35 results on '"Wojda, Thomas"'
Search Results
2. Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes
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Gitajn, Ida Leah, Werth, Paul M., Carlini, Anthony R., Bosse, Michael J., Gary, Joshua L., Firoozabadi, Reza, Obremskey, William, McKinley, Todd O., Castillo, Renan C., O’Toole, Robert V., Westrick, Edward R., Carroll, Eben A., Goodman, James Brett, Holden, Martha B., Miller, Anna N., Spraggs-Hughes, Amanda, Brennan, Michael L., Tornetta, Paul, III, Weaver, Michael J., Heng, Marilyn, Osborn, Patrick M., Rivera, Jessica C., Murray, Clinton K., Kimmel, Joseph E., Moon, Charles, Hsu, Joseph R., Karunakar, Madhav A., Kempton, Laurence B., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Reilly, Rachel M., Zura, Robert D., Howes, Cameron, Mir, Hassan, Wagstrom, Emily A., Mullis, Brian, Anglen, Jeffrey O., Mullis, Leilani S., Shively, Karl D., Gaski, Greg E., Natoli, Roman M., Sorkin, Anthony, Virkus, Walter, Hymes, Robert A., Holzman, Michael A., Malekzadeh, A. Stephen, Schulman, Jeff E., Schwartzbach, Cary C., Lee, Olivia C., Krause, Peter C., Morandi, Massimo 'Max', Choo, Andrew, Munz, John W., Boutte, Sterling, Galpin, Matthew C., Frisch, H. Michael, Kaufman, Adam M., LeCroy, C. Michael, Smith, Christopher S., Stall, Alec C., Horne, Andrea, Nascone, Jason W., OʼHara, Nathan N., Paryavi, Ebrahim, Sciadini, Marcus F., Degani, Yasmin, Howe, Andrea L., Hayda, Roman, Evans, Andrew R., Sietsema, Debra L., Stawicki, Stanislaw P., Wojda, Thomas, Gardner, Michael J., Bishop, Julius A., Rehman, Saqib, Caroom, Cyrus, Sheridan, Elizabeth, Miclau, Theodore, Morshed, Saam, Higgins, Thomas F., Haller, Justin M., Matuszewski, Paul E., Aneja, Arun, Wright, Raymond D., Jr., Bergin, Patrick F., Bhanat, Eldrin, Graves, Matt L., Morellato, John, Spitler, Clay A., Teague, David, Ertl, William, Ahn, Jaimo, Hesketh, Patrick, Moloney, Gele B., Weinlein, John C., Zelle, Boris A., Agarwal, Animesh, Karia, Ravi A., Sathy, Ashoke, Sanders, Drew T., Weiss, David B., Yarboro, Seth R., Lester-Ballard, Veronica, McVey, Eric D., Dagal, Arman, Githens, Michael, Kleweno, Conor, Agel, Julie, Whiting, Paul S., Simske, Natasha M., Siy, Alexander B., Attum, Basem, Burgos, Eduardo, Gajari, Vamshi, Rodriguez-Buitrago, Andres, Sethi, Manish, Tummuru, Rajesh R., DʼAlleyrand, Jean-Claude G., Allen, Lauren E., Collins, Susan C., Huang, Yanjie, and Taylor, Tara J.
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- 2024
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3. Digital Identity, Computational Reliabilism, and the Future of IOMT: Epistemic Reasoning and the Role of Blockchain in Removing Human Tampering from Pharmacovigilance Decision Making
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Plaza, Mateusz, Batzel, Sean, Wojda, Thomas, Alcaro, M. M., Rezaei, Nima, Editor-in-Chief, and Stawicki, Stanislaw, editor
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- 2023
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4. AI in Healthcare: Implications for Family Medicine and Primary Care
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Wojda, Thomas, primary, Hoffman, Carlie, additional, Jackson, Jeffrey, additional, Conti, Traci, additional, and Maier, John, additional
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- 2023
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5. Emotional Intelligence and Leadership Development: Implications for Family Medicine Residency Programs
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Jee Ha, Seul, primary, Reddy Patlolla, Sridhar, additional, and Robert Wojda, Thomas, additional
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- 2021
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6. Thumb interphalangeal joint arthrodesis angles in patients with carpometacarpal osteoarthritis
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Ramski, David E., McGowan, Shane M., Wojda, Thomas R., Rae, Matthew A., and Matullo, Kristofer S.
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- 2020
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7. Does Topical Vancomycin Powder Use in Fracture Surgery Change Bacteriology and Antibiotic Susceptibilities? An Analysis of the VANCO Trial
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Joshi, Manjari, O'Toole, Robert V., Carlini, Anthony R., Gary, Joshua L., Obremskey, William T., Murray, Clinton K., Gaski, Greg, Reid, J. Spence, Degani, Yasmin, Taylor, Tara J., Collins, Susan C., Huang, Yanjie, Whiting, Paul S., Patterson, Joseph T., Lee, Olivia C., Castillo, Renan C., Bosse, Michael J., Hsu, Joseph R., Karunakar, Madhav A., Kempton, Laurence B., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Carroll, Eben, Goodman, James Brett, Holden, Martha B., Gardner, Michael J., Miller, Anna N., Spraggs-Hughes, Amanda, Brennan, Michael L., Weaver, Michael J., Rivera, Jessica C., Kimmel, Joseph E., Reilly, Rachel M., Zura, Robert D., Howes, Cameron, Mir, Hassan, Schmidt, Andrew H., Wagstrom, Emily A., Westberg, Jerald R., McKinley, Todd O., Natoli, Roman M., Sorkin, Anthony, Virkus, Walter, Hill, Lauren C., Hymes, Robert A., Holzman, Michael, Malekzadeh, A. Stephen, Schulman, Jeff E., Schwartzbach, Cary C., Krause, Peter C., Choo, Andrew, Boutte, Sterling, Frisch, H. Michael, Kaufman, Adam M., Large, Thomas M., LeCroy, C. Michael, Smith, Christopher S., Horne, Andrea, LeBrun, Christopher T., Nascone, Jason W., O'Hara, Nathan N., Sciadini, Marcus F., Slobogean, Gerard P., Howe, Andrea L., Rudnicki, Joshua S., Evans, Andrew R., Sietsema, Debra L., Stawicki, Stanislaw P., Wojda, Thomas R., Bishop, Julius A., Rehman, Saqib, Caroom, Cyrus, Ly, Thuan V., Sheridan, Elizabeth, Haller, Justin M., Bergin, Patrick F., Bhanat, Eldrin, Graves, Matt L., Jones, LaRita C., Morellato, John, Spitler, Clay A., Teague, David, Ertl, William, Moloney, Gele B., Weinlein, John C., Zelle, Boris A., Agarwal, Animesh, Karia, Ravi A., Sathy, Ashoke, Sanders, Drew, Weiss, David B., Yarboro, Seth R., Lester-Ballard, Veronica, McVey, Eric D., Firoozabadi, Reza, Simske, Natasha M., Siy, Alexander B., Attum, Basem, Burgos, Eduardo J., Gajari, Vamshi, Rodriguez-Buitrago, Andres, Sethi, Manish K., Trochez, Karen M., and Allen, Lauren E.
