Digital Commons Network^™

Naloxone Administration Route In Opioid Overdose: A Review Of Vermont Ems Data, Alden York Sacco Mph, Chris Lamonda Mph, Michael O'Keefe, Daniel Wolfson Md, Mario Trabulsy Md

Master of Public Health Culminating Projects

Objective: Emergency Medical System (EMS) personnel administer the direct opioid antagonist naloxone in cases of opioid overdose via intramuscular (IM), intravenous (IV), subcutaneous (SQ), intraosseous (IO), or intranasal (IN) routes. Some early studies suggest that the intranasal route of administration is of similar effectiveness to injectable routes. The main objective of our study was to compare the efficacy of intravenous and intraosseous (IV/IO) routes of naloxone administration to the intranasal (IN) route in suspected opioid overdoses in Vermont.

Methods: We reviewed retrospective data from Vermont EMS Statewide Incident Reporting Network (SIREN) between April 2014 and August 2016. We included all …

Increasing Pneumococcal Vaccination Among Adults 65 And Older: The Development And Implementation Of A Pneumococcal Vaccine Administration And Documentation Protocol For A Small Primary Care Practice., Marina M. Ecklund

College of Nursing and Health Sciences Nursing Master Project Publications

This project focuses on the development of a protocol to increase administration and documentation of pneumococcal vaccination among patient 65 years and older in a primary care practice setting. The project entails reviewing immunization records of all patients age ≥ 65 years at Appletree Bay Primary Care (ABPC) practice to determine current pneumococcal vaccination rates among the specified age group within the practice. A single trial vaccination clinic was it established in collaboration with the Vermont Family Pharmacy wherein patients were contacted by phone by the primary investigator, informed that they may be due for one or more pneumococcal vaccination …

Expanding Access To Dental Care For Patients On Suboxone, Nathan E. White

Family Medicine Clerkship Student Projects

Those using Suboxone® for medication-assisted treatment for opioid dependence are at increased risk for poor oral health for a variety of reasons including lifestyle factors, effects of opioids and the direct impact of Suboxone® on the oral environment. Medication assisted addiction treatment programs do not regularly address these concerns. This project aims to educate patients about the importance of oral health, remind providers to screen for dental issues and make referrals for dental care and to promote oral health as an important aspect of well being in this vulnerable population

Peer-Led Smoking Prevention In Winooski, Vermont, Grace Culley Adamson

Family Medicine Clerkship Student Projects

Smoking is the number-once preventable cause of death, contributing to more than 1 in 5 deaths per year in the United States. Statistics indicate that 90% of adult smokers tried their first cigarette before the age of 18. In Vermont, the rate of youth smoking dramatically increases between middle school and high school, and individuals in the State with lower incomes have significantly higher smoking rates than those with middle and upper class incomes. Whether a youth decides to try smoking is strongly influenced by their peers’ smoking behavior and beliefs, and several studies have shown that peer-led tobacco prevention …

Food For All, Vicenta Hudziak

Family Medicine Clerkship Student Projects

Hardwick area free and reduced-cost local food resources. Includes schedules and contact information for local meals, food pantries, assistance programs, educational programs, and cookbook information.

Uncovering The Lived Experience Of Community-Dwelling Jewish Women Over 80 Who Self-Identify As Aging Successfully: A Phenomenological Study, Rebecca Fredman

Graduate College Dissertations and Theses

Background: Although there is significant scholarly interest in defining the concept of successful aging, there are very few small-scale, in-depth qualitative studies examining the lived experience of women over 80 who self-identify as aging successfully.

Aim: The aim of this study is to explore the lived experience of a small group of community-dwelling Jewish women over 80 in a single county in Northwestern Vermont who self-identify as aging successfully.

Approach: This study has a phenomenological approach.

Method: Phenomenological interviews were conducted with five women over 80 years of age. Interview content was analyzed, and shared themes were synthesized.

