Medicine and Health Sciences Commons^™

Urticarial Rash In A Patient With Alpha-Gal Syndrome Caused By Subcutaneous Heparin At Prophylactic Dosing: A Case Report, Russell G. Behmer, Randolph S. Thomas, Hani T. Jarawan

Journal of Maine Medical Center

Introduction: We report a patient with a history of red meat allergy, or alpha-gal syndrome, who had an urticarial rash after exposure to unfractionated heparin at a dose typically used for prophylaxis of deep venous thrombosis. Although anaphylactic reactions have been reported with systemic intravenous heparin, we believe this case is the first report of an immunoglobulin E–mediated reaction to subcutaneous heparin at prophylactic dosing.

Clinical Findings: An 85-year-old male had a 3-year history of red meat allergy and was intolerant of pork and beef. He developed an immunoglobulin E–mediated allergic reaction to subcutaneous heparin at a dose of 5000 …

Projected Utility Of The Ready Set Return Application, Erin Hartigan, Cassidy Sirois, Jonathan Lindau, Taylor Lockwood, Valerie Nesom, Nan M. Solomons

Journal of Maine Medical Center

Introduction: An application (app) that summarizes best practices may promote standardized care among clinicians treating patients during anterior cruciate ligament (ACL) rehabilitation. The purpose of this study was to test the prototype of the Ready Set Return (RSR) app to determine receptiveness for use in clinical practice.

Methods: Two mock patient cases were used to familiarize 19 physical therapists and athletic trainers with the RSR app. Then these participants provided feedback about the user experience, features, and content using Likert ratings and free-text fields through an online survey.

Results: Most participants (89%-95%) would recommend the RSR app to others and …

Who And How: Telemedicine Eligibility And Participant Guidelines In The Ambulatory Setting, Tracy Jalbuena, Rebecca Hemphill, Megan Selvitelli, Jasmine Bishop, Adam Ouellette, Rachel Alfiero

Journal of Maine Medical Center

Introduction: Telehealth use has dramatically increased due to the COVID-19 pandemic. Yet there are significant gaps in evidence regarding the clinical appropriateness of synchronous visits for ambulatory telemedicine that are under the umbrella of telehealth and defined as video appointments between patients and providers. As a result, there are few sensible guidelines for day-to-day practice, resulting in a lack of standardization and risk of suboptimal care.

Methods: We developed patient inclusion/exclusion guidelines for use in ambulatory telemedicine. Complementary tools included guides on patient preparation, telemedicine physical exam, and provider etiquette. We analyzed telemedicine use by practice type and surveyed a …

Association Between Primary Care Provider Status And Preventive Health Care Among People Who Inject Drugs, E Katherine Nenninger, Katherine Sharp, Bianca Bustamente, Kim Murray, Kinna Thakarar

Journal of Maine Medical Center

Introduction: People who inject drugs (PWID) are at increased risk for preventable, communicable infections, such as hepatitis B. Preventive care, such as hepatitis B vaccination, is often delivered through primary care providers (PCPs). However, PWID may not have access to PCPs and, therefore, may receive preventive care through other sites. We aimed to characterize PCP and preventive care use among PWID in Maine.

Methods: This is a cross-sectional study of PWID hospitalized with infections associated with injection drug use in Maine from January 2019 to May 2020. Descriptive analyses were used to identify characteristics of participants, rates of screening, and …

Family  Caregivers  Identify  Their Needs From The Inpatient Team  During A Loved One’S Inpatient Psychiatric Hospitalization, Elizabeth M. Oakleaf, Lillian J. Shields

Journal of Maine Medical Center

Introduction: According to existing literature, family-caregiver needs during a loved one’s inpatient psychiatric hospitalization are not fully understood or addressed in practice. We aimed to identify specific, practical family caregiver needs from the inpatient team during a loved one’s psychiatric hospitalization.

Methods: Semi-structured interviews were designed and tested through a phenomenological analytical approach. Interviews were conducted with family caregivers (n = 16, one caregiver per loved one) who participated in caring for a loved one (age 18-30 years) during an inpatient psychiatric hospitalization.

