Table of Contents

Message from the Chair

Upcoming Events

Focus of the Week - Education

Announcements

Presentations & Publications

Department Member Recognition

Frankly Speaking Podcast

Message from the Chair

Happy New Year to all! Hoping everyone was able to enjoy time with friends and family over the holidays.

Two updates to keep everyone informed:

• The “Tridemic” of Flu, RSV and COVID continues to stress all hospitals in New England, especially those that are safety net providers. At UMMH, RSV rates have come down dramatically, with about 1-2% test positivity, and only about 2 patients/day admitted to the Children’s Hospital. Flu continues with a current positivity rate of 9.6%, though this is down slightly from last week. And we have seen a surge of COVID among patients (daily census 60-70 inpatients) and caregivers. The rolling average of employees out due to COVID is 25-30/day, so please be vigilant.
• Capacity Crisis-The inpatient capacity crisis shows no signs of improving. The daily ‘bed deficit’ (patients admitted awaiting a bed) at the medical center continues to exceed 100. This morning,126 patients awaited a med-surge bed and 16 await a critical care bed. Mitigation efforts include use of hallway beds and surge beds opened in several locations. A number of groups are working on other short term strategies for ED or hospital avoidance, including expansion of Hospital@Home, and increasing capacity at the Benedict Urgent Care. Longer term solutions are in development for opening new acute care beds and working to improve access to post-acute care facilities to reduce length of stay. 

FMCH Grand Rounds

Tuesday, January 17th, 12:00 - 1:00 pm, "Inclusive Communication: The Language of Belonging", presented by Tiffany Cook, MA.

Meeting ID: 191 986 273 Passcode: FMCH

https://umassmed.zoom.us/j/91581334605?pwd=dndhY3paSmRRZ1RTQndtTEwxaWZOdz09

FMCH Grand Rounds

Tuesday, January 24th, 12:00 - 1:00 pm, "Navigating the Substance Use Disorder System in Massachusetts-Referrals, Consults, and More", presented by Hugh Silk, MD, James Ledwith, MD, Jay Broadhurst, MD, Heidi Ginter, MD, Kavita Babu, MD, Jillian Joseph, MPAS, PA-C and Justin LaPorte.

Meeting ID: 191 986 273 Passcode: FMCH

https://umassmed.zoom.us/j/91581334605?pwd=dndhY3paSmRRZ1RTQndtTEwxaWZOdz09

FMCH Grand Rounds

Tuesday, January 31st, 12:00 - 1:00 pm, "Management of First Trimester Pregnancy Loss", presented by Kristina Gracey, MD, MPH.

Meeting ID: 191 986 273 Passcode: FMCH

https://umassmed.zoom.us/j/91581334605?pwd=dndhY3paSmRRZ1RTQndtTEwxaWZOdz09

Family Medicine Education Consortium Webinar Series

Free webinars available through the FMEC, highlighting the most highly rated webinars from the 2022 FMEC Annual Meeting in Arlington, VA. See schedule attached or linked here.  https://fmec.memberclicks.net/assets/images/2022b%20Schedule%20Annual%20Meeting%20Virtual%20Seminar%20Sampler%20Flyer.pdf. Registration is required to receive zoom link.

Undergraduate Medical Education

VISTA Update

Vista Town Hall, this Wednesday, January 11th, 12:00-1:00pm in person in Amp II, S4-102 as well as streaming on Zoom.

The Agenda Includes:

• Pathway lottery/student placements
• Discovery/P3 update
• Portfolio Update
• WIN week discussion
• Student and Community Q&A regarding any curriculum phases 

If you are unable to join in-person, join by zoom at: https://umassmed.zoom.us/j/92221689006?pwd=eHhEL01vUmNHV1o4MnBXK2s1djJPUT09&from=addon 

ETHICS CORNER (A new monthly feature)

In the new monthly feature, Ethics Corner, Philip Day, PhD, will share his ethics expertise on topics germane to family medicine education and practice. The format will be simple and will address general ethical issues for each topic, followed by citations for further reading. Please email Dr. Day with your ideas, questions, or conundrums! (philip.day@umassmed.edu) This first edition of Ethics Corner has been adapted from the October 11, 2022 Grand Rounds presentation, “ Medical Emergencies Outside of the Clinical Setting” presented by Stacy Potts, MD, MEd, and Philip G. Day, PhD. 

