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  1. Article ; Online: Limited Resources at a Community Based Level 1 Trauma Center: Does This Affect Pelvic Angioembolization Times During Daylight Hours versus after Hours, Weekends, and Holidays?

    Aukerman, William / Simunich, Thomas / Boer, Justin / Dumire, Russell

    The American surgeon

    2023  Volume 89, Issue 8, Page(s) 3626–3628

    Abstract: Hemodynamically unstable patients with pelvic fractures require swift intervention due to the high mortality of their injuries. A delay in embolization of these patients significantly affects survival. We therefore, hypothesized that there would be a ... ...

    Abstract Hemodynamically unstable patients with pelvic fractures require swift intervention due to the high mortality of their injuries. A delay in embolization of these patients significantly affects survival. We therefore, hypothesized that there would be a significant difference between time to embolization at our larger rural Level 1 Trauma Center. This study investigated the relationship between interventional radiology (IR) order time to IR procedure start time over 2 time periods at our large, rural Level 1 Trauma Center with those having sustained a traumatic pelvic fracture requiring IR, and having been identified as being in shock. The current study found no statistically significant difference from time from order to IR start between the 2 cohorts (Mann-Whitney U test,
    MeSH term(s) Humans ; Trauma Centers ; Holidays ; Pelvis/injuries ; Pelvic Bones/injuries ; Embolization, Therapeutic/adverse effects ; Embolization, Therapeutic/methods ; Fractures, Bone/therapy ; Retrospective Studies ; Injury Severity Score
    Language English
    Publishing date 2023-03-30
    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 10.1177/00031348231167391
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Evaluation of Gender Bias Through Autonomy During Laparoscopic Cholecystectomy at a Rural Community General Surgery Residency Program.

    Biller, Jessica / Simunich, Thomas / Morrissey, Shawna / Dumire, Russell

    Journal of surgical education

    2023  Volume 80, Issue 11, Page(s) 1508–1515

    Abstract: Objective: Gender bias not only continues to exist in surgical specialties, but in the medical field overall. Despite females graduating from medical schools at the same rate as men, a discrepancy still exists in the number of females pursuing surgical ... ...

    Abstract Objective: Gender bias not only continues to exist in surgical specialties, but in the medical field overall. Despite females graduating from medical schools at the same rate as men, a discrepancy still exists in the number of females pursuing surgical specialties compared to their male counterparts. We hypothesized that surgical training occurring in smaller institutions with close-knit relationships between faculty and residents should decrease the likelihood of gender bias towards females, as measured by perceived autonomy during laparoscopic cholecystectomy.
    Design: All 17 surgery residents at a community surgery residency program were asked to voluntarily and anonymously complete an investigator-created questionnaire after every laparoscopic cholecystectomy from October 2020 to May 2022. The questionnaire included details regarding overall resident operative experience, case complexity, patient diagnosis, resident autonomy throughout the case, and perceived autonomy compared to their peers. Each respondent estimated their percent autonomy from 0% to 100% during 5 distinct portions of the case, from which, a mean overall percent autonomy was calculated.
    Results: A total of 233 questionnaires (98 female, 135 male) were completed during the study period, with 8 females and 9 males in the first study year and 7 females and 10 males in the second. Mean overall autonomy was statistically similar between males and females, 71% and 72% respectively (p = 0.967). Case difficulty was not statistically different between males and females (p = 0.445). There was a significant difference in autonomy of all residents with male and female attendings, 67.5% and 80.3%, respectively (p = 0.001), however this did not differ between male and female residents. Eighty-three percent of respondents felt that their level of autonomy was acceptable for their postgraduate year (PGY) level. Over 90 percent of respondents felt their autonomy was not affected by their gender.
    Conclusions: There was no significant difference in perceived autonomy between male and female residents during laparoscopic cholecystectomy at our small general surgery residency program. Gender bias did not appear to be a prohibiting factor in the amount of autonomy given to male and female residents.
    MeSH term(s) Humans ; Male ; Female ; Internship and Residency ; Cholecystectomy, Laparoscopic ; Sexism ; Rural Population ; Clinical Competence ; General Surgery/education
    Language English
    Publishing date 2023-06-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2277538-9
    ISSN 1878-7452 ; 1931-7204
    ISSN (online) 1878-7452
    ISSN 1931-7204
    DOI 10.1016/j.jsurg.2023.05.019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Comparison of Biomet Omnimax

    Aukerman, William / Dodson, Byron / Simunich, Thomas / Shayesteh, Kamran

    The American surgeon

    2020  Volume 88, Issue 3, Page(s) 523–524

    MeSH term(s) Cimetidine ; Facial Bones/surgery ; Fracture Fixation, Internal ; Humans ; Skull Fractures/complications ; Skull Fractures/surgery
    Chemical Substances Cimetidine (80061L1WGD)
    Language English
    Publishing date 2020-12-30
    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 10.1177/0003134820960018
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Medical Degree Disparity Among Authors in Obstetrics and Gynecology Journals.

