279 results on '"Brasel KJ"'
Search Results
2. Statistical machines for trauma hospital outcomes research: Application to the PRospective, Observational, Multi-center Major trauma Transfusion (PROMMTT) study
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Moore, SE, Decker, A, Hubbard, A, Callcut, RA, Fox, EE, Del Junco, DJ, Holcomb, JB, Rahbar, MH, Wade, CE, Schreiber, MA, Alarcon, LH, Brasel, KJ, Bulger, EM, Cotton, BA, Muskat, P, Myers, JG, Phelan, HA, Cohen, MJ, Moore, SE, Decker, A, Hubbard, A, Callcut, RA, Fox, EE, Del Junco, DJ, Holcomb, JB, Rahbar, MH, Wade, CE, Schreiber, MA, Alarcon, LH, Brasel, KJ, Bulger, EM, Cotton, BA, Muskat, P, Myers, JG, Phelan, HA, and Cohen, MJ
- Abstract
Improving the treatment of trauma, a leading cause of death worldwide, is of great clinical and public health interest. This analysis introduces flexible statistical methods for estimating center-level effects on individual outcomes in the context of highly variable patient populations, such as those of the PRospective, Observational, Multi-center Major Trauma Transfusion study. Ten US level I trauma centers enrolled a total of 1,245 trauma patients who survived at least 30 minutes after admission and received at least one unit of red blood cells. Outcomes included death, multiple organ failure, substantial bleeding, and transfusion of blood products. The centers involved were classified as either large or small-volume based on the number of massive transfusion patients enrolled during the study period. We focused on estimation of parameters inspired by causal inference, specifically estimated impacts on patient outcomes related to the volume of the trauma hospital that treated them. We defined this association as the change in mean outcomes of interest that would be observed if, contrary to fact, subjects from large-volume sites were treated at small-volume sites (the effect of treatment among the treated). We estimated this parameter using three different methods, some of which use data-adaptive machine learning tools to derive the outcome models, minimizing residual confounding by reducing model misspecification. Differences between unadjusted and adjusted estimators sometimes differed dramatically, demonstrating the need to account for differences in patient characteristics in clinic comparisons. In addition, the estimators based on robust adjustment methods showed potential impacts of hospital volume. For instance, we estimated a survival benefit for patients who were treated at large-volume sites, which was not apparent in simpler, unadjusted comparisons. By removing arbitrary modeling decisions from the estimation process and concentrating on parameters that
- Published
- 2015
3. TREATMENT OF OCCULT PNEUMOTHORACES FROM BLUNT TRAUMA
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Brasel, KJ, primary, Stafford, RE, additional, Tenquist, JE, additional, Borgstrom, &NA;, additional, and Weigelt, JA, additional
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- 1998
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4. The Dedicated Operating Room for Trauma
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Brasel, KJ, primary, Akason, J, additional, and Weigelt, JA, additional
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- 1997
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5. Injury severity and quality of life: whose perspective is important?
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Brasel KJ, Deroon-Cassini T, and Bradley CT
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- 2010
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6. Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial.
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Biffl WL, Kaups KL, Cothren CC, Brasel KJ, Dicker RA, Bullard MK, Haan JM, Jurkovich GJ, Harrison P, Moore FO, Schreiber M, Knudson MM, and Moore EE
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- 2009
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7. Rib fractures: relationship with pneumonia and mortality.
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Brasel KJ, Guse CE, Layde P, and Weigelt JA
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OBJECTIVE: In single-institution studies, age is a risk factor for mortality after rib fracture. Sample size has limited the assessment of other risk factors. We used a national database to analyze suspected risk factors contributing to pneumonia and mortality in patients sustaining rib fractures. DESIGN: Database analysis. PATIENTS: All patients with rib fractures discharged from hospitals submitting information to the Nationwide Inpatient Sample database. INTERVENTIONS: The 1999 Nationwide Inpatient Sample was queried for all patients with rib fracture. Age, gender, number of rib fractures, Injury Severity Score, comorbidities, pneumonia, and mortality were abstracted from the database. Comorbidities were scored according to Elixhauser. Multivariate analysis identified independent risk factors for mortality and pneumonia. MEASUREMENTS AND MAIN RESULTS: We identified 23,426 patients; 17,308 patients had a primary diagnosis of trauma and were included in the analysis. Mean age was 56. Mean Injury Severity Score was 13.1. The number of comorbidities ranged from 0 to 9. Overall mortality was 4%. Six percent of patients had pneumonia. In a multivariate model, age and Injury Severity Score were significantly associated with both mortality and pneumonia. Comorbidity score was associated with pneumonia and mortality only in patients with isolated thoracic trauma. Pneumonia was associated with mortality only in patients with isolated thoracic trauma. CONCLUSIONS: In a model controlling for multiple known risk factors, age and Injury Severity Score were the only important predictors of mortality in patients with rib fractures and multiple-system injury. Pneumonia was significantly associated with mortality only in patients with isolated thoracic trauma. [ABSTRACT FROM AUTHOR]
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- 2006
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8. Correlation of intracellular organisms with quantitative endotracheal aspirate.
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Brasel KJ, Allen B, Edmiston C, and Weigelt JA
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- 2003
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9. Food dye use in enteral feedings: a review and a call for a moratorium.
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Maloney JP, Ryan TA, Brasel KJ, Binion DG, Johnson DR, Halbower AC, Frankel EH, Nyffeler M, and Moss M
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- 2002
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10. Incidence and significance of free fluid on abdominal computed tomographic scan iin blunt trauma.
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Brasel KJ, Olson CJ, Stafford RE, and Johnson TJ
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- 1998
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11. Dedicated operating room for trauma: a costly recommendation.
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Brasel KJ, Akason J, and Weigelt JA
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- 1998
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12. Splenic injury: trends in evaluation and management.
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Brasel KJ, DeLisle CM, Olson CJ, and Borgstrom DC
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- 1998
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13. Cost-effective prevention of pulmonary embolus in high-risk trauma patients.
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Brasel KJ, Borgstrom DC, and Weigelt JA
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- 1997
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14. The association of blood component use ratios with the survival of massively transfused trauma patients with and without severe brain injury.
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Brasel KJ, Vercruysse G, Spinella PC, Wade CE, Blackbourne LH, Borgman MA, Zarzabal LA, Du F, Perkins JG, Maegele M, Schreiber M, Hess JR, Jastrow KM 3rd, Gonzalez EA, Holcomb JB, Kozar R, MacLeod J, Dutton RP, Duchesne JC, and McSwain NE
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- 2011
15. Increased platelet:RBC ratios are associated with improved survival after massive transfusion.
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Holcomb JB, Zarzabal LA, Michalek JE, Kozar RA, Spinella PC, Perkins JG, Matijevic N, Dong JF, Pati S, Wade CE, Cotton BA, Brasel KJ, Vercruysse GA, MacLeod JB, Dutton RP, Hess JR, Duchesne JC, McSwain NE, Muskat PC, and Johannigamn JA
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- 2011
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16. An executive summary of the National Trauma Research Action Plan.
