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. The primary 10-item survey instrument administered was the Dermatology Life Quality Index (DLQI). Respondents were asked a series of 10 additional questions concerning the degree to which abnormal mask-related skin conditions affect their skin symptoms, possible embarrassment/self-consciousness, and perceived impact of mask-related skin changes. A series of descriptive statistics, cross-tabulation charts, and graphical examinations of data was utilized to evaluate sample subgroup and outcome distributional patterns. Pearson r bivariate correlation coefficients between possible collinear predictive measures on the primary study outcome were calculated. A series of simple inferential chi-squared (Χ2) tests of independence were also conducted. RESULTS: A total of 370 out of 430 (86.0%) Beaumont Health employees noticed some degree of skin changes since the work-hours face mask requirement was instituted, while 378 out of 430 (87.9%) felt that their skin was better when not wearing a mask. The majority of respondents, 283 (65.8%), reported having at least a little symptomatic skin (i.e., itchy, painful, sore, stinging) during the prior week. Furthermore, 72.3% reported that they were at least a little embarrassed or self-conscious of their skin. Chi-squared analysis of composite DLQI score categories by the number of types of masks utilized (Pearson X2=19.0, df=8, p=0.015), and some degree of symptomatic skin (Pearson X2=156.4, df=4, p<0.001) were found to be statistically significant. CONCLUSIONS: A large number of healthcare workers are affected by mask-related skin changes. Further research should be directed at better understanding how skin changes associated with mask wearing impact one's quality of life and mental health.

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. METHODS: A 15-month retrospective chart review of ventilator settings and subject characteristics (N = 200) was conducted before and after a series of 10-15-minute educational sessions were delivered to improve LPV adherence. This information was presented at a series of four educational sessions for 25 attending physicians (n = two sessions) and 27 residents at conferences (n = two sessions). Two additional materials (e.g., LPV reference charts, tape measures to gauge patients' heights) were also posted in three ED resuscitation rooms and on cabinets containing emergency airway equipment. The pre and post-intervention occurrence rates of LPV setting orders were inferentially compared before and after educational sessions. RESULTS: Patients ventilated using LPV increased from 70% to 82% after the educational sessions (p = 0.04). All patients who were 67 inches or greater in height were ventilated appropriately before and after sessions. For patients under 65 inches in height, post-session LPV adherence increased from 13% to 53% (p = 0.01). CONCLUSIONS: Based on these results, a brief ED provider educational intervention can significantly improve the utilization of LPV guideline-based settings. Patients under 65 inches in height may also be especially at risk of receiving non-LPV ventilator setting orders.

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. RESULTS: The authors will discuss a total of 26 problematic project-related novice expectations during five typical project phase categories. CONCLUSIONS: Learning to navigate the complexities of training to become a practicing physician, while also planning high quality SA project designs has been and will continue to be a complex challenge. The authors hope that this article can be used by supervising faculty and other graduate medical education mentors to assist the SA project novice (SAPN) plan SA projects. By establishing realistic expectations during project planning phases, the SAPN can avoid potential missteps that typically impede SA project completion.

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. Overall responses were measured on a possible 0-10 scale and individual responses were tracked. The debrief process was triggered by one of four criteria and followed a standard format using a readily available form. RESULTS: A total of 178 pre- and post-debriefing protocol implementation survey responses were collected throughout the duration of the study. Of those, 79 (44.4%) were pre-protocol response surveys. The post-protocol responses were comprised of 51 (51.5%) six month and 48 (48.5%) 12-month surveys. The average overall satisfaction with code-response performance increased significantly following the implementation of the debriefing protocol, from M=6.661, SD=2.028 to M=7.90, SD=1.359 (independent t-test = 5.069, p<0.001). There was a statistically significant decrease regarding how respondents felt emotionally supported after a code by their staff, (Pearson Chi Square 14.977, df 4, p = 0.005). CONCLUSION: During this study, implementation of a post-code debriefing resulted in increased overall satisfaction with how codes had been conducted and there was a significant change in how staff felt in regards to code team leaders and an expectation of "returning to work." However, there a noted overall decrease in perceptions of feeling supported by other staff involved during the code. Further studies in both community and academic-based ED settings are needed to further explore these complex relationships.

