Recently Published

  • Over Fartsgrensen

    Gracey, Kristina (2024-03-14)
    Introduction: This week I am grateful to Kristina Gracey, faculty at Barre Family Health Center, for her essay that is both personal and informative. She is an avid and successful runner. Which can be dangerous. She has been thinking about this element of risk and adds a public health perspective to her reflection that I personally admire. Food for thought for possible collective advocacy by us all on this topic.
  • Sampling of healthcare professionals' perspective on point-of-care technologies from 2019-2021: A survey of benefits, concerns, and development

    Orwig, Taylor; Sutaria, Shiv; Wang, Ziyue; Howard-Wilson, Sakeina; Dunlap, Denise; Lilly, Craig M; Buchholz, Bryan; McManus, David D; Hafer, Nathaniel (2024-03-08)
    Point-of-care technology (POCT) plays a vital role in modern healthcare by providing a fast diagnosis, improving patient management, and extending healthcare access to remote and resource-limited areas. The objective of this study was to understand how healthcare professionals in the United States perceived POCTs during 2019-2021 to assess the decision-making process of implementing these newer technologies into everyday practice. A 5-point Likert scale survey was sent to respondents to evaluate their perceptions of benefits, concerns, characteristics, and development of point-of-care technologies. The 2021 survey was distributed November 1st, 2021- February 15th, 2022, with a total of 168 independent survey responses received. Of the respondents, 59% identified as male, 73% were white, and 48% have been in practice for over 20 years. The results showed that most agreed that POCTs improve patient management (94%) and improve clinician confidence in decision making (92%). Healthcare professionals were most concerned with potentially not being reimbursed for the cost of the POCT (37%). When asked to rank the top 3 important characteristics of POCT, respondents chose accuracy, ease of use, and availability. It is important to note this survey was conducted during the COVID-19 pandemic. To achieve an even greater representation of healthcare professionals' point of view on POCTs, further work to obtain responses from a larger, more diverse population of providers is needed.
  • Photos of Meaningful Things and Places

    Penumetcha, Venkata "Sai Sri"; Isaac, Tamika; Coderre, Danielle; Silk, Hugh (2024-03-07)
    Introduction: This week I have a visual treat. Last week Sara Shields and I had a session with the PGY1s on the topic of medical humanities and one of the prompts was to go into the hospital and return with a photo of something that is meaningful to you - can be a piece, a thing, a person. The discussion that ensued from these photos was wonderful! I am sharing some of the photos here for you with their title. Enjoy.
  • Adulting Shorts: Let’s Talk About Workplace Accommodations

    Seward, Hannah (2024-02-27)
    Work can be hard! If you have a mental health condition, you might need to ask for an accommodation at work. An accommodation is a change to the way your job is done to allow you to do your job well when you have a disability. This comic by the NIDILRR-funded Learning & Working RRTC shares some real-world experiences young adults with lived experience of mental health conditions when working. For more information about requesting accommodations at work, please read our Accommodations at Work tip sheet.
  • Racial and Ethnic Disparities in Use of Colorectal Cancer Screening Among Adults With Chronic Medical Conditions: BRFSS 2012-2020

