RCHC Community Project Abstracts

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As Cool as ICE: A Community Health Initiative Supporting the Use of "In Case of Emergency" Contact Numbers in Cell Phones
Date of project: 10/12/2009

Programming an ICE number, or In Case of Emergency contact number, into a cell phone can help emergency workers gain important medical information or contact a family member in the event that a patient is found unconscious or unable to communicate such vital information. Many community members have heard of the worldwide ICE number initiative, yet relatively few have one programmed into their cell phones. Based on previous research investigating methods for increasing the use of ICE numbers among patients already in Emergency Department waiting rooms, this project uses a preventative approach based on the paradigm of inoculation in the primary care setting using the training of “ICE Ambassadors” in the clinic and community. ICE numbers were directly entered into the cell phones of more than 30 community members. Additionally, medical clinic staff and over 80 volunteers with the local fire department were trained how to increase ICE prevalence by explaining WHY the program is important, by knowing HOW to program an ICE number, and by directly HELPing someone else enter one. The student produced and distributed to community members a “business card” with directions for programming an ICE number on one side and the principles of being an ICE Ambassador on the other.

Medical Marijuana for Chronic Pain Management at a Mixed Rural/Urban Adult Primary Care Practice:
Date of project: 9/7/2009

Following passage of the Oregon Medical Marijuana Act in 1998, medical marijuana has been available to Oregonians with severe pain with the endorsement of their physicians. However, this is a controversial subject involving debates of medical marijuana’s legality and effectiveness for treating chronic pain. While scientific evidence supporting an analgesic benefit of medical marijuana has started to materialize, legal conflict between federal and state statues remains. Complicating this is the unique nature of medical marijuana. It is patient-directed therapy that has standard preparation and consequently, diminished ability to determine dose received. These factors have made it hard for physicians to equate treatment with benefit. While working with Dr. John Allcott at Applegate Medical Associates, a primary care clinic with offices in Veneta and Eugene, OR, a 3 component strategy was derived to monitor the effectiveness of therapy for medical marijuana patients. The components are: 1) determining the level of patient disability through evaluation of patient ability to achieve patient-directed goals addressing social, emotional and physical parameters. 2) Educating patients about possible benefits of medical marijuana, potential adverse reactions, and risks of use. 3) Reviewing patient progress with data obtained from standardized instruments (the PHQ-9 depression screening questionnaire for example) and patient ability to achieve individual goals. The final result was a proposed set of questions to be entered into the EMR and utilized by the clinic staff for medical marijuana patients.

The Usage and Understanding of the POLST Form among Independently Living Senior Citizens in Veneta, Oregon
Date of project: 6/29/2009

Oregon has been very successful in implementing portable orders for end-of-life care via the POLST, which is used in nursing homes, hospitals and hospice. For elderly people that aim to stay in their homes until their final days, their introduction to the POLST is usually from a primary care provider. This project was conducted in the Garcia Senior Center lunch program in Veneta, Oregon, where many of the participants live-independently. The aim was identify if the POLST was being used, identify barriers to its use and to create a presentation to break through some of the barriers. In a total of 6 hours spent at the Tony Garcia Center, data was collected that showed the POLST was not commonly used. Barriers included lack of exposure to the topic, confusing medical terminology and the lack of enthusiasm to talk about end-of-life care. Additionally, two presentations on the POLST were given to break through some of the barriers and forms were filled out on a one-on-one basis. The result was an increased awareness and interest in making choices regarding end-of-life care, and an increase in the number of participants that have POLST forms filled out.

Reducing Obesity in Veneta, Oregon: Is TOPS (Take Off Pounds Sensibly) Part of the Solution?
Date of project: 10/13/2008

