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Evaluation of Engagement and Collaboration Among Hospitals in the Maine Rural Maternity & Obstetrics Management Strategies (RMOMS) Network
Get PDFIntroduction
• Maine RMOMS Network: Grant awarded to Maine in 2022, 16 rural birthing hospitals & 5 state partners
• Network Goal: Improve access to maternity and obstetrics care for rural communities
• A qualitative Network Health Evaluation was conducted to diagnose strengths and areas of growth regarding engagement and collaborationhttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1015/thumbnail.jp
Ethical considerations in shoulder arthroplasty in patients who are obese
No full textObesity and osteoarthritis are two of the most common conditions in the United States and often co-occur. Obese patients with osteoarthritis are at increased risk for complications when undergoing total shoulder arthroplasty (TSA). The ethical consideration relevant to the decision to perform TSA in obese and morbidly obese patients who may benefit from surgery is not well understood. We performed an ethical analysis for patients undergoing TSA who are obese by analyzing the 4 core bioethical principles, beneficence, nonmaleficence, autonomy, and justice. To provide the most benefit to patients, counseling patients on weight loss before surgery should be attempted including bariatric surgery or weight loss medication in select patients. To respect the ethical principles of beneficence and nonmaleficence, the surgeon must carefully weigh the potential for debilitating progression of disease, pain, and the psychological toll of osteoarthritis against the concern that obese patients may have a higher risk of complications. Respecting patient autonomy requires a rigorous, standardized consent process, which is informed by an understanding of common cognitive biases that affect patient understanding and minimization of perverse incentives that make it more difficult for the surgeon to spend adequate time and resources counseling the patient. Improving incentives for hospitals and physician alike to treat patients with obesity and other comorbidities will provide most just care while minimizing long-term harmful effects to the patient, surgeon, and health-care system
Efficacy of stochastic vibro-tactile stimulation for newborns at risk of neonatal opioid withdrawal syndrome
No full textBACKGROUND: Neonatal Opioid Withdrawal Syndrome (NOWS) continues to be a major public health burden. Our objective was to assess the efficacy of a stochastic vibro-tactile stimulation (SVS) mattress in reducing initiation of pharmacotherapy in neonates at risk for NOWS. METHODS: A multicenter, prospective, non-blinded, randomized clinical trial of neonates born ≥ 35 weeks gestation. Neonates randomized to either SVS mattress or standard crib mattress The outcomes examined were initiation of pharmacotherapy, readiness for discharge, NOWS monitoring scores, cry quality and mattress acceptability surveys. RESULTS: Of 62 infants enrolled, 4 infants (10.0%) in the SVS group and 4 infants (18.2%) in the standard group were initiated on pharmacotherapy. Infants in SVS group demonstrated early readiness for discharge, with no differences between the two groups for NOWS scoring or cry quality. Overall, 60% of nurses and 80% of parents found the SVS mattress helped calm the neonate. CONCLUSION: Although the SVS mattress demonstrated a trend towards lower initiation of pharmacotherapy and earlier readiness for discharge, the results were not statistically significant due to fewer neonates being enrolled than expected. The mattress was highly acceptable to parents and nurses. CLINICAL TRIAL: Registered at ClinicalTrials.gov ID # NCT04834297; https://clinicaltrials.gov/study/NCT04834297 IMPACT: Improving on current non-pharmacologic interventions for the prevention and treatment of Neonatal Opioid Withdrawal Syndrome (NOWS) is critically important. Our study focused on assessing the efficacy of a stochastic vibro-tactile stimulation (SVS) mattress in reducing the use of pharmacotherapy in neonates at risk for NOWS within the first 5 days after birth. In neonates at risk for NOWS, the SVS mattress may reduce the need for pharmacotherapy and improve readiness for discharge while being acceptable to parents and nurses
Clinician Experiences and Comfort with Providing Harm Reduction Resources to People Who Use Drugs
Get PDFIntroduction: Although there is extensive evidence supporting harm reduction strategies for managing substance use disorders, wide implementation in clinical settings has been limited. In this study, we examined clinicians’ harm reduction experiences and comfort with providing harm reduction resources.
