Medicine and Health Sciences Commons^™

Social Services Cases, Maria Hervada-Page, Mms

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Understand common Social Work referrals and possible solutions
• Understand the roles of the members of our team
• Understand the basics of insurance
• Basic community resources

"I Had No Other Choice But To Catch It Too": The Roles Of Family History And Experiences With Diabetes In Illness Representations., Amy T Cunningham, Alexzandra Gentsch, Lsw, Amanda M B Doty, Geoffrey Mills, Marianna Lanoue, Brendan G. Carr, Judd E Hollander, Kristin L Rising

Department of Family & Community Medicine Faculty Papers

BACKGROUND: A family history of diabetes and family members' experiences with diabetes may influence individuals' beliefs and expectations about their own diabetes. No qualitative studies have explored the relationship between family history and experiences and individuals' diabetes illness representations.

METHODS: Secondary data analysis of 89 exploratory, semi-structured interviews with adults with type 1 or type 2 diabetes seeking care in an urban health system. Participants had a recent diabetes-related ED visit/hospitalization or hemoglobin A1c > 7.5%. Interviews were conducted until thematic saturation was achieved. Demographic data were collected via self-report and electronic medical record review. Interviews were audio-recorded, transcribed, and coded …

Breast Cancer Treatment: Basics For The Primary Care Provider, Sarah Hirsh, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

1. To review the prevalence of breast cancer and the mortality rate of breast cancer in the United States.
2. To understand breast cancer staging and its role in prognostication.
3. To understand the therapies offered for the treatment of non-metastatic, invasive breast cancer and their side effects.
4. To review the role of the PCP in caring for patients undergoing treatment for breast cancer and those in remission.

Today's Cigarette And E-Cigarette Landscape, Richard C. Wender, Md

Department of Family & Community Medicine Presentations and Grand Rounds

E-cigarettes are one of the most difficult and complex public health issues most of us have confronted.

Most anti-tobacco experts and advocates line up on a spectrum from embracing e-cigarettes as a promising way to reduce the harm of tobacco products all the way to being the greatest threat to progress in our 60 year war on big tobacco.

Journal Club, Zeynep Uzumcu, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline

• Review coronavirus life-cycle
• Review mechanism of action of remdesivir
• Review previous research on remdesivir
• Close reading of article - Methods - Results - Discussion
• Future research
• Implications for our practice

Covid: Decoded - A Website, Blog, And Social Media Page With Resources And Information For The Public, Jessica Smith, Taylor Jones, Madeline Norris, Benjamin Meyers, Christopher Haines, Md

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

Information about COVID19 in the news and on social media platforms is overwhelming, confusing, riddled with jargon and sometimes straight up wrong. Makig it easy for the public to misinterpret facts or simply accept headlines and infographics at facevalue without checking with primary and/or reputable sources.

The nature of social media also allows for a perpetuation of this misinformation without recourse. Recall the one article floating around Facebook reporting that gargling salt/vinegar water could help prevent COVID19. We needede a source of simplified, reliable information about the pandemic for people outside of the health professions.

Medical students …

Expansion And Conversion Of Family Medicine And Neurohospitalist Services Into Covid-19 Services, Zachary Klock, Md, Aimee Mcmullin, Md, Jesse Edwards, Md, Christopher Haines, Md

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

• During the COVID-19 pandemic, there was an anticipated increase in the number of patients admitted with COVID-19.
• To meet the increased number of admitted patients, additional providers and teams were needed to care for hospitalized patients during the pandemic.
• Pre-existing teams needed to find ways to expand (in the case of the Family Medicine service) and repurpose (in the case of the Neurohospitalist service) in order to care for an increased number of patients.

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

Health Equity and Quality Improvement (HEQI) Summit

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.

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

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

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

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

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

Health Screenings Administered During The Domestic Medical Examination Of Refugees And Other Eligible Immigrants In Nine Us States, 2014-2016: A Cross-Sectional Analysis., Clelia Pezzi, Deborah Lee, Gayathri S. Kumar, Breanna Kawasaki, Lori Kennedy, Jenny Aguirre, Melissa Titus, Rebecca Ford, Blain Mamo, Kailey Urban, Stephen Hughes, Colleen Payton, Kevin Scott, Jessica Montour, Emily S. Jentes

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Refugees and other select visa holders are recommended to receive a domestic medical examination within 90 days after arrival to the United States. Limited data have been published on the coverage of screenings offered during this examination across multiple resettlement states, preventing evaluation of this voluntary program's potential impact on postarrival refugee health. This analysis sought to calculate and compare screening proportions among refugees and other eligible populations to assess the domestic medical examination's impact on screening coverage resulting from this examination.

METHODS AND FINDINGS: We conducted a cross-sectional analysis to summarize and compare domestic medical examination data from …

Primary & Secondary Prevention Of Cardiovascular Disease In Primary Care, Marshall Miller, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Overview

Review historical perspective and complexity of primary CVD prevention

Discuss primary & secondary prevention of CAD and the 2019 ACC/AHA guidelines

-- Review of the evidence & primary literature

• Focus on CV risk assessment, DM, ASA/DAPT
• Practical guidance and management considerations

-- CASES- let’s practice and discuss

Proteinuria, Goni Katz-Greenberg, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline and Objectives

• Definition
• Screening/Measurement
• Etiology
• Treatment

Male Luts – Introduction And Overview, Thenappan Chandrasekar, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline & Goals

• Background – What are “LUTS”?

