222 results match your criteria: "Los Angeles County-USC Medical Center.[Affiliation]"

Background: Before SARS-CoV-2 vaccination availability, medical center employees were at high risk of COVID-19. However, risk factors for SARS-CoV-2 infection in medical center employees, both healthcare and non-healthcare workers, are poorly understood.

Methods: From September-December 2020, free IgG antibody testing was offered to all employees at a large urban medical center.

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Article Synopsis
  • The study aimed to establish international consensus on optimal Textbook Outcomes for patients undergoing emergency laparotomies, focusing on both trauma and non-trauma cases.
  • A modified Delphi exercise was conducted with 337 participants globally, which involved multiple rounds to refine the outcome criteria based on expert and patient input.
  • The agreed outcomes include short-term goals, such as being discharged without serious complications, and long-term goals, which involve restoring quality of life one year post-surgery; these findings will need clinical validation.
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Trauma and acute care surgeons commonly perform high acuity and emergent interventions on critically ill or injured patients. This often entails making life or death decisions rapidly and with incomplete and imperfect information, and in patients who may have a variety of comorbidities that contribute to the risk of adverse outcomes. In cases where there are real or perceived breaches of care, a medical malpractice claim may result.

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Promoting Responsible Antibiotic Usage in Dental Implant Procedures.

J Oral Maxillofac Surg

July 2024

Clinical Associate Professor, Department of Oral & Maxillofacial Surgery, The Herman Ostrow School of Dentistry at USC, Los Angeles County/USC Medical Center, Los Angeles, CA.

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Nutritional support for the trauma and emergency general surgery patient: What you need to know.

J Trauma Acute Care Surg

June 2024

From the Division of Acute Care Surgery, Department of Surgery (J.L.H.), University of Kansas Medical Center, Kansas Center, Kansas; Department of Surgery (D.C.E.), Ohio University, OhioHealth Grant Medical Center, Columbus, Ohio; and Division of Trauma and Surgical Critical Care (M.J.M.), Los Angeles County + USC Medical Center, Los Angeles, California.

Abstract: Decades of research have provided insight into the benefits of nutritional optimization in the elective surgical patient. Patients who are nutritionally prepared for surgery enjoy reduced length of hospital and intensive care unit stays and suffer fewer complications. In the trauma and emergency general surgery patient populations, we are not afforded the preoperative period of optimization and patients often suffer longer lengths of hospital stay, discharge to nonhome destinations, and higher infectious and mortality rates.

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Common postbariatric surgery emergencies for the acute care surgeon: What you need to know.

J Trauma Acute Care Surg

December 2023

From the Division of Trauma and Surgical Critical Care (V.C., M.J.M.), Los Angeles County + USC Medical Center, University of Southern California; Division of Upper GI and General Surgery (V.C., K.S., A.B.D., J.D.N., S.A.A., M.J.M.), Keck School of Medicine of the University of Southern California, Los Angeles; Surgical Specialties (A.P.), Simi Valley Adventist Hospital, Simi Valley, California; and Division of Acute Care Surgery and Trauma (A.B.), University of Kentucky-Lexington, Lexington, Kentucky.

Article Synopsis
  • * Despite fewer postoperative complications, patients still face potential risks after surgery that can occur long after the initial procedure, needing urgent medical attention.
  • * The article reviews common bariatric surgeries, their complications, and offers guidelines for emergency care providers to manage these complex cases effectively.
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Importance: The long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome remain to be definitively clarified.

Objective: To examine the effect of MIST on death or neurodevelopmental disability (NDD) at 2 years' corrected age.

Design, Setting, And Participants: Follow-up study of a randomized clinical trial with blinding of clinicians and outcome assessors conducted in 33 tertiary-level neonatal intensive care units in 11 countries.

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Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking.

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Aim: The aim of this study is to evaluate utility and reliability of chest CT as a standalone screening modality for stable patients with thoracic GSWs and potential transmediastinal trajectories.

Methods: All patients with thoracic GSWs over a 5-year period were identified. Unstable patients requiring immediate surgery were excluded and the remaining underwent chest CT with intravenous contrast.

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Committee on Surgical Combat Casualty Care position statement: Neurosurgical capability for the optimal management of traumatic brain injury during deployed operations.

