Primary Care Commons^™

Deprescribing Proton Pump Inhibitors In A Rural Health Clinic, Jason Thomas Barney

Doctoral Dissertations & Projects

Background: Proton pump inhibitors (PPIs) have been extensively prescribed for gastrointestinal pathologies, contributing to $14 billion in annual expenditure in the United States alone. Inappropriate PPI prescriptions, affecting 48% of adults, raise concerns about prolonged usage and associated health risks. Addressing these issues is vital, considering the significant impact of PPIs on patient health and healthcare costs.

Local Problem: A Midwestern clinic grapples with inappropriate and unnecessary PPI use among patients. In response, a comprehensive deprescribing intervention combining a provider algorithm with patient education was implemented to reduce PPI usage that was medically unnecessary.

Methods: A literature …

The Dementia Care Study (D-Care): Recruitment Strategies And Demographic Characteristics Of Participants In A Pragmatic Randomized Trial Of Dementia Care, Mia Yang, Rafael Samper-Ternent, Elena Volpi, Aval-Na'ree Green, Maya Lichtenstein, Katy Araujo, Pamela Borek, Peter Charpentier, James Dziura, Thomas M Gill, Rebecca Galloway, Erich J Greene, Kristin Lenoir, Peter Peduzzi, Can Meng, Jordan Reese, Amy Shelton, Eleni A Skokos, Jenny Summapund, Erin Unger, David B Reuben, Jeff D Williamson, Alan B Stevens

Faculty, Staff and Student Publications

INTRODUCTION: Pragmatic research studies that include diverse dyads of persons living with dementia (PLWD) and their family caregivers are rare.

METHODS: Community-dwelling dyads were recruited for a pragmatic clinical trial evaluating three approaches to dementia care. Four clinical trial sites used shared and site-specific recruitment strategies to enroll health system patients.

RESULTS: Electronic health record (EHR) queries of patients with a diagnosis of dementia and engagement of their clinicians were the main recruitment strategies. A total of 2176 dyads were enrolled, with 80% recruited after the onset of the pandemic. PLWD had a mean age of 80.6 years (SD 8.5), …

Effectiveness Of A Training Program For The Management Of Risky Alcohol Use In Primary Care Professionals Based On Motivational Interviewing, Celia Pérula-Jiménez, Esperanza Romero-Rodríguez, Juan Manuel Parras-Rejano, Ana González De La Rubia, Juan Baleato Gómez, Luis Angel Pérula De Torres

Faculty, Staff and Student Publications

OBJECTIVE: To assess the effectiveness of a training program for Primary Care (PC) professionals developed to increase knowledge, attitudes, and skills for managing patients with risky alcohol use and in the motivational interview.

DESIGN: Multicenter, two-arm parallel, randomized, open-label controlled clinical trial.

SETTING: PC of the Andalusian Health Service.

PARTICIPANTS: The study was completed by 80 healthcare professionals from 31 PC centers.

INTERVENTIONS: In both experimental and control groups, a workshop on managing patients with risky alcohol consumption and the resolution of two videotaped clinical cases with standardized patients were conducted. The experimental group attended a workshop on motivational interviewing. …

Supervision Needs Of Novice Behavioral Health Providers In Integrated Primary Care Settings: A Delphi Study, Nicholas D. Schmoyer

Counseling & Human Services Theses & Dissertations

The integration of behavioral health providers (BHPs, i.e., clinical mental health counselors, clinical psychologists, clinical social workers, marriage and family therapists) into primary care settings has developed as a healthcare practice associated with enhanced patient clinical outcomes, enhanced patient satisfaction, reduced healthcare expenditures, and enhanced provider wellness and satisfaction, known together as the Quadruple Aim. For BHPs practicing in integrated primary care (IPC) settings, researchers have highlighted a variety of challenges they experience when integrating in these settings, with a consistent challenge being a lack of satisfactory training and supervision. Clinical supervision has been hailed as the “signature pedagogy” for …

Establishing The First Student-Run Clinic To Provide Free Health Care To A South Texas Colonia, John Nicholas Cauba, Andrew B. Callan, Beatriz Tapia

Research Symposium

Purpose: The purpose of the University of Texas Rio Grande Valley School of Medicine Student Run Clinic is to bridge the healthcare gap in the local colonias by providing excellent, compassionate primary care to all who enter our doors, free of charge. We also work to connect our patients to low-cost, high-quality services in the area like women’s health visits, appointments with social workers, and dental services. Additionally, we offer medical students’ opportunities from their first year to serve an underserved population and get hands-on experience with patients.

