Medicine and Health Sciences Commons^™

Demographic Factors Contributing To Nas Treatment, Meg Curran, Emma Freeman

Costas T. Lambrew Research Retreat 2022

Infants that were formula fed, had unpartnered parents, birthing parents who used illicit substances, and multiple medication exposures were more likely to be treated for NAS

Pre-Operative Anxiety Related To Major Urogynecologicsurgery, Nadi Nina Kaonga, Mary C Brandes, Caroline Foust-Wright

Costas T. Lambrew Research Retreat 2022

Introduction •Higher levels of pre-operative anxiety are associated with adverse outcomes1-3(e.g., delayed recovery, higher post-op pain levels) •Most evidence arose from cardiothoracic and orthopedic literature (on emergent surgeries) and there is opportunity to further understand perioperative anxiety and elective/quality of life surgeries [within gynecology]4

Applying The ‘Problem And Solution Trees’ Participatory Method To Design A Public Health Program On Covid 19 Testing For Underserved Populations, Mike Kohut, Elizabeth A Jacobs, Kathleen M Fairfield, G D. Sclar, K Hudak

Costas T. Lambrew Research Retreat 2022

Here we present a case study example of how we applied qualitative research and ‘problem and solution ’trees’( to identity barriers to testing for people who are unhoused

Assessment Of Obstetric Outcomes Graphs And Figures For New Mainers, Amy Haskins, Brendan Prast, Tina Holt

Costas T. Lambrew Research Retreat 2022

Introduction

• 4% of Maine’s population in 2018 was recent immigrants

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

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

Center For Applied Science And Technology, Robert Carlson, Scot Remick, Lindsey Gower, Sue Lapierre, Anne Breggia, Bob Carlson

Costas T. Lambrew Research Retreat 2022

The journey from basic research to its application in clinical medicine is long and often fragmented. MaineHealth, as the largest healthcare system in Maine, is uniquely situated to create synergies between research and clinical medicine. The new MMCRI Center for Applied Science and Technology is a collaborative effort between the MMC Research Institute (MMCRI) and NorDx, the MaineHealth Diagnostic Laboratory, that provides the infrastructure needed for coordinated integration of MMCRI research core facility instrumentation and data resources with NorDx clinical instrumentation, data resources and support services. The new infrastructure provided by the Center will facilitate and broaden participation in the …

Exploring Provider Attitudes Toward Falls Prevention In The Inpatient Setting, Emily Carter Md, Sarah Hallen, Gavin Welch, Nikki Gordon, Mark Parker

Costas T. Lambrew Research Retreat 2022

The rate of falls and falls with injury within Maine Medical Center are rising. •MMC’s InterprofessionalFalls Committee performed a root cause analysis to identify the factors driving this change. •This analysis highlighted the role that nursing and PT/OT’s have on fall prevention and it uncovered the lack of engagement amongst physicians and APPs. •We performed a literature review and found that there were no references identifying specific barriers to inpatient provider engagement; however, in other clinical settings such as the ED and assisted living, barriers to provider falls assessment have been identified. •We utilized the theoretical domains framework (TDF) to …

Perioperative And Postoperative Outcomes Of Morbidly Obese Patients Undergoing Primary Elective Total Hip Arthroplasty With A Muscle Sparing Approach, Brian J. Mcgrory, George Babikian, Adam Rana

Costas T. Lambrew Research Retreat 2022

Obesity is associated with an increased risk of complications after total hip arthroplasty (THA), including infection and dislocation. •Due to the higher risk of osteoarthritis in obese individuals, understanding factors that can reduce the risk of complications is important. •This study examined the outcomes of morbidly obese (BMI ≥ 40) compared to healthy weight patients(BMI between 18.5-24.9 kg/m2)who underwent a THA with the ABLEapproach. •The ABLE approach: •This approach uses the interval between the anterior aspect of the gluteus mediusand the posterior aspect of the tensor fascia lata. •ABLE is minimally invasive, muscle sparing, and is associated with less painful …

