Monthly Archives: January 2014

Section of Pediatric Surgery at Boston Medical Center has a unique collaboration with Boston Children’s Hospital

Image

Photographed is Kate Madden, MD from Boston Children’s Hospital and Karran Barry RN, BSN from Boston Medical Center

The Section of Pediatric Surgery at Boston Medical Center provides exceptional surgical care to infants, children and adolescents who require operative or non-operative intervention for routine and complex medical issues. The team is committed to excellence in clinical care, research and the education of future pediatric providers. The Section of Pediatric Surgery consists of attending surgeons from Boston Children’s Hospital. This unique relationship between the two hospitals brings the highest level of expertise in pediatric surgical and critical care together under one roof and is a beneficial relationship for our patients.

Shopping Carts Can Pose Big Danger to Little Kids

Study found one youngster seriously injured in falls, tip-overs every 22 minutes.

Be careful when you plunk your youngster into a shopping cart on your next trip to the grocery store.

New U.S. research finds that one child winds up in the emergency room every 22 minutes because of an injury related to shopping carts.

Falling from shopping carts caused most of the injures (about 70 percent), followed by running into/falling over a cart, cart tip-overs, and fingers, legs or arms getting trapped in a cart, according to the study in the January issue of Clinical Pediatrics.

Overall, the researchers found that more than 500,000 children under the age of 15 were treated at emergency rooms for shopping cart-related injuries between 1990 and 2011, an average of more than 24,000 a year.

The head was the area of the body most often injured in shopping cart accidents, at 78 percent. Soft tissue injuries were the most common type of head injury, but the annual rate of concussions and internal head injuries rose by more than 200 percent during the study period, from 3,483 in 1990 to 12,333 in 2011. Most of this increase occurred in infants and toddlers.

Voluntary shopping cart safety standards introduced in the United States in 2004 have done little good, the researchers noted.

“The findings from our study show that the current voluntary standards for shopping cart safety are not adequate,” Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, said in a hospital news release.

“Not only have the overall number of child injuries associated with shopping carts not decreased since implementation of the safety standards, but the number of concussions and closed head injuries is actually increasing,” Smith said. “It is time we take action to protect our children by strengthening shopping cart safety standards with requirements that will more effectively prevent tip-overs and falls from shopping carts.”

Suggestions include improved restraint systems, placing child seats in shopping carts closer to the floor, teaching parents about shopping cart safety and having stores promote the use of cart safety belts.

The researchers added that there is even more that parents can do to keep their children safe around shopping carts. These include not using carts that lack safety restraints or have broken wheels, staying with your cart and your child at all times and not putting infant seats on top of shopping carts. Parents should also consider putting their infants either in strollers or in carriers that strap to the front or back of the parent’s body.

“It is important for parents to understand that shopping carts can be a source of serious injury for their children,” said Smith, a professor of pediatrics at Ohio State University College of Medicine. “However, they can reduce the risk of injury by taking a few simple steps of precaution, such as always using the shopping cart safety belts if their child needs to ride in the cart.”

More information: The American Academy of Pediatrics has more about shopping cart safety.

Copyright © 2014 HealthDay.

Analysis: A Conflicting Voice in Concussion Dialogue

2013-01-14_AFCA-Concussions

By the end of a morning lecture Monday, Sandra Chapman, Ph.D., had essentially told an auditorium full of football coaches that all the doomsday stuff they’ve been hearing about concussions isn’t quite as bad the media has made it seem.

“What’s being touted is ahead of the evidence,” Chapman later told a small group of reporters off to the side.

Welcome to the newest twist in the discussion of head injuries and football – commissioned and endorsed, of course, by the folks whose livelihood depends on football.

Don’t like what the research says? Find another researcher.

“Youth football’s benefits to health and well-being far, far exceed the risks,” Chapman, who is not a medical doctor but founded the Center for BrainHealth at UT-Dallas in 1999, told the American Football Coaches Association.

No wonder folks like National Football Foundation president Steve Hatchell and AFCA executive director Grant Teaff were giddy over Chapman’s appearance, which concluded a morning session that sounded a lot like a pep rally for the football.

All the bad stuff you’ve heard lately about the sport, the declining participation among teenagers and the increased focus on its long-term dangers? The overarching message here Monday was this: Football is under attack, and it’s time to fight back.

“In 38 years, I don’t have one former player who isn’t functional due to concussions, but I do have a whole lot of healthy players,” Duke coach David Cutcliffe told USA TODAY Sports. “That’s a case study, isn’t it? We’re trying to make people think before they react.”