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. SETTING: A community practice of otolaryngology-head and neck surgery with 3 clinical offices and a socioeconomically diverse patient population. SUBJECTS AND METHODS: Clinical data were collected retrospectively from the electronic health records of a continuous 4-year series of 628 patients with BPPV and age- and sex-matched controls. RESULTS: There were no statistically significant associations found between BPPV and diabetes, hypertension, dyslipidemia, or body mass index in the study population in pairwise comparisons or multivariable modeling. CONCLUSION: This study suggests that BPPV as encountered in a community ear, nose, and throat practice is not generally associated with cardiovascular risk factors. The possibility that these or other cardiovascular risk factors may be causative in some cases cannot be excluded, though most cases of BPPV appear to be caused primarily by shedding of otoconia from the utricle that is idiopathic or at least in part by unconfirmed noncardiovascular factors.

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. METHODS: For the initial session, the lead instructor conducted a focused two-hour course with the novice instructors. A subsequent four-hour session was then repeated for EM residents whereby the aforementioned novice instructors provided the hands-on instruction. The residents were given 10-item pre- and 20-item post-course knowledge tests to gauge the effectiveness of the instruction model. After the course, a satisfaction survey was administered to the resident participants and a qualitative open-ended survey to the volunteer EM physicians who served as instructors. RESULTS: Forty-two EM residents from 11 different residency programs attended at one of the three courses that were offered. After adjustments for size differences in the pre- and post-training tests, 35 (87.5%) of total sample resident learners' scores proportionately increased from pre- to post-test scores, with five (11.9%) other residents maintaining their pre-course score levels and only two (4.8%) residents experienced a post-score decline. In addition, resident participants responded favorably to a post-course summary evaluation with an average response of 4.8 (0-5 Likert scale) demonstrating overall satisfaction with the course. In the separate qualitative survey given to instructors, comments consistently conveyed a perceived benefit for the volunteer EM physicians. CONCLUSIONS: The evaluation of this novel model supports the feasibility of the 'train the trainer' program. It provides a proof of principle that train the trainer model can be implemented for POCUS training courses. Despite the small sample size, our results show an increase in the pre- to post-test scores among most participating residents. This model provides an additional option for EM residency program educators to consider when developing their POCUS training courses across multiple GME settings.

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. Ancillary findings were assessed by review of the radiographic reports. RESULTS: Ancillary findings were identified in N=338 (40.9%) of 825 patients with CTPAs that were negative for PE. Most ancillary findings, 254 (75.1%) of 338 were pulmonary or pleural abnormalities. Liver, gall bladder, kidney, or pancreatic abnormalities were shown in 26 (7.7%) cases, and abnormalities of the heart or great vessels were shown in 23 (6.8%) of cases. Abnormalities of the esophagus or intestine were shown in 12 (3.6%), abnormalities of the thyroid in 10 (3.0%) and abnormalities of bone or soft tissue lesions were shown in three (0.9%) cases. Inferential statistical procedures demonstrated that the occurrence of ancillary findings in patients with negative CTPAs was proportionately greater in patients who were 50 years and older (p < 0.001), although not between genders (p = 0.145). CONCLUSIONS: Ancillary findings on CTPAs that were negative for PE were frequently reported. Future studies might focus of the extent to which ancillary findings on CTPA assisted physicians in management of the patient.

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 boot camps 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. METHODS: Boot camps were of two different lengths: a five-day 2014 camp (n = 32 residents) and shortened three-day 2015 boot camp (n = 29 residents). Respondents from both boot camp cohorts were invited to complete the same 25-item OB/GYN practice skills confidence and knowledge survey. The first three authors developed this survey prior to the initial boot camp (2014). Revisions/adjustments were then made to content after the 2014 to pare down from the initial five days' worth of content for the 2014 boot camp to three days for the 2015 boot camp. RESULTS: Each of 45 sample resident respondents who provided complete pre-and post-boot camp data demonstrated improvements in self-rated practice confidence and knowledge levels. Mean per resident pre-post-boot camp survey rating levels for individual items in the shorter 2015 boot camp cohort increased by 1.096 (SD = 0.5487), over a two-fold increase for most individual items in the 2014 residents. Mean cohort differences represented a non¬-significant equivalent increase in pre-post practice confidence and knowledge levels for individual ratings items between the 2014 and 2015 cohorts (p = 0.241). CONCLUSIONS: Based on these preliminary results, the authors conclude that it may be possible to adjust their OB/GYN boot camp from five days to three and still achieve comparable learner outcomes while delivering the same basic content.

