Easing the Pain: An Argument for Prescribing Opiates in Continuity Clinic

Continuity clinic can be painful. The patients are often non-adherent, the no-show rate is high, and the paperelectronic records hybrid system is less than ideal. Added to that is the stress of caring for patients with a variety of medical issues and the burden of being expected to prescribe opiates for them. Given all of the difficulties associated with opiate prescribing, including the potential for abuse, limited continuity with providers, and poor overall adherence to medical advice, it has been proposed that these medications should no longer be prescribed at our resident clinic, and many residents support this plan. However, implementing a blanket moratorium on opiate prescribing would violate several of the fundamental principles of our medical training. According to U.S. Food and Drug Administration data, approximately one hundred million new opiate prescriptions were written in the year 2009. Of these prescriptions, general internists were responsible for writing about fifteen percent of them, including both immediate and extended release formulations.1 So, if opiate use is so fraught with problems, why are physicians prescribing so many of them? This is likely because they are some of our most effective medicines and many of our patients need immediate relief from acute pain

Adolescent and Young Adult Oncology Patient and Provider Perspectives in Philadelphia (AYA-4P)

Primary Objectives To assess the current perspective of AYA patients regarding medical services and psychosocial support delivered to AYAs in Philadelphia To assess the current knowledge and perspective of healthcare providers at the SKCC about the care and services needed by AYA patient

Caring for AML Patients During the COVID-19 Crisis: An American and Italian Experience.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the subsequent pandemic have impacted every aspect of oncology care worldwide. Healthcare systems have been forced to rapidly change practices in order to maximize the safety of patients and healthcare providers and preserve scare resources. Patients with acute myeloid leukemia are at increased risk of complications from SARS-CoV-2 not only due to immune compromise related to the malignancy but also due to the acuity of the disease and intensity of treatment. These issues have created unique challenges during this difficult time. In this article, we present the approaches taken by two groups of hematologist/oncologists, one in the United States and one in Italy, who have been caring for acute myeloid leukemia (AML) patients in the face of the pandemic

Hematemesis, a Distended Abdomen, and Pulseless Electrical Activity – An Unusual Presentation of Boerhaave’s Syndrome

Case Presentation An 82-year-old male with a past medical history significant for coronary artery disease with three stents placed over the last 15 months, diastolic heart failure with preserved EF, atrial fibrillation on warfarin, colon cancer status-post sigmoid resection and prostate cancer status-post prostatectomy who presented with three episodes of melena, hematemesis, and weakness. The patient was in his usual state of health prior to these symptoms. He had no history of gastrointestinal (GI) bleeding or other GI pathology and was a non-drinker and non-smoker. He denied frequent use of non-steroidal anti-inflammatory medications

Smoking and Other Determinants of COVID Severity Among Cancer Patients

Introduction Cancer patients might be more susceptible to COVID-19 infection. With a higher incidence of acute complications, severe disease and higher mortality rates. Identifying factors contributing to severe disease remains essential to avoid the risk of severe and often fatal COVID-19 exposure. We report on the predisposing factors for severe COVID-19 and increased hospitalization burden in cancer patients at the Sidney Kimmel Cancer Center (SKCC) in Philadelphia.https://jdc.jefferson.edu/medoncposters/1015/thumbnail.jp

Pilot Study For Using Fitbit Activity Trackers To Monitor And Predict Onset Of CAR-T Cell Immunotherapy Related Adverse Events Including Cytokine Release Syndrome

Introduction: Immunotherapy using T Cells with engineered chimeric antigen receptors (CAR) is a revolutionary modality for treating cancer, especially B cell malignancies. It also has specific toxicities. The most common toxicities observed are cytokine-release syndrome (CRS) and neurotoxicity. These therapy-related adverse events can range from mild to fatal. If appropriately and timely treated, they have a good prognosis. Thus, further insight into predictive biomarkers can help clinical management of patients and reduce morbidity and mortality. Objective: One of the constitutional symptoms associated with CRS is fatigue. With the advent of activity tracking digital technology, I propose a pilot study exploring the use of fitness trackers to quantify activity level as a potential predictive biomarker of CRS due to CAR T-Cell immunotherapy. Methods: The proposed study would be a single-arm trial. Patients who are receiving CAR-T Cell immunotherapy will be given a Fitbit Flex 2™ tracker. One week of activity data (measured as steps per day) prior to CAR-T Cell infusion will establish patient baseline activity. From the date of infusion, activity levels will continue to be tracked and analyzed through CRS onset. The patient data will be gathered from Fitbit’s server via a customized app built using Fitbit’s Web Application Programming Interface (API). Results: This is a proposed study. No results have been gathered. Discussion: If a correlation is established between activity levels and onset of CRS, it would enhance the current predictive algorithm, allow easier outpatient management and remote monitoring, decrease costs, and reduce morbidity and mortality

Eliminating Unnecessary Premedications before Outpatient Transfusions

Aims for Improvement Our aim is to eliminate premedication prior to outpatient transfusions in patients without a prior transfusion reaction by 75% within 1 year

The Glasgow Outcome Scale -- 40 years of application and refinement

The Glasgow Outcome Scale (GOS) was first published in 1975 by Bryan Jennett and Michael Bond. With over 4,000 citations to the original paper, it is the most highly cited outcome measure in studies of brain injury and the second most-cited paper in clinical neurosurgery. The original GOS and the subsequently developed extended GOS (GOSE) are recommended by several national bodies as the outcome measure for major trauma and for head injury. The enduring appeal of the GOS is linked to its simplicity, short administration time, reliability and validity, stability, flexibility of administration (face-to-face, over the telephone and by post), cost-free availability and ease of access. These benefits apply to other derivatives of the scale, including the Glasgow Outcome at Discharge Scale (GODS) and the GOS paediatric revision. The GOS was devised to provide an overview of outcome and to focus on social recovery. Since the initial development of the GOS, there has been an increasing focus on the multidimensional nature of outcome after head injury. This Review charts the development of the GOS, its refinement and usage over the past 40 years, and considers its current and future roles in developing an understanding of brain injury

COVID-19 in Patients With Hematologic Malignancies: A Single Center Retrospective Study

Initial studies that described the novel coronavirus (COVID-19) reported increased morbidity and mortality in patients with cancer. Of this group, patients with hematologic malignancies (HM) had the highest disease severity and death rates. Subsequent studies have attempted to better describe how COVID-19 affects patients with HM. However, these studies have yielded variable and often contradictory results. We present our single-institution experience with patients with HM who were diagnosed with COVID-19 from March 2020 to March 2021. We report 62 total cases with 10 patients who died during this time. The overall mortality was 16.1%. Mortality during the first two waves of COVID was 27.8% and 25%. Mortality during the third wave of COVID was 10%. The median age of patients was 67 years (range 20-89 years). 55% of patients had lymphoid malignancies and the majority had active disease at the time of diagnosis with COVID-19. 87% of patients had more than one co-morbidity. Important co-morbidities included cardiovascular disease and smoking history. 38.7% of patients had asymptomatic or mild disease, 54.8% required hospitalization, and 17.5% required ICU level care. In patients who required ICU level care, the mortality was 60%