Family Medicine Commons^™

Accelerating Primary Care Transformation At Jefferson (Jeffapct): Reflections From A Five- Year Hrsa Grant, Christine A. Arenson, Md, Amy Cunningham, Phd, Mph, Samantha Kelly, Ma, Randa Sifri, Md

Department of Family & Community Medicine Presentations and Grand Rounds

JeffAPCT Overview

Five year HRSA-funded grant (7/1/15-6/30/20)

Leadership team from Family Medicine, Internal Medicine, Physician Assistant Program

• Objective 1: To improve/ expand primary care and population health curriculum across the continuum of primary care providers and trainees (students, residents, and practitioners)
• Objective 2: To create an enhanced, sustainable model of primary care physician faculty development for PCMH Transformation
• Objective 3: To create a new, sustainable model of faculty development for community-based primary care preceptors (MD/DO, PA, NP, others)

Exploring The Relationship Between Dietary Self-Monitoring With A Mobile App And Weight Change, Jason Payne

Electronic Theses and Dissertations

Background: Approximately 70% of the adult population in the United States has overweight or obesity and increased risk for developing chronic diseases. Dietary self-monitoring adherence using a paper diary is associated with weight loss; however, few studies have examined this association with dietary self-monitoring apps. Objectives: 1) explore if an association exists between app-based dietary self-monitoring and weight change among adults with overweight or obesity and 2) explore the relationships between the frequency, consistency, and completeness of self-monitoring and weight change. Methods: Participants self-monitored dietary intake for 8 weeks using the app Calorie Counter by FatSecret. Participants were assigned …

Goals Of Care 101, Alexandra Evans, Do, Adam Pennarola, Md, Elham Siddiqui, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Hospice and Palliative Medicine - Alexandra Evans, DO

Approaching Goals of Care in the Outpatient World - Elham Siddiqui, MD

Inpatient Goals of Care Discussion - Adam Pennarola, MD

Identification And Management Of Adolescent Alcohol Use: Screening And Motivational Interviewing, Kelsie L. Berger

Evidence-Based Practice Project Reports

Adolescent alcohol consumption is a serious health problem in the United States. Alcohol is the most widely used substance, and it continues to be the drug of choice for adolescents (CDC, 2018). Over 7 million adolescents and approximately 30 percent of high school students in the U.S. that admit to drinking more than a few sips of alcohol in the past 30 days (NIAAA, n.d.). Underage alcohol use can lead to many complications such as social, school, and legal problems, and when initiated early in life is associated with the development of alcohol use disorder (NIAAA, n.d.). The purpose of …

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

West Florida Division GME Research Day 2020

No abstract provided.

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 GME 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.

What's All The Buzzy About? Using Cryotherapy And Vibration For Pain During Vaccinations In Children, Marta L. Byma

Evidence-Based Practice Project Reports

Vaccinations are the most common painful needle procedure, with an estimated 12 billion injections given per year (CDC, 2019). The usual method for administration of vaccinations is through needle puncture, which is often painful. Children often report receiving a shot as one of the most feared and painful experiences (McMurtry et al., 2015). The purpose of this evidence-based practice (EBP) project was to improve patient experiences by decreasing the pain that is associated with vaccinations through the use of a nonpharmacological method for comfort via the Buzzy® device. After thorough analysis and synthesis of the literature, the Buzzy® device that …

Results Of Lung Cancer Screening In The Community., John R Handy, Michael Skokan, Erika Rauch, Steven Zinck, Rachel E Sanborn, Svetlana Kotova, Mansen Wang

Articles, Abstracts, and Reports

PURPOSE: To address doubts regarding National Lung Screening Trial (NLST) generalizability, we analyzed over 6,000 lung cancer screenings (LCSs) within a community health system.

METHODS: Our LCS program included 10 sites, 7 hospitals (2 non-university tertiary care, 5 community) and 3 free-standing imaging centers. Primary care clinicians referred patients. Standard criteria determined eligibility. Dedicated radiologists interpreted all LCSs, assigning Lung Imaging Reporting and Data System (Lung-RADS) categories. All category 4 Lung-RADS scans underwent multidisciplinary review and management recommendations. Data was prospectively collected from November 2013 through December 2018 and retrospectively analyzed.

