Burns: Recent Advances and Perennial Challenges
In this issue of Surgical Clinics, we document advances and challenges across the entire spectrum of burn care –from prehospital, austere, and mass-casualty environments; to the intensive care unit (ICU) and operating room; all the way to postburn recovery and reintegration. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - April 4, 2023 Category: Surgery Authors: Leopoldo C. Cancio Tags: Preface Source Type: research
Critical Care of the Burn Patient
Care of the critically ill burned patient must integrate a multidisciplinary care team composed of burn care specialists. As resuscitative mortality decreases more patients are surviving to experience multisystem organ failure relating to complications of their injuries. Clinicians must be aware of physiologic changes following burn injury and the implicated impacts on management strategy. Promoting wound closure and rehabilitation should be the backdrop for which management decisions are made. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - April 4, 2023 Category: Surgery Authors: Garrett W. Britton, Amanda R. Wiggins, Barret J. Halgas, Leopoldo C. Cancio, Kevin K. Chung Source Type: research
Radiation Injuries
Radiation-related injuries are rare. Yet the consequences of an event involving a radiation source can be substantial. As with any clinical emergency that rarely occurs, we are typically less prepared to deal with the situation. Compounding the crisis will be the “worried well” population who may believe that they too are contaminated or suffering from radiation poisoning and report to the hospital for evaluation. Identifying and triaging those who are sick or injured, managing the surge of patients, and knowing where resources can be accessed are all es sential. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - April 4, 2023 Category: Surgery Authors: Randy D. Kearns, William L. Hickerson, Jeffery E. Carter Source Type: research
Burn Care in Low-Resource and Austere Settings
More than 95% of the 11 million burns that occur annually happen in low-resource settings, and 70% of those occur among children. Although some low- and middle-income countries have well-organized emergency care systems, many have not prioritized care for the injured and experience unsatisfactory outcomes after burn injury. This chapter outlines key considerations for burn care in low-resource settings. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - April 4, 2023 Category: Surgery Authors: Barclay T. Stewart, Kwesi Nsaful, Nikki Allorto, Shankar Man Rai Source Type: research
Prehospital and Emergency Management
Burn care in the prehospital and emergency settings requires rapid assessment of airway, breathing, and circulation. Intubation (if indicated) and fluid resuscitation are most important in emergency burn care. Total body surface area burned and depth of burn are important early assessments that help guide resuscitation and disposition. Burn care in the emergency department further includes carbon monoxide and cyanide toxicity evaluation and management. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - April 4, 2023 Category: Surgery Authors: Jasmine M. Williams, Chelsea L. Ingle, Steven G. Schauer, Joseph K. Maddry Source Type: research
Infections in Burn Patients
Infections are the leading cause of mortality in burn patients who survive their initial resuscitation. Burn injury leads to immunosuppression and a dysregulated inflammatory response which can have a prolonged impact. Early surgical excision along with support of the multidisciplinary burn team has improved mortality in burn patients. The authors review diagnostic and therapeutic challenges as well as strategies for management of burn related infections. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - April 4, 2023 Category: Surgery Authors: John L. Kiley, David G. Greenhalgh Source Type: research
Categories of Evidence and Methods in Surgical Decision-Making
Surgical decision-making is a continuum of judgments that take place during the preoperative, intraoperative, and postoperative periods. The fundamental, and most challenging, step is determining whether a patient will benefit from an intervention given the dynamic interplay of diagnostic, temporal, environmental, patient-centric, and surgeon-centric factors. The myriad combinations of these considerations generate a wide spectrum of reasonable therapeutic approaches within the standards of care. Although surgeons may seek evidenced-based practices to support their decision-making, threats to the validity of evidence and a...