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Bulger EM, Bixby PJ, Price MA, Villarreal CL, Moreno AN, Herrera-Escobar JP, Bailey JA, Brasel KJ, Cooper ZR, Costantini TW, Gibran NS, Groner JI, Joseph B, Newgard CD, and Stein DM
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- Humans, United States, Traumatology organization & administration, Wounds and Injuries therapy, Biomedical Research organization & administration
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Abstract: The National Trauma Research Action Plan project successfully engaged multidisciplinary experts to define opportunities to advance trauma research and has fulfilled the recommendations related to trauma research from the National Academies of Sciences, Engineering and Medicine report. These panels identified more than 4,800 gaps in our knowledge regarding injury prevention and the optimal care of injured patients and laid out a priority framework and tools to support researchers to advance this field. Trauma research funding agencies and researchers can use this executive summary and supporting manuscripts to strategically address and close the highest priority research gaps. Given that this is the most significant public health threat facing our children, young adults, and military service personnel, we must do better in prioritizing these research projects for funding and providing grant support to advance this work. Through the Coalition for National Trauma Research, the trauma community is committed to a coordinated, collaborative approach to address these critical knowledge gaps and ultimately reduce the burden of morbidity and mortality faced by our patients., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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17. Decision-Making Confidence of Clinical Competency Committees for Entrustable Professional Activities.
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Montgomery KB, Mellinger JD, McLeod MC, Jones A, Zmijewski P, Sarosi GA Jr, Brasel KJ, Klingensmith ME, Minter RM, Buyske J, and Lindeman B
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- Humans, Pilot Projects, Male, Competency-Based Education, Female, United States, Clinical Competence, Internship and Residency, General Surgery education, Decision Making
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Importance: A competency-based assessment framework using entrustable professional activities (EPAs) was endorsed by the American Board of Surgery following a 2-year feasibility pilot study. Pilot study programs' clinical competency committees (CCCs) rated residents on EPA entrustment semiannually using this newly developed assessment tool, but factors associated with their decision-making are not yet known., Objective: To identify factors associated with variation in decision-making confidence of CCCs in EPA summative entrustment decisions., Design, Setting, and Participants: This cohort study used deidentified data from the EPA Pilot Study, with participating sites at 28 general surgery residency programs, prospectively collected from July 1, 2018, to June 30, 2020. Data were analyzed from September 27, 2022, to February 15, 2023., Exposure: Microassessments of resident entrustment for pilot EPAs (gallbladder disease, inguinal hernia, right lower quadrant pain, trauma, and consultation) collected within the course of routine clinical care across four 6-month study cycles. Summative entrustment ratings were then determined by program CCCs for each study cycle., Main Outcomes and Measures: The primary outcome was CCC decision-making confidence rating (high, moderate, slight, or no confidence) for summative entrustment decisions, with a secondary outcome of number of EPA microassessments received per summative entrustment decision. Bivariate tests and mixed-effects regression modeling were used to evaluate factors associated with CCC confidence., Results: Among 565 residents receiving at least 1 EPA microassessment, 1765 summative entrustment decisions were reported. Overall, 72.5% (1279 of 1765) of summative entrustment decisions were made with moderate or high confidence. Confidence ratings increased with increasing mean number of EPA microassessments, with 1.7 (95% CI, 1.4-2.0) at no confidence, 1.9 (95% CI, 1.7-2.1) at slight confidence, 2.9 (95% CI, 2.6-3.2) at moderate confidence, and 4.1 (95% CI, 3.8-4.4) at high confidence. Increasing number of EPA microassessments was associated with increased likelihood of higher CCC confidence for all except 1 EPA phase after controlling for program effects (odds ratio range: 1.21 [95% CI, 1.07-1.37] for intraoperative EPA-4 to 2.93 [95% CI, 1.64-5.85] for postoperative EPA-2); for preoperative EPA-3, there was no association., Conclusions and Relevance: In this cohort study, the CCC confidence in EPA summative entrustment decisions increased as the number of EPA microassessments increased, and CCCs endorsed moderate to high confidence in most entrustment decisions. These findings provide early validity evidence for this novel assessment framework and may inform program practices as EPAs are implemented nationally.
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- 2024
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18. Risk of motor vehicle collision associated with cannabis and alcohol use among patients presenting for emergency care.
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Choo EK, Trent SA, Nishijima DK, Eichelberger A, Kazmierczak S, Ye Y, Brasel KJ, Audett A, and Cherpitel CJ
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- Humans, Cross-Sectional Studies, Risk Factors, Motor Vehicles, Emergency Service, Hospital, Ethanol, Accidents, Traffic, Cannabis
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Background: The objective of this study was to examine the relationship between cannabis and alcohol use and occurrence of motor vehicle collision (MVC) among patients in the emergency department (ED)., Methods: This was a cross-sectional study of visits to EDs in Denver, CO, Portland, OR, and Sacramento, CA by drivers who were involved in MVCs and presented with injuries (cases) and non-injured drivers (controls) who presented for medical care. We obtained blood samples and measured delta-9-THC and its metabolites. Alcohol levels were determined by breathalyzer or samples taken in the course of clinical care. Participants completed a research-assistant-administered interview consisting of questions about drug and alcohol use prior to their visit, context of use, and past-year drug and alcohol use. Multiple logistic regression was used to estimate the association between MVC and cannabis/alcohol use, adjusted for demographic characteristics. We then stratified participants based on levels of cannabis use and calculated the odds of MVC across these levels, first using self-report and then using blood levels for delta-9-THC in separate models. We conducted a case-crossover analysis, using 7-day look-back data to allow each participant to serve as their own control. Sensitivity analyses examined the influence of usual use patterns and driving in a closed (car, truck, van) versus open (motorcycle, motorbike, all-terrain vehicle) vehicle., Results: Cannabis alone was not associated with higher odds of MVC, while acute alcohol use alone, and combined use of alcohol and cannabis were both independently associated with higher odds of MVC. Stratifying by level of self-reported or measured cannabis use, higher levels were not associated with higher odds for MVC, with or without co-use of alcohol; in fact, high self-reported acute cannabis use was associated with lower odds of MVC (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.05-0.65). In the case-crossover analysis, alcohol use alone or in combination with cannabis was associated with higher odds of MVC, while cannabis use alone was again associated with decreased odds of MVC., Conclusions: Alcohol use alone or in conjunction with cannabis was consistently associated with higer odds for MVC. However, the relationship between measured levels of cannabis and MVC was not as clear. Emphasis on actual driving behaviors and clinical signs of intoxication to determine driving under the influence has the strongest rationale., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Eichelberger is an employee of the Insurance Institute of Highway Safety, the funder of the study., (Copyright © 2024. Published by Elsevier Ltd.)
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- 2024
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19. Validity of Entrustable Professional Activities in a National Sample of General Surgery Residency Programs.
