Browsing by Author "Bui, Priya"
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Item A Rare Case of Multiple Sclerosis in a Pediatric Patient(2022) Akhtar, Rukaiya; Bui, Priya; Garcia, JoannaBackground: Multiple sclerosis (MS) is an immune-mediated, inflammatory disease primarily affecting the central nervous system (CNS). It is characterized by demyelination and axonal loss, and results from a combination of environmental and genetic factors. While rare, MS can develop in pediatric patients. Diagnosis of MS in pediatric patients can be very difficult as signs and symptoms appear differently in individuals and because it can mimic other diseases, such as acute disseminated encephalomyelitis (ADEM). Case Presentation: The patient is a 5-year-old female who began experiencing symptoms around 3 years old. In March 2020, she presented to the ER with unsteady gait, abnormal behavior, and decreased appetite. Upon completing a lumbar puncture and getting a brain MRI, she was initially diagnosed with ADEM. In the coming months, she was admitted to the ER two more times - once in May and again in June 2020. Each time she presented with different neurological symptoms. During her admission in June, brain imaging taken confirmed lesions consistent with MS and she was diagnosed with MS. Conclusion: Both ADEM and MS are inflammatory disorders of CNS characterized by demyelination. Distinguishing between the two diseases can be challenging as initial signs and symptoms, as well as imaging can look very similar. However, knowing key differences can help in establishing a proper diagnosis. Current treatment strategies include high dose corticosteroids for acute attacks, and disease modifying therapies for long-term treatment. Understanding how MS differs from similar diseases and how pediatric MS varies from adult MS is critical for proper diagnosis and treatment. Furthermore, while there is increasing recognition of pediatric MS, there is a need for more research and literature in this field to raise awareness and better diagnose, treat, and manage this disease.Item Analysis of the UNTHSC Teen Clinic(2018-03-14) Bui, Priya; Moses, MichelleBackground: The UNTHSC Teen Clinic was established in June 2015 by Dr. Priya Bui as a result of her experiences working with teens in the UNTHSC pediatric clinic. The clinic is run ½ day per week by Dr. Bui and PA Lauren Dobbs. Typical visits include taking a thorough history and physical, screening for psychiatric problems, running special labs (for STIs, lipids, etc.) when indicated, and conducting an in-depth confidential interview to explore the teen’s environment and any risky or dangerous behavior or thoughts. The aim of this project is to analyze the first year of teen clinic so as to show others who may be interested in starting a clinic of this kind what exactly it may entail. Specifically, the research objectives were to create a raw database of information from the first year of UNTHSC’s Teen Clinic (stripped of identifiers); discover the population served; and analyze the depression and risky sexual behavior populations and the interventions used for them. Methods: Retrospective data collection and analysis. Created a raw database of all cases seen in teen clinic from 06/04/15 to 06/24/16. Collected and placed the following coded information into a protected Excel file: Age, Sex/gender, Referral Source, Chief Complaint (CC), History of Present Illness (HPI), Assessment, Medical Intervention, Psychiatric Intervention, Outcomes, Provider, and any Miscellaneous Information. Total of 196 encounters and 116 patients were included in the present study with no exclusion criteria. Analyzed chief complaint (CC), history of present illness (HPI), and assessment. Separately analyzed CC, HPI, assessments, and interventions of the Depression/Adjustment Disorder and Hypersexual Behavior populations. Preliminary Results: The top four CC, HPI, and assessments seen were determined. CC: Well child check (80), follow up (44), establish teen clinic (27), and depression (17); HPI: depressive symptoms (56), family instability (45), acute symptoms (31), well child check (29); Assessment: well child check within normal limits (72), depression (49), asthma/allergies (22), obesity (21). Populations with depression/adjustment disorder and hypersexual behavior were analyzed. In the small hypersexual group, there was successful intervention in 44% of females seen (i.e. Nexplanon placement). We found that in the depressive group 54.8% followed up. Conclusions: In its first year alone, Teen Clinic addressed a variety of unique issues not often explored in a typical pediatrician’s visit- most importantly (indicated by the frequency seen) symptoms of depression and adjustment disorder. Additionally, many teens were recommended for follow up, and many actually came back, successfully establishing a medical home. There are many possibilities for future studies, including, but not limited to: correlational analysis between family issues and risk taking behavior; analysis of patient compliance (by tracking follow up visits); analysis of outcomes