Valerie Weber | Drexel University College of Medicine (original) (raw)

Papers by Valerie Weber

JCR: Journal of Clinical Rheumatology, 2005

We describe a case of Phaeoacremonium olecranon osteomyelitis. The patient, initially felt to hav... more We describe a case of Phaeoacremonium olecranon osteomyelitis. The patient, initially felt to have traumatic olecranon bursitis, was found to have an indolent filamentous fungus cultured from the olecranon bursa. In retrospect, x-rays revealed bony erosion, which heightened the index of suspicion for infection in this particular case. Surgical bursal excision was performed and antifungal therapy was administered with clinical resolution. This case emphasizes that aspiration, synovial fluid analysis, and culture of bursal fluid is essential in excluding typical and atypical causes of chronic bursitis.

Clinical Medicine & Research, 2010

Clinical Medicine & Research, 2010

Mammography utilization gap has been significantly narrowed between urban and rural settings in r... more Mammography utilization gap has been significantly narrowed between urban and rural settings in recent years. Yet, evaluation of breast cancer incidence and mortality data suggest that women residing in rural areas in the US experience a higher incidence of breast cancer and shorter disease free and overall survival regardless of access to health care services. We have implemented a cohort study design to evaluate the pathologic prognostic indicators of breast cancer at the initial presentation of the disease and their association with shorter survival among women in rural PA. We identified women (n=550) diagnosed with their first primary invasive cancer between January 1, 2001 and December 31, 2007 from the Cancer Registry at Geisinger Health System (GHS). Pathologic, clinical and demographic data were retrieved from electronic health records. The mean age at the initial clinical presentation of the disease was 67(± 12.5). The majority, were diagnosed with either stages I and II, 58.6% and 26.8%, respectively. About 6.9% of women were diagnosed with stage III and 7.6% with stages IV. The proportions of women diagnosed with histologic grade 1, 2, and 3 were 31.8%, 41.7% and 26.5%, respectively. Assessment of the joint distribution of estrogen receptor (ER) and progesterone receptor (PR) yielded 58.6% as phenotypic positive for both receptors and, 26.8% as negative. The remaining 16.5% were discordant for the expression of hormone receptors. Sub-typing of breast cancer biomarkers by the three prognostic markers, ER, PR and HER 2/neu, yielded 69.7% as hormone receptor positive, epidermal growth factor negative; 7.5% as triple positive; 3.5% as hormone receptor negative, epidermal growth factor positive and 19.3% as triple negative. Preliminary findings from this ongoing research project suggest that the prevalence of triple negative breast cancer is higher in this population. Expression of other markers such as HER1, Viminetin, CK 5/6, P53 and E-Cadherin are also being evaluated.

Journal of the American Geriatrics Society, 2007

In this review of a recent set of faculty development initiatives to promote geriatrics teaching ... more In this review of a recent set of faculty development initiatives to promote geriatrics teaching by general internists, nontraditional strategies to promote sustained change were identified, included enrolling a limited number of ''star'' faculty, creating ongoing working relationships between faculty, and developing projects for clinical or education program improvement. External funding, although limited, garnered administration support and was associated with changes in individual career trajectories. Activities to enfranchise top leadership were felt essential to sustain change. Traditional faculty development programs for clinician educators are periodic, seminar-based interventions to enhance teaching and clinical skills. In 2003/04 the Collaborative Centers for Research and Education in the Care of Older Adults were funded by the John A. Hartford Foundation and administered by the Society of General Internal Medicine. Ten academic medical centers received individual grants of $91,000, with required cost sharing, to develop collaborations between general internists and geriatricians to create sustained change in geriatrics clinical teaching and learning. Through written and structured telephone surveys, activities designed to foster sustainability at funded sites were identified, and the activities and perceived effects of funding at the 10 funded sites were compared with those of the 11 highest-ranking unfunded sites. The experience of the Collaborative Centers supports the conclusion that modest, targeted funding can provide the credibility and legitimacy crucial for clinician educators to allocate time and energy in new directions. Key success factors likely include high intensity and duration, integration into career trajectories, integration into clinical programs, and activities to enfranchise institutional leadership.

