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Perceptions of X+Y Scheduling Among Combined Internal Medicine-Pediatrics Residency Trainees: A Qualitative Program Evaluation
No full textOBJECTIVE: The study aims to elicit perceived benefits and downsides of X+Y scheduling for combined Internal Medicine-Pediatrics (Med-Peds) residents via focus groups. METHODS: Five focus groups were conducted with Med-Peds residents in participating programs which utilized X+Y scheduling. Onefocus group was held per participating institution. Each focus group was facilitated by a chief resident from a different participating institution. Questions were developed by the study team after a review of the literature and local experience with X+Y scheduling and included open-ended questions. Focus groups were recorded and transcribed. Transcripts were reviewed by study team members, and representative themes and quotes were presented. The main outcome was to evaluate the perceived benefits and downsides of X+Y scheduling for Med-Peds. RESULTS: Results from four of the five focus groups were fully reviewed. Themes regarding the benefits of X+Y scheduling included (1) improved inpatient and outpatient experience, (2) predictability in schedule which improved wellness, and (3) longitudinal time for career exploration. Downsides of X+Y scheduling were highlighted as well including (1) condensing too many experiences into Y time and (2) challenges that exist when categorical medicine and pediatrics programs use different block schedules. CONCLUSIONS: X+Y schedules create potential solutions for longstanding barriers to medical education and notably conflict with inpatient and outpatient responsibilities. Our data shows similar benefits to X+Y scheduling for combined residents as for their categorical colleagues and sheds light on some unique considerations for combined programs and trainees. Additional studies should continue to assess the effect of X+Y scheduling on our combined trainees
The Mental Health Crisis: Evolving Role of Primary Care Pediatricians
No full textPresented by Makenzie Zidek, DO PGY-3, Pediatric Resident, The Barbara Bush Children\u27s Hospital at Maine Medical Center
Date of Presentation: April 11th, 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/1043/thumbnail.jp
A Novel Needs Assessment in Rural Maine to Explore the Obstetric Care Workforce within the Maine Rural Maternity & Obstetrics Strategies (RMOMS) Network
Get PDFIntroduction
• Since 1970, 12+ obstetric units in Maine have closed, with 6 of those closures in the last decade
• In 2022, Maine was awarded a HRSA RMOMS grant to strengthen the system of maternity care in rural Maine
• The MaineHealth RMOMS grant team partnered with the Roux Institute at Northeastern University to do an obstetric workforce assessment at all Maine rural birthing hospitals
• The purpose was to observe and explore services, patterns, resources gaps, and other facility characteristicshttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2024/1010/thumbnail.jp
Achieving Goals of Care Decisions in Chronic Critical Illness: A Multi-Institutional Qualitative Study
No full textBACKGROUND: Clinicians, patients, and families alike perceive a need to improve how goals of care (GOC) decisions occur in chronic critical illness (CCI) but little is currently known about this decision making process. RESEARCH QUESTION: How do intensivists from various health systems facilitate decision-making about GOC for patients with CCI? What are barriers to, and facilitators of, this decision-making process? STUDY DESIGN: AND METHODS: We conducted semi-structured interviews with a purposeful sample of intensivists from the United States and Canada using a \u27mental models\u27 approach adapted from decision science. We analyzed transcripts inductively using qualitative description. RESULTS: We interviewed 29 intensivists from six institutions. Participants across all sites described GOC decision-making in CCI as a complex, longitudinal, and iterative process that involved substantial preparatory work, numerous stakeholders, and multiple family meetings. Intensivists required considerable time to collect information on prior events and conversations, and to arrive at a prognostic consensus with other involved clinicians prior to meeting with families. Many intensivists stressed the importance of scheduling multiple family meetings to build trust and relationships prior to explicitly discussing GOC. Physician-identified barriers to GOC decision-making included one week staffing models, limited time and cognitive bandwidth, difficulty eliciting patient values, and interpersonal challenges with care team members or families. Potential facilitators included scheduled family meetings at regular intervals, greater interprofessional involvement in decisions, and consistent messaging from care team members. INTERPRETATION: Intensivists described a complex time and labor-intensive group process to achieve GOC decision-making in CCI. System-level interventions that improve how information is shared between clinicians and decrease logistical and relational barriers to timely and consistent communication are key to improving goals-of-care decision making in chronic critical illness
Tranexamic acid reduces inflammation, edema and burn wound conversion in a rodent model