RESULTS: Of 4,666 referrals, 1,264 individuals were excluded or …

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

Capital Division GME 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 …

Provider-Led Intervention For Overweight Or Obese African American Women Ages 18-65 With A Bmi 25 Kg/ M₂, Tonya A. Harvey

Evidence-Based Practice Project Reports

Overweight and obese African American women tend to suffer most from the impacts of diseases, health disparities, disabilities, and decreased qualities of life (Sutton et al., 2016). Most weight loss programs are not culturally specific, despite the benefits of dietary changes and increased physical activity for all groups. The purpose of this EBP project was to implement a provider-led program including lifestyle, dietary, and activity components to decrease weight, BMI, waist circumference and blood pressure in African American women. The Iowa Model of Evidence-Based Practice to promote quality care was used to guide the EBP project, aimed to address obesity …

Effectiveness Of A Multi-Component Intervention Program For Treating Childhood Obesity, Suzy Free

Evidence-Based Practice Project Reports

Childhood obesity is one of the most chronic childhood illness worldwide (Centers for Disease Control and Prevention [CDC], 2019; World Health Organization [WHO], 2019). The prevalence of childhood obesity has been described as one of the most common chronic childhood conditions (CDC). The purpose of this evidence-based practice (EBP) project was to reduce the BMI scores of obese children using a multi-component intervention program that incorporates healthy eating, physical activity, and family involvement. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model was used to facilitate the implementation of this EBP project. The synthesis of the appraised literature established that utilizing …

Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn

Evidence-Based Practice Project Reports

Diabetes is a complex, chronic illness, and a leading cause of morbidity and mortality (ODPHP, 2019). Gaps in diabetes care exist between clinical guidelines and interventions provided in the clinical setting (ADA, 2015; Chauhan et al., 2017; Renders et al., 2001; Worswick et al., 2013). Improved diabetes management strategies and interventions among healthcare providers are essential to close the quality gap. The purpose of this evidenced-based practice (EBP) project was to prompt providers to adhere to diabetes care guidelines using a paper point-of-care reminder over a 12-week period. Provider performance rates covering four specific guidelines were measured: HbA1c, microalbuminuria, diabetic …

A Descriptive Study Of Racial Inequalities In Mortality From Hepatocellular Cancer Before And After Licensure Of Lifesaving Drugs For Hepatitis C Virus In The United States, Robert S Levine, Maria C Mejia, Jason L Salemi, Sandra J Gonzalez, Muktar H Aliyu, Baqar A Husaini, Roger J Zoorob, Charles H Hennekens

Faculty, Staff and Students Publications

BACKGROUND: Since 1979, mortality from hepatocellular cancer (HCC) has doubled in the United States (US). Lifesaving drugs, prohibitively expensive for some, were approved and marketed to treat hepatitis C virus (HCV), a major risk factor for HCC, beginning in 1997. After the prior introduction of other lifesaving innovations, including active retroviral drug therapy for human immunodeficiency virus and surfactant for respiratory distress syndrome of the newborn, racial inequalities in their mortalities increased in the US. In this descriptive study, we explored racial inequalities in mortality from HCC before and after licensure of HCV drugs in the US.

METHODS: The US …

Acute Disseminated Encephalomyelitis, Ashan Hatharasinghe, Hossein Akhondi, Don Pepito

HCA Healthcare Journal of Medicine

Introduction: Acute Disseminated Encephalomyelitis (ADEM) is a rare autoimmune demyelinating disorder of the central nervous system. Clinical manifestations include encephalopathy, motor deficits, ataxia, and meningeal signs. In most cases, ADEM is preceded by either vaccination or viral illness. Here, we present a case with neither of the two predisposing elements.

Discussion: A 28-year-old Hispanic female presenting with substance use and suicidal ideation was placed on an involuntary psychiatric hold, started on olanzapine and scheduled for a psychiatric facility transfer. The following day, she was noted to have neurological deficits when ambulating. Computed tomography of the brain showed a right frontal …

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.