Obesity is a major health issue for Americans including residents of Veneta, Oregon. A survey of the electronic medical record used at Dr. John Allcott’s Veneta clinic revealed 495 patients with a Body Mass Index (BMI) over 30 (medically obese) out of his 1483 active patients. While observing Dr. Allcott it became apparent that he refers many of his obese patients to a group program for weight management called TOPS (Take Off Pounds Sensibly). In order to learn about TOPS, assess its effectiveness for Dr. Allcott’s obese patients, and determine whether it could be part of a refined obesity initiative patients were interviewed, a local meeting was attended, the TOPS website was explored, and the medical literature was searched. A review of weight loss programs including Weight Watchers and TOPS concluded that TOPS helps some people and is inexpensive, but given the lack of scientific studies demonstrating its effectiveness the decision to join should be left up to the individual. Personal success stories were compelling, but other patients identified barriers that turned them away from TOPS. Survey of the electronic medical record revealed that out of the 110 (22 male, 88 female) patients who were referred to TOPS, 24 had insufficient chart data to analyze, 39 (45%) decreased their BMI overall, 41 (48%) increased their BMI overall, and 6 (7%) had unchanged BMIs. Limitations exist in determining which patients were truly attending TOPS meetings and given that nearly half saw an increase in BMI and half saw a decrease in BMI, the objective evidence is unconvincing. However, given the many compelling success stories heard it was determined that TOPS should be a key component of the menu of options for weight loss. The final product was the development of a system for addressing weight management with obese patients in the Veneta clinic which includes identifying patients with BMIs > 30, a screening question asked by the medical assistant, and recommendations by the physician. This system has been implemented in the Veneta clinic and will hopefully help reduce obesity, its comorbidities, and its unnecessary cost.

Educating and Empowering Patients and Physicians to Reduce Diabetes-Associated Morbidity in Eugene, Oregon
Date of project: 4/28/2008

Diabetes is an epidemic in the United States. Successful management of A1C, LDL, weight, and blood pressure reduces diabetes associated mortality and morbidity. Patients and physicians have ever-increasing expectations to reach established target goals, many times without complete success. Reaching targets requires a partnership between the patient and physician; patient responsibility, motivation, and investment in their personal health care can have tremendous impact in outcomes. Educational and motivational barriers can be overcome through the use of a patient-specific visual risk assessment profile that demonstrates the direct influence patient actions today have on future risk of complications including heart attack, stroke, kidney failure, foot problems, and eye problems. The American Diabetes Association’s online Personal Health Decisions (ADA’s PHD) risk profile can be used by physicians and patients together in order to successfully move toward established targets, reducing morbidity. Specifically, integration of the PHD into the existing PeaceHealth Diabetes Wellness Assessment Program (DWAP) could increase successful management of physician and patient management of diabetic targets within the PeaceHealth system in Eugene, Oregon.

Avoiding Unintentional Doping Violations
Date of project: 4/28/2008

The problem addressed in this project was the possibility of a volunteer physician at the 2008 Olympic Trials causing an unintentional doping violation in an elite athlete/patient, by unknowingly prescribing a medication containing an agent prohibited by anti-doping regulations. The proposed solution was the creation of a concise educational report, detailing the appropriate prescribing practices for elite competitive athletes, and warning them of the often-prescribed medications which may cause positive drug screen results. This was accomplished by researching the anti-doping policies, practices, and requirements of US Track and Field and the International Olympic Committee, and the US Anti-Doping Agency and World Anti-Doping Agency. Research was also done to determine the medications most likely to cause unintentional doping violations. The result was a concise report, intended to be distributed to the physician volunteers for the Olympic Trials. True assessment of the success of the project would require follow up surveys of the physicians after the conclusion of the competition.

Barriers and Solutions to Receiving Adequate and Continuous Mental Health Services Among the Underserved Population in Lane County
Date of project: 3/17/2008

Mental illnesses have a long history of being grossly underdiagnosed and undertreated. This is especially true for the medically underserved because they are not able to receive the health care needed to treat their mental illness. This problem stems from several major factors which were investigated during this five week clerkship. There were two main goals to this project. The first was to take a closer look at the barriers contributing to this problem, especially from the perspective of the provider. The design was to interview people in the community who treated members of the medically underserved and had a good understanding their social/mental problems. The second goal of this study was to identify what resources were available and what measures were being taken by the community to address this problem. Despite high levels of awareness in the community regarding the great need of mental health services for the indigent population, there exists many barriers preventing the progress of accessibility, availability, continuity of care, and general knowledge of services. Included is a handout summarizing mental health services in Lane County produced by the 100% Access Healthcare Initiative, a group geared towards providing services to all members of Lane County.

