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Journal of the Royal Army Medical Corps

Jason E Smith, S Watts, A M Spear, C Wilson, E Kirkman
INTRODUCTION: Primary blast lung injury causes intrapulmonary haemorrhage. A number of case reports have suggested the efficacy of recombinant activated factor VII (rFVIIa) in the treatment of diffuse alveolar haemorrhage from a range of medical causes, but its efficacy in blast lung is unknown. The aim of this study was to investigate whether nebulised rFVIIa attenuates the haemorrhagic effects of blast lung injury in an animal model. METHODS: Terminally anaesthetised rabbits subjected to blast lung injury were randomised to receive either rFVIIa or placebo via a nebuliser...
November 12, 2018: Journal of the Royal Army Medical Corps
Katherine R Cornes, M Boardman, C Ford, S Smith
During the conflicts in Afghanistan and Iraq, many UK military personnel were killed or injured by improvised explosive devices (IEDs). Insurgents sought to develop new ways of concealing and detonating IEDs, and UK forces invested significantly in finding new ways of detecting and avoiding them. Between 2010 and 2014 the UK's Defence Science and Technology Laboratory's Human and Social Sciences Group (HSSG) was asked to investigate the factors that might affect the performance of these specialist search teams and identify ways to improve effectiveness and maximise safety through training, human factors advice on equipment design, and recommendations on changes to tactics techniques and procedures...
November 9, 2018: Journal of the Royal Army Medical Corps
Jonathan David Pearson, A Maund, C P Jones, E Coley, S Frazer, D Connor
Defence Anaesthesia is changing its draw-over anaesthetic capability from the Tri-Service Anaesthetic Apparatus (TSAA) to the Diamedica Portable Anaesthesia Machine 02 (DPA02). The DPA02 will provide a portable, robust, lightweight and simple method for delivering draw-over volatile anaesthesia with the option of positive pressure ventilation through manual or mechanical operation for paediatric and adult patients. The UK Defence Medical Services uses a modified configuration of the DPA02; this paper seeks to explain the rationale for the differing configurations and illustrates alternative assemblies to support integration with other Defence Anaesthesia equipment...
November 9, 2018: Journal of the Royal Army Medical Corps
Marie-Cécile Nierat, M Raux, S Redolfi, J Gonzalez-Bermejo, G Biondi, C Straus, I Rivals, C Morélot-Panzini, T Similowski
INTRODUCTION: Preventing in-flight hypoxia in pilots is typically achieved by wearing oxygen masks. These masks must be as comfortable as possible to allow prolonged and repeated use. The consequences of mask-induced facial contact pressure have been extensively studied, but little is known about mask-induced breathing discomfort. Because breathlessness is a strong distractor and engages cerebral resources, it could negatively impact flying performances. METHODS: Seventeen volunteers (age 20-32) rated respiratory discomfort while breathing with no mask and with two models of quick-donning full-face crew oxygen masks with regulators (mask A, mask B)...
November 9, 2018: Journal of the Royal Army Medical Corps
Imogen Sturgeon-Clegg, H Hurn, M McCauley
Neuropsychological testing has been used in a wide range of applications across military settings, including the selection of personnel to engage in covert operations, battlefield assessment and rehabilitation following blast exposure, traumatic brain injury, other neurological conditions and assessments of malingering. Over recent decades, military psychologists have helped to shape the advances in assessing and remediating the psychological sequela that is associated with operationally related neurological and other physical injuries...
