Wilderness & Environmental Medicine最新文献

{"title":"Delayed Treatment of Misdiagnosed Mushroom Poisoning: Do Organic Anion Transporting Polypeptide Substrates Matter?","authors":"Zanina Pereska, Dushan Petkovski, Valentina Arsova","doi":"10.1177/10806032251338278","DOIUrl":"https://doi.org/10.1177/10806032251338278","url":null,"abstract":"<p><p>A middle-aged male was admitted to the clinic 4 d after ingestion of wild mushrooms. His medical history included type 2 diabetes, hypertension, and coronary bypass. Initially misdiagnosed with infectious enterocolitis, the patient was treated as an outpatient with intravenous fluids while continuing his chronic medications (i.e., statins, beta-blockers, and aspirin). On Day 3, blood tests confirmed hepatorenal syndrome, and the patient was transferred to the clinic. On admission, he was alert with a blood pressure of 100/60 mmHg, heart rate of 100 beats/min, sinus rhythm, right upper quadrant pain, and jaundice. Lab results showed thrombocytopenia, severe hepatorenal dysfunction, prolonged prothrombin time (29.3 s), and a Model for End-Stage Liver Disease score of 30. For 3 d, the patient was simultaneously exposed to amatoxin and chronic cardiovascular medications, both substrates for the same transporters. Treatment was adjusted to intravenous acetylcysteine (double regimen), oral silymarin (600 mg/d), and supportive therapy. The patient recovered within 10 d, with transaminases normalizing after 3 mo. Understanding transporter-related drug interactions and patient-specific metabolic differences may improve future management strategies and patient survival. Further research is needed on alternative inhibitors of amatoxin uptake and competitive organic anion-transporting polypeptide substrates to expand treatment options.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251338278"},"PeriodicalIF":1.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heroes in Red: Traumatic Event Exposure Linked to Reduced Wellbeing Among a Cohort of U.S. Ski Patrollers.","authors":"Elizabeth Keller, Wendie Robbins, Yijia Sun, Jian Li","doi":"10.1177/10806032251337468","DOIUrl":"https://doi.org/10.1177/10806032251337468","url":null,"abstract":"<p><p>IntroductionSki patrollers face unique occupational risks and may be exposed to traumatic events. This study aimed to determine the relationship between traumatic event exposures and wellbeing among a cohort of U.S. ski patrollers.MethodsA non-experimental, descriptive, longitudinal design was followed to complete a pilot study. An online survey was employed with repeated measures (1, 2, & 3 months). Participants were conveniently sampled from one ski resort in the Western United States. This study was informed by the stress continuum model.ResultsA total of 29 participants completed at least one follow-up survey and were included as the analytic sample. Participants were primarily White (<i>n</i> = 27, 93.10%), non-Hispanic or Latino (<i>n</i> = 27, 93.10%), and male (<i>n</i> = 19, 65.52%), aged 39.07 on average. Three-quarters of participants reported exposure to traumatic events at Survey 1 (<i>n</i> = 22, 75.86%), and the frequency ranged from 1 to 20 events. Increased frequency of traumatic events by each one event was significantly related to decreased wellbeing levels over 3 months (β = -0.0253, <i>p</i> < .0001, 95% CI: [-0.0364, -0.0141]), after controlling for age, sex, race, ethnicity, marital status, and working hours. When included as an interaction term, resilience was found to buffer the negative effect of traumatic event exposure on wellbeing (β = -0.0068, <i>p</i> < .0001, 95% CI: [-0.0099, -0.0038]).ConclusionsFindings underscore the need for additional research to identify the most effective ways to support the wellbeing and resilience of ski patrollers.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251337468"},"PeriodicalIF":1.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blazing the Trail: A Novel Longitudinal Approach to Wilderness Medicine Education for Preclinical Medical Students.","authors":"Jennifer McGowan","doi":"10.1177/10806032251338012","DOIUrl":"https://doi.org/10.1177/10806032251338012","url":null,"abstract":"<p><p>Introduction-Wilderness medical education for medical students is generally intended for senior medical students during their clinical years. Several universities have established elective rotations for clinical students or longitudinal 4-y tracks, but these opportunities are frequently restricted to a limited number of students. This novel program sought to fill a deficit of wilderness medicine curricula for preclinical medical students by creating a longitudinal course over one academic year.Methods-This curriculum includes a certification