Gait outcomes of patients with severe slipped capital femoral epiphysis after treatment by flexion-rotation osteotomy.

Background: Flexion-rotational osteotomy of the proximal femur is an accepted intervention in the management of severe deformity and femoral acetabular impingement secondary to slipped capital femoral epiphysis (SCFE). The impact of this surgical intervention on gait kinematics and kinetics, validated functional questionnaires, and patient outcomes has not been well studied. The purpose of this study was to analyze the changes in standard gait parameters of patients with moderate to severe SCFE who were treated with a flexion-rotational osteotomy.

Treatment of complex medical emergencies in a forward deployed setting: a case of out-of-hospital cardiac arrest.

The Joint Trauma System in Afghanistan, while designed for the care of injured patients, can provide timely, multimodal, coordinated care for nontraumatic medical emergencies as patients are evacuated from theater. To illustrate this, a case of out-of-hospital cardiac arrest is presented. The patient was able to receive all recommended components of postcardiac arrest care in a timely, coordinated manner at four different medical treatment facilities and while traveling over 8,600 miles with critical care provided en route.

Integration of XNAT/PACS, DICOM, and Research Software for Automated Multi-modal Image Analysis.

Traumatic brain injury (TBI) is an increasingly important public health concern. While there are several promising avenues of intervention, clinical assessments are relatively coarse and comparative quantitative analysis is an emerging field. Imaging data provide potentially useful information for evaluating TBI across functional, structural, and microstructural phenotypes.

A review of the inflammatory chorioretinopathies: the white dot syndromes.

The white dot syndromes are a group of inflammatory chorioretinopathies of unknown etiology which have in common a unique and characteristic appearance of multiple yellow-white lesions affecting multiple layers of the retina, retinal pigment epithelium (RPE), choriocapillaris, and the choroid. They also have overlapping clinical features. We discuss acute retinal pigment epitheliopathy, multiple evanescent white dot syndrome, acute posterior multifocal placoid pigment epitheliopathy, multifocal choroiditis and panuveitis, acute zonal occult outer retinopathy, birdshot chorioretinopathy, and serpiginous choroidopathy.

The diagnosis of autism in community pediatric settings: does advanced training facilitate practice change?

The increased prevalence of autism spectrum disorder and documented benefits of early intensive intervention have created a need for flexible systems for determining eligibility for autism-specific services. This study evaluated the effectiveness of a training program designed to enhance autism spectrum disorder identification and assessment within community pediatric settings across the state. Twenty-seven pediatric providers participated in regional trainings across a 3.

Acute zonal occult outer retinopathy: vision loss in an active duty soldier.

Objective. To describe a case of acute zonal occult outer retinopathy (AZOOR) in an active duty patient. Methods.

Transforming US Army trauma care: an evidence-based review of the trauma literature.

The US Army has been charged to transform to meet the demands of current and anticipated near-future combat needs, covering a full spectrum of military operations. The US Army combat trauma care system was created to deliver combat casualty care in a variety of situations and has been adapted to meet the needs of such care in both Operations Enduring Freedom and Iraqi Freedom. Questions related to our current system include the use and positioning of medical evacuation assets, the type of training for our trauma care providers, the positioning of these providers in proximity to the battlefield, and the type of units most suited to the wide variety of medical operations required of today's military medical team.

The role of screening electrocardiograms in the evaluation of ROTC cadets applying for flight status.

The majority of sudden, nontraumatic deaths in young, otherwise healthy individuals result from an unknown underlying cardiac abnormality. The low sensitivity of the traditional history and physical exam in detecting these anomalies has led to a debate regarding the use of routine screening electrocardiograms (ECGs) in young adults. The present study screened 1,099 ROTC cadets applying for aviator status during the summers of 2005 and 2006.

Live birth sex ratios are not influenced by blastocyst-stage embryo transfer.

Objective: To analyze the sex ratio of infants born after blastocyst-stage transfer of embryos with normal preimplantation FISH genetic screening.

Design: Retrospective cohort analysis.

Setting: Large academic assisted reproductive technology center.

Partial anomalous pulmonary venous return.

Partial anomalous pulmonary venous return (PAPVR) is an uncommon congenital abnormality that occurs in 0.4 to 0.7% of postmortem examinations.

Lumbopelvic manipulation for the treatment of patients with patellofemoral pain syndrome: development of a clinical prediction rule.

Study Design: Prospective cohort/predictive validity study.

Objective: To determine the predictive validity of selected clinical exam items and to develop a clinical prediction rule (CPR) to determine which patients with patellofemoral pain syndrome (PFPS) have a positive immediate response to lumbopelvic manipulation.

Background: Quadriceps muscle function in patients with PFPS was recently shown to improve following treatment with lumbopelvic manipulation.

