Assessing the Burden of Unnecessary Central Venous Catheters in Patients on Medical-Surgical Floors

Project goals: Our project goals are to: a) assess the burden of unnecessary PICCs and other non-tunneled central lines on med-surg units at TJUH and b) understand the underlying reasons behind the problem. In the first phase of our project we conducted an audit of med-surg unit PICCs and other non-tunneled central lines with the goal of obtaining a rough estimate of the number of line days that are unnecessary. SMART AIM By December 31, 2017, the TJUH medical-surgical floors will reduce the number of unnecessary PICC lines by 30%.https://jdc.jefferson.edu/patientsafetyposters/1024/thumbnail.jp

Transrectal Ultrasound Guided Prostate Biopsy Antibiotic Prophylaxis: Standard vs. Augmented Antibiotic Regimens, and the Role for Pre-Biopsy Rectal Swab Cultures

Objectives: To evaluate peri-procedural antibiotic prophylaxis regimens based on pre-procedural rectal swab cultures. To evaluate infection rates between transrectalbiopsy patients receiving FQs alone and those receiving ceftriaxone or gentamicin in addition to FQs.https://jdc.jefferson.edu/patientsafetyposters/1056/thumbnail.jp

Increasing Ultrasound-Guided Thyroid Biopsy Yield

Objectives: Conduct Plan-Do-Study-Act (PDSA) performance improvement project to improve thyroid biopsy yield Short Term\u3ereduce unsuccessful biopsies by 50% Long-Term\u3eeliminate unsuccessful biopsieshttps://jdc.jefferson.edu/patientsafetyposters/1064/thumbnail.jp

Principles of Pituitary Surgery

Key Points 1. Understand the principles of pituitary surgery including the key-elements of surgical planning and decision-making 2. Identify the technical nuances distinguishing the endoscopic from the microscopic transsphenoidal approach 3. Understand the strategies utilized during the nasal, sphenoidal, and sellar stages of surgery that maximize tumor resection while minimizing complications and preserving sino- nasal anatomy/functio

Consecutive Case Series of Melanoma Sentinel Node Biopsy for Lymphoseek Compared to Sulfur Colloids

Introduction: Sentinel lymph node biopsy (SLNB) is an important adjunct in the staging of patients with melanoma. Preoperative lymphoscintigraphy (LS) with radiolabeled isotopes is essential to localize sentinel nodes for removal. Our study compared the effectiveness of Lymphoseek to standard sulfur colloids (SC) in patients with melanoma undergoing SLNB. Methods: We queried our IRB-approved melanoma database to identify 370 consecutive patients who underwent SLNB from 2012-2016 with at least one year of follow up. There were 185 patients in each group. Data points included characteristics of the primary melanoma lymphoscintigraphy, and SLNB. Student’s t-test and Chi-Square were used to analyze the data with a p-value of \u3c0.05 being considered significant. Results: Patients were equally matched in regard to age, sex, and primary characteristics of their melanoma. In comparison to SC, Lymphoseek required lower radiation dosages (p\u3c0.001), shorter mapping times (p=0.008), and decreased number of sentinel nodes removed (p=0.03). There was no difference in the number of patients with positive nodes (p=0.5). Additionally, there were no statistical differences between the two radioactive tracers in regard to the number of patients with false negative SLNB. Conclusion: Lymphoseek has the potential to decrease radioactivity and mapping time in patients who need SLNB. With a decrease in the number of nodes removed without loss of sensitivity, there is a potential to avoid unnecessary node removal and thus complications such as lymphedema. Longer follow-up will help to determine if there is any increase in false negative rates despite fewer nodes removed

Shedding Light on the Off-Hours Coverage Gap in Radiology: Improving Turnaround Times and Critical Results Reporting

Objective: Devise a plan to optimize off-hours faculty and trainee staffing within the Department of Radiology Measure the magnitude of patient safety gains in terms of report turnaround times (TAT) and critical results communication times (CRC)https://jdc.jefferson.edu/patientsafetyposters/1044/thumbnail.jp

The Genetic and Environmental Etiology of Schizophrenia in Palau

Schizophrenia is a chronic, severe, and disabling brain disorder that has been affecting people throughout the world. There is an established worldwide 1% average prevalence of schizophrenia; however there are high degrees of variability between different regions. Palau, an oceanic nation located in Micronesia, has an abnormally high prevalence rate of schizophrenia at 1.99%. When separated by gender, women have abnormal prevalence rate of 1.24%, while the men have a high prevalence rate of 2.77%, which is over twice the average worldwide. There has been a plethora of research conducted over the years to determine the genetic and environmental etiology of schizophrenia in Palau. Palau’s somewhat isolated and small population offer the advantage of a valuable insular population for the study of genetic etiology of schizophrenia because there may be fewer susceptibility genes for schizophrenia than in heterogeneous populations throughout the world. Recent studies have highlighted that schizophrenia in Palau is a complex genetic disease, yet is also greatly influenced by certain environmental factors. As part of the research, blood and tissue samples from 160 schizophrenic Palauan patients were sampled. In addition, 400 relatives of the patients were reviewed and shown as unaffected by the disease; although there were first and second-degree relatives who were affected. The patients were also interviewed frequently about relevant matters, such as their diet and daily activities. By examining these studies, I was able to determine that many environmental factors may be involved with the disease, such as exposure to viruses, heavy marijuana use, malnutrition before birth, and other not yet known psychosocial factors. Because of Palau’s intricately, interconnected families and small population and isolation, it has a high prevalence rate of schizophrenia

Theme and Content of Delusions in Asian Indian Psychotic Patients: Correlation with Diagnosis

The aim of this study was to investigate the types of delusions present in Asian Indian psychotic patients and evaluate correlation with patient diagnosis. Delusional narratives were collected from 50 Indian patients with schizophrenia or an affective disorder. These narratives were judged for delusional theme and content and were correlated with DSM-III-R diagnoses. Using simple categorical analysis, delusional themes of grandiosity and guilt correlated with affective diagnoses. Delusional themes of reference and Schneiderian types were more often associated with schizophrenia. These findings support the concept that delusional themes can be used as valid diagnostic clues in the assessment of psychotic Indian patients

The Last Chapter in the Story: A Place for Aristotle\u27s Eudaemonia in the Lives of the Terminally Ill

The \u27deficiency model\u27 of aging has often been criticized for its lack of attention to the individual patient\u27s narrative understanding of his own life. However, such narrative conceptions tend to focus on a generic adult person, situated in specific on-going projects and relationships, moving toward a more or less clear conception of the future. What interest me, on the other hand, are those individuals who have become aware of their own death as imminent, and who therefore strive to compose the \u27last chapter\u27 of their life story. Imminence is not to be taken in chronological or clinical terms, but as revealing an attitude to oneself and one\u27s own life. The composition of the last chapter requires recollecting and reappraising the events of one\u27s life in an effort to make sense of the life as a whole. I propose revising the ancient Greek word eudaemonia to capture this sense of achieving an integrated meaning to one\u27s life