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- 2024
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8. Teaching Balanced Patient Care Using Principles of Reductionism and Holism: The Example of Chronic Low Back Pain
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Remde, Alan, primary, DeTurk, Stephen, additional, and Wojda, Thomas, additional
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- 2019
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9. The eighth annual academic international medicine congress and scientific Forum, July 14–16, 2023: Thinking globally, acting locally.
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Stawicki, Stanislaw, Cai, Jenny, Choron, Rachel, Narayan, Mayur, Izurieta, Ricardo, Galwankar, Sagar, Barrera, Rafael, Wojda, Thomas, Davila, Victor, Kar, A, and Christopherson, Nathan
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ACADEMIC medical centers ,WORLD health ,CONFERENCES & conventions ,CONTINUING medical education ,COVID-19 pandemic - Abstract
The first in-person Academic International Medicine Congress (AIM 2023) since the beginning of the COVID-19 Pandemic took place at Rutgers University in New Brunswick, NJ, almost exactly 4 years after a meeting at the same location had to be canceled due to the global calamity. Featuring 3 days packed with high quality continuing medical education content and leadership development sessions, AIM 2023 set several important records for our organization. Among the most important sessions was the half-day strategic leadership retreat, with a goal of charting ACAIM's path for the next 3-5 years. The main program featured more than 35 speakers and panelists, and offered more than 20 hours of continuing medical education credits. The scientific program included more than 30 abstracts and interesting case presentations. The AIM 2023 Gala and Awards Ceremonies were among the most attended attractions. This report includes a summary of key events and sessions from the AIM 2023 Congress, inclusive of published abstracts from the meeting. The following core competencies are addressed in this article: Interpersonal and communication skills, Professionalism, Practice-based learning and improvement, Systems based practice. [ABSTRACT FROM AUTHOR]
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- 2023
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10. Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen
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Bird, Benjamin, primary, Dingley, Stephen, additional, Stawicki, Stanislaw P., additional, and Wojda, Thomas R., additional
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- 2018
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11. Introductory Chapter: Developing Patient Safety Champions
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Tolentino, Julia C., primary, Martins, Noel, additional, Sweeney, Joan, additional, Marchionni, Christine, additional, Valenza, Pamela, additional, McGinely, Thomas C., additional, Wojda, Thomas R., additional, Firstenberg, Michael S., additional, and Stawicki, Stanislaw P., additional
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- 2018
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12. Foreign Intravascular Object Embolization and Migration: Bullets, Catheters, Wires, Stents, Filters, and More
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Wojda, Thomas R., primary, Dingley, Stephen D., additional, Wolfe, Samantha, additional, Terzian, W. T. Hillman, additional, Thomas, Peter G., additional, Vazquez, Daniel, additional, Sweeney, Joan, additional, and Stawicki, Stanislaw P., additional
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- 2017
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13. Septic Embolism: A Potentially Devastating Complication of Infective Endocarditis
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Wojda, Thomas R., primary, Cornejo, Kristine, additional, Lin, Andrew, additional, Cipriano, Anthony, additional, Nanda, Sudip, additional, Amortegui, Jose D., additional, Wojda, Barbara T., additional, and Stawicki, Stanislaw P., additional
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- 2016
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14. Perioperative Nutrition Support for Surgical Patients: Aspects and Commentary
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Wojda, Thomas R., Mohammed, Omnia, and Evans, David C.
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- 2015
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15. Plant-predominant eating patterns – how effective are they for treating obesity and related cardiometabolic health outcomes? – a systematic review
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Remde, Alan, primary, DeTurk, Stephen N, additional, Almardini, A, additional, Steiner, Lauren, additional, and Wojda, Thomas, additional
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- 2021
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16. Ultrasound and Computed Tomography Imaging Technologies for Nutrition Assessment in Surgical and Critical Care Patient Populations
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Wojda, Thomas R., Cardone, Michael Scott, Lo, Wilson D., Stawicki, Stanislaw P. A., and Evans, David C.
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- 2015
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17. Plant-predominant eating patterns – how effective are they for treating obesity and related cardiometabolic health outcomes? – a systematic review.
