Family Medicine Commons^™

Introduction To Atls And Emergency Preparedness, Leon Gu, Urvashi Firozi, Pradeep D'Souza

Gulf Coast Division Research Day 2024

No abstract provided.

Phenytoin Toxicity And Hypoglycemia - Case Study, Daniel Khashchuk, Natarajan Venkatayan

Gulf Coast Division Research Day 2024

No abstract provided.

Thoracic Spine Lesion With Paralysis: A Rare Presentation Of Plasmacytoma, Daniel Khashchuk, Natarajan Venkatayan

Gulf Coast Division Research Day 2024

No abstract provided.

Empowering Patients Undergoing Speculum Exam, Sarah Caffry

Family Medicine Clerkship Student Projects

No abstract provided.

Improving Clostridium Difficile Detection At Medical City Arlington: A Quality Improvement Project, Bremmy Alsbrooks, Nur-Alhuda Shahub, Shabaz Mallick, Jesse Brown

North Texas Research Forum 2024

INTRODUCTION: Hospital acquired Clostridium difficile infection are one of the costliest hospital acquired infections. Over the past year, there were 19 C diff cases. Reasons for this uptick in cases from previous years could be waiting too long for collection (where a patient has C diff on admission, but does not receive testing until several days later), antibiotics, environmental (for example, using the same toilet brush to clean bathrooms on the floor as well as the bathroom in a C diff patient's room, cleaning high touch areas less than two times during the day, etc.), or staff education. From our …

Case Report: Unilateral Internuclear Ophthalmoplegia As First Manifestation In Multiple Sclerosis, Imaad Zaman, Tyler Adame, Steven Do, Kien Nham, Azeem Muhammad

North Texas Research Forum 2024

Multiple Sclerosis is an inflammatory disorder of the central nervous system secondary to myelin degeneration. The disease is mediated by reactive lymphocytes where the spinal cord, brain and optic nerves are attacked. Diagnosis of MS is made clinically and confirmed via MRI with T2 hyperintensities. On presentation, a 26-year-old female with no significant past medical history presented with frequent headaches and blurry vision. There was right eye nystagmus on L lateral gaze with CN III deficits with absent medial rotation. MRI Head presented with a classic presentation of T2 hyperintensities in the subcortical and deep white matter. Further confirmed with …

Bridging The Gap For Hiv Education In Primary Care Setting, Oregon Mcdiarmid, Lindsay Porter

North Texas Research Forum 2024

No abstract provided.

Angioedema Linked To Combination Pill Trandolapril/Verapamil, Aadil Bhutta, Sana Khan, Monica Dhiman, Udit Bhatt, Akinjide Onifade

North Texas Research Forum 2024

Angioedema is the swelling of deeper layers of skin caused by a build-up fluid, oftentimes due to the culmination of immune system activation against allergens. There are several causes of angioedema, including animal dander, exposure to various foods, insect bites, and medications such as Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs). This swelling primarily presents periorbital and periorally, however can also less-commonly affect the airway. Angioedema can be life-threatening if involving the throat and larynx given the potential of respiratory airway compromise. This case presents a patient who had been on an ACE-ARB for almost 2 decades, …

Current Trends In School Nursing In Musculoskeletal Injuries And Concussions, Christoffer Amdahl, Hans Drawbert, Sadra Forati, Joshua Allen, Sana Qureshi

North Texas Research Forum 2024

Background: School nurses are on the front lines of assessing, identifying and treating school age children with a number of health complications. Implementing nursing services in schools have previously demonstrated improved medical care costs for students, less productivity loss for parents, and less productivity loss for teachers. As a result, nursing services in schools provide a cost-beneficial investment of public money, and warrant both financial support from policy makers as well as educational support from local healthcare services. Communicable disease, asthma, musculoskeletal injuries, concussions are common conditions seen in school aged children and a fundamental understanding of these issues …

