American Surgeon最新文献_第9页

Optimizing Nutritional Needs of Burn Patients: An Evaluation of Nutritional Assessment Tools, Feeding Strategies, and Their Impact on Patient Outcomes. 优化烧伤患者的营养需求：评估营养评估工具、喂食策略及其对患者疗效的影响。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-06-03 DOI: 10.1177/00031348241259042

Ruth Zagales, Emelia Watts, Muhammad Usman Awan, Nickolas Hernandez, Minna Haddadi, Howard G Smith, Adel Elkbuli

{"title":"Optimizing Nutritional Needs of Burn Patients: An Evaluation of Nutritional Assessment Tools, Feeding Strategies, and Their Impact on Patient Outcomes.","authors":"Ruth Zagales, Emelia Watts, Muhammad Usman Awan, Nickolas Hernandez, Minna Haddadi, Howard G Smith, Adel Elkbuli","doi":"10.1177/00031348241259042","DOIUrl":"10.1177/00031348241259042","url":null,"abstract":"BackgroundOptimal nutritional support is essential to the recovery and improved outcomes of burn patients. This review aims to explore existing literature to evaluate nutrition assessment tools, feeding formulations' caloric predictive ability, timing of initiation of feeding, optimal nutritional composition, and caloric intake in burn patients.MethodsThree databases were searched to glean studies investigating nutrition in acute severe adult burn patient populations in four areas: outcomes based on feeding type and timing, the caloric predictability of nutritional assessment tools, outcomes associated with the composition of feeding formulas, and considerations related to caloric intake. Outcomes of interest included the effects of nutritional assessments using feeding type, nutritional administration timing, formula composition, and caloric intake on mortality rate, length of stay, and infection.ResultsA total of 19 studies were included. Nutritional assessment tools were determined to over- or underestimate resting energy expenditure (REE). Milner was the most accurate alternative to indirect calorimetry. Early enteral nutrition in burn patients within 24 hours of admission was preferred. 5 studies evaluated micronutrients and yielded variable results. Low-fat high-carbohydrate diets were the ideal macronutrient composition. Burn patients were shown to receive lower caloric intake than recommended.ConclusionsFindings showed that while nutritional assessment tools tend to inaccurately estimate REE in burn patients, the ideal alternative to indirect calorimetry is the Milner equation. Several new equations may be worthy alternatives but require further validation. Enteral feeding should be initiated within the first 24 hours of burn injury whenever possible and should contain a high-carbohydrate/low-fat composition.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"393-406"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141237186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of Trauma Center Type on Outcomes in Pediatric Population Following Severe Isolated Blunt Traumatic Brain Injuries: A National Analysis. 创伤中心类型对严重孤立性钝性创伤性脑损伤后儿科人群预后的影响：全国分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-06-20 DOI: 10.1177/00031348241262432

Hazem Nasef, Brian Chin, Tessa Breeding, Nikita Bundschu, D-Dre Wright, Donald Plumely, Adel Elkbuli

{"title":"Impact of Trauma Center Type on Outcomes in Pediatric Population Following Severe Isolated Blunt Traumatic Brain Injuries: A National Analysis.","authors":"Hazem Nasef, Brian Chin, Tessa Breeding, Nikita Bundschu, D-Dre Wright, Donald Plumely, Adel Elkbuli","doi":"10.1177/00031348241262432","DOIUrl":"10.1177/00031348241262432","url":null,"abstract":"IntroductionThis study aims to evaluate the association between trauma center type, verification level, and clinical outcomes in pediatric trauma patients with moderate and severe isolated blunt traumatic brain injury (TBI).MethodsThis is a retrospective cohort study utilizing the American College of Surgeons (ACS) Trauma Quality Program (TQP) Participant Use File (PUF) database from 2017 to 2021. Severely injured pediatric (<18 years) trauma patients with isolated moderate and severe TBI (AIS head >2, all other body regions <3) were included. Outcomes included in-hospital mortality, discharge disposition, intensive care unit length-of-stay (ICU-LOS), and ventilator-free days (VFDs).ResultsPatients treated at a level-I combined adult and pediatric trauma centers (CTCs) had significantly lower odds of in-hospital mortality than those treated at adult trauma centers (ATCs) (OR .495, 95% CI 0.291-.841, P = .009). Patients treated at level-I pediatric trauma centers (PTCs) (OR 2.726, 95% CI 2.059-3.609, P < .001) and level-II PTCs (OR 6.18, 95% CI 3.402-11.239, P < .001) were significantly more likely to be discharged home than equivalent-level ATCs.ConclusionPediatric patients with isolated blunt moderate and severe TBI treated at level-I PTCs and CTCs had reduced odds of in-hospital mortality compared to level-I ATCs. Patients at level I and II PTCs had significantly higher odds of discharge home than those at equivalent-level CTCs and ATCs.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"313-324"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Letter re: Acute Appendicitis in the Epicenter of the COVID-19 Pandemic: A New York City Single-Center Experience. 致信：COVID-19 大流行中心的急性阑尾炎：纽约市单中心经验。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-11-15 DOI: 10.1177/00031348241300359

