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Background: This systematic review aims to assess different effective hospital-based violence intervention programs (HVIP) design strategies and their effects on reducing the incidence of violence-related injuries, impact on healthcare outcomes including behavioral and psychosocial outcomes, and effects on healthcare system costs., Methods: A comprehensive search of five databases included studies that assessed the effects of HVIPs in adolescent and adult populations. The outcomes of interest included different effective HVIP design strategies that most effectively decreased the incidence of violence-related injuries, as well as their effects on behavior and psychosocial outcomes, effects on hospital costs, and whether they adequately addressed medico-legal aspects., Results: Following the application of inclusion and exclusion criteria, 25 studies were included in the final analysis. Effective HVIP design strategies primarily focused on mentorship and hands-on learning, contributing to successful program implementation. Overall, HVIPs significantly reduced the incidence of violence-related injuries and recidivism rates among participants. Improvements in psychosocial outcomes were observed, with increased employment rates and educational engagement reported among HVIP participants. Additionally, the included studies demonstrated that implementing HVIPs led to cost-effectiveness as well as cost savings from reduced injury recidivism. Despite the acknowledgment of medico-legal resources' importance, the absence of formal partnerships hinders HVIPs from fully addressing legal barriers to recovery, such as housing insecurity, employment discrimination, and protection from violence., Conclusion: HVIPs are effective in reducing violence-related injuries, enhancing psychosocial outcomes, and offering cost savings, however, they often lack established medico-legal resources. Further research on establishing effective medico-legal partnerships within these programs is needed., Competing Interests: Declaration of competing interest None., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Introduction: This systematic review aims to evaluate the optimal management of acute respiratory distress syndrome (ARDS) in critically ill surgical patients, specifically focusing on positioning, extracorporeal membrane oxygenation (ECMO) use, ventilation, fluid resuscitation, and pharmacological treatments., Methods: A systematic review was conducted utilizing four databases including PubMed, Google Scholar, EMBASE, and ProQuest. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with The International Prospective Register of Systematic Reviews. Studies published until May 20, 2024, that assessed the management of ARDS in critically ill surgical adult populations were included in our review. The primary outcome of interest was mortality, with secondary outcomes like intensive care unit (ICU) length of stay (LOS), ventilator days, and oxygenation also being considered., Results: A total of fifteen studies met inclusion criteria; four studies assessed positional interventions, four assessed treatments with ECMO, three assessed mechanical ventilation settings, and four assessed fluid resuscitation and medications. Prone position was found to decrease mortality, ICU LOS, ventilator days, and increased oxygenation (P < 0.001). ECMO utilization decreased the overall mortality rate when compared to patients without ECMO (36.4% versus 43.9%, P < 0.001). Maintaining a tidal volume ≤8 mL/kg body weight and plateau pressure ≤35 cm H 2 O on mechanical ventilation also decreased patient mortality (P < 0.001). Finally, conservative fluid management decreased ICU LOS, whereas methylprednisolone use demonstrated decreased mortality., Conclusions: Prone positioning, ECMO utilization, lung protective ventilation settings, and methylprednisolone reduced mortality among surgical patients with ARDS. In addition, prone positioning and conservative fluid management were associated with decreased ICU LOS, ventilator days, and improved oxygenation status., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: This review aims to provide a comprehensive overview of electric-scooter (E-Scooter) injuries by evaluating the incidence, common mechanisms of injury, clinical outcomes, associated costs, and effective interventions for injury prevention., Methods: A literature search using PubMed, Google Scholar, EMBASE, and ProQuest was performed to identify relevant articles published between July 10, 2014, and July 10, 2024. Outcomes of interest included epidemiologic trends of E-Scooter injuries, common mechanisms of injury, associated risk factors, clinical outcomes, and interventions to decrease E-Scooter injuries., Results: A total of 41 articles were included in this study, with 39 evaluating the epidemiologic trends of e-scooter injuries, 22 the most common mechanisms of injury, 21 assessed intoxication, 15 assessed helmet usage, 33 determined patient's clinical outcomes, and 3 assessed