Primary Care Commons^™

Dynamic Knee Hyperextension Screening As A Predictor Of Acl Injury Potential In Competitive High School Soccer Players, Jon-Paul W. Ciszewski, David Mcgehee, Jessica Schindler

All Electronic Theses and Dissertations

Introduction: Young, active populations who play sports that include sudden cutting motions, are at heightened risk of injury to the anterior cruciate ligament (ACL). Female athletes with increased joint laxity and subsequent hyperextension of the knee, are at greatest risk of ACL injury when compared to males. Purpose: The purpose of this retrospective study was to explore the incidence of dynamic knee hyperextension in high school soccer athletes by sex and team level, as observed through high-speed photography. This could lead to a potentially practicable screening tool for identifying high school soccer athletes at increased risk of ACL injury. Methods: …

Prevalence Of Caffeine Use And Knowledge Of Its Benefits, Side Effects, And Withdrawal Symptoms Among Pre-Pa Students, Pa Students, And Clinically Practicing Pas, Kjerstin Grace Durie, Chelsie Nicole Horner, Greta Sowles

All Electronic Theses and Dissertations

Caffeine is consumed daily by eighty percent of the world’s population, making it the most widely used stimulant drug. Caffeine has various benefits, side effects, and withdrawal symptoms associated with its use, but there is a lack of research that studies how much caffeine users know about these effects. This research study assessed the use of caffeine for academic and professional purposes and the knowledge about the benefits, side effects, and withdrawal symptoms of caffeine among pre-PA students, PA students, and practicing PAs in Minnesota. To do so, a paper copy of a survey was given to pre-PA students and …

Patient Satisfaction Of Physician Assistants And Physicians In The Emergency Department, Brittany Geditz, Yu Guan, Lauren Lahr

All Electronic Theses and Dissertations

Introduction: Emergency medicine has developed rapidly since the 1960s with an increasing need for providers due to the increasing number of presenting patients in the emergency department. Physician assistants have filled that gap; however, patient knowledge and subsequent patient satisfaction of emergency department physician assistants remains to be researched. Purpose: The purpose of this study is to determine and evaluate patient satisfaction after seeing a physician assistant and a physician in the emergency department. Patient knowledge of the role of a physician assistant in an emergency department setting was assessed, as well as the possible correlation between patient knowledge of …

End-Of-Life Education And Preparedness Of Physician Assistants In Minnesota And The Surrounding States, Julie Ann Graner, Lukas Steffan, Zachary Stutzman

All Electronic Theses and Dissertations

As the population in the United States ages, palliative care spending and needs have been increasing. Most quality outcome measures, however, have shown inadequate satisfaction among patients and caregivers. A number of studies have investigated the preparation and preparedness of physicians and other medical providers when dealing with end-of-life care, but few have looked in the preparedness of physician assistants (PAs). The aim of this study was to assess the preparedness of PAs when it comes to dealing with end-of-life care and to determine when and how comfort is achieved when dealing with patients at end-of-life. A novel electronic survey …

Health Literacy And Medication Administration Knowledge Of Unlicensed Health Care Workers In Assisted Living Facilities, Lynsey Jae Kissinger, Kelsey Walczak

All Electronic Theses and Dissertations

The purpose of this research was to determine the health literacy and medication administration knowledge of unlicensed health care workers such as certified nursing assistants and non-certified caregivers working in assisted living facilities in Minnesota. Currently, there is a lack of research about both the health literacy and medication administration knowledge of unlicensed health care workers. Unlicensed health care workers in assisted living facilities provide healthcare assistance to the elderly and may provide services such as medication administration, blood glucose monitoring, and assistance with activities of daily living. This research utilized the Newest Vital Sign (NVS) assessment to determine the …

The Barriers: Psychosocial And Economic Resistance Men Face In Seeking Fertility Evaluations, Cynthia C. Konrath, Ashton Makwana

All Electronic Theses and Dissertations

There has been a minimal amount of research conducted regarding barriers presenting to male patients presenting for fertility evaluations. Research that focuses on the male gender’s reactions to infertility has been just as limited. The purpose of this research, which was preformed through a literature review and custom survey, was to find some foundational insight on the barriers encountered by men seeking a fertility evaluation. These barriers include psychosocial and economical barriers. The medical field can use the outcomes of this research to as a basis to direct further studies, and to better understand barriers affecting men from seeking infertility …

