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Military surgery

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
Thomas J Papadimos, Evadne G Marcolini, Mehrnaz Hadian, George E Hardart, Nicholas Ward, Mitchell M Levy, Stanislaw P Stawicki, Judy E Davidson
OBJECTIVES: Outbreaks of disease, especially those that are declared a Public Health Emergency of International Concern, present substantial ethical challenges. Here we start a discourse (with a continuation of the dialogue in Ethics of Outbreaks Position Statement. Part 2: Family-Centered Care) concerning the ethics of the provision of medical care, research challenges and behaviors during a Public Health Emergency of International Concern with a focus on the proper conduct of clinical or epidemiologic research, clinical trial designs, unregistered medical interventions (including vaccine introduction, devices, pharmaceuticals, who gets treated, vulnerable populations, and methods of data collection), economic losses, and whether there is a duty of health care providers to provide care in such emergencies, and highlighting the need to understand cultural diversity and local communities in these efforts...
November 2018: Critical Care Medicine
Art Ambrosio, Diana D Jeffery, Laura Hopkins, Harry B Burke
Introduction: Examining costs and utilization in a single-payer universal health care system provides information on fiscal and resource burdens associated with head and neck cancer (HNC). Here, we examine trends in the Department of Defense (DoD) HNC population with respect to: (1) reimbursed annual costs and (2) patterns and predictors of health care utilization in military only, civilian only, and both systems of care (mixed model). Materials and Methods: A retrospective, cross-sectional study was conducted using TRICARE claims data from fiscal years 2007 through 2014 for reimbursement of ambulatory, inpatient, and pharmacy charges...
October 6, 2018: Military Medicine
Zhao-Wen Zong, Zhi-Nong Wang, Si-Xu Chen, Hao Qin, Lian-Yang Zhang, Yue Shen, Lei Yang, Wen-Qiong Du, Can Chen, Xin Zhong, Lin Zhang, Jiang-Tao Huo, Li-Ping Kuai, Li-Xin Shu, Guo-Fu Du, Yu-Feng Zhao
The emergency treatment of thoracic injuries varies of general conditions and modern warfare. However, there are no unified battlefield treatment guidelines for thoracic injuries in the Chinese People's Liberation Army (PLA). An expert consensus has been reached based on the epidemiology of thoracic injuries and the concept of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since there are no differences in the specialized treatment for thoracic injuries between general conditions and modern warfare, first aid, emergency treatment, and early treatment of thoracic injuries are introduced separately in three levels in this consensus...
October 4, 2018: Military Medical Research
Khalid S Aljabri, Samia A Bokhari, Muneera A Al, Patan Murthuza Khan
BACKGROUND: Thyroid carcinoma (TC) is the ninth most common site of all cancers in women in the world and the second most common malignancy in Saudi Arabia. This reports updates data on the epidemiology of the disease in Saudi Arabia. OBJECTIVE: Describe and interpret changes in the frequency of TC to compare with other populations and determine proportions of certain histological types of TC. DESIGN: Medical record review. SETTING: Military hospital in Jeddah, Saudi Arabia...
September 2018: Annals of Saudi Medicine
Christina L Jones, Daniel D Gruber, John R Fischer, Katherine Leonard, Sandra L Hernandez
BACKGROUND: Effective post-operative pain management is a crucial component of recovery following surgery. Narcotics are a cornerstone of post-operative analgesia, but can require a re-dosing requirement, encompass a lengthy list of side effects and adverse reaction risks as well as carry a dependency potential. The national focus on decreasing opioid use has directly impacted post-operative pain management. Previous studies have reported the beneficial use of a single intra-operative injection of extended-release liposomal bupivacaine in post-operative pain management, however the same results have not been extensively studied in the urogynecology literature...
September 28, 2018: American Journal of Obstetrics and Gynecology
Kaiyang Lv, Zhaofan Xia
Following injury, Asian skin has a tendency toward hyperpigmentation and scar formation than Caucasians. A standardized algorithm tailored to Asian patients, especially Chinese patients, is in great demand. Twelve independent, self-selected academic and military physicians from the department of burn/trauma, plastic surgery and dermatology with extensive experience in treating scars were assembled on January 17, 2015, establishing the consensus panel. This consensus was then appraised, drafted, reviewed, and finalized during the following 3 years, aiming to standardize and improve scar prevention and treatment in China...
