Family Medicine Commons^™

Transgender Care, Nyasha George, Md, Pgy 3

Department of Family & Community Medicine Presentations and Grand Rounds

Outline:

Objectives

Review of trans epidemiology

Healthcare and the Transcommunity

Cases 1&2

• Taking a transgender history
• CSH indications

Case 3

• Mental Health and Transpersons

Case 4

• Cardiovascular Risks and Estrogen in Transwomen
• Provider Resources

Objectives

My goals for you at the end of this lecture:

Comfort in determining which transgender patients meet criteria for initiating CSH

Appreciation of the overlap between transgender identity and psychiatric disease as mediated primarily by trauma

Improved self efficacy in weighing risks/benefits of CSH therapy

Familiarity with resources available to help support primary care providers take care of transgender patients.

Presentation: 58:36

Promoting Family Resilience As A Population Health Strategy, Barry J. Jacobs, Psy.D.

Department of Family & Community Medicine Presentations and Grand Rounds

Today's Talk:

• Why family matters to population health
• Research from two movements
• Steps toward patient and family resilience
• Barriers to integrating family caregivers into healthcare
• Healthcare-based family caregiver support programs: Baylor Scott & White, Concord Hospital

No audio, just PowerPoint slides

Barriers And Facilitators To Cervical Cancer Screening Among Iraqi Refugees Resettled In Philadelphia: A Qualitative Analysis Of Patient And Provider Perceptions, Colleen Payton, Mph, Ches, Laura Parente, Md, Dalea Al-Hawarri, Md, Philip Manasseh, Mph, Kevin Scott, Md, Marc Altshuler, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Oral presentation at the 6^th Annual North American Refugee Health Conference, Niagara Falls, New York.

Research Questions:

1. What is the prevalence of cervical cancer and cervical cancer screening among recently resettled refugees seen at Jefferson's Center for Refugee Health?

2. Are patient-and provider-identified barriers to cervical cancer screening at CRH consistent with those identified in previous research efforts?

3. What are patient-and provider identified facilitators to cervical cancer screening for Iraqi refugee women?

The Pennsylvania Emergency Department Geriatric Readiness Project, Adam Perry, Md, Alyssa Sipes, Bs

College of Population Health Posters

BE THE ED DOC – Illustrating Geriatric Readiness

An independent, right handed 81 year old who lives alone trips and falls while walking with her walker. A thorough evaluation at her local ED reveals only a nonoperative right proximal humeral fracture. Her pain is well controlled with immobilization and oral analgesics.

What is her disposition?

• Discharge home with shoulder immobilizer and instructions to call orthopedics in the morning.
• Admit to Telemetry Bed for “Syncope” with orthopedics and cardiology consultations, with subsequent SubAcute Rehabilitation stay.
• Admit to Observation Status for “Ambulatory Dysfunction”.
• Discharge home with her daughter, who lives locally, with …

Sonographic Findings Of A Semi-Professional Football Player With 1st Mtp Joint Pain: Gout Or Turf Toe?, David Jeong, Md, Caqsm, Cep, Rmsk, Danielle Snyderman, Md, Lauren Hersh, Md, Jeremy Close, Md

Department of Family & Community Medicine Posters

Purpose

Aim : To review the applications and indications of sonography for forefoot disorders, especially gout and plantar plate injury of 1^st MTP joint.

Introduction

• Forefoot disorders are common but forefoot ultrasound is underutilized.
• Point-of-Care Ultrasound was utilized in initial workup evaluating acute on chronic 1^st MTP joint pain in our case study.

Association Between Knowledge And Performance In Clerkships And Usmle Step 2 Ck Scores: Implications For Counseling And Academic Decision-Making, Abigail Kay, Md, Kristin Desimone, Md, Jon Veloski, Ms, Steven Herrine, Md

Department of Family & Community Medicine Posters

Background

Step 2 CK scores are of increasing importance in medical student career planning. In the National Resident Matching Program 2014 Program Director Survey, Step 1 scores were the highest-rated among 33 factors used in screening applicants to be interviewed (94% cited it with a mean rating of 4.1 on a 5 point Likert scale); Step 2 scores were rated fourth in importance (80% cited it, mean rating of 4.1). When citing factors for ranking a given applicant, Step 1 scores ranked 5^th (80% cited, with mean rating of 4.1) and Step 2 CK scores ranked 7^th (71% …

Obsessive-Compulsive Disorder, Elizabeth Collins, Md

Department of Family & Community Medicine Presentations and Grand Rounds

PowerPoint only, no audio.

