Medicine and Health Sciences Commons^™

Dashing Away Hypertension: Evaluating The Efficacy Of The Dietary Approaches To Stop Hypertension Diet In Controlling High Blood Pressure, Preeya Shah Phd, Kyle D. Maxwell, Joseph I. Shapiro Md

Biochemistry and Microbiology

The dietary approaches to stop hypertension (DASH) diet has been developed and popularized as a non-pharmaceutical intervention for high blood pressure reduction since 1995. However, to date, a comprehensive description of the biochemical rationale behind the diet’s principal guidelines has yet to be compiled. With rising interest for healthy and reliable life-style modifications to combat cardiovascular disease, this review aims to compile the most recent and relevant studies on this topic and make an informed assessment as to the efficacy of and underlying mechanisms operant in the DASH diet. Specifically, the merits of lowering dietary intake of sodium and saturated …

Small Intestinal Bacterial Overgrowth: A Case-Based Review, Kristen H. Reynolds

Journal of Patient-Centered Research and Reviews

Small intestinal bacterial overgrowth (SIBO) is a condition of increased microbial load in the small intestine. The microbes feed on dietary carbohydrates and starches via fermentation, leading to gas production, inflammation and damage to the lining of the small intestine. Clinical presentation is varied, including abdominal pain, bloating, malabsorption and systemic symptoms. SIBO is associated with many challenging and chronic conditions such as fibromyalgia, chronic fatigue and chronic pain syndromes, and has been shown to be a causative factor in two out of three cases of irritable bowel syndrome. Symptoms improve with antimicrobial treatment, but recurrence is common. Many providers …

Should Primary Care Physicians Address Sleep To Improve Weight Loss In Obese Patients? A Clin-Iq, Kjersti E. Knox

Journal of Patient-Centered Research and Reviews

Obesity is a commonly encountered problem in the primary care setting. Simultaneously, sleep is seen to hold an increasingly important role in many components of health and wellness. A review of the literature was performed to determine if improving sleep positively impacts weight loss in obese adults. The evidence reviewed suggests that improving patients’ sleep may initially improve patient weight loss; however, current studies do not show a sustained statistically significant impact. Until higher powered and higher quality studies are completed, there are no clear evidence-based guidelines for primary care physicians to follow regarding sleep and obesity.

Velamentous Cord: A Dangerous Case Complicated By A Rural Population#11;#11;, Adam M. Franks, Carolyn Curtis, Shawndra Barker

Shawndra Barker MD

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. Figure 1 depicts the velamentous cord insertion.

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Shawndra Barker MD

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

Velamentous Cord: A Dangerous Case Complicated By A Rural Population#11;#11;, Adam M. Franks, Carolyn Curtis, Shawndra Barker

Adam M. Franks, MD

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. Figure 1 depicts the velamentous cord insertion.

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Adam M. Franks, MD

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

Residual Barriers For Utilization Of Maternal And Child Health Services: Community Perceptions From Rural Pakistan., Zahid Memon, Shehla Zaidi, Atif Riaz

Community Health Sciences

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the …

Can Contracted Out Health Facilities Improve Access, Equity, And Quality Of Maternal And Newborn Health Services? Evidence From Pakistan., Shehla Zaidi, Atif Riaz, F. Rabbani, Iqbal Azam Syed, Syeda Nida Imran, Nousheen Pradhan, Gul Nawaz Khan Nawaz Khan

Community Health Sciences

BACKGROUND:

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan.

METHODS:

An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A …

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Marshall Journal of Medicine

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

Exploring Attitudes Toward Physician-Nurse Collaboration Within A Team-Based Primary Care Environment, Tom Karagiannis Pharmd, C. Coschignano, Sarah E. Hegarty Mphil, L. Polenzani, E. Messina, R. Zoli, Mohammadreza Hojat Phd, Vittorio Maio Pharmd,Msph

Sarah E Hegarty

No abstract provided.

Severity Of Depression, Anxious Distress And The Risk Of Cardiovascular Disease In A Swedish Population-Based Cohort., Aysha Almas, Yvonne Forsell,, Romaina Iqbal, Imre Janszky,, Jette Moller

Department of Medicine

Background: Depression is known to be associated with cardiovascular diseases (CVD). This population-based cohort study aimed to determine the association between depression of varying severity and risk for CVD and to study the effect of concomitant anxious distress on this association.

Methods: We utilized data from a longitudinal cohort study of mental health, work and relations among adults (20–64 years), with a total of 10,443 individuals. Depression and anxious distress were assessed using psychiatric rating scales and defined according to DSM-5. Outcomes were register-based and self-reported cardiovascular diseases.

Findings: Overall increased odds ratios of 1.5 to 2.6 were seen …

Effect Of Nutritional Deficiency On The Efficacy Of The Polio Vaccines In Pakistan., Aamir Abbas, Romaina Iqbal

Department of Medicine

No abstract provided.

