Antibiotic Overprescription in Rural Communities: Clinical, Agricultural, and Systemic Drivers of Antimicrobial Resistance
Presented by Benjamin Allen, PA-S, and Christopher Grimm, MPAS, PA-C, Miami University
Purpose:
Antimicrobial resistance (AMR) is an increasing public health concern that is driven by the misuse and overuse of antibiotics in human healthcare as well as in agricultural settings. This poster examines the effect of inappropriate antibiotic use in rural communities and explores strategies to improve antimicrobial stewardship in these populations.
Methodology:
A narrative review of published literature and public health reports regarding antibiotic use was conducted. The literature focused on outpatient prescribing practices, rural healthcare access, livestock-associated antibiotic exposure, and stewardship interventions. Key sources included peer-reviewed studies evaluating differences in antibiotic use between rural and urban populations, the World Health Organization, and the Centers for Disease Control and Prevention.
Results:
Existing evidence demonstrates that rural patients are more likely to receive broad-spectrum antibiotics, including fluoroquinolones, and to be prescribed treatment durations longer than urban patients. Geographic barriers, limited access to diagnostic testing, shortages of infectious disease specialists, reduced follow-up opportunities, and fewer antimicrobial stewardship resources contribute to greater reliance on empiric prescribing practices. Additionally, agricultural communities experience increased exposure to resistant organisms through livestock production systems, where antibiotics are frequently used both in feed and in general animal management. Together, these healthcare and environmental factors create a dual risk that may accelerate the development and spread of AMR in rural populations.
Conclusions:
Addressing AMR in rural America requires targeted interventions that extend beyond traditional clinical settings: Expanding antibiotic stewardship programs for both humans and livestock, along with increasing access to specialist consultation through telehealth, improving rapid diagnostic capabilities, and strengthening patient education initiatives are essential steps toward reducing unnecessary antibiotic use. Future research should investigate rural patients’ knowledge of the dangers of AMR, expectations, and perceptions regarding antibiotics to create and to inform community-specific stewardship strategies, slow the progression of antimicrobial resistance, and improve health outcomes in rural populations.
Bridging the Gaps: Cervical Cancer Disparities in Rural and Urban America
Presented by Caroline Craft, PA-S, and Karey Davis, PA-C, Miami University
Abstract:
Cervical cancer is a highly preventable and treatable disease; however, women living in rural America continue to experience disproportionately higher incidence and mortality rates compared to their urban counterparts. A comprehensive literature review was conducted to evaluate the factors contributing to this health disparity and identify strategies to improve cervical cancer prevention and early detection. This research was conducted as part of the graduate research capstone requirement at Miami University’s Physician Associate Program. Sources for this literature review were obtained primarily from PubMed, the Centers for Disease Control and Prevention (CDC), the American Cancer Society, the Health Resources and Services Administration (HRSA), and peer-reviewed journals including JAMA Network Open. The literature consistently demonstrated that suboptimal cervical cancer prevention and screening contribute to rural women experiencing a 25% higher incidence and a 42% higher mortality rate from cervical cancer compared with urban women. Contributing factors include lower cervical cancer screening and HPV vaccination rates, limited access to healthcare providers, reduced rates of clinician recommendation for screenings, and delayed diagnosis. The findings suggest that improving HPV vaccination and screening rates, and culturally sensitive patient education may reduce the burden of cervical cancer among rural American women. A multifaceted approach at the patient, clinician, and community level is required to improve early detection and cervical cancer outcomes in rural America.
Disparities in Dental Disease Between Rural And Urban Populations
Presented by Zoe Wilks, PA-S, and Sandy Leventen, PA-C, Miami University
Abstract:
Dental disease disproportionately affects those living in rural areas due various factors. This is concerning due to the severity of health implications associated with poor oral health such as dental caries, tooth decay, periodontal disease, and oropharyngeal cancers. This research identifies factors impact oral health, and the underlying reasons behind the disparities faced by rural populations. The purpose of this research was to identify factors that need to be improved upon, and address those problems with practical solutions. This research is a review of current literature and studies analyzing oral health metrics from sources such as Centers for Disease Control and Prevention (CDC), the Ohio Department of Health, and others. The findings identified some barriers to equal dental care between rural and urban populations. One such finding was provider shortage decreases accessibility to dental care. Rural communities often have limited access to nutritious food leading to higher intake of sugars and lower intake of vitamins. Education regarding the importance of nutrition is lacking as well. Finally, more rural residents rely on Medicaid or have no insurance compared to those living in urban areas. These insurance plans often do not include dental coverage, leaving payment to be challenging for a patient to obtain. The proposed solutions to address the problems are to encourage local stores that carry food to provide and clearly label nutritious options, promote oral health education to younger populations, incentivize dental providers, utilize synchronous teledentistry, and improve vitamin intake. There are negative outcomes for individuals with poor oral health if the problems are not addressed, additionally there is a burden on providers as well. Dentists who provide care to a larger population like those who practice in rural areas have a heavier patient load leading to a higher burden. Additionally, there is a higher percentage of residents living in rural areas who present to the emergency department with oral health complaints rather than dentists due to limited accessibility. There are further research points that may be addressed in the future. One example is the potential outcomes from poor oral health on other health problems such as endocarditis. Additionally, evaluating individual insurance plans and how they incorporate dental care may provide more insight into the disparities regarding insurance. Addressing oral health disparities in rural populations is essential because poor oral health can lead to many serious health consequences. Avoiding these consequences may be difficult due to the many factors that contribute to rural communities being disproportionately affected. It is important to continue studying the effects and the causes of these disparities, in addition to implementing education in as many settings as possible to reach a wider range of community members, including providers and patients.
