Medicine and Health Sciences Commons^™

Small But Mighty: Letters-To-The-Editor Published On The Zika Virus, 1952 - 2018, Frances A. Delwiche

University Libraries Faculty and Staff Publications

Objective:

To conduct a bibliometric analysis of Letters-to-the-Editor published on the Zika Virus between 1952 and 2018.

Methods:

A PubMed search was conducted on the terms (Zika OR ZIKV). Results were limited to Publication Date = 1952-2018, and Publication Type = Letter. Results were exported to EndNote, and the full-text (PDF) of each Letter was examined. Non-Letters, duplicates, irrelevant results, and incorrectly indexed items were excluded. Letters discovered serendipitously were added. The total number of Letters published and their date distribution was determined. The Letters were categorized as Reader Response, Author Reply, Observation, Case Report, or Research. Additional parameters …

Barriers And Facilitators To Use Of A Clinical Evidence Technology For Management Of Skin Problems In Primary Care: Insights From Mixed Methods, Marianne Burke Phd, Alan Rubin Md, Liliane Savard Dpt, Benjamin Littenberg Md

Larner College of Medicine Faculty Publications

Background: A previous cluster-randomized controlled trial tested the effectiveness of a clinical evidence technology (CET), VisualDx, for skin problems seen by Primary Care Providers (PCPs). Based on patient report, there was no effect on time to problem resolution or return appointments.

Objective: To explain, from the provider perspective, why the CET did not make a difference in the clinical trial and to identify barriers and facilitators to use.

Methods: Mixed methods study design. Providers from both arms completed a survey about their use of VisualDx and information-seeking during and after the trial. Active arm providers participated in interviews to explore …

Active-Learning Quality Improvement Training Curriculum For Faculty In Hospital Medicine, Preetika Muthukrishnan, Maria Burnett, Allen B. Repp, Amanda Kennedy

Larner College of Medicine Faculty Publications

• Background: There is a growing emphasis on teaching Quality Improvement (QI) to resident physicians and medical students. However, faculty with QI skills and knowledge is lacking at many academic medical centers.Active learning programs to improve faculty capacity for QI have shown positive outcomes. We sought to develop a QI curriculum for faculty within the Division of Hospital Medicine.
• Description of project/program/innovation: We conducted a needs assessment focus group for Hospital Medicine faculty at our academic medical center. Six faculty members participated and identified priorities and potential challenges. Based on the focus group feedback, we designed a 12-session curriculum that uses …

Improving Adolescent Health Care Transition: Piloting The Transition Readiness Assessment Questionnaire, Meghan D. Foster Msn, Rn-Bc

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose. Successful adolescent health care transition (HCT) is a vital process in providing developmentally appropriate care and minimizing negative outcomes, especially in adolescents with special health care needs. The purpose of this mixed-methods quality improvement project was to pilot the Transition Readiness Assessment Questionnaire (TRAQ) tool in a pediatric rheumatology clinic and assess its utility as a transition tool as well as to inquire about specific patient and family-based transition needs.

Methods. The TRAQ tool and follow-up survey were administered in dyads to all established pediatric rheumatology patients between the ages of 12-18, and one caregiver, who presented to the …

Mitigating Negative Impacts Of Adverse Childhood Experiences: A Strength-Based Approach, Nicholas Montello Iii

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Mitigating Negative Impacts of Adverse Childhood Experiences:

A Strength-Based Approach

Nicholas Montello, RN

Purpose: Adverse Childhood Experiences (ACEs) are common among Vermont youth, and Vermont has insufficient treatment resources to address their negative impacts. A strength-based approach (SBA) mitigates the negative impacts of ACEs by using a person’s assets to build resilience to ACEs. This project is designed to increase healthcare worker and patient/caregiver knowledge of ACEs via the SBA.

Methods: An evidence-based quality improvement intervention was implemented at a pediatric primary care office in rural Vermont, based on the Bodega Model for a strength-based approach. Healthcare worker knowledge and …

Implementation Of A Chronic Pain Functional Assessment Tool In Primary Care Practice, Jude Emerson Stevens

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background

An estimated 20% of patients with non-cancer pain symptoms or pain-related diagnoses receive an opioid prescription. Current guidelines advocate use of a functional assessment as a strategy to improve the efficacy and safety of chronic pain management using opioids. This project aimed to integrate functional assessments into patient care visits for chronic pain and optimize safe and effective prescribing.