And in Chapman, who described herself as a former Texas cheerleader, the coaches have found their champion.

Which isn’t to suggest Chapman’s research and her conclusions about concussions are wrong. But they certainly are different.

Essentially, Chapman’s point is that while the bulk of the research on concussions has focused on what goes wrong in the brain, her focus is on healing and regaining full function after an injury. And not only does the brain heal itself, it can “build resilience” through certain exercises she has developed.

Her method for how that happens was a bit fuzzy – it sounded like physical therapy for the brain through problem-solving and other intense cognitive exercises – but her basic conclusion was that concussions don’t pose a significant long-term health risk and that the brain will return to normal given proper care and recovery time.

“The myth is that brain damage is permanent,” Chapman said, though she acknowledged later that once cases of Chronic Traumatic Encephalopathy (CTE) become severe, there is very little that can be done to bring them back.

Maybe that sounds more controversial than it really is. Chapman, after all, acknowledged that the most important aspect is concussion prevention and that there are risks if a football player returns to the field before being fully healed.

In other words, she’s not saying concussions are good. And she claims that her methods to measure brain function are more intricate than conventional baseline tests, which are far from foolproof if a player wants to “sandbag” so that it’s easier to meet the threshold once he gets a concussion.

On the other hand, it was a little curious to hear a neuroscientist tout health benefits of football such as making teenagers less likely to engage in other risky behaviors, less likely to become addicted to video games and encourage better sleep. She even talked about “brainomics” – her own word – which she defined as “the high economic cost if we don’t encourage youth to play team sports.”

Is that science or propaganda?

“We pick up where basic medicine drops off,” Chapman explained. “Basic medicine will say, ‘O.K., you’ve got this concussion; here, take this and go to sleep.’ I’m a cognitive neuroscientist that is focused on how the brain learns, rewires. Medicine doesn’t study how the brain rewires.

“Most research centers are focused on what goes wrong with the brain. We want to know how can we maximize it regardless of whether it’s concussions or ADHD or drug addiction or bipolar disorder. Medicine doesn’t do that. They kind of say here’s your pill, goodbye.”

This was the first time Chapman, who said she wasn’t paid for the appearance, officially spoke with the backing of an organization like the AFCA, which is comprised mainly of college and high school coaches. The NCAA, which is embroiled in several lawsuits over concussion issues, “has been the toughest nut to crack in this whole domain,” said Lori Cook, her research partner specializing in pediatrics. Cook also noted that a person like Dr. Robert Cantu, arguably the nation’s leading voice on sports concussions, “has been so overpowering it’s crowded out” other research.

But the AFCA is going to make sure Chapman’s voice is heard, and she comes to the table with a very different viewpoint than what coaches and parents have been hearing the past couple years.

“A lot of moms will say, should (their son) take the risk if he’s not going to be an NFL player?” Chapman said. “Yeah, because the benefits are so much greater than the risks. Just because he won’t play in the NFL doesn’t mean don’t let him play football.”

In other words, the battle over the concussion narrative has now been engaged, with the backing of an organization that represents thousands of coaches at all levels.

Game on.

*courtesy of usatoday.com

Young Kids Drawn to Guns – A “National Public Health Problem” – Dr. Robert Sege, Director, Div Family and Child Advocacy at Boston Medical Center

Parents are shocked to see how their kids react to finding a gun in an unattended classroom. Video courtesy: ABC News

WCVB Channel 5 Boston also reports on Dr. Robert Sege’s findings: http://bit.ly/1dJLJut

A little bit about Lisa Allee, LICSW – Director of Community Violence Response Team

Image

Lisa Allee, LICSW, is the Director of Community Violence Response Team for one of the busiest urban Level 1 Trauma Center. She graduated with her Bachelors in Psychology from Northeastern University and her Masters in Social Work from University of Pennsylvania.  She previously worked for ten years as a Clinical Social Worker for Inpatient Pediatrics and Pediatric Intensive Care here at BMC. Since 2006 she has been spearheading evidenced based injury prevention programs and in 2011 created and became Director of BMC’s Community Violence Response Team. Her responsibilities include overseeing development, deployment and maintenance of injury prevention programs for the department. 

Her clinical research interests involve injury prevention throughout the lifespan.  Her current research projects   include research on older adult driving, safe sleep for infants and toddlers, PTSD and Depression among Trauma and Acute Care surgical Patients as well as lower level violence related injury recidivism.  Our injury prevention programming efforts include a BMC Low Cost Helmet Program, Cribs for Kids©, BMC Child Passenger Safety Program and the Community Violence Response Team amongst others.

