Military Medicine

This study examines the relationship between a computerized neuropsychological assessment battery, the Automated Neuropsychological Assessment Metrics (ANAM) and a widely used ability measure, Woodcock-Johnson III Tests of Cognitive Ability (WJ-III). Results indicated substantial relationship between the ANAM throughput (accuracy/response time) scores and the WJ-III Cognitive Efficiency cluster. An unexpectedly strong relationship was evident between accuracy scores on the ANAM Logical Reasoning scale and the WJ-III General Intellectual Ability score, purporting to measure the g factor. The findings support the viability of the ANAM as a time- and cost-effective tool for appraisal of cognitive function.

Pilot testing has begun on the Recruit Assessment Program (RAP). The RAP is a proposed Department of Defense (DoD) program for the routine collection of baseline demographic, medical, psychosocial, occupational, and health risk factor data from all U.S. military personnel at entry into the armed forces. The RAP currently uses an optically scannable paper questionnaire, which will provide data for the first building block of an electronic medical record within the DoD and the Department of Veterans Affairs, The RAP will serve several important functions, including automating enrollment into the military health care system, improving patient care and preventive medicine efforts, and providing critical data for investigations of health problems among military personnel and veterans. If the feasibility of the RAP is demonstrated and the program is fully implemented throughout the DoD, it could provide a substantial improvement in health care delivery. For the first time, DoD and Department of Veterans Affairs physicians, public health officers, and researchers will have access to comprehensive baseline health status data.

To measure key neurocognitive performance effects following stellate ganglion block (SGB) administered to treat post-traumatic stress disorder (PTSD) symptoms. Eleven patients diagnosed, screened, and scheduled for SGB to treat their PTSD symptoms were administered a panel of eight cognitive measures before and 1 to 3 weeks after undergoing this procedure. PTSD symptoms were evaluated using the Posttraumatic Stress Disorder Checklist-Military. One to three weeks post-SGB, none of the patients showed any statistically significant decline in neurocognitive performance. Rather, there was a clear trend in improvement, with four out of eight measures reaching statistical significance following SGB. All patients improved in PTSD symptoms with a mean improvement on Posttraumatic Stress Disorder Checklist-Military of 29. In this case series of 11 patients, SGB effectively treated PTSD symptoms and did not impair reaction time, memory, or concentration. Therefore, SGB should be considered as...

Although the USA spends more on health care than any other comparable nation, Americans are less healthy than citizens of high-income countries that spend far less. Over the past 12 years, the number of physicians per capita in the USA has been a concerning problem that may contribute to the disparity between health care costs and health status. Some have argued that remediating the shortage of primary care physicians will improve patient health. Others assert that the relationship between health care costs and health outcomes is more complex, influenced by a broad range of variables intrinsic to health care (i.e., provider availability, continuity, coordination); patient factors (ethnicity, socioeconomic status, health behaviors, health literacy, and other social factors); and systems factors (health information management, health information technology and health care measurement itself). This article contends that increasing the physician supply will not improve the health of Americans. Rather, solutions which lower health care costs while concomitantly improving health status will. Aside from community-level actions, health can improve at lower costs by increasing the prevalence of and proficiency in team-based care models, that address individual patient determinants of health, and poorly coordinated care. Future directions for this research and policy development are discussed.

U.S. Army mortuary affairs (MA) soldiers experience stressors of deployment and exposure to the dead, increasing risk for post-traumatic stress and depression. This study examines Troop Education for Army Morale, a postdeployment early intervention based on Psychological First Aid. MA soldiers (N = 126) were randomized to intervention or comparison groups 1-month postdeployment. Intervention sessions were held at 2, 3, 4, and 7 months. Assessments of post-traumatic stress disorder (PTSD), depression, and quality of life (QOL) were conducted at 1, 2, 3, 4, 7, and 10 months for both groups. At baseline, 25.0% of the total sample had probable PTSD (17-item PTSD Checklist M = 35.4, SD = 16.9) and 23.6% had probable depression (9-item Patient Health Questionnaire Depression Scale M = 7.8, SD = 6.9). Over 10 months, PTSD and depression symptoms decreased and QOL improved for the total sample. At study conclusion, intervention and comparison groups were not different. Intervention group males showed a transient symptom increase at 2 to 3 months. Males attended fewer intervention sessions than females. Lower attendance was associated with more symptoms and lower QOL. Higher attendance was associated with greater intervention benefits. Findings highlight the need for better understanding postdeployment interventions and facilitating attendance. Further intervention for MA soldiers is indicated.

