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https://www.readbyqxmd.com/read/29608545/adherence-to-20-emergency-general-surgery-best-practices-results-of-a-national-survey
#1
Angela M Ingraham, M Didem Ayturk, Catarina I Kiefe, Heena P Santry
OBJECTIVE: To examine national adherence to emergency general surgery (EGS) best practices. BACKGROUND: There is a national crisis in access to high-quality care for general surgery emergencies. Acute care surgery (ACS), a specialty leveraging strengths of trauma systems, may ameliorate this crisis. A critical component of trauma care is adherence to clinical guidelines. We previously established best practices for EGS using RAND Appropriateness Methodology and pilot data...
March 30, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29580362/inadequacy-of-algorithmic-ventilator-associated-pneumonia-diagnosis-in-acute-care-surgery
#2
Jacob A Quick, Matthew D Breite, Stephen L Barnes
Clinical utility of algorithms to diagnose ventilator-associated pneumonia (VAP) in surgical patients has not been established. We aimed to test the diagnostic accuracy of two established methods to reliably diagnose VAP in acutely ill and injured surgical patients. After institutional review board approval, we prospectively collected data on 508 mechanically ventilated acute care surgery patients. Microbiologic samples were taken daily from all patients. Demographics, clinical, laboratory, and radiographic data were collected...
February 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29580353/when-hiring-new-trauma-and-surgical-critical-care-fellowship-graduates-what-qualities-are-most-desirable-a-survey-of-trauma-directors-and-trauma-program-administrators
#3
Michael Kalina, Joseph Ferraro, Stephen Cohn
A general surgeon shortage exists and fewer surgical residents specialize in trauma and surgical critical care (TSCC). We conducted a survey of trauma directors and administrators to determine what qualities are most desirable when hiring new TSCC fellowship graduates. METHODS: The survey, entitled "A Survey of Directors of Trauma on Hiring New Attending Trauma Surgeons," was submitted to the Eastern Association for the Surgery of Trauma (EAST) and distributed to the association members in January 2016...
February 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29478178/modified-finney-enteroplasty-a-bowel-sparing-damage-control-stapled-technique-for-penetrating-jejunal-and-ileal-injuries
#4
EDITORIAL
Eduardo Smith-Singares
The rise in gun violence and other penetrating trauma constitutes one of the main challenges in the modern practice of Acute Care Surgery. Expertise in the emergency management of this type of injuries is needed if one is to avoid preventable complications, such as short bowel syndrome. Revisiting and sometimes repurposing old surgical techniques may facilitate this task. The use of a modified Finney enteroplasty as a bowel sparing damage control technique for penetrating jejunal and ileal injuries was studied on 87 gunshot wound victims...
February 24, 2018: Updates in Surgery
https://www.readbyqxmd.com/read/29464491/do-i-need-to-operate-on-that-in-the-middle-of-the-night-development-of-a-nomogram-for-the-diagnosis-of-severe-acute-cholecystitis
#5
Mattia Portinari, Michele Scagliarini, Giorgia Valpiani, Simona Bianconcini, Dario Andreotti, Rocco Stano, Paolo Carcoforo, Savino Occhionorelli
BACKGROUND: Some authors have proposed different predictive factors of severe acute cholecystitis, but generally, the results of risk analyses are expressed as odds ratios, which makes it difficult to apply in the clinical practice of the acute care surgeon. The severe form of acute cholecystitis should include both gangrenous and phlegmonous cholecystitis, due to their severe clinical course, and cholecystectomy should not be delayed. The aim of this study was to create a nomogram to obtain a graphical tool to compute the probability of having a severe acute cholecystitis...
February 20, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29462081/the-opioid-epidemic-in-acute-care-surgery-characteristics-of-overprescribing-following-laparoscopic-cholecystectomy
#6
Kristine T Hanson, Cornelius A Thiels, Stephanie F Polites, Halena M Gazelka, Mohamed D Ray-Zack, Martin D Zielinski, Elizabeth B Habermann
BACKGROUND: Postoperative prescribing following acute care surgery must be optimized to limit excess opioids in circulation as misuse and diversion are frequently preceded by a prescription for acute pain. This study aimed to identify patient characteristics associated with higher opioid prescribing following laparoscopic cholecystectomy (LC). METHODS: Among patients age ≥18 years who underwent LC at a single institution 2014-2016, opioids prescribed at discharge were converted to oral morphine equivalents (OME) and compared to developing state guidelines (max 200 OME)...
February 17, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29421694/resuscitative-endovascular-balloon-occlusion-of-the-aorta-and-resuscitative-thoracotomy-in-select-patients-with-hemorrhagic-shock-early-results-from-the-american-association-for-the-surgery-of-trauma-aortic-occlusion-in-resuscitation-for-trauma-and-acute-care
#7
Megan Brenner, Kenji Inaba, Alberto Aiolfi, Joseph DuBose, Timothy Fabian, Tiffany Bee, John B Holcomb, Laura Moore, David Skarupa, Thomas M Scalea
BACKGROUND: Aortic occlusion (AO) is a potentially valuable tool for early resuscitation in patients nearing extremis or in arrest from severe hemorrhage. STUDY DESIGN: AAST AORTA registry identified trauma patients without penetrating thoracic injury undergoing AO at the level of the descending thoracic aorta (RT or Zone 1 REBOA) in the Emergency Department (ED). Survival outcomes relative to the timing of CPR need and admission hemodynamic status were examined...
