Primary Care Commons^™

Effect Of Food Selectivity On Dyslipidemia In Autism Spectrum Disorder, Ankith Rao

Rowan-Virtua Research Day

This survey-based study sought to determine whether there is a correlation between food selectivity and blood lipid levels in autistic patients.

Increasing Human Papillomavirus Vaccine Uptake In Primary Care Using The 4 Pillars Program: A Quality Improvement Project, Hannah Lyons

The Eleanor Mann School of Nursing DNP Capstone Projects

Aim: To explore the effectiveness of the 4 Pillars Program on increasing human papillomavirus vaccination use in patients ages 9-18 years.

Design: A retrospective quasi-experimental research design comparing pre- and post-implementation human papillomavirus vaccination rates.

Keywords: human papillomavirus, vaccination, pillars, program, communication, tool, quasi-experimental, retrospective

Methods: A retrospective chart review identified the rate of encounters per provider where the human papillomavirus vaccine was administered to patients ages 9-18 years. Interventions including increasing access to the vaccine, standardizing provider recommendation of the vaccine, enhancing utilization of the electronic health record, and introducing a vaccine champion, known as …

Barriers And Facilitators To Kinship Care In Texas: A Multi-Stakeholder, Mixed Methods Perspective, Lauren Malthaner, Jill Mcleigh, Hilda Loria, Erinne Conner, Mike Henson-Garcia

Caregiver Needs and Supports

Kinship caregivers face numerous barriers to providing care for children placed with them and limited facilitators to help ensure successful placements. Although the needs of kinship caregivers are being examined and prioritized in the legislature, operational and policy-level interventions are needed. Results from this study allow for interventions tailored to the needs of kinship caregivers in the State of Texas as identified by a multitude of stakeholder groups.

For questions about this study or others, please email [email protected]

childrens.com/fostercare

A Medical Perspective On Policy Prohibiting Gender-Affirming Care For Missouri Minors: A Policy Review, Hayley Lange

Capstone Experience: Master of Public Health

The Save Adolescents from Experimentation (SAFE) Act is a law enacted in August of 2023 that bans gender-affirming medical care for individuals under eighteen years old in Missouri and states any medical provider who gives medical gender-affirming care to a minor will have their professional medical license revoked. The impact of medical professionals withholding proven gender-affirming care is a clear concern for the medical community, advocates, and other care professionals.
/="/">
/="/">PURPOSE: The purpose of this policy review is to compare the content of the Missouri Save Adolescents from Experimentation (SAFE) Act with states with similar policies and standard-of-care …

Evaluating The Association Of Influenza Vaccination On Long-Term Covid-19 Symptoms In U.S. Adults, Ratnakar Pingili

Capstone Experience: Master of Public Health

Objective. To evaluate the association of influenza vaccination in the past 12 months with Long COVID effects and clinical and sociodemographic factors.

Methods. Cross-sectional study with data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), covering 415,132 non-institutionalized U.S. adults with a confirmed COVID-19 diagnosis and influenza vaccination reported within the last 12 months. Logistic regression was conducted between influenza vaccination (exposure) and Long COVID (outcome), controlling for demographic variables, pre-existing health conditions, and socioeconomic status.

Results. Of 120,603 participants, 21.89% reported Long COVID symptoms and 42.04% had received an influenza vaccine. Findings indicate a statistically significant 13% reduction …

The Effect Of Using A Meal Tracking Smartphone Application In Overweight And Obese Adolescents With Prediabetes Or Type 2 Diabetes To Improve Bmi And Hba1c, Lauren Torhorst

Evidence-Based Practice Project Reports

Obesity has become one of the most common chronic pediatric illnesses worldwide and is closely linked to the onset of prediabetes and subsequent Type 2 Diabetes (T2D); therefore, preventing and treating childhood obesity has become a high priority (Hampl et al., 2023). The purpose of this Evidence-Based Practice (EBP) project is to lower Glycosylated Hemoglobin A1c (HbA1C) and Body Mass Index (BMI) in overweight and obese youth with prediabetes and T2D using a meal tracking smartphone application. The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was utilized to pilot this project between two pediatric endocrinology offices located in Southeast Wisconsin. …

A Multimodal Approach To Decreasing Hesitancy Of The Influenza Vaccine In The Family Care Setting, Carley J. Ellenberger

