Mental and Social Health Commons^™

Offering Medical Providers Capacity And Competence In Caring For Transgender And Non-Binary Patients: Evaluation Of A Pilot Digital Training Program, Lexis Manzara

Master's Projects and Capstones

Purpose: Stigma and discrimination in health care settings contribute to health disparities for transgender and non-binary (TGNB) people. Evidence suggests that a lack of training on the care for transgender and non-binary TGNB patients in medical school curricula has contributed to providers feeling unprepared to provide quality care for this population. Health care providers have the opportunity to play a key role in the reduction of health disparities for TGNB patients.

Methods: Twenty-five health care providers completed the eight-module digital training program. Pre- and post-tests assessed provider knowledge, self-efficacy, preparedness, and behavior. Paired samples t-tests were conducted to compare pre-and …

Wellness Domains For Residency Training Programs, Danielle Hart, Glenn Paetow, Ramin Tabatabai, Rochelle Zarzar, Arlene S. Chung

Journal of Wellness

In this editorial, we describe a residency-specific wellness framework that residency leadership can utilize in developing their local wellness programs.

The Impact Of Socioeconomic Factors On Food Insecurity Among Syrian Refugees In Florida, Racha Sankar

FIU Electronic Theses and Dissertations

Syrian refugees settled in the United States may experience food insecurity due to different socioeconomic factors that may include nutrition knowledge, language proficiency, women’s education, and perceived stress. The structure and the type of households may also contribute to food insecurity in this population.

The objective of this study was to measure food security among Syrian refugees residing in Florida. It also aimed to determine the socioeconomic factors that may attribute to food insecurity at household level.

A comprehensive 228-item questionnaire was administered to N=80 households (n=43 in rural areas, n=37 in urban areas). Families with and without children were …

Mindfulness Based Stress Reduction Increases Pathology Resident Self Wellness, Kaitlin Collura, Md, Phd, Joanna Chan, Md

Department of Pathology, Anatomy, and Cell Biology Posters

Stress during medical residency is a common, complex issue influenced by time demands, level of social support, and environmental factors. Increased stress levels can lead to resident burnout, and may contribute to the high rates of depression and suicide seen among physicians. In 2015, the ACGME began a campaign to promote resident wellness by calling on programs to implement strategies to develop resiliency, identify problems, and promote wellbeing. Mindfulness based stress reduction (MBSR) strategies have been shown to decrease burnout, improve mood, and increase compassion in healthcare providers. We implemented a wellness retreat to educate residents on the principles of …

Reflection: Reducing Long-Term Mortality In Suicidal Adolescents, Nina R. Bihani

Clinical Research in Practice: The Journal of Team Hippocrates

A transformative method to reducing mortality in suicidal adolescents involves a novel approach of educating and empowering their loved ones.

Treating Substance Use Disorders: Enhancing Attendance At The Weekly Inpatient Medication Assisted Treatment Group, Devon Gillis, Jayne Weisberg, Dena Whitesell, Amy Mcauliffe, Amy Sparks, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Operations Transformation

At a large academic tertiary medical center, an Integrated Medication Assisted Treatment (IMAT) program has been established for those medically stable inpatients with an addiction diagnosis. Over a four month period, this program had experienced a decline in attendance and a quality improvement project was initiated is to better understand the barriers to attendance and institute a process that would reverse the decline.

A goal was established to improve attendance by medically stable patients that have consented to participate to a minimum of 50%.

A root cause analysis outlined numerous causes for low attendance and several countermeasures were established to …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Impact Of Adverse Childhood Experiences On Mental Health Outcomes And Related Prescription Practices In A Psychiatric Inpatient Sample, Carrie Lemay

Electronic Theses and Dissertations

A definitive association between adverse childhood experiences (ACEs) and negative physical and mental health outcomes has been established. There is evidence that individuals in forensic psychiatric facilities are disproportionately exposed to ACEs, which may impact severity, prognosis, and age of onset of psychiatric symptoms, including behavioral concerns of institutional aggression, self-harm behaviors, and suicide attempts. Such psychiatric and behavioral concerns are often managed through multiple psychotropic prescriptions, leading to psychotropic polypharmacy. This study evaluated the relationship between ACEs, mental health and behavioral concerns, and psychotropic polypharmacy through analysis of archival data from a forensic inpatient psychiatric facility. A total of …