Difficulties in Narcotic Prescriptions for Chronic Pain Patients in a Rural Clinic
Date of project: 3/17/2008

Background : It is difficult and time-consuming for different providers in a small rural healthcare practice to determine when a pain medication is due for a patient under a narcotic contract, because of different levels of patient understanding and variability in the wording within the prescriptions. Furthermore, the dispensation of narcotics causes significant tension in the doctor patient relationship. Question: I set out to determine if there was a way to improve the communication between a patient and a provider and among different providers in a group. Methods: I conducted a number of interviews with staff and patients and used the GE Centricity electronic medical record to better define the population with narcotic prescriptions within the practice, and then attempted to use the electronic medical record to generate uniform narcotic prescriptions. Results: The population receiving narcotics prescriptions in this practice were disproportionately Medicaid and Medicare patients. Although prescribing practices varied significantly among providers, the idea of creating a uniform disclaimer for narcotics prescriptions was met with enthusiasm. Therefore, a quick text generator, or “dot phrase” was created that could be entered into a prescription that read “Do not refill. Do not drink alcohol while taking this prescription. Do not operate a motor vehicle if impaired. Limit to Applegate Medical Providers. Limit to _______ Pharmacy. This medication is to last until ________.” This was then linked into the patient’s medication chart, the current visit note, and the after-visit summary. Although this was not a complete solution, the project was viewed as a success by groups prescribers

Effect Of Computer-Based Patient Record System On Patient Satisfaction In Eugene, Oregon.
Date of project: 2/11/2008

Background and objectives: Computer-based patient record system is being increasingly implemented in physician offices. Implementation of electronic medical record changes the work process during the patient encounters. Studies have identified that physicians are concerned about electronic medical record utilization in the exam room negatively impacting physician-patient relations, leading to diminished patient satisfaction. The objective of this study was to determine the effect of computer-based patient record system in the examination room on patient satisfaction one year after implementation of the electronic medical record system when the physician is proficient at utilizing the EMR. The other objective was to determine patient satisfaction with web-based services, particularly secure messaging, lab result reporting, and medication refill requests, and confidentiality. Methods: A survey was given to 50 patients at the end of the visit at a family medicine physician’s clinic in Eugene, Oregon. The survey assessed the following factors: overall patient satisfaction, patient’s perception of the doctor’s proficiency, effect of computers in the exam room, patient satisfaction with patient web portal system, and patient’s concern about the confidentiality. Results: Majority (84% to 86%) of those surveyed rated computers in the exam room as very or somewhat positive in all five aspects of physician-patient communications. 83% to 100% of those who used the web-based services rated the four aspects as very satisfied. Discussion: This study showed that at 1 year after implementation of the electronic medical record system, CBPR in the exam room had a positive effect on all five aspects of physician-patient communications. Majority of the patients were very satisfied with the web services, which is consistent with other studies and adds to the existing data.

Intimate Partner Violence: Toward an Inclusive Paradigm
Date of project: 2/11/2008

Background: Intimate partner violence (IPV) is an important public health concern, associated with many significant adverse psychological and physical health consequences. The Centers for Disease Control and Prevention estimates an annual national cost of IPV of $5.8 billion, with $4.1 billion attributable to direct medical and mental health services costs. A large body of evidence shows that a substantial percentage of victims of IPV are males. Despite widespread recognition of the impact of IPV on public health, and despite concentrated efforts for better prevalence data collection processes by the CDC and others, the role of male victims in prevention and treatment strategies is frequently underestimated and marginalized. To facilitate better understanding of male victimization and informed intervention strategies within the community, we sought to elucidate the services available for male victims of IPV in Eugene, Oregon. Methods: We performed a literature search on national, state and local prevalence rates of male victims of intimate partner violence. Data on community resources for IPV were gathered using the Internet, the community phonebook, and resource listings provided by the City of Eugene. We conducted interviews with staff members of community organizations providing services for IPV to ascertain service availability by patron sex. Results: We found that the majority of community IPV services were available to men and women with relatively few instances of sex-specific eligibility for services. Significant discrepancy existed between advertised sex-specific eligibility for services and actual sex-specific eligibility for services. Conclusions: Of the available resources in Eugene, Oregon dedicated to providing services to victims of IPV, nearly all of them are available to men as well as women. Nonetheless, several barriers to care were identified that may hinder access by men to these resources. These include IPV data collection processes that exclude men from survey pools, intervention strategies that seek to identify only female victims in the health care setting, and language and terminology in educational materials that phrases IPV as a gender-specific form of violence.

Writing Exercise Prescriptions For the Primary Care Physician.
Date of project: 12/31/2007

The epidemic of overweight and obesity in America is on the rise. Many public health organizations, including the National Institutes of Health and the U.S. Department of Health and Human Services Office of the Surgeon General, have called upon physicians in the primary care arena to assess and treat this growing problem. Numerous scientific studies have revealed the benefit of physical activity on not only preventing and treating obesity, but also on the prevention of other diseases; indeed exercise has been associated with a decreased risk of overall mortality. The use of a written exercise prescription, as opposed to verbal advice, is a significantly superior method of galvanizing sedentary individuals to start and follow a regular exercise schedule. Here, an exercise algorithm was developed and built-in to the EMR at AppleGate Internal Medicine Clinic to facilitate discussion about exercise between physicians and patients, and to generate a written exercise prescription based upon individual patient needs, limitations, and desires.

