"Over the last 20 years, care for injured patients has undergone a revolution. As noted by many authors, war’s only silver lining is to improve the care of the injured, and this era is no exception. Why do wars always seem to change the existing paradigm? Most experienced military personnel describe a 100% focus on the injured, stemming from the emotional impact of proximity to the battlefield, the close living and working quarters of medical personnel and combatants, and the sense of duty towards those who are injured while serving their country. Whatever the reasons, the results speak for themselves. The present era of conflict, starting on September 11, 2001 and continuing today is no exception. Amazing changes have occurred in care in the combat theater, and
some of these have transitioned into the civilian world. This is critically important, as the scope of the civilian injury problem is 300 times that of the military, while militarystyle injuries are, unfortunately, becoming more common in civilian life."
. . .
"Receiving a penetrating brain injury was previously assumed to be fatal and the idea of aggressive intervention by medical
personnel misplaced. However, the experience gained through treating a large number of penetrating brain injuries in the current conflicts has reconfirmed the utility of aggressive surgical intervention and maximal intensive care."
shared by https://combatresearchandprose.com
This document summarizes a presentation on how patient preference studies contribute to personalized medicine. It discusses when preference studies are conducted, common methods for assessing preferences, and applications in personalized medicine. An example is given of a preference study on treatment options for shoulder dislocation, showing how preferences can vary between individuals. Whole genome sequencing is also discussed as an area where preferences are complex, with patients valuing different aspects. Preference studies aim to better engage patients in medical decisions by accounting for heterogeneity in what patients value.
The Coagulopathy of Trauma: A Review of MechanismsEmergency Live
Coagulopathy associated with traumatic injury is the result of multiple independent but interacting mechanisms. Early coagulopathy is driven by shock and requires thrombin generation from tissue injury as an initiator. Initiation of coagulation occurs with activation of anticoagulant and fibrinolytic pathways.
Running head PTSD ANNOTATED BIBLIOGRAPHY 1PTSD ANNOTATED .docxtoltonkendal
Running head: PTSD ANNOTATED BIBLIOGRAPHY
1
PTSD ANNOTATED BIBLIOGRAPHY
2
PTSD Annotated Bibliography
Student’s name
University affiliation
PTSD Annotated Bibliography
Post-Trauma Stress Disorder (PTSD) is a condition that individuals who involve in forms of psychologically stressing situations and events attain. This condition is significant since it has caused a large number of individuals to live lives that are not as comfortable as they would have wished to live. Due to this reason, a large number of individuals have authored articles and other literal sources that address aspects of this topic. PTSD revolves around four main topics of psychology. These topics include:
i. Social Psychology
ii. Contemporary issues in psychology
iii. Crisis and emergency intervention
iv. Psychopathology
This paper provides articles and their explanations grouped within these four main topics, which provides information relating to the condition of PTSD.
Social Psychology Topic
Magdalena, K. & Bogdan, Z. (2012). Exposure to Trauma, Emotional Reactivity, and Its Interaction as Predictors of the Intensity of PTSD Symptoms in the Aftermath of Motor Vehicle Accidents: Journal of Russian & East European Psychology. Retrieved from http://bit.ly/2lGXePY
This article provides information on post-traumatic stress disorder obtained from individuals that have been involved in a form of car accident. The individuals are considered to be people that have experienced stress in a certain way, mainly due to the experience of involving in the car accident. The authors of the article explain that majority of the individuals attain the condition due to the situation that they believe they were in during the occurrence of the accident. The article involves an original study that involves experimentation of how the individuals were exposed to trauma due to the occurrence of the accident.
Maja, O., Mathias, L., Helle, S. & Ask, E. (2007). The Impact of Different Diagnostic Criteria on PTSD Prevalence: A Comparison of PTSD Prevalence Using the DSM-IV and ICD-10 PTSD-Criteria on a Population of 242 Danish Social Work Students: Nordic Psychology, Vol 59(4). Retrieved from http://bit.ly/2mTh3nq
This article explains that a large number of individuals obtains the PTSD disorder from many causes. Unlike many other diseases, an individual can obtain the PTSD condition from either an accident, an action that is committed to him or her by another individual like rape, or even a bad decision that he or she makes. The impact that these diseases and conditions have on such individuals are significantly different. Trauma that is brought about by rape, for example, is significantly different with the trauma that is brought about by events like accidents. The authors examine the causes of trauma and in their article explain the difference in effect that the individuals from various sources of the condition obtain. This article is thus significantly important and ...
