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  1. Article ; Online: Correction

    Ted Melcer / Jay Walker / Vibha Bhatnagar / Erin Richard / V Franklin Sechriest Ii / Michael Galarneau

    PLoS ONE, Vol 12, Iss 2, p e

    A Comparison of Four-Year Health Outcomes following Combat Amputation and Limb Salvage.

    2017  Volume 0173214

    Abstract: This corrects the article DOI:10.1371/journal.pone.0170569.]. ...

    Abstract [This corrects the article DOI:10.1371/journal.pone.0170569.].
    Keywords Medicine ; R ; Science ; Q
    Language English
    Publishing date 2017-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: A Comparison of Four-Year Health Outcomes following Combat Amputation and Limb Salvage.

    Ted Melcer / Jay Walker / Vibha Bhatnagar / Erin Richard / V Franklin Sechriest / Michael Galarneau

    PLoS ONE, Vol 12, Iss 1, p e

    2017  Volume 0170569

    Abstract: Little research has described the long-term health outcomes of patients who had combat-related amputations or leg-threatening injuries. We conducted retrospective analysis of Department of Defense and Department of Veterans Affairs health data for lower ... ...

    Abstract Little research has described the long-term health outcomes of patients who had combat-related amputations or leg-threatening injuries. We conducted retrospective analysis of Department of Defense and Department of Veterans Affairs health data for lower extremity combat-injured patients with (1) unilateral amputation within 90 days postinjury (early amputation, n = 440), (2) unilateral amputation more than 90 days postinjury (late amputation, n = 78), or (3) leg-threatening injuries without amputation (limb salvage, n = 107). Patient medical records were analyzed for four years postinjury. After adjusting for group differences, early amputation was generally associated with a lower or similar prevalence for adverse physical and psychological diagnoses (e.g., pain, osteoarthritis, posttraumatic stress disorder) versus late amputation and/or limb salvage. By contrast, early amputation was associated with an increased likelihood of osteoporosis during the first year postinjury. The prevalence of posttraumatic stress disorder increased for all patient groups over four years postinjury, particularly in the second year. The different clinical outcomes among combat extremity injured patients treated with early amputation, late amputation, or limb salvage highlight their different healthcare requirements. These findings can inform and optimize the specific treatment pathways that address the physical and psychological healthcare needs of such patients over time.
    Keywords Medicine ; R ; Science ; Q
    Subject code 150
    Language English
    Publishing date 2017-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Lower-limb amputation and effect of posttraumatic stress disorder on Department of Veterans Affairs outpatient cost trends

    Vibha Bhatnagar, MD, MPH / Erin Richard, MPH / Ted Melcer, PhD / Jay Walker, BS / Michael Galarneau, MS, NREMT

    Journal of Rehabilitation Research and Development, Vol 52, Iss 7, Pp 827-

    2015  Volume 838

    Abstract: Department of Veterans Affairs (VA) outpatient costs were analyzed for combat Veterans injured in Iraq and Afghanistan from 2001 to 2008. Patients had serious lower-limb injuries (n = 170) or unilateral (n = 460) or bilateral (n = 153) lower-limb ... ...

