It\u27s Midnight. Do you know how your patient is doing?

Transitions of care are vulnerable points in patient care. With the volume of information transferred, quality of care and patient safety are at risk. Numerous attempts at standardization of transitions of care have been utilized; however no consensus regarding the optimal method has been reached. We developed a “watcher” model in addition to standard end of shift sign out. Patients at risk were identified by the day team and seen overnight by a senior and junior surgery resident, along with a nursing representative: either a bedside RN or nursing supervisor. We hypothesized that these midnight rounds could proactively identify patient care issues and intervention would be implemented sooner in a patient’s hospital coursehttps://jdc.jefferson.edu/patientsafetyposters/1036/thumbnail.jp

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

AOSpine—Spine Trauma Classification System: The Value of Modifiers: A Narrative Review With Commentary on Evolving Descriptive Principles

Study Design: Narrative review. Objectives: To describe the current AOSpine Trauma Classification system for spinal trauma and highlight the value of patient-specific modifiers for facilitating communication and nuances in treatment. Methods: The classification for spine trauma previously developed by The AOSpine Knowledge Forum is reviewed and the importance of case modifiers in this system is discussed. Results: A successful classification system facilitates communication and agreement between physicians while also determining injury severity and provides guidance on prognosis and treatment. As each injury may be unique among different patients, the importance of considering patient-specific characteristics is highlighted in this review. In the current AOSpine Trauma Classification, the spinal column is divided into 4 regions: the upper cervical spine (C0-C2), subaxial cervical spine (C3-C7), thoracolumbar spine (T1-L5), and the sacral spine (S1-S5, including coccyx). Each region is classified according to a hierarchical system with increasing levels of injury or instability and represents the morphology of the injury, neurologic status, and clinical modifiers. Specifically, these clinical modifiers are denoted starting with M followed by a number. They describe unique conditions that may change treatment approach such as the presence of significant soft tissue damage, uncertainty about posterior tension band injury, or the presence of a critical disc herniation in a cervical bilateral facet dislocation. These characteristics are described in detail for each spinal region. Conclusions: Patient-specific modifiers in the AOSpine Trauma Classification highlight unique clinical characteristics for each injury and facilitate communication and treatment between surgeons

Editor\u27s Column

As this issue of the Journal goes to press, it seems apt to reflect upon several years of editorship. An esteemed colleague, Gregory B. Sullivan , M.D .,is in the process of taking over the responsibilities of Chief Editor; the Journal is in able hands as I move on to other endeavors. Since its inception nearly five years ago, th e Journal has flourished , riding out occasional rough weather in its course from a local to a national publication. Many residents and faculty members have worked with spirit and diligence to foster its growth ; I am thankful for this participation. It has been a privilege to edit this Journal, and there is sadness in leaving, for much emotion has been invested in this experience. It is not only that a scientific enterprise has grown; so too have personal relationships that, in the end, sustain the meaning of this work. The Journal has succeeded because people have believed in it , had faith that is should exist, indeed must exist. I have faith that the Journal will continue toward excellence

Improving Resulted Hemoglobin A1c Rates: A Feasibility Study for Point-of-Care Hemoglobin A1c Testing at an Urban Family Medicine Office

Study Aims: Our practice’s goal is to increase the number of up to date hemoglobin A1c for diabetic patients seen at JFMA in order to help improve glycemic control The aim of this study is to see if point of care (POC) hemoglobin A1C is a feasible way to increase the number of up to date hemoglobin A1C. We looked at various factors including timing, training, and flow.https://jdc.jefferson.edu/patientsafetyposters/1037/thumbnail.jp

Preventing Isolated Perioperative Reintubation: Who is at highest risk?

Objectives: 1. We aim to characterize IPR nationally through a retrospective review of the National Surgical Quality Improvement Program participant user file (NSQIP PUF). 2.Identify risk factors for IPR including analysis of procedure type and preoperative characteristics.https://jdc.jefferson.edu/patientsafetyposters/1041/thumbnail.jp

Editor\u27s Column: Remarkable Conversations

Over the past year or so, several of us who are intimately involved in the editing and production of this journal have been personally challenged by the emergence of serious illness in either ourselves or our immediate fami lies. In each instance, the psyc hiatrist so affected has maintained the degree of equilibrium necessary to permit continuing, effective participation in this enterprise.Given this, the question emerges: Why do we do the work that has led us from a journal with a press run of four hundred copies in 1983, to a journal with a national circulation of seven thousand copies in 1986, in the face of what sometimes seem to be tremendous hurdles

In Search of the Fundamental Rule of Supportive Psychotherapy

Early in my first year of residency training in psychiatry, while working between acute-care inpatient units and a busy crisis service, it appeared that virtually every patient was said to have been treated with supportive psychotherapy, in conjunction with psychotropic medication. This appearance was deceiving, and if not for thorough supervision, reading, discussion with faculty and peers, and autocritical review, I might still believe that my earliest, and perhaps sickest, patients were indeed treated with supportive psychotherapy. In retrospect, some were and some were not; the explanation for this discrepancy came with the realization that I did not have very clear ideas about the nature of supportive psychotherapy, its indications and contraindications, its technical practice, its efficacy, or its derivation from psychoanalytic theory. Without this knowledge, I could not practice supportive psychotherapy

Static vs. Expandable PEEK Interbody Cages: A Comparison of One-Year Clinical and Radiographic Outcomes for One-Level TLIF

Introduction: Degenerative spine disease is a disabling condition affecting many worldwide. Transoforaminal lumbar interbody fusion (TLIF) procedures help stabilize the spine, while improving back and/or leg pain. With the introduction of new implant designs and modifications, focus has shifted to optimizing spinopelvic alignment, fusion rates, and more. This study aims to explore the effect of static versus expandable polyetheretherketone (PEEK) cages on patient-reported outcomes (PROMs) and radiographic outcomes (subsidence, disk height, and alignment parameters). Materials/Methods: A retrospective cohort study was conducted using a database of patients in a single, high volume academic center. Patient outcomes were obtained from charts and radiographic outcomes were measured using standing, lateral radiographs. Data were analyzed using mean sample t-tests or categorical chi-squared tests, and multiple linear regression where appropriate. Results: Our results showed improved Oswestry Disability Index (ODI) scores perioperatively in the expandable cage group compared to the static cage group at the three-month and one-year time periods. In addition, there were a significantly greater proportion of patients that reached minimal clinically important difference (MCID) in the expandable group compared to the static cage group. There were no significant changes in subsidence or alignment parameters between the two groups at the one-year time period. Conclusion: Overall, our results show that TLIF patients treated with expandable PEEK cages had significantly greater improvement in one-year outcomes compared to patients with static cages. Expandable cages confer the advantage of more precise insertion into the intervertebral disk space, while providing a way to tailor the cage height for better distraction and spinal alignment. Further prospective studies are warranted to get a better idea of the impact of interbody design on clinical/radiographic outcomes

Samuel D. Gross, M.D. (1805-1884): an innovator, even in death.

Dr. Samuel Gross\u27 contributions to the field of surgery are well known and range from numerous clinical advances to pioneering scholarship and professional activities. Dr. Gross was ceaselessly ambitious and even remarked in his autobiography that his ‘‘conviction has always been that is far better for a man to wear out than to rust out.’’1 It is through this frame of motivation that Dr. Gross lived his life