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. METHODS: Data was retrospectively collected on 170 consecutive patients who underwent primary THA at a single institution from January 2014 to October 2014. Outcomes from the first 85 patients who received intraoperative LB were compared to the prior 85 patients who received a standard intraoperative "cocktail" without LB. The remainder of the multimodal pain management protocol was identical between groups. RESULTS: Total continuous and categorical postoperative hospital opioid consumption rates in the LB subgroup were significantly lower than the non-LB subgroup ( p < 0.001). The use of LB was associated with a relative reduction in opioid consumption on the day of surgery ( p = 0.001), postoperative day 1 ( p < 0.001), postoperative day 2 ( p < 0.001) and postoperative day 3 ( p < 0.001). Patients who received LB had decreased length of stay ( p = 0.001) and were discharged on lower doses of opioids. CONCLUSION: Substituting to LB from a standard wound infiltrate during primary THA, in addition to our standard multimodal pain management protocol, resulted in significantly lower postoperative opioid consumption and decreased length of stay.

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. More such encounters and costlier approved encounters were recorded female subjects, African Americans, dually eligible adults, urban elderly, those with fee-for-service Medicaid coverage, and those residing in urban-density counties.Especially notably for patient safety policymakers, more than 9% of total E-coded encounters for children and adults were primarily attributed by providers to likely preventable poisoning causes such as exposure to household cleaning agents/gases, cosmetic products, illicit drug/alcohol, or secondary tobacco smoke. Encounter costs for the total sample totaled $37 million but ranged considerably up to more than a quarter million dollars.In view of the future expanding Medicaid-covered beneficiary cohorts, the authors propose several key patient safety/public health policy implications for researchers and policymakers striving to serve lower-income health care consumer groups.

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. Our group described this form of hypoglycemia and introduced the term FEEHD to refer to it (fasting-evoked en route hypoglycemia in diabetes). In a recently published small study, we reported a rate of occurrence of FEEHD of 27.1%. The objective of this study was to evaluate the rate of occurrence of FEEHD in another clinic. METHODS: Patients with diabetes were asked to complete a simple, 2-page survey inquiring about hypoglycemic events while fasting for labs in the preceding 12 months. RESULTS: A total of 525 patients completed the surveys out of 572 patients invited (91.8% response rate). A total of 363 patients with complete data were analyzed, with a mean age of 60.6 (SD 12.5) years. A total of 62 (17.1%) patients reported having experienced one or more FEEHD events in the prior 12 months. Of the 269 patients who were at higher risk of FEEHD (on insulin secretagogues or on insulin), 59 (21.9%) reported having experienced FEEHD. Only 33 of FEEHD patients (53%) recalled having contacted their provider regarding the events and only 22 (35%) indicated having received some sort of FEEHD prevention instructions. CONCLUSION: Our study shows a significant rate of occurrence of FEEHD in the real world (a clinical practice). FEEHD is especially dangerous, as patients often commute (drive) to and from the laboratory facility (potential risk of traffic accidents). Given study limitations, further studies are needed to assess prevalence of FEEHD in other settings and in the general populations.

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. METHODS: The overall purpose of this exploratory pilot project was to examine the pre-post impact of a faculty feedback flipped training model course provided to a convenience sample of community-based faculty learners. After receiving campus IRB approval, the authors developed a set of five primary course goals and objectives. A convenience sample of n = 17 community-based faculty who had completed the entire course were administered a pair of pre and post-course surveys regarding their overall feedback satisfaction and comfort levels for supervising residents. RESULTS: In summary, five of the 13 total survey items increased at statistically significant levels from pre-course levels. The majority of qualitative faculty comments also positively evaluated the flipped training model approach. CONCLUSIONS: These promising pilot findings suggest that a flipped GME faculty feedback skills training model can help improve faculty learners' satisfaction and confidence as they supervise residents and/or medical students. The impact of these types of flipped training models for GME faculty needs to be more rigorously examined in project settings with larger samples to identify what specific types of curricular activities might prove to be most effective for diverse faculty learners in GME programs across the nation.