Source: Surgical Clinics of North America - March 21, 2023 Category: Surgery Authors: Samuel P. Carmichael, David A. Kline Source Type: research
Machine Learning and Artificial Intelligence in Surgical Research
Machine learning, a subtype of artificial intelligence, is an emerging field of surgical research dedicated to predictive modeling. From its inception, machine learning has been of interest in medical and surgical research. Built on traditional research metrics for optimal success, avenues of research include diagnostics, prognosis, operative timing, and surgical education, in a variety of surgical subspecialties. Machine learning represents an exciting and developing future in the world of surgical research that will not only allow for more personalized and comprehensive medical care. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - March 21, 2023 Category: Surgery Authors: Shruthi Srinivas, Andrew J. Young Source Type: research
Cognitive Bias and Dissonance in Surgical Practice
A cognitive bias describes “shortcuts” subconsciously applied to new scenarios to simplify decision-making. Unintentional introduction of cognitive bias in surgery may result in surgical diagnostic error that leads to delayed surgical care, unnecessary procedures, intraoperative complications, and delayed recognition of p ostoperative complications. Data suggest that surgical error secondary to the introduction of cognitive bias results in significant harm. Thus, debiasing is a growing area of research which urges practitioners to deliberately slow decision-making to reduce the effects of cognitive bias. (Source: Surgi...
Source: Surgical Clinics of North America - March 21, 2023 Category: Surgery Authors: Caroline E. Richburg, Lesly A. Dossett, Tasha M. Hughes Source Type: research
Interpretation and Use of Applied/Operational Machine Learning and Artificial Intelligence in Surgery
Applications for artificial intelligence (AI) and machine learning in surgery include image interpretation, data summarization, automated narrative construction, trajectory and risk prediction, and operative navigation and robotics. The pace of development has been exponential, and some AI applications are working well. However, demonstrations of clinical utility, validity, and equity have lagged algorithm development and limited widespread adoption of AI into clinical practice. Outdated computing infrastructure and regulatory challenges which promote data silos are key barriers. Multidisciplinary teams will be needed to a...
Source: Surgical Clinics of North America - March 21, 2023 Category: Surgery Authors: Molly J. Douglas, Rachel Callcut, Leo Anthony Celi, Nirav Merchant Source Type: research
Clinical Informatics and the Electronic Medical Record
This article reviews the history of the electronic medical record, discusses use cases of additional data resources, and highlights the pitfalls of this relatively new technology. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - March 21, 2023 Category: Surgery Authors: Mustafa Abid, Andrew B. Schneider Source Type: research
Impact of Digital Health upon the Surgical Patient Experience
The adoption of digital health services in surgical care delivery is changing the patient experience. The goal of patient-generated health data monitoring incorporated with patient-centered education and feedback is to optimally prepare patients for surgery and personalize postoperative care to improve outcomes that matter to both patients and surgeons. Challenges include the need for the adoption of new methods for implementation and evaluation and equitable application of surgical digital health interventions, with considerations for accessibility as well as the development of new diagnostics and decision support that in...
Source: Surgical Clinics of North America - March 21, 2023 Category: Surgery Authors: Heather L. Evans, Joseph Scalea Source Type: research
Beyond the Spreadsheet
This article introduces the fundamentals of Big Data management and encourages clinicians to work with their information technology partners to further understand these processes and to identify opportunities for collaboration. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - March 21, 2023 Category: Surgery Authors: Carly Eckert Source Type: research
Generation Learning Differences in Surgery
The evolution of the knowledge economy and technology industry have fundamentally changed the learning environments occupied by contemporary surgical trainees and created pressures that will force the surgical community to consider. Although some learning differences are intrinsic to the generations themselves, these differences are primarily a function of the environments in which surgeons of different generations trained. Acknowledgment of the principles of connectivism and thoughtful integration of artificial intelligence and computerized decision support tools must play a central role in charting the future course of s...
Source: Surgical Clinics of North America - March 21, 2023 Category: Surgery Authors: Mike Weykamp, Jason Bingham Source Type: research
Modern Statistical Methods for the Surgeon Scientist
The practice of evidence-based medicine is the result of a multitude of research and trials aimed toward improving health-care outcomes. An understanding of the associated data remains paramount toward optimizing patient outcomes. Medical statistics commonly revolve around frequentist concepts that are convoluted and nonintuitive for nonstatisticians. Within this article, we will discuss frequentist statistics, their limitations, as well as introduce Bayesian statistics as an alternative approach for data interpretation. By doing so, we intend to highlight the importance of correct statistical interpretations through clini...
Source: Surgical Clinics of North America - March 21, 2023 Category: Surgery Authors: Daniel Lammers, John McClellan Source Type: research
