Parkland Memorial Hospital

The objectives of the study were to describe an integrated screening, brief intervention, treatment and referral (SBIRT) prenatal care program for opioid use disorder (OUD), factors influencing program engagement, and the characteristics of pregnant and postpartum people with OUD. This was a retrospective cohort study of 245 pregnant and postpartum people with OUD who had access to a 30-day SBIRT program at a safety-net hospital between March 15, 2021, and March 15, 2024. Multivariable logistic regression models assessed predictors of program completion, defined as engaging in 4 weekly outpatient visits. Forty-two percent of participants completed the program, and 86% received medication for opioid use disorder (MOUD). Factors that increased the likelihood of program completion included entry through referral versus the emergency department (OR: 3.05, 95% CI: 1.58-6.04), family history of SUD (OR: 2.28, 95% CI: 1.31-4.01), and comorbid psychiatric diagnosis (OR: 1.87, 95% CI: 1.04-3.39). The use of multiple substances (OR: 0.43, 95% CI: 0.19-0.92) and positive fentanyl screens (OR: 0.26, 95% CI: 0.12-0.55) decreased the likelihood of program completion. Neither trimester of pregnancy nor severity of OUD influenced program completion. Social determinants of health were common. An SBIRT program offering 24-hour coverage with skilled providers offering trauma-informed care and social supports integrated with prenatal care results in high engagement and acceptance of MOUD. Policy implications support improved access to naloxone, fentanyl testing strips, and maternity housing. Results suggest further research into the specific nature of how family history of SUD improves engagement in treatment programs.

The incidence of admissions for burn and inhalation injuries related to home oxygen therapy remains poorly defined in the U.S. We analyzed the American Burn Association's Burn Care Quality Platform (BCQP) database (2013-2022) to generate national estimates of supplemental home oxygen therapy-related injuries and outcomes. Text string extraction identified cases using multiple search permutations related to home oxygen use. Patient demographics, injury characteristics, and inpatient outcomes were described. Logistic regression assessed predictors of oxygen therapy injuries, and Poisson regression estimated adjusted incidence rates. Of 207 364 burn admissions, 79 114 (28%) contained injury descriptions, with 3.0% (2360 cases) attributed to home oxygen therapy. These patients had a median age of 65 years (IQR: 59-71), mean total body surface area (TBSA) of 4.1%, were predominantly male (62.6%) and white (79.0%). Medicare was the most common payer (57.7%). Inhalation injury was present in 11.4%, mean length of stay was 8 days, and inpatient mortality was 6.1%. Smoking was the leading ignition source (63%), followed by cooking/stove (4%), while 22% had no identified cause. The adjusted incidence rate of supplemental home oxygen injuries was 3.6% (95% CI, 2.7%-2.9%; P < 0.001), with a significant annual increase (incidence rate ratio: 1.03; 95% CI, 1.02-1.04). Oxygen therapy-related injuries account for 1088 (95% CI, 1065-1113) burn admissions per year in the U.S. Despite smaller TBSA burns, mortality was twice the national average for burn patients, and for survivors, the odds of discharge home were 15% less likely. Targeted prevention strategies are needed to mitigate this growing public health problem.

