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Pedi Psych Boarding in the Emergency Department
No full textWill implementation of structured intervention(s) during ED boarding improve the boarding experience for our pediatric psych patients?https://knowledgeconnection.mainehealth.org/nurseresidency/1137/thumbnail.jp
Raising the Bar: Growth of Specialized Hospital Psychiatric Units for Youths With Neurodevelopmental Disabilities
No full textOBJECTIVE: Co-occurring psychiatric conditions and externalizing behaviors are prevalent among youths with neurodevelopmental disabilities (NDDs). For youths with NDDs and serious emotional and behavioral challenges, specialized inpatient psychiatric units are a critical part of the care continuum. Since 2011, the number of these units, their geographic distribution, and the diversity of their host institutions have expanded, and a coalescence has formed around a care model. This study aimed to examine these specialized units and describe their key features. METHODS: A 41-item survey was developed and distributed in 2023 to organizations that have an inpatient psychiatric unit dedicated to youths with NDDs. RESULTS: Twenty units were identified, with at least one in every major U.S. geographic region; the directors of 13 units responded to the survey. These units served primarily male (70%), non-Hispanic (89%), White (62%) patients ages 13-18 years (57%) with autism spectrum disorder (88%). The average length of stay was 41.3 days (median=34.2 days). The average unit size was 15 beds. Most units were in psychiatric hospitals (62%) and were part of nonprofit organizations (77%). The units deployed multidisciplinary teams, with an average of seven disciplines represented. All units employed psychologists or board-certified behavior analysts. CONCLUSIONS: The number of specialized inpatient psychiatric units for youths with NDDs in the United States has more than doubled since 2011, and the geographic distribution of these units has widened. Nationwide, units use similar treatment models to provide a distinct form of targeted patient care to meet the needs of this growing and unique population
Epidemiology of spinal cord injury in the context of closed head injury
No full textDESIGN: Retrospective Study. BACKGROUND: The incidence of traumatic brain injury (TBI) in patients with spinal cord injury (SCI) is well documented. However, the incidence of SCI specifically in patients with closed head injury (CHI) is understudied. SCI and CHI are underdiagnosed, and this can be complicated history. Facilities are often focused on patients\u27 primary issues, and with polytrauma patients\u27 cognitive impairment, SCI can be missed. Thus, this study aimed to determine the incidence of SCI in patients with CHI. METHODS AND MATERIALS: This retrospective study used Pennsylvania Trauma Systems Foundation database to identify patients with SCI among those with CHI (2010 through 2020 end) and described the patient demographics; incidence per year; frequencies of the various causes and types of injuries; and the underlying CHI in terms of frequencies of diagnosis and severity. The frequencies of various diagnoses associated with SCI, neurologic level of injury, severity and the associated vertebral fractures, and in-hospital mortality were also described. RESULTS: Among patients with CHI, 2.6% were found to have SCI. Patients mostly affected were male (73.5%), Caucasian (78.4%), and a mean age (SD, range) of 46.3 (15.5, 19-70) years. Blunt injury, predominantly in the form of motor vehicle collisions (55.7%) and falls (34.6%) constituted the main causes. Cervical spine was most affected (76.2%), with C1-C4 region comprising the most injuries (39%), followed by thoracic spine (26.4%). Vertebral Fracture (VF) was noted in 47.1%; C5-C7 was the most fractured region (28.9%). VF levels matched SCI levels in 52-70%. Complete SCI was diagnosed in 18.6% of patients. The mean duration of stay in hospital was 11 days (range 0-262). In-hospital mortality was noted in 8.2% of patients. CONCLUSION: The CHI should not necessarily be severe to have a suspicion of SCI. The clinical findings of SCI in CHI mostly follow the pattern in dual diagnosis of TBI/SCI, such as frequent involvement of cervical spine with less involvement of the thoracic and lumbar sections of the spine. An appropriate clinical suspicion to screen and follow management protocols for SCI is recommended for the best patient care
Practicing Curiosity: An Art Museum-Based Course for Medical Students
No full textProblem: Although curiosity is essential to medicine, it can sometimes seem expendable or counterproductive. Medical students, however, must be encouraged to develop curiosity skills in order to sustain a lifelong pursuit of knowledge. Incorporating visual art into medical education has been associated with multiple favorable outcomes, including improved observational skills. Undoubtedly, artworks stimulate curiosity. Of the many museum-based courses for medical students offered across the country, none have focused on enhancing curiosity skills. Thus, the development of a curriculum using visual art to improve curiosity skills would be an innovative pedagogical approach to museum-based education.
Approach: A hospitalist at MaineHealth Maine Medical Center developed a museum-based course for medical students that focuses on enhancing curiosity skills (called Practicing Curiosity). The curriculum uses a multidimensional model of curiosity, and selected artworks speak to 1 or more of the curiosity dimensions. Participants practice curiosity skills as the course director makes direct connections to the practice of medicine.
Outcomes: Two pilot sessions of Practicing Curiosity were implemented in 2024. The course was well-received by participating students. The selected artworks served as effective backdrops to discussions about the multidimensional nature of curiosity, which encouraged participants to practice individual curiosity skills.
