An overview of space medicine Hodkinson, P.D.; Anderton, R.A.; Posselt, B.N. ...
British journal of anaesthesia : BJA,
December 2017, 20171201, 2017-Dec-01, 2017-12-00, Letnik:
119, Številka:
suppl_1
Journal Article
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Space medicine is fundamental to the human exploration of space. It supports survival, function and performance in this challenging and potentially lethal environment. It is international, ...intercultural and interdisciplinary, operating at the boundaries of exploration, science, technology and medicine. Space medicine is also the latest UK specialty to be recognized by the Royal College of Physicians in the UK and the General Medical Council. This review introduces the field of space medicine and describes the different types of spaceflight, environmental challenges, associated medical and physiological effects, and operational medical considerations. It will describe the varied roles of the space medicine doctor, including the conduct of surgery and anaesthesia, and concludes with a vision of the future for space medicine in the UK.
Space medicine doctors have a responsibility to space workers and spaceflight participants. These ‘flight surgeons’ are key in developing mitigation strategies to ensure the safety, health and performance of space travellers in what is an extreme and hazardous environment. This includes all phases from selection, training and spaceflight itself to post-flight rehabilitation and long-term health. The recent recognition of the speciality provides a pathway to train in this fascinating field of medicine and is a key enabler for the UK Government's commercial spaceflight ambition.
Stereopsis is usually required in military aviators and may become increasingly important with reliance on newer technologies such as binocular Helmet-Mounted Displays (HMDs) and stereo displays. The ...current stereo test used to qualify UK military aircrew (TNO test) has many limitations. To address these limitations, two computer-based digital versions of a random dot stereogram (RDS) were developed: a static version (dRDS-S), and a version in which the dots appear to move dynamically within the depth plane (dRDS-D), both capable of measuring stereo acuity to threshold.
There were 41 participants who performed all 3 stereo tests, TNO and both digital dRDS tests, on two separate occasions.
The best (lowest) mean stereo acuity threshold was measured with dRDS-S (33.79 arcseconds, range 12.64-173) and the worst mean stereo acuity thresholds were measured with the TNO test (91 arcseconds, range 60-240). Both dRDS tests were strongly correlated, but neither correlated with the TNO test. Both dRDS tests were more reliable, as indicated with tighter limits of agreement.
With a large floor effect at 60 arcseconds, the TNO test was unable to characterize any finer degree of stereo acuity. Both dRDS tests demonstrated better test-retest reliability and addressed many of the limitations seen with the TNO test. The dRDS tests were not correlated with the TNO test, which suggests that the TNO test does not provide the accuracy or reliability for use as a meaningful aeromedical screening test. The dRDS tests will enable research to investigate the relationship between stereo acuity and operational performance.
Space agencies use terrestrial-based analog missions to reduce risk and cost of spaceflight operations. This paper explains how research simulations differ from more traditional spaceflight analogs, ...and describes medical mishaps that may occur. Suggested paths to improved safety standards will better prepare health and safety officers to address healthcare gaps.
•Analog space missions use terrestrial environments to simulate aspects of real space.•They vary significantly in fidelity, funding, resources, and organization.•A safety focused risk assessment should be conducted regardless of analog type.•The roles and responsibilities of health and safety officers are many and diverse.•Reporting significant adverse events is encouraged.
The Royal Air Force (RAF) came into being during World War I as the world's first independent air force on the 1 April 1918, amalgamating elements of the Royal Flying Corps (RFC), itself established ...in 1912 and the Royal Naval Air Service which had formally separated from the Admiralty's administered Air Wing of the RFC in 1915. The RAF therefore celebrates its 100th anniversary in the same year that the Royal College of Physicians of London celebrates its 500th. This article will cover the contribution that military aviation has made to medicine since 1913 with the emphasis of three examples focusing on delivering care by air, providing care in the air and in developing systems for supporting aircrew or patients at the extremes of physiological stress.
Although rare, sudden cardiac death does occur in British military personnel. In the majority of cases, the cause is considered to be a malignant ventricular tachyarrhythmia, which can be ...precipitated by a number of underlying pathologies. Conversely, a tachyarrhythmia may have a more benign and treatable cause, yet the initial clinical symptoms may be similar, making differentiation difficult. This is an overview of the mechanisms underlying the initiation and propagation of arrhythmias and the various pathological conditions that predispose to arrhythmia genesis, classified according to which parts of the heart are involved: atrial tachyarrhythmias, atrial and ventricular, as well as those affecting the ventricles alone. It encompasses atrial tachycardia, atrial flutter, supraventricular tachycardias and ventricular tachycardias, including the more commonly encountered inherited primary electrical diseases, also known as the channelopathies. The clinical features, investigation and management strategies are outlined. The occupational impact-in serving military personnel and potential recruits-is described, with explanations relating to the different conditions and their specific implication on continued military service.
