The Effect of Conflict on Obstetric and Non-Obstetric Surgical Needs and Operative Mortality in Fragile States.
World journal of surgery
Médecins Sans Frontières (MSF) provides surgical care in fragile states, which are more vulnerable to conflict. The primary objective of this study was to compare the indications for operative intervention in surgical projects in fragile states during periods of active conflict (CON) and non-conflict (NON-CON). In addition, risk factors for non-obstetric and obstetric operative mortality were identified.This was a retrospective analysis of MSF surgical projects in fragile states January 1, 2008-December 31, 2017. Variables considered in the analysis include age, gender, American Society of Anesthesiology physical status, emergency status, re-intervention status, indication for surgical intervention, and conflict/non-conflict time period.There were 30 surgical projects in 13 fragile states with 87,968 surgical interventions in 68,667 patients. Obstetric needs were the most common indication for surgical intervention (n?=?28,060, 31.9%) but were more common during NON-CON (n?=?23,142, 35.7%) compared to CON periods (n?=?4,918, 21.2%, p?0.001). Trauma was more common during CON (42.0%) compared to NON-CON (23.0%) periods (p?0.001). Non-obstetric operative mortality was similar during CON (0.2%) compared to NON-CON (0.2%, p?=?0.920), but obstetric operative mortality was higher (0.5%) during CON compared to NON-CON (0.2%, p?0.001) periods. Risk factors for obstetric and non-obstetric mortality included age???30 years, ASA greater than 1, and emergency intervention.Humanitarian surgeons working in fragile states should be prepared to treat a range of surgical needs including trauma and obstetrics during conflict and non-conflict periods. The mortality in obstetric patients was higher during conflict periods, and further research to understand ways to protect this vulnerable group is needed.
View details for DOI 10.1007/s00268-021-05972-1
View details for PubMedID 33560502
- Digital Addictions. Academic medicine : journal of the Association of American Medical Colleges 2020
Catastrophic expenditures in California trauma patients after the Affordable Care Act: reduced financial risk and racial disparities.
American journal of surgery
BACKGROUND: Hospital charges due to major injury can result in high out-of-pocket expenses for patients. We analyzed the effect of the Affordable Care Act (ACA) on catastrophic health expenditures (CHE) among trauma patients.METHODS: We identified trauma patients aged 19-64 admitted to a safety-net Level 1 trauma center in California from 2007 to 2017. Out-of-pocket expenditures and income were calculated using hospital charges, insurance status, and ZIP code. CHE was defined using the World Health Organization definition of out-of-pocket spending exceeding 40% of inflation-adjusted income minus food and housing expenditures. Multivariable logistic regression was performed to assess odds of CHE post-ACA (2014-2017) vs. pre-ACA (2007-2013).RESULTS: Of 7519 trauma patients, 20.6% experienced CHE, including 89.0% of uninsured patients. There was a 74% decrease in odds of CHE post-ACA (aOR: 0.26, 95% CI: 0.22-0.30), with greater decreases among Black (aOR: 0.09, 95% CI: 0.04-0.18) and Hispanic (aOR: 0.23, 95% CI: 0.19-0.29) patients.CONCLUSIONS: ACA implementation was associated with markedly decreased odds of catastrophic expenditures and decreased racial disparities in financial protection among trauma patients in our study.
View details for DOI 10.1016/j.amjsurg.2020.04.012
View details for PubMedID 32354603
- Indications and Outcomes for Patients With Limited Symptoms Undergoing Endoscopic Sinus Surgery. American journal of rhinology & allergy 2020: 1945892420912159
Operative Burden in Conflict vs Nonconflict Settings: Experience of Medecins Sans Frontieres
ELSEVIER SCIENCE INC. 2019: S136
View details for Web of Science ID 000492740900249
- Family. Annals of internal medicine 2019; 171 (1): 66?67
The Beige Room.
Academic medicine : journal of the Association of American Medical Colleges
2019; 94 (2): 181
View details for PubMedID 30694904
Waiting it out: consultation delays prolong in-patient length of stay.
