Surgery Commons^™

The Implementation And Efficacy Of A Breast Cancer Wellness Group At Thomas Jefferson University Hospital, Steven Woodward, Md, Peter Altshuler, Md, Theodore N. Tsangaris, Md

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

Abstract

Introduction: Breast cancer is not only a physical disease but something that affects our patients’ mental, spiritual, emotional and social wellbeing. There has been literature that demonstrates the positive benefits of exercise, social support, and nonmedical adjuncts for breast cancer patients. There is currently a lack of wellness support within the Jefferson breast cancer community.

Methods: A wellness survey will be distributed throughout the breast surgery and breast oncology clinics to assess the current level of wellness and interest in a breast cancer wellness group at TJUH. This survey will be used both before and after implementation …

Lack Of Utility And Excess Cost Of Routine Perioperative Hematologic Testing In Patients Undergoing Elective Neurosurgical Procedures Of The Spine, Lucas Philipp, Md, Mph, Catriona Harrop, Md, David Wyler, Md, James Harrop, Md

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

Objective

To prospectively conduct a "mock trial" among 100% (minimum n=200) of elective neurosurgery spine patients to estimate the total projected cost, savings, risk, and feasibility of a redefined/restricted lab testing protocol over the next 12 months

“Can You Send Over The Imaging?” Analyzing The Patient Transfer Process At Tjuh, Walker Lyons, Md, Peter Altshuler, Md, Andrew Hallett, Md, Lindsay Lynch, Md, Tommy O'Malley, Md, Steven Woodward, Md, Alicja Zalewski, Md, Scott Cowan, Md

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

Objective

Our goal was to investigate possible ways to improve the transition of care when patients are transferred to Jefferson Center City. As a quaternary care hospital with a large transfer volume, it is especially important to look for ways to optimize this process because it can improve timely patient care, reduce and eliminate unnecessary studies and diagnostic tests and save time and work that could be better spent in other aspects of treating the patient.

Developing A Neurosurgical Spine Post-Operative Note Template On Epic For Improved Multi-Disciplinary Care, Omaditya Khanna, Md, Geoffrey P. Stricsek, Md, Giuliana Labella, Rn, James Harrop, Md, Jesse Edwards, Md

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

Introduction

The care of neurosurgical spine patients often involves a multi-disciplinary team, including neurosurgery residents, hospitalists, nursing staff, and physical/occupational therapists.

Oftentimes, post-op spine patients are on a non-neurosurgical service (hospitalist, MICU/SICU, medicine), who are provided with scant sign out on the procedure(s) performed.

The treatment team(s) that are helping manage patient care post-operatively are often unaware of the procedure performed, and what are the salient clinical signs/symptoms, radiographic findings, and laboratory values that need to be closely monitored

Stopping Clots While Saving Time: Creating An Epic Index For A Vital Daily Task, Juergen Kloo, Md, Jeffrey Riggio, Md

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

Introduction

• Appropriate thromboprophylaxis is a pressing issue across the united states and the rate of VTE at Thomas Jefferson University Hospital is higher than hospitals of similar complexity.
• A new tool was created for our EPIC EMR, the VTE Merli Index, that provided at a glance and detailed feedback regarding VTE prophylaxis status
• Prior to implementation of the index, we studied its ease of use. Our goal was to show the tool would decrease the amount of time and number of clicks required to interrogate the EMR for relevant VTE information by at least 50%.

Every Minute Counts: Using Health Information Technology To Reduce Chart Abstraction Times, Christine Schleider, Rn, Bsn, Cnor, Adam P. Johnson, Md, Mph, Kathleen Shindle, Rn, Bsn, Ccds, Henry A. Pitt, Md, John R. Kairys, Md, Scott W. Cowan, Md

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

No abstract provided.

Application Of Alvimopan As A Component Of Enhanced Recovery After Surgery (Eras) Protocol For Patients Undergoing Radical Cystectomy And Diversion (C&D), Thomas Hardacker, Md, Mba, May Jean Counsilman, Md, Benjamin H. Rudnick, Md, Edouard J. Trabulsi, Md, James R. Mark, Md, Leonard G. Gomella, Md, Mark J. Mann, Md, Costas D. Lallas, Md, Scott G. Hubosky, Md

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

Introduction

• Radical cystectomy with urinary diversion (C&D) is performed for patients with muscle-invasive bladder cancer (MIBC) or refractory carcinoma in situ (CIS)
• C&D patients receive one of several types of diversion depending on their age, comorbidities, functional status, and extent of disease (Figure 1)
• Post-operative length of stay (LOS) can be prolonged (9-11 days) and 30 day readmission rates and mortality elevated (30% and 1.5%); return of bowel function usually the rate-limiting step to discharge
• Enhanced Recovery After Surgery (ERAS) protocols utilize pre-, intra-, and postoperative elements in order to improve return of bowel function and decrease LOS
• Alvimopan is …

Coaching Operating Room To Pacu Handoff With A Standardized, Multidisciplinary Checklist, Courtney L. Devin, Md, Kathleen Grife, Rn, Ms, Marissa Weber, Md, Richard F. Schmidt, Md, Megan P. Lundgren, Md, Scott W. Cowan, Md

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

Purpose

To pilot a standardized multidisciplinary bedside handoff for any patient admitted to the post-anesthesia care unit (PACU) from the operating room.

