Health Systems Research

Public Perceptions of Certified Registered Nurse Anesthetists Anesthesia Care in the United States

Nikhil D. Aggarwal, B.A.¹, Forrest Bohler, B.S.¹, Tristan Attisha¹, Varna Taranikanti, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
Certified Registered Nurse Anesthetists (CRNAs) deliver anesthesia and surgical care throughout the United States. Recent regulatory changes in multiple states have expanded opportunities for independent CRNA practice in operative settings. However, anesthesia represents a uniquely high-risk, time-limited clinical context in which patients cannot participate in real-time decision-making. Despite ongoing policy debates regarding CRNA scope-of-practice expansion, national data describing public attitudes toward CRNA-led anesthesia care remain limited. This study assessed public comfort and perceptions of CRNA-delivered anesthesia.

METHODS
We conducted a cross-sectional survey of U.S. adults to assess public perceptions of anesthesia care delivered by CRNAs. The survey was administered online via Qualtrics and distributed through Centiment. Eligible participants were U.S. residents aged 18 years or older. The instrument assessed comfort with CRNA-led anesthesia care, perceived safety and training equivalence, provider involvement preferences, and disclosure expectations. Descriptive statistics and χ² tests (p < 0.05) were used for analysis.

RESULTS
Among 1,046 respondents, 35.2% reported limited familiarity with CRNAs. Most respondents (45.7%) opposed total unrestricted independent CRNA practice, while 46.0% reported discomfort receiving anesthesia from CRNAs without physician anesthesiologist involvement compared to 31.6% reporting comfort. Only 18.4% believed CRNA anesthesia was equally safe across all procedures; 50.5% believed it was equally safe only for low-risk procedures. A majority (76.5%) wanted advance notification if a CRNA would deliver their anesthesia. Routine CRNA substitution was associated with reduced institutional trust (49.5% reported decreased trust). Attitudes did not differ by rurality or race.

CONCLUSIONS
While conditional support for CRNA practice in low-risk contexts exists, unrestricted independent practice lacks public support. The desire for provider transparency and disclosure, coupled with reduced institutional trust following CRNA substitution, indicates that transparency, informed consent, and clearly defined supervisory models are essential for maintaining patient confidence as workforce policies evolve. These patient-centered concerns are broadly held across demographic subgroups.

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Assessing the Impact of Preoperative Conservative Treatment Options Prior to Cervical Surgical Procedures: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study

Matthew R. Cederman, B.S.¹, Christopher L. Nikolopoulos, B.S.¹, Arthur Saroyan, M.D.¹, Jeffrey Fischgrund, M.D.², Jad Khalil, M.D.², Khalid Odeh, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Orthopaedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Cervical spine pathology can substantially impair quality of life. Anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (cTDR) are established surgical treatments, yet the impact of preoperative conservative care on postoperative recovery remains unclear. This study evaluated the association between preoperative conservative treatment and outcomes following ACDF or cTDR.

METHODS
This retrospective cohort study used the Michigan Spine Surgery Improvement Collaborative database to identify patients undergoing ACDF (n = 12,363) or cTDR (n = 1,041) from 2017–2023. Patients were categorized by type of preoperative conservative treatment. Analyses were stratified by procedure, and multivariable generalized estimating equation models identified predictors of achieving a minimum clinically important difference (MCID) in neck pain at 90-days postoperatively.

RESULTS
In ACDF patients, preoperative conservative care was associated with younger age, female sex, longer symptom duration, fewer comorbidities, shorter hospital stays, fewer complications, and higher rates of home discharge and return to work (all P < .041). Injection therapy correlated with higher preoperative depression (P = .026), whereas physical therapy or chiropractic care was linked to lower postoperative depression (P = .027). In cTDR patients, preoperative care was associated with shorter hospital stays and longer symptom duration (P < .015) but no other differences. Multivariable analysis identified increasing age, White race, osteoporosis, and higher BMI as predictors of MCID achievement, while hypertension, longer symptom duration, and anxiety predicted lower odds. Preoperative treatment cohorts showed no significance in reaching MCID in neck pain at 90-days postoperative.

