Medical Specialties Commons^™

Implementation Of Adverse Childhood Experiences Screening Tool For Providers In Primary Care Pediatrics, Morgan P. Via

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Adverse childhood experiences (ACEs) are recognized by the American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) as contributing factors to poor health outcomes in childhood and beyond. Many pediatric providers are aware of the importance of ACEs, yet most do not participate in routine screening. The goal of this project was to implement ACEs screening at a semi-rural pediatric primary care office, aiming to screen 50% of eligible patients over 6 weeks. A secondary goal included increasing provider knowledge of and comfort with discussing ACEs through participation in an online training module.

Methods: Families …

Disruption Of Mitochondrial Trafficking In Lung Epithelial Cells Potentiates Allergic Asthma Phenotypes, Amelia M. Lamberty

Graduate College Dissertations and Theses

Allergic asthma is a serious socioeconomic and health issue that is characterized by chronic inflammation of the lungs and affects as many 300 million people worldwide of all ages. Inhaled environmental factors, such as allergens, can disrupt the airway epithelium, which is the physical barrier and the first line of defense against external irritants. Consequently, exposure to allergens can cause episodes of airway inflammation, increased mucus production and tissue remodeling, that leads to the obstruction and narrowing of the airways, which may present as difficulty breathing, wheezing, and persistent coughing. Unfortunately, there is no cure for allergic asthma, but allergen …

Association Of Urine Findings With Metabolic Syndrome Traits In A Population Of Patients With Nephrolithiasis, Virginia L. Hood, Kevan M. Sternberg, Desiree De Waal, John R. Asplin, Carley Mulligan, Peter W. Callas

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

1. Background The odds of nephrolithiasis increase with more metabolic syndrome (MetS) traits. We evaluated associations of metabolic and dietary factors from urine studies and stone composition with MetS traits in a large cohort of stone-forming patients.

   Methods Patients .18 years old who were evaluated for stones with 24-hour urine collections between July 2009 and December 2018 had their records reviewed retrospectively. Patient factors, laboratory values, and diagnoses were identified within 6 months of urine collection and stone composition within 1 year. Four groups with none, one, two, and three or four MetS traits (hypertension, obesity, dyslipidemia, and diabetes) were evaluated. …

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Medical Repatriation In Vermont: The Current Landscape And Recommendations, Olivia Dominque, Kelly Knight, Aathmika Krishnan, Kassondra Little, Clara Maxim, Sofia Toro Alvarez, Patti Smith Urie, Mark Pasanen Md, Charles Maclean Md

UVM AHEC

Background: Medical repatriation is the practice of returning patients to their country of origin when they have major medical problems_. Forced repatriation, or “medical deportation”, disproportionately affects undocumented individuals. This project aimed to assess the prevalence of medical repatriation in Vermont, identity factors that lead to it, and recommendations to prevent it.

Methods: Interviews were conducted with ten stakeholders including physicians, lawmakers, and advocates for undocumented patients. Team members then analyzed interview transcripts for major themes.

Results: This study did not uncover any occurrences of forced repatriation. Qualitative themes included: lack of awareness about medical repatriation, inability to track …

Perceptions Of Teleophthalmology, Kisha Kalra

Family Medicine Clerkship Student Projects

One of the greatest burdens facing patients with eye-related pathologies is access to ophthalmologists in the area. Teleophthalmology is a way for eye examinations to be conducted in the easily-accessible primary care setting, with images sent to ophthalmologists for interpretation. This project addresses the perceptions of this model amongst patients and primary care physicians.

The File Of Life: A Lifeline For First Responders In Fairfield County, Ct, Brittany Gilmore

Family Medicine Clerkship Student Projects

During a medical emergency, it can be difficult for first responders to obtain crucial medical information about their patients for a variety of reasons. The patient may be unconscious, have an altered mental status, or simply not know their medical history. This project aimed to increase awareness of the File of Life program, which many local Fire and EMS departments are implementing to improve their ability to deliver life-saving care.

