Barriers to Affordable Prescriptions in Rural Vermont

This project aimed at understanding why people in Rutland County, Vermont struggle with buying medications for their health. The project implemented and proposed several methods to help the population of Rutland area better adapt to the growing cost of prescriptions via $4 medication lists, rebates, samples, etc.https://scholarworks.uvm.edu/fmclerk/1337/thumbnail.jp

Prenatal Lead Exposure Risk Assessment by Vermont Maternity Care Providers

Introduction. One percent of women of childbearing age in the U.S. have blood lead levels ≥ 5 ug/dL, which are associated with maternal hypertension during pregnancy, neural tube and cardiac defects in infants, low birth weight, prematurity, and spontaneous abortion. It is unknown whether obstetrics providers in Vermont are screening their pregnant patients for lead levels and educating them on lead exposure risks. Objective. To gain an understanding of current lead screening practices in Vermont and issue recommendations for disseminating lead screening information. Methods. We developed and e-mailed a survey to practicing OB/GYN physicians, maternity care focused family medicine physicians, nurse midwives, and professional midwives. The survey assessed current screening practices for lead exposure in their pregnant patients, interest in receiving statewide guidelines, and guideline dissemination preferences. Results. Of the 41 respondents, 12% currently conduct risk assessments for lead exposure with all of their pregnant patients. Fifty four percent of maternity providers give all of their patients educational materials about lead exposure and risk of toxicity. Seventy one percent of maternity providers think that having guidelines provided by the Vermont Department of Health would encourage them to begin or continue lead exposure screening. The two preferred methods of communicating guidelines to physicians were grand rounds and email whereas non-physician providers preferred email and webinar. Discussion. The majority of pregnant patients in Vermont are not properly assessed or educated about lead risks. However, there is interest in having statewide standardized lead risk assessment guidelines, with dissemination preferences differing by provider type.https://scholarworks.uvm.edu/comphp_gallery/1248/thumbnail.jp

Use of a rapid intraoperative parathyroid hormone assay in the surgical management of parathyroid disease.

OBJECTIVE: To evaluate the utility of a rapid intraoperative parathyroid hormone (PTH) immunoradiometric assay in the surgical management of parathyroid disease, particularly with reference to limiting extent of cervical exploration. DESIGN: Nonrandomized prospective study. SETTING: Academic tertiary care center. PATIENTS: Forty-three consecutive patients undergoing parathyroid exploration for adenoma or hyperplasia had rapid PTH assays performed from blood drawn at induction and 7 minutes after resection of all hyperfunctioning parathyroid tissue. OUTCOME MEASURES: Excision of all hyperfunctioning parathyroid tissue as assessed by bilateral neck exploration, postoperative normalization of serum calcium and PTH levels, and resolution of clinical symptoms. RESULTS: The intraoperative rapid PTH assay accurately reflected whether all hyperfunctioning parathyroid tissue was excised in every patient. In 41 patients, all hyperfunctioning parathyroid tissue was resected at the time of surgery and confirmed by a corresponding decrease in the intraoperative postexcision rapid PTH determination as well as by subsequent normalization of postoperative serum calcium and PTH levels and resolution of clinical symptoms. In 2 patients, the postexcision rapid PTH assay determination was not consistent with removal of all hyperfunctioning parathyroid disease and both patients demonstrated persistent hyperparathyroidism postoperatively. CONCLUSIONS: The intraoperative rapid PTH assay may be of significant benefit in permitting directed unilateral parathyroid explorations for adenoma when combined with preoperative localization with a technetium-99m sestamibi scan. Additionally, the rapid PTH assay has proved to be of benefit in confirming excision of all hyperfunctioning parathyroid tissue in patients with multiple gland hyperplasia, particularly those who may harbor ectopic parathyroid tissue

Comparison of transconjunctival versus subciliary approaches for orbital fractures: a review of 60 cases.

The increasing emphasis on open reduction in the management of orbital fractures has led to an extensive debate as to which approach provides adequate exposure for these fractures. This retrospective study compares the exposure provided and the rate of complications between transconjunctival and subciliary incisions for orbital rim and floor fractures. The charts of 55 patients with orbital fractures, treated with open reduction and internal fixation, were reviewed. A total of 30 subciliary and 30 transconjunctival incisions had been performed, and the adequacy of exposure as well as intraoperative and postoperative complication rates were compared. The authors found a higher rate of complications with the subciliary approach and, therefore, advocate the use of a transconjunctival incision for the management of orbital fractures