Please see the fifth article of the Spring 2026 issue!

Background: On November 6, 2018, 56% of Michigan voters approved Proposition 1, making Michigan the first state in the Midwest to legalize cannabis. Currently, about one in nine Michigan residents (11.6%) reports past-month cannabis use. The growing availability and public acceptance of cannabis in Michigan has led to a marked increase in emergency department (ED) visits.

Objectives: Our purpose was to analyze the clinical characteristics and outcomes of patients presenting to the ED following recreational cannabis use. Patients admitted to the hospital were compared to those treated in the ED and released.

Methods: This was a retrospective cohort analysis of consecutive patients diagnosed with toxicity related to cannabis use. Patients were seen at eight EDs over a 36-month study period (November 2018-October 2021). Spanning 13 counties in Michigan, affiliated institutions included three rural medical centers, three university-affiliated hospitals, and a children’s tertiary care facility. Data included demographics, clinical features, and treatment outcomes in cannabis patients admitted to the hospital from the ED versus those treated and released. Chi-squared and t-tests were used to compare these cohorts across key demographic and clinical variables.

Results: During the study period, 1435 patients were evaluated for cannabis toxicity; 1256 (87.5%) were treated and discharged from the ED, 120 (8.4%) were hospitalized, and 59 (4.1%) were transferred to a psychiatric facility. The majority (65.4%) of children less than 12 years of age were admitted for accidental ingestions of cannabis. In comparison, adolescents (ages 12-19) and adults (> 19 years) had similar rates of hospital admission (6.4% versus 7.3%, respectively; p=0.61). Adolescents and young adults had a higher frequency of psychiatric chief complaints compared to older adults (25.5% vs. 7.5%, p< 0.001) and were more likely to be transferred to a psychiatric facility or jail (7.5% vs 1.9%, p< 0.001). Emergency department patients were significantly more likely to be admitted if they were male, ingested cannabis (e.g., baked goods), presented with cardiovascular or neurological chief complaints, were pregnant, had multiple comorbidities, or had a history of polysubstance abuse. The mean hospital length of stay was 2.3 days (range 1-11 days).

Conclusions: In this community-based ED study, 12.5% of patients with cannabis toxicity were hospitalized or transferred to a psychiatric facility. Because of the widespread use of cannabis in our society, ED clinicians must educate and inform our high-risk patients of the dangers of continued cannabis use.

Please see the third article of the Spring 2026 issue!

Introduction
Depression is a disease that plagues a high percentage of adults in the United States. Utilization of public online resources as a learning resource for those with depression is a new and upcoming tool. This study examined public online resources which provide information pertaining to the treatment of depression, rating the effectiveness of present resources.

Methods/Results
A YOUTUBE search was conducted to collect videos which could be used as resources to patients diagnosed with depression. Medical students then ranked these videos utilizing the DISCERN criteria, a tool established to determine the quality of patient resources. The rankings for each video were averaged for a variety of categories. These averages were then utilized to determine the overall quality of publicly available videos and to compare different aspects of the videos. The majority of categories were determined to have average ratings placing videos in the “partially met criteria” categories. Videos uploaded directly by physicians scored higher than those uploaded by non-physicians. Videos with greater than one million views performed slightly better than those with fewer views.
PPI Statement: Patients and public were not involved in this research.

Conclusion
There are many barriers to mental health care for those diagnosed with depression. Public online resources may help to eliminate these barriers. Despite this positive outlook, this study ranked the overall quality of the resources as “average”. The inconclusive nature of this study calls for further research to be conducted. Barriers may be erased by online resources, but the effectiveness of online resources is not clear. More time must be granted to physicians to counsel their patients about mental health or more standardized online materials must be offered to patients.

Please see the fourth article of the Spring 2026 issue!

Health services available to women and critical to the practice of women’s health are historically linked to state funding within the United States. This relationship has been underscored by the overturn of Roe v. Wade. Private women’s health clinics rely on donations and state based funding. Additionally, organizations such as Planned Parenthood which receive federal money are dependent on state dictated allocation of those funds. This leads to vast differences in the availability and outcomes of women’s healthcare by state, which also disproportionately affects women of lower socioeconomic status. This research aims to explore the significance and impact of state funding as it relates to the state total available budget for women’s health services. Although each state has their own unique clinics and state-based rules, regulations, and funding sources, grouping into rough tiers of high, medium, and low funding allows for a more holistic analysis while helping minimize geographic biases. Cancer screenings (breast and cervical), STI testing and treatment, contraception availability and use, as well as prenatal care and abortion access are the key aspects of women’s health that will be examined. The aim is to highlight the vital correlation between available funding and the quantitative impact on women’s health. Disparities have been further widened as a result of funding differences, such as delay of cancer diagnoses, the public health risk of inadequate STI treatment, and the tragic increase in both maternal and fetal death following a lack of proper prenatal care. It is also necessary to acknowledge that all individuals in need of women’s health services, regardless of gender identity or sexual orientation, are part of the relevant patient population of this study. Women have a right to knowledge about available health services. It is imperative to know how the state in which one lives affects health care options and thus the health of women and their families.

