Family Medicine Commons^™

Applying Mixed-Effects Modeling To Behavioral Economic Demand: An Introduction, Brent A. Kaplan, Christopher T. Franck, Kevin Mckee, Shawn P. Gilroy, Mikhail N. Koffarnus

Family and Community Medicine Faculty Publications

Behavioral economic demand methodology is increasingly being used in various fields such as substance use and consumer behavior analysis. Traditional analytical techniques to fitting demand data have proven useful yet some of these approaches require preprocessing of data, ignore dependence in the data, and present statistical limitations. We term these approaches “fit to group” and “two stage” with the former interested in group or population level estimates and the latter interested in individual subject estimates. As an extension to these regression techniques, mixed-effect (or multilevel) modeling can serve as an improvement over these traditional methods. Notable benefits include providing simultaneous …

Opioid Use Disorder: The Timeline For Medication Assisted Therapy, Alexander Cristofori

Capstone Showcase

Opioid Use Disorder is patterns of opioid use leading to withdrawal, giving up important life events in order to use opioids, and excessive time spent using opioids, to name a few diagnostic criteria. The clinical progression of the disorder involves periods of acute exacerbation and remission that are cyclic in nature. Treatment is most effective when it includes both pharmacological and psychosocial modalities, referred to as medication assisted therapy (MAT). Three drugs used commonly in MAT-based treatment for OUD from oldest to newest include Methadone, Buprenorphine-naloxone, and Naltrexone. Treatment program models that prioritize total abstinence from the addictive substance attached …

Acupuncture Therapy In The Treatment Of Osteoarthritis Of The Knee, Reece Bartell

Capstone Showcase

Abstract

Introduction: Osteoarthritis (OA) is a chronic condition that affects the joints of the body, most commonly the knees; it has the potential to cause debilitating pain, and stiffness and decrease quality of life. The current management involves lifestyle modifications of a healthy diet and exercise as well as analgesics like NSAIDs or acetaminophen to manage symptoms. Long-term use of these medications has been associated with many side effects affecting the GI and CV system. This review analyzes the use of acupuncture therapy (I) for symptom management (O) in patients aged 60-80 years old suffering from mild to moderate …

Statins And Women, Debra Schulte

Rural Health Professions Projects

Low-density lipoprotein (LDL) elevation is a primary risk factor for atherosclerotic cardiovascular problems such as heart disease and stroke. Heart disease is the leading cause of death in the United States and stroke is the fifth leading. Earlier LDL reduction improves morbidity and mortality. Literature indicates fewer women start statin medications compared to men.

The Effectiveness Of Digital Health Interventions For Weight Loss In Postpartum Women: A Systematic Review And Meta-Analysis, Logan Rabuogi

Master of Medicine in Family Medicine

Objectives: This systematic review and meta-analysis aimed (1) to determine the effectiveness of digital health intervention (DHI) components on weight loss in postpartum women, (2) to determine the effect of DHIs on body mass index and (3) to determine the attrition rates within DHIs. Methods: Electronic searches were conducted on PubMed (MEDLINE), Cochrane Library, Google Scholar, and Web of Science from inception to 22nd April 2020. Studies included were; (1) randomized controlled trials (RCT), quasi-experimental trials, and controlled before-after studies (2) of weight loss interventions delivered by either website, Internet, email, computer, Apps, SMS, phone call, or video player (3) …

Developing An End-Of-Life Discussion Protocols, James Hawley

Rural Health Professions Projects

End of life (EOL) issues are far too often addressed reactively in Emergency Departments when patients can no longer express their wishes. This scenario can result in unwanted futile care, increased healthcare costs, and emotional hardships for family and healthcare workers. The purpose of this quality improvement project was to implement a provider-patient communication protocol that would shift advanced directive conversations proactively back into the local rural primary care setting.

