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Rattray NA, Flanagan M, Mann A, Danson L, Do AN, Natividad D, Spontak K, True G. Conceptualizing care partners' burden, stress, and support for reintegrating Veterans: a mixed methods study. Front Public Health 2024; 11:1295627. [PMID: 38440161 PMCID: PMC10910616 DOI: 10.3389/fpubh.2023.1295627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/07/2023] [Indexed: 03/06/2024] Open
Abstract
Background People who support Veterans as they transition from their military service into civilian life may be at an increased risk of psychological distress. Existing studies focus primarily on paid family caregivers, but few studies include spouses and informal non-family "care partners." We sought to identify key challenges faced by care partners of Veterans with invisible injuries. Methods Semi-structured interviews were conducted with 36 individuals involved in supporting a recently separated US military Veteran enrolled in a 2-year longitudinal study. CPs completed validated measures on perceived stress, caregiving burden, quality of their relationship, life satisfaction, and flourishing. Independent t-tests were used to compare cases in these groups on caregiving burden, quality of their relationship, life satisfaction, and flourishing. Care partners were categorized as reporting high and low levels of stress. Exemplar cases were used to demonstrate divergences in the experiences of CPs with different levels of stress over time. Results Care partners reported shifts in self-perception that occurred from supporting a Veteran, emphasizing how they helped Veterans navigate health systems and the processes of disclosing health and personal information in civilian contexts. Exemplar cases with high and low burdens demonstrated divergent experiences in self-perception, managing multi-faceted strain, and coping with stress over time. Case studies of specific care partners illustrate how multi-faceted strain shifted over time and is affected by additional burdens from childcare, financial responsibilities, or lack of education on mental health issues. Conclusions Findings suggest the unique needs of individuals who support military Veterans with invisible injuries, highlighting variations and diachronic elements of caregiving. This sample is younger than the typical caregiver sample with implications for how best to support unpaid care partners caring for Veterans in the early to mid-period of their use of VA and civilian health services.
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Affiliation(s)
- Nicholas A. Rattray
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Inc., Indianapolis, IN, United States
- Department of General Internal Medicine and Geriatrics, Indiana School of Medicine, Indianapolis, IN, United States
| | - Mindy Flanagan
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Allison Mann
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Leah Danson
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Ai-Nghia Do
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Diana Natividad
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Katrina Spontak
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Gala True
- South Central Mental Illness Research, Education, and Clinical Center, Southeast Louisiana Veterans Health Care System, New Orleans, LA, United States
- Section of Community and Population Medicine, Louisiana State University School of Medicine, New Orleans, LA, United States
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Liu T, Fang X, Bai Z, Liu L, Lu H, Qi X. Outcomes of selective non-operative management in adults with abdominal gunshot wounds: a systematic review and meta-analysis. Int J Surg 2024; 110:1183-1195. [PMID: 38051918 PMCID: PMC10871643 DOI: 10.1097/js9.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/05/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND AND AIMS Abdominal gunshot wounds (GSWs), a clinically devastating injury, can result in a variety of severe and lethal complications. Traditionally, exploratory laparotomy is the first-line approach for the management of abdominal GSWs, but it is associated with a considerable amount of unnecessary surgeries. At present, selective non-operative management (SNOM) of abdominal GSWs is becoming an effective and well-recognized approach, but it remains widely disputed since many surgeons are skeptical about the validity of SNOM in clinical practice. This meta-analysis aims to estimate the outcomes of SNOM and immediate laparotomy in patients with GSWs by collecting the currently available evidence. METHODS The PubMed , EMBASE , and Cochrane Library databases were searched. A random-effects model was employed. A pooled proportion with 95% confidence intervals (CIs) was calculated. Heterogeneity was evaluated using Cochran's Q test and I2 statistics. RESULTS Overall, 53 studies involving 60 291 participants were included. The pooled proportions of SNOM and SNOM failure were 27.0% (95% CI=24.0-30.0%) and 10.0% (95% CI=7.0-13.0%), respectively. The pooled mortality after SNOM and SNOM failure were 0.0% (95% CI=0.0-1.0%) and 0.0% (95% CI=0.0-0.0%), respectively. The pooled proportions of immediate laparotomy and unnecessary immediate laparotomy were 73.0% (95% CI=70.0-76.0%) and 10.0% (95% CI=8.0-13.0%), respectively. The pooled mortality after immediate laparotomy and unnecessary immediate laparotomy was 10.0% (95% CI=8.0-13.0%) and 0.0% (95% CI=0.0-1.0%), respectively. Heterogeneity was statistically significant in nearly all meta-analyses. CONCLUSION Immediate laparotomy is still the mainstay approach for the management of abdominal GSWs. Approximately one-third of patients with abdominal GSWs undergo SNOM. SNOM failure is not frequent, and its related mortality is also rare.