Listen To Her Heart: Bridging The Gap In Recognizing, Preventing, & Treating Ascvd In Women, Stephen J. Foley

Family Medicine Clerkship Student Projects

Atherosclerotic cardiovascular disease (ASCVD) is traditionally considered a male disease, yet it is the leading cause of death in women. This may be associated with the significant lack of research of ASCVD in women, leading to poor recognition, diagnosis, prevention, and treatment. The American Heart Association reports that a majority of women experience prodromal symptoms more than one month before a heart attack or stroke, and these symptoms are often underestimated. This project intends to help address the question: How can earlier detection of ASCVD risk in women reduce missed signs of acute myocardial infarction/stroke and thereby reduce preventable ASCVD …

Optimizing Secure Patient Messaging Workflow In A Vermont Primary Care Clinic, Kimberly S. Oleary

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Optimizing Secure Patient Messaging Workflow in a Vermont Primary Care Clinic

Kim O’Leary, DNPc, RN

DNP Advisor: Margaret Aitken, DNP, AGNP, ANP-BC

Site Mentor: James Williamson, MHA, Site Supervisor, Adult Primary Care

Background: Secure patient messaging is a popular tool designed for non-urgent questions, yet patients sometimes use it to relay urgent concerns. As office workflows tend to prioritize responses to other methods of communication, this presents a potentially unsafe situation in which clinical staff may not respond to these urgent messages in a timely manner.

Purpose: To develop a methodology to improve the timeliness, effectiveness, and safety of secure …

Developing A Telehealth Protocol For Cognitive Testing, Victoria M. Greenough Dnpc, Rn

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

BACKGROUND:

When the Coronavirus pandemic reached the United States in March 2020, many healthcare services moved to telehealth delivery. For patients with cognitive impairment, the Mini Mental Status Examination (MMSE) moved from traditional face-to-face assessment to telehealth testing in one Vermont specialty clinic. The aim of this DNP project was to provide quality assurance of this method prior to implementation of the MMSE Version 2 that would follow a similar telehealth protocol.

METHODS:

To assess MMSE quality administered via telehealth, a retrospective chart review of patients (n=30) seen between April 2020 and September 2021 was completed. Linear regression calculated the …

Accurate At-Home Blood Pressure Readings, Shivani Mathur, Shivani Mathur

Family Medicine Clerkship Student Projects

Blood pressure follow-ups are some of the most common reasons for clinic visits. Patients are told to monitor their blood pressures at home and medication dosages are adjusted in clinic to reflect their blood pressure readings at home. However, many patients are not aware of proper blood pressure measurement techniques, which could lead to inaccurate readings and therefore, inaccurate treatment. This project will provide a simple infographic to increase compliance with accurate blood pressure measurements.

Mapping Pediatric Vaccination Schedule, Mialovena C. Exume

Family Medicine Clerkship Student Projects

Taking care of a child can be daunting and parents/guardians/families often report not being sure of what vaccinations their child might need and when. This project aims to provide a map of the pediatric vaccination schedule from birth to 18 months. This project also provides a booklet to help families track vaccination in the hopes of increasing vaccination adherence and providing education on routine recommended childhood vaccines.

Stratifying Back Pain In Primary Care With The Start Screening Tool, Patrick Mcclurg

Family Medicine Clerkship Student Projects

No abstract provided.

Improving Mental Health Access In A Rural Setting Via Telehealth, Timothy W. Greenfield

Family Medicine Clerkship Student Projects

There are several barriers patients face when accessing mental healthcare in rural areas including: lack of internet, lack of resources, and stigma.

Local options are limited, and patients face barriers such as access to transportation.

These factors position telehealth as a unique, tangible solution for patients in the community.

