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Ingram J, Williams AY, Bright AC, Caleb Butts C. Use of lateral femoral cutaneous nerve blocks by landmark technique is ineffective in decreasing narcotic usage after skin grafts: A retrospective case-control study. Burns 2024; 50:997-1002. [PMID: 38331662 DOI: 10.1016/j.burns.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/24/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Cutaneous burns are commonly treated with autologous skin grafts. Following skin grafting, many patients complain of pain at the donor site. Donor sites are taken most commonly from the lateral thigh, which is innervated by the lateral femoral cutaneous nerve (LFCN). Use of a LFCN blocks should decrease nociception from the donor site. METHODS Our group began utilizing LFCN blocks in 2019. Utilizing anatomic landmarks, LFCN blocks were performed on all patients who received autologous skin grafts to reduce perioperative pain. A retrospective cohort study was performed on all patients with 10% or less total body surface areas burns who received an autologous skin graft. A similar cohort from 2016, prior to use of any local or regional analgesia, was used as a historical control. Post-operative enteral and parenteral narcotic analgesics were collected for each post-operative day up to day 5 or discharge (whichever came first) and converted to morphine milligram equivalents (MME) to quantify analgesia after surgery. RESULTS Chart review identified 55 patients in the 2020 cohort. Fifty-five patients from the 2016 cohort were matched based upon size of skin graft, total body surface area (TBSA) burned, gender, and age. There were no statistically significant differences between the two groups in terms of size of graft, TBSA burned, age, gender, or type of burn. When examining narcotics usage in the immediate perioperative period (days 0-2), we found no difference between the two groups for total MME (113 vs 133, p = 0.28) or IV MME (38 vs 33, p = 0.45). Similar relationships existed in the extended post-operative period (days 1-5) for total MME (149 vs. 188, t = 0.22) or IV MME (37 vs. 50, t = 0.25). Examining daily narcotic usage also yielded no statistically different values. CONCLUSION Our data shows that use of LFCN block by landmark technique did not reduce narcotic usage in patients that undergo skin grafting procedures. Future studies should consider ultrasound-guided LFCN blocks.
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Affiliation(s)
- Jordan Ingram
- University of South Alabama College of Medicine, 5795 USA Drive North, CSAB 170, Mobile, AL 36688, USA.
| | - Ashley Y Williams
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
| | - Andrew C Bright
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
| | - C Caleb Butts
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
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Blackley SK, Lawrence J, Blevins A, Howell C, Butts CC, Polite NM, Capasso TJ, Bright AC, Hall KA, Haiflich AN, Williams AY, Kinnard CM, Mbaka MI, Audia JP, Simmons JD, Lee YL. A Single Hospital-Wide Antibiogram is Insufficient to Account for Differences in Antibiotic Resistance Patterns Across Multiple ICUs. Am Surg 2024:31348241241636. [PMID: 38597604 DOI: 10.1177/00031348241241636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Infection is a common cause of mortality within intensive care units (ICUs). Antibiotic resistance patterns and culture data are used to create antibiograms. Knowledge of antibiograms facilitates guiding empiric therapies and reduces mortality. Most major hospitals utilize data collection to create hospital-wide antibiograms. Previous studies have shown significant differences in susceptibility patterns between hospital wards and ICUs. We hypothesize that institutional or combined ICU antibiograms are inadequate to account for differences in susceptibility for patients in individual ICUs. METHODS Culture and susceptibility data were reviewed over a 1-year period for 13 bacteria in the following ICUs: Surgical/Trauma, Medical, Neuroscience, Burn, and Emergency department. Antibiotic management decisions are made by individual teams. RESULTS Nine species had sufficient data for inclusion into an All-ICU antibiogram. E coli and S aureus were the most common isolates. Seven species had significant differences in susceptibility patterns between ICUs. E cloacae showed higher rates of resistance to multiple antibiotics in the STICU than other ICUs. P aeruginosa susceptibility rates in the NSICU and BICU were 88% and 92%, respectively, compared to 60% and 55% in the STICU and MICU. Cephalosporins and Aztreonam had reduced efficacy against E coli in the NSICU, however remain effective in other ICUs. CONCLUSIONS The results of this study show that different ICUs do have variability in antibiotic susceptibility patterns within a single hospital. While this only represents a single institution, it shows that the use of hospital-wide antibiograms is inadequate for creating empiric antibiotic protocols within individual ICUs.
