2024 Annual Report Department of Medicine

2024 ANNUAL REPORT DEPARTMENT OF MEDICINE

Department of Medicine College Building, Room 822 1025 Walnut Street Philadelphia, PA 19107

ACKNOWLEDGEMENTS Department of Medicine 200: Through the Lens Capturing Art, Medicine, & Humanity

TABLE OF CONTENTS

ATTENDINGS Jonathan Foster, MD Gregory Kane, MD Alyssa Yeager, MD

0 3 Division of Cardiology

RESIDENTS

17

Sara Badenhausen, MD

Division of Endocrinology, Diabetes and Metabolic Diseases

Susanna Betti, MD

21

Jessica Cobb, MD

Division of Gastroenterology and Hepatology

Joseph DeSimone, MD Abdulmojeed Ekiyoyo, MD

27

Division of Hematology and Cardeza Foundation for Hematologic Research

Umma Fatema, MD Ilana Goldberg, MD

31

Division of Hospital Medicine

37

Division of Infectious Diseases and Environmental Medicine

Natasha Reddy, MD Brian Schonewald, MD

STUDENTS Anna Hamtic

43

Division of Internal Medicine

Junthe Jonth Emilio Mansilla

47

Division of Nephrology

53

Division of Pulmonary, Allergy and Critical Care Medicine

59

Division of Rheumatology

61

Center for Translational Medicine

65

Graduate Medical Educational Programs in Internal Medicine

Rachel Menane Kathleen Spritzer Mary Wilkinson

Cover Photo ©Thomas Jefferson University Photography Services

Department of Medicine 2024 Annual Report

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CHAIRMAN'S LETTER OF INTRODUCTION Dear Friends and Colleagues: This past year 2024 marked Jefferson's 200th anniversary. Thinking back to 1824 it is remarkable to note that Jefferson was the fifth medical school in the United States and the second in Philadelphia; underscoring the importance of Philadelphia in our new nation and in American Medicine. One of the most important aspects of our founding was the creation of the “Hall of the Jefferson Medical College,” which offered free care for outpatients and served as the first clinic established by any medical college in the United States. Placing patients at the center of all we do would become the cornerstone not only for the Sidney Kimmel Medical College, but for the Department of Medicine. Today, we remain focused on providing care for the most complex patients as well as those seeking primary care. Our mission extends to the general population at large through transformative research conducted in our laboratories, in our outpatient practices and the training of the next generation of physicians for tomorrow and beyond in our residency programs, fellowships, and advanced fellowships. For the Department of Medicine this has really meant that 200 years later we continue to re-dedicate ourselves to the core of our mission every day — our patients. We also continue to adapt and change to ensure that we remain at the forefront of Medicine.

I invite you to read about our strength and excellence across a broad array of programs.

We continue to experience growth in our outpatient practices despite continued cases of COVID-19; our total outpatient visits topped 265,000, with over 42,000 of those being new patient visits. Additionally, our telehealth services expanded dramatically from 9,000 visits in FY20, to over 58,000 in FY21 and settled at 28,885 in FY24. It is clear that telehealth has become a mainstay of our core business providing flexibility for both patients and providers. Our Bala Cynwyd multispecialty practice has seen significant growth, with visit numbers increasing from 15,634 in FY21 to 19,681 in FY24. In this location, providers from Primary Care, Cardiology, Endocrinology, Gastroenterology, Nephrology, Pulmonary, and Rheumatology

see outpatients in a multidisciplinary setting.

Our ability to grow at this multispecialty site has further enhanced the health of the enterprise and set the stage for an upcoming expansion at this site for FY25.

In this report, I welcome you to enjoy a number of black and white photographs collected in celebration of our 200th year. These remarkable photographs, obtained with the consent of our patients, demonstrate the humanism of our work and the power of human touch. How fitting that 200 years after the creation of one of the first medical college clinics, we can celebrate the power of human connection and care-one patient at a time. I urge you to enjoy the photography in this annual report and look for it around the campus or on the eighthfloor hallway adjacent to our Education Offices. We also look forward to seeing many of these photographs in the new Jefferson archives located in the Scott Building on Walnut Street.

265,056 Total outpatient visits

42,684

New patient visits in 2024

28,885 Telehealth visits

While the impressive numbers referenced in the right-side column are a testament to our success, we must remember that each patient is seen as an individual. We are not defined by the number of visits, volume, revenue, or profits, our true identity as a Department is revealed through our commitment to exceptional care in every encounter, whether with learners or without.

It is the quality of our relationships that shapes our legacy.

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Thank you for your interest in the Department of Medicine. We look forward to continuing to serve our patients, trainees, and students.

Liver Transplants

Sincerely,

Gregory C. Kane, MD, MACP The Jane and Leonard Korman Professor of Pulmonary Medicine Chair of the Department of Medicine

Divisions Ranked in USNWR Top 50

101

Best of Philadelphia Doctors

75

99

Kidney Transplants

12

Heart Transplants

1

Pancreas Transplants

Department of Medicine 2024 Annual Report

DIVISION OF CARDIOLOGY

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The Division of Cardiology is a core component of Jefferson’s Cardiovascular Service Line, combining cardiology, cardiac surgery, vascular medicine, vascular surgery, and interventional radiology to focus on the care of patients with heart and vascular disease. The Jefferson Heart Institute at 1101 Chestnut Street is the hub of outpatient cardiology teaching and clinical activity. It is the primary site of the clinical practice for the 47 Jefferson University Physicians (JUP) cardiologists.

On-site stress testing, nuclear cardiology, vascular imaging, echocardiography, and electrophysiologic device testing and management are available for patient convenience.

The Jefferson Heart Institute is committed to excellence in patient care, education, research, and graduate medical education. We continue to strive to meet the needs of our patients, community, and institution. Our reach extends from Center City to Northeast Philadelphia, its western suburbs and South Jersey. We are actively recruiting the best and the brightest physicians to help the Jefferson Heart Institute grow and deliver the best healthcare to our patients and lead in innovation, education, clinical care, and research.

PATIENT CARE

OUTPATIENT Outpatient care and consultation are provided in Center City at Jefferson’s new multidisciplinary practice site at the Honickman Center (general cardiology, electrophysiology, advanced heart failure and transplantation, cardiooncology, interventional cardiology and structural heart disease). Strong demand to see JHI cardiologists continues at Center City and across all our practice sites. In Center City, the number of patients seen grew by 9% from the previous year. 31,188 outpatients were seen, 18% of whom were new patients.

20,988 patient visits in our many satellite offices comprised a 21% increase, yielding a total of over 52,000 visits across all our sites.

The Jefferson Outpatient Cardiac Imaging Center at the Honickman Center, is the principal cardiac

imaging site for JHI and for TJUH. A satellite imaging site at the Korman Respiratory Institute supports our joint programs in cardiopulmonary medicine. In 2024, 13,125 imaging studies were performed at the Center City locations. A total of 17,482 cardiac imaging studies were done across all our sites.

The section of Nuclear Cardiology continues to expand its offerings with pyrophosphate scans to assist the advanced heart failure program with the diagnosis of TTR amyloidosis. We are now performing MUGA scans as well. Over the last 3 years, we have been doing PET/CT using Rubidium. This procedure has a greater diagnostic accuracy than conventional SPECT imaging.

It also allows for the absolute quantitation of coronary blood flow, which improves the diagnosis of transplant arteriopathy and microvascular disease.

The JHI has multiple outpatient satellite locations; the largest is in Northeast Philadelphia, with others in the Art Museum area, South Philadelphia, Bala Cynwyd, PA, Voorhees, NJ and Turnersville, NJ. Convenient access to clinical cardiologists, subspecialty physicians in electrophysiology and heart failure, Jefferson vascular surgeons, as well as advanced cardiac imaging, are provided at our satellite locations.

In 2024, the JHI faculty expanded to support growth in our clinical cardiology programs.

We added one clinical and imaging cardiologist, one electrophysiologist and two advanced heart failure and transplant physicians.

The JHI provides expert consultation and cardiac assessment with a special focus on perioperative cardiac assessment and management with a rapid access program with the Patient Testing Center to facilitate patient

FACU LT Y Rene J. Alvarez, Jr., MD, FACC, FAHA, FACP Lubert Family Professor of Cardiology Division Director Enterprise Executive Lead, Cardiovascular Service Line

Yevgeniy Brailovsky, DO Assistant Professor of Medicine Sung-Hae Cho, MD Clinical Assistant Professor of Medicine Glenn S. Cooper, MD Clinical Assistant Professor of Medicine Indranil Dasgupta, MD, MPh, MBA Assistant Professor of Medicine Mark DeCaro, MD Clinical Assistant Professor of Medicine Danielle Duffy, MD Associate Professor of Medicine Howard J. Eisen, MD Professor of Medicine Darius Farzad, MD Clinical Assistant Professor of Medicine Brian D Fedgchin, MD Clinical Instructor of Medicine David L. Fischman, MD Professor of Medicine Lori Frank, MD Clinical Assistant Professor of Medicine Daniel R. Frisch, MD Associate Professor of Medicine Jack L. Garden, MD Clinical Instructor of Medicine Gregory Gibson, MD Clinical Assistant Professor of Medicine Paulina Gorodin-Kiliddar, MD Clinical Associate Professor of Medicine Christopher L. Hansen, MD Professor of Medicine and Radiology Reginald T. Ho, MD Professor of Medicine Drew Johnson, MD Assistant Professor of Medicine Andria Jones, DO Clinical Assistant Professor of Medicine

Department of Medicine 2024 Annual Report

4 care and partnering with the Farber inpatient neurohospitalists.

We offer a one-call continuum of high value, patient-oriented outpatient and inpatient cardiac assessment and management, and access to our specialized cardiology programs, across the Jefferson Center City Campus.

INPATIENT The Cardiovascular Intensive Care Unit (CVICU) is a 25 bed, shared Medical and Surgical subspecialty ICU on both the 3rd and 4th floors of the Gibbon building with highly trained Critical Care Registered Nurse (CCRN) certified nursing staff. The medical patients are now managed exclusively by three Cardiac Intensivists (Gregary D. Marhefka, MD (Director, Medical CVICU), Mark J. DeCaro, MD and Darius Farzad, MD) in three repeating 7-day continuous shifts ensuring the highest level of expertise, quality and continuity of care. In addition to rounding on some of the sickest patients admitted from within the hospital and transferred from the surrounding tristate area, the attending faculty provide critical care cardiology consultative services to the other intensive care units and are an integral part of the multidisciplinary Cardiogenic Shock Team. Dedicated Advanced Heart Failure & Transplant cardiologists provide highly specialized consultative services to both the Medical and Surgical CVICU patients. Cardiovascular conditions treated by our devoted staff include: complicated ST-segment Elevation Myocardial Infarction (STEMI) and high-risk non-STEMI; out-of-hospital and in-hospital cardiac arrest and anoxic brain injured patients; hypertensive emergencies including acute aortic syndromes (active site for the International Registry of Acute Aortic Dissection (IRAD)); lethal arrhythmias including ventricular

tachycardia storm; heart block requiring temporary transvenous pacing; pericardial diseases including cardiac tamponade requiring pericardiocentesis; cardiogenic shock in acute and chronic advanced heart failure patients some of whom go on to require mechanical circulatory support such as left and/or right ventricular assist devices, VenousArterial Extra Corporal Membrane Oxygenation (VA-ECMO), Venous-Venous ECMO, and those who ultimately require left ventricular assist devices (LVAD) or orthotopic heart transplantation (OHT); high risk Maternal Fetal Medicine patients with complex cardiovascular conditions through delivery; acute endocarditis with severe valvular heart failure; and before and after structural heart disease interventions like higher risk Transcatheter Aortic Valve Replacement and MitraClip percutaneous mitral valve repair.

ECHOCARDIOGRAPHY The Echocardiography laboratory provides a wide array of cardiac ultrasound services at Thomas Jefferson University Hospital (TJUH), Jefferson Hospital for Neuroscience (JHN), and several outpatient facilities across the greater Philadelphia area managed by the Jefferson Heart Institute. The lab is comprised of twenty-two sonographers, sixteen full-time faculty members in the Division of Cardiology, and three nurses. The lab provides several fundamental cardiac ultrasound services, including transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and stress (treadmill and pharmacologic) echocardiography, as well as several advanced services including contrast, threedimensional, myocardial strain, and interventional echocardiography.

In FY24, the echocardiography lab performed 23,065 transthoracic echocardiograms, 906 stress echocardiograms, and 1,057 transesophageal echocardiograms including 131 transesophageal studies to guide interventional structural heart disease procedures. This past year, the echocardiography lab added one new full-time faculty member – Dr. Meghan Nahass who joined after completing her fellowship in cardiovascular diseases at Rutgers Health and Robert Wood Johnson Medical School. Dr. Nahass will also be serving as an Associate Program Director of the cardiovascular diseases fellowship.

Two faculty members, Dr. Ira Cohen and Dr. Barbara Berko, retired in 2023 after lengthy careers in the field of cardiac ultrasound and cardiovascular medicine.

Members of the echocardiography laboratory continue to be active at the national and local level.

Dr. David Wiener served as Vice President of the American Society of Echocardiography (ASE) and in the following year will serve as President-Elect of the American Society of Echocardiography, an 18,000member global organization for cardiovascular ultrasound imaging. Dr. Peters is a member of the Guidelines and Standards committee for the American Society of Echocardiography. Drs. Praveen Mehrotra and Andrew Peters also sit on the Board of Directors for the Delaware Valley Echocardiography Society.

The echocardiography laboratory continues to be active in education and research. This past year, Dr. Mehrotra continued its partnership with AISAP, a company focusing on AI solutions for ultrasound, to validate the use of their software for AI-assisted cardiac ultrasound.

Partnership in the pivotal study led to the software’s FDA approval in 2024. In collaboration with the Department of Emergency

FACU LT Y Yair Lev, MD Clinical Associate Professor of Medicine Gregary D. Marhefka, MD Howard H. Weitz, MD, MACP, FRCP (London), FACC Professor in Cardiology Praveen Mehrotra, MD Associate Professor of Medicine Meghan Nahass, MD Clinical Assistant Professor of Medicine Steven J Nierenberg, MD Clinical Assistant Professor of Medicine David O’Neil, MD, FACC Clinical Assistant Professor of Medicine Alyson Owen, MD Clinical Assistant Professor of Medicine Behzad Pavri, MD, FACC Professor of Medicine Ashley Pender, MD Clinical Assistant Professor of Medicine Andrew Peters, MD Assistant Professor of Medicine Ileana Pina, MD, MPH Robert M. Stein, MD 68', FACC, FAHA Professor in Cardiovascular Quality & Safety Indranee Rajapreyar, MD Associate Professor of Medicine J. Eduardo Rame, MD, M.Phil, FAHA, FESC Louis R. Dinon, MD, Teaching Chair of Clinical Cardiology Professor Steven Roberts, MD Clinical Assistant Professor of Medicine Nicholas Ruggiero, MD, FACP, FACC, FSCAI, FSVM Professor of Medicine Michael Savage, MD Ralph J. Roberts Professor of Cardiology Mital P Sheth, MD Clinical Instructor of Medicine David M. Shipon, MD Clinical Assistant Professor of Medicine Alexis Sokil, MD Associate Professor of Medicine Eugene Storozynsky, MD, PhD, FACC Professor of Medicine and Oncology

Department of Medicine 2024 Annual Report

5 Medicine, Dr. Mehrotra is also now studying the benefits of AIassisted cardiac ultrasound on cardiac patients admitted to the ED observation unit. Dr. Nahass published a unique case report on a patient with constrictive pericarditis in the New England Journal of Medicine. Dr. Sung-Hae Cho was awarded teacher of the year by the cardiology fellows, serves as the program director for the cardiovascular fellowship and provides echocardiography board review preparation for the fellows. Lastly, in collaboration with the cardiac catheterization laboratory, Dr. Mehrotra presented data at the annual American Heart Association conference in November 2024 on the utilization of a novel 3D-TEE sizing method for transcatheter patent foramen ovale closure.

ELECTROPHYSIOLOGY The section of clinical cardiac electrophysiology is committed to delivering compassionate and innovative care to patients with a variety of heart rhythm disorders while training the next generation of cardiologists and electrophysiologists. Our section consists of four full-time faculty members, two nurse practitioners, two clinical nurses, and one nurse dedicated to remote monitoring of CIEDs. We have two state-ofthe-art EP laboratories located at Thomas Jefferson University Hospital with three computerized mapping systems to assist in catheter ablation procedures. We are in the process of upgrading one of the catheterization labs to be able to perform EP procedures as well. Currently, we perform more than 1,000 procedures, including ablation for atrial fibrillation, supraventricular and ventricular arrhythmias (including epicardial ablation), as well as implantation of CIEDs including pacemakers, ICDs, cardiac resynchronization devices

(CRT), and implantable loop recorders (ILRs). We also implant leadless pacemakers, conduction system pacing leads, cardiac implantable loop recorders for remote ECG monitoring and left atrial occlusion (WATCHMAN) devices for left atrial appendage occlusion collaboratively with our colleagues in the structural heart section. Additionally, we are able to implant cardiac contractility modulation therapy systems and implantable systems for central sleep apnea. We are again a center for complex lead extraction procedures utilizing laser sheaths and mechanical sheaths. We have been at the forefront of delivering the latest technology to the care of our patients.

We have transitioned most patients with CIEDs to remote monitoring of their devices.

This was particularly important during the COVID-19 pandemic.

Remote monitoring is another form of telehealth where patients do not have to come to their physician’s office for interpretation of their device function or cardiac rhythm disturbance. Currently, we are following more than 3,000 patients. We have developed a program with stroke neurologists and neurosurgeons for evaluating patients with unexplained stroke who may have occult atrial fibrillation.

Patients have ILRs implanted at the time of their hospitalization at JHN. Our team follows them remotely. If atrial fibrillation is detected, the stroke neurologist and primary care physicians receive an immediate message via the EPIC EMR, which significantly shortens the time to anticoagulation.

All core EP faculty are actively engaged in clinical research, including home-grown projects, industry-sponsored studies, and federally approved trials.

The collective publication output of the EP core continues to grow. The faculty are also active participants in education efforts/conferencing in the cardiovascular diseases and CCEP fellowship programs, and the ECG core curriculum is taught entirely by the EP faculty. Faculty members are invited every year to lecture at local, national and international conferences.

INTERVENTIONAL CARDIOLOGY Jefferson’s Interventional Cardiology Section has a long tradition of clinical excellence and innovation. Over 25 years ago, Drs. David Fischman and Michael Savage were the lead authors of the landmark STRESS and SAVED trials published in the New England Journal of Medicine. These studies revolutionized the management of coronary artery disease.

Their coronary brachytherapy program for in-stent restenosis of drug eluting stents, an interdisciplinary collaboration involving Interventional Cardiology and Radiation Oncology has been a regional referral center for this specialized procedure for many years. This program will be expanded to include the utilization of drug coated balloons to further treat this complex patient population. Their contributions to interventional cardiology with investigator-initiated studies, ongoing clinical trials (including novel drug coated balloons) and multicenter meta-analyses have answered many important questions for the practicing clinician. In the next few months, their novel ANOCA (Angina with non-obstructive coronary arteries) program will be starting to treat patients with coronary microvascular dysfunction, endothelial dysfunction,

FACU LT Y Marc Tecce, MD Clinical Assistant Professor of Medicine Alec Vishnevsky, MD, FACC Assistant Professor of Medicine Howard Weitz, MD, FACP, FACC Vice Chair, Department of Medicine Bernard L. Segal Endowed Professor of Medicine David Whellan, MD, MHS, FACC, FAHA Deputy Provost for Research Executive Director, Jefferson Clinical Research Institute James C. Wilson Professor of Medicine David Wiener, MD, FACC, FAHA, FASE Clinical Professor of Medicine Mark Jay Zucker, MD, JD, FACC, FACP, FCCP Clinical Professor of Medicine

Department of Medicine 2024 Annual Report

6 microvascular and epicardial spasm, and myocardial bridging.

The Structural Heart Program, led by Dr. Nicholas Ruggiero, in conjunction with Dr. Alec Vishnevsky, has become a national leader in trans-catheter valve therapies. Structural heart procedures including aortic and mitral balloon valvuloplasty, TAVR, TMVR, TTVR, MitraClip, Pascal, Watchman LAA closure, ASD closure, VSD closure, PFO closure, PDA closure and paravalvular leak closure are performed routinely.

Management of tricuspid valve disease including Triclip and Evoque are beginning.

Research studies such as the Empower trial for left ventricular remodeling in patients with cardiomyopathies and Corvia interatrial shunts are ongoing.

Upcoming trials looking at new PFO closure devices (ENCORE PerFOrm Trial) and a novel interatrial shunt (Alleviant) will be starting in the next few months.

The Cardiogenic Shock and Temporary Mechanical Circulatory Support program, led by Dr. Alec Vishnevsky, is a multidisciplinary effort involving Structural Cardiology, Heart Failure/Transplant, Cardiac Surgery, and Cardiac Intensivists that enables a nuanced and tailored approach for each patient presenting with Cardiogenic Shock. Since its inception, the program has been very successful, achieving a survival rate above the national average in patients with shock who require temporary mechanical circulatory support, including ECMO, Impella, TandemHeart, and ProtekDuo. Under Dr. Vishnevsky’s leadership, the Jefferson Enterprise has joined the Cardiogenic Shock Working Group, a multicenter, multinational registry consortium

of over 40 health systems, and is one of the highest enrollers each year. This collaborative initiative has led to numerous publications and continues to be at the forefront of cutting-edge care for patients with Cardiogenic Shock. The continued growth of the program has also led to the initiation of numerous device trials, including the AortixDrain HF trial investigating the use of novel therapies for these patients. With these efforts, the Jefferson Enterprise has quickly become amongst the national leaders in care of patients with Cardiogenic Shock.

From 2023 to 2024, under the direction of Dr. Nicholas Ruggiero, the Jefferson catheterization laboratory performed over 5,500 diagnostic and interventional procedures.

Complex percutaneous coronary interventions are performed with the utilization of state-of-theart devices, including excimer laser, orbital atherectomy, rotational atherectomy, Shockwave lithotripsy, fractional flow reserve, instantaneous flow reserve and intravascular imaging (both intravascular ultrasound and optical coherence tomography). The tradition of exemplary patient outcomes continues, in the most recent NCDR PCI registry report, where Jefferson’s outcomes were once again above the 90% percentile. The section is also launching renal denervation for the management of patients with uncontrolled hypertension.

The Jefferson Angioplasty Center provides a unique regional resource as a secondopinion center for thousands of high-risk patients with complex cardiovascular disease each year looking to bypass open heart surgery. The section is also very academically productive as seen by over 50 peer reviewed

manuscripts, numerous abstracts and complex case presentations. The section members have been honored to be selected to edit multiple prestigious journals including JACC Case Reports and JSCAI. They have served as faculty at SCAI, TCT, ACC and the AHA scientific meetings. The Center’s Philadelphia Cardiovascular Congress Meeting has become a national entity with international faculty and attendees.

Drs. Savage, Fischman and Ruggiero have been annually named as “Philly Top Docs” in Interventional Cardiology.

STRUCTURAL HEART PROGRAM The Jefferson Structural Heart Program, under the leadership of Dr. Nicholas Ruggiero, in conjunction with Dr. Alec Vishnevsky and stewardship of Rebecca Marcantuono CRNP and Emily Alliss CRNP has grown exponentially into a preeminent program with national recognition. The program has expanded to include AngioVac management of bacterial endocarditis and tricuspid valve interventions including TriClip and soon Evoque.

The “Heart-Brain-Blood” model of collaboration between Neurology, Hematology and Cardiology to evaluate patients with PFO and cryptogenic stroke has become the national gold standard for managing patients with this diagnosis. Drs. Ruggiero, Vishnevsky, Tzeng, Dharia and Rhoades have published and spoken extensively on this topic, awarding Jefferson the designation of a National PFO Center of Excellence.

Our Jefferson Structural Heart Program prides itself on not only the ability to scientifically provide improved quality of life with

NEW GRANTS ABBOTT LABORATORIES Award Title: Specimen Collection for the Evaluation of Alere NT-proBNP for Alinity i System in Outpatient Setting for Heart Failure (LANAIS-HF) PRINCIPAL INVESTIGATOR: DR. SOFIA CAROLINA MASRI Date: 07/17/2023 BAYER HEALTHCARE PHARMACEUTICALS THROUGH PIER Award Title: Multicenter, randomized, active comparator-controlled, double-blind, double-dummy, parallel group phase III study of the oral FXIa inhibitor BAY 2433334 for the prevention of stroke or systemic embolism in patients with atrial fibrillation PRINCIPAL INVESTIGATOR: DANIEL FRISCH, MD Date: 08/08/2023 ENCORE MEDICAL, INC. Award Title: Encore PFO Closure Device U.S. IDE Randomized Trial; the PerFOrm Trial PRINCIPAL INVESTIGATOR: DR. MICHAEL P SAVAGE Date: 11/09/2023 PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE (PCORI)/BAYLOR COLLEGE OF MEDICINE Award Title: Cardiac Resynchronization Therapy Using His/Left Bundle Branch Pacing vs Biventricular Pacing with a Left Ventricular Epicardial Lead in Patients with Heart Failure (HF) with Left Ventricular Ejection Fraction (LVEF) ≤ 50% and with either a Wide QRS Complex (> 130 ms) or with/anticipated > 40% Pacing Randomized Clinical Trial (RCT) (Left vs Left RCT) PRINCIPAL INVESTIGATOR: DR. BEHZAD PAVRI Date: 12/19/2023

Department of Medicine 2024 Annual Report

7 trans-catheter therapies, but also the ability to make our patients feel comfortable and safe.

ADVANCED CARDIAC AND PULMONARY VASCULAR DISEASE

We believe that collaboration is the key to success, and we have created relationships with multiple cardiology groups throughout the tri-state area, as well as unique relationships with our cardiothoracic surgery, electrophysiology, and imaging colleagues. Drs. John Entwistle and Vakhtang Tchantchaleishvili have been integral in providing surgical support to the TAVR and MitraClip programs. Dr. Daniel Frisch of Electrophysiology has been instrumental in the growth of the left atrial appendage occlusion program.

Drs. Konstadinos Plestis of Cardiothoracic Surgery and Paul Dimuzio of Vascular Surgery are instrumental in the management of patients with complex aortic disease. Drs. Mehrotra, Peters and Pender, our interventional echocardiographers, have been paramount to our program’s success and have taken the lead on multiple groundbreaking investigator-initiated trials including upcoming presentation at the ACC 2024 looking at a novel TAVR valve sizing approach for patients with borderline aortic annular sizes.

The field of heart failure is dynamic with multi-faceted acute and chronic syndromes that require timely targeted interventions delivered by an integrated medical and surgical team. Since the first successful application of heart-lung bypass in May of 1953 by Dr. John Gibbon to surgically correct a young woman suffering from an atrial septal defect at Jefferson University Hospital, the teams at Jefferson have been committed to innovation and clinical excellence in the management of complex cardiovascular disease. Nearly 70 years later, the current teams at Jefferson are applying a broad spectrum of medical and device innovation for patients with inherited and acquired cardiomyopathies— from novel therapeutics and remote monitoring systems to short-term and durable mechanical cardiopulmonary support and transplantation— are committed with the same rigor to excellence in the delivery of complex, personalized clinical care. To meet the current challenge of delivering targeted and timely multidisciplinary care across the Jefferson Enterprise for patients with chronic heart failure, the section for Advanced Cardiac and Pulmonary Vascular Disease was established under the leadership of Dr. J. Eduardo Rame in the spring of 2020.

The vision—to have a group of physician faculty, nursing clinical providers and clinical staff working together at the nexus of advanced heart failure and pulmonary hypertension to provide the most specialized and uncompromising care for patients progressing along the stages of complex heart disease. Focused on these

The structural heart disease fellowship under the direction of Dr. Nicholas Ruggiero is producing highly skilled structural interventionalists who are providing top notch care to patients all over the United States.

Our team continues to look forward to representing Jefferson as a leader in the delivery of trans-catheter therapies and further evolution of our Structural Heart Program for many years to come with an emphasis on providing cuttingedge treatment with patient focused care.

goals, the multi-disciplinary team at Jefferson currently boasts the highest rating in heart transplantation in our region and has continued to remain one of the leading centers successfully implanting long-term ventricular assist device (LVAD) therapy.

A long-standing legacy of heart transplantation and mechanical circulatory support devices including total artificial heart already existed at Thomas Jefferson University Hospital. Beyond focusing on advanced surgical therapies for heart failure, the section has grown with expertise in cardiomyopathic, pulmonary vascular and inherited heart and vascular disease. From three attendings in the spring of 2020 to now being the academic and clinical practice hub for 10 faculty members staffing two independent inpatient services focused on advanced and critical care patients. Consistent with its clinical goals of bringing expertise and extending access to the periphery of Jefferson Health, the faculty see patients on a regular basis at 12 distinct clinical sites across the Enterprise. With expertise in the areas of myocardial recovery, cardiovascular genetics, right heart failure and pulmonary vascular disease, multi-organ transplantation, and ventricular assist device (VAD) /total artificial heart (TAH) technologies, the recently recruited team boasts a cumulative experience in the practice of advanced heart disease of > 200 years. Most recently, Dr. Ileana Pina, an internationally recognized expert in HF disease management, was recruited as Jefferson’s Chief Quality Officer for the Cardiovascular Service Line.

This year, several unique areas of expertise deserve mention as programs have launched to bring specialized tailored care

NEW GRANTS CARDIAC DIMENSIONS, INC. Award Title: Assessment of the Carillon Mitral Contour System® in Treating Heart Failure with Functional Mitral Regurgitation - The EMPOWER Trial PRINCIPAL INVESTIGATOR: DR. NICHOLAS RUGGIERO Date: 03/22/2024 VIZ.AI Award Title: VIZ ACCESS HCM - Real World Evidence for Viz CardioSuite assisted HCM Screening and Access to Care - A Multi-Site Longitudinal Cohort Study PRINCIPAL INVESTIGATOR: DR. DAVID SHIPON Date: 06/19/2024

Department of Medicine 2024 Annual Report

8 to patients living with complex cardiovascular disease.

Working closely with critical care, cardiac surgery, and interventional cardiology, the section has promoted a program in cardiac recovery from cardiogenic shock. The multidisciplinary program working within the SHOCK team model addresses the acute aspects of heart recovery and then transitions to the chronic phase of promoting durable and optimized cardiac performance for patients who were treated for cardiopulmonary shock.

Another area of expertise that is being developed is the reversal of end-stage heart failure using long-term mechanical circulatory support with ventricular assist devices. In this area, the group has experience evaluating for and ultimately performing left ventricular assist (LVAD) decommissioning or explanation in the appropriate patient who has been tested rigorously for cardiac recovery.

The clinical program for an integrated center for Amyloidosis involves cardiovascular [Dr. Brailovsky], Neurology [Dr. Hristelina S. Ilieva] and structural heart disease and electrophysiology have come together to establish a multidisciplinary clinic serving patients across the spectrum of amyloid heart disease.

The Enterprise-wide CardioOncology Program [Dr. Storozynsky] provides tailored and timely input for patients with heart disease and cancer diagnoses.

Collaborating with the center for aortic disease [Dr. Konstadinos Plestis and Jacqueline McGee CRNP], a multidisciplinary inherited vascular disease program is bringing together the disciplines of cardiac surgery,

vascular surgery and medicine to deliver first-in-region specialized care focusing on patients and their families with genetic aortic disease and aortopathies.

Collaborating with the cardiac MRI Center, the section is also the home of the inherited cardiomyopathy program which is growing at a very fast pace over the past year with the advent of myosin inhibitors that are now available to treat hypertrophic obstructive cardiomyopathy (HOCM). The current program in genetic cardiomyopathy and hypertrophic obstructive cardiomyopathy incorporates expertise from cardiac surgery [Dr. Rakesh Suri] cardiopulmonary Pathology, [Dr. John Farber], Cardiovascular Genetics, [Dr, Glen Gerhard] from Temple University, Cardiac Imaging [Dr. Carolina Masri and Dr. Andrew Peters] and expertise from Sports Cardiology [Dr. Drew Johnson and Dr. David Shipon]. This program works to bring together the surgical, medical and device [Electrophysiology] therapies to treat patients with symptomatic hypertrophic cardiomyopathy.

In close collaboration with the Division of Maternal-Fetal Medicine, the cardio-obstetrics program works to provide highly tailored care to women with high-risk pregnancies with complex cardiovascular and cardiopulmonary disease.

Collaborating closely with the Korman Institute and Pulmonology Sections of Pulmonary Hypertension [Dr. Michael Scharf] and Interstitial Lung Disease, the Integrated program for Pulmonary Heart Disease and Right Heart Failure focuses on bringing highly specialized care to the patient with refractory right ventricular failure.

Across all these programs, the Section for Advanced Cardiac and Pulmonary Vascular Disease incorporates three pillars to strengthen the clinical and academic mission.

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Timely, Tailored, and Team-Oriented Clinical management of patients across the spectrum of left and right heart failure.

A commitment by our engaged full-time Faculty to train the fellows and academic clinicians who will define the future of this field.

A commitment by our world-class faculty to innovative scholarship and research that will advance science in our field.

These clinical teams with proven excellence in building advanced cardiac disease management programs and shaping discovery and innovation in research will be leading Jefferson Health in this new era of heart transplantation and heart failure while training the next generation of academic clinicians in the field.

N OTA B L E ACH I E V E M E N T S 2024 Philadelphia Magazine Top Doctors and 2023 America’s Top Doctors RENE ALVAREZ, MD, FACC, FAHA, FACP SUNG-HAE CHO, MD GLENN COOPER, MD YEVGENIY BRAILOVSKY, DO INDRANIL DASGUPTA, MD, MPH, MBA DANIELLE DUFFY, MD BRIAN FEDGCHIN, MD DAVID FISCHMAN, MD LORI FRANK, MD DANIEL FRISCH, MD JACK GARDEN, MD PAULINA GORODIN-KILIDDAR, MD CHRISTOPHER HANSEN, MD REGINALD HO, MD GREGARY MARHEFKA, MD BEHZAD PAVRI, MD NICHOLAS RUGGIERO, MD MICHAEL SAVAGE, MD DAVID SHIPON, MD ALEXIS SOKIL, MD HOWARD WEITZ, MD DAVID WIENER, MD KEYNOTE FOR CHRIST HOSPITAL WOMEN’S HEART SYMPOSIUM ILEANA L PIÑA, MD, MPH

QUALITY INITIATIVES

Over the past year, under the leadership of Dr. Yair Lev and in close collaboration with Dr. Ileana Piña (Chief Quality Officer for the Cardiovascular Service Line), the Division of Cardiology has expanded its quality improvement (QI) efforts to encompass both traditional quality measures and innovative, generative AI-based interventions. Building on the successes of prior years, we have launched a series of multifaceted projects aimed at improving patient safety, reducing hospitalacquired conditions, enhancing patient education, and elevating

CINCINNATI, OCTOBER 2024 Keynote and Leadership Award January 2024 The Annual Linda Joy Pollin Women’s Heart Health Cedars Sinai Medical Center ILEANA L PIÑA, MD, MPH

NHLCC for the American Heart Association Speaker for Equity in the Hispanic population College of Medicine, and Bristol Meyers Squibb ILEANA L PIÑA, MD, MPH September 2024

Department of Medicine 2024 Annual Report

9 overall outcomes in both inpatient and outpatient settings.

One noteworthy development involves the integration of generative AI into multiple domains of cardiac care. This initiative—encompassing projects like “HeartWise AI,” an AI-driven system for improving adherence to dual antiplatelet therapy (DAPT)—is designed to create personalized educational materials based on each patient’s needs and clinical profile. In conjunction with these efforts, our teams have begun leveraging AI to identify hospitalized cardiac patients with morbid obesity, providing them with tailored counseling documents that detail available weight management resources, such as GLP-1 receptor agonists, bariatric surgery, and referral pathways to our weight loss center. Additionally, AI-driven interventions are being designed to prepare patients for various electrophysiology (EP) and interventional cardiology procedures, offering individualized explanations and checklists that reduce pre-procedure anxiety while improving follow-through and satisfaction.

These transformative initiatives in patient education are complemented by robust quality projects on our 5W unit. Nursing teams and operational leaders have intensified their efforts to reduce hospital-acquired conditions (notably CAUTI and CLABSI) through the training of specialized “champions” who oversee best practices and implement evidence-based guidelines. Early results show a decrease in central line days, a promising indicator for CLABSI reduction, and the introduction of new devices such as the Versette 2 external female catheter has contributed to fewer indwelling catheters overall. Meanwhile, 5W’s Falls Committee has

taken an active role in reducing inpatient falls via staff education and enhanced technologybased monitoring. The unit’s ongoing “speed rounds,” in which interdisciplinary teams gather to expedite discharge planning and coordinate patient care, have helped lower the average length of stay and further boost patient satisfaction metrics.

Beyond the general inpatient environment, the Echo Laboratory continues its qualityenhancement journey. In addition to refining measurement-driven reporting and using AI-based solutions to assist in image acquisition (building on last year’s pilot collaborations), the lab is also optimizing its Dobutamine Stress Echocardiography (DSE) protocols.

By introducing a low-dose approach for low-flow, lowgradient aortic stenosis and raising atropine limits to reduce nondiagnostic studies, the team aims to streamline patient pathways and minimize unnecessary follow-up testing. The lab works closely with Interventional Cardiology colleagues on advanced structural heart disease interventions, where echo guidance is critical to procedural success.

In Interventional Cardiology, our TAVR, MitraClip, and other structural heart programs remain key areas of clinical and research focus. As part of our QI efforts, the interventional team has collaborated with hospital-based stakeholders to track and improve patient education regarding new devices, advanced post-procedure care, and the importance of medication adherence. This aligns with the broader Division goal of using data-driven insights— derived from a combination of registry data, EHR reviews, and AI-based risk stratification— to identify at-risk patients early and proactively address their clinical needs.

Collectively, these projects underscore our commitment to continuous improvement, leveraging cutting-edge technology without losing sight of fundamental bedside principles.

As in previous years, we maintain regular audits, educational sessions, and collaborative feedback loops to ensure interventions remain evidencebased, patient-centered, and equitable across diverse populations. We also continue to disseminate best practices through departmental grand rounds, professional conference presentations, and peer-reviewed publications.

1984, and Advanced Heart Failure & Transplant in 2004. Our 4 fellowship programs are accredited by the ACGME (American College of Graduate Medical Education).

The Interventional Cardiology program has an optional nonaccredited second year for selected fellows who wish to focus on advanced structural heart and peripheral vascular disease. The Division of Pulmonary and Critical Care, in conjunction with the Division of Cardiology, provides a one-year ACGME accredited training program in critical care cardiology for fellows who have completed a Cardiovascular Disease Fellowship.

By integrating generative AI into the existing culture of QI and rigorous clinical care, our Division aims not only to safeguard patient safety and satisfaction but also to forge new pathways in personalized medicine. While key quality indicators—such as readmission rates—remain stable, we anticipate that these nextgeneration interventions will help us address nuanced barriers to care, improve adherence to life-saving therapies, and further enhance the overall patient experience. With multiple grants under review and new collaborations on the horizon, the Division of Cardiology remains poised at the forefront of healthcare innovation, providing cutting-edge interventions and setting ever-higher standards of care.

Sung-Hae Cho, MD, is the Program Director of the General Cardiovascular Disease Fellowship supervising 24 general fellows during a 3-year program. Of these fellows, there are 6 (2 per class) in the community track with Abington Jefferson Health in partnership with Associate Program Director, Adam Cohen, MD, from Abington, and 2 currently in the newly formed community track with Jefferson Torresdale Hospital with Associate Program Director, Mohammed Murtaza, MD, from Torresdale. David L. Fischman, MD, is the Program Director for the Interventional Cardiology Fellowship, supervising 2 fellows.

Behzad Pavri, MD, is the Program Director for the Clinical Cardiac Electrophysiology Fellowship, overseeing 2 fellows. Howard Eisen, MD, is the Program Director for the Advanced Heart Failure & Transplant Fellowship, supervising 1 fellow. David Oxman, MD, is the Program Director for the Critical Care Medicine Fellowship.

EDUCATION

The Division of Cardiology has been providing comprehensive training of cardiovascular disease fellows since 1959, later introducing sub-specialty training in Interventional Cardiology in 1982 (with Structural Heart Disease added in 2017), Clinical Cardiac Electrophysiology in

The faculty provides direct teaching and supervision of fellows, with fellows playing an active role in patient care, including diagnosis and management of a wide range of cardiac conditions. The inpatient

Department of Medicine 2024 Annual Report

10 care includes general cardiology, heart failure, electrophysiology, critical care, and postoperative care of the cardiac surgery patients. The fellows receive comprehensive hands-on training in both inpatient and outpatient procedures which include cardiac catheterization, percutaneous intervention, structural interventions, electrophysiology studies, ablations, device placements, transthoracic and transesophageal echocardiography, stress echocardiography, interventional echocardiography, and nuclear cardiology. The program also provides training in cardioobstetrics, women’s health, cardio-oncology, cardiac MRI, and congenital heart disease.