    Castañeda-Avila, Maira A; Tisminetzky, Mayra; Oyinbo, Atinuke G; Lapane, Kate L (2024-02-22)
    Introduction: People with chronic conditions and people with colorectal cancer (CRC) may share common risk factors; thus, CRC screening is important for people with chronic conditions. We examined racial and ethnic differences in the use of CRC screening among people with various numbers of chronic conditions. Methods: We included data on adult respondents aged 50 to 75 years from the Behavioral Risk Factor Surveillance System in 2012 through 2020. We categorized counts of 9 conditions as 0, 1, 2, 3, and ≥4. We classified self-reported CRC screening status as up to date or not. We used Poisson models to estimate adjusted prevalence ratios (APRs) among the different counts of chronic conditions in 4 racial and ethnic groups: Hispanic adults with limited English proficiency (LEP), Hispanic adults without LEP, non-Hispanic Black adults, and non-Hispanic White adults. Results: Overall, 66.5% of respondents were up to date with CRC screening. The prevalence of being up to date increased with the number of chronic conditions. We found disparities among racial and ethnic groups. Hispanic respondents with LEP had lower rates than non-Hispanic White adults of being up to date with CRC screening across all counts of chronic conditions (APR for 0 conditions = 0.67; 95% CI, 0.64-0.71; APR for ≥4 conditions = 0.85; 95% CI, 0.79-0.91). Hispanic respondents without LEP with 0, 1, or 2 conditions were less likely than non-Hispanic White respondents to be up to date with CRC screening. We found no significant differences between non-Hispanic Black and non-Hispanic White respondents. Conclusion: We found disparities among Hispanic BRFSS respondents with LEP, who had lower rates than non-Hispanic White respondents of being up to date with CRC screening, regardless of the number of chronic conditions. Tailored interventions are needed to address these disparities and improve screening rates, particularly among Hispanic people.
  • The Greatest Health Care System in the World

    Adelstein, Pamela (2024-02-22)
    Introduction: This week I am sharing with you another piece from Pam Adelstein, a former resident of the Family Health Center of Worcester, and now the Medical Director at Fenway Health. Her piece was written as a reflection on the prompt “cold”. As you can see, she writes about way too many people being left out in the cold in our healthcare system.
  • 2024 Gold Humanism Summit Art Gallery

    Silk, Hugh (2024-02-15)
    Introduction: This week I do not have a local piece to share, per se. However, I am sending you all to explore the 2024 Gold Humanism Summit Art Gallery, which showcases artwork that reflects experiences, creativity and insights from clinicians, trainees, patients, caregivers, and members of the healthcare community. I hope you enjoy this collection of visual art, video, performance, song, poetry, narrative writing, pottery, and more. The entries are from across the country. Represented from UMass are Jennifer Sohn and myself. Jennifer, (who worked with me during her LPP,) did a lovely drawing entitled, "the same on the inside". She wrote - I drew this during my second year of medical school after working for several months with local community members experiencing homelessness. I was struck by the way people tend to see unhoused individuals as intrinsically different from themselves. I wanted to emphasize that we are all human and feel joy and sadness in the same ways, no matter what our lived experiences may include. Mine is a poem entitled, Brief Advice to a Young Doctor. You can find them and many more incredible offerings here: https://www.gold-foundation.org/programs/2024-gold-humanism-summit/2024-gold-humanism-summit-art-gallery/
  • Examining Race-Based and Gender-Based Discrimination, Trust in Providers, and Mental Well-Being Among Black Women

    Cuffee, Yendelela L; Preston, Portia A Jackson; Akuley, Suzanne; Jaffe, Rachel; Person, Sharina D.; Allison, Jeroan J. (2024-02-12)
    Objectives: To examine experiences of discrimination among Black women, and to determine if experiencing race- and gender-based discrimination is associated with mental well-being and trust. Methods: Data from the TRUST study were used to examine experiences of discrimination among 559 Black women with hypertension receiving healthcare at a safety-net hospital in Birmingham, Alabama. A three-level variable was constructed to combine the race-based and gender-based measures of the Experiences of Discrimination scale. Linear regression was used to examine the association between experiences of discrimination with mental well-being and trust. Results: Women who reported no experiences of race- or gender-based discrimination were older and reported higher mental well-being scores and greater trust. Fifty-three percent of study participants reported experiencing discrimination. Compared to participants who did not experience race- or gender-based discrimination, participants reporting experiences of race- or gender-based discrimination and those reporting experiencing both race- and gender-based discrimination were more likely to report poorer mental health. Conclusion: Reported experiences of gender- and/or race-based discrimination in this study were associated with lower mental health scores and less trust in health care providers. Our findings highlight the importance of examining experiences of discrimination among Black women, and the role of discrimination as a stressor and in reducing trust for providers. Incorporating an understanding and acknowledgement of experiences of discrimination into interventions, programs, and during clinical encounters may foster more trusting relationships between providers and patients.
  • Randomized-controlled trial of anakinra plus zinc vs. prednisone for severe alcohol-associated hepatitis

