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  Assessing Disparities in SEP-1 Bundle Compliance at Corewell Health

  Zachary Awad, Mark Munir, Paul Bozyk, and Ramin Homayouni

  Publication Date: 5-2025

  Sepsis, a life-threatening condition resulting from a dysregulated immune response to infection, carries significant mortality. To improve sepsis management, the Centers for Medicare & Medicaid Services (CMS) introduced the SEP-1 bundle, outlining critical interventions within specified timelines. This study aimed to investigate disparities in SEP-1 bundle compliance, examining variations among septic patients based on sociodemographic factors like age, race, and area deprivation index (ADI), as well as clinical factors like chronic health conditions.

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  Implementation of an ERAS Program and a Standardized Closing Tray Reduces SSIs in Colorectal Operations

  Elizabeth Carlson, Nora Laban, Shelli Bergeron, Diana Lee, Donna Kayal, Michelle Jankowski, Lihua Qu, Kristin LeMarbe, and Harry J. Wasvary

  Publication Date: 5-2025

  ● Colorectal surgeries exhibit a postoperative surgical site infection (SSI) rate of up to 30%, surpassing rates in other surgical disciplines.1,2

  ● Previous studies have emphasized preventative approaches, including multidisciplinary SSI bundles, to mitigate postoperative SSIs.3,4

  AIM: To assess the efficacy of the Closing Tray Protocol and the Enhanced Recovery After Surgery (ERAS) Program in reducing SSIs, addressing the pressing need for effective infection control measures.

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  Enhancing Reproductive Anatomy Education: A Comprehensive Approach Integrating Near-Peer and Reciprocal Peer Tutoring

  Hope Hefferan, Emelie-jo Scheffler, Erin Mueller, and Varna Taranikanti

  Publication Date: 5-2025

  • Near-peer tutoring (NPT): Tutors are more advanced than tutees, typically offering support in understanding complex concepts.1

  • Reciprocal peer tutoring (RPT): Students with similar levels of training alternate between tutor and tutee roles, facilitating collaborative learning.1

  • Peer tutoring fosters professional development and improves long-term retention of complex medical concepts.3,4,5

  • Reproductive anatomy is a challenging area for many medical students; Innovative peer tutoring methods may help improve understanding and retention of anatomical structures.

  • We hypothesize that integrating NPT and RPT within the laboratory setting in the reproductive organ system course will enhance student motivation, self-efficacy, and long-term retention of reproductive anatomical structures.

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  Allergies Coinciding with Central Sensitization Syndromes (ACCeSS)

  Jacqueline Morey, Alemu Fite, Carl Lauter, and Matthew Sims

  Publication Date: 5-2025

  Significance of Reported Allergies: Many reported drug allergies are mislabeled side effects or misinterpretations, leading to suboptimal treatment, antibiotic resistance, and worse patient outcomes.¹

  Central Sensitization Syndromes (CSS): CSSs are chronic pain conditions linked to altered sensory perception, including pain, fatigue, and neurologic dysfunction.² These patients may be more likely to misattribute medication side effects as allergies.

  Previous Findings & Hypothesis: Prior research found high allergy reporting in interstitial cystitis and fibromyalgia—both CSS conditions.⁴ We hypothesized that other CSS diagnoses also correlate with increased allergy reporting, emphasizing the need for better allergy evaluation.

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  Epic Best Practice Alerts Increases SEP1 Orderset Usage

  Mark Munir, Zachary Awad, Paul Bozyk, and Ramin Homayouni

  Publication Date: 5-2025

  Sepsis is a massive, system-wide inflammatory response to an infection that can lead to multisystem organ failure.1 Sepsis has a very high mortality rate of 20-50% in patients with severe sepsis and is the 10th leading cause of death in the United States.2 One of the most significant ways of reducing mortality from sepsis is timely detection and initiation of treatment in septic patients.3

  Electronic medical records such as Epic have implemented sepsis warning algorithms and alerts to facilitate quicker detection of sepsis and thus earlier initiation of treatment. The goal of this study is to determine if an Epic Best Practice Alert (BPA) of 5 is correlated with an increased likelihood of clinician’s using the sepsis order set in the EMR to assist in effective treatment of sepsis.

