Beat to Beat: Implementing a Tailored Literature Review e-Newsletter for a Multidisciplinary Subspecialty Group

Objective: To increase availability and exposure to recent, relevant, reliable literature from a range of sources, for a multidisciplinary cardiac center, by creating an e-newsletter summarizing articles of interest.https://jdc.jefferson.edu/patientsafetyposters/1043/thumbnail.jp

Afternoon Keynote: Pennsylvania Gun Policies and Nationwide Comparison

Allison Anderman became the managing attorney at Giffords Law Center in April 2017, where one of her primary focuses is partnering with cities and counties around the country to improve local gun laws. A leading expert on firearms policy and legislation, Allison frequently speaks at conferences and events around the country and has analyzed and debated gun laws on CNN, HuffPost Live, and other news programs. Allison’s radio appearances include national NPR, KQED in San Francisco, KCRW in Los Angeles, and many other regional stations. She has been quoted extensively in the press, including by the New York Times, the Los Angeles Times, Newsweek, the Guardian, and many others

Surgeon-Influenced Variables in Rectal Cancer Surgery

At the conclusion of this presentation the participant should be able to: 1. Evaluate the influence of distal and circumferential margins on local recurrence rates. 2. Assess the role of total mesorectal excision in reducing local recurrence rates. 3. Describe the role of laparoscopy in rectal cancer surgery. 4. Analyze methods of reconstruction following total mesorectal excision. Presentation: 50 minute

Fitting the Means to the Ends: One School’s Experience with Quantitative and Qualitative Methods in Curriculum Evaluation During Curriculum Change

Curriculum evaluation plays an important role in substantive curriculum change. The experience of the University of Texas Medical Branch (UTMB) with evaluation processes developed for the new Integrated Medical Curriculum (IMC) illustrates how evaluation methods may be chosen to match the goals of the curriculum evaluation process. Quantitative data such as ratings of courses or scores on external exams are useful for comparing courses or assessing whether standards have been met. Qualitative data such as students’ comments about aspects of courses are useful for eliciting explanations of observed phenomena and describing relationships between curriculum features and outcomes. The curriculum evaluation process designed for the IMC used both types of evaluation methods in a complementary fashion. Quantitative and qualitative methods have been used for formative evaluation of the new IMC courses. They are now being incorporated into processes to judge the IMC against its goals and objectives

Spinal Cord Stimulators: an Introduction

Pain can be divided into two broad categories, nociceptive pain and neuropathic pain. Nociceptive pain is a dull, throbbing pain which results from irritated nerves after physical tissue injury. This is seen commonly in cancer or after a fracture. Nociceptive pain is amenable to treatment with pain medications such as opioids and/or anti-inflammatories. Neuropathic pain is described as burning, shooting, or shocking pain. This type of pain results from nerve damage or abnormal nerve conduction such as pain exhibited with failed back syndrome, post surgical pain, neuromas, shingles, and complex regional pain syndrome (previously called RSD or causalgia). Neuropathic pain tends to be resistant to treatment with pain medications. Neurostimulation has been an effective treatment option for the management of chronic neuropathic pain. It is a reversible therapy which can even be tested before permanent implantation. Spinal cord stimulation (SCS) is an adjustable, non-destructive, neuromodulatory procedure which delivers therapeutic doses of electrical current to the spinal cord or to a targeted nerve. This low-voltage stimulation can block the transmission of pain. The enthusiasm for SCS began with the introduction of the gate control theory for pain control by Melzack and Wall in 1965 1.They noted that stimulation of large myelinated fibers of peripheral nerves resulted in paresthesias and blocked the activity in small nociceptive projections. In other words, pain receptors compete with each other and with other sensory afferents. Appropriate stimulation of a “rival” afferent can effectively block a pain signal. This is why rubbing your chin after its been hit relieves the pain – the bump is still present, but the rubbing blocks it. The SCS system is implanted in a space surrounding the spinal cord, called the epidural space, where it stimulates the dorsal columns which can mask the sensation of pain by producing a tingling sensation

A Case Study of Pseudo-Neuropathic Pseudogout

Background This interesting case highlights the clinical progression of a rare disease process and the important role of a multi-disciplinary team in achieving a diagnosis and successful management plan. Case Presentation A 76-year-old male with a history of coronary artery disease, hypertension and hyperlipidemia presented as an outpatient with left foot pain and swelling. He had spent a week bicycling in Colorado one month prior to presentation. The pain was initially localized to the plantar surface of his foot and progressed to involve the lateral and dorsal aspects of the foot, as well as his great toe. The pain was accompanied by swelling of the midfoot without erythema and he was unable to bear weight. His podiatrist prescribed Ibuprofen and a foot brace for empiric treatment of tendonitis. An outpatient MRI demonstrated extensive bony edema and synovial enhancement within the midfoot, as well as severe superficial edema and peroneal tendonitis with mild subluxation. The patient was sent to the emergency department to be evaluated for osteomyelitis

Case Report: Intramedullary Cervical Spinal Cord Hemangioblastoma with an Evaluation of von Hippel-Lindau Disease

History of Present Illness MO is a 49 year old male with a history of multiple sclerosis who presents with a one year history of progressive numbness in his shoulders bilateral and upper back. The patient describes occasional sharp pains that radiate to his first three fingers on his right hand. He denies weakness, clumsiness, difficulty walking, or bladder/bowel dysfunction. He describes no problems with handwriting, or fine motor skills

Shoulder arthroscopy positioning: lateral decubitus versus beach chair.

Since the introduction of the beach chair position for shoulder arthroscopy, orthopaedic surgeons have debated whether the beach chair or lateral decubitus is superior. Most surgeons use the same patient position to perform all of their arthroscopic shoulder procedures, regardless of the pathology. Each position has its advantages and disadvantages. The evidence regarding the efficiency, efficacy, and risks of the lateral decubitus and the beach chair positions for shoulder arthroscopy does not show one position to be superior. This review presents a comparison of these positions with regard to setup, surgical visualization, access, and patient risk

Botulinum Toxin for giant omphalocele abdominal wall reconstruction

Introduction The use of Botulinum Toxin A (BTA) has been shown to be safe and efficacious in neuromuscular blockade in both adult and pediatric patients. While BTA injections have been used safely in the pediatric population for a variety of medical conditions, its use in pediatric abdominal wall reconstruction has not been described. This report describes a unique surgical technique that will increase abdominal domain and allow for earlier closure of giant omphalocele defects. Case report A 33-week twin premie was born with a giant omphalocele. In an effort to achieve primary closure without the need for mesh, BTA injections were performed under ultrasound guidance two weeks prior to a planned closure. BTA injections included administration of 8 units at separate sites of the abdominal musculature bilaterally. After reduction, a component separation, and primary approximation of the fascial defect were achieved without signs of abdominal compartment syndrome. Conclusion BTA injection into the abdominal wall musculature provides a safe and effective mechanism to increase laxity of the abdominal wall musculature and decrease tension on the reconstruction for giant omphaloceles defects. The use of BTA may allow earlier repair in this subset of patients without the need for mesh

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