    Gawrieh, Samer; Dasarathy, Srinivasan; Tu, Wanzhu; Kamath, Patrick S; Chalasani, Naga P; McClain, Craig J; Bataller, Ramon; Szabo, Gyongyi; Tang, Qing; Radaeva, Svetlana; et al. (2024-02-09)
    Background & aims: Severe alcohol-associated hepatitis (SAH) has high 90-day mortality. Glucocorticoid therapy for 28 days improves 30- but not 90-day survival. We assessed the efficacy and safety of a combination of anakinra, an IL-1 antagonist, plus zinc (A+Z) compared to prednisone (PRED) using the Day-7 Lille score as a stopping rule in patients with SAH. Methods: In this phase IIb double-blind randomized trial in adults with SAH and MELD scores 20-35, participants were randomized to receive either anakinra 100 mg subcutaneously daily for 14 days plus zinc sulfate 220 mg orally daily for 90 days or daily prednisone 40 mg orally for 30 days. Prednisone or prednisone placebo was stopped if Day-7 Lille score was >0.45. All study drugs were stopped for uncontrolled infection or ≥ 5 points increase in MELD score. The primary endpoint was overall survival at 90 days compared using a two-sided log-rank test. Results: Seventy-three participants were randomized to PRED and 74 to A+Z. The trial was stopped early after a prespecified interim analysis showed PRED had higher 90-day overall survival (90% vs 70%, HR for death =0.34, 95% CI [0.14, 0.83], P =0.018) and transplant-free survival (88% vs 64%, HR for transplant or death =0.30, 95% CI: [0.13, 0.69], P =0.004) than A+Z. Acute kidney injury was more frequent with A+Z (45%) than PRED (22%) (P = 0.001), but rates of infections were similar (31% in A+Z vs 27% in PRED, P =0.389). Conclusions: Participants with SAH treated with prednisone using the Day-7 Lille score as a stopping rule had significantly higher overall and transplant-free 90-day survival and lower incidence of acute kidney injury than those treated with A+Z. Trial registration: NCT04072822. Impact and implications: There is no approved treatment for severe alcohol-associated hepatitis (SAH). In this double-blind randomized trial, patients with SAH treated with prednisone using the Lille stopping rule on Day-7 had higher 90-day overall and transplant-free survival and lower rate of acute kidney injury compared to patients treated with a combination of anakinra and zinc. The data support continued use of glucocorticoids for patients with SAH, with treatment discontinuation for those with Lille score > 0.45 on Day-7.
  • Effects of intervention stage completion in an integrated behavioral health and primary care randomized pragmatic intervention trial [preprint]

    Stephens, Kari A; van Eeghen, Constance; Zheng, Zihan; Anastas, Tracy; Ma, Kris Pui Kwan; Prado, Maria G; Clifton, Jessica; Rose, Gail; Mullin, Daniel J; Chan, Kwun C G; et al. (2024-02-08)
    Purpose: A pragmatic, cluster-randomized controlled trial of a comprehensive practice-level, multi-staged practice transformation intervention aimed to increase behavioral health integration in primary care practices and improve patient outcomes. We examined association between the completion of intervention stages and patient outcomes across a heterogenous national sample of primary care practices. Methods: Forty-two primary care practices across the U.S. with co-located behavioral health and 2,426 patients with multiple chronic medical and behavioral health conditions completed surveys at baseline, midpoint and two year follow-up. Effects of the intervention on patient health and primary care integration outcomes were examined using multilevel mixed-effects models, while controlling for baseline outcome measurements. Results: No differences were found associated with the number of intervention stages completed in patient health outcomes were found for depression, anxiety, fatigue, sleep disturbance, pain, pain interference, social function, patient satisfaction with care or medication adherence. The completion of each intervention stage was associated with increases in Practice Integration Profile (PIP) domain scores and were confirmed with modeling using multiple imputation for: Workflow 3.5 (95% CI: 0.9-6.1), Integration Methods 4.6 (95% CI: 1.5-7.6), Patient Identification 2.9 (95% CI: 0.9-5.0), and Total Integration 2.7 (95% CI: 0.7-4.7). Conclusion: A practice-centric flexible practice transformation intervention improved integration of behavioral health in primary care across heterogenous primary care practices treating patients with multiple chronic conditions. Interventions that allow practices to flexibly improve care have potential to help complex patient populations. Future research is needed to determine how to best target patient health outcomes at a population level.
  • What Still I Rise Means to Me