CONCLUSIONS
Preoperative conservative treatment was associated with improved postoperative outcomes following ACDF, but not cTDR. Clinically meaningful neck pain improvement was driven primarily by patient-specific demographic, clinical, and psychosocial factors rather than treatment cohort, underscoring the importance of patient selection and preoperative optimization. 

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Gender-Based Disparities in Academic Orthopaedic Surgery Physician Compensation in 2023

Dhun Chauhan, B.S.¹, Joshua K. DeYoung, B.S.², Ezra Goodrich, M.D.³, Kimberly Templeton, M.D.⁴, Charles S. Day, M.D.^5,6

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Wayne State University School of Medicine, Detroit, MI
³Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
⁴Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City
⁵Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI
⁶Wayne State University School of Medicine, Detroit, MI}

INTRODUCTION
Orthopaedic surgery remains one of the least diverse specialties in medicine. Parity in opportunity and recognition are key factors in attracting and retaining a diverse group of individuals to the field. The primary purpose of this study is to assess gender-based discrepancies in total salary compensation by rank for academic orthopaedic surgery faculty.

METHODS
Aggregate data was obtained from the Association of American Medical Colleges for FY 2023. Mean compensation was compared for orthopaedic surgery faculty and total surgery faculty at all academic ranks based on gender and race.

RESULTS
Men received significantly higher total compensation for all ranks except chair within orthopaedic surgery. At the instructor level, men earned an average annual income of $554,245, while women received $229,204, demonstrating a significant pay gap (p = 0.0019). At the assistant professor (men: $628,346; women: $475,857), associate professor (men: $732,381; women: $575,877), and professor levels (men: $743,822; women: $472,140), there existed significant pay disparities (p < 0.0001 for all three academic levels, respectively). At the chief position, men earned an average of $1,185,873 annually, while women received $596,270 (p = 0.0006). Aggregate data for other surgical specialties demonstrated similar results, with women receiving lower total compensation at all ranks compared to men.

CONCLUSIONS
This analysis of the 2023 AAMC Faculty Salary Report demonstrates a significant pay differential between men and women in orthopaedic surgery and surgical specialties, in general, across multiple academic levels, including instructor, assistant professor, associate professor, professor, and chief of division. Although there has been increasing awareness of gender-based compensation disparities within surgical specialties, particularly in orthopaedic surgery, these disparities are still clearly present. 

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Accessibility and Practicality of Actionable Cancer Genetic Testing Guidelines for Primary Care: A Systematic Review

Ethan Dimock, B.S.¹, Paul Megee, Ph.D.², Ramin Homayouni, Ph.D.², Julie Zenger-Hain, M.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI
³Corewell Health East, Genetic Counseling}

INTRODUCTION
The integration of germline and somatic genetic testing into routine cancer care has expanded rapidly over the past decade. As genetic testing increasingly moves into primary care and non-specialty settings, clinicians must rely on published guidelines to inform appropriate testing and management decisions. However, the accessibility, usability, and clinical practicality of these guidelines for non-genetic specialists remain unclear.

METHODS
A systematic review was conducted using PubMed, Embase, and Scopus to identify English-language cancer genetic testing guidelines published within the past 10 years. Searches included combinations of “genetic testing,” “genetic screening,” “cancer,” “neoplasm,” and “guideline.” Title and abstract screening were performed independently by two reviewers using Covidence. Included documents were evaluated using a standardized scoring rubric assessing accessibility, level of detail, understandability, and practicality (1–5 scale). Alignment with NCCN recommendations and authorship type were recorded. Sixty-five guidelines met inclusion criteria.

RESULTS
Sixty-five documents met inclusion criteria. Professional society guidelines consistently demonstrated the highest level of detail (mean score 4.8) but lower understandability (mean score 2.6) compared to group-authored publications (mean detail 3.6; mean understandability 3.4). NCCN guidelines uniformly scored 5 for detail but frequently scored 2 for understandability. Abstract-only publications clustered at detail and practicality scores of 2. Open-access publications demonstrated the highest accessibility (mean score 4.7) and higher understandability compared to subscription-based documents. Variant-classification and molecular biomarker standards exhibited high technical detail but the lowest practicality for primary care application.

