Family Medicine Commons^™

Teratogenic Medication Usage In Primary Care Of Women Of Reproductive Age, Krys Foster, Md, Mph, Faafp

Department of Family & Community Medicine Presentations and Grand Rounds

Introduction

• Teratogenic medications are commonly prescribed to individuals with pregnancy potential
• Despite knowledge of potential teratogenic effects, data suggest that effective communication regarding the risks and benefits of medication use in the context of the patient’s fertility goals remains inadequate
• We will discuss recommendations for changes in education and healthcare delivery to facilitate thoughtful prescribing in this population

Learning Objectives

• To review a common scenario faced by primary care physicians caring for individuals at risk of pregnancy
• To recognize factors that might place certain patients at increased risk of teratogenic exposure in early pregnancy
• To gain competence in assessing fertility …

Osteoporosis, Susan Mockus Parks, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

Review importance of bone health

Define and identify osteopenia and osteoporosis

Learn treatment options for osteopenia

• How to counsel patients
• How to use FRAX calculator to assist with treatment decisions

Learn treatment options for osteoporosis

• Become familiar with treatment guidelines and options

Residency Training On The Frontlines Of The Covid-19 Pandemic - A Qualitative Study From Tanzania, Mariam Noorani, Hussein Manji, Elizabeth Mmari, Samina Somji, Nahida Z. Walli, Sherin Kassamali, Shabbir Adamjee, Nancy Matillya, Hanifa Mbithe, Aliasger Nagri, Neelam Ismail

Paediatrics and Child Health, East Africa

Introduction: the Coronavirus Disease 2019 pandemic has affected residency training globally. The aim of this study was to understand how the pandemic affected teaching and learning in residency programs in low resource settings where residents and faculty were working on the front line treating patients with the disease.

Methods: this qualitative study enrolled residents and faculty from the Aga Khan University in Tanzania who were providing front line care during the pandemic. Purposeful sampling was used and data was collected using focus group discussions and in-depth interviews between August and September 2020. Analysis was done using qualitative content analysis.

Results: …

An Approach To Faculty Development For Underrepresented Minorities In Medicine., Juan Robles, Tanya Anim, Maria Harsha Wusu, Krys E. Foster, Yury Parra, Octavia Amaechi, Kari-Claudia Allen, Jose E. Rodríguez, Kendall M. Campbell, Dmitry Tumin, Judy Washington

Department of Family & Community Medicine Faculty Papers

OBJECTIVES: The diversity of the US physician workforce lags significantly behind the population, and the disparities in academic medicine are even greater, with underrepresented in medicine (URM) physicians accounting for only 6.8% of all US medical school faculty. We describe a "for URM by URM" pilot approach to faculty development for junior URM Family Medicine physicians that targets unique challenges faced by URM faculty.

METHODS: A year-long fellowship was created for junior URM academic clinician faculty with funding through the Society of Teachers of Family Medicine Project Fund. Seven junior faculty applied and were accepted to participate in the fellowship, …

Utilization Of Patient-Controlled Analgesia Reduces Length Of Stay Of Sickle Cell Crisis Hospitalizations, Brett M. Prestia, Talha Ramzan, Catherine Waldron, Ameer Malik, Robert M. Pallay, Candace R. Murbach, Mike Flynn, Eric Shaw Phd, Abdullah Kutlar, Daniel Lowe

HCA Healthcare Journal of Medicine

Background

Sickle cell crisis hospitalizations are emotionally and financially burdensome to patients and healthcare systems, and processes to decrease the frequency or length of stay of these crises should be examined.

Methods

This is a multicenter retrospective hospital record review of sickle cell crisis hospitalizations as defined by ICD-10 codes (D57.1-4), from January 2016 through December 2019, examining inpatient medication administration records and length of stay among admitted adults aged 18–65 years. Patient controlled analgesia orders using morphine, hydromorphone, fentanyl and/or merperidine at any point of an admission (n=188) were compared to admissions without any patient-controlled analgesia orders (n=2,159). The …

Use Of Ultrasound-Guided Platelet-Rich Plasma In The Treatment Of Carpometacarpal Osteoarthritis, Manuel Britto, Siraaj Dawood, Siyang Lu, Martin Canillas

HCA Healthcare Journal of Medicine

Introduction

Osteoarthritis (OA) is the most common form of arthritis and can severely affect function and quality of life. Platelet-rich plasma (PRP) is derived from a patient’s own blood and has potential as an adjunct to treat OA. However, research has been limited for small joints such as the carpometacarpal (CMC) joint.