Improving Documentation Of Patients' Physical Activity In The Outpatient Setting, Jordan Price, Syed Abbas, William Bass, Rigoberto Hernandez, Abdullah Shuaib

North Texas Research Forum 2024

Background: There is vast data on the health benefits of physical activity (PA) and the serious health consequences that are associated with a sedentary lifestyle. Research suggests that physicians who have meaningful conversations about exercise with their patients can be effective at increasing their patients' PA. In order to measure the effects of these discussions, the clinician must be able to document the baseline and subsequent PA of their patients. Our project seeks to improve the assessment and documentation of patient PA. Methods: Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team was created to identify ways to improve documentation …

Osteopathic Manipulative Treatment (Omt) Utilization In The Primary Care Setting, Ceferino Cruz, Afsha Rais

North Texas Research Forum 2024

INTRODUCTION: Osteopathic Manipulative Treatment (OMT) is a skillset used to help diagnose and treat patients with a wide range of musculoskeletal complaints and can also be used as adjunctive treatment modalities for other organ systems. The project is designed to increase OMT usage across 3 clinical sites in our residency program to improve the quality of care provided to our patients. OBJECTIVES: Integrate OMT review into longitudinal clinical education. Address the shortage of faculty members that can precept OMT across all three sites. METHODS: The metrics being tracked are various OMT CPT codes ranging from 98925 to 98929 …

Type Ii Diabetes And Keto Diet In Family Medicine Clinic: A Case Report, Dante Paredes, Karos Torres, Joshua Moton

North Texas Research Forum 2024

The management of patients with high cardiac risk profiles who require insulin therapy for diabetes can be challenging due to the potential adverse effects of insulin on cardiovascular health. In order to achieve remission of type 2 diabetes mellitus (T2DM) and discontinue the need for insulin, weight loss has long been recognized as a valuable approach. The goal for this case was to implement dietary and lifestyle changes in a safe and efficient manner to induce remission of T2DM, without increasing the sympathetic load often associated with fully dosed ketogenic and other fasting strategies. This case report highlights the successful …

The Anthropometric Determinants Of Peak Expiratory Flow Rate Among Children In Dar Es Salaam, Tanzania, Willbroad Kyejo, Nancy Matillya, Neelam Ismail, Gloria Gachocha, Hajaj Salum, Rosebella Iseme, Mariam Noorani

Family Medicine, East Africa

Background: Peak expiratory flow rate (PEFR) is an important tool for assessing lung function, which can be affected by environmental and physical factors such as altitude, nutrition, genetics, age, height, and weight. Conducting a study to assess the correlation between peak expiratory flow rate and anthropometric measurements in Tanzanian schoolchildren is crucial to derive a population-specific prediction formula and further simplify respiratory health assessment.

Methods: This cross-sectional study was conducted in a single center private primary and secondary school in Dar es Salaam, Tanzania using data from an asthma screening camp. Variables of interest were height, weight, Body Mass Index …

Obesity, Overweight Rates, And Related Factors Among Adults In The Rustic Realm Of Western India, Monika Patel, Jimmy Kagathara, Eshwar Kumar Gupta, Nancy Kagathara, Jitesh Mehta, Dipesh Parmar

Makara Journal of Health Research

Background: Obesity and overweight pose significant challenges in developing countries, underscoring the need for evidence-based prevention strategies. This study focuses on assessing the prevalence and associated factors of overweight and obesity in the rural areas of Jamnagar district, Gujarat, India.

Methods: Data collection encompassed six tehsils within Jamnagar district, with primary health center selection via simple random sampling. Individual selection employed the consecutive sampling approach. Statistical analysis was conducted using SPSS software. Regression analysis was employed to identify the independent factors linked to overweight and obesity.

