Medicine and Health Sciences Commons^™

Analysis Of Anti-Diabetic Exosomes Secreted From Beige Adipocytes, Rachelle Mendola, Chad Doucette, Daniel Nguyen, Su Su, Aaron Brown

Maine Medical Center

Accumulation of excess fat in white adipose tissue is associated with an increase in risk for type 2 diabetes. Within white fat tissue resides a population of “beige” adipocytes that are activated by cold exposure and expend energy contained in fats, which is released as heat. Increasing energy expenditure through beige adipocyte activation has been shown to reduce diabetic symptoms in rodent models of obesity. However, activation of beige adipocytes through exposure of humans to cold temperatures is uncomfortable and likely not a realistic strategy to control body weight. In addition to its fat burning potential, secreted factors derived from …

Per- And Polyfluoroalkyl Substances And Bone Mineral Density In Mid-Childhood, Shravanthi M. Seshasayee, Rachel Cluett, Lisa B. Rokoff, Sheryl L. Rifas-Shiman, Diane R. Gold, Brent Coull, Catherine M. Gordon, Clifford J. Rosen, Emily Oken, Sharon K. Sagiv, Abby F. Fleisch

Maine Medical Center

Background:

• Identifying factors that impair bone accrual during childhood is a critical step toward osteoporosis prevention.

• One potential risk factor not well characterized in childhood is the role of chemicals in the environment.

• Perfluoroalkyl substances (PFASs) are synthetic additives used to make clothing, furniture, and cookware stain repellant and are detectable in almost all US adults.

• PFASs act as PPAR-γ agonists,2 androgen receptor antagonists, and directly intercalate into bone, raising the possibility that they may lead to low bone accrual.

• While two population-based studies in adults have shown associations between PFASs and low areal bone …

Validity Of Neonatal Poc Glucose Testing, Matthew Turnquist, Amy Haskins, Christina Holt

Maine Medical Center

Background:

Glucose monitoring a common invasive intervention in newborn period

•most commonly obtained laboratory value

Appropriate identification of hypoglycemia is critical:

•Severe hypoglycemia can lead to neurologic insult

•Cerebral palsy, developmental delay, seizures, death

Feasibility Of Pre-Operative Mtor Inhibitor Sirolimus In Children And Young Adults With Desmoid Tumor, Stephanie Verwys, Clara Magyar, Kathleen Glick, Douglas Hawkins, Archana Sharma, Brenda Weigel, Katherine Chastain, Joseph Khoury, Michele Manalang, Sarah Dry, Noah Federman, Aaron Weiss

Maine Medical Center

Background:

• Desmoid tumor represents an intermediate grade neoplasm with a striking predilection for locally invasive growth and recurrence following resection

• More effective, well-tolerated non-surgical treatment options are needed

• Current approaches

• If feasible, watchful waiting is the preferred approach

• 20-30% spontaneous regression

• In situations where treatment is indicated, the following approaches are utilized

• Surgery is the primary approach if minimal morbidity is anticipated

• Medical therapies

• Cytotoxic drugs

• Tyrosine kinase inhibitors

• Hydroxyurea

• Gamma secretase inhibitors

• mTOR Inhibitor Rationale

• Desmoid tumor is well-known to be associated with deregulation of …

Identifying Youth At Clinical High Risk: What’S The Emotional Impact?, K A. Woodberry, K S. Powers, C Bryant, D Downing, M Verdi, L Kennedy, D I. Shapiro, R Girgis, G Brucato, D Huang, F M. Crump, C M. Corcoran, L I. Seidman, B Link, W R. Mcfarlane, L Yang

Maine Medical Center

Background:

Early intervention in major mental illness promises to improve the lives of those identified.

• But could identifying youth as at clinical high risk (CHR) for psychosis also do harm given that the majority never develop a psychotic disorder?

• Could telling someone they are at risk for psychosis activate internalized stigma that has been associated with increased emotional distress, social withdrawal, non-engagement in treatment, and suicide risk in CHR youth?

• Within the context of a larger study of stigma in CHR, we compared emotional responses to the CHR concept assessed before and after clinical feedback by study …

Social Influence And Moment-To-Moment Changes In Young Adults’ Mood And Psychotic Symptoms, K Powers, K A. Johnson, M Graham, A Cloutier, K Stewart, S Lynch, D Robbins, R Mesholm-Gately, K A. Woodberry

Maine Medical Center

Background:

• Social situations can have a significant impact on young people’s mood and mental experiences.

• More specifically, we want to know how someone’s perceived social influence in social situations relates to their mood and psychotic symptoms.

