Inappropriate electrolyte repletion for patients undergoing endoscopic procedures

At Thomas Jefferson University Hospital (TJUH), there has been a perceived necessity among housestaff and fellows to routinely check and replete serum potassium and magnesium for inpatients prior to endoscopic procedures In addition, there was an unwritten policy that these electrolytes needed to be aggressively repleted, with a goal potassium above 4.0 and magnesium above 2.0 Contributing factors include absence of clear policy, fear of adverse outcomes during procedures, and fear of delay of procedures leading to increased hospital stay This practice has led to unwarranted lab draws, costs of lab tests and electrolyte riders, and possible delayed procedures Goals Clarify policies regarding electrolyte repletion Determine frequency of inappropriate electrolyte checking and repletion Determine monetary cost of this action Decrease frequency of inappropriate electrolyte lab check and repletionhttps://jdc.jefferson.edu/patientsafetyposters/1023/thumbnail.jp

Phase 1 Trial of Vaccination with Autologous Tumor Cells and Antisense Directed Against the Insulin Growth Factor Type 1 Receptor (IGF-1R AS ODN) in Patients with Recurrent Glioblastoma

Background: Extending a previous Phase I study, we report the results of a second Phase I autologous tumor cell vaccination trial for patients with recurrent glioblastomas (IND 14379-101, NCT01550523). Methods: Following surgery, subjects were treated by 24 hour implantation in the rectus sheath of ten biodiffusion chambers containing irradiated autologous tumor cells and IGF-1R AS ODN with the objective of stimulating tumor immunity. Patients were monitored for safety, clinical and radiographic as well as immune responses. Results: There were no Grade 3 toxicities related to protocol treatment and overall median survival from initial diagnosis was 91.4 weeks. Two protocol survival cohorts with median survivals of 48.2 and 10 weeks were identified and predicted by our pre-treatment assessments of immune function, corroborated by post-vaccination pro-inflammatory cytokine profiles. Longer survival subjects had imaging findings including transient elevations in cerebral blood volume (rCBV) and sustained elevations of apparent diffusion coefficient (ADC) interpreted as transient hyperemia and cell loss. Conclusions: The vaccine paradigm was well-tolerated with a favorable median survival. Our data support this as a novel treatment paradigm that promotes anti-tumor immunity

Double-Row Repair Technique for Bursal-Sided Partial-Thickness Rotator Cuff Tears

Rotator cuff pathology is a common cause of shoulder pain in the athletic and general population. Partial-thickness rotator cuff tears (PTRCT) are commonly encountered and can be bursal-sided, articular-sided, or intratendinous. Various techniques exist for the repair of bursal-sided PTRCTs. The 2 main distinctions when addressing these lesions include tear completion versus preservation of the intact fibers, and single- versus double-row suture anchor fixation. We present our method for addressing bursal-sided PTRCTs using an in situ repair technique with double-row suture anchors. © 2017 Arthroscopy Association of North Americ

An Interactive Curricula Experience (iCE) for Latino Immigrant Health

The Interactive Curricula Experience (iCE) is an educational platform intended for interactive education utilizing multiple forms of media. It is being utilized at Thomas Jefferson University (TJU) in various classes, among them Global Health. One of the pertinent global-health-at-home topics at TJU relates to Latino immigrant health. Latino immigrants number more than 20,000 in Philadelphia. They are located throughout the city, although the highest concentrations are in North and South Philadelphia. With respect to health care, Latino immigrants are less likely to have a regular health care provider than non-immigrant Latinos. Education to provide culturally sensitive care to Latino immigrants is vital to establish longer-lasting patient-doctor partnerships and decrease the number of Latino immigrants without a regular health care provider. iCE is an attempt to provide that education by stepping out of the lecture hall and assigned readings, and instead allowing students to engage with the material at their own pace.https://jdc.jefferson.edu/cwicposters/1021/thumbnail.jp

Prevalence of Asthma Severities in Children and Adolescents in a Wilmington, DE Hospital