CONCLUSIONS
Significant variability exists in the accessibility and usability of cancer genetic testing guidelines. While professional society guidelines provide comprehensive recommendations, they may be less accessible and less understandable for non-specialists. Efforts to optimize clarity, public accessibility, and workflow integration may enhance implementation of genomic medicine in primary care settings.

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Michigan Emergency Department Responses to Callers Requesting Emergency Contraception

Andrew Eibling, B.S.¹, Jessica Cummings, B.S.¹, Marlee Mason-Maready, Ph.D.¹, Abram Brummett, Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI} 

INTRODUCTION
Sexual assault remains a critical public health issue in the United States. From 2002 to 2005 a series of studies used a female mystery-caller approach to simulate the experience of a victim of sexual assault seeking emergency contraception (EC) from emergency departments (EDs) in various U.S. jurisdictions. These studies found that, in contradiction with guidelines from the American College of Obstetricians and Gynecologists (ACOG), over half the EDs declined to provide emergency contraception to a victim of sexual assault based on information provided during the mystery-caller interaction.  

METHODS
Using a  “mystery client” approach, a well-documented and widely utilized methodology in the literature, all Michigan EDs were contacted to inquire if EC was available and if not, if they would be willing provide a referral to it's eventual attainment. This methodology does not measure clinical behavior or hospital policies directly, but instead simulates what a prospective patient might experience when attempting to access information about critical reproductive care over the phone.      

RESULTS
Our findings closely resemble the results of the original studies, reflecting the experience of a mystery-caller and indicating that a victim of sexual assault may encounter significant barriers when attempting to access EC in both Catholic and non-Catholic Michigan EDs.

CONCLUSIONS
Given the evolving reproductive healthcare landscape, especially following the 2022 Dobbs decision, the Food and Drug Administration’s 2022 removal of “impeding implantation” from Plan B’s labeling, and the adoption of the American College of Emergency Physicians’ Resolution 27 advocating for equitable access to EC, this study offers timely insights into persistent systemic barriers. Our results raise questions about institutional policies, staff training, and opportunities for improving access to EC in both Catholic and non-Catholic EDs. We recommend standardizing institutional communication protocols, implementing comprehensive staff education, and fostering accountability mechanisms to ensure equitable and trauma-informed access for sexual assault victims.

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Influence of Remote Digital Fundus Imaging on Binocular Indirect Ophthalmoscopy Screening in Retinopathy of Prematurity

Felicia Fong, B.S.¹, Matthew Trese, D.O.^2,3

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Ophthalmology Corewell Health William Beaumont University Hospital, Royal Oak, MI
³Associated Retinal Consultants, Royal Oak, MI}

INTRODUCTION
Retinopathy of Prematurity (ROP) remains a significant cause of visual morbidity. Current ROP screening recommendations have allowed for earlier intervention and improved patient outcomes. However, traditional ROP screening involves binocular indirect ophthalmoscopy (BIO) in the hospital and clinic. BIO screening at the hospital requires personnel, time, and financial support, all of which are limited. The purpose of this project is to evaluate the impact that remote digital fundus imaging (RDFI) screening has on BIO examinations as infants are followed throughout the entirety of their ROP screening.

METHODS
A retrospective review (1/1/2017 – 12/31/2022) of inpatient and outpatient electronic health records of infants with stage 0 ROP who were screened through 45 weeks postmenstrual age was performed. Demographics and screening sessions (RDFI + BIO) were tabulated. Next, a two-armed (i.e. weekly and biweekly) screening model was developed. This model represented the predicted number of expected BIO-ROP examinations. We compared our real-world screening to the model to determine if there was a significant difference in the number of BIO examinations. 

RESULTS
Of the 468 infants that were identified, 193 met inclusion criteria. Mean birth weight and gestational age were 1,050 g and 27.9 weeks. The average number of RDFI + BIO total screening sessions was 10.1±3.1 (RDFI = 5.8±3.0 and BIO = 4.3±1.9). Using a two-armed model, the total number of BIO screening sessions would be 14.5±2.7 if performed weekly and 7.4±1.5 if performed biweekly. Thus, RDFI significantly reduced BIO examinations by 70% and 42% (p<0.0001), respectively.