Results: The analysis included 408 participants, revealing a higher obesity prevalence …

On The Discontinuation Of Enteral Feeding In Head And Neck Cancer: A Case Report, Kyle Fisk, Ana Sanchez

HCA Healthcare Journal of Medicine

Introduction

The goal of palliative care is to preserve the quality of life or patient “comfort” in patients with serious diseases. Palliative care providers serve a wide range of patients: from those who seek curative treatment to those who are actively dying. Given this range, palliative care must mirror the dynamic goals of the patient at different stages of life and treatment. Throughout these stages, a goal of the palliative care provider would be to avoid hastening death; however, this often leads to clinical decisions that directly pit the patient’s comfort against the patient’s life span. This is most salient …

The Implementation Of Nurse Practitioner Residency Programs To Increase The Employment Retention Of New Graduates, Roni-Jo Panganiban

Master of Science in Nursing Family Nurse Practitioner

This review explores the effectiveness of Nurse Practitioner (NP) residency programs in addressing role strain, burnout, and retaining new graduates. It emphasizes the factors contributing to NP resignations and proposes formal residency programs to improve job satisfaction and retention rates. Research highlights benefits such as enhanced preparedness, credibility, and better patient care, advocating for increased program accessibility and funding. Additionally, the application of the theory of planned behavior underscores compliance with regulations, evidence-based practice, and environmental influences for patient safety in advanced practice registered nursing. The literature review on NP residency programs draws from six empirical articles, focusing on job …

A Quality Improvement Project On Blood Pressure Measurement: Are We Failing Our Patients?, Michael Baker

Doctoral Projects

Despite billions of dollars invested in research, education, and equipment, high blood pressure remains a significant contributor to mortality rates across the globe. According to the Centers for Disease Control (2019), hypertension was listed as a primary or contributing cause of over a half-million deaths in the United States (Centers for Disease Control [CDC], 2021). Without regard to race, gender, background, or socioeconomic level, this “silent killer” the Mississippi State Department of Health estimated that over 700,000 Mississippi adults were diagnosed with high blood pressure and thousands more at an increased risk each year (MSDH, 2019). Failure to identify and …

Support, Networks, And Relationships: Findings From A Mixed-Methods Evaluation Of A Mentorship Programme For Early Career Women Researchers In Sexual And Reproductive Health And Rights, Muhammad Asim, Peter Muriuki Gatheru, Joy J. Chebet, Mehr G. Shah, Anna Thorson, Vanessa Brizuela

Community Health Sciences

Low research output among women researchers in health research has been linked to inadequate mentorship opportunities for early career women researchers and particularly in sexual and reproductive health and rights (SRHR) field. Mentorship has been recognized as a contributor to strengthening research capacity and as beneficial for both mentors and mentees. Women researchers oftentimes experience negative impacts of organizational and structural gender inequities related to formal and informal mentoring. In 2020, the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction at WHO launched a mentorship programme for early career SRHR women researchers from low- and …

Primary Care Provider Receptivity To Multi-Cancer Early Detection Test Use In Cancer Screening, Christopher Chambers, William Leach, Kaitlyn V Davis, Ronald Myers

Department of Family & Community Medicine Faculty Papers

Multi-cancer early detection tests (MCEDs) are blood-based tests that detect biomarkers released or induced by cancer cells. If MCED tests are shown to be safe and effective in cancer screening, they are likely to be ordered and managed in primary care. To understand primary care providers’ support for and concerns about the implementation and management of MCED testing, the research team developed a cross-sectional survey that was sent to 939 primary care providers (physicians, residents/fellows, and advanced practice providers) in a large academic health system in the greater Philadelphia area. The survey included standard items used to assess provider background …

An American Medical Economics Phenomenon, Richard Guthmann Md, Mph

Clinical Research in Practice: The Journal of Team Hippocrates

The author reflects on his own experience with medical economics-driven phenomena in healthcare.

