Family Medicine Commons^™

Improving Sexually Transmitted Infection Knowledge In Community College Students: A Path To Prevention, Rebecca F. Halford

Electronic Theses and Dissertations

This DNP project was conducted to identify gaps in knowledge focusing on sexually transmitted infections within Texas and Region one. The research study gathered data from first-year nursing students who have chosen to participate in a sexually transmitted infection-focused educational module. Participants were first-year nursing students and understood the research study was strictly voluntary with no forms of compensation. Currently, the curriculum in the nursing program at which the study took place does not focus on sexually transmitted infections and is directed to speak minimally on the subject. This is a contributing factor to why the rise in sexually transmitted …

Alpha-Gal Allergy: A New Threat To Appalachia, Adam M. Franks Md, Makala Murphy Bs, Madison Griffis Md, Rebekah Franks Ba, Cwr, Colin M. Franks, Gary Petty Md

Marshall Journal of Medicine

Abstract

Alpha-gal allergy, or mammalian meat allergy, is described as the development of IgE antibodies to the oligosaccharide galactose-a-1,3-galactose following a bite from the tick species Amblyomma americanum (Lone Star tick) or Dermacentor variabillis (Wood tick). Dermatologic or gastrointestinal symptoms are usually delayed by four to six hours after exposure, making the diagnosis difficult. Due to the use of mammalian proteins in many common medications, surgical equipment and prosthesis, unexpected reactions can occur. In the United States, this pathology is predominately seen in the southeast, but has been associated with other tick species on every continent except Antarctica. As the …

Improving Cancer Screening Rates In Primary Care Via Practice Facilitation And Academic Detailing: A Multi-Pbrn Quality Improvement Project, Christopher P. Morley, Laura A. Schad, Laurene M. Tumiel-Berhalter, Laura A. Brady, Alexandrea Bentham, Karen Vitale, Amanda Norton, Gary Noronha, Carlos Swanger

Journal of Patient-Centered Research and Reviews

Purpose: In the United States, cancer screening rates are often below national targets. This project implemented practice facilitation and academic detailing aimed at increasing breast, cervical, and colorectal cancer screening rates in safety-net primary care practices.

Methods: Three practice-based research networks across western and central New York State partnered to provide quality improvement strategies on breast, cervical, and colorectal cancer screening. Pre/postintervention screening rates for all participating practices were collected annually, as were means across all practices over 7 years. Simple ordinary least squares linear regression was used to calculate the trend for each cancer type and test for statistical …

Patient-Centered Home Cancer Screening Attitudes During Covid-19 Pandemic, Christelle El Khoury, Elizabeth Haro, Martha Alves, Marie Claire O'Dwyer, Kate Meixner, Laura Crespo Albiac, J Nicoll Capizzano, Manasi Ramakrishnan, Cullen Salada, Sherri Sheinfeld Gorin, Masahito Jimbo, Ananda Sen, Diane M. Harper

Journal of Patient-Centered Research and Reviews

The COVID-19 pandemic disrupted health care delivery of cancer screenings. The primary aim of our work was to evaluate the degree to which populations were accepting of home-based screenings for colorectal cancer (CRC) and cervical cancer (ie, primary human papillomavirus [HPV] testing). Three groups of adults having distinct health burdens that may affect acceptance of home-based cancer screening were identified through outpatient electronic medical records: those having survived a COVID-19 hospitalization; those having been positive for a non-COVID-19 respiratory illness; or those having type 2 diabetes. A total of 132 respondents (58% female) completed an online survey with hypothetical cases …

Conference Proceedings: Select Abstracts Presented At 2021 Advocate Aurora Health Scientific Day

Journal of Patient-Centered Research and Reviews

Abstracts published within this supplement were presented at the 47th annual Advocate Aurora Health Scientific Day, held virtually on May 26, 2021. This research symposium provides a forum for disseminating results from studies conducted by faculty, fellows, residents, and other allied health professionals associated with Midwest-based health system Advocate Aurora Health, which publishes the Journal of Patient-Centered Research and Reviews.

