Table of Contents

Upcoming Events

Focus of the Week - Diversity

Announcements

Faculty Presentations/Publications

Department Member Recognition

Frankly Speaking Podcast

Clinical Services Spotlight

Upcoming Events

FMCH Grand Rounds relaunches after the summer hiatus for the academic year 2023

Tuesday, August 30th, 12:00 - 1:00 pm. "Integration of Doulas into Maternity Care Settings: Overcoming Barriers and Bolstering Facilitators to Teaming with Doulas and Improving Health Equity", presented by Christina Gebel, MPH, Birth Doula (DONA), LCCE.

Meeting ID: 191 986 273 Passcode: FMCH

https://us02web.zoom.us/j/191986273?pwd=NEtlZmNkdWlSUGwyeTJQU3dCeUs1QT09

Focus of the Week - Diversity

UMass Memorial Health has an opportunity for UMass Memorial caregivers to get funding for innovative ideas that may bring increased diversity, inclusion, and equity to our institution. Please email Dr. Jennifer Bradford MD or Dr. Heather-Lyn Haley if you have a project that would meet the guidelines of the program. See link below for more information. 

Health Equity and Inclusion Seed Program | The Hub (umassmemorialhub.org) 

UMass Memorial Health has a system in place that allows caregivers to report instances of discrimination, harassment or retaliation. See Link below. 

Report Discrimination, Harassment or Retaliation | The Hub (umassmemorialhub.org) 

Announcements

FMCH GME Leadership Team

The quarterly FMCH GME Leadership meeting will be September 7, 2022 at Peppercorn’s Grille and Tavern. Please RSVP through your Outlook invite or contact Erica White at Erica.white@umassmemorial.org

Hepatitis C and General Hepatology

Project ECHO (Extension for Community Healthcare Outcomes)

You are invited to join an exciting virtual collaborative learning opportunity!

What? Hepatitis C ECHO, a virtual case-based tele-mentoring educational model

Who? Primary care interdisciplinary team members (providers, nurses, social workers, community health workers, patient navigators, etc.)

Why? Tele-mentoring model that links specialists to primary care providers (PCPs) via video conferencing from any computer; Case based, iterative learning facilitated by specialists and related experts; through guided practice, PCPs become proficient in specialty care

When? A new cohort begins Friday, September 9th, 2022, 12:30 - 1:30pm ~ with 10 sessions held bi-monthly.

Curriculum content includes:

• HCV screening
• Acute HCV
• Chronic HCV: Workup
• Treatment of non-cirrhotic patients
• Treatment of cirrhotic patients
• Monitoring during treatment
• Monitoring post treatment
• "Topic by request"
• Other hepatitides in the context of HCV/Hepatitis A&B
• Treatment of special populations

Register Today!

The annual Family Medicine Education Consortium meeting is September 16-18 in Arlington, VA. The residencies will be represented at the recruitment fair, and many faculty, residents, and students will be presenting their great work. Find more information here: 2022 Annual Meeting (fmec.net). Medical student scholarships are available. Consider encouraging enthusiastic students.

There will be an evening celebration on Thursday September 15^th for Larry Bauer, the founding CEO of the FMEC. If you are interested in joining, please contact Stacy Potts, she will be sponsoring a table for department members. 

Stacy.potts@umassmemorial.org.

Putterman Lecture: SAVE THE DATE

Please join us on Tuesday, September 20^th, 12:00 - 1:00pm, for our Family Medicine and Community Health Grand Rounds 23^rd annual Putterman Lecture, being presented by Aletha Maybank, MD, MPH. Her lecture topic will be on “Building Alliances and Sharing Power for Health Equity and Racial Justice”. For those of you who wish to join us in person, a location is to be determined. As for those who would like to join via Zoom, please copy this link into your calendar: https://us02web.zoom.us/j/191986273?pwd=NEtlZmNkdWlSUGwyeTJQU3dCeUs1QT09.

We look forward to you joining us for this event.

Calling All Fellows and Chief Residents

The FMCH Fellows and Chief Residents are invited to a dinner gathering and get to know each other on September 29th, 2022, 6:30 - 8:30pm. Location TBD.

Please RSVP through your Outlook invite or contact Erica White at Erica.white@umassmemorial.org.

