PHQ 9 Utilization in Maine Health

The PHQ is a brief patient survey for diagnosing depression and monitoring response to treatment.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1039/thumbnail.jp

An Evaluation of the Rollout of Aunt Bertha, a Community-Centered Directory, Across the MaineHealth Network

Remote interviews were conducted with community-based organizations across Maine to gain insight to their perspective of Aunt Bertha’s use and potential.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1002/thumbnail.jp

A New Project ECHO focused on Clinical Research in development by the NNE-CTR

I diagram presented for the project by the NNE-CTRhttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1034/thumbnail.jp

Boot Camp Translation: Community Engaged Research Process Evaluation

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.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1003/thumbnail.jp

Patient and Provider Experience with Artificial Intelligence Screening Technology for Diabetic Retinopathy in a Rural Primary Care Setting

Introduction: The development of autonomous artificial intelligence for interpreting diabetic retinopathy (DR) images has allowed for point-of-care testing in the primary care setting. This study describes patient and provider experiences and perceptions of the artificial intelligence DR screening technology called EyeArt by EyeNuk during implementation of the tool at Western Maine Primary Care in Norway, Maine. Methods: This non-randomized, single-center, prospective observational study surveyed 102 patients and 13 primary care providers on their experience of the new screening intervention. Results: All surveyed providers agreed that the new screening tool would improve access and annual screening rates. Some providers also identified initial challenges in incorporating the tool into the primary care visit (31%). Patients expressed a favorable view of the service, sharing an openness to being screened more regularly (75%) and a desire to have screenings performed at Western Maine Primary Care going forward (81%). Discussion: Patients were generally favorable about their experience with the new DR screening technology. Providers indicated challenges due to the limited availability of trained medical assistant photographers during the initial implementation of DR screening, as well as timing issues in coordinating screening with regular office appointments. Conclusions: This study supports further investigation of this technology in primary care, particularly in areas with challenges to care access. The potential benefits of this innovative tool in caring for people with diabetes includes improving access to retinopathy screenings and supporting wider detection of vision-threatening retinopathy

The Implementation of Telemedicine in the Covid-19 Era

Introduction: During the COVID-19 global pandemic in 2020, social distancing policies called for health care providers to turn to telemedicine platforms for most of their patient encounters. We aimed to better understand the experiences and perspectives of patients and providers who used telemedicine in the primary care setting. Methods: This study included semi-structured interviews with patients and providers who participated in telemedicine visits during the beginning of the COVID-19 pandemic. Patients (n = 14) were from a rural Maine practice and providers (n = 10) were from practices within 100 miles of a tertiary care center. The interviews were analyzed through inductive coding and applying the constant comparative method. Results: Both patients and providers expressed general satisfaction with their telemedicine experiences. Patients (64%) and providers (90%) felt “comfortable” with telemedicine. They praised telemedicine for its convenience and recognized the benefit of having a telemedicine option in the future. However, there was a mixed response regarding perceived efficacy of telemedicine and the ability to emotionally connect over virtual platforms. Finally, the participants in this study discussed dissatisfaction with the loss of the “ritual of medicine.” Discussion: The COVID-19 pandemic posed barriers to health care that parallel existing barriers in rural states. For much of this rural population, the rapid implementation of telemedicine enabled easier access to care. However, the implementation also saw many technological and infrastructural roadblocks. Conclusions: Understanding the benefits and challenges of telemedicine for patients and providers will be critical in assuring that telemedicine continues to improve access to health care

Toward reflexivity: Adventures of Huckleberry Finn and George Washington G'omez

Due to the character of the original source materials and the nature of batch digitization, quality control issues may be present in this document. Please report any quality issues you encounter to [email protected], referencing the URI of the item.Includes bibliographical references (leaves 66-70).Issued also on microfiche from Lange Micrographics.Since the publication of Huckleberry Finn in 1885, numerous highly esteemed authors and critics have reviewed the work. By examining the rhetorical situation of currents of praise and rejection in this scholarship, one can understand how complicated rhetorical trends in criticism occurred in discussions on Twain's novel and how discourses of praise lavished on Huckleberry Finn often were articulated as sensational celebrations of "greatness" and "Americanness." To downplay the celebration of jingoistic elements in a work of art or artist, literary critics should articulate more balanced perspectives that encourage the author to include himself or herself into the object of the discourse, showing readers how the critic's own life and circumstances self-consciously shape and influence theory, assessment and the dissemination of an artistic product or how an artist practices his or her craft. Reflexive interpretation involves both a researcher's questions in light of his or her conscientious self-referencing examination of shaping cultural and social assumptions. In this thesis, a reflexive critical approach is utilized as the author explores her own subject position in relation to historical significations in Americo Paredes's George Washington G' omez, a book written in 1936-40 and only narrowly received since its publication in 1990

