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Wakam GK, Palmon I, Kulick AA, Lark M, Sonnenday CJ, Waits SA. Adapting to the Times: Combining Microlearning Videos and Twitter to Teach Surgical Technique. J Surg Educ 2022; 79:850-854. [PMID: 35227624 DOI: 10.1016/j.jsurg.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/29/2022] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Surgical videos are commonly utilized by trainees to prepare for surgical cases. However, currently available videos tend to be of excessive length, variable quality, and exist behind paywalls or in other exclusive formats. Our objective was to create a series of videos that would address these shortcomings, and further allow for dynamic engagement between learners and experts. DESIGN Our group created surgical videos using principles of microlearning, an educational strategy which deconstructs content into small units and uses social media platforms where learners and educators may actively engage. We published a library of short (<3 min) videos covering various steps of abdominal transplantation operations on a YouTube channel. We leveraged Twitter to disseminate the content and engage with experts and learners from around the world. SETTING Multi-institutional. RESULTS Over the period from July 2020 to January 2021, 24 microlearning videos were created, stored on a YouTube channel, and posted to Twitter weekly using a newly created account. During that time period, the videos, averaging 124 seconds in length, were viewed 4393 times and watched for a total of 127 hours. The account gained 611 followers in 37 countries and 37 US states with 312,400 impressions (defined as tweet views). Twitter users who engaged with our microlearning content (favorite, retweet, or reply) included faculty (27%), residents (21%), fellows (8%), and medical students (11%). CONCLUSIONS Broad participation with the educational material and discussion on Twitter demonstrated the potential for the microlearning technique to provide educational benefit for learners internationally. The spread of the tweets shows an opportunity to augment traditional surgical education, and the willingness of faculty to discuss alternative techniques with their peers. Our group will continue to develop a library of microlearning videos for surgical operations and engage with other institutions for collaboration and expansion.
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Affiliation(s)
- Glenn K Wakam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Itai Palmon
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Meghan Lark
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Seth A Waits
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Campion EM, Cralley A, Sauaia A, Buchheit RC, Brown AT, Spalding MC, LaRiccia A, Moore S, Tann K, Leskovan J, Camazine M, Barnes SL, Otaibi B, Hazelton JP, Jacobson LE, Williams J, Castillo R, Stewart NJ, Elterman JB, Zier L, Goodman M, Elson N, Miner J, Hardman C, Kapoen C, Mendoza AE, Schellenberg M, Benjamin E, Wakam GK, Alam HB, Kornblith LZ, Callcut RA, Coleman LE, Shatz DV, Burruss S, Linn AC, Perea L, Morgan M, Schroeppel TJ, Stillman Z, Carrick MM, Gomez MF, Berne JD, McIntyre RC, Urban S, Nahmias J, Tay E, Cohen M, Moore EE, McVaney K, Burlew CC. Prehospital end-tidal carbon dioxide is predictive of death and massive transfusion in injured patients: An Eastern Association for Surgery of Trauma multicenter trial. J Trauma Acute Care Surg 2022; 92:355-361. [PMID: 34686640 DOI: 10.1097/ta.0000000000003447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prehospital identification of the injured patient likely to require emergent care remains a challenge. End-tidal carbon dioxide (ETCO2) has been used in the prehospital setting to monitor respiratory physiology and confirmation of endotracheal tube placement. Low levels of ETCO2 have been demonstrated to correlate with injury severity and mortality in a number of in-hospital studies. We hypothesized that prehospital ETCO2 values would be predictive of mortality and need for massive transfusion (MT) in intubated patients. METHODS This was a retrospective multicenter trial with 24 participating centers. Prehospital, emergency department, and hospital values were collected. Receiver operating characteristic curves were created and compared. Massive transfusion defined as >10 U of blood in 6 hours or death in 6 hours with at least 1 U of blood transfused. RESULTS A total of 1,324 patients were enrolled. ETCO2 (area under the receiver operating characteristic curve [AUROC], 0.67; confidence interval [CI], 0.63-0.71) was better in predicting mortality than shock index (SI) (AUROC, 0.55; CI, 0.50-0.60) and systolic blood pressure (SBP) (AUROC, 0.58; CI, 0.53-0.62) (p < 0.0005). Prehospital lowest ETCO2 (AUROC, 0.69; CI, 0.64-0.75), SBP (AUROC, 0.75; CI, 0.70-0.81), and SI (AUROC, 0.74; CI, 0.68-0.79) were all predictive of MT. Analysis of patients with normotension demonstrated lowest prehospital ETCO2 (AUROC, 0.66; CI, 0.61-0.71), which was more predictive of mortality than SBP (AUROC, 0.52; CI, 0.47-0.58) or SI (AUROC, 0.56; CI, 0.50-0.62) (p < 0.001). Lowest prehospital ETCO2 (AUROC, 0.75; CI, 0.65-0.84), SBP (AUROC, 0.63; CI, 0.54-0.74), and SI (AUROC, 0.64; CI, 0.54-0.75) were predictive of MT in normotensive patients. ETCO2 cutoff for MT was 26 mm Hg. The positive predictive value was 16.1%, and negative predictive value was high at 98.1%. CONCLUSION Prehospital ETCO2 is predictive of mortality and MT. ETCO2 outperformed traditional measures such as SBP and SI in the prediction of mortality. ETCO2 may outperform traditional measures in predicting need for transfusion in occult shock. LEVEL OF EVIDENCE Diagnostic test, level III.
