Primary Care Commons^™

Post-Traumatic Stress Disorder: Review Of Dsm Criteria And Functional Neuroanatomy, Cornelius W. Thomas

Marshall Journal of Medicine

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for post-traumatic stress disorder (PTSD) consist of over twenty possible symptoms that can be divided into six broad categories. These categories correlate with specific brain networks that regulate emotions, behaviors, and autonomic function. Normal functioning of these networks depends on two key regions; the prefrontal cortex and the amygdala. The prefrontal cortex provides top-down executive control over amygdala, whereas the amygdala is critical for threat detection and activation of the ‘fight or flight’ response. Events that trigger extreme and/or prolonged fear can cause persisting dysregulation within the prefrontal-amygdala circuit; resulting …

A Multi-Faceted Intervention To Improve Naloxone Co-Prescription Rates Among Primary Care Providers, Jolane S. Conklin

Evidence-Based Practice Project Reports

It is estimated that 91 Americans die every day due to opioid overdoses, with at least half of those overdoses involving an opioid prescription (CDC, 2016d). To address this issue, the U.S. Department of Health and Human Services (USDHHS) has initiated an opioid initiative, and the Centers for Disease Control and Prevention (CDC) has released a clinical guideline, both of which include a focus on increasing use of naloxone. Despite these recommendations, providers often fail to co-prescribe naloxone to patients at increased risk of opioid overdose. The purpose of this evidence-based practice (EBP) project was to evaluate the effect of …

Uncertainty And Competing Priorities In Shared Clinical Decision-Making, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this issue introduction, the editor-in-chief of Journal of Patient-Centered Research and Reviews observes that a connecting thread among the articles published therein is an element of uncertainty among patients and clinicians. Competing priorities for the patient also may be present. Several approaches to overcoming these prevalent conflicts to delivery of better health care have been proposed, the most important of which may be clinicians embracing a will to practice shared decision-making.

Ot In Pediatric Primary Care, Anne H. Zachry, J. Flick

Faculty Presentations

This session described a program where licensed occupational therapists and master’s level OT students provide free developmental screenings to infants and young children in local pediatric medical practice. Strategies for strategies for developing relationships and bridging communication between occupational therapists, primary practice physicians, and families were reviewed.

Proposal Defense: Improving Patient Portal Adoption In Primary Care, Melissa Wagner

Doctoral Projects

Introduction: Stage three of Meaningful Use (MU) is currently underway and is focused on promoting patient portal use. If the electronic medical record patient portal use is less than 25%, primary care providers face reductions in value-based reimbursements. National adoption rates from portal use remain under 27% with some providers averaging well below the needed 25%. The following practice question is proposed, “In a low-income urban adult clinic, how does an interactive electronic education intervention compared to no education intervention affect patient portal adoption rates?”

Objectives: The purpose of this project is to identify whether an electronic patient educational video …

Implementing A Mobile Health System To Integrate The Treatment Of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study, Andrew Quanbeck, David H. Gustafson, Lisa A. Marsch, Ming-Yuan Chih, Rachel Kornfield, Fiona Mctavish, Roberta Johnson, Randall T. Brown, Marie-Louise Mares, Dhavan V. Shah

Health and Clinical Sciences Faculty Publications

Background: Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care.

Objective: The objective of this paper was to report the effects of implementing an mHealth system for addiction in …

Facilitating Factors And Barriers To Weight Management In Women: Physician Perspectives, Renee E. Walker, Jennifer Kusch, Jennifer T. Fink, David A. Nelson, George Morris Iii, Jessica Skalla, Ron A. Cisler

Journal of Patient-Centered Research and Reviews

Purpose: The complexity of addressing overweight and obesity in women has been an ongoing public health and health care challenge. While the mechanism for addressing overweight and obesity in women remains unclear, it has been speculated that disparities in overweight and obesity by race and gender contribute to the complexity. The purpose of the present study was to examine perceptions of primary care physicians when discussing weight management with their patients.

