RESUMEN
BACKGROUND: The care of trauma patients in combat operations is handwritten on a five-page flow sheet. The process requires the manual scanning and uploading of paper documents to bridge the gap between electronic and paper record management. There is an urgent operational need for an information technology solution that will enable medics to better capture patient treatment information, which will improve long-term health care without impacting short-term care responsibilities. METHODS: We conducted a process improvement project to evaluate the ability of T6 Health Systems Mobile Application to improve combat casualty care data collection at a deployed trauma hospital. We performed a head-to-head comparison of the completeness and accuracy of data capture of electronic versus handwritten records to determine noninferiority. RESULTS: During the 90-day pilot, there were 131 trauma evaluations of which 53 casualty resuscitations (40.5%) were also documented in the electronic application. We compared completeness and accuracy of admit, prehospital, primary survey, secondary survey, interventions, and trends data. We found an overall 13% increase in data capture at 96% accuracy compared with the written record, suggesting that the electronic record was superior. Completion of electronic documentation compared with paper by section was statistically significantly higher for admitting data, 119.7% (p < 0.0001); prehospital, 116.2% (p = 0.0039); primary, 109.6% (p < 0.001); and secondary, 125.5% (p < 0.001). We also had the medical evacuation teams document prehospital and en route care and then synchronize the record in the trauma bay, allowing the trauma teams there to continue documenting on the same casualty record, likely contributing to superiority because teams did not have to redocument based on an oral report. CONCLUSION: Our pilot program in the deployed environment demonstrated a mobile technology that actually enhanced the completeness and accuracy of paper trauma documentation that has the capability of providing patient-specific decision support and real-time data analysis. LEVEL OF EVIDENCE: Care Management, level IV.
Asunto(s)
Documentación/métodos , Registros Electrónicos de Salud/estadística & datos numéricos , Aplicaciones Móviles , Resucitación/estadística & datos numéricos , Heridas y Lesiones/terapia , Técnicas de Apoyo para la Decisión , Humanos , Medicina Militar/métodos , Proyectos Piloto , Resucitación/métodos , Centros TraumatológicosRESUMEN
Uncontrolled noncompressible torso hemorrhage remains a leading cause of potentially preventable death on the battlefield. The utilization of resuscitative endovascular balloon occlusion of the aorta (REBOA) has gained considerable traction in civilian and military trauma care. Establishment of arterial access remains the rate-limiting step in endovascular aortic occlusion. The decision to place arterial access, including size, location, and the appropriate clinician and scenario all must be considered to achieve the optimal patient outcome. This report is submitted by the Joint Medical Augmentation Unit, an elite surgical/resuscitation team that provides medical care in the most far-forward, austere environments in the special operations community. The authors highlight two cases where early arterial access, REBOA utilization, and massive blood transfusion with damage-control surgery were associated with patient survival. We also address the prehospital application of REBOA in battlefield trauma. LEVEL OF EVIDENCE: Special Report, Level V.
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Oclusión con Balón/métodos , Procedimientos Endovasculares/métodos , Hemorragia/terapia , Medicina Militar/métodos , Personal Militar , Resucitación/métodos , Heridas Relacionadas con la Guerra/terapia , Adulto , Angiografía , Aorta , Arteria Femoral/diagnóstico por imagen , Humanos , MasculinoRESUMEN
BACKGROUND: Adenovirus (Ad), associated with significant morbidity, has no topical treatment. A leading CTC compound (CTC-96), a Co(III) chelate, was found to have potent in vitro and in vivo antiviral efficacy against herpes viruses. In this study CTC-96 is being tested for possible anti-Adenovirus activity. METHODS: The biological anti-adenovirus activity of CTC-96 in concentrations from 5 to 250 ug/ml, was evaluated initially by viral inactivation (viral exposure to CTC-96 followed by dilution and inoculation of cells), virucidal (viral exposure to CTC-96 and inoculation of cells without dilution) and antiviral (effect of CTC-96 on previously adsorbed virus) plaque assays on HeLa (human cervical carcinoma), A549 (human lung carcinoma) and SIRC (rabbit corneal) cells. After verifying the antiviral activity, New Zealand White rabbits were infected with Ad-5 into: 1) the anterior cul-de-sac scarifying the conjunctiva (Group "C+"); 2) the anterior cul-de-sac scarifying the conjunctiva and cornea (Group "CC+"); 3) the stroma (Group "CI+"). Controls were sham-infected ("C-", "CC-", "CI-"). Other rabbits, after "CC", were treated for 21 days with: 1) placebo, 9x/day ("-"); 2) CTC-96, 50 ug/ml, 9x/day ("50/9"); CTC-96, 50 ug/ml, 6x/day ("50/6"); CTC-96, 25 ug/ml, 6x/day ("25/6"). All animals were monitored via examination and plaque assays. RESULTS: In vitro viral inactivation, virucidal and antiviral assays all demonstrated CTC-96 to be effective against Adenvirus type 5 (ad-5). The in vivo model of Ad keratoconjunctivitis most similar to human disease and producing highest viral yield was "CC". All eyes (6/6) developed acute conjunctivitis. "CI" yielded more stromal involvement (1/6) and iritis (5/6), but lower clinical scores (area x severity). Infection via "C" was inconsistent (4/6). Fifty (50) ug/ml was effective against Ad-5 at 6x, 9x dosings while 25 ug/ml (6x) was only marginally effective. CONCLUSION: CTC-96 demonstrated virucidal activity against Ad5 in tissue culture with HeLa, A549 and SIRC cell lines. Animal Model Development: 1) "CC" produced conjunctival infection with occasional keratitis similar to human disease; "CI" yielded primarily stromal involvement; 2) "C" consistently produced neither conjunctivitis nor keratitis.CTC Testing: 1) Conjunctivitis in all eyes; 2) Resolution fastest in "50/9" ("50/9". "50/6" > "25/6" > "-"); 3) Efficacy in "50/6" was not statistically different than "50/9"; 4) Conjunctival severity was lower in treatment groups then controls; 5) Little corneal or intra-ocular changes were noted.
Asunto(s)
Infecciones por Adenoviridae/prevención & control , Adenovirus Humanos/efectos de los fármacos , Antivirales/farmacología , Cobalto , Conjuntivitis Viral/prevención & control , Modelos Animales de Enfermedad , Compuestos Organometálicos/farmacología , Enfermedad Aguda , Infecciones por Adenoviridae/virología , Adenovirus Humanos/crecimiento & desarrollo , Administración Tópica , Animales , Antivirales/administración & dosificación , Técnicas de Cultivo de Célula , Conjuntivitis Viral/virología , Relación Dosis-Respuesta a Droga , Células HeLa/virología , Humanos , Neoplasias Pulmonares/virología , Compuestos Organometálicos/administración & dosificación , Conejos , Ensayo de Placa Viral , Replicación Viral/efectos de los fármacosRESUMEN
This preliminary study was conducted to explore different analytical shape methods for use in evaluating children born with cranial vault deformities. Twenty skull outlines from patients with metopic craniosynostosis were ascribed landmarks. Scale, location, and rotational factors were removed using Procrustes analysis. A single index of severity from 0-5, with 5 being the most severe, was developed using Procrustes distance in shape space. Skull 20 had the highest score in our data set. Principal component analysis was performed to determine areas of large shape variability. Principal component 1 and 2 accounted for 86 % of the shape variability which was attributed to early closure of the metopic suture. Procrustes analysis used in combination with Procrustes distance and principal component analysis are powerful tools for the evaluation of cranial vault deformities and can be used to objectively categorize the severity of the skull deformity and outcome from surgical reconstructive surgery.