New Mexico Trauma System Funding Strategy

Trauma is the leading cause of death among individuals 1 to 44 years of age. Nationally, one individual dies of traumatic injuries every three minutes. In the United States, the financial impact of trauma is estimated to be approximately $671 billion annually, spent on direct trauma care and associated costs, such as loss in productive days and rehabilitation. The New Mexico trauma system registered dramatic development over the past 10 years. In 2007, the state had only three designated trauma centers, and today there are 12. However, over the same period, trauma system funding registered an equally dramatic decrease of approximately 70%. Having a functional trauma system in New Mexico is an absolute necessity. The purpose of this project was to identify potential sources of sustainable revenue for the New Mexico’s trauma system and to take the initial steps towards introducing legislation that will secure trauma system funding for the future. The work on this project resulted in initiating the first legislative step of this process

Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results