6289 research outputs found
Sort by
Changing behavior and promoting clinical empathy through a patient experience curriculum for health profession students
No full textOBJECTIVES: The authors sought to explore how a curriculum that uses a patient experience simulation followed by reflection can lead to clinical empathy in learners and whether this experience leads to behavioral change. Further, in response to critiques of common pragmatic approaches to clinical empathy teaching in which empathy is operationalized and taught through formal trainings and checklists, the study aimed to contribute insights regarding how clinical empathy may best be taught to health profession students. METHODS: Twenty-six senior medical students participated in an in situ patient experience simulation during a 4-month period in 2021-2022 in an academic emergency department. The simulation was followed by a written reflection and a structured debrief. A thematic analysis was performed on transcripts of the group debriefs. RESULTS: In the group debriefs, learners described several empathetic behavioral changes they made after this intervention. First, learners discussed performing more small acts of kindness to improve patient care and humanize the patient experience. Second, learners discussed seeking to improve their communication through acknowledgment and validation of the patient experience. Finally, learners described actions to keep patients informed through frequent check-ins and setting expectations on time. CONCLUSIONS: The findings suggest that empathy may not be simply transactional for health profession students and that an understanding of the patient experience leads to actions that improve the patient experience and alleviate suffering
Early identification of vascular access site complications and frequent heart rate and blood pressure monitoring after cardiac catheterization: A scoping review
No full textBACKGROUND: Nurses perform frequent heart rate (HR) and blood pressure (BP) monitoring, a widespread and longstanding practice, after cardiac catheterization (CC) to identify vascular access site complications for femoral and radial arterial approach in adult patients. OBJECTIVE: The objective of this scoping review was to answer two questions: (1) how does the available evidence support frequent HR and BP monitoring after CC via femoral and radial approach in adult patients and (2) how does this practice prompt bedside nurses in identifying the procedure\u27s major vascular access site complications, including bleeding, hematoma, and pseudoanurysm? METHOD: Following the scoping review approach, literature search was conducted (PubMed, CINAHL, Google Scholar) by two co-authors and medical librarian. We reviewed, evaluated, and analyzed the evidence from twenty articles. RESULTS: The reviewed medical and nursing literature revealed findings challenging the present practice. Out of fifteen research studies, five found frequent HR and BP monitoring after CC to be uninformative while the remaining ten did not report frequent vital signs. Two research articles reported that vascular complications after CC were discovered by RNs directly assessing the access site or by the patients themselves, unrelated to HR and BP. Five non-research articles were included, which all recommended frequent HR and BP monitoring. CONCLUSIONS: Frequent HR and BP assessment during the recovery period is not supported by empirical research despite being consistently recommended by nursing guidelines and expert opinion articles. Current evidence supports frequent vascular access site assessments and patient education
Novel Therapeutics for Hemophilia
No full textPresented by Sarah Lazure, MD, PGY-4, Medicine-Pediatrics Resident at the Barbara Bush Children\u27s Hospital at Maine Medical Center
Date of Presentation: March 14th, 2024
CME available for 1 year after presentation
Please complete an evaluation in CloudCME to claim credit for this presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1041/thumbnail.jp
Outcome of patients with relapsed or refractory nonrhabdomyosarcoma soft tissue sarcomas enrolled in phase 2 cooperative group clinical trials: A report from the Children\u27s Oncology Group
