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rogression of colorectal cancer. this website Further human studies are needed to translate the experimental evidence and to definitively associate sepsis and neutrophil extracellular traps with poor colorectal cancer-specific outcomes.

International rotations with hands-on experience are commonly cited as a potential supplement to the current experience of surgical trainees in trauma; however, quantification of this experience remains unclear.

A link to an online survey was distributed by electronic mail to physicians who rotated for any period of time at the Trauma Unit of the Groote-Shuur Hospital of the University of Cape Town from January 1, 2006, to December 2016.

Of 160 participants, 75 (47%) completed the survey. A high proportion (45%) had performed less than 25 trauma-related surgical procedures during their previous training. Most (56%) performed ≥10 trauma laparotomies and sternotomies/thoracotomies during their rotation, whereas 43% performed ≥5 vascular procedures. The level of perceived confidence in managing trauma patients increased significantly from a median of 3/10 to 7/10 (

< .05).

Rotations at large-volume trauma centers abroad offer the opportunity for a hands-on operative experience and may enhance the confidence of surgical trainees. Further standardization of these opportunities may result in a larger-scale participation of graduate residents and fellows.

Rotations at large-volume trauma centers abroad offer the opportunity for a hands-on operative experience and may enhance the confidence of surgical trainees. Further standardization of these opportunities may result in a larger-scale participation of graduate residents and fellows.

To address the national opioid and death from overdose crisis in the United States, take-back programs were created to collect and properly dispose of unused abuse-prone drugs.

Surgeons at Central Michigan University College of Medicine led a community prescription medication take-back drive, administered surveys, characterized event participant demographics, prescription indications, and type and quantity of medications dropped off for disposal.

A total of 74,363 dosing units of unused medication were brought in from the homes of 104 event participants. Returned opioids were often prescribed after surgery. Hydrocodone was collected most. Unused opioids were frequently available in homes with children or youth. Collected opioids and benzodiazepines alone had an estimated trademark retail value of over $20,000.

This surgeon-led public health initiative helped properly dispose a significant amount of unneeded abuse-prone prescription medicine. It highlighted the presence of excess opioid prescribing in a typical Midwestern community. Issues related to improved physician prescribing, utility of take-back drives, and proper drug disposal to avoid misappropriation and abuse by younger generations are discussed.

This surgeon-led public health initiative helped properly dispose a significant amount of unneeded abuse-prone prescription medicine. It highlighted the presence of excess opioid prescribing in a typical Midwestern community. Issues related to improved physician prescribing, utility of take-back drives, and proper drug disposal to avoid misappropriation and abuse by younger generations are discussed.

Perioperative care after appendectomy may be the first exposure to opioids for many children. A quality improvement project was implemented to assess current practice of prescribing pain medications after a laparoscopic appendectomy to decrease unnecessary opioid use via simple, targeted steps.

Three measures were implemented in patients undergoing laparoscopic appendectomy for acute appendicitis (1) ice packs to incision in postanesthesia care unit, (2) standard pain scores within 30 minutes of admission to ward postoperatively, and (3) standardized postoperative order set minimizing opioid utilization and limited number of opioids prescribed at discharge. Pre- and postimplementation data were compared with the primary outcome variable opioid utilization during the postoperative period.

There were no statistically significant differences in age or gender between the 814 preimplementation and 263 postimplementation patients. Postimplementation compliance is 66.9% for icepacks, 88% for pain scores, and 94.7% for postoperative order set. There were statistically significant decreases in intravenous and enteral opioids administered, number of opioid doses prescribed at discharge, and patients discharged with an opioid prescription.

By using a multidisciplinary assessment of current state, culture, and management of parental, patient, and nursing expectations, our institution was able to reduce overall opioid consumption.

By using a multidisciplinary assessment of current state, culture, and management of parental, patient, and nursing expectations, our institution was able to reduce overall opioid consumption.

Although ejections from motor vehicles are considered a marker of a significant mechanism and a predictor of severe injuries and mortality, scant recent data exist to validate these outcomes. This study investigates whether ejections increase the mortality risk following a motor vehicle crash using data that reflect the introduction of new vehicles to the streets of a large city in the United States.

The Trauma and Emergency Medicine Information System of Los Angeles County was queried for patients ≥16 years old admitted following a motor vehicle crash between 2002 and 2012. Ejected patients were compared to nonejected. Primary outcome was mortality. A logistic regression model was used to identify predictors of mortality and severe trauma.

A total of 9,742 (6.8%) met inclusion criteria. Of these, 449 (4.6%) were ejected; 368 (82.0%) were passengers and 81 (18.0%) were drivers. The rate of ejection decreased linearly (6.1% in 2002 to 3.4% in 2012). Compared to nonejected patients, ejected patients were more likely to require intensive care unit admission (43.7% vs 22.1%,

 < .01), have critical injuries (Injury Severity Score > 25) (24.2% vs 7.3%,

 <.01), require emergent surgery (16.3% vs 8.0%,

 <.01), and expire in the emergency department (3.6% vs 1.2%,

 <.01). Overall mortality was 3.6% 9.6% for ejected and 3.3% for nonejected patients (

 <.01). In a logistic regression model, ejection and extrication both predicted mortality (adjusted odds ratio 1.83,

 <.01 and 1.87,

 <.01, respectively). Ejection also predicted critical injuries (Injury Severity Score > 25) with adjusted odds ratio of 2.48 (

 <.01).

Ejections following motor vehicle crash have decreased throughout the years; however, they remain a marker of critical injuries and predictive of mortality.

Ejections following motor vehicle crash have decreased throughout the years; however, they remain a marker of critical injuries and predictive of mortality.