Family Medicine Commons^™

Geriatrics In Clinical Practice And Beyond: Brain Health, The Sixth Vital Sign?, Nannette Hoffman

HCA Healthcare Journal of Medicine

Brain health in middle age and geriatric patients will take on greater importance for health care practitioners in our aging society. This article discusses various approaches clinicians can use for their patients to promote and improve brain health. These are generally the same lifestyle adoptions for cerebrovascular disease and cardiovascular disease prevention: weight management, exercise, and blood pressure and cholesterol lowering. Social stimulation and cognitive activities may also be important for the elderly.

A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, Robert G. Michaud, Lesley B. Gordon

Journal of Maine Medical Center

Introduction: Rectus sheath hematomas (RSH) generally occur due to damage to the inferior epigastric artery. They are rare causes of abdominal pain or acute blood loss anemia, but are an important diagnostic consideration because they can be cryptic and are potentially fatal.

Clinical Findings: An 85-year-old female who had been admitted to the hospital for 10 days with a myasthenia crisis was found to be abruptly hypotensive with a tender abdominal mass in the left lower quadrant subtly crossing midline. She was on prophylactic anticoagulation during her hospitalization.

Main diagnosis, therapeutics, interventions, and outcomes: The patient was initially stabilized with …

Magnitude Of Screening For Gestational Diabetes Mellitus In An Urban Setting In Tanzania; A Cross-Sectional Analytic Study, Akampa Mukuve, Mariam Noorani, Ibrahim Sendagire, Miriam Mgonja

Faculty of Health Sciences, East Africa

Background

Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally.

The primary objective was to determine the magnitude of screening for GDM among …

Hpv Vaccination In Females: The Role Of Primary Health Care And Primary Health Care Providers, Brooke Bouza

Graduate Theses and Dissertations

Two reasons for subpar coverage of the Human papillomavirus (HPV) vaccine are missed clinical opportunities and nonacceptance of the vaccine upon recommendation from a medical provider. The purpose of study one was to examine factors associated with access and adherence to physician’s recommendations in association with HPV vaccine uptake. Data were obtained from National Health Interview Survey (2017). Variables theoretically related to clinical opportunities and adherence to physician’s recommendations were examined in association with HPV vaccine uptake. Univariate logistic regressions were run to determine the associations between the aforementioned variables and uptake of the HPV vaccine. Multinomial logistic regressions were …

Working With People With Disabilities: An Interactive Video/Lecture Session For First- And Second-Year Medical Students., Sandra L Hearn, Pamela J Hearn

Articles, Abstracts, and Reports

Introduction: Negative physician attitudes toward people with disabilities create barriers to health care for these individuals. Barriers can include withholding of standard medical and preventive care, provision of inferior treatment, and patient mistrust of the health care system. Thus, preparing medical students to care for people with disabilities is especially important. Educating health care providers early in their careers can shape their interactions while their approach to patients is still deliberate.

Methods: We developed an interactive introductory session for first- and second-year medical students on how to approach individuals with observable disability in clinical settings. In the session, we explored-through …

Social Services Cases, Maria Hervada-Page, Mms

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Understand common Social Work referrals and possible solutions
• Understand the roles of the members of our team
• Understand the basics of insurance
• Basic community resources

"I Had No Other Choice But To Catch It Too": The Roles Of Family History And Experiences With Diabetes In Illness Representations., Amy T Cunningham, Alexzandra Gentsch, Lsw, Amanda M B Doty, Geoffrey Mills, Marianna Lanoue, Brendan G. Carr, Judd E Hollander, Kristin L Rising

Department of Family & Community Medicine Faculty Papers

BACKGROUND: A family history of diabetes and family members' experiences with diabetes may influence individuals' beliefs and expectations about their own diabetes. No qualitative studies have explored the relationship between family history and experiences and individuals' diabetes illness representations.

