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1.
Wilderness Environ Med ; 32(3): 365-376, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34215513

RESUMO

Rodents can transmit infectious diseases directly to humans and other animals via bites and exposure to infectious salivary aerosols and excreta. Arthropods infected while blood-feeding on rodents can also transmit rodent-borne pathogens indirectly to humans and animals. Environmental events, such as wet winters, cooler summers, heavy rains, and flooding, have precipitated regional rodent-borne infectious disease outbreaks; these outbreaks are now increasing with climate change. The objectives of this review are to inform wilderness medicine providers about the environmental conditions that can precipitate rodent-borne infectious disease outbreaks; to describe the regional geographic distributions of rodent-borne infectious diseases in North America; and to recommend prophylactic treatments and effective prevention and control strategies for rodent-borne infectious diseases. To meet these objectives, Internet search engines were queried with keywords to identify scientific articles on outbreaks of the most common regional rodent-borne infectious diseases in North America. Wilderness medicine providers should maintain high levels of suspicion for regional rodent-borne diseases in patients who develop febrile illnesses after exposure to contaminated freshwater after heavy rains or floods and after swimming, rafting, or paddling in endemic areas. Public health education strategies should encourage limiting human contact with rodents; avoiding contact with or safely disposing of rodent excreta; avoiding contact with contaminated floodwaters, especially contact with open wounds; securely containing outdoor food stores; and modifying wilderness cabins and campsites to deter rodent colonization.


Assuntos
Doenças Transmissíveis , Medicina Selvagem , Animais , Doenças Transmissíveis/epidemiologia , Surtos de Doenças , Inundações , Humanos , América do Norte/epidemiologia , Roedores
2.
Wilderness Environ Med ; 32(3): 355-364, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34217603

RESUMO

When considering medical emergencies that might affect an expedition, urologic emergencies are typically not included. However, the reality is that manageable and prevalent urologic disease processes can pose significant challenges for the wilderness medicine physician and warrant consideration. The purpose of this review is to identify and discuss the most commonly encountered urologic emergencies and diseases in the wilderness setting and to prepare the expedition medicine physician for management of these urgent conditions. A PubMed and Internet search for urologic emergencies and diseases in wilderness conditions was conducted. We also searched bibliographies for useful supplemental literature and material from leading mountain medicine and wilderness medicine societies as well as population-based studies for common urologic diseases. Urologic emergencies and diseases on expeditions and in wilderness conditions have been reported primarily with retrospective case series and case reports. The most commonly reported urologic emergencies in this setting include urologic trauma, renal calculi, and urinary retention. Parasitic infections in the urinary tract also have been reported to cause urinary symptoms and urinary retention in wilderness conditions. Although urologic diseases in such conditions are uncommon, significant morbidity and even potentially life-threatening sequelae to urologic emergencies were found to occur. Major genitourinary emergencies in expedition medicine are uncommon but involve both potentially manageable urgent conditions and serious life-threatening conditions best treated with urgent stabilization and occasionally medical evacuation. The opportunity exists for increased awareness for management strategies for urologic conditions in the often remote or extreme environments of an expedition.


Assuntos
Expedições , Medicina Selvagem , Emergências , Humanos , Estudos Retrospectivos , Meio Selvagem
4.
Pediatr Ann ; 50(6): e234-e239, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34115562

RESUMO

With more families spending time outdoors or embarking on wilderness adventures, pediatricians may be tasked with providing appropriate counseling to parents and children. Although the breadth of wilderness medicine can be extensive, this article will focus on preventive measures, common injuries, and injury treatment options in an outdoor environment. [Pediatr Ann. 2021;50(6):e234-e239.].


Assuntos
Medicina Selvagem , Criança , Humanos , Exame Físico , Medição de Risco
5.
Wilderness Environ Med ; 32(2): 187-191, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33966974

RESUMO

INTRODUCTION: Wilderness medicine (WM) is a growing subspecialty of emergency medicine. In 2018, we surveyed all 240 emergency medicine residencies in the United States to assess the scope of WM education in emergency medicine training programs in light of the nearly 30% increase in the number of residencies since 2015. METHODS: A survey was e-mailed to the Council of Residency Directors in Emergency Medicine listserv and individual program directors of each of the 240 residencies. The survey included questions on educational content, format, number of hours taught, availability of conference credit, offering of an elective or fellowship, and several predefined WM curricula. We evaluated differences between 3-y and 4-y residencies using the χ2 test, where P<0.05 was considered significant. RESULTS: We had a response rate of 57% for completed surveys. Analysis showed 63% of respondent programs teach WM material. The majority (86%) partially or completely developed their curriculum, with 33% offering at least 1 of the predefined curricula. Thirteen percent taught with lecture only, 2% taught by hands-on only, and 85% used a combination of the 2. WM electives were significantly more likely to be offered by 4-y than 3-y residencies (P=0.009). CONCLUSIONS: Almost two-thirds of respondent residency programs teach WM material. Of these, only one-third teach any of the predefined curricula. Four-year residencies are more likely to offer WM electives but are otherwise comparable to 3-y programs.


