Omar S. Bholat, M.D.

Alcohol use by pedestrians who are struck by motor vehicles: how drinking influences behaviors, medical management, and outcomes
Dultz, Linda A; Frangos, Spiros; Foltin, George; Marr, Mollie; Simon, Ronald; Bholat, Omar; Levine, Deborah A; Slaughter-Larkem, Dekeya; Jacko, Sally; Ayoung-Chee, Patricia; Pachter, H Leon
2011 Nov;71(5):1252-1257, Journal of trauma
BACKGROUND: : Injuries to pedestrians struck by motor vehicles represent a significant public health hazard in large cities. The purpose of this study is to investigate the demographics of alcohol users who are struck by motor vehicles and to assess the effects of alcohol on pedestrian crossing patterns, medical management, and outcomes. METHODS: : Data were prospectively collected between December 2008 to September 2010 on all pedestrians who presented to a Level I trauma center after being struck by a motor vehicle. Variables were obtained by interviewing patients, scene witnesses, first responders, and medical records. RESULTS: : Pedestrians who used alcohol were less likely to cross the street in the crosswalk with the signal (22.6% vs. 64.7%) and more likely to cross either in the crosswalk against the signal (22.6% vs. 12.4%) or midblock (54.8% vs. 22.8%). Alcohol use was associated with more initial computed tomography imaging studies compared with no alcohol involvement. Alcohol use was associated with a higher Injury Severity Score (8.82 vs. 4.85; p < 0.001) and hospital length of stay (3.89 days vs. 1.82 days; p < 0.001) compared with those with no alcohol involvement. Patients who used alcohol had a lower average Glasgow Coma Scale score (13.80 vs. 14.76; p < 0.001) and a higher rate of head and neck, face, chest, abdomen, and extremity/pelvic girdle injuries (based on Abbreviated Injury Scale) than those with no alcohol involvement. CONCLUSION: : Alcohol use is a significant risk factor for pedestrians who are struck by motor vehicles. These patients are more likely to cross the street in an unsafe manner and sustain more serious injuries. Traffic safety and injury prevention programs must address irresponsible alcohol use by pedestrians
— id: 141084, year: 2011, vol: 71, page: 1252, stat: Journal Article,

U.S. surgeon and medical student attitudes toward organ donation
Hobeika, Mark J; Simon, Ronald; Malik, Rajesh; Pachter, H Leon; Frangos, Spiros; Bholat, Omar; Teperman, Sheldon; Teperman, Lewis
2009 Aug;67(2):372-375, Journal of trauma
BACKGROUND: Nearly 100,000 people await an organ transplant in the U.S. Improved utilization of potential organ donors may reduce the organ shortage. Physician attitudes toward organ donation may influence donation rates; however, the attitudes of U.S. physicians have not been formally evaluated. METHODS: Anonymous questionnaires were distributed to surgical attendings, surgical residents, and medical students at two academic medical centers. Willingness to donate one's own organs and family member's organs was examined, as well as experience with transplant procedures and religious views regarding organ donation. RESULTS: A total of 106 surveys were returned. Sixty-four percent of responders were willing to donate their own organs, and 49% had signed an organ donor card. Willingness to donate inversely correlated with professional experience. Eighty-four percent of those surveyed would agree to donate the organs of a family member, including 55% of those who refused to donate their own organs. Experience on the transplant service influenced 16% of those refusing donation, with the procurement procedure cited by 83% of this group. Sixteen percent refused organ donation on the basis of religious beliefs. CONCLUSIONS: The surveyed U.S. physicians are less willing to donate their organs compared with the general public. Despite understanding the critical need for organs, less than half of physicians surveyed had signed organ donor cards. Previous experiences with the procurement procedure influenced several responders to refuse organ donation. As the lay public traditionally looks to physicians for guidance, efforts must be made to improve physician attitudes toward organ donation with the hope of increasing donation rates
— id: 101453, year: 2009, vol: 67, page: 372, stat: Journal Article,

Pseudoachalasia as a result of metastatic cervical cancer
Bholat OS; Haluck RS
2001 Jan-Mar;5(1):57-62, Journal of the Society of Laparoendoscopic Surgeons
BACKGROUND: Distinguishing achalasia from pseudoachalasia can be difficult, as the clinical, radiological, and manometric findings can be similar to those seen in achalasia. The features that may differentiate achalasia from pseudoachalasia are reviewed and the pathogenesis of pseudoachalasia is discussed. METHODS: A patient presented with a clinical scenario of achalasia that was documented by radiographic, endoscopic, and manometric studies. Her past medical history was significant for cervical cancer. Although brief improvement in symptoms was achieved with botulinum toxin injections and esophageal dilation, she had continued progression of symptoms. This direct involvement of the esophagus by a tumor was not demonstrated by any of the routine preoperative studies. RESULTS: At the time of surgery, extensive involvement of the diaphragm, esophagus, and pericardium by a tumor was noted. Pathologic analysis of the tumor was consistent with metastatic cervical cancer CONCLUSION: Pseudoachalasia has been known to occur in response to both benign and malignant causes. Differentiating between pseudoachalasia and achalasia is often difficult because of the similarities. As in this case, the diagnosis of pseudoachalasia may be made by surgical exploration
— id: 62781, year: 2001, vol: 5, page: 57, stat: Journal Article,

