Infectious Disease Commons^™

Trends In Legionnaires' Disease-Associated Hospitalizations, United States, 2006-2010, Gayathri Mudali, Paul E. Kilgore, Abdulbaset Salim, Shawn P. Mcelmurry, Marcus Zervos

Department of Pharmacy Practice

Background: Legionella pneumophila is a waterborne cause of both healthcare-associated and community-acquired pneumonia. Legionella pneumophila serogroup 1 is responsible for 80% of infections. There is currently limited published disease burden data on Legionnaires' disease-associated hospitalization in the United States.

Methods: In this study, we estimated the annual incidence of Legionnaires' disease-associated hospitalizations in United States and identified demographic, temporal, and regional characteristics of individuals hospitalized for Legionnaires' disease. A retrospective study was conducted using the National Hospital Discharge Survey (NHDS) data from 2006 to 2010. The NHDS is a nationally representative US survey, which includes estimates of inpatient stays in …

Epstein Barr Virus-Immortalizedｂlymphocytes Exacerbate Experimental Autoimmune Encephalomyelitis In Xenograft Mice, Pascal Polepole, Alison Bartenslager, Yutong Liu, Thomas M. Petro, Samodha C. Fernando, Luwen Zhang

Nebraska Center for Virology: Faculty Publications

Multiple sclerosis (MS) is the most common autoimmune disorder affecting the central nervous system. Epstein-Barr virus (EBV) is a causative agent for infectious mononucleosis (IM) that is associated with MS pathogenesis. However, the exact mechanism by which EBV, specifically in IM, increases the risk for MS remains unknown. EBV immortalizes primary B lymphocytes in vitro and causes excessive B lymphocyte proliferation in IM in vivo. In asymptomatic carriers, EBV-infected B lymphocytes still proliferate to certain degrees, the process of which is tightly controlled by the host immune systems. Experimental autoimmune encephalomyelitis (EAE) mimics key features of MS in humans …

Host Immune Response To Enterovirus And Parechovirus Systemic Infections In Children., Anjana Sasidharan, Wail M. Hassan, Christopher J. Harrison, Ferdaus Hassan, Rangaraj Selvarangan

Manuscripts, Articles, Book Chapters and Other Papers

Background: Enterovirus (EV) and parechovirus type A3 (PeV-A3) cause infections ranging from asymptomatic to life-threatening. Host immune responses in children, particularly innate responses to PeV-A3, remain largely unknown. The aim of this study was to determine aspects of the cytokine/chemokine responses to EV and PeV-A3 in cerebrospinal fluid (CSF) and plasma obtained from children with systemic/central nervous system infection.

Methods: A total of 74 salvaged CSF samples (27 with EV, 23 with PeV-A3, and 24 with neither EV nor PeV-A3) and 35 paired blood samples (10 with EV, 14 with PeV-A3, and 11 with neither) were studied. Concentrations of cytokines …

Intoxication With Endogenous Angiotensin Ii: A Covid-19 Hypothesis, Adonis Sfera, Carolina Osorio, Nyla Jafri, Eddie Lee Diaz, Jose Campo Maldonado

School of Medicine Publications

Severe acute respiratory syndrome coronavirus 2 has spread rapidly around the globe. However, despite its high pathogenicity and transmissibility, the severity of the associated disease, COVID-19, varies widely. While the prognosis is favorable in most patients, critical illness, manifested by respiratory distress, thromboembolism, shock, and multi-organ failure, has been reported in about 5% of cases. Several studies have associated poor COVID-19 outcomes with the exhaustion of natural killer cells and cytotoxic T cells, lymphopenia, and elevated serum levels of D-dimer. In this article, we propose a common pathophysiological denominator for these negative prognostic markers, endogenous, angiotensin II toxicity. We hypothesize …

Psjh Telehealth Covid-19 Repsonse, Todd Czartoski

Articles, Abstracts, and Reports

No abstract provided.

