Military medicine
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Comparative Study
Safe lithium use in a non-psychiatric versus a psychiatric inpatient veterans affairs hospital setting: a retrospective assessment.
This study examined practices for monitoring lithium in a non-psychiatric versus psychiatric inpatient setting at a Veterans Affairs facility. ⋯ Our results demonstrate significant differences between the non-psychiatric and psychiatric inpatient settings in respect to monitoring lithium. The frequency of serum lithium level monitoring in both groups was below the level set by both the National Institute for Clinical Excellence and British Association for Psychopharmacology guidelines. Additionally, frequency of corrective measures in both settings was low, indicating a need for improvement in this area.
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The main goal of the North Atlantic Treaty Organization role 3 hospital located in Kabul is to provide comprehensive medical services to troops engaged in Afghanistan. Nevertheless, it also provides care for Afghan National Security Forces and for Afghan and non-Afghan civilians. ⋯ Reasons of admission to the conventional hospitalization unit were numerous. Care provided to Afghan and non-Afghan civilians represented the main activity of this unit.
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Soldiers must perform a variety of physical tasks that the civilian population does not. The Modified Oswestry Disability Index (M-ODI) is the most widely used measure of function in patients with low back pain but does not include military tasks. The Military Low Back Pain Questionnaire (MBQ) was developed by military Physical Therapists to include tasks such as wearing body armor. ⋯ The correlation between the M-ODI and the MBQ was r = 0.80 indicating good concurrent validity. The MBQ was as reliable as the M-ODI in an Army population. There were trends in the psychometrics suggesting the MBQ may be more sensitive to change than the M-ODI in this population.
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The lower extremity tourniquet failure rate remains significantly higher in combat than in preclinical testing, so we hypothesized that tourniquet placement accuracy, speed, and effectiveness would improve during training and decline during simulated combat. Navy Hospital Corpsman (N = 89), enrolled in a Tactical Combat Casualty Care training course in preparation for deployment, applied Combat Application Tourniquet (CAT) and the Special Operations Forces Tactical Tourniquet (SOFT-T) on day 1 and day 4 of classroom training, then under simulated combat, wherein participants ran an obstacle course to apply a tourniquet while wearing full body armor and avoiding simulated small arms fire (paint balls). Application time and pulse elimination effectiveness improved day 1 to day 4 (p < 0.005). ⋯ CAT was more quickly applied (p < 0.005) and more effective (p < 0.002) than SOFT-T. Training fostered fast and effective application of leg tourniquets while performance declined under simulated combat. The inherent efficacy of tourniquet products contributes to high failure rates under combat conditions, pointing to the need for superior tourniquets and for rigorous deployment preparation training in simulated combat scenarios.
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Case Reports
Treatment of complex medical emergencies in a forward deployed setting: a case of out-of-hospital cardiac arrest.
The Joint Trauma System in Afghanistan, while designed for the care of injured patients, can provide timely, multimodal, coordinated care for nontraumatic medical emergencies as patients are evacuated from theater. To illustrate this, a case of out-of-hospital cardiac arrest is presented. The patient was able to receive all recommended components of postcardiac arrest care in a timely, coordinated manner at four different medical treatment facilities and while traveling over 8,600 miles with critical care provided en route.