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Montgomery KB, Mellinger JD, Jones A, McLeod MC, Zmijewski P, Sarosi GA Jr, Brasel KJ, Klingensmith ME, Minter RM, Buyske J, and Lindeman B
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- Humans, Pilot Projects, Education, Medical, Graduate, Clinical Competence, Competency-Based Education, Internship and Residency
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Background: The American Board of Surgery has endorsed competency-based education as vital to the assessment of surgical training. From 2018 to 2020, a national pilot study was conducted at 28 general surgery programs to evaluate feasibility of implementing entrustable professional activities (EPAs) for 5 common general surgical conditions. ACGME core competency Milestones were also rated for each resident by program clinical competency committees. This study aimed to evaluate the validity of general surgery EPAs compared with Milestones., Study Design: Prospectively collected, de-identified EPA Pilot Study data were analyzed. EPAs studied were EPA-1 (gallbladder), EPA-2 (inguinal hernia), EPA-3 (right lower quadrant pain), EPA-4 (trauma), and EPA-5 (consult). Variables abstracted included levels of EPA entrustment (1 to 5) and corresponding ACGME Milestone subcompetency ratings (1 to 5) for the same study cycle. Spearman's correlations were used to evaluate the relationship between summative EPA scores and corresponding Milestone ratings., Results: A total of 493 unique residents received a summative entrustment decision. EPA summative entrustment scores had moderate-to-strong positive correlation with mapped Milestone subcompetencies, with median rho value of 0.703. Among operation-focused EPAs, median rho values were similar between EPA-1 (0.688) and EPA-2 (0.661), but higher for EPA-3 (0.833). EPA-4 showed a strong positive correlation with diagnosis and communication competencies (0.724), whereas EPA-5, mapped to the most Milestone subcompetencies, had the lowest median rho value (0.455)., Conclusions: Moderate-to-strong positive correlation was noted between EPAs and patient care, medical knowledge, and communication Milestones. These findings support the validity of EPAs in general surgery and suggest that EPA assessments can be used to inform Milestone ratings by clinical competency committees., (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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20. Faculty Entrustment and Resident Entrustability.
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Millar JK, Matusko N, Evans J, Baker SJ, Lindeman B, Jung S, Minter RM, Weinstein E, Goodstein F, Cook MR, Brasel KJ, and Sandhu G
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- Humans, Male, Female, Operating Rooms, Cross-Sectional Studies, Faculty, Medical, Professional Autonomy, Clinical Competence, Communication, Internship and Residency
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Importance: As the surgical education paradigm transitions to entrustable professional activities, a better understanding of the factors associated with resident entrustability are needed. Previous work has demonstrated intraoperative faculty entrustment to be associated with resident entrustability. However, larger studies are needed to understand if this association is present across various surgical training programs., Objective: To assess intraoperative faculty-resident behaviors and determine if faculty entrustment is associated with resident entrustability across 4 university-based surgical training programs., Design, Setting, and Participants: This cross-sectional study was conducted at 4 university-based surgical training programs from October 2018 to May 2022. OpTrust, a validated tool designed to assess both intraoperative faculty entrustment and resident entrustability behaviors independently, was used to assess faculty-resident interactions. A total of 94 faculty and 129 residents were observed. Purposeful sampling was used to create variation in type of operation performed, case difficulty, faculty-resident pairings, faculty experience, and resident training level., Main Outcomes and Measures: Observed resident entrustability scores (scale 1-4, with 4 indicating full entrustability) were compared with reported measures (faculty level, case difficulty, resident postgraduate year [PGY], resident gender, observation month) and observed faculty entrustment scores (scale 1-4, with 4 indicating full entrustment). Path analysis was used to explore direct and indirect effects of the predictors. Associations between resident entrustability and faculty entrustment scores were assessed by pairwise Pearson correlation coefficients., Results: A total of 338 cases were observed. Cases observed were evenly distributed by faculty experience (1-5 years' experience: 67 [20.9%]; 6-14 years' experience: 186 [58%]; ≥15 years' experience: 67 [20.9%]), resident PGY (PGY 1: 28 [8%]; PGY 2: 74 [22%]; PGY 3: 64 [19%]; PGY 4: 40 [12%]; PGY 5: 97 [29%]; ≥PGY 6: 36 [11%]), and resident gender (female: 183 [54%]; male: 154 [46%]). At the univariate level, PGY (mean [SD] resident entrustability score range, 1.44 [0.46] for PGY 1 to 3.24 [0.65] for PGY 6; F = 38.92; P < .001) and faculty entrustment (2.55 [0.86]; R2 = 0.94; P < .001) were significantly associated with resident entrustablity. Path analysis demonstrated that faculty entrustment was associated with resident entrustability and that the association of PGY with resident entrustability was mediated by faculty entrustment at all 4 institutions., Conclusions and Relevance: Faculty entrustment remained associated with resident entrustability across various surgical training programs. These findings suggest that efforts to develop faculty entrustment behaviors may enhance intraoperative teaching and resident progression by promoting resident entrustability.
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- 2024
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21. Implementation of Entrustable Professional Activities in General Surgery: Results of a National Pilot Study.
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Brasel KJ, Lindeman B, Jones A, Sarosi GA, Minter R, Klingensmith ME, Whiting J, Borgstrom D, Buyske J, and Mellinger JD
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- Humans, Pilot Projects, Education, Medical, Graduate, Competency-Based Education methods, Clinical Competence, Internship and Residency
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Objective: The ongoing complexity of general surgery training has led to an increased focus on ensuring the competence of graduating residents. Entrustable professional activities (EPAs) are units of professional practice that provide an assessment framework to drive competency-based education. The American Board of Surgery convened a group from the American College of Surgeons, Accreditation Council for Graduate Medical Education (ACGME) Surgery Review Committee, and Association of Program Directors in Surgery to develop and implement EPAs in a pilot group of residency programs across the country. The objective of this pilot study was to determine the feasibility and utility of EPAs in general surgery resident training., Methods: 5 EPAs were chosen based on the most common procedures reported in ACGME case logs and by practicing general surgeons (right lower quadrant pain, biliary disease, inguinal hernia), along with common activities covering additional ACGME milestones (performing a consult, care of a trauma patient). Levels of entrustment assigned (1 to 5) were observation only, direct supervision, indirect supervision, unsupervised, and teaching others. Participating in site recruitment and faculty development occurred from 2017 to 2018. EPA implementation at individual residency programs began on July 1, 2018, and was completed on June 30, 2020. Each site was assigned 2 EPAs to implement and collected EPA microassessments on residents for those EPAs. The site clinical competency committees (CCC) used these microassessments to make summative entrustment decisions. Data submitted to the independent deidentified data repository every 6 months included the number of microassessments collected per resident per EPA and CCC summative entrustment decisions., Results: Twenty-eight sites were selected to participate in the program and represented geographic and size variability, community, and university-based programs. Over the course of the 2-year pilot programs reported on 14 to 180 residents. Overall, 6,272 formative microassessments were collected (range, 0 to 1144 per site). Each resident had between 0 and 184 microassessments. The mean number of microassessments per resident was 5.6 (SD = 13.4) with a median of 1 [interquartile range (IQR) = 6]. There were 1,763 summative entrustment ratings assigned to 497 unique residents. The average number of observations for entrustment was 3.24 (SD 3.61) with a median of 2 (IQR 3). In general, PGY1 residents were entrusted at the level of direct supervision and PGY5 residents were entrusted at unsupervised practice or teaching others. For each EPA other than the consult EPA, the degree of entrustment reported by the CCC increased by resident level., Conclusions: These data provide evidence that widespread implementation of EPAs across general surgery programs is possible, but variable. They provide meaningful data that graduating chief residents are entrusted by their faculty to perform without supervision for several common general surgical procedures and highlight areas to target for the successful widespread implementation of EPAs., Competing Interests: A.J., J.B., and J.D.M. are employees of the American Board of Surgery. K.J.B., B.L., G.A.S., J.W., M.E.K., and R.M. are or have been volunteers for the American Board of Surgery. The remaining author reports no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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22. Pediatric emergency resuscitative thoracotomy: A Western Trauma Association, Pediatric Trauma Society, and Eastern Association for the Surgery of Trauma collaborative critical decisions algorithm.
