Carbon and Travel Cost Reduction from Remote Medication Titration for Advanced Heart Failure: A Secondary Analysis of a Randomized Controlled Trial.

Background: Optimization of guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF) often requires frequent in-person visits, contributing to patient burden and healthcare-related carbon emissions. Remote patient management (RPM) may offer a lower-carbon and cost alternative while maintaining care quality.

Methods: This is a secondary analysis of the Medly Titrate randomized controlled trial comparing RPM-based remote GDMT titration with usual care.

Strong laws aren't enough: Historic redlining, state firearm laws, and urban firearm violence in the United States.

Background: Urban firearm violence (UFV) has independently been associated with redlining and firearm laws. This study aims to examine how state firearm laws moderate urban firearm violence in census tracts historically exposed to redlining.

Methods: We conducted a retrospective ecological study of UFV in census tracts exposed to historic redlining.

Measurement of Long-Term, Quality of Life Outcomes in Injury Databases.

Introduction: Traumatic injuries affect patients' long-term quality of life (QOL). In 2016, the National Academies highlighted the need to record long-term QOL outcomes within trauma databases. We studied national injury-specific databases to assess whether they capture QOL outcomes, and their key determinants, across the entire continuum of trauma care.

Assessing a partnership-based model of surgical education in the Global South: a mixed methods study of the University of Global Health Equity, Rwanda.

Background: Workforce shortages, resource limitations, and inadequate capacity in African higher education institutions are significant challenges that hinder their global competitiveness in generating knowledge products. Academic partnerships have been established to address these gaps. It is essential to evaluate these partnerships to ensure they align with principles of ethics, equity, reciprocity, and the achievement of shared goals.

Adherence to breast screening guidelines and breast cancer mortality: a population cohort study.

Background: Population-based breast screening programs diagnose cancers at earlier stage when they are easier to treat. Indeed, individuals screened as part of the Ontario Breast Screening Program (OBSP) are diagnosed with a lower stage of breast cancer than those who have never been screened. We sought to determine if adherence to OBSP guidelines is associated with differences in the rate of death from breast cancer in addition to cancer stage at diagnosis.

Hospital-based violence intervention programs may positively influence mental health outcomes.

Background: Hospital-based violence intervention programs (HVIPs) are interdisciplinary teams and interventions designed to improve outcomes for violently injured patients. There is a lack of literature showing longitudinal assessment of mental health outcomes among survivors of violence who use HVIPs. This study examines whether HVIP engagement by survivors of community violence improves long-term mental health-related quality of life.

Trauma disparities occur upstream from hospitals: Neighborhood social vulnerability predicts incidence of various traumatic injuries but not case fatality.

Background: Trauma is a complex disease process often affecting the most vulnerable members of society. This cross-sectional study aims to identify the relationship between incidence and case fatality rate of injury with the Social Vulnerability Index (SVI), a composite score of community disparity.

Methods: A convenience sample of six State Inpatient Databases from 2016, provided by the Healthcare Cost Utilization Project, was generated for patients older than 18 years with specific International Classification of Diseases, Tenth Revision, codes for external cause of injury.

Surgical Infection Society Multi-Center Observational Study: Empiric Anti-Fungal Coverage after Non-Colonic Gastrointestinal Perforation.

Empiric anti-fungals are frequently administered in patients with non-colonic gastrointestinal (GI) perforations, but there is limited evidence of their benefit. We hypothesized that empiric anti-fungals would offer no clinical benefit compared with a standard course of antimicrobial therapy. This multi-center prospective cohort study included patients ≥18 years old undergoing operative management for non-colonic GI perforations across 15 centers between August 2021 and January 2024.

Teaching health systems leadership and innovation to physicians.

Background: A master's programme in Health Systems Leadership and Innovation was launched in 2016 to integrate health systems science and innovation management within the medical education continuum.

Objectives: To identify faculty and staff perceptions of tailoring the programme to accommodate potential future learning needs as a continuous quality improvement initiative of the programme.

Methods: A combination of two qualitative research methodologies was used: (1) a situational analysis to explain context and (2) a collaborative autoethnographic approach to understand the evolution of the programme and future directions.

Pre- and postinjury financial hardship among trauma survivors: A national survey study.

Background: National estimates of financial hardship because of injury are lacking, which limits our ability to both define and mitigate the impacts of financial outcomes of trauma care. Furthermore, the absence of preinjury data limits our understanding of the association between injury and financial hardship.

