The National Capital Region HKIA attack response: A course of action for optimizing casualty receiving systems in the Military Health System.

The mass casualty event at the Hamid Karzai International Airport (HKIA) in the summer of 2021 marked the exit of the U.S. military from Afghanistan.

Refocusing the Military Health System to support Role 4 definitive care in future large-scale combat operations.

The last 20 years of sustained combat operations during the Global War on Terror generated significant advancements in combat casualty care. Improvements in point-of-injury care, en route care, and forward surgical care appropriately aligned with the survival, evacuation, and return to duty needs of the small-scale unconventional conflict. However, casualty numbers in large-scale combat operations have brought into focus the critical need for modernized casualty receiving and convalescence: Role 4 definitive care.

Casualty care implications of large-scale combat operations.

Analysis and review of combat casualty care challenges in future large-scale and medical multi-domain operations from the perspective of past, present, and potential future conflicts.

Clinical Readiness Program: Refocusing the Military Health System.

Introduction: The Military Health System serves to globally provide health services and trained medical forces. Military providers possess variable levels of deployment preparedness. The aim of the Clinical Readiness Program is to develop and assess the knowledge, skills, and abilities (KSAs) needed for combat casualty care.

Femoral Hernias: Analysis of Preoperative Risk Factors and 30-Day Outcomes of Initial Groin Hernias Using ACS-NSQIP.

Femoral hernias are infrequently encountered groin hernias. The purpose of this study was to describe the natural history of femoral hernias by evaluating patient demographics, comorbidities, operative details, 30-day mortality, and risk factors for postoperative complications compared with inguinal hernias and in reducible incarcerated hernias. Overall 5360 femoral hernia repairs and 183,173 inguinal hernia repairs were identified using the 2005 to 2015 American College of Surgeon-National Surgical Quality Improvement Program's database.

Achieving Mastery of General Surgery Operative Skill in the Army Healthcare System.

Introduction: Operative case volumes for military surgeons are reported to be significantly lower than civilian counterparts. Among the concern that this raises is an inability of military surgeons to achieve mastery of their craft.

Material And Methods: Annual surgical case reports were obtained from seven Army military treatment facilities (MTF) for 2012-2016.

Determination of Proper Timing for the Placement of Intra-Abdominal Mesh after Incidental Enterotomy in a Rodent Model ().

Controversy exists regarding the appropriate timing for placement of permanent intra-abdominal mesh after inadvertent enterotomy during elective hernia repair. The aim of this study was to examine mesh placement at variable postoperative periods and the subsequent risk of infection. Fifty rodents were divided into five groups.

Hematologic, Plasma Biochemical, and Lipid Panel Reference Intervals in Orange-winged Amazon Parrots ( Amazona amazonica ).

To establish reference intervals in orange-winged Amazon parrots ( Amazona amazonica ) for the complete blood count, plasma biochemical values, and lipid panel and to evaluate age- and sex-related variations, blood samples were obtained from 29 healthy juvenile and adult parrots. Concentrations of total protein, bile acids, phosphorus, total cholesterol, low-density-lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol were significantly higher in adult compared with juvenile birds, while uric acid concentration was significantly higher in juveniles. The white blood cell count, lymphocyte count, and phosphorus and potassium concentrations were significantly higher in females, while chloride concentration was significantly higher in males.

Effects of hyperglycemia and continuous intravenous insulin on outcomes of surgical patients.

Background: Hyperglycemia in critically ill patients has been associated with increased morbidity and mortality. It is unclear to what degree hyperglycemia should be regulated in a mixed surgical population.

Study Design: A retrospective chart review of 210 surgical patients in the intensive care unit (ICU) was performed.

Effect of diabetes mellitus on outcomes of hyperglycemia in a mixed medical surgical intensive care unit.

Background: Intensive insulin therapy and degree of glycemic control in critically ill patients remains controversial, particularly in patients with diabetes mellitus. We hypothesized that diabetic patients who achieved tight glucose control with continuous insulin therapy would have less morbidity and lower mortality than diabetic patients with uncontrolled blood glucose.

Method: A retrospective chart review was performed on 395 intensive care unit (ICU) patients that included 235 diabetic patients.

Burnout in medical students: examining the prevalence and associated factors.

Objective: Burnout has been described as a syndrome of emotional exhaustion, depersonalization, and decreased personal accomplishment, and may originate during medical school. The objective of this study is to determine the prevalence of burnout and contributing factors in medical students.

Methods: A survey was administered to 249 medical students using a modified Maslach Burnout Inventory Human Services Survey (MBI-HSS) and scales of stressors, assessment of workload, relaxation, control, accomplishment, support systems, and demographics.

Thoracoscopic decortication for advanced pediatric empyema.

Background: Although tube thoracostomy with fibrinolytic agents and video-assisted thoracoscopic (VATS) decortication are relatively equivalent in the treatment of empyema with regard to time to patient defervescence and hospital discharge, the potential for greater benefit with VATS decortication in the setting of advanced empyema has not been explored fully. This paper describes our transition from a policy of drainage and antibiotics to primary operative management with VATS. We wanted to assess the safety and efficacy of primary operative management as a first-line treatment for advanced disease.

Effects of combination dobutamine and vasopressin therapy on microcirculatory blood flow in a porcine model of severe endotoxic shock.

Background: Dobutamine (DB) has been recommended in combination with vasopressor therapy in septic shock, given its reported ability to improve mesenteric and microcirculatory perfusion. Vasopressin (VP) is typically reserved as a second-line agent due to the concern of ischemia. The purpose of our study was to determine whether combination DB and VP therapy improved microcirculatory blood flow in severe endotoxic shock.