Burnout and its relationship with perceived stress, self-efficacy, depression, social support, and programmatic factors in general surgery residents.

Background: Burnout affects surgical residents' well-being.

Objective: We sought to identify factors associated with burnout among surgery residents.

Methods: An electronic/anonymous survey was sent to surgical residents at 18 programs, consisting of demographic/programmatic questions and validated scales for burnout, depression, perceived stress, self-efficacy, and social support.

Randomized Comparison of Hypochlorous Acid With 5% Sulfamylon Solution as Topical Therapy Following Skin Grafting.

Infections are a serious complication of thermal injury. Excision and grafting have led to a decrease in incidence, but to ensure successful skin grafting, antimicrobial irrigants are frequently utilized to prevent infection. A safe, efficacious, and cost-effective irrigant capable of preventing infections would be a valuable adjunctive therapy.

Endoscopic management of colovaginal fistulas in advanced cancer patients.

Background And Aims: Colovaginal fistula (CVF) in cancer patients can cause significant morbidity. In addition to causing local symptoms and infections, the constant stool leakage contributes to a poor quality of life, psychological distress, and possible social isolation. Patients with CVFs often have advanced disease, poor nutrition, and complex anatomy, making them poor candidates for major surgical interventions.

Thoracic Liposarcoma In An End Stage Renal Disease Patient.

Liposarcoma arising in the thoracic cavity is a rare entity. It is usually found in the retroperitoneal space and the extremities. No case of thoracic liposarcoma in a patient suffering from the end-stage renal disease has been reported in the literature.

Barriers to Positively Impact Weight Gain in a Psychiatric Inpatient Unit.

Weight gain is a problematic issue for patients with serious mental illness. A previously published study found that hospitalized psychiatric patients gained over 6 lb in stays ≥ 30 days. Furthermore, hospital-wide changes to promote healthy eating were unsuccessful in stemming weight gain.

Avoiding obstetrical interventions among US-based Somali migrant women: a qualitative study.

Somali refugee women are known to have poor health-seeking behavior with a higher proportion of adverse pregnancy outcomes compared to US-born women. Yet unknown is how they avoid obstetrical interventions. This study sought to identify perceived protective mechanisms used to avoid obstetric interventions as well as the underpinning factors that influence aversion to obstetrical interventions by Somali refugee women.

Opiate leukoencephalopathy in a pediatric patient.

A 17-year-old male presented from an outside facility in acute respiratory failure and profound hypotension. He was found to have classic MRI brain findings of opiate-induced leukoencephalopathy which was corroborated with urine drug screen and history. This entity has been described in the adults but is not as well recognized in the pediatric population.

The Efficacy of Antivenin Latrodectus (Black Widow) Equine Immune F(ab') Versus Placebo in the Treatment of Latrodectism: A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial.

Study Objective: The antivenom currently available for treatment of systemic black widow envenomation (latrodectism) is composed of equine whole immunoglobin. Although considered effective, it has been associated with anaphylaxis and 2 reported fatalities. We test the efficacy and safety of new equine antivenom composed of purified F(ab') antibody fragments.

How Transparency Efforts Helped One System's Financial Turnaround.

Healthcare consumerism, costs, and price transparency are garnering unprecedented attention from hospitals and health systems in the United States. To many observers of the US healthcare delivery system, the inability to provide accurate pricing information and the variability in prices for comparable services are utter failures of the administrative infrastructure that supports patient care processes.Price transparency and the affordability of healthcare have also become top concerns for professional and trade organizations, which are devoting significant resources to assist member institutions in facing these issues.

Comparing clinical outcomes between two scorpion antivenom dosing strategies in children.

The clinical course from scorpion envenomation can range from mild to life threatening, particularly in younger children. The F(ab') antivenom currently available in the United States is extremely effective for countering the neurotoxic effects but extremely expensive. This dose comparison study assesses clinical outcomes between two antivenom dosing strategies.

The Use of V.A.C. VERAFLO CLEANSE CHOICE in the Burn Population.

Negative pressure wound therapy (NPWT) is routinely used in the treatment of acute and chronic wounds. The technology continues to evolve with improved results NPWT is routinely used at the Arizona Burn Center and the addition of the V.A.

Aortitis and pachymeningitis: an unusual combination in granulomatosis with polyangiitis (myeloperoxidase-associated vasculitis).

