Application of Evidence into Practice in Trauma: The Purpose to Practice (P2P) Approach to Consensus Generation.

Introduction: In trauma care, there is a need to increase communication to ensure evidence-informed, best practice care guidelines are easily accessible to all providers to yield continuity of care. Clinical guidance use is one way to address this need while employing a patient-centered team approach.

Methods: During year two of the conference series, participants gathered in person and virtually to further develop the Minimum Viable Product (MVP) created during year one.

A Better Way: Initial Acceptability Testing of Using Artificial Intelligence Tools to Accelerate Development of Trauma Clinical Guidance.

Introduction: Representatives of the trauma community have voiced a need for a new approach to developing clinical guidance. In this study, we test the initial acceptability of a proposed 12-step approach that aims to reduce the current clinical guidance timeline from more than 24 months to 24 weeks.

Methods: Investigators hypothesized that artificial intelligence (AI) tools could be leveraged to improve and make the process of clinical guidance development more efficient, facilitating AI initial output that could later be reviewed by subject matter experts (SMEs).

Impact of viral load kinetics and recurrent cytomegalovirus infection in kidney transplantation.

Background: We have shown that viral load kinetics during the first cytomegalovirus (CMV) viremic episode are important predictors of kidney transplant failure. This article evaluates the incremental hazard of recurrent CMV viremia and of viral load kinetics on graft and patient survival.

Methods: This retrospective cohort study included 2,464 sequential kidney transplants performed between 2008 and 2018.

Exploring the Relationship Between Personalization of Care and Participation in Sport Activities Among People with Severe Hemophilia A Across Europe: Post Hoc Analysis of the CHESS II Study.

Purpose: To describe the demographic and clinical characteristics of patients with hemophilia A receiving different levels of treatment personalization (TP), and to assess the relationship between TP and sport active time (SAT).

Patients And Methods: This post hoc analysis of the CHESS II study used data from physician-completed patient record forms and patient self-completion forms for adult males receiving prophylaxis for severe hemophilia A in Europe between November 2018 and October 2020. SAT was assessed using propensity score matching (PSM) across levels of TP, including pharmacokinetic (PK)-guided and non-PK-guided.

Antibiotic-Induced Bacterial Cell Death: A "Radical" Way of Dying?

The rising prevalence of antibiotic resistance is rendering certain antibiotics ineffective in treating bacterial infections of public health importance. Deepening our understanding of how these drugs induce bacterial cell death, and whether antibiotics trigger a cell death program compared to direct killing, could help generate novel antibiotics or modify existing therapeutic approaches to improve clinical outcomes. Among the most widely used bactericidal antibiotics (beta-lactams, aminoglycosides, and fluoroquinolones), the primary drug-target interactions, and how they induce cell death, are well characterized.

Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) Society and International Association of Trauma Surgery and Intensive Care (IATSIC) Recommendations: Paper 1: Initial Care-Pre and Intraoperative Care Until ICU, Including Non-Operative Management.

Background: Enhanced recovery after surgery (ERAS) protocols reduce length of stay, complications, and costs for elective surgical procedures. It remains challenging to implement ERAS concepts in the acute trauma patient due to deranged physiological reserve from the penetrating or blunt trauma producing altered physiology. However, systems of care improve access to early intervention and potentially reduce mortality.

Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) and International Association for Trauma Surgery and Intensive Care (IATSIC) Society Recommendations: Paper 2: Postoperative and Intensive Care Recommendations.

Background: Enhanced recovery after surgery (ERAS) protocols reduce length of stay, complications, and costs for elective surgical procedures. It remains challenging to implement ERAS concepts in the acute trauma patient due to deranged physiological reserve from the penetrating or blunt trauma producing altered physiology. However, systems of care improve access to early intervention and potentially reduce mortality.

Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) and International Association for Trauma Surgery and Intensive Care (IATSIC) Society Recommendations: Part 3: Trauma Ethics and Systems Aspects.

Background: Enhanced recovery after surgery (ERAS) protocols reduce length of stay, complications, and costs for elective surgical procedures. It remains challenging to implement ERAS concepts in the acute trauma patient due to deranged physiological reserve from the penetrating or blunt trauma producing altered physiology. However, systems of care improve access to early intervention and potentially reduce mortality.

exhibits spatiotemporal heterogeneity in Sae activity during kidney abscess development.

Unlabelled: Virulence factors are required for bacterial pathogens to establish infection, however, their expression can be energetically costly, and must be tightly controlled to avoid fitness costs. Expression can be controlled at specific stages during infection (temporal regulation) or expressed by small subsets of the bacterial population (spatial regulation). There has been a great deal of interest in developing virulence factor-targeting strategies to combat infection, but the spatiotemporal regulation of the virulence factor master regulatory systems (Agr, Sae) has not been explored during kidney abscess formation.

Yersinia pseudotuberculosis growth arrest during type-III secretion system expression is associated with altered ribosomal protein expression and decreased gentamicin susceptibility.

It has been long appreciated that expression of the Yersinia type-III secretion system (T3SS) in culture is associated with growth arrest. Here we sought to understand whether T3SS expression is sufficient to trigger loss of exponential phase markers, and utilized a fluorescent reporter for ribosomal protein expression to detect changes in bacterial growth state. Using a fluorescent transcriptional reporter with the rpsJ/S10 promoter fused to a destabilized gfp variant, we confirmed reporter expression significantly increases in exponential phase and decreases as cells transition to stationary phase.