February 5, 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29356604/procalcitonin-usefulness-in-acute-care-surgery-and-trauma
#8
Sara E Parli, Grishma Trivedi, Alison Woodworth, Phillip K Chang
BACKGROUND: Procalcitonin (PCT) is a serum biomarker currently suggested by the Surviving Sepsis Campaign to aid in determination of the appropriate duration of therapy in sepsis patients. We review the use of procalcitonin in patients after trauma or acute care surgery. METHOD: A MEDLINE search via PubMed was performed using the combination of "procalcitonin" and "humans" and "injuries, trauma," "wounds and injuries," or "wounds." Studies of burn patients, children, other biomarkers, and non-acute care surgery were excluded...
January 22, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29352339/effect-of-time-to-operation-on-value-of-care-in-acute-care-surgery
#9
Tyler J Loftus, Martin D Rosenthal, Chasen A Croft, R Stephen Smith, Philip A Efron, Frederick A Moore, Alicia M Mohr, Scott C Brakenridge
BACKGROUND: As reimbursement models evolve, there is increasing emphasis on maximizing value-based care for inpatient conditions. We hypothesized that longer intervals between admission and surgery would be associated with worse outcomes and increased costs for acute care surgery patients, and that these associations would be strongest among patients with high-risk conditions. METHODS: We performed a 5-year retrospective analysis of three risk cohorts: appendectomy (low-risk for morbidity and mortality, n = 618), urgent hernia repair (intermediate-risk, n = 80), and laparotomy for intra-abdominal sepsis with temporary abdominal closure (sTAC; high-risk, n = 102)...
January 19, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29336769/processes-of-health-care-delivery-education-and-provider-satisfaction-in-acute-care-surgery-a-systematic-review
#10
REVIEW
Kristin DeGirolamo, Patrick B Murphy, Karan D'Souza, Jacques X Zhang, Neil Parry, Elliott Haut, W Robert Leeper, Ken Leslie, Kelly N Vogt, S Morad Hameed
In recent years, significant workload, high acuity, and complexity of emergency general surgery conditions have led hospitals to replace the traditional on-call model with dedicated acute care surgery (ACS) service models. A systematic search of Ovid, EMBASE, and MEDLINE was undertaken to examine the impact of ACS services on health-care delivery processes and cost, education, and provider satisfaction. From 1827 papers, reviewers identified 22 studies that met inclusion criteria and subsequently used The Evidence-Based Practice for Improving Quality method and Newcastle-Ottawa Scale to score quality and level of evidence...
December 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29336766/the-implications-of-transfer-to-an-acute-care-surgical-tertiary-service
#11
Rebecca Britt, Pamela Davis, Anjali Gresens, Leonard Weireter, T J Novosel, Jay Collins, L D Britt
Tertiary hospitals are increasingly called on by smaller hospitals and free-standing emergency rooms (ERs) to provide surgical care for complex patients. This study assesses patients transferred to an acute care surgery service. The ER and transfer center logs, as well as billing data, were reviewed for 12 months for all cases evaluated by acute care surgery. The charts were reviewed for demographics, comorbidities, and outcomes. A total of 111 transferred patients with complete data were identified, with 59 transferred from another hospital and 52 from a free-standing ER...
December 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29280925/ontemporary-utilization-of-resuscitative-thoracotomy-results-from-the-aast-aortic-occlusion-for-resuscitation-in-trauma-and-acute-care-surgery-aorta-multicenter-registry
#12
Joseph DuBose, Timothy Fabian, Tiffany Bee, Laura J Moore, John B Holcomb, Megan Brenner, David Skarupa, Kenji Inaba, Todd E Rasmussen, David Turay, Thomas M Scalea
INTRODUCTION: Several reviews of Resuscitative thoracotomy (RT) use over the last 5 decades have been conducted, most recently the evidence-based practice management guideline (PMG) of the Eastern Association for the Surgery of Trauma (EAST). The present study was designed to examine contemporary RT utilization and outcomes compared to historical data (n = 10,238) from the EAST PMG review from published series 1974 - 2013. METHODS: The AAST AORTA registry was utilized to identify patients undergoing RT in the ED from Nov 2013 to Dec 2016...
December 26, 2017: Shock
https://www.readbyqxmd.com/read/29274376/trauma-still-the-cornerstone-of-acute-care-surgery-specialty
#13
L D Britt
No abstract text is available yet for this article.
March 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29251703/a-pilot-registry-of-trauma-surgeons-willing-and-ready-to-respond-to-disasters
#14
Daniel Grabo, Aaron Strumwasser, Kyle Remick, Susan Briggs
BACKGROUND: A well-defined means of organizing surgeons based on functional capabilities in disaster response has been lacking. We sought to create a pilot registry of surgeons, organized by functional capacities, available to respond to disasters in conjunction with the American College of Surgeons Operation Giving Back and to better understand their participation in disaster medicine training. METHODS: The authors conducted a survey of the members of the American Association for the Surgery of Trauma and the Eastern Association for the Surgery of Trauma aimed at establishing a pilot registry of qualified trauma surgeons available to respond to disasters...
