339 results on '"Norwood, Scott"'
Search Results
102. THE EARLY EFFECTS OF IMPLEMENTING ACS LEVEL II CRITERIA ON TRANSFER AND SURVIVAL RATES AT A RURALLY-BASED COMMUNITY HOSPITAL
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Norwood, Scott, primary, Fernandez, Luis, additional, and Roettger, Richard, additional
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- 1994
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103. TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR DIAGNOSING AORTIC INJURY
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Fernandez, Luis G., primary, Lain, Kristine Y., additional, Messersmith, Richard N., additional, Jairam, Sharanda, additional, Gordon, Robert T., additional, Shah, Manoj R., additional, Roettger, Richard H., additional, and Norwood, Scott H., additional
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- 1994
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104. Blunt Chest Trauma Causing Isolated Single Papillary Muscle Dysfunction and Mitral Regurgitation
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Zabaneh, Raja I., primary, Venkataramani, Arjun, additional, Zabaneh, Sami S., additional, and Norwood, Scott H., additional
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- 1993
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105. Catheter-Related Infections and Associated septicemia
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Norwood, Scott, primary
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- 1992
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106. Blunt Traumatic Occult Pneumothorax: Is Observation Safe?--Results of a Prospective, AAST Multicenter Study.
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Moore, Forrest O., Goslar, Pamela W., Coimbra, Raul, Velmahos, George, Brown, Carlos V. R., Coopwood Jr., Thomas B., Lottenberg, Lawrence, Phelan, Herb A., Bruns, Brandon R., Sherck, John P., Norwood, Scott H., Barnes, Stephen L., Matthews, Marc R., Hoff, William S., de Moya, Marc A., Bansal, Vishal, Hu, Charles K. C., Karmy-Jones, Riyad C., Vinces, Fausto, and Pembaur, Karl
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- 2011
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107. Proximal Ureteral Avulsion from Blunt Abdominal Trauma
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Howerton, Richard A., primary and Norwood, Scott N., additional
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- 1991
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108. Finding Our Way as "Embedded Librarians".
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Love, Mark and Norwood, Scott
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ONLINE information services , *INSTRUCTIONAL systems , *COMPUTER assisted instruction , *GRADUATE study in education , *EDUCATIONAL technology , *LIBRARIANS , *AUTHORSHIP collaboration , *INFORMATION literacy , *UNIVERSITIES & colleges - Abstract
Librarians at the University of Central Missouri were invited to provide research assistance for an online history course delivered through the Blackboard course management system. In consultation with the course instructor, it was decided that we would serve as "embedded librarians," offering online tutorials on library resources and providing research assistance to students as they worked on a short research paper assignment. Our experiences with the course instructor and with students have provided us with some clear insights into the particular challenges that librarians face in an online course environment. [ABSTRACT FROM AUTHOR]
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- 2007
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109. Applying RUSA Guidelines in the Analysis of Chat Reference Transcripts.
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Fu Zhuo, Love, Mark, Norwood, Scott, and Massia, Karla
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LIBRARY reference services ,ACADEMIC libraries ,INFORMATION services ,GOVERNMENT libraries ,PUBLIC universities & colleges ,INFORMATION science ,LIBRARY science - Abstract
The James C. Kirkpatrick Library at Central Missouri State University launched a chat reference service in 2002. To analyze the effectiveness of this service, the transcripts of 100 chat reference sessions were examined. ALA's RUSA Guidelines for Behavioral Performance of Reference and Information Service Providers were used as an evaluation tool. Our analysis has provided insights into the current state of our service and how it can be improved. The analysis also demonstrated that when chat reference sessions are conducted effectively, the user leaves the session with direction toward the information needed and with a positive impression of library service. [ABSTRACT FROM AUTHOR]
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- 2006
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110. An Evaluation of Triple-lumen Catheter Infections Using a Guidewire Exchange Technique
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NORWOOD, SCOTT, primary and JENKINS, GRANT, additional
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- 1990
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111. The Incidence and Complications of Methicillin-Resistant Staphylococcus aureusin a Community Level I Trauma Center
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Cook, Alan, Berne, John, and Norwood, Scott
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Methicillin-resistant Staphylococcus aureus(MRSA) is a growing cause of infections among hospitalized trauma patients. We examined the incidence and infectious consequences of MRSA among trauma patients admitted to our Level I Trauma Center during 24 months.
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- 2009
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112. Ventilatory Support in Patients with ARDS
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Norwood, Scott H. and Civetta, Joseph M.
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This article reviews the most recent literature concerning risk factors leading to the development of the adult respiratory distress syndrome and discusses current pathophysiologic theories. The various ventilatory and pharmacologic therapeutic maneuvers are surveyed, emphasizing the differences between standard forms of therapy in clinical use today and other possible interventions, which, at present, must be considered for use only in experimental protocols.
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- 1985
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113. Defunctionalized jejunal limb for long-term access to the biliary tree.
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OHSIEK, CATHERINE C., NORWOOD, SCOTT H., Ohsiek, C C, and Norwood, S H
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- 1988
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114. Pancreatic pseudocyst with splenic involvement: an uncommon complication of pancreatitis.
