Social and Behavioral Sciences Commons^™

A Mixed Methods Acceptability And Feasibility Study Of A Patient-Initiated Approach To Increasing Weight Communication In Primary Care, Jocelyn E. Remmert, Leon Mccrea, Nicole T. Crane, Adam Gilden, Meghan L. Butryn

The Journal of Integrated Primary Care

Background: Weight discussions between patients and physicians can have a positive impact on patients’ health, yet they occur infrequently in primary care. No study to date has promoted patient-initiated weight discussions. This study aimed to test the feasibility, acceptability, and explore trends of the effect of a waiting room-based pamphlet intervention to promote patient-initiated weight discussions.

Methods: Adults (n=60) with overweight or obesity attending a primary care appointment were recruited from the waiting room and randomized to receive the intervention pamphlet or to a non-intervention control condition. All participants attended their appointment and completed post-appointment assessments.

Results: Three …

Case Report Of A Brief Modular Anxiety Intervention For Integrated Primary Care: Addressing Clinician Feasibility Concerns And Barriers To Using Manualized Treatments, Katherine Buckheit, Robyn L. Shepardson, Luke Mitzel, Risa B. Weisberg, Stephen A. Maisto, Jennifer Funderburk

The Journal of Integrated Primary Care

Individuals with anxiety symptoms commonly present in primary care settings and prefer behavioral health (versus pharmacotherapy) treatment, but behavioral health interventions are underutilized. Primary care behavioral health (PCBH) models, in which embedded behavioral health providers deliver behavioral treatment in primary care, may help address the gap in provision of anxiety treatment. However, evidence-based anxiety treatment options feasible for delivery in primary care are limited, and clinicians often report concerns about using manualized interventions. Recent recommendations by the U.S. Preventative Services Task Force to increase anxiety screening among adults in primary care may result in increased identification of individuals with anxiety …

The Attitudes, Level Of Interest, And Knowledge Held By Physicians And Psychologists Toward Integrated Healthcare Practices And The Patient-Centered Medical Home Model, Mark Cassano, Robert A. Ditomasso, Barbara Golden, Scott D. Glassman

The Journal of Integrated Primary Care

As the healthcare system evolves, issues related to cost and access to care continue to persist. In response to this concern, integrated models of healthcare, like the Patient-Centered Medical Home (PCMH), have been developed to work toward reducing cost for both patients and providers, increasing patient access to quality care, and improving patients’ overall satisfaction with the care that they are provided. However, despite the overwhelming evidence found in the literature supporting the efficacy and benefit of these treatment models, it is unclear as to why more providers do not choose to practice and support collaborative forms of healthcare provision. …

Biopsychosocial Management Of Long Covid Fibromyalgia: Lessons From The Penn Medicine Lancaster General Health Fibromyalgia Program, Joseph Harrison, Dennis Given Psy.D.

The Journal of Integrated Primary Care

The COVID-19 pandemic has increased the prevalence of chronic health concerns worldwide, leading to a new population of patients suffering from Long Covid. Patients with Long Covid often experience persistent symptoms impacting multiple organ systems, including neuroimmune and neurological manifestations. Recently, attention has grown toward Long Covid patients developing chronic widespread pain similar to fibromyalgia. Fibromyalgia is a nociplastic pain disorder characterized by widespread pain and central sensitization with fatigue, sleep disturbances, and impairments in cognitive functioning. Given the nascent and limited research exploring new treatment options, patients need support now from biopsychosocial multi-modal pain management strategies. The Fibromyalgia Program …

An Exploration Of Self-Reported Training Needs For Anxiety Interventions Among Primary Care Behavioral Health Consultants, Katherine Buckheit, Ryan Willard, Kyle Possemato, Robyn Shepardson, Abigail Lashinsky, Jen Funderburk

