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Domestic Health Assessment for Syrian Refugees in Rutland, VT
Ian Grant
The Vermont Dept. of Health/Agency of Human Services “Refugee Domestic Health Assessment Form” was reviewed, edited, and reformatted to improve provider work-flow, ensure accuracy, and ease the process of data collection. This form was redesigned specifically to be used by providers in Rutland, VT when assessing the health of newly-arrived Syrian refugees.
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Improving Adolescent Nutrition: Using Smartphone Applications to Guide Healthy Eating
Allison Greene
Rates of adolescent obesity remain high throughout the United States. While Vermont fares better than other states, 12.4% of high school students in the state are obese. This project sought to harness teens' frequent use of smartphones to communicate important nutrition information and promote healthy eating patterns. A search was conducted for nutrition-related iPhone and Android applications to create a list for distribution to adolescent patients at South Burlington Family Practice.
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The Facts - Your Choice: STD Risk Information for the Adolescent Patient
J C. Gwilliam
Sexual health education is one of the factors that has led to a dramatic drop in adolescent pregnancy since the 1990s. Paradoxically, though, rates of sexually transmitted-infections (STI) in the adolescent population during that period soared. The educational deficit appears to be a lack of understanding of both short- and long-term health risks that STIs pose, and conflation of contraceptive effectiveness with STI prevention. This project sought to develop an inexpensive, office-based education product that would aid practitioner-adolescent patient discussion and facilitate follow-up in the family medicine setting.
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Concussions: A general approach to management for coaches
Morgan Hadley
Youth sports (including Central Vermont Little League) are mostly coached by parents and while concussion training is suggested, it often does not occur. This leaves coaches much less likely to recognize concussion symptoms which can be dangerous. Additionally if coaches do not understand the impact of concussions they will be unable to provide any information to the youth athletes they are working with. Concussions symptoms have been shown to last longer in younger athletes and returning to play too soon puts the athlete at increased risk of an additional concussion. Therefore, education was provided to Little League coaches with the goal of ensuring that concussions can be recognized and proper management will be initiated with athletes.
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Chronic Pain: Improving Patient Awareness of Management Options
Lauren E. Haggerty
Chronic pain affects 100 million Americans and places a significant burden on patients and their families. Opioids are frequently used to manage chronic pain, and their potential for misuse, addiction, and adverse effects are of growing concern in Vermont. Increasing patient awareness of different pain management options could decrease patient suffering and mitigate the opioid epidemic. This project aimed to educate patients on chronic pain management and resources available in Franklin County.
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Use of Opioids for Pain Management: Educating Patients and Providers on Upcoming Changes to Vermont State Law
Ashley C. Hodges
Vermont is suffering from an opioid epidemic. With 112 opioid-related deaths in 2016, nearly every community has been touched by this crisis. In an attempt to combat this problem, new legislation (effective July 1, 2017) will change how opioids are prescribed for both acute and chronic pain management in Vermont. Changes include dose limitations for acute pain, stricter monitoring requirements, and mandated prescribing of naloxone (an overdose reversal agent) for patients on high doses of opioids or on both opioids and benzodiazepines. This project aims to educate patients about upcoming changes.
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Health Care Shares: Vermont Community Wellness through a Farm to Patient Collaboration
Lindsay S. Howe
Food insecurity in Vermont has increased over the past decade, with nearly 85,000 Vermonters struggling to provide adequate amounts of food for their families during the past year. Families living in the Northeast Kingdom of Vermont have higher rates of food insecurity than those in urban settings. Unfortunately, when families are living with or threatened with food insecurity, they often rely on cheaper, processed foods that have a longer shelf life than fresh produce. This is likely contributing to the increase in obesity and chronic health conditions such as diabetes. Programs such as Health Care Share aim to combat food insecurity by providing free, fresh produce to families identified by health care professionals in the community. In addition to providing produce, participants are provided with healthy recipes, as well as information regarding safe food preparation and healthy living.
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Food For All
Vicenta Hudziak
Hardwick area free and reduced-cost local food resources. Includes schedules and contact information for local meals, food pantries, assistance programs, educational programs, and cookbook information.
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Organ Donation: Gauging Perception, Interest, and Clarifying Misconceptions
Tridu Huynh
Around 120,000 people currently need a lifesaving organ transplant in the United States. On average, 22 people die each day while waiting for a life-saving organ transplant. In 2011, over $34 billion dollars were spent on dialysis patients with end-stage renal disease. Only 52% of the national population is registered for organ donation. In Vermont, that number is 44%. This project aimed to clarify some common misconceptions regarding organ donation in the form of a brochure. Participants' subsequent interest and concerns regarding registering as an organ donor were also gauged. A total of 50 people filled out the form. There was a significant positive change in interest regarding registering as an organ donor after reading the informational brochure (p < 0.0001). There was no difference between genders or age groups. People reported that they were neutral to likely (mean = 3.31) regarding registering during an advance directive talk. The most common reasons cited for not registering as organ donors were concerns over organ quality due to age, medical condition, or substance use (6/16), religious or philosophical beliefs (4/16), and needing more time (4/16). Until such a time that we move from an opt-in to opt-out system of organ registration, the only way to maximize the probabilities of having successful organ transplants is to maximize recruitment. This project is proof of concept that an informational brochure can significantly encourage people to register as organ donors. It also provides modest evidence that yearly reminders during advance directive talks on top of the DMV would increase registration.
