AL MDA 2019 Mid Winte r Confe re nc e Poste r Pre se nta tion - PDF document

AL MDA 2019 Mid Winte r Confe re nc e Poste r Pre se nta tion Abstra c t 19- 1- 01 itle : T ra nsfo rming De live ry o f Ca re a t the Ha rm Re duc tio n Clinic T Author: T i Ho a ng , MS, OMS-I I I , Ala b a ma Co lle g e o f Oste o pa thic Me dic ine , Do tha n, AL Summa ry: Opio ids we re histo ric a lly pre sc rib e d to tre a t c hro nic pa in a c ro ss the Unite d Sta te s. Ho we ve r, it ha s tra nsc e nde d the b o unda rie s o f a ppro pria te me dic a l a pplic a tio n, a s pa tie nts b e c a me inc re a sing ly a ddic te d o r de pe nde nt. F o r e xa mple , b e twe e n 2014 a nd 2015, Ma ssa c huse tts wa s o ne o f nine te e n sta te s to ha ve a sta tistic a lly sig nific a nt inc re a se in the ra te o f o pio id-re la te d de a ths. 1 Be twe e n 2012 a nd 2016, the sta te sa w a 170% diffe re nc e . 2 Ho we ve r, Bro c kto n, MA in pa rtic ula r e xpe rie nc e d a 367% diffe re nc e . 3 By a na lyzing the c a use s o f re la pse in suc h a hig h-risk c o mmunity, da ta c a n b e e xtra po la te d to the sta te a nd/ o r na tio na l le ve l to ide ntify trig g e rs a nd sub se q ue ntly me tho ds o f pre ve ntio n o r c e ssa tio n. T we nty-thre e pa tie nts in the Bro c kto n Ne ig hb o rho o d He a lth Ce nte r (BNHC) Ha rm Re duc tio n Clinic (HRC) we re inte rvie we d o n-site b e fo re o r a fte r the ir a ppo intme nts. We a dministe re d a vo lunta ry surve y tha t c o nta ine d te n o pe n-e nde d q ue stio ns a b o ut b a rrie rs to so b rie ty, re la pse , mo tiva tio n a nd c o nfide nc e to a c hie ve g o a ls, a nd c linic impro ve me nt. Re po nse s we re a no nymo us a nd re c o rde d in a priva te se tting . Qua lita tive re sults we re c o nve rte d to q ua ntita tive re sults fo r a na lysis. Mo tiva tio n a nd c o nfide nc e to a c hie ve g o a ls we re ra nke d o n a sc a le o f 1-10. T he a ve ra g e fo r mo tiva tio n wa s 8.7 a nd c o nfide nc e 7.8. Appro xima te ly 60% o f pa tie nts re po rte d “me nta l he a lth” o r a so c ia l fa c to r a s a trig g e r fo r o pio id use o r re la pse . T he c o mmo n sug g e stio n fo r impro ving the HRC wa s to ha ve e ve ning o r we e ke nd a ppo intme nt time s a s we ll a s the a dditio n o f g ro up me e ting s. Ba se d o n o ur finding s, o ur re c o mme nda tio ns to impro ve de live ry o f c a re a t HRC we re e xpa nding a ppo intme nt a va ila b ility to the e ve ning s o r we e ke nds, the a dditio n o f e ve ning g ro up me e ting s, the hiring o f a ma le c o unse lo r, a nd inc luding a b e ha vio ra l o r me nta l he a lth spe c ia list in the sa me visit a s the physic ia n o r c o unse lo r. T he a b se nc e o f the se fe a ture s pa rtia lly e xpla ine d the disc re pa nc y b e twe e n the sc o re a ve ra g e s b e twe e n mo tiva tio n a nd c o nfide nc e in a c hie ving g o a ls. I de ntifying c a use s o f re la pse a nd se e king a re a s to impro ve tre a tme nt de live ry a re e sse ntia l in c urb ing the rise in o pio id use . Re fe re nc e s: 1 https:/ / www.c dc .g o v/ drug o ve rdo se / da ta / sta te de a ths.html 2 http:/ / www.ma ss.g o v/ e o hhs/ do c s/ dph/ sto p-a ddic tio n/ c urre nt-sta tistic s/ da ta -b rie f- o ve rdo se -de a ths-ma y-2017.pdf 3 http:/ / www.ma ss.g o v/ e o hhs/ do c s/ dph/ sto p-a ddic tio n/ c urre nt-sta tistic s/ to wn-b y- to wn-listing s-ma y-2017.pdf

