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  • Francis Fontan (1929-2018): Pioneer pediatric cardiac surgeon

    Huynh, Elisah; Chernick, Rebecca E.; Desai, Manisha S. (2022-09-07)
    Up until the mid-1900s, tricuspid atresia - a birth defect of the tricuspid valve, was once categorized as a "death sentence." The challenge of achieving positive health outcomes for affected patients was compounded by a hesitancy to operate on children. The main concern was safely administering anesthesia to young patients who were going through a strenuous operation that was often poorly tolerated. Despite these assumed limitations, Francis Fontan, a pediatric cardiothoracic surgeon at the Hospital of Tondu in Bordeaux, was able to redirect blood flow from the superior and inferior vena cava to the pulmonary arteries in 1971, which elucidated the process of advancing clinical practice in medicine. With the support of mentors and a firm belief in this new technique, Fontan pioneered his eponymous procedure and ultimately paved the way for modern cardiovascular surgical techniques that helped to prolong the life of those with single functioning ventricles. The aim of this study is to examine the genesis and the evolution of the Fontan procedure to elucidate the process of advancing clinical practice in medicine by utilizing personal interviews, Fontan's works, associated primary and secondary sources in the context of 20th century cardiothoracic surgery and innovations.
  • COVID-19: a gray swan's impact on the adoption of novel medical technologies

    Dunlap, Denise; Santos, Roberto S.; Lilly, Craig M.; Teebagy, Sean; Hafer, Nathaniel S.; Buchholz, Bryan O.; McManus, David D. (2022-07-08)
    The COVID-19 pandemic offers a unique context and opportunity to investigate changes in healthcare professional perceptions towards the adoption of novel medical technologies, such as point-of-care technologies (POCTs). POCTs are a nascent technology that has experienced rapid growth as a result of COVID-19 due to their ability to increase healthcare accessibility via near-patient delivery, including at-home. We surveyed healthcare professionals before and during COVID-19 to explore whether the pandemic altered their perceptions about the usefulness of POCTs. Our network analysis method provided a structure for understanding this changing phenomenon. We uncovered that POCTs are not only useful for diagnosing COVID-19, but healthcare professionals also perceive them as increasingly important for diagnosing other diseases, such as cardiovascular, endocrine, respiratory, and metabolic diseases. Healthcare professionals also viewed POCTs as facilitating the humanization of epidemiology by improving disease management/monitoring and strengthening the clinician-patient relationship. As the accuracy and integration of these technologies into mainstream healthcare delivery improves, hurdles to their adoption dissipate, thereby encouraging healthcare professionals to rely upon them more frequently to diagnose, manage, and monitor diseases. The technological advances made in POCTs during COVID-19, combined with shifting positive perceptions of their utility by healthcare professionals, may better prepare us for the next pandemic.
  • Updating and Improving the Capstone Course Experience for Learners and Teachers