Results: Four main themes arose: the need to be listened to and collaborated with regarding treatment planning, …

A Qualitative Analysis Of Postgraduate Training Programs For Family Nurse Practitioners, John R. Massey

Journal of Maine Medical Center

Introduction: Family nurse practitioners (FNPs) are registered nurses who are trained at the master’s level and manage the care of patients in the primary care setting. FNP postgraduate training programs further prepare them and ease their transition from education to practice. Although these programs are emerging and relatively new, they are becoming more common as graduates and employers seek further preparation to practice in the primary care setting.

Methods: Interview questions were developed using guidelines from the Consolidated Framework for Implementation Research. Participants were selected using convenience sampling. Fourteen semi-structured interviews with key informants were conducted between July 2021 and …

Trends In Cannabis-Related And Opioid-Related Hospitalization Rates In Maine, 2010-2020, Suzanne Mcmahon, Katherine Ahrens

Journal of Maine Medical Center

Introduction: Medical marijuana use became legal in the state of Maine in 1999, and recreational adult-use marijuana became legal in 2016. However, the rates of hospitalization related to marijuana (also known as cannabis) use have not been studied. We estimated trends in cannabis-related hospitalization rates in Maine based on rurality and descriptively compared these trends to opioid-related hospitalization rates during the past decade.

Methods: We obtained de-identified data of inpatient encounters for Maine residents between 2010 and 2020 from MaineHealth Data Organization. We then calculated age-standardized rates of cannabis-related and opioid-related hospitalizations overall and by rural-urban residence using International Classification …

Thanking Our Reviewers!, Robert Bing-You

Journal of Maine Medical Center

No abstract provided.

The Anatomy Of Human Occupation, Jennifer K. Fortuna

The Open Journal of Occupational Therapy

Dr. Emily Balog, PhD., OTR/L, ECHM, an occupational therapy professor and artist based in New Jersey, provided the cover art for the Summer 2022 edition of The Open Journal of Occupational Therapy (OJOT). “The Knitting Brain” is an 11” x 15” painting made from watercolors. The inspiration for this painting came from years of experience working with individuals with head injury, stroke, and mental illness. The piece is from her Anatomy of Human Occupation series. This collection of paintings is a unique and authentic representation of Dr. Balog’s love of the human body and the healing power of occupation. Dr. …

Occupational Therapists’ Perspectives During The Covid-19 Pandemic, Emily N. Maas, Allison Sullivan, Said Nafai, James Plummer

The Open Journal of Occupational Therapy

On March 11, 2020, the World Health Organization declared the outbreak of the coronavirus disease 2019 (COVID-19) as a global pandemic. Hospitals, nursing homes, and communities worldwide were flooded with patients diagnosed with COVID-19, resulting in the increased need for medical care and treatment by health care professionals, such as occupational therapists. This study analyzes output from a quantitative online survey design, which was created on SurveyMonkey and included 43 questions. Data from the survey were collected, categorized, and measured through the SurveyMonkey computer system and included information gathered from 204 occupational therapists from October 2020 to February 2020. Based …

Occupational Disruptions Among Health Professional Graduate Students During Covid-19 Pandemic, Supawadee C. Lee, Blerta Blushi, Joy Ann Dimaculangan, Anahid Keshishian, Michelle Segovia

The Open Journal of Occupational Therapy

The COVID-19 pandemic created a global lockdown and restricted people from leaving their homes. The current study aimed to explore the impact of the pandemic on occupational engagement among health professional graduate students. A web-based survey consisting of quantitative and qualitative responses was sent out to graduate students enrolled in health professional programs at a private university in the Northeast and received 86 responses. The results revealed that social participation and education were the most impacted occupations. The least affected occupations among the graduate students in health professional programs was ADLs. The participants reported the pandemic did not negatively affect …

Peer Mentoring In An Entry-Level Occupational Therapy Program: Student Experiences During The Covid-19 Pandemic, Lauren E. Stone Kelly

The Open Journal of Occupational Therapy

Background: The COVID-19 pandemic has had significant impacts on education. During this time, educators were tasked to develop creative and new ways to engage and teach students. Mentoring has been shown to positively impact academic and psychosocial outcomes and can enhance clinical skills in both in-person and e-learning environments. However, there is need for further research on peer mentoring programs in occupational therapy curriculum.