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Affiliation(s)
- Eric M Campion
- From the Department of Surgery (E.M.C., A.C., M. Cohen, E.E.M., C.C.B.), Denver Health Medical Center, Denver, Colorado; School of Public Health (A.S.), University of Colorado, Aurora, Colorado; Department of Surgery (R.C.B., A.T.B.), Erlanger Health System, Chattanooga, Tennessee; Department of Surgery (M.C.S., A.L.), Grant Medical Center, Columbus, Ohio; Department of Surgery (S.M., K.T.), Wakemed, Raleigh, North Carolina; Department of Surgery (J.L.), Mercy Health, Toledo, Ohio; Department of Surgery (M. Camazine, S.L.B.), University of Missouri Health Care, Columbia, Missouri; Department of Surgery (B.O., J.P.H.), Penn State Health, Hershey, Pennsylvania; Department of Surgery (L.E.J., J.W.), Ascension, Indianapolis, Indiana; Department of Surgery (R.C., N.J.S.), St. Lukes University Health Network, Bethlehem, Pennsylvania; Department of Surgery (J.B.E., L.Z.), UCHealth Medical Center of the Rockies, Loveland, Colorado; Department of Surgery (M.G., N.E.), University of Cincinnati, Cincinnati, Ohio; Department of Surgery (J.M., C.H.), Premier Health Miami Valley, Dayton, Ohio; Department of Surgery (C.K., A.E.M.), Massachusetts General Hospital, Boston, Massachusetts; USC Medical Center, University of Southern California (M.S., E.B.), Los Angeles, California; Department of Surgery (G.K.W., H.B.A.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (L.Z.K., R.A.C.), Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California; Department of Surgery (L.E.C., D.V.S.), University of California, Davis, Sacramento, California; Department of Surgery (S.B., A.C.L.), Loma Linda University Health, Loma Linda, California; Department of Surgery (L.P., M.M.), Penn Medicine, Philadelphia, Pennsylvania; Department of Surgery (T.J.S., Z.S.), UCHealth Memorial Hospital, Springs Colorado, Colorado; Department of Surgery (M.M.C.), Medical City Plano, Plano, Texas; Department of Surgery (M.F.G., J.D.B.), Broward Health, Ft. Lauderdale, Florida; Department of Surgery (R.C.M., S.U.), University of Colorado Anschutz, Aurora, Colorado; University of California, Irvine (J.N., E.T.), Irvine, CA; and Denver Paramedics, Department of Emergency Medicine (K.M.), Denver Health Medical Center, Denver, Colorado
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Pienta M, Fallon B, Wakam GK, Kim GY, Zogaib J, Corriere MA. Identifying Low-value Inpatient Hospitalizations Following Emergency Department Requests for Surgical Consultations. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wakam GK, Biesterveld BE, Pai MP, Kemp MT, O’Connell RL, Rajanayake KK, Chtraklin K, Vercruysse CA, Alam HB. A single dose of valproic acid improves neurologic recovery and decreases brain lesion size in swine subjected to an isolated traumatic brain injury. J Trauma Acute Care Surg 2021; 91:867-871. [PMID: 34695064 PMCID: PMC8715863 DOI: 10.1097/ta.0000000000003136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We lack specific treatments for traumatic brain injury (TBI), which remains the leading cause of trauma-related morbidity and mortality. Treatment with valproic acid (VPA) improves outcomes in models of severe TBI with concurrent hemorrhage. However, it is unknown if VPA will have similar benefits after isolated nonlethal TBI, which is the more common clinical scenario. The goal of this study was to evaluate the effect of VPA treatment in a preclinical isolated TBI swine model on neurologic outcomes and brain lesion size and to perform detailed pharmacokinetic analyses for a future clinical trial. METHODS Yorkshire swine (n = 10; 5/cohort) were subjected to TBI (8-mm controlled cortical impact). An hour later, we randomized them to receive VPA (150 mg/kg) or saline placebo (control). Neuroseverity scores were assessed daily (0 [normal] to 36 [comatose]), brain lesion size was measured on postinjury 3, and serial blood samples were collected for pharmacokinetic studies. RESULTS Physiologic parameters and laboratory values were similar in both groups. Valproic acid-treated animals demonstrated significantly better neuroseverity scores on postinjury 1 (control, 9.2 ± 4.4; VPA, 0 ± 0; p = 0.001). Valproic acid-treated animals had significantly smaller brain lesion sizes (mean volume in microliter: control, 3,130 ± 2,166; VPA, 764 ± 208; p = 0.02). Pharmacokinetic data confirmed adequate plasma and tissue levels of VPA. CONCLUSION In this clinically relevant model of isolated TBI, a single dose of VPA attenuates neurological impairment and decreases brain lesion size.