    Bronwyn Cooper; Lin, Ashley; Cooper, Bronwyn (2022-06-30)
    Background:The Capstone Scholarship and Discovery Course (“Capstone course”) is a required four-year course which aims to support students in the design, execution, writing, and presentation of a longitudinal scholarly project. Currently, the Capstone course meets criteria for “underperforming” designation (<75% approval) designationin two areas: Overall, how would you rate this course? | 2.52/4 | 52.77% Feedback on reports supported progress/learning | 2.95/4 | 74.07% The overall medical school curriculum is transitioning to a new curriculum (“Vista”) in which Capstone will fit into the context of student-selected Pathways. As the Capstone student representative responsible for communicating student feedback to Capstone leadership, I became interested in taking advantage of this opportunity to improve the course. I believe that every medical student should feel supported in their Capstone research and finish medical school with a foundational understanding of how to conduct longitudinal scholarly work. Objectives: 1) Identify student and faculty concerns about the Capstone course 2) Propose potential changes to the Capstone course to address the most significant concerns 3) Measure student approval towards these proposed changes 4) Summarize and present the most highly student-approved proposed changes to Capstone Course Leadership Team. Methods: I reviewed all Capstone oasis evaluations from the 2020 – 2021 Academic Year, which included 109 faculty evaluations of students, 133 student evaluations of Capstone faculty (~80% response rate), and 136 student evaluations of the Capstone course (~81% response rate). I also created a pre-survey to assess the most unclear aspects of the Capstone course as well as top barriers to meeting deadlines. I received 44 survey responses from third-year students (~22% response rate) and 47 responses from fourth-year students (~30% response rate). From the oasis evaluations and survey responses, I identified the most significant concerns. I generated twenty-two proposed changes to address these concerns, and created a slideshow that summarizes these proposed changes to the Capstone course. This was distributed to current third- and fourth-year medical students, along with a post-survey where students could vote on the proposed changes and indicate whether these changes addressed the unclear aspects of the Capstone course and top barriers to meeting deadlines. (Terminology note: learning community assigned affiliate = “affiliate”, faculty advisor specific to project = “advisor”). Results: I received 29 post-survey responses from third-year students (~15% response rate) and 37 responses from fourth-year students (~23% response rate). Between the pre- and post-surveys, the average % of students finding certain aspects of Capstone “unclear” decreased by 26.1%, and the average % of students rating certain barriers as significant for meeting Capstone deadlines decreased by 15.5%. Notably, the post-survey found that some students believe the proposed changes would not address their lack of interest in doing a longitudinal project (53.1%), and that certain projects students are interested in would still not meet Capstone requirements (31.3%). An abbreviated summary of the most popular proposed changes (>50% of students agree, and/or >10% of students indicated it as one of their top three changes, highlighted in bold) is below. Proposed Solution | % top 3 | % disagree | % neutral | % agree 1a) Create research project database | 30.4 | 3.1 | 12.3 | 84.6 1b) Create roster of past highly-rated advisors (based on oasis evals) | 7.1 | 4.6 | 24.6 | 70.8 1d) MS1 Capstone curriculum focused on developing research skills | 23.2 | 9.2 | 18.5 | 72.3 1e) Affiliate must give feedback on project feasibility as a Capstone project within a month of project proposal. | 5.4 | 6.2 | 32.3 | 61.5 2a) Add additional, optional Capstone poster presentation session before ERAS deadline so presentation can be on ERAS app | 10.7 | 6.2 | 24.6 | 69.2 2b) Optional workshops (or asynchronous videos) on common issues | 5.4 | 15.4 | 32.3 | 52.3 3a) In place of report submissions, create a live document that can be accessed by affiliate and mentor | 16.1 | 10.8 | 26.2 | 63.1 3b) Flexible format (such as Senior Scholars format: background, objectives, methods, results, conclusion) with no length requirement | 21.4 | 1.5 | 12.3 | 86.2 3c) Rework deadlines to avoid exam dates, Step 1 period, holidays, and flexible range of deadlines provided during clinical rotations | 33.9 | 0 | 3.1 | 96.9 3d) Timeline of deadlines given to affiliates and mentors, with exam dates and Step 1 period marked on timeline | 5.4 | 1.6 | 15.6 | 82.8 3e) No punishment for those who get their work done early | 23.2 | 0 | 4.7 | 95.3 3f) Meeting with affiliate can substitute for an update with affiliate approval | 1.8 | 4.7 | 25 | 70.3 4a) Projects that take place over >1 month should be accepted as “longitudinal” and all affiliates should be on the same page. | 42.9 | 1.5 | 16.9 | 81.5 5a) Students may submit outside project to their affiliate to be approved for Capstone credit as long as they worked on this project during med school | 44.6 | 1.5 | 10.8 | 87.7 5c) Website should be simplified. | 7.1 | 0 | 21.9 | 78.1 Conclusion: Students enter medical school with widely differing levels of experience in conducting scholarly research, and the current Capstone course does not have flexibility for different types of projects, or the resources needed to accommodate student needs. Capstone affiliates and advisors also face difficulties providing optimal assistance to students. Through this work, I have identified solutions that are popular amongst students, which address unclear aspects of the Capstone course and top barriers to meeting deadlines. Bringing these solutions to the Capstone Course Leadership Team is the next step to addressing these concerns. Future goals include asking Capstone affiliates for their input, as this group was not included either in the oasis evaluations or the surveys. Another limitation of this study was the low survey response rates, ranging from 15-30%. I hope that ultimately some of these proposed changes to the Capstone course will be adopted and integrated into the new Vista curriculum.
  • Henry Jacob Bigelow (1818-1890): A champion for anesthesia and catalyst for the advancement of surgery