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Affiliation(s)
- Tingwei Liu
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
- Graduate School, Jinzhou Medical University, Jinzhou, People’s Republic of China
| | - Xiaohui Fang
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
- Shenyang Pharmaceutical University, Shenyang
| | - Zhaohui Bai
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
- Shenyang Pharmaceutical University, Shenyang
| | - Lu Liu
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
| | - Hui Lu
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
| | - Xingshun Qi
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
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Maroufi SF, Sohrabi H, Dabbagh Ohadi MA, Mohammadi E, Habibi Z. Neurosurgery in 21st-Century Wars in the Middle East: Narrative Review of Literature. World Neurosurg 2022; 166:184-190. [PMID: 35944854 DOI: 10.1016/j.wneu.2022.07.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Abstract
Military neurosurgery has played a crucial role in the development of neurosurgery over time. Much of this progress is due to war-related experiences. Owing to the number and severity of war injuries and the limitations caused by war, surgeons have had to examine different methods and design special protocols for patient management. Given that in recent decades most wars have taken place in the Middle East, many lessons can be learned by reviewing the experiences of neurosurgeons in these wars. Wars in Iraq, Syria, Afghanistan, Lebanon, and Yemen have been the largest and longest conflicts in the Middle East since the beginning of the 21st century, and a number of studies reported the experiences of surgeons in these wars. In this study, we reviewed the experience of military surgeons in managing war neurosurgical injuries in these areas within the last 2 decades.
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Affiliation(s)
- Seyed Farzad Maroufi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanye Sohrabi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Dabbagh Ohadi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Habibi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Hu X, Liu L, Xu Z, Yang J, Guo H, Zhu L, Lamers WH, Wu Y. Creation and application of war trauma treatment simulation software for first aid on the battlefield based on undeformed high-resolution sectional anatomical image (Chinese Visible Human dataset). BMC MEDICAL EDUCATION 2022; 22:498. [PMID: 35752811 PMCID: PMC9233836 DOI: 10.1186/s12909-022-03566-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Effective first aid on the battlefield is vital to minimize deaths caused by war trauma and improve combat effectiveness. However, it is difficult for junior medical students, which have relatively poor human anatomy knowledge and first aid experience. Therefore, we aim to create a treatment simulation software for war trauma, and to explore its application for first aid training. METHODS : This study is a quantitative post-positivist study using a survey for data collection. First, high-resolution, thin-sectional anatomical images (Chinese Visible Human (CVH) dataset) were used to reconstruct three-dimensional (3D) wound models. Then, the simulation system and the corresponding interactive 3D-PDF, including 3D models, graphic explanation, and teaching videos, were built, and used for first aid training in army medical college. Finally, the interface, war trauma modules, and training effects were evaluated using a five-point Likert scale questionnaire. All measurements are represented as mean and standard deviations. Moreover, free text comments from questionnaires were collected and aggregated. RESULTS The simulation software and interactive 3D-PDF were established. This included pressure hemostasis of the vertex, face, head-shoulder, shoulder-arm, upper forearm, lower limb, foot, and punctures of the cricothyroid membrane, pneumothorax, and marrow cavity. Seventy-eight medical students participated in the training and completed the questionnaire, including 66 junior college students and 12 graduate students. The results indicated that they were highly satisfied with the software (score: 4.64 ± 0.56). The systems were user-friendly (score: 4.40 ± 0.61) and easy to operate (score: 4.49 ± 0.68). The 3D models, knowledge of hemostasis, and puncture were accurate (scores: 4.41 ± 0.67, and 4.53 ± 0.69) and easily adopted (scores: 4.54 ± 0.635, and 4.40 ± 0.648). They provided information about hemostasis and puncture (all scores > 4.40), except for cricothyroid membrane puncture (scores: 4.39 ± 0.61), improved the learning enthusiasm of medical students (score: 4.55 ± 0.549), and increased learning interest (score: 4.54 ± 0.57). CONCLUSION Our software can effectively help medical students master first aid skills including hemostasis, cricothyroid membrane and bone marrow puncture, and its anatomy. This may also be used for soldiers and national first aid training.