Methods: In this cross-sectional study, we distributed surveys electronically to clinicians employed in our institution’s outpatient and inpatient settings. We measured comfort using a 10-point scale and practices by asking participants if they had prescribed or provided specific harm reduction resources. We measured perceived importance of various factors in providing harm reduction resources using a 5-point Likert scale.
Results: Of the 1210 clinicians who received the survey, 126 participants responded (10% response rate). Most felt comfortable with providing naloxone and referring to syringe services programs (both 8.3/10). In practice, many participants had provided naloxone (71 [56%]) or wound care supplies (71 [56%]), or referred patients to syringe services programs (57 [45%]). However, fewer participants had provided safer drug use supplies (26 [21%]) or syringes (16 [13%]). Responses included the desire for more harm reduction education and system standardization.
Discussion: Although many participants reported being comfortable with harm reduction strategies, fewer provided harm reduction resources in practice. Barriers to improving harm reduction strategies include insufficient provider education and lack of system standardization.
Conclusions: Participants were comfortable with providing harm reduction resources, but less likely to translate this comfort into practice. It is necessary to address barriers to implementation to support greater uptake of harm reduction strategies
Preparing Residents for Rural Practice and Advocacy: The Experiences of Three Residency Training Programs in the Northeast United States (2009-2023)
No full textResidents that are exposed to rural practice during their training may be more likely to consider working in rural settings after training, whether that be in primary or specialty care. The authors describe 3 programs in northern New England that have had rural rotations and opportunities for residents for decades, and discuss curricular similarities and differences, and workforce outcomes postresidency. In addition, they share a collaborative curriculum and approach to advocacy that brings residents together to share ideas and projects to learn from each other
A Scoping Review on Pathways of Care for Children with Acquired Brain Injury
Get PDFImportance: A review of research evidence related to long-term monitoring systems for children with acquired brain injury (ABI) will help communities plan for and implement evidence-based systems that better meet the needs of these children.
Objective: This scoping review explored the research evidence on available programs and approaches related to pathways of care for children with ABI.
Review: A systematic search of relevant databases identified 6 studies that met inclusion criteria using the Preferred Reporting Items for Systematic reviews and Meta-analysis extension for Scoping Reviews guidelines. Findings: The 6 included studies broadly addressed identifying and monitoring children with ABI, individualizing services and educational plans for children with ABI, and using a team-based approach for long-term management that includes training of and communication between parents and medical and educational professionals.
Conclusions: Structured care pathways are crucial to address the needs of children with ABI, but the literature on the effectiveness of these pathways is limited, particularly for children from historically marginalized or underserved populations. Given the small number of studies that include heterogenous samples, the results of this scoping review should be interpreted and applied with caution as little consensus was found among studies. Data collected by programs with structured care pathways would meaningfully add to the research evidence-base to inform changes to existing programs and development of new programs
Adherence to American College of Surgeons Best Practices Guidelines in Imaging for Pediatric Patients with Trauma
Get PDFHow is Telehealth Used to Increase Access to Specialty Palliative Care? A Systematic Review
No full textCONTEXT: Specialty palliative care remains inaccessible for many with serious illness, especially in rural areas. Telehealth may be one solution. OBJECTIVES: To describe how telehealth increases access to specialty palliative care, describe facilitators and barriers to its use, and summarize evidence of patient benefits. METHODS: We conducted a systematic review using database-specific vocabulary and Boolean logic focusing on concepts telemedicine, remote consultation, palliative medicine, and hospice care. Included articles described original research evaluating a telehealth intervention addressing ≥2 National Consensus Project for Quality Palliative Care domains. Two researchers reviewed and abstracted articles; disagreements