Improving Postoperative Handoffs In The Neuro-Intensive Care Unit, Richard F. Schmidt, Md, Andrew Mendelson, Md, Sonia Gill, Md, Nicole Hollup, Crnp, Matthew Vibbert, Md, Coleen Vernick, Md, Giuliana Labella, Msn, Marie Wilson, Msn, Caitlin Harley, Msn, Maryanne Mccarrin, Msn, Jack Jallo, Md, Rebecca Jaffe, Md

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

Introduction

• Transitions of care represent a major source of medical errors, patient morbidity/mortality, and increased healthcare waste.
• 2018 CLER report indicated largely unfavorable responses toward handoffs and care transitions for perioperative services and neurointensive care.
• Use of the IPASS handoff tool is associated with up to 30% reduction in adverse events and 23% reduction in medical errors.
• Implementation of IPASS for postoperative handoffs in the SICU resulted in improved organization, safety, and communication.

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

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

Introduction

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

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

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

Objectives

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

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

Department of Surgery

No abstract provided.

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

Department of Surgery

No abstract provided.

Early Versus Delayed Flow Diversion For Ruptured Intracranial Aneurysms: A Meta-Analysis, Rimal Hanif Dossani, Devi P. Patra, Jennifer Kosty, Fareed Jumah, Okkes Kuybu, Nasser Mohammed, Muhammad Waqas, Muhammad Riaz, Hugo Cuellar

Section of Neurosurgery

Objective: The use and timing of flow diversion for aneurysmal subarachnoid hemorrhage is controversial. The objective of this study is to perform a meta-analysis and systematic review to compare overall complication rate between early versus delayed flow diversion for ruptured aneurysms.
Methods: A literature search for all eligible articles was performed using PubMed, Cochrane, and Web of Science databases. The primary outcome was the overall complication rate (any complication in the perioperative period), and secondary outcomes were 1) hemorrhage and 2) stroke/death (all hemorrhagic/ischemic strokes and/or death).
Results: Thirteen articles including 142 patients met inclusion criteria. Eighty-nine (62.7%) patients underwent …

Serum Biomarkers For Glioblastoma Multiforme, Ayesha Quddusi, Muhammad Shahzad Shamim

Section of Neurosurgery

A number of different serum biomarkers are currently being evaluated for their potential use as diagnostic and prognostic biomarkers in Glioblastoma Multiforme. Amongst these, a vast number of different microRNAs have been studied, that are up-regulated or downregulated in relation to Glioblastoma Multiforme. Different studies have found numerous associations of these different microRNAs with recurrence, Karnofsky Performance Score, Progression Free Survival and Overall Survival. Other than microRNAs, serum Glial Fibrillary Acid Protein, cytokines and YLK-40, as well as a number of other candidate serum biomarkers are being studied.More studies, with larger sample sizes are required before these serum biomarkers can …

Cardiothoracic Surgery Residency Training In Surgical Ablation For Atrial Fibrillation., Zachary M Deboard, Thomas K Varghese, John R Doty, Craig H Selzman

Articles, Abstracts, and Reports

Background: As no standardized curriculum exists for training cardiothoracic surgery residents in surgical ablation for atrial fibrillation there is potential for variation in operative technique, patient selection, and overall application. Thus we sought to assess the exposure of current residents in order to identify areas for improvement in their education.

Methods: A survey was emailed to residents inquiring about their training experience in surgical ablation for atrial fibrillation. Residents were asked about case volume, procedural variety, and guideline-based clinical scenarios where they felt ablation would be appropriate. Residents were also queried about their abilities to perform various lesion sets and …

The Validation Of Swahili Version Of The International Prostate Symptom Score Questionnaire, Miten Ramesh Patel

Master of Surgery

Background: Benign prostatic hyperplasia is a common condition encountered in men who are 50 years and above, presenting in hospitals for evaluation of lower urinary tract symptoms. The International Prostate Symptom Score is one of the questionnaires used to assess these symptoms. However, this questionnaire has not yet been validated among patients with Benign Prostate Hypertrophy in the Tanzanian setting. Objectives: The primary objective of this study was to assess the validity of the Swahili version of the IPSS questionnaire among patients with benign prostatic hyperplasia. Methods: We employed a cross-sectional study design in patients that presented at the Aga …