Trauma Quality Improvement Program mortality reporting system case reports: Anticipated mortality with opportunity for improvement related to more timely palliative care services.

The Trauma Quality Improvement Program Mortality Reporting System is an online anonymous case reporting system designed to share experiences from rare events that may have contributed to unanticipated mortality at contributing trauma centers. The Trauma Quality Improvement Program Mortality Reporting System Working group monitors submitted cases and organizes them into emblematic themes. This report summarizes two cases of anticipated mortality that both had opportunity for improvement related to more timely provision of palliative care cases.

Mental Health Professionals' Views on Artificial Intelligence as an Aide for Children Anticipating or Suffering the Loss of a Parent to Cancer: Helpful or Harmful?

: Assess mental health professionals' attitudes regarding the timing and characteristics of therapeutic interventions for children whose parents have incurable cancer, and whether professionals would use artificial intelligence (AI) in these interventions. : Professionals were surveyed about their therapeutic approaches to caring for children when parents have incurable cancer under different scenarios. Data from N = 294 (69% male, 72% white, 26% Latine, 56% rural or underserved communities) physicians, psychologists, social workers, hospital chaplains, community health workers, and others were analyzed.

Do as I say and not as I do: Surgical critical care program directors and diplomates shape the future.

Background: In 1987, the Trauma, Burn, Surgical Critical Care Specialty Board of the American Board of Surgery began offering certification in surgical critical care (SCC). The blueprint for the certifying examination (CE) has changed little since then. The Trauma, Burn, Surgical Critical Care Specialty Board sought to modernize the content of the CE.

Health care utilization after operative versus nonoperative appendicitis management using an administrative claims database.

Background: Use of nonoperative management for uncomplicated appendicitis is increasing. Recurrent appendicitis is only one measure of successful nonoperative management. We examined health care utilization and exposure to medical imaging between patients postappendectomy and those with an in situ appendix over the year after initial diagnosis.

Development of a preclinical model of ICU-associated sleep fragmentation and effects on pneumonia recovery in mice.

Patients in the intensive care unit (ICU) experience many ICU-specific factors that could impact their outcomes apart from their underlying acute illness. The precise function of sleep is not clear, but its importance is suggested by the literature on the deleterious effects of poor sleep and sleep deprivation and may represent a modifiable opportunity in ICU patients. Investigation into the role of sleep in critical illness is impeded by a lack of sufficient murine models.

Antibiotics and Surgically Treated Acute Appendicitis, When, Where, and Why?

Antibiotics within an hour of incision reduce the incidence of surgical site infection (SSI) in clean-contaminated abdominal surgery. However, patients undergoing emergency surgery for an intra-abdominal infectious process often receive treatment antibiotics and may not benefit from additional pre-incisional antibiotics (POA). We hypothesized that POA would not lead to a reduction in the occurrence of SSIs following emergency appendectomy.

Health-Related Quality of Life and Perceived Stigma in Eosinophilic Esophagitis: A Real-World, US, Web-Based Survey.

Background And Aims: Eosinophilic esophagitis (EoE) is associated with impaired health-related quality of life (HRQoL) and stigma perceptions. Therefore, we examined the real-world impact of EoE on the daily life and ability to function in adolescents (caregiver-reported) and adults with EoE in the United States of America in a noninterventional, cross-sectional, web-based survey.

Methods: HRQoL was assessed using the Short Form Health Survey (domains: vitality and social functioning) and the European Health Interview Survey (domain: sleep).

growth arrest during type-III secretion system expression is associated with altered ribosomal protein expression and decreased gentamicin susceptibility.

It has been long appreciated that expression of the type-III secretion system (T3SS) in culture is associated with growth arrest. Here we sought to understand whether this impacts expression of ribosomal protein genes, which were among the most highly abundant transcripts in exponential phase based on RNA-seq analysis. To visualize changes in ribosomal protein expression, we generated a fluorescent transcriptional reporter with the promoter upstream of /S10 fused to a destabilized variant.

Obstructive Bilateral Renal Fungal Bezoars in an Extremely Premature Neonate Treated With Antifungals and Urokinase Irrigation: A Case Report and Review of the Literature.

Background: An ex-27-week gestation female infant developed bilateral forearm nodules at 4 weeks of life during treatment for methicillin-sensitive Staphylococcus aureus bacteremia. A pure growth of Candida albicans was isolated on culture of both sterile aspiration of the forearm abscess and urine without evidence of methicillin-sensitive Staphylococcus aureus . The patient went on to develop bilateral obstructive renal fungal bezoars at 11 weeks of life.

Host stress drives tolerance and persistence: The bane of anti-microbial therapeutics.

Antibiotic resistance, typically associated with genetic changes within a bacterial population, is a frequent contributor to antibiotic treatment failures. Antibiotic persistence and tolerance, which we collectively term recalcitrance, represent transient phenotypic changes in the bacterial population that prolong survival in the presence of typically lethal concentrations of antibiotics. Antibiotic recalcitrance is challenging to detect and investigate-traditionally studied under in vitro conditions, our understanding during infection and its contribution to antibiotic failure is limited.