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L'Huillier JC, Boccardo JD, Stewart M, Wang S, Myneni AA, Bari AA, Nitsche LJ, Taylor HL, Lukan J, Noyes K. Gun violence revictimization in New York State: What increases the risk of being shot again? J Trauma Acute Care Surg 2024:01586154-990000000-00719. [PMID: 38689385 DOI: 10.1097/ta.0000000000004370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND While gun injuries are more likely to occur in in urban settings and affect people of color, factors associated with gun violence revictimization-suffering multiple incidents of gun violence-are unknown. We examined victim demographics and environmental factors associated with gun violence revictimization in New York state (NYS). METHODS The 2005-2020 NYS hospital discharge database was queried for patients aged 12-65 years with firearm-related hospital encounters. Patient and environmental variables were extracted. Patient home zip code was used to determine the Social Deprivation Index (SDI) for each patient's area of residence. We conducted bivariate and multivariate analyses among patients who suffered a single incident of gun violence or gun violence revictimization. RESULTS We identified 38,974 gun violence victims among whom 2,243 (5.8%) suffered revictimization. The proportion of revictimization rose from 4% in 2008 to 8% in 2020 (p < 0.01). The median [IQR] time from first to second incident among those who suffered revictimization was 359 [81-1,167] days. Revictimization was more common among Blacks (75.0% vs 65.1%, p < 0.01), patients with Medicaid (54.9% vs 43.2%, p < 0.01), and in areas of higher deprivation (84.8 percentile vs 82.1 percentile, p < 0.01). CONCLUSIONS Gun violence revictimization is on the rise. People of color and those residing in areas with high social deprivation are more likely to be re-injured. Our findings emphasize the importance of community-level over individual-level interventions for prevention of gun violence revictimization. LEVEL OF EVIDENCE Epidemiological, Level III.
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Affiliation(s)
| | | | - Morgan Stewart
- University at Buffalo, School of Architecture and Planning, Buffalo, NY
| | - Suiyuan Wang
- University at Buffalo, Department of Geography, Buffalo, NY
| | - Ajay A Myneni
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Surgery, Buffalo, NY
| | - Asm Abdul Bari
- University at Buffalo, School of Architecture and Planning, Buffalo, NY
| | - Lindsay J Nitsche
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Surgery, Buffalo, NY
| | - Henry L Taylor
- University at Buffalo, School of Architecture and Planning, Buffalo, NY
| | - James Lukan
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Surgery, Buffalo, NY
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Chopko A, Tian M, L'Huillier JC, Filipescu R, Yu J, Guo WA. Utility of intracranial pressure monitoring in patients with traumatic brain injuries: a propensity score matching analysis of TQIP data. Eur J Trauma Emerg Surg 2024; 50:173-184. [PMID: 36795136 DOI: 10.1007/s00068-023-02239-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Intracranial pressure monitoring (ICPM) is central to traumatic brain injury (TBI) management, but its utility is controversial. METHODS The 2016-2017 TQIP database was queried for isolated TBI. Patients with ICPM [(ICPM (+)] were propensity-score matched (PSM) to those without ICPM [ICPM (-)] and divided into three age groups by years (< 18, 18-54, ≥ 55). RESULTS PSM yielded 2125 patients in each group. Patients aged < 18 years had a higher survival probability (p = 0.013) and decreased mortality (p = 0.016) in the ICPM (+) group. Complications were higher and LOS was longer in ICPM (+) patients aged 18-54 years and ≥ 55 years, but not in patients aged < 18 years. CONCLUSIONS ICPM (+) is associated with a survival benefit without an increase in complications in patents aged < 18 years. In patients aged ≥ 18 years, ICPM (+) is associated with more complications and longer LOS without a survival benefit.
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Affiliation(s)
- Ashley Chopko
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
| | - Mingmei Tian
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, 401 Kimball Tower, Buffalo, NY, 14214, USA
| | - Joseph C L'Huillier
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
- Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, School of Public Health and Health Professions, University at Buffalo, 270 Farber Hall, Buffalo, NY, 14214, USA
| | - Radu Filipescu
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, 818 Ellicott Street, Buffalo, NY, 14203, USA
| | - Jinhee Yu
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, 401 Kimball Tower, Buffalo, NY, 14214, USA
| | - Weidun A Guo
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA.