Teaching of Tomorrow (TOT) is a nationally recognized and highly acclaimed faculty development program that focuses on building and refining foundational skills for effective clinical teaching in inpatient and ambulatory settings. Preceptors from any specialty and discipline will enhance their clinical teaching skills through discourse and practice. Workshop dates are November 18-19, 2022 and March 10-11, 2023 and will be held at the Hotel Northampton. Participants must attend all four days. See brochure for details and how to register. 

Faculty Presentations/Publications



A large team from UMass Chan and the MA Department of Public Health recently published their work on the implementation of a LTBI/ECHO. Daria Szkwarko (Preventive Med), Michael Urbanowski (MassAHEC Rural Health Scholars), Rebecca Thal (FHCW), Sue Foley (Benedict 3^rd floor), and Judy Savageau (Benedict 3^rd floor) contributed to the recently published article, Expanding Latent Tuberculosis Infection Testing and Treatment in Massachusetts Primary Care Clinics via the ECHO Model in the Journal of Primary Care and Community Health, 2022;13: Vol. 1: 1-8, doi:10.1177/21501319221119942.

Department Member Recognition

Primary care sports medicine team has been off to a busy start this fall. They started off covering the Worcester World Cup Friday, August 12 to Sunday, August 13, which is a community event run by the Cultural Exchange Through Soccer. The team included Drs. Lee Mancini, Angela Rufo, Emily Eshelman, Adam Ridley, and Laurel Banach. Residents from both Worcester and Fitchburg programs included Nick Martin, Alec Tributino, Matt Migliozzi, Paul Kehoe, Brennan Dagle, and Liz Douglas (IM). 

In order to get students ready for athletics, pre-participation exams were held for Worcester public school students athletes Tuesday, August 16 at South High School. This marks a new relationship between the UMass primary care sports medicine departments Who will continue to provide on-field coverage for the WPS varsity Football games this upcoming season and continue to host sports physicals for our local athletes. 

Thanks to Nick Hajj and William Brown, PGY3 for kicking off a very successful recruitment session for Rural and Urban Health Scholars on wound care and dressings. 36 students were in attendance! Thanks in advance for those that have volunteered to be the students LPPs. If you are interested in being a LPP (or want to know what that is), please contact Linda.Cragin@umassmed.edu.

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: Concerns have been raised over guideline recommendations for lowering systolic blood pressure (BP) to 60 years. To Achieve such targets often requires intensive BP treatments, which can result in harms from syncope or falls. Join us to review the results of a recently published meta-analysis done to estimate the time needed to potentially derive clinical benefit from such BP treatments in patients 60 years and older. Guest: Robert A. Baldor, MD, presents: "Is Less More When Treating BP in Older Adults?". - Frankly Speaking Ep 291.

CLINICAL UPDATES

COVID-19 MA

• Confirmed cases: 1,838,163.
• Confirmed deaths: 20,063.
• The 7-day average of positivity is 7.84%. 

COVID UMMMC

• In-House August 28: 51 patients.
• Of the 51, 59% are fully vaccinated.
• Of the 51, 29% have primary COVID.

Monkeypox

• The demographics continue to show that the predominant infection is in males.
• The median age is 37 years old. 
• Cases of Monkeypox in US: 17,432.
• Global cases: 47,652. Cases are slowing in the big cities.

Spread of Disease

•  Spread from humans to animals and animals to humans (zoonotic).
•  Can be spread by droplet exposure and via exhaled large droplets.
•  Spread from contact with the Monkeypox rash, scab, or body fluids.
•  Contact with cloths or surfaces that have been touched with Monkeypox.
•  The incubation period is 7-14 days but can range from 5-21 days.
•  Symptoms can be mild or severe. Lesions are itchy or painful.

What should you do after exposure?

• If you are exposed, regardless of the level of exposure, monitor symptoms for 21 days.
• If there are symptoms, immediately isolate infected persons.
• If asymptomatic, continue with daily activities.
• Healthcare workers who have cared for patients with Monkeypox who had direct or indirect exposure can continue their work if asymptomatic. Adhere to infection control protocols and PPE guidelines.
• If at any time the healthcare worker becomes symptomatic, immediately isolate yourself, and contact the DPH. 

Suspected Monkeypox in Patient Care Area (Guidelines/protocol)

Take immediate action

• Ensure the patient is wearing a facemask (if the patient can tolerate).
• Put the patient in a PRIVATE ROOM; Strict Airborne Isolation (NEGATIVE PRESSURE ROOM NOT INDICATED).

Healthcare Worker PPE

• Healthcare workers must wear a respirator (either a fit-tested N95 respirator or PAPR), gown, gloves, and eye protection (e.g., goggles or a face shield) to enter the room for any suspected or confirmed case of Monkeypox. 

