Medicine and Health Sciences Commons^™

A Month In Manila, Robin M. Lund

Posters

Describes a global health learning experience at Philippines Children's Medical Center in Manila.

A Month At The Lake Clinic - Cambodia, Mara Horwitz

Posters

Describes a global health learning experience in Cambodia on floating clinics that serve residents of remote villages of the Tonie Sap Lake and Stung Sen River.

Sanibonani! A Global Health View Of The Hiv/Aids Epidemic In Swaziland, Angie Schmidt

Posters

Describes a global health learning experience with the Baylor International Pediatric AIDS Initiative in Swaziland.

South Africa: Combatting The Rise Of Hiv In Adolescents, Ryan Northrup

Posters

Describes a global health learning experience in South Africa in 2017, focused on educating teenagers in schools about sexual health and AIDS prevention.

Use Of Personalized Patient Heart Diagrams At The Bedside To Improve Quality Of Care, Melissa D. Elliott

Posters

Title: Use of personalized patient heart diagrams at the bedside to improve quality of care

Background/Introduction: With congenital heart disease no two hearts are exactly the same. Even with the same lesion, the anatomy of the heart can be completely different. In response to a bedside nursing idea following a cardiac arrest, advanced practice nurses (APN) initiated a program to provide personalized cardiac anatomy diagrams at the bedside of every patient on the cardiology service.

Methods: When a cardiac patient is admitted to cardiology floor, the nurse will check the patients chart for an anatomy picture, then will place …

Tct-732 Relationship Between Stent Diameter, Platelet Reactivity, And Adverse Events After Pci: Analysis From The Adapt-Des Study., Björn Redfors, Philippe Généreux Md, Bernhard Witzenbichler Md, Ajay J. Kirtane Md, Thomas Mcandrew, Bruce R. Brodie Md, Michael J. Rinaldi Md, Timothy D. Henry Md, David A. Cox Md, Ernest L. Mazzaferri Md, Ori B. Yehuda, Roxana Mehran Md, Gregg W. Stone Md

Department of Medicine

Background

Small vessel diameter and residual high platelet reactivity (HPR) have both been associated with adverse events after PCI. We sought to determine whether a specific interaction exists between HPR and stent diameter in regard to outcomes after PCI.

Methods

We stratified pts in the prospective ADAPT-DES registry who underwent successful single-lesion PCI with DES according to whether or not they received only small diameter stents (diameter ≤2.5 mm). Pts receiving ≤2.5 mm stents were compared to pts receiving a stent with a diameter >2.5 mm using propensity score (PS) adjusted Cox proportional hazards regression. HPR was defined as P2Y12 …

Havoc In The Gut: Ipilimumab-Induced Prolonged Steroid Dependent Autoimmune Gastroenterocolitis., Abdul Aleem Md, Anam Malik Md, Eric Nellis Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Development Of A Health Care Systems Curriculum., Zachary Pruitt, Rahul Mhaskar, Bryan G. Kane Md, Robert D. Barraco Md, Mph, Deborah J Dewaay, Alexander M. Rosenau Do, Kristin A. Bresnan Md, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

Background: There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution.

Methods: This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created …

Mutational Landscapes Of Smoking-Related Cancers In Caucasians And African Americans: Precision Oncology Perspectives At Wake Forest Baptist Comprehensive Cancer Center., Ville Kytola, Umit Topaloglu, Lance D Miller, Rhonda L Bitting, Michael M Goodman, Ralph B D Agostino, Rodwige J Desnoyers, Carol Albright, George Yacoub, Shadi A Qasem, Barry Deyoung, Vesteinn Thorsson, Ilya Shmulevich, Meng Yang, Anastasia Shcherban, Matthew Pagni, Liang Liu, Matti Nykter, Kexin Chen, Gregory A Hawkins, Stefan C Grant, W Jeffrey Petty, Angela Tatiana Alistar, Edward A Levine, Edgar D Staren, Carl D Langefeld, Vincent Miller, Gaurav Singal, Robin M Petro, Mac Robinson, William Blackstock, Bayard L Powell, Lynne I Wagner, Kristie L Foley, Edward Abraham, Boris Pasche, Wei Zhang

