Journal of Maine Medical Center最新文献

{"title":"Sports-Related Concussion Management and Guideline Awareness in the Primary Care Setting","authors":"Stephanie K Eble, Oleksandra Pashchenko, William Patterson, Christina T Holt, William Dexter, Kristine Karlson","doi":"10.46804/2641-2225.1174","DOIUrl":"https://doi.org/10.46804/2641-2225.1174","url":null,"abstract":"","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":"58 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139534943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Epidemic of Gun Violence and the Role of Health care Professionals","authors":"Daniel Meyer, Kurt Granhke","doi":"10.46804/2641-2225.1181","DOIUrl":"https://doi.org/10.46804/2641-2225.1181","url":null,"abstract":"","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":" 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139627634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Victor A. McKusick, MD and The Osler Medical Service – Firm System Threads Between Baltimore and Maine: The 15th Annual McKusick Lecture","authors":"S. Remick","doi":"10.46804/2641-2225.1175","DOIUrl":"https://doi.org/10.46804/2641-2225.1175","url":null,"abstract":"","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":"67 50","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139534611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of a Needs Assessment: Use of Sexual Orientation and Gender Identity Data in Health Systems in Maine","authors":"Lucy Soule, Melissa Fairfield, Sivana Barron, Natalie Kuhn, Brandy Brown","doi":"10.46804/2641-2225.1167","DOIUrl":"https://doi.org/10.46804/2641-2225.1167","url":null,"abstract":"","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139627796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Analytics in Cardiothoracic Care: Enhancing Outcomes with the Healthcare Enabled by Artificial Intelligence in Real Time (HEART) Project.","authors":"Felistas Mazhude, Robert S Kramer, Anne Hicks, Qingchu Jin, Melanie Tory, Jaime B Rabb, Mahsan Nourani, Douglas B Sawyer, Raimond L Winslow","doi":"10.46804/2641-2225.1195","DOIUrl":"10.46804/2641-2225.1195","url":null,"abstract":"<p><strong>Problem: </strong>Postoperative complications after cardiac surgery significantly impact both the short-term and long-term survival of patients. Cardiovascular diseases are a major health concern, accounting for 12% of health expenditures in the United States. A substantial number of patients with cardiovascular disease undergo invasive procedures, including cardiac surgery, and the incidence of postoperative complications is notable. This information underscores the need to effectively prevent postoperative adverse events to improve outcomes, reduce morbidity, shorten hospital stays, and lower health care costs.</p><p><strong>Approach: </strong>The Healthcare Enabled by Artificial Intelligence in Real Time (HEART) project is a collaborative effort involving clinicians from MaineHealth, industry experts from Nihon Kohden, and data scientists from the Roux Institute. The project aims to develop a real-time predictive analytics model as a decision support tool for clinicians in the cardiothoracic intensive care unit who care for patients after cardiac surgery. The team is using a supervised, closed-loop, machine learning design to train the model. The initiative involves collecting static and dynamic preoperative, intraoperative, and postoperative variables from a cohort of patients undergoing cardiac surgery at Maine Medical Center. These variables, including data on blood product transfusions and inotropic and vasoactive medications administered, are being transmitted from the electronic health record to a data warehouse. The model will predict the following adverse outcomes: acute kidney injury, renal failure, new onset postoperative atrial fibrillation, prolonged ventilation, reoperation, operative mortality, delirium, stroke, deep sternal wound infection, and extended hospital length of stay.</p><p><strong>Outcomes: </strong>The HEART team successfully established a data-collecting infrastructure. Data collection and validation are ongoing, with an emphasis on accuracy and completeness.</p><p><strong>Next steps: </strong>The project will advance by developing a user-friendly, real-time interface, incorporating feedback from clinicians in the operating room and cardiothoracic intensive care unit to ensure practicality and acceptance of the technology. This interface will provide adverse outcome predictions in real time, support clinical decision-making, and become a regular part of patient care.</p>","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":"6 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process Improvement Initiative to Reduce Average Length of Stay in a Community Hospital - A Preliminary Report.","authors":"Alexander M Reppond, Nicholas Flavin, Michael N Albaum","doi":"10.46804/2641-2225.1197","DOIUrl":"10.46804/2641-2225.1197","url":null,"abstract":"<p><strong>Introduction: </strong>Average length of stay (ALOS) has increased in many US hospitals in the post-COVID-19-pandemic world. We undertook a process improvement initiative to reduce the ALOS in our community hospital.