Increasing Advance Directive Participation In Primary Care, Rhys Niedecker

Family Medicine Clerkship Student Projects

Advance directives are a critical part of patient management and care, yet the majority of adults have not completed the documentation. Using fliers in exam rooms and encouraging provider engagement can help increase the proportion of patients who complete advance care documents in Family Medicine settings.

Improving Patient Education Surrounding Imaging Modalities, Tayler Drake

Family Medicine Clerkship Student Projects

Musculoskeletal complaints are among the most common problems seen in family medicine clinics. Patients may expect that every musculoskeletal complaint requires imaging, however, they may leave the clinic without a referral to radiology. This discrepancy between reality and expectation may strain the patient-provider relationship. The goal of this project is to educate patients regarding imaging modalities and when it is appropriate for imaging to be ordered in the workup of a musculoskeletal complaint.

Benign Vs. Malignant: Improving Prevention And Detection Of Cancerous Vs. Non-Cancerous Skin Lesions Through Inclusive Patient Education, Simran Kalsi, Sam Afshari

Family Medicine Clerkship Student Projects

Vermont consistently has one of the highest annual rates of melanoma in the United States. This is likely due to a range of factors including population demographics (predominantly white, aging population), active outdoor lifestyles, intense seasonal bursts of sun exposure, and inadequate Winter sun protection. The COVID-19 pandemic and its associated shutdowns have caused significant delays in healthcare delivery, further exacerbating the incidence and severity of melanoma. Primary care providers are therefore an increasingly essential first line of defense in detecting suspicious skin lesions and expediting treatment of skin cancer, but patients should be aware of when to seek evaluation. …

Supporting Patient Education During Infant Formula Shortage: Washington County, Vt, Rachel A. Wayne

Family Medicine Clerkship Student Projects

The infant formula shortage is a current national public health concern. Many guardians of formula-fed infants are struggling to find appropriate nutrition for their babies. Families of low socioeconomic status are being disproportionately affected because many of them rely on the Women, Infants, and Children program (WIC) to obtain formula, and their formula options through this program are limited. This project aims to provide Vermont families who have formula-fed infants with education and resources to navigate the formula shortage and keep their children healthy and fed.

Keep An Eye On Your Ocular Health: The Importance Of Routine Eye Exams, Kiana Heredia

Family Medicine Clerkship Student Projects

When it comes to scheduling preventive health screening exams, eye exams are often overlooked. Individuals may not understand the importance of their ocular health, and many assume a basic vision screening is comprehensive. However, that is not the case and eye diseases are common and can go undetected for a long period of time before symptoms appear. Seeing a licensed optometrist or ophthalmologist for comprehensive eye exams is important for detecting eye disease in the early stages when treatment is available to prevent vision loss is most effective.

A Mobile App To Improve Patient Education In The Management Of Chronic Lbp, Cole Lutz

Family Medicine Clerkship Student Projects

The purpose of this project is to educate patients about the treatment of CLBP through an interactive mobile app, with the goal of improving transparency regarding the risks and benefits of various interventions. Most patients with CLBP lack the time and knowledge to perform a thorough literature review to determine the rates of efficacy and complications associated with their treatment. A mobile app that summarizes this data and translates it in a way that patients can understand would facilitate clearer communication and expectations between patients and providers. With improved patient education, patients would presumably be more likely to participate in …

Signs, Symptoms, And Clinical Approach To Monkeypox, Sean Wang

Family Medicine Clerkship Student Projects

No abstract provided.

Increasing Awareness Of Pharmacologic Interventions For Smoking Cessation, Jeremy Frank

Family Medicine Clerkship Student Projects

Smoking is a large cause of morbidity and mortality in the healthcare system. Many patients are interested in quitting smoking but have not found an effective strategy that works for them. There have been times when patients have been receptive to a discussion regarding medication assisted cessation but ultimately were not prescribed any medications from their provider. Despite the fact that it has been proven that pharmacotherapy increases the chances of smoking cessation. The goal of this community health project is to create a change within the healthcare system by providing evidenced based recommendations regarding pharmacologic treatment in smoking cessation …

