Telehealth Challenges, Opportunities, and Policy Recommendations for Rural Older Adults Living with HIV in the United States.

Over one million people in the United States (U.S.) are living with HIV.

Area deprivation index and social vulnerability index in Milwaukee County: Impact on hospital outcomes after traumatic injuries.

Background: Predisposing factors for traumatic injuries are complex and variable. Neighborhood environments may influence injury mechanism or outcomes. The Social Vulnerability Index (SVI) identifies areas at risk for emergencies; Area Deprivation Index (ADI) measures socioeconomic disadvantage.

Food cravings after bariatric surgery: comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass.

Background: Research suggests that food choices, preferences, and tastes change after bariatric surgery, but evidence regarding changes in food cravings is mixed.

Objectives: The primary aim of this cohort study was to compare food cravings during the first year following bariatric surgery in patients who had undergone sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB).

Setting: Integrated multispecialty health system, United States.

A Milwaukee Syndemic? Penetrative Injury and COVID-19.

Introduction: This study sought to evaluate injury frequency of penetrative trauma before and after stay-at-home orders were implemented due to COVID-19 in Wisconsin.

Methods: Patients who presented to a level I trauma center from January 2018 through December 2021 with a mechanism of injury of firearm or stab wound were included. The study was split into pre-COVID (January 2018-February 2020) and COVID (March 2020-December 2021) periods.

Mechanisms of traumatic injury by demographic characteristics: an 8-year review of temporal trends from the National Trauma Data Bank.

Background/purpose: This 8-year retrospective study of the National Trauma Data Bank describes temporal trends of traumatic injury by mechanism of injury (MOI) by demographic characteristics from 2012 to 2019 for adult patients 18 years and older.

Methods: Overall, 5 630 461 records were included after excluding those with missing demographic information and International Classification of Disease codes. MOIs were calculated as proportions of total injury by year.

Trauma and Death in the Emergency Department: A Time to PAUSE (Promoting Acknowledgment, Unity, and Sympathy at the End of Life).

Background: Witnessing death can be difficult and emotionally draining for health care workers and presents a risk factor for burnout. The practice of a ritual pause at patient death to recognize the patient as a person, reflect, and acknowledge the health care team is an emerging intervention that has not been well studied in trauma.

Objective: This study aims to explore the effect of a team pause on trauma team member attitudes after emergency department patient death.

Patient characteristics and diagnostic tests associated with syncopal falls: A Southwestern surgical congress multicenter study.

Background: Patients suspected of syncope frequently undergo laboratory and imaging studies to determine the etiology of the syncope. Variability exists in these workups across institutions. The purpose of this study was to evaluate the utilization and diagnostic yield of these workups and the patient characteristics associated with syncopal falls.

The Effect of CMS's Comprehensive Care for Joint Replacement Bundled Payment Model on Trajectories of Post-acute Rehabilitation Care After Total Hip Arthroplasty.

Objective: To evaluate the effect of the Comprehensive Care for Joint Replacement (CJR) policy on the 90-day trajectory of post-acute care after a total hip arthroplasty (THA).

Design: Multivariable difference-in-difference models applied to Medicare beneficiaries undergoing a THA prior to (2014-2015) and post-CJR implementation (2017) in areas subjected to or exempt from the policy.

Setting: Hospitals in standard metropolitan statistical areas.

Postoperative Outcomes in the Plain Community Population of Western Wisconsin.

Background: Residents of plain communities constitute an underserved minority population that is not reliably captured in contemporary surgical outcomes research. We hypothesized that plain communities (PC) patients would have higher postoperative complication rates than a general surgical population.

Methods: A retrospective review of 30-day postoperative outcomes for PC patients compared to a majority (non-PC) matched patient population from September 2014 to March 2020 was performed.

The role of food and activity environment in a bariatric surgery population: impact on postoperative weight loss.

Background: Food and activity factors may have an impact on weight in the general population, but little is known about how this affects postbariatric surgery weight loss.

Objectives: To understand the impact of environmental food and activity factors on weight loss after bariatric surgery.

Setting: A multidisciplinary integrated health system with an accredited bariatric surgery program.

Emergency department encounters, hospital admissions, course of treatment, and follow-up care for behavioral health concerns in patients after Roux-en-Y gastric bypass surgery.

Background: The benefits of bariatric surgery are well-established, however, concerns surrounding postoperative psychiatric destabilization and alcohol misuse remain. Research has initiated the process of identifying risks associated with bariatric surgery, although less is known regarding when or why psychiatric hospitalizations occur postoperatively.

Objectives: The goal of the current study was to examine the incidence of, and contributing factors to, behavioral health-related emergency room (ER) encounters and hospitalization after bariatric surgery.

Validation of the Yale Food Addiction Scale 2.0 in Patients Seeking Bariatric Surgery.

Background: The Yale Food Addiction Scale (YFAS) was developed in 2009 to assess food addiction (FA); a revised version was released in 2016 (YFAS 2.0). The objective of this study was to determine the statistical and clinical validity of the YFAS 2.

Epidemiology, Management, and Outcomes of Accidental Hypothermia: A Multicenter Study of Regional Care.