From Recall to Reasoning: A Longitudinal Active-Learning Framework for Clinical Decision-Making in Physician Assistant Education
Presented by Brook Wong, PA-C, and Jennifer Garrett, PA-C, Mount Saint Joseph University
Purpose:
To describe the development and implementation of an active-learning framework designed to address a common educational challenge: moving physician assistant (PA) students beyond diagnostic recognition toward clinical reasoning and management.
Methodology:
An active-learning framework was integrated throughout the didactic phase of a PA curriculum. The framework was structured around three interconnected domains of clinical thinking – Recognition, Reasoning, and Management – and reinforced through activities including Pill Drills, Rapid Fire Recall, Application Stations, Practice PANCE-style Questions, The Next Move, and Case-Based Discussions. Activities were implemented across multiple organ systems and disease states to provide repeated opportunities for students to apply increasingly complex levels of clinical thinking.
Results:
The framework was implemented across multiple organ systems within the Principles of Medicine curriculum and reinforced through active-learning experiences designed to strengthen recognition, reasoning, and management. Early learner feedback has been favorable, with consistently high course evaluations (overall course value 4.9/5), and students reported increased confidence in connecting foundational knowledge to clinical decision-making. Formal longitudinal evaluation, including analysis of examination performance and other educational outcomes across future cohorts, is underway.
Conclusions:
This framework provides a practical, scalable approach for reinforcing recognition, reasoning, and management throughout the didactic curriculum. Ongoing evaluation will guide iterative refinement of the framework while assessing its impact on learner performance and educational outcomes across successive cohorts. By intentionally structuring active-learning experiences around these domains, educators may better support students’ progression from diagnostic identification to confident clinical decision-making.
Methamphetamine Use Disorder in Rural America: Impact and Potential Solutions
Presented by Alexander Dyar, PA-S, and Christopher Grimm, PA-C, MPAS, Miami University
Abstract:
Methamphetamine use disorder (MUD) is a growing result of the methamphetamine epidemic nationally. MUD disproportionately affects rural areas through increased healthcare utilization, crime, and socioeconomic instability in an area that, by its nature, has limited resources. This research highlights the impact of MUD in rural populations, as well as individual and community-based strategies to reduce its burden in rural areas. A narrative review of current literature and national surveillance data was performed using the Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and published literature. By analyzing the 2024 National Survey on Drug Use and Health and the data changes from the previous year, focusing on how poverty status, education level, and geographic isolation further contribute to the methamphetamine epidemic. Further evidence of medical complications, healthcare resource utilization, and methamphetamine–opioid co-use was synthesized to identify challenges to rural communities and inform intervention strategies. Results from nationwide data shows that approximately 2.3 million Americans reported methamphetamine use in the past year, with 1.4 million meeting the criteria for MUD. Rural populations have more than twice the prevalence of methamphetamine use compared to urban populations. Further, the largest annual increase in methamphetamine use was a 55% increase from 2023 to 2024 in rural populations. Individuals with MUD were disproportionately less educated, reported lower income, and reported psychiatric complications. Methamphetamine use was also associated with increased criminal activity and healthcare resource utilization. These findings demonstrate the burden that MUD places on rural communities and on their healthcare systems. The effects of MUD go beyond the individual and represent a concerning social and public health challenge, especially in rural America. Mitigating this epidemic requires a holistic implementation of strategies for prevention, expansion of addiction and mental health services, research for optimized treatment methods, community engagement, and support to MUD patients and their families throughout treatment. Addressing each of these areas has the potential to improve patient outcomes, reduce costs and the burden on already overwhelmed rural healthcare systems, and strengthen rural communities as well as their long-term outlook.
Pathologic Fracture in an Adolescent Female
Presented by Ellie Absten, PA-S, and Jeffrey Vasiloff, M.D., Ohio University
Purpose:
Pathologic fractures are not uncommon in adults with bone metastases. Yet these fractures, which are due to non-traumatic forces, are less common children. We report a case of a pathologic fracture in an adolescent girl.
