6289 research outputs found
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Clocking In, Burning Out: Resident Duty Hours, Health, and the Quest for Competence
No full textCME available for 1 year after presentation
CME Text Code: 103878
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1090/thumbnail.jp
Perceptions of an Electronic Patient Symptom Reporting Tool by Clinicians
No full textPrior to implementing an electronic health record-integrated patient-reported outcomes system, eSyM, the perceived facilitators and barriers to implementation from multiple stakeholder perspectives were sought. The purpose is to report the findings of the perceived facilitators and barriers to implementation of eSyM from multiple clinician stakeholder perspectives. Stakeholders included administrators, clerical staff, information technology professionals, support staff, physicians, providers, and nurses from six Symptom Management Implementation of Patient-Reported Outcomes in Oncology health systems, a diverse mix of academic/community, rural/metropolitan, and Northeastern and Southern community-based cancer centers. Site information, participant information, perceived effectiveness, and perceived patient barriers to use were collected from 173 stakeholders. RNs were the most represented participants, followed by physicians, physician assistants, and nurse practitioners. Stakeholders felt that eSyM would be effective in improving patient symptom management, keeping patients out of the hospital and emergency department, and improving clinic efficiency. Clinician stakeholders perceived eSyM as necessary and effective for improving symptom management. Most stakeholders felt that their colleagues would be supportive of using eSyM. Stakeholders perceived minor patient barriers were access to technology, distrust of technology, and English language proficiency. Computer literacy was perceived as a major barrier. Future longitudinal mixed-methods design that combines quantitative findings with qualitative observations is needed. Understanding the contextual factors that influence the facilitation or barriers of implementing eSyM is needed to scale and spread the intervention to other institutions. As a nursing intervention, the assessment of the perceptions of improvement of eSyM workflow would be especially useful
Embracing Compassion for People Facing Lung Cancer-the American Cancer Society National Lung Cancer Roundtable
No full textFGF21 promotes longevity in diet-induced obesity through metabolic benefits independent of growth suppression
No full textApproximately 35% of US adults over 65 are obese, highlighting the need for therapies targeting age-related metabolic issues. Fibroblast growth factor 21 (FGF21), a hormone mainly produced by the liver, improves metabolism and extends lifespan. To explore its effects without developmental confounders, we generated mice with adipocyte-specific FGF21 overexpression beginning in adulthood. When fed a high-fat diet, these mice lived up to 3.3 years, resisted weight gain, improved insulin sensitivity, and showed reduced liver steatosis. Aged transgenic mice also displayed lower levels of inflammatory immune cells and lipotoxic ceramides in visceral adipose tissue, benefits that occurred even in the absence of adiponectin, a hormone known to regulate ceramide breakdown. These results suggest that fat tissue is a central site for FGF21\u27s beneficial effects and point to its potential for treating metabolic syndrome and age-related diseases by promoting a healthier metabolic profile under dietary stress and extending healthspan and lifespan
Comparing Claims Data to Stroke and Bleeding in the NCDR Left Atrial Appendage Occlusion Registry
No full textBACKGROUND: Claims data are increasingly used for postmarketing surveillance of therapies such as transcatheter left atrial appendage occlusion (LAAO), but their accuracy remains uncertain. OBJECTIVES: This study aimed to compare stroke and bleeding events in the National Cardiovascular Data Registry LAAO Registry with claims data. METHODS: LAAO Registry data for patients aged ≥65 years were linked to 2016 to 2021 Medicare claims. Primary diagnosis International Classification of Diseases-Tenth Revision codes from inpatient hospitalizations were compared to adjudicated registry-reported stroke and major bleeding events after discharge, including estimation of sensitivity and positive predictive value of claims for identifying registry-reported events. Kappa statistics and incidence rates were also assessed. RESULTS: Among 71,043 LAAO Registry patients, sensitivity and positive predictive value of claims were 60.8% and 50.5% for ischemic stroke (kappa 0.55), 42.7% and 50.5% for hemorrhagic stroke (kappa 0.46), 55.9% and 40.3% for gastrointestinal bleeding (GIB) (kappa 0.43), 62.2% and 38.0% for intracranial hemorrhage (kappa 0.47), and 20.4% and 10.0% for other major bleeding (kappa 0.12). Sensitivity and negative predictive values were \u3e92% for all events. Two-year incidence rates were higher in claims vs registry data for ischemic stroke (2.5% vs 2.2%), GIB (6.8% vs 5.2%), intracranial hemorrhage (1.6% vs 1.1%), and other bleeding (3.1% vs 1.5%; P \u3c 0.01 for all events), and lower for hemorrhagic stroke (0.4% vs 0.5%; P = 0.03). CONCLUSIONS: In the LAAO Registry, International Classification of Diseases-Tenth Revision codes have moderate agreement with stroke, GIB, and intracranial hemorrhage, and overestimate most event rates compared to adjudicated registry-reported events. Nonclaims-based methods are needed to ensure accurate assessment of clinical events in postmarketing surveillance
Staff Perspectives on Normalizing and Sustaining Electronic Patient-Reported Outcomes Monitoring at Six US Health Systems.
