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

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).https://jdc.jefferson.edu/cwicposters/1038/thumbnail.jp

A Guide to Point of Care Ultrasound Lung and IVC Examination of a Volume Overloaded Patient

A patient presents with dyspnea, hypoxia, and lower extremity edema. Their history is notable for recent high salt intake and non-compliance with diuretics, and their lungs have rales bilaterally. Clinically, we can diagnose a heart failure exacerbation with pulmonary edema. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis and explore the etiology of the hypoxia and dyspnea to narrow the differential. Ultrasound is an effective modality for identifying pulmonary edema and pleural effusions while at the same time ruling out other etiologies such as pneumonia and pneumothorax. With bedside point of care ultrasound (POCUS), there is no radiation risk and no delay in obtaining imaging. A systematic review and meta-analysis study by Maw et al. published in 2019 found that lung ultrasound diagnosis of pulmonary edema in the setting of clinical suspicion for acute decompensated heart failure had a pooled sensitivity of 0.88 and specificity of 0.9, which is superior to X-ray imaging which demonstrated a pooled sensitivity of 0.73 and a pooled specificity of 0.9.

A Guide to Point of Care Ultrasound Examination of a Pericardial Effusion

A patient presents with pleuritic chest pain, dyspnea, and a recent viral illness. They have no prior cardiac or pulmonary history. Their X-ray on admission demonstrates no pulmonary findings and an enlarged cardiac silhouette, and their EKG is low voltage with electrical alternans. Ultrasound is an effective modality for identifying pericardial effusion and cardiac tamponade while at the same time evaluating for other causes, such as heart failure. Often patients with symptomatic pericardial ef fusion present with non-specific symptoms. While a “formal” transthoracic echocardiogram remains the gold standard for diagnosis, a bedside point of care ultrasound (POCUS) cardiac evaluation can significantly decrease the time to diagnosis and trigger an order for an urgent “formal” echocardiogram.1 A retrospective study by Hanson and Chan in 2021 found that POCUS led to an expedited average time to diagnosis of 5.9 hours compared to \u3e12 hours with other imaging. Those with a symptomatic pericardial effusion identified by POCUS had a significantly decreased time to treatment; time to pericardiocentesis of 28.1 hours compared to \u3e 48 hours with other diagnostic modalities.

A Guide to Point of Care Ultrasound Evaluation of Pneumonia

A patient presenting with fever, hypoxia, productive cough, and leukocytosis can be diagnosed with pneumonia without any imaging findings. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis. Ultrasound is an effective imaging modality for identifying pneumonia without delay and radiation risks.1,2 A meta-analysis by Ye et al. in 2015 found that ultrasound diagnosis of pneumonia had a pooled sensitivity of 0.95 and a pooled specificity of 0.9, which is superior to X-ray imaging which had a pooled sensitivity of 0.77 and a similar pooled specificity of 0.9.3 This study used CT imaging as a gold standard for comparison

A Guide to Point of Care Ultrasound Examination of Acute Decompensated Heart Failure

A patient presents with dyspnea on exertion, orthopnea, and lower extremity edema. They have a prior history of coronary artery disease and reported episodes of chest pain three months ago. They did not seek medical evaluation at the time and have had no chest pain recently. In this setting, there is a high clinical suspicion of heart failure with concern for ischemic heart disease. The gold standard for diagnosis of heart failure is a formal transthoracic echocardiogram. Bedside point of care ultrasound (POCUS) is a tool that can provide essential information without delay in diagnosis

Needs Assessment: Northeast Philly Opioid Epidemic

Introduction: Philadelphia has the 3rd highest rate of opioid-related overdoses in the nation. This crisis is worsening in Northeast Philadelphia and the Department of Public Health lacks necessary information to intervene in an informed manner. Objective: This study aims to better understand the crisis in this community and to provide key information to guide future harm reduction interventions in the Northeast Philadelphia region. Methods: Using a designed discussion guide, qualitative interviews were completed with key stakeholders and community members. Information regarding personal experiences and opinions about the epidemic was gathered and interviews were analyzed using narrative analysis. In addition, needle counts were completed in public spaces. These counts were used to measure the free needle burden in this community. The findings of this study will be reported to the Department of Public Health. Results: Community member and stakeholder interviews produced a spectrum of opinions surrounding this issue. Major themes include the need for better access to needle exchange services and the idea that the harm reduction needed in this community differs from what would be accepted by its community members. The needle counts reveal that there is not a serious burden in the community, suggesting little need for further needle disposal kiosks in the area. Conclusion: In conclusion, future interventions should be centered around increasing needle exchange services and improving access and visibility of treatment centers in this community. Furthermore, further action should be taken to address the stigma of substance abuse in this community