Postgraduate medical journal
Decreasing delays for hospitalised patients results in improved hospital efficiency, increased quality of care and decreased healthcare expenditures. Delays in subspecialty consultations and procedures can cause increased length of stay due to reasons outside of necessary medical care.To quantify, describe and record reasons for delays in consultations and procedures for patients on the general medicine wards.We conducted weekly audits of all admitted patients on five Internal Medicine teams over 8 weeks. A survey was reviewed with attending physicians and residents on five internal medicine teams to identify patients with a delay due to consultation or procedure, quantify length of delay and record reason for delay.During the study period, 316 patients were reviewed and 48 were identified as experiencing a total of 53 delays due to consultations or procedures. The average delay was 1.8 days for a combined total of 83 days. Top reasons for delays included scheduling, late response to page and a busy service. The frequency in length of consult delays vary among different specialties. The highest frequency of delays was clustered in procedure-heavy specialties.This report highlights the importance of reviewing system barriers that lead to delayed service in hospitals. Addressing these delays could lead to reductions in length of stay for inpatients.
View details for PubMedID 30674619
- Impact of Affordable Care Act Implementation on Catastrophic Health Expenditures among Trauma Patients ELSEVIER SCIENCE INC. 2018: S148?S149
Adipocyte arrestin domain-containing 3 protein (Arrdc3) regulates uncoupling protein 1 (Ucp1) expression in white adipose independently of canonical changes in beta-adrenergic receptor signaling
2017; 12 (3)
Adaptive thermogenesis and cold-induced activation of uncoupling protein 1 (Ucp1) in brown adipose tissue in rodents is well-described and attributed to sympathetic activation of ?-adrenergic signaling. The arrestin domain containing protein Arrdc3 is a regulator of obesity in mice and also appears linked to obesity in humans. We generated a mouse with conditional deletion of Arrdc3, and here we present evidence that genetic ablation of Arrdc3 specifically in adipocytes results in increased Ucp1 expression in subcutaneous and parametrial adipose tissue. Although this increase in expression did not correspond with significant changes in body weight or energy expenditure, adipocyte-specific Arrdc3-null mice had improved glucose tolerance. It was previously hypothesized that Arrdc3 ablation leads to increased ?-adrenergic receptor sensitivity; however, in vitro experiments show that Arrdc3-null adipocytes responded to ?-adrenergic receptor agonist with decreased Ucp1 levels. Additionally, canonical ?-adrenergic receptor signaling was not different in Arrdc3-null adipocytes. These data reveal a role for Arrdc3 in the regulation of Ucp1 expression in adipocytes. However, this adipocyte effect is insufficient to generate the obesity-resistant phenotype of mice with ubiquitous deletion of Arrdc3, indicating a likely role for Arrdc3 in cells other than adipocytes.
View details for DOI 10.1371/journal.pone.0173823
View details for Web of Science ID 000396094700043
View details for PubMedID 28291835
View details for PubMedCentralID PMC5349670
Radiologists' Role in the Communication of Imaging Examination Results to Patients: Perceptions and Preferences of Patients
AMERICAN JOURNAL OF ROENTGENOLOGY
2014; 203 (5): 1034-1039
It has been suggested that radiology reporting practices would be improved if radiologists were to discuss the results of an examination directly with the patient. The attitudes and preferences of patients with regard to direct communication with the radiologist are not well-defined. The purpose of this study was to survey patients about their preferred method of receiving radiologic results.An anonymous survey was distributed to adult patients undergoing contrast-enhanced CT or MRI over a 2-week period in June 2013.The response rate was 58.4% (642 responses). For normal examination results, the preferred mode of communication was a telephone call from the ordering physician (34.1%); only 12% of respondents opted for a telephone call from the radiologist, and 2.6% chose a face-to-face meeting with the radiologist. For abnormal test results, the preferred mode of communication was also a telephone call from the ordering physician (49.8%); 14.4% of respondents selected a telephone call from the radiologist, and 8.3% chose a face-to-face meeting with the radiologist. Patients preferred receiving very detailed versions of radiology reports for both normal (46.4%) and abnormal (81.8%) test results. Patients also expressed a desire to have access to at least key images from their examinations.Patients prefer receiving both normal and abnormal examination results from the physicians who ordered the examination rather than the radiologist. They also prefer to receive very detailed examination results rather than a brief summary in lay terms.
View details for DOI 10.2214/AJR.14.12470
View details for Web of Science ID 000347415700042
View details for PubMedID 25341142