Publications by authors named "Mary Aaland"

13 Publications

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Appendectomy on Board a Submarine by a Pharmacist's Mate Under the South China Sea During World War II.

Am Surg 2021 Jun 1:31348211023422. Epub 2021 Jun 1.

Department of Surgery, University of North Dakota School of Medicine, Grand Forks, ND, USA.

A historical review and case report of the first appendectomy ever performed on a submarine 120 feet below sea level and far behind enemy lines during World War II. This case history will be told uniquely from the perspective of a modern-day rural surgeon with an emphasis on the extraordinary leadership, teamwork, and heroism of the endeavor. All health care providers and administrators are in desperate need of these qualities to successfully unite, navigate, and conquer the attacks on today's health care system.
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http://dx.doi.org/10.1177/00031348211023422DOI Listing
June 2021

Scope of Practice of the Rural Surgeon.

Surg Clin North Am 2020 Oct 15;100(5):861-868. Epub 2020 Jul 15.

Department of Surgery, University of North Dakota, Grand Forks, ND, USA. Electronic address:

The scope of practice of a rural surgeon depends not only the individual skillset of the surgeon, but also local resources.
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http://dx.doi.org/10.1016/j.suc.2020.06.002DOI Listing
October 2020

M1 Macrophage Polarization Is Dependent on TRPC1-Mediated Calcium Entry.

iScience 2018 Oct 20;8:85-102. Epub 2018 Sep 20.

Department of Biomedical Sciences and Department of Surgery, School of Medicine & Health Sciences, The University of North Dakota, 1301 N Columbia Road, Grand Forks, ND 58202, USA. Electronic address:

Macrophage plasticity is essential for innate immunity, but in-depth signaling mechanism(s) regulating their functional phenotypes are ill-defined. Here we report that interferon (IFN) γ priming of naive macrophages induces store-mediated Ca entry and inhibition of Ca entry impairs polarization to M1 inflammatory phenotype. In vitro and in vivo functional analyses revealed ORAI1 to be a primary contributor to basal Ca influx in macrophages, whereas IFNγ-induced Ca influx was mediated by TRPC1. Deficiency of TRPC1 displayed abrogated IFNγ-induced M1 inflammatory mediators in macrophages. In a preclinical model of peritonitis by Klebsiella pneumoniae infection, macrophages showed increased Ca influx, which was TRPC1 dependent. Macrophages from infected TRPC1 mice showed inhibited expression of M1-associated signature molecules. Furthermore, in human patients with systemic inflammatory response syndrome, the level of TRPC1 expression in circulating macrophages directly correlated with M1 inflammatory mediators. Overall, TRPC1-mediated Ca influx is essential for the induction/shaping of macrophage polarization to M1 inflammatory phenotype.
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http://dx.doi.org/10.1016/j.isci.2018.09.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174824PMC
October 2018

The lost to trauma patient follow-up: a system or patient problem.

J Trauma Acute Care Surg 2012 Dec;73(6):1507-11

Department of Surgery, University of North Dakota, Grand Forks, North Dakota, USA.

Background: The objective of this study was to explore the reasons for trauma patients' failure to follow up at a trauma clinic (TC).

Methods: A 1-year retrospective analysis was conducted on those trauma services patients (n = 799) who were discharged from Parkview Hospital in 2009. Hospital electronic medical records were examined to identify variables of interest; telephone interviews were attempted on those patients who failed to follow up (FTF); and calls were made to the offices of involved subspecialist (SS) to determine if any follow-up had occurred. Data analysis was performed by Microsoft Excel and SPSS.

Results: Two hundred thirty-three patients were identified as having FTF in the TC. Patient or external factors caused a follow-up loss for 147 patients (63.1%), and 44% of them did have a follow-up with an SS. Hospital or internal factors resulted in 86 patients (36.9%) being FTF, and 43% of them were seen by an SS. The physician compliance rate per policy was 89.2% (713 of 799). The patient compliance rate at TC follow-up was 79.3% (566 of 713). The total patient compliance rate both at the TC and SS follow-up was 87.2% (669 of 767). No significant demographic differences in age, sex, Injury Severity Scores, hospital payment status, or distance from the hospital were noted between those patients who had FTF in the external or internal factor groups. Of the 130 patients who had no follow-up, 39% did meet follow-up criteria.

Conclusion: Only 10.8% of the trauma patients who had appointments for any posttrauma follow-up had FTF, implying that the patient is not the reason for FTF but that FTF is a system issue. With improved patient education on the day of hospital discharge and improved physician discharge orders, trauma patient follow-up could approach 100%.

Level Of Evidence: Epidemiologic study, level III.
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http://dx.doi.org/10.1097/TA.0b013e31826fc928DOI Listing
December 2012

Readmission of trauma patients in a nonacademic Level II trauma center.

J Trauma Acute Care Surg 2012 Feb;72(2):531-6

Indiana University School of Medicine, Indianapolis, IN, USA.

Background: Readmission of trauma patients has been identified as a quality indicator for trauma care. Few if any studies on this topic can be found from a nonacademic trauma center. The objectives of the study were to determine the rate, cause, and preventability for readmission and to identify predictors of readmission in a nonacademic trauma center.