Complications Of Bone And Soft Tissue Sarcoma Patients Following Limb Salvage And Amputation Procedures, Sandra Ogato

All Electronic Theses and Dissertations

Background: Extremity bone and soft tissue sarcoma are a rare type of cancer with treatment modalities to include chemotherapy and radiation and surgical procedures. Surgery can be limb salvage or limb amputation. Patients of extremity bone and soft tissue sarcomas may experience physical and psychosocial effects due to sarcoma treatments impacting physical performance, quality of life, and social support. Therefore, this study sought to evaluate the complications of extremity bone and soft tissue sarcoma in patients following limb salvage and amputation surgeries. Methods: Patients were selected from the University of Minnesota Fairview Hospital database and had a primary tumor located …

Pa Compensation Models In The Twin Cities, Kayli J. Piechowski, Alannah Pratt

All Electronic Theses and Dissertations

A variety of compensation models for medical providers exist today. Current literature reveals that the main compensation models present for physicians and other advanced practice providers today include fee for service (FFS), fixed salary, pay for performance (P4P), and mixed models. To our knowledge, no previous studies that have characterized the compensation models of physician assistants (PAs) or their satisfaction in relation to those models exists. This study aims to characterize PA compensation models in the Twin Cities metro area and analyze PA satisfaction with these models. An electronic survey was used to collect data characterizing compensation models of PAs …

A Role For B Cells In Organic Dust Induced Lung Inflammation, Jill A. Poole, Ted R. Mikuls, Michael J. Duryee, Kristi J. Warren, Todd A. Wyatt, Amy J. Nelson, Debra J. Romberger, William W. West, Geoffrey M. Thiele

Journal Articles: Internal Medicine

BACKGROUND: Agriculture organic dust exposures induce lung disease with lymphoid aggregates comprised of both T and B cells. The precise role of B cells in mediating lung inflammation is unknown, yet might be relevant given the emerging role of B cells in obstructive pulmonary disease and associated autoimmunity.

METHODS: Using an established animal model, C57BL/6 wild-type (WT) and B-cell receptor (BCR) knock-out (KO) mice were repetitively treated with intranasal inhalation of swine confinement organic dust extract (ODE) daily for 3 weeks and lavage fluid, lung tissues, and serum were collected.

RESULTS: ODE-induced neutrophil influx in lavage fluid was not reduced …

The Effect Of Statins In Primary Prevention On All-Cause Mortality, Brian Adams

Physician Assistant Scholarly Project Posters

During routine yearly physicals, primary care providers often evaluate serum laboratory lipid levels. Many of these patients have no past medical history of cardiovascular events related to atherosclerotic disease. Some patients do not have secondary risk factors, such as diabetes mellitus or smoking history.

Previous cardiovascular events provide stronger indications for the use of HMG-CoA reductase inhibitors (statins). In the absence of these, the provider may turn to current guidelines, in this case the 2013 the American College of Cardiology and the American Heart Association published the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular …

Brief Cognitive Screening Tools For Primary Care Practice, K Rhoads, Nancy B. Isenberg, L Korte

Articles, Abstracts, and Reports

Early detection and diagnosis of Alzheimer’s disease and other cognitive impairment presents as a critical issue facing primary and specialty care providers in Washington State. In order to address the gaps and challenges faced by providers, the Dementia Action Collaborative offers the current paper to provide information and guidance around early detection and diagnosis of memory loss and dementia, including Alzheimer’s disease. At the conclusion of this paper, providers should be able to identify indications and opportunities for detection, appropriate tools, and care pathways for individuals and families affected by cognitive impairment and dementia.

Barriers To Colorectal Cancer Screening Within A Rural Community In Ohio, Kristina Knoll

DNP Projects

Purpose: The purpose of this study was to perform a needs assessment within the primary care practice of ProMedica Family Medicine in Fostoria, OH. The needs assessment will specifically identify intentions and behaviors, attitudes and beliefs, subjective norms about behavioral control, and healthcare provider or healthcare system barriers related to colorectal cancer screening.

