Now showing items 1-20 of 31

    • Approach to Stereotactic Body Radiotherapy for the Treatment of Advanced Hepatocellular Carcinoma in Patients with Child-Pugh B-7 Cirrhosis

      Daniell, Kayla M; Banson, Kara Micah; Diamond, Brett H; Sioshansi, Shirin (2022-11-05)
      Patients with hepatocellular carcinoma (HCC) with underlying Child-Pugh B-7 cirrhosis benefit from management from an experienced, multidisciplinary team. In patients with localized disease who meet criteria for liver transplant, establishing care at a liver transplant center is crucial. For those awaiting transplant, local bridge therapies have emerged as a strategy to maintain priority status and eligibility. Multiple liver-directed therapies exist to provide locoregional tumor control. The careful selection of locoregional therapy is a multidisciplinary endeavor that takes into account patient factors including tumor resectability, underlying liver function, performance status, previous treatment, tumor location/size, and vascular anatomy to determine the optimal management strategy. Technological advances in external beam radiation therapy have allowed stereotactic body radiation therapy (SBRT) to emerge in recent years as a versatile and highly effective bridge therapy consisting of typically between 3 and 5 high dose, highly focused, and non-invasive radiation treatments. When treating cirrhotic patients with HCC, preserving liver function is of utmost importance to prevent clinical decline and decompensation. SBRT has been shown to be both safe and effective in carefully selected patients with Child-Pugh B cirrhosis; however, care must be taken to prevent radiation-induced liver disease. This review summarizes the evolving role of SBRT in the treatment of HCC in patients with Child-Pugh B-7 cirrhosis.
    • Lost in Transition: The Journey from Pediatric to Adult Care for Youth with Mental Health Conditions

      Hugunin, Julie; Skehan, Brian M. (2022-10-07)
      Nearly one out of three (30.6%) young adults (18–25 years) experience mental illness (NIMH). In the United States suicide is the third leading cause of death for young people. Transition age youth (16–25 years) with mental health conditions such as mood disorders, anxiety disorders, and psychotic disorders, experience substantial adversity during the shift from pediatric to adult health care. Research by our team has shown that youth with mental health conditions utilize less outpatient care as they emerge into adulthood. These results echo the American Psychiatric Association position statement that transition age youth are “underserved in current mental health systems”. Understanding provider perspectives to caring for this unique patient population may help to increase health care utilization and quality of care for transition age youth with mental health conditions. This product offers providers real-world tips on what they can do to help and advocate for based on our work.
    • 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.
    • Cancer; Pathophysiology and Stress Modulation (Cancer, Therapeutic Interventions)

      Scarpetti, Lauren; Guarino, Matthew; Baima, Jennifer (2022-08-19)
      Objective: The purpose of this review is to describe the myriad complications of cancer and its therapies to emphasize the pathophysiological need for prehabilitation. Data sources: The information presented in this review is from applicable, peer-reviewed scientific articles. Conclusion: Cancer itself renders negative effects on the body, most notably unintentional weight loss and fatigue. Cancer treatments, especially surgical interventions, can cause detrimental short- and long-term impacts on patients, which translate to suboptimal treatment outcomes. Prehabilitation can be used to improve patient health prior to anticancer therapies to improve treatment tolerance and efficacy. Implications for nursing practice: Nurses play an important role in the treatment of patients with cancer throughout the cancer care continuum. Many nurses are already aiding their patients in cancer prehabilitation through education. By describing common impairments amenable to multimodal prehabilitation, nurses may better advocate for their patients and can become even more involved in this aspect of care.
    • Video and In-Person Palliative Care Delivery Challenges before and during the COVID-19 Pandemic