Ethics Corner

Topic: Responding to Medical Emergencies of Non-patients

Question 1: Is it legal to intervene in an emergency?

• Response 1: YES: All 50 states have a Good Samaritan Law that protects medical professionals providing care if it is within the standard of care and not grossly negligent. 

Question 2: Do I have a moral obligation to intervene?

• Response 2: YES: The ethical principle of beneficence obligates healthcare professionals to provide care for those in danger.

Question 3: I have answered the ethical call and responded to an emergency – now what?

• Response 3: Assess the situation, including personnel, available resources, professional competency, your own mental and physical disposition, and the patient’s ability to provide consent.

Summary: In the United States, providers are ethically but not legally required to respond to medical emergencies of non-patients. Good Samaritan laws, which vary by state, offer legal protections for responders. Professional codes and the principles of medical ethics obligate a response in emergency scenarios. Further reading: 1) Hu JS, Smith JK. In-flight Medical Emergencies. Am Fam Physician. 2021;103(9):547-552. 2) Chaet HC. AMA Code of Medical Ethics’ Opinions Related to Urgent Decision Making. AMA J Ethics. 2018;20(5):464-466.

Faculty Presentations and Publications

Potts SE. Grandfathered In? Fam Med. 2023;55(1):57-58. https://doi.org/10.22454/FamMed.55.599129.

SAVE THE DATE: The MassAFP Annual Meeting and Spring Refresher will be March 24-25. See the attached flyer for more details or go to: massafp.org. Manju Mahajan is co-chair of the MassAFP Education Committee. 

UMass Department of Family Medicine & Community Health (FMCH) Climate Survey

Please look for an email this week to take our annual FMCH Climate Survey. Thank you for working with us to develop a departmental diversity plan that responds to identified needs among our faculty, staff, and learners on both the school and clinical sides. We have made strides in developing a strategic plan for diversity based on prior results. Your participation in this survey will help us to continue to take steps towards meaningful and data-driven action to create a more inclusive work space. This survey is intended for faculty, staff, residents, and fellows who identify as members of the Department of Family Medicine and Community Health (FMCH). Your responses are anonymous and data will only be shared in ways that protect individual identities. Our Diversity Equity Action Plan (DEAP) team appreciate your time and effort in helping us to move this initiative forward.

The Chancellor’s Award for Advancing Institutional Excellence in Diversity and Inclusion is bestowed annually upon an individual or group exemplifying characteristics embodied in UMass Chan’s diversity statement and values. The Chancellor's Award for Advancing Institutional Excellence in Diversity and Inclusion award will be presented at the Medical School’s annual Martin Luther King Jr. Day Celebration on Wednesday, January 25, 2023. Any questions may be directed to the Diversity and Inclusion Office at 508-856-2179 or diversity@umassmed.edu.

The new VISTA curriculum will have 8 Pathways. All students need to choose a Pathway. Pathways include the following themes:

• Inequity/Advocacy/social justice ​
• Entrepreneurship/biomedical innovation​
• Clinical care​
• Research​
• Population/global/community health​
• Health systems science ​
• Education​
• PURCH - Springfield students

Students will be required to work on a project over 3.5 years. This will replace Capstone projects. They can be very diverse in nature. Faculty who mentor students on their project will meet with them initially and then periodically.

There are 3 ways to get onto a list for potential students to work with:

1. Put your name out there with an area that you are interested in (e.g. substance use disorder or women's health) and which Pathway or Pathways appeal to you and you will be put on a list for students to look at
2. Have an idea for a project and forward that project and students can look at your idea
3. Already have a project you are working on and list that and a student can join your project with you.

If you have an idea, please reach out to Hugh Silk at hugh.silk@umassmemorial.org.

