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Establishment of an Accurate and Precise Alternative Intraoperative Technique for Determination of Femoral Version
No full textBACKGROUND: Accurate assessment of the femoral version can be challenging in the operating room. We evaluated if an observer can reliably and accurately determine when a femoral neck is parallel to the floor with a modified C-arm technique. We compared this technique to the previously reported modified Ogata-Goldsand technique for determining the intraoperative femoral version. METHODS: To evaluate if an observer can determine when the femoral neck is level to the ground, 72 cadaveric femurs were photographed laterally at the proximal femur with the bone rotated to simulate a version ranging from -20 degrees to +20 degrees in 5-degree increments. These were arranged in a grid layout and validated through 3-fold randomization and blinding. Five investigators selected the orientation they believed to be closest to the neutral (0 degrees) femoral version. Then, 4 full-size cadavers were examined in a surgical suite. The femoral version of each full-size femoral cadaver was estimated utilizing the modified C-arm technique versus the modified Ogata-Goldsand technique, with the Kingsley and Olmsted technique used as the widely accepted standard to measure the femoral version. RESULTS: In determining the neutral femoral neck position, observers were able to determine 0 degrees of version accurately, with the average deviation being 4.4 ± 2.4 degrees. The modified C-arm technique produced an average measurement deviating 3.2 ± 4.2 degrees from the true value. The modified Ogata-Goldsand technique had an average measurement deviation of 2.3 ± 2.6 degrees from the true angle. The modified C-arm technique had an intraclass correlation coefficient of 0.82 for different observers and 0.81 when compared to the Kingsley and Olmsted method as the standard, versus 0.72 and 0.90 for the modified Ogata-Goldsand technique. CONCLUSIONS: Observers can accurately perceive when a femoral neck is parallel to a virtual floor, supporting the inclusion of this parameter in the modified C-arm technique. Utilization of the modified C-arm technique is comparable to the modified Ogata-Goldsand technique. CLINICAL RELEVANCE: The relative simplicity of the modified C-arm technique versus the modified Ogata-Goldsand technique makes the modified C-arm technique a reasonable additional option for measuring intraoperative femoral version
Leveraging strain competition to address antimicrobial resistance with microbiota therapies
No full textThe enteric microbiota is an established reservoir for multidrug-resistant organisms that present urgent clinical and public health threats. Observational data and small interventional studies suggest that microbiome interventions, such as fecal microbiota products and characterized live biotherapeutic bacterial strains, could be an effective antibiotic-sparing prevention approach to address these threats. However, bacterial colonization is a complex ecological phenomenon that remains understudied in the context of the human gut. Antibiotic resistance is one among many adaptative strategies that impact long-term colonization. Here we review and synthesize evidence of how bacterial competition and differential fitness in the context of the gut present opportunities to improve mechanistic understanding of colonization resistance, therapeutic development, patient care, and ultimately public health
Tick-borne Diseases: New Territory, New Agents
Get PDFImportance: The incidence of tick-borne diseases is on the rise across North America as the ranges of tick vectors, such as the blacklegged or deer tick and the lone star tick, expand. In addition, 8 new agents of human tick-borne disease have been discovered in North America in the past few decades.
Objective: Our objective is to provide a current overview of tick-borne diseases, including recently described pathogens, in North America for public health professionals, researchers, and clinicians. Our focus is on the importance of regional epidemiology and the clinical spectrum of tick-borne diseases to increase their recognition.
Review: We summarize key aspects of the epidemiology, clinical presentation, diagnosis, and treatment of major tick-borne diseases encountered in North America, but we do not provide in-depth descriptions of the diseases or their management. Although not a formal literature review, selected articles are referenced to provide more detailed information on disease epidemiology and specific tick-borne diseases.
Findings: Geography determines the likelihood of exposure to different tick-borne diseases, but known regions of risk have changed substantially during the past few decades. Lyme disease remains the most common tick-borne disease, with its highest incidence in the northeast and upper Midwest United States. The erythema migrans rashes of Lyme disease have a wider spectrum of morphology than the textbook “bull’s eye” pattern. Standard or modified 2-tier antibody testing is recommended to aid in diagnosing extra-cutaneous Lyme disease, but the results of this test are often negative during the first few weeks of illness when erythema migrans presents. Many tick-borne diseases, except Lyme disease, present with non-specific febrile illness accompanied by thrombocytopenia and/or leukopenia and elevated hepatic transaminases. Rarely, tick-borne disease may present as fever with cutaneous ulcers or eschars, or with isolated severe neurologic disease, such as encephalitis.
Conclusions: Clinicians need to be familiar with the regional epidemiology and clinical presentation of tick-borne diseases. In addition, due to travel to other regions by many North Americans, clinicians also need to be aware of the common tick-borne diseases that may be acquired across our continent
Spectrum of Pediatric Babesia Infection: A Retrospective Case Series
Get PDFIntroduction: Babesiosis is a tick-borne infection, primarily reported in the Northeastern and northern Midwest states. Asymptomatic or mildly symptomatic infection is common in healthy individuals, but severe disease can occur in those with impaired splenic function or other immunosuppression. Older adults and infants may also develop severe disease. There are little data reported about Babesia infection in children.