Point counterpoint theodore joyce,editorperspectives on SAHIL781034
The document discusses the opioid epidemic in the United States. It argues that expanding access to medication-assisted treatment (MAT), such as methadone and buprenorphine, is needed to effectively combat the epidemic. While policies have aimed to increase treatment capacity, more funding is still required to engage the majority of people with opioid use disorder and improve retention in long-term treatment programs. The failure to widely implement evidence-based MAT has allowed demand for opioids to persist and contributed to the ongoing epidemic.
This editorial introduces a research topic on the regulation of endurance performance. It discusses how successful endurance requires integrating physiological and psychological systems to regulate exercise intensity. The factors limiting performance are debated and may depend on the task, environment, training, and psychology. Traditionally, research has focused on muscle and cardiovascular physiology, but the brain's role in integrating systems is an emerging area. Bringing together physiological and brain-centered perspectives may provide a more comprehensive understanding. The research topic aims to compare paradigms and exercise models to better understand how exercise is regulated and performance limited.
Dr. Vinod Shidham is a recognized leader in cytopathology and surgical pathology. He is currently a Professor of Pathology and Vice Chair at Wayne State University School of Medicine. His areas of expertise include cytopathology, surgical pathology, and he has invented and developed novel technologies and methods in these fields. He has extensive publications, serves in leadership roles for professional organizations, and is the editor-in-chief of the open access journal CytoJournal.
GEMC - Bone and Joint Infections - Resident TrainingOpen.Michigan
This is a lecture by Dr. Keith Kocher from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Keith Kocher from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document summarizes a presentation on how patient preference studies contribute to personalized medicine. It discusses when preference studies are conducted, common methods for assessing preferences, and applications in personalized medicine. An example is given of a preference study on treatment options for shoulder dislocation, showing how preferences can vary between individuals. Whole genome sequencing is also discussed as an area where preferences are complex, with patients valuing different aspects. Preference studies aim to better engage patients in medical decisions by accounting for heterogeneity in what patients value.
The Coagulopathy of Trauma: A Review of MechanismsEmergency Live
Coagulopathy associated with traumatic injury is the result of multiple independent but interacting mechanisms. Early coagulopathy is driven by shock and requires thrombin generation from tissue injury as an initiator. Initiation of coagulation occurs with activation of anticoagulant and fibrinolytic pathways.
Running head PTSD ANNOTATED BIBLIOGRAPHY 1PTSD ANNOTATED .docxtoltonkendal
Running head: PTSD ANNOTATED BIBLIOGRAPHY
1
PTSD ANNOTATED BIBLIOGRAPHY
2
PTSD Annotated Bibliography
Student’s name
University affiliation
PTSD Annotated Bibliography
Post-Trauma Stress Disorder (PTSD) is a condition that individuals who involve in forms of psychologically stressing situations and events attain. This condition is significant since it has caused a large number of individuals to live lives that are not as comfortable as they would have wished to live. Due to this reason, a large number of individuals have authored articles and other literal sources that address aspects of this topic. PTSD revolves around four main topics of psychology. These topics include:
i. Social Psychology
ii. Contemporary issues in psychology
iii. Crisis and emergency intervention
iv. Psychopathology
This paper provides articles and their explanations grouped within these four main topics, which provides information relating to the condition of PTSD.
Social Psychology Topic
Magdalena, K. & Bogdan, Z. (2012). Exposure to Trauma, Emotional Reactivity, and Its Interaction as Predictors of the Intensity of PTSD Symptoms in the Aftermath of Motor Vehicle Accidents: Journal of Russian & East European Psychology. Retrieved from http://bit.ly/2lGXePY
This article provides information on post-traumatic stress disorder obtained from individuals that have been involved in a form of car accident. The individuals are considered to be people that have experienced stress in a certain way, mainly due to the experience of involving in the car accident. The authors of the article explain that majority of the individuals attain the condition due to the situation that they believe they were in during the occurrence of the accident. The article involves an original study that involves experimentation of how the individuals were exposed to trauma due to the occurrence of the accident.
