Reducing Benzodiazepine Use for the Treatment of Insomnia and Supporting Nonpharmacological Therapies
UnChan PyonShort-term Project
Most medical organizations recommend against the use of benzodiazepine use for the treatment of insomnia, especially in the elderly. However, the percentage of the adult population on benzos increase with age: 7.5% in adults ages 51-64; 9% in adults over 65. Alternative therapies for insomnia, including online CBT, require more commitment than taking a medication so many patients opt for medication. This project aims to increase awareness of benzodiazepine use for insomnia and provide support for nonpharmacological therapies.
Khaled H. Al TawilShort-term Project
Ultrasound has been found to be a valuable diagnostic tool for ruling in or out serious and common medical conditions. The advent of Point of Care Ultrasound (POCUS) provides trained primary care providers the technology to gather immediate data for clinical decision making and to move patient care down the correct clinical pathway in a timely and more cost effective manner. This tool has been shown to assist in motivational interviewing by giving real time evidence to the patient. This technology has the potential to significantly enhance access for patients in rural communities where diagnostic centers and specialty care can be geographically and financially challenging.
The purpose of this retrospective study is to identify the benefits of the use of handheld ultrasound versus in the rural Primary Care setting to rule in/rule out specific diagnoses: The scope of diagnoses or ruled out pathologies for the purpose of this study will consist of the following: Deep Vein Thrombosis (DVT)/Abdominal Aortic Aneurysm (AAA)/Joint Effusion/Hydronephrosis/ Tendinopathy/ Thyroid disease/ Cysts--specifically subdural or liver cyst/Rotator cuff injury/ Cholecystitis.
POCUS was introduced in the Hudson Headwaters Network in 2015 when the Network purchased units for their primary and urgent care clinics and trained clinicians began providing this service at no cost to patients. This quality improvement project is a retrospective chart review to document time to diagnosis, time to initiation of intervention if appropriate, any additional diagnostic evaluation, related subspecialty referrals and care and location of any out of office care provided in relation to site where POCUS was performed.
Holly BachilasShort-term Project
Smoking rates nationally have declined over the past several decades, however, tobacco use in the North Country of upstate New York remains higher than the national average. Group discussion programs have been shown to be more effective for smoking cessation than pharmacologic efforts alone. A 7-week smoking cessation support group was started in Glens Falls, New York using the Butt Stops Here curriculum. Participants were encouraged to also use pharmacologic methods as directed by their medical providers. Participants completed a brief survey before and after the program. Participants generally felt less motivated, but more equipped to quit after the seven weeks. One participant out of eight was able to quit entirely and 7/8 participants were able to decrease their level of tobacco use. A larger sample size is needed before conclusions can be drawn about the effectiveness of this smoking cessation support group.
Tessa R. BarclayShort-term Project
Splenic rupture is a rare, but potentially life-threatening, complication of infectious mononucleosis. Splenic rupture is generally uncommon four weeks after infection onset, however given the long incubation period and prodromal symptomatology characteristic of infectious mono, it can be difficult to determine an individual patient's risk in the clinical setting. Additionally, diagnostic labs have high false negative rates in the first 1-2 weeks of infection. To help alleviate diagnostic uncertainty and protect patients against outcomes such a splenic rupture, an evaluation and consolidation of the available literature yielded a simplified schematic of advisable activity levels for each stage of infection.
Nate BennerShort-term Project
Food insecurity is a worldwide public health issue, and is even pervasive among relatively affluent communities in the United States. This project evaluated healthcare workers comfort in the topics of epidemiology and locally available resources with respect to food insecurity before and after an informational presentation. Results showed overall improvement in comfort on these topics following the presentation. Future research should be aimed at understanding if this changes referral rates.
Michael BurtonShort-term Project
The United States Preventative Services Task Force (USPSTF) is planning to update their prostate cancer PSA screening guidelines to a category C from category D grade. This could potentially lead to confusion among both providers and patients as they have become accustomed to the previous guidelines and there has always been much discussion among providers about whether to offer the test. This project seeks to provide information to patients about the upcoming change so that they are more informed and able to better participate in discussion with their doctor about the pros and cons of PSA testing.
