Medicine and Health Sciences Commons^™

Being There: Engaging In Conversations About A Child’S Future When They Are Facing Serious Illness, Christine Bennett Md

Journal of Maine Medical Center

No abstract provided.

Increasing Naloxone Co-Prescribing Among At-Risk Individuals: Evaluation Of A Quality Improvement Project In A Large Health System, Sarah Hemphill Ba, Kristen Silvia Md, Marc D. Kimball Md

Journal of Maine Medical Center

Background: Naloxone availability and early administration is key in preventing death following opioid overdose. The CDC advises that naloxone should be made available to all at-risk individuals. In 2017, providers at Maine Medical Center noted that only 6% of at-risk patients had naloxone prescriptions

Methods: Included in this study were all patients of MaineHealth, a health system comprising 9 hospitals and 30 primary care practices, serving approximately 1.1 million patients. Between 2017 and 2020, we implemented several system-wide quality improvement interventions to increase rates of naloxone co-prescribing among at-risk individuals. Risk factors included prescribed opioids ≥50 morphine milligram equivalents, concurrent …

Urticarial Rash In A Patient With Alpha-Gal Syndrome Caused By Subcutaneous Heparin At Prophylactic Dosing: A Case Report, Russell G. Behmer, Randolph S. Thomas, Hani T. Jarawan

Journal of Maine Medical Center

Introduction: We report a patient with a history of red meat allergy, or alpha-gal syndrome, who had an urticarial rash after exposure to unfractionated heparin at a dose typically used for prophylaxis of deep venous thrombosis. Although anaphylactic reactions have been reported with systemic intravenous heparin, we believe this case is the first report of an immunoglobulin E–mediated reaction to subcutaneous heparin at prophylactic dosing.

Clinical Findings: An 85-year-old male had a 3-year history of red meat allergy and was intolerant of pork and beef. He developed an immunoglobulin E–mediated allergic reaction to subcutaneous heparin at a dose of 5000 …

Projected Utility Of The Ready Set Return Application, Erin Hartigan, Cassidy Sirois, Jonathan Lindau, Taylor Lockwood, Valerie Nesom, Nan M. Solomons

Journal of Maine Medical Center

Introduction: An application (app) that summarizes best practices may promote standardized care among clinicians treating patients during anterior cruciate ligament (ACL) rehabilitation. The purpose of this study was to test the prototype of the Ready Set Return (RSR) app to determine receptiveness for use in clinical practice.

Methods: Two mock patient cases were used to familiarize 19 physical therapists and athletic trainers with the RSR app. Then these participants provided feedback about the user experience, features, and content using Likert ratings and free-text fields through an online survey.

Results: Most participants (89%-95%) would recommend the RSR app to others and …

Who And How: Telemedicine Eligibility And Participant Guidelines In The Ambulatory Setting, Tracy Jalbuena, Rebecca Hemphill, Megan Selvitelli, Jasmine Bishop, Adam Ouellette, Rachel Alfiero

Journal of Maine Medical Center

Introduction: Telehealth use has dramatically increased due to the COVID-19 pandemic. Yet there are significant gaps in evidence regarding the clinical appropriateness of synchronous visits for ambulatory telemedicine that are under the umbrella of telehealth and defined as video appointments between patients and providers. As a result, there are few sensible guidelines for day-to-day practice, resulting in a lack of standardization and risk of suboptimal care.

Methods: We developed patient inclusion/exclusion guidelines for use in ambulatory telemedicine. Complementary tools included guides on patient preparation, telemedicine physical exam, and provider etiquette. We analyzed telemedicine use by practice type and surveyed a …

Association Between Primary Care Provider Status And Preventive Health Care Among People Who Inject Drugs, E Katherine Nenninger, Katherine Sharp, Bianca Bustamente, Kim Murray, Kinna Thakarar

Journal of Maine Medical Center

Introduction: People who inject drugs (PWID) are at increased risk for preventable, communicable infections, such as hepatitis B. Preventive care, such as hepatitis B vaccination, is often delivered through primary care providers (PCPs). However, PWID may not have access to PCPs and, therefore, may receive preventive care through other sites. We aimed to characterize PCP and preventive care use among PWID in Maine.

