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The effect of early reintervention on late outcomes following infrarenal and fenestrated endovascular aneurysm repair
No full textOBJECTIVE: In this study, we examined the association between early reintervention and 5-year outcomes following endovascular aneurysm repair (EVAR) and fenestrated EVAR (FEVAR), and assessed factors associated with higher risk of early reintervention. METHODS: We identified all patients undergoing elective infrarenal EVAR and juxtarenal FEVAR (custom-made devices [CMDs] and physician-modified endografts [PMEGs]) in the Vascular Implant Surveillance and International Outcomes Network dataset (2014-2019). Patients with \u3c 6 months of follow-up were excluded to address potential survival bias. We stratified the population by the occurrence of an early reintervention within the first postoperative year (early reintervention), and assessed association with 5-year all-cause mortality, reintervention, and rupture, using Kaplan-Meier methods and multivariable Cox regression analysis. Second, we assessed factors associated with early reintervention with multivariable logistic regression and performed a sensitivity analysis by restricting the definition of early reintervention to the first 6-months postoperatively. RESULTS: We identified 10,348 EVARs and 1154 FEVARs (456 PMEGs, 698 CMDs), of which 3.1% and 7.2% (3.1% CMD, 4.0% PMEG) underwent early reintervention, respectively. Among EVARs, compared with no early reintervention, early reintervention patients were younger, and more frequently had chronic obstructive pulmonary disease, anemia, prior abdominal aortic surgery, and more distal sealing zone (all P \u3c .05). Compared with no early reintervention, early reintervention was associated with higher 5-year mortality (42% vs 33%; hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.29-2.02; P \u3c .001), reintervention (34% vs 13%; HR, 4.96; 95% CI, 3.77-6.52; P \u3c .001), and rupture (5.3% vs 0.5%; HR, 20.2; 95% CI, 9.97-40.8; P \u3c .001). At the sensitivity analysis, the 5-year outcomes remained similar. Factors associated with a higher risk of early reintervention were anemia, chronic obstructive pulmonary disease, renal dysfunction, and prior aortic surgery. Among FEVARs, compared with no early reintervention, early reintervention patients were more frequently treated by a high-volume physician (≥21 complex [EVAR] cEVAR/year) and in high-volume centers (≥22 cEVAR/year; both P \u3c .005). Compared with no early reintervention, early reintervention was associated with similar 5-year mortality (41% vs 38%; HR, 0.96; 95% CI, 0.60-1.54; P = .87), but greater reintervention rates (38% vs 26%; HR, 3.02; 95% CI, 1.88-4.86; P \u3c .001) and rupture rates (6.8% vs 2.2%; HR, 6.52; 95% CI, 1.98-21.5; P \u3c .001). At the sensitivity analysis, the 5-year outcomes remained similar. Factors associated with higher early reintervention risk were female sex, larger diameter, and PMEG. CONCLUSIONS: Because early reintervention after EVAR and FEVAR proved to be a marker of increase risk for 5-year reintervention and rupture, these patients have a uniquely high-risk phenotype that warrants vigilant surveillance and underscores the need for rigorous preoperative risk stratification and planning. Understanding factors associated with early reintervention allows health care professionals to identify high-risk patients, leading to informed counseling and more personalized follow-up care
Psychosocial distress among individuals residing in a rural PFAS-contaminated community
No full textFew studies have evaluated how awareness of PFAS contamination impacts psychosocial distress. We sought to quantify psychosocial distress associated with awareness of drinking water PFAS contamination in the Maine Biosolids Study (n=146), a rural cohort affected by agricultural biosolids spreading. Participants had residential well water PFAS concentrations measured by the Department of Environmental Protection and were notified about concentrations above or below the Maine Interim Drinking Water Standard [∑6 PFAS (PFOA, PFOS, PFNA, PFHxS, PFHpA, PFDA) ≥20 ng/L]. We utilized negative binomial mixed effects regression to study associations of awareness of water PFAS above the Standard with PFAS-related psychosocial outcomes and state-dependent anxiety. We explored effect modification by pre-existing mental health diagnoses and resilience coping style. Fifty-eight percent of participants had drinking water PFAS above the Standard, and 35% had pre-existing mental health diagnoses. Affected participants with drinking water PFAS above the Standard had greater PFAS-related anxiety, worry and fears about health risk, and perceived stigma [for example, IRR (95% CI): 1.69 (1.32, 2.15)]. Knowledge of elevated water PFAS was associated with greater state-dependent anxiety, although confidence intervals included the null [IRR (95% CI): 1.21 (0.90, 1.61)]. Associations of awareness of water PFAS with worry about PFAS health risk and state-dependent anxiety were stronger among individuals without a prior mental health diagnosis [e.g., IRR (95% CI): 2.30 (1.49, 3.57) versus 1.27 (0.80, 2.02)]. We found no effect modification by resilience coping style. Individuals with knowledge of elevated drinking water PFAS had greater PFAS-related psychosocial distress. Mental health support and community education are public health needs in PFAS-affected communities
Summary of: AI Diabetic Retinopathy Screening in a Primary Care Setting in Rural Maine
Get PDFDiabetic retinopathy (DR) is the leading cause of blindness globally. Early diagnosis and treatment reduce the risk of vision loss by 98%.