Abstract Introduction While the understanding of secondary traumatic stress (STS) has grown over the past 30 years, there is a lack of research examining STS amongst burn care clinicians. Burn care clinicians’ experiences are unique due to the combination of often-traumatic mechanism of burn injuries, provision of repetitive and painful treatment, and continuing to provide life-long care. The current study aimed to determine the prevalence of secondary traumatic stress in a sample of burn care clinicians across all occupational roles. Methods Participants completed a one-time survey including measures of STS (Secondary Traumatic Stress Scale [STSS]) and demographic/occupational information. The sample included 102 clinicians working in one of the largest civilian burn centers in the nation. All clinicians providing direct patient care were eligible to participate, including: advance practice provider; support services (case manager, respiratory therapist, social worker); chaplain; therapists (occupational, physical, speech therapists); attending physicians (PM&amp;R, surgical); PM&amp;R resident/fellow; registered nurse; surgical resident/fellow; wound care technician; other. Results Recruitment occurred from 11/2/23 through 7/25/24 with a completion rate of 83.74%. The mean STSS total score among all clinicians was 37.24 (SD = 12.57), falling in the Mild STS range and just below the recommended cut-off value (38) for likely experiencing PTSD at a diagnostic level due to STS. Of the three STSS symptom subscales (Intrusion, Avoidance, Arousal), the Avoidance subscale had the highest mean score (M = 15.17, SD = 5.37). Of the seventeen STSS individual items, item #10 (“I thought about my work with my patients when I didn’t intend to”) had the highest mean severity rating (M = 3.01, SD = 1.23). There was not a significant difference in STSS total scores across occupational groups, χ² (9, n = 101) = 8.77, p =.46. Notably, the two occupations with the highest mean STSS total scores, in the Moderate STS range, were wound care technicians (M = 43.00, SD = 14.69) and registered nurses (M = 42.41, SD = 14.43). Excluding residents (N = 70), mean STSS total score was 38.04 (SD = 13.35), falling above the recommended cut-off value. Conclusions While mean STSS total scores were in the Mild STS range for this sample, several occupations with potentially higher rates of secondary exposure to the traumatic experiences of burn patients did have mean scores in the Moderate/clinically significant range. Burn clinician STS prevalence rates are comparable to similar healthcare occupational roles. Applicability of Research to Practice These findings have implications regarding the mental and physical health of burn care clinicians but also the potential impact on patient care and the hospital system. Research should focus efforts towards prevention and intervention in this setting. Funding for the Study N/A

Digital data processing has revolutionized medical documentation and enabled the aggregation of patient data across hospitals. Initiatives such as those from the AO Foundation about fracture treatment (AO Sammelstudie, 1986), the Major Trauma Outcome Study (MTOS) about survival, and the Trauma Audit and Research Network (TARN) pioneered multi-hospital data collection. Large trauma registries, like the German Trauma Registry (TR-DGU) helped improve evidence levels but were still constrained by predefined data sets and limited physiological parameters. The improvement in the understanding of pathophysiological reactions substantiated that decision making about fracture care led to development of patient’s tailored dynamic approaches like the Safe Definitive Surgery algorithm. In the future, artificial intelligence (AI) may provide further steps by potentially transforming fracture recognition and/or outcome prediction. The evolution towards flexible decision making and AI-driven innovations may be of further help. The current manuscript summarizes the development of big data from local databases and subsequent trauma registries to AI-based algorithms, such as Parkland Trauma Mortality Index and the IBM Watson Pathway Explorer.

Objective: Aimed to potentially risk-stratify patients with different cervical cytology diagnoses, by HPV genotypes and/or age, we have conducted a series of studies to examine the prevalence of cervical precancers and cancers for women with different cytology diagnoses. This paper will be focusing on patients with ASC-H/HSIL cytology.Methods: In total, 1183 patients aged 20-78 years with atypical squamous cells, cannot rule out HSIL (ASC-H)/HSIL by cytology underwent AHPV assay and cervical biopsy in a developed region in southern China were included in this study.Results: Overall, 59.2% women with ASC-H/HSIL cytology had cervical intraepithelial neoplasia (CIN)2/3 lesions while 1.6% had adenocarcinoma in situ (AIS) lesions. Compared to other groups, HPV-16+ group (80.8%) showed a significantly higher prevalence of CIN2/3 than other genotype+ groups (p<0.0001). Further, HPV-16+ (9.3%) or HPV-18/45+ (6.3%) group showed a significantly higher prevalence of squamous cell carcinoma (SCC) than other genotype+ groups (p<0.0001). The prevalence of AIS glandular lesions in HPV-18/45+ group (13.8%) is significantly higher than other genotype groups (p<0.0001). When stratified by age, younger group showed a significantly higher prevalence of CIN2/3 (p=0.009) while older group presented an obvious higher prevalence of SCC (p<0.0001).Conclusions: In this patient population, among women with ASC-H/HSIL cytology, HPV positive groups are at significantly higher risk of CIN2/3 compared to HPV negative group. Specifically, prevalence of CIN2/3 and SCC is significantly higher in HPV-16+ group while AIS lesions are more prevalent among HPV-18/45+ patients. In addition, younger group showed a significantly higher prevalence of CIN2/3 while older group presented an obvious higher prevalence of SCC.