Medicine and Health Sciences Commons^™

Virtual Rounds: Improving Family Participation In Multidisciplinary Rounds Via Telehealth, Gerald Durkan

CwiC Posters

Background

What Are Multidisciplinary Care Rounds (MDR’s)?

MDRs are defined by the unique characteristic of incorporating a multitude of both physician and non-physician specialties into the conversation with the patient for the coordination of their care.

What is Discussed During an MDR?

Activities relating to the care of the patient that may be incorporated into the MDR include summarizing the treatment that the patient has undergone, discussing the treatment approach that is planned for the patient, working through potential issues that may arise from the treatments, and discussing the potential future therapy.

What is Telehealth?

Telehealth is the delivery of …

Improving Rural Community Health Through Care Coordination, Alexander Miller

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DEMOGRAPHICS OF CRAWFORD COUNTY^1,2

• Population – 87,600
• Population density – 86.5 per mi²
• Ratio of patients to PCPs – 1,685:1
• Number of hospitals – 2
• Population 65 and older – 17.4%
• Overweight – 65% Obesity – 32%
• Population with Diabetes – 12%
• Heart disease death rate – 200 deaths per 100,000 people.

The above percentages and rates of disease are either equal to or higher than the averages for the state of Pennsylvania.

School Wellness Assessment: Creating A Culture Of Health, Kaitlyn Petruccelli, Bs, Rickie Brawer, Mph, Phd

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Introduction

The Center for Urban Health (CUH) and the Office for Student Life and Engagement at Thomas Jefferson University (TJU) are working with two public elementary schools in Philadelphia – Southwark School and Independence Charter School – to create a culture of health in the schools. Both schools wish to establish an environment that promotes health and safety and assists children in developing life-long healthy habits. The offices at TJU set out a plan to

(1) Assess the current policies and climate at the schools,

(2) Identify priority weaknesses to address,

(3) Connect TJU’s various health professional schools and student …

The Public Health Of Youth And High School Athletics, Michael Haines

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The Problem

• The number of participants in high school sports has increased since 1989 (National Federation of State HS Association).
• From 2000-2010 7% of public schools cut athletic programs while less than 1% added them (Sharp Center Univ. Michigan).
• Some estimates predict 27% of public high schools will not offer varsity athletics by 2020 (Sharp Center Univ. Michigan).
• School’s are dropping athletic programs (as well as music and theater programs) due to budget cuts.
• Alternative approaches schools are taking include “pay to play” which increases the financial burden on students and families.
• In 2011, 3 out of 4 school districts …

Jeffhealth Medical Student Exchange In Rwanda, Amanda Nemecz, Alexander Rowan, Talia Stark

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Teaching Community Health Workers

In rural Rwandan villages, the communities are linked to healthcare through Community Health Workers (CHW). CHW are appointed based on village election and the requirement that they can read and write. The Rwandan Ministry of Health provides general health training to the CHW so that they can educate and advise the village on health related matters. CHW administer educational sessions at village meetings about prevalent health issues, and advise members of the village when they should go to the Health Center. JeffHEALTH’s teaching aims to supplement the Ministry of Health training. Topics are chosen and approved …

Clinical Experience At Pasteur Clinic Đà Lạt, Vietnam, Emma Howard-Young, Jordan Howard-Young, Ma

CwiC Posters

History of the Pasteur Clinic Đà Lạt

The Pasteur Clinic is associated with the Institut Pasteur, part of the international network of research institutes dedicated to the prevention and treatment of infectious diseases. The Đà Lạt branch of Vietnam’s Institut Pasteur was built between 1930 and 1936 under the direction of Dr. Alexandre Yersin, a physician remembered for identifying Yersinia pestis as the causative agent of Plague and a student of the eponymous French chemist and microbiologist Louis Pasteur. While many overt references to the French colonial tradition have been supplanted in Vietnam by nationalist sentiments, the Institut Pasteur …

Developing Maternal And Child Health Curriculum In Rural Uganda, Rebecca Newbrander, Md Candidate

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Maternal and Child Health in Iganga District Uganda

Maternal and child health outcomes in the East Central Region of Uganda are especially poor compared to the rest of Uganda [1]:

• Only 32% of women (50.7% nationally) informed about signs of pregnancy or delivery complications
• Only 12% of women (62% nationally) received malaria prophylaxis during pregnancy

The “Three Delays Model” of barriers to care[3]:

• Knowing when to seek care and making the decision to do so
• Access to care once decision is reached to seek it
• Receiving quality care at a health center or hospital

Maternal and Child Heath Care in …

The Intersection Between Medication Tablets And Electronic Tablets: Determining The Usability And Acceptability Of A Patient-Centered Cardiovascular Risk Assessment (Pccra) Ios App, Nisha Patel, Ms2, Geoffrey Mills, Md, Phd, Marianna Lanoue, Phd, Amy Cunningham, Mph

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Background

One American dies from cardiovascular disease (CVD) every 40 seconds. Risk factor awareness, assessment, and communication has been shown to improve efficacy of patient treatment and also decline overall risk in the population over time. Traditional cardiac risk assessment tools (e.g. Framingham risk assessment, FRA) generate a risk score in a format that may not appreciated or easily understood by all patients. A new patient-centered approach, in which the patient becomes an active participant in the decision-making process, has shown significant increase in patient-provider communication and diagnosis/management.