Quality Assurance at PeaceHealth: Medication Reconciliation as a Priority Patient Safety Goal
Date of project: 12/31/2007

Despite the best intentions and hard work of healthcare providers, thousands of patients are harmed across the United States everyday. These instances of medical harm include adverse drug events (ADEs), which are many times the result of incomplete or inaccurate patient medication lists. ADEs can be reduced by implementing improved medication safety, so strategies to achieve this goal are a national patient safety priority. This study attempted to identify the process, successful implementation, and outcome of a medication reconciliation program led by the Medication Oversight Safety Team of the Quality Committee (QC) at PeaceHealth ambulatory clinics in Eugene, Oregon. Because medication reconciliation is a PeaceHealth system-wide initiative, the population studied was all patients seen at PeaceHealth ambulatory clinics across several departments, including internal medicine, family medicine, and pediatrics. The methods included observation of and direct participation in the medication reconciliation process with patients. Formal interviews with the QC chairperson, PeaceHealth healthcare improvement coordinator, and internal medicine clinic front- and back-office staff were conducted. Weekly meetings with the QC chairperson and PeaceHealth quality department manager as well as participation in a QC retreat also contributed to the study. At PeaceHealth, the medication reconciliation process involves a defined series of interactions between patients, clinic staff, and physicians and monthly report of these events to the quality department for an audit. Over the last 9 months, PeaceHealth clinics have on average performed medication reconciliation with 88.5% of their patients, which is just under the set target of 90%. At this stage, the outcome, or actual reduction of ADEs correlated with medication reconciliation, is not being measured at PeaceHealth.

A better way to manage Diabetes in Eugene, Oregon: The DWAP
Date of project: 10/15/2007

The prevalence of Diabetes Mellitus in the United States has been rapidly increasing in the past seventeen years. The complications of poorly managed diabetic care can be disastrous for patients, their families, and society as a whole. PeaceHealth Medical Group of Eugene, Oregon has instituted a Diabetes Wellness Assessment Program (DWAP) in order to maximize diabetes management and avoid these complications. The DWAP program follows the American Diabetes Association’s guidelines of care, and includes comprehensive visits, modifying behaviors, and data reporting in order to improve care for patients with diabetes. Since its inception three years ago, the DWAP program has shown widespread improvement in the way physicians and clinics manage this chronic and potentially debilitating condition.

Assessment of the Gay Friendly Literature and Postings in the Waiting Areas of Local Eugene, Oregon Clinics Catering to Adolescent Populations
Date of project: 8/6/2007

Adolescence is a time of great discovery, when important facets of our personalities are experimented with and solidified. It is also a time of great confusion and vulnerability. This vulnerability puts adolescents at increased physical and mental health risks. Gay youth, an often overlooked subpopulation of adolescents, are often at increased risk compared to their heterosexual peers for certain health problems. As medical providers, there are many things we can do to assist our young gay patients during this tumultuous time. Unfortunately, despite our best efforts to provide adequate care to this population of patients, studies show that gay youth are hesitant to disclose their identity to health care providers. Gay youth need to feel safe before disclosing their identity as this leaves them in an extremely vulnerable position. We can help increase their trust in us as providers, simply by encouraging gay friendly literature in our waiting rooms. A cursory assessment was made of local Eugene clinics. Ninety seven percent of clinics available for response did not display gay friendly literature in their waiting areas. The same percentage did not have any brochures on local gay resources to offer their patients. It was evident that if a gay adolescent was presenting at any of these clinics, they would have no obvious signs letting them know that they were in a safe place. It was also evident that a resource guide for gay youth was lacking in local Eugene clinics.

