Medicine and Health Sciences Commons^™

Chronic Pain Management With High Dose Opioid Medication, Joshua Cohen

Family Medicine Clerkship Student Projects

Chronic pain management with non-abuse deterrent high dose opioids is a necessary but dangerous practice. This project addressed physician opinions about this sensitive issue and audited patient records to assess documentation compliance with VT rules. The goal is to standardize communication and documentation in order to improve safety for patients, physicians, and the community at large.

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.

Influenza Vaccination In The Elderly, Ayse Nur Celebioglu

Family Medicine Clerkship Student Projects

Influenza is responsible for an estimated 300,000 hospitalizations and 23,000 deaths annually, the majority of which occur in elderly populations. Despite a physiologic vulnerability to this infection, every year millions of seniors do not receive the seasonal flu vaccine. This project set out to understand the myths surrounding influenza vaccinations in the elderly and to educate them on the different types of vaccines available.

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 …

Increasing The Use Of Dementia Screening In The Primary Care Setting, Syed S. Shehab

Family Medicine Clerkship Student Projects

More than 5 million people have Alzheimer’s disease today and 450,000 people in the US die of Alzheimer’s every year. By 2050 the number of people living with Alzheimer’s could triple. 40% of patients living with Alzheimer's disease are undiagnosed. Early detection promotes better dementia care, lowers costs of care, and increases quality of life

Hpv Education And Prevention Amongst Danbury High School Students, Elizabeth Cochrane

Family Medicine Clerkship Student Projects

Human Papillomavirus (HPV) is currently the most prevalent sexually transmitted infection in the United States with an estimated 79 million people infected. In the state of Connecticut, HPV vaccination is not required for entrance into the 9th grade and because of this, there is less awareness of the importance of HPV prevention and immunization among high school students. As of 2013, 37.7-49.9% of females ages 13-17 living in Connecticut completed the HPV vaccine regimen. My objective for this project was to promote awareness about HPV infection and HPV vaccination among high school students.

Polypharmacy Management In A Rural Family Medicine Practice: View From Multiple Perspectives, Sarah Anne Kelso

Family Medicine Clerkship Student Projects

Polypharmacy is a growing problem in the United States. The elderly population is expanding, and the use of specialists to manage their healthcare is increasing. This project looks at the role of the primary care physician at a rural Family Medicine practice in reducing the risks of polypharmacy. The perspectives of patients and the local pharmacist were used to create an education tool about polypharmacy management within this community. Increased awareness of this issue and how it applies to patients within the practice were the results of this intervention.

Mental Health Screening In Nursing Homes, Meghan Breen

Family Medicine Clerkship Student Projects

Depression and dementia are two of the most common mental health conditions in nursing homes. Screening for these conditions does not have to be difficult or time consuming, but doing it can significantly improve the health of nursing home residents. The WHO-Five for depression and the Mini-Mental Status Exam are both sensitive, specific, and time-sensitive. Using these screening in a nursing home in rural Vermont helped improve the accuracy of patient records and impacted medical care.

Bridging The Gap Between The Primary Care Physician And Accessible Resources For Patients With Mental Health Needs, Tracey Dafonte

Family Medicine Clerkship Student Projects

Mental illness and maintaining mental health is a significant problem in the world, the United States, and here in Vermont. The burden of mental illness can lead to disability, lost work productivity, and at its worst, suicide. Vermont ranks 14th in the United States for rates of death by suicide. Many people struggle every day with mental health needs from depression, anxiety disorders, ADHD, and more. The aim of this project was to create a mental health resource card that can be used in primary care offices to provide patients with information to get the help they need and attempt …

Assessing Barriers To Meeting Weight Gain Goals In Obese Pregnant Women, Margo Seybolt

Family Medicine Clerkship Student Projects

Obesity is a known risk factor for complications during pregnancy and birth, as well as worse outcomes. This study looked at the health risks and outcomes of pregnancy in obese women (BMI>35) at the family medicine clinic in Bangor, ME as well as what interventions are being done know to encourage women to meet their weight gain goals. Interviews and literature searches were conducted to determine possible strategies to better get obese pregnant women to meet their weight gain goals.

Promoting Awareness Of Hepatitis C In Burlington, Vermont’S Homeless Population, Catherine M. Lapenta

Family Medicine Clerkship Student Projects

Chronic Hepatitis C infection is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Most Hep C + patients are unaware that they are infected. Chronic HCV infection represents a huge public health and financial burden. While about 1% of the general U.S. population is HCV+, the prevalence is as high as 41.7% in some homeless populations in the U.S. Awareness of Hep C is low and Vermont’s homeless patients who are HCV+ are likely severely underdiagnosed and undertreated.

