Family Medicine Commons^™

Prevalence Of Depression And Factors Associated With Depressive Symptoms Among Patients Diagnosed With Benign Prostatic Enlargement At Aga Khan University Hospital, Nairobi, Husni Abdalla

Master of Medicine in Family Medicine

Background: There is a relationship between Benign Prostatic Enlargement (BPE) and Lower Urinary Tract Symptoms (LUTS). The persistence of LUTS can negatively affect the quality of living by interrupting daily activities. Depressive symptoms occur commonly in patients with BPE. Depression is a taboo subject in Africa, and Kenya is no exception. Depression at its worst can lead to suicide. Thus, it is of great importance to recognise the factors associated with depressive symptoms in patients with BPE and hence reinforce the need to assess depression in patients with BPE in our clinical practice. Objective: This study sought to determine the …

Critical Conversations: Improving Goals Of Care Conversations At Southeast Family Medicine, Elizabeth Deyo, Michael Dirks, Tyler Nelson, Katherine Cobb, Nicholas Wolfgang, Hannah Kadavy, Ben Pederson

Milwaukie Family Medicine 2021

Quality Improvement Project - Background

Introduction Goals of care (GOC) conversations are an essential element of high quality patient care across care contexts. At our residency clinic site, Southeast Family Medicine, there currently is not a standardized workflow that encourages and reminds providers to complete and document GOC discussions with their patients. Currently, end of life planning is tracked and monitored primarily through two tools: patient completion of advanced directives and POLST forms. Although these two documents are important, their use and application is at times to general or specific to truly reflect a patient’s perspective on their goals of …

Initiation Of Medication-Assisted Treatment At A Resident Clinic Site Transitioning To A Federally Qualified Health Center, Yoonjie Chung Md, Marlene Gonzalez Md, Angela Colistra Lpc, Phd, Ms, Drew Keister Md

Department of Family Medicine

No abstract provided.

Mr. Watson, Come Here-I Want To See You: One Rural Residency Program’S Rapid Pivot To Telemedicine During The Pandemic, William J. Crump, Diana M. Nims, Douglas J. Hatler

Marshall Journal of Medicine

Introduction

Telemedicine has been used for over a generation, but application has been limited in rural areas due to lack of payment, licensure issues, cumbersome video equipment, and challenges with digital communications. Early in the COVID-19 pandemic, our rural family medicine residency made a rapid shift to all telemedicine services for our patients.

Methods

We collected data over a four-week period in April 2020 as we transitioned to 100% telemedicine consultations. We compare that to a four-week period prior to mid-March when COVID-related shutdowns began. We collected detailed visit summaries, patient feedback, and physician feedback to compare these two periods. …

Hydrogen Peroxide Colitis: The Accidental Enema, Ramin Karimi, Ashish Sharma, Kevin Tran, Sebastian Montgomery

HCA Healthcare Journal of Medicine

Chemical colitis is defined as inflammation of the large intestine or colon as a result of exposure from a harsh chemical through an enema or other procedure. In this case, the chemical is hydrogen peroxide, which is commonly used as an antiseptic for minor abrasions. Hydrogen peroxide enemas were once popular for difficult to treat constipation. However, resultant colitis and proctitis limited its use. When administered rectally in a high enough concentration, intense abdominal pain and transient bloody diarrhea can occur, with the majority of affected patients making a full recovery with supportive management. Here we discuss a case of …

Erythema Ab Igne: Toasted Skin Syndrome, Vincent Ly, James E. Vandruff, Julia Fashner

HCA Healthcare Journal of Medicine

Introduction

Erythema ab igne is a benign skin condition caused by long-term exposure to infrared radiation and/or heat. Erythema ab igne begins as a mild erythema over the previously exposed areas and develops into an erythematous reticulated hyperpigmentation with scaling and telangiectasias.

