Ketamine for acute pain after trauma: A pragmatic, randomized clinical trial.

Background: Non-narcotic intravenous medications may be a beneficial adjunct to oral multimodal pain regimens (MMPRs) which reduce but do not eliminate opioid exposure and prescribing after trauma. We hypothesized that the addition of a subdissociative ketamine infusion (KI) to a standardized oral MMPR reduces inpatient opioid exposure.

Methods: Eligible adult trauma patients admitted to the intermediate or intensive care unit were randomized upon admission to our institutional MMPR per usual care (UC) or UC plus subdissociative KI for 24 hours to 72 hours after arrival.

Ketamine for acute pain after trauma: the KAPT randomized controlled trial.

Background: Evidence for effective pain management and opioid minimization of intravenous ketamine in elective surgery has been extrapolated to acutely injured patients, despite limited supporting evidence in this population. This trial seeks to determine the effectiveness of the addition of sub-dissociative ketamine to a pill-based, opioid-minimizing multi-modal pain regimen (MMPR) for post traumatic pain.

Methods: This is a single-center, parallel-group, randomized, controlled comparative effectiveness trial comparing a MMPR to a MMPR plus a sub-dissociative ketamine infusion.

When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis.

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%).

Handover Practices in Trauma and Acute Care Surgery: A Multicenter Survey Study.

Background: The handover period has been identified as a particularly vulnerable period for communication breakdown leading to patient safety events. Clear and concise handover is especially critical in high-acuity care settings such as trauma, emergency general surgery, and surgical critical care. There is no consensus for the most effective and efficient means of evaluating or performing handover in this population.

n-Alcohol Length Governs Shift in L-L Mixing Temperatures in Synthetic and Cell-Derived Membranes.

A persistent challenge in membrane biophysics has been to quantitatively predict how membrane physical properties change upon addition of new amphiphiles (e.g., lipids, alcohols, peptides, or proteins) in order to assess whether the changes are large enough to plausibly result in biological ramifications.

An urgent need to understand and address the safety and well-being of hospital "sitters".

Background: Hospital sitters provide continuous observation of patients at risk of harming themselves or others. Little is known about sitters' occupational safety and well-being, including experiences with patient/visitor-perpetrated violence (type II).

Methods: Data from surveys, focus groups, individual interviews at six U.

Physical assault, physical threat, and verbal abuse perpetrated against hospital workers by patients or visitors in six U.S. hospitals.

Background: An elevated risk of patient/visitor perpetrated violence (type II) against hospital nurses and physicians have been reported, while little is known about type II violence among other hospital workers, and circumstances surrounding these events.

Methods: Hospital workers (n = 11,000) in different geographic areas were invited to participate in an anonymous survey.

Results: Twelve-month prevalence of type II violence was 39%; 2,098 of 5,385 workers experienced 1,180 physical assaults, 2,260 physical threats, and 5,576 incidents of verbal abuse.

Carcinosarcomas: tumors in transition?

Carcinosarcomas are rare, biphasic tumors that are comprised of carcinomatous and sarcomatous elements. While the exact mechanism by which these two phenotypes arise within a single tumor remains unclear, molecular evidence indicates that the epitheliod and spindle-cell components share a clonal origin. We propose that the biphasic nature of these neoplasms may represent an extreme case of epithelial plasticity, in which an epithelial-like cell undergoes a transition to a more mesenchymal phenotype.

Prognostic significance of immunophenotypic and karyotypic features of Philadelphia positive B-lymphoblastic leukemia in the era of tyrosine kinase inhibitors.

Background: Philadelphia chromosome (Ph)-positive B-lymphoblastic leukemia exhibits immunophenotypic, karyotypic, and molecular genetic heterogeneity. The prognostic significance of these parameters was assessed in the context of intensive tyrosine kinase inhibitor (TKI)-based chemotherapy.

Methods: The authors studied 65 adult patients with Ph-positive acute lymphoblastic leukemia (ALL) who received treatment with TKI-based therapy, correlated their clinicopathologic heterogeneity with patient outcome, and compared the findings with those from 60 adult patients with diploid B-cell ALL who received similar chemotherapy without a TKI.

A novel magnetic anchoring and guidance system to facilitate single trocar laparoscopic nephrectomy.

A transabdominal magnetic anchoring and guidance system (MAGS) deploys multiple instruments through a single 15-mm diameter, transabdominal trocar. These instruments are positioned in the peritoneal cavity and controlled by externally placed magnets to reduce the need for multiple transabdominal trocars. To assess the feasibility of MAGS technology in a single keyhole, complex laparoscopic procedure, nonsurvival porcine nephrectomies were completed without complications via a single 15-mm transumbilical trocar using a prototype MAGS camera and a magnetically anchored, robotic arm cauterizer.

Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints.

The kinematics of the 2nd through 5th carpometacarpal (CMC) joints was investigated by using a 3-dimensional dynamic motion analysis system to delineate flexion-extension motion, radial-ulnar deviation, and pronation-supination motion. Analysis of the axes of rotation revealed that the axes of rotation for flexion-extension motion are located within the base of each respective metacarpal bone. The axis of rotation for radial-ulnar deviation passes through the distal carpal bone of each CMC joint except in the 3rd CMC joint where the axis of rotation is located within the base of the 3rd metacarpal.

The scaphotrapezio-trapezoidal joint. Part 2: A kinematic study.

Kinematics of the scaphotrapezio-trapezoidal joint during wrist flexion/extension motion (FEM) and radial/ulnar deviation (RUD) was investigated using a 3-dimensional dynamic motion analysis system. The scaphoid/trapezoid motion was found to be a rotational motion obliquely oriented relative to the sagittal plane of the wrist and described in an ulnoflexion/radial extension motion plane in both FEM and RUD of the wrist. The axis of rotation of the scaphoid/trapezoid motion during both FEM and RUD wrist motions was essentially the same and runs through the radiopalmar aspect of the distal scaphoid and the waist of the capitate.

The scaphotrapezio-trapezoidal joint. Part 1: An anatomic and radiographic study.

To evaluate anatomic variations and distribution of degenerative changes in the scaphotrapezio-trapezoidal (STT) joint, 165 embalmed cadaver wrists were examined. An interfacet ridge on the distal scaphoid was found in 81% of the wrists and the shape of the distal joint surface of the scaphoid was classified into 3 types. Underdevelopment of the capitate-trapezium ligament was found in 15% of the wrists.

Scaphoid nonunions: a 3-dimensional analysis of patterns of deformity.

We tested the hypothesis that the fracture location of scaphoid nonunions relates to the fracture displacement, development of dorsal intercalated segment instability (DISI) deformity, and changes in the contact area of the bones in the radiocarpal joint. Eleven patients with scaphoid nonunions were examined with 3-dimensional computed tomography and a new method of proximity mapping. Two different patterns of displacement of scaphoid nonunions were demonstrated, 1 volar and 1 dorsal.