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1.
Khirurgiia (Mosk) ; (5): 162-169, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38785253

RESUMO

The world fame of Friedrich von Esmarch (1823-1908) is based on his universal effectiveness as a surgeon and innovative physician. He was primarily a military surgeon, and some ones call him the «Ambroise Pare of Germany¼. He owns numerous ideas in optimizing care for wounded and innovative developments in surgery. Friedrich von Esmarch improved methods of asepsis and antisepsis, anesthesia and sanitation in German hospitals. He is also considered as one of the pioneers in primary care. Friedrich von Esmarch is an author of more than 80 publications including a first aid textbook.


Assuntos
Cirurgia Geral , Medicina Militar , História do Século XIX , Alemanha , História do Século XX , Humanos , Medicina Militar/história , Cirurgia Geral/história , Aniversários e Eventos Especiais
4.
Georgian Med News ; (348): 94-98, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38807400

RESUMO

Artificial intelligence (AI) encompasses the advancement of computers and robots, enabling them to surpass human capabilities in various aspects. By utilizing AI, programs have the ability to autonomously analyze and interpret data, offering information and executing actions without any human involvement. The ongoing war in Ukraine showed various aspects of severe gunshot injuries because of previously unknown course of wounds after application of ballistic missiles, drones, etc., which is frequently applied by russians. In such conditions, decision-making process by military medical doctors must be quick and rational, however in case of massive casualties, combined trauma (e.g. thoracoabdominal gunshot injury) MDs might have permanent challenges to apply appropriate care options and individualized approach. The aim of this study is to start the discussion about role and possible application of AI in management of gunshot injuries in combat patients or other individuals who received wounds relating to high-energy weapon. Conclusions. Gunshot wound is a clinical challenge in many cases among patients who were injured by high-energy weapons, requiring complex and quick decisions. AI might be applied as an additional tool for the decision-making process in case of severe trauma in deployed field hospitals, or in hospitals of higher Roles (3-4). This study is to start the research discussion about the utility of AI application for the management of the injured in the war associated with high-energy weapons.


Assuntos
Inteligência Artificial , Medicina Militar , Ferimentos por Arma de Fogo , Humanos , Ferimentos por Arma de Fogo/epidemiologia , Medicina Militar/métodos , Ucrânia
5.
Am J Disaster Med ; 19(1): 45-51, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38597646

RESUMO

OBJECTIVE: Active duty military surgeons often have limited trauma surgery experience prior to deployment. Consequently, military-civilian training programs have been developed at high-volume trauma centers to evaluate and maintain proficiencies. Advanced Surgical Skills for Exposure in Trauma (ASSET) was incorporated into the predeployment curriculum at the Army Trauma Training Detachment in 2011. This is the first study to assess whether military surgeons demonstrated improved knowledge and increased confidence after taking ASSET. DESIGN: Retrospective cohort study. SETTING: Quaternary care hospital. PATIENTS AND PARTICIPANTS: Attending military surgeons who completed ASSET between July 2011 and October 2020. MAIN OUTCOME MEASURE(S): Pre- and post-course self-reported comfort level with procedures was converted from a five-point Likert scale to a percentage and compared using paired t-tests. RESULTS: In 188 military surgeons, the median time in practice was 3 (1-8) years, with specialties in general surgery (52 percent), orthopedic surgery (29 percent), trauma (7 percent), and other disciplines (12 percent). The completed self-evaluation response rate was 80 percent (n = 151). The self-reported comfort level for all body regions improved following course completion (p < 0.001): chest (27 percent), neck (23 percent), upper extremity (22 percent), lower extremity (21 percent), and abdomen/pelvis (19 percent). The overall score on the competency test improved after completion of ASSET, with averages increasing from 62 ± 18 percent pretest to 71 ± 13 percent post-test (p < 0.001). CONCLUSIONS: After taking the ASSET course, military surgeons demonstrated improved knowledge and increased confidence in the operative skills taught in the course. The ASSET course may provide sustainment of knowledge and confidence if used at regular intervals to maintain trauma skills and deployment readiness.


