Family Medicine Commons^™

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 …

Spinal Cord Injury Provider Knowledge And Attitudes Toward Bacteriuria Management And Antibiotic Stewardship, Felicia Skelton, Sarah May, Larissa Grigoryan, Ivy Poon, Sally Ann Holmes, Lindsey Martin, Barbara W Trautner

Faculty, Staff and Students Publications

INTRODUCTION: Bacteriuria, either asymptomatic or urinary tract infection, is common in persons with spinal cord injury or disorder (SCI/D). In the Veterans Health Administration (VHA), conflicting clinical practice guidelines make appropriate bacteriuria management and antibiotic stewardship challenging.

OBJECTIVE: To explore SCI/D provider knowledge, attitudes, and teamwork around bacteriuria management during the VHA SCI/D annual examination.

DESIGN: Mixed methods.

SETTING: VHA SCI/D centers.

PARTICIPANTS: SCI/D staff providers and physical medicine and rehabilitation resident physicians.

MAIN OUTCOME MEASUREMENTS: Knowledge, safety, and teamwork scores on bacteriuria management using a validated questionnaire. Themes on barriers and facilitators to bacteriuria management during the SCI/D annual …

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.

Missed Appointment Rates And The Implication On Primary Care Practice, Kelly Martin

Dissertations

Problem: Missed appointments cost primary care facilities money and resources through lack of utilization. When patients fail to attend their scheduled appointment the providers are non-productive when they could be seeing other patients that are potentially moved to other days, sending patients to other providers, or worse sending patients to the prompt care or the Emergency Department for care. The missed appointment rate at Office A Primary Care is approximately ten percent, while Office B has a nearly 11% missed appointment rate. Both facilities make reminder calls to patients the day before their appointments to remind them of their appointment …

Day In The Life: Indian Health Service - Zuni, Nm, Rebecca Simon, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline:

• Zuni Pueblo (Geographics/ Demographics/ History and Culture)
• Rural Medicine (Full spectrum/ Day in the Life)
• Working for the Indian Health Service
• New Mexico Living

Implementing Trauma-Informed Care Early In The Lives Of Children And Adults, Carley Clymer

Scholars Week

Throughout the health care industry, providers are failing to recognize the implications that adverse childhood experiences (ACEs) have upon adult health. As a result, these patients not only have to endure these traumas, but they’re also faced with crippling health conditions that accompany them including depression, heart disease and obesity. The prevalence of common high-risk behaviors such as smoking, drinking and illicit drug use can also co-exist with adversity, which leads to an exacerbation of already poor health. This presentation aims to relay the significance of adopting a trauma informed care (TIC) approach early in the lives of clients to …

Exercise Prescriptions In Primary Care, Caitlyn Haines, Pgy-2

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives:

●Review the health benefits of physical activity.

●Recognize barriers on the part of the provider that limit our discussion of exercise with our patients.

●Understand the current recommendations for physical activity including: time per week, exercise intensity, and recommendations for pregnant patients and those with chronic disease.

●Understand the current recommendations for screening prior to exercise in patients with chronic medical conditions.

●Help patients devise strategies to introduce physical activity into their routine.

●Become familiar with resources to connect our patients with for exercise in their area.

Sleep And Its Relation With Academic Performance Among Adolescents: An Analytical Cross Sectional Study In Gulshan Town, Karachi, Zainab Mohammad Anjarwala, Niloufer Sultan Ali, Kashmira Nanji, Anum Arshad Beg, Veena Kumari Karmani

Department of Family Medicine

Objective: To determine the prevalence of sleep patterns and their relationship with academic performance among adolescents.
Methods: The analytical cross-sectional study was conducted from March to August 2015 in Gulshan Town of Karachi and comprised students in grades 6 to 8 who were selected from six government and private schools. Data was collected regarding their sleeping time, wake-up time, sleep latency and total sleep duration. Paediatric Daytime Sleepiness Scale was administered to calculate daytime sleepiness. Academic performance of students was taken from school academic records. Data was analysed using SPSS 22.
Results: Of the 440 subjects, 234 (53.2%) were boys …

Postoperative Retroperitoneal Hematoma: A Case Of Saw Palmetto And The Importance Of Primary Care Intervention, Seetha Venkateswaran, Ricardo Declet-Bauzo, Michael Shodeinde, Patricia Gilford

HCA Healthcare Journal of Medicine

Introduction: A middle-aged male with a history of bilateral inguinal hernia repair was admitted for acute abdominal pain. The patient reported that he took prescribed hydrocodone and a saw palmetto supplement prior to surgery. He denied any recent trauma after the procedure, and he was unable to schedule a follow-up appointment with the surgeon or the primary care physician.

