Battle fatigue identification and management for military medical students.

Battle fatigue, a temporary response to the stress of combat capable of reducing the fighting force by 10% to 50%, is an inevitable consequence of military conflict. Effective application of established preventive and management techniques by line and medical corps personnel can turn this "force reducer" into a "force multiplier," returning 80% or more of these seasoned troops to their original units within 72 hours. The proper management of battle fatigue is an essential readiness element in the medical support mission. The "Battle Fatigue Identification and Management" course prepares future military medical officers for this important contingency role.     

Time: a vital resource

Resolving problems with time management requires an understanding of the concept of working smarter rather than harder. Therefore, managing time effectively is a vital responsibility of department managers. When developing a plan for more effectively managing time, it is important to carefully analyze where time is currently being used/lost. Keeping a daily log can be a time consuming effort. However, the log can provide information about ways that time may be saved and how to organize personal schedules to maximize time efficiency. The next step is to develop a strategy to decrease wasted time and create a more cohesive radiology department. The following list of time management strategies provides some suggestions for developing a plan. Get focused. Set goals and priorities. Get organized. Monitor individual motivation factors. Develop memory techniques. In healthcare, success means delivering the highest quality of care by getting organized, meeting deadlines, creating efficient schedules and appropriately budgeting resources. Effective time management focuses on knowing what needs to be done when. The managerial challenge is to shift the emphasis from doing everything all at once to orchestrating the departmental activities in order to maximize the time given in a normal workday.     

Multi-segment coordination: fatigue effects.

PURPOSE: The aim of this study was to investigate the segmental coordination of vertical jumps under fatigue. METHODS: Twelve subjects performed maximal countermovement jumps with and without fatigue, which was imposed by maximal continuous jumps in place until their maximal jump height corresponded to 70% of the nonfatigued condition. Video, ground reaction forces, and electromyographic signals were recorded to analyze the segmental coordination of countermovement jumps before (CMJ1) and after (CMJ2) fatigue. The magnitude of joint extension initiation, peak joint angular velocity, and peak net power around the ankle, knee, and hip joints and their respective times were determined. RESULTS: CMJ2 was characterized by a longer contact time, which was accompanied with an earlier movement initiation and several differences (P < 0.05) in the variables used to describe coordination. When the movement duration was normalized with respect to the contact phase duration, the differences between CMJ1 and CMJ2 were not sustained. A consistent pattern was indicated, in which the segmental coordination did not differ between jump conditions. When the magnitude of the muscle activation was set aside, a remarkably consistent muscle activation time was noticed between conditions. CONCLUSIONS: It was indicated that countermovement jumps were performed with a consistent well-timed motion of the segments. A "common drive," which acts without the knowledge of the muscle properties, was suggested as mediating and controlling the muscle activation timing between agonist-antagonist muscle pairs.     

Pathophysiology of radiocontrast nephropathy: a role for medullary hypoxia.

Recent experimental data underlies the role of hypoxic tubular injury in the pathophysiology of radiocontrast nephropathy. Although systemic transient hypoxemia, increased blood viscosity, and a leftward shift of the oxygen-hemoglobin dissociation curve may all contribute to intrarenal hypoxia, imbalance between oxygen demand and supply plays a major role in radiocontrast-induced outer medullary hypoxic damage. Low oxygen tension normally exists in this renal region, reflecting the precarious regional oxygen supply and a high local metabolic rate and oxygen requirement, resulting from active salt reabsorption by medullary thick ascending limbs of Henle's loop. Radiologic contrast agents markedly aggravate outer medullary physiologic hypoxia. This results from enhanced metabolic activity and oxygen consumption (as a result of osmotic diuresis and increased salt delivery to the distal nephron) because the regional blood flow and the oxygen supply actually increase. The latter effect may result in part from the activation of various regulatory mediators of outer medullary blood flow to ensure maximal regional oxygen supply. Low-osmolar radiocontrast agents may be less nephrotoxic because of the smaller osmotic load and vasomotor alterations. Experimental radiocontrast-induced renal failure requires preconditioning of animals with various insults (for example, congestive heart failure, reduced renal mass, salt depletion, or inhibition of nitric oxide and prostaglandin synthesis). In all these perturbations, which resemble clinical conditions that predispose to contrast nephropathy, outer medullary hypoxic injury results from insufficiency or inactivation of mechanisms designed to preserve regional oxygen balance. This underlines the importance of identifying and ameliorating predisposing factors in the prevention of this iatrogenic disease.     