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Hepatitis C Screening in the Baby Boomer Cohort
Peter Hyson
The USPSTF recommends a one-time screening for Hepatitis C, irrespective of prior risk factors, for individuals born between 1945-1965. Many patients in this group may not be aware of this recommendation or understand very much about Hepatitis C infection. This project sought to educate and promote screening among the "Baby Boomer" cohort at Hinesburg Family Medicine Clinic. A literature review on HCV screening in the age group cohort was carried out and a poster was created.
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Educating Patients about Behavioral Interventions and Exercises for Musculoskeletal Lower Back Pain
Alex Jacobson
Low back pain (LBP) is a common problem which affects all genders and most ages. It results in considerable direct and indirect costs, and these costs are financial, workforce and social. The majority of lower back pain occurs due to a musculoskeletal etiology and often presents to the primary care physician. We worked with local physicians, chiropractors, physical therapists, and athletic trainers to develop exercises and behavioral modifications that patients can do to improve lower back pain symptoms.
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Advance Directive Initiative- St. Johnsbury, VT
Arjun Janardhan
Valuable time is frequently lost during end of life care or in the unforeseen circumstance of severe injury or illness when a patient does not have appropriate advance care planning. While end of life care costs continue to increase in an aging U.S. population, only 26% of U.S. healthcare consumers have completed Advance Directives (ADs). One of the key barriers to increased participation and awareness continues to be lack of patient education. Due to the complicated terminology often used in these legal documents, one essential component of the AD initiative at St. Johnsbury Community Health Center is creating a simple and effective handout to improve patient education.
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Cervical Cancer Screening at Community Health Centers of Burlington
Adrienne Jarvis
Most invasive cervical cancers are found in women who have never been screened or who have not been screened in the last five years. In order to improve the cervical cancer screening rate at the Community Health Centers of Burlington, a chart review was conducted of female patients who did not have records of Pap tests within current guidelines. It was found that the 28% of these patients had pap tests by outside providers, indicating local care coordination is a major barrier to cervical cancer screening tracking. Another major barrier to screening was patients seen for acute visits only or for management of multiple chronic conditions but not for preventive visits.
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MAT for Opioid Use Disorder in Maine
Eliot S. Jia
Opioid Use Disorder (OUD) is a major problem in the state of Maine with one person dying from overdose every day. Medication Assisted Treatment (MAT) using Suboxone has been shown to be helpful in the treatment of OUD, but there is currently a great need for providers to prescribe Suboxone in this region. We looked at barriers that providers saw for obtaining a waiver to prescribe Suboxone and created a handout to educate providers on MAT and the process for getting the waiver.
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Driving Under the Influence of Marijuana: Education of Vergennes Union High School Students
Margaret S. Johnston
The leading cause of death for high school students is motor vehicle accidents and the risk of involvement in a motor vehicle accident increases 10-fold after marijuana smoking. There are many misconceptions surrounding driving under the influence of marijuana in adolescents and few high schools are spending adequate time addressing this issue directly. The 2015 Vermont Youth Risk Behavior Survey found that 18% of students in Addison County rode in a car or other vehicle in the past 30 days with someone who was using marijuana. This project was designed to present information about driving under the influence of marijuana to Vergennes Union High School students in small group settings. Topics discussed include the effects of smoking marijuana on clinical judgement and reaction time, consequences of driving under the influence, and how to talk to peers about this issue.
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Media Screen Time for Young Children, a Culturally Competent Approach
Jenna Conway Jorgensen
Young children are being exposed to excessive screen time. There are many health and developmental risks of excessive or inappropriate media exposure, including sleep disturbances, developmental delays, and obesity. New American families are likely unaware of the consequences of too much screen time in young children.
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Acrylate Allergy to Fake Nails: Unique Presentations of Onchodystrophy and Subungual Hyperkeratosis
Marie Kenney
Artificial nails are commonly used worldwide for cosmetic nail enhancement. Chittenden County, Vermont has 20 operating salons that offer acrylic nail procedures. Common procedures for the administration of acrylic nails include self-curing sculptured nails and light-cured nail lacquer, also known as “gel” nails. Both methods employ binding agents that utilize acrylic monomers or polymers. These acrylates are a frequent cause of allergic contact dermatitis in both manicurists and clients. A distinct presentation of allergic contact dermatitis to nail lacquer has been recently recognized in the community. It involves the sudden onset of painful nails and lack of associated eczematous changes. There are currently two reported cases in the literature which also describe onycholysis and subungual hyperkeratosis without surrounding dermatitis, and two reported cases recognized by dermatologists in Chittenden County. This project aims to identify offending acrylic chemicals in the community and educate primary care providers about this specific allergic presentation that can masquerade as onychomycosis or nail psoriasis.