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  Examining Health Disparities: An Observational Study on Peripheral Vascular Access Outcomes among Hospitalized Patients

  Charlotte O’Sullivan, Nicholas Mielke, Yuying Xing, and Amit Bahl

  Publication Date: 5-2025

  Peripheral intravenous catheter (PIVC) placement is the most common invasive procedure performed in healthcare, with an estimated 90% of hospitalized patients requiring PIVC access during their stay. This equates to around two billion PIVCs used annually.1–3 Studies report 36% to 63% of catheters fail due to a variety of complications, including infiltration, occlusion, phlebitis, dislodgment, and infection. 2–6 These failures not only cause immediate patient discomfort and increased clinical workload but also have wider implications such as prolonged hospital stays and delays in critical treatments.2 The factors contributing to PIVC failure are multifaceted, involving clinical presentation, patient anatomy, provider skill level, and procedural circumstances. One significant determinant that has not been comprehensively addressed within the literature is healthcare inequities. These inequities permeate the healthcare system, adversely influencing outcomes across a spectrum of conditions and interventions. 7,8 It is well-documented that such disparities contribute to differential rates of chronic diseases and mortality; yet, their impact on PIVC placement and outcomes has not been similarly scrutinized.

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  Associations Between Health Literacy and Comprehension of Health Visits in a Community Setting

  Amanda Romaya, Adel Andemeskel, Salim Abdul-Razak, Linda Dillon, and Victoria Lucia

  Publication Date: 5-2025

  Low health literacy is a significant social determinant of health that is associated with poor health outcomes1-3. Bringing attention to health literacy will aid in promoting the health of the population. However little has been done to implement national policies and interventions that address patient health literacy, especially in a community setting4.

  We hypothesized that our assessment of the identified patient population’s health literacy will not meet adequate standards and will indeed demonstrate a need for community-focused interventions

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  Implementation of an Opioid Free Pediatric Hernia Repair Protocol

  Corey Shafer, Antonela Muca, Randy Hilleary, Kristin LeMarbe, Diane Studzinsk, Kaveh Aslani, Nathan Novotny, Pavan Brahmamdam, and Begum Akay

  Publication Date: 5-2025

  Surgery most often provides children with their first exposure to opioids which may lead to misuse and overuse. Protocolizing pain management perioperatively can reduce opioid exposure in children while still providing adequate pain management.

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  Surgical Site Infection Bundle For Babies: Preliminary Data

  Cullen Woodley, John Nida, Alexis Lonjin, Katelyn Ward, Diane Studzinski, and Begum Akay

  Publication Date: 5-2025

  Surgical Site Infections (SSIs) are infections that occur in or around the area where a surgery was recently performed. They are estimated to account for 20% of all healthcare associated infection, and lead to an increase in morbidity and mortality. Perioperative care bundles show promise in reducing SSIs in adults but are not often used in neonatal surgery. Infections in babies after surgery are less common than adults but carry significant morbidity in a fragile patient.

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  Analysis of ED Visitors for Dermatological Disorders Prior to and During the COVID Pandemic

  Faris Alkhouri, Jacob Keeley, and Ramin Homayouni

  Publication Date: 5-2024

  Dermatology-related Emergency Department (ED) visits make up more than 3% of total ED visits1; however, only around 2% of these visits can be considered true emergencies.2 To our knowledge, there are no studies that examined demographic influences on ED visits in regards to skin disorders in the adult population.

  The sudden onset of the COVID-19 pandemic had significant effects on healthcare systems and policies, which resulted in a nationwide decline of 20-43% in ED visits.3 However, no studies have examined the impact of the pandemic on the presentation of skin disorders in the ED.

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  Use of Early Enteral Nutrition in Mechanically Ventilated COVID-19 Patients

  Vivian Chang, Ramin Homayouni, and Virginia Uhley

  Publication Date: 5-2024

  Malnutrition in critically ill patients has been associated with a greater length of hospital stay, incidence of complications, and risk of death. Up to 37% of critically ill patients in the intensive care unit (ICU) are either moderately or severely malnourished1. Optimizing enteral nutrition delivery is key to maximizing the benefits of nutrition support for critically ill patients. At the onset of the COVID-19 pandemic in March 2020, the role of nutrition support for COVID-19 patients was poorly understood. In May 2020, the American Society of Parenteral and Enteral Nutrition (ASPEN) approved nutrition guidelines for COVID-19 patients that state that the initiation of early enteral nutrition should occur within 24-36 hours of ICU admission or within 12 hours of intubation and placement on mechanical ventilation.

