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Introduction Acute care surgery (ACS) was initiated two decades ago to address timeliness and quality in emergency general surgery. We hypothesized that ACS has improved the management of acute appendicitis and biliary disease. Methods A comprehensive systematic review and meta-analysis of outcome studies for emergent appendectomy and cholecystectomy from 1966 to 2017, comparing studies prior to and following ACS implementation. Results Of 1704 studies, 27 were selected for analysis (appendicitis = 16, biliary pathology= 7, both = 4). Following ACS introduction, the complication rate was significantly reduced in both appendectomy and cholecystectomy (Risk ratios = 0.70; 95% CI 0.57 to 0.85; I 9.2% and RR= 0.62; 95% CI 0.41 to 0.94; I 63.5%) respectively. There was a significant reduction in the time from arrival in emergency until admission and from admission to operation (-1.37 hours 95% CI -1.93 to -0.80 and -2.51 hours 95% CI -4.44 to -0.58) in the appendectomy cohort. Time to operation was shorter in the cholecystectomy group (-6.46 hours; 95% CI -9.54 to -3.4). Length of hospital stay was reduced in both groups (appendectomy = -0.9 day, cholecystectomy = -1.09 day). There was a reduction in overall cost in cholecystectomy group (-$854.37 USD; 95% CI -1554.1 to -154.05). No statistical significance was detected for wound infection, abscess, conversion of laparoscopy to open, rate of negative appendectomy, after-hours, readmission and cost. Conclusion The implementation of ACS models in general surgery emergency care has significantly improved system and patient outcomes for appendicitis and biliarypathology. Level of evidence Systematic review and meta-analysis of a retrospective study. Level III.Direct Oral Anticoagulants (DOACs) are widely used among patients requiring anticoagulant therapy. These drugs are associated with a lower risk of bleeding than vitamin K antagonists (VKA). However, the outcomes of elderly trauma patients receiving DOACs are not well known. Methods We reviewed data from trauma patients at our Level I trauma center (University of Pittsburgh Medical Center, Presbyterian Hospital) seen from January 2011 to July 2018. We identified trauma patients taking DOACs or VKA and compared these cohorts using 11 propensity score matching based on patient characteristics, antiplatelet use, comorbidities, and laboratory values. The primary outcome was in-hospital mortality. Secondary outcomes included the proportion of patients discharged to SNF (Skilled nursing facility)/ rehabilitation facility discharge or to home, and transfusion volume. Results Of 32,272 trauma patients screened, 530 were taking DOACs and 1702 were taking VKA. We matched 668 patients in a 11 ratio (DOACs group 334 vs. VKA group 334). The DOACs group had similar mortality (4.8% vs. 1.6%, odds ratio (OR) 3.0, 95% confidence interval (CI) 0.31-28.8, p=0.31) among patients less than 65 years-old, but mortality differed (3.0% vs. 6.6%, OR 0.41, 95%CI 0.17-0.99, p=0.048) among patients over 65 years-old. BGB-8035 The proportion of patients discharged to SNF/rehabilitation facility (50.0% vs. 50.6%, OR 0.98, 95%CI 0.72-1.32, p=0.88) and to home (40.4% vs. 38.6%, OR 1.08, 95%CI 0.79-1.47, p=0.64) were similar. Patients in the DOACs group received fewer fresh frozen plasma (p=0.032) but packed red blood cells (p=0.86) and prothrombin complex concentrate (p=0.48) were similar. Conclusions In this matched cohort of anticoagulated trauma patients, DOACs were associated with the decreased in-hospital mortality and decreased administration of fresh frozen plasma compared to VKA among trauma patients 65 years of age or greater taking anticoagulant therapy. Level of evidence Therapeutic study, level III.COVID-19 has disrupted every aspect of the U.S. health care and health professions education systems, creating anxiety, suffering, and chaos and exposing many of the flaws in the nation's public health, medical education, and political systems. The pandemic has starkly revealed the need for a better public health infrastructure and a health system with incentives for population health and prevention of disease as well as outstanding personalized curative health. It has also provided opportunities for innovations in health care and has inspired courageous actions of residents, who have responded to the needs of their patients despite risk to themselves.In this Invited Commentary, the author shares lessons he learned from three earlier disasters and discusses needed changes in medical education, health care, and health policy that the COVID-19 pandemic has revealed. He encourages health professions educators to use the experiences of this pandemic to reexamine the current curricular emphasis on the bioscientific model of health and to broaden the educational approach to incorporate the behavioral, social, and environmental factors that influence health. Surveillance for disease, investment in disease and injury prevention, and disaster planning should be basic elements of health professions education. Incorporating innovations such as telemedicine, used under duress during the pandemic, could alter educational and clinical approaches to create something better for students, residents, and patients. He explains that journals such as Academic Medicine can provide rapid, curated, expert advice that can be an important counterweight to the misinformation that circulates during disasters. Such journals can also inform their readers about new training in skills needed to mitigate the ongoing effects of the disaster and prepare the workforce for future disasters.The COVID-19 pandemic has been particularly severe in New York City, resulting in a rapid influx of patients into New York-Presbyterian Hospital/Columbia University Irving Medical Center. The challenges precipitated by this pandemic have required urgent changes to existing models of care. Internal medicine residents are at the forefront of caring for patients with COVID-19, including the critically ill. This article describes the exigent restructuring of the New York-Presbyterian Hospital/Columbia University Internal Medicine Residency Program. Patient care and educational models were fundamentally reconceptualized, which required a transition away from traditional hierarchical team structures and a significant expansion in the program's capacity and flexibility to care for large numbers of patients with disproportionately high levels of critical illness. These changes were made while the residency program maintained the priorities of patient care and safety, resident safety and well-being, open communication, and education.