effective interventions for decreasing the incidence of e-scooter injuries. Falls were the most common mechanism of injury; however, collisions with motor vehicles caused more severe injuries. Additionally, studies showed that up to 74 % of all E-Scooter injuries included alcohol intoxication, and over 80 % did not use a helmet leading to severe head injuries., Conclusion: The incidence of E-Scooter related injuries rose significantly in recent years. These injuries typically result from falls and MVAs and are compounded by factors including limited helmet usage and riding while intoxicated. These contribute to the poorer clinical outcomes seen with E-Scooter injuries. However, there remains a significant paucity of literature focused on the outcomes of policies and interventions designed to reduce these injuries. Further investigation must address these gaps and discrepancies to inform future policies., Competing Interests: Declaration of competing interest Authors have nothing to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: We aim to explore and target factors contributing to disparities in trauma-care outcomes between urban vs rural trauma centers including EMS protocols, trauma centers' (TC) distribution, infrastructure, and hospital resources., Methods: A comprehensive literature review was conducted from January 1988 through April 1st, 2024, using Google Scholar, Embase, Cochrane, ProQuest, and PubMed. Included studies evaluated prehospital and in-hospital factors impacting trauma outcomes in urban and rural care settings. Key outcomes of interest were EMS transport times, TC access, inter-hospital transfers, trauma system utilization, and workforce infrastructure., Results: A review of 29 studies demonstrated prolonged EMS on-scene and transport times, higher undertriage rates, and lower geospatial access to TCs in rural compared to urban settings. Transferring from rural to urban TCs was associated with increased mortality and designating rural TCs as Level III TCs reduced mortality (32 % decrease, p < 0.0001). The unregulated expansion of TCs did not improve patient access or outcomes. Rural hospitals lacked specialized providers, had more hospitalizations (x̄ rural = 685.4 vs x̄ urban = 566.3; p = 0.005), ICU admissions (20.2% vs 11.6 %, p = 0.042), and ventilation requirements (37.8% vs 20.7 %, p = 0.001) among trauma patients., Conclusions: Rural trauma patients often experience worse outcomes than their urban counterparts, possibly due to longer prehospital times, reduced TC access, and less specialized care. The designation of targeted Level III TCs in rural areas has been associated with improved outcomes. In contrast, unregulated TC expansion has not necessarily enhanced access or outcomes for rural patients., Competing Interests: Declaration of competing interest None, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Optimal nutritional support is essential to the recovery and improved outcomes of burn patients. This review aims to explore existing literature to evaluate nutrition assessment tools, feeding formulations' caloric predictive ability, timing of initiation of feeding, optimal nutritional composition, and caloric intake in burn patients., Methods: Three databases were searched to glean studies investigating nutrition in acute severe adult burn patient populations in four areas: outcomes based on feeding type and timing, the caloric predictability of nutritional assessment tools, outcomes associated with the composition of feeding formulas, and considerations related to caloric intake. Outcomes of interest included the effects of nutritional assessments using feeding type, nutritional administration timing, formula composition, and caloric intake on mortality rate, length of stay, and infection., Results: A total of 19 studies were included. Nutritional assessment tools were determined to over- or underestimate resting energy expenditure (REE). Milner was the most accurate alternative to indirect calorimetry. Early enteral nutrition in burn patients within 24 hours of admission was preferred. 5 studies evaluated micronutrients and yielded variable results. Low-fat high-carbohydrate diets were the ideal macronutrient composition. Burn patients were shown to receive lower caloric intake than recommended., Conclusions: Findings showed that while nutritional assessment tools tend to inaccurately estimate REE in burn patients, the ideal alternative to indirect calorimetry is the Milner equation. Several new equations may be worthy alternatives but require further validation. Enteral feeding should be initiated within the first 24 hours of burn injury whenever possible and should contain a high-carbohydrate/low-fat composition., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The Wood lamp is an effective diagnostic tool for skin conditions such as vitiligo, erythrasma, and scabies. However, it can be an expensive and cumbersome tool or may be unavailable in some settings. Smartphone applications that simulate UV light may be helpful in these instances.