Methods: This was a cross-sectional study using a survey among a convenience sample of patients who were 50 - 75 years of age and were not currently up-to-date with their colorectal cancer screening. In total, 222 patients were screened, 133 patients were determined to not be up-to-date, …

Gastrointestinal Bleeding Events And Statin Use: A Large Propensity Score-Matched Retrospective Cohort Study, Ashley I. Martinez

Theses and Dissertations--Pharmacy

Literature is conflicting regarding the association between statin use and gastrointestinal (GI) bleeding. This study sought to determine whether there is an association between statin use and GI bleeding by comparing incidence of gastrointestinal events between statin users and an active comparator group.

Data was obtained from a large administrative claims database composed of subjects enrolled in a selection of insurance plans throughout the United States from 2009-2014. New statin users (exposed) and thyroid medication users (active comparator, unexposed) were followed from the baseline period (one year prior to medication initiation) until first event, discontinuation, or disenrollment. Subjects were matched …

A Month At The Lake Clinic - Cambodia, Mara Horwitz

Posters

Describes a global health learning experience in Cambodia on floating clinics that serve residents of remote villages of the Tonie Sap Lake and Stung Sen River.

Tender Loving Care At The Lake Clinic, Cambodia, Shubra Srinivas

Posters

Describes a global health learning experience at The Lake Clinic in Cambodia caring for children and adults in a low resource setting in 2017.

Screening For Alcohol Use/Abuse In The Primary Care Setting Using The Audit-C And Sbirt (Screening, Brief Intervention, Referral To Treatment), Whitney D. Spear

DNP Projects

PURPOSE: The purpose of this study was to examine the feasibility of alcohol screening in the primary care setting to detect alcohol abuse or misuse using the AUDIT-C standardized screening tool and SBIRT.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected via retrospective chart review from the electronic medical records by the type of office visit; either new patient initial visit or annual well visit. The patient sample consisted of 25 participants for the study period of September 19^th through October 10^th, 2017.

RESULTS: There were 37 patients eligible to participate …

Improving Healthcare Provider Knowledge In Acute And Primary Transgender Health Needs: The Implementation Of A Clinical Education Program With Urgent Care And Emergency Room Staff And Providers, Tonia Lower

Doctor of Nursing Practice Scholarly Projects

The purpose of this project was to improve knowledge and identify personal bias and beliefs in the acute and primary healthcare needs of transgender persons, through the implementation of a clinical education program with healthcare providers and staff working within the urgent care and emergency department settings. The need for such a program exists due to the lack of suitable and accessible healthcare that may lead to misdiagnosis, delay of treatment and poor health outcomes. Including clinical education in the acute and primary healthcare needs of transgender persons that can be integrated into healthcare organizations may aid in the improvement …

Why Didn’T I Know? Perspectives From Adult Children Of Elderly Parents With Dementia, Debbie Conner, Julie Postma, Catherine Van Son

All Faculty and Staff Scholarship

Purpose: Approximately 27 million adults are living with undiagnosed dementia worldwide. The purpose of this study was to learn about the experiences of adult children of elderly parents who were ultimately diagnosed with dementia.

Data sources: A descriptive qualitative design was used for identifying if there were prodromal signs or symptoms that preceded the more commonly known warning signs of dementia. Twelve, 60-min interviews were conducted over the telephone.

Conclusions: The overarching theme was: “Why didn't I know?” Subthemes were “We ignored it because we didn't want it to be,” “We thought it was grief,” and “They wouldn't diagnose dementia.” …

Decreasing Cost Associated Medication Nonadherence, Shawn E. Raymond

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Shawn E. Raymond

Medication cost is a major contributor for patient medication nonadherence. Take in the fact that a large population lives in poverty, many cannot afford to pay the retail prices associated with purchasing their medications. By incorporating wholesale medications into a charitable health clinic, the reduced cost of medications for treatment of both acute and chronic illnesses could be passed on to those in need thereby decreasing cost associated medication nonadherence. Nurse Practitioners in the state of Kansas are not afforded the privilege to purchase, repackage and distribute or resell wholesale …

Proceedings Of 2016 Aurora Scientific Day

Journal of Patient-Centered Research and Reviews

This supplement includes select abstracts presented at the 42nd annual Aurora Scientific Day research symposium, held May 25, 2016, in Milwaukee, Wisconsin. Aurora Scientific Day provides a forum for original research conducted by faculty, fellows, residents, students and other allied health professionals affiliated with Aurora Health Care, a not-for-profit health system comprised of integrated hospitals and clinics across eastern Wisconsin and northeastern Illinois.