The Journal of Integrated Primary Care

Introduction: Despite the need for greater training in evidence-based interventions for the treatment of anxiety in primary care behavioral health (PCBH), there are limited data on which interventions are desired by behavioral healthcare consultants (BHCs). The objective of this study was to identify which interventions BHCs desired more training in when treating anxiety in PCBH practice, and to examine if this preference was associated with theoretical orientation. Method: We conducted an online survey of PCBH providers regarding their training preferences for treatment of anxiety symptoms. The final sample comprised 291 BHCs recruited from e-mail listservs of national professional organizations. Providers …

End Of Life In The Ed – Brain Death And Organ Transplantation, Madison Cohen, Donald Penney

The Journal of Integrated Primary Care

Every year thousands of Americans die awaiting an organ transplant. While our knowledge and experience with organ transplantation has only improved, organ availability continues to be a major issue due to a lack of suitable donor organs. A large population of organ donors are those who have been clinically diagnosed as brain dead. Brain death is defined as the irreversible loss of all brain and brainstem functions. Despite brainstem functions being lost, mechanical ventilation and perfusion techniques allow for proper organ maintenance. This gives brain-dead individuals a unique opportunity to serve as multiple organ donors. However, due to mistrust of …

Recovery Capital, Mental Health And Substance Use Among Individuals Initiating Office-Based Buprenorphine Treatment For Opioid Use Disorder, Hannah R. Callahan, Karen Dugosh, Emily Hurstak, Patty Mccarthy, Emily Garber, Daniel Dejoseph, Julia Dejoseph, Michelle R. Lent

The Journal of Integrated Primary Care

Recovery capital refers to the internal and external resources available to support an individual in their recovery from substance use disorders. Using data from an ongoing trial, the current study examined recovery capital among 225 individuals initiating office-based buprenorphine treatment for opioid use disorder (OUD) at Federally Qualified Health Centers in the mid-Atlantic region. At baseline, participants completed the Brief Assessment of Recovery Capital-10 (BARC-10), a validated measure assessing the 4 major domains of recovery capital and completed a urine toxicology screening. Participants reported BARC-10 scores of 49.22 on average (SD = 8.14). Average scores were highest for the …

Differential Diagnostic Considerations In A Patient With New Onset Apathy: A Case Study On Frontal Lobe Glioblastoma Multiforme, Joy Zarandy, Sarah Yoon, Sharnikha Saravanan, Sanjana Das, Sarah Thomas

The Journal of Integrated Primary Care

This case study involves a 50 year-old previously healthy female presenting with a two-week history of clinically significant apathy. The patient and her family assume her symptoms are due to a potential underlying psychiatric condition; however, neurologic and systemic disorders should also be considered when evaluating a patient with sudden personality change. After a thorough history and physical exam, further evaluation with neuroimaging is performed due to suspicion of neurological etiology. A sizable ring-enhancing lesion in the frontal lobe is noted on MRI, and a diagnosis of glioblastoma multiforme (GBM) is confirmed with biopsy. GBM, or grade 4 astrocytoma, is …

In Great Health: Basal Cell Carcinoma And Denial Of Progressive Disease In The Elderly, Yusur Alsalihi, Alexa Truong, Patrick Golden

The Journal of Integrated Primary Care

Basal Cell Carcinoma (BCC) is the most common skin cancer across the world and occurs predominantly on sun-exposed or sun-damaged skin, particularly on the head, face, and neck. Slow-growing and unremoved lesions can become destructive and progress to the rare Giant Basal Cell Carcinoma subtype that occurs in a very small subset of patients (

Anxiety Severity And Prescription Medication Utilization In First-Time Medical Marijuana Users, Karen L. Dugosh, Megan M. Short, Paulina Syracuse, Thomas R. Mccalmont, Michelle R. Lent

PCOM Scholarly Works

Background

Anxiety and post-traumatic stress disorder (PTSD) are qualifying psychiatric conditions for medical marijuana (MM) treatment in Pennsylvania. This study examined baseline prevalence and changes in prescription anxiety medication use three months following MM treatment initiation among individuals with these qualifying conditions.

