Medicine and Health Sciences Commons^™

Transgender Care, Nyasha George, Md, Pgy 3

Department of Family & Community Medicine Presentations and Grand Rounds

Outline:

Objectives

Review of trans epidemiology

Healthcare and the Transcommunity

Cases 1&2

• Taking a transgender history
• CSH indications

Case 3

• Mental Health and Transpersons

Case 4

• Cardiovascular Risks and Estrogen in Transwomen
• Provider Resources

Objectives

My goals for you at the end of this lecture:

Comfort in determining which transgender patients meet criteria for initiating CSH

Appreciation of the overlap between transgender identity and psychiatric disease as mediated primarily by trauma

Improved self efficacy in weighing risks/benefits of CSH therapy

Familiarity with resources available to help support primary care providers take care of transgender patients.

Presentation: 58:36

Promoting Family Resilience As A Population Health Strategy, Barry J. Jacobs, Psy.D.

Department of Family & Community Medicine Presentations and Grand Rounds

Today's Talk:

• Why family matters to population health
• Research from two movements
• Steps toward patient and family resilience
• Barriers to integrating family caregivers into healthcare
• Healthcare-based family caregiver support programs: Baylor Scott & White, Concord Hospital

No audio, just PowerPoint slides

Download Entire Issue: Collaborative Healthcare: Interprofessional Practice, Education And Evaluation (Jcipe), Volume 7, Number 2, 2016

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Articles in this issue include:

Interprofessional Peer Teaching: Physical Therapy Students Teaching Dental Students to Transfer Patients

The Development of the Interprofessional Leadership Institute for Mental Health Equity

Teaching Interprofessional Practice Skills by “Saving Humanity”: An Innovative IPE Curricular Method Using a Cooperative Strategy Board Game

Reflections from the Bedsides of Dying Patients

Reflections From The Bedsides Of Dying Patients, Hannah Decleene, Patrick Kukulich

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

I walked into a room with its lights glaring and television blaring, a room where a man I had never met before would take his final breath two hours later. The attending nurse kindly dimmed the lights and turned off the television. I sat down next to him. I felt panic. I felt sadness, and I felt peace. This individual would have passed without me knowing, yet I was there with him; he wouldn’t be alone.

The No One Dies Alone (NODA) chapter at Jefferson launched in May, 2016. It launched as a vision in which students of Thomas Jefferson …

Teaching Interprofessional Practice Skills By "Saving Humanity": An Innovative Ipe Curricular Method Using A Cooperative Strategy Board Game, Emily Mccave, Phd, Msw, Lmsw

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Statement of Issue

Increasingly, team-based interprofessional (IP) collaboration is the central model of practice for health disciplines (Khalili, Orchard, Laschinger, & Farah, 2013). Yet traditional education models can foster a uniprofessional identity that leads to “turf protection” and subsequent resistance to IP collaboration (Bronstein, 2003, p. 448). Interprofessional education (IPE) models, however, are designed to promote team competency and an IP identity (Lindgard, 2013). IPE activities often focus on building student competency in four core areas: efficient and effective teamwork, effective communication, understanding of professional roles, and shared values (Interprofessional Education Collaborative (IPEC), 2016). Innovative IPE activities provide students with …

The Development Of The Interprofessional Leadership Institute For Mental Health Equity, Cheryl L. Woods-Giscombe, Phd, Rn, Pmhnp

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Abstract

The Interprofessional Leadership Institute for Mental Health Equity is being developed at the University of North Carolina at Chapel Hill to reduce mental health disparities by (1) engaging students in interprofessional service learning and research activities, (2) promoting integration of community-based strategies and social determinants of mental health conditions among underserved and vulnerable groups as required curricular components, (3) enhancing workforce diversity (in partnership with Racial/Ethnic Minority-Serving Colleges/Universities) by supporting students to obtain professional careers in mental health care, mental health policy, and mental health leadership, and (4) supporting current mental health providers, educators, and researchers who are working …

Interprofessional Peer Teaching: Physical Therapy Students Teaching Dental Students To Transfer Patients, Kim Dunleavy, Pt, Phd, Ocs, Venita Sposetti, Dmd

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Background While the need for interprofessional education (IPE) has been clearly elucidated, (Interprofessional Education Collaborative, 2016), one of the major barriers is the logistical challenge of meeting curricular requirements for all involved. The organization and time required in an already full schedule are often deterrents. Ideal opportunities meet specific program curricular requirements as well as enhancing interprofessional competencies. Interprofessional competencies include developing skills to teach other health care providers about profession-specific skills and enhancing communication across the professions (Bridges, 2011; Interprofessional Education Collaborative, 2016). Active learning techniques have been advocated for adult learners to promote motivation and engagement (Knowles, 1984), …

