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The implementation of an electronic symptom management system to monitor postoperative pain in thoracic surgery patients: A multicenter evaluation
No full textOBJECTIVE: Few studies have evaluated postoperative recovery of patients after thoracic surgery using patient-reported outcome measures. This multi-institutional study analyzed postoperative pain and opioid use among patients undergoing thoracic surgery based on patient-reported outcome measures data collected through an electronic symptom management system. METHODS: The electronic symptom management system is a multi-symptom questionnaire based on a Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events that is integrated into the electronic health record and administered via the patient portal. Patients undergoing lung resections were invited to complete electronic symptom surveys within the electronic symptom management system during their 90-day postoperative period. Baseline patient demographics, surgical data, and postoperative opioid data were gathered from the electronic health record. Multivariable hierarchical regression was used to evaluate predictors of postoperative pain and opioid prescriptions. RESULTS: Of 680 patients who met the inclusion criteria, 258 (37.9%) reported at least 1 severe pain score. Patients reporting severe pain were more likely to have undergone open surgery, to receive at least 1 postoperative opioid prescription, and to become persistent opioid users compared with patients reporting no severe pain. In multivariable logistic regression analysis, the only factor associated with a severe pain score was female sex (odds ratio, 1.67, 95% CI, 1.17-2.39; P = .005). CONCLUSIONS: This multicenter study used patient-reported outcome measures to evaluate predictors of postoperative pain and opioid prescriptions in patients undergoing thoracic surgery. Further investigation into the administration of patient-reported outcome measures is needed to assess their ability to impact postsurgical care and postoperative outcomes
Phantom Limb Pain Assessment Tools: A Literature Review Exploring Strengths and Limitations
No full textOBJECTIVE: To identify and categorize the pain instruments used to evaluate phantom limb pain (PLP), phantom limb sensations (PLSs), and residual limb pain (RLP) stratified by frequency of use, instrument completion time, and inclusion of descriptive terms to distinguish between the 3 phenomena. DATA SOURCES: MEDLINE/PubMed and Google Scholar from 1986 to 2024. STUDY SELECTION: Cross-sectional, cohort, and case-control studies investigating the prevalence of PLP in adults (18y or older) with surgical and traumatic upper or lower limb amputation. DATA EXTRACTION: Studies were identified and their methods were evaluated for mention of instruments used to assess for PLP. Tools were then evaluated for frequency of usage, completion time, differentiation of pain and sensations after limb amputation, and qualitative assessment using descriptor words associated with PLP and PLSs. DATA SYNTHESIS: The review included 44 studies and identified 25 tools (5 unidimensional and 20 multidimensional). Unidimensional pain scales, particularly the Numeric Rating Scale, were the most frequently used. Of the multidimensional instruments identified, 9 of them were specific to PLP, and 6 distinguished between PLP, PLS, and RLP. Only one multidimensional instrument that was specific to PLP used descriptor words to differentiate between PLP and PLS. No tool was assessed for all 3 conditions and used descriptor words to distinguish between PLP and PLSs. CONCLUSIONS: Based on this systematic review, no PLP-specific instrument is suitable for standardizing the diagnosis of PLP in its current form. Further research is needed to establish a standardized tool that can reliably distinguish between PLP, PLS, and RLP while incorporating qualitative assessments to ensure accurate diagnosis
Accuracy of the Surprise Question in predicting 90-day mortality among hospitalized patients with decompensated cirrhosis
No full textTrends in Isolated and Combined Aortic Valve Replacement for Severe Aortic Stenosis in Patients Younger Than 65 Years.
No full textBACKGROUND: Recent data demonstrate near equalization in the use of transcatheter aortic valve replacement (TAVR) and isolated bioprosthetic surgical aortic valve replacement (SAVR) in patients aged \u3c 65 years for treatment of isolated aortic stenosis (AS). Whether these trends are also seen across the entire spectrum of aortic valve replacement (AVR) procedures (including mechanical SAVR and concomitant procedures) is unknown.
METHODS: This retrospective study included patients aged \u3c 65 years who underwent AVR for severe AS in the multicenter Northern New England Cardiovascular Disease Group registry between 2015 and 2023. Patients were stratified by approach: TAVR, isolated SAVR, and combined SAVR (SAVR with concomitant procedures).
RESULTS: Of 1254 patients younger than 65 years who underwent AVR, 21.9% underwent TAVR, 39.7% underwent isolated SAVR, and 38.4% underwent combined SAVR. TAVR utilization more than doubled during the study period, with near equalization of TAVR and isolated bioprosthetic SAVR (28.3% and 30.8% of all AVR in 2021-2023, respectively). However, when including mechanical AVR and combined SAVR, TAVR only comprised approximately one-fourth of all AVR procedures. TAVR patients had a significantly higher burden of comorbidities compared with patients receiving isolated or combined SAVR.
CONCLUSIONS: In this multicenter study, there is a consistent increase in TAVR use in patients \u3c 65 years old with preferential TAVR utilization in patients with higher comorbidities and risk. While approximately 50% of younger patients with isolated AS are receiving TAVR in recent study years, the overall utilization of TAVR in the broader group of patients with both isolated and combined AS remains approximately 25% of the overall AVR cohort
Primary Results From Blood and Marrow Transplant Clinical Trials Network 1702: Clinical Transplant-Related Long-Term Outcomes of Alternative Donor Allogeneic Transplantation.