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Affiliation(s)
- Glenn K. Wakam
- Department of Surgery, University of Michigan, Ann Arbor, MI, 48109; USA
| | - Ben E. Biesterveld
- Department of Surgery, University of Michigan, Ann Arbor, MI, 48109; USA
| | - Manjunath P. Pai
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, 48109; USA
| | - Michael T. Kemp
- Department of Surgery, University of Michigan, Ann Arbor, MI, 48109; USA
| | | | | | - Kiril Chtraklin
- Department of Surgery, Northwestern University, Chicago, IL, 60611; USA
| | | | - Hasan B. Alam
- Department of Surgery, Northwestern University, Chicago, IL, 60611; USA
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Palmon I, Brown CS, Highet A, Kulick AA, Barrett ME, Cassidy DE, Herman AE, Gomez-Rexrode AE, O'Reggio R, Sonnenday C, Waits SA, Wakam GK. Microlearning and Social Media: A Novel Approach to Video-Based Learning and Surgical Education. J Grad Med Educ 2021; 13:323-326. [PMID: 34178254 PMCID: PMC8207915 DOI: 10.4300/jgme-d-20-01562.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Itai Palmon
- Itai Palmon, BS, is a Medical Student, Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, University of Michigan Medical School
| | - Craig S. Brown
- Craig S. Brown, MD, MSc, is a Resident, Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, and Fellow, Center for Health Outcomes and Policy, Michigan Medicine
| | - Alexandra Highet
- Alexandra Highet, MS, is a Medical Student, Transplant Research, Education, and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, University of Michigan Medical School, and Fellow, Center for Health Outcomes and Policy, Michigan Medicine
| | - Alexandra A. Kulick
- Alexandra A. Kulick, is a Student, Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine
| | - Meredith E. Barrett
- Meredith E. Barrett, MD, is a Clinical Lecturer in Transplant Surgery, Transplant Research, Education, and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine
| | - Devon E. Cassidy
- Devon E. Cassidy, BS, is a Medical Student, Transplant Research, Education, and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, University of Michigan Medical School
| | - Alexandra E. Herman
- Alexandra E. Herman, BS, is a Medical Student, Transplant Research, Education, and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, University of Michigan Medical School
| | - Amalia E. Gomez-Rexrode
- Amalia E. Gomez-Rexrode, BS, is a Medical Student, Transplant Research, Education, and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, University of Michigan Medical School
| | - Rachel O'Reggio
- Rachel O'Reggio, MPH, is a Medical Student, Transplant Research, Education, and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, University of Michigan Medical School
| | - Christopher Sonnenday
- Christopher Sonnenday, MD, MHS, is Professor of Surgery, Transplant Research, Education, and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine
| | - Seth A. Waits
- Seth A. Waits, MD, is Assistant Professor of Surgery and Abdominal Transplant Fellowship Director, Transplant Research, Education, and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, and Faculty, Center for Health Outcomes and Policy, Michigan Medicine
| | - Glenn K. Wakam
- Glenn K. Wakam, MD, is a Resident, Transplant Research, Education, and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine
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Kemp MT, Williams AM, Brown CS, Liesman DR, Sharma SB, Wakam GK, Biesterveld BE, Wilson JK, Cohen MS, Alam HB. Practical Guidance for Early Identification of Barriers in Surgical Telehealth Clinics. Ann Surg 2021; 273:e268-e270. [PMID: 33214474 PMCID: PMC8119297 DOI: 10.1097/sla.0000000000004633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Early identification of and response to barriers in telehealth settings will help patients receive optimal care. Here, the authors, based on institutional experience, provide advice on such strategies. This guidance focuses on standardizing expectations, assessing technological knowledge and resource access, evaluating understanding and comfort with telehealth, and assessing social support.