Apart from her duties and responsibilities at BMC, she is also involved in various membership and leadership roles in professional chapters across New England as well as Nationally.   She currently co-chairs MassPINN, The Massachusetts Prevent Injuries Now! Network which was founded in March 2006 as part of Centers for Disease Control-funded project to support injury prevention efforts at the state level.   She is a member of MA COT – IPC Consortium, the New England Injury and Violence Prevention Research Collaborative and the Eastern Association for the Surgery of Trauma amongst others .  She also continues to serve as a mentor to many medical students performing research projects for the department.

Elisha G. Brownson, fourth year general surgery resident at BMC selected as winner of the Resident and Associate Society of the American College of Surgeons (RAS-ACS) annual essay contest

Each year, the Communications Committee of the RAS-ACS selects a topic of broad interest to young surgeons and solicits brief essays from interested members on the subject. This year’s topic — How Surgeons Deal with Complications – generated a robust response from RAS-ACS membership. This year’s winning essay by Elisha G. Brownson, MD, details lessons learned from a case involving a lucid patient and a snapped catheter.

Image

Accepting accountability and moving forward

by ELISHA G. BROWNSON, MD
PUBLISHED JANUARY 3, 2014 in Jan 2014 /Volume 99 Number 1/Bulletin of the American College of Surgeons

Snap.

In an instant, the whole procedure changed. I had been called to assist another co-resident in removing a port-a-cath at the bedside. It had been difficult, and despite retrieving the port, the tunneled line was proving to be more of a struggle to remove. It was my hands that came to assist, that applied stronger tension, and that snapped the catheter. It was my complication.

My thoughts flashed back to the consent form that the patient had signed. The risks of the procedure include: bleeding (not expected to be more than a tablespoon), infection (we are removing the port due to suspected infection), damage to nearby structures…

Did we even mention retained foreign body?

In a calm voice, I asked my co-resident to get our chief resident to the bedside and get the nurse to put the patient on telemetry. There we were, with an awake patient and a catheter that I could not retrieve.

Surgeons must often face complications in a much more overt way than our medical colleagues. And, unlike a hospital-acquired pneumonia, which often can be attributed to several factors with shared responsibility among numerous providers, surgical complications can often fall into the operator’s hands. Our hands, which we have trained to heal, are also held accountable for their actions.

I returned to our workroom feeling a mixture of embarrassment, regret, and disappointment in myself. My chief’s response surprised me. She said that this problem was a sign that I was operating because, in the end, we cannot operate without encountering complications. We must reconcile this fact within ourselves to move forward, while at the same time proceeding with great care and detail so that we do not advance recklessly to the operating room. It is this awareness that our colleagues and attendings attempt to reproduce at the podium of our morbidity and mortality conferences, but often we are our own greatest critic in this process.

The sterile field was taken down. My gown, gloves, and mask were removed. Are you all done now? We invited the patient’s wife back to the room so the attending surgeon and I could explain our findings and the plan going forward. It is a challenge, in a field wrought with pride and confidence, to expose our failures to patients and their families. But this humility carries forward with us and shapes us. Every surgeon has those poignant faces or names engraved in their memory, and they stay with us for the duration of our career.

The patient was wheeled off to interventional radiology. Thankfully, retrieval of his catheter was resolved promptly and without further complications. The next day, I apprehensively walked into the patient’s room to round. Deep breath. Move forward. Another day in residency. These were the thoughts that were running through my head that morning.

I am a surgeon in training and as my responsibilities grow, I understand more intimately the unique challenges of our field. I have learned from this patient and have found that our complications spur us on to strive for better care in the future.

Courtesy of: http://bulletin.facs.org/2014/01/accepting-accountability-and-moving-forward/

A Streamlined Perioperative Experience at Boston Medical Center

Image

Dr. Tracey Dechert, one of our Trauma & Acute Care Surgeon, preforming surgery.

 

BY: Boston Trauma Staff, Boston Medical Center offers patients undergoing a surgical procedure a streamlined perioperative experience. The process begins in the pre-operative holding area, and continues where final preparations and an emphasis on patient safety occurs, and includes pre-operative consultation if needed. After the surgical procedure takes place, patients recover in the Post Anesthesia Care Unit (PACU). Each year 20,000 cases of all types are performed by 16 surgical services, including pediatric and obstetrical procedures, and complex minimally invasive robotically assisted cardiac and urological operations. As part of its commitment to care for the critically-ill patients, BMC has perioperative services available 24/7, 365 days a year for all ill and injured patients and of the 20,000 annual cases approx. 15-20% are urgent/emergent cases.