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Having a Conversation About Health Care Wishes and Goals in Vermont
Eric C. King
Research has shown that people think talking with family and friends about end-of-life care is important, but they do not actually have this conversation. The majority of adults do not have any form of advance care planning in place. In the state of Vermont if you are 18 years of age or older there is no default person to make decisions for you (such as a spouse or next of kin) in the event that you would be unable to do so, which can result in a complicated ethical dilemma. The goal of this project is to improve conversation rates between patients and their friends and families about their health care wishes and goals.
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My First Cookbook! Healthy Recipes that Kids Can Make
Emily KINN
The obesity epidemic in the United States continues to negatively impact health outcomes in every age group. Interventions aimed at the pediatric population is an especially attractive public health strategy to help kids early on develop important skills for healthy eating to carry with them into adulthood. Childhood obesity prevalence remains alarmingly high at about 17% and has a huge impact on children’s health including higher likelihood of developing risk factors for heart disease, high blood pressure, asthma, sleep apnea, psychiatric problems and problems with self-esteem. This project aims to help elementary school aged children become more involved in making their own healthy food choices by creating a cookbook with recipes that children in this age bracket can make themselves. Its recipes are guided by the recommendations of the Mediterranean diet.
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Promoting Skin Cancer Awareness
Sree Sahithi Kolli
Skin cancer is the most common cancer in the nation and the cost to treat it is around 8 billion dollars a year. Sun exposure is linked to all three types of skin cancer and incidence of melanoma is highest in Caucasians compared to other races. In Brookfield, CT which is comprised of a predominantly Caucasian population, there is a lack of awareness of skin cancer detection and prevention. One of the best ways to promote skin cancer awareness is through education about the different types of skin cancers and sun safety behaviors. The idea is to start the conversation about skin cancer by capturing people’s attention with a visual poster. A poster is multifaceted in that patients can spend time reading it while in the waiting or exam room, can be used as instructional aide by the physician and can be transformed into a miniature handout made available for patients to take home with them. The goal is to promote skin cancer awareness so skin cancer can be detected and treated in a timely manner and patients are equipped with tips on how to minimize sun exposure.
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Making Diagnostic Testing for Lyme Disease More Approachable
Jacob A. Korzun
The CDC’s recommended testing and treatment guidelines can be confusing for patients and healthcare providers alike. There is often a knowledge gap in understanding what is being analyzed in serologic tests as well as why two step testing is employed. With the increasing incidence of Lyme in the northeast it is as important as ever to ensure that there is an approachable resource for patients to learn from. Better patient care can be provided while also reducing unnecessary testing and resource overutilization by empowering patients with a better understanding of the process of diagnosis of Lyme disease
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Primary Care Treatment of HCV in Medicaid Patients
Stephanie S. Kulaga
New, safer HCV treatment regimens make it more feasible than ever for primary care providers to manage Hepatitis C patients in their own practices, rather than leaving management solely to specialists. With the current prevalence of HCV and increasing number of new cases linked to the opiate epidemic, it makes sense to expand the number of providers who manage this illness. However, the landscape of new treatments and changing Medicaid requirements present administrative barriers to primary care treatment of HCV. This project aimed to clarify what those barriers were and create a treatment algorithm to simplify decision-making around which patients should be referred to management solely by specialists, and around how to manage those patients appropriate for primary care.
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Provider Education: Managing Depression in Cancer Patients
Nicole Leonard
Depression is more prevalent and less often treated in cancer patients compared to the general population. Cancer can increase the risk of depression in multiple different ways, but depression can also increase the risk of cancer. Untreated depression in cancer patients can increase the risk of metastasis and worsen prognosis. The purpose of this project is to educate providers on the connection between mental health and cancer as well as provide them resources on how to approach and manage patients with cancer and depression.
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Provider Education & Requirements for Opioid Prescriptions
Lawrence J. Leung
Nationally, there has been a surge in the opioid prescription crisis with associated overdose deaths. Vermont is no exception, with increasing opioid overdose related deaths within the last 10 years. A sample (n=111) of opioid addiction patients at the Community Health Centers of Burlington (CHCB) have demonstrated that 25% have their initial use due to provider prescription. New Vermont regulations to decrease opioid prescriptions are inefficient. The goal of this project is to implement a streamlined intervention to improve provider education and comfort regarding new Vermont state opioid prescribing regulations.
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Community Awareness of Burgeoning Prostate Cancer Screenings
Rose Kristine Leu
Prostate cancer screening is an ever-changing field because the benefits of using PSA as a screening tool is not clear-cut, subsequently causing a lack of standardization of screening protocols among various providers. In 2012, the USPSTF published their recommendation of grade D to prostate cancer screening, which caused a decrease in its use. However, the USPSTF recently changed their recommendation from grade D to C, conceding that screening can be beneficial to a certain group of people. Patients are understandably confused about what is appropriate for them; now is the perfect time to raise awareness about the importance of prostate cancer screening and to motivate patients to start a shared-decision making conversation with their provider.
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