Presentations & Publications

Hugh Silk, MD, MPH, FAAFP, was featured in the Diary of Family Physician section in American Family Physician in the December edition. https://www.aafp.org/pubs/afp/issues/2022/1200/diary.html

Philip Day, PhD, two recent publications:

1. Day PG, Woods SB, Gonzalez L, Fernandez-Criado R, Shakil A. Validating the TeenHITSS to Assess Child Abuse in Adolescent Populations. Family Medicine. 2023;55(1):12-19. https://doi.org/10.22454/FamMed.55.203565. a. The findings of this study suggest that TeenHITSS is a valid and reliable tool to screen for physical and sexual abuse in children ages 13 years and older in clinical settings and can help health care providers detect adolescent abuse and initiate intervention and prevention of future abuse.
2. Liu A, Suarez A, Lehnen J, Day PG, Gimpel N. Training Students as Navigators for Patients Experiencing Homelessness. Family Medicine. 2023;55(1):45-50. https://doi.org/10.22454/FamMed.55.143409. a. Formal education in patient navigation and caring for individuals experiencing homelessness improves self-assessed preparedness of future health care providers in serving homeless and underserved populations.

Department Member Recognition

Paula Gardiner, MD, MPH received the American Public Health Association’s Integrative, Complementary, and Traditional Health Practices (ICTHP) Impact Award during the organization’s annual meeting in November. This award recognizes her work in health equity and medical group visits. 

Dr. Carolyn Langer directed this year's Health Policy Interstitial and is very appreciative of all the FMCH faculty who participated. Dr. Tom Scornavacca gave a presentation on "Population & Community Health Management from the Clinical Perspective." The following FMCH faculty served as small group facilitators, guiding the medical and graduate nursing students in a case study of a multispecialty medical group that is transitioning from a fee-for-service to a value-based care model:  Michele Pugnaire, MD, Peter McConarty, MD, Michael Tutty, PhD, MHA, Hugh Silk, MD, Suzanne Cashman, MD, Josh Twomey, PhD, Jennifer Bradford, MD, MPH, Ron Adler, MD, Dennis Dimitri, MD, Emily Lauer, MPH, Beth Mazyck, MD, Jay Broadhurst, MD, Kimberly Lenz, PharmD, MBA, Linda Weinreb, MD, and David Brumley, MD, MBA.

Frankly Speaking Podcast

A weekly Podcast series covering newsworthy topics in primary care medicine.

Listen on Apple Podcasts: https://podcasts.apple.com/us/podcast/frankly-speaking-about-family-medicine/id1194659367.

Please join us for an overview: Listen to this podcast to get answers to important questions about vitamin D supplementation in the first year of life. We will review a recent systematic review and meta-analysis on the relationship between vitamin D supplementation in the first year of life and outcomes, and we will discuss how these finding can be applied to your practice. Guest: Robert A. Baldor, MD, FAAFP, presents: "Should There Be a Contraindication to CPR?". - Frankly Speaking Ep 309.

Clinical Services Spotlight:

Happy New Year! 2023!

The new year brings new opportunities and new beginnings. I hope for all of us that as we enter 2023, we remember our accomplishments and victories in 2022.

News from the MA Board of Medicine

The Board of Medicine has a new online Licensing platform. Please use the link below to review the link and process.

https://www.mass.gov/news/borim-launches-new-online-licensing-platform

Quality Scholars Program

Congratulations to Dr. Shahida Fareed on her graduation from the Quality Scholars Program. 

Medication Shortages

The list of medication shortages across the country is increasing. Please review the information below from Medical Center Leadership.

Shortages we are currently watching:

• Liquid acetaminophen and ibuprofen
• The national shortage is impacting hospital and retail pharmacies.
• At UMass, in the inpatient areas, we have adequate supply but will be monitoring closely.
• In the Prescription Centers, supply is also impacted. In many cases, patients have been able to be prescribed chewable acetaminophen tablets (when appropriate) or identify alternatives with the prescriber.

• Update: Oseltamivir (Tamiflu)
• The oseltamivir shortage continues to be critical.
• In the inpatient setting, oseltamivir needs to be approved by Infectious Disease, following the same process as obtaining ID approval for other restricted antimicrobial use. The order in Epic has been updated with a default stop date of 5 days. Any use beyond 5 days will be at the discretion of ID. The order has also been updated to request a symptom start date to more clearly determine appropriateness of use. 
• For inpatients oseltamivir is only indicated within 5 days of symptom onset; for outpatients, oseltamivir is only indicated within 48 hours of symptom onset.
• Who should get oseltamivir:
• High Priority Groups are: (1) Hospitalized patients, (2) patients with progressive illness, and (3) patients are at higher risk for complications.

