Military medicine
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Comparative Study
The impact of physician training on child maltreatment reporting: a multi-specialty study.
Past studies have suggested that physicians underreport suspected child maltreatment (CM) cases, possibly because of a lack of knowledge of the subject. ⋯ CME seems to positively influence physician reporting practices for CM cases, suggesting a need for universal training protocols.
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Lemierre syndrome consists of septic thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection, usually with Fusobacterium necrophorum. Septic metastatic emboli and distant infection are characteristic. ⋯ In addition, we used magnetic resonance imaging to effectively distinguish between inflammatory venous thrombosis and abscess, thus avoiding surgery in our patient. Early directed antibiotic therapy is mandatory to ensure good outcome.
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Stevens-Johnson syndrome is a cutaneous reaction pattern that represents the progression of symptoms of erythema multiforme. These reactions can range from mild (EM minor) to severe (EM major) and even life-threatening (Stevens-Johnson syndrome or toxic epidermal necrolysis). ⋯ The three most common triggers for Stevens-Johnson syndrome are herpes simplex infection, Mycoplasma infection, and drug reactions. This is a case of Stevens-Johnson syndrome occurring after erythromycin treatment aboard an aircraft carrier while deployed at sea in the Persian Gulf.
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The results reported in this paper are from a larger study examining the relationship between access and stage at diagnosis of breast cancer in African-American and white women. This paper focuses on the results describing the extent to which potential and realized access predict stage at diagnosis within an equal economic access health care system. ⋯ Logistic regression analysis revealed that late-stage breast cancer was more likely to be diagnosed in African-American women from low socioeconomic strata with incidental breast self-examination-discovered cancers. The most significant predictors of late-stage diagnosis were means of discovery and the length of time between discovery and diagnosis.
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The objective of this study was to evaluate the outcome of an early discharge program for infants with regard to length of stay, patient safety, maternal satisfaction, and hospital expense in a military population. The study consisted of a retrospective analysis of data from two 6-month periods--March to August 1994 (before early discharge) and March to August 1996 (after early discharge)--in a military, tertiary care, teaching hospital. The criteria for early discharge included healthy term singleton newborns delivered by uncomplicated vaginal delivery with maternal support systems, transportation, and phone access. ⋯ In addition, the program was able to save 599 inpatient hospital days, for a total cost savings of $442,903.23 in 1996. This reduction in inpatient hospital days netted an average cost savings of $509.67 per infant. By following strict discharge criteria, increasing parent education before discharge, implementing a phone follow-up system, and ensuring easy access to care, an early discharge program in our military population was not associated with increased adverse newborn outcomes and reduced costs.