TIPS术后患者延续护理干预研究

目的 探讨延续护理在TIPS术后患者中的应用效果.方法 将68例行TIPS手术的符合纳入标准的患者,随机分为对照组和观察组,各34例.对照组进行常规护理.观察组在此基础上还接受延续护理干预,通过电话随访、家庭访视以及微信平台指导:消化道再出血预防,感染预防,便秘防治,优质低蛋白饮食控制,轻微肝性脑病识别,监测血氨,定期复诊,抗凝药物不良反应的处理.分别于出院前、术后1和3个月比较两组患者的肝功能Child-Pugh评分、血氨、遵医行为、不良事件发生率.结果 观察组患者术后1、3个月的遵医行为得分均高于对照组,t=-2.8,P=0.007,t=-5.57,P＜0.001.术后3个月内消化道出血、肝性脑病、下肢肿胀以及死亡不良事件的发生率,观察组显著低于对照组,x2=5.581,P＜0.05.重复测量方差分析结果显示两组患者术后肝功能评分在不同时间点上的变化趋势不同,P＜0.001,术后1、3个月观察组患者肝功评分低于对照组,P＜0.05.两组患者术后血氨比较差异不具有统计学意义,P＞0.05.结论 延续护理可提高TIPS术后患者对出院后科学护理的可及性,显著地提高患者的遵医依从性和健康水平,改善患者术后的肝功,减少术后不良事件的发生.     

Vertical jump coordination: fatigue effects.

PURPOSE: The aim of this study was to investigate the segmental coordination of vertical jumps under fatigue of the knee extensor and flexor muscles. METHODS: Eleven healthy and active subjects performed maximal vertical jumps with and without fatigue, which was imposed by requesting the subjects to extend/flex their knees continuously in a weight machine, until they could not lift a load corresponding to approximately 50% of their body weight. Knee extensor and flexor isokinetic peak torques were also measured before and after fatigue. Video, ground reaction forces, and electromyographic data were collected simultaneously and used to provide several variables of the jumps. RESULTS: Fatiguing the knee flexor muscles did not reduce the height of the jumps or induce changes in the kinematic, kinetic, and electromyographic profiles. Knee extensor fatigue caused the subjects to adjust several variables of the movement, in which the peak joint angular velocity, peak joint net moment, and power around the knee were reduced and occurred earlier in comparison with the nonfatigued jumps. The electromyographic data analyses indicated that the countermovement jumps were performed similarly, i.e., a single strategy was used, irrespective of which muscle group (extensor or flexors) or the changes imposed on the muscle force-generating characteristics (fatigue or nonfatigue). The subjects executed the movements as if they scaled a robust template motor program, which guided the movement execution in all jump conditions. It was speculated that training programs designed to improve jump height performance should avoid severe fatigue levels, which may cause the subjects to learn and adopt a nonoptimal and nonspecific coordination solution. CONCLUSION: It was suggested that the neural input used in the fatigued condition did not constitute an optimal solution and may have played a role in decreasing maximal jump height achievement.     

The basal ganglia: a substrate for fatigue in multiple sclerosis

Introduction The origin of fatigue in multiple sclerosis (MS) remains uncertain. However, the use of nonconventional magnetic resonance techniques has increased our understanding of this problem. We aimed to study the relationship between fatigue in MS and the presence of focal dysfunction in the basal ganglia and frontal white matter. Methods Included in the study were 41 patients with relapsing–remitting MS with mild disability and 20 healthy controls. Fatigue was assessed by the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS). Patients were classified as “fatigued” when they expressed a subjective feeling of fatigue, and the FSS score was ≥5.0 and/or the MFIS score was >38. Patients with no subjective fatigue were classified as “nonfatigued” when the FSS score was <4.0. Proton magnetic resonance spectra were obtained from two different regions: the frontal white matter and the lentiform nucleus. The relationships between fatigue and NAA/Cr, NAA/Cho and Cho/Cr ratios were analysed. Results A significant decrease in NAA/Cr in the lentiform nucleus region in patients with fatigue was observed. No differences between the groups were found in the frontal white matter. Conclusion Although confirmatory studies are needed, our results would support the idea that a specific dysfunction or involvement of the basal ganglia might partly contribute to the development of MS-related fatigue. This study was partly supported by Spain’s MEC-FIS programme, grant no. 01/1374.     

