critical. In addition, chemotherapy is associated with toxicities that often require supportive care management.
• Historically, institutions and providers decide upon the type, format, and amount of information provided to patients.
• The aim of the project is to assess patient understanding of information provided in clinic, retention of information after clinic, and patient satisfaction.

Lung Cancer In Immunosuppressed Patients, Garrett Melby, Andrew Bernstein, Md, Matthew Tucker, Md, Julia Palecki, Md, Zoe Begun, Md, Amman Bhasin, Md, Tingting Zhang, Phd, Ida Micaily, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

- Lung cancer is the #1 cause of cancer-related mortality in U.S. adults

- Immune evasion is a key mechanism in tumor cell proliferation

• Immunosuppressed patients have higher lung cancer incidences and worse lung cancer outcomes

- Success of immunotherapies supports the role of host immune function in host tumor response

• Studies have shown immunotherapy to be safe and effective in a variety of immunosuppressed populations
• Immunosuppressed patients are often excluded from immunotherapy trials and under-treated with immunotherapy compared to immunocompetent cohorts

- This study aimed to assess the disease course, PD-L1 expression, and utilized treatment modalities across patients …

Improving Post-Operative Educational Handouts After Spine Surgery, Arbaz A. Momin, James Harrop

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: After spine surgery, patients are given take home instructions which are outdated and provide limited answers to frequently asked questions. This leads to increased office calls and overnight calls to on-call physician.

Project AIM:

• Improving educational handouts given to patients after spine surgery
• Aim is to analyze current handouts given to patients after spine surgery
• Identify frequently asked questions by patients after surgery

Bad Blood – A Patient Safety Analysis, Daniel Moylan, Md, Jonathan Colon Sanchez, Md, Tatianna Branch, Do, Ryan Gardner, Md, Taha Awan, Md, Emily Custer, Do, Tram Phung, Md, Sandy Samuel, Md, Gabrielle Mangan, Rn, Tamar Wolinsky, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Context: In this patient safety analysis, the authors review a case in which a patient’s labs collected in a large, quaternary care hospital's ER demonstrated concerning results that significantly deviated from labs drawn only hours prior

Problem Statement: The suspected mislabeling of patient labs resulted in a near-miss for the identified patient and unknown consequences for a second patient

Project AIM: Determine the root causes of this error and identify mechanisms to improve patient safety by reducing the incidence of similar errors

Pharmacist-Assisted Insulin Titration In Primary Care To Improve Diabetes Outcomes, Megana Murugesh, Md, Alisha Goyal, Michael Kelly, Pharmd, Emily Scopelliti, Pharmd, Barbara Simon, Md, Aparna Sarin, Md, Mph

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Approximately, 90% of patients with Type 2 Diabetes (T2DM) are treated by primary care providers (PCPs) and with a growing aging population, and a shrinking primary care workforce, the demand for PCPs to provide care to diabetics is only expected to further worsen.

Despite novel therapies in T2DM, insulin remains a mainstay in treatment. Titrating insulin is a tedious and time-consuming task, requiring frequent follow-ups and lengthy conversations, increasing the burden of care on PCPs.

Project AIM:

1. Assess efficacy of pharmacy–assisted insulin titration in T2DM in achieving glycemic control by monitoring blood glucose and A1c changes
2. Evaluate …

Interprofessional Pilot Approach To Standardizing Nursing-Provider Driven Postpartum Urinary Retention Protocol, Mymy Nguyen, Mary Van Schaick, Md, Charlette E. Williams, Md, Anne Bocage, Md, Julia Switzer, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Postpartum urinary retention is a frequent cause of distress to new mothers, affecting 1 in 500 patients¹. It is imperative that patients receive prompt diagnosis and management to avoid long term sequelae of urogenital tract morbidity, including detrusor damage and bladder rupture². Although hospital protocols for urinary retention in the non-obstetric setting exist, management of urinary retention in the postpartum setting often varies by nursing-provider preference.

Project AIM: In this QI project, we developed a standardized protocol for postpartum urinary retention, and a comprehensive training model for provider and nursing teams. We assessed …

Medication Access Barriers To Hepatitis C Anti-Viral Therapy Following Transplantation Of Hepatitis C Positive Donors Into Hepatitis C Negative Recipients, Harry Rockower, Md, Sarah Yeager, Pharmd, Jami Schulte, Pharmd, Dagan Coppock, Md, Jonathan Fenkel, Md, Katherine Belden, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Over the past decade there has been a paradigm shift in solid organ transplantation with the use of Hepatitis C (HCV) positive donor organs for HCV negative recipients.
• This evaluation looks through the lens of insurance approval for direct acting antivirals (DAA) and the process needed for obtaining and ensuring affordability of these medications.
• While the AASLD/IDSA guidelines recommend early initiation of pangenotypic DAA therapy after organ transplant without the need to confirm recipient viral replication many centers often initiate the DAA approval process after viremia is detected due to insurance barriers.¹
• The process for obtaining insurance approval …

Resumption Of Anti-Platelet/Anticoagulation Therapy Following Lumbar Spine Surgery, Stephanie Serva, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• No current guideline or protocol for AC/AP resumption in neurosurgical spine patients at TJUH
• There is difficulty in providing consistent perioperative anticoagulation recommendations to patients, as there remains no widely accepted, definitive literature of evidence or guidelines (Louie et al, 2020)

Project Aims:

• To determine standardized protocol for resuming antiplatelet/anticoagulation therapy following lumbar surgery
• To reduce combined postoperative cardiac/cerebrovascular/thrombotic events, and post-operative hematomas

Cardiology Referrals For African-American Basketball Players Falls Below Expectation, Vacha Shah, Blaise O'Malley, Douglas Corsi, Avinash Saraiya, Margaret Doyle, I. Masood, Brian Osler, A. Hajduczok, David Shipon

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• Rates of sudden cardiac death due to hypertrophic cardiomyopathy are higher in male African American basketball players compared with White players (Maron, 2003)
• Male African American NCAA Division I basketball players have the highest incidence of sudden cardiac arrest and death between the ages of 11 and 29 (Peterson, 2020)
• Retrospective analysis of the HeartBytes Registry collected by Simon’s Heart Organization identified multiple risk factors, such as asthma and sickle cell anemia, higher in this population than in the general population
• Increased murmurs and EKG abnormalities such as ST-segment depressions and other nonspecific changes are present in …