Medicine and Health Sciences Commons^™

A Case Study On Toxoplasmosis: Ocular Disease, Caleb A. Vass, Elliot Freed

Capital Division Virtual Research Day 2020

Toxoplasmosis is an infection caused by the protozoan parasite Toxoplasma gondii. Primary infection by this organism is usually asymptomatic. Some immunocompetent patients infected with this parasite can present as an acute systemic infection but symptoms can also present as ocular disease. In these instances, the ocular disease may be the only symptom, and can be from either an acute infection or a reactivation of the disease.

Evaluating Awareness Of Low-Dose Computerized Tomography For Lung Cancer Screening, Roshni Leboutillier, Bansi Savla, Vincent Wu, Zia Khan, Erick Mejia, Leah Tehranchi, My Myers, Khine Min, Jennifer Broyles, Stacy Chase

West Florida Division Virtual Research Day 2020

In the U.S., excluding melanoma, lung cancer is the leading cause of cancer-related deaths.¹
Cigarette smoking is the number one risk factor and is linked to 80-90% of lung cancer deaths.²
Low-dose Computerized Tomography has been shown to reduce lung cancer deaths by 20% in randomized control trials and observational studies.⁴
The U.S. Preventative Task Force recommends annual screening for lung cancer with low-dose computerized tomography (LDCT) in adults ages 55-80 years of age who:

• Have a 30 pack-year smoking history and
• Currently smoke or
• Have quit within the past 15 years.

Effect Of An Electronic Order Set On Newborn Hepatitis B Immunization Rates, Daniel Pedersen, Angelina Rodriguez, Michael King, Heather Schramm

West Florida Division Virtual Research Day 2020

No abstract provided.

Diaphragmatic Paralysis: A Presentation Of Spontaneous Chest Pain And Shortness Of Breath, Donna Dorriz, Hilary Lois, Candace Wise, Brady Dehart

Capital Division Virtual Research Day 2020

Chest pain accounts for approximately 7.6 million annual visits to emergency departments (ED) in the United States and can include a broad differential1. The workup warranted includes extensive testing with the goal of demonstrating a reassuring cardiopulmonary status. When preliminary chest pain workup is negative, the subtle features of common primary symptoms can provide insight into other less common etiologies. This case looks to highlight the rare presentation of a relatively healthy middle age male with complaint of chest pain and shortness of breath, worsened with exertion and supine position. When standard cardiopulmonary workup was negative, further specialty testing was …

Miliary Tb Disease With Tb Meningitis, Jamie Skreen

Milwaukie Family Medicine 2020

Context/background: Miliary tuberculosis is a condition that is fatal if not diagnosed and can present in the outpatient setting with vague symptoms that resemble a viral illness, therefore, can be easily missed. Recognition of this disease as a differential is important in the primary care setting, especially when caring for immigrant and International patient populations.

Case Description: A previously healthy 35 yo female from Vietnam whom presented initially to the ER for headache and fever for the past 2 weeks. She was diagnosed with acute viral syndrome given her symptoms, normal labs, and head CT, and discharged home. A few …

Diabetes Education With A Teaching Kitchen Intervention Can Improve Hemoglobin A1c For Type 2 Diabetics Compared To Traditional Diabetes Education, Jill Christensen, Heidi Davis, Charlotte Navarre, Hsin-Fang Li, Kathy Schwab, Richard O'Neil, Justin Ferley

Milwaukie Family Medicine 2020

Authors
Jill Christensen MD MPH Providence Milwaukie Hospital
Heidi Davis MSW Providence Milwaukie Hospital
Charlotte Navarre RN Providence Milwaukie Hospital
Hsin-Fang Li PHD Providence Medical Data Research Center
Kathy Schwab MPH RDN Providence Health Education
Richard O’Neil MBA Providence Planning Analyst

Title Diabetes Education with a Teaching Kitchen Intervention Can Improve Hemoglobin A1c for Type 2 Diabetics Compared to Traditional Diabetes Education

Purpose The Providence Milwaukie Community Teaching Kitchen offers health-focused, budget friendly cooking classes for patients. In 2019, we piloted diabetes education classes with an added hands-on culinary session. This study compares the change in hemoglobin A1c for patients …

Sola Dosis Facit Venenum: Understanding Severity Of Tca Intoxication, Sean Brachvogel, Justin Osborn, Tanya Page

Milwaukie Family Medicine 2020

The Dose Makes the Poison, or does it? Judicious Management of TCA Intoxication.