Anesthesia Non-Technical Skills In The Operating Room Clinical Learning Environment (Orcle), Denham S Ward

Costas T. Lambrew Research Retreat 2022

Anesthesia non-technical skills (ANTS) are critically important to patient safety in the operating room. The purpose of this study was to examine the global experience of ANTS in the clinical learning environment of the operating room (OR). Our goal is to answer the research question: “How are ANTS perceived by residents early in their training in the ORCLE?” Ultimately, we wish to use this information to inform curricula to teach ANTS in daily clinical practice.

Bilateral Total Hip Arthroplasty: Outcomes Of Staged Vs. Simultaneous Tha Performed Using The Anterior Based Muscle Sparing Approach, Brian J. Mcgrory, George Babikian, Adam Rana

Costas T. Lambrew Research Retreat 2022

•Total Hip Arthroplasty (THA) procedures are becoming increasingly common globally. •There is current debate surrounding the efficacy of simultaneous versus staged bilateral total hip arthroplasty, mainly with regards to patient outcomes and complications. •This study examines the perioperative and postoperative outcomes of simultaneous and staged bilateral THA procedures using the Anterior Based Muscle Sparing (ABMS) approach, also known as the ABLE Advanced Anterior Approach.

The Creation Of A Sdot And Its Implementation In The 4th Year Em Clerkship, Lauren Wendell, Evan Gill, Sara Nelson

Costas T. Lambrew Research Retreat 2022

Background •Clinical assessments of EM clerkship students are variable and institution specific. •Direct observation is used in residencies •EM clerkship instituted a student SDOT using a modified National Clinical Assessment Tool for Medical Students in EM (NCAT-EM)

Us-Guided Regional Anesthesia (Ugra) In The Ed- A Qi Project, Joshua Rehberg

Costas T. Lambrew Research Retreat 2022

Introduction-

Between 01/2021-09/2021 there were 95 people diagnosed with hip fractures in the emergency department. •56% (n= 53) got a fascia iliacacompartment block. •9% of notes had a comment on reevaluation of effectiveness or re-evaluation post-block, only ~50% had a neurovascular exam commenting on both motor function and pulses, and 7% of all blocks (n= 4) had no procedure note. •Goal: The purpose of was to improve the quality of care given to patients receiving US-guided regional anesthesia, provide a way to track the number of ultrasound-guided regional blocks performed in the emergency department, and improve resident education and documentation

Adolescent And Young Adult (Aya) Cancer Survivorship Survey, Amy Haskins, Christina Holt, Lauren Boehm, Ashley Speckhart

Costas T. Lambrew Research Retreat 2022

Introduction •AYA cancer survivors face unique healthcare challenges following curative therapy •High loss to follow up rate despite importance of survivorship care

Improving Car-Bed Discharge Process And Follow Up, Haley Pelletier, Gina Trachimowicz

Costas T. Lambrew Research Retreat 2022

The car seat challenge test is most commonly performed on premature infants prior to discharge home from the hospital. Infants who fail the car seat test twice at MMC are discharged home in a carbed. The process of discharging an infant home in a car-bed and the subsequent re-testing prior to transitioning safely to a rear-facing car seat is neither widely understood or standardized among Maine Health providers.