Study found @ AI Diabetic Retinopathy Screening in a Primary Care Setting in Rural M by Rachel Heuer, Emma DayBranch et al.https://knowledgeconnection.mainehealth.org/nnectr/1007/thumbnail.jp
April 30th, 2025: Finding the Patent in Patient Safety
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1040/thumbnail.jp
Access to Pediatric Asthma Specialty Care: A Survey and Geospatial Analysis Across a Rural State
No full textOBJECTIVE: Although children with asthma have improved outcomes when accessing asthma specialists (allergist/immunologists and pediatric pulmonologists), this care may not be available if no specialists are located nearby, or if nearby specialists do not accept children or a given child\u27s insurance. We aimed to describe the physical proximity of children to pediatric asthma specialty care in a largely rural state and to assess the degree to which the availability of pediatric specialty asthma care was impacted by provider nonacceptance of pediatric patients and patients with Medicaid insurance. METHODS: We conducted a telephone survey of pediatric pulmonology and allergy/immunology practices in the rural state of Maine and adjacent areas during June and July 2024, asking whether they accepted pediatric patients, whether they accepted pediatric patients with Maine Medicaid insurance, and their wait times for new patient appointments. We assessed the association of acceptance policies and clinician specialty (allergy vs pulmonology), training (physician vs advanced practice provider), and state (Maine vs other) using Fisher\u27s exact tests and we calculated the travel time to the nearest provider locations for children across Maine. RESULTS: Among 49 asthma specialists in and around Maine, 41 (84%) accepted pediatric patients. Eighty-nine percent of Maine providers and 6% of out-of-state providers accepted children with Maine Medicaid insurance. The median distance to any asthma specialist was 30.5 minutes (IQR 17.2, 51.0) and 18% of children would need to travel \u3e60 minutes for care. CONCLUSION: Nearly one in five children in Maine would be required to travel more than 60 minutes to reach an asthma specialist, nearly one in five allergy providers do not accept children, and few out of state providers accept Maine Medicaid insurance. Future research should assess the impacts of these barriers on children\u27s receipt of care
Complementary effects of postoperative delirium and frailty on 30-day outcomes in spine surgery
No full textBACKGROUND CONTEXT: With an increasingly older population, the number of frail patients requiring surgical management for degenerative spine diseases is rapidly increasing. Older patients are at increased risk of developing postoperative delirium (POD), which increases the odds of postoperative morbidity and mortality in spine surgery patients. Therefore, frail spine surgery patients may be at greater risk of developing POD and subsequent adverse outcomes. PURPOSE: To understand the relationship between frailty and POD in spine surgery patients, and the effect of POD on nonfatal and fatal adverse outcomes in frail patients. STUDY DESIGN/SETTING: Retrospective cohort study utilizing data from the 2021 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. PATIENT SAMPLE: Patients aged ≥75 years undergoing spine surgery screened for POD, with a total sample size of 4,195 patients. OUTCOME MEASURES: Primary outcomes were postoperative delirium (POD), 30-day mortality, and nonfatal adverse outcomes. METHODS: Frailty was measured using the Risk Analysis Index (RAI) with tiered cutoffs indicating increasing frailty. Statistical methods included multivariable logistic regression and mediation analysis to evaluate the relationships between RAI, postoperative delirium, and 30-day mortality. RESULTS: Out of 4,195 spine surgery patients aged ≥75 years screened for POD, 353 (8.4%) exhibited POD. POD patients had significantly higher RAI scores relative to those without POD (p\u3c.001). Multivariable analysis demonstrated that increasing frailty predicted POD (p\u3c.001). In patients with POD, there were increased odds of mortality and all nonfatal adverse outcomes within 30 days (p\u3c.001). A complementary mediation effect of POD on frailty\u27s contribution to 30-day mortality was observed (p\u3c.001). CONCLUSION: POD and increasing preoperative frailty RAI scores were independent predictors of mortality and morbidity in older spine surgery patients. POD has a significant synergistic contribution to the adverse effects of frailty following spine surgery. The RAI may be used to identify frail patients at risk of developing POD to enable optimal surgical candidate selection and provide opportunities for risk mitigation, such as prehabilitation and/or specialized perioperative care teams for frail patients
A Pediatric Coinfection with Babesia microti and Plasmodium falciparum
Get PDFIntroduction: Babesiosis and malaria are diseases caused by intraerythrocytic protozoan parasites. Both parasites are spread by arthropod vectors—Babesia spp by ticks and Plasmodium spp by mosquitoes—and share similar clinical and diagnostic characteristics. The geographic distributions of these 2 pathogens are historically distinct. Coinfections that lead to concurrent babesiosis and malaria are rare.
Clinical Findings: A prepubescent child presented with symptoms of malaria 2 weeks after returning from a trip to Central Africa and was subsequently hospitalized for assessment and treatment.
Clinical Course: The patient had anemia and thrombocytopenia on admission with steady decreases in leukocytes, erythrocytes, hemoglobin, and hematocrit reported through day 5 of hospitalization. Initial polymerase chain reaction testing revealed coinfection with Babesia microti and Plasmodium falciparum. A blood smear sent to the Centers for Disease Control and Prevention identified Babesia sp. and P. falciparum in the blood, confirming coinfection that led to concurrent babesiosis and malaria. The patient recovered and was discharged home.
Conclusions: Patients who spend time in both mosquito and tick habitats are at risk of coinfection with multiple parasites. Clinicians should consider babesiosis testing for patients with malaria who may have spent time in tick habitats where Babesia spp are endemic
Physical Activity Programming to Improve QoL in Pediatric IBD Patients
Get PDFDiscussion: This work contributes to limited literature supporting the positive impact of PA in a target population and provides novel guidelines to implement an accessible PA program proven to be effective and well-liked by patients & families. Findings support incorporation of PA into the holistic care of pediatric patients with IBD.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1002/thumbnail.jp
Improving MaineHealth Behavioral Health Non-clinical Staff Knowledge and Comfort to Ask About Suicide with Question, Persuade, Refer (QPR) Training
Get PDFhttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1020/thumbnail.jp