bluuebunny/crossref_metadata_2025_split huggingface dataset:
What do we need for airway management of adult casualties on the Primary Casualty Receiving Facility? A review of airway management on Role 3 Afloat
Authors: Mercer SJ , Read J , Sudheer Maj S , Risdall JE , Conor D 
Published: February 2021

AbstractThe Primary Casualty Receiving Facility (PCRF) of the Royal Navy (RN) is currently based on Royal Fleet Auxiliary (RFA) ARGUS and provides a functioning hospital with surgical teams and a CT scanner (Role 3) within the maritime environment. The case mix could include complex trauma, critically ill patients returning to theatre several times, as well as non-battle injury procedures. This paper describes how we have used national guidelines, evidence from recent military experience, and the Clinical Guidelines for Operations (CGOs) to review and rationalise the airway equipment that is available and that would be required for the PCRF in its current configuration, whilst maintaining capability in a deployed setting.
Abdominal hernias: a clinical review of their assessment and management in the Naval Service
Authors: Roy S , Khan M 
Published: February 2021

AbstractHernias are a relatively common occurrence in the armed forces community and may affect an individual’s fitness for duty and impact on operational capability, particularly in specialist occupations. Their early identification and management will allow appropriate treatment and minimise any impact on operational capability. This article aims to summarise the assessment and management of simple hernias and considers occupational considerations in their management for personnel serving in the Royal Navy and Royal Marines.
100 Years of British military neurosurgery: on the shoulders of giants
Authors: Roberts SAG 
Published: February 2021

AbstractDeath from head injuries has been a feature of conflicts throughout the world for centuries. The burden of mortality has been variously affected by the evolution in weaponry from war-hammers to explosive ordnance, the influence of armour on survivability and the changing likelihood of infection as a complicating factor. Surgery evolved from haphazard trephination to valiant, yet disjointed, neurosurgery by a variety of great historical surgeons until the Crimean War of 1853-1856. However, it was events initiated by the Great War of 1914-1918 that not only marked the development of modern neurosurgical techniques, but our approach to military surgery as a whole. Here the author describes how 100 years of conflict and the input and intertwining relationships between the 20th century’s great neurosurgeons established neurosurgery in the United Kingdom and beyond.
The early management of the burned patient in the Naval service
Authors: Rylah OJA , Smith JJ 
Published: February 2021

AbstractBurns represent a perpetual threat in military combat and are a pervasive threat in the land, maritime and air arenas. Therefore, it is imperative that military clinicians are well versed in managing burns in order to ensure optimal survival and recovery. This article aims to explore the epidemiology, pathophysiology, assessment and early management of the burned patient with a focus on the austere maritime environment and current military guidance.
Meningitis in service-age personnel
Authors: Miller R , Houlberg K 
Published: February 2021

AbstractThe incidence of meningitis is declining in the UK population largely due to increased availability of vaccinations against the most common bacterial strains. Acute bacterial meningitis, however, is a life-threatening condition and distinguishing it from more benign causes of headache and fever is difficult in an operational environment due to limited access to diagnostic tests. Despite medical advances, the case fatality rate in the United Kingdom in adults with invasive meningococcal disease is 10.5%. Acute bacterial meningitis presents with the classical triad of fever, neck pain and altered mental state in less than half of adults, and in the initial course of the disease it frequently mimics common viral illnesses. The aim of this article is to discuss the recognition and management of meningitis with special emphasis on the deployed military environment.
Action Stations! 100 years of trauma care on maritime and amphibious operations in the Royal Navy
Authors: Osborne M , Smith JE 
Published: February 2021

AbstractOver the past century trauma care within the Royal Navy (RN) has evolved; wartime experiences and military medical research have combined to allow signifi cant improvement in the care of casualties. This article describes the key maritime and amphibious operations that have seen the Royal Navy Medical Service (RNMS) deliver high levels of support to wherever the Naval Service has deployed in the last 100 years. Key advancements in which progress has led to improved outcomes for injured personnel are highlighted – the control and treatment of blood loss, wound care, and the prevention and management of organ failure with optimal resuscitation.Historians often point out how slowly military medicine progressed for the fi rst few thousand years of its recorded history, and how quickly it has progressed in the last century. This refl ective article will show how the RNMS has been an integral part of that story, and how the lessons learnt by our predecessors have shaped our modern day doctrine surrounding trauma care.
Surgery in an Afghan population: is pictorial consent and injury pattern recognition identification of patients appropriate?
Authors: Matheson A S , Howes R D , Midwinter M J , Lambert A W 
Published: February 2021

