Block Clerkship Projects

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Increasing Advance Directive Knowledge among Healthcare Professionals

Laura K. Donnelly

Advance Directives (ADs) have been shown to be associated with increased patient satisfaction with end-of-life care, decreased in-hospital deaths, and decreased end-of-life costs in high-cost regions. Nationally, prevalence of ADs has increased over the last 20 years, but the majority of patients still have not completed an AD. A significant obstacle to completion is lack of awareness. A presentation to increase knowledge regarding ADs among primary care staff was created to address this.
Debate as a tool for rehabilitation: a 8 week debate and public speaking course at Woodside Juvenile Rehabilitation Center

Liam Donnelly

Sanction based prison approaches help to prevent crimes, but newer studies have shown that they do not prevent recidivism. Conversely, rehabilitation based programs have been shown to reduce recidivism rates, sparking a resurgence in these types of programs. Further, sanction based practices cost significantly more than rehabilitation programs that use parole. While rehabilitation programs are more effective and cheaper, more studies need to be performed to determine which type of rehabilitation program is the easiest and most effective. Preliminary studies show that education and CBT based programs are among the most effective. In order to add to the knowledge about education based approaches, we conducted an 8 week debate and public speaking intervention developed and organized by Jessica Bullock and SPEAK Inc. We hope to show that debate programs can provide valuable rehabilitation skills to students in prisons and help to reduce recidivism rates.
Assessing Patient Perspective of Current Suboxone Treatment

Midori Eckenstein

The number of people seeking treatment for opioid abuse and heroin use. While this number is increasing the number of heroin fatalities is also on the rise. Methadone clinics are reporting better retention rates than suboxone treatment. This project explores the patient perspectives of suboxone therapy and what can be improved to help establish better practices.
Hidden Adolescent Risks: Provider Education on Non-Suicidal Self-Injury

Bailey Fay

Non-suicidal self-injury (NSSI) has been shown to be a strong risk factor for suicidal ideation and suicide attempt. One study has shown over 50% of people engaging in NSSI have at least one suicide attempt in their lifetime. The 2015 Vermont Youth Risk Behavior Survey found 17% of high school students reported non-suicidal self-injury at least once in the past year. This reflects roughly one in four females and one in ten males. Furthermore, these numbers have increased significantly since 2013. In an effort to promote awareness of NSSI in the primary care setting, a handout was created for providers at UVMMC Family Medicine on this topic. The goal of this handout was to increase early detection and intervention for adolescents engaging in non-suicidal self-injury. Information covered in the handout includes the prevalence of NSSI, who is at risk and why, signs of self-injury, how to assess the severity of NSSI and if emergency intervention is needed, how to discuss this topic with teens, available treatments, and local resources for adolescents.
Counseling Pregnant Women on Marijuana Use

Theresa B. Flanagan

Marijuana is the most commonly used illicit substance for pregnant women nationwide, with rates of use trending upward. Marijuana use in Penobscot County is elevated well above the national average, and is likely to continue to rise with the legalization of recreational marijuana in the state of Maine. Though the American Congress of Obstetricians and Gynecologists (ACOG) discourages marijuana use during pregnancy and breastfeeding, studies have shown that providers do not emphasize counseling pregnant patients on marijuana use. This project looked at provider practices and perceptions regarding marijuana use during pregnancy at the Center for Family Medicine at Eastern Maine Medical Center in Bangor, ME. Addtionally, an information sheet for providers regarding marijuana use during pregnancy was created based on current research and survey results.
Sleep Hygiene In Danbury CT: Providing a Resource to Prompt and Initiate Behavior Change

Sebastian A. Franco

Sleeplessness is a problem encountered frequently in the primary care setting, and often is inappropriately addressed by prescribing pharmacological intervention for indefinite periods of time. This project sought to promote behavioral intervention strategies modeled after CBT-I to address sleep hygiene in patients struggling with their sleep.
Immunization Safety: Addressing Parental Safety Concerns

Andrew Gallagher

Since 1998, when a fraudulent research paper alleged a connection between the MMR vaccine and autism, increasing numbers of parents are refusing routine childhood vaccinations. Recent research has shown parents’ top vaccine-related concerns included the number of vaccines during the first 2 years of life, administration of too many vaccines in a single doctor visit, and a possible link between vaccines and autism. More than 10% of parents of young children refuse or delay vaccinations, with most believing that delaying vaccine doses is safer than providing them in accordance with the Centers for Disease Control and Prevention’s recommended vaccination.
Backpack Safety Awareness to Prevent Back Pain in School-Aged Children

Aaron M. Gelinne

According to the Consumer Product Safety Commission, more than 6,300 children between the ages of 5 and 18 were treated in emergency rooms for backpack injuries in 2016. Swanton Elementary School services over 500 children and frequently cites back pain as a reason for nurse visits, but does not provide any education on proper backpack safety. September 20, 2017 was National School Backpack Awareness Day which provided a unique opportunity to educate school parents and children about backpack safety.
Improving Diabetes with an Exercise Log

Ramya Ghantasala

Diabetes is a prevalent and costly disease. Everyone benefits from physical activity, but it is particularly beneficial for people with diabetes. One method to improve motivation and adherence to physical activity may be the use of monitoring with an exercise log.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.