Predicting the need for tracheostomy in trauma patients without severe head injury.

Background: Early tracheostomy is recommended in patients with severe traumatic brain injury (TBI); however, predicting the timing of tracheostomy in trauma patients without severe TBI can be challenging.

Methods: A one year retrospective analysis of all trauma patients who were admitted to intensive Care Unit for > 7 days was performed, using the ACS-TQIP database. Univariate and Multivariate regression analyses were performed to assess the appropriate weight of each factor in determining the eventual need for early tracheostomy.

Developing a Simple Clinical Score for Predicting Mortality and Need for ICU in Trauma Patients.

Several models exist to predict trauma center need in the prehospital setting; however, there is lack of simple clinical tools to predict the need for ICU admission and mortality in trauma patients. The aim of our study was to develop a simple clinical tool that can be used with ease in the prehospital or emergency setting and can reliably predict the need for ICU admission and mortality in trauma patients. We abstracted one year of National Trauma Data Bank for all patients aged ≥ 18 years.

Cost Analysis of Direct Oral Anticoagulants Compared with Warfarin in Patients with Blunt Traumatic Intracranial Hemorrhages.

Direct oral anticoagulants (DOACs) are rapidly gaining popularity as alternatives to warfarin in the prevention of stroke or systemic embolic events because of the simplicity of their dosing and lack of monitoring requirement. Many physicians feared that these novel agents would be cost-prohibitive not only in their administration but also in their sequelae of bleeding, given the few reversal agents available. Whereas the medication itself is more expensive than traditional warfarin, the total cost of a hospital admission has not been compared between patients on DOACs and warfarin who have sustained a blunt traumatic intracranial hemorrhage (ICH).

Tourniquet use in the prehospital setting: Are they being used appropriately?

Objective: The objective of this study was to evaluate tourniquet use in the Hartford prehospital setting during a 34-month period after the Hartford Consensus was published, which encouraged increasing tourniquet use in light of military research.

Design: This was a retrospective review of patients with bleeding from a serious extremity injury to determine appropriateness of tourniquet use or omission.

Setting: Level II trauma center between April 2014 and January 2017.

Readmissions in Patients with Anticoagulated Intracranial Hemorrhage: A Retrospective Review.

Objective: To determine the effect of direct oral anticoagulants (DOACs) compared with warfarin on the 30-day readmission rates in patients with traumatic intracranial hemorrhage (ICH).

Methods: We conducted a retrospective review of patients from our hospital's trauma database admitted between June 2011 and October 2015 to our level II trauma center after sustaining a traumatic ICH while receiving anticoagulant therapy. Patients were stratified based on the anticoagulation drug (DOAC or warfarin) prescribed on admission.

Gamified Twitter Microblogging to Support Resident Preparation for the American Board of Surgery In-Service Training Examination.

Objective: We sought to determine if a daily gamified microblogging project improves American Board of Surgery In-Service Training Examination (ABSITE) scores for participants.

Design: In July 2016, we instituted a gamified microblogging project using Twitter as the platform and modified questions from one of several available question banks. A question of the day was posted at 7-o׳clock each morning, Monday through Friday.

A multidisciplinary approach to improve the quality of care for patients with fragility fractures.

Background: Fragility fractures have become a worldwide epidemic associated with significant morbidity and mortality. As the world population ages, the number of patients that experience these fractures is also expected to rise. A multidisciplinary team was assembled that was coordinated by the Acute Inpatient Medical Service and included orthopedic surgeons, geriatricians, anesthesiologists, cardiologists, nurses, trauma surgeons, emergency medicine physicians, physiatrists, and physical therapists.

Immediate Tube Feeding after Percutaneous Endoscopic Gastrostomy: Early Return to Goal Tube Feeds without Added Complications.

Background: Percutaneous endoscopic gastrostomy (PEG) is frequently performed for delivery of nonoral enteral nutrition (EN) in critically ill patients. Tube-based supplement initiation is often delayed for a variety of reasons despite evidence that EN interruption results in worse outcomes.

Objective: To determine if early initiation of EN after PEG placement is safe and well-tolerated in critically ill patients and if early initiation of EN results in more goal-accomplished days of EN.

Compared to warfarin, direct oral anticoagulants are associated with lower mortality in patients with blunt traumatic intracranial hemorrhage: A TQIP study.

Background: Falls represent the leading cause of traumatic brain injury in adults older than 65, with nearly one third experiencing a fall each year. Evidence suggests that up to 0.5% of anticoagulated patients suffer from intracranial hemorrhage (ICH) annually.

Direct oral anticoagulants compared with warfarin in patients with severe blunt trauma.

Methods: We queried our Trauma Quality Improvement Program registry for patients who presented between 6/1/2011 and 9/1/2015 with severe (injury severity score (ISS)>15) blunt traumatic injury during anticoagulant use. Patients were then grouped into those prescribed warfarin and patients prescribed any of the available novel Direct Oral Anticoagulants (DOAC) medications. We excluded severe (AIS≧4) head injuries.

Cost Savings Associated with the Adoption of a Cloud Computing Data Transfer System for Trauma Patients.

