Identification of Factors Associated with Both Frequency and Severity of Deer-Related Motorcycle Crashes.

Introduction: Motorcyclists are particularly vulnerable to injury when encountering large animals such as deer in the roadway. The frequency of these events, factors associated with their occurrence, and the extent of injuries sustained from such crashes are not yet well described.

Methods: A review of 10 years (2012-2021) of statewide motorcycle crash reports from a single state with a large deer population was performed to ascertain the frequency of deer-associated motorcycle crashes.

Mask-related skin changes among healthcare workers in a community-based hospital.

Context: During the COVID-19 pandemic, dermatologists within the Beaumont Farmington Hills' Dermatology program noticed an increase in conditions associated with mask wearing, such as "maskne" (acne in a mask distribution, thought to be caused by mask wearing), as well as worsening of previously diagnosed dermatologic conditions.

Objectives: The goal of our study was to explore various factors that impacted mask-related skin changes and how these skin changes affected quality of life.

Methods: A cross-sectional study was performed.

Quality Improvement Intervention associated with Improved Lung Protective Ventilation Settings in an Emergency Department.

Introduction: Patients requiring endotracheal intubation and mechanical ventilation in the emergency department (ED) are critically ill, and their ventilator management is crucial for their subsequent clinical outcomes. Lung-protective ventilation (LPV) setting strategies are key considerations for this care. The objectives of this 2019-2020 community-based quality improvement project were to: a) identify patients at greater risk of not receiving LPV, and b) evaluate the effectiveness of a series of brief quality improvement educational sessions to improve LPV setting protocol adherence rates.

Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting.

Context: Regular debriefing has been associated with improved resource utilization and measurable improvements in team performance in crisis situations. While Emergency Department (ED) staff have often stated that they would like to be provided a formal debriefing model after "code blue" and similar events, few EDs have such protocols in place.

Methods: The study consisted of two data collection processes: (1) completion of a 7-item survey distributed pre-intervention, 6-months post-intervention, and 1-year post-intervention, and (2) completion of a Rapid Post-Code Debriefing form.

Common Problematic Scholarly Activity Project Planning Expectations of Project Novices.

Introduction: Scholarly Activity (SA) projects, whether using methods more traditionally associated with research and or "quality improvement" projects, have been shown to confer value to resident physicians and other project novices in multiple ways. The inclusion of community and university-based residents and faculty in spearheading SA projects has led to improved understanding of medical literature and enhanced clinical practices, arguably producing more "well-rounded" physicians.

Purpose Of Paper: The primary purpose of this paper is to provide a summary of problematic expectations frequently assumed by project novices when developing and conducting SA projects.

Cardiovascular Risk Factors and Benign Paroxysmal Positional Vertigo in Community Otolaryngology-Head and Neck Surgery.

Objective: Cardiovascular risk factors have been associated with benign paroxysmal positional vertigo (BPPV), possibly causing degeneration of the utricular epithelium and subepithelium, but supportive evidence is mixed. This is the first study to examine the association between cardiovascular risk factors and BPPV as they present in the community practice of comprehensive otolaryngology-head and neck surgery.

Study Design: Cross-sectional case-matched case-control series.

Ancillary Findings on CT Pulmonary Angiograms that are Negative for Pulmonary Embolism.

Context: One advantage of computed tomographic pulmonary angiograms (CTPA) is that they often show pathology in patients in whom pulmonary embolism (PE) has been excluded. In this investigation, we identified the ancillary findings on CTPAs that were negative for PE to obtain an impression of the type of findings shown.

Methods: This was a retrospective analysis of findings on CTPAs that were negative for PE obtained in nine emergency departments between January 2016 - February 2018.

A Novel 'Train the Trainer' Emergency Medicine Resident Point-of-Care Ultrasound Course: A Feasibility Study.

Context: A novel multi-site 'train the trainer' point-of-care ultrasound (POCUS) training course was designed to better meet the graduate medical education learning needs of a geographically dispersed consortium of 16 community-based Michigan emergency medicine (EM) residency programs. The specific aim of this study was to explore the feasibility of using volunteer EM physicians who were novices with ultrasound techniques as instructors for a POCUS course. Additionally, the authors evaluated the effectiveness and consistency of a POCUS course delivered over multiple sites to enhance EM residents' ultrasound knowledge and skill acquisition.

Comparative Evaluation of Two Obstetrical/Gynecology Resident "Boot Camps" of Different Lengths: Equivalent Practice Skills Confidence and Knowledge Levels.

