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The Use of Nitrous Oxide in Adult Inpatient Populations for Analgesic and Anxiety Management During Bedside Procedures
Get PDFPICOT question: In adult medical-surgical inpatient populations, how does nitrous oxide compared to commonly used pain medications, affect patient procedure compliance and/or experience, within the length of their hospital visit?https://knowledgeconnection.mainehealth.org/nurseresidency/1060/thumbnail.jp
Subcutaneous Anticoagulation Administration vs Ecchymosis
Get PDFIn adult patients receiving subcutaneous anticoagulation, how does using a slow injection time and local cold application compared to standard practice affect bruising?https://knowledgeconnection.mainehealth.org/nurseresidency/1070/thumbnail.jp
Pediatric Lifestyle Medicine 101
No full textDate of Presentation: October 3rd, 2024
Presented by: Jennifer Dubail, MD, FAAP, DipABLM, Pediatrician, MaineHealth Maine Medical Partners, Portland Pediatrics & Jenn Valliere, LCSW, Behavioral Health Integrated Program Manager, MaineHealth-Portland Pediatrics, & MaineHealth Barbara Bush Children\u27s Hospital
CME available for 1 year after presentation
CME Text Code: 90195
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1053/thumbnail.jp
Role of patient-provider communication on older adults\u27 preferences for continuing colorectal cancer testing and visit satisfaction
No full textOBJECTIVE: To identify possible predictors of older adults\u27 preferences for stopping or continuing colorectal cancer (CRC) testing and satisfaction with medical visits. METHODS: Cross-sectional, secondary analysis of patient data. The parent study was a two-arm, multi-site clustered randomized trial, assigning primary care physicians to receive shared decision making training plus a reminder, or reminders alone for patients who were due for CRC testing. For the current analysis, patient data were pooled and analyzed without regard to study arm. Patients were aged 76-85 years. RESULTS: In total, 375 patients reported their preference: 74 % preferred continued testing while 26 % preferred no further testing. In multivariable models, patients were more likely to prefer CRC testing if they had more maximizing preferences for health care, higher anticipated regret at missing a diagnosis, and lower anticipated regret about colonoscopy complications. Patients were more likely to report being extremely satisfied with the visit with longer duration spent discussing testing options. CONCLUSION: Anticipated decision regret and medical maximizing were associated with preferences for CRC testing. Time spent discussing CRC testing was associated with visit satisfaction. PRACTICE IMPLICATIONS: To support informed decision making, older adults should be given thorough information about CRC testing, treatments, and post-treatment follow up
Evaluating the safety and efficacy of medical management in extracranial pseudoaneurysms: a comparative study
No full textOBJECTIVE: As endovascular interventions become safer and their use more prevalent for treating extracranial pseudoaneurysms, fewer pseudoaneurysms are treated with medical therapy alone. This study aimed to assess the indications for intervention and the safety of medical management. METHODS: A dual-center retrospective analysis was conducted on patients diagnosed with extracranial carotid and vertebral pseudoaneurysms between December 2006 and June 2023. RESULTS: Of 145 pseudoaneurysms, 121 (83%) received medical therapy, 22 (15%) were treated endovascularly, and 2 (1.4%) were treated with open surgery. In the medical group, there were 2 (1.9%) complications, one unrelated to the pseudoaneurysm. In the intervention group, there were 3 (16%) complications, with 1 patient requiring two retreatments and sacrifice of the vessel. Major trauma (OR 4.0, 95% CI 1.3-14; p = 0.02), use of digital subtraction angiography as the initial imaging modality (OR 9.8, 95% CI 2.5-42; p \u3c 0.01), and a maximum lesion diameter \u3e 6 mm (OR 5.3, 95% CI 1.4-25; p = 0.03) proved to be significant in the decision to intervene. At a median follow-up of 18.1 months, 94.7% of the lesions treated with intervention healed completely compared with 19% of aneurysms in the medical group. Among those medically managed that did not resolve, the median change in diameter was -0.4 mm (IQR -1.8 to 0.4 mm). Age ≤ 50 years and aneurysm maximum diameter ≤ 6 mm predicted healing at follow-up in the medical group with 92% specificity and 65% sensitivity (area under the curve 0.87). At follow-up, 98% of patients were functionally independent (modified Rankin Scale score ≤ 2). CONCLUSIONS: Medical management alone is safe for most extracranial pseudoaneurysms, resulting in significantly fewer complications than endovascular intervention. Maximum diameter ≤ 6 mm and age ≤ 50 years were significant predictors of pseudoaneurysm resolution with medical therapy alone. Lesions that do not heal do not cause further symptoms or require additional intervention
Delirium Prevention Strategies in Hospitalized Patients
Get PDFIn hospitalized patients do pharmacological interventions targeted to prevent or treat delirium reduce the incidence, severity or duration of delirium compared to non-pharmacological interventions during hospitalization?https://knowledgeconnection.mainehealth.org/nurseresidency/1037/thumbnail.jp
Postpartum Mood and Anxiety Disorders and Ways to Support Parents
No full textDate of Presentation: October 24th, 2024
Presented by: Kasey Moss, DO, MPH, Regional Medical Director of Maine Behavioral Healthcare, Brunswick/Damariscotta, Instructor of Psychiatry, Tufts School of Medicine and Leora Rabin, MD, Medical Director, Perinatal Psychiatry Maine Medical Center Outpatient Adult Psychiatry
CME Text Code: 90198
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1055/thumbnail.jp
Associations of ethnicity, skin tone, and genome-wide sequencing with bone mineral density in adolescents