Recruiting And Retaining Individuals With Serious Mental Illness And Diabetes In Clinical Research: Lessons Learned From A Randomized, Controlled Trial., Stephanie W. Kanuch M.Ed., Kristin A. Cassidy Ma, Neal Dawson Md, Melanie Athey Ms, Edna Fuentes-Casiano Mssw, Martha Sajatovic Md

Journal of Health Disparities Research and Practice

Abstract: Recruitment and retention of individuals with serious mental illness (SMI) and comorbid diabetes mellitus (DM) in research studies can be challenging with major impediments being difficulties reaching participants via telephone contact, logistic difficulties due to lack of transportation, ongoing psychiatric symptoms, and significant medical complications. Research staff directly involved in recruitment and retention processes of this study reviewed their experiences. The largest barriers at the macro, mediator, and micro levels identified in this study were inclement weather, transportation difficulties, and intermittent and inaccessible telephone contact. Barrier work-around practices included using the health system’s EHR to obtain current phone numbers, …

Outpatient Antibiotic Prescribing Among United States Nurse Practitioners And Physician Assistants., Guillermo V Sanchez, Adam L Hersh, Daniel J Shapiro, James F. Cawley, Lauri A Hicks

Prevention and Community Health Faculty Publications

We examined US nurse practitioner (NP) and physician assistant (PA) outpatient antibiotic prescribing. Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). Antibiotic stewardship interventions should target NPs and PAs.

Antiretroviral Therapy For The Prevention Of Hiv-1 Transmission., Myron S. Cohen, Ying Q. Chen, Marybeth Mccauley, Theresa Gamble, Mina C. Hosseinipour, Nagalingeswaran Kumarasamy, James G. Hakim, Johnstone Kumwenda, Beatriz Grinsztejn, Jose H.S. Pilotto, Sheela V. Godbole, Suwat Chariyalertsak, Breno R. Santos, Kenneth H. Mayer, Irving F. Hoffman, Susan H. Eshleman, Estelle Piwowar-Manning, Leslie Cottle, Xinyi C. Zhang, Joseph Makhema, Lisa A. Mills, Ravindre Panchia, Sharlaa Faesen, Joseph Eron, Joel Gallant, Diane Havlir, Susan Swindells, Vanessa Elharrar, David Burns, Taha E. Taha, Karin Nielsen-Saines, David D. Celentano, Max Essex, Sarah E. Hudelson, Andrew D. Redd, Thomas R. Fleming

Journal Articles: Internal Medicine

BACKGROUND: An interim analysis of data from the HIV Prevention Trials Network (HPTN) 052 trial showed that antiretroviral therapy (ART) prevented more than 96% of genetically linked infections caused by human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. ART was then offered to all patients with HIV-1 infection (index participants). The study included more than 5 years of follow-up to assess the durability of such therapy for the prevention of HIV-1 transmission.

METHODS: We randomly assigned 1763 index participants to receive either early or delayed ART. In the early-ART group, 886 participants started therapy at enrollment (CD4+ count, 350 …

Primary Health Care: Potential Home For Family-Focused Preventive Interventions, Laurel K Leslie, Christopher J Mehus, J David Hawkins, Thomas Boat, Mary Ann Mccabe, Shari Barkin, Ellen C Perrin, Carol W Metzler, And 4 Others

Pediatrics Faculty Publications

Family-focused prevention programs have been shown to effectively reduce a range of negative behavioral health outcomes but have had limited reach. Three key barriers must be overcome to expand the reach of family-focused prevention programs and thereby achieve a significant public health impact. These barriers are (1) current social norms and perceptions of parenting programs; (2) concerns about the expertise and legitimacy of sponsoring organizations to offer parenting advice; and (3) a paucity of stable, sustainable funding mechanisms. Primary healthcare settings are well positioned to overcome these barriers. Recent changes within health care make primary care settings an increasingly favorable …

