Medicine and Health Sciences Commons^™

Increasing Utilization Of Community Resources To Address Social Determinants Of Health Barriers In Patients With Diabetes Mellitus Type 2, Kimberly Williams

The Eleanor Mann School of Nursing Student Works

PURPOSE: To determine if identifying SDOH barriers to care in adults with DMT2 and providing information about community-based resources designed to decrease the impact of these barriers will improve adherence, decrease SDOH barriers, and reduce HbA1c levels.

DESIGN/METHODS: Quasi-experimental design. Participants completed PRAPARE screenings and received handouts detailing contact information for local resources. HbA1c levels were collected prior to or at the initial appointment. Contact was attempted at 4-6 weeks to ensure resources were utilized. 3-month follow up appointments were completed during which PRAPARE screenings were repeated, HbA1c levels were collected, and post-intervention surveys were completed.

CONClUSIONS: Participants who did …

Family Physicians And Menstrual Care: An Analysis Of Cera 2023, Allison Casola, Olivia Rea, Tiffany Ho

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Menstrual health is an important indicator of overall health and has large impacts on quality of life. Despite number and impact, discussion of menstruation remains largely taboo within health care. Patients and physicians are not engaging in regular, meaningful discussions on menstruation. Family physicians, as primary care providers, can facilitate these important conversations.

OBJECTIVES: We sought to understand the profile of menstrual care providing family physicians and assessed physician comfort, knowledge, training, and perceived importance regarding menstrual care.

DESIGN/METHODS: This is a cross-sectional analysis of the 2022 Council of Academic Family Medicine Educational Research Alliance survey. The survey included …

Antibiotic Stewardship In Patients With Viral Upper Respiratory Illness: Improving Quality Measures In Retail Health, Meredith A. Nolan, Robin Harris, Clay Smith

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Millions of people will die from antibiotic-resistant bacterial infections in the next 30 years. Retail health providers are pivotal in this global epidemiological problem.

LOCAL PROBLEM: Setting included 15 retail health clinics operated by Vanderbilt University Medical Center in Middle Tennessee. Project examined provider education, patient engagement, and commitment to antibiotic stewardship, components of the CDC's Core Elements of Outpatient Antibiotic Stewardship framework. Specific aims were that providers would have a significant reduction in the percentage of antibiotics prescribed for viral illness over the study period.

METHODS: Using the Evidence-Based Practice Improvement Model, a Quality Improvement …

Discussing Menstrual Health In Family Medicine, Allison Casola, Alice Renaud, Ashwini Kamath Mulki

Department of Family & Community Medicine Faculty Papers

No abstract provided.

Primary Health Care And The Tanzania Comprehensive Cancer Project, Gijs Walraven, Harrison Chuwa, Alain Fourquet, Paschal Ruggajo

Internal Medicine, East Africa

No abstract provided.

Use Of Translational Science, Continuous Glucose Monitoring In The Primary Care Setting For Management Of Nesidioblastosis: A Case Report And Literature Review, Karuna Manandhar, Othman Farahneh, Ahmad Damlakhy, Ali Lattouf, Gerardo Munoz-Monaco

School of Medicine Publications and Presentations

Nesidioblastosis is a term used to describe histologic changes in the pancreatic cell, which are defined by beta cell hypertrophy and the formation of ductoinsular complexes. It is a disease previously most extensively identified in neonates and is a rare cause of endogenous hypoglycemia in the adult population. However, with increasing numbers of gastric bypass surgeries for the management of obesity in recent years, there has been a growing number of populations with post-gastric bypass surgery-related nesidioblastosis. Here, we will present a case of a 60-year-old female with a history of Roux-en-Y gastric bypass (RYGB) surgery who initially presented with …

Implementing In-Room Recycling On A Family Medical Center, Ariann Schultz, Sarah Johnson

Articles, Abstracts, and Reports

No abstract provided.

Assessment Of Breastfeeding Education In Medical Training, Saranya Madan, Abigail Kuplicki

Medical Student Research Symposium

In 2019, the Academy of Breastfeeding Medicine issued a revised set of educational objectives for medical trainees at various stages of education. In this statement, objectives for medical school were broken down into preclinical and clinical training objectives. In this project, our goal is to assess the degree to which medical training at Wayne State University School of Medicine is addressing these aims.