Structured AbstractSurgery in an Afghan population: is pictorial consent and injury pattern recognition identification of patients appropriate?ObjectiveThe aim of this study was to develop a safe way to obtain informed consent and ensure the correct patient was operated on in a generally poorly educated, non-English speaking Afghan patient population admitted to a military role 2 (enhanced) hospital facility.Summary Background DataPrior to Herrick 9, surgical consent for Afghan patients was obtained via an interpreter in the traditional manner and documented on a UK formatted consent form (MOD form 660) (group 1) with patient identification largely being the responsibility of the interpreter. Patient agreement was documented by placing a thumbprint on the form. During Herrick 9, pictorial consent and injury pattern recognition (IPR) identification of patients was introduced. The consent was written as part of the case note narrative with diagrammatic representation of the injuries and the proposed surgery, which was explained by the interpreter (Group 2).MethodsWe compared the consent and identification process for ten consecutive patients from each group. Each method of consent was examined for documentary evidence of the procedure, patient identification and method of patient agreement. The senior Afghan interpreter was asked for his personal views on the benefit or otherwise of the pictorial consent.ResultsFor group 1, each of the nine MOD form 660s were completed in English by the operating surgeon and included details of the procedure. Seven had been signed by the interpreter. Each had a thumbprint on the form but there was no name or date alongside it. There was no way of confirming that the thumbprint was that of a particular patient.For group 2, pictorial consent was documented in the narrative with specific documentation of the injury pattern of that patient. Confirmation of consent and patient identification by IPR was by the operating surgeon.ConclusionsWhen possible, informed consent is required for all patients undergoing surgery in line with Department of Health guidelines. The use of pictorial consent and IPR identification, as part of patient documentation, would appear to be superior in this particular environment.
Maritime Pre-Hospital Emergency Care Primary Retrieval Team – Operational Considerations
Authors: Newman D 
Published: February 2021

AbstractThis article examines the non clinical skills and training required for effective maritime pre-hospital emergency care provision within a Role Two Afloat facility, allowing for a Primary Retrieval Team to be deployed in support of boarding operations. The provision of pre-hospital emergency care and sending a retrieval team forward has been trialled in various forms. In 2010 and 2011 a R2A team was deployed aboard RFA FORT VICTORIA. This included a Primary Retrieval Team consisting of an Emergency Nurse Specialist, a Medical Assistant which can be enhanced when required by an Emergency Care or Anaesthetic Consultant. This differs from the land operations support provided by the airborne Medical Emergency Response Team (MERT) as the maritime environment requires a bespoke solution for casualty retrieval as the method of deployment and the type of casualties and their locations may be more varied, requiring greater flexibility of approach.
Chronic Fatigue Syndrome in the UK Armed Forces
Authors: LeQ Blackadder-Coward J C , Perry S 
Published: February 2021

AbstractChronic Fatigue Syndrome (CFS) is a debilitating condition that can have a significant impact on the lives of patients and those who care for them. In the UK Armed Forces this condition can also have a marked impact on a patient’s career and their ability to function in the deployed environment. In this article the recognition and management of CFS will be discussed, as well as the occupational considerations within the UK Armed Forces.
The primary care diagnosis and management of social phobia and its relevance in the UK Armed Forces
Authors: Dubif JR , Coetzee RH 
Published: February 2021

AbstractSocial phobia can be a distressing anxiety disorder that in the clinical experience of the authors may be under-recognised in the UK Armed Forces. In this article we consider the diagnosis and management of social phobia. We also discuss the occupational and operational considerations for the military environment.
Pre-hospital, Maritime In-Transit Care from a Role 2 Afloat Platform
Authors: Whalley L , Smith S 
Published: February 2021