Toll-Like Receptor 4 Signaling Pathway Mediates Inhalant Organic Dust-Induced Bone Loss., Elizabeth Staab, Geoffrey M. Thiele, Dillon Clarey, Todd A. Wyatt, Debra J. Romberger, Adam D. Wells, Anand Dusad, Dong Wang, Lynell W. Klassen, Ted R. Mikuls, Michael J. Duryee, Jill A. Poole

Journal Articles: Internal Medicine

Agriculture workers have increased rates of airway and skeletal disease. Inhalant exposure to agricultural organic dust extract (ODE) induces bone deterioration in mice; yet, mechanisms underlying lung-bone crosstalk remain unclear. Because Toll-like receptor 2 (TLR2) and TLR4 are important in mediating the airway consequences of ODE, this study investigated their role in regulating bone responses. First, swine facility ODE stimulated wild-type (WT) bone marrow macrophages to form osteoclasts, and this finding was inhibited in TLR4 knock-out (KO), but not TLR2 KO cells. Next, using an established intranasal inhalation exposure model, WT, TLR2 KO and TLR4 KO mice were treated daily …

Motivation And Retention Of Physicians In Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan, Sayed Masoom Shah, Shehla Zaidi, Jamil Ahmed, Shafiq Ur Rehman

Community Health Sciences

BACKGROUND:

Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan.

METHODS:

An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental …

The Carefirst Patient-Centered Medical Home Program: Cost And Utilization Effects In Its First Three Years, Alison Cuellar, Lorens A. Helmchen, Gilbert Gimm, Jay Want, Sriteja Burla, Bradley Kells, Iwona Kicinger, Len M. Nichols

Health Policy and Management Faculty Publications

Background

Enhanced primary care models have diffused slowly and shown uneven results. Because their structural features are costly and challenging for small practices to implement, they offer modest rewards for improved performance, and improvement takes time.

Objective

To test whether a patient-centered medical home (PCMH) model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits.

Design

We compared medical care expenditures and utilization among adults who participated in the PCMH program to adults who did not participate. We computed difference-in-difference estimates using two-part multivariate generalized …

Improving Collaboration Between Pharmacists And Physicians, Paras Patel

BU Well

Physicians and pharmacists have differing but complementary roles that can optimize patient care when structured effectively. Unfortunately, these two professionals are not collaborating well enough, as patient outcomes, especially in relation to medication adherence, continue to decline. Coordinated care of patients can improve by expanding bidirectional communication and sharing additional patient information with each other. It will be necessary to continue to promote collaborative care in the educational and training stages of these professionals’ careers to build trust and understanding of professional scope. Ultimately, the healthcare infrastructure will have to continue to progress to make collaboration more available and valuable …

Modifiable Barriers To Optimal Outcomes In Gout Management, Brian W. Coburn

Theses & Dissertations

Improving patient outcomes in chronic disease is of critical importance to the future of health care. Gout, affecting 4% of the US population, is a highly treatable chronic disease from which patients experience unnecessarily suboptimal outcomes. In this dissertation, I demonstrate how interrelated patient and provider factors affect patient outcomes in gout. First, I describe how only 14% of gout patients know their serum urate (SU) goal for urate lowering therapy (ULT) despite otherwise being knowledgeable about gout and its treatment. I then demonstrate the importance of multiple patient and provider factors in achieving SU goal. Specifically, I demonstrate that …

Routine Screening For Abdominal Aortic Aneurysm: Is It For Everyone?, Catherine E. Nowak

Physician Assistant Capstones, 2016 to 2019

Objective: Determine whether routine abdominal ultrasound screening in all men ages 65 and over, not just those who are symptomatic or at risk, would be beneficial in reducing the mortality rate from abdominal aortic aneurysms (AAA). Design: Systematic literature review. Methods: The clinical question investigated is whether routine ultrasound screening of AAA for men over age 65 reduces AAA-related mortality as compared to not routinely screening. Searches were done through PubMed using the keywords: screening, abdominal aortic aneurysm, reduce, and mortality. Citations used by the USPSTF AAA screening guidelines were also added to the literature search. In PubMed, further limitations …