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Martin MJ, Brasel KJ, Brown CVR, Hartwell JL, de Moya M, Inaba K, Ley EJ, Moore EE, Peck KA, Rizzo AG, Rosen NG, Weinberg JA, Coimbra R, Crandall M, Mukherjee K, Ignacio R, Longshore S, Flynn-O'Brien KT, Ng G, Selesner L, and Jafri M
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- Humans, Child, Thoracotomy, Emergency Service, Hospital, Retrospective Studies, Resuscitation, Algorithms, Wounds, Penetrating surgery, Wounds, Nonpenetrating surgery
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Level of Evidence: Literature synthesis and expert opinion, Level V., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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23. The Journal of Trauma and Acute Care Surgery position on the issue of disclosure of conflict of interests by authors of scientific manuscripts.
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Biffl WL, Stein DM, Livingston DH, Winchell RJ, Diaz JJ, Albrecht R, Brasel KJ, Burlew CC, Costantini TW, Dicker RA, Inaba K, Kozar RA, Nance ML, Napolitano LM, Salim A, Santry HP, Valadka AB, Wolinsky P, Zarzaur B, and Coimbra R
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- Disclosure, Conflict of Interest
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- 2023
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24. The Value of a Spork.
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Brasel KJ
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- 2023
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25. Integrating Surgical Palliative Care Into the Full Spectrum of Medical Education.
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Cook MR, Schultz Reed K, Crannell WC, Brasel KJ, and Siegel TR
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- Humans, Palliative Care, Education, Medical, Graduate, Curriculum, Education, Medical, Internship and Residency, Education, Medical, Undergraduate
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We describe our institutional approach to incorporating surgical palliative care education into the Undergraduate Medical Education, Graduate Medical Education and Continuing Medical Education spaces as a model to help guide similarly interested educators. We had a well-established Ethics and Professionalism Curriculum, but an educational needs assessment revealed that both the residents and faculty felt that additional training in palliative care principles was crucial. We describe our full spectrum palliative care curriculum, which begins with the medical students on their surgical clerkship and continues with a 4 week surgical palliative care rotation for categorical general surgery PGY-1 residents, as well as a Mastering Tough Conversations course over several months at the end of the first year. Surgical Critical Care rotations, Intensive Care Unit debriefs after major complications, deaths, and other high-stress events are described, as is the CME domain, which includes routine Department of Surgery Death Rounds and a focus on palliative care concepts in Departmental Morbidity and Mortality conference. The Peer Support program and Surgical Palliative Care Journal Club round out our current educational endeavor. We describe our plans to create a full spectrum surgical palliative care curriculum that is fully integrated with the 5 clinical years of surgical residency, and include our proposed educational goals and year-specific objectives. The development of a Surgical Palliative Care Service is also described.
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- 2023
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26. Blunt splenic injury, Emergency Department to discharge: A Western Trauma Association critical decisions algorithm.
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Shatz DV, de Moya M, Brasel KJ, Brown CVR, Hartwell JL, Inaba K, Ley EJ, Moore EE, Peck KA, Rizzo AG, Rosen NG, Sperry JL, Weinberg JA, Moren AM, Coimbra R, and Martin MJ
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- Humans, Spleen injuries, Emergency Service, Hospital, Retrospective Studies, Injury Severity Score, Splenectomy, Patient Discharge, Wounds, Nonpenetrating
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- 2023
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27. Blunt pancreatic trauma: A Western Trauma Association critical decisions algorithm.
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Moren AM, Biffl WL, Ball CG, de Moya M, Brasel KJ, Brown CVR, Hartwell JL, Inaba K, Ley EJ, Moore EE, Peck KA, Rizzo AG, Rosen NG, Sperry JL, Weinberg JA, Coimbra R, Shatz DV, and Martin MJ
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- Humans, Algorithms, Pancreas, Abdominal Injuries, Multiple Trauma therapy, Thoracic Injuries, Wounds, Nonpenetrating therapy
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Background: The Western Trauma Association (WTA) has undertaken publication of best practice clinical practice guidelines on multiple trauma topics. These guidelines are based on scientific evidence, case reports, and best practices per expert opinion. Some of the topics covered by this consensus group do not have the ability to have randomized controlled studies completed because of complexity, ethical issues, financial considerations, or scarcity of experience and cases. Blunt pancreatic trauma falls under one of these clinically complex and rare scenarios. This algorithm is the result of an extensive literature review and input from the WTA membership and WTA Algorithm Committee members., Methods: Multiple evidence-based guideline reviews, case reports, and expert opinion were compiled and reviewed., Results: The algorithm is attached with detailed explanation of each step, supported by data if available., Conclusion: Blunt pancreatic trauma is rare and presents many treatment challenges., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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28. Blunt thoracic aortic injury: A Western Trauma Association critical decisions algorithm.
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Brown CVR, de Moya M, Brasel KJ, Hartwell JL, Inaba K, Ley EJ, Moore EE, Peck KA, Rizzo AG, Rosen NG, Sperry JL, Weinberg JA, Moren AM, DuBose JJ, Coimbra R, and Martin MJ
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- Humans, Aorta injuries, Algorithms, Aorta, Thoracic surgery, Aorta, Thoracic injuries, Retrospective Studies, Wounds, Nonpenetrating diagnosis, Wounds, Nonpenetrating therapy, Thoracic Injuries diagnosis, Thoracic Injuries therapy
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- 2023
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29. Developing a National Trauma Research Action Plan: Results from the long-term outcomes research gap Delphi survey.
