Medicine and Health Sciences Commons^™

The Effect Of An Educational Intervention On Oral Anticoagulation Therapy Knowledge In Primary Care, Elizabeth D. Deck

Evidence-Based Practice Project Reports

It is estimated that three million people in the United States are on oral anticoagulation therapy (warfarin). Populations studied have been found in therapeutic range 64% of the time (Pernod, Labarere, & Bosson, 2008). The low percentage of therapeutic range is attributable to (a) adherence, (b) monitoring infrequency, (c) Vitamin K antagonists, and (d) the effects of aging and comorbidities. The purpose of this evidence-based practice (EBP) project was to examine whether an educational intervention would improve the knowledge of patients receiving warfarin therapy. Roy’s model for patient adaptation and the Stetler Model for EBP were used as frameworks for …

Anal Cancer Risk Factor Management Practices And The Barriers And Facilitators Of Addressing Anal Health In The Hiv Primary Care Setting, Crystal Martin Walker

Theses and Dissertations (ETD)

Background: The incidence of anal cancer is only 1-2 per 100,000 people in the general population, but in people living with HIV and AIDS (PLWHA), the incidence is far greater by about 80 times. This is a striking disproportion, and it is vital for the healthcare provider and healthcare system to become more attentive to the risk of anal cancer in high-risk populations such as PLWHA. There are a number of modifiable risk factors for anal cancer in PLWHA such as smoking, non-adherence to antiretroviral therapy (ART), and risky sexual behaviors. The HIV primary care provider (HIV PCP) plays a …

One Final Goodbye, Dennis Baumgardner

Journal of Patient-Centered Research and Reviews

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Mindfulness-Based Stress Reduction And Transcendental Meditation: Current State Of Research, Adam Holt

Journal of Patient-Centered Research and Reviews

This article summarizes the current state of meditation research, specifically focusing on mindfulness-based stress reduction and transcendental meditation. Despite significant methodological problems with the studies reported to date on the subject, there is consistent evidence that meditation can produce changes in the nervous system and physiology of the meditator, and can help with various psychological markers of well-being. Regarding improvement in specific clinical diseases, research is generally mixed and preliminary. Strong recommendations cannot be made based on current evidence, and further studies are needed. In general, there is a stronger body of evidence supporting mindfulness-based stress reduction than for transcendental …

Implementation Of An Advance Directive Protocol In A Primary Care Setting, Gloria Dillman

Evidence-Based Practice Project Reports

Despite the passage of the Patient Self-Determination Act in 1992, only 15% of the United States population has completed an advance directive (AD). This statistic will be exaggerated with the future growth of older adults in the year 2030, at which time this portion of the population is expected to double to 72.1 million people. Without an AD, patients lose their autonomy and may be subjected to costly, life prolonging treatments that they would never choose for themselves. The unnecessary costs and unwanted treatment are preventable with an AD, and primary care providers are in a prime position to initiate …

The Effects Of Nutrition And Physical Activity Education On Knowledge And Glycemic Control Among Persons With Type 2 Diabetes, Alexandra Harris

Evidence-Based Practice Project Reports

Diabetes affects millions of people worldwide. Approximately 29.1 million people or 9.3% of the United States population has diabetes (Centers for Disease Control (CDC), 2014). Diabetes was the seventh leading cause of death in the United States in 2010 and is projected by the World Health Organization (WHO) to be the seventh leading cause of death globally by 2030. The purpose of this evidence-based project was to provide nutrition and physical activity education in an effort to improve diabetes knowledge and glycemic control among persons with type 2 diabetes. Hemoglobin A1c levels and Diabetes Knowledge Test scores were compared from …

Hepatitis C Virus Infection Screening Test Compliance At Primary Care Clinic, Talal Alzahrani, Brandon Rieders, Mohammed Fadlalla, Jason Gendell, Anne Cioletti

GW Research Days 2015

Introduction:

Hepatitis C Virus (HCV) is the most common cause of liver cirrhosis and hepatocellular carcinoma, and is the leading cause of liver transplantation in the US. About 3.2 million individuals are chronically infected with HCV. Most of these patients are unaware of their infection because they are largely asymptomatic. Approximately three-fourths of them were born between 1945-1965. Furthermore, with the advances in HCV treatment, it is imperative to identify chronically infected individuals in order to avert the long-term, costly, sequelae of the virus. The U.S. Preventive Services Task Force recently recommended a one-time screening test for HCV for those …

