6289 research outputs found
Sort by
Work Hard, Play Hard: How Game-Based Learning Impacts Learner\u27s Engagement and Satisfaction in Intern Academic Half-Day
Full text linkBackground: Gamification and game-based learning (GBL) is being incorporated into graduate medical education (GME) to augment the more traditional lecture-based format, with the goal of promoting an interactive learning environment that strengthens collaboration. Although some GME programs have adopted GBL, there is limited study on its effect on learners.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1030/thumbnail.jp
June 11th, 2025: Re-Defining Primary Aldosteronism and the Approach to Hypertension
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1042/thumbnail.jp
Brivaracetam effectiveness and patient-reported outcomes in clinical practice: Data from a 12-month prospective, observational study in the United States
No full textOBJECTIVE: Evaluate real-world effectiveness, patient-reported outcomes (PROs), and safety/tolerability of brivaracetam in patients (≥16 years) with focal-onset seizures currently receiving ≥ 1 antiseizure medication (ASM), and with historical or current use of levetiracetam, lamotrigine, oxcarbazepine, and/or carbamazepine. METHODS: EP0088 was a 12-month, prospective, observational study of brivaracetam in a clinical practice setting in the US. Primary study outcome was brivaracetam retention at 12 months after brivaracetam initiation. Effect of brivaracetam on patients\u27 perceptions of their health was assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) short forms and Seizure-Related Disability Assessment Scale (SERDAS). Safety outcomes included incidence of treatment-emergent adverse events (TEAEs). RESULTS: 254 patients (mean age: 44.3 years; median duration of epilepsy: 17.3 years) received ≥ 1 brivaracetam dose (Safety Set; SS). Patients had a median of 3.0 historical and 2.0 concomitant ASMs (SS). For all patients (SS), including those who dropped out with unknown brivaracetam treatment status, 12-month brivaracetam retention was 57.1 % (n = 145/254); in patients with known brivaracetam treatment status (post hoc analysis), 12-month brivaracetam retention was 72.1 % (n = 145/201). Slight improvements in mean PROMIS T-scores, and improvements in mean SERDAS scores, were seen by month 1.5, and generally maintained up to 12 months (Full Analysis Set). 49.6 % of patients reported ≥ 1 TEAE, 38.2 % had drug-related TEAEs, and 16.1 % discontinued due to TEAEs (SS). CONCLUSIONS: Brivaracetam was effective in patients with difficult-to-control focal-onset seizures; as shown by brivaracetam retention at 12 months. Improvements in PROs were seen early. Brivaracetam was well-tolerated and no new safety signals were observed
Neurodevelopmental Outcomes in Early Adolescence: The Pediatric Heart Network Single Ventricle Reconstruction Trial
No full textBACKGROUND: Neurodevelopmental and functional impairments are among the most consequential morbidities for survivors of hypoplastic left heart syndrome after staged single ventricle surgical palliation. The SVRIII trial (Long-Term Outcomes of Children With Hypoplastic Left Heart Syndrome and the Impact of Norwood Shunt Type) enrolled adolescents, who were randomized to different surgical shunt types at the time of Norwood procedure as neonates, for multifaceted in-person evaluation. This study reports their neurodevelopmental outcomes. METHODS: Transplant-free survivors from SVRIII were invited to complete an in-person comprehensive neurodevelopmental evaluation in early adolescence. Outcomes across domains of cognition, academics, learning, memory, and attention, as well as social, emotional, behavioral, adaptive, and executive function, were compared with those of normative populations. Associations with demographic and medical covariates, including Norwood shunt type, were also assessed. RESULTS: Among 549 participants enrolled in the SVR trial (Single Ventricle Reconstruction), 200 of the 237 SVRIII participants (84%) completed a neurodevelopmental evaluation at a mean age of 11 years (range, 10 to 14 years). SVRIII participants who did versus did not undergo evaluation were more likely to be male (63% versus 51%), to be White (87% versus 76%), and to have a higher Childhood Opportunity Index score (61±26 versus 46±39). Full-scale intelligence quotient (88±18) was significantly lower than in the normative population, with 39% \u3e1 and 15% \u3e2 SD below the normative mean. Similar patterns were seen for reading (38% \u3e1 SD and 16% \u3e2 SD below the normative mean) and math (38% \u3e1 SD and 19% \u3e2 SD below the normative mean) scores. Attention, executive functioning, social development, visual memory, and adaptive functioning were all more impaired than in the normative population. Measures of socioeconomic status, number of medical complications, and requirement for a gastrostomy tube were each independent predictors of neurodevelopment, with socioeconomic status the most consistently significant factor across models. Group differences by shunt type were inconsistent across neurodevelopmental domains without a clear benefit of one surgical strategy. CONCLUSIONS: In early adolescence, transplant-free survivors of surgical palliation for hypoplastic left heart syndrome show concerning impairments across all domains of neurodevelopment. The distribution of affected outcomes is broad and associated with demographic, medical, and, most frequently, socioeconomic factors. Our findings support recommendations for neurodevelopmental evaluation during adolescence to guide individualized interventions to promote educational success and psychosocial well-being. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02455531
Dietary effects on cardiac lipid composition, mitochondrial respiration, stress proteins and thermal tolerance in the American lobster (Homarus americanus)
No full textLipids are fundamental components of many biological structures, and their composition is partially diet dependent. Differences in lipid composition can impact the functioning of cellular membranes and proteins, subsequently altering the organism\u27s ability to respond to environmental conditions. The American lobster (Homarus americanus) is an economically important shellfish in New England and is frequently kept in lobster impoundments (pounds) for prolonged periods, typically on a diet of herring, which differs from the natural diet of wild-caught lobsters. In this study, we compared the lipid composition of lobster muscle, heart and hepatopancreas from wild-caught and from pound-kept lobsters that were fed either herring or blue mussels. We performed lipidomic analysis, measured mitochondrial function, determined gene expression of cellular stress markers and evaluated thermal stress tolerance by assessing heart and ventilation rate, as well as hemolymph oxygenation during a fast progressive temperature challenge. We found a significant shift in lipid composition in pound-kept lobster hearts together with reduced mitochondrial function, and increased gene transcription of the cellular stress markers HSP70 and AMPK, indicating a worse nutritional state, compared with wild-fed lobsters. The changes did not lead to a shift in thermal thresholds, indicating a substantial plasticity and tolerance to compensate for adverse diet-induced conditions. This study mechanistically links diet, lipid composition, mitochondrial function and thermal tolerance and highlights the need for a more detailed understanding of cellular processes to understand climate change-induced impacts on marine invertebrates
What Sucks the Best? The DuCanto!
