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Enhancing Patient Safety and Satisfaction: Evaluating the Impact of Bedside Shift Reporting on a MedSurg Floor
No full textOn Medical Surgical hospital units, how does the implementation of RN bedside shift report, compared to traditional shift report away from the patient, impact patient satisfaction and patient safety outcomes?https://knowledgeconnection.mainehealth.org/nurseresidency/1145/thumbnail.jp
Long-term Outcomes of Persistent Postoperative Opioid Use: A Retrospective Cohort Study
No full textOBJECTIVE: To determine the association between PPOU and the long-term risk of OUD and opioid overdose. SUMMARY BACKGROUND DATA: PPOU is a commonly used outcome in the surgical literature; its incidence and risk factors have been well described. However, its association to long term outcomes, including OUD and opioid overdose, is unknown. METHODS: A retrospective cohort study utilizing the Veterans Health Administration corporate data warehouse. Patients undergoing any surgery between January 1, 2008 and December 31, 2018 were included and followed until December 31, 2020. Univariate and multivariate survival analysis were used to determine the association between PPOU and OUD and overdose. Sensitivity analyses were conducted to determine the impact of different definitions of persistent opioid use and the effect of preoperative opioid use. RESULTS: A total of 344,745 patients undergoing surgery were included and followed for a median of 6.18 years (IQR 3.53-9.12). PPOU was associated with an increased hazard of developing both OUD (HR = 1.88, CI: 1.81-1.95, P \u3c 0.001) and overdose (HR = 1.83, CI: 1.72-1.94, P \u3c 0.001). This association remained consistent after adjustment for comorbidities and across all sensitivity analyses. CONCLUSIONS: Surgical patients who develop PPOU are at increased risk of both OUD and overdose as compared to surgical patients who do not develop persistent use
Digital Storytelling to Communicate COVID-19 Research Efforts
Full text linkProblem statement: COVID-19 was a once-in-a-century pandemic that hit the world in March 2020. Overnight, the SARS-CoV-2 virus threatened not only survival, but also food security, social supports, transportation issues, financial constraints, and more. Timely research became crucial to understanding how to mitigate viral spread, treat patients, and address the consequences and health implications.
Background: Advancing the infrastructure to support research in northern New England has been the focus of the Northern New England Clinical and Translational Research (NNE-CTR) Network since 2017. The NNE-CTR Network is a multi-year initiative in Maine, Vermont, and New Hampshire that brings together academic institutions, health care organizations, and local community stakeholders to foster new research and address health challenges unique to the northeast region. The NNE-CTR Network was well-positioned to help address COVID-19, not only locally, but also nationally and worldwide.
Application: The NNE-CTR Network\u27s Tracking and Evaluation Core (TEC) assessed the NNE-CTR Network\u27s COVID-19 research during the first 3 years of the pandemic. Using an innovative, arts-based dissemination method known as digital storytelling, the TEC summarized and shared the NNE-CTR Network\u27s immediate and broad response to the pandemic. The analysis revealed 4 major ways the NNE-CTR Network responded to the pandemic: (1) quickly reallocating funding for early pandemic research, (2) providing innovative laboratory support and technologies, (3) collaborating in national research efforts, and (4) conducting research on a range of pandemic topics. The TEC used digital storytelling to highlight 18 research projects that addressed the pandemic
Evaluating Perceptions of Shared Decision-Making in Hospitalized Older Adults: Impact of Targeted Education in What Matters Conversations
Full text linkWhat Happens in the End: A Review of Pediatric Concurrent Hospice Care
No full textCME available for 1 year after presentation
CME Text Code: 97016
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1073/thumbnail.jp
Infant with Fever and Splenomegaly—Time is Ticking
Full text linkIntroduction: We report on a case of babesiosis in an infant younger than 6 months who presented with fever and splenomegaly in late fall.
Clinical Findings: This full-term, previously healthy infant was febrile at home and clinically well-appearing, though pale with splenomegaly on examination.
Clinical Course: The patient presented with several days of irritability and pallor, following suspected viral illness with fever, and treated at home. Initial outpatient work-up revealed a normocytic anemia and splenomegaly was confirmed on abdominal ultrasound. They were admitted to the hospital for blood transfusion and comprehensive evaluation. Peripheral smear was normal and Babesia microti was detected by polymerase chain reaction. Parasite levels were less than 0.1%. They completed a 7-day course of atovaquone and azithromycin. They followed up with Pediatric Infectious Disease, which documented resolution of symptoms.