Modified Cage As A Screening Tool For Mechanical Fall Risk Assessment: A Pilot Survey, Marna R. Greenberg Do, Mph, Facep, Michael Nguyen Md, Bernadette Gl-Porter Bs, Robert D. Barraco Md, Brian Stello Md, Arnold R. Goldberg Md, Clare M. Lenhart Phd, Mph, Anita Kurt Phd, Rn, Bryan G. Kane Md

Robert D Barraco MD, MPH

Modified CAGE as a Screening Tool for Mechanical Fall Risk Assessment: A Pilot Survey

Marna Rayl Greenberg DO, MPH, Michael C Nguyen MD, Bernadette G Porter BA,Robert DBarraco, MD MPH, Brian Stello MD, Arnold Goldberg MD, Clare M Lenhart, PhD MPH,Anita Kurt PhD, RN, Bryan G Kane, MD

Background: Falls in the elderly cause serious injury. The literature does not hold answers to patient perceptions about their personal fall risk, their comfort level in discussing their fall history, or a home safety plan with their healthcare provider. Existing risk-assessing tools may be prohibitive in the Emergency Department due to their …

Cost Of Primary Health Care In Pakistan, Muhammad Ashar Malik, Wahid Gul, Saleem Per Waiz Iqbal, Farina Abrejo

Community Health Sciences

Background: Detailed cost analysis is an important tool for review of health policy and reforms. We provide an estimate of cost of service and its detailed breakup on out-door patient visits (OPV) to basic health units (BHU) in Pakistan.

Method: Six BHUs were randomly selected from each of the five districts in Khyber Pukhtonkhawa (KPK) and two agencies in Federally Administered Tribal Areas (FATA) of Pakistan for this study. Actual expenditure data and utilization data in the year 2005 –06 of 42 BHUs was collected from selected district health offices in KPK and FATA. Costs were estimated for outpatient visits …

Everyday Life In Southeast Asia, Kathleen Adams

Kathleen M. Adams

This lively survey of the peoples, cultures, and societies of Southeast Asia introduces a region of tremendous geographic, linguistic, historical, and religious diversity. Encompassing both mainland and island countries, these engaging essays describe personhood and identity, family and household organization, nation-states, religion, popular culture and the arts, the legacies of war and recovery, globalization, and the environment. Throughout, the focus is on the daily lives and experiences of ordinary people. Most of the essays are original to this volume, while a few are widely taught classics.

Family Preservation And Healthy Outcomes For Pregnant And Parenting Teens In Foster Care: The Inwood House Theory Of Change, Lisa D. Lieberman, Linda Lausell Bryant, Keneca Boyce

Department of Public Health Scholarship and Creative Works

Teens in foster care give birth at more than twice the rate of other teens in the United States. Significant challenges exist for these most vulnerable teens and their babies. To preserve teens’ families, programs and services need to be able to improve teens’ prospects for parenting success, delay subsequent pregnancies, and reduce intergenerational placement in care. The Inwood House theory of change for pregnant and parenting teens is a roadmap for providing the range and types of services that have the potential to improve outcomes for these most vulnerable families. The theory of change builds on insights and data …

A Missed Opportunity For Shared Responsibility In Adolescent Contraception, Vasiliki Rahimzadeh

Journal of Adolescent and Family Health

The American Academy of Pediatrics Committee on Adolescence recently endorsed IUDs as the clinical contraceptive method of choice among sexually active adolescents. This commentary highlights the ways in which these recommendations reinforce a gender normative notion that contraceptive responsibilities continue to lie squarely with young women, and now adolescent girls. It critiques the absence of guidance from the Committee regarding how to approach both sexual partners equally in discussions of contraception. The reflection also identifies paucity in how to address sexual health among trans/intersexed adolescents and those with complex sexual orientations. Such exclusion has adverse implications, inviting marginalization of young …

Celiac Is A Social Disease: Family Challenges And Strategies, Gonzalo Bacigalupe, Aleksandra Plocha