• Past studies have found connections between lower perceived social status (rank, comparison, and related concepts) and psychotic symptoms anxiety, depression, and other mood related psychopathology.

• We use experience sampling methods to capture moment-to-moment changes in mood and psychotic symptoms in a variety of social settings.

Effect Of A Robust Electronic Medical Record Order Set On Hepatitis C Screening Rate At A Community Hospital, Hannah Olsen, Caroline Knight, Harold Van Lonkhuyzen

Maine Medical Center

Background:

Hepatitis C Virus (HCV) infection is a liver infection that typically begins as an acute infection and if left untreated, can become a chronic infection. One-time HCV testing is recommended by the CDC and United States Preventive Services Task Force (USPSTF) for asymptomatic individuals based on evaluated exposure or other circumstances that increase HCV exposure (HCV Guidance, 2018); (CDC, 2012). Patients with severe mental disorders, such as schizophrenia and bipolar disorders are particularly at risk for HCV infection with past studies finding approximately 6.2 - 29.8% of patients with severe mental disorders having comorbid HCV (Ayano et al., 2018) …

Characteristics Of Inpatients With Opioid Use Disorder Seen By “Imat” Consult Service From 7/2016 - 6/2017, Katherine Nenninger, Jenny Carwile, Jonathan Fellers, Kinna Thakarar

Maine Medical Center

Introduction:

• For people with opioid use disorder (OUD), admission to the hospital can provide an opportunity to initiate substance use disorder (SUD) treatment and preventive care

• In 2016, a multidisciplinary “IMAT” (integrated medication for addiction treatment) inpatient team was established to help treat patients with SUD

Neurocardiac Risk Stratification 6 Hours After Resuscitation From Cardiac Arrest, A Bilkanovic, Z Haxhija, L Lucas, J Dziodzio, R R. Riker, T May, H Friberg, D B. Seder

Maine Medical Center

Introduction:

• An increasing number of patients are resuscitated from out-ofhospital cardiac arrest. Triage to optimal treatment pathways could improve and increase the efficacy of post-resuscition care.

• Despite great variability in etiology, duration, and patterns of injury from cardiac arrest, post-resuscitation treatment guidelines emphasize standard treatments. We hypothesize that by categorizing competing risks very early after resuscitation, it may be possible to improve the efficacy and efficiency of care.

• When measured very early after resuscitation, suppression ratio (SR, the percentage of suppressed EEG), correlates with severity of brain injury and the likelihood of poor neurological outcome.

• The …

Potential Of Vascular Endothelial Growth Factor As A Biomarker Of Coronary Artery Disease In Subjects Undergoing Cabg Surgery, Teaka Jackson, Sarah Peterson, Amanda Favreau-Lessard, Joanne Burgess, Susan Bosworth-Farrell, Robert S. Kramer, Douglas B. Sawyer, Sergey Ryzhov, Michael P. Robich

Maine Medical Center

Introduction:

• Coronary artery disease (CAD) causes local hypoxia due to reduced blood flow

• Hypoxic conditions are known to induce vascular endothelial growth factor (VEGF) production, a key contributor to angiogenesis

• The purpose of this study was to determine the potential of VEGF as a marker of myocardial stress in subjects with CAD undergoing coronary artery bypass grafting (CABG) surgery

The Relationship Between Uncertainty Tolerance And Oncologists’ Perceptions Of Large-Panel Genomic Tumor Testing, Eric Anderson, Alexandra Hinton, Christine Lary, Kimberly Murray, Leo Waterson, Paul Han, Maine Cancer Genomics Initiative

Maine Medical Center

Introduction:

Large-panel genomic tumor testing (GTT) is a new technology that promises to make cancer treatment more precise, but that currently poses many uncertainties regarding its clinical value and appropriate use. Uncertainty Tolerance (UT), a psychological construct that describes trait-level differences in individuals’ responses to uncertainty, may influence oncologists’ perceptions and attitudes regarding GTT.