Evidence-Based Practice Project Reports

The uptake of the influenza vaccine is the most effective and proactive action an individual can take to defend themselves against the influenza outbreak each season; therefore, it is recommended that everyone at least six months of age and older should receive the annual flu vaccine (CDC, 2022; WHO, 2023). Unfortunately, influenza vaccine hesitancy is demonstrated on a global level affecting the uptake compliance annually each influenza season despite the millions of people that experience influenza symptoms annually (CDC, 2022, WHO, n.d.; Healthy People 2030, n.d.). The PICOT question for this project was in adults, over the age of 18, …

Guidance For Assessment Of The Inflammation Etiologic Criterion For The Glim Diagnosis Of Malnutrition: A Modified Delphi Approach., Tommy Cederholm, Gordon L Jensen, Maria D Ballesteros-Pomar, Renee Blaauw, M Isabel T D Correia, Cristina Cuerda, David C Evans, Ryoji Fukushima, Juan Bernardo Ochoa Gautier, M Cristina Gonzalez, Andre Van Gossum, Leah Gramlich, Joseph Hartono, Steven B Heymsfield, Harriët Jager-Wittenaar, Renuka Jayatissa, Heather Keller, Ainsley Malone, William Manzanares, M Molly Mcmahon, Yolanda Mendez, Kris M Mogensen, Naoharu Mori, Maurizio Muscaritoli, Guillermo Contreras Nogales, Ibolya Nyulasi, Wendy Phillips, Matthias Pirlich, Veeradej Pisprasert, Elisabet Rothenberg, Marian De Van Der Schueren, Han Ping Shi, Alison Steiber, Marion F Winkler, Rocco Barazzoni, Charlene Compher

Ambulatory and Primary Care Articles

BACKGROUND & AIMS: The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation in support of the …

An Atypical Facial Eruption In Skin Of Color: A Rare Presentation Of Histiocytoid Sweet Syndrome., Brittany Ehlert, Lauren Shegos, Matthew Franklin, Kaila Buckley, Jaimie Rodger

Ambulatory and Primary Care Articles

No abstract provided.

Improvements In Appropriate Placement Of Dental Sealants After Implementation Of A Clinical Decision Support System, Joanna Mullins, Ryan Brandon, Nicholas Skourtes, Elsbeth Kalenderian, Muhammad Walji

Faculty, Staff and Student Publications

BACKGROUND: Dental sealants are effective for the prevention of caries in children at elevated risk levels, and increasing the proportion of children and adolescents who have dental sealants on 1 or more molars is a Healthy People 2030 objective. Electronic health record (EHR)-based clinical decision support systems (CDSSs) have the ability to improve patient care. A dental quality measure related to dental sealant placement for children at elevated risk of caries was targeted for improvement using a CDSS.

METHODS: A validated dental quality measure was adapted to assess a patient's need for dental sealant placement. A CDSS was implemented to …

Ovarian Cancer Prevention And Screening – Where Do We Stand Today?, Cristina Bucur, Irina Balescu, Sorin Petrea, Bogdan Gaspar, Lucian Pop, Valentin Varlas, Adrian Hasegan, Marilena Stoian, Gabriel Petre Gorecki, Nicolae Bacalbasa

Journal of Mind and Medical Sciences

Widely recognized as the most deathful gynecologic malignancy affecting women worldwide, ovarian cancer has reported a significant decline in terms of prevalence and incidence in the last decades. This fact has been especially explained by to the use of menopausal hormonal therapy and of oral contraceptives in association with genetic, oncologic and gynecologic counseling. The aim of the current review is to discuss about actual ovarian cancer prevention and screening tools. For this reason, we reviewed several data related to ovarian cancer, such as: incidence and risk factors, histopathological types (epithelial with high- and low-grade serous carcinomas, clear cell carcinoma, …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Chronic Atopic Dermatitis, Cecilia Nguyen, Jordan Thompson, Daniel A. Nguyen, Christopher M. Wong, Christian J. Scheufele, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Atopic dermatitis is a chronic inflammatory skin disorder classically affecting flexural areas of the body. It is present in children and adults, including those with darker skin pigmentation. Chronic lesions are hyperpigmented plaques that are dry, cracked, and/or scaly often with lichenification. Differential diagnoses include psoriasis, seborrheic dermatitis, ichthyosis, and pityriasis rosea. This article will showcase clinical images with varying presentations of chronic atopic dermatitis in a range of age groups and skin colors according to the Fitzpatrick scale.