- Erie County Medical Center, 462 Grider Street, Buffalo, NY, 14215, USA.
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L'Huillier JC, Hua S, Logghe HJ, Yu J, Myneni AA, Noyes K, Guo WA. Transfusion futility thresholds and mortality in geriatric trauma: Does frailty matter? Am J Surg 2024; 228:113-121. [PMID: 37684168 DOI: 10.1016/j.amjsurg.2023.08.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Data on massive transfusion (MT) in geriatric trauma patients is lacking. This study aims to determine geriatric transfusion futility thresholds (TT) and TT variations based on frailty. METHODS Patients from 2013 to 2018 TQIP database receiving MT were stratified by age and frailty. TTs and outcomes were compared between geriatric and younger adults and among geriatric adults based on frailty status. RESULTS The TT was lower for geriatric than younger adults (34 vs 39 units; p = 0.03). There was no difference in TT between the non-frail, frail, and severely frail geriatric adults (37, 30 and 25 units, respectively, p > 0.05). Geriatric adults had higher mortality than younger adults (63.1% vs 45.8%, p < 0.01). Non-frail geriatric adults had the highest mortality (69.4% vs 56.5% vs 56.2%, p < 0.01). CONCLUSIONS Geriatric patients have a lower TT than younger adults, irrespective of frailty. This may help improve outcomes and optimize MT utilization.
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Affiliation(s)
- Joseph C L'Huillier
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA; Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14203, USA
| | - Shuangcheng Hua
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14203, USA
| | - Heather J Logghe
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA
| | - Jihnhee Yu
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14203, USA
| | - Ajay A Myneni
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA
| | - Katia Noyes
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA; Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14203, USA
| | - Weidun A Guo
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA.
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Ruggiero N, L'Huillier JC, Marine N, Burns O, Mawani F, Sanders LTM, Abbas A, Adams TM, Santos BF, Wirengard YR, Rosser JB. Perceptions of Competition-Based Learning After a Brief Experience at a National Surgical Meeting. Surg Innov 2023; 30:720-727. [PMID: 37831491 DOI: 10.1177/15533506231207438] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Competition-based learning (CBL) facilitates learning through competitions. At the 2022 & 2023 Annual SAGES meetings, we evaluated a CBL experience (TOP GUN Shootout) developed from a modified version of the previously validated TOP GUN Laparoscopic Skills and Suturing Program. The project sought to evaluate the TOP GUN Shootout's (TGS) ability to enhance participant engagement in pursuit of laparoscopic surgical skills. METHODS Participants competed in the TGS. Their scores (time and errors) were recorded for: Fundamentals of Laparoscopic Surgery Peg Pass, Cup Drop Task, and Intracorporeal Suturing. All participants completed a 10-question satisfaction survey on a 7-point Likert scale, with questions assessing 3 domains: (1) capability/confidence in MIS skill performance prior to the competition; (2) applicability and satisfaction with TGS's capacity to develop MIS skills; and (3) interest in seeking additional MIS training and appropriateness of CBL in MIS training. Descriptive statistics were used to evaluate these areas. RESULTS Overall, 121 participants completed the TGS, of whom 84 (69%) completed the satisfaction survey. The average age was 32.9 years, 67% were males. On average (+/- SD), participant satisfaction was 5.04 (+/- 2.08) for Domain 1, 6.20 (+/- 1.28) for Domain 2, and 6.58 (+/- .95) for Domain 3. CONCLUSION Participants described an overall lack of confidence in their MIS skills prior to the 2022-2023 Annual SAGES conference. Participants felt that this brief CBL experience, aided in the development of their MIS skills. Furthermore, this brief CBL experience may inspire learners to seek out further training of their MIS skills.
