Military medicine
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The study determines the extent to which payment thresholds for reporting malpractice claims to the National Practitioner Data Bank identifies substandard health care delivery in the Department of Defense. Relevant data were available on 2,291 of 2,576 medical malpractice claims reported to the closed medical malpractice case data base of the Office of the Assistant Secretary of Defense (Health Affairs). Amount paid was analyzed as a diagnostic test using standard of care assessment from each military Surgeon General office as the criterion. ⋯ Positive and negative predictive values and likelihood ratio were similar at all thresholds. Malpractice case payment was of limited value for identifying substandard medical practice. All paid claims missed about 30% of substandard care, and reported about 25% of acceptable medical practice.
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A random sample of 86 Army nurses from a major metropolitan area participated in a study to investigate their attitudes toward African American and Hispanic patients. Information was collected using the Ethnic Attitude Assessment Survey. Cronbach alpha for the African American patient was 0.74, with 0.72 for the Hispanic patient. ⋯ Attitudes were statistically more positive toward the African American patient than toward the Hispanic patient. Females had more positive attitudes than males, but only toward the African American patient. Finally, nurses perceived a need for cultural understanding when providing care to patients of different ethnic groups.
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The most serious complication of sickle cell trait (SCT) is sudden death during exertion. SCT often remains unrecognized in the 2.5 million African Americans affected. ⋯ There have been no cases reported in soldiers beyond basic training. In the case presented, a soldier with 3 years of military service succumbed to SCT-associated sudden death during physical fitness testing.
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British and Australian medical teams working in Northern Iraq in 1991 providing primary care to refugees and the war wounded were subjected to a descriptive retrospective survey, 5 weeks after arriving in Iraq. The aim was to document different rates of diarrhea in British and Australian troops. The British, who were not taking daily doxycycline and did not enforce a plate- and hand-washing routine, experienced higher rates of diarrhea (69% of British troops compared with 36% of Australian troops), which was more severe and of a longer duration (p < 0.001) and resulted in twice as many days being lost (p < 0.001) in spite of the British team being half the size of the Australian contingent, and the region having enteropathogens with a high rate of antibiotic resistance. Vigorous hand- and plate-washing routines along with doxycycline prophylaxis appear to significantly reduce incapacitation from diarrhea in this military setting and have an important implication for operational effectiveness.
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During the early stages of Operation Restore Hope, three U. S. Army preventive-medicine detachments were deployed to Somalia to counter the disease and non-battle injury threat to deployed forces. ⋯ Vector control and pest management operations of the entomology detachment are highlighted, and how they related to the health and comfort of deployed personnel. These operations ranged from routine mosquito surveillance to large-area vector-control missions using a helicopter-slung pesticide dispersal unit. A variety of "lessons learned" are also discussed, focusing on individual and company-level PVNTMED measures.