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Remde, Alan, DeTurk, Stephen N, Almardini, A, Steiner, Lauren, and Wojda, Thomas
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REDUCING diets ,FOOD habits ,CARDIOVASCULAR diseases risk factors ,HYPERTENSION ,ONLINE information services ,CINAHL database ,MEDICAL databases ,INFORMATION storage & retrieval systems ,GLYCEMIC control ,SYSTEMATIC reviews ,CARDIOVASCULAR diseases ,PLANT-based diet ,HYPERLIPIDEMIA ,TYPE 2 diabetes ,TREATMENT effectiveness ,MEDLINE ,INSULIN resistance - Abstract
Context The obesity epidemic is a main driver of the chronic disease epidemic; however, present treatment approaches have suboptimal efficacy. Objectives To assess the efficacy of plant-predominant (vegan, vegetarian, plant-based whole foods [PBWFs]) diets in treating obesity and its main cardiometabolic sequelae: hyperlipidemia (HLD); indices of insulin resistance, glycemic control, and diabetes mellitus type 2 (DM2); and cardiovascular disease (CVD), including hypertension (HTN). Data Sources A systematic search of multiple databases was conducted for articles published between November 2019 and February 2020; databases searched included: PubMed, Medline (Ovid), Cochrane, CENTRAL, and CINAHL. Data Extraction and Analysis All interventional trials (randomized controlled trials [RCTs] and trials of non-randomized experimental design) that met the inclusion criteria (English language, duration of at least 4 weeks, primary end point congruent with above objectives, no major flaws in research design that would prevent interpretation) were included in the review. A total of 3135 articles were scanned and 84 were selected. The articles were collated and summarized in 2 evidence tables. Risk of bias for RCTs was assessed using the Cochrane Risk-of-Bias tool 2 as a guide. For non-randomized trials, higher risk of bias was assumed, and the JBI Critical Appraisal tool was used as a guide to determine inclusion. Results Plant-based diets, in general, demonstrated improved weight control and cardiometabolic outcomes related to lipids, cardiovascular end points, blood pressure, insulin sensitivity, A1C, and fasting glucose, and a lower risk of diabetes compared with usual diets and in some cases standard health-oriented diets such as the American Heart Association (AHA), American Diabetic Association (ADA), and Mediterranean diets. Preliminary studies suggest plant-predominant diets practiced as part of healthy lifestyle interventions may stabilize or even reverse DM 2 and CVD. The acceptability and sustainability of plant-predominant diets where measured were generally similar to other health-oriented diets. Conclusion Plant-predominant diets can play a major role in reversing the obesity and chronic disease epidemics. In the setting of sustained lifestyle intervention programs, they may arrest or even reverse DM2 and CVD. Further higher-level RCTs are needed to confirm and expand on these findings. [ABSTRACT FROM AUTHOR]
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- 2022
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18. Medical Demographics in Sub-Saharan Africa:Measuring Temporal Trends in Emergency Department Visits among Elderly Patients
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Yellapu, Vikas, Wojda, Thomas R., Perez-Figueroa, Ileana J., Alaa-Eldin A. Mira, Chinenye O Nwachuku, and Stawicki, Stanislaw P.
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- 2018
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19. Emotional Intelligence and Leadership Development : Implications for Family Medicine Residency Programs
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Robert Wojda, Thomas, Reddy Patlolla, Sridhar, and Ha, Seul Jee
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Medical - Abstract
High-level emotional Intelligence (EI) and leadership skills are crucial for physicians to prioritize responsibilities and successfully interact with numerous stakeholders in an every-increasingly complex healthcare system. Although recent research has shown an association between emotional intelligence and leadership, few studies have examined this relationship among family and primary care physicians. Family physicians play an essential role in the evaluation and treatment of illnesses as well as health and wellness promotion. These providers are often the first point of contact with the patient and the use of emotional intelligence and development of leadership abilities of primary care physicians are vital to the maintenance, sustainability, and optimization of a medical organization. Furthermore, high- level emotional intelligence and sharpened leadership skills may aid the patient-provider relationship and dealings with coworkers. This chapter explores key themes of EI and physician leadership as it pertains to Family Medicine Residency.
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- 2018
20. Impact of blood alcohol concentration on hematologic and serum chemistry parameters in trauma patients: Analysis of data from a high-volume level 1 trauma center.
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Kelley, Kathryn, Salen, Philip, Wojda, Thomas, Hasani, Aliaskar, Luster, Joshua, Seoane, Jacqueline, Cohen, Marissa, Castillo, Roberto, and Stawicki, Stanislaw
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TRAUMA centers ,BLOOD alcohol ,LEUCOCYTES ,LIVER function tests ,BIOMARKERS ,DATA analysis ,BLOOD platelet disorders - Abstract
Background: Alcohol (EtOH) intoxication is common among trauma patients. While providers are familiar with the clinical aspects of acute EtOH intoxication, few studies have investigated the effects that EtOH levels may have on common laboratory markers. The aim of this study was to identify hematologic and serum chemistry parameters that may be affected by the blood alcohol concentration (BAC), hypothesizing that BAC influences both comprehensive blood count (CBC) and comprehensive serum chemistry (CSC) components. Methods: We performed an IRB-exempt institutional registry review of all trauma patients who had serum EtOH levels measured between January 2009 and June 2015. Data for each patient included: patient demographics, BAC determinations (g/dL), injury mechanism/severity information (ISS), hematologic parameters included in a CBC (hemoglobin, hematocrit, white blood cell [WBC] count, and platelet count), and CSC panel components (sodium, potassium, chloride, bicarbonate, blood urea nitrogen [BUN], creatinine, glucose, and hepatic function tests). Laboratory markers were contrasted across predefined categories of BAC: <0.10%, 10%–15%, 15%–20%, and >20%. Statistical comparisons were performed using SPSS 18 Software, employing analysis-of-covariance with adjustments performed for the patient demographics and injury characteristics. Statistical significance was set at α = 0.005. Results: A total of 2167 patient records were analyzed. After adjusting for patient age, gender, and ISS, increasing BAC correlated with 4.8% increase in hemoglobin and 32.5% higher hematocrit (both P < 0.001), as well as a 27.8% decrease in WBC count. There were also statistically significant differences between low (<0.10%) and high (>0.20%) BAC groups across multiple CSC parameters, with largest impact on BUN (32.2% decrease); creatinine (31.5% decrease); and glucose (13.6% decrease) values. Elevated BAC (>0.20 g/dL) was also associated with 81.8% increase in total bilirubin, and hepatic transaminases were elevated among patients with BAC >0.10. Conclusion: Due to the paucity of literature relating to the effects of BAC on serum hematologic and biochemical markers in acute trauma, this study provides a foundation for further exploration of these relationships and their clinical impact. More specifically, we found that BAC levels significantly influenced key laboratory markers, suggesting that acute EtOH intoxication may lead to hematologic and CSC changes that are potentially important in acute trauma management by frontline clinical staff. [ABSTRACT FROM AUTHOR]
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- 2021
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21. Foreign Intravascular Object Embolization and Migration: Bullets, Catheters, Wires, Stents, Filters, and More
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Wojda, Thomas R., Dingley, Stephen D., Wolfe, Samantha, Terzian, W. T. Hillman, Thomas, Peter G., Vazquez, Daniel, and Stawicki, Joan Sweeney and Stanislaw P.