Articles, Abstracts, and Reports

Background: Cancers related to tobacco use and African-American ancestry are under-characterized by genomics. This gap in precision oncology research represents a major challenge in the health disparities in the United States. Methods: The Precision Oncology trial at the Wake Forest Baptist Comprehensive Cancer Center enrolled 431 cancer patients from March 2015 to May 2016. The composition of these patients consists of a high representation of tobacco-related cancers (e.g., lung, colorectal, and bladder) and African-American ancestry (13.5%). Tumors were sequenced to identify mutations to gain insight into genetic alterations associated with smoking and/or African-American ancestry. Results: Tobacco-related cancers exhibit a high …

Thyroid Hormone Receptor Ss (Trß) Regulation Of Runt-Related Transcription Factor 2 (Runx2) In Thyroid Tumorigenesis: Determination Of The Trß Nuclear Protein Complexes That Associate With The Runx2 Gene., Thomas Howland Taber

Graduate College Dissertations and Theses

Thyroid Tumorigenesis is typically a well understood process, with well delineated oncogenic factors. Follicular and papillary thyroid cancers are typically survivable, with 5-year survival rates being >95% for Stage I-III of both cancer types. Anaplastic thyroid cancer, in contrast, lacks this prognosis, and is the most lethal of all endocrine-related cancers. The median survival time after a diagnosis is generally between 6-8 months, with a 5-year survival rate of <10%. Current treatment for anaplastic thyroid cancers routinely meet roadblocks, as resistance is quickly developed. Even non-discriminatory kinase inactivators, such as sorafenib, which are generally considered a drug of last resort, are unable to effect survival rates. As such, there is a clear need for further investigation of the causes of anaplastic thyroid cancer mechanisms.

Previous work in the Carr lab revealed a novel regulatory pathway of an oncogene that is associated with several other endocrine-related cancers, as well as other non-endocrine-related cancers. Specifically, the Runt-related …

Co-Localization Of Basal And Proliferative Cells In The Murine Main Olfactory Epithelium And Vomeronasal Organ After Injury With Cyclophosphamide, Kyle Barnes Joseph

Graduate College Dissertations and Theses

ABSTRACT

In humans, advanced malignancies are often targeted with broad-spectrum cytotoxic drugs that engender several detrimental side effects, in addition to their primary usage for eradicating cancerous cells. One of the lesser-researched of these effects, histological distortion of the olfactory system impedes a patient's ability to smell, perceive flavor, and ultimately may interfere with their nutritional intake and recovery from chemotherapy. Recent studies have indicated that cytotoxic drugs can damage gustatory epithelia immediately following administration (Mukherjee & Delay, 2011, 2013). We sought to observe the histological effects that cyclophosphamide (CYP), one of the oldest and most popular alkylating antineoplastic agents, …

Validation Of Patient-Reported Outcomes Measurement Information System Short Forms For Use In Childhood-Onset Systemic Lupus Erythematosus., Jordan T. Jones, Adam C. Carle, Janet Wootton, Brianna Liberio, Jiha Lee, Laura E. Schanberg, Jun Ying, Esi Morgan Dewitt, Hermine I. Brunner

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To validate the pediatric Patient-Reported Outcomes Measurement Information System short forms (PROMIS-SFs) in childhood-onset systemic lupus erythematosus (SLE) in a clinical setting.

METHODS: At 3 study visits, childhood-onset SLE patients completed the PROMIS-SFs (anger, anxiety, depressive symptoms, fatigue, physical function-mobility, physical function-upper extremity, pain interference, and peer relationships) using the PROMIS assessment center, and health-related quality of life (HRQoL) legacy measures (Pediatric Quality of Life Inventory, Childhood Health Assessment Questionnaire, Simple Measure of Impact of Lupus Erythematosus in Youngsters [SMILEY], and visual analog scales [VAS] of pain and well-being). Physicians rated childhood-onset SLE activity on a VAS and completed …

Promotion Of Skin Protection In Children In Waterbury, Vt, Kelsey M. Sullivan

Family Medicine Clerkship Student Projects

Background: Vermont has among the highest rates of skin cancer in the nation. Between 2001 and 2005, Vermont had the highest incidence of melanoma of any state, 63% higher than the national average. It is also estimated that if children under 18 regularly used sunscreen of at least SPF 15, the incidence of squamous and basal cell carcinomas would decrease by 78%. Modeling by the EPA and CDC suggests that recommended sun protection measures could prevent 11,000 cases of skin cancer, 50 deaths, and $30 million in cancer treatment costs nationwide. Intervention: To create an information sheet on skin protection …

Assessing Patient Perspective Of Current Suboxone Treatment, Midori Eckenstein

Family Medicine Clerkship Student Projects

The number of people seeking treatment for opioid abuse and heroin use. While this number is increasing the number of heroin fatalities is also on the rise. Methadone clinics are reporting better retention rates than suboxone treatment. This project explores the patient perspectives of suboxone therapy and what can be improved to help establish better practices.

