Table of Contents

Upcoming Events

Focus of the Week - Diversity

Announcements

Faculty Presentations/Publications

Frankly Speaking Podcast

Clinical Services Spotlight

Upcoming Events

FMCH Grand Rounds

Tuesday, November 29th, 12:00 - 1:00 pm, "Epic Best Practices for Writing Notes Efficiently", presented by Henry Del Rosario, MD, Nicholas Hajj, MD, Jeanette Ryan-Alkasab, MD, Veronica Farrell, CNP and Megan Brochu, PA-C.

Meeting ID: 191 986 273 Passcode: FMCH

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

Psychiatry Grand Rounds

Thursday, December 1st, 12:00 - 1:00 pm, "Neurodevelopmental Underpinnings of Depression, Self-Injury and Suicide Risk in Youth: Ideas to Guide Treatment Design", presented by Kathryn Cullen, MD.

Meeting ID: 818349233 Passcode: PsychGR1

https://umassmed.zoom.us/j/818349233?pwd=VVRDNUxZZmF4K3NqNXppTHJiVmNSUT09

Training Modules

We would like to thank Tiffany E. Cook, MA, the director of diversity, equity, and inclusion education and integration who presented an interactive Grand Rounds session on 11/22/22 entitled, “Putting Antiracism Into Practice in Health Care Settings”. 

FMCH Survey on Anti-Racism and Microaggression

In the next two weeks, we plan to send our annual survey intended for faculty, staff, and learners who identify as members of the Department of Family Medicine and Community Health (FMCH). We appreciate you working with us to further develop action steps that respond to identified needs among our faculty, staff, and learners on both the school and clinical sides. Your participation in this survey will help us to see where we are as a department and will direct meaningful, data-driven action toward a more inclusive workplace.

Suturing skills instructors needed! Please volunteer December 12^th at 6pm in the Albert Sherman Center with students from FMIG, MassAHEC Rural and Urban Health Scholars and Primary Care Principles OEE.  We want to show students that Family Medicine ROCKS with different skills sessions over the year. This is the ONLY suturing session for AY22-23.  If available, please contact Linda.Cragin@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.

Faculty Presentations/Publications

Jim Ledwith, MD, and Juan Ding, DO presented at the UMass Chan Vision Seminar Series on November 17, "Artificial Intelligence for Diabetic Retinopathy Screening in Primary Care". The presentation discussed the project that will soon pilot the use of retinal cameras and an AI interface to screen patients for retinopathy in family medicine practices.  

The Worcester District Medical Society is recognizing James Ledwith, MD, assistant professor of family medicine & community health, with the Dr. A. Jane Fitzpatrick Community Service award for his years of service to vulnerable patient populations in the Worcester area.

https://www.umassmed.edu/news/news-archives/2022/11/james-ledwith-honored-with-worcester-district-medical-society-community-service-award/

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: Pharmacogenomic testing has been suggested as a way to personalize medicine, particularly where the metabolism of medications can vary significantly. Unfortunately, despite increasing use of this testing, there has been little evidence showing a benefit in clinical outcomes. Listen to this podcast to explore the data on clinical outcomes for pharmacogenetic testing and how to best select medication for patients with depression. Guest: Alan Ehrlich, MD, FAAFP, presents: "Time to Stop Recommending Vitamin D?". - Frankly Speaking Ep 304.

COVID-19 UPDATES

COVID-19 MA

• In the last week, there were 4,425 new cases of COVID. 
• The 7-day average of percent positivity is 5.59%.
• On November 22, there were 179 patients hospitalized for COVID-related illness and 562 total patients hospitalized with COVID. 
• Total confirmed deaths according to the State of MA is 20,833. 

Source: COVID-19 Response Reporting | Mass.gov

COVID-19 UMMMC

• The 7-day average current positivity rate is 25.1%, up from 19.1% seven days ago.
• In-House COVID positive inpatients 7-day average is 34; 65% are fully vaccinated and 1 in the ICU. 

Holidays and Sickness

What to expect after the holidays during the era of Pandemics and Seasonal Infections

• Omicron variants are great spreaders, spreading more easily then original COVID-19 virus. 
• BQ subvariants are more contagious. 
• Omicron variants surfaced 1 year ago and have a higher tendency to mutate. The omicron has been less severe than Delta. 
• The new BQ1.1 has become the dominant strain in MA. It is a subvariant of Omicron. 
• BQ1.1 accounts for 39 percent of the cases in MA. 
• The most prominent case in the northeast is XBB a recombinant of BA.2.10.1 and BA.2.75. It is more invasive than BQ.1 and BQ.1.1.
• The updated booster may offer some protection but it is not known whether it will be optimal protection. 
• The current antibodies used to treat COVID may not be sufficient for BQ1.1.
• The high-risk population are those who are immunocompromised. 

COVID, RSV, and Influenza 

The COVID pandemic has placed stress on the healthcare workforce with noted increase in shortages, ED crowding, increased burnout, and moral injury. Although numbers are decreasing, we are now in the season for the potential of 3 major viruses spreading during the winter season, namely COVID, RSV, and the flu. As the pressure to get people seen and minimize ED referrals, we can optimize our skills in preventive health. 

• Educate patients about the signs and symptoms of upper respiratory infections. 
• Discuss warning signs and when to call the doctor. 
• Pre- educate them about ED overcrowding and what can be done at home, by telehealth, or seen in the office. 
• Discuss what to do if they feel ill. 
• Discuss vaccination and how the virus spreads.
• Discuss Safe Environments: 3 C’s- Avoiding closed , crowded, or places with people in close contact. 
• Discuss handwashing and hygiene. 

Key medications shortages

• Adderall is at a critical shortage. 
• Patients are at risk for withdrawals and shortages are not going away soon. 
• Educate patients about symptoms of withdrawal and the potential for rebound symptoms. 
• The manufacturer has similar problems to other large organization related to staffing and supply chain.
• Amoxicillin shortages. The following have not been impacted by the shortage: amoxicillin tablets, capsules, or chew tabs for children. Round doses (+/-10%) to 125mg, 250mg, 500mg, 750mg, 875mg, 1000mg. 
• Alternatives for pediatric patients:

Source: American Academy of Pediatrics. 

Amoxicillin Shortage: Antibiotic Options for Common Pediatric Conditions (aap.org)

• Tylenol Shortages. There is a children’s Tylenol shortage in the US and Canada. 
• There is not a shortage of baby Tylenol. 
• The most common alternatives are Ibuprofen, Motrin, Aleve, and Naproxen.
• Other Shortages
• Albuterol Sulfate inhalation solution.
• Cefazoline shortage.
• Cefoxitin shortage.

MCH Updates

Outpatient Cervical Ripening Live!

We can now (FINALLY) schedule outpatient cervical ripening. (There will no longer be an inpatient cervical ripening slot, this was converted to an induction slot).  Patients should be 39w0d or greater, with a singleton fetus and no other contraindications to vaginal delivery. They should also have no indications for fetal or maternal monitoring during an induction. I have attached the policy for the contraindications list. There are a few quirks to this process that you should know.  

The order: Labor Induction with Cervical Ripening (OBO011)

• This is a stand-alone order. It does not exist in the labor/induction admission order set at this time.  
• The proposed date should be the start of the cervical ripening. The induction order will be automatically scheduled for 12 hours later.  

Only Central Scheduling can schedule these appointments at this time.  

Please tell outpatient cervical ripening patients to present to West 4 at the scheduled time for their cervical ripening. (This is different from our inductions).  

Just in case you missed the memo, see the enclosed attachment.

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.