Next Steps: Practicing Curiosity will continue to be offered each year. Curiosity will be assessed before and after the course alongside a qualitative exploration of thematic relationships. If successful, further study of the Practicing Curiosity curriculum will call attention to the importance of curiosity in medical education. It will also demonstrate (1) how a multidimensional model of curiosity can be applied to the practice of medicine and (2) how visual art can be a lens through which medical students can explore individual curiosity dimensions
Innovative Technology to Improve Simulation Access for Rural Clinicians
No full textRural pediatric clinicians face barriers to accessing health care simulation, an educational standard to prepare for high-acuity, low-occurrence (HALO) events. Simulation is typically accessible in urban academic medical centers, as it is resource-intensive owing to the necessary equipment and expertise needed to implement training. Rural hospitals face geographic and financial barriers to providing simulation training. Paradoxically, rural clinicians may benefit from additional training owing to infrequent clinical HALO events in rural centers. Emerging simulation modalities, including mobile simulation, telesimulation, and extended reality, offer more accessible simulation alternatives for rural clinicians, addressing geographic and financial gaps in access
The rise of endovascular repair for abdominal, thoracoabdominal, and thoracic aortic aneurysms
No full textBACKGROUND: Given changes in intervention guidelines and the growing popularity of endovascular treatment for aortic aneurysms, we examined the trends in admissions and repairs of abdominal aortic aneurysms (AAAs), thoracoabdominal aortic aneurysms (TAAAs), and thoracic aortic aneurysms (TAAs). METHODS: We identified all patients admitted with ruptured aortic aneurysms and intact aortic aneurysms repaired in the Nationwide Inpatient Sample between 2004 and 2019. We then examined the use of open, endovascular, and complex endovascular repair (OAR, EVAR, and cEVAR) for each aortic aneurysm location (AAA, TAAA, and TAA), alongside their resulting in-hospital mortality, over time. cEVAR included branched, fenestrated, and physician-modified endografts. RESULTS: 715,570 patients were identified with AAA (87% intact repairs and 13% rupture admissions). Both intact AAA repairs and ruptured AAA admissions decreased significantly between 2004 and 2019 (intact 41,060-34,215, P \u3c .01; ruptured 7175-4625, P = .02). Of all AAA repairs performed in a given year, the use of EVAR increased (2004-2019: intact 45%-66%, P \u3c .01; ruptured 10%-55%, P \u3c .01) as well as cEVAR (2010-2019: intact 0%-23%, P \u3c .01; ruptured 0%-14%, P \u3c .01). Mortality after EVAR of intact AAAs decreased significantly by 29% (2004-2019, 0.73%-0.52%, P \u3c .01), whereas mortality after OAR increased significantly by 16% (2004-2019, 4.4%-5.1%, P \u3c .01). In the study, 27,443 patients were identified with TAAA (80% intact and 20% ruptured). In the same period, intact TAAA repairs trended upward (2004-2019, 1435-1640, P = .055), and cEVAR became the most common approach (2004-2019, 3.8%-72%, P = .055). A total of 141,651 patients were identified with ascending, arch, or descending TAAs (90% intact and 10% ruptured). Intact TAA repairs increased significantly (2004-2019, 4380-10,855, P \u3c .01). From 2017 to 2019, the mortality after OAR of descending TAAs increased and mortality after thoracic endovascular aneurysm repair decreased (2017-2019, OAR 1.6%-3.1%; thoracic endovascular aneurysm repair 5.2%-3.8%). CONCLUSIONS: Both intact AAA repairs and ruptured AAA admissions significantly decreased between 2004 and 2019. The use of endovascular techniques for the repair of all aortic aneurysm locations, both intact and ruptured, increased over the past two decades. Most recently in 2019, 89% of intact AAA repairs, infrarenal through suprarenal, were endovascular (EVAR or cEVAR, respectively). cEVAR alone increased to 23% of intact AAA repairs in 2019, from 0% a decade earlier. In this period of innovation, with many new options to repair aortic aneurysms while maintaining arterial branches, endovascular repair is now used for the majority of all intact aortic aneurysm repairs. Long-term data are needed to evaluate the durability of these procedures
January 29th, 2025: Achieving Health Equity by Addressing the Harms of Incarceration
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1033/thumbnail.jp
Pilot Study of Serial Telemedicine Assessments to Safely Exclude Neonates from Therapeutic Hypothermia Treatment
Full text linkTwo neonatal encephalopathy exams performed by telemedicine, with scores of less than 4, correctly excluded neonates from treatment with therapeutic hypothermia.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1038/thumbnail.jp
Lessons learned: enhancing rural risk communication for future health crises through the PHERCC framework.
No full textINTRODUCTION: Public health emergencies, such as the COVID-19 pandemic, highlight the critical role of effective risk communication in managing crises. The Public Health Emergency Risk and Crisis Communication framework (PHERCC) provides a structured approach to crafting, delivering, and refining public health messages to build trust, promote compliance, and enhance societal resilience.
METHODS: This qualitative study examined COVID-19 risk communication strategies in rural Northern New England using the PHERCC framework. Data were collected through seventeen stakeholder interviews, seven focus groups, and a pilot study conducted between November 2022 and March 2023. Stakeholders represented state and local organizations, while focus group participants included rural residents. A thematic analysis using NVivo software aligned findings with the six PHERCC domains: Evidence, Initiator, Channel, Publics, Message, and Feedback.
RESULTS: Stakeholders emphasized transparency in public health messaging, adapting to evolving evidence while maintaining consistency. Trusted local sources and traditional media were essential for reaching vulnerable populations, particularly older adults in rural areas. Public feedback highlighted barriers such as misinformation, translation challenges, and limited internet access. The pilot study confirmed that community collaboration and tailored messaging increased understanding and trust among rural residents. Simplified accessible core messages and consistent updates further enhanced public engagement.
CONCLUSION: This study shows the importance of evidence-based, adaptive, and population subgroup sensitive communication during public health emergencies. The PHERCC framework proved instrumental in addressing challenges, promoting trust, and refining strategies. Investing in inclusive communication systems and leveraging community partnerships are important for effective responses to future health crises.
Summary found @ Summary of: Lessons Learned: Enhancing Rural Risk Communication for Fu by Abimbola Leslie, Elizabeth K. Woods et al