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Dexmedetomidine As An Adjunct To Local Anesthetics In Neuraxial Anesthesia: A Scoping Review, Meaghan Elrod, Jacob Flake, Sarah Eggers, Kieraney Coston, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Neuraxial anesthesia is key for pain management and comfort during surgery. While local anesthetics and opioids have notable side effects, Dexmedetomidine (DEX) offers a promising alternative. Early studies suggest DEX improves pain control, prolongs anesthesia duration, and reduces opioid-related side effects. This review explores the benefits of incorporating DEX into neuraxial anesthesia for better patient safety and comfort

Methods

This scoping literature review took place from August 2023 to April 2024, utilizing PubMed, CINAHL, Cochrane Library, and Google Scholar for sources. After reviewing over 2,000 abstracts, 25 articles met the inclusion criteria, with nine selected as most relevant. Four …

Acne On The Valve: A Case Of Cutibacterium Acnes Prosthetic Valve Endocarditis And Aortic Root Abscess, Aiden Van Loo, Mitchell Schwocho, Francisco Davila

Conference Presentation Abstracts

Introduction Infective endocarditis (IE) is a serious infection of the endocardium and the cardiac valves. Its incidence is on the rise, and this has been attributed to the aging population, healthcare-associated infections, and the growing use of intracardiac devices and prosthetic valves. IE is typically caused by gram positive cocci; although other more fastidious organisms can present in a subacute fashion. One such organism that is now becoming identified is Cutibacterium Acnes. It is a gram-positive anaerobe, most commonly known for causing acne. Given its ubiquity as skin flora, it can enter the blood stream and cause systemic infections. Here …

A Case Of Futile Mechanical Thrombectomy In Chronic Thromboembolic Pulmonary Hypertension, Daivd Connolly, Michael Barnes

Conference Presentation Abstracts

Introduction Percutaneous mechanical thrombectomy is a mainstay therapy in the management of high-risk acute pulmonary embolism (PE), as it reduces pulmonary artery pressure and improves right ventricular function. However, the role of percutaneous mechanical thrombectomy in the management of chronic PE or acute on chronic PE is unclear. Case Description We present the case of a 46-year-old male who presented to the emergency department with 4 days of worsening dyspnea and pleuritic chest pain. Past medical history is significant for class II obesity, prior transient ischemic attack, pulmonary hypertension with right-sided heart failure, and four admissions over the previous 10 …

Unmasking Lupus Through Myopericarditis, Athanasios Rempakos, Lark Steafo, Tawhida Khatoon

Conference Presentation Abstracts

Systemic lupus erythematosus (SLE) is a complex, multisystem autoimmune that often presents with nonspecific symptoms, complicating diagnosis. Myopericarditis is a rare initial manifestation, mimicking infections or malignancies. We present a case underscoring the importance of considering SLE in refractory multisystem illness. A 26-year-old previously healthy male presented to an outside hospital with a one-week history of left-sided pleuritic chest pain, fever, chills, palpitations, fatigue, cough, sinus congestion, and headache. Initial evaluation revealed marked tachycardia (heart rate 180s/min on exertion). CT pulmonary angiography excluded pulmonary embolism but identified a large right-sided consolidation consistent with pneumonia. His initial troponin was 223 with …

Stroke With Pfo, Uncovering Underlying Mutations And Malignancy: A Case Report, Haiqi Guo, Karan Chhabra, Atulya Khosla, Florian Bukovec, Dilip Khanal

Conference Presentation Abstracts

Introduction: Stroke is the leading cause of long-term disability, with most cases being ischemic. In patients aged 18–60 years, patent foramen ovale (PFO) is implicated in 10% of strokes. Pathophysiologies include paradoxical thromboembolism and thrombus formation in the PFO, leading to cerebral or systemic embolism. Cancer is a comorbidity in 5–10% of patients with acute stroke, with mechanisms such as direct tumor effects, coagulopathy, and cancer therapy. Two common inherited thrombophilia predisposing to deep vein thrombosis (DVT) are Factor V Leiden (FVL) and G20210A Prothrombin gene mutation (PTM). FVL results in poor anticoagulant response to activated Protein C, while PTM …

