Bronchial Thermoplasty – Principles and Controversies

Objectives: 1) Learn the indications and contraindications to bronchial thermoplasty. 2) Develop a basic understanding of the controversies about, and the barriers to, the use of thermoplasty. 3) Understand the peri-procedural care and follow-up of patients who receive bronchial thermoplasty. No Audio. PowerPoint slides only

A 22-year-old man with pleural tuberculosis associated hydropneumothorax: Case report and literature review.

A 22-year-old Asian male presented with fever, non-productive cough, right-sided pleuritic chest pain and was found to have a large right hydropneumothorax. A chest tube was placed. Pleural fluid analysis revealed a lymphocytic predominant exudate and he was subsequently started on four-drug daily anti-tuberculosis therapy (isoniazid, ethambutol, rifampin, pyrazinamide). Pleural biopsy revealed acid-fast bacilli. Given his persistent pleural effusion, he was given four doses of intrapleural tissue plasminogen activator (tPA) and dornase alpha (DNase) via his chest tube over a period of 6 days resulting in clinical and radiologic improvement. Pleural biopsy and pleural fluid culture specimens later revealed Mycobacterium tuberculosis. Intrapleural tPA-DNase therapy has demonstrated improved resolution of infections and shortened hospitalizations for parapneumonic infectious effusions. However, there is little literature on the use of intrapleural fibrinolytics specifically for pleural tuberculosis associated effusions. Furthermore, the American Thoracic Society does not comment on therapeutic thoracentesis or intrapleural fibrinolytic therapy in their recommendations for treatment of pleural tuberculosis. In our case of pleural TB-associated hydropneumothorax, the use of intrapleural tPA-DNase therapy facilitated pleural fluid drainage and resulted in near-complete resolution of the effusion

Quality Improvement of Diabetic Care at a Resident Clinic

Our objective was to develop a quality improvement project on diabetes mellitus at our internal medicine residency clinic. Residents developed projects aimed at improving an aspect of diabetic care. Continuity of care, achievement of clinical targets, no-show rates, patient knowledge of diabetes, and preventive care were evaluated. Our data was obtained with a questionnaire and a retrospective review of medical records. A different provider was scheduled about every 1.78 visit. The no-show rate was 25.4%. About half of patients identified goal hgbA1c and BPs, and 35% and 60% achieved their hgbA1c and SBP goals respectively. Nearly all of the charts planned for screening exams. We concluded that our clinic needs to improve diabetes education, reaching clinical targets, continuity of care and no-shows. Incorporating a QI project into the clinic with one disease such as diabetes is an efficient way to include practice based learning into an internal medicine residency’s curriculum

Lung Cancer Screening: Current Recommendations and Controversies

Objectives: Develop an understanding of the history of lung cancer screening and the reasons why it has not been undertaken until recently Understand the criteria for lung cancer screening and the data behind it Learn the limitations to lung cancer screening and the new technologies being tested to improve the screening process Presentation: 45:4

Ventilator Management for the Non-Intensivist

The management of the mechanical ventilator is one of the most complex and dynamic, yet ubiquitous issues to face the critical care physician. As we as a medical community have become more advanced, so too, have our ventilators, with new modes and variables having been added beyond more traditional modeslike Assist Control and Intermittent Mandatory Ventilation. This article is designed to give a very basic understanding of what the individual ventilatory modes do and how they are set.It is in no way meant to be a replacement for either a medical intensivist or a respiratory therapist

The Bug-Bag: Consolidating Medications to Cut Costs

Background Founded in 1991, JeffHOPE is an organization of student run medical clinics providing care to the homeless and underserved populations of Philadelphia. JeffHOPE currently operates at 5 different sites Eliza Shirley Population served: Women and children Serves as a transitional shelter and aims to help newly homeless women and children find more stable housing Sunday Breakfast Population served: Men older than 18 Serves as a transitional shelter offering housing for 30 days for homeless men ACTS Population served: Women and children Provides long term housing for women and children who are homeless. The shelter is also located next to a recovery house for drugs and alcohol whose participants are also seen in clinic. Our Brothers’ Place Population served: Men older than 18 Serves as a long term men’s homeless shelter. Most residents stay in the shelter for 60-90 days before finding more permanent housing. Prevention Point Population served: Men, women, and children Mobile clinic conducted along with a needle exchange program using a harm reduction model of care.https://jdc.jefferson.edu/pharmacyposters/1004/thumbnail.jp

Diet, Gut Microbiota, and Vitamins D + A in Multiple Sclerosis

Central to the understanding of the relationships between diet, gut microbiota, and vitamins D and A in multiple sclerosis is low-grade inflammation, which is involved in all chronic inflammatory diseases and is influenced by each of the above effectors. We show that food components have either proinflammatory or anti-inflammatory effects and influence both the human metabolism (the “metabolome”) and the composition of gut microbiota. Hypercaloric, high-animal-fat Western diets favor anabolism and change gut microbiota composition towards dysbiosis. Subsequent intestinal inflammation leads to leakage of the gut barrier, disruption of the blood–brain barrier, and neuroinflammation. Conversely, a vegetarian diet, rich in fiber, is coherent with gut eubiosis and a healthy condition. Vitamin D levels, mainly insufficient in a persistent low-grade inflammatory status, can be restored to optimal values only by administration of high amounts of cholecalciferol. At its optimal values (>30 ng/ml), vitamin D requires vitamin A for the binding to the vitamin D receptor and exert its anti-inflammatory action. Both vitamins must be supplied to the subjects lacking vitamin D. We conclude that nutrients, including the nondigestible dietary fibers, have a leading role in tackling the low-grade inflammation associated with chronic inflammatory diseases. Their action is mediated by gut microbiota and any microbial change induced by diet modifies host–microbe interactions in a consequent way, to improve the disease or worsen it