Maja, O., Mathias, L., Helle, S. & Ask, E. (2007). The Impact of Different Diagnostic Criteria on PTSD Prevalence: A Comparison of PTSD Prevalence Using the DSM-IV and ICD-10 PTSD-Criteria on a Population of 242 Danish Social Work Students: Nordic Psychology, Vol 59(4). Retrieved from http://bit.ly/2mTh3nq
This article explains that a large number of individuals obtains the PTSD disorder from many causes. Unlike many other diseases, an individual can obtain the PTSD condition from either an accident, an action that is committed to him or her by another individual like rape, or even a bad decision that he or she makes. The impact that these diseases and conditions have on such individuals are significantly different. Trauma that is brought about by rape, for example, is significantly different with the trauma that is brought about by events like accidents. The authors examine the causes of trauma and in their article explain the difference in effect that the individuals from various sources of the condition obtain. This article is thus significantly important and ...
Point counterpoint theodore joyce,editorperspectives on SAHIL781034
The document discusses the opioid epidemic in the United States. It argues that expanding access to medication-assisted treatment (MAT), such as methadone and buprenorphine, is needed to effectively combat the epidemic. While policies have aimed to increase treatment capacity, more funding is still required to engage the majority of people with opioid use disorder and improve retention in long-term treatment programs. The failure to widely implement evidence-based MAT has allowed demand for opioids to persist and contributed to the ongoing epidemic.
This editorial introduces a research topic on the regulation of endurance performance. It discusses how successful endurance requires integrating physiological and psychological systems to regulate exercise intensity. The factors limiting performance are debated and may depend on the task, environment, training, and psychology. Traditionally, research has focused on muscle and cardiovascular physiology, but the brain's role in integrating systems is an emerging area. Bringing together physiological and brain-centered perspectives may provide a more comprehensive understanding. The research topic aims to compare paradigms and exercise models to better understand how exercise is regulated and performance limited.
Dr. Vinod Shidham is a recognized leader in cytopathology and surgical pathology. He is currently a Professor of Pathology and Vice Chair at Wayne State University School of Medicine. His areas of expertise include cytopathology, surgical pathology, and he has invented and developed novel technologies and methods in these fields. He has extensive publications, serves in leadership roles for professional organizations, and is the editor-in-chief of the open access journal CytoJournal.
GEMC - Bone and Joint Infections - Resident TrainingOpen.Michigan
This is a lecture by Dr. Keith Kocher from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Keith Kocher from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
combatresearchandprose.com Independence day 2018: we still our warriorsCharles Bloeser
“Let us therefore rely upon the goodness of the Cause, and the aid of the supreme Being, in whose hands Victory is, to animate and encourage us to great and noble Actions—The Eyes of all our Countrymen are now upon us.”
General George Washington, General Orders, July 2, 1776
combatresearchandprose.com: a new open-source applied research initiativeCharles Bloeser
combatresearchandprose.com : a new open-source applied research initiative examining combat and those marked by it (34 slides)
https://combatresearchandprose.com/
Strife blog. charles bloeser. henry. part ii. published 7 august 2018Charles Bloeser
“Decades of medical practice have allowed the physician to see the signs of trauma in a broad range of patients who’ve served in the military and those who haven’t. In patients who’ve been in combat and those who have not. And while he does not suggest that a survivor of domestic violence has no claim to the label or resources associated with a PTSD diagnosis, there is, he agrees, a clinically meaningful difference between the kind of trauma that person suffers and the nature of the trauma experienced by members of the armed forces who must decide again and again which of the identically dressed men, women, and children in a dust-soaked, IED-laced town square can and might kill you or those you’ve sworn to protect.”