Not A Cyst, But Gist: A Case Report, Jessica Kopchia, Amira Al-Nabolsi, Barbara Senger, Gurveer Gill, Yevhen Drobot

Conference Presentation Abstracts

Gastrointestinal Stromal Tumors (GISTs) are the most common mesenchymal neoplasms found in the gastrointestinal (GI) tract, although they only account for 1-2% of gastrointestinal tumors. It is suspected that GISTs originate from the Cajal cells, necessary for regulating peristalsis. Diagnosis relies heavily on histopathologic examination, majority of GISTs being caused by an oncogenic mutation in the KIT gene, responsible for the regulation of tyrosine kinase. KIT upregulates the interstitial cells of Cajal, resulting in tumor formation. Therefore, these tumors are predominantly found in the stomach and small intestine, less frequently in colon, esophagus, and rectum. Often these neoplasms are benign, …

An Incidental Finding Of Inferior Vena Cava Thrombosis In A Patient Presenting With Gastroenteritis, Berk Celik, Ovidiu Niculescu

Conference Presentation Abstracts

Introduction Inferior vena cava (IVC) thrombosis is an under-recognized entity that is associated with significant morbidity and mortality. IVC thrombosis is prevalent (60% to 80%) among patients with congenital IVC anomalies. These anomalies occur in 0.5%–1% of the general population. Thrombosis of the IVC in the absence of congenital abnormalities is rare and is usually a result of a predisposing hypercoagulable state or IVC filter. Here, we present a case of an incidental finding of IVC thrombosis in a patient presenting with gastroenteritis. Case description A 57-year-old female with a past medical history of obstructive sleep apnea, and non-alcoholic steatohepatitis …

Recurrent Malignant Retroperitoneal Solitary Fibrous Tumour Leading To Obstructive Uropathy And Sepsis, A Case Report, Wesam Almasri, Imran Bitar, Aagamjit Singh, Yusra Zakria, Dilip Khanal

Conference Presentation Abstracts

Introduction Solitary Fibrous Tumours (SFT) are rare mesenchymal tumours. Although initially described pleural in origin, they can arise from virtually any site. SFTs of retroperitoneal origin are especially rare, with limited literature on their management. Here we present a unique case of an aggressive recurrent retroperitoneal SFT causing mass effect leading to obstructive uropathy. Brief case description A 47-year-old Hispanic man without past medical history presented to a neighboring hospital with months-long abdominal pain and urinary retention. CT showed a 14x12x12 cm pelvic mass that could not be separated from the prostate, together with right hydroureteronephrosis. He was discharged with …

Severe Digital Necrosis In The Context Of Raynaud's Phenomenon, Antiphospholipid Antibody Syndrome, And Vasculitis: A Diagnostic Dilemma, Silvana Iskandar, Karan Chhabra, Omar Jameel, Tucker Billups

Conference Presentation Abstracts

Abstract: A 73-year-old male with polyarticular gout, hypertension, and rheumatoid arthritis presented with non-healing necrotic wounds on the distal aspect of his upper extremity digits, most severely affecting the left index finger with eschar. His symptoms had been present for the past six weeks. He also had a history of Raynaud’s phenomenon, which preceded these symptoms. Examination revealed necrotic wounds on the nail beds of seven fingers bilaterally, with significant left index finger necrosis. Despite the severity of his condition, he remained hemodynamically stable throughout hospitalization. Laboratory studies showed positive cardiolipin IgM and beta-2 glycoprotein antibodies on two separate occasions, …

Streptococcus Pneumoniae Cervical Abscess In A Pcv-Immunized Female With Waldenstrom's Macroglobulinema: Exploring The Role Of Opsosonization Failure And Functional Hyposplenesim Beyond The Spectrum Of Malignant B-Cell Disorders, Tanya Amal, Paul Johnson, Ayesha Sharif, Usman Bin Hameed

