Browsing by Author "Menard, Laura"

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    Damage Control Thoracotomy: A Systematic Review of Techniques and Outcomes
    (Elsevier, 2021-05) Douglas, Anthony, II; Puzio, Thaddeuss; Murphy, Patrick; Menard, Laura; Meagher, Ashley D.; Surgery, School of Medicine
    Background : Damage control surgery is the practice of delaying definitive management of traumatic injuries by controlling hemorrhage in the operating room and restoring normal physiology in the intensive care unit prior to definitive therapy. Presently, damage control or “abbreviated” laparotomy is used extensively for abdominal trauma in an unstable patient. The application of a damage control approach in thoracic trauma is less established and there is a paucity of literature supporting or refuting this practice. We aimed to systematically review the current data on damage control thoracotomy (DCT), to identify gaps in the literature and techniques in temporary closure. Methods : An electronic literature search of Pubmed, MEDLINE, and the Cochrane Database of Collected Reviews from 1972-2018 was performed using the keywords “thoracic,” “damage control,” and “thoracotomy.” Studies were included if they reported the use of DCT following thoracic trauma and included survival as an outcome. Results : Of 723 studies, seven met inclusion criteria for a total of a 130 DCT operations. Gauze packing with temporary closure of the skin with suture was the most frequently reported form of closure. The overall survival rate for the seven studies was 67%. Survival rates ranged from 42-77%. Average injury severity score was 30, and 64% of injuries were penetrating in nature. The most common complications included infections (57%; pneumonia, empyema, wound infection, bacteremia), respiratory failure (21%), ARDS (8%), and renal failure (18%). Conclusion : DCT may be associated with improved survival in the critically injured patient population. Delaying definitive operation by temporarily closing the thorax in order to allow time to restore normal physiology may be considered as a strategy in the unstable thoracic trauma patient population. The impact an open chest has on respiratory physiology remains inconclusive as well as best mechanisms of temporary closure. Multi-center studies are required to elucidate these important questions.
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    Heavy metals and neurodevelopment of children in low and middle-income countries: A systematic review
    (PLOS, 2022-03-31) Heng, Yi Yan; Asad, Iqra; Coleman, Bailey; Menard, Laura; Benki-Nugent, Sarah; Were, Faridah Hussein; Karr, Catherine J.; McHenry, Megan S.; Pediatrics, School of Medicine
    Background: The presence of harmful environmental exposures, which disproportionately affects low-and-middle income countries (LMICs), contributes to >25% of deaths and diseases worldwide and detrimentally affects child neurodevelopment. Few resources succinctly summarize the existing literature on this topic. Our objective is to systematically review and characterize the evidence regarding the relationship between heavy metals and neurodevelopment of children in LMICs. Methods: We conducted a medical librarian-curated search on multiple online databases to identify articles that included individuals <18 years living in a LMIC, quantitatively measured exposure to a heavy metal (either prenatal or postnatal), and used a standardized measurement of neurodevelopment (i.e. cognitive, language, motor, and behavior). Reviews, editorials, or case studies were excluded. Results were analyzed qualitatively, and quality was assessed. Results: Of the 18,043 screened articles, 298 full-text articles were reviewed, and 100 articles met inclusion criteria. The included studies represented data from 19 LMICs, only one of which was classified as a low-income country. Ninety-four percent of postnatal lead and all postnatal manganese studies showed a negative association with metal exposure and neurodevelopment, which were the strongest relationships among the metals studied. Postnatal exposure of mercury was associated with poor neurodevelopment in only half of studies. Limited data on postnatal arsenic and cadmium suggests an association with worse neurodevelopment. Findings were mixed for prenatal arsenic and lead, although some evidence supports that the neurotoxicity of lead was amplified in the presence of manganese. Conclusions and potential impact: We found that lead and manganese appear to consistently have a detrimental effect on the neurodevelopment of children, and more evidence is needed for mercury, arsenic, and cadmium. Better characterization of these effects can motivate and inform prioritization of much needed international policies and programs to reduce heavy metal exposures for young children within LMICs.