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McMAHON, NEIL G., NORWOOD, SCOTT H., SILVA, JOHN S., McMahon, N G, Norwood, S H, and Silva, J S
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- 1988
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115. Subcutaneous Tumors: Incidence of Malignancy
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Crabbe, Mark M., primary, Norwood, Scott H., additional, McClellan, Stephen L., additional, and Dyer, Morgan C. D., additional
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- 1988
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116. Acute respiratory failure: Mortality associated with underlying disease
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COX, STEVEN C., primary, NORWOOD, SCOTT H., additional, and DUNCAN, CHARLES A., additional
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- 1985
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117. Hyperamylasemia due to Poorly Differentiated Adenosquamous Carcinoma of the Ovary
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Norwood, Scott H., primary
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- 1981
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118. THE CLINICAL UTILITY OF CONTINUOUS VENOUS OXIMETRY IN THE CARE OF CRITICALLY ILL PATIENTS
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Nelson, Loren D., primary and Norwood, Scott R., additional
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- 1984
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119. Necrotizing Soft Tissue Infections and Adjunctive Hyperbaric Oxygen
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Norwood, Scott, primary
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- 1988
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120. Necrotizing fasciitis from invasive Phycomycetes
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NEWTON, WILLIAM D., primary, CRAMER, FREDERICK S., additional, and NORWOOD, SCOTT H., additional
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- 1987
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121. Prospective study of catheter-related infection of ring prolonged arterial catheterization
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NORWOOD, SCOTT H., primary, CORMIER, BARBARA, additional, McMAHON, NEIL G., additional, MOSS, ALECIA, additional, and MOORE, VICKI, additional
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- 1988
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122. Early Treatment of Adult Respiratory Distress Syndrome with Positive End-expiratory Pressure
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Crabbe, Mark M., primary, Norwood, Scott H., additional, and Fontenelle, Larry J., additional
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- 1988
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123. Mallory-Weiss Syndrome in Children
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COUNTRYMAN, DAVID, primary, NORWOOD, SCOTT, additional, and ANDRASSY, RICHARD J., additional
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- 1982
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124. Primary Hyperparathyroidism in Children: A Review
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Norwood, Scott, primary and Andrassy, Richard J., additional
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- 1983
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125. Continuous elemental enteral alimentation in children with Crohn's disease and growth failure
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Norwood, Scott, primary
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- 1981
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126. Abdominal CT Seanning in Critically III Surgical Patients
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NORWOOD, SCOTT H., primary and CIVETTA, JOSEPH M., additional
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- 1985
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127. Conservative Treatment for Adenocarcinoma of the Pancreas
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McMahon, Neil G., primary, Norwood, Scott H., additional, Lamb, Johnny M., additional, Fontenelle, Larry J., additional, Smith, Donna K., additional, and Patrissi, Geoffrey A., additional
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- 1989
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128. Outpatient Lateral Internal Subcutaneous Sphincterotomy: A Safe and Effective Procedure
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Norwood, Scott H., primary and Biehl, Albert G., additional
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- 1981
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129. Trendelenburg Positioning to Correct Hypoxemia from Chest Trauma
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Marcum, Robert E, primary and Norwood, Scott H., additional
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- 1984
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130. Purulent Rhinosinusitis is Also a Cause of Sepsis in Critically III Patients
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Norwood, Scott H., primary
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- 1988
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131. Shattered Kidney After Renal Trauma: Should It Be Classified As an American Association for the Surgery of Trauma Grade V Injury?
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Keihani, Sorena, Rogers, Douglas M., Wang, Sherry S., Gross, Joel A., Joyce, Ryan P., Hagedorn, Judith C., Majercik, Sarah, Sensenig, Rachel L., Schwartz, Ian, Erickson, Bradley A., Moses, Rachel A., Selph, J. Patrick, Norwood, Scott, Smith, Brian P., Dodgion, Christopher M., Mukherjee, Kaushik, Breyer, Benjamin N., Baradaran, Nima, and Myers, Jeremy B.
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TRAUMA surgery , *NEPHRECTOMY , *KIDNEYS , *CROSS-sectional imaging , *TRAUMA centers , *COMPUTED tomography - Abstract
To study the prevalence and management of shattered kidney and to evaluate if the new description of "loss of identifiable renal anatomy" in the 2018 American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) would improve the ability to predict bleeding control interventions. We used high-grade renal trauma data from 21 Level-1 trauma centers from 2013 to 2018. Initial CT scans were reviewed to identify shattered kidneys, defined as a kidney having ≥3 parenchymal fragments displaced by blood or fluid on cross-sectional imaging. We further categorized patients with shattered kidney in two models based on loss of identifiable renal parenchymal anatomy and presence or absence of vascular contrast extravasation (VCE). Bleeding interventions were compared between the groups. From 861 high-grade renal trauma patients, 41 (4.8%) had shattered kidney injury. 25 (61%) underwent a bleeding control intervention including 18 (43.9%) nephrectomies and 11 (26.8%) angioembolizations. 18 (41%) had shattered kidney with "loss of identifiable parenchymal renal anatomy" per 2018 AAST OIS (model-1). 28 (68.3%) had concurrent VCE (model-2). Model-2 had a statistically significant improvement in area under the curve over model-1 in predicting bleeding interventions (0.75 vs 0.72; P =.01). Shattered kidney is associated with high rates of active bleeding, urinary extravasation, and interventions including nephrectomy. The definition of shattered kidney is vague and subjective and our definition might be simpler and more reproducible. Loss of identifiable renal anatomy per the 2018 AAST OIS did not provide better distinction for bleeding control interventions over presence of VCE. [ABSTRACT FROM AUTHOR]
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- 2023
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132. THE WORST DAY I EVER HAD SCOTT NORWOOD HAD TO MAKE A BIG KICK FOR THE BILLS TO WIN SUPER BOWL XXV -- BUT HE MISSED.
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Norwood, Scott
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- 1992
133. PRESIDENT'S MESSAGE.
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Norwood Scott, W.
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WEB development ,CANOES & canoeing ,ASSOCIATIONS, institutions, etc. - Abstract
The article presents a letter from the president of the American Whitewater on recent development of the organization. The organization is planning to roll out its new website in the first quarter of 2014. It is stated that the organization's Our Development Committee has created the Enduring Rivers Circle, a legacy giving fund, chaired by Chris Hest.
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- 2013
134. Achieving Health Equity and Continuity of Care for Black and Latinx People Living With HIV.
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Loeb, Tamra Burns, Banks, Devin, Ramm, Kate, Viducich, Isabella, Beasley, Quonta, Barron, Juan, Chen, Elizabeth Lee, Norwood-Scott, Enricka, Fuentes, Kimberly, Zhang, Muyu, Brown, Arleen F., Wyatt, Gail E., and Hamilton, Alison B.
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PREVENTION of epidemics , *PSYCHOLOGY of Black people , *HIV-positive persons , *EVALUATION of medical care , *RACISM , *STRATEGIC planning , *HEALTH services accessibility , *SOCIAL determinants of health , *SUBSTANCE abuse , *HISPANIC Americans , *DRUG overdose , *TRANSITIONAL care , *DIGITAL health , *PUBLIC health , *MEDICAL care , *CONTINUUM of care , *HARM reduction , *PSYCHOSOCIAL factors , *DRUGS , *HEALTH equity , *ETHNIC groups , *PATIENT compliance , *COVID-19 pandemic - Abstract
The authors consider how the care experiences of African Americans and Latinx people living with HIV (PLWH) could inform culturally relevant, multilevel strategies for managing public health crises like COVID-19 in the context of structural racism and bolster care for PLWH facing new health threats. Topics include conditions of the COVID-19 pandemic, public health strategies for HIV to COVID-19, and continuity of care and digital inclusion.
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- 2023
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135. 128 - Vascular Catheter–Related Infections
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Norwood, Scott and Cook, Alan D.
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136. Tracheal, Laryngeal, and Oropharyngeal Injuries
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Fernandez, Luis G., Norwood, Scott H., and Berne, John D.
