Perspectives of Surgical Research Residents on Improving Their Reentry Into Clinical Training.

OBJECTIVE: Concerns exist about clinical and operative skill decay in surgery residents when they dedicate time away from clinical training to pursue research. However, it remains undetermined how to best prevent these negative impacts. Our study evaluated the perspectives of surgical research residents on interventions to improve their reentry into clinical training. DESIGN, SETTING, AND PARTICIPANTS: An anonymous web-based survey was distributed between 5/01/2023 and 6/01/2023 to 102 current and former (within the previous 3 years) general surgery research residents from 4 academic medical centers in Boston, MA. RESULTS: Survey response rate was 35.3% (36/102 residents). About 22 of 36 residents (61.1%) felt that their clinical aptitude decreased during the research years, whereas 33 of 36 (91.7%) reported reduced surgical skills. When reflecting on their re-entry to residency, former research residents reported feeling anxious and less confident (3.84/5 on a 1-5 Likert scale) as well as being below the expected level of clinical performance (3.42/5). Most of them (12 of 17; 70.6%) reported that it took up to 6 months, whereas 5 of them (29.4%) up to 12 months to feel at the expected level. When compared to nonmoonlighting residents, those who moonlighted often and operated during moonlighting, denied a decrease in clinical and surgical skills, and reported less anxiety, higher confidence, and a quicker return to the expected level of performance. Interventions proposed for improving their clinical re-entry included individualized development plans for 3 months before returning to clinical training, established curriculum for clinical work throughout the research years, clinical preceptorships throughout the research years, and simulation curriculum throughout the research years. CONCLUSIONS: General surgery residents feel that their clinical and surgical skills decreased during the research years, leading to anxiety and lack of confidence when returning to residency. Therefore, comprehensive interventions are needed to improve the reentry of the research residents into clinical training.

Outcomes of emergency general surgery admissions in patients experiencing homelessness: A matched cohort study.

BACKGROUND: Housing status impacts outcomes after elective and emergent operations but has not been well studied in the emergency general surgery population. This study investigates the impact of housing status on complications and 30-day follow-up, emergency department visits, and readmissions after emergency general surgery admission. METHODS: We conducted a retrospective matched cohort study of adult patients admitted with an emergency general surgery diagnosis at an urban, safety net hospital from 2014 to 2021. Patients were matched 1 to 2 on the basis of age, sex, Charlson Comorbidity Index, diagnosis, and operative status. The primary exposure was unhoused status. The primary outcome was in-hospital complications. Secondary outcomes included intensive care unit admission, extended length of stay, follow-up attendance, and emergency department visit or unplanned readmission within 30 days. Multivariable conditional logistic regression was used to determine the association between housing status and the outcomes of interest. RESULTS: The study included 531 patients (177 unhoused, 354 housed). There were no significant differences in complications, intensive care unit admissions, or extended length of stay. Unhoused patients had lower odds of outpatient follow-up (odds ratio, 0.54; 95% confidence interval, 0.35-0.85, P = .008) and higher odds of emergency department utilization (odds ratio, 2.72; 95% confidence interval, 1.78-4.14, P < .001) and readmission (odds ratio, 1.87; 95% confidence interval, 1.09-3.19, P = .02). CONCLUSION: Compared with housed patients, unhoused patients with emergency general surgery conditions have lower rates of outpatient follow-up and greater odds of using the emergency department and being readmitted within 30 days of discharge. This points to a need for dedicated posthospitalization care and creative methods of engaging with this population.

Assessing the utility of the PC-PTSD-5 as a screening tool among a cancer survivor sample.