from various interventions; and continuing the analysis of interventions in the hypersexual and depressed groups.Item Assessment of Food Insecurity Amongst HSC Patients Using the Hunger Vital Signs Screening Tool(2024-03-21) Brooks, Kate; Bui, Priya; Garcia, JoannaPurpose: The US Department of Agriculture (USDA) defines food insecurity (FI) as “lack of consistent access to enough healthy food for an active healthy life.” FI is associated with negative developmental and health outcomes in children and adults but is less often associated with the physical appearance of malnourishment in children. Because of this, the American Academy of Pediatrics recommends FI screening for all pediatric patients. The Hunger Vital Signs (HVS) screening tool was developed as an efficient and effective way to screen for FI in clinical settings. Since its development, the HVS has been found to be sensitive, specific, and valid as a screening tool for FI in all populations, as compared to the USDA’s 18-item Household Food Security Survey. This project aims to assess the prevalence and distribution of food insecurity within HSC’s patient population. Methods: As part of the check-in process, patients or their caregivers completed an HVS screening at each clinic visit. HVS asks if within the past 12 months, patients “worried whether our food would run out before we got money to buy more,” and if “the food we bought just didn’t last and we didn’t have money to get more,” and allows patients to answer along a 4-point scale. Patients who screened positive for FI then received in person or mailed resources from the clinic Social Worker, including various local food resources. The results of these screenings along with various patient demographics were then analyzed for various trends and distributions via Excel. Additionally, patients who screened positive for food insecurity were then provided resources by the clinic social workers, and results of these patients’ subsequent HVS screenings were followed to assess effectiveness of these resources. Results: Overall, 10.1% of patients screened positive for FI. Disparities across various factors were present, including percent FI amongst Asian patients of 6.1% compared to that of Native American patients of 15.5%. Additionally, patients from the UNT HSC Center for Older Adults showed only a 6.0% FI percentage. After intervention by the social work team, 40% of patients experiencing FI showed improvement on subsequent screenings. Conclusions: This study shows that food insecurity is a prevalent issue in our clinic’s patient population. Disparities across various factors were present, including ethnicity and clinic location, suggesting important areas for improved interventions. While 40% of food insecure patients showed improvement following intervention, several challenges were met regarding validation of this improvement data, emphasizing important areas for future research.Item Assessment of health literacy and potential barriers regarding Human Papillomavirus (HPV) and the HPV vaccine among parents/guardians(2016-03-23) Fernando, Shane; Habiba, Nusrath; Magie, Richard; Bui, Priya; Rovner, GracePurpose: As the number of epidemics that are currently threatening the health of Americans and the associated health consequences continue to grow, protecting future generations from sexually infected viruses has become a concern. With the recent release of Human Papillomavirus (HPV) vaccines, children have the chance to be protected from some of the more common and symptomatic types of the virus. However, vaccine uptake has remained low, leaving many children and adolescents at risk for contracting HPV once they become sexually active. This research study aims at increasing the uptake of the HPV vaccine by identifying potential barriers in completing the three-dose regimen. Information gained will provide the basis for developing a new health literacy intervention within the department of Pediatrics at UNT Health Science Center (UNTHSC). Methods: Parents/guardians of pediatric patients at the department of Pediatrics at UNTHSC will be asked to participate in the study. There are two parts to this study: the initial interview used to establish a baseline, and a follow-up interview to estimate efficacy of the health literacy intervention. The multiple choice questionnaire evaluates the parent’s/guardian’s general perception of vaccinations, knowledge of HPV and the HPV vaccine, and potential obstacles that parents may face when obtaining immunizations for their child. After the initial interview, there will be a short 5 to 10 minute education session about HPV and the HPV vaccine, and the parent/guardian will be given a handout to take home. Additionally, a different questionnaire will be given to pediatricians to help assess their thoughts and perceptions behind the low uptake of the HPV vaccine among adolescents and recommendations of better ways to improve uptake of the vaccine. Projected goals/findings: The goal is to increase parent/guardian understanding about HPV and the HPV vaccine and to determine barriers to receiving the vaccination. By