Full text linkBackground: Airway management is a defining skill that demands mastery by emergency physicians. Airway emergencies pose considerable morbidity and mortality risks. Familiarity with, and mastery of, a variety of airway management approaches and equipment can prove invaluable for management of anatomically and physiologically difficult airways.https://knowledgeconnection.mainehealth.org/nurseresidency/1124/thumbnail.jp
Bridging the Gap: Enhancing Pediatric Subspecialty Care Through Clinic-to-Clinic Telemedicine
No full textCME available for 1 year after presentation
CME Text Code: 97035
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1081/thumbnail.jp
Trends in Osteoporosis Drug Therapy Receipt Among Commercial and Medicare Advantage Enrollees in the United States, 2011-2022
No full textCONTEXT: A national assessment of osteoporosis drug therapy (ODT) use can inform the extent of underdiagnosis and undertreatment of osteoporosis. OBJECTIVE: The aim was to describe trends in ODT use by age, sex, fragility fracture, and documented osteoporosis. METHODS: This was a retrospective analysis of patient-quarter observations for adults aged ≥50 years with commercial or Medicare Advantage health insurance in the OptumLabs Data Warehouse between 2011 and 2022. The primary outcome was the proportion of patient-quarter observations with ODT use stratified by age, sex, fragility fracture, and documented osteoporosis. Cuzick tests were performed to assess trends ODT use. RESULTS: Analysis of 166 673 420 patient-quarter observations revealed that over 70% of patients with fragility fractures did not have documented osteoporosis. Among women aged ≥65 years with documented osteoporosis, ODT fill rates increased between 2011 and 2022 from 36.3% to 50.1% for women without fragility fractures (P \u3c .001) and from 30.8% to 43.7% for women with fragility fractures (P \u3c .001). However, ODT fill rates declined (9.2% to 7.4% between 2011 and 2022) for women with fragility fractures and no documented osteoporosis (P = .015). Similar trends were observed among women aged 50-64 years and men. CONCLUSION: ODT use for patients with documented osteoporosis has increased but remains low. Low rates of ODT use for patients with fragility fractures in the absence of documented osteoporosis suggests that underdiagnosis of osteoporosis contributes to underuse of ODTs
Associations of maternal per- and polyfluoroalkyl substance plasma concentrations during pregnancy with offspring polycystic ovary syndrome and related characteristics in project viva
No full textBACKGROUND: Per- and polyfluoroalkyl substances (PFAS) may impact ovarian folliculogenesis and steroidogenesis, but whether prenatal exposure may impact offspring reproductive health is unknown. This study examines the extent to which maternal PFAS plasma concentrations during pregnancy are associated with polycystic ovary syndrome (PCOS) and related characteristics in female offspring. METHODS: We studied 322 mother-daughter pairs in Project Viva, a Boston-area longitudinal pre-birth cohort enrolled 1999-2002. We examined associations of maternal prenatal (median: 9.6 weeks gestation) plasma concentrations of six PFAS (log2 transformed) with PCOS and related characteristics among daughters during mid-to-late adolescence. We estimated the associations of single PFAS and PFAS as a mixture with each outcome, using logistic regression and quantile g-computation, respectively, adjusting for parity, and maternal sociodemographic and other lifestyle/health factors. RESULTS: Among the 322 mother-daughter pairs, the majority of mothers identified as non-Hispanic White and had a college degree, and 13% of daughters had either self-reported PCOS or probable PCOS based on irregular menstrual cycles and clinical or biochemical markers of hyperandrogenism. Among all daughters, there were 27% with irregular menstrual cycles, 34% with hirsutism, and 6% with moderate-to-severe acne. When fully adjusted for confounders, per doubling of maternal 2-(N-ethyl-perfluorooctane sulfonamido) acetate (EtFOSAA) concentration was associated with higher odds of self-reported PCOS [OR (95% CI) = 2.66 (1.18, 5.99)], and per doubling of maternal perfluorononanoate (PFNA) concentration was associated with higher odds of moderate-to-severe acne [OR (95% CI) = 2.33 (1.09, 4.99)] in daughters with or without irregular menstrual cycles. We found no associations of the mixture of six PFAS with PCOS or related traits. CONCLUSION: Our findings suggest a positive association between maternal concentrations of EtFOSAA and PCOS in their daughters during mid-to-late adolescence, although future studies with larger sample size and extended follow-up across the reproductive life-course are needed