A luteal estradiol protocol for anticipated poor-responder patients may improve delivery rates.

Objective: To compare IVF data and outcomes between a standard protocol and a luteal phase E(2) protocol.

Design: Retrospective cohort analysis.

Setting(s): Large academic assisted reproduction technologies center.

A study comparing chloroprocaine with lidocaine for skin infiltration before intravenous catheter insertion.

A prospective, double-blind, mixed, crossover study was conducted to determine the perception of pain associated with intradermal lidocaine and chloroprocaine for insertion of an 18-gauge intravenous catheter. A convenience sample of 64 healthy, adult volunteers was used. Each participant received an intradermal injection of lidocaine or chloroprocaine on the dorsum of one hand followed by insertion of an 18-gauge intravenous catheter.

Cutaneous leishmaniasis in soldiers from Fort Campbell, Kentucky returning from Operation Iraqi Freedom highlights diagnostic and therapeutic options.

Background: Cutaneous leishmaniasis (CL), rare in the first Gulf War, is common in American troops serving in Operation Iraqi Freedom. Awareness of the clinical features and treatment options of CL would benefit clinicians who may encounter soldiers, as well as civilians, returning from the Middle East with skin lesions.

Objective: Our purpose was to describe our clinical experience in treating soldiers with CL.

Emergency preparedness--is your OR ready?

Emergency situations only recently have come to include terrorist threats, such as radiation, biological and chemical attacks, and bombings. The importance of emergency preparedness in health care facilities has increased as a result of recent terrorist threats. Perioperative leaders must meet the challenge of preparing their departments for a wide range of potential disasters.

To air is human: altitude illness during an expedition length adventure race.

Objective: To calculate the incidence and prevalence of altitude illness (acute mountain sickness [AMS], high altitude pulmonary edema, and high altitude cerebral edema) during an expedition length adventure race and to determine factors contributing to its development as well as identify cases requiring medical treatment, withdrawal from the event, or both.

Methods: The Primal Quest Expedition Length Adventure Race was held in Colorado in July 2002. Sixty-two coed teams of four participated in the event.

A model for demand management in a managed care environment.

Downsizing of personnel and budgets demands effective means of managing patients' demand for care to ensure that care assets are appropriately utilized. Preliminary data indicate that the Central Triage concept of demand management is effective, efficient, and satisfactory to patients. As a centralized portal to care for individuals presenting without appointments, registered nurses screen and triage via protocol.

Military training at civilian trauma centers: the first year's experience with the Regional Trauma Network.

The Regional Trauma Network was launched in 1996 to provide trauma training opportunities for Army surgeons in the Southeast Regional Medical Command. Training directors at eight civilian level I trauma centers agreed to allow military surgeons to function at the fellowship level of responsibility for up to 30 days at a time. In the first year, 7 surgeons participated in rotations at five different centers and 13 surgeons attended nationally recognized trauma symposia.

Hand-assisted laparoscopic sigmoidectomy for diverticulitis.

Background: Sigmoid colectomy for diverticular disease, a routine procedure when performed using standard open methods, can prove much more challenging using minimum access techniques. Hand-assisted laparoscopic colectomy is a new technique that reportedly has a minimum learning curve, yet retains the benefits of a laparoscopic procedure. The purpose of this study was to perform and then prospectively to evaluate the outcome of this procedure on patients needing elective sigmoidectomy for diverticular disease.

A descriptive, correlational study of patient satisfaction, provider satisfaction, and provider workload at an army medical center.

Strong national interest in health care delivery systems and a highly competitive marketplace have mandated that military hospital commanders be increasingly aware of organizational performance. Historically, one variable that has been used to assess such performance is patient satisfaction with the care received. The purpose of this study was to measure patient satisfaction at a major military medical center and to assess how patient satisfaction correlated with the variables of provider satisfaction and nurse/patient ratio.

Sevoflurane concentration available from the universal drawover vaporizer.

Field anesthesia can have special considerations because of the possibly primitive conditions. The drawover vaporizer has enjoyed increased interest because of the ability to deliver an anesthetic without electricity or compressed gases. Sevoflurane is a potentially attractive field agent because of its relative insolubility in blood, giving more rapid control over anesthetic depth.

Phonophoretic delivery of 10% hydrocortisone through the epidermis of humans as determined by serum cortisol concentrations.

Background And Purpose: The purpose of this investigation was to determine whether application of hydrocortisone phonophoresis enhances transcutaneous delivery of topically applied hydrocortisone in humans, as determined by blood cortisol levels.

Subjects: The subjects were 16 men and women, between the ages of 18 and 33 years (X = 25, SD = 2.74), without symptoms of any ongoing inflammatory condition.