assessing parent/guardian retention of the information regarding HPV and the HPV vaccine and changes in their perception and/or opinions about HPV and the HPV vaccine, this project will gauge the effectiveness of the education session and handout method. If parents/guardians are made aware of HPV and the HPV vaccine, we predict that more children would receive the vaccine and complete all three doses of the vaccine. Moreover, since the population being evaluated in this study tends to have lower levels of education and income, identifying barriers will help increase our understanding of how to get the HPV vaccine to these individuals and be affordable for them. This project is ongoing and the protocol will be adjusted according to the study results.Item Assessment of the Pediatric Mental Health Calls Program during the COVID-19 Pandemic and Stress Findings Among Teens and Adolescents.(2023) Song, Joice; Bui, Priya; Garcia, JoannaPurpose: The Pediatric Mental Health Calls Program was created in March 2020 as a response to the dramatically reduced in-person medical visits and increased virtual visits at the UNTHSC Pediatrics Clinic in Fort Worth following the COVID-19 pandemic. The program was initially used as a tool to support pediatric patients and caregivers while following up on their mental health status. However, considering the potential for the PMHC program in monitoring the long-term and enduring effects of the pandemic on the mental health of teens and adolescents, the program was assessed for data summary and project growth. Methods: The Pediatric Mental Health Calls were previously performed by trained medical and PA student volunteers who used call scripts to standardize the conversation with patients and their caretakers. In a retrospective review, data collected by REDCap electronic data capture tools was then stratified into three main groups: Infant, Toddler and Teens from 2020-2022. Data was then screened and summarized based on yes or no questions as answered by the patient’s caregivers regarding stress levels and mental health. Interview questions were also assessed for areas of improvement. A Chi-squared test of independence analysis was used, and significance was set at p < 0.05. Results: When surveying parents of teens and adolescents age 10-19, there was a higher percentage that reported yes to increased stress due to COVID-19 in 2021 (53%) compared to 2020 (39%), with a statistical significance of p < 0.015. Of the teens and adolescents who had online schooling for six months to one year or greater at the time of surveying in 2021, the percentage of increased stress was even higher at 61%. In addition, problems with discipline, motivation and/or socialization in teens and adolescents were higher in students who reported increased stress due to the pandemic in 2021 than in students who reported no stress. Conclusions: Due to the relatively inexpensive and flexible nature of home calling by volunteers, the PMHC program is a viable way to monitor stress and its effect on mental health amongst the pediatric population alongside changes in the COVID-19 pandemic, especially with the lift of quarantine mandates and return to in-person schooling. Future health calls may be improved by incorporating more of the teen/adolescent answers alongside parents to gauge correspondence between answers as well as providing scaled answer choices for further quantitative analysis.Item Asthma Care in an Academic Pediatric Primary Care Clinic: An Examination of Asthma Triggers(2020) Bui, Priya; Garcia, Joanna; Habiba, Nusrath; Guerra, AlejandroPurpose: The prevalence of asthma among pediatric populations is increasing: 8.4% of children (approximately 6.2 million) in the United States have asthma. It is the leading cause of chronic disease in children. It is hoped the implementation of asthma action plans will better help children (and their parents) manage their condition. A primary way in which asthma action plans are believed to assist their patients in understanding their condition is the identification of triggers for each patient's asthma. In pursuit of this goal, a local study of the asthmatic pediatric patient population at the UNTHSC Health Pavilion was carried out; specifically, research into the most prevalent asthma triggers within this population, as well as trigger exposures and disease severity. Methods: In order to craft a questionnaire designed to capture relevant information, PubMed was utilized to research pre-existing asthma action plans and questionnaires in order to create our own questionnaire for use at the Health Pavilion. This questionnaire was then used to attempt to contact 300 pediatric asthma patients currently being seen at the clinic and gather information on their asthma triggers and disease state, with data recorded in RedCap. Results: Data from 107 of these patients was recorded, which demonstrated a predominance of allergy-induced asthma, with exercise- and dust-induced asthma close behind. Conclusions: An emphasis on identifying prevalent asthma triggers can help pediatric patients and their parents better