Food Security: An Unmet Need in Outpatient Burn Care.

Nutrition is paramount for wound healing after burn injury. With rising food prices and time off work due to burn injuries, access to adequate nutrition may be a significant financial stressor. We asked patients at an outpatient burn clinic to complete the Household Food Security Module, which queries about food security over the preceding 12 months. Demographics and burn characteristics were abstracted from the medical record. We assessed the overall prevalence of food insecurity, risk factors for food insecurity, and potential effects of food insecurity on nutritional status and wound healing time. Wound healing time was assessed via Cox regression while adjusting for burn depth, total body surface area burned, and diabetes. Over 40% of participants reported experiencing food insecurity; it was more common in patients who preferred Spanish language (p=0.014) or were unemployed (p=0.049). Just over half of participants experiencing food insecurity were using any food assistance resources. Among patients more than 30 days from burn injury, patients who were food insecure had larger burns (p=0.01). Experience of food insecurity was not associated presence of malnutrition on nutrition-focused physical exam (p=0.47). Wound healing time for burns managed in the outpatient setting was associated with burn depth (p<0.001), but not food insecurity (p=0.95), burn size (p=0.17), or diabetes (p=0.14). Although food insecurity did not result in malnutrition or negatively impact wound healing time, it is important for providers to routinely screen for food insecurity due to increased nutritional requirements and loss of wages after burn injury.

The Effects of Cannabis: Implications for the Surgical Patient.

Cannabis use is increasingly prevalent. Cannabinoid receptors regulate pro-inflammatory cytokines, and compounds in marijuana exert diverse physiologic effects. As more patients use cannabis, clinicians should recognize implications of perioperative cannabis use. Although the role of cannabis use in perioperative pain control has been explored, little is known about its effect on perioperative wound healing or on hematologic, pulmonary, and cardiovascular physiology. METHODS: We searched PubMed for English-language articles related to cannabis (ie, marijuana, cannabidiol oil, and tetrahydrocannabinol) and wound healing, cardiovascular, pulmonary, or hematologic outcomes, and surgery. Titles and abstracts were reviewed, and relevant articles were analyzed. Human, animal, and pathology studies were included. Editorials, case reports, and review articles were excluded. RESULTS: In total, 2549 wound healing articles were identified; 5 human studies and 8 animal/pathology studies were included. Results were conflicting. An estimated 2900 articles related to cardiovascular effects were identified, of which 2 human studies were included, which showed tetrahydrocannabinol and marijuana caused tachycardia. A total of 142 studies regarding pulmonary effects were identified. Three human studies were included, which found no difference in respiratory complications. In total, 114 studies regarding hematologic effects were identified. The 3 included human studies found conflicting venous thromboembolism risks. The overall study quality was poor. Information about dose/duration, administration route, and follow-up was reported with variable completeness. CONCLUSIONS: Surgeons should consider effects of cannabis in the perioperative setting. Little is known about its perioperative effects on wound healing, or on cardiovascular, pulmonary, and hematologic physiology. Further research should elucidate the effects of administration route, dose, and timing of cannabis use among surgical patients.

AAMC Data Shows Effect of Surgery Faculty Diversity on General Surgery Resident Attrition Rate at Programs Sponsored by LCME-Accredited Medical Schools.

OBJECTIVE: General surgery resident (GSR) 5-year attrition rates of 12% to 20% are currently reported. This study explores the impact of full-time surgery faculty (FSF) diversity on GSR attrition. DESIGN: Deidentified data were obtained from the Association of American Medical Colleges (AAMC) for FSF at US Liaison Committee on Medical Education (LCME)-accredited medical schools and GSR at the affiliated general surgery residency programs (2001-2016). Data included annual GSR attrition rate and the number, gender, and race of FSF and GSR. Data were analyzed using linear and logarithmic regression. SETTING: The study was conducted at the University of Miami Leonard M. Miller School of Medicine in Miami, Florida. PARTICIPANTS: The data obtained included FSF from US LCME-accredited medical schools and GSR from those residency programs affiliated with US LCME-accredited medical schools. Data were included only if available for both FSF and GSR at a single institution. There were 107,300 annual FSF positions and 39,504 annual GSR positions from 61 U.S. LCME-accredited medical schools included in the analysis. RESULTS: Data included 107,300 FSF positions (26% non-white; 20% female) and 39,504 GSR positions (41% non-white; 33% female) summed across 1034 institution years. Increased female FSF is associated with decreased GSR attrition (R2 = 0.009, p = 0.002, Fig. 1). For every 1% increase in female FSF, GSR programs were 4% less likely to have an attrition rate in the top quartile (odds ratio 0.96, confidence interval 0.94-0.98). CONCLUSIONS: Gender diversity of FSF has an impact on GSR attrition; more female FSF correlates with lower GSR attrition rates.