Purpose: Trauma patients are at high risk of venous thromboembolism (VTE). We summarize the comparative efficacy and safety of anti-Xa-guided versus fixed dosing for low molecular weight heparin (LMWH) for the prevention of VTE in adult trauma patients. Methods: We searched Medline and Embase from inception through June 1, 2022. We included randomized controlled trials or observational studies comparing anti-Xa-guided versus fixed dosing of LMWH for thromboprophylaxis in adult trauma patients. We incorporated primary data from 2 large observational cohorts. We pooled effect estimates using a random-effects model. We assessed risk of bias using the ROBINS-I tool for observational studies and assessed certainty of findings using GRADE methodology. Results: We included 15 observational studies involving 10,348 patients. No randomized controlled trials were identified. determined that, compared to fixed LMWH dosing, anti-Xa-guided dosing may reduce deep vein thrombosis [adjusted odds ratio (aOR); 0.52, 95% CI: 0.40–0.69], pulmonary embolism (aOR: 0.48, 95% CI: 0.30–0.78) or any VTE (aOR: 0.54, 95% CI: 0.42–0.69), though all estimates are based on low certainty evidence. There was an uncertain effect on mortality (aOR: 1.06, 95% CI: 0.85–1.32) and bleeding events (aOR: 0.84, 95% CI: 0.50–1.39), limited by serious imprecision. We used several sensitivity and subgroup analyses to confirm the validity of our assumptions. Conclusion: Anti-Xa-guided dosing may be more effective than fixed dosing for prevention of deep vein thrombosis, pulmonary embolism, and VTE for adult trauma patients. These promising findings justify the need for a high-quality randomized study with the potential to deliver practice changing results.

Background: The acquisition of procedural competence is of vital importance in the training of physicians. It has been observed that medical students with extensive musical backgrounds often learn surgical techniques more rapidly than other students, raising the question of motor skill transfer from one area to another. Objective: It is the aim of this project to explore whether musicians can learn and perform surgical skills more rapidly than non-musicians. This study explores the claims that musicians’ proficiency in playing their instrument can translate into benefits when learning complex and refined motor skills in another domain. Even basic surgical skills, such as suturing, become difficult in cognitively demanding environments such as the operating room, containing a barrage of multisensory stimuli where the surgeon must triage and respond to clinically salient information. Method: Participants with piano expertise and participants with no formal music training learned how to do a surgical knot and sutures. They had two practice sessions and were tested after each session. The two test parameters measured were time to complete the task and an OSATS (Objective Structures Assessment of Technical Skills) score. Results for each group (musicians and non-musicians) were analysed and compared. Results: Musician participants performed the surgical tasks faster and received higher scores than the controls; for knot tying, the difference between the two groups was statistically significant. Gender and proficiency using chopsticks also exhibited some influence on test times and scores. Conclusion: Musical training in piano appeared to be of benefit in the initial stage of learning new simple surgical skills. This indicates that at least some aspects of a musicians’ skillset (such as fine motor control, bimanual dexterity and good hand-eye coordination) might be transferrable to an ostensibly disparate domain, and may be important for incorporation in surgical training where the skill of suturing can impact both surgical outcomes, patient safety, and patient satisfaction.

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Background: Self-inflicted trauma (SIT) is a public health issue ranking 4th as leading cause of death and disability in young adults. Methods: Retrospective descriptive analysis of patients admitted to a level 1 trauma centre with self-inflicted injuries, 2008-2013. Results: Over a 5-year period, 268 patients with SIT presented to our hospital, 177 (66%) male, average age 39.4 years (SD 16). The most common mechanism of injury was stabbing, (47%), followed by jumping (26.86%). Jumpers had higher ISS (22 v. 9). Seasonal variation showed summer with highest incidence (34%), winter having the lowest (17%). Patients from rural areas accounted for 28%, these were younger (30 v. 42 years, p = 0.002), had lower ISS (9 v. 14, p = 0.007), presented with more firearm injuries (18.6% vs. 2.3%). Overall, 63 (23%) patients had pre-existing psychiatric disease; these patients had longer LOS (20 v. 7 days, p = 0.002), and had jumping from height as predominant mechanism (p = 0.01). Mortality was 13.8%. Patients that died were older (42 v. 30 years, p = 0.002), had higher ISS (14 v. 9, p = 0.007), longer LOS (13.5 v. 6 days, p = 0.004), with fall being the predominant mechanism associated with mortality (p < 0.0001). Conclusion:Our study defines and characterizes the population at risk for SIT in an attempt to implement appropriate prevention strategies and improve the existing post-injury care pathway.Abdominal compartment syndrome in the child. Gilgamesh Eamer,* Ioana Bratu.