Research Design Creates Ambiguity Related To Efficacy Of Sickle Cell, Chronic Disease Specialty Clinic, Scott J. Dawsey

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Koch KL, Karafin MS, Simpson P, Field JJ. Intensive management of high-utilizing adults with sickle cell disease lowers admissions. Am J Hematol. 2015 Jan;90(3):215-219. doi:10.1002/ajh.23912

Hospitalist Involvement In Family Medicine Residency Training: A Cera Study, Robert A. Baldor, Judith A. Savageau, Navkiran Shokar, Stacy E. Potts, Joseph Gravel Jr., Kimberly Eisenstock, James Ledwith

Judith A. Savageau

BACKGROUND AND OBJECTIVES: Little is known about the impact of hospitalists on family medicine residencies. We surveyed family medicine residency directors to assess attitudes about hospitalists and their involvement in residency teaching.

METHODS: Questions were included in the 2012 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency directors. Univariate statistics were used to describe programs, directors, and our questions on the use of hospitalists. Bivariate statistics were used to examine relationships between the use of hospitalists to teach and program characteristics.

RESULTS: Forty-one percent (n=175) of residency directors completed the hospitalist section of the …

Teaching The Value Of Continuity Of Care: A Case Conference On Long-Term Healing Relationships, Jeffrey L. Sternlieb Phd

Jeffrey L Sternlieb PhD

No abstract provided.

Teaching The Value Of Continuity Of Care: A Case Conference On Long-Term Healing Relationships, Jeffrey L. Sternlieb Phd

Jeffrey L Sternlieb PhD

No abstract provided.

Primary Care Practice Development: A Relationship-Centered Approach, William L. Miller Md, Benjamin F. Crabtree Phd, Paul A. Nutting Md, Msph, Kurt C. Stange Md, Phd, Carlos Roberto Jaén Md, Phd

William L Miller MD, MA

No abstract provided.

Landscape Analysis Of Multi-Sectoral Initiatives For Under-Nutrition In Pakistan, Zulfiqar Ahmed Bhutta, Albertha Nyaku, Jane Keylock, Shehla Zaidi, Jai Das

Community Health Sciences

Mapping of Multi-Sectoral Initiatives for Nutrition in Pakistan, Challenges faced, Opportunities, and potential for Cross- Sectoral Synergies.

Induced Lactation, Katherine M. Evans

Family Medicine Scholarly Works

Induced lactation refers to the production of breast milk in a woman who has never been pregnant. While induced lactation has been practiced developing nations for centuries, it has only recently been introduced to the United States. Induced lactation allows a woman to provide both nutrition and nurture an emotional bond with an infant in cases of adoption, surrogacy, same-sex couples, maternal-infant separation, and emergencies/natural disasters. Many protocols for inducing lactation have been described, though all vary widely in methodology and effectiveness. The current review summarizes the physiology of human lactation, psychosocial factors involved with inducing lactation, non-pharmacologic and pharmacologic …

The Skinny On Pediatric Obesity, Kim Hageman Md, Rob Luebbers Md

Family Medicine Scholarly Works

Pediatric obesity prevalence in the U.S. has been on the rise for the past few decades. Providers of pediatric patients need to be able to properly define pediatric weight concerns (overweight and obesity) in order to accurately diagnose and therefore help manage the problem. There are a number of contributing factors, which also need to be understood in order to help families manage pediatric weight concerns. Current guidelines to help define and manage pediatric weight concerns are discussed in this lecture.

Undergraduate Student Attitudes On Concierge Medicine, Sushane Gupta

Honors Theses

The purpose of this thesis was to examine the opinions of undergraduate students on a field of personalized primary care known as concierge medicine, as well as assess their satisfaction with their current non-concierge healthcare providers. Concierge medicine aims to provide patients with a high level of customer service and satisfaction, and in exchange for an annual fee, they receive benefits such as lower waiting times for appointments, access to the physician by phone or e-mail, and a stronger patient-physician relationship focused on preventative care. The current literature on non-concierge healthcare reveals several deficiencies including poor insurance coverage, poor patient …

A Comparative Analysis Of Medical Pluralism In Fiji And The United States, Meaghan Jain

Honors Theses

Both indigenous Fijians and Americans practice a medically pluralistic style of healing that includes biomedicine, herbal medicines, and spiritual healing. People in both cultures use alternative medicinal styles to fill in around gaps left by biomedicine, but the reasons why they do this, and how they do this, are different. Urban indigenous Fijians supplement biomedicine with healing styles that utilize their social networks. Fijians have a sociocentric sense of self and the body; they feel uncomfortable with impersonal treatment by doctors and feel better about treatments that bring social support. Americans, on the other hand, follow a rhetoric strongly oriented …

Exploring Doctor-Patient Communication In The Context Of Complementary And Alternative Medicine, Eva Rachelle Zimmerman