    Makris, Elizabeth M.; Makhoul, Kevin G.; Lee, Terence B. Jr.; Desai, Manisha S. (2022-01-20)
    Prior to the advent of anesthesia, surgery was limited in scope due to the excruciating pain experienced by patients. This raised challenges for surgeons who were distressed by the inadvertent suffering caused by surgery. The first successful use of ether anesthesia by William Thomas Green Morton (1819–1868) in 1846 at Massachusetts General Hospital was a turning point for the profession. The innovation and proliferation of operations catalyzed by the introduction of anesthesia altered the landscape of surgical practice. Initially, the introduction of ether into the field was met with hesitation and resistance by several parties in the medical field. It took the efforts of prominent surgeons to ensure that ether achieved its full potential. The greatest supporter of ether during this epoch was the young surgeon Henry Jacob Bigelow (1818–1890), who spent 30 years of his career advocating for and experimenting with anesthesia. The efforts of Bigelow, a gifted surgeon renowned for his contributions to orthopedic surgery, were instrumental in the promotion of anesthesia and the advancement of the surgical profession. In this article, we discuss the life, career, and contributions of Bigelow, particularly in the context of the introduction of modern anesthesia.
  • Season 2, Episode 6: Hiya: Saving Face, Anxiety, and Asian-Americans

    Silk, Hugh; Yang, Qiuwei; Ngangmeni, Lael; Del Rosario, Henry (2022-01-03)
    Qiuwei Yang ('22) and Laël Ngangmeni ('23, MD/PhD) are joined by family physician Dr. Henry Del Rosario to discuss an interesting experience at a car dealership, as well as how his creative side and his faith impact his perspectives on healing. Recorded October 2021. Dr. Del Rosario's piece "Hiya: Saving Face, Anxiety, and Asian-Americans" was first published on his blog. The Workers of Worcester website created by Dr. Del Rosario and Dr. An-Hoa Giang is available at: https://www.workersofworcester.org/. The transcript for this episode is available for download as an additional file.
  • Season 2, Episode 5: Julie

    Silk, Hugh; Sardell, Jesse; Ngangmeni, Lael; Wang, Sara (2021-12-27)
    Laël Ngangmeni ('23, MD/PhD) and Jesse Sardell ('24) are joined by Sara Wang ('24) for a discussion on how to tell stories from a patient's perspective, as well as what medical students should consider when they meet a patient for the first time. Sara Wang's piece "Julie" was first published on The Interstitium blog. The transcript for this episode is available for download as an additional file.
  • Season 2, Episode 4: An Appreciative Inquiry Narrative

    Silk, Hugh; Ngangmeni, Lael; Peterson, Kenneth S.; Yang, Qiuwei (2021-12-20)
    Laël Ngangmeni ('23, MD/PhD) and Dr. Hugh Silk are joined by Ken Peterson, a family nurse practitioner and assistant professor in the Graduate School of Nursing, to reflect on his experience as a nurse during the HIV/AIDS epidemic. Recorded August 2021. Ken Peterson's piece "An Appreciative Inquiry Narrative" and the transcript for this episode are available for download as additional files.
  • Dataset from: COVID-19: A Gray Swan’s Impact on the Adoption of Novel Medical Technologies

    Dunlap, Denise; Santos, Roberto S.; Lilly, Craig M.; Teebagy, Sean; Hafer, Nathaniel S.; Buchholz, Bryan O.; McManus, David D. (eScholarship@UMassChan, 2021-12-20)
    This dataset is used to examine how the COVID-19 pandemic has shifted many providers and patient perspectives related to healthcare and offers an opportunity to investigate potential changes in provider perceptions towards the adoption of novel point-of-care technologies (POCTs).
  • Clinician perspectives on the need for training on caring for pregnant women with intellectual and developmental disabilities

