Early Colostomy Formation Can Improve Independence Following Spinal Cord Injury and Increase Acceptability of Bowel Management.

Colostomy formation can solve complications of bowel management following spinal cord injury (SCI). Newly injured patients at this spinal unit have chosen colostomy as a preferred option for bowel management. To discover the reasons patients choose colostomy formation early following SCI and make comparison with those choosing it later, and to establish whether early colostomy is safe and advisable.

Gap Analysis to Identify Clinical Education Needs of Aeromedical Evacuation Clinicians.

Background: The Air Force has unique challenges in ensuring clinical proficiency for en route care clinicians. These challenges pertain to existing care environments, training opportunities, and the spectrum of training needed to care for patients with polytrauma and complicated medical conditions while being transported between medical treatment facilities.

Objective: The purpose of this study was to identify the clinical education needs of students entering the United States Air Force School of Aerospace Medicine Flight Nurse (FN) or Aeromedical Evacuation Technician (AET) course and Air Force FNs and AETs assigned to active duty aeromedical evacuation units.

Psychiatric Aeromedical Evacuations of Deployed Active Duty U.S. Military Personnel During Operations Enduring Freedom, Iraqi Freedom, and New Dawn.

Introduction: The primary objective of this study was to describe the demographic, clinical, and attrition characteristics of active duty U.S. military service members who were aeromedically evacuated from Iraq and Afghanistan theaters with a psychiatric condition as the primary diagnosis.

An Occupational Paradox: Why Do We Love Really Tough Jobs?

Background: Sometimes we come upon unexpected or counterfactual results during research that make us wonder and lead us into unknown territory. Such was the experience of a team of Air Force researchers exploring aeromedical evacuation crew members' experiences of safety and patient care concerns throughout the en route care system.

Objective: To explore what it is about the aeromedical evacuation crew members' occupation that generates a strong motivation to the mission despite the demands it places on its workers.

Factors That Affect Pain Management in Aeromedical Evacuation: An Ethnographic Approach.

Background: Pain management is a challenge in the transport setting, but actual factors that influence pain have not been assessed systematically.

Objective: To describe the environmental factors and social context that affect pain management in military aeromedical evacuation.

Methods: Field notes were taken throughout flight, including observational measures of pain, environmental factors, and interactions between the patient and crew.

Pressure Injury Development in Patients Treated by Critical Care Air Transport Teams: A Case-Control Study.

Background: The US Air Force transports critically ill patients from all over the world, with transport times commonly ranging from 6 to 11 hours. Few outcome measures have been tracked for these patients. Traditional methods to prevent pressure injuries in civilian hospitals are often not feasible in the military transport environment.

Experiences with Regional Anesthesia for Analgesia During Prolonged Aeromedical Evacuation.

Introduction: There is much debate regarding the appropriate analgesic management of patients undergoing medical evacuation following combat trauma. Our primary objective was to review the utility of regional anesthetic techniques in patients undergoing aeromedical evacuation following surgical limb amputation as treatment for combat trauma.

Methods: This study was conducted as an observational retrospective cohort whereby acutely injured amputee patients were identified via the U.

Understanding Post-Deployment Reintegration Concerns Among En Route Care Nurses: A Mixed-Methods Approach.

The objective of this study was to better understand the post-deployment behavior health symptoms and readjustment/reintegration experienced by military nurses who provided en route care while serving in Operation Enduring Freedom/Operation Iraqi Freedom. Employing an exploratory, concurrent, mixed-methods design with an electronic survey consisting of several valid instruments and single, face-to-face interviews; data were gathered from 119 surveys and 22 interviews. Four qualitative themes aligned with the Post-Deployment Readjustment Inventory items.

Clinical Experience and Learning Style of Flight Nurse and Aeromedical Evacuation Technician Students.

Background: The clinical experience and preferred learning style of U.S. Air Force flight nurses and aeromedical evacuation technicians are unknown.

Investigation of Self-Reported Musculoskeletal Injuries on Post-Deployment Health Assessment Forms for Aeromedical Evacuation Personnel.

Musculoskeletal injuries (MSIs) are a concern for the military community because of medical expenses, possible disability, and separation from the military. This study investigated the prevalence of MSIs in deployed aeromedical evacuation (AE) populations reported on Post-Deployment Health Assessment (PDHA) forms. A secondary aim was to examine the relationship between the occurrence of self-reported MSIs on PDHAs and a subsequent medical diagnosis.

Deficiency or dementia? Exploring B12 deficiency after urostomy.

Vitamin B12 deficiency can be misdiagnosed as a variety of other illnesses, and if left untreated can lead to irreversible damage to the brain and nervous system. This article discusses the case of a 70-year-old female with a urostomy, well known to the stoma care department, who shortly after a routine parastomal hernia repair developed severe confusion, immobility and was unable to communicate. Subsequent investigations ruled out a cerebrovascular accident (CVA) and a diagnosis of rapidly progressing vascular dementia was made.

Ileostomy closure in an enhanced recovery setting.