No full textPURPOSE: We assessed the perspectives of staff from six health systems to understand how electronic Symptom Management (eSyM), an eSyM program that supports patients during chemotherapy and after surgery, is normalized and sustained.
METHODS: Starting in 2019, we integrated eSyM into routine clinical practice and assessed its effectiveness using a cluster randomized stepped-wedge trial design. At least 1 year after implementation, we administered cross-sectional surveys to elicit the perspectives of physicians, nurses, advanced practice providers (APPs), hospital administrators, information technology, and research staff using the Normalization MeAsure Development (NoMAD) and the Clinical Sustainability Assessment Tool (CSAT).
RESULTS: Of the 211 staff who initiated the survey, 169 (80%) completed it. Respondents included 64 nurses (38%), 38 physicians (23%), 20 research staff (12%), 17 APPs (10%), 16 administrators (10%), and nine information technologists (5%). The mean NoMAD familiarity score was 5.90 (standard deviation [SD], 3.06) and the mean score for eSyM becoming a part of routine practice was 4.84 (SD, 3.21), scored on a 0-10 scale. Compared with physicians, nurses reported higher familiarity scores and lower NoMAD domain scores for
CONCLUSION: Clinical staff reported moderate levels of normalization and capacity for sustainability. Nurses and APPs reported lower levels of sustainability compared with physicians and administrators. Future studies should explore novel workflows and tools that support clinical staff who provide symptom management support
Human myocardial-derived highly proliferative cells improve cardiac remodeling after myocardial infarction in mice.
No full textHuman highly proliferative cells (hHiPCs) isolated from the adult heart have progenitor and angiogenic properties. However, the mechanisms underlying hHiPCs in myocardial repair in vivo have yet to be investigated. We characterized the hHiPC proteome and secretome and found that hHiPCs express and secrete proangiogenic and proreparative proteins, including CXCL6, CTHRC1, and CD73, and are ontologically enriched in pathways related to cytokine signaling and glucose metabolism. Using publicly available single-cell data (GSE149699), we found that CXCL6, CTHRC1, and CD73 are also expressed in adult and neonatal cardiospheres, resembling a therapeutic cell population currently being tested in clinical trials. With the prominent role of these enriched secreted factors in cardiac repair and highly proliferative phenotype, we hypothesized that hHiPC injection would improve heart function following ischemic injury. Following experimental myocardial infarction (MI) in immunocompromised male and female mice, we found that intramyocardial injection of hHiPCs (2.5 × 1
Mastering the Art of Adaptive Teaching and Learning
No full textCME available for 1 year after presentation
CME Text Code: 97040
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1085/thumbnail.jp
The Anterior-Based Muscle-Sparing Approach for Conversion Total Hip Arthroplasty is Safe and Effective.
No full textBACKGROUND: Total hip arthroplasty (THA) after prior hip or acetabular fracture fixation is considered higher risk than primary THA, as studies have shown reduced implant survival and higher infection rates. The anterior-based muscle-sparing (ABMS) approach can potentially reduce some of these risks by utilizing a new surgical interval. The goal of this study is to analyze the efficacy of the ABMS approach for conversion to hip arthroplasty surgery after previous fracture fixation with comparison to posterior approach.
METHODS: This retrospective cohort study included patients with prior hip surgical intervention requiring hardware then converted to a THA using the ABMS or posterior approach at 1 institution between 2013 and 2020. Outcomes studied included postoperative complications, 30-day emergency department visits, 90-day readmission rates, any reoperation and patient-reported outcome measures.
RESULTS: A total of 85 patients (51 male and 34 female) in the ABMS group and 17 patients (9 male and 8 female) in the posterior group were included. Within the ABMS group, the mean age was 65.6 years (±16.2) with a mean body mass index of 27.5 kg/m
CONCLUSIONS: This study is the first to evaluate outcomes of conversion THA using the ABMS approach, when compared to the posterior approach. Our institution\u27s experience demonstrates that the ABMS approach is safe and effective for conversion THA after prior fracture fixation
October 15th, 2025: Driving Fitness, Health, & Aging: The Clinician\u27s Role in Driver Licensing in Maine
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1051/thumbnail.jp