The Impact Of Telehealth In Urgent Care Settings, Annie Dong

Applied Research Projects

Telehealth is an emerging modality of patient care and has since expanded to urgent care facilities. Urgent care facilities have been around for decades; however, along with telehealth, it has only grown in popularity in recent years due to the COVID-19 pandemic. However, the implementation and usage of telehealth in urgent care facilities is dependent on the provider being able to use it. This study aimed at looking at the perspective of the provider on the implementation and usage of telehealth in the urgent care setting.

Using Digital Assessment Technology To Detect Neuropsychological Problems In Primary Care Settings, David J Libon, Emily Frances Matusz, Stephanie Cosentino, Catherine C Price, Rod Swenson, Meagan Vermeulen, Terrie Beth Ginsberg, Adaora Obiageli Okoli-Umeweni, Leonard Powell, Robert Nagele, Sean Tobyne, Joyce Rios Gomes-Osman, Alvaro Pascual-Leone

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

INTRODUCTION: Screening for neurocognitive impairment and psychological distress in ambulatory primary and specialty care medical settings is an increasing necessity. The Core Cognitive Evaluation™ (CCE) is administered/scored using an iPad, requires approximately 8 min, assesses 3- word free recall and clock drawing to command and copy, asks questions about lifestyle and health, and queries for psychological distress. This information is linked with patients' self- reported concerns about memory and their cardiovascular risks.

METHODS: A total of 199 ambulatory patients were screened with the CCE as part of their routine medical care. The CCE provides several summary indices, and scores on …

Designing For Community Engagement: User-Friendly Refugee Wellness Center Planning Process And Concept, A Health Design Case Study, Ellen Solomon, Brandon Joa, Shandon Coffman, Billie Faircloth, Marc Altshuler, Bon Ku

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Refugee and immigrant populations have diverse cultural factors that affect their access to health care and must be considered when building a new clinical space. Health design thinking can help a clinical team evaluate and consolidate these factors while maintaining close contact with architects, patients' community leaders, and hospital or institutional leadership. A diverse group of clinicians, medical students, community leaders and architects planned a clinic devoted to refugee and immigrant health, a first-of-its-kind for South Philadelphia.

METHODS: The planning process and concept design of this wellness center is presented as a design case study to demonstrate how principles …

Renal Disease Rehabilitation And Delaying Dialysis, Spencer Brown, Natalie Sterner

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Greenwood SA, Koufaki P, Mercer TH, et al. Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory fitness in patients with CKD: a pilot randomized controlled trial. Am J Kidney Dis. 2015;65(3):425-434. https://doi.org/10.1053/j.ajkd.2014.07.015

for a patient with non-dialysis CKD interested in slowing the progression toward necessary dialysis.

The Pattern Of Admission, Clinical Characteristics, And Outcomes Among Patients Admitted To The Intensive Care Unit Of A Tertiary Hospital In Tanzania: A 5-Year Retrospective Review, Nadeem Kassam, Philip Adebayo, Iris Martin Matei, Eric Aghan, Samina Somji, Samwel Paul Kadelya, Yasson Abha, Frank Elton Swai, Mangaro Mabusi, Kamran Hamid

Internal Medicine, East Africa

Introduction: Despite the implementation of complex interventions, ICU mortality remains high and more so in developing countries. The demand for critical care in Sub-Saharan Africa is more than ever before as the region experiences a double burden of rising rates of non-communicable diseases (NCD) in the background battle of combating infectious diseases. Limited studies in Tanzania have reported varying factors associated with markedly high rates of ICU mortality. Investigating the burden of ICU care remains crucial in providing insights into the effectiveness and challenges of critical care delivery.