  Further research is needed to investigate the impact of early nutrition support therapy on the clinical outcomes of COVID-19 patients on mechanical ventilation.

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  Trends in Thoracic Endovascular Aortic Repair in Patients 45 Years Old and Younger

  Brandon Diaz, Alexander Chen, Graham W. Long, Rose Callahan, Diane Studzinski, and Otto W. Brown

  Publication Date: 3-2024

  Objective:Thoracic endovascular aortic repair (TEVAR) is now the preferred method of repair for most aortic pathology. This report explores the indications, morbidity, and long-term implications of TEVAR in patients under 45 years old.
  /="/">Methods:This is a retrospective, single-institution study of electronic medical records for all patients under age 45 years treated with TEVAR from July 2006 to December 2022. Data collected included demographics, comorbidities, and 30-day and long term outcomes, including medical and aortic-related complications.
  /="/">Results:The study cohort consisted of 30 patients, mean age 32 years, 22 males (73.3%), 10 (33.3%) with hypertension, and 15 (50%) were smokers. There were 16 (53.3%) traumatic disruptions, 1 (3.3%) aneurysm, 1 (3.3%) penetrating atherosclerotic ulcer, and 12 (40%) dissections (7 Type A and 5 Type B). Three patients died within 30 days of their procedure for a perioperative mortality rate of 10%; the interval from procedure to death was a mean 4.3 days (SD ± 3.8). Twenty-one had at least 1 follow-up visit post-TEVAR and 22 underwent at least one follow-up imaging study. Thirty-day morbidity overall was 50% and included endoleak in 6 (20%), cardiac complications in 5 (16.7%), renal failure in 7 (23.3%), spinal cord ischemia in 1 (3.3%), graft failure in 1 (3.3%), limb ischemia in 3 (10%), and multi-system organ failure in 3 (10%). Of the 22 patients with follow-up imaging, endovascular reinterventions were required in 4 (18.2%), while open surgical reintervention was necessary in 1 (4.5%). Reinterventions occurred at a median of 3.7 months postoperatively (0.7-60.8) and were indicated for 1 expanding aneurysm, 3 endoleaks, and 1 for combined endoleak and expanding aneurysm. There was one late death at 1.1 months (aortic-related) and another deceased patient whose cause and date of death are unknown.
  /="/">Conclusion: Historically, patients that undergo TEVAR for underlying aortic pathologies, especially young patients, are followed long-term to monitor for further aortic degeneration and possible reintervention. In our study, majority of all reinterventions (80%) occurred within 1 year. However, all patients with traumatic aortic disruption who underwent TEVAR did not require any reintervention upon follow-up imaging. These patients may not require surveillance past one year

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  Characterizing the Effectiveness of Prehospital Pediatric Pain Management in Children with Long Bone Fractures

  Revelle Gappy, Ashima Goyal, John Frawley, Sariely Sandoval, Nai-Wei Chen, Remle Crowe, and Robert Swor

  Publication Date: 5-2024

  Prehospital pediatric pain management has been poorly understood and sub-optimally treated.1-3 Pain scales for children differ from adult pain scales and it is unclear if pain assessments are well documented, particularly in infants and toddlers.4-6 Surveys of emergency medical services (EMS) personnel identify barriers to pain management including discomfort with emergency care of injured children, concern for allergic reactions, additional pain from intravenous catheter insertion, parental influence, as well as lack of knowledge and experience secondary to the relatively infrequent treatment of acutely injured children.7-9

  The effectiveness of prehospital pain medication administration for children is unknown, as is the efficacy of basic, non-pharmacological measures such as splinting and icing for pain management. Historically, opioids for pediatric pain management have been in widespread use.10 The American Academy of Pediatrics (AAP 11) and several other national organizations created a joint policy statement in 2009 that reaffirms the importance of pain assessment and treatment, including sedation and analgesia, as a potential development topic for pediatric care and professional performance.

