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.

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.

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.

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.

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.

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.

Increasing comorbidity with diabetes in the community: diabetes research challenges.

Background: The purpose of this paper is to discuss the ongoing definitional, measurement and analytic challenges imposed on community-based diabetes researchers examining the experiences and outcomes of home-dwelling adults surviving longer with diabetes and additional comorbid health conditions. When selecting from the still limited number of standard hospital-oriented comorbidity methods, researchers across the world will need to consider a frequently complex series of methodological decisions from their enrolling such adults with increased comorbidity into study samples.

Conclusions: Three categories of methodological implications from increasing forms of comorbid diabetes are discussed for diabetes researchers.

Do self-report and medical record comorbidity data predict longitudinal functional capacity and quality of life health outcomes similarly?

Background: The search for a reliable, valid and cost-effective comorbidity risk adjustment method for outcomes research continues to be a challenge. The most widely used tool, the Charlson Comorbidity Index (CCI) is limited due to frequent missing data in medical records and administrative data. Patient self-report data has the potential to be more complete but has not been widely used.

Increasing primary care comorbidity: a conceptual research and practice framework.

Purpose: To present a "contrasting perspectives" conceptual framework reflecting the typically strained experiences of many comorbid adults now interacting with primary care clinicians across the world.

Background: More comorbidity-related needs are presented to primary care clinicians during typically shorter office-based health care encounters. The overall perceptual differences between many comorbid consumers and health care clinicians and systems in many countries are likely to worsen.

Posthospital heart-healthy behaviors in adults with comorbid diabetes.

The purpose of these secondary analyses was to examine relationships between patient factors and patient-provider decision-making style (PDM) on heart-healthy behavior changes in 142 adults with diabetes after hospitalization for an acute coronary syndrome (ACS). A clinical trial randomized adults to either control or a telephone coaching intervention. Generalized estimating equations were used to analyze the relationship between patient factors and PDM style on longitudinal postdischarge changes in three heart-healthy behaviors, avoiding high fat foods, weight loss, and increased physical activity.

Hopelessness and its effect on cardiac rehabilitation exercise participation following hospitalization for acute coronary syndrome.

Purpose: Hopelessness has been associated with a higher risk of fatal and nonfatal coronary heart disease, yet very few studies have examined hopelessness after a cardiac event. This investigation examined hopelessness as an independent predictor of participation in a hospital-based cardiac rehabilitation exercise program.

Methods: A total of 207 patients with acute coronary syndrome were interviewed at 3 and 8 months after hospital discharge.

Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome?

Background: Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care.

Objective: To test the effectiveness of a six-session outpatient telephone-based counseling intervention to improve secondary prevention (behaviors, medication) in patients with acute coronary syndrome (ACS) following discharge from hospital, and impact on physical functioning and quality of life at 8 months post-discharge.

Design: Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus).

The perceptions of older veterans concerning their postdischarge outcome experiences.

This study investigated the perceptions of a sample of older veterans regarding their outcome experiences after hospital discharge. Qualitative data from 165 participants were analyzed for major conceptual themes that best fit the structure of comments regarding participants' postdischarge experiences. Most responses were brief and suggested that few participants had considered their outcomes as being influenced by prior discharge planning interventions.

Postdischarge outcome rates influenced by comorbidity and interdisciplinary collaboration.

This study investigated the relationship between health care professionals' ratings of their discharge planning collaboration and other patient characteristics with rates of postdischarge outcomes experienced by a sample of elderly veterans. The significant influence of interdisciplinary collaboration levels and comorbidity was demonstrated on emergency room visits and postdischarge fall rates. The author discusses several complex methodological issues for future studies on the relationship between programmatic and patient characteristics and cross-sector patient outcomes.