Core faculty update and deliver a daily, rigorous 45-minute morning lecture curriculum in a repeating weekly format: ECG and Electrophysiology (coordinated by Behzad Pavri, MD), Interventional Cardiology (coordinated by David L. Fischman, MD), Echocardiography (coordinated by Sung-Hae Cho, MD), and Clinical Cardiology Conference, also known as Cardiology Grand Rounds, for all faculty and fellows (coordinated

by Gregary D. Marhefka, MD). Both Echocardiography and Clinical Cardiology Conferences are ACCME (Accreditation Council for Continuing Medical Education) accredited. Friday morning conferences also include monthly Morbidity & Mortality Conference, 8 combined RadiologyCardiology Advanced Imaging Conferences, and multiple funded Louis R. Dinon, MD, Memorial Lectureship, attracting highly renowned, external speakers from all over the world. This past year’s speakers were Nisha Gilotra, MD Johns Hopkins, Gianluca Iacobellis, MD, O. Howard Frazier, MD, Daniel Culver, MD, Calambur Narasihan, MD, Stephan

Ensminger, MD, Bartley Griffith, MD, Sharonne Hayes, MD, and Jon Kobashigawa, MD. On a repeating monthly basis, core faculty provide lectures to our fellows in Nuclear Cardiology (coordinated by Christopher L. Hansen, MD), Advanced Heart Failure & Transplant (coordinated

by Yevgeniy Brailovsky, DO), Adult Congenital Heart Disease (coordinated by Gregary D. Marhefka, MD, also ACCME accredited), Journal Club (coordinated by Sung-Hae Cho, MD). Additionally, there are lectures/didactics in Cardiac MRI (coordinated by Andrew Peters, MD), General Cardiovascular Disease Board Review (coordinated

by Alec Vishnevsky, MD), and Echocardiography Board Review (coordinated by Sung-Hae Cho, MD). Furthermore, the Interventional and Structural Heart Disease and the Advanced Electrophysiology programs provide weekly educational conferences for their own subspecialty fellows. Last, but not least, the Cardiology Division also provides recurring formal didactics to Internal Medicine and Family Medicine residents, to residents and fellows from other departments and divisions, as well as to medical students, both from Sidney Kimmel Medical College (coordinated by Lori Frank, MD) and visiting from abroad.

RESEARCH

For research within the Cardiology Division, despite continued challenges from the ongoing global pandemic, our team was incredibly active. From fellows initiating independent projects to sponsored trials, investigatorinitiated studies, and faculty grants, the Jefferson Cardiology group continues to strive to maintain their competitive edge at the forefront of cardiology knowledge.

There are currently 20 cardiac trials open to enrollment, with an overall total accrual of 105 patients across all studies. Dr. Brailovsky, Dr. Eisen, Dr. Frisch, Dr. Lev, Dr. Marhefka, Dr. Mehrotra, Dr. Pavri, Dr. Rame, Dr. Roberts, Dr. Savage, Dr. Shipon, Dr. Ruggiero, Dr. Vishnevsky, and Dr. Whellan are currently involved in funded research exceeding $7,000,000 in overall award amount. Topics include long-term outcomes of catheter ablation, point of care ultrasound acquisition, coronary vasomotor disorders, and catheter ablation for atrial fibrillation, and novel biomarkers for detecting cardiac transplant rejection and cardiac allograft vasculopathy.

Novel collaborations with Wills Eye Hospital include using abnormalities in the eye, known as oculomics, to detect abnormalities in cardiac hemodynamics from cardiac transplant and mechanical circulator support.

The team has continued to benefit from a full-time senior research project manager, Jordan Price who has coordinated the cardiology group’s involvement with several prospective registries and helped to match several students and fellows with ongoing faculty research. She has also assisted numerous cardiologists in applying for grants, developing, and implementing investigatorinitiated trials as well as managing research projects from conception to execution, documenting results and drafting presentations.

PUBLICATIONS (2023-2024) Acharya D, ManandharShrestha N, Leacche M, Rajapreyar I, William P, Kazui T, et al. Extracorporeal membrane oxygenation as a bridge to advanced heart failure therapies. Journal of Heart and Lung Transplantation.

2023;42(8):1059‑71.

Ackermann LL, Schwenk ES, Li CJ, Vaile JR, Weitz H. The effects of a multidisciplinary pathway for perioperative management of patients with hip fracture. Hospital Practice.

2023;51(4):233‑9.

Ahmad D, Brodie A, Pritting C, Rajapreyar I, Rame JE, Rajagopal K, et al. Predicted heart mass based on ideal body weight for donor-to-recipient size matching. Clinical Transplantation.

2023;37(12).

Austin MA, Ahmad D, Rosen JL, Weber MP, Rajapreyar I, Rame JE, et al. Impact of waitlist weight change on outcomes in heart transplant recipients: a UNOS database analysis. General Thoracic and Cardiovascular Surgery. 2024.

Bhardwaj A, Fedson S, Munagala M, Pinney S, Rajapreyar I, Mancini D. Pregnancy in Patients With Advanced Heart Failure: Impact of Overturn of Roe v Wade Ruling. JACC: Heart Failure.

2023;11(3):362-4.

Bhardwaj A, Pirlamarla P, Brailovsky Y, Nair A, Rajapreyar I. Combined Heart Kidney Transplantation Versus Heart Transplant in Patients with Renal Failure: Contemporary Insights and Future Perspectives.

Current Cardiology Reports.

2024;26(3):83-90.

Brailovsky Y, Lakhter V, Newman J, Allen S, Elkaryoni A, Desai P, et al. Fibrinolytic Status and Risk of Death After Acute Pulmonary Embolism. Clinical and Applied Thrombosis/Hemostasis. 2023;29.

Brailovsky Y, Rajapreyar I, Alvarez R. TTR Amyloidosis: Current State of Affairs and Promise for the Future. JACC: Case Reports.

2023;10.

Brailovsky Y, Ullah W. Breaking Down Barriers in Pursuit of Thrombolytic Perfection. JACC: Advances. 2023;2(9).

Department of Medicine 2024 Annual Report

11 Bruno ES, Mujer MTP, Desai PV, Brailovsky Y, Darki A. A Metaanalysis of Standard Versus Ultrasound-Assisted CatheterDirected Thrombolysis in the Management of Acute Pulmonary Embolism. Journal of the Society for Cardiovascular Angiography and Interventions.

2023;2(1).

Calogiuri G, Savage MP, Congedo M, Nettis E, Mirizzi AM, Foti C, et al. Is Adrenaline Always the First Choice Therapy of Anaphylaxis?

An Allergist-cardiologist Interdisciplinary Point of View.

Current Pharmaceutical Design.

2023;29(32):2545-51.

Chatterjee A, Shanmugasundaram M, Lee KS, Kazui T, Rajapreyar IN, Acharya D. Optical Coherence Tomography in the Assessment and Management of Cardiac Allograft Vasculopathy.

Current Cardiology Reports.

2024;26(8):777-82.

Devich R, Neuendorff NR, Frazier OH, Eisen HJ, Dowling R, Freundt M. Hematopoietic Stimulation during Impella 5.5 Support to Avoid Transfusions in a Jehovah's Witness. ASAIO Journal. 2023;69(8):E384-E7.

Dharmavaram N, Esmaeeli A, Jacobson K, Brailovsky Y, Raza F. Cardiopulmonary Exercise Testing, Rehabilitation, and Exercise Training in Postpulmonary Embolism.

Interventional Cardiology Clinics.

2023;12(3):349-65.

Didichenko SA, Velkoska E, Navdaev AV, Greene BH, Lorkowski SW, Duffy D, et al. CSL112 Infusion Rapidly Increases APOA1 Exchange Rate via Specific Serum AmyloidPoor HDL Subpopulations When Administered to Patients Post-Myocardial Infarction.

Arteriosclerosis, Thrombosis, and Vascular Biology.

2023;43(6):855‑69.

Dimond MG, Fiuzat M, Mentz RJ, Lala-Trindade A, Whellan DJ, Walsh MN, et al. Rewarding SiteBased Research: A Step Toward Improving the Ecosystem of Heart Failure Clinical Trials. JACC: Heart Failure.

2024;12(1):226-8.

Doherty JU, Daugherty SL, Kort S, London MJ, Mehran R, Merli GJ, et al. ACC/AHA/ASE/ ASNC/HFSA/HRS/SCAI/SCCT/ SCMR/STS 2024 Appropriate Use Criteria for Multimodality Imaging in Cardiovascular Evaluation of Patients Undergoing Nonemergent, Noncardiac Surgery. Journal of the American College of Cardiology. 2024;84(15):1455‑91.

Doshi H, Savage MP, Ruggiero N, Walinsky P, Davis M, Troia J, et al.

Recyclable Waste in the Cardiac Catheterization Laboratory: The Potential to Curb the Carbon Footprint. JACC: Cardiovascular Interventions. 2023;16(6):737-8.

Doyle M, Corsi D, Osler B, Vishnevsky O. Unexpected finding in a man in his 50s with postprandial and exertional chest pain. European Heart Journal Cardiovascular Imaging.

2024;25(7):e186.

Doyle M, Dikdan S, Farzad D, Marhefka GD. Three, dynamic variants of ST segment elevations in a patient with osteosarcoma and cardiac metastasis. Journal of Electrocardiology. 2023;78:29‑33.

Eisen HJ. Chicken or Egg: Tricuspid Regurgitation - The Cause or the Consequence of Post-Heart Transplant Allograft Dysfunction. Transplantation.

2023;107(6):1246-7.

Esposito C, Machado P, McDonald ME, Savage MP, Fischman D, Mehrotra P, et al. Noninvasive Evaluation of Cardiac Chamber Pressures Using Subharmonic-Aided Pressure Estimation With

Definity Microbubbles.

JACC: Cardiovascular Imaging.

2023;16(2):224-35.

Esposito C, Machado P, McDonald ME, Savage MP, Fischman D, Mehrotra P, et al. Evaluation of Intracardiac Pressures Using Subharmonicaided Pressure Estimation with Sonazoid Microbubbles.

Radiology: Cardiothoracic Imaging. 2024;6(1).

Farber J, Dikdan S, Ruge M, Johnson D, Shipon D. Relationship Between Caffeine Consumption and Young Athletes’ Comorbidities, Exercise-Related Symptoms, and Baseline Electrocardiogram.

Sports Health. 2024;16(3):448‑56.

Fischman DL, Mahadevan VS, Bates ER. The “Evolving” Role of Intravascular Imaging in Myocardial Infarction With Nonobstructive Coronary Arteries. JACC: Case Reports.

2023;6.

Foster MW, Riley JM, Kaki PC, Al Soueidy A, Aligholiazadeh E, Rame JE. Metabolic Adaptation in Heart Failure and the Role of Ketone Bodies as Biomarkers.

Current Heart Failure Reports.

2024;21(5):498-503.

Fradin J, Kim FJ, Lu-Yao GL, Storozynsky E, Kelly WK. Review of Cardiovascular Risk of Androgen Deprivation Therapy and the Influence of Race in Men with Prostate Cancer.

Cancers. 2023;15(8).

Frankel E, Ho R. Management of Ventricular Arrhythmias in Heart Failure: Can Less Be More?

Current Cardiology Reports.

2024;26(10):1097-103.

Frankel ES, Frisch DR. Atrial Flutter. Ferri's Clinical Advisor 2025: 5 Books in 1. 2024. p. 148‑51.e2.

Frisch DR, Frankel ES. Sick Sinus Syndrome. Ferri's Clinical Advisor 2025: 5 Books in 1. 2024. p. 984-.e1.

Gamero MT, Brailovsky Y, Eisen HJ. Going the distance: Long-term follow-up of the randomized, prospective Scandinavian heart transplant everolimus de novo study with early calcineurin inhibitors avoidance (SCHEDULE) trial. Journal of Heart and Lung Transplantation.

2024;43(12):1960-2.

Gamero MT, Patel A, Storozynsky E. The Good (Tumor Killing) and the Bad (Cardiovascular Complications) of Immunologic Checkpoint Inhibitors. Current Cardiology Reports. 2024.

Gamero MT, Uber P, Brailovsky Y, Gibson G, Rame E, Alvarez R, et al. The dilemma of the role of the non-HLA antibodies in AMR. Clinical Transplantation.

2024;38(3).

Gibson CM, Chi G, Duffy D, Bahit MC, White H, Korjian S, et al.

ApoA-I Infusions and Burden of Ischemic Events After Acute Myocardial Infarction: Insights From the AEGIS-II Trial. Journal of the American College of Cardiology. 2024;84(22):2185‑92.

Gibson CM, Duffy D, Korjian S, Bahit MC, Chi G, Alexander JH, et al. Apolipoprotein A1 Infusions and Cardiovascular Outcomes after Acute Myocardial Infarction. New England Journal of Medicine.

2024;390(17):1560-71.

Gilbert ON, Mentz RJ, Bertoni AG, Kitzman DW, Whellan DJ, Reeves GR, et al. Relationship of Race With Functional and Clinical Outcomes With the REHAB-HF Multidomain Physical Rehabilitation Intervention for Older Patients With Acute Heart Failure. Journal of the American Heart Association. 2023;12(21).

Gomaa S, Kelly WK, Mitchell E, Storozynsky E, ZeiglerJohnson C, Juon HS, et al.

Racial disparities in new-onset diabetes mellitus in prostate

Department of Medicine 2024 Annual Report

12 cancer patients on androgen deprivation therapy: a retrospective analysis of TriNetX data. World Journal of Urology.

2023;41(9):2351-7.

Grapsa J, Walsh MN, EnriquezSarano ML, Sorgente A, Vidovich MI, Fischman DL, et al. 2022 Year in Review: Countdown of the Best Manuscripts in 2022. JACC: Case Reports. 2023;7.

Hansen CL. Improving evaluation for TTR amyloidosis by interactive filtering of Tc-99 m PYP SPECT images. The role for “clean blood pool” imaging.

Journal of Nuclear Cardiology.

2023;30(6):2418-26.

Hansen CL. Shedding Light on the Puzzle in the Paradox.

American Journal of Cardiology.

2024;215:78-9.

Hansen CL. From Prematurity to Lifestyle Choices: A Cohort Comes of Age. American Journal of Cardiology. 2024;212:141-2.

Hansen CL. Is the Advantage of DOACs Due to Better Targeting?

American Journal of Cardiology.

2024;231:92-3.

Hansen CL, Farber J, Binder A, Reist K, Brailovsky Y. Conversion of PYP/HMDP scanning on sequential imaging in a patient with a TTR gene mutation.

Journal of Nuclear Cardiology.

2024;37.

Arrhythmia and Electrophysiology.

2023;16(5):E011771.

Ho RT. An atypical short RP tachycardia: What is the mechanism? Heart Rhythm.

2023;20(11):1583-5.

Ho RT. “Wireless telegraphy” 100 years later—Good for the world or a menace? Heart Rhythm.

2023;20(4):520-1.

Ho RT. Macroreentrant scar-mediated atrial tachycardia terminated by a nonpropagated stimulus within a narrow diastolic isthmus: Electroanatomic correlation.

Heart Rhythm. 2023;20(2):307‑8.

Junarta J, O'Neill P, Dikdan SJ, Pang Z, Fradin JJ, Frisch DR. Mobile electrocardiographic devices and healthcare utilization in post-atrial fibrillation ablation patients.

Journal of Electrocardiology.

2023;80:139-42.

Kaneyuki D, Yost CC, Wu M, Pfeil DS, Mehrotra P, Guy TS. Robotic mitral valve re-repair with removal of transcatheter mitral valve repair clips. Multimedia manual of cardiothoracic surgery : MMCTS. 2023;2023.

Keteyian SJ, Piña IL. Heart failure and exercise cardiac rehabilitation in the 21st Century. Heart Failure Reviews.

2023;28(6):1237-8.

Hennessy-Strahs S, Kang J, Krause E, Dowling RD, Rame JE, Bartoli CR. Patient-specific severity of von Willebrand factor degradation identifies patients with a left ventricular assist device at high risk for bleeding. Journal of Thoracic and Cardiovascular Surgery.

2024;167(1):196-204.

Khan MS, Anker SD, Friede TIM, Jankowska EA, Metra M, PiÑA IL, et al. Minimal Clinically Important Differences in 6-Minute Walk Test in Patients With HFrEF and Iron Deficiency: MCID for 6MWT in patients with HFrEF and iron deficiency.

Journal of Cardiac Failure.

2023;29(5):760-70.

Higuchi S, Gerstenfeld EP, Hsia HH, Wong CX, Ho RT, Tchou PJ, et al. Novel Approaches for the Diagnosis of Concealed Nodo-Ventricular and HisVentricular Pathways. Circulation:

Kingwell BA, Duffy D, Clementi R, Velkoska E, Feaster J, Gibson CM. CSL112 (Apolipoprotein A-I [Human]) Reduces the Elevation in Neutrophil-toLymphocyte Ratio Induced by Acute

Myocardial Infarction. Journal of the American Heart Association.

2024;13(9).

Kocovic N, Round K, Marchenko R, Frisch DR. Premature ventricular complexes originating from slow pathway region following AV nodal reentrant tachycardia ablation.

HeartRhythm Case Reports.

2024;10(11):812-5.

Leon SA, Rosen JL, Ahmad D, Austin MA, Vishnevsky A, Rajapreyar IN, et al. Microaxial circulatory support for percutaneous coronary intervention: A systematic review and meta-analysis. Artificial Organs. 2023;47(6):934-42.

Lohre J, Rame JE, Mechler K. The Blood Crown Princess: Family-centered care of a parent on mechanical support. Artificial Organs. 2023;47(7):1226-7.

Marchenko R, Higuchi S, Ho RT. Unusual responses of a short RP tachycardia to Hisrefractory ventricular premature depolarizations: What is the mechanism? Heart Rhythm.

2024;21(2):224-7.

Marek-Iannucci S, Junarta J, Vishnevsky A, Rajapreyar IN, Fradin JJ, Arditi M, et al.

Severe late cardiovascular sequelae of Kawasaki disease in a young adult. Journal of Paediatrics and Child Health.

2024;60(4‑5):147 50.

Marek-Iannucci S, Oliveros E, Brailovsky Y, Pirlamarla P, Roman A, Rajapreyar IN. Natriuretic peptide biomarkers in the imminent development of preeclampsia. Frontiers in Cardiovascular Medicine. 2023;10.

Marek-Iannucci S, Rajapreyar IN, Huaman MG, Uber P, Alvarez R, Rame EJ, et al. COVID-19 associated development of antibody mediated rejection in orthotopic heart transplantation patients.

Clinical Transplantation. 2023;37(8).

Marek-Iannucci S, Uber P, Rajapreyar I. Management of pregnancy in left ventricular assist device and heart transplant recipients: A concise review. Current Opinion in Cardiology. 2023;38(3):257-65.

Marek-Iannucci S, Ullah W, Uber P, Oliveros E, Brailovsky Y, Ramu B, et al. Association of chronic kidney dysfunction and preeclampsia: insights of the Nationwide Inpatient Sample: Chronic kidney dysfunction and preeclampsia: cause or consequence? American Journal of Obstetrics and Gynecology MFM. 2023;5(6).

Marek-Iannucci S, Wildemann R, Brailovsky Y, Dyer S, Gamero MT, Alvarez RJ, et al. Peri-operative fever and LVAD: SIRS or impaired right ventricular strain? Artificial Organs. 2024;48(10):1162-7.

Marion W, Schanz JD, Patel S, Co ML, Pavri BB. Single operator experience, learning curve, outcomes, and insights gained with conduction system pacing. PACE - Pacing and Clinical Electrophysiology.

2024;47(2):211‑21.

Matsui Y, Higuchi S, Yagishita D, Ho RT, Scheinman MM, Mori F, et al. The Masked Right Bundle Branch Block in the Setting of a Wide Complex Tachycardia.

JACC: Clinical Electrophysiology.

2024;10(7):1760-9.

Mazur M, Bhat G, Popjes E, Dowling R, Eisen HJ. Long-term post-transplantation outcomes in patients with hypertrophic cardiomyopathy: Single-center 35-year experience. Clinical Transplantation. 2024;38(2).

Mazur M, Eisen H. Cardiac Allograft Vasculopathy. Textbook of Transplantation and Mechanical Support for End-Stage Heart and Lung Disease. 2023. p. 461-75.

Mazur M, Rubio AC, Eisen HJ, Bhat G, Dowling R. Impact of the New Heart Allocation System on

Department of Medicine 2024 Annual Report

13 the Medium-Term Outcomes in Patients with Hypertrophic Cardiomyopathy. ASAIO Journal.

2024;70(9):778‑86.

Mitchell J, Storozynsky E, Lopez AM. The Nuance of Studying and Prescribing Supplements.

Journal of the American College of Cardiology. 2023;81(17):e149.

Miyamoto T, Pritting CD, Tatum R, Ahmad D, Brailovsky Y, Shah MK, et al. Characterizing Adaptive Changes and Patient Survival after 2018 Donor Allocation Restructuring: A UNOS Database Analysis. Critical Pathways in Cardiology. 2024;23(2):81-8.

Mohebi R, Liu Y, Felker GM, Ward JH, Piña IL, Butler J, et al. Mechanistic Efficacy of Sacubitril/ Valsartan in Ischemic Versus Nonischemic Heart Failure. Journal of the American Heart Association. 2023;12(8).

Mohebi R, Liu Y, Myhre PL, Felker GM, Prescott MF, Piña IL, et al. Heart Failure Phenotypes According to Natriuretic Peptide Trajectory Following Initiation of Sacubitril/Valsartan. JACC: Heart Failure. 2023;11(7):855-8.

Moledina SM, Matetic A, Weight N, Rashid M, Sun L, Fischman DL, et al. Trends in STelevation myocardial infarction hospitalization among young adults: A binational analysis.

European Heart Journal - Quality of Care and Clinical Outcomes.

2024;10(3):216-27.

Nagashima K, Michaud GF, Ho RT, Okumura Y. SVT quest: The adventure diagnosing narrow QRS tachycardia. Journal of Arrhythmia. 2024;40(4):767-85.

Nelson MB, Shiroma EJ, Kitzman DW, Duncan PW, Reeves GR, Whellan DJ, et al. Physical activity and relationship to physical function, quality of life, and cognitive function in older patients with acute decompensated heart failure. American Heart Journal.

2023;256:85-94.

Newman E, Kamanu C, Gibson G, Brailovsky Y. How to Optimize Goal-Directed Medical Therapy (GDMT) in Patients with Heart Failure. Current Cardiology Reports. 2024;26(9):995-1003.

Oliveros E, Brailovsky Y, Beneduce A, Bakhshi H, Zancanaro E, Sukmawati I, et al. Impact of Social Media and Multimedia Platforms: View From the JACC: Case Reports SoMe Editors. JACC: Case Reports. 2023;15.

Oliveros E, Ibrahim M, Romero CM, Navo P, Otero Valdes P, Brailovsky Y, et al. Novel Computed Tomography Angiography Parameter Is Associated with Low Cardiac Index in Patients with Chronic Thromboembolic Pulmonary Hypertension: A Retrospective Analysis. Journal of Cardiovascular Development and Disease. 2024;11(9).

Pandey A, Kitzman DW, Nelson MB, Pastva AM, Duncan P, Whellan DJ, et al. Frailty and Effects of a Multidomain Physical Rehabilitation Intervention Among Older Patients Hospitalized for Acute Heart Failure: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiology.

2023;8(2):167-76.

Patil S, Ahmad D, Shah K, Vishnevsky A, Ruggiero N, Rajapreyar IN, et al. Outcomes of outflow graft stenting in HeartMate 3 left ventricular assist devices: A systematic review and individual patient data meta-analysis. Artificial Organs. 2024;48(6):577-85.

Pavri BB. Helping the hypertrophied (but nonobstructed) heart. Heart Rhythm. 2023;20(9):1314-5.

Pavri BB. To the Editor— Alternate interpretation of left bundle branch potential. Heart Rhythm. 2024;21(4):505.

Peters AC, Gong FF, Ramesh A, Andrei A, Jankowski M, Cantey E, et al. Echocardiographic parameters associated with less reverse left ventricular remodeling after transcatheter aortic valve implant in subjects with prosthesis patient mismatch.

Echocardiography. 2024;41(1).

Peters AC, Lee J, Jankowski M, Thomas JD. Relationship between left atrial reservoir strain, volumes, and geometry: Insights from simple theoretical model. Echocardiography.

2023;40(6):592-5.

Piña IL. Consistency Breeds Confidence: The Continuing Story of SGLT2 Inhibitors.

Circulation. 2023;147(8):635-7.

Povsic TJ, Korjian S, Bahit MC, Chi G, Duffy D, Alexander JH, et al. Effect of Reconstituted Human Apolipoprotein A-I on Recurrent Ischemic Events in Survivors of Acute MI. Journal of the American College of Cardiology. 2024;83(22):2163‑74.

Pritting C, Ahmad D, Patel K, Miyamoto T, Rajab TK, Rajapreyar IN, et al. Microaxial mechanical circulatory support after orthotopic heart transplantation. International Journal of Artificial Organs.

2024;47(3):173-80.

Qiu G, Riley JM, Dikdan S, Johnson D, Masood I, Hajduczok AG, et al. Relationship Between Obesity and Youth Athletes' Physical Activity and ExerciseRelated Cardiac Symptoms.

Childhood Obesity. 2024.

Rajapreyar I, Soliman O, Brailovsky Y, Tedford RJ, Gibson G, Mohacsi P, et al.

Late Right Heart Failure After Left Ventricular Assist Device Implantation: Contemporary Insights and Future Perspectives. JACC: Heart Failure.

2023;11(8):865-78.

Randhawa VK, Spataru A, Jory L, Moussa F, Bhardwaj A,

Rajapreyar I. Effects of Inhaled Pulmonary Vasodilators on Perioperative Right Ventricular Hemodynamics: Are These “Nebs” Simply Nebulous?

Canadian Journal of Cardiology.

2023;39(4):483-6.

Ravipati G, Luo M, Ullah W, Fischman DL, McCarey MM, Ruggiero NJ, et al. Three Time Loser or Third Time's the Charm? PCI of Recurrent Restenosis After Overlapped Drug-Eluting Stents. Journal of the Society for Cardiovascular Angiography and Interventions.

2023;2(5).

Riley JM, Fradin JJ, Russ DH, Warner ED, Brailovsky Y, Rajapreyar I. Post-Capillary Pulmonary Hypertension: Clinical Review. Journal of Clinical Medicine. 2024;13(2).

Rosen JL, Ahmad D, Uphadyaya A, Brodie AT, Gaw G, Rajapreyar I, et al. Association of Heart Transplant Volume with Presence of Lung Transplant Programs and Heart Transplant's SRTR One-year Survival Rating.

Thoracic and Cardiovascular Surgeon. 2024;72(4):261-5.

Ruge M, Fischman DL, Rajapreyar I, Brailovsky Y. The Value of Right Heart Catheterization: Case Series Showing Benefits in a Variety of Diagnoses. JACC: Case Reports. 2023;21.

Sabouret P, Spadafora L, Fischman D, Ullah W, Zeitouni M, Gulati M, et al. De-escalation of antiplatelet therapy in patients with coronary artery disease: Time to change our strategy?

European Journal of Internal Medicine. 2023;110:1-9.

Sankisa D, Tatum R, Saxena A, Whellan DJ, Alvarez RJ, Morris RJ, et al. Leadership Practices, Organization Structure, and Other Factors Associated with Higher 2022–2023 US News and World Report Ranking. Journal of General Internal Medicine. 2024.

Department of Medicine 2024 Annual Report

14 Saraiya A, Yu J, Huang C, Frisch D, Pavri BB. Evaluating Goldberger's triad as a marker of congestive heart failure: A systematic review and retrospective study.

Journal of Electrocardiology.

2023;81:207‑13.

Savage MP, Fischman DL. Resistant Drug-Eluting Stent Restenosis and Resurrection of Intracoronary Brachytherapy: The Lazarus of Contemporary Coronary Intervention. Journal of the Society for Cardiovascular Angiography and Interventions.

2023;2(1).

Savage MP, Fischman DL, Mamas MA. Between a Rock and a Hard Place: Technological Progress in Treating Calcified Coronary Lesions. JACC: Cardiovascular Interventions. 2024;17(6):768-70.

Saxena A, Curran J, Ahmad D, Nasher N, Miyamoto T, Brailovsky E, et al. Utilization and outcomes of V-AV ECMO: A systematic review and metaanalysis. Artificial Organs.

2023;47(10):1559-66.

Sherazi S, Schleede S, McNitt S, Casulo C, Moore JE, Storozynsky E, et al. Arrhythmogenic Cardiotoxicity Associated With Contemporary Treatments of Lymphoproliferative Disorders.

Journal of the American Heart Association. 2023;12(6).

Siddiqui MU, Junarta J, Sathyanarayanan S, Kochar K, Ullah W, Fischman DL. Risk of coronary artery disease in patients with gout on treatment with Colchicine: A systematic review and meta-analysis. IJC Heart and Vasculature. 2023;45.

Siruvallur Vasudevan V, Rajagopal K, Rame JE, Antaki JF. Trans-aortic Valvular Ejection Fraction for Monitoring Recovery of Patients with Ventricular Systolic Heart Failure.

Annals of Biomedical Engineering.

2023;51(12):2824‑36.

Sistla P, Kheder K, Iourinets J, Arora P, Desai PV, Brailovsky Y, et al. Catheter-Directed Thrombolysis or CatheterBased Thrombectomy in Acute Pulmonary Embolism: Horses for Courses.

Interventional Cardiology Clinics.

2023;12(3):309-21.

Sukhavasi A, Ahmad D, Austin M, Rame JE, Entwistle JW, Massey HT, et al. Utility of Recipient Cardiothoracic Ratio in Predicting Delayed Chest Closure after Heart Transplantation. Thoracic and Cardiovascular Surgeon.

2024;72(4):253-60.

Tan TC, Mullie L, Flynn AW, Mehrotra P, Shahian DM, Nunes MCP, et al. Association Between Functional Tricuspid Regurgitation and Mortality Following Cardiac Surgery.

JACC: Advances. 2023;2(7).

Taramasso M, Tagliari AP, Fischman DL. TAV-in-TAV and Beyond: How Far Can We Go? JACC: Case Reports. 2023;22.

Ullah W, DiMeglio M, Frisch DR, Bagur R, Sun LY, Fischman DL, et al. Outcomes and Discriminatory Accuracy of the CHA2DS2VASc Score in Atrial Fibrillation and Cancer. JACC: Advances. 2023;2(8).

Ullah W, Johnson D, Nair AS, Dikdan SJ, Frankel E, Humayun W, et al. Ablation Versus Antiarrhythmic Drugs as FirstLine Therapy for TreatmentNaive Atrial Fibrillation: A Systematic Review and MetaAnalysis. American Journal of Cardiology. 2024;213:63-8.

Ullah W, Rajapreyar I, Brailovsky Y. Heart Failure Readmissions After Cardiac Surgeries: Navigating the High-Risk Terrain.

JACC: Advances. 2023;2(8).

Ullah W, Ruge M, Hajduczok AG, Kochar K, Frisch DR, Pavri BB, et al. Adverse outcomes of atrial fibrillation ablation in

heart failure patients with and without cardiac amyloidosis: A Nationwide Readmissions Database analysis (2015-2019).

European Heart Journal Open.

2023;3(2).

NJ, Keith SW, et al. Clinical Outcomes in Adult Patients With an Anomalous Right Coronary Artery from the Left Sinus of Valsalva. American Journal of Cardiology. 2023;204:122-9.

Ullah W, Sana MK, Hajduczok AG, Brailovsky Y, Haas DC, Rajapreyar IN. Trend of left ventricular assist device related complications: Insight from the National Inpatient Sample Database. American Heart Journal Plus: Cardiology Research and Practice. 2023;26.

Warner ED, Liotta M, Fatema U, Kamanu C, Mallari K, Brailovsky Y, et al. Transcatheter Edge-toEdge Repair in Patients With End-Stage Renal Disease on Dialysis: A USRDS Registry Study.

Current Problems in Cardiology.

2024;49(1).

Underberg DL, DeMario NJ, Rodriguez S, Mirzozoda K, DeCaro MJ, Marhefka GD. Chylopericardium and Superior Vena Cava Syndrome Caused

by Central Venous Occlusion From Indwelling Hemodialysis Catheters. JACC: Case Reports.

2024;29(17).

Urina Jassir D, Chaanine AH, Desai S, Rajapreyar I, Le Jemtel TH. Therapeutic Dilemmas in Mixed Septic-Cardiogenic Shock. American Journal of Medicine. 2023;136(1):27-32.

Vishnevsky A, Fischman DL. Bridging the Gap: An Unusual Cause of Acute Coronary Syndrome. JACC: Cardiovascular Interventions. 2024;17(6):818-9.

Warner ED, Brailovsky Y, Oliveros E, Bhardwaj ANJU, Rajapreyar IN. High-Output Heart Failure, Pulmonary Hypertension and Right Ventricular Failure in Patients With Arteriovenous Fistulas: A Call to Action.

Journal of Cardiac Failure.

2023;29(6):979-81.

Warner ED, Corsi DR, Jimenez D, Bierowski M, Brailovsky Y, Oliveros E, et al. Determinants of pulmonary hypertension in patients with end-stage kidney disease and arteriovenous access. Current Problems in Cardiology. 2024;49(4).

Warner ED, Gulati A, Halpern E, Fischman DL, Ruggiero

Warner ED, Liotta MARK, Dyer N, Brailovsky Y, Rajapreyar IN. The Swan is not the Ugly Duckling.

Journal of Cardiac Failure. 2024.

Warner ED, Pritting C, Dutta S, Bierowski M, Ullah W, Brailovsky Y, et al. The impact of the OPTN policy change on patients with a durable left ventricular assist device and chronic kidney disease: Analysis of the UNOS database. Artificial Organs.

2024;48(10):1180-9.

Warner ED, Riley J, Liotta M, Pritting C, Brailovsky Y, Jimenez D, et al. Aortic Valve Replacement in Patients With ESRD and Heart Failure With Reduced Ejection Fraction.

American Journal of Cardiology.

2023;205:111-9.

Warner ED, Ullah W, Farber J, Brailovsky Y, Vishnevsky A, Tchantchaleishvili V, et al. PCI for acute myocardial infarction in patients with a pre-existing LVAD, does it improve survival?

Artificial Organs. 2023;47(4):761‑9.

Weitz HH, Merli GJ. Annals Consult Guys - Can You Stop Heart Failure Medications if the Ejection Fraction Recovers?

Annals of Internal Medicine.

2023;176(7).

Weitz HH, Merli GJ. Web Exclusive. Annals Consult Guys - Spontaneous Coronary Artery Dissection.

Annals of Internal Medicine.

2023;176(9):eW220022.

Department of Medicine 2024 Annual Report

15 Weitz HH, Merli GJ. Annals Consult Guys - When Is a Coronary Calcium Score Helpful? Annals of Internal Medicine. 2023;176(6).

Weitz HH, Merli GJ. Annals Consult Guys - Postoperative Troponin Elevation.

Annals of Internal Medicine.

2023;176(11):eW220024.

Weitz HH, Merli GJ. Annals Consult Guys - Care of a Patient With Left Ventricular Thrombus.

Annals of Internal Medicine.

2023;176(1):eW220014.

Weitz HH, Merli GJ. Annals Consult Guys - Is This Patient a Good Candidate for Bariatric Surgery? Annals of Internal Medicine. 2023;176(2):eW220015.

Weitz HH, Merli GJ. Web Exclusive. Annals Consult Guys - A Perplexing Case of Muscle Weakness.

Annals of Internal Medicine.

2024;177(8):e2401424CG. Weitz HH, Merli GJ. Web Exclusive. Annals Consult Guys - Antiphospholipid Antibody Syndrome.

Annals of Internal Medicine.

2024;177(10):e2402756CG. Weitz HH, Merli GJ. Annals Consult Guys - Postoperative Euglycemic Diabetic Ketoacidosis. Annals of Internal Medicine. 2024;177(1):eW230012.

Weitz HH, Merli GJ. Web Exclusive. Annals Consult Guys - The Diagnosis and Pathophysiology of Claudication. Annals of Internal Medicine. 2024;177(3):eW230014.

Annals of Internal Medicine.

2024;177(7):e2401138CG.

Annals of Internal Medicine.

2023;176(3).

Weitz HH, Merli GJ. Web Exclusive. Annals Consult Guys - Reversals of Care Started After a Myocardial Infarction.

Annals of Internal Medicine.

2024;177(2):eW230013.

Whellan DJ. Physical Activity for Patients With Heart Failure With Reduced Ejection Fraction: Pump up the Volume. Circulation.

2024;149(3):189-91.

Weitz HH, Merli GJ. Annals Consult Guys - How Many Steps Are Associated With Better Health? Annals of Internal Medicine.

2024;177(9):e2402522CG. Weitz HH, Merli GJ, Benesch C. Annals Consult Guys - Surgery After Thromboembolic Stroke.

Annals of Internal Medicine.

2023;176(12):eW220025.

Weitz HH, Merli GJ, Carson JL. Web Exclusive. Annals Consult Guys - Acute Coronary Syndrome and Anemia: When to Transfuse?

Annals of Internal Medicine.

2024;177(5):eW240002.

Weitz HH, Merli GJ, Fischman DL. Web Exclusive. Annals Consult Guys - Management of DualAntiplatelet Therapy in a Patient Undergoing Colonoscopy.

Annals of Internal Medicine.

2023;176(8):eW220021.

Weitz HH, Merli GJ, Greenspon AJ. Annals Consult Guys Central Retinal Artery Thrombus.

Annals of Internal Medicine.

2023;176(4):eW220017.

Weitz HH, Merli GJ, Lip GYH. Annals Consult Guys - The ABCs of Atrial Fibrillation.

Annals of Internal Medicine.

2024;177(6):e2400618CG.

Weitz HH, Merli GJ. Annals Consult Guys COVID-19 and Surgery: A Postpandemic Update.

Annals of Internal Medicine.

2024;177(4):eW240001.

Weitz HH, Merli GJ, O’Glasser AY. Annals Consult Guys Noncardiac Surgery Following COVID-19: A Coast-to-Coast Update. Annals of Internal Medicine. 2023;176(5).

Weitz HH, Merli GJ. Annals Consult Guys - Congestive Heart Failure: GuidelineDirected Medical Therapy.

Weitz HH, Merli GJ, Warkentin TE, Ruggiero Ii NJ. Annals Consult Guys - Could This Patient Have Heyde Syndrome?

Zivan T, Ruiz RL, Martinez A, Pavri BB. Safety of Adenosine for the Treatment of Supraventricular Tachycardia in Hospitalized Patients with COVID-19 Pneumonia. Journal of Clinical Medicine. 2023;12(3).

Department of Medicine 2024 Annual Report

16

Department of Medicine

DIVISION OF ENDOCRINOLOGY, DIABETES AND METABOLIC DISEASES The Division of Endocrinology, Diabetes, and Metabolic Diseases has continued its high profile clinical, educational, and clinical research activities, with a primary focus on diabetes, obesity, and related disorders. Our clinical practice has accommodated the widespread activities of the Jefferson Health System, and we operate busy practice locations at Walnut Towers (9th street) in Center City, Methodist Hospital (Bove) in South Philadelphia, and Jefferson locations in Turnersville (NJ), Navy Yard, Art Museum, Bala Cynwyd, JIMA, and Women’s Center.

We have numerous programs within the Division. A comprehensive weight management program that focuses on serving patients with medical complications of obesity and rapid weight loss for patients anticipating organ transplantation or major surgery. The Jefferson Diabetes Center where patients are seen by expert diabetologists and certified diabetes educators, offering the most advanced technology, including insulin pumps and continuous glucose sensors. We also have a Jefferson Thyroid and Parathyroid Center in collaboration with other departments, including ENT, surgery, radiology, and pathology. Our Jefferson Neuroscience Center, in collaboration with neurosurgery, offers the most advanced treatments for patients with a variety of pituitary disorders.

2024 Annual Report

17

FACU LT Y Serge Jabbour, MD Professor of Medicine Division Director

Intekhab Ahmed, MD Professor of Medicine Raad Haddad, MD Assistant Professor of Clinical Medicine Jeffrey Miller, MD Professor of Medicine Eric Shiffrin, MD Assistant Professor of Clinical Medicine Monika Shirodkar, MD Associate Professor of Clinical Medicine Barbara Simon, MD Associate Professor of Clinical Medicine Jessica Watari, DO Assistant Professor of Clinical Medicine Lubna Zuberi, MD Assistant Professor of Clinical Medicine

N U RS E PRACTITIONE RS Lisa Coco, CRNP, CDE Christine Clancy, CRNP, CDE

PAT I E N T C A R E The Division provides comprehensive services for inpatient and ambulatory care at TJUH, Methodist Hospital, Turnersville, Navy Yard, Art Museum, Bala Cynwyd, Women’s Center, and JIMA outpatient locations, covering all aspects of Endocrinology and Diabetes. We offer specialty care centers for diabetes, obesity, thyroid disease, parathyroid disease, pituitary diseases, adrenal disorders, calcium, and bone disorders as well as gonadal disorders. We work in concert with other experts in different departments at Jefferson.

In FY24, the Division had 25,007 outpatient visits, which was a 1.8% increase over FY23. Of these, 3,692 were new patient visits and 8,326 were telehealth visits.

and guidelines, including the intravenous insulin infusion protocols, DKA/HHNK guidelines, hypoglycemia protocols, etc.

DIETICIANS/ DIABETES EDU CATORS

In the outpatient setting, we also offer a variety of classes or individual sessions covering diabetes education as well as nutritional counseling in addition to a low-calorie diet combined with behavioral modification, which is an integral part of our weight management program.

Q UA L I T Y I N I T I AT I V E S

Cheryl Marco, RD, CDE Cindy Cogen, RD (Research)

In the inpatient setting, we see all of the endocrine consults.

Our team was behind the creation and the cornerstone of all inpatient diabetes protocols

Our quality committee representative is Dr. Eric Shiffrin.

He works closely with our faculty and fellows on various quality improvement projects.

Quality Improvement (QI) activities within the Division of Endocrinology, Diabetes, and Metabolic Diseases in the past year have focused on various clinical outcome measures associated with diabetes.

