CwiC Posters

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  Reaching high-risk patient populations through emergency department opt-out HIV testing: A retrospective chart review

  Tyler G. Boyce, BA and Priya Mammen, MD, MPH

  Specific Aims and Hypotheses:

  This study aimed to identify socioeconomic (SE), sexual, and other risk factors (RFs), among patients diagnosed with HIV infection through an emergency department-based opt-out HIV screening program, and to examine trends in intravenous drug use (IVDU) as a RF.

  • H1: Unsafe sexual practices are the most commonly reported RF.
  • H2: Role of IVDU as a RF has increased over the time period studied.

  Poster presented at 2017 APHA conference in Atlanta Georgia.

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  Baseline Assessment of Providers' Perspectives on Integrating Community Health Workers into Primary Care Teams to Improve Diabetes Prevention

  Ariel Brown; Garseng Wong; Radhika Gore; and Mark Schwartz, MD

  • Type 2 Diabetes Mellitus (T2DM) affects 11% of U.S. adults

  • Additional 35% considered pre-diabetic, at-risk for developing T2DM1

  • Bellevue Hospital and the VA NY Harbor Hospital disproportionately affected: 2x the prevalence in the general population, and increasing2

  • Only 55% of adults receive recommended preventive services3

  • Panel management: each care team is responsible for preventive care, disease management, and acute care of a patient panel

  • Community health worker (CHW): non-clinical frontline public health professional trained in behavioral counseling, care follow-up, program referrals, and health education4-8

  • Come from the community that they serve, so they can offer ongoing social support, key to successful behavior change9-12

  • CHW interventions have been shown to improve diabetes outcomes and progression to diabetes13

  • Lack of literature on integrating CHWs on a larger scale into a clinical care team

  • CHORD study: Community Health Outreach to Reduce Diabetes

  • Randomized controlled intervention trial to assess the efficacy of integrating CHWs into primary care teams at Bellevue and the VA to prevent T2DM in pre-diabetic patients

  • Present study is a baseline assessment in preparation for the CHORD study

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  Depression, Cognition, & Social Determinants of Health: Assessing Associations in Older African Americans with Diabetes

  Jeremiah Davis; Robin Casten, PhD; and Barry W. Rovner, MD

  Social determinants of health have been widely identified as characteristics of one’s social and economic climate that affect one’s health outcomes1. (see Graphic 1)

  The Alzheimer’s Association indicates that rates of Alzheimer’s disease (AD) and other forms of dementia are two times higher in older African Americans than their white counterparts2. People who have diabetes are also at an increased risk.

  The prevalence and co-morbidity of depression among older Americans with diabetes (both with and without cognitive impairment) has been well established3.

  Understanding the effect that social determinants of health have on the onset and progression of dementia and depression in older African American diabetics is important as such an understanding may better inform future health policy and government spending on healthcare intervention(s).

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  Assessing Variability in End-of-Life Intensity of Care After Out-of-Hospital Cardiac Arrest

  Polina Ferd, MD Candidate; David Karp, MUSA; Alexis Zebrowski, PhD Candidate; and Brendan G. Carr, MD, MA, MS

  Out of hospital cardiac arrest (OHCA) affects over 300,000 Americans per year.1 Many factors affect the outcomes and overall OHCA survival in a community; some of these include an individual’s characteristics such as age, co-morbid conditions, availability of an AED on scene, time to CPR, and the characteristics of the hospital they are treated at.1,2 Directly following resuscitation from cardiac arrest, the individual is at risk of developing numerous problems caused by sequelae of ischemic injury sustained during the arrest. The national average rate of survival to discharge is only 10%.2,3 Many of these factors are modifiable and provide an opportunity to improve outcomes. In our project, we focus on lifesustaining procedures administered by hospitals upon receiving and admitting individuals experiencing OHCA.

  We used previously validated measures as defined by Barnato et al as “life sustaining end of life (EOL) measures”:4

  • Intubation and mechanical ventilation

  • Tracheostomy

  • Gastrostomy tube insertion

  • Hemodialysis

  • Enteral/parenteral nutrition

  • CPR

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  Examining the Role of Diagnosis in the Emergency Department Experience

  Danielle Kovalsky, BS; Angela Gerolamo, PhD, APRN, BCPS; Amanda Doty, MS; Alexzandra Gentsch, LSW; Annemarie Jutel, RN, BPhEd (Hons), PhD; and Kristin L. Rising, MD, MS

  Study Objective:

  To explore the social, functional, and emotional needs that patients want addressed when seeking a diagnosis at their ED visit.