INTRODUCTION: Hematopoietic stem cell transplantation (HCT) is an intensive and invasive procedure used in cancer treatment that can lead to posttraumatic stress disorder (PTSD) symptoms. These symptoms are frequently overlooked in oncology and general health care settings. The suitability and utility of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) within the cancer population remains uncertain. This study aims to evaluate its performance as a brief (five-item) case-finding screening alternative to the longer (20-item) PTSD Checklist for DSM-5 (PCL-5) in survivors who received an HCT 1 to 5 years ago. METHODS: A total of 817 cancer survivors completed the PC-PTSD-5 and PCL-5 during recruitment for a randomized clinical trial. Optimal cut scores for identifying probable PTSD and item performance were determined using indices correcting for chance and item response theory analyses. RESULTS: Of the HCT sample, 10.4% screened as positive for probable DSM-5 PTSD using the PCL-5. The PC-PTSD-5 exhibited strong internal consistency and significant associations with PCL-5 scores (total, r = .82; items, rs = .56-.61). A cutoff score of 2 provided optimal sensitivity for screening (κ[Se] = .95), whereas a cut score of 4 demonstrated the highest efficiency for detecting a probable DSM-5 PTSD diagnosis on the PCL-5 (κ[Eff] = .39). Item response theory analyses indicated that item 4 (numbing) of the PC-PTSD-5 yielded the most informative data, with other items potentially lacking incremental utility. CONCLUSION: Although not an instrument validation study, these findings offer efficient evidence for using the PC-PTSD-5 as a succinct screening tool among cancer survivors in a clinical context. TRIALS REGISTRATION: ClinicalTrials.gov, NCT04058795, registered 8/16/2019.

Ixodes ricinus bites promote allergic skin inflammation and intestinal tuft and mast cell expansion in mice.

Background: Tick bites often promote local allergic reactions in the skin and predispose to red meat allergy. The mechanisms involved in these processes are not fully understood. Here we investigated the local changes to the skin and intestine induced by tick bites. Methods: C3H/HEN or Balb/c mice were subjected to either tick bites by Ixodes ricinus ( I. ricinus ) or mechanical skin injury. Skin or intestine was analyzed a different time point by transcriptomic and histological techniques. Results: Our results indicate that I. ricinus bites promote epidermal hyperplasia, spongiosis and an accumulation of eosinophils and mast cells in the bitten skin. In addition, I. ricinus bites promote the expression of genes and activate pathways also induced by mechanical skin injury elicited by tape stripping. Remarkably, similar to tape stripping, I. ricinus bites promote an increase in total serum IgE, and intestinal tuft cell and mast cell expansion. Conclusion: I. ricinus bites in mice promote cutaneous inflammation that resembles allergic skin inflammation, as well as intestinal changes that could play a role in the predisposition to red meat allergy.

Feasibility and acceptability of measuring positivity resonance in nurse-patient telehealth videoconferencing visits: A mixed-methods observational study.

AIM: To investigate the feasibility and acceptability of the training process, procedures, measures and recruitment strategies necessary for a future investigation to test the reliability and validity of using positivity resonance measures in health care encounters. BACKGROUND: Although the measurement of positivity resonance is promising, and non-participant observation is considered effective, their approaches to studying nurse-patient relationships have not been fully explored. DESIGN: A mixed-methods observational study. METHODS: Video recordings of 30 nurse-patient dyads completing telehealth video visit encounters were edited and coded using behavioural indicators of positivity resonance. A post-visit survey gathered data on the participants' perceptions of positivity resonance and the study procedures. The research team completed memos and procedural logs to provide narrative data on the study's training, coding, recruitment and operational procedures. The study included 33 persons with cancer and 13 oncology nurses engaging in telehealth video visit encounters at an academic oncology ambulatory care center located in the southeastern United States. RESULTS: Study procedures were found to be feasible and acceptable to participants. An adequate sample of participants (N = 46) were enrolled and retained in the study. Interrater reliability, as evidenced by Cohen's weighted kappa, ranged from .575 to .752 and interclass correlation coefficients >.8 were attainable within a reasonable amount of time and with adequate training. Behavioural indicators of positivity resonance were observed in all telehealth visits and reported by the participants in the perceived positivity resonance survey. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided reporting. CONCLUSIONS: Designing research around the concept of positivity resonance is an innovative and feasible approach to exploring how rapport is cultivated within nurse-patient relationships. RELEVANCE TO PROFESSIONAL PRACTICE: Measuring positivity resonance may hold promise for exploring patient and nurse outcomes including trust, responsiveness, health-related behaviours, well-being, resilience and satisfaction. REPORTING METHOD: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided the reporting of results to ensure that adequate details of the study were provided to ensure an accurate and complete report. PATIENT OR PUBLIC CONTRIBUTION: Planning of the research design and study procedures was done in consultation with nurse clinicians with experience with telehealth and managers responsible within the practice setting where the study was conducted. This ensured the study procedures were ethical, safe, secure and did not create unnecessary burden to the study participants. The study included collecting data from nurse and patient participants about the acceptability of the study procedures.