Context: Since the earlier time of master-apprentice type GME relationships, more residency program educators have developed various forms of to ease incoming learners into their new specialty roles as first-year residents. Such boot camps have ranged from informal informational sessions with faculty using simulation activities, to more formal workshops entailing pre- and post-event skills assessments with simulation exercises, formative feedback and debriefing sessions. The purpose of this pilot project was to examine for relative pre- and post-boot camp changes in Obstetrics/Gynecology (OB/GYN) practice skills confidence and knowledge levels in two consecutive cohorts (2014 and 2015) of first-year residents.

Fasting-Evoked En Route Hypoglycemia in Diabetes (FEEHD): An Overlooked Form of Hypoglycemia in Clinical Practice.

Objective: Many patients with diabetes opt to fast for lab tests, especially for lipid profiles, thus missing breakfast. In parallel, recent studies and international guidelines have indicated that routine fasting for lipid panels may not be necessary. Missing breakfast while fasting for lab tests may invoke hypoglycemia, if patients are not properly instructed about adjusting diabetes medications on the night before or on the day of the lab test.

Delivering the AAMC "Teaching for Quality" Program through a Community-Based GME Collaborative: Lessons Learned to Date.

Context: To address scholarly activity (SA) accreditation standards, the Michigan State University's College of Osteopathic Medicine Statewide Campus System has offered the Association of American Medical Colleges' (AAMC) Teaching for Quality Program for two cohorts of community-based faculty. The purpose of this paper was to describe the design and delivery of the customized program, the authors' initial lessons learned, and their plans for further evaluation and dissemination.

Methods: The authors customized the program to overcome the barriers typically faced by community-based program faculty learners through a graduate medical education (GME) consortium model.

Liposomal bupivacaine reduces opioid consumption and length of stay in patients undergoing primary total hip arthroplasty.

Background: Optimising postoperative pain management after total hip arthroplasty (THA) has been associated with improved patient outcomes. However, conclusions regarding the role of liposomal bupivacaine (LB) during THA remain mixed. The purpose of this study was to determine whether substituting a standard intraoperative wound infiltrate with LB as part of a multimodal pain management protocol would decrease subsequent opioid consumption and overall length of hospital stay in patients undergoing primary THA.

The Statewide Campus System Scholarly Activity Developmental Planning Framework for Community-Based GME Leaders.

Context: During recent years, Graduate Medical Education (GME) leaders in the United States of America have witnessed many substantive changes, including movement to a single accreditation system under the Accreditation Council for Graduate Medical Education. Both MD- and DO-trained residents and faculty must now meet an increasingly stringent set of accreditation standards outlined in Next Accreditation System standards. Specifically, updated scholarly activity standards emphasize a consistent volume and quantity of quality improvement/research projects and dissemination products.

Effectiveness of a Faculty Development Course on Delivering Learner-Centered Feedback Utilizing the Flipped Training Model.

Context: Effective feedback is an important step in the acquisition of residents' clinical skills and a key component of most adult learning strategies. Faculty-resident feedback discussions can facilitate resident self-assessment and reflection on their performance and motivate them to study and ask questions in areas where their knowledge may be evaluated as deficient. The flipped training model approach, a type of blended learning that reverses the traditional learning environment by delivering instructional content outside of the classroom, has garnered increased support within both graduate medical education (GME) and other healthcare disciplines.

Perceived Importance of Pursuing Osteopathic Recognition in the Single Accreditation System: A Survey of Medical Students, Residents, and Faculty.

Context: As graduate medical education evolves under the single accreditation system, osteopathic residency programs and consortia strive for sustainable ways to achieve and support the Osteopathic Recognition (OR) designation.

Objective: To determine whether differences existed in perceived importance of OR from 3 cohorts of osteopathic stakeholders: students, residents, and faculty.

Methods: A nonexperimental quantitative cross-sectional online survey was administered during February and March 2016 to osteopathic medical students at Michigan State University College of Osteopathic Medicine and residents and faculty from the affiliated Statewide Campus System.

The Use of Magnetic Resonance Cholangiopancreatography (MRCP) in the Setting of Acute Pancreatitis: When is it Most Useful?

Context: The usefulness of MRCP in the workup of acute pancreatitis has long been debated.

Methods: 2013-2016 chart review data were collected by the authors from adult patients with acute pancreatitis who also had received Magnetic Resonance Cholangiopancreatography (MRCP). Those patients were categorized by diagnosis and according to whether or not the MRCP changed healthcare services.