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  A Pilot Study for Enhancing Postpartum Discharge Instructions for Incision Care: Assessment of Comprehension

  Rebekah Jo McCurdy, MD; Rebecca Lawrence, BS; Sarah Cohen, BS; and Jason K. Baxter, MD, MSCP

  Literacy and Health Care

  • 14.5% of United States is illiterate 1

  • Reading level of most medical forms is 10th grade 2

  Improving Outcomes with a Visual Aid

  • Cesarean Surgical Site Infection (SSI) rate is 5% 3

  • A patient with a SSI can be 2 times as expensive 4

  • Visual aids improve information recall 8 and confidence in wound care 5

  Study Objectives

  1. To evaluate the readability of the cesarean wound care discharge instructions relative to the patient population’s reading level

  2. To conduct a pilot Randomized Control Trial (RCT) to evaluate the effectiveness of a visual aid on improving comprehension of the cesarean wound care instructions

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  Leading Causes of Death in Vietnam

  Lindsey Roth

  Vietnam is currently facing a public health crisis. Rates of chronic and preventable diseases are climbing, in addition to mortality rates from these diseases. If nothing is done to halt these rising rates, the health of the Vietnamese people will only continue to decline. Although there may be many factors contributing to these high death rates due to chronic diseases, risky health behaviors, such as smoking, and the state of the healthcare system can be considered two main contributors to the leading causes of death in Vietnam. The high smoking rates and high costs of healthcare are hindering the health of Vietnam, and may be related to the top causes of death, including stroke, ischemic heart disease, chronic obstructive pulmonary disease (COPD), and lower respiratory infections (World Health Organization and UN partners, 2015). Implementing government programs, including smoking cessation, smoking education, tobacco taxes, healthcare education, and continued work toward universal healthcare coverage, will hopefully help decrease the rising rates of chronic diseases and the high mortality rates they cause.

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  Initiating C.H.E.W. at Maternity Care Coalition

  Haley Wicklum and Rickie Brawer, MPH, PhD

  The purpose of this project is to provide access to healthy and affordable foods to the families involved in Maternity Care Coalition’s Early Head Start program as means to reduce obesity in the 0-3 year old children. Implementing the C.H.E.W. (Cultivating Healthy Eating and Wellness) program, which includes a new food buying club where families can access healthy food at whole sale prices as well as nutrition education workshops throughout the year, will provide access to the healthy and affordable foods needed. The program is focused on pregnant women and young families with children 0-3 years of age to attempt to reach children at a young age as to prevent a future of obesity and chronic disease.

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  Public Health Considerations and the Culture of Alcohol in Vietnam

  Daniel Baquet

  The problem of alcohol in Vietnam is interesting when considering the culture surrounding alcohol throughout the country, particularly amongst men. In 2010, Vietnamese men drank 12.1 liters of pure alcohol per capita, while women drank only 0.2 liters (WHO, 2014). The WHO Global Status Report on Alcohol and Health stated, “Vietnam’s national drinking patterns … are among the most fatal with the highest possible score for alcohol-attributable years of life lost,” a metric which includes liver cirrhosis, road traffic crashes, and the prevalence of alcohol use disorders and alcohol dependence (WHO, 2014). In addition, domestic alcohol production in Vietnam has increased and presumably continues to do so (Ngoc, Thieng, Huong 2012). This poster aims to discuss the culture of alcohol in Vietnam, highlight problems it presents to the health of the Vietnamese people, and propose possible policies designed to help ameliorate the burden of alcohol abuse on the Vietnamese healthcare system.

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  Barriers to Care Amongst Rural Indigenous Mayans in Guatemala’s Western Highlands

  Nirali Butala

  Information presented here is based on 5-week volunteering experience at Primeros Pasos clinic in the rural Palajunoj Valley outside the city of Quetzaltenango, Guatemala. Almost all of the patient population is rural, indigenous Quiche Maya. Guatemala has a relatively high GDP and patient-doctor ratio (1000:1) compared to its neighboring Latin American countries, but these resources are extremely localized to its capital, Guatemala City, where 70% of the country’s physicians work.

  Only the wealthy are able to utilize private clinics and hospitals that are known to provide the highest quality care. At these clinics, patients pay out-of-pocket. Indigenous, rural communities typically rely on under-funded, understaffed, overcrowded government Puestos and Centros de Salud that are often far from their homes and difficult to access.