Scheduled Follow-Up and Association with Emergency Department Use and Readmission after Trauma.

BACKGROUND: After traumatic injury, 13% to 14% of patients use the emergency department (ED) and 11% are readmitted within 30 days. Decreasing ED visits and readmission represents a target for quality improvement. This cohort study evaluates risk factors for ED visits and readmission after trauma, focusing on outpatient follow-up. STUDY DESIGN: We conducted a retrospective chart review of adult trauma admissions from January 1, 2018, to December 31, 2021. Our primary exposure was outpatient follow-up, primary outcome was ED use, and secondary outcome was readmission. Multivariable logistic regression evaluated the association between primary exposure and outcomes, adjusting for factors identified on unadjusted analysis. RESULTS: In total, 2,266 patients met inclusion criteria, with an 11.3% ED visit rate and 4.1% readmission rate. Attending follow-up did not have a significant association with ED visit (odds ratio 0.99, 95% CI 0.99 to 2.01, p = 0.05) or readmission rate (odds ratio 1.68, 95% CI 0.95 to 2.99, p = 0.08). Significant associations with ED use included non-White race, depression, anxiety, substance use disorder, discharge disposition, and being discharged with lines or drains. Significant associations with readmission included depression, anxiety, and discharge disposition. CONCLUSIONS: Emphasizing outpatient follow-up in trauma patients is not an effective target to decrease ED use or readmission. Future studies should focus on supporting patients with mental health comorbidities and investigating interventions to optimally engage with trauma patients after hospital discharge.

Timing of venous thromboembolism prophylaxis initiation and complications in polytrauma patients with high-risk bleeding orthopedic interventions: A nationwide analysis.

INTRODUCTION: There are no clear recommendations for the perioperative timing and initiation of venous thromboembolism pharmacologic prophylaxis (VTEp) among polytrauma patients undergoing high-risk bleeding orthopedic operative intervention, leading to variations in VTEp administration. Our study examined the association between the timing of VTEp and VTE complications in polytrauma patients undergoing high-risk operative orthopedic interventions nationwide. METHODS: We performed a retrospective cohort study of trauma patients 18 years or older who underwent high-risk bleeding operative orthopedic interventions for pelvic, hip, and femur fractures within 24 hours of admission at American College of Surgeons-verified trauma centers using the 2019-2020 American College of Surgeons Trauma Quality Improvement Program databank. We excluded patients with a competing risk of nonorthopedic surgical bleeding. We assessed operative orthopedic polytrauma patients who received VTEp within 12 hours of orthopedic surgical intervention compared with VTEp received beyond 12 hours of intervention. The primary outcome assessed was overall VTE events. Secondary outcomes were orthopedic reinterventions within 72 hours after primary orthopedic surgery, deep venous thromboembolism, and pulmonary embolism rates. RESULTS: The study included 2,229 patients who underwent high-risk orthopedic operative intervention. The median time to VTEp initiation was 30 hours (interquartile range, 18-44 hours). After adjustment for baseline patient, injury, and hospital characteristics, VTEp initiated more than 12 hours from primary orthopedic surgery was associated with increased odds of VTE (adjusted odds ratio, 2.02; 95% confidence interval, 1.08-3.77). Earlier initiation of prophylaxis was not associated with an increased risk for surgical reintervention (hazard ratio, 0.90; 95% confidence interval, 0.62-1.34). CONCLUSION: Administering VTEp within 24 hours of admission and within 12 hours of major orthopedic surgery involving the femur, pelvis, or hip demonstrated an associated decreased risk of in-hospital VTE without an accompanying elevated risk of bleeding-related orthopedic reintervention. Clinicians should reconsider delays in initiating or withholding perioperative VTEp for stable polytrauma patients needing major orthopedic intervention. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.