Conference Presentation Abstracts

A 64-year-old female with recently diagnosed Waldenström's macroglobulinemia presented with pain and swelling in the neck. Three weeks prior, she had accidentally punctured her neck with her fingernail, leading to initial swelling. She visited the ER, but workup showed no acute infection. A contrast-enhanced CT scan revealed enlarged bilateral cervical lymph nodes. Over the next two weeks, the swelling became increasingly painful. On presentation, she had sharp, localized pain (10/10 intensity), tachycardia, and a 3x3 cm swelling on the right side of her neck, with redness, warmth, and tenderness. Laboratory results showed lymphocytic leukocytosis (WBC 31.5, lymphocyte 24.8%, neutrophil 6.1%). …

A Rare Case Of Horner Syndrome Secondary To Perineural Catheter Placement After Orif Of The Right Humeral Shaft, Joseph Dakki, Natalie Dakki, Sant Yadav, Justine Nasr

Conference Presentation Abstracts

Introduction: Horner Syndrome (HS) is a clinical syndrome characterized by the triad of unilateral ptosis, miosis, and anhidrosis. HS is caused by an interruption of the oculosympathetic nerve pathway, a three-neuron pathway. Common causes of Horner Syndrome include carotid dissection, stroke, trauma, tumors, cluster headaches, inflammation, and medical and surgical procedures. However, many cases of HS are also idiopathic. The standard workup of Horner Syndrome includes MRI of the brain, cervical spine, and upper thoracic spine and CT angiography of the circle of willis, aortic arch, and intracranial arteries. This case report will analyze an instance of Horner Syndrome that …

The Diagnostic Dilemma Of Multisystemic Vasculitides - A Case Report Of Granulomatosis With Polyangiitis, Muhammed Hussain, Tabssum Chauhan, Hafsa Hassan, Marian Jamil, Cecilia Big, Rajiv John

Conference Presentation Abstracts

Granulomatosis with Polyangiitis (GPA) is a small vessel vasculitis disorder that classically involves the upper and lower respiratory tract as well as the kidneys. However, its presentation is not limited to these organ systems as it can present with ocular, dermatological or cardiac involvement, thus creating a broad differential when evaluating patients. This case illustrates the diagnostic challenges with infectious and inflammatory etiologies in a patient with systemic symptoms, concerning imaging and travel to a TB-endemic region. A 57-year-old female with a pertinent history of recurrent sinusitis, left otitis media, and prior sinus surgeries was evaluated for suspicion of possible …

Septic Arthritis Caused By A Rare Yeast, Lodderomyces Elongisporus, Osman Muslehuddin, Daphne Pete, Husam Muslehuddin, Hafeezuddin Ahmed

Conference Presentation Abstracts

Introduction: We present a rare case of septic arthritis caused by Lodderomyces elongisporus, a yeast rarely implicated in human infections. This case highlights the diagnostic challenges and management strategies for fungal septic arthritis in an immunocompromised patient. Case Presentation: A 63-year-old African American woman with a complex medical history, including chronic heart failure (CHF), hypertension, end-stage renal disease (ESRD) on hemodialysis, severe protein-energy malnutrition on total parenteral nutrition, duodenal switch with malabsorption, deep vein thrombosis (DVT) on warfarin, and previous sepsis episodes, presented with worsening dyspnea. She was admitted in August 2024 for acute-on-chronic CHF exacerbation. During her admission, she …

Characterization Of Contributors To Pleural Fluid Viscosity, Yujai Lin, Megan Rushmeyer, Christopher G. Roy, Shannon Donovan, Rachel Cutting, Matthew Buttarazzi, Charlotte Crist, Ted Sears, J B. Zuckerman

Costas T. Lambrew Research Retreat 2025

Background: Pleural effusion is a common consequence of pulmonary disease and may result from a spectrum of conditions. This pilot study seeks to describe relationships between pleural fluid viscosity and fluid analytes commonly measured in clinical laboratories.

Physical Activity Programming To Improve Qol In Pediatric Ibd Patients, George Russell, Anya K. Cutler, Anna Furr, Julia Fritz, Kevin Sztam, Birgitta Polson, Rebecca Edwards, Noah Hoffman

Costas T. Lambrew Research Retreat 2025

Discussion: This work contributes to limited literature supporting the positive impact of PA in a target population and provides novel guidelines to implement an accessible PA program proven to be effective and well-liked by patients & families. Findings support incorporation of PA into the holistic care of pediatric patients with IBD.