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Affiliation(s)
- Shem K Blackley
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Jay Lawrence
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Addison Blevins
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Caroline Howell
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Charles C Butts
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Nathan M Polite
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Thomas J Capasso
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Andrew C Bright
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Kayla A Hall
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | | | | | | | - Maryann I Mbaka
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Jonathon P Audia
- Department of Microbiology and Immunology, University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Department of Surgery, University of South Alabama, Mobile, AL, USA
- Department of Cellular & Molecular Pharmacology, University of South Alabama, Mobile, AL, USA
| | - Yannleei L Lee
- Department of Surgery, University of South Alabama, Mobile, AL, USA
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Gautreaux CE, Robinson TW, Dunbar EG, Lee YLL, Mbaka M, Kinnard CM, Bright AC, Williams AY, Polite NM, Capasso TJ, Simmons JD, Butts CC. Admission Medication Reconciliation Discrepancies in Trauma Patients: Consistent Nursing Care May Not Be the Answer. Am Surg 2024:31348241241647. [PMID: 38532294 DOI: 10.1177/00031348241241647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Inadvertent medication reconciliation discrepancies are common among trauma patient populations. We conducted a prospective study at a level 1 trauma center to assess incidence of inadvertent medication reconciliation discrepancies following decreased reliance on short-term nursing staff. Patients and independent sources were interviewed for home medication lists and compared to admission medication reconciliation (AMR) lists. Of the 108 patients included, 37 patients (34%) never received an AMR. Of the 71 patients that had a completed AMR, 42 patients (59%) had one or more errors, with total 154 errors across all patients, for a rate of 3.7 per patient with any discrepancy. Patients taking ≥ 5 medications were significantly more likely to have an incomplete or inaccurate AMR than those taking <5 medications (89% vs 41%, P < .0001). Decreased reliance on short-term nursing staff did not decrease inadvertent admission medication reconciliation discrepancies. Additional interventions to decrease risk of medication administration errors are needed.
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Affiliation(s)
- Corinne E Gautreaux
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Thomas W Robinson
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Elisabeth G Dunbar
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Yann-Leei L Lee
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Christopher M Kinnard
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Andrew C Bright
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Ashley Y Williams
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Nathan M Polite
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Thomas J Capasso
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - C Caleb Butts
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
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Hart K, Thames MA, Massey AC, Capasso T, Lee YL, Mbaka M, Kinnard CM, Bright AC, Williams AY, Polite NM, Simmons JD, Butts CC. Diabetes in Trauma Patients: A Potential Gateway to a Medical Home. Am Surg 2024:31348241241615. [PMID: 38516800 DOI: 10.1177/00031348241241615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Diabetes is a major determinant of health outcomes. Trauma patients are disproportionately from lower socioeconomic status, where lack of access to health care prevents timely treatment. Trauma centers could play a role in identifying patients in need of improved glucose management, but the current burden of disease is not known. We assessed the incidence of patients in need of intervention that presented to a level 1 trauma center over a 6-month period. METHODS A retrospective chart review over 6 months of all trauma patients admitted to a level 1 trauma center was performed. Patients' past medical history (PMH), medication reconciliation, and hemoglobin A1c (HbA1c) were recorded on initial assessment; patients <18 years old, lacking an HbA1c, or missing PMH were excluded. Patients with PMH of diabetes or antihyperglycemic use were classified by HbA1c: well-controlled ≤8.0% or poorly controlled >8.0%. Patients with no history of diabetes or antihyperglycemic use were classified based on their HbA1c: non-diabetic <5.7%, pre-diabetic 5.7-6.4%, and undiagnosed diabetic ≥6.5%. RESULTS Overall, 1377 patients were identified. After exclusion criteria, 903 patients were classified as follows: 593 (66%) non-diabetics, 160 (18%) pre-diabetics, and 150 (17%) diabetics. Fifteen diabetics were undiagnosed; 39 of the diagnosed diabetics were poorly controlled. Including pre-diabetics, a total of 214 (24%) trauma patients were in need of improved glycemic control. DISCUSSION One in four trauma patients would benefit from improved outpatient glycemic management, representing a missed opportunity for preventative health care. Trauma centers should develop strategies to meet this need as part of their post-discharge care.
