首页 > 最新文献

Military Medicine最新文献

英文 中文
A Comprehensive Summary of the Meta-Analyses and Systematic Reviews on Platelet-Rich Plasma Therapies for Knee Osteoarthritis. 关于富血小板血浆疗法治疗膝骨关节炎的元分析和系统综述的全面总结。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae022
Emily Mende, Ryan J Love, Jody-Lynn Young

Introduction: Osteoarthritis (OA), including that of the knee joint, represents a significant proportion of musculoskeletal injuries in the Canadian Armed Forces (CAF) due to the frequent, high-stress physical activity for which member participation is necessary. Platelet-rich plasma (PRP) is a conservative, autologous treatment that has the potential to relieve symptoms and improve functionality of military members to decrease the impact of the disease and ultimately strengthen the CAF.

Materials and methods: A search of systematic reviews and meta-analyses was conducted to determine the efficacy of PRP injections in treating knee OA. The Scopus database, PubMed database, and Omni academic search tools were scoped for relevant publications. English literature, published up to and including March 2023, that investigated only clinically randomized controlled trials (RCTs) was eligible for inclusion. The results of network meta-analyses were investigated and summarized independent of reviews and non-network meta-analyses.

Results: A total of 225 unique systematic reviews and meta-analyses were initially identified, of which 39 publications, including 7 network meta-analyses, adhered to the defined inclusion and exclusion criteria. PRP was found to significantly alleviate symptoms of pain based on the visual analog scale and Western Ontario and McMaster Universities Arthritis Index pain scores within the 12-month follow-up. Function, activity, sport, quality of life, and stiffness were additionally determined to generally improve to a greater extent from PRP treatment compared to controls, while adverse effects were minor and temporary. PRP placed in the top 3 in 9 reported surface under the cumulative ranking curves, while individually reported rankings of leukocyte-poor and leukocyte-rich PRP both placed in the top 4. The clinical recommendations made were generally positive, with 17 publications acknowledging the benefits of PRP, 3 supporting possible efficacy, and an additional 8 recommending that it be an option for the conservative treatment of knee OA.

Conclusion: The results of this review support the efficacy of PRP for relieving symptoms of pain and improving function, stiffness, and quality of life for patients experiencing knee OA within 12 months. As a result, leukocyte-poor-PRP could be considered for members of the CAF with mild to moderate knee OA (Kellgren-Lawrence grades 1-3) to slow the progression of OA and extend the military careers of CAF members. There continues to be a need for future studies to investigate the longer-term effects of PRP to verify sustained benefits at follow-up points greater than 12 months, including findings of improvement in a delayed fashion at the 3- and 6-month timeframe compared to hyaluronic acid treatment.

导言:骨关节炎(OA),包括膝关节骨关节炎,在加拿大武装部队(CAF)的肌肉骨骼损伤中占很大比例,这是因为成员必须参加频繁、高压力的体育活动。富血小板血浆(PRP)是一种保守的自体治疗方法,有可能缓解症状并改善军人的功能,从而减少疾病的影响,最终增强加拿大武装部队的实力:为了确定 PRP 注射治疗膝关节 OA 的疗效,我们对系统综述和荟萃分析进行了检索。在 Scopus 数据库、PubMed 数据库和 Omni 学术搜索工具中搜索了相关出版物。截至 2023 年 3 月(含 2023 年 3 月)发表的只调查临床随机对照试验 (RCT) 的英文文献符合纳入条件。对独立于综述和非网络荟萃分析的网络荟萃分析结果进行了调查和总结:结果:最初共确定了 225 篇独特的系统综述和荟萃分析,其中 39 篇出版物(包括 7 篇网络荟萃分析)符合规定的纳入和排除标准。研究发现,根据视觉模拟量表和西安大略及麦克马斯特大学关节炎指数疼痛评分,PRP能在12个月的随访中明显减轻疼痛症状。此外,与对照组相比,PRP 治疗在功能、活动、运动、生活质量和僵硬度方面的改善程度更大,而不良反应轻微且暂时。在累积排名曲线下的 9 个报告表面中,PRP 排在前 3 位,而单独报告的白细胞贫乏型和白细胞丰富型 PRP 排名均排在前 4 位。临床建议总体上是积极的,有 17 篇文献承认 PRP 的益处,3 篇文献支持其可能的疗效,另有 8 篇文献建议将其作为膝关节 OA 保守治疗的一种选择:本综述结果支持 PRP 在 12 个月内缓解膝关节 OA 患者的疼痛症状并改善其功能、僵硬程度和生活质量的疗效。因此,对于患有轻度至中度膝关节 OA(凯尔格伦-劳伦斯 1-3 级)的中国空军成员,可以考虑使用白细胞贫化的 PRP,以减缓 OA 的进展,延长中国空军成员的军旅生涯。未来仍有必要对 PRP 的长期效果进行研究,以验证其在超过 12 个月的随访中的持续疗效,包括与透明质酸治疗相比,在 3 个月和 6 个月的随访中发现的延迟改善。
{"title":"A Comprehensive Summary of the Meta-Analyses and Systematic Reviews on Platelet-Rich Plasma Therapies for Knee Osteoarthritis.","authors":"Emily Mende, Ryan J Love, Jody-Lynn Young","doi":"10.1093/milmed/usae022","DOIUrl":"10.1093/milmed/usae022","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoarthritis (OA), including that of the knee joint, represents a significant proportion of musculoskeletal injuries in the Canadian Armed Forces (CAF) due to the frequent, high-stress physical activity for which member participation is necessary. Platelet-rich plasma (PRP) is a conservative, autologous treatment that has the potential to relieve symptoms and improve functionality of military members to decrease the impact of the disease and ultimately strengthen the CAF.</p><p><strong>Materials and methods: </strong>A search of systematic reviews and meta-analyses was conducted to determine the efficacy of PRP injections in treating knee OA. The Scopus database, PubMed database, and Omni academic search tools were scoped for relevant publications. English literature, published up to and including March 2023, that investigated only clinically randomized controlled trials (RCTs) was eligible for inclusion. The results of network meta-analyses were investigated and summarized independent of reviews and non-network meta-analyses.</p><p><strong>Results: </strong>A total of 225 unique systematic reviews and meta-analyses were initially identified, of which 39 publications, including 7 network meta-analyses, adhered to the defined inclusion and exclusion criteria. PRP was found to significantly alleviate symptoms of pain based on the visual analog scale and Western Ontario and McMaster Universities Arthritis Index pain scores within the 12-month follow-up. Function, activity, sport, quality of life, and stiffness were additionally determined to generally improve to a greater extent from PRP treatment compared to controls, while adverse effects were minor and temporary. PRP placed in the top 3 in 9 reported surface under the cumulative ranking curves, while individually reported rankings of leukocyte-poor and leukocyte-rich PRP both placed in the top 4. The clinical recommendations made were generally positive, with 17 publications acknowledging the benefits of PRP, 3 supporting possible efficacy, and an additional 8 recommending that it be an option for the conservative treatment of knee OA.</p><p><strong>Conclusion: </strong>The results of this review support the efficacy of PRP for relieving symptoms of pain and improving function, stiffness, and quality of life for patients experiencing knee OA within 12 months. As a result, leukocyte-poor-PRP could be considered for members of the CAF with mild to moderate knee OA (Kellgren-Lawrence grades 1-3) to slow the progression of OA and extend the military careers of CAF members. There continues to be a need for future studies to investigate the longer-term effects of PRP to verify sustained benefits at follow-up points greater than 12 months, including findings of improvement in a delayed fashion at the 3- and 6-month timeframe compared to hyaluronic acid treatment.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139996806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ultrasound-Guided Lidocaine Injection as a Novel Predictor of Response to Botulinum for Patients With Myofascial Pain Syndrome: A Case Report. 超声引导下的利多卡因注射是预测肌筋膜疼痛综合征患者对肉毒素反应的新方法:病例报告。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae201
Olivia A Agee, Jeffery C Leggit