Assuntos
Medicina de Emergência , Internato e Residência , Medicina Selvagem , Currículo , Medicina de Emergência/educação , Bolsas de Estudo , Inquéritos e Questionários , Estados Unidos , Medicina Selvagem/educação
7.
PLoS One ; 16(1): e0243908, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33406103

RESUMO

OBJECTIVES: Systematic mapping of the concept, content, and outcome of wilderness programs for childhood cancer survivors. DESIGN: Scoping review. SEARCH STRATEGY: Searches were performed in 13 databases and the grey literature. Included studies describe participation of childhood cancer survivors in wilderness programs where the role of nature had a contextual and therapeutic premise. At least two authors independently performed screening, data extraction and analysis. RESULTS: Database searches yielded 1848 articles, of which 15 met the inclusion criteria. The majority of programs (73%) employed adventure therapy. Five activity categories were identified as components of wilderness programs: challenge/risk, free time/leisure, experiential learning, physical activity and psychotherapeutic activities. A majority of the participating childhood cancer survivors were female, white, aged 8-40 years, with a wide range of cancer diagnoses. Reported outcomes included increased social involvement, self-esteem, self-confidence, self-efficacy, social support, and physical activity. Key gaps identified included the absence of randomized controlled trials (RCTs), lack of studies on long-term effects, lack of information on the multicultural aspects of programs, and missing information on engagement in nature activities after the program ended. CONCLUSIONS: This scoping review guides childhood cancer survivors, their families, practitioners, clinicians and researchers in the development and optimization of wilderness programs for childhood cancer survivors. In addition, it informs the utilization of these programs, and identifies gaps in the evidence base of wilderness programs. It is recommended that future study reporting on wilderness programs include more detail and explicitly address the role of nature in the program. Performing RCTs on wilderness programs is challenging, as they occur in real-life contexts in which participants cannot be blinded. Creative solutions in the design of pragmatic trials and mixed method studies are thus needed for further investigation of the effectiveness and safety of wilderness programs in childhood cancer survivors.


Assuntos
Sobreviventes de Câncer , Adolescente , Adulto , Criança , Feminino , Objetivos , Humanos , Masculino , Saúde Mental , Publicações , Medicina Selvagem , Adulto Jovem
8.
Wilderness Environ Med ; 32(1): 55-58, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33516624

RESUMO

Anaphylaxis is a life-threatening allergic reaction involving multiple organ systems that can result in significant morbidity and mortality if left untreated. Epinephrine is the mainstay of treatment. Most episodes of anaphylaxis resolve after a single dose of epinephrine, but biphasic and protracted courses of anaphylaxis are well described. The need for additional doses of epinephrine poses a significant challenge in the wilderness setting, because patients and providers may only carry a single autoinjector. Prior work has demonstrated successful disassembly of various brands of epinephrine autoinjectors to retrieve additional drug product for repeat dosing. We describe 2 techniques to retrieve additional doses of epinephrine from Adrenaclick-style epinephrine autoinjectors. The techniques described are off-label and are not approved by the manufacturer or the Food and Drug Administration. Wilderness providers should familiarize themselves with techniques for retrieval of additional epinephrine from various autoinjectors in light of significant differences in product design.


Assuntos
Epinefrina/administração & dosagem , Injeções/instrumentação , Anafilaxia/tratamento farmacológico , Humanos , Autoadministração , Medicina Selvagem
9.
Wilderness Environ Med ; 32(1): 102-111, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33423896

RESUMO

Telemedicine potentially offers enormous value to expeditions to remote environments. For healthcare professionals, telemedicine can provide access to specialist advice. Where no healthcare professionals are present, telemedicine may be the sole source of expert care. This systematic review appraises and summarizes the current literature regarding telemedicine in patient management on expeditions to remote locations and identifies areas for future research. MEDLINE and EMBASE were systematically searched for relevant articles from 1980 through February 2018. Data were handled according to the PRISMA process and analyzed using type-specific critical appraisal checklists where possible. Two hundred twenty-five articles were identified, 33 of which were included in this systematic review. They encompassed a variety of remote environments, including maritime (13), polar (9), mountainous (5), jungle (1), and multiple austere environments (6). Although some environments were better reported than others, many overarching concepts were generalizable. Through channels of communication that included telephone, radio, videoconferencing, and email, telemedicine has been used effectively in a range of environments to initiate treatment, follow up with patients, and determine the appropriateness of evacuation. Telementoring, in which a remote expert guides a local care provider in performing a procedure or task, is a promising aspect of telemedicine that is currently being developed. As technology advances, the scope of telemedicine will continue to expand. However, each new telemedical development must be shown to do more than simply function in a remote environment. Instead, new technologies should be tested for improved patient, practitioner, or expedition outcomes, within a telemedical system.


