bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diverting Ileostomy vs Colostomy in Colorectal Surgery: A Single Institution Outcomes Comparison
Authors: Cairl Nicholas , Huebner Marianne , Kolli Nivya , Cleary Robert 
Published: August 2024

Introduction: Diverting stomas often accompany total mesorectal excision (TME) for rectal cancer and for patients having anterior resection for complicated diverticulitis when the risk for anastomotic leak is increased. Diverting stomas are also an option to urgently relieve colonic obstruction from neoplasia or diverticular disease. The diverting stoma choice is often a loop ileostomy that increases the risk for acute kidney injury (AKI) or a diverting loop transverse that may be greater risk for stoma prolapse. The objective of this study is to determine if ileostomy or colostomy is a better diversion option when considering complications and outcomes on a dedicated enhanced recovery colorectal surgery service. Methods: This is a single institution analysis of a prospectively maintained institutional colorectal surgery database between 01/01/2018 and 09/30/2023. The primary outcome was the postoperative 30-day complication rate after diverting ileostomy or colostomy. Secondary outcomes were AKI, stoma prolapse, other individual complications, and readmissions. Strength of association was estimated with multivariable logistic regression models adjusted for patient characteristics. Results: 347 patients met inclusion criteria – 81 with a diverting colostomy and 266 with a diverting ileostomy. Patients undergoing diverting colostomy were older than those undergoing diverting ileostomy (64.2 +/- 14.5 years versus 59.1 +/- 13.9 years, p =0.006), had lower BMI (26.32 +/- 5.95 kg versus 27.66 +/- 6.39 kg, p = 0.028), and had a higher incidence of diabetes (18.5% versus 10.2%, p = 0.043). The overall complication rate was significantly higher for ileostomies (29.6% vs 59.8%, p<0.001 ) as was acute kidney injury (1.2% vs 16.2%, p<0.001), ileus (13.6% vs 35.7%, p<0.001), SSI III (2.5% vs 9.8%, p=0.035), ED visits (9.9% vs 24.4%, p=0.005), and readmissions (6.2% vs 18%, p=0.009). Stoma prolapse within 6 months (4.9% vs 0.4%, p=0.003), reoperation (7.4% vs 0.8%, p<0.001), and postoperative death (4.9% vs 0%, p<0.001) were significantly higher for the colostomy group. Conclusions: Colostomies are associated with fewer complications and may be a better option for fecal diversion when there are no other factors that preclude this choice.
The Management and Outcomes in Blunt Splenic Injury: A Comparison Between a Rural and Urban Trauma Center
Authors: Graham Isabella , Ethridge Meryl , Kole Kerry , Helveston Sarah , Adams Courtney , Valencia Jason , Szpunar Susan , Edhayan Elango 
Published: August 2024

Introduction: The management of blunt splenic trauma (BST) has evolved over the last 20 years, with nonoperative management in hemodynamically stable patients prevailing as the standard of care. Nonoperative management includes angioembolization of the splenic artery. Although non-operative management has increased in use, there is limited standardization of practices for the management of blunt splenic trauma. The objective was to compare outcomes for BST and the use of angioembolization between a Level 1 urban trauma center, Ascension St. John Hospital, Detroit MI (ASJH) and a Level 2 rural trauma center, Munson Medical Center, Traverse City MI (MMC). Methods: Our study used registry data comprising all patients from 1/2015-12/2021 who presented to ASJH and MMC with BST. Patients were divided into operative intervention versus non-operative management groups. Data collected included timing of intervention, length of stay, severity scores, blood product requirements and concomitant injuries. The management and outcomes between the two institutions were compared. Data were analyzed using Student’s t-test, the χ2 test, the Mann-Whitney U test and logistic regression. Results: Data were collected on 93 patients from ASJH and 189 patients from MMC. Splenic injury grade was scored from one to five, with 60.0% of patients scoring grade three or higher and 62.1% of patients having active blush identified on imaging. Eighty-four patients (28.4%) had operative intervention and 24 patients (8.5%) underwent angioembolization. ASJH had an angioembolization rate of 15.1% vs 5.3% at MMC (p=0.006). When comparing the two hospitals, patient groups were different in terms of race (p=0.001), fresh frozen plasma administered (p=0.046) and presenting systolic blood pressure (p=0.001). In patients with active blush, after adjusting for hemoglobin on arrival, ASJH patients were 3.8 times more likely to have angioembolization than patients at Munson (p=0.02). TRISS and race dropped out of the model. Conclusions: There is a significant difference in the rate of non-operative management between the hospitals. Higher rates of angioembolization at an urban center may reflect a difference in resource distribution between urban and rural centers.
Consistent Support Group Attendance is Vital for Clinically Sustained Weight Loss in a Community Gastroenterology Clinic
Authors: Tolia Sangini , Gunaratnam Sejal , Kumar Nishant , Evans Mallory , Gunaratnam Naresh 
Published: August 2024