CONCLUSIONS
Effective screening for ROP is of paramount importance. Current practice patterns, namely in-person BIO examinations, place the burden on ophthalmologists, drawing them away from their clinical practice. Embracing validated RDFI technology significantly reduces the number of BIO examinations while maintaining current screening guidelines.

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Assessment of the Management of Head Collisions in the 2023 Women’s FIFA World Cup

Austin Johnson, B.S.¹, Jacob Coleman, B.S.¹, Collin Van Wagoner, B.S.¹, Talon Shumway, B.S.¹, Jack Dryden, B.S.¹, Joseph Guettler, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI 
²Department of Orthopaedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Recent studies have shown inadequate management of possible concussions in professional soccer.1-4 This study analyzed the assessment of head collision events (HCE) in the 2023 Women’s FIFA World Cup (FWC) compared to previous men’s and women’s FWC tournaments.

METHODS
Five researchers identified HCE through video review of the 2023 Women’s FWC. A HCE was defined as any event where a player stopped playing immediately after contact to the head or neck region. Signs of concussion, as defined by FIFA5, were recorded for further analysis. Time spent on the ground and duration of stoppage were recorded for each HCE. Each game was reviewed by at least 2 reviewers. Findings were compared to similar studies analyzing the 2019 Women’s FWC and 2022 Men’s FWC. 

RESULTS
 In 64 matches, 126 HCE’s were identified, 1.97 HCE/match, 59.6 HCE/1000 athlete-hours of exposure. Pending statistical analysis, preliminary comparison shows more HCE compared to the 2019 Women’s FWC, greater percentage of HCE evaluated by medical staff, less players displaying >2 signs of concussion, and increased duration of time stopped for on-field evaluation. Compared to the 2022 Men’s FWC, more players were evaluated by medical staff, however a persistence of few players removed for concussion and relatively similar time for evaluation was noted.

CONCLUSIONS
This study shows improvement in the percentage of players displaying head injury ultimately being evaluated by medical staff. Despite this, few players, 18% of those displaying > 2 signs of concussion and 4.7% total, were removed from play. This study demonstrates improved on-field concussion evaluation, yet re-demonstrates possible resistance to remove participants from play.

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Evaluating the Quality of AI-Generated Health Information on  Perinatal Psychopharmacology

Lydia Kim, M.S.¹, Kurt R Wharton, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Recent surveys indicate that nearly half of consumers use generative AI for health-related inquiries,1 driven largely by the convenience these platforms offer. As these tools gain widespread popularity, patients are increasingly turning to AI chatbots as convenient sources of medical information,2 a trend with significant implications for patient safety. AI chatbots can produce incorrect information, warranting caution in medical practice.2 Standardized frameworks for evaluating the quality of AI-generated health information remain underdeveloped. This study aims to evaluate and compare the quality of responses provided by ChatGPT, Gemini, and Claude to a clinically realistic patient query.

METHODS
Each of the three AI platforms - ChatGPT (OpenAI), Gemini (Google), and Claude (Anthropic) - received a single, identical prompt simulating a realistic patient query from a 30-year-old, 10-week pregnant first-time mother with a history of major depressive disorder asking about the safety of continuing sertraline throughout pregnancy and breastfeeding, including dose adjustment. Each platform’s combined response was evaluated by one rater using the DISCERN instrument, producing item-level scores for Questions 1-16 and a total score ranging from 16 to 80.

RESULTS
Claude received the highest total score (44), followed by Gemini (41) and ChatGPT (37). Using published DISCERN quality benchmarks, all three platforms fell within the “fair quality” range (39-50), with the exception of ChatGPT, which fell just below this threshold in the “poor quality” range (27-38).

CONCLUSIONS
Universal deficiencies were identified across all platforms, particularly in acknowledging uncertainty in current evidence, presenting alternative treatment options, and directing patients to additional sources of support. These findings suggest that publicly available AI platforms should not be relied upon as standalone sources of perinatal medication information, and highlight the need for ongoing quality evaluation of AI-generated health content against validated consumer health information standards.