How A Civil War Surgeon’S Population Health Initiatives Helped Save The Union, 2lt Tyler Walker

CwiC Posters

Introduction

Dr. Jonathan Letterman was the medical director for the Army of the Potomac during the American Civil War. Dr. Letterman graduated from Jefferson Medical College in Philadelphia in 1849. With his appointment to the largest portion of the Union Army, Dr. Letterman was tasked with improving what would today be called a population health nightmare. Soldiers lived in filth, ate food devoid of nutrition, were forced to train beyond what was necessary no matter the conditions, and worst of all, were not provided with an organized medical department to treat them if they were wounded or became ill. He …

Housing First: A Solution To Urban Homelessness, Kelsey L. Capron, Lara C. Weinstein, Md

CwiC Posters

Homelessness in the United States

• 630,000 homeless in the US in 2012, thousands in Philadelphia
• Over 3% of the US population has been homeless during the past 5 years
• Homeless = no stable residence

Temporary shelters, unsheltered locations (the street, transit stations, parked cars), etc.

• High rates of legal issues, substance abuse/dependency, & lack of stable employment

Severe mental illness = overrepresented & linked to severe health disparities

• Higher risk for all-cause mortality (primarily due to injuries, overdose, CV disease)

Mortality rates 3-4x higher than the general population

Chronic & acute mental & physical health conditions

HIV, tuberculosis, hypertension, diabetes …

Adolescent Pregnancy In Ecuador, Paige Bates

CwiC-PH

Description of the Problem

• Teen pregnancy, commonly defined as pregnancy in a girl less than 18 or 19 years of age, is often a target of public health efforts because of the far-reaching economic, social and health effects.¹
  • A girl who becomes pregnant attends 2.5 less years of school, and each additional child translates into 1 less year of education.²
  • Girls who get pregnant before age 18 are more likely to experience violence within marriage or a partnership than girls who postpone child-bearing.¹
  • Babies born to adolescent mothers have a higher incidence of perinatal complications (like asphyxia …

Regional Disparities In Neurocritical Care Outcomes, Kali Graham

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BACKGROUND

• Determinants of Neurocritical Care Outcomes: Social as opposed to biological disparities can frequently dictate health outcomes for neurocritically ill patients. Survival rates are determined both by a patient’s access to a NCU (Neurocritical Care Unit) as well as the level of inpatient care he or she receive once admitted to a NCU.
• Regional Inequality in Access to Care¹:
• Only 12.8% of Americans have access to a NCU within 45 min by ground transportation and 36.8% have access to a NCU within 45 minutes by air transportation.
• Racial Disparities in NCU Admissions and Outcomes²:
• Non …

The Effect Of Peer Educators On Medication Adherence In Hiv Patients In Cochabamba, Bolivia, George Ru

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BACKGROUND INFORMATION

• Bolivia is the least developed country in South America, with high levels of poverty, poor access to safe water, and low economic activity. Bolivia’s GDP, in US dollars, in 2013 was $30.60 billion and the gross national income, per capita in US dollars was $2,550, which both rank either at or near the bottom of the list for all South American countries (7).
• The Ministry of Health and Sports (MSD) is the national governing body responsible for formulating the strategy, policies, plans and programs in health. The Department of Health Services (SEDES) is the highest level of technical …

Care With Dignity: Understanding How To Care For Hiv Positive And Formerly Incarcerated Populations, Caroline Komanecky, Terry Trudeau, Med, James D. Plumb, Md, Mph, Helen Koenig, Md

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Philadelphia FIGHT is a comprehensive HIV/AIDS service organization providing primary care, consumer education, advocacy, and research on potential treatments and vaccines. FIGHT was formed as a partnership of individuals living with HIV/AIDS and clinicians, who joined together to improve the lives of people living with the disease. Today, FIGHT serves an even broader patient population and recently received designation as a Federally Qualified Health Center. FIGHT strives to address not only HIV-infected patients, but all at-risk populations through education, outreach, and preventative medicine. The annual Bridging the Gaps interns are responsible for several projects, including a client satisfaction survey, a …

Establishing Roots In West Philadelphia, Nina Millman, James Larosa, Skip Weiner, Rickie Brawer, Mph, Phd, James D. Plumb, Md, Mph

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Urban Tree Connection

Urban Tree Connection is an organization that utilizes plots of land which have been abandoned. The organization uses the land to create gardens that grow produce which is then sold at markets and to the community. Their goal is to provide access to fresh fruits and vegetables in the food desert areas of West Philadelphia. Members of the community are able to get involved by allowing some of their land to be used as gardens and helping to maintain the sites. The organization also tries to spread information about sustainability including a compost program in the neighborhood.