Introduction: Among transferred trauma patients, challenges with the transfer of radiographic studies include problems loading or viewing the studies at the receiving hospitals, and problems manipulating, reconstructing, or evalu- ating the transferred images. Cloud-based image transfer systems may address some ofthese problems.

Methods: We reviewed the charts of patients trans- ferred during one year surrounding the adoption of a cloud computing data transfer system.

Use of a Modified American College of Surgeons Trauma Quality Improvement Program to Enhance 30-Day Post-Trauma Readmission Detection.

Background: Traumatic injury remains the leading cause of preventable morbidity and mortality worldwide, with a large economic burden. One fourth of annual Medicare expenditures result from readmissions, including trauma. The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) has elevated care for >200 trauma programs worldwide.

Terrorist Event Training in US Medical Schools. A Survey of Chemical, Biologic, Radiologic, Nuclear, and High-Yield Explosives Training in US Medical Schools.

Unlabelled: September 11, 2001 saw the dawn of the US-led global war on terror, a combined diplomatic, military, social, and cultural war on terrorist activities. Chemical, biological, radiological, nuclear, and high-yield explosives (CBRNE), as a group of tactics, are often the preferred weapons of terrorists across the globe. We undertook a survey of US medical schools to determine what their self-reported level of training for terrorist events encompasses during the four years of undergraduate medical education.

The use of simulation procedural training to improve self-efficacy, knowledge, and skill to perform cricothyroidotomy.

The pre-eminent requirement for surgical education is that it is effective and efficient. We sought to determine if the addition of low-fidelity simulation to our standard method of teaching cricothyroidotomy improves Postgraduate Year 1 residents' self-efficacy, knowledge, and skill to perform cricothyroidotomy. The teaching methods were standard education using a lecture and video compared with standard education plus low-fidelity simulation instruction and practice on a mannequin.

Retrospective review of the use and costs of routine chest x rays in a trauma setting.

Introduction: Chest x-rays (CXR) are routinely obtained on blunt trauma patients. Many patients also receive additional imaging with thoracic computed tomography scans for other indications. We hypothesized that in hemodynamically normal, awake and alert blunt trauma patients, CXR can be deferred in those who will also receive a TCT with significant cost savings.

NMR structures of apo L. casei dihydrofolate reductase and its complexes with trimethoprim and NADPH: contributions to positive cooperative binding from ligand-induced refolding, conformational changes, and interligand hydrophobic interactions.

In order to examine the origins of the large positive cooperativity (ΔG(0)(coop) = -2.9 kcal mol(-1)) of trimethoprim (TMP) binding to a bacterial dihydrofolate reductase (DHFR) in the presence of NADPH, we have determined and compared NMR solution structures of L. casei apo DHFR and its binary and ternary complexes with TMP and NADPH and made complementary thermodynamic measurements.

Retrospective review of the costs of routine pelvic X-rays in a trauma setting.

Multidetector Computed Tomography (MDCT) technology plays an important role in the evaluation of injured patients. At our institution pelvic X-ray (PXR) is obtained routinely on trauma patients. Many also receive MDCT of the abdomen and pelvis for other indications.

Management of the most severely injured spleen: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT).

Objective: To determine the rate and predictors of failure of nonoperative management (NOM) in grade IV and V blunt splenic injuries (BSI).

Design: Retrospective case series.

Setting: Fourteen trauma centers in New England.

Prehospital HMG Co-A reductase inhibitor use and reduced mortality in ruptured abdominal aortic aneurysm.

Background: The compounds 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (HMG Co-A reductase inhibitors, statins) are popular medications for the control of elevated serum cholesterol. Recent evidence has demonstrated a survival benefit to patients who take statins in the premorbid period with severe sepsis, septic shock, or severe trauma. We hypothesized that a similar benefit would be seen in patients with ruptured abdominal aortic aneurysm.

Structural studies on Plasmodium vivax merozoite surface protein-1.

Plasmodium vivax infection is the second most common cause of malaria throughout the world. Like other Plasmodium species, P. vivax has a large protein complex, MSP-1, located on the merozoite surface.

Effects of co-operative ligand binding on protein amide NH hydrogen exchange.

Amide protection factors have been determined from NMR measurements of hydrogen/deuterium amide NH exchange rates measured on assigned signals from Lactobacillus casei apo-DHFR and its binary and ternary complexes with trimethoprim (TMP), folinic acid and coenzymes (NADPH/NADP(+)). The substantial sizes of the residue-specific DeltaH and TDeltaS values for the opening/closing events in NH exchange for most of the measurable residues in apo-DHFR indicate that sub-global or global rather than local exchange mechanisms are usually involved. The amide groups of residues in helices and sheets are those most protected in apo-DHFR and its complexes, and the protection factors are generally related to the tightness of ligand binding.

September 11, 2001, revisited: a review of the data.

Hypothesis: The September 11, 2001, World Trade Center (WTC) attack was a disaster of epic proportion in New York City, NY. It was unprecedented in terms of the number of people who were killed in the bombings, as well as in terms of the volume of patients received at local (New York City) hospitals. The strain on local emergency medical services, hospitals, and the citywide trauma system is still felt today as the hospitals, physicians, and agencies involved struggle to train for similar events that may occur in the future, cope with the psychological and social aftermath, and even pay for the response to the bombing.