Lost in Translation: A Standardized, Interdepartmental Approach to Improve the Safety of Inpatient Transitions of Care

AIM: During the 2016-2017 academic year physician perception of favorability regarding inpatient interunit handoffs will meet the national HSOPS benchmark without negatively impacting patient bed flow. All ACGME training programs at Thomas Jefferson University Hospital will expose their new trainees to standardized handoff training during orientation in June 2017 as well as adapt a framework for monitoring trainee compliance and proficiency.https://jdc.jefferson.edu/patientsafetyposters/1028/thumbnail.jp

Baseline Assessment of Providers\u27 Perspectives on Integrating Community Health Workers into Primary Care Teams to Improve Diabetes Prevention

• Type 2 Diabetes Mellitus (T2DM) affects 11% of U.S. adults • Additional 35% considered pre-diabetic, at-risk for developing T2DM1 • Bellevue Hospital and the VA NY Harbor Hospital disproportionately affected: 2x the prevalence in the general population, and increasing2 • Only 55% of adults receive recommended preventive services3 • Panel management: each care team is responsible for preventive care, disease management, and acute care of a patient panel • Community health worker (CHW): non-clinical frontline public health professional trained in behavioral counseling, care follow-up, program referrals, and health education4-8 • Come from the community that they serve, so they can offer ongoing social support, key to successful behavior change9-12 • CHW interventions have been shown to improve diabetes outcomes and progression to diabetes13 • Lack of literature on integrating CHWs on a larger scale into a clinical care team • CHORD study: Community Health Outreach to Reduce Diabetes • Randomized controlled intervention trial to assess the efficacy of integrating CHWs into primary care teams at Bellevue and the VA to prevent T2DM in pre-diabetic patients • Present study is a baseline assessment in preparation for the CHORD studyhttps://jdc.jefferson.edu/cwicposters/1036/thumbnail.jp

Sarcomatoid Mesothelioma in a Patient with Asbestos Exposure

Case A 76-year-old man with no significant past medical history presented with a two month history of progressive shortness of breath, 25-pound weight loss, and sharp right-sided chest, abdomen, and pelvic pain without radiation. The patient noted his dyspnea became more pronounced in recent weeks, notably worse with climbing stairs or performing work around the house. He described the pain as having a positional component, and exacerbated with deep-inspiration. On further questioning, the patient reported a 50-pack-year history of smoking and past exposure to asbestos while working with heating insulation. Physical examination revealed an age-appropriate, but cachectic appearing male with tenderness of the right abdomen to palpation, mild tachypnea with 95% oxygen saturation on two liters of oxygen, and normal cardiac rate and rhythm. Initial chest radiograph revealed a large mass causing near complete opacification of the right hemithorax (Figure 1) which was a new finding compared to the patient’s previous chest radiograph two years prior (Figure 2). Computed tomography (CT) scan of the chest/abdomen/pelvis performed to further evaluate this mass (Figure 3) revealed a 20 x 21 x 23 cm heterogeneous tumor above the right hemidiaphragm with extension into the left atrium via the right pulmonary vein (white arrow), as well as lateral and anterior diaphragmatic and pleural involvement. Differential diagnosis at this stage included malignant mass, benign pleural wall tumor, and mesothelioma. Pathology from surgical biopsy (Figure 4) suggested Sarcomatoid mesothelioma

Bioethical Issues in the Management of Gender Dysphoria

The term gender dysphoria ( I) describes a heterogeneous group of individuals who express varying degrees of dissatisfaction with their anatomic gender (hence gender dysphoria ), and the desire to possess the secondary sexual characteristics of the opposite sex. Only a minority o f these patients can be considered on the extreme end of a spectrum of subjective dissatisfaction with assigned anatomy and societally sanctioned gender role (i.e., transsexual ). The number of such patients presenting to psychiatric clinics has greatly increased subsequent to the 1966 publication of Harry Benjamin\u27s seminal work, The Transsexual Phenomenon (2), and extensive media coverage of individual cases, e.g., Christine Jorgensen, J an Morris, and Renee Richards, MD

Fatty-acid uptake in prostate cancer cells using dynamic microfluidic raman technology

It is known that intake of dietary fatty acid (FA) is strongly correlated with prostate cancer progression but is highly dependent on the type of FAs. High levels of palmitic acid (PA) or arachidonic acid (AA) can stimulate the progression of cancer. In this study, a unique experimental set-up consisting of a Raman microscope, coupled with a commercial shear-flow microfluidic system is used to monitor fatty acid uptake by prostate cancer (PC-3) cells in real-time at the single cell level. Uptake of deuterated PA, deuterated AA, and the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) were monitored using this new system, while complementary flow cytometry experiments using Nile red staining, were also conducted for the validation of the cellular lipid uptake. Using this novel experimental system, we show that DHA and EPA have inhibitory effects on the uptake of PA and AA by PC-3 cells

