Medicinal Cannabis Use in Sickle Cell Anemia

Approximately 100,000 Americans suffer from sickle cell anemia (SCA), a severe hereditary form of anemia in which red blood cells can mutate into a sickled shape causing severe pain crises that can lead to ED visits, hospitalization, and negatively impact multiple organ systems. Pain crises greatly impact the quality of life for SCA patients. Living with SCA can be stressful and often affects patients’ mental health, causing anxiety or depression (National Heart, Lung, and Blood Institute, 2016). Opioids have been a treatment mainstay for the severe pain caused by SCA but the side effects of opioids, plus the risk of dependence, are issues that have led both patients and researchers to consider medicinal cannabis as a treatment option. While there is limited research addressing the treatment of sickle cell pain with cannabis some research does suggest that cannabis could have a beneficial effect on the management of both chronic pain and acute pain (Choo, Feldstein Ewing, & Lovejoy, 2016; Kroenke & Cheville, 2017). The aim of this study is to evaluate the association between medicinal cannabis use and quality of life for individuals with SCA. The primary goal of this pilot study is to gather a cohort of participants and administer a baseline survey that will be used in a larger study. The goal of the larger study is to assess the impact of medicinal cannabis available through Pennsylvania’s Department of Health-approved dispensaries in Philadelphia on the quality of life for individuals with sickle cell anemia (SCA)

Stereotactic Radiosurgery Practice Patterns for Brain Metastases in the United States: A National Survey

Background: Stereotactic radiosurgery (SRS) has emerged as an important modality for the treatment of intracranial metastases. There are currently few established guidelines delineating indications for SRS use and fewer still regarding plan evaluation in the treat- ment of multiple brain metastases. Methods: An 18 question electronic survey was distributed to radiation oncologists at National Cancer Institute (NCI) designated cancer centers in the US (60). Centers without radiation oncologists were excluded. Physicians who indicated that they do not prescribe SRS were excluded from the remaining survey questions. Sign test and Chi-square test were used to determine if responses differed significantly from random distribution. Results: 116 of the 697 radiation oncologists surveyed completed the questionnaire, representing 51 institutions. 62% reported treating patients with brain metastases using SRS. Radiation oncologists prescribing SRS most commonly treat CNS (66.2%) and lung (49.3%) malignancies. SRS was used more frequently for \u3c10 brain metastases (73.7%; p\u3c.0001) and whole brain radiation therapy (WBRT) for \u3e10 brain metastases (82.5%; p\u3c.0001). The maximum number of lesions physicians were willing to treat with SRS without WBRT was 1-4 (40.4%) and 5-10 (42.4%) (p\u3c.0001 compared to 11-15, 16-20 and no limit). The most important criteria for choosing SRS or WBRT were number of lesions (p\u3c.0001) and performance status (p=.016). The most common margin for SRS was 0 mm (49.1%; p=.0021). The most common dose constraints other than critical structure was conformity index (84.2%) and brain V12 (61.4%). The LINAC was the most common treatment modality (54.4%) and mono-isocenter technique for multiple brain metastases was commonly used (43.9%; p=.23). Most departments do not have a policy for brain metastases treatment (64.9%; p=.024). Conclusions: This is one of the first national surveys assessing the use of SRS for brain metastases in clinical practice. These data highlight some clinical considerations for physicians treating brain metastases with SRS. Summary: This is among the first national surveys to assess the use of SRS for brain metastases in clinical practice. Specifically, radiation oncologist reported increasingly using SRS instead of WBRT for treating \u3c10 metastases, with the LINAC being the most common modality. Further, treatment parameters considered the most important included 0 mm margins, conformity index, brain V12, and mono- isocenter technique for multiple brain metastases. These results may provide context regarding the use of SRS for brain metastases in clinical practice

Improved cardiac management with a disease management program incorporating comprehensive lipid profiling.