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Urologist Experiences with Outpatient Radical Prostatectomy in Michigan

Max Kuang, B.S.¹, William Johnston, M.D.², Bernadette Zwaans, M.D.², Kenneth Peters, M.D.²

_{¹Oakland University Willam Beaumont School of Medicine, Rochester, MI
²Department of Urology, Corewell William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Robotic assisted radical prostatectomy (RARP) is a common urological surgery conducted for prostate cancer that is typically followed by hospital admission. Same-Day Discharge (SDD) for RARP has started gaining traction in the US and in the state of Michigan as an alternative to hospital admission following RARP due to cost savings and patient preference to recover in the comfort of their own home. 

METHODS
We conducted an anonymous online Qualtrics survey distributed to members of the Michigan Urologic Surgeons Improvement Collaborative (MUSIC). Survey participants were screened first to be urologists in active practice. The survey collected demographic information about urologist training, practice setting, and RARP volume. Additionally, survey participants were asked to select factors that would make them more or less likely to perform SDD for RARP. 

RESULTS
After three mass emails to the MUSIC Listserv, a total of 31 participants completed the survey. Of the total participants, 13 had performed same-day discharge for RARP while 18 had not. Of the respondents that had performed same-day discharge, 9 reported favorable experiences performing SDD, 3 were indifferent, and 1 reported unfavorable experiences. However, all participants who performed SDD reported that their patients had favorable experiences to same-day discharge RARP. Factors that increased urologists’ desire to perform SDD included: patient age under 65, BMI under 30, and no prior surgical compilations. Factors that were of concern for performing SDD were underlying hypertension, hyperlipidemia, type 2 diabetes.

CONCLUSIONS
SDD continues to be an option for urologists performing RARP on patients with prostate cancer. While some urologists are offering SDD for RARP in Michigan, it is not as popular as traditional hospital admission. Within the survey population, the majority of urologists who have offered SDD for RARP have had favorable experiences. Future studies for RARP patients may clarify whether SDD for RARP will become more widespread.

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SSI Bundle in Neonatal Surgery: A Look at the Closing Protocol

Alexis Lonjin, B.S.¹, Cullen Woodley, M.D.¹, John Nida, M.D.², Katie Ward, M.D.², Diane Studzinski, B.S.², Begum Akay, M.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Corewell Health East William Beaumont University Hospital, Royal Oak, MI
³Corewell Health Children’s at William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Perioperative care bundles reduce surgical site infections (SSIs) in adults but are not routine in infant surgery. SSI in babies are less common but carry significant morbidity. This study aims to evaluate the effects of one specific intervention of a broad perioperative care bundle in patients less than 6 months old undergoing open gastrointestinal surgery. 

METHODS
We evaluated two years of closing protocol outcomes within an infant SSI bundle. The closing protocol was applicable to a subset of patients where bowel work was performed and fascia was closed. When a wound was considered dirty/infected, a skin wound vacuum (skin vac) was recommended. Outcomes including SSI rates, closing protocol compliance, and associated complications were evaluated. 

RESULTS
There was a decrease in SSI rates from 15 (11.4%) to 7 (7.8%), p=0.380 post-implementation. Bundle adherence was lower in urgent/emergent cases and declined from 64.4% to 37.8% in year one versus two. SSI occurred in 4/15 patients (26.7%) in whom the closing protocol was used and 1/8 patients (12.5%) in whom it was applicable but not used. Among eligible patients who did not receive a skin vac, no SSIs were observed. Among patients who received a skin vac (n=4), two developed SSIs. Complications with the skin vac included need for replacement due to poor vacuum seals.  

CONCLUSIONS
There were several barriers identified to the closing protocol’s use, including case urgency, time added to surgery and lack of routine. Based on initial results, the closing protocol may provide some benefit, but education and better compliance is critical to understand the true efficacy of this closing protocol in SSI reduction. Future efforts should prioritize re-education and strategies to improve adherence, particularly in high-acuity cases to optimize patient outcomes. 

