Military medicine
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To determine whether having a partner deployed during wartime increased the stress levels in pregnant women and altered the attitudes toward pregnancy or changed birth outcomes. ⋯ Pregnant women with deployed partners gave birth to larger babies. They also more frequently report a change in eating habits and that media coverage impacted their stress level.
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Randomized Controlled Trial Comparative Study
Dolasetron versus ondansetron as single-agent prophylaxis for patients at increased risk for postoperative nausea and vomiting: a prospective, double-blind, randomized trial.
This study identified 100 ambulatory surgery patients receiving general anesthesia who were at increased risk for postoperative nausea and vomiting (PONV) and randomly assigned them to receive single-agent prophylaxis (12.5 mg of dolasetron or 4 mg of ondansetron) 15 to 30 minutes before the end of surgery. Data were collected in the postanesthesia care unit, and patients completed a questionnaire 24 hours after surgery. ⋯ No statistically significant difference existed in satisfaction with the overall surgical experience (dolasetron, 87.9 of 100 mm; ondansetron, 85.3 of 100 mm; p = 0.36). Costminimization strategies should be considered without fear of substandard care or increased patient dissatisfaction.
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The aims of this study were to develop and to test a noninvasive hemodynamic monitoring system that could be applied to combat casualties to supplement conventional vital signs, to use an advanced information system to predict outcomes, and to evaluate the relative effectiveness of various therapies with instant feedback information during acute emergency conditions. In a university-run inner city public hospital, we evaluated 1,000 consecutively monitored trauma patients in the initial resuscitation period, beginning shortly after admission to the emergency department. In addition to conventional vital signs, we used noninvasive monitoring devices (cardiac index by bioimpedance with blood pressure and heart rate to measure cardiac function, arterial hemoglobin oxygen saturation by pulse oximetry to reflect changes in pulmonary function, and tissue oxygenation by transcutaneous oxygen tension indexed to fractional inspired oxygen concentration and carbon dioxide tension to evaluate tissue perfusion). ⋯ The rate of misclassification of survival probability was 13.5% in the series as a whole but only 6% for patients without severe head injuries and brain death. Application of noninvasive hemodynamic monitoring to acute emergency trauma patients in the emergency department is feasible, safe, and inexpensive and provides accurate hemodynamic patterns in continuous, on-line, real-time, graphical displays of the status of cardiac, pulmonary, and tissue perfusion functions. Combined with an information system, this approach provided an early outcome predictor and evaluated, with an objective individualized method, the relative efficacy of alternative therapies for specific patients.
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The assessment of combat-related post-traumatic stress disorder (PTSD) relies upon self-reported symptoms and the need for indicators of valid reporting is critical. The Trauma Symptom Inventory (TSI) is a testing instrument specific to PTSD which includes validity scales. In a pilot study examining the use of the TSI with combat veterans, 50 male veterans diagnosed with PTSD were administered the TSI. ⋯ Differences between veterans with valid and invalid TSI profiles are examined in terms of demographic and historical factors, TSI profiles, and individual scale items. The model best able to predict invalid profiles included high scores on subscales measuring dissociative experiences and tension reduction behaviors. Implications for the interpretation of TSI validity scales in assessing combat-related PTSD are discussed.