Department of Medicine 2024 Annual Report

18 E D U C AT I O N Our Division is involved in teaching at all levels of medical school and graduate school curriculum, residency, and fellowship programs: biochemistry and physiology clinical lectures, medical students lectures/case based learning, pharmacology course and physical diagnosis, medical students clerkships, ambulatory interns rotations, residency electives, and all facets of the clinical fellowship program in Endocrinology.

We also provide education (lectures, grand rounds) to all departments across Jefferson.

Our internal educational activities include: a weekly CMEactivity, Friday Forum, with case discussions/presentations (with other local endocrinologists); monthly thyroid conference in collaboration with ENT, surgery, radiology, and cytopathology; monthly pituitary conference in collaboration with neurosurgery; monthly Philadelphia Endocrine Society meetings (at Jefferson, in collaboration with local/regional endocrinologists); and the fellows weekly curriculum lectures.

R E S E A RC H We have experience in both federally funded, pharmaceutical industry-sponsored clinical trials and investigator-initiated research studies. We have 10-20 active studies at any point in time.

In these research studies, our focus is mostly on diabetes and obesity. Occasional studies might focus on pituitary or adrenal disorders. We study new insulin analogs, new diabetes & obesity drugs, as well as new delivery systems for the management of high glucose levels (including insulin pumps and continuous glucose sensors) and novel medications for the

prevention or management of the complications of diabetes, including hypertension, lipid disorders, nephropathy, etc., in patients with type 1 and type 2 diabetes. We also have experience and interest in trials looking at cardiovascular outcomes in type 2 diabetes. Each study enrolls between 5 and 40 patients and lasts between 24 and 104 weeks, some with extensions up to 5 years.

The NIH-sponsored Diabetes Prevention Program Outcomes Study involves testing lifestyle and metformin in patients at high risk for diabetes to see if it can be prevented or its onset delayed.

Cardiovascular endpoints are also evaluated in this study as an extension to the initial DPP study (called DPPOS). Jefferson is one of 27 centers in the U.S. to follow patients (our Jefferson cohort includes 150 patients) with impaired glucose tolerance to determine whether lifestyle modification or medications can prevent or delay the onset of type 2 diabetes or its vascular complications.

We are also part of another NIHfunded trial in collaboration with the Emergency Medicine research team: it is a pragmatic randomized controlled trial assessing the impact of medically tailored meals and medical nutrition therapy via telehealth among patients with poorly controlled diabetes.

P U B L I C AT I O N S Simonson DC, Testa MA, Ekholm E, Su M, Vilsbøll T, Jabbour SA, Lind M. Improved Continuous Glucose Monitoring Profiles and Health Outcomes after Randomisation to Dapagliflozin plus Saxagliptin vs. Insulin Glargine in Type 2 Diabetes. J Clin Endocrinol Metab 2024 Feb 27:dgae105. doi: 10.1210/clinem/ dgae105

Nasser M, Nasr J, Jabbour S. Two-Bag vs. One-Bag Fluid Delivery in Pediatric Diabetic Ketoacidosis: A Systematic Review and Metaanalysis. Clin Exp Pediatr 2024 Oct;67(10):486-497. doi: 10.3345/ cep.2023.01536.

Jabbour SA, Paik JS, Aleppo G, Sharma P, Valderas EG, Benneyworth BD. Switching to Tirzepatide 5 mg from GLP1-Ras: Clinical Expectations in the First 12 Weeks of Treatment. Endocr Pract 2024 Aug;30(8):701-709. doi: 10.1016/j.eprac.2024.05.005.

Khan AA, Abbott LG, Ahmed I, Ayodele O, Gagnon C, Finkelman RD, Mezosi E, Rejnmark L, Takacs I, Yin S, Ing SW. Open-label extension of a randomized trial investigating safety and efficacy of rhPTH(184) in hypoparathyroidism. JBMR Plus. 2024 Jan 5;8(3):ziad010. doi: 10.1093/jbmrpl/ziad010. eCollection 2024 Mar.PMID: 38741607 Naeem, Z, Leong, JY, Morton, A, Hrizat, A, Shiffrin, E, Gomella, A, McCue, P, Mann, M, Li, L. Primary adrenal angiosarcoma: A case report and review of the literature. Urology Case Reports, Volume 50, September 2023.

Justin Robbins, M.D., Dina Halegoua-DeMarzio, M.D., Atrayee Basu Mallick, M.D., Namrata Vijayvergia, M.D., Rebecca Ganetzky, M.D., Harish Lavu, M.D., Veda N. Giri, M.D., Jeffrey Miller, MD , and Daniel S. Lefler, M.D. Liver Transplantation in a Woman with Mahvash Disease. Published November 22, 2023. N Engl J Med 2023;389:1972-1978. DOI: 10.1056/NEJMoa2303226. VOL. 389 NO. 21 Wolinsky, T, Simon B. Rapid Acting Insulin Used to Treat a Case of Early Cystic Fibrosis Related Diabetes. AACE Clinical Case Reports. July 2023;9(5):170–173. doi: 10.1016/j. aace.2023.07.001

N OTA B L E ACH I E V E M E N T S 2024 Philadelphia Magazine Top Doctors SERGE JABBOUR, MD INTEKHAB AHMED, MD Diabetes Symposium 10/11/2024 Philadelphia Endocrine Society Board BARBARA SIMON, MD ERIC SHIFFRIN, MD US News and World Report 2024-2025: High Performing

Department of Medicine 2024 Annual Report

19 Murugesh M, Themo F, Shirodkar, M. Uncontrolled Acromegaly Resulting in the Need for Left Ventricular Assist Device as a Bridge to Heart Transplant. JCEM Case Reports, Volume 2, Issue 5, May 2024 https://doi.org/10.1210/ jcemcr/luae072

A B S T R AC T S/P O S T E R S Cheng C, Corsi D, Dong J, Solowey M, Soltani S, Ackley O, DeMichele A, Mairata N, Jabbour S, Marco C. The Effectiveness of a Student Delivered Weight Loss Program in a High-Risk Urban Practice. AHA (American Heart Association), November 2023, Philadelphia, Pennsylvania Jabbour SA, Paik JS, Aleppo G, Sharma P, Valderas EG, Benneyworth BD. Switching to Tirzepatide 5 mg from GLP1-Ras: Clinical Expectations in the First 12 Weeks of Treatment. AACE (American Association of Clinical Endocrinologists), May 2024, New Orleans, Louisiana Umarji G, Thelmo FL, Jabbour SA. A Rare Case of Hereditary 1,25 (OH)2-D Resistant Rickets.

Endocrine Society, June 2024, Boston, Massachusetts M. S. Maharaul, F. Thelmo, and I. Ahmed. Lymphocytic Hypophysitis secondary to a ruptured Rathke’s Cleft Cyst complicated by post surgical recurrence: A rare phenomenon. Journal of the Endocrine Society, Volume 8, Issue Supplement_1, OctoberNovember 2024; https://doi. org/10.1210/jendso/bvae163.1270 Gunjan Umarji, Mashrutee Maharaul, Jeffrey Miller. A NET with Unknown Primary Masked as a Lipid Poor Adrenal Adenoma.

AACE Annual Meeting; May 2024; New Orleans, Louisiana Patel A., Simon B. Time in Range Preferred over A1c and Fructosamine to Monitor Glycemic Control in Sickle Cell Disease.

Presented at ENDO 2024, Boston MA, June 1-4 2024 Mallari, K., Wolinsky T, Keenan K., Patel A., Claxton B., Simon B. Integration of Diabetes Technology into a Medicaid-Heavy Resident Ambulatory Practice: Improving Diabetes Health Equity. Poster and Abstract presented at AAIM 2024, Columbus Ohio, April 14-18 2024; Selected for Oral Presentation, Jefferson Health Equity and Quality Improvement Summit, May 2024 Mallari, K., Wolinsky T, Keenan K., Patel A., Claxton B., Simon B. Integration of Diabetes Technology into a Medicaid-Heavy Resident Ambulatory Practice: Improving Diabetes Health Equity.

Oral Presentation, Society of Hospital Medicine, South Central Pennsylvania Chapter Meeting, September 28, 2024 Thelmo F, Murugesh M, Simon B. Non-Progressive Diabetes leading to Neurologic Diagnosis.

Presented at ENDO 2024. Boston MA, June 1-4, 2024.

Murugesh M., Goyal A., Kelly M., Scopelliti E., Simon B., Sarin A. Pharmacist-Assisted Insulin Titration in Primary Care to Improve Diabetes Outcomes.

Presented, Society of General Internal Medicine (SGIM) 2024 Annual Meeting, May 15-18, 2024 Boston MA; Poster presentation at Jefferson Health Equity and Quality Improvement Summit, May 2024, 2nd Place Winner, Patient Safety Goldberg R, Thelmo F, Ahmed I. Overstimulation Overload: Evidence of Overuse of the Cosyntropin Stimulation Test in the Hospital Setting. Endocrine Society, June 2024, Boston, Massachusetts

Department of Medicine 2024 Annual Report

20

Department of Medicine

DIVISION OF GASTROENTEROLOGY AND HEPATOLOGY

2024 Annual Report

21

FACU LT Y David Kastenberg, MD

The Division of Gastroenterology and Hepatology continues to be at the forefront and one of Jefferson’s flagship programs. This year the Division celebrates 29 years of growth and national prominence. Under Dr. Kastenberg’s leadership the Division continued their commitment to philanthropy and raised support for the Honickman Center as well as other innovative technology and Division programs.

Division Chief J. Edward Berk Professor in Medicine

In May 2024, the Division moved clinical operations to the Honickman Center. The GI Division maintains two floors in the new building, one for our office visit setting and one for our new outpatient endoscopy center, which currently has five state of the art procedure rooms.

Jeffrey Abrams, MD Clinical Assistant Professor Christopher Adkins, MD Assistant Professor Monjur Ahmed, MD Professor Curtis Alloy, DO Clinical Assistant Professor Charles Andrew Kistler, MD, PharmD Clinical Assistant Professor Louis Broad, MD Clinical Assistant Professor Austin Chiang, MD Assistant Professor Cuckoo Choudhary, MD Clinical Professor Dorrance H. Hamilton Professor of Medicine Jesse Civan, MD Associate Professor Robert Coben, MD Anthony J. DiMarino, Jr., MD Professor Mitchell Conn, MD Clinical Professor Andrew Dargan, MD Clinical Assistant Professor Richard Denicola, MD Clinical Assistant Professor Michael DiMarino, MD Clinical Assistant Professor Jonathan Fenkel, MD Professor Dina Halegoua-DeMarzio, MD Professor Christopher Henry, MD Assistant Professor Steven Herrine, MD Professor Faisal Kamal, MD Assistant Professor Leo Katz, MD Clinical Associate Professor Cecilia Kelly, MD Clinical Assistant Professor Thomas Kowalski, MD Professor Patricia Kozuch, MD Associate Professor

PAT I E N T C A R E In 2024 the Division had three major goals 1) recruitment to backfill vacant positions and for growth 2) to move into our new facilities at Honickman Center 3) to maintain and grow its reputation as a leader in therapeutic and diagnostic patient care. The Division ranked 31st in Adult Gastroenterology and GI Surgery Hospital in US News and World Report this year. GI has been in the top fifty programs for over 13 years now. The Division continues to work hard on growing its national reputation.

The GI Division recruited nine faculty members this past year.

The new providers will allow us to grow in the areas of Hepatology, IBD, Barretts, Advanced Endoscopy and General GI services. Our new faculty will expand our services in Center City, South Philadelphia, Bala Cynwyd and New Jersey.

Our main clinical practice moved to Honickman Center where patients are enjoying the latest in technology and convenience to

other specialties located within the building. The new endoscopy center completed over five hundred procedures in its first month of opening. We also continued to grow our practice locations in South Philadelphia, Bala Cynwyd and in New Jersey.

The Jefferson Endoscopy Center in Bala Cynwyd continues to grow and performed over 3,800 cases last year which was the highest volume yet. The Division’s network of private practice groups, extending from the southern tip of New Jersey to the Lehigh Valley, continues strong with referrals for advanced procedures, liver transplant, and management of complicated IBD. The GI Division expanded our Direct Access Colonoscopy program to include Saturday services. Patients now have more access to screening services within their community. We performed over 150 Direct Access Colonoscopies in this program this past year. We are planning to continue to build on the success and expand the program next year.

The liver program performed 75 transplants in FY2024, performing

the second highest number of transplants in the region. The program has done well with over 1,200 liver transplants in total.

Transplant outcomes continue to exceed the national benchmark.

This coming year, Jefferson Health will begin to combine its transplant programs into one to serve patients optimally and efficiently.

In FY24, the Division of Gastroenterology and Hepatology continued to be recognized for the quality of its clinical programs and advanced endoscopy medical services, which includes third space endoscopy (POEM, G-POEM, and ESD). The Third Space program completed over two hundred procedures this year.

The Pancreaticobiliary Center and its physicians are advancing cancer treatment using minimally invasive endoscopic treatments to diagnose and manage cancers of the pancreas and biliary tree.

E D U C AT I O N The Division’s commitment to education continued its journey

Department of Medicine 2024 Annual Report

22 in excellence hosting three annual conferences:

using the electronic medical record system.

The 42nd “Advances in Gastroenterology Update Course” which updates over 150 Primary Care Physicians, Gastroenterologists and Nurse Practitioners on the newest diagnostic and therapeutic advances in GI disorders.

Several Fellow QI projects were undertaken, to improve teaching, documentation, and overall patient care.

The 9th Annual Liver Disease Symposium which was a combined effort by Center City and Einstein Hepatology.

The 5th Women’s GI Conference, which was phenomenally successful and filled to capacity.

In the 2024 academic year, 36 medical students, 51 internal medicine residents and 18 outside fellows rotated through our Division. The Division’s Fellowship Program continued strong. Again, we received about 600 applications for 4 Fellowship positions, this along with the Advanced Endoscopy Fellowship (1 of 68 in the U.S.), the IBD Fellowship (1 of 28 in the U.S.) and the Advanced Hepatology Fellowship (1 of 59 in the U.S.) continues to foster our national reputation as leaders in GI/Hepatology and advanced training.

Q UA L I T Y I N I T I AT I V E S The Division of Gastroenterology has an active Quality Improvement Program. Over the past year, our efforts have continued to focus on patient satisfaction, first case on-time starts (FCOTS), length of stay, readmissions, colonoscopy metrics (cercal intubation rate, average withdrawal time, adenoma detection rates (ADR)), reduction of procedure cancellation rates and prep adequacy and developing best practice advisories

This year, in addition to our general morbidity, mortality and improvement conference, we introduced a monthly session dedicated solely to endoscopy.

I N T E R N AT I O N A L A F FA I R S Several members of the Division participated in International Affair programs this past year.

Dr. David Kastenberg traveled to the Virgin Islands and met with government officials on potential future partnerships.

Drs. Schlachterman and Choudhary traveled to Rome and worked with local leadership about future research collaborations. Drs. Kowalski and Tholey traveled on a medical mission trip to Rwanda where they lectured and participated in hands on procedure education.

RESE ARCH We continue at the forefront of high quality innovative clinical research with Co-PI’s on 2 NIH grants and over 20 Industrysponsored clinical trials, and innumerable investigatorinitiated studies.

P U B L I C AT I O N S Halegoua-De Marzio D, Navarro VJ, A comprehensive update in herbal and dietary supplementinduced liver injury. Clin Liver Dis (Hoboken). 2024 Jun 21;23(1):e0185. doi: 10. 1097/ CLD.0000000000000185.

PMID: 38912001; PMCID: PMC11191983.

Varghese N, Majeed A, Nyalakonda S, Boortalary T, Halegoua-DeMarzio D, Hann H-W. Review of Related Factors for Persistent Risk of Hepatitis B Virus-Associated Hepatocellular Carcinoma. Cancers. 2024; 16(4):777. https://doi. org/10.3390/cancers16040777 Alice S. Pang, Robert Adamo, Robert Coben; Treatment of Gastrointestinal Bleeding in the Biliopancreatic Limb with Embolization in a Patient with Duodenal Switch Anatomy. Case Rep Gastroenterol 4 January 2024; 18 (1): 117–121. https://doi. org/10.1159/000536095 Sengupta, N., Kastenberg, D. M., Bruining, D. H., Latorre, M., Leighton, J. A., Brook, O. R., Wells, M. L., Guglielmo, F. F., Naringrekar, H. V., Gee, M. S., Soto, J. A., Park, S. H., Yoo, D. C., Ramalingam, V., Huete, A., Khandelwal, A., Gupta, A., Allen, B. C., Anderson, M. A., Dane, B. R., … Fidler, J. L. (2024). The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations.

Radiology, 310(3), e232298. https://doi.org/10.1148/ radiol.232298 Moleski S, Adams DW, Jossen J, Tye-Din JA. Clinical Presentation and Spectrum of Gluten Symptomatology in Celiac Disease. Gastroenterology. 2024 Apr 16:S0016‑5085(24)00417-7. doi: 10.1053/j.gastro.2024.01.052.

Epub ahead of print. PMID: 38636679.

Abrams E, Moore K, Kastenberg D, White M, Israilevich R, Lam S, McCarthy M, Mico V, Chipkin B, Timely Completion of Direct Access Colonoscopy Is Noninferior to Office Scheduled for Screening and Surveillance. J Clin Gastroenterol.

2024 Apr 18. doi: 10.1097/ MCG.0000000000002000. Epub ahead of print. PMID: 38630852.

Halegoua-DeMarzio D, Pop A, Barnhart H, Kleiner D, Avigan

FACU LT Y Howard Kroop, MD Clinical Assistant Professor Anand Kumar, MD Clinical Associate Professor Aarati Malliah, MD Clinical Assistant Professor Aaron Martin, MD Clinical Assistant Professor Stephanie Moleski, MD Associate Professor Nicholas Orfanidis, MD Clinical Assistant Professor Jorge Prieto, MD Clinical Assistant Professor Leonard Salese, MD Clinical Instructor David Sass, MD Professor Rorer Professor of Medicine Debbie Schiller, MD Instructor Alexander Schlacterman, MD Associate Professor Raina Shivashankar, MD Associate Professor Kristen Singer, MD Clinical Assistant Professor Colin Smith, MD Assistant Professor Danielle Tholey, MD Assistant Professor

Department of Medicine 2024 Annual Report

23 M, Gu J, Chalasani N, Ahmad J, Fontana RJ, Lee W, Barritt AS, Durazo F, Hayashi PH, Navarro VJ. Amiodarone and Dronedarone Causes Liver Injury with Distinctly Different Clinical Presentations. Dig Dis Sci. 2024 Apr;69(4):14791487. doi: 10.1007/s10620023-08251-2. Epub 2024 Feb 28. PMID: 38416280; PMCID: PMC11026178.

Loh R, Noverati N, Goldberg I, Josloff K, Schiavone G, Halegoua-DeMarzio D, Schlachterman A. Safe Use of POEM in a Patient With Decompensated Cirrhosis and Severe Achalasia.

ACG Case Rep J. 2023 Sep 23;10(9):e01144. doi: 10.14309/ crj.0000000000001144.

PMID: 37753108; PMCID: PMC10519461.

Ahmed, M. (2024). A New Organ: The Mesentery and Non-Vascular Mesenteric Diseases. Preprints

Noverati N, Yan V, Jun JW, Halegoua-DeMarzio D, Hann H-W. The Long Game: A Functional Cure Is Possible with Nucleoside Analogues and the Tincture of Time. Livers.

2023; 3(3):325-330. https://doi. org/10.3390/livers3030024

Kumar A, Tofani C, Kim RE, Westanmo A, Moy BM, Dang F, Canakis A, Sharma N, Muniraj T, Azeem N, Bilal M. Outcomes of cold snare EMR of nonampullary duodenal adenomas ≥1 cm: a multicenter study. Gastrointest Endosc. 2024 Jun;99(6):971980.e1. doi: 10.1016/j. gie.2023.12.007. Epub 2023 Dec 11. PMID: 38092125.

Robles MR, Johnson PC, Kastenberg DM. A commentary on: Impact of bowel preparation quality on colonoscopy findings and colorectal cancer deaths in a nation-wide colorectal cancer screening program.

PracticeUpdate website.

Available at: https://www. practiceupdate.com/content/ impact-of-bowel-preparationquality-on-colonoscopyfindings-and-colorectalcancer-deaths/167679/65/9/1.

Accessed July 24, 2024 Liu JB, Machado P, Eisenbrey JR, Gummadi S, Forsberg F, Wessner CE, Kumar AR, Chiang A, Infantolino A, Schlachterman A, Kowalski T, Coben R, Loren D. Identification of sentinel lymph nodes in esophageal cancer patients using contrast-enhanced EUS with peritumoral injections.

Endosc Ultrasound. 2023 JulAug;12(4):362-368. doi: 10.1097/ eus.0000000000000001. Epub 2023 Sep 13. PMID: 37795347; PMCID: PMC10547247.

Duffey, K., Halegoua-DeMarzio, D., Shah, A. P., & Tholey, D. M. (2023). Sex and racial disparities in living donor liver transplantation in the United States. Liver transplantation: official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 29(11), 1172–1180. https://doi.org/10.1097/ LVT.0000000000000197 Schmoyer, C. J., Sun, K., Zack, J., Kumar, P., & Shivashankar, R. (2023). Adverse Events and Compliance Among Inflammatory Bowel Disease Patients Treated with Homevs Office-Based Biologic Infusions. Inflammatory bowel diseases, izad226. Advance online publication. https://doi. org/10.1093/ibd/izad226 Freeland, C., Sreepathi, V., Hass, R. W., Fenkel, J. M., Torgersen, J., Rothstein, K., Cohen, C., & Gish, R. G. (2023). The importance of triple panel testing for hepatitis B and the burden of isolated anti-hepatitis B core antibodies within a community sample.

Journal of virus eradication, 9(4), 100358. https://doi. org/10.1016/j.jve.2023.100358

Mitsuhashi, S., Azari, J., Dioguardi, V., Bilello, J., Tang, M., & Kastenberg, D. (2023).

Age Matters: Adenoma Detection Rates in Averagerisk Screening Patients Aged 45 to 49 Compared with Those Aged 50 to 54. Journal of clinical gastroenterology, 10.1097/ MCG.0000000000001953.

Advance online publication. https://doi.org/10.1097/ MCG.0000000000001953

N OTA B L E ACH I E V E M E N T S 42nd Annual Advances in Gastroenterology Update Course 10th Annual Jefferson Liver Disease Symposium 5th Jefferson Women and GI Health Symposium

MacDonald, N., Loh, R., Fenkel, J. M., Sass, D. A., & Halegoua-DeMarzio, D. (2024).

Pharmacotherapy for primary biliary cholangitis: an assessment of medication candidacy and rates of treatment. BMC gastroenterology, 24(1), 18. https://doi.org/10.1186/s12876023-03108-4

Jefferson GI ranked 31st in US News and World Report

Ahmed M. Intestinal Parasitic Infections in 2023.

Gastroenterology Res. 2023 Jun;16(3):127-140. doi: 10.14740/gr1622. Epub 2023 Jun 11. PMID: 37351081; PMCID: PMC10284646.

CUCKOO CHOUDHARY, MD - Named professorship – 1st woman in GI to hold named professorship - Fellowship, AMWA 2023 Fellowship, College of Physicians, Philadelphia 2023

Tahmasebi A, Wang S, Wessner CE, Vu T, Liu JB, Forsberg F, Civan J, Guglielmo FF, Eisenbrey JR. Ultrasound-Based Machine Learning Approach for Detection of Nonalcoholic Fatty Liver Disease. J Ultrasound Med. 2023 Aug;42(8):1747-1756. doi: 10.1002/jum.16194. Epub 2023 Feb 20. PMID: 36807314.

Savsani E, Shaw CM, Forsberg F, Wessner CE, Lyshchik A, O'Kane P, Liu JB, Balasubramanya R, Roth CG, Naringrekar H, Keith SW, Tan A, Anton K, Bradigan K, Civan J, Schultz S, ShamimiNoori S, Hunt S, Soulen MC, Mattrey RF, Kono Y, Eisenbrey JR. Contrast-enhanced US Evaluation of Hepatocellular Carcinoma Response to Chemoembolization: A Prospective Multicenter Trial. Radiology. 2023 Oct;309(1):e230727. doi: 10.1148/radiol.230727.

CHRISTOPHER ADKINS, MD - Teacher of the Year. Division of Gastroenterology and Hepatology. 2023.

- Dean’s Award for Faculty Team Achievement. Sidney Kimmel Medical College.

2023

ROBERT COBEN, MD - 2023- Pennsylvania Medical Society, Doctor’s Day Honoree DINA HALEGOUADE MARZIO, MD - Outstanding Faculty Clinical Researcher Award, Department of Medicine, TJUH, 2024 - Selected to be a Fellow of the American Association for the Study of Liver Disease (FAASLD), 2024 - Winner of Jefferson Health’s Inaugural Physician Excellence in Medical Research Award, 2024 THOMAS KOWALSKI, MD - A SGE Distinguished Educator Award, 2024, ASGE, two physicians/year are chosen for this lifetime achievement award

Department of Medicine 2024 Annual Report

24 PMID: 37847138; PMCID: PMC10623205.

Bilello, J., Kulak, O., Selvarajan, S., Tholey, D., & Civan, J. (2023).

A Rare Red Herring: Intrahepatic Splenosis Masquerading as Hepatocellular Carcinoma. ACG Case Reports Journal, 10, e01103.

Mitsuhashi, S., Chalikonda, D., Nazir, B., Agarwal, A, Coben, R. Recurrent bleeding duodenal and colonic ulcers due to posttransplant lymphoproliferative disorder. Clin J Gastroenterol 16, 39–42 (2023). https://doi. org/10.1007/s12328-022-01718-1 Flerova, E., Inniss, S., Nwaoduah, N., Denicola, R. P., & Huang, J. (2023). Acute systemic infectionassociated Russell body gastroesophagitis: A case report and literature review. Human Pathology Reports, 31, 300696.

Boudova, S., Tholey, D., Fenkel, J. M., Derman, R., & Boelig, R. C. (2023). Pregnancy as an Opportunity for Hepatitis C Virus Elimination and Eradication, 110, 199–201.

Torkzaban, M., Wessner, C. E., Halegoua-DeMarzio, D., Lyshchik, A., & Nam, K. (2023). Diagnostic Performance of Quantitative Ultrasound Parameters in Nonalcoholic Fatty Liver Disease, 31, 199–211.

Parra, N. S., Schafer, M., Ross, H. M., Bruckbauer, J., Yan, B., Chen, S. L., … Halegoua-DeMarzio, D. (2023). Prevalence of postliver transplant complications and NASH-related cirrhosis in postmenopausal women, 29, 101157.

Halegoua-DeMarzio, D., Navarro, V., & Khan, I. (2023). The Reply.

The American Journal of Medicine, 136, e168.

Robbins, J., Halegoua-DeMarzio, D., Basu Mallick, A., Vijayvergia, N., Ganetzky, R., Lavu, H., … Lefler, D. S. (2023). Liver Transplantation in a Woman

with Mahvash Disease. The New England Journal of Medicine, 389, 1972–1978.

Duffey, K., Halegoua-DeMarzio, D., Shah, A. P., & Tholey, D. (2023). Sex and racial disparities in live donor liver transplantation in the United States.

Noverati, N., Nguyen, A., Chalikonda, D., HalegouaDeMarzio, D., & Hann, H.-W. (2023). The Role of Host in the Spectrum of Outcomes in Family Clusters of Hepatitis Infection: From Asymptomatic to Hepatocellular Carcinoma, 17, 104–110.

Agnihotri, A., Mitsuhashi, S., Holmes, I., Kamal, F., Chiang, A. L., Loren, D. E., … Kumar, A. R. (2023). A randomized trial comparing gastric and colorectal endoscopic submucosal dissection defect closure using novel through the scope suturing system with overthe-scope suturing system.

Tarar, Z. I., Farooq, U., Gandhi, M., Zafar, M. U., Saleem, S., & Kamal, F. (2023). Safety and indications for endoscopic retrograde cholangiopancreatography in liver transplant patients: an analysis of the United States’ National Inpatient Sample database, 36, 459–465.

Gangwani MK, Aziz M, Dahiya DS, Aziz A, Priyanka F, Karna R, Lee-Smith W, Ahmed Z, Kamal F, Inamdar S, Alastal Y, Adler D. Comparable Efficacy for Push Versus Pull Technique in Esophageal Food Impaction: Systematic Review with MetaAnalysis. Dig Dis Sci. 2023 Aug;68(8):3354-3364. doi: 10.1007/s10620-023-079880. Epub 2023 Jun 6. PMID: 37278950.

Gangwani MK, Nawras M, Aziz M, Rani A, Priyanka F, Dahiya DS, Ahmed Z, Sohail AH, Karna R, Lee-Smith W, Kamal F,

Kobeissy A, Alastal Y. Comparing adalimumab and infliximab in the prevention of postoperative recurrence of Crohn's disease: a systematic review and metaanalysis. Ann Gastroenterol. 2023 May-Jun;36(3):293-299. doi: 10.20524/aog.2023.0786. Epub 2023 Apr 3. PMID: 37144019; PMCID: PMC10152807.

Kamal F, Khan MA, Lee-Smith W, Sharma S, Acharya A, Farooq U, Aziz M, Kouanda A, Dai SC, Munroe CA, Arain M, Adler DG. Efficacy and safety of EUS-guided gallbladder drainage for rescue treatment of malignant biliary obstruction: A systematic review and metaanalysis. Endosc Ultrasound.

2023 Jan-Feb;12(1):8-15. doi: 10.4103/EUS-D-21-00206.

PMID: 36861505; PMCID: PMC10134926.

Kamal, F., Khan, M. A., Lee-Smith, W., Sharma, S., Acharya, A., Farooq, U., … Adler, D. G. (2023).

Efficacy and safety of EUS-guided biliary drainage for benign biliary obstruction - A systematic review and meta-analysis, 12, 228–236.

Chandan S, Deliwala S, Khan SR, Mohan BP, Dhindsa BS, Bapaye J, Goyal H, Kassab LL, Kamal F, Sayles HR, Kochhar GS, Adler DG. EUS-guided versus percutaneous liver biopsy: A comprehensive review and meta-analysis of outcomes. Endosc Ultrasound.

2023 Mar-Apr;12(2):171-180. doi: 10.4103/EUS-D-21-00268.

PMID: 36204798; PMCID: PMC10237604.

Aziz M, Haghbin H, Gangwani MK, Nawras M, Nawras Y, Dahiya DS, Sohail AH, Lee-Smith W, Kamal F, Shaukat A. 9-Minute Withdrawal Time Improves Adenoma Detection Rate Compared With 6-Minute Withdrawal Time During Colonoscopy: A Meta-analysis of Randomized Controlled Trials.

N OTA B L E ACH I E V E M E N T S STEPANIE MOLESKI, MD - 2023 Top 25 teachers as Rated by Residents Dept of Internal Medicine Residency, 2023, Dept of Internal Medicine Residency - 2023 Sidney Kimmel Medical College - Education Honor Roll, 2023, TJUH Internal Medicine Residency, Top 25 educators in Internal Medicine Residency DAVID SASS - 2023 Sidney Kimmel Medical College - Education Honor Roll, 2023, TJUH Internal Medicine Residency, Top 25 educators in Internal Medicine Residency - Professorship recipient Philadelphia Magazine Top Doctors in Gastroenterology CHRISTOPHER ADKINS, MD CUCKOO CHOUDHARY, MD JESSE CIVAN, MD ROBERT COBEN, MD MITCHELL CONN, MD ANDREW DARGAN, MD MICHAEL DIMARINO, MD JONATHAN FENKEL, MD C. JONATHAN FOSTER, DO DINA HALEGOUADEMARZIO, MD STEVEN HERRINE, MD DAVID KASTENBERG, MD THOMAS KOWALSKI, MD PATRICIA KOZUCH, MD ANAND KUMAR, MD AARATI MALLIAH, MD STEPHANIE MOLESKI, MD JORGE PRIETO, MD DAVID SASS, MD DEBBIE E. SCHILLER, MD ALEXANDER SCHLACHTERMAN, MD RAINA SHIVASHANKAR, MD

Department of Medicine 2024 Annual Report

25 J Clin Gastroenterol. 2023 Oct 1;57(9):863-870. doi: 10.1097/ MCG.0000000000001878.

PMID: 37389958.

Tarar, Z. I., Farooq, U., Gandhi, M., Ghous, G., Saleem, S., Kamal, F., … Jamil, L. (2023). Effect of radiofrequency ablation in addition to biliary stent on overall survival and stent patency in malignant biliary obstruction: an updated systematic review and meta-analysis. European Journal of Gastroenterology & Hepatology, 35, 646–653.

Faggen, A. E., Kamal, F., LeeSmith, W., Khan, M. A., Sharma, S., Acharya, A., … Kouanda, A. (2023). Over-the-Scope Clips Versus Standard Endoscopic Treatment for First Line Therapy of Non-variceal Upper Gastrointestinal Bleeding: Systematic Review and MetaAnalysis. Digestive Diseases and Sciences, 68, 2518–2530.

Kamal, F., Khan, M. A., LeeSmith, W., Sharma, S., Acharya, A., Farooq, U., … Adler, D. (2023).

Cold snare versus cold forceps polypectomy for endoscopic resection of diminutive polyps: meta-analysis of randomized controlled trials. Gastrointestinal Endoscopy, 98, 7–18.e4.

Agnihotri, A., Mitsuhashi, S., Holmes, I., Kamal, F., Chiang, A., Loren, D. E., … Kumar, A. R. (2024). Randomized trial of gastric and colorectal endoscopic submucosal dissection defect closure comparing a novel through-thescope suturing system with an overthe-scope suturing system (with video). Gastrointestinal Endoscopy, 99, 237–244.e1.

Shinn, B., Burdick, J., Berk, K., Hwang, J. H. H., El-Dika, S., Juakiem, W., … Kowalski, T. (2024). Safety, Efficacy and Clinical Utility of the 5.1mm EndoRotor Powered Debridement Catheter for Treatment of Walled-Off Pancreatic Necrosis.

Mitsuhashi, S., Kamal, F., Shinn, B. J., Chalikonda, D., Tyberg, A., Shahid, H., … Kowalski, T. (2023).

Colonic-enteric lumen-apposing metal stents: a promising and safe alternative for endoscopic management of small-bowel obstruction, 99, 606–613.

Farooq, U., Tarar, Z. I., Kamal, F., Schlachterman, A., Kumar, A., Loren, D. E., & Kowalski, T. E. (2024). Increased risk of acute pancreatitis in patients with post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis: findings from a National Cohort. HPB: The Official Journal of the International Hepato Pancreato Biliary Association, 26, 313–315.

Johnson, P. C., Agnihotri, A., Loren, D. E., Kowalski, T. E., Schlachterman, A., Kamal, F., & Kumar, A. (2023). Clip Dislodgement After FullThickness Endoscopic Resection Device Removal of Scarred Gastric Subepithelial Lesion Leading to Delayed Perforation.

ACG Case Reports Journal, 10, e01214 Kumar, A. (2024). The Impact of Frailty on ERCP-Related Adverse Events: Findings from a National Cohor. Techniques and Innovations in Gastrointestinal Endoscopy.

Bucobo JC, Kassim O, Konijeti GG, Abraham BP, Abegunde AT, Farraye FA, Guha S, Kowalski T, Kumar A, Markowitz AJ, Schoeppner HL, Tierney WM; (ASGE ARIA Committee Chair). Role of the industry representative in the practice of gastroenterology and GI endoscopy. Gastrointest Endosc.

2024 Mar;99(3):307-313. doi: 10.1016/j.gie.2023.10.057. Epub 2024 Jan 23. PMID: 38260918.

Yu, T. Z., Agnihotri, A., Zheng, R., Bashir, B., Nasher, N., Yeo, C. J., … Kumar, A. (2023). Salvage endoscopic ultrasound-guided gastrojejunostomy as a bridge

to definitive surgical therapy for duodenal adenocarcinoma presenting with duodenal stent obstruction. Clinical Journal of Gastroenterology, 16, 387–391.

Farha J, Ramberan H, Aihara H, Zhang LY, Mehta A, Hage C, Schlachterman A, Kumar A, Shinn B, Canakis A, Kim RE, D’Souza LS, Buscaglia JM, Storm AC, Samarasena J, Chang K, Friedland S, Draganov PV, Qumseya BJ, Jawaid S, Othman MO, Hasan MK, Yang D, Khashab MA, Ngamruengphong S; ESD-Closure working group.

A novel through-the-scope helix tack-and-suture device for mucosal defect closure following colorectal endoscopic submucosal dissection: a multicenter study. Endoscopy.

2023 Jun;55(6):571-577. doi: 10.1055/a-1970-5528. Epub 2022 Nov 2. PMID: 36323330.

Bi D, Zhang LY, Alqaisieh M, Shrigiriwar A, Farha J, Mahmoud T, Akiki K, Almario JA, Shah-Khan SM, Gordon SR, Adler JM, Radetic M, Draganov PV, David YN, Shinn B, Mohammed Z, Schlachterman A, Yuen S, Al-Taee A, Yunseok N, Trasolini R, Bejjani M, Ghandour B, Ramberan H, Canakis A, Ngamruengphong S, Storm AC, Singh S, Pohl H, Bucobo JC, Buscaglia JM, D'Souza LS, Qumseya B, Kumta NA, Kumar A, Haber GB, Aihara H, Sawhney M, Kim R, Berzin TM, Khashab MA. Novel through-the-scope suture closure of colonic EMR defects (with video). Gastrointest Endosc. 2023 Jul;98(1):122-129. doi: 10.1016/j.gie.2023.02.031.

Epub 2023 Mar 6. PMID: 36889364.

Agnihotri, A., & Schlachterman, A. (2023). A novel endoscopic ultrasound-guided transluminal anchor device, 55, E775–E776.

Gomez, J., Felder, L., Chalikonda, D., Schlachterman, A., & Berghella, V. (2023). Per Oral Endoscopic Myotomy

in pregnancy. The Journal of Maternal-Fetal & Neonatal Medicine: The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 36, 2229474.

Ladd, A. M., Park, K., Bilal, M., Schlachterman, A., Amin, S., Obeng, G., … Thakkar, S. (2023). Prophylactic stenting to decrease incidence of strictures after extensive ESD in the esophagus. The first American experience.

Freeman M, Lally L, Teigen L, Graziano E, Shivashankar R, Shmidt E. Hormone Replacement Therapy Is Associated with Disease Activity Improvement among PostMenopausal Women with Inflammatory Bowel Disease. J Clin Med. 2023 Dec 23;13(1):88. doi: 10.3390/jcm13010088.

PMID: 38202098; PMCID: PMC10779540.

Edirisuriya, C., Goldenberg, J., Bresler, Z., Tofani, C., & Tholey, D. M. (2024). The Effect of Implementing Gamification in Hepatology Curriculum for Medical Students. Med Ed Publish.

Tholey, D. M., Lopatin, S., Roth, N., & Im, G. Y. (2023). What’s in a name? Higher risks with donation after cardiac death than public health service increased risk livers. Journal of Liver Transplantation, 9, 100133 Tholey, D., & ManirahoNshimiyimana, R. (2024).

Rwanda’s Progress in Eradicating Hepatitis C Virus: A Feasible Approach to Reducing Liver Cancer Incidence in SubSaharan Africa. American Society of Clinical Oncology (ASCO) Post.

Kaplan, A., Aby, E., Scott, S., Sonneday, C., Fox, A., & Tholey*, D. (2024). Financial Toxicity in Living Donor Liver Transplantation: A call to Action

Department of Medicine 2024 Annual Report

26 for Financial Neutrality. American Journal of Transplantation.

Boudova, S., Tholey, D. M., & Ferries-Rowe, E. (2024). Hepatitis C virus detection and management after implementation of universal screening in pregnancy, 4, 100317.

Ho, J., Bresler, Z., Lally, L., Halegoua-DeMarzio, D., & Tholey, D. M. (2024). The Effect of Sirolimus Immunosuppression on Cardiovascular Outcomes in Liver Transplantation. Journal of Liver Transplantation, 14.

Department of Medicine

DIVISION OF HEMATOLOGY AND CARDEZA FOUNDATION FOR HEMATOLOGIC RESEARCH The Division of Hematology and Cardeza Foundation for Hematologic Research provides inpatient and outpatient clinical Hematology services, trains students, residents, and fellows in clinical and research aspects of Hematology, runs an NIH-funded research enterprise, and provides administrative support to the Department of Medicine, Sidney Kimmel Medical College, and Thomas Jefferson University Hospital.

PAT I E N T C A R E High quality patient care was provided in the Hematology inpatient consult service of TJUH and JHN, and in the JUP outpatient Hematology practice. The Division saw 3,286 outpatients in FY24, which included 1,387 new patient visits.

Additionally, we continued to have Centers of Excellence in the Cardeza Foundation Hemophilia and Thrombosis Center, which is federally and statedesignated, and the Hereditary Anemias Center, with its statedesignated Sickle Cell Program (in conjunction with the Division of Internal Medicine). The Special Hemostasis laboratory was supervised by Drs. McKenzie and Rhoades in conjunction with the Department of Pathology.

Q UA L I T Y I N I T I AT I V E S Quality improvement projects in the Division of Hematology have primarily focused on our role as stewards for hematology-specific laboratory tests and transfusions of blood products. These projects have included ones aimed at decreasing the ordering of

low-value inherited thrombophilia tests, as well as establishment of a preoperative anemia clinic in which surgical patients with anemia are seen by Hematology and treated preoperatively to improve anemia before surgery, with the goal of avoiding severe anemia, transfusions, and longer length of stay after surgery. Other recent projects have focused on improving care in our longitudinal patients, including studying the impact of menopause in women with sickle cell disease and nonattended appointments in our bleeding disorders patients. In addition, we are building capacity in our sickle cell program with plans to assist the two largest pediatric sickle cell programs transition their patients to high quality adult care. We are working with our emergency department colleagues to decrease the time to first dose of pain medications for patients with sickle cell disease who present with acute pain.