Camilla Mattiuzzi, Giuseppe Lippi

引用次数: 0

Predictors of Clinical Outcomes and the Need for Massive Transfusion Protocols in Geriatric Trauma Patients With Hemorrhagic Shock: A Systematic Review. 老年失血性休克创伤患者临床结果的预测因素和大规模输血方案的必要性：系统性综述。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-05-31 DOI: 10.1177/00031348241256069

Hazem Nasef, Caitlin Tweedie, Nikita Bundschu, Quratulain Amin, Nickolas Hernandez, Francis Cruz, Chadwick P Smith, Adel Elkbuli

{"title":"Predictors of Clinical Outcomes and the Need for Massive Transfusion Protocols in Geriatric Trauma Patients With Hemorrhagic Shock: A Systematic Review.","authors":"Hazem Nasef, Caitlin Tweedie, Nikita Bundschu, Quratulain Amin, Nickolas Hernandez, Francis Cruz, Chadwick P Smith, Adel Elkbuli","doi":"10.1177/00031348241256069","DOIUrl":"10.1177/00031348241256069","url":null,"abstract":"IntroductionThe current literature lacks a clear consensus on the predictors of mortality and outcomes of geriatric trauma patients in hemorrhagic shock. This systematic review aims to investigate predictors of clinical outcomes and the need for massive transfusion protocol in the geriatric trauma population with hemorrhagic shock.MethodsPubMed, EMBASE, Cochrane, ProQuest, and Google Scholar were searched for studies evaluating geriatric trauma patients in hemorrhagic shock or receiving MTP. Outcomes of interest included the effect of advanced age on clinical outcomes, the accuracy of SI and other variables in predicting mortality and need for MTP, and associations between blood product ratio and clinical outcomes.ResultsFifteen studies were included in this systematic review. In most studies, advanced age was an accurate predictor of mortality and complication rates in geriatric patients undergoing management of shock with MTP. SI along with other variables such as systolic blood pressure (SBP) were sensitive predictors of mortality and the need for MTP. Studies evaluating blood product ratio found an increased incidence of complications with higher plasma: red blood cell ratios.ConclusionAdvanced age among geriatric patients is associated with increased mortality and complications when undergoing MTP. Shock Index and age x Shock Index are accurate and reliable predictors of mortality and need for MTP in the geriatric trauma population with hemorrhagic shock suffering blunt and/or penetrating injuries. An increased plasma: RBC ratio was associated with more complications in geriatric patients.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"407-416"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiac Trauma: A Review of Penetrating and Blunt Cardiac Injuries. 心脏创伤：穿透性和钝性心脏损伤的综述。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-12-11 DOI: 10.1177/00031348241307400

Carlin Lee, Mallory Jebbia, Raveendra Morchi, Areg Grigorian, Jeffry Nahmias

引用次数: 0

National Analysis of Clinical Outcomes Associated With Cirrhotic Blunt Trauma Patients Undergoing Emergency Laparotomy Versus Non-operative Management: A Propensity Case-Matched Analysis. 肝硬化钝性外伤患者接受紧急腹腔手术与非手术治疗相关临床结果的全国性分析：倾向病例匹配分析

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-05-21 DOI: 10.1177/00031348241256078

Adel Elkbuli, Nikita Bundschu, Hazem Nasef, Brian Chin, David L McClure, Heather X Rhodes-Lyons