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137. Contributors
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Abraham, Edward, Abrams, Peter, Abu-Elmagd, Kareem, Abu-Omar, Yasir, Agustí, Carlos, Aird, William C., Alapat, Philip, Al-Khafaji, Ali H., Angaramo, Gustavo G., Angus, Derek C., Antoniadou, Anastasia, Anupam, Anupam, Argent, Andrew C., Arnold, John H., Arroyo, Anna, Ashwal, Stephen, Astiz, Mark E., Azoulay, Elie, Bajwa, Omer A., Baldea, Anthony, Baldisseri, Marie R., Balogh, Zsolt J., Balogun, Rasheed Abiodun, Banerjee, Arna, Barie, Philip S., Barrett, Brendan, Bartlett, Robert, Bartlett, John G., Bassi, Gianluigi Li, Bassin, Sarice L., Bastarache, Julie A., Bauer, Colin, Bausch, Daniel G., Bayýr, Hülya, Bearden, David T., Beilman, Gregory J., Bellomo, Rinaldo, Bennett, E. David, Bernard, Gordon R., Bhama, Jay K., Bierens, Joost J.L.M., Biffl, Walter L., Bleck, Thomas P., Bledsoe, Thomas A., Bloch, Karen C., Bloos, Frank, Bohn, Desmond, Bouchard, Nicole C., Boujoukos, Arthur J., Brady, William J., Brimioulle, Serge, Brooks, Daniel E., Brundage, Richard C., Burns, Jeffrey P., Cabello, Belén, Calhoun, Karen H., Callaway, Clifton W., Calverley, Peter M.A., Camm, John, Cappelletty, Diane M., Carcillo, Joseph A., Carlese, Anthony J., Carlos-Puyana, Juan, Carnevale, Franco A., Chan, Edward D., Chawla, Sanjay, Chelluri, Lakshmipathi, Chen, David C., Chevrier, Annie S., Cho, Su Min, Clark, Robert S.B., Coady, Michael A., Cohn, Stephen M., Cook, Alan D., Cook, Deborah J., Cooney, Robert N., Corbridge, Susan J., Corbridge, Thomas C., Corwin, Howard L., Crowther, Mark A., Cunha, Burke A., Cunha, Cheston B., Curtis, J. Randall, D’Intini, Vincenzo, Daeihagh, Pirouz, Darby, Joseph M., Dargin, James M., Darmon, Michaël, Dasta, Joseph F., Davies, John D., Derlet, Robert W., Dershwitz, Mark, de Smet, Anne Marie G.A., Dhand, Monica, Dhillon, Anahat, Dhupar, Rajeev, Diringer, Michael N., Doelken, Peter, Donahoe, Michael, Donahue, Timothy R., Dries, David J., DuBose, Thomas D., Jr., Duthie, Susan, Edwards, Randy, Eggimann, Philippe, Elhassan, Waleed A., Ely, E. Wesley, Emeriaud, Guillaume, Eschenauer, Gregory A., Ettinger, Joel H., Ettinger, Joshua H., Evans, David Clay, Everson, Gregory T., Exner, Derek V., Falk, Ronald J., Farrar, Jeremy, Farwell, Alan P., Felmet, Kathryn, Ferguson, Niall D., Ferrer, Miguel, Fink, Mitchell P., Fink, Ericka L., Fish, Douglas N., Florescu, Diana F., Fortune, Brett E., Freeman, Bradley D., Froberg, Blake, Fung, John J., Furbee, Brent, Gamelli, Richard L., Gazmuri, Raúl J., Geelkerken, Robert H., Gehr, Todd W.B., Gentile, Michael A., George, M. Patricia, Gerlach, Herwig, Ghobrial, R. Mark, Giamarellou, Helen, Ginsberg, Fredric, Gleason, Thomas G., Goldstein, Jacques P., Gomez, Hernando, Burroughs, Sherilyn Gordon, Gradon, Jeremy David, Graves, Cornelia R., Gregoretti, Cesare, Groeger, Jeffrey S., Grounds, R. Michael, Gubbins, Paul O., Gunnerson, Kyle J., Habib, Fahim A., Halperin, Mitchell L., Hartman, Mary E., Harvey, Maurene A., Hassan, Moustafa A., Hayashi, Yoshiro, Hazelzet, Jan A., Heard, Stephen O., Hébert, Paul C., Hermsen, Elizabeth D., Heyland, Daren K., Hiatt, Jonathan R., Hickey, Robert W., Hien, Tran Tinh, Higgins, Thomas L., Hill, Nicholas S., Hojman, Horacio, Hollenberg, Steven M., Huggins, J. Terrill, Huang, David T., Hughes, Christopher G., Hull, Russell D., Isaac, Margaret, Isbister, James P., Jastremski, Connie, Jenkins, Larry, Jodka, Paul, Johnson, Robert G., Jorens, Philippe G., Juel, Vern C., Jung, Rose, Kahl, Christina R., Kalil, Andre C., Kaluski, Edo, Kamel, Kamel S., Kane-Gill, Sandra, Kanne, Jeffrey P., Karlin, Lionel, Kartalija, Marinka, Kasiewicz, James, Katz, Kenneth D., Kaufman, David, Kellum, John A., Kingston, Rick, Kirton, Orlando C., Kleinschmidt, Kurt, Knight, Jason, Kochanek, Patrick M., Kofke, W. Andrew, Kolkman, Jeroen J., Kormos, Robert L., Kozar, Rosemary A., Kramer, David J., Kreit, John W., Kruse, James A., Kumar, Anand, Kvetan, Vladimir, Lacroix, Jacques, Lebuffe, Gilles, Lemiale, Virginie, Leung, Angela M., Leung, Sharon, Levi, Allan D., Levin, Phillip D., Levy, Mitchell M., Liang, Mah Chou, Liebman, Scott, Linas, Stuart L., Lip, Gregory Y.H., Lipsett, Pamela A., Lisbon, Alan, Lucena, Carmen, Maas, Andrew I.R., MacIntyre, Neil R., Macrae, Duncan, Maisch, Bernhard, Malik, Amer M., Mancebo, Jordi, Mann, Henry J., Manocha, Sanjay, Manzo-Silberman, Stéphane, Marik, Paul E., Marini, John J., Marion, Donald W., Martin, Steven J., Martinez-Camacho, Alvaro, Mattingly, Anne Marie, Matzke, Gary R., Max, Adeline, Mazariegos, George V., Mazzarelli, Joanne, McClave, Stephen A., McEnaney, Ryan M., McIllwaine, John K., McNutt, Michelle K., Mehta, Sangeeta, Mesotten, Dieter, Meyer, Kimberly S., Michelson, David J., Minha, Saar, Mirski, Marek A., Mohammad, Rima A., Monnet, Xavier, Moore, Frederick A., Moore, Laura J., Moreau, Anne-Sophie, Moreau, Delphine, Morris, Alison, Morris, Amy E., Mourvillier, Bruno, Munger, Mark A., Murugan, Raghavan, Muth, Claus-Martin, Naber, Kurt G., Napolitano, Lena M., Nasraway, Stanley A., Navarro, Jovany Cruz, Nelson, Lewis S., Niederman, Michael S., Njoku, Jessica C., Norwood, Scott, Ochoa, Juan B., Okusa, Mark D., Olsen, Keith M., Opal, Steven M., Orlowski, James P., Otto, Catherine M., Oudemans-van Straaten, Heleen M., Pandharipande, Pratik P., Parrillo, Joseph E., Paterson, David L., Paulin, Frédéric L., Peitzman, Andrew B., Penoyer, Daleen Aragon, Peterson, Bradley, Pineo, Graham F., Pinsky, Michael R., Piper, Greta, Pittet, Didier, Plum, Fred, Pollack, Murray M., Ponce, Lucido L., Pousman, Robert, Pronovost, Peter