Decreasing The Smoking Rate At Emmc Family Medicinecenter And Residency In Bangor, Me, Alex Coffman

Family Medicine Clerkship Student Projects

Maine's rate of adult current smoking is 20%, which is significantly higher than all other New England states (Connecticut 16%, New Hampshire 17%, Massachusetts 16%, Vermont 17%, and Rhode Island 17%). The national adult smoking rate in the US is 17.8%. An estimated 2,200 Maine adults die each year from their own smoking.

Implementing Developmental Screening Per Aap Guidelines, Douglas Handley

Family Medicine Clerkship Student Projects

"Fewer than half of the nation's pediatricians conduct systematic surveillance of young children's development… time and cost are among the barriers." Missing developmental delay leads to further attenuation of the problem and can lead to additional developmental problems. Developmental delay can often be corrected or treated to reduce the impact it has on the child. The AAP suggests "developmental surveillance" at every well child visit and standardized "developmental screening" at WCC 9 months, 18 months, and 24 or 30 month.

Osteoporosis: Prevention, Screening, And Treatment In The Primary Care Setting, Jeanne T. Gosselin

Family Medicine Clerkship Student Projects

Osteoporosis, with its related fragility fractures, is largely a preventable disorder, not an inevitable part of aging. Through effective education, screening, and treatement in the primary care setting, it may be possible to curb the impending rise of osteoporosis and costly fractures as the population ages. A time-conserving patient education pamphlet on osteoporosis was developed for a family medicine practice in central Vermont. The educational intervention is sensitive to the time constraints of a busy practice and may provide a much needed foundation for osteoporosis education in the primary care setting.

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 …

Increasing Provider Awareness Regarding Act 39 In Middlebury Vermont, Kyle F. Concannon

Family Medicine Clerkship Student Projects

Vermont passed the Patient Choice and Control at End of Life Act (Act 39) in 2013 and as knowledge of this law is increasing in the community more patients are requesting it. To address the need for further education, an educational pamphlet was produced and provided to practitioners in Middlebury Vermont, many of whom had patients request Act 39.

Implications Of Long-Term Proton Pump Inhibitor Use: Promoting Step-Down Therapy For Management Of Gastro-Esophageal Reflux Disease In The Outpatient Setting, Sonam Kapadia

Family Medicine Clerkship Student Projects

Per the International Montreal Consensus, gastro-esophageal reflux disease (GERD) is defined as a "condition which develops when the reflux of stomach contents causes troublesome symptoms or complications". GERD is the most common disease of the gastrointestinal tract with an estimated prevalence affecting 20% of the Western population. According to the National Ambulatory Medical Care Survey, 38.53 million annual outpatient visits are related to GERD. The ABIM Foundation's "Choosing Wisely" initiative in collaboration with the American Gastroenterological Association draws attention to the evidence based recommendation: "For pharmacological treatment of patients with gastro-esophageal reflux disease (GERD), long-term acid suppression therapy (proton pump …

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.

Increasing The Recognition Of Generalized Anxiety Disorder In Primary Care, Sarah Rosner

Family Medicine Clerkship Student Projects

National Comorbidity Survey has shown that anxiety disorders are the most frequent disorders in the population, with a lifetime prevalence of 28.8%, and a 5.7% lifetime prevalence of Generalized Anxiety Disorder (GAD) specifically. The presence of anxiety disorders contribute in an additive fashion to poor function, reduced quality of life, and more sick days from work. Despite being as common and impairing as depressive disorders, anxiety disorders have received much less attention in terms of the media, research, and public health efforts, and are often undetected and undertreated. Only a minority of patients with anxiety, 15-36%, are recognized in primary …

Educating The Colchester Community About Measles And Its Prevention, Phildrich Teh

Family Medicine Clerkship Student Projects

Measles is a highly contagious disease with potential complications ranging from diarrhea, pneumonia, otits media, uveitis, and encephalitis. Since the introduction of the measles vaccine in 1967, incidence of measles in the United States has drastically decreased: by 1985, number of cases had fallen by 99%, by 2000, measles was declared to be eliminated from the US. Over the last decade, measles cases per year has been limited to a median of 70. In recent years however, the U.S. has seen an alarming rate of measles cases. The increasing number of measles cases per year in the U.S. highlights the …

Allergic Rhinitis: Treatment Of A Seasonal Problem, John Whittier

Family Medicine Clerkship Student Projects

Allergic rhinitis affects up to 30% of the population yet there is evidence that it is under treated and misdiagnosed. Allergy symptoms closely mimic other common illnesses and most medication used to treat seasonal allergies is now available over the counter. This shift in therapy means that patients are now self-medicating with little knowledge of what they are actually treating. Therefore this project aims to clear common misconceptions that prevail in the general population of Vermont as well as provide some guidance on the types of medications used to treat seasonal allergies.

