Publications

Share Our Stories: An Exploration of the Healthcare Experiences of Child Sex Trafficking Survivors

Feb. 1, 2021

Carmelle Wallace, Ilana Lavina, Cynthia Mollen 

Abstract [from journal]

Background: The trafficking of children and adolescents is widespread, and pediatric providers are on the front line. Current research demonstrates that trafficked children do access health care. However, few studies describe these interactions from their perspectives. In order to elucidate the healthcare experiences of sex trafficked children, we designed a qualitative study utilizing semi-structured interviews to explore their health care interactions.

Participants and setting: Homeless

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Racial, Gender, and Socioeconomic Disparities in Liver Transplantation

Jan. 25, 2021

Lauren D. Nephew, Marina Serper

Abstract [from journal]

Liver transplantation (LT) is a life-saving therapy; therefore, equitable distribution of this scarce resource is of paramount importance. We searched contemporary literature on racial, gender, and socioeconomic disparities across the LT care cascade in referral, waitlisting practices, allocation, and post-LT care. We subsequently identified gaps in the literature and future research priorities. Studies found that racial and ethnic minorities (Black and Hispanic patients) have lower rates of LT referral, more advanced liver disease

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The Cost of Quarantine: Projecting the Financial Impact of Canceled Elective Surgery on the Nation’s Hospitals

Jan. 22, 2021

Sourav K. Bose, Serena Dasani, Sanford E. Roberts, Chris Wirtalla, Ronald P. DeMatteo, Gerard M. Doherty, Rachel R. Kelz

Abstract [from journal]

Objective: We sought to quantify the financial impact of elective surgery cancellations in the United States (US) during COVID-19 and simulate hospitals' recovery times from a single period of surgery cessation.

Background: COVID-19 in the United States (US) resulted in cessation of elective surgery-a substantial driver of hospital revenue-and placed patients at risk and hospitals under financial stress. We sought to quantify the financial impact of elective surgery

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Implementation of a Calculator To Predict Cesarean During Labor Induction: A Qualitative Evaluation of the Clinician Perspective

Jan. 22, 2021

Rebecca F. Hamm, Lisa D. Levine, Maria N. Nelson, Rinad Beidas

Abstract [from journal]

Background: We previously conducted a prospective cohort study (n=1610) demonstrating that implementation of a validated calculator to predict likelihood of cesarean delivery during labor induction was associated with reduced maternal morbidity, reduced cesarean delivery rate, and improved birth satisfaction.

Objective: To optimize future implementation, we used qualitative interviews to understand the clinician perspective on: (1) the cesarean risk calculator implementation, and (2) the

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The Relationship Between Surgeon Gender and Stress During the COVID-19 Pandemic

Jan. 22, 2021

Catherine L. Mavroudis, Sarah Landau, Ezra Brooks, Regan Bergmark, Nicholas L. Berlin, Blanche Blumenthal, Zara Cooper, Eun Kyeong Hwang, Elizabeth Lancaster, Jennifer Waljee, Elizabeth Wick, Heather Yeo, Christopher Wirtalla, Rachel R. Kelz

Abstract [from journal]

Objective: To investigate the relationship between surgeon gender and stress during the Covid-19 pandemic.

Background: While female surgeons face difficulties integrating work and home in the best of times, the Coronavirus Disease 2019 (Covid-19) pandemic has presented new challenges. The implications for the female surgical workforce are unknown.

Methods: This cross-sectional, multi-center telephone survey study of surgeons was conducted across five

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Prioritization of Pediatric Palliative Care Field-Advancement Activities in the United States: Results of a National Survey

Jan. 21, 2021

Chris Feudtner, Jennifer A. Faerber, Abby R. Rosenberg, Kathie Kobler, Justin N. Baker, Brynn A. Bowman, Joanne Wolfe, Sarah Friebert

Abstract [from journal]

Background: The field of pediatric palliative care (PPC) continues to encounter challenges and opportunities to improving access to high-quality PPC services. In early 2019, a workshop identified eleven potential "next step" actions, and subsequently a national survey-based poll of members of the PPC community was conducted to prioritize these potential actions in terms of their "actionable importance."

Methods: Invitations to the survey were distributed in October 2019 to interdisciplinary

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The Effects of the Affordable Care Act on Access and Outcomes of Colon Surgery

Jan. 19, 2021

Ezra S. Brooks, Jason Tong, Catherine W. Mavroudis, Christopher Wirtalla, Giorgos C. Karakousis, Nicole M. Saur, Cary B. Aarons, Najjia N. Mahmoud, Rachel R. Kelz

Abstract [from journal]

Background: Insurance status has been strongly associated with both access to and outcomes of colon resection (CRS). Under the Affordable Care Act (ACA), individual states opted to participate in Medicaid expansion (ME) and adopt essential health benefits (EHB).

Methods: We performed a quasi-experimental difference-in-differences (DID) analysis of 2012-2017 state-level inpatient claims with risk adjustment. We examined frequency of emergent presentation and in-hospital death. Subset analyses

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Preconception and Interconception Pediatric Primary Care Utilization of Pregnant and Parenting Teens

Jan. 19, 2021

Emily F. Gregory, Drisana Henry, Aletha Y. Akers

Abstract [from journal]

Purpose: Gaps in preventive care may contribute to adverse outcomes among pregnant teens. This study quantified teen preventive care utilization before and after pregnancy.