Implementation Of An Evidence-Based, Electronic Clinical Algorithm To Improve Screening, Evaluation, And Referral Of College Students For Depressive Symptoms And An Evaluation Of Differences Based On Sexual Orientation And Gender Identity Data, Chris Webb

Graduate Theses, Dissertations, and Capstones

The purpose of this project was to improve the screening, evaluation, and referral of college students (LGBTQ+/Heterosexual) for depressive symptoms through the implementation of an evidence-based, electronic clinical algorithm. There is evidence in the literature indicating that there are increased mental health disparities among college students and the LGBTQ+ population. The prevalence of depressive symptoms among university students is higher than the general population, requiring university student health centers to implement enhanced screenings for depressive symptoms and identification of depression predictors. Prior to implementation of this project, a student health clinic in the Southeastern part of the United States used …

House Calls Are Reaching The Tipping Point — Now We Need The Workforce, Thomas Cornwell

Journal of Patient-Centered Research and Reviews

Home-based primary care (HBPC) improves the lives of high-cost, frail, homebound patients and their caregivers while reducing costs by keeping patients at home and reducing the use of hospitals and nursing homes. Several forces are behind the resurgence of HBPC, including the rapidly aging population, advancements in portable medical technology, evidence showing the value of HBPC, and improved payments for HBPC. There are 2 million to 4 million patients who could benefit from HBPC, but only 12% are receiving it. The number of these patients is expected to double over the next two decades. This requires a larger and better …

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Obat Kuat Pria | Obat Perangsang Wanita | Alat Bantu Pria / Wanita

Developing Physician Educational Competencies For The Management Of Female Genital Cutting: A Call To Action, Holly G. Atkinson, Amaris Geisler

Publications and Research

Female genital cutting (FGC), also called female genital mutilation, is defined as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other nontherapeutic reasons.” FGC can have significant health consequences, including multiple physical and psychological complications, throughout the life course. Despite violating numerous human rights and existing legal prohibitions, the practice continues. In the United States, FGC is becoming increasingly prevalent, however, physicians are not routinely trained to care for these patients. Despite the evidence of the need, there is a woeful lack of …

Healthcare Access And Poverty Among Central Appalachian Residents, Kacey M. Lefevers

Kentucky Journal of Undergraduate Scholarship

Healthcare access is an important shaping force in the lives of Appalachian people. Appalachians often face both inadequate availability of medical facilities and poverty, which limits access to health insurance and therefore healthcare. This results in reduced life expectancy and health disparity. In this study, the author examines relationships between adequate healthcare and access to healthcare among Appalachian residents. Using a convenience sample of Appalachian residents, the author finds that income, education, and being an Appalachian resident have unique impacts on healthcare access or perceptions of healthcare in general.

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Using Short Message (Sms) To Deliver Appointment Reminders And Reduce No-Show Rates: An Evidence-Based Practice Project, Fernando Serrano

Doctor of Nursing Practice Final Manuscripts

Background/Objectives: Missed appointments (MAs) are correlated with reduced treatment efficacy, increased financial burden on medical institutions, and early treatment terminations for therapy (DeFife, Conklin, Smith, & Poole, 2010). MAs occur for a variety of reasons including, but not limited to severity of illness, financial/geographic constraints, and forgetting the appointment (Filippidou, Lingwood, & Mirza, 2014). Appointment compliance within outpatient mental health clinics has a wide variance with some clinics reporting MAs ranging from 15% to 50% (Car, Gurol-Urganci, de Jongh, Vodopivec-Jamsek, & Atun, 2013).