Botulinum injection is a well-known non-surgical intervention utilized in the management of myofascial pain syndrome (MPS). However, sparse evidence exists regarding the utility of ultrasound guidance of injectate or lidocaine as a predictive marker of patient response to botulinum toxin A (BTX-A). A 39-year-old male active duty service member demonstrated typical signs and symptoms of MPS. He reported a 10-year history of neck and back spasms that were triggered by exertion but also could occur spontaneously. Based on the characteristic regional motor-sensory defects, treatment options were discussed. With shared decision-making, the patient opted to try ultrasound-guided injection of lidocaine followed by xenomin brand BotoxA. Immediately following lidocaine injection, the patient reported complete relief of symptoms. Both injections were uncomplicated, and the patient reported great reduction in symptoms during the subsequent visit 2 months later. Relief of pain following ultrasound-guided injection of lidocaine may serve as an indicator of successful patient response to BTX-A in patients with MPS.

肉毒杆菌注射是治疗肌筋膜疼痛综合征(MPS)的一种众所周知的非手术干预方法。然而,关于注射剂或利多卡因的超声引导作为患者对 A 型肉毒毒素(BTX-A)反应的预测标志物的效用,目前证据还很稀少。一名 39 岁的男性现役军人表现出 MPS 的典型体征和症状。他报告说自己有 10 年的颈部和背部痉挛病史,这些痉挛会在用力时触发,但也可能自发发生。根据特征性区域运动感觉缺陷,讨论了治疗方案。在共同决策的情况下,患者选择尝试在超声引导下注射利多卡因,然后再注射xenomin品牌的肉毒杆菌毒素A。注射利多卡因后,患者立即报告症状完全缓解。两次注射都不复杂,患者在两个月后的复诊中表示症状大为减轻。超声引导下注射利多卡因后疼痛的缓解可作为 MPS 患者对 BTX-A 成功应答的指标。
{"title":"Ultrasound-Guided Lidocaine Injection as a Novel Predictor of Response to Botulinum for Patients With Myofascial Pain Syndrome: A Case Report.","authors":"Olivia A Agee, Jeffery C Leggit","doi":"10.1093/milmed/usae201","DOIUrl":"10.1093/milmed/usae201","url":null,"abstract":"<p><p>Botulinum injection is a well-known non-surgical intervention utilized in the management of myofascial pain syndrome (MPS). However, sparse evidence exists regarding the utility of ultrasound guidance of injectate or lidocaine as a predictive marker of patient response to botulinum toxin A (BTX-A). A 39-year-old male active duty service member demonstrated typical signs and symptoms of MPS. He reported a 10-year history of neck and back spasms that were triggered by exertion but also could occur spontaneously. Based on the characteristic regional motor-sensory defects, treatment options were discussed. With shared decision-making, the patient opted to try ultrasound-guided injection of lidocaine followed by xenomin brand BotoxA. Immediately following lidocaine injection, the patient reported complete relief of symptoms. Both injections were uncomplicated, and the patient reported great reduction in symptoms during the subsequent visit 2 months later. Relief of pain following ultrasound-guided injection of lidocaine may serve as an indicator of successful patient response to BTX-A in patients with MPS.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exploring Combat Tourniquet Application Errors and Duration Among Skilled and Novice Medical Trainees. 探讨熟练和新手受训医护人员使用战斗止血带的错误和持续时间。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae277
Bradley A Drahos, Katelyn R Schwieters, Curtis M Craig, Jack E Norfleet, Mark V Mazzeo, Nichole L Morris

Introduction: The use of tourniquets in combat medicine continues to be a key focus as they have consistently been shown to combat one of the leading causes of preventable death on the battlefield, massive hemorrhage to extremities. The present study analyzed tourniquet application among combat medics (68W) and combat lifesavers (CLSs) in a training environment to determine whether trainees' performance is consistent among one another and whether performance can be associated with participant demographics such as experience or role.

Materials and methods: Study participants treated male and female patient simulators within a tactical field care phase, both of which experienced an amputated leg and required the application of a Combat Application Tourniquet (CAT). To assess tourniquet application variability and performance, a series of application subtasks and potential errors were measured via video coding of the scenarios by a team of 5 coders. Time to tourniquet application and tourniquet application duration were also coded to assess correlations between application duration and variability or performance.

Results: Results from analyzing tourniquet application subtasks and errors through a series of one-way ANOVA tests showed that application of the CAT first, hasty CAT application, and high tourniquet application were not predictive of participant role, time within the role, and self-reported tourniquet skill, confidence, or experience. Such demographic variables were also not predictive of successful tourniquet application as defined by the number of windlass rod rotations. Results from binomial logistic regressions showed that participant role and self-reported tourniquet skill and experience were predictors of tourniquet application duration.

Conclusion: The findings suggest that high variability in CAT application methodology and performance exists among CLS and combat medics, which is largely not predictable by various demographics such as role, experience within the designated role, and self-reported confidence, skill, or experience. The observed disconnect between training or experience and CAT application performance suggests substantial variability in the consistency of training for both CLS and 68W soldiers. These inconsistencies may stem from variability in instructor knowledge, teaching styles, or training materials or may be developed through informal methods such as experiences in the field or recommendations from colleagues and experts. These findings highlight a potential need to reassess CAT application training, particularly in regard to consistency and validation. Finally, it should be noted that the study's findings may be limited or fail to capture some study effects because of the sample size and wide range of reported experience among participants.

