Abstract Background Although involvement of geriatricians in the care of older trauma patients is associated with changes in processes of care and improved outcomes, few geriatrician consultations ...were ordered on our service. Study Design Mandatory geriatric consults were initiated in Sept 2013 for all trauma patients 70 years and older admitted to our hospital. We prospectively collected data on patients admitted from Oct 2013–Sept 2014 (post-intervention) and compared to patients admitted from Jun 2011–Jun 2012 (pre-intervention). We collected data on processes of care (Do Not Resuscitate/ Do Not Intubate (DNR/DNI) status, delirium, referral for cognitive evaluation) and patient outcomes (mortality, readmission, length of stay). Descriptive statistics and post-hoc power analyses were performed. Results There were 215 and 191 patients included in the pre-intervention and post-intervention cohorts respectively. After the intervention, geriatric consults increased from 3.26% to 100%. Patients on DNR/DNI status increased from 10.23% to 38.22% ( P <0.01). Referral for formal cognitive evaluation increased from 2.33% to 14.21% ( P <0.01) and delirium documentation increased from 31.16% to 38.22% ( P= 0.14). In-hospital mortality and 30-day mortality in the pre- and post-intervention periods were 9.30% vs. 5.24% ( P =0.12) and 11.63% vs. 6.81% ( P =0.10) respectively. ICU readmission was 8.26% pre-intervention and 1.96% post-intervention ( P =0.06). There were no changes in 30-day hospital readmission and length of stay. Power analyses showed more patients were needed to show statistically significant outcomes. Conclusions The initiation of mandatory geriatric consults on our trauma service was associated with improved advance care planning and increased multidisciplinary care. Ensuring involvement of geriatricians may aid in reducing adverse outcomes among geriatric trauma patients.
Matching into integrated plastic surgery residency is highly competitive. Applicants to these programs are among the most accomplished graduating medical students, consistently demonstrating some of ...the highest United States Medical Licensing Examination scores, mean numbers of research publications, and rates of Alpha Omega Alpha Honor Medical Society membership. The applicant review process requires programs to rely on a number of objective and subjective factors to determine which of these qualified applicants have the most potential for success. We outline these factors, discuss their correlation with resident performance, and provide our institution’s applicant review process both for applicants hoping to optimize their applications for success in the National Resident Matching Program and for program faculty hoping to optimize their resident selection process.
Abstract Background Although high absolute hospital geriatric trauma volume (GTV) is associated with improved outcomes among geriatric trauma patients, the actual geriatric trauma proportion (GTP) ...may be a better predictor of outcomes. Study Design Adult trauma admissions were identified in the California State Inpatient Database, 2007-2011. Hospital characteristics were extracted from the American Hospital Association database. The annual trauma volume of patients 65 years and older (GTV) was calculated. The GTP was derived by dividing the GTV by the overall adult trauma volume and hospitals were categorized into tertiles of GTP. Outcomes were hospital mortality, failure to rescue (FTR) and 30-day readmission in geriatric trauma patients. Independent risk factors were assessed with clustered multivariate logistic regression models adjusted for patient and hospital characteristics. Results There were 61,915 geriatric trauma patients included from 63 trauma centers. Hospital mortality, FTR, and 30-day readmission rates were 4.99%, 16.07% and 12.03% respectively. The adjusted Odds Ratio and 95% Confidence Intervals for in-hospital mortality and FTR per 100 patient increase in GTV were 0.91 (0.83-1.00) and 1.01 (0.90-1.14) respectively. As compared to hospitals in the lowest tertile, adjusted odds of mortality and FTR in the highest tertile were 0.71 (0.54-0.94) and 0.67 (0.48-0.92) respectively. None of the hospital factors measured was significantly associated with readmission. The Wald test revealed that GTP played a larger role than GTV in predicting hospital mortality ( P =0.018 vs. P =0.048) and FTR ( P =0.015 vs. P =0.985). Conclusions Treatment at hospitals with higher GTP is associated with lower hospital mortality and FTR among geriatric patients. These findings suggest that creation of specialized services for geriatric trauma care may improve outcomes among geriatric trauma patients.
Ocular surface disorder--and dry eye, in particular--is a leading reason for visits to eye care professionals. It has been generally accepted that meibomian gland dysfunction (MGD) is a leading cause ...of evaporative dry eye, as well as being associated with aqueous-deficient dry eye. Yet, researchers and clinicians have lacked a global consensus on the definition of MGD, its epidemiology, pathophysiology, and management. Various systemic diseases and medications have been associated with the progression of both dry eye and MGD, as have several ocular disorders beyond those directly affecting the surface. It is in the best interest of patients for clinicians to be able to better identify and diagnose MGD, differentiating it from other ocular surface disorders, and to recognize the effects of MGD on the ocular surface, and thus initiate appropriate therapy. This CME activity provides expert insight into the Tear Film and Ocular Surface Society's International Workshop on MGD consensus report, offering practical application of its findings to better manage MGD patient care, particularly for those patients facing or undergoing ocular surgery.
Deformation of the cranium in infancy represents a spectrum of deformity, ranging from severe asymmetric yet proportional distortion of the skull in plagiocephaly, to nearly symmetric yet ...disproportional distortion in brachycephaly. As such, the condition is best described as deformational plagiocephaly-brachycephaly with isolated plagiocephaly and/or isolated brachycephaly being at either ends of the spectrum. Due to its symmetric appearance, deformational brachycephaly is often incorrectly dismissed as being less concerning, and it has sometimes erroneously been reported that brachycephaly cannot be treated successfully with a cranial orthosis. We prospectively report on 4205 infants with isolated deformational brachycephaly treated with a cranial orthosis from 2013 to 2017. These results demonstrate that the orthosis is successful in the treatment of deformational brachycephaly with an 81.4% improvement toward normal (95.0 to 89.4) in cephalic index. We furthermore demonstrate that entrance age influences treatment results, with younger infants demonstrating both improved outcomes and shorter treatment times.
A simplified and consensus-based donor scoring process could improve donor lung use.
To develop the University of Minnesota Donor Lung Quality Index (UMN-DLQI), we used expert opinion to create an ...online survey that ranked 17 lung donor and recipient factors and graded their importance on a scale of 0 to 10. To arrive at consensus-based weights for each of the 17 factors, we used magnitude estimation (ME) methods. We performed receiver operating characteristic (ROC) analyses to evaluate predictive value. An application (app) was developed to simplify the scoring process. A second review process was instituted for every donor offer with an UMN-DLQI score greater than 40 as of September 2014 (post-donor score era).
Worldwide, 11 transplantation centers (including ours) completed our survey. Results showed strong consensus among transplantation physicians across disparate practices. UMN-DLQI scores greater than 40 provided a sensitivity of 89%, a specificity of 55%, and a positive predictive value of 52% for donor offer acceptance. Number of transplants (63 versus 48) and donor lung use (15.1% versus 8.9%; p = 0.02) were significantly better in the post-donor score era without a penalty in transplantation outcomes. There was a trend toward a lower incidence of any primary graft dysfunction within 72 hours (40% versus 75%; p = 0.06) with a UMN-DLQI greater than 40 but no difference in 30-day or 1-year survival.
The UMN-DLQI scoring app is a simple tool for describing the attributes of a donor lung offer. More attention to scores greater than 40 safely improved donor lung use at a single institution.
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