Tumor Heterogeneity As A Predictor Of Response To Neoadjuvant Chemotherapy In Locally Advanced Rectal Cancer, Alissa Greenbaum, David R. Martin, Therese J. Bocklage, Ji-Hyun Lee, Scott A. Ness, Ashwani Rajput

Pathology and Laboratory Medicine Faculty Publications

BACKGROUND: Neoadjuvant chemoradiotherapy (nCRT) is the standard of care for locally advanced adenocarcinoma of the rectum, but it is currently unknown which patients have disease that will respond. This study tested the correlation between response to nCRT and intratumoral heterogeneity using next-generation sequencing assays.

PATIENTS AND METHODS: DNA was extracted from formalin-fixed, paraffin-embedded biopsy samples from a cohort of patients with locally advanced rectal adenocarcinoma (T3/4 or N1/2 disease) who received nCRT. High read-depth sequencing of > 400 cancer-relevant genes was performed. Tumor mutations and variant allele frequencies were used to calculate mutant-allele tumor heterogeneity (MATH) scores as measures of intratumoral …

How Should We Deal With "Black Swan" Surgeons In Spine Surgery?, Jens R Chapman, Jeffrey C Wang, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Limited Morbidity And Possible Radiographic Benefit Of C2, Peter G Passias, Cole A Bortz, Frank Segreto, Samantha Horn, Katherine E Pierce, Haddy Alas, Avery E Brown, Renaud Lafage, Virginie Lafage, Justin S Smith, Breton Line, Robert Eastlack, Daniel M Sciubba, Eric O Klineberg, Alexandra Soroceanu, Douglas C Burton, Frank J Schwab, Shay Bess, Christopher I Shaffrey, Christopher P Ames

Articles, Abstracts, and Reports

Background: The study aims to evaluate differences in alignment and clinical outcomes between surgical cervical deformity (CD) patients with a subaxial upper-most instrumented vertebra (UIV) and patients with a UIV at C2. Use of CD-corrective instrumentation in the subaxial cervical spine is considered risky due to narrow subaxial pedicles and vertebral artery anatomy. While C2 fixation provides increased stability, the literature lacks guidelines indicating extension of CD-corrective fusion from the subaxial spine to C2.

Methods: Included: operative CD patients with baseline (BL) and 1-year postop (1Y) radiographic data, cervical UIV ≥ C2. Patients were grouped by UIV: C2 or subaxial …

Negative Appendectomy Rate And Associated Factors In Urban Referral Hospitals In Tanzania, Masawa Klint Nyamuryekung’E

Master of Medicine in General Surgery

Background: Acute appendicitis is a common surgical emergency. In atypical presentation, making a clinical diagnosis is difficult leading to delays with high perforation rate or misdiagnoses and high negative appendectomy rates. In the urban referral hospitals in Tanzania the baseline perforation rate, negative appendectomy rate, and factors that drive it are unknown. These could serve as measures of performance, and as evaluation parameters of future interventions aimed at improving acute appendicitis case management in Tanzania. Objectives: The aim of this study was to establish the negative appendectomy rate and associated factors among patients undergoing emergency appendectomy for suspected acute appendicitis …

Performance Of The Promis In Patients Undergoing 3 Common Elbow Procedures, Edward O. Rojas, Natalie Glass, Jessell Owens, Chris A. Anthony, Matthew Bollier, Brian R. Wolf, Carolyn Hettrich

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Ulnar collateral ligament (UCL) reconstruction, distal biceps tendon repair, and elbow arthroscopic surgery are common elbow procedures performed in active patients.

Hypothesis: We hypothesized (1) good to excellent correlation between Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and traditional orthopaedic upper extremity patient-reported outcome (PRO) measures; (2) that PROMIS instruments would demonstrate ceiling effects; and (3) that the PROMIS physical function computer adaptive test (PF CAT) would demonstrate a low question burden compared with other PRO instruments.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: A total of 76 patients undergoing UCL repair/reconstruction, distal biceps tendon repair, …

Aseptic Loosening Of An Aptis Distal Radioulnar Joint Arthroplasty – Case Report, Karis Bennett, Srinath Kamineni

Orthopaedic Surgery and Sports Medicine Faculty Publications

Dysfunction of the distal radioulnar joint can cause significant pain and instability. The self-stabilizing APTIS distal radioulnar joint prosthesis is used as a solution for severe distal radioulnar joint pathologies. We present a case of a 60-year-old male, who received an APTIS distal radioulnar joint prosthesis which resulted in aseptic loosening within five years of the initial implantation. Infection, incorrect implantation, demographic differences and over-activity were all excluded as the source; therefore, mechanical aseptic loosening was concluded. Ultimately, two surgeries were required to resolve the patient's pain, which resulted in a one-bone forearm once the implant was extracted. The solution …