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Affiliation(s)
- Xin Hu
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Li Liu
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Zhou Xu
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Jingyi Yang
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Hongfeng Guo
- Department of Basic Operative Surgery, College of General Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Street, Shapingba District, 400038, Chongqing, China
| | - Ling Zhu
- Frontier Medical Training Brigade, Third Military Medical University (Army Medical University), No. 75, Dongfeng Street, Hutubi country, 831200, Xinjiang, China
| | - Wouter H Lamers
- Academic Medical Center, Tytgat Institute for Liver and Intestinal Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Yi Wu
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Street, Shapingba District, 400038, Chongqing, China.
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Pierre NL, Yeo CJ, Tholey RM. What We Owe the World Wars: Challenges That Fueled Surgical Innovation. Am Surg 2021; 87:1525-1528. [PMID: 33502229 DOI: 10.1177/0003134820973400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
War has the unique ability to intensify obstacles that surgeons face daily in civilian hospitals. After a brief overview of the historical context of the first and second world wars, this article will focus on how those daily challenges, namely limited skill, bleeding, and infection, led to an era of surgical innovation and standardization of surgical education.
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Affiliation(s)
- Nadj L Pierre
- Sidney Kimmel Medical College, 12313Thomas Jefferson University, Philadelphia, PA, USA
| | - Charles J Yeo
- Sidney Kimmel Medical College, 12313Thomas Jefferson University, Philadelphia, PA, USA.,Department of Surgery, 23217Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Renee M Tholey
- Sidney Kimmel Medical College, 12313Thomas Jefferson University, Philadelphia, PA, USA.,Department of Surgery, 23217Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Coughlin DJ, Boulter JH, Miller CA, Curry BP, Glaser J, Fernandez N, Bell RS, Schuette AJ. An Endovascular Surgery Experience in Far-Forward Military Healthcare-A Case Series. Mil Med 2020; 185:2183-2188. [PMID: 32812042 DOI: 10.1093/milmed/usaa219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
SUMMARY INTRODUCTION The advancement of interventional neuroradiology has drastically altered the treatment of stroke and trauma patients. These advancements in first-world hospitals, however, have rarely reached far forward military hospitals due to limitations in expertise and equipment. In an established role III military hospital though, these life-saving procedures can become an important tool in trauma care. MATERIALS AND METHODS We report a retrospective series of far-forward endovascular cases performed by 2 deployed dual-trained neurosurgeons at the role III hospital in Kandahar, Afghanistan during 2013 and 2017 as part of Operations Resolute Support and Enduring Freedom. RESULTS A total of 15 patients were identified with ages ranging from 5 to 42 years old. Cases included 13 diagnostic cerebral angiograms, 2 extremity angiograms and interventions, 1 aortogram and pelvic angiogram, 1 bilateral embolization of internal iliac arteries, 1 lingual artery embolization, 1 administration of intra-arterial thrombolytic, and 2 mechanical thrombectomies for acute ischemic stroke. There were no complications from the procedures. Both embolizations resulted in hemorrhage control, and 1 of 2 stroke interventions resulted in the improvement of the NIH stroke scale. CONCLUSIONS Interventional neuroradiology can fill an important role in military far forward care as these providers can treat both traumatic and atraumatic cerebral and extracranial vascular injuries. In addition, knowledge and skill with vascular access and general interventional radiology principles can be used to aid in other lifesaving interventions. As interventional equipment becomes more available and portable, this relatively young specialty can alter the treatment for servicemen and women who are injured downrange.
