Journal of Maine Medical Center最新文献

{"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}

{"title":"Optimizing Psychological Safety: Using a Focus Group to Acquire Perspectives from Standardized Patients Who Identify as LGBTQ+","authors":"B. Brown, Rachel Kupferman, Bethany Rocheleau, Christine Mallar, Karissa Hannifan, Bette Gray, V. Hayes, Leah A. Mallory","doi":"10.46804/2641-2225.1158","DOIUrl":"https://doi.org/10.46804/2641-2225.1158","url":null,"abstract":"Introduction: Gender and sexual minority (lesbian, gay, bisexual, transgender, questioning; LGBTQ+) patients report poor health care experiences, partly because health care providers are not trained to meet their needs. Simulation can help learners practice competencies related to diversity, equity, and inclusion, but there are psychological safety considerations when recruiting standardized patients (SPs). Our objective was to incorporate the expertise of members of the LGBTQ+ community in our SP pool as we developed related curriculum. Methods: All SPs were invited to participate in a focus group if they identified as LGBTQ+ and wanted to contribute. Content experts developed a focus group guide and facilitated the meeting. Additional members of the research team took de-identified notes. After notes were reviewed for agreement, a thematic analysis was performed. An anonymous survey was sent to SP participants after the focus group meeting. Results: Six SPs verbally participated in a 90-minute focus group, and 4 completed an anonymous follow-up survey. SPs acknowledged psychological safety risks but universally supported the developing curriculum. Most were willing to assume personal risk for the greater good. They emphasized the importance of lived experience to authentic portrayal, but they were open to eventual broader casting with coaching and proposed SP peer support and learner preparation as possible protective measures. Discussion: SPs appreciated the recognition of content expertise and opportunity to influence curricular design. They shared concerns about LGBTQ+ SP self-portrayal in simulation and offered creative suggestions to promote psychological safety. Conclusion: SPs with lived experience can share nuanced feedback and be a resource to co-create curriculum related to diversity, equity, and inclusion.","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45629995","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":"Improving Inclusive Communication: Pilot Results from a Simulation-Based Learning Opportunity to Practice Taking a Sexual Health History","authors":"Rachel Kupferman, Bette Gray, Bethany Rocheleau, Christine Mallar, Karissa Hannifan, V. Hayes, Leah B. Mallory, B. Brown","doi":"10.46804/2641-2225.1157","DOIUrl":"https://doi.org/10.46804/2641-2225.1157","url":null,"abstract":"Sexual and gender minority (lesbian, gay, bisexual, transgender, questioning; LGBTQ+) patients experience health care inequities. Simulation using standardized patients (SPs) is an effective tool for communication-based training. To promote equitable practice, we created an experiential learning opportunity for residents to practice inclusive communication and improve their comfort in caring for LGBTQ+ patients while maintaining the psychological safety of SPs. Methods: Our interdisciplinary team explored relevant simulation curricula, conducted a focus group with LGBTQ+ SPs, created a didactic presentation, and designed and implemented a simulated case. Family medicine residents participated in the training and completed pre-and post-training surveys rating their confidence in sexual health communication and working with sexual and gender minority patients. We compared Likert scale ratings in pre-and post-training surveys using a Wilcoxon signed-rank test. SPs completed post-simulation surveys rating their psychological safety. Results: Residents completed pre-training (n = 13) and post-training (n = 12) surveys. Confidence improved in every category, reaching significance for confidence in obtaining a sexual health history from LGBTQ+ patients. Four SPs completed post-simulation surveys. All SPs reported that the event had educational value and was a positive experience.","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46093140","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":"Under One Roof – An Integrated Clinic for Substance Use Disorder and Viral Hepatitis/HIV Treatment","authors":"Sarah Hipkens, E. Caron, W. Craig, K. Thakarar","doi":"10.46804/2641-2225.1140","DOIUrl":"https://doi.org/10.46804/2641-2225.1140","url":null,"abstract":"Introduction: Integration of viral hepatitis/HIV care and substance use disorder (SUD) treatment has been shown to improve patient outcomes, but data are lacking in rural states like Maine. Our study objective was to assess the baseline characteristics and outcomes of patients with SUD who receive combined substance use and viral hepatitis/HIV treatment at a recently established “Bridge Program” in our rural state. Methods: We conducted a retrospective chart review of patients enrolled in the Bridge Program between January 2020 and November 2021. We then performed a descriptive analysis of demographics, health characteristics, preventive services, and treatment outcomes. Results: A total of 14 patients were enrolled in the Bridge Program, of which 13/14 (93%) had hepatitis C, and 3/14 (21%) had HIV. When indicated, 100% of participants received appropriate medication for addiction treatment (buprenorphine/naloxone or naltrexone), naloxone kits, and hepatitis A and B vaccinations. Among patients with hepatitis C, 12/13 (92%) started antiviral treatment, of which 10/12 (83%) either achieved treatment cure or are receiving ongoing treatment. Discussion: Integrated care models can successfully treat SUD and HIV/viral hepatitis as co-occurring medical conditions. These models must consider approaches to reduce the number of visits and travel time required for optimal treatment, and enhance recovery by consistently prescribing evidence-based medication for SUD. Conclusions: Our study shows how an integrated clinic model in a rural state can provide comprehensive care, including SUD treatment, naloxone prescribing, vaccinations, and, importantly, high rates of successful hepatitis C/HIV treatment.","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44881102","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":"How Are Our Athletes Doing? A Cross-Sectional Analysis of Student-Athlete Mental Health in Fall 2022 at a Maine Division III University","authors":"Emma Cronk, Adriana Isacke, Amy E. Haskins, C. Holt, Krystian Bigosinski","doi":"10.46804/2641-2225.1155","DOIUrl":"https://doi.org/10.46804/2641-2225.1155","url":null,"abstract":"Recommended Citation Cronk, Emma; Isacke, Adriana; Haskins, Amy; Holt, Christina; and Bigosinski, Krystian (2023) \"How Are Our Athletes Doing? A Cross-Sectional Analysis of Student-Athlete Mental Health in Fall 2022 at a Maine Division III University,\" Journal of Maine Medical Center: Vol. 5 : Iss. 2 , Article 7. Available at: https://knowledgeconnection.mainehealth.org/jmmc/vol5/iss2/7 https://doi.org/10.46804/ 2641-2225.1155","PeriodicalId":93781,"journal":{"name":"Journal of Maine Medical Center","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47505821","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}