Patient And Clinician Characteristics That Predict Breast Cancer Screening Behavior In 40–49-Year-Old Women, Sarina Schrager, Claudia Evaristo, Terry Little, Lori Dubenske, Elizabeth S. Burnside

Journal of Patient-Centered Research and Reviews

Guidelines recommend that clinicians practice shared decision-making (SDM) with women in their 40s to discuss breast cancer screening. Traditionally, SDM includes discussion of values and preferences to help determine a decision that is congruent with what the patient desires. We analyzed 54 women’s breast cancer screening decisions after a SDM conversation with their clinician. We looked at both patient and clinician characteristics that predicted whether or not a woman would get a screening mammogram. Women with a family history of breast cancer or who had a previous abnormal mammogram had higher rates of screening. Screening rates also varied widely between …

Increasing Breast, Cervical, And Colorectal Cancer Screenings: A Qualitative Assessment Of Barriers And Promoters In Safety-Net Practices, Laura A. Brady, Laurene M. Tumiel-Berhalter, Laura A. Schad, Alexandrea Bentham, Karen Vitale, Amanda Norton, Gary Noronha, Carlos Swanger, Christopher P. Morley

Journal of Patient-Centered Research and Reviews

Purpose: Breast, cervical, and colorectal cancer screening rates are suboptimal in underserved populations. A 7-year quality improvement (QI) project implemented academic detailing and practice facilitation in safety-net primary care practices to increase cancer screening rates. This manuscript assesses barriers and promoters.

Methods: Primary care practices providing care to underserved patients were recruited in New York cities Buffalo, Rochester, and Syracuse. Enrollment totaled 31 practices, with 12 practices participating throughout. Annually, each practice received 6 months of practice facilitation support for development and implementation of evidence-based interventions to increase screening rates for the three cancer types. At the end of each …

Neuroimaging Referral For Reassurance In Evaluation Of Headache With Low-Risk Features, Omar E. Fernandez

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Howard L, Wessely S, Leese M, et al. Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache. J Neurol Neurosurg Psychiatry. 2005;76(11):1558-1564. https://doi.org/10.1136/jnnp.2004.057851

for a patient with daily headache.

Lifestyle Intervention Is Superior To Metformin In Prevention Of Microvascular Complications Of Diabetes In Women, But Socioeconomic Barriers May Lead To Use Of Combination, Katanya C. Alaga, Jesse Haddad

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using

Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: The Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol. 2015;3(11):866-875. https://doi.org/10.1016/S2213-8587(15)00291-0

for a patient with pre-diabetes who is concerned about the prevention of microvascular complications through lifestyle intervention while managing her busy schedule as a traveling house cleaner.

Limb Salvage Therapy In Septic Diabetic Foot Ulcer In Patients Unwilling To Undergo Amputation, Luke Hong

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising

Shojaiefard A, Khorgami Z, Larijani B. Septic diabetic foot is not necessarily an indication for amputation. J Foot Ankle Surg. 2008;47(5):419-423. https://doi.org/10.1053/j.jfas.2008.05.005

for a patient with a septic diabetic foot.

Using A Single Tablet Regimen Of Darunavir, Cobicistat, Emcitrabine, And Tenofovir Alafenamide In Virally Suppressed Hiv-1 Patients Is An Adequate Treatment Option For Controlling Hiv, Priya Kathuria

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Orkin C, Molina JM, Negredo E, et al. Efficacy and safety of switching from boosted protease inhibitors plus emtricitabine and tenofovir disoproxil fumarate regimens to single-tablet darunavir, cobicistat, emtricitabine, and tenofovir alafenamide at 48 weeks in adults with virologically suppressed HIV-1 (EMERALD): a phase 3, randomised, non-inferiority trial. Lancet HIV. 2018;5(1):e23-e34. https://doi.org/10.1016/S2352-3018(17)30179-0

for a patient with viriologically suppressed HIV-1.

Effect Of Presence And Absence Of Parents On The Emotional Maturity And Perceived Loneliness In Adolescents, Sana Fatima, Momal Bashir, Kainat Khan, Sheeza Farooq, Sidra Shoaib, Sheeba Farhan

Journal of Mind and Medical Sciences

The present study was conducted to examine the Emotional Maturity and Perceived Loneliness of adolescents with respect to the presence and absence of parents. It was hypothesized that the absence or presence of parents of adolescents would affect the level of emotional maturity and perceived loneliness among adolescents. The adolescent participants N=250 (males n=125 and females n=125; age range= 13-18; M=16.63; SD=0.87) were approached through purposive convenient sampling technique. Measures included the Emotional Maturity Scale and the UCLA loneliness scale V-III. Results indicated that adolescent who lived with their guardians had greater perceived loneliness than those who lived with their …

Adverse Childhood Experiences And Urinary Incontinence In Elementary School Aged Children, Amanda Jill Travis Msn, Fnp-C, Margaret C. Harvey Phd, Aprn, Acnp-Bc, Chfn, Michelle Rickard Dnp, Apnp-C

Doctor of Nursing Practice Projects

Purpose/Background: Adverse Childhood Experiences (ACEs) have an impact on health throughout the lifespan (Filletti et al., 1999; Hughes et al., 2017). These experiences range from physical and mental abuse, substance abuse in the home, parental separation or loss, financial instability, acute illness or injury, witnessing violence in the home or community, and incarceration of family members (Hughes et al., 2017). Understanding and screening for ACEs in children with urinary incontinence can help practitioners identify psychological stress as a potentially modifiable risk factor.

