The Readiness Imperative: Leveraging Large Animal Resident Research to Enhance Expeditionary Surgical Skills.

INTRODUCTION: The Defense Health Agency aims to ensure that military surgical residents have the expeditionary general surgical skills necessary to deploy to a combat environment and maintains the Clinical Investigation Programs (CIPs) that foster research during graduate medical education. This project evaluates the potential to achieve both aims simultaneously through a large animal Combat Casualty Care Research Program (CCCRP). MATERIALS AND METHODS: Large animal experimental protocols within a single CIP's CCCRP were collected from July 1, 2017, to June 30, 2022. Operations performed were tabulated and categorized by Emergency General Surgery procedure equivalent. In addition, procedures performed by a single resident from July 1, 2020, to June 30, 2022, were separately indexed for a more granular analysis. RESULTS: The results are presented with total 5-year numbers listed first, followed by single resident 2-year numbers in parentheses. The residents at the CIP carried out 8676 (1,609) tabulated procedures. Major surgical procedures included 573 (154) laparotomies, 364 (129) thoracotomies, 279 (125) splenectomies, 219 (108) craniotomies, 206 (81) hepatorrhaphies, 363 (62) nephrectomies, 383 (48) bowel resections, 215 (48) spine exposures with laminectomies, and 173 (9) sternotomies. Additional procedures included 1028 (127) central venous lines, 878 (127) arterial lines, 90 (67) tube thoracostomies, 199 (37) carotid artery exposures, 394 (29) suprapubic urostomies, and placement of 278 (10) aortic occlusion catheters. At this time, the residents had 17 (10) presentations at national meetings, 8 (7) research awards, and published 20 peer-reviewed manuscripts. Additionally, the residents involved in the CCCRP gained valuable experience in critical care, including management of 110 traumatic brain injuries, 121 Intercranial Pressure catheters, 316 cases of hemorrhagic shock, and 211 massive transfusion protocols, among a variety of other vital critical care skills. CONCLUSIONS: This large animal CCCRP represents a unique training model that not only achieves its primary goal of fostering graduate medical education research but also bolsters Emergency General Surgery readiness for military surgical residents.

Smell and Taste Disorders in Primary Care.

Disorders of smell and taste are reported by approximately one-fifth of people 40 years and older, and one-third of people 80 years and older. These disorders affect quality of life and the ability to identify smoke and toxins. Smell and taste disorders can be early signs of dementia or Parkinson disease and are associated with increased mortality. Dysfunction may be apparent or may develop insidiously. Screening questionnaires are available, but many patients are unaware of their disorder. Most smell and taste disorders are due to sinonasal disease but also could be caused by smoking, medications, head trauma, neurodegenerative disease, alcohol dependence, or less common conditions. The differential diagnosis should guide the evaluation and include anterior rhinoscopy and an examination of the oral cavity, head, and cranial nerves. Further investigation is often unnecessary, but nasal endoscopy and computed tomography of the sinuses may be helpful. Magnetic resonance imaging of the head with contrast should be performed if there is an abnormal neurologic examination finding or if trauma or a tumor is suspected. Olfactory testing is indicated in refractory cases or for patients with poor quality of life and disease associated with smell or taste dysfunction. Smell and taste disorders may resolve when reversible causes are treated, but improvement is less likely when they are due to trauma, age, or neurodegenerative disease. Olfactory training is a self-administered mindful exposure therapy that may improve olfactory function. Physicians should encourage patients to ensure that smoke and other alarms are operational and to adhere to food expiration dates.