Gonzalo Bacigalupe, EdD, MPH

Celiac disease is the most common autoimmune inherited disorder in the United States, affecting approximately 1% of the population. Little research exists on the impact of family processes on adherence to a gluten-free diet (GFD), the only treatment for celiac disease. The objective of this qualitative study was to examine the barriers that families with a celiac child face and the strategies they use to adhere to the recommended diet. In-depth interviews were conducted with 10 families with a child between the ages of 6 and 12 diagnosed with celiac disease. Grounded theory and narrative analysis were used to analyze …

An Analysis Of The Effects Of The Carbohydrate Intake And Hydration On Feeling Of Exertion Throughout A Marathon, Kristine M. Baumann, Kaitlyn Proulx

All Electronic Theses and Dissertations

The popularity of marathon running has grown exponentially since the 1970s (Noakes, 2003). This major gain in popularity has led to an increased interest in hydration and nutrition for marathon runners (Tucker et al 2009). The effects of dietary factors such as carbohydrates (CHO) and water on endurance has been extensively studied related to performance, but few studies have examined nutrition’s effect on feelings of exertion. The current study aimed to determine how the in-race nutrition and hydration habits of marathon runners affect their feelings of exertion throughout a 26.2-mile race. Individuals running Grandma’s Marathon in Duluth, MN on June …

The Effect Of Education On Folic Acid In Women On Childbearing Age And Low Socioeconomic Status, Macey I. Bentley, Anna R. Goetsch, Courtney L. Perpich

All Electronic Theses and Dissertations

The purpose of this study was to investigate the effect of education to women of lower socioeconomic status about the importance of folic acid use before and during pregnancy. Previous research has shown the significance of folic acid in preventing neural tube defects; however, research has shown that women of lower socioeconomic status are not equipped with proper education regarding folic acid usage periconceptionally. An educational session was provided to three women’s shelters regarding folic acid, and questionnaires were used to gauge knowledge on folic acid before and after the sessions. The statistical analysis was consistent with our hypothesis in …

Concussion Education In High School Athletes, Nathan A. Birno, Larson Davick, Kyle Oostra

All Electronic Theses and Dissertations

This paper examines concussion education in high school athletes. Specifically, it examines how educationally beneficial a concussion presentation is for high school athletes. The study examined eighteen-year-old participants from two Minnesota high schools participating in Minnesota State High School League (MSHSL) sanctioned spring sports. A presentation on concussion definitions, signs/symptoms, and adverse effects was presented to the participants. A pre and posttest questionnaire was used to evaluate participants’ baseline knowledge on concussion related topics and their knowledge gained after hearing the presentation. Data was analyzed via a comparison of the mean score differences using a paired t-test of within group …

Analysis Of Lean/Six Sigma Production Model In A Tertiary Care Asthma And Allergy Clinlic, Erika Lynn Bullert, Laura Johnson, Ariel M. Schibilla

All Electronic Theses and Dissertations

In response to demands on healthcare, systems have looked to refine current processes to use time, materials, and finances more efficiently. Lean/Six Sigma (L/SS) is a model that has been used to improve procedural efficiency in various settings. The purpose of this study was to implement L/SS into an outpatient private practice setting and to evaluate the effect on efficiency as measured in the length of individual patient visits who presented to that clinic for routine re-evaluation. In this study, the amount of time between a patient’s entrance and exit from the clinic was documented for 878 patients before implementation …

Oncology Providers’ Opinions On Preventative Recommendations For Patients With Brca1 Or Brca2 Breast Cancer Mutations, Rebecca L. Crissman, Kathleen Dunsmore

All Electronic Theses and Dissertations

BRCA1 and BRCA2 gene mutations have been identified as increasing an individual’s risk for developing breast cancer. Genetic testing for these genes has become increasingly more common. However, once genetic testing has established that an individual has either a BRCA1 or BRCA2 mutation, there is no set guideline for preventative measures. The purpose of this study is to gain the opinions of oncology healthcare providers on their recommendation for preventative treatment in women who have been diagnosed with the mutation at varying ages. A web-based survey was emailed to oncology healthcare providers from Minnesota Oncology in Minnesota and Allegheny Health …

Current Usage Of Animal Assisted Therapy In Nursing Homes In Ramsey County, Minnesota, Lauren K. Duerst, Natalie E. Nikonovich, Ashley M. Young

All Electronic Theses and Dissertations

The main purpose of this study was to determine the use of animal assisted therapy (AAT) for residents living in nursing home facilities in Ramsey County, Minnesota. Furthermore we compiled the thoughts and opinions of each facility director regarding the usage and perceived barriers that accompany the implementation of AAT programs.

