Welcome to the FMCH Tuesday Talk. Please continue to send us your announcements, celebrations, and accomplishments to FMCHtuesdaytalk@umassmed.edu.
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Table of Contents
Message from the Chair
Upcoming Events
Focus of the Week - Clinical
Announcements
Frankly Speaking Podcast
Faculty Presentations/Publications
Clinical Services Spotlight
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MESSAGE FROM THE CHAIR
Please plan to join us next week, Tuesday, December 14th, at noon, for our virtual ANNUAL FACULTY AWARDS ceremony. We look forward to recognizing and celebrating the accomplishments of our extraordinary faculty.
Important Updates:
A federal judge has blocked the Biden administration’s plan for CMS to enforce a COVID-19 vaccine mandate for facilities receiving CMS funds, however this does not prevent institutions from establishing a policy to require vaccination for their employees. The UMass policy remains in effect.
Surge planning is very active throughout the system. As the numbers below highlight, we are bracing for weeks to months of increasing COVID-19 patient demand. There are no plans at present to stand up a field hospital. The system’s approach is to identify beds across the system that can be opened. This wave is unique in that staffing is the critical rate limiting step to opening additional beds. All options are being considered to fill critical staffing needs. Additionally, Hospital@Home is expanding. Reduction of non-essential surgeries and screening endoscopy are also being considered. And finally, Internal Medicine, Med Peds, and Family Medicine have been asked to help on the inpatient side. We are discussing how to staff a third Family Medicine Inpatient team (as we did last winter), by shifting more provider effort to inpatient roles. System leadership understands the hardship this places on our ambulatory practices and very much values our contribution and sacrifice.
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Upcoming Events
FMCH Grand Rounds
Tuesday, December 7th, 12:00 - 1:00 pm, Patrick Smallwood, MD, Presents: 'Section 12/35 and Capacity Evaluation' for Family Medicine Patients.
Meeting ID: 191 986 273 Passcode: FMCH
https://us02web.zoom.us/j/191986273?pwd=NEtlZmNkdWlSUGwyeTJQU3dCeUs1QT09
Strategic Planning Listening Sessions for Community Health
Thursday, December 9th, 12:00-1:00 PM
If you are interested in participating, here is the Zoom Link.
2021-2022 FMCH Annual Awards Ceremony
Tuesday, December 14th, 12:00 - 1:00 pm. Please join us (virtually) to acknowledge great teaching, great care and community engagement in our department!
Meeting ID: 915 8133 4605 Passcode: 334605
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Focus of the Week - Clinical
Implicit Bias Training Required by Board of Medicine
The MA Board of Medicine will require applicants for initial licensure and license renewal to complete a CME requirement of 2 credits on the topic of implicit bias beginning June 1, 2022. The 2 hours may be applied to the 10 hours of risk management.
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Announcements
Faculty Opportunity: Interstitial (ISC) Course Co-leader
UMass Chan School of Medicine seeks a co-leader for the Interstitial (ISC) course which is a year-long, longitudinal series of seven required 1-day programs and events scheduled at intervals during the Core Clinical Experiences year (CCE). Content areas are threaded in small aliquots throughout the year to foster spiral learning. Each content area is broadly significant to medical education/medical practice and is often under-represented in clinical education. In AY21-22, ISC topics include: Caring for People with Disabilities; Criminal Justice and Health; Oral Health; Military Service (Veteran’s) Health; US Healthcare Policy; Patient Safety and Quality Improvement; Trauma Informed Care; Informatics; Caring for LGBTQIA+ People; and Disaster Management. PURCH students are integrated into all ISC days and GSN students are integrated into some of the ISC days, as permitted by the academic calendar. The ISC will sunset in two years (AY 24-25) as content will be integrated into the new Vista clerkship curriculum. The FTE equivalent is .05, which is rolled into the educational effort model currently. Opportunities exist for co-leaders to participate in that planning and apply for new leadership roles in the future. Please reach out to Stacy Potts, stacy.potts@umassmemorial.org if you have questions or interest.
The UMMS Prevention Research Center invites you to order #PostVaxLife fliers and posters featuring Worcester Youth Vaccine Ambassadors sharing their own motivations for vaccination and detailing the locations/days/times of community vaccination clinics. These are all at no cost to everyone. The PRC’s goal is to blanket the city with them! Here is the link to order them: https://arcsapps.umassmed.edu/redcap/surveys/?s=X8XPKJCMDD
FMCH Vision 2030 Strategic Planning Fall Listening Sessions
With 2021 drawing to a close, the department would like to continue work on a strategic planning process. Vision 2030 is a project to look at the department’s long-term goals. What do you want our department to achieve by 2030? What will we be known for? We want your voice to be heard, please consider attending one (or more) listening sessions which will occur over the next two months. Site specific sessions will occur during standard meeting times to allow for easy access and minimize scheduling issues.