Methods: Cases registered from 2007 to 2009 were identified from trauma registry. A retrospective chart review of 98 readmission trauma patients was done to elicit the complications and outcomes. Criteria were selected to elicit preventability of readmissions.Predictors for readmission were identified by using a logistic regression analysis.

Results: Of 4,986 patients, 98 (1.96%) required readmission due to wound (23.47%), abdominal (16.33%), thromboembolic (4.08%),central nervous system (21.43%), hematoma (5.10%), and pulmonary (7.14%) complications. Among all readmission cases,surgery was performed in 38.78%, days to readmission was 19.44 ± 8.80, and six patients experienced a readmission chain.Penetrating injury, Injury Severity Score 25, and hospital length of stay were predictors of readmission. 90.82% of the trauma readmissions were trauma related and 15% were potentially preventable readmissions. Fifty-three percent of the readmissions occurred before a follow-up appointment.

Conclusions: The incidence of readmissions was similar to published data from academic trauma centers, but the reason for readmission and the need for surgery at readmission were very different. Potentially preventable readmissions have not been well addressed in literature. Therefore, further multicenter studies that include nonacademic trauma centers are needed to analyze this complicated problem.
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http://dx.doi.org/10.1097/ta.0b013e3182326172DOI Listing
February 2012

The reliability of nonreconstructed computerized tomographic scans of the abdomen and pelvis in detecting thoracolumbar spine injuries in blunt trauma patients with altered mental status.

J Bone Joint Surg Am 2009 Oct;91(10):2342-9

Trauma Services, Parkview Hospital, 2200 Randallia Drive, Fort Wayne, IN 46805, USA.

Background: Computerized tomography, traditionally utilized to evaluate and detect visceral abdominal and pelvic injuries in multiply injured patients with altered mental status, also has been useful for detecting thoracolumbar spine fractures and dislocations. The purpose of the present study was to test the reliability of nonreconstructed computerized tomography of the abdomen and pelvis as a screening tool for thoracolumbar spine injuries in blunt trauma patients with altered mental status.

Methods: The study consisted of fifty-nine consecutive patients with altered mental status who were admitted to a Level-II trauma center. Each patient had a nonreconstructed computerized tomographic scan of the abdomen and pelvis (5-mm slices), and of the chest when indicated, as well as anteroposterior and lateral radiographs of the thoracolumbar spine. Reconstructed computerized tomographic scans dedicated to the spine (< or =2-mm slices) were completed. With use of the reconstructions as the gold standard, sensitivity and specificity with 95% confidence intervals were calculated to assess the diagnostic accuracy of using the nonreconstructed computerized tomographic scans and the radiographs.

Results: Reconstructions of the spine detected seventy-two thoracolumbar spine fractures, whereas nonreconstructed computerized tomographic scans of the abdomen and pelvis detected fifty-eight and those of the chest detected sixteen. With use of the reconstructions as the standard, computerized tomography of the chest, abdomen, and pelvis had a sensitivity of 89% (95% confidence interval, 65% to 96%) and a specificity of 85% (95% confidence interval, 65% to 96%) for the detection of all fractures, compared with 37% and 76% for plain radiographs, respectively. Computerized tomography of the chest, abdomen, and pelvis was 100% sensitive and specific for the detection of whether a patient had any fracture at all, whereas radiographs were 54% sensitive and 86% specific. No fractures that were missed on nonreconstructed computerized tomography required surgery or other interventions.

Conclusions: Nonreconstructed computerized tomography detected fractures of the thoracolumbar spine more accurately than plain radiographs did and is recommended for the diagnosis of thoracolumbar spine fractures in acute trauma patients with altered mental status. Reconstructions do not need to be ordered unless an abnormality that is found on the nonreconstructed computerized tomographic scan needs additional elucidation.
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http://dx.doi.org/10.2106/JBJS.H.01304DOI Listing
October 2009

Ten-year retrospective study of delayed diagnosis of injury in pediatric trauma patients at a level II trauma center.

Pediatr Emerg Care 2009 Aug;25(8):489-93

Fort Wayne Medical Education Program, 10107 Lake Tahoe Ct., Fort Wayne, IN 46804, USA.

Background: Published rates of delayed diagnosis of injury (DDI) in pediatric trauma vary from 1.0% to 18%. The purpose of this study was to determine the long-term trend of DDI over 10 years, to identify risk factors associated with DDI, and to elucidate patterns of DDI.

Methods: All patients aged 14 and younger who were admitted to Parkview Hospital for major trauma between January 1, 1997 and December 31, 2006 were included (1100 patients). Data were collected from a trauma registry that is maintained of all trauma admissions.

Results: A total of 47 delayed diagnoses of injury were found in 44 patients for a rate of 4.0%. Patients with a DDI were more likely to have been intubated in the emergency department, transported by air, have an Injury Severity Score greater than 15, and have a Glasgow Coma Scale below 8 (P < 0.05). Mean intensive care unit and overall length of stay was longer in the DDI group. Missed injuries resulted in a change in therapy in 80% of cases. There were 5 missed intra-abdominal injuries, 4 of which required surgery. Three injuries were discovered upon outpatient follow-up. There was a trend for more missed upper extremity injuries in older patients and missed lower extremity injuries in younger patients.

