Family Medicine Commons^™

Pengaruh Durasi Pengobatan Dan Preferensi Pasien Kanker Stadium Akhir Terhadap Layanan Homecare Di Rumah Sakit Medistra Pada Tahun 2021-2023, Peter Brian Sutanto Putra Dr, Erfen Gustiawan Suwangto Dr, Tena Djuartina Dr, Iskandar Rahardjo Budianto Dr, C. Rinaldi A. Lesmana

Jurnal Penyakit Dalam Indonesia

Introduction. Cancer is still an enormous health problem in the world and rank second as the most common cause of mortality. End-stage cancer requires end-of-life or palliative care to improve the patient’s quality of life before death. Homecare services have become an option for providing palliative care to avoid long-term hospital stays. The study aimed to provide an overview of the treatment duration and other factors in end-stage cancer patients regarding the selection of homecare services at Medistra Hospital during the period of 2021-2023.

Methods. This study with a cross-sectional design analyzed medical records of end-stage cancer patients …

Partnerships To Improve Access To Healthcare For Refugees And Immigrants In Philadelphia, Jessica Deffler, Chelsea Salas-Tam, Jenna Gosnay, Marc Altshuler

Department of Family & Community Medicine Faculty Papers

The United States has welcomed refugees since World War II. Currently, the world is experiencing an unparalleled refugee crisis that calls for action by nations across the globe. There are over 82 million people who are forcibly displaced from their homes today (UNHCR Global Trends, Forced displacement in 2020. [cited 2021 Sep 28]. Available from: https://www.unhcr.org/flagship-reports/globaltrends/). Over the last decade, Philadelphia has become home to hundreds of refugees from countries in Southeast and Central Asia, Africa, the Middle East, as well as many others. For newly arrived refugees, finding stable housing, medical care, and employment is difficult due to cultural, …

Guidelines For Returning To Dance Following Concussion: Adaptations From Sport Concussion Literature, Sheyi Ojofeitimi, Lauren Mcintyre, Elizabeth Barchi, Sarah S. Rae, Brittney Winnitoy, Jeffrey A. Russell

Department of Family & Community Medicine Faculty Papers

Sport concussion receives substantial attention as a public health concern. Conversely, performing artists, including dancers, sustain concussions, but these aesthetic athletes do not receive the same level of consideration nor care for this injury as that offered to traditional athletes. The concussion literature pertaining to dance is sparse, and, to our knowledge, no recommendations exist for the crucial aspect of care related to returning to dance following a concussion. The purpose of this article is to assimilate the current knowledge about post-concussion return to activity management in sport—the closest analog of the physical demands required in dance—as a means to …

The Revised Cdc Chronic Pain Guidelines And Payer Opioid Analgesic Policies In Michigan, Victoria Tutag Lehr, Cynthia L. Arfken

Michigan Journal of Public Health

Abstract

The 2016 publication of A Guideline for Prescribing Opioids for Chronic Pain by the Centers for Disease Control and Prevention motivated commercial and Medicaid payers to restrict their opioid prescribing policies including the imposition of hard limits on opioid daily dosages and duration. One result of these policies was an increase in abrupt opioid discontinuation and rapid tapering events for patients receiving long-term opioid therapy. Responding to this misapplication of the 2016 guideline, the 2022 revised guidelines emphasized individualized opioid therapy and exclusion of certain chronic diseases. However, it is not known if the payers changed their policies to …

Addressing Alcohol Use Disorder In The Outpatient Indigenous Health Clinic Setting, Kylie M. Timmerman

Doctor of Nursing Practice (DNP) Projects

Background: Alcohol use disorder disproportionately impacts American Indian and Alaska Native (AIAN) populations at higher rates of disease morbidity and mortality. In the primary care setting, few treatment resources are available to patients outside of medication-only options.