2018: Burns and trauma
Daniel I Rhon, Tina A Greenlee, Bryant G Marchant, Charles Dennis Sissel, Chad E Cook
OBJECTIVES: We aimed to identify the rate of seven comorbidities (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) that occurred within 2 years after hip arthroscopy. METHODS: Data from individuals (ages 18-50 years) undergoing arthroscopic hip surgery between 2004 and 2013 were collected from the Military Health System (MHS) Data Repository (MDR). The MDR captures all healthcare encounters in all settings and locations for individuals within the MHS...
September 27, 2018: British Journal of Sports Medicine
Jason S Radowsky, Romon Neely, Jonathan A Forsberg, Felipe A Lisboa, Christopher J Dente, Eric A Elster, Nicole J Crane
BACKGROUND: The complexity and severity of traumatic wounds in military and civilian trauma demands improved wound assessment, before, during, and after treatment. Here, we explore the potential of 3 charge-coupled device (3CCD) imaging values to distinguish between traumatic wounds that heal following closure and those that fail. Previous studies demonstrate that normalized 3CCD imaging values exhibit a high correlation with oxygen saturation and allow for comparison of values between diverse clinical settings, including utilizing different equipment and lighting...
2018: PloS One
L Zelenka, J Alt, I Knížková, P Kunc, D Lukešová
PURPOSE OF STUDY Based on the selected criteria the study presents the evaluation of data of patients who underwent a surgery for proximal femoral fracture at the Department of Orthopaedic Trauma of the 1 st Faculty of Medicine and Military University Hospital Prague in the period 2013-2016. The paper aimed to determine whether there are any differences in proximal femoral fractures depending on the selected criteria. MATERIAL AND METHODS The study comprised 805 patients (562 women and 243 men) older than 21 years with proximal femoral fractures who were treated between January 1, 2013 and December 31, 2016...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Bülent Devrim Akçay, Vahit Onur Gül, Serhat Özer, Duygu Akçay, Onur Eyigün
OBJECTIVES: The aim of the present study was to evaluate the subjective sleep quality in patients with anorectal disorder, to determine the factors associated with subjective sleep quality, and to explore the relationship between subjective sleep quality and quality of life. MATERIAL AND METHODS: This descriptive study was conducted between April 8, 2015 and April 12, 2016. The research population consisted of 284 patients who attended the general surgery outpatient clinics of Konya Military Hospital and were subsequently diagnosed with one of the four most common anorectal disorders (hemorrhoidal disease, anal fissure, anorectal abscess/fistula, and sacrococcygeal pilonidal disease)...
September 13, 2018: Turkish Journal of Surgery
Erika Stoerkel, Dawn Bellanti, Charmagne Paat, Kimberly Peacock, James Aden, Robert Setlik, Joan Walter, Alice Inman
OBJECTIVE: To assess whether a self-care toolkit (SCT) provided to breast cancer patients undergoing surgery could mitigate distress and lessen symptoms associated with surgery. DESIGN: One hundred women with breast cancer, planning to undergo initial surgery, were randomly assigned to either one of two groups: treatment as usual (TAU; n = 49) or TAU with the addition of an SCT (n = 51). The SCT contained an MP3 player with audio-files of guided mind-body techniques (breathing, progressive muscle relaxation, meditation, guided imagery, and self-hypnosis) and acupressure antinausea wristbands...
September 2018: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
Christopher L Camp, Dean Wang, Norman S Turner, Brian M Grawe, Monica Kogan, Anne M Kelly
INTRODUCTION: The purpose of this study was to identify objective predictors of grit, self-control, and conscientiousness in orthopaedic surgery residency applicants. METHODS: The following attributes were assessed in 455 applicants: grit, self-control, conscientiousness, consistency of interest, perseverance of effort, and ambition. These measures were correlated with standard, objective demographics obtained during the application process. RESULTS: Alpha Omega Alpha status, additional degrees, and number of publications did not predict any of the studied attributes...