Upcoming:
- Community Health: Thursday, December 9th, 12:00 - 1:00 pm.
- Undergraduate Medical Education - TBD.
Please RSVP to jennifer.masoud@umassmemorial.org for any of the theme based sessions and specifically to be included in the scheduling of the community health session.
Please consider for in-person learning Pri-Med East
Thursday−Saturday, December 9−11, 2021 at the Boston Exhibition and Convention Center. Many of our colleagues will be presenting for 19 AAFP CME hours. This year’s keynote speaker is Pulitzer Prize-winning author Siddhartha Mukherjee, MD on: “Themes From the Future of Medicine”. I hope to see you there.
TendHealth Faculty COVID Recovery Series
You matter! The Department wants to support you through your COVID recovery efforts. We have hired TendHealth to provide recovery courses for our faculty. A series of four sessions over two months will guide you through recovery and build resilience.
Objectives:
Learn new concepts, build resiliency, and find community through live courses.
The team of expert and diverse instructors bring together a community of like-minded health professionals to learn new skills and expand our insights.
Faculty will need to choose one cohort and stick with it for all the sessions.
TEND is able to move the start date of the faculty cohorts back to hopefully avoid cancelling patient sessions. Here are the new dates:
Cohort 1: Mondays 8-9:15am, 12/13
Cohort 2: Fridays 4-5:15pm, 12/17
RSVP as soon as possible to Jennifer Masoud to reserve your spot in your chosen cohort, Jennifer.masoud@umassmemorial.org.
Communication Skills Training for COVID-19 Vaccination
UMass Chan Medical School is implementing multi-factor authentication (MFA) to reduce the risk of unauthorized access to information systems. MFA is a digital authentication method that requires two or more forms of verification factors before access is granted. Prior to MFA, only a valid username and password have been required. Adding a second form of authentication is a best practice. MFA registration is required for all who use UMass Chan information systems, including email. Students, faculty, and staff must register by Friday, December 17th. You will need to choose at least one secondary authentication method: a text to a mobile device; a phone call to a mobile device or landline; or an alert on the Microsoft Authenticator mobile app. Similar to our current use of the Duo app to access HR Direct, Microsoft Authenticator provides a secure method for multi-factor authentication. To learn more about multi-factor authentication and how to register, visit the MFA information page. The Help Desk will also host training sessions on Thursdays from noon to 12:30 to assist users in learning how to register. Register here for a session. By December 31st, all users will need to use MFA. If you have any questions, please contact the IT Help Desk via chat, email or phone (508-856-8653).
Mick Huppert Community Health Scholar Awards
If you are working on a community engaged initiative with a second year medical or nursing student, please reinforce for them this opportunity: For the fourth year, the annual Mick Huppert Community Health Scholar awards will be given to second year medical and graduate school of nursing students who have demonstrated a commitment to community engaged service and scholarship. Students should also have an interest in a career as a family physician or family nurse practitioner. Between two and four awards, each up to $2,500 will support awardees’ proposed community health initiatives. Medical and nursing student pairs will be considered and are encouraged. A pair would split one award. Click the link to get to the full announcement and application form. https://umassmed.edu/fmch/communityhealth/sep/mick-huppert-community-health-scholar-awards/ Applications due to Suzanne.Cashman@umassmed.edu by January 17, 2022.
White Belt Training Opportunity - Upcoming LEAN Training
UMassMemorial Health is committed to disseminate LEAN management tools to all physicians and clinicians and offer leadership development to our providers. Practicing LEAN principles enables team building and promotes respect to our fellow caregivers. It’s a platform that fosters innovation and improves the care we provide to our patients — as well as to advance our own work environment. LEAN is practiced by many caregivers in our health care system. Physicians and clinicians should be educated and have the tools needed to implement successful huddles, idea board systems and process improvement efforts. Our department will offer LEAN white belt training through two upcoming grand rounds. The first session will be a great refresher for those trained many years ago and the second session will include important updates including how to use Innovation Station. For individuals who have not done LEAN training in the past, this is an opportunity to meet the institution's requirement for white belt certification.
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January 25th, 12-1pm: LEAN White Belt: Part 2 - Innovation Station
If you are unable to make these trainings and are in need of certification, additional Lean White Belt training registration is available through E-learning 4U.
UMass Chan Medical School is leading a statewide collaborative to improve training for all medical students in serious illness communication, which was featured at the annual summit of the Massachusetts Coalition for Serious Illness Care (http://maseriouscare.org/news/summit-2021). The summit focused on an equity-first approach to improve communication and care of people and families facing serious illness. Jennifer Reidy, MD, chief, Division of Palliative Care, is chair of the collaborative which includes faculty, administrators and students from Boston University, Harvard and Tufts Medical Schools. The group has created shared competencies, mapped current curricula and conducted student focus groups at each school. This data is timely with UMass Chan's curriculum revolution. For more information, check out the collaborative's website here: http://maseriouscare.org/medical-schools-collaborative.
