Evaluation and Management of Common Anorectal Complaints

Objectives: Review the anatomy of the rectum and anus Learn skills to perform an appropriate H&P for anorectal complaints Appreciate key diagnostic features to common anorectal diagnoses Recognize risk factors and red flag signs/symptoms that prompt further evaluation and possible referra

Assessing the Accessibility and Integration of Community Resources for Autism in Sri Lanka

Introduction: Similar to many other developing countries, Sri Lanka also has challenges meeting the needs of autistic individuals. While progress has been made in evaluating autism screening tools and home-based therapy, limited data exists on the utilization of community resources. Objective: The objective of this study is to assess the accessibility and integration of community resources for autistic individuals in Sri Lanka. Questions to explore will center on how different sectors work with families and each other to address an autistic individual’s needs. Methods: Informal interviews were conducted with professionals who have direct experience working with individuals with autism and their families. The total sample size was ten interviewees. Interviews were conducted in English or in Sinhalese with assistance from a native speaker. Conversations were not recorded but notes at their permission were taken. Their responses were then categorized based upon shared themes and subthemes. Results: The most frequently identified challenges to families’ access to care centered around transportation and the sparsity of providers. Many interviewees discussed the extensive breadth of services their respective organizations provided, the personalized plans individuals received, and the training of staff done internally. Conclusion: As this is a pilot study with a low sample size, the investigators hesitate to make broad conclusions. However, due to lack of precedent in regard to autism research in Sri Lanka, the investigators hope the noted themes will hopefully point future studies in directions that yield more concrete findings. Next steps should involve including families in the study and expanding the sample size to gain parents’ perspective

Cirrhosis for the PCP

Objectives: Understand the morbidity and mortality associated with Cirrhosis in the United States Recognize etiologies and clinical presentation of cirrhosis Identify decompensated cirrhosis and approaches to treatment and monitoring Agenda Definition and Epidemiology Etiologies Clinical Presentation Diagnosis and Evaluation/Classification Management of Compensated Cirrhosis Decompensated Cirrhosis & Complications ○ Portal Hypertension ○ Varices ○ Ascites ○ SBP ○ Hepatorenal Syndrome ○ Hepatic Encephalopathy Secondary Prevention and Long Term Management Conclusion

Assessing the utilization and effectiveness of pediatric order sets in HPV vaccine administration in a large urban family medicine practice

Introduction: Human papilloma virus (HPV) vaccination remains a controversial topic with low rates of vaccination completion. According to a 2017 National Immunization Survey, only 49% of adolescents were up to date (UTD) on their HPV vaccination, an alarming statistic given its importance in reducing HPV-related cancers. This project seeks to determine the effectiveness of pediatric order sets in affecting rates of HPV vaccine administration in a large urban family medicine practice. Methods: A retrospective, qualitative chart review was conducted on patients nine years or older seen at Jefferson Family Medicine Associates in Philadelphia, PA from April 2019 to April 2020. Of the 1177 encounters, status was determined as followed: HPV series completed, vaccine series in progress and currently UTD, or HPV vaccine due at encounter but not administered (“missed opportunity”). Results: Of the 49 encounters of patients older than 15 years and not UTD before the encounter, 29% were a “missed opportunity.” None of these encounters utilized the pediatric order sets. Of the 251 encounters of patients between the age of 11-14 years, 21% were a “missed opportunity.” Of these, 87% of the encounters did not utilize smart sets. Discussion: These results demonstrate that a majority of missed opportunities for HPV immunization are during encounters where the pediatric order sets were not being utilized. Although further studies are needed to address missed opportunities, this data illustrates that pediatric order sets have the potential to improve rates of HPV vaccination administration and completion at a family medicine practice

Attitudes Surrounding a Community-Based Fitness Intervention at an Urban FQHC

BACKGROUND AND OBJECTIVES: The population surrounding an urban federally qualified health center (FQHC) in Philadelphia has poorer health than Philadelphia overall. Community residents identified aerobics and dance classes as very important services or programs that an FQHC might provide. We sought to measure the impact of participation in a resident physician-led, patient-centered fitness and nutrition class on participants’ attitudes, knowledge, and self-efficacy regarding their health. METHODS: An urban line dancing class and brief healthy eating intervention for adults was held at a YMCA adjacent to a residency-affiliated FQHC weekly for 8 weeks. Pre/postsurveys were administered to assess attitudes and confidence toward physical activity and healthy lifestyles. RESULTS: Participants’ self-assessment of health and levels of physical activity improved. Confidence in performing everyday activities, doing regular exercise and exercising without making symptoms worse increased. A significant decrease in participants’ physical activity gratification was observed. Participants’ confidence improved in reading food labels for health, but confidence in eating a balanced diet did not improve. CONCLUSIONS: A resident-led fitness and nutrition class, tailored to perceived community needs, generated significant interest and sustained participation. This pilot study furthered development of community infrastructure addressing health, nutrition, and overall fitness, and the results reflect opportunities and challenges of engaging communities in physical fitness

On-Site Test Collection Intervention Improves Lead Screening Rates at an Urban Family Medicine Practice

Study Aims: Examine the effect of on-site lead screening collection on resulted lead screening rates.https://jdc.jefferson.edu/patientsafetyposters/1018/thumbnail.jp

Cases from Puentes de Salud

Learning Objectives Review the background and current state of Latin American migration in Philadelphia Introduce Puentes de Salud as a Center of Health and Wellness for this population Review several cases that highlight challenges in patient care in this clinical setting Discuss patient morbidity that can result from access, environmental and political factors, and healthcare system issues affecting this unique patient populatio

Use of Teratogenic Medicines in Women of Reproductive Age

Outline: Teratogenic medications are commonly prescribed to women of reproductive age. Despite knowledge of potential teratogenic effects, effective communication regarding the risks and benefits of medication use in the context of the patient’s fertility goals remains inadequate. This lecture will discuss recommendations to facilitate thoughtful prescribing in this population Presentation: 38:1

Strategies to Reduce Bias in Medical Documentation

Objectives Examine the impact of language biases in the Electronic Health Record (EHR) on Patient Care Describe strategies clinicians can use to mitigate impact of language biases in EHR documentation Apply strategies learned to minimize and address use of stigmatizing language in the EH

Contraception for PCPs 2021

Objectives: Review evidence-based, flexible and patient-centered approaches to contraceptive management in individuals with reproductive potential Discuss updates in contraceptive prescribing and management Highlight considerations for management of contraception in the time of COVID-19 and in special populations Outline Introduction Approach to initiation of contraception Overview of methods of contraception Special Considerations Resources (Medical Eligibility and Special Practice Recommendations; Contraception App) Summary Reference