Exploring the Feasibility of Incorporating Sexual Education into Routine Adolescent Office Visits

Preventative sexual education can reduce the negative health outcomes of sexual behavior in adolescent populations.1 The objective of this pilot study was to determine if sexual education can be delivered as a scripted five-minute module during a routine adolescent office visit in a manner that is non-disruptive of clinic flow and acceptable to both patients and providers. • 85% of providers reported the intervention did not interrupt clinic flow • 86% of patients reported the intervention to be appropriate and 92% of providers were satisfied overall with the intervention These pilot data highlight that the incorporation of brief scripted sexual education into routine adolescent preventative office visits is both feasible and acceptable to patients and providers.https://jdc.jefferson.edu/cwicposters/1024/thumbnail.jp

John Chalmers DaCosta (1863-1933): restoration of the old operating table.

John Chalmers DaCosta was an influential chairman and the first Samuel D. Gross Professor of Surgery at Jefferson Medical College in Philadelphia. He was well known throughout the field as a skilled surgeon, passionate speaker, and exceptional writer. In addition to countless accomplishments during his career, DaCosta was deeply dedicated to the preservation and commemoration of surgical history. This ideology was exemplified when he set out on a mission to recover the old wooden operating table used by many of his iconic mentors including Samuel D. Gross, Joseph Pancoast, and William W. Keen. This table was originally used for surgical demonstrations and anatomy lessons in a lecture room of the Ely Building and later in the great amphitheater of the Jefferson Sansom Street Hospital. It was found forgotten in the basement of the College Building and was promptly refurbished, donned with dedicatory plaques, and returned to its honored position in the medical college. Dr. DaCosta also contributed a detailed article recalling the history of the table and the notable leaders in surgery who taught and practiced on its surface. The old table currently stands proudly in the entranceway of the Department of Surgery where it will remain as a cherished symbol of the early beginnings of surgical practice and education

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

Introduction

It is with great pride that we introduce our new resident JOURNAL. This unique forum was created to allow our resident s the opportunity to explore the challenges and pleasures to writing and publishing. Putting one\u27s thoughts and experiences on paper demands a clarity of thinking and a willingness to share what is otherwise private. For the resident this becomes a valuable educational enterprise. For the faculty this is an opportunity to view first hand the work of our trainees . Not limited to reading course descriptions of clinical service schedules, our staff can now get to know t he depth, variety , and quality of resident work. Evan further, we welcome input from the faculty on the ideas presented in THE JOURNAL. We will be beginning a \u27Letters to the Journal\u27 section and hope that it becomes a significant arena for interdepartmental discussion

Cardio-oncology for the 21st century: introduction.

Based on the latest statistics the prognosis for patients with malignancy has dramatically improved. The overall 5 year survival rate for those who were diagnosed with a cancer between 2002 and 2008 was approximately 65%1, and as of 2008, 12 million Americans were cancer survivors.2 However, this extended longevity now exposes these patients to the risk of other health issues related to their primary cancer or to the treatment that ensured their survival. Specifically, patients who have not succumbed prematurely to their oncologic disease may develop cardiovascular disease that is either a result of the long-term effects of their traditional cardiovascular risk factors or that is due to the direct cardiovascular toxicity of the cancer itself or from the administered therapy. In fact, Patnaik and colleagues reviewed the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database and found that breast cancer survivors were as likely to die from cardiovascular disease as from recurrent breast cancer.3 Additionally, Mertens and colleagues found that cardiovascular events are the leading cause of nonmalignant deaths in survivors of childhood cancers.

Faculty Advisor\u27s Column

The teaching of the concepts and techniques of dynamic psychotherapy to residents is a formidable task facing most all residency directors and faculty. The challenge of \u27new\u27 therapies and the revolution in neurobiology has led to a significant deemphasis in dynamic training in many programs in recent years. Where once there was relative uniformity of philosophy, a variety of approaches now abound. Medical school graduates can choose from programs that offer intensive training in psychoanalytic psychiatry as well as those that mention Freud only in passing. Most call themselves \u27eclectic\u27 and teach a potpourri of therapies that vary with faculty interest. Graduates of all these programs become psychiatrists though their clinical experiences and expertise may differ widely. The array of approaches available often leaves the prospective patient (and third party payers) bewildered

Use of observation followed by outpatient stress testing in chest pain patients with prior coronary artery disease history: An evaluation of prognostic utility.

OBJECTIVE: To determine the outcomes of patients with chest pain (CP) and prior history of coronary artery disease (CAD) managed with observation followed by outpatient stress myocardial perfusion imaging (MPI). METHODS: Retrospective analysis of patients with CP managed with observation followed by outpatient stress MPI, comparing cardiovascular (CV) event rates stratified by CAD history. RESULTS: 375 patients were included: 111 with and 264 without a CAD history. All patients underwent outpatient stress MPI within 72 h of observation. MPI identified patients at risk for CV events. However, while patients with negative MPI and without a CAD history had very low rates of short- and long-term CAD events (0.8%, 0.8%, and 1.3% at 30 days, 1 year, and 3 years, respectively), event rates of those with a negative test but a CAD history were significantly higher (2.6%, 5.3%, and 6.6% at 30 days, 1 year and 3 years, respectively; p = 0.044 and p = 0.034 compared to CAD- patients at 1 year and 3 years, respectively). In a multivariable logistic regression model, a positive MPI proved to be an independent predictor of long-term CV events in patients with CP and prior CAD. CONCLUSION: Observation followed by stress MPI can effectively risk stratify CP patients with prior CAD for CV risk. These patients are at increased risk of CV events even after a low-risk stress MPI study. Patients presenting with CP and managed with a strategy of observation followed by a negative stress MPI warrant close short- and long-term monitoring for recurrent events