Heartbreak hotel: a convergence in cardiac regeneration

In February 2016, the Company of Biologists hosted an intimate gathering of leading international researchers at the forefront of experimental cardiovascular regeneration, with its emphasis on ‘Transdifferentiation and Tissue Plasticity in Cardiovascular Rejuvenation’. As I review here, participants at the workshop revealed how understanding cardiac growth and lineage decisions at their most fundamental level has transformed the strategies in hand that presently energize the prospects for human heart repair

Standardization of Monofilament use in a Resident-Run Clinic

Study Aim: The aim of this study was to improve incidence of regular foot exams among clinic diabetic patients.https://jdc.jefferson.edu/patientsafetyposters/1040/thumbnail.jp

Maintaining Continuity in a resident run clinic-Impact of the 6+2 Scheduling.

Objective: The aim of this study was to evaluate the continuity of care with regards to follow up with the same team (and optimally same resident) 1 year prior to implementing the 6+2 scheduling block and 1 year post schedule block change.https://jdc.jefferson.edu/patientsafetyposters/1039/thumbnail.jp

From the Chief Residents

As your Chief Residents, we would like to take a moment to express our heartfelt congratulations to each and every one of you on your incredible scholarly achievements over the past year. We have been impressed by the quality and diversity of your scholarly work. From interdisciplinary clinical research projects that have been submitted to journals across numerous subspecialties, to contributions to the Health Equity and Quality Improvement Summit, you have all demonstrated a passion for excellence and a commitment to advancing the field of medicine. We are grateful for the opportunity to have worked alongside you and to have witnessed your growth and development as physician scholars. We are confident that your accomplishments will serve as a source of inspiration for future generations of medical professionals. Once again, congratulations on your achievements, and we wish you all the best in your future endeavors

Complication Rates in Resident Cataract Surgery After Elective Operating Room Shutdown During the COVID-19 Pandemic

Purpose: To assess the types of cataract surgeries being performed at one large eye institute from before and after the COVID-19 induced shutdown of elective surgeries in Spring 2020. Methods: This is a retrospective chart review study of operative reports from resident performed cataract surgeries from January 1st, 2020 through July 31st, 2020. Cataract surgeries were categorized into Pre-COVID (Jan – Mar 2020) if they occurred prior to operating room (OR) shutdown on March 18th, 2020 and Post COVID for all cases which occurred after the shutdown orders were lifted (May – July 2020). A resident survey was also used to gather data regarding resident case numbers and resident concern performing cataract upon re-opening of the operating room for elective surgeries. Results: A total of 480 cases (n=306 Pre-COVID and n=174 Post-COVID) were analyzed. Our study shows a higher frequency of complex cataract surgeries being boarded after the COVID-19 pandemic induced shutdown of elective surgeries in Michigan (P\u3c0.0001). However, the incidence rate of complications in resident performed cataract surgeries was not significantly higher immediately following the government induced shutdown. Complications analyzed included anterior rent or capsulorrhexis, wound burn, placement of iris dilator, posterior capsular rupture, anterior vitrectomy, and capsular ring tension. Survey results showed that phacoemulsification was the step of cataract surgery which residents were most concerned about when returning to the OR after their hiatus from operating. Conclusion: Significantly more complex cataract surgeries were performed immediately after opening of the OR, however, there was no significant increase in resident complications in performing cataract surgery

Effects of Ohio Opioid Prescribing Policy on Postsurgical Prescriptions Following Sports Procedures

Background: Prescribed opioid medication after orthopedic sports surgery has been shown to exceed patient requirements. In 2017, as a response to the opioid epidemic, Ohio passed Opioid Prescribing Guidelines (OPG) limiting narcotic prescriptions for acute pain. This study sought to evaluate the effects of the OPG on prescribing behavior of orthopedists following knee arthroscopy (KA), shoulder arthroscopy (SA), and anterior cruciate ligament reconstruction (ACLR). Methods: An institutional database was queried to calculate morphine equivalent dose (MED) prescribed at discharge, acute follow-up (\u3c90 days), and chronic follow-up (\u3e90 days) and compare MED pre- and post-OPG. Cases were identified over a 2-year period starting 1 year prior to OPG implementation. Individual surgeon data were tracked to control for inter-surgeon variability. Results: A total of 1663 patients were included in the analysis. Demographic variables were similar pre- and post-OPG for each procedure group. With all surgeons included, average discharge MED decreased significantly for all procedures from pre- to post-OPG. Surgeons qualified for individual analysis if they had at least 10 surgeries pre- and post-OPG. Of qualifying providers, 80% of KA, 25% of SA, and 0% of ACLR surgeons reduced discharge MED prescribed post-OPG. MED prescribed during follow-up was largely unaffected by implementation of the OPG. Conclusion: Average discharge morphine equivalent dose (MED) prescribed after SA, KA, and ACLR decreased following the implementation of the OPG. The MED reduction effect of the OPG was the greatest in magnitude after SA, and SA was the only surgery that showed MED reductions that persisted during acute follow up. Opioid prescriptions beyond 90 days postoperatively were unchanged by the OPG for all surgeries. Policy that restricts postoperative opioid prescriptions can be an effective, but incomplete method to address the opioid crisis