Design of multi-frequency acoustic kinoforms

Complex diffraction limited acoustic fields can be generated from a single element transducer using inexpensive 3-D printable acoustic kinoforms. This is extremely promising for a number of applications. However, the lack of ability to vary the field limits the potential use of this technology. In this work, this limitation is circumvented using multi-frequency acoustic kinoforms for which different acoustic fields are encoded onto different driving frequencies. An optimisation approach based on random downhill binary search is introduced for the design of the multi-frequency kinoforms. This is applied to two test cases to demonstrate the technique: a kinoform designed to generate the numerals “1,” “2,” and “3” in the same plane but at different driving frequencies, and a kinoform designed to generate 3 sets of eight foci lying on a circle with a driving-frequency-dependent radius. Field measurements from these samples confirmed that multi-frequency acoustic kinoforms can be designed that switch between different arbitrary, pre-designed, acoustic field patterns in the target plane by changing the driving frequenc

Survivorship, Complications, and Outcomes Following Distal Femoral Replacement Using Megaprosthesis

Introduction: Distal femoral bone loss is often managed with a combination of modular prostheses, structural and non-structural allografts, and metal augmentation. However, when bone loss of the distal femur is severe, the viability of these methods can be limited.In the setting of severe bone loss, endoprosthetic reconstruction (EPR) with a megaprosthesis has become increasingly popular for both malignant and non-neoplastic indications. The primary aim of this study was to determine the short-term prosthesis survivorship, as well as complications, for patients who presented with non-neoplastic disease indications for megaprosthesis distal femoral replacement (DFR) at a single institution. The secondary aim was to identify factors that influenced the outcome of DFR. Methods: A retrospective review was performed to identify patients who underwent megaprosthetic DFR surgery for a non-neoplastic indication, including native and preiprosthetic fractures, septic and aseptic nonunion, periprosthetic joint infection (PJI), and aseptic loosening or mechanical failure of a previous prosthesis. Information regarding complications, reoperations, demographics and comorbidities were recorded, excluding patients with less than 24 months follow-up. Reoperation for implant failure was used as the final endpoint for survivorship. Results: Seventy-five patients were identified. DFR survivorship was 86% at one year and 76% at five years. Patients who sustained a native fracture or had non-union demonstrated the highest survival rate at one and five years, (91%, 82% respectively) followed by patients with aseptic loosening or mechanical failure of previous implants, and then patients with PJI. A total of 36 (48 %) patients experienced at least one post-operative complication and 27 patients (36%) required at least one reoperation. Fracture, aseptic loosening, and PJI were complications more likely to require reoperation for prosthesis failure. Furthermore, patient demographics and comorbidities were not significant for predicting failure. Discussion: DFR is a viable surgical option for significant distal femoral bone loss with good short-term survivorship. There is a high overall complication rate, however the complication profile, as well as survivorship may vary based on the initial indication for DFR

Stackable acoustic holograms

Acoustic holograms can be used to form complex distributions of pressure in 3D at MHz frequencies from simple inexpensive ultrasound sources. The generation of such fields is vital to a diverse range of applications in physical acoustics. However, at present, the application of acoustic holograms is severely hindered by the static nature of the resulting fields. In this work, it is shown that by intentionally reducing the diffraction efficiency of each hologram, it is possible to create stackable acoustic holograms that can be repositioned to reconfigure the combined acoustic field. An experimental test-case consisting of two holograms, each designed to generate a distinct distribution of acoustic foci, is used to demonstrate the feasibility of this approach. Field scans taken for four different positions of the two holograms confirm that the individual patterns for each hologram can be arbitrary translated relative to one another. This allows for the generation of a much greater range of fields from a single transducer than could be created using a single hologram

Binary Volume Acoustic Holograms

In recent years, high-resolution additive manufacturing has enabled a diverse range of low-cost methods for ultrasonic wave-front shaping. Acoustic holograms, in particular, allow for the generation of arbitrary diffraction-limited acoustic fields at megahertz frequencies from single-element transducers. These are phase plates that function as direct acoustic analogs to thin optical holograms. In this work, it is shown that, by using multiple polymer three-dimensional (3D) printing, two-material (binary) acoustic analogs to "thick"or volume optical holograms can also be generated. First, an analytic approach for designing a volume hologram that diffracts a set of input fields onto a desired set of output fields is briefly summarized. Next, a greedy-optimization approach based on random downhill binary search able to account for the constraints imposed by the chosen fabrication method is introduced. Finally, an experimental test case designed to diffract the field generated by a 2.54-cm planar lead zirconate titanate (PZT) transducer onto eight distinct patterns dependent on the direction of the incident field is used to validate the approach and the design method. Field scans of the eight target fields demonstrate that acoustic analogs of optical volume holograms can be generated using multipolymer printing and that these allow the multiplexing of distinct fields onto different incident field directions