Aortitis and pachymeningitis are uncommon manifestations of the antineutrophil cytoplasmic antibody-associated vasculitides, a group of systemic autoimmune diseases mainly affecting small vessels. We present a case of a 71-year-old woman with a remote history of idiopathic chronic granulomatous pachymeningitis complicated with aortic thickening due to autoimmune aortitis.

Genomic Analyses of Acute Flaccid Myelitis Cases among a Cluster in Arizona Provide Further Evidence of Enterovirus D68 Role.

Enteroviruses are a common cause of respiratory and gastrointestinal illness, and multiple subtypes, including poliovirus, can cause neurologic disease. In recent years, enterovirus D68 (EV-D68) has been associated with serious neurologic illnesses, including acute flaccid myelitis (AFM), frequently preceded by respiratory disease. A cluster of 11 suspect cases of pediatric AFM was identified in September 2016 in Phoenix, AZ.

Use of Polarized Sunglasses During Video Laryngoscopy: A Cause of Difficult Prehospital Intubation.

Background: In the prehospital setting, many providers advocate for video laryngoscopy as the initial method of intubation to improve the likelihood of a successful first attempt. However, bright ambient light can worsen visualization of the video laryngoscope liquid crystal display (LCD).

Case Report: A patient involved in a motor vehicle accident was evaluated by an Emergency Medical Services (EMS) crew.

A Unique Case of Midvariant Reverse Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is known to have 4 variants: apical, midventricular, basal, and focal. Here, we report the 2nd case of reverse midvariant (midventricular) stress cardiomyopathy and the 1st case of reverse midvariant takotsubo cardiomyopathy with apical thrombus.

Positive Murphy's Sign in Pericardial Hematoma from a Right Atrial Tear.

A positive Murphy's sign in a patient with right upper quadrant abdominal pain is the arrest of inspiration during deep palpation of the quadrant. It is usually suggestive of acute cholecystitis. We report an unusual case of a positive Murphy's sign not due to acute cholecystitis, but rather from a pericardial hematoma from a right atrial tear causing right heart failure.

Female Genital Cutting: Clinical knowledge, Attitudes, and Practices from a Provider survey in the US.

Migration from countries where female genital cutting (FGC) is practiced means women's healthcare providers need to meet this population's unique healthcare needs. We explored providers' FGC-related experience, knowledge of the cultural practice, prior training, attitudes towards medicalization, including reinfibulation, and clinical practice. An online, 53-question survey to a multidisciplinary sample of women's health providers in the US were recruited by email via professional organizations, medical departments, and the authors' professional networks.

Convulsion and Atrial Fibrillation after Transforaminal Cervical Epidural Lidocaine Injection.

Lidocaine has been widely used as a local anesthetic as well as an antiarrhythmic. Its use in epidural anesthesia is increasing, which has introduced new risk and potential for harm not associated with older indications. We present a case of convulsion and atrial fibrillation seen after transforaminal cervical epidural injection with two milliliters of 2% lidocaine (40 milligrams) that resolved with no long-term sequelae.

A Society of Gastrointestinal and Endoscopic Surgeons (SAGES) statement on closed social media (Facebook®) groups for clinical education and consultation: issues of informed consent, patient privacy, and surgeon protection.

Introduction: Closed social media groups (CSMG), including closed Facebook® groups, are online communities providing physicians with platforms to collaborate privately via text, images, videos, and live streaming in real time and optimize patient care. CSMG platforms represent a novel paradigm in online learning and education, so it is imperative to ensure that the public and patients trust the physicians using these platforms. Informed consent is an essential aspect of establishing this trust.

A comparison of injury scoring systems in predicting burn mortality.

The models most widely used to predict burn patient mortality are the revised Baux score, Ryan, Smith, McGwin, Abbreviated Burn Severity Index (ABSI), Belgian Outcome of Burn Injury (BOBI), and the Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex (FLAMES). Improvements in critical care have reduced mortality resulting from severe burns, which may affect the predictive strength of older models. We conducted a cross-validation study on all burn patients (n = 114) with TBSA greater than 20%, admitted to the Arizona Burn Center between 2014 and 2016.

Wound botulism caused by after a heroin injection.

Botulism is caused by toxin production from many species of , most commonly as well as and . Development of wound botulism is associated with injection drug users but has also been described in traumatic injuries with exposure to soil. A patient presented to the emergency department with a complaint of descending, progressive weakness.