Conscientious Objection: Understanding When And Why Primary Care Physicians Object To Providing Health Care To Transgender And Gender-Diverse Patients In An Appalachian Medical Center, Mili S. Patel, Kelley A. Jones, Laura Davisson, Elizabeth Miller, Nicole Kahn, Pamela J. Murray, Kacie M. Kidd

Journal of Appalachian Health

Introduction: Transgender and gender-diverse (TGD) individuals face barriers to accessing primary and gender-affirming care, especially in rural regions where a national shortage of medical providers with skills in caring for TGD people is further magnified. This care may also be impacted by individual providers’ strongly held personal or faith beliefs and associated conscientious objection to care.

Purpose: This study assesses the prevalence of conscientious objection to providing care and gender-affirming hormone (GAH) therapy to TGD individuals among physicians in an Appalachian academic medical center.

Methods: An anonymous, online, cross-sectional survey of physicians was distributed to resident and faculty physicians in …

A Multimodal Intervention To Aid In Smoking Cessation, Lauren Druzbicki

Evidence-Based Practice Project Reports

The Centers for Disease Control and Prevention (CDC; 2023a) notes there are 28.3 million smokers in the United States. In Indiana alone, nearly 29% of adults currently use tobacco, with 19% of the total being cigarette smokers (Indiana Department of Health, 2022). The purpose of this evidence-based practice (EBP) project was to implement a multi-modal intervention to aid in smoking cessation in adults aged 18 and older who are cigarette smokers. The intervention included physician/nurse advise using the ask, advise, refer (AAR) model, the SmokefreeTXT program, and FDA approved smoking cessation medications. The project took place at a primary care …

Bilateral Eagle Syndrome: A Surprising Cause Of Neck Pain, Kailyn M. Mutsch, Alla Zamulko

Aesculapius Journal (Health Sciences & Medicine)

We report the case of a 45-year-old female who presented with chronic neck pain primarily left sided, globus sensation, and dysphagia for several years. Bilateral elongated styloid processes were identified on CT scan completed prior to the visit. Clinical and radiographic features were consistent with bilateral Eagle syndrome. Eagle syndrome can manifest as a constellation of symptoms characterized by throat and neck pain aggravated by rotation of the head, globus sensation of the throat, dysphagia, headache, tinnitus, syncope, or transient ischemic attacks in some cases. The objective of this case report was to discuss the features of Eagle syndrome and …

Strategies For Combating Vaccine Hesitancy In Primary Care, Elizabeth Perkins Hayes

Student Scholar Showcase

This article will summarize methods for providers to effectively combat vaccine hesitancy in their patient populations. Vaccine hesitancy is a growing concern in the medical field, as new cases of vaccine preventable diseases arise. However, vaccine hesitancy is more common than vaccine resistance and can be converted into vaccine acceptance with effective communication strategies.

There is no easy solution to the complex problem of vaccine hesitancy. Most studies demonstrate that effective conversion to vaccine acceptance requires tailoring vaccine information to the patient and listening to their concerns. Other methods include exposing patients to survivors of vaccine preventable diseases, or using …

Measuring The Impact Of Primary Care Team Composition On Patient Activation Utilizing Electronic Health Record Big Data Analytics, Kristen K. Will, Yue Liang, Chih-Lin Chi, Gerri Lamb, Michael Todd, Connie Delaney

Journal of Patient-Centered Research and Reviews

Purpose

Team-based care has been linked to key outcomes associated with the Quadruple Aim and a key driver of high-value patient-centered care. Use of the electronic health record (EHR) and machine learning have significant potential to overcome previous barriers to studying the impact of teams, including delays in accessing data to improve teamwork and optimize patient outcomes.

Methods

This study utilized a large EHR dataset (n = 316,542) from an urban health system to explore the relationship between team composition and patient activation, a key driver of patient engagement. Teams were operationalized using consensus definitions of teamwork from the literature. …

Adult Development And Associated Health Risks, Elizabeth C. Halloran

Journal of Patient-Centered Research and Reviews

Much has been learned about adult development in recent decades. Adults go through stages of development (emerging adulthood, young adulthood, middle adulthood, post-retirement, and very old age) with certain challenges at each stage. Viewing patients through a developmental lens is part of providing patient-centered care. Knowing the prominent issues, stressors, and risks at each stage of development is important in understanding patients. This knowledge can help customize medical advice to patients regarding obesity, disability, sleep, substance use, relationships, and age-related declines. This paper summarizes an updated view of adult development and discusses its relevance to health risks and patient-centered care …

A Systematic Review: Mirror Neurons & Schizophrenia, Yashesvi Sharma, Surajit Dey

Annual Research Symposium

This research project establishes a link between Mirror Neuron System (MNS) activity and this information's implications in treating and understanding schizophrenia, specifically, schizophrenic patients with negative symptoms.

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 …