Surgery Commons^™

Unique Classification Of Parathyroid Dysfunction In Patients With Transfusion Dependent Thalassemia Major Using Nomogram: A Cross Sectional Study, Hafsa Majid, Lena Jafri, Jamsheer Jehangir Talati, Sibtain Ahmed, Bushra Moiz, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

Introduction: Hypoparathyroidism is a rare complication of iron overload in patients with transfusion dependent β thalassemia major (β-TM). We aim to determine the prevalence of parathyroid dysfunction in patients with β-TM.
Methods:Diagnosed cases of transfusion dependent β-TM between 5 and 17 years of age were recruited from outpatient clinics of a non-profit organization in Karachi, Pakistan. Blood and urine samples were collected in fasting to determine Ca, P, Alb, Mg, Cr 25OHD and iPTH. Patients were grouped on the basis of upper and lower levels of Ca, 25OHD and iPTH for assessing parathyroid dysfunction into primary hypoparathyroidism [low calcium …

Commentary: The History Of Neurosurgery At Albany Medical College And Albany Medical Center Hospital, Albany, New York., Pouya Entezami, Michael R. Gooch, Adedamola Adepoju, Julie Pilitsis, Tyler J. Kenning, Alan Boulos, David L. Semenoff

Department of Neurosurgery Faculty Papers

The origins of the Department of Neurosurgery at Albany Medical College closely parallel the development of early America and the establishment of modern health care.The tales of Washington Irving, the works of the Hudson River School of painters, and summers in the Catskill Mountains or Adirondacks are the stories that color the history of Upstate New York (Figure1). As a social, industrial, and political hub of the American colonies, New England’s need for centers providing structured medicine led to the creation of Albany Medical College in1839, one of the earliest such institutions in the young nation.1 Rapid progress in nearly …

Changing The Surgical Residency: A Mixed-Methods Study Of Residents’ And Faculty Experiences One Year After Implementation, Sarah B. Cairo, Wendy Craig, Caitlin Gutheil, Paul K. J. Han, Kristiina Hyrkas, Lynda Macken, Jim Whiting

Journal of Maine Medical Center

Objective: To evaluate a reformed surgical residency curriculum aimed at addressing emerging practice models, enhancing residents’ educational experience, and improving the quality/continuity of patient care by reducing the service size and enhancing attending-resident interactions.

Methods: A mixed-methods study of the surgical training program following curriculum reform including: 1) focus group and individual qualitative interviews with residents, attendings, nurses, and advanced practice providers to explore stakeholder perspectives on curriculum reform, 2) time study of surgical resident activities, and 3) quantitative assessment of surgical case logs.

Results: Qualitative interviews demonstrated disparate knowledge and attitudes regarding the goals of the curriculum with emergence …

Interpreting Patient Reported Outcomes In Orthopaedic Surgery: A Systematic Review, Shgufta Docter, Zina Fathalla, Michael Lukacs, Michaela Khan, Morgan Jennings, Shu-Hsuan Liu, Dong Zi, Dianne Bryant

Western Research Forum

Background: Reporting methods of patient reported outcome measures (PROMs) vary in orthopaedic surgery literature. While most studies report statistical significance, the interpretation of results would be improved if authors reported confidence intervals (CIs), the minimally clinically important difference (MCID), and number needed to treat (NNT).

Objective: To assess the quality and interpretability of reporting the results of PROMs. To evaluate reporting, we will assess the proportion of studies that reported (1) 95% CIs, (2) MCID, and (3) NNT. To evaluate interpretation, we will assess the proportion of studies that discussed results using the MCID or the effect sizes and how …

Graves, Guthrie Yochlee, 1903-1967 (Sc 3449), Manuscripts & Folklife Archives

Manuscript Collection Finding Aids

Finding aid only for Manuscripts Small Collection 3449. Typescript of an article dated in pencil 4/22/50 and titled "Congenital Subtotal Duodenal Stenosis" by Dr. Guthrie Y. Graves of Bowling Green, Kentucky. Includes three x-rays of an infant’s abdominal section and a copy of the bill from Bowling Green's City Hospital for $132. The x-rays and bill, dated 1946, were for one of the patients mentioned in the article, the case of Baby Wanda Faye Pearson of Bowling Green. Also includes a proof for an article by Drs. Graves and Henry S. Harris titled "Carcinoma of the Male Breast with Axillary …