understand their disease. These triggers can also be focused on and worked into action plans in future patient care.Item Human Papillomavirus (HPV) and Oropharyngeal Cancer in the LGBT Population(2020) Raines-Milenkov, Amy; Bui, Priya; Fulda, Kimberly; Thompson, Erika; Fernando, Shane; Felini, Martha; Aziz, HadiaPurpose: In 2015, HPV-positive oropharyngeal squamous cell carcinoma (oropharyngeal SCC) became the most prevalent HPV-associated cancer in the United States. Oral HPV infection disproportionately affects gay and bisexual males, with men who have sex with men almost twice as likely to have a high-risk oral HPV infection than men with predominantly female sex partners. Despite the rise of HPV-positive oropharyngeal SCC, the rate of HPV vaccination among male adolescents in Texas lags behind the national rate of vaccine uptake. This review examines the barriers to vaccination uptake in gay and bisexual males. Methods: The databases used for this review were PubMed Central, UpToDate, and the Center for Disease Control. Key words searched included HPV rates in LGBT, HPV Oropharyngeal cancer, HPV vaccine barriers, and HPV vaccination rates in LGBT. Results: Three main barriers to vaccination were identified in the LGBT population. These barriers included lack of recommendation from a healthcare provider, lack of funding for new age of majority individuals, and outdated marketing strategies. Conclusion: The most important factor that determines whether a LGBT adolescent receives the HPV vaccine is a recommendation from a healthcare provider. Additionally, when the HPV vaccine is marketed as preventing anal, penile, and oral cancer in males versus just preventing genital warts, the intent of an LGBT patient to initiate the vaccination series is greater. Further research should be done to determine which educational methods and marketing materials used by a healthcare provider impact a patient's decision to vaccinate most significantly.Item Implementation of Pediatric Mental Health Calls During the COVID-19 Pandemic and Postnatal Depression Findings Among Mothers(2022) Desai, Sarina; Bui, Priya; Garcia, JoannaPurpose: During the COVID-19 pandemic, starting in March 2020 the University of North Texas Health Science Center (UNTHSC) Pediatrics Clinic had to limit in-person visits. With concern for the health of patients during this time, the Pediatric Mental Health Calls (PMHC) was created to provide support to patients at the UNTHSC Pediatrics Clinic and their caregivers. Methods: UNTHSC Pediatrics Clinic patient information was uploaded onto a database called REDcap. Medical and Physician Assistant (PA) student volunteers were trained to use call scripts to standardize phone conversations. An Edinburgh Postnatal Depression Scale (EPDS) was administered during calls to assess maternal mental health. Mothers with EPDS scores ≥ 12 were referred for risk of postnatal depression. Data collected from patients ranging from 2 to 6 months of age was analyzed and included demographic information and information about maternal mental health from the EPDS. Analysis used Chi-squared test of independence. Significance was set at p< 0.05. Results: The percentage of mothers with elevated EPDS scores was higher among Black or African American mothers compared to White mothers, showing a statistically significant relationship. Mothers who were working and had the father or a grandparent as the primary caretaker during the workday exhibited a higher percentage of elevated EPDS scores (42.86% father caretaker, 29.41% grandparent caretaker) compared to mothers not working (25.92%). Additionally, mothers with older infants had a higher percentage of elevated EPDS scores (5.08% at 2 months to 18.75% at 6 months). Conclusion: The PMHC program should be continued after the pandemic as an accessible and convenient means for maternal mental health evaluation and referral to resources. Future implementation should be modified to include mothers of infants of increased age ranges and culturally sensitive treatment models to improve racial disparities in postnatal depression.Item Pediatric Response to Psychosocial Stressors During the COVID-19 Pandemic(2021) Bui, Priya; Fernandez, Jazmin; Singhal, Juhi; Garcia, Joanna; Chor, Holy; Villarreal, Marcus; Petrus-Jones, MichaelPurpose: Due to the coronavirus (SARS-CoV-2) pandemic, the University of North Texas Health Science Center (UNTHSC) Pediatrics Clinic reduced the number of in-person visits starting in March of 2020. In response to a rise in child abuse-related fatalities in Tarrant County, the Pediatric Mental Health Calls (PMHC) Program was created with the goal of checking-in and providing support for patients at the UNTHSC Pediatrics Clinic and their caregivers. Methods: A list of patients from the UNTHSC Pediatrics Clinic is uploaded onto a database called REDCap. Call scripts are designed to standardize telephone conversations and evaluate mental and physical well-being during isolation. Medical and physician assistant (PA) students from UNTHSC are recruited and trained as volunteers. A UNTHSC Pediatric Clinic manager/licensed