Defining the role of haptic feedback in minimally invasive surgery
Bholat OS; Haluck RS; Kutz RH; Gorman PJ; Krummel TM
1999 ;62:62-66, Studies in health technology & informatics
INTRODUCTION: The applications of Minimally Invasive Surgery (MIS) and Laparoscopy are rapidly expanding. Despite this expansion, the technology related to our understanding of the importance of haptic feedback related to laparoscopic surgery remains in its infancy. While many surgeons feel that the use of minimally invasive techniques eliminates force feedback and tactile sensation, the importance of haptics in MIS has not been fully evaluated. Moreover, there is considerable interest in the development of haptic simulators for MIS even though the importance of force feedback remains poorly understood. This study was designed to determine the ability of novice surgeons to interpret haptic feedback with respect to texture, shape and consistency of an object. METHOD: Subjects were presented objects in a random order and participants were blinded as to their identity. Inspection by direct palpation, palpation with conventional instruments, and palpation with laparoscopic instruments was performed on all objects. Statistical analysis of the data was performed using a Fischer exact probability test. RESULTS: Direct palpation provided the greatest degree of haptic feedback and was associated with the highest accuracy for texture discrimination, shape discrimination, and consistency discrimination. A significant decrease in the ability to identify shapes was noted with both CI and LI. A significant decrease in the ability to differentiate consistency was noted for LI only. When comparing palpation with conventional instruments to palpation with laparoscopic instruments, there was no significant difference in shape or texture discrimination. There was, however, a significant decrease in consistency discrimination. CONCLUSION: This data indicates that laparoscopic instruments do in fact provide the surgeon with haptic feedback. While the instruments change the information available to the surgeon, interpretation of the texture, shape and consistency of objects can be performed. Our ongoing work is directed at further defining force interactions. Through the use of force feedback impulse devices in VR simulators, one should be able to create a more realistic theatre in which the novice surgeon can learn operative skills that will readily translate into the operating room
— id: 62782, year: 1999, vol: 62, page: 62, stat: Journal Article,

Tactile feedback is present during minimally invasive surgery
Bholat OS; Haluck RS; Murray WB; Gorman PJ; Krummel TM
1999 Oct;189(4):349-355, Journal of the American College of Surgeons
BACKGROUND: The applications of minimally invasive surgery (MIS) and laparoscopy are rapidly expanding. Despite this expansion, our understanding of the importance of haptic feedback during laparoscopic surgery is incomplete. Although many surgeons believe that the use of minimally invasive techniques eliminates force feedback and tactile sensation (haptics), the importance of haptics in MIS has not been fully evaluated. There is considerable interest in the development of simulators for MIS even though the importance of force feedback remains poorly understood. This study was designed to determine the ability of experienced surgeons to interpret haptic feedback with respect to texture, shape, and consistency of an object. STUDY DESIGN: A randomized, single-blinded study was designed. Twenty surgeons were presented objects in a random order, with participants blinded as to their identity. Inspection by direct palpation, conventional instruments, and laparoscopic instruments was performed on all objects. Statistic analysis of the data was performed using chi-square analysis and, when appropriate, a Fischer exact probability test. RESULTS: Direct palpation was associated with the highest accuracy for shape identification and was superior to both conventional instruments (p < 0.001) and laparoscopic instruments (p<0.001). Fine texture analysis with either a conventional instrument or a laparoscopic instrument was superior to direct palpation (p < 0.05). Finally, the three methods of analysis were comparable for consistency analysis. CONCLUSIONS: These data indicate that laparoscopic instruments do, in fact, provide surgeons with haptic feedback. Interpretation of the texture, shape, and consistency of objects can be performed. In some situations, laparoscopic instruments appear to amplify the haptic information available. Our ongoing work is directed at further defining force interactions
— id: 62783, year: 1999, vol: 189, page: 349, stat: Journal Article,

The role of tracheostomy in acquired immunodeficiency syndrome
Flum DR; Bholat OS; Wallack MK
1997 Oct;64(4):982-985, Annals of thoracic surgery
BACKGROUND: Tracheostomy tube (TT) insertion for respiratory failure in patients with acquired immunodeficiency syndrome has been associated with an early mortality rate of 100%. We have reviewed our experience with tracheostomy to determine if there is a role for this procedure among certain subgroups. METHODS: A retrospective review was conducted of 47 patients diagnosed with acquired immunodeficiency syndrome who underwent tracheostomy from 1988 to 1995. Patients were divided into three groups based on indications for tracheostomy: group 1, Pneumocystis carinii pneumonia (PCP); group 2, non-PCP pneumonia; and group 3, others (including neurosyphilis, endocarditis, and trauma). RESULTS: All groups were similar with regard to demographic details and laboratory values (mean age, 38 +/- 1.4 years; 95% male; CD4 count = 21.8 +/- 3.6 cells/microL). In the vast majority of cases the decision to place a TT was elective. Forty-three percent of all patients had signed do not resuscitate orders before endotracheal tube intubation. The mean time from endotracheal tube to TT insertion was 14.1 +/- 1.6 days. Early mortality after TT placement was dismal (91%) for group 1 patients but significantly better (47%) in group 2 patients (p = 0.04). Early mortality usually occurred within 3 weeks of TT placement (range, 1 to 54 days). The cause of pneumonia (PCP versus non-PCP) was the only statistically significant variable in predicting outcome. For those who survived to TT removal (26%), the average time to removal of TT was 67 +/- 11 days. Long-term survival was noted in 8 group 2 patients (mean, 584 days) and in 2 group 1 patients (450 days). CONCLUSIONS: Outcome after tracheostomy in patients with AIDS is generally poor. Patients with PCP should not undergo TT placement; however, patients with non-PCP pneumonia have a reasonable expected survival and should undergo the operation
— id: 62784, year: 1997, vol: 64, page: 982, stat: Journal Article,