Perioperative VTE Chemical Prophylaxis at Jefferson Hospital: A Retrospective Review of the Department of Surgery

Only 26.1% of patients are receiving perioperative VTE chemical prophylaxis for elective cases in the Department of Surger

Using a Resident-Led Process Improvement Committee to Change Pain Medication Prescribing Habits: Early Results

The aims of this project were to: Streamline the ordering of IV and PO pain meds Encourage the appropriate ordering of Ofirmev

The influence of intrapersonal sensorimotor experiences on the corticospinal responses during action-observation

The coupling of perception and action has been strongly indicated by evidence that the observation of an action primes a response in the observer. It has been proposed that these primed responses may be inhibited when the observer is able to more closely distinguish between self- and other-generated actions – the greater the distinction, then the greater the inhibition of the primed response. This self–other distinction is shown to be enhanced following a period of visual feedback of self-generated action. The present study was designed to examine how sensorimotor experiences pertaining to self-generated action affect primed responses from observed actions. Single-pulse transcranial magnetic stimulation was used to investigate corticospinal activity elicited during the observation of index- and little-finger actions before and after training (self-generated action). For sensorimotor training, participants executed finger movements with or without visual feedback of their own movement. Results showed that the increases in muscle-specific corticospinal activity elicited from action–observation persisted after training without visual feedback, but did not emerge following training with visual feedback. This inhibition in corticospinal activity during action–observation following training with vision could have resulted from the refining of internal models of self-generated action, which then led to a greater distinction between “self” and “other” actions

Moving beyond misuse and diversion: the urgent need to consider the role of iatrogenic addiction in the current opioid epidemic.

An epidemic of drug overdose deaths has led to calls for programs and policies to limit misuse and diversion of opioid medications. Any parallel call to consider the risk of iatrogenic addiction when treating pain has been muted in comparison. We have moved beyond questions of nonmedical use, abuse, and diversion to highlight the role of prescription opioids in causing addiction even when prescribed and used appropriately. Unfortunately, current evidence is insufficient, and a rapid expansion of longitudinal research is urgently needed to guide clinicians in balancing the need for opioids with the risk of adverse consequences. Meanwhile, medical education should place greater emphasis on the abuse liability of prescription opioids, and providers should endeavor to attenuate risk when possible

A Qualitative Analysis of Student Understanding of Team Function Through the use of the Jefferson Teamwork Observation Guide (JTOG)

Background: Several early IOM reports identified the need to educate medical and health professions students in delivering patient-centered care as members of interprofessional teams (IOM, 2001; IOM, 2003). Evidence shows that conducting interprofessional education during education and training prepares student learners for collaborative practice when they enter the workplace, which in turn helps to achieve the Triple Aim of 1) enhancing the patient experience; 2) improving the health of populations; and 3) decreasing costs (WHO, 2010; Berwick, et al., 2008). One way to prepare students for collaborative practice is to have them observe real teams in action. Thus, the Jefferson Teamwork Observation Guide (JTOG) was created to serve as an educational tool in aiding students to better recognize the characteristics of effective teams. It has since been used to assess teams in the majority of clinical observation, simulation and collaborative practice activities offered by Jefferson Center for Interprofessional Education (JCIPE). The JTOG is a two-part assessment comprised of identifiable characteristics of well-functioning teams drawn from the literature about teamwork. The first part consists of Likert Scale questions (strongly disagree to strongly agree) regarding the behavior of the interprofessional team observed in the domains of Values/Ethics in Interprofessional Practice, Roles/Responsibilities, Interprofessional Communication, Teams and Teamwork, and Leadership (IPEC, 2011; IPEC 2016). The second part includes qualitative questions relating to team-based care, patient-centered care, and teamwork

The modulation of motor contagion by intrapersonal sensorimotor experience

Sensorimotor experiences can modify the internal models for action. These modifications can govern the discrepancies between predicted and actual sensory consequences, such as distinguishing self- and other-generated actions. This distinction may also contribute toward the inhibition of movement interference, which is strongly associated with the coupling of observed and executed actions. Therefore, movement interference could be mediated by the sensorimotor experiences underlying the self-other distinction. The present study examined the impact of sensorimotor experiences on involuntary movement interference (motor contagion). Participants were required to complete a motor contagion paradigm in which they executed horizontal arm movements while observing congruent (horizontal) or incongruent (vertical) arm movements of a model. This task was completed before and after a training protocol in which participants executed the same horizontal arm movements in the absence of the model stimuli. Different groups of participants trained with or without vision of their moving limb. Analysis of participants who were predisposed to motor contagion (involuntary movement interference during the observation of incongruent movements) revealed that the no vision group continued to demonstrate contagion at post-training, although the vision group did not. We propose that the vision group were able to integrate the visual afferent information with an internal model for action, which effectively refines the ability to match self-produced afferent and efferent sources of information during response-execution. This enhanced matching allows for a better distinction between self and other, which in turn, mediates the inhibition of motor contagion