Director as of 2024, and Dr. Sanaa Rizk is Associate Program Director. Dr. Rhoades directs the Hematology portion of Medicine Resident teaching, and our faculty make strong contributions to lecturing at fellow noon conferences. Dr. Rhoades supervises the Hematology portion of the JeffMD block for first year medical students and the inpatient elective for fourth year medical students. Divisional faculty also played major roles in MS, PhD, and MD/PhD student education. Most faculty hold either secondary appointments in basic science departments or membership in graduate groups.

Dr. Goldfinger is the Director of the Molecular Physiology and Translational Medicine PhD program in the graduate school.

Dr. Lanzkron runs a weekly telementoring conference (ECHO) on sickle cell disease attended by 40-50 clinicians and nurses across the US.

E D U C AT I O N

RESE ARCH

The Hematology-Oncology fellowship has 19 fellows in our 3-year training program. Dr. Lindsay Wilde is the Program

The Cardeza Foundation for Hematologic Research was established in 1939 by Thomas Drake Martinez Cardeza and

2024 Annual Report

27

FACU LT Y Sophie Lanzkron, MD, MHS Leandro M. Tocantins, MD - Farid I. Haurani, MD Director, Cardeza Foundation for Hematologic Research Thomas Drake Martinez Cardeza Research Professor in Medicine Division Director

Ashwin Chandar, MD Clinical Assistant Professor Douglass Drelich, MD Assistant Professor Lawrence Goldfinger, PhD Professor Director, Integrative Physiology Graduate Program John Kostyak, PhD Research Assistant Professor Steven McKenzie, MD, PhD Professor of Medicine and Pediatrics Peisong Ma, PhD Assistant Professor James Michael, PhD Research Assistant Professor Ulhas Naik, PhD Professor Director, Cardeza Center for Hemostasis, Thrombosis and Vascular Biology Ruben Rhoades, MD Assistant Professor Co-Director, Hemophilia and Thrombosis Treatment Center Sanaa Rizk, MD Clinical Associate Professor Director, Hereditary Anemias Center Associate Program Director, Hematology/Oncology Fellowship Program Amit Srivastava, PhD Assistant Professor Timothy Stalker, PhD Assistant Professor

Department of Medicine 2024 Annual Report

28 his wife Mary in honor of Mr. Cardeza’s mother, Charlotte.

The purpose is to support Hematology research. Cardeza faculty conduct translational, basic, clinical, and outcomes/ quality research. Translational and basic research in our state-of-the-art laboratories is based in the Cardeza Center for Hemostasis, Thrombosis, and Vascular Biology. Major efforts involve the basic biology, genetics, pharmacogenetics, and pathophysiology of blood platelets and bleeding and clotting disorders. Our faculty are recognized internationally for their work, and they are supported by multiple NIH research grants. Cardeza research involves collaborations with Sidney Kimmel Cancer Center, the Center for Computational Medicine, the Department of Biochemistry and Molecular Biology, the Divisions of Cardiology and Pulmonary Medicine, and the Center for Translational Medicine (CTM). Cardeza lab research faculty belong to several MS and PhD programs and are founding leaders with CTM faculty of the PhD Program in Integrative Physiology, with its focus on heart, lung, blood and vascular biology.

Hematology clinical research foci include the Cardeza Hemostasis and Thrombosis Center, a federal and staterecognized center of excellence, and the Hereditary Anemias Center, which includes the Sickle Cell Disease Program, a joint effort with Internal Medicine and Hospital Medicine.

Both industry-sponsored and investigator-initiated clinical trials are being conducted, along with outcomes and quality studies. Dr. Lanzkron is the PI of the GRNDaD registry, the largest sickle cell registry in the US. She is also funded by PCORI to examine the implementation

of the infusion clinic model for people with SCD in nine sites across the US. These have led to impactful peer-reviewed publications. Hematology clinical faculty engage Hematology/Oncology fellows and medical students in these research projects.

P U B L I C AT I O N S

GRANTS LAWRENCE GOLDFINGER, PHD NIH R33HL173910 2024-2026 “RNA-based therapeutics for hemostasis and thrombosis” Role: Multi-Principal Investigator TOTAL AWARD: $1,092,000, DIRECT COSTS: $700,000

Fu, JJ; Seth, A; Ali, N; Chandar, A; Bains, A. "ALK-positive Large B-cell Lymphoma with Multiple Epithelial Antigen Expression and PABPC1:ALK Fusion, a Novel Molecular Alteration". Am J Surg Pathol. 2023 Aug 1;47(8):950-954.

LAWRENCE GOLDFINGER, PHD AHA 24PRE1194157 2024-2025 “Deciphering the roles of ADAM17 translation in platelet function” Role: Mentor, for Shayan Askari TOTAL AWARD: $67,388

Malika A, Stephenson KE, Collier AY, Michael JV, McKenzie SE, Barouch DH. Activation of Coagulation and Proinflammatory Pathways in Thrombosis with Thrombocytopenia Syndrome and Following COVID-19 Vaccination. Nat Comm. 2023 Oct 23; 14(1):6703

SOPHIE LANZKRON, MD PCORI through Johns Hopkins DI-2021C2-23827 2024-2025 “Implementing the Infusion Clinic Model In Sickle Cell Disease” Role: Principal Investigator TOTAL AWARD: $76,680, DIRECT COSTS: $54,772

Gupta S, Cooper M, Zhao X, Yarman Y, Thomson H, DeHelian D, Brass, LF, Ma P. A regulatory node involving Gq, PLC, and RGS proteins modulates platelet reactivity to critical agonists.

J Thromb Haemost. 2023.

Dec;21(12):3633-3639. PMID: 37657560.

Wurtzel, J.G.T., Lazar, S., Askari, S., Zhao, X., Severa, J., Ayombil, F., Michael, J.V., Camire, R.M., McKenzie, S.E., Stalker, T.J., Ma, P., Goldfinger, L.E.: Plasma growth factors maintain constitutive translation in platelets to regulate reactivity and thrombotic potential. Blood Advances 8(6):1550-1566, 2024. with Inside Blood Advances commentary article. Portier, I., Rondina, M.T. Platelets, plasma, and proteostasis: a translation tightrope. Blood Advances 8(6):1567-1569,2024.

Carpio-Cano, F.D.*, Mao, G.*, Goldfinger, L.E.*, Wurtzel,

SOPHIE LANZKRON, MD PCORI through University of Rocheste BPS-2023C1-31041 2024-2025 “Comparative Effectiveness of MRD HCT and NT-DMT for Pediatric Sickle Cell Disease (WeDecide)” Role: Co-investigator TOTAL AWARD: $241,611, DIRECT COSTS: $172,579 PEISONG MA, PHD AHA 24PRE1195534 2024-2025 “GRK5 and GRK6 are critical regulators of hemostasis and thrombosis” Role: Mentor, for Xuefei Zhao TOTAL AWARD: $67,388 JAMES MICHAEL, PHD AHA 24CDA1276922 2024-2027 “Mechanisms and roles of inflammasome-mediated signaling in heparin-induced thrombocytopenia” Role: Principal Investigator TOTAL AWARD: $231,000, DIRECT COSTS: $210,000

TIMOTHY STALKER, PHD NIH R33HL173910 2024-2026 “RNA-based therapeutics for hemostasis and thrombosis” Role: Multi-Principal Investigator TOTAL AWARD: $1,092,000, DIRECT COSTS: $700,000

Department of Medicine 2024 Annual Report

29 J.G.T., Guan, L., Alam, A.M., Lee, K., Poncz, M.E., Rao, A.K.: Altered platelet-megakaryocyte endocytosis and trafficking of albumin and fibrinogen in RUNX1 haplodeficiency. Blood Advances 8(7):1699-1714, 2024. *, equal contributors. Cover article.

Wurtzel, J.G.T., Gray, B.D., Pak, K.Y., Zhao, X., Ma, P., McKenzie, S., Tanujaya, M., Rizzo, V., Del Carpio-Cano, F., Rao, A.K., Chong, P.L-G., Goldfinger, L.E.: Phosphatidylserine-blocking nanoparticles inhibit thrombosis without increased bleeding in mice. Journal of Thrombosis and Haemostasis Oct 16:(24)00613-5 (pre-print), 2024.

Lazar, S., Wurtzel, J.G.T., Askari, S., Cooper, M., Zhao, X., Ma, P., Goldfinger, L.E.: Argonaute2 modulates megakaryocyte development and sex-specific control of platelet protein expression and reactivity. In review (10 October, 2024).

Kelly DL, Glassman M, Wonodi I, Vyas G, Richardson CM, Nwulia E, Wehring HJ, Oduguwa T, Mackowick M, Hipolito MMS, Peters O, Rai N, Park J, Adebayo AO, Gorelick DA, Weiner E, Liu F, Kearns AM, Adams HA, Love RC, Chen S, Olaniyan A, Ambulos N, McKoy D, Nallani MC, Lanzkron S, Mengistab M, Barr B, Davis E, Lawal R, Buchanan RW, Adebayo R. Clozapine and neutrophil response in patients of African descent: A six-month, multinational, prospective, openlabel clinical trial Schizophr Res. 2023 Aug 24:S09209964(23)00260-8.

Pecker LH, Ruvalcaba E, Lanzkron S, Eakin MN. Online ahead of print. "The Patient Should Have a Choice": Adults with Sickle Cell Disease Advise Integration of Telemedicine into the Comprehensive Sickle Cell Disease Care Model. J Racial Ethn Health Disparities. 2023 Sep 8. doi: 10.1007/s40615-023-01780-6.

Leung, H., Ahmadi, Z., Lee, B., Casey, J., Ratnasingam, S., McKenzie, S.E., Perdomo, J., Chong, B.H. Antithrombotic Efficacy and Bleeding Risks of Vaccine-Induced Immune Thrombotic Thrombocytopenia Treatments. Blood Advances 2024; doi.org/10.1182/ bloodadvances.2024013883 Han X, Knauss EA, Fuente M, Li W, Conlon RA, LePage DF, Jiang W, Renna SA, McKenzie SE, Nieman MT. A mouse model of the protease-activated receptor 4 Pro310Leu variant has reduced platelet reactivity.

J Thromb Haemost. 2024 Jun;22(6):1715-1726. doi: 10.1016/j. jtha.2024.03.004. Epub 2024 Mar 19. PMID: 38508397 Boelig RC, Kaushal G, Rochani A, McKenzie SE, Kraft WK. Aspirin pharmacokinetics and pharmacodynamics through gestation. Am J Obstet Gynecol.

2024 Sep; 231(3):344.e1-344.e16. doi: 10.1016/j.ajog.2023.12.028.

Epub 2023 Dec 23.PMID: 38145726 Kostyak JC, McKenzie SE, Naik UP. The Function of ASK1 in Sepsis and Stress-Induced Disorders. Int J Mol Sci. 2023 Dec 22;25(1):213. doi: 10.3390/ijms25010213. PMID: 38203381 Denorme F, Armstrong ND, Stoller ML, Portier I, Tugolukova EA, Tanner RM, Montenont E, Bhatlekar S, Cody M, Rustad JL, Ajanel A, Tolley ND, Murray DC, Boyle JL, Nieman MT, McKenzie SE, Yost CC, Lange LA, Cushman M, Irvin MR, Bray PF, Campbell RA. The predominant PAR4 variant in individuals of African ancestry worsens murine and human stroke outcomes. J Clin Invest. 2023 Jul 20:e169608. doi: 10.1172/ JCI169608. Online ahead of print.

PMID: 37471144 Golla, K., Yasgar, A., Manjuprasanna, V.N., Naik, M.U., Baljinnyam, B., Zakharov, A.V., Jain, S., Rai, G., Jadhav, A., Simeonov,

A., and Naik, U.P. Small-molecule Disruptors of the interaction between calcium- and integrinbinding protein 1 and αIIbβ3 as novel antiplatelet agents. ACS Pharmacol. and Transl. Sci. 2024. In press. DOI assigned to it: 10.1021/ acsptsci.4c00026.

Gautam, D., Naik, U.P., Naik, M.U., Yadav, S. K., Chaurasia, R. N., and Dash, D. Glutamate Receptor Dysregulation and Platelet Glutamate Dynamics in Alzheimer’s and Parkinson’s Diseases: Insights into Current Medications. Biomolecules. 2023.

13(11):1609 PMID: 38002291 Naranjo, N., Testa, A., Yadav, S.K., Naik, U.P., Yu, L., Kelly, K., Liu, Q., Ding, J., Yang, H., Tang, H.Y., Hooper, D.C., Languino. L.R. Prostate Cancer Cell-derived sEVs Regulate Healthy and Prostate Cancer Macrophage Polarization and Functionality via STEAP4.

Nature Communications. 2024 In Press Tucker CM, Rhoades R, Sharma R, Gong JZ. Optimization of laboratory diagnosis of heparininduced thrombocytopenia using HemosIL-AcuStar-HIT-IgG assay.

Laboratory Medicine. 2024; 55(1): 34-39. PMID: 37094798 Rhoades R, McLaughlin C, Kaatz S. (2023). COVID-19 and Pulmonary Embolism: Incidence & Pathophysiology. In: Grodzin, C.J., Merli, G.J., Ross, C.B., Rosovsky, R. (eds). PERT Consortium Handbook of Pulmonary Embolism. New York, NY: Springer, Cham. https:// doi.org/10.1007/978-3-03070904-4_38-1. Accepted for publication July 2023, in press Gulati G, Adcock D, Rhoades R. Interpretation of Results of Routine and Special Coagulation Tests: A Practical Guide. 1st edition. Oxford University Press; 2024. Accepted for publication, in-press Kaur, M., Salvatore, F., van den Broek, B., Aseervatham, J., Rostami, A., Iacovitti, L., Grassi,

C., Lukomska, B., Srivastava, A.K. (2024) Most recent advances and applications of extracellular vesicles in tackling neurological challenges. Medicinal Research Reviews 44(4):1923-1966.

Gomez-Galvez, Y., Gupta, M., Kaur, M., Fusco, S., Podda, M.V., Grassi, C., Srivastava, A.K., Iacovitti, L., Blanco-Suarez, E. (2024) Recovery after human bone marrow mesenchymal stem cells (hBM-MSCs)-derived extracellular vesicles (EVs) treatment in post-MCAO rats requires repeated handling. PLoS One 19 (10): e0312298.

Srivastava, A.K., Welsh, J.A., Goberdhan, D.C., O'Driscoll, L., et al. (2024) Minimal information for studies of extracellular vesicles (MISEV2023): from basic to advanced approaches. Journal of Extracellular Vesicles 13 (2), e12404.

Bedi, S.S., Scott, M.C., Skibber, M.A., Kumar, A., Caplan, H.W., Xue, H., Sequeira, D., Speer, A., Cardenas, F., Gudenkauf, F, Uray, K., Srivastava, A.K., Prossin, A.R., Cox, C.S. (2023) PET imaging of microglia using PBR28suv determines therapeutic efficacy of autologous bone marrow mononuclear cells therapy in traumatic brain injury. Scientific Reports 13:16142.

Zhao L, Thorsheim CL, Suzuki A, Stalker TJ, Min SH, Krishnaswamy S, Cockcroft S, Anderson KE, Weiderhold B, Abrams CS. Individual phosphatidylinositol transfer proteins have distinct functions that do not involve lipid transfer activity. Blood Adv. 7(16):4233-4246. Aug 2023.

Liu Y, Crossen J, Stalker TJ, Diamond SL. Fluorescent peptide for detecting FXIIIa activity and fibrin in whole blood clots under flow. Res Prac Thromb Haemost.

8(1):102291. Dec 2023.

Mansi CD, Severa JR, Wilhelm JN, Marar TT, Roberts ME, Zhao X,

Department of Medicine 2024 Annual Report

30 Stalker TJ. Dual antithrombotic therapy dose-dependently alters hemostatic plug structure and function. J Thromb Haemost.

22(4):1016-1023. Apr 2024.

Teeraratkul C, Tomaiuolo M, Stalker TJ, Mukherjee D. Investigating clot-flow interactions by integrating intravital imaging with in silico modeling for analysis of flow, transport, and hemodynamic forces. Sci Rep. 14(1):696. Jan 2024.

Jones JM, Wool J, Crowe EP, Bloch EM, Pecker LH, Lanzkron S. Longitudinal outcomes of chronically transfused adults with sickle cell disease and a history of childhood stroke. Transfusion.

2024 Nov 5. doi: 10.1111/trf.18041.

Online ahead of print.

Jonassaint CR, Lalama CM, Carroll CP, Badawy SM, Hamm ME, Stinson J, Lalloo C, Saraf SL, Gordeuk VR, Cronin RM, Shah N, Lanzkron S, Liles DK, O'Brien JA, Trimnell C, Bailey L, Lawrence RH, Saint-Jean L, DeBaun MR, De Castro LM, Palermo T, Abebe KZ. Digital Cognitive Behavioral Therapy vs Education for Pain in Adults with Sickle Cell Disease. Blood Adv. 2024 Oct 7:bloodadvances.2024013861. doi: 10.1182/bloodadvances.

2024013861. Online ahead of print.

Lanzkron S, Crook N, Wu J, Hussain S, Curtis RG, Robertson D, Baker JR, Nugent D, Soni A, Roberts JC, Ullman MM, Kanter J, Nichol MB. Costs and impact of disease in adults with sickle cell disease: a pilot study. Blood Adv. 2024 Jul 23;8(14):3629-3638.

Department of Medicine 2024 Annual Report

DIVISION OF HOSPITAL MEDICINE The mission of the Division of Hospital Medicine is “to deliver the highest value clinical care and medical education in a safe learning and working environment that cultivates respect and wellbeing for all patients and team members.”

A robust Hospital Medicine program is essential to the operation of Thomas Jefferson University Hospital, where in fiscal year 2024, we discharged approximately 19% of all inpatients (5,401) and 24% of all observation/short-stay patients (2,238).

The division maintained strong performance metrics in FY24. To achieve annual objectives, the division invested in co-management services, interprofessional care models, faculty development, and innovations in areas such as care for individuals with substance use disorders and improving patient flow and hospital throughput.

The Division's clinical presence grew in FY24 with the addition of four new full-time faculty members and the allocation of one FTE to staff the Jefferson Addiction Multidisciplinary Consult Service (JAMS). In alignment with Central Region capacity management strategies, the division also developed a process to facilitate transfers from the University Hospital to Methodist Hospital, utilizing the Medical Officer of the Day. The division also continues to innovate with regards to clinical team structures and the roles of advanced practice clinicians.

The division places a strong emphasis on staff retention, aiming to foster a positive and supportive work environment where hospital medicine is a sustainable and fulfilling academic career. Both stay and exit interviews are routinely conducted to gain valuable feedback from faculty, ensuring we learn from their experiences and address areas for growth. FY24 saw the launch of a division recognition program to celebrate exceptional contributions, including a monthly peer-to-peer award that honors faculty members who go above and beyond for their teams.

C L I N I C A L PAT H WAYS & Q UA L I T Y Clinical pathways are critical tools in quality improvement, designed to standardize care, reduce variability, and enhance patient outcomes. By leveraging evidence-based practices, they ensure that patients receive consistent, high-quality treatment across diverse medical scenarios.

The development and success of these pathways rely heavily on cross-specialty collaboration, bringing together expertise from various medical disciplines to address complex care needs. This multidisciplinary approach fosters

innovation, promotes teamwork, and aligns care delivery with best practices to improve both efficiency and patient satisfaction.

IN DEVELOPMENT Giant Cell Arteritis: The pathway prioritizes timely diagnosis and treatment by streamlining biopsies and outpatient follow-up to ensure rapid initiation of steroidsparing agents and prompt response to diagnostic results management. The pathway aims to decrease delays in diagnosis, treatment initiation, and timely steroid dose reduction. This work was done in collaboration with Farber NSGY hospitalists,

Ophthalmology, Rheumatology, and Vascular Medicine.

COMPASS: This complex care program aims to identify medically, socially, and behaviorally complex patients who would benefit from continuity of care in the inpatient setting with a goal of decreasing resource utilization and improving patient and provider centered outcomes. Individual care plans are developed for selected patients by a panel of interprofessional experts. Specific SMART goals are identified and measured with iterative change to the care plans.

31

FACU LT Y Rebecca Jaffe, MD Associate Professor Division Director Division Director, Vice Chair, Inpatient Services

Lily Ackermann, MD Clinical Associate Professor Section Lead, Comanagement, Onboarding Lauren Ammerman, MD Clinical Assistant Professor Heather Baran, DO Clinical Instructor Sabrina Barik, MD Clinical Instructor Sonia Bharel, MD Clinical Assistant Professor Dianna Cheney-Peters, MD Clinical Assistant Professor Medicine Sub-Internship Director Clinical Skills Thread Director SKMC Jillian Cooper, MD Clinical Assistant Professor, POCUS Leadership Gretchen Diemer, MD Professor Vice Chair of Education, Department of Medicine Senior Associate Dean for GME Marie DiMattia, DO Clinical Assistant Professor Colin Dunn, MD Clinical Instructor Philip Durney III, MD Clinical Assistant Professor Section Lead, Jefferson Addiction Multidisciplinary Service Assistant Program Director for Addiction Medicine Fellowship Hanna Ellingsen, MD Clinical Assistant Professor Course Director Evidence Based Medicine Jonathan Foster, MD Clinical Instructor Associate Program Director POCUS Fellowship Alexis Gerber, MD Clinical Assistant Professor Section Lead, GI Co-Management Service

Department of Medicine 2024 Annual Report

32 Heart Failure Readmission: Jefferson Health has elected Heart Failure as a focus area for FY25. Division Representatives have joined institutional work groups at Regional and Enterprise levels to support the development and implementation of systemic advances in health failure care.

Initial targets include heart failure ordersets and documentation strategies. Early actions led by the division include attributing a Community Health Worker to identify and mitigate Health Related Social Needs for patients admitted for Heart Failure Exacerbations at TJUH. Lab Utilization: This project aims to decrease routine daily lab testing, promoting evidencebased decision-making to enhance patient care and reduce healthcare costs. Intended impacts include reducing patient discomfort and sleep disruption, while supporting resource stewardship and maintaining high-quality clinical outcomes.

Current interventions include educating providers about appropriate ordering practices with evidence from the Choosing Wisely campaign, implementing electronic health record (EHR) tools to flag redundant orders, and an audit/feedback process at the individual provider level.

COMPLETED Expected Mortality: Historically, the hospital’s patient acuity was underestimated, with a low CMI and expected mortality, prompting targeted interventions. The initiative included collaborating with documentation specialists and coders, refining the physician query process, implementing EHR enhancements to automatically suggest relevant diagnoses, and developing a comorbidity capture tool to facilitate comprehensive documentation. Overall, the

hospital’s expected mortality rate increased from 1.77% to 3.07%, reflecting improved accuracy in assessing patient acuity and severity of illness.

Blood Utilization: The division was charged with developing recommendations to reduce packed red blood cell (PRBC) utilization where clinically appropriate. A workgroup reviewed the hospital’s current transfusion stewardship process compared to available guidelines and evidence, examined metrics, researched blood management guidelines, and performed targeted case review. Suggested interventions included improving the attribution of individual data, excluding cases involving hemodynamic instability or active bleeding from the “multiple unit transfusion” metric, developing an internal guideline for patients with coronary artery disease cases, peer review for transfusions outside guidelines, editing Epic order sets to include more detailed indications, and redefining attribution to include specialists and surgical teams.

MAINTAINING Acute Hip Fracture: Annual goals of this collaborative and multidisciplinary pathway included minimizing transfusions through the integration of a blood management program that includes the use of IV iron and erythropoietin (EPO), supporting institutional Trauma designation through regular peer review of cases with the ER and Trauma teams, and revision of VTE prevention protocols. The program prioritizes preventing and managing complications such as acute kidney injury (AKI), respiratory failure, and delirium through an Enhanced Recovery After Surgery protocol (ERAS). Pathway performance

is reviewed quarterly, and approximately 120 patients are cared for annually.

Renal Transplant: The nephrology transplant program at TJUH continues to rank among the top in the country, with all inpatient posttransplant care after acute surgical management occurring on Hospital Medicine teams.

Building on this foundation, there is ongoing work with the new transplant leadership to improve discharge care coordination, including appropriate immunosuppressant dosing, and time to follow up.

Sickle Cell: Over the past year, our commitment to advancing care for patients with sickle cell disease has been strengthened through new collaborations and initiatives. The Sickle Cell Committee welcomed two new members: Dr. Sophie Lanzkron, Director of the Division of Hematology, and Ashley Lauriello, CRNP, both of whom bring valuable expertise to our multidisciplinary efforts. This collaborative approach aims to improve both patient-centered outcomes and throughput metrics. Key updates include optimizing patient-controlled analgesia protocols, reduction in reliance on intravenous diphenhydramine, and incorporating safer long-acting opioids when clinically needed.

Addiction Medicine: The Jefferson Addiction Multidisciplinary Service Leadership Counsel is a cross departmental collaborative managing initiatives under the Addiction Consult Service and the Steven and Sandra Sheller Bridge Program. TJUH has generously supported expanding staffing for the inpatient consult service allowing the financial and workforce security to expand clinical services to Jefferson Methodist Hospital,

FACU LT Y Samuel Hofacker, MD Clinical Instructor Maura Huffner, MD Clinical Assistant Professor Claire Ketchem, MD Clinical Instructor Joanne Kim, MD Clinical Instructor Alan Kubey, MD Clinical Assistant Professor Section Lead, Continuous Improvement and High Value Care Timothy Kuchera, MD Clinical Assistant Professor Associate Program Director, Internal Medicine Residency Patrick Kukulich, MD Clinical Instructor Natalie Margules, MD Clinical Assistant Professor Section Lead, Active Bed Management Naveed Mohsin, MD Clinical Instructor Rachelle Nelson, MD Clinical Assistant Professor Medical Director, COMPASS Complex Care Program Nimesh Patel, MD Clinical Instructor Lakshmi Ravindran, MD Clinical Assistant Professor Jeffrey Riggio, MD Professor Associate CMIO Marcel Robles, MD Clinical Instructor Seema Singh, MD Clinical Assistant Professor John Stewart, MD Clinical Assistant Professor Section Lead, Gold medicine Luis Taboada, MD Clinical Assistant Professor Jennifer Valentine, MD Clinical Assistant Professor Associate Program Director, Internal Medicine Residency JeffMD Phase 3 Medicine Pathway Director, Sidney Kimmel Medical College Rebecca Vento, MD Clinical Assistant Professor Section Lead, Night Medicine Jenny Wang, MD Assistant Professor Section Lead, Peer review, CDI Improvement

Department of Medicine 2024 Annual Report

33 and to invest heavily in medical education, clinical operations, and community engagement.

Multiple impactful initiatives are arising from this work, including an educational strategy involving cross specialty rotations and a Health System Wide OUD Echo; a pipeline for HCV and HIV treatment; and novel withdrawal management protocols informing regional and national approaches to care to name a few.

physician, along with highyield ICU step-up and mortality cases. From this screening or from referred cases, 2–4 cases are selected each month for discussion during divisional Peer Review Committee meetings. To promote a culture of safety and inclusivity, all practitioners are part of the Peer Review Committee, with all attendings both leading and undergoing review.

Other: We continue to maintain pathways to facilitate efficient care for IR interventions needing overnight observation, Chronic Regional Pain Syndrome, and ED access for hemodialysis.

The division is also committed to ongoing improvements in our interprofessional bedside rounding process, plan of care rounds, and collaboration on multiple institutional committees including HAPI, CAUTI, Sepsis, Delirium prevention, Age friendly care, VTE prevention and others.

Over the past year, we have maintained stability in our peer review structure while further developing a non-conference pathway. This pathway is now routinely used for reviewing HACs, PSIs, infection control fallouts, and standard mortality reviews. Given our expanded clinician team, the peer review conference has increasingly focused on clinical opportunity discussions, de-emphasizing documentation peer review given the group’s consistently strong performance in this area.

PAT I E N T S A F E T Y

Our enterprise has retired its prior online peer review system, and we are currently participating in the design of a new system. In the interim, a temporary peer review system was developed and implemented with the approval of the CMO, chair, division director, and legal team, ensuring continuity of our processes without significant impact on the division. This temporary system is functioning well and supports our ongoing efforts.

Hospital Medicine continues to partner on many interprofessional safety committees focusing on prevention of hospital acquired conditions and optimizing emergency systems. In FY24, we included engagement in event reporting in the faculty incentive, aligning with priorities defined by the Enterprise OnPoint Program. As a result, 254 safety events were reported by Hospital Medicine with another 88 from Medicine residents.

Peer Review: Peer review remains a cornerstone of our division’s safety work, fostering quality, accountability, and continuous improvement in patient care through a structured, casebased review process. All mortalities and patient safety indicator (PSI) cases are screened monthly by our peer review

O P E R AT I O N S & THROUGHPUT Medical Officer of the Day (MOD) & TJUH/JMH Transfers: The MOD assigns any patient admitted or transferred to the Department of Medicine to one of 22 teams, providing critical capacity management and patient flow services to the

Department and to TJUH Inc. In June 2023, after a 9-month process design engagement, the MOD assumed responsibility for selecting patients for transfer to Methodist Hospital Medicine services and facilitating communication between sending and receiving teams.

Over the course of FY24, TJUH successfully transferred 1,460 patients to Methodist, a notable increase from the prior year’s 948 transfers. By alleviating patient volume in the Center City Emergency Department, this MOD-driven process directly contributes to reducing ED crowding, thereby improving access to timely care for incoming patients and enhancing patient throughput. To further refine and optimize the transfer process, a Temporary Action Group (TAG) was initiated, bringing together key stakeholders from hospital medicine, the ED, nursing, and administration. This collaborative team is focused on identifying and addressing barriers to efficient patient transfers, standardizing transfer protocols, and ensuring continuity of care throughout the transition.

Through this coordinated effort, TJUH is building a more resilient and responsive healthcare network across the central region.

Billing Improvements: Throughout FY24, Hospital Medicine conducted several physician-to-physician billing and coding education sessions in collaboration with billing, coding, and revenue cycle teams. These sessions aimed to train physicians in appropriately determining billing levels for initial and subsequent visits and to deepen their understanding of the billing process as it applies to hospital medicine. The data shows that Hospital Medicine continues to perform at or above industry benchmarks for

FACU LT Y Alexis Wickersham, MD Clinical Associate Professor Assistant Program Director, QI and Wellbeing Vice Chair for Wellbeing, Department of Medicine Lim Wong, MD Clinical Assistant Professor Medicine Pathway Gateway Lead Facilitator Alyssa Yeager, MD Clinical Assistant Professor Jillian Zavodnick, MD Associate Professor Medicine Clerkship Director Associate Program Director, Internal Medicine Residency

Department of Medicine 2024 Annual Report

34 billing at appropriately high levels of service for both initial and subsequent visits, resulting in additional net revenue.

Importantly, these skills are ineffectively taught during residency training. Thus, it is critical to incorporate specialty specific education in the early years of practice.

CO L L A B O R AT I V E P R AC T I C E In FY24, the division hired and oriented six staff Advanced Practice Clinicians (APCs) and one per diem APC, utilizing a standardized 6-week onboarding process to support seamless integration into the team. This year’s priorities included expanding educational opportunities, procedural training, and clinical skill-building tailored to hospital medicine. Procedural training on Dobhoff feeding tube placement using CoreTrak and ultrasound guided IV training, supported by previous and current POCUS fellows, was continued in order to enhance procedural autonomy and reduce reliance on housestaff.

To further support professional growth, the division implemented an APC peer mentoring program, assigning mentors to new staff, with plans for expansion in FY25 to include feedback methods and needs assessments. The division aims to support education for APCS in school by providing on-site training to NPs and PAs placed on our non-resident teams. Six nurse practitioner students completed their clinical rotations (totaling 224 hours) with our team. This year also marked the launch of a monthly clinical lecture series focused on hospitalbased practice topics, reinforcing our commitment to continuous learning and excellence in patient care.

E D U C AT I O N Hospital medicine faculty play critical roles in all levels of medical education at SKMC. Several faculty also participate in interprofessional education programs, through the Jefferson Center of Interprofessional Practice and Education, and the Jefferson College of Health Professions.

UME: The Division of Hospital Medicine plays a key role in the education of medical students.

Members of the Division with formal educational roles oversee and evaluate all the required and elective rotations within the Department of Medicine and counsel all students pursuing internal medicine residency, with all Structured Letters of Evaluation (required for IM residency applicants) written by division faculty. In FY24, a record 121 SELs were written: 68 for students applying to internal medicine and 53 for those applying to preliminary programs.

In addition, the majority of near-daily lectures for clerkship students are delivered by faculty members from the division. In FY24, the division welcomed 124 third-year medical students to its teaching services as part of the medicine clerkship, and an additional 60 fourth-year students for their medicine subinternship. The popularity of the hospital medicine rotation has resulted in all students now being assigned for a two-week period, effectively doubling the number of learners annually. In a new endeavor division nocturnists provided valuable hands-on education for sub-interns, allowing them to participate in cross-coverage, respond to rapid response teams (RRTs) and codes, and manage patient admissions.

In addition, whenever students face challenges during their clinical rotations in Medicine,

remediation takes place on a hospital medicine service given standards for high-quality instruction, faculty dedication to personalized learning plans, and comprehensive feedback for students.

GME: Six hospitalists were recognized as top 25 teachers by the IM residency program at the graduation ceremony in June 2024. There are four associate program directors in the division, demonstrating a strong commitment to leadership in resident education.

APDs are responsible for such critical areas as recruitment, remediation, wellbeing, quality/ safety education, and two areas of focused study in medical education and hospital medicine careers. Several faculty are also actively involved in meded research and curriculum development within the GME program. These include a focus on the transition of trainees to independent practice; quality and safety education; and the night educational experience.

As one example of division success, the transition to practice project boasted two AAMC innovation grants including one in the emerging field of precision education, and has been presented nationally through workshops, podium presentations, and peer reviewed manuscripts.

Fellowship: In FY24 we maintained the Point Of Care UltraSound fellowship in partnership with Emergency Medicine, Pulmonary Critical Care, and General Internal Medicine. We transitioned the Program Director position to Hospital Medicine and continue to have two fellows annually. We have a high rate of hiring fellows to full employment, and those not hired have become local leaders in developing and implementing POCUS curricula in other health systems.

Faculty Development: Hospital Medicine regularly recruits new physicians directly out of residency, many of whom are both new attendings and new employees at Jefferson. To better support these early-career faculty members, the division runs a robust orientation and onboarding program. We continue to manage a “buddy system” for new hires, and a longitudinal onboarding program called “minischool.” For first- and second-year faculty, we have expanded guidance on academic promotion and created a directory of opportunities to collaborate with clinical, education, and operations leaders within the division.

These resources are designed to help early faculty engage in projects that will support future scholarships. Recognizing the importance of developing an area of interest early, we introduced a “speed mentoring” event to connect new faculty with division leaders in clinical care, operations, education, and quality improvement. Onboarding has also been expanded to include shadowing division leaders within each clinical service team, offering new physicians a deeper understanding of division operations and leadership roles.

These initiatives aim to foster professional growth and ensure a successful transition into academic medicine at Jefferson.

In FY24 the division launched its own CME granting grand rounds series, which extends to other regional hospital medicine groups.

This infrastructure provides the opportunity for departmental colleagues to give local CME granting lectures, for our own faculty to develop talks, and for a speaker exchange with other institutions. We also piloted a visiting professor program, inviting a leader in Hospital Medicine research to spend a day and a half meeting with small groups of our faculty and learners for

Department of Medicine 2024 Annual Report

35 the purpose of networking and mentoring.

R E S E A RC H & S E L EC T P U B L I C AT I O N S Faculty members in the division conducted research and published/presented over 30 original works in medical education, quality improvement, and patient safety. Representative national publications and presentations are included in Select Publications.

Ackermann LL, Schwenk ES, Li CJ, Vaile JR, Weitz H. The effects of a multidisciplinary pathway for perioperative management of patients with hip fracture. Hosp Pract (1995).

2023 Oct;51(4):233-239. doi: 10.1080/21548331.2023.2274307.

Epub 2023 Nov 16. PMID: 37927222.

Bann M, Meo N, Lopez JP, Ou A, Rosenthal M, Khawaja H, Goodman LA, Barone M, Coleman B, High HJ, Overbeek L, Shelbourn P, VerMaas L, Baughman A, Sekaran A, Cyrus R, O'Dorisio N, Beatty L, LoicaMersa S, Kubey A, Jaffe R, Vokoun C, Koom-Dadzie K, Graves K, Tuck M, Helgerson P. Medically ready for discharge: A multisite "point-in-time" assessment of hospitalized patients. J Hosp Med. 2023 Sep;18(9):795-802. doi: 10.1002/ jhm.13184. Epub 2023 Aug 8.

PMID: 37553979.

Benau EM, Zavodnick JH, Jaffe RC. Initial evidence of reliability and validity of an implicit association test assessing attitudes toward individuals who use substances. The American Journal of Drug and Alcohol Abuse. 2024;50(1):64–74. https:// doi.org/10.1080/00952990.202 3.2300398

Bharel S, McGillen B, Salas R, Pandya DS. Health Systems Science Integration in Graduate Medical Education: A Pathway to Quintuple Aim Success for Independent Practice. Am J Med. 2024 Jul;137(7):677-681. doi: 10.1016/j.amjmed.2024.04.008.

Epub 2024 Apr 12. PMID: 38614273.

Brandon W, Dunn C, Bollineni S, Joerns J, Lawrence A, Mohanka M, Timofte I, Torres F, Kaza V. Management of donorspecific antibodies in lung transplantation. Front. Transplant.

2023;2:1248284. doi: 10.3389/ frtra.2023.1248284 Cheney-Peters D, Liveright E, Shusted C, Sinnott JF, Diemer G, Jaffe R. A Learning Community Supporting Experiential Education to Learn About Healthcare Equity Quality Improvement. J Gen Intern Med. 2023 Oct;38(13):30603064. doi: 10.1007/s11606023-08314-0. Epub 2023 Jul 24. PMID: 37488367; PMCID: PMC10593695.

Mrani AJ, Kuchera T, Strohl A, Laoteppitaks C, Flomenberg P, Phillips L. Stingray Impalement and Envenomation: Local Envenoming Causing Necrosis and Sepsis.

Wilderness Environ Med. 2024 Mar;35(1):108-112. doi: 10.1177/10806032231223326.

Epub 2024 Jan 22. PMID: 38379482.

Perkons M, Wickersham A, Bharel S, Kuchera T, Jaffe R. Early Immersion in Team-Based Event Review: Experiential Patient Safety Education for PGY 1 Internal Medicine Residents.

MedEdPORTAL. 2024;20:11376. https://doi.org/10.15766/ mep_2374-8265.11376

Department of Medicine 2024 Annual Report

36

Department of Medicine

DIVISION OF INFECTIOUS DISEASES AND ENVIRONMENTAL MEDICINE The Division of Infectious Diseases is comprised of a core of clinical faculty who provide consultative expertise across the spectrum of infections and syndromes managed within the Thomas Jefferson University system. Members of the Division provide all ID consultative activities at Thomas Jefferson University Hospital, Jefferson Hospital for Neurosciences, Methodist Hospital, and Wills Eye Hospital. In addition, comprehensive HIV care services are provided by a Ryan White Care Act-supported outpatient program. The Division has established and continues to develop a group of core programs, both clinical and non-clinical, that form a blueprint for future direction (see attached, “ID Division Programs”).

Infectious Diseases Division Programs CLINICAL Clinical Center City

All

Methodist

Royer*, Hancock (Almost all faculty)

Solid Organ Transplant ID Program

Belden*, Coppock, Royer, Moss, Tucker, Flomenberg

HIV/AIDS

Coppock*, Braden, DeSimone, Green, Livinsky, Support staff

Bone Marrow Transplant ID Program

Flomenberg*, Moss

OPAT

Brugger & Taupin*, Carr, Phillips, Livinsky

APP

Brugger*, Carr, Green, Hancock, Livinsky

Orthopedic Infections

Belden*, Brugger, Carr, Gancher, Hess, Kramer, Taupin, Zurlo

Lankenau

Gilbert**

NTM

Tucker*, Novick, Livinsky, Zurlo

SUD

Kramer*, Novick, Seval, Taupin, Tucker, Zurlo

NON-CLINICAL Fellowship Program

Weber*, Novick

Education

Moss*, Weber, Kramer, Tucker, Novick

Infection Control

Flomenberg*, Gancher, Hess

Antimicrobial Stewardship

Hess*, Gancher, Braden

Research

Flomenberg*, Coppock, Belden,

ID Interest Group

Coppock*, Weber, DeSimone, Novick

Drexel Collaboration

Zurlo*, Gancher, Seval, Coppock

Patient Safety/Quality

Taupin*

TJUH ID P&T Subcommittee

Hess*, Belden, Flomenberg, Gancher, Royer, Tucker, Zurlo

Pandemic Preparedness

Zurlo*, Flomenberg, Gancher, Hess, Taupin

*Signifies Lead

**Lankenau Faculty

2024 Annual Report

37

FACU LT Y John Zurlo, MD Professor of Medicine The W. Paul and Ida Havens Professorship of Infectious Diseases Director, Division of Infectious Diseases Clinical Advisor of Pandemic Preparedness for the Jefferson Enterprise

Katherine Belden, MD Associate Professor of Medicine Director, Solid Organ Transplant ID Program Dagan Coppock, MD Associate Professor of Medicine Assistant Director, Solid Organ Transplant ID Program Director, HIV/AIDS Program Joseph A. DeSimone, MD Professor of Medicine Phyllis R. Flomenberg, MD Professor of Medicine Infection Control Officer, Jefferson University Hospitals Elizabeth Gancher, MD Clinical Assistant Professor of Medicine Associate Medical Director, Antimicrobial Stewardship Program Bryan D. Hess, MD Clinical Associate Professor of Medicine Director, Antimicrobial Stewardship Program Carolyn Kramer, MD Clinical Assistant Professor of Medicine Thread-Director, Medical School Curriculum Sean Moss, MD Clinical Assistant Professor of Medicine Associate Director, Solid Organ Transplant ID Program Elizabeth Novick, MD Clinical Assistant Professor of Medicine Associate Program Director, Infectious Diseases Fellowship Training Program

Department of Medicine 2024 Annual Report

38 CLINICAL Sixteen clinical faculty members provide consultative support to the medical staff of Jefferson University Hospital, Jefferson Hospital for Neurosciences, Methodist Hospital, and Wills Eye Hospital and/or specialty care of patients with HIV/AIDS. One of these faculty members worked on a part-time basis (Dr. Nikhil Seval). Dr. Seval is a faculty member at the Drexel HIV Partnership where 90% of his job description involves outpatient HIV care. He is hired by the Jefferson ID division for the remaining 10% of his effort in which he provides inpatient infectious disease consultations for the population of patients with infections related to substance use disorder (SUD).