November 9, 2018: Journal of the Royal Army Medical Corps
Peter Ladlow, N Bennett, R Phillip, S Dharm-Datta, L McMenemy, A N Bennett
INTRODUCTION: Individuals with delayed below-knee amputation have previously reported superior clinical outcomes compared with lower limb reconstruction. The UK military have since introduced a passive-dynamic ankle-foot orthosis (PDAFO) into its rehabilitation care pathway to improve limb salvage outcomes. The aims were to determine if wearing a PDAFO improves medium-term clinical outcomes and what influence does multidisciplinary team (MDT) rehabilitation have after PDAFO fitting? Also, what longitudinal changes in clinical outcomes occur with MDT rehabilitation and how do these results compare with patients with previous lower extremity trauma discharged prior to PDAFO availability? METHODS: We retrospectively evaluated levels of mobility, activities of daily living, anxiety, depression and pain in a heterogeneous group of 23 injured UK servicemen 34±11 months after PDAFO provision...
November 9, 2018: Journal of the Royal Army Medical Corps
Zhao Yongqiang, H Dousheng, L Yanning, M Xin, W Kunping
PURPOSE: To describe the combat-related injuries cured by Chinese Level 2 medical treatment facility (CHN L2) in Mali from 1 March 2016 to 1 March 2018, including type of weapon, mortality, nature of injuries, degree and location of injuries and surgical procedures. METHODS : A retrospective, descriptive study of 176 injured cases that met the terrorist attacks was conducted. The medical data were collected by an electronic database system. All collected data were entered into an Excel spreadsheet for calculation...
November 9, 2018: Journal of the Royal Army Medical Corps
Ruth Rushton, K Lynch
The consumption of alcohol in the UK Armed Forces (AF) as 'an agent to assist cohesion and informal operational debriefing' is a social and psychological conceptualisation that has some empirical support. Indisputable data exist to suggest that high levels of alcohol misuse and related problems are prevalent among UK AF. Recent research indicates that the overall level of hazardous alcohol consumption remains high in the UK military, with little evidence of reduced consumption over time. Meanwhile, risky drinking in the general population appears to be decreasing...
November 9, 2018: Journal of the Royal Army Medical Corps
Jamie Hacker Hughes, M McCauley, L Wilson
Military psychology is a specialist discipline within applied psychology. It entails the application of psychological science to military operations, systems and personnel. The specialty was formally founded during World War I in the UK and the USA, and it was integral to many early concepts and interventions for psychological and neuropsychological trauma. It also established a fundamental basis for the psychological assessment and selection of military personnel. During and after World War II, military psychology continued to make significant contributions to aviation psychology, cognitive testing, rehabilitation psychology and many models of psychotherapy...
November 9, 2018: Journal of the Royal Army Medical Corps
Joanna E Surtees, N R Heneghan
OBJECTIVE: To investigate whether general group exercise (GGE) offers the same outcomes compared with a specific spinal group exercise (SSGE) for chronic low back pain (CLBP) in a military population. DESIGN: Retrospective service evaluation using routine service activity data. SETTING: A UK military rehabilitation centre. PARTICIPANTS: A total of 106 patients with CLBP. INTERVENTIONS: Three-week intensive (5  days per week, 15-day intervention) rehabilitation course for patients with CLBP...
October 30, 2018: Journal of the Royal Army Medical Corps
James A Kuht, D Woods, S Hollis
BACKGROUND: Non-freezing cold injury (NFCI) occurs when the peripheral tissue is cooled sufficiently that damage occurs, but not to the point of tissue freezing. Historically, the phenotype of the injuries studied was often severe, and it is unclear whether knowledge gained from these cases is entirely relevant to the frequently subtle injuries seen today. METHODS: We therefore sought to characterise a recent case series of 100 patients referred with suspected NFCI to a military UK NFCI clinic...
October 25, 2018: Journal of the Royal Army Medical Corps
T C Nicholson-Roberts
World War 1 ended 100 years ago. The aftermath included the consolidation of significant advances in medical care of casualties. Some of these advances were made in the care of chemical casualties, in particular the mechanisms of toxicity and treatment of phosgene exposure. Phosgene, or carbonyl chloride, is an extremely poisonous vapour that was used to devastating effect during World War 1. Observations made of acutely poisoned casualties formed the basis of much research in the early post-World War 1 era...
October 23, 2018: Journal of the Royal Army Medical Corps
Martin Bricknell
No abstract text is available yet for this article.