Maine Medical Center Experience With Left Ventricular Device Explantation, Laura Onderko, Lauren Vickerson, Andrew Schwartzman

Costas T. Lambrew Research Retreat 2022

Introduction •Left ventricular assist device (LVAD) is an implantable heart pump that helps support the heart in patients with end stage heart failure with reduced ejection fraction •LVAD therapy is now approved for use as a bridge to transplantation (BTT) and as a destination therapy (DT) in patients who are not candidates for heart transplantation. •The existing literature suggests that close to 10% of patients implanted with LVAD could be explanted for recovery, but the actual rate of explant is significantly lower •Need to examine the clinical course of explanted patients to provide better guidance for the decision to explant …

Implementing Trauma-Informed Developmental Care In Nicu/Ccn: Findings From A Pre-Intervention Care Team Survey, Megan Flynn

Costas T. Lambrew Research Retreat 2022

Priorities Identified by Care Team in NICU/CCN Provide Path to Improving Patient Care

Takotsubo’Scardiomyopathy: Clinical Characteristics And Outcomes In The Rural State Of Maine, Laura Onderko, Bhavini Prajapati, Wendy Craig, Roisin Morgan

Costas T. Lambrew Research Retreat 2022

Pre-existing psychiatric diagnosis linked to developing Takotsubo’sCardiomyopathy. Patients from rural areas less likely to be on psychiatric medications and had higher Takotsubo’srecurrence rate.

The Shifting Role And Expectations Of Physical Therapy In The Pediatric Cystic Fibrosis Clinic During A Global Pandemic, Ana Cairns, Colby Wyatt, C Chaloner, J Takatsuki-Jordan, A Williams

Costas T. Lambrew Research Retreat 2022

In January 2020, a CFF supported quality improvement study to optimize physical therapy (PT) services in our pediatric CF clinic was underway. •An initial survey had been completed in 2019 to assess family satisfaction with the current provision of PT services. •In March 2020 the COVID-19 pandemic caused a major shift in clinical care in the midst of our project. •Care was changed to telehealth and “hybrid” clinic visits, thereby altering the context of our study, necessitating a change in the focus.

A Period Seroprevalence(Sars-Cov-2) Survey In Mhccn Cancer Healthcare Workers (Hcws) Providing Patient Care During The Height Of The Outbreak: A Registry Study (Second Year Progress), Caroline Knight, Jill Prescott, Jill Hobart, Jamie Saunders, Kimberly Caron, Sandra Neptune, Patty Brown, Kyla Sturtevant, Sean Eller, Lisa Lemire, Anne Breggia, Susan L. Guerin-Staples, Lee Lucas, Paul Han, Rachit Kumar, Johnson Liu, Robert Carlson, Scot Remick

Costas T. Lambrew Research Retreat 2022

In December 2019, emergence of a new coronavirus in Wuhan, China heralded the onset of a global pandemic (aka Covid-19) that is well into its third year. At the outset, the initial first wave of the alpha variant in 2020 had less impact on our state and HCWs. In December 2020, Covid-19 vaccinations became available. By fall and winter 2021-2022, the delta and subsequent omicron variants nearly overwhelmed Maine healthcare systems and work force. In June 2020, we embarked on a period seroprevalencestudy in the MaineHealthCancer Network (MHCCN) to document Covid-19 exposure in our rural cancer care workforce. Enrollment continues …

A Multicenter Pilot Study To Evaluate The Effect Of Evoo On Lipid Parameters, Caroline Knight, Ralph Hamill, Katherine Brady, Stacia Kozidis

Costas T. Lambrew Research Retreat 2022

Purpose:

The purpose of this multi-center, double-blinded pilot study was to determine if EVOO has a positive effect on HDL cholesterol levels and anti-inflammatory markers for subjects diagnosed with CVD and to determine if the polyphenol concentration is proportional to those effects. Subjects completed consecutive 28-day periods (with a 14- day washout between) in which they will either consume the low polyphenol EVOO daily or the high polyphenol EVOO. In a double-blinded manner, each subject was his or her own control with a 14-day washout between study periods. HDL levels and other parameters were be measured after each period of …

Behavioral Support Checklist Making Mmc More Autism Friendly, Rachel Coffey, Sarah Reynolds

Costas T. Lambrew Research Retreat 2022

Introduction • Patients with Autism Spectrum Disorder and their families report suboptimal medical experiences. • Boston Medical Center championed the “Autism Friendlieness Initiative” through ● Autism Support Checklist ● Provider Training ● Visit Preparation ● Sensory Accommodations

