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Scarcity of operating rooms and personal protective equipment in far-forward field settings make surgical infections a potential concern for combat mortality and morbidity. Surgical and transport personnel also face infectious risks from bodily fluid exposures. Our study aimed to describe the serial, proof-of-concept testing of the SurgiBox technology an inflatable sterile environment that addresses the aforementioned problems, fits on gurneys and backpacks, and drapes over incisions.
The SurgiBox environmental control unit and inflatable enclosure were optimized over five generations based on iterative feedback from stakeholders experienced in surgery in austere settings. The airflow system was developed by analytic modeling, verified through in silico modeling in SOLIDWORKS, and confirmed with prototype smoke-trail checking. Particulate counts evaluated the enclosure's ability to control and mitigate users' exposures to potentially infectious contaminants from the surgical field in various settings. Surential procedures, automating airflow control, and accelerating system setup. SurgiBox's ultimate goal is to take timely, safe surgery to patients in even the most austere of settings.
Rehabilitation research of wounded service members (SMs) commonly focuses on physical ability to return to duty (RTD) as a measure of successful recovery. However, numerous factors or barriers may influence a SM's ability and/or desire to RTD after lower extremity musculoskeletal trauma. SMs themselves as well as the clinical care team that works with them daily, often for years at a time, both offer unique perspectives on the influential factors that weigh into decisions to RTD. selleck inhibitor The purpose of this study was to identify the intrinsic and extrinsic factors patients and clinicians recognized as influencing the decision to RTD after severe lower extremity trauma.
Thirty-two SMs with severe lower extremity trauma (amputation and lower limb salvage) and 30 providers with at least 2 years' experience caring for SMs with similar injuries participated separately in either a SM or provider/clinician focus group. Open-ended questions on factors influencing RTD and other rehabilitation success were discussed. Data ting RTD barriers, better monitoring of the changing landscape of RTD after lower extremity trauma, improving systems of health care, and/or reducing turnover and facilitating force readiness.
The Security Force Assistance Brigades (SFABs) are specialized units designed to strengthen allied and partnered nations through advising, supporting, liaising, and assessing in support of U.S. national security interests and combatant commanders' war fighting objectives. As the 1st SFAB was the pioneer unit, descriptive analysis of the musculoskeletal injures and body regions occurring before, during, and after deployment was previously unavailable, limiting the ability of embedded holistic health and fitness teams to proactively address the unit's musculoskeletal needs and medical readiness.
Physical therapists collected and retrospectively analyzed data from 4597 encounters over 19 months 4 months before, 9 months during, and 4 months after deployment using descriptive statistics.
Physical therapy encounters averaged 124 per month during pre-deployment preparation, 363 per month during deployment, and 206 per month post-deployment. The most common musculoskeletal injuries identified during pre-deployck pain is the primary musculoskeletal injury of the 1st SFAB throughout the entire deployment cycle. Based on these findings, recommendations include embedding injury prevention programs to address low back pain to improve medical readiness. More research is required to assess the effectiveness of these programs in reducing incidents of musculoskeletal injuries before, during, and after deployment cycles.
Point of care ultrasound (POCUS) is increasingly used in primary care in the USA and has been shown to provide significant benefit to care in deployed military settings and during disaster relief efforts. It is less studied as a tool during humanitarian assistance missions. We sought to determine the utility of POCUS in a humanitarian assistance setting during the February 2019 joint U.S.-Brazilian hospital assistance mission aboard the Hospitalar Assistance Ship Carlos Chagas along the Madeira River in the Brazilian Amazon.
Point of care ultrasound was offered as a diagnostic modality to primary care physicians during the course of a month-long mission. A handheld IVIZ ultrasound machine was loaned for use during this mission by Sonosite. A P21v phased array (5-1 MHz) or an L38v linear (10-5 MHz) transducer was used for scanning. Requests for POCUS examinations, their findings, and changes in patient management were recorded.
Point of care ultrasound examinations were requested and performed in 24 of 814 (3%) outpatient primary care visits. Ten of these studies (42% of POCUS examinations, 1.2% of all patient visits) directed patient management decisions, in each case preventing unnecessary referral.
In this austere setting, POCUS proved to be an inexpensive, effective tool at preventing unnecessary referrals. Future medical humanitarian assistance missions may likewise find POCUS to be a primary care force-multiplier.
In this austere setting, POCUS proved to be an inexpensive, effective tool at preventing unnecessary referrals. Future medical humanitarian assistance missions may likewise find POCUS to be a primary care force-multiplier.
Localization of internal arterial bleeds is necessary for treatment in the battlefield. link2 In this article, we describe a novel approach that utilizes pulse wave reflections generated by a bleed to locate it.