Prioritizing Zoonoses for Global Health Capacity Building—Themes from One Health Zoonotic Disease Workshops in 7 Countries, 2014–2016

Zoonotic diseases represent critical threats to global health security. Effective mitigation of the impact of endemic and emerging zoonotic diseases of public health importance requires multisectoral collaboration and interdisciplinary partnerships. The US Centers for Disease Control and Prevention created the One Health Zoonotic Disease Prioritization Tool to help countries identify zoonotic diseases of greatest national concern using input from representatives of human health, agriculture, environment, and wildlife sectors. We review 7 One Health Zoonotic Disease Prioritization Tool workshops conducted during 2014–2016, highlighting workshop outcomes, lessons learned, and shared themes from countries implementing this process. We also describe the tool’s ability to help countries focus One Health capacity-building efforts to appropriately prevent, detect, and respond to zoonotic disease threats

Anticoagulation in the Very Old: Does Age Matter?

Background: There is a 4.5% annual risk of a thromboembolic stroke in patients with atrial fibrillation (AF) and a CHADS2-VASC score 2 or greater. Among these patients, anticoagulation using Warfarin or a direct oral anticoagulant has been shown to reduce the risk of events by 45%. However, there has been some provider concern about the increased risk of bleeding while on anticoagulation in patients who are older, frailer, and have multiple comorbidities. Previous studies have suggested that anticoagulation is recommended in nearly all patients with a CHADS2-VASC score at 2 or greater. Understanding factors that make patients poor candidates for anticoagulation may help providers with their decision to start patients on therapy. This study attempted to identify characteristics or risk factors that affect anticoagulation treatment success among older patients at Pen Bay Medical Center (PBMC). Methods: Patients aged 70 and older treated with warfarin and managed by the Anticoagulation Services at PBMC were followed for 24 months. Data collected at enrollment and at every 6 months included patient demographics, clinical characteristics, and time in therapeutic range (TTR), a percentage of time that a patient’s International Normalized Ratio (INR) values were in range over a 6-month period, and the primary outcome of interest. TTR was dichotomized at the end of the study as in range (\u3e=60%) or out of range (\u3c60%). Chi-square tests of association were performed to compare characteristics between those in range at least 60% of the time vs. who were not at study end. A regression model is currently being developed in order to identify predictors of TTR in range/out of range. Results: This study enrolled 132 patients aged 70 and older seen at the Anticoagulation Services at PBMC over a 24-month period. Males were significantly more likely than females to be in range at least 60% of the time at study end (92% vs. 72%, respectively, p=0.004). There was no statistically significant difference in age category (p=0.74), mini Cognitive scores (p=0.26), Frailty scores (p=0.09), mobility scale (p=0.51), CHADS2-VASC (p=0.78), living arrangement (p=0.09), or alcohol use (p=0.06) between the two groups. Conclusions: Preliminary results from this analysis indicate that age and other factors among elderly patients, including frailty, cognitive ability, or mobility do not affect whether anticoagulation is successful at the end of a 24-month period. Further work is underway to develop a model to understand how these factors may interact with each other to predict anticoagulation treatment outcomes in this patient population

Understanding the Role of Misinformation in COVID-19 Vaccine Hesitancy in a Rural State

OBJECTIVE: to identify factors associated with COVID19 vaccine hesitancy, including sources of information among residents of Maine. METHODS: 148 study participants, recruited through community partners and primary care offices in Maine, completed an anonymous 15 item online survey. Recruitment and data collection occurred from May to September, 2021. Hesitancy was determined through a single question, Will you get one of the COVID vaccines when it is offered to you? RESULTS: vaccine hesitant respondents were younger than not hesitant respondents ( = 0.01). Hesitant individuals were significantly more likely to report concerns regarding the speed of COVID-19 vaccine production, vaccine efficacy, and potential vaccine side effects ( \u3c 0.05 for each). Hesitant individuals were also significantly more likely to have discussed vaccination with their primary physician ( = 0.04). CONCLUSIONS: overall, hesitant individuals are more likely to be younger and had less trust in information from government sources, but they sought input from primary care. They were also more concerned about efficacy, side effects, and the rapid development of COVID-19 vaccines. Primary care physicians are in key positions to address these concerns due to contact with individuals who need accurate information