J., Radwański, Przemyslaw B., Rainey, Thomas G., Rajan, Thomas, Ranieri, Vito Marco, Reinhart, Konrad, Reyes, Jorge, Rhodes, Andrew, Ricci, Zaccaria, Richard, Christian, Richards, John R., Riordan, John, Ristic, Arsen D., Rizoli, Sandro, Robertson, Claudia S., Robin, Emmanuel, Roche-Campo, Ferran, Rogers, Paul, Ronco, Claudio, Rotschafer, John C., Rubenfeld, Gordon D., Ruppel, Randall A., Russo, Laura T., Rusyniak, Daniel E., Sahn, Steven A., Salgado, Juan C., Santonocito, Cristina, Sappington, Penny Lynn, Sarko, John, Savel, Richard H., Savelieva, Irina, Schlemmer, Benoit, Schofield, Minka, Schonder, Kristine S., Schoolwerth, Anton C., Schrier, Robert W., Schulman, Carl, Schwarz, Evan, Scifres, Aaron M., Seger, Donna L., Seguin, Amelie, Sellke, Frank W., Shahul, Sajid, Shamseddin, M. Khaled, Shank, Erik S., Shantsila, Eduard, Sharma, Kapil, Sheridan, Robert L., Shiloh, Ariel L., Skaar, Debra J., Slonim, Anthony D., Smith Jacobs, Teresa L., Solís-Muñoz, Pablo, Sosin, Michael D., Sprung, Charles L., Squadrone, Vincenzo, Starzl, Thomas E., Steinberg, Steven M., Steinhorn, David M., Stern, Eric J., Stewart, Thomas E., Stocchetti, Nino, Stübgen, Joerg-Patrick, Subramanian, Sanjay, Szawlewicz, Justin, Szpilman, David, Taggart, David P., Talmor, Daniel, Teboul, Jean-Louis, Teitelbaum, Isaac, Thom, Stephen R., Thwaites, C. Louise, Timsit, Jean-François, Tinmouth, Alan, Tisherman, Samuel A., Todd, S. Rob, Torres, Antoni, Truog, Robert D., Turner, Krista, Tzeng, Edith, Uriel, Nir, Vallet, Benoit, Van den Berghe, Greet, van Heerden, P. Vernon, Van Tassell, Benjamin W., Eynden, Frédéric Vanden, Varenne, Olivier, Venkataraman, Ramesh, Ventre, Kathleen M., Vered, Zvi, Vincent, Jean-Louis, Vitarbo, Elizabeth A., Voigt, Louis, Wagenlehner, Florian M.E., Wai, Christina J., Walley, Keith R., Ward, Nicholas S., Ware, Lorraine B., Weber, Robert J., Wechsler, Lawrence R., Weill, David, Weinert, Craig R., Wendon, Julia, Wolff, Michel, Wrigley, Benjamin, Wunderink, Richard G., Yen, Lam M., Zanotti-Cavazzoni, Sergio L., Zazulia, Allyson R., Zimmerman, Janice, and Zingg, Walter
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138. Proposed revision of the American Association for Surgery of Trauma Renal Organ Injury Scale: Secondary analysis of the Multi-institutional Genitourinary Trauma Study.
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Matta R, Keihani S, Hebert KJ, Horns JJ, Nirula R, McCrum ML, McCormick BJ, Gross JA, Joyce RP, Rogers DM, Wang SS, Hagedorn JC, Selph JP, Sensenig RL, Moses RA, Dodgion CM, Gupta S, Mukherjee K, Majercik S, Broghammer JA, Schwartz I, Elliott SP, Breyer BN, Baradaran N, Zakaluzny S, Erickson BA, Miller BD, Askari R, Carrick MM, Burks FN, Norwood S, and Myers JB
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- Humans, Male, Female, Retrospective Studies, Adult, Middle Aged, United States, Trauma Centers statistics & numerical data, Hemorrhage etiology, Hemorrhage therapy, Hemorrhage diagnosis, Wounds, Nonpenetrating diagnosis, Wounds, Nonpenetrating surgery, Wounds, Nonpenetrating therapy, Wounds, Nonpenetrating complications, Tomography, X-Ray Computed, Kidney injuries, Injury Severity Score
- Abstract
Background: This study updates the American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for renal trauma using evidence-based criteria for bleeding control intervention., Methods: This was a secondary analysis of a multicenter retrospective study including patients with high-grade renal trauma from seven level 1 trauma centers from 2013 to 2018. All eligible patients were assigned new renal trauma grades based on revised criteria. The primary outcome used to measure injury severity was intervention for renal bleeding. Secondary outcomes included intervention for urinary extravasation, units of packed red blood cells transfused within 24 hours, and mortality. To test the revised grading system, we performed mixed-effect logistic regression adjusted for multiple baseline demographic and trauma covariates. We determined the area under the curve (AUC) to assess accuracy of predicting bleeding interventions from the revised grading system and compared this to 2018 AAST OIS., Results: Based on the 2018 OIS grading system, we included 549 patients with AAST grades III to V injuries and computed tomography scans (III, 52% [n = 284]; IV, 45% [n = 249]; and V, 3% [n = 16]). Among these patients, 89% experienced blunt injury (n = 491), and 12% (n = 64) underwent intervention for bleeding. After applying the revised grading criteria, 60% (n = 329) of patients were downgraded, and 4% (n = 23) were upgraded; 2.8% (n = 7) downgraded from grade V to IV, and 69.5% (n = 173) downgraded from grade IV to III. The revised renal trauma grading system demonstrated improved predictive ability for bleeding interventions (2018 AUC, 0.805; revised AUC, 0.883; p = 0.001) and number of units of packed red blood cells transfused. When we removed urinary injury from the revised system, there was no difference in its predictive ability for renal hemorrhage intervention., Conclusion: A revised renal trauma grading system better delineates the need for hemostatic interventions than the current AAST OIS renal trauma grading system., Level of Evidence: Diagnostic Test/Criteria; Level III., (Copyright © 2024 American Association for the Surgery of Trauma.)
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- 2024
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139. Increasing Urban African American Women's Readiness for Pre-exposure Prophylaxis: A Pilot Study of the Women Prepping for PrEp Plus Program (WP3+).