Dr. Dagan Coppock remains in the leadership role for the HIV/ AIDS program at Jefferson. Dr. Elizabeth Braden is our newest faculty member who started with the division in July 2023. She was an Internal Medicine resident here at Jefferson who then completed her fellowship training in infectious diseases at George Washington University Hospital in Washington, DC. Her principal interests lie in HIV care, and she has assumed a clinical role in the HIV program at Jefferson as well as providing inpatient consultative patient care. She also works as part of our Antimicrobial Stewardship team.

A total of five APPs work in the Division, led by Ms. Caroline Clark Brugger as Lead APP. Ms. Brugger and Ms. Carr, along with a dedicated nurse, Tom Phillips, manage a large number of patients receiving outpatient parenteral antimicrobial therapy (OPAT), averaging around 100 patients at any given time, the majority being those with orthopedic-related infections

including prosthetic joint infections and osteomyelitis.

Mr. Livinsky manages OPAT for a select group of patients with non-tuberculous mycobacterial (NTM) infections (see below). The physician lead for OPAT is Dr. Daniel Taupin. OPAT patients are typically seen first as inpatients and transitioned to the outpatient setting with a formalized handoff structure that is seamless. The team follows weekly laboratory results for each patient watching for antibiotic-associated toxicities and serves as the principal contact for patients, their families, and outpatient pharmacies and visiting nurses who serve these patients.

Ms. Sarah Green is a CRNP who works full-time in our HIV/AIDS program. Ms. Molly Hancock is a PA who works exclusively at Methodist Hospital working on our inpatient infectious diseases consult service. Mr. Ross Livinsky is a PA who was hired to assist in our pandemic management program. He worked closely with the group arranging monoclonal antibody infusions during COVID and directed testing and treatment for MPox for the Jefferson Enterprise. He continues in a standby role for future pandemics as he has transitioned to work in the HIV/AIDS program and in our (NTM) program.

The Division has seen a continued increase in requests for inpatient consultations which has, in turn, driven RVU generation.

The number of new consults increased in FY 24 to 5,886, up from 5,761 in FY 23 (see “New Inpatient Consults 2020-2024”).

RVU generation has increased dramatically from 43,969 in FY 20 to 64,723 in FY24 (see “RVU Generation 2020-2024”).

H I V/A I D S P R O G R A M The Division provides outpatient treatment for a variety of infectious diseases, including HIV/AIDS. The HIV/AIDS program receives grants awarded through the City of Philadelphia Department of Public Health and the Department of Health and Human Services (Ryan White Care Act) to provide HIV medical care, case management, and outreach for the entire HIV patient population along with gynecological care for female patients. Comprehensive HIV care is offered to all patients presenting to the Jefferson program regardless of their insurance status. Dr. Dagan Coppock is the Program Director and Dr. Elizabeth Braden has taken a role as Associate Director for the program.

N E W I N PAT I E N T CO N S U LT S 2 0 2 0 –2 0 24

5,987 5,761

5,673

5,886

5,137

2020

2021

2022

2023

2024

Major bump in 2022, likely due to COVID with an otherwise continued upward slope since 2021.

FACU LT Y Tricia Royer, DO Clinical Assistant Professor of Medicine Associate Director, Solid Organ Transplant ID Program Vice Division Chief at Methodist Hospital Nikhil Seval, MD Adjunct Assistant Professor of Medicine Adjunct Faculty from Drexel University Daniel Taupin, MD Clinical Assistant Professor of Medicine Director of Quality/Safety for the Division Mollie Tucker, MD Clinical Assistant Professor of Medicine Associate Director, Solid Organ Transplant ID Program Mudit Tyagi, PhD, PGDBT Associate Professor of Immunology Center for Translational Medicine Devin Weber, MD Clinical Assistant Professor of Medicine Program Director, Infectious Diseases Fellowship Training Program

ADVAN CED PRACTICE PROV IDERS Caroline Clark Brugger, CRNP Lead APP for the Division Rachel Carr, PA TJUH inpatient services and OPAT Program Sarah Green, CRNP HIV/AIDS Program Molly Hancock, PA Methodist inpatient service Ross Livinsky, PA Pandemic-related activities and OPAT management

Department of Medicine 2024 Annual Report

39 RV U G E N E R AT I O N 2 0 2 0 –2 0 24

62,313 49,923

64,723

52,918

43,969

2020

2021

2022

We continue our relationship with the Drexel HIV Partnership clinic located several blocks from Jefferson. As part of this relationship, we share faculty, create links for the Partnership HIV patients to our inpatient and outpatient specialty services, offer our ID trainees an excellent teaching site for their continuity clinics, and develop collaborative research opportunities. Dr. Seval was hired by the Partnership to provide management of HIV patients. He serves as a mentor for two ID fellows who see patients in their continuity clinics at the Drexel Partnership.

O U T PAT I E N T P R AC T I C E We moved our outpatient site to the Honickman Center beginning in April 2024.

Previously we saw ID outpatients in two locations, 1015 Chestnut St. (non-HIV patients) and 33 S. 9th St. (HIV patients). Our two practices are now combined into one clinic site on the 11th floor of the Honickman Center.

It has been a long-term goal to bring all our ID outpatients to one outpatient location.

2023

2024

A D M I N I S T R AT I V E Infectious Diseases Division faculty members staff hospital positions at Jefferson University Hospital and Methodist Hospital as Infection Control Officers (Dr. Phyllis Flomenberg) and at Magee Rehab Hospital (Dr. Elizabeth Gancher) and for Antibiotic Stewardship. Dr. Bryan Hess directs the Enterprise Antimicrobial Stewardship Council focused on aligning guidelines, policies, and formularies among all Jefferson Enterprise Hospitals and directs Antimicrobial Stewardship at the Center City hospitals along with Drs. Elizabeth Gancher and Elizabeth Braden in conjunction with the TJUH Pharmacy Department. The Antimicrobial Stewardship Program received the prestigious recognition as a Center of Excellence by the Infectious Diseases Society of America (IDSA).

E D U C AT I O N The wide array of clinical problems seen by infectious disease specialists at Thomas Jefferson and Methodist

Hospitals provides an outstanding environment for training medical students, house staff, and clinical fellows. Students, residents, and clinical fellows are provided education in infectious diseases care primarily on a dedicated teaching service. The infectious diseases elective remains one of the most popular among 4th-year medical students. A major project was completed to create a more formalized structure to the 4th year elective to include an orientation welcome pack, a series of lectures on key infectious diseases topics, and basics of clinical microbiology.

The division recently expanded the ID elective offerings for 4th year medical students effectively doubling the available slots. We now have students rotating with us on four of our consultation services for two, 2-week blocks.

Dr. Carolyn Kramer continues in her role as thread leader for the medical school Microbiology/ Immunology block.

I N F EC T I O U S D I S E A S E S F E L LOW S H I P P R O G R A M The Division continues to sponsor a training program for infectious disease physician trainees. The training program comprises all aspects of infectious diseases and venues that include the inpatient teaching service, other specialty inpatient services (e.g., transplant-related infections, surgical infections, etc.), outpatient services (e.g., HIV, sexually transmitted infections, etc.), and conferences that include core curriculum, journal club, and guidelines review. With the generous donation from the Havens family, the program added an additional infectious diseases trainee in July 2022. We sought further funding and added another position beginning in July 2023 now increasing our total fellow complement to six.

Despite a waning interest in careers in ID as evidenced by a continued fall in the number of applicants to fellowship positions nationally, we fared exceptionally well in the fellow match for positions starting in July 2023. We ranked nearly 40 candidates and matched our three positions, all in the top 15 of our choices. We have made changes to the program: • We have created a pandemic preparedness teaching module for ID fellows and for infection preventionists.

• We have expanded our continuity care clinic opportunities to include the Drexel HIV/AIDS Partnership.

Two of our fellows began their continuity clinics there beginning July 2023.

• We have added a minimum of 4 weeks of inpatient clinical training on our SUD inpatient consult service.

We also have added an SUD track to our program for interested trainees for 2024.

• We have created a transplant concentration for interested fellows.

One of our fellows who graduated from the program in 2023 has completed this concentration and is now at Vanderbilt University where she is developing a career in transplant infectious diseases.

• We have created a medical education concentration for fellows interested in developing careers in academic medicine.

• We offer a combined, 3-year ID-critical care medicine training for fellows who are qualified and interested in this career pathway.

Department of Medicine 2024 Annual Report

40 R E S E A RC H The Jefferson ID Division has long been known for its clinical and educational strengths and expertise. While research has been part of our mission/ we have continued to develop our research portfolio. Multiple faculty members were successful in submitting manuscripts for publication. Our output of published works has expanded on a yearly basis. In addition, we are moving ahead with participation in multi-centered clinical trials focusing on transplant infections and HIV. Drs. Belden, Coppock, and Flomenberg now lead a team focused on research for the Division. They maintain a catalogue of research projects for our program trainees, as well as medical residents and students who are considering careers in infectious diseases or who simply want to be involved in clinical research. As a division, we have also reached out to develop collaborations with units at Jefferson including Clinical Microbiology and ID Pharmacy and units outside Jefferson, most notably at the Drexel HIV/AIDS Partnership. Our ultimate goals are to focus our research efforts on selected major topics including HIV/AIDS, transplant-related infections, orthopedic infections, NTM infections and substance use disorder. In that regard we have submitted our first NIH grant application in many years, a collaboration with Drexel, to study xylazine-related ulcers in our injection drug use population. We hope to hear back in late 2024 for a potential April 2025 start.

Q UA L I T Y I N I T I AT I V E S The Division’s quality initiatives center around our major hospital programs that are managed by the Division, namely Infection Control

and Prevention (led by Dr. Phyllis Flomenberg) and Antimicrobial Stewardship (led by Dr. Bryan Hess). Institution-wide quality projects have included C. difficile infection, central line associate bloodstream infections, and improved antibiotic utilization.

Our HIV/AIDS program has created a comprehensive set of quality measures and quality initiatives that have performed well in comparison with other programs in the City of Philadelphia. Dr. Daniel Taupin who joined our division in 2022 has taken a divisional and departmental lead in quality initiatives as part of his job responsibilities. He was recently selected to be Vice Chair of Quality and Safety for the Department of Medicine. He has introduced more formalized training in patient safety and quality to the fellowship. He also has introduced regular M&M presentations for our weekly clinical conference, the first time ever for the division.

NEW AND ONGOING I N I T I AT I V E S A N D FUTURE PL ANS Substance Use Disorder (SUD). To help meet the growing problem of patients admitted with complications of SUD, most particularly those who inject, we staff a seventh infectious diseases consult service focused on this patient group. Serious infections are a major reason for hospitalization for these patients.

Our initiative fits in with institutional efforts on multiple fronts to address this problem. We actively coordinate care with the various services including hospitalists, psychiatry, pain medicine, and our Jefferson Addiction Multispecialty Service (JAMS). We are pursuing research projects for this patient population.

Non-Tuberculous Mycobacteria (NTM). We have worked in setting

up a multi-specialty program focusing on patients with nontuberculous mycobacterial lung infections. This is a collaboration that includes the Division of Pulmonary and Critical Care Medicine, Clinical Microbiology, and Infectious Diseases that enhances our existing collaboration with National Jewish Health in Denver, CO which is a world leader in this and many other lung related diseases. For the ID Division, one of our faculty members, Dr. Mollie Tucker, leads this effort with assistance from Drs. Elizabeth Novick, John Zurlo, and Mr. Livinsky.

Solid Organ Transplant. Our Solid Organ Transplant ID Program includes five key faculty members led by Dr. Katherine Belden. All five have had specialized training and experience in transplant ID and have worked closely with the various transplant teams at Jefferson to provide expert consultation both in the preand post-transplant settings.

The team has been preparing for the initiation of lung transplants at Jefferson and has created a set of guidelines for infection management for this complex group of patients. We expect the first lung transplant to occur sometime in FY 25.

Drexel Collaboration. We have established a collaboration with the Drexel HIV Partnership.

We share faculty at each location. Two of our ID fellows have their continuity clinics at the Partnership. We look forward to developing further collaborations on the research front.

Methodist Hospital. Dr. Tricia Royer continues in the role of Vice Division Chief at Methodist Hospital. She works closely with our PA (Molly Hancock) and the medical staff to meet the increasing demands for ID support.

Pandemic Preparedness.

Dr. John Zurlo along with Ms. Kelly Zabriskie (Jefferson Enterprise VP for Infection Control and Prevention) have been tasked to develop a pandemic prevention plan for the Jefferson Enterprise. A total of 20 units/divisions have been identified in the Enterprise that were involved in our COVID response and would be expected to again be involved with any future pandemics.

Citywide Conference. The Division continues to serve as host for the monthly Philadelphia region Citywide ID Conference.

S E L EC T D I V I S I O N P U B L I C AT I O N S (2 0 2 3-24) Belden K, Schultz J, Yeager L, Coppock D. Nirmatrelvir-ritonavir in solid organ transplant patients with COVID-19. Transplant Infectious Diseases. 2023 Feb 27;e14037.

Belden KA, Yeager S, Schulte J, Cantarin MPM, Moss S, Royer T, Coppock D. Saving lives with nirmatrelvir/ritonavir one transplant patient at a time. Transpl Infect Dis. 2023 Apr;25(2):e14037. doi: 10.1111/ tid.14037. Epub 2023 Feb 27. PMID: 36847419.

Chen R, Vaughan A, Cox R, Alfosi S, Belden KA, Namdari, S. Shoulder Periprosthetic Joint Infection is Associated with Increased Mortality. J Shoulder Elbow Surg.

2023 Feb 18;S1058-2746(23)00089 Cox AL, Tsang D, Spacek LA, Daskalakis C, Coppock D. The impact of telemedicine on human immunodeficiency virus (HIV)related clinical outcomes during the COVID-19 pandemic. AIDS Behav. 2024 Jul;28(7):2438-2443. doi: 10.1007/s10461-024-04342-x.

Epub 2024 Apr 25.PMID: 38662279 Gould CV, Free RJ, Bhatnagar J, Soto RA, Royer TL, Maley WR,

Department of Medicine 2024 Annual Report

41 Moss S, et. al. Yellow Fever Vaccine Virus Transplant and Transfusion Investigation Team. Transmission of yellow fever vaccine virus through blood transfusion and organ transplantation in the USA in 2021: report of an investigation.

Lancet Microbe. 2023 Aug 3:S2666‑5247(23)00170-2. doi: 10.1016/S2666-5247(23)00170‑2.

Epub ahead of print. PMID: 37544313.

Gould CV, Free RJ, Bhatnagar J, Soto RA, Royer TL, Maley WR, Moss S, et.al. Transmission of yellow fever vaccine virus through blood transfusion and organ transplantation in the USA in 2021: report of an investigation. Lancet Microbe 2023 Sep;4(9):e711-721 doi: 10.1016/S26665247(23)00170-2. Epub 2023 Aug 3.PMID: 37544313 (Nominated for the CDC's prestigious Charles C. Shepard Science Award) Haddad S, Zurlo J, Wang Z, RichardsB, Badjatia N, Coppock D. Genetic sequencing of breakthrough SARS-CoV-2 infections in fully vaccinated healthcare workers. Infectious Diseases in Clinical Practice.

31(1):e1202, January 2023.

Hamiter M, Amorosa V, Belden K, Gidley PW, Mohan S, Perry B, Kim AH. Skull base osteomyelitis: historical perspectives, diagnosis and management update.

Otolaryngol Clin North Am. 2023 Jul 19: online ahead of print Kramer TS, Soriano A, Tedeschi S, Chen AF, Tattevin P, Senneville E, Gomez-Junyent J, Birlutiu V, Petersdorf S, de Brito VD, Gonzalez IS, Belden KA, et. al.

Should we use rifampicin in periprosthetic joint infections caused by Staphylococci when the implant has been exchanged? A multicenter observational cohort study.

Open Forum Infect Dis. 2024 Feb 8;11(3):ofae075. doi: 10.1093/ ofid/ofae075. eCollection 2024 Mar.PMID: 38516383

Larnard J, Swords K, Taupin D, Padival S. From sea to shining IV: the current state of OPAT in the United States.

Therapeutic Advances in Infectious Disease. 2023 Jun 19;10:20499361231181486.

Luterbach CL, Chen L, Novick E, et al. Transmission of CarbapenemResistant Klebsiella pneumoniae in US Hospitals. Clin Infect Dis. 2023 January, Volume 76, Issue 2, pages 229-237. doi: 10.1093/cid/ciac791.

Morton AB, Boyle E, Pettengill MA, Gancher E. The Brief Case: Strictly Anaerobic and Staining Acid Fast. J Clin Microbiol. 2023 May 23;61(5):e0015022. doi: 10.1128/ jcm.00150-22. Epub 2023 May 23. PMID: 37219093; PMCID: PMC10204630.

Seval N, Nunez J, Roth P, Schade MA, Strong M, Frank CA, Litwin AH, Levin FR, Brady KT, Nunes EV, SpringerSA. Inpatient Low Dose Transitions from Full Agonist Opioids Including Methadone onto Long-Acting Depot Buprenorphine: Case Series from a Multicenter Clinical Trial. J Addict Med. 2023 Jan 26. doi: 10.1097/ ADM.0000000000001136. PMID: 36701748 Tran C, Hargy J, Hess B, Pettengill M. Estimated Impact of Low Isolate Numbers on the Reliability of Cumulative Antibiogram Data.

Microbiology Spectrum 2023: e03939-22 Yost CC, Jimenez DC, Weber MP, Maynes EJ, Belden KA, Tchantchaleishvili V, Massy HT, Sass DA, Rame JE, Zurlo JJ, Aburjania N. Hepatitis B in heart transplant donors and recipients: A systematic review and meta-analysis. J Surg Res 2023;283, 1078-1090 doi. org/10.1016/j.jss.2022.10.078

Department of Medicine 2024 Annual Report

DIVISION OF INTERNAL MEDICINE

43

FACU LT Y

The Division of Internal Medicine is home to over forty physicians who work in partnership with advance practice providers and other team members to provide comprehensive primary care and serve as educators and leaders across Jefferson with a focus on patient care, education, and scholarship.

PAT I E N T C A R E The Division of Internal Medicine is dedicated to providing highquality, patient-centered primary care to a diverse population throughout the greater Philadelphia region. In FY24, the Internal Medicine Division cared for patients with 101,186 visits across their ten clinical practices in Center City, South Philadelphia, Bala Cynwyd, and Havertown. The commitment to patient care among faculty in the Division is reflected by the 17 "Top Doc" awards received by faculty from Philadelphia Magazine. The Division's strength is comprehensive adult primary care, supported by a robust infrastructure and a culture of continuous improvement.

Highlights of the Division’s patient care programs include: • Quality Improvement Leadership: The Division of Internal Medicine leads primary care quality improvement initiatives and collaborates with the enterprise-wide Population Health team to achieve quality goals in preventive care and chronic disease management.

• Comprehensive Weight Management: Dr. Janine Kyrillos directs the Jefferson Comprehensive Weight Management program.

This interprofessional team provides comprehensive medical weight management for patients across the Jefferson enterprise.

• Point of Care Ultrasound (POCUS) Innovation: Jefferson is a national leader in outpatient POCUS training, including one of the few Department of Medicinerun POCUS fellowships. Dr. Rebecca Davis leads the Division's POCUS program, collaborating with Dr. Barry Ziring (Internal Medicine) and faculty across Jefferson.

• Specialized Population Health Expertise: Division faculty possess specialized expertise in caring for key populations, including individuals with sickle cell disease (Dr. David Axelrod), people living with disabilities (Dr. Michael Stillman), and those seeking genderaffirming care (Dr. Sean Hurt).

• Women's Health Expertise: The Women's Primary and Specialty Care practice in the Division of Internal Medicine offers comprehensive women's health services including specialized expertise in polycystic ovary syndrome (Dr. Katherine Sherif) and coordination with specialists with expertise in women’s health (Dr. Shailaja Nair).

Rhea Powell, MD Associate Professor Division Director

E D U C AT I O N The Division of Internal Medicine demonstrates a strong commitment to medical education, with faculty members actively participating in the training of medical students and residents at all levels. Within the undergraduate medical education program, faculty members have leadership roles in the JeffMD curriculum at the Sidney Kimmel Medical College, including in case-based learning (Dr. Susan Truong), the Phase 2: Core Clinical Clerkships (Dr. Nina Mingioni), and the Clinical Experience course for first-year students (Dr. Aparna Sarin). Several other faculty members serve as facilitators for the first and second-year case based learning and clinical skills small group courses. Dr. John Spandorfer serves as the Roger B. Daniels Associate Dean of Professionalism, overseeing professional development throughout the undergraduate curriculum.

Faculty in the Internal Medicine Division also plays a significant role in graduate medical education, providing ambulatory training to internal medicine residents through preceptorship in continuity clinics and didactic lectures. The primary care track within the residency program, under the leadership of Drs. Ojeda and Davis, offers mentorship and focused primary

David Axelrod, MD Associate Professor Bracken Babula, MD Clinical Associate Professor Associate Chief Medical Informatics Officer Karl T. Benedict III, MD Clinical Assistant Professor Joseph Boselli, MD Clinical Associate Professor Elizabeth Boyle, MD Clinical Assistant Professor John Caruso, MD Professor Senior Associate Dean, Graduate Medical Education and Affiliates Edgar Chou, MD Clinical Associate Professor Carissa Cicchinelli, MD Clinical Instructor Jennifer T. Cowan, MD Clinical Assistant Professor Rebecca Davis, MD Clinical Associate Professor Associate Program Director, Internal Medicine Residency Associate Program Director, EM/IM Point of Care Ultrasound Fellowship Marjorie Friedman, MD Clinical Instructor Mark Graham, MD Professor Sean Hurt, MD Clinical Assistant Professor Rong Ji, MD Clinical Assistant Professor Keino Johnson DO Clinical Instructor Michael Kaufman, MD Clinical Instructor Sunaina Kaushal, MD Clinical Assistant Professor Barbara S. Knight, MD Clinical Assistant Professor Benjamin Krempley, MD Clinical Assistant Professor Janine V. Kyrillos, MD Clinical Associate Professor Christine Laine, MD Clinical Associate Professor

Department of Medicine 2024 Annual Report

44 care education, consistently attracting highly qualified residents. Other faculty are also very involved in resident primary care education: Drs. Knight and Lee provide leadership for the Jefferson Hospital Ambulatory Practice where over 70 residents have their continuity clinical practice and Drs. Boyle, Nair, and Shroff lead education related to women’s health for the internal medicine residency program.

R E S E A RC H A N D SCHOL ARSHIP Faculty members are recognized leaders in their fields, disseminating their expertise through presentations at national conferences and publications in peer-reviewed journals.

Among the highlights from FY24, Dr. Babula shared insights on improving clinician efficiency and risk coding at the American Medical Group Association and American College of Physicians meetings, respectively. Dr. Kaushal presented at a national HRSA conference, while Dr. Schroff led a workshop on promoting diversity in academic medicine for the Society of General Internal Medicine. Dr. Mingioni addressed physician digital efficiency at the American Medical Women's Association meeting, and Dr. Kyrillos delivered multiple regional and national presentations on weight management. These scholarly activities, as well as the publications noted below, demonstrate the Division's commitment to advancing knowledge and improving healthcare.

P U B L I C AT I O N S Blue, L., Kranker, K., Markovitz, A.R., Powell, R.E., Williams, M.V., Pu, J., Magid, D.J., McCall, N., Steiner, A., Stewart, K.A.,

Rollison, J.M., Markovich, P., & Peterson, G.G. (2023). Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending: A Randomized Clinical Trial. JAMA, 330(15), 1437–1447. doi:10.1001/ jama.2023.19597 Dong, M., West, F.M., Cooper, J., Foster, J., & Davis, R. (2023).

A Guide to Point of Care Ultrasound Examination of a Pericardial Effusion. The Medicine Forum, 24, 34-38.

Dong, M., West, F.M., Davis, R., Foster, J., & Cooper, J. (2023). A Guide to Point of Care Ultrasound Evaluation of Pneumonia. The Medicine Forum, 24, 43-45.

Farrehi, C., Pazzi, C., Capron M., & Stillman, M. (2024). Medical Student Health Care: A Single Center Pilot Study of Utilization and Barriers. Discover Health Systems. doi: 10.1007/s44250024-00071-z Gill, L., Coborn, J.E., Hoovler, A.R., & Sherif, K. (2023). Polycystic Ovary Syndrome and Obesity: A Cross-Sectional Survey of Patients and Obstetricians/Gynecologists.

Journal of Women's Health, 32(6), 723-731. doi: 10.1089/ jwh.2022.0471. Epub 2023 Apr 19.

PMID: 37074669 Liotta, M., Bell, H., Vu, A., & Stillman, M. (2023) Drug-Induced Parkinsonism: Too Many Cooks in the Kitchen. Cueus, 15(9), e44896.

Petersen, D.M., O’Malley, A.S., Felland, L., Peebles, V., Rittenhouse, D.R., Powell, R.E., Rich, E.C., Sarwar, R., Sorensen, A., Hoag, S., & Finucane, M. (2023). Reducing Acute Hospitalizations at HighPerforming CPC+ Primary Care Practice Sites: Strategies, Activities, and Facilitators. The Annals of Family Medicine, 21(4), 313-21.

Qaseem, A., Andrews, R.A., Campos, C., Goldzweig, C.L., MacDonald, S., McLean, R.M.,

Powell, R.E., Fitterman, N., & the Performance Measurement Committee of the American College of Physicians. (2024).

Quality Indicators for Major Depressive Disorder in Adults: A Review of Performance Measures by the American College of Physicians. Annals of Internal Medicine. 177(4):507-513. doi:10.7326/M23-3077 Qaseem, A., Mount, C.A., Campos, K., McLean, R.M., Tierney, S., Cross, J.T. Jr., Fitterman, N., Andrews, R.A., Basch, P., Goldzweig, C.L., MacDonald, S.T., MacLean, C.H., Mathew, S.M., Powell, R.E., & Saini, S.D. (2023). Quality Indicators for Osteoporosis in Adults: A Review of Performance Measures by the American College of Physicians.

Annals of Internal Medicine, 176(10), 1386‑1391.

Saati, A., Au, A., Joshi, A.U., Davis, R.L., West, F.M., & Lewiss, R.E. (2023). Can Untrained Patients Perform Their Own Skin and Soft Tissue Ultrasound Examination by Teleguidance? POCUS Journal, 8(2), 51-57. PMID: 38033176 Sherif, K., Coborn, J., Hoovler, A., & Gill, L. (2023). Medical journey of patients with polycystic ovary syndrome and obesity: a cross-sectional survey of patients and primary care physicians. Postgraduate Medicine, 135(3), 312-320. doi: 10.1080/00325481.2022.2140511.

Shroff, S., Casas, R., Bachorik, A., Gopinath, V., & Schwarz, E.B. (2023). Pre- and Post-Abortion Care: A Primer for the General Internist. GIM Learn. E-published.

Zavodnick, J., Doroshow, J., Rosenberg, S., Banks, J., Leiby, B.E., & Mingioni, N. (2023). Hawks and Doves: Perceptions and Reality of Faculty Evaluations.

Journal of Medical Education and Curricular Development. doi: 10.1177/23821205231197079

FACU LT Y Hillary Landon, MD Clinical Assistant Professor Kenneth Lau, MD Clinical Assistant Professor Albert Lee, MD Clinical Assistant Professor Associate Program Director, Internal Medicine Residency Nidhi Master, MD Clinical Instructor Amanda Matheson, MD Clinical Assistant Professor Nina Mingioni, MD Professor Director, Phase 2 Core Clinical Rotations, Sidney Kimmel Medical College Yuan Mirow, MD Clinical Instructor Shailajah Nair, MD Clinical Associate Professor Director, Integrated Program in Women's Health Jason C. Ojeda, MD Clinical Associate Professor Director, Internal Medicine Primary Care Program Associate Program Director, Internal Medicine Residency Kyong B. Park, MD Clinical Assistant Professor Aparna Sarin, MD Clinical Associate Professor Physician Director of Clinical Experience, Sidney Kimmel Medical College Katherine Sherif, MD Professor Vice Chair for Academic Affairs Aleksandr Shpigel, MD Clinical Assistant Professor Swati Shroff, MD Clinical Associate Professor Christine V. Soutendijk, MD Clinical Assistant Professor John Spandorfer, MD Professor Associate Dean of Professionalism in Medicine Michael Stillman, MD Professor Ashley K. Summer, MD Clinical Assistant Professor Susan Truong MD Clinical Associate Professor Director of Case Based Learning, Sidney Kimmel Medical College Jonathan Zaid, MD Clinical Assistant Professor Barry Ziring, MD Clinical Associate Professor

Department of Medicine 2024 Annual Report

45

N OTA B L E ACH I E V E M E N T S 2024 Philadelphia Magazine Top Doctors BRACKEN BABULA, MD JOSEPH BOSELLI, MD EDGAR CHOU, MD JENNIFER COWAN, MD JANINE KYRILLOS, MD SEAN HURT, MD CHRISTINE LAINE, MD ALBERT LEE, MD NINA MINGIONI, MD YUAN MIROW, MD SHAILAJA NAIR, MD KATHERINE SHERIF, MD ALEKSANDR SHPIGEL, MD CHRISTINE SOUTENDIJK, MD JOHN SPANDORFER, MD ASHLEY SUMMER, MD BARRY ZIRING, MD

Department of Medicine 2024 Annual Report

DIVISION OF NEPHROLOGY

47

The Division of Nephrology continues its mission of education, research, and clinical care under the leadership of Jerry McCauley, MD. In the coming year, the leadership will change to Pooja Singh, MD, MBA. We continue to publish in prestigious, peer-reviewed journals and offer a Transplant Nephrology Fellowship that has been approved by the American Society of Transplantation.

PATIENT CARE Our goal remains to provide the highest level of service to our patients as well as our colleagues.

We strive to deliver these services with care, professionalism, teamwork, and respect. Our inpatient clinical activities remain robust among the Renal Dialysis Consult, Renal Medical Consult, and Renal Transplant Consult Services. The inpatient dialysis service provides treatment for an estimated 800-900 patients per month. We provide Medical Directorship for four outpatient dialysis units and patient care to seven chronic units, one transition of care unit, one home unit, and four long-term care facilities.

Our outpatient service is a vital part of our patient care mission.

In FY24, the division saw 10,921 outpatients, which is a 2% increase from FY23. Of these, 2,269 were new patient visits, 1,055 were telehealth visits. In addition to the ambulatory practice the division saw 3,548 outpatient dialysis patients in FY24.

We provide Medical Directorship at Magee Rehabilitation and patient care.

Under the Direction of Dr. Seyed Hamrahian, the Division of Nephrology retained Certification as the Jefferson Comprehensive Hypertension Center from the American Heart Association. This certification was made effective

August 22, 2022, through August 23, 2025. We held successful annual Jefferson Hypertension Symposiums in 2019, 2020 and 2021.

work, more than 350 patients were reviewed and more than 170 had the time adjusted. On average patients gained about 3.3 years of wait time and 47 patients were transplanted.

TRANSPLANT OUTCOMES

The Nicoletti Kidney Transplant Center, which opened in December 2016, is a comprehensive multidisciplinary center wherein patients and live donors can come to be evaluated, for transplantation and donation in one location. The hallmark of the Center, recently relocated to the Honickman building in May 2024, is the Living Donation Education Program.

The Living Donor Education Program is a customized education and coaching program conducted once monthly to assist patients in finding a living donor, which has been proven effective nationally.

Under the leadership and direction of Dr. Pooja Singh, the Kidney Transplant Program at TJUH currently has approximately 641 patients on the waitlist (kidney, kidney/pancreas, and pancreas). Our transplant list continues to grow, with a total of 200 new patients added to the waitlist during FY24. We have increased our referral volumes from 528 referrals in FY17 to 870 FY24. Our living donor transplant program more than doubled its live donor transplants and went from 16 live donor transplants in FY23 to 34 in FY24. We completed a total of 100 kidney transplants overall.

We have maintained a strong presence with UNOS through Dr. McCauley as immediate past president of UNOS/OPTN and Dr. Singh’s participation on the Membership and Professional Standards Committee (MPSC).

Additionally, in FY23 following a change in regulations that eliminated the race-based calculations of eGFR, transplant centers begun to apply for adjusted wait time for their African American patients. As a result of the program’s swift

Holding steadfast to our commitment of eliminating the financial burden of living donations, The Jefferson Transplant Institute is a Living Donor Circle of Excellence Center and became part of the National Kidney Registry’s Donor Care Network Centers of Excellence. We are the only Living Donor Circle of Excellence Center in the Philadelphia area and 1 of the 3 programs considered Donor Shield Center.

Through these partnerships, the Jefferson Transplant Institute has reinforced its strong commitment

FACU LT Y Jerry McCauley, MD Division Director Robert Capizzi Professor of Medicine

Hasan Arif, MD Clinical Associate Professor Xiaoying Deng, MD Clinical Assistant Professor Bonita Falkner, MD Emeritus Professor Jesse Goldman, MD Clinical Professor Rakesh Gulati, MD Clinical Professor Maitreyee Gupta, MD Clinical Assistant Professor Fitsum Hailemariam, MD Clinical Assistant Professor Seyed Hamrahian, MD Professor Omar Hussein Maarouf, MD Associate Professor Maria Martinez, MD Associate Professor Prashamsa Shenoy, MD Instructor Pooja Singh, MD, MBA Enterprise Director, Kidney Transplant Services Beatrice F. Nicoletti Professor of Medicine Hannah Troutman, DO Clinical Assistant Professor Anju Yadav, MD Associate Professor Jingjing Zhang, MD Associate Professor

ADVAN CED PRACTICE CLIN ICIA N Christine Chmielewski, CRNP

Department of Medicine 2024 Annual Report

48 to providing the highest level of care and support to living kidney donors.

The Kidney Transplant Program continues to see patients conveniently in Egg Harbor Township, NJ, at Voorhees, NJ, Langhorne, PA, Willow Grove, PA and Blue Bell, PA through a partnership with a site champion.

We have further expanded to Lankenau Medical Center to service patients following the closure of the Mainline Kidney Transplant Program. Additionally, the program will begin seeing patients at the Navy Yard.

We continue to offer nononcology infusions in our Stratford campus including Jefferson Washington Township Hospital, at Abington Hospital, and at Sidney Kimmel Cancer Center- Bodine Center for Radiation Oncology and Jefferson Hospital for Neuroscience. We expect to be able to offer infusions also at Honickman Center at some point over the next year.

As part of our ongoing response to the COVID-19 crisis and under the direction of Dr. Pooja Singh, the Kidney Transplant team collaborated closely with our Transplant Pharmacy and Infectious Disease colleagues to safely administer Paxlovid and other antiviral therapies to our transplant patients.

Immunosuppressant medications present a strong interaction with Paxlovid and require a significant medication adjustment to avoid medication toxicity.

With the collaboration of our Infectious Disease Partners lead by Dr. Dagan Coppock and our transplant nephrologist Dr. Maitreyee Gupta, we were able to participate in the HIV Organ Policy Equity (HOPE) research study. This study allows HIV

positive waitlisted patients to receive HIV positive kidney offers.

The goal of this research is to increase knowledge about the safety, efficacy, and effectiveness of solid organ transplantation (SOT) utilizing HIV- positive donors in HIV-positive recipients.

Through a partnership with Strive Health in PA, the Jefferson Kidney Transplant Program begun participating in the Strive Kidney Contracting Entity in January 2023. In January 2024 we expanded participation in Kidney Contracting Entity by providing services to our New Jersey patients in partnership with Interwell. Participation in the Kidney Contracting Entity builds upon the existing Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model structure in which dialysis facilities, nephrologists, and other health care providers form ESRD-focused accountable care organizations to manage care for Medicare beneficiaries with ESRD by adding strong financial incentives for health care providers to manage the care for patients with chronic kidney disease (CKD) stages 4 and 5 and ESRD, to delay the onset of dialysis and to incentivize kidney transplantation.

Looking forward to FY 2025, Dr Paula Martinez has stepped in as the Medical Director of Kidney Transplantation with the goal to continue to push live donor transplantation and increase access to kidney transplant evaluations through our vast network of kidney satellites.

QUALITY INITIATIVES The past year has been an exceptional period for our quality improvement initiatives, encompassing acute kidney injury (AKI), chronic kidney disease

(CKD), end-stage renal disease (ESRD), and transplant care.

These efforts have been integral to enhancing workflows, safety protocols, patient satisfaction, and overall care delivery. Below is a detailed account of our accomplishments and ongoing projects: Over the past year, we have successfully completed several specific projects: EDHD PATHWAY PROGRAM The Patient Triage and ED Transfers project is an ongoing initiative aimed at improving patient flow and enhancing care for ESRD patients. One of the key components of this project is the implementation of expedited transfers for ESRD patients from the Emergency Department (ED) to the Acute Dialysis Unit (ADU).

This initiative has significantly reduced ED congestion, enabling a more efficient triage process and better overall management of patient care.

The expedited transfers have been especially beneficial for patients who do not have access to an outpatient dialysis unit due to behavioral or compliance issues. By swiftly transferring these patients to the ADU, we can ensure they receive the necessary dialysis treatment without further delays, preventing potential complications and hospital readmissions. This approach not only improves patient care but also alleviates pressure on the ED, allowing for more effective use of hospital resources.

Overall, the ongoing success of this project highlights its positive impact on both patient outcomes and hospital operations, reinforcing the commitment to providing efficient, timely, and compassionate care for patients with end-stage renal disease.

N E W G R A N T S/ CL I N I C A L T R I A L S HASAN ARIF Amplitude Study. 4 screened, zero enrolled. (Study on pause as Honickman being accredited) HASAN ARIF rimary Hyperaldosteronism in Stroke Patients. 4 screened, zero enrolled.

VERTEX, INC. Small Molecule Inhibitors of APOL1 gene to reduce CKD progression. Phase IIb/III Randomized Study to Evaluate the Efficacy and Safety of Inaxaplin in Patients with ApoL1 gene mutation in CKD. PI: OMAR MAAROUF VERA THERAPEUTICS Origin Study, Phase IIb Randomized Study to Evaluate the Efficacy and Safety of Atacicept in Patients with IgAN. OMAR MAAROUF CO-PI WITH DR. JINGJING ZHANG SPECTRAL DIAGNOSTICS INC. (US) Safety and Efficacy of Polymyxin B Hemoperfusion (PMX) for Endotoxemic Septic Shock in a Randomized, Open-Label Study (TIGRIS).

OMAR MAAROUF CO-PI WITH DR. MICHAEL BARAM

Department of Medicine 2024 Annual Report

49 HOME DIALYSIS PROGRAM The home dialysis program has experienced significant growth, reflecting a commitment to expanding patient-centered care and increasing access to home dialysis options. The Center for Specialty Care in South Philadelphia now serves as a hub for training and educating in-center dialysis patients about transitioning to home dialysis modalities. This initiative has enabled patients to take greater control of their treatment, enhancing their quality of life and improving clinical outcomes. The program has already successfully initiated its first peritoneal dialysis (PD) patient and is actively training a patient for home hemodialysis, marking critical milestones in the expansion effort.

Collaboration with the Baxter PD Task Force has been instrumental, particularly during the nationwide shortage of hemodialysis IV fluids and peritoneal dialysis solutions.

Leveraging the expertise of Dr. Maarouf, the team effectively navigated these supply challenges, ensuring continuity of care for patients and avoiding disruptions in treatment. This collaboration underscores the resilience and adaptability of the program in the face of systemic challenges.

These developments highlight the division’s strategic focus on growing home dialysis options, which aligns with broader healthcare goals of improving patient autonomy, reducing hospitalization rates, and promoting cost-effective care. As the program continues to expand, it aims to serve as a model for innovative and patientcentered nephrology care, with plans to train more patients and further refine support systems for those transitioning to home dialysis modalities.

The collaboration with DaVita Hemodialysis has been pivotal in enhancing the efficiency and accessibility of renal replacement therapy for newly diagnosed patients. Through this partnership, the focus has been on streamlining the initiation process for outpatient hemodialysis, ensuring that patients who are ready to start renal replacement therapy can do so seamlessly in an outpatient setting. This initiative reduces delays in care, minimizes hospital admissions, and provides patients with a more convenient and patientcentered experience. By leveraging DaVita’s extensive infrastructure and expertise, the program aims to improve the continuity and quality of care for individuals starting dialysis.