    Tiffany A. Moore Simas; Amir, Nili S.; Smith, Lauren; Valentine, Anne M.; Mitra, Monika; Parish, Susan L.; Moore Simas, Tiffany A. (2021-12-17)
    BACKGROUND: Women with intellectual and developmental disabilities (IDDs) experience disparities in obstetric care access and quality, in addition to communication gaps with healthcare providers. Many obstetric providers are untrained and uneducated about critical aspects of providing care to persons with IDDs. OBJECTIVE: The study was conducted to describe obstetric clinicians' training experiences related to providing obstetric care to women with IDDs, to assess the perceived need for formalized training, and to identify recommendations for training content. METHODS: This study involved qualitative individual interviews (n = 9) and one focus group (n = 8) with obstetric clinicians who self-reported experience caring for women with IDDs during pregnancy. Descriptive coding and content analysis techniques were used to develop an iterative codebook related to education and training; codes were applied to the data. Coded data were analyzed for larger themes and relationships. RESULTS: Analysis revealed three main themes: 1. Need for obstetric training and education: No participant reported receiving any training in caring for pregnant women with IDDs. Participants expressed a need for formal education. 2. Recommendations for formal training: Participants noted the need for training during residency and beyond, and all healthcare staff members should be included in training. 3. Training outcomes should increase knowledge, enhance attitudes, and develop practical skills related to care for pregnant women with IDDs. CONCLUSION: Results indicate a need for systematic training efforts regarding obstetric care for women with IDDs. Improved training and education may decrease health inequities and improve the quality of care, and thus pregnancy outcomes, for women with IDDs. LEVEL OF EVIDENCE: VI.
  • Season 2, Episode 3: People and Places

    Silk, Hugh; Sardell, Jesse; Botros, Mina; Yang, Qiuwei (2021-12-13)
    Dr. Hugh Silk and Jesse Sardell ('24) are joined by Mina Botros ('24) to hear about his experience meeting people -- both similar and quite different from himself -- as he got involved with vaccination efforts early in the COVID-19 pandemic. Mina Botros' piece "People and Places" and the transcript for this episode are available for download as additional files.
  • Season 2, Episode 2: Check Engine Light

    Yang, Qiuwei; Sardell, Jesse; Finlay-Morreale, Heather; Silk, Hugh (2021-12-06)
    Qiuwei Yang ('22) and Jesse Sardell ('24) are joined by pediatrician Dr. Heather Finlay-Morreale to discuss her experience of being diagnosed with a chronic illness and how that has influenced the way she cares for her own patients. Recorded April 2021. Dr. Finlay-Morreale's piece "Check Engine Light" was first published in JAMA Neurology. The transcript for this episode is available for download as an additional file.
  • Pediatric basal cell carcinoma burden and management preferences in Gorlin syndrome: A survey study

    Neale, Holly; Breneiser, Julie A.; Hawryluk, Elena B. (2021-12-01)
    Gorlin syndrome (GS) is a risk factor for early basal cell carcinomas (BCCs), although its prevalence of fewer than 1 in 30,000 individuals limits existing literature. There are sparse pediatric GS studies beyond case reports, creating a knowledge gap regarding childhood cutaneous findings and sequelae, including BCC age at onset, quantity, treatments, and impact. Herein, we describe a global survey to illustrate the clinical presentation, childhood perspectives, and BCC management trends for pediatric GS to improve the understanding and inform patient care.
  • Season 2, Episode 1: Reflections on a Visit to Holland

    Bhatia, Divya; Silk, Hugh; Hirsh, Michael P. (2021-11-29)
    Dr. Divya Bhatia ('21) and Dr. Hugh Silk are joined by pediatric surgeon Dr. Michael Hirsh to talk about a trip to Holland and visiting the Westerbork transit camp. Recorded April 2021. Michael Hirsh's piece "Reflections on a Visit to Holland" and the transcript for this episode are available for download as additional files.
  • Season 2: Welcome to Season 2!

    Yang, Qiuwei; Silk, Hugh; Bhatia, Divya; Sardell, Jesse; Ngangmeni, Lael (2021-11-22)
    Join us for Season 2 of Murmurs: Stories from our Journey in Medicine. We'll be featuring new voices from the UMass (now UMass Chan) community. First episode premieres Monday, November 22nd with new episodes weekly! The transcript for this episode is available for download as an additional file.
  • Topical 5% 5-fluorouracil versus procedural modalities for squamous cell carcinoma in situ and superficial basal cell carcinoma: A retrospective cohort analysis

