Medical Specialties Commons^™

Evaluation Of Hydrocortisone, Vitamin C, And Thiamine For The Treatment Of Septic Shock: A Randomized Controlled Trial (The Hyvits Trial), Adham Mohamed, Mohamed Abdelaty, Mohamed O. Saad, Ahmed Shible, Hassan Mitwally, Abdel-Rauof Akkari, Abdurrahmaan Elbuzidi, Awadh Bintaher, Ahmed Hashim, Marcus Lance

Anaesthesiology, East Africa

Purpose: The aim of the study is to evaluate the effect of combined hydrocortisone, vitamin C, and thiamine (triple therapy) on the mortality of patients with septic shock.

Methods: This multicenter, open-label, two-arm parallel-group, randomized controlled trial was conducted in four intensive care units in Qatar. Adult patients diagnosed with septic shock requiring norepinephrine at a rate of ≥0.1 μg/kg/min for ≥6 h were randomized to a triple therapy group or a control group. The primary outcome was in-hospital mortality at 60 days or at discharge, whichever occurred first. Secondary outcomes included time to death, change in Sequential Organ …

The Ethical And Validity Conundrum In Epilepsy Research In Lmic Settings, Pauline Samia, Adeel Shah, Archana Patel, Philip Olielo, Lionel Mudave, Samson Gwer

Brain and Mind Institute

In the last few decades, research in epilepsy has significantly improved understanding of risk factors and etiologies associated with epilepsy, promoting greater access to interventions and medications that have improved health-related outcomes for patients. However, these advances and benefits are not being felt evenly on a global scale due to significant inequalities in access to and utilization of research resources and expertise in Low-and Middle-Income Countries (LMICs).

To promote effective research output, and advance evidence-based practices; the context, disease burden, and challenges that hinder good research need to be re-defined and addressed. This is key in facilitating implementation of coherent …

Psychometric Evaluation Of The Computerized Battery For Neuropsychological Evaluation Of Children (Benci) Among School Aged Children In The Context Of Hiv In An Urban Kenyan Setting, Rachel Maina, He Jia, Amina Abubakar, Miguel Perez-Garcia, Manasi Kumar, Jelte M. Wicherts

Brain and Mind Institute

Introduction Culturally validated neurocognitive measures for children in Low‐ and Middle‐Income Countries are important in the timely and correct identification of neurocognitive impairments. Such measures can inform develop‐ ment of interventions for children exposed to additional vulnerabilities like HIV infection. The Battery for Neuropsy‐ chological Evaluation of Children (BENCI) is an openly available, computerized neuropsychological battery specifically developed to evaluate neurocognitive impairment. This study adapted the BENCI and evaluated its reliability and validity in Kenya.

Methodology The BENCI was adapted using translation and back‐translation from Spanish to English. The psy‐ chometric properties were evaluated in a case–control study of 328 …

Oral Manifestations Of Acute Lymphocytic Leukemia, Angela Yepes Dds, Ms, Mba, Juan Yepes Dds, Md, Mph, Ms, Drph, James E. Jones Dmd, Msd, Edd, Phd

The Journal of the Michigan Dental Association

Leukemia is the most prevalent malignancy of leukocytes and can occur in children and adults. Oral manifestations are part of the complexity of signs and symptoms in patients with leukemia and, in some patients, oral manifestations precede systemic manifestations. Oral signs of leukemia include spontaneous bleeding, gingival enlargement, and whiteness of the oral mucosa. Head and neck lymphadenopathy is common in patients with leukemia. Oral manifestations are the result of the direct invasion of immature cells in the oral cavity tissues or indirectly caused by the replacement of the normal blood cells for immature cells causing anemia, leucopenia, and thrombocytopenia. …

Use, Durability, And Risks For Discontinuation Of Initial And Subsequent Biologics In A Large Pediatric-Onset Ibd Cohort., Jess L. Kaplan, Chunyan Liu, Eileen C. King, Julie A. Bass, Ashish S. Patel, Jeanne Tung, Shiran Chen, Trevor Lissoos, Ninfa Candela, Shehzad Saeed, Richard B. Colletti, Improvecarenow Network

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Biologic medications are recommended for treatment of moderately-to-severely active Crohn disease (CD) or ulcerative colitis (UC) in children. However, many patients require sequential biologic treatment because of nonresponse or loss of response to the initial biologic.

METHODS: We analyzed pediatric inflammatory bowel disease (IBD) data from the ImproveCareNow Network registry between May 2006 and September 2016, including time to biologic initiation, choice of first subsequent biologics, biologic durability, and reasons for discontinuation.