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. The GME literature to date has frequently provided general commentaries regarding individual project strategies or oriented to settings with greater project-related resources. There have also been few articles offering scholarly activity planning strategies for community-based GME officials striving to increase scholarly activity levels. PROPOSED PLANNING FRAMEWORK: The authors propose a customizable assessment-planning framework, largely derived from their combined decades of consultation experiences with hundreds of community-based resident and faculty projects. The authors will first describe the primary elements of their proposed scholarly activity planning approach for GME leaders so often subject to worsening resource constraints. They will describe six ongoing developmental strategies with several exemplars described. Such a framework will likely require ongoing reassessments and modification. CONCLUSIONS: The authors hope that this proposed planning framework will offer GME administrators, faculty and residents with a pragmatic set of strategies to develop scholarly activity projects and supports. Ideally, GME leaders can use this approach to inform their design of a sustainable system-customized infrastructure of scholarly activity supports.

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. This was the first time this program was delivered in this manner. RESULTS: The authors' initial cohort of 19 learners successfully developed 15 projects, with two pairs of learners collaborating on projects. The second cohort of 15 learners developed 11 projects, with one pair of learners collaborating. The authors present a series of principles for community-based GME leaders striving to develop SA projects in their respective GME environments. CONCLUSIONS: The "consortium advantage" derived from entities such as the SCS may prove integral to efficiently coordinating SA project resources and knowledge across diverse GME systems.

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. After examining final working dataset patterns, a series of Kruskal-Wallis tests were conducted to identify statistically significant differences in perceived OR importance response categories across sample subgroups, including program specialty and primary vs non-primary care specialty. RESULTS: The final analytic sample comprised 278 osteopathic medical students, 359 residents, and 94 faculty members. Of 728 respondents, 497 (67.9%) indicated that OR was "somewhat important," "important," or "very important." The overall perceived importance category patterns varied significantly across students, residents, and faculty cohort respondents (, P<.001) and program specialty (, P<.001), as well as between primary care and non-primary care residents and faculty (, P<.001). CONCLUSION: Based on these initial results, OR is generally valued across osteopathic stakeholder groups, but significant differences may exist between different types of students, residents, and faculty. Pre- and postgraduate educational support structures designed to reduce barriers to OR implementation may help to sustain osteopathic principles and practice in the single accreditation system.

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. The 12-item survey questionnaire asked respondents a series of questions about their personal characteristics, prior experiences of treating PTSD and opinions concerning the use/potential use of MM for treatment of PTSD. RESULTS: A total of 83 psychiatrists (11.7% of total invited) responded to the survey. Several statistically significant correlations between respondent characteristics and other key measures (e.g., Age Category, Gender, Years of Psychiatric Practice, Psychiatric Practice Role (i.e., resident vs. attending), Number of Psychiatric Subspecialties, and Number of PTSD Patients Diagnosed and/or Treated to date) were found. A composite summary score was also formulated from questions related to opinion regarding the use of MM for PTSD and categorized into three comparison groups. The final stepwise multinomial logistic model demonstrated three statistically significant factors influencing what response category respondents fell into regarding MM use for PTSD: a) how often respondents had been exposed to recommendations concerning the use of MM for PTSD (p < 0.001), b) Age Category (p = 0.001) and how frequently respondents had recommended MM for treatment of PTSD (p < 0.001). CONCLUSIONS: The results from this smaller sample indicate that the majority of psychiatrist respondents did not support MM for the treatment of PTSD. Judging from these results, Michigan psychiatrists may be extremely conservative regard the prospective use of MM for PTSD. Few sample respondents indicated that they had been exposed to professional literature detailing MM and derivatives as a treatment for PTSD. Most respondents also indicated that they were Unsure/There is Not Enough Research concerning the scientific evidence for the use of MM for PTSD. Based on these findings from a smaller sample, the use of MM and its derivatives for treatment of PTSD may not currently be supported by the majority of Michigan psychiatrists.