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Affiliation(s)
- Daniel J Coughlin
- Department of Neurosurgery, Madigan Army Medical Center, Tacoma, WA 98431, United States
| | - Jason H Boulter
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Charles A Miller
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Brian P Curry
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Jacob Glaser
- Department of Naval Medical Research, Fort Sam Houston, TX, United States
| | | | - Randy S Bell
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Albert J Schuette
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
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7
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Affiliation(s)
- Abigail H Gewirtz
- Institute for Translational Research in Children's Mental Health, University of Minnesota, Minneapolis
| | - Stephen J Cozza
- Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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8
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Terrorist attacks: common injuries and initial surgical management. Eur J Trauma Emerg Surg 2020; 46:683-694. [PMID: 32342113 DOI: 10.1007/s00068-020-01342-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/02/2020] [Indexed: 01/22/2023]
Abstract
Terrorism-related incidents and shootings that involve the use of war weapons and explosives are associated with gunshot and blast injuries. Despite the perceived threat of terrorism, these incidents and injuries are rare in Germany. For this reason, healthcare providers are unlikely to have a full understanding of the special aspects of managing these types of injuries. Until a clear and complete picture of the situation is available after a terrorist or shooter incident, tactical and strategic approaches to the clinical management of the injured must be tailored to circumstances that have the potential to overwhelm resources temporarily. Hospitals providing initial care must be aware that the first patients who are taken to medical facilities will present with uncontrollable bleeding from injuries to the trunk and body cavities. To improve the outcome of these patients in extremis, the aim of the index surgery is to stop the bleeding and control the contamination. Unlike damage control surgery, which is tailored to the patient's condition, tactical abbreviated surgical care (TASC) is first and foremost adapted to the overall situation. Once the patients are stabilised and all information on the situation is available, the surgical management and reconstruction of gunshot and blast injuries can follow the principles of damage control (DC) and definitive early total care (ETC). The purpose of this article is to provide an overview of the pathophysiology of gunshot and blast injuries, wound ballistics, and the approach and procedures of successful surgical management.
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Robbins T, Hudson S, Ray P, Sankar S, Patel K, Randeva H, Arvanitis TN. COVID-19: A new digital dawn? Digit Health 2020; 6:2055207620920083. [PMID: 32313668 PMCID: PMC7153182 DOI: 10.1177/2055207620920083] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Tim Robbins
- University Hospitals Coventry & Warwickshire NHS Trust, UK.,Institute of Digital Healthcare, WMG, University of Warwick, UK
| | - Sarah Hudson
- Bristol Heart Institute, United Hospitals Bristol NHS Foundation Trust, UK
| | - Pijush Ray
- University Hospitals Coventry & Warwickshire NHS Trust, UK.,Warwick Medical School, University of Warwick, UK
| | - Sailesh Sankar
- University Hospitals Coventry & Warwickshire NHS Trust, UK.,Warwick Medical School, University of Warwick, UK
| | - Kiran Patel
- University Hospitals Coventry & Warwickshire NHS Trust, UK
| | - Harpal Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, UK.,Warwick Medical School, University of Warwick, UK
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10
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Janatpour ZC, Welch MC, Shanmuga S, Curry BP, Coughlin DJ, Sabersky AE, Bell RS, Gilhooly JE. The Silver Lining: Advances in the Surgical Management of Brain Trauma Attributable to War. Mil Med 2020; 185:8-11. [PMID: 31781754 DOI: 10.1093/milmed/usz381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Within the text we elaborate on the relationship between war and medicine, particularly as it pertains to neurosurgery and the management of brain trauma, and emphasize neurosurgical advancements in the treatment of brain trauma gleaned from U.S.-involved conflicts of the 21st century.
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Affiliation(s)
- Zachary C Janatpour
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
| | - Matthew C Welch
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
| | - Santosh Shanmuga
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
| | - Brian P Curry
- Division of Neurosurgery, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20814
| | - Daniel J Coughlin
- The Center for Spine Health, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Abraham E Sabersky
- Division of Neurosurgery, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20814
| | - Randy S Bell
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814.,Division of Neurosurgery, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20814
| | - Jonathan E Gilhooly
- Division of Neurosurgery, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20814
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Franke A, Bieler D, Friemert B, Kollig E, Flohe S. [Preclinical and intrahospital management of mass casualties and terrorist incidents]. Chirurg 2019; 88:830-840. [PMID: 29149359 DOI: 10.1007/s00104-017-0489-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Due to the recent terrorist attacks in Paris, Brussels, Ansbach, Munich, Berlin and more recently Manchester and London, terrorism is realized as a present threat to our society and social life, as well as a challenge for the health care system. Without fueling anxiety, there is a need for sensitization to this subject and to familiarize all concerned with the special kind of terrorist attack-related injuries, the operational priorities and tactics and the individual basic principles of preclinical and hospital care. There is a need to adapt the known established medical structure for a conventional mass casualty situation to the special requirements that are raised by this new kind of terrorist threat to our social life. It is the aim of this article, from a surgical point of view, to depict the tactics and challenges of preclinical care of the special kind of terrorist attack-related injuries from the site of the incident, via the advanced medical post or casualty collecting point, to the triage point at the hospital. The special needs of medical care and organizational aspects of the primary treatment in the hospital are highlighted and possible decisional options and different approaches are discussed.
