Military medicine
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Comparative Study
A 5-year retrospective review of experience with Clostridium difficile-associated diarrhea.
The incidence and virulence of Clostridium difficile-associated diarrhea (CDAD) has increased dramatically from the mid 1990s to the mid 2000s. This research assessed recent CDAD patterns at a major military medical center from 2005 to 2009, by retrospectively reviewing clinical data of each CDAD case identified using the center's electronic medical record system. Two hundred and thirty-two cases were identified. ⋯ Most cases were initially treated with metronidazole, which was associated with a 14% (27/188) recurrence rate versus 9% (2/22) treated with vancomycin (p > 0.05). In contrast to earlier reports, our center has experienced a low and stable rate of CDAD since 2005. Severe CDAD is common and associated with significant mortality.
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Case Reports
Peripartum cardiomyopathy and acute fatty liver of pregnancy: one patient with two zebras.
Peripartum cardiomyopathy (PPCM) and acute fatty liver of pregnancy (AFLP) are rare complications of pregnancy affecting approximately 1/10,000 pregnancies each. We describe a patient who had biopsy-proven AFLP complicated by PPCM. ⋯ AFLP and PPCM are rare complications of pregnancy. We present a patient who had both. Both diseases carry a high mortality rate, and together, are likely fatal.
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Comparative Study
Temporary disability retirement cases: variations in time to final disposition and disability rating by service and medical condition.
Service members undergoing disability evaluation are placed on the temporary disability retirement list (TDRL) when their disabling medical condition(s) may change in severity over time. Information is sparse on the epidemiology of the TDRL population and factors influencing time spent on the TDRL or changes in compensation ratings before final disability outcome. ⋯ Most cases retained the same disability rating and were permanently retired by the first re-evaluation. Important areas of future research include cost-benefit analyses to determine if length of time currently allowable on the TDRL can be shortened or if repeated evaluations are necessary and exploration of specific medical conditions likely to change in severity over time.
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Uncontrolled bleeding remains the leading cause of preventable death in trauma. Hemostatic agents are effective in hemorrhage control but often fail following high-volume crystalloid resuscitation. Aggressive fluid resuscitation increases the blood pressure which may dislodge the newly formed clot causing rebleeding. ⋯ The control group underwent the same procedures but without the hemostatic agent. After 30 minutes, dressings were removed and the SBP was increased incrementally using intravenous phenylephrine until rebleeding occurred or until the arterial blood pressure reached 210 mm/Hg. The SBP and MAP were significantly higher in the BleedArrest, TraumaDex, and Celox groups compared to a control group (p < 0.05).
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To describe the perceptions of training and deployment preparation and combat experiences and exposures of U.S. Army combat medics. ⋯ The military has shown considerable progress in addressing and understanding the mental health care needs of Soldiers. However, challenges remain. Additional emphasis should be placed on reducing the stigma and barriers related to mental health care both in theatre and garrison and on developing an evidence-based, validated program for medics and other Soldiers to recognize stress and mental health issues on the battlefield. For medics, this should be from two perspectives-that of a combat Soldier and that of a medical provider.