- Author
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Wyatt GE, Norwood-Scott E, Cooley-Strickland M, Zhang M, Smith-Clapham A, Jordan W, Liu H, and Hamilton AB
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- Humans, Female, Pilot Projects, Adult, Patient Acceptance of Health Care, Sexual Behavior, Social Support, Middle Aged, Risk-Taking, Risk Reduction Behavior, Surveys and Questionnaires, Young Adult, Sexual Partners, Qualitative Research, Pre-Exposure Prophylaxis, Black or African American psychology, Black or African American statistics & numerical data, HIV Infections prevention & control, HIV Infections ethnology, Health Knowledge, Attitudes, Practice, Urban Population, Anti-HIV Agents therapeutic use, Anti-HIV Agents administration & dosage
- Abstract
Background: African American women are disproportionately at risk for HIV infection. To increase women's readiness to consider taking pre-exposure prophylaxis (PrEP), we conducted a pilot study of Women Prepping for PrEP Plus (WP3+). Adapted from an evidence-based HIV risk reduction intervention for African American couples who are HIV-serodiscordant, WP3+ is a group-based culturally congruent program designed for African American women without HIV., Methods: Women were screened for eligibility; if eligible, they were invited to participate in the four-session WP3+ group. Participants completed surveys at baseline (n = 47) and post-implementation (n = 28); surveys assessed demographics, HIV and PrEP knowledge, depression and posttraumatic stress (PTS) symptoms, substance use, sexual risk behaviors, health care-related discrimination, and social support. In a process evaluation, a subset of women completed qualitative interviews at baseline (n = 35) and post-implementation (n = 18); the interviews were designed to converge with (e.g., on HIV and PrEP knowledge) and expand upon (e.g., unmeasured perceived impacts of WP3+) quantitative measures. To triangulate with the quantitative data, deductive qualitative analysis concentrated on women's knowledge and awareness of PrEP and HIV, their relationship dynamics and challenges, and their considerations (e.g., barriers, facilitators) related to taking PrEP; inductive analysis focused on women's experiences in the intervention., Results: Participants in the WP3+ intervention reported: improved proportion of condom use in the past 90 days (p < .01) and in a typical week (p < .05); reduced PTS symptoms (p < .05); increased HIV knowledge (p < .0001) and awareness of PrEP (p < .001); and greater consideration of using PrEP (p < .001). In interviews, participants expressed not only increased knowledge but also appreciation for learning how to protect themselves against HIV, communicate with their partners, and take charge of their health, and they expressed greater receptiveness to using PrEP as a result of the knowledge and skills they gained., Conclusions: The WP3+ pilot study demonstrated preliminary efficacy and acceptability as an HIV-prevention program for African American women. A controlled trial is needed to confirm its efficacy for increasing PrEP use among African American women., (Copyright © 2023. Published by Elsevier Inc.)
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- 2024
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140. Synergistic clinical application of synthetic electrospun fiber wound matrix in the management of a complex traumatic wound: degloving left groin and thigh auger injury.
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Fernandez LG, Orsi C, Okeoke B, Moudy P, Critelli PA, Norwood S, Matthews MR, Kim PJ, MacEwan M, and Sallade E
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- Humans, Male, Treatment Outcome, Soft Tissue Injuries surgery, Adult, Wound Healing physiology, Skin Transplantation methods, Groin, Degloving Injuries surgery, Thigh
- Abstract
Background: Managing complex traumatic soft tissue wounds involving a large surface area while attempting to optimize healing, avoid infection, and promote favorable cosmetic outcomes is challenging. Regenerative materials such as ECMs are typically used in wound care to enhance the wound healing response and proliferative phase of tissue formation., Case Report: The case reported herein is an example of the efficacious use of an SEFM in the surgical management of a large complex traumatic wound involving the left lower extremity and lower abdominal region. The wound bed was successfully prepared for skin grafting over an area of 1200 cm2, making this among the largest applications of the SEFM reported in the literature., Conclusion: This case report demonstrates the clinical versatility of the SEFM and a synergistic approach to complex traumatic wound care. The SEFM was successfully used to achieve tissue granulation for a successful skin graft across a large surface in an anatomic region with complex topography.
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- 2024
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141. Failure rates of nonoperative management of low-grade splenic injuries with active extravasation: an Eastern Association for the Surgery of Trauma multicenter study.
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Spoor K, Cull JD, Otaibi BW, Hazelton JP, Chipko J, Reynolds J, Fugate S, Pederson C, Zier LB, Jacobson LE, Williams JM, Easterday TS, Byerly S, Mentzer C, Hawke E, Cullinane DC, Ontengco JB, Bugaev N, LeClair M, Udekwu P, Josephs C, Noorbaksh M, Babowice J, Velopulos CG, Urban S, Goldenberg A, Ghobrial G, Pickering JM, Quarfordt SD, Aunchman AF, LaRiccia AK, Spalding C, Catalano RD, Basham JE, Edmundson PM, Nahmias J, Tay E, Norwood SH, Meadows K, Wong Y, and Hardman C
- Abstract
Objectives: There is little evidence guiding the management of grade I-II traumatic splenic injuries with contrast blush (CB). We aimed to analyze the failure rate of nonoperative management (NOM) of grade I-II splenic injuries with CB in hemodynamically stable patients., Methods: A multicenter, retrospective cohort study examining all grade I-II splenic injuries with CB was performed at 21 institutions from January 1, 2014, to October 31, 2019. Patients >18 years old with grade I or II splenic injury due to blunt trauma with CB on CT were included. The primary outcome was the failure of NOM requiring angioembolization/operation. We determined the failure rate of NOM for grade I versus grade II splenic injuries. We then performed bivariate comparisons of patients who failed NOM with those who did not., Results: A total of 145 patients were included. Median Injury Severity Score was 17. The combined rate of failure for grade I-II injuries was 20.0%. There was no statistical difference in failure of NOM between grade I and II injuries with CB (18.2% vs 21.1%, p>0.05). Patients who failed NOM had an increased median hospital length of stay (p=0.024) and increased need for blood transfusion (p=0.004) and massive transfusion (p=0.030). Five patients (3.4%) died and 96 (66.2%) were discharged home, with no differences between those who failed and those who did not fail NOM (both p>0.05)., Conclusion: NOM of grade I-II splenic injuries with CB fails in 20% of patients., Level of Evidence: IV., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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142. A Novel Rabbit Model of Retained Hemothorax with Pleural Organization.