Methods

This quality improvement project was conducted at a primary care clinic in Burlington, VT. Baseline data on current functional assessment utilization and barriers amongst providers were collected. The validated Pain, Enjoyment, and General Activity (PEG) scale was administered from …

Cyberbullying: A Resource For School-Aged Children, Adolescents, And Parents In Milton, Vermont, James K. Rohwer

Family Medicine Clerkship Student Projects

Cyberbullying occurs when harmful words or actions by one or more persons are intentionally and repeatedly directed against another person in the digital world through text message, social media, e-mail, apps, online video games, forums, etc. Today, more children and adolescents are connected to the internet than ever before, which puts them at risk of becoming victims of cyberbullying. Many victims, as well as parents of victims, may not be familiar with the resources that are available to them in the areas in which they live when concerns of cyberbullying arise. Therefore, the goal of this project was to create …

Patient Guide To Access Quality Health Information Online, Danielle Wall

Family Medicine Clerkship Student Projects

A large percentage of patients use online search engines to access health information. However, there is a large amount of health information online that is unregulated and not evidence-based. As a result patients may acquire health information that is incorrect which may negatively affect patient-provider relationships and patient's healthcare. A brochure was created to highlight safe practices for accessing health information online.

A Quick Guide To Eating Healthy With Type Ii Diabetes, Caleb Lee Watkins

Family Medicine Clerkship Student Projects

Diabetes is becoming increasingly more prevalent in the U.S. and in the state of Vermont. With an increased prevalence of diabetes and a worsening obesity crisis, the total cost of diabetes management is increasing as well. The population around Bellows Falls, VT has not been spared from this epidemic. Many patients in this region have struggled to make and maintain lifestyle changes, particularly surrounding diet and exercise. Therefore, a one-page, double-sided handout was created to provide easily digestible information to patients about managing their diabetes through proper nutrition.

Improving Patient Educational Materials For A Suboxone Clinic In Southeastern Vermont, C. Wesley Cubberley

Family Medicine Clerkship Student Projects

Access to medical treatment for opioid use disorder plays a significant role in the ability of a community to support a person's recovery. In Springfield, VT, community workers and providers are attempting to organize a Suboxone (buprenorphine + naloxone) clinic in order to bridge the significant geographic and socioeconomic gaps implicit to this rural community's location. In order to garner interest and increase awareness of this forthcoming project, a short, accessible educational flyer was developed with the input of the health center's staff for future use.

Accessing Opioid Use Disorder Resources In Vermont, Wendy Hou

Family Medicine Clerkship Student Projects

A handout listing contact information for opioid use disorder resources in Vermont.

Educating Parents On Newborn Health And Safety, Jenna Rose Dafgek

Family Medicine Clerkship Student Projects

More than 90% of unintentional injuries in children aged 5 years or younger occur in and around the home. Recommended infant care practices are below national target goals. Adherence to these recommendations increases when parents receive appropriate advice from multiple sources, including physicians. The goal of this project was to identify major newborn health and safety concerns. These concerns included car safety, safe sleep practices, and lead exposure. Educational handouts specific for age ranges spanning from first week of life to 1 year old were created for parents to address these issues.

Intimate Partner Violence: Improving Screening Rates In The Primary Care Setting, Alexandra E. Churchill

Family Medicine Clerkship Student Projects

The high prevalence of intimate partner violence (IPV) has led to recommended screening for all women of child-bearing age. Implementing validated screening tools within routine wellness visits at primary care offices facilitates awareness and patient support through identification and resource referral.

Increasing Bicycle Safety In South Burlington, Sam Epstein

Family Medicine Clerkship Student Projects

While there are many mixed use lanes in South Burlington, many people still do not use bicycle travel to get to work or the store. This occurs for many reasons, but one reason may be that people are not comfortable riding on roads. There is also a lack of bicycle friendly transportation between Burlington and South Burlington. This simple and easy to read handout provides tips on how to ride bicycles safely as well as a map of the existing bike and pedestrian friendly roads in SB.

