Military medicine
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Two hundred one consecutive adult admissions to a 3-bed Special Care Unit in a 25-bed military hospital were scored using APACHE II (Acute Physiology and Chronic Health Evaluation). Outcome measures included APACHE II scores and mortality predictions; active intensive care interventions; transfers for specialized care; and mortality. ⋯ APACHE II scoring can be applied in small intensive care settings. Scoring criteria and logistic regression equations may need to be customized accordingly.
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Biography Historical Article
Hospital ship doctrine in the United States Navy: the Halsey effect on scoop- and-sail tactics.
Although hospital ships have a long history, naval strategists have paid little attention to their tactical employment in naval and amphibious warfare. Often employed as floating ambulances, operational doctrine for hospital ships did not permit their use as floating combat surgical hospitals until the final amphibious campaigns of World War II. Based on operational archives-ships' logs, war diaries, battle plans, and other official records-this essay traces the evolution of tactical doctrine on hospital ships from Guadalcanal to Inchon. ⋯ Nimitz approved Halsey's proposal, and the battle plan at Iwo Jima combined the careful triage of casualties at the waterfront with early, forward employment of hospital ships. Despite more than 21,000 casualties at Iwo Jima, they were handled better than at any previous operation in the Pacific theater. The tactical doctrine for hospital ships suggested by Halsey has since been employed in every major amphibious operation, including Okinawa and Inchon, and has also been used in modern-era contingency and humanitarian missions.
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This study investigated the microbial causes of diarrheal disease among U. S. troops deployed near Alexandria, Egypt, during October 1995. Bacterial causes associated with 19 cases of diarrhea included: enterotoxigenic Escherichia coli (ETEC), 42% (21% heat-stable, 11% heat-labile, and 11% heat-stable/ heat-labile producers); enteropathogenic E. coli (5.3%); and enteroadherent E. coli (42%). ⋯ Shigella, Aeromonas, Plesiomonas, Vibrio, Campylobacter, and Salmonella were not detected. Of the eight ETEC cases, one was colonization factor antigen (CFA)/I only, one was both CFA/I and CFA/III, three were CFA/II, two were CFA/IV, and two were CFA-negative. Antibiograms of the ETEC and enteroadherent E. coli strains showed that all isolates were susceptible to norfloxacin, ciprofloxacin, and nalidixic acid but resistant to ampicillin, tetracycline, chloramphenicol, and sulfamethoxazole.
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A retrospective study on the occurrence of septic syndrome and septic shock, as well as multiorgan failure, in the wounded at the Split Clinical Hospital Intensive Care Unit (ICU). ⋯ Septic syndrome and septic shock were the most common causes of death in wounded persons treated at Split Clinical Hospital ICU. At the earliest phase the main cause of death was refractory hypotension, and at the later stage the main cause of death was multiorgan failure.
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In 1991, musculoskeletal injuries prevented 488 recruits from completing basic training at the Naval Recruit Training Command, Great Lakes, Illinois. These losses cost the Navy an estimated $5 million. ⋯ These changes were associated with an increase in the recovery rate for injured recruits requiring physical therapy, a decrease in the amount of training time lost per injury, and fewer total lost training days due to musculoskeletal problems. In addition, this new system was associated with a decrease in the overall attrition rate for musculoskeletal injuries and a cost savings to the Navy of several million dollars per year.