No full textPURPOSE: The likelihood of finding a human leukocyte antigen (HLA)-matched unrelated donor (MUD) for hematopoietic cell transplantation can be predicted using a donor search prognosis score. Patients without a MUD may use alternative donors (haploidentical related, mismatched unrelated, or umbilical cord blood).
METHODS: This multicenter biological assignment trial was conducted by the Blood and Marrow Transplant Clinical Trials Network (BMT CTN 1702). Eligibility criteria were broad to mirror clinical practice. The primary end point was 2-year survival from evaluability and compared between those Very Likely (\u3e90%) and Very Unlikely (\u3c 10%) to find a MUD. All other patients, Less Likely to find a MUD, were enrolled in an observational arm. Transplant outcomes were compared for all three groups.
RESULTS: A total of 1,751 evaluable patients at 47 centers were Very Likely (54.7%), Less Likely (29.5%), and Very Unlikely (15.8%) to identify a MUD. Survival did not differ in univariate (hazard ratio [HR], 1.00 [95% CI, 0.82 to 1.21];
CONCLUSION: Using a donor search prognosis strategy to prioritize an alternative donor for patients Very Unlikely to find a MUD resulted in survival and transplant outcomes that were not statistically different compared with those Very Likely to find a MUD
Autism Spectrum Disorder in Primary Care.
No full textAutism is a lifelong neurodevelopmental condition that affects approximately 1 in 31 US children and 1 in 45 US adults; autism spectrum disorder includes a wide range of neurologic diversity, symptoms, challenges, strengths, and abilities. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision criteria for autism spectrum disorder require deficits in three areas of communication and social interaction across multiple settings, with at least two restricted or repetitive behaviors, not explained by another condition, and causing functional impairment. The American Academy of Pediatrics recommends screening for autism at ages 18 and 24 months in addition to routine developmental surveillance, whereas screening in adults is not recommended. Diagnosis should include a multidisciplinary team and a multidimensional assessment. Autistic individuals have a 20- to 30-year lower life expectancy than nonautistic people and experience higher rates of many chronic conditions, such as diabetes, epilepsy, gastrointestinal concerns, feeding disorders, and mental health disorders (eg, attention-deficit/hyperactivity disorder, depression, anxiety, schizophrenia). Treatment of children with autism spectrum disorder focuses on minimizing core deficits, maximizing functional independence, and preventing problem behaviors. Pharmacologic therapy may be indicated for related conditions or symptoms, such as sleep disorders, seizures, mental health conditions, behavior problems, and gastrointestinal issues. Melatonin effectively reduces sleep symptoms and improves daytime behaviors with minimal adverse effects. The SPACE (sensory, predictability, acceptance, communication, empathy) framework provides specific interventions that make health care more accessible and affirming to autistic patients
Inpatient postpartum contraception provision among individuals with opioid use disorder in Maine, 2016-2023.
No full textPURPOSE: To compare trends in inpatient postpartum (IPP) long-acting reversible contraception (LARC) and permanent contraception provision among women with and without opioid use disorder (OUD) in Maine, which has recently seen a decrease in prevalence of maternal OUD.
MATERIALS AND METHODS: We used diagnosis codes recorded in hospital discharge data to identify deliveries with and without OUD in Maine during 2016-2023. We calculated trends in annual rates per 1000 deliveries of IPP LARC or permanent methods of contraception (LAPM), permanent contraception, and LARC. We ran tests of coincidence to compare trends between deliveries with and without OUD.
RESULTS: Among the 87,339 delivery hospitalisations identified, 2604 (3.0%) had an OUD diagnosis code. Women with OUD had higher IPP contraception provision (LAPM: 12.1%, permanent contraception: 9.0% LARC: 3.1%) than those without OUD (LAPM: 6.2%, permanent contraception: 5.4%, LARC: 0.9%). Annual rate increases per 1000 deliveries were larger over the study period for women with OUD (LAPM: 11.8 [
CONCLUSIONS: Among deliveries in Maine during 2016-2023, provision of IPP LAPM, permanent contraception, and LARC were higher and increased at a greater rate over time among deliveries with OUD compared to those without OUD. Our findings suggest that IPP contraceptive use could be one of many factors in the recent decrease in maternal OUD and NAS rates in Maine
Next-gen tools in cancer neuroscience.
No full textThe emerging field of cancer neuroscience is rapidly evolving, driven by novel technologies and tools. These include advances in single-cell and spatial transcriptomics; genetic mouse models paired with automated high-throughput; and innovative optical electrophysiological approaches, optogenetics, chemogenetics, engineered viruses, and new methods for visualizing neuronal activity. Collectively, these technologies are revolutionizing how we investigate, manipulate, and characterize distinct components that contribute to the nervous system-cancer interface. In the present review, we discuss the key technologies that are closing the gap between oncology and neuroscience, highlighting the innovations that are propelling the cancer neuroscience field forward
September 17th, 2025: Addressing Cancer Health Equity in a Unique Rural Population
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1049/thumbnail.jp
Decreasing Patient Harm Through Structured Interprofessional Bedside Rounding
No full textThis project examined the association between MMC IPBR augmented with standardized data visualization and analysis tools with team-sensitive patient safety events in the inpatient setting