Many patients in colonias face challenges like limited transportation options and a …

Development Of Solitary Keratoacanthoma From A Cutaneous Wart, Joshua M. Ninan, Veronica Salazar

Research Symposium

Background: Common cutaneous warts, referred to in medicine as verrucae vulgaris, are proliferative lesions caused by human papillomavirus. These lesions are mostly benign and usually resolve without incident, except in the case of the patient mentioned in this report. Our patient developed a solitary keratoacanthoma, currently accepted as a clinical variant of squamous cell carcinoma, as a result of several risk factors and traumatic exposure. The current literature does not have an established association of HPV with solitary keratoacanthomas. This case report explores the presentation and pathogenesis of solitary keratoacanthomas within the setting of HPV.

Case Presentation: 48-year-old Caucasian female …

Baclofen Induced Excessive Perspiration; A Case Report, Othman Farahneh, Lois C. Akpati, Miguel Alvarez Silva

Research Symposium

This case report highlights an unexpected side effect of Baclofen, a well-known medication, excessive sweating, a rare occurrence not typically associated with the drug. The patient, a 63-year-old woman, experienced persistent sweating despite initial attributions to postmenopausal symptoms and subsequent medication adjustments. Extensive testing revealed an association between Baclofen use and the symptoms, which resolved upon discontinuation of the drug.

The significance of this case lies in drawing attention to the underreported side effects of excessive sweating linked to Baclofen, emphasizing the importance of considering medication-related effects even with established drugs. The report urges increased awareness among healthcare professionals, addressing …

A True Bloody Emergency: An Unusual Case Of Thrombotic Thrombocytopenic Purpura, Joshua M. Ninan

Research Symposium

Background: Thrombotic thrombocytopenic purpura (TTP) is a primary thrombotic microangiopathy that is classically characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA). Although rare with an annual incidence of 3.7 cases per one million adults, it is considered a true hematological emergency due to its fatality rate of almost 100% if appropriate treatment is not initiated immediately. This makes it vitally important to identify and treat patients with TTP, a task that becomes unusually challenging in the absence of the disorder’s other characteristically diagnostic clinical features such as mucosal bleeding, fever, or presence of schistocytes.

Case Presentation: A 30-year-old gentleman with …

Assessment Of Breastfeeding Education In Medical Training, Saranya Madan, Abigail Kuplicki

Medical Student Research Symposium

In 2019, the Academy of Breastfeeding Medicine issued a revised set of educational objectives for medical trainees at various stages of education. In this statement, objectives for medical school were broken down into preclinical and clinical training objectives. In this project, our goal is to assess the degree to which medical training at Wayne State University School of Medicine is addressing these aims.

The assessment of breastfeeding education is accomplished by surveying medical students at various stages of training (M1-M4) and eliciting their level of confidence in and understanding of the topics outlined in the objectives by the Academy of …

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Efficacy Of A Primary Care Ehealth Obesity Treatment Pilot Intervention Developed For Vulnerable Pediatric Patients, Joshua S Yudkin, Marlyn A Allicock, Folefac D Atem, Carol A Galeener, Sarah E Messiah, Sarah E Barlow

Faculty, Staff and Student Publications

Background:

Challenges to treat excess weight in primary care settings include time constraints during encounters and barriers to multiple visits for patient families, especially those from vulnerable backgrounds. Dynamo Kids! (DK), a bilingual (English/Spanish) e-health intervention, was created to address these system-level challenges. This pilot study assessed the effect of DK use on parent-reported healthy habits and child BMI.

Methods:

In this 3-month, quasi-experimental cohort design, DK was offered to parents with children aged 6–12 years with BMI ≥85th percentile in three public primary care sites in Dallas, Texas. DK included three educational modules, one tracking tool, recipes, and links …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Acne Vulgaris - Comedonal Acne, Christopher M. Wong, Christina Guo, Christian J. Scheufele, Daniel A. Nguyen, Jean Elizze M. Charles, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Acne vulgaris is a common inflammatory skin condition of the pilosebaceous unit in adolescents and young adults and is primarily characterized by the presence of open and closed comedones. In patients of various skin pigmentations, skin-colored comedones may be difficult to appreciate and lead to incorrect or delayed diagnosis of acne. To aid in the identification of acne vulgaris in patients of various skin pigmentations, we present comedonal acne in different skin types and commonly encountered differential diagnoses. With its significant volume and burden of disease, acne vulgaris should be correctly identified in various skin pigmentations by primary care clinicians …

Identifying Virtual Care Modality In Electronic Health Record Data, Kurt C. Stange