    Merritt, Brian / Simunich, Thomas / Ashurst, John

    The Journal of the American Osteopathic Association

    2019  Volume 119, Issue 2, Page(s) e1–e8

    Abstract: Context: With the transition to a single accreditation system for graduate medical education, the scholarly activity among core faculty in osteopathic and allopathic residency programs has come under scrutiny. Currently, major differences in scholarly ... ...

    Abstract Context: With the transition to a single accreditation system for graduate medical education, the scholarly activity among core faculty in osteopathic and allopathic residency programs has come under scrutiny. Currently, major differences in scholarly activity requirements exist between core faculty in obstetrics and gynecology residencies accredited by the Accreditation Council for Graduate Medical Education and those accredited by the American Osteopathic Association.
    Objective: To determine whether there is a disparity between osteopathic and allopathic physicians among authors with original research published in 4 high-impact obstetrics and gynecology journals during 4 select years.
    Methods: The authors reviewed Obstetrics & Gynecology (Obstet Gynecol), the American Journal of Obstetrics and Gynecology (Am J Obstet Gynecol), Fertility and Sterility (Fertil Steril), and Menopause for the degree designation of the first and senior (last) author of each original manuscript for the years of 2000, 2005, 2010, and 2015. Data were analyzed using simple descriptive statistics and linear regression.
    Results: In total, 3311 articles and 5909 authors were reviewed. Of these authors, 0.80% (47) had a DO degree. Of 1692 authors with dual advanced degrees, only 0.53% (9) had a DO degree. On subgroup analysis of each journal, 0.87% (13 of 1494) of identified authors in Obstet Gynecol, 1.03% (21 of 2038) in Am J Obstet Gynecol, 0.44% (9 of 2030) in Fertil Steril, and 2.20% (4 of 347) in Menopause were osteopathic physicians. During the years studied, no statistically significant trend could be established for first or senior author publication by osteopathic physicians over time, for all 4 journals or for any individual journal.
    Conclusion: Very few osteopathic physicians have served as either the first or the senior author in articles published in Obstet Gynecol, Am J Obstet Gynecol, Fertil Steril, or Menopause during the years studied, and no trend was seen for increased publication by osteopathic physicians in these journals over time.
    MeSH term(s) Authorship ; Bibliometrics ; Education, Medical, Graduate ; Gynecology/education ; Humans ; Internship and Residency ; Obstetrics/education ; Osteopathic Medicine/education ; Osteopathic Medicine/trends ; Periodicals as Topic/trends ; Retrospective Studies ; United States
    Language English
    Publishing date 2019-03-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 410350-6
    ISSN 1945-1997 ; 0003-0287 ; 0098-6151
    ISSN (online) 1945-1997
    ISSN 0003-0287 ; 0098-6151
    DOI 10.7556/jaoa.2019.020
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Benefit of continued noninvasive cardiac monitoring in geriatric trauma: A retrospective review of geriatric pelvis, hip, and femur fractures and analysis of cardiac events during immediate post-traumatic course.

    Curfman, Karleigh R / Urias, Daniel S / Simunich, Thomas J / Dodson, Byron D / Morrissey, Shawna L

    SAGE open medicine

    2021  Volume 9, Page(s) 20503121211047379

    Abstract: Objective: The geriatric population suffers from a predisposition to cardiac events due to physiologic changes commonly associated with aging. The majority of the trauma population seen at our facility is within the geriatric population (greater than 65  ...

