Have you ever wondered about the first surgeons who operated on patients without anesthesia on fully conscious patients, screaming in excruciating agony and being held captive by their assistants? Fortunately, substances were being discovered that can cause pain when not felt. This manuscript will summarize the following first attempts at painless surgery.

Dr James Barry was born Margaret Ann Bulkley around 1789 in Cork, Ireland, at a time when women were barred from most formal education and were certainly not allowed to practice medicine. Barry had hoodwinked Edinburgh University, the Royal College of Surgeons, and the British Army to become the first female doctor in the United Kingdom. She had masqueraded as a man in a life-long deception of breathtaking proportions. A renowned military surgeon, she rose to become inspector general of hospitals, one of the highest army medical posts. She created strict new hygiene standards, an improved diet for patients, and new medicines for syphilis and gonorrhea. She worked diligently to improve the welfare of commoners and slaves wherever she encountered them and arranged for a better water system for Cape Town. However, her biggest accomplishments occurred while stationed in South Africa (1826), where she performed a cesarean section (C-section) recorded as the “first known case of a British surgeon performing the procedure with both the mother and child surviving.” It was remarkable at the time, as C-sections were still a rarity, performed to save the baby only when it looked like the mother wasn't going to make it. The child, a boy, was named after “Barry.” When Dr James Barry died in 1865, she became infamous. By all accounts, she had led a colorful life. Yet all these eccentricities were nothing compared to the revelations that emerged on Barry's death. For the brilliant Dr Barry was, in fact, a woman. The charwoman who washed the body discovered “he” was “a perfect female” and furthermore surmised from stretch marks on the abdomen—that she had once given birth. The doctor who signed Barry's death certificate said it was “none of my business” whether Barry was male or female, and perhaps he was right. Dr Barry's story is of a brilliant physician, a woman ahead of her time, yet one of a scandalous subterfuge somewhat unprecedented in modern history.

Aims and background: The epidemic of youth violence is sweeping the nation and has become a public health crisis. The impact of hospital-based interventions on risk (violent attitudes and behaviors) and protective factors [attitudes toward school (ATS) and attitudes toward employment (ATE)] remains unknown. This study will assess changes in attitudes toward violence (ATV) in response to a hospital-based brief violence intervention (BVI) and community case management services (CCMS). Materials and methods: Youths (10–24 years) who were intentionally injured and admitted to a level 1 trauma center were prospectively randomly assigned to BVI alone (group I) or in combination with BVI + CCMS (group II). Recidivism, ATV, triggers for fighting (TFF), ATS, ATE, and future aspirations (FAs) were assessed at baseline (BsL) during admission, 6 weeks (6W), and 6 months (6M) postdischarge. Results: A total of 75 injured patients were enrolled. The groups did not significantly differ in demographics or injuries. Around 21% of the participants reported having a history of violent recidivism. ATS improved from 64% BsL to 81% 6W (p = 0.14) and 92% 6M (p = 0.07). ATV improved from 68% BsL to 79% at 6W (p = 0.0061) and (78%) at 6M (p = 0.0199). TFF was transiently decreased (<50%) at 6W, returning back to BsL (>50%) at 6M. ATE was high, >90% at all levels. The hospital experience was associated with a positive change in future outlook and aspirations in 70 to 80% (group I 75% and group II 78%) at all time periods. Conclusion and clinical significance: Hospital BVI has a positive impact on youths’ perception of and vulnerability to violence while promoting protective factors.