Methods: We conducted focus group discussions exploring facilitators and barriers to discussing weight management and weight loss among women patients. Participants included 18 family medicine and internal medicine physicians …

Challenges Of Refugee Health Care: Perspectives Of Medical Interpreters, Case Managers, And Pharmacists, Fabiana Kotovicz, Anne Getzin, Thy Vo

Journal of Patient-Centered Research and Reviews

Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin.

Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. …

Community Health, Advocacy, And Managing Populations (Champ) Longitudinal Residency Education And Evaluation, Kjersti E. Knox, Will Lehmann, Joseph Vogelgesang, Deborah Simpson

Journal of Patient-Centered Research and Reviews

Purpose: Longitudinal education initiatives designed to prepare residents to address health disparities and social determinants of health (SDH) are needed. This report addresses this gap by describing a family medicine residency’s Community Health, Advocacy, and Managing Populations (CHAMP) curriculum and its evaluation by learners, faculty, and community partners. The CHAMP longitudinal curriculum is explicitly designed to prepare residents to address health disparities and SDH. We report early outcomes, including community partner feedback, of this innovative curriculum.

Methods: Data were obtained through standardized rotation evaluations, thematic analysis of structured group and individual interviews, and aggregated competency milestone data. Kirkpatrick’s four-level model …

Chasing The Dragon, Daniel Young Cho, Hani Nazha, Kalin Fisher

Marshall Journal of Medicine

Abstract: Although rare, toxic leukoencephalopathy (TLE) associated with heroin inhalation have been reported. ‘Chasing the dragon’ may lead to progressive spongiform degeneration of the brain and presents with a large range of neuropsychological sequelae. A thorough social history and clinical suspicion are paramount in recognizing the diagnosis. This case is an example of TLE in a middle-aged white male with a history of polysubstance abuse. He presented with a three week history of progressive neuropsychological symptoms, including abulia, bradyphrenia, hyperreflexia, and visual hallucinations. He was initially suspected to have progressive multifocal leukoencephalopathy, however, JCV PCR was negative. MRI showed diffuse …

Anxiety Reduction Among Washington County Jail Inmates: A Community Service Project, Tyler J. Back, Laura Bakke, Daniel Cuppy

All Electronic Theses and Dissertations

The general principle of anxiety has been thoroughly studied in many populations and shown to have variable underlying etiology, partially related to abnormalities in brain chemistry as well as unfamiliar or uncomfortable social situations. The role of environmental factors pertaining to anxiety is the particular interest of this community service project, to which the research team and the staff of the Washington County Jail have focused the efforts of this community service project in improving and reducing anxiety levels among Washington County Jail inmates.The research team and the staff of the Washington County Jail identified the use of pharmacologic agents …

The Prevalence Of Cigarette Smoking Among Registered Nurses And Certified Nursing Assistants, Ana R. Brown, Taylor Paulson, Kathryn A. Peterson

All Electronic Theses and Dissertations

Cigarette smoking is a dangerous addiction that affects over 45 million Americans. Smoking has been proven to cause a variety of diseases that result in about 480,000 U. S. deaths per year. Healthcare workers have the ability and responsibility to assist patients in smoking cessation; however, a significant number of healthcare workers also participate in cigarette smoking. Studies have shown that healthcare workers with higher levels of education are less likely to smoke; physicians are less likely to smoke than registered nurses, who are less likely to smoke than licensed practical nurses. There is a lack of research done on …

Physician Assisted Suicide: Attitudes Of The Minnesota General Population, Jennifer M. Bretscher, Tammy J. Estrem

All Electronic Theses and Dissertations

Having the choice to hasten death via physician assisted suicide (PAS) is becoming increasingly more popular in the United States. The majority of states do not yet have laws that legalize PAS, but many, including Minnesota, are currently entertaining legislation to allow PAS as an end-of-life option if a person is over the age of 18 and has a terminal illness with only six months to live. To date, little research has been done to evaluate the attitudes about PAS in the Minnesota general population. The goal of this study was to determine whether demographics, namely, age, gender, educational level, …

