CURRENT award Winners
Ramie Fathy (Funding: Bertha Dagan Berman)
(faculty mentors: Jules Lipoff, MD [Dermatology])
Fellowship term, 6 months: June 2021, December 2021
Project: Characterizing Cutaneous Manifestations of COVID-19 and Dermatologic COVID-19 Vaccine Reactions
COVID-19 is a systemic disease whose pathophysiology remains incompletely understood. Among the myriad symptoms of COVID-19 are a diverse array of skin manifestations that shed light on how SARS-CoV-2 impacts the body. Now, as more citizens received their vaccination against the disease, public concern remains about possible reactions to the vaccine, many of which occur in the skin. Since April 2020, reports of these skin symptoms of COVID-19 and, more recently, cutaneous reactions to the vaccine have been collected from across the globe in the American Academy of Dennatology/International League of Dermatologic Societies (AAD/ILDS) registry of COVID-related skin conditions, By investigating these reported skin conditions, we aim to gain insight into the COVID's pathophysiology as well as into the immune response to the vaccine. Given the international nature of the AAD/ILDS registry, this work also represents a unique opportunity to characterize vaccine reactions on an unprecedented scale. Additionally, we intend to characterize the impacts of COVID-19 and COVID vaccination on autoimmune conditions that involve the skin, such as lupus and dermatomyositis, which disproportionately affect women.
Finally, in characterizing potentially concerning skin findings, our work has the potential to significantly benefit public health. With vaccine hesitancy limiting the path to herd immunity, it is vital that healthcare providers do whatever they can to combat misinformation amongst the general population. By demystifying possible skin reactions to COVID-19 vaccines, our work will provide reassurance - particularly among women, who are more likely to experience such reactions - and thereby promote overall vaccine uptake.
James Ding (Funding: Bertha Dagan Berman)
(faculty mentor: Daniel Lee, MD, MS [Surgery/Urology])
Fellowship term, 6 months: December 2021 - May 2022
Project: Assessing Baseline Knowledge and Usage Patterns of Gender-Affirming EHR Modules within a Urology Division at a Single Tertiary Care Institution
One of the most powerful ways providers can affirm the identity of patients is through correct pronoun/name usage from the moment patients enter the building to the moment they leave. This is particularly important for auxiliary points of contact, such as check-in staff, schedulers, transport personnel, and so on. Recently, PennChart released an update that allows display of a patient’s preferred name, pronouns, and titles. However, these modules can be difficult to access, and the real-world usage patterns of these modules remain to be seen. While gender-affirming EHR modules such as this are a crucial step in improving culturally competent care, real-world usage patterns must be investigated to evaluate the ultimate efficacy of these changes. This qualitative study aims to survey current Penn Urology provider/staff usage patterns and baseline knowledge of PennChart SOGI modules. Additionally, we will assess potential technological, logistical, and cultural competency barriers to optimal usage of these modules. By understanding to what degree providers already understand these features and pin-pointing obstacles in the way of correct feature usage, we can ameliorate them via targeted tech/cultural competency trainings and ergonomic PennChart alterations. Moreover, as transgender EHR modules continue to gain popularity among EHR vendors across the country, these data can inform the effective adoption and usage of these technologies beyond Penn Urology, both within other fields and at other institutions.
Naomi Fields (Funding: Bertha Dagan Berman)
(faculty mentor: Florence M. Momplaisir, MD, MSHP, FACP [Medicine/Infectious Diseases])
Fellowship term, 6 months: September 2021 - May 2022
Project: Assessing the prevalence and feasibility of integrated cervical cancer screening within HIV care amongst women living with HIV at an urban academic infectious diseases clinic
The incidence and mortality of cervical cancer decreased markedly over the past 40 years with the advent and widespread implementation of Pap tests. However, women living with HIV (WLWH) in the U.S. have a four-fold higher risk of cervical cancer than do HIV-uninfected women, and experience elevated cancer-related mortality. This disparity is multifactorial. While coital behaviors confer both HIV and HPV risk, WLWH are also more likely to develop higher degrees of precancerous lesions with eventual transformation to cervical cancer, owing to reduced immunologic control of infected cervical cells. Incomplete use of cervical cancer screening also contributes to this elevated risk. Nevertheless, screening via Pap smear remains an effective tool for disease detection amongst WLWH when performed at appropriate intervals with pertinent follow-up. Given that WLWH may frequently access healthcare services via their HIV care, integration of cervical cancer screening within their HIV care may prove worthwhile and effective. However, data regarding the extent and feasibility of such integration in the U.S. and similar countries is sparse. Our objective is to evaluate the proportion of WLWH who received care at the MacGregor Infectious Disease clinic in the past two years who had cervical cancer screening (i.e. Pap tests) integrated into their HIV care. We want to also assess barriers and facilitators to the receipt of cervical cancer screening during routine HIV care using the perspectives of the patient, provider, and practice. This project will employ retrospective chart review as well as mixed-methods surveys to accomplish its objectives.