Assuntos
Medicina Militar , Militares , Cirurgiões , Traumatologia , Humanos , Traumatologia/educação , Estudos Retrospectivos , Competência Clínica
7.
Artigo em Russo | MEDLINE | ID: mdl-38640228

RESUMO

The review considers the approach placing famous French surgeon A. Paré into more general European context of European Renaissance of XVI century and into local context of intellectual life of Paris of this period. The refutation of widespread in history of medicine opinion about strict separation of university medicine from artisan surgery in Medieval Europe is discussed.


Assuntos
Cirurgia Geral , Medicina , Medicina Militar , Cirurgiões , Humanos , Europa (Continente) , Medicina Militar/história , França , Cirurgia Geral/história
10.
BMJ Mil Health ; 170(2): 150-154, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38508774

RESUMO

The UK military prehospital emergency care (PHEC) operational clinical capability framework must be updated in order that it retains its use as a valid operational planning tool. Specific requirements include accurately defining the PHEC levels and the 'Medical Emergency Response Team' (MERT), while reinforcing PHEC as a specialist area of clinical practice that requires an assured set of competencies at all levels and mandatory clinical currency for vocational providers.A military PHEC review panel was convened by the Defence Consultant Advisor (DCA) for PHEC. Each PHEC level was reviewed and all issues which had, or could have arisen from the existing framework were discussed until agreement between the six members of this panel was established.An updated military PHEC framework has been produced by DCA PHEC, which defines the minimum requirements for each operational PHEC level. These definitions cover all PHEC providers, irrespective of professional background. The mandatory requirement for appropriate clinical exposure for vocational and specialist providers is emphasised. An updated definition of MERT has been agreed.This update provides clarity to the continually evolving domain of UK military PHEC. It sets out the PHEC provider requirements in order to be considered operationally deployable in a PHEC role. There are implications for training, manning and recruitment to meet these requirements, but the processes required to address these are already underway and well described elsewhere.


Assuntos
Cisteína/análogos & derivados , Serviços Médicos de Emergência , Medicina Militar , Militares , Humanos , Medicina Militar/educação , Reino Unido
11.
Transfusion ; 64 Suppl 2: S34-S41, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38441209

RESUMO

BACKGROUND: On the battlefield, hemorrhage is the main cause of potentially preventable death. To reduce mortality due to hemorrhagic injuries, the French Military Medical Service (FMMS) has deployed low titer group O whole blood (LTOWB) since June 2021 during operation BARKHANE in the Sahel-Saharan strip. Questions persist regarding the circumstances under which the FMMS employs LTOWB during overseas operations. STUDY DESIGN: We performed a retrospective analysis of all LTOWB transfused by the FMMS during overseas operations in the Sahel-Saharan strip between June 1, 2021, and June 1, 2023. Information was collected from battlefield forward transfusion sheets. RESULTS: Over the 2-year study period, 40 units of LTOWB were transfused into 25 patients. Of the 25 patients, 18 were combat casualties and seven were transfused for non-trauma surgery. Of the 40 units of LTOWB transfused, 22 were provided during Role 2 care, 11 during tactical medical evacuation (MEDEVAC), and seven in light and mobile surgical units. Among combat casualties, LTOWB was the first blood product transfused in 13 patients. In combat casualties, 6 h post-trauma, the median ratio of plasma: red blood cells (RBCs) was 1.5, and the median equivalent platelet concentrate (PC) transfused was 0.17. No immediate adverse events related to LTOWB transfusion were reported. CONCLUSION: LTOWB is transfused by the FMMS during overseas operations from the tactical MEDEVAC until Role 2 care. Deployment of LTOWB by the FMMS enables an early high-ratio plasma/RBC transfusion and an early platelet transfusion for combat casualties.


