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Improving Blood Pressure Control Through Blood Pressure Measurement In An Ambulatory Urban Family Medicine Clinic, Sara Ancona, MD, Zachary Klock, MD, Aimee McMullin, MD, Zeynep Uzumcu, MD, Olivia Seecof, MD, Graham Stratton, MD, Alexa Waters, MD, Caitlyn Haines, MD, Brittany Hozick, MD, Jose Medina, MD, Geoffrey Mills, MD, PhD 2020 Thomas Jefferson University

Improving Blood Pressure Control Through Blood Pressure Measurement In An Ambulatory Urban Family Medicine Clinic, Sara Ancona, Md, Zachary Klock, Md, Aimee Mcmullin, Md, Zeynep Uzumcu, Md, Olivia Seecof, Md, Graham Stratton, Md, Alexa Waters, Md, Caitlyn Haines, Md, Brittany Hozick, Md, Jose Medina, Md, Geoffrey Mills, Md, Phd

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aim Statement: To increase the percentage of patients over the age of 18 with BP controlled to a goal of <140/90 from a baseline of 58% to 68% by April 2020.


Vaccines, Children, And The Public Health Trust, Christopher Chambers, MD 2020 Thomas Jefferson University

Vaccines, Children, And The Public Health Trust, Christopher Chambers, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

  1. Review the impact of immunizations on the public health over the past 50 years.
  2. Childhood Vaccines Now
  3. Describe the challenges associated with trying to eliminate “immunizable” diseases. Examples: Invasive Pneumoccal Disease, Neisseria meningitis
  4. The Future


Cirrhosis For The Pcp, Krys Foster, MD, MPH 2020 Thomas Jefferson University

Cirrhosis For The Pcp, Krys Foster, Md, Mph

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives:

  • Understand the morbidity and mortality associated with Cirrhosis in the United States
  • Recognize etiologies and clinical presentation of cirrhosis
  • Identify decompensated cirrhosis and approaches to treatment and monitoring

Agenda

  • Definition and Epidemiology
  • Etiologies
  • Clinical Presentation
  • Diagnosis and Evaluation/Classification
  • Management of Compensated Cirrhosis
  • Decompensated Cirrhosis & Complications
  • ○ Portal Hypertension ○ Varices ○ Ascites ○ SBP ○ Hepatorenal Syndrome ○ Hepatic Encephalopathy
  • Secondary Prevention and Long Term Management
  • Conclusions


Accelerating Primary Care Transformation At Jefferson (Jeffapct): Reflections From A Five- Year Hrsa Grant, Christine A. Arenson, MD, Amy Cunningham, PhD, MPH, Samantha Kelly, MA, Randa Sifri, MD 2020 Thomas Jefferson University

Accelerating Primary Care Transformation At Jefferson (Jeffapct): Reflections From A Five- Year Hrsa Grant, Christine A. Arenson, Md, Amy Cunningham, Phd, Mph, Samantha Kelly, Ma, Randa Sifri, Md

Department of Family & Community Medicine Presentations and Grand Rounds

JeffAPCT Overview

Five year HRSA-funded grant (7/1/15-6/30/20)

Leadership team from Family Medicine, Internal Medicine, Physician Assistant Program

  • Objective 1: To improve/ expand primary care and population health curriculum across the continuum of primary care providers and trainees (students, residents, and practitioners)
  • Objective 2: To create an enhanced, sustainable model of primary care physician faculty development for PCMH Transformation
  • Objective 3: To create a new, sustainable model of faculty development for community-based primary care preceptors (MD/DO, PA, NP, others)


Goals Of Care 101, Alexandra Evans, DO, Adam Pennarola, MD, Elham Siddiqui, MD 2020 Thomas Jefferson University

Goals Of Care 101, Alexandra Evans, Do, Adam Pennarola, Md, Elham Siddiqui, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Hospice and Palliative Medicine - Alexandra Evans, DO

Approaching Goals of Care in the Outpatient World - Elham Siddiqui, MD

Inpatient Goals of Care Discussion - Adam Pennarola, MD


What's All The Buzzy About? Using Cryotherapy And Vibration For Pain During Vaccinations In Children, Marta L. Byma 2020 Valparaiso University

What's All The Buzzy About? Using Cryotherapy And Vibration For Pain During Vaccinations In Children, Marta L. Byma

Evidence-Based Practice Project Reports

Vaccinations are the most common painful needle procedure, with an estimated 12 billion injections given per year (CDC, 2019). The usual method for administration of vaccinations is through needle puncture, which is often painful. Children often report receiving a shot as one of the most feared and painful experiences (McMurtry et al., 2015). The purpose of this evidence-based practice (EBP) project was to improve patient experiences by decreasing the pain that is associated with vaccinations through the use of a nonpharmacological method for comfort via the Buzzy® device. After thorough analysis and synthesis of the literature, the Buzzy® device that ...


