Military medicine
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In order to assist future medical officers in planning for overseas deployment to austere areas where resupply is non-existent and support from higher echelons is extremely limited, we surveyed the most common medical problems and most frequently used drugs during a 6-week deployment of 1,159 troops to Khorat, Thailand, from April 21 to June 1, 1992. We consumed 358 l of parenteral fluids--markedly less than anticipated. ⋯ Overall attack rate for all injuries and diseases combined was 34%. Eight patients required hospitalization at local native hospitals longer than 24 hours, and two patients required evacuation to tertiary care centers in CONUS.
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The development of amputation surgery has closely paralleled progress in combat casualty care. Since the Civil War, care at hospitals close to the front lines has been improved by advances in both medical care (safer anesthesia, antibiotics, and fluid resuscitation) and medical field service (field hospitals and evacuation of the wounded). ⋯ Because residents are not routinely taught this technique, military surgeons have been forced to relearn it during every conflict since World War II. This paper outlines the indications, techniques, and special postoperative care of amputees from the Civil War through Vietnam.
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The Navy Forward Laboratory (NFL) was an advanced infectious disease laboratory which provided a theater-wide reference diagnostic capability during Operations Desert Shield/Storm. During Operation Desert Shield, when massive numbers of troops were being deployed, the NFL primarily supported medical personnel in the diagnosis and treatment of infectious diseases. During the war, the laboratory provided rapid biologic warfare diagnostic support. The NFL demonstrated the benefits of a comprehensive, on-site diagnostic laboratory when large numbers of troops are deployed to high-risk areas and demonstrated the importance of military medical research laboratories for training of scientists and physicians, threat assessment, and product development.
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This paper describes the pressures for health care reform which are impinging on the United States health care system. These are costs, access, allocation of resources, unnecessary care, and administrative costs and confusion. ⋯ Ten persistent issues are identified which will need to be addressed, regardless of whatever changes are proposed in the immediate future. These are the quality of health care, improved management of the military health care system, costs of care including pharmaceuticals, recruitment and retention of health care professionals, graduate medical education, renewed emphasis on health promotion and disease prevention, discharge planning and patient education, development and diffusion of new technologies, information management, and the management of environmental waste.
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One hundred fifteen physicians participating in advanced trauma life support (ATLS) training courses had entry (pre-test) and exit (post-test) level knowledge compared. There was significant improvement for the overall group mean score from the pre-test to post-test (p = 0.0001). ⋯ Residents in training had significantly higher scores for both pre-test (p = 0.0177) and post-test (p = 0.0024) than did the practicing physician group. No significant differences were detected in the cognitive achievement between the residents according to practice specialty.