Objectives: This study evaluates what type of patient prepares a birth plan, identifies common requests made, and determines how closely these are followed during labor. Methods: Patients who were admitted in labor with birth plans during a 3.5-year period ...

Damage control resuscitation (DCR) is emerging as a standard practice in civilian and military trauma care. Primary objectives include resolution of immediate life threats followed by optimization of physiological status in the perioperative period. To accomplish this, DCR employs a unique hypotensive-hemostatic resuscitation strategy that avoids traditional crystalloid intravenous fluids in favor of early blood component use in ratios mimicking whole blood. The presence of uncontrolled major hemorrhage (UMH) coupled with a delay in access to hemostatic surgical intervention remains a primary contributor to preventable death in both combat and in many domestic settings, including rural areas and disaster sites. As a result, civilian and military emergency care leaders throughout the world have sought a means to project DCR principles forward of the traditional trauma resuscitation bay, into such remote environments as disaster scenes, rural health facilities, and the contemporary battlefield. After reflecting on experiences from past conflicts, defining current capability gaps, and examining available and potential solutions, a strategy for "remote damage control resuscitation" (RDCR) has been proposed. In order for RDCR to progress from concept to clinical strategy, it will be necessary to define existing gaps in knowledge and clinical capability; develop a lexicon so that investigators and operators may understand each other; establish coherent research and development agendas; and execute comprehensive investigations designed to predict, diagnose, and mitigate the consequences of hemorrhagic shock and acute traumatic coagulopathy before they become irreversible. This article seeks to introduce the concept of RDCR; to reinforce the importance of identifying and optimally managing UMH and the resulting shock state as part of a comprehensive approach to out-of-hospital stabilization and en route care; and to propose investigational strategies to enable the development and broad implementation of RDCR principles.

Current military personnel are at risk of developing serious mental health problems, including chronic stress disorders and substance use disorders, as a result of military deployment. The most frequently studied effect of combat exposure is post-traumatic stress disorder (PTSD). High-risk behaviors, including alcohol use and aggression, have been associated with PTSD, but the optimal cutoff score on the PTSD Checklist (PCL) for determining the risk for these behaviors has not been clearly delineated. Using postdeployment active duty (AD) and Reserve component military personnel, the relation between various cutoff scores on the PCL and engaging in high-risk behaviors was examined. AD personnel, for every outcome examined, showed significantly greater odds for each problem behavior when PCL scores were 30 or higher compared to those with PCL scores in the 17 to 29 range. A similar pattern was shown for Reserve component personnel with respect to several problem behaviors, although not for alcohol use behaviors. The differences in problem behaviors for these two populations may be an indication that deployment experiences and combat exposure affect them differently and suggest that despite lower critical PCL scores, AD personnel may be at higher risk for developing problems as a function of the deployment cycle.

The system of medical support in the territory of military operations in Iraq and Afghanistan is based on four levels of medical treatment. Level 4 is organized outside the war theatre, in the territories of the countries that are a part of the stabilization forces of international organizations (NATO). Both the tasks and the structure of medical support are adjusted to fit the requirements of the U.S. Forces. The same tasks and structure are also recognized by medical services of other NATO countries participating in military operations in Iraq and Afghanistan. Each subsequent level of medical support is progressively more highly specialized and capable of providing more advanced medical treatment in comparison to the preceding level. Medical evacuation is executed either by air or overland depending on the type of illness or injury as well as the tactical situation prevailing in the combat zone. The aim of this paper is to present the planning, challenges, and problems of medical ...

Women account for nearly 17% of the soldiers serving in the U.S. Army. 1 As of 2016, all combat jobs are open to women, and females are now assigned to every combat arms military occupational specialty. 1 While serving with demonstrated success, women are uniquely impacted by menstrual-related conditions and unplanned pregnancy. Many of these issues can be addressed or eliminated with the use of available and accepted contraceptive therapies, which would provide a reduction of significant medical events by 66-99%. 2 Although military women report a desire to use contraceptives for menstrual control, the rates remain low. Every deploying soldier is mandated to have a predeployment Soldier Readiness Program (SRP) appointment to assure appropriate vaccines, vision, and medical issues are addressed, however, there is no policy for predeployment consultation regarding menstrual suppression or contraception. Service members may or may not receive counseling and treatment based on the individual training and preferences of their primary care provider. Department of Defense policy (CENTCOM MOD14-TAB A) states "evaluating providers must consider that in addition to the individual's assigned duties, severe environmental conditions, extremes of temperature, high