METHODS: Secondary data analysis of 89 exploratory, semi-structured interviews with adults with type 1 or type 2 diabetes seeking care in an urban health system. Participants had a recent diabetes-related ED visit/hospitalization or hemoglobin A1c > 7.5%. Interviews were conducted until thematic saturation was achieved. Demographic data were collected via self-report and electronic medical record review. Interviews were audio-recorded, transcribed, and coded …

A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula

Nursing Masters Papers

Abstract

Delirium is a complex syndrome resulting from compounding effects of acute illness, comorbidities, and the environment. It results in adverse outcomes: elevated mortality rates, length of stay, readmissions, institutionalization, long-term cognitive changes, and diminished quality of life. The rate of iatrogenic delirium is astounding, ranging from 10%-89%. There are no curative treatments; thus, primary prevention is the key. The purpose of this literature review is to identify and critique the research for the accuracy of risk stratification and feasibility in practice. Support for interventions that prevent delirium is mounting; however, interventions are resource-intensive and often not implemented. Researchers have …

Effectiveness Of Home-Based Rehabilitation Program In Minimizing Disability And Secondary Falls After A Hip Fracture: Protocol For A Randomized Controlled Trial, Anum Sadruddin Pidani, Saniya Sabzwari, Khabir Ahmad, Ata Khan, Shahryar Noordin

Department of Surgery Docs

Introduction: Hip fractures are a major health problem globally and are associated with increased morbidity, mortality, and substantial economic costs. Successful operative treatment of hip fracture patients is necessary for the optimization of post-op mobility and functional recovery of the patient. Rehabilitation after surgical stabilization of a hip fracture is crucial in order to restore pre-fracture function and to avoid long-term institutionalization. In particular ongoing exercise which targets balance can prevent up to 40% of falls. Therefore, we have designed a post-discharge home-based physical rehabilitation intervention program to minimize disability and falls in this high-risk elderly population.
Methods and analysis: …

10 Patient-Centered Questions For Clinical Encounters With Transgender Patients, Blossom Kim

Physician Assistant Studies | Student Authored Articles

Transgender (TG) individuals face extensive barriers to care that result in detrimental health disparities and increased prevalence of certain medical conditions such as mood disorders, HIV, and substance abuse. Existing research details multiple approaches to aid healthcare providers in reducing these disparities, but they tend to either generalize the transgender community or provide a surplus of information that may potentially overwhelm healthcare providers. This best practices review aims to provide clinicians with an approach that includes 10 patient-centered questions in hopes of improving patient-clinician rapport and addressing the main disparities and health concerns a TG patient may have.

Breast Cancer Treatment: Basics For The Primary Care Provider, Sarah Hirsh, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

1. To review the prevalence of breast cancer and the mortality rate of breast cancer in the United States.
2. To understand breast cancer staging and its role in prognostication.
3. To understand the therapies offered for the treatment of non-metastatic, invasive breast cancer and their side effects.
4. To review the role of the PCP in caring for patients undergoing treatment for breast cancer and those in remission.

Today's Cigarette And E-Cigarette Landscape, Richard C. Wender, Md

Department of Family & Community Medicine Presentations and Grand Rounds

E-cigarettes are one of the most difficult and complex public health issues most of us have confronted.

Most anti-tobacco experts and advocates line up on a spectrum from embracing e-cigarettes as a promising way to reduce the harm of tobacco products all the way to being the greatest threat to progress in our 60 year war on big tobacco.

Journal Club, Zeynep Uzumcu, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline

• Review coronavirus life-cycle
• Review mechanism of action of remdesivir
• Review previous research on remdesivir
• Close reading of article - Methods - Results - Discussion
• Future research
• Implications for our practice

Evaluation Of An Innovative Transitional Care Clinic In An Interprofessional Teaching Practice, Mckenzie Calhoun Highsmith, Jesse Gilreath, Peter Bockhorst, Kathleen White, Beth Bailey

International Journal of Health Sciences Education

During transitions of care, great opportunity exists for miscommunication, poor care coordination, adverse events, medication errors and unnecessary healthcare utilization costing billions of dollars annually. An Interprofessional Transitions of Care (IPTC) clinic was developed utilizing a Family Medicine team that included physicians, nurses, a clinical social worker, and a clinical pharmacist. The purpose of this study was to determine if utilization of an IPTC clinic prevented hospital readmission, and to identify factors that predict most benefit from an interprofessional approach to transitions of care. A retrospective chart review of 1,001 patients was completed. A treatment group (TG) of 501 patients …

A Case Study On Toxoplasmosis: Ocular Disease, Caleb A. Vass, Elliot Freed

Capital Division GME Virtual Research Day 2020

Toxoplasmosis is an infection caused by the protozoan parasite Toxoplasma gondii. Primary infection by this organism is usually asymptomatic. Some immunocompetent patients infected with this parasite can present as an acute systemic infection but symptoms can also present as ocular disease. In these instances, the ocular disease may be the only symptom, and can be from either an acute infection or a reactivation of the disease.

