Primary Care Commons^™

Off-Label Long-Term Use Of Phentermine For Weight Management, Monique Morin, Yamini Pandey, Sarah Bdeir, Rumyah Rafique, Taim-Allah Al-Jarrah, Ali Farhat

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Hendricks EJ, Greenway FL, Westman EC, Gupta AK. Blood pressure and heart rate effects, weight loss and maintenance during long-term phentermine pharmacotherapy for obesity. Obesity. 2011;19(12):2351-2360 https://doi.org/10.1038/oby.2011.94

for a patient struggling at the intersection of weight loss and financial instability.

Indeterminate Benefit Of Long-Term Beta-Blocker Use After Acute Myocardial Infarction For Some Patients, Logan S. Thayer, Khush Hussain, Nicholas Apostolakis, Gretchen Swift, Arifbillah Sarowar, Mohammad Al-Hadidi, Scott Yaekle

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Yndigegn T, Lindahl B, Mars K, et. al., Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. April 7 2024;390:1372-1381. https://doi.org/10.1056/NEJMoa2401479

for a patient showing 55% left ventricular ejection fraction after myocardial infarction.

Primary Place To Go For Health Care And Its Association With Hpv Prevalence In Us Adults: Results From Nhanes 2013-2016, Amy L. Mcveety, Miyuki Sun

OHSU-PSU School of Public Health Annual Conference

Background: While access to health care is a known risk factor for many infectious diseases, including sexually transmitted infections, little research has investigated the relationship between access to primary care services and prevalent human papillomavirus (HPV) infection. Given HPV’s prevalence in the general population and lack of available treatments, it is necessary to understand possible risk factors to identify areas for intervention. This study uses primary place to go for health services as a proxy measure for access to care, in order to understand which sources of health care are serving patients with the highest prevalence of HPV infections and …

Self-Management Program For Dyslipidemia: Impact On Health Behaviors To Modifiable Risk Factors And Compliance, Michael S. Lespron

Student Scholarly Projects

Practice Problem: Dyslipidemia management requires participation by both the healthcare provider and the patient alike. The inability to control lipid levels, including modifiable risk factors, can lead to cardiovascular disease which is the leading cause of death globally.

PICOT: In patients at a federally qualified health center that are 18-99 years of age and have a diagnosis of any type of dyslipidemia (P), does the implementation of a self-management program (SMP) via continued access to video recordings, take-home booklets, and biweekly follow-up calls (I) compared to current practices (C), increase compliance to medication adherence and lifestyle modification recommendations (O) within …

Evaluating Engagement In Health Care And Substance Use Disorder Services Among People Who Use Drugs, Tiffany Mckenney, Kevin Cobty, Divya Boorle, Julie Gleason-Comstock

Medical Student Research Symposium

An urban community-based organization conducted a study to examine demographics of individuals who use drugs and their approaches to risk reduction. A substantial proportion reported encountering significant barriers to accessing substance use disorder (SUD) services.

In collaboration with a state survey, the community organization recruited a convenience sample of individuals who actively used drugs, examining substance use patterns, healthcare access, and barriers to SUD services. Community health workers facilitated outreach efforts, focusing on harm reduction engagement, and healthcare access.

Data were collected from 55 individuals. 51% identified as male, 48% as female, and 2% as LGBTQIA+. 67% identified as White/Caucasian, …

Virtual Hospital Follow-Up: Effects On 30-Day Readmission And Patient Satisfaction, Lidia Wiersum, Karen Valiyev, Kristin Wisegarver, Lucas Hopkins

Articles, Abstracts, and Reports

No abstract provided.

Fostering Cognitive Complexity In Behavioral Health Providers: Perspectives From Supervisors In Integrated Primary Care, Katherina Nako

Counseling & Human Services Theses & Dissertations

The integration of behavioral health into primary care settings, known as Integrated Primary Care (IPC), offers a holistic approach to addressing both physical and mental health needs (Ramanuj et al., 2019). Efforts to expand access to mental healthcare have contributed to the growing presence of IPC settings (Martin 2017), with mental health providers, such as mental health counselors, joining these teams as Behavioral Health Providers (BHPs; Blount, 2017). However, the unique complexities of IPC often leave BHPs feeling underprepared, largely due to the traditional training frameworks emphasized in many graduate counseling programs. The need for BHPs to adapt to the …

"Health Gatekeepers": The Influence Of Women On Health Practices In Rural, Central Appalachia, Reese Lycan

