Maia Winkel

All Publications

• From Why to How in Physician Well-Being: Aligning Strategies for Sustainable Cultural Change in Healthcare. Rhode Island medical journal (2013) Alvarez, A., Winkel, M., Karamatsu, M. L. 2025; 108 (3): 11-15

  Abstract

  The evolution from the Triple Aim to the Quintuple Aim has highlighted physician well-being as crucial for healthcare delivery. While evidence- based interventions exist, implementing sustainable well- being initiatives remains challenging for healthcare organizations.This report demonstrates how three established business frameworks - McKinsey 7S Framework, Kotter's 8-Step Change Model, and PESTEL analysis - can be adapted to implement physician well-being initiatives in healthcare settings.These frameworks analyzed three initiatives: promoting break-taking behaviors (McKinsey 7S), transitioning from a sick-call to a back-up call system (Kotter's model), and updating Work-Family-Career Guidelines (PESTEL). Each framework provided unique insights: 7S enabled systematic organizational alignment, Kotter's model facilitated change management, and PESTEL assessed external factors influencing implementation.Adapting business frameworks to healthcare settings provides structured approaches for implementing physician well-being initiatives, demonstrating how cross-sector tools can advance the Quintuple Aim while addressing systemic drivers of burnout.

  View details for PubMedID 40009094

• Spontaneous tumor lysis syndrome in a patient with chronic myeloid leukemia treated successfully with allopurinol. The American journal of emergency medicine Gartenberg, A., Winkel, M., Leonard, N. 2024; 78: 242.e1-242.e3

  Abstract

  Tumor Lysis Syndrome (TLS) is an oncologic emergency that may occur in any patient with a hematologic malignancy, even prior to initiation of chemotherapy. Spontaneous TLS massive tumor cell destruction with intracellular electrolyte release prior to the initiation of chemotherapy. Spontaneous tumor lysis syndrome is a rare presentation, mainly occurring in Acute Leukemia and non-Hodgkin Lymphoma. Chronic Myeloid Leukemia (CML) is a low-risk disease based on TLS risk stratification. To the best of our knowledge, spontaneous TLS in the chronic phase of CML successfully treated with allopurinol and aggressive hydration has yet to be reported in the literature. A case report is described regarding a 67 year old Jamaican female with a history of hypertension who presented to the emergency department with abdominal pain, nausea, and vomiting for 1 day. The patient was found to have leukocytosis to 344,000 with 4% Blasts, hyperuricemia, and acute kidney injury. A peripheral blood smear confirmed the diagnosis of CML. Bone marrow biopsy was performed with evidence of the chronic phase of CML. The patient met clinical criteria for spontaneous tumor lysis syndrome. The patient was started on aggressive intravenous hydration, allopurinol, hydroxyurea and imatinib. Creatinine and uric acid level improved on this regimen within 48 h of initiation.

  View details for DOI 10.1016/j.ajem.2023.11.010

  View details for PubMedID 38007380

• Interpreting the Post-ROSC ECG Avoiding Common Errors in the Emergency Department Winkel, M., McGregor, M., Winters, M. E., Woolridge, D. P., Marcolini, E., Lu, M., Dubbs, S. B. Lippincott Williams & Wilkins (LWW). 2024; 3: 47-49
• Evidence-based emergency department management of migraine and other primary headaches. Emergency medicine practice Panjwani, R., Saini, A. S., Winkel, M., Friedman, B. 2023; 25 (10): 1-24

  Abstract

  Headache is the fifth most common presenting chief complaint in emergency departments, and it is vital to quickly rule out life-threatening secondary causes. Though there are many medications, new and old, that can be used to treat primary headache, the evidence for their effectiveness can be conflicting. This review describes the pathology, workup, and treatment for migraine and other primary headaches based on the best available evidence, including novel medications, nerve blocks, and strategies for preventing postdrome recurrence. Other headache disorders, including cluster headache, medication overuse headache, and chronic migraine are also reviewed.

  View details for PubMedID 37768684

• Neuro-surgical considerations for treating IgG4-related disease with rare spinal epidural compression. Surgical neurology international Winkel, M., Lawton, C. D., Sanusi, O. R., Horbinski, C. M., Dahdaleh, N. S., Smith, Z. A. 2018; 9: 209

  Abstract

  Immunoglobulin G4-related disease (IgG4-RD) is a group of distinct autoimmune disorders affecting nearly every organ system in the body. Although central nervous system involvement is quite rare, it may present as hypertrophic pachymeningitis more frequently affecting the brain than the spine. In this study, we provide a case of spinal IgG4-RD pseudotumor resulting in cord compression, and a comprehensive review of the literature.A patient presented with an extradural mass causing spinal cord compression at the L2-L3 level. Pathologically this proved to be an IgG4-RD pseudotumor. The patient was treated with thecal sac decompression and post-operative steroids that resulted in complete resolution of his symptoms.IgG4-RD is typically under-recognized and under-reported in the spinal literature. The clinical spinal presentation and non-surgical vs. surgical treatment are relatively straightforward. Although most cases can be managed with a course of steroids, surgical decompression may be required in patients presenting with spinal cord and/or nerve root compression. The differential diagnoses for these spinal tumors or pseudotumors should include IgG4-RD. Early detection and appropriate treatment can lead to satisfactory outcomes.

  View details for DOI 10.4103/sni.sni_156_18

  View details for PubMedID 30488007

  View details for PubMedCentralID PMC6213809