Optimizing Nutritional Needs of Burn Patients: An Evaluation of Nutritional Assessment Tools, Feeding Strategies, and Their Impact on Patient Outcomes.

BACKGROUND: Optimal nutritional support is essential to the recovery and improved outcomes of burn patients. This review aims to explore existing literature to evaluate nutrition assessment tools, feeding formulations' caloric predictive ability, timing of initiation of feeding, optimal nutritional composition, and caloric intake in burn patients. METHODS: Three databases were searched to glean studies investigating nutrition in acute severe adult burn patient populations in four areas: outcomes based on feeding type and timing, the caloric predictability of nutritional assessment tools, outcomes associated with the composition of feeding formulas, and considerations related to caloric intake. Outcomes of interest included the effects of nutritional assessments using feeding type, nutritional administration timing, formula composition, and caloric intake on mortality rate, length of stay, and infection. RESULTS: A total of 19 studies were included. Nutritional assessment tools were determined to over- or underestimate resting energy expenditure (REE). Milner was the most accurate alternative to indirect calorimetry. Early enteral nutrition in burn patients within 24 hours of admission was preferred. 5 studies evaluated micronutrients and yielded variable results. Low-fat high-carbohydrate diets were the ideal macronutrient composition. Burn patients were shown to receive lower caloric intake than recommended. CONCLUSIONS: Findings showed that while nutritional assessment tools tend to inaccurately estimate REE in burn patients, the ideal alternative to indirect calorimetry is the Milner equation. Several new equations may be worthy alternatives but require further validation. Enteral feeding should be initiated within the first 24 hours of burn injury whenever possible and should contain a high-carbohydrate/low-fat composition.

An examination of antibiotic administration in septorhinoplasty: A systematic review and meta-analysis.

PURPOSE: Septoplasty and rhinoplasty are common otolaryngological procedures, often combined as septorhinoplasty (SRP), offering aesthetic and functional benefits. These surgeries are believed to potentially risk postoperative infections due to natural bacterial flora in the nares. This study evaluates the effectiveness of prophylactic antibiotics in reducing post-surgical infection complications. MATERIALS AND METHODS: A systematic review was conducted using PubMed, Cochrane, and Web of Science, adhering to PRISMA guidelines, focusing on antibiotic use in septoplasty, rhinoplasty, and SRP. The study included randomized control trials, single/double-blind studies, retrospective chart reviews, and prospective cohort studies, excluding pediatric, non-human research, or studies with inaccessible data. Postoperative infection rates were analyzed utilizing R software as a form of Statistic. RESULTS: From 697 articles, 15 studies were chosen for meta-analysis, involving 2225 patients, with 1274 receiving prophylactic antibiotics and 951 as controls. The meta-analysis indicated an odds ratio of 0.65 (95 % CI: [0.23, 1.89]), showing no significant protective effect of prophylactic antibiotics. DISCUSSION: The study found no significant infection rate reduction with prophylactic antibiotic use. Notable were inconsistencies in study designs, antibiotic administration timing, and varied surgical practices. Antibiotic use risks were considered. Study limitations include potential biases and the retrospective nature of many studies. CONCLUSIONS: This review and meta-analysis found no substantial evidence supporting prophylactic antibiotics' effectiveness in reducing postoperative infection rates in septoplasty, rhinoplasty, and SRP, indicating a need to reevaluate practices and develop evidence-based guidelines. Future research should focus on comprehensive, randomized control studies, covering both preoperative and postoperative stages.

Evaluating the Effectiveness of Trauma-Informed Care Frameworks in Provider Education and the Care of Traumatized Patients.

INTRODUCTION: Trauma-informed care (TIC) spans many different health care fields and is essential in promoting the well-being and recovery of traumatized individuals. This review aims to assess the efficacy of TIC frameworks in both educating providers and enhancing care for adult and pediatric patients. METHODS: A literature search was conducted using PubMed, EMBASE, Proquest, Cochrane, and Google Scholar to identify relevant articles up to September 28, 2023. Studies implementing TIC frameworks in health care settings as a provider education tool or in patient care were included. Studies were further categorized based on adult or pediatric patient populations and relevant outcomes were extracted. RESULTS: A total of 36 articles were included in this review, evaluating over 7843 providers and patients. When implemented as a provider education tool, TIC frameworks significantly improved provider knowledge, confidence, awareness, and attitudes toward TIC (P < 0.05 to P < 0.001). Trauma screenings and assessments also increased (P < 0.001). When these frameworks were applied in adult patient care, there were positive effects across a multitude of settings, including women's health, intimate partner violence, post-traumatic stress disorder, and inpatient mental health. Findings included reduced depression and anxiety (P < 0.05), increased trauma disclosures (5%-30%), and enhanced mental and physical health (P < 0.001). CONCLUSIONS: This review underscores the multifaceted effectiveness of TIC frameworks, serving both as a valuable educational resource for providers and as a fundamental approach to patient care. Providers reported increased knowledge and comfort with core trauma principles. Patients were also found to derive benefits from these approaches in a variety of settings. These findings demonstrate the extensive applicability of TIC frameworks and highlight the need for a more comprehensive understanding of their applications and long-term effects.