Introduction: The increasing prevalence of obesity places a high burden on the economy with annual medical expenses approximating 150 billion dollars. Obesity-related gastrointestinal disorders, including non-alcoholic fatty liver disease (NAFLD), account for over 30% of patient visits to community GI practices. Total body weight loss (TBWL) of 10% or more is associated with reversal of NAFLD-associated fibrosis and steatosis. However, achieving this goal alone can be difficult. Support groups have proven to be vital in allowing individuals to recover from other lifestyle diseases like alcohol overuse. The aim of this study was to assess the impact of support group attendance on a patient achieving 10% TBWL while enrolled in a structured, community-based weight loss program. Methods: Patients enrolled in the weight-loss program participated in a 6 month support group with weekly online meetings. These sessions included discussions of shared experiences and education on the 4 pillars of the program - nutrition, exercise, sleep, and mindfulness. TBWL was calculated by taking the difference of the patients starting weight and their 6 month weight divided by the starting weight. Data was collected retrospectively through chart review. By April 2023, a total of 95 patients completed the support group program. Statistical analysis was performed using ANOVA and Tukey-Kramer post-hoc tests. Results: The mean percent weight loss was 6.30% for the group with 0-50% attendance, 9.30% for the group with 51-75% attendance, and 13.15% for the group with 76-100% attendance. A one-way ANOVA revealed a statistically significant difference in the percent weight loss across the three groups (F(2,92) = 8.66, p <0.001). Further analysis with a Tukey-Kramer post-hoc test revealed a significant difference in percent weight loss between the group with 76-100% attendance and groups with 0-50% attendance (p<0.05) and 51-75% attendance (p<0.05). There was no significant difference in percent weight loss between the groups with 0-50% and 51-75% attendance (p>0.05). Conclusions: The results of this study indicate that patients with more than 75% attendance at support group meetings across a six-month period reported significantly higher percent weight loss than patients with lower attendance. This study supports the efficacy of support group meetings toward achieving weight loss. Further studies with larger sample sizes are ongoing to measure the efficacy of support groups on a long-term basis.
Digital Stethoscope Utility in NICU, SCN, and LDRP Patients
Authors: Forbes Kathryn , Covi Stuart , Nazee Marla , Al-Anani Shada , Anne Premchand , Pappas Athina , Zoma Justino , Szpunar Susan 
Published: August 2024

Introduction: To this day, abnormal auscultatory findings on acoustic examination of the cardiovascular system remains the most common reason for referral to a cardiologist. Three limitations exist with acoustic stethoscopes: 1) high selective sensitivity requirement is needed; 2) easy disruption by ambient environmental noise; 3) subjectivity of interpretation based on the provider’s experience, skills, and auditory proficiency. The introduction of digital stethoscopes offered a solution to the limitations of the traditional acoustic stethoscope while at the same time broadening the diagnostic potential of such devices: 1) improvement in sound quality; 2) amplification of the acoustic signal; 3) reduction of ambient noise. The objectives were: 1. To determine the accuracy of the digital stethoscope when used in neonatal intensive care unit (NICU), Special Care Nursery (SCN), and Labor & Delivery Recovery Postpartum (LDRP) patients; and 2. To determine if its use leads to improved detection rates of cardiac pathologies compared to the use of a classic acoustic stethoscope. Methods: This is a single center, prospective study of neonates in the NICU, SCN, and LDRP at Ascension St. John Children’s Hospital. After obtaining informed consent, infants were examined using both acoustic and electronic stethoscopes by trained residents. Data from chart review and echocardiography were also collected. Results from the two stethoscopes were compared to each other and to echocardiographic findings. Data were analyzed using Student’s t-test, the χ 2 test and the McNemar χ 2 test. Results: The study included 15 infants, mean of 33.3 ± 3.8 weeks’ gestation at birth, 46.7% female (7/15) and 66.7% (10/15) black. Of the 15 patients evaluated, for the differential diagnosis and the ECHO results, there was 56% (5/9) better agreement with the electronic stethoscope, 33% (3/9) equivocal agreement between the electronic and acoustic stethoscopes, and 11% (1/9) worse agreement between the electronic stethoscope differential diagnosis and the actual ECHO results. Conclusions: There is a trend towards better agreement between the electronic stethoscope differential diagnosis and the actual ECHO results. A larger sample size is needed to determine true statistical significance of the data and probability.
A Review of High-Risk Pregnancy Complications in the Resident Clinic
Authors: Saleh Ali Aya , Bain Tolbey , Juma Mina , Katz Samantha , Hoofman Jacob , Khan Ayesha 
Published: August 2024

