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Research Special- introduction
During the conflicts in Iraq and Afghanistan there have been major changes in the way we care for our battlefield casualties. Clinical Guidelines for Operations and BATLS have been updated and refined to offer best practice- and this practice is based on best evidence where available. This special edition of the journal focusses on how that evidence is generated, and how research is translated into clinical improvements.
The Academic Pillar at the Royal Centre for Defence Medicine (RCDM) houses a number of Defence Professorial Departments and a Director of Research. Each department runs a research programme involving military partners and the wider academic community and where possible these projects are linked to Defence personnel undertaking higher degrees.
One of the Defence partners is the Combat Casualty Care programme at the Defence Science and Technical Laboratories (Dstl), Porton Down. This is a multifaceted programme addressing issues ranging from resuscitation strategies to battlefield pain management; highlights from the programme are described. A key academic partner is the recently founded Centre for Blast Injury Studies (CBIS) at Imperial College, London with work strands working from cellular effects of blast injury through to whole system injury. Elements of this work will be presented.
Each Professorial department was invited to participate and showcase aspects of their work in order that the wider Defence Medical Services could see the background work that occurs to generate operational clinical guidance- and hopefully encourage people to consider undertaking research themselves.
The article by Nordmann et al examines in some detail the issues involved in undertaking deployed research. The authors use several examples of recent deployed research and examine the many challenges faced from the preparatory phases including dealing with the numerous ethics submission problems through to the practical issues presented ‘in theatre’. The fact that these projects are delivering high quality research serves to commend the individual authors for their perseverance.
Most of the medical profession are brought up understanding the concepts involved in quantitative research, and so it is timely to read the two articles by the Defence Professor of Nursing which explain in detail both the underlying principles, and the practical constraints within the military, of quantitative research. These articles are a welcome addition to this edition as they highlight an important and often overlooked area of research.
The mental health of the Armed Forces is always of utmost concern to those within the services as well as those outwith, and it is particularly high profile area within the media. This authoritative review of the literature presents reassuring knowledge that UK serviceman may not be suffering from mental health issues as a result of deployment as often or as badly as might have been proposed. Clearly this is not an area in which to rest on ones laurels and the excess of alcohol related issues remains a cause for concern – but nevertheless this review is reassuring
The conflict in Afghanistan has stimulated unprecedented levels of research into blast injury reflecting the importance of this mechanism of injury. Two papers from Singleton et al demonstrate a major new insight into the mechanism of blast-related amputation. Previously thought to be a combination of primary and tertiary mechanism, they explain how through joint amputation appears to be much more common than previously thought and the previously noted association of traumatic blast mediated amputation with primary blast injury did not seem to be apparent. In addition Hepper et al detail how a multidisciplinary team produced analysis of the injury patterns from the 2005 London bombings.
. . . and finally
Research is often viewed as a ‘means to an end’ and articles by Amos and Frazer and Garner explain both how to get a research proposal accepted and funded within the military and then how to maximise ones chances of getting it published.
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