Clinical Outcomes of Early Versus Late Enteral Nutrition Support in Critically Ill Trauma Patients With Isolated Traumatic Brain Injury.

INTRODUCTION: This study aims to compare the impact of early initiation of enteral feeding initiation on clinical outcomes in critically ill adult trauma patients with isolated traumatic brain injuries (TBI). METHODS: A retrospective cohort analysis of the American College of Surgeons Trauma Quality Program Participant Use File 2017-2021 dataset of critically ill adult trauma patients with moderate to severe blunt isolated TBI. Outcomes included ICU length of stay (ICU-LOS), ventilation-free days (VFD), and complication rates. Timing cohorts were defined as very early (<6 hours), early (6-24 hours), intermediate (24-48 hours), and late (>48 hours). RESULTS: 9210 patients were included in the analysis, of which 952 were in the very early enteral feeding initiation group, 652 in the early, 695 in intermediate, and 6938 in the late group. Earlier feeding was associated with significantly shorter ICU-LOS (very early: 7.82 days; early: 11.28; intermediate 12.25; late 17.55; P < .001) and more VFDs (very early: 21.72 days; early: 18.81; intermediate 18.81; late 14.51; P < .001). Patients with late EF had a significantly higher risk of VAP than very early (OR .21, CI 0.12-.38, P < .001) or early EF (OR .33, CI 0.17-.65, P = .001), and higher risk of ARDS than the intermediate group (OR .23, CI 0.05-.925, P = .039). CONCLUSION: Early enteral feeding in critically ill adult trauma patients with moderate to severe isolated TBI resulted in significantly fewer days in the ICU, more ventilation-free days, and lower odds of VAP and ARDS the sooner enteral feeding was initiated, with the most optimized outcomes within 6 hours.

The National Resident Matching Program: An Outdated Business Model Due for Reform.

INTRODUCTION: This study aims to examine the trends across the entire NRMP application cycles from 2007-2008 to 2022-2023, specifically exploring trends across competitive surgical specialties to assess the efficacy of the existing NRMP business model and provide evidence-based recommendations to better address the current needs of both applicants and programs. METHODS: A cross-sectional study exploring the trends in the mean number of applicants and mean number of total ranked positions per applicant across surgical, the top 5 most competitive surgical specialties, and non-surgical specialties from 2007-2008 to the 2022-2023 match cycles utilizing data from the NRMP database. RESULTS: Over the studied 16 match cycles, the mean number of applicants to surgical specialties has increased by 47.99% and the mean number of total ranked positions per applicant has increased by 88.07%. For the top 5 most competitive specialties, the mean number of applicants has increased by 57.66% and the mean number of total ranked positions per applicant has increased by 83.33%. CONCLUSION: Trends across the 16 most recent NRMP cycles show evidence of increased congestion in the match system, the burden of which is primarily placed on applicants. Our findings support the need for drastic reform in the NRMP to relieve this burden, and we discuss practical solutions to allow the NRMP to better meet the needs of applicants and residency programs alike.

Clinical Surveillance vs Anticoagulation Therapy for Isolated Subsegmental Pulmonary Embolism: A Systematic Review of Clinical Outcomes.

BACKGROUND: This systematic review aims to evaluate and compare differences in clinical outcomes for adult patients diagnosed with ISSPE who were managed with anticoagulation vs clinical surveillance. METHODS: PubMed, Embase, ProQuest, Cochrane, and Google Scholar were searched to identify studies evaluating the use of anticoagulation and/or clinical surveillance in patients diagnosed with ISSPE. The search included studies published up to August 3, 2023. Outcomes of interest included 90-day recurrent venous thromboembolism (VTE), major bleeding, and all-cause mortality rates. RESULTS: Ten studies were included with a total of 1224 patients. Of these patients, 791 were treated with anticoagulation and 433 underwent surveillance. Studies found no difference in recurrent VTE rates, with the majority of studies reporting no recurrence. Of the studies that reported VTE recurrence, rates were .5% to 1.4% for the anticoagulation groups and 3.1% to 3.2% for the surveillance groups. Major bleeding rates were also similar. In anticoagulated patients, major bleeding rates ranged from 1% to 10%. In clinical surveillance patients, the majority found no rate of major bleeding, with 2 studies reporting rates of .8% to 3.2%. Mortality rates ranged widely with no significant differences reported. CONCLUSION: Clinical surveillance appears to be a safe and effective alternative to anticoagulation in patients with ISSPE. Ninety-day rates of recurrent VTE, major bleeding, and mortality were comparable between groups. These findings highlight the need for updated practice management guidelines to improve patient outcomes.