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Affiliation(s)
- Kaylee Hart
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Margaret A Thames
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Ashley Caroline Massey
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Thomas Capasso
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Yannlei L Lee
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Christopher M Kinnard
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Andrew C Bright
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Ashley Y Williams
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Nathan M Polite
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Jon D Simmons
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - C Caleb Butts
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
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5
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Alexander KM, Davis SN, Butts CC, Morgan J, Croft LK, Lee YLL, Kinnard CM, Polite NM, Mbaka MI, Williams AY, Barrington RA, Audia JP, Simmons JD. Defining Pathogen and Susceptibility Patterns for Early Versus Late Ventilator Associated Pneumonia in Trauma Patients to Guide Empiric Treatment Decisions. Am Surg 2023; 89:4536-4541. [PMID: 35979859 DOI: 10.1177/00031348221121539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Studies have demonstrated that trauma patients with early-ventilator associated pneumonia (early-VAP, < 7 days) have decreased risk of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa infections. We hypothesize that routinely using broad-spectrum antibiotics is unnecessary to treat trauma patients with the diagnosis of early-VAP. METHODS This retrospective cohort study included adult trauma patients with the diagnosis of VAP. The primary outcome was the presence of MRSA and/or P. aeruginosa in patients with early- and late-VAP. Secondary outcomes included the bacterial susceptibility of pathogens to methicillin, ampicillin/sulbactam, ceftriaxone, piperacillin/tazobactam, and cefepime. Intensive care unit (ICU) and hospital length of stay (LOS), ventilator-free days, and in-hospital mortality were also collected. RESULTS 164 patients met inclusion criteria, and 208 organisms (n = 90 early vs n = 118 late) were identified by respiratory culture. The incidence of MRSA and P. aeruginosa in early-VAP was 7.7% (7/90) and 5.6% (5/90), respectively. The susceptibility of bacteria causing early-VAP to ampicillin/sulbactam and ceftriaxone was 73.3% (66/90) and 83.3% (75/90), respectively. Ventilator-free days at 30 days was similar between groups (P = .649). Patients with late-VAP spent more time in the ICU (P = .040); however, in-hospital mortality was higher in the early-VAP group (P = .012). CONCLUSIONS Ampicillin/sulbactam or ceftriaxone monotherapy did not provide reliable broad-spectrum coverage for early-VAP in our cohort. These findings highlight the importance of each institution performing a similar analysis to ensure adequate initial treatment of VAP.
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Affiliation(s)
| | - S Noelle Davis
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - C Caleb Butts
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - John Morgan
- School of Medicine, The University of South Alabama, Mobile, AL, USA
| | - Leah K Croft
- Department of Pharmacy, USA Health University Hospital, Mobile, AL, USA
| | - Yann-Leei L Lee
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | | | - Nathan M Polite
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Maryann I Mbaka
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | | | - Robert A Barrington
- Department of Microbiology and Immunology, Univeristy of South Alabama, Mobile, AL, USA
| | - Jonathon P Audia
- Department of Microbiology and Immunology, Univeristy of South Alabama, Mobile, AL, USA
- Center for Lung Biology, University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Department of Surgery, University of South Alabama, Mobile, AL, USA
- Department of Pharmacology, The University of South Alabama, Mobile, AL, USA
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Gilligan-Lee KA, Hawes ZCK, Williams AY, Farran EK, Mix KS. Hands-On: Investigating the role of physical manipulatives in spatial training. Child Dev 2023; 94:1205-1221. [PMID: 37547951 DOI: 10.1111/cdev.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/11/2023] [Accepted: 06/03/2023] [Indexed: 08/08/2023]
Abstract
Studies show that spatial interventions lead to improvements in mathematics. However, outcomes vary based on whether physical manipulatives (embodied action) are used during training. This study compares the effects of embodied and non-embodied spatial interventions on spatial and mathematics outcomes. The study has a randomized, controlled, pre-post, follow-up, training design (N = 182; mean age 8 years; 49% female; 83.5% White). We show that both embodied and non-embodied spatial training approaches improve spatial skills compared to control. However, we conclude that embodied spatial training using physical manipulatives leads to larger, more consistent gains in mathematics and greater depth of spatial processing than non-embodied training. These findings highlight the potential of spatial activities, particularly those that use physical materials, for improving children's mathematics skills.
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Affiliation(s)
- Katie A Gilligan-Lee
- School of Psychology, University College Dublin, Dublin, Ireland
- School of Psychology, University of Surrey, Guildford, UK
- Centre for Educational Neuroscience, Birkbeck, University of London, London, UK
| | - Zachary C K Hawes
- Department of Applied Psychology & Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | | | - Emily K Farran
- School of Psychology, University of Surrey, Guildford, UK
- Centre for Educational Neuroscience, Birkbeck, University of London, London, UK
| | - Kelly S Mix
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
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Sheppard K, Roberts ME, Bernard J, Wood B, Lee YL, Williams AY, Capasso T, Butts CC, Polite N, Simmons JD, Bright A, Kinnard C, Mbaka M. A Multidisciplinary Approach for the Management of Portal Vein Thrombosis. Am Surg 2023; 89:3817-3819. [PMID: 37132031 DOI: 10.1177/00031348231173964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Portal venous thrombosis (PVT) is an uncommon disease associated with highly morbid conditions such as intestinal ischemia and portal hypertension. Patients at higher risk of developing PVT include those with cirrhosis, malignancy, or prothrombotic states. The mainstay of treatment is early initiation of anticoagulation. The first case is a 49-year-old female diagnosed with a cecal mass and PVT. She was started on anticoagulation and underwent a right hemicolectomy with several small bowel resections. She developed portal hypertension that required TIPS and mechanical thrombectomy. The second patient is a 65-year-old female found to have PVT. She was anticoagulated with heparin and given systemic TPA. She developed intestinal ischemia and portal hypertension requiring small bowel resection, TIPS, and mechanical thrombectomy. These cases give insight into the impact of a multidisciplinary team approach to PVT. The role and timing of endovascular treatment is not well established and needs to be further investigated.