Assuntos
Expedições , Telemedicina/instrumentação , Telemedicina/métodos , Humanos , Comunicação por Videoconferência , Medicina Selvagem
10.
Wilderness Environ Med ; 32(1): 12-18, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33298355

RESUMO

INTRODUCTION: The national resident matching program specialties matching service (SMS) fills fellowship positions for 66 subspecialties. Wilderness medicine (WM) fellowships currently do not participate in SMS; instead, WM uses an offer date to fill positions. To be successful, at least 75% of the available positions within a subspecialty must be within the SMS match. METHODS: All 13 civilian WM fellowship directors recruiting for academic year (AY) 2019 to 2020 and WM fellowship alumni were surveyed regarding future participation in the SMS. Estimation of the performance of SMS for WM was calculated using data published by the national resident matching program. RESULTS: Fellowship directors from all 13 civilian WM fellowships and 60 fellowship alumni participated in the survey. SMS was supported by 62% (n=8) of fellowship directors and 55% (n=33) of fellows. Willingness to pay SMS fees was 54% (n=7) among fellowship directors and 60% (n=36) among fellows. Of matched applicants, 85% (n=51) obtained their top choice program. SMS, if implemented, was perceived to have no impact on matching a top choice program by 53% (n=31); however, 34% (n=20) believed SMS would improve the chance of an applicant matching higher. The match success of SMS for specialties with fewer than 30 programs is 74%. Of the 20 WM fellowship positions in AY 2019 to 2020, 16 were matched, for a success rate of 80%. CONCLUSIONS: There is insufficient support (<75%) at this time to institute an SMS match for WM. The offer date performed similarly to SMS for filling fellowship positions in AY 2019 to 2020.


Assuntos
Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Internato e Residência , Medicina Selvagem/educação , Coleta de Dados , Humanos , Estados Unidos
11.
Wilderness Environ Med ; 31(4): 489-497, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32891500

RESUMO

Ticks are versatile vectors of infectious diseases and transmit a broad range of pathogens, including bacteria, viruses, and parasites. Ticks harbor pathogens without infection and share pathogens with other ticks while feeding together on a host. The primary objective of this review is to identify tickborne viral pathogens in the United States, focusing on emerging pathogens. Additional objectives include describing the epidemiology of tick-transmitted viruses, identifying the most common tick vectors of viral pathogens in the United States, identifying the most common tick-transmitted viruses worldwide, and recommending effective strategies for the prevention and treatment of tickborne viral infections. Flaviviruses transmitted by ixodid ticks cause most tickborne viral infections that present clinically as either encephalitis or hemorrhagic fever. Recently, several new tickborne viruses have emerged in the United States, including Bourbon virus, Heartland virus, Powassan virus, and the severe fever with thrombocytopenia syndrome virus transmitted by a tick recently introduced from China, the Asian long-horned tick (Haemaphysalis longicornis). In most cases, there are no specific drug therapies for tickborne viral infections, and treatment is supportive. Vaccination, personal protection, landscape management, and wildlife management are all effective strategies for the primary prevention and control of tickborne viral infectious diseases.


Assuntos
Doenças Transmissíveis Emergentes , Doenças Transmitidas por Carrapatos/virologia , Viroses/transmissão , Viroses/virologia , Medicina Selvagem , Animais , Humanos , Doenças Transmitidas por Carrapatos/epidemiologia , Carrapatos/virologia
13.
Wilderness Environ Med ; 31(3): 358-366, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773355

RESUMO

The objective of this review is to provide recommendations on the evaluation and management of urologic conditions in a resource-poor or austere setting from the perspective of the urological literature. The material was synthesized predominantly from urologic society guidelines and journals to bring additional urology-focused insight to the topic to complement the currently available literature, which is largely based on recommendations from nonurologic specialties. We sought to provide a reference guide from a urology-based framework that encourages a collaborative multidisciplinary approach to the development of a resource that serves those in a wilderness, austere, or resource-poor setting.