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Affiliation(s)
- Michael T. Kemp
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Craig S. Brown
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | | | - Glenn K. Wakam
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Jesse K. Wilson
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Mark S. Cohen
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Hasan B. Alam
- Department of Surgery, University of Michigan, Ann Arbor, MI
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Biesterveld BE, Siddiqui AZ, O'Connell RL, Remmer H, Williams AM, Shamshad A, Smith WM, Kemp MT, Wakam GK, Alam HB. Valproic Acid Protects Against Acute Kidney Injury in Hemorrhage and Trauma. J Surg Res 2021; 266:222-229. [PMID: 34023578 DOI: 10.1016/j.jss.2021.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/22/2021] [Accepted: 04/10/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Trauma is the leading cause of death among young people. These patients have a high incidence of kidney injury, which independently increases the risk of mortality. As valproic acid (VPA) treatment has been shown to improve survival in animal models of lethal trauma, we hypothesized that it would also attenuate the degree of acute kidney injury. METHODS We analyzed data from two separate experiments where swine were subjected to lethal insults. Model 1: hemorrhage (50% blood volume hemorrhage followed by 72-h damage control resuscitation). Model 2: polytrauma (traumatic brain injury, 40% blood volume hemorrhage, femur fracture, rectus crush and grade V liver laceration). Animals were resuscitated with normal saline (NS) +/- VPA 150 mg/kg after a 1-h shock phase in both models (n = 5-6/group). Serum samples were analyzed for creatinine (Cr) using colorimetry on a Liasys 330 chemistry analyzer. Proteomic analysis was performed on kidney tissue sampled at the time of necropsy. RESULTS VPA treatment significantly (P < 0.05) improved survival in both models. (Model 1: 80% vs 20%; Model 2: 83% vs. 17%). Model 1 (Hemorrhage alone): Cr increased from a baseline of 1.2 to 3.0 in NS control animals (P < 0.0001) 8 h after hemorrhage, whereas it rose only to 2.1 in VPA treated animals (P = 0.004). Model 2 (Polytrauma): Cr levels increased from baseline of 1.3 to 2.5 mg/dL (P = 0.01) in NS control animals 4 h after injury but rose to only 1.8 in VPA treated animals (P = 0.02). Proteomic analysis of kidney tissue identified metabolic pathways were most affected by VPA treatment. CONCLUSIONS A single dose of VPA (150 mg/kg) offers significant protection against acute kidney injury in swine models of polytrauma and hemorrhagic shock.
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Affiliation(s)
| | - Ali Z Siddiqui
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Rachel L O'Connell
- Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Surgery, Northwestern University, Chicago, IL
| | - Henriette Remmer
- Department of Biological Chemistry, University of Michigan, Ann Arbor, MI
| | | | - Alizeh Shamshad
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - William M Smith
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Glenn K Wakam
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Hasan B Alam
- Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Surgery, Northwestern University, Chicago, IL
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Brown CS, Montgomery JR, Neiman PU, Wakam GK, Tsai TC, Dimick JB, Scott JW. Assessment of Potentially Preventable Hospital Readmissions After Major Surgery and Association With Public vs Private Health Insurance and Comorbidities. JAMA Netw Open 2021; 4:e215503. [PMID: 33847752 PMCID: PMC8044735 DOI: 10.1001/jamanetworkopen.2021.5503] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Rehospitalization after major surgery is common and represents a significant cost to the health care system. Little is known regarding the causes of these readmissions and the degree to which they may be preventable. OBJECTIVE To evaluate the degree to which readmissions after major surgery are potentially preventable. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used a weighted sample of 1 937 354 patients from the 2017 National Readmissions Database to evaluate all adult inpatient hospitalizations for 1 of 7 common major surgical procedures. Statistical analysis was performed from January 14 to November 30, 2020. MAIN OUTCOMES AND MEASURES The study calculated 90-day readmission rates as well as rates of readmissions that were considered potentially preventable. Potentially preventable readmissions (PPRs) were defined as those with a primary diagnosis code for superficial surgical site infection, acute kidney injury, aspiration pneumonitis, or any of the Agency for Healthcare Research and Quality-defined ambulatory care sensitive conditions. Multivariable logistic regression was used to identify factors associated with PPRs. RESULTS A total weighted sample of 1 937 354 patients (1 048 046 women [54.1%]; mean age, 66.1 years [95% CI, 66.0-66.3 years]) underwent surgical procedures; 164 755 (8.5%) experienced a readmission within 90 days. Potentially preventable readmissions accounted for 29 321 (17.8%) of all 90-day readmissions, for an estimated total cost to the US health care system of approximately $296 million. The most common reasons for PPRs were congestive heart failure exacerbation (34.6%), pneumonia (12.0%), and acute kidney injury (22.5%). In a multivariable model of adults aged 18 to 64 years, patients with public health insurance (Medicare or Medicaid) had more than twice the odds of PPR compared with those with private insurance (adjusted odds ratio, 2.09; 95% CI, 1.94-2.25). Among patients aged 65 years or older, patients with private insured had 18% lower odds of PPR compared with patients with Medicare as the primary payer (adjusted odds ratio, 0.82; 95% CI, 0.74-0.90). CONCLUSIONS AND RELEVANCE This study suggests that nearly 1 in 5 readmissions after surgery are potentially preventable and account for nearly $300 million in costs. In addition to better inpatient care, improved access to ambulatory care may represent an opportunity to reduce costly readmissions among surgical patients.