Putting the brakes on diabetes in Eugene, Oregon by putting the facts in a patient's hands: Development of a handout incorporating diabetes risk assessment and prevention strategies.
Date of project: 7/2/2007

Diabetes Mellitus has grown into one of the nation's largest health concerns for the new millennium. Because of its insidious effects on the arteries of many organs, diabetes has a significant morbidity and mortality. The cost of treating diabetes also has a significant impact on healthcare and the economy. Dr. Larry Hirons, a family physician in downtown Eugene, Oregon, has watched many of his patients develop diabetes. He is always counseling his patients concerning weight loss and exercise, but would like a more specific tool to help patients realize their risk for developing diabetes, why they do not want to become diabetic, and how they can avoid diabetes. The prevalence of obesity in patients presenting to Dr. Hirons was observed, as well as his interaction with patients motivating them to lose weight and avoid becoming diabetic. A literature search was performed to identify a tool for diabetes risk assessment as well as studies showing effective risk reduction strategies. A handout was designed using the information from the literature search and the effectiveness of this handout was assessed by patient and physician interviews.

Vitamin D Deficiency: Causes, Patients at Risk, Prevention and Treatment
Date of project: 7/2/2007

Vitamin D deficiency is a common but often undiagnosed problem in both children and adults. There are many patient groups at risk for vitamin D deficiency, but currently no guidelines for vitamin D screening have been established. The patient base of my rural preceptor's practice includes many individuals who would fit into one or more of the groups at increased risk. This project began as a literature search to attempt to find suggested screening guidelines, and eventually became a project aimed at creating a useful table adapted from a recent meta-analysis of vitamin D deficiency that outlines causes of vitamin D deficiency, patients at risk, and vitamin D supplementation levels for prevention and treatment.

Screening for Depression
Date of project: 3/19/2007

Depression is the most common psychiatric disorder making it a very important issue in primary care practices. This project looked at ways to screen for depression in rural primary care offices, the effectiveness of doing so, and what to do with positive screening results. Design began with observation of an internist’s interaction with patients throughout a five week rotation. Literature review and professional contacts were utilized to evaluate the evidence regarding the efficacy of depression screening in primary care and what tools are most useful if it is to be done. The result of this project was the incorporation of two screening questions into the routine ‘rooming procedure,’ with a follow-up questionnaire for positive screens, informing the staff about what to do with a positive screen, and making information about non-pharmacologic community resources readily available.

The Role of the Primary Care Provider in Identifying And Treating Postpartum Depression
Date of project: 2/12/2007

Postpartum depression (PPD) is a significant public health problem in the US affecting approximately 1 out of 8 women. Antenatal depression can also occur and when present, is a risk factor for PPD. Although the prevention and treatment of PPD (or perinatal depression) is a public health priority, screening for the disorder is not typically standard of care and therefore PPD is often under diagnosed and inadequately treated placing women, infants and families at risk. Because multidisciplinary primary care providers usually have the most mother/child contact, they are in a prime position to screen for depression and identify risk factors that might lead to PPD. Risk factors such as poor partner/family relationships, lower socioeconomic status, unemployment of self/partner and lack of social support are not uncommon in Eugene, Oregon. The purpose of this project was to: 1. Increase the awareness among the PeaceHealth system (PHS) primary care physicians and midwives of the importance of identifying, treating and/or referring cases of PPD. 2. Introduce a validated screening tool for identifying women at risk of developing or suffering from PPD. 3. Provide a referral list for the treatment and support of PPD. 4. Invite clinician participation in the Lane County PPD Consortium, 5. Provide a PPD screening tool for the PeaceHealth Sacred Heart Hospital labor and delivery social workers. Methods: The patient statistics justifying this project came from 2006 and reflect the number of all PHS physicians’ patients who gave birth at the PHSHH. Information was gathered through conversations with PHS physicians, ancillary staff, the Lane County PPD Consortium and several others. An informational packet (IP) was prepared and distributed to individuals involved with the identification, treatment, referral and quality care of patients with PPD. Findings/Results: Last year, the percentage of diagnosed cases of PPD among PHS primary care physicians’ patients who gave birth at PHSHH was .18%. This is far short of the estimated prevalence of 10-20%. Screening for PPD is not standard of care for primary care doctors in the PHS. Many doctors reported they did not have time to use the IP screening tool and there was a general lack of knowledge of the importance of the role of the primary care provider in addressing the problem of PPD. There were no reported cases of PPD diagnosed during the five week clerkship.

