Costas T. Lambrew Research Retreat 2021

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Studying Emotions in Tele-Palliative Care, a Small Formative Study

Eric Anderson, Rebecca Hutchinson, Mollie Ruben, Noah Manning, Kathleen Walsh, Robert Gramling, and Paul Han

Can emotional connection be formed in virtual consults?
Leveraging Spiritual Care Resources to Reduce the Number of Behavioral Events on an Acute and Intermediate Medical-Surgical Unit

Natasha Bartlett, Tia Jamir, Sally Langerak, and Heather Weidemann

In 2018, R4/AVU an acute and intermediate care medical unit at Maine Medical Center (MMC), had a high level of distressing behavioral events (Code Grays) and staff stress.
Exploration of telemedicine for the delivery of Substance Use Disorder treatment during the COVID-19 Pandemic

Rebecca Bell, Hannah Loeb, Michael Kohut, Eric Anderson, Kinna Thakarar, and Rebecca Hutchinson
The MMC BioBank is a Resource that Supports Biomedical Research

Anne C. Breggia, Sue LaPierre, Christopher Keister, Dawn Charnetzky, Hannah Brown, Joseph Nano, Sydney Robinson, Howard Feller, Susan Nester, Elizabeth Hamir, Heidi Ingersoll, Anthony Sellner, Trevor Jorgensen, and Mike Jones

Mission: To provide normal and diseased annotated human biospecimens to the research community that supports discoveries leading to improved patient therapies and advances in personalized medicine.
The NCI/NIH Cancer Moonshot BioBank (CMB) and the Maine Cancer Genetics/Genomics Education Core (ME-CGEC) Collaborate to Improve Cancer Care in Maine

Anne C. Breggia, Sue Miesfeldt, Neil Korsen, Jill Prescott, Lisa Lemire, Meghan Searight, Jamie Saunders, and Scot Remick

Goal: To better understand drug resistance and sensitivity in patients with late stage (Stage III & IV) cancers that are receiving standard of care molecularly targeted therapies through next generation sequencing (NGS) of biopsy and blood samples collected longitudinally (diagnosis-- treatment--progression).
Perceptions of Self-Efficacy and Experiences of Mindfulness on Pain and Anxiety in Patients Undergoing a Colorectal Surgery: A Prospective Mixed Methods Study

Rebecca Brown, Julie Fitzgibbons, and Rachel Farrington

Introduction

• Pain and anxiety have a physiological response on the body.

• Increased heart rate, respiratory rate and blood pressure can lead to complications, and thus longer hospitalization along with decreased patient satisfaction.
Ketamine Infusions For Post-Cesarean Pain In Patients with Opioid Use Disorder

Talitha Budi, Johanna Cobb, Wendy Craig, Heather Turcotte, Janelle Richard, and Aurora Quaye

Discussion:

• Opioid consumption may be reduced during ketamine infusion without significant side effects

• Further investigation planned with a prospective, randomized, double-blind, placebo-controlled trial.
The Introduction of a Multimodal Clinical Pathway for Outpatient Total Knee Arthroplasty in the Era of COVID-19

D Bunch, R Mountjoy, G Korsunsky, A Rana, and C Sturgeon

The combination of a short acting spinal and muscle-sparing regional blocks, including adductor canal and iPACK blocks, can allow for successful outpatient total knee arthroplasty.
Determinants of private well water testing in Maine

Jenny Carwile, Shravanthi M. Seshasayee, Kritika Anand, and Abby F. Fleisch

Objectives: Describe sociodemographic characteristics associated with ever testing well water using data from the 2014-2017 Maine Behavioral Risk Factor Surveillance System (BRFSS) (n= 12,152).
Improving safety using HFMEA and insitu simulation prior to initiating contrast MRI studies in an ambulatory setting