Objectives: To describe the visual outlook and quality of life of service members after combat ocular trauma. Methods: In a single-center, prospective observational study of service members sustaining ocular trauma, participants underwent a series of ocular examinations and noninvasive tests, including the National Eye Institute Visual Functioning Questionnaire (VFQ-25). Results: Of the 165 enrolled participants, 137 completed the VFQ-25. The mean VFQ-25 composite score was 74.4 ± 20.7 (range: 1.4-100). Among 118 participants with visual acuity assessment, 92% had best corrected visual acuity (BCVA) of 20/20 or better in at least one eye. Among participants with severe vision loss (BCVA ≤20/200), there was no statistically significant difference in self-reported general health compared to those without severe vision loss (p = 0.17). However, there was a significantly lower visual quality of life reported in the composite score and all of the 11 subscales of the VFQ-25. Conclusions: While this study provides evidence that combat ocular trauma is associated with a lower visual quality of life, limitations include the relatively small sample size and the limited documentation of the use of eye protection at time of injury among participants.

Objective: The purpose of this study was to review incidence of stress fractures in military and athlete populations and identify factors explaining causes and differences in the incidence among genders. Methods: Searches were conducted using several major databases. The studies were included if they were original studies including both male and female subjects and their aim was to identify incidence rates and risk factors contributing to the development of stress fractures. Of several thousand studies, 11 focusing on military populations and 10 on athletes are discussed. Results: In both populations, females had higher incidence of stress fractures, with incidence of ~3% and ~9.2% for males and females, respectively, in military populations and ~6.5% and ~9.7%, respectively, in athletes. Conclusions: Factors possibly explaining why females are more susceptible to stress fractures include bone anatomy, lower aerobic capacity, smaller muscle, and poor diet. However, both female recruits and athletes with normal weight and bone health are less likely to develop stress fractures, showing that gender is less important than the overall physical shape/condition.

When militaries mention loyalty as a value they mean loyalty to colleagues and the organisation. Loyalty to principle, the type of loyalty that has a wider scope, plays hardly a role in the ethics of most armed forces. Where military codes, oaths and values are about the organisation and colleagues, medical ethics is about providing patient care impartially. Being subject to two diverging professional ethics can leave military medical personnel torn between the wish to act loyally towards colleagues, and the demands of a more outward looking ethic. This tension constitutes a test of integrity, not a moral dilemma.

Introduction: Antihistamines are easily accessible and cover the vast majority of the medical therapy of
allergic rhinitis. However, their systemic administration may more frequently associate with their wellknown side-effect, sedation, which is a serious problem in persons in safety-critical jobs such as aviation.
We have a poor understanding whether a non-sedative antihistamine has an impact on vigilance when
hypobaric hypoxia occurs during flight.
Methods: In this randomized, placebo-controlled, double-blind, cross-over study the effect of 20 mg
bilastine was compared to 10mg cetirizine and to placebo (20mg pyridoxine) in 33 individuals at ground
level and at 4,000 m altitude simulated in hypobaric chamber. Levels of vigilance, ultrashort memory,
combined distributive attention, monotony tolerance and peripheral blood oxygen saturation (SpO2)
were assessed.
Results: Bilastine did not impair the tested abilities in comparison with the control groups either at
ground level or hypobaric hypoxia. Administration of cetirizine increased the number of errors at ground
level. At the simulated altitude, already impaired results were additionally demonstrated with regards to
the distributive attention test.
Conclusions: From the two examined antihistamines, bilastine should be the preferred medication for by
individuals who require constant attention and are exposed to hypobaric hypoxia.

Historically, populations stressed by natural disasters, military deployment, or wartime refugee status have demonstrated an increased incidence of infectious diseases. An example was the explosive increase in active tuberculosis and typhus in Germany towards the end of World War 11. Military recruits in basic training also have incurred endemic infectious diseases such as streptococcus, meningococcus, and adenovirus. It is unclear, however, if the prevalence of infectious diseases in such situations is best attributed to defects in public health and personal hygiene or to an underlying increased suceptibility of stressed populations.

The integration of mental health treatment with primary care is a U.S. Air Force priority. Unfortunately, manning shortages limit the utility of psychiatry in existing Air Force health care models. In this study, we present efficient and datadriven models for psychiatric involvement with primary care. These models include the use of psychiatrists as clinical consultants and primary care educators. Certain factors are required to implement these models including command support for locating psychiatrists within primary care, data-driven educational approaches, collaborative clinical care, and administrative support.

