Military medicine
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The growing global problem of antibiotic resistance requires a worldwide surveillance strategy to characterize the magnitude of the problem, guide clinical care decisions, and assess the impact of prevention and control interventions. Because many existing antibiotic resistance surveillance activities have developed independently of one another and vary greatly in their focus, key organizations are promoting strategies to standardize surveillance activities and build collaboration to promote effective global surveillance. With medical facilities operating throughout the world to support a highly mobile beneficiary population, the Department of Defense's Military Health System could benefit from partnership with civilian efforts to achieve global antibiotic resistance surveillance. This article's overview of existing surveillance activities and new strategies provides information requisite to the Department of Defense undertaking of development of a worldwide antibiotic resistance surveillance program to complement and integrate with civilian programs.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ketamine and oxycodone in the management of postoperative pain.
Relief of pain, whether post-traumatic or postoperative, is a prerequisite for the prevention of its deleterious effects on the whole organism. Unalleviated pain also increases the victim's or patient's anxiety and apprehension, which in turn increase the intensity of the pain. In the management of pain, opiates have maintained their position as the most common form of analgesic therapy despite the many side effects associated with their use. ⋯ Also, the suitability of oxycodone for field use was evaluated with respect to ketamine. Plethysmographic pulse-wave amplitude changes were compared with the pain visual analogue scale scores as measures of postoperative pain. The results of this study did not reveal any significant differences between the analgesic potencies of the studied drugs and clearly demonstrate that even suboptimal doses of both ketamine and oxycodone can provide appreciable relief of pain.
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We conducted a retrospective review of all patients with orthopedic injuries evacuated to a single medical center to evaluate the treatment and outcome of these injuries in three recent U. S. military conflicts: Operation Urgent Fury (Grenada), Operation Desert Shield/Storm (southwest Asia), and Operation Restore Hope (Somalia). Sixteen orthopedic casualties were originally treated at the medical detachment in Grenada before evacuation to the medical center. ⋯ Many of these injuries are the result of high-velocity weapons or blast injuries. Regardless of the size and/or purpose of the intervention, similar injury patterns and severity can be expected, because 51% of orthopedic patients had open fractures. Similarly, the rate of amputation associated with extremity trauma has not varied significantly since the Vietnam War.