Medicine and Health Sciences Commons^™

Mmc Simulation Annual Report 2020

Journal of Maine Medical Center

No abstract provided.

Mmc Wellbeing & Peer Support Program, Christine Hein Md

Journal of Maine Medical Center

No abstract provided.

Healthcare Systems Should Be Leaders In Patient-Centered Sustainability, Katherine T. Liu Md, Facp, Lesley B. Gordon Md, Ms

Journal of Maine Medical Center

No abstract provided.

Qualitative Evaluation Of A Certificate In Health Care Improvement For Interprofessional Teams, Hannah R. Martin, Eilish W. Carpenter, Peter W. Bates, Erin M. Graydon-Baker, Mark G. Parker, Jordan S. Peck, Debra Rothenberg Md, Phd, Isaac Z. Stickney, Ghassan A. Saleh, John E. Wennberg, John Tooker, Robert Trowbridge Jr, Kathleen M. Fairfield

Journal of Maine Medical Center

No abstract provided.

Case Report: Pheochromocytoma Presenting With Cushing’S Syndrome And Hyperglycemia, Elizabeth Garbitelli, Halla Bates, Cheryl Liechty, Robert Bing-You

Journal of Maine Medical Center

Introduction: Pheochromocytomas are catecholamine-producing neuroendocrine tumors that arise from the adrenal medulla. Pheochromocytomas typically present with uncontrollable or paroxysmal hypertension that can be accompanied by other common initial symptoms, including headache, diaphoresis, arrhythmia, and pallor. Given the morbidity and mortality associated with undiagnosed pheochromocytomas, and their potential for treatment, primary care physicians should consider this tumor type, and other endocrinological phenomena, when evaluating new onset hyperglycemia.

Clinical Findings: Patient G was a 76-year-old female who presented in her primary care office with newly uncontrollable hyperglycemia. During initial evaluation, her clinical condition deteriorated rapidly. Her laboratory studies revealed markedly elevated cortisol, …

A Rare Entity: Case Report Of Recurrent Hypertrophic Pyloric Stenosis, Astrid A. Gleaton, Kartikey Pandya

Journal of Maine Medical Center

Introduction: Hypertrophic pyloric stenosis (HPS) is well known in pediatric surgery and has good outcomes after pyloromyotomy.1 Emesis in the immediate postoperative period occurs in 40% of patients with HPS and is attributed to gastroparesis from prolonged gastric distention.2 Emesis presenting weeks to months after pyloromyotomy prompts an evaluation that often yields pathology unrelated to HPS. Because recurrent HPS is rare, making this diagnosis highlighted the importance of practicing broad differential diagnoses, ruling out most common causes, and including obscure etiologies.

Clinical Findings: A 3-week-old male born after full-term gestation with a history of HPS underwent an uncomplicated laparoscopic pyloromyotomy. …

Spouses With Pulmonary Mycobacterium Avium Complex Infections: A Case Report, Gregg Raymond Md, Emily Wood Md

Journal of Maine Medical Center

Introduction: Mycobacterium avium complex (MAC) is the most common cause of pulmonary infections due to nontuberculous mycobacterium in the United States. While there have been reports of geographic variations in incidence as well as disease clusters among genetically related individuals, there have been no published reports describing clusters of co-occurring pulmonary MAC disease among genetically unrelated individuals.

Clinical Findings: Patient 1 was a 56-year-old male with worsening asthma exacerbations associated with recurrent bronchitis. Patient 2 was a 55-year-old female with worsening asthma exacerbations, progressive dyspnea, and recurrent bronchitis. The 2 patients lived together, were immunocompetent, and genetically unrelated. They were …

Building Innovation Capacity In A Learning Health System: The Innovation Cohort Experience, Jennifer Monti, Owen Sanderson

Journal of Maine Medical Center

Introduction: People with ideas about how to improve products and services often benefit from a structured process to test their ideas. The Innovation Cohort was developed to empower staff at MaineHealth to create solutions to unmet needs. This article describes the progress and perspectives gained over 3 years of the program.