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  Utility of Great Saphenous Vein Mapping in the Detection of Superficial Vein Thrombosis Prior to Infrainguinal Arterial Bypass

  Melissa C. Hetrick, Ashley E. Beale, Graham W. Long, Sarvar Oreizi-Esfahani, Rose E. Callahan, Diane M. Studzinski, and Otto W. Brown

  Publication Date: 3-2024

  OBJECTIVE: The great saphenous vein (GSV) is widely used as a bypass conduit for the treatment of infrainguinal peripheral arterial disease. Preoperative vein mapping assesses both the quality and diameter of the GSV. Ultrasound findings regarded as unfavorable are the presence of superficial vein thrombosis (SVT), ipsilateral deep vein thrombosis (DVT), and small vessel diameter. Identifying a suitable conduit is of utmost importance as GSV bypasses have improved patency compared to alternative conduits. The primary objective of this study was to identify the percentage of patients with ipsilateral SVT as well as patient characteristics associated with SVT and unsuitable GSV.
  /="/">METHODS: Retrospective, single-institution study from March 2013-December 2021. All patients with peripheral arterial disease who underwent outpatient vein mapping were included. Unsuitable GSV was defined by the presence of SVT, DVT, or size < 2.5 mm in any segment (from proximal thigh to distal calf).
  RESULTS: A total of 191 patients met inclusion criteria. Most patients were male (71.7%), Caucasian (69.8%), and the mean(SD) age was 68.6(10.8) years. Ipsilateral SVT was identified in 10.5% of patients. No significant differences in demographics or comorbidities were identified in patients with and without ipsilateral SVT. Less than half (45.8%) of patients had GSV that was greater than 2.5 mm throughout, and only one third (37.4%) had a GSV conduit of adequate size without SVT or ipsilateral DVT. GSV conduits of adequate size and without SVT or ipsilateral DVT were associated with male gender, 86.6% male vs 13.4% female (p=0.001, OR 3.6 (95% CI 1.6-8.2)). After completion of vein mapping, 90 (62.1%) patients underwent infrainguinal bypass and the ipsilateral GSV was used as a conduit in 58.9% of cases.
  /="/">CONCLUSIONS: Our study revealed that 10.5% of patients have SVT identified on preoperative vein mapping. Given these findings, routine preoperative venous duplex should be performed to assess for the presence of SVT, as this finding is difficult to identify intraoperatively and may predict lower patency rates. Veins identified as unsuitable, based on size criteria alone, should still be investigated intraoperatively with ultrasound or direct surgical exploration as vessel diameter, unlike SVT, is a dynamic finding.

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  Heart Rate Metrics in Surgical Residents Performing an Educational Task Under Stress

  Harkirat Jawanda, Kathryn K. Howard, and Rose E. Callahan

  Publication Date: 5-2024

  Although a moderate amount of stress can be beneficial for performance, excess stress can lead to a decrease in fine motor skills, focus, decision-making skills, and communication.1-3.

  • These effects can be especially detrimental in the operating room, where a stress-induced lapse in performance can lead to catastrophic outcomes for patients.
  • One unique stressor experienced by surgical residents is observation by an attending surgeon during procedures, which has been shown to lead to an increase in stress related behaviors.4
  • Mimicking the stress of the operating room in simulation environments presents the opportunity for residents to improve their ability to recognize and manage stress.

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  Association Between Primary Care and Emergency Department Utilization

