Implementation of a Stepped Care Program to Address Emotional Recovery among Traumatic Injury Patients.

Background: Annually, over 600,000 adults served in US trauma centers (≥20%) develop posttraumatic stress disorder (PTSD) and/or depression in the first year after injury. American College of Surgeons guidelines include screening and addressing mental health recovery in trauma centers. Yet, many trauma centers do not monitor and address mental health recovery, and it is a priority to learn how to implement evidence-informed mental health programs in trauma centers.

Impact of Transfusing Packed Red Blood Cells Through a Rapid Infuser on Potassium Levels.

Background: Hyperkalemia is associated with the rapid transfusion of packed red blood cells in trauma patients. Rapid infusers can infuse blood up to 500 ml/min.

Objective: This study aimed to determine whether infusing packed red blood cells through a rapid infuser impacts the potassium levels of the infused blood.

Isolated Rib Fractures in Elderly Falls: Not As Deadly As We Think.

Background: Rib fractures in elderly patients have been associated with high morbidity and mortality; however, many of these patients had substantial mechanisms of injury, which may have contributed to these high rates.

Objective: The purpose of this study was to determine the morbidity and mortality of elderly patients with isolated rib fractures who fell from standing.

Methods: A single-institution retrospective study was conducted in a Level I trauma center using the trauma registry and a separate elderly fall from standing database.

Development of Trauma Level Prediction Models Using Emergency Medical Service Vital Signs to Reduce Over- and Undertriage Rates in Penetrating Wounds and Falls of the Elderly.

Determining triage activation levels in geriatric patients who fall (GF), and patients with penetrating wounds can be difficult and inaccurate, resulting in excessive overtriage (OT) and undertriage (UT) rates. We developed trauma activation prediction models using field data to predict with greater accuracy trauma activation level and triage rates consistent with the ACS recommendations. Using data from the 2014 National Trauma Data Bank, we created binary regression equations for each type of injury (GF and penetrating wounds).

Impact of a Quality Improvement Intervention to Increase Brief Alcohol and Drug Interventions on a Level I Trauma Service.

Screening and brief intervention (SBI) decreases alcohol use and related consequences among trauma patients. Although SBI is required in Level I and II trauma centers, implementation often is difficult. This study used the Plan-Do-Study-Act approach to identify and implement measures to increase the number of patients receiving SBI at a Level I trauma center.

Utility of urodynamics in the management of asymptomatic tethered cord in children.

Background: We have noted a recent increase in neurosurgical requests at our institution for urodynamics (UDS) prior to release of asymptomatic tethered cord. Our aim was to determine how preoperative UDS results are used in the clinical management of asymptomatic tethered cord.

Methods: A retrospective review was performed of 120 patients diagnosed with primary tethered cord from 2007 to 2010.

The current state of surgical practice for neonatal torsion: a survey of pediatric urologists.

Objective: The evaluation and treatment of perinatal testicular torsion is controversial. We performed a survey to assess practice patterns among pediatric urologists regarding treatment of perinatal torsion.

Methods: An internet survey was administered to members of two pediatric urology societies.

Outcome after discontinuing prophylactic antibiotics in children with persistent vesicoureteral reflux.

Purpose: Treatment for vesicoureteral reflux remains controversial. Lacking an evidence-based treatment protocol, we offered the option of terminating prophylactic antibiotics in otherwise healthy patients with persistent vesicoureteral reflux at age 5 years or greater. We report outcomes with respect to the urinary tract infection incidence and to whether surgical intervention was eventually done.

Oral microbial and respiratory status of persons with mental retardation/intellectual and developmental disability: an observational cohort study.

Objective: The objective of this study was to determine the prevalence of select microorganisms in oral biofilms and to investigate relationships between oral and respiratory status in persons with mental retardation/intellectual and developmental disabilities (IDD).

Study Design: We conducted a 6-month-long observational cohort study with 63 persons with IDD. Oral examinations, oral sampling, and medical record reviews were performed at baseline and then monthly.

The management of ureteropelvic junction obstruction presenting with prenatal hydronephrosis.

The treatment of the newborn diagnosed with a ureteropelvic obstruction prenatally should follow a systematic approach. Although a majority of patients can be followed without surgical intervention, controversy exists concerning appropriate follow-up. Furthermore, a significant number of patients will manifest mild disease and thus deserve abbreviated follow-up.

Postnatal imaging of antenatal hydronephrosis.

Radiologic imaging of the newborn detected prenatally with hydronephrosis should follow a systematic approach. Upper and lower urinary tract imaging should be performed in most cases in order to determine the etiology and gauge the use of future imaging. An overview of renal ultrasound, voiding cystourethrography, renal scintigraphy, and magnetic resonance urography in the setting of antenatal hydronephrosis are discussed.

Prenatal intervention for lower urinary tract obstruction.

Hydronephrosis is one of the most common abnormalities detected on routine prenatal ultrasounds, being noted in up to 1% of fetuses. Rarely, severe hydronephrosis coexists with oligohydramnios, which portends a poor prognosis. We review the most recent literature on the results of prenatal intervention in this setting.

