Predicting Unplanned Readmissions to the Intensive Care Unit in the Trauma Population.

Background: Unplanned readmission to intensive care units (UR-ICU) in trauma is associated with increased hospital length of stay and significant morbidity and mortality. We identify independent predictors of UR-ICU and construct a nomogram to estimate readmission probability. Materials and Methods: We performed an IRB-approved retrospective case-control study at a Level I trauma center between January 2019 and December 2021. Patients with UR-ICU (n = 175) were matched with patients who were not readmitted (NR-ICU) (n = 175). Univariate and multivariable binary linear regressionanalyses were performed (SPSS Version 28, IBM Corp), and a nomogram was created (Stata 18.0, StataCorp LLC). Results: Demographics, comorbidities, and injury- and hospital course-related factors were examined as potential prognostic indicators of UR-ICU. The mortality rate of UR-ICU was 22.29% vs 6.29% for NR-ICU (P < .001). Binary linear regression identified seven independent predictors that contributed to UR-ICU: shock (P < .001) or intracranial surgery (P = .015) during ICU admission, low hematocrit (P = .001) or sedation administration in the 24 hours before ICU discharge (P < .001), active infection treatment (P = .192) or leukocytosis on ICU discharge (P = .01), and chronic obstructive pulmonary disease (COPD) (P = .002). A nomogram was generated to estimate the probability of UR-ICU and guide decisions on ICU discharge appropriateness. Discussion: In trauma, UR-ICU is often accompanied by poor outcomes and death. Shock, intracranial surgery, anemia, sedative administration, ongoing infection treatment, leukocytosis, and COPD are significant risk factors for UR-ICU. A predictive nomogram may help better assess readiness for ICU discharge.

The Role of Procalcitonin in Predicting Failure of Non-operative Management in Bowel Obstructions.

Procalcitonin has been investigated as a marker for bowel ischemia. This study examined the role of procalcitonin in predicting failure of non-operative management (NOM) in bowel obstructions. Patients with bowel obstructions at a single center from August 2022 to January 2023 were prospectively enrolled (n = 79). Lactic acid (LA) and procalcitonin were collected after surgical consultation. The primary outcome was success or failure of NOM. Univariate analysis, multivariable logistic regression, and performance measures of procalcitonin and LA in predicting bowel ischemia was performed. Of 79 patients included, 48 (61%) required operative intervention during index admission. There were no significant differences in demographics, comorbidities, procalcitonin, nor LA between groups. Time from last bowel movement was associated with failure of NOM (OR 1.03 [95% CI 1.01-1.06]; P = .008), though initial procalcitonin or LA was not. Procalcitonin >.3 ng/mL had acceptable sensitivity in screening for bowel ischemia.

Contralateral prophylactic mastectomy in a rural population: A single-institution experience.

Background: The incidence of contralateral prophylactic mastectomy (CPM) for unilateral breast cancer (UBC) has continued to increase, despite an absent survival benefit except in populations at highest risk for developing contralateral breast cancer (CBC). CPM rates may be higher in rural populations but causes remain unclear. A study performed at our institution previously found that 21.8 % of patients with UBC underwent CPM from 2000 to 2009. This study aimed to evaluate the CPM trend at a single institution serving a rural population and identify the CPM rate in average-risk patients. Methods: Retrospective review of patients who underwent mastectomies for UBC at our institution from 2017 to 2021 was performed. Analysis utilized frequencies and percentages, descriptive statistics, chi-square, and independent sample t-tests. Results: A total of 438 patients were included, of whom 64.4 % underwent bilateral mastectomy for UBC (CPM). Patients who underwent CPM were significantly younger, underwent genetic testing, had germline pathogenic variants, had a family history of breast cancer, had smaller tumors, underwent reconstruction, and had more wound infections. Of CPM patients, 50.4 % had no identifiable factors for increased risk of developing CBC. Conclusions: The rate of CPM in a rural population at a single institution increased from 21.8 % to 64.4 % over two decades, with an average-risk CPM rate of 50.4 %. Those that undergo CPM are more likely to undergo reconstruction and have more wound infections. Identifying characteristics of patients undergoing CPM in a rural population and the increased associated risks allows for a better understanding of this trend to guide conversations with patients. Key message: This study demonstrates that the rate of contralateral prophylactic mastectomy for unilateral breast cancers performed at a single institution serving a largely rural population has nearly tripled over the last two decades, with half of these patients having no factors that increase the risk for developing contralateral breast cancers. Contralateral prophylactic mastectomy was significantly associated with smaller tumors, younger age, genetic testing, germline pathogenic variants, family history of breast cancer, breast reconstruction, and increased wound infections.

"Early Post-operative Mechanical Small Bowel Obstruction Induced by Unidirectional Barbed Suture".

Unidirectional barbed suture is widely used in minimally invasive procedures as a secure alternative to traditional knot tying. In this report, a 44-year-old female with endometriosis and complex gynecological history presented to our emergency department 2 weeks after undergoing minimally invasive gynecological surgery. She had persistent, progressive signs and symptoms typical of intermittent partial small bowel obstruction. On her third admission within 7 days for this pattern, laparoscopic abdominal exploration was performed. She was noted to have small bowel obstruction secondary to ingrowth of the tail of a unidirectional barbed suture kinking the terminal ileum during this procedure. We discuss small bowel obstruction due to unidirectional barbed suture and make recommendations on how to avoid this complication.

Validating a Novel Emotional Intelligence Instrument for Resident Physicians.

To construct and validate a scale of emotional intelligence (EI) for the medical field, n = 80 resident physicians responded to a 69-item self-report measure during the pilot phase of development of the Scale of Emotional Functioning: Medicine (SEF:MED). Based on multiple-phase item and structural analyses, a final 36-item version was created based on data from n = 321 respondent residents. Initially exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) supported the expected three-factor solution as did additional CFA from a second sample of n = 113 participants. Internal consistency reliabilities obtained from the original n = 321 residents for the three SEF:MED subscales of Interpersonal Skills (IS), Emotional Awareness (EA), and Emotional Management (EM) were 0.81, 0.82, and 0.84, respectively. Alphas for the second CFA data set were 0.89, 0.87, and 0.88 for IS, EM, and EA, respectively. In addition, the SEF:MED was validated by comparing it to related measures (i.e., the Profile of Emotional Competence (PEC) and the Maslach Burnout Inventory-Human Services Survey for Medical Personnel [MBI-HSS (MP)]); Correlation coefficients between the Total EI composite on the SEF:MED and the PEC global scales ranged from r = 0.64 to 0.68. Finally, correlation coefficients from the Total EI composite on the SEF:MED significantly related to the MBI-HSS (MP) Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) scales (r = -0.50, -0.44, and 0.52, respectively). The SEF:MED may provide useful data to physicians and other medical professionals as they consider their own well-being and how it may affect care of their patients.