Findings: Findings …

Breast Density Notification: A Primary Care Summary, Nicole Lin Mendelson

Family Medicine Clerkship Student Projects

On January 15^th, 2017 Vermont Senate Bill 157 took effect requiring healthcare facilities that perform mammography to provide patients information that identifies their individual breast tissue classification. 40-50% of women fall into the category of having increased breast density. Increased breast density reduces the sensitivity of mammography and increases the chance that cancer will not be detected. Additionally, women who have dense breasts are at an increased risk for developing breast cancer. Supplemental screening provides an opportunity to increase detection of breast cancer, but comes with an increased rate of false positives. With this new law in place, …

Nutrition And Exercise Resources For Clinton County, Paige M. Wood

Family Medicine Clerkship Student Projects

The obesity epidemic is a nation wide problem that has increased prevalence in Clinton County, NY when compared to the surrounding areas. Obesity leads to many co-morbid health conditions and is associated with a large increase in health care spending costs. This brochure tackles the limited resources, such as limited number of fitness centers, lack of nutrition education and an overall lower socioeconomic status, that is present in the Clinton County area. This brochure offers help in these areas through free phone applications which cover nutrition education, healthy shopping guidance, at home exercise routines, motivation, habit trackers and mindfulness exercises.

Primary Care Treatment Of Hcv In Medicaid Patients, Stephanie S. Kulaga

Family Medicine Clerkship Student Projects

New, safer HCV treatment regimens make it more feasible than ever for primary care providers to manage Hepatitis C patients in their own practices, rather than leaving management solely to specialists. With the current prevalence of HCV and increasing number of new cases linked to the opiate epidemic, it makes sense to expand the number of providers who manage this illness. However, the landscape of new treatments and changing Medicaid requirements present administrative barriers to primary care treatment of HCV. This project aimed to clarify what those barriers were and create a treatment algorithm to simplify decision-making around which patients …

Chronic Pain: Improving Patient Awareness Of Management Options, Lauren E. Haggerty

Family Medicine Clerkship Student Projects

Chronic pain affects 100 million Americans and places a significant burden on patients and their families. Opioids are frequently used to manage chronic pain, and their potential for misuse, addiction, and adverse effects are of growing concern in Vermont. Increasing patient awareness of different pain management options could decrease patient suffering and mitigate the opioid epidemic. This project aimed to educate patients on chronic pain management and resources available in Franklin County.

Domestic Health Assessment For Syrian Refugees In Rutland, Vt, Ian Grant

Family Medicine Clerkship Student Projects

The Vermont Dept. of Health/Agency of Human Services “Refugee Domestic Health Assessment Form” was reviewed, edited, and reformatted to improve provider work-flow, ensure accuracy, and ease the process of data collection. This form was redesigned specifically to be used by providers in Rutland, VT when assessing the health of newly-arrived Syrian refugees.

Identification Of Barriers To Organ Donation: A Primary Care Interventional Approach, Brittany L. Rocque Msc

Family Medicine Clerkship Student Projects

Organ transplantation provides a potentially life saving intervention for patient with end-organ failure as well as substantial cost-benefit with relation to Medicare expenditure. Despite the advantages of transplantation, deceased organ donors are in short supply and many patients die or lose quality years while awaiting transplantation. Registered organ donor rates are relatively low in our opt-in system being 52% nationwide and only 44% in Vermont, which is below the >50% per state goal. Non-organ donor patients were given and informational brochure and surveyed regarding their attitudes and beliefs toward organ donation.

Promoting Antibiotic Stewardship, Saurabh Patel

Family Medicine Clerkship Student Projects

Antibiotics are not always prescribed optimally in the outpatient setting for common respiratory illnesses. Providers also spend time reiterating the same facts to patients about antibiotics and why their use is not warranted for their common cold symptoms. By providing a visual aid that can capture the attention of patients and present concise, easy to retain facts, we may lessen the amount of time providers spend counseling. At the same time, we are able to get patients to contribute to the fight against antibiotic overuse, antimicrobial resistance, and healthcare associated infections.

Intimate Partner Violence In Immigrant/Refugee Populations, Lisa H. Wang

Family Medicine Clerkship Student Projects

Intimate partner violence (IPV) is the most common type of violence affecting women. Globally, Central Africa and South Asia have some of the highest rates of IPV. In Vermont, the majority of refugees are from these regions. Individual, interpersonal, and especially cultural values play critical roles in the definition/appraisal and decision to seek help in these women. This study examines ways to mitigate challenges that healthcare professionals have in identifying women who need help and barriers preventing these women from seeking help.

