A5026860205- Cardiac, Anesthesia and Surgical Outcomes
- Clinical Nutrition and Gastroenterology
- Trauma and Emergency Care Studies
- Appendicitis Diagnosis and Management
- Nutrition and Health in Aging
- Hip and Femur Fractures
- Pelvic and Acetabular Injuries
- Hernia repair and management
- Abdominal Surgery and Complications
- Trauma Management and Diagnosis
- Abdominal Trauma and Injuries
- Emergency and Acute Care Studies
- Enhanced Recovery After Surgery
- Cardiac Arrest and Resuscitation
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Electrolyte and hormonal disorders
- Intraperitoneal and Appendiceal Malignancies
- Blood transfusion and management
- Gallbladder and Bile Duct Disorders
- Intestinal and Peritoneal Adhesions
- Meta-analysis and systematic reviews
- Intensive Care Unit Cognitive Disorders
- Diverticular Disease and Complications
- Innovations in Medical Education
- Surgical Simulation and Training
Denver Health Medical Center
2022-2025
University of Colorado Denver
2022-2025
Massachusetts General Hospital
2011-2024
University of Tennessee Health Science Center
2022-2024
Johns Hopkins University
2020-2024
University of California, San Francisco
2011-2024
University of Washington
2024
Christiana Care Health System
2024
Stanford University
2024
Wake Forest University
2024
In Brief Twenty-eight patients with 41 full-thickness decubitus ulcers were randomized to compare the Vacuum-Assisted Closure device (VAC) Healthpoint System (HP) of wound gel products in promoting ulcer healing. A total 22 35 completed 6-week trial treatment, during which time 2 (10%) VAC group (N =20) and (13%) HP = 15) healed completely. The mean percent reduction volume was 42.1% 51.8% (p 0.46). number PMNs lymphocytes per high-power field decreased increased 0.13, p 0.41 respectively)....
Background : Macronutrient deficit in the surgical intensive care unit (ICU) is associated with worse in‐hospital outcomes. We hypothesized that increased caloric and protein also a lower likelihood of discharge to home vs transfer rehabilitation or skilled nursing facility. Materials Methods Adult ICU patients receiving >72 hours enteral nutrition (EN) between March 2012 May 2014 were included. Patients absolute contraindications EN, <72‐hour stay, moribund state, EN prior admission,...
OBJECTIVES: To determine the incidence of enteral feed intolerance, identify factors associated with and assess relationship between intolerance key nutritional clinical outcomes in critically ill patients. DESIGN: Analysis International Nutrition Survey database collected prospectively from 2007 to 2014. SETTING: Seven-hundred eighty-five ICUs around world. PATIENTS: Mechanically ventilated adults ICU stay greater than or equal 72 hours received nutrition during first 12 days....
Nutrition support is a necessary therapy for critically ill cardiac surgery patients. However, conclusive evidence this population, consisting of well-conducted clinical trials lacking. To clarify optimal strategies to improve outcomes, an international multidisciplinary group 25 experts from different specialties Germany, Canada, Greece, USA and Russia discussed potential approaches identify patients who may benefit nutrition support, when best initiate the use pharmaco-nutrition modulate...
Background: Malnutrition and underfeeding are major challenges in caring for critically ill patients. Our goal was to characterize interruptions enteral nutrition (EN) delivery their impact on caloric debt the surgical intensive care unit (ICU). Materials Methods : We performed a prospective, observational study of adults admitted ICUs at Boston teaching hospital (March–December 2012). categorized EN as “unavoidable” vs “avoidable” compared deficit between patients with ≥1 interruption...
BACKGROUND There currently exists no preoperative risk stratification system for emergency surgery (ES). We sought to develop an Emergency Surgery Acuity Score (ESAS) that helps predict perioperative mortality in ES patients. METHODS Using the 2011 American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database (derivation cohort), we identified all surgical procedures were classified as "emergent." A three-step methodology was then performed. First, multiple...
Hemostatic resuscitation has been shown to be beneficial for patients with trauma, but there is little evidence that it equally bleeding without trauma. The practice of a high transfusion ratio fresh frozen plasma (FFP) red blood cells (RBCs) spread other surgical and medical fields.To identify whether ratio-based in trauma associated improved survival.This study retrospective review all massive transfusions provided an urban academic hospital from January 1, 2009, through December 31, 2012....
Abstract Background Malnutrition influences clinical outcomes. Although various screening tools are available to assess nutrition status, their use in the intensive care unit (ICU) has not been rigorously studied. Our goal was compare Nutrition Risk Critically Ill (NUTRIC) Nutritional Screening (NRS) 2002 terms of associations with macronutrient deficit ICU patients. Methods We performed a retrospective analysis investigate relationship between NUTRIC vs NRS and (protein calories) critically...
We sought to assess the impact of intraoperative adverse events (iAEs) on 30-day postoperative mortality, morbidity, and length stay (LOS) among patients undergoing abdominal surgery. hypothesized that iAEs would be associated with significant increases in each outcome.The relationship between clinical outcomes remains largely unknown.The 2007 2012 institutional ACS-NSQIP administrative databases for surgeries were matched then screened using Agency Healthcare Research Quality's 15 Patient...
The Emergency Surgery Score (ESS) was recently validated as a scoring system to predict mortality in emergency surgery (ES) patients. We sought examine the ability of ESS occurrence 30-day postoperative complications ES.The 2011-2012 American College Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database screened for all surgical operations classified "emergent." Thirty-day were defined per ACS-NSQIP (e.g., site infection, respiratory failure, acute renal failure). Each...
Objective: We sought to describe contemporary presentation, treatment, and outcomes of patients presenting with acute (A), perforated (P), gangrenous (G) appendicitis in the United States. Summary Background Data: Recent European trials have reported that medical (antibiotics only) treatment is an acceptable alternative surgical appendectomy. However, type operation (open appendectomy) average duration stay are not consistent current American practice therefore their conclusions do apply...
The mortality of patients with Clostridium difficile-associated disease (CDAD) requiring surgery continues to be very high. Loop ileostomy (LI) was introduced as an alternative procedure total colectomy (TC) for CDAD by a single-center study. To date, no reproducible results have been published. objective this study compare these two procedures in multicentric approach help the surgeon decide what is best suited patient need.This retrospective multicenter conducted under sponsorship Eastern...
To compare the risk factors and costs associated with readmission after firearm injury nationally, including different hospitals.No national studies capture to hospitals injury.The 2013 2014 Nationwide Readmissions Database was queried for patients admitted injury. Logistic regression identified 30-day same hospital readmission. Cost calculated. Survey weights were used estimates.There 45,462 during study period. The rate 7.6%, among those, 16.8% readmitted a hospital. Admission cost $1.45...
Serum albumin and prealbumin levels, may be more strongly associated with inflammation than nutrient delivery. Their predictive value has not been extensively described in surgical intensive care unit (ICU) patients.We analyzed a registry of adult ICU patients receiving enteral nutrition. Subjects at least 1 serum albumin, prealbumin, or C-reactive protein (CRP) level were included. Demographic, nutrition, clinical outcome data collected.A total 252 subjects A subset had serial measurements:...
BACKGROUND Emergency surgery (ES) is acknowledged to be riskier than nonemergency (NES). Yet, little known about the relative impact of individual perioperative risk factors on 30-day outcomes in ES versus NES. METHODS Using 2011–2012 American College Surgeons National Surgical Quality Improvement Program nationwide database, 20 most common procedures were identified by Current Procedural Terminology code. codes with less 300 observations either or NES excluded. cases defined as "emergent"...