Block Clerkship Projects

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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.
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.
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.
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.
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
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.
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.
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.
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.
Evaluation of a cancer risk assessment questionnaire to guide cancer screening decision-making in primary care

Anita Li
Improving our response to positive food insecurity screening at Colchester Family Practice

Callie Linehan

My project is to raise awareness of food insecurity among providers, and identify resources and next steps providers can take to help patients who screen positive for food insecurity using the AAP-recommended Hunger Vital Sign.
Patient-Oriented Smartphone Apps to Improve Health & Wellbeing

Geordie C. Lonza

Patients have the ability to improve their health outcomes, but their capacity to do so is sometimes underutilized due to misunderstandings or ineffective engagement in their healthcare. Nearly everyone owns a smartphone today, and there are innumerable patient-oriented smartphone apps in both the Apple and Android app stores. However, the clinical utility of these apps has not been widely studied. It is possible that we can incorporate the use of technology such as smartphone apps into our recommendations to patients in order to improve their management of their chronic diseases and their abilities to make lifestyle modifications.
Lyme Disease Education: Prevention and Response to Tick Bites

Nicholas S. LoSchiavo

Lyme disease is a major public health concern in Vermont, and is only becoming more prevalent. There were nearly 800 probable cases of Lyme disease in 2016, compared to 100 cases in 2006. Untreated Lyme disease has significant effects on overall health including cardiac disease. Lyme disease also has severe impacts on public health costs, and is responsible for roughly $1 billion annually. A Lyme disease handout for patients at a primary care outpatient center in Vermont was designed to help educate the public on disease prevention and progression.
Combating Diabetes in Chittenden County: A Healthcare Provider Referral Campaign to Increase Patient Participation in the Vermont Diabetes Prevention Program

Samantha Magier

As of 2016, diabetes affects more than 29 million people in the United States and is the 7th leading cause of death nationwide. In Vermont, 1/10 people are diagnosed with either diabetes or prediabetes, with 6% of Vermonters affected by prediabetes and 5% of Chittenden Country affected by prediabetes. The public health burden of this chronic disease is immense: diabetes costs Vermont an estimated $543 million each year and is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness. Prediabetes occurs when blood sugar is higher than normal but not at the diagnostic threshold of diabetes. Prediabetes does not definitely progress to type 2 diabetes if interventions are made, including healthier eating and physical activity to promote modest weight loss. The CDC has developed evidence-based curricula for lifestyle intervention in prediabetics with intensive individual counseling and motivational support on effective diet, exercise, and behavior modification. One of these curricula is currently run through the CDC-led National YMCA Diabetes Prevention Program (YDPP). Participation in this program reduces the risk of developing type 2 diabetes by 58% across all ethnic groups and sexes overall and by 71% in individuals over age 60. The Vermont YDPP had 325 participants in 2016, with only 21% (n=70) of those referrals to the program coming from healthcare providers. Healthcare providers have a unique role in the community of being the voices of health promotion. With the correct provider awareness of the YDPP and patient identification, awareness, and education, an increase in the percentage of YDPP-referring healthcare providers can increase the overall YDPP participation in Chittenden county. As of 2016, 60,038 people in Chittenden county have prediabetes, but only 8,026 are diagnosed, and an additional 52,012 people could be diagnosed with prediabetes by their healthcare professional and referred to the YDPP. This campaign intends to serve as a pilot project to create provider and patient awareness of the YDPP, identify patients with prediabetes, and ensure providers screen and refer prediabetic patients to the YDPP. Through exam room posters, panel query management, electronic medical record reprogramming, and targeted patient intervention, this study aims to increase YDPP patient participation via healthcare provider referral and refine the model for adaptation and implementation in other healthcare centers throughout Chittenden County.
A Multimodal Approach to Hypertension: Behavioral Modifications on a Budget

Jayne Manigrasso

Hypertension is one of the most common diagnoses in the adult population in the United States. Hypertension also has various sequelae that are preventable with adequate treatment, including medication and lifestyle modification.
Rutland City Public School At Risk Youth Mentorship

Michael J. Marallo

This after school program’s purpose is to address the unique challenges of Rutland, VT Middle/High School students with multiple psychosocial risk factors (as determined by comparison to the ACE questionnaire) through mentorship, health and life skills education, and by guiding the development of positive coping skills. Activities will allow for self-expression outside of the classroom in a safe environment. Focus will be placed on assisting paraeducators and teachers with meeting goals that are appropriate for each individual student.
Teaching Value-based Care: A Framework for a Family Medicine Resident Clinic