    Neale, Holly; Michelon, Melissa; Jacob, Susan; Pinkston, Mary; Ukaegbu, Rebecca; Zamor, Waldo; Morrison, Emily; Deng, April; Levin, Nikki A. (Mosby, 2021-08-31)
    The topical chemotherapeutic agent 5-fluorouracil (5-FU) is commonly used to treat squamous cell carcinoma in situ (SCCIS) and superficial basal cell carcinoma (sBCC). Additional investigation is needed to understand whether topical 5-FU, under real-world conditions, has comparable treatment success to procedures for epidermally-limited keratinocyte carcinomas. Approval was obtained from the University of Massachusetts Medical School institutional review board to perform a retrospective chart review.
  • Parent-Reported Symptoms and Perceived Effectiveness of Treatment in Children Hospitalized with Advanced Heart Disease

    Molloy, Meaghan A.; DeWitt, Elizabeth S.; Morell, Emily; Reichman, Jeffrey R.; Brown, David W.; Kobayashi, Ryan; Sleeper, Lynn A.; Elia, Eleni G.; Samsel, Chase; Blume, Elizabeth D. (Mosby, 2021-07-01)
    OBJECTIVE: To characterize parent-reported symptom burden and effectiveness of symptom management in children hospitalized with advanced heart disease. STUDY DESIGN: Prospective survey study of 161 parents whose child was admitted to a single institution with AHD between March 2018 and February 2019 using the Survey about Caring for Children with Heart Disease. RESULTS: Of the 161 patients, 54% were under 2 years old with a diagnosis of single ventricle physiology (39%), pulmonary hypertension (12%), and other congenital heart disease (28%). Over half (56%) of parents reported that their child was experiencing a high degree ('a great deal'/'a lot') of symptoms. The most frequently reported symptoms were pain (68%), fatigue (63%), and breathing difficulties (60%). Of the symptoms that were treated, parents perceived successful treatment to be least likely for their child's sleep disturbance (24%), depression (29%), and fatigue (35%). Parents who reported their child's functional status as NYHA class III/IV were more likely to report that their child was experiencing 'a great deal' of symptoms, compared with those who reported class I/II (51% vs. 19%, p<0.001). Parents who reported their child was experiencing a high degree of suffering from fatigue were also more likely to report a high symptom burden (P < .001). CONCLUSIONS: Parents of children with AHD reported high symptom burden with a broad spectrum of symptoms. Parents reported fatigue and psychiatric symptoms frequently and rarely reported treatment as successful. Parents' view of their child's symptom burden was concordant with their perception of their child's functional status.
  • Neurosteroid and White Matter Correlates of ADHD and Autism Symptoms in Children with ADHD