Clinical Findings

A 55-year-old female presented to the primary care clinic with concerns due to the development of a rash on her lower back in the previous 1 to 2 weeks. She had a history of chronic back pain and was using conservative treatment for pain management, including daily use of a heating pad for 15 minutes every …

Prevalence And Risk Factors Of Drug-Induced Gingival Overgrowth In Hypertensive Patients, Haslina Taib, Muhammad Haziq Mohd Radzwan, Muhammad Annurdin Sabaruddin, Wan Majdiah Wan Mohamad, Noraini Mohamad

Journal of Dentistry Indonesia

Gingival overgrowth (GO) or enlargement is an unwanted effect occurring on the gingiva that commonly associated with medications. Hypertension is a global burden systemic conditions and showed high prevalent and more patients are taking antihypertensive drugs. Objective: This study aimed to assess the prevalence of drug-induced gingival overgrowth (DIGO) and its associated risk factors among hypertensive patients attending Hospital Universiti Sains Malaysia, Kelantan, Malaysia. Methods: A total of 42 patients with the mean age of 57.1 (SD=9.3) years had participated in this cross-sectional study. They were recruited if they had consumed anti-hypertensive agents for at least 6 months. Demographic …

Predictive Factors For Early Breastmilk Discontinuation In Premature Infants: A Retrospective Study, Smiti Gupta, Darah Yuhas, Janet Wasylyshen-Valesco, Adrienne Stolfi

Medical Student Research Symposium Abstracts and Posters

The AAP recommends exclusive breastfeeding for 6 months, followed by continuation of breastfeeding with introduction of complimentary foods for at least 1 year (1). There has been considerable success initiating breastfeeding in birth hospitals. This can largely be attributed to many beneficial programs, including the WHO/UNICEF Baby-Friendly Hospital Initiative and “10 Steps to Successful Breastfeeding” (2, 3). Despite the success with increasing breastfeeding rates in birth hospitals, only 58.3% of US infants received breast milk at 6 months of age and only 25.6% of US infants were exclusively breastfed at 6 months in 2019 (4).This discrepancy is even greater for …

Global And Local Service Connection: Global Health Experiences And Local Community Engagement In Wright State University Boonshoft School Of Medicine Alumni, Katie Lomeo, Katharine A. Conway, Kelly Muterspaw, Kaitlyn Danner, Virginia Keim

Medical Student Research Symposium Abstracts and Posters

The Global Health Scholars Program (GHSP) at Wright State University Boonshoft School of Medicine (BSOM) has been in place for 18 years. The GHSP gives medical students an opportunity to serve in various medical settings around the world. There are many reasons why healthcare professionals seek global health experiences. One main reason for global health participation is altruism and the desire to improve community health abroad. However, global health participants are widely criticized for neglecting their home countries’ problems to solve those around the world. The goal of this study is to assess the relationship between global health experiences and …

Acupuncture For Pain, Julita Mitchell, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

➢ To introduce basic acupuncture theory and proposed mechanisms.

➢ To describe a typical acupuncture encounter.

➢ To outline the indications for acupuncture.

➢ To explore clinical evidence behind acupuncture for pain
○ Knee osteoarthritis, low back pain, headache

➢ Review AAFP Clinical Recommendations for acupuncture.

➢ To discuss logistical aspects of acupuncture referral.

The Use Of Automated Text Messaging As An Intervention For Smoking Cessation, Oluwasayo Sinkaiye

Evidence-Based Practice Project Reports

Tobacco smoking is a widespread problem that affects the adult population in the United States (U.S.). In 2018, about 14 of every 100 adults in the USA aged 18 years or older were cigarette smokers (Centers for Disease Control and Prevention [CDC], 2020). Tobacco smoking is associated with chronic disease conditions that have serious health implications including cancer, heart disease, diabetes, and chronic obstructive pulmonary disease (COPD) (CDC, 2020). The purpose of this evidence-based practice project (EBP) was to determine the effectiveness of an automated text messaging application (SmokefreeTXT) for smoking cessation in a primary care setting for adult cigarette …

Service Use By Medicaid Recipients With Serious Mental Illness During An Rct Of The Bridge Peer Health Navigator Intervention, Erin L Kelly, Benjamin Hong, Lei Duan, Laura Pancake, Heather Cohen, John S Brekke

Department of Family & Community Medicine Faculty Papers

OBJECTIVE: Integration of general medical care and mental health care is a high priority for individuals with serious mental illnesses because of their high risk of morbidity and early mortality. The Bridge is a peer-led, health navigator intervention designed to improve access to and use of health care and self-management of medical services by individuals with serious mental illnesses. This study expands on a previous study in which the authors examined participants' self-reported outcomes from a 12-month randomized controlled trial of the Bridge. In the study reported here, Medicaid data were used to assess the impact of the intervention on …

Contingency Management Implementation: Strengthening Mat In Primary Care, Angela Colistra Lpc, Phd, Ms, Sophia Harbove Ms, Ctp, Yamelisa Taveras Ma, Caadc, Ccs, Abby S. Letcher Md, Nyann Biery Ms

Department of Family Medicine

No abstract provided.