Introduction: A high risk status can develop during a patient’s pregnancy or can be present from conception. These include maternal pre-existing conditions such as hypertension, diabetes, infection such as HIV, and obesity. Fetal complications such as anomaly or multiple gestation also constitute high risk pregnancies. The Corewell Health East Dearborn resident high risk clinic helps to manage these patients’ pregnancies and deliveries. This study aims to analyze the current complications and delivery outcomes of pregnancies from this clinic. Methods: The prenatal care data and pregnancy outcomes from patients in our high-risk resident clinic was collected from Jan 1st 2023 to Jan 1st 2024. The prenatal care data was analyzed for maternal and fetal complications along with delivery outcomes. Results: During the year 2023, 100 patients delivered from the high-risk clinic. Fetal complications were found in 32% of these deliveries. These included 12% twin gestation, 14% growth restriction, 6% fetal anomalies. Maternal complications included 27% with chronic hypertension, 23% with prior cesarean section, 27% with a BMI of 40 or higher, 10% cardiac complications, 4% pre-existing renal complications, 26% with pre-existing diabetes, 3% wtih HIV, and 6% with polysubstance use. The deliveries included 62% cesarean sections and 34% vaginal deliveries. Discussion: The results from our cross-sectional study revealed a high rate of maternal and fetal complications among patients from our high-risk clinic when compared to national averages. There was a high cesarean section rate for these patients. Conclusions: This study allowed us to better understand the patient population that receives care through the resident high-risk clinic. Future studies can explore how to decrease the cesarean section rate.
Prognostic Value of MRI-Assessed Central Gland Volume for Biochemical Recurrence after Prostate Cancer Radiotherapy
Authors: Lee Joseph , Salari Kamran , Nandalur Sirisja , Shen Chen , Al-Katib Sayf , Zhao Lili , Krauss Daniel J , Thompson Andrew B , Seymour Zachary A , Nandalur Kiran R 
Published: August 2024

Introduction: Increasing central gland volume has been associated with less aggressive prostate cancer, theorized to be secondary to biomechanical stress from benign prostatic hyperplasia (BPH). The aim of this study was to evaluate pretreatment prostate magnetic resonance imaging (MRI) metrics and clinical characteristics in predicting biochemical recurrence (BCR) after definitive radiotherapy (RT) for prostate cancer. Methods: In this retrospective single institution study, we identified men in our database with prostate cancer who underwent MRI within 6 months prior to completing definitive RT from May 2011 to February 2023. Total prostate volume, central gland volume, and peripheral zone volume were measured by a radiologist using manual segmentation. The primary objective was to determine the association of central gland volume with biochemical recurrence, defined by Phoenix criteria. A multivariable Cox proportional hazards regression model was constructed and adjusted for clinical factors. Results: A total of 373 men (median age 68 years) were included, with a median follow-up of 28 months. 13 (3.5%) were low risk, 97 (26%) favorable intermediate ris, 201 (53.9%) unfavorable intermediate risk, and 62 (16.6%) high risk. 54 (14.5%) patients received conventionally fractionated RT, 105 (28.2%), moderately hypofractionated RT, 121 (32.4%), high-dose rate brachytherapy, and 93 (24.9%) stereotactic body RT. The 3 and 5 year rates of BCR were 7.8% and 18.3%, respectively. Taking into account NCCN risk group and RT type, higher central gland volume was associated with decreased risk of BCR (HR: 0.73, 95% CI: 0.55-0.98, p=0.03). No significant association was seen with peripheral zone volume, PI-RADS score, or RT type. Conclusions: Increased central gland volume on pretreatment prostate MRI is independently associated with a lower risk of biochemical recurrence after definitive radiation for prostate cancer. BPH appears to confer favorable outcomes in RT patients and represents a novel, easily quantifiable metric in risk-stratification.
Improvements in Efficiency and Resident Satisfaction Following the Implementation of a Central Supply Closet
Authors: Amalathasan Theourrn , Moughnyeh Mohamad , Bolliet Marine , Oppat William 
Published: August 2024