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 …

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 …

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 …

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 …

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 …

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 …

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 …

Sti & Prep Updates, Marshal Miller, Md, Aahivs, Sunny Lai, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Apply key findings from the DISCOVER trial to PrEP clinical decision-making
• Understand the gaps in PrEP research for cisgender women and adolescents
• Understand the use of on-demand pre-exposure prophylaxis
• Review Current treatment recs and emerging data on Gonococcal and Chlamydial infection
• Discuss diagnostic and management options for non-gonococcal urethritis

Implementing Inter-Professional Patient-Family Centered Plan Of Care Meetings On An Inpatient Hospital Unit, Nicolas Hernandez, Alice Fornari, Sage Rose, Leanne Tortez

Patient Experience Journal

Inpatient plan of care meetings support efforts to encourage collaborative practice and patient-family centered care and result in an effective strategy to enhance communication and patient satisfaction. Clinical team members participated in patient/family centered plan of care meetings at a community hospital in a selected inpatient unit with full time hospitalist physicians. Quantitative data were gathered pre/post implementation from the external Hospital Consumer Assessment of Health Care Providers (HCAHPS) survey. HCAHPS data were collected independently, specifically for questions related to communication between patients, family members/guardians and the medical team and also the effects of care transition. There was a slow …

Dancing During Labor: Social Media Trend Or Future Practice?, Caroline P. Toberna, Drew Horter, Kayla Heslin, Marie M. Forgie, Emily Malloy, Jessica J. F. Kram

Journal of Patient-Centered Research and Reviews

Over the past 30 years, medical interventions in pregnancy and childbirth have increased. Some pregnant women seek less invasive and nonpharmacological options to manage discomforts during labor. While exercise during pregnancy is recommended, less is known about exercise, specifically dancing, during labor. While anecdotal evidence is supportive, little is known about the implications of exercise and dance during the first stage of labor for pain reduction and labor progression. Some movements common in dance, such as expanding hip circles that loosen and relax muscles of the pelvic floor, may be beneficial to women during labor. Available evidence suggests that dancing …

Challenges Of Pediatric Disease In Adulthood, Dennis J. Baumgardner, Brian Chicoine

Journal of Patient-Centered Research and Reviews

Some chronic diseases — such as the rare bone disease X-linked hypophosphatemia, the impetus for a study reported within Volume 7, Issue 2 of the Journal of Patient-Centered Research and Reviews — are diagnosed in childhood but become more symptomatic in adulthood. In this editorial, the challenges, pitfalls, and opportunities regarding the care of adults with childhood-onset chronic diseases are examined using Down syndrome, cystic fibrosis, congenital heart disease, and Hirschsprung disease as examples.

Non-Traumatic Dislocation Of The Knee, Xander Arwand Do

Department of Family Medicine

No abstract provided.

Covid-19, Colleagues, Confusion, And Conversations, Nathanael R. Sanchez M.D., Katherine S. Lee , M.D., Karen Weaver M.D.

Clinical Research in Practice: The Journal of Team Hippocrates

During the COVID-19 pandemic, doctors in a community hospital reflect on their decision-making regarding treatment options for COVID-19. Whether to use hydroxychloroquine is the treatment discussed in most detail.

Compassion And Suppression In Caregivers: Twin Masks Of Tragedy And Joy Of Caring, Emanuele Maria Merlo, Sean M. Mcnabney, Fabio Frisone, Federica Sicari, Mihai Paunica, Catalina Motofei, Salvatore Settineri

Journal of Mind and Medical Sciences

Background: Compassionate caregiving is a critical skill for workers among the helping professions, but the degree of empathy required by caregivers can place high demands on their mental and emotional resources. While many professionals employ successful coping strategies to mitigate these stressors, others experience compassion fatigue or burnout from emotional exhaustion. The objective of this research was to evaluate the relationships between caregivers’ demographic/career variables, compassion satisfaction, compassion fatigue, and psychodynamic defense mechanisms such as suppression, repressive function, regression in the service of the Ego, and rationalization. Methods: Participants were 250 caregivers with 178 (71,2%) women and 72 men (28,8%) …