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- 2017
22. Getting “More Mileage” Out of the Trauma and Injury Severity Score: Extending the Paradigm to Morbidity and Length of Stay Predictions
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Terzian, Hillman WT, primary, Hoey, Brian A., additional, Hoff, William S., additional, Thomas, Peter, additional, Wojda, Thomas R., additional, Cipolla, James, additional, and Stawicki, Stanislaw P., additional
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- 2017
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23. Prognostication of Traumatic Brain Injury Outcomes in Older Trauma Patients: A Novel Risk Assessment Tool Based on Initial Cranial CT Findings
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Mubang, Ronnie, primary, Wojda, Thomas R., additional, Nuschke, John D., additional, Hoff, William S., additional, Hoey, Brian A., additional, Thomas, Peter, additional, Falowski, Steven, additional, and Stawicki, Stanislaw P., additional
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- 2016
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24. Injury and fatality risks in aeromedical transport: focus on prevention
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Hon, Heidi H., primary, Wojda, Thomas R., additional, Barry, Noran, additional, MacBean, Ulunna, additional, Anagnostakos, John P., additional, Evans, David C., additional, Thomas, Peter G., additional, and Stawicki, Stanislaw P., additional
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- 2016
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25. Leukocytosis after Splenic Injury: A Comparison of Splenectomy, Embolization, and Observation
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Wernick, Brian, primary, MacBean, Ulunna, additional, Mubang, Ronnie N., additional, Wojda, Thomas R., additional, Liu, Suzanne C., additional, Evans, David C., additional, Hoey, Brian A., additional, Hoff, William S., additional, Thomas, Peter, additional, and Stawicki, Stanislaw P., additional
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- 2015
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26. Early results of fecal microbial transplantation protocol implementation at a community-based university hospital.
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Duarte-Chavez, Rodrigo, Wojda, Thomas, Zanders, Thomas, Geme, Berhanu, Fioravanti, Gloria, and Stawicki, Stanislaw
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CLOSTRIDIOIDES difficile , *FECES , *MICROBIOLOGY , *GUT microbiome , *THERAPEUTIC use of probiotics , *UNIVERSITY hospitals , *DISEASE risk factors ,SIDE effects of antibiotics ,INFECTION treatment - Abstract
Introduction: Clostridium difficile (CD) is a serious and increasingly prevalent healthcare-associated infection. The pathogenesis of CD infection (CDI) involves the acquisition of CD with a concurrent disruption of the native gut flora. Antibiotics are a major risk although other contributing factors have also been identified. Clinical management combines discontinuation of the offending antibiotic, initiation of CD-specific antibiotic therapy, probiotic agent use, fecal microbiota transplantation (FMT), and surgery as the “last resort” option. The aim of this study is to review short-term clinical results following the implementation of FMT protocol (FMTP) at our community-based university hospital. Methods: After obtaining Institutional Review Board and Infection Control Committee approvals, we implemented an institution-wide FMTP for patients diagnosed with CDI. Prospective tracking of all patients receiving FMT between July 1, 2015, and February 1, 2017, was conducted using REDCap™ electronic data capture system. According to the FMTP, indications for FMT included (a) three or more CDI recurrences, (b) two or more hospital admissions with severe CDI, or (c) first episode of complicated CDI (CCDI). Risk factors for initial infection and for treatment failure were assessed. Patients were followed for at least 3 months to monitor for cure/failure, relapse, and side effects. Frozen 250 mL FMT samples were acquired from OpenBiome (Somerville, MA, USA). After 4 h of thawing, the liquid suspension was applied using colonoscopy, beginning with terminal ileum and proceeding distally toward mid-transverse colon. Monitored clinical parameters included disease severity (Hines VA CDI Severity Score or HVCSS), concomitant medications, number of FMT treatments, non-FMT therapies, cure rates, and mortality. Descriptive statistics were utilized to outline the study results. Results: A total of 35 patients (mean age 58.5 years, 69% female) were analyzed, with FMT-attributable primary cure achieved in 30/35 (86%) cases. Within this subgroup, 2/30 (6.7%) patients recurred and were subsequently cured with long-term oral vancomycin. Among five primary FMT failures (14% total sample), 3 (60%) achieved medical cure with long-term oral vancomycin therapy and 2 (40%) required colectomy. For the seven patients who either failed FMT or recurred, long-term vancomycin therapy was curative in all but two cases. For patients with severe CDI (HVCSS ≥3), primary and overall cure rates were 6/10 (60%) and 8/10 (80%), respectively. Patients with CCDI (n = 4) had higher HVCSS (4 vs. 3) and a mortality of 25%. Characteristics of patients who failed initial FMT included older age (70 vs. 57 years), female sex (80% vs. 67%), severe CDI (80% vs. 13%), and active opioid use during the initial infection (60% vs. 37%) and at the time of FMT (60% vs. 27%). The most commonly reported side effect of FMT was loose stools. Conclusions: This pilot study supports the efficacy and safety of FMT administration for CDI in the setting of a community-based university hospital. Following FMTP implementation, primary (86%) and overall (94%) nonsurgical cure rates were similar to those reported in other studies. The potential role of opioids as a modulator of CDI warrants further clinical investigation. [ABSTRACT FROM AUTHOR]
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- 2018
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27. Keys to successful organ procurement: An experience-based review of clinical practices at a high-performing health-care organization.