      Chua, Isaac S; Olmsted, Molly; Plotke, Rachel; Turk, Yael; Trotter, Chardria; Rinaldi, Simone; Kamdar, Mihir; Jackson, Vicki A; Gallagher-Medeiros, Emily R; El-Jawahri, Areej; et al. (2022-08-17)
      Context: Palliative care (PC) clinicians faced many challenges delivering outpatient care during the coronavirus-19 (COVID-19) pandemic. Objectives: We described trends for in-person and video visit PC delivery challenges before and during the COVID-19 pandemic in the U.S. Methods: We performed a secondary data analysis of patient characteristics and PC clinician surveys from a multisite randomized controlled trial at 20 academic cancer centers. Patients newly diagnosed with advanced lung cancer (N = 653) were randomly assigned to receive either early in-person or telehealth PC and had at least monthly PC clinician visits. PC clinicians completed surveys documenting PC delivery challenges after each encounter. We categorized patients into 3 subgroups according to their PC visit dates relative to the onset of the COVID-19 pandemic in the U.S.-pre-COVID-19 (all visits before March 1, 2020), pre/post-COVID-19 (≥1 visit before and after March 1, 2020), and post-COVID-19 (all visits after March 1, 2020). We performed Pearson's chi-squared, Fisher's exact, and Kruskal-Wallis tests to examine associations. Results: We analyzed 2329 surveys for video visits and 2176 surveys for in-person visits. For video visits, the pre-COVID-19 subgroup (25.8% [46/178]) had the most technical difficulties followed by the pre/post-COVID-19 subgroup (17.2% [307/1784]) and then the post-COVID-19 subgroup (11.4% [42/367]) (P = 0.0001). For in-person visits, challenges related to absent patients' family members occurred most often in the post-COVID-19 subgroup (6.2% [16/259]) followed by the pre/post-COVID-19 subgroup (3.6% [50/1374]) and then the pre-COVID-19 subgroup (2.2% [12/543]) (P = 0.02). Conclusion: Technical difficulties related to PC video visits improved, whereas in-person visit challenges related to absent patients' family members worsened during the pandemic.
    • 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.
    • Cancer Prehabilitation in Practice: the Current Evidence

      Coderre, Danielle; Brahmbhatt, Priya; Hunter, Tracey Louise; Baima, Jennifer (2022-07-05)
      Purpose of Review This article serves to describe recent controversies in cancer prehabilitation including efficacy, dose, cost effectiveness, stakeholder input, and international implementation. Recent Findings Appropriate frequency, type, and timing have yet to be determined, but high intensity exercise is recommended. Costs are favorable when modeled and information on costs of real-world application are forthcoming. Patients are interested in and willing to attend cancer prehabilitation. Cancer prehabilitation research is spreading throughout the world. Summary Cancer prehabilitation includes assessment of a newly diagnosed cancer patient’s baseline fitness and targeted interventions to improve their health before surgery, chemotherapy, or radiation. Cancer prehabilitation improves fitness as measured preoperatively and improves outcomes postoperatively.
    • Perspectives on addressing bipolar disorder in the obstetric setting

      Masters, Grace A; Xu, Lulu; Cooper, Katherine M; Moore Simas, Tiffany A; Brenckle, Linda; Mackie, Thomas I; Schaefer, Ana J; Straus, John; Byatt, Nancy (2022-05-25)
      Objective: Perinatal Psychiatry Access Programs have emerged to help obstetric professionals meet the needs of perinatal individuals with mental health conditions, including bipolar disorder (BD). We elucidate obstetric professionals' perspectives on barriers and facilitators to managing BD in perinatal patients, and how Access Programs may affect these processes. Methods: We conducted three focus groups with obstetric professionals, two with- and one without-exposure to an Access Program, the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. Focus groups discussed experiences, barriers, facilitators, and solutions to caring for perinatal individuals with BD. Qualitative data were coded and analyzed by two independent coders; emergent themes were examined across exposure groups. Results: Thirty-one obstetric professionals (7 without-exposure, 24 with-exposure) participated. Identified themes included: (1) gaps in perinatal BD education; (2) challenges in patient assessment; (3) MCPAP for Moms as a facilitator for addressing BD; and (4) importance of continued outreach and destigmaization to increase care collaboration. Conclusions: Barriers to obstetric professionals accessing adequate mental healthcare for their patients with BD abound. With psychiatric supports in place, it is possible to build obstetric professionals' capacity to address BD. Perinatal Psychiatry Access Programs can facilitate obstetric professionals bridging these gaps in mental health care.
    • Morbidity and mortality of fragility proximal humerus fractures: a retrospective cohort study of patients presenting to a level one trauma center

