Primary Care Commons^™

A Watched Pot Never Boils: Attentive Care Needs No Timer, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this issue introduction, the editor-in-chief of Journal of Patient-Centered Research and Reviews comments on the premise that length of patient consultation time is less important than what patients perceive happened during that time. Regardless of the time allotted to a clinical visit, health care providers should make efforts to address the emotional and psychosocial needs of their patients. As always, taking a little time to express empathy can make a big difference in patient satisfaction.

Approach To Ruq Pain, Jose Medina, Md, Msw

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives:

• Highlight the prevalence of RUQ pain
• Review the anatomy relevant to RUQ pain
• Discuss the broad differential associated
• Walk through important history, physical exam, and lab work components of the work up for RUQ pain
• Review the appropriateness/clinical utility of different imaging modalities
• Highlight common US findings associated with RUQ pain
• Case review and management of common RUQ diagnoses

The Implementation Of Telemedicine In The Covid-19 Era, Rebecca K. Bell, Katherine Badger, Kerri L. Barton Mph, Michael Kohut Phd, Michael Clark Md

Journal of Maine Medical Center

Introduction: During the COVID-19 global pandemic in 2020, social distancing policies called for health care providers to turn to telemedicine platforms for most of their patient encounters. We aimed to better understand the experiences and perspectives of patients and providers who used telemedicine in the primary care setting.

Methods: This study included semi-structured interviews with patients and providers who participated in telemedicine visits during the beginning of the COVID-19 pandemic. Patients (n = 14) were from a rural Maine practice and providers (n = 10) were from practices within 100 miles of a tertiary care center. The interviews were analyzed …

Implementing A Health And Wellness Program For Low Income Children And Their Families: A Community Outreach Program, Kailey Ann Geib, Hannah N. Moland, Emily Nicole Nelson

All Electronic Theses and Dissertations

Low income status has been proven to have negative effects on overall health, such as increased prevalence of chronic diseases and poor childhood development (Gupta, de Wit, & McKeown, 2007). Children living in communities of this status often do not have access to healthy foods or exercise facilities in comparison to middle and upper class children (Gupta, de Wit, & McKeown, 2007). Enhancement of education on these topics has the ability to combat the risk for poor health outcomes. A health and wellness program called SMILE was created and implemented at a child care center, called Carol Mathey’s Center for …

Pa School And Relationship Satisfaction, Hannah M. Kerkhof, Rebecca Kornowski

All Electronic Theses and Dissertations

Physician assistant programs are rigorous, fast-paced, and time intensive, putting significant stress on PA students themselves and their romantic relationships. Research has been done on the effects of medical school on student mental health and romantic relationships, but there is a lack of research on PA students who undergo a similar didactic education. Determining the relationship between PA school stressors and relationship satisfaction may aid in the development of coping mechanisms for couples, reduce student and partner stress, and improve student well-being. The study revealed students who were married, male, between the ages of 30-39,cohabiting, or in long term relationships …

Assessment Of Medical Experiences Of Hearing Guardians With Deaf Or Hard Of Hearing Children In The Twin Cities, Hannah R. Jaster, Erin R. Rudolph, Melinda Sorensen

All Electronic Theses and Dissertations

This paper assesses the medical experiences guardians of deaf or hard of hearing children have after their children are first diagnosed with a hearing loss within the Twin Cities region of Minnesota. Data collection used a mixed methods approach through a survey containing Likert scale questions and opportunities to elaborate on personal experiences. The non-profit organization MN Hands & Voices provided a population qualified to participate in this study who were hearing guardians with a child under ten years old diagnosed within the Twin Cities region of Minnesota. Hearing loss can cause delays in language development if not diagnosed early, …

Diagnosing Dermatological Conditions In The Non-Caucasian Population, Mackenzie M. Mellum, Candace Joyce Nysted, Kassidy E. Westrom

All Electronic Theses and Dissertations

There is currently a lack of resources available on dermatological conditions in the non-Caucasian population; therefore, additional educational materials are needed to supplement the education of healthcare professionals (Ebede & Papier, 2006). The researchers created an educational module with common dermatological conditions, the presentation of various dermatological conditions, and descriptive pictures of how each condition presents in the non-Caucasian population to use as a supplement to the current dermatology modules that are used throughout various health and social science programs at Bethel University in Arden Hills, MN. The topics of the module include basal cell carcinoma, squamous cell carcinoma, melanoma, …

The Effects Of Socialization On The Progression Of Dementia, Caitlyn Hagstrom, Ashley G. Heppner, Katelyn N. Kunde

All Electronic Theses and Dissertations

Dementia is an umbrella term for a group of disorders marked by a decline from baseline in memory, executive function, and other cognitive functions such as reasoning, handling complex tasks, and spatial orientation, all of which interferes with activities of daily living and independence (Larson, 2019). Current pharmaceutical management of dementia and related symptoms is limited (Press & Alexander, 2019b). As dementia progresses, the cognitive skills required to maintain social interactions and familial relationships decline, therefore affecting the perceived loneliness and isolation of the person living with dementia. This research was conducted to understand the role of socialization in the …