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    Optimal Timing of Venous Thromboembolic Chemoprophylaxis Initiation Following Blunt Solid Organ Injury: Meta-Analysis and Systematic Review
    (2021-04-22) Murphy, Patrick; de Moya, Marc; Karam, Basil; Menard, Laura; Holder, Erik; Inaba, Kenji; Schellenberg, Morgan
    PURPOSE: The need to prevent venous thromboembolism (VTE) following blunt solid organ injury must be balanced against the concern for exacerbation of hemorrhage. The optimal timing for initiation of VTE chemoprophylaxis is not known. The objective was to determine the safety and efficacy of early (≤48 hours) VTE chemoprophylaxis initiation following blunt solid organ injury. METHODS: An electronic search was performed of medical libraries for English-language studies on timing of VTE chemoprophylaxis initiation following blunt solid organ injury published from inception to April 2020. Included studies compared early (≤48 hours) versus late (>48 hours) initiation of VTE chemoprophylaxis in adults with blunt splenic, liver and/or kidney injury. Estimates were pooled using random-effects meta-analysis. Odds ratios were utilized to quantify differences in failure of nonoperative management, need for blood transfusion and rates of VTE. RESULTS: The search identified 2,111 studies. Of these, ten studies comprising 14,675 patients were included. All studies were non-randomized and only one was prospective. The overall odds of failure of nonoperative management were no different between early and late groups, OR 1.09 (95%CI 0.92-1.29). Similarly, there was no difference in the need for blood transfusion either during overall hospital stay, OR 0.91 (95%CI 0.70-1.18), or post prophylaxis initiation, OR 1.23 (95%CI 0.55-2.73). There were significantly lower odds of VTE when patients received early VTE chemoprophylaxis, OR 0.51 (95%CI 0.33-0.81). CONCLUSIONS: Patients undergoing nonoperative management for blunt solid organ injury can be safely and effectively prescribed early VTE chemoprophylaxis. This results in significantly lower VTE rates without demonstrable harm.
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    Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review
    (Springer, 2022-09-18) Murphy, Patrick B.; de Moya, Marc; Karam , Basil; Menard, Laura; Holder, Erik; Inaba, Kenji; Schellenberg, Morgan; Library and Information Science, Luddy School of Informatics, Computing, and Engineering
    Purpose: The need to prevent venous thromboembolism (VTE) following blunt solid organ injury must be balanced against the concern for exacerbation of hemorrhage. The optimal timing for initiation of VTE chemoprophylaxis is not known. The objective was to determine the safety and efficacy of early (≤ 48 h) VTE chemoprophylaxis initiation following blunt solid organ injury. Methods: An electronic search was performed of medical libraries for English language studies on timing of VTE chemoprophylaxis initiation following blunt solid organ injury published from inception to April 2020. Included studies compared early (≤ 48 h) versus late (> 48 h) initiation of VTE chemoprophylaxis in adults with blunt splenic, liver, and/or kidney injury. Estimates were pooled using random-effects meta-analysis. Odds ratios were utilized to quantify differences in failure of nonoperative management, need for blood transfusion and rates of VTE. Results: The search identified 2,111 studies. Of these, ten studies comprising 14,675 patients were included. All studies were non-randomized and only one was prospective. The overall odds of failure of nonoperative management were no different between early and late groups, OR 1.09 (95%CI 0.92-1.29). Similarly, there was no difference in the need for blood transfusion either during overall hospital stay, OR 0.91 (95%CI 0.70-1.18), or post prophylaxis initiation, OR 1.23 (95%CI 0.55-2.73). There were significantly lower odds of VTE when patients received early VTE chemoprophylaxis, OR 0.51 (95%CI 0.33-0.81). Conclusions: Patients undergoing nonoperative management for blunt solid organ injury can be safely and effectively prescribed early VTE chemoprophylaxis. This results in significantly lower VTE rates without demonstrable harm.