Micheline Chipman, Todd Dadaleares, Heather Beaulieu, and Leah Mallory

The objective of this event was to test a new system for emergency response to MRI contrast reactions by ensuring staff familiarity with emergency equipment and a newly drafted emergency response protocols, and to mitigate any LST identified.
Telemedicine Consultation to Assess Neonatal Encephalopathy in Rural Community Hospitals

Rachel Coffey, Misty Melendi, Anya J. Cutler, and Alexa K. Craig

We studied the feasibility of tele consults in community hospitals for neonatal encephalopathy evaluation.
Boot Camp Translation: Community Engaged Research Process Evaluation

Emma DayBranch, Kerri Barton, Brendan Schauffler, Lisbeth Wierda, and Neil Korsen

The BCT process was first developed by the High Plains Research Network and its Community Advisory Council in rural Colorado. Between 2004 and 2015 the BCT process was used 31 times across the U.S. on a broad range of topics.
Would Surgeons Opt for Polypropylene Mesh if They Hypothetically Had Stress Urinary Incontinence or Pelvic Organ Prolapse?

William J. Devan, Sanchita Bose, Dayron Rodriguez, Ricardo Munarriz, and Linda Ng

Introduction

• Controversy surrounding vaginal mesh kits

• Many patients have negative connotations regarding mesh

• If patients were shown that their surgeons would opt for mesh –maybe this would help lessen the negativity?
Examining the Relationship Between Markers of Emergency Department Crowding and Physician Wellbeing

Jessica DiBiase, Tania D. Strout, Samir Haydar, Karla Hyde, Elizabeth Hamilton, and Christine Hein

Objectives-

Explore changes to EP wellbeing over time.

Evaluate the relationships between markers of ED crowding and boarding and EP wellbeing
An Evaluation of the Rollout of Aunt Bertha, a Community-Centered Directory, Across the MaineHealth Network

Samantha Dinsdale, Lisbeth Wierda, Kerri Barton, and Ellen Freedman

Remote interviews were conducted with community-based organizations across Maine to gain insight to their perspective of Aunt Bertha’s use and potential.
Standardized EKG curriculum

Michael Ellerman, Jon Nichols, and Sanjeev Francis

Goal: To study the effect of a standardized EKG curriculum on competency of interpreting common EKGs among internal medicine residents
A New Project ECHO focused on Clinical Research in development by the NNE-CTR

Ivette Emery, Kerri Barton, Meredith Oestreicher, Neil Korsen, and Irwin Brodsky

I diagram presented for the project by the NNE-CTR
Investigation of the relationship between obesity, weight cycling, and tumor progression in murine myeloma models

Heather Fairfield, Catherine R. Marinac, Mariah Farrell, Brenda M. Birmann, and Michaela R. Reagan

We investigated this relationship in two murine myeloma models with a high fat diet (HFD) to induce obesity, and a diet cycling (DC) regimen to model weight cycling.
Inhibiting Fatty Acid Binding Protein Family Members Decreases Multiple Myeloma Cell Proliferation Through Effecting the myc Pathway

Mariah Farrell, Heather Fairfield, Anastasia D'Amico, Carolyne Falank, Connor Murphy, and Michaela Reagan

FABP inhibition leads to increased survival of myeloma bearing mice and decreased cell growth by inhibiting MYC signaling.
Impact of a Primary Care Clinical Pharmacist on the Management of Hepatitis C Viral Infection

Sierra Ferreiira, Adam Normandin, Linh Gagnon, and Corinn Martineau

Interprofessional care including a pharmacist demonstrates a positive trend towards increasing access to care and improving adherence to Hepatitis C management in a primary care setting.
PHQ 9 Utilization in Maine Health

Steven Gerrish, Kerri Barton, and Neil Korsen

The PHQ is a brief patient survey for diagnosing depression and monitoring response to treatment.
Improving the Care of Patients with Cirrhosis at MMC

Lesley B. Gordon, Elizabeth Herrle, Matt Buttarazzi, Monica Thim, Jenna S. Ptaschinski, Victoria Molina, and Natalie Channell