    Jean A. Frazier, MD; Eichenberg, Tzeidel B.; Frazier, Jean A. (2021-05-12)
    Background: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder (NDD) characterized by inattention, hyperactivity and impulsivity, whereas autism spectrum disorder (ASD) is an NDD characterized by impaired social functioning and restricted interests and behaviors. These two NDD’s often co-occur in individuals—up to 50% of people with ASD may show significant traits of ADHD and approximately 66% of individuals with ADHD exhibit significant traits of ASD. Co-occurring symptoms of both ASD and ADHD are a risk factor for decreased quality of life in the NDD population, and more research on this intersection is needed to better serve these individuals. Study of sex hormone levels and study of brain white matter (WM) have suggested several key differences in sex hormone profiles and WM tracts among individuals with ASD, ADHD, and comorbid ASD and ADHD. People with ASD generally show higher levels of both testosterone (T) and dehydroepiandrosterone (DHEA) when compared to controls, while boys with ADHD have been shown to have lower levels of DHEA, but similar T levels, when compared with controls. Furthermore, altered sex hormone levels have been correlated with symptom severity in both individuals with ADHD and with ASD. For these reasons and more, DHEA and T are often referred to in the neurodevelopment literature as “neurosteroids.” WM tract alterations are typically investigated using diffusion tensor magnetic resonance imaging (DTI) of the head. The measure used as a proxy for WM tract integrity is fractional anisotropy (FA). Both abnormally high and low FA values have been detected in individuals with ADHD, ASD, or features of both, particularly in the tracts connecting the two cerebral hemispheres, tracts connecting multiple cortical areas, and tracts connecting the cortex and the primitive motor control center. Just as with alterations in sex hormone levels, these alterations in FA values are correlated with both ADHD and ASD symptom severity. Although one study on typically developing pubertal boys showed higher rates of increasing T were correlated with lower FA in a WM tract within the brain’s memory and emotion center, there is a gap in the literature around a potential link between neurosteroids and WM integrity in children with ADHD. Better understanding of neurosteroidal regulation of aberrant WM development in ADHD, and its relationship to both ASD and ADHD symptom severity within this population would contribute to our understanding of the ASD-ADHD intersection. Objectives: The goal of this analysis was to elucidate a relationship between the neurosteroids T and DHEA, and integrity of one or more particular WM tracts in children with ADHD. Methods: Four groups of children ages 9-11 years were compiled from the Adolescent Brain Cognitive Development Study (ABCD) via the National Database for Autism Research—males with ADHD, females with ADHD, TD females, and TD males (n=121 per group). Children with ASD, obsessive compulsive disorder, conduct disorder, and schizophrenia diagnoses were excluded. Groups were matched 1:1 by handedness and age. Groups were mean-matched by Parent Pubertal Development Scale (PDMS) item sum within sex. Group status served as the dependent variable, and the independent variables were mean FA within the 23 WM areas examined by ABCD, prepubertal salivary T concentration, prepubertal salivary DHEA concentration, number of ADHD items endorsed on DSM interview (ADHD symptom severity measure), and Parent Short Social Responsiveness Scale (SRS) sum (autistic trait severity measure). All measures were collected at the ABCD baseline visit, except for the SRS, which was conducted at the 1-year follow-up visit. Statistical analysis included two-way ANOVA’s and unpaired, two-way t-tests. The following Pearson linear regression analyses were also conducted: mean FA of each tract over each hormone, symptom severity (both ASD and ADHD) over mean FA of each tract, and symptom severity (both ASD and ADHD) over each hormone. Results: Subjects with ADHD showed significantly higher autistic traits than TD subjects. There were sex-by-diagnosis interaction effects on two tracts: the left inferior fronto-occipital fasciculus (IFOF) and the left cingulate cingulum (CGC). Both autistic trait severity and ADHD symptom severity were negatively correlated with both DHEA and T in males with ADHD, but not in females with ADHD or in TD subjects. ADHD symptom severity was positively correlated with mean FA in the frontal region of the right superior corticostriate (SCS) among all subjects with ADHD pooled (R=0.14, p=.03), whereas analysis of the females and males with ADHD separately showed a positive trend among females (R=0.15, p=.10) and a negative trend among males (R=-0.12, p=.19). TD males showed a negative correlation between DHEA and mean FA in the left SCS (R=-0.21, p=.02), which was notably absent among males with ADHD. TD females showed a positive correlation between T and mean FA in forceps major (FM) (R=0.27, p<.01), while females with ADHD showed a negative correlation between T and mean FA in FM (R=-0.22, p=.02). Conclusion: These findings reinforce the important role of low levels of DHEA in development of ADHD symptoms in boys, while highlighting that T may be a previously unknown mediator. Furthermore, low DHEA and T may play a more significant role in ADHD symptom development in boys than in girls. While higher levels of DHEA and T are linked to higher severity of autistic traits in the ASD population, these results suggest that lower levels of DHEA and T are correlated with higher autistic trait severity in boys with ADHD. This analysis supports the hypothesis that hormonal influence on ADHD symptom severity may take place via neurosteroidal regulation of development of one or more specific WM tracts, and that the anatomy and pathophysiology of this process may be sex-specific. DHEA’s role in the typical development of cortico-basal-ganglia communication may be suppressed in boys with ADHD. Aberrant regulation of interhemispheric communication development by T may be an important factor in the pathogenesis of ADHD in girls. Additionally, the opposing effects of cortico-basal-ganglia WM integrity on ADHD symptom severity in girls versus boys with ADHD, and the presence of sex-by-diagnosis interaction effects in this analysis further reinforce the hypothesis that WM differences in ADHD differ between boys and girls. This was a cross-sectional analysis of prepubescent and early pubescent subjects, therefore it is important to place any sex differences demonstrated here in the context of longitudinal neurodevelopment literature given the disparity in pubertal timing between the sexes.
  • Clinician Perspectives on the Need for Training and Caring for Pregnant Women with Intellectual and Developmental Disabilities [poster]