    Street, Ashley; Mbusa, Daniel (2024-02-08)
    Introduction: As we reflect on Black History Month, honoring the contributions, triumphs, and struggles of African Americans throughout our history, this is a timely submission. Ashley Street and Daniel Mbusa, who are both starting medical school in the fall (congratulations!), are participating in the Scribe Fellowship/PRISM’s academic enrichment sessions coordinated by Linda Cragin and Dr. Mariann Manno. During a recent session on Reflective Medicine with Dr. Bronwyn Cooper, they all discussed Maya Angelo’s poem, Still I Rise (https://www.poetryfoundation.org/poems/46446/still-i-rise). Daniel and Ashley share what this poem means to them. On a personal note, my wife and I saw Maya Angelou speak when we were in our informative years and were so moved, we gave our youngest daughter her name as a middle name. Her words are a powerful reminder of what many endure and overcome. The words below are inspiring as the next generation learns from Maya's message and prepares for their own path forward. Our future is bright with physicians like them – we wish them well.
  • The contextual interview: a cross-cutting patient-interviewing approach for social context

    Cahill, Amber; Martin, Matthew; Beachy, Bridget; Bauman, David; Howard-Young, Jordan (2024-02-06)
    Patient interviewing pedagogy in medical education has not evolved to comprehensively capture the biopsychosocial model of healthcare delivery. While gathering a patient's social history targets important aspects of social context it does not adequately capture and account for the real-time reassessment required to understand evolving factors that influence exposure to drivers of health inequities, social determinants of health, and access to supports that promote health. The authors offer a patient interviewing approach called the Contextual Interview (CI) that specifically targets dynamic and ever-changing social context information. To substantiate the use of the CI in medical education, the authors conducted a qualitative review of the Accreditation Council for Graduate Medical Education Milestones for primary care specialties (Family Medicine, Internal Medicine, and Pediatrics). Milestones were coded to the extent to which they reflected the learner's need to acknowledge, assess, synthesize and/or apply patient contextual data in real-time patient encounters. Approximately 1 in 5 milestones met the context-related and patient-facing criteria. This milestone review further highlights the need for more intentional training in eliciting meaningful social context data during patient interviewing. The CI as a cross-cutting, practical, time-conscious, and semi-structured patient interviewing approach that deliberately elicits information to improve the clinician's sense and understanding of a patient's social context. The authors reviewed future directions in researching adapted versions of the CI for undergraduate and graduate medical education.
  • UMCCTS Newsletter, February 2024

    UMass Center for Clinical and Translational Science (2024-02-01)
    This is the February 2024 issue of the UMass Center for Clinical and Translational Science Newsletter containing news and events of interest.
  • No wrong of their own

    Yalakkishettar, Pratiksha (2024-02-01)
    Introduction: This week I share with you a poem from Pratiksha Yalakkishettar, a former family medicine resident at Hahnemann Family Health Center and current Preventive Medicine resident. She says this is "a piece I wrote recently reflecting on an incident on L&D from a few years ago during FM residency where a mother was going to be separated from her child after discharge." There is nothing as overwhelming in life as being separated from a loved one and even worse when it is a child. Pratiksha captures the moment from the clinician's perspective.
  • Association of spatial proximity to fixed-site syringe services programs with HCV serostatus and injection equipment sharing practices among people who inject drugs in rural New England, United States

