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Family Medicine Community Project
Daniel Castro
The goal of this project is to improve diet and nutrition literacy in the community. Though Vermont ranks low in the US in terms of obesity, it is still estimated the 60% of Vermonters are either overweight or obese. This represents an area of need in terms of improving diet and nutrition education to combat obesity, the health issues it produces, and the subsequent strain on the medical system
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Assessment and Awareness of Mental Health Conditions among Refugees in Vermont
Sandi Caus
Refugees experience profound hardship in their home-country, displaced country and throughout the period of re-settlement. Experiences like direct or indirect exposure to traumatic events, torture, sexual abuse and stigmatized refugee identity post-resttlement are major risk factors for the development of mental health coniditions inlcuding PTSD, depression and psychosis. Despite major risk factors for the development of mental health conditions, culturally-specific mental health stigma persists as a major barrier to addressing mental health among refugees. This project emphasizes techniques and self-education that can be utilized to improve mentah health screening and identification among refugee patients in Vermont.
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Preventive Healthcare Education in Primary Care
Anna B. Chamby
Primary and secondary prevention are vitally important mainstays of primary care. Every well visit at Newtown Primary Care involved some discussion of preventive health screening and services and relied on patient recall or EHR document search for last screening/intervention dates. We aimed to find ways to make use of wait times for in-office visits that could also potentially improve efficiency during patient encounters and help educate patients about preventive health measures.
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Lifestyle Changes in Covid-19 Pandemic and Impact on Modifiable Stroke Risk Factors
Kelly J. Chan
Stroke is one of the leading causes of mortality and disability in the USA. Underlying conditions such as hypertension, diabetes and cardiovascular disease predispose an individual to increased risk of stroke. In addition, the Covid-19 pandemic presents many challenges to these patients in terms of active health management and maintenance. A screening tool was developed to assess patient patterns of lifestyle behavioral changes measured by modifiable risk factors for stroke (medical condition management, diet, exercise, and smoking habits).
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First Contact: Headache Management in Primary Care
Sydney Chatfield
Primary headaches are one of the most common and debilitating disorders experienced worldwide. Many people are unaware of the everyday triggers and continue to take over the counter medication with little to no relief. Primary care providers are often the first or only people patients will address the issue with, but are faced with time constraints and lack of resources. I created an educational pamphlet on common triggers and solutions for patients to begin to think about root causes of their headaches and implement lifestyle changes.
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Improving Access to Meditation and Mindfulness for the Management of Anxiety, Stress, and other Chronic Diseases
Alex Cohen and Jesse Naumann
Chronic diseases can have an enormous burden on not only an individual’s quality of life, but their economic output as well. The challenge is that many patients with a chronic disease are not fully treated despite many different medications and doctor’s appointments. Mindfulness is an extremely beneficial tool that can be used as an adjunctive treatment for different chronic health diseases including anxiety, depression, insomnia, chronic pain, and many others. An enormous barrier is that many patients are unsure about what mindfulness truly is, and where one can go about accessing mindfulness resources. Our goal was to create a quick and easy smart phrase that providers can add to any after-visit summary that provides basic information about mindfulness, different resources to access free mindfulness meditations, and our own unique 8 minute mindfulness meditation for patients to try free of charge.
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Primary Cardiovascular Disease Prevention
Kaileen Cruden
Cardiovascular Disease is the leading cause of death in the United States, causing about 1 in 4 deaths. Cardiac rehabilitation is often only suggested to patients AFTER a hospitalization for serious heart conditions such as heart attack or heart failure. Data demonstrates the decrease of a secondary cardiac event for individuals who were enrolled in cardiac rehab as well as an improvement in cardiac risk factors including: decrease in lipid levels and insulin resistance with increased smoking cessation and exercise tolerance. Levels of depression and anxiety also improved in this population. This leads us to ask: How can we take what has been proven to improve heart health and prevent secondary cardiac events to prevent primary cardiac events?