Method: This retrospective qualitative study investigates the effects of peer mentoring on student perceptions of learning and professional development. Experiences were tracked for three semesters during the pandemic at an accredited entry-level occupational therapy …

Occupational Disruptions Among Health Professional Faculty During Covid-19 Pandemic, Supawadee C. Lee, Mahrukh Awan, Uruj Chaudhary, Priyanka John

The Open Journal of Occupational Therapy

The coronavirus disease was an unexpected pandemic. It led faculty in the health professional graduate programs to adjust and adapt to the new reality, which impacted them mentally, physically, and emotionally, and disrupted their occupational performance. The purpose of this phenomenological study was to examine the impact of COVID-19 on occupational engagement through semi-structured interviews conducted to understand the lived experiences of graduate faculty in health professional programs at one university in the northeast region. The interviews were analyzed by creating codes and themes through the process of peer debriefing. Eight faculty participated in the study, including faculty from the …

Occupational Disruption: The Influence Of The Covid-19 Pandemic On The Behavioral Inflexibility And Anxiety Of Autistic Children, Aaron R. Dallman, Catherine Perry, Jessica Goldblum, Nicole M. Butera, Brian Boyd, Clare Harrop

The Open Journal of Occupational Therapy

Background: The COVID-19 pandemic caused unprecedented changes to the lives of many. The aim of this paper was to understand how the COVID-19 pandemic impacted behavioral inflexibility (BI) and anxiety among autistic children and how autistic children and their families have adapted to COVID-19-related routine changes.

Methods: This sequential mixed-method study included two phases. During the first phase, parents of autistic children (N = 48) completed an online survey consisting of the Behavioral Inflexibility Scale (BIS) and the Parent-Rated Anxiety Scale – Autism Spectrum Disorder (PRAS-ASD). During the second phase, a subset of parents (parents of adolescents, N …

Occupational Therapists And Covid-19 Pandemic: An Observational Survey In Europe, Christian Pozzi, Alessandro Lanzoni, Pier Carlo Battain, Evelyn Alvarez, Eduardo Tobar, Ruth Hersche, Stefano Cavalli, Anna Monsò, Eva Llarch, Giuseppe Bellelli, Alessandro Morandi, Maud Graff

The Open Journal of Occupational Therapy

Background: The COVID-19 pandemic has resulted in a health care emergency in Europe since the first wave in 2020. Several challenges have arisen for occupational therapists, as well as all the health care professionals. The aim of this study was to determine what occupational therapists have changed to adapt their therapeutic processes for this catastrophic situation.

Method: An online survey was developed and sent in conjunction with the Council of Occupational Therapy for European Countries (COTEC) to European national associations of occupational therapists.

Results: The study was based on a sample of 65 occupational therapists who worked …

From Isolation To Connection: A Cross-Sectional Analysis Of Older Adults’ Social Participation Using The Cov19-Qol Scale, Kathleen Melei, Jill Linder

The Open Journal of Occupational Therapy

Background: Social isolation during COVID-19 has the capacity to impact older adults’ physical health, mental health, and quality of life. Using an occupational therapy perspective of social participation as an occupation, the current study explores (a) the extent to which social participation (habits/routines) has changed following the onset of the COVID-19 pandemic, (b) differences in perceptions of social participation in relation to the COVID-19 pandemic, and (c) differences in scores on the COVID-19 Quality of Life (COV19-QoL) scale by demographics, access to health care, and lifestyle routine.

Method: Community-dwelling adults (N = 230) 65 years of age or …

A Dialogue Regarding The Current Status Of Mental Health And Occupational Therapy Practice In The United States, Bryan M. Gee, Sonia Zimmerman, Janice Hinds, Halley Read

The Open Journal of Occupational Therapy

No abstract provided.

Increasing Occupational Engagement By Addressing Psychosocial And Occupational Factors Of Chronic Pain: A Case Report, John V. Rider, Monica C. Tay

The Open Journal of Occupational Therapy

Background: Chronic pain can significantly disrupt occupational engagement through physical, psychological, and social domains. Because pain is a subjective experience influenced by numerous factors, it has the capacity to become increasingly complex. Evidence supports addressing chronic pain through a biopsychosocial approach and promoting health and well-being through occupational engagement.