Assuntos
Sistema ABO de Grupos Sanguíneos , Transfusão de Sangue , Militares , Humanos , Estudos Retrospectivos , França , Transfusão de Sangue/métodos , Masculino , Feminino , Adulto , Hemorragia/terapia , Hemorragia/etiologia , Ferimentos e Lesões/terapia , Medicina Militar
12.
J Surg Educ ; 81(5): 647-655, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38553366

RESUMO

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to complete competency-based assessments of medical trainees based on nationally established Milestones. Previous research demonstrates a strong correlation between CCC and resident scores on the Milestones in surgery, but little is known if this is true between specialties. In this study, we investigated a variety of specialties and sought to determine what factors affect self-assessment of milestones. In addition, a post-hoc analysis was completed on the COVID-19 pandemic effects on self-evaluation. METHODS: This is an IRB approved observational study on prospectively collected self-evaluation milestone data that is used within each ACGME program's Clinical Competency Committees. Medical trainees within the San Antonio Uniformed Services Health Education Consortium were approached for possible participation in this study with permission from program directors. RESULTS: There was no significant difference between self-assessments and CCC-assessments based on self-identified gender or residency type (surgical versus nonsurgical) for any milestone domain. Within the postgraduate year (PGY) groups, the PGY5 and PGY6 tended to rate themselves higher than CCC. Chiefs (Internal Medicine PGY2/3, and General Surgery PGY5/6) tended to be more accurate in scoring themselves than the interns (PGY1) within the milestone of Interpersonal Skills and Communication (chiefs 0.5 vs. interns 0.62, p = 0.03). On post hoc analysis of self-rating, during the first wave of the COVID 19 pandemic, Post-Covid residents were more likely to underrate themselves in Systems-Based Practice compared to the Pre-Covid cohort (-0.49 vs 0.10; p = 0.007) and more likely to rate themselves higher in Professionalism (-0.54 vs. -0.10, p = 0.012). CONCLUSION: Unique to this study and our institution, there was no gender difference found in self vs CCC evaluations. With the change in learning environment from COVID, there was also a change in ability for some learners to self-assess accurately. As medical educators, we should understand the importance of both encouraging learners to practice self-assessment as well as give feedback to trainees on their progress. We also need to educate our faculty on the use of milestones for assessment to create a true gold standard in the CCC.


Assuntos
COVID-19 , Competência Clínica , Educação de Pós-Graduação em Medicina , Internato e Residência , Medicina Militar , Autoavaliação (Psicologia) , Humanos , Masculino , Feminino , COVID-19/epidemiologia , Medicina Militar/educação , Estados Unidos , SARS-CoV-2 , Estudos Prospectivos , Pandemias , Acreditação
14.
Aerosp Med Hum Perform ; 95(4): 230, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38486316
15.
Aerosp Med Hum Perform ; 95(4): 226-229, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38486312
18.
Transfusion ; 64 Suppl 2: S58-S61, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38400632

RESUMO

BACKGROUND: The Committee of the Chiefs of Military Medical Services (COMEDS) initiated the Prehospital Care Improvement Initiative Task Force (PHCII TF) to advise on how to improve prehospital care within NATO nations. The Task Force consisted of the NATO Military Health Care Working Group and its subordinated expert panels, including the Blood Panel, the Emergency Medicine Panel and the Special Operations Forces Medicine Panel. METHOD: The PHCII TF identified four key prehospital care themes for exploration: 1) Tactical Casualty Care, 2) Blood Far Forward), 3) Forward Surgical Capabilities), and 4) Prolonged Casualty Care. A consensus experimentation workshop explored the four themes, utilizing a modified Delphi technique and Utstein rotations during syndicate work, resulting in 83 consensus statements. The consensus statements were further evaluated on six criteria: actionable, measurable, urgent, interoperability, low risk/threat and impact. RESULTS: The 83 consensus statements, when weighted against the six criteria, resulted in 15 recommendations, focusing on standardization of training, ensuring provision of evidence-based practices and removing legislative barriers to improve prehospital care. CONCLUSION: The recommendations on these four themes reflect the most significant priorities in improving prehospital care, and must be incorporated in the on-going revision of NATO doctrine.


Assuntos
Serviços Médicos de Emergência , Humanos , Serviços Médicos de Emergência/normas , Comitês Consultivos , Medicina Militar/normas
19.
Aerosp Med Hum Perform ; 95(3): 171, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38356128
20.
Aerosp Med Hum Perform ; 95(3): 167-170, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38356132
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