Senior Theses

Women have historically assumed leadership roles in familial and community health promotion, intervention, and facilitation. While the role of women in family health is globally understood and the historical importance of female leadership has been documented, there remains a gap in knowledge regarding the role of women as “health gatekeepers”. Furthermore, when considering the Appalachian region, there are limited studies regarding women’s place in leadership as far as health is concerned. Therefore, this study employs a hermeneutic phenomenological framework to explore the lived experiences of women in relation to their family and community’s health in rural, Central Appalachia- a region …

Health Literacy: Impact And Interventions, Elizabeth Simpson

Lynchburg Journal of Medical Science

The objectives of this paper are to examine the connection between health literacy level and patient outcome, identify contributing factors of low health literacy, and identify ways in which providers and health literacy programs can promote health literacy on an individual and community level. I conducted a literature search using PubMed and Google Scholar in order to lend evidence to these objectives.

The results demonstrated a clear correlation between low health literacy levels and poor patient outcomes. Low health literacy is also correlated with reduced medication adherence, improper use of medication, more emergency department visits, and unhealthy habits during pregnancy …

Stop The Bleed! Acute Epistaxis Management, Christopher R. Cannell

Lynchburg Journal of Medical Science

Epistaxis, the most common Otolaryngology-related emergency, is responsible for one in 200 emergency department (ED) visits in the United States (US) and one-third of otolaryngology visits.^1,11 Up to 60% of the population will experience epistaxis during their lifetime, and 6% -10 % will require medical intervention.^2,3 Epistaxis occurs in children and adults and has a seasonal variation. Although 85% of nosebleeds are idiopathic, they are more frequent in those on supplemental oxygen, anticoagulation, antiplatelet therapy, and in those with other conditions that may predispose them to bleeding. Most clinicians will encounter patients with acute epistaxis; therefore, it is …

Testosterone Replacement Therapy In The Middle-Aged Male, Gina N. Demilt

Lynchburg Journal of Medical Science

The purpose of this review was to investigate the use of testosterone supplementation in the middle-aged male with a focus on the pathophysiology of testosterone throughout the lifespan, current supplementation options and their adverse effects, and the overall benefit of supplementing to enhance quality of life. A comprehensive search of electronic databases was conducted identifying studies that assessed clinical outcomes, pathophysiology, supplementation options, adverse effects and benefits of treatments. The findings suggested that testosterone levels naturally decline with age with most men developing symptoms of hypogonadism around age 60. Testosterone supplementation outside of current guidelines is not recommended, however men …

Therapeutic Effectiveness Of Lumbar Medial Branch Block And Lumbar Intra-Articular Facet Injections: A Propensity-Matched Cohort Study., Ian S Ackers, Jacquelyn A Witzke, Arvin Saremi, Tyler K Farley, Nicolas R Thompson, Yadi Li, Brian D Foresi, Kush K Goyal

Ambulatory and Primary Care Articles

BACKGROUND: Chronic low back pain is a prevalent condition that is treated commonly with radiofrequency neurotomy (RFN) after diagnostic targeting with medial branch blocks (MBB) or intra-articular (IA) injection.

PURPOSE: We evaluated the long-term therapeutic value of MBB and IA injection of steroids for relief from chronic low back pain beyond the current diagnostic utility.

METHODS AND OUTCOME MEASURES: This was a retrospective propensity-matched cohort study from a single physician injection census at a tertiary care hospital. A total of 460 patients receiving MBB (n=383) or IA injection (n=77) in 2013-2020 were included. Primary outcome measures were patient-reported outcomes (PROs) …

Updating A Rural Clinic In Tiburón, Haiti, Akankcha Alok, Mohamed Bakhit, Djenie Helne, Philipe Milord, Marcellas Socrate, Camil Clermont, Marie A. Kima

HCA Healthcare Journal of Medicine

Background

Tiburón is a small fishing village in Haiti with a clinic overseen by the Oblate missionaries and the Ministry of Public Health and Population (MSPP). This village was hugely impacted by Hurricane Matthew in 2016, leading to increased health care demands. The clinic was inaccessible from the furthest parts of the village and lacked basic medication supplies and adequate manpower. We aimed to reinforce the infrastructure and update the clinic using a multifaceted approach.

Methods

We developed a quality improvement project to strengthen the clinic's infrastructure and modernize its facilities with a comprehensive approach focused on enhancing health care …

A Literary Review Of Physician Approach To Patient Care: Implications In Cancer Care, Daniel Ramirez, Kinsley Batson

Annual Research Symposium

No abstract provided.

