Military medicine
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Since the beginning of military operations in Iraq and Afghanistan, multidrug-resistant bacteria have been noted to be infecting and colonizing combat casualties. Studies suggest the primary source of these bacteria is nosocomial transmission. A focus area for improvement has been to enhance infection control (IC) at hospitals in the combat theater. ⋯ A pre- and post-course test showed an average 21% improvement in knowledge. A follow-up questionnaire provided to those students who deployed found the course had enhanced performance of their IC duties. We describe the deployment-unique training developed to provide basic IC, emphasizing the unique challenges found in the combat setting.
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Shrapnel injuries in soft tissues often do not require surgical excision. Metals that remain embedded in the surrounding tissue are not thought to cause significant damage and the patients are generally asymptomatic. This case presentation describes a patient who sustained a penetrating shrapnel injury to his thigh, where the metal fragment was not removed. However, more than 20 years later, the patient developed knee synovitis. On X-ray the shrapnel was seen in the suprapatellar pouch. An arthroscopy was preformed and the shrapnel was removed with full healing of the patient. ⋯ although nonsurgical treatment of shrapnel in soft tissues is the treatment of choice in many cases, late migration is possible, causing distal symptoms and may require surgical excision.
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Editorial Biography Historical Article
The community-acquired pneumonia that doomed the south: the death of Stonewall Jackson.