Introduction: In the 1970’s, the idea of burnout began and was defined as emotional exhaustion, depersonalization, and low sense of personal accomplishment (1). Recently, there has been a push by graduate medical education to counter resident burnout, as demonstrated by resident wellness initiatives becoming a requirement for residency programs in the United States (2). At our institution, a source of burnout was the time it took to gather supplies for critical bedside procedures, which was addressed by instituting a central supply closet. Methods: A checklist was made of the supplies needed for four common bedside procedures: central venous access, arterial line placement, thoracostomy tube placement, and incision and drainage. 9 surgery residents were individually timed to locate the equipment required for each individual procedure with the supply closet and without. A survey was used to evaluate resident satisfaction in the number of locations to search, timeliness, and ability to provide quality patient care before and after the supply closet. This survey was done on a scale of 1 to 5, with 1 being very dissatisfied, and 5 being very satisfied. Paired t-tests were used for data analysis; p<0.05 was considered statistically significant. Results: For central line supplies, the average times were 542 seconds (s) without the closet, and 211s with the closet (p=0.0041), arterial line supplies took 570s without and 178s with (p=0.0114), thoracostomy tube supplies took 590s without, and 213s with (p=0.0017), and incision and drainage supplies took 518s without, and 239s with the closet (p=0.0066). Average resident satisfaction for the number of locations to search for supplies went from 1.5 to 4.8 with the closet, length of time to gather supplies went from 1.3 to 4.9 with the closet, and ability to provide quality patient care went from 1.4 to 4.8 (all p<0.0001). Conclusions: The implementation of a supply closet with easy access to supplies allowed for improved speed in completing bedside procedures, leading to expedited patient care, improved resident satisfaction and well-being, and decreasing a source of surgery resident burnout.
Vaccine Hesitancy in HIV Patients Following the COVID-19 Pandemics
Authors: Kropman Kory , Vahia Amir , Johnson Leonard , Szpunar Susan 
Published: August 2024

Introduction: The prevalence of vaccine hesitancy has been on the rise for several years in the United States leading up to the Covid19 pandemic. During the pandemic, there was controversy and media attention surrounding the effectiveness and safety of the Covid19 vaccine, with many individuals, including patients with HIV, refusing vaccination, despite evidence of its benefit. There are further concerns that patients with HIV are reluctant to receive additional vaccines that existed prior to the Covid19 pandemic. In this study, we evaluated the rate of refusal of non-Covid19 vaccines in the pre- and post-period after release of the Covid19 vaccine. Methods: We measured and compared the number of vaccines offered and refused at each visit over the total number of visits for 195 patients with HIV during a pre-Covid (approximately 18 months before the release of the Pfizer vaccine to the public on August 23, 2021) and post-Covid period (approximately 18 months after the previously mentioned date). The vaccines studied included the following: tetanus, pneumococcal, shingles, hepatitis A/B, and influenza. The data was collected using hospital records from Athena and Cerner, as well as Michigan State Records. Data was analyzed using descriptive statistics and the Wilcoxon signed ranks test. The Mann-Whitney U test, Kruskal-Wallis test and Pearson’s correlation were performed for the Covid19 vaccine statistics. In all statistical tests, a p-value less than 0.05 was taken to indicate statistical significance. Results: Collectively, there were more refusals in the period after release of the Covid19 vaccine for non-Covid19 vaccines. This was also the case for all individual vaccines, except Hepatitis A. There was an overall statistically significant difference (p <0.001) in the distribution of vaccine refusals between the pre-Covid19 and post-Covid19 period. This was observed for the Pneumococcal (p=0.026), Hepatitis B (p=0.035), and Shingles vaccine (p <0.001) respectively. The Covid19 vaccine was more likely to be refused in female patients (p=0.005), non-white patients (p=0.02), and younger patients (p=0.04, r= -0.21). Discussion/Conclusion: This study provides evidence that there is an increase in non-Covid19 vaccine hesitancy following the release of the Covid19 vaccine in patients with HIV at Ascension St. John Hospital. Given the small size of the study population and this study being an initial evaluation, more will need to be performed. This is to further test these findings in other regions of the United States.
A Review of Abnormal Pap Smear Follow Up in the Resident Clinic
Authors: Bain Tolbey , Juma Mina , Hoofman Jacob , Khan Ayesha 
Published: August 2024