Local Problem: While the intervention site (rural Tribal Federally Qualified Health Center [FQHC]) was known to have a well-established medication-assisted treatment (MAT) program for opiate use disorder (OUD), the was a need for alcohol use disorder (AUD) resources.

Methods: A review of current evidence was conducted to explore best practices for addressing AUD in the AIAN outpatient clinic setting.

Intervention(s): A quality improvement …

Virtual Primary Care In A Large Delaware-Based Independent Academic Medical Center: Impact And Opportunity, Darrell C. Dow, Sarah E. Schenck, Tracy L. Bell, Stephanie C. Roth, Omar Khan

Department of Family & Community Medicine Faculty Papers

COVID-19 and related challenges to patient access necessitated the development of new models of care to ensure a healthy patient population. This paper describes the outcomes of a pilot virtual primary care program at a large independent academic health center in Delaware. The preliminary results are encouraging from the perspective of provider and patient satisfaction, as well as the utility of the operational model. A complete cost-benefit analysis was beyond the scope of the paper; thus, future operational research should focus on the metrics of cost and quality as key indicators of model sustainability.

Perceived Patient-Centered Care In Marching Band Artists, A L. Merrill, Z K. Winkelmann, N A. Uriegas

Bakerman Student Research Awards

Objective: Approximately 27,000 college marching band (MB) artists in the United States could benefit from access to healthcare services and patient-centered clinicians. The purpose of this study was to explore HCPs MB artists have access to and their perceptions of patient-centered care (PCC). Methods: We used a cross-sectional web-based survey of MB artists (n=751, age=20±8 years). MB directors from 242 colleges were emailed a survey link to forward to MB artists. Participants indicated which HCPs they could access. Those who reported no access or unsure were prompted to describe what they would do if an injury or illness occurred. Participants …

Obstructive Sleep Apnea And Obesity: How Weight Loss Improves Sleep Apnea Severity And Quality Of Life - An Integrative Review, Hannah Wilson, Neda Akbarshahi

Master's Projects

Introduction: With the growing prevalence of OSA due to the obesity epidemic, there is an urgent need to update treatment regimens. While CPAP continues to be the gold standard of OSA care, challenges with adherence and limited access to effective weight management strategies often impede care. The complex bidirectional relationship between obesity and OSA highlights the importance of addressing weight management in this patient population to help mitigate cardiometabolic risks. Personalized weight loss therapies should be integrated into standard OSA treatment regimens to reduce OSA severity, reduce comorbid conditions, and improve quality of life.

Aim: The objective of this integrative …

Social Media As Health Educator: An Assessment Of The Understandability And Accuracy Of Tiktok Content About Contraception, Julianna Coleman, Maetal Haas-Kogan, Andrea Pelletier, Rachel Stoddard, Natasha Johnson, Julia Beatini, Nora Sun, Alex Keuroghlian, Deborah Bartz

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Contraception knowledge and attitudes are largely formed from conversations within one's social network. More recently, this network has expanded to include social media. As the fastest growing social media platform, we aimed to assess popular contraception videos on TikTok for content understandability, actionability and accuracy.

METHODS: This is a secondary analysis of the most viewed, contraception-specific TikTok videos that were previously coded as containing educational messaging in a content-analysis study. We assessed videos for understandability (ability to explain a key message) and actionability (identify what they can do to act on that message) using the Patient Education Materials Assessment …

Best Practice Advice For Asthma Exacerbation Prevention And Management In Primary Care: An International Expert Consensus, Neil Skolnik, Barbara P. Yawn, Jaime Correia De Sousa, María Mar Martínez Vázquez, Amanda Barnard, Wendy L. Wright, Austin Ulrich, Tonya Winders, Stephen Brunton