AbstractMaritime In-Transit Care (MITC) is a new concept to allow the provision of pre-hospital care in the maritime environment within Role 2 Afloat (R2A) teams. This article describes the experiences of an Emergency Medicine nurse and a Medical Assistant who made up the MITC team on the recent R2A exercise on RFA CARDIGAN BAY. As well as describing their personal experiences, the concept of the MITC team is introduced and their role within R2A outlined.
The sensitivity of pre-hospital and in-hospital tools for the identification of major trauma patients presenting to a major trauma centre.
Authors: Potter D , Kehoe A , Smith JE 
Published: February 2021

AbstractThe identification of major trauma patients before arrival in hospital allows the activation of an appropriate trauma response. The Wessex triage tool (WTT) uses a combination of anatomical injury assessment and physiological criteria to identify patients with major trauma suitable for triage direct to a major trauma centre (MTC), and has been adopted by the South-West Peninsula Trauma Network (PTN). A retrospective database review, using the Trauma Audit Research Network (TARN) database, was undertaken to identify a population of patients presenting to Derriford Hospital with an injury severity score (ISS) > 15. The WTT was then applied to this population to identify the sensitivity of the tool. The sensitivity of the WTT at identifying patients with an ISS>15 was 53%. One of the reasons for this finding was that elderly patients who are defined as having major trauma due to the nature of their injuries, but who did not have a mechanism to suggest they had sustained major trauma (such as a fall from standing height), were not identified by these triage tools. The implications of this are discussed.
Safety of the APOLLO Onyx delivery microcatheter for embolization of brain arteriovenous malformations: results from a prospective post-market study
Authors: Meyers Philip M , Fifi Johanna T. , Cockroft Kevin M. , Miller Timothy R. , Given Curtis A. , Zomorodi Ali R. , Jagadeesan Bharathi D. , Mokin Maxim , Kan Peter , Yao Tom L. , Diaz Orlando , Huddle Daniel , Bellon Richard J. , Seinfeld Joshua , Polifka Adam J , Fiorella David , Chitale Rohan V. , Kvamme Peter , Morrow Jay T. , Singer Justin , Wakhloo Ajay K. , Puri Ajit S. , Deshmukh Vivek R. , Hanel Ricardo A. , Gonzalez L. Fernando , Woo Henry H. , Aziz-Sultan Mohammad Ali 
Published: February 2021

BackgroundCatheter retention and difficulty in retrieval have been observed during embolization of brain arteriovenous malformations (bAVMs) with the Onyx liquid embolic system (Onyx). The Apollo Onyx delivery microcatheter (Apollo) is a single lumen catheter designed for controlled delivery of Onyx into the neurovasculature, with a detachable distal tip to aid catheter retrieval. This study evaluates the safety of the Apollo for delivery of Onyx during embolization of bAVMs.MethodsThis was a prospective, non-randomized, single-arm, multicenter, post-market study of patients with a bAVM who underwent Onyx embolization with the Apollo between May 2015 and February 2018. The primary endpoint was any catheter-related adverse event (AE) at 30 days, such as unintentional tip detachment or malfunction with clinical sequelae, or retained catheter. Procedure-related AEs (untoward medical occurrence, disease, injury, or clinical signs) and serious AEs (life threatening illness or injury, permanent physiological impairment, hospitalization, or requiring intervention) were also recorded.ResultsA total of 112 patients were enrolled (mean age 44.1±17.6 years, 56.3% men), and 201 Apollo devices were used in 142 embolization procedures. The mean Spetzler–Martin grade was 2.38. The primary endpoint was not observed (0/112, 0%). The catheter tip detached during 83 (58.5%) procedures, of which 2 (2.4%) were unintentional and did not result in clinical sequelae. At 30 days, procedure related AEs occurred in 26 (23.2%) patients, and procedure-related serious AEs in 12 (10.7%). At 12 months, there were 3 (2.7%) mortalities, including 2 (1.8%) neurological deaths, none of which were device-related.ConclusionThis study demonstrates the safety of Apollo for Onyx embolization of bAVMs.Clinical trial registrationCNCT02378883.
Duration of symptomatic stroke and successful reperfusion with endovascular thrombectomy for anterior circulation large vessel occlusive stroke
Authors: de Havenon Adam , Alexander Matthew D , Nogueira Raul G , Haussen Diogo C , Castonguay Alicia C , Linfante Italo , Johnson Michael Austin , Nguyen Thanh N , Mokin Maxim , Zaidat Osama O 
Published: February 2021