Psychosocial Impacts And Employment Preparedness Of Participating In An Hiv Peer Program: Implications For Tailoring A Vocational Counseling Model For Plwh, Erin R. Mckinney-Prupis

Dissertations and Theses

Background:

Medical advancements in HIV care should have reduced barriers to employment for PLWH, yet in 2017 only 47.7% of PLWH reported being employed, as compared to 62.9% in the general population. Employment is a significant social determinant of health, it impacts a variety of factors related to health, including earned income, access to healthcare, and social connectedness. Quantitative and qualitative studies have identified several concerns PLWH have about entering the workforce; the most pressing being fear of losing benefits. Targeted work readiness programs for PLWH is an important approach to help PLWH overcome their unique barriers to work, such …

A Case Of Pott's Disease: Typical Presentation Of An Uncommon Disease In The United States, Neha Patel, Ravi Patel, Marek Krysztofiak, K V. Sundaresh

West Florida Division GME Research Day 2020

Pott’s disease (PD), also known as tuberculosis spondylitis, is a rare disease of the spine which is typically caused by extraspinal infection. The basic lesion in Pott's disease is a combination of osteomyelitis and arthritis, usually affecting more than one vertebra. The anterior aspect of the vertebral body adjacent to the subchondral plate is commonly involved. Spinal TB can include any of the following: progressive bone destruction leading to vertebral collapse and kyphosis, cold abscess formation (due to extension of infection into adjacent ligaments and soft tissues), spinal canal narrowing by abscesses, granulation tissue or direct dural invasionresulting in spinal …

Pasteurella Multocida Bacteremia Secondary To Multiple Cat Scratches, Charles Boadu, Andrea Hernandez, Bassem Zeidan, John T. Young, Johnathan Frunzi

West Florida Division GME Research Day 2020

Pasteurella multocida(P. multocida)is part of the normal gastrointestinal and upper respiratory flora of domestic and wild animals such as dogs, cats, rabbits, opossums, boars, tigers, lions and horses ^{(1, 2)}. Transmission of P. multocidais usually through scratches and bites leading to infections of the soft tissue and skin ^(3,4). P. multocida bacteremia is rare, but occurs in individuals with major risk factors including chronic pulmonary disease, diabetes mellitus, end state renal disease (ESRD), and an immunocompromised state ^(3,4). Non traumatic infections of P. multocida in immunocompromised individuals,are more likely to require care in the intensive care unit …

Knowledge, Attitude And Perception Survey Of Doctors Regarding Antibiotic Use And Resistance In Karachi, Pakistan, Hassan Ahmed, Sameer Bhimani, Iffat Khanum, Ammara Khan, Akash Khetpal, Mohammad Abubakar Abbas, Faizan Godil, Ansab Godil, Inam Ul-Haq Muhammad Makhdoom

Department of Medicine

Objective: To establish a better understanding of physicians' knowledge and beliefs, and to compare distinctions in knowledge, attitude and perception of junior and senior doctors regarding rational use of antibiotics.
Methods: The cross-sectional study was conducted at a tertiary care hospital in Karachi, from June 1 to July 31, 2016, and comprised senior and junior doctors. A 26-item questionnaire divided in three sections was used to test knowledge, attitude and perception of the subjects regarding rational use of antibiotics. Data was analysed using SPSS 23.
Results: Of the 200 subjects, 132(66%) were senior doctors; 68(34%) were junior; …

As The Covid-19 Pandemic Drags On, Where Have All The Stemis Gone?, Waqas Ullah, Yasar Sattar, Rehan Saeed, Asrar Ahmad, Margot I. Boigon, Donald C. Haas, M. Chadi Alraies

Abington Jefferson Health Papers

In the midst of current pandemic individuals with all sorts of medical ailments are afraid to venture into health-care settings and risk contracting Coronavirus disease 2019 (COVID-19). Irrespective of the inherent thromboembolic risks associated with COVID-19, this puts patients at high risk of cardiac complications

Outcomes Of Patients Hospitalized With Community-Acquired Pneumonia With Liver Disease Or Cirrhosis., Bibodh Jung Karki, Sravan K. Ponnekanti, Vidyulata Salunkhe, Nishita Tripathi, Mahder A. Tella, Stephen P. Furmanek, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

Introduction: Liver disease and cirrhosis are common causes of mortality worldwide. Community-acquired pneumonia is recognized as a significant cause of morbidity and mortality in this population of adults. There is a lack of data regarding outcomes or prognosis in patients with liver dysfunction who develop CAP. The objective of this study was to evaluate the clinical characteristics, incidence, and outcomes of hospitalized patients with CAP and liver disease.