Mutational Landscape Of Head And Neck Squamous Cell Carcinomas In A South Asian Population, Kulsoom Ghias, Sadiq S. Rehmani, Safina Abdul Razzak, Sarosh Madani, M Kamran Azim, Rashida Ahmed, Mumtaz J Khan

Department of Biological & Biomedical Sciences

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer type globally and contributes significantly to burden of disease in South Asia. In Pakistan, HNSCC is anmong the most commonly diagnosed cancer in males and females. The increasing regional burden of HNSCC along with a unique set of risk factors merited a deeper investigation of the disease at the genomic level. Whole exome sequencing of HNSCC samples and matched normal genomic DNA (n=7) was performed. Significant somatic single nucleotide variants (SNVs) were identified and pathway analysis performed to determine frequently affected signaling pathways. We identified significant, novel …

Comparison Of Surgical Outcomes Of The Posterior And Combined Approaches For Repair Of Cervical Fractures In Ankylosing Spondylitis., Panya Luksanapruksa, Paul William Millhouse, Victor Carlson, Thanase Ariyawatkul, Joshua Heller, Christopher K. Kepler

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: To evaluate surgical outcomes and complications of cervical spine fractures in ankylosing spondylitis (CAS) patients who were treated using either the posterior (P) or combined approach (C).

OVERVIEW OF LITERATURE: Ankylosing spondylitis typically causes progressive spinal stiffness that makes patients susceptible to spinal fractures. CAS is a highly unstable condition. There is contradictory evidence regarding which treatment option, the posterior or the combined approach, yields superior clinical results.

METHODS: A single institution database was reviewed for data in the period 1999 to 2015. All CAS patients who underwent posterior or combined instrumented fusion were …

Automated Fiber Tract Reconstruction For Surgery Planning: Extensive Validation In Language-Related White Matter Tracts., Matteo Mancini, Sjoerd B. Vos, Vejay N. Vakharia, Aidan G. O'Keeffe, Karin Trimmel, Frederik Barkhof, Christian Dorfer, Salil Soman, Gavin P. Winston, Chengyuan Wu, John S. Duncan, Rachel Sparks, Sebastien Ourselin

Department of Neurosurgery Faculty Papers

Diffusion MRI and tractography hold great potential for surgery planning, especially to preserve eloquent white matter during resections. However, fiber tract reconstruction requires an expert with detailed understanding of neuroanatomy. Several automated approaches have been proposed, using different strategies to reconstruct the white matter tracts in a supervised fashion. However, validation is often limited to comparison with manual delineation by overlap-based measures, which is limited in characterizing morphological and topological differences. In this work, we set up a fully automated pipeline based on anatomical criteria that does not require manual intervention, taking advantage of atlas-based criteria and advanced acquisition protocols …

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

Challenges Of Training And Delivery Of Pediatric Surgical Services In Developing Economies: A Perspective From Pakistan, Amir Humza Sohail, Muhammad Hassaan Arif Maan, Mohammed Sachal, Muhammad Soban

Medical College Documents

Background: As the pediatric population requiring health services rises globally, developing countries are struggling to cater to the growing burden of non-communicable diseases - particularly those requiring specialized surgical care.
Main body: Despite the literature supporting specialized pediatric surgical care, the developing world is far from meeting the American Pediatric Surgical Association (APSA) Manpower taskforce recommendation of at least 1 qualified pediatric surgeon per 100,000 patients (0-15 years-old). In Pakistan, there is an unmet surgical need in the pediatric population due to a multitude of short shortcomings, notably in quality and quantity of the training programs on offer, and urgent …

Lymphocytic Lobulitis Presenting In An Adolescent Female: A Case Report, Kevin Meilak Md

Research Days

No abstract provided.

Improved Orthopaedic Repairs Through Mechanically Optimized, Adhesive Biomaterials, Stephen Wheeler Linderman

McKelvey School of Engineering Graduate Student Theses & Dissertations

Despite countless surgical advances over the last several decades refining surgical approaches, repair techniques, and tools to treat tendon and tendon-to-bone injuries, we are still left with repair solutions that rely on fairly crude underlying mechanical principles. Musculoskeletal soft tissues have evolved to transfer high loads by optimizing stress distribution profiles across the tissue at each length scale. However, instead of mimicking these natural load transfer mechanisms, conventional suture approaches are limited by high load transfer across only a small number of anchor points within tissue. This leads to stress concentrations at anchor points that often cause repair failure as …