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Affiliation(s)
- Kyle Sheppard
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Morgan E Roberts
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Jonathan Bernard
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Brian Wood
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Yannlei L Lee
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Ashley Y Williams
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Thomas Capasso
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Caleb C Butts
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Nathan Polite
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - John D Simmons
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Andrew Bright
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Christopher Kinnard
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
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Michael JA, Roberts ME, Haiflich AN, Boyer E, Capasso TJ, Butts CC, Bright AC, Kinnard CM, Simmons JD, Williams AY, Lee YL, Polite NM, Mbaka MI. Effects of the COVID-19 Pandemic on the Trauma Population in a Level 1 Trauma Center. Am Surg 2023; 89:3962-3964. [PMID: 37144279 PMCID: PMC10160817 DOI: 10.1177/00031348231174005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In this study, we evaluated the effects of the pandemic on our trauma population. We performed a retrospective review of the trauma registry in the 2 years prior, and then 2 years during the pandemic. We evaluated age, race, gender, injury severity score (ISS), mechanism of trauma, rate of self-inflicted injury, rate of gunshot wounds (GSW), presence of EtOH, drug screen results, mortality, rate of burn traumas, and zip code of residence. Our query captured 5 054 patients before, and 5 731 during the pandemic. We found no statistical difference in age, gender, mechanism of trauma, rate of self-inflicted injuries, and mortality during the pandemic when compared to before. There were statistically significant differences in race, ISS, rate of GSWs, EtOH use, drug screen results, and burn traumas. Geospatial mapping found a rise in GSWs for zip code 36606. Gun violence and substance use rose in our trauma population during COVID-19.
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Affiliation(s)
- Javier A. Michael
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Morgan E. Roberts
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Andrew N. Haiflich
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Edwin Boyer
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Thomas J. Capasso
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Charles C. Butts
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Andrew C. Bright
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Christopher M. Kinnard
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Jon D. Simmons
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Ashley Y. Williams
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Yannlei L. Lee
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Nathan M. Polite
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
| | - Maryann I. Mbaka
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, University of South Alabama College of Medicine, Mobile, AL, USA
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Malone K, Hogue A, Naman E, Graves C, Haiflich A, Simmons JD, Williams AY. Project Inspire pilot study: A hospital-led comprehensive intervention reduces gun violence among juveniles delinquent of gun crimes. J Trauma Acute Care Surg 2023; 95:137-142. [PMID: 37068000 DOI: 10.1097/ta.0000000000003957] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Gun violence disproportionately affects young Black men, but the impact extends to families and communities. Those at highest risk are teens delinquent of gun crimes. While there is no nationally accepted juvenile rate of recidivism, previous literature reveals rearrest rates from 50% to 80% in high-risk youth, and some reports show that up to 40% of delinquent juveniles are incarcerated in adult prisons before the age of 25 years. We hypothesize that Project Inspire, a hospital-led comprehensive intervention, reduces recidivism among high-risk teens. METHODS Led by a level 1 trauma center, key community stakeholders including the juvenile court, city, and city police department joined forces to create a community-wide program aimed at curbing gun violence in high-risk individuals. Participants, aged 13 to 18 years, are selected by the juvenile gun court. They underwent a rigorous 3-week program with a curriculum incorporating the following: trauma-informed training and confidence building, educational/professional development, financial literacy, entrepreneurship, and career-specific job shadowing and mentorship. Rates of recidivism were measured annually. RESULTS Project Inspire has hosted two classes in 2018 and 2019, graduating nine participants aged 14 to 17 years. Sixty-seven percent were Black. All were males. At 1 year, none of the graduates reoffended. At 2 years, one participant reoffended. At 3 years, no additional participants reoffended. No graduate reoffended as a juvenile. Thus, the overall rate of recidivism for Project Inspire is 11% to date. Eighty-nine percent of graduates received a diploma, general educational development, or obtained employment. CONCLUSION Project Inspire is a hospital-led initiative that effectively reduces recidivism among juveniles delinquent of gun crimes. This sets the framework for trauma centers nationwide to lead in establishing impactful, comprehensive, gun-violence intervention strategies. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level V.