简介:止血带在战斗医疗中的使用仍然是一个重点,因为止血带一直被证明可以消除战场上可预防死亡的主要原因之一--四肢大出血。本研究分析了战斗医护人员(68W)和战斗救生员(CLS)在训练环境中使用止血带的情况,以确定学员之间的表现是否一致,以及表现是否与学员的人口统计学特征(如经验或角色)有关:研究人员在战术野战护理阶段对男性和女性患者模拟人进行了治疗,这两名模拟人都经历了截肢,需要使用战斗应用止血带(CAT)。为了评估止血带应用的可变性和性能,由 5 名编码员组成的小组通过对场景进行视频编码,对一系列应用子任务和潜在错误进行了测量。此外,还对使用止血带的时间和使用止血带的持续时间进行了编码,以评估使用止血带的持续时间与可变性或表现之间的相关性:结果:通过一系列单因子方差分析对使用止血带的子任务和错误进行分析的结果表明,首先使用 CAT、匆忙使用 CAT 和大量使用止血带与参与者的角色、在角色中的时间以及自我报告的止血带技能、信心或经验无关。这些人口统计学变量也无法预测成功使用止血带的情况(以卷扬杆旋转次数来定义)。二项逻辑回归结果表明,参与者的角色、自我报告的止血带技能和经验是预测使用止血带持续时间的因素:研究结果表明,CLS 和作战医护人员在使用止血带的方法和表现上存在很大差异,这在很大程度上无法通过各种人口统计学特征(如角色、指定角色的经验以及自我报告的信心、技能或经验)来预测。观察到的训练或经验与 CAT 应用表现之间的脱节表明,CLS 和 68W 士兵的训练一致性存在很大差异。这些不一致性可能源于教官知识、教学风格或培训材料的差异,也可能是通过非正式方法形成的,如实战经验或同事和专家的建议。这些发现凸显了重新评估 CAT 应用培训的潜在必要性,特别是在一致性和验证方面。最后,需要指出的是,由于样本量和参与者报告的经验范围较广,研究结果可能存在局限性或未能反映某些研究效果。
{"title":"Exploring Combat Tourniquet Application Errors and Duration Among Skilled and Novice Medical Trainees.","authors":"Bradley A Drahos, Katelyn R Schwieters, Curtis M Craig, Jack E Norfleet, Mark V Mazzeo, Nichole L Morris","doi":"10.1093/milmed/usae277","DOIUrl":"10.1093/milmed/usae277","url":null,"abstract":"<p><strong>Introduction: </strong>The use of tourniquets in combat medicine continues to be a key focus as they have consistently been shown to combat one of the leading causes of preventable death on the battlefield, massive hemorrhage to extremities. The present study analyzed tourniquet application among combat medics (68W) and combat lifesavers (CLSs) in a training environment to determine whether trainees' performance is consistent among one another and whether performance can be associated with participant demographics such as experience or role.</p><p><strong>Materials and methods: </strong>Study participants treated male and female patient simulators within a tactical field care phase, both of which experienced an amputated leg and required the application of a Combat Application Tourniquet (CAT). To assess tourniquet application variability and performance, a series of application subtasks and potential errors were measured via video coding of the scenarios by a team of 5 coders. Time to tourniquet application and tourniquet application duration were also coded to assess correlations between application duration and variability or performance.</p><p><strong>Results: </strong>Results from analyzing tourniquet application subtasks and errors through a series of one-way ANOVA tests showed that application of the CAT first, hasty CAT application, and high tourniquet application were not predictive of participant role, time within the role, and self-reported tourniquet skill, confidence, or experience. Such demographic variables were also not predictive of successful tourniquet application as defined by the number of windlass rod rotations. Results from binomial logistic regressions showed that participant role and self-reported tourniquet skill and experience were predictors of tourniquet application duration.</p><p><strong>Conclusion: </strong>The findings suggest that high variability in CAT application methodology and performance exists among CLS and combat medics, which is largely not predictable by various demographics such as role, experience within the designated role, and self-reported confidence, skill, or experience. The observed disconnect between training or experience and CAT application performance suggests substantial variability in the consistency of training for both CLS and 68W soldiers. These inconsistencies may stem from variability in instructor knowledge, teaching styles, or training materials or may be developed through informal methods such as experiences in the field or recommendations from colleagues and experts. These findings highlight a potential need to reassess CAT application training, particularly in regard to consistency and validation. Finally, it should be noted that the study's findings may be limited or fail to capture some study effects because of the sample size and wide range of reported experience among participants.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An Analysis of the Association of Arrival Hemoglobin With Overtransfusion at 24 Hours in a Trauma Population. 分析创伤患者到达时的血红蛋白与 24 小时内输血过量的关系。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae293
Nicholas K Lahvic, Steven G Schauer, Sophie S Higgins, Jay A Johannigman, Kurt W Grathwohl

Background: Hemorrhage control and resuscitative concepts have evolved in recent years, leading to aggressive use of blood products in trauma patients. There is subsequently a potential risk for overtransfusion, adverse effects, and waste associated with unnecessary transfusion. Methods for conserving blood products are of particular importance in future large-scale combat operations where supply chains are likely to be strained. This study examined the association of emergency department (ED) arrival hemoglobin (HGB) with overtransfusion among survivors at 24 hours after major trauma at a military trauma center.

Materials and methods: We performed a retrospective cohort study of patients who had a "major trauma" activation and received any red blood cells. Overtransfusion was defined as a HGB level ≥11.0 g/dL at 24 hours (outcome variable). Multivariable logistic regression statistics were used to compare groups and adjust for confounders (injury severity score, arrival modified shock index, injury type, age, and gender). A receiver operating characteristic was constructed with overtransfusion at 24 hours as the outcome (binary) and arrival HGB (continuous) as the independent variable.

Results: A total of 382 patients met inclusion criteria. Overtransfusion occurred in 30.4% (n = 116) of patients, with mean ED HGB levels of 13.2 g/dL (12.9 to 13.6) versus 11.6 g/dL (11.3 to 11.8, P < .001). Receiver operating characteristic analysis showed that ED HGB was highly sensitive (0.931) for predicting 24-hour overtransfusion. In our multivariable logistic regression analysis, when adjusting for injury severity score, arrival modified shock index, injury type, age, and gender, we found that the ED HGB value had a per-unit odds ratio of 1.60 (95% CI, 1.38 to 1.86) for 24-hour overtransfusion. Hospital and intensive care unit length of stay, mechanical ventilator days, and mortality did not increase.

Conclusion: We found that the arrival HGB value was associated with overtransfusion among 24-hour survivors in a civilian trauma setting. Our findings will inform future prospective studies that investigate blood sparing clinical practice guidelines.

