A Primer for Pediatric Emergency Front-of-the-Neck Access

"Cannot intubate, cannot oxygenate" situations in healthy children are uncommon but are often associated with poor outcomes. Clinical assessment, anticipatory planning, and the use of algorithms can lessen the likelihood of untoward outcomes, but the common final pathway of many algorithms for a difficult pediatric airway involves obtaining emergency tracheal access. The airway practitioner must have the know-how and training needed to invasively secure the airway when confronted with this rare but potentially devastating emergency. We provide practitioners with an overview of pediatric emergency front-of-the-neck access strategies and a structure for their management

Quality of Life in Endometrial Cancer Survivors: What Does Obesity Have to Do with It?

Objective. Most women with type I endometrial cancer (EC) are obese, increasing the risk of morbidity and mortality in this population. The study objective was to evaluate the impact of obesity on quality of life (QOL) and general health status in EC survivors with early-stage disease. Methods. A prospective ancillary analysis of stage I/II EC survivors. The association of BMI with QOL questionnaire variables measured with the functional assessment of cancer therapy (subscales: physical (PWB), functional (FWB), social, and emotional well-being) and the physical (PCS) and mental component summary subscales of the short-form medical outcomes survey was determined. Results. 152 women completed both questionnaires; 81% were obese. After multiple linear regression, BMI was inversely associated with PWB (P = .001), FWB (P = 0.048), and PCS (P = .001). Conclusions. Despite the good prognosis associated with early-stage EC, QOL, and physical health are not optimized in obese survivors. This paper highlights the importance of incorporating health-related QOL assessments and obesity interventions during the survivorship period

Utilization profile of the Canadian-led coalition Role 2 Medical Treatment Facility in Iraq: the growing requirement for multinational interoperability.

Background: The Canadian Armed Forces deployed a Role 2 Medical Treatment Facility (R2MTF) to Iraq in November 2016 as part of Operation IMPACT. We compared the multinational interoperability required of this R2MTF with that of similar facilities previously deployed by Canada or other nations. Methods: We reviewed data (Nov. 4, 2016, to Oct. 3, 2017) from the electronic Disease and Injury Surveillance Report and the Daily Medical Situation Report. Clinical activity was stratified by Global Burden of Diseases category, ICD-10 code, mechanism of injury, services used, encounter type, nationality and blood product usage. We reviewed the literature to identify utilization profiles for other MTFs over the last 20 years. Results: In total, 1487 patients were assessed. Of these, 5.0% had battle injuries requiring damage-control resuscitation and/or damage-control surgery, with 55 casualties requiring medical evacuation after stabilization. Trauma and disease non-battle injuries accounted for 44% and 51% of patient encounters, respectively. Other than dental conditions, musculoskeletal disorders accounted for most presentations. Fifty-seven units of fresh frozen plasma and 64 units of packed red blood cells were used, and the walking blood bank was activated 7 times. Mass casualty activations involved coordination of health care and logistical resources from more than 12 countries. In addition to host nation military and civilian casualties, patients from 15 different countries were treated with similar frequency. Conclusion: The experience of the Canadian R2MTF in Iraq demonstrates the importance of multinational interoperability in providing cohesive medical care in coalition surgical facilities. Multinational interoperability derives from a unique relationship between higher medical command collaboration, international training and adherence to common standards for equipment and clinical practice

1 Canadian Field Hospital in Haiti: surgical experience in earthquake relief

The Canadian Forces’ (CF) deployable hospital, 1 Canadian Field Hospital, was deployed to Haiti after an earthquake that caused massive devastation. Two surgical teams performed 167 operations over a 39-day period starting 17 days after the index event. Most operations were unrelated to the earthquake. Replacing or supplementing the destroyed local surgical capacity for a brief period after a disaster can be a valuable contribution to relief efforts. For future humanitarian operations/disaster response missions, the CF will study the feasibility of accelerating the deployment of surgical capabilities. On Jan. 12, 2010, a 7.0-magnitude earthquake occurred in Haiti. The intensity of the earthquake and the frailty of the buildings in most of the country combined to cause extensive structural damage and casualties.1,2 An intense multinational relief effort followed. The Canadian Forces (CF) contributed by sending a contingent of more than 2000 personnel.3 This included 1 Canadian Field Hospital (1 CFH), the CF deployable field hospital. While 1 CFH itself provided the core nucleus of staff for the hospital, 21 reserve and regular forces units across Canada also provided personnel. The full contingent of 117 CF members was first assembled in Petawawa, Ont., home of 1 CFH. Ninety-seven were medical or dental personnel, including medics; dental, laboratory, x-ray and operating room (OR) technicians; pharmacists; nurses; physicians; and surgeons. The remaining 20 were from various nonmedical trades, including signallers, truckers, mechanics, logisticians and others. From Petawawa, the unit moved by ground to Canadian Forces Base Trenton and then by air to Port-Au-Prince on the recently acquired CC-177 aircraft. The first elements of 1 CFH arrived in theatre on January 21. It was decided to position 1 CFH in Léogane, a hard-hit town near the epicentre of the earthquake. Over the next few days, the hospital personnel arrived and contributed to establishing the hospital. Security was provided by 3 Battalion Royal 22e Régiment and naval personnel from the HMCS Athabaskan. Once it was fully operational, the hospital had a 100-bed ward, a 4-bed intensive care unit, radiology and dental suites, a primary care section, a laboratory and 2 ORs (Fig. 1). The first OR became functional on January 29. There were 2 surgical teams, each consisting of an anesthesiologist, general surgeon, orthopedic surgeon, OR technician and OR nurses. This paper discusses our surgical experience during this deployment

Estratégias de Internacionalização, Marketing Internacional e Desempenho Exportador: Um Panorama das Vinícolas Pertencentes ao Projeto Wines of Brasil

Em uma era de constantes competições, as empresas precisam conquistar novos mercados a fim de diversificar os seus clientes, ampliar seu conhecimento, acessar novas tecnologias, e expandir a sua escala de produção. A entrada no mercado externo é uma forma pela qual as empresas brasileiras estão buscando hoje atingir estes objetivos. Sendo assim, o presente trabalho teve como foco central identificar as estratégias de internacionalização, as ações de marketing internacional e o desempenho exportador de vinícolas brasileiras pertencentes ao projeto Wines of Brasil. O procedimento metodológico utilizado para esta pesquisa seguiu as etapas do método quantitativo e descritivo, sendo operacionalizado por meio de uma survey. O universo de estudo foi composto por 35 empresas participantes do projeto, sendo a amostra final composta por 4 questionários válidos. Esta pesquisa é de natureza descritiva, e foi analisada por meio de técnicas estatísticas univariadas. Conclui-se que as principais estratégias de internacionalização utilizadas pelas empresas são relacionadas com a busca pela satisfação dos consumidores. As ações de marketing internacional desenvolvidas pelas empresas concentram-se principalmente na adequação das embalagens dos produtos para os clientes; e em relação ao desempenho exportador as empresas obtiveram resultados positivos nos últimos em função do seu reconhecimento no mercado externo.  Destarte, os resultados demonstraram que empresas nacionais tendem a inovar, difundir a sua marca e inserir-se no mercado internacional por meio de parcerias, como é caso do próprio projeto Wines of Brasil, que facilita e fortalece este processo de entrada no mercado externo