Introduction: The pap smear is a screening tool designed to reduce the incidence of invasive cervical cancer. The incidence of cervical cancer diagnosis has decreased by 50% from 1970 to 2010. This is largely accredited to pap smear screening, follow up colposcopy appropriate surgical treatment. The pap smear was performed annually for many years; however, in 2012 the guidelines changed to spaced screening pap smears. In our resident clinic we serve patients with barriers to health care. These barriers limit follow up for abnormal pap smears. This study aimed to identify the follow up rate after abnormal pap with colposcopy among resident continuity clinic patients. Methods: The patients with annual exams from resident clinic were collected from Jan 1st, 2023 to Jan 1st, 2024. Study Design: The pap smear results and follow up were reviewed. Results: During the year 2023, 402 patients presented to the resident continuity clinic for annual exams. Pap smears were obtained in 82% of our annuals and 12% had an abnormal pap result. Of these patients, only 62% had appropriate follow up colposcopy. Discussion: The results from our study revealed a low rate of follow up from abnormal pap smear. Conclusion: This study allowed us to better understand the abnormal pap smear follow up in our resident clinic population. Future area of study includes how shorter interval follow up after abnormal pap smear screening may affect colposcopy follow up rates.
Quality Improvement: Improving the Screening of Fatty Liver Disease in Patients with Type 2 Diabetes
Authors: Antonios Kais , Berinstein Elliot , Dutta Priyatta , Ammar Afnan 
Published: August 2024

Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common type of chronic liver disease in the world and is projected to become the leading indication for liver transplantation. Studies have shown that in patients with type 2 diabetes mellitus (T2DM), liver steatosis, advanced fibrosis, and cirrhosis were present in 73.8% 15.4%, and 7.7% of patients, respectively. The American Association For The Study Of Liver Disease recently published new guidelines that recommend that all patients with T2DM be screened for MAFLD. The Fibrosis-4 (FIB-4) is a validated non-invasive screening tool that can be used as an initial screen for MAFLD. We identified that T2DM patients were not being screened appropriately in our outpatient internal medicine clinic. The goal of this quality improvement project was to increase the screening of T2DM for NAFLD by creating a smart phrase and providing education to providers. Methods: We reviewed the medical charts for 514 patients with T2DM seen in our Academic Internal Medicine (AIM) Clinic between 2020 and 2022 to assess baseline screening rates. A smartphrase was created through EPIC and included all relevant information to help providers assess for complications of T2DM including MAFLD. For cycle 1, starting in 12/2022, the smart phrase was piloted with 5 residents, and their usage was recorded. For cycle 2, starting 04/2023, the smartphrase was shared with all residents, and multiple educational sessions were held. Usage of the smartphrase, recording a FIB-4 score or collecting labs to do so were monitored. Results: Results of a baseline assessment of 514 patients with T2DM showed that 0 % of patients were screened with a FIB 4 score. During cycle 1, the smart phrase was used in 41% of patient visits when T2DM was addressed. A FIB-4 score was recorded or labs were ordered to do so in 20.9 % of patients. During cycle 2, the smart phrase was used in 10% of patient visits and FIB-4 score was recorded or labs were ordered 10.6% of the time. However, when the smartphrase was used, a FIB-4 score was recorded in 85.7% of the time. Conclusions: It is important to identify individuals with NAFLD while it is in the early stages to prevent progression to cirrhosis and hepatocellular carcinoma. Implementing a smart phrase was shown to improve the screening rates for NAFLD. Further improvement can be made by automatically calculating a FIB-4 score and alerting providers if a FIB-4 score has not been documented in the past 2 years.