September 18, 2018: Journal of the American Academy of Orthopaedic Surgeons
Michael Kryshtalskyj, Vance Jonathan, Chryssa McAlister
We report the serendipitous discovery of a map drawn by an army surgeon during the First World War. The map, entitled “Loos 36° NW3,’”was drawn by 24-year-old Captain Alexander Edward MacDonald in fall 1917 and was found in his old surgery textbook. MacDonald’s map depicts the positions of Canadian frontlines and medical units after the Battle of Hill 70. During the battle, Dr. MacDonald tended to the wounded in an aid post that he constructed in a ruined coal mine near the Front. MacDonald would go on to serve with distinction in the Battle of Passchendaele and Canada’s Hundred Days, and he received the Military Cross for gallantry...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
John L Falcone
BACKGROUND: American Board of Surgery examination performance represents an important residency metric. The hypothesis is that demographic differences exist between the most and least successful programs. METHODS: This was a retrospective fifteen-year study. Data focused on program Examination Index (EI). The first and tenth decile programs were compared across demographics, using an α = 0.05. RESULTS: The first decile had a higher EI than the tenth decile (91...
September 7, 2018: American Journal of Surgery
Kamil Sobociński, Jacek Doniec, Magdalena Biela, Monika Szafarowska, Krzysztof Paśnik, Paweł Kamiński
Hysteroscopy is a gold standard in 21st -century gynaecology for both diagnosis and treatment procedures of intrauterine pathologies. Miniaturisation of the equipment and better techniques of performing this procedure allowed it to become the gold standard. Nevertheless, hysteroscopy has its limitations, which is the size of the endometrial polyps or submucous myomas. We have invented a new device for the 5Fr working channel hysteroscopes for possessing and resecting intrauterine structures: the cryoprobe. The retrospective cryobiopsy study presented here was conducted at the Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine in Warsaw, Poland, from October 2017 to January 2018...
2018: BioMed Research International
Wesley M Hutto, Paul B Schroeder, Jeffery C Leggit
Chronic exertional compartment syndrome (CECS) is a debilitating condition that is not uncommon in athletes and military service members. The only curative treatment for this condition, surgical fascial release, was first described in 1956. In the ensuing 62 years, this has remained the standard therapy despite symptom recurrence in 45% of military service members who underwent surgery. In 2013, a case series introduced intracompartmental injections of botulinum toxin A as a non-surgical treatment option for CECS, which proved effective in 15 out of 16 patients...
September 12, 2018: Military Medicine
Timothy P Plackett, Joel R Brockmeyer, Danielle B Holt, Robert M Rush, Joy Sarkar, Steven A Satterly, Jason M Seery, Bradley R Zagol
Introduction: Operative case volumes for military surgeons are reported to be significantly lower than civilian counterparts. Among the concern that this raises is an inability of military surgeons to achieve mastery of their craft. Material and Methods: Annual surgical case reports were obtained from seven Army military treatment facilities (MTF) for 2012-2016. Operative case volume and cumulative operative time were calculated for active duty general surgeons and for individual MTFs...
September 12, 2018: Military Medicine
Shane J Andrews, Todd M Thomas, Joe G Hauptman, Bryden J Stanley
OBJECTIVE To identify risk factors for mesenteric volvulus (MV) in military working dogs (MWDs). DESIGN Retrospective case-control study. ANIMALS 211 MWDs (54 with and 157 without MV [case and control dogs, respectively]). PROCEDURES Medical records (cases and controls) and necropsy reports (cases) were reviewed. Signalment, pertinent medical and surgical history, behavior and temperament characteristics, feeding schedules, and training types were recorded. Weather patterns for regions where dogs resided were researched...
October 1, 2018: Journal of the American Veterinary Medical Association
Rose K Sia, Denise S Ryan, Bruce A Rivers, Lorie A Logan, Jennifer B Eaddy, Lamarr Peppers, Samantha B Rodgers
PURPOSE: To assess vision-related quality of life and military readiness and capabilities among active duty U.S. military service members undergoing refractive surgery. METHODS: In this prospective, single-center, observational study, active duty U.S. military service members electing to undergo refractive surgery were asked to complete a military performance questionnaire and the National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42) preoperatively and at 6 months postoperatively...
September 1, 2018: Journal of Refractive Surgery
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