    Romo, Eric; Stopka, Thomas J; Jesdale, Bill M; Wang, Bo; Mazor, Kathleen M; Friedmann, Peter D (2024-01-28)
    Background: Hepatitis C virus (HCV) disproportionately affects rural communities, where health services are geographically dispersed. It remains unknown whether proximity to a syringe services program (SSP) is associated with HCV infection among rural people who inject drugs (PWID). Methods: Data are from a cross-sectional sample of adults who reported injecting drugs in the past 30 days recruited from rural counties in New Hampshire, Vermont, and Massachusetts (2018-2019). We calculated the road network distance between each participant's address and the nearest fixed-site SSP, categorized as ≤ 1 mile, 1-3 miles, 3-10 miles, and > 10 miles. Staff performed HCV antibody tests and a survey assessed past 30-day injection equipment sharing practices: borrowing used syringes, borrowing other used injection equipment, and backloading. Mixed effects modified Poisson regression estimated prevalence ratios (aPR) and 95% confidence intervals (95% CI). Analyses were also stratified by means of transportation. Results: Among 330 PWID, 25% lived ≤ 1 mile of the nearest SSP, 17% lived 1-3 miles of an SSP, 12% lived 3-10 miles of an SSP, and 46% lived > 10 miles from an SSP. In multivariable models, compared to PWID who lived within 1 mile of an SSP, those who lived 3 to 10 miles away had a higher prevalence of HCV seropositivity (aPR: 1.25, 95% CI 1.06-1.46), borrowing other used injection equipment (aPR: 1.23, 95% CI 1.04-1.46), and backloading (aPR: 1.48, 95% CI 1.17-1.88). Similar results were observed for PWID living > 10 miles from an SSP: aPR [HCV]: 1.19, 95% CI 1.01-1.40; aPR [borrowing other used equipment]:1.45, 95% CI 1.29-1.63; and aPR [backloading]: 1.59, 95% CI 1.13-2.24. Associations between living 1 to 3 miles of an SSP and each outcome did not reach statistical significance. When stratified by means of transportation, associations between distance to SSP and each outcome (except borrowing other used injection equipment) were only observed among PWID who traveled by other means (versus traveled by automobile). Conclusions: Among PWID in rural New England, living farther from a fixed-site SSP was associated with a higher prevalence of HCV seropositivity, borrowing other used injection equipment, and backloading, reinforcing the need to increase SSP accessibility in rural areas. Means of transportation may modify this relationship.
  • Investigating the etiologies of non-malarial febrile illness in Senegal using metagenomic sequencing

    Levine, Zoë C; Sene, Aita; Mkandawire, Winnie; Deme, Awa B; Ndiaye, Tolla; Sy, Mouhamad; Gaye, Amy; Diedhiou, Younouss; Mbaye, Amadou M; Ndiaye, Ibrahima M; et al. (2024-01-25)
    The worldwide decline in malaria incidence is revealing the extensive burden of non-malarial febrile illness (NMFI), which remains poorly understood and difficult to diagnose. To characterize NMFI in Senegal, we collected venous blood and clinical metadata in a cross-sectional study of febrile patients and healthy controls in a low malaria burden area. Using 16S and untargeted sequencing, we detected viral, bacterial, or eukaryotic pathogens in 23% (38/163) of NMFI cases. Bacteria were the most common, with relapsing fever Borrelia and spotted fever Rickettsia found in 15.5% and 3.8% of cases, respectively. Four viral pathogens were found in a total of 7 febrile cases (3.5%). Sequencing also detected undiagnosed Plasmodium, including one putative P. ovale infection. We developed a logistic regression model that can distinguish Borrelia from NMFIs with similar presentation based on symptoms and vital signs (F1 score: 0.823). These results highlight the challenge and importance of improved diagnostics, especially for Borrelia, to support diagnosis and surveillance.
  • Strengthening Quality Measurement to Predict Success for Total Knee Arthroplasty: Results from a Nationally Representative Total Knee Arthroplasty Cohort