  Theoretically, these public clinics allow for Guatemala’s healthcare system to claim “universal coverage,” but a lack of funding for public hospitals and clinics have left many of them in dire condition.

  By 2015, 4 out of the 44 public hospitals were forced to shut down all but emergency services because they could not afford to pay their employees. [3] Guatemala’s Deputy Prosecutor, Hilda Morales, blames the lack of funding and resources on “structural failures,” such as corruption within the system, debt, delays in payment to suppliers, and the poor maintenance of medical equipment. Many of these issues are rooted in the violence, corruption and prejudice against indigenous cultures during the Civil War.

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  The public health crisis in Greece and its ties to a failing economy

  Anna M. Carleen

  In 2009 the Greek government admitted that the numbers it had been reporting to the European Union about its national budget deficit were artificially small. The deficit was actually huge, way larger than what the EU requires of member countries if they want to reap the benefits of being in this financial network. A benefit of being in the EU is that it makes it much easier for governments to take out large loans, because lenders trust that a member country will make good on its debts due to the security it has from being part of the union. This admission by the Greek government came at the tail end of, and was very much linked to, the global financial crisis felt here in the United States in 2008. As a result, lenders started enacting stricter borrowing rules, and Greece had to take out even more loans. By spring of 2010 it was veering towards bankruptcy, and in May of 2010 the first of three bailout agreements with the troika (International Monetary Fund, European Central Bank, and the European Commission) was reached. This bailout came with conditions, or austerity terms, that the Greek government had to agree to. These included deep budget cuts, steep tax increases, and promises to implement anti-corruption strategies and cut down on tax evasion. The second bailout came in 2012 after the recession continued to worsen. The third bailout came in summer of 2015 after a series of failed negotiations between Greece’s newly in power Syriza party and the troika, Greece defaulting on its loans, and a popular vote by the Greek people to reject the latest proposed bailout conditions.

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  Does Age Influence Knowledge and Attitudes about Intrauterine Devices?

  Sara Edwards; Lisa Perriera, MD, MPH; and Rebecca J. Mercier MD MPH

  Primary objectives:

  • Are there differences in attitudes and beliefs about IUDs based on age?
  • We hypothesized that older women may be more familiar with the negative outcomes of earlier models of the IUD and therefore may hold more negative attitudes toward IUDs.

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  Stephen Klein Wellness Center Patient Satisfaction Survey: Development and Preliminary Results

  Emily Knudsen-Strong, MSc; Joseph Flaxer; Rickie Brawer, MPH, PhD; Mudit Gilotra, MD; and James Plumb, MD, MPH

  Study design:

  •Selected the CAHPS® with Patient Centered Medical Home question set to administer to patients receiving medical care at SKWC (52 questions)

  •Included 2 supplemental questions to assess patients’ likelihood to refer others to SKWC

  •Developed an additional survey for patients receiving behavioral health services (16 questions)

  Participant recruitment and data collection:

  •Calculated a target number of 130 participants based on CAHPS® guidelines of 50 surveys per Full Time Employee

  •Observed patient flow and developed recruitment strategy for a convenience sample

  •Eligibility criteria: patient ≥18 y/o and had a medical appointment in the last 12 months

  •Participants were invited to enter an optional raffle to win a $25 gift card to the Fresh Grocer

  Data analysis:

  •Responses were coded and entered into Microsoft Excel Database

  •Average scores and response frequencies for each survey question were calculated

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  JeffHEALTH: Helping East Africa Link to Health

  Elizabeth Kuhn, Emily Zhang, Naveed A. Rahman, Rebecca Margolis, and Savannah Coe

  JeffHEALTH-Helping East Africa Link to Health is a student-run organization at Thomas Jefferson University dedicated to improving basic medical education and quality of life in Rwanda, which was devastated in 1994 by civil war and genocide. Working in partnership with the Rwanda Village Concept Project, a student organization at the National University of Rwanda, JeffHEALTH seeks to implement sustainable health initiatives in our partner villages. Graduate students from Thomas Jefferson University travel to Rwanda where we taught Community Health Workers from the Villages of Akarambi and Ruli the following topics: Nutrition and Vitamin Deficiencies, Family Planning, Prenatal care, HIV, Sexually Transmitted Illnesses and Hepatitis, Breast and Cervical Cancer, Diabetes, and Fistulas. We also taught two programs to children of the villages (Oral Hygiene and Soil Transmitted Helminths) and talked with young adults about Circumcision and HIV Prevention and Sex Education.

