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Fracture Risk Assessment and Osteoporosis Screening of Postmenopausal Women in Primary Care: A Quality Improvement Project
No full textBackground. Osteoporosis and risk of fragility fracture increase with age, often resulting in fracture-related disability, decreased quality of life, morbidity, and mortality. The available fracture risk and osteoporosis screening tools that promote early risk identification and subsequent fracture prevention are underutilized in primary care; opportunities to prevent progressive bone loss and fracture are often missed. Purpose. This project aims to improve the identification of postmenopausal women at risk of fragility fractures within a primary care setting. Objectives. Educate clinic staff on clinical risk factors of fragility fractures and osteoporosis. Facilitate communication of osteoporosis risk and prevention to patients. Establish the baseline fracture risk for postmenopausal women aged 50 to 75 years to improve the number of appropriately ordered bone density scans. Methods. A fracture risk questionnaire informed by current guidelines and recommendations was developed and integrated into a primary care clinic\u27s current appointment process. The questionnaire was administered to postmenopausal women aged 50 to 75 years. Clinical risk factors were assessed to determine patients\u27 fracture risk, guide preventive education, and inform clinical decisions on the appropriateness of bone density scans. Outcomes. A total of 177 eligible patients were seen during the 10-week project. Fracture risk was calculated on 41.81% of patients, 44.21% of patients screened received education on osteoporosis risk and prevention, and bone density scans increased to 57.58% from 11% baseline. Implications. A standardized process to assess fracture risk promotes appropriate osteoporosis screening and early identification of those who would benefit from treatment
Implementing the Depression Screening Tool PHQ-9 in the Annual Wellness Exam of Concierge Family Medicine
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Background: Depression has been one of the most common mental health disorders that our population fact but is underdiagnosed and undertreated. Primary care providers are often the first line of defense in detecting depression. Because of this, implementing a depression screening tool in a primary care setting will improve holistic management of care and improve quality of life.
Project Aim: The aim of this project was to increase the number of clients who are evaluated for depression by using the PHQ-9 screening tool during their annual wellness exam and initiate treatment according to the Veteran’s Affairs/Department of Defense Depression Treatment Guidelines.
Methods: The project took place at a concierge medicine family practice with no current depression assessment tool in place. It involved the clients, medical assistant performing the screening and the provider. The provider reviewed the PHQ-9 score and implemented the appropriate treatment based on the guideline for each of the five categories ranging from continued reassessment to medication initiation or adjustment and referral to a specialist.
Results: Out of a total of 47 patients screened, 10 of them (21%) required at least a follow-up, and 2 out of these 10 were referred for a higher level of treatment with a counselor.
Implications: The implication for practice is to ensure all clients are screened for depression as part of the holistic management of care. Use of the PHQ-9 tool in primary care can lead to early identification and treatment for this overwhelming condition which can improve health outcomes overall
COVID Impact and the Rise of Antisemitism
Get PDFMy experiences with COVID and the accompanying anti semitism
Optimizing Diabetes Self-Management Using Continuous Glucose Monitoring and Improving the Transition of Care for Adult Patients Discharged From the Hospital
Get PDFBackground: Diabetes mellitus is a chronic medical condition that affects more than 34 million Americans (Centers for Disease Control and Prevention, 2020). The financial impact of diabetes is significant. Americans spend $327 billion on direct medical costs to treat the disease and its associated complications (American Diabetes Association, 2018). The management of diabetes requires a multidisciplinary approach that involves healthcare providers, diabetes self-management support resources, and a high level of commitment from the patient. Patients with diabetes discharged from the hospital often receive fragmented and inconsistent information about managing their health issues. As they transition from hospital to home, their care is often inefficient and lacks proper coordination. Many patients simply fail to follow up with a primary care provider.
Purpose and Objectives: The purpose of this project was to introduce continuous glucose monitoring during a patient’s transition from hospital to home, thereby improving diabetes self-management. The objectives were to educate patients on adapting their diet and lifestyle in response to real-time glucose readings and to enable healthcare providers to adjust treatment based on trends retrospectively. A long-term goal was to reduce the financial burden of type 2 diabetes by decreasing re-admissions.
Interventions & Evaluation: Patients received comprehensive diabetic education and continuous glucose monitoring devices. Follow-up appointments were made for patients before discharge, and the follow-up communication was conducted with each patient. Each intervention was measured on its effectiveness.