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Affiliation(s)
- Kaleb Malone
- From the Frederick P. Whiddon College of Medicine (K.M.) and Department of Internal Medicine (A.H.), University of South Alabama; Juvenile Court of Mobile County (E.N.), James T. Strickland Youth Center; City of Mobile (C.G.); and Department of Surgery (A.H., J.D.S., A.Y.W.), University of South Alabama, Mobile, Alabama
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Bates KE, Williams AY, Gilligan‐Lee KA, Gripton C, Lancaster A, Williams H, Borthwick A, Gifford S, Farran EK. Practitioners' perspectives on spatial reasoning in educational practice from birth to 7 years. Br J Educ Psychol 2023; 93:571-590. [PMID: 36806150 PMCID: PMC10952197 DOI: 10.1111/bjep.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/28/2022] [Indexed: 02/22/2023]
Abstract
BACKGROUND There is a growing evidence base for the importance of spatial reasoning for the development of mathematics. However, the extent to which this translates into practice is unknown. AIMS We aimed to understand practitioners' perspectives on their understanding of spatial reasoning, the extent to which they recognize and implement spatial activities in their practice, and the barriers and opportunities to support spatial reasoning in the practice setting. SAMPLE Study 1 (questionnaire) included 94 participants and Study 2 (focus groups) consisted of nine participants. Participants were educational practitioners working with children from birth to 7 years. METHODS The study was mixed methods and included a questionnaire (Study 1) and a series of focus groups (Study 2). RESULTS We found that whilst practitioners engage in a variety of activities that support spatial reasoning, most practitioners reported little confidence in their understanding of what spatial reasoning is. CONCLUSION Informative and accessible resources are needed to broaden understanding of the definition of spatial reasoning and to outline opportunities to support spatial reasoning.
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Affiliation(s)
- Kathryn E. Bates
- Department of Psychology, Institute of Psychology, Psychiatry and NeuroscienceKings College LondonLondonUK
| | | | - Katie A. Gilligan‐Lee
- Centre for Educational NeuroscienceUniversity of LondonLondonUK
- School of PsychologyUnivesity College DublinDublinIreland
| | | | | | | | | | - Sue Gifford
- School of EducationUniversity of RoehamptonRoehamptonUK
| | - Emily K. Farran
- School of PsychologyUniversity of SurreyGuildfordUK
- Centre for Educational NeuroscienceUniversity of LondonLondonUK
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Donnellan KA, Hinson CS, Blevins AC, Weaver KL, Lintner AC, Butts CC, Williams AY, Lee YLL, Simmons JD, Bright AC. Treatment of Chronic Hypertrophic Burn Scars With a Fractional CO 2 Laser Is Well Tolerated in an Outpatient Clinic Setting. Ann Plast Surg 2023; 90:444-446. [PMID: 36913562 DOI: 10.1097/sap.0000000000003526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION The necessity of treating hypertrophic burn scars has expanded significantly with increased burn survivorship. Ablative lasers, such as carbon dioxide (CO 2 ) lasers, have been the most common nonoperative option for improving functional outcomes in severe recalcitrant hypertrophic burn scars. However, the overwhelming majority of ablative lasers used for this indication require a combination of systemic analgesia, sedation, and/or general anesthesia due to the painful nature of the procedure. More recently, the technology of ablative lasers has advanced and is more tolerable than their first-generation counterparts. Herein, we hypothesized that refractory hypertrophic burn scars can be treated by a CO 2 laser in an outpatient clinic. METHODS We enrolled 17 consecutive patients with chronic hypertrophic burn scars that were treated with a CO 2 laser. All patients were treated in the outpatient clinic with a combination of a topical solution (23% lidocaine and 7% tetracaine) applied to the scar 30 minutes before the procedure, Cryo 6 air chiller by Zimmer, and some patients received a mixture of N 2 O/O 2 . Laser treatments were repeated every 4 to 8 weeks until the patient's goals were met. Each patient completed a standardized questionnaire to assess tolerability and patient satisfaction of functional results. RESULTS All patients tolerated the laser well in the outpatient clinic setting, with 0% indicating "not tolerable," 70.6% "tolerable," and 29.4% "very tolerable." Each patient received more than 1 laser treatment for the following complaints: decreased range of motion (n = 16, 94.1%), pain (n = 11, 64.7%), or pruritis (n = 12, 70.6%). Patients were also satisfied with the results of the laser treatments ("no improvement or worsened" = 0%, "improved" = 47.1%, and "significant improvement" = 52.9%). The age of patient, type of burn, location of burn, presence of skin graft, or age of scar did not significantly affect the tolerability of treatment or satisfaction of outcome. CONCLUSIONS The treatment of chronic hypertrophic burn scars with a CO 2 laser is well tolerated in an outpatient clinic setting in select patients. Patients reported a high level of satisfaction with notable improvement in functional and cosmetic outcomes.