Faculty Scholarship

Background: Virtual care increased dramatically during the COVID-19 pandemic. The specific modality of virtual care (video, audio, eVisits, eConsults, and remote patient monitoring) has important implications for the accessibility and quality of care, but rates of use are relatively unknown. Methods for identifying virtual care modalities, especially in electronic health records (EHR) are inconsistent. This study (a) developed a method to identify virtual care modalities using EHR data and (b) described the distribution of these modalities over a 3-year study period. Methods: EHR data from 316 primary care safety net clinics throughout the study period (4/1/2020-3/31/2023) were included. Visit type …

Revolutionizing Denture Excellence: An Invigorating In-Vitro Exploration Of Organic Products In Prosthetic Rehabilitation, Nighila Ravindran, Sneha Joseph, Aswani Surya K

Annual Research Symposium

The denture base comes into contact with diverse substances in the oral cavity, acting as a reservoir for microorganisms like corynebacterium, streptococcus, lactobacillus, and candida. This colonization elevates the risk of complications such as denture stomatitis and candidiasis. Commercial denture cleaners have explored the use of natural ingredients, less commonly employed but offering various advantages. These ingredients aim to mitigate the potential issues associated with microbial colonization on denture surfaces, contributing to improved oral hygiene for denture wearers. The exploration of natural elements reflects a nuanced approach to denture care, considering both efficacy and less conventional alternatives.

Investigating Racial And Ethnic Healthcare Disparities In Screenable Ob/Gyn-Related Cancers, Lara Laughrey

Annual Research Symposium

This is a scoping review of peer-reviewed literature addressing healthcare inequity based on race and ethnicity with a specific focus on Ob/Gyn-related management and treatment of screenable cancers.

Assessment Of Emotional Intelligence Among Students In Dental College, Gowri Nandana S Final Year Student, Sudeep C. B Professor And Head Of The Department Of Public Health Dentistry

Annual Research Symposium

Over an extended period, the examination of intelligence predominantly centered on the adaptive deployment of cognitive abilities. In more recent times, scholars such as Gardner (1983) and Sternberg (1988) have proposed comprehensive frameworks for comprehending intelligence. Pioneering the concept of "emotional intelligence," Salovey and Mayer (1990) posited that emotional intelligence encompasses three distinct categories of adaptive capabilities: the evaluation and expression of emotions, the regulation of emotions, and the utilization of emotions in problem-solving. The objective is to evaluate emotional intelligence among dental students across various educational institutions.

Quality Of Life In Orthodontics, Claudia Eisenhuth, Gabriel Eisenhuth, Connor Schwartz, Amir Mohajeri, Man Hung, Tiffany Nelson, Ryann Glenn

Annual Research Symposium

Orthodontic treatment goes beyond mere cosmetic enhancement; it significantly impacts various aspects of an individual's quality of life. Beyond the physical benefits of improved oral function and prevention of dental issues, orthodontics also yields profound psychological benefits. Aligned teeth enhance self-confidence, reduce social anxiety, and contribute to better relationships and professional opportunities. Moreover, addressing dental concerns through orthodontic treatment reduces psychological distress and promotes overall happiness and satisfaction. Real-life case studies vividly illustrate the transformative effects of orthodontic interventions, emphasizing the importance of considering quality of life outcomes in dental care.

De Novo Microdeletion Spanning Ywhae And Crk In An Individual With Intellectual Disability And Stunted Growth, Eden E. Pope, John A. Kriak, Kyle B. Bills, David W. Sant

Annual Research Symposium

In this report, we present a case of a 20-year-old female with congenital intellectual disability, stunted growth, and hypothyroidism. Competitive genetic hybridization (CHG) revealed a loss of a portion of 17p13.3 at least 195 Kb in size, not present in either parent. This area of chromosome 17 is associated with Miller-Dieker Syndrome (MDS) and Isolated Lissencephaly Sequence (ILS), but these conditions are related predominantly to PAFAH1B1, which is not included in the patient’s deletion.

Investigating The Interplay Between Glucose Regulation, Neural Activity, And Motivation: A Novel Approach Utilizing Vibration Stimulation, Blake D. Harris, Patrick Tanner Brain, Alessandra Maisie Rivera, Tiffany Nguyen, James Barber, Amar Paul, John Dougherty Jr., Matthew Jennings, Bridger Gunter, David W. Sant, Christina A. Small, Scott Steffenson, Kyle B. Bills

Annual Research Symposium

This research explores the intricate relationship between glucose regulation, neural activity, and motivation in key brain regions, including the hypothalamus, basal ganglia, ventral tegmental area (VTA), and nucleus accumbens (NA). We aim to unravel the potential relationship of these factors on dopamine (DA) release and the broader implications for mental health, glucose regulation, well-being, and overall health. Our innovative approach involves using a chair that causes heterodyned whole-body vibration designed to stimulate DA release from the VTA and NA, areas associated with motivation and rewards.

