Surgery
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We have recently demonstrated that treatment with suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor, before a lethal dose of lipopolysaccharide (LPS) improves survival in mice. The purpose of the present study was to determine whether SAHA treatment would attenuate LPS-induced shock and improve survival when given postinsult in a rodent model. ⋯ We report for the first time that administration of SAHA (50 mg/kg IP) after a lethal dose of LPS significantly improves long-term survival, and attenuates expression of the proinflammatory mediators TNF-alpha and IL-6. Furthermore, our data suggest that the anti-inflammatory effects of SAHA may be due to downregulation of the MyD88-dependent pathway, and decreased expression of associated proinflammatory genes.
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The purpose of this prospective study was to determine the effectiveness of targeted interventions to improve compliance with antibiotic prophylaxis guidelines (timing, spectrum, and discontinuation) at 2 university-affiliated hospitals. ⋯ Simply increasing attention to a quality problem can result in a significant and sustained improvement. Quality improvement interventions should be evaluated rigorously for effectiveness given hospital-specific differences in effectiveness and for correlation of guideline compliance with outcome.
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Advance directive (AD) use is uncommon in surgical patients, yet the exact reasons for this are unknown. Our aim was to identify and describe beliefs held by surgeons regarding ADs. A qualitative exploration of physicians' opinions of ADs for surgical patients was designed. This methodology is preferred to quantitative techniques, which are subject to bias when an issue's underlying themes are unknown. ⋯ Surgeons describe conflicting feelings about ADs for high-risk surgical patients. These beliefs and attitudes may be an underlying factor for the limited use of ADs by surgical patients. Methods for improving effective use of ADs in surgical practice must address these attitudes.
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We investigated the outcomes of injured patients who were undertriaged and compared them with those meeting full trauma team activation (TTA) criteria. ⋯ The UTG had a lower ISS and improved outcomes compared to the CTG with no differences in OR delays. Despite inherent challenges in TTA protocols, patients who were undertriaged at our institution appear to have satisfactory outcomes.
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Pedestrian trauma is the most lethal blunt trauma mechanism, and the rate of mortality in African Americans and Hispanics is twice that compared with whites. Whether insurance status and differential survival contribute to this disparity is unknown. ⋯ African American and Hispanic race, as well as uninsured status, increase the risk of mortality after pedestrian crashes. Given the greater incidence of pedestrian crashes in minorities, this compounded burden of injury mandates pedestrian trauma prevention efforts in inner cities to decrease health disparities.