Enhancing safety & reducing fatalities in U.S. national parks: An evaluation of injury trends and policy implications in the ten most visited parks.

INTRODUCTION: National parks in the United States experience a significant number of annual visits, and with increasing popularity, injuries are expected to rise. This study aims to assess fatal injuries in the top ten most visited U.S. national parks from 2013 to 2022 to improve current policies and develop effective prevention strategies. METHODS: A cross-sectional study was conducted using public National Park Service data. Data including visitor demographics, injury cause, and location, were collected. Fatal injuries were categorized by season, age group, and gender. RESULTS: Summer had the highest total number of fatal injuries. The winter season had the highest rate of fatal injuries per 10 million visitors. The number of fatal injuries per 10 million visitors decreased from 2013 to 2022 for most parks. The South Region reported the highest total number of fatalities. The West Region demonstrated higher rates when adjusted for visitor volume. Fatal injuries were most prevalent in the 35-44 age group, followed by the 15-24 and 25-34 age groups, with the least incidents in the 0-14 age group, and were more common among males (71.5 % of total injuries). CONCLUSION: This study found the highest number of total injuries occurring in summer; however, winter presented a higher risk per visitor. Slips and falls were the most common cause of injuries, requiring targeted safety measures. Males in the 35-44 age group reported the highest fatality rates. These findings highlight the necessity for improved monitoring and reporting to better understand injury causes and formulate specific, evidence-based policies for prevention.

Exploring the role of ranking systems towards university performance improvement: A focus group-based study.

The development of multiple university ranking systems at national and global levels has been driven by increasing interest in improving efficiency in the national educational sector without compromising the demand for international standards. Global university ranking systems play an important role by providing the foundation for competing in this global era. One approach could be developing and evaluating criteria to reduce the unnecessary use of standard, less productive indicators. This study aims to systematically exploit national and global university ranking systems in terms of their indicators and relevance to national educational needs. This study uses two online qualitative focus groups with 10 participants each. The participants were purposively sampled, and the transcribed data from the focus group were thematically analyzed. Findings indicate that university ranking should include indicators like governance and digital presence, as these are missing in global ranking indicators. These findings will guide the development of a university ranking framework that policymakers and universities can implement to improve institutional performance.

Elective Hand Surgery in Patients With History of Axillary Node Dissection: Risks and Patient Education.

OBJECTIVE: To determine if patients with a prior history of axillary lymph node dissection (ALND) secondary to breast cancer surgery and other procedures are at an increased risk of postoperative complications including lymphedema and infection following elective upper extremity surgery. Furthermore, the study aimed to evaluate the extent of patient education regarding lymphedema as a possible complication of upper extremity surgery. METHODS: A review of 312 patients presenting to the clinic with upper extremity pathologies was performed of which 15 patients had a history of surgeries secondary to breast cancer and 297 had no prior history of breast cancer. Nine out of 15 patients with prior breast procedures and 66 out of 297 patients with no such history underwent elective hand surgeries, with 22 out of the 75 patients having a history of ALND. Incidences of postoperative complications including lymphedema and infection were recorded. Afterward, a survey inquiring about patient education was conducted to assess whether the patients were educated regarding lymphedema and if so, when and from whom they received the counseling. RESULTS: No patients with a prior history of ALND secondary to breast cancer or other surgeries developed a postoperative infection or onset of lymphedema, and no patients with preoperative lymphedema had any worsening of lymphedema or infection postoperatively. The survey conducted afterward revealed that 61% of the patients with a prior history of breast cancer-related procedures including lymph node dissection were never counseled regarding lymphedema as a possible complication of hand surgery. Furthermore, 75% of the survey participants wished they were given more information about possible causes and complications of, and ways to prevent or minimize the possibility of lymphedema developing postoperatively. CONCLUSION: Prior history of ALND did not make patients more susceptible to postoperative complications, thus a history of isolated ALND or breast cancer surgery including ALND should not preclude elective hand surgical procedures from being performed ipsilaterally. Additionally, improvements in the degree of patient counseling regarding postoperative complications following hand surgery are needed as increased patient education is shown to be associated with a lower rate of complications and faster recovery times.