Outcomes in Pediatric Burn Patients With Additional Trauma-Related Injuries.

The addition of trauma to burn injuries may result in higher morbidity and mortality. The purpose of this study was to evaluate the outcomes of pediatric patients with a combination of burn and trauma injuries, and included all pediatric Burn only, Trauma only, and combined Burn-Trauma patients admitted between 2011 and 2020. Mean length of stay, ICU length of stay, and ventilator days were highest for the Burn-Trauma group.

Survey of the US Surgeon Workforce: Practice Characteristics, Job Satisfaction, and Reasons for Leaving Surgery.

Background: An impending surgeon shortage looms in the US due to increasing demand and a stagnant number of surgeons entering practice. We sought to evaluate the state of our surgical workforce by exploring current practice patterns, job satisfaction, and reasons why surgeons consider leaving surgery.

Study Design: In 2018, a link to a detailed survey was distributed by email to Fellows of the American College of Surgeons (ACS) who actively practice in the US and have completed a general surgery residency or integrated cardiothoracic, vascular, or plastic surgery fellowship.

Risks and Realities of Delayed Splenic Bleeding.

Delayed splenic bleeding (DSB) is a poorly understood complication of blunt splenic injury. Treatment for splenic bleeding may involve splenectomy, but angioembolization is becoming a widely used adjuvant for management. Using the North Carolina Trauma Registry, this study aimed to evaluate the incidence, mortality, and risk factors for DSB in North Carolina.

Measuring Patterns of Surgeon Confidence Using a Novel Assessment Tool.

Confidence should increase during surgical training and practice. However, few data exist regarding confidence of surgeons across this continuum. Confidence may develop differently in clinical and personal domains, or may erode as specialization or age restricts practice.

Laser resurfacing and remodeling of hypertrophic burn scars: the results of a large, prospective, before-after cohort study, with long-term follow-up.

Objectives: Hypertrophic burn scars produce significant morbidity, including itching, pain, stiffness, and contracture, but best management practices remain unclear. We present the largest study to date that examines long-term impact of laser therapies, a potentially transformative technology, on scar remodeling.

Methods: We conducted a prospective, before-after cohort study in burn patients with hypertrophic scars.

Acrylic coatings with surprising antifogging and frost-resisting properties.

We report an unusually effective antifogging/frost-resisting coating based on conventional acrylic polymers. The intriguing antifogging property originated from the delicate balance between the hydrophilicity and hydrophobicity of the acrylic copolymers of 2-(dimethylamino)ethyl methacrylate and methyl methacrylate, as well as between the water-swellability of the copolymer and the cross-linked network due to ethylene glycol dimethacrylate.

Bronchoscopy-derived correlates of lung injury following inhalational injuries: a prospective observational study.

Background: Acute lung injury (ALI) is a major factor determining morbidity following burns and inhalational injury. In experimental models, factors potentially contributing to ALI risk include inhalation of toxins directly causing cell damage; inflammation; and infection. However, few studies have been done in humans.

The price of acute care surgery.

Background: Numerous organizations have identified access to emergency surgical care as a crisis. One barrier is the financial disincentive associated with caring for this patient population. We sought to identify contributing factors by analyzing endemic data during the development of an acute care surgery (ACS) service at an academic health care system.

Logistics of building a laser practice for the treatment of hypertrophic burn scars.

Introduction: Although lasers can improve burn scars, such treatment has not been adopted universally, due to operational challenges starting a practice and the perception that such a program is not financially viable. We report the logistics of building a laser practice for the treatment of hypertrophic burn scars.

Methods: We analyzed the clinical, operational, and financial components of our laser practice, focusing on treatment of hypertrophic burn scars, using pulsed dye laser, fractional CO2 laser, and intense pulsed light.

Competence and confidence with basic procedural skills: the experience and opinions of fourth-year medical students at a single institution.

Purpose: Data indicate that students are unprepared to perform basic medical procedures on graduation. The authors' aim was to characterize graduating students' experience with and opinions about these skills.