Mitigating Mitochondrial Dysfunction In The Insulin Resistant Phenotype: A Ketogenic Diet And Intermittent Hypoxia, William Christian Grillo, Joshua Pinson, Bethany K. Tangen

All Electronic Theses and Dissertations

Chronic disease currently affects 45%, nearly half, of all persons in the United States (Raghupathi & Raghupathi, 2018). A systemic, cellular etiology of chronic disease has been proposed: literature supports the mechanism of a universal cell danger response (CDR) (Naviaux, 2019). The hallmark of the CDR, the shift in metabolism to anaerobic glycolysis, is initiated by altered functionality of the mitochondria (Naviaux, 2019). Current research on mitochondrial dysfunction has demonstrated that a hypoxic intervention has successfully increased longevity in mice with mitochondrial dysfunction, but such an intervention has not, to our knowledge, been attempted in humans (Jain et al., 2016). …

High-Throughput Analysis Of Lung Immune Cells In A Combined Murine Model Of Agriculture Dust-Triggered Airway Inflammation With Rheumatoid Arthritis, Rohit Gaurav, Ted R. Mikuls, Geoffrey M. Thiele, Amy J. Nelson, Meng Niu, Chittibabu Guda, James D. Eudy, Austin E. Barry, Todd A. Wyatt, Debra J. Romberger, Michael J. Duryee, Bryant R. England, Jill A. Poole

Journal Articles: Internal Medicine

Rheumatoid arthritis (RA)-associated lung disease is a leading cause of mortality in RA, yet the mechanisms linking lung disease and RA remain unknown. Using an established murine model of RA-associated lung disease combining collagen-induced arthritis (CIA) with organic dust extract (ODE)-induced airway inflammation, differences among lung immune cell populations were analyzed by single cell RNA-sequencing. Additionally, four lung myeloid-derived immune cell populations including macrophages, monocytes/macrophages, monocytes, and neutrophils were isolated by fluorescence cell sorting and gene expression was determined by NanoString analysis. Unsupervised clustering revealed 14 discrete clusters among Sham, CIA, ODE, and CIA+ODE treatment groups: 3 neutrophils (inflammatory, resident/transitional, …

Early Palliative Care Implementation In Metastatic Lung Cancer Patients: A Quality Improvement Project, Megan Joan Biegler, Erin Hamar, Stephanie Spinolo

All Electronic Theses and Dissertations

This was a quality improvement project that will allow improvements to be made in healthcare services offered and the overall health status of Stage IV metastatic lung cancer patients receiving palliative care referrals. Data was collected retrospectively from electronic medical records of Stage IV metastatic lung cancer patients with palliative care referrals between January 2019 and March 2020. The palliative care referrals between January 2019 and August 2019 were given per oncologist discretion in timing compared to August 2019-March 2020 when new patients received nurse navigator driven palliative care referrals immediately upon diagnosis. Data analysis looked at correlations for each …

Preventive Healthcare Services Receipt And Primary Care Provider Utilization Among People Who Inject Drugs, E K. Nenninger, Kinna Thakarar

Costas T. Lambrew Research Retreat 2021

Introduction:

People who inject drugs (PWID) face barriers to accessing primary care providers (PCPs) and preventive services, but are at increased risk for preventable infections

Preventive services can be accessed through PCPs, or while hospitalized or at community organizations like syringe service programs (SSPs)

Transitioning From Foster Care To Adulthood: Supporting Adolescents And Young Adults, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Children involved in foster care have significant trauma histories and have often experienced substantial neglect and/or abuse. Such adverse childhood experiences can lead to cumulative toxic stress, which if not buffered by support and a consistent adult caregiver, can negatively impact physical, mental and socio-emotional development. Such experiences can also result in a lack of trust in adults and systems of care, which can further reduce sources of support for children in foster care.

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

childrens.com/fostercare

The Critical Need For A Culturally Sensitive Suicide Risk Assessment Instrument For American Indian And Alaska Native Youth, Courtney E. Shaw

All Graduate Theses, Dissertations, and Other Capstone Projects

Objective: This systematic literature review was conducted to better understand why there has been a significant increase in America Indian/Alaska Native (AI/AN) youth suicides in tribes across the United States today. The intent of this review is to understand key issues surrounding the increasing numbers of AI/AN youth with suicide ideation, plans, and attempt in order to be able to answer the following clinical question: Is there a valid and reliable culturally sensitive assessment tool designed to recognize at-risk AI/AN youth presenting for primary care? If not, what are key aspects to consider for developing an instrument that could …

Alcohol-Induced Lysosomal Damage And Suppression Of Lysosome Biogenesis Contribute To Hepatotoxicity In Hiv-Exposed Liver Cells, Moses New-Aaron, Paul G. Thomes, Murali Ganesan, Raghubendra Singh Dagur, Terrence Donohue, Kusum K. Kharbanda, Larisa Y. Poluektova, Natalia A. Osna

