Medicine and Health Sciences Commons^™

Reaching High-Risk Patient Populations Through Emergency Department Opt-Out Hiv Testing: A Retrospective Chart Review, Tyler G. Boyce, Ba, Priya Mammen, Md, Mph

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Specific Aims and Hypotheses:

This study aimed to identify socioeconomic (SE), sexual, and other risk factors (RFs), among patients diagnosed with HIV infection through an emergency department-based opt-out HIV screening program, and to examine trends in intravenous drug use (IVDU) as a RF.

• H1: Unsafe sexual practices are the most commonly reported RF.
• H2: Role of IVDU as a RF has increased over the time period studied.

Poster presented at 2017 APHA conference in Atlanta Georgia.

A Pilot Study For Enhancing Postpartum Discharge Instructions For Incision Care: Assessment Of Comprehension, Rebekah Jo Mccurdy, Md, Rebecca Lawrence, Bs, Sarah Cohen, Bs, Jason K. Baxter, Md, Mscp

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Literacy and Health Care

• 14.5% of United States is illiterate 1

• Reading level of most medical forms is 10th grade 2

Improving Outcomes with a Visual Aid

• Cesarean Surgical Site Infection (SSI) rate is 5% 3

• A patient with a SSI can be 2 times as expensive 4

• Visual aids improve information recall 8 and confidence in wound care 5

Study Objectives

1. To evaluate the readability of the cesarean wound care discharge instructions relative to the patient population’s reading level

2. To conduct a pilot Randomized Control Trial (RCT) to evaluate the effectiveness of …

Assessing Variability In End-Of-Life Intensity Of Care After Out-Of-Hospital Cardiac Arrest, Polina Ferd, Md Candidate, David Karp, Musa, Alexis Zebrowski, Phd Candidate, Brendan G. Carr, Md, Ma, Ms

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Out of hospital cardiac arrest (OHCA) affects over 300,000 Americans per year.1 Many factors affect the outcomes and overall OHCA survival in a community; some of these include an individual’s characteristics such as age, co-morbid conditions, availability of an AED on scene, time to CPR, and the characteristics of the hospital they are treated at.1,2 Directly following resuscitation from cardiac arrest, the individual is at risk of developing numerous problems caused by sequelae of ischemic injury sustained during the arrest. The national average rate of survival to discharge is only 10%.2,3 Many of these factors are modifiable and provide an …

Examining The Role Of Diagnosis In The Emergency Department Experience, Danielle Kovalsky, Bs, Angela Gerolamo, Phd, Aprn, Bcps, Amanda Doty, Ms, Alexzandra Gentsch, Lsw, Annemarie Jutel, Rn, Bphed (Hons), Phd, Kristin L. Rising, Md, Ms

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Study Objective:

To explore the social, functional, and emotional needs that patients want addressed when seeking a diagnosis at their ED visit.

Baseline Assessment Of Providers' Perspectives On Integrating Community Health Workers Into Primary Care Teams To Improve Diabetes Prevention, Ariel Brown, Garseng Wong, Radhika Gore, Mark Schwartz, Md

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• Type 2 Diabetes Mellitus (T2DM) affects 11% of U.S. adults

• Additional 35% considered pre-diabetic, at-risk for developing T2DM1

• Bellevue Hospital and the VA NY Harbor Hospital disproportionately affected: 2x the prevalence in the general population, and increasing2

• Only 55% of adults receive recommended preventive services3

• Panel management: each care team is responsible for preventive care, disease management, and acute care of a patient panel

• Community health worker (CHW): non-clinical frontline public health professional trained in behavioral counseling, care follow-up, program referrals, and health education4-8

• Come from the community that they serve, so they …

Depression, Cognition, & Social Determinants Of Health: Assessing Associations In Older African Americans With Diabetes, Jeremiah Davis, Robin Casten, Phd, Barry W. Rovner, Md

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Social determinants of health have been widely identified as characteristics of one’s social and economic climate that affect one’s health outcomes1. (see Graphic 1)

The Alzheimer’s Association indicates that rates of Alzheimer’s disease (AD) and other forms of dementia are two times higher in older African Americans than their white counterparts2. People who have diabetes are also at an increased risk.

The prevalence and co-morbidity of depression among older Americans with diabetes (both with and without cognitive impairment) has been well established3.