Methods

The study sample was comprised of 108 adults with anxiety or PTSD as a referring condition; they were enrolled in a longitudinal study evaluating biopsychosocial outcomes in new MM patients. Consenting participants completed an assessment battery at baseline and Month 3 (n = 94, 87 % follow-up rate) that included a measure of anxiety severity and …

Awareness With Paralysis And Symptoms Of Post-Traumatic Stress Disorder Among Mechanically Ventilated Emergency Department Survivors (Ed-Awareness-2 Trial): Study Protocol For A Pragmatic, Multicenter, Stepped Wedge Cluster Randomized Trial., Brian M Fuller, Brian E Driver, Michael B. Roberts, Christa A Schorr, Kathryn Thompson, Brett Faine, Julianne Yeary, Nicholas M Mohr, Ryan D Pappal, Robert J Stephens, Yan Yan, Nicholas J Johnson, Brian W Roberts

PCOM Scholarly Works

BACKGROUND: Awareness with paralysis (AWP) is memory recall during neuromuscular blockade (NMB) and can cause significant psychological harm. Decades of effort and rigorous trials have been conducted to prevent AWP in the operating room, where prevalence is 0.1-0.2%. By contrast, AWP in mechanically ventilated emergency department (ED) patients is common, with estimated prevalence of 3.3-7.4% among survivors given NMB. Longer-acting NMB use is a critical risk for AWP, and we have shown an association between ED rocuronium use and increased AWP prevalence. As NMB are given to more than 90% of ED patients during tracheal intubation, this trial provides a …

Revisiting The Global Measures Of Overall Neuropsychological Function And The Impact Of Race-Based Normative Data In Clinical And Forensic Populations, Zachary Dipasquale, Donald Masey, Robert A. Ditomasso, Gabriel Stanziano

Research Day

This study aims to examine the impact of race-based normative data on global measures of overall neuropsychological functioning. Further, it examines the changes made to the Average Impairment Rating (AIR) in the context of race-based norming and the dismissal of a previously included measure, Picture Arrangement. The AIR is a commonly used index to classify the severity of diffuseness related to brain injury. Despite its use, the AIR has a very limited body of research describing the impact of racial norming on the index. Based on a review of the literature, the Picture Arrangement subtest removal was never researched in …

Sex And Gender Differences In Attention-Deficit / Hyperactive Disorder (Adhd): A Literature Review, Kaitlyn N. Blair, Min Young Kim

Research Day

Background:

The American Medical Women's Association (AMWA) Sex and Gender Health Collaborative identified the need for a concise factsheet for clinicians outlining sex and gender differences in Attention Deficit Hyperactive Disorder (ADHD) as ADHD is underdiagnosed, undertreated, and frequently misdiagnosed in women due to lack of recognition of gender-specific presentation. AMWA's goal is to improve access and exposure to sex and gender differences in healthcare as few medical schools educate students on these differences. The poster summarizes the reviewed literature on the prevalence, diagnosis, referral for, prevention, clinical presentation, and treatment of ADHD with a goal to reduce sex and …

The Development, Implementation And Early Learnings Of A Training Program To Advance Interest In Behavioral Research Careers Among Undergraduate Bipoc Students Majoring In Psychology., Michelle R. Lent, Denise Gaither-Hardy, Kevin E Favor, Diana Harris, Travis A Cos, Conor Millard, Zatio Kone, Ashley Van Riper, Karen L Dugosh

PCOM Scholarly Works

OBJECTIVES: Black, indigenous and people of color (BIPOC) remain underrepresented in research occupations. This report discusses a collaboration to train undergraduate BIPOC students in clinical research between a public health institute, two medical schools, and a historically Black College or University (HBCU). This nine-month program trained BIPOC undergraduates in research methodology, psychology, and addiction science, and immersed trainees in real-world research. The program included didactic seminars, experiential activities, and a mentored research project culminating in a poster and oral presentation.