Methods: This is a cross-sectional study of PWID hospitalized with infections associated with injection drug use in Maine from January 2019 to May 2020. Descriptive analyses were used to identify characteristics of participants, rates of screening, and …

Family  Caregivers  Identify  Their Needs From The Inpatient Team  During A Loved One’S Inpatient Psychiatric Hospitalization, Elizabeth M. Oakleaf, Lillian J. Shields

Journal of Maine Medical Center

Introduction: According to existing literature, family-caregiver needs during a loved one’s inpatient psychiatric hospitalization are not fully understood or addressed in practice. We aimed to identify specific, practical family caregiver needs from the inpatient team during a loved one’s psychiatric hospitalization.

Methods: Semi-structured interviews were designed and tested through a phenomenological analytical approach. Interviews were conducted with family caregivers (n = 16, one caregiver per loved one) who participated in caring for a loved one (age 18-30 years) during an inpatient psychiatric hospitalization.

Results: Four main themes arose: the need to be listened to and collaborated with regarding treatment planning, …

A Qualitative Analysis Of Postgraduate Training Programs For Family Nurse Practitioners, John R. Massey

Journal of Maine Medical Center

Introduction: Family nurse practitioners (FNPs) are registered nurses who are trained at the master’s level and manage the care of patients in the primary care setting. FNP postgraduate training programs further prepare them and ease their transition from education to practice. Although these programs are emerging and relatively new, they are becoming more common as graduates and employers seek further preparation to practice in the primary care setting.

Methods: Interview questions were developed using guidelines from the Consolidated Framework for Implementation Research. Participants were selected using convenience sampling. Fourteen semi-structured interviews with key informants were conducted between July 2021 and …

Trends In Cannabis-Related And Opioid-Related Hospitalization Rates In Maine, 2010-2020, Suzanne Mcmahon, Katherine Ahrens

Journal of Maine Medical Center

Introduction: Medical marijuana use became legal in the state of Maine in 1999, and recreational adult-use marijuana became legal in 2016. However, the rates of hospitalization related to marijuana (also known as cannabis) use have not been studied. We estimated trends in cannabis-related hospitalization rates in Maine based on rurality and descriptively compared these trends to opioid-related hospitalization rates during the past decade.

Methods: We obtained de-identified data of inpatient encounters for Maine residents between 2010 and 2020 from MaineHealth Data Organization. We then calculated age-standardized rates of cannabis-related and opioid-related hospitalizations overall and by rural-urban residence using International Classification …

Thanking Our Reviewers!, Robert Bing-You

Journal of Maine Medical Center

No abstract provided.

Cardiotoxicity From Immune Checkpoint Inhibitors: Myocarditis, Laura Onderko, Elizabeth Bennett, Sanjeev Francis

Journal of Maine Medical Center

Importance: Immune checkpoint inhibitors (ICIs) are a class of immunotherapies that have significant clinical efficacy in treating many cancer types, but they are also associated with systemic effects, including myocarditis.

Objective: This review describes potential mechanisms underlying ICI-associated myocarditis; data on epidemiology, including possible risk factors; diagnostic criteria for ICI-associated myocarditis; and recommendations for managing ICI-associated myocarditis.

Review: This paper is a narrative literature review that summarizes existing literature to increase awareness of ICI-associated cardiotoxicities, including myocarditis.

Findings: Reported cardiovascular adverse events include myocarditis, cardiomyopathy, arrhythmias, pericarditis, vasculitis, atherosclerotic cardiovascular events, Takotsubo syndrome, and venous thromboembolism. Myocarditis is associated with …

A Descriptive Analysis Of Patient Demographics At A Sports Medicine Clinic During The Covid-19 Pandemic, William S. Douglas, Williams Dexter, Amy Haskins Phd, Christina Holt

Journal of Maine Medical Center

No abstract provided.

Geographic Preference In The Residency Match Before And After The Emergence Of The Covid-19 Pandemic, Andrew Beauchesne, Campbell Belisle Haley

Journal of Maine Medical Center

No abstract provided.

Telemedicine Consultation To Assess Neonatal Encephalopathy In Rural Community Hospitals And Tertiary Care Centers, Rachel Coffey, Misty Melendi, Anya K. Cutler, Alexa K. Craig

Journal of Maine Medical Center

Introduction: Teleconsultation is used in tertiary care hospitals to evaluate neonatal encephalopathy. Neonates born in community hospitals, however, often experience delayed evaluation due to transport to the tertiary care center. We studied teleconsultations in community hospitals to decrease this disparity.