Please see the second article of the Spring 2026 issue!

Background: The frequency of opioid and antibiotic prescribing for pediatric patients presenting to emergency departments (ED) for dental pain without overt infection is not well known. The aim of this study is to analyze ED prescribing patterns for the treatment of “simple toothache” in children.

Methods: This was a retrospective, cohort analysis of consecutive pediatric patients (ages 1-19 years) diagnosed with dental pain without trauma or obvious infection (defined as fever, intraoral or extraoral swelling, purulence, or trismus). Patients were seen at seven emergency departments (ED) over a 4-year study period (2018-2021). Clinical findings, treatment in the ED, and final disposition were recorded using an institutional honest broker system. Our study hypothesis was that both opioids and antibiotics are overutilized for the ED treatment of simple toothache in children. Descriptive statistics (frequency tables, confidence intervals) were used to summarize the data.

Results: A total of 683 pediatric patients met the inclusion criteria. The average age was 11.6 + 5.8 years. The 17- through 19-year age group had the highest rate of dental-related ED visits (33.1%). A higher proportion of Medicaid beneficiaries (66.6%) had dental visits compared with the commercially insured (26.9%) or uninsured (6.5%). Virtually all patients had a documented primary care physician (99.0%). The most common diagnoses were nonspecific odontalgia (55.4%) or dental caries (33.7%). An antibiotic, most often amoxicillin or penicillin, was prescribed in 60.1% (95% CI 57.3% to 64.7%) of ED visits. Opioids, most often hydrocodone, were prescribed in 18.7% (95% CI 15.9% to 21.9%). Dental nerve blocks were performed in only 43 patients (6.3%). Twelve percent of patients returned within 7 days requesting further analgesia.

Conclusion: The ED is a well-known safety net for children with a simple toothache who have no direct access to dental care. However, the recommended treatment for these patients are usually dental procedures rather than antibiotics or narcotics. Data-driven solutions, such as guideline implementation, provider education, use of nonsteroidal anti-inflammatory drugs, and dental nerve blocks could reduce medication-related harms and avert health care expenditures.

Please see the first article of the Spring 2026 issue!

Study Objectives: The increased use of computers at work has resulted in a similar increase in the number of musculoskeletal disorders reported. These disorders involve recurrent and persistent pain, may involve disability in any body part, and may happen progressively over periods of weeks to years. The goal of this pilot study was to assess the prevalence of ergonomic risk factors in emergency department (ED) clinicians while sitting at computer workstations.

Methods: This was a prospective, blinded, clinical assessment analysis conducted over a 2-month study period. ED clinicians (physicians, residents, and advanced practice providers) from a children’s tertiary care facility and a university-affiliated adult hospital were observed during routine computer tasks. Clinicians were blinded to the purpose of the study. Trained observers completed a Rapid Office Strain Assessment (ROSA) checklist to evaluate computer use ergonomic risk factors.  ROSA final scores ranged in magnitude from 1 to 10, with higher scores representing increasing risk factors. A ROSA score of 5 is considered an action level indicating when immediate change is necessary. One-way analysis of variance tests was used to compare ergonomic assessments at each level of postgraduate training.

Results: Seventy-six ED providers were observed performing a total of 89 tasks on computers. Providers were residents (42.1%), faculty (30.3%), and advanced practice providers (27.6%). Computer tasks included dictation, placing orders, and reviewing digital records. The mean ROSA score for all providers was 3.4 (SD 1.0). Overall, 24.2% of clinicians were scored at high risk for musculoskeletal disorders (ROSA score was >4). ROSA scores did not differ significantly among the various levels of postgraduate training. Computer use risk factors included awkward postures of the wrist and forearm, improper sitting posture, height of chair and workstation, and lack of lumbar support.

Conclusions: The Rapid Office Strain Assessment (ROSA) can be used to quickly quantify ergonomic risks associated with each component of a typical computer workstation and provide information to the ED provider regarding the need for change. In this small study, almost one-quarter of providers demonstrated ergonomic risk factors that make them susceptible to musculoskeletal disorders. These results occurred irrespective of postgraduate training levels.