Patient-Oriented Smartphone Apps To Improve Health & Wellbeing, Geordie C. Lonza

Family Medicine Clerkship Student Projects

Patients have the ability to improve their health outcomes, but their capacity to do so is sometimes underutilized due to misunderstandings or ineffective engagement in their healthcare. Nearly everyone owns a smartphone today, and there are innumerable patient-oriented smartphone apps in both the Apple and Android app stores. However, the clinical utility of these apps has not been widely studied. It is possible that we can incorporate the use of technology such as smartphone apps into our recommendations to patients in order to improve their management of their chronic diseases and their abilities to make lifestyle modifications.

Education On Tick Bites, Tick Borne Disease, And Prevention In Middlebury, Vt, Florence Dibiase

Family Medicine Clerkship Student Projects

Tick borne disease and tick encounters are continuing to increase significantly in Vermont, and represent a significant portion of primary and urgent care visits. In order to spread awareness and educate both providers and patients as to the incidence, symptoms, treatment, and prevention of tick borne diseases, an informational guide was made. This guide includes information for providers including up to date statistics, a tick identification and life cycle guide, and a chart explaining symptoms, lab findings, diagnosis, and treatment of the diseases found in Vermont. It also includes a patient education handout with a cut out identification card. This …

Breast Cancer Screening - Helping Patients Choose, Fran Riley

Family Medicine Clerkship Student Projects

Breast cancer imaging has been covered broadly in the lay press. Many questions have been raised in the past few years, which bring confusion to patients in terms of risks vs benefits. In addition, new research shows dense breasts to be a significant risk factor to developing breast cancer, warranting additional modalities. All of this requires the patient to have an understanding of the risks versus benefits so they can choose what's best for them. This project creates an information brochure for patients, using numbers to give patients objective perspective to inform their decision.

Hidden Adolescent Risks: Provider Education On Non-Suicidal Self-Injury, Bailey Fay

Family Medicine Clerkship Student Projects

Non-suicidal self-injury (NSSI) has been shown to be a strong risk factor for suicidal ideation and suicide attempt. One study has shown over 50% of people engaging in NSSI have at least one suicide attempt in their lifetime. The 2015 Vermont Youth Risk Behavior Survey found 17% of high school students reported non-suicidal self-injury at least once in the past year. This reflects roughly one in four females and one in ten males. Furthermore, these numbers have increased significantly since 2013. In an effort to promote awareness of NSSI in the primary care setting, a handout was created for providers …

Provider Education & Requirements For Opioid Prescriptions, Lawrence J. Leung

Family Medicine Clerkship Student Projects

Nationally, there has been a surge in the opioid prescription crisis with associated overdose deaths. Vermont is no exception, with increasing opioid overdose related deaths within the last 10 years. A sample (n=111) of opioid addiction patients at the Community Health Centers of Burlington (CHCB) have demonstrated that 25% have their initial use due to provider prescription. New Vermont regulations to decrease opioid prescriptions are inefficient. The goal of this project is to implement a streamlined intervention to improve provider education and comfort regarding new Vermont state opioid prescribing regulations.

Mindfulness As An Effective Strategy For Anxiety Relief In Adolescent Patients, Desiree N. Dibella

Family Medicine Clerkship Student Projects

Anxiety disorders affect 6.8 million adults over the age of 18 in the United States, and anxiety disorders are the most common mental health illness in children.

Risk Factors for anxiety disorders in young adults include the following: -Shyness, or behavioral inhibition, in childhood -Being of the female sex -Having few economic resources -Exposure to stressful life events in childhood -Anxiety disorders in close biological relatives -Parental history of mental disorders -Elevated afternoon cortisol levels in the saliva Teens and young adults increasingly suffer from anxiety disorders with the CDC reporting the rate of anxiety disorders among 3 to 17 …

Lyme Disease Education: Prevention And Response To Tick Bites, Nicholas S. Loschiavo

Family Medicine Clerkship Student Projects

Lyme disease is a major public health concern in Vermont, and is only becoming more prevalent. There were nearly 800 probable cases of Lyme disease in 2016, compared to 100 cases in 2006. Untreated Lyme disease has significant effects on overall health including cardiac disease. Lyme disease also has severe impacts on public health costs, and is responsible for roughly $1 billion annually. A Lyme disease handout for patients at a primary care outpatient center in Vermont was designed to help educate the public on disease prevention and progression.