Outcomes: Results were as follows: (N=46) Continuous glucose monitoring increased from 0 to 70% 100% of patients who were provided a continuous glucose monitor received diabetic education and support on diabetes management 100% of patients who received a continuous glucose monitor reported awareness of glycemic trends 50% of patients were scheduled for a follow-up appointment upon discharge No patients were readmitted within 30 days for diabetes-related complications
Implications for Practice: Nurse Practitioners are at the forefront of providing clinical advances that improve the patient’s well-being. By utilizing continuous glucose monitoring in primary care settings, Nurse Practitioners can reduce the incidence of hospitalizations by effectively treating patients with type 2 diabetes
U.S. Army Physician Assistant Retention: A Latent Class Analysis
Get PDFIntroduction: Retaining employees is crucial to the success of organizations. While significant effort has been made to model employee retention, models have been unable to significantly predict retention. The purpose of this quantitative, non-experimental, cross-sectional study was to develop an improved employee retention model which could be used as a practical guide to improve employee retention. Materials and Methods: The study analyzed a survey created, implemented, and collected by the Statistical Cell at the U.S. Army Center of Excellence. In September of 2020, all 864 active-duty PAs were sent a link to the survey and 290 completed the survey, for a participation rate of 33.6%. The study used a combination of population-based regression analysis and subgroup-based latent class analysis. To guide the study a conceptual model combined a population-based retention model (Causal Model of Turnover) with a subgroup-based person-centered model (Proximal Withdrawal State Theory). IRB approval was obtained thru the U.S. Army Medical Center of Excellence and University of the Incarnate Word. Results: Multivariate logistical regression found belief career goals were achievable in Army medicine (adjusted odds ratio 0.74, 95% CI 0.57, 0.98), age (adjusted odds ratio 0.63, 95% CI 0.41, 0.98), and perception DHA control of Army medicine affects retention (adjusted odds ratio 0.54, 95% CI 0.39, 0.75) as factors able to predict the intent to serve 20 years in the Army. Latent Class Analysis (LCA) divided the population into three groups, the sensitive stayers, moderates, and indifferent leavers. The sensitive stayers had the highest retention (0.93) and were most likely to be concerned about variables affecting retention. The indifferent leavers had the lowest retention (0.68) and the least concern for variables affecting retention. The moderates fell in between the other two groups. Belief career goals were achievable in Army Medicine was the only variable able to predict class memberships in the three classes of LCA (p \u3c .001). A revised conceptual model was improved by adding perception career goals were achievable in the organization to better unify the model. Conclusions: The extent goals are perceived to be achievable in the current job create job satisfaction and organizational commitment which strengthens intent to stay. Career goals vary based on the individual and accounting for these individual preferences provides a bridge to cohesively unite population-based retention models with person centered retention models. Strengths of this study include the incorporation of two leading retention theories into one cohesive model improved by the study using results triangulated with multiple statistical techniques and past criticisms of retention theories. Weaknesses include the use of secondary cross-sectional data not designed to support the conceptual framework and the population was limited to only U.S. Army PAs. Future studies should utilize experimental longitudinal studies to consider how the perception of career goals being achievable in an organization can be improved to increase retention
An Interprofessional Prediabetes and Diabetes Self--Management Education Quality Improvement Project Among Vulnerable Populations at a Tuberculosis Hospital
Get PDFBackground. Patients greatly benefit from diabetes self-management education (DSME) as it boosts knowledge and self-efficacy, decreases body weight, fasting blood sugar, and hemoglobin A1C levels, and improves overall health outcomes in a cost-effective manner. Unfortunately, many individuals with prediabetes and diabetes who qualify for DSMEs do not attend these classes nor receive sufficient prediabetes and diabetes support elsewhere to attain guideline recommended metrics. However, individuals from vulnerable populations and without DSME education experience disproportionate diabetes-related complications worsening health outcomes. Aims: Increase general prediabetes and diabetes knowledge, facilitate behavior change, improve glycemic, metabolic, and lipid values, and increase healthy dietary planning and physical activity among patients with prediabetes and diabetes. Purpose. Provide an interdisciplinary team DSME education program to patients at a tuberculosis hospital with diabetes and prediabetes in order to empower patients in self-management knowledge and skills in order to prevent or delay complications. Objectives. Review American Diabetes Association (ADA) medical care guidelines with providers, monitor changes to ordered dietary and medication regimens based on laboratory values as per guideline recommendations, reduce individual glycemic, metabolic, and lipid laboratory markers, improve patients’ verbalization of guideline-supported dietary and exercise recommendations, increase patient recognition of signs and symptoms of dysglycemia along with its management, and increase aerobic and resistance exercise participation. Interventions. Provide a closed-caption television (CCTV) prediabetes and diabetes educational programming, conduct weekly DSME classes, initiate a walking and yoga exercise program, encourage online educational module learning, and reinforce class and CCTV interventions with prediabetes and diabetes infographic handouts. Evaluation. Monitor the electronic health record for orders, laboratory results, and staff documentation of education and participation along with the use of patient surveys to assess changes in knowledge, motivation, and self-efficacy. Practice Implications. Many studies have researched the effectiveness of DSMEs in many settings, but none have studied the application of this intervention in a long-term care setting among individuals from vulnerable populations who are experiencing an acute bout of illness. The findings from this quality improvement project will help establish the efficacy of implementing prediabetes and diabetes education programs in hospitals as this presents an opportune time to educate patients
Advancing Together. 15th Annual Research Week: Event Proceedings
Get PDFPresentations of completed and ongoing research activity conducted by graduate students, undergraduate students, and faculty at University of the Incarnate Word. Includes poster, podium, visual arts, interactive demo, creative and performing arts presentations. Coordinated and presented by the Office of Research and Graduate Studies
Cefuroxime-Induced Toxic Maculopathy: A Cataract Co-Management Conundrum
Get PDFBackground: Cefuroxime-induced toxic maculopathy can occur when an incorrect dilution is injected intracamerally after cataract surgery. This results in a guarded visual prognosis. Cefuroxime-induced toxic maculopathy can also occur sporadically even when the medication dilution is the standard correct dosage. These patients usually recover their vision by the first postoperative week.
Case Report: A 72-year-old Caucasian female developed cefuroxime-induced toxic maculopathy after uneventful cataract surgery. Investigation of the case confirmed that she had a sporadic response to the cefuroxime. It was verified that she received the standard correct dilution of cefuroxime intracamerally. The patient showed a significant improvement in her vision by her first postoperative weekly visit. By her last postoperative visit at 7 weeks her best corrected visual acuity was 20/20.
Conclusion: Optometrists should be aware of cefuroxime-induced toxic maculopathy and distinguish between sporadic cases and those where the patient received an incorrect medication dilution dosage