Assuntos
Guias como Assunto , Doenças Urológicas , Medicina Selvagem/normas , Humanos , Sociedades Médicas , Doenças Urológicas/diagnóstico , Doenças Urológicas/patologia , Doenças Urológicas/fisiopatologia , Doenças Urológicas/terapia , Urologia/normas
15.
Wilderness Environ Med ; 31(1): 110-115, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32734896

RESUMO

We developed an elective course titled Medicine in Extreme Environments (MEE) at the University of Texas Southwestern Medical Center for first- and second-year medical students. This course covered physiology, research, clinical practice, and career guidance regarding the fields of wilderness, space, hyperbaric, combat, and exercise medicine. The primary aim was to generate interest in and awareness of these seldom covered fields of medicine by exposing medical students to these disciplines during their preclinical years. A postcourse questionnaire was implemented to investigate whether the MEE course increased awareness of, interest in, and knowledge in the fields of medicine included in the curriculum. Through 2 iterations of the class, a total of 67 students enrolled in the course, and 38 students completed the questionnaire. After course completion, 95% felt they better understood the work and lifestyle of the fields covered, 100% learned more about concepts of each field, and 74% agreed that the elective influenced the direction of their future careers to include some part of the fields emphasized. Although only a limited number of students enrolled in this course, these initial findings suggest that the MEE curriculum may have some utility in promoting awareness of and interest in these medical disciplines among students who attend the course. With continued student and faculty support, this course will likely be continued annually at our institution. We believe that certain aspects of this course may be useful in helping develop similar courses at other medical schools.


Assuntos
Medicina Aeroespacial/educação , Educação Médica/organização & administração , Terapia por Exercício/educação , Ambientes Extremos , Oxigenação Hiperbárica , Medicina Militar/educação , Medicina Selvagem/educação , Conflitos Armados , Humanos , Meio Selvagem
16.
Wilderness Environ Med ; 31(2): 247-254, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32734899

RESUMO

INTRODUCTION: The UK undergraduate medicine curriculum provides insufficient opportunities for medical students to explore the field of wilderness medicine, despite interest in the area. The student-led Cambridge University Wilderness Medicine Society devised a low-cost wilderness medicine teaching weekend that can be replicated at other institutions. METHODS: The weekend course consisted of small-group lessons introducing the roles of the expedition doctor and expedition leader and the assessment and management of acute conditions in remote environments. This was followed by a 3-station circuit to teach the principles of casualty triage, splinting, and construction of rope stretchers. These skills were then practiced in simulations in which participants rotated roles as care providers and patients. Participant confidence was compared before the course and immediately on course completion using the related-samples Wilcoxon signed-ranks test with significance accepted at P<0.05. Usefulness of course content and perceptions of learning were also assessed. RESULTS: Sixty-one medical students attended the wilderness teaching weekend and completed the structured feedback questionnaires. Participants rated the course highly in terms of usefulness of course content (mean±SD=18.3±1.9, range=12-20) and perceptions of learning (mean±SD=37.6±2.6, range=31-40), with 92% of participants "strongly agreeing" that the course was of high quality. There was an improvement in perceived confidence after course completion (P<0.001). CONCLUSIONS: We have demonstrated that a teaching program consisting of structured, low-cost "teaching weekends" is a potential solution to the lack of centralized national wilderness medicine teaching and can be integrated, with minimal disruption, into the undergraduate curriculum.


Assuntos
Currículo , Educação Médica/organização & administração , Medicina Selvagem/educação , Humanos , Estudantes de Medicina , Reino Unido
17.
Zhonghua Shao Shang Za Zhi ; 36(7): 631-635, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32842419

RESUMO

The Wilderness Medical Society updated and published the Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite in July 2019. The guidelines provide evidence-based recommendations for the prevention and treatment of frostbite, mainly including pathophysiology, classification, prevention, and treatment of frostbite. This paper focuses on the interpretation of the guidelines, aiming at making clinical medical staff understand the new progress of frostbite treatment and providing reference for clinical practice.


