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Article ; Online: Assessing the Need for Transfer to a Trauma Center for Isolated Craniofacial Injury in a Rural State.

Ciraulo, Luciano A / Connolly, Katharine A / Falank, Carolyne R / Ciraulo, David L

2023 Volume 89, Issue 8, Page(s) 3484–3486

Abstract: Management of craniofacial injuries typically defaults to plastic, ophthalmology, and oral maxillofacial surgeons which can challenge these surgical subspecialists' capacity to care for both trauma victims and non-trauma patients. Evaluating the need to ... ...

Abstract	Management of craniofacial injuries typically defaults to plastic, ophthalmology, and oral maxillofacial surgeons which can challenge these surgical subspecialists' capacity to care for both trauma victims and non-trauma patients. Evaluating the need to transfer patients to a higher level of trauma care for isolated craniofacial injuries warrants investigation. Our 5-year retrospective study measured the frequency of craniofacial injuries and subsequent surgical interventions in elderly trauma patients' ≥65 years old. Eighty-one percent of patients consulted with plastic surgeons and 28% with ophthalmology. Twenty percent had craniofacial surgery with the majority of surgical interventions were in soft tissue (97%), mandible (48%), and Le Fort III (29%) injuries. A patient's ISS, GCS, head and face AIS, and presents of spinal or brain injury had no statistically significant impact on injury repair. Elderly patients with isolated craniofacial trauma may be better served by pretransfer consultation with a surgical subspecialist to determine the necessity.
MeSH term(s)	Humans ; Aged ; Trauma Centers ; Retrospective Studies ; Brain Injuries ; Fractures, Bone ; Referral and Consultation
Language	English
Publishing date	2023-03-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348231161666
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Article ; Online: Obstetrical Trauma: Reducing the Burden of Trauma Transfer to Tertiary Care Centers.

Kirk, Charlotte H / Ciraulo, Giovanni E / Ciraulo, Rocco S / Falank, Carolyne R / Ciraulo, David L

The American surgeon

2023 Volume 89, Issue 7, Page(s) 3084–3088

Abstract: Background: In rural state trauma systems, management of the obstetrical trauma patient often defaults to transfer to level I trauma centers. We evaluate the necessity of transferring obstetrical trauma patients without severe maternal injury.: ... ...

Abstract	Background: In rural state trauma systems, management of the obstetrical trauma patient often defaults to transfer to level I trauma centers. We evaluate the necessity of transferring obstetrical trauma patients without severe maternal injury. Materials and methods: A retrospective 5-year review of obstetrical trauma patients admitted to a rural state-level I trauma center was conducted. Injury severity measures such as abdominal AIS, ISS, and GCS were correlated with outcomes. Furthermore, the impact of maternal and gestational age on uterine compromise, uterine irritability, and the need for cesarean section intervention are presented. Results: Twenty-one percent of patients were transferred from outside facilities with a median age of 29 years, average ISS of 3.9 ± 5.6, GCS of 13.8 ± 3.6, and abdominal AIS of 1.6 ± .8. Outcomes included maternal fatality of 2%, fetal demise of 4%, 6% experienced premature rupture of membranes, 9% experienced fetal placental compromise, 15% had uterine contractions, 15% of cesarean deliveries, and fetal decelerations occurred in 4%. Predictors of fetal compromise are strongly associated with high maternal ISS and low GCS. Discussion: The frequency of traumatic injury in this unique population of patients is fortunately limited. The best predictor for fetal demise and uterine irritability is maternal injury severity, measured by ISS and GCS. Therefore, without severe maternal trauma, obstetrical trauma patients with minor injuries can safely be managed at non-tertiary care facilities with obstetrical capabilities.
MeSH term(s)	Humans ; Female ; Pregnancy ; Adult ; Retrospective Studies ; Cesarean Section ; Tertiary Care Centers ; Placenta ; Fetal Death ; Pregnancy Complications ; Trauma Centers
Language	English
Publishing date	2023-02-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348231157847
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Article ; Online: Educational Value of Surgical Residents Operating as Teaching Assistant.