Sarcopenia: A Functional Chronic Disease, Mike Haines, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Define sarcopenia as a clinical diagnosis as described by the European Working Group on Sarcopenia in Older Persons (EWGSOP2)
• Recognize, identify, and describe sarcopenia as a distinct disease process
• Review impact on health outcomes and healthcare costs
• Explain tools used to aid in diagnosis in clinical practice
• Explore the nuances of therapeutic interventions
• Discuss role of the primary care physician

Outline

● What is sarcopenia?

• Definition provided by EWGSOP2
• Brief overview of pathophysiology

● Why is it important?

• Epidemiology
• Impact on health outcomes
• Healthcare costs

● Diagnosis

• Review EWGSOP2 framework for clinical practice
• Questionnaires
• Office based testing
• Imaging

● …

Innovations In U.S. Health Care Delivery To Reduce Disparities In Maternal Mortality Among African American And American Indian/Alaskan Native Women, Swapna Reddy, Nina Patel, Mary Saxon, Nina Amin, Rizwana Biviji

Journal of Patient-Centered Research and Reviews

Despite spending more on health care than any other country, the United States has the worst maternal mortality rate among all developed nations. African American and American Indian/Alaskan Native women have the worst outcomes by race, representing a stark health disparity within the country. Contributing factors disproportionately experienced by these minority populations include challenges of access to consistent and high-quality prenatal care, prevalence of underlying conditions, toxic stress due to systemic racism, and unconscious bias in health care. While many of these factors lie upstream in the lives of women, and seemingly beyond the scope of the clinical walls, the …

Prevalence Of Common Disease Conditions In A Large Cohort Of Individuals With Down Syndrome In The United States, Brian Chicoine, Anne Rivelli, Veronica Fitzpatrick, Laura Chicoine, Gengjie Jia, Andrey Rzhetsky

Journal of Patient-Centered Research and Reviews

Purpose: Given the current life expectancy and number of individuals living with Down syndrome (DS), it is important to learn common occurrences of disease conditions across the developmental lifespan. This study analyzed data from a large cohort of individuals with DS in an effort to better understand these disease conditions, inform future screening practices, tailor medical care guidelines, and improve utilization of health care resources.

Methods: This retrospective, descriptive study incorporated up to 28 years of data, compiled from 6078 individuals with DS and 30,326 controls matched on age and sex. Data were abstracted from electronic medical records within a …

The Focused Rapid Assessment Process (Frap): Utilizing Geospatial Mapping And Rapid Qualitative Analysis To Impact Cancer Survivorship Disparities, Autumn Kieber-Emmons Md, Mph

Department of Family Medicine

No abstract provided.

Double Trouble, Elisa Giusto Do

Department of Family Medicine

No abstract provided.

Hypertension Management: Improving Medication Adherence Through The Use Of Daily Text Messages, Gaelle Bulabula

Evidence-Based Practice Project Reports

Hypertension (HTN) is the leading cause of hospitalization and is responsible for approximately 50% of cardiovascular and cerebrovascular events (Al-Noumani, et al., 2018). Uncontrolled HTN can lead to comorbidities including ischemic heart disease, renal disease, or life-threatening arrythmias (World Health Organization [WHO], 2019). The leading cause of HTN is medication non-compliance (Varleta, et al., 2017). The purpose of this evidence-based practice project was to determine the effectiveness of daily text messages on antihypertensive medication adherence. A comprehensive review of literature generated ten high-level evidence studies demonstrating that daily text messages near each medication dosing time is best practice for improving …

Support For Family Members Who Are Caregivers To Relatives With Acquired Brain Injury, Janet Walker, Lourens Schlebusch, Bernhard Gaede

Journal of Mind and Medical Sciences

Objectives. Family members caring for a patient with acquired brain injury (ABI) are coping with inordinate levels of stress partially due to their lack of understanding of the neuropsychological effects of acquired brain injury in the patient. The objective of this research is to show that as the caregivers’ stress levels increase, there is an increase in suicidal ideation. This highlights the causal relationship between unhealthy stress and reduced psychological well-being in these caregivers. In addition, qualitative research evidence regarding the caregivers’ views of their main sources of stress are presented. Methods. The participants were a random sample of 80 …