Assuntos
Congelamento das Extremidades , Humanos , Padrões de Prática Médica , Sociedades Médicas , Medicina Selvagem
18.
Wilderness Environ Med ; 31(3): 291-297, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32855020

RESUMO

INTRODUCTION: Cricothyroidotomy is an advanced and life-saving technique, but it is also a rare and a difficult procedure. The purpose of the present study was to produce a low-cost simulation model with realistic anatomic features to investigate its effectiveness in developing cricothyroidotomy skills. METHODS: This study was performed at a university simulation center with 57 second-year student paramedics and a cricothyroidotomy simulation model. Total scores were assessed using a checklist. This consisted of 13 steps and was scored as misapplication/omission=0, correct performance and timing with hesitation=1, and correct performance and timing without hesitation=2. One of these steps, local anesthesia of the area if time is available, was not performed owing to time limitations. The highest possible score was 24. Data are presented as mean±SD with range, as appropriate. Normal distribution was evaluated using the Kolmogorov-Smirnov test, Student t test, and Mann-Whitney U test, and correlation analysis was used for statistical analysis. RESULTS: Students completed the cricothyroidotomy procedure steps in 116±46 (55-238) s. At performance assessment, the score achieved was 12±5 (2-24). The highest total score of 24 was achieved by 3 students (5%). Total scores exhibited negative and significant correlation with procedure time (r=-0.403, P=0.002). CONCLUSIONS: The model developed in this study is an inexpensive and effective method that can be used in cricothyroidotomy training for student paramedics. We think that repeating the cricothyroidotomy procedure on the model will increase success levels.


Assuntos
Materiais Biocompatíveis , Cartilagem Cricoide/cirurgia , Medicina Ambiental/métodos , Cirurgia Geral/educação , Medicina Selvagem/métodos , Animais , Modelos Animais , Carneiro Doméstico , Traqueia
19.
MedEdPORTAL ; 16: 10900, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32656321

RESUMO

Introduction: Wilderness recreation is increasingly popular among people of all ages. Pediatric providers should have the skills to counsel on risk reduction and respond to medical emergencies in remote settings. However, few physicians receive training in wilderness medicine, and this simulation-based curriculum aims to address that gap. Methods: The scenario features an adolescent male in a remote setting with hypothermia, dehydration, and an ankle injury. The simulation is not resource intensive, utilizing a simulated patient actor and minimal equipment. The case includes a case description, learning objectives, instructor notes, example of ideal scenario flow, and anticipated management mistakes. A didactic PowerPoint highlighting the learning objectives is included. Results: The simulation was carried out over 1 year in various settings, including urban parks, the wilderness, and the classroom, with 35 medical trainees. Thirty participants (11 medical students, eight residents, and 11 fellows) completed postsimulation surveys; more than 86% gave the highest score of 5 (strongly agree) when asked if the simulation improved their understanding of managing hypothermia, dehydration, and ankle injury in the wilderness. Discussion: This simulation case trains responders to recognize an injured hiker; activate the emergency response system; initiate appropriate treatment for hypothermia, dehydration, and an ankle injury; and stabilize for transport. It reinforces medical conditions unique to the wilderness, improvisation in managing medical issues outside of the usual health care environment, and teamwork/communication skills. This case has been found to be an effective learning tool for medical students, residents, and fellow physicians alike.


Assuntos
Traumatismos do Tornozelo , Hipotermia , Medicina Selvagem , Adolescente , Criança , Currículo , Desidratação , Humanos , Hipotermia/terapia , Masculino , Medicina Selvagem/educação
20.
Wilderness Environ Med ; 31(3): 285-290, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32682705

RESUMO

INTRODUCTION: The purpose of this work was to evaluate the effectiveness of 3 rewarming techniques to determine how warfighters, and perhaps other populations in wilderness environments, should prioritize field rewarming options after a brief accidental immersion in cold water. METHODS: As part of a cold weather military training exercise, 31 military personnel (mean±SD age: 26±5 y, height: 180±10 cm, weight: 83.2±10.9 kg) completed a 10-min immersion in cold (0°C) water and subsequently rewarmed for 60 min using 3 different field rewarming techniques (sleeping bag, sleeping bag + warm fluids, or exercise). Heart rate, core and skin temperatures, thermal and shivering sensations, and manual dexterity (intravenous setup and insertion) were measured during the training exercise. RESULTS: Cold water immersion decreased core temperature (pre: 37.4±0.4; post: 36.4±1.0°C; P<0.001) and mean skin temperature (pre: 27.9±1.3; post: 15.6±1.8°C; P<0.001) and impaired manual dexterity (intravenous insertion time, pre: 71±12, post: 166±48 s; P<0.001). Recovery from mild cold stress was similar among all 3 rewarming techniques for all measurements. CONCLUSIONS: Findings suggesting similar rewarming responses in field settings are beneficial for the warfighter, and perhaps others, in that rewarming options exist and can be implemented with no compromise in recovery from cold stress.


Assuntos
Temperatura Baixa , Exercício Físico , Militares/estatística & dados numéricos , Reaquecimento/métodos , Medicina Selvagem/métodos , Feminino , Humanos , Recém-Nascido , Masculino , Adulto Jovem
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