Presentation includes:

• Definitions
• Epidemiology and Pathology
• Diagnosis
• Dermatologic Manifestations
• Management

Cancer Screening 2014, Richard C. Wender, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Presentation celebrating 40th reunion symposium for the Department of Family and Community Medicine at Thomas Jefferson University Hospital.

Presentation outline includes:

Breast, Colon, Lung and Prostate Cancer

Learning objective: Apply new cancer screening guidelines to primary care physicians

Generating Hypotheses About Care Needs Of High Utilizers: Lessons From Patient Interviews., Dawn B Mautner, Hauchie Pang, Jeffrey C Brenner, Judy A Shea, Kennen S Gross, Rosemary Frasso, Carolyn C Cannuscio

Department of Family & Community Medicine Faculty Papers

Informed by a largely secondary and quantitative literature, efforts to improve care and outcomes for complex patients with high levels of emergency and hospital-based health care utilization have offered mixed results. This qualitative study identifies psychosocial factors and life experiences described by these patients that may be important to their care needs. Semi-structured interviews were conducted with 19 patients of the Camden Coalition of Healthcare Providers' Care Management Team. Investigators coded transcripts using a priori and inductively-derived codes, then identified 3 key themes: (1) Early-life instability and traumas, including parental loss, unstable or violent relationships, and transiency, informed many participants' …

An Interdisciplinary Model To Improve Completion Of Latent Tuberculosis Infection Treatment In The Refugee Population, Christine O'Leary, Pharmd, Marc Altshuler, Md, Kevin Scott, Md, Karen Kitagawa-James, Rn, Bsn, Maria Hervada-Paige, Mss

Department of Family & Community Medicine Presentations and Grand Rounds

Background: Refugees are disproportionately affected by latent tuberculosis infection (LTBI) and active tuberculosis (TB) compared to the general US population. More than 50% of TB cases in the US occur in foreign-born persons. In addition, approximately 80% of TB cases in the US are a result of reactivation of LTBI. Treatment of LTBI is effective to prevent and control TB. Unfortunately, LTBI treatment completion rates in the foreign-born are less than 50%. Methods: After conducting a retrospective chart review to establish baseline rates of treatment completion in our LTBI refugee patients, we implemented a model of prospective chart review, initial …

The Effects Of A Group Visit Program On Outcomes Of Diabetes Care In An Urban Family Practice., Jeffrey A Reitz, Mona Sarfaty, James Diamond, Brooke Salzman

Department of Family & Community Medicine Faculty Papers

Diabetes mellitus is a prevalent chronic health condition associated with significant morbidity and mortality. Those with diabetes must acquire self-efficacy in the tasks necessary for them to successfully manage their disease. In this study, a controlled pre- and post-design was used to determine the effect of an adult support and education group visit program embedded in an urban academic family medicine practice on weight and the achievement of treatment goals for hemoglobin A1C, low-density lipoprotein (LDL) blood concentration, and blood pressure (BP) several months after it was implemented. Participants in the program were matched to a comparison group based on …

Community-Based Partnerships For Improving Chronic Disease Management, James Plumb, Laura Carson Weinsten, Rickie Brawer, Kevin Scott

Department of Family & Community Medicine Faculty Papers

With the growing burden of chronic disease, the medical and public health communities are re-examining their roles and opportunities for more effective prevention and clinical interventions. The potential to significantly improve chronic disease prevention and have an impact on morbidity and mortality from chronic conditions is enhanced by adopting strategies that incorporate a social ecology perspective, realigning the patient-physician relationship, integrating population health perspectives into the Chronic Care Model, and effectively engaging communities using established principles of community engagement.

Copyright © 2012 Elsevier Inc. All rights reserved.

Performance Of Colorectal Cancer Screening Steps In Primary Care, Salini Mohanty, Mph, Mona Sarfaty, Md, Mph, Faafp, Randa Sifri, Md

Mona Sarfaty

Discussion:

This analysis revealed the differences in which physicians in primary care complete CRC screening steps. The approach and completion of screening steps varied greatly among practices.

There was a correlation between the quantitative data and the qualitative data. The analysis from both methodologies produced similar results and supports each other's assessment.

All of the practices analyzed possessed one of the essential elements (a physician recommendation) which is the foundation for increased screening. All of the practices have the potential to expand upon this foundation in order to ensure that all eligible patients are approached and screened for CRC.

