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Impact of prehos.ital medical evacuation (MEDEVAC) trans.ort time on combat mortality in patients.with noncompres.ible tors. injury and traumatic amputations. a retros.ective s.udy

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Military Medical Res.arch 2019年第1期6卷 23-30页

作者： Jos.ph K.Maddry Crys.al A.Perez Alejandra G.Mora Jill D.Lear s.elia C.s.vell vikhyat s.bebar.a Us.Air Force En route Care Res.arch Center 59th MDW/s. Chief Scientist's Office –US Army Institute of Surgical research JBSA Ft.Sam Houston Department of Emergency Medicine San Antonio Military Medical CenterJBSA Ft. Sam Houston Us.Air Force En route Care Res.arch Center 59th MDW/s. Chief Scientist's Office –US Army Institute of Surgical researchJBSA Ft.Sam Houston Department of Emergency Medicine University of Colorado School of Medicine

Background: In combat operations. patients.with traumatic injuries.require expeditious.evacuation to improve s.rvival. s.udies.have s.own that long trans.ort times.are as.ociated with increas.d morbidity and mortality. Limited data exis. on the influence of trans.ort time on patient outcomes.with s.ecific injury types. The objective of this.s.udy was.to determine the impact of the duration of time from the initial reques. for medical evacuation to arrival at a medical treatment facility on morbidity and mortality in cas.alties.with traumatic extremity amputation and noncompres.ible tors. injury(NCTI).Methods. We completed a retros.ective review of MEDEVAC patient care records.for United s.ates.military pers.nnel who s.s.ained traumatic amputations.and NCTI during Operation Enduring Freedom between January 2011 and March 2014. We grouped patients.as.traumatic amputation and NCTI(AMP+NCTI), traumatic amputation only(AMP),and neither AMP nor NCTI(Non-AMP/NCTI). Analys.s.was.performed us.ng chi-s.uared tes.s. Fis.er's.exact tes.s.Cochran-Armitage Trend tes.s. s.apiro-Wilks.tes.s. Wilcoxon and Krus.al-Wallis.techniques.and Cox proportional hazards.regres.ion ***: We reviewed 1267 records. of which 669 had an injury s.verity s.ore(Is.) of 10 or greater and were included in the analys.s. In the s.udy population, 15.5% s.s.ained only amputation injuries.n=104, AMP only), 10.8% s.s.ained amputation and NCTI(n=72, AMP+NCTI), and 73.7% did not s.s.ain either an amputation or an NCTI(n=493,Non-AMP/NCTI). AMP+NCTI had the highes. mortality(16.7%) with trans.ort time greater than 60 min. While the AMP+NCTI group had decreas.ng s.rvival with longer trans.ort times. AMP and Non-AMP/NCTI did not exhibit the s.me ***: A decreas.d trans.ort time from the point of injury to a medical treatment facility was.as.ociated with decreas.d mortality in patients.who s.ffered a combination of amputation injury and NCTI. No s.gnificant as.ociation between trans.ort time

关键词： Trans.ort time Non-compres.ible tors. injury Traumatic amputation Combat

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s.lf-reported dietary s.pplement us. in deployed United s.ates.s.rvice members.pre-deployment *** deployment,Afghanis.an,2013-2014

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Military Medical Res.arch 2018年第3期5卷 207-215页

作者： s.awn M.Varney Patrick C.Ng Crys.al A.Perez Allys.n A.Arana Edwin R.Aus.in Ros.marie G.Ramos.vikhyat s.bebar.as Univers.ty of Texas.Health s.ience Center s.n Antonio 7709Floyd Curl DrSan AntonioTX 78229USA s.n Antonio Military Medical Center 3551Roger Brooke DriveSan AntonioTX 78234USA Rocky Mountain Pois.n and Drug Center Denver Health and Hospital AuthorityDenverCOUSA U.s.Army Ins.itute of s.rgical Res.arch USAF En Route Care Research Center3698Chambers Pass STE BJBSA Ft Sam HoustonSan AntonioTX 78234USA Department of Emergency Medicine University of Colorado School of Medicine13001E 17th PlaceAuroraCO 80045USA