Clinical Findings: Diagnosis: The CT angiography of the abdomen/pelvis was indicative of new interval development of a large left retroperitoneal hematoma. Intervention: No emergent intervention was required following the evaluation by the surgery and interventional radiology (IR) departments. Outcome: There was …

Chronic Inflammatory Demyelinating Polyneuropathy (Cidp) In A Patient With Diabetes: A Primary Care Perspective, Jordan Dever, Adam M. Franks, Laura M. Given, William Rollyson, Adrienne Mays-Kingston

Marshall Journal of Medicine

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a recurrent and progressive disease that causes proximal, symmetrical extremity weakness. The disease is diagnosed using clinical features, electrophysiologic testing, albumino-cytological disassociation in the cerebrospinal fluid, and sural nerve plexus biopsy. However, because of the low sensitivity of diagnostic criteria and other similar neuropathies, including diabetic polyneuropathy (DPN), accurate diagnosis is difficult. Differentiating between these diseases is especially important as CIDP’s changes are reversible and DPN’s are not. Making this differentiation allows for symptomatic improvement in a patient’s quality of life that would not be achieved otherwise. Early recognition and treatment, with modalities including …

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Dancing During Labor: Are Women Down To Boogie?, Drew A. Horter, Kayla Heslin, Marie Forgie, Emily Malloy, Jessica J. F. Kram

Journal of Patient-Centered Research and Reviews

Recent social media trends have demonstrated increased interest in dancing during the final weeks of pregnancy and labor. However, there is limited evidence about dancing during labor and its impact on labor pain and duration as well as patient satisfaction. Before conducting a prospective study, given that enrollment is often challenging, our feasibility study aimed to assess the willingness of pregnant women to participate in a future study evaluating low-impact dance during labor. We anonymously surveyed a convenience sample of English-speaking/reading pregnant women who presented for prenatal care at 1 of 3 clinics from June 2019 to July 2019. Questions …

Updates In Cervical Cancer Screening, Sarah Cokenakes (Hirsh), Md - Pgy 3

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives:

• To review the incidence of cervical cancer in the United States and the relationship between the HPV virus and invasive cervical cancer.
• To review the 2019 ASCCP guidelines and how they differ from 2012 guidelines.
• To discuss use of technology to aid in appropriate decision making and management.

Applicants' Interview Experience Of Family Medicine Residency Match: Reflections From A Quality Improvement Initiative At A Community Hospital, Abdul Waheed, Masooma S. Rana, Muhammad A. Rauf, Landen Green, Salma Green, Erum Azhar

Medical College Documents

Background and objective: Both family medicine applicants and programs dedicate significant resources to the interview process, a time for both parties to make an impression on the other in an attempt to find their best match. Despite the importance of this process, little research has been completed to ensure the process efficiently addresses applicant preferences on interview day and the surrounding process. This study aimed to determine the factors influencing the family medicine applicant preferences regarding the pre-interview, interview, and post-interview ranking process.
Methods: The study method was a cross-sectional electronic survey utilizing anonymous questionnaires that assessed demographics, pre-interview, interview, …

Level 4 Visit, George Valco, Md

Department of Family & Community Medicine Presentations and Grand Rounds

• Medicare guidelines specifically with regard to PATH rules ( Physicians At Teaching Hospitals).
• Specific Documentation is a requirement for reimbursement under Medicare, Medicaid, and any 3rd party payers who refer to Medicare guidelines.
• Resident participation & documentation is incorporated by the Teaching Physicians (TP).

Mental Health Care Transitions From Incarceration, Graham Stratton, Md

Department of Family & Community Medicine Presentations and Grand Rounds

The scope of the problem of mental health and incarceration

• Case & Consideration 1: Severe Mental Illness ○ Brief history of de institutionalization and re institutionalization ○ Philadelphia’s jails at a glance
• Case & Consideration 2: Violence and trauma
• Consideration & Consideration 3: Addiction and substance use
• Models of transitions of care for reentry
• Community teams and resources
• Next steps for a Family Medicine physician

Brief Psychotherapy In Primary Care, Geoffrey Mills, Md, Phd

Department of Family & Community Medicine Presentations and Grand Rounds

Overview

Overview Case

Thread Goals

• Acknowledgement
• Rationale
• Background ‘theory’
• Framework(s) Practical applications