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Affiliation(s)
- Craig S. Brown
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - John R. Montgomery
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Pooja U. Neiman
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- National Clinician Scholars Program, University of Michigan, Ann Arbor
| | - Glenn K. Wakam
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Thomas C. Tsai
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Justin B. Dimick
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - John W. Scott
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
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Pumiglia L, Williams AM, Kemp MT, Wakam GK, Alam HB, Biesterveld BE. Brain proteomic changes by histone deacetylase inhibition after traumatic brain injury. Trauma Surg Acute Care Open 2021; 6:e000682. [PMID: 33880414 PMCID: PMC7993337 DOI: 10.1136/tsaco-2021-000682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 11/04/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a leading cause of morbidity and mortality. There are currently no cytoprotective treatments for TBI. There is growing evidence that the histone deacetylase inhibitor valproic acid (VPA) may be beneficial in the treatment of TBI associated with hemorrhagic shock and in isolation. We sought to further evaluate the mechanistic underpinnings of this demonstrated efficacy via proteomic analysis of injured brain tissue. Methods Swine were subjected to TBI via controlled cortical impact, randomized to treatment with VPA or control and observed for 6 hours. The brains of the pigs were then sectioned, and tissue was prepared and analyzed for proteomic data, including gene ontology (GO), gene-set enrichment analysis and enrichment mapping, and network mapping. Results Proteomic analysis demonstrated differential expression of hundreds of proteins in injured brain tissue after treatment with VPA. GO analysis and network analyses revealed groups of proteins and processes that are known to modulate injury response after TBI and impact cell fate. Processes affected included protein targeting and transport, cation and G-protein signaling, metabolic response, neurotransmitter response and immune function. Discussion This proteomic analysis provides initial mechanistic insight into the observed rescue of injured brain tissue after VPA administration in isolated TBI. Level of evidence Not applicable (animal study).
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Affiliation(s)
| | - Aaron M Williams
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Glenn K Wakam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Hasan B Alam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - Ben E Biesterveld
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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10
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Biesterveld BE, O'Connell R, Kemp MT, Wakam GK, Williams AM, Pai MP, Alam HB. Validation of intraosseous delivery of valproic acid in a swine model of polytrauma. Trauma Surg Acute Care Open 2021; 6:e000683. [PMID: 33791436 PMCID: PMC7978107 DOI: 10.1136/tsaco-2021-000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/04/2021] [Accepted: 02/28/2021] [Indexed: 11/03/2022] Open
Abstract
Background Intraosseous (IO) drug delivery may be necessary in emergency situations when intravenous access is unattainable. Valproic acid (VPA) is a histone deacetylase inhibitor that has previously been shown to improve survival in preclinical models of lethal polytrauma. In this study, we sought to compare serum levels of intravenously and IO-delivered VPA, and to analyze the effect of IO-delivered VPA. Methods Swine were subjected to 40% blood volume hemorrhage, brain injury, femur fracture, rectus crush injury and liver laceration. After 1 hour of shock, animals were randomized (n=3/group) to receive normal saline resuscitation (control), normal saline+intravenous VPA 150 mg/kg (intravenous group) or normal saline +IO VPA 150 mg/kg (IO group). Serum levels of VPA were assessed between groups, and proteomics analyses were performed on IO and control groups on heart, lung and liver samples. Results Intravenous and IO serum VPA levels were similar at 1, 3, 5 and 7 hours after starting the infusion (p>0.05). IO-delivered VPA induced significant proteomics changes in the heart, lung and liver, which were most pronounced in the lung. Biologic processes affected included inflammation, metabolism and transcriptional & translational machinery. The control group had 0% survival, and the intravenous and IO group both had 100% survival to the end of the experiment (p<0.05). Discussion IO-delivered VPA is noninferior to intravenous administration and is a viable option in emergent situations when intravenous access is unattainable. Level of evidence Not applicable (animal study).
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Affiliation(s)
- Ben E Biesterveld
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel O'Connell
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Glenn K Wakam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron M Williams
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Manjunath P Pai
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Hasan B Alam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Surgery, Northwestern University, Evanston, Illinois, USA
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11
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Kemp MT, Wakam GK, Williams AM, Biesterveld BE, O'Connell RL, Vercruysse CA, Chtraklin K, Russo RM, Alam HB. A novel partial resuscitative endovascular balloon aortic occlusion device that can be deployed in zone 1 for more than 2 hours with minimal provider titration. J Trauma Acute Care Surg 2021; 90:426-433. [PMID: 33492106 DOI: 10.1097/ta.0000000000003042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemorrhage is a leading cause of mortality in trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) can control hemorrhage, but distal ischemia, subsequent reperfusion injury, and the need for frequent balloon titration remain problems. Improved device design can allow for partial REBOA (pREBOA) that may provide hemorrhage control while also perfusing distally without need for significant provider titration. METHODS Female Yorkshire swine (N = 10) were subjected to 40% hemorrhagic shock for 1 hour (mean arterial pressure [MAP], 28-32 mm Hg). Animals were then randomized to either complete aortic occlusion (ER-REBOA) or partial occlusion (novel pREBOA-PRO) without frequent provider titration or distal MAP targets. Detection of a trace distal waveform determined partial occlusion in the pREBOA-PRO arm. After 2 hours of zone 1 occlusion, the hemorrhaged whole blood was returned. After 50% autotransfusion, the balloon was deflated over a 10-minute period. Following transfusion, the animals were survived for 2 hours while receiving resuscitation based on objective targets: lactated Ringer's fluid boluses (goal central venous pressure, ≥ 6 mm Hg), a norepinephrine infusion (goal MAP, 55-60 mm Hg), and acid-base correction (goal pH, >7.2). Hemodynamic variables, arterial lactate, lactate dehydrogenase, aspartate aminotransferase, and creatinine levels were measured. RESULTS All animals survived throughout the experiment, with similar increase in proximal MAPs in both groups. Animals that underwent partial occlusion had slightly higher distal MAPs. At the end of the experiment, the partial occlusion group had lower end levels of serum lactate (p = 0.006), lactate dehydrogenase (p = 0.0004) and aspartate aminotransferase (p = 0.004). Animals that underwent partial occlusion required less norepinephrine (p = 0.002), less bicarbonate administration (p = 0.006), and less fluid resuscitation (p = 0.042). CONCLUSION Improved design for pREBOA can decrease the degree of distal ischemia and reperfusion injury compared with complete aortic occlusion, while providing a similar increase in proximal MAPs. This can allow pREBOA zone-1 deployment for longer periods without the need for significant balloon titration.