Annals of Internal Medicine, 2010

Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Com... more Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Community-acquired pneumonia is a serious respiratory tract infection that is a common reason for admission to the hospital. In the United States, pneumonia is the sixth leading cause of death and the primary cause of death from infectious diseases. The proper use of pneumococcal vaccination is up

Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Com... more Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Community-acquired pneumonia is a serious respiratory tract infection that is a common reason for admission to the hospital. In the United States, pneumonia is the sixth leading cause of death and the primary cause of death from infectious diseases. The proper use of pneumococcal vaccination is up

Journal of General Internal Medicine, 2008

BACKGROUND: Falls are the leading cause of injuryrelated deaths in the aging population. Electron... more BACKGROUND: Falls are the leading cause of injuryrelated deaths in the aging population. Electronic medical record (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls.

Journal of General Internal Medicine, 2008

INTRODUCTION: Type 2 diabetes is one of the nation's most prevalent chronic diseases. Although we... more INTRODUCTION: Type 2 diabetes is one of the nation's most prevalent chronic diseases. Although well-known practice guidelines exist, real-life clinical performance often falls short of benchmarks. AIM: Employ an electronic registry derived from a fully integrated electronic health record (EHR) as the cornerstone of an intervention to improve compliance with recommended diabetes performance measures in an integrated practice network. SETTING: Geisinger Health System's network of 38 practice sites providing care to over 20,000 persons with diabetes located in a 40-county region of central and northeastern Pennsylvania. PROGRAM DESCRIPTION: A multidisciplinary group of physicians worked to create a "bundle" of best practice measures for diabetes. This measurement tool was then used as part of a multifaceted intervention to improve physician performance in diabetes care, including audit and feedback, computerized reminders, and financial incentives. Changes in performance of individual measures and the total "bundle" were tracked monthly over 1 year. PROGRAM EVALUATION: Significant increases were seen in all measures of diabetes care over the 12-month period of the study. Vaccination for pneumococcal disease and influenza improved from 56.5% to 80.8% (p<.0001) and 55.1% to 71.0% (p<.0001), respectively. The percentage of patients with ideal glucose control (HBA1c<7.0) increased from 32.2% to 34.8% (p<.001), and blood pressure control (<130/80) improved from 39.7% to 43.9% (p<.0001). The overall number of patients receiving all 9 "bundled" measurements improved from 2.4% to 6.5% (p<.0001). DISCUSSION: Diabetes care improved significantly in response to a multifaceted intervention featuring the use of an EHR-derived registry in an integrated delivery system. More work is needed to demonstrate that such improvements will translate into improved patient health outcomes.

Journal of General Internal Medicine, 2009

BACKGROUND: The field of hospital medicine is growing rapidly in academic medical centers. Howeve... more BACKGROUND: The field of hospital medicine is growing rapidly in academic medical centers. However, few organizations have explicitly considered the opportunities for and barriers to hospital medicine's development as an academic field in internal medicine. OBJECTIVE: The objective was to develop consensus around key areas limiting or facilitating hospital medicine's development as an academic discipline. DESIGN: The design was a consensus format conference of key stakeholders in academic hospital medicine. RESULTS: The consensus group identified several issues impeding the development of academic hospital medicine as a recognized entity in academic settings, including extraordinarily rapid growth, increasingly preponderant nonteaching roles, and demands to perform nonclinical duties (such as quality improvement) not generally viewed as academic pursuits. The consensus group developed recommendations for addressing these concerns, specifically: 1) characterizing the optimal job description for an academic hospitalist, 2) developing better local and at-a-distance opportunities for training academic hospitalists in key aspects of early career success, and 3) advocating for the development of fellows and junior faculty researchers in hospital medicine.

Journal of general internal medicine, 2008

BACKGROUND: Falls are the leading cause of injury-related deaths in the aging population. Electro... more BACKGROUND: Falls are the leading cause of injury-related deaths in the aging population. Electronic medical record (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls. OBJECTIVE: The objectives of this study ...