      Curtin, Patrick B; Hall, Robert R; Molla, Vadim G; Lansbury, Jenna N; O'Connor, Edward P; Aaron, Daniel L (2022-04-21)
      Purpose: Fragility fractures are a significant source of morbidity and have high associated mortality. Identifying risk factors for poor outcomes is essential for guiding treatment and for setting expectations for patients and their families. Although fragility hip fractures have been abundantly explored, there is a paucity of information regarding proximal humerus fractures (PHFs). Methods: We retrospectively review the electronic medical records of 379 patients who presented to a level 1 trauma center with a PHF secondary to a fall. Patient demographics, handedness, comorbidities, treatment, imaging data, follow-up data, and death date (if applicable) were recorded. Results: Our cohort consisted of 279 females and 100 males with an average age of 71.4 years. Distribution of injuries was 178 left, 141 right, and 7 bilateral. Compared with handedness, 179 were ipsilateral, 141 were contralateral, and 59 were unknown. A total of 81.3% of injuries were treated nonoperatively, whereas 18.7% were managed surgically. One-year mortality was 17.4%, and 2-year mortality was 24.0%.Males demonstrated a 2.28 increased risk of 1-year mortality (P = .004). Patients who died within 1 year of fracture had significantly higher Charlson comorbidity index scores (P < .0001) and age (P = .0003). Risk of death was significantly lower in patients who underwent surgery compared with those who were treated nonoperatively (P = .01). Patients who used an assist device before fracture had 4.2 increased risk of 1-year mortality (P < .0001). Patients who presented from nursing homes or assisted living had a 2.1 increased risk of 1-year mortality (P = .02). Patients with severe liver disease had a 5.5 increased risk of 1-year mortality (P < .0001), and those with metastatic cancer had a 13.7 increased risk of 1-year mortality (P < .0001). Bilateral fractures, side of injury in relation to handedness, rehospitalization, Neer classification, and PCP follow-up within 30 days were not associated with increased mortality. Conclusions: Increased understanding risk factors for mortality after PHF will allow for more informed patient discussions regarding treatment outcomes and risk of death. Our data suggest that mortality at 1 year for fragility PHF is universally high regardless of risk factors. This risk is increased in patients who are older, functionally limited, or who have medical comorbidities. Our data demonstrate the importance of medical optimization of patients with a fragility PHF and underscore the importance of fall prevention in high-risk patients.
    • Information scarcity among otolaryngology applicants: A review of the largest database of programs

      Roychowdhury, Prithwijit; Wu, Matthew James; Kozin, Elliott Davin; Remenschneider, Aaron K.; Gray, Stacey Tutt (2022-03-29)
      Objective: Otolaryngology residency applicants face challenges finding accurate information about training programs. Social media platforms are not verified, and official training program websites are not standardized. Currently, the American Medical Association's Fellowship and Residency Electronic Interactive Database (FREIDA) is the most comprehensive sanctioned and verified otolaryngology residency program database. However, the exact amount of information shared by individual programs included is not presently known. Methods: Herein, we analyzed the available data on all 124 otolaryngology residency programs in FREIDA to assess the completeness of the database. Results: While every program listed an address, contact email, and the name of the program director, more than half of programs (n = 65, 52.4%) did not provide additional information. Most programs (70.2%) did not include a one-paragraph program description. Conclusion: Our findings suggest that while FREIDA is the only sanctioned online database for residency programs, it is inadequately populated with detailed program information. Level of evidence: N/A.
    • Online health information seeking, low atrial fibrillation-related quality of life, and high perceived efficacy in patient-physician interactions in older adults with atrial fibrillation

      Mehawej, Jordy; Mishra, Ajay; Saczynski, Jane S; Waring, Molly E; Lessard, Darleen; Abu, Hawa O; La, Vincent; Tisminetzky, Mayra; Tran, Khanh-Van; Hariri, Essa; et al. (2022-03-11)
      Background: Little is known about online health information-seeking behavior among older adults with atrial fibrillation (AF) and its association with self-reported outcomes. Objective: To examine patient characteristics associated with online health information seeking and the association between information seeking and low AF-related quality of life and high perceived efficacy in patient-physician interaction. Methods: We used data from the SAGE-AF (Systematic Assessment of Geriatric Elements in AF) study, which includes older participants aged ≥65 years with AF and a CHA2DS2-VASc risk score ≥2. To assess online health information seeking, participants who reported using the Internet were asked at baseline if they used the Internet to search for advice or information about their health in the past 4 weeks (not at all vs at least once). Atrial Fibrillation Effect on Quality of Life and Perceived Efficacy in Patient-Physician Interactions questionnaires were used to examine AF-related quality of life (QOL) and patient-reported confidence in physicians. Logistic regression models were used to examine demographic and clinical factors associated with online health information seeking and associations between information seeking and low AF-related QOL (AFEQT <80) and high perceived efficacy for patient-physician interactions (PEPPI ≥45). Results: A total of 874 online participants (mean age 74.5 years, 51% male, 91% non-Hispanic White) were studied. Approximately 60% of participants sought health information online. Participants aged 74 years or older and those on anticoagulation were less likely, while those with a college degree were more likely, to seek online health information after adjusting for potential confounders. Participants who sought health information online, compared to those who did not, were significantly more likely to have a low AF-related QOL, but less likely to self-report confidence in patient-physician interaction (aOR = 1.56, 95% CI: 1.15-2.13; aOR = 0.68, 95% CI: 0.49-0.93, respectively). Conclusion: Clinicians should consider barriers to patient-physician interaction in older adults who seek health information online, encourage shared decision-making, and provide patients with a list of online resources for AF in addition to disease education plans to help patients manage their health.
    • 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.
    • 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. (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).
    • 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.
    • 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. (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.
    • 2020 Hindsight