Heidt, Nicole / Whiting, James / Falank, Carolyne / Olsen, Bridget / Miller, Heidi / Sawhney, Jaswin

Journal of surgical education

2023 Volume 80, Issue 11, Page(s) 1522–1528

Abstract: Objective: To assess the educational of value of teaching assistant (TA) cases from the perspectives of attending, chief resident, and junior resident. We hypothesized the greatest educational value of TA cases would be for chief residents more so than ... ...

Abstract	Objective: To assess the educational of value of teaching assistant (TA) cases from the perspectives of attending, chief resident, and junior resident. We hypothesized the greatest educational value of TA cases would be for chief residents more so than other team members. Design: A prospective survey was designed and collected for TA cases separately from attendings, chief residents, and junior residents to assess operative details and educational value. The study period ran from August 2021 through December 2022. Qualitative and quantitative analysis was undertaken to compare answers and discover themes in the free-text responses of attendings and residents. Setting: Single center, tertiary care institution, Maine Medical Center, Department of Surgery, Portland, ME PARTICIPANTS: Sixty-nine teaching assistant cases were captured from a total of 117 completed surveys that were completed by 44 chief residents, 49 junior residents, 22 attendings (n = 22) and 2 APPs. Results: A wide variety of TA cases were included in the study with the most common reason for performing a TA case being resident request 68%. Operative complexity was most commonly rated easiest third (50%) and middle third (41%) of overall cases. Both junior and chief residents felt that compared to working with an attending alone, TA cases contributed more or much more to their procedural independence >80% of the time. Attendings reported learning something about the resident's skills that they were not expecting in 59% of the cases. Thematic analysis: attendings focused on the steps of the procedure, including the technical aspects, particularly regarding opening while residents largely focused on communication and preparation. Conclusions: Teaching assistant cases seem to have more educational value for chief and junior residents than attendings. Both junior and chief residents felt that compared to working with an attending alone, TA cases contributed more or much more to their procedural independence >80% of the time.
MeSH term(s)	Humans ; Internship and Residency ; Prospective Studies ; Surveys and Questionnaires ; Clinical Competence ; Medical Staff, Hospital ; General Surgery/education ; Teaching
Language	English
Publishing date	2023-07-07
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2023.06.008
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Article ; Online: "Should We Phenobarb-it-All?" A Phenobarbital-Based Protocol for Non-Intensive Care Unit Trauma Patients at High Risk of or Experiencing Alcohol Withdrawal.

Wang, Michelle / Falank, Carolyne / Simboli, Vincent / Ontengco, Julianne B / Spurling, Brandi / Rappold, Joseph / Chung, Bruce / Smith, Kathryn E

The American surgeon

2024 Volume 90, Issue 6, Page(s) 1531–1539

Abstract: Background: Alcohol use is frequent in trauma patients and alcohol withdrawal syndrome (AWS) is associated with significant morbidity. Benzodiazepines are commonly used for AWS, but may cause neurologic and respiratory adverse events (AEs). The ... ...