</p><p><strong>Methods: </strong>Three core tactics were developed with a goal of reducing our ALOS by 10%. These tactics were early mobilization, Interprofessional Partnership to Advance Care and Education rounding, and structured interdisciplinary care rounds. Workgroups in each of these domains designed the improvement, devised measures of success, and implemented the tactic. A process improvement specialist worked with each workgroup using elements of the Model for Improvement. Process measures were reported weekly. Outcome measures (ALOS, observed vs expected LOS) were reported weekly. A central steering committee oversaw the initiative. All tactics were fully implemented by February 2023.</p><p><strong>Results: </strong>For the first 6 months after implementing our tactics, the ALOS on our inpatient medical units decreased from 6.3 to 5.5 days (13.7%) when compared with the same 6-month period in the prior year (P < .01).</p><p><strong>Discussion: </strong>We used 3 interventions to impact the ALOS in our community hospital. Preliminary data show a significant improvement. We cannot isolate the independent contribution of each intervention and did not control for confounders.</p><p><strong>Conclusions: </strong>Our interdisciplinary team developed and implemented tactics to reduce the ALOS in our community hospital by 13.7%.</p>","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":"6 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous Iron in Patients Hospitalized with Bacterial Infections: Utilization and Outcomes.","authors":"Nicolette Centanni, Jennifer Hammond, Joshua Carver, Wendy Craig, Stephanie Nichols","doi":"10.46804/2641-2225.1176","DOIUrl":"10.46804/2641-2225.1176","url":null,"abstract":"<p><strong>Introduction: </strong>Given the uncertainties related to IV iron therapy and the potential risk of infection, health care providers may hesitate to use this preparation to treat hospitalized patients with bacterial infections, even if clinically indicated. The aim of this study was to examine patterns of prescribing IV iron in patients who were hospitalized and treated for a bacterial infection, and their associated clinical outcomes.</p><p><strong>Methods: </strong>This retrospective chart review evaluated adult patients who received both IV iron sucrose and antibiotics during the same admission at Maine Medical Center in 2019. Data collected included iron studies, practices for prescribing IV iron, and clinical outcomes. Data were summarized using descriptive statistics.</p><p><strong>Results: </strong>A total of 197 patients were evaluated. The median duration of antibiotic therapy was 5(4-9) days. Iron and antibiotic administration overlapped in 153(77.7%) patients, with a mean overlap of 2.7(1-7) days. In the 44 patients without overlap, 20(46%) received IV iron before antibiotics. More than half (57%) of infection types involved urinary tract and respiratory systems. Approximately 2% of patients had antibiotic therapy broadened or duration extended, 7% died, and 16% were readmitted within 30 days of discharge.</p><p><strong>Discussion: </strong>Prior studies evaluating the risk of infection with IV iron published conflicting results. This is the only study that analyzed outcomes in patients receiving IV iron and antibiotics for infection but not undergoing hemodialysis during a hospital admission. Although our findings support that IV iron treatment is safe among patients with concomitant infection and iron deficiency, this finding may not be the case for all clinical subgroups.</p><p><strong>Conclusions: </strong>This study showed that when patients were administered IV iron in the setting of acute bacterial infection in our facility, most patients did not have negative outcomes.</p>","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":"6 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11238909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Evaluation of the COVID-19 Contact Tracing Program at the Maine Center for Disease Control and Prevention","authors":"Elisabeth Brewington MHA, MPH, Ben K. Greenfield, Jessica Purser PhD","doi":"10.46804/2641-2225.1161","DOIUrl":"https://doi.org/10.46804/2641-2225.1161","url":null,"abstract":"Introduction: Despite the widespread use of contact tracing efforts throughout the COVID-19 pandemic, there are limited findings available about best practices and recommendations. The Maine Center for Disease Control and Prevention contracted staff to conduct COVID-19 contact tracing from August 2020 through February 2022. A retrospective evaluation of this program was conducted to share lessons learned with public health and health care leaders for future use. Methods: Contracted contact tracing staff participated in facilitated discussions structured by the Strengths, Weaknesses, Opportunities, and Threats analysis framework. Three sessions were recorded and transcribed, and qualitative analysis through thematic review and evaluation coding was conducted. Results: The thematic review identified 27 codes of participant responses. Codes were categorized into 4 overarching themes: pandemic collective, organizational placement, team structure, and team environment. These