No full textBACKGROUND: The aim of this study was to estimate the event-free survival (EFS) of children and young adults with relapsed or refractory nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) treated in nonrandomized phase 2 studies conducted by the Children\u27s Oncology Group (COG) and predecessor groups to establish a benchmark EFS for future phase 2 NRSTS trials evaluating the activity of novel agents. METHODS: A retrospective analysis of patients with recurrent or refractory NRSTS prospectively enrolled in nonrandomized phase 2 COG and predecessor group trials between 1994 and 2015 was conducted. EFS was defined as disease progression/relapse or death and calculated via the Kaplan-Meier method. The log-rank test and relative risk regression were used to compare EFS distribution by age at enrollment, sex, race, NRSTS histology, prior lines of therapy, calendar year of trial, and type of radiographic response. RESULTS: In total, 137 patients were enrolled in 13 phase 2 trials. All trials used radiographic response rate as a primary outcome, and none of the agents used were considered active on the basis of trial-specified thresholds. The estimated median EFS and 6-month EFS of the entire study cohort was 1.5 months (95% confidence interval [CI], 1.3-1.8 months) and 19.4% (95% CI, 12.7%-26%), respectively. No difference in EFS was observed by age at enrollment, sex, race, NRSTS histology subtype, prior lines of therapies, and trial initiation year. EFS significantly differed by radiographic response. CONCLUSIONS: The EFS for children and young adults with relapsed or refractory NRSTS remains suboptimal. Established EFS can be referenced as a benchmark for future single-agent phase 2 trials incorporating potentially active novel agents in this population
Clinicians and Caseworkers: A Practical Guide for Navigating the Intersection of Pediatrics and Child Protection Services
No full textDATE OF PRESENTATION: May 23th, 2024
CME available for 1 year after presentation
Please complete an evaluation in CloudCME to claim credit for this presentationhttps://knowledgeconnection.mainehealth.org/pediatrics_gr/1047/thumbnail.jp
Updates in Newborn Screening: Ensuring a Healthy Start
No full textPresented by Gina Trachimowcz, MD, Neonatologist, The Barbara Bush Children\u27s Hospital at Maine Medical Center
Date of Presentation: May 30th, 2024
CME available for 1 year after presentation
Please complete an evaluation in CloudCME to claim credit for this presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1048/thumbnail.jp
Intravenous Iron in Patients Hospitalized with Bacterial Infections: Utilization and Outcomes
Get PDFIntroduction: Given the uncertainties with IV iron therapy and potential risk of infection, there may be hesitation to treat hospitalized patients with bacterial infections with this preparation even if clinically indicated. The aim of this study was to examine patterns of prescribing IV iron in hospitalized patients being treated for a bacterial infection and associated clinical outcomes in those with severe infections.
Methods: This retrospective chart review evaluated adult patients who received both IV iron sucrose and antibiotics during the same admission at Maine Medical Center during 2019. Data collected included iron studies and IV iron prescribing practices. Clinical outcomes were collected on patients with severe infections. Data were summarized using descriptive statistics.
Results: A total of 202 patients were evaluated. The median duration of antibiotic therapy was 5 (4-9) days. There was overlap between iron and antibiotic administration in 153 (75.7%) patients with a mean overlap duration of 2.7 (1-7) days. In the 49 instances without overlap, 20 (41%) received IV iron before antibiotics. 20 (10%) patients had a severe infection, the majority (75%) of patients with severe infection had antibiotic and iron overlap and no patients had new MRSA colonization. Two patients with severe infection died during hospitalization and two were readmitted within 30 days of discharge.
Conclusion: This study shows that IV iron is frequently prescribed in patients in the setting of acute bacterial infection in our facility. Patients with severe infection did not appear to have negative outcomes when overlap existed between antibiotics and IV iron
Chylous Ascites as a Contributor to Severe Malnutrition in Advanced Cirrhosis: A Case Report
Get PDFIntroduction: Chylous ascites is the accumulation of chyle, a triglyceride and calorie-rich fluid, in the peritoneal cavity. It develops when the intra-abdominal lymphatics that contain chyle are damaged. It is a rare complication of liver cirrhosis that affects less than 1% of patients with this condition. Prompt identification may allow for treatment of associated caloric wasting.
Clinical Findings: A 52-year-old woman with alcohol-related cirrhosis and refractory transudative ascites presented for her second scheduled revision of a transjugular intrahepatic portosystemic shunt. She had confusion, constipation, worsening ascites, and severe malnutrition with muscle wasting (body mass index 12.6). The procedure was deferred, and the patient was admitted to the inpatient internal medicine service.
