Application of electronic medical record-derived analytics in critical care: Rothman Index predicts mortality and readmissions in surgical intensive care unit patients.

Introduction: The Rothman Index (RI) is an objective measurement of a patient's overall condition, automatically generated from 26 variables including vital signs, laboratory data, cardiac rhythms, and nursing assessments. The purpose of this study was to assess the validity of RI scores in predicting surgical ICU (SICU) readmission rates and mortality.

Methods: We conducted a single-center retrospective analysis of surgical patients who were transferred from the SICU to the surgical floor from December 2014 to December 2016.

Pathophysiology, research challenges, and clinical management of smoke inhalation injury.

Smoke inhalation injury is a serious medical problem that increases morbidity and mortality after severe burns. However, relatively little attention has been paid to this devastating condition, and the bulk of research is limited to preclinical basic science studies. Moreover, no worldwide consensus criteria exist for its diagnosis, severity grading, and prognosis.

The National Trauma Research Repository: Ushering in a New ERA of trauma research (Commentary).

Despite being the leading cause of death in the United States for individuals 46 years and younger and the primary cause of death among military service members, trauma care research has been underfunded for the last 50 years. Sustained federal funding for a coordinated national trauma clinical research program is required to advance the science of caring for the injured. The Department of Defense is committed to funding studies with military relevance; therefore, it cannot fund pediatric or geriatric trauma clinical trials.

The National Trauma Institute: Lessons learned in the funding and conduct of 16 trauma research studies.

Background: To increase trauma-related research and elevate trauma on the national research agenda, the National Trauma Institute (NTI) issued calls for proposals, selected funding recipients, and coordinated 16 federally funded (Department of Defense) trauma research awards over a 4-year period. We sought to collect and describe the lessons learned from this activity to inform future researchers of barriers and facilitators.

Methods: Fifteen principal investigators participated in semistructured interviews focused on study management issues such as securing institutional approvals, screening and enrollment, multisite trials management, project funding, staffing, and institutional support.

Reflection: evolution of the field over seven decades.

Marked expansion of physiologic understanding and the improvement of burn patient outcomes have resulted from multidisciplinary clinical/laboratory research programs at burn centers in the United States and elsewhere.

Malpractice risk and cost are significantly reduced after tort reform.

Background: Rising medical malpractice premiums have reached a crisis point in many areas of the United States. In 2003 the Texas legislature passed a comprehensive package of tort reform laws that included a cap at $250,000 on noneconomic damages in most medical malpractice cases. We hypothesized that tort reform laws significantly reduce the risk of malpractice lawsuit in an academic medical center.

Cardiac contractility during hemofiltration in an awake model of hyperdynamic endotoxemia.

Background: To determine whether continuous veno-venous hemofiltration can ameliorate hemodynamic instability and left ventricular (LV) dysfunction by reducing circulating plasma mediators, the authors used the LV end-systolic elastance (Ees) as a contractility index, in an awake swine model simulating human hyperdynamic endotoxemia.

Methods: Nineteen instrumented pigs were divided into a control group (CTRL, n = 7), a hemofiltration (HF, n = 7) group, and an extracorporeal circuit (ECC, n = 5) only group. All animals received intravenous E.

An historical perspective on advances in burn care over the past 100 years.

The accelerated pace of clinical and laboratory research over the past century and application of the research findings to patient care have resulted in unprecedented survival of burned patients in all age groups. Resuscitation based on an understanding of the nature and magnitude of the multisystem response to injury now prevents burn shock; effective topical antimicrobial chemotherapy and early excision prevent wound toxemia and sepsis; biologic and bioengineered dressings compensate for the missing skin; and broad spectrum metabolic support regimens prevent exhaustion and accelerate convalescence. Rehabilitation programs have also been developed to restore physical function and permit the burn patient to reenter society as a productive individual.

Perceptions and attitudes of critical care training and careers among United States surgical residents: who wants to be a surgical intensivist?

Less than 50 per cent of surgical critical care (SCC) fellowship positions are filled each year. We surveyed senior surgical residents to determine their opinions regarding a career in SCC and acute care surgery. A survey was sent to 1348 postgraduate year 3, 4, and 5 residents in the United States.

Intensive insulin protocol improves glucose control and is associated with a reduction in intensive care unit mortality.

Background: Intensive insulin therapy to maintain serum glucose levels between 80 and 110 mg/dL has previously been shown to reduce mortality in the critically ill; recent data, however, have called this benefit into question. In addition, maintaining uniform, tight glucose control is challenging and resource demanding. We hypothesized that, by use of a protocol, tight glucose control could be achieved in the surgical trauma intensive care unit (STICU), and that improved glucose control would be beneficial.

A crisis in the delivery of care to patients with brain injuries in South Texas.

Background: To determine the opinions of neurosurgeons regarding the care of the injured and to assess the impact of these attitudes on the care of the patients with brain injuries.

Methods: A survey was sent to the 2,465 active members of the American Association of Neurologic Surgeons. A manpower assessment of neurosurgical coverage of South Texas was also performed.

Transparent and open discussion of errors does not increase malpractice risk in trauma patients.

Objective: We set out to determine if there is an increased medical malpractice lawsuit rate when trauma patient cases are presented at an open, multidisciplinary morbidity and mortality conference (M&M).

Introduction: Patient safety proponents emphasize the importance of transparency with respect to medical errors. In contrast, the tort system focuses on blame and punishment, which encourages secrecy.

Topical silver treatment after escharectomy of infected full thickness burn wounds in rats.

White male Sprague Dawley rats (200 g.) with 20% full thickness scald burns seeded with 10 Pseudomonas aeruginosa, strain 59-1244, were used as experimental animals. Studies including the following: (1).

Trauma surgery malpractice risk: perception versus reality.

Objective: We set out to compare the malpractice lawsuit risk and incidence in trauma surgery, emergency surgery, and elective surgery at a single academic medical center.

Summary And Background Data: The perceived increased malpractice risk attributed to trauma patients discourages participation in trauma call panels and may influence career choice of surgeons. When questioned, surgeons cite malpractice risk as a rationale for not providing trauma care.

Xenoestrogens: do they lower survival after thermal injury?

The effect of hormone disruptors on human health is an area of recent concern. The authors measured heptachlor epoxide and oxychlordane--the body storage forms of estrogenic insecticides-in the sera of patients with major burns (i.e.