ETC MODEL In addition, the division is actively participating in the End-Stage Renal Disease Treatment Choice (ETC) Model, a national initiative designed to increase the use of home dialysis and kidney transplants.

Within this framework, the focus has been on promoting pre-transplants, facilitating living donor transplants, and encouraging transitions to home dialysis modalities, such as peritoneal dialysis and home hemodialysis. These efforts align with the broader goals of improving patient outcomes, enhancing quality of life, and reducing the overall costs associated with ESRD care.

The partnership with DaVita and participation in the ETC Model represent a concerted effort to innovate and adapt nephrology care to meet the evolving needs of patients. By integrating these initiatives, the division continues to set benchmarks in providing efficient, patient-centered, and forward-thinking renal care.

MAGEE REHABILITATION The safety enhancements at Magee Rehabilitation, initiated last year, have significantly improved patient care and outcomes. These initiatives, including renal dosing guidelines for medications like Pregabalin, Gabapentin, Vancomycin, and Gentamycin, as well as updated heart failure management protocols and the addition of essential medications such as Lokelma, Veltassa, UreNa, and Droxidopa to the formulary, have effectively mitigated the risks of adverse outcomes. By focusing on tailored medication management and thorough reconciliation processes, these measures have played a crucial role in ensuring patient safety and delivering high-quality care.

MULTI-SPECIALTY CLINICS The multi-specialty clinic initiative aims to foster collaboration between Rheumatology, Urology, and Nephrology to provide comprehensive care for complex patient populations, specifically those with lupus nephritis and kidney stone disease. For lupus patients, Rheumatology and Nephrology will work together to address the overlapping and systemic complications of the disease, with a focus on optimizing management of lupus nephritis, monitoring disease progression, and tailoring immunosuppressive therapies.

This integrated approach ensures that patients receive holistic care that encompasses both autoimmune and renal health.

For kidney stone patients, Nephrology and Urology will collaborate to create a streamlined care pathway. This will include advanced diagnostic evaluation, metabolic testing, and individualized treatment plans. The clinic will prioritize both acute management of

stone episodes and long-term prevention strategies, such as dietary modifications, medical therapies, and surgical interventions when necessary.

By bringing together specialists from these disciplines, the multispecialty clinic aims to enhance patient outcomes, reduce healthcare fragmentation, and provide a seamless and patientcentered care experience for these complex conditions.

EDUCATION The division’s faculty members serve as the educational resource for students, interns, residents, and fellows year-round. Subspecialty fellows, as well as students and house staff rotating through our service, participate in didactic lecture series in Nephrology, basic and clinical research, journal club, clinical case conference, mortality and morbidity conference, and kidney biopsy conference. Our fellowship program continues to offer a Transplant Nephrology Fellowship (PGY 6) approved by the American Society of Transplantation. The purpose of this fellowship program is to be able to graduate UNOScertified transplant nephrologist from Jefferson and enhance the prestige and visibility of our transplant program.

The effectiveness of our educational mission is evidenced by a renewed interest in Nephrology as a career option for the Jefferson medical residents.

RESEARCH Dr. McCauley encourages faculty in the continued development of clinical research activities. Our faculty and fellows are actively involved in both basic science and clinical research projects.

Department of Medicine 2024 Annual Report

50 EDITORIAL, REVIEW, BOOK/CHAPTERS Manual of Nephrology (Edgar Lerma, Seth Ferguson): The patient with kidney disease and hypertension in pregnancy.

Maitreyee Gupta, MD.

PUBLICATIONS Xiaoying Deng, Omar Maarouf, Seyed M Hamrahian: Acute Tubular Necrosis (ATN) chapter.

Medscape – Oct 4th 2023 Hooper SR, Lande MB, Flynn JT, Hanevold CD, Meyers KE, Samuels J, Becker RC, Daniels SR, Falkner BE, Ferguson MA, Ingelfinger JR, Martin LJ, Mitsnefes M, Khoury P, Seo J, and Urbina EM. Systolic Blood Pressure, Cardiovascular Health, and Neurocognitive in Adolescents. Hypertension.

Published online September 19, 2024. https://doi.org/10.1161/ HYPERTENSIONAHA.124.2283 Rosner B, Cook NR, Glynn RJ, Bress A, Derington AG, Falkner B, Allen N. Use of Censored Data Methods to Estimate Blood Pressure Percentiles in US Adults.

Am J Epidemiol. 2024 Sep 17:kwae363. doi: 10.1093/aje/ kwae363. Online ahead of print.

PMID: 39289167 Falkner B, Gidding SS, Baker-Smith CM, Brady TM, Flynn JT, Malle LM, South AM, Tran AH, Urbina EM; on behalf of the American Heart Council on Hypertension; Council on Lifelong Congenital Heart Health in the Young; Council on Kidney tub Cardiovascular Disease; Council on Lifestyle and Cardiometabolic Health; and Council on Cardiovascular and Stroke Nursing. Pediatric Primary Hypertension: An Underrecognized Condition: A Scientific Statement from the American Heart Association.

Hypertension. 2023 | Volume 80, Issue 6: e101–e111,

Published Online: March 30, 2023. https://doi.org/10.1161/ HYP.0000000000000228

and refractory gout in sickle nephropathy. American Society of Nephrology 2024

Falkner B, Alexander BT, Nuyt AM, South AM, Ingelfinger J. Cardiovascular Health Starts in the Womb. Hypertension.

2024;81:2016-1026. doi: 10.1161/ HYPERTENSIONAHA. Online July 29, 2024 ahead of print124.21359 PMID:39069922

Islam R, Roche ME, Lin Z, Whitaker-Menezes D, DiazBarros V, Serrano E, Martinez Cantarin MP, Philp NJ, Basu Mallick A, Martinez-Outschoorn U. TOMM20 as a driver of cancer aggressiveness via oxidative phosphorylation, maintenance of a reduced state, and resistance to apoptosis. Under review Molecular Oncology (MOLONC-24-0676)

Falkner B. (2022) Development of Blood Pressure Norms and Definition of Hypertension in Children. In Pediatric Hypertension 5th Edition. Editors: Flynn JT, Ingelfinger JR, Brady T. Springer, Cham DOI: 10.1007/978-3-0315_10 First online: 10 January 2023 Thaker V, Falkner B. (2022) Insulin Resistance and other Mechanisms of Obesity Hypertension. In Pediatric Hypertension 5th Edition.

Editors: Flynn JT, Ingelfinger JR, Brady T. Springer, Cham 2023 https://doi.org/10.1007/978-3319-31420-4_39-2 Gupta, M; Yadav, A. Reproductive health in kidney transplant.

Accepted for publication Advances in Kidney Disease and Health 2024 Hamrahian SM, Vilayet S, Herberth J, Fülöp T. Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects. International Journal of Nephrology and Renovascular Disease. July 25, 2023 (31):173-81.

Maarouf, O. - Amyloidosis and the kidney. Amyloidosis Foundation Newsletter-Winter 2023 Maarouf, O. - PGNMID in a pregnant patient with SLE. Penn Glomerular disease workshop 2024 Maarouf, O. - Admitted Patients Without a Hemodialysis Center: Can they be Safely Discharged?

Society of Hospital Medicine 2023.

Maarouf, O. - An alternative method of controlled fluid removal in the setting of hypervolemia

Late-Onset Recurrent Lupus Nephritis (rLN) in a Kidney Transplant Recipient. Prashamsa Shenoy MD, Nora Hajnoczky MD, Yutao Deng MD, Anju Yadav MD, Rakesh Gulati MD. Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, United States.

Prolonged myoglobinuria AKI in a young female in the era of COVID-19 pandemic. Nora Hajnoczky MD, Prashamsa Shenoy MD, Rakesh Gulati MD. Einstein Healthcare Network, East Norriton, PA; Thomas Jefferson University Hospital, Philadelphia, PA Jingjing Zhang, Wing Zeng, Seyed Hamrahian, and Omar H. Maarouf.

Incorporating genetic testing into a routine kidney clinic. Clin Nephrol. 2024 Apr 25.

LECTURES BY INVITATION Jesse Goldman MD, Family Practice Course Part 1, Temple University, April 2024 Jesse Goldman MD, Family Practice Course Part 2, Temple University, April 2024 Jesse Goldman MD, Cardiovascular Course, University of Pennsylvania, October 2023 Omar Maarouf MD, “Urinary Neutrophil Gelatinase–Associated Lipocalin Predicts Intensive Care Unit Admission Diagnosis:

N OTA B L E ACH I E V E M E N T S 2023 Philadelphia Magazine, Top Doctors: JESSE GOLDMAN, MD RAKESH GULATI, MD JERRY MCCAULEY, MD OPTN, Past President UNOS POOJA SINGH, MD, OPTN Membership and Professional Standards Committee UNOS ZHANG, J. Center of Excellence Designation from PKD Foundation $80,000 per year for 3 years for Patient Navigator position.

Department of Medicine 2024 Annual Report

51 A Prospective Cohort Study”, World Nephrology Congress (WNC-2023), Barcelona, Spain.

10/09/2023. Guest speaker.

CO M M U N I T Y S E RV I CE

ABSTRACTS

OMAR MAAROUF, MD National Kidney Foundation

Omar Maarouf, ASN 2024: Aquapheresis: An alternative method of controlled fluid removal in the setting of hypervolemia and refractory gout in sickle nephropathy

JINGJING ZHANG, MD Physician volunteer at Holy Cross Baptist Church for PennKDSAP. October 21, 2023

Jingjing Zhang, Benefits of Genetic Testing in Patients with PKD, ASN kidney week, 2023, Philadelphia

OTHER SCHOLARLY WORK Omar Maarouf MD, Unversity of Pennsylvania Glomerular Disease boot camp, February 2024 Omar Maarouf MD, NKF midAtlantic Fellowship Workshop, July 2024 Omar Maarouf MD, ED HD pathway — innovative hospital work/discharge pathway

Department of Medicine 2024 Annual Report

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Department of Medicine

DIVISION OF PULMONARY, ALLERGY & CRITICAL CARE MEDICINE The Division of Pulmonary, Allergy and Critical Care Medicine and the Jane & Leonard Korman Respiratory Institute (KRI) have continued to grow in services and footprint. Since 2018, when the KRI was created, the division engaged in an aggressive strategy that resulted in the recruitment of new faculty; an increase in the number of physician extenders, nurses and medical assistants; the establishment of a robust clinical trials enterprise; and the development of ten new clinical programs of excellence. Today, the division houses 36 faculty (including 5 basic scientists) and four training programs distributed throughout multiple clinics and two hospitals, and is considered one of the strongest clinical, research, and education programs in the region. Thanks to these and related efforts, the Thomas Jefferson University Hospital was again ranked in the top 50 (#39) in Pulmonology by US News and World Report and ranked ‘high performing’ for the treatment of patients with COPD.

PAT I E N T C A R E The Division is the home to outstanding programs in several clinical areas including the Interstitial Lung Disease and Sarcoidosis Program, considered one of the top programs in the region. The program includes clinicians, clinical and basic science researchers, and its efforts include the development of patient support programs and quality improvement projects. The Critical Care Program continues to provide the best care to patients with respiratory failure, shock, and other critical illnesses. The Lung Cancer Program leads efforts to standardize lung cancer screening and treatment throughout Jefferson Health and is studying the impact of community factors and race on compliance with screening guidelines. The Severe Asthma Program has joined forces with the Allergy/Immunology Program to establish one of

the largest biological delivery programs in the region. The Adult Cystic Fibrosis Center is one of two CF Foundation supported programs in the city.

The Bronchiectasis Program, the Pulmonary Hypertension Program, the Chronic Respiratory Failure Program and others are providing service to patients with rare lung disorders in need of a medical home. The Interventional Pulmonology Program helped orchestrate the deployment of robotic bronchoscopy throughout Jefferson Health. To date, Jefferson has performed over 1,000 robotic bronchoscopies, over 80 bronchoscopic lung volume reduction procedures, and over 60 ICU tracheostomies.

Finally, just this year, the Division started a Lung Transplantation Program that obtained state approval and is already evaluating patients for the procedure.

Division programs are focused on the delivery of highquality care, engaging in the education of trainees,

evaluating outcomes via quality improvement projects, and driving discovery through clinical trials and/or collaborations that drive translational research.

These efforts are performed in collaboration with other Jefferson programs including those of the Department of Otorhinolaryngology, Pathology, Radiology and the Divisions of Thoracic Surgery, Infectious Diseases, and Rheumatology as well as Palliative Care, among others. The strengths of these programs are best highlighted by strong associations and/ or sponsorship from national organizations such as the Pulmonary Fibrosis Foundation, Cystic Fibrosis Foundation, Hermansky-Pudlak Syndrome Network, and Foundation for Sarcoidosis Research, and the American Lung Association.

Q UA L I T Y I N I T I AT I V E S The Division of Pulmonary, Allergy and Critical Care Medicine is dedicated to improving patient

2024 Annual Report

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FACU LT Y Jesse Roman, MD Ludwig Kind Professor of Medicine CEO, Jane & Leonard Korman Respiratory Institute Director, Respiratory Enterprise at Jefferson

Bharat Awsare, MD Clinical Associate Professor Volunteer Faculty Saqib Baig, MD Clinical Associate Professor Co-Director of Bronchiectasis / COPD Program Director of Physiology Michael Baram, MD Professor Director, In-Patient Research Director, Post-ICU Clinic Julie Barta, MD Associate Professor Co-Director Lung Cancer Program Prarthna Chandar, MD Clinical Assistant Professor Director, Interventional Pulmonology Deepak Deshpande, PhD Professor Director, Center for Translational Research and Pulmonary Research Linda Earle, MD Assistant Professor Megan Ford, MD Assistant Professor Volunteer Faculty Shirley Fung, MD Clinical Assistant Professor Gautam George, MD Associate Professor Associate Fellowship Program Director Ritu Grewal, MD Associate Professor Monica Gupta, MD Clinical Assistant Professor Volunteer Faculty Robert Hilton, MD Clinical Assistant Professor Director of MICU / Acting Vice Chair, Methodist Hospital

Department of Medicine 2024 Annual Report

54 safety and quality of care across the full range of pulmonary and critical care. Division quality initiatives are chosen for their impact on patient care and their alignment with division priorities.

Our quality improvement projects also serve as an opportunity to teach our trainees the principles and methods of quality improvement (QI). In addition to projects within the division, our faculty also lead several institution-wide quality and safety initiatives.

Recently completed QI projects include the creation of an ‘extubation bundle’ to reduce avoidable ventilator days in our medical intensive care unit. This project was designed to improve interdisciplinary collaboration around the ventilator liberation process and resulted in a significant reduction in the duration of mechanical ventilation in the intervention arm. A second project involved reducing variation in management of patients who have a tracheostomy admitted to the pulmonary inpatient service.

To improve recognition around milestones in the decannulation process we developed an Epic dot phrase that automatically pulls critical information into the patient note, allowing our pulmonary attendings to view immediately all the information they need to assess progress towards decannulation.

The cystic fibrosis team focused efforts in improving communication with patients after identifying deficiencies in communicating solely through Mychart. By incorporating telemedicine follow-ups, they were able to significantly increase the number of patients acknowledging discussions regarding their test results.

Current QI initiatives include an effort to increase uptake of influenza vaccination in the

high-risk population of patients with interstitial lung disease, improve the utilization of the AIRQ questionnaire to identify and manage patients with poorly controlled asthma, and reduce hemodialysis catheter failure rates in the medical intensive care unit. The divisional quality team continues to be involved in other institution-wide activities such as a collaboration with the heart failure stat team to improve the outcomes of patients with heart failure, reduce rates of urinary catheter associated urinary tract infections, and review data and processes to reduce mortality, length or stay, and readmission amongst patients admitted to the medical intensive care unit or pulmonary inpatient service.

E D U C AT I O N The Division houses four training programs. The Pulmonary – Critical Care Medicine Fellowship is an accredited 3-year program with 5 fellows per year. The Critical Care Fellowship is a 1-year training program with 1-2 fellows. The Point-of-Care Ultrasound (POCUS) Program is training fellows in this technology and recently expanded to train residents. Finally, the Division Allergy/Immunology Program supports the Allergy-Immunology Fellowship based at Christiana in Delaware. We are extremely proud that our fellows have gone on to further their training in highly specialized areas or into fulfilling careers. The faculty has worked hard to promote education through faculty engagement and the mentorship of trainees. The Division continues to incorporate research into our training and supervise and measure mentorship activities. Members of the Division are heavily involved in the education and mentorship of medical students at the Sidney Kimmel College of Medicine.

The Division also engages in educational activities for the community ranging from patient support group sessions and virtual lectures on several respiratory related topics. Some recurrent sessions include the Annual Lung Cancer Screening Symposium, the Annual Lung Cancer Symposium, and the Annual Pulmonary Fibrosis Update. Finally, the Division participated in an effort to start a new Respiratory Therapy Program with two sites: Denver and Philadelphia.

RESE ARCH Division faculty and trainees collaborate with basic scientists in translational projects, and fellows are taking advantage of this relationship. The Division’s Clinical Trials Program remains strong with over 20-25 clinical trials and registries performed alone or in collaboration with the Jefferson Clinical Research Institute, including studies in pulmonary fibrosis, asthma, pulmonary hypertension, sarcoidosis, critical care, and obstructive airways disease. Basic science projects are exploring factors involved and mechanisms of action related to lung airway, matrix, epithelial and fibroblast biology using sophisticated in vitro, ex vivo, and in vivo models including genetically engineered animals.

P U B L I C AT I O N S Baig SH, Yoo EJ. The impact of chronic comorbidities on outcomes in acute exacerbations of idiopathic pulmonary fibrosis.

Life. 2024 Jan 21;14(1):156. PMID 38276285 David Wyler, MD; Marc C. Torjman, PhD; Ron Leong, MD; Michael Baram, MD; William Denk, MD; Sarah C. Long, MD; Richard J. Gawel, BS; Eugene R.

FACU LT Y Jeffrey Hoag, MD Professor Section Chief, Jefferson Northeast Director, Adult Cystic Fibrosis Center Jonathan Iaccarino, MD Clinical Assistant Professor Gregory Kane, MD Jane & Leonard Korman Professor of Pulmonary Medicine Chair, Department of Medicine Behram Khan, MD Clinical Assistant Professor Daniel Kramer, MD Clinical Assistant Professor Associate Fellowship Program Director Michael Lippmann, MD Professor Volunteer Faculty Salvatore Mangione, MD Associate Professor Director, Physical Diagnosis Course Christopher McGrath, MD Clinical Assistant Professor Jessica Most, MD Clinical Associate Professor Ajay Nayak, PhD Assistant Professor David Oxman, MD Associate Professor Co-Leader, Quality Director, Critical Care Fellowship Damaris Pena Evertz, MD Clinical Assistant Professor Director, Severe Asthma Program Raymond Penn, PhD Robley Dunglison Professor of Pulmonary Research Director, Pulmonary Research, Jane and Leonard Korman Lung Center Vice Chair for Research Tonio Pera, PhD Assistant Professor Rafael L. Perez, MD Professor Director, Sarcoidosis Program Michael Scharf, MD Clinical Associate Professor Director of Pulmonary Vascular Program William Sexauer, MD Clinical Professor Neeraj Sinha, MD Clinical Professor Medical Director, Lung Transplantation

Department of Medicine 2024 Annual Report

55 Viscusi, MD; Irving W. Wainer, PhD; Christine Radomski, MS; Scott W. Keith, PhD; Eric S. Schwenk, MD. Observational study of the effect of ketamine infusions on sedation depth, inflammation, and clinical outcomes in mechanically ventilated patients with SARSCoV-2. Anaesth Intensive Care.

2023 Nov 25:310057X231201184. doi: 10.1177/0310057X231201184.

Andrea L, Herman NS, Vine J, Berg KM, Choudhury S, Vaena M, Nogle JE, Halablab SM, Kaviyarasu A, Elmer J, ... Baram M, and colleagues; Society of Critical Care Medicine’s Discovery, the Critical Care Research Network DISCOVER In-Hospital Cardiac Arrest (DISCOVER IHCA): Investigator Group. The Discover In-Hospital Cardiac Arrest (Discover IHCA) Study: An Investigation of Hospital Practices After In-Hospital Cardiac Arrest. Crit Care Explor. 2024 Sep 11;6(9):e1149. doi: 10.1097/ CCE.0000000000001149.

Barta JA, Mazzone P, Nair V. MultiCancer and Single-Cancer Early Detection Testing: Opportunities and Challenges. CHEST 2024.

Tasevac B, Shusted CS, Ruane BM, Muse E, Okusanya O, Grenda TR, Evans NR, Kane GC, Wen KY, Juon HS, Barta JA. Asian-Americans in a Lung Cancer Screening Program Have Lower Annual Adherence Compared with Other Race Groups. CHEST Pulmonary 2024, https://doi.org/10.1016/j. chpulm.2024.100051.

Wen KY, Liang J, Diep D, Barta J, Juon HS. Smoking Cessation Interventions Among Asian Americans: A Scoping Review.

Racial Ethn Health Disparities.

2024. 11(5):3015-3028. doi: 10.1007/s40615-023-01760-w.

Shusted CS, Barta JA, Nguyen A, Wen KY, Juon HS, ZeiglerJohnson CJ. Characterizing Lung Cancer Burden Among Asian-American Communities in Philadelphia. Racial Ethn Health

Disparities. 2024. 11(5):25832595. doi: 10.1007/s40615023‑01723‑1.

for lung nodule evaluation and management. Cancer. 2024. doi: 10.1002/cncr.35181.

Martin JF, Kane GC, Shusted CS, Barta JA. Implementation of High-Quality Lung Cancer Screening: Impact of Centralized vs. Decentralized Processes. Popul Health Manag. 2024. 27(4):291293. doi: 10.1089/pop.2023.0266.

Glatt J, Chandar P. The future of chemical pleurodesis: A review of novel and investigational sclerosant agents. Am J Med Sci. 2024. 368(3):175-181. doi: 10.1016/j.amjms.2024.04.008.

Till BM, Grenda T, Tidwell T, Wickes B, Shusted C, Ruane B, Okusanya O, Evans NR 3rd, Barta JA. Brief Report: Nonmalignant Surgical Resection Among Individuals with ScreeningDetected Versus Incidental Lung Nodules. Clin Lung Cancer. 2024.

25(3):e129-e132.e4. doi: 10.1016/j. cllc.2023.12.006.

Shusted CS, Eberth JM, Juon HS, Barta JA. Characteristics associated with early vs. late adoption of lung cancer screening. Prev Med Rep. 2024.

44:102820. doi: 10.1016/j. pmedr.2024.102820.

Rshaidat H, Meredith L, Woodroof J, Aikhionbare I, Koeneman SH, Shusted C, Ruane B, Barta J, Okusanya OT. Incidence and Management of Cardiothoracic Relevant Extrapulmonary Findings Found on Low-Dose Computed Tomography. Ann Thorac Surg.

2024. 118(2):358-364. doi: 10.1016/j.athoracsur.2024.05.012.

Farjah F, Barta JA, Wood DE, Rivera MP, Osarogiagbon RU, Smith RA, Mullett TW, Rosenthal LS, Henderson LM, Detterbeck FC, Silvestri GA. The American Cancer Society National Lung Cancer Roundtable strategic plan: Promoting guideline-concordant lung cancer staging. Cancer. 2024. doi: 10.1002/cncr.34627.

Barta JA, Farjah F, Thomson CC, Dyer DS, Wiener RS, Slatore CG, Smith-Bindman R, Rosenthal LS, Silvestri GA, Smith RA, Gould MK. The American Cancer Society National Lung Cancer Roundtable strategic plan: Optimizing strategies

Garvey E, Naimi B, Duffy A, Kahn C, Farquhar D, Rosen M, Rabinowitz M, Evertz DP, Most J, Toskala E, Nyquist GG. Medication utilization for patients with chronic rhinosinusitis with nasal polyposis and asthma in 12 months preand post-dupilumab initiation. Int Forum Allergy Rhinol. 2024. doi: 10.1002/alr.23340.

Pena-Evertz D, BajantryB. Immunomodulation Therapy in Severe COVID-19 Infection: Where Do We Stand? COVID in focus: Perspective on the literature. CHEST NetWorks COVID-19 Task force. https:// www.chestnet.org/Guide lines-and-Resources/COVI D-19/COVID-in-Focus/1 mm unomodulation-Therapy in Severe COVID-19 infection.

Mangione S. The Empathy Gap. Am J Med. 2024.

137(3):290-291. doi: 10.1016/j. amjmed.2023.12.008.

Mangione S. The Naming: Tell Me How You Say it, and I'll Tell You What You Think. J Gen Intern Med. 2024. 39(6):1053-1055. doi: 10.1007/s11606-023-08602-9.

Mangione S, Basile M, Post SG. Out of Touch. JAMA. 2024 Mar 5;331(9):729-730. doi: 10.1001/ jama.2024.0888.

Mangione S. Did Jesus Die of Takotsubo Cardiomyopathy? A Medical Revisiting of the Gospels.

J Gen Intern Med. 2024. doi: 10.1007/s11606-024-09042-9.

Kazi AW, Yoo EJ, Oxman D. “Trust in the ICU: What every clinician should know.” J Crit Care. 2024; 83:154540.

FACU LT Y Ross Summer, MD Professor Deputy Division Director & Director of ILD Program Section Chief, TJU Hospital Michael Unger, MD Professor Volunteer Faculty Urvashi Vaid, MD Associate Professor Director of Foundations in Clinical Medicine Marcia Watson, DO Clinical Assistant Professor Director, Methodist Pulmonary Ambulatory Clinics Sandra Weibel, MD Clinical Assistant Professor Director of TJUH In-patient Pulmonary Care Frances Mae West, MD Associate Professor Fellowship Program Director Co-Director, Internal Medicine Point-of-Care Ultrasound Fellowship Co-Director, JeffPERT: Jefferson Pulmonary Embolism Response Team Erika Yoo, MD Associate Professor Director of TJUH MICU Director, Critical Care Program

Department of Medicine 2024 Annual Report

56 Oxman, D.A., & Richter, B. (2024).

Withdrawing Life Support After Attempted Suicide: A Case Study and Review of Ethical Consideration. Narrative Inquiry in Bioethics. 2024; 14:51-57.

ML Scharf. Potential respiratory complications in multiple myeloma patients undergoing percutaneous vertebroplasty may include non-thrombotic pulmonary embolism. Journal of Blood and Lymph. 2024. 14:2.

Loebe M, Deuse T, Sinha N, Koster A, Erdoes G. Lung Transplantation in Patients with Cystic Fibrosis: A Complex Task, A Changing Target.

J Cardiothorac Vasc Anesth. 2024.

38(3):635-637. doi: 10.1053/j. jvca.2023.12.020.

Pathak A, Sinha S, Sinha N. Lung transplant access disparities for Asian patients with idiopathic pulmonary fibrosis. Am J Med Sci. 2024 Sep 18:S00029629(24)01472-1. doi: 10.1016/j. amjms.2024.09.006.

Manickavel S, Ponsineras R, Fernandez J, Sinha N. Use of a Novel Algorithm for Multi-Genome Analysis in the Interpretation of Donor-derived Cell-free DNA in Lung Transplantation Following Allogeneic Hematopoietic Stem Cell Transplantation. American Journal of Transplantation. 2024; 84:102055.

Manickavel S, Glehn-Ponsirenas R, Gray J, Furuya Y, Fu D, Gulbahce N, Woodward R, Kaneku H, Castillo-Fernandez J, Salgado J, Pelaez A, Pipkin M, Machuca T, Sinha N. Nuances in the interpretation and utility of donor-derived cell-free DNA in lung transplantation following allogeneic hematopoietic stem cell transplantation - Case report.

Transpl Immunol 2024. 84:102055. doi: 10.1016/j.trim.2024.102055.

Sindhu R. Johnson, MD, PhD, Elana J. Bernstein, MD, MSc, Marcy B. Bolster, MD , Jonathan H. Chung, MD , Sonye K. Danoff,

MD, PhD , Michael D. George, MD, MSCE, Dinesh Khanna, MD, MS, Gordon Guyatt, MD, Reza D. Mirza, MD, Rohit Aggarwal, MD , Aberdeen Allen, Jr., PhD, ..., Ross Summer, MD. Guideline for Screening of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases Arthritis and Rheumatology.

Arthritis Care Res. 2024.

76:1051‑1069.

Sindhu R. Johnson, MD, PhD, Elana J. Bernstein, MD, MSc, Marcy B. Bolster, MD , Jonathan H. Chung, MD , Sonye K. Danoff, MD, PhD , Michael D. George, MD, MSCE, Dinesh Khanna, MD, MS, Gordon Guyatt, MD, Reza D. Mirza, MD, Rohit Aggarwal, MD, Aberdeen Allen, Jr., PhD, Ross Summer, MD, et al. 2023 ACR Guideline for the Treatment of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases, Arthritis and Rheumatology, 2024; 76:1182‑1200.

Kulkarni T, Criner GJ, Kass DJ, Rosas IO, Scholand MB, Dilling DF, Summer R, Duncan SR. Design of the STRIVE-IPF TrialStudy of Therapeutic Plasma Exchange, Rituximab, and Intravenous Immunoglobulin for Acute Exacerbations of Idiopathic Pulmonary Fibrosis. BMC Pulm Med. 2024. 24(1):143. doi: 10.1186/s12890-024-02957-3.

PMID: 38464052 Summer, R; Todd, JL; Neely, ML; Lobo, JL; Namen, A; Newby, KL; Shafazand, S; Suliman, S; Hesslinger, C; Keller, S; Leonard, KB. Palmer, SM; Ilkayeva, O; Muehlbauer, MJ; Newgard, CB; Roman, J. Circulating Metabolic Profile in Idiopathic Pulmonary Fibrosis: Data from the IPF-PRO Registry. Respir Res 2024; 25(1):58.

Summer R, Chun P. Pressed for understanding: Interstitial lung disease in dry-cleaning workers.

Am J Med Sci. 2024 Sep 3:S00029629(24)01442-3. doi: 10.1016/j. amjms.2024.08.026.

Kulkarni T, Criner GJ, Kass DJ, Rosas IO, Scholand MB, Dilling DF, Summer R, Duncan SR. Design of the STRIVE-IPF trialstudy of therapeutic plasma exchange, rituximab, and intravenous immunoglobulin for acute exacerbations of idiopathic pulmonary fibrosis. BMC Pulm Med. 2024. 24(1):143. doi: 10.1186/ s12890-024-02957-3.

Guo ZF, Tongmuang N, Li C, Zhang C, Hu L, Capreri D, Zuo MX, Summer R, Sun J. Inhibiting endothelial cell Mst1 attenuates acute lung injury in mice. JCI Insight. 2024. 9(17):e178208. doi: 10.1172/jci.insight.178208.

Fares J, Summer R, Loizidis G. Low utilization of statins in patients with dermatomyositis/ polymyositis and hyperlipidemia: a multicenter USA-based study (2013-2023). Clin Rheumatol.

2024. 43(1):325-338. doi: 10.1007/ s10067-023-06801-7.

Zhao J, Fares J, George G, Maheu A, Loizidis G, Roman J, Kramer D, Li M, Summer R. Racial and ethnic disparities in antifibrotic therapy in idiopathic pulmonary fibrosis.

Respirology. 2023; doi:10.1111/ resp.14563 Summer R, Todd JL, Neely ML, Lobo LJ, Namen A, Newby K, Shfazand S, Suliman S, H C, Kellre S, Leonard TB, Palmer SM, Ilkayeva O, Muehlbauer M, Newgard CB, Roman J. Circulating metabolic profile in idiopathic pulmonary fibrosis: data from the IPF-PRO Registry.

Respiratory Research, 25:58, 2024.

Mulkareddy V, Roman J. Pulmonary manifestations of alpha 1 antitrypsin deficiency. Am J Med Sci. 2024. 368(1):1-8. doi: 10.1016/j.amjms.2024.04.002.

Howard-Anderson JR, Gewin L, Rockey DC, Krousel-Wood M, Roman J. Strategies for developing a successful career in academic medicine. Am J Med

N OTA B L E ACH I E V E M E N T S Hospital US News & Report Ranking TOP 50 RANKING IN PULMONOLOGY & LUNG CANCER (39) 2024 Division Attending Teaching Award PRARTHNA CHANDAR, MD 2024 Ambulatory Attending of the Year Award DANIEL KRAMER, MD 2024 SKMC Dean’s Award for Excellence in Education URVASHI VAID, MD 2024 Golden Apple Award POCUS Group FRANCES MAE WEST, MD 2024 ICU Attending Educator of the Year ERIKA YOO, MD 2024 Top 25 Teachers JULIE BARTA, MD DAMARIS EVERTZ, MD GAUTAM GEORGE, MD DANIEL KRAMER, MD ROSS SUMMER, MD URVASHI VAID, MD ERIKA YOO, MD Pennsylvania Society for Respiratory Care 2024 GOLD AWARD TO RESPIRATORY THERAPY TEAM Spotlight Award KERRI BAUMGARDNER, RT Excellence in APC Precepting Award SEAN DEITER 2024 Philadelphia Magazine Top Doctors GREGORY C. KANE, MD JESSE ROMAN, MD MICHAEL L. SCHARF, MD National Posts RAFAEL L. PEREZ, MD Coalition of Sarcoidosis Research JESSE ROMAN, MD Treasurer, American Thoracic Society ROSS SUMMER, MD Pulmonary Fibrosis Foundation FY 2024 Symposia 3RD PULMONARY FIBROSIS 1 3TH ANNUAL LUNG CANCER SYMPOSIUM 6TH ANNUAL LUNG CANCER SCREENING SUMMIT

Department of Medicine 2024 Annual Report

57 Sci. 2024. 367(4):215-227. doi: 10.1016/j.amjms.2023.12.010.

Atabai K, Badr MS, Costello J, Ridge K, Rounds S, Turenne M, White ES, Roman J. The American Thoracic Society Research Program: Twenty Years of Driving Discovery in Respiratory Medicine.

Am J Respir Crit Care Med. 2024 May 1;209(9):1047-1048. doi: 10.1164/rccm.202402-0348ED. PMID: 38422387 Ritzenthaler JD, Watson WH, Roman J. α4 Nicotinic Acetylcholine Receptors in Lipopolysaccharide-Related Lung Inflammation. Int J Mol Sci. 2024. 25(20):11305. doi: 10.3390/ ijms252011305.PMID: 39457087 Fares J, El Fadel O, Zhao J, Sun J, Roman J, Loizidis G, Summer R. Mortality and Health Outcomes Among Patients with Sarcoidosis Treated with AngiotensinConverting Enzyme Inhibitors and Angiotensin Receptor Blockers. Chest. 2024. S00123692(24)05265-6. doi: 10.1016/j. chest.2024.09.009.

Oto B, Baeten R, Chen L, Dalal P, Dancel R, Fox S, Lange Iv CW, Baston C, Bornemann P, Dugar S, Goldsmith A, Herbst MK, Kirkpatrick JN, Koratala A, Lanspa MJ, Lobo V, Nomura JT, Pustavoitau A, Senussi MH, Sorrell VL, West FM, Sarwal A. Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus. POCUS J. 2024. 9(1):95-108. doi: 10.24908/ pocus.v9i1.17240.

Kirkpatrick JN, Panebianco N, Díaz-Gómez JL, Adhikari S, Bremer ML, Bronshteyn YS, Damewood S, Jankowski M, Johri A, Kaplan JRH, Kimura BJ, Kort S, Labovitz A, Lu JC, Ma IWY, Mayo PH, Mulvagh SL, Nikravan S, Cole SP, Picard MH, Sorrell VL, Stainback R, Thamman R, Tucay ES, Via G, West FM. J Am Soc Echocardiogr. 2024. S08947317(24)00222-0. doi: 10.1016/j. echo.2024.05.001.

Teran F, West FM, Jelic T, Taylor L, Jafry ZM, Burns KM, Owyang CG, Emt CC, Abella BS, Andrus P; On behalf ACEP Emergency Ultrasound Section and the Resuscitative TEE Collaborative Registry (rTEECoRe) Investigators.

Resuscitative transesophageal echocardiography in emergency departments in the United States and Canada: A cross-sectional survey. Am J Emerg Med. 2024.

76:164-172. doi: 10.1016/j. ajem.2023.11.041.

Giri J, Mahfoud F, Gebauer B, Andersen A, Friedman O, Gandhi RT, Jaber WA, Pereira K, West FM. J Soc Cardiovasc Angiogr Interv.

2024 May 3;3(6):101982. doi: 10.1016/j.jscai.2024.101982.

Moriarty JM, Dohad SY, Schiro BJ, Tamaddon H, Heithaus RE, Iliadis EA, Dexter DJ 2nd, Shavelle DM, Leal SRN, Attallah AS, West FM, Keeling WB, Sharp ASP, Weinberg I. Clinical, Functional, and Qualityof-Life Outcomes after Computer Assisted Vacuum Thrombectomy for Pulmonary Embolism: Interim Analysis of the STRIKE-PE Study.

J Vasc Interv Radiol. 2024.

35(8):1154-1165.e6. doi: 10.1016/j. jvir.2024.04.028.

Teran F, Owyang CG, Wray TC, Hipskind JE, Lessard J, Bédard Michel W, Lanthier C, Nazerian P, de Villa E, Nogueira J, Doynow D, Clinton M, Myslik F, Prager R, Arntfield R, Salinas PD, Dieiev V, Woo MY, Thavanathan R, Puskas G, Singh K, West FM, et al. Resuscitative TEE Collaborative Registry (rTEECoRe) Investigators. Development and Implementation of a Multicenter Registry for ResuscitationFocused Transesophageal Echocardiography. Ann Emerg Med. 2024. S01960644(24)00448-7. doi: 10.1016/j. annemergmed.2024.08.004.

S E L EC T E D G R A N T S & CL I N I C A L T R I A L S RO1HL147088 (NIH/NHLBI) Early life exposures and chronic lung disease PI: ROMAN RO1HL152703 (NIH/NHLBI) Targeting latexin signaling for endothelial barrier dysfunction in inflammatory lung injury MPI: SUMMER AND SUN CLINICAL TRIALS: SPONSOR: BOEHRINGER INGELHEIM PHARMACEUTICALS INC. Idiopathic Pulmonary Fibrosis Prospective Outcomes (IPF-PRO) and Chronic Fibrosing Interstitial Lung Disease with Progressive Phenotype Prospective Outcomes (ILD-PRO) Registry PI: ROMAN

SPONSOR: DELFI DIAGNOSTICS, INC. CASCADE-LUNG. Cancer Screening Assay using DELFI; A Clinical Validation Study in Lung PI: BARTA SPONSOR: ASTRA ZENECA UK LIMITED. COPD in LCS Registry Leveraging Lung Cancer Screening to Optimize Screening Outcomes and COPDManagement PI: BARTA SPONSOR: NUCLEIX INC. Lung-RND-003 Determination and Validation of Lung EpiCheck a Multianalyte Assay for Lung Cancer Prediction. A CaseControl Study.

PI: BARTA

SPONSOR: BOEHRINGER INGELHEIM PHARMACEUTICALS INC. 1305-0014 (Fibroneer) A double blind, randomized, placebo-controlled trial evaluating the efficacy and safety of BI 1015550 over at least 52 weeks in patients with Idiopathic Pulmonary Fibrosis (IPF) PI: ROMAN

SPONSOR: BRISTOL-MYERS SQUIBB COMPANY. IM027068 A Multicenter, Randomized, Double-blind, Placebocontrolled, Phase 3 Study to Evaluate the Efficacy, Safety, and Tolerability of BMS-986278 in Participants with Idiopathic Pulmonary Fibrosis PI: SUMMER

SPONSOR: BOEHRINGER INGELHEIM PHARMACEUTICALS INC. 1305-0023 (Fibroneer 2) A double blind, randomized, placebo-controlled trial evaluating the efficacy and safety of BI 1015550 over at least 52 weeks in patients with Progressive Fibrosing Interstitial Lung Diseases (PF-ILDs) PI: ROMAN

SPONSOR: BRISTOL-MYERS SQUIBB COMPANY IM0271015 A Multicenter, Randomized, Double-blind, Placebocontrolled, Phase 3 Study to Evaluate the Efficacy, Safety, and Tolerability of BMS-986278 in Participants with Progressive PulmonaryFibrosis PI: SUMMER

SPONSOR: VERACYTE, INC. DHF-009-050 / Nightingale CliNIcal Utility of ManaGement of Patients with CT and LDCT Identified Pulmonary Nodules UsinG the Percepta NasAL Swab ClassifiEr PI: BARTA SPONSOR: ASTRAZENECA. D5989C00001/THARROS A Study Evaluating the Efficacy of Breztri/Trixeo on Cardiopulmonary Outcomes in Chronic Obstructive Pulmonary Disease THARROS PI: BARTA

SPONSOR: AVALYN PHARMA INC. AP01-007 A Placebo-Controlled Study of Inhaled Pirfenidone in Progressive Pulmonary Fibrosis PI: SUMMER SPONSOR: NIH THROUGH THE UNIVERSITY OF ALABAMA. Strive – IPF Management of acute exacerbation of IPF PI: SUMMER

Department of Medicine 2024 Annual Report

58

S E L EC T E D G R A N T S & CL I N I C A L T R I A L S

SPONSOR: NIH THROUGH NATIONAL JEWISH HEALTH. A Phase 2, Randomized, Double-Blind, PlaceboControlled Efficacy and Safety Study of Obinutuzumab in Subjects with Connective Tissue Disease-Related Interstitial Lung Disease PI: SUMMER SPONSOR: UNITED THERAPEUTICS CORP. RIN-PF-301/TETON Intervention in idiopathic pulmonary fibrosis PI: GEORGE SPONSOR: UNITED THERAPEUTICS CORP. RIN-PF-302/TETON Extension Study of Inhaled Treprostinil in Subjects with Fibrotic Lung Disease PI: GEORGE SPONSOR: UNITED THERAPEUTICS CORP. GMS-PH-401 A Real-world Patient Registry in Group 3 Pulmonary Hypertension Associated with Interstitial Lung Disease (PH ILD) PI: GEORGE SPONSOR: ASTRAZENECA PHARMACEUTICALS LP CHRONICLE / D3250R00023.