Methods: A continuous retrospective cohort identified 150 teens with a positive pregnancy test (July 2015 to May 2017) at two pediatric primary care sites. Chart review assessed office visits for 18 months before and after the pregnancy test. We also assessed contraceptive counseling, pregnancy outcomes (live birth,

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Characteristics, Outcomes, and Trends of Patients With COVID-19-Related Critical Illness at a Learning Health System in the United States

Jan. 19, 2021

George L. Anesi, Juliane Jablonski, Michael O. Harhay, Joshua H. Atkins, Jasmeet Bajaj, Cameron Baston, Patrick J. Brennan, Christina L. Candeloro, Lauren M. Catalano, Maurizio F. Cereda, John M. Chandler, Jason D. Christie, Tara Collins, Katherine R....

Abstract [from journal]

Background: The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally.

Objective: To describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery.

Design: Single-health system, multihospital retrospective cohort study.

Setting: 5 hospitals within the University of Pennsylvania Health System.

Patients: Adults with COVID-19-related

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Timing and Efficacy of Mifepristone Pretreatment for Medical Management of Early Pregnancy Loss

Jan. 18, 2021

Anne N. Flynn, Andrea H. Roe, Nathanael Koelper, Arden McAllister, Mary D. Sammel, Courtney A. Schreiber

Abstract [from journal]

Objectives: To determine the time interval between mifepristone and misoprostol administration associated with the most efficacious early pregnancy loss (EPL) management.

Study design: We performed a secondary analysis of a randomized trial. Participants with EPL were instructed to take 200 mg oral mifepristone followed by 800 mcg vaginal misoprostol 24 hours later. The primary outcome was gestational sac expulsion at the first follow-up visit (1-4 days after misoprostol use) after a single

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Financial Incentives and Real-Time Adherence Monitoring To Promote Daily Adherence to HIV Treatment and Viral Suppression Among People Living With HIV: A Pilot Study

Harsha Thirumurthy
Jan. 15, 2021

Cedric H. Bien-Gund, Joshua I. Ho, Elizabeth F. Bair, Noora Marcus, Rebekah Ji Choi, Zsofia Szep, Amy Althoff, Florence M. MomplaisirHarsha Thirumurthy

Abstract [from journal]

Background: Interventions to promote medication adherence and viral suppression are needed among HIV-positive individuals. We aimed to determine the feasibility, acceptability, and preliminary impact of daily financial incentives linked to real-time adherence monitoring among treatment-experienced individuals.

Methods: At an HIV clinic in Philadelphia, we conducted a pilot randomized trial among treatment-experienced HIV-positive adults with unsuppressed viral loads (>400 copies/ml).

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Delayed Emergencies: The Composition and Magnitude of Non-Respiratory Emergency Department Visits During the COVID-19 Pandemic

Jan. 14, 2021

Ari B. Friedman, Deidre Barfield, Guy David, Thomas Diller, Candace Gunnarson, Miao Liu, Benjamin V. Vicidomina, Ruthann Zhang, Yuan Zhang, Somesh C. Nigam

Abstract [from journal]

Importance: COVID-19 has been associated with excess mortality among patients not diagnosed with COVID-19, suggesting disruption of acute health care provision may play a role.

Objective: To determine the degree of declines in emergency department (ED) visits attributable to COVID-19 and determine whether these declines were concentrated among patients with fewer comorbidities and lower severity visits.

Design: We conducted a differences-in-differences analysis of all

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Developing a Family-Reported Measure of Experiences With Home-Based Pediatric Palliative and Hospice Care: A Multi-Method, Multi-Stakeholder Approach

Mary Ersek
Jan. 14, 2021

Jackelyn Y. Boyden, Chris Feudtner, Janet A. Deatrick, Kimberley Widger, Gwenn LaRagione, Blyth Lord, Mary Ersek

Abstract [from journal]

Background: Many children with serious illnesses are receiving palliative and end-of-life care from pediatric palliative and hospice care teams at home (PPHC@Home). Despite the growth in PPHC@Home, no standardized measures exist to evaluate whether PPHC@Home provided in the U.S. meets the needs and priorities of children and their families.

Methods: We developed and conducted a preliminary evaluation of a family-reported measure of PPHC@Home experiences using a multi-method, multi-stakeholder

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Developing the eMedical Student (eMS)-A Pilot Project Integrating Medical Students Into the Tele-ICU During the COVID-19 Pandemic and Beyond

Jan. 14, 2021

Joshua Ho, Philip Susser, Cindy Christian, Horace DeLisser, Michael J. Scott, Lynn A. Pauls, Ann M. Huffenberger, C. William Hanson 3rd, John M. Chandler, Lee A. FleisherKrzysztof Laudanski

Abstract [from journal]

The COVID-19 pandemic has accelerated the demand for virtual healthcare delivery and highlighted the scarcity of telehealth medical student curricula, particularly tele-critical care. In partnership with the Penn E-lert program and the Department of Anesthesiology and Critical Care, the Perelman School of Medicine (PSOM) established a tele-ICU rotation to support the care of patients diagnosed with COVID-19 in the Intensive Care Unit (ICU). The four-week course had seven elements: (1) 60 h of clinical engagement; (2) multiple-choice

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Clarifying the Role of the Modern General Surgeon: The Effect of Specialization on Inpatient Practice Patterns in General Surgery

Jan. 13, 2021

Catherine L. Mavroudis, Christopher Wirtalla, Jason Tong, Ezra S. Brooks, Cary B. Aarons, Rachel R. Kelz

Abstract [from journal]

Objective: The growing concentration of fellowship-trained and integrated residency-trained subspecialty surgeons has encroached on the breadth and volume of a so-called "true" general surgery practice, leaving the role of new general surgeons in flux. We aimed to describe the surgical practice of new general surgeons with and without subspecialty fellowship training.

Design: In this retrospective cohort study, state discharge data was linked to American Medical Association Masterfile and

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