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Herrera-Escobar JP, Reidy E, Phuong J, Brasel KJ, Cuschieri J, Fallat M, Potter BK, Price MA, Bulger EM, Haider AH, Bonne S, Brasel KJ, Cuschieri J, de Roon-Cassini T, Dicker RA, Fallat M, Ficke JR, Gabbe B, Gibran NS, Heinemann AW, Ho V, Kao LS, Kellam JF, Kurowski BG, Levy-Carrick NC, Livingston D, Mandell SP, Manley GT, Michetti CP, Miller AN, Newcomb A, Okonkwo D, Potter BK, Seamon M, Stein D, Wagner AK, Whyte J, Yonclas P, Zatzick D, and Zielinski MD
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- Aged, Humans, Delphi Technique, Consensus, Surveys and Questionnaires, Research Design, Outcome Assessment, Health Care
- Abstract
Background: In the National Academies of Sciences, Engineering, and Medicine 2016 report on trauma care, the establishment of a National Trauma Research Action Plan to strengthen and guide future trauma research was recommended. To address this recommendation, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care. We describe the gap analysis and high-priority research questions generated from the National Trauma Research Action Plan panel on long-term outcomes., Methods: Experts in long-term outcomes were recruited to identify current gaps in long-term trauma outcomes research, generate research questions, and establish the priority for these questions using a consensus-driven, Delphi survey approach from February 2021 to August 2021. Panelists were identified using established Delphi recruitment guidelines to ensure heterogeneity and generalizability including both military and civilian representation. Panelists were encouraged to use a PICO format to generate research questions: Patient/Population, Intervention, Compare/Control, and Outcome model. On subsequent surveys, panelists were asked to prioritize each research question on a 9-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as ≥60% of panelists agreeing on the priority category., Results: Thirty-two subject matter experts generated 482 questions in 17 long-term outcome topic areas. By Round 3 of the Delphi, 359 questions (75%) reached consensus, of which 107 (30%) were determined to be high priority, 252 (70%) medium priority, and 0 (0%) low priority. Substance abuse and pain was the topic area with the highest number of questions. Health services (not including mental health or rehabilitation) (64%), mental health (46%), and geriatric population (43%) were the topic areas with the highest proportion of high-priority questions., Conclusion: This Delphi gap analysis of long-term trauma outcomes research identified 107 high-priority research questions that will help guide investigators in future long-term outcomes research., Level of Evidence: Diagnostic Tests or Criteria; Level IV., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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30. Developing a National Trauma Research Action Plan: Results from the postadmission critical care research gap Delphi survey.
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Brasel KJ, Braverman MA, Phuong J, Price MA, Kaplan LJ, Kozar R, Michetti CP, Callcut R, Bulger EM, Callcut R, Codner P, Evans S, Kaplan LJ, Kim D, Kozar R, Lipsett P, Lissauer M, Maier RV, Martin ND, May AK, Michetti CP, Murray MJ, Napolitano L, Nirula R, Pittet JF, Robinson B, Rodgers RB, Thakkar R, Tisherman SA, West M, and Zonies D
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- Humans, Delphi Technique, Consensus, Surveys and Questionnaires, Research Design, Critical Care
- Abstract
Introduction: The 2016 National Academies of Science, Engineering and Medicine report included a proposal to establish a National Trauma Research Action Plan. In response, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care from prehospital care to rehabilitation as part of an overall strategy to achieve zero preventable deaths and disability after injury. The Postadmission Critical Care Research panel was 1 of 11 panels constituted to develop this research agenda., Methods: We recruited interdisciplinary experts in surgical critical care and recruited them to identify current gaps in clinical critical care research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. The first of four survey rounds asked participants to generate key research questions. On subsequent rounds, we asked survey participants to rank the priority of each research question on a 9-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as ≥60% of panelists agreeing on the priority category., Results: Twenty-five subject matter experts generated 595 questions. By Round 3, 249 questions reached ≥60% consensus. Of these, 22 questions were high, 185 were medium, and 42 were low priority. The clinical states of hypovolemic shock and delirium were most represented in the high-priority questions. Traumatic brain injury was the only specific injury pattern with a high-priority question., Conclusion: The National Trauma Research Action Plan critical care research panel identified 22 high-priority research questions, which, if answered, would reduce preventable death and disability after injury., Level of Evidence: Diagnostic Tests or Criteria; Level IV., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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31. Increased identification of cannabis use among drivers involved in motor vehicle collisions using an expanded cannabis inventory.
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Choo E, Trent SA, Nishijima DK, Audett A, Hendrickson RG, Eichelberger A, Brasel KJ, Ye Y, and Cherpitel CJ
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- Humans, Dronabinol, Accidents, Traffic, Cohort Studies, Analgesics, Motor Vehicles, Cannabis adverse effects
- Abstract
Objectives: The objectives of this study were to implement and examine the potential capture rate of a novel instrument, the Expanded Cannabis Inventory, in a population of emergency department (ED) patients presenting after motor vehicle collisions (MVC)., Methods: Study participants who presented to the ED after MVC were recruited from three hospitals in cannabis-legal states (Denver, CO; Portland, OR; and Sacramento, CA). Research assistants (RAs) administered the Expanded Cannabis Inventory, which includes a wide variety of products that have become readily available in states where cannabis is legal, in addition to assessments related to patient demographic characteristics, general health, cannabis attitudes, and dependency measures. RAs also obtained blood samples for delta-9-THC and metabolites., Results: Among 692 participants who provided responses to questions about cannabis use, 292 (42%) reported past-year use. Seventy-eight (27%) of those identified as using cannabis were only captured due to items in the expanded instrument. These patients were more likely to be White and were more likely to perceive daily use to be of high risk. Fewer had Cannabis Use Disorder Inventory Test (CUDIT) scores consistent with hazardous cannabis use. However, more of the patients only captured by the expanded instrument had high measured blood levels of delta-9-THC on samples obtained in the ED., Conclusions: Changing cannabis use patterns must be reflected in our measurements for clinical practice, research, and surveillance. Instruments that are the current standard in clinical practice capture limited data and may no longer perform well enough to identify a complete cohort or to provide insight into the health behaviors of patients., (© 2022 Society for Academic Emergency Medicine.)
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- 2022
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32. Developing and leading a sustainable organization for early career acute care surgeons: Lessons from the inaugural American Association for the Surgery of Trauma Associate Member Council.
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Dumas RP, Bankhead BK, Coleman JR, Dhillon NK, Meizoso JP, Bessoff K, Butler WJ, Strickland M, Dultz LA, Davis K, Bulger EM, Reilly PM, Croce MA, Spain DA, Livingston DH, Brasel KJ, Coimbra R, and Knowlton LM
- Subjects
- Critical Care, Humans, Retrospective Studies, Severity of Illness Index, United States, Surgeons
- Abstract
Abstract: The associate membership of the American Association for the Surgery of Trauma (AAST) was established in 2019 to create a defined but incorporated entity within the larger AAST for the next generation of acute care surgeons. The Associate Member Council (AMC) was subsequently established in 2020 to provide the new AM with an elected group of leaders who would represent them within the AAST. In its inaugural year, this cohort of junior faculty and surgical trainees had developed for the AM a set of bylaws, a mission statement, a strategic vision, and a succession plan. The experience of the AAST AMC is exemplary of what can be accomplished with collaboration, mentorship, innovation, and tenacity. It has the potential to serve as a template for the creation and vitalization of future professional groups. In this piece, the AMC proposes a blueprint for the successful conception of a new organization., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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33. Technology and Surgical Training-Friend or Foe?