Methods: This was a secondary analysis of the University of Louisville Pneumonia Study, which was a prospective population-based cohort study of adults hospitalized with community-acquired pneumonia. All patients were divided into three …

Covid-19 Student Telehealth Support Initiative, Yash Varma, Mary White, Alexandra Leto

Health Equity and Quality Improvement (HEQI) Summit

SKMC students partnered with numerous TJUH departments and developed a telehealth support initiative to:

• Help TJUH patients navigate the telehealth system
• Reduce system-wide appointment delays experienced by patients
• Provide direction to COVID-19 resources

A Volunteer Script was prepared to help patients troubleshoot common issues with accessing the telehealth system and provide up to date recommendations from the CDC to remain safe.

Twilighter Role To Support Primary Team Patient Care, Workflow Efficiency, And Physician Wellbeing, Jesse Edwards, René Daniel, Catriona Harrop

Health Equity and Quality Improvement (HEQI) Summit

Objective

Enhance patient care, process efficiency, and physician wellbeing by decompressing primary team workload and reducing the multitasking demands during critical hours of the daily workflow

Ventilator Decision And Allocation Pathway For Surge Conditions, Bridget Gekas, Jerin Juby, Monica Purcell, John Smith, Laura Fantazzi, Raymond Malloy

Health Equity and Quality Improvement (HEQI) Summit

We created a deployment plan of the available ventilator fleet to be deployed during surge conditions. The plan includes appropriate allocation of acute care ventilators to manage complex respiratory patients, while a percentage of stable respiratory patients can be safely managed using a back-up ventilator.

Organizing A System-Wide Effort On Ventilator Supply Management During Covid-19, Jerin Juby, Raymond Malloy, Bridget Gekas, Laura Fantazzi, Monica Purcell, John Smith, Kathryn Sebastian, Lauren Diduch, Melissa Brancolassi, Megan Hennessy, James Fields

Health Equity and Quality Improvement (HEQI) Summit

We developed a concise definition of ventilators to accurately represent them in all reports across the enterprise, and a ventilator deployment plan.

Use Of Mobility And Exercise Videos During Covid-19 To Minimize Deconditioning, Nethra Ankam, Md, Tulasi Gude, Md, Courtney Back, Pt, Monina Florendo, Pt, Elizabeth Hearn, Pt, Morgan Miller, Pt, Kristen Stout, Pt

Health Equity and Quality Improvement (HEQI) Summit

COVID19 patients are at risk for becoming quickly deconditioned, especially in the hospital setting given the nature of the virus and those that get admitted. The concern for deconditioning stems from patients being confined to their room, the need to minimize exposure amongst healthcare providers and the need to conserve PPE.

We wanted to find ways to optimize opportunities for patient mobility, maintain patient and provider safety, all while conserving PPE. We reviewed the Chinese Association of Rehabilitation Medicine guidelines to help develop the exercise program.

Repairing A Damaged Powered Air-Purifying Respirator (Papr) Battery Component Component With 3-D Printing, Robert Ries, Dante Varotsis, Michelle Ho, Kathryn Linder, Jordan Kurzum, Bon Ku, Md, Mpp, Matt Fields, Md, Robert Pugliese, Pharmd, Morgan Hutchinson, Md

Health Equity and Quality Improvement (HEQI) Summit

• A team from the Thomas Jefferson University Health Design Lab worked with local engineers at FKB to create a 3-D replacement model for the faulty component
• A new component was designed to function with existing battery components
• The new component was created using a desktop fused deposition modeling (FDM) 3-D printer with polylactic acid (PLA) filament

Safer Ambu-Bag Manual Ventilation Through Addition Of A Second High Efficiency Particulate Air (Hepa) Filter, Robert Ries, Morgan Hutchinson, Md, Robert Pugliese, Pharmd, Bon Ku, Md, Mpp, Matt Fields, Md

Health Equity and Quality Improvement (HEQI) Summit

• Experts from the Thomas Jefferson University Health Design Lab met with Emergency Medicine and Anesthesia physicians and local engineers
• A design was envisioned in which 3-D printed connectors could be created to add an additional HEPA Filter as shown in Figure 1
• STL Files for the adapters were created based on standard HEPA filter diameters and 3-D printed
• The second HEPA filter was easily assembled by novice users using the adapters
• Ventilation adequacy using the double HEPA filter ambu-bag was similar to single HEPA filtered ambu-bag ventilation based on observed inflation of a test lung