{"title":"National Analysis of Clinical Outcomes Associated With Cirrhotic Blunt Trauma Patients Undergoing Emergency Laparotomy Versus Non-operative Management: A Propensity Case-Matched Analysis.","authors":"Adel Elkbuli, Nikita Bundschu, Hazem Nasef, Brian Chin, David L McClure, Heather X Rhodes-Lyons","doi":"10.1177/00031348241256078","DOIUrl":"10.1177/00031348241256078","url":null,"abstract":"IntroductionThis study aims to evaluate clinical outcomes among severely injured trauma patients presenting with isolated blunt abdominal solid organ injuries with a pre-diagnosis of liver cirrhosis (LC) undergoing emergency laparotomy vs nonoperative management (NOM).MethodsThis retrospective cohort study utilized the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) dataset from 2017 to 2021. Adults (≥18 years) with a pre-existing diagnosis of LC who presented with severe blunt (ISS ≥ 16) isolated solid organ abdominal injuries and underwent laparotomy or NOM were included. Outcomes of interest included in-hospital mortality, intensive care unit length of stay (ICU-LOS), and in-hospital complications such as acute renal failure and deep vein thrombosis.Results929 patients were included in this analysis, with 355 undergoing laparotomy and 574 managed nonoperatively. Laparotomy patients suffered greater in-hospital mortality (n = 186, 52.3% vs n = 115, 20.0%; P < .01), required significantly more blood within 4 hours (8.9 units vs 4.3 units, P < .01), and had a significantly longer ICU-LOS (10.2 days vs 6.7 days, P < .01). In the 1:1 propensity score matched analysis of 556 matched patients, in-hospital mortality was greater for laparotomy patients (52.3% vs 20.0%, P < .01).ConclusionLaparotomy was associated with significantly higher in-hospital mortality in propensity-matched trauma patients, longer ICU-LOS, and more blood products given at 4 hours compared to NOM. These findings illustrate that NOM may be a safe approach in managing severely injured trauma patients with isolated blunt abdominal solid organ injuries and a pre-diagnosis of LC.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"336-344"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Can't Buy Me Love? The Use of Gifts in the Residency Application Process. 买不到爱？驻地申请过程中的礼物使用。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-11-11 DOI: 10.1177/00031348241300357

Brigitte Anderson, Nicole Ducich, Brady Campbell, Matthew Cahn, Stephen M Kavic

{"title":"Can't Buy Me Love? The Use of Gifts in the Residency Application Process.","authors":"Brigitte Anderson, Nicole Ducich, Brady Campbell, Matthew Cahn, Stephen M Kavic","doi":"10.1177/00031348241300357","DOIUrl":"10.1177/00031348241300357","url":null,"abstract":"IntroductionTo set themselves apart, some programs use gifts or promotional items to highlight the residency program or unique local culture. The distinction between advertisement and persuasion may be blurry in this case. We sought to quantify the prevalence of gifts to applicants and how frequently the US federal threshold for \"nominal gifts\" was exceeded.MethodsWe reviewed a publicly accessible, Internet resource called the \"ERAS Megathread.\" This is a Google spreadsheet found on Reddit where applicants participating in The Match can anonymously contribute information about their experience. The incidence of \"gifts\" was quantified for surgical residency programs, along with the nominal value if indicated. The spreadsheets were reviewed for 2021, 2022, and 2023.ResultsOver the past 3 application cycles, 15.1% [11.1%-18.2%] of general surgery residency programs provided a gift to applicants. Of these programs, the majority (70.2%) are university-based programs. In 2023, 57.9% of these gifts exceeded US$20. Given the anonymous nature of the data set, and the lack of transparency in the match process, it was not possible to correlate gift giving with its effect on recruitment.Discussion/ConclusionStudents are courted by residency programs, and a significant minority of programs provide a gift to applicants. The impact of a substantial gift on a financially vulnerable student is difficult to quantify. It behooves us as a specialty to determine what should be a universal standard and to consider outlining explicit guidelines for The Match.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"361-364"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improving Trauma Surgeons Prospective Estimation of the Injury Severity Score. 改进创伤外科医生对损伤严重程度评分的前瞻性估计。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-11-11 DOI: 10.1177/00031348241300365

Eli Mlaver, Christopher J Dente, Gina Solomon, Morgan Krause, William Matthew Vassy, S Rob Todd, Patricia Ayoung-Chee

引用次数: 0

Letter re: "Open Versus Minimally Invasive Emergent Colectomy for Diverticulitis". 关于 "憩室炎的开放式与微创紧急结肠切除术 "的信件。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-11-25 DOI: 10.1177/00031348241304003

Uday Singh Dadhwal, Mohamed Arsath Shamsudeen

引用次数: 0

Juan Miguel Acosta: His Revolutionary Contribution to Our Understanding of the Pathophysiology of Gallstone Pancreatitis. 胡安·米格尔·阿科斯塔：他对我们理解胆石性胰腺炎病理生理学的革命性贡献。

IF 1 4区医学

American Surgeon Pub Date : 2025-03-01 Epub Date: 2024-12-02 DOI: 10.1177/00031348241303996

Luigi S Pianetti, Lauren N Smith, Christian M de Virgilio

引用次数: 0