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Nikolian VC, Stowers J, and Brasel KJ
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- Humans, Technology
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- 2022
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34. Surgery and Geriatric Medicine: Toward Greater Integration and Collaboration.
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Sloane PD, Portelli Tremont JN, Brasel KJ, Dhesi J, Hewitt J, Joseph BA, Ko FC, Kow AWC, Lagoo-Deenadelayan SA, Levy CR, Louie RJ, McConnell ES, Neuman MD, Partridge J, and Rosenthal RA
- Subjects
- Aged, Humans, Geriatrics, Health Services for the Aged
- Published
- 2022
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35. A Western Trauma Association critical decisions algorithm: Resuscitative endovascular balloon occlusion of the aorta.
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Inaba K, Alam HB, Brasel KJ, Brenner M, Brown CVR, Ciesla DJ, de Moya MA, DuBose JJ, Moore EE, Moore LJ, Sava JA, Vercruysse GA, and Martin MJ
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- Algorithms, Aorta injuries, Aorta surgery, Resuscitation, Balloon Occlusion
- Published
- 2022
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36. Toward improved reporting and use of race, ethnicity, sex, and gender: An editorial.
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Brasel KJ and Coimbra R
- Subjects
- Humans, Research Design, Ethnicity, Racial Groups
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- 2022
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37. Circulating endocannabinoids and genetic polymorphisms as predictors of posttraumatic stress disorder symptom severity: heterogeneity in a community-based cohort.
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deRoon-Cassini TA, Bergner CL, Chesney SA, Schumann NR, Lee TS, Brasel KJ, and Hillard CJ
- Subjects
- Cohort Studies, Endocannabinoids, Female, Humans, Longitudinal Studies, Male, Polymorphism, Genetic, Prospective Studies, Stress Disorders, Post-Traumatic diagnosis
- Abstract
The endocannabinoid signaling system (ECSS) regulates fear and anxiety. While ECSS hypoactivity can contribute to symptoms of established post-traumatic stress disorder (PTSD), the role of the ECSS in PTSD development following trauma is unknown. A prospective, longitudinal cohort study of 170 individuals (47% non-Hispanic Caucasian and 70% male) treated at a level 1 trauma center for traumatic injury was carried out. PTSD symptom assessments and blood were obtained during hospitalization and at follow-up (6-8 months post injury). Serum concentrations of the endocannabinoids N-arachidonoylethanolamine (AEA) and 2-arachidonoylglycerol (2-AG) were determined at both time points and selected genetic polymorphisms in endocannabinoid genes, including rs324420 in fatty acid amide hydrolase, were assessed. For the entire sample, serum concentrations of AEA at hospitalization were significantly higher in those diagnosed with PTSD at follow-up (p = 0.030). Serum concentrations of 2-AG were significantly, positively correlated with PTSD symptom severity at follow-up only in minorities (p = 0.014). Minority participants (mostly Black/African American) also demonstrated significant, negative correlations between serum AEA concentrations and PTSD symptom severity both measured at hospitalization (p = 0.015). The A/A genotype at rs324420 was associated with significantly higher PTSD symptom severity (p = 0.025) and occurred exclusively in the Black participants. Collectively, these results are contrary to our hypothesis and find positive associations between circulating endocannabinoids and risk for PTSD. Minority status is an important modulator of the association between endocannabinoids and risk for PTSD, suggesting that the ECSS contributes to risk most significantly in these individuals and the contextual factors related to these findings should be further explored., (© 2022. The Author(s).)
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- 2022
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38. Surgical Trainees and The Geriatric Patient: A Scoping Review.
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Koprowski MA, Nagengast AK, Finlayson E, and Brasel KJ
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- Aged, Humans, Curriculum, Internship and Residency
- Abstract
Objective: There is an increasing emphasis on surgical trainees learning how to appropriately provide care for the geriatric patient. We hypothesized that little published formal curriculum on the topic exists. We sought to perform a scoping review to test this hypothesis., Design: PubMed, OVID Medline, and EMBASE databases were queried from inception, supplemented by hand search of references and the grey literature. Included English language abstracts and articles described trainee perceptions of geriatric patients and/or description of dedicated geriatric curricula for trainees., Results: There were 21 included abstracts or papers, which were categorized into 8 survey-based studies, 6 descriptions of curricular design, and 7 interventional studies with pre- and post-intervention knowledge tests. General surgery residents were most frequently included. Self-rated confidence and comfort were typically higher than objective measures of resident performance in the care of geriatric patients. Residents were commonly unaware of the standardized assessment tools and recommendations that exist. Medication and delirium management were frequently-identified topics posing the widest gaps in resident knowledge., Conclusion: There are few published examples of curricula on the care of geriatric patients for surgical trainees. More work is needed for the creation of specialty-specific and needs-based geriatric surgical curricula., (Copyright © 2021. Published by Elsevier Inc.)
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- 2022
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39. Career Advancement for Surgeon-Educators:Findings from a Modified Delphi Process.
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Cochran A, Neumayer LA, Mellinger JD, Klingensmith ME, Scott DJ, Dunnington GL, and Brasel KJ
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- Career Mobility, Consensus, Fellowships and Scholarships, Humans, Mentors, Faculty, Medical, Surgeons
- Abstract
Objectives: Reward and recognition of surgical education as an academic activity remains a highly variable process between institutions. The goal of this study is to provide expert consensus definition of an academic surgical educator, with focus on criteria for academic promotion., Study Design and Setting: Following IRB approval, a Web-based modified Delphi process was used to generate prioritized academic promotion criteria for surgical educators., Participants and Setting: Participants were recruited nationally from a pool of senior academic surgeons who are members of the Society of University Surgeons and the Society of Surgical Chairs., Results: Following a three-round modified Delphi process, the top domains of educational activity for promotion to associate professor and professor were scholarship, teaching, and administration; mentorship was also a priority category for promotion to professor. The top three activities described for promotion to Associate Professor were active participation in conferences/ departmental educational activities for medical students and residents; educational portfolio demonstrating commitment to activities as an educator; and clinical teaching excellence at their home institution. The three activities most highly scored items for promotion to Professor were mentorship of junior surgical educators; active participation in conferences/ departmental educational activities for medical students and residents; and a record of teaching excellence at the medical student and resident levels., Conclusions: These findings demonstrate a progression from teacher to scholar to leader across a surgical educator's career, with each level incorporating and building upon the prior activities. Identification of categories and criteria may meaningfully inform best practices to be incorporated into the career development and promotion processes for surgeons on an educator academic pathway., (Copyright © 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2022
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40. Identification of Leadership Behaviors that Impact General Surgery Junior Residents' Well-being: A Needs Assessment in a Single Academic Center.