    Abstract Objective: The geriatric population suffers from a predisposition to cardiac events due to physiologic changes commonly associated with aging. The majority of the trauma population seen at our facility is within the geriatric population (greater than 65 years old). Therefore, this study was aimed to determine which of those preexisting factors were associated with an increased risk for developing cardiac event. By assessing those risks, we hoped to determine a timeline for the highest risk of cardiac event occurrence, in order to identify a safe period of when cardiac monitoring was indicated.
    Methods: A retrospective study performed over 6 months reviewing geriatric trauma patients with hip, pelvis, or femur fractures,
    Results: In 125 patients, 40 cardiac events occurred in 30 patients. The analyzed variables with statistically significant associations for having a cardiac event were comorbidities (p = 0.019), elevated body mass index (p = 0.001), abnormal initial phosphorus (p = 0.002), and an electrocardiogram finding of other than normal sinus rhythm (p = 0.020). Of the identified cardiac events, we found that by hospital day 3 68% of cardiac event had occurred, with 85% by hospital day 4, 95% by day 5, and 100% within the first 7 days of admission.
    Conclusion: Patient history of cardiac comorbidities, elevated body mass index, abnormal phosphorus, and abnormal electrocardiogram findings were found to be significant risk factors for cardiac event development in geriatric trauma. All recorded events in our study occurred within 7 days of the initial trauma.
    Language English
    Publishing date 2021-10-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 2735399-0
    ISSN 2050-3121
    ISSN 2050-3121
    DOI 10.1177/20503121211047379
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Bronchoscopy Decreases Ventilator-Associated Pneumonia in Trauma Patients.

    Nannapaneni, Siddhartha / Silvis, Jennifer / Curfman, Karleigh / Chung, Timothy / Simunich, Thomas / Morrissey, Shawna / Dumire, Russell

    The American surgeon

    2021  Volume 88, Issue 4, Page(s) 653–657

    Abstract: Health care-associated pneumonias (HAPs) are a significant comorbidity seen in hospitalized patients. Traumatic injury is a known independent risk factor for the development of HAP. Trauma-related injuries also contribute to an increase in the rate of ... ...

    Abstract Health care-associated pneumonias (HAPs) are a significant comorbidity seen in hospitalized patients. Traumatic injury is a known independent risk factor for the development of HAP. Trauma-related injuries also contribute to an increase in the rate of pneumonia in mechanically ventilated patients requiring intensive care unit (ICU) treatment. In 2011, the ventilator-associated pneumonia (VAP) rate among ICU patients at our institution (CMMC) increased dramatically. As a result, our infection control specialists performed a focused review of these patients and found a likely association between these infections and patients requiring pre-hospital intubation. Their determination prompted a July 2012 revision of the CMMC Trauma/Surgery Admission ICU protocol for ventilated patients to include bronchoscopy for
    MeSH term(s) Bronchoscopy ; Humans ; Intensive Care Units ; Pneumonia, Ventilator-Associated/diagnosis ; Pneumonia, Ventilator-Associated/prevention & control ; Retrospective Studies ; Trauma Centers
    Language English
    Publishing date 2021-12-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/00031348211058639
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Authorship Trends of Emergency Medicine Publications over the Last Two Decades.

    Lammers, Richard / Simunich, Thomas / Ashurst, John

    The western journal of emergency medicine

    2016  Volume 17, Issue 3, Page(s) 367–371

    Abstract: Introduction: With the recent merger of the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME) a heightened pressure for publication may become evident. Our objective was to determine whether ... ...

    Abstract Introduction: With the recent merger of the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME) a heightened pressure for publication may become evident. Our objective was to determine whether there was a gap in the type of both medical degree designation and advanced degree designation among authorship in three United States-based academic emergency medicine journals.
    Methods: We reviewed the Journal of Emergency Medicine, Academic Emergency Medicine and Annals of Emergency Medicine for the type of degree designation that the first and senior authors had obtained for the years 1995, 2000, 2005, 2010 and 2014.
    Results: A total of 2.48% of all authors held a degree in osteopathic medicine. Osteopathic physician first authors contributed to 3.26% of all publications while osteopathic physician senior authors contributed 1.53%. No statistical trend could be established for the years studied for osteopathic physicians. However, we noted an overall trend for increased publication for allopathic senior authors (p=0.001), allopathic first authors with a dual degree (p=0.003) and allopathic senior authors with a dual degree (p=0.005). For each journal studied, no statistical trend could be established for osteopathic first or senior authors but a trend was noted for allopathic first and senior authors in the Journal of Emergency Medicine (p-value=0.020 and 0.006). Of those with dual degrees, osteopathic physicians were in the minority with 1.85% of osteopathic first authors and 0.60% of osteopathic senior authors attaining a dual degree. No statistical trend could be established for increased dual degree publications for osteopathic physicians over the study period, nor could a statistical trend be established for any of the journals studied.
    Conclusion: Very few osteopathic physicians have published in the Journal of Emergency Medicine, Academic Emergency Medicine or Annals of Emergency Medicine over the last two decades. Despite a trend for increased publication by allopathic physicians in certain journals, there appears to be no trend for increased publication of osteopathic physicians in emergency medicine.
    MeSH term(s) Authorship ; Biomedical Research/trends ; Education, Medical, Graduate/trends ; Emergency Medicine/education ; Faculty, Medical/statistics & numerical data ; Faculty, Medical/trends ; Humans ; Internship and Residency/trends ; Journal Impact Factor ; Periodicals as Topic/trends ; Publishing/trends ; Retrospective Studies ; Societies, Medical ; United States
    Language English
    Publishing date 2016-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2375700-0
    ISSN 1936-9018 ; 1936-900X
    ISSN (online) 1936-9018
    ISSN 1936-900X
    DOI 10.5811/westjem.2016.2.29779
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Patient and Health-Care Provider Interpretation of do not Resuscitate and do not Intubate.