Background: Hypothermia is an uncommon, potentially life-threatening condition. We hypothesized (1) advanced rewarming techniques were more frequent with increased hypothermia severity, (2) active rewarming is increasingly performed with smaller intravascular catheters and decreased cardiopulmonary bypass, and (3) mortality was associated with age, hypothermia severity, and type.

Methods: Trauma patients with temperatures <35°C at 4 ACS-verified trauma centers in Wisconsin and Minnesota from 2006 to 2016 were reviewed.

The role of palliative care in acute trauma: When is it appropriate?

Introduction: We hypothesized that trauma providers are reticent to consider palliative measures in acute trauma care.

Methods: An electronic survey based on four patient scenarios with identical vital signs and serious blunt injuries, but differing ages and frailty scores was sent to WTA and EAST members.

Results: 509 (24%) providers completed the survey.

Lack of Correlation Between Subjective and Objective Measures of Gastroesophageal Reflux Disease: Call for a Novel Validated Assessment Tool.

Objective measures including the DeMeester score, lower esophageal sphincter (LES) pressure, acid exposure time, and body mass index (BMI) are used to determine gastroesophageal reflux disease (GERD) severity and eligibility for various antireflux surgical procedures. The GERD Health-Related Quality of Life (GERD-HRQL) survey is widely used to evaluate patients' subjective severity of symptoms and GERD-related quality of life. The purpose of this project was to identify whether or not the subjective measure (GERD-HRQL) correlated with objective measures (DeMeester score, LES, acid exposure time, and BMI) of GERD severity.

Pre-screening for bariatric surgery patients: comparative effectiveness of transnasal endoscopy versus esophagogastroduodenoscopy.

Background: Endoscopic evaluation is frequently performed before bariatric surgery to identify foregut pathology that may alter procedure selection. Transnasal endoscopy (TNE) is an alternative to esophagogastroduodenoscopy (EGD). The objective of this study was to compare TNE to EGD.

Is Chief Resident Autonomy Safe for Patients? An Analysis of Quality in Training Initiative (QITI) Data to Assess Chief Resident Performance.

Objective: A chief resident service (CRS) provides a unique environment to assess competence throughout all aspects of patient care. The American College of Surgeons National Surgical Quality Improvement Program and Quality in Training Initiative databases are utilized to assess patient outcomes by individual residents with institutional and national comparisons. We hypothesized that residents on the CRS would have equivalent patient care outcomes to peers not on CRS and to chief residents nationally.

Career Satisfaction, Gender Bias, and Work-Life Balance: A Contemporary Assessment of General Surgeons.

Objective: To identify factors and patterns of career and life satisfaction among general surgery residency graduates who completed all of their general surgery training after the implementation of duty hour restrictions.

Design: A 91-point electronic survey was distributed to assess experiences during medical school, residency, current surgical practice and work-life balance. Descriptive statistics and chi-square tests were completed.

Underrepresented Minorities in General Surgery Residency: Analysis of Interviewed Applicants, Residents, and Core Teaching Faculty.

Background: The Accreditation Council for Graduate Medical Education (ACGME) requires diversity in residency. The self-identified race/ethnicities of general surgery applicants, residents, and core teaching faculty were assessed to evaluate underrepresented minority (URM) representation in surgery residency programs and to determine the impact of URM faculty and residents on URM applicants' selection for interview or match.

Study Design: Data from the 2018 application cycle were collated for 10 general surgery programs.

Impact of Advance Directives on Outcomes and Charges in Elderly Trauma Patients.

As the number of geriatric trauma patients rises, end-of-life planning is of increased importance. A community-wide initiative to increase advance care planning was undertaken in the 1990s, resulting in a high rate (85%) of completed advance directives (ADs). To assess the impact of ADs on quality measures of care and outcomes for elderly trauma patients.

Nephrolithiasis after bariatric surgery: A comparison of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy.

Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is known to increase risk for calcium oxalate nephrolithiasis due to hyperoxaluria; however, nephrolithiasis rates after laparoscopic sleeve gastrectomy (LSG) are not well described. Our objective was to determine the rate of nephrolithiasis after LRYGB versus LSG.

Methods: The electronic medical records of patients who underwent LRYGB or LSG between 2001 and 2017 were retrospectively reviewed.

Delayed splenic hemorrhage: Myth or mystery? A Western Trauma Association multicenter study.

Background: Multi-detector computed tomography imaging is now the reference standard for identifying solid organ injuries, with a high sensitivity and specificity. However, delayed splenic hemorrhage (DSH), defined as no identified injury to the spleen on the index scan but delayed bleeding from a splenic injury, has been reported. We hypothesized that the occurrence of DSH would be minimized by utilization of modern imaging techniques.

Defining Weight Loss After Bariatric Surgery: a Call for Standardization.

Background: Some weight regain is expected after bariatric surgery; however, this concept is not well defined. A favorable weight loss response has commonly been defined as 50% excess weight loss (EWL). The medical literature uses %total weight loss (%TWL), which has recently been adopted in some surgical literature.

Underrepresented Minorities are Underrepresented Among General Surgery Applicants Selected to Interview.

Objective: Diversity is an ill-defined entity in general surgery training. The Accreditation Council for Graduate Medical Education recently proposed new common program requirements including verbiage requiring diversity in residency. "Recruiting" for diversity can be challenging within the constraints of geographic preference, type of program, and applicant qualifications.