Addressing Geriatric Falls In The Outpatient Setting: A Prevention Initiative, Brian W. Gross

Family Medicine Clerkship Student Projects

With approximately 25% of older aged 65 or greater falling each year, and 20% of these incidents resulting in serious injury, falls are of significant concern for both the geriatric community and the healthcare system at large. In 2017, Vermont ranked 41st in the nation with respect to the percent of older adults with self-reported falls in the past 12 months, according to the United Health Foundation’s “America’s Health Rankings" report. Many patients at risk for falling remain uneducated regarding environmental, pharmacological, and/or behavioral risk factors that may be contributing to their fall risk. In addition, providers often have limited …

Beyond Acute Lyme, Nicholas Haslett

Family Medicine Clerkship Student Projects

Vermont has one of the highest rates of Lyme disease infection in the country. There is growing disagreement not only between the medical community and a growing patient population, but also within the medical community itself, around the issue of persistent syndromes that may or may not be related to a Lyme diagnosis. Many patients seek treatment for persistent symptoms outside of physician guidelines for either Post Treatment Lyme Disease or the contentious "Chronic Lyme Disease" via prolonged courses of IV antibiotics, colloidal silver infusions, electromagnetic frequency treatments, and more. Regardless of the debatable extent of spirochete carnage in vivo, …

Addressing Food Insecurity In The Clinical Setting, Annabelle Davey

Family Medicine Clerkship Student Projects

Food insecurity is defined as having inadequate resources to ensure that everyone in a household has enough food to be properly nourished, without disruptions. 12% of the population in Clinton County, NY is food insecure. The aim of this project was to identify barriers to clinicians addressing food insecurity, and to provide information for both patients and providers to improve utilization of food assistance resources among food-insecure patients.

Standardizing Asthma Management In Primary Care, Michael Vernon Chmielewski

Family Medicine Clerkship Student Projects

Asthma is a chronic, relapsing-remitting inflammatory airway disease that continues to increase in prevalence in the United States. When properly managed, patients with asthma experience less morbidity than those whose asthma is poorly controlled. Although the National Heart, Lung and Blood Institute (NHLBI) has published guidelines regarding the evidence-based diagnosis and management of asthma, many primary care practices do not fully utilize these best-practices. The purpose of this project was to develop a system of standardized protocols and a reference guide to promote adherence to evidence-based guidelines in asthma management for the Champlain Valley Physician’s Hospital Family Medicine residents and …

Screening For Developmental Delays During The Well-Child Visit, Ellen Walker Seyller

Family Medicine Clerkship Student Projects

Due to recent staffing transitions, family medicine physicians at Newtown Primary Care in Danbury, CT are now managing the care of an increasing number of pediatric patients. The goal of this project was to develop a screening tool to allow practitioners to assess for developmental delays during well-child visits. The tool includes 10-question surveys for ages 1mo, 2mo, 4mo, 6mo, 12mo, 15mo, 2yo, 3yo, or 4yo with a scoring guide and a list of some concerning signs at each stage.

Spirometry In Primary Care, Megan Garrido

Family Medicine Clerkship Student Projects

Prevalence of COPD in the United States is rising, yet many people with Chronic Obstructive Pulmonary Disease (COPD) diagnoses do not have diagnoses. In Vermont 18% of adults are current smokers and 27% are former smokers. The lack of provider and nurse training regarding indications, mechanism, interpretation and benefit of spirometry have limited it's use. Spirometry is recommended for both asthma & COPD diagnoses and management, and may provide better disease management.

Improving Cardiac Arrest Outcomes With Hands-Only Cpr, Ethan Witt

Family Medicine Clerkship Student Projects

Bystander CPR is one of the most effective and necessary components of cardiac arrest management, increasing survival rates by two to three times. However, rates of bystander CPR are inadequately low. Hands-only CPR has been found to be an effective intervention in the management of cardiac arrest and addresses many of the barriers to bystander CPR.

Patient Education On The Association Of Hormonal Contraception With Depression, Julia E. Hannigan

Family Medicine Clerkship Student Projects

Hormonal contraceptive agents are widely used by women during their reproductive years. In recent years, research has been released linking hormonal contraception with the initiation of antidepressant medication and a first diagnosis of depression. More research is still warranted in order to further elucidate the relationship between hormonal contraception and depression, but current evidence prompts the necessity for shared decision making between clinicians and women considering treatment with hormonal contraceptive agents. The goal of this project is to give providers easily accessible patient educational materials in the form of epic smart phrases to aid in informed decision making.