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Frankly Speaking Podcast
A weekly Podcast series covering newsworthy topics in primary care medicine.
Please join us to discuss. Overview: ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are both recommended as first-line treatments for hypertension. ACE inhibitors have known side effects, such as cough, that are frustrating for many patients, while ARBs appear to have less annoying side effects. This podcast will review a recently published retrospective, comparative cohort study comparing the effectiveness and safety of ACE inhibitors vs ARBs in the first-line treatment of hypertension. Guest: Robert A. Baldor, MD, FAAFP, presents: "The End of ACE Inhibitors?". - Frankly Speaking Ep 253.
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Faculty Presentations/Publications
The New England AIDS Education and Training Center, under the leadership of Philip Bolduc and Vanessa Carson-Sasso, recently tapped the skills of instructional designer Jess Baer in the Center for Integrated Primary Care to provide a multi-lingual video on the importance of community health workers, Unseen Work of the Community Health Worker that has been posted nationally in the National Coordinating Resource Center for AIDS Education and Training Center grantees.
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Clinical Services Spotlight: |
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COVID-19 UPDATES
MA
- Confirmed cases 870,629 with 1,003 hospitalized, 191 in the ICU, and 109 intubated.
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The 7-day positivity rate is 4.74%.
- The largest number of positive cases are in the 30-39 year-old age group.
- Total confirmed deaths 19,074.
- The first case due to the Omicron variant has been detected in MA.
UMMMC
- As of 12/6: 120 patients admitted across the system; 70 at the medical center (18 in ICU).
- Worcester Stop-the-Spread test positivity is at 10.9% (up from 7.9% last week); Marlboro is at 12.8% (doubled over the past week).
- In-house test positivity is at 17.5% for symptomatic patients (up from 14.3%) and 3.3% for asymptomatic patients.
- Employees out over weekend due to COVID: 8
CMS and Healthcare Workers COVID Vaccination
- CMS has suspended implementation and enforcement of the COVID-19 mandate for healthcare workers pending development in litigation. The injunction issued November 30 by a federal judge in Louisiana blocks CMS from enforcing the mandate for vaccination for healthcare workers.
Omicron COVID-19 and The New Travel Ban
- All inbound international travelers will be required to test for COVID-19 within one day of departure for the US.
- If you plan to travel internationally, you need a COVID-19 viral test regardless of vaccination status no more than 1 day before returning to the US.
- Negative results must be shown before boarding the plane.
- Travel should be delayed and travelers should self-isolate if they have symptoms or test positive for the pre-travel testing.
Pregnancy and COVID-19
- People who are pregnant or recently pregnant are at severe risk for COVID-19 when compared to people who are not pregnant.
- People who have COVID-19 during pregnancy are at increased risk for preterm birth, stillbirth, and other pregnancy complications.
- Remind your patients to take precautions.
- https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnant-people.html
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Q: Should pregnant health care personnel be transferred to roles where they are not providing in-person patient care to help reduce their risk? REVISED Last updated July 1, 2021, at 11:53 a.m. EST. Available data suggest that symptomatic pregnant and recently pregnant women with COVID-19 are at increased risk of more severe illness compared with nonpregnant peers (Ellington MMWR 2020, Collin 2020, Delahoy MMWR 2020, Khan 2021). Currently, there are insufficient data in pregnant health care personnel that stratify risk by either gestational age, medical comorbidities, the availability of recommended personal protective equipment (PPE), capacity to screen for SARS-CoV-2 infection, vaccination status, or the effect of the level of community prevalence of SARS-CoV-2 infection. However, the correct and comprehensive use of recommended PPE, alongside vaccination, hand hygiene, and environmental cleaning, leads to the optimal decreased risk of transmission of COVID-19, making it unnecessary, in most cases, to transfer pregnant health care personnel to roles where they are not providing in-person patient care.
Monoclonal Antibody Availability
- The state has launched three mobile units for monoclonal antibody treatment.
- Providers may call the mobile clinic referral line at (508) 974-3431 to refer their patients to one of these sites.
- The following links can help physicians access monoclonal antibody treatment and information for high-risk COVID-19 patients.
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Monoclonal antibody support tools and resources for physicians and patients from the US Department of Health and Human Services (HHS)
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Anti-SARS-CoV-2 mAb recommendations and guidance from the National Institutes of Health COVID-19 Treatment Guidelines.
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The HHS mAb national map and locator tool display locations and contact information for facilities that have received shipments of monoclonal antibody therapeutics.