Battle injuries of the rectum: options for the field surgeon

Historically, battle wounds of the rectum have had high mortality and morbidity. This has improved greatly over several decades as a result of battle experience. This article highlights the value of civilian gunshot experience and its possible use in the military setting. The standard principles of rectal examination, followed by proctosigmoidoscopy after initial resuscitation, remain unchanged. Thereafter, the surgical decisions are made at laparotomy. Rectal injuries commonly have other injuries in association which must also be dealt with. In the stable patient rectal repair may be possible. Where repair is hazardous due to extensive injury (rectum or adjacent structures), the well-proven protective colostomy is used. A loop colostomy with or without distal closure is effective and is used to protect most injuries; possible exceptions being injuries dealt with early, in which there is minimal contamination and repair is easy. Presacral drainage can generally be reserved for severely destructive wounds or those in which repair has not been done. Rectal washout remains an option in patients with inspissated faeces. The basic military surgical principles remain valid, their extent and degree of implementation depending on the anatomical location of injury, degree of damage and any delay in presentation to surgery.     

脊髓损伤尿潴留患者无创护理干预研究进展

尿潴留是脊髓损伤患者常见的并发症之一,目前对尿潴留缺乏有效的治疗,临床上主要采用留置导尿管引流尿液,被动等待膀胱功能的恢复。由于导尿易致尿道黏膜损伤,尿道附近及尿道内存在的细菌可经损伤的黏膜进入机体,引起上行感染;通过无创护理干预来解决患者的尿潴留问题显得尤为重要,本文从促进排尿和膀胱功能训练两方面,综述了脊髓损伤患者尿潴留的无创护理干预进展。     

以舒适为基础的延续性护理干预用于经皮冠状动脉介入术后患者效果分析

【摘要】 目的 分析以舒适为基础的延续性护理干预用于经皮冠状动脉介入术后患者效果分析。方法 选择医院2019年1月至2020年3月接受冠状动脉介入术后冠心病患者113例。根据护理干预方案不同分为对照组（n=55）和干预组（n=58）。对照组患者接受基础护理,干预组患者接受以舒适为基础的延续性护理。两组干预时间为15 d。比较两组患者心功能、焦虑心理、自我管理、依从性、护理满意度、心脏事件。 结果 随着干预时间延长,两组患者左心室射血分数（LVEF）值均升高,其中干预组患者干预1周、2周、4周LVEF值大于对照组（P＜0.05）。随着干预时间延长,两组患者心功能HAMA评分降低,其中干预组患者干预1、2和4周HAMA评分低于对照组（P＜0.05）。干预两组患者情绪认知、不良嗜好、急救和总分较干预前增加,其中干预组患者情绪认知、不良嗜好、急救和总分高于对照组（P＜0.05）。干预组患者依从性率、护理满意率高于对照组（P＜0.05）。干预组患者心脏事件发生率低于对照组（P＜0.05）。结论 以舒适为基础的延续性护理干预用于外周血管介入术后患者可以促使患者心功能和负性心理有效改善,并能显著提升护理满意度和依从性,建议使用。     

Ibuprofen intake increases exercise time to exhaustion: A possible role for preventing exercise‐induced fatigue

Although the intake of nonsteroidal anti‐inflammatory drugs (NSAIDs) intake by athletes prevents soreness, little is known concerning their role in exercise performance. This study assessed the effects of ibuprofen intake on an exhaustive protocol test after 6 weeks of swimming training in rats. Animals were divided into sedentary and training groups. After training, animals were subdivided into two subsets: saline or ibuprofen. Afterwards, three repeated swimming bouts were performed by the groups. Ibuprofen (15 mg/kg) was administered once a day. Pain measurements were performed and inflammatory and oxidative stress parameters were assayed in cerebral cortex and gastrocnemius muscle. Training, ibuprofen administration, or both combined (P < 0.05; 211 ± 18s, 200 ± 31s, and 279 ± 23s) increased exercise time to exhaustion. Training decreased the acetylcholinesterase (AChE) activity (P < 0.05; 149 ± 11) in cerebral cortex. Ibuprofen intake decreased the AChE activity after exhaustive protocol test in trained and sedentary rats (P < 0.05; 270 ± 60; 171 ± 38; and 273 ± 29). It also prevented neuronal tumor necrosis factor‐α (TNF‐α) and interleukin (IL 1β) increase. Fatigue elicited by this exhaustive protocol may involve disturbances of the central nervous system. Additive anti‐inflammatory effects of exercise and ibuprofen intake support the hypothesis that this combination may constitute a more effective approach. In addition, ergogenic aids may be a useful means to prevent exercise‐induced fatigue.