Abstract	Background: Alcohol use is frequent in trauma patients and alcohol withdrawal syndrome (AWS) is associated with significant morbidity. Benzodiazepines are commonly used for AWS, but may cause neurologic and respiratory adverse events (AEs). The objective was to evaluate the effectiveness and safety of a phenobarbital-based protocol for the treatment of AWS in non-intensive care unit (ICU) trauma patients. Methods: Adult non-ICU trauma patients at high risk of or experiencing AWS PRE and POST implementation of a phenobarbital-based protocol were included. Outcomes were AWS-related complications (AWS-RC), benzodiazepine use, adjunctive medication use, hospital length of stay (HLOS), and medication-related AEs. Subgroup analyses were performed on patients with traumatic brain injury (TBI), rib fractures, and at high risk of severe AWS. Results: Overall, 110 patients were included (51 PRE, 59 POST). AWS-RC developed in 17 PRE patients compared to 10 POST patients (33% vs 17%; Discussion: A phenobarbital-based protocol in trauma patients is effective in preventing AWS-RC and decreasing benzodiazepine use without increasing AEs.
MeSH term(s)	Humans ; Phenobarbital/therapeutic use ; Male ; Female ; Middle Aged ; Adult ; Benzodiazepines/therapeutic use ; Retrospective Studies ; Clinical Protocols ; Wounds and Injuries/complications ; Substance Withdrawal Syndrome ; Hypnotics and Sedatives/therapeutic use ; Hypnotics and Sedatives/administration & dosage ; Hypnotics and Sedatives/adverse effects ; Length of Stay/statistics & numerical data ; Brain Injuries, Traumatic/complications ; Alcohol Withdrawal Delirium/drug therapy ; Aged
Language	English
Publishing date	2024-04-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348241244639
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Article ; Online: Thoracoscopic-assisted rib plating (TARP): initial single-center case series, including TARP in the super elderly, technical lessons learned, and proposed expanded indications.

Zhang, Gary / Shurtleff, Eric / Falank, Carolyne / Cullinane, Daniel / Carter, Damien / Sheppard, Forest

Trauma surgery & acute care open

2022 Volume 7, Issue 1, Page(s) e000943

Abstract: Objectives: The application of surgical stabilization of rib fractures (SSRF) remains inconsistent due to evolving indications and perceived associated morbidity. By implementing thoracoscopic-assisted rib plating (TARP), a minimally invasive SSRF ... ...

Abstract	Objectives: The application of surgical stabilization of rib fractures (SSRF) remains inconsistent due to evolving indications and perceived associated morbidity. By implementing thoracoscopic-assisted rib plating (TARP), a minimally invasive SSRF approach, we expanded our SSRF application to patients who otherwise might not be offered fixation. This report presents our initial experience, including fixation in super elderly (aged ≥85 years), and technical lessons learned. Methods: This was a retrospective cohort study at a level 1 trauma center of admitted patients who underwent TARP between August 2019 and October 2020. Patient demographics, injury characteristics, surgical indications and outcomes are represented as mean±SD, median or percentage. Results: A total of 2134 patients with rib fractures were admitted. In this group, 39 SSRF procedures were performed, of which 54% (n=21) were TARP. Average age was 68.5±16 years. Patients had a median of 5 fractured ribs, with an average of 1 rib that was bicortically displaced, and 19% presented with 'clicking' on inspiration. Patient outcomes were a mean hospital length of stay (LOS) of 11±3.7 days, mean postoperative LOS of 8 days, and mean intensive care unit LOS of 6.6±2.9 days. Five patients were ≥85 years old with a mean age of 90.8±4.7 years. They presented with an average of 4 rib fractures, of which an average of 2.4 ribs were plated. The procedure was well tolerated in this age group with a hospital LOS of 9.4±2 days, and all five patients were discharged to a rehab facility with no in-hospital mortalities. Conclusion: Our experience incorporating TARP at our institution demonstrated feasibility of the technique and application across a broad range of patients. This approach and its application warrants further evaluation and potentially expands the application of SSRF..
Language	English
Publishing date	2022-09-01
Publishing country	England
Document type	Journal Article
ISSN	2397-5776
ISSN (online)	2397-5776
DOI	10.1136/tsaco-2022-000943
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Article ; Online: Collaborative care when older adults fall: The benefits of geriatric consultation for trauma patients aged 75 years and older.

Roberts, Amanda R A / Falank, Carolyne R / Ontengco, Julianne B / Carter, Emily L / Hallen, Sarah A M

Journal of the American Geriatrics Society

2022 Volume 70, Issue 4, Page(s) 1284–1286

MeSH term(s)	Aged ; Geriatric Assessment ; Humans ; Referral and Consultation ; Trauma Centers ; Wounds and Injuries
Language	English
Publishing date	2022-01-04
Publishing country	United States
Document type	Letter
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.17637
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Article: Interleukin-6 Interweaves the Bone Marrow Microenvironment, Bone Loss, and Multiple Myeloma.