Antenatal hydronephrosis.

The diagnosis, workup, and management of prenatal hydronephrosis have undergone a swing from preemptive surgical treatment to a more conservative approach as the natural history of the differential diagnoses becomes more appreciated. We examine different radiologic tests for determining the diagnoses associated with antenatal hydronephrosis. A review of the more common differential diagnoses of prenatal hydronephrosis and current treatment options for ureteropelvic junction obstruction, vesicoureteral reflux, ureteroceles, ectopic ureters, and megaureters is undertaken.

Helicobacter pylori infection in people who are intellectually and developmentally disabled: a review.

The Helicobacter pylori (H. pylori) bacterium has been classified by the World Health Organization as a type 1 carcinogen with associations to the development of peptic and gastric ulcers, gastric carcinoma and primary B-cell lymphoma. Individuals who have intellectual disabilities and developmental disabilities (IDDD) exhibit H.

Pediatric urodynamics: basic concepts for the neurosurgeon.

A great deal of information about overall bladder and urethral function can be obtained with the utilization of urodynamics. Urodynamics itself does not constitute a single test but more precisely the acquisition of multiple interconnected data combined to give an overall study of the storage and emptying phases of the bladder, function of the urethra, as well as the activity of the pelvic floor musculature. Urodynamic investigation represents one of the few reliable objective tests available to help guide therapy for the neurosurgeon.

End cutaneous ureterostomy for the management of severe hydronephrosis.

Purpose: Although rarely indicated, surgical treatment of severe megaureter can pose a formidable technical challenge, especially in the small infant. We present our experience and outcomes with end cutaneous ureterostomy as a temporizing adjunct to future ureteral reimplantation.

Materials And Methods: We performed a retrospective cohort study of patients who underwent end cutaneous ureterostomy between 1993 and 2005.

Incontinence following bladder neck reconstruction--is there a role for endoscopic management?

Purpose: Little has been reported concerning the efficacy of endoscopic injection of dextranomer/hyaluronic acid for the treatment of residual incontinence following bladder neck reconstruction. We present the experience of 2 institutions using endoscopic submucosal injection of dextranomer/hyaluronic acid to correct incontinence in patients who had previously undergone bladder neck reconstruction with or without concomitant enterocystoplasty.

Materials And Methods: A retrospective chart review was performed with patient demographics, indications for treatment and outcomes recorded.

Endoscopic injection of dextranomer/hyaluronic acid copolymer to correct vesicoureteral reflux following failed ureteroneocystostomy.

Purpose: The efficacy of endoscopic injection of dextranomer/hyaluronic acid to correct primary vesicoureteral reflux is well documented. We present experience at 2 institutions with endoscopic treatment for vesicoureteral reflux after failed ureteroneocystostomy.

Materials And Methods: A retrospective review was performed of the records of all patients who underwent endoscopic dextranomer/hyaluronic acid injection to correct vesicoureteral reflux following ureteral reimplantation between April 2002 and July 2005.

Perforation of Malone antegrade continence enema: diagnosis and management.

Purpose: Severe bowel dysfunction often accompanies neurogenic bladder, and Malone antegrade continence enema (MACE) procedures can lead to improvement in the quality of life of these patients. However, complications such as catheter false passage with subsequent intraperitoneal instillation of irrigation can lead to significant morbidity. We present our experience with the diagnosis and management of this condition.

The economics of pit and fissure sealants in preventive dentistry: a review.

Oral diseases are progressive, cumulative, and become more intricate to treat with advancement. While dental caries is an infectious transmissible disease with children being at the highest risk, primary prevention can reduce this risk. Primary prevention in dentistry is usually considered to be community fluoridated water supplies, professional fluoride treatments, and pit and fissure sealants.

Xylitol in the prevention of oral diseases.

Special needs populations such as the mentally disabled or developmentally disabled present a unique challenge for the dental professionals providing dental treatment. Among those challenges is oral health promotion through primary prevention of dental caries and periodontal disease. There are many barriers to adequate oral care for these special needs patients that include cost, physical limitations, low levels of perceived need and lack of dental knowledge by residents and staff, if the person resides in an institution.

Bedside insertion of vena cava filters in the intensive care unit using intravascular ultrasound to locate renal veins.

Background: Historically, contrast venography has been used to determine renal vein location and assist with vena cava filter placement. This technique, however, exposes the patient to nephrotoxic contrast and radiation. For trauma patients in the intensive care unit (ICU), inferior vena cava filters should ideally be placed without contrast at the bedside to avoid nephrotoxic agents, radiation, and transport of a critically injured patient to the operating room or x-ray department.

Successful renal transplantation in children with posterior urethral valves.

Purpose: The treatment of children with posterior urethral valve (PUV) and end-stage renal disease can be challenging. Some series have had poor outcomes after renal transplantation with an increased risk of graft dysfunction and urinary tract infections. We present our experience with a pediatric population and compare it to all the other pediatric renal transplants done at our institution.