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  Quality of Care Assessment at a Resident-based Primary Care HIV Clinic

  Amanda Lacue and Marshall Miller, MD

  A quality improvement study based in a primary care resident-based HIV clinic, the Kendig Clinic, was conducted within Jefferson Family Medicine Associates. The study objectives were to

  • Determine the percentage of the clinic patients meeting each quality measure

  • Compare these calculated clinic measures to known national averages

  • Use the data to determine areas to target for future quality improvement initiatives.

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  Decentralization and Health: Case Studies of Kenya, Pakistan, and the Philippines

  Christina E. Lewis; David Clarke, JD; and Maryam Bigdeli, PhD

  Decentralization, defined by the World Bank (2001) as, “the transfer of authority and responsibility for public functions from the central government to intermediate and local governments or quasi-­‐independent government organizations and/or the private sector,” is a movement that has gained much traction in recent history. For many countries undergoing decentralization, a major driver has been a desire to increase the role and participation of local governments in the decision-­‐making space. In doing this, it is hoped to create governance structures that are more accountable and responsive to the people. For health, decentralization has been touted as a potential way to improve responsiveness to local needs, improve service delivery, and improve equitability. In light of these goals, many countries as part of their political decentralization have also opted to decentralize healthcare.

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  Exercise Beliefs During Pregnancy in a Predominantly Low-Income, Urban Minority Population

  Lindsay S. McAlpine, MSIII; Christine A. Marschilok, PGY-3; Amber S. Maratas, MD; and Jeremy D. Close, MD

  In 2002, and reaffirmed in 2009, The American College of Obstetricians and Gynecologists recommended that healthy pregnant women exercise for at least thirty minutes most days of the week. Exercise during a healthy pregnancy is safe and has many maternal and fetal benefits. Identified benefits include management of weight gain, improvement in mood, and preparation for labor. Previous research has evaluated women’s beliefs and practices of exercise in pregnancy, but it has focused on affluent, ethnic majority populations. This survey study was performed to assess beliefs about exercise in pregnancy in a predominantly low-income, urban minority population.

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  Recurrence of Ganglion Cysts Following Re-excision

  Lindsay S. McAlpine, MSIII; Juana Medina, MD; Nayoung Kim, BS; and Michael Rivlin, MD

  Previous studies have examined the recurrence of ganglion cysts after surgical excision at a rate of 4 to 40%. However, recurrence after revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cysts in patients who underwent a 2nd excisional procedure.

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  An Interactive Curricula Experience (iCE) for Latino Immigrant Health

  Kevin Molyneux; Ellen Plumb, MD; and Martha Langley Ankeny, MEd

  The Interactive Curricula Experience (iCE) is an educational platform intended for interactive education utilizing multiple forms of media. It is being utilized at Thomas Jefferson University (TJU) in various classes, among them Global Health.

  One of the pertinent global-health-at-home topics at TJU relates to Latino immigrant health. Latino immigrants number more than 20,000 in Philadelphia. They are located throughout the city, although the highest concentrations are in North and South Philadelphia. With respect to health care, Latino immigrants are less likely to have a regular health care provider than non-immigrant Latinos.

  Education to provide culturally sensitive care to Latino immigrants is vital to establish longer-lasting patient-doctor partnerships and decrease the number of Latino immigrants without a regular health care provider. iCE is an attempt to provide that education by stepping out of the lecture hall and assigned readings, and instead allowing students to engage with the material at their own pace.

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  Addressing Childhood Obesity in Early Head Start Population in Philadelphia through Early Intervention and Food Buying Clubs

  Nishant Pandya; Rickie Brawer, MPH, PhD; and Sarah Roescher

  Aims:

  To implement a food buying club model to increase access to fresh and healthy foods for families whose children (ages 2-5) participate in Early Head Start and the Maternity Care Coalition.

  Compare four potential food distributors: Philadelphia SHARE, Asociacion Puertorriquenos in Marcha (APM), The Common Market, and JETRO to find the organization that can best implement a feasible food buying club run through Early Head Start to fit the families needs.

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  An Evaluation of Risk Attitudes and Risk Tolerance in Emergency Medicine Residents

  Nishad A. Rahman and Dimitrios Papanagnou, MD

  An underlying issue to our current healthcare system is how decisions made in the emergency department affect patients. This is paramount for underserved populations, which are more likely to have poor physical and mental health, lack of primary care, greater use of health services, and be generally dissatisfied with their medical care.1,2 What should the emergency physician (EP) do for these patients?