Personal Health Habits Of Pas And The Effect These Habits Have On Preventive Health Counseling Practices, Emily A. Carstens, Megan L. Englund

All Electronic Theses and Dissertations

Chronic disease is the leading cause of morbidity and mortality in the United States. The burden of chronic disease can be largely prevented by following a healthy lifestyle. Individuals often receive their knowledge about preventive health recommendations from their primary care provider, and healthcare providers are more likely to counsel patients about the healthful behaviors they themselves practice. This study utilized a survey distributed to the Wisconsin Academy of Physician Assistants to assess the personal health habits of physician assistants and the effect personal health has on preventive health counseling practices. A personal health score and counseling score were calculated …

A Community Outreach Project Assisting Evergreen Elementary School With Students’ Nutritional Needs, Robin C. Erickson, Nicole Roach, Megan Smith

All Electronic Theses and Dissertations

Nine months out of the year, students within the United States attend elementary school to be educated on English, mathematics, history, and other topics. The Anoka- Hennepin School District’s philosophy of an elementary education highlights many important factors for success in school but neglects to highlight nutrition as one of the factors. The purpose of our community outreach project is aimed at reducing the stress of hunger for the students at Evergreen Elementary School (EES) by implementing a food drive. Through the food drive, the project team members were able to collect various donations including food, clothing items, and hygiene …

Barriers To Preventive Care For The Immigrant Population In Minnesota, Andrew Kenneth Gernand, Dustin Wayne Kingsley, Daleso Yadetta

All Electronic Theses and Dissertations

Immigrants in Minnesota face several barriers regarding access and use of preventive healthcare services. Current literature indicates a high area of need exists within the immigrant population for the prevention of chronic illness. Language, health literacy, cultural norms, and citizenship all play a role in limiting the use of preventive care. As the number of elderly immigrants increases and the overall immigrant population steadily rises in the United States, it is in the best interest of patients and providers to prevent or reduce the burden of long term diseases like diabetes, cancer, and hypertension. Knowing that barriers are present within …

Examining The Effects Of Caffeine, Sleep And Exercise On The Academic Performance Of Pa Students, Saira Haq, Katelyn M. Walsh

All Electronic Theses and Dissertations

Caffeine is the most widely consumed stimulant drug in the world and is consumed by nearly ninety percent of North Americans (Mednick, Cai, Kanady, & Drummond, 2008). Since caffeine is a highly consumed drug amongst a wide variety of demographics, it is important to consider the ramifications of caffeine on a person’s general well-being. In recent years, there has also been an increasing correlation between the number of individuals consuming caffeine and the rise of insufficient sleep (Mednick et al., 2008). Due to the high demands and stresses of college and graduate school, it is not surprising that many students …

Factors Influencing Provider Antibiotic Prescribing Behaviors: A Qualitative Study, Patrick Kevin Hayden, Emily Palmer

All Electronic Theses and Dissertations

The prevalence of antibiotic resistance has grown steadily over the past few decades. Hundreds of thousands of people are dying each year due to the unavailability of previously effective antibiotic regimens. A major influence in the continued progression of this resistance can be attributed to the overuse and inappropriate prescribing of antibiotics. This study explored the factors that influence medical providers to use or prescribe antibiotics in situations when they are not indicated. The study was conducted through a semi-structured interview to providers from Minnesota and Wisconsin who work or have previously worked in urgent cares or emergency rooms. Providers …

Prevention And Education Of Sexually Transmitted Diseases Within Lesbian, Gay, Bisexual, Transgender, And Queer Adolescents, Kalie S. Johnson, Hayden Middleton