背景:近年来,出血控制和复苏理念不断发展,导致创伤患者积极使用血液制品。随之而来的是过度输血、不良反应以及不必要输血造成浪费的潜在风险。在未来的大规模作战行动中,保存血液制品的方法尤为重要,因为在这种情况下,供应链可能会出现紧张。本研究探讨了急诊科(ED)到达血红蛋白(HGB)与军事创伤中心重大创伤后 24 小时内幸存者过度输血的关系:我们对发生 "重大创伤 "并接受过任何红细胞的患者进行了一项回顾性队列研究。输血过量的定义是 24 小时内 HGB 水平≥11.0 g/dL(结果变量)。多变量逻辑回归统计用于比较各组,并调整混杂因素(损伤严重程度评分、到达时修正休克指数、损伤类型、年龄和性别)。以 24 小时内输血量过大为结果(二元),以到达时 HGB(连续)为自变量,构建了接收者操作特征:共有 382 名患者符合纳入标准。30.4%的患者(n = 116)发生了过度输血,平均 ED HGB 水平为 13.2 g/dL(12.9 至 13.6)对 11.6 g/dL(11.3 至 11.8,P 结论:我们发现,在平民创伤环境中,到达时的 HGB 值与 24 小时幸存者的过度输血有关。我们的研究结果将为今后调查血液稀释临床实践指南的前瞻性研究提供参考。
{"title":"An Analysis of the Association of Arrival Hemoglobin With Overtransfusion at 24 Hours in a Trauma Population.","authors":"Nicholas K Lahvic, Steven G Schauer, Sophie S Higgins, Jay A Johannigman, Kurt W Grathwohl","doi":"10.1093/milmed/usae293","DOIUrl":"10.1093/milmed/usae293","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhage control and resuscitative concepts have evolved in recent years, leading to aggressive use of blood products in trauma patients. There is subsequently a potential risk for overtransfusion, adverse effects, and waste associated with unnecessary transfusion. Methods for conserving blood products are of particular importance in future large-scale combat operations where supply chains are likely to be strained. This study examined the association of emergency department (ED) arrival hemoglobin (HGB) with overtransfusion among survivors at 24 hours after major trauma at a military trauma center.</p><p><strong>Materials and methods: </strong>We performed a retrospective cohort study of patients who had a \"major trauma\" activation and received any red blood cells. Overtransfusion was defined as a HGB level ≥11.0 g/dL at 24 hours (outcome variable). Multivariable logistic regression statistics were used to compare groups and adjust for confounders (injury severity score, arrival modified shock index, injury type, age, and gender). A receiver operating characteristic was constructed with overtransfusion at 24 hours as the outcome (binary) and arrival HGB (continuous) as the independent variable.</p><p><strong>Results: </strong>A total of 382 patients met inclusion criteria. Overtransfusion occurred in 30.4% (n = 116) of patients, with mean ED HGB levels of 13.2 g/dL (12.9 to 13.6) versus 11.6 g/dL (11.3 to 11.8, P < .001). Receiver operating characteristic analysis showed that ED HGB was highly sensitive (0.931) for predicting 24-hour overtransfusion. In our multivariable logistic regression analysis, when adjusting for injury severity score, arrival modified shock index, injury type, age, and gender, we found that the ED HGB value had a per-unit odds ratio of 1.60 (95% CI, 1.38 to 1.86) for 24-hour overtransfusion. Hospital and intensive care unit length of stay, mechanical ventilator days, and mortality did not increase.</p><p><strong>Conclusion: </strong>We found that the arrival HGB value was associated with overtransfusion among 24-hour survivors in a civilian trauma setting. Our findings will inform future prospective studies that investigate blood sparing clinical practice guidelines.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tips: Leading From the Middle of an Organization. 提示:从组织中层开始领导。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae444
Kristin Mangalindan, Elexis McBee

The vast majority of medical officers and physicians are called upon to lead from the middle of the organization. To be effective, one must understand the different approaches needed to exert positive influence up, down, and across the chain of command while delineating the overlapping relationship between leadership and management.

绝大多数医务官员和医生都被要求从组织的中层进行领导。要想有效地发挥领导作用,就必须了解在指挥链的上下左右施加积极影响所需的不同方法,同时划清领导与管理之间的重叠关系。
{"title":"Tips: Leading From the Middle of an Organization.","authors":"Kristin Mangalindan, Elexis McBee","doi":"10.1093/milmed/usae444","DOIUrl":"10.1093/milmed/usae444","url":null,"abstract":"<p><p>The vast majority of medical officers and physicians are called upon to lead from the middle of the organization. To be effective, one must understand the different approaches needed to exert positive influence up, down, and across the chain of command while delineating the overlapping relationship between leadership and management.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Return to Sport and Duty in French Military Personnel After Medial Opening Wedge High Tibial Osteotomy. 法国军人胫骨内侧开口楔形高位截骨术后恢复运动和履行职责的情况。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae005
Bernard de Geofroy, Lucas Chateau, Olivier Barbier, Thomas Demoures, Sébastien Coste, Laurent Mathieu, Nicolas de L'Escalopier, Camille Choufani

Introduction: Medial opening wedge high tibial osteotomy (MOWHTO) is a surgical option for medial femorotibial osteoarthritis, which preserves articular cartilage by correcting the extra-articular deformities of the lower limbs that cause osteoarthritis. This is an increasingly popular treatment in a population with high functional demand, such as the French military population. The aim of this study was to evaluate the rate of return to work and military activities at 6 months postsurgery and at last follow-up in this military population following MOWHTO.The hypothesis of this study was that MOWHTO enabled a majority of service members to return to the same level of activity within 6 months of surgery.

Materials and methods: This was a retrospective, multicenter study including all French military personnel operated on for MOWHTO alone for osteoarthritis of medial compartment between 2008 and 2018 in different Military Teaching Hospitals. We excluded civilian patients. For each patient, a questionnaire was used to collect epidemiological, professional, sports, and functional data. The primary endpoint was the rate of return to work at 6 months postsurgery. We also studied the recovery of sports activities and functional results at a 6.6-year follow-up by standardized questionnaires (Tegner activity scale, Lysholm, IKDC subjective (International Knee Documentation Commitee)).

Results: Twenty-four MOWHTOs were performed during this period in a cohort of 22 French military personnel. Return to work at 6 months was possible in 20/24 cases (83.3%). Of the four patients who did not return to work at 6 months, two changed their activities, while the other two returned to their jobs after 6 months. The rate of resumption of sporting activities at an equal or higher level was 50% (11/22). There was no difference between pre- and postoperative Tegner Activity Scale scores at the longest follow-up (P = .08). The mean postoperative Lysholm scores were 73.5 (standard deviation 17.8) and IKDC 59 (standard deviation 8.7). No intraoperative complications were found, and one case of postoperative infection was found.