Methods: Prospective observational study in 9 community hospitals and 1 neonatal intensive care unit. Inclusion criteria: gestational age greater than or equal to 35 weeks and one of the following: umbilical cord pH less than or equal to 7.2, 5-minute Apgar less than 7, prolonged respiratory support, perinatal event, or abnormal neurological exam. We performed synchronized, unscheduled telemedicine consults with …

A Four-Year Longitudinal Curriculum To Improve Feedback-Seeking Behaviors For Medical Students, Vicki Hayes, Robert Bing-You, Tamara Palka, Marybeth D. Ford, Robert Trowbridge Jr

Journal of Maine Medical Center

Introduction: Feedback is essential for performance improvement and plays a pivotal role in competency-based medical education. Medical learners need training to acquire skills to effectively seek feedback for their unique situations.

Methods: We developed a 4-year longitudinal curriculum designed to encourage feedback-seeking by medical students. The 4.5-hour curriculum consisted of interactive lectures, feedback-seeking surveys, trigger videotapes, and peer-group discussions in small- and large-group formats.  A volunteer study cohort (n = 14/37, 38%) was interviewed in 4 separate waves in individual and focus-group formats to explore perceptions about feedback-seeking and effectiveness of the curriculum.

Results: Themes and student quotes related to …

Senior Academic Ranks In Us Anesthesiology Programs: Differences Between Women And Men And Examination Of Independent Factors For Success, Brenda Lee, Farhad Zahedi, Ina Zaimi, Roman Schumann

Journal of Maine Medical Center

Introduction: Gender equality among faculty is a challenge in academic medicine, including anesthesiology. We investigated the likelihood that several factors were associated with academic success in the United States (US), defined as having achieved a senior academic rank (SAR) in a US anesthesiology training program.

Methods: We collected data available on the Internet on 131 anesthesiology programs, including faculty academic rank, gender, number of faculty, graduate status from an American medical school, fellowship training status, number of residents, number of program fellowships, and geographic location. SAR was defined as either associate professor or professor. Data were analyzed with logistic regression. …

Inpatient Discharge-By-Noon: Are Fewer Better Than All?, Nicholas Ballester, Pratik J. Parikh, Kara Combs, Jordan S. Peck

Journal of Maine Medical Center

Introduction: To address boarding in hospital emergency departments, discharge-by-noon could free up inpatient beds earlier in the day. However, discharging all patients by noon can heavily burden inpatient units and may not be feasible. In this study, we determine the number of discharges after which the benefits of an additional discharge-by-noon diminish.

Methods: We conducted a simulation analysis to quantify how occupancy rate, mean daily number of discharges, and peak discharge time impact upstream boarding time in an inpatient neurology unit at Maine Medical Center. Using a day-of-discharge simulation model with one year of retrospective data, we assessed configurations approximating …

Desperately Seeking Feedback: A Phenomenographic Study Of Medical Students’ Experiences During A 4-Year Longitudinal Feedback Curriculum, Robert Bing-You, Victoria Hayes, Tamara Palka, Marybeth Ford, Robert Trowbridge

Journal of Maine Medical Center

Introduction: The focus of feedback in medical education recently shifted to a dialogic partnership between teachers and learners, co-creating effective feedback exchanges. We previously described a prototype, longitudinal 4-year curriculum for medical students to develop feedback-seeking behaviors. We explored the students’ experiences as participants in this novel program.

Methods: Beginning in academic year 2017-2018, we assessed the 4-year experiences of 14 medical students with a phenomenographic, qualitative approach. Three waves of semi-structured, individual interviews were conducted during the first 3 years. Focus groups were conducted in the final year of the program. Meaning units were identified, and categories were determined …

Monthly Trends Of Substance Use Among Mainers Receiving Buprenorphine Treatment During The Covid-19 Pandemic, Sarosh Khan

Journal of Maine Medical Center

Introduction: Drug-related deaths in Maine increased by 23% in the first quarter of 2020 compared to the last quarter of 2019. Most of these deaths were accidental overdoses involving at least one opioid, and 65% of these deaths were caused by fentanyl, according to the Maine Center for Disease Control and Prevention.

Methods: This research explored substance use in Maine during 2020. Among the sample of individuals, 46% were homeless and receiving recovery services at a buprenorphine-assisted treatment program at a federally qualified health center in Maine. Charts of 35 patients were reviewed for emergency room visits and urine drug …

How Do You Measure The Success Of A New Journal Launch?, Robert Bing-You, Devin Carr, Carolyne Falank, Vicki Hayes, Dina Mckelvy, Charlotte Bailey

Journal of Maine Medical Center

No abstract provided.