Primary Care Commons^™

Patient And Clinician Characteristics That Predict Breast Cancer Screening Behavior In 40–49-Year-Old Women, Sarina Schrager, Claudia Evaristo, Terry Little, Lori Dubenske, Elizabeth S. Burnside

Journal of Patient-Centered Research and Reviews

Guidelines recommend that clinicians practice shared decision-making (SDM) with women in their 40s to discuss breast cancer screening. Traditionally, SDM includes discussion of values and preferences to help determine a decision that is congruent with what the patient desires. We analyzed 54 women’s breast cancer screening decisions after a SDM conversation with their clinician. We looked at both patient and clinician characteristics that predicted whether or not a woman would get a screening mammogram. Women with a family history of breast cancer or who had a previous abnormal mammogram had higher rates of screening. Screening rates also varied widely between …

Integrating Patient-Reported Outcomes Into Clinical Genetic Testing For Familial Hypercholesterolemia, Rachele M. Hendricks-Sturrup, Robert Block, Christine Y. Lu

Journal of Patient-Centered Research and Reviews

Patient-reported outcomes (PROs) and PRO measures (PROMs) are often used to help clinicians and researchers understand patients’ personal concerns, feelings, experiences, and perspectives following the implementation of an intervention. Notably, PROs and PROMs can inform health systems, health policy, and payers on the utility of clinical genetic testing based on each patient’s personal values, perspectives, and potential health behaviors subsequent to testing. In this topic synopsis, we discuss the underexplored role of and implications for PROs and PROMs following genetic testing for familial hypercholesterolemia (FH), an autosomal dominant genetic disorder of cholesterol metabolism that can lead to highly premature fatal …

Substance Abuse Relapse Is Not About Willpower But Is The Culmination Of Psychological And Socioeconomic Stress, Paul A. Steffes

Clinical Research in Practice: The Journal of Team Hippocrates

The author reflects on the impact of non-judgmental listening on patient care outcomes.

The Efficacy Of A Sumatriptan And Naproxen Combination Pill In A Patient With Chronic Migraines Who Discontinued Triptan Therapy In The Past Due To A Self-Reported Poor Response To Sumatriptan Monotherapy, Ethan M. Cohen

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Mathew NT, Landy S, Stark S, et al. Fixed-dose sumatriptan and naproxen in poor responders to triptans with a short half-life. Headache. 2009;49(7):971-982. https://doi.org/10.1111/j.1526-4610.2009.01458.x

for a patient with chronic migraines who had self-reported poor response to sumatriptan monotherapy.

Limb Salvage Therapy In Septic Diabetic Foot Ulcer In Patients Unwilling To Undergo Amputation, Luke Hong

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising

Shojaiefard A, Khorgami Z, Larijani B. Septic diabetic foot is not necessarily an indication for amputation. J Foot Ankle Surg. 2008;47(5):419-423. https://doi.org/10.1053/j.jfas.2008.05.005

for a patient with a septic diabetic foot.

The Diagnostic Algorithm In Pre-Invasive Cervical Lesions, Mihai-George Loghin, Oana Denisa Balalau, Nicolae Bacalbasa, Adriana Vasilache, Octavian Gabriel Olaru, Andrei Vasilache, Anca Daniela Stanescu

Journal of Mind and Medical Sciences

The screening for pre-invasive cervical lesions has significantly decreased the incidence of cervical neoplasm. It is recommended to be performed starting with the age of 21 with a frequency of 3-5 years and it consists of pap smear testing and HPV genotyping, and, if required, it can be continued with colposcopy or biopsy followed by pathological assessment. The importance of the early diagnosis of pre-invasive cervical lesions has led to several studies on this topic. The paper analyzed the modern literature published on the PubMed and Scopus databases. Reference studies have found that most intraepithelial lesions are caused by the …

Integrated Behavioral Health (Ibh) Program Updates And Evidence For Ibh In Sud, Rachelle Rene, Phd, Bcb, Hsmi

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

At the end of this presentation, the participant will be able to:

1. Describe core components of the Primary Care Behavioral Health Model
2. Identify IBH Program implementation highlights and challenges
3. Discuss at least one intervention to address SUD in primary care