• NEW Critical shortage: Albuterol (concentrated) inhalation solution
• Concentrated albuterol for inhalation is at a critical drug shortage level where multiple mitigation strategies are required.
• Estimated release of the 20 mL bottles for continuous nebs is April-May 2023. 503B sources may have release mid-January.
• The following changes are being implemented effective immediately:
• Providers, nurses, and respiratory therapists will reassess patients who are on albuterol continuous inhalation q4hr or 1-2 hours prior to needing a new syringe.
• The pharmacy will use concentrated albuterol nebs to compound 100 mg/ 20 mL syringe in the IV room.
• We are implementing pediatric weight-based albuterol volume to prevent waste.
• We are also bringing in Levalbuterol as a substitute if needed (can be used as continuous neb).

• Shortages of ADHD medications that started this summer with Adderall have widened to now include another major category of stimulants: Novartis AG’s Ritalin and Johnson & Johnson’s Concerta.

Additional Information is available for shortages at the link below.

https://www.accessdata.fda.gov/scripts/drugshortages/default.cfm

Update on Colon Cancer Screening: Closing the GAP

Colon cancer screening is our "True North" goal for 2023. The goal is to improve colon cancer screen among BIPOC Populations. The US Preventive task force recommends screening for colon cancer in persons between the age of 45 and 75. Between 76 and 85, screening decisions should be made on an individual basis.

Definition:

BIPOC= Black and Indigenous people of color

 Includes Black/African American, Hispanic (both White and Black),

 Asian, Other Race, Multi Race

Goal:

Improve the colorectal cancer screening rate of the BIPOC population by

 0%        Target goal: 51.8%

 4% Reach goal: 55.8%

 8% Stretch goal: 59.8%

Three options for screening:

People with average risk can have FIT testing or Cologuard screening annually. These tests are stool-based tests that can be performed at home. Any abnormal test results should be followed up with a timely colonoscopy.

For screening, people are considered to be at average risk if they do not have:

• A personal history of colorectal cancer or certain types of polyps.
• A family history of colorectal cancer.
• A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease).
• A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC).
• A personal history of getting radiation to the abdomen or pelvic area to treat a prior cancer.

People at increased or high risk of colorectal cancer might need to start colorectal cancer screening before age 45, be screened more often, and/or get specific tests.

Visual (structural) exams of the colon and rectum are done at the intervals below:

• Colonoscopy every 10 years.
• CT colonography (virtual colonoscopy) every 5 years.
• Flexible sigmoidoscopy (FSIG) every 5 years.

Cologuard Ordering Instructions

• Place order in EPIC (Code 'PRO278').
• Follow the instructions on steps to ordering on the included attachment.
• The company will follow-up with the patient to initiate the process. They will do insurance verification, confirm address, and review the process. 
• The company will mail the kit to the patient. They will follow-up with the patient at 30-, 60-, and 90-day intervals once the kit is mailed. 
• The Cologuard order guidelines are included in the kit.

COVID Updates

COVID-19 US

• COVID is increasing in the US at a rapid rate.
• The new omicron variant XBB.1.5 is very contagious and now accounts for 40% of cases in the US.
• Several countries have imposed restrictions on travelers coming from China including the US. 
• It is anticipated that patients will experience recurrent infection at a higher rate.

COVID-19-UMMMC

• The current 7-day average positivity rate UMMHC, 19.8% compared to 11.6% last week.
• The current 7-day average positivity rate UMMMC, 17.5% compared to 11.4% last week.
• Total 67 COVID positive inpatients.
• Rolling 7-day average employees out due to COVID 25-30/day.

COVID-MA

• COVID, RSV, and the flu continue to place stress on the healthcare system.
• MA states that 50% of the new cases are the new XBB.1.5 subvariant.
• In MA, there were 8,372 new cases in the last 7 days.
• The 7-day average of percent positivity is 11.7%.

Wellness Resources

The Caring for the Caregiver Program provides resources such as the Caregiver Support Line (508-334-HELP) and The Employee Assistance Program (EAP) which offers a variety of services and supports (including virtual peer support and wellness tips. EAP can be accessed at 866-263-3525, or www.LiveandWorkWell.com, [company code UmassMemorial]. More information is available on the Caring for the Caregiver page.