BackgroundIt has been reported that longer time intervals from stroke onset to endovascular therapy are associated with lower rates of successful reperfusion in acute ischemic stroke patients with large vessel occlusion. However, procedural variables and potential mechanisms of this association have not been fully elucidated.MethodsWe performed a secondary analysis of individual patient data from the North American Solitaire Stent Retriever Acute Stroke (NASA) and Trevo Stent-Retriever Acute Stroke (TRACK) registries. We included patients with occlusion of the internal carotid artery or middle cerebral artery (M1 and M2 segments) who were treated by mechanical thrombectomy within 24 hours of last known normal. The primary outcome was reperfusion, defined as a Thrombolysis In Cerebral Infarction (TICI) score ≥2b. The secondary outcome was reperfusion on the first pass. The primary predictor was duration of symptomatic stroke, defined as time from last known normal to time of final pass. Adjusted logistic regression models were utilized to determine associations between variables and outcome.ResultsWe included 506 patients, of which 401 (79.3%) achieved successful reperfusion (TICI 2b/3). The mean (SD) duration of symptomatic stroke was 6.8 (3.5) hours and in the adjusted logistic regression model the duration of symptomatic stroke was associated with reperfusion (OR 0.90, 95% CI 0.84 to 0.96) and reperfusion on the first pass (OR 0.89, 95% CI 0.83 to 0.95). In that model, the predicted probability of reperfusion was 88% (95% CI 0.83 to 0.92) at 1 hour, 81% (95% CI 0.78 to 0.84) at 6 hours, 70% (95% CI 0.63 to 0.77) at 12 hours, and 42% (95% CI 0.17 to 0.67) at 24 hours (ptrend=0.001). Reperfused patients were significantly younger, more likely to be male, and to have had a balloon guide catheter used during the procedure.ConclusionIn a real-world cohort of acute ischemic stroke patients with anterior circulation occlusion treated with endovascular therapy, longer duration of symptomatic stroke is associated with lower rates of successful reperfusion and reperfusion on the first pass.
Long-term safety and efficacy of sirukumab for patients with rheumatoid arthritis who previously received sirukumab in randomised controlled trials (SIRROUND-LTE)
Authors: Aletaha Daniel , Bingham Clifton O , Karpouzas George Athanasios , Takeuchi Tsutomu , Thorne Carter , Bili Androniki , Agarwal Prasheen , Hsu Benjamin , Rao Ravi , Brown Kurt , Tanaka Yoshiya 
Published: February 2021

ObjectiveInterleukin (IL)-6 is a pleiotropic cytokine involved in the pathophysiology of rheumatoid arthritis (RA). Sirukumab is a human monoclonal antibody that binds to IL-6 with high affinity and specificity.MethodsThis long-term extension (LTE) study of the SIRROUND-D and SIRROUND-T studies assessed long-term safety and efficacy of sirukumab in adults with moderate-to-severe RA refractory to conventional disease-modifying antirheumatic drug therapy or antitumor necrosis factor agents. Patients received sirukumab 100 mg subcutaneously (SC) every 2 weeks (q2w) or sirukumab 50 mg SC every 4 weeks (q4w).Results1820 patients enrolled in the LTE; median exposure was 2.34 and 2.07 years in sirukumab 50 mg q4w and 100 mg q2w groups, respectively. Adverse events (AEs) occurred in similar proportions between groups, with the exception of major adverse cardiovascular events (MACE), which were more common in the 50 mg q4w versus 100 mg q2w group (2.2% vs 1.0%), and injection-site reactions, more common in the 100 mg q2w group versus 50 mg q4w group (7.5% vs 3.7%). The most common serious AEs were infections (10% of the patients); 32 (1.8%) patients died during the study (primarily from serious infection and MACE). Malignancies were reported in 24 (1.3%) patients. Gastrointestinal perforations, hepatobiliary abnormalities and changes in laboratory parameters were rare. Reductions in RA signs and symptoms and improvements in physical function were maintained throughout the LTE.ConclusionsThe safety profile of sirukumab in the LTE remained consistent with that reported in SIRROUND-D and SIRROUND-T and efficacy was maintained.Trial registration numberNCT01856309.
Significant flow velocity reduction at the intracranial aneurysm neck after endovascular treatment leads to favourable angiographic outcome: a prospective study
Authors: Tian Zhongbin , Liu Jian , Kumar Jay , Li Wenqiang , Zhang Yisen , Zhang Ying , Wang Kun , Wang Shengzhang , Ren Zeguang , Yang Xinjian 
Published: February 2021