To demonstrate our approach, velocity and diameter waveforms in the presence of bleeds were simulated using the 1D wave propagation equations in a straight-vessel model of the human thoracic aorta. The simulated waveforms were then decomposed into forward and backward components using wave intensity analysis. Reflections arising from the bleed were identified from the decomposed waveforms.
Reflection generated by the bleed introduced a new feature in the backward component, compared to the normal, no-bleed condition. The bleed location could be determined from the time delay between this reflection feature and the forward wave creating it, and the pulse wave velocity in the vessel.
The findings of this study could be utilized by ultrasound for hemorrhage localization.
The findings of this study could be utilized by ultrasound for hemorrhage localization.
The CogScreen-Aeromedical Edition (CogScreen-AE) is a computerized neurocognitive assessment screening tool developed for the Federal Aviation Administration as a rapid, reliable means of measuring neurocognitive deficiency in civilian airline pilots. This has potential use and assessment of military aviators flying high performance aircraft under extreme conditions; however, no data exist on how the dynamic flight environment affects CogScreen-AE scores. The objectives of this study were to determine what changes in performance on CogScreen-AE scores are seen post-flight in Naval Aviators flying high performance aircraft and to determine the potential for use of CogScreen-AE as a screening tool to evaluate degree of impairment, recovery from neurological illness, and return to duty status of a military aviator.
Repeated measures, within-subjects experimental design with three CogScreen-AE administrations-introduction session, preflight session, and postflight session. An experimental study group was expolight. These data show that CogScreen-AE may be a reliable clinical instrument for assessing aviators' cognitive function with regard to return to flight duty decision-making. We anticipate future work in determining how CogScreen-AE can be utilized in the operational environment and documenting recovery from neurologic illness.
Developing affordable and effective hemostatic and antimicrobial wound dressings for prolonged field care (PFC) of open wounds is of interest to prevent infection, to prevent sepsis, and to conserve tissue viability. The need for an effective hemostatic dressing that is also antimicrobial is required of a hemostatic dressing that can be left in place for extended periods (days). This is particularly important in light of the existence of pathogens that have coagulopathy properties. Thus, dressings that provide effective hemostasis and reduction in the frequency of dressing changes, whereas exerting robust antimicrobial activity are of interest for PFC. Highly cleaned and sterile unbleached cotton has constituents not found in bleached cotton that are beneficial to the hemostatic and inflammatory stages of wound healing. Here, we demonstrate two approaches to cotton-based antimicrobial dressings that utilize the unique components of the cotton fiber with simple modification to confer a high degree of hemosta a multilayered hemostatic dressing with antimicrobial properties is envisioned. This dressing would be safe, would be economical, and have a stable shelf-life that would be conducive for using PFC.
The use of photobiomodulation has been proposed to improve wound healing for the last two decades. Recent development in photobiomodulation has led to the development of a novel biophotonic platform that utilizes fluorescent light energy (FLE) within the visible spectrum of light for healing of skin inflammation and wounds.
In this article, FLE was used in preliminary analysis on 18 case studies of acute second-degree burns and in a pilot study using an ex vivo human skin model. Efficacy of FLE on wound healing and tissue remodeling was evaluated by monitoring improvements in the treated tissues, assessing pain for the patients, and by performing human genome microarray analysis of FLE-treated human skin samples.
Healing was reported for all 18 patients treated with FLE for acute second-degree burns without reported adverse effects or development of infections. Furthermore, preliminary ex vivo skin model data suggest that FLE impacts different cellular pathways including essential immune-modulatory mechanisms.
The results presented in this article are encouraging and suggest that FLE balances different stages of wound healing, which opens the door to initiating randomized controlled clinical trials for establishing the efficacy of FLE treatment in different phases of wound healing of second-degree burns.
The results presented in this article are encouraging and suggest that FLE balances different stages of wound healing, which opens the door to initiating randomized controlled clinical trials for establishing the efficacy of FLE treatment in different phases of wound healing of second-degree burns.
The ability to accurately detect hypotension in trauma patients at the earliest possible time is important in improving trauma outcomes. The earlier an accurate detection can be made, the more time is available to take corrective action. Currently, there is limited research on combining multiple physiological signals for an early detection of hemorrhagic shock. We studied the viability of early detection of hypotension based on multiple physiologic signals and machine learning methods. We explored proof of concept with a small (5 minutes) prediction window for application of machine learning tools and multiple physiologic signals to detecting hypotension.
Multivariate physiological signals from a preexisting dataset generated by an experimental hemorrhage model were employed. link3 These experiments were conducted previously by another research group and the data made available publicly through a web portal. This dataset is among the few publicly available which incorporate measurement of multiple physiological signals from large animals during experimental hemorrhage.