• Physical Therapy Evaluation and Management of a Patient with Acute Anterior Cruciate Ligament and Meniscal Tears Complicated by Hereditary Multiple Osteochondromas in the Occupational Health Setting: A Case Report

      Pendergrast, Sarah; Ebert, Jeffrey (2021)
      Background: Hereditary Multiple Osteochondromas (HMO) is a disease that primarily affects the musculoskeletal system. Sequelae of the disease are often treated via outpatient orthopedic physical therapy. There is a lack of literature on HMO in physical therapy. The purpose of this report is to discuss management of a man with HMO and an acute orthopedic injury. Description: A 44-year-old male with HMO and acute knee injury presented with instability and structural abnormalities as well as impaired range of motion, gait, and muscle performance. MRI confirmed anterior cruciate ligament rupture, meniscal tear, and nondisplaced fibular fracture. The examination and plan of care for this patient included special considerations due to the presence of HMO and nuances of the occupational health setting and insurance. Outcomes: The lower extremity functional scale was used to assess the patient�s functional abilities related to his injury, and objective tests and measures were used to assess the impairments. Discussion: Clinicians should treat within the individual context of each patient, including all comorbidities and patient specific findings in order to make effective clinical decisions. Evaluating and treating a patient in the occupational health setting with HMO that has sustained an acute orthopedic injury requires a combination of disease knowledge, clinical reasoning, collaboration with other healthcare providers, and diagnostic imaging.
    • Platelet-Rich Plasma for Chronic Plantar Fasciitis

      Shimada, Yoichiro; Heard, Henry (2021)
      Platelet-rich plasma (PRP), also referred to as autologous platelet gel, has been increasingly used for musculoskeletal injuries, including Achilles tendonitis, shoulder impingement, rotator cuff tear, lateral epicondylitis, patellar tendinopathy, and plantar fasciitis. Chronic plantar fasciitis is defined as degenerative irritation of the plantar fascia that has failed to respond to conservative therapy, and it presents with non-inflammatory, fibroblastic hypertrophy and dysfunctional vasculature. With the chronic degenerative changes of the tissue along with zones of avascularity, chronic plantar fasciitis is difficult to treat, and the recurrence is common even after prolonged rest. Current treatments for chronic plantar fasciitis include corticosteroid injection, extracorporeal shock wave therapy, and surgery. Corticosteroid injections are common treatments for chronic plantar fasciitis; however, there are potential disabling complications associated with corticosteroid injections. PRP has been proposed as an effective, safer alternative treatment option for chronic plantar fasciitis. Due to the hypovascularity and hypocellularity nature of the injury, directly introducing growth factors and cytokines found in PRP to the fascia is believed to promote tissue heal. The purpose of this review is to examine current literature on PRP treatment for chronic plantar fasciitis.
    • Reliability of Low-Cost Thermometers for Monitoring Foot Temperature

      Doolittle, Kristen M.; Wendland, Deborah M. (2021)
      Diabetes prevalence is high and often burdens the economically disadvantaged. With the risk for foot complications in those with diabetes, foot temperature monitoring can help lessen ulcer risk. Higher cost thermometers have been validated. Validation of lower cost thermometers could improve access for the underserved. Purpose: To assess device repeatability, reliability, and ease of use. Methods: 3 inexpensive infrared thermometers were compared against a reference thermometer for repeatability. Rater reliability was assessed by 2 raters using 3 trials at 3 sites across 25 subjects. Feasibility was assessed by subjects ranking the thermometers after testing them. Data Analysis: Descriptive statistics were used for device repeatability. Intra-class correlation coefficient was used to assess rater reliability. Results: Device repeatability: single day coefficients of variation (CV) ranged from 0.20%-0.91%; all days CVs ranged from 3.32%-4.69%. Rater reliability: 25 subjects (49.6�15.8 years). Intra-rater ICC was >0.99 for researchers and thermometers. Inter-rater ICC was 0.965 - 0.975. Thermometers were ranked based on comfort, handling, size, and the light presence. Discussion: Reliability and repeatability of thermometers were good and measurements correlated strongly with the reference. The subjects had little difficulty using the devices. Conclusions: Inexpensive, commercially available infrared thermometers can be a reliable/valid way to assess local skin temperature.
    • Return to Golf Post Subscapularis Repair: Consideration of Regional Interdependence

      Williams, Katelyn; Ebert, Jeffrey G. (2021)
      Return to golf post subscapularis repair Background Isolated subscapularis tears are uncommon in relation to the frequency of rotator cuff (RTC) pathology. However, in specific populations such as golfers, the subscapularis is the second most torn RTC muscle. Purpose The purpose of this case is to encourage clinicians to consider regional interdependence between a subscapularis tear/repair and a history of low back pain in a recreational golfer. Standard rehabilitation specific to the shoulder post subscapularis repair achieved full functional use of the upper extremity, but limitations persisted specific to golf. This case report highlights the importance of assessing golf mechanics with regional interdependence in mind in order to assist a patient in returning to functional golf performance. Case description A 42-year-old male, recreational golfer since age 14, presented to the clinic post subscapularis RTC repair with a goal of returning to golf. Golf swing analyses were performed pre and post treatment and test retest treatment methods assessed patient�s lingering pain complaints during golf. Outcomes The FOTO and numeric pain rating scale were used to measure improvement along with the patient�s subjective report and golf swing analysis with video footage. The patient�s FOTO score improved by 50 points over 6 months of rehabilitation indicating return to functional use of the UE. Patient�s pain decreased to 0/10 during golf game.
    • School-Based Health Centers and Mental Health Access among Minority and Low-Socioeconomic Adolescents