Managing Medical Complications of Eating Disorders in the Outpatient Setting
Date of project: 10/16/2006

"Eating disorder patients can be challenging for physicians to manage since there are many medical complications that arise in the setting of starvation or persistent purging. These medical complications put patients at risk and can add considerable cost to the health care system if not addressed properly. The purpose of this project was two-fold: 1) to identify the most important medical problems experienced by eating disorder patients that should be looked for and treated, and 2) to develop a screening tool for physicians to follow the symptoms of medical complications and guide treatment decisions. Visiting residents of an outpatient residential eating disorders treatment program outside of Eugene provided a unique opportunity to have good continuity with eating disorder patients and deal specifically with the medical (as opposed to psychiatric) aspects of their care. The population studied was a group of female patients diagnosed with either anorexia nervosa or bulimia nervosa that were currently undergoing medical, nutritional, and psychological intervention for their eating disorders. After reviewing the literature and conducting patient interviews, a worksheet of medical symptoms was created. The final product is designed to be filled-out by patients prior to seeing their doctor for medical appointments. The utility of such a tool is to focus the patient encounter towards relevant medical problems, to consolidate symptom information into one place, and to allow for the consistent tracking of the persistence or resolution of symptoms with treatment."

Methamphetamine Abuse in Lane County
Date of project: 10/16/2006

This project seeks to illuminate the story of methamphetamine abuse in Lane County: the drug's history, the experience of its users, its production and the effects of "meth labs" in the county, the effects on the community and on families, and resources available to help users quit. Through interviews with physicians, law enforcement officials, nonprofit organization workers, and users themselves; journal articles; and interaction with local service organizations, I discuss the history and scope of the problem in Lane County. Finally, I suggest three broad categories of solutions to the problem, and steps I would take if I were to continue this project further.

Diabetes Mellitus and Obesity in Eugene, OR: An Assessment of the Epidemic and Development of Treatment Recommendations.
Date of project: 9/11/2006

Diabetes is a growing epidemic worldwide. In the U.S. diabetes is the sixth leading cause of death and affects 18.2 million Americans currently, with an estimated 5.2 million who have not yet been diagnosed. Importantly, overweight and obesity are the main modifiable risk factors for type 2 diabetes. The goal of this community project was: 1) to assess the nature of the problem of diabetes and its relationship to obesity at Barger Family Medicine Clinic, 2) to develop a guideline based on an extensive literature review in the management of diabetes and obesity and 3) to develop a hand-out and nutritional food guide for patients with diabetes.

The identification and care of substance exposed newborns, a case study.
Date of project: 8/7/2006

There are numerous children born in Eugene already compromised because they have been exposed to substances in utero. I identified this problem when I met Teresa Donavan who has eleven children; she has three biological children and eight foster children. All of her foster children were born to substance abusing mothers and have similar health challenges. There is a meth epidemic in Eugene and all of Oregon; the number of substance exposed newborns is on the rise. These children face similar problems such as a diminished suck reflex, increased incidence of pneumonia, minimal circadian rhythm, need for routines, and ADHD. Parents receive financial and training support from the state because children are deemed to have “special needs.” Little of the Eugene care system is organized to specifically help substance exposed newborns. However with the development of FEAT: Family Early Advocacy and Treatment, there plans to be increased identification, referral, treatment, and support of newborns exposed in utero.

Primary Prevention in Eugene Oregon: Recognizing Environmental Injuries during youth sporting events
Date of project: 8/7/2006

Heat injuries have the potential to become a medical emergency if not detected and treated in a timely manner. Heat stroke, the most severe form of heat injury, carries a significant mortality rate, especially when therapy is delayed. Some studies cite mortality rates between 10-70% depending on several factors including duration of peak body temperature. Heat stroke is 100% preventable and with such a high morbidity and mortality rate primary prevention is paramount. Youth sports that start in the fall begin practice in August and there is a potential to develop heat injuries in this population. Coaches involved with these sports should be trained to recognize the signs, symptoms, and initial treatment of heat injuries to prevent the progression to heat exhaustion or heat stroke. In addition, it is important for coaches to recognize when the local emergency medical services should be activated in order to institute a higher level of care with regard to the injured individual. This project focused on educating youth coaches about the signs, symptoms, and treatment of heat injuries in the effort to prevent the morbidity and mortality associated with the more severe forms of heat injury, heat exhaustion and particularly heat stroke.

Fathers of newborns: Are your new babies health care needs being met?
Date of project: 7/3/2006

Many people consider the birth of a child to be a highlight of one's life. Naturally, bringing one's own offspring into the world can be a thrilling experience and much focus is spent on ensuring quality health care for both mother and child. The purpose of this community oriented primary care project is to investigate any potential problems with the health care of newborn babies by interviewing fathers of newborn children. Accessing the opinion of a father should reveal new insight into the success and comptetence of newborn healthcare from a perspective not usually considered. The project design included interviewing fathers of newborns in the medical clinic, night clinic and hospital.

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