Mental Health Conditions Among Patients With A Disorder Of The Gut-Brain Interaction, Ambia Ahmed, Nicole Smith, Anya Cutler, Mariaelena Terzis, Laura J. Faherty, Julia Fritz

Costas T. Lambrew Research Retreat 2025

Two thirds of pediatric patients with disorders of the gut-brain interaction have mental health comorbidity.

Laying The Groundwork: Implementing The 2021 Aap Well Appearing Febrile Infant Clinical Practice Guideline Across A Rural Health System, E Freeman, L Mallory, Lm Seften, T Palnitkar, A Cutler, J Gregory, M Jackson

Costas T. Lambrew Research Retreat 2025

The American Academy of Pediatrics (AAP) published their first-ever Clinical Practice Guideline (CPG) on the management of well-appearing febrile infants aged 8-60 days in 2021. A system specific CPG and order set for the management of well-appearing febrile infants has been published across MaineHealth (MH) to align with the AAP.

Factors Influencing No Show Rates In Adult Urology Patients, Bruce T. Ndebanje, Ethan Griffin, Evelyn James, Lily C. Wang

Costas T. Lambrew Research Retreat 2025

Our study highlights a strong association between insurance status and no-show rates. Patients with Medicaid or no insurance were significantly more likely to miss appointments (OR 3.25 and 5.99).

Test-Retest Agreement And Reliability Of Psychosis And Mental Health Screens For Maine Adolescents And Young Adults In Primary Care, Erika Mayer, Eb Bernier, Merelise Ametti, Julia Plumb, Adriana Lovric, Yaerin Wallenberger, Kristen Woodberry

Costas T. Lambrew Research Retreat 2025

Psychotic spectrum disorders are among the most severe mental health conditions. Although early intervention can lead to significantly improved outcomes, minimizing delays in the identification of psychotic spectrum symptoms (PSS) remains challenging.

Implementation And Evaluation Of A Resident Pediatric Complex Care Education Series, Calivin Schaffer, Danielle Doctor, Amy Buczkowski, Bonnie Lynne Boomsma, Logan Murray

Costas T. Lambrew Research Retreat 2025

Children with medical complexity have significant chronic health problems that affect multiple organ systems and result in functional limitations, high health care need or utilization, and often dependence on medical technology. Addressing their needs requires optimizing care within the medical home and medical neighborhood.

Evaluation Of Engagement And Collaboration Among Hospitals In The Maine Rural Maternity & Obstetrics Management Strategies (Rmoms) Network, Molly Volt, Lori Travis, Caroline Zimmerman, Erica Swan, Katherine Crothers, Anna Gilbert, Kate Allerding

Costas T. Lambrew Research Retreat 2025

Introduction

• Maine RMOMS Network: Grant awarded to Maine in 2022, 16 rural birthing hospitals & 5 state partners

• Network Goal: Improve access to maternity and obstetrics care for rural communities

• A qualitative Network Health Evaluation was conducted to diagnose strengths and areas of growth regarding engagement and collaboration

Rigid Sternal Fixation Alone Does Not Result In A Reduction In Postoperative Opiod Administration Following Cardiac Surgery, Jane Branch, Chinedu Okoli, Kyla Wigant, Jaime Rabb, Robert S. Kramer, Anne Hicks, Ansar Hassan

Costas T. Lambrew Research Retreat 2025

Background: Persistent postoperative pain, infection, and sternal dehiscence are devastating complications after cardiac surgery that affect patient quality of life and increase healthcare system burden. Chronic sternal pain lasting more than 1 year affects 25 to 33% of cardiac surgery patients, and wound complications such as infection and sternal nonunion represent significant peri-operative risk factors1,2. Wire cerclage (WC) is the most widely accepted sternal closure technique among cardiac surgeons because of its perceived lower rates of sternal dehiscence, wound infection, and cost.