Conclusions: Although a palpable spleen may be present in up to 30% of healthy infants, true splenomegaly (\u3e1 to 2 cm below the costal margin) warrants a prompt further work-up. This work-up is particularly important if infants have other symptoms, such as fever, because fever may indicate a severe underlying illness. Although rare, babesiosis does occur in infants, and, thus, tick-borne illnesses should be considered
Ulceroglandular Tularemia in a Pediatric Patient in Maine After a Trip to Martha’s Vineyard
Full text linkIntroduction: Vector-borne lymphadenitis in children is uncommon. A detailed exposure and travel history can facilitate diagnosis.
Clinical Findings: The pediatric inpatient service admitted a 6-year-old patient after multiple acute care visits for right posterior auricular tenderness, erythema, and swelling.
Clinical Course: Upon admission, the patient received intravenous ceftriaxone and clindamycin for progressive suppurative lymphadenitis. After a review of the patient’s history, which included the removal of an engorged tick and recent travel to Martha’s Vineyard, Massachusetts, the treatment was transitioned to intravenous gentamicin for ulceroglandular tularemia.
Conclusions: Francisella tularensis can be transmitted via tick and deer-fly bites and should be considered in patients with an exposure history and compatible symptoms, such as skin ulceration, and lymphadenopathy after traveling to endemic regions
A Case of Anaplasmosis Infection with Rash and Coinfection or Antibody Cross-Reactivity
Full text linkIntroduction: Tick-borne illnesses are on the rise in Maine and include Lyme disease, anaplasmosis, and babesiosis. Anaplasmosis is an infection caused by Anaplasma phagocytophilum, a bacterium of the Rickettsiales order. A. phagocytophilum is transmitted by Ixodes scapularis, also known as the blacklegged or deer tick. Symptoms of fever, chills, headache, malaise, cough, and confusion usually occur within several days of the tick bite. Rash in patients with anaplasmosis is uncommon and may indicate coinfection with another tick-borne disease. Laboratory values may show thrombocytopenia, leukopenia, and transaminitis. Bacteria may be visible within the granulocytes on peripheral smear. Rocky Mountain spotted fever is another tick-borne illness, transmitted by American dog ticks in the eastern United States. American dog ticks in Maine are not known to transmit the bacteria that causes Rocky Mountain spotted fever.
Clinical Findings: A 74-year-old man was admitted with fever, acute encephalopathy, acute kidney injury, transaminitis, and petechial rash 2 weeks after a tick bite.
Clinical Course: The patient was started on doxycycline for presumed tick-borne illness. Laboratory results for antibody screening were negative for Lyme, Anaplasma, Babesia, and Ehrlichia. However, testing with polymerase chain reaction returned positive for A. phagocytophilum on hospital day 4. The petechial rash worsened on hospital day 5, and laboratory results for spotted fever group antibodies showed a 4-fold increase in serum immunoglobulin G levels over 4 weeks. He was discharged in stable condition.
Conclusions: This patient represents a case of anaplasmosis with (1) rash and antibody cross-reactivity between A. phagocytophilum and spotted fever group antibodies or (2) a less likely co-infection with Rocky Mountain spotted fever or other spotted fever or Rickettsia bacteria
Community Health Workers: Putting Community in the MaineHealth Vision
Full text linkCommunity Health Workers (CHW) play an increasingly key role across the MaineHealth system. The integration of CHWs and growth of the workforce enhances care and improve patient engagement and outcomes. Utilizing data from FY24, modelling from the MH CHW Work Group as well as patient feedback, this poster illustrates the impact CHWs are having on the lives of patients, the care teams they support and the communities in which they live, work and play.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1017/thumbnail.jp
Ethical Management of Challenging Behaviors in Hospitalized People Who Use Drugs
No full textFrom drug use in the hospital to patient-directed discharges and threatening behavior, challenging behaviors arise frequently in inpatients with infectious complications of substance use disorders (SUDs). The management of such challenging behaviors can bring key ethical values into tension and be susceptible to clinician bias. Here, we characterize the ethical tensions that emerge in the management of challenging behaviors in inpatients with infectious complications of SUD, identify preventive approaches, and delineate how clinicians can respond when preventive measures fail. Such preventive and post hoc responses incorporate the principles of harm reduction as well as of patient-centered care and trauma-informed care