BackgroundWith widely usage of flow diverter in intracranial aneurysm treatment, some previously used predictors may not be effective in evaluating the recurrence risk. We aimed to comprehensively re-evaluate the predictors of intracranial aneurysm outcome with various endovascular treatment methods and devices.MethodsThis is a prospective registered study. We analysed 6-month and 18-month follow-up angiographic data from the prospective study. Data on patient demographics, aneurysm morphology and type of treatment were recorded. Patient-specific haemodynamic simulations were performed. An unfavourable angiographic outcome was defined as recurrence of aneurysm in cases with coiling or stent-assisted coiling, patency of aneurysm in cases with flow diverters or retreatment during follow-up.ResultsIn total, 165 patients (177 intracranial aneurysms) with at least one angiographic follow-up data were analysed. For the short-term (6-month) results, after univariate analysis, the demographic, morphological and treatment-related factors did not achieve significantly statistical differences. The reduction ratio (RR) of velocity at aneurysm neck after embolisation was significantly lower in the unfavourable angiographic group than the favourable angiographic outcome group (p=0.002). After the Cox regression analysis, the RR of velocity at aneurysm neck was the only independent factor associated with favourable angiographic outcome (OR 0.028; p=0.001) and had an acceptable area under the curve (0.714) with a clear cut-off value (46.14%). Similarly, for the analysis of midterm (18-month) results, the RR of velocity at the aneurysm neck was the only independent significant factor for the unfavourable angiographic outcome (OR 0.050; p=0.017). The area under the curve was 0.754 and the cut-off value was 48.20%.ConclusionsThe haemodynamics showed an independent effect on angiographic follow-up results and may provide helpful suggestions for clinical practice in the future.
Smoking influences outcome in patients who had thrombolysed ischaemic stroke: the ENCHANTED study
Authors: Sun Lingli , Song Lili , Yang Jie , Lindley Richard I , Robinson Thompson , Lavados Pablo M , Delcourt Candice , Arima Hisatomi , Ovbiagele Bruce , Chalmers John , Anderson Craig S , Wang Xia 
Published: February 2021

Background and purposeAs studies vary in defining the prognostic significance of smoking in acute ischaemic stroke (AIS), we aimed to determine the relation of smoking and key outcomes in patient participants who had thrombolysed AIS of the international quasi-factorial randomised Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).MethodsPost-hoc analyses of ENCHANTED, an international quasi-factorial randomised evaluation of intravenous alteplase-dose comparison and levels of blood pressure control in patients who had thrombolysed AIS. Multivariable logistic regression models with inverse probability of treatment weighting (IPTW) propensity scores were used to determine associations of self-reported smoking status and clinical outcomes, according to 90-day modified Rankin Scale (mRS) scores and symptomatic intracerebral haemorrhage (sICH).ResultsOf 4540 patients who had an AIS, there were 1008 (22.2%) current smokers who were younger and predominantly male, with more comorbidities of hypertension, coronary artery disease, atrial fibrillation and diabetes mellitus, and greater baseline neurological impairment, compared with non-smokers. In univariate analysis, current smokers had a higher likelihood of a favourable shift in mRS scores (OR 0.88, 95% CI 0.77 to 0.99; p=0.038) but this association reversed in a fully adjusted model with IPTW (adjusted OR 1.15, 95% CI 1.04 to 1.28; p=0.009). A similar trend was also apparent for dichotomised poor outcome (mRS scores 2–6: OR 1.18, 95% CI 1.05 to 1.33; p=0.007), but not with the risk of sICH across standard criteria.ConclusionSmoking predicts poor functional recovery in patients who had thrombolysed AIS.Trial registration numberNCT01422616.