were resolved by consensus. RESULTS: Of 13,928 articles identified, 150 were eligible. Of these, 112 involved telemedicine (direct care from a clinician to a patient); 15 involved tele coaching (connection of non-palliative care clinician with a palliative care specialist to increase primary palliative care skills); 16 involved e-health (an app to monitor symptoms); and 7 involved e-consults (connection to a palliative care clinician to advise on a particular case). About two-thirds (65%) of articles were published since 2020. Common barriers included broadband issues, lack of familiarity with technology, and lack of access to a device. Facilitators included having a technology-skilled assistant and providing a device. Few studies assessed patient outcomes. CONCLUSION: While telehealth is widely used to increase access to specialty palliative care, more evidence is needed to evaluate effectiveness. Further research is needed to understand how to overcome barriers prominent in rural settings and to optimize integration of multiple modalities of telehealth in specialty palliative care
Bone Marrow Adipocytes as Novel Regulators of Metabolic Homeostasis: Clinical Consequences of Bone Marrow Adiposity
No full textPURPOSE OF REVIEW: Bone marrow adipose tissue is a distinctive fat depot located within the skeleton, with the potential to influence both local and systemic metabolic processes. Although significant strides have been made in understanding bone marrow adipose tissue over the past decade, many questions remain regarding their precise lineage and functional roles. RECENT FINDINGS: Recent studies have highlighted bone marrow adipose tissue\u27s involvement in continuous cross-talk with other organs and systems, exerting both endocrine and paracrine functions that play a crucial role in metabolic homeostasis, skeletal remodeling, hematopoiesis, and the progression of bone metastases. The advancement of imaging techniques, particularly cross-sectional imaging, has profoundly expanded our understanding of the complexities beyond the traditional view of bone marrow adipose tissue as an inert depot. Notably, marrow adipocytes are anatomically and functionally distinct from brown, beige, and classic white adipocytes. Emerging evidence suggests that bone marrow adipocytes, bone marrow adipose tissue originate from the differentiation of bone marrow mesenchymal stromal cells; however, they appear to be a heterogeneous population with varying metabolic profiles, lipid compositions, secretory properties, and functional responses depending on their specific location within the bone marrow. This review provides an up-to-date synthesis of current knowledge on bone marrow adipocytes, emphasizing the relationships between bone marrow adipogenesis and factors such as aging, osteoporosis, obesity, and bone marrow tumors or metastases, thereby elucidating the mechanisms underlying musculoskeletal pathophysiology
A Quality Improvement Initiative to Optimize Follow-Up in the New England Area for Pediatric Patients With Cardiovascular Implantable Electronic Devices
No full textBACKGROUND: The use of cardiac implantable electronic devices (CIEDs) continues to grow. Despite the presence of implanted hardware, patient compliance with in-clinic visits and remote transmissions is poor. We performed a quality improvement (QI) initiative to assess and optimize CIED follow-up in the New England area. METHODS: A regional network of eight pediatric institutions was created. All patients with CIEDs were identified starting in 2016. Noncompliance was defined as: no in-person evaluation within 1 year, or no remote transmission within 6 months. Interventions performed included automated texts/emails, certified letters, and personal phone calls. RESULTS: A total of 612 patients were identified, with the total number of patients increasing over the 5-year QI period as patients had devices implanted and removed. Initial noncompliance with in-person annual follow-up was 29%. If patients were noncompliant, a personal phone call was made, reminding them to return to clinic. If the patient could not be reached for 3 months, a certified letter was sent. The noncompliance rate decreased to 5% over the first year and remained around this level over the QI period (3%-9%). For remote transmissions, 54% of patients were noncompliant. Interventions were performed on subgroups of patients. Automated texts/emails were trialed in 126; after 6 months, 41% of these patients remained noncompliant. Phone calls were then trialed on 87 patients. Over 6 months, noncompliance decreased to 11%. CONCLUSIONS: Patients with CIEDs have poor compliance with regular follow-up. Patients have a limited response to automated measures (texts/emails). Personal phone calls had the greatest impact in improving compliance