Aim: Hospital stays of 5 days or more are not uncommon following ileostomy closure, yet within an enhanced recovery programme (ERP) it is possible for patients to be discharged on the first postoperative day following anterior resection. The aim of this study was to evaluate whether the introduction of an ERP for ileostomy closure reduced hospital stay without affecting morbidity or readmission rates.

Method: Consecutive patients undergoing elective ileostomy closure from October 2000 to March 2013 were included in this study.

Assessment of pain in less severely ill and injured aeromedical evacuation patients: a prospective field study.

Pain management is vitally important to injured patients being evacuated from the warzone. A prospective assessment of real-time ratings of pain acceptability, intensity, and satisfaction of a convenience sample of 114 less severely ill and injured U.S.

Finishing what was started: an analysis of theater research conducted from 2010 to 2012.

The Joint Combat Casualty Research Team (JC2RT) is part of the human research protection regulatory system implemented in 2005 to oversee the conduct of research in a deployed military combatant command. In 2010, SharePoint, a web-based tool, was established to track study documents. This study conducted by JC2RT no.

Records review of musculoskeletal injuries in aeromedical evacuation personnel.

Background: Aeromedical evacuation providers care for patients during air transport. By applying standard medical practices, oftentimes developed for ground care, these practitioners perform their mission duties under additional physical stress in this unique medical environment. Awkward postures and excessive forces are common occurrences among personnel operating in this domain.

Using the Health Belief Model to develop educational strategies to improve pertussis vaccination rates among preschool staff.

The number of pertussis or "whooping cough" cases has steadily increased in the United States in the last 20 years. Many of the cases are adults who have not kept up with current vaccination recommendations. Adults are unknowingly exposing susceptible infants and unvaccinated children to this potentially deadly disease.

Chapter 3 innovations in the en route care of combat casualties.

The en route care environment is dynamic and requires constant innovation to ensure appropriate nursing care for combat casualties. Building on experiences in Iraq and Afghanistan, there have been tremendous innovations in the process of transporting patients, including the movement of patients with spinal injuries. Advances have also been made in pain management and noninvasive monitoring, particularly for trauma and surgical patients requiring close monitoring of their hemodynamic and perfusion status.

En route care patient safety: thoughts from the field.

The purpose of this study was to describe the patient safety culture of en route care in the United States Air Force aeromedical evacuation system. Almost 100,000 patients have been transported since 2001. Safety concerns in this unique environment are complex because of the extraordinary demands of multitasking, time urgency, long duty hours, complex handoffs, and multiple stressors of flight.

MicroRNAs participate in the murine oligodendroglial response to perinatal hypoxia-ischemia.

Background: Hypoxic-ischemic injury (HI) to preterm brain results in white matter loss. The endogenous oligodendroglial response to perinatal HI is characterized by increased oligodendroglial progenitor cells (OPCs). MicroRNAs (miRs) are important post-transcriptional regulators of gene expression, and a few miRs have been shown to regulate differentiation of OPCs into mature oligodendroglia.

Occurrence of secondary insults of traumatic brain injury in patients transported by critical care air transport teams from Iraq/Afghanistan: 2003-2006.

Traumatic brain injury patients are susceptible to secondary insults to the injured brain. A retrospective cohort study was conducted to describe the occurrence of secondary insults in 63 combat casualties with severe isolated traumatic brain injury who were transported by the U.S.

Considerations when caring for a person with a prolapsed stoma.

Stomal prolapse is a complication that can occur with all types of stoma. Not only does a prolapse cause issues with pouch management for the ostomist, but can also lead to many psychological problems. Stoma care nurses are often the first point of contact for ostomists when they prolapse, and are therefore in a position to assess, reassure and educate.

The Enhanced Recovery Programme for stoma patients: an audit.

An enhanced recovery programme was implemented at Salisbury NHS Foundation Trust for elective patients undergoing colonic surgery with a stoma in October 2007. The programme is a multimodal approach first described by Professor H. Kehlet in 2000.

Case study: negative pressure wound therapy in an abdominal wound.

This article explores the history and management of large abdominal wounds and the importance of a multi-disciplinary team approach to wound healing. It identifies the difficulties of using negative pressure wound therapy (NPWT) in a patient with a large abdominal wound, which is further complicated by an ileostomy. NPWT is increasingly used for large wounds with positive outcomes, however, the case study demonstrates the many difficulties involved and how they were overcome.

Substantial archaeocortical atrophy and neuronal loss in multiple sclerosis.

Recent studies have revealed extensive neocortical pathology in multiple sclerosis (MS). The hippocampus is a unique archaeocortical structure understudied in MS. It plays a central role in episodic and anterograde memory-the most frequently impaired cognitive modalities in MS.

Use of local anesthesia for arterial punctures.

Background: Except for intravenous therapy, arterial access is the most common invasive procedure performed on critically ill patients. Arterial puncture is a source of pain and discomfort. Intradermal injection of lidocaine around the puncture site decreases the incidence and severity of localized pain when used before arterial puncture.