The Functional Food Diet: A Pilot Study, Caroline Knight, Ralph Hamill

Maine Medical Center

Background: Recently, several functional foods have been identified which have health benefits beyond providing energy and substrate molecules for cellular chemistry. These foods are effective in reducing fat absorption and lowering lowdensity lipoprotein (LDL) cholesterol (Asgary, Rasquar, & Keshvari, 2018). In the past, diets low in saturated fat have been found to be ineffective in lowering LDL cholesterol. Statins are capable of lowering LDL cholesterol up to 60% when the latest generation is used at maximal dose (Law, Wald & Rudnicka, 2003). However, some patients do not tolerate statins because of side effects. Evidently, decreasing the LDL lowers the risk …

Community Oncology Clinicians’ Knowledge, Beliefs, And Attitudes Regarding Genomic Tumor Testing, Eric Anderson, Alexandra Hinton, Kimberly Murray, Hayley Mandeville, Caitlin Gutheil, Leo Waterston, Lee Lucas, Christine Duarte, Christian Thomas, Susan Miesfeldt, Petra Helbig, Andrey Antov, Jens Rueter, Paul Han

Maine Medical Center

Introduction: Genomic tumor testing (GTT) is a new technology that promises to make cancer treatment more precise. However, little is known about clinicians’ knowledge, beliefs, and attitudes regarding GTT, particularly in community oncology settings.

Seerratus Anterior Plane Block (Sapb) Improves Paine Control In Rib Fractures, Randy Kring, Peter Croft, David Mackenzie, Christina Wilson, Joseph Rappold, Tania D. Strout

Maine Medical Center

Background:

•Trauma is a major cause of morbidity and mortality worldwide. Rib fractures are identified in at least 10% of all injured patients.

•Rib fractures can lead to significant respiratory complications, with pneumonia and respiratory failure occurring in up to 31% of patients with rib fractures. Early initiation of aggressive pain control and pulmonary hygiene with incentive spirometry are standard of care to prevent complications from developing.

•In the Emergency Department, patients with rib fractures typically receive systemic analgesia that is largely narcotic-based. This pain control strategy puts patients at risk for the side effects of narcotics such as constipation, …

What’S Happening To Our Patients In Their Final Year Of Life?, Teresa Letellier, Amy Haskins, Christina Holt

Maine Medical Center

We want to “die well” which includes:

• Effective symptom management

• Receiving care consistent with wishes Who achieves this, and how?

• Primary care physicians (PCPs) – Insufficient time and training

• Palliative care physicians – Better quality care and decreased health care cost in last years of life

• “Surprise Question” – “Would you be surprised if this patient dies in the next year?”

• To recognize our sickest patients and discuss goals of care and consult palliative care, if appropriate • “Advance care planning tab” – To record code status, advance directive, POLST forms, medical power of …

Reducing Catheter Associated Urinary Tract Infections (Cauti) By Decreasing Use Of Indwelling Catheters, Joanne Chapman, Brenda Clark, Brian Jumper, Carrie Strick

Maine Medical Center

Background:

Catheter Associated Urinary Tract Infections (CAUTI) are considered a preventable hospital-acquired infection [2]. Centers for Medicaid and Medicare no longer reimburse hospitals for preventable CAUTIs [2]. A concerted effort to decrease our indwelling urinary catheter (IUC) rate has led to a decrease in the number of infections related to these catheters at Maine Medical Center (MMC) in Portland, Maine. Starting in 2012 as a result of The Joint Commission National Patient Safety Goal, the inter-professional CAUTI committee focus has been on decreasing utilization of IUC[1]. After an initial large decrease in utilization, the rates have flattened. The effort over …

Post Lumbar-Puncture Headache Experience In A Community Hospital (Peach) Study, Melissa Kessel, Caroline Knight, Robert Stein

Maine Medical Center

Introduction:

Post lumbar puncture (LP) headaches have been reported to occur in 10 to 30% of patients . The incidence of post-LP headaches at Pen Bay Medical Center (PBMC) was unknown prior to this study. This study was undertaken to attempt to understand the local experience with this procedural complication.

Northern New England Palliative Care Teleconsult Research Laboratory, Ava Daruvala, Rebecca N. Hutchinson, Eric Anderson, Paul Han

Maine Medical Center

Introduction:

• Palliative care (PC) is an approach that improves the quality of life of patients and their families.

• Delivery of PC via telehealth technology (tele-PC) has been proposed as a solution to increase access to PC in rural areas. • The feasibility, acceptability, and effectiveness of applying telehealth technology to PC remains unknown.

