Medical Specialties Commons^™

Convalescent Plasma In Covid-19, Ranjit S. Banwait, Joshua K. Salabei, Troy J. Fishman, Uma G. Iyer

HCA Healthcare Journal of Medicine

The recent pandemic of SARS-CoV-2, which causes novel coronavirus disease 2019 (Covid-19), has had devastating impact on a global and national scale. In order to overcome this outbreak it is imperative we find treatments that are safe and effective. To date, no definitive treatment is available that can curtail the spread of this viral syndrome. Convalescent plasma (CP) is one such option that has repeatedly served as an important tool in treatment of various bacterial and viral infections, especially in the setting of no specific antimicrobial or vaccination against an infectious disease. Herein, we review the history of CP, prior …

Geriatrics In Clinical Practice And Beyond: Brain Health, The Sixth Vital Sign?, Nannette Hoffman

HCA Healthcare Journal of Medicine

Brain health in middle age and geriatric patients will take on greater importance for health care practitioners in our aging society. This article discusses various approaches clinicians can use for their patients to promote and improve brain health. These are generally the same lifestyle adoptions for cerebrovascular disease and cardiovascular disease prevention: weight management, exercise, and blood pressure and cholesterol lowering. Social stimulation and cognitive activities may also be important for the elderly.

The Other Epidemic, Bruce Deighton

HCA Healthcare Journal of Medicine

The epidemic level of opioid abuse in the U.S. population continues to present a major challenge to our society and to the medical profession. Medical education has a significant role in improving screening, diagnosis, appropriate treatment and management of opioid use disorder. Addressing the problem of overprescribing opioids through physician education, surveillance and opioid management has resulted in significant improvement, translating to fewer overdose deaths from prescription opioids. Graduate medical education can increase access to care by training more addiction medicine specialists, and training other physicians to prescribe buprenorphine and provide access to medically assisted care.

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 …

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 …

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

Current Recommendations For The Perioperative Management Of Patients On Buprenorphine: A Case Study, Coreen Tanner

Nurse Anesthesia Student Capstones

According to the US Department of Health and Human Services, more than 2 million Americans suffer from opioid use disorder (DHHS, 2020). Opioid maintenance therapy (OMT) for OUD has been shown to reduce the rates of inpatient hospitalization and overall opioid-related mortality (Quaye & Zhang, 2019). Buprenorphine is a partial mu receptor agonist and kappa receptor antagonist that is used frequently by patients on OMT. Beginning in 2010 annual prescriptions for buprenorphine products have increased dramatically (Lembke, Ottestad, & Schmiesing, 2019).

With the rising level of chronic pain and opioid use nationally, more and more patients taking buprenorphine are presenting …

Norepinephrine Use In Septic Patients Undergoing General Anesthesia, Lauren Reed

Nurse Anesthesia Student Capstones

Anesthesia providers are frequently confronted by the problem of caring for patients presenting with sepsis in the operating room. Sepsis is associated with high healthcare costs and a significant mortality rate despite advancements in the understanding of its complicated pathophysiology. The 2016 Surviving Sepsis Campaign recommends norepinephrine as the first-choice vasopressor in septic patients. Its mild beta-adrenergic effects, in addition to its alpha-adrenergic effects, make it an attractive agent for the vasoplegia and myocardial dysfunction associated with sepsis. Earlier achievement of adequate perfusion pressures, earlier lactate clearance, and higher in-hospital survival have all been associated with norepinephrine use in the …

Simulation To Reduce Medical Errors And Improve Patient Safety In Anesthesia, Matthew Leblanc

Nurse Anesthesia Student Capstones

Over the past two decades, simulation in medical education has been adopted by health education programs and established as a proven method of education for health care students and providers. Despite the addition of simulation to healthcare education, medical errors are ranked as the third leading cause of death in the United States. The purpose of this literature review is to investigate the translation of simulation education into increased patient safety and reduction of medical errors in anesthesia. Overall, the literature reviewed confirms that simulation can be used to reduce medical errors and improve patient safety. Additional correlational research between …