Methods: We analyzed data from the 2014-2021 Medical Expenditure Panel Survey.

Informal Caregiving: Health System Cost Implications.

Background: Informal caregiving is seen as a low-cost substitute for care provided by health care professionals. However, caregiving is known to negatively impact caregivers' health and, subsequently, their health care use and costs. This could potentially offset the caregivers' contributions to the health care system.

Designing, implementing and evaluating multidisciplinary healthcare training programmes in the wartime humanitarian context of Ukraine.

Introduction: Civilian healthcare workers (HCW) and medical facilities are directly and indirectly impacted by armed conflict. In the Russia-Ukraine war, acute trauma care needs grew, the workforce was destabilised by HCW migrating or shifting roles to meet conflict needs, and facilities faced surge events. Chemical, biological, radiological, nuclear and explosive (CBRNE) exposure risks created unique preparedness needs.

Long-term functional recovery after rib fractures: The impact of frailty.

Background: Previous studies have shown that patients with rib fractures experience long-term functional limitations. However, the specific predictors of these worse long-term functional limitations remain under-characterized.

Methods: We conducted a prospective cohort study including patients ≥18 years with an injury severity score ≥9 and isolated chest injury.

Enhancing trauma care in Ukraine amid conflict: A successful implementation of the modified advanced trauma life support course in an active war zone.

Background: Following the 2022 Russian invasion, Ukraine's healthcare system suffered extensive damage, with over 1000 medical facilities destroyed, exacerbating the trauma care crisis. The absence of standardized trauma training left Ukrainian healthcare providers ill-equipped to manage the surge in trauma cases amid conflict. To bridge this gap, we implemented advanced trauma life support (ATLS) courses in Ukraine amid active warfare, aiming to enhance trauma care expertise among healthcare professionals.

Implementation of an Intensive Surgical Simulation Week for Medical Students in Rwanda.

Introduction: Simulation-based training often fails to meet the needs of low- and middle-income countries with limited access to high-cost models. We built on an existing surgical simulation curriculum for medical students in Rwanda and assessed students' experience.

Methods: Based on a contextual simulation-based education curriculum that was piloted in 2022, our team designed and delivered an intensive week-long surgical simulation course for medical students.

Examining nonmilitary and nongovernmental humanitarian surgical capacity and response in armed conflicts: A scoping review of the recent literature.

Background: Armed conflicts pose a burden on health care services. We sought to assess the surgical capacity and responses of nonmilitary and nongovernmental humanitarian responders in armed conflicts through proxy indicators to identify strategies to address surgical needs.

Methods: We searched 6 databases for articles/studies from January 1, 2013, to March 10, 2023.

Understanding and Assisting the Recovery of Non-English-Speaking Trauma Survivors: Assessment of the NESTS Pathway.

Background: Spanish-speaking trauma and burn patients have unique needs in their postdischarge care navigation. The confluence of limited English proficiency, injury recovery, mental health, socioeconomic disadvantages, and acute stressors after hospital admission converge to enhance patients' vulnerability, but their specific needs and means of meeting these needs have not been well described.

Study Design: This prospective, cross-sectional survey study describes the results of a multi-institutional initiative devised to help Spanish-speaking trauma and burn patients in their care navigation after hospitalization.

Why digital innovation may not reduce healthcare's environmental footprint.

In order for digital innovations to have a positive role in efforts to make healthcare more environmentally sustainable, it is important to understand the environmental consequences of investment in digital infrastructure, argue Samuel and colleagues.

Intubation and In-Hospital Mortality After Trauma With Glasgow Coma Scale Score Eight or Less-A Cohort Study.

Introduction: Most trauma societies recommend intubating trauma patients with Glasgow Coma Scale (GCS) scores ≤8 without robust supporting evidence. We examined the association between intubation and 30-d in-hospital mortality in trauma patients arriving with a GCS score ≤8 in an Indian trauma registry.

Methods: Outcomes of patients with a GCS score ≤8 who were intubated within 1 h of arrival (intubation group) were compared with those who were intubated later or not at all (nonintubation group) using various analytical approaches.

Beyond surviving: A scoping review of collaborative care models to inform the future of postdischarge trauma care.

Trauma centers demonstrate an impressive ability to save lives, as reflected by inpatient survival rates of more than 95% in the United States. Nevertheless, we fail to allocate sufficient effort and resources to ensure that survivors and their families receive the necessary care and support after leaving the trauma center. The objective of this scoping review is to systematically map the research on collaborative care models that have been put forward to improve trauma survivorship.