    Tiffany A. Moore Simas; Amir, Nili S.; Smith, Lauren; Valentine, Anne M.; Mitra, Monika; Parish, Susan L.; Moore Simas, Tiffany A. (2021-04-15)
    Background: Women with intellectual and developmental disabilities (IDD) experience disparities in obstetric care access and quality, in addition to communication gaps with healthcare providers. Many obstetric providers are untrained and uneducated about critical aspects of providing care to persons with IDD. Objectives: The present study was conducted (1) to describe obstetric clinicians’ training experiences related to providing obstetric care to women with IDD, (2) to assess obstetric clinicians’ perceived need for formalized training, and (3) to identify recommendations for training content and dissemination. Methods: This study involved qualitative individual interviews (n=9) and one focus group (n=8) with obstetric clinicians who self-reported experience caring for women with IDD during pregnancy. Descriptive coding and content analysis techniques were used to develop an iterative codebook related to education and training; codes were applied to the data. Coded data were analyzed for larger themes and relationships. Results: Analysis revealed three main themes: 1. Need for obstetric training and education: No participant reported receiving any training in caring for pregnant women with IDD. Participants expressed a need for formal education. 2. Recommendations for formal training: Participants noted a dearth of clinical practice guidelines, the need for pregnancy-specific training during residency and beyond, and all healthcare staff should be included in training opportunities. 3. Training outcomes should increase knowledge, enhance attitudes, and develop practical skills related to communication and care for pregnant women with IDD. Conclusion: Study results indicate a need for and interest in systematic training efforts regarding obstetric care for women with IDD. Improved training and education may decrease health inequities and improve the quality of obstetric care, and thus pregnancy outcomes, for women with IDD.
  • Response to the influence of teledermatology on health care access and equity

    Mehdi Rashighi, MD; Franciosi, Ellen B.; Tan, Alice J.; Kassamali, Bina; O'Connor, Daniel M.; Rashighi, Medhi; LaChance, Avery (2021-04-01)
    To the Editor: We thank Hadeler and his co-authors for their support of our research and for providing additional context regarding telemedicine's impact on health care access and equity.Although we found that teledermatology services performed during the COVID-19 pandemic benefitted minority and Medicaid patients, Hadeler et al highlight previous survey-based studies from 2011 and 2013 to 2016 that demonstrated these patients were the least likely to utilize telemedicine. We believe there are 2 key factors that likely contributed to the increased appointment attendance among minority and Medicaid patients found in our study reflecting the rapidly evolving landscape of telemedicine. These factors are also notable, as they have implications for future access to telemedicine.
  • Joining the Fight Against the Opioid Epidemic through the Head Start Program in Lowell, MA

    Leanne Winchester, MS RN; Pandya, Aniket N.; Tawadros, Monica; Winchester, Leanne (2021-03-17)
    What is Head Start? Head Start, a federally funded program of the United States Department of Health and Human Services, promotes school readiness and family well-being in children from birth to age five who meet specific criteria. Lowell Head Start Partnership The Lowell Head Start program is engaged in efforts to combat the opioid epidemic after an incident involving an overdose by a parent in the center. To support the Lowell Head Start program, our team forged collaborations with facilities close to Head Start in Lowell by creating informational pamphlets that detail services offered to people with substance use disorders in Lowell. Opioid trends in Lowell Lowell is a very diverse city, with 40% of the population being non-white and 25% being foreign born. Lowell has a highest poverty rate at 19.1%, in the region, a low median household income at $49,164, and a high rate of unemployment according to the 2016 greater Lowell community health needs assessment (CHNA). Opioid overdose death rate in Lowell is 43 fatalities per 100,000 – a rate greater than double the average fatality rate in the state of Massachusetts. Quick overview of project To capitalize on the statewide and local efforts to bring opioid addition out in the open, the presenters created an informational pamphlet as a resource and educational tool for families that seek or are referred for services. Description of many relevant provisional services are expanded upon in the capstone project submission – including detox, hotline and support services, medication management, behavioral health, counseling and relapse tools training. Additionally, the presenters actively forged connections with local community organizations serving those struggling with opioid use disorder. Please see capstone document for additional information regarding specific resources. Conclusions With the significant rise in fatal overdoses in the city of Lowell, many departments and programs have been developed to combat the opioid epidemic. This project aims to provide vital information to the Head Start Program and the families they serve, and to provide established resources available in Lowell, such as medication disposals, Narcan and signs of overdose training, needle drop-off services, available hotlines, and city-wide programs, including Lowell Community Opioid Outreach Programs, MA Opioid Abuse and Prevention Collaborative of Greater Lowell, and Partnerships for Success Program.

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