      Barfield, Kailey; Martinelli, LeAnne (2021)
      School-Based Health Centers (SBHCs) are comprehensive health clinics that provide a myriad of services to the students that they serve. SBHCs are meant to overcome barriers students face when it comes to accessing healthcare such as transportation, limited clinic hours, and parent work schedules. However, many of the most vulnerable populations - like those living in poverty and those that identify as racial/ethnic minorities - may still encounter barriers when it comes to accessing mental healthcare. A review of previous studies was done, and suggestions were provided for improved access to mental health services through SBHCs to even the most vulnerable populations.
    • Subcutaneous CGRP Antagonist Injections: A Novel Approach to the Treatment of Chronic Migraines

      Burrows, Caroline; Sadowski, Catherine (2021)
      Nearly 4 million Americans suffer from chronic migraines. These patients have severe headaches that occur for 15 or more days a month, leading to a diminished quality of life. Current recommended therapy is not conducive to all patients, as one study shows 68% of these patients experience at least one medication treatment failure. Within the last few years, the FDA has approved new medications, known as CGRP antagonists, that are proving to be efficacious in the treatment of chronic migraine.
    • Teledermatology: Preventing and Diagnosing Skin Cancer in the Rural United States

      Benedit, Veronica; Aycock, Mallory (2021)
      In the United States, skin cancer is a prevalent and sometimes preventable form of cancer that causes a significant disease burden on both rural and urban communities. Studies have shown, however, that rural communities bear a unique burden in that rural residents are less likely to engage in primary prevention behaviors against skin cancer. Additionally, skin cancer incidence and mortality are higher among rural residents. Teledermatology can be used to address disparities in both skin cancer diagnosis and health education to improve dermatology outcomes in rural communities. Teledermatology is the use of technological advancements in both image acquisition and communication to improve access to dermatology care. This poster reviews teledermatology formats, barriers, and benefits to encourage integration of teledermatology modalities into regular physician assistant practice. Both family practice as well as dermatology physician assistants can utilize teledermatology to improve access to dermatology care, especially for patients living in rural areas.
    • The Bridge to Better Health

      Gould, Chelsea; Washington, Kayla; Thomas, Joy; Lepp, Erin; May, Stephanie (2021)
      Nutrition education is important for all individuals but most people do not have this knowledge. The lack of nutritional knowledge is a growing problem that contributes to the growth of obesity in Dekalb county. In Dekalb county, approximately 30% of adults and 13% of high school students are obese. Even more people in Dekalb county (73.4% of adults and 79% of youth) do not consume the recommended amount of fruits and vegetables per day(CDC, 2013). Objectives: Increasing knowledge of healthy foods Increasing understanding of nutritional value Ability to participate in healthier eating habits Increasing community support for a healthier well-being Identifying barriers to healthy eating Methods: Mercer University College of Health Professions, Department of Public Health, and the professional program in Physician Assistant Studies program partnered with the Bridge at Austin Community Center's leaders, Dr. Stephanie May and Ms. Bernita Reese. Interactive and educational sessions are held online using Zoom. They are open to both males and females of all ages in Dekalb county. Participants filled out a registration form which included information on their name, children�s names, phone number, address, email, race/ethnicity, ages of household members, and what they are looking to learn from the sessions. This intervention is still currently in progress. The goal of the intervention was to help improve health and wellness for participants.
    • The Use of Metformin in Breast Cancer Treatment in Non-Diabetic Women

      Weintraub, Taylor; Mattingly, Jill (2021)
      Breast cancer is the second leading cause of death of women in the United States, with approximately 245,000 new cases being diagnosed each year. The current primary treatment is lumpectomy or total mastectomy, radiation therapy, along with adjuvant hormone and chemotherapy as indicated for metastatic disease. While each of these invasive treatments are effective at killing cancer cells, they are extremely toxic to every cell in the patient�s body. Metformin, a biguanide, is the most commonly prescribed drug for diabetes mellitus type 2. It�s mechanism of action works by decreasing the amount of glucose synthesized in the liver and increasing insulin sensitivity in muscle cells. Studies have already shown that diabetic patients taking metformin have a decreased risk of developing breast cancer, in addition to a better prognosis in those diagnosed with breast cancer. However, there has been no conclusion about the benefit of metformin in non-diabetic patients with breast cancer. This review presentation describes the numerous proposed anti-tumor mechanisms of metformin, such as its ability to enhance the effects chemotherapy, and inhibit cancer cell growth before and after it has begun. Metformin is a well-tolerated, inexpensive and safe medication. If its effectiveness is proven as an adjuvant treatment, breast cancer patients could reach remission with less harmful radiation and chemotherapy.
    • Understanding Teachers-Researcher Collaboration: Designing a Next Generation Science Standards (NGSS) Aligned Curriculum