    Abstract Department of Veterans Affairs (VA) outpatient costs were analyzed for combat Veterans injured in Iraq and Afghanistan from 2001 to 2008. Patients had serious lower-limb injuries (n = 170) or unilateral (n = 460) or bilateral (n = 153) lower-limb amputation(s). Total costs over the follow-up period (2003 to 2012) and annual costs were analyzed. Unadjusted mean costs per year in 2012 U.S. dollars were $7,200, $14,700, and $18,700 for limb injuries and unilateral and bilateral lower-limb amputation(s), respectively (p < 0.001). Multivariate modeling indicated that annual cost declined after the first year in the VA for Veterans with limb injuries (p < 0.001, repeated measures). In contrast, annual costs doubled after 3–5 years with unilateral (p < 0.001) and bilateral amputation(s) (p < 0.001). Among amputees, prosthetics comprised more than 50% of outpatient cost; unadjusted mean cost per year for prosthetics was 7–9 times higher in comparison with Veterans with limb injuries. Amputation status was associated with an adjusted 3.12-fold increase in mean prosthetic cost per year (p < 0.001, general linear model). In addition, posttraumatic stress disorder (PTSD) was associated with increased prosthetic cost by amputation status (p < 0.001) and increased psychiatric and pharmacy costs (both p < 0.001). Results indicate relatively high and sustained outpatient costs driven by prosthetics following amputation. Finally, PTSD affected cost for multiple domains of health, highlighting the importance of accurate diagnosis, treatment, and support for PTSD.
    Keywords amputation ; amputee ; Department of Veterans Affairs ; Expeditionary Medical Encounter Database ; outpatient cost ; pharmacy ; posttraumatic stress disorder ; prosthetic ; psychiatry ; rehabilitation ; utilization ; Therapeutics. Pharmacology ; RM1-950 ; Medicine ; R
    Subject code 150
    Language English
    Publishing date 2015-11-01T00:00:00Z
    Publisher Rehabilitation Research and Development Service, Department of Veterans Affairs
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Heterotopic ossification in combat amputees from Afghanistan and Iraq wars

    Ted Melcer, PhD / Brian Belnap, DO / G . Jay Walker, BA / Paula Konoske, PhD / Michael Galarneau, MS

    Journal of Rehabilitation Research and Development, Vol 48, Iss 1, Pp 1-

    Five case histories and results from a small series of patients

    2011  Volume 12

    Abstract: Heterotopic ossification (HO) is excess bone growth in soft tissues that frequently occurs in the residual limbs of combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively. HO can ... ...

    Abstract Heterotopic ossification (HO) is excess bone growth in soft tissues that frequently occurs in the residual limbs of combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively. HO can interfere with prosthetic use and walking and delay patient rehabilitation. This article describes symptomatic and/or radiographic evidence of HO in a patient series of combat amputees rehabilitating at a military amputee care clinic (27 patients/33 limbs). We conducted a retrospective review of patient records and physician interviews to document evidence of HO symptoms in these limbs (e.g., pain during prosthetic use, skin breakdown). Results showed HO-related symptoms in 10 of the 33 residual limbs. Radiographs were available for 25 of the 33 limbs, and a physician identified at least moderate HO in 15 of the radiographs. However, 5 of the 15 patients who showed at least moderate radiographic HO did not report adverse symptoms. Five individual patient histories described HO onset, symptoms, treatments, and outcomes. These case histories illustrated how HO location relative to pressure-sensitive/pressure-tolerant areas of the residual limb may determine whether patients experienced symptoms. These histories revealed the uncommon but novel finding of potential benefits of HO for prosthetic suspension.
    Keywords Afghanistan war ; amputation ; blast injury ; combat amputee ; heterotopic ossification ; Iraq war ; physical medicine ; prosthesis ; radiograph ; rehabilitation ; Therapeutics. Pharmacology ; RM1-950 ; Medicine ; R ; DOAJ:Therapeutics ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Subject code 150 ; 310
    Language English
    Publishing date 2011-01-01T00:00:00Z
    Publisher Rehabilitation Research and Development Service, Department of Veterans Affairs
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees

    Ted Melcer, PhD / Jay Walker, BA / Vibha Bhatnagar, MD / Erin Richard, MPH / Peggy Han, MPH / V. Franklin Sechriest II, MD / Martin Lebedda, RN / Kimberly Quinn, RN / Michael Galarneau, MS, NREMT

    Journal of Rehabilitation Research and Development, Vol 51, Iss 5, Pp 697-

    2014  Volume 710

    Abstract: Morphine and fentanyl are frequently used for analgesia after trauma, but there is debate over the advantages and disadvantages of these opioids. Among combat amputees, intravenous (IV) morphine (vs IV fentanyl) after injury was associated with reduced ... ...