Acute Disseminated Encephalomyelitis, Ashan T. Hatharasinghe, Hossein Akhondi, Don Pepito 2020 Sunrise Health GME Consortium

Acute Disseminated Encephalomyelitis, Ashan T. Hatharasinghe, Hossein Akhondi, Don Pepito

HCA Healthcare Journal of Medicine

Introduction: Acute Disseminated Encephalomyelitis (ADEM) is a rare autoimmune demyelinating disorder of the central nervous system. Clinical manifestations include encephalopathy, motor deficits, ataxia, and meningeal signs. In most cases, ADEM is preceded by either vaccination or viral illness. Here, we present a case with neither of the two predisposing elements.

Discussion: A 28-year-old Hispanic female presenting with substance use and suicidal ideation was placed on an involuntary psychiatric hold, started on olanzapine and scheduled for a psychiatric facility transfer. The following day, she was noted to have neurological deficits when ambulating. Computed tomography of the brain showed a right frontal ...


Sola Dosis Facit Venenum: Understanding Severity Of Tca Intoxication, Sean Brachvogel, Justin Osborn, Tanya Page 2020 Providence Milwaukie Family Medicine

Sola Dosis Facit Venenum: Understanding Severity Of Tca Intoxication, Sean Brachvogel, Justin Osborn, Tanya Page

Milwaukie Family Medicine

The Dose Makes the Poison, or does it? Judicious Management of TCA Intoxication.

Author(s): Sean Brachvogel, MD, MPH; Justin Osborn, MD; Tanya Page, MD

Context/background: Tricyclic antidepressants (TCAs) have been mostly supplanted by SSRIs in the treatment of depression, however they remain a mainstay of chronic pain management.1 Untreated suicide attempts with a TCAs carry a 70% fatality rate, which drops dramatically to 3% with hospitalization.2 As such, maintaining healthcare provider recognition and management of TCA toxicity is of lifesaving importance.

Objective: Here we describe a case report in which alcohol ingestion masked the severity of ...


Diabetes Education With A Teaching Kitchen Intervention Can Improve Hemoglobin A1c For Type 2 Diabetics Compared To Traditional Diabetes Education, Jill Christensen, Heidi Davis, Charlotte Navarre, Hsin-Fang Li, Kathy Schwab, Richard O'Neil, Justin Ferley 2020 Providence Milwaukie Family Medicine

Diabetes Education With A Teaching Kitchen Intervention Can Improve Hemoglobin A1c For Type 2 Diabetics Compared To Traditional Diabetes Education, Jill Christensen, Heidi Davis, Charlotte Navarre, Hsin-Fang Li, Kathy Schwab, Richard O'Neil, Justin Ferley

Milwaukie Family Medicine

Authors
Jill Christensen MD MPH Providence Milwaukie Hospital
Heidi Davis MSW Providence Milwaukie Hospital
Charlotte Navarre RN Providence Milwaukie Hospital
Hsin-Fang Li PHD Providence Medical Data Research Center
Kathy Schwab MPH RDN Providence Health Education
Richard O’Neil MBA Providence Planning Analyst

Title Diabetes Education with a Teaching Kitchen Intervention Can Improve Hemoglobin A1c for Type 2 Diabetics Compared to Traditional Diabetes Education

Purpose The Providence Milwaukie Community Teaching Kitchen offers health-focused, budget friendly cooking classes for patients. In 2019, we piloted diabetes education classes with an added hands-on culinary session. This study compares the change in hemoglobin A1c for ...


Acute Pancreatitis: Case Report And The Importance Of Early Prediction Of Severity, Christelle Serra-Van Brunt 2020 Providence Milwaukie Family Medicine

Acute Pancreatitis: Case Report And The Importance Of Early Prediction Of Severity, Christelle Serra-Van Brunt

Milwaukie Family Medicine

INTRODUCTION: Acute Pancreatitis (AP) was the third most common GI diagnosis in 2012, resulting in approximately 275,000 admissions and costing about $2.6 billion. It remains a disease characterized by significant morbidity and mortality, and to this day, there is not a medication to treat it. Most care is supportive. Establishing the severity of the disease accurately is important in order to triage patients to the correct level of care to decrease rate of complications, mortality, and potentially shorten duration of stay.

CASE REVIEW: 30yo male with history of alcohol use/abuse, with prior episode of pancreatitis 5mo earlier ...


