The management of multiply injured trauma patients is a skill requiring broad knowledge, sound judgment, and leadership capabilities. The purpose of this study was to evaluate the effectiveness of a computer-based trauma simulator as a teaching tool for senior medical students.
All year-4 clinical clerks at the University of Toronto were approached to participate in a focused, 2-hour trauma management course. The volunteer rate for the course was 79%. Students were randomized to either computer-based simulator or seminar-based teaching groups. Outcome measures in this study were students' trauma objective structured clinical examination (OSCE) scores.
Both the trauma simulator and seminar teaching groups performed significantly better than the comparison group (no additional teaching) on the trauma OSCE patient encounter component, but not the written component of the examination. There was no significant difference in the performances of the trauma simulator and seminar teaching groups. Students overwhelmingly felt the trauma simulator was effective for their trauma teaching, and improved their overall confidence in clinical trauma scenarios.
There is a significant benefit associated with a focused, clinically based trauma management course for senior medical students. No additional improvement was noted with the use of a high fidelity computer-based trauma simulator.
In a suburban area of Copenhagen with approximately 620,000 inhabitants, all the openly operated on meniscal lesions of the knee joint between 1982 and 1984 inclusive were reviewed. The mean annual incidence of meniscal lesions per 10,000 inhabitants was 9.0 in males and 4.2 in females. The highest incidences were seen in the 3rd, 4th, and 5th decades of life. A higher frequency of trauma related to onset of symptoms was found among males (77 percent) than among females (64 percent). The bucket-handle lesion was the most frequent type of meniscal lesion in males (35 percent), whereas peripheral detachment was the most frequent in females (41 percent). A variable frequency of trauma inducing the lesions in males and females did not explain differences in type of meniscal lesion. Nineteen percent of our 1,215 patients had a partial meniscectomy, whereas 0.7 percent had meniscal repair.
Medical troops supply in local armed conflicts demonstrated advantages of fast evacuation of wounded personnel by aviation from the seat of combat actions to the stage of specialized surgical care. Wounded in head, breast, abdomen (particularly in case of multiple and combined character of wounds) are evacuated for treatment to central military hospitals equipped with modern diagnostic and medical equipment, completed with qualified specialists and having the opportunity of prolonged treatment. Surgical care in the zone of combat actions is confined to hemostasis, intensive therapy -to supporting of main vital functions. The article contains the data about terminations of wounded personnel treatment in central military-fleet clinical hospital.
In the article the final analysis of organization of surgical care during the local military conflict in northern Caucasus was presented. The real possibilities of different medical units such as single medical company and medical squadron of special assignment was described. Also concrete contents of emergency specialized surgical care and its role in improvement of outcomes in patients with combined combat injuries was reflected. Mortality in this patients was decreased from 25.2 to 12.8%. The defects of surgical care were analyzed and the main ways of improvement of surgical care in local military conflict were presented. In the result of using the principle of moving the medical care closer to the wounded in the whole system of consecutive care the mortality was decreased up to 1.3%.
At present the hepatosurgery in the Vishnevsky Central Military Clinical Hospital has become one of the most perspective and rapidly developing directions of the surgery. The authors present the review of hepatosurgery development in the hospital with the detailed analysis of treatment results at each stage of development, the description of technical support of the new methods for conducting the complex operations on liver. For the short time (since 1991) we have passed the way from atypical hepatic resections up to the liver autotransplantation. The importance of additional surgical manipulations and procedures facilitating the surgery, the postoperative period and improving the operation results are underlined.
Treatment and diagnostic measures, including anesthesia during catastrophes and natural disasters are a world known problem. The paper presents the experience of anesthetic care provision during specialized surgical care to the victim children of the earthquake in Haiti. The materials of analysis were 529 anesthesias conducted to 72 children, who were in the treatment for crush syndrome, skeletal and concomitant injury. The peculiarities of anesthesia during the treatment of wound process depending on the stage of surgery are brought into view. During the preparatory phase the optimal type of anesthesia is inhalation and intravenous anesthesia, whereas for the defect closure (main stage) all types of anesthesia, including balanced endotracheal and combined anesthesia were used.
Experience of organization of the surgical care in the military hospital to 438 wounded in extremities during armed conflict in Republic of Chechnya is generalized. Maximum reduction of stages of medical evacuation of the wounded in extremities, approaching of the qualified and urgent specialized surgical care directly to the region of battle actions, use of opportunities for it one-moment rendering corresponded to principles of the modern military-medical doctrine. Due to realization of the requirements of the doctrine life of many wounded ++ was saved, terms of treatment, medical and social rehabilitation are reduced. Besides lethality, treatment cost and numbers of transferring to the reserve from the Armed Forces were reduced.