Exploring The Interconnected Role Of The Oral Microbiome And Periodontal Disease In The Development And Progression Of Oral Squamous Cell Carcinoma, Malak Al-Regib, Claudia M. Tellez Freitas

Annual Research Symposium

This comprehensive review explores the complex linkage among the oral microbiome, periodontal disease, and the onset and progression of oral squamous cell carcinoma (OSCC).

A Rare Appendiceal Mucocele Of The Appendix Captured On The Ultrasound: Case Report, Vera Shulgina, Meghan Single, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Appendiceal mucocele is a rare disease which results from an accumulation of mucus in the lumen of the appendix, leading to distension and obstruction of the lumen. Clinical diagnosis is often delayed, as the presenting symptoms are usually non-specific. Even with the use of imaging, preoperative diagnosis is difficult. The treatment is surgical, with the extent determined by the surgical specimen. Definitive diagnosis is by histopathology. Our case report presents a rare case of appendiceal mucocele originally captured by ultrasound. The aim of this paper is to further understand the clinical presentation, discuss key ultrasound findings, and examine the proper …

Dna Extraction Method Development For Ocular Tissues, Conrad K. Ashby, Michael C. Trapnell, Walker C. Kay, Jonathon C. Reynolds, Noah R. Schultz, Brandon J. Burger, Christina A. Small, John A. Kriak, Kyle B. Bills, David W. Sant

Annual Research Symposium

Purpose: DNA extraction kits are traditionally developed to work with liquid tissues such as blood, saliva, and swabs, but some have been proposed to work with solid tissues. Somatic variation in cancers can be important for tumor subtyping and treatment guidance, including ocular tumors. Additionally, epigenetic marks such as 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC) are tissue-specific and change in disease states, particularly evident in diabetic retinopathy and age-related macular degeneration. Commercial DNA extraction kits are available from several vendors, but the various kits have different strengths and weaknesses, and the removal of PCR inhibitors will vary with each kit. This …

Non-Traditional Presenting Grade Ii Brain Meningioma: A Case Study, Alessandra M. Rivera, Garret Phillips, Serin Baker, Michael Trapnell, Conrad Ashby, Jacob Hill, Prina Patel, Alexander Ruiz, Elden Jenkins, Johan A. Kriak, Kyle B. Bills, Voicu S. Ciobanu, Tipsuda Bahri, David W. Sant

Annual Research Symposium

Meningioma is a relatively common form of cancer, occurring in approximately 97 out of 100,000 individuals. Although it arises from the meninges surrounding the central nervous system (CNS) rather than from neurons, it is classified with CNS tumors due to overlapping symptoms caused by compression of nerves and vessels in the head. Extracranial metastasis is rare, at less than 1%, and correlates with reduced survival rates.

Neurocognitive Considerations And Impacts In Chronic Migraines, Kennedy Madrid, Jacob Warner, Jordyn Huecker, Cassidy Byers, Kyle Reaveley, Kailee Edwards, Luke Sanders, Christina A. Small, David W. Sant, John A. Kriak, Kyle B. Bills

Annual Research Symposium

Migraine, characterized by moderate-to-severe headache, may arise from neurological, psychological, orthopedic, metabolic, or endocrine origins. Pain associated with migraine, while commonly cited as the primary patient concern, only represents a small portion of short- and long-term effects caused by the condition. Many presenting cases include neuromuscular dysfunction, increased neuronal firing, inflammation, and cortical spreading depression. These effects can induce multiple symptoms such as pain, aura, brain fog, confusion, hangover, multiple hypersensitivities, and decreased memory capacity. These effects and symptoms can lead to neurocognitive and neuropsychological deficiencies in many patients. This study aims to investigate the relationship between migraines and neurocognitive …

Neuropsychological Findings In Idiopathic Adult-Onset Epilepsy Case Study: Noorda Com Student Investigation, Jacob Warner, Michael Milius, Jordyn Huecker, Tiffany Nguyen, Luke Sanders, Joseph Harbold, Kennedy Madrid, Nicholas Curtis, Chase Taylor, James Barber, Jayne Stuter, Ethan Zaugg, Aaron Andrews, John A. Kriak, David W. Sant, Kyle B. Bills

Annual Research Symposium

We report the case of a 25-year-old male patient with idiopathic adult-onset epilepsy. The patient presented with a chief complaint of recurrent seizures and no identifiable cause. These seizures were associated with a lack of extremity control, muscle spasms, and loss of cognitive function. His condition began while living in Thailand, where he experienced multiple environmental stressors including hostile living conditions and tense situations, approximately five years before being seen in the clinic. Over the past several years, the seizures have not ceased, and the patient now notes a loss or decrease of several special senses.