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Wojda, Thomas R., Stawicki, Stanislaw P., Axelband, Jennifer, Wilde-Onia, Rebecca, Thomas, Peter G., Cipolla, James, Hoff, William S., Shultz, Jill, Yandle, Kathy P., and Bleil, Maria
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PROCUREMENT of organs, tissues, etc. , *HEALTH services administration , *ORGAN donors - Abstract
Organ procurement (OP) from donors after brain death and circulatory death represents the primary source of transplanted organs. Despite favorable laws and regulations, OP continues to face challenges for a number of reasons, including institutional, personal, and societal barriers. This focused review presents some of the key components of a successful OP program at a large, high-performing regional health network. This review focuses on effective team approaches, aggressive resuscitative strategies, optimal communication, family support, and community outreach efforts. [ABSTRACT FROM AUTHOR]
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- 2017
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28. Prognostication of traumatic brain injury outcomes in older trauma patients: A novel risk assessment tool based on initial cranial CT findings.
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Stawicki, Stanislaw P., Wojda, Thomas R., Nuschke, John D., Mubang, Ronnie N., Cipolla, James, Hoff, William S., Hoey, Brian A., Thomas, Peter G., Sweeney, Joan, Ackerman, Daniel, Hosey, Jonathan, and Falowski, Steven
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BRAIN injuries , *BRAIN tomography , *HEALTH outcome assessment , *PROGNOSIS - Abstract
Introduction: Advanced age has been traditionally associated with worse traumatic brain injury (TBI) outcomes. Although prompt neurosurgical intervention (NSI, craniotomy or craniectomy) may be life-saving in the older trauma patient, it does not guarantee survival and/or return to preinjury functional status. The aim of this study was to determine whether a simple score, based entirely on the initial cranial computed tomography (CCT) is predictive of the need for NSI and key outcome measures (e.g., morbidity and mortality) in the older (age 45+ years) TBI patient subset. We hypothesized that increasing number of categorical CCT findings is independently associated with NSI, morbidity, and mortality in older patients with severe TBI. Methods: After IRB approval, a retrospective study of patients 45 years and older was performed using our Regional Level 1 Trauma Center registry data between June 2003 and December 2013. Collected variables included patient demographics, Injury Severity Score (ISS), Abbreviated Injury Scale Head (AISh), brain injury characteristics on CCT, Glasgow Coma Scale (GCS), Intensive Care Unit (ICU) and hospital length of stay (LOS), all-cause morbidity and mortality, functional independence scores, as well as discharge disposition. A novel CCT scoring tool (CCTST, scored from 1 to 8+) was devised, with one point given for each of the following findings: subdural hematoma, epidural hematoma, subarachnoid blood, intraventricular blood, cerebral contusion/intraparenchymal blood, skull fracture, pneumocephalus, brain edema/herniation, midline shift, and external (skin/face) trauma. Descriptive statistics and univariate analyses were conducted with 30-day mortality, in-hospital morbidity, and need for NSI as primary end-points. Secondary end-points included the length of stay in the ICU (ICULOS), step-down unit (SDLOS), and the hospital (HLOS) as well as patient functional outcomes, and postdischarge destination. Factors associated with the need for NSI were determined using matched NSI (n = 310) and non-NSI (n = 310) groups. All other analyses examined the combined patient sample (n = 620). Variables achieving a significance level of P < 0.20 were included in the logistic regression. Receiver operating characteristic curves, with corresponding area under the curve (AUC) determinations, were also analyzed. Statistical significance was set at a = 0.05. Data are presented as percentages, mean ± standard deviation, or adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs). Results: A total of 620 patients were analyzed, including 310 patients who underwent NSI and 310 age. and ISS.matched non-NSI controls. Average patient age was 72.8 ± 13.4 years (64.1% male, 99% blunt trauma, mean ISS 25.1 ± 8.68, and mean AISh/GCS of 4.63/10.9). CCTST was the only variable independently associated with NSI (AOR 1.23, 95% CI 1.06-1.42) and was inversely proportional to initial GCS and functional outcome scores on discharge. Increasing CCTST was associated with greater mortality, morbidity, HLOS, SDLOS, ICULOS, and ventilator days. On multivariate analysis, factors independently associated with mortality included AISh (AOR 2.70, 95% CI 1.21-6.00), initial GCS (AOR 1.14, 1.07-1.22), and CCTST (AOR 1.31, 1.09-1.58). Variables independently associated with in-hospital morbidity included CCTST (AOR 1.16, 1.02-1.34), GCS (AOR 1.05, 1.01-1.09), and NSI (AOR 2.62, 1.69-4.06). Multivariate models incorporating factors independently associated with each respective outcome displayed good overall predictive characteristics for mortality (AUC 0.787) and in-hospital morbidity (AUC 0.651). Finally, modified CCTST demonstrated good overall predictive ability for NSI (AUC 0.755). Conclusion: This study found that the number of discrete findings on CCT is independently associated with major TBI outcome measures, including 30-day mortality, in-hospital morbidity, and NSI. Of note, multivariate models with best predictive characteristics incorporate both CCTST and GCS. CCTST is easy to calculate, and this preliminary investigation of its predictive utility in older patients with TBI warrants further validation, focusing on exploring prognostic synergies between CCTST, GCS, and AISh. If independently confirmed to be predictive of clinical outcomes and the need for NSI, the approach described herein could lead to a shift in both operative and nonoperative management of patients with TBI. [ABSTRACT FROM AUTHOR]
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- 2017
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29. Medical demographics in sub-Saharan Africa: Does the proportion of elderly patients in accident and emergency units mirror life expectancy trends?
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Wojda, Thomas R., Cornejo, Kristine, Valenza, Pamela L., Carolan, Gregory, Sharpe, Richard P., Mira, Alaa-Eldin A., Galwankar, Sagar C., and Stawicki, Stanislaw Peter
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OLDER patients , *LIFE expectancy - Abstract
A letter to the editor is presented in response to the article related to the life expectancy in the elderly patients in accidents and emergency units.