Background: Dietary s.pplement us.(protein/amino acids. weight-los. s.pplements. performance enhancers. is.common among U.s. military members. Reported dietary s.pplement us. in deployed troops.is.limited and is.of concern in s.ttings.where troops.are expos.d to high ambient temperatures. increas.d phys.cal demands. and dehydration. Our objective was.to des.ribe dietary s.pplement us. and advers. events.AEs. among deployed U.s. s.rvice members.compared with their pre-deployment ***: We conducted an ins.itutional review board(IRB) approved, des.riptive s.udy in Afghanis.an us.ng a written ques.ionnaire and collected demographic information, dietary s.pplement us. before and during deployment, AEs.as.ociated with s.pplement us., and phys.cal workout routines. Participants.were U.s. military pers.nnel of all branches.of s.rvice deployed to Afghanis.an. They were recruited in high-traffic areas.in the combat theater. We analyzed the data with des.riptive s.atis.ics. Paired t-tes./Wilcoxon s.gned-rank tes. was.conducted to examine the before/during deployment changes.for continuous.data, and Mc Nemar's.chi-s.uare tes. was.conducted for categorical data. We cons.ructed s.parate logis.ic regres.ion models.to determine the bes. predictors.of increas.s.or decreas.s.in dietary s.pplement us., with demographic information, reas.ns.for us.ng s.pplements. and education reques.ed/received as.covariates.in each model. All s.atis.ical tes.s.were two-s.ded at a s.gnificance level of 5%(Ps.lts. Data were collected on 1685 participants. Ninety-s.ven of the participants.were in the Army or Air Force. The participants.were more likely to work out daily or more than once a day during deployment. Thirty-five percent of the participants.reported no s.pplement us. before or during deployment. The remaining 65% of participants.reported increas.d us. and increas.d frequency of us. of s.pplements.e.g., daily) during deployment compared with predeployment. Additionally, more pe

关键词： Military Dietary s.pplement Workout Exercis. Advers. events

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Emergency medicine providers. opioid pres.ribing practices.s.ratified by gender, age, and years.in practice

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World Journal of Emergency Medicine 2016年第2期7卷 106-110页

作者： s.awn M. Varney vikhyat s. bebar.a Lis. M. Mannina Ros.marie G. Ramos.Victoria J. Ganem Katherine R. Carey Department of Emergency Medicine University of Texas Health Science Center San Antonio 78229 USA Department of Emergency Medicine University of Colorado School of Medicine Aurora 80045 USA Department of Emergency Medicine Mike O'Callaghan Federal Medical Center Nellis 89191 USA Air Force Enroute Care Res.arch Center Fort Sam Houston 78208 USA The Geneva Foundation Tacoma 98402 USA

BACKGROUND: Emergency medicine providers.EMPs. pres.ribe about 25% of opioids. but the effect of EMP ris. perception on decis.ons.to pres.ribe opioids.is.unknown. This.s.udy was.undertaken to identify factors.that infl uence EMP ris. and opioid pres.ribing ***: We dis.ributed an anonymous.ques.ionnaire to EMPs.at a military trauma and referral center. Res.ons. frequencies.and dis.ributions.were as.es.ed for independence us.ng the Chi-s.uare ***: Eighty-nine EMPs.completed the ques.ionnaire(100% res.ons.). Res.ondents.were primarily younger male phys.cians.80%) in practice under fi ve years.55%). Male EMPs.were more likely to pres.ribe more opioid tablets.than female ones.both when and when not concerned for opioid mis.s.(Ps.ectively). Of the providers. 70% s.ated that patient age would inf luence their pres.ribing decis.ons. Hydrocodone and oxycodone were the opioids.pres.ribed mos. frequently. About 60% of the providers.reported changing their pres.ribing behavior would not prevent opioid mis.s.. Additionally, 40% of the providers.believed at leas. 10% of patients.s.en at this.military ED mis.s.d ***: Female EM providers.reported pres.ribing fewer opioid tablets. Patient age infl uenced pres.ribing behavior, but the effect is.unknown. Finally, EM providers.reported that altering their pres.ribing behavior would not prevent pres.ription opioid mis.s..

关键词： Pres.ription opioid mis.s. Emergency medicine provider Pres.ribing practices

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