Medicine and Health Sciences Commons^™

Costas T. Lambrew Research Retreat At Maine Medical Center - Abstracts From 2020

Journal of Maine Medical Center

No abstract provided.

2019 Mite Annual Report

Journal of Maine Medical Center

No abstract provided.

Lessons From An Evidence-Based Medicine Exploration: When Transparency And Sensitivity (Analyses) Can Change The Take-Home Message, Nadi N. Kaonga, Toby Fitzgerald

Journal of Maine Medical Center

No abstract provided.

Strengthening The Evidence Base For Telehealth For Abortion Service Delivery, Nadi Kaonga

Journal of Maine Medical Center

Telehealth – which is the use of information and communication technology to provide clinical services to patients remotely – provides an opportunity to extend safe abortion services to women. A recent review article on telehealth for abortion service delivery found it to be acceptable, feasible and safe when compared to in-person service delivery. Despite the promising findings, the evidence base can and should be strengthened to optimize the impact of such services for women. Areas for improvement include evaluating the efficacy and effectiveness of telehealth implementations in more remote settings and with women across variable levels of technoliteracy, conducting cost-effectiveness …

Association Of Palliative Care Consultation With Advance Directive Completion For Patients Admitted With An Acute Heart Failure Exacerbation, Michelle Crispo, Doug Sawyer, Kathleen Fairfield, Rebecca N. Hutchinson

Journal of Maine Medical Center

No abstract for research letter

A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, Robert G. Michaud, Lesley B. Gordon

Journal of Maine Medical Center

Introduction: Rectus sheath hematomas (RSH) generally occur due to damage to the inferior epigastric artery. They are rare causes of abdominal pain or acute blood loss anemia, but are an important diagnostic consideration because they can be cryptic and are potentially fatal.

Clinical Findings: An 85-year-old female who had been admitted to the hospital for 10 days with a myasthenia crisis was found to be abruptly hypotensive with a tender abdominal mass in the left lower quadrant subtly crossing midline. She was on prophylactic anticoagulation during her hospitalization.

Main diagnosis, therapeutics, interventions, and outcomes: The patient was initially stabilized with …

A Case Of Disseminated Nocardia Beijingensis In An Immunocompetent Patient, Manifesting As Subcutaneous And Cns Nocardiosis., Scott Cathcart, Patricia Stogsdill, Rebecca Bell

Journal of Maine Medical Center

Introduction

Nocardiosis is an uncommon infection, typically encountered in immunocompromised patients. With only 5 cases reported thus far in the United States, we present a case of disseminated Nocardia beijingensis in an immunocompetent patient, involving the lung, subcutaneous tissue, and CNS.

Clinical Findings

A 60-year-old immunocompetent male with no significant medical history presents to our institution after a complicated medical course, beginning with vague respiratory complaints. Initial work-up revealed a large right upper lung mass of unclear etiology. A month later he had a syncopal episode followed by the development of focal neurologic deficits.

Main Diagnoses, Therapeutics Interventions, and Outcomes …

Multifocal Bone Pain, Recurrent Fevers And Anemia In A 15-Year-Old, Anna M. Martens, Catherine Ezzio, Amanda Goddard, Leah Mallory

Journal of Maine Medical Center

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disorder that primarily affects children with recurrent episodes of sterile osteomyelitis in one or more bones. Patients usually present with recurrent bone pain, though it is often a diagnosis of exclusion with most patients undergoing extensive work-up to arrive at a diagnosis.

Clinical Findings: This 15-year-old female presented with months of progressive multifocal bone pain, 22-pound weight loss and recurrent fevers. Work-up as an outpatient included a positive screening assay and IgM Western blot Panel positive for Lyme disease, treated with a 28-day course doxycycline without resolution of the symptoms, …

Is Rocky Mountain Spotted Fever Transmitted In Maine?, Eric J. Ray

Journal of Maine Medical Center

Introduction:

Tickborne disease occurs worldwide with recent recognition of changes in tick vector distributions. Rocky Mountain Spotted Fever (RMSF) is already widespread across the United States; however, it is being monitored for introduction to non-endemic areas.