Outpatient Mineralocorticoid Receptor Antagonist Prescription Rate for Heart Failure

Aims for Improvement: Improve MRA prescription rate in the outpatient cardiology clinic by 25

Estimation of Stock Status Using the LBB and CMSY Methods for the Indian Salmon Leptomelanosoma indicum (Shaw, 1804) in the Bay of Bengal, Bangladesh

As one of the largest and most commercially valuable finfish species, Leptomelanosomaindicum (Indian salmon) significantly contributes to Bangladesh’s marine catches. The length-based Bayesian biomass (LBB) method and catch-based Monte Carlo method (CMSY) are among the most recent and powerful methods for predicting the state of fisheries resources from data-limited fisheries. CMSY requires catch and resilience data, as well as quantitative stock status information. For LBB, only length–frequency (LF) data are required. The stock status of L. indicum was estimated using these two independent methods, utilizing twenty-one years of catch–effort and length–frequency data (978 individuals) from commercial fisheries on the Bangladesh coast. Here, a BSM (Bayesian state-space implementation of the Schaefer surplus production model) was also employed. The current study’s findings showed that the B/B0 ratio of currently exploited biomass to unexploited biomass (0.1) was smaller than BMSY/B0 (0.36) and B/BMSY = 0.28 was smaller than the reference value of 1.0, indicating the grossly overfished and depleted condition of the stock. Similar trends in the results were found for B/BMSY = 0.11 ( FMSY) further justify the severely overfished conditions of L. indicum stock in the study area. Furthermore, the Lc_opt (optimal length at first capture) was higher than the Lc (length at first capture), indicating that this species is being overfished, and that mesh sizes should be increased for better management. This study provides information on biological reference points (BRPs), and confirms the severely overfished status of L. indicum in the coastal waters of Bangladesh. More specific and prompt management measures are required to recover and sustainably manage this valuable species, and protect the fish stock from commercial extinction

Estimation of Stock Status Using the LBB and CMSY Methods for the Indian Salmon Leptomelanosoma indicum (Shaw, 1804) in the Bay of Bengal, Bangladesh

As one of the largest and most commercially valuable finfish species, Leptomelanosomaindicum (Indian salmon) significantly contributes to Bangladesh’s marine catches. The length-based Bayesian biomass (LBB) method and catch-based Monte Carlo method (CMSY) are among the most recent and powerful methods for predicting the state of fisheries resources from data-limited fisheries. CMSY requires catch and resilience data, as well as quantitative stock status information. For LBB, only length–frequency (LF) data are required. The stock status of L. indicum was estimated using these two independent methods, utilizing twenty-one years of catch–effort and length–frequency data (978 individuals) from commercial fisheries on the Bangladesh coast. Here, a BSM (Bayesian state-space implementation of the Schaefer surplus production model) was also employed. The current study’s findings showed that the B/B0 ratio of currently exploited biomass to unexploited biomass (0.1) was smaller than BMSY/B0 (0.36) and B/BMSY = 0.28 was smaller than the reference value of 1.0, indicating the grossly overfished and depleted condition of the stock. Similar trends in the results were found for B/BMSY = 0.11 ( FMSY) further justify the severely overfished conditions of L. indicum stock in the study area. Furthermore, the Lc_opt (optimal length at first capture) was higher than the Lc (length at first capture), indicating that this species is being overfished, and that mesh sizes should be increased for better management. This study provides information on biological reference points (BRPs), and confirms the severely overfished status of L. indicum in the coastal waters of Bangladesh. More specific and prompt management measures are required to recover and sustainably manage this valuable species, and protect the fish stock from commercial extinction

Population Health and Complexity Science: A Leadership Primer

Objectives 1) Describe the current state of health outcomes2) Define complexity science3) Describe healthcare as a complex adaptive system4) Introduce implementation science5) Describe the Cynefin framework for decision makin