Clinical Course: The patient was initially treated with intravenous ceftriaxone for presumed spontaneous bacterial peritonitis. The peritoneal fluid was cloudy but did not show evidence of infection. Further testing of the peritoneal fluid revealed elevated triglycerides, indicating chylous ascites. The patient’s condition improved after large-volume paracentesis, lactulose, and supportive measures. However, she developed a rapid re-accumulation of ascites and, on hospital day 5, developed anorexia, somnolence, and hypotension. Tube feedings and broad-spectrum antibiotics for empiric sepsis treatment were started. Her condition continued to deteriorate, and she died on hospital day 7.
Conclusions: Chylous ascites may lead to a loss of dietary triglycerides that can exacerbate the malnutrition that is common in liver cirrhosis. Resultant loss of dietary triglycerides can exacerbate the malnutrition that is already common in liver cirrhosis. If chylous ascites is identified promptly, dietary changes and nutritional interventions can be implemented. However, lymph-specific imaging is often needed for accurate and definitive surgical treatment
In Support of Overdose Prevention Centers: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education and Research in Substance Use and Addiction)
No full textGiven increasing rates of fatal overdoses in the United States and the rapidly changing drug supply, overdose prevention centers (OPCs; also known as safe consumption sites) have been identified as a vital, evidence-based strategy that provide people who use drugs (PWUD) the opportunity to use drugs safely and receive immediate, life-saving overdose support from trained personnel. In addition to providing a safe, supervised space to use drugs, OPCs can house further essential harm reduction drop-in services such as sterile supplies, social services, and medical care. There are established national and international data demonstrating the lifesaving services provided by OPCs, inspiring a groundswell of advocacy efforts to expand these programs in the United States. Thus, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) endorses OPCs, in addition to other harm reduction strategies that protect PWUD. Ultimately, it is imperative to increase access to OPCs across the United States and support key policy changes at the local, state, and federal levels that would facilitate urgent expansion
Calorie Restriction in Mice Impairs Cortical but not Trabecular Peak Bone Mass by Suppressing Bone Remodeling
No full textCalorie restriction (CR) can lead to weight loss and decreased substrate availability for bone cells. Ultimately, this can lead to impaired peak bone acquisition in children and adolescence and bone loss in adults. But the mechanisms that drive diet-induced bone loss in humans are not well characterized. To explore those in greater detail, we examined the impact of 30% calorie restriction for 4 and 8 weeks in both male and female 8-week-old C57BL/6 J mice. Body composition, areal bone mineral density (aBMD), skeletal microarchitecture by micro-CT, histomorphometric parameters, and in vitro trajectories of osteoblast and adipocyte differentiation were examined. After both 4 weeks and 8 weeks, CR mice lost weight and exhibited lower femoral and whole-body aBMD vs. ad libitum (AL) mice. By micro-CT, CR mice had lower cortical bone area fraction vs. AL mice, but males had preserved trabecular bone parameters and females showed increased bone volume fraction compared to AL mice after 8 weeks. Histomorphometric analysis revealed that CR mice had a profound suppression in trabecular as well as endocortical and periosteal bone formation in addition to reduced bone resorption compared to AL mice. Bone marrow adipose tissue was significantly increased in CR mice vs. AL mice. In vitro, the pace of adipogenesis in bone marrow stem cells was greatly accelerated with higher markers of adipocyte differentiation and more oil red O staining, whereas osteogenic differentiation was reduced. qRT-PCR and western blotting suggested that the expression of Wnt16 and the canonical β-catenin pathway were compromised during CR. In sum, CR causes impaired peak cortical bone mass due to a profound suppression in bone remodeling. The increase in marrow adipocytes in vitro and in vivo is related to both progenitor recruitment and adipogenesis in the face of nutrient insufficiency. Long-term calorie restriction may lead to lower bone mass principally in the cortical envelope, possibly due to impaired Wnt signaling