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- 2016
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30. The Ebola Outbreak of 2014-2015: From Coordinated Multilateral Action to Effective Disease Containment, Vaccine Development, and Beyond.
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Wojda, Thomas R., Valenza, Pamela L., Cornejo, Kristine, McGinley, Thomas, Galwankar, Sagar C., Kelkar, Dhanashree, Sharpe, Richard P., Papadimos, Thomas J., and Stawicki, Stanislaw P.
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- *
EBOLA virus disease , *HEMORRHAGIC fever , *VIRUS diseases , *PREVENTIVE medicine , *MEDICAL care - Abstract
The Ebola outbreak of 2014-2015 exacted a terrible toll on major countries of West Africa. Latest estimates from the World Health Organization indicate that over 11,000 lives were lost to the deadly virus since the first documented case was officially recorded. However, significant progress in the fight against Ebola was made thanks to a combination of globally-supported containment efforts, dissemination of key information to the public, the use of modern information technology resources to better track the spread of the outbreak, as well as more effective use of active surveillance, targeted travel restrictions, and quarantine procedures. This article will outline the progress made by the global public health community toward containing and eventually extinguishing this latest outbreak of Ebola. Economic consequences of the outbreak will be discussed. The authors will emphasize policies and procedures thought to be effective in containing the outbreak. In addition, we will outline selected episodes that threatened intercontinental spread of the disease. The emerging topic of post-Ebola syndrome will also be presented. Finally, we will touch on some of the diagnostic (e.g., point-of-care [POC] testing) and therapeutic (e.g., new vaccines and pharmaceuticals) developments in the fight against Ebola, and how these developments may help the global public health community fight future epidemics. [ABSTRACT FROM AUTHOR]
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- 2015
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31. Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial
- Author
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O’Toole, Robert V., Joshi, Manjari, Carlini, Anthony R., Murray, Clinton K., Allen, Lauren E., Huang, Yanjie, Scharfstein, Daniel O., O’Hara, Nathan N., Gary, Joshua L., Bosse, Michael J., Castillo, Renan C., Bishop, Julius A., Weaver, Michael J., Firoozabadi, Reza, Hsu, Joseph R., Karunakar, Madhav A., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Brennan, Michael L., Gonzales, Gabriela, Reilly, Rachel M., Zura, Robert D., Howes, Cameron R., Mir, Hassan R., Wagstrom, Emily A., Westberg, Jerald, Gaski, Greg E., Kempton, Laurence B., Natoli, Roman M., Sorkin, Anthony T., Virkus, Walter W., Hill, Lauren C., Hymes, Robert A., Holzman, Michael, Malekzadeh, A. Stephen, Schulman, Jeff E., Ramsey, Lolita, Cuff, Jaslynn A. N., Haaser, Sharon, Osgood, Greg M., Shafiq, Babar, Laljani, Vaishali, Lee, Olivia C., Krause, Peter C., Rowe, Cara J., Hilliard, Colette L., Morandi, Massimo Max, Mullins, Angela, Achor, Timothy S., Choo, Andrew M., Munz, John W., Boutte, Sterling J., Vallier, Heather A., Breslin, Mary A., Frisch, H. Michael, Kaufman, Adam M., Large, Thomas M., LeCroy, C. Michael, Riggsbee, Christina, Smith, Christopher S., Crickard, Colin V., Phieffer, Laura S., Sheridan, Elizabeth, Jones, Clifford B., Sietsema, Debra L., Reid, J. Spence, Ringenbach, Kathy, Hayda, Roman, Evans, Andrew R., Crisco, M.J., Rivera, Jessica C., Osborn, Patrick M., Kimmel, Joseph, Stawicki, Stanislaw P., Nwachuku, Chinenye O., Wojda, Thomas R., Rehman, Saqib, Donnelly, Joanne M., Caroom, Cyrus, Jenkins, Mark D., Boulton, Christina L., Costales, Timothy G., LeBrun, Christopher T., Manson, Theodore T., Mascarenhas, Daniel C., Nascone, Jason W., Pollak, Andrew N., Sciadini, Marcus F., Slobogean, Gerard P., Berger, Peter Z., Connelly, Daniel W., Degani, Yasmin, Howe, Andrea L., Marinos, Dimitrius P., Montalvo, Ryan N., Reahl, G. Bradley, Schoonover, Carrie D., Schroder, Lisa K., Vang, Sandy, Bergin, Patrick F., Graves, Matt L., Russell, George V., Spitler, Clay A., Hydrick, Josie M., Teague, David, Ertl, William, Hickerson, Lindsay E., Moloney, Gele B., Weinlein, John C., Zelle, Boris A., Agarwal, Animesh, Karia, Ravi A., Sathy, Ashoke K., Au, Brigham, Maroto, Medardo, Sanders, Drew, Higgins, Thomas F., Haller, Justin M., Rothberg, David L., Weiss, David B., Yarboro, Seth R., McVey, Eric D., Lester-Ballard, Veronica, Goodspeed, David, Lang, Gerald J., Whiting, Paul S., Siy, Alexander B., Obremskey, William T., Jahangir, A. Alex, Attum, Basem, Burgos, Eduardo J., Molina, Cesar S., Rodriguez-Buitrago, Andres, Gajari, Vamshi, Trochez, Karen M., Halvorson, Jason J., Miller, Anna N., Goodman, James Brett, Holden, Martha B., McAndrew, Christopher M., Gardner, Michael J., Ricci, William M., Spraggs-Hughes, Amanda, Collins, Susan C., Taylor, Tara J., and Zadnik, Mary
- Abstract
IMPORTANCE: Despite the widespread use of systemic antibiotics to prevent infections in surgically treated patients with fracture, high rates of surgical site infection persist. OBJECTIVE: To examine the effect of intrawound vancomycin powder in reducing deep surgical site infections. DESIGN, SETTING, AND PARTICIPANTS: This open-label randomized clinical trial enrolled adult patients with an operatively treated tibial plateau or pilon fracture who met the criteria for a high risk of infection from January 1, 2015, through June 30, 2017, with 12 months of follow-up (final follow-up assessments completed in April 2018) at 36 US trauma centers. INTERVENTIONS: A standard infection prevention protocol with (n = 481) or without (n = 499) 1000 mg of intrawound vancomycin powder. MAIN OUTCOMES AND MEASURES: The primary outcome was a deep surgical site infection within 182 days of definitive fracture fixation. A