Healthy Habits, Happy Baby!, Amanda Ocran, Suvidha Polu, Joan I. Gluch, Phd, Rdh, James D. Plumb, Md, Mph, Rickie Brawer, Mph, Phd

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Cribs for Kids, a component program of the Maternity Care Coalition, provides needy families in Philadelphia with cribs and education on safe sleeping environments.

• Cribs for Kids also provides education on how to reduce the risk of sudden infant death syndrome (SIDS).
• The organization hosts workshops throughout the city and home visits for those who cannot attend the workshops.
• Cribs for Kids also increases awareness about safe sleeping habits and their program by attending community health fairs.
• In the last year Cribs for Kids has provided families the city of Philadelphia with over 2,000 safe sleeping environments.

An Interdisciplinary Approach To Combat Obesity In The Galapagos, Christopher Busack, Bethany Fox

CwiC-PH

Galapagos Background

• Total Population (2010) = 25,124¹
• Largest city = Puerto Ayora (Santa Cruz)
• Average monthly income in Galapagos = $772.03/month²
• Average monthly income in mainland Ecuador = $251.70/month²
• Booming tourism industry contributes to rapid population growth³

4 of 18 main islands (>1km²) open for human residence (Santa Cruz, Isabela, San Cristobal, Floreana)

The Heart Of Healthcare: The Role Of Authentic Relationships In Caring For Patients With Frequent Hospitalizations, Charlotte Weisberg, Ba, Margaret Hawthorne, Mph, Marianna Lanoue, Phd, Jeffrey Brenner, Md, Dawn B Mautner, Md, Ms

CwiC-PH

INTRODUCTION

Frequent hospital utilization is a major contributor to the costs of healthcare. Despite a vast body of literature, there remains great uncertainty about the characteristics and care needs of individuals with frequent hospitalizations.^1,2 In the movement to reduce the need for hospitalizations, care management programs have garnered wide attention and support. Of the many studies that exist on the efficacy of care management interventions, only a handful espouse the benefits of “continuous healing relationships.”^3,4,5 Fewer studies, if any, explain the role of affect between care providers and patients in the healing process and how to achieve a …

Experiences With Prenatal Care Among Women In A Philadelphia Homeless Shelter, Stephanie Rand, Ms4, Montida Fleming, Ms3, Maria Somohod, Ms3, Caitlin Callaghan, Ms2, Alexandra Strauss, Ms2, Natalie Ziegler, Ms2, Anita Modi, Ms4, Rickie Brawer, Mph, Phd, James D. Plumb, Md, Mph

CwiC-PH

Prenatal care for the underserved is a national concern, with pregnancy rates as high as 22% in homeless women and 75% of these women reporting barriers to care during pregnancy. Inadequate prenatal care confers increased risk for gestational complications and unfavorable postnatal outcomes, including prematurity and low birth weight. Yet while many studies delineate the prevalence and health consequences of inconsistent prenatal care in the homeless population, few address healthcare barriers. To both fill this gap in the literature and design effective interventions increasing consistency of care, we explored prenatal care experiences of pregnant homeless women at Philadelphia’s primary intake …

Cervical Cancer In Guatemala: Using Visual Inspection With Acetic Acid Screening To Reduce Incidence Of And Mortality From Cervical Cancer, Zachary Klock

CwiC-PH

Guatemala is a developing nation of nearly 16 million in Central America. Among the many health problems the nation suffers, cervical cancer remains a leading cause of cancer-related death. Cervical cancer, an easily detectable cancer, predominantly affects women in developing nations. Traditional cytology techniques have been used to screen women in the country for over 25 years, but less than 10% of the Guatemalan population is screened. The Visual Inspection with Acetic Acid (VIA) is a simple produce that uses acetic acid to visualize precancerous cervical lesions and has been proven to be more effective in resource-poor settings. The screening …

Health Needs Assessment For Head Start Children, Gerald Gibbons

CwiC-PH

Background: Head Start Program

• Preschool program for low-income families, providing comprehensive learning and care for children ages birth through 5 years old.¹
• Receives federal funds through the Department of Health & Human Services. However, each Head Start program is a locally designed and implemented model based on local community needs and resources.¹
• One of many government requirements involves yearly health check-ups and up-to-date immunization records for all children enrolled.¹
• NSCA elicited services from Jefferson Center for Urban Health to investigate why some families have a difficult time completing the medical record requirements.