Clinical Findings

A 65-year-old Caucasian male complained of bilateral wrist and neck pain after a motor vehicle accident. His initial exam noted swelling, tenderness and pain with movement at the bilateral thumb CMC joints and anatomic snuffboxes. However, there was no strength, range of motion or tactile deficits …

Management And Diagnosis Of Hypothyroidism, Catherine Guariglia, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Goals

• Recognize the different etiologies of hypothyroidism
• Identify signs and symptoms of hypothyroidism
• Feel comfortable diagnosing and treating primary hypothyroidism
• Define subclinical hypothyroidism and when/if it is necessary to treat
• Recognize how pregnancy influences hypothyroidism management
• Be able to counsel patients on treatment for hypothyroidism

There Is Insufficient Evidence To Recommend Bremelanotide For Hypoactive Sexual Desire Disorder, Scott Yaekle Md, Halima Ali Md, Carol Baker Md

Clinical Research in Practice: The Journal of Team Hippocrates

An informed consent discussion for a patient with Hypoactive Sexual Desire Disorder.

Heart Failure Transitions Of Care Program, Samantha Macko, Pharmd

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Heart failure overview; statistics, risk factors, signs and symptoms
• List heart failure therapeutic treatment options
• Explain importance of continuation of care for heart failure patients after initial hospital discharge
• Discuss importance of multidisciplinary approach to treatment of heart failure (HF) patients
• Discuss components of heart failure transitions of care (HFTOC) program at Thomas Jefferson University Hospital

Adhd In Adolescents And Adults, Hannah Facey, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Understand the concept of neurodiversity
• Define ADHD
• Review the diagnostic criteria and challenges with diagnosis for ADHD in adults
• Explore our role as family medicine physicians in diagnosis and treatment
• Discover the prevalence of comorbid conditions associated with ADHD
• Obtain a general understanding of the categories of medical treatments available for adults with ADHD
• Gain a deeper appreciation for the role that biases play in the under- and misdiagnosis of women and BIPOC

Community-Dwelling Older Adult Fall Prevention Improvement Project, Evan Edminster Bsn, Rn, Cfrn, Tcrn, Cen, Nhdp-Bc

Master's Projects and Capstones

Abstract

Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also …

Pharmaceutical Management Of Weight Loss, Jake Schutzman, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Briefly review some context & consequences of the US obesity epidemic
• Review available prescription anti-obesity medications
• Discuss details specific to each of these medications
• Review other medications affecting weight

After this lecture, I hope you will:

• Have a greater understanding of available anti-obesity medications
• Be more comfortable in patient discussions & management of obesity

Contraception For Pcps 2021, Krys Foster, Md, Mph, Faafp

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives:

• Review evidence-based, flexible and patient-centered approaches to contraceptive management in individuals with reproductive potential
• Discuss updates in contraceptive prescribing and management
• Highlight considerations for management of contraception in the time of COVID-19 and in special populations

Outline

• Introduction
• Approach to initiation of contraception
• Overview of methods of contraception
• Special Considerations
• Resources (Medical Eligibility and Special Practice Recommendations; Contraception App)
• Summary
• References

Copd Topic Discussion, Clarice Resso, Pharmd, Farzana Tarannum, Pharmd

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

Prevalence And Social Determinants Of Alcohol Use Disorders In Patients Attending Primary Care Clinics In Nairobi Kenya, Verah Kabwayi

Master of Medicine in Family Medicine

Introduction: In Kenya, studies have been conducted at community levels aiming at understanding the determinants of Alcohol-Use and heavy episodic drinking which may include healthy people. However, limited studies have been done to find out social determinants of alcohol use disorders in patients at private primary care clinics in Nairobi County. The study aimed to find out the prevalence and social determinants of alcohol use disorders in patients attending primary care clinics in Nairobi. Methods: A cross-sectional survey design was used and 389 respondents purposefully recruited into the study. Data was collected using a self-administered questionnaire adapted from the alcohol …

Application Of The Ultra-Poverty Graduation Model In Understanding Community Health Volunteers’ Preferences For Socio-Economic Empowerment Strategies To Enhance Retention: A Qualitative Study In Kilifi, Kenya, Njeri Nyanja, Nelson Nyamu, Lucy Nyaga, Sophie Chabeda, Adelaide Lusambili, Marleen Temmerman, Michaela Mantel, Anthony Ngugi

