Accessing perinatal substance use disorder care in your local community: A case study of an innovative hub and spoke network in western North Carolina.

Introduction: The incidence of substance use disorders (SUD) in the general population and in the pregnant person population has risen over the last 20 years. Concurrently, both perinatal and SUD care in rural areas is laden with access barriers including but not limited to geographical distance from potential treatment and stigma. An integrated outpatient perinatal substance use disorder (PSUD) clinic in an urban area in western North Carolina (WNC) found that patients who traveled further for prenatal care were less likely to continue seeking care in the postpartum period.

Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study.

Background: Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals.

Addressing cannabis consumption among patients with hyperemesis gravidarum.

Severe nausea and vomiting of pregnancy and hyperemesis gravidarum affect up to 3% of all pregnant people, causing substantial maternal and neonatal morbidity, suffering, and financial cost. Evidence supports the association of cannabis consumption with symptoms of severe nausea and vomiting of pregnancy or hyperemesis gravidarum as the general public has come to believe that cannabis is a natural, safe antiemetic. Cannabis consumption in pregnancy is discouraged strongly by the Surgeon General of the United States and the American College of Obstetricians and Gynecologists because of evidence of potential harms.

What happy physicians have in common: A qualitative study of workplace perceptions of physicians with low burnout scores.

Introduction: Burnout is a phenomenon in the medical field that adversely affects patient care, physician retention, and physician well-being. The preponderance of burnout research has primarily focused on exploring what parts of medical practice and individual characteristics contribute to burnout. Our research aims to add to the growing body of evidence exploring what physicians who love their work have in common.

Using a Community Engagement Approach to Enhance Contraception Awareness in Rural Western North Carolina.

Unintended pregnancy rates remain higher than the national average in North Carolina. Although long-acting reversible contraception (LARC) use has reduced rates of unintended pregnancy, this contraceptive method is widely underused, often due to low community awareness. Boot Camp Translation is a community engagement process that promotes community awareness of evidence-based medical recommendations by designing culturally meaningful messages.

The association of cannabis use late in pregnancy with engagement and retention in perinatal substance use disorder care for opioid use disorder: A cohort comparison.

Background: Prenatal use of cannabis and opioids are increasing and very concerning. Engagement and retention in comprehensive, perinatal substance use disorder (PSUD) care are associated with better outcomes for mothers and babies. We compared the characteristics and engagement in care among women with opioid use disorder who used cannabis late in pregnancy versus those who didn't.

A Cohort Comparison of Differences Between Regional and Buncombe County Patients of a Comprehensive Perinatal Substance Use Disorders Program in Western North Carolina.

Pregnant patients from rural counties of Western North Carolina face additional barriers when accessing comprehensive perinatal substance use disorders care at Project CARA as compared to patients local to the program in Buncombe County. We hypothesized regional patients would be less engaged in care. Using a retrospective cohort design, univariate analyses (χ, t-test; < .

Unexpected ICU Admission Is Associated with Pulmonary Complications but Not Increased Mortality; Rescue Is Essential for Optimal Patient Outcome.

ICU beds are in demand in large regional referral hospitals; therefore, nonintubated polytrauma patients are often admitted to general care (GC) wards. We hypothesized that trauma patients with Injury Severity Score (ISS) greater than 15 and unexpected ICU admission (U-ICU) after initial admission to GC had increased morbidity and mortality. We also hypothesized that those requiring U-ICU could be predicted based on admission parameters.

Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study.

Objective: To compare maternal and fetal outcomes among dyads prescribed buprenorphine and naloxone or buprenorphine during pregnancy.

Methods: Retrospective cohort study of patients with opioid use disorder obtaining care in a comprehensive, perinatal program. Patients utilized medication for opioid use disorder: a buprenorphine and naloxone combination product or buprenorphine monotherapy.

Association of Maternal Buprenorphine or Methadone Dose with Fetal Growth Indices and Neonatal Abstinence Syndrome.

Objective: Our objective was to compare fetal growth and incidence of neonatal abstinence syndrome requiring treatment across pregnant women with opioid use disorders on two types and two dose categories of medication-assisted treatment.

Study Design: A retrospective cohort study was conducted in a comprehensive, perinatal program in western North Carolina comparing growth percentiles on third-trimester ultrasound and at birth, and diagnosis of neonatal abstinence syndrome requiring treatment. Singletons were exposed in utero to low- to moderate-dose buprenorphine (≤16 mg/day;  = 70), high-dose buprenorphine (≥17 mg/day;  = 36), low- to moderate-dose methadone (≤89 mg/day;  = 41), or high-dose methadone (≥90 mg/day;  = 74).

Teaching Opioid Tapering Through Guided Instruction.

Background And Objectives: Given the current opioid epidemic, national practice guidelines and many state laws are shifting the treatment paradigm for chronic, noncancer pain to a judicious use of opioids. This has prompted a need to teach family medicine residents how to appropriately taper opioids. We created a multifaceted approach to integrate teaching of opioid tapering into a family medicine curriculum with an emphasis on guided instruction.

Evaluation of the need for a fracture liaison service in a patient-centered medical home.