themes led to several recommendations for future efforts. Discussion: External networks and partnerships, strong engaged leadership, staff specialization, and use of innovative technology to foster regular communication were identified as contributors to the program’s success. The supportive team environment and collective purpose found in COVID-19 work were also important to the contact tracing team experience. Conclusion: This study is a retrospective evaluation of the Maine Center for Disease Control and Prevention’s COVID-19 contact tracing team. Best practices in hiring, staff engagement and retention, and collaboration were identified. These lessons are valuable for future public health emergencies and more broadly for contract tracing of other infectious diseases. Building a national consensus of best practices through systematic review or larger evaluation efforts is an important next step.","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43750600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Onset, Refractory Hyperglycemia with Diabetic Ketoacidosis After Enfortumab Vedotin Treatment: A Case Report","authors":"Ross Heinrich, M. Caldwell","doi":"10.46804/2641-2225.1159","DOIUrl":"https://doi.org/10.46804/2641-2225.1159","url":null,"abstract":"Introduction: A patient with no prior diagnosis of diabetes presented with diabetic ketoacidosis (DKA) and severe insulin resistance after being treated with enfortumab vedotin (EV). EV-associated DKA is uncommon— described in only a few case reports—and has unknown pathophysiology. This case characterizes the unique features of DKA in this patient and an unusual amount of insulin resistance not typically seen in patients with diabetes. Clinical Findings: A 71-year-old male presented with fatigue, xerostomia, and increased thirst. He had a history of obesity, hypertension, and invasive, high-grade papillary urothelial carcinoma. His laboratory results were consistent with DKA. Clinical Course: The patient was admitted to the hospital and treated using a standardized protocol to correct the hyperosmolality, hypovolemia, metabolic acidosis, and hyperglycemia associated with DKA. After the DKA resolved, the patient needed substantial daily doses of insulin, up to 1000 units per day, for multiple days before being transitioned to an oral antihyperglycemic regimen. His workup included negative results for autoantibodies associated with type 1 diabetes and an elevated C-peptide level, suggesting preserved endogenous production of insulin with severe insulin resistance. Conclusions: EV has a clear role in treating urothelial carcinoma, showing improved survival in certain clinical contexts. Hyperglycemia is a common (14% of patients) side effect, with DKA being a rare and potentially fatal consequence. Patients with known risk factors, such as obesity or elevated hemoglobin A1c, should be closely monitored for hyperglycemia and DKA during EV treatment.","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41795872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Referral Patterns for Pediatric Sports-Related Concussion in One New England Health Care System","authors":"Joseph Benert, Amy E. Haskins, C. Holt, Krystian Bigosinski","doi":"10.46804/2641-2225.1154","DOIUrl":"https://doi.org/10.46804/2641-2225.1154","url":null,"abstract":"Introduction: Patients with concussion may benefit from care provided by professionals from multiple disciplines based on the constellation of symptoms being reported. This study analyzed referral patterns from primary care and sports medicine clinicians for pediatric patients with sports-related concussion in one health care system. Methods: A retrospective chart review identified referrals placed to physical therapy, occupational therapy, speech pathology, optometry, psychology, neuropsychology, audiology, neurology, ophthalmology, otolaryngology, psychiatry, and sports medicine for pediatric patients with sports-related concussion. These patients were evaluated at MaineHealth family medicine, internal medicine/pediatrics, pediatrics, and sports medicine clinics in southern Maine between February 2019 and June 2022. Results: We identified 375 patients with concussions. These patients were most often evaluated by pediatrics (199; 53.1%) and sports medicine (160; 42.7%), with fewer evaluated by family medicine (28; 7.5%), internal medicine/pediatrics (8 patients; 2.1%), or internal medicine (6; 1.6%). The most common referrals were to physical therapy (40; 10.7%), sports medicine (21; 5.6%), psychology (11; 2.9%), and neurology (9; 2.4%). Sports medicine placed a significantly higher number of referrals ( P < .0001) than non-sports medicine disciplines. Discussion: Compared to prior research, fewer referrals were placed in this cohort of patients with concussion. Possible explanations include a larger population of uncomplicated concussions, the more rural setting in which this study occurred, or a lack of awareness of resources for further concussion care. Conclusions:","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":"412 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41283060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}