Medical Marijuana and the Treatment of Post Traumatic Stress Disorder: A Survey of Michigan Psychiatrists' Opinions.

Context: Although recent studies have indicated a potential mechanism of action through which medical marijuana (MM) and its derivatives may treat Posttraumatic Stress Disorder (PTSD) symptoms, definitive evidence is still lacking. Few studies concerning physician attitudes regarding MM and/or marijuana-derived medications for PTSD are found in the psychiatric literature.

Methods: A non-probability convenience sample of psychiatric physicians in Michigan was surveyed during 2016.

Examination of Resident Physician Quality Improvement/Patient Safety Project Confidence Levels from Multiple Programs.

Context: It is now increasingly recognized that physicians should be engaged in quality improvement/patient safety (QIPS) activities to make their patient care systems perform more reliably and safely. In order to ensure that our nation's physicians embed this aspect of practice into their work, there also is a growing expectation for effective integration of QIPS training into graduate medical education. This exploratory pilot study was conducted to identify how residents' personal and residency program characteristics might be related to their perceived confidence to develop and conduct prospective QIPS projects.

Billing Implications of Emergency Medicine Resident Physicians' Laceration Length Estimates.

Context: Lacerations are a common occurrence in urgent care and emergency room settings. The types of lacerations repaired in these settings range from superficial and linear to deep and stellate. Healthcare professionals are required to describe these wounds in documentation and part of that description is length.

Development of a Quality Improvement/Patient Safety Curriculum to Increase Emergency Medicine Resident Scholarly Activity.

Context: There currently is no standard method for teaching Quality Improvement/Patient Safety (QIPS) content to prepare resident physicians planning QIPS projects. As part of the 2015-2016 MSU Statewide Campus System (Te4Q) learner cohort, the first two authors from the McLaren Oakland Hospital Emergency Medicine (EM) residency program developed a structured multi-phase QIPS curriculum. The curriculum was developed to help a cohort of seven second-year EM residents feel more confident to design and conduct their own QIPS projects.

Electronic Medical Record Use and Maternal and Child Care and Health.

Objectives: To evaluate effects of EHR adoption and use during pregnancy on maternal and child health care utilization and health among pregnant mothers and their infants.

Methods: The study population was comprised of all Medicaid-insured pregnant women who delivered a singleton birth in Michigan between 1/1/2009 and 12/31/2012 and their infants (N = 226,558). Linked data included birth records, maternal and infant medical claims, and EHR adoption, implementation, upgrading and meaningful use data.

Mixed Influence of Electronic Health Record Implementation on Diabetes Order Patterns for Michigan Medicaid Adults.

Background: These 2011-2013 analyses examined the authors' hypothesis that relative diabetes care order changes would be measured after electronic health record (EHR) implementation for 291 Medicaid adults who received all of their office-based care at one midwestern federally qualified health center (FQHC) over a 24-month period (n = 2727 encounters, 2489 claims).

Method: Beneficiary sociodemographic, clinical, and claims data were validated with clinic EHR and state Medicaid claims linked to providers' national identifier numbers. Overall pre-post order rate comparisons, and a series of controlled within group binary logistic models were conducted under penalized maximum likelihood estimation terms.

Predictors of 2010-2011 Michigan Medicaid Beneficiary Adverse E-Code Health Care Encounters.

To inform Medicaid medication management and public health policymaking, the authors analyzed the major predictive factors influencing program-approved therapeutic use or poisoning E-coded encounters leading to emergency department visits and hospital admission for the totality of Michigan Medicaid beneficiaries during a 12-month 2010-2011 period. The analytic cohort was composed of 26,134 approved E-code encounters submitted for 19,865 discrete Michigan Medicaid beneficiaries.More than 1% of all beneficiaries experienced at least one adverse medication/agent-related E-code encounter during the period.

Is quality improvement sustainable? Findings of the American College of Cardiology's Guidelines Applied in Practice.

Objective: (i) To examine the sustainability of an in-hospital quality improvement (QI) intervention, the American College of Cardiology's Guideline Applied to Practice (GAP) in acute myocardial infarction (AMI). (ii) To determine the predictors of physician adherence to AMI guidelines-recommended medication prescribing.

Design: Prospective observational study.

Predictors of diabetes self-management in older adults receiving chemotherapy.

Background: Cancer patients with diabetes have higher mortality rates and are more likely to develop infections, and be hospitalized during treatment. Hyperglycemia has been hypothesized as one of the factors associated with this increased risk. Diabetes self-management is one of the essential elements used by patients to maintain glucose levels.