Dexmedetomidine Use And Various Techniques Of Administration To Reduce Emergence Delirium In Pediatric Surgical Patients Undergoing General Anesthesia With Volatile Agents, Sara K. Dusza

Nurse Anesthesia Student Capstones

This analysis of literature evaluated retrospective chart reviews and randomized controlled trials of school aged children undergoing surgical procedures necessitating general anesthesia with volatile inhalant anesthetic agents. These studies assessed and compared the efficacy of various routes and timing of administration of dexmedetomidine as a pre-medication to determine the most effective technique in reducing the incidence of postoperative emergence delirium (ED). ED presents as a transient, acute episode of delirium occurring during the transition from unconsciousness to complete wakefulness after general anesthesia with anesthetic gases. The results of this review suggested that pediatric patients treated with intranasal dexmedetomidine preoperatively experienced …

Treating Post-Dural Puncture Headaches: Sphenopalatine Block, Cosyntropin And Epidural Blood Patch, Amalia Zychowicz

Nurse Anesthesia Student Capstones

Post-dural puncture headache (PDPH) is a severe and debilitating complication that can occur following neuraxial anesthesia. Obstetric patients are at an increased risk for this complication due to their gender, young age, and widespread use of neuraxial anesthesia. A hallmark sign of PDPH is a postural headache that improves when lying down and worsens when sitting or standing. It requires prompt diagnosis and treatment due to its incapacitating effects. The gold-standard treatment for PDPH is an epidural blood patch (EBP). However, this is an invasive procedure with multiple contraindications and the potential for severe complications. Noninvasive, more conservative therapies such …

Sugammadex Versus Neostigmine In Reducing Postoperative Adverse Effects In The Pediatric Population, Robert Vieto Jr.

Nurse Anesthesia Student Capstones

Neostigmine and sugammadex are two medications used to reverse the neuromuscular blockade caused by nondepolarizing aminosteroidal neuromuscular blocking agents. Research has shown an association between the use of acetylcholinesterase inhibitors, such as neostigmine, and residual neuromuscular blockade in pediatric patients. Sugammadex has been shown to reduce residual neuromuscular blockade in adults without adverse effects, but minimal research has been performed on the effects of sugammadex in the pediatric population. Therefore, the objective of the present study is to compare sugammadex and neostigmine to determine if using sugammadex instead of neostigmine reduces postoperative adverse effects in the pediatric population. A systematic, …

Basic Airway Management For Non-Anesthesia Operating Room Personnel: Education Implementation, Dylan Ouellette

Nurse Anesthesia Student Capstones

A review of basic airway management for non-anesthesia personnel is presented. Included is a literature review of 20 articles surrounding the most current literature on preoperative airway assessment, cricoid pressure, video laryngoscopy, adjuncts for airway management, and airway management education for non-anesthesia health-care personnel. Following the review, an in-service style education presentation was developed and implemented at two sites in Maine. A pre- and post-test evaluation of the participants demonstrated an overall increase in test scores of 22%.

Anesthetic Implications Of Intraarterial Chemotherapy For Retinoblastoma: A Literature Review, Marguerite Mullin

Nurse Anesthesia Student Capstones

Retinoblastoma (RB) is a rare pediatric cancer commonly diagnosed in patients at a very young age. New therapies for this disease are emerging that involve some degree of sedation, requiring anesthesia providers to be involved in their care. Intraarterial chemotherapy (IAC) is one of these new exciting treatment options and requires general anesthesia. Multiple studies and case reports have reported a sudden decrease in pulmonary compliance during IAC for RB and attribute this response to the trigemino-cardiac reflex (TCR). Once this event occurs, patients experience associated hypoxemia, hypotension, bradycardia, and cardiovascular collapse. A systematic literature review was aimed at educating …

Exparel Versus Bupivacaine: Outcomes, Advantages, And Costs, Jessica Duraney

Nurse Anesthesia Student Research Posters

Research poster comparing two local anesthetics, bupivacaine and Exparel (liposomal bupivacaine). The use of these drugs in various regional techniques, specifically for total knee arthroplasty (TKA) and abdominal surgeries, is discussed. Research shows that adequate pain control is associated with increased patient satisfaction, faster rehabilitation, mobilization, reduced hospital stays, and ultimately decreased hospital costs. Due to the many disadvantages of opioids, such as ileus, nausea, vomiting, respiratory depression, tolerance, and physical dependence, there has been a push for opioid-sparing and multimodal analgesia perioperatively.

