Medicine and Health Sciences Commons^™

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 …

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 …

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%) …

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 …

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 …

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 …

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 …