Military medicine
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Comparative Study
Physician attire in the military setting: does it make a difference to our patients?
To examine patient preference regarding physician attire and whether perception of medical competence was influenced by the physician's clothing style. ⋯ Overall, female patients in a military setting do not have a preference for specific physician attire and attire does not influence their perception of the doctor's competence. However, a greater number of dependent wives report physician attire has no influence on their comfort level discussing both general and personal topics when compared with active duty women. This finding highlights the unique role of the military uniform in the eyes of active duty women and their potential discomfort in discussing personal medical issues with a physician in military uniform.
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We describe identified injuries, effectiveness of treatment, and triage categories for combat casualties at echelon 1 from April 1 to June 30, 2005 from western Iraq. A total of 133 casualties were evaluated including 12 who were killed in action and 7 who died of wounds. A medic or corpsman treated 75% of the remaining patients, 9% were treated by bystanders, 2% were seen by a physician or physician assistant, and 15% administered self-aid. ⋯ Field triage categories at echelon I and casualty evacuation categories at echelon II were congruent. No significant injuries were missed and there were no detrimental interventions. In conclusion, combat casualties were assessed, treated, and evacuated appropriately by echelon I providers during this time frame.
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Evidenced based practice guidelines for nutrition support recommend implementation of early enteral nutrition (EEN) in certain patient populations, including trauma and critical illness. Early enteral nutrition has been associated with immune benefits, improved healing, reduced length of stay, and a trend towards a reduction in mortality. Rapid evacuation of combat casualties across the continuum of care presents challenges to implementing EEN during wartime operations. ⋯ S. military combat casualties evacuated from a Combat Support Hospital (CSH) in Iraq, from 1 November to 31 December 2006. The results of this study suggest that casualties who meet the criteria for EEN are not receiving it at the CSH in theater. Further research is needed to explore the impact of delayed enteral nutrition in the combat casualty.
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Case Reports
Prepatellar septic bursitis: a case report of skin necrosis associated with open bursectomy.
Patients with prepatellar septic bursitis are typically successfully managed nonoperatively with rest, compression, immobilization, aspiration, and antibiotics. Rarely, surgical excision of the bursa may be required for recalcitrant cases. Prepatellar bursectomy, however, has been associated with considerable risk of surgical-site morbidity. Although skin necrosis is frequently cited as a complication of open bursectomy, there is limited information in the medical literature on the etiology and management of this rare but serious complication.
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Randomized Controlled Trial
Cardiopulmonary resuscitation in the combat hospital and forward operating base: use of automated external defibrillators.
Time to defibrillation (t(defib)) directly correlates with survival from cardiac arrest. We investigated whether automated external defibrillators (AED) in a combat setting would improve this crucial variable. ⋯ In simulated cardiac arrest, the AED model demonstrated significantly improved t(defib) compared to the standard response for both training and combat settings.