Improving the Patient Colonoscopy Prep Experience

AIM: To improve patient prep compliance, prep quality, and an overall better experience by designing a prep specific website that will address the most common prep questions and concerns Once launched, the website address will be placed on printed colonoscopy prep instructions and stated on the after hours GI clinic voicemail as an additional patient resourcehttps://jdc.jefferson.edu/patientsafetyposters/1049/thumbnail.jp

Improving Utilization of SGLT2 Inhibitors in the Inpatient Setting

SGLT2 inhibitors have been shown to have a significant benefit for patients with DM2 or CAD (DAPA-HF, Emperor-reduced) The usage of these medications are low compared to other Goal Directed Medical Therapy. There are multiple contributing factors as to why these medications are underutilized Our aim is to assess barriers against prescription of SGLT2-i at the time of discharge from TJUH and to increase utilization after placement on formulary

Biomechanical Analysis of an Interspinous Process Fixation Device with In Situ Shortening Capabilities: Does Spinous Process Compression Improve Segmental Stability?

OBJECTIVE: The objective of this study was to characterize the biomechanical implications of spinous process compression, via in situ shortening of a next-generation interspinous process fixation (ISPF) device, in the context of segmental fusion. METHODS: Seven lumbar cadaveric spines (L1-L4) were tested. Specimens were first tested in an intact state, followed by iterative instrumentation at L2-3 and subsequent testing. The order followed was 1) stand-alone ISPF (neutral height); 2) stand-alone ISPF (shortened in situ from neutral height; shortened); 3) lateral lumbar interbody fusion (LLIF) + ISPF (neutral); 4) LLIF + ISPF (shortened); 5) LLIF + unilateral pedicle screw fixation; 6) LLIF + bilateral pedicle screw fixation. A 7.5-Nm moment was applied in flexion/extension, lateral bending, and axial rotation via a kinematic test frame. Segmental range of motion (ROM) and lordosis were measured for all constructs. Comparative analysis was performed. RESULTS: Statistically significant flexion/extension ROM reductions: all constructs versus intact condition (P \u3c 0.01); LLIF + ISPF (neutral and shortened) versus stand-alone ISPF (neutral and shortened) (P \u3c 0.01); LLIF + USPF versus ISPF (neutral) (P = 0.049); bilateral pedicle screw fixation (BPSF) versus stand-alone ISPF (neutral and shortened) (P \u3c 0.01); LLIF + BPSF versus LLIF + unilateral pedicle screw fixation (UPSF) (P \u3c 0.01). Significant lateral bending ROM reductions: LLIF + ISPF (neutral and shortened) versus intact condition and stand-alone ISPF (neutral) (P \u3c 0.01); LLIF + UPSF versus intact condition and stand-alone ISPF (neutral and shortened) (P \u3c 0.01); LLIF + BPSF versus intact condition and all constructs (P \u3c 0.01). Significant axial rotation ROM reductions: LLIF + ISPF (shortened) and LLIF + UPSF versus intact condition and stand-alone ISPF (neutral) (P ≤ 0.01); LLIF + BPSF versus intact condition and all constructs (P ≤ 0.04). CONCLUSIONS: In situ shortening of an adjustable ISPF device may support increased segmental stabilization compared with static ISPF

Spinal anesthesia: should everyone receive a urinary catheter?: a randomized, prospective study of patients undergoing total hip arthroplasty.

BACKGROUND: The objective of this randomized prospective study was to determine whether a urinary catheter is necessary for all patients undergoing total hip arthroplasty under spinal anesthesia. METHODS: Consecutive patients undergoing total hip arthroplasty under spinal anesthesia were randomized to treatment with or without insertion of an indwelling urinary catheter. All patients received spinal anesthesia with 15 to 30 mg of 0.5% bupivacaine. The catheter group was subjected to a standard postoperative protocol, with removal of the indwelling catheter within forty-eight hours postoperatively. The experimental group was monitored for urinary retention and, if necessary, had straight catheterization up to two times prior to the placement of an indwelling catheter. RESULTS: Two hundred patients were included in the study. There was no significant difference between the two groups in terms of the prevalence of urinary retention, the prevalence of urinary tract infection, or the length of stay. Nine patients in the no-catheter group and three patients in the catheter group (following removal of the catheter) required straight catheterization because of urinary retention. Three patients in the catheter group and no patient in the no-catheter group had development of urinary tract infection. CONCLUSIONS: Patients undergoing total hip arthroplasty under spinal anesthesia appear to be at low risk for urinary retention. Thus, a routine indwelling catheter is not required for such patients

Formulation and Characterization of Mouth Dissolving Tablet of Antiepileptic Drug using Natural Superdisintegrants