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Walking Towards a Healthier Future: A Pocket Guide to Walking Routes in Colchester and the Health Benefits of Walking
Kevin DiBona
The obesity epidemic is a complex problem necessitating a multifaceted long-term response. While there is no single solution to this decade-evolving issue, exercise remains one of the most important health interventions available. This project aims to serve as a resource for patients seeking to lose weight; outlining some of the walking routes local to Colchester Vermont, as well as the health benefits of a sustained exercise plan.
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Emergency Medicine Super Utilizers and the Role of Targeted Community Paramedicine
Nathan E. Dow
Frequent emergency department (ED) users, colloquially known as “frequent fliers,” are a small population that account for a disproportionately large number of ED visits. Depending on the criteria used, ED super users may constitute as little as 1% of the individuals seen through the department, while accounting for up to 60% of the visit volume. There is an associated stress on the 911 system and a public health concern with burdening of already busy emergency departments. Unsurprisingly, ED super users have an associated financial cost. A 2015 Milwaukee area pilot program provided community outreach to only 39 of their well-known ED utilizers and still managed to return just over one million dollars in cost savings to the healthcare system. This patient population is frequently characterized by chronic illness including cancer, mental health disorders, substance use disorders, chronic kidney disease and chronic obstructive pulmonary disease (COPD).
At the University of Vermont Medical Center (UVMMC), a community outreach program is being assembled. Using both grant and internal funding, HealthNet paramedics and ED nurses will provide community-based care to the top 100 utilizers of the UVMMC Emergency Department. Methods include outreach to patients missing primary and subspecialty appointments, tracking pill counts, monitoring prescription refills, assessing medication adherence at home visits and assessing and addressing social determinants of health including housing and food stability. The program aims to decrease ED and EMS utilization, reduce health system costs and ultimately, improve patient outcomes. A similar program might be considered at CVPH, potentially utilizing CVPH Family Medicine staff for community outreach, as well as the clinic itself as a primary care alternative to frequent ED evaluation for chronic medical conditions.
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Kangaroo Care in the Community: Creating antenatal informational resources for providers and expectant parents
Emma Dunne
Obstetric care providers at the Community Health Centers of Burlington create, implement, and coordinate resources to help support parents through pregnancy, delivery, and child rearing. The COVID-19 pandemic has altered the accessibility of existing resources, exacerbating the need for creative support of prenatal learning, breastfeeding, and postpartum socialization. Regular skin-to-skin contact between newborn infants and their parents is a low-cost, low-risk intervention with demonstrated benefits to breastfeeding, infant and parent physiology, emotional health, and bonding. This project aimed to establish antenatal informational resources for providers and expectant parents about the potential benefits of skin-to-skin care in the community setting.
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Addressing Rational Barriers to Lifestyle and Behavioral Modification
Ahmed Eldakroury
Rational barriers contribute to resistance towards initiating, restarting or maintaining lifestyle/behavioral modification. Such barriers include lack of confidence in the proposed intervention(s), exaggerated perspectives, unsubstantiated beliefs and feelings of futility/hopelessness in the setting of past failures or relapse. Lifestyle and behavioral modification are core elements of preventative health and mental health—identifying and addressing erroneous thought processes, perspectives or beliefs that contribute to hesitancy may empower patients to trust the process and put an honest effort towards making those changes. Thus, a motivational pamphlet was created for patients with the goal of addressing hesitancy/resistance towards initiating or maintaining lifestyle/behavioral modification. The pamphlet attempts a different approach to motivational priming using mechanisms such as (1) informing and emphasizing the tangible changes in brain architecture that result from continued effortful thinking and reorientation, (2) surveying different demotivating thoughts while providing examples of cognitive techniques to reorient dissonant thought processes towards more rational and evidence based analyses. Additionally, the pamphlet attempts a discussion on relapse with the goal of restructuring the thoughts of defeat and hopelessness that impede progress and prevent effortful persistence. Future work should be targeted at evaluating the efficacy of this approach and fine tuning elements in the clinical motivational process.
