The Affordable Care Act and its association with length of stay and payer status for trauma patients at a level I trauma center.

Background: We hypothesized that the ACA would shorten length of stay and increase numbers of insured patients without changing trauma patient outcomes.

Methods: A retrospective review of adult trauma patients admitted to a level I trauma center between 2012 and 2014 was performed. Demographics, length of stay, payer status, discharge disposition, and complications before and after the ACA implementation were analyzed.

Early analysis of laparoscopic common bile duct exploration simulation.

Background: We developed a laparoscopic common bile duct exploration (LCBDE) simulation course for resident surgeons (RS) and practicing surgeons (PS). We hypothesized that course completion would provide LCBDE procedural skills and increase procedure utilization.

Methods: RS and PS were prospectively enrolled.

Does surgery residency prepare residents to work at critical access hospitals?

Background: Operations performed by surgeons working at Critical Access Hospitals (CAHs) and surgery residents have not been compared.

Methods: Procedure codes logged by general surgery residents graduating from our institution in 2013 and 2014 were obtained. Procedure codes were obtained for all CAHs in our state for 2012 to 2013.

Prospective clinical trial of surgical intervention for painful rib fracture nonunion.

We performed a prospective clinical trial of resection with or without plate fixation for symptomatic rib fracture nonunion three or more months postinjury with 6-month postoperative followup. The McGill Pain Questionnaire (MPQ) and RAND 36 Health Survey were administered and activity level (sedentary, ambulatory, moderately active, vigorous), functional status (disabled, nonphysical labor, physical labor), and work status (employed, unemployed, retired, student) were queried pre- and postoperatively. Twenty-four patients 4 to 197 months (median, 16 months) postinjury underwent surgical intervention for one to four rib fracture nonunions (median, two nonunions).

NCCN roundtable: talking to children about cancer.

A roundtable presentation at the NCCN 19th Annual Conference focused on the child's experience when a parent has cancer and concluded that honest communication, appropriate to the child's age and temperament, is essential, and that oncology providers should institute programs that help families deal with the illness.

A Novel Drug for Treatment of Necrotizing Soft-Tissue Infections: A Randomized Clinical Trial.

Importance: Necrotizing soft-tissue infections (NSTI) have high morbidity and mortality rates despite aggressive surgical debridement and antibiotic therapy. AB103 is a peptide mimetic of the T-lymphocyte receptor, CD28. We hypothesized that AB103 will limit inflammatory responses to bacterial toxins and decrease the incidence of organ failure.

The contribution of rib fractures to chronic pain and disability.

Background: The contribution of rib fractures to chronic pain and disability is not well described.

Methods: Two hundred three patients with rib fractures were followed for 6 months. Chronic pain was assessed using the McGill Pain Questionnaire Pain Rating Index and Present Pain Intensity (PPI) scales.

Prolonged pain and disability are common after rib fractures.

Background: The contribution of rib fractures to prolonged pain and disability may be underappreciated and undertreated. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6 to 8 weeks.

Methods: This study was a prospective observation of 203 patients with rib fractures at a level 1 trauma center.

Management of full-thickness duodenal laceration in the damage control era: evolution to primary repair without diversion or decompression.

The management of duodenal laceration (DL) is controversial. We sought to determine the influence of damage control (DC) on the use of decompression/diversion/exclusion (DDE) techniques and the risk of duodenal-related complications (DRC). We conducted a retrospective review of all patients with full-thickness DL surviving more than 72 hours in the years 1989 to 2009.

Blood volume analysis can distinguish true anemia from hemodilution in critically ill patients.

Background: Peripheral hematocrit (pHct) is traditionally used as a marker for blood loss. In critically ill patients who are fluid resuscitated, pHct may not adequately represent red blood cell volume (RBCV). We hypothesize that the use of pHct alone may overestimate anemia, potentially leading to unnecessary interventions.

Long-term morbidity, pain, and disability after repair of severe chest wall injuries.

Long-term morbidity after severe chest wall injuries is common. We report our experience with acute chest wall injury repair, focusing on long-term outcomes and comparing our patients' health status with the general population. We performed a retrospective medical record review supplemented with a postal survey of long-term outcomes including the McGill Pain Questionnaire (MPQ) and RAND-36 Health Survey.

Surveyed opinion of American trauma, orthopedic, and thoracic surgeons on rib and sternal fracture repair.

Introduction: Rib and sternal fracture repair are controversial. The opinion of surgeons regarding those patients who would benefit from repair is unknown.

Methods: Members of the Eastern Association for the Surgery of Trauma, the Orthopedic Trauma Association, and thoracic surgeons (THS) affiliated with teaching hospitals in the United States were recruited to complete an electronic survey regarding rib and sternal fracture repair.

Biomechanical testing of a novel, minimally invasive rib fracture plating system.

Background: A novel rib fracture repair plating system was developed to provide durable fixation with a shorter length than standard systems and thus facilitate minimally invasive repair. We hypothesized that U-plate fixation would be at least equivalent in durability to standard anterior fixation.

Study: Twenty fresh frozen ribs (10 pairs) from two human cadavers were first tested for intact stiffness (force or deformation).

Management and outcome of pneumatosis intestinalis.

Background: Pneumatosis intestinalis (PI), infiltration of gas into the bowel wall, has traditionally been associated with immediate operative intervention and a high mortality rate.

Methods: We retrospectively reviewed the diagnosis and management of pneumatosis in an attempt to characterize the disease, and examined management strategies.

Results: Ninety-seven patients had a computed tomography (CT) diagnosis of pneumatosis.

Traumatic thoracic aortic transection in small-diameter aortas: percutaneous endograft repair.

The authors describe percutaneous repair of traumatic aortic transection in small-caliber aortas by using iliac extender stent-grafts in three patients (two female and one male patient; average age, 29.3 years). The average aortic diameters were 18.

Statewide assessment of injury and death rates among riders of off-road vehicles treated at trauma centers.

Background: Injuries and deaths among riders of off-road motorized all-terrain vehicles are increasing in the US. We hypothesized that serious injuries in Oregon have increased among riders of both four-wheel and two-wheel vehicles.

Study Design: We analyzed the Oregon Trauma Registry.

Fine-needle aspiration diagnosis of plasmacytoma presenting as breast masses in a patient on estrogen therapy for prostate cancer.

We describe a 79-yr-old man with a history of androgen-independent metastatic prostate cancer treated with exogenous estrogens presenting with bilateral breast masses associated with bilateral axillary lymphadenopathy. Although the findings on physical examination with the concomitant history of estrogen therapy for metastatic prostate cancer raised the clinical suspicion of breast cancer, fine-needle aspiration (FNA) cytology identified the lesions as multiple myeloma.

DNA fingerprints provide a patient-specific breast cancer marker.

Background: Detection of systemic breast cancer recurrence is limited by lack of universally expressed tumor cell markers. We hypothesized that a test that detects genetic alterations specific to breast cancer cells of an individual patient would provide a superior cancer marker.

Methods: DNA was extracted from blood, primary tumor, and axillary lymph nodes of 33 breast cancer patients and normal breast tissue of 12 control patients.

Breast cancer severity score is an innovative system for prognosis.

Background: Survival in breast cancer maybe more accurately predicted by a scoring system based on the biologic characteristics of the tumor such as diameter, number of involved nodes, and hormone receptor status than by conventional staging.

Methods: Medical records of 419 patients with a diagnosis of breast cancer from a university hospital between 1997 and 2002 were reviewed. Tumor characteristics were given a value reflecting the impact on survival.