October 18, 2018: Journal of the Royal Army Medical Corps
Jason Watterson, B Gabbe, P Dietze, A Bowring, J V Rosenfeld
BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) is widely used for monitoring harmful alcohol consumption among high-risk populations. A number of short versions of AUDIT have been developed for use in time-constrained settings. In military populations, a range of AUDIT variations have been used, but the optimal combination of AUDIT items has not been determined. METHODS: A total of 952 participants (80% male), recruited as part of a wider study, completed the AUDIT-10...
October 18, 2018: Journal of the Royal Army Medical Corps
Nicola Elliott-Mabey, H Davison
The tri-Service Armed Forces Continuous Attitude Survey, commonly known as AFCAS, was introduced in 2007 to coherently assess and monitor the attitudes of Regular Service personnel in key policy and management areas and is used by groups internal and external to the Ministry of Defence. It is a statistically valid and robust survey which is annually distributed to almost 28 000 regular serving personnel. AFCAS data have been used to inform the development and evaluation of a wide range of personnel policies, including remuneration, accommodation, flexible working, career management and training...
October 18, 2018: Journal of the Royal Army Medical Corps
Fritz Allhoff, K Potts
Under customary international law, the First Geneva Convention and Additional Protocol I, medical personnel are protected against intentional attack. In § 1 of this paper, we survey these legal norms and situate them within the broader international humanitarian law framework. In § 2, we explore the historical and philosophical basis of medical immunity, both of which have been underexplored in the academic literature. In § 3, we analyse these norms as applied to an attack in Afghanistan (2015) by the United States; the United States was attempting to target a Taliban command-and-control centre but inadvertently destroyed a Médecins Sans Frontières hospital instead, killing 42 people...
October 16, 2018: Journal of the Royal Army Medical Corps
Thomas Richards, C Wright
BACKGROUND: Recruits undergoing military training experience a particularly high incidence of stress fractures. The role of combined calcium and vitamin D (25-OHD) deficiency and subsequent supplementation has been well described in the literature, but the role of 25-OHD deficiency alone is less well understood, particularly its influence on recovery once a stress fracture has been incurred. METHODS: Retrospective data of recruits who had incurred stress fractures were collected (n=37)...
October 15, 2018: Journal of the Royal Army Medical Corps
Michael L Gross
Military medical research requires informed consent from test subjects, which is difficult to obtain for deployed (in-theatre) or prehospital studies where patients are incapacitated and legal representatives are not available. Although US and UK regulations make provisions for exceptions to informed consent, these are rarely used, thereby hindering trauma research and prospective experimental studies of new devices, surgeries or drugs. In their place, a survey of research articles published in the Journal of the Royal Army Medical Corps and Military Medicine between 2004 and 2018 shows how researchers turned to clinical surveys and retrospective, case or animal studies instead...
October 15, 2018: Journal of the Royal Army Medical Corps
Jason E Smith, J Garner
The majority of patients injured in the recent conflicts in Iraq and Afghanistan were as a result of explosion, and terrorist incidents have brought blast injuries to the front door of many civilian hospitals that had not previously encountered such devastation. This article reviews the physics and pathophysiology of blast injury with particular relevance to the presentation and management of primary blast injury, which is the mechanism least familiar to most clinicians and which may cause devastating injury without externals signs...
October 12, 2018: Journal of the Royal Army Medical Corps
Sheena M Eagan
Often known as ' global health diplomacy ' , the provision of medical care to accomplish strategic objectives, advance public diplomacy goals and enhance soft power is increasingly emphasised in international affairs and military policies. Despite this emergent trend, there has been little critical analysis and examination of the ethics of military actors engaging in this type of work. This type of mission represents the most common form of military medical deployment within the International Security Assistance Force in Afghanistan and is now explicitly emphasised in many militaries' defence doctrine...
October 12, 2018: Journal of the Royal Army Medical Corps
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