J Trauma Acute Care Surg

August 2023

From the Joint Trauma System (J.M.G., R.S.K., J.C.G., B.J.S., S.D.J.), DoD Center of Excellence for Trauma, Joint Base San Antonio-Fort Sam Houston, Texas; Department of Surgery (M.D.T.), Navy Medical Center San Diego, San Diego, California; Department of Neurosurgery (B.A.D.), Walter Reed National Military Medical Center, Bethesda, Maryland; US+UAE Trauma (B.J.G.), Burn, and Rehabilitative Medicine Mission; Department of Surgery (M.S.D.) and Department of Neurosurgery (M.S.D.), Womack Army Medical Center, Fort Bragg, North Carolina; Uniformed Service University of Health Sciences (J.B.H., R.S.K., J.W.C., M.J.E., M.A.S., M.J.M.), Bethesda, Maryland; Division of Trauma and Acute Care Surgery, Department of Surgery (J.B.H.), University of Alabama at Birmingham, Birmingham, Alabama; Department of Surgery (L.C.B.), Madigan Army Medical Center, Joint Base Lewis-McChord, Washington; Department of Trauma, Surgical Critical Care and Emergency Surgery (J.W.C.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; 1st Medical Battalion (T.E.), 1st Marine Logistics Group, Oceanside, California; Division of Trauma (J.C.G., B.J.S.), Brooke Army Medical Center, Joint Base San Antonio, San Antonio, Texas; Traumatic Brain Injury Center of Excellence (TBICoE) (D.W.M.), Silver Spring, MD; General Dynamics Information Technology (D.W.M.), Falls Church, VA; Division of Acute Care Surgery Joint Medical Unit (M.J.E.), University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; Oregon Health and Science University (M.A.S.), Portland, Oregon; DoD Combat Casualty Care Research Program (T.M.P.), US Army Medical Research and Development Command, Fort Detrick, Maryland; Division of Trauma and Acute Care Surgery, Department of Surgery (M.J.M.), Los Angeles County + USC Medical Center, Los Angeles, California; Division of Surgery, Department of Neurosurgery (B.A.J.), University of Arizona School of Medicine, Tucson, Arizona; Department of Neurological Surgery (A.V.), University of Texas Southwestern Medical Center, Dallas, Texas; and American College of Surgeons Committee on Trauma (J.D.K.).

Background: Experiences over the last three decades of war have demonstrated a high incidence of traumatic brain injury (TBI) resulting in a persistent need for a neurosurgical capability within the deployed theater of operations. Despite this, no doctrinal requirement for a deployed neurosurgical capability exists. Through an iterative process, the Joint Trauma System Committee on Surgical Combat Casualty Care (CoSCCC) developed a position statement to inform medical and nonmedical military leaders about the risks of the lack of a specialized neurosurgical capability.

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The coronavirus disease 2019 (COVID-19) pandemic has raised serious concerns about child maltreatment, which is known to increase in frequency and severity during times of high stress. The present study used diverse datasets to concurrently examine changes in identification and medical evaluation of maltreatment allegations from before to during COVID-19. Four sources of data were collected from two counties for the months of March-December in 2019 and 2020, including reports to social services and child maltreatment evaluation clinic medical evaluations (CMECs).

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Article Synopsis
  • The study investigated vaccine hesitancy among essential workers, highlighting how factors like perceived susceptibility, perceived threat, and self-efficacy are linked to reluctance to receive the COVID-19 vaccine.
  • A survey was conducted with 1,327 essential workers at a Los Angeles medical center, revealing that 22% were hesitant about getting vaccinated, particularly among women and racial/ethnic minorities.
  • Results showed that prior flu vaccination behavior and job type influenced hesitancy, with a notable difference between healthcare roles, but the expected psychological factors were not linked to vaccine attitudes, suggesting other unassessed influences may play a role.
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Financial vulnerability of trauma centers: A national analysis.

J Trauma Acute Care Surg

May 2023

From the Trauma Service, Department of Surgery (A.M., R.Y.C., B.C., C.G., A.S.R., A.C., A.K., V.B., M.S.), Scripps Mercy Hospital, San Diego; and Division of Trauma and Acute Care Surgery, Department of Surgery (M.J.M.), Los Angeles County + USC Medical Center, Los Angeles, California.

