Military medicine
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Comparative Study
Military internal medicine resident performance on the American Board of Internal Medicine Certifying Examination.
The mission of military graduate medical education in internal medicine is to produce high-quality military internists prepared to practice in military environments. Board certification in internal medicine is an important outcome of internal medicine residency training. The American Board of Internal Medicine Certifying Examination (ABIMCE) first-taker pass rate of the graduates of an internal medicine residency program is a key measure of the quality of the program. ⋯ Military internal medicine residency graduates had higher first-taker pass rates than their civilian counterparts. This is likely a reflection of the high-quality residents and the faculty at military programs. These results support the notion that military internal medicine residency programs continue to fulfill their mission of training high-quality internists.
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Cervical spine injuries occur in 2.3% to 6.4% of victims of blunt trauma. The difficulty of identifying the minority of patients with cervical spine injuries continues to challenge those who triage and treat the acutely injured. We retrospectively reviewed our practice for cervical spine clearance, which consists of three-view plain radiographs supplemented by focused further studies, such as computed or plain film tomography and flexion/extension views, as needed. ⋯ Eighty cervical spine injuries were found, of which nine were missed. Review of the six patients in whom the nine cervical spine injuries were missed demonstrated error in the interpretation of radiographic studies in five patients, only two of whom were felt to have technically adequate films in hindsight. We conclude that a protocol based on three-view plain film radiographs supplemented by focused additional studies will allow the visualization of virtually all cervical spine injuries and that the main cause of missed injuries is errors of interpretation.
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Physician-to-physician consultation and discussion have traditionally been conducted by telephone, paper, and "curbside" (face to face meetings). The implementation and use of physician-to-physician consultation via electronic mail in a military health care system has not been reported previously. ⋯ Use of the Ask a Doc system was representative of total clinical workload and increased access to specialty medical care over a wide geographic area. The distribution of use indicated that user statistics were legitimate, and quality improvement programs could easily troubleshoot the system. Ask a Doc was inserted into a regional health care network with minimal cost to support and implement and was sustained with very little effort for 3 years. Barriers to even wider use currently include lack of secure communications and the difficulty in assigning workload credit for electronic consultations.
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The last 10 years has seen a reduction in defense spending and a contraction in military force size in all NATO countries. This has had a direct effect on military medical capability. ⋯ Military surgeons are now few in number, and fewer still have had recent operational experience. This article addresses the problem and offers some solutions.
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Racial variations in Department of Veterans Affairs ambulatory care use and unmet health care needs.
Our objective was to describe racial/ethnic variations in Department of Veterans Affairs (VA) ambulatory care use and its association with the presence of unmet health care needs. Using the 1992 National Survey of Veterans, we examined race/ethnicity and unmet health care need for ambulatory care users of VA and non-VA facilities. Black and Hispanic veterans were more likely to report any VA use. ⋯ Adjusting for VA ambulatory care use diminished the disparity in inability to get needed care between American Indian/Eskimo or Hispanic veterans and white veterans and eliminated the disparity between black and white veterans. Our findings support the VA's role as a medical safety net provider and suggest that VA ambulatory care use is effective in mitigating health-related racial disparities for some veterans. Additional facilitators for reducing unmet need should be explored.