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Preventative Health Care Shortage
Jenna A. Elkhoury
The primary care shortage is major problem that impacts people in rural and often low income communities. Our project seeks to address the primary care workforce shortage affecting the Vermont and Connecticut communities by better understanding current medical school student perspectives on primary care as a career of interest. Attractors and deterrents of primary care were highlighted through a survey distributed to all medical students at the Larner College of Medicine at the University of Vermont.
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Nutritional Habits: Encouraging Simplicity and Consistency
Alim Esemenli
Nutrition plays a crucial role in development of diseases that are the leading causes of morbidity and mortality in the Unites States. However, due to reasons such as time limitations, lack of clear guidelines, and what seems like a sense of hopelessness felt by providers and patients alike upon lack of results, discussions around nutrition may lack in frequency, consistency, and/or adequacy of duration, Research shows that flexibility of mindset, as well as achievability and sustainability of nutritional goals, play a key role in achieving success in weight This project proposes a three-page document that can potentially help primary care providers support and monitor nutritional behavioral changes determined by their patients.
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Skin Cancer, Skin Biopsies and Mohs Surgery: Patient Education
Negar Esfandiari
Skin cancer is the most common cancer in the United States. There are three main types of skin cancer: Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma. While Melanoma is less common than Basal Cell and Squamous Cell Carcinoma, it has a higher mortality rate. If diagnosed in earlier stages, Melanoma has a significantly better prognosis and lower patient costs. Most skin cancers are diagnosed through skin biopsies. Vermont has one of the highest rates of skin cancer. The goal of this project was to develop a patient handout to bring patient awareness to skin cancer and describe the different types of skin biopsies (shave, punch and excisional), as well as Mohs surgery.
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DASHing into a Healthier Life
Megan N. Eubank
Almost half of all US adults have hypertension (high blood pressure), which is a major risk factor for heart disease and stroke. Hypertension can be controlled through a combination of diet, exercise, and medications. The DASH diet has been proven to lower blood pressure in as little as two weeks. I created a brochure and Epic SmartPhrase that explains and simplifies the DASH diet for patients.
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Frequently asked questions by patients about exercise
Julie Evans
A significant portion of patient visits at Milton Family Practice are related to one or multiple aspects of metabolic syndrome. Exercise is a common topic during these visits either brought up by patients or providers. This project focused on creating a handout for patient education with answers to commonly asked questions pertaining to exercise and resources in the community.
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The Use of Technology for Mental Wellbeing in the Era of COVID-19
Adam Fakhri
Prevalence of mental health issues has increased during the time of COVID-19. There are many contributing factors to consider, the main one reported has been social isolation due to quarantine precautions. Members of the community have spent extended periods of time at home and away from their loved ones during this pandemic. Many patients have reported many life events occurring including deaths in the family without the ability to even mourn with their family members. This has taken a toll on the community, especially in Vergennes where this small tight knit community that has relied on its tight social bonds for wellness. There has been a trend of depressive symptoms rising in the community as well as an increase in reported anxiety. There is a shortage of mental health services through therapists and psychiatrists during this time, and a possible solution is the use of technology, specifically phone apps to aid with mental health concerns for members of the community who are unable to meet with a specialist. This project consists of a handout containing 7 apps for mental wellbeing reviewed by the Anxiety and Depression Association of America (ADAA).
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Helping schools support transgender and non-binary students
Nina Feinberg and Naomi Koliba
According to the 2019 Youth Risk Behavior Survey, LGBT middle and high school students are twice as likely to be bullied and are five times more likely to attempt suicide.
Coping with a stressful environment at school puts LGBT youth at risk of detriment to mental health, educational inequities, and even physical harm.
Adults at school who have relationships with youth are in a position of power to uplift and advocate for LGBT youth, and to educate those around them to create a safe environment for everyone to learn.
While teachers and other staff may offer students support, they may be unable to answer healthcare related questions that gender questioning adolescents have.