    Abstract Morphine and fentanyl are frequently used for analgesia after trauma, but there is debate over the advantages and disadvantages of these opioids. Among combat amputees, intravenous (IV) morphine (vs IV fentanyl) after injury was associated with reduced likelihood of posttraumatic stress disorder (PTSD). The previous results were based on military health diagnoses over 2 yr postinjury. The present study followed psychological diagnoses of patients with amputation for 4 yr using military and Department of Veterans Affairs health data. In-­theater combat casualty records (n = 145) documented Glasgow Coma Scale (GCS) scores and/or morphine, fentanyl, or no opioid treatment within hours of injury. We found that (1) GCS scores were not significantly associated with PTSD; (2) longitudinal modeling using four (yearly) time points showed significantly reduced odds of PTSD for patients treated with morphine (vs fentanyl) across years (adjusted odds ratio = 0.40; 95% confidence interval = 0.17–0.94); (3) reduced PTSD prevalence for morphine (vs IV fentanyl; morphine = 25%, fentanyl = 59%, p < 0.05) was significant, specifically among patients with traumatic brain injury during the first 2 yr postinjury; and (4) PTSD prevalence, but not other disorders (e.g., mood), increased between year 1 (PTSD = 18%) and years 2 through 4 postinjury (PTSD range = 30%–32%).
    Keywords combat amputee ; fentanyl ; Glasgow Coma Scale ; Iraq/Afghanistan conflicts ; long-term psychological outcomes ; loss of consciousness ; military and VA health data ; morphine ; posttraumatic stress disorder ; traumatic brain injury ; Therapeutics. Pharmacology ; RM1-950 ; Medicine ; R
    Subject code 150
    Language English
    Publishing date 2014-09-01T00:00:00Z
    Publisher Rehabilitation Research and Development Service, Department of Veterans Affairs
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Effect of traumatic brain injury among U.S. servicemembers with amputation

    Mitchell J. Rauh, PhD, PT, MPH / Hilary J. Aralis, MS / Ted Melcer, PhD / Caroline A. Macera, PhD / Pinata Sessoms, PhD / Jamie Bartlett, PhD / Michael R. Galarneau, MS

    Journal of Rehabilitation Research and Development, Vol 50, Iss 2, Pp 161-

    2013  Volume 172

    Abstract: Servicemembers with combat-related limb loss often require substantial rehabilitative care. The prevalence of traumatic brain injury (TBI), which may impair cognitive and functional abilities, among servicemembers has increased. The primary objectives of ...

    Abstract Servicemembers with combat-related limb loss often require substantial rehabilitative care. The prevalence of traumatic brain injury (TBI), which may impair cognitive and functional abilities, among servicemembers has increased. The primary objectives of this study were to determine the frequency of TBI among servicemembers with traumatic amputation and examine whether TBI status was associated with discharge to civilian status and medical and rehabilitative service use postamputation. U.S. servicemembers who had a combat-related amputation while deployed in Iraq or Afghanistan between 2001 and 2006 were followed for 2 yr postamputation. Data collected includes injury mechanism; postinjury complications; Injury Severity Score (ISS); and follow-up data, including military service discharge status and number of medical, physical, occupational therapy, and prosthetic-related visits. Of the 546 servicemembers with combat-related amputations, 127 (23.3%) had a TBI diagnosis. After adjusting for ISS and amputation location, those with TBI had a significantly greater mean number of medical and rehabilitative outpatient and inpatient visits combined (p < 0.01). Those with TBI were also at greater odds of developing certain postinjury complications. We recommend that providers treating servicemembers with limb loss should assess for TBI because those who sustained TBI required increased medical and rehabilitative care.
    Keywords amputation ; blasts ; combat-related ; military ; occupational therapy ; odds ratio ; physical therapy ; postinjury complications ; prosthetic use ; rehabilitative use ; service discharge ; traumatic brain injury. ; Therapeutics. Pharmacology ; RM1-950 ; Medicine ; R ; DOAJ:Therapeutics ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Subject code 150
    Language English
    Publishing date 2013-04-01T00:00:00Z
    Publisher Rehabilitation Research and Development Service, Department of Veterans Affairs
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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