vocational nurse contacts patients that desire to speak with a provider in order to schedule an in-person appointment or virtual visit. Results: There have been 110 medical student and physician assistant volunteers that have participated in calling patients in this program. During the timeframe of April to November of 2020, there were a total of 2,338 patients called. Out of these patients, 262 of them requested to speak to a provider. Conclusion: Goals for the program include continuing to collect data, adding new patients to the database, and editing the call script to reflect changes. Future research plans are to identify rates of anxiety and depression among teenagers and postpartum mothers in social isolation.Item Polypharmacy in management of a pediatric patient with GBS(2020) Yuet, Wei; Bui, Priya; Kim, SuhhyunBackground: Guillain-Barre Syndrome (GBS) is an immune-mediated polyneuropathic disease usually provoked by a preceding infection. It is characterized by peripheral nerve damage, presenting with "ascending paralysis" of the lower limbs, eventually leading to respiratory paralysis if no proper interventions are taken. Current pediatric GBS management involves minimizing residual symptoms by combining medications and physical therapy. This case presents a 3-year-old female who sustained numerous adverse effects secondary to polypharmacy in managing residual GBS symptoms. Case Information: A 3-year-old female with a history of recurrent upper respiratory disease, presented with fever, cough, diffuse pain, and refusal to eat. Her history is positive for a 2-week prior hospitalization for poor eating, emesis, and pain. During this past admission, she tested positive for parainfluenza. A physical exam revealed signs of GBS: fine-motor incoordination, generalized decrease in strength and tone in lower extremities with decreased deep tendon reflexes. She also had elevated CSF proteins and red blood cell counts, and MRI showed diffuse cranial and spinal nerve root enhancements. Upon discharge, she was prescribed fifteen medications for allergies, insomnia, and residual neuropathic symptoms and three had anticholinergic properties and five were CNS depressants. The usage of multiple CNS depressants may exacerbate the adverse effects, which in this case were ataxia, confusion, drowsiness, and weakness. Upon discontinuing therapeutic duplications, patient showed significant improvement on rehabilitation. Conclusions: Polypharmacy should be considered in complex management cases since it may affect the patient's overallItem Use of an Integrated Collaborative Care Model for Pediatric Mental Health Care(2024-03-21) Taft, Carter; Bui, PriyaPurpose This study evaluates the effectiveness of collaborative care models in pediatric psychiatry aimed at addressing the mental health (MH) needs of children and adolescents within the primary care setting. The model integrates primary care clinicians and mental health professionals to provide comprehensive, patient-centered MH care. In addition to reviewing existing literature on collaborative care models, this study aims to describe the unique collaborative care model implemented at the University of North Texas Health Science Center (UNTHSC) Department of Pediatrics and Women’s Health. Methods The collaborative care model at UNTHSC involves a team structure comprising Pediatricians, Behavioral Health Care Managers, and Child and Adolescent Psychiatric consultants. Patients eligible for the model receive initial assessments, treatment plans, and routine interventions tailored to their MH needs. The treatment process involves regular case reviews, interventions, and relapse planning, with specific adaptations to align with the needs and resources available within the UNTHSC pediatric department. Results Previous studies on integrated care models, including the TEAM UP and Behavioral Health Integration Program, have demonstrated improved treatment effectiveness and patient outcomes. In these models, warm handoffs, increased visits, and enhanced competence in managing MH conditions were observed. Collaborative care has been shown to significantly reduce depression scores, with 55% achieving remission in one study. The findings from the UNTHSC collaborative care model are anticipated to complement existing literature, offering insights into the specific strategies and outcomes achievable within a pediatric primary care setting. Conclusions The findings demonstrate the effectiveness of the collaborative care model in treating pediatric MH conditions within primary care settings. Patients enrolled in this model are expected to experience improved treatment outcomes, while healthcare professionals benefit from enhanced satisfaction and coordination of care. This study aims to provide detailed insights into the logistics, fiscal considerations, patient population, and staff involved, including the unique collaborative care model implemented at UNTHSC Department of Pediatrics, enabling the replication of similar collaborative care approaches in pediatric primary care settings to address MH needs comprehensively.