Methods: The Innovation Cohort was loosely modeled on the National Science Foundation’s iCorp that emphasizes customer discovery and hypothesis testing early during development. Innovation Cohort applicants proposed a specific problem and answered 5 basic questions related to solving that problem. Selected participants shared readings and attended 5 in-person meetings …

Total Body Photography And Sequential Digital Dermoscopy Imaging For Melanoma Surveillance In Patients Starting Natalizumab For Multiple Sclerosis, Tyler Nussinow Ba, Amanda Robinson Np, Biljana Beretich Md, Kathryn Stevens Np, Elizabeth Seiverling Md

Journal of Maine Medical Center

Introduction: Natalizumab is an integrin receptor antagonist that has been approved by the Food and Drug Administration to treat multiple sclerosis and Crohn’s disease. The drug has been linked to an increased risk of melanoma. This brief report highlights an innovative clinical approach for monitoring the skin of patients prescribed natalizumab.

Methods: We include 2 cases from our skin oncology clinic and a literature review on the incidence of melanoma in patients prescribed natalizumab between 2004 and 2019.

Results: In addition to our 2 cases, we found 193 reports of patients with melanoma who were prescribed natalizumab. We propose an …

Inclusive Language Matters: Recommendations For Health Care Providers To Address Implicit Bias And Equitable Health Care, Crystal R. Herron

Journal of Maine Medical Center

Problem Statement: Stigmatizing language—written and verbal—can fuel implicit bias among health care professionals, leading to unintentional negative effects in how they care for patients. To provide equitable care, health care professionals and systems must become aware of the language they use and learn to replace biased language with inclusive language.

Background: The medical field strives to treat all patients equally, yet disparities in health care persist. These disparities are due, in part, to implicit bias that affects how health care professionals and systems care for patients. Although reports recommend developing education programs that address implicit bias, these programs fail to …

Patient Transport In The Time Of Covid-19: Using Health Care Failure Mode And Effect Analysis With Simulation To Test And Modify A Protocol, John Kwock, Jeffrey Holmes, Shelly Chipman, Erin Siebers, Angela Berry, Sonja Orff, Victoria Boutin, Leah Mallory

Journal of Maine Medical Center

Introduction: In March 2020, in response to the COVID-19 pandemic, an interprofessional, interdisciplinary team at Maine Medical Center used Healthcare Failure Mode and Effect Analysis (HFMEA) and in situ simulation to rapidly identify and mitigate latent safety threats (LST) in patient transport protocols.

Methods: Following HFMEA steps, stakeholders representing a variety of disciplines assembled to address transport of patients with COVID-19. A process map was created to describe the process. With hazard analysis using table-top simulation followed by in situ simulation, we identified, categorized, and scored LSTs. Mitigation strategies were identified during structured debriefing.

Results: Fourteen LSTs were identified in …

Implementing A Clinical Practice Guideline For Pediatric Appendicitis Safely Reduced Health Care Use And Improved Antimicrobial Stewardship, Jack Vernamonti, Robin Cotter, Jennifer Jubulis, Kartikey Pandya

Journal of Maine Medical Center

Introduction: Appendicitis is the most common emergency surgical disease in children. Those with perforated appendicitis have a more complicated and varied course. Through a clinical practice guideline (CPG), we sought to reduce computed tomography scans, laboratory draws, and exposure to broad-spectrum antibiotics without adversely affecting length of stay, hospital readmission, or repeat antibiotic administration.

Methods: Electronic records were retrospectively reviewed before and after CPG implementation, and data was collected in REDCap.

Results were reported as mean or percent incidence, and statistical analysis was done using a Student’s t-test, Mann-Whitney U test, or Pearson’s χ2 with P < .05 considered significant. Results: One hundred patients with a perforated appendix (50 before and 50 after CPG implementation) were included in our analysis. Length of stay (4.98 vs 4.46 days; P = .25), hospital readmission rate (10% vs 14%; P = .54), and additional antibiotic administration (2% vs 4%; P = .56) did not change. We observed no difference in the Pediatric Appendicitis Score (9 vs 9; P = .48) and a trending increase in evaluation at an outside hospital (56% vs 74%; P = .06). Rates of computed tomography scans did not differ overall (50% vs 40%; P = .31), but showed a decreasing trend at our institution (30% vs 12%; P = .06). We also found fewer post-operative laboratory studies (90% vs 38%; P < .01) and patients who received broad-spectrum intravenous antibiotics (92% vs 18%; P < .01).

