Medicine and Health Sciences Commons^™

Increasing Advanced Directive Utilization In Primary Care, Alejandro Castro

Family Medicine Clerkship Student Projects

Advance directives are a vital tool ensuring patient’s wishes regarding end-of-life care are met. End-of-life discussions with physicians are associated with fewer aggressive interventions and greater quality of life metrics. Increased utilization of advance directives by Vermonters could ensure the wishes of patients are met.

Healthier Living: Diabetes Management, Brandon Childs

Family Medicine Clerkship Student Projects

More than 55,000 Vermonters suffer from diabetes, which is the 6th leading cause of death in the state. There are currently 705 patients in South Burlington Family Practice with a diagnosis of diabetes. More than 100 of them are living with uncontrolled diabetes (elevated HbA1c > 8%) and have not yet obtained the necessary education to manage their chronic disease. Physicians must manage all patients diabetes goals and expectations in 15-30 minute appointments alone, but may refer patients to the Community Health Team for further diabetes education.

Strides For Change: Incentivizing Hispanic Youth To Promote Exercise, Fitness And Wellbeing, Priyanka Chilakamarri

Family Medicine Clerkship Student Projects

The United Way of Western Connecticut's 2014 annual report on Danbury's Young Children found that Danbury's children are facing many physical fitness challenges compared to the state of CT. A study looking at 4th graders in a physical fitness test finds that Danbury students consistently have a harder time passing the fitness test. Of the population studied, 42.5% were ethnically Hispanic.

Increasing Awareness Of Community Resources And Support For Individuals With Depression, Erin Mcelroy

Family Medicine Clerkship Student Projects

Depression is a common mental disorder characterized by loss of interest or pleasure, feelings of guilt or low-self worth, disturbed sleep or appetite, low energy, poor concentration, insomnia or hypersomnia, and occasionally suicidal thoughts. These problems can lead to substantial impairments in an individual's daily functioning. At its worst, depression can lead to suicide. In Vermont, suicide consistently ranks as one of the top 10 leading causes of death.

Radon: The New Carbon Monoxide, Katherine M. Evans

Family Medicine Clerkship Student Projects

Radon is derived from breakdown of uranium naturally found in the environment all across the globe. Some geographic locations have higher levels of radon than others. Like carbon monoxide, radon is colorless and odorless. It is the second leading cause of lung cancer in the United States. Human exposure happens primarily via buildings: 1 in 8 Vermont homes exceed the recommended level. In Brattleboro, 1 in 5 homes exceed the recommended level, but between January 1993 and January 2014, the Vermont Department of Health received only 329 home testing kits from Brattleboro.

Preventing Lyme Disease In Windsor County, Vt, J P

Family Medicine Clerkship Student Projects

Lyme disease is a bacterial infection caused by Borrelia burgdorferi and is transmitted primarily by deer ticks (Ixodes scapularis). A deer tick must be attached for at least 36 hours for transmission to occur. It can be prevented by preventing tick bites, removing ticks early, and providing post-bite prophylaxis when appropriate. Lyme disease has been on the rise in Vermont since 2005. The Vermont Department of Health (VDH) has launched its “Be Tick Smart” Lyme disease prevention campaign, promoting tick-bite reduction through its slogan, “Repel, Inspect, Remove.” This project extended the campaign to school children in Windsor County, Vermont.

Alcohol Use Among Middle School Children In Vermont, Sargis Ohanyan

Family Medicine Clerkship Student Projects

Alcohol and drug education classes have reduced alcohol use in Vermont middle schools to approximately 20%, however currently no screening or intervention programs are available for the aforementioned 20%. Experts agree that early alcohol use significantly increases the risk of myriad psychosocial problems later in life, therefore early screening and intervention is paramount. The focus of this project is to raise awareness for the need of early screening/intervention regarding alcohol use in Vermont middle schools.

Obesity Intervention And Prevention, Bridget Ann Colgan

Family Medicine Clerkship Student Projects

Obesity is a prevalent health concern at Berlin Family Practice, with 41% of the patients seen in the past two years with a BMI greater than or equal to 30, many suffering from comorbid diseases of hypertension, diabetes, high cholesterol, and stroke. In an effort to assist patients in making lifestyle changes to improve nutrition, activity level, and weight loss, this project aims to incorporate the Vermont Department of Health's Weight and Health Profile into patient visits. Feedback from both practitioners and patients on how to improve and update this tool will be provided to Vermont Department of Health Physical …

Burnout Prevention In Primary Care Providers, Dylan M. Devlin

Family Medicine Clerkship Student Projects

Burnout is a pervasive problem in primary healthcare. Mindfulness training has been shown in decrease symptoms associated with burnout and improve overall patient care. This project attempts to evaluate the rates of both burnout and mindfulness in healthcare workers within Rutland County, Vermont. A survey was distributed to both administrative and primary healthcare workers within the Community Health Centers of the Rutland Region system to determine if employees suffer from symptoms of burnout as well as their willingness to participate in mindfulness training.

Determining Barriers To Oral Health Care In Bennington County, Taylor Goller Ms-3

Family Medicine Clerkship Student Projects

Bennington County has some of the worst oral health outcomes in the state of Vermont. A survey was designed to assess current oral health problems, maintenance habits, and barriers to oral health services access. Results are preliminary.

