Medicine and Health Sciences Commons^™

Machine Learning Approaches For Neurological Risk Stratification Within 6 Hours Of Cardiac Arrest, Richard R. Riker, Qingchu Jin, Hunter Williams, Teresa May, David Seder, Raimond L. Winslow

Costas T. Lambrew Research Retreat 2024

Background:

• Prognostication of neurological outcome should be delayed at least 72 hours after cardiac arrest. Early stratification of risk severity provides important information enabling improved medical decision making, research enrollment, and precision medicine approaches.

• We propose that electroencephalography (EEG)-derived indices are valid biomarkers of severity of neurological injury very early after cardiac arrest.

• This study was designed to assess the relative impact of early clinical data and processed EEG indices in the first 6 hours after recovery of spontaneous circulation (ROSC) after cardiac arrest.

A Continuous Objective Shivering Monitor During Targeted Temperature Management After Cardiac Arrest, Richard R. Riker, Erica Schlichting, David Seder, Mary Weatherbee, David J Gagnon, Teresa May

Costas T. Lambrew Research Retreat 2024

Background:

• Shivering during targeted temperature management (TTM) after cardiac arrest is stressful and linked to cerebral metabolic crisis.

• Few publications report shivering incidence, timing, or severity during TTM, and shivering treatment recommendations conflict.

• To evaluate multimodal shivering assessments, we studied patients during TTM managed with surface cooling, moderate analgosedation, surface counterwarming, and intermittent neuromuscular blockade (NMB) and evaluated surface electromyographic (EMG) power in decibels using the Medtronic bispectral index (BIS) monitor.

Risky Business: Creating A Process To Review Accuracy Of American Society Of Anesthesia (Asa) Classification And To Improve Overall Quality Risk Adjustment Of Surgical Patients, Jane Kinney, Sonja Orff, Robyn Begin, Nicholas Flavin, Eira Hyrkas, Christopher Adams, Ian Neilson

Costas T. Lambrew Research Retreat 2024

Through interdisciplinary education and the creation of an audit process, we have observed a 30.6% reduction in the number of ASA assignment misclassifications.

The Association Of Season Of Surgery And Patient Reported Outcomes Following Total Hip Arthroplasty, Catherine M. Call, Andrew Lachance, Zachary Radford, Henry Stoddard, Callahan Sturgeon, George Babikian, Adam Rana, Brian J. Mcgrory

Costas T. Lambrew Research Retreat 2024

Introduction

• Understanding the impact of situational variables on surgical recovery can improve outcomes in total hip arthroplasty (THA).

• Literature examining hospital outcomes by season remains inconclusive, with limited focus on patient experience.

• The aim of this study was to investigate if there were differences in hospital and patient-reported outcomes measures (PROMS) after THA depending on the season in an area with 4 distinct seasons.

Healthcare Enabled By Artificial Intelligence In Real-Time, Felistas Mazhude, Robert S. Kramer, Qingchu Jin, Paul Terwilliger, Alan Hicks, Tyler Kelting, Douglas Sawyer, Jaime Rabb

Costas T. Lambrew Research Retreat 2024

INTRODUCTION: The HEART (Healthcare Enabled by Artificial Intelligence in Real-Time) Project pioneers developing real-time machine learning (ML) predictive analytics to address the need to improve outcomes during recovery from open heart surgery. Our broad objective is to enhance patient outcomes by developing, validating and deploying predictive algorithms into the hands of clinical teams as an early warning and guidance system, allowing care teams an opportunity to be proactive.

Increasing Equitable Access To Pediatric Specialty Care In Maine Through Implementation Of Econsults, David Ireland, Rachel Rockers, Sarah M. Gabrielson, Anya K. Cutler, Laura J. Faherty, Genevieve Whiting

Costas T. Lambrew Research Retreat 2024

Introduction

•Barriers to accessing pediatric specialty care exist for many and are not experienced equally by all.

•eConsults are an asynchronous provider-provider referral modality to obtain low-barrier specialist input in place of some face-to-face (F2F) visits.