Journal of Hospital …, 2009

Journal of general internal …, 2008

Valerie Weber, MD1, Frederick Bloom, MD2, Steve Pierdon, MD 2, and Craig Wood, MS3 ... 1Departmen... more Valerie Weber, MD1, Frederick Bloom, MD2, Steve Pierdon, MD 2, and Craig Wood, MS3 ... 1Department of General Internal Medicine, Geisinger Health System, Danville, PA, USA; 2Division of Community Practice, Geisinger Health System, Danville, PA, USA; 3Center for Health ...

Joint Commission Journal on Quality and …, 2000

Understanding change is crucial to implementing quality improvement (QI) initiatives. Widespread ... more Understanding change is crucial to implementing quality improvement (QI) initiatives. Widespread change will be required to correct what many consider to be outmoded and deficient systems of care. This article summarizes the current literature--within both health care and the fields of business and management--regarding how change occurs at the individual and organizational levels. Part 1 focuses on changing clinician behavior, which is instrumental to any effort directed in the health care setting. Part 2 examines the culture of change. Part 3 addresses issues of leadership, along with the necessary steps to guide change in an organization. Part 4 summarizes key elements of change. Finally, Part 5 provides three case examples of QI initiatives reported in the recent literature to illustrate how the application of the knowledge of change management can assist in the successful implementation of QI programs. The knowledge base regarding successful change in health care organizations can be summarized in eight crucial strategies or principles: (1) develop a vision for change, (2) focus on the change process, (3) analyze which individuals in the organization must respond to the proposed change and what barriers exist, (4) build partnerships between physicians and the administration, (5) create a culture of continuous commitment to change, (6) ensure that change begins with leadership, (7) ensure that change is well communicated, and (8) build in accountability for change. A knowledge of change management can help leaders of QI programs in health care organizations successfully apply these concepts to bring about much-needed transformations in health care.

Academic Medicine, 2010

... Biopolymers 73: 556-568, 2004. Sergi, M., Zurawski, J., Cocklin, S., and Chaiken, I. Proteins... more ... Biopolymers 73: 556-568, 2004. Sergi, M., Zurawski, J., Cocklin, S., and Chaiken, I. Proteins, recognition networks and developing interfaces for macromolecular biosensing. Journal of Molecular Recognition 17: 198-208, 2004. ...

JCR: Journal of Clinical Rheumatology, 2005

We describe a case of Phaeoacremonium olecranon osteomyelitis. The patient, initially felt to hav... more We describe a case of Phaeoacremonium olecranon osteomyelitis. The patient, initially felt to have traumatic olecranon bursitis, was found to have an indolent filamentous fungus cultured from the olecranon bursa. In retrospect, x-rays revealed bony erosion, which heightened the index of suspicion for infection in this particular case. Surgical bursal excision was performed and antifungal therapy was administered with clinical resolution. This case emphasizes that aspiration, synovial fluid analysis, and culture of bursal fluid is essential in excluding typical and atypical causes of chronic bursitis.

Clinical Medicine & Research, 2010

Clinical Medicine & Research, 2010

Mammography utilization gap has been significantly narrowed between urban and rural settings in r... more Mammography utilization gap has been significantly narrowed between urban and rural settings in recent years. Yet, evaluation of breast cancer incidence and mortality data suggest that women residing in rural areas in the US experience a higher incidence of breast cancer and shorter disease free and overall survival regardless of access to health care services. We have implemented a cohort study design to evaluate the pathologic prognostic indicators of breast cancer at the initial presentation of the disease and their association with shorter survival among women in rural PA. We identified women (n=550) diagnosed with their first primary invasive cancer between January 1, 2001 and December 31, 2007 from the Cancer Registry at Geisinger Health System (GHS). Pathologic, clinical and demographic data were retrieved from electronic health records. The mean age at the initial clinical presentation of the disease was 67(± 12.5). The majority, were diagnosed with either stages I and II, 58.6% and 26.8%, respectively. About 6.9% of women were diagnosed with stage III and 7.6% with stages IV. The proportions of women diagnosed with histologic grade 1, 2, and 3 were 31.8%, 41.7% and 26.5%, respectively. Assessment of the joint distribution of estrogen receptor (ER) and progesterone receptor (PR) yielded 58.6% as phenotypic positive for both receptors and, 26.8% as negative. The remaining 16.5% were discordant for the expression of hormone receptors. Sub-typing of breast cancer biomarkers by the three prognostic markers, ER, PR and HER 2/neu, yielded 69.7% as hormone receptor positive, epidermal growth factor negative; 7.5% as triple positive; 3.5% as hormone receptor negative, epidermal growth factor positive and 19.3% as triple negative. Preliminary findings from this ongoing research project suggest that the prevalence of triple negative breast cancer is higher in this population. Expression of other markers such as HER1, Viminetin, CK 5/6, P53 and E-Cadherin are also being evaluated.