Exploration Of The Psychometric Properties Of The Person-Centred Primary Care Measure (Pcpcm) In A Chinese Primary Care Population In Hong Kong: A Cross-Sectional Validation Study, Stephen J. Zyzanski, Kurt C. Stange

Faculty Scholarship

Objectives To evaluate the validity and psychometric properties of the Chinese Person-Centred Primary Care Measure (PCPCM) in a Chinese-speaking population. Design A cross-sectional study. Setting A primary care clinic in Hong Kong. Participants 300 Chinese adult patients (150 males and 150 females) were recruited from a primary care clinic to complete a questionnaire containing the PCPCM, Consultation and Relational Empathy (CARE), Patient Enablement Index (PEI) and Adult (short version) Primary Care Assessment Tool (PCAT). The Chinese PCPCM was readministered to 118 participants after 14 days for test-retest reliability. Outcome measures The construct validity, reliability and sensitivity of the Chinese PCPCM. …

Management Of Recurrent Bacterial Vaginosis, Barbara Cymring, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Review the importance of appropriate management of recurrent BV (rBV)
• Review the appropriate diagnosis of rBV
• Review the causes and risk factors for BV and rBV
• Review the current literature on treatment for rBV
• Discuss some preventative measures for decreasing risk of BV infection

Teratogenic Medication Usage In Primary Care Of Women Of Reproductive Age, Krys Foster, Md, Mph, Faafp

Department of Family & Community Medicine Presentations and Grand Rounds

Introduction

• Teratogenic medications are commonly prescribed to individuals with pregnancy potential
• Despite knowledge of potential teratogenic effects, data suggest that effective communication regarding the risks and benefits of medication use in the context of the patient’s fertility goals remains inadequate
• We will discuss recommendations for changes in education and healthcare delivery to facilitate thoughtful prescribing in this population

Learning Objectives

• To review a common scenario faced by primary care physicians caring for individuals at risk of pregnancy
• To recognize factors that might place certain patients at increased risk of teratogenic exposure in early pregnancy
• To gain competence in assessing fertility …

Osteoporosis, Susan Mockus Parks, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

Review importance of bone health

Define and identify osteopenia and osteoporosis

Learn treatment options for osteopenia

• How to counsel patients
• How to use FRAX calculator to assist with treatment decisions

Learn treatment options for osteoporosis

• Become familiar with treatment guidelines and options

Food Addiction And Obesity, Lisa Ling

Electronic Theses and Dissertations

The obesity rate in the U.S. adult population has increased to epidemic levels despite attempts to decrease obesity through evidence-based knowledge, clinical practice guidelines, medical interventions, and individual efforts. For certain individuals, food addiction behaviors such as food cravings, loss of control, and binge eating contribute to obesity and require a different approach to care. Little work has been done on adding the possibility of food addiction to obesity screening and treatment. This study utilized a quasi-experimental quantitative pre- and postsurvey research design based on Lewin’s change theory. Nurse practitioners were surveyed regarding the provider’s perceptions, attitudes, and beliefs about …

Utilization Of Patient-Controlled Analgesia Reduces Length Of Stay Of Sickle Cell Crisis Hospitalizations, Brett M. Prestia, Talha Ramzan, Catherine Waldron, Ameer Malik, Robert M. Pallay, Candace R. Murbach, Mike Flynn, Eric Shaw Phd, Abdullah Kutlar, Daniel Lowe

HCA Healthcare Journal of Medicine

Background

Sickle cell crisis hospitalizations are emotionally and financially burdensome to patients and healthcare systems, and processes to decrease the frequency or length of stay of these crises should be examined.

Methods

This is a multicenter retrospective hospital record review of sickle cell crisis hospitalizations as defined by ICD-10 codes (D57.1-4), from January 2016 through December 2019, examining inpatient medication administration records and length of stay among admitted adults aged 18–65 years. Patient controlled analgesia orders using morphine, hydromorphone, fentanyl and/or merperidine at any point of an admission (n=188) were compared to admissions without any patient-controlled analgesia orders (n=2,159). The …

Use Of Ultrasound-Guided Platelet-Rich Plasma In The Treatment Of Carpometacarpal Osteoarthritis, Manuel Britto, Siraaj Dawood, Siyang Lu, Martin Canillas

HCA Healthcare Journal of Medicine

Introduction

Osteoarthritis (OA) is the most common form of arthritis and can severely affect function and quality of life. Platelet-rich plasma (PRP) is derived from a patient’s own blood and has potential as an adjunct to treat OA. However, research has been limited for small joints such as the carpometacarpal (CMC) joint.