Purpose: Improve the rate and timeliness of paracenteses for patients with decompensated cirrhosis.
Thyroid Hormone-Clearing Deiodinase 3 Protects from Cranio- Encephalic and Cardiac Congenital Abnormalities

Arturo Hernandez, M Elena Martinez, Ilka Pinz, Marilena Preda, and Thomas Gridley

Implications: Transient overexposure to TH during development may contribute to idiopathic congenital syndromes in humans (cleft palate, hydrocephalus, cardiac and Chiari malformations, others)
Spiritual/Religious Orientation and Moral Distress in Pulmonary Care Nurses: An Exploration of Ethical Norms, Moral Agency and Moral Resilience

Kristiina Hyrkas and Myrna Koonce

Introduction

• Nurses who provide care which they perceive as increasing suffering often experience moral distress (MD).

• Response to MD is a key factor in nurse wellbeing and retention, and is widely studied in nurses.

• Less research exists on foundations of moral belief and practice among nurses.
Plasma concentrations of per- and polyfluoroalkyl substances and body composition from mid-childhood to early adolescence

Jaclyn Janis, Sheryl Rifas-Shiman, Shravanthi M. Seshasayee, Clifford J Rosen, Abby F Fleisch, Sharon Sagiv, and Emily Oken

BACKGROUND

• Per- and polyfluoroalkyl substances (PFAS) may alter body composition by lowering anabolic hormones and increasing inflammation.

Prior studies have found positive, inverse, and null associations of PFAS concentrations with adiposity among children and adolescents.

Few studies have examined associations of PFAS concentrations with changes in body composition longitudinally.

No study has examined the association of PFAS plasma concentrations with lean mass.
Exploring OB/GYN provider knowledge, practice and confidence levels before and after ACEs training

Nadi Nina Kaonga, Alexandra Turnbull, Paula Vokey, and Julia Brock

Trauma-informed training on ACEs improves provider confidence on screening and treating their prenatal patients.
Novel roles of miR-199b in regulating fat and bone metabolism

Aldona Karaczyn, Victoria DeMambro, Jennifer Daruszka, Patrizia Roy, Clifford Rosen, and Calvin Vary

Public Health Problem:

The incidence of obesity has reached epidemic proportions worldwide and has contributed to an increase in the risk of numerous chronic disorders-type 2 diabetes-liver pathologies, dyslipidemia, and cardiovascular diseases.

Obesity can have negative effects on bone remodeling-reduced mineral density-osteoporosis

Imbalance between food intake and energy expenditure-obesity-accumulation of fat mass and energy storage in white adipose tissue (WAT).
Insulin Signaling in Osteocytes in Bone Development

Vivin Karthik

Hypothesis: IRS1/2 signaling is necessary for osteocyte development and function
Naloxone Co-Prescribing Across a Large Health System: A Quality Improvement Project

Marc D. Kimball, Sarah Hemphill, and Kristen Silvia

Introduction:

• Naloxone availability and administration saves lives

• The CDC recommends naloxone co-prescribing for patients with OUD and other eligibility criteria

• Maine Medical Center’s baseline was found to be 6% in one clinic. This held true across the entire MaineHealth system.
Improving Diabetic Retinopathy Screening Rate in a Rural Primary Care Setting Using Point of Care AI Technology

Shane Kirkegaard

Point of Care AI Technology Poised to Improve Diabetic Retinopathy Screening Rate in Rural Primary Care Setting
Measuring Vastus Medialis Cross-Sectional Area with Panoramic Ultrasound Over Time

Kaitlin Minnehan, Elizabeth Scharnetzki, Kaitlyn Chin, Christina Holt, and William Dexter

Panoramic ultrasound detected a statistically significant decrease in the VM CSA of participants after 70 days of bedrest without exercise.
Preventive healthcare services receipt and primary care provider utilization among people who inject drugs