We aim to investigate nationwide and state trends of bicyclist injuries, fatalities, and associated costs amongst adult and pediatric populations to assess the need for effective and strategic interventions. An epidemiologic study was performed investigating the injury and fatality rate of bicyclists from 2010 to 2020. The fatality rate was higher in adults compared to pediatric bicyclists (0.36 vs. 0.12 per population of 100,000, P < .001), but pediatric bicyclists suffered higher rates of injury (246.19 vs. 102.11 per population of 100,000, P < .001). The medical cost of fatalities for adult bicyclists was $139.1 million compared to $9.0 million for pediatric bicyclists. Bicyclist fatality rates are significantly higher per capita for adult bicyclists. States including Florida, South Carolina, and Louisiana had the highest bicyclist fatalities per capita for both adults and children., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Despite the increasing importance of coding and billing in healthcare as a whole and calls from the Accreditation Council for Graduate Medical Education (ACGME) to emphasize systems-based practice, many surgical training programs have not prioritized coding and billing within their curricula. We aim to evaluate the performance of surgical residents and early career surgeons in coding and billing and to appraise interventions to improve coding and billing abilities within this group., Methods: A literature search from conception to March 15th, 2022 utilizing PubMed, Google Scholar, and EMBASE was conducted to search for studies that evaluate surgical resident coding practices and interventions to improve practice management and financial competency., Results: Discrepancies in coding and billing ability are prominent between residents, surgeons, and professional coders. One study demonstrated coding accuracy of 76.5% for professional coders, 62.1% for surgical attendings, and 54.1% for surgical residents, whereas another study reported a 52.82% coding accuracy and residents. Resident performance in coding and billing was inferior to their more experienced surgical attending counterparts and professional coders. Surgical residents and fellows demonstrated significantly improved knowledge and confidence in coding following the administration of either individual or longitudinal educational interventions., Conclusion: Coding and billing discrepancies among students, residents, and surgeons persist due to a lack of formalized training. Integration of standardized and mandated medical coding curricula and interventions within residency programs has great potential to improve surgical coding practices and should be a mandatory component of graduate medical education.

Introduction: A debate currently exists regarding the efficacy of pigtail catheters vs chest tubes in the management of thoracic trauma. This meta-analysis aims to compare the outcomes of pigtail catheters vs chest tubes in adult trauma patients with thoracic injuries., Methods: This systematic review and meta-analysis were conducted using PRISMA guidelines and registered with PROSPERO. PubMed, Google Scholar, Embase, Ebsco, and ProQuest electronic databases were queried for studies comparing the use of pigtail catheters vs chest tubes in adult trauma patients from database inception to August 15th, 2022. The primary outcome was the failure rate of drainage tubes, defined as requiring a second tube placement or VATS, unresolved pneumothorax, hemothorax, or hemopneumothorax requiring additional intervention. Secondary outcomes were initial drainage output, ICU-LOS, and ventilator days., Results: A total of 7 studies satisfied eligibility criteria and were assessed in the meta-analysis. The pigtail group had higher initial output volumes vs the chest tube group, with a mean difference of 114.7 mL [95% CI (70.6 mL, 158.8 mL)]. Patients in the chest tube group also had a higher risk of requiring VATS vs the pigtail group, with a relative risk of 2.77 [95% CI (1.50, 5.11)]., Conclusions: In trauma patients, pigtail catheters rather than chest tubes are associated with higher initial output volume, reduced risk of VATS, and shorter tube duration. Considering the similar rates of failure, ventilator days, and ICU length-of-stay, pigtail catheters should be considered in the management of traumatic thoracic injuries., Study Type: Systematic Review and meta-analysis.