Family Medicine, East Africa

Background: A significant shortage of healthcare workforce exists globally. To achieve Universal Healthcare cover- age, governments need to enhance their community-based health programmes. Community health volunteers (CHVs) are essential personnel in achieving this objective. However, their ability to earn a livelihood is compromised by the voluntary nature of their work; hence, the high attrition rates from community-based health programmes. There is an urgent need to support CHVs become economically self-reliant. We report here on the application of the Ultra-Poverty Graduation (UPG) Model to map CHVs’ preferences for socio-economic empowerment strategies that could enhance their retention in a rural area …

Barriers To Timely Disclosure Of Hiv Serostatus: A Qualitative Study At Care And Treatment Centers In Dar Es Salaam, Tanzania, Neelam Ismail, Nancy Matillya, Riaz Ratansi, Columba Mbekenga

Family Medicine, East Africa

Introduction: Disclosure of Human Immunodeficiency Virus (HIV) status is important to prevent the spread of HIV and maintain the health of people living with HIV, their spouses, and the community. Despite the benefits of disclosure, many people living with HIV delay disclosing their status to those close to them thereby increasing the risk for disease transmission. This study aimed to determine the barriers to timely disclosure of HIV serostatus for people living with HIV in Dar es Salaam, Tanzania, and identify what motivated disclosure.

Methods: A qualitative descriptive study using in-depth individual interviews was conducted with10 participants attending …

Physician Burnout Among West Virginia Primary Care Providers, Kevin S. Mccann, Adam Baus, Joanna Bailey, Laura Boone, Jennifer Boyd, Martha Cook-Carter, Dan Doyle

Marshall Journal of Medicine

Introduction

Work related burnout is highly prevalent in US physicians and linked to adverse effects on patients, providers and organizations. This study measures burnout in West Virginia (WV) primary care providers, allowing for comparison of results to a similar, recent study of US physicians.

Methods

Anonymous survey through email that included Maslach Burnout Inventory, demographic, workload, and practice characteristics. Responses were analyzed using JMP Pro 13. Analysis used JMP Pro 13 for descriptive statistics, chi-square and regression modeling.

Results

Subjects = 110, female/male ratio 1.4, all primary care physicians (PCP), or advanced practice registered nurses or physician assistants (APRN/PA). PCP …

Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Diagnosis Obscured By Concomitant Recreational Drug Use, Paige Lester Ms Ii, Adam M. Franks Md, William Rollyson Ms Iv, Jenna K. Barbour Md, Matthew B. Curry Md

Marshall Journal of Medicine

Anti-NMDA receptor encephalitis (aNMDAre) is a relatively newly discovered autoimmune and inflammatory disorder affecting the limbic system. It has a clinical course that includes Prodromal, Psychiatric, Unresponsive and Hyperkinetic stages. These stages are often confused with mental health issues in the medical literature, but they also share symptoms of various drug intoxication and withdrawal states. Implicit bias in physicians regarding substance use disorder and patient demographics can impair delivery of care and outcomes in patients with aNMDAre, especially in an environment of recreational drug use. When clinical presentation aligns, this diagnosis should be investigated as soon as possible, even in …

Qualitative Research Methods, Erin Kelly, Md

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

The Relation Of Abo Blood Group To The Severity Of Coronavirus Disease: A Cross-Sectional Study From A Tertiary Care Hospital In Karachi, Fazal Ur Rehman, Syed Furrukh Omair, Fatima Memon, Bakhtawar J. Rind, Danish Ahmed Memon, Syed Ahsan Ali, Bilal Ahmed, Naureen Ali

Section of Internal Medicine

Background: Blood groups are considered to have an impact on the occurrence and severity of coronavirus disease. While among Chinese and Caucasian, blood group O individuals were less and group A were more likely to have severe disease and mortality, data on South Asians aren’t available.
Objective: This study aimed to find out the association of disease severity with blood group among coronavirus disease 2019 (COVID-19) patients.
Materials and methodology: Data were collected on a predesigned questionnaire containing details of patient demographics, medical comorbidities, clinical presentation, and laboratory parameters. Multiple logistic regression was used to determine the association of the …

Global Initiative For Asthma (Gina): What’S New In Gina 2021?, Christopher Chambers, Md

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

Determining The Perception And Willingness Of Primary Care Providers To Prescribe Advanced Diabetes Technologies, Alexander O’Donovan, Sean M. Oser, Jessica Parascando, Arthur Berg, Donald E. Nease Jr., Tamara K. Oser