      Jenkins, Tynetta; Hochuli, Caitlin; Sharma, Meenakshi (2021)
      National curriculum framework for science education (NRC, 2012) makes various recommendations for increasing collaborations among various stakeholders to facilitate the implementation of NGSS. This ongoing study presents a case that exemplifies such a collaboration between two certified teachers (co-authors) and a science education researcher (primary author). The partnership was initiated for designing a K-8 STEM curriculum focused on 3D learning (core ideas, science & engineering practices and crosscutting concepts). This is a qualitative study that uses data from regular curriculum development meetings that involve planning, design, and feedback regarding the STEM curriculum. Teachers and researcher constantly reflect on their role, contributions, and biases during these meetings and by keeping individual written reflective journals to deeply understand the nature of the existing collaboration. The goal of the study is to understand the strengths, dilemmas, and challenges of this collaboration. Most importantly as participants, we strive to understand how we develop a shared vision, how the researcher recognizes teacher voice and how teachers develop a deeper understanding of the NGSS in the process. Initial findings reveal that this partnership is a dynamic process that involves constant negotiations and compels us to revisit and rethink our current roles, values and priorities as we transition to being joint curriculum developers. We are examining changes in teachers� understanding of NGSS as an outcome of this partnership. Also, researcher�s recognition of the school contexts and students� needs as seen through the eyes of teachers will also be examined. Such collaborations are being highly advocated by the NRC (2012) committee. Our research finding can provide useful insights and strategies to build productive learning communities among teachers and researchers to support the goals of K-12 science education. National Research Council. (2012). A framework for K-12 science education: Practices, crosscutting concepts, and core ideas. National Academies Press.
    • Use of Progressive Neurodynamic Exercises in Conservative Treatment of Acute Lumbar Radiculopathy

      O'Neill, Kathleen; Christ, Tom; Collier, Beth (2021)
      Background: Radiculopathy occurs when there is compression of the nerve at the level of the spinal nerve root. The clinical presentation of radiculopathy depends on the level of spinal compression but involves corresponding diminished reflex, impaired dermatomal sensation, and myotomal weakness. Current research supports conservative physical therapy management of acute low back pain with a symptom modulation approach including manual therapy, directional preference exercises, or traction. The objective of this case report is to explore the effectiveness of incorporating progressive neurodynamic exercises into physical therapy treatment of acute lumbar radiculopathy. Case Description: A 26-year-old female patient presents to an outpatient physical therapy clinic with complaints of right lower extremity weakness, numbness, and pain. Myotomal, dermatomal, and reflex testing revealed signs and symptoms consistent with L5-S1 lumbar radiculopathy. The patient was conservatively treated with progressive neurodynamic exercises in addition to traction and other manual therapy techniques. Patient saw significant improvements in lower extremity neurodynamics, pain, and function following 14 sessions of interventions. Discussion: Further research involving larger, randomized control trials are needed to explore whether utilizing progressive neurodynamic exercises should be more regularly incorporated into existing guidelines for conservative management of acute lumbar radiculopathy.
    • Utilization of the patient portal billing feature for patients to improve the quality of care in the facility.

      Mohamed, Ekran (2021)
      Intro: Creating and being able to provide a really good quality of care is not only important but being able to have a really good patient satisfaction at your facility is very important also . Being able to use a system we already have in place and by looking into the different features that aren't in use in the facility is important. E-clinical systems would be able to help out the facilityand be able to minimize the patients call volume about financial aspect because the patient portal billing feature will be able to allow patients to be able to view and or pay their bills online, being able to view patient statements immediately, and being able to update their insurance information as soon as they get new insurance coverage or if an insurance term be able to update their information online, and lastly will be able to allow the patients to communicate with the staff members by being able to send messages instead of calling for explanations. Obj:Improving patient care & quality Reducing the number of calls Allowing patients, the ability to view/pay bills online, seeing payment statements immediately improve the revenue cycle management Methods:Take advantage of the patient portal we use at work by being able to use the different financial features that are offered to be able to create a much better quality and much better satisfaction care for the patients that come to the facility. Also, by looking into the software system we use and being able to look at the type of call volume about financial questions we mostly get our facility and being able to talk with coworkers and other people who do use the different features at their workplace and be able to compare and ask open ended questions to be able to analyze and see how this would be able to affect my facility and how will the type of quality we provide be able to increase the patient satisfaction. Results: After analyzing the data from interviews and literature reviews being able to use the patient portal billing feature would be a huge impact in improving the quality of care in the facility by being able to improve on the revenue cycle by being able to allow patents the opportunity to be able to view their statements and bd able to update any insurance information. This will also help by reducing the number of calls that are related to billing.