Conclusions: A total of 83% of the operated soldiers were able to return to their professional activities in less than 6 months. We observed a functional improvement at the last follow-up. Comparing these results with data from civilian populations, the rate of occupational recovery is comparable. However, the return to sport is much better in the series of nonmilitary patients with approximately 90% return to work and sport in the year following surgery. MOWHTO improves the functional results of the knee, enabling a return to work and sport in most cases in young, active populations such as the French military.

导言:股胫骨内侧开口楔形高位截骨术(MOWHTO)是治疗股胫骨内侧骨关节炎的一种手术选择,它通过矫正导致骨关节炎的下肢关节外畸形来保护关节软骨。在法国军人等对功能要求较高的人群中,这种治疗方法越来越受欢迎。本研究的目的是评估 MOWHTO 术后 6 个月和最后一次随访时军队人群恢复工作和军事活动的比率。本研究的假设是,MOWHTO 使大多数军人在术后 6 个月内恢复到相同的活动水平:这是一项回顾性多中心研究,包括2008年至2018年期间在不同军事教学医院接受单纯MOWHTO手术治疗内侧室骨关节炎的所有法国军人。我们排除了平民患者。我们对每位患者进行了问卷调查,以收集流行病学、职业、运动和功能数据。主要终点是术后 6 个月的恢复工作率。我们还通过标准化问卷(Tegner活动量表、Lysholm、IKDC主观问卷(国际膝关节文献委员会))研究了术后6.6年的运动恢复情况和功能效果:22名法国军人在此期间接受了24例MOWHTO手术。20/24例患者(83.3%)在6个月后可以重返工作岗位。4 名在 6 个月后未能重返工作岗位的患者中,有 2 人改变了活动方式,另外 2 人在 6 个月后重返工作岗位。恢复同等或更高水平体育活动的比例为 50%(11/22)。在最长的随访时间内,术前和术后的泰格纳活动量表(Tegner Activity Scale)评分没有差异(P = 0.08)。术后 Lysholm 评分的平均值为 73.5(标准差为 17.8),IKDC 评分为 59(标准差为 8.7)。术中未发现并发症,术后发现一例感染:结论:共有 83% 的手术士兵在不到 6 个月的时间内恢复了职业活动。在最后一次随访中,我们发现他们的功能得到了改善。将这些结果与来自平民的数据进行比较,职业恢复率不相上下。不过,非军人患者的运动恢复情况要好得多,约有 90% 的患者在术后一年内恢复了工作和运动。MOWHTO改善了膝关节的功能效果,使法国军人等年轻活跃人群在大多数情况下都能恢复工作和运动。
{"title":"Return to Sport and Duty in French Military Personnel After Medial Opening Wedge High Tibial Osteotomy.","authors":"Bernard de Geofroy, Lucas Chateau, Olivier Barbier, Thomas Demoures, Sébastien Coste, Laurent Mathieu, Nicolas de L'Escalopier, Camille Choufani","doi":"10.1093/milmed/usae005","DOIUrl":"10.1093/milmed/usae005","url":null,"abstract":"<p><strong>Introduction: </strong>Medial opening wedge high tibial osteotomy (MOWHTO) is a surgical option for medial femorotibial osteoarthritis, which preserves articular cartilage by correcting the extra-articular deformities of the lower limbs that cause osteoarthritis. This is an increasingly popular treatment in a population with high functional demand, such as the French military population. The aim of this study was to evaluate the rate of return to work and military activities at 6 months postsurgery and at last follow-up in this military population following MOWHTO.The hypothesis of this study was that MOWHTO enabled a majority of service members to return to the same level of activity within 6 months of surgery.</p><p><strong>Materials and methods: </strong>This was a retrospective, multicenter study including all French military personnel operated on for MOWHTO alone for osteoarthritis of medial compartment between 2008 and 2018 in different Military Teaching Hospitals. We excluded civilian patients. For each patient, a questionnaire was used to collect epidemiological, professional, sports, and functional data. The primary endpoint was the rate of return to work at 6 months postsurgery. We also studied the recovery of sports activities and functional results at a 6.6-year follow-up by standardized questionnaires (Tegner activity scale, Lysholm, IKDC subjective (International Knee Documentation Commitee)).</p><p><strong>Results: </strong>Twenty-four MOWHTOs were performed during this period in a cohort of 22 French military personnel. Return to work at 6 months was possible in 20/24 cases (83.3%). Of the four patients who did not return to work at 6 months, two changed their activities, while the other two returned to their jobs after 6 months. The rate of resumption of sporting activities at an equal or higher level was 50% (11/22). There was no difference between pre- and postoperative Tegner Activity Scale scores at the longest follow-up (P = .08). The mean postoperative Lysholm scores were 73.5 (standard deviation 17.8) and IKDC 59 (standard deviation 8.7). No intraoperative complications were found, and one case of postoperative infection was found.</p><p><strong>Conclusions: </strong>A total of 83% of the operated soldiers were able to return to their professional activities in less than 6 months. We observed a functional improvement at the last follow-up. Comparing these results with data from civilian populations, the rate of occupational recovery is comparable. However, the return to sport is much better in the series of nonmilitary patients with approximately 90% return to work and sport in the year following surgery. MOWHTO improves the functional results of the knee, enabling a return to work and sport in most cases in young, active populations such as the French military.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139642444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Doxycycline-Mediated Inhibition of Snake Venom Phospholipase and Metalloproteinase. 强力霉素介导的蛇毒磷脂酶和金属蛋白酶抑制作用
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae184
Daniel K Arens, Meaghan A Rose, Emelyn M Salazar, Merideth A Harvey, Eun Y Huh, April A Ford, Daniel W Thompson, Elda E Sanchez, Yoon Y Hwang
<p><strong>Introduction: </strong>Warfighters are exposed to life-threatening injuries daily and according to the Joint Trauma System Military Clinical Practice Guideline-Global Snake Envenomation Management snakebites are a concerning threat in all theaters of operation. Snake venom is a complex mixture of toxins including phospholipases A2 (PLA2) and snake venom metalloproteinases (SVMP) that produce myotoxic, hemotoxic, and cytotoxic injuries. Antibody-based antivenom is the standard of care but new approaches including small-molecule inhibitors have gained attention in recent years. Doxycycline is an effective inhibitor of human metalloproteinases and PLA2. The enzymatic activities of 3 phylogenetically distinct snakes: Agkistrodon piscivorus, Naja kaouthia, and Daboia russelii were tested under inhibitory conditions using doxycycline.</p><p><strong>Materials and methods: </strong>Enzymatic activity of PLA2 and SVMP was measured in N. kaouthia, D. russelii, and A. piscivorus venom alone and with doxycycline using EnzChek Phospholipase A2 and Gelatinase Assay Kits. A 1-way ANOVA with Tukey's post-hoc test was used to conduct comparative analysis. The median lethal dose of the venoms, the effective dose of doxycycline, and creatine kinase (CK) inhibition levels were measured in a murine model with adult Bagg Albino (BALB/c) mice using intramuscular injections. Median lethal and effective doses were determined using Spearman-Karber's method and a 1-way ANOVA with Tukey's post-hoc test was used to compare CK inhibition levels.