Harmer, Danielle / Falank, Carolyne / Reagan, Michaela R

Frontiers in endocrinology

2019 Volume 9, Page(s) 788

Abstract: The immune system is strongly linked to the maintenance of healthy bone. Inflammatory cytokines, specifically, are crucial to skeletal homeostasis and any dysregulation can result in detrimental health complications. Interleukins, such as interleukin 6 ( ... ...

Abstract	The immune system is strongly linked to the maintenance of healthy bone. Inflammatory cytokines, specifically, are crucial to skeletal homeostasis and any dysregulation can result in detrimental health complications. Interleukins, such as interleukin 6 (IL-6), act as osteoclast differentiation modulators and as such, must be carefully monitored and regulated. IL-6 encourages osteoclastogenesis when bound to progenitors and can cause excessive osteoclastic activity and osteolysis when overly abundant. Numerous bone diseases are tied to IL-6 overexpression, including rheumatoid arthritis, osteoporosis, and bone-metastatic cancers. In the latter, IL-6 can be released with growth factors into the bone marrow microenvironment (BMM) during osteolysis from bone matrix or from cancer cells and osteoblasts in an inflammatory response to cancer cells. Thus, IL-6 helps create an ideal microenvironment for oncogenesis and metastasis. Multiple myeloma (MM) is a blood cancer that homes to the BMM and is strongly tied to overexpression of IL-6 and bone loss. The roles of IL-6 in the progression of MM are discussed in this review, including roles in bone homing, cancer-associated bone loss, disease progression and drug resistance. MM disease progression often includes the development of drug-resistant clones, and patients commonly struggle with reoccurrence. As such, therapeutics that specifically target the microenvironment, rather than the cancer itself, are ideal and IL-6, and its myriad of downstream signaling partners, are model targets. Lastly, current and potential therapeutic interventions involving IL-6 and connected signaling molecules are discussed in this review.
Language	English
Publishing date	2019-01-08
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2018.00788
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Article ; Online: Severity and patterns of injury in helmeted vs. non-helmeted motorcyclists in a rural state.

Barron, Sivana / Falank, Carolyne / Ontengco, Julianne / Chung, Bruce / Carter, Damien W

Journal of safety research

2021 Volume 77, Page(s) 212–216

Abstract: Introduction: Under current law in our rural state, there is no universal requirement for motorcyclists to wear helmets. Roughly 500 motorcycle crashes are reported by the state each year and only a fraction of those riders wear helmets. We sought to ... ...

Abstract	Introduction: Under current law in our rural state, there is no universal requirement for motorcyclists to wear helmets. Roughly 500 motorcycle crashes are reported by the state each year and only a fraction of those riders wear helmets. We sought to determine the difference in injury patterns and severity in helmeted versus non-helmeted riders. Methods: Retrospective review (2014-2018) of a single level 1 trauma center's registry was done for subjects admitted after a motorcycle collision. Demographic, injury and patient outcome data were collected. Patients were stratified by helmet use (n = 81), no helmet use (n = 144), and unknown helmet use (n = 194). Statistical analysis used Student's t-test or Pearson's χ Results: Of the 2,022 state-reported motorcycle collisions, 419 individuals admitted to our trauma center were analyzed (21% capture). State-reported field fatality rate regardless of helmet use was 4%. Our inpatient mortality rate was 2% with no differences between helmet uses. Helmeted riders were found to have significantly fewer head and face injuries, higher GCS, lower face, neck, thorax and abdomen AIS, fewer required mechanical ventilation, shorter ICU length of stay, and had a greater number of upper extremity injuries and higher upper extremity AIS. Conclusions: Helmeted motorcyclists have fewer head, face, and cervical spine injuries, and lower injury severities: GCS and face, neck, thorax, abdomen AIS. Helmeted riders had significantly less mechanical ventilation requirement and shorter ICU stays. Non-helmeted riders sustained worse injuries. Practical Applications: Helmets provide safety and motorcycle riders have a 34-fold higher risk of death following a crash. Evaluating injury severities and patterns in motorcycle crash victims in a rural state with no helmet laws may provide insight into changing current legislation.
MeSH term(s)	Accidents, Traffic/mortality ; Accidents, Traffic/statistics & numerical data ; Adult ; Age Distribution ; Craniocerebral Trauma/epidemiology ; Female ; Head Protective Devices/statistics & numerical data ; Hospitalization/statistics & numerical data ; Humans ; Incidence ; Male ; Middle Aged ; Motorcycles/statistics & numerical data ; Registries ; Respiration, Artificial ; Retrospective Studies ; Rural Population/statistics & numerical data ; Severity of Illness Index ; Sex Distribution ; Socioeconomic Factors ; Trauma Centers/statistics & numerical data
Language	English
Publishing date	2021-03-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2015321-1
ISSN	1879-1247 ; 0022-4375
ISSN (online)	1879-1247
ISSN	0022-4375
DOI	10.1016/j.jsr.2021.03.004
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Article ; Online: Body Contour Surgery After Weight Loss Operations by a Non-Specialty Surgeon in a Rural Hospital.

