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A pilot survey into the landscape of neuro-oncology care in the community
No full textBACKGROUND: The complexities of the field of neuro-oncology require multidisciplinary collaboration in order to deliver contemporary comprehensive care. There is increasing awareness that much of neuro-oncology care occurs in the community setting. In 2022, the Society for Neuro-Oncology (SNO) created the Community Neuro-Oncology Committee (CNO) in an inaugural attempt to formally acknowledge community neuro-oncology practitioners. METHODS: A 19 question survey was developed by SNO-CNO to gather initial data on the current landscape of neuro-oncology care in the community. The survey was distributed via the SNO newsletter and email blasts as well as through partnerships with multiple advocacy groups. Results were analyzed and tabulated through R2. RESULTS: There were 112 responses from providers in the United States and Canada. Most providers were physicians and represented multiple disciplines including neurology, neuro-oncology, medical oncology, neurosurgery, and radiation oncology. Sixty-four (57%) described themselves as neuro-oncology-focused. Eighty-eight (79%) reported access to neuro-oncology tumor boards. Sixty-eight (73%) stated they had access to molecular tumor boards. Most respondents felt that they were adequately supported to manage neuro-oncology patients. When dividing responses based on a neuro-oncology-focused practice compared to a less neuro-oncology-focused practice, there were significant differences between access to molecular tumors boards (85% vs 63%, P = .023) and access to clinical trials (98% vs 82%, P = .022). CONCLUSION: This qualitative and quantitative hypothesis-generating data is the start of understanding the challenges faced by community neuro-oncology providers. These results will guide future studies and recommendations aimed toward better supporting them and their patients
Coaching Learners During Medical School Training: Faculty Reflections on the Coaching Experience
No full textPURPOSE: Research has shown the impact that coaching medical trainees has on the coaches\u27 professional development and relationships. However, this research has not specifically investigated the evolution of this impact. The authors conducted a longitudinal qualitative research study to follow faculty as they developed their role as coaches of medical students during a 4-year coaching experience. METHOD: The authors conducted 60-minute semistructured interviews with a selected group of faculty coaches at Tufts University School of Medicine, Boston, Massachusetts, from September 2019 to June 2023. Interviews were conducted at the beginning of the coaching experience and revisited at the end of the coaching experience with the first cohort of students. The authors performed a reflexive thematic analysis of all the transcripts using inductive open coding to construct themes. RESULTS: Nine faculty coaches participated in the study. The coaches\u27 reflections on their experiences coaching the same group of medical students for 4 years focused on the centrality of relationships in coaching, the evolving nature of the coaching relationship with medical students, and the impact of coaching on the coaches\u27 professional and personal relationships, including their relationship with the field of medicine. The coaches found building the relationship as the most meaningful, as well as the most challenging, aspect of their coaching. CONCLUSIONS: The authors propose continuing to define skills for faculty to strengthen and expand relationships with trainees in these coaching relationships, which are at the core of the coaching endeavor and which our participants found as the most rewarding and yet challenging aspect of their role
Addressing Inpatient Hyponatremia Through Targeted Automatic E-consults: A Pilot Randomized Trial
No full textBACKGROUND: Hyponatremia is the most common electrolyte abnormality in hospitalized patients. Treatment of hyponatremia is associated with improved outcomes, but more than one in three cases of new onset hyponatremia is not corrected by the time of hospital discharge. Nephrologist input may improve the diagnosis and treatment of hyponatremia, but specialist resources are limited. Targeted automatic electronic consultations (TACos) may be one approach to provide expert nephrologist guidance to the workup and management of hyponatremia using a scalable model. OBJECTIVE: Evaluate the feasibility and acceptability of a TACo intervention for hospitalized patients with hyponatremia. DESIGN: Single-site, parallel-group cluster randomized trial. PARTICIPANTS: Adult inpatients with hyponatremia on the hospital medicine service. INTERVENTIONS: A nephrologist conducted TACos on intervention patients, making diagnostic and therapeutic recommendations daily (if warranted) until discharge or resolution of hyponatremia. MAIN MEASURES: Measures of feasibility included the number of eligible participants, percentage receiving TACos, number of TACos per participant, and percentage of formal nephrology consults. Acceptability was assessed by a post-intervention survey. Clinical outcomes, including the percentage of hyponatremia cases that resolved by discharge, were also assessed. KEY RESULTS: We identified 62 patients who met inclusion criteria: 38 in the intervention group and 24 in the control group. A nephrologist determined that 26 of 38 intervention patients (68%) would likely benefit from diagnostic and management recommendations; 67 TACos were performed (mean 2.6 per patient). Fourteen of 18 primary team physicians (78%) reported that the e-consults changed their management, and 15 of 18 (83%) wanted TACOs to continue. Resolution of hyponatremia, length of stay, 30-day readmissions, and costs were similar in the intervention and control groups. CONCLUSIONS: Inpatient TACos for hyponatremia were feasible and acceptable to primary teams, and frequently led to changes in diagnosis and management. Further studies are needed to determine the impact of the TACo model on clinical outcomes and cost-effectiveness
An Overview of the History, Ecology, and Phylogeny of Powassan Virus in Maine
Full text linkImportance: Powassan virus is a tick-transmitted flavivirus that is increasingly reported and can cause fatal human encephalitis. Two lineages circulate in nature: lineage I (Powassan virus-1) is transmitted primarily by the woodchuck tick Ixodes cookei and the squirrel tick I. marxi, and lineage II (deer tick virus) is transmitted by the deer tick I. scapularis. Both lineages can cause human disease and are serologically indistinguishable. In Maine, human cases are increasing—35 cases were reported from 2000 to 2024, of which 14 were reported between 2022 and 2024.