Colorectal Cancer: Screening And Prevention Education, Johnna Boggs

Rural Health Professions Projects

Colorectal cancer is the 2^nd leading cause of cancer related deaths in the United States (USPSTF, 2016). In 2017 there were over 141, 000 cases diagnosed with over 51,000 deaths reported (Center for Disease Control, 2020). This raises great concern for primary care clinicians. One guideline recommended by USPSTF, is that patients undergo screening who are at low to moderate risk for colorectal cancer. This can be done by various studies. Cologuard, which is a fecal occult screening that detects certain DNA markers or blood is currently recognized by the USPSTF for colorectal cancer. The purpose of this quality …

Evaluation Of A Rural Clinic's Compliance With Bone Density Screening In Women Aged 65 And Greater, Chelsea B. Brincks

Rural Health Professions Projects

Osteoporosis affects over 12 million Americans, leading to fractures, chronic pain, reduced independence, and decreased quality of life (United States Preventative Services Task Force [USPSTF], 2018). Up to 30% of individuals who suffer an osteoporotic hip fracture will not survive 12 months post-fracture, and 71% of all osteoporotic fractures occur in women (USPSTF, 2018). Due to increased risk with age, the USPSFT recommends all women have initial bone densitometry at age 65 or greater (2018). Medicare reimburses DEXA screening, the gold standard bone densitometry, every 24 months in individuals at risk (Centers for Medicare & Medicaid Services [CMMS], 2018). The …

Physician Knowledge, Attitudes, And Behaviors Towards Registered Dietitian Nutritionists, Amy Motley Jones

UNF Graduate Theses and Dissertations

Diet is increasingly linked with overall quality of life, and a healthy diet is now being considered one of the cornerstones of preventative care. Physicians rely on Registered Dietitian Nutritionists (RDNs) as most doctors lack the nutrition knowledge to properly treat their patients, especially during their residency. Little published information exists on the specific collaboration of RDNs and resident physicians. This study aimed to determine whether mentoring with an RDN increased physician nutrition knowledge, increased consults to RDNs, and whether physician attitudes improved regarding their understanding of the role of the RDN in healthcare. Knowledge or attitude alone are not …

Evaluating The Use Of Telehealth To Manage Hypertension In Primary Care, Alexandra M. Wiesner

DNP Projects

Background: Hypertension remains one of the most common chronic conditions in the United States leading to several health complications and immense financial burdens, yet it remains grossly undertreated despite the availability of evidence-based treatment options. The 2017 guidelines from the American College of Cardiology and American Heart Association recommended the use of home blood pressure monitoring with a telehealth component as an adjunct to regular hypertension treatment; however, implementing this into practice can be difficult depending on the setting, available resources, and the knowledge and skills of the providers. Aims: The purpose of this investigation is to evaluate patient adherence …

The Primary Care Provider’S Role In Screening And Intervening In The Human Trafficking Of Adolescents: A Systematic Literature Review, Brittany Schmid

All Graduate Theses, Dissertations, and Other Capstone Projects

Human trafficking (HT) is a growing concern within the United States (U.S.) and internationally. With the alarming number of HT victims presenting for medical care, primary care providers (PCPs) are in a unique and privileged position to encounter HT victims within the healthcare system. Adolescents, in particular, are vulnerable to HT because of minimal life experiences, inadequate social support, and limited coping mechanisms (Ertl et al., 2020). Failure to recognize and intervene in cases involving HT victims who are minors is detrimental to the individual’s health, wellbeing, and safety. With the assistance of education and training, community resources, guideline adoption, …

Re: "Psychiatric Medication Users By Age And Sex"., Kelsey Sicker

Ambulatory and Primary Care Articles

No abstract provided.

Effect Of An Electronic Order Set On Newborn Hepatitis B Immunization Rates, Daniel Pedersen, Angelina Rodriguez, Olu Oyesanmi, Heather Schramm, Michael King

HCA Healthcare Journal of Medicine

Objective

Hepatitis B is an infectious deoxyribonucleic acid virus which can cause significant morbidity and mortality. There is no current definitive treatment, however in the United States immunization is widely available. A paper published by the Advisory Committee on Immunization Practices/Centers for Disease Control (ACIP/CDC) in 2018 made updated recommendations regarding vaccination practices in the United States. The most notable change made was that all healthy newborns weighing ≥2000 g with a negative hepatitis B-status mother should receive hepatitis B immunization within 24 hours of birth. This quality improvement project studied the effect of the electronic medical record newborn admission …

Elderly Musculoskeletal Disease Burden In Karachi, Pakistan: Associations And Implications For Developing Countries, Saniya Sabzwari, Zafar Fatmi, Adeel Ahmed Khan