Introduction: Current literature contains an extensive number of analyses on the diagnostic value and utilization of the direct rectal exam in trauma patients. Presently, ATLS recommends the application of the digital rectal exam in trauma patients following a primary assessment of traumatic injuries. We aim to assess the validity and diagnostic value of the digital rectal exam in trauma populations., Methods: PubMed, Google Scholar, EMBASE, ProQuest, and CINAHL databases were searched for studies from the date of database conception to August 6th, 2022. Studies that assessed the validity of the digital rectal exam performed in the emergency department or trauma bay, in both adult and pediatric trauma patients were included. Study outcomes and measurements of validity were summarized and compared., Results: A total of 9 studies met inclusion criteria for both adult and pediatric trauma populations. The sensitivity of the digital rectal exam in detecting both spinal cord and urethral injuries in adult trauma populations ranged from 0 to 50%, while the sensitivity in detecting gastrointestinal injuries ranged from 0% to 51%. When compared to other clinical indicators, the digital rectal exam was consistently worse at detecting injuries. Within the pediatric trauma populations, the digital rectal exam resulted in high false negative rates ranging from 66% to 100%, failing to detect all urethral and gastrointestinal injuries and pelvic fractures., Conclusion: The use of digital rectal exams in trauma patients illustrates limited to no validity and reliability in assessing pertinent injuries and does not influence the management of injuries. Trauma societies should consider creating guidelines and algorithms to clarify the use of digital rectal exams in specific situations and injury types., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: Surgeon burnout has received increasing attention due to evidence of high prevalence across specialties. We aimed to (1) systematically characterize existing definitions of burnout, (2) evaluate tools to measure burnout, and (3) determine risk factors of surgical burnout., Design: PubMed, Google Scholar, and Embase databases were searched to identify burnout rates and tools used to measure the quality of life (QoL) published from January 2000-December 2021., Participants: Surgical Trainees and Practicing Surgeons., Results: We identified 39 studies that defined surgical burnout, with 9 separate tools used to measure QoL. Surgeon burnout rates were found to be highest among general surgery trainees (20%-95%). Burnout among general surgery attendings ranged from 25% to 44%. Those most likely to experience burnout were younger and female. High rates of surgeon burnout were reported among all surgical specialties; however, these rates were lower than those of general surgeons., Conclusion: Definitions of burnout vary throughout the surgical literature, but are consistently characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. The most utilized tool to measure surgical burnout has been the Maslach Burnout Inventory. Across specialties, there are high rates of burnout in both surgical trainees and attendings, indicating that this is a systemic issue within the field of surgery. Given the wide-scale nature of the problem, it is recommended that institutions provide support to surgical trainees and attending surgeons and that individual surgeons take steps toward mitigating burnout., (Copyright © 2022. Published by Elsevier Inc.)

Introduction: The aim of this study is to investigate the gender distribution of first and senior authors in the most highly cited original research studies published in the top 10 surgical journals from 2015 to 2020 to identify disparities and changes over time., Methods: A retrospective study analyzing the gender distribution of first and senior authors in the top 10 most cited studies from the top 10 surgical journals from 2015 to 2020. The genders of the first and senior authors of each study were assessed using National Provider Identifier (NPI) numbers or pronouns from institutional biographies or news articles., Results: The genders of 1200 first and senior authors from 600 original research studies were assessed. First author gender distribution consisted of 71.8% men, 22.3% women, 0% non-binary, and 5.8% unknown. Senior author gender distribution was 82.3% men, 14.3% women, 0% non-binary, and 3.3% unknown. Studies published by first authors who are women received more citations than those published by first authors that are men in 2015 (169.1 versus 112.9, P = 0.002) and 2016 (144.2 versus 101.5, P = 0.011). There was an increase in first authorship among men from 2015 to 2020 (P = 0.035)., Conclusions: Men represent a significantly higher proportion of both first and senior authorships in top surgical research and the gap has widened from 2015 to 2020. However, studies written by women first authors received significantly more citations than those written by men., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Opioids have been proven effective in pain management, but overprescription can lead to addiction and abuse. Although current guidelines