Aims and background: Intentional violence is a public health crisis requiring an urgent and innovative response. Prior to 2019, there was only one hospital-based violence intervention program (HVIP) in Virginia. The rise in gun violence in recent years underscored the urgent need to expand beyond a one-center approach into a regional approach to violence through a network of HVIPs. This study notes the early feasibility and implementation of the regionalization of HVIPs across competing health systems. Materials and methods: In collaboration with several partners, an evidence-based HVIP program led a technical assistance center (TAC) and conducted site visits across nine facilities in three health systems. This was followed by a systematic, combined, regional-based approach to HVIP development. Data from each facility were collected prospectively, with point-of-care feedback given during site visits and weekly coaching sessions. Results: Between July 2019 and June 2021, program development support from TAC included six collective seminars, 151 coaching sessions, and 67 weekly meetings with program faculty and stakeholders. HVIPs were established in nine facilities during this time, and 2,259 patients were enrolled. Over half of patients were African American (64%) and between the ages 18 and 59 (77%). Around 60 and 17% were secondary to assault and domestic violence (DV), respectively. The most common services used were information and referrals (100%) and emotional support and/or safety planning (72%). Conclusion and clinical significance: The use of a well-established HVIP as a TAC could serve as an effective model for regionalization of violence intervention efforts, which is the next logical step in mitigating the impact of violence.

Aims and background: Interpersonal violence poses significant health and social challenges. This study examines trends in interpersonal physical violence in Chile from 2003 to 2022. Materials and methods: Observational cross-sectional study. Data obtained from the Servicio Médico Legal and Departamento de Estadísticas e Información de Salud. Variables analyzed included sex, age, region, type of aggression, and injury. Statistical analysis, using Stata 17, evaluated trends, mortality, and hospital discharge rates (HDR). Ethical committee approval was unnecessary. Results: Between 2003 and 2022, Chile recorded 75,129 hospital admissions and 14,519 deaths related to physical assaults. While HDR due to assaults (HDRA) showed a decline, a rising trend was seen post-2019. The highest HDRA rates were in the northern area of Chile. Mortality rates decreased overtime and varied by region. Men had higher hospital admissions (91.36%), HDRAs, and mortality, revealing a gender gap. Variations were also noted by age, types of aggression, and trauma. Sharp object assaults were most prevalent, but firearms and blunt objects increased. Conclusion: Findings suggest a complex landscape of interpersonal physical violence in Chile, with significant regional, gender, and age disparities. While violence incidence is decreasing, severity could be rising, reflected by lethality rates. Gender inequalities in exposure and risk of violence are evident. Changes in aggression types and injuries impact health services readiness and response. Clinical significance: This study provides information to guide effective intervention policies in Chile, considering trends, geographical differences, gender inequalities, and changes in types of aggression and injuries.

Aim and background: Violence is a global crisis causing deleterious effects on survivors and the health of communities. Yet, there is limited prospective research examining the mental health of violence-related injury survivors. Longitudinally assessing differences in mental health outcomes following violence-related and nonviolent injuries can inform what comprehensive approaches to recovery are needed to reduce disparities following violence. Materials and methods: Participants (N = 245) presenting to a midwestern level 1 trauma center following injury completed measures of posttraumatic stress disorder [PTSD symptom checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)], depression, anxiety, stress, [Depression, Anxiety, and Stress Scale (DASS-21)] posttrauma and 6 months later. Results: Analyses of variance revealed that violence-related injury patients experienced chronic or worsening symptoms of PTSD, depression, anxiety, and stress levels, whereas nonviolently injured patients had less severe symptoms that diminished over time. Conclusion: Compared with nonviolent injury patients, patients with violence-related injuries have poorer mental health, regardless of injury severity. Further, this disparity appears to grow by 6 months, which has significant implications regarding individual and community health. Screening and effective treatment of mental health issues among violence survivors is necessary to address comprehensive needs and reduce the overall impact of violence. Clinical significance: Violence-related injury survivors are at risk for psychopathology, which impacts recovery, quality of life and limits, and reengagement with society. Tertiary prevention efforts must account for the role of mental health when supporting survivors.

The current report aims to underscore intimate partner violence (IPV) domestic violence (DV) as an important cause of preventable injury. It briefly outlines global efforts to minimize it and focuses on the role of healthcare, especially in trauma centers. The Virginia Commonwealth University (VCU) model is briefly presented with a brief summary of the evolution and results of the program. A call to action is issued for the Panamerican Trauma Society (PTS).