The …

The Career Support Network (Csn): Workforce Programming Through A New Lens, Rickie Brawer, Mph, Phd, James D. Plumb Md, Mph, Stephen Kern, Phd, Otr/L, Faota

Department of Family & Community Medicine Faculty Papers

Challenges:

Loss of Earn center as referral source

Multiple IRB submissions

Training/orientation at Philadelphia Prison System for working with pre-release prisoners

Service team organization/scheduling

Coordinating of cohorts at various stages of enrollment

Sepa-Reads: Cardiovascular Health Literacy Coalition, Rickie Brawer, Mph, Phd, James D. Plumb Md, Mph, Rob Simmons Drph,Mph,Ches, Martha Romney Rn,Ms,Jd,Mph, Patricia Yurchick, Rn, Mba, Cphq, Leslie Stearns

Department of Family & Community Medicine Faculty Papers

Poster includes:

Health literacy definition

Factors that contribute to health literacy

Extent of the literacy problem

What do we know from a decade of research?

Readmission rates

Evaluation: long and short term outcomes

And much more.

Participatory Research At Pathways To Housing-Pa: A Consumer Perspective, Patways To Housing Consumer Health Research Team And Department Of Family And Community Medicine

Department of Family & Community Medicine Presentations and Grand Rounds

Research Question: How does housing affect healthcare decision making?

Methods: 11 Clients took part in a 9-week project focused on health. Using qualitative methodology, weekly meetings were recorded, transcribed, then analyzed resulting in the development of thematic findings.

Baseline Monitoring Of Standard Health Indicators In A Formerly Homeless Population, Lara Carson Weinstein, Md, Mph, Marianna Lanoue, Phd, Elizabeth Collins, Bs

Department of Family & Community Medicine Presentations and Grand Rounds

Research Question: What are the rates of baseline health status indicators recording at Pathways to Housing (PTH) using select recommended measures from the National Association of State Mental Health Program Directors (NASMHPD) and the Healthcare Effectiveness Data Information Set (HEDIS)?

How do health indicators compare between clients receiving direct clinical care in the integrated care program vs non-integrated care clients?

Individual Agency, Community Capacity Building, And Chronic Illness Care: Using Participatory Methods To Implement The Stanford Chronic Disease Self Management Program In A Housing First Program, Lara Carson Weinstein, Md, Mph, Abbie Santana, Msph, Carolyn Armour, Cornelius Crossan, James Lawson, Karen Webb

Department of Family & Community Medicine Presentations and Grand Rounds

Research questions:

Is a standardized chronic disease self management program (CDSMP) experienced as a valuable intervention by Pathways' consumers?

What is the impact of collaborative inquiry into health program development on participant's critical agency?

Performance Of Colorectal Cancer Screening Steps In Primary Care, Salini Mohanty, Mph, Mona Sarfaty, Md, Mph, Faafp, Randa Sifri, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Discussion:

This analysis revealed the differences in which physicians in primary care complete CRC screening steps. The approach and completion of screening steps varied greatly among practices.

There was a correlation between the quantitative data and the qualitative data. The analysis from both methodologies produced similar results and supports each other's assessment.

All of the practices analyzed possessed one of the essential elements (a physician recommendation) which is the foundation for increased screening. All of the practices have the potential to expand upon this foundation in order to ensure that all eligible patients are approached and screened for CRC.

The …

Obesity And Cancer Screening According To Race And Gender., Heather Bittner Fagan, Richard Wender, Ronald E Myers, Nicholas Petrelli

Department of Family & Community Medicine Faculty Papers

The relationship between obesity and cancer screening varies by screening test, race, and gender. Most studies on cervical cancer screening found a negative association between increasing weight and screening, and this negative association was most consistent in white women. Recent literature on mammography reports no association with weight. However, some studies show a negative association in white, but not black, women. In contrast, obese/overweight men reported higher rates of prostate-specific antigen (PSA) testing. Comparison of prostate cancer screening, mammography, and Pap smears implies a gender difference in the relationship between screening behavior and weight. In colorectal cancer (CRC) screening, the …

Intracerebral Hemorrhage For The Palliative Care Provider: What You Need To Know., B Brent Simmons, Susan M Parks

Department of Family & Community Medicine Faculty Papers

Intracerebral hemorrhage (ICH) makes up 10%-30% of all strokes. Palliative care providers are often asked to get involved with ICH cases to aid with development of short-term and long-term goals. Prognosis can be calculated using the ICH score (based on Glasgow Coma Score score, ICH volume, presence of intraventricular hemorrhage, age, and location of origin) or the Essen score (based on age, NIH Stroke Scale [NIHSS], and level of consciousness). Do-not-resuscitate (DNR) status is important to discuss with families. Expert consensus states DNR is appropriate if the patient has two of the following: severe stroke, life-threatening brain damage, or significant …