Maintaining good hospital records during military conflicts can provide medical personnel and researchers with feedback to rapidly adjust treatment strategies and improve outcomes. But to convert the resulting raw data into meaningful conclusions requires clear terminology and well thought out equations, utilizing consistent numerators and denominators. Our objective was to arrive at terminology and equations that would produce the best insight into the effectiveness of care at different stages of treatment, either pre or post medical treatment facility care. We first clarified three essential terms: 1) the case fatality rate (CFR) as percentage of fatalities among all wounded; 2) killed in action (KIA) as percentage of immediate deaths among all seriously injured (not returning to duty); and 3) died of wounds (DOW) as percentage of deaths following admission to a medical treatment facility among all seriously injured (not returning to duty). These equations were then applied consistently across data from the WWII, Vietnam and the current Global War on Terrorism. Using this clear set of definitions we used the equations to ask two basic questions:

U.S. military forces are increasingly involved in a variety of multinational peacekeeping and humanitarian assistance missions. How well combat-trained units and soldiers adapt to these new roles will determine U.S. success in such operations, as well as the future health and readiness of the force. In preparing soldiers for such missions, it is critical that leaders and health care providers have a clear understanding of the nature of the stressors they are likely to encounter. This report summarizes findings from a longitudinal, descriptive case study of a U.S. Army medical unit performing a peacekeeping mission in the former Yugoslavia. The goal of the investigation was to identify key sources of stress and to delineate the effect of these stressors on the health, morale, and mental readiness of soldiers. Findings suggest a range of psychological stressors that varies somewhat across operational phases of a peacekeeping mission. Furthermore, the degree of stress experienced in va...

The Crimean War (1854-1856) was the result of the protection offered to Turkey by United Kingdom and France. Casualties and sufferings experienced by the soldiers mobilized public opinion, especially in England. Disparity among French and British health services fails to explain the losses which were mostly illness rather than fighting related. Logistical deficiencies during the first winter (1854-1855) reduced the British Army to one third of its nominal strength. The following winter, although all fighting has resumed, typhus fever striked the French Army confounded by overcrowded camps and deficient sanitation. With the public opinion acting as a catalyst, the Parliament and Royal Commission moved the War Department towards required reforms. As the French lack their ally capacity to openly examine their own mistakes, the subsequent Second Empire military campaigns will bear the consequences of this flaw…

The symptoms of lifetime post-traumatic stress disorder (PTSD) and comorbid diagnoses were compared among 502 combat-experienced soldiers under examination for compensation-related purposes to confirm or deny the diagnosis of PTSD and 196 soldiers with combat experience without any psychiatric disorder. The two groups were matched with regard to duration of combat experience, time between combat experience and the study, age, marital status, and education. PTSD was diagnosed by psychiatrists with a structured clinical interview according to the research version of the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders. The psychologists applied the Mississippi Scale for Combat-Related PTSD, Watson's criteria for PTSD, the Minnesota Multiphasic Personality Inventory version 201, and the Trauma Questionnaire. Also, a very detailed heteroanemnestic questionnaire was completed by social workers. Medical documentation and data from ...

A total of 626 U S . male Marine Corps recruits underwent anthropometric measurements and dual-energy X-ray absorptiometry (DXA) scans of the femoral midshaft and the distal third of the tibia prior to a 12 week physical training program. Conventionally obtained frontal plane DXA scan data were used to measure the bone mineral density (RMD) as well as to derive the cross-sectional area, moment of inertia, section modulus, and bone width in the femur, tibia, and fibula. During training, 23 recruits (3.7%) presented with a total of 27 radiologically confirmed stress fractures in various locations in the lower extremity. After excluding 16 cases of shin splints, periostitis, and other stress reactions that did not meet fracture definition criteria, we compared anthropometric and bone structural geometry measurements between fracture cases and the remaining 587 normals. There was no significant difference in age ( p = 0.8), femur length ( p = 0.2), pelvic width ( p = 0.08), and knee width at the femoral condyles ( p = 0.06), but fracture cases were shorter (p = 0.01), lighter ( p = 0.0006), and smaller in most anthropometric girth dimensions ( p < 0.04). Fracture case bone cross-sectional areas ( p < 0.001), moments of inertia ( p < 0.001), section moduli ( p < 0.001), and widths (p < 0.001) as well as BMD ( p < 0.03) were significantly smaller in the tibia and femur. After correcting for body weight differences, the tibia cross-sectional area ( p = 0.03), section modulus ( p = 0.05), and width (p = 0.03) remained significantly smaller in fracture subjects. We conclude that both small body weight and small diaphyseal dimensions relative to body weight are factors predisposing to the development of stress fractures in this population. These results suggest that bone structural geometry measurements derived from DXA data may provide a simple noninvasive methodology for assessing the risk of stress fracture. (J Bone Miner Res 1996;11:645-653) S lctes and during military recruit training, particularly for the primary fracture site is the tibia, followed by mct;rtarelite program5 requiring intense physical conditioning such sals, femur, and calcaneus in descending order of prevzi-;IS the U.S. Marine Corps." ') Data indicate that the inci-Ience,(2) Stress fractures, which predominantly occur in the lower extremity, are believed t o result from bone structural failure *Some of work were the 1yy4 Ortho-caused by repetitive weight bearing loads. Weight bearing under training regimens subjects thesc bones t o repetitive piicdic Research Society meeting. Address reprint requests to: I)r. 7lioniu.s J. Reck liurliologicul Physics Luhorutoty J o h 11s Hopkit 1,s O i r tputien I Cm t u 601 N. c'urolitic Strwt Hiiltit?ior.i~. MD 21287-04Wv U. S.A.