Aim and background: Short, pragmatic measures of interpersonal violence are needed to facilitate effective evaluation and equitable translation of prevention interventions in low-resource contexts. Measures need to be (1) valid in contexts of high vulnerability, (2) capable of efficiently evaluating multiple forms of violence perpetration/victimization in diverse settings, (3) brief and inexpensive to users/implementers, and (4) sensitive to change. This study reports on the development and evaluation of a measure of adolescent interpersonal violence for use in low-resource contexts. Materials and methods: Informed by the “Psychometric and Pragmatic Evidence Rating Scale” (PAPERS) process, we followed a four-step process: (1) define violence using qualitative interviews with local stakeholders, (2) develop items for a pragmatic measure, (3) pilot the survey measure with target populations in two different low-resource contexts to evaluate the psychometric properties, and (4) review and revise the measure to maximize future use. Results: We synthesized qualitative interviews, community engagement (CE) studios, and expert reviews to generate 20 perpetration and 20 matched victimization items across eight categories of interpersonal violence. We then deployed the measure on adolescents from Nicaragua (N = 101) and the Dominican Republic (DR) (N = 111) who were participating in school-based violence prevention interventions. Exploratory factor analysis (EFA) resulted in an eight-item, one-factor measure in Nicaragua and a 10-item, one-factor measure in the DR. The psychometric evaluation demonstrates acceptable reliability but limited statistically significant findings for some validity tests. Conclusion: Drawing from existing measures and sequential mixed methods analysis in low-resource contexts in Latin America and the Caribbean (LAC), we present a pragmatic measure for tapping into adolescent interpersonal violence. Additional refinement and cultural adaptation may be needed in each specific context to achieve maximum practicality. Clinical significance: Synthesizing existing measures into pragmatic ones improves researchers’ ability to evaluate outcomes of psychosocial health interventions.

Aim and background: To describe the challenges of a multitrauma patient with severe blunt chest trauma, including thoracic aortic injury, and the need for emergent extracorporeal membrane oxygenation (ECMO) in the operating room. Case description: A young man was involved in a high-speed motorcycle accident with his chest reportedly hitting the curb. In the trauma bay, he was unstable, with a positive abdominal focused assessment with sonography for trauma (FAST), and a chest X-ray (CXR) with a widened mediastinum. He underwent emergent damage control abdominal surgery, followed by a total body computed tomography (CT), and definitive endovascular repair of a proximal descending thoracic aortic injury with carotid-carotid-left subclavian bypass graft. During the first 36 hours, he received ultramassive blood product transfusion and emergent venovenous (VV) ECMO placement in the operating room. Despite his survival, he suffered from partial paralysis and infection of the vascular bypass graft. Conclusion: Thoracic aortic injury in the multitrauma patient remains a challenge. The use of ECMO in the acute setting has life-saving potential. Multidisciplinary teams optimize the outcome of these difficult patients. Clinical significance: Here, we show examples of a supine trauma bay CXR that was sensitive for aortic injury, the complexity of blunt thoracic aortic trauma definitive care, and utilization of emergent ECMO.

Giant thymomas pose a challenge to surgeons and anesthetists alike due to their size and proximity to vessels and organs. Here we would like to report on the anesthetic management of a case of giant thymoma. This 51-year-old lady presented with left-sided pectoralgia and progressive breathlessness of 4 months duration. Computed tomography (CT) thorax showed a large defined heterogeneously enhancing mass lesion {[180 mm [craniocaudal (CC)] × 142 mm [transverse (TR)] × 152 mm [anteroposterior (AP)]} in the left anterior, middle, and posterior mediastinum extending to the left thoracic cavity displacing the mediastinum to the right side with no obvious invasion of adjacent structures. This giant thymoma was entirely resected under general anesthesia with adequate preparations using a left posterolateral thoracotomy surgical approach.