Alternative Income Generation For Kenyan Women: Preventing Prostitution And The Spread Of Hiv, Megan Elizabeth Lundy

CwiC-PH

HIV/AIDS in Mlolongo, Kenya

Mombasa Highway and Weigh Station

• Truckers spend 3+ days waiting to be processed, providing a costumer base for prostitution
• In Kenya, 27.6% of female sex workers are HIV positive and only 26.8% use condoms with all of their partners (Morris, Morris, and Ferguson, 2009).
• The rampant spread of HIV and lack of contraception has led to rapid growth in the population in an area that has little ability to support any residents
• Development of Slums that now line the highway

Comparison Of Breastfeeding Among White And African American Patients Delivering At Thomas Jefferson University Hospital, Rachel Horowitz, Theresa Burcher, Md, Abigail Wolf, Md, Rebecca J. Mercier Md Mph

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BACKGROUND

• Maternal breastfeeding has been widely accepted as the gold standard for infant nutrition during the first six months of life.¹
• Healthy People 2020 goals:

– 89.1% initiation of breastfeeding

– 60.6% breastfeeding for 6 months

– 32.4% breastfeeding for 1 year¹

• Global promotion of breastfeeding though Baby-Friendly Hospital Initiative

– Started by WHO and UNICEF in 1991 to assist hospitals in facilitating and promoting breastfeeding

– Provides education and skill building for all levels of staff

– Recognizes hospitals providing optimal care for infant nutrition²

• While the rates of breastfeeding have increased nationally since 1990, the …

Health Care In Bolivia: A First Hand Experience, Sanchi Malhotra

CwiC-PH

This research project is based on a one month work experience in Cochabamba, Boliva through the NGO Sustainable Bolivia at Hosptial Viedma, a major public hospital and Centre de Salud Pacata, a rural outpatient health clinic. The information presented below is derived from both research and personal experience. This trip was partially funded by Jefferson Office of International Affairs with the goal of gaining experience and knowledge about the Bolivian health care system.

Addiction: A Treatable Disease, Nathaniel Graham

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Addiction: Definitions and Statistics

Nearly 1 in 7 Americans (~40 million people) are addicted to a chemical substance.

An additional 2 in 7 Americans (~80 million people) qualify as risky substance users; those who use chemical substances in ways that threaten their health and safety.

Rural And Urban Medicine In Ecuador, Moira Black

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Free, Universal Health Care

• Health care is free to all workers and their children with support from the government, employers, and a portion of the workers’ paychecks.¹
• Military personnel do not contribute part of their paychecks to paying for healthcare.¹

Underrepresented Minorities And Jefferson Medical System Healthcare: What Can We Do To Diversify The Physician Workforce?, David Halpen

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Why Diversity?

• An increasingly diverse workforce leads to better levels of care.¹
• Underserved areas need better care and this is currently not being provided by Physicians from non URM backgrounds. ²
• Research shows that physicians from diverse backgrounds are more likely to return to service the communities of underrepresented minorities (URMs). ³
• There will be a decrease in overall healthcare disparities between different groups. ⁴

Globally Minded, Locally Serving: Refugee Health In Philadelphia, Sarah Jamieson, Angelica Montes, Gretchen Shanfeld, Mph, Rickie Brawer, Mph, Phd, Caryn Johnson, Ms, Otr/L, Faota, James D. Plumb, Md, Mph

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Introduction

A refugee is someone who is forced to leave their country of origin due to war, violence, or persecution. The United States is the world’s top resettlement country. Out of the 50 states, Pennsylvania is 5^th in terms of the number of annually resettled refugees. Each year, Philadelphia resettles approximately 800 refugees. Bhutan, Burma, Iraq, Eritrea, Sudan, and Democratic Republic of Congo are the most frequent countries of origin in Philadelphia.

Hernia Surgery In Rural Ghana, West Africa: Barriers To Health Care And Their Implications, Laura Traub

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The information presented is a the product of a six week international rotation at Volta Regional Hospital and Royal Hospital through Blue-Med Africa, a non-governmental organization based out of Ho, Ghana. The goal of the rotation was to obtain an understanding of healthcare in Ghana and identify the differences between surgical procedures in West Africa and the U.S.

Lgbt Healthcare And Our Role In Smoking Cessation, Leor Krichilsky, John Covotta, Valerie Canavin, Rickie Brawer, Mph, Phd, Robert Winn, Md, Ms, Aahivs

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Mazzoni’s goal is comprehensive LGBT care

The interns learned the value of comprehensive care through observing roles of the nurses, transgender intake counselor, case managers, and physicians. Mazzoni’s multi-disciplinary model allows patients’ various needs to be met directly.

The interns also learned the importance of LGBT care through discussions about use of unisex bathrooms, preferred pronouns, and inclusive language. This is demonstrated by Mazzoni’s new patient forms.