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Affiliation(s)
- A Franke
- Klinik für Unfallchirurgie, Orthopädie, Rekonstruktive- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstrasse 170, 56072, Koblenz, Deutschland
| | - D Bieler
- Klinik für Unfallchirurgie, Orthopädie, Rekonstruktive- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstrasse 170, 56072, Koblenz, Deutschland.
| | - B Friemert
- Klinik Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - E Kollig
- Klinik für Unfallchirurgie, Orthopädie, Rekonstruktive- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstrasse 170, 56072, Koblenz, Deutschland
| | - S Flohe
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Städt. Klinikum Solingen, Solingen, Deutschland
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Typische Verletzungen durch terrorassoziierte Ereignisse und ihre Implikationen für die Erstversorgung. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s10039-018-0393-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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13
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Valero-Cuevas FJ, Santello M. On neuromechanical approaches for the study of biological and robotic grasp and manipulation. J Neuroeng Rehabil 2017; 14:101. [PMID: 29017508 PMCID: PMC5635506 DOI: 10.1186/s12984-017-0305-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/04/2017] [Indexed: 12/31/2022] Open
Abstract
Biological and robotic grasp and manipulation are undeniably similar at the level of mechanical task performance. However, their underlying fundamental biological vs. engineering mechanisms are, by definition, dramatically different and can even be antithetical. Even our approach to each is diametrically opposite: inductive science for the study of biological systems vs. engineering synthesis for the design and construction of robotic systems. The past 20 years have seen several conceptual advances in both fields and the quest to unify them. Chief among them is the reluctant recognition that their underlying fundamental mechanisms may actually share limited common ground, while exhibiting many fundamental differences. This recognition is particularly liberating because it allows us to resolve and move beyond multiple paradoxes and contradictions that arose from the initial reasonable assumption of a large common ground. Here, we begin by introducing the perspective of neuromechanics, which emphasizes that real-world behavior emerges from the intimate interactions among the physical structure of the system, the mechanical requirements of a task, the feasible neural control actions to produce it, and the ability of the neuromuscular system to adapt through interactions with the environment. This allows us to articulate a succinct overview of a few salient conceptual paradoxes and contradictions regarding under-determined vs. over-determined mechanics, under- vs. over-actuated control, prescribed vs. emergent function, learning vs. implementation vs. adaptation, prescriptive vs. descriptive synergies, and optimal vs. habitual performance. We conclude by presenting open questions and suggesting directions for future research. We hope this frank and open-minded assessment of the state-of-the-art will encourage and guide these communities to continue to interact and make progress in these important areas at the interface of neuromechanics, neuroscience, rehabilitation and robotics.
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Affiliation(s)
- Francisco J Valero-Cuevas
- Biomedical Engineering Department, University of Southern California, Los Angeles, CA, USA.
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA.
| | - Marco Santello
- School of Biological and Health Systems Engineering Arizona State University, Tempe, AZ, USA
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14
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Khrapov YV, Alekseev DE, Svistov DV. [A new concept of organization and scope of neurosurgical care in the US army during armed conflicts in the early 2000s]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 81:108-117. [PMID: 28291221 DOI: 10.17116/neiro2017807108-117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Military operations in various parts of the world in the early 2000s are becoming more regionalized; new warfare tactics emerge, which makes it necessary to review and modify the neurosurgical care system. The article reviews the results of original studies on this issue and summarizes the experience of the US Army medical service in Afghanistan and Iraq. The article discusses the structure of sanitary losses, organization and scope of medical and evacuation neurosurgical measures, types and techniques of surgical interventions, and the rate of complications. We describe five levels of neurosurgical care echelons and an implemented "injury control - neurosurgery" concept; particular attention is paid to the peculiarities of research and specialist training. We demonstrate that implementation of the new concept for organization and scope of neurosurgical care has improved treatment outcomes and reduced the mortality rate in the mentioned military conflicts of recent years compared to those in the Vietnam War. We may conclude that the described experience of the US Army can be used to improve the efficacy of neurosurgical care to the wounded and victims of armed conflicts.