The assessment of breastfeeding education is accomplished by surveying medical students at various stages of training (M1-M4) and eliciting their level of confidence in and understanding of the topics outlined in the objectives by the Academy of …

Knowledge, Attitudes And Beliefs Toward Polypharmacy Among Older People Attending Family Medicine Clinic, Nairobi, Kenya, Maureen Kamau, Njeri Nyanja, Adelaide Lusambili, Jacob Shabani, Gulnaz Mohamoud

Family Medicine, East Africa

Background Life expectancy has increased over the last century among older people, particularly those aged over 60 years. Aging is associated with increased disability, multiple chronic conditions, and increased use of health services managed with polypharmacy. There are few studies on polypharmacy and aging in sub-Saharan Africa, and it is unclear what older people know and their attitudes toward polypharmacy. This paper presents findings from a study that aimed to understand older people’s knowledge, attitudes and beliefs about polypharmacy.

Methods A qualitative study using in-depth interviews of 15 patients aged 60 years and older who were taking more than five …

Metabolic Syndrome And Obesity Among Marginalised School-Going Adolescents In Karachi, Pakistan: A Cross-Sectional Study, Hina Sharif, Sana Sharif Sheikh, Tooba Seemi, Hira Naeem, Unab Khan, Shah Sumaya Jan

Department of Family Medicine

Background: Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors which increase the likelihood of developing type 2 diabetes and cardiovascular disease. This study aimed to determine the prevalence of MetS among adolescents living in slums aged 11-18 years in Karachi, Pakistan.
Methods: Data were collected from 689 adolescents attending five schools in two slum areas of Karachi, Korangi and Baldia, from February 2023 to March 2023. Measurements of weight, height, waist circumference, and blood pressure were obtained from the study participants. Blood samples were collected to assess fasting plasma glucose, High density lipoprotein HDL-cholesterol, and triglyceride levels as …

Women’S Comfort With Mobile Applications For Menstrual Cycle Self-Monitoring Following The Overturning Of Roe V. Wade, Gabrielle M. Salvatore, Iris Bercovitz, Danielle Arigo

Faculty Scholarship for the College of Science & Mathematics

Background: The overturning of Roe v. Wade in June 2022 has many implications for American women of reproductive age, as well as for researchers focused on women’s health in the United States (U.S.). Personal reproductive health data, such as information collected by menstrual cycle (MC) tracking applications (apps), can now be bought, sold, or accessed by law enforcement to enforce limits on abortion. American women have grown concerned about data privacy and have even deleted MC tracking apps following the overturning of Roe v. Wade. This concern is problematic as these apps may advance our understanding of women’s MC experiences …

The Anthropometric Determinants Of Peak Expiratory Flow Rate Among Children In Dar Es Salaam, Tanzania, Willbroad Kyejo, Nancy Matillya, Neelam Ismail, Gloria Gachocha, Hajaj Salum, Rosebella Iseme, Mariam Noorani

Family Medicine, East Africa

Background: Peak expiratory flow rate (PEFR) is an important tool for assessing lung function, which can be affected by environmental and physical factors such as altitude, nutrition, genetics, age, height, and weight. Conducting a study to assess the correlation between peak expiratory flow rate and anthropometric measurements in Tanzanian schoolchildren is crucial to derive a population-specific prediction formula and further simplify respiratory health assessment.

Methods: This cross-sectional study was conducted in a single center private primary and secondary school in Dar es Salaam, Tanzania using data from an asthma screening camp. Variables of interest were height, weight, Body Mass Index …

Examining Menstrual Health Experiences In Philadelphia, Pa: A Qualitative Investigation, Allison Casola, Oriana Pando, Lynette Medley, Brianna Kunes, Nya Mcglone, Olivia Rea

Department of Family & Community Medicine Faculty Papers

BACKGROUND: While menstruation is a physiologic process, it remains highly stigmatized. Despite the sheer number of menstruators, menstruation is a highly individualized experience, with wide variation in duration, symptoms, and management. This wide variability lends itself to large disparities in access to menstruation management products and subsequently the lived experience of menstruators.

OBJECTIVES: The research team sought to understand lived menstrual experiences, symptoms, management tactics, and commonly used and desired resources among 20 cisgendered women aged 18-45 years in Philadelphia.

DESIGN: This project was a qualitative research study.