Suicide Assessment, Angelo Rannazzisi, Psyd

Department of Family & Community Medicine Presentations and Grand Rounds

Agenda

● Risk & Protective Factors of Suicide

• Demographic, Diagnostic, Psychological Variables

● Suicide Risk Assessment

• C-SSRS (Columbia-Suicide Severity Rating Scale)
• BDI-II (Beck Depression Inventory 2nd Edition)
• Reasons for Living Inventory (RFL)

● Creating a Safety Plan

Patellofemoral Disfunction, Chris Mulholland, Md

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

In-Situ Simulation In Interdisciplinary Family Practice Improves Response To In-Office Emergencies., Brad D Gable, Laurie Hommema

Ambulatory and Primary Care Articles

Background Medical emergencies can present to family medicine offices. For optimal patient outcomes, multiple team members must come together to provide emergency care and mobilize the appropriate resources. In-situ simulation has been used to improve provider knowledge, skills, and attitudes as well as identify latent safety threats. The aim of this training was to provide family medicine physicians, nurses, and office staff education about how to manage in-office emergencies. Specifically, we sought to clarify team members' roles, improve communication, and identify latent safety threats. Methodology Two different in-situ simulations were performed with debriefing sessions. The first was a pediatric patient …

Examining Factors Associated With Bcg And Poliomyelitis Vaccination Coverage In Tanzanian And Kenyan Children Aged 12 To 23 Months Using Dhs Surveys, Ognyan Simeonov

Independent Study Project (ISP) Collection

The rapid spread of infectious diseases in eastern Africa has made vaccination a major health factor in the region. This study aims to evaluate the factors affecting vaccination coverage with the BCG and Poliomyelitis vaccines in Tanzanian and Kenyan children aged 12 to 23 months. In May 2021, we collected data from the Demographic and Health Surveys (DHS) from 2014-2016 for Kenya and Tanzania and evaluated how different variables such as the sex of the child, maternal age, maternal educational level, availability of health facilities, access to electricity in the household, and birth order affect the vaccination coverage. We used …

Preventing Physician Suicide., Jennifer L Middleton

Ambulatory and Primary Care Articles

No abstract provided.

Need For Clinical Guidelines For Management Of Osteoporosis And Way Forward For Pakistan, Aysha Habib Khan, Manju Chandran

Department of Pathology and Laboratory Medicine

No abstract provided.

Implementation And Evaluation Of Employee Health And Wellness Program Using Re-Aim Framework, Unab I. Khan, Asra Qureshi, Karishma Lal, Shehreen Ali, Arshnoor Barkatalia, Shamim Nayani

Department of Family Medicine

Purpose: To describe the design, implementation, and evaluation of an employer-sponsored health screening program [Employee Health and Wellness Program (EHWP)] in an academic healthcare system in Pakistan.
Design/methodology/approach: One-year after implementation, we use the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to evaluate and report participant- and organizational-level indicators of success.
Findings: Of 5286 invited employees, 4523 (86%) completed blood work and 1809 (34%) completed health risk assessment (Reach). Of the 915 (51%) who required referrals, 3% were referred for new diagnoses of diabetes, hepatitis C or severe anemia; 63% for elevated 10- year risk of cardiometabolic diseases (cardiovascular …

Social Isolation: Impact On Physical And Mental Health, Alexa Waters, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Review the impact of social isolation and loneliness on important aspects of health and well-being, with a focus on older adults
• Review risk and protective factors for social isolation and loneliness
• Discuss how the health care system and primary care physicians can better identify and address social isolation
• Briefly highlight interventions to enhance social connectedness and reduce loneliness

Outline

• Background
• Impacts of social isolation and loneliness on health and well-being
• Risk and protective factors for social isolation and loneliness
• Role of the health system and primary care in addressing social isolation and loneliness
• Cases throughout

Preparticipation Evaluation Of The Special Olympics Athlete, Mary M. Stephens, Md, Mph

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• By the end of this module the student will be able to describe the components of a pre-participation sports evaluation.
• By the end of this module the student will be able to articulate an assessment for atlantoaxial instability.
• By the end of this module the student will be able to apply the learned knowledge from the module to a case study.
• By the end of this module the student will be able to recommend appropriate anticipatory guidance to the athlete.

The Limping Child, Bob Wiley, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Review the definition of limp
• Describe the approach to initial evaluation of a limping child, including key items in the history and physical exam
• Appreciate the broad differential that one must keep when evaluating a limping child
• Understand the different types of limp and how they can be used to formulate a differential
• Recognize red flag signs and symptoms which require more urgent evaluation
• Use cases to demonstrate some of the common presentations that are seen by the GP