Military medicine
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Cataract is the most common age-related disorder amenable to surgical correction in persons 65 years or older in the United States. Persons who are eligible for benefits through both the Veterans Health Administration (VHA) and Medicare have a choice in which system to receive medical care. ⋯ The VHA remains an important safety net for many veterans who are dually enrolled in Medicare. Dependency on the VHA for quality of life surgery needs to be kept in mind if budgetary pressures lead to restrictions of VHA services for veterans with Medicare.
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A case is described where recombinant activated factor VII was used to control pulmonary hemorrhage in a patient who had sustained a high-velocity gunshot wound to the chest, in the deployed medical setting, allowing onward transfer of the patient to the United Kingdom for further management.
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Case Reports
Iatrogenic pneumomediastinum and subcutaneous emphysema as a complication of colonoscopy with cold forceps biopsy.
A 58-year-old woman underwent outpatient colonoscopy with multiple cold forceps biopsy for evaluation of a presumptive diagnosis of ulcerative colitis. Six hours following the procedure, she developed subcutaneous crepitus and presented to the emergency department, where chest X-ray revealed pneumomediastinum and subcutaneous emphysema. Our case discusses this unusual complication of colonoscopy and its diagnosis and management.
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U.S. military accession mental health screening includes cognitive testing and questions regarding the applicants' past mental health history. This process relies on applicants' knowledge of and willingness to disclose symptoms and conditions. Applicants have a strong incentive to appear qualified, which has resulted in a long history of frequent mental health conditions presenting during recruit training. ⋯ AIM offers the potential to improve screening of military applicants and reduce mental disorders and attrition in new recruits beyond the current process.