METHODS: Key learnings, program satisfaction survey results, and preliminary outcomes from the first three program cohorts (N = 6 students) …

Motherhood And Me (Mom-Me): The Development Of An Acceptance-Based Group For Women With Postpartum Mood And Anxiety Symptoms, Victoria A Grunberg, Pamela A Geller, Kelley Durham, Alexa Bonacquisti, Jennifer L Barkin

PCOM Scholarly Works

Untreated postpartum mood and anxiety disorders (PMADs) place women and their families at risk for negative biopsychosocial sequelae. Innovative and tailored treatments are needed to address potential disruptions in maternal functioning. Third-wave cognitive-behavioral approaches, including acceptance and commitment therapy (ACT) and dialectical behavioral therapy (DBT), hold promise for optimizing functioning given the focus on values-based living, rather than symptom reduction.

Purpose: The purpose of this paper is to describe the development of an innovative psychotherapy group for women with symptoms of PMADs.

Methods: This seven-session group, Motherhood and Me (Mom-Me), includes selected skills training from ACT, DBT, and Emotion-Centered …

Study Protocol: Cluster Randomized Trial Of Consultation Strategies For The Sustainment Of Mental Health Interventions In Under-Resourced Urban Schools: Rationale, Design, And Methods., Ricardo Eiraldi, Barry L. Mccurdy, Muniya S Khanna, Courtney Benjamin Wolk, Henry A Glick, Quinn A Rabenau-Mcdonnell, Rachel Comly, Laura E Rutherford, Jayme Banks, Steven A Rufe, Kristina M Popkin, Tara Wilson, Kathryn Henson, Abraham Wandersman, Abbas F Jawad

PCOM Scholarly Works

BACKGROUND: The school is a key setting for the provision of mental health services to children, particularly those underserved through traditional service delivery systems. School-wide Positive Behavioral Interventions and Supports (PBIS) is a tiered approach to service delivery based on the public health model that schools use to implement universal (Tier 1) supports to improve school climate and safety. As our prior research has demonstrated, PBIS is a useful vehicle for implementing mental and behavioral health evidence-based practices (EBPs) at Tier 2 for children with, or at risk for, mental health disorders. Very little research has been conducted regarding the …

Unconscious Bias In Medicine, Dorothy E. Roberts, Pcom Office Of Diversity And Community Relations

Diversity and Inclusion

2019 Dr. Martin Luther King, Jr. Lecture Series

Given by Dorothy E. Roberts, University of Pennsylvania School of Law, George A. Weiss University, Professor of Law

Examining The Impact Of Educational Modules On Self-Care, Burnout, And Professional Impairment On Graduate And Medical Students, Samantha Giangrande

PCOM Psychology Dissertations

Graduate school is a time of academic rigor, personal growth, stress, change, fear, and confrontation. It is important for medical and other graduate students to prepare themselves to serve and treat their patients effectively. An important part of this involves learning skills to better manage challenges and demands through ongoing self-care. However, little research has examined what knowledge students have of self-care strategies and burnout or whether education about these constructs is lacking in higher education. The purpose of this study was to examine the efficacy of self-care and impairment modules for medical and other graduate students enrolled in an …

Long-Term Use Of Beta-Blocker Medication In Pediatric Long Qt Syndrome Patients: Neuropsychological Profiles, Kara J. Rudisill

PCOM Psychology Dissertations

Long QT syndrome (LQTS) is a heart rhythm disorder characterized by a disruption of the heart’s electrical activity that may cause accelerated and uncontrolled heartbeats referred to as ventricular fibrillation. LQTS is primarily treated with beta-blocker medications, which reduce the risk of experiencing an arrhythmia through regulating the heart rate. However, the potential neuropsychological side-effects associated with the use of beta-blocker medication may impact the executive functioning skills, mental health, and behavior of the affected pediatric population at home. As a result, a child’s academic performance and emotional regulation etiology may be misunderstood by his or her parents, caregivers, and …