A document was created integrating resources centered on LGBT+ youth in Chittenden County, in Vermont, and across the country.
The document contained a series of questions and answers that adolescents may have about gender and what a doctor’s appointment would include.
An online version of the document was given to Milton High School and Champlain Valley Union High School to distribute to all students via email.
Both interviewees agreed that Milton High School staff are well-versed in the basics of pronoun use, but could use more training to apply their knowledge to support students.
Both interviewees also agreed that additional staff-wide training has been challenging during the COVID-19 pandemic but would be beneficial in following years.
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Waist Circumference as a Vital Sign
Brad R. Fiske
Conversion of research protocol into QI project at Norwalk Community Health Center. Goal is to implement waist circumference as a vital sign.
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How PrEPped Are Our Providers?: Assessing Vermont Primary Care Providers’ Knowledge and Awareness of Pre-Exposure Prophylaxis (PrEP) Options for HIV Prevention
Christopher Flynn
In recent years, a number of pre-exposure prophylaxis (PrEP) medications and dosing strategies have become available to patients to help prevent human immunodeficiency virus (HIV) infection. The primary objective of this research was to assess current PrEP awareness and prescribing practices of family medicine providers at the Hinesburg Family Medicine practice in Hinesburg, VT.
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Herbs and Natural Supplements for Treatment of Anxiety
Agatha Forstein
In the primary care setting, patients frequently bring in a list of various supplements or herbs that they are taking for a variety of medical conditions, including anxiety, with the hope to engage in a conversation with their PCP about whether these various supplements are safe and worth the cost. Physicians are often limited by a lack of training on the topic and/or by time constraints in the clinic. Thus, this aspect of care is not well addressed. This project includes the creation of a patient education sheet containing information about common herbal/natural supplements used for anxiety. It highlights the current evidence for efficacy, adverse effects, and drug/medication interactions. By providing some basic information on natural anxiety treatments, this aspect of care that is important to patients may be better addressed.
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Addressing COVID-19 Vaccine Hesitancy Part 2
Akua Frimpong
This project is a continuation from the Addressing COVID-19 Vaccine Hesitancy project. As time has progressed since the Pfizer, Moderna, and Johnson & Johnson vaccine were first distributed in the United States, more individuals are getting vaccinated. However, there is still many individuals who are hesitant to get the COVID-19 vaccine. CDC has been addressing this by encouraging medical providers to educate their patients about COVID-19 and the COVID-19 vaccines. With the recall and resumption of Johnson and Johnson, engaging in conversations about the mRNA vaccine technology, efficacy, and safety of the vaccines may help reduce public hesitancy. An educational handout that was created by a prior medical student was distributed at the Brookfield Family Practice. A survey was created and distributed to the patients. The survey looked at patients’ demographics, if patients were vaccinated, and whether the handout provided guidance in understanding more about COVID-19 and the vaccines.
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How to Have the “Vape Talk” with Adolescent Patients
Helen Gandler
Recent years have shown a dramatic increase in the popularity of electronic vapor products, which include e-cigarettes, vapes, vape pens, e-cigars, e-hookahs, hookah pens, and mods. While emerging data shows that adolescents are becoming more aware of the dangers posed by these products, more than 3.6 million US youth still use e-cigarettes. As of February 18, 2020, a total of 2,807 hospitalized e-cigarette, or vaping, product use-associated lung injury (EVALI) cases or deaths in the United States have been reported to CDC.
This project had two goals: to create a tool to help facilitate discussions between providers and their adolescent patients around vaping, and to create an infographic that would simply and clearly provide adolescents with information about the dangers of vaping as well as resources to quit.
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Addressing COVID-19 Vaccine Hesitancy
Aram S. Garewal
COVID-19 vaccine hesitancy in the United States is a major roadblock in the fight against a raging pandemic. Education on mRNA vaccine technology, efficacy, and safety may help reduce public hesitancy. An educational handout was created and distributed at the Brookfield Family Practice to help alleviate COVID-19 vaccine hesitancy in the local community.
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