series of didactic lectures on core wilderness medical topics interspersed with hands-on skills sessions and simulated patient scenarios led by emergency medicine-trained faculty. Established medical education strategies were employed to improve learning, including spacing, interleaving, gamification, review quizzes, and frequent low-stakes assessments.Results-During the first 3 y of this innovative teaching method, 48 preclinical students completed all components of the course, with another 20 students in progress for this academic year. Postintervention surveys have yielded positive feedback, with students reporting improved confidence on patient assessment, increased wilderness medical knowledge, and the acquisition of procedural skills.Conclusions-Implementing a 1-y longitudinal wilderness medicine curriculum for preclinical medical students allows learners to gain valuable skills while building their confidence to assess and treat patients in a wilderness environment. The curriculum can be designed to incorporate best practices in medical education and adapted to a variety of practice situations and learners.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251338012"},"PeriodicalIF":1.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trail Running Safety: A Review of Serious Adverse Events Reported in Online News Articles.","authors":"Carel Viljoen, Monique da Cruz, Kgame Matlala, Megan Groves, Kaylin du Toit, Loria Fourie, Bruno Silva, Volker Scheer, Candice MacMillan, Dina C Janse van Rensburg","doi":"10.1177/10806032251338703","DOIUrl":"10.1177/10806032251338703","url":null,"abstract":"<p><p>Trail running is an endurance sport that entails running outdoors on natural terrain. Scientific literature provides minimal information on serious adverse events that occur during trail running. The objectives of this review were to identify and summarize the available information published in online worldwide news articles and to categorize the results in fatal, missing, and catastrophic events in trail running. Over a 14-wk period, online news articles were searched using Google Advanced Search and DuckDuckGo for reports on serious adverse events during trail running. Data were extracted and summarized from online news articles that met the inclusion criteria. Ninety-four online news articles reported on 127 runners involved in serious adverse events during trail running. Among the serious adverse events reported in this review, 82% (n = 104) were fatal trail running events; 29% (n = 37) were related to missing events, of which 54% (n = 20) of the missing events resulted in death; and 6% (n = 6) were catastrophic injuries. Most runners were males (73%) aged 16 to 75 y (41.5 ± 12.6 y). The most common intrinsic causes of death were cardiac arrest (58%) and collapse (38%), whereas the most common extrinsic causes of death were cold weather resulting in potential hypothermia (40%) and blunt trauma following falling/slipping (25%). Almost half the runners who went missing (41%) were found. The 6 runners involved in catastrophic events (6%) suffered severe burn wounds, brain damage, and frostbite. Serious adverse events in trail running seem to be rare. This review reports multiple serious adverse events during trail running. Although these events are rare, they highlight the need for further research and improved reporting. These findings can assist in developing future prevention strategies for trail running events and guide medical staff during race-day medical planning.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251338703"},"PeriodicalIF":1.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Forest to Intensive Care Unit: Managing Severe Complications of <i>Bothrops bilineatus</i> Envenomation.","authors":"Percy Josué Vásquez Paredes","doi":"10.1177/10806032251337667","DOIUrl":"https://doi.org/10.1177/10806032251337667","url":null,"abstract":"<p><p>Snakebites are a critical health issue in remote regions of the Amazon basin. I report a case of <i>Bothrops bilineatus</i> envenomation in a 29-y-old biologist conducting fieldwork in Parque Nacional del Manu, Peru. Following significant logistic delays-including an initial suboptimal antivenom dose and limited access to additional vials-the patient developed progressive edema, necrosis, coagulopathy, and signs of compartment syndrome. Management involved 2 partial doses of antivenom (1 at 1600 and the other at 2100), a subsequent transfer to a tertiary care center, antibiotics, analgesia, and eventually surgical intervention, including debridement and partial amputation. Although the patient received some treatment on the day of the bite, fragmented antivenom dosing and delayed transport likely contributed to worse local injury. This case highlights the importance of prompt, complete antivenom therapy, effective logistics, advanced diagnostic resources, and comprehensive rehabilitation in resource-limited settings.