E K. Nenninger and Kinna Thakarar

Introduction:

People who inject drugs (PWID) face barriers to accessing primary care providers (PCPs) and preventive services, but are at increased risk for preventable infections

Preventive services can be accessed through PCPs, or while hospitalized or at community organizations like syringe service programs (SSPs)
Evaluation of the Multidisciplinary Endocarditis Treatment Team at Maine Medical Center

Bridget C. Olsen and Jessica Kvasic

Maine Medical Center started a Multidisciplinary Endocarditis Treatment (MET) team to improve the care of patients with IE by streamlining consults and coordinating care between multiple specialties.
Institutional Experience with Primary Interventional Radiology Sclerotherapy for Lymphatic Malformation

Obiyo Osuchukwu, Brenton Reading, Charlene Dekonenko, Wendy Jo Svetanoff, Jeff Thekkekara, Douglas C. Rivard, Charles L. Snyder, and Tolulope A. Oyetunji

Interventional Radiology Sclerotherapy is effective for treatment of primary and recurrent lymphatic malformations
The Effect of High Fat Diet on Marrow Adipocytes from C57BL/6J (B6) Mice

Gisela Pachón-Peña, Clifford J. Rosen, and Samantha Costa

In mice models, the administration of a high fat diet (HFD) is an accelerating factor for metabolic syndrome, impaired glucose tolerance, and early type 2 diabetes mellitus (T2DM) (1)
Resilience of regional hospital nursing staff working during the COVID-19 pandemic measured by the Connor-Davidson resilience scale

Jill Petzel Baer

Low resilience is widespread in nursing staff during the COVID-19 pandemic
A Period Seroprevalence (SARS-CoV-2) Survey in MHCCN Cancer Healthcare Workers (HCWs) Providing Patient Care during the Height of the Outbreak: A Registry Study (Initial Progress)

Jill Prescott, Caroline Knight, Erin Hobart, Jamie Saunders, Kimberly Caron, Sandra Neptune, Patty Brown, Lisa Lemire, Anne Breggia, Susan L. Guierin-Staples, Lee Lucas, Paul Han, Rachit Kumar, Robert Carlson, and Scot Remick

Introduction: There is little information on the basic epidemiologic and serologic profile(s) of the novel SARSCoV- 2 coronavirus especially in HCWs employed in rural settings. We embarked on a period seroprevalence study in the MaineHealth Cancer Network (MHCCN) to document Covid-19 exposure in our rural cancer care workforce. Our fundamental hypothesis is that despite implementing procedures to safeguard patients and the use of appropriate PPE in the care of known source patients/PUIs in both the inpatient and outpatient cancer care settings a small, but not insignificant number of cancer care providers (hereafter referred to as cancer HCWs) will have evidence of exposure by virtue of plasma antibody seroconversion.
Multiple myeloma cells Graphs and Figures inhibit adipogenesis, increase senescencerelated and inflammatory gene transcript expression, and alter metabolism in preadipocytes

Michaela R. Reagan, Heather Fairfield, Samantha Costa, Carolyne Falank, Mariah Farrell, Connor S. Murphy, Anastasia D'Amico, and Heather Driscoll

Myeloma cells alter metabolism & induce senescence in adipocyte-lineage cells, suggesting that senescence-associated proteins are involved in multiple myeloma.
Resident Instruction in Social Emergency Medicine

Heidi Roche, Christine Knettel, Brandon Knettel, Justin Myers, Jessica Dunn, and Timothy S. Fallon

Understanding social determinants of health (SDH) and their intersection with emergency medicine, also known as social emergency medicine (SEM), is an important area of EM training.
Family planning outpatient provider survey; evaluating resident confidence in knowledge of family planning topics and barriers to providing effective care

Hannah Rosenfield and Kohar Der Simonian

The Question-

How do residents feel about their knowledge and skills in applying evidence- based care around contraception, miscarriage management and options counseling?
Parent experience of HIE and hypothermia: A call for trauma informed care

