Browsing by Author "Garcia, Joanna"
Now showing 1 - 8 of 8
- Results Per Page
- Sort Options
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 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 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 Evaluating student responses to incorporate Vulnerable Patient Population centered content into the curriculum(2023) Panzanaro, Victoria; Kremer, Timothy; Srivastava, Prakriti; Valdez, Alia; Wiemann, Natalia; Basha, Riyaz; Garcia, JoannaPurpose: Vulnerable patient populations are considered groups of people who cannot access healthcare resources or services due to social barriers. Despite advances in the healthcare system and medical education, providers still report feeling less comfortable caring for these patients, and medical students around the country report not feeling this topic is adequately addressed in their curricula. The goal of this project was to evaluate students’ responses to introducing an optional curriculum dedicated to discussing four vulnerable populations (Transgender Patients, Incarcerated Patients, Housing Insecure Patients, and Intellectually and Developmentally Disabled Patients). Our expectation is that students will feel more comfortable being a part of these patient’s healthcare teams, and determine the value of providing students with a manageable curriculum focused on these topics. Methods: The tested curriculum consists of four modules, with each dedicated to one of the populations. Each module consists of a pre-recorded video lecture, a supplemental article, and an optional 30 minute interactive session with a content expert who is currently a healthcare provider focused on each population. Texas College of Osteopathic Medicine students voluntarily participated in this evaluation activity. A literature review was performed to create the content outline and objectives. This information was presented in a short pre-recorded video lecture taught by peers. Supplemental articles were chosen to pair with each video. After completing the modules, participants had the option to a virtual interactive meeting where a content expert that works with each of these patient populations had 30 minutes to talk about their experiences and answer questions. The students then consented to an anonymous post-survey to evaluate if they feel that taking this course has benefited their educational experience and if they feel more prepared to be a part of a healthcare team for these patients. All content and materials were reviewed by content experts. Results: 26 students signed up to take the course, and 20 students completed the modules and attended the optional content expert session. Of those 20 students, 90% completed the post-course survey. The survey showed that students feel vulnerable patient populations are important to learn about, that each population has specific healthcare considerations that should be taught, and that a course similar to this is beneficial to their education. Participants reported feeling more informed about caring for these patients and have taken away information that will be valuable in their future practice. Conclusion: Medical students feel that vulnerable patient populations and their barriers to healthcare are important topics that should be discussed in medical school curriculums. Students recognize that each population has specific healthcare needs that should be individualized to them, and that incorporating a course that discusses this would be beneficial to their classroom and clinical training. The participating students reported that they gained new, useful knowledge that will help them be more supportive for these patients, and wish to see similar content incorporated into the curriculum and expanded on in the future. In conclusion these results are interesting and suggest conducting a research study in the future.Item Fort Worth Adolescent and Young Adult Cancer Registry: First Look at Initial Data(2021) Rose, Sushreyta; Bowman, William; Basha, Riyaz; Albritton, Karen; Garcia, JoannaPurpose: The adolescent and young adult (AYA) cancer population, defined as patients diagnosed between the age of 15-39, may benefit from focused research in improving health outcomes as compared to younger and older patients. A retrospective data registry was created to collect protected health information (PHI) on AYA cancer cases from four Fort Worth healthcare systems to foster collaboration in research. Methods: Initially testing feasibility, the registry is currently collecting a limited dataset of demographic, diagnostic and treatment information on incident AYA malignant cases between January 2016 through December 2019 via a secure database. A descriptive analysis was performed on the current data. Results: 3 of 4 institutions have submitted data on 514 AYA cancer patients. Even though expected cancer incidence rates increase with age, 195 patients were between 15-19 years of age followed by 128 patients in the 35-39 years of age range. 59% of the total patients were females. The top five cancers with the highest incidence rates were Thyroid cancer, Breast Cancer, GI tract cancer, Germ Cell cancer and Hodgkin's Lymphoma. In terms of insurance, 47% of the total patients were covered by private insurance followed by 18% covered by Medicaid. Conclusions: Initial analysis highlighted the need for further improving the data collection process in terms of handling delays retrieving data and ensuring good data quality. In the future, the registry seeks to increase institutions submitting data with PHI. This repository should be a useful resource for community partners for AYA research.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.