Military medicine
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Extremity injuries have comprised the majority of battlefield injuries in modern U.S. conflicts since World War II. Most reports have focused on serious injuries only and, to date, no reports have described the full extent of combat extremity injuries, from mild to severe, resulting from post-9/11 conflicts. This study aims to identify and characterize the full spectrum of non-amputation combat-related extremity injury and extend the findings of previous reports. ⋯ This study is the first publication to capture, review, and characterize the full range, from mild to severe, of non-amputation combat-related extremity injuries resulting from post-9/11 conflicts. The high prevalence of extremity injury, particularly in such a young population, and associated short- and long-term health outcomes, will impact military health care systems for decades to come.
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The DoD Global Health Engagement community of policymakers, planners, and implementers-to include Combatant Command Surgeons' offices, humanitarian/civic assistance program managers, and tactical units-is uniquely positioned to be a leader within the wider security cooperation community for integrating Women, Peace, and Security (WPS) principles into existing programming and planning, and for executing WPS activities with partner nations in support of U. S. national security goals. Global Health Engagement and the WPS Agenda together can serve as mutually reinforcing, valuable capabilities to support U. S. security cooperation goals.
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Trimethoprim-sulfamethoxazole, otherwise known as Bactrim or Septra, is a commonly prescribed antibiotic for soft tissue infections. Drug-induced thrombocytopenia is a rare but serious adverse reaction to sulfonamide antibiotics like Bactrim/Septra. A 34-year-old active duty marine male with no significant past medical history presented with a chief complaint of a rash on his lower extremities. ⋯ This case illustrates the importance of conducting a thorough review of systems and physical examination in stable and otherwise healthy patients. In this case, the seemingly benign rash was one of the only clinical signs of severe thrombocytopenia, with a high risk of spontaneous bleeding in clinically significant organ systems. It is important to recognize immune thrombocytopenic purpura as a potential complication of Bactrim/Septra, as this antibiotic is widely used by military providers in operational settings.
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Analysis of military Graduate Medical Education (GME) remains in the discussion forefront as resources continue to face scrutiny along with military-specific obligation challenges. The Military Health System Quadruple Aim of Better Care, Better Health, Lower Cost, and Increased Readiness continues to drive debate of the right approach to both GME and Graduate Allied Health education. In this paper, we expand the discussion beyond traditional physician-focused GME and include the military's highly trained allied health specialists. ⋯ These specialists also carry a significant deployment and operational medicine footprint complimenting core physician medical specialties delivering cost-efficient, optimal patient care and providing a ready force. This paper addresses GME and GAH interprofessionalism, institutional culture endorsement, patient safety, increasing demand, research productivity, and encouraging physician retention altogether benefiting the Military Health System. This institution's support for the interprofessional GME model works well, expanding physician and GAH specialists' professional application and knowledge while garnering mutual respect across all medical disciplines ultimately benefiting all.
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Decision-making related to the utilization of host-nation medical resources in austere forward-deployed environments is complex. Clinical circumstances, local medical intelligence availability, transportation assets, uncertainty regarding standard-of-care variations, military/host-nation funding complications, and regional security concerns all factor into consideration. A case of a U. ⋯ After return of circulation following defibrillation, he was administered thrombolytic therapy for an electrocardiogram-identified ST-elevation myocardial infarction and transported to a local host-nation cardiac hospital for emergent percutaneous coronary intervention. During his subsequent transportation back to the USA, surveillance testing identified that he was colonized with a rare strain of Pseudomonas aeruginosa, demonstrating New Delhi metallo-beta-lactamase-1 and 16S RNA methyltransferase-2 enzymes, which confer significant resistance to carbapenem and aminoglycoside antibiotics, respectively.1-3 This combination of antibiotic resistance has been reported very rarely in the medical literature and has never been reported within the deployed military health system until now. The risk of exposure to multidrug-resistant organisms was not a factor initially considered in the decision to utilize host-nation medical resources in this case, which provided lesson learned and raised new questions, for future operational medical planning.