Author(s): Sean Brachvogel, MD, MPH; Justin Osborn, MD; Tanya Page, MD

Context/background: Tricyclic antidepressants (TCAs) have been mostly supplanted by SSRIs in the treatment of depression, however they remain a mainstay of chronic pain management.¹ Untreated suicide attempts with a TCAs carry a 70% fatality rate, which drops dramatically to 3% with hospitalization.² As such, maintaining healthcare provider recognition and management of TCA toxicity is of lifesaving importance.

Objective: Here we describe a case report in which alcohol ingestion masked the severity of an accidental …

Necrotizing Fasciitis – Time Is Of The Essence, Jeffrey Sun, Edward Kim

Milwaukie Family Medicine 2020

Necrotizing fasciitis (NF) is a life threatening rapidly progressive soft tissue infection that carries a high mortality rate. There are approximately 500-1,500 cases per year in the United States with a mortality rate of up to 18-20%. Without surgical intervention, the mortality rate is near 100%. NF can be characterized by tissue involvement, polymicrobial or monomicrobial etiology, or site of infection. The most common risk factor includes diabetes (reported in up to 60% of cases), IV drug use history, malnutrition, and chronic alcohol abuse. In about 50% of group A streptococcus cases, there is an associated streptococcal toxic shock syndrome …

Increasing Vaccination Rates Of Children Up To 24 Months Old At Pmg Milwaukie Family Medicine, Justin Ferley, Rachel Jackson, Aubrey Miller, Sebastian Reeve, Christelle Serra-Van Brunt, Jamie Skreen, Jeffrey Sun, John Yates, Daniel Ruegg

Milwaukie Family Medicine 2020

Increasing Vaccination Rates of children up to 24 months old at PMG Milwaukie Family Medicine

Authors: Justin Ferley DO; Rachel Jackson MD; Aubrey Miller MD; Sebastian Reeve MD; Christelle Serra Van-Brunt DO; Jamie Skreen DO; Jeffrey Sun DO; John Yates MD; Daniel Ruegg MD

Introduction: Each year in the US, 42000 adults and 300 children die of vaccine preventable diseases. Yet across the country, clinics – including ours – fall short of the CDC Healthy People 2020 goals of pediatric vaccination rates. This resident-led quality improvement (QI) project aimed to improve our clinic vaccination rates in the under …

Acute Pancreatitis: Case Report And The Importance Of Early Prediction Of Severity, Christelle Serra-Van Brunt

Milwaukie Family Medicine 2020

INTRODUCTION: Acute Pancreatitis (AP) was the third most common GI diagnosis in 2012, resulting in approximately 275,000 admissions and costing about $2.6 billion. It remains a disease characterized by significant morbidity and mortality, and to this day, there is not a medication to treat it. Most care is supportive. Establishing the severity of the disease accurately is important in order to triage patients to the correct level of care to decrease rate of complications, mortality, and potentially shorten duration of stay.

CASE REVIEW: 30yo male with history of alcohol use/abuse, with prior episode of pancreatitis 5mo earlier, presented …

Project Nurture: An Educational Model For Substance Use Disorder Treatment During & After Pregnancy: Saving Lives, Saving Money, Saving Families, And Training Future Doctors, Roxanne Thomas, Brenda Brischetto, Josh Reagan, Daniel Ruegg

Milwaukie Family Medicine 2020

BACKGROUND: • 25% of women presenting for prenatal care are using substances. • Substance Use Disorders (SUDs) in pregnancy are associated with preterm birth, intrauterine growth restriction, placental abruption, increased risk of C-section. • Infants exposed to in utero illicit substances have higher likelihood of being small for gestational age, experiencing a neonatal opioid withdrawal syndrome that requires prolonged NICU hospitalization, and are at higher risk of developmental delay. • Societal costs of SUDs in pregnancy include worsening mental illness, increased utilization of the foster care system, early death secondary to overdose, and associated financial burdens. • The nature of …