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Affiliation(s)
- Yu V Khrapov
- Military Hospital #413, Defense Ministry of the Russian Federation, Volgograd, Russia
| | - D E Alekseev
- Kirov Military Medical Academy, Defense Ministry of the Russian Federation, Saint-Petersburg, Russia
| | - D V Svistov
- Kirov Military Medical Academy, Defense Ministry of the Russian Federation, Saint-Petersburg, Russia
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Lydon HL, Hall CA, Dalton CH, Chipman JK, Graham JS, Chilcott RP. Development of haemostatic decontaminants for treatment of wounds contaminated with chemical warfare agents. 3: Evaluation of in vitro
topical decontamination efficacy using damaged skin. J Appl Toxicol 2017; 37:976-984. [DOI: 10.1002/jat.3446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/06/2016] [Accepted: 12/28/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Helen L. Lydon
- Centre for Radiation, Chemical and Environmental Hazards; Health Protection Agency; Chilton UK
- University of Birmingham; Edgbaston Birmingham UK
| | - Charlotte A. Hall
- Centre for Radiation, Chemical and Environmental Hazards; Health Protection Agency; Chilton UK
- University of Birmingham; Edgbaston Birmingham UK
| | | | | | - John S. Graham
- Medical Toxicology Branch Analytical Toxicology Division; US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground; MD 21010 USA
| | - Robert P. Chilcott
- Centre for Radiation, Chemical and Environmental Hazards; Health Protection Agency; Chilton UK
- Research Centre for Topical Drug Delivery and Toxicology; University of Hertfordshire; Hatfield UK
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16
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Nathan DE, Bellgowan JF, Oakes TR, French LM, Nadar SR, Sham EB, Liu W, Riedy G. Assessing Quantitative Changes in Intrinsic Thalamic Networks in Blast and Nonblast Mild Traumatic Brain Injury: Implications for Mechanisms of Injury. Brain Connect 2016; 6:389-402. [PMID: 26956452 DOI: 10.1089/brain.2015.0403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the global war on terror, the increased use of improvised explosive devices has resulted in increased incidence of blast-related mild traumatic brain injury (mTBI). Diagnosing mTBI is both challenging and controversial due to heterogeneity of injury location, trauma intensity, transient symptoms, and absence of focal biomarkers on standard clinical imaging modalities. The goal of this study is to identify a brain biomarker that is sensitive to mTBI injury. Research suggests the thalamus may be sensitive to changes induced by mTBI. A significant number of connections to and from various brain regions converge at the thalamus. In addition, the thalamus is involved in information processing, integration, and regulation of specific behaviors and mood. In this study, changes in task-free thalamic networks as quantified by graph theory measures in mTBI blast (N = 186), mTBI nonblast (N = 80), and controls (N = 21) were compared. Results show that the blast mTBI group had significant hyper-connectivity compared with the controls and nonblast mTBI group. However, after controlling for post-traumatic stress symptoms (PTSS), the blast mTBI group was not different from the controls, but the nonblast mTBI group showed significant hypo-connectivity. The results suggest that there are differences in the mechanisms of injury related to mTBI as reflected in the architecture of the thalamic networks. However, the effect of PTSS and its relationship to mTBI is difficult to distinguish and warrants more research.
