Journal of the American College of Surgeons
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Firearms are the leading cause of death among US children and adolescents. This study evaluates whether state gun laws are associated with firearm suicides and homicides in children. ⋯ Firearm legislation is associated with decreased suicide rates for individuals younger than 18 years of age, but its influence on homicides is less certain. Comprehensive research and thoughtful policy formulation are essential for addressing this pressing public health concern.
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Historical Article
The Public Health Leader Who Brought Antisepsis to William Halsted.
William Halsted wrote to aging surgeon, Stephen Smith, in 1919, that he remembered the lessons Smith had taught him, "when I walked with you through the wards of Bellevue Hospital." Smith was an early advocate of Joseph Lister's antiseptic method, and because of his public health work, he was also an early advocate of environmental hygiene and microbial control based on the unproved germ theory. Although Lister's work at the time emphasized germ killing around the operative site with carbolic acid (antisepsis), Smith adopted and encouraged surgical practices at Bellevue that would be hallmarks of the germ-preventing (asepsis) surgical approach that fully developed after German bacteriologic discoveries in the mid-1880s, and with which Halsted is historically identified. Some physicians and historians have emphasized temporal and conceptual differences between Lister's antisepsis and German asepsis, but Smith and Halsted's experiences argue that surgical asepsis was the evolutionary outcome of germ theory-based surgical changes that began well before scientific proof arrived.
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Before kidney transplantation (KT), most patients have an elevated parathyroid hormone (PTH). However, the impact of PTH on post-KT mortality and graft loss is unclear. We quantified the association between PTH levels measured at transplantation and adverse post-KT outcomes. ⋯ PTH more than 600 pg/mL before KT increased the risk of DCGL by 76%, demonstrating the importance of treating PTH before KT to prevent graft loss in a contemporary era with the introduction and widespread availability of medical therapy.
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The association between preoperative wearable device step counts and surgical outcomes has not been examined using commercial devices linked to electronic health records (EHRs). This study measured the association between daily preoperative step counts and postoperative complications. ⋯ This study found an increase in overall postoperative complication rate in patients recording lower average preoperative step counts. Patients with a baseline of less than 7,500 steps per day had increased odds of postoperative complications in this cohort. These data support the use of wearable devices for surgical risk stratification and suggest step count may measure preoperative fitness.