Postoperative Pain: Factors And Tools To Improve Pain Management In Children, Mai M. Makhlouf, Eric Robles Garibay, Brooke N. Jenkins, Zeev N. Kain, Michelle Fortier

Psychology Faculty Articles and Research

Outpatient surgery has made it increasingly common for parents to manage pain in the home setting. Studies have shown that parents often under treat pain, leaving children vulnerable to the negative side effects of suboptimal pain management. Multiple factors affect pain management like child’s age and developmental stage, language, cultural values like stoicism, parental beliefs about medication, biological differences among groups, etc. Understanding all the factors involved can help healthcare providers and parents better understand pain and contribute to optimal pain management. Multiple tools and technological interventions have been created to help create a better understanding of pain and a …

Long–Term Patency Of Arteriovenous Fistula After Endovascular Salvage Procedure And It's Affecting Factors, Patrianef Darwis, Londung B. Sitorus, Akhmadu Muradi

The New Ropanasuri Journal of Surgery

Introduction. The limited durability of vascular access referred to the great challenges in hemodialysis. An immature arteriovenous fistula (AVF) that inadequately develops to support dialysis noted as the leading cause to immature AVF if stenosis found after creation. The endovascular fistula salvage (EFS) addressed for the preemptive repair of immature AVF despite surgicalrevision. However, no study on EFS proceeded in Indonesia with its specific characteristics. Thus, this study aimed to evaluate the efficacy of EFS and its influencing factors. Method. A retrospective cohort study carried out on those with immature AFV who underwent EFS procedures during the period ofJanuary 2016 …

Packed Red Blood Cell Transfusion Associates With Acute Kidney Injury After Transcatheter Aortic Valve Replacement, Akeel M. Merchant, Javier A. Neyra, Abu Minhajuddin, Lauren E. Wehrmann, Richard A. Mills, Sarah K. Gualano, Dharam J. Kumbhani, Lynn C. Huffman, Michael E. Jessen, Amanda A. Fox

Internal Medicine Faculty Publications

Background: Acute kidney injury after cardiac surgery significantly associates with morbidity and mortality. Despite not requiring cardiopulmonary bypass, transcatheter aortic valve replacement patients have an incidence of post-procedural acute kidney injury similar to patients who undergo open surgical aortic valve replacement. Packed red blood cell transfusion has been associated with morbidity and mortality after cardiac surgery. We hypothesized that packed red blood cell transfusion independently associates with acute kidney injury after transcatheter aortic valve replacement, after accounting for other risk factors.

Methods: This is a single-center retrospective cohort study of 116 patients undergoing transcatheter aortic valve replacement. Post-transcatheter aortic valve …

The Impact Of Cholesterol Deposits On The Fibrillar Architecture Of The Achilles Tendon In A Rabbit Model Of Hypercholesterolemia., Andrzej Steplewski, Jolanta Fertala, Ryan Tomlinson, Kevth'er Hoxha, Lin Han, Ocean Thakar, Jason Klein, Joseph A. Abboud, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Increased tendon pain and tendon damage is a significant complication related to hyperlipidemia. Unlike the well-established pathogenesis associated with increased serum concentrations of total cholesterol, triglycerides, and low-density lipoprotein in atherosclerotic cardiovascular disease, the role of hyperlipidemia in promoting tendon damage remains controversial and requires mechanistic clarity.

METHODS: In this study, we analyzed the consequences of hypercholesterolemia on the integrity of the collagen-based architecture of the Achilles tendon. The Achilles tendons from rabbits fed with normal-cholesterol (nCH) and high-cholesterol (hCH) diets were analyzed. We studied the morphology of tendons, distribution of lipids within their collagen-rich milieu, the relative amounts …

Creation Of An Institutional Toolkit For Evaluation Of Multidisciplinary Handoffs, Richard F. Schmidt, Md, Courtney Devin, Md, Nicholas Tarangelo, Md, Andrew Mendelson, Md, Bracken Babula, Md, Rebecca Jaffe, Md

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

Objectives

1. Create a method for analyzing different handoffs in a variety of clinical settings and scenarios at TJUH.
2. Develop a set of standardized survey tools using existing validated language to quantify the perceptions, quality, and needs for different patient care transitions.
3. Use results from these tools to cater focused handoff improvement interventions for specific patient care settings.

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.