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De Vera CJ, Emerine RL, Girard RA, Sarva K, Jacob J, Azghani AO, Florence JM, Cook A, Norwood S, Singh KP, Komissarov AA, Florova G, and Idell S
- Subjects
- Animals, Female, Male, Humans, Rabbits, Pleura diagnostic imaging, Thorax, Blood Donors, Hemothorax diagnostic imaging, Hemothorax etiology, Lagomorpha
- Abstract
Retained hemothorax (RH) is a commonly encountered and potentially severe complication of intrapleural bleeding that can organize with lung restriction. Early surgical intervention and intrapleural fibrinolytic therapy have been advocated. However, the lack of a reliable, cost-effective model amenable to interventional testing has hampered our understanding of the role of pharmacological interventions in RH management. Here, we report the development of a new RH model in rabbits. RH was induced by sequential administration of up to three doses of recalcified citrated homologous rabbit donor blood plus thrombin via a chest tube. RH at 4, 7, and 10 days post-induction (RH4, RH7, and RH10, respectively) was characterized by clot retention, intrapleural organization, and increased pleural rind, similar to that of clinical RH. Clinical imaging techniques such as ultrasonography and computed tomography (CT) revealed the dynamic formation and resorption of intrapleural clots over time and the resulting lung restriction. RH7 and RH10 were evaluated in young (3 mo) animals of both sexes. The RH7 recapitulated the most clinically relevant RH attributes; therefore, we used this model further to evaluate the effect of age on RH development. Sanguineous pleural fluids (PFs) in the model were generally small and variably detected among different models. The rabbit model PFs exhibited a proinflammatory response reminiscent of human hemothorax PFs. Overall, RH7 results in the consistent formation of durable intrapleural clots, pleural adhesions, pleural thickening, and lung restriction. Protracted chest tube placement over 7 d was achieved, enabling direct intrapleural access for sampling and treatment. The model, particularly RH7, is amenable to testing new intrapleural pharmacologic interventions, including iterations of currently used empirically dosed agents or new candidates designed to safely and more effectively clear RH.
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- 2023
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143. Hospitalization and readmission after single-level fall: a population-based sample.
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Cook A, Swindall R, Spencer K, Wadle C, Cage SA, Mohiuddin M, Desai Y, and Norwood S
- Abstract
Background: Single-level falls (SLFs) in the older US population is a leading cause of hospital admission and rates are increasing. Unscheduled hospital readmission is regarded as a quality-of-care indication and a preventable burden on healthcare systems. We aimed to characterize the predictors of 30-day readmission following admission for SLF injuries among patients 65 years and older., Methods: We conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2019. Included patients were 65 and older, admitted emergently following a SLF with a primary injury diagnosis. Hierarchical logit regression was used to model factors associated with readmission within 30 days of discharge., Results: Of 1,338,905 trauma patients, 65 years or older, 61.3% had a single-level fall as the mechanism of injury. Among fallers, the average age was 81.1 years and 68.5% were female. SLF patients underwent more major therapeutic procedures (56.3% vs. 48.2%), spent over 2 million days in the hospital and incurred total charges of over $28 billion annually. Over 11% of SLF patients were readmitted within 30 days of discharge. Increasing income had a modest effect, where the highest zip code quartile was 9% less likely to be readmitted. Decreasing population density had a protective effect of readmission of 16%, comparing Non-Urban to Large Metropolitan. Transfer to short-term hospital, brain and vascular injuries were independent predictors of 30-day readmission in multivariable analysis (OR 2.50, 1.31, and 1.42, respectively). Palliative care consultation was protective (OR 0.41). The subsequent hospitalizations among those 30-day readmissions were primarily emergent (92.9%), consumed 260,876 hospital days and a total of $2.75 billion annually., Conclusions: SLFs exact costs to patients, health systems, and society. Transfer to short-term hospitals at discharge, along with brain and vascular injuries were strong predictors of 30-day readmission and warrant mitigation strategy development with consideration of expanded palliative care consultation., (© 2023. Columbia University Center for Injury Epidemiology and Prevention.)
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- 2023
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144. Does lower extremity fracture fixation technique influence neurologic outcomes in patients with traumatic brain injury? The EAST Brain vs. Bone multicenter trial.
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Ghneim M, Kufera J, Zhang A, Penaloza-Villalobos L, Swentek L, Watras J, Smith A, Hahn A, Rodriguez Mederos D, Dickhudt TJ, Laverick P, Cunningham K, Norwood S, Fernandez L, Jacobson LE, Williams JM, Lottenberg L, Azar F, Shillinglaw W, Slivinski A, Nahmias J, Donnelly M, Bala M, Egodage T, Zhu C, Udekwu PO, Norton H, Dunn JA, Baer R, McBride K, Santos AP, Shrestha K, Metzner CJ, Murphy JM, Schroeppel TJ, Stillman Z, O'Connor R, Johnson D, Berry C, Ratner M, Reynolds JK, Humphrey M, Scott M, Hickman ZL, Twelker K, Legister C, Glass NE, Siebenburgen C, Palmer B, Semon GR, Lieser M, McDonald H, Bugaev N, LeClair MJ, and Stein D
- Subjects
- Humans, Adolescent, Fracture Fixation, Brain, Lower Extremity surgery, Treatment Outcome, Retrospective Studies, Leg Injuries, Fracture Fixation, Intramedullary methods, Tibial Fractures complications, Tibial Fractures surgery, Brain Injuries, Traumatic complications, Brain Injuries, Traumatic surgery
- Abstract
Objective: This study aimed to determine whether lower extremity fracture fixation technique and timing (≤24 vs. >24 hours) impact neurologic outcomes in TBI patients., Methods: A prospective observational study was conducted across 30 trauma centers. Inclusion criteria were age 18 years and older, head Abbreviated Injury Scale (AIS) score of >2, and a diaphyseal femur or tibia fracture requiring external fixation (Ex-Fix), intramedullary nailing (IMN), or open reduction and internal fixation (ORIF). The analysis was conducted using analysis of variamce, Kruskal-Wallis, and multivariable regression models. Neurologic outcomes were measured by discharge Ranchos Los Amigos Revised Scale (RLAS-R)., Results: Of the 520 patients enrolled, 358 underwent Ex-Fix, IMN, or ORIF as definitive management. Head AIS was similar among cohorts. The Ex-Fix group experienced more severe lower extremity injuries (AIS score, 4-5) compared with the IMN group (16% vs. 3%, p = 0.01) but not the ORIF group (16% vs. 6%, p = 0.1). Time to operative intervention varied between the cohorts with the longest time to intervention for the IMN group (median hours: Ex-Fix, 15 [8-24] vs. ORIF, 26 [12-85] vs. IMN, 31 [12-70]; p < 0.001). The discharge RLAS-R score distribution was similar across the groups. After adjusting for confounders, neither method nor timing of lower extremity fixation influenced the discharge RLAS-R. Instead, increasing age and head AIS score were associated with a lower discharge RLAS-R score (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.002-1.03 and OR, 2.37; 95% CI, 1.75-3.22), and a higher Glasgow Coma Scale motor score on admission (OR, 0.84; 95% CI, 0.73-0.97) was associated with higher RLAS-R score at discharge., Conclusion: Neurologic outcomes in TBI are impacted by severity of the head injury and not the fracture fixation technique or timing. Therefore, the strategy of definitive fixation of lower extremity fractures should be dictated by patient physiology and the anatomy of the injured extremity and not by the concern for worsening neurologic outcomes in TBI patients., Level of Evidence: Prognostic and Epidemiological; Level III., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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145. Grade V renal trauma management: results from the multi-institutional genito-urinary trauma study.
