Identifying Barriers to Statin Therapy in Diabetic Patients in a Large Ambulatory Practice

Aim 1: To understand the root cause(s) for gaps in statin therapy within a large ambulatory care practice. Aim 2: To improve provider awareness of indications for statin therapy, as recommended by the ACC/AHA guidelines. Aim 3: To increase the proportion of patients with diabetes at our practice that are on statin therapy

Assessment of Suicidal Patients in Primary Care

Objectives Understand epidemiology of suicide Know risk factors and protective factors for patients Become familiar with Columbia Suicide Screening Tool Learn about legal process for voluntary and involuntary commitment Know several resources in center city for patient referral

Thyroid Function Disorders: Diagnosis through Lab Testing

Learning Objectives Understand the feedback regulation in the HPA axis Understand what thyroid labs are available to order Learn how to interpret lab test results with patient cases Be able to follow algorithm for diagnosis of thyroid function disorders based on results of testin

Substance Use Disorder: Geriatric Edition

Roadmap Why SUD and geriatrics? Define SUD Challenges in diagnosis for geriatric patients Screening for geriatric patients Specific substances Alcohol Prescription drug misuse (Benzodiazepine, Opiod) Future directions

SGLT2 inhibitors and Cardiovascular Outcomes: Journal Club

Outline Review mechanism of SGLT2 inhibitor Review increased risk of cardiac outcomes in diabetes Journal dissection Title Abstract conclusion Methods/Study design (Type I error inflation) Results Dsicussion What about at JFMA? Future research

Chronic Obstructive Pulmonary Disease: Outpatient Diagnosis and Management

Learning Objectives To review diagnosis of COPD Review spirometry Review treatment modalities Understand pulmonary rehabilitation Discuss when to refer patients to specialists Roadmap1. Presenting symptoms 2. Epidemiology 3. Diagnosis Formal diagnosis Categorization of class 4. Disease course and pathology 5. Outpatient management options Counseling Pharmacology Pulmonary rehab Oxygen therapy 6. Conclusion

Improving Diabetic Retinopathy Screening in a Large Ambulatory Practice

Aim 1: To increase the percentage of JFMA diabetic patients with up-to-date retinopathy screening to 60% by April 1, 2019. Aim 2: To increase the utilization of an in-office portable retinal scanner by identifying current barriers to its use and developing a standardized workflow to overcome these barriers. Outcome measure: The percentage of adult diabetic patients with a JFMA provider listed as the PCP who have been seen in the Jefferson health system within the last 24 months, who had retinopathy screening once in the last 24 months. Process measure: The number of retinal scans completed each week.https://jdc.jefferson.edu/patientsafetyposters/1143/thumbnail.jp

Improving follow-up for family medicine patients after hospital discharge

Aims Increase percentage of JFMA patients with follow-up appointment scheduled after discharge to 100% by March 2018 Increase percentage of JFMA patients who show up to their follow up appointments after discharge to 80% by March 2018https://jdc.jefferson.edu/patientsafetyposters/1083/thumbnail.jp

Viral cross-class serpin inhibits vascular inflammation and T lymphocyte fratricide; a study in rodent models in vivo and human cell lines in vitro.

Poxviruses express highly active inhibitors, including serine proteinase inhibitors (serpins), designed to target host immune defense pathways. Recent work has demonstrated clinical efficacy for a secreted, myxomaviral serpin, Serp-1, which targets the thrombotic and thrombolytic proteases, suggesting that other viral serpins may have therapeutic application. Serp-2 and CrmA are intracellular cross-class poxviral serpins, with entirely distinct functions from the Serp-1 protein. Serp-2 and CrmA block the serine protease granzyme B (GzmB) and cysteine proteases, caspases 1 and 8, in apoptotic pathways, but have not been examined for extracellular anti-inflammatory activity. We examined the ability of these cross-class serpins to inhibit plaque growth after arterial damage or transplant and to reduce leukocyte apoptosis. We observed that purified Serp-2, but not CrmA, given as a systemic infusion after angioplasty, transplant, or cuff-compression injury markedly reduced plaque growth in mouse and rat models in vivo. Plaque growth was inhibited both locally at sites of surgical trauma, angioplasty or transplant, and systemically at non-injured sites in ApoE-deficient hyperlipidemic mice. With analysis in vitro of human cells in culture, Serp-2 selectively inhibited T cell caspase activity and blocked cytotoxic T cell (CTL) mediated killing of T lymphocytes (termed fratricide). Conversely, both Serp-2 and CrmA inhibited monocyte apoptosis. Serp-2 inhibitory activity was significantly compromised either in vitro with GzmB antibody or in vivo in ApoE/GzmB double knockout mice. Conclusions The viral cross-class serpin, Serp-2, that targets both apoptotic and inflammatory pathways, reduces vascular inflammation in a GzmB-dependent fashion in vivo, and inhibits human T cell apoptosis in vitro. These findings indicate that therapies targeting Granzyme B and/or T cell apoptosis may be used to inhibit T lymphocyte apoptosis and inflammation in response to arterial injury