Evaluating Operative Exposure for Medical Students in the Era of Virtual Learning: A Single-Institution Experience.

Introduction: Training at a tertiary center offers clerkship students the opportunity to rotate through a wide range of surgical specialties that may not be otherwise available. At our institution, students rotate through general surgery for 3 out of 9 weeks, with the remainder offering electives. As a result, students may have limited experience with core general surgery cases which are necessary to complete by the end of the clerkship to demonstrate competency.

Continuing Medical Education Questions: May 2021.

Article Title: ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding.

Ultrasonographic (US) Two-Dimensional Measurement of Spleen Is Superior to Traditional Length Measurement Alone in Diagnosing Cirrhosis.

Background: Splenomegaly measured by spleen length has been an imaging evidence for cirrhosis. However, data remains lacking on the value of other US findings for diagnosing cirrhosis. This study evaluated the value of spleen two-dimensional measurements (2D, i.

Surgeon as Double Agent: Perception of Conflicting Expectations of Patient Care and Stewardship of Resources.

Background: Physicians must satisfy 2 competing expectations: advocate for patients and serve as stewards of resources. No guidelines exist for surgeons on resolving this conflict. We surveyed surgeons' perceptions about these dual obligations.

Decreased risk of hepatocellular carcinoma recurrence with direct-acting antivirals compared with no treatment for hepatitis C: a meta-analysis.

Background: Studies investigating the association between direct-acting antivirals (DAAs) and the recurrence of hepatocellular carcinoma (HCC) related to hepatitis C (HCV) have yielded conflicting results. The objective of this meta-analysis was to define the short- and long-term recurrence rates of HCC after DAA treatment.

Methods: A search of multiple databases was performed, including Scopus, Cochrane, MEDLINE/PubMed and abstracts from gastroenterology meetings.

Resident Education in End-of-Life Communication and Management: Assessing Comfort Level to Enhance Competence and Confidence.

Objectives: Our primary objective was to understand residents' baseline comfort with end-of-life (EOL) communication and management and to compare this with their comfort after completion of their surgical intensive care unit (SICU) rotation. We also evaluated the association between prior training with perceived level of comfort with EOL issues, and whether the resident believed in the concept of a "better death."

Design, Setting, Participants: As a quality improvement initiative, we conducted surveys of trainees before and after their rotation in the Yale New Haven Hospital SICU.

Primary prevention of contact sports-related concussions in amateur athletes: a systematic review from the Eastern Association for the Surgery of Trauma.

Background: Awareness of the magnitude of contact sports-related concussions has risen exponentially in recent years. Our objective is to conduct a prospectively registered systematic review of the scientific evidence regarding interventions to prevent contact sports-related concussions.

Methods: Using the Grading of Recommendations Assessment, Development, and Evaluation methodology, we performed a systematic review of the literature to answer seven population, intervention, comparator, and outcomes (PICO) questions regarding concussion education, head protective equipment, rules prohibiting high-risk activity and neck strengthening exercise for prevention of contact sports-related concussion in pediatric and adult amateur athletes.

Ethnic disparities in gastric cancer incidence and survival in the USA: an updated analysis of 1992-2009 SEER data.

Background: Gastric cancer (GC) is the second-leading cause of cancer-related deaths worldwide, with overall 5-year survival less than 20%. However, limited data exist investigating ethnic disparities in stage-specific GC incidence and survival in the USA.

Aim: To evaluate ethnicity-specific differences in GC incidence and survival in the USA.

Using the Rothman index to predict early unplanned surgical intensive care unit readmissions.

Background: The Rothman index (RI) is a numerical score calculated hourly from 26 data points in the electronic medical record by a commercial software package. Although it is purported to serve as an indicator of change in a patient's condition, it has not been extensively evaluated in the literature. Our objective was to determine whether the RI can be used to predict early surgical intensive care unit (SICU) readmissions.

The use of magnetic resonance imaging in the diagnosis of suspected appendicitis in pregnancy: shortened length of stay without increase in hospital charges.

Importance: Making an accurate diagnosis of appendicitis in pregnancy is critical for maternal and fetal outcomes.

Objective: To determine whether magnetic resonance (MR) imaging in pregnant patients with suspected appendicitis improves outcomes, minimizes length of stay (LOS), and lowers hospital charges.

Design, Setting, And Participants: Retrospective review at a university tertiary referral center of all pregnant patients seen with abdominal pain and suspected appendicitis who were followed up through delivery during an 11-year period.

Low dietary vitamin D in mid-life predicts total mortality in men with hypertension: the Honolulu heart program.

Background: Vitamin D deficiency was associated with total mortality in previous epidemiological studies. Little is known about the effects of dietary vitamin D intake on mortality. We examined the association between mid-life dietary vitamin D intake and 45-year total mortality.