Limit staff in room

• Especially for any aerosol-generating procedures. Document on log all caregivers who enter room.

If the patient is in an ambulatory setting

• Minimize contact with the patient.
• Provide a facemask for the patient to put on. 
• Escort the patient to a private room, maintaining 6 feet distance.
• Most patients will not need to be referred to the Emergency Department (ED) and will not need hospitalization.  
• If a patient does need to be sent to the ED, please call TrAC and request that the EDAOC be contacted directly to be made aware of the case. This should be done BEFORE the patient is transferred to ensure that they are sent to the best equipped ED to handle the case.

If the patient is at home:

• If the patient is calling from home, and is clinically stable, obtain the clinical and epidemiological history and instruct the patient to isolate at home.
• The clinician should then contact the State Epidemiologist at 617-983-6800 for further guidance. 

Evaluation and management of potential exposures. 

• Infection Prevention and Control will work with Employee Health Services and State DPH as appropriate to identify and evaluate potentially exposed health care individuals. 

Waste Management.

• Waste (i.e., bodily fluids such as urine, stool, blood, sharps, and trash) generated from a patient should be managed as biohazard medical waste (red bag.) 

Cleaning and Room Turnover

The following procedures should be followed:

• Standard cleaning and disinfection procedures should be performed using a hospital-grade disinfectant in an outpatient or inpatient setting.
• Activities such as dry dusting, sweeping, or vacuuming should be avoided. Wet cleaning methods are preferred.
• Isolation precautions should be maintained until all lesions have crusted, those crusts have separated, and a fresh layer of healthy skin has formed underneath. 
• For patients with confirmed disease or at high suspicion, most patients will be able to go home and isolate effectively. As a last resort, if there are extenuating circumstances and home isolation is not feasible then admission may be considered, however this should only be utilized in rare cases.

Vaccine

The vaccine is recommended if you have had contact with someone who has Monkeypox or you were identified as possibly being exposed. 

• You have had sex with a sexual partner in the last 2 weeks that has Monkeypox.
• Multiple sexual partners in a high-risk area of people with Monkeypox.
• You are a lab or healthcare worker who is around orthopox viruses including in animals. 

Treatment

The antiretroviral tecovirimat may be recommended to those with Monkeypox who are more likely to get severely ill or have a reduced immune system. 

According to the CDC:

• Oral tecovirimat is most practical for children (less than 8 years old) with severe disease or underlying medical conditions that put them at risk for severe disease who weigh at least 13kg or 29 lbs. 
• They can take the capsules, or the contents of the capsules mixed with soft food, and they should eat a fatty meal that helps in absorbing the tablet.
• For children less than 13kg, IV therapy is recommended. 
• Monitoring renal function for children and adolescents receiving IV tecovirimat weekly is recommended during treatment especially for patients less than 2 years. 
• Contact the DPH for additional information.
• **Pregnant or breastfeeding women. It is not known whether treatment with tecovirimat during pregnancy prevents congenital Monkeypox virus infection. No human data is available on the use of tecovirimat during pregnancy and reproductive development, and toxicity data is limited to animal studies.
• JYNNEOS is a modified non-replicating vaccine that has been approved for the prevention of both smallpox and Monkeypox. It was initially approved as a 2-dose regimen given subcutaneously, but protection is afforded with a single dose, and can also be given intradermally. It is currently available for post-exposure prophylaxis by appointment at AIDS Project Worcester.

Ordering Monkeypox Testing 

QUEST LAB TEST CODE: 1234774 Orderable procedures: MONKEYPOX DNA,RT- PCR –QML-12084 (LAB32024)

Supplies & Materials needed :

3 mL Universal Viral Transport Medium ( RED CAP) or Nasopharyngeal swab in VCM Medium (GREEN CAP)

GREEN CAP- PMM# 190112. 

Red CAP-PMM# 206168 

• Anyone who is being tested for Monkeypox is considered a Person Under Investigation (PUI) and should be told to isolate pending test results.
• Isolation at home is preferred and means staying away from household members to the extent possible.
• The PUI should cover all lesions and wear a mask at any time they are around anyone else. Household members should also mask if they must be in the same room.
• The PUI should have their own bedroom and should use a separate bathroom from household members (if possible). Disinfection of high touch surfaces in a shared bathroom and kitchen between uses should be performed.

** Continue to check the hub for additional information