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Traumatic brain injury (TBI) is associated with one-third of all deaths from trauma. Preinjury exposure to cardiovascular drugs may affect TBI outcomes. Angiotensin-converting enzyme inhibitors (ACEIs) exacerbate brain cell damage and worsen functional outcomes in the laboratory setting. β-blockers (BBs), however, appear to be associated with reduced mortality among patients with isolated TBI. Examine the association between preinjury ACEI and BB use and clinical outcome among patients with isolated TBI. A retrospective cohort study of patients age ≥ 40 years admitted to an academic level 1 trauma center with isolated TBI between January 2010 and December 2014 was performed. Isolated TBI was defined as a head Abbreviated Injury Scale (AIS) score ≥ 3, with chest, abdomen, and extremity AIS scores ≤ 2. Preinjury medication use was determined through chart review. All patients with concurrent BB use were initially excluded. In-hospital mortality was the primary measured outcome. Over the 5-year study period, 600 patients were identified with isolated TBI who were naive to BB use. There was significantly higher mortality (P = .04) among patients who received ACEI before injury (10 of 96; 10%) than among those who did not (25 of 504; 5%). A multivariate stepwise logistic regression analysis revealed a threefold increased risk of mortality in the ACEI cohort (P

Background Resident involvement in operations increases operative duration. This study investigated resident impact on operative time for a single general surgeon in an outpatient surgical setting. Methods A retrospective review was performed of index general surgical operations meeting inclusion criteria. Operative duration, patient demographics, 30-day complication/readmission rates, and degree of resident involvement were collected. Results 625 cases were analyzed. Patient demographics were similar for all procedural comparison groups. Operative time increased with resident involvement for each operation—umbilical hernia repairs were associated with a 19% increase (22.3 ± 6.7 versus 26.5 ± 7.5 min, p = 0.002), laparoscopic cholecystectomies demonstrated a 15% increase (25.8 ± 8.7 versus 29.7 ± 10.2 min, p = 0.001), and laparoscopic inguinal hernia repairs demonstrated a 25% increase (32.1 ± 11.3 versus 40.2 ± 8.9 min, p Conclusions Each surgeon must decide if the increase in operative duration caused by resident involvement is justified by the intangible benefits residents provide.

Background Immediately fatal motorcycle crashes have not been well characterized. This study catalogues injuries sustained in fatal motorcycle crashes and assesses the impact of crash conditions on injury patterns. Methods Autopsy records from the office of the medical examiner of Kent County, MI and publicly available traffic reports were queried for information pertaining to motorcyclists declared dead on-scene between January 1, 2007, and December 31, 2016. Results A total of 71 autopsies of on-scene motorcycle crash fatalities were identified. The two most prevalent injuries were traumatic brain injury (TBI) (85%) and rib fractures (79%). The majority of fatalities occurred in daylight hours (54.3%) and in a 55 mph speed limit zone (63.8%). Conclusions This study provides a catalogue of the injuries sustained in immediately fatal motorcycle crashes and the associated conditions. Advocacy efforts that highlight the risks associated with motorcycle riding and that promote safe riding practices are warranted.

Many postoperative concerns after common general operative procedures may be addressed over the phone, thereby saving time and resources for both the patient and surgeon.Over a 6-month time period, patients who underwent laparoscopic cholecystectomy, appendectomy for uncomplicated appendicitis, and inguinal or umbilical hernia repair were mailed an anonymous survey. The primary outcome measure was whether or not patients felt their concerns could have been addressed adequately over the phone in place of an office visit.A total of 1,406 surveys were mailed with 339 responses (24%: 174 laparoscopic cholecystectomy, 83 inguinal hernia, 41 appendectomy, and 41 umbilical hernia). One hundred twelve (33%) felt their concerns could have been addressed adequately over the phone without an office visit. Patients who spent less time with their doctor at the appointment favored telephone follow-up (P.001). Patients undergoing inguinal hernia were less interested in telephone follow-up compared with laparoscopic cholecystectomy (15% vs 41%; P.001), appendectomy (15% vs 34%; P = .018), and umbilical hernia (15% vs 37%; P = .010). Of 66 patients (20%) with self-reported complications, 44% sought care from a healthcare provider other than their primary surgeon.These observations are important for healthcare organizations seeking to maximize surgeon efficiency while improving patient satisfaction.