Strife blog. charles bloeser. henry. part i published 2 august 2018Charles Bloeser
“But for this combat veteran’s wife, Henry was never the kind of man who could be distilled into simple words like “defendant” and “perpetrator and “abuser.” There was no black and white in being struck by a man she knew had always loved her but whose best efforts to get relief from the symptoms of war had proved little more than the American version of a snipe hunt.[v]”
Fathers Day 2018: A Veteran Returns to Verdun to Honor the DeadCharles Bloeser
“The battle of Verdun was the longest, if not the bloodiest, single battle in World War I. Launched by the German Fifth Army on 21 February 1916, it did not come to an end until the final French counterattack was ended on 19 December 1916. For most of 1916, German and French soldiers fought tooth and nail for a few square miles of terrain around the French fortress city of Verdun, in what was the quintessential “battle of attrition” of World War I. Most units of the French army and many of the German army fought in what was described by both sides as the “hell of Verdun.” Between the battle’s start and the end of August (when the Germans ceased offensive operations), some 281,000 Germans and some 315,000 Frenchmen were killed or wounded. . . .”
- Dr. Robert Foley, Dean of Academic Studies/Head of Department at the Defence Studies Department, Joint Services Command and Staff College (JSCSC), the Defence Academy of the UK.
https://www.facebook.com/notes/charles-bloeser/fathers-day-2018-a-veteran-returns-to-verdun-to-honor-the-dead/10156262002281438/
Owned Lock, Stock, and Barrel: grandad's memorial day lesson for civiliansCharles Bloeser
"But here’s where grandad has a lesson for those of us who have never served. Had he known earlier what the intel really showed – that Communist China cared a great deal about what happened the other side of the Yalu river - it wouldn’t have mattered. It must not be allowed to matter.
"Like all who serve, grandad was owned by the United States lock, stock, and barrel, to be used as his nation deemed necessary. Even if ordered to march into Hell itself."
Writing is About Turning Blood Into Ink: 'time to 'fess upCharles Bloeser
This document provides an autobiographical account from the author about their experiences that have prepared them to tell stories of wounded veterans, despite not being a veteran themselves. The author details experiencing violence as a child in Africa, working as a prosecutor and seeing traumatic crime and suicide cases, experiencing their own mental health struggles, and bonding with veterans struggling with mental health in treatment facilities. The author argues these experiences have taught them to ask the right questions, listen carefully, and understand veterans, though they cannot fully understand the experience of combat. The goal is to honor veterans' stories and bring more nuanced understanding of mental health issues.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
combatresearchandprose.com Independence day 2018: we still our warriorsCharles Bloeser
“Let us therefore rely upon the goodness of the Cause, and the aid of the supreme Being, in whose hands Victory is, to animate and encourage us to great and noble Actions—The Eyes of all our Countrymen are now upon us.”
General George Washington, General Orders, July 2, 1776
combatresearchandprose.com: a new open-source applied research initiativeCharles Bloeser
combatresearchandprose.com : a new open-source applied research initiative examining combat and those marked by it (34 slides)
https://combatresearchandprose.com/
Strife blog. charles bloeser. henry. part ii. published 7 august 2018Charles Bloeser
“Decades of medical practice have allowed the physician to see the signs of trauma in a broad range of patients who’ve served in the military and those who haven’t. In patients who’ve been in combat and those who have not. And while he does not suggest that a survivor of domestic violence has no claim to the label or resources associated with a PTSD diagnosis, there is, he agrees, a clinically meaningful difference between the kind of trauma that person suffers and the nature of the trauma experienced by members of the armed forces who must decide again and again which of the identically dressed men, women, and children in a dust-soaked, IED-laced town square can and might kill you or those you’ve sworn to protect.”
Strife blog. charles bloeser. henry. part i published 2 august 2018Charles Bloeser
“But for this combat veteran’s wife, Henry was never the kind of man who could be distilled into simple words like “defendant” and “perpetrator and “abuser.” There was no black and white in being struck by a man she knew had always loved her but whose best efforts to get relief from the symptoms of war had proved little more than the American version of a snipe hunt.[v]”
Fathers Day 2018: A Veteran Returns to Verdun to Honor the DeadCharles Bloeser
“The battle of Verdun was the longest, if not the bloodiest, single battle in World War I. Launched by the German Fifth Army on 21 February 1916, it did not come to an end until the final French counterattack was ended on 19 December 1916. For most of 1916, German and French soldiers fought tooth and nail for a few square miles of terrain around the French fortress city of Verdun, in what was the quintessential “battle of attrition” of World War I. Most units of the French army and many of the German army fought in what was described by both sides as the “hell of Verdun.” Between the battle’s start and the end of August (when the Germans ceased offensive operations), some 281,000 Germans and some 315,000 Frenchmen were killed or wounded. . . .”