No full textBurn wound conversion is the observed process where superficial partial thickness burns convert into deep partial or full thickness burn injuries. This conversion process often involves surgical excision to achieve timely wound healing. Unfortunately, the pathophysiology of this phenomenon is multifactorial and poorly understood. Thus, a therapeutic intervention that may prevent secondary progression and cell death in burn-injured tissue is desirable. Recent work by our group and others has established that tranexamic acid (TXA) has significant anti-inflammatory properties in addition to its well-known anti-fibrinolytic effects. This study investigates TXA as a novel therapeutic treatment to mitigate burn wound conversion and reduce systemic inflammation. Sprague-Dawley rats were subjected to a hot comb burn contact injury. A subset of animals underwent a similar comb burn with an adjacent 30%TBSA contact injury. The interspaces represent the ischemic zones simulating the zone of stasis. The treatment group received injections of TXA (100 mg/kg) immediately after injury and once daily until euthanasia. Animals were harvested for analyses at 6 h and 7 days after injury. Full-thickness biopsies from the ischemic zones and lung tissue were assessed with established histological techniques. Plasma was collected for measurement of damage associated molecular patterns (DAMPs), and liver samples were used to study inflammatory cytokines expression. Treatment with TXA was associated with reduced burn wound conversion and decreased burn-induced systemic inflammatory response syndrome (SIRS). Lung inflammation and capillary leak were also significantly reduced in TXA treated animals. Future research will elucidate the underlying anti-inflammatory properties of TXA responsible for these findings
Diagnostic stewardship to improve patient outcomes and healthcare-associated infection (HAI) metrics
No full textDiagnostic stewardship seeks to improve ordering, collection, performance, and reporting of tests. Test results play an important role in reportable HAIs. The inclusion of HAIs in public reporting and pay for performance programs has highlighted the value of diagnostic stewardship as part of infection prevention initiatives. Inappropriate testing should be discouraged, and approaches that seek to alter testing solely to impact a reportable metric should be avoided. HAI definitions should be further adapted to new testing technologies, with focus on actionable and clinically relevant test results that will improve patient care
Trends in maternal opioid use disorder and neonatal abstinence syndrome in Maine, 2016-2022.
No full textOBJECTIVE: To estimate trends in maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) in Maine using the most recent data available.
STUDY DESIGN: We used hospital discharge data to estimate the annual prevalence of maternal OUD and NAS between 2016 and 2022. In addition, we used birth certificate-linked Medicaid data to estimate related trends among Medicaid enrollees.
RESULT: From 2016 to 2022, the prevalence of maternal OUD decreased from 35.3 to 18.8 per 1000 deliveries and the prevalence of NAS decreased from 33.2 to 14.0 per 1000 newborns (linear trend p values
CONCLUSION: In Maine between 2016 and 2022, there was a decrease in maternal OUD and NAS diagnoses recorded in administrative datasets. These findings should be interpreted with caution due to changes in how OUD and NAS diagnoses are recorded and COVID-related changes in healthcare utilization
Brief Report: Genital Microbiome, Inflammation, and Tenofovir Levels in Transgender Men and Cisgender Women Taking Oral PrEP
No full textBACKGROUND: Little is known about the efficacy of preexposure prophylaxis (PrEP) or what biologic factors may influence HIV transmission in transgender men (TGM). In this study, we sought to explore the effect of testosterone on the vaginal microbiome, cervicovaginal fluid (CVF) tenofovir concentrations, and levels of CVF inflammatory markers in TGM on PrEP. METHODS: Cervicovaginal fluid was collected from 13 TGM (7 using testosterone) and 32 cisgender women (CGW) on PrEP. The vaginal microbiome, CVF tenofovir concentrations, and CVF inflammatory markers were determined and compared. RESULTS: The proportion of CVF Lactobacillus was significantly higher in CGW than in TGM (78% vs 24%, P \u3c 0.001). Among TGM, the proportion of CVF Lactobacillus was lower, though not statistically significant, in those taking testosterone than in those not taking testosterone (14% vs 35%, P-value = 0.3). Interestingly, mean CVF tenofovir concentrations were the lowest in TGM on testosterone at 884 ng/mL compared with 3150 ng/mL in TGM not on testosterone and 1932 ng/mL in CGW; however, this difference was not statistically significant. There was no statistically significant difference in any of the genital inflammatory markers between groups and no correlation between inflammation and tenofovir levels. CONCLUSIONS: Our findings suggest a potential correlation between testosterone use, Lactobacillus dominance, and lower TFV concentrations in CVF, which may have implications on HIV acquisition from vaginal sex in TGMT. Future studies with larger sample sizes are needed to further investigate these relationships
Postoperative Atrial Fibrillation
Get PDFWhat is the more effective treatment metoprolol or amiodarone for best patient outcomes?https://knowledgeconnection.mainehealth.org/nurseresidency/1042/thumbnail.jp
Early Mobilization in Mechanically Ventilated ICU Patients
Get PDFPICOT Question: In mechanically ventilated ICU patients, does early mobilization decrease length of ICU stay in comparison with patients on strict bedrest?https://knowledgeconnection.mainehealth.org/nurseresidency/1046/thumbnail.jp