Wilderness & Environmental Medicine最新文献

IntroductionWilderness medicine specializes in delivering clinical care in austere environments, far from healthcare facilities, with limited resources. There is no standardized wilderness medicine training for medical students within the United Kingdom. The aim of this research was to identify what wilderness medicine training is being delivered to undergraduate medical students in the United Kingdom to guide future educational research.MethodA scoping review following a PRISMA-ScR protocol was undertaken in the Medline and Scopus databases. This was supported by a digital survey sent to all UK university medical schools wilderness medicine interest groups to identify wilderness medicine teaching both within the curriculum and extracurricularly.ResultsOf the initial 1186 articles identified, 23 met the inclusion criteria. Seven represented practices in UK universities, and 21 represented a teaching module delivered to undergraduate students. Nineteen of the articles (91%) described faculty-delivered modules; two peer-led modules were both from UK universities. Thirty-one UK based wilderness medicine interest groups members responded to the online survey representing 13 different UK universities. All had been involved with extracurricular peer-led wilderness medicine teaching compared with 10% who received curriculum-based faculty-led teaching.ConclusionMost UK wilderness medicine training is extracurricular and peer led. Current research into this field provides excellent examples of wilderness medicine within UK medical schools but no comparisons between the methodologies for outcomes or cost efficiency. This review recommends more structured investigation to determine the optimal introduction to wilderness medicine for undergraduate medical students.

IntroductionWilderness medicine (WM) tracks provide residents with a framework to foster their interests in wilderness medicine. However, there is little literature specific to WM tracks. We sent surveys to all 287 ACGME-recognized emergency medicine residencies in the United States to obtain data on the prevalence and characteristics of these tracks.MethodsA survey was distributed via the Society for Academic Emergency Medicine and American College of Emergency Physicians listservs with follow-up emails sent to nonrespondents. The survey included questions regarding program demographics, the presence of a WM track, and the characteristics of the track. Residencies lacking a track were asked about their interest, and challenges faced, in creating a track. We evaluated differences between 3-y and 4-y residency programs, smaller and larger programs, and scholarly activity production using the χ² test, where P < 0.05 was considered significant. We evaluated the differences between academic, community/county, and military centers using the ANOVA test, where P < 0.05 was considered significant.ResultsThe response rate was 28%; 24% of respondents had a WM track, and the majority of these were offered at academic centers, 4-year programs, or larger programs. Track participation, administration, and requirements varied significantly. Among programs without a WM track, a minority (35%) reported planning to develop one in the next few years.ConclusionsDespite the popularity of wilderness medicine, many residency programs do not have a WM scholarly track. Their engagement, administration, funding, scholarly productivity, and requirements are quite variable.

In 1951, Riley's classic 3-compartment model of gas exchange estimated pulmonary shunt, alveolar dead space, and an effective compartment representing the functioning lung. But trial-and-error steps and conversion charts made its application impractical. We implemented estimates of alveolar and effective PCO₂ to simplify computations, making it useful when more advanced technologies are unavailable. Using stepwise computations, we studied 10 healthy individuals and 43 outpatients with mild to severe chronic obstructive pulmonary disease and, in another study, 32 healthy subjects during 12 h of hypobaric hypoxia at 426 mm Hg (ALT). The "effective" PaCO₂ due to pulmonary shunt and Haldane effect when breathing increased O₂ was calculated via the CO₂ dissociation curve. The model was applied while breathing air and 25% O₂ to simulate sea level in outpatients at 1620 m. Pulmonary shunt rose significantly with increasing hypoxemia (P<0.001), whereas alveolar dead space remained high. Breathing 25% O₂ reduced the shunt (P<0.001) by elevating systemic PO₂. The effective compartment in healthy subjects was 0.87, but only 0.41 in patients with severe hypoxemia, increasing to 0.45 on 25% O₂ (P=0.031). In ALT, a scoring system demonstrated that 16 subjects experienced acute mountain sickness (AMS) after 1 h with a significant increase in pulmonary shunt compared with 16 subjects without AMS. The model shows that hypoxemia in patients is associated with perfusion redistribution from high to low V/Q regions, consistent with reports using more sophisticated techniques. Subjects susceptible to AMS also increased shunt, suggesting autonomic instability.

BackgroundIn India, emergency medicine is a developing specialty and is not yet integrated into undergraduate medical education (bachelor of medicine and bachelor of surgery [MBBS]). Against this backdrop, introducing wilderness medicine may seem premature, but its relevance is clear given the country's vast rural geography and limited prehospital care. This study evaluated the impact of a 1-d wilderness medicine elective on medical students' motivation, self-directed learning, and satisfaction.MethodThis mixed-methods study involved 53 MBBS students from a tertiary care teaching institute divided into 3 independent batches that sequentially underwent wilderness medicine training across 3 curricular iterations. Data collection included pre- and post-tests, surveys using validated scales, and qualitative feedback from focus group discussions.ResultsConfidence improved significantly (P<0.001) in scene size-up (2.66±0.99 to 4.22±0.53), first aid (2.66±0.99 to 4.22±0.53), identification of life-threatening emergencies (2.66±0.94 to 4.20±0.51), and first aid kit preparation (2.39±1.07 to 4.29±0.72, all scores out of 5). The module was highly valued, with strong support from the learners for its inclusion in the curriculum (4.14±0.94 to 4.86±0.35; P<0.001) and reported high satisfaction and demonstrated intrinsic motivation.ConclusionsThe elective module enhanced students' confidence and engagement, supporting its integration into undergraduate curricula. Further research is warranted to assess long-term impact and scalability. Further research is needed to validate these findings and assess the long-term effects on clinical practice.

The use of potassium chlorate and other chlorates from the nineteenth century until the present is reviewed with an emphasis on use at high altitude. Chlorates that undergo high-temperature thermal decomposition are a source of supplemental oxygen for inhalation. The oral uses of potassium chlorate on mountaineering expeditions have ranged from simple lozenges for pharyngitis to the erroneous idea that oral ingestion could provide supplemental oxygen and prevent or treat mountain sickness. Furthermore, today's aircraft and spacecraft still employ chlorates and perchlorates to produce emergency supplemental oxygen for inhalation.

IntroductionHeadache is a hallmark symptom of chronic mountain sickness (CMS), a high altitude disease thought to be induced by excessive erythrocytosis (EE) in highlanders. Nevertheless, headache characteristics related to permanent high altitude residence remain understudied, as does the association between headache occurrence and hemoglobin concentration ([Hb]) in highlanders.MethodsA pilot cross-sectional study was conducted in La Rinconada, Peru (altitude 5100 m), over a 2-y period. During all comers' medical consultations, highlanders with no known history of chronic medical conditions (except EE/CMS) were questioned regarding headache symptoms. Headache characteristics were collected as well as clinical data and [Hb].ResultsHeadache prevalence was 61% (200 of 330 highlanders). Clinical characteristics of headache attacks (ie, location, onset, intensity, quality, and duration) were similar between highlanders with and without EE. In multivariate analysis, headache occurrence was associated with lower oxygen saturation (P<0.001), higher body mass index (P<0.001), and lower self-reported sleep duration (P<0.001) but not with [Hb] or sex.ConclusionsThe absence of a statistically significant association between headache occurrence and [Hb] questions the use of headache as a symptom reflecting EE in CMS highlanders.