Abstra c t 19- 1- 02 itle : Mic ro sc o pic po lya ng iitis re la pse diffe rs fro m initia l pre se nta tio n T Author: T i Ho a ng , MS, OMS-I I I , Ala b a ma Co lle g e o f Oste o pa thic Me dic ine , Do tha n, AL Summa ry: Mic ro sc o pic po lya ng iitis (MPA) is a ne c ro tizing va sc ulitis with fe w o r no immune c o mple xe s a ffe c ting sma ll ve sse ls. Altho ug h it ha s dia g no stic o r sug g e stive fe a ture s, MPA do e s no t ha ve a sing le pre se nta tio n a nd c a n re la pse with diffe re nt sig ns a nd sympto ms. A 72-ye a r-o ld fe ma le pre se nte d to the e me rg e nc y ro o m with b la dde r pa in tha t b e g a n two we e ks prio r a nd dysuria a nd a b urning se nsa tio n upo n urina tio n tha t b e g a n o ne we e k prio r. She ha d so me he ma turia , a nd urine c ulture wa s po sitive fo r E nte ro c o c c us . He r c re a tinine wa s 2. Co nse q ue ntly, she wa s dia g no se d with a urina ry tra c t infe c tio n, urina ry re te ntio n, a nd a c ute kidne y injury. T he pa tie nt impro ve d with tre a tme nt a nd wa s disc ha rg e d with a c re a tinine o f 1.1. T wo mo nths la te r, she re turne d to the E R with we a kne ss a nd c o nfusio n fo r two we e ks. Afte r she finishe d he r c o urse o f a ntib io tic s a fte r disc ha rg e , the pa tie nt ha d two mo re e piso de s o f the sympto ms fro m the first E R visit, b ut the y we re wo rse this time . T he re wa s a n a dditio n o f a no re xia , we ig ht lo ss, fa tig ue , dizzine ss, sto ma c h pa in with b o we l mo ve me nts, dia rrhe a , vo miting , a nd le ft fla nk pa in. E rythro c yte se dime nta tio n ra te a nd C-re a c tive pro te in we re e le va te d. Urine a na lysis wa s do ne a nd wa s fo und to ha ve 4+ pro te in (4.1 g / dL ), 3+ b lo o d, hya line c a sts, a nd fe w e o sino phils. She ha d a c re a tinine (c r) o f 6, b lo o d ure a nitro g e n (BUN) o f 80, a nd g lo me rula r filtra tio n ra te (GF R) o f 7. Pro te inuria a b o ve 3 g ra ms pe r da y c o uld imply pre vio us ne c ro tizing g lo me rulo ne phritis, b ut a pre limina ry dia g no sis o f a c ute kidne y injury wa s ma de . T he pa tie nt b e g a n he mo dia lysis a nd tre a tme nt with do pa mine a nd pre dniso ne , re sulting in a n impro ve me nt in c re a tinine , BUN, a nd GF R. F urthe r wo rkup with a n a b do mina l so no g ra m a nd e so pha g o g a stro duo de no sc o py yie lde d dia g no se s o f H. pylo ri-po sitive e ro sive g a stritis, a ntritis, a nd g a llsto ne s. He ma to lo g ic wo rkup re ve a le d po sitive p-ANCA, c -ANCA, a nd ANA. Re na l b io psy sho we d pa uc i-immune ra pidly pro g re ssive g lo me rulo ne phritis, whic h wa s sub se q ue ntly na rro we d to MPA. Ac c o rding ly, c yto xa n wa s a dde d to the me dic a tio n re g ime n. T he pa tie nt c o ntinue s to fo llo w-up with o utpa tie nt ne phro lo g y. He r la te st BUN is 42, c r 3.3, a nd GF R 15. T his c a se illustra te s the multisyste mic na ture o f MPA a nd ho w re la pse c a n po ssib ly ma nife st diffe re ntly fro m the initia l pre se nta tio n. T he re fo re , MPA c o uld b e c o nside re d in c a se s o f multisyste m dise a se in the c o nte xt o f re c urre nt ne phro sis. Re c o g nitio n o f this dise a se is c ritic a l to initia tio n o f a ppro pria te tre a tme nt a nd pre ve ntio n o f re na l de c line .