Methods: Children younger than 18 years were identified in a search of patients diagnosed with babesiosis in the MaineHealth medical record between January 1, 2010, and September 30, 2024. Charts were reviewed by standardized data extraction.
Results: The 19 cases ranged in age from 4 weeks to 17 years, with an average age of 7.4 years. All children were previously healthy and had not received a prior blood transfusion. Two children required hospitalization, both of whom were young infants who required blood transfusions and did well on atovaquone and azithromycin. Most children were identified from a diagnostic panel that detects multiple tick-borne infections. Except in 1 case, babesiosis was not suspected when testing was done.
Discussion: In this retrospective series, older children with positive test results for Babesia recovered with or without anti-babesial treatment. Tick panels were frequently done because of signs of Lyme disease. Most children (74%) were treated for babesiosis after getting a positive test result, and many had concurrent Lyme disease.
Conclusions: Babesiosis is an uncommon infection detected in children. Testing for babesiosis should be considered in infants and children who are immunosuppressed and have a compatible illness. More targeted use of tick panels is recommended
High Incidence of Tick-Borne Disease in Midcoastal Maine and Possible Contributing Factors
Get PDFIntroduction: Since the 2010s, researchers and public health officials have noted that Maine’s midcoastal counties have higher incidences of Lyme disease, anaplasmosis, and babesiosis than elsewhere in the state.
Methods: We examined available data to quantify geospatial clustering, (i.e., “hotspots”) of tick-borne disease incidence and hospitalizations for tick-borne illness. Passive tick surveillance entails collecting ticks found on people and pets, whereas active tick surveillance entails collecting ticks directly from the environment. Using both types of surveillance data, we searched for hotspots of higher blacklegged-tick abundance and pathogen prevalence in ticks. We qualitatively reviewed factors possibly related to tick exposure, such as landscape characteristics and human demographics.
Results and Discussion: Lyme disease, anaplasmosis, and babesiosis incidence, as well as hospitalizations and tick-related emergency department visits clustered in Maine’s midcoastal counties. Data from passive tick surveillance indicated a midcoastal county cluster of blacklegged-tick submissions, whereas data from active tick surveillance indicated tick density was dispersed across regions. Passive surveillance is complicated by human behavior leading to human-tick encounters but has excellent spatial coverage. Active tick surveillance data is not confounded by human behavior but has sparse spatial coverage. The distribution of white-tailed deer did not align with the midcoastal hotspot. Climate was not more permissive in the midcoastal than south coastal counties.
Conclusions: Residential-scale analysis is needed to understand how factors, such as landscape, age, lifestyle, and health-seeking behavior, elevate exposure to ticks in landscapes that superficially appear similar
Improving Clinician Competence to Screen for Suicide Risk: An Organizational Change
Get PDFMHBH is on a journey to implement Zero Suicide across the organization. Zero Suicide is a quality improvement model that transforms system-wide 0% 10% 20% 30% 40% 50% 60% Outpatient Staff Inpatient Staff September 2021 May 2024 Project Life Worth Living is supported by a grant from Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), under Grant No. 1H79SM088556 % who strongly agree: “I have the knowledge and skills to screen for suicide risk” prevention and care with an aspirational goal of zero suicide deaths among the people we serve.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1021/thumbnail.jp
A Quality Improvement Project to Reduce Variation in Pediatric Asthma Care Using the Hospital Asthma Severity Scoring (HASS) Tool
Get PDFThe aim of this project was to increase HASS score use to greater than 50%within one year and determine the impact of our interventions on the quality of asthma care and patient outcomes.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1022/thumbnail.jp
Professional Medical Writing & the Publication Process
Get PDFNavigating the professional writing & publishing landscape can be intimidating and time consuming for the working healthcare professional.
This course provides familiarity, tips, & best practices to mitigate barriers; especially for first time authors & investigators.https://knowledgeconnection.mainehealth.org/mite/1000/thumbnail.jp
Implementation and Sustainability of a Neonatal Resuscitation Telesimulation Program in Rural Delivery Hospitals: A Qualitive Study
Get PDFBackground:
• Rural teams have limited exposure to neonatal resuscitation due to low birth volumes making it challenging to maintain skills
• Developed Maine Ongoing Outreach Simulation Education (MOOSE), offering interprofessional NRP® telesimulation (TS)
• Facilitated scheduling and provided remote debriefing support from neonatologists & simulation educators • Implemented in rural delivery hospitals in a longitudinal phased approach: Phase 1, monthly TS; Phase 2, quarterly TS
• Our objective was to explore the MOOSE implementation across a rural health system, including program impacts, challenges, and strategies for sustainability (with rural hospitals facilitating ongoing implementation more with less support from the remote team)https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1026/thumbnail.jp
Shortage as a Catalyst for High-Value Care: Evaluation of a Bloof Culture Stewardship Intervention Driven by Supply Chain Disruption
Get PDFEvaluate the impact of diagnostic stewardship interventions on repeat blood culture ordering in bacteremic patients during the 2024 BD Bactec™ blood culture bottle shortage.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1032/thumbnail.jp