All Electronic Theses and Dissertations

Sexually transmitted diseases (STDs) are becoming an increasingly significant issue faced by high school adolescents in the United States. According to the Centers for Disease Control and Prevention (CDC), adolescents 15 to 21 years of age account for over half of the STDs acquired in the United States every year. The lesbian, gay, bisexual, transgender, and queer (LGBTQ) sub-group of adolescent populations is at a higher risk for STDs than their heterosexual counterparts, and with ten percent of American adolescents identifying as lesbian, gay, bisexual, transgender, or queer, the prevention and education of STDs in this sub-population is of utmost …

Attitudes Towards Vaccinations In The Minnesota Slavic Community, Maksim Kozak, Hannah Margaret Roy, Rachel Van Heest

All Electronic Theses and Dissertations

The incidence of vaccine preventable illnesses is increasing in the United States. Negative attitudes towards vaccinations, or vaccine hesitancy is fueling the decreasing vaccination rates. Ascertaining the level of vaccine hesitancy in susceptible populations is essential in combatting the rise of vaccine preventable illnesses in the United States. Very little research has previously been compiled on vaccine attitudes in Slavic immigrants. Slavic immigrants identify racially as “white” on surveys, masking differences in the Slavic population from the much larger Caucasian population in the United States. In order to better understand the level of vaccine hesitancy in the Minnesota Slavic immigrant …

Factors Contributing To Physician Assistant Burnout, Sarah F. Leonard, Tiffany J. Mellang, Connor Sacks

All Electronic Theses and Dissertations

Workplace burnout is known to be extremely prevalent among employees in the medical professions. For other health care professions such as physicians or nurses there is a plethora of existing literature on workplace burnout, but there is a lack of research on workplace burnout as it relates to Physician Assistants (PAs). This research study sought to discover what potential factors are specifically contributing to workplace burnout among PAs, symptoms of burnout experienced, and the personal strategies that PAs have found useful in coping with burnout. Interviews with ten currently practicing PAs in the Minnesota and Wisconsin region were conducted to …

The Impact Of Religious Beliefs Of Medical Practitioners On The Prescribing Of Contraceptives, Ashley M. Overby, Kayla Westling

All Electronic Theses and Dissertations

For centuries, the use of artificial birth control has been a highly debated topic across different religions and this debate continues to remain strong today. Living in a country made up of diverse cultural backgrounds and beliefs, religious differences may influence the way practitioners and patients interact with each other when it comes to a variety of medical issues, especially contraception. There is little research, however, that has been done to evaluate for a significant correlation between religious views of practitioners and their tendencies to prescribe contraceptives to patients. A questionnaire was distributed to the Association of Physician Assistants in …

An Overview Of Perinatal Health And Childhood Development In Honduras, Rose Margaret Carlson, Abigail D. Conrad, Alexandra Nicole Lothe, Caitlin M. O'Donnell, Cameron Svihla

All Electronic Theses and Dissertations

Honduras is a country with great healthcare needs. Within health care, the largest percentage of mortality is due to conditions occurring in the perinatal period, including prenatal and maternal health, delivery and postnatal care (PAHO, 2017a). Additionally, malnutrition continues to affect infants as they growth throughout their childhood (Gray, Cossman, & Powers, 2006). Education is shown to produce positive outcomes in low-income populations (Perkins, et al, 2011). The purpose of this project was to identify Honduran healthcare needs and provide effective and sustainable intervention. A needs assessment with a Honduran-Canadian health organization reiterated evidence found in the literature, illustrating the …

Attitudes Regarding Physician-Assisted Suicide Among Minnesota Family Medicine Physicians, Lauren M. Cooke, Lindsay Emmerich, Sam Feyder

All Electronic Theses and Dissertations

An affinity for bioethics lead researchers to investigate the attitudes of physicians toward physician-assisted suicide amidst growing conversation regarding patient liberties. Physician-assisted suicide (PAS) refers to the prescription of a lethal dose of a drug to prematurely end a patient’s life (Gather & Vollmann, 2013). The purpose of this study was to understand the attitudes of physicians toward PAS and thus, predict how their approach to end-of-life issues will change under its legalization. A case-based survey was created to determine the relationship between physician age and support for access to PAS, patient diagnosis and support for access to PAS, physician …

Integrative Medicine In Primary Care, Ashley M. Bjornerud

Physician Assistant Scholarly Project Posters

Integrative medicine (IM) is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health (Rakel, 2017). Commonly, IM is associated with complementary and alternative medicine therapies (CAM). These are two separate entities. CAM is one of the modalities used in integrative medicine.