Burgess, Molly P / Ciraulo, Rocco S / Ciraulo, Giovanni E / Sheets, Bethany F / Ciraulo, Nicolas A / Falank, Carolyne R / Ciraulo, David L

The American surgeon

2022 Volume 89, Issue 6, Page(s) 2907–2909

MeSH term(s)	Humans ; Hospitals, Rural ; Body Contouring ; Surgeons ; Bariatric Surgery ; Weight Loss
Language	English
Publishing date	2022-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221074239
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Article ; Online: Tranexamic acid: Beyond antifibrinolysis.

Prudovsky, Igor / Kacer, Doreen / Zucco, Victoria Vieira / Palmeri, Monica / Falank, Carolyne / Kramer, Robert / Carter, Damien / Rappold, Joseph

Transfusion

2022 Volume 62 Suppl 1, Page(s) S301–S312

Abstract: Tranexamic acid (TXA) is a popular antifibrinolytic drug widely used in hemorrhagic trauma patients and cardiovascular, orthopedic, and gynecological surgical patients. TXA binds plasminogen and prevents its maturation to the fibrinolytic enzyme plasmin. ...

Abstract	Tranexamic acid (TXA) is a popular antifibrinolytic drug widely used in hemorrhagic trauma patients and cardiovascular, orthopedic, and gynecological surgical patients. TXA binds plasminogen and prevents its maturation to the fibrinolytic enzyme plasmin. A number of studies have demonstrated the broad life-saving effects of TXA in trauma, superior to those of other antifibrinolytic agents. Besides preventing fibrinolysis and blood loss, TXA has been reported to suppress posttraumatic inflammation and edema. Although the efficiency of TXA transcends simple inhibition of fibrinolysis, little is known about its mechanisms of action besides the suppression of plasmin maturation. Understanding the broader effects of TXA at the cell, organ, and organism levels are required to elucidate its potential mechanisms of action transcending antifibrinolytic activity. In this article, we provide a brief review of the current clinical use of TXA and then focus on the effects of TXA beyond antifibrinolytics such as its anti-inflammatory activity, protection of the endothelial and epithelial monolayers, stimulation of mitochondrial respiration, and suppression of melanogenesis.
MeSH term(s)	Antifibrinolytic Agents/pharmacology ; Antifibrinolytic Agents/therapeutic use ; Blood Coagulation Disorders ; Fibrinolysin/pharmacology ; Fibrinolysin/therapeutic use ; Fibrinolysis ; Hemorrhage ; Humans ; Tranexamic Acid/pharmacology ; Tranexamic Acid/therapeutic use
Chemical Substances	Antifibrinolytic Agents ; Tranexamic Acid (6T84R30KC1) ; Fibrinolysin (EC 3.4.21.7)
Language	English
Publishing date	2022-07-14
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, Non-U.S. Gov't
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.16976
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