With decreasing costs and a subsequent massive increase in mobile phone technology use by the general population, …

Health Literacy Challenges And Opportunities: Bringing Children’S Mercy And Kansas City Together, Jennifer A. Lyon, Angie Knackstedt, Barbra Rudder, Mamta Reddy Md, Courtney R. Butler

Posters

BACKGROUND: A multidisciplinary group at Children's Mercy Kansas City applied for and received the NNLM MCR's Immersive Workshop Grant in December, 2017, and used the funding to organize and host a two-day immersive, interprofessional workshop in April, 2018, that 1) brought together health literacy-invested groups and individuals within the Kansas City community to learn about health literacy including cultural, language, numeracy and digital inclusion factors; and 2) provided specialized training to targeted CM participants to improve the provision of bedside health information to patients and caregivers. Objectives included: increasing community-wide collaboration, sharing resources, encouraging participants to become change agents, and …

Understanding The Help-Seeking Behaviors Of Student-Athletes: Effect Of A Multidisciplinary Healthcare Team And The Perception Of Barriers And Facilitators For Seeking Help, Lauren M. Sander

Masters Theses, 2010-2019

This study was aimed at identifying barriers and facilitators that influence help-seeking as well as the effect of implementing an integrated healthcare approach based on current recommendations. A total of 411 student-athletes from 18 intercollegiate teams at a mid-major Division I institution in the mid-Atlantic region completed a 12–item instrument comprised of ten quantitative items and two open-ended questions. The quantitative data was analyzed using SPSS software, and a constant comparative method was used to code responses from the open-ended questions. Findings suggested a prevalence of mental health challenges among student-athletes, especially overwhelming stress, struggles with time management, and anxiety. …

The Effects Of A Dementia Simulation Experience On Attitudes Towards People With Dementia, Micah Huckabee

Health, Human Performance and Recreation Undergraduate Honors Theses

Introduction: The neurodegenerative effects of dementia resulting in cognitive and behavioral impairments is plausibly one of the reasons for a societal stigma towards individuals with dementia. Societal stigmas are associated with decreased life satisfaction, depressive symptoms, and decreased psychological well-being for stigmatized individuals. In an effort to improve attitudes towards individuals with dementia, this study utilized a dementia simulation to measure attitudinal changes after a dementia simulation. Methods: There were 33 participants in this study (13 male and 20 female) between the ages of 18 and 25. Participants completed a Dementia Attitudes Scale (DAS) survey, and then they dressed in …

Bridging The Synapse: Seeing The World Through A Neuroscience Lens, Madeline Macarthur

Chancellor’s Honors Program Projects

No abstract provided.

The Intersection Of Marital Problems, Unhealthy Lifestyles, And Adhd Challenges.Pdf, Ron J. Hammond, Christopher Anderson Ph.D., Devin Gilbert, Justin Wilbert, Michelle Chatterly

Ron J. Hammond

Diet And Addiction: Interview With A Former Food, Pornography, And Alcohol Addict, Tro Kalayjian, Brian Lenzkes

Dignity: A Journal of Analysis of Exploitation and Violence

Drs. Tro Kalayjian (Tapan, New York) and Brian Lenzkes (Santee, California) talk to Matt about his struggles with food, pornography, and alcohol addiction, and how changing his diet contributed to his recovery from his addictions. This report is excerpted from the audio podcast LowCarbMD, Episode 13 (https://itunes.apple.com/us/podcast/low-carb-md-podcast/ ), January 30, 2019). This podcast has filled us with immense hope for those struggling with addiction.

When Self-Care Is Not Enough: Reflections On How To Make Trauma-Intensive Clinical Work More Sustainable, Brianna C. Delker

Dignity: A Journal of Analysis of Exploitation and Violence

As a psychology resident on the psychiatry consultation-liaison service at a trauma center, I was asked by another trainee how I cope with the devastating cases of traumatic injury and abuse that we witnessed regularly on the service. This trainee’s courageous question about how we as providers cope sustainably with bearing witness to trauma coincided with my own reflection on the limits of “self-care” as it is often discussed and practiced in human service professions. In this article, I argue that an activity-based approach to self-care is not enough for providers in trauma-intensive service settings and must be complemented with …

Development Of The Resident Wellness Scale For Measuring Resident Wellness, R. Brent Stansfield, Dan Giang, Tsveti Markova

Journal of Patient-Centered Research and Reviews

Purpose: Graduate medical education programs have a responsibility to monitor resident wellness. Residents are at risk of burnout, depression, and suicide. Burnout and depression are associated with poor patient care. Many existing tools measure burnout, depression, and general human well-being, but resident wellness is a distinct construct. We aimed to develop an instrument to measure resident wellness directly.

