The Journal of surgical research
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Recent studies demonstrate favorable diabetic foot ulcer (DFU) healing outcomes with the implementation of a multidisciplinary team. We aimed to describe the incidence of and risk factors associated with ulcer recurrence after initial complete healing among a cohort of patients with DFU treated in a multidisciplinary setting. ⋯ In this prospective cohort of patients with DFU, time to diagnosis and healing was significantly lower for recurrent ulcers, and downstaging was common. These data suggest that engaging patients with DFU in a multidisciplinary care model with frequent follow-up and focused patient education may serve to decrease DFU morbidity.
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Injured children who arrive by self-transport to the emergency department (ED) may receive delayed or inadequate care. We studied differences in demographics, clinical characteristics, and trauma activation status for admitted pediatric trauma patients based on arrival by self-transport or Emergency Medical Services (EMS). ⋯ Almost half of admitted pediatric trauma patients arrived by self-transport; however, trauma team activation rarely occurs for these patients. Trauma team activation may be underutilized in self-transport patients with injuries resulting in hospital admission.
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Observational Study
Sensor-Based Upper-Extremity Frailty Assessment for the Vascular Surgery Risk Stratification.
Available methods for determining outcomes in vascular surgery patients are often subjective or not applicable in nonambulatory patients. The purpose of the present study was to assess the association between vascular surgery outcomes and a previously validated upper-extremity function (UEF) method, which incorporates wearable motion sensors for the physical frailty assessment. ⋯ This is the first study to validate the utility of UEF among patients undergoing any vascular surgery. Findings suggest that UEF may provide an objective and simple approach for assessing frailty to predict adverse events after vascular surgery, especially for nonambulatory patients.
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Surgical coaching is an emerging concept of education and collaboration to improve surgical performance. Surgical education in low-resource settings remains a challenge because of confounding barriers of access, resources, and sustainability. No formal assessments of coaching as a means to improve surgical quality in low- or middle-income countries (LMICs) exist. The purpose of this review is to explore if surgical coaching could serve as an effective method of fostering continued education and advancement of surgical skills in low-resource settings. ⋯ Coaching is a method of teaching surgeons at multiple stages of a career. The explored advantages of surgical coaching may be applied to continuous performance improvement and collaboration with surgeons in LMICs. Furthermore, coaching may aid in advancement of the well-established Lancet Global Surgery Indicators, improving surgical capacity and quality in LMICs.