Clinical Findings:

A 65-year-old male with a history of psoriatic arthritis on adalimumab and local tick exposures but no known recent bites presented to the emergency department with fevers, myalgias, arthralgias, and a maculopapular rash of unclear etiology. Initial testing showed transaminitis, worsened chronic thrombocytopenia, and slight neutropenia with absolute neutrophil count 2,330 (reference value: 2,400-7,600 cells per µL); however, he was stable …

Ruptured Splenic Hemangioma Presenting As Small Bowel Obstruction: A Case Report, Haya S. Raef, Karin L. Cole Md

Journal of Maine Medical Center

Introduction: Splenic hemangioma is a rare vascular tumor of the spleen. Typically asymptomatic, these lesions can present with rupture and hemoperitoneum. Clinical Findings: We report the case of a patient with no previous abdominal surgery that presented with symptoms and imaging consistent with small bowel obstruction (SBO), and an incidental finding of a splenic lesion. Main diagnoses, therapeutic interventions, and outcomes: At diagnostic laparoscopy, a ruptured splenic hemangioma was identified, with obstructive ileus due to hemoperitoneum. The patient subsequently underwent splenectomy to prevent recurrent bleeding. Conclusions: Splenic hemangiomas are rare vascular neoplasms of the spleen, which can be complicated by …

Development Of A Certificate In Healthcare Improvement For Inter-Professional Teams, Kathleen M. Fairfield, Hannah R. Martin, Peter W. Bates, Erin M. Graydon-Baker, Mark G. Parker, Jordan S. Peck, Debra A. Rothenberg, Ghassan A. Saleh, Isaac Z. Stickney, John Tooker, Robert L. Trowbridge, John E. Wennberg

Journal of Maine Medical Center

Introduction

To address gaps in care team improvement-science education and connect geographically dispersed learners, we created a healthcare improvement certificate program, now completing the third program year, for inter-professional (IP) healthcare teams, including third year medical students.

Methods

This hybrid learning program consists of five modules: Learning Healthcare Systems, Improvement Science, Patient Safety and Diagnostic Error, Population Health and Health Equity and Leading Change. The curricular materials are comprised of focused readings, concise videos, faculty-moderated discussion boards, weekly synchronous calls of participants with faculty, and a longitudinal improvement project. The faculty are content experts, and worked with a curricular designer …

Building A Peer Reviewer Community Of Practice, Victoria Hayes Md, Robert Bing-You Md, Med, Mba, Wendy Craig Phd

Journal of Maine Medical Center

Introduction: Scholarly peer review is the cornerstone for maintaining quality and relevance in the medical literature. Few programs that support peer-reviewer training have been described.

Methods: We developed a 2-pronged approach to support peer-reviewer training at our institution. This approach included a formal online course that offered a certificate of completion and an informal group manuscript peer review (GMPR) meeting held monthly.

Results: A total of 13 participants completed the online course in the first 2 years (2017-2018). Nineteen enrolled in the third year. The GMPR met regularly over 3 years and reviewed 26 manuscripts. Typical attendance has been 8-10 …

Evaluation Of Pharmacist- Or Nurse-Driven Long-Acting Insulin Titration Protocol In Adult Primary Care Patients With Type 2 Diabetes, Ruth Manzi, Corinn Martineau, Carmine Laporta, Mary Muca, Samantha Marrier, Donald Medd, Jennifer Aronson

Journal of Maine Medical Center

INTRODUCTION

Studies have supported protocolized insulin titration to optimize insulin therapy. We implemented a long acting insulin titration (LAIT) protocol in a primary care setting to aid patients achieve optimal control of their diabetes. The purpose of the study was to evaluate the performance of the LAIT protocol.

METHODS

This retrospective analysis included patients ≥18 years with type 2 diabetes (T2D) and a hemoglobin A1c (A1C) >8% who were managed as outpatients at clinics within our health care system. We collected demographic and clinical data before and after a patient’s enrollment in the LAIT protocol. Our primary outcome measure was …

A Primer On Cognitive Errors Illustrated Through The Lens Of A Neurosurgical Practice, Jeffrey Evan Florman, Lisa Almeder, Robert Trowbridge

Journal of Maine Medical Center

Problem Statement:

Diagnostic error is often attributed to cognitive errors, including biased thinking patterns, rather than knowledge or data limitations, and education on cognitive bias deserves review in all spheres of practice.