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Hakam N, Keihani S, Shaw NM, Abbasi B, Jones CP, Rogers D, Wang SS, Gross JA, Joyce RP, Hagedorn JC, Selph JP, Sensenig RL, Moses RA, Dodgion CM, Gupta S, Mukherjee K, Majercik S, Smith BP, Broghammer JA, Schwartz I, Baradaran N, Zakaluzny SA, Erickson BA, Miller BD, Askari R, Carrick MM, Burks FN, Norwood S, Myers JB, and Breyer BN
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- Humans, Injury Severity Score, Kidney surgery, Nephrectomy, Retrospective Studies, Urogenital System injuries, Adult, Middle Aged, Multiple Trauma, Trauma Centers
- Abstract
Purpose: To investigate management trends for American Association for the Surgery of Trauma (AAST) grade V renal trauma with focus on non-operative management., Methods: We used prospectively collected data as part of the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). We included patients with grade V renal trauma according to the AAST Injury Scoring Scale 2018 update. All cases submitted by participating centers with radiology images available were independently reviewed to confirm renal trauma grade. Management was classified as expectant, conservative (minimally invasive, endoscopic or percutaneous procedures), or operative (renal-related surgery)., Results: Eighty patients were included, 25 of whom had complete imaging and had independent confirmation of AAST grade V renal trauma. Median age was 35 years (Interquartile range (IQR) 25-50) and 23 (92%) had blunt trauma. Ten patients (40%) were managed operatively with nephrectomy. Conservative management was used in nine patients (36%) of which six received angioembolization and three had a stent or drainage tube placed. Expectant management was followed in six (24%) patients. Transfusion requirements were progressively higher with groups requiring more aggressive treatment, and injury characteristics differed significantly across management groups in terms of hematoma size and laceration size. Vascular contrast extravasation was more likely in operatively managed patients though a statistically significant association was not found., Conclusion: Successful use of nonoperative management for grade V injuries is used for a substantial subset of patients. Lower transfusion requirement and less severe injury radiologic phenotype appear to be important characteristics delineating this group., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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146. An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients.
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Taghavi S, Maher Z, Goldberg AJ, Chang G, Mendiola M, Anderson C, Ninokawa S, Tatebe LC, Maluso P, Raza S, Keating JJ, Burruss S, Reeves M, Coleman LE, Shatz DV, Goldenberg-Sandau A, Bhupathi A, Spalding MC, LaRiccia A, Bird E, Noorbakhsh MR, Babowice J, Nelson MC, Jacobson LE, Williams J, Vella M, Dellonte K, Hayward TZ 3rd, Holler E, Lieser MJ, Berne JD, Mederos DR, Askari R, Okafor BU, Haut ER, Etchill EW, Fang R, Roche SL, Whittenburg L, Bernard AC, Haan JM, Lightwine KL, Norwood SH, Murry J, Gamber MA, Carrick MM, Bugaev N, Tatar A, Duchesne J, and Tatum D
- Subjects
- Adult, Emergency Medical Services methods, Female, Hospital Mortality, Humans, Injury Severity Score, Logistic Models, Male, Middle Aged, Prospective Studies, United States epidemiology, Urban Health Services, Wounds, Gunshot therapy, Wounds, Penetrating therapy, Young Adult, Emergency Medical Services statistics & numerical data, Trauma Centers statistics & numerical data, Wounds, Gunshot mortality, Wounds, Penetrating mortality
- Abstract
Background: Prehospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHPs on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged. We hypothesized that patients without PHPs would have better outcomes than those undergoing PHP., Methods: This was an Eastern Association for the Surgery of Trauma-sponsored, multicenter, prospective, observational trial of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. The impact of PHPs and transport mechanism on in-hospital mortality were examined., Results: Of 2,284 patients included, 1,386 (60.7%) underwent PHP. The patients were primarily Black (n = 1,527, 66.9%) males (n = 1,986, 87.5%) injured by gunshot wound (n = 1,510, 66.0%) with 34.1% (n = 726) having New Injury Severity Score of ≥16. A total of 1,427 patients (62.5%) were transported by Advanced Life Support EMS, 17.2% (n = 392) by private vehicle, 13.7% (n = 312) by police, and 6.7% (n = 153) by Basic Life Support EMS. Of the PHP patients, 69.1% received PHP on scene, 59.9% received PHP in route, and 29.0% received PHP both on scene and in route. Initial scene vitals differed between groups, but initial emergency department vitals did not. Receipt of ≥1 PHP increased mortality odds (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.01-1.83; p = 0.04). Logistic regression showed increased mortality with each PHP, whether on scene or during transport. Subset analysis of specific PHP revealed that intubation (OR, 10.76; 95% CI, 4.02-28.78; p < 0.001), C-spine immobilization (OR, 5.80; 95% CI, 1.85-18.26; p < 0.01), and pleural decompression (OR, 3.70; 95% CI, 1.33-10.28; p = 0.01) had the highest odds of mortality after adjusting for multiple variables., Conclusion: Prehospital procedures in penetrating trauma patients impart no survival advantage and may be harmful in urban settings, even when performed during transport. Therefore, PHP should be forgone in lieu of immediate transport to improve patient outcomes., Level of Evidence: Prognostic, level III., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.)
- Published
- 2021
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147. How Mental Health Professionals Can Address Disparities in the Context of the COVID-19 Pandemic.
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Loeb TB, Ebor MT, Smith-Clapham AM, Chin D, Novacek DM, Hampton-Anderson JN, Norwood-Scott E, Hamilton AB, Brown AF, and Wyatt GE
- Abstract
The Coronavirus 2019 (COVID-19) pandemic is an unparalleled crisis, yet also a unique opportunity for mental health professionals to address and prioritize mental and physical health disparities that disproportionately impact marginalized populations. Black, Indigenous, and People of Color (BIPOC) have long experienced structural racism and oppression, resulting in disproportionately high rates of trauma, poverty, and chronic diseases that span generations and are associated with increased COVID-19 morbidity and mortality rates. The current pandemic, with the potential of conferring new trauma exposure, interacts with and exacerbates existing disparities. To assist mental health professionals in offering more comprehensive services and programs for those who have minimal resources and the most profound barriers to care, four critical areas are highlighted as being historically problematic and essential to address: (a) recognizing psychology's role in institutionalizing disparities; (b) examining race/ethnicity as a critical variable; (c) proactively tackling growing mental health problems amidst the COVID-19 crisis; and (d) understanding the importance of incorporating historical trauma and discrimination in research and practice. Recommendations are provided to promote equity at the structural (e.g., nationwide, federal), professional (e.g., the mental health professions), and individual (e.g., practitioners, researchers) levels., Competing Interests: We have no known conflict of interest to disclose.
