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Seven Tips for Successfully Operationalizing GME Innovations at the System Level: The iPACE Experience
No full textManagement of human babesiosis - approaches and perspectives
No full textINTRODUCTION: Human babesiosis is an emerging tick-borne disease caused by intraerythrocytic Babesia protozoa. Most cases are due to Babesia microti, which is endemic in the northeastern and upper Midwestern United States. Other Babesia spp. cases are endemic in China and/or sporadically reported in the United States, Europe, Asia, and elsewhere in the Northern Hemisphere. Cases in immunocompetent hosts are typically mild to moderate, while disease in immunocompromised hosts is often severe. AREAS COVERED: A historical perspective of compounds that are effective against Babesia spp. is provided. The current management of mild, moderate, and severe babesiosis is discussed, as is the genetic basis of antimicrobial resistance associated with relapsing babesiosis. The use of red blood cell exchange transfusion is reviewed. EXPERT OPINION/COMMENTARY: Most cases of human babesiosis are successfully treated with atovaquone plus azithromycin or clindamycin plus quinine. A major research topic is the management of immunocompromised hosts, especially those experiencing severe or relapsing babesiosis. Two immediate goals are, (i) to develop new antimicrobial agents that target Babesia spp. through novel mechanisms and can overcome resistance to currently recommended antimicrobial agents and, (ii) to gain a better understanding of the efficacy of red blood cell exchange transfusion and indications for its use
Long-Term Outcomes Following Left Atrial Appendage Occlusion in Medicare Beneficiaries: Outcomes From the National Cardiovascular Data Registry
No full textBACKGROUND: Percutaneous left atrial appendage occlusion (LAAO) is an alternative to long-term anticoagulation for preventing ischemic stroke in patients with atrial fibrillation. There are limited long-term outcomes data for real-world patients undergoing LAAO. METHODS: We performed a retrospective cohort study using the National Cardiovascular Data Registry LAAO registry from January 1, 2016, through December 31, 2019. We linked LAAO data to inpatient Medicare fee-for-service claims data using probabilistic matching to establish a cohort of patients 65 years and older undergoing LAAO with a WATCHMAN device. The primary outcomes were any stroke and all-cause mortality. RESULTS: A total of 34 975 patients with a mean±SD CHADS-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, and sex category) score of 4.7±1.4 were included. The median follow-up was 2.8 years (interquartile range, 2.2-3.7 years). The cumulative incidence of any stroke was 1.57 per 100 person-years (95% CI, 1.45-1.70), with a 1-year and 5-year any stroke estimate of 1.70% (95% CI, 1.57-1.84%) and 5.70% (95% CI, 5.37-6.05%), respectively. The cumulative incidence of ischemic stroke was 1.36 per 100 person-years (95% CI, 1.25-1.48), with a 1-year and 5-year ischemic stroke estimate of 1.42% (95% CI, 1.30-1.54%) and 5.03% (95% CI, 4.71-5.36%), respectively. The cumulative incidence of death was 10.82 per 100 person-years (95% CI, 10.49-11.13), with a 5-year mortality estimate of 44.34% (95% CI, 43.35-45.23%). CONCLUSIONS: Long-term stroke rates in a large nationally representative cohort of Medicare patients following LAAO were low and durably consistent during long-term follow-up despite a high thromboembolic risk. High mortality rates in this elderly population underscore the importance of incorporating patient values and preferences when considering LAAO
Association of Sedation Depth With Detection of Small Serrated Polyps and Serrated Polyp Counts During Colonoscopy: A Registry-Based Cohort Study.
No full textThe Impact Workplace Violence Has on Nurse Burnout
No full textIn nurses working in the healthcare field, how does increased exposure to workplace violence, in comparison to an environment with effective violence prevention affect the rates of nurse burnout and retention of staff?https://knowledgeconnection.mainehealth.org/nurseresidency/1135/thumbnail.jp
Music Therapy: Treating Pain and Anxiety in the Perioperative Patient
No full textIn perioperative patients, what is the effectiveness of music therapy in treating anxiety and pain compared to standard care without music therapy?https://knowledgeconnection.mainehealth.org/nurseresidency/1132/thumbnail.jp
Commentary on Tummy Time Tracking: Concurrent-Validity of Wearable Sensors in Home Settings for Term and Preterm Infants
No full textEvaluation of Connections Clinic: The Bridge Program located within the Preble Street Learning Collaborative
No full textProblem: The opioid epidemic continues, and overdose rates throughout the United States remain high. Only 22% of people diagnosed with opioid use disorder (OUD) access medications for OUD (MOUD). Bridge clinics may improve access to MOUD, specifically buprenorphine. Individuals experiencing homelessness (IEH) face additional barriers to accessing care, though little is known about bridge clinics specifically focused on IEH. The bridge clinic embedded within the MaineHealth–Preble Street Learning Collaborative, called Connections Clinic (CC), aims to address unmet health care needs of IEH in Portland, Maine, by providing low-barrier health care and access to buprenorphine.
Approach: We analyzed demographics, health access, health outcomes and mortality, and MOUD use among a cohort of 471 patients who received buprenorphine at CC from January 1, 2018, through December 31, 2023, using data from the electronic health record.
Outcomes: The median age of patients was 37 years. A total of 67% identified as male, and 89% were White. There were 309 (66%) patients who were insured at their first visit and 419 (89%) who were insured at their most recent visit. A total of 248 (53%) patients received hepatitis C virus screening with 195 (78.6%) screens returning positive. The all-cause mortality rate was 4%. Regarding MOUD use, patients received a mean of 2.5 prescriptions for buprenorphine per month. Of the 2666 urine drug screens performed during the study, 2148 (81%) returned positive for buprenorphine.
Next Steps: We found strong treatment adherence and a low all-cause mortality rate among IEH at CC where patients had flexible and low-barrier access to comprehensive services, including buprenorphine treatment, infectious disease screening, and health insurance. These findings suggest that CC is an effective care model for IEH in Portland, Maine. Future areas of focus include analyzing outcomes after transfer to long-term MOUD management and improving screening for infectious diseases
End-of-Rotation Objective Structured Clinical Examination: Proposal to Reduce Grading Bias in the Family Medicine Core Clerkship
No full textProblem Statement: In medical education, learner assessment drives learning and documents competency. A drawback of the traditional clinical performance assessment by a preceptor, however, is a potential halo effect. This effect is an unearned positive bias toward a student the supervisor likes, or conversely, a negative implicit bias about the student’s race, gender, or other aspects of identity. These biases, in either direction, can lead to unfair grading. A preceptor’s bias can be particularly problematic in a family medicine clerkship in which a student may be evaluated and graded by a single preceptor.
Background: An end-of-clerkship objective structured clinical examination (OSCE) is a more objective evaluation with a standard cadre of assessors and grading rubrics. This approach can complement a single assessor and may mitigate biases that stem from individual relationships.
Application: We describe the mechanics of end-of-clerkship OSCEs at 4 medical schools and the reasons behind those pedagogic choices as approaches to more objective assessment of student clinical performance in the family medicine clerkship. A medical school’s pursuit of bias reduction and more equitable assessments related to race, gender, and other identities of medical students requires considerable effort. OSCEs, although not perfectly objective, represent an important step that may decrease bias in clinical assessment