We investigated the charts of 129 patients treated for oral squamous cell carcinoma (SCC) in the Department of Oral and Maxillofacial Surgery, University of Cologne, between 1995 and 2004. Only ...patients treated preoperatively with combined radio-chemotherapy (carboplatin/39.6 Gy) were included. The purpose of the present study was to show the therapeutic outcome and the survival rates for this regimen. The mean age of the patients was 56.6 years. Male patients outnumbered female patients by 3:1. The floor of the mouth was the most common location (48.1%), and three out of four tumours (76.7%) had a G2 grading, while 82.9% were keratinized. Grade T4 was most the common (53.4%), and all patients were operated after preoperative treatment. In 82.2% of the cases, there were no tumour cells detectable microscopically (R0). In 34.1% there were viable tumour cells in the cervical lymph nodes, whereas in 66.7% these cells were found in the primary tumour despite preoperative treatment. A total of 38.8% of patients showed a recurrence of SCC. Mean survival was 4.8 years and 5 year survival 46.6%. The overall survival time of the disease was significantly influenced by pT (P=0.004), pN (P>0.001), R0 resections (P=0.0002), viable tumour cells in lymph node metastasis (P=0.0001), viable tumour cells in the primary (P=0.0004) and recurrence of the disease (P>0.001). In comparison to the current literature, no improvements in prognosis and survival of oral squamous cell carcinoma could be observed.
Plattenepithelkarzinom der Mundhöhle Reuther, T; Posselt, N K; Rabbels, J ...
Oral and maxillofacial surgery,
01/2006, Letnik:
10, Številka:
1
Journal Article
Recenzirano
In einer an der Klinik für Mund-, Kiefer- und Gesichtschirurgie der Universität zu Köln durchgeführten Studie wurden die Krankenakten von insgesamt 129 Patienten mit primären Plattenepithelkarzinomen ...der Mundhöhle aus einem Zeitraum von 1995-2004 retrospektiv ausgewertet. Es wurden nur neoadjuvant mittels kombinierter Radiochemotherapie (39,6 Gy/Carboplatin) behandelte Patienten eingeschlossen. Ziel der Studie war, die therapeutischen Ergebnisse und die Überlebensraten der multimodalen Behandlung zu ermitteln. Das Patientendurchschnittsalter betrug 56,6 Jahre, das Geschlechterverhältnis lag bei 3:1 zugunsten der männlichen Patienten. Mit 48,1% am häufigsten vertreten waren Tumoren im Bereich des Mundbodens. 76,7% der Tumoren waren mäßig differenziert (G2) und 82,9% verhornend. Das Stadium T4 war mit 54,3% am häufigsten vertreten. Alle Patienten wurden nach der neoadjuvanten Radiochemotherapie operiert. Die pathohistologische Untersuchung erbrachte Ergebnisse von 82,2% R0-Resektionen, in 34,1% der Fälle waren in den Lymphknoten und in 66,7% im Tumorresektat nach der neoadjuvanten Radiochemotherapie noch vitale Zellen nachweisbar. 38,8% der Patienten entwickelten im weiteren Verlauf des Krankheitsgeschehens ein Rezidiv. In Bezug auf alle Patienten (n=129) wurden eine geschätzte mediane Überlebenszeit von 4,8 Jahren und eine 5-Jahres-Überlebensrate von 46,6% ermitteln. Die Auswertungen zeigten bei wechselnd hohen statistischen Signifikanzen einen Einfluss des pT-Stadiums (p=0,004), des pN-Status (p<0,0001), der R0-Resektion (p=0,0002), der vitalen Zellen in den Lymphknoten (p=0,0001), der vitalen Zellen im Tumorresektat (p=0,0004) sowie der Rezidive (p<0,0001) auf die Prognose. Im Vergleich der Überlebenszeiten zur aktuellen Literatur ergaben sich keine signifikanten Verbesserungen oder Steigerungen. We investigated the charts of 129 patients treated for oral squamous cell carcinoma (SCC) in the Department of Oral and Maxillofacial Surgery, University of Cologne, between 1995 and 2004. Only patients treated preoperatively with combined radio-chemotherapy (carboplatin/39.6 Gy) were included. The purpose of the present study was to show the therapeutic outcome and the survival rates for this regimen. The mean age of the patients was 56.6 years. Male patients outnumbered female patients by 3:1. The floor of the mouth was the most common location (48.1%), and three out of four tumours (76.7%) had a G2 grading, while 82.9% were keratinized. Grade T4 was most the common (53.4%), and all patients were operated after preoperative treatment. In 82.2% of the cases, there were no tumour cells detectable microscopically (R0). In 34.1% there were viable tumour cells in the cervical lymph nodes, whereas in 66.7% these cells were found in the primary tumour despite preoperative treatment. A total of 38.8% of patients showed a recurrence of SCC. Mean survival was 4.8 years and 5 year survival 46.6%. The overall survival time of the disease was significantly influenced by pT (P=0.004), pN (P>0.001), R0 resections (P=0.0002), viable tumour cells in lymph node metastasis (P=0.0001), viable tumour cells in the primary (P=0.0004) and recurrence of the disease (P>0.001). In comparison to the current literature, no improvements in prognosis and survival of oral squamous cell carcinoma could be observed.PUBLICATION ABSTRACT
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