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Affiliation(s)
- Michael T Kemp
- From the Department of Surgery (M.T.K., G.K.W., A.M.W., B.E.B., R.L.O., C.A.V., K.C., H.B.A.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (R.M.R.), UC Davis Medical Center, Sacramento; US Air Force Medical Corps, 60th Medical Group (R.M.R.), Travis AFB, Fairfield, California; and Department of Surgery (H.B.A.), Northwestern University, Chicago, Illinois
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12
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Wakam GK, Biesterveld BE, Pai MP, Kemp MT, O'Connell RL, Williams AM, Srinivasan A, Chtraklin K, Siddiqui AZ, Bhatti UF, Vercruysse CA, Alam HB. Administration of valproic acid in clinically approved dose improves neurologic recovery and decreases brain lesion size in swine subjected to hemorrhagic shock and traumatic brain injury. J Trauma Acute Care Surg 2021; 90:346-352. [PMID: 33230090 DOI: 10.1097/ta.0000000000003036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) and hemorrhage remain the leading causes of death after trauma. We have previously shown that a dose of valproic acid (VPA) at (150 mg/kg) can decrease brain lesion size and hasten neurologic recovery. The current Food and Drug Administration-approved dose of VPA is 60 mg/kg. We evaluate neurologic outcomes and brain lesion size of a single dose of VPA at a level currently within Food and Drug Administration-approved dose in swine subjected to TBI and hemorrhagic shock. METHODS Swine (n = 5/group) were subjected to TBI and 40% blood volume hemorrhage. Animals remained in shock for 2 hours before randomization to normal saline (NS) resuscitation alone (control), NS-VPA 150 mg/kg (VPA 150), or NS-VPA 50 mg/kg (VPA 50). Neurologic severity scores (range, 0-32) were assessed daily for 14 days, and brain lesion size was measured via magnetic resonance imaging on postinjury day (PID) 3. RESULTS Shock severity and laboratory values were similar in all groups. Valproic acid-treated animals demonstrated significantly less neurologic impairment on PID 1 and returned to baseline faster (PID 1 mean neurologic severity score, control = 22 ± 3 vs. VPA 150 mg/kg = 8 ± 7 or VPA 50 mg/kg = 6 ± 6; p = 0.02 and 0.003). Valproic acid-treated animals had significantly smaller brain lesion sizes (mean volume in mm3, control = 1,268.0 ± 241.2 vs. VPA 150 mg/kg = 620.4 ± 328.0 or VPA 50 mg/kg = 438.6 ± 234.8; p = 0.007 and 0.001). CONCLUSION In swine subjected to TBI and hemorrhagic shock, VPA treatment, in a dose that is approved for clinical use, decreases brain lesion size and reduces neurologic impairment compared with resuscitation alone.
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Affiliation(s)
- Glenn K Wakam
- From the Department of Surgery (G.K.W., B.E.B., M.T.K., R.L.O., A.M.W., K.C., A.Z.S., U.F.B., C.A.V., H.B.A.), Department of Clinical Pharmacy (M.P.P.), and Section of Neuroradiology, Department of Radiology (A.S.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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13
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O'Connell RL, Wakam GK, Siddiqui A, Williams AM, Graham N, Kemp MT, Chtraklin K, Bhatti UF, Shamshad A, Li Y, Alam HB, Biesterveld BE. Development of a large animal model of lethal polytrauma and intra-abdominal sepsis with bacteremia. Trauma Surg Acute Care Open 2021; 6:e000636. [PMID: 33537457 PMCID: PMC7852924 DOI: 10.1136/tsaco-2020-000636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/03/2020] [Accepted: 12/14/2020] [Indexed: 11/04/2022] Open
Abstract
Background Trauma and sepsis are individually two of the leading causes of death worldwide. When combined, the mortality is greater than 50%. Thus, it is imperative to have a reproducible and reliable animal model to study the effects of polytrauma and sepsis and test novel treatment options. Porcine models are more translatable to humans than rodent models due to the similarities in anatomy and physiological response. We embarked on a study to develop a reproducible model of lethal polytrauma and intra-abdominal sepsis, which was lethal, though potentially salvageable with treatment. Methods Our laboratory has a well-established porcine model that was used as the foundation. Animals were subjected to a rectus crush injury, long bone fracture, liver and spleen laceration, traumatic brain injury and hemorrhage that was used as a foundation. We tested various colon injuries to create intra-abdominal sepsis. All animals underwent injuries followed by a period of shock, then subsequent resuscitation. Results All animals had blood culture-proven sepsis. Attempts at long-term survival of animals after injury were ceased because of poor appetite and energy. We shifted to an 8-hour endpoint. The polytrauma injury pattern remained constant and the colon injury pattern changed with the intention of creating a model that was ultimately lethal but potentially salvageable with a therapeutic drug. An uncontrolled cecal injury (n=4) group resulted in very early deaths. A controlled cecal injury (CCI; n=4) group had prolonged time prior to mortality with one surviving to the endpoint. The sigmoid injury (n=5) produced a similar survival curve to CCI but no animals surviving to the endpoint. Conclusion We have described a porcine model of polytrauma and sepsis that is reproducible and may be used to investigate novel treatments for trauma and sepsis. Level of evidence Not applicable. Animal study.