Understanding the effect that social determinants of health have on the onset and progression of dementia and depression …

Leading Causes Of Death In Vietnam, Lindsey Roth

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Vietnam is currently facing a public health crisis. Rates of chronic and preventable diseases are climbing, in addition to mortality rates from these diseases. If nothing is done to halt these rising rates, the health of the Vietnamese people will only continue to decline. Although there may be many factors contributing to these high death rates due to chronic diseases, risky health behaviors, such as smoking, and the state of the healthcare system can be considered two main contributors to the leading causes of death in Vietnam. The high smoking rates and high costs of healthcare are hindering the health …

Initiating C.H.E.W. At Maternity Care Coalition, Haley Wicklum, Rickie Brawer, Mph, Phd

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The purpose of this project is to provide access to healthy and affordable foods to the families involved in Maternity Care Coalition’s Early Head Start program as means to reduce obesity in the 0-3 year old children. Implementing the C.H.E.W. (Cultivating Healthy Eating and Wellness) program, which includes a new food buying club where families can access healthy food at whole sale prices as well as nutrition education workshops throughout the year, will provide access to the healthy and affordable foods needed. The program is focused on pregnant women and young families with children 0-3 years of age to attempt …

Jeffhealth: Helping East Africa Link To Health, Elizabeth Kuhn, Emily Zhang, Naveed A. Rahman, Rebecca Margolis, Savannah Coe

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JeffHEALTH-Helping East Africa Link to Health is a student-run organization at Thomas Jefferson University dedicated to improving basic medical education and quality of life in Rwanda, which was devastated in 1994 by civil war and genocide. Working in partnership with the Rwanda Village Concept Project, a student organization at the National University of Rwanda, JeffHEALTH seeks to implement sustainable health initiatives in our partner villages. Graduate students from Thomas Jefferson University travel to Rwanda where we taught Community Health Workers from the Villages of Akarambi and Ruli the following topics: Nutrition and Vitamin Deficiencies, Family Planning, Prenatal care, HIV, Sexually …

Exploring The Feasibility Of Incorporating Sexual Education Into Routine Adolescent Office Visits, Holly A. Rankin, Alisa Losasso, Md, Beth I. Schwartz, Md

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Preventative sexual education can reduce the negative health outcomes of sexual behavior in adolescent populations.1 The objective of this pilot study was to determine if sexual education can be delivered as a scripted five-minute module during a routine adolescent office visit in a manner that is non-disruptive of clinic flow and acceptable to both patients and providers.

• 85% of providers reported the intervention did not interrupt clinic flow

• 86% of patients reported the intervention to be appropriate and 92% of providers were satisfied overall with the intervention

These pilot data highlight that the incorporation of brief scripted sexual …

Addressing Childhood Obesity In Early Head Start Population In Philadelphia Through Early Intervention And Food Buying Clubs, Nishant Pandya, Rickie Brawer, Mph, Phd, Sarah Roescher

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Aims:

To implement a food buying club model to increase access to fresh and healthy foods for families whose children (ages 2-5) participate in Early Head Start and the Maternity Care Coalition.

Compare four potential food distributors: Philadelphia SHARE, Asociacion Puertorriquenos in Marcha (APM), The Common Market, and JETRO to find the organization that can best implement a feasible food buying club run through Early Head Start to fit the families needs.

Sexual And Reproductive Health In Rwanda, Emily Zhang

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KEY MESSAGES

• Empowerment (women, youth, communities)
• Inclusion (age + gender)
• Prevention/Early Detection

PROGRAM RECOMMENDATIONS

• Partner with Rwandan medical students to improve program delivery
• Communicate monthly with local leaders
• Partner with Community Health Center

FUTURE INTERVENTIONS

• Partner with Rwandan medical students to improve program delivery
• Communicate monthly with local leaders
• Partner with Community Health Center

An Evaluation Of Risk Attitudes And Risk Tolerance In Emergency Medicine Residents, Nishad A. Rahman, Dimitrios Papanagnou, Md

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An underlying issue to our current healthcare system is how decisions made in the emergency department affect patients. This is paramount for underserved populations, which are more likely to have poor physical and mental health, lack of primary care, greater use of health services, and be generally dissatisfied with their medical care.1,2 What should the emergency physician (EP) do for these patients?

These decisions are largely based upon individual risk tolerance. While risk is a indelible part of emergency medicine (EM), a risk profile of EM residents has not been compiled. Knowledge of risk taking tendencies among this niche of …

Decentralization And Health: Case Studies Of Kenya, Pakistan, And The Philippines, Christina E. Lewis, David Clarke, Jd, Maryam Bigdeli, Phd

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Decentralization, defined by the World Bank (2001) as, “the transfer of authority and responsibility for public functions from the central government to intermediate and local governments or quasi-­‐independent government organizations and/or the private sector,” is a movement that has gained much traction in recent history. For many countries undergoing decentralization, a major driver has been a desire to increase the role and participation of local governments in the decision-­‐making space. In doing this, it is hoped to create governance structures that are more accountable and responsive to the people. For health, decentralization has been touted as a potential way to …

Public Health Considerations And The Culture Of Alcohol In Vietnam, Daniel Baquet

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The problem of alcohol in Vietnam is interesting when considering the culture surrounding alcohol throughout the country, particularly amongst men. In 2010, Vietnamese men drank 12.1 liters of pure alcohol per capita, while women drank only 0.2 liters (WHO, 2014). The WHO Global Status Report on Alcohol and Health stated, “Vietnam’s national drinking patterns … are among the most fatal with the highest possible score for alcohol-attributable years of life lost,” a metric which includes liver cirrhosis, road traffic crashes, and the prevalence of alcohol use disorders and alcohol dependence (WHO, 2014). In addition, domestic alcohol production in Vietnam has …

Water Crisis In Vietnam, Jordan M. Zaid

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• Immediately after the Vietnam War ended in 1975, Vietnam experienced economic turmoil and famine as the roots of industrialization began to grip the nation.

