Public Health Commons^™

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Shawndra Barker MD

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Adam M. Franks, MD

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Marshall Journal of Medicine

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

Promoting Completion Of Advance Directives In A Hispanic Religious Congregation: An Evidence-Based Practice Project, Luis Daniel San Miguel, Mary Jo Clark

Doctor of Nursing Practice Final Manuscripts

Background: Hispanics utilize more aggressive medical treatment at the end of life and are less likely to receive end-of-life care consistent with their wishes than nonHispanic Whites. Hispanics are less likely than nonHispanic Whites to have an advance directive (AD). Increasing AD completion among Hispanics can promote end-of-life care consistent with their wishes, diminish healthcare disparities, and eliminate unnecessary healthcare spending. Objectives: To promote completion of advance directives by increasing knowledge, positive attitudes, and comfort with advance care planning (ACP) among Hispanics through culturally sensitive interventions. Intervention: The project was conducted in Spanish and implemented among a …

Family Preservation And Healthy Outcomes For Pregnant And Parenting Teens In Foster Care: The Inwood House Theory Of Change, Lisa D. Lieberman, Linda Lausell Bryant, Keneca Boyce

Department of Public Health Scholarship and Creative Works

Teens in foster care give birth at more than twice the rate of other teens in the United States. Significant challenges exist for these most vulnerable teens and their babies. To preserve teens’ families, programs and services need to be able to improve teens’ prospects for parenting success, delay subsequent pregnancies, and reduce intergenerational placement in care. The Inwood House theory of change for pregnant and parenting teens is a roadmap for providing the range and types of services that have the potential to improve outcomes for these most vulnerable families. The theory of change builds on insights and data …

Improving Healthy Habits In Berlin, Vt, Amy I. Triano

Family Medicine Clerkship Student Projects

A significant percentage of patient’s at Berlin Family Practice have diagnoses of Type II Diabetes, hypertension, high cholesterol, and/or obesity. Essential to treatment and management of these conditions are a healthy diet and exercise. There are many local and national resources available but no single place where patient’s can find links to national as well as local resources in the Central Vermont community. There is also insufficient time for physicians or nurses to counsel patients on relevant resources. This project involved creation of a website with community and national resources for healthy living that providers could refer patients to. A …

Determining Barriers To Oral Health Care In Bennington County, Taylor Goller Ms-3

Family Medicine Clerkship Student Projects

Bennington County has some of the worst oral health outcomes in the state of Vermont. A survey was designed to assess current oral health problems, maintenance habits, and barriers to oral health services access. Results are preliminary.

Community Perception Of Electronic Cigarettes And Their Role As Smoking Cessation Aids, Alejandro Velez

Family Medicine Clerkship Student Projects

The popularity of electronic cigarettes is increasing, yet the research is lagging behind. In an effort to better understand, and therefore better advice our patients, a small number of current daily cigarette smokers were surveyed on their understanding of electronic cigarettes and their usage. Two smoking cessation counselors were also interviewed to better contextualize the role of electronic cigarettes as possible smoking cessation aids. Finally, a review of the available research was done to produce a poster, and possibly a handout, in hopes to educate all patients (regardless of their current smoking habits) regarding electronic cigarettes.

Provider Resources For Smoking Cessation Counselling, Pierre Galea

Family Medicine Clerkship Student Projects

Tobacco is still the leading cause of preventable death. The Vermont Department of Health has instituted smoking-related goals for "Healthy Vermonters 2020." One resource that is useful for providers who counsel patients to quit smoking is 802quits. Strategic utilization of this resource and implementation within the healthcare center, is invaluable for providers, and is an effective tool to reach patients and support them throughout their journey.

Slow Foods For Health Increasing Knowledge Of Glycemic Index In Adolescents For Healthier Food Choices, Meredith Kayleigh Sooy

Family Medicine Clerkship Student Projects

Obesity has reached epidemic proportions through the United States affect all age groups, genders, and races. This is especially troubling in the pediatric population where 12.5 million children were found to be overweight in 2010. Many adolescents have inadequate knowledge of nutrition basics to make healthy choices. Based on interviews within the community of Colchester, VT a need for information about the glycemic index was seen. A handout geared towards adolescents was created with information about the glycemic index and using this information to make healthy food choices. This handout was made available to all providers of Colchester Family Practice …

Lyme Disease Awareness In Downeast Maine, Justin L. Genziano

Family Medicine Clerkship Student Projects

Lyme disease is caused by the bacteria Borrelia burgdorferi and is transmitted by the deer tick (Ixodes scapularis). Lyme disease is endemic in the state of Maine with 1,399 probable and confirmed cases reported in 2014. The rate in coastal Hancock County has doubled since 2012, and has the third highest rate of infection in the state.

Medical providers in Hancock County have observed an increase in anxiety and concern about Lyme disease in the community, and have found that much of this is driven by hearsay or unreliable information from the internet. The goal of this project …

The Role Of Occupational Therapy In Primary Care, Priti Patel

Occupational Therapy Doctorate Capstone Projects

The Capstone Project is focused on communicating, influencing and educating other health care professionals regarding the role of occupational therapy in the future model of primary care delivery initiated by the adoption of the Affordable Care Act and the Triple Aim Initiative. Currently, primary care, the largest health care platform in United States, is not inclusive of occupational therapy services. Occupational therapists have the scope, knowledge and understanding to be part of the redesigned team model of primary care. Educating those currently working in primary care about adding occupational therapy services can have a significant impact on the profession of …

Barriers To Recovery For Bangor's Buprenorphine Patients, John R. Mclaren, Erin Keller

Family Medicine Clerkship Student Projects

There are several buprenorphine providers at EMMc's Center for Family Medicine serving the greater Bangor, ME region - an area of substantial opiate use. Among the patient population of outpatient buprenorphine users, both locally and nationally, there are high rates of relapse (~32%). In order to decrease relapse rates, it's first imperative to conduct a baseline review of the current buprenorphine population to identify specific types of patients who are at higher risk of relapse. By understanding the barriers to recovery, the office hopes to apply an intervention to the current program, targeting this local demographic more effectively.

Pediatric Lipid Screening Guidelines: Information For Patients And Families, Erin R. Pichiotino, Mph

Family Medicine Clerkship Student Projects

Universal Pediatric Lipid Screening Guidelines are currently based on expert opinion only. Bright Futures/American Academy of Pediatrics currently recommends screening all patients ages 9-11 and again at ages 17-21. The US Preventive Services Task Force (USPSTF), however, concludes the evidence is insufficient to recommend for or against routine screening. This discordance leaves ambiguity for implementation in Family Medicine practices in Vermont. A survey of providers at Milton Family Practice showed that only 14% of providers at Milton Family Practice regularly perform lipid screening on their pediatric patients.

Adhd Versus Ptsd In Preschool-Aged Children: Implications For Misdiagnosis, Klaudette D. Stewart

PCOM Psychology Dissertations

Attention Deficit Hyperactivity Disorder (ADHD) has been one of the most diagnosed disorders in children since it was included in the Diagnostic and Statistical Manual of Mental Disorders−III (DSM−III) in 1980. The number of children who have been diagnosed since that time has grown significantly, raising concerns about the overwhelming number of young children being diagnosed and prescribed medication. According to the literature, young children are diagnosed at a higher rate by pediatric primary care physicians (PCPs) than clinical child psychologists (CCPs) because they are taken to a PCP’s office by a parent, rather than referred from a school environment, …