    Zheng, Hua; Ash, Arlene S.; Yang, Wenyun; Liu, Shao-Hsien; Allison, Jeroan J.; Ayers, David C (2024-01-25)
    Background: When performed well on appropriate patients, total knee arthroplasty (TKA) can dramatically improve quality of life. Patient-reported outcome measures (PROMs) are increasingly used to measure outcome following TKA. Accurate prediction of improvement in PROMs after TKA potentially plays an important role in judging the surgical quality of the health-care institutions as well as informing preoperative shared decision-making. Starting in 2027, the U.S. Centers for Medicare & Medicaid Services (CMS) will begin mandating PROM reporting to assess the quality of TKAs. Methods: Using data from a national cohort of patients undergoing primary unilateral TKA, we developed an original model that closely followed a CMS-proposed measure to predict success, defined as achieving substantial clinical benefit, specifically at least a 20-point improvement on the Knee injury and Osteoarthritis Outcome Score, Joint Arthroplasty (KOOS, JR) at 1 year, and an enhanced model with just 1 additional predictor: the baseline KOOS, JR. We evaluated each model's performance using the area under the receiver operator characteristic curve (AUC) and the ratio of observed to expected (model-predicted) outcomes (O:E ratio). Results: We studied 5,958 patients with a mean age of 67 years; 63% were women, 93% were White, and 87% were overweight or obese. Adding the baseline KOOS, JR improved the AUC from 0.58 to 0.73. Ninety-four percent of those in the top decile of predicted probability of success under the enhanced model achieved success, compared with 34% in its bottom decile. Analogous numbers for the original model were less discriminating: 77% compared with 57%. Only the enhanced model predicted success accurately across the spectrum of baseline scores. The findings were virtually identical when we replicated these analyses on only patients ≥65 years of age. Conclusions: Adding a baseline knee-specific PROM score to a quality measurement model in a nationally representative cohort dramatically improved its predictive power, eliminating ceiling and floor effects and mispredictions for readily identifiable patient subgroups. The enhanced model neither favors nor discourages care for those with greater knee dysfunction and requires no new data collection. Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
  • Microaggressions and resiliency during residency: creating more inclusive environments based on a true experience during residency

    Biggers, Alana; Binder, Ashley; Gerber, Ben S (2024-01-25)
    Microaggressions are ubiquitous in residency programs. Microaggressions are “brief, everyday exchanges that send denigrating messages to certain individuals because of their group membership.” Though race/ethnicity is often considered the target of microaggressions, they can also be aimed at a person’s gender, sexual orientation, religion, or other marginalized status. All microaggressions are particularly harmful in medicine and can interfere with patient care and the professional interactions and development of resident physicians.
  • Multifocal emphysematous osteomyelitis, a do not miss diagnosis for the emergency radiologist: a case report with literature review

    Saha, Debajyoti; Tai, Ryan; Kapare, Vaishali; Joshi, Ganesh (2024-01-25)
    Emphysematous osteomyelitis (EO) is an uncommon fatal condition with high morbidity and mortality. Simultaneous involvement of the axial and appendicular skeleton with multifocal disease is even rarer, with only a few cases being reported in the literature. We present a case of multifocal emphysematous osteomyelitis in a 56-year-old woman with concurrent emphysematous pyelonephritis complicated by psoas and epidural abscesses. The causative organism in our patient was Escherichia coli. Emergency radiologists should be aware of this condition and differentiate it from other benign entities that can present with intraosseous gas. Prompt diagnosis is important given the high morbidity and mortality with this condition. This case report emphasizes the specific pattern of intraosseous gas seen with EO, which can help diagnose EO with confidence.
  • Dementia

    Gussak, Lisa S. (2024-01-25)
    Introduction: This week I am delighted to include a visual reflection. It's not often that we do that with FMM. Thank you to Lisa Gussak who is a faculty member in our department, the director of the center for clinical communication and professionalism, and an avid photographer. She often finds things in nature that reminds her of medical conditions or findings. For this image, she writes the following: It’s called Dementia, and this is what I’ve written about it: I have a dear friend who is just one day older than me. For many years we toasted to our growing maturity with a night out in late December. Roughly three years ago, she was diagnosed with Alzheimer's. I no longer want to celebrate our aging, a potent reminder of the changes in her thinking, in our conversation, what we laugh about. I want to freeze her mind, just as it is, while she knows me and smiles at our shared memories.

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