Military medicine
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Randomized Controlled Trial
Treatment efficacy of virtual reality distraction in the reduction of pain and anxiety during cystoscopy.
Assessment of virtual reality (VR) distraction for alleviating pain and anxiety during flexible cystoscopy. Cystoscopy is a common ambulatory procedure performed in Urology and can be associated with moderate pain and anxiety. Sophisticated distraction techniques are not used with cystoscopy and VR has not been studied for this procedure. We designed a prospective, randomized, controlled trial assessing the efficacy of VR for alleviating pain and anxiety during flexible cystoscopy. ⋯ We concluded no benefit to VR distraction mitigating pain in male patients during cystoscopy.
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Randomized Controlled Trial
Increasing engagement in evidence-based PTSD treatment through shared decision-making: a pilot study.
Within the Veterans Health Administration, post-traumatic stress disorder (PTSD) treatment decisions are left to the patient and provider, allowing substantial variability in the way treatment decisions are made. Theorized to increase treatment engagement, shared decision-making interventions provide a standardized framework for treatment decisions. This study sought to develop (phase 1) and pilot test the feasibility and potential effectiveness (phase 2) of a brief shared decision-making intervention to promote engagement in evidence-based PTSD treatment. ⋯ Participants randomized to the intervention condition (n = 13) participated in a 30-minute shared decision-making session, whereas patients randomized to the usual care condition (n = 14) completed treatment planning during their intake appointment, per usual clinic procedures. Among the 20 study completers, a greater proportion of participants in the intervention condition preferred an evidence-based treatment and received an adequate (≥9 sessions) dose of psychotherapy. Results provide preliminary support for the feasibility and potential effectiveness of the intervention and suggest that larger-scale trials are warranted.
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Randomized Controlled Trial
Randomized controlled trial of accelerated resolution therapy (ART) for symptoms of combat-related post-traumatic stress disorder (PTSD).
Therapies for post-traumatic stress disorder (PTSD) endorsed by the Department of Defense and Veterans Administration are relatively lengthy, costly, and yield variable success. We evaluated Accelerated Resolution Therapy (ART) for the treatment of combat-related psychological trauma. ⋯ ART appears to be a safe and effective treatment for symptoms of combat-related PTSD, including refractory PTSD, and is delivered in significantly less time than therapies endorsed by the Department of Defense and Veterans Administration.
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Randomized Controlled Trial Multicenter Study
Identification of barriers to adaptation of battlefield technologies into civilian trauma in California.
To characterize the adoption of routine battlefield medical techniques (tourniquets, hemostatic agents, and tactical combat casualty care into civilian prehospital trauma care and to identify the barriers to their use in the state of California through anonymous electronic survey of local emergency medical services agency (LEMSA) directors. ⋯ Tourniquets, hemostatic agents, and tactical medical care are the integral components of battlefield medicine and have been lifesaving in these settings. The barriers to this transition are multifactorial. Physicians familiar with these technologies should become advocates for their integration in civilian trauma patient care.
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Randomized Controlled Trial
Effects of simulation-based practice on focused assessment with sonography for trauma (FAST) window identification, acquisition, and diagnosis.
We compared the effects of simulator-based virtual ultrasound scanning practice with classroom-based ultrasound scanning practice on participants' knowledge of focused assessment with sonography for trauma (FAST) window quadrants and interpretation, and on participants' performance on live patient FAST examinations. Novices with little or no ultrasound training experience received simulation-based practice (n = 24) or classroom-based practice (n = 24). Participants who received simulation-based practice scored significantly higher on interpreting static images of FAST windows. ⋯ Overall, classroom-based practice appeared to promote physical acquisition skills and simulator-based practice appeared to promote window interpretation skills. Accurate window interpretation is critical to identification of blunt abdominal trauma injuries. The simulator used (SonoSimulator) appears promising as a training tool to increase probe time and to increase exposure to FAST windows reflecting various anatomy and disease states.