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Affiliation(s)
- Dominic E Nathan
- 1 National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center , Bethesda, Maryland.,2 North Tide LLC , Dulles, Virginia.,3 Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Julie F Bellgowan
- 1 National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center , Bethesda, Maryland.,2 North Tide LLC , Dulles, Virginia
| | - Terrence R Oakes
- 1 National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center , Bethesda, Maryland
| | - Louis M French
- 1 National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center , Bethesda, Maryland.,4 Center of Neuroscience and Regenerative Medicine (CNRM) , Bethesda, Maryland
| | - Sreenivasan R Nadar
- 1 National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center , Bethesda, Maryland.,5 Henry M. Jackson Foundation , Bethesda, Maryland
| | - Elyssa B Sham
- 1 National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center , Bethesda, Maryland.,2 North Tide LLC , Dulles, Virginia
| | - Wei Liu
- 1 National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center , Bethesda, Maryland.,2 North Tide LLC , Dulles, Virginia
| | - Gerard Riedy
- 1 National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center , Bethesda, Maryland.,3 Uniformed Services University of the Health Sciences , Bethesda, Maryland
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17
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Chatfield-Ball C, Boyle P, Autier P, van Wees SH, Sullivan R. Lessons learned from the casualties of war: battlefield medicine and its implication for global trauma care. J R Soc Med 2015; 108:93-100. [PMID: 25792616 DOI: 10.1177/0141076815570923] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
According to the Global Burden of Disease, trauma is now responsible for five million deaths each year. High-income countries have made great strides in reducing trauma-related mortality figures but low-middle-income countries have been left behind with high trauma-related fatality rates, primarily in the younger population. Much of the progress high-income countries have made in managing trauma rests on advances developed in their armed forces. This analysis looks at the recent advances in high-income military trauma systems and the potential transferability of those developments to the civilian health systems particularly in low-middle-income countries. It also evaluates some potential lifesaving trauma management techniques, proven effective in the military, and the barriers preventing these from being implemented in civilian settings.
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Affiliation(s)
| | - Peter Boyle
- University of Strathclyde Institute of Global Public Health at iPRI, Lyon, 69130 France International Prevention Research Institute, Lyon, 69130 France
| | - Philippe Autier
- University of Strathclyde Institute of Global Public Health at iPRI, Lyon, 69130 France International Prevention Research Institute, Lyon, 69130 France
| | | | - Richard Sullivan
- Conflict & Health Research Group, King's Centre for Global Health, Kings College London, London SE5 9RJ, UK
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Chico-Fernández M, Terceros-Almanza LL, Mudarra-Reche CC. Innovation and new trends in critical trauma disease. Med Intensiva 2014; 39:179-88. [PMID: 25449666 DOI: 10.1016/j.medin.2014.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/05/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
Abstract
The management of critical trauma disease (CTD) has always trends the trends in military war experiences. These conflicts have historically revolutionized clinical concepts, clinical practice guidelines and medical devices, and have marked future lines of research and aspects of training and learning in severe trauma care. Moreover, in the civil setting, the development of intensive care, technological advances and the testing of our healthcare systems in the management of multiple victims, hasve also led to a need for innovation in our trauma care systems.
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Affiliation(s)
- M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Grupo de Trabajo de Trauma y Neurocríticos de la SEMICYUC.
| | - L L Terceros-Almanza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Grupo de Trabajo de Trauma y Neurocríticos de la SEMICYUC
| | - C C Mudarra-Reche
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Grupo de Trabajo de Trauma y Neurocríticos de la SEMICYUC
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Senanayake EL, Poon H, Graham TR, Midwinter MJ. UK specialist cardiothoracic management of thoracic injuries in military casualties sustained in the wars in Iraq and Afghanistan. Eur J Cardiothorac Surg 2014; 45:e202-3207. [DOI: 10.1093/ejcts/ezu076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Epidemiology of moderate-to-severe penetrating versus closed traumatic brain injury in the Iraq and Afghanistan wars. J Trauma Acute Care Surg 2012. [DOI: 10.1097/ta.0b013e318275473c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Beck JJ. Trauma imaging in and out of conflict: A review of the evidence. Radiography (Lond) 2012. [DOI: 10.1016/j.radi.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Bjerkan G, Iversen P, Asak H, Pillgram-Larsen J, Rolandsen BÅ. Krig er alvor - sårede og falne norske soldater i Afghanistan. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:1076-9. [DOI: 10.4045/tidsskr.11.1441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Schulz C, Kunz U, Mauer UM. Three years of neurosurgical experience in a multinational field hospital in northern Afghanistan. Acta Neurochir (Wien) 2012; 154:135-40; discussion 140. [PMID: 22005958 DOI: 10.1007/s00701-011-1185-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/21/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since July 2007, neurosurgical services have been continuously available in a multinational Role 3 field hospital in Mazar-e-Sharif (MeS), Afghanistan. In this paper, we analyse a 3-year neurosurgical caseload experience. METHODS We retrospectively analysed the neurosurgical caseload at a Role 3 medical treatment facility in northern Afghanistan between October 2007 and October 2010. The cases were divided into acute, urgent and elective procedures and into cranial, spinal, peripheral nerve and miscellaneous surgeries. RESULTS A total of 190 surgeries were performed. Of these, 50 operations (26.3%) were acute procedures that were conducted to save lives or preserve neurological function. In addition, operations included 47 urgent (24.7%) and 93 elective (49%) procedures. There were 58 cranial surgeries (30.5%), 113 spinal surgeries (59.5%), 11 peripheral nerve surgeries (5.8%), and 8 miscellaneous surgeries (4.2%). Surgical treatment was provided to 13 International Security Assistance Force (ISAF) soldiers (6.8%), 22 members of the Afghan National Security Forces (11.6%), and 155 Afghan civilians (81.6%). CONCLUSIONS The primary mission of the field hospital is to provide sick, injured or wounded ISAF personnel with medical and surgical care, the outcome of which must correspond to standards prevailing in Germany. Only a very small number of neurosurgical operations performed in MeS met the criteria established by this mission statement and by the modern principles of damage-control wartime surgery. This is completely different from the experience reported by other ISAF nations in eastern and southern Afghanistan.
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Affiliation(s)
- Chris Schulz
- Department of Neurosurgery, German Armed Forces Hospital Ulm, Germany.
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Affiliation(s)
- Hasan B Alam
- Harvard Medical School, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA
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25
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Current world literature. Curr Opin Anaesthesiol 2011; 24:224-33. [PMID: 21386670 DOI: 10.1097/aco.0b013e32834585d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW To review the emerging literature on traumatic brain injury (TBI) caused by explosive blast. RECENT FINDINGS Efforts are underway to understand how explosive blast injures brain, what is the clinical presentation and how best to manage it. A major way blast injures brain is from detonation pressure waves coupling to a victim's head leading to brain deformation. The effect of other explosion-related elements is unknown. Because scientific insights take time to develop but injuries are occurring now, the military adopts existing civilian standard of care practices developed for similar diseases, such as the Guidelines for the Management of Severe Traumatic Brain Injury developed mainly for closed head TBI. When these do not exist, the military creates them, such as the Veterans Administration and Department of Defense Clinical Practice Guidelines for Concussion/Mild TBI. Another treatment advance is the creation of the first large system-wide approach to diagnosis and clinical management of TBI, which begins at the site of injury and extends through both the military and the Veterans' Administration medical care systems. SUMMARY Explosive blast TBI is being addressed at all levels - basic research through clinical care. New clinical practice guidelines are being used in a standardized system-wide approach.
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Sniffing enables communication and environmental control for the severely disabled. Proc Natl Acad Sci U S A 2010; 107:14413-8. [PMID: 20660716 DOI: 10.1073/pnas.1006746107] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Paradoxically, improvements in emergency medicine have increased survival albeit with severe disability ranging from quadriplegia to "locked-in syndrome." Locked-in syndrome is characterized by intact cognition yet complete paralysis, and hence these individuals are "locked-in" their own body, at best able to communicate using eye blinks alone. Sniffing is a precise sensory-motor acquisition entailing changes in nasal pressure. The fine control of sniffing depends on positioning the soft palate, which is innervated by multiple cranial nerves. This innervation pattern led us to hypothesize that sniffing may remain conserved following severe injury. To test this, we developed a device that measures nasal pressure and converts it into electrical signals. The device enabled sniffs to control an actuator with speed similar to that of a hand using a mouse or joystick. Functional magnetic resonance imaging of device usage revealed a widely distributed neural network, allowing for increased conservation following injury. Also, device usage shared neural substrates with language production, rendering sniffs a promising bypass mode of communication. Indeed, sniffing allowed completely paralyzed locked-in participants to write text and quadriplegic participants to write text and drive an electric wheelchair. We conclude that redirection of sniff motor programs toward alternative functions allows sniffing to provide a control interface that is fast, accurate, robust, and highly conserved following severe injury.
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