METHODS: We used a collaborative, community-based participatory research approach with No More …

The Implementation Of Nurse Practitioner Residency Programs To Increase The Employment Retention Of New Graduates, Roni-Jo Panganiban

Master of Science in Nursing Family Nurse Practitioner

This review explores the effectiveness of Nurse Practitioner (NP) residency programs in addressing role strain, burnout, and retaining new graduates. It emphasizes the factors contributing to NP resignations and proposes formal residency programs to improve job satisfaction and retention rates. Research highlights benefits such as enhanced preparedness, credibility, and better patient care, advocating for increased program accessibility and funding. Additionally, the application of the theory of planned behavior underscores compliance with regulations, evidence-based practice, and environmental influences for patient safety in advanced practice registered nursing. The literature review on NP residency programs draws from six empirical articles, focusing on job …

Support, Networks, And Relationships: Findings From A Mixed-Methods Evaluation Of A Mentorship Programme For Early Career Women Researchers In Sexual And Reproductive Health And Rights, Muhammad Asim, Peter Muriuki Gatheru, Joy J. Chebet, Mehr G. Shah, Anna Thorson, Vanessa Brizuela

Community Health Sciences

Low research output among women researchers in health research has been linked to inadequate mentorship opportunities for early career women researchers and particularly in sexual and reproductive health and rights (SRHR) field. Mentorship has been recognized as a contributor to strengthening research capacity and as beneficial for both mentors and mentees. Women researchers oftentimes experience negative impacts of organizational and structural gender inequities related to formal and informal mentoring. In 2020, the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction at WHO launched a mentorship programme for early career SRHR women researchers from low- and …

Primary Care Provider Receptivity To Multi-Cancer Early Detection Test Use In Cancer Screening, Christopher Chambers, William Leach, Kaitlyn V Davis, Ronald Myers

Department of Family & Community Medicine Faculty Papers

Multi-cancer early detection tests (MCEDs) are blood-based tests that detect biomarkers released or induced by cancer cells. If MCED tests are shown to be safe and effective in cancer screening, they are likely to be ordered and managed in primary care. To understand primary care providers’ support for and concerns about the implementation and management of MCED testing, the research team developed a cross-sectional survey that was sent to 939 primary care providers (physicians, residents/fellows, and advanced practice providers) in a large academic health system in the greater Philadelphia area. The survey included standard items used to assess provider background …

The Impact Of Telehealth In Urgent Care Settings, Annie Dong

Applied Research Projects

Telehealth is an emerging modality of patient care and has since expanded to urgent care facilities. Urgent care facilities have been around for decades; however, along with telehealth, it has only grown in popularity in recent years due to the COVID-19 pandemic. However, the implementation and usage of telehealth in urgent care facilities is dependent on the provider being able to use it. This study aimed at looking at the perspective of the provider on the implementation and usage of telehealth in the urgent care setting.

Using Digital Assessment Technology To Detect Neuropsychological Problems In Primary Care Settings, David J Libon, Emily Frances Matusz, Stephanie Cosentino, Catherine C Price, Rod Swenson, Meagan Vermeulen, Terrie Beth Ginsberg, Adaora Obiageli Okoli-Umeweni, Leonard Powell, Robert Nagele, Sean Tobyne, Joyce Rios Gomes-Osman, Alvaro Pascual-Leone

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

INTRODUCTION: Screening for neurocognitive impairment and psychological distress in ambulatory primary and specialty care medical settings is an increasing necessity. The Core Cognitive Evaluation™ (CCE) is administered/scored using an iPad, requires approximately 8 min, assesses 3- word free recall and clock drawing to command and copy, asks questions about lifestyle and health, and queries for psychological distress. This information is linked with patients' self- reported concerns about memory and their cardiovascular risks.

METHODS: A total of 199 ambulatory patients were screened with the CCE as part of their routine medical care. The CCE provides several summary indices, and scores on …

Designing For Community Engagement: User-Friendly Refugee Wellness Center Planning Process And Concept, A Health Design Case Study, Ellen Solomon, Brandon Joa, Shandon Coffman, Billie Faircloth, Marc Altshuler, Bon Ku

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Refugee and immigrant populations have diverse cultural factors that affect their access to health care and must be considered when building a new clinical space. Health design thinking can help a clinical team evaluate and consolidate these factors while maintaining close contact with architects, patients' community leaders, and hospital or institutional leadership. A diverse group of clinicians, medical students, community leaders and architects planned a clinic devoted to refugee and immigrant health, a first-of-its-kind for South Philadelphia.