• The overarching purpose of the proposed study is to 1) evaluate the feasibility and acceptability of a tele-PC intervention for seriously ill patients, and 2) generate pilot data to better understand provider-patient communication during tele-PC consultations

Getting Personal With Dementia: Physician Assistant Student Virtual Reality Immersion, Diane Visich, Dana Vilmore, Elizabeth Dyer

Maine Medical Center

Introduction:

Approximately 5.7 million people in the United States are living with dementia, with numbers expected to rise to 13.8 million by 2050 As prevalence grows, it is crucial to train future providers to meet the complex and diverse needs of patients and caregivers. Virtual reality (VR) is a growing tool in medical education, but few studies explore this tool for dementia education. One study found VR had a positive impact on medical and pharmacy students’ knowledge and attitudes toward people with dementia.Another study found VR increased the understanding and empathy in medical and physician assistant (PA) students for adults …

Reducing Length Of Stay For Mental Health Patients, Faye Collins, Nancijean Goudey

Maine Medical Center

Background:

Our facility sees an average of over 200 mental health patients every month, with limited community resources. The length of stay (LOS) for these patients had slowly risen to unacceptable levels; the number of patients whose LOS was greater than 24 hours increased in fiscal year (FY) 2017, from 633 patients to 1145. Patients in crisis require expedited transfer to appropriate care locations. Our goal was to decrease the overall length of stay for mental health patients in the Emergency Department.

The Development And Implementation Of A Resource Nurse In The Float Pool: A Review Of The Literature And A Pilot Study Plan, Crystal M. Wiley

Interprofessional Research and Innovations Council

The Development and Implementation of a Resource Nurse in the Float Pool: A review of the Literature and a Pilot Study Plan.

Crystal M Wiley, BSN, RN, CMSRN

Background/Literature: It is pivotal that resources are available at the point of care allowing excellence in nursing care and exceptional outcomes. Currently, the staff have multiple resources to help with ethical dilemmas, patients who are unstable, and research. Discussion with leadership revealed a need for a support to busy units with a few newly hired staff and an interest in a resource nurse program to address these concerns and areas for improvement. …

Advanced Cardiovascular Life Support (Acls) And Obstetrical Critical Care (Ob Cc) Education For High Risk Labor And Delivery Nurses In Caring For Growing Population Of High Risk Patients, Tracey E. Mcmillan

Interprofessional Research and Innovations Council

Advanced Cardiovascular Life Support (ACLS) and Obstetrical Critical Care (OB CC) education for high risk Labor and Delivery nurses in caring for growing population of high risk patients

Tracey E. McMillan RNC, BSN

Clinical Nurse III

Labor and Delivery Unit Coordinator

BACKGROUND: Many studies show that an increasing number of pregnant women in the United States have chronic health conditions such as hypertension, diabetes, and chronic heart disease. The factors that place a pregnancy at risk can be divided into four categories: existing health conditions, age, lifestyle factors and conditions of pregnancy. The recent statistics from the Centers for Disease …

Improvement Of Chf Patients’ Fluid Restriction Education Through Self-Efficacy, Johanna Ruckey, William Fyler

Interprofessional Research and Innovations Council

Improvement of CHF patients’ fluid restriction education through self-efficacy

Johanna Ruckey RN and William Fyler BSN

Background: Dietary discretion through limited salt and fluid intake is an important aspect of heart failure (HF) management. Keeping accurate account of fluid intake has shown itself to be a difficult task, as both staff and patients often fail to do so on a fairly regular basis. Although staff are aware of a patient's fluid restrictions, there is a deficit in the patient's role in tracking their own intake. Patients often express confusion and frustration regarding their daily fluid intake, but also lack …

Did You Wash Your Hands?, Kelley Coyne

Interprofessional Research and Innovations Council

Did You Wash Your Hands?

Kelley Coyne, RN, OPD Maine Medical Center

Introduction: While there is great focus and education regarding the importance of hand hygiene among healthcare workers there appears to be less focus and education on the importance of patient’s hand hygiene. My observation, as a healthcare provider in pediatrics, is that patient’s compliance with hand hygiene is rare and it appears that there is a need to educate patients on the importance of hand hygiene. Hand Hygiene has the highest efficacy and is a cost effective measure for preventing infection. Researchers in London estimate that if everyone …

In Patients Having A Robotic Hysterectomy, How Does The Amount Of Iv Fluids Given Post-Operatively Affect The Patients' Length Of Stay?, Heidi Fox

Interprofessional Research and Innovations Council

In patients having a robotic hysterectomy, how does the amount of IV fluids given post-operatively affect the patients' length of stay?

Heidi Fox, RN III, CAPA, ASU, MMC

Background: Over the last few years, ASU (ambulatory surgery unit) nurses have noted difficulty with discharging patients undergoing robotic hysterectomy in a timely manner due to both nausea and the inability to void. The nurses have also discerned inconsistencies with regards to the post-operative care including pre-operative bowel prep, amount of IV fluid given post-operatively and anti-nausea meds given. This prompted a literature search and a critical appraisal of pertinent research articles …