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How Advances In Battlefield Medicine Can Save Civilians' Lives

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Medics surround a wounded U.S. soldier as he arrives at Kandahar Air Field in Afghanistan. Chris Hondros/Getty Images hide caption

Medics surround a wounded U.S. soldier as he arrives at Kandahar Air Field in Afghanistan.

About 10 years ago, Dr. Swaminatha Mahadevan was conducting research at a Nepalese hospital, when he witnessed something that would never have happened back home in California.

An older man had been in a road accident and was thrown from a car. He was lying on a hospital gurney. He was bleeding to death. "But no one was doing anything about it," says Mahadevan, an emergency medicine professor at Stanford University. "In the States, this man would have had a whole team of doctors leaning over him."

But in Nepal, there was no one. The hospital didn't have the staff or resources to save the man's life.

Mahadevan jumped into action, tying a sheet around the man's wounds to slow the bleeding. "I don't know if he survived," Mahadevan says. But the incident helped him realize something: Most poor countries just aren't equipped to deal with such emergencies. And yet, violence and injuries cause more deaths each year worldwide than HIV, tuberculosis and malaria combined.

Now researchers in London think tools developed for battlefield hospitals in Iraq and Afghanistan can help fill in this gap. They want to adapt wartime medical techniques to help civilians in poor countries, which often have high rates of traffic accidents, building collapses, fires and gun violence.

With new technologies and some innovative tricks, Army medics have gotten really good at treating injured troops. Battlefield casualties have fallen sharply, says Richard Sullivan, an epidemiologist at King's College London. "It's one positive thing that has come out of these conflicts," he says.

Sullivan and his colleagues published a study last month in the Journal of the Royal Society of Medicine exploring advancements in battlefield medicine, along with recommendations for how to use them in low- and middle-income countries.

In many cases, the key to saving someone whether injured in a war zone or a traffic accident is to keep him from bleeding to death before he gets to a hospital, the team wrote.

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How Advances In Battlefield Medicine Can Save Civilians' Lives

Science and medicine have a 'publication pollution' problem

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Dr. Arthur Caplan warns that plagiarism, fraud and predatory publishing is 'corroding the reliability of research'

(New York, NY) April 3, 2015 - The scientific community is facing a 'pollution problem' in academic publishing, one that poses a serious threat to the "trustworthiness, utility, and value of science and medicine," according to one of the country's leading medical ethicists.

Arthur L. Caplan, PhD, director of the Division of Medical Ethics in the Department of Population Health at NYU Langone Medical Center, shares these and other observations in a commentary publishing April 3 in the journal Mayo Clinic Proceedings.

"The pollution of science and medicine by plagiarism, fraud, and predatory publishing is corroding the reliability of research," writes Dr. Caplan. "Yet neither the leadership nor those who rely on the truth of science and medicine are sounding the alarm loudly or moving to fix the problem with appropriate energy."

In his commentary, Dr. Caplan describes several causes of publication pollution:

According to Dr. Caplan: "All these polluting factors detract from the ability of scientists and physicians to trust what they read, devalue legitimate science, undermine the ability to reproduce legitimate findings, impose huge costs on the publication process, and take a toll in terms of disability and death when tests, treatments, and interventions are founded on faulty claims."

Dr. Caplan proposes a national meeting of leaders in science and medicine to lead a sustained challenge to proactively and aggressively go after this pollution problem.

"The currency of science is fragile, and allowing counterfeiters, fraudsters, bunko artists, scammers, and cheats to continue to operate with abandon in the publishing realm is unacceptable," he asserts.

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About NYU Langone Medical Center

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Science and medicine have a 'publication pollution' problem

How to crowdsource the world for emergency medicine

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WASHINGTON --Two new studies, published online Tuesday in Annals of Emergency Medicine, illustrate the power of social media and the Internet to promote scholarly dialogue around the world and the importance of establishing criteria for what constitutes high-quality blogs and podcasts ("Global Emergency Medicine Journal Club: A Social Media Discussion About the ADJUST-PE Trial" and "Emergency Medicine and Critical Care Blogs and Podcasts: Establishing an International Consensus on Quality").

"Our Global Emergency Medicine Journal Club creates a virtual space to allow interested stakeholders to share insights, perspectives and concerns in an open and transparent arena," said lead study author Salim Rezaie, MD, of The University of Texas Health Science Center in San Antonio, Texas. "Sharing information globally helps emergency medicine practitioners identify knowledge gaps, generate hypotheses and potentially achieve community consensus."

Annals of Emergency Medicine collaborated with an educational website, Academic Life in Emergency Medicine, to host an online discussion session on whether an age-adjusted D-dimer cutoff would improve the diagnostic yield in excluding pulmonary embolism (PE) in older patients. Digital conversations occurred on Twitter, a Google Hangout video interview and a podcast review. By the end of two weeks, this worldwide academic dialogue among clinicians attracted 1,169 page views from 391 cities in 52 countries.

The proliferation of resources such as blogs and podcasts has been driven in part by the popularity of the Free Open-Access Medical Education (FOAMed) movement. This prompted researchers to develop a set of quality indicators by which to evaluate credibility, content and design of online resources for medical education. Researchers whittled a list of 151 indicators down to the most important quality indicators: 14 for blogs and 26 for podcasts.

"This information may be helpful for resource producers looking to improve the quality of their websites as well as for learners, educators and academic leaders struggling to assess the quality of online resources," said lead study author Brent Thoma, MD, MA of Massachusetts General Hospital in Boston, Mass. "In the future, we hope to develop a user-friendly quality assessment tool for blogs and podcasts. Emergency physicians go online to educate themselves, just like everyone else, and share ideas about how to improve the practice of emergency medicine."