Barriers To Recovery For Buprenorphine Patients In Bangor, Maine, Erin L. Keller, John Mclaren

Family Medicine Clerkship Student Projects

Opiate addiction is a major public health problem in Maine. Addiction is a chronic disease with high relapse rates. A better understanding of the demographics and barriers to recovery in opiate addicted populations can help to improve the success of buprenorphine treatment programs.

Resources For Smoking Cessation In Milton Vt, Kai Ping Wang

Family Medicine Clerkship Student Projects

Today, Tobacco is still the #1 leading cause of preventable death in the United States. Use of tobacco products leads to chronic illnesses such as asthma, heart disease, cancer, lung disease, and stroke. According to the latest data in 2013 from the Behavioral Risk Factor Surveillance System, 16.6% of adults in Vermont are current smokers compared to 19% of adults nationwide. This projects seeks to provide easier access to the available resources in the local Milton, VT community for smoking cessation.

Drug Treatment Court: The Power Of Understanding Addiction, Asaad Traina

Family Medicine Clerkship Student Projects

The Drug Treatment Court in Burlington is one of about 3000 drug treatment courts nationwide. They were developed as an “alternate sentencing court”, a method of restorative justice that would allow people who had multiple criminal charges related to substance abuse to overcome their addiction, have their criminal charges dismissed, and pursue a fuller life. As part of this program, many participants attend an Intensive Outpatient Program (IOP). As a third year medical student, I lead an educational session with the aim of helping participants understand the neurophysiology behind their addiction.

Substance Abuse Amongst High School And College Students, Herman Kalsi

Family Medicine Clerkship Student Projects

Substance abuse among young adults is hardly a new trend. About 50% of full-time college students binge drink or abuse prescription drugs, 25% of which meet the definition of having substance abuse or a dependence. That is three times the rate of the general population. Estimated overall total cost of substance abuse in US is $600 billion annually. Ease of access is a main contributor to drug abuse amongst college students.

Improving Vaccination Rates At Uvmmc Family Medicine, Berlin, Emily G. Jones

Family Medicine Clerkship Student Projects

Practitioners don't know current vaccination rates for their practice. Some current reported rates look incorrect, according to the Medical Director. Other reports show areas for improvement. One problem is that patients no longer in the practice remain in the system and decrease rates; another problem is that paper records were loaded manually by persons without medical training when the electronic medical record.

Education In Over The Counter Medications, For High School Freshmen, Ian Crane

Family Medicine Clerkship Student Projects

Over the medications offer numerous benefits, allowing short term treatment of symptoms, and reducing unnecessary Doctor’s visits for things like viral illness. Yet these medications also have potential for misuse. Roughly 10% of Danbury High School students abused OTC medications in 2013.

Screening For Developmental Delays In Brandon Vt, Flang Nguyen

Family Medicine Clerkship Student Projects

Brandon Medical Center (BMC) currently uses the developmental milestones screening tool built into their electronic medical record to look for developmental delays. Usage of the tool has been awkward, inconvenient, and unmanageable in the office setting. BMC, being the main health care provider for newborns, infants, and toddlers of Brandon, VT, is looking to improve their screening systems for developmental delays during well-child visits

Assessing Patient Barriers To Community Health Team Referral, Benjamin Scott Albertson

Family Medicine Clerkship Student Projects

Objective: To assess patient barriers to Community Health Team (CHT) referrals at Hinesburg Family Practice.

Methods: Patients of Hinesburg Family Practice who were referred to the CHT by a physician and subsequently declined to be seen within the last 15 months were interviewed via telephone to assess what barriers prevented them from accessing CHT services. Twenty five patients were identified and called a minimum of 3 times using contact information obtained from the EHR. Eleven patients were contacted, one of whom had since followed through with the CHT. Responses from the ten patients who met the criteria and …

Increasing Naloxone Availability, Brian Till

Family Medicine Clerkship Student Projects

Administration of naloxone is credited with the reversal of at least 10,000 opioid overdoses in the United States between 1996-2010 alone.[i] Moreover, intranasal naloxone has proven an equally effective route of drug administration when compared to IV dosing in emergent prehospital settings[ii], and retrospective studies have shown no significant difference in efficacy between doses delivered by healthcare professionals and non-healthcare professionals.[iii] Despite these facts, and broad protections provided to physicians prescribing naloxone and citizens administering naloxone outlined in Vermont Act 75, few if any Vermont physicians have incorporated prescribing naloxone into their practice. This project intended …