Sawyer, Mark D.

The rapid adoption of telemedicine has transformed healthcare delivery in the US, enhancing access and communication for surgical patients across wide geographic areas. However, a critical challenge persists: the need to define and standardize quality metrics specifically for telemedicine in surgery. Existing studies suggest that telemedicine can yield equivalent or improved outcomes compared with in-person visits. Nevertheless, literature remains limited in evaluating patient satisfaction, cost-effectiveness, and diagnostic accuracy. Through expert consensus within the American College of Surgeons Board of Governors Telehealth Pillar, we propose a structured framework for defining and implementing quality metrics for surgical telemedicine. This is based on the Donabedian model, addressing structure, process, and outcome, while also considering the distinct phases of surgical care: preoperative, intraoperative, and postoperative. This framework identifies unique domains of telemedicine in surgical care, emphasizing hospital and organizational structure, patient and provider readiness, and policy alignment. A comparative analysis with existing AHRQ and WHO frameworks highlights gaps in surgical applicability. Finally, we propose an implementation roadmap prioritizing immediate, feasible metrics while identifying areas for future validation. Collaboration among researchers, clinicians, and policymakers will be essential to establish these metrics and ensure that telemedicine delivers on its potential to improve surgical care delivery while addressing disparities in access and outcomes.

Tigers, as well as other large predators, are being held in private settings with increasing frequency. Unregulated private “zoos” are cropping up in many rural and suburban settings across the country. The number of attacks from captive predators also is on the rise. This case highlights the potentially violent and aggressive nature of wild animals held in captivity. Treatment principals and wounding patterns of large cat attacks are emphasized.

AbstractBackgroundThe aim is to study the safety of Angioembolization on long-term sexual function and quality of life.MethodsIRB approval was gained to review the prospectively collected trauma database as well as prospective questionnaires of patients at least 1 year out from pelvic fractures that occurred between 1996 and 2009. Surveys included the SF36v2, Female Sexual Function Index and the International Index of Erectile Function. Values for each domain were compared between patients treated with AE and 2:1 case-matched control patients as well as between the national norms. Values are presented as percentages or means with 95 % CI. P < 0.05 was considered statistically significant.ResultsThirty Seven cases and 74 matched controls were identified. 42 patients completed the survey. There were 13 cases (12 males), and 29 controls (22 males). There was a higher ISS (Injury Severity Score) (32 vs 27; p = 0.048) in the cases, but no difference in pelvic AIS (Abbreviated Injury Severity Score) (3 vs 3). Both groups scored similarly in the SF36 in all domains, but the entire cohort scored lower than the national norms in the physical functioning (41.9 (37.8–46.0) vs50), role physical (40.9 (36.2–45.7) vs50), body pain 43.8 (40.7–46.9) vs50), role emotional 46.3 (42.8–49.8) vs50), and physical composite score (42.1 (38.0–46.3) vs50). All domains of the sexual function in both questionnaires showed significant impairment in our cohort compared with norms. Male cases had similar scores to the controls.ConclusionPelvic fractures portend a worse long-term QOL and sexual function than the general population. AE, however, does not have an additive affect to these indices.