Characteristics And Outcomes Of Adults Hospitalized With Respiratory Syncytial Virus, Brian S. Shaw, Cara Slaton, Ian P. Murphy, Michael Mcalister, Daniel Egan, Kwabena Ayesu

The University of Louisville Journal of Respiratory Infections

Background: Respiratory syncytial virus (RSV) is a negative sense single-stranded RNA virus (ssRNA) that primarily causes respiratory infections in both children and older adults. We examined clinical characteristics and outcomes of hospitalized adult patients who tested positive for RSV.

Methods: This was a multicenter, retrospective, descriptive study that examined adult patients admitted with a positive RSV test over two years across eight hospitals in Orlando, Florida.

Results: A total of 120 patients were included, of which 88 (73%) were 60 years old and older. Overall, patients with RSV infection were caucasian (62%) with a median age of 70 years and …

Implementation Of Endometriosis Toolkit: A Quality Improvement Project To Enhance Nurse Practitioners’ Knowledge And Management, Hasbun Rachel

DNP Qualifying Manuscripts

Abstract

Background: Endometriosis, characterized by the ectopic growth of endometrial-like tissue, affects approximately 11% of reproductive-aged women in the United States. Diagnosing endometriosis is challenging due to its diverse clinical presentations, reliance on laparoscopic procedures, absence of biomarkers, and limited awareness among healthcare providers and patients.

Local Problem: The diagnostic complexity of endometriosis, compounded by reduced provider awareness and a lack of comprehensive resources, leads to delayed and suboptimal care for affected women.

Methods: This Doctor of Nursing Practice quality improvement project aimed to enhance nurse practitioners’ (NPs) knowledge and management of endometriosis through a 1-hour educational session at the …

Perspectives On A Recently Merged Family Medicine Residency Program: A Post-Match Survey Of Ranked, Unmatched Applicants, John E. Snellings, Karo G. Ohanian, Ismail El Moudden

Eastern Virginia Medical Journal

Introduction: Residency program mergers are a topic of much consternation and relatively little scholarly investigation in graduate medical education. After undergoing a residency merger in July 2020, the newly formed Eastern Virginia Medical School (EVMS) Family Medicine Residency Program investigated the effects of the merger on the perspectives of the applicant pool for the subsequent 2020–2021 recruiting season. Methods: We conducted an anonymous survey of EVMS Family Medicine applicants during the 2020– 2021 recruiting season. Students who interviewed with the residency and were subsequently placed on the program’s National Residency Matching Program (NRMP) rank order list (ROL) but did not …

Priority Competencies For Designated Education Officers In The Veterans Health Administration, Duane R. Bidwell, Anita Samuel, Ronald M. Cervero, Steven J. Durning, Sherri L. Stephan, Erin L. Patel, Marjorie A. Bowman, Holly S. Meyer

Population and Public Health Sciences Faculty Publications

Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance. Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that …

Prospective Receptivity And Acceptability Of Brief Alcohol Interventions Among Women And Racial/Ethnic Minority Veterans In Primary Care, Jacob L. Scharer, Robyn Shepardson, Brandi Roelk, Julie C. Gass, Laura Wray, Stephen A. Maisto, Jennifer Funderburk

The Journal of Integrated Primary Care

Brief alcohol interventions (BAIs) are an evidence-based practice for addressing hazardous drinking among primary care patients, yet implementation of BAIs in practice has been difficult and disparities have been identified regarding implementing BAIs with women and racial/ethnic minority patients. Further, patient engagement is a commonly identified barrier to BAI implementation. This mixed methods study aimed to assess acceptability of BAIs among women and racial/ethnic minority primary care patients and to identify factors that may impact their receptivity to engaging in a BAI. Qualitative interviews were conducted with 17 patients who had screened positive for hazardous alcohol use. Patients reported neutral …

Improving Patient Engagement Through Whole Health: Veteran Perspectives On A Values Assessment Tool, Luke D. Mitzel, Robyn Shepardson, Emily M. Johnson, Jennifer Funderburk

The Journal of Integrated Primary Care

Amidst rising rates of costly chronic diseases, a growing emphasis for integrated primary care settings is offering proactive, person-centered, and whole-person care. Through its Whole Health approach, the Veterans Health Administration (VA) is a leading force in this movement. VA’s Whole Health focuses on delivering patient-centered care that engages and empowers Veterans to improve health outcomes. The Personal Health Inventory (PHI) is a brief, whole-person focused, values assessment of what matters most that can lead to personalized health planning. Using a concurrent triangulation (convergent) mixed methods design, we examined the perspectives of 25 post-9/11 Veterans using semi-structured telephone interviews. Qualitative …