</p><p><strong>Results: </strong>Phospholipases A2 activity was reduced to 1.5% to 44.0% in all 3 venoms in a dose-dependent manner using 0.32, 0.16, and 0.08 mg/mL doxycycline when compared to venom-only controls (P < .0001) (Fig. 1A). Snake venom metalloproteinases activity was reduced to 4% to 62% in all 3 venoms in a dose-dependent manner using 0.32, 0.16, and 0.08 mg/mL doxycycline (P < .0001) (Fig. 1B). The lethal dose (LD50) values of the venoms in the murine model were calculated as follows: A. piscivorus = 20.29 mg/kg (Fig. 2A), N. kaouthia = 0.38 mg/kg (Fig. 2B), and D. russelii = 7.92 mg/kg (Fig. 2C). The effective dose (ED50) of doxycycline in A. piscivorus was calculated to be 20.82 mg/kg and 72.07 mg/kg when treating D. russelii venom. No ED50 could be calculated when treating N. kaouthia venom (Fig. 3). Creatine kinase activity was significantly decreased in all 3 venoms treated with doxycycline (P < .0001) (Fig. 4).</p><p><strong>Conclusion: </strong>Doxycycline reduced PLA2- and SVMP-related lethality, particularly in A. piscivorus envenomings and in a limited capacity with D. russelii revealing its promise as a treatment for snakebites. In addition, CK activity, a common indicator of muscle damage was inhibited in mice that received doxycycline-treated venom. The doxycycline concentrations identified in the ED50 studies correspond to 1,456 to 5,061 mg dosages for a 70 kg human. Factors including venom yield
简介:根据《联合创伤系统军事临床实践指南--全球毒蛇啮咬管理》,蛇咬伤在所有战区都是一种令人担忧的威胁。蛇毒是一种复杂的毒素混合物,包括磷脂酶 A2 (PLA2) 和蛇毒金属蛋白酶 (SVMP),可产生肌毒性、血液毒性和细胞毒性损伤。以抗体为基础的抗蛇毒血清是标准的治疗方法,但包括小分子抑制剂在内的新方法近年来也备受关注。强力霉素是人类金属蛋白酶和 PLA2 的有效抑制剂。3 种不同系统发育的蛇的酶活性:在多西环素的抑制条件下测试了 Agkistrodon piscivorus、Naja kaouthia 和 Daboia russelii 的酶活性:使用 EnzChek 磷脂酶 A2 和明胶酶检测试剂盒测定了 N. kaouthia、D. russelii 和 A. piscivorus 毒液中单独和与强力霉素一起使用时的 PLA2 和 SVMP 酶活性。采用单因素方差分析和Tukey事后检验进行比较分析。在巴格白化(BALB/c)成年小鼠模型中,采用肌肉注射法测定了毒液的中位致死剂量、强力霉素的有效剂量和肌酸激酶(CK)抑制水平。使用 Spearman-Karber 方法确定了中位致死剂量和有效剂量,并使用单因素方差分析和 Tukey 后检验比较了肌酸激酶抑制水平:结果:与仅使用毒液的对照组相比,使用 0.32、0.16 和 0.08 毫克/毫升多西环素可将所有 3 种毒液中的磷脂酶 A2 活性降低 1.5% 至 44.0%,且其降低呈剂量依赖性(P 结论:多西环素可降低磷脂酶 A2 活性,但其降低幅度与毒液对照组无关):多西环素降低了PLA2-和SVMP相关的致死率,尤其是在A. piscivorus蛇毒中毒中,而且在有限的D. russelii蛇毒中毒中,这揭示了多西环素作为蛇咬伤治疗药物的前景。此外,接受过多西环素处理毒液的小鼠肌肉损伤的常见指标--CK活性也受到了抑制。ED50 研究中确定的多西环素浓度相当于 70 公斤体重的人服用 1,456 至 5,061 毫克的剂量。毒液产量和蛇的种类等因素会影响实际所需剂量。需要对大剂量强力霉素的安全性及其对多种蛇类的有效性进行研究,以便将其完全应用于人类。在这项工作的基础上,多西环素可作为一种治疗方法,用于更高级别的治疗,保护肌肉免受损伤,并降低不同蛇类的致死率。
{"title":"Doxycycline-Mediated Inhibition of Snake Venom Phospholipase and Metalloproteinase.","authors":"Daniel K Arens, Meaghan A Rose, Emelyn M Salazar, Merideth A Harvey, Eun Y Huh, April A Ford, Daniel W Thompson, Elda E Sanchez, Yoon Y Hwang","doi":"10.1093/milmed/usae184","DOIUrl":"10.1093/milmed/usae184","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Warfighters are exposed to life-threatening injuries daily and according to the Joint Trauma System Military Clinical Practice Guideline-Global Snake Envenomation Management snakebites are a concerning threat in all theaters of operation. Snake venom is a complex mixture of toxins including phospholipases A2 (PLA2) and snake venom metalloproteinases (SVMP) that produce myotoxic, hemotoxic, and cytotoxic injuries. Antibody-based antivenom is the standard of care but new approaches including small-molecule inhibitors have gained attention in recent years. Doxycycline is an effective inhibitor of human metalloproteinases and PLA2. The enzymatic activities of 3 phylogenetically distinct snakes: Agkistrodon piscivorus, Naja kaouthia, and Daboia russelii were tested under inhibitory conditions using doxycycline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Enzymatic activity of PLA2 and SVMP was measured in N. kaouthia, D. russelii, and A. piscivorus venom alone and with doxycycline using EnzChek Phospholipase A2 and Gelatinase Assay Kits. A 1-way ANOVA with Tukey's post-hoc test was used to conduct comparative analysis. The median lethal dose of the venoms, the effective dose of doxycycline, and creatine kinase (CK) inhibition levels were measured in a murine model with adult Bagg Albino (BALB/c) mice using intramuscular injections. Median lethal and effective doses were determined using Spearman-Karber's method and a 1-way ANOVA with Tukey's post-hoc test was used to compare CK inhibition levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Phospholipases A2 activity was reduced to 1.5% to 44.0% in all 3 venoms in a dose-dependent manner using 0.32, 0.16, and 0.08 mg/mL doxycycline when compared to venom-only controls (P &lt; .0001) (Fig. 1A). Snake venom metalloproteinases activity was reduced to 4% to 62% in all 3 venoms in a dose-dependent manner using 0.32, 0.16, and 0.08 mg/mL doxycycline (P &lt; .0001) (Fig. 1B). The lethal dose (LD50) values of the venoms in the murine model were calculated as follows: A. piscivorus = 20.29 mg/kg (Fig. 2A), N. kaouthia = 0.38 mg/kg (Fig. 2B), and D. russelii = 7.92 mg/kg (Fig. 2C). The effective dose (ED50) of doxycycline in A. piscivorus was calculated to be 20.82 mg/kg and 72.07 mg/kg when treating D. russelii venom. No ED50 could be calculated when treating N. kaouthia venom (Fig. 3). Creatine kinase activity was significantly decreased in all 3 venoms treated with doxycycline (P &lt; .0001) (Fig. 4).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Doxycycline reduced PLA2- and SVMP-related lethality, particularly in A. piscivorus envenomings and in a limited capacity with D. russelii revealing its promise as a treatment for snakebites. In addition, CK activity, a common indicator of muscle damage was inhibited in mice that received doxycycline-treated venom. The doxycycline concentrations identified in the ED50 studies correspond to 1,456 to 5,061 mg dosages for a 70 kg human. Factors including venom yield","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Hydrocolloid Dressing and Moisturizing Cream as Facial Skin Protectants Among Health Care Workers. 水胶体敷料和保湿霜作为面部皮肤保护剂对医护人员的影响。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae202
Pedro N Oblea, Elizabeth D Nguyen-Wu, Leilani A Siaki, Sunghun Cho, Kenneth J Romito, Wenyaw Chan