Piriformis Syndrome With A Variant Presentation, Roberto Chuapoco, Ryan E. Linford

Annual Research Symposium

Piriformis syndrome has long been a diagnostic quandary due to its tendency to present as other nerve-related conditions. Piriformis syndrome is commonly caused by entrapment of the sciatic nerve as it travels through the greater sciatic foramen due to hypertrophy of the piriformis muscle. However, its constellation of symptoms, including radiating pain down the thigh, can easily be mistaken for lumbosacral radiculopathy. This case report aims to address the misdiagnosis of piriformis syndrome which has prolonged pain for many patients and increased the cost of medical care. It demonstrates a 76-year-old female with a confounding presentation of piriformis syndrome: buttock …

Development Of A Protocol For Obtaining Biological Samples For Genetic Testing From Remote Individuals, Noah R. Schultz, Brandon J. Burger, Jacob Warner, Alfred Amendolara, Jameson Williams, Molly Henley, Layla Risdon, Alessandra Maisie Rivera, Amanda Page, Millicent Jiang, Denisse Castaneda, Garret Phillips, John A. Kriak, Kyle B. Bills, David W. Sant

Annual Research Symposium

Pharmacogenomic sequencing allows individuals to learn more about how they will respond to certain medications but requires shipping of a biological sample. One complication of sending biological samples to remote laboratories is stability. Blood generally yields sufficient quantities of high-quality DNA but requires a clinic visit. Saliva and buccal swabs are routinely used for DNA extractions, but the DNA quality is notoriously low due to the presence of bacteria in the mouth. Additionally, elderly individuals have difficulty producing enough saliva for testing, and the tubes contain several milliliters of liquid and shipping requires special considerations. Dried blood spot cards, which …

Dna Extraction Method Development For Solid Tissues, Ryan Powers, Noah R. Schultz, Brandon J. Burger, John Dougherty Jr., Ezenna Obilor, Alexander Ruiz, Corwin Frey, Nathaniel Hill, Lara Laughrey, Patrick Tanner Brain, Sara Mcmahon, Parker Feltner, Steven Tung, Daoud Sajady, Elden Jenkins, Julian Jarquin, Serin Baker, Aaron Andrews, John A. Kriak, Kyle B. Bills, David W. Sant

Annual Research Symposium

Although germline variation testing is traditionally performed using DNA obtained from blood or other liquid samples, determining somatic variation in cancer samples requires DNA extraction directly from tissues. Additionally, epigenetic markers, such as 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC) are tissue-specific and change in selected disease states. However, several substances present in tissues are known to inhibit downstream reactions, including polymerase chain reaction PCR). For this project, we are assessing the quantity and quality of DNA obtained from extractions of various vital organs using 30 different commercially available DNA extraction kits to determine optimal kits for each tissue.

Investigating The Genetics Of Chronic Intractable Migraine With Reactive Hypoglycemia, C Yvonne Russell, Jacob Warner, Brandon J. Burger, Jordan Cutshall, Naeel Uddin, Patrick Tanner Brain, Alessandra Maisie Rivera, Braden Cunningham, Kailee Edwards, Katie Beechay, Luke Sanders, Zachary Ta, John A. Kriak, David W. Sant, Kyle B. Bills

Annual Research Symposium

Migraines affect roughly 1-in-6 males and 1-in-5 females in the United States. Of these, approximately 5-30% experience intractable migraines, or migraines resistant to abortive treatments. Despite this large population, relatively little is known about intractable migraines compared to other types of migraines. Our recent work indicates that reactive hypoglycemia is common among these individuals. Additionally, empirical evidence suggests that individuals in families with chronic intractable migraines are more likely to have the same condition than people of the general population, suggesting a possible genetic link between both migraines and metabolic abnormalities. Previous Genome Wide Association Studies (GWAS) have found several …

Investigating The Role Of Chaos In Minimizing Tumor Growth, Maxwell Geiger

Annual Research Symposium

Chaos is a type of motion found in mathematical systems that is highly sensitive to initial conditions. While many biological systems described in literature have been analyzed for the presence of chaotic dynamics, there are still many that are yet to be discovered. The goal of this project is to reassess Itik and Banks’ discovery of chaotic behavior in their population dynamics model of cancer growth. Once chaotic behavior is confirmed, we want to investigate how chaos could possibly be controlled to minimize tumor growth and discover novel treatments for cancer patients.