Trauma Treatment For Children In The Child Welfare System, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Children involved in the child welfare system almost universally have experienced trauma, and many have experienced complex trauma. Research has shown that early intervention, treatment, and positive caregiving can reduce damage to the brain caused by trauma. Children coming into care should be screened to determine their trauma histories and related symptoms. Based on the outcomes of screenings and assessments, trauma-specific, evidence-based treatments or interventions should be provided.

For questions about this publication or others, please email [email protected]

childrens.com/fostercare

Root-Cause Analysis Of Persistently High Maternal Mortality In A Rural District Of Indonesia: Role Of Clinical Care Quality And Health Services Organizational Factors, Mohammad Afzal Mahmood, Ismi Mufidah, Steven Scroggs, Amna Rehana Siddiqui, Hafsa Raheel, Koentijo Wibdarminto, Bernardus Dirgantoro, Jorien Vercruyssen, Hayfaa A. Wahabi

Community Health Sciences

Background: Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants.
Method: Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays.
Findings: The root causes were found in poor quality of care, which caused …

Midwest Pharmacists' Familiarity, Experience, And Willingness To Provide Pre-Exposure Prophylaxis (Prep) For Hiv, Jordan M. Broekhuis, Kimberly K. Scarsi, Harlan R. Sayles, Donald G. Klepser, Joshua P. Havens, Susan Swindells, Sara H. Bares

Journal Articles: Internal Medicine

INTRODUCTION: Pharmacist provision of pre-exposure prophylaxis (PrEP) through collaborative practice agreements with physicians could expand access to people at risk for HIV. We characterized pharmacists' familiarity with and willingness to provide PrEP services in Nebraska and Iowa.

METHODS: An invitation to complete an 18-question survey was emailed to 1,140 pharmacists in Nebraska and Iowa in June and July of 2016. Descriptive analyses and Pearson chi-square tests were used to determine to what extent demographics, familiarity and experience were associated with respondent willingness to provide PrEP. Wilcoxon rank-sum tests compared ages and years of experience between groups of respondents.

RESULTS: One …

Impact Of Advanced Practice Providers (App) Care Models And Outcomes In Primary Care, Kathleen Exline

DNP Projects

Background: The Affordable Care Act, an aging population, and the increased burden of caring for the chronically ill are factors that have resulted in a significantly increased demand on primary care. This has prompted the strategy to utilize advanced practice providers (APPs) to supplement primary care physicians. Due to the inconsistency of a defined national model and measurement system, the impact of APP utilization in healthcare is not clear.

Purpose: The purpose of this project was to examine the use of APPs in primary care. The study involved a review of the current utilization of APPs, an evaluation of the …

Inequities In Antenatal Care, And Individual And Environmental Determinants Of Utilization At National And Sub-National Level In Pakistan: A Multilevel Analysis, Ambreen Sahito, Zafar Fatmi

Community Health Sciences

Background: Nationally representative surveys are vital for gauging progress in health and planning health services. However, often marred with inadequate analysis to provide any guidance to health policy and planning. Most recent Pakistan Demographic and Health Survey (PDHS) 2012-2013 is an inclusive nationally representative investigation. Nonetheless, its published report offers limited evidence regarding antenatal care (ANC). Furthermore, after 18th constitutional amendment, policies are principally made at provincial level in Pakistan; therefore, it is imperative to have contextual evidence at sub-national level to feed programs and policies.
Methods: We analysed 7142 women with a recent birth, to assess the …