Lessons Amidst A Pandemic, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Malignant Hyperthermia For The Nurse Anesthetist, Victor Clark

Nursing Student Class Projects (Formerly MSN)

Malignant Hyperthermia (MH) is a rare, autosomal dominant skeletal muscle disorder that can have an insidious onset in susceptible patients exposed to the triggering agents succinylcholine, halothane, desflurane, sevoflurane, and isoflurane. MH can occur in patients who have received anesthesia with these agents in the past (Nagelhout & Plaus, 2018, p 775). Patients with a family history of MH or associated skeletal muscle disorder must be treated as MH-susceptible until proven otherwise. Failure to detect an MH crisis can lead to kidney failure, profound acidosis, coagulopathies, rhabdomyolysis, cardiac dysrhythmias, cardiovascular collapse, and death (Seifert et al., 2015). It is the …

A Comparison Efficacy Study Of Commercial Nasopharyngeal Swabs Versus A Novel 3d Printed Swab For The Detection Of Sars-Cov-2, Forest W. Arnold, Gerald Grant, Phillip F. Bressoud, Stephen P. Furmanek, Donghoon Chung, Nadine Sbaih, Dipan Karmali, Meredith Cahill, George Pantalos

The University of Louisville Journal of Respiratory Infections

Introduction: The large volume of diagnostic tests required by the response to the COVID-19 pandemic resulted in a shortage of commercial nasopharyngeal swabs. In an effort to alleviate the shortage, swabs created by 3D printing may be a solution.

Methods: We designed and produced 3D printed swabs and sought to compare their ability to detect SARS-CoV-2 in patients admitted for COVID-19 or who were suspected of having COVID-19.

Results: A total of 30 patients were swabbed with a commercial and a 3D printed swab. Results matched in 27 of 30 patients (90%). Two patients were discordant with a positive commercial …

Psychometric Properties Of The College Athlete Psychological Screening Tool: Validation Of The Depression And Anxiety Subscales, Joseph C. Case

Dissertations

The aim of the present study was to gain a better understanding of the descriptive psychometric properties of the College Athlete Psychological Screening (CAPS) measure. The CAPS is a newly developed assessment screening measure designed to assess 14 common problem areas for college athletes. For the present investigation, 395 participants completed the 108-item CAPS measure. To establish criterion validity, participants also completed the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The present study had three research questions. Question one discussed the descriptive psychodynamic properties (Cronbach’s alpha, means, and standard deviations) of the 14 CAPS subscales. Question two …

Exparel Versus Bupivacaine: Outcomes, Advantages, And Costs, Jessica Duraney

Nurse Anesthesia Student Capstones

Research shows that adequate pain control is associated with increased patient satisfaction, faster rehabilitation, mobilization, reduced hospital stays, and ultimately decreased hospital costs. Due to the many disadvantages of opioids, such as ileus, nausea, vomiting, respiratory depression, tolerance, and physical dependence, there has been a push for opioid-sparing and multimodal analgesia perioperatively. The purpose of this paper is to compare two local anesthetics, bupivacaine and Exparel (liposomal bupivacaine). The use of these drugs in various regional techniques, specifically for total knee arthroplasty (TKA) and abdominal surgeries, will be discussed.

Reducing Anesthesia Workstation Contamination, Taryn Giese

Nurse Anesthesia Student Capstones

Healthcare-associated infections are a source of morbidity and mortality in the United States and have been shown to be more preventable than current incidence. Anesthesia providers may be a source of and vector for some of these infections. Nurse anesthetists provide direct individual care for numerous patients daily, managing airways and invasive devices that contaminate hands with secretions which then may be transferred to the anesthesia workstation. Due to its complexity, the anesthesia machine is difficult to thoroughly clean and may become a reservoir for contaminants.

The purpose of this paper will be to examine new interventions being explored to …