  These decisions are largely based upon individual risk tolerance. While risk is a indelible part of emergency medicine (EM), a risk profile of EM residents has not been compiled. Knowledge of risk taking tendencies among this niche of medical professionals could be critical. If EM residents have great risk aversion, they might practice defensive medicine, thereby incurring crippling costs4. On the other hand, if emergency medicine residents are greatly risk tolerant, they may make decisions that lead to significant morbidity and mortality. It is essential to establish a baseline risk profile before any corrective measures can be advanced. This study attempted to accomplish precisely that using Risk Type CompassTM.

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  Exploring the Feasibility of Incorporating Sexual Education into Routine Adolescent Office Visits

  Holly A. Rankin; Alisa LoSasso, MD; and Beth I. Schwartz, MD

  Preventative sexual education can reduce the negative health outcomes of sexual behavior in adolescent populations.1 The objective of this pilot study was to determine if sexual education can be delivered as a scripted five-minute module during a routine adolescent office visit in a manner that is non-disruptive of clinic flow and acceptable to both patients and providers.

  • 85% of providers reported the intervention did not interrupt clinic flow

  • 86% of patients reported the intervention to be appropriate and 92% of providers were satisfied overall with the intervention

  These pilot data highlight that the incorporation of brief scripted sexual education into routine adolescent preventative office visits is both feasible and acceptable to patients and providers.

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  Water Crisis in Vietnam

  Jordan M. Zaid

  • Immediately after the Vietnam War ended in 1975, Vietnam experienced economic turmoil and famine as the roots of industrialization began to grip the nation.

  • In 1986, the government declared a rapid transition from a planned to a market economy would take hold. The ensuing change caused further increased industrial development and a subsequent growth of the emerging market economy. 1

  • To this day, Vietnam’s GDP is rising yearly at a rapid rate.

  • For this reason, much of Vietnam has been developed in a relatively short amount of time (since the end of the war) but much of it has lagged behind, including the infrastructure including water pipes and water sanitation plants. This lag has caused limited access to sanitized water in both rural and urban areas.

  • Despite an overall adequate water access for Vietnamese citizens, the sanitation of supplied water has not improved as markedly as the country as a whole.

  • Sanitation has increased from 37% in 1990 to 75% in 2011 as defined by the JMP’s sanitation standards. Here, sanitation is defined as the distance between a water supply and human excretion.2

  • Although Vietnam’s water has been made safer over the past few decades, it is largely undrinkable.

  • A 2009 study done by scientists at the Vietnam Institute of Biotechnology concluded that ammonia levels in Vietnam’s waters range from an average of 6-18 times higher than an acceptable level. 3

  Furthermore, arsenic levels range from 2-3 times higher than an acceptable level.

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  Sexual and Reproductive Health in Rwanda

  Emily Zhang

  KEY MESSAGES

  • Empowerment (women, youth, communities)
  • Inclusion (age + gender)
  • Prevention/Early Detection

  PROGRAM RECOMMENDATIONS

  • Partner with Rwandan medical students to improve program delivery
  • Communicate monthly with local leaders
  • Partner with Community Health Center

  FUTURE INTERVENTIONS

  • Partner with Rwandan medical students to improve program delivery
  • Communicate monthly with local leaders
  • Partner with Community Health Center

  
  

  
  

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  Hepatitis C Screening in the Homeless Population of Philadelphia

  Adam Zimilover

  Hepatitis C is a viral infectious disease that is a major cause of liver disease around the world. By the 1970s, it was recognized that many hepatitis cases were not due to the known hepatitis A or hepatitis B viruses. It was not until 1989 when the virus, then known as non--‐A, non--‐B hepatitis, was identified as a new distinct virus, hepatitis C. The virus has seven major genotypes, with genotype 1 causing about 75% of cases in the United States. By 1990, a screening test for the virus was developed, and within a year, the first treatment for the virus was approved.1 Research through the 1990s and into the early 2000s improved treatment options. Before 2011, the standard of care treatment for hepatitis C consisted of pegylated interferon and ribavirin, which successfully cured between 45% and 80% of individuals, depending on the specific genotype of HCV. In recent years, new treatments consisting of a combination of ledpiasivir, sofosbuvir, ribavirin, and pegylated interferon have improved the cure rate to up to 99% in some genotypes.2 These drugs work without the many severe side effects of older classes of drugs, which had a relatively high risk of causing life threatening hemolytic anemia.3 However, the cost of these new treatments can approach $100,000 for a twelve--‐week therapy, making the cost of treatment prohibitively expensive for many Americans. 4