Trauma programs that are verified by the American College of Surgeons are required to have a multidisciplinary committee that examines trauma-related patient care operations. To facilitate a potentially large number of issues relevant to patient care, the Trauma Performance Improvement and Patient Safety Committee can apply team principles to promote success. A literature review concerning effective teams was conducted. Eleven principles were identified as essential for developing an effective committee that can properly respond to and resolve performance issues in complex trauma care. This article describes and applies these 11 principles to the Trauma Performance Improvement and Patient Safety Committee.

Ischemia-reperfusion injury is a rare but serious complication encountered after spinal decompression surgery. This is only the 11th case reported in the literature. There is no current mainstay of treatment; however, several therapies have been studied. This case presents a patient with myelomalacia who underwent posterior laminectomy and developed diffuse cord edema with postoperative quadriplegia. Ischemia-reperfusion injury is believed to be mediated by oxidative and nitrosative stress leading to protein degradation and lipid peroxidation. It is characterized by myelomalacia in a chronically ischemic spinal cord and hyperintensity on T2-weighted MRI after decompression. Treatment has involved steroids and rehabilitation, and outcomes have ranged from minor improvement to full recovery. Novel treatment options have shown promise in animal models.

Background. The purpose of this exploratory study was to determine if the importance of chaplain care is associated with and could be predicted by patient or injury characteristics. Methods. A telephone survey of recently discharged trauma patients was conducted. Logistic regression analyses were conducted to determine what factors are associated with the importance of chaplain care and satisfaction with chaplain care. Results. Self-reported religious affiliation was associated with the importance of chaplain care and importance of chaplain care was associated with satisfaction with chaplain care. Conclusions. The value of chaplain care cannot be measured by patient characteristics, therefore, chaplain care should be offered to all patients and families. KJM 2012; 5(2):44-50.

Inpatient Sample (NIS) from the Healthcare Utilization Project (HCUP) developed by AHRQ. Methods: We queried the NIS database for cases coded for VAP using the ICD-9 code of 997.31. Data were analyzed according to year from 2008-2011, representing the years data was available from AHRQ. Incidence rates are reported per 100,000 persons based upon US census data. Results: From 2008 to 2011, 73,215 cases were coded as VAP in the US. The incidence rate ranged from 1.6 to 7.3 per 100,000 persons across study years. The majority Caucasians and Hispanics were noted to have a 2-fold lower rate of VAP development compared to African Americans across study years. The incidence rate for men (8.9-9.6%) was significantly higher than women from 2009 to 2011. A higher rate of documentation of VAP was noted in the south region of the United States (37.6%) compared to the northeast (16.6%), mid-west (23.3%) and west (22.7%) regions. The overall rate of death across cohorts was 19.2% and improved from 2008 (20.8%) to 2011 (18.0%). Patients aged >80 years accounted for the smallest group of patients (11.3%) but had the highest rate of death (30.6%, RR 3.71, 95% CI 3.10-4.44, p<0.001) compared to patients <40 years of age. Rates of death for patients coded with VAP did not differ significantly according to gender, race, hospital type, or geographic location. Conclusions: The incidence of VAP has remained stable across study periods with a trend towards improved rates of death. African Americans may have a higher incidence rate of VAP compared to their Caucasian and Hispanic counterparts. Further research of the effect of racial disparities on VAP is warranted.Learning Objectives: The use of vasopressors was common in intensive care unit (ICU). Due to the lack of conclusive evidence in superiority in efficacy among various types of vasopressors, the choice of vasopressor use mainly depends on the physician preference. This study aims to describe the prevalence of vasopressor use and the trend in the use of each vasopressor medication in ICU over the past 7 years. Methods: This is a descriptive study conducted at a tertiary referral hospital. All ICU admissions, including both medical and surgical ICU, at our institution between January 2007 and December 2013 were included in this study. The use of vasopressors within given ICU day (12.00 am -11.59 pm) during ICU stay was reviewed. Vasopressors were defined as the continuous intravenous administration of norepinephrine, epinephrine, dopamine, phenylephrine, or vasopressin regardless of duration and dosage. Results: A total of 52410 unique patients had 72005 ICU admissions in the course of study, (272271 patient*ICU day). Vasopressors were used in 17767 (24.7%) ICU admissions and on 53898 (19.8%) patient*ICU day, resulting in a total of 76564 vasopressor day. Vasopressin was used on 21955 (41%), epinephrine on 20958 (39%), norepinephrine on 17919 (33%), dopamine on 8636 (16%) and phenylephrine on 7096 (13%) patient*ICU day. Over 2007-2013, there was an upward trend in the use of norepi...