Meeting The Critical Need For Ventilators In Treatment Of Covid-19 Patients, Alessandro Naopli, Nicholas Satterthwaite, Lawrence Husick, Dietrich Gravenstein, Jerin Juby, Monica Purcell, Bridget Gekas, Zvi Grunwald, Mae West, Bon Ku, Chip Malloy, Michael Mahla, Mijail Serruya

Health Equity and Quality Improvement (HEQI) Summit

We have designed and built a microprocessor-controlled valve manifold having a single air input supplied from a standard ventilator, three air outlets (one per patient), and a digital control panel for setting the pressure supplied to each patient as well as the desired respiration rate. The manifold features multiple pressure sensors for system monitoring. Each inspiration limb of the manifold will be fitted with a viral filter. Each expiration limb will have a passive HME in line with a viral filter to prevent patient cross-contamination and spread of virions.

Each patient will receive one epoch of inspiration pressure followed by …

Increasing Polst Documentation For Patient Transfers From Long Term Care Facilities, Jennifer White, Md, Mari Siegel, Chris Haines, Chris Pitsch, Heather Peiritsch, Erica Westlake

Health Equity and Quality Improvement (HEQI) Summit

With an increase in patients from long term care facilities being admitted to the hospital, a lack of goals of care documentation became evident and presented the providers with many unknowns regarding patient care.

Without documentation and sick with COVID, patients cannot always advocate for themselves. This problem is worsened by the ban on visitors, preventing surrogate decision makers from being in the room.

There is a need for providers at long term care facilities to have these goals of care discussions, for COVID specific circumstances and for long term care.

Creation Of A Dedicated Anesthesia Airway Cart For Use In High-Volume Covid-19 Airway Management, Anna Rabinowitz, Alexander M. Olson, Daniel Casey, Elaine Kilmartin

Health Equity and Quality Improvement (HEQI) Summit

The COVID-19-specific approach to intubation required a change in the team structure and workflow for emergent airway management.

1. New need for bulky PPE and the introduction of an aerosol barrier shield for emergent intubations
2. Higher volume of intubations and use of videolaryngoscopy requires additional equipment
3. Concern for Code Cart contamination and wastage of airway equipment
4. Desire for more efficient approach to selecting and customizing equipment

Telemedicine Certified Recovery Specialists For Patients With Opioid Use Disorders In The Emergency Department In Covid-19, Kory S. London, Md

Health Equity and Quality Improvement (HEQI) Summit

COVID-19 is a staggering tragedy in a number of manners, but the lack of available access points to healthcare services due to federal, state, local and institutional regulations and decisions creates higher levels of patient vulnerability.

Patients with opioid use disorders (OUD) are especially vulnerable given high levels of coexistent housing insecurity, food insecurity and lack of primary care at baseline. These patients frequently utilize the emergency department for both medical and non-medical concerns.

Existing pathways to assist these patients utilize in person certified (peer) recovery specialists (CRS) who are not employed by the enterprise. Given the need to limit …

Training New Providers Dobhoff Tube Insertion During Covid-19: Rapid Training And A Novel “Opt In” Approach To Learning, Michele Decastro, Msn, Crnp, Heather M. Etzl, Msn, Rn, Cbc, Jacqueline E. Crawford, Ms, Rn, Accns-P

Health Equity and Quality Improvement (HEQI) Summit

As increasing numbers of Covid-19 patients were admitted to the hospital and progressed thru their disease course, the Division of Hospital Medicine noted an increased need for enteral feeding access for their patients. At the same time, the Nutritional Support Clinical Nurse Specialists were seeing an increase in requests for assistance with use of Cortrak technology for insertion of Dobhoff tube (DHT) insertion for high risk patients diagnosed with Covid-19.

Progression Of Patient Cohorting In Response To Covid-19 At The Jefferson Methodist Emergency Department, Kory S. London, Md, Efrat Kean, Md

Health Equity and Quality Improvement (HEQI) Summit

While COVID-19 and it’s various complications are a source of a substantial number of Emergency Department (ED) visits, many patients still arrive to the ED for non-COVID-19 indications.

Due to pre-existing construction which was halted by the pandemic, external space for a tent configuration was unavailable.

In effort to decrease patient, staff and nurse exposure to COVID, a system of cohorting was created to assure uninterrupted service in a manner as safe as possible for all involved.