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Affiliation(s)
- Rachel L O'Connell
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Glenn K Wakam
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ali Siddiqui
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron M Williams
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nathan Graham
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael T Kemp
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kiril Chtraklin
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Umar F Bhatti
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alizeh Shamshad
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yongqing Li
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Hasan B Alam
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ben E Biesterveld
- Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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14
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Highet A, Gomez-Rexrode AE, Barrett M, Santos-Parker KS, Santos-Parker JR, Cassidy DE, Herman AE, Kulick AA, Brown CS, Montgomery JR, Wakam GK, Englesbe MJ, Waits SA. Fostering Passion and Skills in Surgical Research Across the Medical Education Continuum: The Transplant Research, Education, and Engagement Group. J Surg Educ 2021; 78:356-360. [PMID: 32739442 PMCID: PMC7788517 DOI: 10.1016/j.jsurg.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We describe a multilevel, collaborative research group for trainees and faculty engaging in transplant surgery research within one institution. DESIGN Transplant Research, Education, and Engagement (TREE) was designed to develop trainees' research skills and foster enthusiasm in transplant surgery along the educational continuum. Our research model intentionally empowers junior researchers, including undergraduates and medical students, to assume active roles on a range of research projects and contribute new ideas within a welcoming research and learning environment. SETTING Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan. PARTICIPANTS Undergraduate premedical students, first through fourth year medical students, general surgery residents, transplant surgery fellows, and transplant surgery faculty. RESULTS TREE was founded in September 2019 and has grown to include over 30 active members who meet weekly and collaborate virtually on a range of research projects, many of which are led by students. Trainees can assume both mentee and mentor roles and build their research, presentation and writing skills while collaborating academically. CONCLUSIONS Our model has increased trainees' engagement in transplant research projects and fosters early enthusiasm for the field. This model can be feasibly replicated at other institutions and within other subspecialties.
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Affiliation(s)
- Alexandra Highet
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Amalia E Gomez-Rexrode
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Meredith Barrett
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Keli S Santos-Parker
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Jessica R Santos-Parker
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Devon E Cassidy
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Alexandra E Herman
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Alexandra A Kulick
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Craig S Brown
- University of Michigan Medical School, Ann Arbor, Michigan; Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan
| | - John R Montgomery
- University of Michigan Medical School, Ann Arbor, Michigan; Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan
| | - Glenn K Wakam
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Michael J Englesbe
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan; Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan
| | - Seth A Waits
- University of Michigan Medical School, Ann Arbor, Michigan.
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Kemp MT, Liesman DR, Williams AM, Brown CS, Iancu AM, Wakam GK, Biesterveld BE, Alam HB. Surgery Provider Perceptions on Telehealth Visits During the COVID-19 Pandemic: Room for Improvement. J Surg Res 2020; 260:300-306. [PMID: 33360755 PMCID: PMC7664345 DOI: 10.1016/j.jss.2020.11.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/24/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Background COVID-19 has mandated rapid adoption of telehealth for surgical care. However, many surgical providers may be unfamiliar with telehealth. This study evaluates the perspectives of surgical providers practicing telehealth care during COVID-19 to help identify targets for surgical telehealth optimization. Materials and methods At a single tertiary care center with telehealth capabilities, all department of surgery providers (attending surgeons, residents, fellows, and advanced practice providers) were emailed a voluntary survey focused on telehealth during the pandemic. Descriptive statistics and Mann–Whitney U analyses were performed as appropriate on responses. Text responses were thematically coded to identify key concepts. Results The completion rate was 41.3% (145/351). Providers reported increased telehealth usage relative to the pandemic (P < 0.001). Of respondents, 80% (116/145) had no formal telehealth training. Providers estimated that new patient video visits required less time than traditional visits (P = 0.001). Satisfaction was high for several aspects of video visits. Comparatively lower satisfaction scores were reported for the ability to perform physical exams (sensitive and nonsensitive) and to break bad news. The largest barriers to effective video visits were limited physical exams (55.6%; 45/81) and lack of provider or patient internet access/equipment/connection (34.6%; 28/81). Other barriers included ineffective communication and difficulty with fostering rapport. Concerns regarding video-to-telephone visit conversion were loss of physical exam/visual cues (34.3%; 24/70), less personal interactions (18.6%; 13/70), and reduced efficiency (18.6%; 13/70). Conclusions Telehealth remains a new experience for surgical providers despite its expansion. Optimization strategies should target technology barriers and include specialized virtual exam and communication training.