Self-Reflection Book In K-3rd Grade After School Program, Rebekah Wieland

Family Medicine Clerkship Student Projects

Anxiety (3%) and Depression (4%) are the third and fourth most prevalent parent reported mental health diagnosis among children 3-17 years old according to the 2007 National Survey of Children’s Health Study. Both depression and anxiety are increasing in prevalence over time in the United States. Dr. Melanie Lawrence of Newbury Health Clinic reports that a lot of her practice involves anxiety and depression management, especially in young children. The creation of a self-reflection book completed and kept by young children would be a good introduction to talking about stressors and coping strategies.

Community Perception Of Electronic Cigarettes And Their Role As Smoking Cessation Aids, Alejandro Velez

Family Medicine Clerkship Student Projects

The popularity of electronic cigarettes is increasing, yet the research is lagging behind. In an effort to better understand, and therefore better advice our patients, a small number of current daily cigarette smokers were surveyed on their understanding of electronic cigarettes and their usage. Two smoking cessation counselors were also interviewed to better contextualize the role of electronic cigarettes as possible smoking cessation aids. Finally, a review of the available research was done to produce a poster, and possibly a handout, in hopes to educate all patients (regardless of their current smoking habits) regarding electronic cigarettes.

Getting Real About Food: "Fed Up" & Nutrition Education, Hillary Anderson

Family Medicine Clerkship Student Projects

Getting Real About Food: “Fed Up” & Nutrition Education is a summary presentation designed to help facilitate discussion about the U.S. food industry and its impact on the American diet. The Grace Cottage Community Health team identified the 2014 documentary “Fed Up” as a critical learning tool to enhancing their community education programs for patients, providers, and staff members; this project focuses on summarizing key points and statistics as well as highlighting opportunities for pilot-testing and implementation across different community venues.

Opioid Abuse Treatment In Pregnancy, Catherine A. Suppan

Family Medicine Clerkship Student Projects

Opioid abuse remains an enormous issue in the state of Vermont, including among women who are pregnant. Several regional groups exist to help, support and educate women who are newly pregnant and interested in addressing their drug addiction. Knowledge of these programs, however, remains minimal. My project aimed to address the lack awareness of one of these programs in the Rutland region, BAMBI.

Raising Healthy Vermonters: Preventing Childhood Obesity By Establishing Healthy Habits, Melanie Ma

Family Medicine Clerkship Student Projects

The State of Vermont has one of the lowest rates of childhood obesity in the country. While this statistic is encouraging, it does not make our communities immune. Many Vermonters struggle with obesity and its related illnesses, especially in rural, low-income areas of the state where the ability to afford fresh produce can be challenging.

To keep the rate of childhood obesity low in Vermont, children should be encouraged to establish healthy habits as early as possible. The goal of this project is to provide parents with effective and feasible ways to help their children develop healthy eating habits and …

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 …

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.

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 …

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.

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.

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.

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.

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 …

Pediatric Lipid Screening Guidelines: Information For Patients And Families, Erin R. Pichiotino, Mph

Family Medicine Clerkship Student Projects

Universal Pediatric Lipid Screening Guidelines are currently based on expert opinion only. Bright Futures/American Academy of Pediatrics currently recommends screening all patients ages 9-11 and again at ages 17-21. The US Preventive Services Task Force (USPSTF), however, concludes the evidence is insufficient to recommend for or against routine screening. This discordance leaves ambiguity for implementation in Family Medicine practices in Vermont. A survey of providers at Milton Family Practice showed that only 14% of providers at Milton Family Practice regularly perform lipid screening on their pediatric patients.

Screening, Brief Intervention And Referral To Treatment For Substance Abuse In Waitsfield, Vt, Chi An Liu

Family Medicine Clerkship Student Projects

Substance abuse is an issue in Waitsfield, VT and currently there is no formal program or intervention at Mad River Family Practice to help patients overcome their addictions. Screening, brief intervention and referral to treatment (SBIRT) is a program to identify at risk patients, raise awareness of their abuse, and help them find support and treatment they need.

Application Of One Key Question At Hinesburg Family Practice, Katherine Y. Wang

Family Medicine Clerkship Student Projects

About one half of pregnancies in the United States are unintended (mistimed or unwanted). Only 54% of pregnancies in Vermont are planned and only 29% of women in Vermont have talked to a health care worker about healthy pregnancies prior to conception. Physicians are equipped to provide the necessary information to women about preconception care and contraception, but do not regularly have these conversations with the majority of their patients. One Key Question is an initiative developed by the Oregon Foundation for Reproductive Health that allows providers to screen women patients for their pregnancy intention in the next year and …

Identifying Sleep Disorders And Proper Sleep Hygiene In School-Aged Children, Kathryn Colelli

Family Medicine Clerkship Student Projects

Sleep is a daily struggle for many people. Children in particular often suffer from sleep restriction and poor sleep hygiene. Poor sleep can have a negative impact on their physical, social and emotional health. Children in our community are rarely educated about sleep disorders or sleep hygiene. The goal of this project was to create a learning tool to help facilitate sleep education in children.