The ethics of surgical advocacy.

Physician advocacy continues to be controversial. The concept of social medicine is long-standing, though its optimal, even permissible, contemporary application remains dubious. Physicians may be motivated to become active advocates but ought to appreciate ethical concerns regarding the impact of their actions, both on patients and the larger healthcare landscape.

Advocacy education in pediatric surgery: Cultivating leadership and impact beyond the operating room.

This paper explores the integral role of advocacy in pediatric surgery, a critical yet often underrepresented aspect of surgical education that influences healthcare policies, systems, and patient outcomes. Through a comprehensive review, we discuss the challenges and strategies for integrating advocacy training into pediatric surgical curricula,emphasizing experiential learning, structured mentorship, and community engagement. We highlight the unique position of pediatric surgeons in advocating for vulnerable populations, exemplified by their efforts in firearm injury prevention and healthcare accessibility.

Use of magnets in pediatric surgery.

Since the 1970s, magnets have been progressively harnessed for use in minimally invasive treatment of pediatric surgical disease. In particular, multiple magnetic devices have been developed for treating esophageal atresia, pectus excavatum and scoliosis. These devices, which can be placed via small incisions or under endoscopic or fluoroscopic guidance, provide the added benefit of sparing patients multiple large, invasive procedures, and allowing for gradual correction of congenital anomalies over days to months, depending on the disease.

Multicenter Assessment of Cryoanalgesia Use in Minimally Invasive Repair of Pectus Excavatum: A 20-center Retrospective Cohort Study.

Objective: To assess the clinical implications of cryoanalgesia for pain management in children undergoing minimally invasive repair of pectus excavatum (MIRPE).

Background: MIRPE entails significant pain management challenges, often requiring high postoperative opioid use. Cryoanalgesia, which blocks pain signals by temporarily ablating intercostal nerves, has been recently utilized as an analgesic adjunct.

Delayed Repeat Contrast Enema for Treatment of Pediatric Intussusception.

Introduction: Ileocolic intussusception is a common cause of pediatric bowel obstruction. Contrast enema is successful in treating the majority of patients, and if initially unsuccessful, approximately one-third may be reduced with repeat enemas. We sought to study protocol implementation for delayed repeat enema in pediatric patients not reduced completely by an initial contrast enema.

Are Surgical Guideline Changes in Diverticulitis Care Associated With Decreased Inpatient Healthcare Expenditure?

Objective: To examine possible associations in inpatient healthcare expenditure and guideline changes in the surgical management of diverticulitis, in terms of both cost per discharge and total aggregate costs of care.

Background: Medical costs throughout the healthcare system continue to rise due to increased prices for services, increased quantities of high-priced technologies, and an increase in the amount of overall services.

Methods: We used a retrospective case-control design using the Healthcare Cost and Utilization Project National Inpatient Sample to evaluate cost per discharge and total aggregate costs of diverticulitis management between 2004 and 2015.

Analysis of the pediatric surgery fellowship application process using the Thalamus™ database.

Background: The pediatric surgery fellowship interview process is costly and time intensive. We hypothesized that the increasing number of interviews completed by applicants and programs have become inefficient over time.

Methods: We analyzed pediatric surgery fellowship program and applicant interview data between 2018 and 2020.

Trauma system funding: implications for the surgeon health policy advocate.

Background: Trauma systems improve mortality for the most severely injured patients; however, these systems are managed by individual states with different funding mechanisms, which can lead to inconsistencies in the quality of care. This study compiles trauma system legislation and regulations of funding sources and creates a trauma funding categorization system. Such data help to inform the systems of trauma care delivery within and between states.

Failure of primary closure predicts prolonged length of stay in gastroschisis patients.

Purpose: Current literature regarding outcomes of gastroschisis closure methods do not highlight differences in patients who successfully undergo primary closure with those who fail and require silo placement. We hypothesize that failure of primary closure has significant effects on clinical outcomes such as length of stay and time to enteral feeding.

Methods: We conducted a retrospective review between 2009 and 2018 of gastroschisis patients at a tertiary pediatric referral hospital.

Kids grow up so fast: national patterns of positive drug/alcohol screens among pediatric trauma patients.

Background: National guidelines recommend screening all trauma patients for drug and alcohol use beginning at age 12, but no national data have examined rates of screening or positive results in this population.

Methods: We examined national testing rates and results among all trauma patients under 21 years old in the 2017 American College of Surgeons Trauma Quality Programs (TQP) database.

Results: Of a cohort of n = 157,450 pediatric and adolescent trauma patients, n = 45,443 (28.

Association Between Medicaid Expansion and the Use of Outpatient General Surgical Care Among US Adults in Multiple States.

Importance: The Affordable Care Act expanded access to Medicaid coverage in 2014 for individuals living in participating states. Whether expanded coverage was associated with increases in the use of outpatient surgical care, particularly among underserved populations, remains unknown.

Objective: To evaluate the association between state participation in the Affordable Care Act Medicaid expansion reform and the use of outpatient surgical care.

Did The ACA Lower Americans' Financial Barriers To Health Care?

The Affordable Care Act was designed to provide financial protection to Americans in their use of the health care system. This required addressing two intertwined problems: cost barriers to accessing coverage and care, and barriers to comprehensive risk protection provided by insurance. We reviewed the evidence on whether the law was effective in achieving these goals.

Pediatric trauma venous thromboembolism prediction algorithm outperforms current anticoagulation prophylaxis guidelines: a pilot study.

Purpose: Venous thromboembolism (VTE) in injured children is rare, but sequelae can be morbid and life-threatening. Recent trauma society guidelines suggesting that all children over 15 years old should receive thromboprophylaxis may result in overtreatment. We sought to evaluate the efficacy of a previously published VTE prediction algorithm and compare it to current recommendations.

Hyperglycemia down-regulates cGMP-dependent protein kinase I expression in first trimester cytotrophoblast cells.

Diabetes in pregnancy is associated with microvascular complications and a higher incidence of preeclampsia. The regulatory signaling pathways involving nitric oxide, cGMP, and cGMP-dependent protein kinase (PKG) have been shown to be down-regulated under diabetic conditions and contribute to the pathogenesis of vascular complications in diabetes. The present study was undertaken to investigate how high glucose concentrations regulate PKG expression in cytotrophoblast cells (CTBs).

Pre-eclampsia has an adverse impact on maternal and fetal health.

Pre-eclampsia (preE) is a multifaceted complication found uniquely in the pregnant patient and one that has puzzled scientists for years. PreE is not a single disorder, but a complex syndrome that is produced by various pathophysiological triggers and mechanisms affecting about 5% of obstetrical patients. PreE is a major cause of premature delivery and maternal and fetal morbidity and mortality.