•We evaluated sociodemographic factors associated with referral to and receipt of specialist input before and after eConsult implementation at MaineHealth to examine equity implications.

Variations Exist In Hospital And Patient-Reported Outcomes Following Total Hip Arthroplasty According To Biological Sex, Catherine Call, Andrew Lachance, Thomas Zink, Henry Stoddard, Callahan Sturgeon, George Babikian, Adam Rana, Brian J. Mcgrory

Costas T. Lambrew Research Retreat 2024

Introduction

• The effect of biological sex on the outcomes of THA remains unclear.

• Average combined data may mask sex-related variation and obscure clinically relevant differences in outcomes.

Comparing Universal Versus Targeted School Screenings For Depression Among Teens, Research Research Dissemination Committee, Maine, Usa

REACH: Research Evidence-to-Action for Community Health

The US Preventive Services Task Force endorses universal adolescent major depressive disorder (MDD) screening in primary care; however, most adolescents lack preventive health care, resulting in worsening disparities in MDD screening and treatment.

Behavioral Health Integration And Outcomes That Matter To Patients: A Longitudinal Mixed-Methods Observational Study, Research Dissemination Committee, Maine, Usa

REACH: Research Evidence-to-Action for Community Health

The study team hypothesized that patients would have a better experience over time in clinics that had greater degrees of behavioral health integration.

Comparing Two Telehealth Approaches For Treating Psychiatric Disorders In Primary Care, Research Dissemination Committee, Maine, Usa

REACH: Research Evidence-to-Action for Community Health

Federally Qualified Health Centers (FQHCs) are community clinics that provide primary care in rural and other underserved areas. FQHCs often don’t have enough mental health specialists to treat patients with complex mental health conditions.

Comparing Ways To Ask Patients About Sexual Orientation And Gender Identity In The Emergency Department (Ed), Research Dissemination Committee, Maine, Usa

REACH: Research Evidence-to-Action for Community Health

Sexual and gender minority patients report higher satisfaction and comfort with ED encounters when SO/GI is collected along with other demographic information via a nonverbal, written method during patient registration.

Robotic Vs. Laparoscopic Bariatric Surgery, Chloe Aiken, Abigail Reera

Nurse Residency

Background: As OR nurses, we have seen an increase in the number of robot-assisted bariatric surgeries instead of being performed laparoscopically. In the United States, the first surgical robotic telepresence system became available in 1987. From there, IntuitiveSurgical, Inc. reworked that system to create numerous prototypes leading to the DaVinci series that we utilize at SMHC.

Pathways To Care Of Maine Youth With Psychosis, Elizabeth M. Mutina, Rebecca Jaynes, Dave Weiss, Elizabeth Bernier, Kristen A. Woodberry

Costas T. Lambrew Research Retreat 2023

Study clinicians conducted semi-structured interviews to identify the timing and steps of each person’s Pathway to Care (PtC).

Conversion Total Hip Arthroplasty: Perioperative And Postoperative Outcomes With The Able Approach, Bailey Shevenell, Johanna Mackenzie, Sarah Hearns, George Babikian, Brian J. Mcgrory, Adam Rana

Costas T. Lambrew Research Retreat 2023

The ABLE™ Approach for Conversion Total Hip Arthroplasty decreases surgical duration and length of stay

Befast Assessment In A Rural Community Hospital – The Birch Study, Caroline Knight, Eileen Hawkins, Hilary Merrifield, Laura Stein, Robert Stein

Costas T. Lambrew Research Retreat 2023

Background: There are known regional disparities in treatment rates with thrombolysis and thrombectomy for acute ischemic stroke. BEFAST has been implemented in acute stroke protocols to aid in recognition of signs of stroke, but its utility in a rural ED is not well known.