Department of Family Medicine

Objective: The global rise in the older population has increased the rates of osteoporosis and osteoarthritis, conditions that impact mobility and functionality. There is limited data on musculoskeletal disease in older populations residing in developing countries.
Methods: A community-based study using multistage cluster random sampling of older individuals was conducted in Karachi. Predefined criteria were used for osteoporosis and osteoarthritis. Gait assessment was performed.
Results: More than half of the participants were females and 53% reported illiteracy. Around 30% had osteoporosis and two-thirds had osteoarthritis. Multivariate analysis showed associations of female sex, Pashtun ethnicity, illiteracy, and hypertension with the combined …

Association Between Duration Of Residence And Prevalence Of Type 2 Diabetes Among Male South Asian Expatriate Workers In The United Arab Emirates: A Cross-Sectional Study, Syed Mahboob Shah, Lindsay M. Jaacks, Fatima Al-Maskari, Juma Al-Kaabi, Faisal Aziz, Elpidoforos Soteriades, Tom Loney, Hamed Farooqi, Anjum Memon, Raghib Ali

Department of Family Medicine

Expatriates account for about 80% of the total population in the United Arab Emirates (UAE). This study aimed to evaluate the hypothesis that prevalence of type 2 diabetes in male South Asian expatriates increases with increased length of residence in the UAE.
Design, settings and participants: This cross-sectional study recruited a representative sample (n=1375) of male South Asian expatriates aged ≥18 years in Al Ain, UAE. Sociodemographic, anthropometric and lifestyle data were obtained using a pilot-tested adapted version of the WHO STEPS instrument.
Main outcome measures: Duration of residence was used as a marker for acculturation. Type 2 diabetes was …

Improving Colorectal Cancer Screening And Testing In A Primary Care Clinic, Leslie Michelle Dubois

Doctor of Nursing Practice

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related deaths worldwide (World Health Organization, 2019a). In the United States, CRC was the fourth most common cancer in 2016 (Centers for Disease Control and Prevention, 2019a). The American Cancer Society (2020a) estimated that there will be 147,950 estimated new cases and 53,200 estimated deaths of CRC in the U.S. in 2020. The purpose of the project was to improve CRC screening completion rates and follow up referrals from 27.5% to 35% for adult patients, 50-75 years of age, within a family medicine clinic …

Incorporating Hiv Pre-Exposure Prophylaxis In Primary Care, Daniel Manesh

Doctor of Nursing Practice

In 2012, the Food and Drug Administration approved a combination medication named Truvada (tenofovir/emtricitabine) as a prophylactic treatment to prevent HIV transmission. Truvada is also known as pre-exposure prophylaxis (PREP). PREP is a one-pill-a-day regimen proven to be 99% effective against HIV-1 transmission from sex and intravenous drug injection when taken daily. The uptake of PREP remains low because primary care providers fail to identify patients who meet the requirements to start PREP and fail to prescribe PREP for patients at risk. The purpose of this quality improvement project was to increase the uptake of PREP in patients at risk …

Acute Ischemic Stroke As The Presenting Feature Of Covid-19 In The Young And Pregnant, Nermila A. Ballmick, Jiri F. Kubac, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left …

Perceptions, Knowledge And Attitudes Towards The Concept And Approach Of Palliative Care Amongst Caregivers: A Cross-Sectional Survey In Karachi, Pakistan, Sameera Shah, Faizan Qaisar, Iqbal Azam Syed, Khairunnisa Mansoor

Department of Family Medicine

Background: Limited comprehension of the concept of palliative care and misconceptions about it are barriers to meaningful utilisation of palliative care programs. As caregivers play an integral role for patients with terminal illness, it is necessary to assess their perceptions and attitudes towards the palliative care approach.
Method: A cross-sectional survey was conducted. Data was collected from the Aga Khan Hospital in-patient and out-patient departments and home-based palliative care services. All adult caregivers who met the inclusion criteria and consented, completed a questionnaire till the sample size was reached. Univariate and multivariate multivariable analysis was done and results were reported …

Using Frap Mixed Methodology To Identify Multi-Level Policy Levers That Could Improve Cervical Cancer Disparities In Us Hispanic Women, Autumn Kieber-Emmons Md, Mph, William L. Miller Md, Ma, Benjamin F. Crabtree Phd

Department of Family Medicine

No abstract provided.