A Feasibility Study Of A Lqts-Specific Workshop: Childrens' Problem-Solving Skills, Coping, Self-Efficacy, And Locus Of Control, Katherine L. Corvi

PCOM Psychology Dissertations

Living with a chronic medical condition in childhood and adolescence requires many critical lifestyle changes and restrictions, which may compromise psychosocial development. Social problem-solving skills have been shown to enhance the ability to cope with both minor and major daily stressors and to minimize psychological problems associated with physical health problems. The research is part of a larger study with children with long QT syndrome (LQTS) and their parents; the present study focuses on the children. This study was developed to examine the feasibility and efficacy of a problem-solving workshop to increase problem solving, self-efficacy, coping, and locus of control …

The Relationship Between Problem-Solving Ability/Eating Motivation And Perceived Quality Of Life In Individuals Diagnosed With Celiac Disease, Vincenzo Zaccheo

PCOM Psychology Dissertations

Celiac disease (CD) is a digestive disorder resulting from gluten intolerance that leads to damage of the small intestine. The only current available treatment for CD involves adherence to a strict gluten-free diet. Due to the restrictive nature of this treatment diet, and the increasing prevalence of CD in recent years, much research has been conducted examining factors that impact the quality of life (QOL) of individuals with CD. However, there has been a dearth of literature identifying those factors which can be modified within a treatment setting. Thus, a need for further research in this area was identified. Through …

Adolescent Attitudes Toward And Perceptions Of Suicide, Stigma, And Help-Seeking Behavior, Julia M. Hollinger

PCOM Psychology Dissertations

Suicide is a leading cause of death for adolescents and represents a major national health concern (American Foundation for Suicide Prevention, [AFSP], 2015; (Centers for Disease Control [CDC], 2013). Because adolescents spend the majority of their day at school (Erbacher, Singer, & Poland, 2015), the effectiveness of school-based suicide prevention programs may be improved through better understanding of adolescents’ views on the subject of suicide and the factors that may influence participation in prevention efforts. The present study explored the attitudes and perceptions of seventh grade students from a suburban middle school in Pennsylvania, using archival survey data. Variables that …

The Effects Of A Trauma-Informed Care Training Program On Mental Health Professionals Knowledge, Skills, And Attitudes With The Smi, Angelina Pelletier

PCOM Psychology Dissertations

Trauma has been found to be highly prevalent among individuals diagnosed with SMIs. Mental health professionals have been reported to misdiagnose or avoid addressing trauma in this population. There is a need to provide information about trauma and to foster awareness among mental health professionals who are treating individuals diagnosed with SMIs. With a TIC approach, operating from a recovery-oriented philosophy, there have been interventions created to address trauma and SMIs with the aim of developing awareness about trauma and the impact it may have on someone’s life. With these factors in mind, mental health professionals should be competent in …

A Culture That Fosters Concussions: Does Increased Education Lead To More Accurate Reporting Of Concussions?, Michael Heptig

PCOM Psychology Dissertations

With over 1.7 million incidents reported annually, concussion has become the most common class of traumatic brain injury (TBI) in the United States (Bazarian, Zhu, Blyth, Borrino, & Zhong, 2012). As staggering a statistic as this may be, many believe it fails to represent the true number of concussions because the non-reporting of symptoms has been commonplace among athletes (Khurana & Kaye, 2012; Williamson & Goodman, 2006). The aim of this study was to determine those factors that influence the reporting of concussion symptoms. Specific variables that were examined include the amount of concussion education provided (determined by requisite amount …

A Feasibility Study Of Lqts-Specific Problem-Solving Workshop: Parents' Problem-Solving Skills, Coping, Hope, And Worry, Elizabeth A. Phelps