Asthma affects over 24 million individuals in the US and the prevalence of the condition is increasing in the US and worldwide. The prevalence of severe persistent asthma, which incurs a significant health and economic burden, is still poorly understood in children and adolescents. We aimed to define the prevalence of asthma severities in children and adolescents in an urban hospital setting as a function of age, sex, race, and ethnicity by assessing prescribed medications as a proxy for asthma severity according to NIH guidelines for care. We found that a plurality of patients across all age groups, sexes, races, and ethnicities were severe persistent asthmatics. We also found that younger individuals as well as those who are African American have higher odds of being moderate to severe asthmatics. This information can be used to generate hypotheses for future studies and can be used to better address patient needs. In addition, these results suggest that a health disparity among African Americans exists that is consistent with other aspects of the condition. To reduce the prevalence of asthma in all populations, future research should place a greater emphasis on identifying more indicative risk factors for prevention, finding strategies to identify asthma at an earlier age, and developing more effective and personalized therapeutics

Dueling Active Surveillance: Does Utilization of Active Surveillance for Low Risk Prostate Cancer Correspond with Utilization of Active Surveillance for Small Renal Masses?

Background: Active surveillance (AS) is the recommended management strategy for low-risk prostate cancer (LR CaP) and has also been shown to be safe for management of small renal masses \u3c4cm (SRM). We assessed surgeon-level practice patterns for the use of AS in two different genitourinary malignancies: LR CaP and SRM. Methods: We retrospectively reviewed the Michigan Urological Surgery Improvement Collaborative’s (MUSIC) prospectively maintained prostate and kidney registries to identify surgeons that managed at least 10 patients with SRMs and 10 patients with LR CaP from 2017-2021. The outcome was to assess for an association between AS for LR CaP with AS for SRMs among MUSIC surgeons. Results: 27 urologists met inclusion criteria. 82% of men with LR CaP were managed on AS compared with 49% of men with SRMs. Among the surgeons in the lowest quartile of AS use for CaP, 33% of men with SRMs were managed with AS compared to 49% of men with SRMs managed by the surgeons in the highest quartile of CaP AS use (p\u3c0.001). There was a modest correlation between the risk-adjusted proportion of a surgeon’s LR CaP patients and SRM patients managed with AS (correlation coefficient: 0.47, p=0.014). Conclusions: Urologists who use AS for LR CaP are more likely to use AS for patients with SRMs, while urologists that are more likely to operatively manage one indolent malignancy are likely to also operate on a second low risk malignancy

Assessment of Dobhoff Tube Malposition on Radiographs Using Deep Learning

Introduction: Dobhoff tubes (DHT) are narrow-bore flexible devices that deliver enteral nutrition for critically ill patients. Tracheobronchial insertion of DHTs presents a significant risk for pulmonary complications. Thus, DHT insertion requires radiologist confirmation of correct placement with chest x-ray (CXR), increasing clinical delays. To address this, we demonstrate the novel application of Deep Convolutional Neural Networks (DCNNs) to automatically and accurately identify DHTs in CXRs in real time. Methods: 141 de-identified HIPAA compliant frontal view chest radiographs containing DHTs in various positions were obtained. The DHTs were first manually segmented and verified by a board certified radiologist. Images were split into training (126) and test (15) sets. Data augmentation consisted of horizontal flipping, rotation, sheer, and translation steps. A pretrained deep convolutional neural network model with the U-Net architecture was employed. This net was trained using TensorFlow 2.0 and a 1080ti NVIDIA GPU. The training ran for 300 epochs with an Adam optimizer (learning rate = 0.0001), using an intersection over union (IOU) loss function. Results: The fully trained network achieved a Sørensen–Dice coefficient of 0.7 between the predicted and ground truth segmentations. This suggests that the DCNN was able to identify DHT both accurately and in a variety of use cases. Run time per image was less than a second, demonstrating the efficiency of this computer-based method. Discussion: A Dice coefficient of 0.7 represents strong accuracy and supports the hypothesis that DCNN may be employed to automatically identify DHT positioning. This suggests that deep learning can segment and highlight DHTs, potentially aiding clinical teams. Performance could improve with more training cases and standardization of preprocessing. Future directions include research on the real world impact of such solutions on clinical teams, including whether such a system improves safe DHT placement outcomes on floors