Methodology:
A 15-year-old girl was in her usual state of health at tumbling practice at which time she simply touched the mat with both hands in the beginning of a slow, gentle cartwheel, when she felt a sudden snap. The patient did not fall. When she returned to standing, she noticed that she could not abduct her right arm above her waist. Her pain with no motion, however, was minimal-to-mild. She was taken to a local emergency department for suspected shoulder dislocation. The patient was the normal product of a full-term pregnancy. No history of surgery, previous trauma or medical illnesses. No family history of osseous disorders.
Results:
On exam the patient was in mild distress due to pain. Her right arm was held in adduction against her thorax. It was not possible to test strength, ROM, or reflexes in her right arm, but the remainder of the exam yielded normal results. Initial radiographs revealed a multilocular, lucent, expansile lesion within the proximal and mid humeral diaphysis that measured approximately 14.9 cm in length. There was significant thinning of the cortex as well as a superimposed transverse fracture of the proximal humeral diaphysis with approximately 11 degrees of posteromedial apex angulation. There was no extension of lesion to the proximal physis and no evidence of periosteal new bone formation. Radiology provided an interpretation of a right humeral diaphyseal expansile, multilocular lucent lesion with superimposed pathologic transverse fracture of the proximal humeral diaphysis. Due to the possibility of malignancy in this presentation, the patient was seen by orthopedic oncology. However, further evaluation failed to reveal malignancy and the final diagnosis was unicameral bone cyst.
Conclusions:
A pathologic fracture is not a fracture due to significant trauma. Rather, it is caused by an underlying bone-weakening disease. Even large, force-resistant long bones like the humerus can fracture with minimal force if the involved bone structure is destroyed by tumor or metabolic bone disease. In adolescents, the most common cause of pathologic fracture of the humerus is unicameral bone cyst (41%). However, osteosarcoma, Ewing sarcoma, and even metastatic disease cause fractures. In adults, pathologic fractures of the humerus are most often caused by metastatic cancer, especially from breast, lung, or myeloma. This case highlights two important clinical points. First, pathologic fractures can occur in pediatric patients and should not be considered exclusive to adults. Second, although malignancy must always be considered and appropriately excluded regardless of age, it should be noted that the majority of pathologic fractures in children are attributable to benign etiologies.
Tick Bite and Jarisch-Herxeimer Reaction: A Case Study
Presented by Mia Pagliarini, PA-S, Hannah Hopple, PA-S, and Jeffrey Vasiloff, M.D., Ohio University
Purpose:
Treatment of syphilis or Lyme disease is essential, but not without risk. We report a case of a Jarisch-Herxeimer reaction in response to treatment of early localized Lyme disease.
Methodology:
An older male diagnosed with early localized Lyme disease was prescribed a 10-day course of doxycycline 100 mg PO BID. 90 minutes after taking the initial dose, he reported increasing warmth, malaise, lightheadedness, and excessive sweating. He took 3 200 mg ibuprofen tablets in hopes of breaking the fever. When attempting to stand to leave work immediately after, he reported only making it a short distance before having to stop and sit down on the stairs. It required about 30 mins until he felt comfortable enough in his car to drive home. Later in the evening, he felt back to normal. He finished the 10-day course of antibiotics and reported no further symptoms as he experienced after his initial dose.
Results:
On exam, he was found to have a 3cm x 3cm erythematous, pruritic rash under his watchband after outdoor exposure hiking and running in the woods. The patient noted a 1cm/day expansion of the rash and went to see his provider. Both the man and his internist suspected early localized Lyme disease, and he began a 10-day course of doxycycline. The man had a seemingly overwhelming adverse reaction to the first dose of his 100 mg PO of doxycycline nearly 90 minutes after including fever, malaise, diaphoresis, and fatigue on exertion. After taking antipyretics and allowing the remainder of the day to pass, the patient reported no further adverse effects or side effects to the medication. Additionally, he reported complete resolution of the rash over approximately 24 hours after the initial dose of doxycycline. He was reportedly a healthy, active older male with no other comorbidities or health risks. He did not report having similar adverse effects to medication in the past.
Conclusions:
A Jarisch-Herxeimer reaction is a self-limited, acute, inflammatory response to treatment of spirochete infections including syphilis, leptospirosis, and Lyme disease, as seen in this case. The diagnosis of this reaction is often clinical relying on timeline of symptom onset, symptom characteristics, antibiotic initiation, and underlying infection. In this case, the patient had characteristic Jarisch-Herxeimer symptomatology including fever, weakness, and headache, in addition to the timing of onset, which is most often occurring within 24 hours. In this case, the patient was clinically diagnosed with early Lyme disease supported by the appearance of the expanding, erythematous, pruritic rash with central clearing, the frequent known exposure to tick bites, and the onset of the rash. This diagnosis was made more likely by the apparent Jarisch-Herxeimer reaction nearly 90 minutes after the first dose of appropriate antibiotics. At 5 weeks after the rash onset, the man states he has felt well with no symptoms or rash of any kind.