Abstract The objective of this study was to evaluate the improved effectiveness of a disease management treatment protocol incorporating comprehensive lipid profiling and targeted lipid care based on lipid profile findings in patients with ischemic heart disease (IHD) or congestive heart failure (CHF) enrolled in a managed care plan. This retrospective cohort study, conducted over a 2-year period, compared outcomes between patients with a standard lipid profile to those evaluated with a comprehensive lipid profile. All adult members of the WellMed Medical Management, Inc. managed care health plan diagnosed with IHD or CHF, and continuously enrolled between July 1, 2006 and June 30, 2008, were included in the study. Cases were defined as those who had at least 1 comprehensive lipid test (the VAP [vertical auto profile] ultracentrifuge test) during this period (n=1767); they were compared to those who had no lipid testing or traditional standard lipid testing only (controls, n=289). Univariate statistics were analyzed to describe the groups, and bivariate t tests or chi-squares examined differences between the 2 cohorts. Multivariate regression analyses were performed to control for potential confounders. The results show that the case group had lower total costs ($4852.62 vs.$7413.18; P=0.0255), fewer inpatient stays (13.1% vs. 18.3% of controls; P=0.0175) and emergency department visits (11.9% vs. 15.6% of controls; P=0.0832). Prescription use and frequency of lipid measurement suggested improved control resulting from a targeted approach to managing specific dyslipidemias. A treatment protocol incorporating a comprehensive lipid profile appears to improve care and reduce utilization and costs in a disease management program for cardiac patients. (Population Health Management 2012;15:46-51)

Improving Hypertension Knowledge among Formerly Incarcerated Individuals: An Assessment of a Health Education Program during Community Reentry

The prevalence of hypertension (HTN) among adults in the United States is a serious public health concern. Individuals who are currently, or were recently, incarcerated are found to be at greater risk for HTN than those without a history of incarceration. Although previous HTN prevention and self-management interventions have targeted high-risk populations, there is a lack of research regarding the utility of such programs among formerly incarcerated persons. The purpose of the present study was to determine whether Blood Pressure Understanding and Management Progaram (BUMP), a four-week educational program developed for formerly incarcerated persons, would effectively increase participants’ knowledge of HTN and blood pressure self-management. Four weekly, 60-minute sessions were held at the Institute for Community Justice in Philadelphia. Nine participants completed all four sessions. BUMP classes focused on defining medical terms related to blood pressure, interpreting blood pressure readings, explaining causes and complications of high blood pressure, selecting healthy food options, and discussing lifestyle modifications to manage blood pressure. Participants were asked to complete pre-and post-intervention knowledge assessments consisting of 14 items related to topics covered in the BUMP curriculum. Analyses demonstrated a significant improvement in the mean knowledge assessment score after completion of the four sessions. Further, the percentage of correct responses improved across nine assessment items, while two items remained the same, and only one item declined. These findings demonstrate the potential for community-based educational programs to enhance HTN knowledge among formerly incarcerated persons. Future research should focus on how improvement in knowledge relates to changes in health behaviors and outcomes among this population

Human Trafficking: A Curriculum for Public Health Students

Human trafficking is a global issue spanning the entire world through the transportation and purchase of men, women and children for exploitation. Due to overwhelming statistics that victims of trafficking are seen by a healthcare professional; it is important to implement courses into public health curriculum with the hope that the knowledge and attitude changes will create better informed healthcare professionals, with the ability to identify and intervene in clinical settings. This capstone reviews the public health implications of this phenomenon and demonstrates the importance of educating public health students on human trafficking risk factors, identification in medical settings and intervention and prevention strategies. It also develops and provides an educational module for the MPH curriculum to educate Thomas Jefferson students on this fast-growing public health crisis, through a thirty-minute voiceover PowerPoint educational module. In addition, a fact sheet and resource guide is added to the paper so that students in the greater Philadelphia area are aware of the risk factors and who to contact if they do suspect a patient as a victim of human trafficking

Development of a Disaster Preparedness Interprofessional Education (IPE) Program for Health Profession Students

Despite numerous attacks and threats both in the US and around the world, there is no standardized disaster preparedness curriculum for health profession students This project is the development and implementation of an IPE disaster preparedness curriculum with both a mandatory component and additional training as an elective at Thomas Jefferson University (TJU) in Philadelphia Upon completion of the elective component, students are Federal Emergency Management Agency (FEMA) Hospital Emergency Response Team (HERT) certified and become part of the hospital’s disaster response and decontamination teamhttps://jdc.jefferson.edu/jcphposters/1015/thumbnail.jp