Objective: This review summarizes our current understanding of the history, ecology, and phylogeny of Powassan virus in Maine, as well as human demographics of Powassan virus disease.
Review: Because Powassan virus encephalitis is a rare and emerging disease in the United States, there is limited published literature available. Keywords used in the literature search included “Powassan virus,” “tick-borne encephalitis virus,” “deer tick virus,” “Ixodes scapularis,” and “Maine.”
Findings: Human cases of Powassan virus encephalitis are rising, and Powassan virus is now the most common cause of arboviral encephalitis in Maine. Seasonality of cases coincide with all stages of ticks, but fall and spring cases overlap with peak activity of the adult deer tick. Phylogenetic studies have shown that deer tick virus likely emerged in the northeastern United States between 1940 and 1975, and then expanded northward with the reestablishment of the white-tailed deer and I. scapularis ticks.
Conclusions: Additional research is warranted to better characterize the transmission dynamics of Powassan virus in nature and further our understanding of human disease
Clinician Comfort, Attitudes, and Practices with Provision of Harm Reduction Supplies to Patients Who Use Drugs
Full text linkOver 100,000 individuals in the United States died from drug overdose in 2022, over 80,000 of which involved opioids. Overdose deaths from psychostimulants (cocaine, methamphetamine) have also been on the rise.
There has also been an increase in substance-related emergency department visits and hospitalizations. People who use drugs (PWUD) often have longer hospital stays, higher self-discharge, and readmission rates.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1006/thumbnail.jp
Vaccines and Immunizations in a Time of Global Boiling, Megacities, and Anti-Science
No full textCME available for 1 year after presentation
CME Text Code: 97020
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.
Presented by: Peter Hotez, MD, PhD, FAA, Professor of Pediatrics and Molecular Virology & Microbiology Co-Director, Texas Children\u27s Hospital Center for Vaccine Development Dean, National School of Tropical Medicine Baylor College of Medicinehttps://knowledgeconnection.mainehealth.org/pediatrics_gr/1077/thumbnail.jp
Using Social Media to Increase Engagement and Decrease Neurophobia in Learners
Full text linkAdding a social media component to undergraduate medical education courses can increase and prolong student engagement.https://knowledgeconnection.mainehealth.org/mite/1002/thumbnail.jp
Developing a Healthy Lifestyle Counseling Program in the Medical Home for Pediatric Patients with Obesity: A Pilot Program
Full text linkProblem: Lifestyle changes can significantly improve health outcomes for children with obesity and related chronic medical conditions. Families with limited knowledge about effective ways to improve health with lifestyle changes may benefit from frequent interactions with their health care team. This team can provide additional information and support needed to make and sustain lifestyle changes. Though potentially effective, there are often barriers to this care for both providers (limited time and availability of trained axillary staff) and families (missing school and work for frequent appointments).
Approach: A new lifestyle changes program led by nurses was piloted at a primary care clinic based in a rural hospital. Nurses received in-service training, including an overview of motivational interviewing and the fundamentals of obesity pathophysiology and care management. After this training, the nurses met with participating families for 6 trainings at biweekly lunch sessions delivered over 3 months. Each session focused on healthy lifestyle topics using a patient-directed, motivational interviewing model of care, which we termed ``the Wellness Guide program.\u27\u27 Nurses were surveyed about their satisfaction with the training that they received and their experience facilitating this program. Families were surveyed about their healthy lifestyle choices, confidence in their ability to implement and maintain lifestyle changes before and after participation, and overall satisfaction with the program.
Outcomes: The nurses were satisfied with the training and felt that providing this service positively contributed to their work experience. Participating families reported an overall positive experience. Although not the a priori goal of the pilot study, an unexpected finding was a decrease in body mass index in most participants who completed the program.
Next steps: Given the promising results of our pilot Wellness Guide program, we plan to formalize and deliver the training to additional nurses within our health care system to expand the program to other primary care sites
May 14th, 2025: Resident Research Week
No full textClinical outcome of combination of vancomycin and ceftaroline versus vancomycin monotherapy for the treatment of methicillin resistant Staphylococcus aureus bloodstream infection. Rami Waked, MD
Shortage as a catalyst for high-value care: Evaluation of a blood culture stewardship intervention driven by supply chain disruption Camille Ezran, MD
Is FLT3 a hidden catalyst in TKI-Resistant CML Samuel Pettit, DO
Same Day Discharge Project David Ngala, MDhttps://knowledgeconnection.mainehealth.org/medicine_gr/1043/thumbnail.jp
The Impact of Implementing a Nurse Residency Program
Full text linkDoes a nurse residency program enhance retention among new graduate nurses compared to immediately entering practice?https://knowledgeconnection.mainehealth.org/nurseresidency/1128/thumbnail.jp