PCOM Psychology Dissertations

Long-QT Syndrome (LQTS) is an inherited cardiac condition that predisposes individuals to cardiac arrhythmias and is a potentially fatal disorder that affects approximately 1 in 2,000 people. The triggers are difficult to avoid and may cause children and their families to make major life changes to avoid scenarios that can precipitate cardiac events. Parent may become more aware of the risks and may be hypervigilant of their child’s surroundings and exposure to potential triggers. Social problem-solving skills have been shown to enhance the ability to cope with both minor and major daily stressors and minimize psychological problems associated with physical …

Medical Interns', Residents' And Attending Physicians' Attitudes Towards Integrative Medicine And Recommended Treatments For Patients With Psoriasis, Jennifer L. Pacyon

PCOM Psychology Dissertations

Background: Psoriasis is a multifactorial disease that effect approximately 7.5 million Americans. There are a variety of traditional treatments for psoriasis (e.g. topical medications, biologics) that for many, are effective in combating the disease. However, traditional treatments often have aversive side effects and may not be appropriate for every patient (e.g. pregnant women). Additionally, the efficacy of these medications are variable leaving some looking for adjunctive treatment options. There is increasing evidence to support the use of adjunctive treatments for psoriatic patients (e.g. psychotherapy, mindfulness). However, research is variable in regards to medical professionals’ attitudes towards integrative medicine (IM) as …

Perceptions And Attitudes Of A Sample Of Primary Care Patients Receiving Psychological Care From Their Pcp, Nadine Henzes Gowarty

PCOM Psychology Dissertations

With millions of Americans suffering from a mental health disorder and slightly more than half receiving treatment, the demand for psychological services far outweighs the number of practitioners available to provide direct care. Therefore, the majority of all primary-care visits are based on psychosocial factors; one third of a PCP’s caseloads consist of patients with mental-health problems. Given the fact that PCPs provide comprehensive psychosocial care, it is important to determine the beliefs and perceptions of their patients. Results from this study identified numerous factors that influence the relationship between patients receiving mental health care from their PCP. Specifically, if …

An Analysis Of Cognitive Factors In School-Aged Children With Emotional Disturbance And Adhd Using The Wisc-Iv, Maria Fragnito Maddalo

PCOM Psychology Dissertations

Children with Emotional Disturbance and ADHD demonstrate social, emotional, and behavioral symptoms that present many challenges for School Psychologists because of differences between each student’s individual needs. A high level of comorbidity exists for these children with internalizing and externalizing symptoms. Little is known about neurocognitive factors as they relate to ED versus ADHD. The current study examined the cognitive profiles of a total of 58 children with ED versus ADHD, using the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV). Index scores that were examined included Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed. The groups were compared …

Naturalistic Clinical Decision Making By Emergency Department Staff And The Assignment Of Categorical Suicide Risk Ratings Within An Urban Veteran Population, Gerd R. Naydock

PCOM Psychology Dissertations

The ability to comprehensively and effectively identify those individuals who are at greatest risk to engage in self-directed violence (SDV) forms the cornerstone for all professional suicide prevention activities. To that end, mental health professionals have come to rely on the use of risk stratification to identify at-risk individuals as a way to inform and guide risk management and treatment, without having the benefit of empirical evidence to support such practices. The current program evaluation examined archival data comprised of suicide risk assessments conducted by mental health professionals on suicidal veterans (N = 1,560) in the emergency department of a …

Developing Executive Functions Through Mindfulness Training In School-Aged Children, Ashley Black Adams

PCOM Psychology Dissertations

Well-developed executive functions are necessary for successful classroom functioning. Students with executive function deficits can fall behind academically as well as socially and emotionally, relative to their same-aged peers. Effective interventions for developing executive functions within the school environment are essential for addressing this issue. This study examines changes in students’ executive functions as a result of their participation in a mindfulness training intervention. Participants included four ten-year old elementary school boys who took part in a ten-week mindfulness training intervention. The data were generated through pre and post assessments with an executive function teacher rating scale and a Goal-Attainment …