Asthma PI: PENA SPONSOR: SEDANA MEDICAL AB. INSPiRE-ICU2 A Phase 3, Multicenter, Randomized, Controlled, Open-Label, AssessorBlinded Study to Evaluate the Efficacy and Safety of Inhaled Isoflurane Delivered via the Sedaconda ACD-S Compared to Intravenous Propofol for Sedation of Mechanically Ventilated Intensive Care Unit Adult Patients (INSPiRE-ICU2) PI: BARAM SPONSOR: DOMPE PHARMACEUTICAL SPA. REPAVID-22 Reparixin 1200 mg three times a day as add-on therapy to standard of care to limit disease progression in hospitalized adult patients with COVID-19 and other community acquired pneumonia. A multinational, multicentre, randomised, double-blinded, placebocontrolled, parallel-group phase III trial.

PI: BARAM

SPONSOR: BIOTEST AG. ESCAPE A randomized, placebocontrolled, double-blind, multi-center, phase III trial to assess the efficacy and safety of trimodulin (BT588) in hospitalized subjects with severe community-acquired pneumonia (sCAP) PI: BARAM SPONSOR: STIMDIA MEDICAL, INC. CIP0002 / ReInvigorate Study Randomized Study of the pdSTIM&8482; System (Phrenic Nerve to Diaphragm STIMulation) in Failure to Wean Mechanically Ventilated Patients (ReInvigorate) PI: BARAM SPONSOR: ABBOTT POINT OF CARE. CS-2022-0009 / ActPro Clinical Evaluation of the i-STAT ACTpro Cartridge using Venous and Arterial Whole Blood Specimens on the i-STAT 1 Analyzer in an Adult Population PI: BARAM SPONSOR: NIH THROUGH UNIVERSITY OF MARYLAND. Chill Fixed Price Cooling to Help Injured Lungs (CHILL) Phase IIB Randomized Control Trial of Therapeutic Hypothermia in Patients with ARDS PI: BARAM SPONSOR: SPECTRAL MEDICAL, INC. SDI-PMX-NA003 / TIGRIS TRIAL Safety and Efficacy of Polymyxin B Hemoperfusion (PMX) for Endotoxemic Septic Shock in a Randomized, Open-Label Study PI: BARAM SPONSOR: UNITED THERAPEUTICS CORP. ADP9811-301; ROR-PH-301 A Study evaluatiNg the Efficacy and Safety of Ralinepag to Improve Treatment Outcomes in PAH Patients (Advanceoutcomes) PI: SCHARF SPONSOR: AEROVATE THERAPEUTICS, INC. IMAHCT-FUL; AV-101-303 A Study Evaluating the Long-Term Efficacy and Safety of Ralinepag in Subjects with PAH via an Open-Label Extension (Advance‑extension) PI: SCHARF

SPONSOR: JANSSEN RESEARCH AND DEVELOPMENT LLC. AC-077A301, ADUE Prulti-center, double-blind, randomized, activecontrolled, triple-dummy, parallel-group, groupsequential, adaptive Phase 3 clinical study to compare the efficacy and safety of macitentan and tadalafil monotherapies with the corresponding fixed dose combination in subjects with pulmonary arterial hypertension (PAH), followed by an open-label treatment period with macitentan and tadalafil fixed dose combination therapy.

PI: SCHARF

Department of Medicine 2024 Annual Report

DIVISION OF RHEUMATOLOGY

59

The Division of Rheumatology at Thomas Jefferson University, established in 1959, has a long tradition of commitment to specialized care within the discipline of rheumatology. Historically pioneering regional disease-centered clinics, the Division’s faculty expanded over the past decade the scope of caring for patients with autoimmune disorders to collaborative multispecialty channels with allied Divisions and Departments.

by Dr. Chantel Park.

Dr. Park also directs the rheumatologyophthalmologyneurosurgery- neurologyneuroradiologyneuropathology multidisciplinary quarterly conference focusing on rare inflammatory diseases affecting the eye or central nervous system.

CLINICAL The Division’s transition to the Honickman multispecialty building in April 2024 offered a new, modern home to rheumatology patients, faculty, fellows, nurse practitioner, nurses and ancillary staff. Patients and medical teams are exploring and adjusting to evolving workflows.

Established specialized clinics focusing on Systemic Lupus Erythematosus, scleroderma, and neuro-ocular inflammatory disease and collaborative clinics focusing on Interstitial Lung Disease and cutaneous manifestations of autoimmune disorders are sought by trainees as a unique educational opportunity and by patients as a highly desired avenue to efficient and readily accessible expert care.

Specialized rheumatology clinics in the Center City Honickman building location include: •

Scleroderma clinic: directed by Dr. Fabian Mendoza

•

Systemic Lupus Erythematosus clinic: directed by Dr. Marianthi Kiriakidou

•

Neuro and ocular inflammatory disease: specialized outpatient consultative care provided

•

Interstitial Lung Disease in Connective Tissue Disorders: co-directed by Dr. Timothy Wilson (rheumatology) and Drs. Ross Summer and Gautam George (pulmonary medicine).

•

Integrative Medicine: specialized outpatient consultative care provided

by Dr. Yiu Tak Leung, board certified in rheumatology and integrative medicine.

•

Rheumatology – Dermatology collaborative clinic: monthly outpatient clinic co-directed

by Dr. Andres Ponce (rheumatology) and Dr. Sherry Yang (dermatology) and joined by Dr. Fabian Mendoza (rheumatology) and Dr. Matthew Keller (dermatology).

At the Bala Cynwyd location Drs. Yiu Tak Leung, Fabian Mendoza and Chantel Park and at the Navy Yard location Drs. Amanda

Nussdorf, Andres Ponce and Marta Bean provide general and specialized outpatient rheumatology care integrated to a multispecialty practice.

E D U C AT I O N The Rheumatology Fellowship Program now under the direction of Dr. Andres Ponce fosters two trainees per year. The program, supported by faculty dedicated in teaching and mentoring of trainees has been successfully recruiting qualified candidates.

Faculty in the Division teach and mentor medical students, Internal Medicine residents, residents rotating in Women’s Health specialties, and visiting international residents. The Division supports Jefferson’s collaboration with Università Cattolica del Sacro Cuore MD International Program in Rome and welcomed the first rotating student from Italy in 2024.

Rotating Internal Medicine residents and medical students are exposed to a broad spectrum of outpatient and inpatient rheumatology consultations and participate in research projects. The Division’s faculty members participate in the Internal Medicine subspecialty lecture series and in the Jeff MD curriculum. Dr. Chantel Park is a member of the core team of Jeff MD instructors.

FACU LT Y Marianthi Kiriakidou, MD Associate Professor of Medicine Division Director Associate Fellowship Program Director

Andres Ponce, MD Clinical Assistant Professor Fellowship Program Director Yiu Tak Leung, MD, PhD Clinical Assistant Professor of Medicine Michele Meltzer, MD Clinical Associate Professor, Adjunct Fabian Mendoza, MD Associate Professor of Medicine Amanda Nussdorf, MD Clinical Assistant Professor Chantel Park, MD Clinical Assistant Professor Timothy Wilson, MD Assistant Professor of Medicine

Department of Medicine 2024 Annual Report

60 R E S E A RC H Research in the Division includes translational and clinical projects and offers the opportunity to fellows, residents and medical students to participate in a variety of scholarly activities.

Fabian Mendoza MD •

Translational Collaborative Research with the Department of Dermatology Studies of exosomal content and risk of relapse in Diffuse Cutaneous Systemic Sclerosis

•

Cinical Collaborative Research Ultrasound assessment of microvasculature disease in Systemic Sclerosis-related Raynaud’s Respiratory weakness in Scleroderma Ultrasound assessment of peripheral arteries in SSc

Timothy Wilson MD •

Biomarkers in Rheumatoid Arthritis-Associated Interstitial Lung Disease

•

Biomarkers in Preclinical Rheumatoid Arthritis

•

Temporal artery biopsy descriptive cohort

•

Investigate clinical and serologic differences in patients with positive versus negative biopsies at Jefferson

•

Dermatomyositisassociated Interstitial Lung Disease descriptive cohort (multi-institutional)

•

Nailfold capillaroscopy in non-scleroderma CTD-ILD

and interstitial pneumonia with autoimmune features

Q UA L I T Y I M P R OV E M E N T The Division continues to work on quality improvement goals and metrics, engaging fellows and faculty. Areas of focus in the past have included disease activity metrics in Lupus and Rheumatoid Arthritis, smoking cessation in rheumatoid arthritis and osteoporosis prevention in high-risk patients. The faculty’s dedication to osteoporosis prevention and safe management of high-risk medications continues through quality improvement projects now under Dr. Marta Bean’s leadership.

S E L EC T P U B L I C AT I O N S Lescoat A, Huang S, Carreira PE, Siegert E, de Vries-Bouwstra J, Distler JHW, Smith V, Del Galdo F, Anic B, Damjanov N, Rednic S, Ribi C, Bancel DF, Hoffmann-Vold AM, Gabrielli A, Distler O, Khanna D, Allanore Y; EUSTAR collaborators.

Cutaneous Manifestations, Clinical Characteristics, and Prognosis of Patients With Systemic Sclerosis Sine Scleroderma: Data From the International EUSTAR Database.

JAMA Dermatol. 2023 Aug 1;159(8):837-847. doi: 10.1001/ jamadermatol.2023.1729.PMID: 37378994 Mendoza FA, Allawh T, Jimenez SA. Pharmacological treatment of systemic sclerosis-associated interstitial lung disease: an updated review and current approach to patient care.

Clin Exp Rheumatol. 2023 Aug;41(8):1704-1712. doi: 10.55563/clinexprheumatol/ am4nmv. Epub 2023 Jun 22.PMID: 37382458 Review.

Deibel E, Carreira PE, Vonk M, Del Papa N, Bečvář R, GuillénDel-Castillo A, Campochiaro C, Poormoghim H, Liem S, Lazzaroni MG, Giollo A, Mekinian A, de Vries-Bouwstra J, De Santis M, Balbir-Gurman A, Mihai C, De Luca G, Moiseev S, Zanatta E, Foti R, Rednic S, Denton C, Cutolo M, Belloli L, Airo P, Garzanova L, Moroncini G, İnanç M, Panopoulos S, Tandaipan JL, Chatelus E, Rosato E, Kuwana M, Yavuz S, Alegre-Sancho JJ, Smith V, Szűcs G, Henes J, RodríguezPintó I, Atzeni F, Spierings J, Truchetet ME, Milchert M, Brito de Araujo D, Riemekasten G, Bernardino V, Martin T, Del Galdo F, Vacca A, Mendoza F, Midtvedt Ø, Murdaca G, Santiago T, Codullo V, Cacciapaglia F, Walker U, Brunborg C, Tirelli F, Allanore Y, Furst DE, Matucci M, Gabrielli A, Distler O, Hoffmann-Vold AM. Does the Impact of COVID-19 on Patients With Systemic Sclerosis Change Over Time? Arthritis Care Res (Hoboken). 2024 Jan;76(1):8897. doi: 10.1002/acr.25226. Epub 2023 Dec 11.PMID: 37667424 Wilson TM, Bolt M, Stahly A, Lee JS, Bang TJ, Sachs PB, Deane KD, Humphries SM, Solomon JJ, Demoruelle MK. Transforming Growth Factor-Beta is Increased in Sputum from Individuals with Rheumatoid ArthritisAssociated Pulmonary Fibrosis.

Rheumatology (Oxford). 2024 Dec 18:keae697. doi: 10.1093/ rheumatology/keae697. Epub ahead of print. PMID: 39693122.

Nussdorf A, Park E, Amigues I, Geraldino-Pardilla L, Bokhari S, Giles JT, Bathon JM. Associations of galectin-3 levels with measures of vascular disease in patients with rheumatoid arthritis.

Semin Arthritis Rheum. 2024 Apr;65:152357. doi: 10.1016/j. semarthrit.2023.152357. Epub 2024 Jan 15. PMID: 38244444; PMCID: PMC11238268.

N OTA B L E ACH I E V E M E N T S 2018, 2019, 2020, 2021, 2022, 2023, 2024 Philadelphia Magazine Top Doctors MARIANTHI KIRIAKIDOU, MD 2018, 2019, 2020, 2021,2022,2023, 2024 Castle Connolly Top Doctors MARIANTHI KIRIAKIDOU, MD 2024, Castle Connolly Top Doctors ANDRES PONCE MD 2019, 2020, 2021, 2022, 2023, 2024 Exceptional Women In Medicine MARIANTHI KIRIAKIDOU, MD

Department of Medicine 2024 Annual Report

CENTER FOR TRANSLATIONAL MEDICINE

61

FACU LT Y Deepak Deshpande, PhD

On July 1st, 2023, Deepak Deshpande was named Director of the Center, replacing Raymond Penn, who remains in his role as Vice-Chair of research in the DOM. During FY 2024, we lost 1 faculty researcher, Dr. Rafiq. Drs. Ramirez and Chan went part-time.

Most research and educational opportunities remain the same in the Center for Translational Medicine since the last report. Since the development of the new medical school curriculum, opportunities for teaching of medical school students have been limited, although teaching in the new Integrative Physiology graduate school programs has increased.

Extramural Research Grant Funding FY13 - FY24 $7,000,000

$6,000,000

$5,000,000

$4,000,000

$3,000,000

$2,000,000

$1,000,000

$0

•FY13

•FY14

•FY15

•FY16

•FY17

Directs

•FY18

•FY19

•FY20

•FY21

ICD's

•FY22

•FY23

•FY24

Professor Director, Center for Translational Medicine

Tung Chan, PhD Research Assistant Professor Seo-Hee Cho, PhD Associate Professor Jason Choi, PhD Assistant Professor Boopathi Ettickan, PhD Assistant Professor Jarin Hongpaisan, DVM, PhD Research Assistant Professor Ajay Nayak, PhD Assistant Professor Tonio Pera, PhD Assistant Professor Maria Ramirez, PhD Associate Professor Pawan Sharma, PhD Assistant Professor Shey-Shing Sheu, PhD William Wikoff Smith Professor in Cardiovascular Research DirectsSummer, MD Ross IDC's Professor Jianxin Sun, PhD Professor Mudit Tyagi, PhD Associate Professor Bin Wang, PhD Associate Professor

Department of Medicine 2024 Annual Report

62 E D U C AT I O N Dr. Deshpande and Dr. Ramirez teach in the SKMC JeffMD program. Drs. Penn, Pera, Wang, Choi, Sharma, Ettickan, Hongpaisan, Tyagi and Chan teach multiple classes in different graduate programs. Drs. Penn, Deshpande, Pera, Nayak, Choi, Sharma, and Chan are founding faculty in the Integrative Physiology graduate program and will be directing courses and lecturing in the coming year.

Due to our research success, we continue to attract excellent graduate students and Postdoctoral Fellows. We currently have 5 graduate students and 11 Post-doctoral Fellows. We are confident that this robust graduate and post-graduate training will continue. Moreover, our faculty members are actively participating in our school’s teaching for medical and graduate students.

In summary, we continued to succeed in achieving our goals in research and education mission. It is our goal to further build the Center for Translational Medicine in the coming years to maintain and enhance our international reputation as leaders in translational research.

I N S T I T U T I O N A L S E RV I C E Drs. Deshpande, Ettickan, and Chan are serving on TJU’s Institutional Committee on Animal Care and Use committee.

Drs. Deshpande and Nayak are serving on the Committee of Admission (JeffMD) Drs. Nayak, Choi and Deshpande are involved in Committee of Admission for various graduate programs.

P U B L I C AT I O N S Javed E, Nayak AP, Jannu AK, Cohen AH, Dewes I, Wang R, Tang DD, Deshpande DA, Penn RB. A-Kinase-Anchoring-Protein Subtypes Differentially Regulate GPCR Signaling and Function in Human Airway Smooth Muscle.

Am J Respir Cell Mol Biol. 2024 Aug 14. doi: 10.1165/rcmb.20230358OC. Online ahead of print.

PMID: 39141573 Conaway S Jr, Huang W, Hernandez-Lara MA, Kane MA, Penn RB, Deshpande DA Molecular mechanism of bitter taste receptor agonist-mediated relaxation of airway smooth muscle. FASEB J. 2024 Jul 31;38(14):e23842. doi: 10.1096/ fj.202400452R.PMID: 39037554 Liao G, Wang R, Wu Y, Maheshwari NK, Penn RB, Tang DD. Nestin drives allergeninduced airway smooth muscle hyperplasia and airway remodeling. Allergy. 2024 Mar;79(3):744-746. doi: 10.1111/ all.15932. Epub 2023 Oct 27.PMID: 37897062 No abstract available.

Deshpande DA, Penn RB. Reactive Oxygen Species Behaving Badly: Oxidized Phosphatidylcholines Corrupt Ca2+ Signaling in Airway Smooth Muscle. Am J Respir Cell Mol Biol.

2023 Dec;69(6):605-607. doi: 10.1165/rcmb.2023-0295ED. PMID: 37672671 Free PMC article. No abstract available.

Tompkins E, Mimic B, Penn RB, Pera T.J The biased M3 mAChR ligand PD 102807 mediates qualitatively distinct signaling to regulate airway smooth muscle phenotype. Biol Chem.

2023 Oct;299(10):105209. doi: 10.1016/j.jbc.2023.105209. Epub 2023 Sep 1.PMID: 37660916 Free PMC article.

Nayak AP, Javed E, Villalba DR, Wang Y, Morelli HP, Shah SD,

Kim N, Ostrom RS, Panettieri RA Jr, An SS, Tang DD, Penn RB. Prorelaxant E-type Prostanoid Receptors Functionally Partition to Different Procontractile Receptors in Airway Smooth Muscle. Am J Respir Cell Mol Biol.

2023 Nov;69(5):584-591. doi: 10.1165/rcmb.2022-0445OC. PMID: 37523713 Free PMC article.

Ippolito M, De Pascali F, Hopfinger N, Komolov KE, Laurinavichyute D, Reddy PAN, Sakkal LA, Rajkowski KZ, Nayak AP, Lee J, Lee J, Cao G, Donover PS, Reichman M, An SS, Salvino JM, Penn RB, Armen RS, Scott CP, Benovic JL. Identification of a β-arrestin-biased negative allosteric modulator for the β2-adrenergic receptor. Proc Natl Acad Sci U S A. 2023 Aug;120(31):e2302668120. doi: 10.1073/pnas.2302668120. Epub 2023 Jul 25.PMID: 37490535 Free PMC article.

Hernandez-Lara MA, Yadav SK, Conaway S Jr, Shah SD, Penn RB, Deshpande DA. Crosstalk between diacylglycerol kinase and protein kinase A in the regulation of airway smooth muscle cell proliferation. Respir Res. 2023 Jun 10;24(1):155. doi: 10.1186/s12931-023-02465-8.

PMID: 37301818 Free PMC article.

Jason Choi, PhD. Kunal Sikder et al. Perinuclear damage from nuclear envelope deterioration elicits stress responses that contribute to LMNA cardiomyopathy. Sci. Adv. 10, eadh0798 (2024). DOI:10.1126/ sciadv.adh0798 Shigematsu M, Kawamura T, Deshpande DA, Kirino Y. Immunoactive signatures of circulating tRNA- and rRNAderived RNAs in chronic obstructive pulmonary disease.

Mol Ther Nucleic Acids. 2024 Jul 19;35(3):102285.

Javed E, Nayak AP, Jannu AK, Cohen AH, Dewes I, Wang R, Tang DD, Deshpande DA,

N OTA B L E ACH I E V E M E N T S DEEPAK DESHPANDE, PHD Received the Distinguished Mentor Award for postdoctoral fellows from the Jefferson College of Life Sciences Served on two NIH study sections Participated in reviewing grants for a funding agency in Italy BOOPATHI ETTICKAN, PHD Served as an ad hoc reviewer for the Kidney and Urological Systems Function and Dysfunction (KUFD) study section, NIDDK, NIH in October 2023, Feb 2024, and June 2024.

AJAY NAYAK, PHD Professional appointment: Chair – Allergic Fungal Respiratory Diseases Committee, American Academy of Allergy, Asthma and Immunology.

TONIO PERA, PHD Served as ad hoc reviewer on the LCMI NIH study section Served as Guest Editor for International Journal for Molecular Sciences Special Issue: Signaling in Respiratory Diseases ROSS SUMMER, MD Completed 4 year tenure as member of NIH Study Section Appointed Pulmonary Fibrosis Foundation Care Center Network Steering Committee Appointed Pulmonary Fibrosis Foundation Site Selection Committee.

BIN WANG, PHD NIH study sections of SBSR (June 2023), SBDD (February 2023), and SBSR (July 2022).

Department of Medicine 2024 Annual Report

63 Penn RB. A-Kinase-AnchoringProtein Subtypes Differentially Regulate GPCR Signaling and Function in Human Airway Smooth Muscle. Am J Respir Cell Mol Biol. 2024 Aug 14. doi: 10.1165/rcmb.2023‑0358OC. Dogan S, Walseth TF, Guvenc Tuna B, Uçar E, Kannan MS, Deshpande DA. CD38/cADPRmediated calcium signaling in a human myometrial smooth muscle cell line, PHM1. IUBMB Life 2024 Dec;76(12):1223-1233. doi: 10.1002/iub.2904.

Conaway S Jr, Huang W, Hernandez-Lara MA, Kane MA, Penn RB, Deshpande DA. Molecular mechanism of bitter taste receptor agonist-mediated relaxation of airway smooth muscle. FASEB J. 2024 Jul 31;38(14):e23842. doi: 10.1096/ fj.202400452R. Shigematsu M, Kawamura T, Deshpande DA, Kirino Y. Immunoactive signatures of circulating tRNA- and rRNAderived RNAs in chronic obstructive pulmonary disease. bioRxiv [Preprint]. 2024 Jun 19:2024.06.19.599707. doi: 10.1101/2024.06.19.599707.

Krishnan R, Kannan MS, Deshpande DA. Superoxide Anions Inhibit Intracellular Calcium Response in Porcine Airway Smooth Muscle Cells. AJP Rep. 2024 May 23;14(2):e162e169. doi: 10.1055/a-2318-0625.

Hernandez-Lara MA, Richard J, Deshpande DA. Diacylglycerol kinase is a keystone regulator of signaling relevant to the pathophysiology of asthma. Am J Physiol Lung Cell Mol Physiol.

2024 Jul 1;327(1):L3-L18.

Akkenepally SV, Yombo DJK, Yerubandi S, Reddy GB, Deshpande DA, McCormack FX, Madala SK. Interleukin 31 receptor α promotes smooth muscle cell contraction and airway hyperresponsiveness

in asthma. Nat Commun. 2023 Dec 11;14(1):8207. doi: 10.1038/ s41467-023-44040-1.

Singh BK, Yokoyama Y, Tanaka Y, Laczkó D, Deshpande DA, Kambayashi T. Diacylglycerol kinase zeta deficiency attenuates papain-induced type 2 airway inflammation. Cell Immunol.

2023 Nov-Dec;393-394:104780.

Loblundo C, Severa J, Peruggia GA, Black KR, Chandra S, Lata H, ElSohly M, Chapman MD, Deshpande DA, Nayak AP. Proteomics-Based Approach for Detailing the Allergenic Profile of Cannabis Chemotypes. Int J Mol Sci. 2023 Sep 11;24(18):13964.

Deshpande DA, Penn RB. Reactive Oxygen Species Behaving Badly: Oxidized Phosphatidylcholines Corrupt Ca2+ Signaling in Airway Smooth Muscle. Am J Respir Cell Mol Biol.

2023 Dec;69(6):605-607.

Bellucci CHS, Hemerly TS, Albuquerque LRT, Pimenta R, Schreiter VG, Reis STD, Jr JB, Leite KRM, Antunes A, Boopathi E, Nahas WC, Gomes CM. Downregulation of PIEZO2 in the Detrusor of Men with Bladder Outlet Obstruction and its Association with Urinary Retention and Decreased Bladder Compliance. Int Neurourol J. 2024. Sep; 28 (3): 225-231. PMID: 39363413.

Boopathi E, Den RB, Thangavel C. Innate Immune System in the Context of Radiation Therapy for Cancer. Cancers (Basal).

2023 Aug 4; 15(15):3972. PMID: 37568788. Note: EB and CT are corresponding authors.

Wang H, Zhang Z, Hongpaisan J. PKCε activator protects hippocampal microvascular disruption and memory defect in 3×Tg-Alzheimer's disease mice with cerebral microinfarcts. Front Aging Neurosci. 2023 Dec 15;15:1272361. doi: 10.3389/fnagi.2023.1272361. eCollection 2023.

Wang H, Zhang Z, Sittirattanayeunyong S, Hongpaisan J. Association of Apolipoprotein E4-related Microvascular Disease in the Alzheimer's Disease Hippocampal CA1 Stratum Radiatum. Association of Apolipoprotein E4-related Microvascular Disease in the Alzheimer's Disease Hippocampal CA1 Stratum Radiatum.

Inan S, Ward SJ, Baltazar CT, Peruggia GA, Javed E, Nayak AP. Epicutaneous Sensitization to the Phytocannabinoid β-Caryophyllene Induces Pruritic Inflammation. Int J Mol Sci. 2023 Sep 20;24(18):14328. doi: 10.3390/ijms241814328.PMID: 37762646 Ippolito M, De Pascali F, Hopfinger N, Komolov KE, Laurinavichyute D, Reddy PAN, Sakkal LA, Rajkowski KZ, Nayak AP, Lee J, Lee J, Cao G, Donover PS, Reichman M, An SS, Salvino JM, Penn RB, Armen RS, Scott CP, Benovic JL. Identification of a β-arrestin-biased negative allosteric modulator for the β2-adrenergic receptor. Proc Natl Acad Sci U S A. 2023 Aug;120(31):e2302668120. doi: 10.1073/pnas.2302668120. Epub 2023 Jul 25.PMID: 37490535 Nayak AP, Javed E, Villalba DR, Wang Y, Morelli HP, Shah SD, Kim N, Ostrom RS, Panettieri RA Jr, An SS, Tang DD, Penn RB. Prorelaxant E-type Prostanoid Receptors Functionally Partition to Different Procontractile Receptors in Airway Smooth Muscle. Am J Respir Cell Mol Biol.

2023 Nov;69(5):584-591. doi: 10.1165/rcmb.2022-0445OC. PMID: 37523713 Morelli HP, Thorpe C, Ebo DG, Chapman MD, Abbas K, Sussman GL, Nayak AP. Relevance of lipid transfer protein to Cannabis sensitization in North America.

J Allergy Clin Immunol Pract.

NEW GRANTS DEEPAK DESHPANDE, PHD R61 HL168723 (Deshpande, MPI, thru U of Maryland) 6/15/20235/31/2025 Optimizing function-selective ERK1/2 inhibitors for reducing AP-1-mediated airway.

NIH/NHLBI $150,000/yr direct, $234,000/yr total DEEPAK DESHPANDE, PHD R01 HL173113 (Deshpande, PI) 4/1/2024-3/31/2028 Allosteric modulation of beta2adrenoceptors in the treatment of asthma.

NIH/NHLBI $439,593/yr direct, $594,516/yr total RAYMOND PENN, PHD R01 HL058506 (Penn, PI) 4/1/2024-7/31/2028 G Protein-Coupled Receptor Regulation in Airway Myocytes.

NIH/NHLBI $469,761/yr direct, $608,988/yr total RAYMOND PENN, PHD R43 HL167369 (Penn, PI, SBIR thru Holoclara) 7/10/20233/31/2025 Development of a NematodeDerived Drug to Treat Asthma.

NIH/NHLBI $25,000/yr direct, $39,000/yr total RAYMOND PENN, PHD R01 HL169522 (Penn, MPI, thru U of South Alabama) 7/1/20236/30/2027 Compartmentalized signaling and crosstalk in airway myocytes.

NIH/NHLBI $125,000/yr direct, $195,000/yr total SHEY-SHING SHEU, PHD R01 HL164941 (Sheu, MPI) 04/01/2023-03/31/2027 Crosstalk Ca2+ Signaling between Ryanodine Receptors Type 1 and 2 in the Pathogenesis of Cardiac Hypertrophy and Heart Failure NIH/NHLB $480,240/yr direct, $582,440/yr total

Department of Medicine 2024 Annual Report

64 2023 Oct;11(10):3248-3249. doi: 10.1016/j.jaip.2023.06.039. Epub 2023 Jun 28.PMID: 37391020 Curley EO, Abu Aboud O, Chmiel KJ, Nayak AP, Fiehn O, Zeki AA, Sharma P. Heated tobacco product IQOS induces unique metabolic signatures in human bronchial epithelial cells. ERJ Open Res. 2024 Mar 4;10(2):00805-2023. doi: 10.1183/23120541.00805-2023. eCollection 2024 Mar.PMID: 38444658 Tompkins E, Mimic B, Penn RB, Pera T. The biased M3 mAChR ligand PD 102807 mediates qualitatively distinct signaling to regulate airway smooth muscle phenotype. J Biol Chem.

2023 Oct;299(10):105209. doi: 10.1016/j.jbc.2023.105209. Epub 2023 Sep 1. PMID: 37660916 Bernardi P, Gerle C, Halestrap AP, Jonas EA, Karch J, Mnatsakanyan N, Pavlov E, Sheu SS*, Soukas AA. Identity, structure, and function of the mitochondrial permeability transition pore: controversies, consensus, recent advances, and future directions. Cell Death Differ. 2023. Aug; 30(8):18691885. (*corresponding author).

Cardetti C, Tigano M, Sheu SS. Calcium and TFAM crosstalk in the mitochondrial life cycle in cardiomyocytes. Physiological Mini Reviews, Vol 16 No. 4, 2023.

Kulkarni T, Criner GJ, Kass DJ, Rosas IO, Scholand MB, Dilling DF, Summer R, Duncan SR. Design of the STRIVE-IPF trialstudy of therapeutic plasma exchange, rituximab, and intravenous immunoglobulin for acute exacerbations of idiopathic pulmonary fibrosis. BMC Pulm Med. 2024 Mar 20;24(1):143. doi: 10.1186/s12890-024-02957-3.

Summer R, Todd JL, Neely ML, Lobo LJ, Namen A, Newby LK, Shafazand S, Suliman S, Hesslinger C, Keller S, Leonard

TB, Palmer SM, Ilkayeva O, Muehlbauer MJ, Newgard CB, Roman J. Circulating metabolic profile in idiopathic pulmonary fibrosis: data from the IPF-PRO Registry. Respir Res. 2024 Jan 25;25(1):58. doi: 10.1186/s12931023-02644-7.

Fares J, Summer R, Loizidis G. Low utilization of statins in patients with dermatomyositis/ polymyositis and hyperlipidemia: a multicenter USA-based study (2013-2023). Clin Rheumatol.

2024 Jan;43(1):325-338. doi: 10.1007/s10067-023-06801-7.

Epub 2023 Nov 6.

Zhu N, Yi B, Kazama K, Yao HJ, Yang R, Qin YW, Guo Z, Sun J. Epigenetic regulation of vascular smooth muscle cell phenotypic switch and neointimal formation by protein arginine methyltransferase 5. Cardiovasc Res. 2023 Oct 16;119(12):2244‑2255.

Lu L, Jang S, Zhu J, Qin Q, Sun L, Sun J. Nur77 mitigates endothelial dysfunction through activation of both nitric oxide production and anti-oxidant pathways. Redox Biol. 2024;70:103056. PMID: 38290383 Xu K, Saaoud F, Shao Y, Lu Y, Jiang X, Wu S, Sun J, Fernades Conti F, Martinez L, Vazquez-Padron R, Wang H, Yang X. Editorial: Debates in cardiovascular pharmacology and drug discovery: 2022.

Front Cardiovasc Med. 2023;10:1304680.

Hokello J, Tyagi P, Dimri S, Sharma AL, Tyagi M. Comparison of the Biological Basis for Non-HIV Transmission to HIV-Exposed Seronegative Individuals, Disease NonProgression in HIV Long-Term Non-Progressors and Elite Controllers. Viruses. 2023 Jun 13;15(6):1362. doi: 10.3390/ v15061362.

Thornton M, Sommer N, McGonigle M, Ram AK, Yerrathota S, Ehirim H, Chaturvedi A, Phan JD, Chakraborty A, Chakravarthi PV, Gunewardena S, Tyagi M, Talreja J, Wang T, Singhal P, Tran PV, Fields TA, Ray PE, Dhillon NK, Sharma M. Notch3 deletion regulates HIV-1 gene expression and systemic inflammation to ameliorate chronic kidney disease. bioRxiv [Preprint]. 2024 Jun 25:2023.09.12.557484. doi: 10.1101/2023.09.12.557484.

Hokello J, Tyagi K, Owor RO, Sharma AL, Bhushan A, Daniel R, Tyagi M. New Insights into HIV Life Cycle, Th1/Th2 Shift during HIV Infection and Preferential Virus Infection of Th2 Cells: Implications of Early HIV Treatment Initiation and Care.

Life (Basel). 2024 Jan 9;14(1):104. doi: 10.3390/life14010104.

Sharma AL, Tyagi P, Khumallambam M, Tyagi M. Cocaine-induced DNA-PK relieves RNAP II pausing by promoting TRIM28 phosphorylation. bioRxiv [Preprint]. 2024 Aug 19:2024.08.19.608673. doi: 10.1101/2024.08.19.608673.

Yang Y, Tseng WJ, Wang B. Abaloparatide Maintains Normal Rat Blood Calcium Level in Part Via 1,25-Dihydroxyvitamin D/osteocalcin Signaling Pathway. Endocrinology. 2023 Aug 1;164(9). PubMed PMID: 37493045; PubMed Central PMCID: PMC10424883.

Department of Medicine

GRADUATE MEDICAL EDUCATION PROGRAMS IN INTERNAL MEDICINE

2024 Annual Report

65

FACU LT Y Christopher Henry, MD

The Department of Medicine is poised to train both academic and practice leaders for the new millennium through advanced clinical training and active mentorship provided by an outstanding clinical and research faculty. Currently, the Department trains 129 residents and over 50 subspecialty fellows. The program focuses on outstanding clinical training, but there is particular emphasis on training future clinician educators, clinical researchers, physicianscientists, as well as practicing physicians for the community.

MISSION STATEMENT Our mission is to provide excellent training in Internal Medicine for physicians planning careers in General Internal Medicine practice, careers in Academic Medicine, or further training in a Medical Subspecialty. Our graduates shall possess clinical skills and knowledge, professional attitudes and behaviors, humanistic qualities, and a commitment to lifelong learning that is characteristic of the highest caliber Internist and Medical Specialist.

GOALS • To train superior Internists for the 21st century.

• To assist our trainees in their transition to practice, fellowship, or further education.

• To serve as an educational leader – promoting high quality, innovative approaches to training in Internal Medicine.

• To serve our patients, the Jefferson community, and the citizens of Philadelphia and the surrounding region with competent, equitable, inclusive, and compassionate healthcare.

• To ensure quality care through measurement, advocacy,

advances in systems of care, and excellence.

• To educate the students who rotate through the Department providing a sound fundamental experience in Internal Medicine.

RESIDENCY - OVERVIEW AND RECRUITMENT The core mission of the Internal Medicine Residency Program at Thomas Jefferson University Hospital is superior training in Internal Medicine. It is our intent that each resident will acquire the requisite clinical skills and medical knowledge, professional attitudes and behaviors, approach to problem solving, and concern for their patients that is characteristic of the Internist. We recognize that our graduates will be providing medical care in the local community and across the country for the first half of the 21st Century. As a result, our goals include developing sound approaches to educating future Internists, emphasizing excellence, and dedication to the patients whom we serve.

The majority of the residents’ experience occurs at Thomas Jefferson University Hospital. It is here that each resident has the opportunity to work with our nationally recognized faculty in the inpatient and outpatient arenas and develop continuity care skills in

the Jefferson Hospital Ambulatory Practice (JHAP), Jefferson Women’s Primary Care, or Jefferson Internal Medicine Associates (JIMA).

Selected rotations at affiliated hospitals broaden the residents’ experiences beyond tertiary care.

Residents have the opportunity to develop skills in research, and for those interested in research careers, the option to spend elective time in the laboratory of a faculty preceptor. As an academic program, the interns and residents not only learn via excellent teaching but also learn to become teachers themselves. Through informal discussions and a formal teaching skills seminar, our residents develop proficiency as educators to further enhance their preparation for academic medicine or clinical practice, where education of patients and families is a major goal.

Furthermore, we have a dedicated medical education pathway with more robust instruction and opportunity for those interested in becoming clinical educators.

Additionally, we have pathways within the residency for Hospital Medicine, Health System Science, and Disability Care which allow our residents to attain more specific skills, experience, and mentorship, if they wish. The success of our program has been reflected in the remarkable increase in interest in the program that has developed over the last decade.

Program Director, Internal Medicine Residency

Dianna Cheney-Peters, MD Sub-Internship Course Director Christie Crawford, MD Associate Program Director Rebecca Davis, MD Associate Program Director for Primary Care Residency Gretchen Diemer, MD Vice Chair for Education Associate Dean for GME and Affiliations Director, Internal Medicine Residency Education Elective Timothy Kuchera, MD Associate Program Director Course Director, Hospitalist Medicine Elective Albert Lee, MD Associate Program Director Jason Ojeda, MD Associate Program Director Primary Care Track Program Director Barbara Simon, MD Associate Program Director Jennifer Valentine, MD Associate Program Director JeffMD: Phase 3 Medicine Pathway Director Alexis Wickersham, MD Associate Program Director Jillian Zavodnick, MD Associate Program Director Clerkship Director

Department of Medicine 2024 Annual Report

66 APPLICANT STATISTICS Recruitment Season

US Applicants

Total Applicants

Positions/Matched Applicants

Mean USMLE Scores

2001-2002

759

2186*

37

220

2002-2003

833

2480*

37/37

217

2003-2004

908

2894*

35

217

2004-2005

932

2822

37/37

216

2005-2006

957

3521

38/38

220

2006-2007

965

3560

39/39

211

2007-2008

1042

3793

39/39

219

2008-2009

1114

4561

36/36 (3 outside)

214

2009-2010

1156

4607

39/38 (1 outside)

222

2010-2011

1339

4855

39/39

228

2011-2012

1483

4501

36/36 (3 outside)

228

2012-2013

1771

4649 (5114 w/SOAP)

39/38 (1 outside)

234

2013-2014

1787

4937

39/39

235

2014-2015

2039

4902

39/39

235

2015-2016

2514

4602

37/37

235

2016-2017

2660

4577

37/37

241

2017-2018

1760

3097

37/37

238

2018-2019

2283

4409

37/37

241

2019-2020

2268

4409

37/37

239

2020-2021

2102

3284

37/37

239

2021-2022

2323

3332

37/37

244

2022-2023

2371

3586

37/37

239

2023-2024

2472

3669

37/37

256 (Step 2)

*Includes Combined Categorical/Preliminary Applicants

Department of Medicine 2024 Annual Report

67 MATCH RESULTS: RANKED & MATCHED APPLICANTS Recruitment Year

Available Positions

Total Ranked

Highest/Lowest Matched

1995

36

284

10/181

1996

36

318

1/190

1997

38

264

1/248

1998

38

343

16/264

1999

37

342

43/DNF

2000

37

347

18/237

2001

37

484

15/360

2002

37

315

27/232

2003

37

346

5/318

2004

37

345

7/265

2005

38

382

2/249

2006

39

344

8/316

2007

39

396

25/311

2008

36 (3 taken outside Match)

391

30/318

2009

38 (1 taken outside Match)

400

9/301

2010

39

410

40/377

2011

36 (3 taken outside Match)

403

15/337

2012

38 (1 taken outside Match)

393

20/254

2013

39

394

9/216

2014

39

419

6/229

2015

39

419

16/259

2016

37

466

44/374 (*337 without Primary Care)

2017

33 Categorical; 4 Primary Care

515; 74

34/302 (Categorical) 15/33 (Primary Care)

2018

33 Categorical; 4 Primary Care

522; 67

19/332 (Categorical) 20/37 (Primary Care)

2019

33 Categorical; 4 Primary Care

531; 73

42/301 (Categorical) 1/16 (Primary Care)

2020

33 Categorical; 4 Primary Care

494; 69

44/256 (Categorical) 8/35 (Primary Care)

2021

33 Categorical; 4 Primary Care

498; 66

57-232 (Categorical) 1/26 (Primary Care)

2022

33 Categorical; 4 Primary Care

499; 72

12-252 (Categorical) 35/47 (Primary Care)

2023

33 Categorical; 4 Primary Care

506; 72

8-223 (Categorical) 26/66 (Primary Care)

2024

33 categorical; 4 Primary Care

490; 63

23-252 (Categorical); 22-32 (Primary Care)

Department of Medicine 2024 Annual Report

68 WHERE OUR RESIDENTS COME FROM: 1997-2022 MEDICAL SCHOOLS # of Medical Students (1090)

% of Medical Students

State or Province

465

42.66%

Pennsylvania

166

15.22%

New Jersey

118

10.82%

New York

44

4.03%

IMG’s

43

3.94%

Washington DC

41

3.76%

Virginia

29

2.66%

Florida

23

2.11%

Maryland, Massachusetts

17

1.55%

Ohio

16

1.46%

Illinois

12

1.1%

Louisiana

10

.91%

Texas

8

.73%

California

7

.64%

North Carolina, Nebraska, Michigan

6

.55%

Connecticut

5

.45%

Tennessee, South Carolina

4

.36%

Georgia

3

.27%

Kansas, Kentucky, Puerto Rico

2

.18%

Arkansas, Indiana, Missouri, New Mexico, Rhode Island, Vermont, Wisconsin, Canada

1

.09%

Arizona, Hawaii, Iowa, Minnesota New Hampshire, Oregon, Utah

Department of Medicine 2024 Annual Report

69 DEPARTMENT SPONSORED FELLOWSHIPS

NonACGME Approved Positions

Hematologic Malignancies CTCL Fellowship

1

GastroenterologyAdvanced Endoscopy / Inflammatory Bowel Disease

2

Heart Failure

1

ID/Pandemic Preparedness

1

POCUS

2

Transplant Nephrology

1

FELLOWSHIP

ACGME Approved Positions

Cardiology

24

Critical Care

1

Heart Failure

1

Interventional Cardiology

2

Electrophysiology

2

Endocrinology

4

Gastroenterology

12

Pulmonary/ Critical Care

15

Transplant Hepatology

2

Infectious Diseases

6

Nephrology

8

Oncology and Hematology

24

Rheumatology

2

FELLOWSHIPS The Department sponsors ACGME approved fellowships in all the subspecialties in Medicine providing for the demand for subspecialists in both academic and community practice environments.

