Trends in maternal opioid use disorder and neonatal abstinence syndrome in Maine, 2016-2022.

OBJECTIVE: 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

Patients\u27 Perspectives on Health-Related Social Needs and Recommendations for Interventions: A Qualitative Study

RATIONALE & OBJECTIVE: People with low socioeconomic status are disproportionately affected by kidney failure, and their adverse outcomes may stem from unmet health-related social needs. This study explored hemodialysis patient perspectives on health-related social needs and recommendations for intervention. STUDY DESIGN: Qualitative study using semi-structured interviews. SETTINGS & PARTICIPANTS: Thirty-two people with low socioeconomic status receiving hemodialysis at three hemodialysis facilities in Austin, Texas. ANALYTICAL APPROACH: Interviews were analyzed for themes and subthemes using the constant comparative method. RESULTS: Seven themes and 21 subthemes (in parentheses) were identified: 1) kidney failure was unexpected (never thought it would happen to me, do not understand dialysis); 2) providers fail patients (doctors did not act, doctors do not care); 3) dialysis is detrimental (life is not the same, dialysis is all you do, dialysis causes emotional distress, dialysis makes you feel sick); 4) powerlessness (dependent on others, cannot do anything about my situation); 5) financial resource strain (dialysis makes you poor and keeps you poor, disability checks are not enough, food programs exist but are inconsistent, eat whatever food is available, not enough affordable housing, unstable housing affects health and wellbeing); 6) motivation to keep going (faith, support system, will to live); and 7) interventions should promote self-efficacy (navigation of community resources, support groups). LIMITATIONS: Limited quantitative data such as on dialysis vintage. Limited geographic representation. CONCLUSIONS: Dialysis exacerbates financial resource strain, and health-related social needs exacerbate dialysis-related stress. Participants made recommendations to address social needs with an emphasis on increasing support and community resources for this population

Bringing the Heat, When Babies are Too Hot

An Overview of the AAP CPG on Evaluation and Management of the Well-Appearing Febrile Infant 8-60 Days Old and QI Efforts at Maine Medical Center Presented by Gabriela DeOliveira, MD PGY-3 Pediatric Resident, The Barbara Bush Children\u27s Hospital at Maine Medical Center Date of Presentation: January 25th, 2024 CME available for 1 year after presentation CME Text Code 90159https://knowledgeconnection.mainehealth.org/pediatrics_gr/1037/thumbnail.jp

The Association of Season of Surgery and Patient Reported Outcomes following Total Hip Arthroplasty

BACKGROUND: Understanding the impact of situational variables on surgical recovery can improve outcomes in total hip arthroplasty (THA). Literature examining hospital outcomes by season remains inconclusive, with limited focus on patient experience. The aim of this study is to investigate if there are differences in hospital and patient-reported outcomes measures (PROMS) after THA depending on the season of the index procedure to improve surgeon erative counseling. METHODS: A retrospective chart review was performed on patients undergoing primary THA at a single large academic center between January 2013 and August 2020. Demographic, operative, hospital, and PROMs were gathered from the institutional electronic medical record and our institutional joint replacement outcomes database. RESULTS: 6418 patients underwent primary THA and met inclusion criteria. Of this patient population, 1636 underwent surgery in winter, 1543 in spring, 1811 in summer, and 1428 in fall. PROMs were equivalent across seasons at nearly time points. The average age of patients was 65 (+/- 10) years, with an average BMI of 29.3 (+/- 6). Rates of complications including ED visits within 30 days, readmission within 90 days, unplanned readmission, dislocation, fracture, or wound infection were not significantly different by season ( \u3e .05). CONCLUSION: Our findings indicate no differences in complications and PROMs at 1 year in patients undergoing THA during 4 distinct seasons. Notably, patients had functional differences at the second follow-up visit, suggesting variation in short-term recovery. Patients could be counseled that they have similar rates of complications and postoperative recovery regardless of season

Effect of six month\u27s treatment with omega-3 acid ethyl esters on long-term outcomes after acute myocardial infarction: The OMEGA-REMODEL randomized clinical trial