Department of Family & Community Medicine Faculty Papers

Primary care clinicians play a key role in asthma and asthma exacerbation management worldwide because most patients with asthma are treated in primary care settings. The high burden of asthma exacerbations persists and important practice gaps remain, despite continual advances in asthma care. Lack of primary care-specific guidance, uncontrolled asthma, incomplete assessment of exacerbation and asthma control history, and reliance on systemic corticosteroids or short-acting beta2-agonist-only therapy are challenges clinicians face today with asthma care. Evidence supports the use of inhaled corticosteroids (ICS) + fast-acting bronchodilator treatments when used as needed in response to symptoms to improve asthma control and …

Understanding Faculty Perspectives On Health Equity Curriculum Implementation In Graduate Medical Education: A Qualitative Study, Krys Foster, Dhruvi Shah, Quinn Plunkett, Randa Sifri

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Despite increased awareness of persistent healthcare disparities, integrating health equity education into medical residency curricula needs urgent expansion. The Accreditation Council for Graduate Medical Education (ACGME) mandates addressing healthcare disparities and social determinants of health, but implementation remains insufficient due to pervasive barriers.

OBJECTIVE: To explore residency faculty perspectives at one institution surrounding implementing a health equity curriculum within their programs.

METHODS: Between November 2022 and April 2023, qualitative interviews and focus groups were conducted with residency faculty participants (n = 13) from a large academic medical institution. Participants were recruited via an internal email list directory of program …

Health Outcomes Reported By Healthcare Providers And Clients Of A Community-Based Medically Tailored Meal Program, Jessica M. Sautter, Jule Anne Henstenburg, Adrian Glass Crafford, Ian Rowe-Nicholls, Victor S. Diaz, Kaitlyn Ann Bartholomew, Julia S. Evans, Maria R. Johnson, Jeffrey Zhou, Deeksha Ajeya

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Medically tailored meal (MTM) programs provide home-delivered meals to people living with serious illness and poor nutritional status. Client outcome studies have found evidence of decreased healthcare utilization and cost savings associated with MTM program participation, and inconclusive evidence of change in health measures. The purpose of this study was to use a novel observational framework to describe the client profile and change in health outcomes using routinely collected health and program data from a community-based MTM program at MANNA (Philadelphia, PA).

METHODS: Clients reported their self-rated health and experiences of food insecurity and malnutrition. Healthcare providers reported clients' …

Musical Hallucinations In An Elderly Female With Hearing Loss, Jacqueline Cavendish, Lynne J. Goebel

Internal Medicine

Musical hallucinations (MH) are rare auditory phenomena in which patients perceive music without a known source. Risk factors for MH include hearing loss, older age, female gender, epilepsy, and certain medications. This case report details the presentation, diagnosis, and treatment of an 82-year-old woman who developed MH following the onset of hearing loss. Despite treatment attempts with gabapentin, quetiapine, and donepezil, the symptoms persisted, demonstrating the difficulty in treating this condition.

Impact Of State Abortion Policies On Family Medicine Practice And Training After Dobbs V Jackson Women’S Health Organization, Karen L. Roper, Sarah Jane Robbins, Philip Day, Grace Shih, Neelima Kale

UK CARES Faculty Publications

PURPOSE The Dobbs v Jackson Women’s Health Organization (Dobbs) Supreme Court decision revoked the constitutional right to abortion. Now, restrictive state abortion laws may con- tribute to the shortage and strain already felt in primary care practice, especially related to the provision of reproductive health care. The purpose of this study is to evaluate perceived impacts of state abortion legislation on family medicine clinicians’ practice and medical edu- cation regarding reproductive health care.

METHODS Ten questions were added to the 2022 Council of Academic Family Medicine Educational Research Alliance general membership survey to evaluate impact on relevant themes in reproductive …

Maternal Cortisol Concentration Is Associated With Reduced Brain Activation To Infant Cry And More Intrusive Parenting Behavior, Andrew Erhart, Sarah Enos Watamura, Aviva K. Olsavsky, Alexander J. Dufford, Rebekah C. Tribble, Tom Yeh, Pilyoung Kim

Psychology: Faculty Scholarship

Previous research indicates that maternal cortisol function and maternal brain response to infant are each in turn related to variations in parenting behavior. However, little is known about how maternal cortisol and maternal brain function are associated, thus studying these two mechanisms together may improve our understanding of how maternal cortisol assessed during interactions with own infant is associated with brain response to infant cry. First-time mothers (N = 59) of infants aged 3-4 months old were recruited to participate. Mothers' cortisol concentration was measured during a naturalistic interaction with their infant and their behavior was coded for two parenting …

Beyond The Mirage: Confronting Historic Inequities In Maternal Care Deserts., Chynna Smith

Women’s Health Articles

No abstract provided.