Method: This case report describes the implementation of psychosocial and occupation-focused assessments and interventions for a 68-year-old client with chronic pain and increased symptoms of depression, anxiety, and pain catastrophizing. The use of an occupation-focused time-use assessment (Occupational Experience Profile), psychosocial assessments, and pain assessments guided intervention development. Occupational …

Stress Matters: A Case Report In Occupational Therapy For Cancer-Related Cognitive Impairment, Amy Driga, Naomi Dolgoy, Julie Hunley

The Open Journal of Occupational Therapy

Background: This case report details occupational therapy (OT) for a woman with breast cancer experiencing cancer-related cognitive impairment (CRCI), referred to OT for memory strategies.

Method: Preliminary subjective and cognitive screenings were completed with further/finer assessment diarized.

Results: While the cognitive aspect of CRCI is often addressed via OT, in this case, stress was the most prevalent barrier to function reported. Stress was identified as: impacting occupational engagement, CRCI presentation, interfering with return-to-work goals, and accentuated given the COVID-19 pandemic. A common cancer-specific stress screening tool appeared inadequate in identifying the impact and interplay of stress on function, necessitating a …

Addressing Occupational Performance Deficits In A Religious Setting: A Pediatric Case Report, Bryan M. Gee, Daniel Leatham

The Open Journal of Occupational Therapy

Background: The purpose of this pediatric case report is to document how occupational therapy assisted a family with a child who has a diagnosis of ASD and the religious clergy increase the child’s participation in activities in the religious context.

Method: The pediatric case report uses an exploratory approach to explore the process of evaluating challenging psychosocial behaviors and implementing contextual and personal strategies to increase participation in meaningful occupations.

Results: As a result of the occupational therapy recommendations and follow-up consultations, the client demonstrated a reduction in behaviors that were a barrier to her participation in …

Occupational Therapy’S Psychosocial Role For Young Children Transitioning Out Of Foster Care, Patrick J. Walker, Bryan M. Gee, Sharon Leonard

The Open Journal of Occupational Therapy

Background: Unmet needs for children in the foster care system lead to hardships with social participation, healthy relationships, and occupational engagement. Despite an understanding of these needs, there is minimal research on occupational therapy’s role for young children transitioning from foster care back to their biological parents.

Method: A single case report was completed via occupational-based interventions focused on psychosocial development, such as emotional regulation and appropriate social skills. All nine interventions were intended to be provided via 45-min individual treatment sessions followed by biological parent coaching for 15 min with strategies such as role-playing, sensory techniques, and trauma-informed …

Occupational Therapy In Secondary Transition: A Case Report, Latoya Harvey, Susan Zapf, Sandra E. Groger

The Open Journal of Occupational Therapy

Introduction: This case report aims to inform the occupational therapy profession of best practice by providing an example of the profession’s role in secondary transition for students with disabilities.

Method: This qualitative case report examines the value of occupational therapy during transition in the life of one student with a disability. Six weeks of coaching and collaboration were provided to facilitate student engagement to enhance independent living skills, work-related skills, and self-determination. Pre-test and post-test results of the Roll Evaluation of Life Activities (REAL), the Goal-Oriented Assessment of Lifeskills (GOAL), the Goal Attainment Scaling (GAS), interviews, informal discussions, …

Occupational Therapy Enhancing Psychosocial Factors: Through The Lens Of Case Reports, Bryan M. Gee

The Open Journal of Occupational Therapy

No abstract provided.

Ritual During Covid-19, Stephen Covell, Diane Riggs, Cameron Borg, Ryan Lemasters, Jacob Riccioni

Modules for Teaching Pandemic Response and Religion in the USA

The following teaching module is designed for high school and college level instructors who seek to teach a lesson on the impact the COVID-19 pandemic had on the participation and practice of religious rituals. The teaching module features a lesson plan, case studies, and assignments that can be incorporated as the instructor sees fit. This teaching module was created by Western Michigan University's Department of Comparative Religion.