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Dermatologists’ Awareness and Attitudes Toward Oral Nicotinamide for Chemoprevention of Non-Melanoma Skin Cancer and Actinic Keratoses: A Cross-Sectional Survey 

Vicky Kim Lu, B.A.¹, Michael Dorman, M.D.², Virginia Uhley, Ph.D. ³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Dermatology, Corewell Health, Royal Oak, MI
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
Non-melanoma skin cancers (NMSC), such as basal cell carcinoma and squamous cell carcinoma, represent the most common malignancies in the United States. While ultraviolet protection remains the cornerstone of NMSC prevention, recent randomized controlled trials have demonstrated that oral nicotinamide (NAM), a vitamin B3 derivative, reduces the incidence of NMSC and premalignant lesions. Despite this evidence, a gap persists between clinical data supporting nicotinamide chemoprevention and its adoption into dermatology practice. Understanding physician awareness and perceived barriers is essential to improving implementation and patient outcomes.

METHODS
A cross-sectional, anonymous survey was distributed electronically via the Michigan Dermatological Society network. Eligible participants were board-certified dermatologists practicing more than one year and spending at least 25% of their time in direct patient care. 

RESULTS
Despite 100% awareness of evidence supporting the benefits of nicotinamide use (n=10), routine recommendations rates varied with multiple barriers and concerns limiting clinical implications. The most cited factor when deciding whether or not to prescribe NAM was the patient’s risk factors for skin cancer followed by the drug’s potential side effects. The largest concerns regarding the use of NAM include limited data demonstrating efficacy, concerns for drug interactions and minimal FDA regulation. 

CONCLUSIONS
Our study demonstrated that dermatologists are aware of nicotinamide benefits, but implementation remains poor due to practice barriers and concerns rather than lack of knowledge. This study was limited by small sample size and regional sampling. Additionally, clearer clinical guidelines and increased research directly addressing physician concerns may help to facilitate broader integration of nicotinamide into routine practice. 

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Ethical Justifications and Critiques of Deception in Clinical Medicine: A Scoping Review

Hoon Oh, B.S.¹, Reba Aldaire, B.S.¹, Abram Brummett, Ph.D. ²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
Deception in clinical medicine includes practices such as lying, withholding information, placebo administration, and covert treatment. Although medical ethics emphasizes transparency and respect for patient autonomy, clinicians use deception to reduce distress, promote treatment adherence, or navigate institutional constraints. The ethical permissibility of these practices remains debated in the bioethics literature. This project examined how deception is conceptualized, categorized, and ethically justified or criticized in bioethics literature.

METHODS
A scoping review of peer-reviewed bioethics literature discussing deception in clinical medicine was conducted. Articles were included if they described or analyzed deceptive practices in clinical care. Each article underwent extraction and coding for the type of deception, target of deception, actors involved, and ethical arguments. Deception types were categorized into groups, including therapeutic privilege, covert medication, placebo or nocebo use, slow code resuscitation, and additional forms identified during analysis. Articles were also coded according to whether authors endorsed deception, opposed deception, or did not reach a definitive ethical conclusion.

RESULTS
A total of 99 articles were included. Therapeutic privilege was the frequently discussed category (22 articles), followed by covert medication (16), placebo or nocebo use (10), and slow code resuscitation (4). Thirty-six articles described forms of deception, including diagnostic nondisclosure, deception involving insurance systems, genetic and familial secrecy, environmental deception in dementia care, and culturally grounded truth-telling practices. Across the literature, 65 articles concluded deception may be ethically justifiable in certain circumstances, 18 rejected deception as ethically impermissible, and 16 did not reach a definitive conclusion.

CONCLUSIONS
The literature demonstrates disagreement regarding the ethical permissibility of deception in clinical practice. Some authors argue deception may be justified to prevent harm, protect privacy, or address structural barriers to care, while others emphasize risks to autonomy, trust, and professional integrity. These findings highlight the need for ethical guidance for clinicians facing such dilemmas.

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Evaluating Risk Factors to Develop Guidelines for Prophylactic Anticoagulation in Admitted Pregnant Patients

Yasmeen Pihlgren, B.S.¹, Sonia Sajja, M.D.², Zeynep Alpay-Savasan, M.D.², Megan Miller, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Obstetrics and Gynecology Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
The objective of this study was to identify risk factors associated with antepartum venous thromboembolism (VTE) in admitted patients without a personal history of VTE and inform criteria for prophylactic anticoagulation in pregnancy. 