- Published
- 2021
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148. Use of Reticulated Open Cell Foam Dressings With Through Holes During Negative Pressure Wound Therapy With Instillation and Dwell Time: A Large Case Study.
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Fernández LG, Matthews MR, Ellman C, Jackson P, Villarreal DH, and Norwood S
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- Adult, Aged, Bandages, Exudates and Transudates, Female, Granulation Tissue, Humans, Male, Middle Aged, Wound Healing, Negative-Pressure Wound Therapy
- Abstract
Introduction: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been utilized in wounds with positive clinical benefits. A reticulated open cell foam dressing with through holes (ROCF-CC) was developed to assist with wound cleansing by removing thick wound exudate and infectious materials, and it may be used when debridement is not possible or appropriate. Use of NPWTi-d with ROCF-CC dressings has been reported with positive outcomes in complex wounds., Objective: The present study reports the authors' experience using NPWTi-d with ROCF-CC dressings in 19 patients with complex wounds., Materials and Methods: Of the 19 patients, 8 underwent sharp debridement. Oral and/or intravenous antibiotic treatment was initiated as needed prior to NPWTi-d. All patients received NPWTi-d with ROCF-CC dressings with instillation of quarter-strength Dakin's solution, hypochlorous acid solution, or saline with a dwell time of 5 to 10 minutes, followed by 2 to 3.5 hours of continuous negative pressure at -125 mm Hg. Dressing changes occurred every 2 to 3 days. Measurements and assessments of wound progression were done as per institutional protocols., Results: The 19 treated patients consisted of 10 males and 9 females, with an average age of 58.2 ± 15.1 years. Common patient comorbidities included hypertension, diabetes, obesity, and paraplegia. Wound types included pressure injuries, traumatic wounds, and surgical wounds. The average length of NPWTi-d use was 9.5 ± 4.1 days. In all of the patients, the wound beds showed development of healthy granulation tissue following NPWTi-d with ROCF-CC. All patients were discharged to one of the following: another hospital facility, skilled nursing facility, long-term acute care facility, or home., Conclusions: In the authors' clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of thick exudate and infectious materials and promoted development of granulation tissue.
- Published
- 2020
149. Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS).
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Anderson RE, Keihani S, Moses RA, Nocera AP, Selph JP, Castillejo Becerra CM, Baradaran N, Glavin K, Broghammer JA, Arya CS, Sensenig RL, Rezaee ME, Morris BJ, Majercik S, Hewitt T, Burks FN, Schwartz I, Elliott SP, Luo-Owen X, Mukherjee K, Thomsen PB, Erickson BA, Miller BD, Santucci RA, Allen L, Norwood S, Fick CN, Smith BP, Piotrowski J, Dodgion CM, DeSoucy ES, Zakaluzny S, Kim DY, Breyer BN, Okafor BU, Askari R, Lucas JW, Simhan J, Khabiri SS, Nirula R, and Myers JB
- Subjects
- Adult, Drainage, Female, Humans, Male, Middle Aged, Multiple Trauma, Pelvic Bones injuries, Prospective Studies, United States, Urinary Bladder injuries, Wounds, Nonpenetrating surgery, Wounds, Penetrating surgery
- Abstract
Purpose: We studied the current management trends for extraperitoneal bladder injuries and evaluated the use of operative repair versus catheter drainage, and the associated complications with each approach., Materials and Methods: We prospectively collected data on bladder trauma from 20 level 1 trauma centers across the United States from 2013 to 2018. We excluded patients with intraperitoneal bladder injury and those who died within 24 hours of hospital arrival. We separated patients with extraperitoneal bladder injuries into 2 groups (catheter drainage vs operative repair) based on their initial management within the first 4 days and compared the rates of bladder injury related complications among them. Regression analyses were used to identify potential predictors of complications., Results: From 323 bladder injuries we included 157 patients with extraperitoneal bladder injuries. Concomitant injuries occurred in 139 (88%) patients with pelvic fracture seen in 79%. Sixty-seven patients (43%) initially underwent operative repair for their extraperitoneal bladder injuries. The 3 most common reasons for operative repair were severity of injury or bladder neck injury (40%), injury found during laparotomy (39%) and concern for pelvic hardware contamination (28%). Significant complications were identified in 23% and 19% of the catheter drainage and operative repair groups, respectively (p=0.55). The only statistically significant predictor for complications was bladder neck or urethral injury (RR 2.69, 95% 1.21-5.97, p=0.01)., Conclusions: In this large multi-institutional cohort, 43% of patients underwent surgical repair for initial management of extraperitoneal bladder injuries. We found no significant difference in complications between the initial management strategies of catheter drainage and operative repair. The most significant predictor for complications was concomitant urethral or bladder neck injury.
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- 2020
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150. Ground-level falls: 9-year cumulative experience in a regionalized trauma system.
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Cook A, Cade A, King B, Berne J, Fernandez L, and Norwood S
- Abstract
Ground-level falls (GLFs) are the leading cause of nonfatal hospitalized injuries in the US. We hypothesized that risk-adjusted mortality would not vary between levels of trauma center verification if regional triage functioned appropriately. Data were collected from our regional trauma registry for the years 2001 through 2009. A multilevel mixed-effects logistic regression model was developed to compare risk-adjusted mortality rates by trauma center level and by year. GLF patients numbered 8202 over 9 years with 2.1% mortality. Mean age was 74.5 years and mean probability of death was 0.021 (95% confidence interval [CI], 0.020-0.021). The level I center-treated patients had the highest probability of death (0.033) compared to levels II and III/IV patients (0.023 and 0.018, respectively; P < 0.001), with the highest mortality (6.0%, 3.1%, and 1.1% for levels I, II, and III/IV; P < 0.001). The adjusted odds ratio of mortality was lowest at the level I center (0.71; 95% CI, 0.56-0.91), while no difference existed between level II (1.17; 95% CI, 0.90-1.51) and level III/IV centers (1.22; 95% CI, 0.90-1.66). The 95% CIs for risk-adjusted mortality by year overlapped the 1.0 reference line for each year from 2002 to 2009. In conclusion, regional risk-adjusted mortality for GLF has varied little since 2002. More study is warranted to understand the lower risk-adjusted GLF mortality at the level I center for this growing patient population.
- Published
- 2012
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