Objectives: To evaluate the need for a fracture liaison service (FLS) based on postfracture care in a patient-centered medical home (PCMH).

Methods: Patients in a PCMH who presented to a local 763-bed community teaching hospital with fragility fracture of the hip, spine, or forearm between January 1, 2013, and December 31, 2014, were identified using ICD-9 codes. A retrospective chart review of inpatient and outpatient medical records 2 years before the fracture and 1 year afterward was conducted.

Texting Brief Podcasts to Deliver Faculty Development to Community-Based Preceptors in Longitudinal Integrated Clerkships.

Introduction: Longitudinal integrated clerkships (LICs) are an increasingly popular clerkship model that relies heavily on community-based preceptors. The availability of an engaged and prepared community-based faculty is crucial to the success of these programs. Teachers in these programs are often geographically separate from medical school campuses, are engaged in busy practices, and have limited time to devote to faculty development activities.

Use of wearable sensors for pregnancy health and environmental monitoring: Descriptive findings from the perspective of patients and providers.

Background: Wearable sensors and other smart technology may be especially beneficial in providing remote monitoring of sub-clinical changes in pregnancy health status. Yet, limited research has examined perceptions among pregnant patients and providers in incorporating smart technology into their daily routine and clinical practice.

Objective: The purpose of this study was to examine the perceptions of pregnant women and their providers at a rural health clinic on the use of wearable technology to monitor health and environmental exposures during pregnancy.

Adaption and validation of the Working Alliance Inventory for General Practice: qualitative review and cross-sectional surveys.

Background: Relational aspects of primary care are important, but we have no standard measure for assessment. The 'working alliance' incorporates elements of the therapeutic relationship, shared decision-making, goal setting and communication skills. The Working Alliance Inventory (short form) (WAI-SF) has been used in adult psychology, and a high score on the survey is associated with improved outcomes for clients.

Cultivating Country Doctors: Preparing Learners for Rural Life and Community Leadership.

Background And Objectives: Rural health disparities are growing, and medical schools and residency programs need new approaches to encourage learners to enter and stay in rural practice. Top correlates of rural practice are rural upbringing and rurally located training, yet preparation for rural practice plays a role. The authors sought to explore how selected programs develop learners' competencies associated with rural placement and retention: rural life, community engagement, and community leadership.

Effect of Morbid Obesity on Midurethral Sling Efficacy for the Management of Stress Urinary Incontinence.

Objectives: The aim of our study was to assess midurethral sling (MUS) failure rate in the morbidly obese (body mass index [BMI] ≥40 kg/m) population as compared with normal-weight individuals. Our secondary objective was to assess the difference in complication rates.

Methods: This is a retrospective cohort study.

myTIPreport and Training for Independent Practice: A Tool for Real-Time Workplace Feedback for Milestones and Procedural Skills.

Background: Few tools currently exist for effective, accessible delivery of real-time, workplace feedback in the clinical setting.

Objective: We developed and implemented a real-time, web-based tool for performance-based feedback in the clinical environment.

Methods: The tool (myTIPreport) was designed for performance-based feedback to learners on the Accreditation Council for Graduate Medical Education (ACGME) Milestones and procedural skills.

Physician perceptions of integrating advanced practice pharmacists into practice.

Objectives: Barriers have prevented full integration of advanced practice pharmacists (APPs) into collaborative practice in some areas despite evidence describing their value. APPs in North Carolina can be recognized as Clinical Pharmacist Practitioners (CPPs) under a collaborative practice agreement and provide comprehensive medication management under physician supervision. This study describes the perceptions of physicians regarding the barriers and benefits of integrating CPPs into interprofessional teams and compares physician and CPP perceptions.

Improved Utilization of Preventive Services Among Patients Following Team-Based Annual Wellness Visits.

The Annual Wellness Visit was designed to enhance preventive services utilization among Medicare beneficiaries; Annual Wellness Visits are underutilized with sparse documented effectiveness. Patients of 3 community-based and 2 retirement community outpatient clinics in western North Carolina had team-based Annual Wellness Visits over a 20-month program, with the goal of improving the uptake and delivery of the Annual Wellness Visit. A clinical pharmacist saw high-complexity patients (≥5 medications) and a licensed practical nurse saw low-complexity patients.

The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians.

Purpose: To examine the literature documenting successes in recruiting and retaining rural primary care physicians.

Method: The authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural primary care physicians. In May 2016, they searched MEDLINE, PubMed, CINAHL, ERIC, Web of Science, Google Scholar, the Grey Literature Report, and reference lists of included studies for literature published in or after 1990 in the United States, Canada, or Australia.

Graduates' Perceptions of Learning Affordances in Longitudinal Integrated Clerkships: A Dual-Institution, Mixed-Methods Study.

Purpose: The authors explored affordances that contribute to participants' successful learning in longitudinal integrated clerkships (LICs).

Method: This dual-institutional, mixed-methods study included electronic surveys and semistructured interviews of LIC graduates who completed their core clinical (third) year of medical school. These LIC graduates took part in LICs at Harvard Medical School from 2004 to 2013 and the University of North Carolina School of Medicine-Asheville campus from 2009 to 2013.