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251337667"},"PeriodicalIF":1.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Edward F. Adolph, PhD: A Preeminent Physiologist Who Studied Human Exposure to Desert Heat.","authors":"Brad L Bennett, Tony Islas","doi":"10.1177/10806032251337474","DOIUrl":"https://doi.org/10.1177/10806032251337474","url":null,"abstract":"<p><p>During combat with German Nazis in the deserts of North Africa, it became imperative for the United States Army to research to ascertain the physiological limits of military ground troops subjected to extreme desert heat exposure. In the 1940s, Edward F. Adolph, PhD, from the University of Rochester School of Medicine & Dentistry (URSMD), was funded through a contract with the government to initiate research on human tolerance to the extremes of desert heat. Consequently, Adolph and his associates established the university's Desert Research Unit in the California desert. In the 1930s, a team from Harvard University's Fatigue Laboratory established the \"Harvard Desert Expedition\" for field research in the Nevada desert. Notably, both Harvard and Rochester research teams investigated human metabolic responses in desert heat, with Dr Adolph participating in both desert locations. These field studies were conducted during Adolph's time as a faculty member in the Department of Physiology at the URSMD, which spanned over 62 years. Adolph's research interests encompassed investigations into the physiological responses of humans in desert environments, including regulation of water and heat metabolism, sweat formation, dehydration, thirst, physiological adaptations to extreme heat, and survival without water. Adolph authored or co-authored a substantial body of work, including 155 articles and 4 books, culminating in the seminal text <i>Physiology of Man in the Desert</i> (1947). We aim to provide some pertinent lessons learned and practical applications derived from the research conducted by Adolph and his associates in the desert.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251337474"},"PeriodicalIF":1.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision-Making in the Backcountry and Its Clinical Applications in Medical Education-a Pilot Experiential Learning Workshop.","authors":"Sarah Petelinsek, Peilu Zhang, Jorie Colbert-Getz, Theodore Hartridge, Nate Furman, Patrick G Hughes","doi":"10.1177/10806032251334298","DOIUrl":"https://doi.org/10.1177/10806032251334298","url":null,"abstract":"<p><p><b>Introduction-</b>Decision-making in clinical environments is often impacted by cognitive biases and exacerbated by high stakes, time pressures, and unreliable feedback-characteristics of a \"wicked learning environment,\" as defined by Robin Hogarth.^1,2 Traditional medical education inadequately addresses these biases, relying primarily on passive, lecture-based instruction. <b>Objective-</b>To bridge this gap, we designed and piloted an experiential learning workshop for first-year medical students, integrating backcountry skiing as a parallel wicked learning environment to teach decision-making biases, fallacies, and heuristics. <b>Methods-</b>The study employed a qualitative questionnaire to better understand student experience and measured learning outcomes. <b>Results</b><b>-</b>Twenty-six students participated in the classroom-based components, and of those 26, 8 participated in the experiential learning component. Qualitative questionnaire responses suggest an elevated understanding of how backcountry decision-making informs clinical decision-making and the importance of decision-making within patient care. <b>Discussion</b><b>-</b>There is clear potential for the programming to be expanded and applied to other forms of the outdoor recreation experience. Results suggest that applying the experiential learning model provides an additional and broader understanding of how decision-making biases may intersect with practical applications in medical settings. Despite limitations, including a low response rate, the results suggest that this novel approach enhances the understanding of cognitive biases and decision-making in clinical settings. Future iterations will aim to scale participation, include quantitative assessments, and explore alternative wicked learning environments. <b>Conclusion-</b>This pilot program demonstrates the potential of combining outdoor experiential learning with medical education to address critical gaps in teaching decision-making biases and improve clinical practice.