MDTs is regarding as a good candidates for the patients with persistent nausea, who are traveling, or who have little or no access to water.  The objective of present research work was to prepare and evaluate the mouth dissolving tablet of Lacosamide using Super disintegrants like Guar Gum, and other excipients like Microcrystalline Cellulose and Mannitol in different concentrations by Direct Compression method. Lacosamide has been shown to be an effective antiepileptic agent appropriate for the epilepsy patients. Effect of different formulation variables i.e. amount of polymer and type of polymer was studied on release profile and other characteristics. The mouth dissolving tablets were prepared by single punch machine using powder blend of superdisintegrant and Lacosamide. Post-compression parameters like Hardness, weight variation, friability, In-Vitro dispersion, Drug content uniformity and In-vitro drug release studies were carried out for all the formulation. All the Formulations gave the result within the official limits. The prepared mouth dissolving tablet shows the properties of fast disintegration time (28 sec to 47 sec) within official limit.  By the in-vitro disintegration, it is concluded that formulation F2 prepared by Guar Gum (10%) showed the fast disintegration time than the MCC. Therefore, it may be concluded that mouth dissolving tablet was suitable choice for delivery system of Lacosamide. Keywords: Lacosamide, Mouth dissolving tablets, Superdisintegrants, Guargum, microcrystalline cellulose, Direct compression method, Antiepileptic drug

Comparison of Side Effects with Extended Release Epidural Morphine and Other Analgesic Modalities

Opioids are the mainstay of post-operative pain management and may produce side effects that impact patient recovery. Use of Extended Release Epidural Morphine (EREM) has been shown to result in significantly less average morphine usage and to have superior analgesic efficacy than other modes of postoperative pain management. The purpose of this retrospective review was to compare the incidence and onset of side effects of ERE and other post-operative Analgesic regiments

EHR Visual Overlay Promises to Improve Hypertension Guideline Implementation

Background: Primary care management of essential hypertension (HTN) has become increasingly challenging since recently published guidelines integrate atherosclerotic cardiovascular disease (ASCVD) risk stratification into decision making. Our objective was to measure whether overlay of visualdecision support (VDS) with standard electronic health record (EHR) platform improves guideline-based treatment, and reduces time burden associated with EHR use, in management of essential HTN. Methods: This was a quality improvement project. We interviewed primary care physicians and tasked each with two simulated patient encounters for HTN: (1) using standard EHR to guide treatment, and (2) using VDS to guide treatment. The VDS included graphical blood pressure (BP) trends, target BP with recommended interventions, ASCVD risk score, and information on the patient’s social determinants of health. We assessed whether treatment selection was congruent with guidelines and tracked time physicians consulted the EHR. Results: We evaluated 70 case simulations in total. Use of VDS compared to usual EHR was associated with: higher proportion of correct guideline prescribing (94% vs. 60%, p\u3c0.01), more ASCVD risk determination (100% vs. 23, p\u3c0.01), and more correct BP target identification (97% vs. 60%, p\u3c0.01). Time clinicians spent consulting the EHR fell an average of 121 seconds with use of VDS (p\u3c0.01). On a 10-point scale, clinicians rated the VDS 9.2 vs. 5.9 (p\u3c0.01) for ease of gathering necessary information to treat HTN. Conclusions: The integration video decision support tools to standard EHR can reduce physician time spent per patient encounter, while increasing adherence to guidelines and improving patient outcomes. Further testing in clinical practice is indicated.https://scholarlycommons.henryford.com/merf2019qi/1009/thumbnail.jp

DNA topoisomerases participate in fragility of the oncogene RET

Fragile site breakage was previously shown to result in rearrangement of the RET oncogene, resembling the rearrangements found in thyroid cancer. Common fragile sites are specific regions of the genome with a high susceptibility to DNA breakage under conditions that partially inhibit DNA replication, and often coincide with genes deleted, amplified, or rearranged in cancer. While a substantial amount of work has been performed investigating DNA repair and cell cycle checkpoint proteins vital for maintaining stability at fragile sites, little is known about the initial events leading to DNA breakage at these sites. The purpose of this study was to investigate these initial events through the detection of aphidicolin (APH)-induced DNA breakage within the RET oncogene, in which 144 APHinduced DNA breakpoints were mapped on the nucleotide level in human thyroid cells within intron 11 of RET, the breakpoint cluster region found in patients. These breakpoints were located at or near DNA topoisomerase I and/or II predicted cleavage sites, as well as at DNA secondary structural features recognized and preferentially cleaved by DNA topoisomerases I and II. Co-treatment of thyroid cells with APH and the topoisomerase catalytic inhibitors, betulinic acid and merbarone, significantly decreased APH-induced fragile site breakage within RET intron 11 and within the common fragile site FRA3B. These data demonstrate that DNA topoisomerases I and II are involved in initiating APH-induced common fragile site breakage at RET, and may engage the recognition of DNA secondary structures formed during perturbed DNA replication