Journal Articles: Internal Medicine

Although the causes of hepatotoxicity among alcohol-abusing HIV patients are multifactorial, alcohol remains the least explored “second hit” for HIV-related hepatotoxicity. Here, we investigated whether metabolically derived acetaldehyde impairs lysosomes to enhance HIV-induced hepatotoxicity. We exposed Cytochrome P450 2E1 (CYP2E1)-expressing Huh 7.5 (also known as RLW) cells to an acetaldehyde-generating system (AGS) for 24 h. We then infected (or not) the cells with HIV-1_ADA then exposed them again to AGS for another 48 h. Lysosome damage was assessed by galectin 3/LAMP1 co-localization and cathepsin leakage. Expression of lysosome biogenesis–transcription factor, TFEB, was measured by its protein levels and by …

The Influence Of Coronavirus Disease-2019 (Covid-19) On Parkinson’S Disease: An Updated Systematic Review, Vikash Jaiswal, Danah Alquraish, Zouina Sarfraz, Azza Sarfraz, Shavy Nagpal, Prakriti Singh Shrestha, Dattatreya Mukherjee, Prathima Guntipalli, Diana F. Sánchez Velazco, Arushee Bhatnagar

Department of Paediatrics and Child Health

Background: COVID-19 has affected global communities with multiple neurological complications in addition to other critical medical issues. COVID-19 binds to the host's angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in the neurons and glial cells, acting as an entry port to the central nervous system (CNS). ACE2 receptors are abundantly expressed on dopamine neurons, which may worsen the prognosis of motor symptoms in Parkinson's disease (PD). SARS-CoV-2 may lead to an indirect response via immune-mediated cytokine storms and propagate through the CNS leading to damage. In this systematic review, we aim to provide thorough analyses of associations between COVID-19 …

Development Of An Integrated Medical And Behavioral Health Care Model For Children In Foster Care: The Rees-Jones Center For Foster Care Excellence, Kimberly Stone, Sara Moore, Sara Pollard

Integrated, Trauma-Informed Care

Children in foster care are classified as a population with special health care needs. They face multiple adverse childhood experiences and disrupted relationships, yet face barriers accessing consistent, high-quality health care. The American Academy of Pediatrics recommends integrated physical and behavioral health care for children in foster care, but little is known about the implementation of integrated care for this population. As a pediatrician, doctor of nursing practice, and psychologist in an academic medical setting, we describe the development and implementation of the Rees-Jones Center for Foster Care Excellence, emphasizing the role of medical and behavioral health providers in promoting …

A Weight-Loss Intervention Augmented By A Wearable Device In Rural Older Adults With Obesity: A Feasibility Study, John A. Batsis, Curtis L. Petersen, Matthew L. Clark, Summer B. Cook, Francisco Lopez-Jimenez, Rima I. Al-Nimer, Dawna Pidgeon, David Kotz, Todd A. Mackenzie, Stephen J. Bartels

Dartmouth Scholarship

Background

Older persons with obesity aged 65+ residing in rural areas have reduced access to weight management programs due to geographic isolation. The ability to integrate technology into health promotion interventions shows a potential to reach this underserved population. Methods

A 12-week pilot in 28 older rural adults with obesity (body mass index [BMI] ≥ 30 kg/m2) was conducted at a community aging center. The intervention consisted of individualized, weekly dietitian visits focusing on behavior therapy and caloric restriction with twice weekly physical therapist-led group strengthening training classes in a community-based aging center. All participants were provided a Fitbit Flex …

Cost Outcomes Of Physical Therapist Providers Compared To Primary Care Providers In The Treatment Of Musculoskeletal Patients In A Military Treatment Facility: A Retrospective Chart Review”, Troy E. Mcgill, Debra F. Stern, Morey J. Kolber, John Mcgee

Internet Journal of Allied Health Sciences and Practice

Purpose: The purpose of this study was to compare the cost of physical therapist (PT) management of patients with musculoskeletal (MSK) disorders to management by traditional primary care managers (PCMs); medical doctors (MDs), doctors of osteopathic medicine (DOs), advanced registered nurse practitioners (ARNPs), and physician assistants (PAs). Methods: This is a retrospective study of electronic medical records using an exploratory, non-experimental, cross-sectional, and quantitative design method. The records of patients with MSK disorders were assessed at an Air Force military medical clinic for 18 months from January 2016 through June 2017. Results: PT management of MSK patients resulted in a …

Decreasing Use Of Primary Care: A Repeated Cross-Sectional Study Of Meps 2007-2017., Michael E Johansen, Joshua D Niforatos

Ambulatory and Primary Care Articles

We sought to describe the proportion of patients in contact with a primary care physician, as well as the total number of primary care contacts over a 2-year period, using the 2002-2017 Medical Expenditure Panel Survey. The rate of any contact with a primary care physician for patients in the population decreased by 2.5% over the study period (adjusted odds ratio [aOR] = 0.99 per panel, 95% CI, 0.98-0.99;