Increasing Vaccination Rates Of Children Up To 24 Months Old At Pmg Milwaukie Family Medicine, Justin Ferley, Rachel Jackson, Aubrey Miller, Sebastian Reeve, Christelle Serra-Van Brunt, Jamie Skreen, Jeffrey Sun, John Yates, Daniel Ruegg 2020 Providence Milwaukie Family Medicine

Increasing Vaccination Rates Of Children Up To 24 Months Old At Pmg Milwaukie Family Medicine, Justin Ferley, Rachel Jackson, Aubrey Miller, Sebastian Reeve, Christelle Serra-Van Brunt, Jamie Skreen, Jeffrey Sun, John Yates, Daniel Ruegg

Milwaukie Family Medicine

Increasing Vaccination Rates of children up to 24 months old at PMG Milwaukie Family Medicine

Authors: Justin Ferley DO; Rachel Jackson MD; Aubrey Miller MD; Sebastian Reeve MD; Christelle Serra Van-Brunt DO; Jamie Skreen DO; Jeffrey Sun DO; John Yates MD; Daniel Ruegg MD

Introduction: Each year in the US, 42000 adults and 300 children die of vaccine preventable diseases. Yet across the country, clinics – including ours – fall short of the CDC Healthy People 2020 goals of pediatric vaccination rates. This resident-led quality improvement (QI) project aimed to improve our clinic vaccination rates in the under 24mo population.

Methods: We ...


Miliary Tb Disease With Tb Meningitis, Jamie Skreen 2020 PGY3 Providence Oregon Family Medicine Residency, Milwaukie, OR

Miliary Tb Disease With Tb Meningitis, Jamie Skreen

Milwaukie Family Medicine

Context/background: Miliary tuberculosis is a condition that is fatal if not diagnosed and can present in the outpatient setting with vague symptoms that resemble a viral illness, therefore, can be easily missed. Recognition of this disease as a differential is important in the primary care setting, especially when caring for immigrant and International patient populations.

Case Description: A previously healthy 35 yo female from Vietnam whom presented initially to the ER for headache and fever for the past 2 weeks. She was diagnosed with acute viral syndrome given her symptoms, normal labs, and head CT, and discharged home. A ...


Sweets Syndrome: A Case Report, Michael Waddick, Elizabeth Deyo 2020 Providence Milwaukie Family Medicine

Sweets Syndrome: A Case Report, Michael Waddick, Elizabeth Deyo

Milwaukie Family Medicine

Title: Add Sweet’s Syndrome to your dermatologic differential

Authors: Dr. Elizabeth Deyo, Dr. Mike Waddick

Context: Sweet’s Syndrome, an uncommon acute painful inflammatory rash, can be easily misdiagnosed. Early recognition and treatment can speed clinical recovery for patients with this difficult condition.

Objective: Here we describe an interesting case report of Sweet’s Syndrome in one of our patients in order to help providers remember this diagnosis on their dermatologic differential diagnosis.

Case report synopsis: Our 44 year old male HIV positive patient with type 2 diabetes mellitus presents with athralgias, chills, malaise and a plaque-like rash on ...


Necrotizing Fasciitis – Time Is Of The Essence, Jeffrey Sun, Edward Kim 2020 Providence Milwaukie Family Medicine

Necrotizing Fasciitis – Time Is Of The Essence, Jeffrey Sun, Edward Kim

Milwaukie Family Medicine

Necrotizing fasciitis (NF) is a life threatening rapidly progressive soft tissue infection that carries a high mortality rate. There are approximately 500-1,500 cases per year in the United States with a mortality rate of up to 18-20%. Without surgical intervention, the mortality rate is near 100%. NF can be characterized by tissue involvement, polymicrobial or monomicrobial etiology, or site of infection. The most common risk factor includes diabetes (reported in up to 60% of cases), IV drug use history, malnutrition, and chronic alcohol abuse. In about 50% of group A streptococcus cases, there is an associated streptococcal toxic shock ...


Quality Improvement: Improving Depression Screening Rates At Pmg Southeast Family Medicine Clinic, Elizabeth Deyo, Edward Kim, Tyler Nelson, Roxanne Thomas, Jemie Walrod, Nicholas Wolfgang, Ben Pederson 2020 PMG Southeast Family Medicine Clinic

Quality Improvement: Improving Depression Screening Rates At Pmg Southeast Family Medicine Clinic, Elizabeth Deyo, Edward Kim, Tyler Nelson, Roxanne Thomas, Jemie Walrod, Nicholas Wolfgang, Ben Pederson

Milwaukie Family Medicine

Introduction: Major depressive disorder is one of the most common mental health problems encountered by primary care providers in the U.S. For people age 12 and older, prevalence is estimated at eight percent. The economic cost of depression has been estimated at $210.5 billion per year, attributed to both costs to the work place and medical costs. People who experience depression are at greater risk for suicide, an otherwise preventable death if depression can be recognized and adequately treated. For these reasons, depression screening has become an essential function within primary care practices both within Providence and nation-wide.