February 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29229317/team-based-simulations-for-new-surgeons-does-early-and-often-make-a-difference
#15
Kareem R AbdelFattah, M Chance Spalding, David Leshikar, Aimee K Gardner
BACKGROUND: Current work hour restrictions and the expansion of requirements for surgery residents has led to decreased time on high-acuity rotations such as trauma and acute care surgery. In an effort to improve resident competency, we examined the efficacy of a new team-based trauma curriculum for postgraduate year 1 (PGY1) residents. METHODS: After completing required Advanced Trauma Life Support certification, PGY1s participated in a series of trauma simulations in 3-person teams from June to August...
December 8, 2017: Surgery
https://www.readbyqxmd.com/read/29180188/statewide-assessment-of-surgical-outcomes-and-the-acute-care-surgery-model
#16
COMPARATIVE STUDY
Nicholas L Bandy, Sarah C DeShields, Tina D Cunningham, Rebecca C Britt
BACKGROUND: The acute care surgery (ACS) model has been widely implemented with single institution studies demonstrating improved outcomes. Recent multicenter studies have raised questions about the economics and efficacy of ACS. This study compares traditional and ACS outcomes across an entire state. METHODS: A retrospective review of Virginia's Health Information administrative database was completed. Adults admitted with appendicitis or cholecystitis between 2008 and 2014 were included...
December 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29140948/hypertonic-saline-resuscitation-after-emergent-laparotomy-and-temporary-abdominal-closure
#17
Tyler J Loftus, Philip A Efron, Trina M Bala, Martin D Rosenthal, Chasen A Croft, R Stephen Smith, Frederick A Moore, Alicia M Mohr, Scott C Brakenridge
BACKGROUND: Our objective was to establish the safety of 3% hypertonic saline (HTS) resuscitation for trauma and acute care surgery patients undergoing emergent laparotomy and temporary abdominal closure (TAC) with the hypothesis that HTS administration would be associated with hyperosmolar hypercholoremic acidosis, lower resuscitation volumes, and higher fascial closure rates, without adversely affecting renal function. METHODS: We performed a retrospective cohort analysis of 189 trauma and acute care surgery patients who underwent emergent laparotomy and TAC, comparing patients with normal baseline renal function who received 3% HTS at 30 mL/h (n = 36) to patients with standard resuscitation (n = 153) by baseline characteristics, resuscitation parameters, and outcomes including primary fascial closure and Kidney Disease: Improving Global Outcomes stages of acute kidney injury...
February 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28979986/geographic-diffusion-and-implementation-of-acute-care-surgery-an-uneven-solution-to-the-national-emergency-general-surgery-crisis
#18
Jasmine A Khubchandani, Angela M Ingraham, Vijaya T Daniel, Didem Ayturk, Catarina I Kiefe, Heena P Santry
Importance: Owing to lack of adequate emergency care infrastructure and decline in general surgery workforce, the United States faces a crisis in access to emergency general surgery (EGS) care. Acute care surgery (ACS), an organized system of trauma, general surgery, and critical care, is a proposed solution; however, ACS diffusion remains poorly understood. Objective: To investigate geographic diffusion of ACS models of care and characterize the communities in which ACS implementation is lagging...
October 4, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28958272/inclusion-of-the-acute-care-surgeon-in-the-difficult-airway-protocol-a-nine-year-experience
#19
Seong K Lee, Andrew A Rosenthal, Dafney L Davare, Chauniqua Kiffin, Rafael Sanchez, Michael Hurtado, Eddy H Carrillo
An emergency surgical airway is a lifesaving intervention required in the event of airway loss or respiratory failure when conventional endotracheal intubation cannot be performed. The Acute Care Surgery/Trauma Service is a critical component in the angioedema/difficult airway protocol at our institution. We conducted a retrospective review (2007-2016) to analyze the role our service has in managing patients requiring an emergency surgical airway. Cases were analyzed for preexisting conditions, hospital location of procedure, techniques, complications, and mortality...
September 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28930946/evaluating-the-traditional-day-and-night-shift-in-an-acute-care-surgery-fellowship-is-the-swing-shift-a-better-choice
#20
Paul J Chestovich, Christopher F McNicoll, Nichole K Ingalls, Deborah A Kuhls, Douglas R Fraser, Shawna L Morrissey, John J Fildes
BACKGROUND: Fellowship trainees in acute care surgery require experience in the management of complex and operative trauma cases. Trauma center staffing usually follows standard 12-hour or 24-hour shifts, with resident and fellow trainees following a similar schedule. Although trauma admissions can be generally unpredictable, we analyzed temporal trends of trauma patient arrival times to determine the best time frame to maximize trainee experience during each day. METHODS: We reviewed 10 years (2007-2016) of trauma registry data for blunt and penetrating trauma activations...
January 2018: Journal of Trauma and Acute Care Surgery
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