RESULTS: Of 17,649 patients with IBD [CD: 12,410 (70%); UC: 5239 (30%)], 7585 (43%) were treated with a biologic agent before age 18 (CD: 50%; UC: 25%). …

Real-World Experience Of Pediatric Patients Treated With Peanut (Arachis Hypogaea) Allergen Powder-Dnfp., Jay M. Portnoy, Jodi Shroba, Stephen Tilles, Hela Romdhani, Sarah M. Donelson, Dominick Latremouille-Viau, Rebecca Bungay, Kathleen Chen, William Mccann

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Peanut (Arachis hypogaea) allergen powder-dnfp (PTAH) is the first oral immunotherapy indicated for children aged 4 to 17 years with peanut allergy. There are limited real-world data on patients treated with PTAH.

OBJECTIVE: To characterize pediatric patients treated with PTAH and associated treatment patterns in US clinical practice.

METHODS: US-based physicians with allergy and immunology training treating patients with peanut allergy aged 4 to 17 years with PTAH were recruited from an existing physician panel and completed an online case report form (October to December 2021) with data abstracted from patient medical charts. Physician practice circumstances, patient characteristics, and …

Obstetric Outcomes Assessment For New Mainers, Brendan Prast, Christina T. Holt, Amy Haskins, Debra Rothenberg

Costas T. Lambrew Research Retreat 2023

Introduction

• 13% of Portland’s population in 2019 was recent immigrants

• Numbers have increased, with >350 asylum-seeking families (1500 individuals) in 2022 in Portland alone

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

• Total deliveries in 2020, 2021 (6192) broke records at MMC

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

Shortening The Postoperative Length Of Stay Following Total Knee Arthroplasty Does Not Negatively Impact Short-Term Patient Outcomes; A Retrospective Review Of The Response To The Covid-19 Pandemic, Bailey Shevenell, Johanna Mackenzie, Cassandra Lieblein, Brian J. Mcgrory, Michael Becker, Nicholas Colacchio, Adam Rana

Costas T. Lambrew Research Retreat 2023

Safely Decreasing Postoperative Length of Stay for Total Knee Arthroplasty (TKA) Patients Following the COVID-19 Pandemic

Food Insecurity Screening In People With Cystic Fibrosis, Rebecca Edwards, Lauren Tate, Ana Cairns, Cheryl Coyne, Kathleen Walker, Kim Violette, Ann Ladner, Jessica D'Amico

Costas T. Lambrew Research Retreat 2023

Background: Adequate nutrition is a cornerstone in the management of cystic fibrosis (CF). Malabsorption secondary to pancreatic insufficiency and increased energy demands related to lung disease can increase energy requirements over twofold for a person with CF. Food insecurity (FI) affects approximately 10% of Mainers (1). Per the Cystic Fibrosis Foundation, there may be up to a threefold increase in the prevalence of FI in the CF population (2). To address this issue, we implemented FI screening in the adult and pediatric CF programs to identify the prevalence of FI within our population and to offer immediate interventions.

An Educational Intervention To Improve Pediatric Inter-Rater Reliability Of The Hospital Asthma Severity Score (Hass), Anne Coates, Amanda Gagnon, Noah Diminick

Costas T. Lambrew Research Retreat 2023

Objective: To assess if an inter-professional educational intervention can improve the accuracy and inter-rater reliability of the HASS

Covid-19 Prevalence And Trends Among Pregnant And Postpartum Individuals In Maine By Rurality And Pregnancy Conditions, Charlie Grantham, Christina Ackerman-Banks, Heather Lipkind, Kristin Palmsten, Katherine Ahrens

Costas T. Lambrew Research Retreat 2023

Our study is the first to estimate prevalence of COVID-19 among pregnant and postpartum individuals for Maine, using data that captures both commercial and public insurance and examines differences by rurality, a known modifier of COVID-19 infections in the U.S. individuals.

Simulation-Based Resuscitative Transesophageal Echocardiography Training For Emergency Medicine Residents, August Felix, Andrew Fried, Jessica Hathaway, Tania D. Strout

Costas T. Lambrew Research Retreat 2023

Introduction: Resuscitative TEE is an emerging tool in the cardiac arrest tool-box, and can improve outcomes in OHCA.

• Identifies reversible causes

• Decreases time off chest

• Evaluates compression efficacy

• Improves assessment during pulse-checks

• Simulation training can prepare EM residents to obtain and interpret TEE views on a live patient.