Combating Diabetes In Chittenden County: A Healthcare Provider Referral Campaign To Increase Patient Participation In The Vermont Diabetes Prevention Program, Samantha Magier

Family Medicine Clerkship Student Projects

As of 2016, diabetes affects more than 29 million people in the United States and is the 7th leading cause of death nationwide. In Vermont, 1/10 people are diagnosed with either diabetes or prediabetes, with 6% of Vermonters affected by prediabetes and 5% of Chittenden Country affected by prediabetes. The public health burden of this chronic disease is immense: diabetes costs Vermont an estimated $543 million each year and is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness. Prediabetes occurs when blood sugar is higher than normal but not at the diagnostic threshold of diabetes. Prediabetes …

Driving Under The Influence Of Marijuana: Education Of Vergennes Union High School Students, Margaret S. Johnston

Family Medicine Clerkship Student Projects

The leading cause of death for high school students is motor vehicle accidents and the risk of involvement in a motor vehicle accident increases 10-fold after marijuana smoking. There are many misconceptions surrounding driving under the influence of marijuana in adolescents and few high schools are spending adequate time addressing this issue directly. The 2015 Vermont Youth Risk Behavior Survey found that 18% of students in Addison County rode in a car or other vehicle in the past 30 days with someone who was using marijuana. This project was designed to present information about driving under the influence of marijuana …

Preventing Falls In The Elderly, Rebecca Robbins

Family Medicine Clerkship Student Projects

Falls are the leading cause of fatal and non-fatal injuries for older Americans, leading to 27,000 deaths every year and almost 3 million emergency room visits. Many view falls as just part of getting older; however fall risk can be significantly diminished through appropriate screening, education and community programs. Through literature review and talking to members of the local community, I learned about how fall risk is assessed along with what education and programs are provided for those at increased risk of falling. This project sought to educate patients about simple steps that can be made to decrease their fall …

Rural Teens And Stress, Morgan R. Pratt

Family Medicine Clerkship Student Projects

Stress is significantly associated with risk taking behavior and increasing depression/anxiety among teens. There is no shortage of stressors experienced within the teenage years.This project's aim is to create a pamphlet that can be available for teens in rural Vermont. It will contain apps for healthy lifestyle, stress, mood, mindfulness as well as local help line numbers for teens in crisis and signs and symptoms of anxiety and depression.

Use Of Opioids For Pain Management: Educating Patients And Providers On Upcoming Changes To Vermont State Law, Ashley C. Hodges

Family Medicine Clerkship Student Projects

Vermont is suffering from an opioid epidemic. With 112 opioid-related deaths in 2016, nearly every community has been touched by this crisis. In an attempt to combat this problem, new legislation (effective July 1, 2017) will change how opioids are prescribed for both acute and chronic pain management in Vermont. Changes include dose limitations for acute pain, stricter monitoring requirements, and mandated prescribing of naloxone (an overdose reversal agent) for patients on high doses of opioids or on both opioids and benzodiazepines. This project aims to educate patients about upcoming changes.

Health Care Shares: Vermont Community Wellness Through A Farm To Patient Collaboration, Lindsay S. Howe

Family Medicine Clerkship Student Projects

Food insecurity in Vermont has increased over the past decade, with nearly 85,000 Vermonters struggling to provide adequate amounts of food for their families during the past year. Families living in the Northeast Kingdom of Vermont have higher rates of food insecurity than those in urban settings. Unfortunately, when families are living with or threatened with food insecurity, they often rely on cheaper, processed foods that have a longer shelf life than fresh produce. This is likely contributing to the increase in obesity and chronic health conditions such as diabetes. Programs such as Health Care Share aim to combat food …

Promoting Skin Cancer Awareness, Sree Sahithi Kolli

Family Medicine Clerkship Student Projects

Skin cancer is the most common cancer in the nation and the cost to treat it is around 8 billion dollars a year. Sun exposure is linked to all three types of skin cancer and incidence of melanoma is highest in Caucasians compared to other races. In Brookfield, CT which is comprised of a predominantly Caucasian population, there is a lack of awareness of skin cancer detection and prevention. One of the best ways to promote skin cancer awareness is through education about the different types of skin cancers and sun safety behaviors. The idea is to start the conversation …

Approaching Refusal Of Colorectal Cancer Screening, Greg Whitcher

Family Medicine Clerkship Student Projects

This project aimed to investigate the reasons why patients refuse colonoscopy, the screening rates for colonoscopy, alternatives to colonoscopy and methods primary care physicians can use to encourage patients to have colorectal cancer screening.