Alexander W. Marchese

Milton Family Practice is home to the University of Vermont’s Family Medicine residency program. As efforts to improve the value of health care increase, graduate medical education accreditation organizations may begin to reward and penalize residency programs based on their commitment to teaching and providing value-based care. Residency programs currently lack a clear strategy to prepare residents to assess and deliver value-based care. In this presentation, I present the VALUE Framework (Patel, Davis, & Lypson 2012) for the University of Vermont Family Medicine residency program to teach residents to assess and deliver value-based care for their patients during preceptor sessions.
Breast Density Notification: A Primary Care Summary

Nicole Lin Mendelson

On January 15^th, 2017 Vermont Senate Bill 157 took effect requiring healthcare facilities that perform mammography to provide patients information that identifies their individual breast tissue classification. 40-50% of women fall into the category of having increased breast density. Increased breast density reduces the sensitivity of mammography and increases the chance that cancer will not be detected. Additionally, women who have dense breasts are at an increased risk for developing breast cancer. Supplemental screening provides an opportunity to increase detection of breast cancer, but comes with an increased rate of false positives. With this new law in place, there is a need to educate primary care physicians on the risks and benefits of available supplemental screening technologies so that they may appropriately counsel patient that wish to proceed. This project resulted in an educational document and presentation to primary care physicians at Berlin Family Practice with the aim of raising awareness about the topic, providing education on the screening options/counseling patients, and providing a forum to discuss how patients will be affected.
Addiction Recovery Support: Connecting Primary Care Providers and Community Resources

Amber J. Meservey

Addiction to drugs and alcohol is a pervasive problem throughout Vermont and the U.S., and only a fraction of those needing help receive it. The vast majority of admissions to substance abuse treatment programs do not come from healthcare providers, who report a lack of preparedness in managing addiction screening and referrals. Recognizing that Family Medicine Providers are likely to be caring for many patients struggling with substance abuse, this project aims to improve provider familiarity with local resources. In particular, this project focuses on promoting long-term retention in self-help group programs, as these have been demonstrated to be the most approachable form of help for many presenting in the primary care setting.
Talking To Your Teens About Pregnancy

Sergio Andres Munoz

Teen parents are at risk for a variety of adverse life outcomes. The rate of low birth weight and premature delivery is higher among teen mothers than the average population. Teen pregnancy and birth are major contributors to lower educational achievement and income as they are less likely to graduate High school and college, leading to increased rates of poverty among teen mothers. This project aims to educate parents of at risk teens on how to approach the topic with their kids and to provide them with a list of online sources to aid in the process.
Radiation Risks and Safety

Hyunsoo Joshua No

Patient and physician requests for the use of X-Rays, CTs, and other radiation-producing medical imaging are increasing in the US. Both public and physician awareness of radiation knowledge is limited. Studies suggest that the general public is not concerned about exposure to ionizing radiation from medical procedures due to the widespread notion that healthcare professionals have received extensive training in the radiation principles and are competent in minimizing risk. Pamphlets providing simplified information, available for both providers and patients, may provide as an effective intervention to help educate both physicians and the public about radiation risks and safety.
Promoting Awareness of the Opioid Epidemic in Rural Vermont

Kathleen Olson

Vermont is in the middle of an opioid epidemic. Heroin use fatalities are on the rise and the number of people in treatment for opioid use disorder in Rutland County has tripled in recent years. Despite this widespread problem, community members of Rutland County feel that there is reluctance to talk about opioid misuse and lack of awareness. This project aims to bring awareness, provide resources, and encourage people struggling with opioid use disorder to seek treatment.
Aging Well: Informing Seniors About Local Resources Throughout The Aging Process

Sravana Paladugu

A large portion of the Franklin County population is elderly and above the age of 60. They have many unique socioeconomic barriers to healthcare that add to the difficulty of maintaining independence in the community. This has been a burdensome public health cost for not only this community but for Vermont as a whole. The goal of this project was to inform local seniors of services provided by Age Well VT that could enable them to stay at home for longer. This was carried out by designing an Age Well VT handout that could be easily read and utilized by elderly patients at the Fairfield Street Health Center.
Opioid Prescribing: New Vermont Regulations for Providers

Lloyd Patashnick

Opioid abuse is serious problem in Vermont with an estimated yearly health cost of $38 million. In 2015, 28% of Windham county residents were prescribed opioids. In order to combat the ongoing crisis of opioid prescription abuse, the State of Vermont will implement new prescribing regulations which will take effect in July, 2017. To ensure compliance with these new regulations, health care providers need to be educated to allow for a seamless transition in patient care.
Barriers to Affordable Prescriptions in Rural Vermont

Niketu P. Patel

This project aimed at understanding why people in Rutland County, Vermont struggle with buying medications for their health. The project implemented and proposed several methods to help the population of Rutland area better adapt to the growing cost of prescriptions via $4 medication lists, rebates, samples, etc.