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Presentation: Accuracy of ECG Chest Electrode Placement in Prehospital and Hospital Settings
Get PDFRecipient of the Peter W. Bates Award for Excellence in Health Professions Education Research at the 2025 Costas T. Lambrew Research Retreat.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1041/thumbnail.jp
Urgent/emergent carotid revascularization is associated with an increase in stroke and mortality
No full textOBJECTIVE: Despite few clinical indications, numerous urgent or emergent carotid procedures have been recorded in the Vascular Quality Initiative (VQI) database. As such, we sought to assess outcomes of urgent and emergent carotid revascularization in the VQI. METHODS: We identified all patients who underwent carotid revascularization in the VQI from 2011-2024. Patients were stratified by urgency status, preoperative symptom status, and procedure type. Elective revascularization was defined by the VQI as a planned/scheduled procedure, urgent as surgery within 24 hours, and emergent as surgery within 6 hours. We excluded patients whose primary procedure was a planned intracranial treatment, as well as patients presenting with trauma, dissection or other nonatherosclerotic indications. The primary outcome was perioperative stroke/death. Secondary outcomes included perioperative death and stroke. Chi-square and logistic regression were used to evaluate perioperative outcomes. RESULTS: Of the 317,163 carotid revascularizations were performed, of which 268,091 (84%) were elective, 45,021 (14%) were urgent, and 4,051 (1%) were emergent. Most urgent(29,958, 67%) or emergent (2,956, 73%) cases were symptomatic, although there were 15,063 (34%) urgent and 1,095 (27%) emergent, asymptomatic procedures. Stroke was the indication for 44% of urgent procedures and 62% of emergent procedures. There 45,021 cases classified as urgent, of which 28,063(62%) were CEA, 8,172 (18%) TCAR, and 8786 (19.5%) tfCAS. Of the 4,051 emergent procedures, 1,235 (31%) were CEA, 182 (4.5%) TCAR, and 2,634 (65%) tfCAS. Compared to elective procedures, among all patients, urgent procedures were associated with increased odds of stroke/death (3.2% vs. 1.2%; aOR 1.99[95% CI 1.80-2.18] P\u3c .01), as were emergent procedures (10.4% vs. 1.2%; aOR: 3.67[3.03-4.44] P\u3c .01). These differences were also noted following subset analyses of asymptomatic (urgent: 3.0% vs. 1.0%; aOR: 2.52[2.16-2.92] P\u3c .01) and (emergent: 9.9% vs. 1.0%; aOR: 5.5[3.91-7.63] P\u3c .01) and symptomatic patients (urgent: 3.3% vs. 1.7%; aOR: 1.65[1.46-1.86] P\u3c .01) and (emergent: 11% vs. 1.7%; aOR: 3.07 [2.43-3.86] P\u3c .01). These differences persisted after stratifying by procedure type, for both asymptomatic and symptomatic patients. CONCLUSION: Urgent or emergent carotid revascularization was associated with higher odds of perioperative stroke/death, stroke, and death. Given the increased risk of urgent or emergent surgery, careful consideration should be given when assessing patients who may ostensibly benefit from expedited surgery, where possible
Low-volume Resuscitation with VS-101, a Next-Generation PEGylated HBOC, Improves Survival after Severe Hemorrhagic Shock in Rats
No full textOver 30% of trauma-related deaths are from massive hemorrhage with 90% of potentially preventable battlefield deaths occurring pre-hospital. Immediate resuscitation with whole blood is ideal but often limited to hospital and medical treatment facilities. Shelf-stable hemoglobin-based oxygen carriers (HBOCs) are designed to relieve the hypoperfusion and hypoxia of shock during the critical pre-hospital period. A new PEGylated human HBOC product, VS-101, with high oxygen affinity and hyperoncotic pressure, has been designed for hypovolemic resuscitation protocols at the point of injury. Thirty-six Sprague-Dawley rats underwent a severe, pressure-guided 45% total blood volume (TBV) hemorrhage. Shocked animals were randomly assigned to receive 20% TBV Lactated Ringers\u27 (LRS), Plasma, Blood, or VS-101. Cardiovascular parameters, arterial blood gases, 8-hr survival, arteriolar diameters, and oxygenation of the spinotrapezius microvasculature were measured. Even compared with whole blood, VS-101 was the only group with survivors (67%) at the end of the 8-hr observation period. Mean survival times were 49, 95, 197, and 426 min for LRS, Plasma, Blood, and VS-101 (p \u3c 0.05 vs all), respectively. VS-101 produced the highest spinotrapezius interstitial oxygenation and recovery of MAP with no evidence of hypertension or arteriolar vasoconstriction. Hypovolemic resuscitation with VS-101 was effective in stabilizing hemorrhagic shock in a simulated pre-hospital setting, which was associated with its combination of high oncotic pressure and oxygen carrying constituent. The lack of arteriolar vasoconstriction and hypertension suggests VS-101 is poised to pass critical safety and efficacy checkpoints for treatment of severe hemorrhage
Rapid Blood Culture Diagnostics for Ambulatory Management of Uncomplicated Gram-Negative Bloodstream Infections
No full textThe $1,200 Total Joint Arthroplasty Reimbursement: How Did We Get Here, What is the Impact, and What Comes Next?
No full textSBIRT Workflow
Get PDFSBIRT stands for Screening – Identify patients with unhealthy substance use. Brief Intervention – A collaborative conversation that raises a person’s awareness of substance use and its consequences and encourages behavioral changes. Referral to Treatment – Actively link patients to resources when needed. It is a substance use screening tool that we ask patients 18 yrs. old and older to fill out once a year when having their CPE or AWV. SBRIT has been recognized as an integral part of primary care. It is an approach that delivers prevention, detection, and early intervention for individuals at risk of substance use disorders.
The MH PC Fam Med BBH (MaineHealth Primary Care Family Medicine Boothbay Harbor) is not completing the different stages of the screening consistently. Which can lead to increased risk of substance use disorders
Summary of: Financial Impacts of the COVID-19 Pandemic on Immigrant Communities in Portland, Maine: A Qualitative Study
Get PDFThe COVID-19 pandemic not only disproportionately impacted the health of immigrants in the US, but it led to financial disparities as well.
Study found @ Financial impacts of the COVID-19 pandemic on immigrant communities in by Eilish W. Carpenterhttps://knowledgeconnection.mainehealth.org/nnectr/1008/thumbnail.jp
Financial impacts of the COVID-19 pandemic on immigrant communities in Portland Maine: a qualitative study
No full textBACKGROUND: The COVID-19 pandemic not only disproportionately impacted the health of immigrants in the US, but led to financial disparities as well. However, few studies to date capture the experience of asylum-seeking and refugee populations. METHODS: We analyzed semi-structured interviews conducted in fall 2021 with immigrants (primarily asylum-seekers and refugees from countries in Central and East Africa) and key informants, and conducted focus group discussions in spring 2023 with employees of a non-profit supporting the financial needs of asylum-seekers and refugees in Portland, ME. RESULTS: We identified several ways in which the COVID-19 pandemic negatively impacted the financial stability of asylum-seekers and refugees, including: job loss, work permit backlog, lack of sick leave benefits, childcare expenses and related job strain, rising cost of basic goods, issues of housing availability/affordability, and healthcare expenses. CONCLUSION: Policy changes that address structural factors and support financial stability among asylum-seekers and refugees and other low-income populations could help mitigate the impact of future public health crises and ultimately improve health equity
April 23rd, 2025: Integrative Geriatrics
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1039/thumbnail.jp