Objective: Trauma centers function as an essential safeguard in the United States health care system. However, there has been minimal study of their financial health or vulnerability. We sought to perform a nationwide analysis of trauma centers using detailed financial data and a recently developed Financial Vulnerability Score (FVS) metric.

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Background: eCPR, the modality of extracorporeal membrane oxygenation (ECMO) applied in the setting of cardiac arrest, has emerged as a novel therapy which may improve outcomes in select patients with out-of-hospital cardiac arrest (OHCA). To date, implementation has been mainly limited to single academic centres. Our objective is to describe the feasibility and challenges with implementation of a regional protocol for eCPR.

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Objectives: Rearrest after successful resuscitation from out-of-hospital cardiac arrest (OHCA) is common and is associated with worse patient outcomes. However, little is known about the effect of interventions designed to prevent rearrest. We assessed the association between a prehospital care protocol for immediate management after return of spontaneous circulation (ROSC) and rates of field rearrest and survival to discharge in patients with prehospital ROSC.

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Background: Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care.

Methods: A multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established.

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Antimicrobial susceptibility testing (AST) in RPMI 1640, a more physiologically relevant culture medium, revealed that a substantial proportion of carbapenem-resistant Acinetobacter baumannii isolates were susceptible to azithromycin, a macrolide antibiotic not currently considered effective against A. baumannii. Experiments using Galleria mellonella validated these data.

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Common bile duct stones management: A network meta-analysis.

J Trauma Acute Care Surg

November 2022

From the Division of Trauma and Emergency Surgery, Department of Surgery (S.M., M.P.F.), Orebro University Hospital; School of Medical Sciences, Orebro University (S.M., G.A.B., M.P.F.), Orebro, Sweden; Division of Traumatology, Surgical Critical Care and Emergency Surgery (G.A.B.), Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania; Servicio de Cirugía General y Digestiva, Unidad de Cirugía de Urgencias y Trauma (I.M.C.), Hospital Universitario Virgen del Rocio, Sevilla, Andalucia, Spain; Division of Acute Care Surgery (M.M.), Los Angeles County + USC Medical Center, Uniformed Services University Health Sciences, Los Angeles, California; Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery (K.A.D.), Yale School of Medicine, New Haven, Connecticut; Division of Acute Care Surgery, Department of Surgery (E.R.H.), Department of Anesthesiology and Critical Care Medicine (E.R.H.), and Department of Emergency Medicine (E.R.H.), The Johns Hopkins University School of Medicine; Department of Health Policy and Management (E.R.H.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Letterkenny Hospital (M.S.), Galway University, Galway, Ireland; UOSD Chirurgia d'Urgenza (H.K.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Center of Trauma and Critical Care (B.S.), George Washington University, Washington, DC; Clinical Epidemiology and Biostatistics (Y.C.), School of Medical Sciences, Orebro University, Orebro, Sweden; Department of Surgery, Riverside University Health System Medical Center (R.C.); Department of Surgery, Loma Linda University School of Medicine (R.C.), Loma Linda; and Department of Surgery, Comparative Effectiveness and Clinical Outcomes Research Center (R.C.), California.

Background: Timely management is critical for treating symptomatic common bile duct (CBD) stones; however, a single optimal management strategy has yet to be defined in the acute care setting. Consequently, this systematic review and network meta-analysis, comparing one-stage (CBD exploration or intraoperative endoscopic retrograde cholangiopancreatography [ERCP] with simultaneous cholecystectomy) and two-stage (precholecystectomy or postcholecystectomy ERCP) procedures, was undertaken with the main outcomes of interest being postprocedural complications and hospital length of stay (LOS).

Methods: PubMed, SCOPUS, MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were methodically queried for articles from 2010 to 2021.

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Importance: Abdominal seat belt sign (SBS) has historically entailed admission and observation because of the diagnostic limitations of computed tomography (CT) imaging and high rates of hollow viscus injury (HVI). Recent single-institution, observational studies have questioned the utility of this practice.

Objective: To evaluate whether a negative CT scan can safely predict the absence of HVI in the setting of an abdominal SBS.

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