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    Pesticides and neurodevelopment of children in low and middle-income countries: A systematic review
    (Public Library of Science, 2025-06-11) Coleman, Bailey; Asad, Iqra; Heng, Yi Yan; Menard, Laura; Hussein Were, Faridah; Thomas, Melissa R.; Karr, Catherine J.; McHenry, Megan S.; Pediatrics, School of Medicine
    Background: Pesticides are increasingly common in low- and middle-income countries (LMICs), where weaker regulations and multiple risk factors for poor neurodevelopment exist. Due to biological and behavioral factors, children are vulnerable to chronic pesticide exposure at a time when brain development is critical. The objective of this study is to systematically review studies assessing pesticides use with child neurodevelopment in LMICs. Methods: Using terms developed by a medical librarian, a search was performed in June 2023 across online databases, including OVID MEDLINE and EMBASE. For inclusion, studies required a measurement of pesticide exposure and neurodevelopmental outcomes using a standardized tool and study participants ≤18 years within an LMIC, as determined by World Bank criteria. Descriptive analyses were performed using extracted data, including published outcomes of significance. Results were assessed for internal validity and reported by the method of exposure measurement (biomarkers or questionnaires/region of residence). Results: A total of 31 studies spanning 11 LMICs met the inclusion criteria. An adverse association was found between pesticide exposure and at least one domain of neurodevelopment in 23 studies, including 12 studies with child-level measurements, 10 studies with maternal measurements in pregnancy, and one questionnaire-based study. Exposure to organochlorines, carbamates, chlorpyrifos, and fungicides were consistently associated with worse outcomes for neurodevelopment, specifically executive functioning, cognition, motor development, and behavior. Few studies found adverse associations with urine/serum organophosphate levels. Due to the heterogeneity of existing data, we were unable to quantify the relationship between pesticide exposure and neurodevelopment. Conclusions: While studies suggest that some domains of neurodevelopment may be negatively associated with pesticide exposure, extrapolation is limited due to the challenges in measuring pesticide exposure within these contexts and differing study designs. Several research gaps must be addressed to develop policy and regulations that protect children from potential neurodevelopmental deficits associated with pesticide exposure.
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    Treatment of asymptomatic blunt cerebrovascular injury (BCVI): a systematic review
    (BMJ, 2021-04-26) Murphy, Patrick B.; Severance, Sarah; Holler, Emma; Menard, Laura; Savage, Stephanie; Zarzaur, Ben L.; Surgery, School of Medicine
    Background: The management of asymptomatic blunt cerebrovascular injury (BCVI) with respect to stroke prevention and vessel healing is challenging. Objectives: The aim of this systematic review was to determine if a specific treatment results in lower stroke rates and/or improved vessel healing in asymptomatic BCVI. Data sources: An electronic literature search of MEDLINE, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science, and ClinicalTrials.gov performed from inception to March 2020. Study eligibility criteria: Studies were included if they reported on a comparison of any treatment for BCVI and stroke and/or vessel healing rates. Participants and interventions: Adult patients diagnosed with asymptomatic BCVI(s) who were treated with any preventive medication or procedure. Study appraisal and synthesis methods: All studies were systematically reviewed and bias was evaluated by the Newcastle-Ottawa Scale. No meta-analysis was performed secondary to significant heterogeneity across studies in patient population, screening protocols, and treatment selection. The main outcomes were stroke and healing rate. Results: Of 8781 studies reviewed, 19 reported on treatment effects for asymptomatic BCVI and were included for review. Any choice of medical management was better than no treatment, but no specific differences between choice of medical management and stroke outcomes were found. Vessel healing was rare and the majority of healed vessels were following low-grade injuries. Limitations: Majority of the included studies were retrospective and at high risk of bias. Conclusions or implications of key findings: Asymptomatic BCVI should be treated medically using a consistent, local protocol. High-quality studies on the effect of individual antithrombotic agents on stroke rates and vessel healing for asymptomatic BCVI are required.