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Torres-Landa S, Moreno K, Brasel KJ, and Rogers DA
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- Curriculum, Emotional Intelligence, Humans, Leadership, Needs Assessment, General Surgery education, Internship and Residency
- Abstract
Objective: Emerging literature has started to link leadership with the well-being of team members; however, this link during residency training has not been studied. The objective of this study was to perform a needs assessment to identify leadership behaviors among senior residents and evaluate the impact that these behaviors have on junior residents' well-being., Design: A semi-structured question script was developed and ∼60 minute virtual focus groups were held during protected educational time, until data saturation was reached. Data analysis was performed in the tradition of grounded theory., Setting: This study was performed at Oregon Health & Science University, one of the largest general surgery programs., Participants: Participants enrolled in the general surgery residency program from July 2020 to February 2021 were included. 35 general surgery residents participated in the focus groups., Results: Two major themes resulted from the data analysis: (1) Effective leadership behaviors and their positive consequences, and (2) Ineffective leadership behaviors and their negative consequences. Effective and ineffective leadership were characterized by the presence or absence of 6 main behaviors: supportive and empowering, team building, management skills, emotional intelligence, effective communication, and teaching. Effective and ineffective leadership positively and negatively impacted residents' well-being, individual growth, and psychological safety., Conclusions: The results from this study identified leadership behaviors from senior residents and demonstrated that those behaviors have a significant short-term and long-term positive and negative impact on junior residents' well-being. These results fill a gap in the literature, and can serve as a guide for surgical educators to develop evidence-based leadership curricula., (Copyright © 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2022
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41. Evaluation and management of traumatic pneumothorax: A Western Trauma Association critical decisions algorithm.
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de Moya M, Brasel KJ, Brown CVR, Hartwell JL, Inaba K, Ley EJ, Moore EE, Peck KA, Rizzo AG, Rosen NG, Sperry J, Weinberg JA, and Martin MJ
- Subjects
- Algorithms, Chest Tubes, Clinical Decision Rules, Drainage instrumentation, Drainage methods, Humans, Monitoring, Physiologic methods, Radiography, Thoracic methods, Risk Adjustment, Critical Pathways standards, Critical Pathways statistics & numerical data, Decision Support Systems, Clinical, Pneumothorax diagnostic imaging, Pneumothorax etiology, Pneumothorax physiopathology, Pneumothorax surgery, Thoracic Injuries complications, Thoracostomy instrumentation, Thoracostomy methods, Tomography, X-Ray Computed methods
- Abstract
Abstract: This is a recommended algorithm of the Western Trauma Association for the management of a traumatic pneumothorax. The current algorithm and recommendations are based on available published prospective cohort, observational, and retrospective studies and the expert opinion of the Western Trauma Association members. The algorithm and accompanying text represents a safe and reasonable approach to this common problem. We recognize that there may be variability in decision making, local resources, institutional consensus, and patient-specific factors that may require deviation from the algorithm presented. This annotated algorithm is meant to serve as a basis from which protocols at individual institutions can be developed or serve as a quick bedside reference for clinicians., Level of Evidence: Consensus algorithm from the Western Trauma Association, Level V., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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42. Identification of risk for posttraumatic stress disorder symptom clusters early after trauma.
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Timmer-Murillo SC, Hunt JC, Geier T, Brasel KJ, and deRoon-Cassini TA
- Subjects
- Aftercare, Humans, Patient Discharge, Survivors psychology, Syndrome, Stress Disorders, Post-Traumatic diagnosis, Stress Disorders, Post-Traumatic psychology
- Abstract
The current study examined how the injured trauma survivor screen (ITSS), a hospital-administered screener of posttraumatic stress disorder (PTSD) and depression, differentially predicted PTSD symptom cluster severity. Participants from a Level 1 trauma center ( n = 220) completed the ITSS while inpatient and PTSD symptoms were assessed one-month post discharge. Perceived life threat and intentionality of injury were key predictors of avoidance, re-experiencing, and hyperarousal symptom clusters. However, negative alterations in mood and cognition cluster seemed best predicted by mood and cognitive risk factors. Therefore, the ITSS provides utility in differentially predicting symptom clusters and treatment planning after traumatic injury.
- Published
- 2021
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43. Evaluation and management of bowel and mesenteric injuries after blunt trauma: A Western Trauma Association critical decisions algorithm.
- Author
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Weinberg JA, Peck KA, Ley EJ, Brown CV, Moore EE, Sperry JL, Rizzo AG, Rosen NG, Brasel KJ, Hartwell JL, de Moya MA, Inaba K, and Martin MJ
- Subjects
- Humans, Retrospective Studies, Societies, Medical standards, Wounds, Nonpenetrating therapy, Clinical Decision Rules, Clinical Decision-Making methods, Intestines injuries, Mesentery injuries, Wounds, Nonpenetrating diagnosis
- Published
- 2021
- Full Text
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44. Evaluation of leadership curricula in general surgery residency programs.
- Author
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Torres-Landa S, Wairiri L, Cochran A, and Brasel KJ
- Subjects
- Curriculum, Humans, Internship and Residency organization & administration, General Surgery education, Internship and Residency methods, Leadership
- Abstract
The rapid and dynamic surgical environment requires leaders that can help guide their teams to desired outcomes while delivering patient-centered care. The need for early implementation of leadership curricula has been identified; however, most available leadership curricula are tailored for faculty and not embedded within surgery training. The ideal intervention(s) to close this gap while addressing the unique challenges of the demanding surgical training are yet to be identified. This manuscript reviews the current status of residency leadership programs and the relationship of leadership to other essential aspects for optimal training of future surgeon leaders. The use of best practice medical education frameworks is key to help guide effective and sustainable evidence-based leadership curricula. The collaboration, standardization, and publication of leadership curricula for surgery residents can serve as prototypes to address specific needs at different training institutions with the aim of equipping surgeons with the necessary leadership tools for their success., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
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45. How I Do It a Surgical Palliative Care Rotation for Residents.
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Siegel TR and Brasel KJ
- Subjects
- Communication, Humans, Pain, Palliative Care, Internship and Residency, Terminal Care
- Abstract
To address the need for increased exposure to the essential components of Palliative Care in our residency, we created a 4 week rotation in Surgical Palliative Care for all of our categorical interns. The rotation includes time on an interdisciplinary inpatient consultative palliative care service as well as time in the outpatient clinic and in the operating room with the Surgical Palliative Care attending. Most patients who are seen and evaluated have surgical issues, allowing exposure to the fundamental aspects of palliative care as they pertain to surgical practice across the continuum of healthcare settings. Communication around serious illness, complicated decision making, complex pain and symptom management, withdrawal of life-sustaining treatment, and end-of-life care are all integral parts of the rotation. The rotation has been very favorably received by the residents, and the impact on the culture of the department has been tremendous as well. The structured approach provided, including goals and objectives and the weekly schedule, make this rotation easily replicable in other residency programs., (Copyright © 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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46. Nutrition therapy in the critically injured adult patient: A Western Trauma Association critical decisions algorithm.