Journal of the American Geriatrics Society, 2007

In this review of a recent set of faculty development initiatives to promote geriatrics teaching ... more In this review of a recent set of faculty development initiatives to promote geriatrics teaching by general internists, nontraditional strategies to promote sustained change were identified, included enrolling a limited number of ''star'' faculty, creating ongoing working relationships between faculty, and developing projects for clinical or education program improvement. External funding, although limited, garnered administration support and was associated with changes in individual career trajectories. Activities to enfranchise top leadership were felt essential to sustain change. Traditional faculty development programs for clinician educators are periodic, seminar-based interventions to enhance teaching and clinical skills. In 2003/04 the Collaborative Centers for Research and Education in the Care of Older Adults were funded by the John A. Hartford Foundation and administered by the Society of General Internal Medicine. Ten academic medical centers received individual grants of $91,000, with required cost sharing, to develop collaborations between general internists and geriatricians to create sustained change in geriatrics clinical teaching and learning. Through written and structured telephone surveys, activities designed to foster sustainability at funded sites were identified, and the activities and perceived effects of funding at the 10 funded sites were compared with those of the 11 highest-ranking unfunded sites. The experience of the Collaborative Centers supports the conclusion that modest, targeted funding can provide the credibility and legitimacy crucial for clinician educators to allocate time and energy in new directions. Key success factors likely include high intensity and duration, integration into career trajectories, integration into clinical programs, and activities to enfranchise institutional leadership.

Annals of Internal Medicine, 2010

Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Com... more Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Community-acquired pneumonia is a serious respiratory tract infection that is a common reason for admission to the hospital. In the United States, pneumonia is the sixth leading cause of death and the primary cause of death from infectious diseases. The proper use of pneumococcal vaccination is up

Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Com... more Aims: We aimed to improve screening and vaccination rates in hospitalized adults. Background: Community-acquired pneumonia is a serious respiratory tract infection that is a common reason for admission to the hospital. In the United States, pneumonia is the sixth leading cause of death and the primary cause of death from infectious diseases. The proper use of pneumococcal vaccination is up

Journal of General Internal Medicine, 2008

BACKGROUND: Falls are the leading cause of injuryrelated deaths in the aging population. Electron... more BACKGROUND: Falls are the leading cause of injuryrelated deaths in the aging population. Electronic medical record (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls.

Journal of General Internal Medicine, 2008

INTRODUCTION: Type 2 diabetes is one of the nation's most prevalent chronic diseases. Although we... more INTRODUCTION: Type 2 diabetes is one of the nation's most prevalent chronic diseases. Although well-known practice guidelines exist, real-life clinical performance often falls short of benchmarks. AIM: Employ an electronic registry derived from a fully integrated electronic health record (EHR) as the cornerstone of an intervention to improve compliance with recommended diabetes performance measures in an integrated practice network. SETTING: Geisinger Health System's network of 38 practice sites providing care to over 20,000 persons with diabetes located in a 40-county region of central and northeastern Pennsylvania. PROGRAM DESCRIPTION: A multidisciplinary group of physicians worked to create a "bundle" of best practice measures for diabetes. This measurement tool was then used as part of a multifaceted intervention to improve physician performance in diabetes care, including audit and feedback, computerized reminders, and financial incentives. Changes in performance of individual measures and the total "bundle" were tracked monthly over 1 year. PROGRAM EVALUATION: Significant increases were seen in all measures of diabetes care over the 12-month period of the study. Vaccination for pneumococcal disease and influenza improved from 56.5% to 80.8% (p<.0001) and 55.1% to 71.0% (p<.0001), respectively. The percentage of patients with ideal glucose control (HBA1c<7.0) increased from 32.2% to 34.8% (p<.001), and blood pressure control (<130/80) improved from 39.7% to 43.9% (p<.0001). The overall number of patients receiving all 9 "bundled" measurements improved from 2.4% to 6.5% (p<.0001). DISCUSSION: Diabetes care improved significantly in response to a multifaceted intervention featuring the use of an EHR-derived registry in an integrated delivery system. More work is needed to demonstrate that such improvements will translate into improved patient health outcomes.