The Hunger Vital Sign Alone Misses Patients Who Are Not Food Secure, Avry Logeman, Susan Evans, Jenenne Geske

Posters and Presentations: Family Medicine

No abstract provided.

Inappropriate Survey Design Misstates Findings On Use Of Preference Signaling., Bailey Slone White

Medical Education Articles

No abstract provided.

Early Intervention System Contextual Factors Contributing To Treatment Attendance And Clinical Outcomes, Anthony Eldridge

Theses and Dissertations

Early Intervention Programs (EI) are an established method of addressing and treating earlier childhood developmental problems that involves a system of complex processes which families must navigate to secure and maintain care. Extensive wait times and multiple service providers burdensome caregivers which may impact treatment engagement. Telehealth offers some clinical utility for improving EI service provision. However, little is known how system contextual factors predict a child’s Part B Eligibility and level of engagement with treatment. The primary aim of this study is to describe the effect that wait time, number of service providers, number of treatment services, and treatment …

Impact Of Covid-19 Lockdown On Patient-Provider Electronic Communications, Michael A Hansen, Rebecca Chen, Jacqueline Hirth, James Langabeer, Roger Zoorob

Faculty, Staff and Students Publications

BACKGROUND: SARS CoV-2 virus (COVID-19) impacted the practice of healthcare in the United States, with technology being used to facilitate access to care and reduce iatrogenic spread. Since then, patient message volume to primary care providers has increased. However, the volume and trend of electronic communications after lockdown remain poorly described in the literature.

METHODS: All incoming inbox items (telephone calls, refill requests, and electronic messages) sent to providers from patients amongst four primary care clinics were collected. Inbox item rates were calculated as a ratio of items per patient encountered each week. Trends in inbox rates were assessed during …

Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West

Adultspan Journal

This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …

Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego

Adultspan Journal

The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …

The Abfm Core Outcomes: The Next Step To Outcome-Based, Time-Variable Training In Family Medicine., Bryce A Ringwald

Medical Education Articles

No abstract provided.

Assessing Preparedness, Attitudes, And Knowledge Of Knapp-Utrgv Family Medicine Residents On Geriatric Nursing Home Care: Phase 1 - Creation Of Interactive Modules, Maria M. Ferreira Caceres, Miguel A. Alvarez Silva, Juan C. Lopez-Alvarenga

Research Colloquium

Background: Training in geriatrics and nursing home care are a critical element of medical education. This gap in knowledge becomes increasingly significant given the changing demographics and the need to provide adequate care for an aging population. Improving geriatrics curriculum and implementing nursing home rotations are essential to ensure optimal care for the elderly, thereby fulfilling both educational and healthcare imperatives.

Objective: We aim to analyze and assess the influence of geriatrics training through a survey to collect attitudes, skills, and knowledge of UTRGV Knapp Family Medicine residents. Additionally, the goal is to create interactive modules to boost their skills …

Imprecise Clinical Assessments And Inaccurate Grades: Family Medicine Clerkship Director Perspectives, Arindam Sarkar, Joel J Heidelbaugh, Gage Hallbauer, Nital Appelbaum

Faculty, Staff and Students Publications

BACKGROUND AND OBJECTIVES: As application to residency programs becomes increasingly competitive, educational leaders face growing student concern about imprecise clinical assessments and clerkship grades.