Katherine CliffordShort-term Project
About one third of adults in the U.S. get insufficient sleep, defined as less than 7 hours of sleep per 24 hour period, with similar statistics in Chittenden County, Vermont. Poor sleep/insomnia is a common complaint of patients visiting their primary care providers, and has many important consequences for physical and mental health. While sedative hypnotic medications and over the counter sleep aids are commonly used, they have many important side effects. Cognitive behavioral therapy for insomnia (CBT-I), which includes sleep hygiene techniques, is recommended as an effective, first line nonpharmacologic intervention for chronic insomnia. This project sought to create an educational patient handout to promote sleep hygiene techniques, a behavioral intervention aimed to improve sleep in the patient population at Hinesburg, VT.
Sean ClossShort-term Project
This project is an initial pilot idea for hands-on experiences to reinforce smoking prevention in adolescents. The proposed idea is to have students specifically those identified 'at-risk', being given opportunities to interact with pathology specimens on-site at the hospital, introduce spirometry, and real-world panel discussions. The resources of the hospital provide a unique opportunity for promotion of this public health goal.
Cody J. CouperusShort-term Project
Mental health illness is a pervasive and incurs tremendous cost onto society. Patients benefit from a multi factorial approach to treatment including non-pharmacological methods. This project includes development of a handout utilizing compiled resources and motivational interviewing to facilitate patient use of these interventions.
A healthcare provider perspective in overcoming the psychological and emotional barriers of advance care planning: The need to normalize the conversation
Karamatullah DanyalShort-term Project
Barriers to advance care planning in the patient population were explored. The need to normalize the conversation was identified. A more attention grabbing pamphlet was designed.
Pooja T. DesaiShort-term Project
Senior patients (>60 years) have a higher prevalence of chronic diseases, physical disabilities, mental illnesses, and other co-morbidities, when compared with younger patient populations. In the Primary Care setting, prevention and control of health problems of elderly patients necessitates a multifaceted approach incorporating active collaboration of health, social welfare, rural and urban development, and legal sectors. Through research and community outreach, I found that identifying available senior resources was an important need in the Western Connecticut community. My interviews and research guided the creation of an informational handout on the available resources for senior patients. Resources incorporate many aspects of health, including fitness and wellness, housing, socialization and recreation, medical needs, medical equipment and technology, support groups, and transportation. This handout was given to all patients ages 60 and older.
James DuguayShort-term Project
Many adults lack adequate preventative oral healthcare due to multiple factors. Oral health is important due to its effects on systemic health as well as for quality of life issues.
Zachary Winston EhretShort-term Project
Patients may not know where to look when researching a health issue. This may lead them to resources that are not supported by research and may become an issue for their own health. Some websites may be filled with medical jargon, which can potentially exacerbate anxiety about a particular condition or cause concern for unrelated health issues. A handout compiling a list of resources would be helpful to providers and beneficial to patients.
Wyll T. EverettShort-term Project
Tim FieldsShort-term Project
Alcohol abuse accounts for 88,000 deaths and $249 billion annually in the United States. At this point there is not a great evidence based model for the best form of group support. While AA and the twelve step model is the most frequently used group format, it has many limitation especially in small Vermont towns. This proposes an alternative model designed to work well in smaller communities.
Francis G. Gause IVShort-term Project
PSA Screening Patient Information for 2017 guidelines
ACEs and Resilience: Increasing patient knowledge of Adverse Childhood Experiences and stress coping techniques
Mary GriffinShort-term Project
At The Health Center, a federally qualified health center in Plainfield, Vermont, providers have begun an initiative to screen patients during routine clinic visits for their Adverse Childhood Experiences score. In a population subject to the social, economic, and health-related challenges of rural Vermont, providers have identified the screening process as a vital tool for better understanding their patients' health. To better aid in both provider comfort and patient education during said interactions, a pamphlet was created to guide provider conversations concerning ACEs. The pamphlet details information about ACEs and health consequences, the importance of the relaxation response in dealing with toxic stress, and the ways in which we can help foster resilience in children.
Michael J. HallShort-term Project
Intimate partner violence screening is recommended in all women of child-bearing age. Ensuring validated screening tool utilization and employing strategies to identify risk while providing non-judgmental support is critical to identifying patients and optimizing appropriate resource referral.