Journal of Patient-Centered Research and Reviews

Advanced diabetes technologies have produced increasingly favorable outcomes compared to older treatments. Disparities in practice resources have led to a treatment disparity by clinical setting, where endocrinologists typically prescribe far more such technologies than primary care providers (PCPs). Fully automated artificial pancreas systems (APS), which combine technologies to deliver and adjust insulin dosing continuously in response to automatic and continuous glucose monitoring, may be more straightforward for PCPs to prescribe and manage, therefore extending their benefit to more patients. We aimed to assess willingness of PCPs to prescribe advanced diabetes technologies through a cross-sectional survey of PCPs from 4 geographically …

Does Exercise Prevent Gestational Diabetes Mellitus In Pregnant Women? A Clin-Iq, Olivia Lust, Tana Chongsuwat, Elizabeth Lanham, Ann F. Chou, Elizabeth Wickersham

Journal of Patient-Centered Research and Reviews

Excessive weight gain during pregnancy has been on the rise globally, leading to increased prevalence of gestational diabetes mellitus (GDM). A diagnosis of GDM often leads to pregnancy and infant-related complications. Regular exercise may have the potential to prevent GDM. However, evidence surrounding the utility of exercise during pregnancy as an effective risk reduction intervention has been mixed. This clinical inquiry examined the role of regular exercise during pregnancy in preventing GDM in both obese and normal-weight women and analyzed specific aspects of exercise that make it an effective preventive measure. The review of evidence included 3 meta-analyses, 3 systematic …

Loneliness In Primary Care Patients: Relationships With Body Mass Index And Health Care Utilization, Tamara K. Oser, Siddhartha Roy, Jessica Parascando, Rebecca Mullen, Julie Radico, Alexis Reedy-Cooper, Jennifer Moss

Journal of Patient-Centered Research and Reviews

Purpose: Rates of loneliness and obesity have increased in recent decades. Loneliness and obesity independently have been found to be risk factors for negative physical and mental health outcomes. This study examined the rates and interrelationships of loneliness, body mass index (BMI), and health care utilization in a primary care setting.

Methods: A cross-sectional survey of adult patients presenting for outpatient care at 7 family medicine clinical practices in Pennsylvania was conducted. Survey questions included self-reported measures of loneliness, height/weight, number of health care visits, and potential confounders (eg, sociodemographic variables, health status). Bivariate and multivariable linear regression models were …

Covid-19 Deliveries: Maternal Features And Neonatal Outcomes, Viviana Zlochiver, Blair Tilkens, Ana Cristina Perez Moreno, Fatima Aziz, M. Fuad Jan

Journal of Patient-Centered Research and Reviews

Integrated, data-driven criteria are necessary to evaluate delivery outcomes in pregnancies affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the ongoing COVID-19 pandemic. This study analyzed maternal demographics, clinical characteristics, treatments, and delivery outcomes of 85 ethnically diverse, adult pregnant women who tested positive for SARS-CoV-2 at the time of delivery. Median maternal and gestational ages were 27 years (interquartile range [IQR]: 23–31) and 39 weeks (IQR: 37.3–40.0), respectively. Of the 85 SARS-CoV-2–positive participants, 67 (79%) had no COVID-19 symptoms at the time of routine COVID-19 admission testing, 14 (16%) reported mild COVID-19 symptoms, and 4 (5%) presented …

Medical Nutrition Therapy For Diabetes, Cheryl Marco, Rd, Cde

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

What Children Learn About Death From Film, Elissa Miller, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Discuss popular films and how they affect what children know about death
• Discuss child development and development-related concepts of death and dying
• Discuss using films to help discuss death and dying with children

The Evolution Of Breast Imaging, Susanna M. Nazarian, Md, Phd, Facs

Department of Family & Community Medicine Presentations and Grand Rounds

Overview

• A brief overview of the evolution of breast imaging
• Screening and Detection versus Intraoperative Guidance
• Emerging technologies
• Local research opportunities

Characteristics Of Patients Presenting With Covid-19 From Balochistan Province And Lessons Learnt, Abida Munir Badini, Aurangzeb Badini, Naeem M. Mengal, Kashmira Nanji

Department of Family Medicine

Objective: With the spread of COVID-19 in Pakistan, Balochistan province with its unique problems of lowest literacy rates in the country, limited resources and a flail health care system is reporting an increasing number of cases of COVID-19. This study discusses the epidemiological and clinical characteristics of COVID-19 patients from the Balochistan province.
Study design: Situation report Place and Duration of Study: The study was conducted in Balochistan province of Pakistan. The completion date for the study was April 30, 2020.
Methodology: The data was retrieved from the daily situation report from the Health Department, Government of Balochistan. Descriptive statistics …