Medical Specialties Commons^™

Efficacy Of Intravesical Nadofaragene Firadenovec For Patients With Bacillus Calmette-Guérin-Unresponsive Nonmuscle-Invasive Bladder Cancer: 5-Year Follow-Up From A Phase 3 Trial, Vikram M. Narayan, Stephen A. Boorjian, Mehrdad Alemozaffar, Badrinath R. Konety, Neal D. Shore, Leonard G. Gomella, Ashish M. Kamat, Trinity J. Bivalacqua, Jeffrey S. Montgomery, Seth P. Lerner, Joseph E. Busby, Michael Poch, Paul L. Crispen, Gary D. Steinberg, Anne K. Schuckman, Tracy M. Downs, Joseph Mashni, Brian R. Lane, Thomas J. Guzzo, Gennady Bratslavsky, Lawrence I. Karsh, Michael E. Woods, Gordon Brown, Daniel Canter, Adam Luchey, Yair Lotan, Brant A. Inman, Michael B. Williams, Michael S. Cookson, Sam S. Chang, Alexander I. Sankin, Michael A. O'Donnell, David Sawutz, Richard Philipson, Nigel R. Parker, Seppo Yla-Herttuala, Dorte Rehm, Jørn S. Jakobsen, Kristian Juul, Colin P.N. Dinney

Department of Urology Faculty Papers

Purpose: Nadofaragene firadenovec-vncg is a nonreplicating adenoviral vector–based gene therapy for bacillus Calmette-Guérin (BCG)–unresponsive carcinoma in situ (CIS) with/without high-grade Ta/T1. We report outcomes following 5 years of planned follow-up.

Materials and Methods: This open-label phase 3 trial (NCT02773849) enrolled patients with BCG-unresponsive nonmuscle-invasive bladder cancer in 2 cohorts: CIS ± Ta/T1 (CIS; n = 107) and Ta/T1 without CIS (Ta/T1 cohort; n = 50). Patients received 75 mL (3 × 1011 vp/mL) nadofaragene firadenovec intravesically once every 3 months with cystoscopy and cytology assessments, with continued treatment offered to those remaining high grade recurrence–free (HGRF).

Results: One hundred fifty-seven …

Bronchopulmonary Dysplasia: Pathophysiology And The Effects Of The Microbiome, Anjali Jacob

Senior Honors Theses

Bronchopulmonary dysplasia (BPD) is a chronic neonatal lung disease that occurs in over 50% of premature infants. BPD is characterized by damage to the alveoli and bronchioles and improper vasculature formation. It is primarily caused by overexposure to oxygen through mechanical ventilation, but there are other risk factors that make infants more susceptible to BPD. Microbial composition impacts risk for developing BPD, and research is ongoing about the effects of the microbiome on BPD pathogenesis; this information is also valuable for preventative treatment. This paper reviews the normal function of the lungs, pathogenesis of BPD and how it affects normal …

Examining The Rate Of Failed Hearing Tests In Children >15 Months Of Age Who Are Referred To Speech Therapy: A Retrospective Analysis, Malika Goel, Kerry Mychaliska

Conference Presentation Abstracts

No abstract provided.

Assessing Quality Of Health-Related Social Needs Screening Across Jefferson Hospital’S Clinical Sites, Aparna Sarin, Md, Mph, Olivia Quinn, Mph, Nolan Chiles, Bs

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Assess the rate of completed health-related social needs (HRSNs) screenings at different TJUH sites
• Compare screening outcomes across TJUH clinical sites

Background

- Centers for Medicare and Medicaid (CMS) is mandating Health Related Social Needs (HRSNs) screening for all admitted patients

- First-year Sidney Kimmel Medical College (SKMC) students screen patients at four different Jefferson clinical sites alongside Community Health Workers (CHWs) as part of their ‘Clinical Experience’ curriculum

- SKMC screens 7 domains

• Food*
• Housing*
• Utilities*
• Transportation*
• Medication expenses
• Primary care
• Insurance
  
  *Screened by CMS, as well as interpersonal safety

- The data is gathered from:

• inpatient floors …

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

Mortality In Medicine, Maren Dougherty

Honors Projects

Practitioners in the medical field attend to health issues across one’s lifespan from birth to death and everything in between. A common conflict in today’s practice of medicine is establishing the true function of medicine. The complete reliance on medicine to ward off death proliferates the biomedicalization of natural life processes, like death. Biomedicalization is the process in which medical authority and its accompanying technology begin to control other aspects of daily life. With medicine’s ultimate goal being to cure disease and fight death, it interferes with the inevitability of human mortality. End-of-life treatment can be taken too far without …

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 …

Healthier Together: A Holistic Office Protocol Addressing The Chronic Nature Of Children And Adolescents With Adhd, Kimberly Olmos

Evidence-Based Practice Project Reports

Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent, chronic condition with symptoms that include inattention, hyperactivity, and impulsivity. ADHD affects six million children in the United States (Tran et al., 2021). The purpose of this evidence-based practice project was to implement a holistic office protocol that addressed the chronicity and future health outcomes of children and adolescents, ages 2-17 years with ADHD through stimulant or non-stimulant medication prescriptions, behavioral therapy referrals, and education surrounding diet, and exercise. A comprehensive, systematic literature search yielded 16 articles to determine best practice when treating children and adolescents with ADHD in primary or …

Development, Validation, And Diagnostic Performance Of A Novel Radiomic Model For Predicting Prostate Cancer Recurrence, Linda M. Huynh

Theses & Dissertations

Multi-parametric magnetic resonance imaging (MP-MRI)-derived radiomics have been shown to capture sub-visual patterns for the quantitative characterization of prostate cancer (PC) phenotypes. The present dissertation seeks to develop, evaluate, and compare the performance of an MRI-derived radiomic model for the prediction of PC recurrence following definitive treatment with radical prostatectomy (RP).

MP-MRI was obtained from 339 patients who had a minimum of 2 years follow-up following RP at three institutions. The prostate was manually delineated as the region of interest and 924 radiomic features were extracted. All features were evaluated for stability via intraclass correlation coefficient (ICC) and image normalization …

Phase 0 Feasibility And Design Of Mobile Health Applications For Use In Rural Settings, Aubree C. Honcoop

Theses & Dissertations

Background. Mobile Health (mHealth) interventions, when meant to serve as decision support, require an in-depth investigation of current workflows and decisional needs to ensure future usability and acceptability. Rural groups were prioritized due to their limited healthcare access, and therefore, their increased need for interventions like mHealth apps that address health disparities.

Objective. To assess the decisional needs of parents/caregivers and/or Healthcare Providers (HCPs) in rural areas regarding emergencies with children with medical complexity (CMC, Project 1), COVID-19 vaccination (Project 2), and HPV and COVID-19 vaccination (Project 3).

Methods. Parents and HCPs were approached through various methods for participation, primarily …

Impact Of Nutritional Status And Placental Malaria Infection On Pregnancy Outcome In A Population Of Nigerian Maternal-Infant Dyads, Shirley F. Delair

Theses & Dissertations

Nigeria is the most populous country in Africa and accounts for one-quarter of the newborn mortality on the continent. Most newborn deaths are from prematurity (33%), infections (33%), and intrapartum complications (31%). Using an adapted analytical framework for the study of child survival in developing countries, this dissertation aimed to look at the pregnancy outcome of a population of Nigerian women and their offspring by looking at proximate determinants of health from nutritional status and environmental conditions. In Chapter 1, we characterized the micronutrients of the mother-infant dyads, looking specifically at concentrations of vitamin D and its metabolites. In Chapter …

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 …

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 …

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 …

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