Anna Sagaser, Betsy Pilon, Annie Goeller, Monica Lemmon, and Alexa Craig

Objective:

To assess parents’ experience of communication with the medical team and involvement with their infant during HIE treatment.
Safe injection to prevent infection: Specific injection practices are associated with Hepatitis C exposure, suggesting opportunities for targeted harm reduction intervention for people who inject drugs in Maine

N P. Sankar, K Murray, D Burris, and K Thakarar

Background

• The U.S. opioid epidemic has contributed to an increase in infections related to IDU, such as HCV

• Transmission of HCV has been linked to unsafe injection practices

• This study aims to characterize risk factors associated with HCV exposure amongst people who inject drugs in Maine Methods
MaineHealth as a Partner in the National COVID Cohort Collaborative (N3C)

Susan Santangelo, Ivette Emery, Kim Murray, John DiPalazzo, David Denton, and Cliff Rosen
Communicating about COVID-19: Strategies for promoting risk-reducing behaviors on Facebook

Liz Scharnetzki, Nikki Jarvais, Elizabeth Rintz, Leo Waterston, David Pied, and Paul Han

Introduction- Controlling the COVID-19 pandemic requires effective public health communication strategies that can promote risk-reducing behaviors despite scientific uncertainties about their effectiveness. The current project developed and tested different theory-based communication strategies for generating public interest in COVID-19 risk-reducing behaviors. • Assessed the efficacy of two novel message frames – destigmatizing and uncertainty normalizing - relative to existing strategies
Dietary Patterns and PFAS Plasma Concentrations in Childhood: Project Viva, USA

Shravanthi M. Seshasayee, Sheryl L. Rifas-Shiman, Jorge E. Chavarro, Jenny L. Carwile, Antonia M. Calafat, Sharon K. Sagiv, Emily Oken, and Abby F. Fleisch

Children who adhered to a dietary pattern of primarily packaged foods and fish had higher plasma concentrations of select PFAS, reflective of food intake and/or correlated lifestyle factors.
Control of perivascular adipose tissue differentiation during cardiovascular disease

Katie Stieber

Hypothesis: Lower BMI will correlate with lower RAB27a expression
Anterior-Based Muscle Sparing Approach for Total Hip Arthroplasty

Callahan M. Sturgeon, George M. Babikian, Brian J. McGrory, and Adam J. Rana

A high value, high quality and low cost surgery: a 7.5 year single-center, retrospective case series
Prolonged Thunder Before the Storm – Diagnosis of Aortobronchial Fistula After 28 months of Recurrent Hemoptysis

Hilamber Subba, Truc Ta, and Edmund Sears

Aortobronchial fistula (ABF) should always be considered in patients with hemoptysis and previous thoracic surgery, however the diagnosis is known to be difficult both clinically and radiographically1. We present a case with the longest indolent course of hemoptysis reported to date .
Facilitators and Barriers to Accessing Harm Reduction Services in a Rural State

Kinna Thakarar, Michael Kohut, Deb Burris, Hannah Loeb, Rebecca Hutchinson, and Kathleen Fairfield

INTRODUCTION

• The impact of social distancing policies during the COVID-19 pandemic on people who inject drugs (PWID) is not known.

• We aimed to describe the impact of the pandemic on PWID access to harm reduction services in Maine
Impact of Bowel Management Guidelines on Documentation and Patient Outcomes in the Intensive Care Unit

Alana Trottier, Paul Blakeslee, and Kristiina Hyrkas

Introduction

• Bowel management (BM) is an inadvertently overlooked aspect of patient care for critically ill patients who have complex, immediate life-threatening health issues.

