Military medicine
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The use of magnetic resonance (MR) imaging (MRI) among many medical professions is growing. Many health care systems have formed control mechanisms to ensure proper utilization of MRI. This western world trend is also valid in the Israeli Air Force (IAF). At the time of the study, two methods existed for consideration of MR requests in the IAF: (1) consideration by a primary reviewer, no clinical guidelines (applied to all MR examination requests, knee MR excluded). (2) Consideration by a primary reviewer according to basic clinical guidelines established by the Israeli Defense Forces medical section and by communication with an orthopedic specialist (applied to knee MR requests). Both methods did not include consultation with established criteria (such as American College of Radiology (ACR) appropriateness criteria). ⋯ Both MR approval mechanisms that were applied in the IAF have not shown a strong correlation with ACR appropriateness criteria, with significant rates of both overuse and underuse of MRI. The high rate of requests that could not be assigned an ACR appropriateness value may indicate a need to broaden the appropriateness criteria coverage of clinical conditions and variants.
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By the time a cricothyroidotomy is deemed necessary, the patient is in critical need of an emergency airway before anoxic damage ensues. Two things are necessary for the delivery of the requisite oxygen. ⋯ Present methods for emergency cricothyroidotomy include needle cricothyroidotomy, which suffers from difficulties in both establishment and ventilation. We describe here a practical and widely available method for establishing a timely effective airway that has been used successfully for five patients since 1992.
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William Beaumont Army Medical Center conducted quantitative modeling with FluSurge 2.0 (Centers for Disease Control and Prevention) to determine hospital capabilities in responding to patient arrival surges of the Fort Bliss population in mild 1968-type and severe 1918-type influenza pandemics. Model predictions showed that William Beaumont Army Medical Center could adequately care for all intensive care unit (ICU) and non-ICU patients during a mild pandemic, particularly if hospital capacity was expanded using the emergency management plan, excess surge plan, or activation of a contagious disease outbreak facility. ⋯ Even at maximal hospital expansion, for a 12-week severe pandemic with a 35% attack rate there would be peak demand for 214% of available non-ICU beds, 785% of ICU beds, and 392% of ventilators. Health care planners and decision-makers should prepare for resource challenges when developing plans for the next influenza pandemic.
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Comparative Study
Receipt of disability through an outreach program for homeless veterans.
Receipt of public support payments is associated with beneficial outcomes for homeless people with mental illness. The purpose of this study was to identify factors associated with receipt of Department of Veterans Affairs (VA) pension and compensation benefits among homeless veterans after their initial contact with the VA national homeless outreach program. ⋯ A limited number of veterans (15%) were subsequently awarded benefits; they were more likely to have reported recent use of VA services and a greater number of medical and psychiatric problems at the time of outreach. Findings suggest that VA benefit outreach efforts may gain from increased focus on those most vulnerable and most on the outskirts of the VA system.