- Dr. Robert Foley, Dean of Academic Studies/Head of Department at the Defence Studies Department, Joint Services Command and Staff College (JSCSC), the Defence Academy of the UK.
https://www.facebook.com/notes/charles-bloeser/fathers-day-2018-a-veteran-returns-to-verdun-to-honor-the-dead/10156262002281438/
Owned Lock, Stock, and Barrel: grandad's memorial day lesson for civiliansCharles Bloeser
"But here’s where grandad has a lesson for those of us who have never served. Had he known earlier what the intel really showed – that Communist China cared a great deal about what happened the other side of the Yalu river - it wouldn’t have mattered. It must not be allowed to matter.
"Like all who serve, grandad was owned by the United States lock, stock, and barrel, to be used as his nation deemed necessary. Even if ordered to march into Hell itself."
Writing is About Turning Blood Into Ink: 'time to 'fess upCharles Bloeser
This document provides an autobiographical account from the author about their experiences that have prepared them to tell stories of wounded veterans, despite not being a veteran themselves. The author details experiencing violence as a child in Africa, working as a prosecutor and seeing traumatic crime and suicide cases, experiencing their own mental health struggles, and bonding with veterans struggling with mental health in treatment facilities. The author argues these experiences have taught them to ask the right questions, listen carefully, and understand veterans, though they cannot fully understand the experience of combat. The goal is to honor veterans' stories and bring more nuanced understanding of mental health issues.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
2. 8/21/2018 Major scientific lessons learned in the trauma field over the last two decades
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002339 2/4
1.
View Article PubMed/NCBI Google Scholar
practices. In response to this, and leveraging a wellestablished concept from the civilian arena, The Joint Trauma System (JTS)
was created and implemented, quickly becoming the standard across all levels of combat casualty care [3]. Utilizing the concepts of
a learning healthcare system, the JTS could serially improve outcomes after injury across all levels of care. Fundamental to this
approach was an assessment of every death for potential preventability, which drove clinical improvements and focused research
funding [4]. Unfortunately, these comprehensive trauma systems concepts are already being forgotten, as today’s battlefield is
being fought without the guiding presence of the JTS.
Stopping bleeding is important
The idea that it is important to stop bleeding sounds so obvious, but 20 years ago the emphasis when faced with bleeding patients
was largely on resuscitation to various oxygen or cardiac outputbased endpoints. Today, we more clearly understand that a variety
of interventions are required to save lives. The relationship between the multitude of hemorrhage control devices, (truncal,
junctional, extremity, intravascular, and intraperitoneal) combined with hemostatic resuscitation and rapid operative intervention, is
critical for survival. This bundled approach to hemorrhage control minimizes the duration and depth of shock, while surgeons repair
the endothelium and restore hemostatic competency [5]. Integration and implementation of these concepts results in decreased
hemorrhagic death and edemarelated complications and improves patient outcomes.
Transfusion
Those who die after injury frequently do so from exsanguination, the leading cause of potentially preventable death. Bleeding to
death occurs rapidly (within 6 hours of admission), and understanding the time course of hemorrhagic death is critical towards
effective intervention. Through the conflicts of the last 20 years, we have developed the current treatment for traumatic hemorrhagic
shock; simultaneous mechanical hemorrhage control coupled with damage control resuscitation (DCR), with an emphasis on using
plasma as the primary resuscitative fluid [6]. DCR principles include minimization of crystalloid and artificial colloids, permissive
hypotension and balanced resuscitation with early platelets, plasma, cryoprecipitate, and RBCs [7]. Optimal resuscitation now starts
in the prehospital area with blood products. However, the current paradigm is changing with the TCCC guidelines recommending a
move from balanced component transfusion in favor of whole blood (WB) [8]. This important transition has been led by the military
with more than 10,300 units of WB transfused in the war, with favorable clinical outcomes. Several civilian trauma systems are now
routinely using WB, both prehospital and in the hospital [9].