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Affiliation(s)
| | | | | | - Katrina L Weaver
- Division of Pediatric Surgery, Department of Surgery, University of South Alabama School of Medicine, Mobile, AL
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12
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Blackley SK, Smith WC, Lee YL, Kinnard C, Williams AY, Butts CC, Mbaka MI, Haiflich A, Bright A, Simmons JD, Polite NM. Identifying Radiographic and Clinical Indicators to Reduce the Occurrence of Nontherapeutic Laparotomy for Blunt Bowel and Mesenteric Injury. Am Surg 2023:31348231174009. [PMID: 37115715 DOI: 10.1177/00031348231174009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Roughly 5% of patients with blunt abdominal trauma (BAT) have a blunt bowel and/or mesenteric injury (BBMI). Determining the need for operative management in these patients can be challenging when hemodynamically stable. Single center studies have proposed scoring systems based on CT findings to guide management. Our study aimed to determine the predictability of abdominopelvic CT scan (CT A/P) findings in conjunction with clinical exam to determine the necessity of operative intervention for BBMI. METHODS Patients presenting from 2017 to 2022 to the University of South Alabama Level 1 Trauma Center after motor vehicle collision were retrospectively reviewed. Patients with CT findings suggestive of BBMI were further analyzed, noting CT findings, Glasgow coma scale (GCS), shock index, abdominal exam, operative or nonoperative management, and intraoperative intervention. RESULTS 1098 patients with BAT underwent CT A/P. 139 patients had ≥1 finding suggestive of BBMI. 38 patients underwent surgical exploration and 30 had surgically confirmed BBMI. 27 patients required intervention for BBMI. Univariate analysis indicated that pneumoperitoneum (p < 0.0001), active extravasation of contrast (p = 0.0001), hemoperitoneum without solid organ injury (SOI) (p < 0.0001), peritonitis (p < 0.0001), and mesenteric stranding(p < 0.05) were significantly associated with intervention. CONCLUSION In total, 30 patients had surgically confirmed BBMI. Active extravasation, pneumoperitoneum, hemoperitoneum without SOI, mesenteric stranding, and peritonitis were significant indicators of BBMI requiring intervention. CT and clinical findings cannot reliably predict the need for surgical intervention without ≥1 of these findings. Initial nonoperative management with serial clinical exams should be strongly considered to reduce incidence of nontherapeutic laparotomies.
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Affiliation(s)
- Shem K Blackley
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - William C Smith
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Yann-Leei Lee
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | | | | | - Charles C Butts
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Maryann I Mbaka
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Andrew Haiflich
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Andrew Bright
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Nathan M Polite
- Department of Surgery, University of South Alabama, Mobile, AL, USA
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13
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Williams AY, Butts CC. Stress Disorders: the Trauma Surgeon as the Second Victim. Curr Trauma Rep 2023; 9:1-8. [PMID: 37362905 PMCID: PMC10134724 DOI: 10.1007/s40719-023-00259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review We review the vocabulary and studies regarding stress disorders, as it relates to trauma care providers, specifically trauma surgeons. In addition, we make recommendations regarding strategies to address the needs identified and future areas of research to assess the adequacy of these strategies. Recent Findings Stress disorders in trauma are common and constant, identified at levels similar to those seen among first-responders to mass-casualty events. These disorders are identified at every level-from trainee to the most experienced. Trauma surgeons experience the trauma firsthand, as well as through forced re-traumatization as a part of routine care. High levels of cumulative stress result due to the volume of patients that can be difficult to process due to the frequency of shifts and disrupted sleep patterns. This level of chronic stress can lead to a cycle of burnout and increased stress, which is harmful to surgeons and patients. Summary Stress disorders are common and poorly understood. Treatment options are infrequently encountered. In order to more adequately respond to this, systematic change is necessary.