Introduction: During the novel coronavirus disease 2019 pandemic, health care workers experienced facial problems from prolonged use of N95 masks, including skin irritation, pigmentation changes, and contact dermatitis. We assessed the use of hydrocolloid dressing versus dimethicone cream to prevent skin breakdown among military health care workers while wearing an N95.

Materials and methods: Participants were recruited using convenience and snowball sampling in this nonblinded, randomized, cross-over study with 2 active treatments, hydrocolloid dressing and dimethicone cream, across 3 time points. The skin was assessed using photographs and subepidermal moisture scanner (SEM). N95 seal integrity was assessed using qualitative fit test. Institutional review board approval was obtained from the Madigan Army Medical Center Institutional Review Board.

Results: Among the 73 participants, wearing an N95 alone versus with dimethicone cream or hydrocolloid dressing caused more adverse skin reactions. There were no significant differences in qualitative fit test failure rate between groups. Participants experienced minimal to no dizziness, loss of energy/tiredness/fatigue, claustrophobia, shortness of breath, difficulty breathing, and dry or itchy eyes. For all interventions, wearing an N95 did not interfere with participants' concentration, verbal communication, hearing, vision, and, importantly, delivery of care.

Conclusions: Using a skin protectant with an N95 may prevent adverse skin reactions while preserving health care workers' ability to safely and competently care for patients in routine and pandemic conditions.

导言:在 2019 年新型冠状病毒疾病大流行期间,医护人员因长期使用 N95 口罩而出现了面部问题,包括皮肤刺激、色素沉着变化和接触性皮炎。我们评估了使用水胶体敷料和二甲基硅氧烷乳膏来防止军队医护人员在佩戴 N95 时皮肤破损的情况:在这项非盲法、随机、交叉研究中,采用方便和滚雪球抽样的方法招募了参与者,在 3 个时间点上使用了水胶体敷料和二甲基硅氧烷乳膏这两种有效治疗方法。使用照片和表皮下水分扫描仪(SEM)对皮肤进行评估。使用定性密合度测试评估 N95 密封件的完整性。研究结果获得了马迪根陆军医疗中心机构审查委员会的批准:在 73 名参与者中,单独佩戴 N95 与使用二甲基硅氧烷乳膏或水胶体敷料相比,会引起更多的皮肤不良反应。各组之间的定性密合度测试失败率没有明显差异。参与者极少或没有出现头晕、体力不支/疲倦/乏力、幽闭恐惧症、气短、呼吸困难、眼睛干涩或发痒等症状。在所有干预措施中,佩戴 N95 不会影响参与者的注意力、语言交流、听力、视力,更重要的是,不会影响提供护理:结论:使用 N95 皮肤保护剂可以预防皮肤不良反应,同时保护医护人员在常规和大流行条件下安全、称职地护理病人的能力。
{"title":"Impact of Hydrocolloid Dressing and Moisturizing Cream as Facial Skin Protectants Among Health Care Workers.","authors":"Pedro N Oblea, Elizabeth D Nguyen-Wu, Leilani A Siaki, Sunghun Cho, Kenneth J Romito, Wenyaw Chan","doi":"10.1093/milmed/usae202","DOIUrl":"10.1093/milmed/usae202","url":null,"abstract":"<p><strong>Introduction: </strong>During the novel coronavirus disease 2019 pandemic, health care workers experienced facial problems from prolonged use of N95 masks, including skin irritation, pigmentation changes, and contact dermatitis. We assessed the use of hydrocolloid dressing versus dimethicone cream to prevent skin breakdown among military health care workers while wearing an N95.</p><p><strong>Materials and methods: </strong>Participants were recruited using convenience and snowball sampling in this nonblinded, randomized, cross-over study with 2 active treatments, hydrocolloid dressing and dimethicone cream, across 3 time points. The skin was assessed using photographs and subepidermal moisture scanner (SEM). N95 seal integrity was assessed using qualitative fit test. Institutional review board approval was obtained from the Madigan Army Medical Center Institutional Review Board.</p><p><strong>Results: </strong>Among the 73 participants, wearing an N95 alone versus with dimethicone cream or hydrocolloid dressing caused more adverse skin reactions. There were no significant differences in qualitative fit test failure rate between groups. Participants experienced minimal to no dizziness, loss of energy/tiredness/fatigue, claustrophobia, shortness of breath, difficulty breathing, and dry or itchy eyes. For all interventions, wearing an N95 did not interfere with participants' concentration, verbal communication, hearing, vision, and, importantly, delivery of care.</p><p><strong>Conclusions: </strong>Using a skin protectant with an N95 may prevent adverse skin reactions while preserving health care workers' ability to safely and competently care for patients in routine and pandemic conditions.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Coblation Versus Surgical Debridement Against MRSA Infection in Wounds With Shrapnel: A Preliminary Study. 钴化法与手术清创法对抗弹片伤口 MRSA 感染的初步研究:初步研究。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae302
Joel Gil, Michael Solis, Ryan Strong, Stephen C Davis

Introduction: Debridement plays a critical role in wound management. In addition to removing necrotic tissue, debridement can eliminate bacteria frequently harbored within the tissue. This study evaluated a novel debridement method that uses plasma-based radiofrequency technology to remove tissue and bacteria. Coblation is a technology that uses radiofrequency energy to excite the electrolytes in a conductive medium, such as saline, to create a precisely focused plasma. This plasma field contains highly energized particles that possess sufficient energy to break tissue molecular bonds, causing the tissue to dissolve at relatively low temperatures (typically 40 °C to 70 °C).