METHODS
A retrospective chart review was conducted of pregnant inpatients who developed VTE during hospitalization at Corewell Health William Beaumont University Hospital from 2016-2019. Data included demographics, obstetric history, and relevant comorbidities. Risk factors were evaluated independently and compared to age and BMI matched controls from all deliveries during the same timeframe using t-tests, Wilcoxon rank-sum, and Fischer’s Exact tests. 

RESULTS
Among 38,512 pregnant patients, 39 (0.001%) developed VTE during inpatient admission. Analysis revealed patients with VTE had a higher BMI (33 vs 30.8, p < 0.05), history of thrombophilia (22% vs 0%, p < 0.01), sickle cell disease (7.9% vs 0.7%, p < 0.01), multiple gestation (7.7% vs 0.2%, p < 0.01), and hyperemesis gravidarum (15.8% vs 0.1%, p < 0.01). (Table 1) 
In a 2:1 matched analysis by age and BMI, thrombophilia (22.9% vs 0%, p < 0.01), sickle cell disease (8.3% vs 0%, p < 0.05), and hyperemesis gravidarum (13.9% vs 0%, p < 0.01) remained significant. VTE patients were also more likely to be African American (42.9% vs 16.9%, p < 0.01) or non-Caucasian and non-Asian (other) (17.1% vs 4.2%, p < 0.01). (Table 2) 

CONCLUSIONS
Thrombophilia, sickle cell disease, hyperemesis gravidarum, elevated BMI, and non-Caucasian and non-Asian race are potential risk factors for antepartum VTE during hospital admission. These findings support consideration of routine prophylactic anticoagulation in hospitalized pregnant patients without personal VTE history who exhibit these risk factors. Larger prospective studies are needed to validate these associations and develop guidelines for antepartum inpatient thromboprophylaxis. 

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Free Clinics Can Aid in Reducing Cardiovascular Disease Risk for Uninsured Patients: A Preliminary Study & Retrospective Chart Review

Anthony Sanabria, B.A.¹, Nicholas Blackmond, M.S.², Deidre Hurse, Ph.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Gary Burnstein Community Health Clinic, Pontiac, MI
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI} 

INTRODUCTION
Cardiovascular disease (CVD) risk factors such as hypertension (HTN), diabetes mellitus (DM), and hyperlipidemia (HLD) affect a significant number of patients today. Similar to traditional CVD risk factors, social determinants of health (SDOH) also play a substantial role in influencing patients’ cardiovascular health. Currently, there is limited research regarding the impact of free clinics on the health outcomes of uninsured patients. This project seeks to expand on previous research by investigating the effects of receiving care at a free clinic on atherosclerotic cardiovascular disease (ASCVD) risk for patients with HTN, DM, or HLD. 

METHODS
We conducted a retrospective chart review at Gary Burnstein Community Health Clinic (GBCHC), a free clinic in Pontiac, MI. Study subjects were enrolled from a convenience sample of patients aged 40-64 with a diagnosis of HTN, HLD, or DM and no known ASCVD. Only patients who initiated treatment at GBCHC between June 2018 and January 2024 were included. Patient data collected included demographic characteristics and various health indicators that impact cardiovascular disease risk. The Pooled Cohort Equations Risk Calculator was used to estimate participants’ cardiovascular risk at their initial visit and follow-up visit 6-12 months later.

RESULTS
This preliminary analysis of a sample of 28 patients from our total study population showed a statistically significant decrease in median ASCVD 10-year risk from 12.6 percent to 8.3 percent after 6-12 months of care at GBCHC (p<.0001). Lower education attainment was identified as a health-harming social factor that may impact ASCVD risk as the majority of patients (65 percent) reported their highest level of education at the high school level or below (17 out of 26 reporters). 

CONCLUSIONS
For uninsured individuals, access to a free clinic that provides medical and social services, such as GBCHC, is a valuable resource for reducing cardiovascular risk factors.  

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