Outpatient Management of Mood Disorders by the Family Physician

It is well-known that the demand for psychiatric care in the US is higher than the supply of psychiatric clinical providers. Vermont, in particular, has a paucity of psychiatric providers and there are minimal providers in Chittenden County and the greater Burlington area. Many patients with psychiatric conditions are inconsistently managed given the lack of available outpatient providers, particularly for patients on Medicaid. Often times, patients suffer from psychiatric episodes that require an emergency department visit or inpatient stay, and they may leave the hospital with an outpatient medication regimen that can then be carried out by a primary care provider. Patients should not have to endure a psychotic episode bringing them into the hospital in order to receive appropriate psychiatric care. A possible solution to this gap in care would be for primary care providers to be armed with the knowledge and skills to appropriately and sustainably manage psychiatric conditions on an outpatient level. Tools to summarize the evidence and current guidelines around prescribing, testing, surveillance, and other drug-related parameters may enable providers to quickly assess the recommendations during a busy clinical day, especially if such tools were consistently updated and embedded into the electronic medical record. This project focuses on management of mood disorders in the outpatient family medicine clinic; a one-pager table summarizing guidelines around commonly prescribed mood stabilizers in the setting of bipolar disorder was created and displayed in the Hinesburg Family Medicine clinic.https://scholarworks.uvm.edu/fmclerk/1485/thumbnail.jp

Guardians of Chastity and Morality: A Century of Silence in Social Work

Reflecting the social norms of the late 1800s and early 1900s, much of social work practice aimed to promote moral sexual behavior and penalize deviance. Even following the widespread adoption of psychoanalytic theory in the United States, social work persisted in having a poorly defined role with regard to issues of sexuality. In the 21st century, the profession continues to largely limit its involvement in matters of sexuality to those practice situations where deviance and public health concerns predominate. Limited topical exposure in peer-reviewed publications and the lack of broad-based human sexuality education for social workers perpetuate the invisibility of sexuality in the social work profession

Transformational Geometry Unit

The study included the development and writing of a unit on transformational geometry which involved a holistic approach including the cognitive, psychomotor, and affective domains. This unit was taught to the eighth grade class in the Oakville School District in Oakville, Washington. The results showed support that the teaching of this unit was effective

Adolescent depression : a review of theoretical perspectives and considerations for assessment

Depression is one of the most common psychological disorders shared by adolescents and adults. Thus, adolescent depression is an important area of investigation for researchers, parents, clinicians, and teachers. The purposes of this literature review are to (1) provide a critical overview of the major depressive disorder criteria for children and adolescents in the current Diagnostic and Statistical Manual of Mental Disorders, fourth edition, (DSM-IV; American Psychiatric Association, 1994), (2) provide an overview of well-articulated major theories that have attempted to explain the cause(s) of depression in adolescents, and (3) evaluate the psychometric adequacy of those self-report measures of adolescent depression that are related to the identified theories

The domain of Finiteness: Anchoring without Tense in copular amalgam sentences

The central thesis of this work is that a clause consisting only of left-peripheral functional structure can be fully finite. Generative models of clause structure typically assume that a finite clause must be tensed, including a projection of T and a temporal relation between the proposition and the utterance context. In light of evidence from tenseless languages, this assumption has come under scrutiny in recent years. This dissertation offers a new body of evidence from English, a tensed language, in support of the claim that finite clauses can lack the projection of T. Drawing on the results of formal acceptability experiments, this dissertation presents an original investigation of the understudied family of specificational copular amalgam sentences (e.g., She wrote about finiteness is what she did), which differs from canonical specificational copular sentences with respect to a number of syntactic and semantic properties. The most salient of these properties is the occurrence of a root clause in the role of logical and structural subject. I propose that copular amalgam sentences are finite, but their functional spine consists only of the C-domain, lacking projections of T and V. Since C-domain heads can project in the absence of T and V, there can be no implicational relation between higher and lower heads in the functional sequence. Copular amalgams show that finiteness can be reduced to phenomena originating in the left periphery of the clause. These phenomena include [T] and [phi] inflection, the licensing of an independently referential subject, and independent anchoring of the proposition to the utterance context. Independent anchoring, which is typically conflated with temporal anchoring in the T domain, obtains via deixis to the utterance context in finite clauses that lack T. This dissertation has two main contributions: to catalogue the properties of a typologically rare, yet understudied construction, and to challenge the Extended Projections model of the clause