The Past, Present, And Future Of Distress Screening: Launching A Robust Distress Screening Program At A Large Outpatient Medical Oncology Practice Serving Rural/Underserved Communities, Kevin Stein, Trisha Warren-Vanhorn, Meredith Curtis, Amy Litterini, Amit Sanyal

Costas T. Lambrew Research Retreat 2023

After redesign, administration of the DT at initial chemotherapy teaching sessions and robust searchable databases integrated with EHR systems, allowing providers/researchers to create reports filtered by date ranges, encounter type, clinical site/facility, scores of ≥4, domain (physical, emotional, practical), and outcome (referral to specialist)

Neurocope: A Novel Intervention To Increase Professional Fulfillment And Reduce Burnout By Connecting Neuro-Icu Healthcare Workers To Their Post-Recovery Patients, Angela Leclerc, Mary Sorcher, David Seder, Sara Penrod, Meghan Searight, Alison Daley, Sarah Hanken, Christine Lord, Whitney Trosper, Stephanie Chan, Jennifer Cote

Costas T. Lambrew Research Retreat 2023

Background:

Healthcare workers (HCWs) caring for patients with acute neurologic injury in the ICU rarely receive detailed information on the recovery of their patients. The missing connection between the period of acute neurologic injury and long-term outcomes is a psychological burden that contributes to moral fatigue and burnout.

We hypothesize that attending an Interprofessional conference series through which patients describe their acute brain injury and recovery to Neuro-ICU HCWs may ease moral fatigue, increasing professional fulfillment and reducing burnout.

An Educational Intervention To Improve Pediatric Inter-Rater Reliability Of The Hospital Asthma Severity Score (Hass), Anne Coates, Amanda Gagnon, Noah Diminick

Costas T. Lambrew Research Retreat 2023

Objective: To assess if an inter-professional educational intervention can improve the accuracy and inter-rater reliability of the HASS

Healthy Links – Addressing Social Determinants Of Health And Improving Cardiac Health With Medically Tailored Meals, Emily Follo, Katherine Sharp, Mylan Cohen

Costas T. Lambrew Research Retreat 2023

Introduction:

• Social determinants of health (SDOH) strongly influence risk factors for cardiac disease, especially in rural areas

• Medically-tailored meals have shown promising results for reducing hospitalizations

• Some state insurance programs are covering medically-tailored meals given beneficial outcome studies

• This project builds upon prior Healthy Links programs to expand our reach to rural patients

Shortening The Postoperative Length Of Stay Following Total Knee Arthroplasty Does Not Negatively Impact Short-Term Patient Outcomes; A Retrospective Review Of The Response To The Covid-19 Pandemic, Bailey Shevenell, Johanna Mackenzie, Cassandra Lieblein, Brian J. Mcgrory, Michael Becker, Nicholas Colacchio, Adam Rana

Costas T. Lambrew Research Retreat 2023

Safely Decreasing Postoperative Length of Stay for Total Knee Arthroplasty (TKA) Patients Following the COVID-19 Pandemic

Covid-19 And Depression And Anxiety Screening In Primary Care, Elizabeth Bernier, Abrey Feliccia, Leah Wood, Kate Herlihy, Kristen A. Woodberry

Costas T. Lambrew Research Retreat 2023

Introduction:

• The COVID-19 pandemic had a severe effect on mental health, heightening the prevalence and severity of anxiety and depression amongst the general population in rural and non-rural areas, particularly youth.

• Most reports draw from available data from mental health referrals, hospitalizations, suicides, and other incident data

• There is limited longitudinal information from general population samples using standardized mental health assessments.

An Oncology, Lifestyle Medicine, And Cardiac Rehabilitation Partnership In The Development Of A Group Medical Visit Model For Cancer Survivors, Amy Litterini, Caitlin Coppenrath, Ashley Speckhart, Amy Pearl, Theodore Wissink

Costas T. Lambrew Research Retreat 2023

Methods/Approach: An oncology and cardiology team developed an oncology provider survey in REDCap designed to assess attitudes regarding perspectives on cardio-oncology, rehabilitation, and Lifestyle Medicine. The 27-item multiple choice and Likert-style survey was distributed via email on three separate occasions to MaineHealth Cancer Care Network providers (n=66) in spring, 2022.

