Military medicine
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The optimal training of physicians should prepare them for the environment in which they will practice. During the past several years, the practice of internal medicine has shifted from a focus on the inpatient setting to one that includes an emphasis on the ambulatory clinic. Military internists must be further prepared to practice medicine with forward units, at field hospitals, and in other operational settings. ⋯ The program is driven by the residents and chief resident and requires little additional funding. Resident research continues to increase, morale remains high, and the first class to complete the 3-year operational curriculum achieved a 100% pass rate on the American Board of Internal Medicine certification examination. We describe our 3-year experience of implementing this program, with an emphasis on curriculum design and execution, qualitative assessment, and initial lessons learned.
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Comparative Study
Proposed technique for evaluation of endotracheal tube fixation and comparison of four fixation methods.
The fixation of an endotracheal tube must be rapid in conditions involving numerous casualties, such as a chemical warfare (CW) situation. The tube also should be fixed and strong to prevent unplanned extubations. ⋯ With this technique, a good estimation of the time and quality of fixation can be achieved.
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Periodontal diseases are oral disorders characterized by inflammation of the supporting tissues of the teeth. Usually, periodontitis is a progressively destructive loss of bone and periodontal ligament (loss of the attachment apparatus of the teeth). Periodontitis has documented risk factors, including but not limited to specific plaque bacteria, smoking, and diabetes mellitus. ⋯ Additionally, these studies support the central hypothesis that periodontal disease involves both a local and a systemic host inflammatory response. This knowledge of disease interrelationships may prove vital in intervention strategies to reduce patient risks and prevent systemic disease outcomes. Based on the current evidence of the periodontal-systemic disease connection, the purpose of this report is to help establish the groundwork for closer communication between physicians and periodontists in the military health care setting.
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Research and scientific observations indicate that, in the armed forces, some individuals tend to experience strong feelings of solitude and harm and do not always have opportunities to receive help. The inability to solve and successfully cope with problems may lead to adaptive difficulties and provoke reckless reactions, including suicide attempts. The aim of this project was a retrospective analysis of the origins and factors leading to successful suicide attempts undertaken by soldiers from 1989 to 1998, with special emphasis on psychopathological determinants. ⋯ The most common reason for suicides in the analyzed group was the combination of psychiatric disorders and psychosocial factors. Among privates, most of the suicides occurred during the first 12 months of service, whereas professional soldiers committed most suicides between their 11th and 15th years of service. The results suggest the urgent introduction of a suicide prevention program.
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Sulfur mustard has been used as a vesicant chemical warfare agent. To investigate the ocular damage it causes, we studied the effects on chemical casualties in the Iran-Iraq War. The patient population consisted of more than 5,000 chemical casualties, both military and civilian. ⋯ Ocular injuries generally heal completely. In severe cases, blindness may occur. The need for corneal transplantation is rare.