Considerations Of Pocus Vs Manual Pulse Check In Predicting Rosc For Patients Presenting In Pea, Steven M. Shockley, Justin Gambini

Doctor of Medical Science (DMSc)

Background: Point of care ultrasound (PoCUS) has enabled providers to draw a contrast between true PEA (Pulseless Electrical Activity) and pseudo-PEA. The incorporation of PoCUS pulse checks in PEA and pseudo-PEA has been shown to more accurately predict Return of Spontaneous Circulation (ROSC) when compared to standard manual pulse checks. However, concerns have been raised in recent observational studies regarding increased duration of PoCUS pulse checks compared to manual pulse checks leading to suboptimal CPR and subsequent deterioration of ACLS protocol integrity. Objective: This clinical review aims to examine the utility and practical implementation of PoCUS versus manual pulse …

2022-07-18 Michiganoverview_Covidbedppe, Michigan Department Of Health & Human Services

Michigan COVID-19 Hospital Data

Contains the tables Statewide Hospital Capacity Report for COVID-19, COVID-19 Metrics, Statewide Hospital Available PPE Tracking for COVID-19, as well as the tables PPE Days On Hand and Patient Census.

Age And Diet Shape The Genetic Architecture Of Body Weight In Diversity Outbred Mice., Kevin M Wright, Andrew Deighan, Andrea Di Francesco, Adam Freund, Vladimir Jojic, Gary Churchill, Anil Raj

Faculty Research 2022

Understanding how genetic variation shapes a complex trait relies on accurately quantifying both the additive genetic and genotype-environment interaction effects in an age-dependent manner. We used a linear mixed model to quantify diet-dependent genetic contributions to body weight measured through adulthood in diversity outbred female mice under five diets. We observed that heritability of body weight declined with age under all diets, except the 40% calorie restriction diet. We identified 14 loci with age-dependent associations and 19 loci with age- and diet-dependent associations, with many diet-dependent loci previously linked to neurological function and behavior in mice or humans. We found …

An Il1rl1 Genetic Variant Lowers Soluble St2 Levels And The Risk Effects Of Apoe-Ε4 In Female Patients With Alzheimer’S Disease, Yuanbing Jiang, Xiaopu Zhou, Hui Yi Wong, Li Ouyang, Fanny C. F. Ip, Vicky M. N. Chau, Shun-Fat Lau, Wei Wu, Daniel Y. K. Wong, Heukjin Seo, Wing-Yu Fu, Nicole C. H. Lai, Yuewen Chen, Alzheimer’S Disease Neuroimaging Initiative, Charles D. Smith, Gregory A. Jicha, Peter A. Hardy, Partha Sinha, Elizabeth Oates, Gary Conrad

Sanders-Brown Center on Aging Faculty Publications

Changes in the levels of circulating proteins are associated with Alzheimer’s disease (AD), whereas their pathogenic roles in AD are unclear. Here, we identified soluble ST2 (sST2), a decoy receptor of interleukin-33–ST2 signaling, as a new disease-causing factor in AD. Increased circulating sST2 level is associated with more severe pathological changes in female individuals with AD. Genome-wide association analysis and CRISPR–Cas9 genome editing identified rs1921622, a genetic variant in an enhancer element of IL1RL1, which downregulates gene and protein levels of sST2. Mendelian randomization analysis using genetic variants, including rs1921622, demonstrated that decreased sST2 levels lower AD …

2022-07-15 Michiganoverview_Covidbedppe, Michigan Department Of Health & Human Services

Michigan COVID-19 Hospital Data

Contains the tables Statewide Hospital Capacity Report for COVID-19, COVID-19 Metrics, Statewide Hospital Available PPE Tracking for COVID-19, as well as the tables PPE Days On Hand and Patient Census.

Cranial Base Synchondrosis: Chondrocytes At The Hub, Shawn A Hallett, Wanida Ono, Renny T Franceschi, Noriaki Ono

Faculty, Staff and Student Publications

The cranial base is formed by endochondral ossification and functions as a driver of anteroposterior cranial elongation and overall craniofacial growth. The cranial base contains the synchondroses that are composed of opposite-facing layers of resting, proliferating and hypertrophic chondrocytes with unique developmental origins, both in the neural crest and mesoderm. In humans, premature ossification of the synchondroses causes midfacial hypoplasia, which commonly presents in patients with syndromic craniosynostoses and skeletal Class III malocclusion. Major signaling pathways and transcription factors that regulate the long bone growth plate-PTHrP-Ihh, FGF, Wnt, BMP signaling and Runx2-are also involved in the cranial base synchondrosis. Here, …