Pediatric Dermatology Econsult Program With Dermoscopy: Sub Analysis Of Infantile Hemangiomas, Peggy R. Cyr, Madeline Prentiss, Laura Houk, Elizabeth Seiverling

Costas T. Lambrew Research Retreat 2022

There are no pediatric dermatologists in Maine. Greater distance from a dermatologist is associated with delays in care and nonadherence to treatment. Timely care is especially crucial for patients with infantile hemangiomas (IH) due to a narrow “window of opportunity” for optimal treatment. A store and forward electronic consultation eConsult ) platform was implemented within our electronic medical record (Epic) to triage referrals from primary care providers ( PCPs). Here we present an analysis of the program outcomes in respect to pediatric eConsults with emphasis on treatment for IH.

A Coordinated Approach To Implementing Low-Dose Ct Lung Cancer Screening In A Rural Community Hospital, Jessica Currier, Deb Howes, Cherie Cox, Margaret Bertoldi, Kent Sharman, Bret Cook, Derek Baden, Paige E. Farris, Wesley Stoller, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Purpose: The authors describe a rural community hospital’s approach to lung cancer screening using low-dose CT (LDCT) to address the high incidence of lung cancer mortality.

Methods: An implementation project was conducted, documenting planning, education, and restructuring processes to implement a lung cancer screening program using LDCT in a rural community hospital (population 64,917, Rural-Urban Continuum Code 5) located in a region with the highest lung cancer mortality in Oregon. The hospital and community partners organized the implementation project around five recommendations for an efficient and effective lung cancer screening program that accurately identifies high-risk patients, facilitates timely …

Covid-19 Infection During Pregnancy Induces Differential Gene Expression In Human Cord Blood Cells From Term Neonates, Suhita Gayen Nee' Betal, Pedro Urday, Huda B. Al-Kouatly, Kolawole Solarin, Joanna Chan, Sankar Addya, Rupsa Boelig, Zubair H. Aghai

Department of Pediatrics Faculty Papers

Background: The COVID-19 pandemic continues worldwide with fluctuating case numbers in the United States. This pandemic has affected every segment of the population with more recent hospitalizations in the pediatric population. Vertical transmission of COVID-19 is uncommon, but reports show that there are thrombotic, vascular, and inflammatory changes in the placenta to which neonates are prenatally exposed. Individuals exposed in utero to influenza during the 1918 pandemic had increased risk for heart disease, kidney disease, diabetes, stomach disease and hypertension. Early exposure of COVID-19 during fetal life may lead to altered gene expression with potential long-term consequences.

Objective: To determine …

Nr4a Family Genes: A Review Of Comprehensive Prognostic And Gene Expression Profile Analysis In Breast Cancer, Hassan Yousefi, Jordyn Fong, Suresh K. Alahari

School of Medicine Faculty Publications

This report analyzes nuclear receptor (NR) subfamily 4A’s potential role in treating those diagnosed with breast cancer. Here we reviewed the current literature on NR4 family members. We also examined the relative gene expression of the NR4A receptor subfamily in the basal, HER2 (human epidermal growth factor receptor 2) positive, luminal A, and luminal B subtypes using data from tumor samples in The Cancer Genome Atlas (TCGA) and Molecular Taxonomy of Breast Cancer International Consortium (METABRIC). These data showed a positive link between NR4A1-NR4A3 expression and increased overall survival and relapse-free survival in breast cancer patients. In addition, we observed …

Rural Resiliency: The Cause And Effect Of Minnesota's Maternal Health Crisis, Annabel Traudie Gregg