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Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit http://www.acep.org.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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How to crowdsource the world for emergency medicine

Registration for inaugural Stanford Medicine X|ED conference opens today

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Registration opened today for the inaugural Stanford Medicine X|ED conference, which will explore the role of technology and networked intelligence in shaping the future of medical education.

The conference will take place Sept. 23-24 on campus at the Li Ka Shing Center for Learning and Knowledge. It will feature presentations and panels on a range of topics, including engaging millennial learners, opportunities and challenges for innovation in medical education, interdisciplinary learning, and how digital media and massive open online courses are redefining the educational landscape.

Registration details can be found at http://medicinex.stanford.edu/ed/

"Changing the culture of health care starts with redefining medical education," said Lawrence Chu, MD, associate professor of anesthesia at the School of Medicine and executive director of Medicine X. "This conference aims to address gaps in medical education to drive innovation and make health care more participatory, patient centered and responsive."

Digital media pioneer Howard Rheingold will kick off the conference with a keynote address. Rheingold cofounded the groundbreaking virtual communities HotWired and Electric Minds in the mid-1990s, and authored the book Smart Mobs: The Next Social Revolution.

Abraham Verghese, MD, vice chair for the theory and practice of medicine for Stanford's Department of Medicine, will deliver the closing keynote. An infectious disease physician and best-selling author, Verghese led the effort to develop the Stanford25 initiative, which is designed to teach interns the diagnostic benefits of fundamental physical exam skills. He is a strong advocate for the value of bedside medicine and physical diagnosis, which he sees as waning in an era of increasingly sophisticated medical technology.

"Health care has changed dramatically in recent years, but the way we teach the next generation of doctors has largely remained the same," said Lloyd Minor, MD, dean of the School of Medicine. "Stanford Medicine X|ED brings together some of the most innovative minds in medicine, technology and education to re-imagine medical education for the new millennium."

The conference will offer tutorial-style classes called "learning labs" on topics such as incorporating instructional technologies into curricula, and using social media to promote patient safety. Additionally, attendees can participate in 90-minute workshops on using 3D printing in medical education, interprofessional care models and methods for bringing real patients' stories into medical education.

Conference-goers can also enroll in master classes where experts in specific disciplines will conduct small-venue seminars. Confirmed master-class speakers include Minor; Bryan Vartabedian, MD, assistant professor of pediatrics and director of digital literacy at the Baylor College of Medicine; Bertalan Mesko, MD, founder of Webicina; and Kirsten Ostherr, PhD, professor of English at Rice University and director of the Medical Futures Lab.

Medicine X 2015 lineup announced

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Registration for inaugural Stanford Medicine X|ED conference opens today

Penn Medicine: New receptors could underlie the many actions of the anesthetic ketamine

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First of its kind study uses olfactory receptor screening, high-tech computer models and simulations to identify and turn binding sites for increased and decreased ketamine response

PHILADELPHIA-- Penn Medicine researchers are continuing their work in trying to understand the mechanisms through which anesthetics work to elicit the response that puts millions of Americans to sleep for surgeries each day. Their most recent study looked at ketamine, an anesthetic discovered in the 1960s and more recently prescribed as an anti-depressant at low doses. Through collaboration with the University of Pennsylvania's department of Chemistry and scientists at the Duke University Medical Center, researchers at Penn's Perelman School of Medicine have identified an entirely new class of receptors that ketamine binds in the body, which may underlie its diverse actions. The work is published in this week's issue of Science Signaling.

Ketamine is believed to act through glutamate receptors to produce anesthesia, but this is unlikely to explain the anti-depressant effect; most antidepressants target G-protein coupled receptors (GCPRs), the largest class of druggable receptors, located in the body's central nervous system (CNS). To explore the GCPR class of receptors, the investigators screened proteins present in the mouse nasal epithelium, olfactory receptors (ORs), which typically respond very selectively to compounds in the air, giving rise to smell. It turns out that these ORs are also present throughout the nervous system. ORs make up the largest group of GCPRs, yet they are unexplored as transducing components of general anesthesia or of antidepressants.

"Our hope is that we can visualize the precise molecular interactions between ketamine and ORs, and in turn, learn how this old drug interacts with these and other GCPRs throughout the central nervous system," says the study's senior author, Roderic Eckenhoff, MD, the Austin Lamont Professor of Anesthesiology and Critical Care at Penn.

Eckenhoff and a team at Duke University began their study by screening ORs of mice and found that ketamine activated only two types out of more than several hundred, known as MOR136 and MOR139. They then used computational modeling and simulation approaches with Jeffery Saven, PhD, professor of Chemistry at Penn to generate structural models of these ORs and to understand exactly how they recognize ketamine. Several amino acid residues were identified as critical determinants. The team found that by mutating these amino acids, they could turn ketamine responsiveness both on and off.

They also tested these conclusions in mice by stimulating the olfactory epithelium via intranasal application of ketamine and showed that olfactory sensory neurons that expressed these unique ORs responded to ketamine, suggesting that ORs may truly serve as functional targets for ketamine.

"Here we provide evidence that ketamine has a highly specific interaction with the ORs, indicating that at least some of ketamine's actions may result from these or other GCPRs in the central nervous system," says Eckenhoff, noting that "our rigorous combination of simulation and experiment indicates that we can design receptors to respond specifically to certain drugs, which gets us one step closer to doing the opposite and designing drugs to interact specifically with certain receptors."

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Additional Penn authors include Jose Manuel Perez-Aguilar and Lu Gao, department of Chemistry.

This work was funded by NIH grants (DC010857, DC012095, and GM55876), the National Science Foundation through the Penn Nano/Bio Interface Center (NSEC DMR08-3202).

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Penn Medicine: New receptors could underlie the many actions of the anesthetic ketamine


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