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.

Delayed Intracranial Hemorrhage after Blunt Head Trauma while on Direct Oral Anticoagulant: Systematic Review and Meta-Analysis.

Introduction: Delayed intracranial hemorrhage (ICH) after a negative initial head cat scan (CT) is a recognized complication after blunt trauma but the risk of this condition is unknown. Due to theoretical increased risk in patients on direct oral anticoagulants (DOACs) and inability to monitor degree of anticoagulation, there is a lack of consensus regarding need for additional observation or routine repeat head CT. We hypothesized that patients on DOACs would have a low risk of delayed ICH after blunt head trauma.

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.

Predicting delayed discharge in a multimodal Enhanced Recovery Pathway.

Background: Despite advances with Enhanced Recovery Pathways(ERP), some patients have unexpected prolonged lengths of stay(LOS). Our goal was to identify the patient and procedural variables associated with delayed discharge despite an established ERP.

Methods: A divisional database was reviewed for minimally invasive colorectal resections with a multimodal ERP(8/1/13-7/31/15).

A new perspective on the value of minimally invasive colorectal surgery-payer, provider, and patient benefits.

Background: The clinical benefits of minimally invasive surgery (MIS) are proven, but overall financial benefits are not fully explored. Our goal was to evaluate the financial benefits of MIS from the payer's perspective to demonstrate the value of minimally invasive colorectal surgery.

Methods: A Truven MarketScan claim-based analysis identified all 2013 elective, inpatient colectomies.

Anhedonia Is Associated with Poorer Outcomes in Contingency Management for Cocaine Use Disorder.

This study explored anhedonia (lack of interest or pleasure in non-drug rewards) as a potentially modifiable individual difference associated with the effectiveness of Contingency Management (CM). It also tested the hypothesis that a dopaminergic drug, levodopa (L-DOPA), would improve the effectiveness of CM, particularly in individuals high in anhedonia. The study was a single-site, randomized, double-blind, parallel group, 12-week trial comparing L-DOPA with placebo, with both medication groups receiving voucher-based CM targeting cocaine-negative urines.

Global Tn-seq analysis of carbohydrate utilization and vertebrate infectivity of Borrelia burgdorferi.

Borrelia burgdorferi maintains a complex life cycle between tick and vertebrate hosts. Although some genes have been identified as contributing to bacterial adaptation in the different hosts, the list is incomplete. In this manuscript, we report the first use of transposon mutagenesis combined with high-throughput sequencing (Tn-seq) in B.

Image fusion and navigation platforms for percutaneous image-guided interventions.

Image-guided interventional procedures, particularly image guided biopsy and ablation, serve an important role in the care of the oncology patient. The need for tumor genomic and proteomic profiling, early tumor response assessment and confirmation of early recurrence are common scenarios that may necessitate successful biopsies of targets, including those that are small, anatomically unfavorable or inconspicuous. As image-guided ablation is increasingly incorporated into interventional oncology practice, similar obstacles are posed for the ablation of technically challenging tumor targets.

Knot Strength Varies Widely Among Expert Arthroscopists.

Background: While most surgeons can tie visually appealing knots under an arthroscope, few surgeons have undergone an objective evaluation of their ability to consistently tie knots with maximum loop and knot security.

Purpose/hypotheses: The purpose of this study was to evaluate and compare variations in ultimate load to failure, 3-mm displacement (clinical failure), and knot stack height of arthroscopic suture knots tied by 73 independent expert orthopaedic arthroscopists. The hypotheses were (1) that skilled arthroscopic surgeons would be able to routinely tie arthroscopic knots of similar strength, (2) that surgeons with <10 years of clinical practice would tie stronger and more consistent knots, and (3) that surgeons who performed >200 arthroscopic shoulder cases per year would produce stronger and more consistent knots than would surgeons who performed fewer cases.

Reorganization of language-specific cortex in patients with lesions or mesial temporal epilepsy.

Objective: To examine brain activation profiles for receptive language function, using magnetoencephalography (MEG), in patients with left hemisphere space-occupying lesions and patients with left temporal lobe epilepsy due to mesial temporal sclerosis (MTS) and to evaluate whether cross- and intrahemispheric plasticity for language varied as a function of lesion type or location.

Methods: Twenty-one patients with MTS and 23 lesional patients underwent preoperative language mapping while performing a word recognition task. The anatomic location of late activity sources was determined by co-registering MEG coordinates onto structural MRI scans.

Vitamin A and its congeners.

Vitamin A (retinol) is a fat-soluble vitamin that is necessary for cell growth and differentiation. Excess vitamin A has been associated with teratogenic effects in animals and humans. Because vitamin A deficiency is very uncommon in the industrialized world, the current recommendation is that routine vitamin A supplementation is not necessary.

Justifying a "fast acting" claim for antidepressant drugs.

Justification of a "fast acting" claim for antidepressant drugs is, first and foremost, a definition problem. The one controversial statistical issue that has been raised is whether time should enter the equation as an independent or dependent variable. Although alternative models provide essentially equivalent tests of significance and estimates of response latencies, a regression model--in which assessment times are recognized to be fixed independent variables and repeated quantitative measurements of clinical response are the dependent variable--is more congruent with the determinate experimental conditions and sources of error variation in antidepressant drug trials.