Given the uncertainty of patient volumes and the potential for a high burden of disease similar to our colleagues in New York and …

Jefferson Internal Medicine Associates (Jima) Patient Triage Initiative, Mary White, Alexandra Leto, Barry Ziring, Md

Health Equity and Quality Improvement (HEQI) Summit

HOW MIGHT WE:

1. Contact patients to triage them for in-person versus virtual visits and teach them to use telehealth quickly?
2. How might we screen patients who are coming to the office for COVID-19 symptoms and exposures?

Ensure Follow-Up For Functional Issues Post Covid-19, Nethra Ankam, Md, Tulasi Gude, Md, Kristofer Feeko, Do, Shannon Ames, Pt, Catherine Piersol, Ot, Tiffany Prince-Kandrakota, Pt, Erica Rao, Pt, Kristen Stout, Pt, Monina Florendo, Pt

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

Patients post COVID-19 infection have functional limitations at home related to the multi-system effects of the infection, in addition to elevated risk for post-intensive care syndrome.

Our goals were to ensure patients had the resources they needed to safely mobilize at home, ensure referral to appropriate agencies for home care and therapies, and provide guidance on return to life activities in the setting of the stay-at-home order, need to self-quarantine, and limited outpatient therapy options.

Disposable Equipment For Efficient Home Sleep Apnea Testing And Minimizing Human Handling At The Sleep Laboratory, Abigail Quintos, Robert Tavella, Karl Doghramji

Health Equity and Quality Improvement (HEQI) Summit

As part of the disease mitigation strategy at the time of the pandemic, the Jefferson sleep laboratory has completely shifted towards utilization of the third-party vendor for HSATs. The vendor specializes in handling, shipping and disinfecting the HSAT equipment. They send the data electronically to the Jefferson sleep laboratory for interpretation.

We propose a single-use, fully disposable HSAT kit (WatchPAT One) to further minimize potential virus exposures and spread. The single-use design allows no return shipment, no charging or downloading, no cleaning and no infection transmission risk.

Since the equipment utilizes a different mechanism - peripheral arterial tone (PAT) signal …

Virtual Community Health Workers: Outreach Calls During Covid-19, Geoffrey Hayden, Md, Paula Ostroff, Rn, Ms, Emily Romano, Bs, Imani Gray-Taylor, Carl Johnson, Bs, Angelique Miller, Sharla Thomas, Ba, Gina Mccoy, Bs, Deborah Ziring, Md

Health Equity and Quality Improvement (HEQI) Summit

The “Clinical Experience” program at the Sidney Kimmel Medical College, established in 2017, provides pre-clerkship students with an opportunity to identify and address patients’ needs for social determinants of health (SDoH). The COVID-19 pandemic led to a suspension of the student program in the clinical environment, but the CHWs continued to address patients’ social needs from a remote setting. In the absence of established best practices regarding patient outreach calls from a remote setting, we sought to develop an effective workflow that would mask the CHWs’ personal cell phones while leading to fewer “unable to reach” scenarios and improved case …

Progression Of Patient Cohorting In Response To Covid-19 At The Jefferson Methodist Emergency Department, Kory S. London, Md, Efrat Kean, Md

Health Equity and Quality Improvement (HEQI) Summit

COVID-19 is a predominantly respiratory disease and Philadelphia is a city with a myriad of pulmonary comorbidities such as asthma and COPD.

Use of bronchodilator medications through a nebulizer machine is considered an 'Aerosol Generating Procedure' (AGP), and increases risks to staff who and complicates the cleaning and processing of rooms and equipment where AGPs are performed. Additionally, there is a severe limitation in availability of negative pressure rooms, which mitigate these AGPs.

With the COVID pandemic causing supply chain problems across the country, a multidisciplinary approach was required to appropriately ration available inhalers (MDI), the alternatives to nebulized treatments, …

Response To Rapidly Changing Healthcare Information Regarding Covid-19 With Virtual Journal Club, Kelly Hughes, Md, Rachel Redfield, Md, Jetmir Vojnika, Md, Mark Mallozzi, Md, R. Benson Jones, Md, Reem Aoun, Md, Dianna Cheney-Peters, Md

Health Equity and Quality Improvement (HEQI) Summit

Virtual twice weekly COVID-19 journal club (JC) created to optimize residency and faculty education regarding COVID-19 management, critical appraisal of new literature, and improve departmental collaboration and connection.