post hoc comparison assessed the treatment effect on gram-positive and gram-negative-only infections. Other secondary outcomes included superficial surgical site infection, nonunion, and wound dehiscence. RESULTS: The analysis included 980 patients (mean [SD] age, 45.7 [13.7] years; 617 [63.0%] male) with 91% of the expected person-time of follow-up for the primary outcome. Within 182 days, deep surgical site infection was observed in 29 of 481 patients in the treatment group and 46 of 499 patients in the control group. The time-to-event estimated probability of deep infection by 182 days was 6.4% in the treatment group and 9.8% in the control group (risk difference, –3.4%; 95% CI, –6.9% to 0.1%; P = .06). A post hoc analysis of the effect of treatment on gram-positive (risk difference, –3.7%; 95% CI, –6.7% to –0.8%; P = .02) and gram-negative-only (risk difference, 0.3%; 95% CI, –1.6% to 2.1%; P = .78) infections found that the effect of vancomycin powder was a result of its reduction in gram-positive infections. CONCLUSIONS AND RELEVANCE: Among patients with operatively treated tibial articular fractures at a high risk of infection, intrawound vancomycin powder at the time of definitive fracture fixation reduced the risk of a gram-positive deep surgical site infection, consistent with the activity of vancomycin. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02227446
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- 2021
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32. Teaching Balanced Patient Care Using Principles of Reductionism and Holism : The Example of Chronic Low Back Pain
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Remde, Alan H, Wojda, Thomas, and DeTurk, Stephen N.
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Social Science - Abstract
This chapter explores how integrating holistic and reductionistic approaches to care may better optimize value based care. First, we define the terms ‘Holistic,’ ‘Reductionistic’ and ‘Integrative’. Then we explore their scope in the arenas of teaching and patient care, with the advantages, disadvantages and pitfalls of each approach. We review how these styles are embedded in and interact with the cultures of medicine and western societies at large. As an example of a balanced care approach, we focus on the example of chronic low back pain (CLBP), an increasingly common and expensive medical problem. We present practical examples of teaching and practicing these different styles, Holism and Reductionism, illustrating when each may be appropriate to optimize value of patient care. Study questions are included. A list of further readings and resources is included for the interested reader.
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- 2018
33. Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial.
- Author
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O'Toole RV, Joshi M, Carlini AR, Murray CK, Allen LE, Huang Y, Scharfstein DO, O'Hara NN, Gary JL, Bosse MJ, Castillo RC, Bishop JA, Weaver MJ, Firoozabadi R, Hsu JR, Karunakar MA, Seymour RB, Sims SH, Churchill C, Brennan ML, Gonzales G, Reilly RM, Zura RD, Howes CR, Mir HR, Wagstrom EA, Westberg J, Gaski GE, Kempton LB, Natoli RM, Sorkin AT, Virkus WW, Hill LC, Hymes RA, Holzman M, Malekzadeh AS, Schulman JE, Ramsey L, Cuff JAN, Haaser S, Osgood GM, Shafiq B, Laljani V, Lee OC, Krause PC, Rowe CJ, Hilliard CL, Morandi MM, Mullins A, Achor TS, Choo AM, Munz JW, Boutte SJ, Vallier HA, Breslin MA, Frisch HM, Kaufman AM, Large TM, LeCroy CM, Riggsbee C, Smith CS, Crickard CV, Phieffer LS, Sheridan E, Jones CB, Sietsema DL, Reid JS, Ringenbach K, Hayda R, Evans AR, Crisco MJ, Rivera JC, Osborn PM, Kimmel J, Stawicki SP, Nwachuku CO, Wojda TR, Rehman S, Donnelly JM, Caroom C, Jenkins MD, Boulton CL, Costales TG, LeBrun CT, Manson TT, Mascarenhas DC, Nascone JW, Pollak AN, Sciadini MF, Slobogean GP, Berger PZ, Connelly DW, Degani Y, Howe AL, Marinos DP, Montalvo RN, Reahl GB, Schoonover CD, Schroder LK, Vang S, Bergin PF, Graves ML, Russell GV, Spitler CA, Hydrick JM, Teague D, Ertl W, Hickerson LE, Moloney GB, Weinlein JC, Zelle BA, Agarwal A, Karia RA, Sathy AK, Au B, Maroto M, Sanders D, Higgins TF, Haller JM, Rothberg DL, Weiss DB, Yarboro SR, McVey ED, Lester-Ballard V, Goodspeed D, Lang GJ, Whiting PS, Siy AB, Obremskey WT, Jahangir AA, Attum B, Burgos EJ, Molina CS, Rodriguez-Buitrago A, Gajari V, Trochez KM, Halvorson JJ, Miller AN, Goodman JB, Holden MB, McAndrew CM, Gardner MJ, Ricci WM, Spraggs-Hughes A, Collins SC, Taylor TJ, and Zadnik M
- Subjects
- Adult, Anti-Bacterial Agents administration & dosage, Double-Blind Method, Female, Fracture Fixation, Internal adverse effects, Fractures, Ununited etiology, Humans, Intra-Articular Fractures surgery, Male, Middle Aged, Powders, Probability, Prospective Studies, Surgical Wound Dehiscence etiology, Surgical Wound Infection etiology, Time Factors, Vancomycin administration & dosage, Anti-Bacterial Agents therapeutic use, Gram-Negative Bacterial Infections prevention & control, Gram-Positive Bacterial Infections prevention & control, Surgical Wound Infection prevention & control, Tibial Fractures surgery, Vancomycin therapeutic use
- Abstract