Appendiceal endometriosis in a pregnant woman presenting with acute perforated appendicitis.

Endometriosis is a common disease in women of childbearing age and is defined as the presence of endometrial glands and stroma in organs outside of the uterine cavity. Appendiceal endometriosis is very uncommon and accounts for a small fraction of all cases of extrapelvic endometriosis. Cases of that which occur during pregnancy are extremely rare with an incidence that ranges between 3 and 8 deliveries per 10 000.

Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline.

Background: Diagnosing blunt cardiac injury (BCI) can be difficult. Many patients with mechanism for BCI are admitted to the critical care setting based on associated injuries; however, debate surrounds those patients who are hemodynamically stable and do not otherwise require a higher level of care. To allow safe discharge home or admission to a nonmonitored setting, BCI should be definitively ruled out in those at risk.

Compared to conventional ventilation, airway pressure release ventilation may increase ventilator days in trauma patients.

Background: Airway pressure release ventilation (APRV) is used both as a rescue therapy for patients with acute lung injury and as a primary mode of ventilation. Unlike assist-control volume (ACV) ventilation that uses spontaneous breathing trials, APRV weaning consists of gradual decreases in supporting pressure. We hypothesized that the APRV weaning process increases total ventilator days compared with those of spontaneous breathing trials-based weaning.

Development of a computed tomography-based scoring system for necrotizing soft-tissue infections.

Background: Necrotizing soft-tissue infections (NSTIs) are associated with significant morbidity and mortality, but a definitive nonsurgical diagnostic test remains elusive. Despite the widespread use of computed tomography (CT) as a diagnostic adjunct, there is little data that definitively correlate CT findings with the presence of NSTI. Our goal was the development of a CT-based scoring system to discriminate non-NSTI from NSTI.

The status of massive transfusion protocols in United States trauma centers: massive transfusion or massive confusion?

Background: Massive transfusion protocol (MTP) utilization and makeup is unknown.

Study Design And Methods: A Web-based survey was sent to members of the Eastern Association for the Surgery of Trauma and published in the American Association for the Surgery of Trauma newsletter. Comparisons were made with chi-square and logistic regression.

Contrast-induced nephropathy in elderly trauma patients.

Background: Computed tomography (CT) is the gold standard for the identification of occult injuries, but the intravenous (IV) contrast used in CT scans is potentially nephrotoxic. Because elderly patients have decreased renal function secondary to aging and chronic disease, we sought to determine the rate of acute kidney injury (AKI) in elderly trauma patients exposed to IV contrast.

Methods: Medical records of patients older than 55 years evaluated at a level-one trauma center between January 2003 and July 2008 were reviewed.

Pulseless electrical activity, focused abdominal sonography for trauma, and cardiac contractile activity as predictors of survival after trauma.

Background: Pulseless electrical activity (PEA) secondary to both blunt and penetrating trauma is associated with minimal survival. The pericardial view of the focused abdominal sonography for trauma (p-FAST) can differentiate between patients with and without organized cardiac activity and may assist in the decision to terminate ongoing resuscitation.

Methods: A retrospective review was performed for all patients presenting to a level I trauma center from January 2006 through January/2009 who had PEA on arrival or developed PEA in the emergency department.

Uncovering system errors using a rapid response team: cross-coverage caught in the crossfire.

Background: Because of the 80-hour work week, extensive service cross-coverage creates great potential for patient care errors. These patient care emergencies are increasingly managed using a rapid response team (RRT) to reduce patient morbidity. We examine the proximate causes of a surgical RRT activation.

A physicochemical approach to acid-base balance in critically ill trauma patients minimizes errors and reduces inappropriate plasma volume expansion.

Background: This study assesses if a physicochemical (PC) approach to acid-base balance improves the accuracy of acid-base diagnosis, and reduces inappropriate fluid loading.

Methods: Hundred consecutive patients with trauma admitted to a surgical intensive care unit at a level I trauma center were prospectively analyzed. Demographics, acid-base data and diagnoses, and interventions were collected.

Blunt cerebrovascular injuries: does treatment always matter?

Background: Blunt cerebrovascular injuries (BCVI) have become an increasingly recognized entity. Stroke as a result of these injuries can have devastating consequences. Optimal screening criteria, diagnostic imaging, and therapy for BCVIs have not been elucidated.

Stably integrated luxCDABE for assessment of Salmonella invasion kinetics.

Salmonella Typhimurium is a common cause of gastroenteritis in humans and also localizes to neoplastic tumors in animals. Invasion of specific eukaryotic cells is a key mechanism of Salmonella interactions with host tissues. Early stages of gastrointestinal cell invasion are mediated by a Salmonella type III secretion system, powered by the adenosine triphosphatase invC.