Conclusions: The rate of missed injuries remained relatively constant over the past 10 years at our institution. More severely injured patients are more likely to have missed injuries. Special attention to the lower extremities of the younger trauma patient may be warranted.
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http://dx.doi.org/10.1097/PEC.0b013e3181b0a07dDOI Listing
August 2009

Trauma registry data validation: Essential for quality trauma care.

J Trauma 2006 Dec;61(6):1400-7

Background: The main function of a trauma registry is to assess quality assurance and performance improvement (QA/PI) in an individual institution. Nonvalidated registry data may produce unreliable reports and QA/PI information. This study examines the types of data entry errors in a trauma registry database; the effect of errors on time variable estimates, case ascertainment and statistical measurement; dynamics of error occurrence; and data validation (DV) scheme for a trauma registry.

Methods: Query and cross-tabulation techniques were used to expose a variety of data entry errors. Conceptual aspect for each type of error in DV, especially with respect to QA/PI, is given.

Results: Findings of different errors are provided: out-of-range time values; false positive and false negative errors; errors of commission and omission; duplication errors; errors in demographics; and errors because of inconsistent and incongruent coding. Error rates were less than 3% in commonly occurring data, such as scene time, demographics, hospital discharge and transportation, and greater in less commonly occurring but important data, such as thoracic aorta injury (9.5%) and audit filter for admit Glasgow Coma Scale in emergency department (55.6%). Dynamics of error occurrence that can prevent or minimize errors is described. The main features of a data validation scheme are displayed.

Conclusions: Errors in a trauma registry database cause invalid frequencies, rates, time estimates and statistical measures and affect QA/PI in trauma care. Every functioning trauma registry should develop an on-going program for DV.
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http://dx.doi.org/10.1097/01.ta.0000195732.64475.87DOI Listing
December 2006

Discharging to a nursing home: not a terminal event--a follow-up study of senior motor vehicle crash patients.

Am Surg 2006 Sep;72(9):815-9; discussion 819-20

Parkview Hospital, Trauma Services, Fort Wayne, Indiana 46805, USA.

Discharge to a nursing home (NH) because of chronic debilitating diseases or old age is generally a terminal event. The purpose of this study was to evaluate the NH outcome of senior citizens injured in motor vehicle crashes (MVC) discharged to a NH. From 2000 through 2004, 157 patients 75 years and older were admitted to the hospital for MVC. Of these, 32 patients were discharged to a NH, and these patients or their proxies were interviewed by telephone in June 2005 to request information as to driving status before and after the MVC, feeding, expression, and locomotion status, and/or date of death. After discharged from the NH, 72 per cent (23/32) of the patients lived at home, 52.2 per cent (12/23) among the drivers returned to drive, and those with functional impairments (excluding the five NH deaths and four still remaining in a NH) at the time of hospital discharge had 100 per cent or partial improvement in three functional independent measures at the time of the interview: 5 cases in feeding, 2 in expression, and 20 in locomotion. Eleven of the 20 individuals dependent or partially dependent in locomotion status were fully independent. The majority of the senior patients discharged to a NH after a MVC returned to a normal life by going back home, driving again, and regaining functional activities after NH discharge. Discharge to a NH for elderly MVC trauma patients may be regarded as a stepping-stone to independent living rather than a final resting place.
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September 2006

Pediatric trauma deaths: a three-part analysis from a nonacademic trauma center.

Am Surg 2006 Mar;72(3):249-59

Parkview Hospital, Trauma Services, Fort Wayne, Indiana 46805, USA.

A three-part analysis was undertaken to assess pediatric trauma mortality in a nonacademic Level II trauma center at Parkview Hospital in Fort Wayne, Indiana. Part I was a comparison of Parkview trauma registry data collected from 1999 through 2003 with those of pediatric and adult trauma centers in Pennsylvania. The same methodology used in Pennsylvania was used for the initial evaluation of pediatric deaths from trauma in our trauma center. Part II was a formal in-depth analysis of all individual pediatric deaths as well as surgical cases with head, spleen, and liver injuries from the same time frame. Part III proposes a new methodology to calculate a risk-adjusted mortality rate based on the TRISS model for the evaluation of a trauma system. The use of specific mortality and surgical intervention rates was not an accurate reflection of trauma center outcome. The proposed risk-adjusted mortality rate calculation is perhaps an effective outcome measure to assess patient care in a trauma system.
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March 2006

Amish buggy injuries in the 21st century: A retrospective review from a rural level II trauma center.

Am Surg 2004 Mar;70(3):228-34; discussion 234

Parkview Hospital, Fort Wayne, Indiana 46805, USA.

Horse-drawn buggies are rarely used in modern society except among certain religious groups. Northeastern Indiana has one of the largest populations of one such group: the Amish. Although there are papers written about the incidence of buggy crashes, no paper has specifically addressed the specific types of injuries sustained when buggies collide with motorized vehicles. This paper reviews the types of injuries sustained when such events occur.
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March 2004
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