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Hartwell JL, Peck KA, Ley EJ, Brown CVR, Moore EE, Sperry JL, Rizzo AG, Rosen NG, Brasel KJ, Weinberg JA, de Moya MA, Inaba K, Cotton A, and Martin MJ
- Subjects
- Adult, Humans, Retrospective Studies, Societies, Medical standards, Wounds and Injuries diagnosis, Clinical Decision Rules, Clinical Decision-Making methods, Critical Illness therapy, Nutrition Therapy standards, Wounds and Injuries therapy
- Published
- 2021
- Full Text
- View/download PDF
47. Teaching Palliative Care in Surgical Education.
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Ballou JH and Brasel KJ
- Subjects
- Communication, Curriculum, Humans, Pain, Palliative Care, Surgeons, Terminal Care
- Abstract
Without training in how to identify and relieve pain and suffering, surgeons miss opportunities to offer palliative services to patients. Despite explicit calls for expanding palliative care education since the 1990s, palliative care training in surgical curricula is often limited to end-of-life discussions. A growing consensus among palliative care experts suggests that formal palliative care education during surgical training should include structured communication and prognostication tools, strategies for symptom management, and an understanding of palliative care specialists' role in treating patients at all disease stages., (© 2021 American Medical Association. All Rights Reserved.)
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- 2021
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48. Expressions of conflict following postoperative complications in older adults having major surgery.
- Author
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Kalbfell EL, Buffington A, Kata A, Brasel KJ, Mosenthal AC, Cooper Z, Finlayson E, and Schwarze ML
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Conflict, Psychological, Family Conflict, Postoperative Complications psychology, Postoperative Complications therapy
- Abstract
Background: After serious postoperative complications, patients and families may experience conflict about goals of care., Methods: We performed a multisite randomized clinical trial to test the effect of a question prompt list on postoperative conflict. We interviewed family members and patients age ≥60 who experienced serious complications. We used qualitative content analysis to analyze conflict and characterize patient experiences with complications., Results: Fifty-six of 446 patients suffered a serious complication. Participants generally did not report conflict relating to postoperative treatments and expressed support for the care they received. We did not appreciate a difference in conflict between intervention and usual care. Respondents reported feeling unprepared for complications, witnessing heated interactions among team members, and a failure to develop trust for their surgeon preoperatively., Conclusion: Postoperative conflict following serious complications is well described but its incidence may be low. Nonetheless, patient and family observations reveal opportunities for improvement., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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49. Unifying the Hepatopancreatobiliary Surgery Fellowship Curriculum via Delphi Consensus.
- Author
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Park KM, Rashidian N, Mohamedaly S, Brasel KJ, Conroy P, Glencer AC, He J, Passeri MJ, Katariya NN, and Alseidi A
- Subjects
- Consensus, Delphi Technique, Fellowships and Scholarships, Humans, United States, Biliary Tract Diseases surgery, Curriculum standards, Digestive System Surgical Procedures education, Education, Medical, Graduate standards, Gastroenterology education
- Abstract
Background: Hepatopancreatobiliary (HPB) Fellowship training in the Americas consists of 3 distinctive routes with variable curricula: Surgical Oncology Fellowship via the Society of Surgical Oncology (SSO), Abdominal Transplant Surgery Fellowship via the American Society of Transplant Surgeons (ASTS), and HPB Fellowship via the Americas Hepato-Pancreato-Biliary Association (AHPBA). Our objective was to establish a pan-American consensus among HPB surgeons, surgical oncologists, abdominal transplant surgeons, and general surgery residency program directors (GSPDs) on a core knowledge curriculum for HPB fellowship, and to identify topics appropriate for general surgery residency and subspecialty beyond HPB fellowship., Study Design: A 3-round modified Delphi process was used. Baseline statements were developed by the Education and Training Committee of the AHPBA, in collaboration with representatives of the SSO, ASTS, and GSPDs. The expert panel, consisting of members of the 3 societies together with GSPDs, rated the statements on a 5-point Likert scale and suggested editing or adding new statements. A statement was included in the final curriculum when Cronbach's alpha value was ≥ 0.8 and ≥ 80% of the panel agreed on inclusion., Results: The response rate was 100% for the first round, and 98% for the second and third rounds. Eighty-nine of 138 proposed statements were included in the final HPB fellowship curriculum. Curricula for general surgery residency and subspecialty beyond HPB fellowship included 50 and 29 statements, respectively., Conclusions: A multinational consensus on core knowledge for an HPB fellowship curriculum was achieved via the modified Delphi method. This core curriculum may be used to standardize HPB fellowship training across different pathways in the Americas., (Copyright © 2021 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2021
- Full Text
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50. Best case/worst case for the trauma ICU: Development and pilot testing of a communication tool for older adults with traumatic injury.
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Zimmermann CJ, Zelenski AB, Buffington A, Baggett ND, Tucholka JL, Weis HB, Marka N, Schoultz T, Kalbfell E, Campbell TC, Lin V, Lape D, Brasel KJ, Phelan HA, and Schwarze ML
- Subjects
- Aged, Aged, 80 and over, Attitude of Health Personnel, Evaluation Studies as Topic, Female, Humans, Intensive Care Units, Male, Middle Aged, Oregon, Texas, Wisconsin, Clinical Decision-Making, Communication, Surgeons education, Wounds and Injuries therapy
- Abstract
Background: "Best Case/Worst Case" (BC/WC) is a communication tool to support shared decision making in older adults with surgical illness. We aimed to adapt and test BC/WC for use with critically ill older adult trauma patients., Methods: We conducted focus groups with 48 trauma clinicians in Wisconsin, Texas, and Oregon. We used qualitative content analysis to characterize feedback and adapted the tool to fit this setting. Using rapid sequence iterative design, we developed an implementation tool kit. We pilot tested this intervention at two trauma centers using a pre-post study design with older trauma patients in the intensive care unit (ICU). Main outcome measures included study feasibility, intervention acceptability, quality of communication, and clinician moral distress., Results: BC/WC for trauma patients uses a graphic aid to document major events over time, illustrate plausible scenarios, and convey uncertainty. We enrolled 86 of 116 eligible patients and their surrogates (48 pre/38 postintervention). The median patient age was 72 years (51-95 years) and mean Geriatric Trauma Outcome Score was 126.1 (±30.6). We trained 43 trauma attendings and trauma fellows to use the intervention. Ninety-four percent could perform essential tool elements after training. The median end-of-life communication score (scale 0-10) improved from 4.5 to 6.6 (p = 0.006) after intervention as reported by family and from 4.1 to 6.0 (p = 0.03) as reported by nurses. Moral distress did not change. However, there was improvement (less distress) reported by physicians regarding "witnessing providers giving false hope" from 7.34 to 5.03 (p = 0.022). Surgeons reported the tool put multiple clinicians on the same page and was useful for families, but tedious to incorporate into rounds., Conclusion: BC/WC trauma ICU is acceptable to clinicians and may support improved communication in the ICU. Future efficacy testing is threatened by enrollment challenges for severely injured older adults and their family members., Level of Evidence: Therapeutic, level III., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
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