METHODS: The planning process and concept design of this wellness center is presented as a design case study to demonstrate how principles …

The Pattern Of Admission, Clinical Characteristics, And Outcomes Among Patients Admitted To The Intensive Care Unit Of A Tertiary Hospital In Tanzania: A 5-Year Retrospective Review, Nadeem Kassam, Philip Adebayo, Iris Martin Matei, Eric Aghan, Samina Somji, Samwel Paul Kadelya, Yasson Abha, Frank Elton Swai, Mangaro Mabusi, Kamran Hamid

Internal Medicine, East Africa

Introduction: Despite the implementation of complex interventions, ICU mortality remains high and more so in developing countries. The demand for critical care in Sub-Saharan Africa is more than ever before as the region experiences a double burden of rising rates of non-communicable diseases (NCD) in the background battle of combating infectious diseases. Limited studies in Tanzania have reported varying factors associated with markedly high rates of ICU mortality. Investigating the burden of ICU care remains crucial in providing insights into the effectiveness and challenges of critical care delivery.

Material and Methods: A single-center retrospective study that reviewed records of all …

Bricks And Mortar Of Well-Being: Exploring The Housing-Health Connection, Roshanak Mehdipanah, Lara Weinstein

Department of Family & Community Medicine Faculty Papers

Housing is a determinant of health. Increasing housing costs and worsening housing conditions have impacted populations worldwide. This Editorial aims to examine the dynamic connection between housing and health and the role of public health in addressing this relationship for a Collection launched at BMC Public Health on Housing as a determinant of health and well-being.

Multilevel Community Engagement To Inform A Randomized Clinical Trial, Kirby L. Wycoff, Jabina G. Coleman, Christine M. Santoro, Leah L. Zullig, Niesha Darden, Porsche M. Holland, Jane F. Cruice, Shukriyyah Mitchell, Michelle Smith, Saleemah J. Mcneil, Sharon J. Herring

Counseling and Behavioral Health Faculty Papers

OBJECTIVE: To explore how patients, community-based perinatal support professionals, and health system clinicians and staff perceived facilitators and barriers to implementation of a randomized clinical trial (RCT) designed to optimize Black maternal heart health.

METHODS: This article describes the formative work that we believed needed to occur before the start of the Change of H.E.A.R.T (Here for Equity, Advocacy, Reflection and Transformation) RCT. We used a qualitative, descriptive design and community-based, participatory approach, the latter of which allowed our team to intentionally focus on avoiding harm and equalizing power dynamics throughout the research process. Data were collected between November 2021 …

Structurally Competent Healthcare And Health Inequities, James Meza

Conference Presentation Abstracts

No abstract provided.

The Effectiveness Of Disinfection Protocols In Osteopathic Family Medicine Offices, Riley Phyu, Harrison A Patrizio, Thomas Boyle, Todd Schachter

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

CONTEXT: Healthcare-associated infections (HAIs) pose a substantial public health threat. Despite significant strides to curb HAIs in hospital environments, outpatient settings have not received the same degree of attention. Given their emphasis on holistic, patient-centered care, osteopathic family medicine offices are pivotal in both disease prevention and comprehensive patient treatment. The importance of simple yet effective disinfection protocols, such as thorough cleaning between patient appointments, cannot be overstated in these settings because they are integral to minimizing disease transmission.

OBJECTIVES: This study aims to assess the effectiveness of the current disinfection protocols in osteopathic family medicine offices.

METHODS: A cross-sectional …

Outpatient Management Of Urinary Tract Infections By Medical Officers In Nairobi, Kenya: Lack Of Benefit From Audit And Feedback On Adherence To Treatment Guidelines, Florence Mbatia, James Orwa, Mary B. Adam, Gulnaz Mohamoud, Rodney Adam

Family Medicine, East Africa

Introduction: Acute uncomplicated urinary tract infections are common in outpatient settings but are not treated optimally. Few studies of the outpatient use of antibiotics for specifc diagnoses have been done in sub-Saharan Africa, so little is known about the prescribing patterns of medical ofcers in the region.