Honors Theses

The introduction of Complementary and Alternative Medicine (CAM) in the United States has recently led to increased interest in this topic. CAM encompasses a range of health care approaches that attempt to maintain or prevent illness, such as herbal supplements and acupuncture. The integrative health care movement, which is the integration of CAM with conventional medicine, has been rapidly growing among both health care providers and health care consumers, because most consumers use both types of medicine. Despite this growth, there are barriers to the acceptance and integration of CAM, including the inability of doctors to communicate with patients about …

The Affordable Care Act Dependent Health Insurance Mandate's Effect On The Life Satisfaction Of Young Adults, Kirti Chakote

Honors Theses

On September 23, 2010, the dependent health insurance mandate of the Affordable Care Act (ACA) increased the family health insurance coverage of young adults up to age 26. The present study principally examined the effect of this mandate on life satisfaction of young adults, in addition to health care access, self-reported health, preventative care, and labor market outcomes. Through health insurance coverage, it is hypothesized that the ACA mandate will lead to a higher life satisfaction in young adults. Using the Behavior Risk Factor Surveillance System data of 2005 through 2013 to assess the effect of the ACA mandate, this …

Promoting Completion Of Advance Directives In A Hispanic Religious Congregation: An Evidence-Based Practice Project, Luis Daniel San Miguel, Mary Jo Clark

Doctor of Nursing Practice Final Manuscripts

Background: Hispanics utilize more aggressive medical treatment at the end of life and are less likely to receive end-of-life care consistent with their wishes than nonHispanic Whites. Hispanics are less likely than nonHispanic Whites to have an advance directive (AD). Increasing AD completion among Hispanics can promote end-of-life care consistent with their wishes, diminish healthcare disparities, and eliminate unnecessary healthcare spending. Objectives: To promote completion of advance directives by increasing knowledge, positive attitudes, and comfort with advance care planning (ACP) among Hispanics through culturally sensitive interventions. Intervention: The project was conducted in Spanish and implemented among a …

Implementation Of An Evidence-Based Educational Workshop And Toolkit: Menopausal Women's Healthcare Needs For The Primary Care Provider, Pamela Doerr-Kashani Dnp, Rn

Doctor of Nursing Practice (DNP) Projects

This evidence-based change of practice project involved the development of an educational workshop for primary care providers (PCPs). The intent of the project was to improve PCP’s knowledge of menopausal health, and to create their comfort level when discussing menopausal healthcare with clients. The workshop Menopausal Women’s Healthcare Needs for the Primary Care Provider (Doerr-Kashani, 2014) was created in response to an identified gap in knowledge among PCPs nationally on menopause-related health issues. The workshop was designed as a resource to support PCPs to competently address women’s menopause-related health issues, and enable them to provide comprehensive, evidence-based care within the …

Improving Hand Hygiene Compliance To Reduce Clabsi Rate In Oncology Icu, Lorenzo D. San Pedro

Master's Projects and Capstones

The aim of this project is to reduce the rate of central line associated blood stream infection (CLABSI) occurrence in oncology ICU by 50% by the last quarter of 2015. This study was conducted in ICU to assess adherence to the facility’s hand hygiene (HH) protocol among the staff nurses and allied healthcare workers. The facility is best known as a non-profit cancer treatment center and designated as a Comprehensive Cancer Center. Evidence showed that hand hygiene is the most effective way of preventing CLABSI, one of the most common types of infection in ICU microsystem. The project utilized The …

Using Education And A Prevention Protocol Tool To Decrease The Incidence Of Pressure Ulcers In A Nursing Home, Kristina L. Scalzitti

Evidence-Based Practice Project Reports

Over 1.3 million persons are residents in nursing homes (NHs); one in ten have pressure ulcers. The purpose of this evidence based practice project was to determine if implementation of a pressure ulcer prevention tool, along with staff education, decreases the incidence of pressure ulcers within the NH. Florence Nightingale’s Environmental Model and the Stetler Model were used to guide this project. The setting was a NH in northwest Indiana. Eleven nurses attended a 15 minute educational session on pressure ulcer prevention and implementation of the Pressure Ulcer Prevention Protocol Intervention (PUPPI) tool. PowerPoint slides were distributed and flyers about …

Diabetes Type 2 Self-Management Education Program: Short Messaging From Patient Portal To Web-Enabled Device, Lynn S. Holcomb

Evidence-Based Practice Project Reports

Only one in eight adults with diabetes reaches target goals for disease management, which can lead to clinical complications, costly both economically and in quality and duration of human life. The standard of care is a quarterly 15-minute face-to-face visit-- arguably inadequate to impart self-care knowledge. The purpose of this EBP project was to deliver a 30-day diabetes self-management education program (DSMEP) utilizing widely accessible web-based technology to facilitate adults with diabetes to reach targeted goals. Using the Chronic Care Model as a framework, the DSMEP design was based on an extensive literature review of the delivery of DSMEP in …