Discussion: Through implementing the …

Genetic Testing Reveals Germline Mutations Among Patients Undergoing Surgery For Colorectal Carcinoma In A Community Hospital Setting, Alex R. Jones, Dana Greer Rn, Bsn, Ocn, Karin L. Cole Md

Journal of Maine Medical Center

Introduction: Defined germline mutations contribute to 5% to 10% of cases of colorectal carcinoma (CRC). While protocols for universal tumor screening have been adopted to detect mismatch repair (MMR) protein deficiency, widespread multigene panel testing has not been achieved. Barriers to implementing testing protocols may occur in community settings.

Methods: A total of 160 patients presenting for surgical management of CRC between 2011 and 2020 were considered for retrospective analysis in a single-surgeon, single-institution, community-based cohort. The rate of multigene panel testing and prevalence of germline mutations were calculated, and patient characteristics were assessed.

Results: A total of 32/160 (20%) …

Factors That Influence Perception Of Hiv Risk And Willingness To Use Pre-Exposure Prophylaxis In People Who Inject Drugs, Daria Egorova, Anny Fenton, Kinna Thakarar

Journal of Maine Medical Center

Introduction: Sexual and injection behaviors increase the risk of HIV transmission in people who inject drugs (PWID). We aimed to determine the prevalence of sexual and drug behaviors that increase HIV risk in PWID hospitalized for infections related to injection drug use in Maine. We also examined factors that influenced their perception of HIV risk and willingness to take pre-exposure prophylaxis (PrEP).

Methods: We surveyed 101 PWID with infections related to injection drug use who were hospitalized at 4 hospitals in Maine. T-tests assessed differences in means of bacterial infection risk scores and willingness to take PrEP based on different …

Missed Opportunities: Documentation And Referral Rates Among Children And Adults With Obesity, Heidi Walls, Christina Holt, Amy Haskins Phd, Williams Dexter

Journal of Maine Medical Center

Introduction: Our study reports rates of obesity documentation on the problem list (PL) and numbers of referrals to obesity medicine specialists and dietitians among pediatric and adult patients with obesity.

Methods: All pediatric and adult patients with obesity seen at 14 primary care clinics between 7/1/2017 and 6/30/2019 were evaluated for inclusion of obesity on the PL and referrals to obesity medicine specialists or dietitians.

Results: For children with BMI >95% for age, obesity was documented in 31.2%, and 12.5% received a referral. For adults with BMI >30, obesity was documented in 54.2%, and 8.4% received a referral. Significantly more …

Perceptions Of Maine Health Care Providers On Youth Tobacco Use And Prevention Efforts, Titilola Balogun, Toho Soma, Liam O'Brien

Journal of Maine Medical Center

Introduction: Tobacco use causes preventable morbidity and mortality, and leads to high medical costs annually. In Maine, both cigarette and electronic cigarette (e-cigarette) use among high school students are higher than the national average. To what extent Maine health care providers are familiar with tobacco use prevention is unknown. We aimed to describe the knowledge, attitudes, and practices of Maine health care providers regarding youth tobacco use. We also determined what preventive services they provide, and measured their self-efficacy regarding screening and counseling for tobacco use.

Methods: In this cross-sectional study, health care providers were surveyed about their knowledge, attitudes, …

County And Demographic Differences In Drug Arrests And Controlled Substance Use In Maine, Trajan F. Hyde, Amadea D. Bekoe-Tabiri, Amalie K. Kropp Lopez, Luis G. Devia, Belsy D. Gutierrez, Matthew C. Lara, Anthony R. Soto, Daniel E. Kaufman, Matthew T. Moran, Kevin J. Simpson, Dipam T. Shah, Michelle Foster, Clare E. Desrosiers, John Hebert, Stephanie D. Nichols, Kenneth Lee Mccall, Brian J. Piper

Journal of Maine Medical Center

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Introduction: The Diversion Alert Program (DAP) was established to curb misuse of drugs and help identify people who may need treatment for substance use disorder (SUD). Law enforcement compiled arrest data into a database accessible by health care providers. Our objectives were to identify regional and demographic differences in drug use and misuse in Maine.