A Quality Improvement Project To Reduce Variation In Pediatric Asthma Care Using The Hospital Asthma Severity Scoring (Hass) Tool, Sean Patterson, Leah-Marie Seften, Rachel Williams, Noah Diminick, Anne Coates, Laura Amar-Dolan

Costas T. Lambrew Research Retreat 2025

The aim of this project was to increase HASS score use to greater than 50%within one year and determine the impact of our interventions on the quality of asthma care and patient outcomes.

An Opt Out Tobacco Cessation Referral Process For A Cancer Care Network, Amy Litterini, David Spaulding, Tia Robbins, Brett Cropp, Lauren Couture

Costas T. Lambrew Research Retreat 2025

Opt out tobacco cessation referrals should be standard of care.

Pediatric Asthma Subspecialty Referral Practices In Rural Maine, Paras Patnaik, John Dipalazzo, James Bohnhoff

Costas T. Lambrew Research Retreat 2025

Over 7.2 million children in the United States have asthma.

• >300,000 asthma-related ED visits & hospitalizations yearly
• Both PCP’s and pediatric asthma subspecialists (allergist/immunologists and pediatric pulmonologists) provide long-term asthma care

Overcoming Specialty Care Connection Barriers: The Econsult Effect, Genevieve Whiting, Noah Hoffman, Anya K. Cutler, Leah M. Seften, Laura J. Faherty

Costas T. Lambrew Research Retreat 2025

Pediatric patients are 2.6x more likely to attend a new specialist visit after Specialist affirms referral need via eConsult.

Pilot Study Of Serial Telemedicine Assessments To Safely Exclude Neonates From Therapeutic Hypothermia Treatment, Alexa Craig, Anya K. Cutler

Costas T. Lambrew Research Retreat 2025

Two neonatal encephalopathy exams performed by telemedicine, with scores of less than 4, correctly excluded neonates from treatment with therapeutic hypothermia.

Physical Activity Programming To Improve Qol In Pediatric Ibd Patients, Anna Briley, George Russell, Anya K. Cutler, Anna Furr, Julia Fritz, Kevin Sztam, Birgitta Polson, Rebecca Edwards, Noah Hoffman

Costas T. Lambrew Research Retreat 2025

Discussion: This work contributes to limited literature supporting the positive impact of PA in a target population and provides novel guidelines to implement an accessible PA program proven to be effective and well-liked by patients & families. Findings support incorporation of PA into the holistic care of pediatric patients with IBD.

A Rare Presentation Of Necrotizing Fasciits: A Diagnostic Challenge Triggered By Isolated Persistent Atrial Fibrillation With Rapid Ventricular Response (Afib With Rvr), Rosalyn Bloch, Amira Al-Nabolsi, Jessica Kopicha, David Lang

Conference Presentation Abstracts

According to the most recent review on necrotizing fasciitis (NF), NF often presents with nonspecific findings such as pain, erythema, and swelling. Clinical features include pain out of proportion to physical examination, failure to respond to broadspectrum antibiotics, and the presence of cutaneous bullae on the skin. We report a rare case in which the diagnosis of NF was unexpected due to its atypical presentation and was ultimately prompted by further underlying exploration in the setting of diabetic ketoacidosis (DKA) and persistent Afib with RVR. Case Summary: A 61-year-old male with a history of type 2 diabetes mellitus presented with …

Lower Extremity Edema In A 27-Year-Old Female With Systemic Lupus Erythematosus Glomerulonephritis: Is It Renal-Related Or Does It Warrant Further Workup?, Christine Buchanan, Rosalyn Bloch

Conference Presentation Abstracts

Lupus myocarditis (LM) is a potentially fatal manifestation of systemic lupus erythematosus (SLE) occurring in 5-10% of SLE patientspatients with SLE (1). Lupus nephritis (LN) is a form of glomerulonephritis that constitutes one of the most severe organ manifestations of SLE (2). We present a unique case of a 27-year-old female with acute lower extremity edema secondary to LM with concomitant LN . This case report highlights LM as a rare manifestation of SLE and the importance of a thorough workup of acute bilateral lower extremity swelling in SLE patientspatients with SLE and glomerulonephritis. A 27-year-old female with a past …