Method: In 2011, an online survey queried 156 fourth-year medical students about their experience with, and actual and desired levels of competence for, nine procedural skills (Foley catheter insertion, nasogastric tube insertion, venipuncture, intravenous catheter insertion, arterial puncture, basic suturing, endotracheal intubation, lumbar puncture, and thoracentesis).

Sometimes you can't make it on your own: the impact of a professionalism curriculum on the attitudes, knowledge, and behaviors of an academic plastic surgery practice.

Introduction: Professionalism is now recognized as a core competency for graduate medical education and maintenance of certification. However, few models exist in plastic surgery that define, teach, and assess professionalism as a competency. The purpose of this project was to evaluate the effectiveness of a professionalism curriculum in an academic plastic surgery practice.

Projecting surgeon supply using a dynamic model.

Objective: To develop a projection model to forecast the head count and full-time equivalent supply of surgeons by age, sex, and specialty in the United States from 2009 to 2028.

Summary Background Data: The search for the optimal number and specialty mix of surgeons to care for the United States population has taken on increased urgency under health care reform. Expanded insurance coverage and an aging population will increase demand for surgical and other medical services.

Get on your boots: preparing fourth-year medical students for a career in surgery, using a focused curriculum to teach the competency of professionalism.

Introduction: Few educational programs exist for medical students that address professionalism in surgery, even though this core competency is required for graduate medical education and maintenance of board certification. Lapses in professional behavior occur commonly in surgical disciplines, with a negative effect on the operative team and patient care. Therefore, education regarding professionalism should begin early in the surgeon's formative process, to improve behavior.

Who teaches basic procedural skills: student experience versus faculty opinion.

Introduction: Learning procedural skills as a medical student has evolved, as task trainers and simulators are now ubiquitous. It is yet unclear whether they have supplanted bedside teaching or are adjuncts to it, and whether faculty or residents are responsible for student skills education in this era. In this study we sought to characterize the experience and opinions of both medical students and faculty on procedural skills training.

Effectiveness of a radiofrequency detection system as an adjunct to manual counting protocols for tracking surgical sponges: a prospective trial of 2,285 patients.

Background: Despite rigorous manual counting protocols and the classification of retained surgical items (RSIs) as potential "never events," RSIs continue to occur in approximately 1 per 1,000 to 18,000 operations. This study's goals were to evaluate the incorporation of a radiofrequency detection system (RFDS) into existing laparotomy sponge- and Raytec-counting protocols for the detection of RSIs and define associated risk factors.

Study Design: All patients undergoing surgery at the University of North Carolina Hospitals from September 2009 to August 2010 were enrolled consecutively.

Single incision laparoscopic cholecystectomy using a "two-port" technique is safe and feasible: experience in 101 consecutive patients.

Single incision laparoscopic cholecystectomy (SILC) is a new minimally-invasive technique that has recently been developed to address several disease processes of the gallbladder. However, the safety and feasibility of this technique are still being evaluated. Utilizing a "two-port" technique with transabdominal suture retraction and a rigorous adherence to the critical view of safety, we evaluated our experience in a prospectively maintained database and compared this with standard laparoscopic cholecystectomy (SLC) over the same period.

Th17 (IFNγ- IL17+) CD4+ T cells generated after burn injury may be a novel cellular mechanism for postburn immunosuppression.

Background: The mechanism responsible for initiating and controlling the immunosuppressive response after burn injury remains unknown. Interleukin-17 (IL-17) secreting Th17 (interferon [IFN]γ IL17) cells are a novel subset of CD4 T cells associated with a weak, proinflammatory response that antagonizes the proinflammatory Th1 (IFNγ IL17) response. Given that transforming growth factor-β and IL6 mediate Th17 cell development, we hypothesized that burn injury may generate Th17 cells that could mediate postburn immunosuppression.

Increasing the number of trainees in general surgery residencies: is there capacity?

Purpose: General surgeons have decreased as a proportion of the total U.S. surgical workforce.

Teaching technical skills to medical students during a surgery clerkship: results of a small group curriculum.

Background: Opportunities for medical students to learn and perform technical skills during their clinical years have decreased. Alternative means to provide instruction are increasingly important.

Methods: Third-year students were assigned to three weekly small group tutorial sessions during their surgery clerkship.