• In 1986, the government declared a rapid transition from a planned to a market economy would take hold. The ensuing change caused further increased industrial development and a subsequent growth of the emerging market economy. 1

• To this day, Vietnam’s GDP is rising yearly at a rapid rate.

• For this reason, much of Vietnam has been developed in a relatively short amount of time (since the end of the war) but much …

Does Age Influence Knowledge And Attitudes About Intrauterine Devices?, Sara Edwards, Lisa Perriera, Md, Mph, Rebecca J. Mercier Md Mph

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Primary objectives:

• Are there differences in attitudes and beliefs about IUDs based on age?
• We hypothesized that older women may be more familiar with the negative outcomes of earlier models of the IUD and therefore may hold more negative attitudes toward IUDs.

An Interactive Curricula Experience (Ice) For Latino Immigrant Health, Kevin Molyneux, Ellen Plumb, Md, Martha Langley Ankeny, Med

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The Interactive Curricula Experience (iCE) is an educational platform intended for interactive education utilizing multiple forms of media. It is being utilized at Thomas Jefferson University (TJU) in various classes, among them Global Health.

One of the pertinent global-health-at-home topics at TJU relates to Latino immigrant health. Latino immigrants number more than 20,000 in Philadelphia. They are located throughout the city, although the highest concentrations are in North and South Philadelphia. With respect to health care, Latino immigrants are less likely to have a regular health care provider than non-immigrant Latinos.

Education to provide culturally sensitive care to Latino immigrants …

Stephen Klein Wellness Center Patient Satisfaction Survey: Development And Preliminary Results, Emily Knudsen-Strong, Msc, Joseph Flaxer, Rickie Brawer, Mph, Phd, Mudit Gilotra, Md, James Plumb, Md, Mph

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Study design:

•Selected the CAHPS® with Patient Centered Medical Home question set to administer to patients receiving medical care at SKWC (52 questions)

•Included 2 supplemental questions to assess patients’ likelihood to refer others to SKWC

•Developed an additional survey for patients receiving behavioral health services (16 questions)

Participant recruitment and data collection:

•Calculated a target number of 130 participants based on CAHPS® guidelines of 50 surveys per Full Time Employee

•Observed patient flow and developed recruitment strategy for a convenience sample

•Eligibility criteria: patient ≥18 y/o and had a medical appointment in the last 12 months

•Participants were invited …

Hepatitis C Screening In The Homeless Population Of Philadelphia, Adam Zimilover

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Hepatitis C is a viral infectious disease that is a major cause of liver disease around the world. By the 1970s, it was recognized that many hepatitis cases were not due to the known hepatitis A or hepatitis B viruses. It was not until 1989 when the virus, then known as non--‐A, non--‐B hepatitis, was identified as a new distinct virus, hepatitis C. The virus has seven major genotypes, with genotype 1 causing about 75% of cases in the United States. By 1990, a screening test for the virus was developed, and within a year, the first treatment for the …

The Public Health Crisis In Greece And Its Ties To A Failing Economy, Anna M. Carleen

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In 2009 the Greek government admitted that the numbers it had been reporting to the European Union about its national budget deficit were artificially small. The deficit was actually huge, way larger than what the EU requires of member countries if they want to reap the benefits of being in this financial network. A benefit of being in the EU is that it makes it much easier for governments to take out large loans, because lenders trust that a member country will make good on its debts due to the security it has from being part of the union. This …

Barriers To Care Amongst Rural Indigenous Mayans In Guatemala’S Western Highlands, Nirali Butala

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Information presented here is based on 5-week volunteering experience at Primeros Pasos clinic in the rural Palajunoj Valley outside the city of Quetzaltenango, Guatemala. Almost all of the patient population is rural, indigenous Quiche Maya. Guatemala has a relatively high GDP and patient-doctor ratio (1000:1) compared to its neighboring Latin American countries, but these resources are extremely localized to its capital, Guatemala City, where 70% of the country’s physicians work.

Only the wealthy are able to utilize private clinics and hospitals that are known to provide the highest quality care. At these clinics, patients pay out-of-pocket. Indigenous, rural communities typically …

Quality Of Care Assessment At A Resident-Based Primary Care Hiv Clinic, Amanda Lacue, Marshall Miller, Md

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A quality improvement study based in a primary care resident-based HIV clinic, the Kendig Clinic, was conducted within Jefferson Family Medicine Associates. The study objectives were to

• Determine the percentage of the clinic patients meeting each quality measure

• Compare these calculated clinic measures to known national averages

• Use the data to determine areas to target for future quality improvement initiatives.

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 …

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 …

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 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.

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

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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 …

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.

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

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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 …