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Affiliation(s)
- Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Aaron M Williams
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Craig S Brown
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Glenn K Wakam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Hasan B Alam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Wakam GK, Alam HB. An invited commentary on "Does the intermittent pringle's maneuver lose its clinical value in reducing bleeding during hepatectomy? A systematic review and meta-analysis" (International Journal of Surgery 2020 Epub ahead of print) Is there still a role for the intermittent pringle maneuver during hepatic resections? Int J Surg 2020; 83:27. [PMID: 32927141 DOI: 10.1016/j.ijsu.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Glenn K Wakam
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Hasan B Alam
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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Kemp MT, Liesman DR, Brown CS, Williams AM, Biesterveld BE, Wakam GK, Wilson JK, Alam HB. Factors Associated with Increased Risk of Patient No-Show in Telehealth and Traditional Surgery Clinics. J Am Coll Surg 2020; 231:695-702. [PMID: 32891797 PMCID: PMC7470818 DOI: 10.1016/j.jamcollsurg.2020.08.760] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/02/2020] [Accepted: 08/25/2020] [Indexed: 01/18/2023]
Abstract
Background With the growing use of telehealth, understanding factors affecting patient follow-up in traditional and telehealth settings is important. Few data exist examining the use of telehealth compared with traditional settings. Bridging this gap is critical to optimizing telehealth use and reducing barriers. Study Design This is a retrospective cohort study of return and postoperative (electronic video [eClinic] and traditional) visits from January 2018 to March 2020 at single tertiary care center. There were 12,359 unique first-encounter patients with 903 eClinic and 11,456 traditional visits; 11,547 patients completed visits, while 812 patients did not show up. Multivariable logistic regression modeling was performed to identify factors associated with no-show. County-level mapping was used to identify patterns in no-show rates. Results Patients from the eClinic had twice the odds of no-show compared with those from a traditional clinic (p < 0.001). Age was inversely proportional to odds of no-show, with each additional decade associated with a 16% decrease in these odds (p < 0.001). African-American patients had greater odds of no-show compared to Caucasian patients (odds ratio [OR] 2.47; 95% CI 1.95–3.13, p < 0.001). Marital statuses of single and legal separation were associated with higher odds of no-show compared with married marital status (p < 0.001 and p = 0.04, respectively). Minimally invasive and endocrine surgery clinics had lower odds of no-show compared with acute care surgery clinic (p < 0.001 for both). County-level no-show rates demonstrate similar patterns between clinic settings. Conclusions Several factors are associated with increased odds of no-show, including the visit being in eClinic. County-level analysis suggests no-show variation is not dependent on geographic location. Understanding these patterns allows for prospective identification of barriers and development of interventions to optimize access and patient care.
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Affiliation(s)
- Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Craig S Brown
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | | | - Glenn K Wakam
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jesse K Wilson
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Hasan B Alam
- Department of Surgery, University of Michigan, Ann Arbor, MI.
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Affiliation(s)
- Sidra N Bonner
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Glenn K Wakam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gifty Kwayke
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - John W Scott
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
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19
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Affiliation(s)
- Glenn K Wakam
- From the Department of Surgery, University of Michigan , Ann Arbor
| | | | | | - Craig S Brown
- From the Department of Surgery, University of Michigan , Ann Arbor
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20
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Wakam GK, Brown CS, Englesbe MJ. Increased risk donor criteria: The time for change is now. Clin Transplant 2020; 34:e13879. [PMID: 32374460 DOI: 10.1111/ctr.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Glenn K Wakam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Craig S Brown
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.,Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Michael J Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.,Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
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Brown CS, Biesterveld BE, Montgomery JR, Wakam GK, Waits SA. Frailty Is Associated With Increased Rates of Acute Cellular Rejection Within 3 Months After Liver Transplantation. Liver Transpl 2020; 26:606-607. [PMID: 31774614 PMCID: PMC7790166 DOI: 10.1002/lt.25690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/19/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Craig S. Brown
- Transplant Research Education and Enthusiasm University of Michigan Ann Arbor MI
| | - Ben E. Biesterveld
- Transplant Research Education and Enthusiasm University of Michigan Ann Arbor MI
| | - John R. Montgomery
- Transplant Research Education and Enthusiasm University of Michigan Ann Arbor MI
| | - Glenn K. Wakam
- Transplant Research Education and Enthusiasm University of Michigan Ann Arbor MI
| | - Seth A. Waits
- Transplant Research Education and Enthusiasm University of Michigan Ann Arbor MI
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