Monoclonal Antibody Treatment at UMass
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Are you referring patients for Monoclonal Antibody Therapy at UMMMC? Please follow the guidelines below. Please add a short note when referring a patient for therapy. Include the following:
- Date of a positive test (if done outside of UMass)
- Date of onset of symptoms
- Vaccination status
- The risk factor that prioritizes patient:
Revised criteria for mAb treatment are in line with recent guidance issued by the Mass DPH and the Department of Human and Health Services.
Among the patients who meet the EUA criteria, we are prioritizing in the following order:
- Unvaccinated or partially vaccinated patients who have any of Tier 1 (elderly patients over 65 and those over 18 years with the BMI above 35) or Tier 2 (see below) criteria.
- Vaccinated patients but have Tier 1 risk factors (elderly patients over 65 and those over 18 years with a BMI above 35).
- Vaccinated patients who are not expected to mount an adequate immune response. Like those with severe immunosuppression, either due to their disease state (post-transplant, poorly controlled diabetes, ESRD, ESLD) or being on any immunosuppressive agent (chemotherapy, biologics). We also consider vaccinated patients with moderate to severe structural lung disease, and heart failure for treatment.
HIGH-RISK ADULT PATIENTS
*TIER 1:
- Are ≥65 years of age.
- Are ≥ 18 years of age with BMI ≥ 35.
*TIER 2: Are ≥ 18 years of age AND
- Have chronic kidney disease (including end-stage renal disease on hemodialysis).
- Have Diabetes.
- Have immunosuppressive disease.
- Are currently receiving immunosuppressive treatment.
- Have BMI > 25 kg/m2.
- Have cardiovascular disease (congenital heart disease, heart failure, coronary artery disease, and cardiomyopathies).
- Have hypertension.
- Have chronic obstructive pulmonary disease/another chronic respiratory disease (includes asthma (moderate-to-severe), interstitial lung disease, cystic fibrosis, and pulmonary hypertension).
- Are active or current (less than 5 years since quitting) smokers.
- Have substance abuse disorder.
- Have neurological disease states like Dementia, Stroke or Cerebrovascular disorder, or Neurodevelopmental disorders (for example, cerebral palsy).
- Have genetic or metabolic syndromes and severe congenital anomalies.
- Have a medical-related technological dependence (for example, tracheostomy, gastrostomy, or positive pressure ventilation).
*Among those patients who meet the EUA criteria, prioritize patients age ≥ 65 and those ages ≥ 18 with BMI ≥ 35 (Tier 1) over others who meet EUA criteria (Tier 2).
Immunosuppressive disease states: Malignancy, HIV, Primary immunodeficiency diseases, Solid organ or blood/stem cell transplant recipients, chronic liver disease, such as alcohol-related liver disease, nonalcoholic fatty liver disease, and especially cirrhosis, Asplenia, Auto-immune diseases, Sickle cell disease, Thalassemia, Pregnancy.
Receiving immunosuppressive treatment: Steroids, Chemotherapeutic agents, Calcineurin inhibitors (Cyclosporin, Tacrolimus), mTOR inhibitors (Sirolimus), Anti-proliferative agents (Azathioprine, Mycophenolic acid), IL-2 receptor antibodies (Basiliximab, Daclizumab), Polyclonal anti-thymocyte globulin (Thymoglobulin), Muromonab (monoclonal anti-CD3), Alemtuzumab (monoclonal anti-CD52), Rituximab (anti CD20).
Antibody Treatment for High-Risk Children with COVID-19
- The FDA has expanded monoclonal antibody use to children under 12 ages (birth to 12 years old).
- The monoclonal antibody treatment is a combination of bamlanivimab and etesevimab.
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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.
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Yoga Classes with Dr. Liz Erban
New Yoga Link!
Our Yoga class hit the 1 year anniversary - which in zoomland means we need a new link. Happy anniversary yogis and much gratitude to our fearless leader, Liz!
Also, a great time to join, new members always welcome. Start your mid week with some relaxing yoga!
Please join department members for early morning gentle yoga, Wednesday mornings 6:30am via Zoom.
Join Zoom Meeting ID: 923 9393 3653 Passcode: 764113
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Zumba with Dr. Anna Zheng
Zumba Monday 6am is on hold.
On hold until the new year in 2022.
Thursdays 6:15pm: Live/in-person or ZOOM
Please join department members Thursday evenings at 6:15pm**(30 Anna Street: tall ceilings, spacious indoor location) and get moving with Zumba. Please note details and any changes via webpage: http://annazheng.zumba.com/. ZOOM still possible for all classes.
Much appreciation to Dr. Anna Zheng for hosting these outstanding classes. New to the class? If it's your first class or you are interested in joining, please email Dr. Zheng at ZumbawithAnnaZheng@gmail.com to register, complete brief health screen and receive the ZOOM link.
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