Is It Cool To Juul? A Case Of Vaping Induced Lung Injury, Natasha Palmer, Jacqueline Storer, Yaasen Bhutta, Luis A. Murillo

Reading Hospital Family Medicine Residency

“Vaping” is the inhalation of an aerosolized substance produced through heating a solution that typically contains nicotine, cannabis, or other substances. There are many products available commercially used as devices for vaping such as the electronic cigarette, vape, or “JUUL.” Vaping has become especially popular among teens and young adults likely due to marketing these devices as “safe” when compared to the traditional cigarette, and there are a wide variety of flavors.

Cigarette Smoking And Smokeless Tobacco Use Among Male South Asian Migrants In The United Arab Emirates: A Cross-Sectional Study, Raghib Ali, Tom Loney, Mohammed Al-Houqani, Iain Blair, Faisal Aziz, Salma Al Dhaheri, Iffat El Barazi, Elpidoforos S. Soteriades, Syed M. Shah

Department of Family Medicine

Background: Few data were available on smoking and smokeless tobacco use in South Asian migrants in the United Arab Emirates (UAE). This study aimed to identify the prevalence and correlates of cigarette smoking and smokeless tobacco use in male South Asian migrants in the UAE.
Methods: We used a cross-sectional study to recruit a random representative sample of male South Asian migrants, including Indian (n = 433), Pakistani (n = 383) and Bangladeshi (n = 559) nationalities. We used multivariable logistic regression analysis to identify significant correlates of cigarettes smoking and smokeless tobacco use.
Results: 1375 South Asian migrant adult …

Expansion And Conversion Of Family Medicine And Neurohospitalist Services Into Covid-19 Services, Zachary Klock, Md, Aimee Mcmullin, Md, Jesse Edwards, Md, Christopher Haines, Md

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

• During the COVID-19 pandemic, there was an anticipated increase in the number of patients admitted with COVID-19.
• To meet the increased number of admitted patients, additional providers and teams were needed to care for hospitalized patients during the pandemic.
• Pre-existing teams needed to find ways to expand (in the case of the Family Medicine service) and repurpose (in the case of the Neurohospitalist service) in order to care for an increased number of patients.

Covid: Decoded - A Website, Blog, And Social Media Page With Resources And Information For The Public, Jessica Smith, Taylor Jones, Madeline Norris, Benjamin Meyers, Christopher Haines, Md

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

Information about COVID19 in the news and on social media platforms is overwhelming, confusing, riddled with jargon and sometimes straight up wrong. Makig it easy for the public to misinterpret facts or simply accept headlines and infographics at facevalue without checking with primary and/or reputable sources.

The nature of social media also allows for a perpetuation of this misinformation without recourse. Recall the one article floating around Facebook reporting that gargling salt/vinegar water could help prevent COVID19. We needede a source of simplified, reliable information about the pandemic for people outside of the health professions.

Medical students …

Improving Blood Pressure Control Through Blood Pressure Measurement In An Ambulatory Urban Family Medicine Clinic, Sara Ancona, Md, Zachary Klock, Md, Aimee Mcmullin, Md, Zeynep Uzumcu, Md, Olivia Seecof, Md, Graham Stratton, Md, Alexa Waters, Md, Caitlyn Haines, Md, Brittany Hozick, Md, Jose Medina, Md, Geoffrey Mills, Md, Phd

Health Equity and Quality Improvement (HEQI) Summit

Aim Statement: To increase the percentage of patients over the age of 18 with BP controlled to a goal of <140/90 from a baseline of 58% to 68% by April 2020.