    Pirinea, Heather / Simunich, Thomas / Wehner, Daniel / Ashurst, John

    Indian journal of palliative care

    2016  Volume 22, Issue 4, Page(s) 432–436

    Abstract: Background: Advance directives and end of life care are difficult discussions for both patients and health-care providers (HCPs). A HCP requires an accurate understanding of advanced directives to educate patients and their family members to allow them ... ...

    Abstract Background: Advance directives and end of life care are difficult discussions for both patients and health-care providers (HCPs). A HCP requires an accurate understanding of advanced directives to educate patients and their family members to allow them to make an appropriate decision. Misinterpretations of the do not resuscitate (DNR), do not intubate (DNI), and the Physicians Orders for Life-Sustaining Treatment (POLST) form result in ineffective communication and confusion between patients, family members, and HCPs.
    Methodology: An anonymous, multiple choice online and paper survey was distributed to patients, family members of patients (PFMs), and HCPs from December 12, 2012 to March 6, 2013. Data regarding demographics, the accuracy of determining the correct definition of DNR and DNI, the familiarity of the POLST form and if a primary care physician had discussed advanced directives with the participants were collected.
    Results: A total of 687 respondents participated in the survey. Patients and PFMs could not distinguish the definition of DNR (95% confidence interval [CI] [1.453-2.804]) or DNI (95% CI (1.216-2.334)) 52% of the time while HCPs 35% and 39% of the time (
    Conclusion: Discussion of end of life care is difficult for patients and their family members. Often times multiple discussions are required in order to effectively communicate the definition of DNR, DNI, and the POLST form. Education of patients, family members, and HCPs is required to bridge the knowledge gap of advance directives.
    Language English
    Publishing date 2016-11-01
    Publishing country India
    Document type Journal Article
    ISSN 0973-1075
    ISSN 0973-1075
    DOI 10.4103/0973-1075.191784
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Use of Patient-Authored Prehistory to Improve Patient Experiences and Accommodate Federal Law.

    Warner, Michael J / Simunich, Thomas J / Warner, Margaret K / Dado, Joseph

    The Journal of the American Osteopathic Association

    2017  Volume 117, Issue 2, Page(s) 78–84

    Abstract: Context: Although federal law grants patients the right to view and amend their medical records, few studies have proposed a process for patients to coauthor their subjective history in their medical record. Allowing patients to fully disclose and ... ...