STUDENT PROGRAMS Dr. Jillian Zavodnick acts as the Clerkship Director for Internal Medicine. The medicine clerkship lasts 8 weeks and shares a 12-week block with the neurology clerkship. Internal Medicine didactics run throughout the 12-week block and are attended by students on neurology as well as internal medicine. The medicine clerkship consists of two four-week rotations, one at the central Thomas Jefferson University Hospital campus and one at an affiliate site.

These rotations are completed on general medicine and subspecialty services. At the end of the rotation, students are assessed by their clinical supervisors using an evaluation of clinical performance; with an Observed Structured Clinical Encounter which emphasizes information-gathering, data synthesis, differential-building and patient communication; and with a shelf exam. With a robust clinical curriculum, students learn to evaluate patients with a broad array of medical problems and develop clinical reasoning skills that will be beneficial to their development as physicians, regardless of their career path.

Moreover, students encounter positive role models who reinforce the professional values that internists hold as vital to the practice of medicine.

Dr. Dianna Cheney-Peters leads the Sub-Internship program as the Director. As the Director of the Medicine Pathway for

senior-year students, Dr. Jennifer Valentine oversees student elective experiences within the department, supporting a variety of faculty members who direct individual courses.

MAJOR INITIATIVES INVOLVING THE TEACHING PROGRAM

AMBULATORY TRAINING Jefferson continues to distinguish itself through outstanding ambulatory training in continuity and block rotation settings.

The majority of residents are assigned to the JHAP or JIMA offices. JHAP is a Level 2 patient centered medical home (PCMH) that cares for mostly an underserved population. JIMA is a Level 3 PCMH which is also home to the Jefferson Internal Medicine Faculty Practice. Both JHAP and JIMA have a strong relationship with the Jefferson School of Pharmacy, ensuring an inter-professional approach to the management of patients with diabetes, anticoagulation, and complex medication regimen management.

The Jefferson Women’s Primary Care clinic is another ambulatory training site for our residents led by Dr. Swati Shroff. This is a multidisciplinary site that seeks to educate residents in providing comprehensive care to women by highlighting sex and gender differences in disease presentation. They focus on the needs of women spanning the life cycle from adolescence to the geriatric years and includes training in reproductive and nonreproductive health, wellness and prevention, as well as illness and disease. A Women’s Health track, under the supervision of Dr. Shailaja Nair and Dr. Elizabeth Boyle, is currently in development with both clinical and research

faculty at Thomas Jefferson University committed to ensuring that residents are trained to provide optimal care for female patients using an integrated and multidisciplinary approach, while following Evidence Based Medicine guidelines.

Recognizing that superior Internists also have a strong foundation in medical issues common to subspecialties, we have allocated more time for our residents in the outpatient subspecialty setting apart from their varied elective time.

Over the course of three years, residents will rotate through these same clinics multiple times, building a strong outpatient skillset across the medical subspecialties and a rapport working with subspecialist faculty repeatedly and directly and in doing so, also present an opportunity for mentorship. This model not only increases resident access to outpatient experiences, education and mentorship, but it also translates into a more robust outpatient education assuring great competency and success as future internists.

PERSONALIZED CAREER PATHWAYS An individualized approach to IM education in the new millennium.

Our residents receive excellent training and broad exposure to the many facets of internal medicine during the first two years, becoming well versed in the core of internal medicine.

Residents are given elective time in the first and second year to try different specialties and establish career preferences. Instead of dictating the content of the third year, we allow 14 weeks of elective time to target areas that will be most useful to each individual in pursuit of his or her career choice. In addition, we offer

Department of Medicine 2024 Annual Report

70 unique curricular experiences in medical education, physical diagnosis, writing skills, research, and quality care that prepare the trainee for the challenges that lie ahead. The size of our program gives us the needed flexibility to offer this benefit. The wide variety of electives and our willingness to entertain unique ideas are other highlights of this program.

There are 7 areas that are recognized as the most common career choices of our residents, but the design of our personalized career pathway allows for additional choices. The recognized areas include: • Hospital Medicine • Subspecialist Pathway Program • Primary Care Program • Medical Education and Leadership • Masters or Certificate in Clinical Investigation • Disability Care • Health Systems Science Each track has a dedicated track coordinator who is available for mentoring and guidance throughout a resident’s career planning.

HOSPITAL MEDICINE CAREER PATHWAY Dr. Timothy Kuchera directs the formal hospital medicine pathway within the internal medicine residency. The Hospital Medicine Career Pathway provides practical experience and didactic instruction relevant to a career in hospital medicine. Residents in the program participate in elective rotations, receive instruction in relevant nonclinical topics, and engage in scholarship focused on inpatient care. Participants have access to career planning resources and personalized guidance and mentorship from

Dr. Kuchera. By fulfilling the requirements of the pathway, participants will: experience multiple practice environments within hospital medicine; develop the knowledge and skills necessary to be an excellent hospitalist; build non-clinical experience that will enhance their understanding of hospital medicine and prepare them to take advantage of leadership opportunities; and find a job in hospital medicine that is aligned with their interests and goals.

Requirements include 12 weeks of core clinical experiences, 12 weeks of clinical electives (including 6 weeks of hospital medicine-specific electives), engage in a multidisciplinary project, and rotate on an intensive hospital medicine elective aimed at fostering independent decision making.

In FY24, 2 residents completed the pathway and graduated with distinction in Hospital Medicine. Altogether in FY24, Dr. Kuchera mentored and provided career guidance for 7 residents pursuing careers in hospital medicine.

SUBSPECIALIST PATHWAY PROGRAM Dr. Christopher Henry and Dr. Barbara Simon are working with residents to increase both access and meaningful mentorship for those residents interested in pursuing subspecialty fellowship. With a schedule that allocates 50% of resident clinical time in the outpatient setting, residents are being exposed to a greater volume and variety of subspecialties (see section “I. Major Initiatives Involving the Teaching Program, Ambulatory Training). Aside from increasing their participation in both inpatient and outpatient subspecialty patient care, residents are also exposed to a wider breadth of faculty mentors.

This includes Core Faculty members of the program, from which we have selected at least one member representing each medical subspecialty.

These faculty additionally advise, mentor and coach residents as well as supporting and overseeing residents in scholarly works and building their subspecialty applications.

For interested residents, we have established a pathway comprised of suggested goals to achieve with each year of training to prepare them for a successful match in the fellowship of their choice.

This pathway and mentorship includes more robust clinical training, added exposure for more confident career selection, increased opportunities for research and scholarship and easier access to program leadership for guidance and support in fellowship application preparation. Additionally, several meetings are held throughout the year to provide guidance in anticipation of the fellowship application and interview season, including personalized review of applications, CVs, personal statements and interview preparation (including virtual formats).

PRIMARY CARE PROGRAM The Jefferson primary care track was established in 2014 to help those with an interest in general internal medicine become better prepared to pursue primary care careers after residency.

The mission of the program is to train superb clinicians who are dedicated to advancing the field of outpatient general internal medicine through patient care, education, advocacy, and research. The primary care program is predicated on the principles of community, mentorship, advocacy, research, and curricular innovation.

To that end, residents within the program across all three years (Intern-Senior) rotate on ambulatory blocks together and have shared didactic experiences, which consist of lectures, workshops, and training sessions to ensure that each resident is able to deliver high quality, complete care to a varied population and develop the tools to understand and thrive in a changing healthcare system. Residents in the program benefit from early and frequent ambulatory time to build a strong panel of patients in a Level 3 PCMH and develop generalist mentors. To ensure residents are well prepared for a variety of practice settings after graduation, they also have a second longitudinal clinic experience in a federally qualified health center or practice setting of the residents’ choosing.

MEDICAL EDUCATION AND PROGRAM LEADERSHIP PATHWAY This pathway includes participation in the medical education elective in addition to 20 observed teaching hours and biannual meetings with education mentors in addition to their required core presentations during residency. The elective operates as a series of structured teaching sessions as well core seminars coordinated by Program Leadership featuring topics such as learning theory, bedside teaching, teaching groups, professionalism and diagnostic clinical reasoning. Residents spend the bulk of their time in the active process of teaching and preparing lessons for medical students and interns. Residents also spend time learning how to prepare and deliver effective feedback and evaluation and then practicing these skills with the use of standardized patients. In FY24, 18 residents graduated with distinction in medical education.

Department of Medicine 2024 Annual Report

71 MASTERS OR CERTIFICATE IN CLINICAL INVESTIGATION This pathway is available for those residents interested in a career involving clinical or translational research. Thomas Jefferson University offers a Masters in Human Investigation for clinicians who are interested in a career in human investigation or conducting clinical trials.

This program requires a multiyear commitment. Candidates participate in a conference and lecture series concurrent with their residency and fellowship training schedule and are required to finish a clinical research project to receive this degree. Candidates in this program are from the broad spectrum of medical disciplines and have completed projects from basic molecular bench research to exclusively clinical projects. For additional information please visit: http://www.jefferson.edu/university/ biomedical-sciences/degreesprograms/master-programs/clinicalresearch-MS.html DISABILITY CARE TRAINING PATHWAY Beginning in the FY22 year, Dr. Michael Stillman in conjunction with Dr. Emily Stewart and Dr. Jason Ojeda fulfilled an educational need by creating this new pathway.

The disability care concentration was developed in an effort to give select residents knowledge of and expertise in the care of individuals with a variety of disabilities. A narrow literature shows that small minorities of medical students and residents receive disability-specific education. In a study conducted

by SKMC faculty members in 2019, very few internal medicine and family medicine residents at programs across the Northeast felt comfortable co-managing common secondary conditions

associated with disabilities or in identifying their patients' needs for home and communitybased therapies and services.

In response to this educational dearth, residents in this first-ofits-kind concentration will rotate through inpatient rehabilitation services, through a variety of outpatient clinics in which individuals with intellectual and development, neurological, and mobility disabilities seek care, and with a Philadelphia-based home care organization, learning about transitions of care and community-based services. They will also complete an on-line asynchronous certificate program in life care planning, preparing them to anticipate the care needs of individuals with disabilities across their entire lives.

CONFERENCES AND CURRICULA

We have separately created an intern lecture series, a session on "Teaching Residents to Teach", an ICU curriculum, a POCUS curriculum, and an ambulatory curriculum focusing on outpatientbased medicine topics. For the latter series, we have allocated a half day of lectures per week during their ambulatory rotation.

This dedicated time away from any service obligations demonstrates to our residents the value we place on their education above all else.

We also have started two new initiatives in order to ensure our curriculum is more dimensional than just encompassing core medical knowledge. Recent additions within the past 3 years include the recognition and discussion of diversity, equity and inclusion throughout our curriculum. We also incorporated health systems sciences as a mandatory objective in a number of our conference series. In 2023, we initiated a POCUS curriculum which is a comprehensive and multi-faceted approach incorporating teaching, simulation, and patient application to teach objectives of image acquisition, image interpretation, and clinical application.

We have a comprehensive series of lectures aligned with several curricula to prepare a wellrounded future internist. Our inpatient curriculum is largely comprised of traditional morning reports and noon conferences delivered by Jefferson residents, fellows, and faculty. This is supplemented with our grand rounds series that features more nationally renowned speakers on current or controversial topics in medicine. Additionally, we now offer a majority of these conferences virtually, so we can extend our audience to include learners across all our inpatient and outpatient sites. This has garnered increased attendance and participation.

All residents participate in a Quality Improvement and Patient Safety curriculum which is woven in throughout their training. Within the first six months of intern year, all PGY1s participate in a real-time safety event analysis with faculty facilitation and interprofessional collaboration, findings of which are presented to the Hospital Medicine Peer Review Committee. This learning experience engages residents early in their training and sets a strong foundation for continued safety involvement throughout their career. All residents participate in a foundations of quality improvement during their intern year which provides them improvement strategies and

quality improvement, and patient safety). Requirements of the pathway include attending 70% of scheduled HSS didactics, completing 90% of scheduled pre-didactic modules, integrating HSS concepts in personal clinical teaching conferences to be reviewed for feedback, providing systemsbased practice conferences, and completing a longitudinal clinical HSS project. Successful participation provides participants with various scholarship opportunities, directed educational experiences, 1:1 HSS coaching/ mentorship with a matched faculty member, and skills to lead as change agents within micro and macro health systems.

BEDSIDE TEACHING

We expect that residents who complete this concentration will be positioned to lead educational and quality improvement efforts in their future workplaces. As of academic year 2024-25, 6 residents have enrolled in or completed this educational track, only 3 of whom intended to enter a career in primary care.

HEALTH SYSTEMS SCIENCE PATHWAY Dr. Evan Nardone took over as the Director of the Health Systems Science (HSS) Distinction Pathway in 2024.

This specialized pathway was formed with the goals of preparing a cohort of clinicians to lead innovative change within complex health systems, advancing health outcomes for vulnerable patient populations, and fostering career development within the domains of health systems science (health care delivery, health equity, value-based care, population/public health, health advocacy, health policy and economics, clinical informatics,

Bedside teaching continues to be a major focus in the program and is an expectation for faculty on teaching attending rounds.

Our emphasis on bedside rounds continues, with particular focus on physical diagnosis and patient communication.

Department of Medicine 2024 Annual Report

72 tools which they apply towards a longitudinal quality improvement project during their PGY2 year.

Resident groups present their projects at our annual Health Equity and Quality Improvement Summit each spring. Many residents go on to conduct their own quality improvement projects and present safety event cases at our departmental MM&I conference highlighting their ongoing engagement in quality and safety.

To supplement our robust curriculum, we have implemented a number of adjunctive strategies for improved knowledge and educational support. We have an active curriculum committee comprised of residents with some faculty mentorship and supervision. This is to ensure that residents continue to find our curriculum relevant, appropriate, and engaging. We have personalized boards preparation strategy and troubleshooting for those residents who are struggling or seek out additional support with the program director. Our rolling three year board pass rate continues to be at or above 97%, despite a downward trend nationally in program pass rates.

PERFORMANCE IMPROVEMENT AND REMEDIATION PROGRAM In our commitment to training superior internists, we recognized the need for a program that could identify residents in need of more personalized attention and early intervention. A more robust performance improvement and formal remediation program for the internal medicine residency was identified in December of 2023.

Dr. Barbara Simon and Dr. Timothy Kuchera were appointed as the codevelopers and co-directors of the Thomas Jefferson University Hospital Internal Medicine Performance Improvement and Remediation Program.

Residents who are struggling academically are brought to our attention. Using the Accreditation Counsel for Graduate Medical Education Milestones 2.0, Dr. Simon and Dr. Kuchera formulate Performance Improvement Plans to help struggling learners achieve competency and improve their clinical performance. Dr. Simon and Dr. Kuchera interface with the remediating residents at regular intervals and interface with the Clinical Competency Committee, Chief Medical Residents, and Residency Program Director to give interval reports on progress and collaboratively formulate and adjust improvement plans.

The co-directors present clinical data to the Clinical Competency Committee to inform them on resident performance and help determine promotion status. During FY24, 6 residents went through the Performance Improvement and Remediation Program.

DIFFICULT DISCUSSION EDUCATION Beginning in FY23, Dr. Gina Keiffer took over the Direction of this program. It is now co-led

by Dr. Gina Keiffer and Dr. Elizabeth Collins. The overall goals of this experience are to promote professionalism, enhance communication skills and bedside manner, and teach shared decision making with patients and their loved ones, all with empathy, compassion, and proficiency. The session utilizes the VitalTalk curriculum, which teaches communication skills and utilizes role play to provide direct and timely feedback to learners. This session is taught in small groups of 4-6 Interns and 2-3 faculty members. There is an interactive didactic component where various communication skills are taught and discussed.

Following the didactic discussion, the Interns each participate in role

play with a standardized patient trained in the VitalTalk method in the presence of the faculty and their peers. Faculty and peers are instructed to take notes during each role play and use that to provide individualized, direct feedback to each learner.

RESULTS OF THE INTERNAL MEDICINE BOARD EXAMINATION 2023 We previously reported our success for our residents taking the Internal Medicine Certification Exam in 2023.

Test takers included 38 senior residents.

Results include: • 2023 exam: 95% Pass Rate 36 of 38 • Our three year pass rate is 97%. 108 out of 111 THE JEFFERSON MEDICAL FORUM Inaugurated in 1999, our resident edited journal of scholarly work has become part of the tradition of excellence within the Department of Medicine. Each year we recruit new resident editors, but a constant has been the tradition of quality and diversity that has come to characterize the journal. Planning is already underway for the year ahead.

The publication has been generously supported by our faculty and graduates.

MEDICAL SIMULATION TRAINING For over 16 years, we have conducted a program of ACLS skill preparation for our interns and new PGY2 residents. Initially, utilizing a cardiac monitor and CPR mannequins, the exercises tested resident’s abilities to recognize and respond to cardiac arrhythmias appropriately.

In 2000, the Medical College invested in a medical simulator which we have utilized to better prepare interns to advance their rapid response and ACLS skills, as well as enhance their leadership roles in leading the team during high intensity clinical scenarios.

Residents are also led through procedure simulation at the beginning of their PGY1 year as well as a refresher prior to starting PGY2. We now utilize the simulation center for additional training and exposure in the clinical application of POCUS. TEACHING RESIDENTS TO TEACH This year we continued our annual Teaching Residents to Teach course. It is a day-long retreat for PGY1 residents focused exclusively on topics related to being an educator and leader. Through this course and our continued emphasis on education, our department has been recognized for its positive impact on student education.

MEDICAL EDUCATION FACULTY DEVELOPMENT RETREAT Starting in 2024, we received support from the Department of Medicine to host an annual on-campus retreat offering faculty development for key faculty and personnel in our education office. The theme of our inaugural event was “coaching” with an invited speaker and participatory workshop. The full-day event was a great success including the Chief Residents, rising Chief Residents, Associate Program Directors, Program Director, Vice Chair of GME, and the core faculty. The intent of this annual program is to continue to support our lead faculty and educational leadership in developing their skills as educators, advocates, and

Department of Medicine 2024 Annual Report

73 mentors to better support and train our residents.

WORK HOURS The program closely monitors work hours and the work load carried by our residents.

Reductions of inpatient team caps from 14 to 12 have improved the workload, allowing the residents to manage increasingly complex patient population while still focusing on education, including high value care, bedside teaching and patient safety.

WELLNESS In our residency program, we have a robust residentled Wellness Committee focusing on improving resident well-being. This Committee meets regularly with program leadership to discuss initiatives identified by residents as common sources of frustrations in their days, brainstorm actionable ideas for improvement, and engage residents to in meaningful ways to enhance their well-being.

We host programing throughout the year for our residents, including several work-day sessions to best promote work-life integration. In FY24, we hosted several stress-relief events to promote well-being and social connection. We continued to ensure the personal well-being for our residents, including a robust sick-call pull system and offering Opt-Out Wellness check-in for all our residents at times throughout perceived with increase stress amongst our residents.

Residents can meet with a licensed health professional to discuss the current state of mental health, coping strategies, and be connected with ongoing services as interested.

One common frustration identified by our trainees in FY24 was the impact role misidentification plays in their identity as physicians which can impact their wellbeing, particularly amongst women. To combat this, the resident program was awarded a departmental wellbeing grant to implement the Doctor Badge initiative for all residents, fellows, and hospitalist physicians. Analysis of pre-post surveys is ongoing, but results are promising to show improvement in perceived correct role identification with wearing the badge.

To highlight the culture of wellbeing we strive to emulate, many of our residents have been nominated or selected for our departmental I.M. Thankful Recognition Program and continue to be active nominators of their colleagues.

In FY24, we held a resident “Listening Session” to help uncover systems causes of frustration for residents and brainstorm ideas for improvement within the scope of the residency to impact change. We look forward to implementing quick wins in the residency’s scope of influence and advocating for resident well-being as needed at higher levels.

CONTRIBUTING TO THE STATE OF THE ART OF EDUCATION IN INTERNAL MEDICINE The program leadership has continued to build its reputation through contributions to the peer reviewed literature (Academic Medicine, Seminars in Medical Practice, Academic Medicine, and the American Journal of Medicine), presentations at national meetings (AAIM), contributions to programs and activities of the

American College of Physicians (Resident Research Judging, participating in promotional brochures and videos), presentations and contributions to national medical subspecialty societies and delivering numerous invited lectures.

Our focus remains upon developing and extending our traditions of excellence.

A strong residency program enhances the mission of the entire Department by enhancing the quality of patient care and advancing the education of our students.

HIGHLIGHTS OF THE DEPARTMENT'S EDUCATIONAL PERFORMANCE

Our fellowships offer stateof-the-art clinical training and research opportunities for highly competitive residents from Jefferson and top programs across the country.

• An ABIM rolling 3 –year Pass Rate of 97% for the core Residency.

• Primary Care Track Board Pass Rate 100%.

• Ongoing increases in applications from US seniors over the last 8 years.

• A 4+2 block schedule and a trickle admission system ensure superior education over service obligations by mitigating work compression, increasing outpatient exposure and adding dedicated time to education and wellness.

• We have identified our top 25 Teachers and promote their recognition throughout the medical college and hospital.

• The professional educational staff (program directors and clerkship directors) are regularly presenting their work at national meetings or in the peer reviewed literature.

CONCLUSIONS

In summary, the Residency Training program is achieving its goal of training superior Internists for the 21st Century.

Benefiting from the foundations described above, our students also gain core competence in the approach to a variety of clinical problems and preparation for careers in a variety of specialties.

Department of Medicine 2024 Annual Report

75

E D U C AT I O N A P P E N D I X

THOMAS JEFFERSON UNIVERSITY HOSPITAL DEPARTMENT OF MEDICINE HOUSE STAFF: 2024-2025 INTERNS PGY-1'S (CATEGORICAL)

MEDICAL SCHOOL

Mohsin Arsiwala, MD

Boston University School of Medicine

Karlie Brasch, MD

Geisinger Commonwealth School of Medicine

Margaret Carter, MD

Lewis Katz School of Medicine at Temple University

Francesca Ciocco, MD*

Sidney Kimmel Medical College at Thomas Jefferson University

John Cipriasco, MD

Lewis Katz School of Medicine at Temple University

Jessica Cobb, MD

USF Health Morsani College of Medicine

Madeline Collazo Maguire, MD

Drexel University College of Medicine

Nehar Damie, MD

Rutgers Robert Wood Johnson Medical School-Piscataway

Paul Endres, MD*

Sidney Kimmel Medical College at Thomas Jefferson University

Jordan Feingold-Link, MD

Sidney Kimmel Medical College at Thomas Jefferson University

Gilbert Fleischer, MD

Cooper Medical School of Rowan University

Mina Ghbrial, MD

Rutgers New Jersey Medical School

Rebecca Goldfinger-Chanin, MD

Rutgers Robert Wood Johnson Medical School-Piscataway

Yunisse Gonzalez, MD

Boston University School of Medicine

Jack Goodman, MD

Frank H. Netter MD School of Medicine at Quinnipiac University

Minki Hong, MD

Rutgers New Jersey Medical School

Brady Houtz, MD

Sidney Kimmel Medical College at Thomas Jefferson University

Lamya Jaigirdar, DO

Rowan University School of Osteopathic Medicine

Limi Jamma, MD

University of Texas Southwestern Medical Center at Dallas Southwestern Medi-cal School

Allison Kayne, MD

Sidney Kimmel Medical College at Thomas Jefferson University

Jacqueline Krieger, MD

Drexel University College of Medicine

Nathaniel Kuhrt, MD

Rutgers New Jersey Medical School

Jasmine Lee, MD

Boston University School of Medicine

Meiqi Luo, MD

Sidney Kimmel Medical College at Thomas Jefferson University

Sarah Mukhtar, MD*

Sidney Kimmel Medical College at Thomas Jefferson University

Smriti Nair, MD

Rutgers New Jersey Medical School

Theresa Papich, MD

Case Western Reserve University School of Medicine

Sheraz Qamar, MD

Sidney Kimmel Medical College at Thomas Jefferson University

Alexander Reibstein, MD

Sidney Kimmel Medical College at Thomas Jefferson University

John Scalise, MD

Tufts University School of Medicine

Sonali Shah, MD

New York Medical College

Hamzah Shariff, MD

Geisinger Commonwealth School of Medicine

Sanjna Shelukar, MD

Sidney Kimmel Medical College at Thomas Jefferson University

Dustin Sneed, MD*

Virginia Commonwealth University School of Medicine

Sarah Sulkowski, MD

University of Maryland School of Medicine

Gregory Vitone, MD

Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo

Joy Zhao, MD

Sidney Kimmel Medical College at Thomas Jefferson University

*PC – Primary Care Program

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N EU ROLOGY I NTE RNS

MEDICAL SCHOOL

Noah Allanoff, MD

Sidney Kimmel Medical College at Thomas Jefferson University

Sara Badenhausen, MD

Hackensack Meridan School of Medicine

Margaret DenBleyker, MD

Sidney Kimmel Medical College at Thomas Jefferson University

Andrew MacKinnon, MD

University of Cincinnati College of Medicine

Anurag Modak, MD

Rutgers New Jersey Medical School

Alexis Notarianni, MD

Geisinger Commonwealth School of Medicine

Johann Pacheco Marrero, MD

University of New Mexico School of Medicine

Jillian Piskorski, MD

Lewis Katz School of Medicine at Temple University

Amanda Salvatore, MD

Sidney Kimmel Medical College at Thomas Jefferson University

Linda Zhang, MD

Cooper Medical School of Rowan University

O PHTHALMOLOGY P RE LIM S

MEDICAL SCHOOL

David Camacho, MD

Perelman School of Medicine at the University of Pennsylvania

Caroline Cotton, MD

University of Virginia School of Medicine

Joseph DeSimone, MD

Sidney Kimmel Medical College at Thomas Jefferson University

Ankur Nahar, MD

Sidney Kimmel Medical College at Thomas Jefferson University

Bela Parekh, MD

University of Michigan Medical School

Nathalie Perez, MD

University of Miami Leonard M. Miller School of Medicine

Minja Tang, MD

Northwestern University The Feinberg School of Medicine

John Williamson, MD

Sidney Kimmel Medical College at Thomas Jefferson University

*PC – Primary Care Program

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THOMAS JEFFERSON UNIVERSITY HOSPITAL DEPARTMENT OF MEDICINE: 2023-2024 CAREER PLANS GRADUATING CHIEF RESIDENTS

FUTURE PLANS

Benjamin Claxton, MD

Pulmonary/Critical Care-Johns Hopkins Hospital

Michael Dong, MD

Pulmonary/Critical Care- Thomas Jefferson University Hospital

Chantel Venkataraman, MD

Hospitalist-Temple University Hospital

Tamar Wolinsky, MD

Endocrinology-University of California at San Diego

GRADUATING PRIMARY CARE RESIDENTS

FUTURE PLANS

Marie-Laure Flamer, MD

Primary Care – Abington Plaza Medical Associates

Aretina Leung, MD

Primary Care-Mount Sinai Hospital Queens

Ruby Zucker, MD

Primary Care-Capital Health

GRADUATING CATEGORICAL RESIDENTS

FUTURE PLANS

Alexander Anselmi, MD

Hospitalist-Lankenau Medical Center

Zoe Begun, MD

Hematology/Oncology-University of Virginia

Harrison Bell, MD

Pulmonary/Critical Care-Weill Cornell Medical Center

Joshua Bernard, MD

Hospitalist- Thomas Jefferson University Hospital

Justin Bilello, MD

Gastroenterology-Albany Medical Center

Anna Chen, MD

Gastroenterology- Thomas Jefferson University Hospital

Michael Cheung, MD

POCUS Fellowship-Hospital of the University of Pennsylvania

Salil Chowdhury, MD

Gastroenterology-Rutgers New Jersey Medical School

Fernando Cordero-Baez, MD

Infectious Disease-University of South Florida

Vincent Dioguardi, MD

Gastroenterology- Thomas Jefferson University Hospital

Chelsea Edirisuriya, MD

Gastroenterology-Cooper University Hospital

Jason Farber, MD

Cardiology-Lankenau Medical Center

Jason Goldenberg, MD

Motility Fellowship-Temple University Hospital

Jonathan Gross, MD

Gastroenterology-University of Miami/Jackson Health

Emily Hansinger, MD

Hematology/Oncology- Thomas Jefferson University Hospital

Nicholas Kendsersky, MD

Hematology/Oncology-Oregon Health & Science University

Mishael Khan, MD

ICU Hospitalist-Corporal Michael J. Crescenz VA Medical Center

Kristine Lagana, MD

Pulmonary/Critical Care- Temple University Hospital

Aretina Leung, MD

Primary Care-Mount Sinai Hospital Queens

Mark Liotta, MD

Chief Medical Resident (1 yr.), Cardiology Fellowship

Shruti Nanivadekar, MD

POCUS Fellowship- Thomas Jefferson University Hospital

Akash Patel, MD

Chief Medical Resident (1 yr.), Gastroenterology Fellowship

Brandon Pecchia, MD

Cardiology- Thomas Jefferson University Hospital

Megan Pogue, MD

Hospice/Palliative Care- Thomas Jefferson University Hospital

Elias Simon, MD

POCUS Fellowship- Thomas Jefferson University Hospital

Suzanna Talento, MD

Pulmonary/Critical Care-Temple University Hospital

Benjamin Tasevac, MD

Pulmonary/Critical Care-University of Utah

Emilie Thompson, MD

Hematology/Oncology- University of Maryland Medical Center

Ashley Traczuk, MD

Chief Medical Resident (1 yr.), Hospitalist

Eric Warner, MD

Cardiology-Cleveland Clinic

Maria Winte, MD

Gastroenterology- Thomas Jefferson University Hospital

Kelly Zaleski, MD

Hospitalist-University of Pittsburgh Medical Center

Nicholas Zirn, MD

Pulmonary Critical Care-Weill Cornell Medical Center

Ruby Zucker, MD

Primary Care-Capital Health

Claire Zurlo, MD

Chief Medical Resident (1 yr.), Infectious Disease Fellowship

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TOP 25 T E AC H E R S AS R AT E D BY R E S I D E N T S* 2023-2024 Lily Ackerman, MD Julie Barta, MD Adam Bender, MD Joseph Boselli, MD Rebecca Davis, MD Gretchen Diemer, MD Jonathan Fenkel, MD Gautam George, MD Samuel Hofacker, MD Daniel Kramer, MD Timothy Kuchera, MD Patrick Kukulich, MD Albert Lee, MD Gregary Marhefka, MD Evan Nardone, MD Damaris Pena-Evertz, MD Pierluigi Porcu, MD Ross Summer, MD Urvashi Vaid, MD Howard Weitz, MD Susan West, MD Alexis Wickersham, MD Lindsay Wilde, MD Erika Woo, MD Jonathan Zaid, MD

*Requires a minimum of 5 evaluations in the electronic rating database

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UNDERGRADUATE MEDICAL EDUCATION MISSION STATEMENT The mission of the Department of Medicine for undergraduate medical education is to provide the students of Sidney Kimmel Medical College with a high quality educational experience.

Specific facets of this mission include the enhancement of knowledge and the development of the clinical skills of the medical student, the promotion of outstanding professional behaviors and humanistic attributes and the support of altruistic activities. This mission spans the four years of the Sidney Kimmel Medical College curriculum, is directed by the faculty, and supported by the residents of the Department of Medicine.

The Office of Undergraduate Medical Education spearheads this mission by planning and implementing the individual educational experiences, by supporting the faculty and residents who deliver these educational activities, and finally by analyzing the educational outcomes and students’ perceptions of these experiences to ensure continual improvement in these programs.

DEPARTMENT PROGRAMS MEDICINE 350: INTERNAL MEDICINE CLERKSHIP Director: Jillian Zavodnick, MD Coordinator: Hannah Morgan, MAT The Internal Medicine clerkship is structured to allow student exposure to a diverse mix of internal medicine patients on inpatient services. Students spend four weeks of clinical experience at Thomas Jefferson University Hospital, and four weeks at one of our excellent affiliated institutions.

In addition to the clinical experiences on the wards, students participate in a curriculum, which consists of small group sessions, brief lectures, and hands-on workshops and which teaches the diagnosis and treatment of common internal medicine diagnoses; the approach to common presentations and abnormal lab values; core skills like electrocardiogram and chest X-ray interpretation; and clinical reasoning. There is also a session in which students practice arterial puncture and venipuncture. An evidence-based medicine project reinforces the essential skills of performing a literature search to answer clinical questions that arise in the context of daily care of patients. Students are assessed by their clinical evaluators as well as for their evidence-based medicine project, via the NBME subject exam, and via an OSCE. The twostation OSCE assesses information gathering, data interpretation, differential building, recognition of emergencies, basic management, and patient communication.

For the 2024-2025 academic year Faculty that serve as Clerkship Site Directors are: Abington Hospital: Delani DeLiana, MD Atlantic Health/Moorestown: Rafael Pajaro, MD Albert Einstein Medical Center: Eduardo Antonio, MD Bay Health: Zohaib Ghatala, MD Darshan Patel, MD Christiana Hospital: Matthew Burday, DO Lankenau Hospital: Lia Desposito, DO Methodist Hospital: Jennifer Procopio, MD

York Hospital: Daniel Fischman, MD The learning objectives of the clerkship are: • Obtain a history and perform a physical exam that is comprehensive for new patients and appropriately targeted for follow-up patients • Determine appropriate diagnostic testing • Understand the significance of normal and abnormal symptoms, findings, and test results in the context of a patient’s condition • Develop an assessment of a patient’s primary reason for hospitalization using information from the history, physical, and tests • Formulate a prioritized problem list, including a differential diagnosis and plan • Develop oral presentations and written notes that present patient data clearly and concisely while describing clinical reasoning • Maintain professionalism in demeanor, behavior, and dress at all times • Communicate effectively and sensitively with patients, families, hospital staff, and medical team members • Work as an effective and reliable member of a healthcare team • Construct a useful clinical question and use the medical literature to guide clinical practice • Use feedback and selfreflection to identify next steps in development; use self-directed study

and deliberate practice to progress • Gain exposure to the broad variety of career opportunities in Internal Medicine This academic year, the changes in this course have included: • Replacement of “remote” didactics for students during the affiliate portion of their rotation with asynchronous didactics to be completed only if a topic was not covered at the affiliate site • Continued faculty development around assessment among affiliate site directors • Reduction of the OSCE by 1 station to allow all students to complete on the same day • Revision of the OSCE scoring rubric and postencounter note to provide a standardized assessment of clinical reasoning MEDICINE 401: THE INPATIENT SUB-INTERNSHIP IN INTERNAL MEDICINE Director: Dianna Cheney-Peters, MD Coordinators: Shannon Aubin, ABA Hannah Morgan, MAT This year, 223 senior students chose a Sub-Internship in Internal Medicine to fulfill their requirement for a fourth-year inpatient clerkship. One hundred and forty of those students elected to rotate at Thomas Jefferson University Hospital for this experience and 83 at the affiliates. In addition to the experiential learning the students partake in, there are formal didactic sessions dedicated to clinical problem solving, advanced

Department of Medicine 2024 Annual Report

80 decision-making and practical management considerations.

The learning objectives of this sub-internship include: • Recognizing sick vs. non-sick patients – The development of the clinical acumen to distinguish patients requiring urgent or emergent management • Knowing when to ask for assistance – The recognition of one’s limitations and ability to effectively request specialty/ subspecialty consultation • Managing time wisely – The application of time management skills to the work required for the care of a medical inpatient and to effectively organize and prioritize a daily patient care task list • Communicating effectively with patients and families – The application of interpersonal and communication skills when interacting with patients and their families This academic year, the changes in this course have included: • No major changes MEDICINE 402: THE OUTPATIENT SUB-INTERNSHIP IN INTERNAL MEDICINE Coordinator: Shannon Aubin, ABA All outpatient experience courses at Sidney Kimmel Medical College are overseen

by Amanda Matheson, MD, Outpatient Experience Director for Phase 3. This includes courses outside of the Department of Medicine.

The Department of Medicine offers several courses that fulfill SKMC's Outpatient Experience Requirement: MED 402,

E D U C AT I O N A P P E N D I X

Rheumatology, Cardiology, Nephrology, Women's Health, and coming soon, Hepatology.

This year, 41 students selected this Sub-Internship in Internal Medicine to fulfill their requirement for a fourth-year outpatient sub-internship.

Sixteen of those students elected to rotate at Jefferson Hospital for this experience and were accommodated in the Jefferson Internal Medicine Associates Offices. TwentyFive were accommodated at affiliate hospitals and community practices.

The educational goals of this outpatient subinternship include: • The acquisition of advanced knowledge and clinical skills relevant to the care of the ambulatory adult patient.

• Introduction to critical appraisal and comparison of national guidelines and their application to clinical practice.

• The advanced application of clinical reasoning skills acquired in the core ambulatory clerkships of the third year of the curriculum.

• The development of advanced skills in lifelong learning that will allow an educated approach to the medical literature.

• The acquisition of special knowledge in the patterns of health care delivery and the general principles of managed care.

Planned enhancements for the 2024-2025 academic year include: • Continued recruitment of new clinical sites for this rotation.

MEDICINE 403 – 499: ELECTIVES IN INTERNAL MEDICINE Directors: Jennifer Valentine, MD, and Selected Faculty Coordinator: Shannon Aubin, ABA The Department of Medicine sponsored 25 electives in multiple sub-specialty areas. In the 2023-2024 academic year 339 elective spots were taken at Jefferson and 118 spots at the affiliated hospitals. We had 14 students do away rotations at other institutions. We had 79 students participate in research rotations.

The educational goals of these electives include: • The acquisition of advanced knowledge and clinical skills relevant to the care of the patient in a selected discipline in internal medicine.

• The advanced application of clinical reasoning skills acquired in the core ambulatory and inpatient clerkships of the third year of the curriculum.

• The development of a new skill set relevant to the activity of a consultant physician.

• The intensive exposure of the student to a small cadre of faculty with a resultant enhanced ability for faculty role modeling.

CAREER COUNSELING AND DEVELOPMENT In the residency match of March 2024, 58 students matched into three-year residencies in Internal Medicine, 2 into Internal Medicine-Emergency Medicine combined residencies and 1 into Medicine-Pediatrics combined residency. It

is critical that the Office of Educational Programs coordinates the career counseling for this sizable portion of the class, 26.5% - each of these students meets with a faculty advisor (Drs. Dianna CheneyPeters, Lim Wong, or Jillian Zavodnick), who supports them throughout the application season. Additionally, each of the members of this student group requires a summary “Department Letter” for their residency application. For the 2023-2024 academic year, the Department furnished 65 letters for students applying for residencies in Internal Medicine – this includes students applying for combined residencies in internal medicine and pediatrics, as well as several who applied to medicine in addition to other specialties (such as orthopedic surgery or surgery), and 49 for those applying for Preliminary Residencies (these letters were written by Dr. Jennifer Valentine). We continue to use the APDIM/CDIM template for this letter.

FACULTY The faculty with administrative roles within the Undergraduate Medical Education activities of the Department of Medicine are listed individually under their respective areas of supervision above.

ACKNOWLEDGEMENTS Department of Medicine 200: Through the Lens Capturing Art, Medicine, & Humanity

TABLE OF CONTENTS

ATTENDINGS Jonathan Foster, MD Gregory Kane, MD Alyssa Yeager, MD

0 3 Division of Cardiology

RESIDENTS

17

Sara Badenhausen, MD

Division of Endocrinology, Diabetes and Metabolic Diseases

Susanna Betti, MD

21

Jessica Cobb, MD

Division of Gastroenterology and Hepatology

Joseph DeSimone, MD Abdulmojeed Ekiyoyo, MD

27

Division of Hematology and Cardeza Foundation for Hematologic Research

Umma Fatema, MD Ilana Goldberg, MD

31

Division of Hospital Medicine

37

Division of Infectious Diseases and Environmental Medicine

Natasha Reddy, MD Brian Schonewald, MD

STUDENTS Anna Hamtic

43

Division of Internal Medicine

Junthe Jonth Emilio Mansilla

47

Division of Nephrology

53

Division of Pulmonary, Allergy and Critical Care Medicine

59

Division of Rheumatology

61

Center for Translational Medicine

65

Graduate Medical Educational Programs in Internal Medicine

Rachel Menane Kathleen Spritzer Mary Wilkinson

Cover Photo ©Thomas Jefferson University Photography Services

2024 ANNUAL REPORT DEPARTMENT OF MEDICINE

Department of Medicine College Building, Room 822 1025 Walnut Street Philadelphia, PA 19107