Clinical Findings

A 65-year-old Caucasian male complained of bilateral wrist and neck pain after a motor vehicle accident. His initial exam noted swelling, tenderness and pain with movement at the bilateral thumb CMC joints and anatomic snuffboxes. However, there was no strength, range of motion or tactile deficits …

Missed Opportunities: Documentation And Referral Rates Among Children And Adults With Obesity, Heidi Walls, Christina Holt, Amy Haskins Phd, Williams Dexter

Journal of Maine Medical Center

Introduction: Our study reports rates of obesity documentation on the problem list (PL) and numbers of referrals to obesity medicine specialists and dietitians among pediatric and adult patients with obesity.

Methods: All pediatric and adult patients with obesity seen at 14 primary care clinics between 7/1/2017 and 6/30/2019 were evaluated for inclusion of obesity on the PL and referrals to obesity medicine specialists or dietitians.

Results: For children with BMI >95% for age, obesity was documented in 31.2%, and 12.5% received a referral. For adults with BMI >30, obesity was documented in 54.2%, and 8.4% received a referral. Significantly more …

Management And Diagnosis Of Hypothyroidism, Catherine Guariglia, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Goals

• Recognize the different etiologies of hypothyroidism
• Identify signs and symptoms of hypothyroidism
• Feel comfortable diagnosing and treating primary hypothyroidism
• Define subclinical hypothyroidism and when/if it is necessary to treat
• Recognize how pregnancy influences hypothyroidism management
• Be able to counsel patients on treatment for hypothyroidism

Heart Failure Transitions Of Care Program, Samantha Macko, Pharmd

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Heart failure overview; statistics, risk factors, signs and symptoms
• List heart failure therapeutic treatment options
• Explain importance of continuation of care for heart failure patients after initial hospital discharge
• Discuss importance of multidisciplinary approach to treatment of heart failure (HF) patients
• Discuss components of heart failure transitions of care (HFTOC) program at Thomas Jefferson University Hospital

Adhd In Adolescents And Adults, Hannah Facey, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Understand the concept of neurodiversity
• Define ADHD
• Review the diagnostic criteria and challenges with diagnosis for ADHD in adults
• Explore our role as family medicine physicians in diagnosis and treatment
• Discover the prevalence of comorbid conditions associated with ADHD
• Obtain a general understanding of the categories of medical treatments available for adults with ADHD
• Gain a deeper appreciation for the role that biases play in the under- and misdiagnosis of women and BIPOC

What Are The Most Effective Risk Factor Management Strategies For The Prevention And Control Of Hypertension?, Sherlyne Barasa

Theses and Graduate Projects

Hypertension (HTN) affects millions of people globally. With the rising burden of HTN in primary care and its associated morbidity and mortality, it is necessary to explore effective risk factor management to control and prevent it in people most at risk. This research addressed both modifiable risk factors such as obesity, smoking, alcohol, and diet as well as non- modifiable risk factors such as age, race/ethnicity, and family history. The aim of this paper was to examine the most effective risk factor management strategies to control and prevent hypertension. The studies reviewed indicate that there are various risk factor management …

Continuous Glucose Monitoring: Optimizing Type 1 Diabetes Management In Older Adults, Alyssa Clements

Theses and Graduate Projects

Introduction: Type 1 diabetes (T1D) impacts many individuals around the world. Treatment goals of T1D include lowering hemoglobin A1c (HbA1c) values while minimizing the time spent in hypoglycemia. Frequent glucose monitoring is required to achieve optimal glycemic control.

Background: HbA1c has been used for many years to track glycemic control. When discussing care of older adults, hypoglycemia is a more important marker to track. The risks associated with hypoglycemia are higher among older adults with T1D than the general population. Multimorbidity, polypharmacy, and age-related mental decline increase the likelihood and danger of severe hypoglycemic episodes. Self-monitoring blood glucose (SMBG) provides …