    Abstract Context: Although federal law grants patients the right to view and amend their medical records, few studies have proposed a process for patients to coauthor their subjective history in their medical record. Allowing patients to fully disclose and document their medical history is an important step to improve the diagnostic process.
    Objective: To evaluate patients' office experience before and after they authored their subjective medical history for the electronic health record.
    Methods: Patients were mailed a prehistory form and presurvey to be completed before their family medicine office visit. On arrival to the office, the prehistory form was scanned into the electronic health record while the content was transcribed by hospital staff into the appropriate fields in the history component of the encounter note. Postsurveys were given to patients to be completed after their visit. Pre- and postsurveys measured the patients' perception of office visit quality as well as completeness and accuracy of their electronic health record documentation before and after their appointment. Medical staff surveys were collected weekly to measure the staff's viewpoint of the federal law that allows patients to view and amend their medical records.
    Results: Of 405 patients who were asked to participate, 263 patients aged 14 to 94 years completed a presurvey and a prehistory form. Of those 263 patients, 134 completed a postsurvey. The pre- and postsurveys showed improved patient satisfaction with the office visit and high scores for documentation accuracy and completeness. Before filling out the prehistory form, 116 of 249 patients (46.6%) agreed or strongly agreed that they felt more empowered in their health care by completing the prehistory form compared with 110 of 131 (84.0%) who agreed or strongly agreed after the visit (P<.001). Staff members agreed that patients should have the right to view and amend their medical records in accordance with federal law.
    Conclusion: Empowering patients to contribute subjective information to their electronic health record has the potential to improve the diagnostic process. When conducting a medical encounter, the authors recommend having patients complete a prehistory form beforehand to improve the patient experience while accommodating federal law.
    MeSH term(s) Adolescent ; Adult ; Aged ; Cross-Sectional Studies ; Documentation ; Electronic Health Records/legislation & jurisprudence ; Female ; Health Records, Personal/economics ; Humans ; Male ; Middle Aged ; Patient Participation ; Patient Rights/legislation & jurisprudence ; Personal Satisfaction ; Quality Improvement ; Records ; United States ; Young Adult
    Language English
    Publishing date 2017-06-15
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 410350-6
    ISSN 1945-1997 ; 0003-0287 ; 0098-6151
    ISSN (online) 1945-1997
    ISSN 0003-0287 ; 0098-6151
    DOI 10.7556/jaoa.2017.018
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Preoperative decolonization to reduce infections in urgent lower extremity repairs.

    Urias, Daniel S / Varghese, Merin / Simunich, Thomas / Morrissey, Shawna / Dumire, Russell

    European journal of trauma and emergency surgery : official publication of the European Trauma Society

    2018  Volume 44, Issue 5, Page(s) 787–793

    Abstract: Purpose: Medical implants and surgical site infections (SSIs) can be a burden on both patients and healthcare systems with a significant rise in morbidity, mortality and costs. Preoperatively, our practice of a chlorohexidine gluconate (CHG) washcloth ... ...

    Abstract Purpose: Medical implants and surgical site infections (SSIs) can be a burden on both patients and healthcare systems with a significant rise in morbidity, mortality and costs. Preoperatively, our practice of a chlorohexidine gluconate (CHG) washcloth bath or solution shower was supplemented with nasal painting using povidone-iodine skin and nasal antiseptic (PI-SNA). We sought to measure the effectiveness in reducing SSIs in patients undergoing repair of lower extremity fractures.
    Methods: A retrospective review of trauma patients undergoing orthopedic operations conducted at Conemaugh Memorial Medical Center from 10/1/2012 through 9/30/2016. The intervention period was 10/1/2014 to 9/30/2016 which included the addition of nasal painting with PI-SNA preoperatively. All patients were followed for 1 year prior to January 2013 and 30 or 90 days thereafter for the development of a SSI.
    Results: The pre-intervention group consisted of 930 cases with a 1.1% infection rate (10 SSIs). The intervention group consisted of 962 cases with a 0.2% infection rate (2 SSIs). This observed difference was statistically significant (P = 0.020).
    Conclusions: This retrospective review of a methicillin-resistant Staphylococcus aureus decolonization protocol using CHG bath/shower and PI-SNA nasal painting revealed a significant decrease in the infection rate of patients undergoing lower extremity fracture repairs. We recommend its use without contraindications, but recognize that additional investigations are necessary.
    MeSH term(s) Administration, Intranasal ; Adult ; Aged ; Anti-Infective Agents, Local/administration & dosage ; Baths ; Carrier State/drug therapy ; Chlorhexidine/administration & dosage ; Female ; Humans ; Leg Injuries/surgery ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Povidone-Iodine/administration & dosage ; Retrospective Studies ; Staphylococcal Infections/microbiology ; Staphylococcal Infections/prevention & control ; Surgical Wound Infection/microbiology ; Surgical Wound Infection/prevention & control
    Chemical Substances Anti-Infective Agents, Local ; Povidone-Iodine (85H0HZU99M) ; Chlorhexidine (R4KO0DY52L)
    Language English
    Publishing date 2018-01-06
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2275480-5
    ISSN 1863-9941 ; 1863-9933
    ISSN (online) 1863-9941
    ISSN 1863-9933
    DOI 10.1007/s00068-017-0896-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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