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Microbiome and Nutrition in the First 1000 Days: Charting the Future of Metabolic Health in Children
No full textCME available for 1 year after presentation
CME Text Code: 97031
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1078/thumbnail.jp
Care of the Operational Canine in the Prehospital Environment - A Joint Position Statement and Resource Document of NAEMSP, NAVEMS, and VetCOT
No full textThe National Association of Emergency Medical Services Physicians (NAEMSP), National Association of Veterinary Emergency Medical Services (NAVEMS), and the American College of Veterinary Emergency and Critical Care\u27s Veterinary Committee on Trauma (VetCOT) agree that the operational canine (OpK9) injured in the line of duty should be entitled to safe, efficacious, and ethical treatment and transport by prehospital personnel to higher levels of veterinary care. It remains clear that, in situations involving both human and OpK9 casualties, the priority of care and available medical resources should be directed toward preserving human life. The fact that there is currently no organized preveterinary care system in place to treat or transport the injured OpK9 drives the need for collaboration between the existing emergency medical services (EMS) system and the veterinary community. NAEMSP, NAVEMS, and VetCOT recommend:Operational canines injured in the line of duty should receive the highest level of resuscitative care, as close to the point of injury as possible, even without trained and licensed veterinary personnel.Established veterinary and EMS organizations should:Create collaboratively-developed consensus-based guidelines, aligned with the EMS clinician\u27s scope of practice, for providing prehospital preveterinary care of ill or injured operational canines.Support advocacy for legislation and policy development to ensure that prehospital preveterinary care is more readily available to operational canines.Promote increased awareness of the needs and challenges hindering prehospital preveterinary care for ill or injured operational canines
Prenatal screening for trisomy 21 (Down syndrome) using first- and second-trimester biochemistry and nuchal translucency: A technical standard of the American College of Medical Genetics and Genomics (ACMG)
No full textThis technical standard was developed as a guide for laboratories performing prenatal screening for Down syndrome. It addresses 3 topics: second trimester (triple or quad), first trimester, including incorporation of nuchal translucency, and current directions in cell-free DNA screening. Analytic methods, clinical considerations, screening performance, guidelines for reporting second trimester, first trimester, integrated, contingent, and reflex screening tests for Down syndrome, are discussed. Individual laboratories are responsible for meeting the quality assurance standards described by the Clinical Laboratory Improvement Amendments, the College of American Pathologists, and other regulatory agencies, with respect to appropriate sample documentation, assay validation, general proficiency, and quality control measures
Previsit Preparation for Shared Decision-Making in Lung Cancer Screening in Primary Care Using a Paper Decision Aid and an Automated Text Messaging Program: Quasi-Experimental Pilot Study.
No full textBACKGROUND: Patient-provider discussions and shared decision-making (SDM) are essential for tailoring lung cancer screening (LCS) decisions to individual patients. However, the implementation of SDM in primary care settings is challenging. Innovative approaches are needed to reach and prepare patients eligible for LCS for SDM in primary care settings and increase LCS uptake.
OBJECTIVE: We piloted previsit preparation comparing 2 strategies: a paper decision aid (DA; DA group) and an enhanced comparator strategy consisting of the paper DA plus an automated text message program (DA+TM group) designed to promote patient-provider LCS discussions. We explored feasibility and gathered preliminary data on its potential effects on LCS discussions, decision-making, and LCS uptake in primary care settings.
METHODS: In a sequential quasi-experimental pilot study, we recruited patients who were eligible for LCS in a single academic health care system. Prior to an upcoming visit, participants in both groups received a paper-based DA by mail. In the DA+TM group, participants also received a series of automated text messages to help them prepare for their LCS discussions. We monitored participant recruitment and retention, as well as patient engagement in DA and text messages. In exploratory analyses, we assessed patient-provider discussion of LCS, SDM, patient knowledge, decision conflict at baseline and in follow-up telephone surveys, and LCS completion measured by electronic health records.
RESULTS: We enrolled and included 48 participants (DA group=19 and DA+TM group=29) in the final analysis. Participants were predominantly White, with a median age of 61.0 (IQR, 57.0-65.0), and 58% (28/48) of them were female. Engagement was high in both groups. LCS knowledge significantly improved in the DA+TM group (4.5 baseline vs 6.0 follow-up; P=.003), while there was no change in the DA group (5.0 baseline vs 5.0 follow-up, P=.23). Median LCS knowledge change from baseline to follow-up was 0.5 (IQR -1.0 to 2.5) in the DA group and 1.5 (IQR 0-3.0) in the DA+TM group (P=.24). Decision conflict in both groups significantly decreased (DA group: 37.5 baseline vs 0 follow-up, P\u3c .001; DA+TM group: 50.0 baseline vs 20.0 follow-up, P=.003). The median SDM process score (a measure of SDM) was 3.0 (IQR 1.5-4.0) in the DA group and 2.0 (IQR 1.0-3.0) in the DA+TM group (P=.11). The LCS completion rates were 5% (1/19) in the DA group and 31% (9/29) in the DA+TM group at 3 months (P=.07), and 26% (5/19) in the DA group and 34% (10/29) in the DA+TM group at 6 months (P=.75).