No full textBACKGROUND: Dual-energy x-ray absorptiometry reference data designate Black and non-Black categories, as higher BMD has been documented among Black youth. We examined associations of race, skin tone, and genetic factors with bone mineral density (BMD). METHODS: 557 adolescents were followed longitudinally. Exposures included race, skin tone, and principal components (PC) from genome-wide arrays. Total body BMD Z-score (BMD-Z) was the primary outcome using linear regression. RESULTS: 359 adolescents identified as non-Hispanic White (NHW) and 75, non-Hispanic Black (NHB). BMD-Z was higher in NHB vs. NHW (β: 0.92 units, 95% CI: 0.64, 1.19) or those with darker skin (0.79, 95% CI: 0.49, 1.08 for brown vs. medium). The first genetic PC (PC1) correlated with identification as NHB. PC1 was associated with higher BMD-Z (0.09, 95% CI: 0.06, 0.12), even after including race (0.07, 95% CI: 0.00, 0.14) or skin tone (0.10, 95% CI: 0.05, 0.15); both race (0.26, 95% CI: -0.49, 1.01 for NHB vs. NHW) and skin tone (-0.08, 95% CI: -0.59, 0.44 for brown vs. medium) no longer predicted BMD-Z after adjustment for PC1. CONCLUSION: Genetic similarity was robustly associated with BMD, prompting a reevaluation of adolescent BMD reference data to exclude the consideration of race. IMPACT: Current bone density reference databases include a binary assignment of patients into Black and non-Black categories, as a higher BMD has been documented among those identifying as Black compared with individuals of other racial and ethnic backgrounds. This study found genetic similarity to be more strongly associated with bone density by dual-energy x-ray absorptiometry than race or skin tone. These data emphasize a need to reevaluate how bone density measurements are interpreted, including exploring reference data that exclude the consideration of race
Medically Tailored Meals for Patients with Heart Disease in Rural Maine: Lessons Learned and Next Steps
Get PDFProblem: Cardiac disease is the leading cause of death in the United States. Social determinants of health (SDOH), including food insecurity, strongly influence heart disease risk factors and outcomes. Prior studies providing medically tailored meals to patients have shown promising results but have largely been conducted in urban areas. Franklin County, Maine, the target location for this intervention, is a rural setting with more food insecurity and cardiovascular disease than other parts of Maine.
Approach: This program, called Healthy Links, delivered medically tailored meals to patients with cardiac disease and SDOH needs who were living in Franklin County, a rural county in Maine. The 12-week program began with a wellbeing assessment administered by Area Agency on Aging staff. Then each participant received 2 deliveries of 5 heart-healthy meals. Based on identified needs, participants were offered relevant services, such as nutrition education, financial services, and transportation resources.
Outcomes: A total of 58 patients were offered the program and 16 enrolled. Of those who enrolled, 4 (25%) received all 10 meals, 4 (25%) received 5 meals, and 8 (50%) declined all meals. The most common reason for declining meals was that the participant believed the service was unnecessary (6 participants). Self-report of food security on a Likert scale was collected for 2 participants and improved slightly.
Next Steps: This project developed a promising model that could be more impactful with closer examination of patient preferences. As screening for food insecurity increases, effective interventions are needed. This project shows the feasibility of food delivery through interorganizational collaboration and highlights the importance of matching the intervention to the self-identified needs of participants. The study team plans to evaluate cardiovascular outcomes in patients who received medically tailored meals and maintains an interest in engaging patients in rural settings
Magnitude of obesity alone does not alter the alveolar lipidome
No full textObesity may lead to pulmonary dysfunction through complex and incompletely understood cellular and biochemical effects. Altered lung lipid metabolism has been identified as a potential mechanism of lung dysfunction in obesity. Although murine models of obesity demonstrate changes in pulmonary surfactant phospholipid composition and function, data in humans are lacking. We measured untargeted shotgun lipidomes in two bronchoalveolar lavages (BALs) from apical and anteromedial pulmonary subsegments of 14 adult subjects (7 males and 7 females) with body mass indexes (BMIs) ranging from 24.3 to 50.9 kg/m. The lipidome composition was characterized at the class, species, and fatty acyl/alkyl level using total lipid molecular ion signal intensities normalized to BAL protein concentration and epithelial lining fluid volumes. Multivariate analyses were conducted to identify potential changes with increasing BMI. The alveolar lipidomes contained the expected composition of surfactant-associated phospholipids, sphingolipids, and sterols in addition to cardiolipin and intracellular signaling lipid species. No significant differences in lipidomes were detected between the two BAL regions. Though a small number of lipid species were associated with BMI in multivariate analyses, no robust differences in lipidome composition or specific lipid species were identified over the range of body habitus. The magnitude of obesity alone does not substantially alter the alveolar lipidome in patients without lung disease. Differences in lung function in patients with obesity and no lung disease are unlikely related to changes in alveolar lipid composition. Altered lung lipid metabolism has been identified as a potential mechanism of lung dysfunction in obesity, but data in humans are lacking. We measured the alveolar lipidome in bronchoalveolar lavages from subjects with healthy lungs with a wide range of body mass index. There were no differences in lipidome composition in association with the magnitude of obesity. In patients with healthy lungs, obesity alone does not alter the alveolar lipidome