Military medicine
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Needle thoracentesis is an emergency procedure to relieve tension pneumothorax. Published recommendations suggest use of angiocatheters or needles in the 5-cm range for emergency treatment. Multidetector computed tomography scans from 100 virtual autopsy cases were used to determine chest wall thickness in deployed male military personnel. ⋯ Thickness was generally greater than previously reported. An 8-cm angiocatheter would have reached the pleural space in 99% of subjects in this series. Recommended procedures for needle thoracentesis to relieve tension pneumothorax should be adapted to reflect use of an angiocatheter or needle of sufficient length.
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Clinical and demographic data in administrative disability tracking systems have the potential to support disability reduction programs. We analyzed recent Navy Physical Evaluation Board data, compared our findings with previous studies, and evaluated the quality of the case-tracking database as a public health information system. The overall rate of cases was 50% higher than in 2000 and 40% higher than the rate of new long-term group disability insurance claims. ⋯ The tracking system provided unprecedented timeliness and data accessibility, but fell short of its full potential as a public health tool due to poor information quality. Improved interface design and data entry processes combined with improved reporting capability will enhance its epidemiological value. Continued system improvement requires functional evaluation in conjunction with periodic data analysis.
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Postoperative atrial fibrillation following cardiothoracic surgery is common and frequently managed with intravenous (IV) amiodarone. Phlebitis is the most common complication with peripheral infusion of this agent. Current practice guidelines for peripheral IV administration of <2 mg/mL amiodarone were established to reduce the risk of phlebitis. ⋯ The incidence of phlebitis in patients given IV amiodarone (n = 36) was 13.9% (95% confidence interval, 2.6-25.2%; p = 0.001). Logistic regression analysis with backward elimination of other therapeutic risk factors suggests that the odds ratio for phlebitis using current dose regimens without IV filters is 19-fold greater than baseline risk in this population. Phlebitis remains a significant complication associated with peripheral infusion of amiodarone within recommended dosing limits.
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Several international legal instruments and ethical guidelines bestow rights and impose duties on detainees and military physicians, respectively. Ideological totalism, moral disengagement, and victim blame can facilitate the abuse of detainees, and this mindset must be avoided by military physicians. Physicians should report suspected violations of detainee rights to the U. ⋯ If faced with a conflict between following national policies and following universally accepted, multilateral principles of international law and ethics, military physicians should consider themselves ethically bound to follow the latter. The duty of care must supercede any blanket notion of loyalty, obligation, allegiance, or patriotism that the physician may feel is owed to his or her station. This is the true ethos of service to humankind.
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The ways in which members of the armed forces have behaved in past and present conflicts raise questions on the correct ethical behavior of soldiers. Apparently, the end does not justify the means, and critical voices are right to react with concern to military misbehavior, as has been publicized lately. The subject of military ethics, situated within military science, deals with the question of ethically correct behavior of soldiers. The aim of this article was to present an overview of the various fields of military ethics and to show their interrelationship, as well as making suggestions on how to fill these formal aspects with content.