Neurosurgery and orthopedics
Receiving a penetrating brain injury was previously assumed to be fatal and the idea of aggressive intervention by medical
personnel misplaced. However, the experience gained through treating a large number of penetrating brain injuries in the current
conflicts has reconfirmed the utility of aggressive surgical intervention and maximal intensive care [10]. Future randomized studies
focused on these issues are warranted, especially as civilian injuries become more similar to those experienced by military
personnel. However, the true signature wounds of war are those of the extremities, with thousands of fractures managed and soft
tissue debridement’s performed [11]. We learned early that lowpressure and highvolume irrigation combined with serial
debridements resulted in the cleanest wounds, and that transport with negative pressure devices was safe and greatly facilitated
wound care [12–14].
Research funding
Injury is the leading cause of life years lost and the number one cause of death in people under 47. Despite this wellknown fact,
research funding lags far behind every other disease [15]. Continuing this abysmal level of funding by our elected and appointed
officials ensures that the societal damage inflicted by this disease will continue unabated. During intervals of relative peace,
advances in trauma care usually occur in the civilian arena and are driven by injury research funding. The recent National Academy
of Medicine report specifically highlights this 50year disparity in research funding and its continued impact on the health of all
nations [16]. Lack of this funding essentially guarantees lower levels of preparedness at the start of the next war [17].
The future
What does the future look like? While impossible to predict with any certainty, I believe that advances will continue in prehospital
resuscitation and hemorrhage control, extending the survivable prehospital and time to operative intervention. We must decrease
mortality and morbidity from sepsis, all types of TBI, and improve pain control and outcomes from PTSD. Successful rehabilitation
after all injury and reintegration into the workforce must become a focus for every trauma patient. Cellular therapy will become an
important early intervention to appropriately modulate the inflammatory system, decreasing multiple organ failure and rebuild or
replace damaged organs [18].
The most important advance, however, lies within the realm of leadership. Our military and civilian leaders must implement the
lessons learned on the current battlefield and be held responsible for clinical outcomes across all levels of care, wherever the injury
occurs [19–21].
References
Butler FK. Two Decades of Saving Lives on the Battlefield: Tactical Combat Casualty Care Turns 20. Mil Med. 2017 Mar;182(3):e1563–e1568.
pmid:28290925
3. 8/21/2018 Major scientific lessons learned in the trauma field over the last two decades
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002339 3/4
2.
View Article PubMed/NCBI Google Scholar
3.
View Article PubMed/NCBI Google Scholar
4.
View Article PubMed/NCBI Google Scholar
5.
View Article PubMed/NCBI Google Scholar
6.
View Article PubMed/NCBI Google Scholar
7.
View Article PubMed/NCBI Google Scholar
8.
View Article PubMed/NCBI Google Scholar
9.
View Article PubMed/NCBI Google Scholar
10.
View Article PubMed/NCBI Google Scholar
11.
View Article Google Scholar
12.
View Article PubMed/NCBI Google Scholar
13.
View Article PubMed/NCBI Google Scholar
14.
View Article PubMed/NCBI Google Scholar
15.
View Article PubMed/NCBI Google Scholar
16.
17.
View Article PubMed/NCBI Google Scholar
18.
View Article PubMed/NCBI Google Scholar
Dubose J, Rodriguez C, Martin M, Nunez T, Dorlac W, King D, et al. Eastern Association for the Surgery of Trauma Military Ad Hoc Committee.
Preparing the surgeon for war: present practices of US, UK, and Canadian militaries and future directions for the US military. J Trauma Acute Care Surg.