Project Nurture: An Educational Model For Substance Use Disorder Treatment During & After Pregnancy: Saving Lives, Saving Money, Saving Families, And Training Future Doctors, Roxanne Thomas, Brenda Brischetto, Josh Reagan, Daniel Ruegg 2020 Providence Milwaukie Family Medicine

Project Nurture: An Educational Model For Substance Use Disorder Treatment During & After Pregnancy: Saving Lives, Saving Money, Saving Families, And Training Future Doctors, Roxanne Thomas, Brenda Brischetto, Josh Reagan, Daniel Ruegg

Milwaukie Family Medicine

BACKGROUND: • 25% of women presenting for prenatal care are using substances. • Substance Use Disorders (SUDs) in pregnancy are associated with preterm birth, intrauterine growth restriction, placental abruption, increased risk of C-section. • Infants exposed to in utero illicit substances have higher likelihood of being small for gestational age, experiencing a neonatal opioid withdrawal syndrome that requires prolonged NICU hospitalization, and are at higher risk of developmental delay. • Societal costs of SUDs in pregnancy include worsening mental illness, increased utilization of the foster care system, early death secondary to overdose, and associated financial burdens. • The nature of SUDs, and how they are ...


Sti & Prep Updates, Marshal Miller, MD, AAHIVS, Sunny Lai, MD 2020 Thomas Jefferson University

Sti & Prep Updates, Marshal Miller, Md, Aahivs, Sunny Lai, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

  • Apply key findings from the DISCOVER trial to PrEP clinical decision-making
  • Understand the gaps in PrEP research for cisgender women and adolescents
  • Understand the use of on-demand pre-exposure prophylaxis
  • Review Current treatment recs and emerging data on Gonococcal and Chlamydial infection
  • Discuss diagnostic and management options for non-gonococcal urethritis


Implementing Inter-Professional Patient-Family Centered Plan Of Care Meetings On An Inpatient Hospital Unit, Nicolas Hernandez, Alice Fornari, Sage Rose, Leanne Tortez 2020 Northwell Health-Hofstra University

Implementing Inter-Professional Patient-Family Centered Plan Of Care Meetings On An Inpatient Hospital Unit, Nicolas Hernandez, Alice Fornari, Sage Rose, Leanne Tortez

Patient Experience Journal

Inpatient plan of care meetings support efforts to encourage collaborative practice and patient-family centered care and result in an effective strategy to enhance communication and patient satisfaction. Clinical team members participated in patient/family centered plan of care meetings at a community hospital in a selected inpatient unit with full time hospitalist physicians. Quantitative data were gathered pre/post implementation from the external Hospital Consumer Assessment of Health Care Providers (HCAHPS) survey. HCAHPS data were collected independently, specifically for questions related to communication between patients, family members/guardians and the medical team and also the effects of care transition. There ...


Challenges Of Pediatric Disease In Adulthood, Dennis J. Baumgardner, Brian Chicoine 2020 Aurora UW Medical Group, Aurora Health Care

Challenges Of Pediatric Disease In Adulthood, Dennis J. Baumgardner, Brian Chicoine

Journal of Patient-Centered Research and Reviews

Some chronic diseases — such as the rare bone disease X-linked hypophosphatemia, the impetus for a study reported within Volume 7, Issue 2 of the Journal of Patient-Centered Research and Reviews — are diagnosed in childhood but become more symptomatic in adulthood. In this editorial, the challenges, pitfalls, and opportunities regarding the care of adults with childhood-onset chronic diseases are examined using Down syndrome, cystic fibrosis, congenital heart disease, and Hirschsprung disease as examples.


Dancing During Labor: Social Media Trend Or Future Practice?, Caroline P. Toberna, Drew Horter, Kayla Heslin, Marie M. Forgie, Emily Malloy, Jessica J. F. Kram 2020 Aurora Research Institute; Aurora UW Medical Group, Aurora Health Care; Center for Urban Population Health

Dancing During Labor: Social Media Trend Or Future Practice?, Caroline P. Toberna, Drew Horter, Kayla Heslin, Marie M. Forgie, Emily Malloy, Jessica J. F. Kram

Journal of Patient-Centered Research and Reviews

Over the past 30 years, medical interventions in pregnancy and childbirth have increased. Some pregnant women seek less invasive and nonpharmacological options to manage discomforts during labor. While exercise during pregnancy is recommended, less is known about exercise, specifically dancing, during labor. While anecdotal evidence is supportive, little is known about the implications of exercise and dance during the first stage of labor for pain reduction and labor progression. Some movements common in dance, such as expanding hip circles that loosen and relax muscles of the pelvic floor, may be beneficial to women during labor. Available evidence suggests that dancing ...


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