Quality Improvement: Improving Depression Screening Rates At Pmg Southeast Family Medicine Clinic, Elizabeth Deyo, Edward Kim, Tyler Nelson, Roxanne Thomas, Jemie Walrod, Nicholas Wolfgang, Ben Pederson

Milwaukie Family Medicine 2020

Introduction: Major depressive disorder is one of the most common mental health problems encountered by primary care providers in the U.S. For people age 12 and older, prevalence is estimated at eight percent. The economic cost of depression has been estimated at $210.5 billion per year, attributed to both costs to the work place and medical costs. People who experience depression are at greater risk for suicide, an otherwise preventable death if depression can be recognized and adequately treated. For these reasons, depression screening has become an essential function within primary care practices both within Providence and nation-wide.

Sweets Syndrome: A Case Report, Michael Waddick, Elizabeth Deyo

Milwaukie Family Medicine 2020

Title: Add Sweet’s Syndrome to your dermatologic differential

Authors: Dr. Elizabeth Deyo, Dr. Mike Waddick

Context: Sweet’s Syndrome, an uncommon acute painful inflammatory rash, can be easily misdiagnosed. Early recognition and treatment can speed clinical recovery for patients with this difficult condition.

Objective: Here we describe an interesting case report of Sweet’s Syndrome in one of our patients in order to help providers remember this diagnosis on their dermatologic differential diagnosis.

Case report synopsis: Our 44 year old male HIV positive patient with type 2 diabetes mellitus presents with athralgias, chills, malaise and a plaque-like rash on the …

Harm Reduction In The Emergency Department, Alexa J. Golden

Family Medicine Clerkship Student Projects

The number of overdose deaths in Vermont has been trending up over the past several years. A majority of these fatalities involved synthetic opioid fentanyl. The Emergency Department (ED) at Central Vermont Medical Center delivers medication assisted treatment (MAT) through the Rapid Access to MAT (RAM) program. This program has connected many people in the region to treatment for opiate use disorder. However it was identified that we lacked connection to harm reduction services for those not interested in MAT. Harm reduction education was provided for recovery coaches and ED nursing staff. Harm reduction kits containing life-saving supplies such as …

Raising Awareness About The Vermont Donor Milk Center, Rosie Friedman, Emi Eakin

Family Medicine Clerkship Student Projects

The Vermont Donor Milk Center (VDMC) is an emerging community resource that provides donated, pasteurized breast milk to new parents for their infants. Upon questioning, we identified that many providers did not know about the VDMC or how to prescribe milk. In addition, VDMC expressed that they have not been able to complete the community outreach they had initially hoped for. We chose to dedicate our project to disseminating information about VDMC to perinatal care providers in Vermont.

Finding The Silver Linings Of The Cyberattack, Kathleen R. O'Hara, Leah Miller

Family Medicine Clerkship Student Projects

Our project aimed to identify the effects of the UVM Health Network cyberattack and subsequent month-long network downtime on the South Burlington Family Medicine providers and clinic staff. We interviewed staff members about positive adaptations made by the team during the downtime, and inquired whether they planned to keep maintaining any of these changes once the electronic systems returned.

Hhhn Clinicians' Beliefs, Barriers, And Motivations Surrounding Mat, Casandra Nowicki

Family Medicine Clerkship Student Projects

Medication-assisted treatment (MAT) consists of using medications that act on the same receptors as opioids to treat opioid use disorder (OUD). MAT providers require formal training and a DEA waiver in order to prescribe certain medications. Providers were asked to complete a survey about the beliefs, barriers, and motivations surrounding MAT to provide valuable insight into what the future of MAT might look like at a specific nonprofit network of community health centers in upstate New York.

Addressing Exercise Accessibility In Winter Conditions In Milton, Vermont, Liam Du Preez

Family Medicine Clerkship Student Projects

Exercise is a critical aspect of health maintenance, especially in the context of chronic medical problems such as diabetes, heart disease, and obesity. Weather and climate conditions in Vermont directly impact Vermonters' ability to exercise, and this results in negative impacts in their health maintenance and healthcare costs nationally and locally. This project explores the direct and indirect impact of decreased exercise and explore a modality for informing patients on how to stay active safely in the winter.