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. RESULTS: Changes in care were significantly correlated with diagnosis and elevated liver function tests (LFT). The patients who benefitted most from MRCP were those with acute gallstone pancreatitis (r = 0.298, n = 109, p = 0.002) and patients with elevated LFT (r = 0.219, n = 89, p= 0.040). The most common way that MRCP influenced the care of patients with acute gallstone pancreatitis was by allowing providers to forego intraoperative cholangiogram (IOC) when MRCP results were negative (r = 0.335, n = 109, p < 0.001). CONCLUSIONS: The authors conclude that this was not the most cost effective management practice since the cost of intraoperative cholangiogram was about one quarter that of MRCP. Limiting MRCP use in patients with acute gallstone pancreatitis and preferentially using IOC at the time of surgery can likely decrease hospital costs without compromising care.

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. Pre-post comparisons with a control group (difference-in-difference) took advantage of a natural experiment of EHR adoption and use among providers in Michigan. Women and infants who received care from providers who adopted and used EHR were compared with those who received care from other providers, in a quasi-experimental framework. RESULTS: Over 34 % of all women in the analytic sample received perinatal care from providers who adopted and used EHR. Multivariate regressions indicate that women who received prenatal care mainly from a provider who adopted and used EHR were more likely to have any well-child visits (0.05, p = 0.04), and the appropriate number of well-child visits during the first year of life (0.03, p < 0.01). CONCLUSIONS: The findings of this study are consistent with EHR adoption and use supporting improved child health care utilization. The findings have the potential to provide Medicaid and other healthcare program officials with evidence of the potential gains to be derived from EHRs for vulnerable low-income women and infants.

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 Teach for Quality (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. METHODS: After institutional review board project approval was obtained, the first two authors evaluated both the pre and post-curriculum confidence survey scores of enrolled EM residents during May, 2016 as part of their Te4Q program participation. RESULTS: Residents completed a 15-item QIPS confidence survey before and after completing the QIPS curriculum. The mean pre-curriculum score was 3.00 (SD 1.53) on a scale from 0 to 10, indicating that the average sample respondent felt a lower level of comfort concerning their ability to design and conduct a prospective QIPS project. The mean post-curriculum confidence score from residents increased to 6.71 (SD 1.25) on a 0 to 10 scale, over double an increase from the pre-workshop score on this item. Using a series of non-parametric Wilcoxon Matched Pairs Signed Rank Test procedures suitable for smaller samples, statistically significant increases in pre- to post-curriculum differences were shown for composite confidence scores (Z = 2.207, p = 0.027), as well as for five of the 12 individual confidence items (p-values ranged from 0.023 to 0.046). CONCLUSIONS: These initial results certainly indicate that a structured ongoing QIPS curriculum may have the potential to improve EM residents' confidence levels to design and implement QIPS projects with faculty. The impact of these types of curricula for EM and other types of residents needs to be more rigorously examined in more tightly controlled GME settings with larger samples to gauge what types of resident learners will more likely benefit from such educational offerings across the nation.

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. In a busy clinical setting, many providers use a visual estimation of wound length for documentation. The purpose of this exploratory pilot study was to systematically examine the factors (e.g., sex, residency year, prior laceration training) associated with overall accuracy of five laceration length estimates made on a series of five identically-marked linear dummy torso sutured lacerations by a convenience sample of Emergency Medicine (EM) resident physicians. Before the study, the authors hypothesized that laceration estimates from later-year residents and/or those with more prior laceration training would be more accurate. METHODS: The EM residents who attended a statewide educational session were encouraged to participate in the study by independently entering information concerning their a) personal characteristics, and b) five laceration length estimates from five dummy torso sutured lacerations onto hard copy forms during break and lunch periods of the daylong conference. The use of any types of measurement devices was prohibited. RESULTS: A total non-probability convenience sample of 107 participants (93 EM resident physicians and 14 medical student attendees) from 14 different Michigan-based EM residency programs completed a 10-item survey during the educational conference. Results for both composite and individual actual-to-estimated (AE) laceration differences varied widely within the sample, with up to 58.9% of laceration over estimates hypothetically having resulted in overbilling of payers for the laceration repair. CONCLUSIONS: The considerable range in laceration estimates obtained from these EM clinicians indicate the complexity of attempting to estimate lacerations without measuring devices, as well as the potential for over-billing under such conditions. Larger resident samples recording laceration length estimates, with testing of potential interaction effects on AE patterns, are needed in the future to provide additional evidence concerning this aspect of EM billing.