LAC+USC Medical Center

About: LAC+USC Medical Center is a healthcare organization based out in Los Angeles, California, United States. It is known for research contribution in the topics: Population & Poison control. The organization has 1348 authors who have published 886 publications receiving 21927 citations. The organization is also known as: County/USC & Los Angeles County General.

Time is domain: factors affecting primary fascial closure after trauma and non-trauma damage control laparotomy (data from the EAST SLEEP-TIME multicenter registry).

Abstract: Damage control laparotomy (DCL) is used for both traumatic and non-traumatic indications. Failure to achieve primary fascial closure (PFC) in a timely fashion has been associated with complications including sepsis, fistula, and mortality. We sought to identify factors associated with time to PFC in a multicenter retrospective cohort. We reviewed retrospective data from 15 centers in the EAST SLEEP-TIME registry, including age, comorbidities (Charlson Comorbidity Index [CCI]), small and large bowel resection, bowel discontinuity, vascular procedures, retained packs, number of re-laparotomies, net fluid balance after 24 h, trauma, and time to first takeback in 12-h increments to identify key factors associated with time to PFC. In total, 368 patients (71.2% trauma, of which 50.6% were penetrating, median ISS 25 [16, 34], with median Apache II score 15 [11, 22] in non-trauma) were in the cohort. Of these, 92.9% of patients achieved PFC at 60.8 ± 72.0 h after 1.6 ± 1.2 re-laparotomies. Each additional re-laparotomy reduced the odds of PFC by 91.5% (95%CI 88.2–93.9%, p 48 h. Trauma patients had increased likelihood of PFC in two separate analyses (p = 0.022 and 0.002). Time to re-laparotomy ≤ 24 h and minimizing number of re-laparotomies are highly predictive of rapid achievement of PFC in patients after trauma- and non-trauma DCL. 2B.

The Dangers of Equivocal FAST in Trauma Resuscitation.

Abstract: Equivocal focused abdominal sonography for trauma (FAST) examinations confound decision-making for trauma surgeons. We sought to determine whether the equivocal FAST (defined as any nonconcordant result) has a deleterious effect on trauma outcomes. A 2-year review (2014-2015) of all trauma activations at our Level I trauma center was performed. Patients were matched at baseline and FAST results were compared. Outcomes included resuscitation time (h), ventilation days (d), hospital length of stay (HLOS-d), ICU length-of-stay, and survival (%). In addition, skill level of the sonographer was stratified by novice (postgraduate year (PGY) years 1-3) or expert skill levels (PGY-4/fellow or attending). A total of 1,027 patients were included. Compared with concordant FAST examinations, equivocal FASTs were associated with increased HLOS (14.1 vs 10.6, P = 0.05), higher mortality (9.8 vs 3.7%, P = 0.02), decreased positive predictive value in the right upper quadrant (RUQ) (55 vs 79%, P = 0.02) and left upper quadrant (LUQ) (50 vs 83%, P < 0.01) and significantly decreased specificity in the thoracic (83 vs 98%), RUQ (80 vs 98%), LUQ (86 vs 99%), and pelvic (88 vs 98%) windows (P < 0.01 for all). A trend of greater positive predictive value in the thoracic window (100 vs 81%, P = 0.09) among PGY-4/fellow and attending providers compared with PGY levels 1-3 was observed. Equivocal FASTs portend worse outcomes than concordant FASTs because of high false-negative rates, specifically in the thoracic region and the upper quadrants. Lower thresholds for intervention are recommended.

Detection of antigenic differences and similarities between human transitional cell carcinoma cell lines using rabbit antisera.

Abstract: Rabbit antisera to cell lines derived from transitional cell carcinomas were examined by complement dependent cytotoxicity, absorption analysis, and inhibition assays and the staphylococcal protein-A assay. Test cells were from cell lines derived from transitional cell carcinomas (TCC-CL), other tumours, and normal cells. Following several absorptions of the antisera with normal tissues and insolubilized FCS, activity was undet ectable against many carcinoma cell lines but remained against TCC-CL, a lung carcinoma derived line, and many of the non-carcinoma lines. Further absorption of anti-253J (a TCC-CL) antisera with non TCC lines resulted in specific activity against 253J. This selectivity was supported by SpA assay results. Inhibition and absorption experiments using cultured cells and supernatants disclosed a complex quantitative and/or qualitative antigenic relationship between cell lines. Absorption of antisera with tumour and normal tissue specimens and inhibition of cytotoxicity by patients' and controls' sera indicated possible clinical relevance of detected antigens.

Low Back Pain in the Emergency Medicine Department: A Flipped Classroom Module.

Abstract: Introduction Current residency didactic schedules that are built upon hour-long, lecture-based presentations are incongruous with adult learning theory and the needs of millennial generati...

Duty hour reform: only a small piece of a larger problem--reply.

Abstract: We agree with Dr. Runyan that addressing inter-professional communication and handoff training are critical factors in achieving meaningful improvement in both the quality of care that residents provide and the quality of life that they enjoy. Evidence from multiple studies indicate that the most recent set of ACGME duty hour reforms, which focused almost exclusively on reducing maximum shift length, have not achieved the intended improvements in quality of care or quality of life (1–3). If this experience with interns is instructive, then extending work hour limits to all residents, without address the additional factors raised be Dr. Runyan, will likely be ineffective. In addition to communication training, an essential piece of the puzzle not addressed by existing duty hour reforms is work compression. House officers now spend fewer hours in the hospital but their clinical workload and educational requirements have not decreased proportionally, resulting in an even more frenetic pace of work — a phenomenon known as “work compression” (4). In 2000 a typical call day lasted 36 hours. This was specifically reduced for interns from 36 hours to 30 hours in 2004 and to 16 hours with the latest duty hour changes. As a result, current interns have fewer hours to complete their work and engage in learning and team building experiences. This leaves the new intern generation in a frustrating situation where they are often criticized or chided for having less work when, in many cases, they are simply given less time to complete it. If we know that timed tests result in more errors than untimed ones, we should not be surprised that giving interns less time to complete the same amount of work would adversely affect their patient care. Paradoxically, with the addition of new, often untested, educational curriculum in communication skills and systems of care to traditional clinical topics, interns are also being asked to learn more in less time. Collectively, these changes often result in reduced opportunities to double-check orders, follow a disease course, spend time at the patient’s bedside, teach students or share a meal with their team. Incorporating solutions that address the problems associated with work compression are needed to fully achieve the goals of residency duty hour reform.