Methods: A 5-month chart review was performed identifying English speaking patients ages 6-11 years presenting to the outpatient …

Using Frap: A Mixed Method Geospatial Mapping And Rapid Qualitative Analysis Approach, To Uncover Barriers And Facilitators Of Diabetes Care In The Lehigh Valley., Autumn Kieber-Emmons Md, Mph, Kyle Shaak Bs, Melanie B. Johnson Mpa, Susan E. Hansen Ma, Elaine Banerjee Md, Mph

Department of Family Medicine

No abstract provided.

The Mediating/Moderating Role Of Cultural Context Factors On Self-Care Practices Among Those Living With Diabetes In Rural Appalachia, Brittany L. Smalls, Adebola Adegboyega, Ellen Combs, Matthew Rutledge, Philip M. Westgate, Md. Tofial Azam, Felipe De La Barra, Lovoria B. Williams, Nancy E. Schoenberg

Family and Community Medicine Faculty Publications

Background

The aim of this study was to examine whether cultural factors, such as religiosity and social support, mediate/moderate the relationship between personal/psychosocial factors and T2DM self-care in a rural Appalachian community.

Methods

Regression models were utilized to assess for mediation and moderation. Multilevel linear mixed effects models and GEE-type logistic regression models were fit for continuous (social support, self-care) and binary (religiosity) outcomes, respectively.

Results

The results indicated that cultural context factors (religiosity and social support) can mediate/moderate the relationship between psychosocial factors and T2DM self-care. Specifically, after adjusting for demographic variables, the findings suggested that social support may …

A Systematic Review Of The Use Of St John's Wort For Smoking Cessation In Adults, Namrata Walia, Sandra Gonzalez, Roger Zoorob

Faculty, Staff and Students Publications

St. John's wort (SJW) has been researched and clinically used for treating various psychiatric disorders, including depression. Few clinical trials have studied its use in smoking cessation. This systematic review provides comprehensive evidence of the studies conducted to date. Five databases were searched for randomized controlled trials (RCTs) that evaluated the effectiveness of SJW for smoking cessation in adults. The trials included the use of SJW alone, or along with nicotine replacement therapy, chromium, or behavioral therapies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to report this systematic review. Overall, four RCTs met the eligibility …

Down Syndrome And Dementia:: A Patient And Care-Giver Centered Approach, Mary M. Stephens, E. Adel Herge, Charmaine Wright

Department of Occupational Therapy Faculty Papers

No abstract provided.

Integrated Behavioral Health (Ibh) Program Updates And Evidence For Ibh In Sud, Rachelle Rene, Phd, Bcb, Hsmi

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

At the end of this presentation, the participant will be able to:

1. Describe core components of the Primary Care Behavioral Health Model
2. Identify IBH Program implementation highlights and challenges
3. Discuss at least one intervention to address SUD in primary care

Management Of Recurrent Bacterial Vaginosis, Barbara Cymring, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Review the importance of appropriate management of recurrent BV (rBV)
• Review the appropriate diagnosis of rBV
• Review the causes and risk factors for BV and rBV
• Review the current literature on treatment for rBV
• Discuss some preventative measures for decreasing risk of BV infection

A Qualitative Analysis Of Third-Year Medical Students' Reflection Essays Regarding The Impact Of Covid-19 On Their Education., Erin L. Kelly, Allison R. Casola, Kelsey Smith, Samantha Kelly, Maria Syl D. De La Cruz

Department of Family & Community Medicine Faculty Papers

BACKGROUND: The COVID-19 pandemic fundamentally changed every aspect of healthcare delivery and training. Few studies have reported on the impact of these changes on the experiences, skill development, and career expectations of medical students.

METHOD: Using 59 responses to a short reflection essay prompt, 3rd year medical students in Philadelphia described how the COVID-19 pandemic affected their education in mid-2020. Using conventional content analysis, six main themes were identified across 14 codes.

RESULTS: Students reported concerns regarding their decreased clinical skill training and specialty exposure on their career development due to the loss of in-person experience during their family medicine …

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