Methods: All arrests (N = 11 234) reported to the DAP from 2013 to 2018 were examined by county and arrestee demographics, and classified into families (opioids, stimulants, sedatives). The Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) tracks the distribution …

Adopting Inclusive Language As Part Of Patient Centered Care, Ryan Polly

Journal of Maine Medical Center

No abstract provided.

American College Of Physicians Posters, Maine Chapter - 2020

Journal of Maine Medical Center

No abstract provided.

More Than A Prescription, Katherine Rizzolo, John E. Erickson, Sean Lena

Journal of Maine Medical Center

No abstract provided.

Clinical Utility Of Molecular Profiling In Recurrent Glioblastoma Multiforme, Rebecca P. Bystrom, Pavalan Selvam, Jens Rueter, Honey Reddi, Christine Lu-Emerson

Journal of Maine Medical Center

Introduction: Glioblastoma multiforme (GBM) is the most common and aggressive primary malignant brain tumor found in adults. GBM has limited therapeutic options. Initial tumor sampling establishes the histopathologic diagnosis, identifies prognostic and therapeutic biomarkers, and provides an opportunity for molecular profiling. By contrast, the utility of repeat tumor sampling and molecular profiling in recurrent GBM is not well established.

Clinical Findings: We present a 69-year-old woman with GBM whose tumor recurred after standard treatment with temozolomide (TMZ) and concurrent radiation, followed by adjuvant TMZ. This patient had a methylated O6-methylguanine-DNA methyltransferase (MGMT) promoter, which ordinarily predicts a favorable response to …

Focused Hospital Medicine Cme On Pulmonary Point-Of-Care Ultrasound Through Just-In-Time Training During The Covid-19 Pandemic, Matthew Buttarazzi, Kristen Bartlett, Katherine Stebbins, Monica Thim

Journal of Maine Medical Center

Introduction: We describe the use of focused CME with just-in-time training in pulmonary point-of-care ultrasound (POCUS) for hospitalists as part of our response to coronavirus disease 2019 (COVID-19). This training served as a pilot for developing a longitudinal training program for our inpatient adult medicine providers.

Methods: In mid-March 2020, ultrasound education and image review were deployed within hospital medicine at a large academic medical center. Faculty were provided (1) a small-group lecture focused on ultrasound findings in pneumonia, (2) weekly review of imaging, and (3) a monthly review conference of ultrasound imaging.

Results: Use of POCUS for pulmonary pathology …

Community As Medicine: A Trauma-Informed Yoga Program For Multi-Cultural Female Immigrants Identified In The Primary Care Setting, Katherine Rizzolo, Sean Lena, Maha Jaber, Jessica Schaumburg, Kiana Vakil-Gilani, Nicole Rebusi, Dianna Stade, Adriana Nadeau, Nicoleta Toma, Brian King, Lesley Gordon

Journal of Maine Medical Center

Introduction: The immigrant population in Maine represents a unique group of patients with complicated health care needs due to cultural, linguistic, and systemic barriers. We sought to bridge gaps in health access for immigrant women by expanding and integrating community resources through the development and evaluation of a trauma-informed yoga class.

Methods: A needs assessment via a focus group with immigrant women revealed barriers to care and community health needs. Health partners of the immigrant community were identified via word of mouth and a Google search. Yoga participants were recruited in the primary care clinic and by community outreach. Participants …

Physician Shadowing: An Essential Practice In Fostering The Doctors Of Tomorrow, Anna M. Martens, Jo Linder, Janell Lewis

Journal of Maine Medical Center

Problem Statement: Maine Medical Center (MMC) lacks a robust shadowing program, and there is inequity in shadowing opportunities for students from underrepresented minorities and economically disadvantaged backgrounds. Physician shadowing is essential for college students interested in going to medical school as it helps students make career decisions and strengthens their medical school applications. As we continue to expand our undergraduate programs in medical education and seek to grow our physician workforce, we need to provide students with equal opportunities to observe careers in medicine in order to foster interest and passion for the health field.