2012 Dec;73(6 Suppl 5):S423–30. pmid:23192065
Eastridge BJ, Jenkins D, Flaherty S, Schiller H, Holcomb JB. Trauma system development in a theater of war: Experiences from Operation Iraqi
Freedom and Operation Enduring Freedom. J Trauma. 2006 Dec;61(6):1366–72; discussion 1372–3. pmid:17159678
Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, et al. Death on the battlefield (20012011): implications for the future of combat casualty
care. J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S431–7. pmid:23192066
Oyeniyi BT, Fox EE, Scerbo M, Tomasek JS, Wade CE, Holcomb JB. Trends in 1029 trauma deaths at a level 1 trauma center: Impact of a bleeding
control bundle of care. Injury. 2017 Jan;48(1):5–12. pmid:27847192
Holcomb JB, Jenkins D, Rhee P, Johannigman J, Mahoney P, Mehta S, et al. Damage control resuscitation: directly addressing the early coagulopathy
of trauma. J Trauma. 2007 Feb;62(2):307–10. pmid:17297317
Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2
ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015 Feb 3;313(5):471–82. pmid:25647203
Butler FK, Holcomb JB, Schreiber MA, Kotwal RS, Jenkins DA, Champion HR, et al. Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat
Casualty Care: TCCC Guidelines Change 1401—2 June 2014. J Spec Oper Med. 2014;14(3):13–38. pmid:25344706
Spinella PC, Cap AP. Whole blood: back to the future. Curr Opin Hematol. 2016 Nov;23(6):536–542. pmid:27607444
Bell RS, Mossop CM, Dirks MS, Stephens FL, Mulligan L, Ecker R, et al. Early decompressive craniectomy for severe penetrating and closed head
injury during wartime. Neurosurg Focus. 2010 May;28(5):E1. pmid:20568925
Ficke JR, Obremskey WT, Gaines RJ, Pasquina PF, Bosse MJ, Mamczak CN, et al. Reprioritization of research for combat casualty care. J Am Acad
Orthop Surg. 2012;20 Suppl 1:S99–102.
Owens BD, White DW, Wenke JC. Comparison of irrigation solutions and devices in a contaminated musculoskeletal wound survival model. J Bone Joint
Surg Am. 2009 Jan;91(1):92–8. pmid:19122083
FLOW Investigators., Bhandari M, Jeray KJ, Petrisor BA, Devereaux PJ, HeelsAnsdell D, et al. A Trial of Wound Irrigation in the Initial Management of
Open Fracture Wounds. N Engl J Med. 2015 Dec 31;373(27):2629–4. pmid:26448371
Pollak AN, Powell ET, Fang R, Cooper EO, Ficke JR, Flaherty SF. Use of negative pressure wound therapy during aeromedical evacuation of patients
with combatrelated blast injuries. J Surg Orthop Adv. 2010 Spring;19(1):44–8. pmid:20371006
Holcomb JB, Hoyt DB. Comprehensive injury research. JAMA. 2015 Apr 14;313(14):1463–4. pmid:25871672
http://www.nationalacademies.org/hmd/Reports/2016/ANationalTraumaCareSystemIntegratingMilitaryandCivilianTraumaSystems.aspx. Accessed
May 8, 2017.
Rasmussen TE, Kellermann AL. Wartime Lessons—Shaping a National Trauma Action Plan. N Engl J Med. 2016 Oct 27;375(17):1612–1615.
pmid:27783910
Pati S, Pilia M, Grimsley JM, Karanikas AT, Oyeniyi B, Holcomb JB, et al. Cellular Therapies in Trauma and Critical Care Medicine: Forging New
Frontiers. Shock. 2015 Dec;44(6):505–23. pmid:26428845
4. 8/21/2018 Major scientific lessons learned in the trauma field over the last two decades
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002339 4/4
19.
View Article Google Scholar
20.
View Article Google Scholar
21.
View Article PubMed/NCBI Google Scholar
Butler FK. Leadership lessons learned in tactical combat casualty care. J Trauma Acute Care Surg. 2017 Mar 22.
Kotwal RS, Montgomery HR, Miles EA, Conklin CC, Hall MT, McChrystal SA. Leadership and a casualty response system for eliminating preventable
death. J Trauma Acute Care Surg. 2017 Mar 22.
Jacobs LM, Burns KJ, Pons PT, Gestring ML. Initial Steps in Training the Public about Bleeding Control: Surgeon Participation and Evaluation. J Am
Coll Surg. 2017 Jun;224(6):1084–1090. pmid:28501449