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251334298"},"PeriodicalIF":1.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Large Language Models into Space Radiology: Opportunities and Challenges.","authors":"Yasin Celal Gunes, Eren Çamur, Turay Cesur","doi":"10.1177/10806032251337674","DOIUrl":"https://doi.org/10.1177/10806032251337674","url":null,"abstract":"","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251337674"},"PeriodicalIF":1.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Survey of Wilderness Medicine Scholarly Tracks in Emergency Medicine Residency Programs.","authors":"Kevin D Watkins, Justin M Gardner, Ross J Ferrise","doi":"10.1177/10806032251332280","DOIUrl":"https://doi.org/10.1177/10806032251332280","url":null,"abstract":"<p><p>IntroductionWilderness medicine (WM) tracks provide residents with a framework to foster their interests in wilderness medicine. However, there is little literature specific to WM tracks. We sent surveys to all 287 ACGME-recognized emergency medicine residencies in the United States to obtain data on the prevalence and characteristics of these tracks.MethodsA survey was distributed via the Society for Academic Emergency Medicine and American College of Emergency Physicians listservs with follow-up emails sent to nonrespondents. The survey included questions regarding program demographics, the presence of a WM track, and the characteristics of the track. Residencies lacking a track were asked about their interest, and challenges faced, in creating a track. We evaluated differences between 3-y and 4-y residency programs, smaller and larger programs, and scholarly activity production using the <b>χ</b>² test, where <i>P</i> < 0.05 was considered significant. We evaluated the differences between academic, community/county, and military centers using the ANOVA test, where <i>P</i> < 0.05 was considered significant.ResultsThe response rate was 28%; 24% of respondents had a WM track, and the majority of these were offered at academic centers, 4-year programs, or larger programs. Track participation, administration, and requirements varied significantly. Among programs without a WM track, a minority (35%) reported planning to develop one in the next few years.ConclusionsDespite the popularity of wilderness medicine, many residency programs do not have a WM scholarly track. Their engagement, administration, funding, scholarly productivity, and requirements are quite variable.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251332280"},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Large Language Models on Aerospace Medicine Principles.","authors":"Kyle D Anderson, Cole A Davis, Shawn M Pickett, Michael S Pohlen","doi":"10.1177/10806032251330628","DOIUrl":"https://doi.org/10.1177/10806032251330628","url":null,"abstract":"<p><p>IntroductionLarge language models (LLMs) hold immense potential to serve as clinical decision-support tools for Earth-independent medical operations. However, the generation of incorrect information may be misleading or even harmful when applied to care in this setting.MethodTo better understand this risk, this work tested two publicly available LLMs, ChatGPT-4 and Google Gemini Advanced (1.0 Ultra), as well as a custom Retrieval-Augmented Generation (RAG) LLM on factual knowledge and clinical reasoning in accordance with published material in aerospace medicine. We also evaluated the consistency of the two public LLMs when answering self-generated board-style questions.ResultsWhen queried with 857 free-response questions from <i>Aerospace Medicine Boards Questions and Answers</i>, ChatGPT-4 had a mean reader score from 4.23 to 5.00 (Likert scale of 1-5) across chapters, whereas Gemini Advanced and the RAG LLM scored 3.30 to 4.91 and 4.69 to 5.00, respectively. When queried with 20 multiple-choice aerospace medicine board questions provided by the American College of Preventive Medicine, ChatGPT-4 and Gemini Advanced responded correctly 70% and 55% of the time, respectively, while the RAG LLM answered 85% correctly. Despite this quantitative measure of high performance, the LLMs tested still exhibited gaps in factual knowledge that potentially could be harmful, a degree of clinical reasoning that may not pass the aerospace medicine board exam, and some inconsistency when answering self-generated questions.ConclusionThere is considerable promise for LLM use in autonomous medical operations in spaceflight given the anticipated continued rapid pace of development, including advancements in model training, data quality, and fine-tuning methods.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251330628"},"PeriodicalIF":1.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}