Sarah Natasha JostShort-term Project
Herpes zoster (shingles) is a viral infection that results in a painful rash and has a myriad of long-term complications, including post-herpetic neuralgia- chronic pain that does not resolved despite resolution of the rash. Over the last 20 years, incidence of shingles has increased by nearly 50% and now there are 2 vaccines available to prevent shingles. Shingrix was approved by the FDA in 2017 and has garnered public attention for its efficacy. I developed a brochure that gives patients information about shingles, Shingrix, and answers some frequently asked questions.
Amanda M. KardysShort-term Project
In Clinton County, NY residents state that obesity, chronic disease, physical inactivity and low wages are top concerns. Many of these identified problems are tightly integrated and exacerbated by a lack of exercise education in this population. To address this, an exercise education pamphlet was created to be distributed to individuals in the community. The pamphlet focuses on discussing barriers such as time and cost of exercise, as well as enabling individuals with stretching information and local resources.
Promoting health literacy about added sugars, with a focus on patients with limited English proficiency
Megan KawasakiShort-term Project
Excess consumption of added sugars has been linked to the development of obesity, diabetes, and cardiovascular disease. The sequelae of such health conditions accrue significant public health costs - both in terms of healthcare spending as well as associated co-morbidities and mortality. Chittenden County, Vermont is home to at least 6,300 new Americans, many of whom have limited English proficiency (LEP). Although office visits can provide crucial advice regarding proper nutrition, written resources available for LEP patients are lacking. This project aimed to meet that need through development of an infographic-rich handout that both promotes healthier grocery store choices and educates patients about added sugar. While it can be useful to those at all literacy levels, the heavy use of visuals was intended specifically to make the handout accessible for those with little to no English proficiency.
Margaret KlepackShort-term Project
High-dose influenza vaccines are approved by the FDA for use in adults 65 years and older and have been shown to reduce the morbidity and mortality of influenza. However, the pharmacy manager and infection preventionist at Inland Hospital in Waterville, Maine identified the vaccine was not widely utilized at the institution's out-patient practices. This project reviewed the current literature on the high-dose vaccination and provided an educational presentation to family doctors about the evidence supporting the use of the high-dose vaccination. Data were collected from each practice of the number of high-dose influenza vaccines administered in the 2016-2017 and the 2017-2018 flu seasons.
Joseph J. LaheyShort-term Project
Despite public health efforts in recent years to provide additional care to the LGBTQ community, many health disparities still exist. It is difficult to address these problems due to the lack of organized data being received from health care institutions. Many medical offices have failed to provide a comfortable environment for LGBTQ individuals. This project illustrates a presentation given to staff at a primary care office on how to make the clinical environment more inclusive to LGBTQ individuals in order to provide adequate care.
Provider Opinion: Should We Screen and Counsel Parents of Teen Drivers Regarding Texting/Distracted Driving?
Daniel LambertShort-term Project
Adolescent texting and driving has been directly responsible for the deaths of 11 teenagers every day. 33% of teenagers in Vermont admit to texting and driving making it one of the most prevalent risky behaviors in their age group. Currently there is no routine screening recommendation for parents with adolescent drivers addressing texting and driving. Mobile application information can improve parental monitoring and prevent texting and driving habits from forming in adolescents.
Ryan Erik LandvaterShort-term Project
Smoking is still the leading preventable cause of death in the USA with 75% of current smokers expressing a desire to quit, though a meager 2-3% succeed. Previous research has shown that financial incentives for smoking cessation are among the most efficacious. Vermont has implemented high taxation to these ends, though many smokers still do not grasp the financial burden it poses on their discretionary income. A handout was developed that conveys both the cost of smoking at a pack rate over set time frames and provides potential savings rendered by nicotine replacement therapy. The handout will be made available as part of patient instructions printed via the electronic medical record system used by UVM.
These projects were completed by students in the University of Vermont Family Medicine Clerkship. Block Clerkship Projects were completed during a five-week period, while Longitudinal Clerkship Projects were completed over the course of a 12-month longitudinal clerkship.
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