Materials and methods: Eighteen deep dermal wounds measuring 22 mm × 22 mm × 3 mm deep were created on pigs. Wounds were inoculated with methicillin-resistant Staphylococcus aureus USA300 (MRSA USA300) in combination with shrapnel and then covered with a polyurethane dressing for 24 hours. Wounds were then randomly assigned to one of the 3 treatment groups: (1) Coblation, (2) surgical debridement, and (3) no debridement. Wounds were biopsied on days 0, 5, 9, and 12, and specimens were processed for MRSA counts using selective media. Statistical analysis was performed using IBM SPSS statistics 27 using one-way ANOVA.

Results: Comparison between coblation and surgical debridement showed a decrease in bacterial count in all assessment times. The lowest bacterial count in all assessment times was observed in wounds debrided with coblation showing a statistically significant (P ≤ .05) decrease in more than 2 Log CFU/g on days 0, 5, and 9 compared to no debridement. On day 12, coblation-debrided wounds exhibited 6.10 ± 0.22 Log CFU/g, and this value represents 99.99% of reduction compared with non-debrided wounds (P ≤ .05). More than 96% of reduction (P ≤ .05) resulted in wounds treated with coblation compared with surgically debrided.

Conclusions: Reducing MRSA bacterial infection counts, especially of biofilm-associated organisms, in combination with shrapnel may have important clinical implications, especially for the military personnel. Further research into the use of this technology in wound management is warranted.

介绍:清创在伤口管理中起着至关重要的作用。除了清除坏死组织外,清创还能消除组织内经常藏匿的细菌。本研究评估了一种新型清创方法,该方法使用等离子射频技术清除组织和细菌。钴化技术是一种利用射频能量激发导电介质(如生理盐水)中的电解质,从而产生精确聚焦等离子体的技术。这种等离子体场含有高能粒子,具有足够的能量来破坏组织分子键,使组织在相对较低的温度下(通常为 40 °C 至 70 °C)溶解:在猪身上制造了 18 个真皮深伤口,伤口大小为 22 毫米 × 22 毫米 × 3 毫米深。伤口接种耐甲氧西林金黄色葡萄球菌 USA300(MRSA USA300)和弹片,然后用聚氨酯敷料覆盖 24 小时。然后将伤口随机分配到 3 个治疗组中的一个:(1) Coblation,(2) 外科清创,(3) 不清创。在第 0、5、9 和 12 天对伤口进行活检,并使用选择性培养基对标本进行 MRSA 计数。使用 IBM SPSS 统计 27 进行统计分析,采用单因素方差分析:结果:钴溶法和手术清创法的比较显示,在所有评估时间内细菌数量都有所减少。与未清创相比,在第 0、5 和 9 天,用胶囊清创的伤口在所有评估时间内的细菌数最低,细菌数减少超过 2 Log CFU/g,差异有统计学意义(P ≤ .05)。第 12 天,共振清创后的伤口显示出 6.10 ± 0.22 Log CFU/g,与未清创的伤口相比,该值减少了 99.99%(P ≤ .05)。与手术清创的伤口相比,采用钴化处理的伤口减少了 96% 以上(P ≤ .05):结论:结合弹片减少 MRSA 细菌感染数量,尤其是与生物膜相关的细菌感染数量,可能具有重要的临床意义,尤其是对军人而言。有必要进一步研究该技术在伤口管理中的应用。
{"title":"Coblation Versus Surgical Debridement Against MRSA Infection in Wounds With Shrapnel: A Preliminary Study.","authors":"Joel Gil, Michael Solis, Ryan Strong, Stephen C Davis","doi":"10.1093/milmed/usae302","DOIUrl":"10.1093/milmed/usae302","url":null,"abstract":"<p><strong>Introduction: </strong>Debridement plays a critical role in wound management. In addition to removing necrotic tissue, debridement can eliminate bacteria frequently harbored within the tissue. This study evaluated a novel debridement method that uses plasma-based radiofrequency technology to remove tissue and bacteria. Coblation is a technology that uses radiofrequency energy to excite the electrolytes in a conductive medium, such as saline, to create a precisely focused plasma. This plasma field contains highly energized particles that possess sufficient energy to break tissue molecular bonds, causing the tissue to dissolve at relatively low temperatures (typically 40 °C to 70 °C).</p><p><strong>Materials and methods: </strong>Eighteen deep dermal wounds measuring 22 mm × 22 mm × 3 mm deep were created on pigs. Wounds were inoculated with methicillin-resistant Staphylococcus aureus USA300 (MRSA USA300) in combination with shrapnel and then covered with a polyurethane dressing for 24 hours. Wounds were then randomly assigned to one of the 3 treatment groups: (1) Coblation, (2) surgical debridement, and (3) no debridement. Wounds were biopsied on days 0, 5, 9, and 12, and specimens were processed for MRSA counts using selective media. Statistical analysis was performed using IBM SPSS statistics 27 using one-way ANOVA.</p><p><strong>Results: </strong>Comparison between coblation and surgical debridement showed a decrease in bacterial count in all assessment times. The lowest bacterial count in all assessment times was observed in wounds debrided with coblation showing a statistically significant (P ≤ .05) decrease in more than 2 Log CFU/g on days 0, 5, and 9 compared to no debridement. On day 12, coblation-debrided wounds exhibited 6.10 ± 0.22 Log CFU/g, and this value represents 99.99% of reduction compared with non-debrided wounds (P ≤ .05). More than 96% of reduction (P ≤ .05) resulted in wounds treated with coblation compared with surgically debrided.</p><p><strong>Conclusions: </strong>Reducing MRSA bacterial infection counts, especially of biofilm-associated organisms, in combination with shrapnel may have important clinical implications, especially for the military personnel. Further research into the use of this technology in wound management is warranted.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Response to Preparing Future Military Medical Officers to Conduct Emergency Fresh Whole Blood Transfusions in Austere Environments. 为未来的军医在恶劣环境下进行紧急新鲜全血输血做好准备。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae385
Bryan J Colasacco
{"title":"A Response to Preparing Future Military Medical Officers to Conduct Emergency Fresh Whole Blood Transfusions in Austere Environments.","authors":"Bryan J Colasacco","doi":"10.1093/milmed/usae385","DOIUrl":"10.1093/milmed/usae385","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Military Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1