Geography Honors Projects

The United States is experiencing a maternal health crisis that disproportionately affects those who give birth in rural communities. Rural birthing people have higher maternal mortality rates, increased risk of postpartum hemorrhage, non-indicated cesarean sections, and other adverse health outcomes. Despite the enhanced risks of rural birth, rural communities are losing access to hospital-based obstetric care at an unprecedented rate. Minnesota has vast rural territory, with one-fourth of its population living outside the urban sphere ­– making it a strategic area of study. As of July, 2021, 31% of Minnesota’s 91 rural hospitals were at risk of closing. The repercussions …

Intouch April 25, 2022, New York Medical College

InTouch

• D.P.T. Class of 2024 Marks the Transition to Clinical Education with White Coat Ceremony
• Sangmi Chung, Ph.D., Receives Bridge Funding Grant
• Erica Pratt, M.P.H. Class of 2022, Envisions Herself as a Public Health Leader
• The Office of Research Administration Supports NYMC’s Research Endeavors
• Kin Lazzaro Brings 15 Years of Fundraising Expertise to NYMC’s Office of Development and Alumni Relations

Indispensable Role Of Immunophenotyping In Diagnosing Leukemic Phase Of Blastic Plasmacytoid Dendritic Cell Neoplasm Without Cutaneous Manifestation, Hareem Alam, Nabiha Saeed, Anila Rashid

Department of Pathology and Laboratory Medicine

Blastic plasmacytoid dendritic cell neoplasm usually presents as skin lesions. Diagnostic error occurs when it primarily presents in leukemic phase without skin involvement. Triad of CD4, CD56 and CD123 immunophenotype expression is essential to avoid misdiagnosis of this rare hematological malignancy. Here we describe a patient who presented in overt leukemic phase of BPDCN highlighting diagnostic challenges encountered that resulted in delayed diagnosis and poor outcome

Occupational Fine Particulate Matter Exposure And Its Associated Effects On The Cardiovascular System: A Systematic Review, Jordan Rickwa

Honors Theses

Fine particulate matter (PM2.5), the solid and liquid portion of air pollution under 2.5 microns in diameter, has been shown to cause numerous negative effects on the body. These inhalable particles are often researched for their effects on the respiratory system in outdoor settings, however systemic health impacts have been observed following inhalation of PM2.5 . Additionally, exposures to PM2.5 can occur in occupational settings but are less frequently studied compared to outdoors. This literature review seeks to identify studies that determined associations between inhaled PM2.5 and the resulting cardiovascular effects in occupational settings. We conducted a search of literature …

Targeting Platelets Using Ionic Liquid Coated Nanoparticles, Karen Mun Wong

Honors Theses

Platelets are key players in our body’s inflammatory processes upon activation, which can create physiological problems. Researchers are actively seeking solutions by targeting platelets with therapeutics. The objective of the research in this thesis was to investigate a new and potentially less invasive drug delivery platform using nanoparticles. The topic of the project was to explore the world of ionic liquids and their abilities, when coated on nanoparticles, to bind to platelets. A library of choline carboxylic acid-based ionic liquids (ILs) was first synthesized via salt metathesis while PLGA-based nanoparticles were simultaneously being synthesized via the nanoprecipitation method. The ionic …

Pain Management In Postoperative Pediatric Craniotomy Patients: A Scoping Review, Jessica M. Hiltenbrand Bsn, Rn, Sydney A. Scarbrough Bsn, Rn, Kaitlyn E. Shirley Bsn, Rn, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Purpose/Background The pediatric craniotomy procedure is a complex and painful procedure that requires adequate pain management and frequent neurological assessments. Generally, evidence for pediatric pain management is severely lacking in research, and evidence for pediatric craniotomy patients is lacking even further. This scoping review aims to collect, condense, and review the current data in order to fuel future studies to establish more data, protocols, and evidence-based recommendations for analgesia in the pediatric craniotomy patient population.

Methods The studies selected were peer-reviewed, published in a medical or nursing journal, included study ages 0-21 years, or provided evidence on pediatric analgesia. Sources …