Importance: Despite the widespread use of systemic antibiotics to prevent infections in surgically treated patients with fracture, high rates of surgical site infection persist., Objective: To examine the effect of intrawound vancomycin powder in reducing deep surgical site infections., Design, Setting, and Participants: This open-label randomized clinical trial enrolled adult patients with an operatively treated tibial plateau or pilon fracture who met the criteria for a high risk of infection from January 1, 2015, through June 30, 2017, with 12 months of follow-up (final follow-up assessments completed in April 2018) at 36 US trauma centers., Interventions: A standard infection prevention protocol with (n = 481) or without (n = 499) 1000 mg of intrawound vancomycin powder., Main Outcomes and Measures: The primary outcome was a deep surgical site infection within 182 days of definitive fracture fixation. A post hoc comparison assessed the treatment effect on gram-positive and gram-negative-only infections. Other secondary outcomes included superficial surgical site infection, nonunion, and wound dehiscence., Results: The analysis included 980 patients (mean [SD] age, 45.7 [13.7] years; 617 [63.0%] male) with 91% of the expected person-time of follow-up for the primary outcome. Within 182 days, deep surgical site infection was observed in 29 of 481 patients in the treatment group and 46 of 499 patients in the control group. The time-to-event estimated probability of deep infection by 182 days was 6.4% in the treatment group and 9.8% in the control group (risk difference, -3.4%; 95% CI, -6.9% to 0.1%; P = .06). A post hoc analysis of the effect of treatment on gram-positive (risk difference, -3.7%; 95% CI, -6.7% to -0.8%; P = .02) and gram-negative-only (risk difference, 0.3%; 95% CI, -1.6% to 2.1%; P = .78) infections found that the effect of vancomycin powder was a result of its reduction in gram-positive infections., Conclusions and Relevance: Among patients with operatively treated tibial articular fractures at a high risk of infection, intrawound vancomycin powder at the time of definitive fracture fixation reduced the risk of a gram-positive deep surgical site infection, consistent with the activity of vancomycin., Trial Registration: ClinicalTrials.gov Identifier: NCT02227446.
- Published
- 2021
- Full Text
- View/download PDF
34. Exploring the association between initial serum alcohol concentration and polysubstance use: More than a simple "gateway drug" effect?
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Jordan A, Salen P, Wojda TR, Cohen MS, Hasani A, Luster J, Seoane J, Stawicki SP, and Stankewicz H
- Abstract
Introduction: Polysubstance abuse (PSA) is a significant problem affecting our society. In addition to negatively affecting the health and well-being of substance users, alcohol and/or drug abuse is also associated with heavy injury burden. The goal of this study was to determine if elevated serum alcohol (EtOH) levels on initial trauma evaluation correlate with the simultaneous presence of other substances of abuse (SOAs). We hypothesized that PSA would be more common among patients who present with EtOH levels in excess of the legal blood alcohol content (BAC) (≥0.10%)., Methods: An audit of trauma registry records from January 2009 to June 2015 was performed. Abstracted data included patient demographics, BAC measurements, all available formal determinations of urine/serum "drug screening," Glasgow Coma Scale (GCS) assessments, injury mechanism/severity, and 30-day mortality. Stratification of BAC was based on the 0.10% cutoff. Parametric and nonparametric statistical testing was performed, as appropriate, with significance set at α = 0.05., Results: We analyzed 1550 patients (71% males, mean age: 38.7 years) who had both EtOH and SOA screening. Median GCS was 15 (interquartile range [IQR]: 14-15). Median ISS was 9 (IQR: 5-17). Overall 30-day mortality was 4.25%, with no difference between elevated (≥0.10) and normal (<0.10) EtOH groups. For the overall study sample, the median BAC was 0.10% (IQR: 0-0.13). There were 1265 (81.6%) patients with BAC <0.10% and 285 (18.4%) patients with BAC ≥0.10%. The two groups were similar in terms of mechanism of injury (both, ∼95% blunt). Patients with BAC ≥0.10% on initial trauma evaluation were significantly more likely to have the findings consistent with PSA (e.g., EtOH + additional substance) than patients with BAC <0.10% (377/1265 [29.8%] vs. 141/285 [49.5%], respectively, P < 0.001). Among polysubstance users, BAC ≥0.10% was significantly associated with cocaine, marijuana, and opioid use., Conclusions: This study confirms that a significant proportion of trauma patients with admission BAC ≥0.10% present with the evidence of additional substance use. Cocaine and opioids were most strongly associated with acute alcohol intoxication. Our findings support the need for further research in this important area of public health concern. In addition, specific efforts should focus on primary identification, remediation of withdrawal symptoms, prevention of drug-drug interactions, and early PSA intervention., Competing Interests: There are no conflicts of interest.
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- 2018
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35. Intentional ingestions of foreign objects among prisoners: A review.
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Evans DC, Wojda TR, Jones CD, Otey AJ, and Stawicki SP
- Abstract
The intentional ingestion of foreign objects (IIFO) is described more commonly in prison populations than in the general population, with an estimated annual incidence of 1 in 1900 inmates in our state correctional facilities. Incidents often involve ingestion of small metal objects (e.g., paperclips, razor blades) or other commonly available items like pens or eating utensils. Despite ingestion of relatively sharp objects, most episodes can be clinically managed with either observation or endoscopy. Surgery should be reserved for those with signs or symptoms of gastrointestinal perforation or obstruction. For those with a history of IIFO, efforts should focus on prevention of recurrence as subsequent episodes are associated with higher morbidity, significant healthcare and security costs. The pattern of IIFO is often repetitive, with escalation both in frequency of ingestions and in number of items ingested. Little is known about successful prevention strategies, but efforts to monitor patients and provide psychiatric care are potential best-practice strategies. This article aims to provide state-of-the art review on the topic, followed by a set of basic recommendations.
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- 2015
- Full Text
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