• Bowel dysfunction is common with the reported incidence of diarrhea between 3.3%-78% and constipation between 20-83%

• Studies suggest that BM guidelines can standardize care, improve documentation, and impact patient outcomes

• Use of BM guidelines has remained low, probably influenced by clinicians’ resistance to change, resulting in small to moderate improvements and difficulties sustaining new practices

• We anticipated that sustained changes require recognizing clinicians’ current practice, integrating modifications into existing workflow, and engaging staff to contribute to any proposed changes
The Maine Lung Cancer Coalition: A Statewide, Multi-Sector Partnership to Improve Evidence-Based Lung Cancer Prevention & Screening

Leo B Waterston, Liz Scharnetzki, Susan Leeds, Jaclyn A. Janis, Lee Lucas, Deborah Deatrick, Rebecca Boulos, Neil Korsen, and Paul K.J. Han

MLCC has two primary goals:

1. Engage and educate about evidence based lung cancer prevention and screening practices

2. Develop, implement, and evaluate innovative programs to increase access to prevention, screening, and treatment services for all Mainers
Process Evaluation of a Smoking Cessation Group for Adults with Serious Mental Illness

David M. Weiss and Thomas Styron

Tobacco cessation strategies are needed to improve health outcomes among individuals with serious mental illness
Ideographic Modeling and Data Visualization of Sleep, Affect, and Psychotic Symptoms: A Case Example

D M. Weiss, E Aslinger, W L. Cook, K A. Johnson, K M. Elacqua, R I. Mesholam-Gately, and K A. Woodberry

Background:

1. Psychotic disorders are heterogeneous.

2. Current diagnostic categorizations are unable to capture individuals’ unique symptom experiences.

3. Newly-developed ideographic analyses and data visualization tools may be useful in assessing individuals’ symptom experiences and stimulating data informed care.
Notch signaling regulates perivascular adipose tissue (PVAT) function during diet-induced obesity

C Yang, A Harrington, L Ryzhova, and L Liaw

Objectives:

-To test the hypothesis that canonical Notch signaling influence vascular function by regulating PVAT-derived vascular relaxation factors.

-To determine how overexpression of Notch signaling or loss of the key Notch signaling component influence PVAT function.
A Simulation-Based Outreach Program Improves Delivery Room Team Confidence in Neonatal Resuscitation at Rural Community Hospitals

Allison Zanno, Misty Melendi, Micheline Chipman, Jeffrey Holmes, Alexa Craig, Samantha Piro, Anna Gilbert, Sarah Gabrielson, Leah Mallory, Anya Culter, and Mary Ottolini

Objective- Our goal is to pilot the use of an onsite Neonatal Community Outreach Education Program to improve provider confidence with procedural skills and neonatal resuscitation in the delivery room.
Development of Maine Ongoing Outreach Simulation Education (MOOSE), a Novel Telesimulation Program, to Improve Neonatal Resuscitation in a Rural Community Hospital

Allison Zanno, Misty Melendi, Micheline Chipman, Jeffrey Holmes, Alexa Craig, Samantha Piro, Anna Gilbert, Sarah Gabrielson, Leah Mallory, Anya Culter, and Mary Ottolini

Objective- To implement monthly neonatal resuscitation telesimulation team training sessions in a rural community hospital delivery room that is feasible, sustainable, and replicable at other sites.
A Modified SIR Model Equivalent to a Generalized Logistic Model, with Standard Logistic Approximations

David E Clark, Jordan S Peck, and Gavin Welch
Did racial representation change at our outpatient sports medicine clinic during the COVID-19 Pandemic?

William Douglas, William Dexter, Amy Haskins, and Christina Holt

Introduction/Objective

• COVID-19 pandemic has disproportionately affected Black, Indigenous, and People of Color (BIPOC)

• Increased infection, hospitalization, and death rates1,2

• Black Americans unequal access to outpatient care vs. White Americans 3

• Inequity worsened during the COVID-19 Pandemic 4

• Maine population: 94.25% “White;” 1.42% “Black” 5

• July 2020 COVID cases: 66.8% “White;” 22% “Black” 6

• Did this disparity reflect in in our sports medicine clinic?

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