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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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Supporting Patient Education on Bladder Cancer and Risk Factors Specific to Vermont
Evan Gaston
Physician and patient education materials regarding the incidence of bladder cancer in Vermont, the absence of recommended screening, and discussion of risks of bladder cancer with emphasis on private well water testing through the Vermont Department of Health.
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Safe Sleep for Newborns: An Addition to the Infant Care Guide
Charlotte B. Gemes
Many parents at Community Health Center of Burlington have questions about infant care after their baby is born and do not know where to turn to find the answers, An Infant Care Guide is therefore being developed to help new parents on basic topics. The section "Safe Sleep for Newborns" was developed and added to already developed chapters to provide parents the basics on safe sleep.
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Updating Evidence-Based Patient Education Resources for Sleep: Sleep Hygiene and Benzodiazepine Discontinuation
Carolyn Geraci and Madeline Fritz
There is a major need for patient education around the topics of sleep hygiene and benzodiazepine sleep aid discontinuation in the family medicine clinic setting. Current patient-focused educational materials need updating and are not comprehensive enough. We therefore created new handouts and smartphrases which integrate into the electronic medical record system with the goal of educating patients on these topics.
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Patient Education: Low-Carb Substitutes for Pre-diabetes Management
Keira L. Goodell
At Milton Family Practice in Milton, VT, individuals diagnosed with pre-diabetes are referred to a clinical nutritionist and sent home with patient instructions about blood sugar and carbohydrates. For those who decline a meeting with the clinical nutritionist, the patient instructions are not an adequate substitute. This project focused on the creation of a SmartPhrase to be added to patient instructions outlining common high-carbohydrate foods and options for lower-carb alternatives.
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Exercise as a Tool for Treating Anxiety and Depression
Lizzi Hahn
In addition to its important role in the maintenance of physical health, exercise has been shown to have numerous benefits for mental health. Recent studies indicate that even brief engagement in physical activity can make a positive impact on the treatment of pre-existing anxiety and depression - as well as the prevention of future symptoms. Despite this relationship between exercise and emotional wellness, regular activity in the United States is still exceedingly low, and exercise remains an underused tool by healthcare providers in the treatment of their patients’ anxiety and depression. The goal of this project was to assess patient engagement in and barriers to exercise, as well as their understanding of its benefits for mental health as perceived by providers at CVPH Family Medicine Center, and to create a patient-centered resource emphasizing the significance of physical activity in reducing the burden of anxiety and depression.
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Dietary Health Screening
Luke Hallgarth
Dietary recall by patients is time consuming & inefficient. This project aims to develop a screening tool to accurately and efficiently track patient's diets over the course of multiple healthcare visits.
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Evaluation of growth in clinical genetics competency among PCPs participating in the UVMHN Genomic DNA Testing Program
Christina Hansen
Recently UVM Health Network Family Medicine practices have implemented “The Genomic DNA Test” pilot program to begin a concerted effort toward offering genetically informed primary care to all patients. The program aims to increase the number of participating primary care providers stepwise over time. However, some providers may find integration of genomic testing and discussion of clinical genetics issues with patients to be challenging given the relatively recent change toward emphasis on these topics in medical training curricula. The aim of this project was to develop a pilot survey to gather information from current participating providers about how participation in the genomic testing program has influenced their personal knowledge of and comfort with clinical genetics topics and patient counseling.
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Increasing Patient Access to LGBTQ+ Healthcare through Expanding the Vermont Diversity Health Project
Rachel Harrison
Numerous studies have documented various disparities in health outcomes and barriers to healthcare access for LGBTQ+ individuals. One major way to combat this is to increase access to healthcare for LGBTQ+ patients and increase provider knowledge of how to best care for them. Through expanding the Vermont Diversity Health Project database of providers and having providers participate in LGBTQ+ Best Practices trainings (both hosted by Pride Center of Vermont), we may reduce LGBTQ+ health disparities in our local community.
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Harm Reduction in Family Medicine
Tess Hickey
In Lewiston, Maine the opioid epidemic is a public health crisis resulting in overdose-related deaths, infectious disease transmission, and public health costs. Harm reduction through resources such as syringe service centers, peer counseling, and Narcan distribution can help negate the negative health impact of substance use disorder. This project focused on creating a list of local harm reduction resources for providers so they can educate patients on how to be as safe as possible when using substances.
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Exercise and Physical Therapy in the Elderly
William Holden
There are many current barriers to participating in exercise and physical therapy in the elderly. Using reputable online resources, we created a handout containing a list of exercises that can be completed safely at home without equipment. It was designed for elderly individuals, as inactivity tends to increase with age and this population is particularly vulnerable to the deleterious effects of inactivity. The strength and flexibility exercises primarily target the back, hips and core, common problem areas in the elderly. The handout will contain links to further resources for more in-depth physical therapy exercises and will be tailored for administration in a primary care setting.
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