Mexican-American children in the process in acculturation

The web of Mexican-American life is complex in its origins, its manifestations, and its degree of identification with or alienation from the dominant culture. A thesis of the length of this one can deal with all this complexity only in a superficial way. However, by a rather narrowly defined examination of a few children certain insights may be gained which could be used as a basis for generalization about other children of similar background, and perhaps even for some tentative generalizations about the problems of the Mexican-American community as a whole. With this purpose in mind -- to inquire intensively concerning the lives of a very few people for whatever insights may accure -- this study has been undertaken. It should be added that the present paper represents an ongoing study, and should be viewed as part of a larger whole. The conclusions drawn from it are offered at this stage for their suggestiveness rather than as an attempted system or explanation of Mexican-American life. Doubtless with further investigation new questions will arise, and these conclusions may require modification and refinement It is hoped that this continuing investigation may be of service to the peers of the children studied, who need much help in their travels along the way, and for whom, indeed, the route is not clear nor the goal certain

Addressing Gaps in Quality and Safety Education during Pre-Licensure Clinical Rotations

United States national reports have called for improvement in healthcare professions education to better address patient care outcomes. In response, an initiative titled “Quality and Safety Education for Nurses (QSEN)” has been adopted by nursing programs across the nation, which describes the six main competencies to be included in nursing curricula. As early adopters of the QSEN competencies, the University of San Francisco nursing faculty promptly threaded the material throughout the 4-year Bachelor’s of Science in Nursing (BSN) curriculum. Confident that the topics were well covered in the classroom, we then sought to learn how often our students practiced these skills during their assigned clinical rotations. After completing an IRB-approved observational study of junior-level BSN students, we tallied the actual number of minutes spent in each competency area while assigned to the patient care unit. Using a time-on-task author developed QSEN-based tool, we found that our students spent little to no time engaged in quality improvement, evidence based practice, or informatics. This is a very important finding, as it indicates that our students may not be sufficiently developing these particular skills during assigned clinical hours. Weaving the six QSEN competencies throughout the curriculum is a good start, but as we saw in our observational study, all of the competencies are not equally demonstrated in the clinical setting. Continuing to provide QSEN enriched didactic courses, adding targeted simulation experiences, and nourishing academic/practice partnerships may help bridge the gaps

Adolescent depression : further examination of gender differences

This study was designed to examine pertinent research questions that remain unanswered by past investigations of adolescent depression. Specifically this study investigated potential differences between high and low scoring depressed adolescents, and whether gender is an influential variable for consideration. Subjects were 175 adolescent boys and girls from a laboratory school in Midwestern Iowa. Subjects were divided into four groups based on gender and responses two questions on the BDI-A. Specifically, the four groups were: boys who scored at or above IO on the BDI-A (sub-clinical group--boys), boys who scored below 10 on the BDI-A (control group--boys), girls who scored at or above 10 on the BDI-A (sub-clinical group--girls), and girls who scored below IO on the BDI-A (control group--girls). Of the 175 students, 68 were identified as having mild depressive symptoms. Of the 68 students, 36 were male and 32 were female. The dependent variables in this study included three measures that tapped into positive factors, and three measures that tapped into negative factors. Results indicated that participants in the sub-clinical group were more likely to report higher levels of negative factors, and that participants in the control group were more likely to report higher levels of positive factors. There were no significant gender differences in the sub-clinical group or in the control group. In addition, results indicated that sub-clinical males reported elevated levels of negative factors in comparison with females in the control group. Overall, this study was found no significant gender differences when comparing sub-clinical boys and girls, and control group boys and girls. In addition, this study concluded that depressive symptoms is a more important consideration than gender in regards to negative factors. However, additional studies should be conducted to validate these results. In addition, future research should include participants with higher levels of depressive symptoms, as well as a larger sample size