  Donna Kayal, Jacob Keeley, and Ramin Homayouni

  Publication Date: 5-2024

  Emergency departments have been designed to provide rapid and accessible care for emergent and acute needs for a broad scope of illnesses and injuries.1-2 However, the emergency department (ED) has been facing an overwhelming increase in demand, leading to an increase in wait time and significant overcrowding, which decreases the effectiveness of the ED.1-4 A common explanation that has been noted over the years is utilization of ED services for non-emergent care, which professionals have often labeled as “inappropriate use.”2,5 Such encounters take away time from ED physicians and health care workers, compromising the care for true emergencies and leading to suboptimal care of the non-emergency visits that could be addressed more appropriately in a more comprehensive and long-term management and care.1 Numerous studies have shown that Medicaid patients have a higher rate of ED use than the commercially insured patients.1,3,4 Some studies have emphasized the importance of Primary Care Physicians (PCPs) in perhaps decreasing the use of the ED for frequent over-utilizers, however other studies have found contraindicatory results, stating that patient’s use of the ED are more often driven by their health care conditions and needs rather than the involvement of a PCP.4 With the Affordable Care Act, there has been an increase in emphasis of access to PCPs, but there continues to be many limitations for Medicaid patients.

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  Fractionated Radiosurgery Associated with High Rates of Local Control for Large Volume Intact Brain Metastases

  Ryan Ko, Hong Ye, Peter Chen, Zachary Seymour, Kuei Lee, and Inga Grills

  Publication Date: 5-2024

  Radiosurgery is a well-established treatment modality for patients with intact brain metastases, and there is a known impact of tumor size and volume on tumor control. Utilizing our single-institution database, we investigated outcomes for patients with intact brain metastases treated with FSR using LINAC or GK modalities.

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  Effectiveness of a Modified Difficult Colonoscopy Score A Retrospective Review of General Surgeon Performed Colonoscopies at a Community Hospital

  Killian Llewellyn, Lianne Caceres, Christian Przeslawsk, Karen Childers, and John Parmely

  Publication Date: 5-9-2024

  Colonoscopy remains the mainstay of screening for colon cancer in the US and an essential operating room skill for general surgeons.

  A quality review was performed of general surgeons at a community hospital.

  Difficult Colonoscopy Score (DCS) was a score created to predict difficulty of colonoscopy which was defined as prolonged intubation time, need for external compression, or increased pain score [1]. We tested the utility in our community and resident-involved endoscopy department.

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  Perioperative Antibiotic Use in Neonatal General Surgery: A Survey of APSA Membership

  Samuel K. Osei, Ashley Williams, Diane Studzinski, Patrick Karabon, Begum Akay, and Pavan Brahmamdam

  Publication Date: 5-2024

  • Guidelines for antibiotic prophylaxis for surgical site infection (SSI) are widely used for adult patients.
  • There is limited data on prophylaxis in pediatrics, and there are no standardized guidelines for neonates.
  • Perioperative antibiotic use in neonates based on the surgeon’s preference.

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  Traumatic Thoracostomy Tube Management at a Community Hospital A Retrospective Review

  Christian Przeslawski, Peter Habib, Kita Mack, Vimal Love, Julie George, and Amelia Pasley

  Publication Date: 5-9-2024

  Thoracostomy tubes or chest tubes (CT) have been a mainstay in thoracic trauma treatment since the Vietnam war with their roots dating back to the 5th century. Trauma is the number one cause of death in the world, with chest trauma being the second highest cause of trauma related death. 18% of patients with a blunt thoracic injury require chest tube. Management varies widely and there is no general consensus on management.

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  Breast Irradiation is Well Tolerated in Carriers of a Pathogenic ATM Variant

  Leah R. Rotenbakh, Andrew H. Zureick, Dana Zakalik, Thomas J. Quinn, Vincent P. Grzywacz, Peter Y. Chen, and Joshua T. Dilworth

  Publication Date: 5-2024

  • The ataxia telangiectasia mutant (ATM) gene is implicated in DNA damage repair.
  • A pathogenic germline variant of the ATM gene is present in approximately 1% of the population.
  • ATM gene variant increases radiation sensitivity and elevates the life-time risk of developing breast cancer by two- to four-fold.
  • Potential for increased radiosensitivity poses concern for the utilization of radiation therapy (RT) for oncologic treatment in patients with the ATM gene variant.
  • Current data regarding RT tolerance are limited and conflicting in this patient population.
  • Current guidelines for hereditary breast cancer management issued jointly by the American Society for Radiation Oncology, American Society of Clinical Oncology, and the Society of Surgical Oncology in 2020 recommend that radiation should not be avoided in patients with the pathogenic ATM variant, but the quality of evidence supporting this recommendation was low with moderate strength at the time.

