Improving Colon Cancer Screening in a Resident Ambulatory Clinic

AIM Statement: Our aim at Wednesday JHAP was to increase the rate of colorectal cancer screenings from 44.3% to 60% from September 2016 to May 2017 (9 months)https://jdc.jefferson.edu/patientsafetyposters/1032/thumbnail.jp

Got Diabetes? With Us, You\u27ll Have Complete Diabetic Care

AIM: By April 2016, we aim to improve Complete Diabetic Care of Thursday JHAP Clinic\u27s patients with diabetes by 50%. * These authors contributed equallyhttps://jdc.jefferson.edu/patientsafetyposters/1007/thumbnail.jp

Being Stalked: A Psychiatrist\u27s Perspective

It is only recently that stalking has been criminalized after some highly publicized forensic cases. Psychiatric focus has been on erotomania, and in this article we primarily highlight stalking as a separate entity with psychiatric and legal implications. The case reports reveal our vulnerability as therapists, and we hope will raise our awareness of stalking as a potentially dangerous situation. The legal statutes vary in different states, but our recommendations may provide guidelines towards formulating policies and procedures for the safety of healthcare providers

Under Pressure: Ambulatory Blood Pressure Control

Smart AIM: Improve hypertension control with the following goal: Within three months 60% of patients with hypertension will have a blood pressure less than 140/90 during their most recent office visit.https://jdc.jefferson.edu/patientsafetyposters/1029/thumbnail.jp

Development and Evaluation of an Internet-Based Airway Evaluation Tutorial

Airway evaluation and basic management are essential skills for all physicians. Identifying patients for whom mask ventilation or endotracheal intubation will be difficult to impossible is vital for patient safety. Despite this, training in airway evaluation is minimal in the curricula of most medical schools. To ensure a thorough understanding of airway anatomy and evaluation, as well as exposure to various abnormal findings, we developed an Internet-based module including interactive components, graphics, animation, video, and a self-assessment tool. The site received more than 1800 visits in its first nine months of operation, with uniformly laudatory comments. Eighty subjects over a six-month period completed a pre- and post-test quiz structured to evaluate the utility of the site. Of those completing the on-line survey, more than 76% rated the site very useful. Most felt their knowledge of airway examination improved after completion of the site (p<0.00004). The median amount of time spent on the site was 29.5 minutes. Judging from the overwhelming response to this site from around the world and across disciplines, such interactive training tools that exploit the technological capabilities of the Internet provide useful adjuncts to traditional teaching methods

Got Sugar? Pharmacist Intervention to Improve A1c

AIM: Within 6 months, we aim to decrease by 10% the number of our diabetic patients with an A1c \u3e8 through Clinical Pharmacist referrals.https://jdc.jefferson.edu/patientsafetyposters/1033/thumbnail.jp

Down Regulation with Luteal GnRH Agonist Therapy in Euploid Embryo Transfers Does Not Impact Pregnancy Rates

Introduction : Gonadotropin-releasing hormone (GnRH) agonists have been used during assisted reproductive technology (ART) treatment for pituitary suppression and stimulation. Currently, clinical opinion is divided about whether GnRH agonist therapy improves pregnancy rates when used for luteal down-regulation in a frozen euploid embryo transfer (FET). This study evaluated the clinical utility of GnRH agonist down-regulation in single, euploid FET cycles. Methods : A retrospective analysis was performed, using data from patients who underwent a single, euploid FET cycle from 2012 to 2019. Patients were segregated into two cohorts: Group A: single, euploid FET with down-regulation using GnRH agonist; Group B: single, euploid FET without down-regulation using GnRH agonist. Primary outcomes include pregnancy rates among cohorts. Results : Group A demonstrated a pregnancy rate of 72.92% in 96 cycles. Group B demonstrated a pregnancy rate of 73.27% in 5,668 cycles. There was no difference in pregnancy rates between groups, X2(2, N = 5764) = .0061, p = .94. A subgroup of patients (n=5) with endometriosis in Group A achieved an 80% (4/5) pregnancy rate. Discussion : Single, euploid FET cycle pregnancy rates were not affected by the use of down-regulation with a GnRH agonist. Increased pregnancy rates found with prolonged GnRH agonist use in other studies weren’t seen with short term use for FET cycles. Future research should focus on molecular markers and gene transcription signatures to attempt to define whether there is an ideal population of patients who would benefit from GnRH agonist down-regulation prior to FET

A prospective observational study of mycophenolate mofetil treatment in progressive diffuse cutaneous systemic sclerosis of recent onset.

OBJECTIVE: A prospective observational study of mycophenolate mofetil (MMF) treatment in patients with diffuse progressive cutaneous systemic sclerosis (SSc) of recent onset. METHODS: Twenty-five previously untreated consecutive patients with recent-onset (\u3c 24 mo) diffuse progressive cutaneous SSc received MMF as the only disease-modifying therapy. Modified Rodnan skin score (mRSS) and affected body surface area (BSA) were compared from initiation of MMF to study end. Pulmonary function tests performed at the same institution before therapy and at study end were available in 15 patients. Histopathology and real-time PCR assessment of fibrosis-related gene expression were performed before and after treatment in skin biopsies from 3 patients. RESULTS: At 18.2 ± 8.73 months of MMF therapy (median 2000 mg/day) the mRSS decreased from 24.56 ± 8.62 to 14.52 ± 10.9 (p = 0.0004) and the affected BSA from 36% ± 16% to 14% ± 13.3% (p = 0.00001). Pulmonary function tests remained stable from initiation of MMF to the end of the study. Skin histopathology showed a remarkable reduction in accumulation of fibrotic tissue. Real-time PCR of skin biopsies demonstrated a marked decrease in expression of fibrosis-related genes. CONCLUSION: Patients with diffuse progressive cutaneous SSc of recent onset treated with MMF experienced marked improvement in skin involvement and stabilization of pulmonary function. Skin biopsies from 3 patients demonstrated histopathological improvement and decreased expression of fibrosis-related genes