CONCLUSIONS: Previsit preparation was feasible in primary care settings. An enhanced, text message-based strategy has the potential to reach and engage broader LCS-eligible populations and prepare patients for LCS discussions with their primary care providers, which may ultimately improve informed decision-making and LCS uptake
2025 Report of the STAR Working Group on Donor Derived Cell Free DNA: Establishing Analytical Validity as the Basis for Appropriate and Effective Clinical Utilization.
No full textA working group under the Sensitization in Transplant: Assessment of Risk (STAR) initiative was established in 2023 to develop guidelines for analytic and clinical validity of lab-based testing for donor-derived cell-free DNA (dd-cfDNA). Measurement of dd-cfDNA as a minimal invasive marker of allograft injury has become more widely used over the last few years. To date, various technical and quantitation methods have hindered standardized and interpretation of the results, leading to variability in understanding how to best utilize cfDNA in transplantation. Kits are being formulated for local laboratory testing, but we lack an organized framework for laboratory quality assurance. Further, threshold values and methods of measurement have changed over time, indicating that assay sensitivity and clinical relevance are still being refined. Harmonization and reproducibility will be critical as the field moves forward to local laboratory-based testing. The goal of this work group was to review and analyze technical and biological variables, and clinical settings that could contribute to disparities in results, which will ultimately influence clinical validity and utility. High-quality, standardized de-centralized dd-cfDNA testing is the essential pre-requisite for conducting real-world evidence generating multicenter studies to establish the appropriate context of use for this promising assay
October 22nd, 2025: Advances in Melanoma Epidemiology, Diagnosis, and Treatment
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1050/thumbnail.jp
Improving Patient Safety in Hospitals with Smartwatch Technology
No full textIn hospitalized adult patients, how does the use of smart bracelets compare to standard care affect patient safety and monitoring outcomes?https://knowledgeconnection.mainehealth.org/nurseresidency/1142/thumbnail.jp
DIO3 coordinates photoreceptor development timing and fate stability in human retinal organoids
No full textThe mechanisms governing the generation of neuronal subtypes at distinct times and proportions during human retinal development are poorly understood. While thyroid hormone (TH) signaling specifies cone photoreceptor subtypes, how this regulation changes over time remains unclear. To address this question, we studied the expression and function of type 3 iodothyronine deiodinase (DIO3), an enzyme that degrades TH, in human retinal organoids. We show that DIO3 is a master regulator of human photoreceptor developmental timing and cell fate stability. DIO3 is highly expressed in retinal progenitor cells (RPCs) and decreases as these cells asynchronously differentiate into neurons, progressively reducing TH degradation and increasing TH signaling. DIO3 mutant organoids display precocious development of S cones, L/M cones, and rods; increased photoreceptor density; and subpopulations of photoreceptors that coexpress different opsin proteins. Our multiomics and chimeric organoid experiments show that cell-autonomous and non-cell-autonomous mechanisms locally coordinate and maintain DIO3 expression and TH signaling levels among cells. Computational modeling reveals a mechanism that couples TH levels and fate specification, providing robustness to photoreceptor development as compared with a probabilistic, cell-intrinsic mechanism. Based on our findings, we propose an hourglass-like mechanism in which the proportion of progenitors to neurons decreases over time to relieve TH degradation, triggering development of photoreceptor subtypes at specific times. Our study identifies how local regulation of thyroid hormone signaling influences neural cell fate specification, which may be a consideration for designing regenerative therapies
ATS Pediatric Core Curriculum 2024: The Role of the Pediatric Pulmonologist in the Intensive Care Unit
No full textThe American Thoracic Society Core Curriculum updates clinicians annually in relevant topics related to pediatric pulmonary diseases. This is a summary of the Pediatric Pulmonary Medicine Core Curriculum presented at the 2024 American Thoracic Society International Conference. The curriculum focused on clinical topics that are essential to caring for patients in the intensive care unit (ICU), highlighting the specific care of patients with severe asthma, pediatric acute respiratory distress syndrome (PARDS), hemoptysis and pulmonary hemorrhage, serious cardiovascular disease within the cardiac ICU and chronic respiratory failure. In the case of severe asthma, we review risk factors for ICU admission, adjunct pharmacologic therapies and appropriate ventilatory strategies. We discuss the highlights of the recently updated PARDS guidelines are offer further diagnostic stratification including possible and at risk categories to help facilitate early intervention and possibly prevent disease progression. Though relatively rare, pediatric hemoptysis and pulmonary hemorrhage can be devastating clinical scenarios and this review includes the discussion of pharmacologic and bronchoscopic interventions that should be considered in these cases. Additionally, we provide a summary of some of the common respiratory pathophysiology encountered in the cardiac ICU, as well as the diagnostic and therapeutic interventions available to the pulmonologist. Lastly, we review the decision-making considerations when transitioning patients from the ICU to chronic home mechanical ventilation. This manuscript aims to provide basic knowledge regarding each of these topics, in addition to up-to-date literature and resources for practicing pulmonologists and trainees