From The Editors, Christine A. Arenson, Md, Lauren Collins Md, Shoshana Sicks, Med

Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)

Here at JCIPE, another semester has flown by. And again, the Center has been busy expanding and integrating our programs on campus and beyond. This fall, as we welcomed our tenth cohort into the Jefferson Health Mentors Program, we introduced a revised curriculum which is more heavily focused on the social determinants of health and integrates the Social Ecological Model. We also added an eighth profession, Medical Laboratory Sciences, to the mix, expanding our total student enrollment to more than 1400 students! Building on this foundation, this fall we also expanded our more advanced interprofessional TeamSTEPPS® training program. During the …

Jdc Quarterly Report (October-December 2016) Now Available, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

The Jefferson Digital Commons quarterly report for October-December 2016 is now available. View the report to see what assets were added this quarter and to review annual trends and statistics. As 2016 concluded the JDC reached a new milestone by passing the 3 million download mark along with the deposit of more than 12,000 assets to date.

Jefferson Digital Commons Quarterly Report: October-December 2016, Daniel G. Kipnis, Msi, Kelsey Duinkerken, Msi, James Copeland, Libt

Jefferson Digital Commons Reports

This quarterly report includes:

• New departments joining the JDC
• Statistics for 2016
• Assorted assets added to the JDC in the last quarter
• What people are saying about the JDC

A Word From The Writing Center (January 2017), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

This issue includes:

• Writing tip
• Selecting the right journal
• Writing Café

Community Nursing: Health Care Behind Closed Doors, Mary Bouchaud, Phd, Rn, Mary Mangiaracina, Msn, Rn, 2009 Nln

College of Nursing Posters

Focus of nursing education in the 21st century is to teach students how to work with individuals & families within a community setting & to develop skills in providing nursing care that stresses community as the client.

The expectation of the APHA is that BSN students will be educationally prepared to work with & improve the health of individuals, families, & diverse populations within the community.

3 Million Downloads For The Jefferson Digital Commons, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

On December 14, 2016 the Jefferson Digital Commons reached a new milestone by passing the 3 million download mark along with the deposit of more than 12,000 assets to date.

Delay Discounting Of Pregnancy- And Condom-Protected Sex Among Methadone-Maintained Women, Dennis J. Hand, Phd, Lindsay Reid, Diane J. Abatemarco, Msw, Phd

Department of Obstetrics and Gynecology Presentations and Grand Rounds

Introduction

• Over 80% of pregnancies are unintended among women with opioid use disorder (OUD; Heil et al., 2011).
• Use of effective contraception is uncommon in this population (Terplan et al., 2015).
• Initiating and using effective contraception involves delays: to obtain the method from a provider, to become protected after initiating use.
• Interventions that include delay reductions among other elements have increased contraceptive use (Heil et al., 2016; Secura et al., 2014).
• Women with OUD have reported greater likelihood of engaging in unprotected sex at shorter delays to acquiring protection from sexually-transmitted infection (STI) than women without OUD (Herrmann et al., …

Calcium Uptake Hotspots In The Mitochondria Of Cardiac Muscle At The Interface With Dyadic Sr, Sergio De La Fuente, Celia Fernandez-Sanz, Caitlin Vail, Elorm J. Agra, Kira Holmstrom, Junhui Sun, Jyotsna Mishra, Toren Finkel, Elizabeth Murphy, Suresh K. Joseph, Shey-Shing Sheu, György Csordás

Department of Pathology, Anatomy, and Cell Biology Posters

Introduction

• Control of the mitochondrial ATP production by SR-derived Ca2+ signals includes local, nanodomain Ca2+ transfer from ryanodine receptors (RyR2) to the mitochondrial matrix (excitation-bioenergetics coupling).

• Ca2+ crosses the inner mitochondrial membrane (IMM) via the mtCU, a low-affinity Ca2+-activated Ca2+ channel complex.

• The surface area of cardiac IMM is extensively enhanced by cristae folding; however, mitoplast patch clamp studies showed mtCU current density the lowest amongst a range of tissues (Fieni 2012. Nat Commun).

A Word From The Writing Center (December 2016), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

This issue includes:

• Writing tip
• Books on writing
• Writing Café

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

CwiC Posters

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 …

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

CwiC Posters

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.

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

CwiC Posters

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 …

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

CwiC Posters

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 …

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

CwiC Posters

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 …

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

CwiC Posters

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.

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

CwiC Posters

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 …

Sexual And Reproductive Health In Rwanda, Emily Zhang

CwiC Posters

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

CwiC Posters

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 …

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

CwiC Posters

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

CwiC Posters

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 …

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

CwiC Posters

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.

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

CwiC Posters

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

CwiC Posters

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 …