Material and Methods: A single-center retrospective study that reviewed records of all …

Barrett's Esophagus As A Premalignant Condition; Medical And Surgical Therapeutic Management, Vlad Denis Constantin, Adrian Silaghi, Laura Florentina Rebegea, Stana Paunica, Anca Silvia Dumitriu, Doina Andrada Mihai, Ioana Paunica, Dragos Epistatu

Journal of Mind and Medical Sciences

Barrett's esophagus (BE) represents a special clinical entity, which may have reduced symptoms, but an increased potential for malignant degeneration. The factors that lead to the appearance of Barrett's esophagus are multiple, the most important being gastro-esophageal reflux, as well as smoking and obesity. BE occurs as a result of damage of the esophageal mucosa, caused by acid/basic gastroesophageal reflux and resulting in the transformation of the epithelium from squamous to intestinal type. The diagnosis of BE is primarily based on endoscopic examination. This method has not only a diagnostic role, but also a therapeutic one through the minimally invasive …

Enhancing The Rates Of Advance Directive Documentation To Improve The Quality Of Patient Care, Sydney Sheppard, Katie Salyers, Carolyn Curtis, Adam Franks Franks, Courtney Wellman

Marshall Journal of Medicine

Introduction

Advance Directives (AD) allow patients to maintain autonomy during incapacitation. Patients and their caregivers benefit from these documents in times of crisis. Overcoming barriers to AD completion and documentation can improve patient care quality.

Methods

A retrospective chart review was performed initially, after consolidation of the electronic health record (EHR) and after alteration of the EHR, to evaluate the availability of a patient’s medical power of attorney (MPOA), living will (LW), and code status.

Results

Baseline documentation of MPOA (7.33%), LW (6.00%), and code status (5.33%) within the outpatient EHR was low. After 2 cycles, this improved to 13.10%, …

Chronic Exertional Compartment Syndrome: A Case Report About Claudication In A Healthy Adult, Adrienne Mays-Kingston, Jeremy Eckels, Holly Farkosh, Austin Nichols, Paris Johnson, Adam M. Franks

Marshall Journal of Medicine

Claudication occurs when the blood supply is insufficient to service the musculature in the body with oxygen and metabolic waste management. A clinical complaint of claudication is commonly seen in primary care among older patients with vascular risk factors. A young and healthy patient presenting with claudication is less common and often results in delayed diagnosis with numerous extraneous diagnostic studies. This case discusses a young, healthy male patient with lower extremity symptoms that got worse with exercise and better with rest. He had normal physical exam findings leading to multiple diagnostic studies and over 12 months between the onset …

Proton Pump Inhibitor Use And Adverse Effects In South Atlantic Hospitals, Nicholas D'Angelo, Ramyar Sigarchy, Anthony Esswein, Sidra Asrar

HCA Healthcare Journal of Medicine

Background

Proton pump inhibitors (PPI) have transformed the management of acid-related gastrointestinal disorders, becoming one of the top-selling medications in the United States. There is no doubt that PPIs have a significant therapeutic impact on patients with gastroesophageal reflux disease and gastrointestinal bleeding. However, evidence is mounting that PPIs are overprescribed, leading to more patients possibly experiencing adverse effects. There is a great deal of ongoing debate surrounding the significance and impact of these adverse effects.

Methods

We conducted a study in 9 HCA hospitals in the southeastern United States to determine the number of patients who started on PPIs …

Penile Calciphylaxis In An End Stage Renal Disease Patient., Juan Enrique Garcia Lopez, Alain Velazquez Blanco, Aileen Aguilar, Sareena Siyas, Daniel Ibarias Paz, Mays Abdulazeez, Jesus Garza-Tamez, Desmond Adamu

Research Colloquium

Background: Penile Calciphylaxis occurs in about 1–4% of hemodialysis patients worldwide. Associated mortality rates are very high, and hyperparathyroidism is the second most frequently associated disorder. Addressing the resulting metabolic imbalance, and surgical intervention guided by findings of radiological studies may improve quality of life. The pathogenesis is thought to be mediated by vascular smooth muscle cells which differentiate into osteoblast-like cells. Decrease in vascular calcification inhibitory proteins fetuin-A and matrix Gla is found in patients on dialysis causing systemic medial calcification of arterioles, leading to epidermal ischemia, tissue infarction, and ulceration.

Case presentation: 47-year-old male with history of coronary …