Attitudes And Utilization Of Tissue Plasminogen Activator Involving Telemedicine, Karin K. Filip, Brittany R. Kelly, Stacy M. Underhill

All Electronic Theses and Dissertations

Tissue plasminogen activator (tPA) is used to treat acute ischemic stroke and is widely accepted as standard practice in the medical community. Literature shows that providers are hesitant to use this therapy due to the associated risks. Supporting literature shows that tPA is highly effective if administered within a three hour window, when adhering to strict protocols and guidelines for patient qualification. Telestroke programs have been shown to improve the time from stroke onset to administration of tPA by allowing a neurologist to be present during the decision making process. The aim of the study was to examine attitudes of …

Comparison Of Oral And Printed Health Literacy Tools In Hypertension Education For Low-Income Patients, Andrew D. Forsgren, Annie Heggestad, Charles Ruegemer

All Electronic Theses and Dissertations

Hypertension is a prevalent health concern in today’s society, especially among individuals of low-income economic status. An increased risk for heart disease has long been correlated to hypertension, and this risk increases further as the population ages. Patient education is crucial for prevention and management of diseases such as hypertension; therefore it is necessary to develop effective education tools. This is particularly true among high-risk groups such as low-income populations. This study compared the efficacy of printed educational materials versus orally presented educational materials in terms of improving patient knowledge regarding hypertension. Subjects were randomly assigned to either the printed …

Chemically Self-Assembled Antibody Nanorings: A Novel Approach To Bispecific Design For Cancer Therapeutics, Kari A. Gabrielse

All Electronic Theses and Dissertations

Targeted antibody therapeutics are currently being developed for treatment of a wide variety of cancers. By extending the scope of targeted antibody therapeutics into a bispecific design, it has been shown that simultaneous targeting of the CD3 T cell receptor and cancer cell receptors is possible. While great success has been achieved with the use of bispecific agents, many of these agents are genetically fused antibody fragments that can only target one type of cancerous receptor. Here we describe a simple and straightforward method of spontaneously assembling bispecific antibody therapeutics. Using fusion proteins consisting of two dihydrofolate reductase proteins and …

Health Disparities On American Indian Reservations: Can Mid-Level Practitioners Make A Difference?, David Evard Johnston

All Electronic Theses and Dissertations

Introduction: American Indians/Alaskan Natives (AI/AN) suffer from a number of health issues and at higher rates than other United States populations. Efforts have been made through the Indian Health Service (IHS) to improve the AI/AN state of health, but healthcare disparities remain. Purpose: The purpose of this study was to assist in identifying options in reducing healthcare disparities on American Indian reservations in South Dakota. The need for recruitment of additional physicians and mid-level practitioners (also known as mid-level providers or advanced practice providers) was assessed, as well as the potential for mid-level practitioners to meet that need. Methods: A …

Prevalence Of Non-Conventional And Folk Medicine Usage Among Hmong In St. Paul, Minnesota, Matthew T. Vang

All Electronic Theses and Dissertations

Hmong Americans have been identified to utilize various modes of medicine including: folk/herbal remedies, spiritual/shamanistic rituals, and adapted treatments from countries like Thailand or Laos. However, there is a lack of studies that measured the prevalence of these medications among the Hmong community in Saint Paul, Minnesota. A questionnaire was distributed at a Saint Paul, Minnesota Hmong market to explore the prevalence of Hmong medicine usage. Demographical information was also collected to help determine any relationships that might exist between certain socio-cultural factors and Hmong medicine usage. The study had a total of 54 participants. Of the 54 participants, twenty-eight …

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.

Development And Implementation Of A Suboxone Therapy Group, David Hermel

Family Medicine Clerkship Student Projects

Implementing effective opiate detoxification is critical to the health and well-being of the Lewiston-Auburn area, which has the highest rate of admissions for substance abuse (especially non-heroin opiates) and mental health conditions in Maine. The number of Maine residents seeking treatment for prescription drug abuse topped the nation at 368 admissions per 100,000 residents in 2008.