Improving Our Response To Positive Food Insecurity Screening At Colchester Family Practice, Callie Linehan

Family Medicine Clerkship Student Projects

My project is to raise awareness of food insecurity among providers, and identify resources and next steps providers can take to help patients who screen positive for food insecurity using the AAP-recommended Hunger Vital Sign.

Recognizing Depression In Elderly Patients, Maia Sakradse

Family Medicine Clerkship Student Projects

Recognizing depression in elderly patients can be challenging. Lack of awareness of mental health issues amongst elderly patients, ideas that depression is a normal part of aging, and confusing symptoms of depression as symptoms of other conditions are just a few of the challenges. Providing patient information about the signs and symptoms of depression in older patients may help encourage patient to talk to their doctors about depression.

Improving Access To Healthcare For Lgbtq Individuals In Burlington, Andrew Corse

Family Medicine Clerkship Student Projects

Studies consistently show that LGBTQ individuals are at higher risk for substance abuse, tobacco use, suicide, HIV, and chronic health conditions. The Community Health Centers of Burlington recently created a specialty clinic called the Be You Clinic, which will focus on delivering healthcare to LGBTQ persons, by LGBTQ-affirmative and –knowledgeable providers. This project sought to spread awareness of this new clinic by advertising.

A Multimodal Approach To Hypertension: Behavioral Modifications On A Budget, Jayne Manigrasso

Family Medicine Clerkship Student Projects

Hypertension is one of the most common diagnoses in the adult population in the United States. Hypertension also has various sequelae that are preventable with adequate treatment, including medication and lifestyle modification.

Assessing Transportation Hurtles In Lamoille County, Vt, Brian J. Rosen

Family Medicine Clerkship Student Projects

Rural areas are often characterized by low population densities, and large distances between available services and the population they serve. Lack of transportation in these areas makes access to services even more challenging. Access to primary healthcare was listed as the number one concern for patients in 2015 Copley Hospital Service Area (Lamoille County) and lack of suitable transportation was a major reason for this lack of access. The primary purpose of this project was to assess the medical transportation options for patients without appropriate transportation in Lamoille county, and to produce a flyer educating the patients about their options. …

Improving Diabetes With An Exercise Log, Ramya Ghantasala

Family Medicine Clerkship Student Projects

Diabetes is a prevalent and costly disease. Everyone benefits from physical activity, but it is particularly beneficial for people with diabetes. One method to improve motivation and adherence to physical activity may be the use of monitoring with an exercise log.

Headphones And Adolescents: Hearing Loss Prevention, Taylor Sommer

Family Medicine Clerkship Student Projects

Headphone use of adolescents is on the rise due to increased availability of personal listening devices. Hearing loss has also increased in adolescents. This project aims at preventing noise-induced hearing loss by educating adolescents on proper use of headphones.

Organ Donation: Gauging Perception, Interest, And Clarifying Misconceptions, Tridu Huynh

Family Medicine Clerkship Student Projects

Around 120,000 people currently need a lifesaving organ transplant in the United States. On average, 22 people die each day while waiting for a life-saving organ transplant. In 2011, over $34 billion dollars were spent on dialysis patients with end-stage renal disease. Only 52% of the national population is registered for organ donation. In Vermont, that number is 44%. This project aimed to clarify some common misconceptions regarding organ donation in the form of a brochure. Participants' subsequent interest and concerns regarding registering as an organ donor were also gauged. A total of 50 people filled out the form. There …

Counseling Pregnant Women On Marijuana Use, Theresa B. Flanagan

Family Medicine Clerkship Student Projects

Marijuana is the most commonly used illicit substance for pregnant women nationwide, with rates of use trending upward. Marijuana use in Penobscot County is elevated well above the national average, and is likely to continue to rise with the legalization of recreational marijuana in the state of Maine. Though the American Congress of Obstetricians and Gynecologists (ACOG) discourages marijuana use during pregnancy and breastfeeding, studies have shown that providers do not emphasize counseling pregnant patients on marijuana use. This project looked at provider practices and perceptions regarding marijuana use during pregnancy at the Center for Family Medicine at Eastern Maine …