Journal of General Internal Medicine, 2009

BACKGROUND: The field of hospital medicine is growing rapidly in academic medical centers. Howeve... more BACKGROUND: The field of hospital medicine is growing rapidly in academic medical centers. However, few organizations have explicitly considered the opportunities for and barriers to hospital medicine's development as an academic field in internal medicine. OBJECTIVE: The objective was to develop consensus around key areas limiting or facilitating hospital medicine's development as an academic discipline. DESIGN: The design was a consensus format conference of key stakeholders in academic hospital medicine. RESULTS: The consensus group identified several issues impeding the development of academic hospital medicine as a recognized entity in academic settings, including extraordinarily rapid growth, increasingly preponderant nonteaching roles, and demands to perform nonclinical duties (such as quality improvement) not generally viewed as academic pursuits. The consensus group developed recommendations for addressing these concerns, specifically: 1) characterizing the optimal job description for an academic hospitalist, 2) developing better local and at-a-distance opportunities for training academic hospitalists in key aspects of early career success, and 3) advocating for the development of fellows and junior faculty researchers in hospital medicine.

Journal of general internal medicine, 2008

BACKGROUND: Falls are the leading cause of injury-related deaths in the aging population. Electro... more BACKGROUND: Falls are the leading cause of injury-related deaths in the aging population. Electronic medical record (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls. OBJECTIVE: The objectives of this study ...

Journal of Hospital …, 2009

Journal of general internal …, 2008

Valerie Weber, MD1, Frederick Bloom, MD2, Steve Pierdon, MD 2, and Craig Wood, MS3 ... 1Departmen... more Valerie Weber, MD1, Frederick Bloom, MD2, Steve Pierdon, MD 2, and Craig Wood, MS3 ... 1Department of General Internal Medicine, Geisinger Health System, Danville, PA, USA; 2Division of Community Practice, Geisinger Health System, Danville, PA, USA; 3Center for Health ...

Joint Commission Journal on Quality and …, 2000

Understanding change is crucial to implementing quality improvement (QI) initiatives. Widespread ... more Understanding change is crucial to implementing quality improvement (QI) initiatives. Widespread change will be required to correct what many consider to be outmoded and deficient systems of care. This article summarizes the current literature--within both health care and the fields of business and management--regarding how change occurs at the individual and organizational levels. Part 1 focuses on changing clinician behavior, which is instrumental to any effort directed in the health care setting. Part 2 examines the culture of change. Part 3 addresses issues of leadership, along with the necessary steps to guide change in an organization. Part 4 summarizes key elements of change. Finally, Part 5 provides three case examples of QI initiatives reported in the recent literature to illustrate how the application of the knowledge of change management can assist in the successful implementation of QI programs. The knowledge base regarding successful change in health care organizations can be summarized in eight crucial strategies or principles: (1) develop a vision for change, (2) focus on the change process, (3) analyze which individuals in the organization must respond to the proposed change and what barriers exist, (4) build partnerships between physicians and the administration, (5) create a culture of continuous commitment to change, (6) ensure that change begins with leadership, (7) ensure that change is well communicated, and (8) build in accountability for change. A knowledge of change management can help leaders of QI programs in health care organizations successfully apply these concepts to bring about much-needed transformations in health care.

Academic Medicine, 2010

... Biopolymers 73: 556-568, 2004. Sergi, M., Zurawski, J., Cocklin, S., and Chaiken, I. Proteins... more ... Biopolymers 73: 556-568, 2004. Sergi, M., Zurawski, J., Cocklin, S., and Chaiken, I. Proteins, recognition networks and developing interfaces for macromolecular biosensing. Journal of Molecular Recognition 17: 198-208, 2004. ...