Background:

The cognitive biases of practitioners create an inherent fallibility in recognizing and treating medical conditions. Awareness of cognitive errors is valuable for mitigating risk of diagnostic error.

The impact of cognitive error is substantial in the management of neurosurgically relevant disease. Remarkably broad differential diagnoses often accompany neurologic symptoms. Both focal and non-focal symptoms lend themselves to diagnostic inertia that contributes to errors. Further, initial diagnostic direction …

Evaluation Of Geographic Disparities In Cervical Cancer Survival Across Maine, Kaylee Underkofler, Jason Lachance

Journal of Maine Medical Center

Introduction. National data exists suggesting the existence of geographic disparities in oncology care within the United States. It is unknown whether geographic disparities present a problem for women with gynecologic malignancies locally in Maine.

Methods. Data for each cervical cancer case diagnosed or treated under the MaineHealth system between 2007 and 2011 were acquired from the MaineHealth Network Registry. Average annual incidence and 5-year survival were calculated for each county in Maine and were mapped using geographic information systems (GIS) software. Next, cases were divided into 2 groups: those residing less than or equal to 60 miles from the sole …

Does A Diagnostic Algorithm Reduce The Overuse Of Chest Ct Angiography In Suspected Pulmonary Embolism? : A Pre- And Post-Intervention Retrospective Study In A Critical Access Hospital, Rattanaporn Mahatanan, Brianna Philbrick, William J. Hirschfeld, Gina Gomez

Journal of Maine Medical Center

Background: Pulmonary embolism (PE) is a common and potentially fatal disease. Although CTA is a gold standard for diagnosis, it carries risks for patients. We sought to minimize the overutilization of chest CTA by implementing a diagnostic algorithm in the hospital to evaluate the likelihood of PE and determine the need for imaging with CTA.

Methods: A retrospective medical chart review was performed for all patients suspicious of PE at Redington-Fairview General Hospital 3 months before and after diagnostic algorithm implementation. Patients who underwent either D-dimer testing or chest CTA were included. Patients were excluded if d-dimer testing was …

“When I Let Go Of What I Am, I Become What I Might Be.” Lao Tzu, Robert Bing-You

Journal of Maine Medical Center

No abstract provided.

Infuse!_Volume 4_Number 1_2020, College Of Nursing

Infuse! College of Nursing Magazine

No abstract provided.

Whims (Washing Hands, Immunity Boost, Masking & Social Distancing), Srinivasan Ragothaman

Creative Work

This is a shot poem about preventing the spread of Covid-19. It pleads general public to wear masks, wash hands, social distance, and boost immunity. It is set to a popular tune in Hindi - Dil Ke Jharoke Mein.

Guide Lines Vol. Ii, Issue 5 - July 2020, College Of Health And Human Services

GUIDE Lines

Periodic Newsletter of the Governors State University - University of Illinois, Chicago - Disparities Education Cancer research training and education project (The GUIDE Project).

Assessment Of The Effects Of Malaria And Anemia In Pregnant Malawian Women Before And After Treatment Of Moderate Malnutrition, William Shipley

Master's Theses

ABSTRACT

Assessment of the Effects of Malaria and Anemia in Pregnant Malawian Women Before and After Treatment of Moderate Malnutrition

William Shipley

Background: Moderate acute malnutrition (MAM) can lead to adverse maternal and infant outcomes and possibly further complications. Supplementary foods or treatments with high quality nutrients should be administered to those with MAM in hopes to increase the chance of healthy maternal and infant outcomes. Sometimes supplementary food is not enough to overcome MAM and disease may play a role, particularly in pregnant malnourished women.

Objective: To determine if the effects of malaria and anemia moderated the effect of …

Wellness Through Answers News V.35:No.3 July-August 2020, Wendy Urciuoli

Articles - Patient Care

No abstract provided.