BACKGROUND: Omega-3 polyunsaturated fatty acids (O3-FA) have been shown to reduce inflammation and adverse cardiac remodeling after acute myocardial infarction (AMI). However, the impact of O3-FA on long-term clinical outcomes remains uncertain. AIMS: To investigate the impact of O3-FA on adverse cardiac events in long-term follow up post AMI in a pilot-study. METHODS: Consecutive patients with AMI were randomized 1:1 to receive 6 months of O3-FA (4 g/daily) or placebo in the prospective, multicenter OMEGA-REMODEL trial. Primary endpoint was a composite of major adverse cardiovascular events (MACE) encompassing all-cause death, heart failure hospitalizations, recurrent acute coronary syndrome, and late coronary artery bypass graft (CABG). RESULTS: A total of 358 patients (62.8% male; 48.1 ± 16.1 years) were followed for a median of 6.6 (IQR: 5.0-9.1) years. Among those receiving O3-FA (n = 180), MACE occurred in 65 (36.1%) compared to 62 (34.8%) of 178 assigned to placebo. By intention-to-treat analysis, O3-FA treatment assignment did not reduce MACE (HR = 1.014; 95%CI = 0.716-1.436; p = 0.938), or its individual components. However, patients with a positive response to O3-FA treatment (n = 43), defined as an increase in the red blood cell omega-3 index (O3I) ≥5% after 6 months of treatment, had lower annualized MACE rates compared to those without (2.9% (95%CI = 1.2-5.1) vs 7.1% (95%CI = 5.7-8.9); p = 0.001). This treatment benefit persisted after adjustment for baseline characteristics (HR = 0.460; 95%CI = 0.218-0.970; p = 0.041). CONCLUSION: In long-term follow-up of the OMEGA-REMODEL randomized trial, O3-FA did not reduce MACE after AMI by intention to treat principle, however, patients who achieved a ≥ 5% increase of O3I subsequent to treatment had favorable outcomes

Results of a Needs Assessment: Use of Sexual Orientation and Gender Identity Data in Health Systems in Maine

Introduction: Lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) patients experience significantly more health care disparities than non-LGBTQ+ patients. Although sexual orientation and gender identity data (SOGI) would help quantify and track these known disparities, there are no standardized methods for routinely and consistently including SOGI into health care management in Maine. Our needs assessment (1) evaluates the comfort of health care professionals (HCPs) in collecting SOGI and incorporating it into the medical record and (2) identifies barriers to SOGI collection. Methods: An interprofessional team conducted a survey of Maine HCPs who identified as working directly with patients or patient records and information to assess how they manage LGBTQ+ data. We then conducted focus groups with survey participants, coded the transcripts, and identified recurrent themes through thematic analysis. Results: We found that of 357 interprofessional respondents, 62.9% of HCPs agreed that SOGI should be collected with every patient. However, only 30.1% reported collecting SOGI for “all or most” of their patients. The primary barriers to data collection and use were identified as lack of education and comfort with LGBTQ+ topics, HCP concern for causing patient discomfort, and lack of standardization of data management and workflow. Discussion: Most HCPs in Maine are not yet comfortable with routinely incorporating SOGI. Even if they were comfortable, patient workflows and electronic health records vary widely across systems, and this inconsistency is a substantial obstacle to standardizing SOGI collection. A multidimensional approach is needed to address these barriers moving forward. Conclusions: HCP’s discomfort with LGBTQ+ topics and non-standardized workflows are driving factors that must be overcome to fully incorporate SOGI collection as a standard best practice

Use of Syringe Service Programs in Rural vs Urban Maine: A Harm-Reduction Study

Introduction: Syringe service programs (SSPs) reduce HIV and viral hepatitis transmission, as well as the prevalence of improperly disposed needles and needle stick injuries among first responders. Infections associated with injection drug use are rising in rural areas, including Maine, leading to concerns that SSP services are difficult to access for rural residents. Methods: A cross-sectional survey of 101 participants hospitalized with infections associated with injection drug use at 4 hospitals in Maine was collected over a 15-month period. Descriptive analyses were performed. Statistical analyses were completed using Fisher’s exact tests, Pearson’s chi-squared tests, and Student’s t tests. Results: Of 101 participants, 66 (65%) lived in urban areas, and 35 (35%) lived rurally. Participants living in rural areas reported less SSP use in the past 3 months (76% urban vs 43% rural). Rural participants also had a higher prevalence of injecting buprenorphine than urban participants (6% urban vs 12% rural). Rural participants were also more likely to obtain needles from pharmacies than urban participants (40% urban vs 71% rural). Discussion: SSP programs are underrepresented and accessed less in rural areas of Maine. Rural populations of people who inject drugs have unique health characteristics and syringe-use practices. Conclusions: These findings highlight the need to develop rural SSP programs that address the unique needs of rural populations