Antimicrobial resistance is a growing problem in the United States. Up to 50% of antibiotic usage in hospitals is inappropriate. To what extent are physicians at Lancaster General Hospital targeting antibiotic choices based on the results of sensitivity tests of positive blood culture results?

Subjects included 209 inpatients at Lancaster General Hospital in 2005 that had a positive blood culture during their admission and susceptibility results available before discharge.

A retrospective chart review eliminated those with multiple infectious disease diagnoses or that required complicated antibiotic regimens.

 62% of patients did have their antibiotic regimen reduced to a narrower spectrum agent that their infection was sensitive to. 55% of patients were discharged home on an excessive antibiotic regimen.

Childhood obesity continues to be a significant and multi-factorial problem in our country.  The aim of our research was to determine whether proximity to fast food restaurants or convenience stores correlated with pediatric obesity.

Data regarding the body mass index (BMI) of school-aged children (5-18 years) in LGMG practices throughout Lancaster County and a small amount in York County was previously recorded and available for analysis.  Fast food restaurants and convenience stores within a 25 mile radius of Lancaster City were recorded and plotted on a map.  The addresses of the patients and unhealthy food choices were mapped and we were able to evaluate if density of unhealthy food choices impacted the weight in children.  Obesity is defined as a BMI ≥30.

• There is statistically less obesity in Group 3 (25-115 density) compared to Group 2 and 4.
• Proximity to unhealthy food choices, age, and gender do not seem to correlate with childhood obesity.
• Education level of parents and household income appear to be significantly related to childhood obesity.

The purpose of this study was to evaluate the knowledge base of parents in our residency clinics regarding pediatric safety practices and common childhood injuries.

There is a known association between parental knowledge, beliefs, and safety practices with actual childhood injury risk.  It was our hypothesis that parents at our residency clinic sites would be deficient in areas of pediatric safety practices as assessed by our questionnaire.

Surveys were distributed to parents of children ages 0-14 yrs at our FHS and WLA residency clinic sites, with 95 surveys completed.

The data showed children less than 4 years scored lower in fall and poison safety practices, while older children and adolescents ranked lowest in bicycle and motor vehicle safety practices.  A significant number of parents did not perceive adequate physician counseling in the past 12 months.

It is clear that the knowledge base of parents in regard to pediatric safety is deficient.  Our hope is that change can be made through physician visits and community based resources to improve the safety of our children.

The purpose of the study is to examine the reasons why patients in the FHS miss appointments. 

We performed a telephone survey of 30 FHS patients who recently missed an appointment. 

We found both patient-based and clinic-based factors for missing appointments.  Clinic-based factors included prolonged waiting time on the telephone to schedule/reschedule appointments and length of time from calling to schedule an appointment and their actual appointment.  Patient-based factors included works/school conflicts, transportation, forgetting, and severe illness. 

Interventions including better triaging of telephone calls and advanced access scheduling could have an impact on the number of missed appointments.   Future research could include a quantitative study to examine whether the factors identified for missed appointments by a small cohort of FHS patients corresponds to the entire clinic population. 

This survey was conducted in order to determine factors that are associated with parental acceptance of the human papillomavirus vaccine called Gardasil. It was hypothesized that parents’ education, knowledge, age, attitudes and beliefs influence their decision to give HPV vaccine to their child.

112 surveys of 21-item questionnaire assessing awareness, attitudes, and knowledge about HPV and the HPV vaccine, as well as participant characteristics were collected and parents’ acceptance of HPV vaccine was analyzed according to parental characteristics.

There were no significant differences in acceptance of HPV vaccine by the parents for their daughters between educational level (P = 0.666), religion (P= 0.800), ethnicity or previous history of HPV cervical cancer or abnormal Pap smear (P= 0.291).

The results didn’t support the hypothesis that educational level, religion, ethnicity or previous history of HPV cervical cancer or abnormal Pap smear influence parental acceptance of HPV vaccine for their daughters.

Interestingly, the survey showed that the majority of participants do not know that HPV infection is not treatable and that women with a lower level of education are more likely to not know that the HPV vaccine can prevent cervical cancer and genital warts.

The purpose of our study was to look at whether a peer audit with peer education has helped to improve third trimester sexually transmitted disease (STD) screening in our residency program.  In October, a peer lecture was given on the new 2006 STD screening guidelines from the CDC and an audit questionnaire was implemented. Then chart reviews were done before and after the intervention, of high risk pregnant women, looking specifically at third trimester HIV, gonorrhea and chlamydia rescreening.  Our results demonstrated improvement in the HIV, gonorrhea and chlamydia rescreening, but the increase was not statistically significant.

Walter L. Aument Family Health Center uses narcotic contracts as part of the care of chronic narcotic prescribing.  A review of current chronic narcotic use and the utilization of office narcotic contracts were examined.

The electronic medical record database was queried for chronic narcotic prescriptions written. Patient charts were then reviewed for presence of narcotic contracts and the use of and results from urine toxicology screenings.

A total of 202 patients meet criteria for having been prescribed chronic narcotics. Fifty charts were reviewed. From this review 36% of patients have a documented narcotic contract (95% Confidence Interval of 22.7%-49.3%). Only 16% of patients had urine toxicology screenings ordered.

The majority of narcotic prescriptions in this clinic population are for chronic pain use. Narcotic contracts and toxicology screenings are under-utilized at WLAFHC. An increase in the use of narcotic contracts is needed at WLAFHC.