Methods: Aga Khan University has 16 outpatient clinics throughout the Nairobi metro area with a medical ofcer specifcally assigned to that clinic. A baseline assessment of evaluation and treatment of suspected UTI was performed from medical records in these clinics. Then the medical ofcer from each of the 16 clinics was recruited from …

Role Of Hospital Leadership In Pandemic Preparedness: Experience At A Tertiary Hospital In Kenya During The Covid-19 Pandemic, Lucy Mwangi, William Macharia, Benjamin Wachira, Jemimah Kimeu, Boniface Mativa, Lukoye Atwoli

Paediatrics and Child Health, East Africa

Introduction: Pandemic preparedness refers to being ready for, responding to and recovering from public health crises, and is integral for health security. Hospital leadership is a critical building block of an effective healthcare system, providing policy, accountability and stewardship in a health crisis.

Objectives and methods: We aimed to describe the leadership and governance structures put in place at the Aga Khan University Hospital, Nairobi, a private not-forprofit tertiary healthcare facility, following the COVID-19 pandemic. We reviewed over 200 hospital documents archived in the COVID-19 repository including those received from the Kenya Ministry of Health, emails, memos, bulletins, meeting minutes, …

Dorsal Pancreas Agenesis, An Incidental Finding During Acute Appendicitis Diagnosis; A Case Report, Willbroad Kyejo, Ally Zain Ismail, Sajida Panjwani, Nancy Matillya, Ahmed Jusabani, Adil Datoo, Pilly Ally

Family Medicine, East Africa

Introduction and importance: Dorsal pancreas agenesis is a rare congenital anomaly characterized by the absence or severe underdevelopment of the dorsal pancreatic bud. We report a case of a man who presented with features of appendicitis only to the incidentally discovery of dorsal pancreas agenesis during the diagnosis of acute appendicitis. We describe our experience on radiological diagnostic formulation and work up.

Case presentation: We present the case of a 45-year-old male patient who presented to the emergency department with symptoms and signs suggestive of acute appendicitis. A computed tomography scan and laboratory investigations confirmed the diagnosis of appendicitis. Incidentally, …

The Effect Of Perceived Weight Status And Bmi Perception On Food Attitudes And Food Relationships, Sahil K. Patel, Ryan Gericke, Jaime Dougherty, Adarsh Gupta

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

CONTEXT: Obesity has been a national epidemic throughout the United States due to the increasingly sedentary western lifestyle, paired with calorically dense abundant low-nutritional food options. Discussing weight necessitates the conversation of not only the numerical value (body mass index [BMI]) associated with obesity but also the perceived weight or how an individual categorizes their weight, irrespective of their calculated BMI classification. Perceived weight can influence food relationships, overall health, and lifestyle habits.

OBJECTIVES: The purpose of this study was to identify differences in dietary habits, lifestyle habits, and food attitudes among three groups: those correctly identifying as "obese" with …

Factors Associated With Depressive Symptoms In Patients With Benign Prostatic Enlargement, Husni Abdalla, Jasmit Shah, Tabitha A.N. Nyanja, Jacob Shabani

Family Medicine, East Africa

Background: Depression is a common condition that may lead to suicide at its worst. It is considered one of the primary causes of morbidity globally. Among the urological causes of depression is benign prostatic enlargement (BPE).

Aim: To determine the prevalence and factors associated with depressive symptoms among BPE patients.

Setting: This study was conducted in the Urology and Family Medicine Clinic at the Aga Khan University Hospital, Nairobi and Urology clinic at the Aga Khan Hospital Mombasa.

Methods: The study was a cross-sectional design recruiting 308 males above the age of 40. Patient Health Questionnaire-9 …

What Makes A Family: How An Empowerment-Based Health Care Delivery Model Employs Family Planning To Positively Impact Families In Rural Maharashtra: A Study In Jamkhed, Ahmadneger, Sezin Sakmar

Independent Study Project (ISP) Collection

The paper examines how an empowerment-based health care delivery model employs family planning services to positively impact families in rural Maharashtra. Family planning services provide those with the ability to become pregnant the option to control their own reproductive lives, whether they choose in favor of or against having children. Contraceptive use advances people’s human rights to choose whether they want to bear children and how many children they want, and people should have the choice of their preferred contraceptive method. The paper examines this issue within the framework of the Comprehensive Rural Health Project’s Jamkhed Model. Through the Jamkhed …