Background: A robust body of …

The Implementation Of Telemedicine In The Covid-19 Era, Rebecca K. Bell, Katherine Badger, Kerri L. Barton Mph, Michael Kohut Phd, Michael Clark Md

Journal of Maine Medical Center

Introduction: During the COVID-19 global pandemic in 2020, social distancing policies called for health care providers to turn to telemedicine platforms for most of their patient encounters. We aimed to better understand the experiences and perspectives of patients and providers who used telemedicine in the primary care setting.

Methods: This study included semi-structured interviews with patients and providers who participated in telemedicine visits during the beginning of the COVID-19 pandemic. Patients (n = 14) were from a rural Maine practice and providers (n = 10) were from practices within 100 miles of a tertiary care center. The interviews were analyzed …

Access To Point-Of-Care Ultrasound In Maine Emergency Departments, Christina N. Wilson, Campbell Belisle Haley

Journal of Maine Medical Center

Introduction: Point-of-care ultrasound (POCUS) is an essential tool in emergency medicine. We evaluated access to bedside ultrasound machines and characterized POCUS use in Maine emergency departments (EDs).

Methods: We conducted a cross-sectional electronic survey of all ED medical directors in Maine. The survey included questions on ED characteristics, access to ultrasound machines, POCUS use patterns, POCUS administration, and barriers to use.

Results: Thirty-four EDs were identified, and 24 medical directors completed the survey, yielding a response rate of 71%. EDs were predominantly small and rural. Only 21% identified as urban, and 54% reported less than 20 000 annual visits. Surveys …

Trends In Diagnoses Of Neonatal Abstinence Syndrome At Newborn Hospitalization In Maine, 2009-2018, Emily C. Bauer Mph, Katherine Ahrens Phd, Jenny L. Carwile Mph, Scd

Journal of Maine Medical Center

Introduction: Incidence rates of neonatal abstinence syndrome (NAS) have increased in Maine, but whether this increase can be explained by use of different diagnosis codes over time is unknown. Our objective was to estimate trends in diagnoses of NAS at newborn hospitalization in Maine using different NAS case definitions.

Methods: We used International Classification of Diseases (ICD) diagnosis codes to identify newborns diagnosed with NAS in Maine between 2009 and 2018 using state-level hospital discharge data (n = 123 519). First, we considered only ICD-9 and ICD-10 codes used for confirmed NAS. Then we used an expanded ICD-10 NAS case …

Effectiveness Of Two Frequently Used Screening Tools In Identifying Depression And Anxiety In Collegiate Athletes, Adriana C. Isacke Do, Amy Haskins Phd, Christina Holt Md, Msc, Williams Dexter Md, Facsm

Journal of Maine Medical Center

Introduction: To determine whether the Electronic Pre-participation Physical Examination (EPPE), a proprietary and frequently used tool, is an effective method for depression and anxiety screening in the collegiate athlete population as compared to the Patient Health Questionnaire-4 (PHQ-4).

Methods: College athletes at a Division III university completed PHQ-4 questionnaires and a proprietary EPPE. Positive reponse rates to depression and/or anxiety for both questionnaires were collected and analyzed with a kappa (κ) statistic.

Results: Among 420 students, we found that 9 (2%) reported depression and/or anxiety via the EPPE. Of the 26 students (6%) who answered positively on the PHQ-4, we …

Connected: Using A Novel In-House Communication System To Efficiently Deliver Imaging Results, Daniel Greentree, Brendan R. Calhoun, Steven Farraher

Journal of Maine Medical Center

Introduction: The primary objective was to investigate the effectiveness of a fully staffed electronic communication system (1Connect) in delivering timely critical imaging results and incidental findings. The secondary objective was to evaluate the financial impact of this system on a radiology practice.

Methods: From January 2014 through June 2016, the 1Connect database was retrospectively reviewed and sorted by category of submission type: Critical (1-hour communication time), STAT (2 hours), or Unexpected finding (3 business days). The percent of successful communications completed within the appropriate time frame was calculated for each priority category and used as a measure of the system’s …

Restoring Faith In Science, Elizabeth Jacobs, Md Mpp

Journal of Maine Medical Center

No abstract provided.