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Improving Patient Adherence to Medications with Pharmacist-Led Education Program in Primary Care
Get PDFEndocrine Emergencies Supported by Extracorporeal Membrane Oxygenation: A Case Series
Get PDFProblem Statement: This case series showcases the successful use of extracorporeal membrane oxygenation (ECMO) to aid 4 patients facing cardiac collapse or multisystem organ failure due to severe endocrine issues. Background: Between 2019 and 2021, at Maine Medical Center, 4 patients received ECMO for conditions, such as thyroid storm, pheochromocytoma, and post-thyroidectomy complications leading to organ failure. Three patients underwent venoarterial ECMO, and 1 underwent venovenous ECMO. A patient in their 30 s faced multisystem organ failure from thyroid storm and hyperthyroidism, and eventually underwent total thyroidectomy. Another patient in their 30 s experienced severe heart failure and eosinophilic myocarditis and was later discovered to have an extra-adrenal paraganglioma. A patient in their 40 s developed acute respiratory distress syndrome and hypoxia after thyroidectomy for cancer. A patient their 50 s had a cardiac arrest due to a pheochromocytoma. Application: ECMO stabilized these patients, facilitating medical control of endocrine issues and subsequent surgical interventions. Within less than 1 week on ECMO and spending up to 8 days in the hospital pre-ECMO, all patients significantly improved and recovered significantly enough to be discharged home. The findings suggest ECMO could be an effective intervention for endocrine-related cardiogenic shock. Recognizing endocrine disorders as potential causes of cardiac crises is crucial because these conditions can significantly influence heart function to precipitate or exacerbate acute cardiac events. For this reason, it is important to emphasize collaborative efforts between ECMO and endocrine teams for optimal patient care
Predictive Value of Platelet FcγRIIa in Patients Treated With PCI Compared With Medical Therapy Alone After Myocardial Infarction
No full textBACKGROUND: In patients with myocardial infarction (MI), quantifying platelet FcɣRIIa (pFCG) stratifies the risk of subsequent MI, stroke, and death. This report is a subgroup analysis of outcomes in patients treated with percutaneous coronary intervention (PCI) or medical management alone in an 800-patient, 25-center trial. METHODS: Patients were enrolled in a prospective, noninterventional trial during hospitalization for type 1 MI (ST-segment-elevation and non-ST-segment-elevation). Inclusion criteria included at least 2 of the following: aged ≥65 years, multivessel coronary artery disease, prior MI, chronic kidney disease, or diabetes. Flow cytometry was used to quantify pFCG at a core laboratory. High and low pFCG were defined by a prespecified threshold. The primary end point was the composite of MI, stroke, and death. RESULTS: Patients treated with medical therapy alone (n=151) had a greater occurrence of the primary end point (23.8%) than those treated with PCI (n=490, 8.8%). The pFCG test discriminated to a similar extent the risk of the primary end point in both the medical treatment group (hazard ratio, 2.29 [95% CI, 1.18-4.41]; P=0.014) and the PCI group (hazard ratio, 2.57 [95% CI, 1.41-4.69]; P=0.002). There was no significant association between pFCG and clinically relevant bleeding in the medical treatment group (hazard ratio, 1.22 [95% CI, 0.29-5.10]) or the PCI group (hazard ratio, 1.56 [95% CI, 0.67-3.61]). CONCLUSIONS: Quantifying pFCG discerned the risk of subsequent cardiovascular events among patients treated with medical therapy alone or PCI. This prognostic information will be useful for clinical decisions that balance ischemic and bleeding risk. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05175261
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
Current Status, Public Health Implications, and Potential Future Establishment of \u3ci\u3eAmblyomma americanum\u3c/i\u3e, the Lone Star Tick, in Maine
Get PDFIntroduction: Amblyomma americanum is a medically important tick species established in the southeastern United States, with populations gradually spreading northward into New England. This study aimed to evaluate the current presence, distribution, and density of A. americanum in Maine.
Methods: Surveillance efforts focused on Ixodes scapularis have been conducted by the Vector-Borne Disease Laboratory of MaineHealth Institute for Research since 1989. This surveillance uses tick flagging, examination of hunter-harvested game and trapped wild hosts for feeding ticks, and a statewide passive surveillance program. Effort focused on A. americanum surveillance began in 2019 using flagging, carbon dioxide-baited trapping, and serosurveillance (Heartland virus, Bourbon virus) in cervids.
Results: Maine’s passive tick surveillance program has received low numbers of A. americanum (0–17 per year, 1989–2024) from across the state. Immature A. americanum have also been repeatedly collected from migratory birds (0–6 per year, 1991–2024). Serosurveillance of cervids (n = 217) identified 1 deer with Heartland virus. Zero A. americanum were returned from targeted flagging or carbon dioxide-baited trapping.
