Military medicine
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Review Case Reports
Meralgia paresthetica due to body armor wear in U.S. soldiers serving in Iraq: a case report and review of the literature.
Meralgia paresthetica is a disorder of the lateral femoral cutaneous nerve that results in symptoms of anterolateral thigh paresthesias and dysesthesias without associated loss of reflexes or motor weakness. Chronic meralgia paresthetica, not related to traumatic or lesion-producing compression of the nerve, is associated with obesity, pregnancy, tight-fitting garments, as well as specific duty uniform belts used by police officers and carpenters. ⋯ S. soldiers in Iraq experienced symptoms of meralgia paresthetica, most likely due to repetitive wear of protective body armor. Although use of protective body armor is proven to be lifesaving, modifications to improve current equipment may help to decrease morbidities such as meralgia paresthetica.
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The objective of the study was to examine veterans' perceptions of problems and benefits of outsourcing inpatient care from Veterans Affairs (VA) hospitals to private sector hospitals. Primary data were collected from a cross-section of 42 veterans who were VA users and nonusers using focus groups. Focus group discussion examined reasons patients use VA care, differences between VA and civilian care, positive and negative impacts of outsourcing, and special needs of veterans. ⋯ Participants identified a variety of potential positive and negative impacts. In general, veterans perceived more advantages than disadvantages to outsourcing VA care but still expressed significant concerns related to outsourcing. These issues should be considered in the development of future policy toward outsourcing VA care to the private sector.
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In this case report, an elderly combat veteran with a chronic course of post-traumatic stress disorder (PTSD) that was untreated for nearly 60 years was evaluated and treated with a combination of medication and graded exposure psychotherapy. To the best of our knowledge, there have been no reports on graded exposure in the elderly. ⋯ Although a single case report, it would appear that elderly patients do respond to psychotherapeutic techniques such as graded exposure therapy. Given the large percentage of the elderly population that has witnessed combat and due to the continuing military conflicts that the United States has been involved in over recent decades, treatments for PTSD in an aging population will be necessary.
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The purpose of this study was to assess the possible association between scores of >200 on U.S. Medical Licensure Examination (USMLE) step 1 and the Council on Resident Education in Obstetrics and Gynecology (CREOG) in-training examinations and the pass rate on the American Board of Obstetrics and Gynecology (ABOG) written examination. ⋯ Program directors have used USMLE step 1 to identify trainees who are likely to perform well on the CREOG in-training examination. The CREOG in-training examination has been used to identify residents who are likely to pass the ABOG written examination. The results of this study document the strength of these associations.
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The use of magnetic resonance (MR) imaging (MRI) among many medical professions is growing. Many health care systems have formed control mechanisms to ensure proper utilization of MRI. This western world trend is also valid in the Israeli Air Force (IAF). At the time of the study, two methods existed for consideration of MR requests in the IAF: (1) consideration by a primary reviewer, no clinical guidelines (applied to all MR examination requests, knee MR excluded). (2) Consideration by a primary reviewer according to basic clinical guidelines established by the Israeli Defense Forces medical section and by communication with an orthopedic specialist (applied to knee MR requests). Both methods did not include consultation with established criteria (such as American College of Radiology (ACR) appropriateness criteria). ⋯ Both MR approval mechanisms that were applied in the IAF have not shown a strong correlation with ACR appropriateness criteria, with significant rates of both overuse and underuse of MRI. The high rate of requests that could not be assigned an ACR appropriateness value may indicate a need to broaden the appropriateness criteria coverage of clinical conditions and variants.