Return To Play Following Covid-19, Tyler Landman

Family Medicine Clerkship Student Projects

Covid-19 infections among adolescents have led to significant decreases in physical activity and fitness. Many adolescents have been subject to return to play clearance before being able to get back to their sport. Protocols are not only a moving target but are also different from school to school, and county to county. Many patients are not involved in the decision making process of when they get to play again, and furthermore end up being out of sport longer than they need to due to the ordering of unnecessary tests, and long wait times for them. The aim of this study …

Primary Care Management Of Alcohol Withdrawal, Julie Connor

Family Medicine Clerkship Student Projects

Alcohol use disorder (AUD) is prevalent yet undertreated in rural Vermont. Approximately half of those with AUD who stop drinking experience alcohol withdrawal. Alcohol withdrawal can range from uncomfortable to life threatening symptoms. Untreated alcohol withdrawal can also lead to recurrence of alcohol use. The mainstay for management of alcohol withdrawal has been inpatient or intensive outpatient programs. However, there are barriers to accessing these programs including availability of beds, patient reluctance, lack of transportation, not knowing about these programs, and cost. Primary care management of alcohol withdrawal is safe, accessible and has the potential to reduce symptoms of alcohol …

Pelvic Floor Exercises & Pelvic Physical Therapy Directory For Pregnant & Postpartum Individuals, Matthew Breseman

Family Medicine Clerkship Student Projects

No abstract provided.

Differentiating Annual Wellness Visits And Health Maintenance Visits, Benjamin N. Price

Family Medicine Clerkship Student Projects

Due to recent changes in workflow at the office, many visits that should be Medicare Annual Wellness Visits are incorrectly scheduled as health maintenance visits (yearly physical). These mistakes are not always identified leading to confusion for both patients and providers and unnecessary bills for the patient

Improving Housing-Insecurity Screening In A Rural Primary Care Setting, Heather G. Giguere

Family Medicine Clerkship Student Projects

Housing-insecurity and homelessness have a direct impact on individual health, and are well established causes of premature morbidity and mortality (6). Screening for housing-insecurity leads to earlier identification, and more extensive engagement of services, which can help to mitigate the individual and public health ramifications of these social determinants of health (8). The aim of this project was to improve the screening process for housing-insecurity within an rural primary care setting.

Cervical Cancer Screening In The Lgbtq+ Community: Dispelling Common Misconceptions And Improving Patient Comfort, Rebecca B. Rawlings

Family Medicine Clerkship Student Projects

LGBTQ+ patients are more likely to forgo cervical cancer screening due to common misconceptions/misguidance about who needs screening and increased likelihood to experience emotional and/or physical discomfort during screening visits. This project aims to educate LGBTQ+ patients on cervical cancer screening recommendations and provide them with tools to improve their experiences during screening visits.

911 Or Primary Care - Who Should I Call?, Jack F. Mangn

Family Medicine Clerkship Student Projects

US emergency departments (EDs) are overcrowded & overwhelmed - especially in Vermont. An estimated 37% of all ED visits are for non-urgent complaints. Factors associated with frequent ED use for non-urgent complaints include overestimation of disease severity and lack of understanding of services provided.

Hiv Pre-Exposure Prophylaxis (Prep): Increasing Awareness In Primary Care, Carl W. Brasch

Family Medicine Clerkship Student Projects

Primary care is a setting that has great potential for screening and reducing the rate of HIV transmission.

Pediatric Anxiety - A Guide For Parents, Paul Mccleary

Family Medicine Clerkship Student Projects

As of April 2022, the United States Preventive Services Task Force (USPSTF) recommends that all children age 8-18 be screened for anxiety. Whether this recommendation is due to the many changes and stress stemming from Covid-19, the community was left with a need for insight into properly addressing this issue. Whether it be for parents at home or physicians in the clinic, clear educational pamphlets identifying alarm signs and home recommendations will benefit the community.