      Wada-Gill, Bronwyn; Hansen, Megan (2021-01-21)
      Bronwyn Wada-Gill and Megan Hansen, University of Massachusetts Medical School (UMMS) students in the Class of 2022, solicited creative works to commemorate the year 2020 through looking back. The 2020 Hindsight website explores the words, music, and photography that came from the collective hearts of the UMMS community.
    • Using Multisensory Haptic Integration to Improve Monitoring in the Intensive Care Unit

      Burdick, Kendall J.; Bell, Abigail S.; McCoy, Mary C.; Samuels, Jonathan L.; Jolly, Alex S.; Patal, Seema S.; Balas, Julia B.; Patten, K. Jakob; Schlesginer, Joseph J. (2020-06-04)
      Introduction: Alarm fatigue and medical alarm mismanagement reduces the quality of patient care and creates stressful work environments for clinicians. Here, the feasibility of a novel “prealarm” system that utilizes multisensory integration of auditory and haptic stimuli is examined as a possible solution. Methods: Three vital signs (heart rate, blood pressure, and blood oxygenation) were represented by three musically distinct sounds that were combined into soundscapes and progressed through five pre-alarm zones (very low to very high). Three haptic conditions were tested with the auditory stimulus to determine the best combination of auditory and haptic stimulation. Qualitative data was collected through surveys and the NASA TLX index Results: Alterations in frequency and timbre were most effective at transmitting information regarding changing vital sign zones with comparatively higher accuracy and quicker reaction time (RT), p < .01. The addition of haptic stimuli to the auditory soundscape caused no significant decline in study participant accuracy or RT. However, two weeks after training, participants performed the tasks significantly faster ( p < .001) and felt the alarm monitoring task was significantly less cognitively demanding ( p < .01), compared to the unisensory condition. Participants also felt more confident in identifying changing vital signs with the addition of haptic stimuli. Discussion: The current study demonstrates that multisensory signals do not diminish the perception of transmitted information and suggest efficient training benefits over unimodal signals. Multisensory training may be beneficial over time compared to unisensory training due to a stronger consolidation effect. The potential integration of haptic input with existing auditory alarm systems and training is supported.
    • Sleeping Soundlessly in the Intensive Care Unit

      Burdick, Kendall J.; Callahan, Christine J. (2020-03-01)
      An estimated 70% of patients who have been in the Intensive Care Unit (ICU) experience some form of Post-Intensive Care Syndrome (PICS). As a stressful environment, the ICU can be traumatic for any patient; however, the disruption of sleep experienced by patients in ICU negatively impacts their mental status and recovery. One of the most significant contributors to sleep disruption is the constant blare of monitor alarms, many of which are false or redundant. Through multisensory approaches and procedural redesign, the hostile acoustic environment of the ICU that causes so many to suffer from PICS may be alleviated. In this paper, we present suggestions for improving the ICU acoustic environment to possibly reduce the incidence of post-ICU complications such as PICS.
    • SAVIOR ICU: sonification and vibrotactile interface for the operating room and intensive care unit

      Burdick, Kendall J.; Jorgensen, Seiver K.; Combs, Taylor N.; Holmberg, Megan O.; Kultgen, Samantha P.; Schlesinger, Joseph J. (2019-08-27)
      Alarm fatigue is an issue for healthcare providers in the intensive care unit, and may result from desensitization of overbearing and under-informing alarms. To directly increase the overall identification of medical alarms and potentially contribute to a downstream decrease in the prevalence of alarm fatigue, we propose advancing alarm sonification by combining auditory and tactile stimuli to create a multisensory alarm. Participants completed four trials-two multisensory (auditory and tactile) and two unisensory (auditory). Analysis compared the unisensory trials to the multisensory trials based on the percentage of correctly identified point of change, direction of change and identity of three physiological parameters (indicated by different instruments): heart rate (drums), blood pressure (piano), blood oxygenation (guitar). A repeated-measures of ANOVA yielded a significant improvement in performance for the multisensory group compared to the unisensory group (p < 0.05). Specifically, the multisensory group had better performance in correctly identifying parameter (p < 0.05) and point of change (p < 0.05) compared to the unisensory group. Participants demonstrated a higher accuracy of identification with the use of multisensory alarms. Therefore, multisensory alarms may relieve the auditory burden of the medical environment and increase the overall quality of care and patient safety.
    • This Is My Body

      Norman, Kathryn E. (2018-08-07)
      In this narrative medicine essay, a medical student is reminded of Communion service at her New England Protestant church when she sees the beauty of the human anatomy in a cadaver, a former teacher who offered her body as the ultimate teaching moment, in an echo of Jesus’ words at the Last Supper: “This is my body, broken for you. Do this in memory of me.”