regarding opioid prescription for chronic and acute pain are available, they fail to address the use of opioids for pain management in traumatic injury patients who undergo operations. The primary objective of this study was to examine opioid prescribing practices for US adult trauma patients who require surgical management, based on prior history of opioid use, type of surgical practice, and age., Methods: PubMed and Cochrane Journals were used to identify relevant articles between October 2010 and December 29, 2020. Our primary outcome was discrepancies of morphine milligram equivalents (MMEs) prescribed to trauma patients. Significance was defined as p < 0.05., Results: Eleven studies on US trauma patients prescribed opioids were evaluated, creating a total of 30,249 patients stratified by prior opioid use, age, and race. Patterns seen among patients with prior opioid use include higher MMEs prescribed, lower likelihoods of opioid discontinuation, higher mortality rates, and higher complication rates. Orthopedic surgeons prescribed higher values of MMEs than nonorthopedic surgeons., Conclusion: Higher incidences of opioid prescriptions are seen with orthopedic trauma surgery and prior opioid use by the patient. We recommend further development of national protocol implementation for acute pain management for the US trauma population., Level of Evidence: Systematic review, level III., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The purpose of this systematic review was to study 4 different aspects of Roux-en-Y gastric bypass (RYBG) and sleeve gastrectomy (SG). Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are two commonly performed bariatric procedures. This systematic review aims to compare RYGB with SG when it comes to weight changes, and cardiometabolic risk profile. Another aim was to evaluate laparoscopic and robotic techniques for both surgeries. PubMED, Cochrane Library, and JAMA Network were searched for articles evaluating RYGB and SG from 2005-2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Four different categories were analyzed comparing RYGB with SG as well as robotic versus laparoscopic approach. The Critical Appraisal Skills Program (CASP) checklist was used to assess the quality of evidence in the studies included in this systematic review. A total of 29 studies were included looking at different aspects of RYGB and SG. RYGB is superior to SG for weight loss, improved or complete remission of cholesterol and hypertensive medications. Consensus is lacking regarding decrease in BMI, total cholesterol, and triglycerides. There is lack of evidence regarding decrease of incidence of MI or stroke. For RYGB and SG, the majority of studies found that the robotic technique was more expensive and took longer. RYGB when compared with SG was associated with larger weight loss, decreased or cessation of cholesterol and hypertensive medications, and lower cholesterol. Decrease in BMI had varying results, with RYGB being superior in more studies, while there was no difference in other studies. There was a lack of evidence to support if RYGB or SG was superior to decreasing triglyceride levels. For both RYGB and SG, the robotic approach was costlier and took more operating time versus the laparoscopic approach., (Copyright © 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The physician shortage in the United States (US) continues to become more apparent. We aimed to evaluate the relationship between the US physician distribution from 2012-2019 by specialty at the state/regional level relative to the corresponding population growth., Methods: US matched residents and practicing physicians from 2012-2019 were extracted from the National Resident Matching Program and Association of American Medical College databases, respectively. Residents and practicing physicians were divided by geographic regions (West, Midwest, South, Northeast), states, and specialties (anesthesiology, emergency medicine, family medicine, general surgery (GS), internal medicine, obstetrics/gynecology and pediatrics)., Results: Entering residents and physicians increased across 7 specialties from 2012-2019 with the exception of GS, which showed .2% decrease in practicing physicians. GS experienced decreases in entering residents in all US regions except the South. All specialties showed a decrease in the people-per-physician (PPP) except GS and pediatrics, which had a 4.1% and 71.3% increase, respectively. EM showed the largest growth overall, both in entering residents and overall workforce., Conclusion: GS experienced slow growth of residents, decreases in practicing physicians and workforce overall, and an increase in PPP from 2012-2019. Our findings suggest that current population growth rate is exceeding the rate of physicians entering the field of GS and highlights the need for interventions to promote the recruitment of GS residents and retainment of attending physicians, particularly for rural areas. Future research to measure surgeon distribution in relation to patient outcomes and the efficacy of recent policy to address shortages can help define additional interventions to address physician shortages moving forward.