Tiffany S. Huang (Funding: The Edna G. Kynett Memorial Foundation)
(faculty mentors: Cara Dolin, MD; MPH [Obstetrics and Gynecology] Celeste P. Durnwald, MD [Obstetrics and Gynecology])
Fellowship term, 6 months: August, October December 2021and February, March, April 2022
Project 1: Feasibility of a Meal Delivery Program in Gestational Diabetes Mellitus
It is estimated that 7% of pregnancies are complicated by diabetes, with 86% of those cases classified as gestational diabetes mellitus (GDM). Uncontrolled GDM poses many increased maternal and neonatal risks, including neonatal hypoglycemia, hyperbilirubinemia, birth trauma, stillbirth, preeclampsia, shoulder dystocia. Conservative measures such as nutritional counseling can help achieve blood glucose control in both uncontrolled and mild GDM. Using food as medicine has been successful in treating coronary artery disease, diabetes outside of pregnancy, cancer, and obesity. However, many barriers to healthy nutrition have been identified, such as food insecurity and prohibitive cost. To that end, MANNA is a Philadelphia-based program that is revolutionizing healthcare with nutritional interventions such as the weekly distribution of medically tailored, home delivered meals to their clients, free of charge. This feasibility study aims to evaluate the patient acceptability and satisfaction with the distribution of healthy, diabetic-specific meals through MANNA for patients at the Ludmir Center diagnosed with GDM. Secondary outcomes will include monitoring of maternal and neonatal outcomes such as blood glucose control, need for medication (dietary failure), maternal hypoglycemia, and gestational weight gain. Results of this study will provide valuable insight into the role of community organizations in providing access to resources that can assist with dietary intervention in GDM, particularly in patients who may encounter socioeconomic barriers to healthy meals.
Tiffany S. Huang (Funding: The Edna G. Kynett Memorial Foundation)
(faculty mentors: Anna S. Graseck, MD, MSCI [Obstetrics and Gynecology]; Cara Dolin, MD, MPH [Obstetrics and Gynecology])
Fellowship term, 6 months: October 2020 - April 2021
Project 2: The Role of Video-Based Patient Education in Improving Home Blood Pressure Monitoring
It is estimated that 2-8% of pregnancies globally are affected by a hypertensive disorder of pregnancy (HDP), including gestational hypertension, preeclampsia, and eclampsia. HDPs are a leading cause of maternal morbidity and mortality, though maternal death and disease are considered preventable. Timely identification and intervention of HDPs are essential in reducing complications such as stroke, myocardial infarction, and pulmonary edema. Because signs and symptoms of severe HDPs are often reliant on patient reporting, patient education is crucial. However, many online resources available to patients presume a high level of literacy, rendering these educational tools inaccessible. To that end, this project aims to generate videos informing patients about the basics of HDPs, signs and symptoms to monitor, the importance of prophylaxis when recommended, and long-term implications of HDPs. We hypothesize that the distribution of these videos will increase patient knowledge of HDPs and subsequently increase the rate of compliance of home blood pressure monitoring in the existing Take Home Electronic Assessment program.
Adjoa Mante (Funding: The Edna G. Kynett Memorial Foundation)
(faculty mentor: Ayiti-Carmel Maharaj-Best [Family Medicine and Community Health])
Fellowship term, 6 months: September 2021 - March 2022
Project: Exploring Impact of Home Volume Status Monitoring and Patient Education on Heart
With an estimated 30% of adults at risk of developing heart failure in their lifetime, the United States is
facing an epidemic of this highly morbid chronic disease. Approximately 1 million patients are
hospitalized for heart failure (HF) each year, a significant marker of illness severity, and these patients
are at high risk of readmission. While women with heart failure tend to live longer, they report higher
rates of respiratory symptoms and lower quality of life than their male counterparts. Researchers are
increasingly exploring interventions to reduce readmission rates for heart failure patients, however,
exploration of the impact of these interventions by gender and other demographic information is
limited. This study aims to evaluate the impact of equipping patients with scales and education
regarding fluid-related weight monitoring on patient-reported HF symptom burden. The investigation
will conduct subgroup analysis to investigate effectiveness of intervention by gender, in addition to
secondary demographic criteria. Given higher symptom burden amongst women with HF, our team will
supplement this quantitative analysis with semi-structured interviews exploring women’s understanding
of disease presentation and management. The results of this study will inform future patient education
and fluid monitoring based interventions to prevent heart failure exacerbation. Our qualitative data can
further clinician understanding of women’s experience of heart failure symptoms, facilitating improved
tailoring of educational resources for women with heart failure.