Improving Medication Reconciliation Using Provider Education and an EHR Hard Stop

AIM: By using a sequence of two distinct interventions, we aim to improve the rate of medication reconciliation at Jefferson Internal Medicine Assoc.https://jdc.jefferson.edu/patientsafetyposters/1026/thumbnail.jp

Teaching Physicians Procedural Skills at a National Professional Meeting

Background: Practicing physicians often wish to improve their procedural skills but have limited educational opportunities to do so. Description: To summarize the effects of two procedural workshops on participants’ confidence, proficiency, and practice patterns. Evaluation: Following completion of a skin biopsy or arthrocentesis workshop, participants completed a post-course and an 8-month follow up evaluation. Recipients of this training rated it highly and reported that following training they performed more procedures, referred less, and noted an increase in their confidence that was still evident eight months after the workshop. Conclusion: Skin biopsy and arthrocentesis/joint injection skills can be taught to practicing physicians in a workshop setting at national professional meetings. Key Words: clinical competence; internal medicine; teaching; educational measuremen

Taking Free Flap Surgery Abroad: A Collaborative Approach to a Complex Surgical Problem.

Accessibility to health care, especially complex surgical care, represents one of the major health care disparities in developing countries. While surgical teams may be willing to travel to these areas to help address these needs, there are many logistical and ethical dilemmas inherent in this pursuit. We reviewed our approach to the establishment of the team-based surgical outreach program, wherein we perform head and neck free tissue transfer surgery in Haiti. We describe the challenges encountered in the delivery of surgical care as well as ethical dilemmas relevant to surgical outreach trips, highlighting an approach reliant on strong local cooperation. Despite the obstacles in place, our experience shows that free flap surgery can be successfully and ethically performed in these areas of great need

Risk Factor Analysis for 30-Day Readmission Rates of Newly Tracheostomized Children

Objectives: Pediatric patients undergo tracheostomy for a variety of reasons; however, medical complexity is common among these patients. Although tracheostomy may help to facilitate discharge, these patients may be at increased risk for hospital readmission. The purpose of this study was to evaluate our institutional rate of 30-day readmission for patients discharged with new tracheostomies and to identify risk factors associated with readmission. Study Design: A retrospective cohort study was conducted for all pediatric patients ages 0-18 years with new tracheostomies at our institution over a 36-month period. Methods: A chart review was performed for all newly tracheostomizedchildren from 2013 to 2016. We investigated documented readmissions within 30 days of discharge, reasons for readmission, demographic variables including age and ethnicity, initial discharge disposition, co-morbidities, and socioeconomic status estimated by mean household income by parental zip code. Results: 45 patients were discharged during the study time period. A total of 13 (28.9%) required readmission within 30 days of discharge. Among these 13 patients, the majority (61.5%) were readmitted for lower airway concerns, many (30.8%) were admitted for reasons unrelated to tracheostomy or respiratory concerns, and only one patient (7.7%) was readmitted for a reason related to tracheostomy itself (tracheostomalbreakdown). Age, ethnicity, discharge disposition, co-morbidities, and socioeconomic status were not associated with differences in readmission rates. Patients readmitted within 30 days had a higher number of admissions within the first year. Conclusion: Pediatric patients with new tracheostomies are at high risk for readmission after discharge from initial hospitalization. The readmissions are most likely secondary to underlying medical complexity rather than issues related specifically to the tracheostomy procedure.https://jdc.jefferson.edu/patientsafetyposters/1046/thumbnail.jp

Novel nonalloyed thermally stable Pd/Sn and Pd/Sn/Au ohmic contacts for the fabrication of GaAs MESFETs

GaAs metal-semiconductor field-effect transistors (MESFETs) have been fabricated utilizing thermally stable Pd/Sn and Pd/Sn/Au ohmic contacts for the first time. MESFETs with Pd/Ge ohmic contacts are fabricated for comparison. The thermal stability of the Pd/Sn, Pd/Ge and Pd/Sn/Au ohmic contacts is also presente

Addressing Barriers to Breast Cancer Screening: Where to Intervene to Increase Mammogram Completion Rates

Methods: Study sought to determine if an intervention would aid in increasing mammogram screening rates in the Jefferson Family Medicine Associates practice.https://jdc.jefferson.edu/patientsafetyposters/1061/thumbnail.jp

Theodor Billroth and his musical life.

Although most widely recognized for the two types of gastric reconstructions that bear his name, Christian Albert Theodor Billroth was one of the most innovative surgeons of his time. His contributions included developing techniques for procedures on the larynx, breast, and esophagus. He pioneered sterility and antisepsis in operating rooms. He also improved surgical education by advocating for longer apprenticeships, which helped create a framework for today’s residency programs. However, what often goes unnoticed was Dr. Billroth’s love for music, a passion that fueled him throughout his life

An Integrated Approach for Evaluating Students' Achievement of Clinical Objectives

During the clinical phase of undergraduate medical education (UME) students are often geographically dispersed and assigned to preceptors throughout the community. Monitoring, documenting, and evaluating their clinical experiences and achievement of clinical objectives in this venue becomes a challenge, especially for large UME programs. The purpose of this manuscript is to discuss a method for developing and implementing a school-wide evaluation system for the clinical phase of UME. This type of evaluation system links students' clinical experiential data with the objectives of a clerkship, using technological advances, such as the Personal Digital Assistant (PDA), Internet, and intranet. Clerkship directors are provided real-time reports on student's progress toward achieving clerkship objectives and are able to monitor the clinical activities of the clerkship. Students on the other hand, will be empowered to take more control of their educational experiences by monitoring their own progress

Anterior Talofibular Ligament Abnormality on Routine Magnetic Resonance Imaging of the Ankle

The anterior talo­fibular ligament (ATFL) extends from the anteroinferior border of the ­fibula to the talar neck. Primary restraint to ankle inversion in plantar‑exion. Injury (acute or chronic) can be diagnosed with physical exam, stress X-Rays, ultrasound or magnetic resonance imaging (MRI). Purpose: MRI abnormalities in asymptomatic individuals known in other areas of orthopaedics (shoulder and spine). Purpose of our study: determine the prevalence of ATFL abnormalities found on MRI in asymptomatic individuals. Asymptomatic individuals - those undergoing MRI for pathology unrelated to lateral ankle trauma, instability, or inversion injuries

Improving Advanced Care Planning Discussion and Documentation

Our goal is to improve ACP discussion and documentation in patients above the age of 65 in our Jefferson Hospital Ambulatory Practice (JHAP) resident clinic. By instituting procedural changes within the EMR and the clinic, as well as improving provider education, we hope that residents can carry out a comprehensive and streamlined discussion regarding advanced care planning. We will institute these changes over the next 3 months, and we predict that there will be an increase in ACP discussion and uploading of appropriate documentation to 50% and 25%, respectively