Media Screen Time For Young Children, A Culturally Competent Approach, Jenna Conway Jorgensen

Family Medicine Clerkship Student Projects

Young children are being exposed to excessive screen time. There are many health and developmental risks of excessive or inappropriate media exposure, including sleep disturbances, developmental delays, and obesity. New American families are likely unaware of the consequences of too much screen time in young children.

Narrative Medicine: Improving Patient Care And Shifting Office Culture, Yazen Qumsiyeh, Julia Shatten

Family Medicine Clerkship Student Projects

Chronic pain and depression are both prevalent in the Unites States and often co-exist in the same population. According to the literature, there is no consensus between providers as to the best practice of treating chronic pain and concomitant depression. Narrative Medicine, a medical model that uses a patient’s illness narrative to make meaning of their disease, allows patients to tell their stories of chronic pain and other important aspects about their life, while it helps providers better understand patients’ experiences with pain. This project will assess the current culture and attitudes of providers treating chronic pain conditions at the …

Indirect Approach To Intimate Partner Violence, Jasmine Y. Robinson

Family Medicine Clerkship Student Projects

Discussing Intimate Partner Violence can be difficult, and has many barriers. An indirect approach to speaking with patients about domestic violence, whether is is sexual, physical, emotional or financial can be achieve with patient's trust in a physician if they withhold judgement.

My First Cookbook! Healthy Recipes That Kids Can Make, Emily Kinn

Family Medicine Clerkship Student Projects

The obesity epidemic in the United States continues to negatively impact health outcomes in every age group. Interventions aimed at the pediatric population is an especially attractive public health strategy to help kids early on develop important skills for healthy eating to carry with them into adulthood. Childhood obesity prevalence remains alarmingly high at about 17% and has a huge impact on children’s health including higher likelihood of developing risk factors for heart disease, high blood pressure, asthma, sleep apnea, psychiatric problems and problems with self-esteem. This project aims to help elementary school aged children become more involved in making …

Having A Conversation About Health Care Wishes And Goals In Vermont, Eric C. King

Family Medicine Clerkship Student Projects

Research has shown that people think talking with family and friends about end-of-life care is important, but they do not actually have this conversation. The majority of adults do not have any form of advance care planning in place. In the state of Vermont if you are 18 years of age or older there is no default person to make decisions for you (such as a spouse or next of kin) in the event that you would be unable to do so, which can result in a complicated ethical dilemma. The goal of this project is to improve conversation rates …

Management Of Prenatal Depression, Soraiya Thura

Family Medicine Clerkship Student Projects

Depression affects many women during and after pregnancy. As many as 1 in 5 women will experience a depressive episode during their pregnancy, however, studies have shown that less than 20% of these women will discuss their symptoms with their healthcare provider and receive care. Barriers to treatment include poor screening, lack of understanding about safe treatment, and stigma against mental illness in pregnant women. This project aimed to address this issue locally, by presenting to a group of family medicine providers in Vermont on the topic of prenatal depression screening and treatment. The presentation was received well and developed …

A Patient's Perspective On Lower Urinary Tract Symptoms, Curran Uppaluri

Family Medicine Clerkship Student Projects

Lower urinary tract symptoms (LUTS) have been increasing in incidence and prevalence in the United States. With a large annual health care cost, an association with a significantly reduced quality of life, and an aging population, LUTS is increasingly becoming more of a burden on the health care system. The American Urological Association created a symptom index in 1992 that assesses for the severity of seven LUTS associated with benign prostatic hyperplasia. This project seeks to address the question of which symptoms from the index score are more common; whether certain symptoms are more concerning from a patient’s perspective.

Immunization Safety: Addressing Parental Safety Concerns, Andrew Gallagher

Family Medicine Clerkship Student Projects

Since 1998, when a fraudulent research paper alleged a connection between the MMR vaccine and autism, increasing numbers of parents are refusing routine childhood vaccinations. Recent research has shown parents’ top vaccine-related concerns included the number of vaccines during the first 2 years of life, administration of too many vaccines in a single doctor visit, and a possible link between vaccines and autism. More than 10% of parents of young children refuse or delay vaccinations, with most believing that delaying vaccine doses is safer than providing them in accordance with the Centers for Disease Control and Prevention’s recommended vaccination.