Serum Ammonia and Folate Levels: Opportunities for High Value Care

High value care encompasses a variety of principles including ordering tests with high diagnostic yield, while reducing low value practice

Improving Safety of Direct Oral Anticoagulant (DOAC) Dosing in Patients with Severe Chronic and End-Stage Renal Disease

The significance of this study is to determine the degree of inconsistency in dosing practice of DOACs at a quaternary care institution such as Thomas Jefferson University Hospital. What is the primary indication for anticoagulation in out population? What percentage is dosed correctly? Are patients primarily over or underdosed

Procedural and Clinical Outcomes of Transitioning to High Power Short Duration Guided Ablation for Atrial Fibrillation

Introduction: High-power short-duration (HPSD; 50W for up to 15s) ablation is a novel way to use a contact force-sensing catheter optimized for power-controlled radiofrequency ablation of atrial fibrillation (AF). Our goal was to compare the procedural and clinical outcomes of AF ablation with HPSD to previous ablation methods used, including standard-power standard duration (SPSD; 20-25W, up to 60s) and temperature-controlled non-contact (TCNC; 20-40W, up to 60s). Methods: Procedural and clinical data was from consecutive cases of patients with paroxysmal or persistent AF undergoing pulmonary vein isolation with HPSD, TCNC and SPSD between 7/1/13 to 11/1/19. A total of 171 patients were studied (76 HPSD, 44 TCNC, 51 SPSD). Results: There was no difference in age, sex, or AF type between groups. Radiofrequency ablation time was shorter when comparing HPSD to SPSD (71 vs 101min; p\u3c0.01), HPSD to TCNC (71 vs 146min; p\u3c0.01), and SPSD to TCNC groups (101 vs 146min; p\u3c0.01). There was no difference in sinus rhythm maintenance after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume, CHA2DS2-VASc score, or left ventricular EF. There was a numerical difference in safety with no adverse events in HPSD (0/76 in HPSD vs 1/51 in SPSD vs 3/44 in TCNC; p=0.06). Discussion: AF ablation utilizing HPSD ablation reduced procedure times with similar sinus rhythm maintenance compared to SPSD and TCNC ablation. This supports the movement to replace SPSD and TCNC with the novel HPSD approach. Further research is warranted with larger populations and longer follow-up

Pneumatosis Intestinalis in a Patient with Systemic Lupus Erythematosus

Introduction Pneumatosis intestinalis (PI) refers to the radiographic finding of gas within the small or large bowel wall. It can be seen in association with gas in the portal venous system. The clinical significance of these findings is variable and depends on the patient\u27s etiology and initial presentation. PI can be seen anywhere in the gastrointestinal tract distal to the stomach and is caused by a myriad of conditions.1 We present a case of a patient admitted to the intensive care unit with PI and portal vein gas

Increasing Awareness for the Opioid Aftercare Coordination Service (OACS)

Background The United States is in a crisis of opiate related adverse events. From 1999 2017, more than 700,000 people in the U.S. died from drug related overdose; 68% of those involved opioids Admissions at Jefferson Hospital for opioid abuse complications are common among the medicine services. Treating patients for their opiate addiction is essential to prevent future opioid overdoses and other complications Jefferson has initiated an Opioid Aftercare Coordination Service (OACS) consult system in response to this crisis in order to increase the number of patients who receive medications for opioid use disorder on discharge OACS serves both Jefferson Hospital and Methodist and aims to: – Link patients with medications for opioid use disorder after discharge – Provide access to ancillary resources inpatient and outpatient – Provide in hospital counselinghttps://jdc.jefferson.edu/patientsafetyposters/1122/thumbnail.jp