Implementation Of The Vermont Mini-Cog, Hillary E. Danis

Family Medicine Clerkship Student Projects

Cognitive impairment screening is important for early detection, diagnosis, and treatment of cognitive impairment and dementia. Additionally, screening is mandated as part of the Medicare Annual Wellness Visit. Colchester Family Medicine providers were surveyed about their current screening behaviors and then provided a training session on cognitive impairment screening and the Vermont Mini-Cog screening tool. Post-training, providers were surveyed about their likely future screening practices.

Social Stories To Facilitate Preparation For Healthcare Visits, Benjamin Grebber

Family Medicine Clerkship Student Projects

No abstract provided.

Food Label Made Easy, Hanaa Shihadeh

Family Medicine Clerkship Student Projects

The use of food labels and adherence to dietary recommendations are important, especially for those with chronic diseases due to the well known relation between chronic disease and poor nutritional habits. Although food labeling has been introduced since 1994 with the aim of combating obesity and diet-related chronic disease in the USA, the rates of food label use among US adults have decreased over the past decade.

Influenza Vaccine Participation In South Burlington, Vt, Rio Beardsley

Family Medicine Clerkship Student Projects

Influenza vaccination rates in Vermont have declined each year between 2013 and 2016. This study aims to understand why patients decline the annual influenza vaccine. The project was deployed via survey for all adult patients (18 years and older) at the South Burlington UVM Family Medicine practice in 2019. Further information about the influenza vaccine authored by the CDC was then provided to all participating patients, regardless of immunization status.

What's In Your Cup? Increasing Transparency And Confidence In Alcohol Use Screening And Brief Intervention, Dylan C. Koundakjian

Family Medicine Clerkship Student Projects

19% of Vermonters report drinking alcohol at levels which puts their health at risk, but many healthcare providers do not feel confident in addressing their patients' usage. This can stem from lack of experience with alcohol use, worries about stigma, and time constraints. However, data has shown that even 5-15 minute interventional conversations can significantly reduce a patient's risky drinking. This project aims to provide real-world, practical advice for having conversations around alcohol, and provides a conversion chart converting popular alcoholic beverages into standard drink equivalents.

Increasing Awareness Of Health Risks Associated With Vaping In Youths, Patricia Wang

Family Medicine Clerkship Student Projects

E-cigarette and use of electronic nicotine delivery systems is a growing trend among youths in the United States. According to the National Institute of Health 2018 Monitoring the Future Survey, the 10th and 12th grade increases in nicotine vaping are the largest ever recorded for any substance in 44 years of tracking youth drug use. Increasing evidence about the potential health risks of vaping, as well as prediction of future cigarette use or experimentation, underlines the need for more preventative health measures to curtail this growing drug epidemic. The aim of this community health project was the development of an …

Retinopathy Screening: Assessing Knowledge & Educating Diabetic Patients In Caledonia County, Vermont, Ian J. Mcclain

Family Medicine Clerkship Student Projects

Diabetic retinopathy is the most common cause of severe vision loss in US adults. It is estimated that less than 50% of patients with diabetes consistently receive annual eye exams. Diabetic patients in rural communities may face additional barriers towards receiving recommended eye care as these communities generally have lower incomes, lower insurance rates and older populations. This project sought to educate diabetic patients about eye disease in a rural Vermont primary care practice using an active learning modality.

Perceived Barriers And Trends In Hpv Vaccination Among Young Men In Newtown, Ct, Alexander D. Karabachev

Family Medicine Clerkship Student Projects

Human Papillomavirus (HPV) is the most prevalent sexually transmitted infection in the United States. Although the HPV vaccine has been proven to be effective and safe, the vaccination rates are significantly less compared to other vaccines. In males, HPV infection may lead to the development of numerous forms of cancer including oropharyngeal, anal and penile cancer, however, the HPV vaccination rate for males is significantly less than it is for females. This project aims to highlight various medical providers' opinions on the barriers to HPV vaccination for young men in Newtown, Connecticut, as well as, address methods for improvement including …