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Affiliation(s)
- Nicco Ruggiero
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Joseph C L'Huillier
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Nigel Marine
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Owen Burns
- Washington and Lee University, Lexington, VA, USA
| | - Farrah Mawani
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Adam Abbas
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Timothy M Adams
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Byron F Santos
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA
| | - Yana R Wirengard
- Department of Surgery, Contra Costa Health Services, Martinez, CA, USA
| | - James Butch Rosser
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
- Department of Surgery, Gila Regional Medical Center, Silver City, NM, USA
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Muhammad H, L'Huillier JC, Benson Ham P, Vali K. Strategies for appropriate positioning and repositioning the Avalon ECMO cannula in a 17-year-old with left hepatic vein malposition. Perfusion 2023; 38:645-650. [PMID: 34927476 DOI: 10.1177/02676591211063829] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is a well-recognized therapy in children with refractory hypoxia. Different cannulas have been used with reported complications with placement, such as cardiac perforation, and multiple reports focusing on avoiding this. However, strategies to avoid hepatic vein cannulation and reposition when it occurs are not well described. CASE REPORT Here, we report a case where a 27-Fr Avalon bicaval double lumen cannula in the left hepatic vein was successfully repositioning using serial chest X-rays (CXR) and transthoracic echocardiography (TTE) in a 17-year-old female. DISCUSSION While venovenous (VV) ECMO is preferred by many, placement of the Avalon catheter, a cannula available for VV ECMO, may be challenging due to migration or positioning issues. Specific techniques of wire and catheter advancement as well as confirming wire position in the infra-hepatic inferior vena cava can help ensure appropriate positioning while avoiding hepatic vein cannulation and enabling successful repositioning when it occurs. CONCLUSION Wire position in the infra-hepatic inferior vena cava helps ensure safe and appropriate Avalon cannula position and placement. The Avalon cannula can be successfully repositioned from the left hepatic vein by retracting the cannula, reinserting the wire and introducer together, and then manipulation techniques using serial CXR and TTE.
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Affiliation(s)
- Haris Muhammad
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA
| | - Joseph C L'Huillier
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Phillip Benson Ham
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Kaveh Vali
- Department of Pediatric Surgery, 23561John R. Oishei Children's Hospital Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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L'Huillier JC, Kalbfell EL, Lemahieu MR, Stafford NT, Williams KE, Liepert AE. Severe Pancreatitis Multidisciplinary Working Group: Exploratory Analysis to Optimize Care and Cost. J Surg Res 2022; 277:244-253. [DOI: 10.1016/j.jss.2022.04.010] [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] [Received: 12/04/2021] [Revised: 02/18/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
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L'Huillier JC, Larson SL, Awe AM, Cook DS, Elfenbein DM. Surgery Acting Internship Individual Learning Plans: Fostering Mentorship in the COVID-19 Era. J Surg Educ 2022; 79:918-927. [PMID: 35337762 PMCID: PMC8898666 DOI: 10.1016/j.jsurg.2022.02.012] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/31/2022] [Accepted: 02/26/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Mentorship facilitates successful matching for surgical specialties. A formal mentorship plan may counteract restricted mentorship opportunities due to the COVID-19 pandemic. DESIGN We surveyed medical students applying to surgery specialties who participated in our formalized mentorship program (MF) and those of a prior cohort who were informally mentored (MI). Epistemic Network Analysis was used to model qualitative responses. SETTING University of Wisconsin School of Medicine and Public Health. PARTICIPANTS Fourth-year medical students who matched into ACGME-accredited surgical specialties. RESULTS MF students (n = 12) met with their mentors more frequently than MI students (n = 13; p = 0.03). Both groups received career guidance, letters of recommendation and application preparation. However, the MI cohort reported greater psychological and emotional support whereas the MF cohort reported more assistance with skills development. CONCLUSIONS A formalized mentorship program fostered successful mentoring relationships despite limitations from the COVID-19 pandemic.
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Affiliation(s)
- Joseph C L'Huillier
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sarah L Larson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Adam M Awe
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Dorothy S Cook
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Dawn M Elfenbein
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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L'Huillier JC, Williams KE, Liepert AE. Severe Pancreatitis Multidisciplinary Working Group: Optimizing Care and Cost. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1067] [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: 10/25/2022]
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