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Affiliation(s)
- Ashley Y. Williams
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Burns, Whiddon College of Medicine, University of South Alabama, Mobile, AL USA
| | - C. Caleb Butts
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Burns, Whiddon College of Medicine, University of South Alabama, Mobile, AL USA
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14
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Barnes BM, Bouillon V, Haiflich A, Butts CC, Capasso T, Bright A, Polite N, Williams AY, Kinnard C, Simmons JD, Lee YL, Mbaka M. Blunt Cerebrovascular Injury (BCVI) Management: Is There a Right Answer? Am Surg 2023:31348231161684. [PMID: 36869309 DOI: 10.1177/00031348231161684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Blunt cerebrovascular injury (BCVI) results from blunt trauma causing injury to the carotid and/or vertebral arteries. Its most severe manifestation is stroke. The purpose of this study was to evaluate the incidence, management, and outcomes of BCVI at a level one trauma/stroke center. Data on patients diagnosed with BCVI from 2016 to 2021 were extracted from the USA Health trauma registry with associated intervention performed and patient outcomes. Of the 97 patients identified, 16.5% presented with stroke-like symptoms (SS). Medical management was employed for 75%. Intravascular stent alone was utilized for 18.8%. The mean age of symptomatic BCVI patients was 37.6 with a mean injury severity score (ISS) of 38.2. Within the asymptomatic population, 58% received medical management and 3.7% underwent combination therapy. The mean age of asymptomatic BCVI patients was 46.9 with a mean ISS of 20.3. There were 6 mortalities, only one BCVI related.
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Affiliation(s)
- Brandon Michael Barnes
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Victoria Bouillon
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Andrew Haiflich
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - C Caleb Butts
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Thomas Capasso
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Andrew Bright
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Nathan Polite
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Ashley Y Williams
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Christopher Kinnard
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Yannlei L Lee
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Maryann Mbaka
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
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15
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Cockrell BE, Haiflich AN, Lee YLL, Kinnard CM, Butts CC, Polite NM, Mbaka MI, Bright AC, Simmons JD, Williams AY. Social Determinants of Health Impact Physical Recovery After Blunt Injury. Am Surg 2023:31348231161672. [PMID: 36853832 DOI: 10.1177/00031348231161672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
As defined by the United States Department of Health and Human Services, the Social Determinants of Health (SDOH) are conditions in the environment that affect health function and outcomes. The SDOH are divided into the following categories: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community content. It is known that SDOH impact long-term health outcomes. The influence that SDOH have on physical recovery after acute injury is less understood, however. In this study, patients who suffered a traumatic blunt injury completed a survey 12-14 months post-injury to assess their SDOH and physical health before and after their injury. The results showed that for the cohort of patients studied SDOH was the greatest predictor of long-term recovery, having a stronger correlation with recovery than injury severity score (ISS) or hospital length of stay (HLOS).
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Affiliation(s)
| | - Andrew N Haiflich
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Yann-Leei L Lee
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Christopher M Kinnard
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Charles C Butts
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Nathan M Polite
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Maryann I Mbaka
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Andrew C Bright
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Jon D Simmons
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Ashley Y Williams
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
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Dunbar EG, Massey AC, Lee YL, Mbaka M, Kinnard CM, Bright AC, Williams AY, Polite NM, Simmons JD, Butts CC. Incidence and Severity of Medication Reconciliation Discrepancies in Trauma Patients. Am Surg 2023:31348231161686. [PMID: 36853593 DOI: 10.1177/00031348231161686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Trauma patients are especially vulnerable to inadvertent medication reconciliation discrepancies. We conducted a prospective study to evaluate the USA Health University Hospital's incidence and type of inadvertent medication reconciliation discrepancies among trauma patients. Patients were interviewed for accuracy of their admission medication reconciliation (AMR). Eighty-nine patients were included in this study. Twenty-six patients (29%) never received an AMR. There were 107 inadvertent medication reconciliation errors identified from 30 separate patients (48%), for a rate of 3.6 errors per patient with any error. There was a significant difference in the frequency of inadvertent medication reconciliation discrepancies for patients with >5 medication compared to those with fewer (P = .00029). In conclusion, trauma centers must be adequately staffed to provide timely, accurate, and available medication lists so that patients can be appropriately cared for.
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Affiliation(s)
- Elisabeth G Dunbar
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Ashley C Massey
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Yannlei L Lee
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Christopher M Kinnard
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Andrew C Bright
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Ashley Y Williams
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Nathan M Polite
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
| | - Charles C Butts
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, Frederick P. Whiddon College of Medicine, University Hospital, 5557University of South Alabama, Mobile, AL, USA
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17
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Massey AC, Dunbar EG, Lee YLL, Mbaka M, Kinnard CM, Bright AC, Williams AY, Polite NM, Capasso TJ, Simmons JD, Butts CC. Incidence and Outcomes of Undiagnosed and Untreated Diabetes Mellitus in Trauma Patients. Am Surg 2023:31348231157888. [PMID: 36800323 DOI: 10.1177/00031348231157888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Diabetes is a major determinate for mortality in trauma patients. Many diabetics are undiagnosed or poorly controlled. Trauma patients disproportionately come from lower socioeconomic status, making missed diagnoses more likely. We aimed to quantify the incidence of undiagnosed or poorly controlled diabetics assessed at a Level 1 Trauma Center. We did a retrospective chart review of admitted trauma patients over a one-month period. Past Medical History, home medication lists, and Hemoglobin A1c on admission were recorded for each patient. We determined that 30 of 173 trauma patients qualifying for the study were diabetic. Furthermore, 30% of these diabetics were undiagnosed or had poorly controlled diabetes. Undiagnosed pre-diabetics made up 20% of the entire study group. Our data show that 26% of trauma patients would benefit from an intervention for improved glucose control. Trauma centers should consider creating routine clinical practice guidelines to identify at-risk patients and provide intervention for long-term management.