The Maine Obstetric Medical Simulation (Momsim) Program Identifies And Categorizes Latent Safety Threats Across Rural Hospitals, Jeffrey Holmes, Leah Mallory, Micheline Chipman, Becky Hunt, Sarah Austin, Tracey E. Mcmillan, Emily Watson, Mainehealth

Costas T. Lambrew Research Retreat 2023

Objective: Combine in-situ simulation with an HFMEA framework to identify and categorize common system wide LST and opportunities to improve patient safety

Food Insecurity Screening In People With Cystic Fibrosis, Rebecca Edwards, Lauren Tate, Ana Cairns, Cheryl Coyne, Kathleen Walker, Kim Violette, Ann Ladner, Jessica D'Amico

Costas T. Lambrew Research Retreat 2023

Background: Adequate nutrition is a cornerstone in the management of cystic fibrosis (CF). Malabsorption secondary to pancreatic insufficiency and increased energy demands related to lung disease can increase energy requirements over twofold for a person with CF. Food insecurity (FI) affects approximately 10% of Mainers (1). Per the Cystic Fibrosis Foundation, there may be up to a threefold increase in the prevalence of FI in the CF population (2). To address this issue, we implemented FI screening in the adult and pediatric CF programs to identify the prevalence of FI within our population and to offer immediate interventions.

Access To Pediatric Type 1 Diabetes Care In Montana, James C. Bohnhoff, Michael Kohut Phd, Chelsea Bodnar, Elizabeth A. Jacobs

Costas T. Lambrew Research Retreat 2023

Introduction: Management of Type 1 Diabetes (T1D) requires significant family effort and specialty support. We aimed to understand how living in a rural state impacts families’ experiences during and after diagnosis.

Simulation-Based Resuscitative Transesophageal Echocardiography Training For Emergency Medicine Residents, August Felix, Andrew Fried, Jessica Hathaway, Tania D. Strout

Costas T. Lambrew Research Retreat 2023

Introduction: Resuscitative TEE is an emerging tool in the cardiac arrest tool-box, and can improve outcomes in OHCA.

• Identifies reversible causes

• Decreases time off chest

• Evaluates compression efficacy

• Improves assessment during pulse-checks

• Simulation training can prepare EM residents to obtain and interpret TEE views on a live patient.

Covid-19 Prevalence And Trends Among Pregnant And Postpartum Individuals In Maine By Rurality And Pregnancy Conditions, Charlie Grantham, Christina Ackerman-Banks, Heather Lipkind, Kristin Palmsten, Katherine Ahrens

Costas T. Lambrew Research Retreat 2023

Our study is the first to estimate prevalence of COVID-19 among pregnant and postpartum individuals for Maine, using data that captures both commercial and public insurance and examines differences by rurality, a known modifier of COVID-19 infections in the U.S. individuals.

The Use Of The Ipack Block With The Adductor Canal Block (Acb) Decreases 48-Hour Narcotic Usage And Postoperative Pain Following Total Knee Arthroplasty, Bailey Shevenell, Johanna Mackenzie, Matthew Hersch, Michael Becker, Brian J. Mcgrory, Nicholas Colacchio, Adam Rana, Ryan Mountjoy, Rob Hubbs

Costas T. Lambrew Research Retreat 2023

Adductor Canal and iPACK Blocks reduce pain levels and narcotic consumption following Total Knee Arthroplasty

Obstetric Outcomes Assessment For New Mainers, Brendan Prast, Christina T. Holt, Amy Haskins, Debra Rothenberg

Costas T. Lambrew Research Retreat 2023

Introduction

• 13% of Portland’s population in 2019 was recent immigrants

• Numbers have increased, with >350 asylum-seeking families (1500 individuals) in 2022 in Portland alone

• Maine Medical Center (MMC) provides obstetrical care for more newly arrived, non-English speaking patients

• Total deliveries in 2020, 2021 (6192) broke records at MMC

• New Mainers at Increased risk for health disparities due to: language barriers, low socioeconomic status and stressors from a history of trauma

The Gender Clinic At The Barbara Bush Children’S Hospital: Demographics, Diagnoses, And Treatment Goals, Brandy Brown

Costas T. Lambrew Research Retreat 2023

Introduction: Program evaluation to better understand patients referred to The Gender Clinic.