METHODS: As part of a large annual survey of family medicine clerkship directors (FMCDs), 10 questions were disseminated in May 2023 about perceived levels of imprecise assessments by faculty. We aimed to determine to what extent respondents felt their institution's evaluation system propagated inaccurate grading.

RESULTS: A total of 52% of 169 FMCDs responded to the survey. Of these, 7% of respondents were completely confident that their preceptors would give two students of identical competence the …

Can Written Prompts Help Medical Residents To Accurately Monitor Their Own Communication Skills And Those Of Others?, Fleur Demeijer, Nelson Nyamu, A. B. H. De Bruin

Family Medicine, East Africa

In healthcare, effective communication in complex situations such as end of life conversa- tions is critical for delivering high quality care. Whether residents learn from communica- tion training with actors depends on whether they are able to select appropriate informa- tion or ‘predictive cues’ from that learning situation that accurately reflect their or their peers’ performance and whether they use those cues for ensuing judgement. This study aimed to explore whether prompts can help medical residents improving use of predic- tive cues and judgement of communication skills. First and third year Kenyan residents (N = 41) from 8 different specialties …

Can Written Prompts Help Medical Residents To Accurately Monitor Their Own Communication Skills And Those Of Others?, F. O. De Meijer, N. Nyamu, A. H. De Bruin

Family Medicine, East Africa

In healthcare, effective communication in complex situations such as end of life conversations is critical for delivering high quality care. Whether residents learn from communication training with actors depends on whether they are able to select appropriate information or ‘predictive cues’ from that learning situation that accurately reflect their or their peers’ performance and whether they use those cues for ensuing judgement. This study aimed to explore whether prompts can help medical residents improving use of predictive cues and judgement of communication skills. First and third year Kenyan residents (N = 41) from 8 different specialties were randomly assigned to …

Exploring Overactive Bladder Symptoms In Premenopausal And Postmenopausal Women: A Comparative Cross-Sectional Study, Egemen Tural, Ayşe Deniz Ertürk Coşkun, Gizem Pınar, Fisun Vural

Makara Journal of Health Research

Background: Overactive bladder syndrome affects millions globally. It can intermittently cause urinary incontinence, which can significantly diminish the quality of life. This study investigated overactive bladder symptoms in premenopausal and postmenopausal individuals by analyzing the influence of demographic, gynecological, and obstetric factors.

Methods: This single-center prospective cross-sectional study was conducted between September 1 and November 1, 2023, among premenopausal and postmenopausal women. In total, 244 patients meeting the inclusion criteria were selected using a simple random method. Participants were asked to complete an information collection form, and the Turkish version of the Overactive Bladder-V8 questionnaire was administered. A …

Physicians’ Attitude, Knowledge, And Perceived Control Towards The Use Of Exercise As A Form Of Preventive Medicine, Matthew Robert Warner

All-Inclusive List of Electronic Theses and Dissertations

Exercise is a component of physical activity that can aid in the reduction of deaths, lowering obesity rates, and chronic illness. However, many Americans are not meeting the recommended physical activity levels (Carlson, et al., 2018). Quality and accurate health information regarding physical activity is one way to help combat health disparities. Health professionals such as primary care physicians can aid in promoting this lifestyle modification. However, there are shortfalls in physicians’ knowledge of using exercise as a form of preventive medicine for chronic illness. Many medical programs have little to no training in exercise principles (Cardinal et al., 2015). …

"It Shouldn't Be Just Hush-Hush": A Qualitative Community-Based Study Of Menstrual Health Communication Among Women In Philadelphia, Allison R. Casola, Lynette Medley, Brianna C. Kunes, Nya Mcglone, Alexis Silverio

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community.

METHODOLOGY: In partnership with No More Secrets (NMS), a Philadelphia menstrual health non-profit, we conducted a community-based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18-45 recruited from NMS' catchment in Philadelphia participated in semi-structured interviews about their menstrual experiences and communication (N …