Implementation Of A Central Line Bundle As A Quality Improvement Priority., H. Anthony Flood

Doctor of Nursing Practice Papers

Background: Central-line associated blood stream infections (CLABSI) are a major threat to patient morbidity and mortality. Kentucky Continue Care Hospital (KCCH), a long-term acute care hospital, experienced a significant increase in CLABSI in 2018; therefore, implementation of a central-line bundle to reduce CLABSI was identified as a quality improvement priority. Methods: This author used the Quality Improvement Model to plan, study, and evaluate the implementation of a central line bundle in KCCH following University of Louisville Institutional Review Board (ULIRB) approval, staff were educated on the new process and the audit tool using a self-study module over a 2-week period …

Breathing Easier: Indoor Air Quality Education Program., Sarah Kuner

Doctor of Nursing Practice Papers

Background: Exposure to indoor air pollutants increases the risk for poor health outcomes and health disparities among vulnerable groups such as children. The purpose of this evidence-based project was to implement an indoor air quality program that would: 1) improve caregiver awareness of indoor and outdoor environmental health exposures and 2) increase the intention to reduce exposures to indoor household pollutants. The target population included caregivers of preschool children, ages 3 to 5 years, who currently attend the Ohio Valley Education Cooperative. Methods: This project used a pre and post test study design that included two, virtual-learning modules that reviewed …

2020-2021 Pediatric Subspecialty Trainees, Children's Mercy Hospital

Residents and Fellows Portraits

Photo composites of the graduate pediatric trainees in adolescent medicine, allergy/immunology, child abuse pediatrics, child neurology, coagulation, congenital cardiac surgery; clinical child psychology, developmental-behavioral pediatrics, epilepsy, headache medicine, hospice & palliative care, laboratory genetics & genomics, neonatal-perinatal medicine, pediatric adolescent gynecology, pediatric bioethics, pediatric cardiology, pediatric clinical pharmacology, pediatric critical care medicine, pediatric dentistry, pediatric emergency medicine, pediatric EM/child abuse, pediatric dermatology, pediatric endocrinology, pediatric gastroenterology, pediatric hematology/oncology, pediatric hospital medicine, pediatric infectious diseases, pediatric nephrology, pediatric optometry, pediatric otolaryngology, pediatric pathology, pediatric pulmonology, pediatric readiology, pediatric rehabilitation, pediatric sports medicine, pediatric surgery, pharmacy, pediatric residency and med/peds residency

Concussion History’S Impact On Instrumented Bess Scores In Division I Contact-Sport Athletes, Paul Ullucci

Health & Wellness Department Faculty Publications and Research

No abstract provided.

Lessons Amidst A Pandemic, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Early Initiation Of Therapeutic Hypothermia In The Emergency Department., Taylor Purnsley

Doctor of Nursing Practice Papers

Therapeutic hypothermia (TH) is a treatment initiated by critical care providers for the management of cardiac arrest. It has been shown to lower the body temperature, reduce the inflammatory response, and suppress many of the pathways leading to delayed cell death. The American Heart Association (AHA) has strongly recommended to initiate cooling within 4-6 hours after return of spontaneous circulation (ROSC); however, despite the recommendation, the use of TH in emergency departments (ED) is not routine and it is commonly delayed. The purpose of this project was to evaluate the impact of an educational intervention on the timing of initiation …

Improving The Rates Of Smoking History Documentation In The Electronic Medical Record., Megan Mccleese Vitellaro

Doctor of Nursing Practice Papers

Lung cancer is the leading cause of cancer related deaths in the United States, and Kentucky leads the nation in lung cancer deaths. Lung cancer care also contributes billions of dollars a year to the cost of health care in this country. The U.S. Preventive Services Task Force (USPSTF) recommends low-dose computed tomography (LDCT) for lung cancer screening with a grade B recommendation, which is a covered service under the Centers for Medicare and Medicaid Services (CMS) guidelines. In order to qualify, patients must have an appropriately documented smoking history. A primary care office was identified within a major healthcare …

The Impact Of Estimated Weight Versus Accurate Weight On Ischemic Stroke Patients With Tpa., Vanessa Johnson

Doctor of Nursing Practice Papers

Purpose: The gold standard of treatment for an ischemic stroke is the administration of weight based tPA within 4.5 hours of patient last neurological known well. The aim of this project was to improve accuracy of tPA dosing and decrease complications, improving outcomes for the stroke patient population. Method: This project implemented a new system, allowing every stroke patient to be accurately weighed when arriving to the hospital. AIS patients from a historical group were compared to patients receiving tPA within the first 3 months following an in-service, evaluating prospectively to determine if estimated or measured weights were used for …