• Anatomy

• Pathophysiology

• Storage – bladder filling symptoms
• Voiding – urine flow symptoms
• Post-micturition

• Major etiologies and management

• BPH / BOO
• OAB
• Nocturia

• Related to Prostate Cancer?

Health Of Special Immigrant Visa Holders From Iraq And Afghanistan After Arrival Into The United States Using Domestic Medical Examination Data, 2014-2016: A Cross-Sectional Analysis., Gayathri S Kumar, Clelia Pezzi, Simone Wien, Blain Mamo, Kevin Scott, Colleen Payton, Kailey Urban, Stephen Hughes, Lori Kennedy, Nuny Cabanting, Jessica Montour, Melissa Titus, Jenny Aguirre, Breanna Kawasaki, Rebecca Ford, Emily S Jentes

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Since 2008, the United States has issued between 2,000 and 19,000 Special Immigrant Visas (SIV) annually, with the majority issued to applicants from Iraq and Afghanistan. SIV holders (SIVH) are applicants who were employed by, or on behalf of, the US government or the US military. There is limited information about health conditions in SIV populations to help guide US clinicians caring for SIVH. Thus, we sought to describe health characteristics of recently arrived SIVH from Iraq and Afghanistan who were seen for domestic medical examinations.

METHODS AND FINDINGS: This cross-sectional analysis included data from Iraqi and Afghan SIVH …

Training The Next Generation Of Family Medicine Providers Through Group Buprenorphine-Naloxone Visits, Krystina Callahan, Lara Weinstein, Md, Erica Li, Md, Sunny Lai, Md, Alexis Silverio

Phase 1

Introduction: The rise in opioid use disorders (OUD) and fatal overdoses highlight the need to expand access to and capacity for treating OUD. Medication Assisted Treatment (MAT), a medication/group visit model, done in the office setting, is an effective remedy for treating OUD. Understanding residents’ perspectives on their clinical training in MAT can inform the design of a more effective and responsive curriculum.

Methods: A qualitative study using group semi-structured interviews with residents in an urban family medicine residency rotating through a federally qualified health center. Interviews centered on strengths and weaknesses of the MAT program, resident likeliness to …

Adolescent Hiv Pre-Exposure Prophylaxis Prescribing Practices Among Family Medicine Physicians: Limited Immediate Uptake, Emma T. Cooper, Steven A. Elsesser, Md, Amy Cunningham, Phd, Mph, Marshal Miller, Md

Phase 1

Introduction: In the United States, individuals aged 13-24 made up 21% of new HIV infections in 2016. In 2018, the FDA approved tenofovir/emtricitabine as HIV pre-exposure prophylaxis (PrEP) for adolescents aged 15-17. In 2019, we examined adolescent PrEP prescribing practices among family medicine physicians at an academic family medicine practice.

Methods: Physicians were invited to complete an online questionnaire assessing PrEP knowledge, attitudes, and prescribing practices. Differences in PrEP knowledge and attitudes among providers who prescribe PrEP to adolescents versus those who do not were examined using independent samples t-tests.

Results: 50 out of 99 surveys were completed. Respondents were …

The Effect Of Reflection Rounds On Medical Students’ Empathy, Erica Westlake, Jennifer Desantis, Med, Fred Markham, Md

Phase 1

Background: A decline in empathy has been noted in medical students in medical education and training. This decline raises concerns because empathic physician-patient interactions positively impact health outcomes and patient satisfaction. We tested the hypothesis that Reflection Rounds would increase empathy scores of third-year medical students.

Methods: Third-year students entering their Family and Community Medicine (FCM) clerkship completed the Jefferson Physician Scale of Empathy – Student Version (JPSE-S) at the onset of their clerkship; students at the Jefferson Campus site were assigned to the experimental group and students at Affiliate Sites were assigned to the control group. The experimental group …

Identifying The Prevalence Of Underdiagnosed Obstructive Sleep Apnea (Osa) In The Primary Care Population Via Targeted Screening Measures, Risa Goldberg, Alyssa Givens, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a condition with detrimental health consequences, yet over 75% of OSA cases remain undiagnosed in the United States. This study aimed to determine the efficacy of using targeted screening measures to determine the prevalence of undiagnosed OSA in a primary care population.

Methods: This prospective pilot study utilized a primary care population from Thomas Jefferson University’s family medicine department. Participants were selected using three risk criteria for OSA from STOP-BANG identifiable from their EMR records (BMI >35, age over 50, and hypertension). After screening out patients previously diagnosed with OSA, patients were called and …

Primary Care Obstructive Sleep Apnea Screening (Pcosa), Alyssa Givens, Risa Goldberg, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a largely underdiagnosed disorder of upper airway collapse during sleep. Primary care providers do not routinely screen for OSA. This project aims to determine the yield of using the STOP-BANG questionnaire to identify previously undiagnosed OSA in a primary care population.

Methods: This prospective quality improvement pilot project included 181 patients of the Jefferson Department of Family Medicine identified as high-risk for OSA based on 3 EMR-based search criteria taken from STOP-BANG: hypertension, age >50 years, and BMI >35 kg/m². We attempted contact with patients by mail, followed by up to …