Methods: An expert panel from two purposefully different graduate medical education institutions generated a behavior- and experience-based model of resident wellness. The panel and resident leaders from both institutions generated 92 items, which were tested alongside anchor scales measuring burnout, depression, personality, …

Reimagining Medical Education In The Age Of Ai, Steven A. Wartman, C. Donald Combs

Computational Modeling & Simulation Engineering Faculty Publications

Available medical knowledge exceeds the organizing capacity of the human mind, yet medical education remains based on information acquisition and application. Complicating this information overload crisis among learners is the fact that physicians' skill sets now must include collaborating with and managing artificial intelligence (AI) applications that aggregate big data, generate diagnostic and treatment recommendations, and assign confidence ratings to those recommendations. Thus, an overhaul of medical school curricula is due and should focus on knowledge management (rather than information acquisition), effective use of AI, improved communication, and empathy cultivation.

A 10-Year Review Of Opioid-Related Deaths At West Tennessee Regional Forensic Center: 2007-2017, Haley M. St John, Juliette Scantlebury Md

Longitudinal Scholar's Project

Prescription opioid deaths have tripled since 1999, and currently opioid overdose kills 115 Americans per day on average (1). Prior to 2014, prescription opioids have been the primary driver of opioid-related mortality. In recent years, the United States has seen a steady decline in the rate of opioid prescription. At the same time, there has been a significant increase in the number of deaths attributed to non-prescription opioids such as heroin, illicitly manufactured fentanyl, and fentanyl analogues. In 2017, among 70,237 drug overdose deaths nationally, 47,600 (67.8%) involved opioids, with increases across age groups, racial/ethnic groups, and county urbanization levels …

The Equality Toolkit: Practical Skills For Lgbtq And Dsd-Affected Patient Care, Laura Weingartner, Emily Noonan, Amy Holthouser, Jennifer Potter, Stacie Steinbock, Suzanne Kingery, Susan Sawning

Undergraduate Medical Education

The eQuality Toolkit is a training manual that helps healthcare providers build a foundation of inclusive clinical skills to competently care for lesbian, gay, bisexual, transgender, and queer-identified (LGBTQ) patients and individuals born with differences of sex development (DSD). Although this toolkit was designed for medical students, any healthcare provider who wants to learn inclusive clinical skills can benefit from this accessible, brief primer through its actionable steps to improve clinical care.

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.

Substance Use Disorder Treatment Decision Aid For Adults In Chittenden County Vermont, Elizabeth V. Mcleod

Family Medicine Clerkship Student Projects

Substance Abuse Disorders (SUDs) are a prevalent public health concern in both the national and local arena resulting in millions of dollars in pubic health costs and loss of life. Navigating the treatment options available in Chittenden County can be time consuming, difficult, and delay treatment. In order to help guide adult patients and their families in Chittenden County along their journey towards recovery from SUDs, a treatment decision aid was developed for choosing the right level of care.

How To Improve A Medication-Assisted Treatment Program For Opioid Use Disorder: First, Look At The Evidence, Collin York

Family Medicine Clerkship Student Projects

The prevalence of Opioid Use Disorder (OUD) in the United States has been described as an epidemic, and rural areas have been affected in particular. A treatment paradigm called Medication-Assisted Treatment (MAT) has been demonstrated to be effective at treating OUD, and more and more rural, primary care clinics are establishing MAT programs. One such clinic is Hudson Headwaters Health Network, a FQHC in Upstate New York. I wrote a literature review and distributed it to staff involved in MAT program design, and I also wrote a practical evidence guide for MAT providers. Providers completed a survey assessing the evidence …

Improving Awareness Of Opiate Support Programs In Lamoille County, Samantha Bissonette

Family Medicine Clerkship Student Projects

Despite Vermont having doubled the rate per 10,000 people ages 18 to 64 receiving Medication Assisted Treatment (MAT) for Opiate Use Disorder (OUD) since 2012, there are still numerous barriers preventing patients from seeking treatment, including confusion about how to go about entering a treatment program, fear of stigma, and many others. Lamoille County has started to expand outreach to people struggling with OUD by having emergency services personnel, outpatient medical offices, and recovery centers hand out a county-specific information card with clear information about how to enter treatment and support programs. This project builds upon this existing initiative.