Discussion: Uncertainties surrounding the seasonality of possible A. americanum populations in Maine may account for the low numbers seen from active surveillance and examination of game. The low, yet continual, collections from migratory birds and passive surveillance over time mirror patterns of establishment seen previously in New England and indicate repeated introductions into Maine.
Conclusions: Although collections from Maine do not yet meet the US Centers for Disease Control and Prevention requirements for an established population, evidence shows that low numbers are present in the state, and that further range expansion and increased abundance are likely in years to come
Characterization of Contributors to Pleural Fluid Viscosity
Get PDFBackground: Pleural effusion is a common consequence of pulmonary disease and may result from a spectrum of conditions. This pilot study seeks to describe relationships between pleural fluid viscosity and fluid analytes commonly measured in clinical laboratories.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1000/thumbnail.jp
Impact of Individual Team Members on Team Performance in a Longitudinal Neonatal Resuscitation Telesimulation Program
Get PDFPhysician participation in interprofessional simulation program improves team adherence to neonatal resuscitation guidelines.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1025/thumbnail.jp
The Bronchoalveolar Proteome Changes in Obesity
No full textObesity contributes to pulmonary dysfunction through poorly understood biochemical mechanisms. Chronic inflammation and altered cellular metabolism have emerged as pathologic changes across organ systems in obesity, but whether similar changes occur in the lungs with obesity is unknown. We collected bronchoalveolar lavage fluid (BALF) from right upper lobe and lingula pulmonary subsegments of 14 adults (7 males / 7 females) with body mass indexes (BMI) ranging from 24.3 to 50.9 kg/m without lung disease. Proteomes were measured using SWATH mass spectrometry. Proteomic composition and pathway enrichments were examined for the cohort and as a function of BMI. BALF proteomic compositions were consistent with prior studies and had improved protein identification. We found minimal differences in BALF proteomes between lavage regions. Five proteins were strongly correlated with BMI (False Detection Rate / FDR adjusted p-values \u3c 0.05) and 11had weaker correlation (FDR adjusted p-values 0.05 - 0.1). These proteins included acute phase reactants and complement factors. Few proteomic differences between biologic sexes were detected, but some of them coincided with BMI-related proteins. Pathway enrichments impacted by BMI included innate immunity, anti-fibrinolysis, oxidative stress, and lipid metabolism. The bronchoalveolar microenvironment is altered by obesity in humans without lung disease. Pathway alterations associated with BMI included coagulation and fibrinolysis, redox and oxidative stress, energy metabolism, and humoral immune function. Our data support the theory that conserved biochemical and cellular changes in obesity may be fundamental mechanisms of dysfunction in multiple tissues but the specific impact on pulmonary function or disease is not yet known
DERM-SUCCESS FDA Pivotal Study: A Multi-Reader Multi-Case Evaluation of Primary Care Physicians\u27 Skin Cancer Detection Using AI-Enabled Elastic Scattering Spectroscopy
No full textBACKGROUND: Elastic Scattering Spectroscopy (ESS), an optical tissue sampling technique, distinguishes between benign and malignant tissue in vivo without the need to perform a surgical biopsy. A handheld device that employs ESS enabled with an artificial intelligence algorithm was developed as an objective tool to aid primary care physicians (PCPs) in their management of lesions suspicious for skin cancer. The aim of this study was to assess and compare the diagnostic and management performance of PCPs with and without the use of the ESS device in detecting skin cancer. METHODS: In this clinical utility study, 108 PCPs evaluated 100 skin lesion cases (50 aided with the device output and 50 unaided by the device). For each case, PCPs provided a diagnosis, management decision, and level of confidence in that decision initially without, and then subsequently with, device output. Sensitivity, specificity, AUC, and confidence in their assessment prior to, and then with, device output were compared. RESULTS: With visual assessment assisted by device output, diagnostic sensitivity increased significantly from 71.1% to 81.7% (P = .0085) and referral sensitivity increased significantly from 82.0% to 91.4% (P = .0027) compared to visual assessment only. Device-aided diagnostic specificity decreased from 60.9% to 54.7% (P = .1896), and referral specificity decreased from 44.2% to 32.4% (P = .0256). Overall management performance (ie, AUC) also increased from 0.708 to 0.762, and increased from 0.567 to 0.682 for lesions which physicians reported low confidence in their unassisted management decision. Physicians reporting high confidence in their management assessment increased from 36.8% to 53.4%. CONCLUSION: Use of the ESS device output by PCPs significantly improved their diagnostic and management sensitivities as well as their overall management performance. The findings suggest the ESS device can improve PCP skin cancer detection and confidence in their skin lesion evaluation and management
FGF21 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