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Affiliation(s)
- Ashley C Massey
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Elizabeth G Dunbar
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Yann-Leei L Lee
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Christopher M Kinnard
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Andrew C Bright
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Ashley Y Williams
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Nathan M Polite
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Thomas J Capasso
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Jon D Simmons
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Charles C Butts
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 5557University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
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Huffmaster CE, Williams AY, Lee YLL, Butts CC, Polite NM, Mehari KR, Simmons JD. Association Between Adverse Childhood Experiences and Posttraumatic Stress Disorder Symptoms in Adults With Injury. JAMA Surg 2022; 157:1158-1159. [PMID: 36129702 PMCID: PMC9494261 DOI: 10.1001/jamasurg.2022.3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/30/2022] [Indexed: 01/11/2023]
Abstract
This case-control study examines the risk factors associated with acute stress disorder in patients with severe injury.
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Affiliation(s)
| | | | | | - C. Caleb Butts
- Department of Surgery, University of South Alabama, Mobile
| | | | | | - Jon D. Simmons
- Department of Surgery, University of South Alabama, Mobile
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Eden RD, Williams AY, Gall MA, Gall SA. Pregnancy-induced hypertension and postpartum maternal morbidity. Obstet Gynecol 1986; 68:86-90. [PMID: 3725262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Prospective evaluation of 80 patients experiencing preeclampsia/eclampsia was conducted. Traditional antepartum clinical presentation, classification, and laboratory evaluation were found to be imprecise for the prediction of postpartum maternal morbidity. Serial urine samples were collected from all patients during the antepartum, intrapartum, and postpartum period. Urine albumin and immunoglobulin G (IgG) concentrations were measured by rate nephelometry. The degree of albumin and IgG excretion before and after standard treatment modalities correlates with the occurrence of postpartum morbidity. The nephelometric urinalysis appears to be of assistance in the evaluation of disease severity, the effectiveness of treatment modalities on renal function, and the identification of patients destined to develop postpartum morbidity. In addition, rapid nephelometric urinalysis makes the collection of 24-hour urine samples unnecessary for evaluation of renal function in pregnancy-induced hypertension.
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Eden RD, Wahbeh CJ, Williams AY, Easley HA, Gall SA. Serial nephelometric urine IgG measurement and the management of pregnancy-induced hypertension. Am J Obstet Gynecol 1984; 148:1080-8. [PMID: 6711642 DOI: 10.1016/s0002-9378(84)90449-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Serial IgG analysis was performed on the urine and serum of 16 patients with pregnancy-induced hypertension. Significant immunoglobulinuria developed prior to the development of azotemia, significantly decreased creatinine clearance, significant proteinuria (greater than or equal to 3+ dipstick or greater than or equal to 5 gm per 24-hour urine collection), or oliguria. Nephelometric measurement of urine IgG concentrations appears to be a rapid and accurate method for confirming the severity of clinical disease, the degree of renal involvement, the benefit of treatment modalities on renal function, and the likelihood of postpartum maternal morbidity.
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Eden RD, Wahbeh CJ, Williams AY, Gall SA. Nephelometric urinary protein profile as an index of renal involvement in hypertensive disorders of pregnancy. Am J Obstet Gynecol 1983; 147:645-51. [PMID: 6685437 DOI: 10.1016/0002-9378(83)90442-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Protein analysis was performed on the urine of 62 pregnant women with the use of a nephelometric technique. Thirty-seven women were classified as having mild or severe pregnancy-induced hypertension and/or chronic hypertension. The protein analysis was performed on urine samples obtained prior to delivery and was compared to the degree of proteinuria as determined by the dipstick technique. The degree of immunoglobulinuria increases with increasing severity of pregnancy-induced hypertension while the urine concentration of albumin and transferrin becomes nondetectable. The urinary protein profile appears to be extremely sensitive and accurate in predicting severity of disease.
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Eden RD, Wahbeh CJ, Barter JF, Williams AY, Killam AP, Gall SA. Serial nephelometric urinary protein profile as an index of renal involvement in severe pregnancy-induced hypertension: a case report. Am J Obstet Gynecol 1983; 147:106-8. [PMID: 6614077 DOI: 10.1016/0002-9378(83)90095-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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