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  Efficacy of an Integrated Computer Assisted Learning (CAL) Module in Student Understanding of Cardiovascular Embryology

  Nicolaas Schimmel, Forrest Bohler, and Varna Taranikanti

  Publication Date: 5-2024

  • Embryology is one of the most difficult topics for students to master1

  Students’ perceptions of embryology are generally more negative:

  • Not clinically important1

  • More negative attitude than towards gross anatomy1

  • Unhappy with current teaching methods and not confident learning it2

  An integrated CAL module will allow a more linear model for learning congenital heart diseases, which may help improve students’ understanding of cardiovascular embryology.

  • Compared to traditional, more segmental model where students learn embryology separately from clinical presentation, ECG interpretation, etc.
  • CAL modules have proven effective for other organ systems3.

  • We hypothesized that students would demonstrate positive attitudes towards a CAL module for learning cardiovascular embryology and would demonstrate increased understanding of the material (high efficacy)

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  Virtual Pee Pee Party in the Time of a Pandemic: A Cost and Time Analysis of Participant Recruitment and Urine Sample Collection through Social Media Optimization

  Prasun Sharma, Sarah N. Bartolone, Eli P. Ward, Laura E. Lamb, Joseph Janicki, Christopher Smith, Melissa Laudano, Bernadette M. M. Zwaans, and Michael B. Chancellor

  Publication Date: 5-2024

  Conducting a clinical research study can be expensive and time consuming. High cost and/or long duration of a study can delay bringing new diagnostics and therapy to patients and increase cost of care to the patients. Online recruitment of participants, using social media (e.g. Facebook, TikTok, Twitter, YouTube, etc.) for at-home collection of clinical samples has potential to reduce cost of participant acquisition and retention. A cost and time effective online recruitment technique, crowdsourcing, may also help research facilities with smaller budgets to maximize their findings1. Online recruitment may also help reach out to more disease stakeholders including participants outside a clinic’s typical geographic area as well as reach more patients suffering from a particular disease of interest.

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  Smoking and COVID-19: An Analysis of Demographics, Risk Factors, and Outcomes

  Andrew Vrtar, Luca Cucullo, and Richard H. Kennedy

  Publication Date: 5-2024

  • Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a respiratory pathogen that first emerged in late 20191 and was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020.
  • Cigarette use is a significant public health concern throughout the world. Despite reductions in prevalence in recent years, tobacco smoking remains one of the main preventable causes of ill-health and premature death.
  • Both tobacco smoking and vaping are phenomena that may increase the vulnerability of these individuals to COVID19 infection.4 Therefore, it is crucial to explore the medical consequences of and the effects of tobacco exposure in relation to COVID-19.

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  Effects of Education on Gardasil Administration Within Varying Patient Demographics

  Emily Zajac, Megan Amos, Farrar Jean Ford, Kelly Dubay, Teresa Mccartney, and Chen Shen

  Publication Date: 5-9-2024

  The purpose of this quality improvement study is to evaluate how physician education impacts patient education and HPV vaccination rates within obstetric and gynecologic clinics affiliated with Corewell Health Farmington Hills Hospital, with the purpose of improving HPV vaccination rates among women. Patient demographics and incidence of physician education will be analyzed for the relationship to HPV vaccination rates within the three OBGYN clinics.

  Current data indicates that this quality improvement measure is needed for the population seen by these clinics. According to MCIR, a small percentage of teenage patients in Michigan have completed the 3 dose HPV vaccination series (16.7% for males and 32.8% of females). Nationally, while HPV vaccination rates continues to increase, they remain lower than vaccination coverage with routinely recommended vaccines. Locally, Oakland county HPV vaccination rates remain lower than Michigan and national numbers.

  OBGYN providers do not see the target population (11–12-year-olds) for the initial vaccine. Given that ACOG recommendations for vaccination have recently changed, we aim to increase provider knowledge of these recommendations and thus improve the vaccination rates. Provider education and recommendation for vaccines has been shown to correlate in favor of increased incidence of HPV vaccination.

  Initial findings noted that after provider education and education to the patients, patients decided to review information on their own terms. Therefore, not showing a sudden increase in the vaccine rate.