Covid-19 And Depression And Anxiety Screening In Primary Care, Elizabeth Bernier, Abrey Feliccia, Leah Wood, Kate Herlihy, Kristen A. Woodberry

Costas T. Lambrew Research Retreat 2023

Introduction:

• The COVID-19 pandemic had a severe effect on mental health, heightening the prevalence and severity of anxiety and depression amongst the general population in rural and non-rural areas, particularly youth.

• Most reports draw from available data from mental health referrals, hospitalizations, suicides, and other incident data

• There is limited longitudinal information from general population samples using standardized mental health assessments.

Pathways To Care Of Maine Youth With Psychosis, Elizabeth M. Mutina, Rebecca Jaynes, Dave Weiss, Elizabeth Bernier, Kristen A. Woodberry

Costas T. Lambrew Research Retreat 2023

Study clinicians conducted semi-structured interviews to identify the timing and steps of each person’s Pathway to Care (PtC).

Access To Pediatric Type 1 Diabetes Care In Montana, James C. Bohnhoff, Michael Kohut Phd, Chelsea Bodnar, Elizabeth A. Jacobs

Costas T. Lambrew Research Retreat 2023

Introduction: Management of Type 1 Diabetes (T1D) requires significant family effort and specialty support. We aimed to understand how living in a rural state impacts families’ experiences during and after diagnosis.

The Maine Obstetric Medical Simulation (Momsim) Program Identifies And Categorizes Latent Safety Threats Across Rural Hospitals, Jeffrey Holmes, Leah Mallory, Micheline Chipman, Becky Hunt, Sarah Austin, Tracey E. Mcmillan, Emily Watson, Mainehealth

Costas T. Lambrew Research Retreat 2023

Objective: Combine in-situ simulation with an HFMEA framework to identify and categorize common system wide LST and opportunities to improve patient safety

An Oncology, Lifestyle Medicine, And Cardiac Rehabilitation Partnership In The Development Of A Group Medical Visit Model For Cancer Survivors, Amy Litterini, Caitlin Coppenrath, Ashley Speckhart, Amy Pearl, Theodore Wissink

Costas T. Lambrew Research Retreat 2023

Methods/Approach: An oncology and cardiology team developed an oncology provider survey in REDCap designed to assess attitudes regarding perspectives on cardio-oncology, rehabilitation, and Lifestyle Medicine. The 27-item multiple choice and Likert-style survey was distributed via email on three separate occasions to MaineHealth Cancer Care Network providers (n=66) in spring, 2022.

Neurocope: A Novel Intervention To Increase Professional Fulfillment And Reduce Burnout By Connecting Neuro-Icu Healthcare Workers To Their Post-Recovery Patients, Angela Leclerc, Mary Sorcher, David Seder, Sara Penrod, Meghan Searight, Alison Daley, Sarah Hanken, Christine Lord, Whitney Trosper, Stephanie Chan, Jennifer Cote

Costas T. Lambrew Research Retreat 2023

Background:

Healthcare workers (HCWs) caring for patients with acute neurologic injury in the ICU rarely receive detailed information on the recovery of their patients. The missing connection between the period of acute neurologic injury and long-term outcomes is a psychological burden that contributes to moral fatigue and burnout.

We hypothesize that attending an Interprofessional conference series through which patients describe their acute brain injury and recovery to Neuro-ICU HCWs may ease moral fatigue, increasing professional fulfillment and reducing burnout.

Befast Assessment In A Rural Community Hospital – The Birch Study, Caroline Knight, Eileen Hawkins, Hilary Merrifield, Laura Stein, Robert Stein

Costas T. Lambrew Research Retreat 2023

Background: There are known regional disparities in treatment rates with thrombolysis and thrombectomy for acute ischemic stroke. BEFAST has been implemented in acute stroke protocols to aid in recognition of signs of stroke, but its utility in a rural ED is not well known.

The Past, Present, And Future Of Distress Screening: Launching A Robust Distress Screening Program At A Large Outpatient Medical Oncology Practice Serving Rural/Underserved Communities, Kevin Stein, Trisha Warren-Vanhorn, Meredith Curtis, Amy Litterini, Amit Sanyal

Costas T. Lambrew Research Retreat 2023

After redesign, administration of the DT at initial chemotherapy teaching sessions and robust searchable databases integrated with EHR systems, allowing providers/researchers to create reports filtered by date ranges, encounter type, clinical site/facility, scores of ≥4, domain (physical, emotional, practical), and outcome (referral to specialist)

Healthy Links – Addressing Social Determinants Of Health And Improving Cardiac Health With Medically Tailored Meals, Emily Follo, Katherine Sharp, Mylan Cohen

Costas T. Lambrew Research Retreat 2023

Introduction:

• Social determinants of health (SDOH) strongly influence risk factors for cardiac disease, especially in rural areas

• Medically-tailored meals have shown promising results for reducing hospitalizations

• Some state insurance programs are covering medically-tailored meals given beneficial outcome studies

• This project builds upon prior Healthy Links programs to expand our reach to rural patients

Conversion Total Hip Arthroplasty: Perioperative And Postoperative Outcomes With The Able Approach, Bailey Shevenell, Johanna Mackenzie, Sarah Hearns, George Babikian, Brian J. Mcgrory, Adam Rana

Costas T. Lambrew Research Retreat 2023

The ABLE™ Approach for Conversion Total Hip Arthroplasty decreases surgical duration and length of stay

The Use Of The Ipack Block With The Adductor Canal Block (Acb) Decreases 48-Hour Narcotic Usage And Postoperative Pain Following Total Knee Arthroplasty, Bailey Shevenell, Johanna Mackenzie, Matthew Hersch, Michael Becker, Brian J. Mcgrory, Nicholas Colacchio, Adam Rana, Ryan Mountjoy, Rob Hubbs

Costas T. Lambrew Research Retreat 2023

Adductor Canal and iPACK Blocks reduce pain levels and narcotic consumption following Total Knee Arthroplasty

The Relationship Between Adverse Childhood Experiences And Pediatric Functional Gastrointestinal Disorders, Rachel Coffey, Jackson Bloch, Anya K. Cutler, Sarah M. Gabrielson, Stephen Digiovanni, Julia Fritz

Costas T. Lambrew Research Retreat 2023

Introduction:

• 1 in 4 kids in Maine have 3+ adverse childhood experiences (ACEs)

• ACEs negatively impact health outcomes

• Adult literature shows association between ACEs and irritable bowel syndrome, a functional gastrointestinal disorder (FGID)

The Gender Clinic At The Barbara Bush Children’S Hospital: Demographics, Diagnoses, And Treatment Goals, Brandy Brown

Costas T. Lambrew Research Retreat 2023

Introduction: Program evaluation to better understand patients referred to The Gender Clinic.

Improving Adherence To The American Association Of Pediatrics Clinical Practice Guideline For The Evaluation And Management Of Well-Appearing Febrile Infants At Maine Medical Center: A Quality Improvement Project, Gabriela De Oliveira Md, Sarah M. Gabrielson Mph, Bsn, Rn, Jillian Gregory Do, Lori Travis Ms, Kendall Dapprich Mph, Meredith Jackson Md, Erica Swan Mba

Costas T. Lambrew Research Retreat 2023

Educational interventions sustain increased CRP collection rates for better adherence to the AAP guidelines for evaluating well-appearing febrile infants.

A Prospective Sonographic Evaluation Of Peripheral Intravenous Catheter Associated Thrombophlebitis, Nicholas Mielke, Steven Johnson, Patrick Karabon, Amit Bahl

Posters

Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment.

Evaluation Of Online Patient Information Regarding Emergency Center Utilization, Rachel Truland, Steven Joseph

Posters

The decision a patient makes when seeking emergency medical care comes with risks and ambiguity if the right decision is not made. The internet is increasingly accessible to patients, and they often consult an internet search prior to seeking healthcare. The aim of this study is to assess the readability and reliability of online information regarding a patient’s decision to seek emergency care.

Rapid Response Team Codes Following Transition-Of-Care From The Emergency Department To An Inpatient Medicine Unit, Kerrin Bersani, Brett Todd

Posters

Transitions-of-care from the emergency department (ED) to an inpatient unit have been identified as a high-risk period for medical error due to multiple causes, such as communication mishaps, excessive workload, variability in patient flow, and unclear assignment of responsibility. Patients who experience a diagnostic error are also at increased risk for poor outcomes, including increased length-of-stay and mortality. Rapid Response Teams (RRTs) are frequently utilized by hospitals to address a sudden deterioration in clinical status, often after a transition-of-care. We investigated the occurrence of RRT in patients shortly after a transition-of-care from the ED to a medicine unit. Further, we …

Impact Of Earlier Ophthalmology Clerkships On Medical Student Match Rates In Ophthalmology, Andrew Lee, Steven Joseph

Posters

The purpose of this study is to analyze the association between earlier clerkship exposure and match success, specifically in ophthalmology. Medical schools are constantly changing their clinical curriculums to provide a stronger foundational education to their students. The structure of each medical school’s clerkship curriculum varies in timing, length and availability of certain core and elective rotations. Gaining a better understanding of the factors that affect student match rates in certain specialties can influence changes in clinical curricula to maximize future match success.