This study evaluated associations between pre-dcploymenl neurocognitive performance and post-deployment posttraumatic stress disorder (PTSD) symploms in a sample of deployed active duty Army Soldiers. As pan of a larger longitudinal study. each panicipant eompleled baseline measures of memory. executive attenlion, and response inhibilion. and baseline and post-deployment self-reIXln measures of PTSD symptom severity. Data were subjected to multiple regression analyses that examined associations between baseline neurocognitive performances and longitudinal PTSD symptom outcome. Results revealed that pre-trauma immediate recall of visual information was associated wilh post-deployment PTSD symptom severity. even after eonlrolling for prc-dcploymenl PTSD symptom levels. combat intensity, age. gender. and test-relest interval. There was also an interaelion between prc-deployment PTSD symplom severity and prc-deploymenl immediate visual recall and verballeaming, indicating that neu~ognitive performances were more strongly (and negatively) associated with residualized post-deployment PTSD symptoms , 5. SUBJECT TERMS

The capability to make diagnostic assessments of radiation exposure is needed to support triage of radiation casualties and medical treatment decisions in military operations. At the International Conference on Low-Level Radiation Injury and Medical Countermeasures session on biodosimetry in the military, participants reviewed the field of biomarkers, covering a wide range of biological endpoints. Participants evaluated early changes associated with exposure to ionizing radiation, including chromosomal and DNA damage, gene expression and associated proteins, and DNA mutations. The use and development of advanced monitoring and diagnostic technologies compatible with military operations was emphasized. Conventional radiation bioassays require a substantial amount of time between when the sample is taken and when the data can be provided for decision making. These &quot;reach back&quot; bioassays are evaluated in laboratories that are not in the field; these laboratories routinely mea...

Efforts of modernizing the Ottoman Empire and society started during the 19th century. Initially reforms have been limited by institutions such as the armed forces, faculty of engineering and medicine. For this reason, a large number of western physicians invited to state to take prestigious positions in its few existing medical schools and other state establishments, in particular help with reforming its higher education. After the establishment of young Turkish Republic, western forms of science, medicine, art and literature penetrated the culture and continued to flourish. This article brings to light the efforts of these surgeons, and physicians and tells about their contributions to surgery and medicine in Turkey.

Appropriate and effective physical fitness training is imperative for soldier survival and mission success. The purpose of this study was to determine the effects of Mission Essential Fitness (MEF) circuit-style training program compared to standard Army Physical Readiness Training (APRT) on fitness, physiological, and body composition changes. Active duty Army personnel were randomly assigned to two groups (MEF = 34 or APRT = 33) for 8 weeks of training (15 sessions each). The MEF program included functional movements focused on strength, power, speed, and agility. Fifteen exercises were performed continuously for 60 to 90 seconds for 45 minutes. Baseline and post-test measures included the Army physical fitness test, physiological indicators, body composition, and additional fitness indicators. One-way analysis of covariance models indicated that MEF participants significantly increased their push-ups (p = 0.033), bench press (p = 0.001), and fiexibility (p = 0.003) and significantly decreased their 2-mile run (p = 0.003) and step test heart rate (p = 0.004) compared to participants doing APRT. Both groups maintained body composition (p > 0.05) and reported no injuries. The MEF training program safely improved muscular strength and endurance, cardiovascular endurance, and flexibility, supporting functional fitness circuit-style exercise training for military personnel.

The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.

In 1536, at the siege of Turin, French military surgeon Ambroise Paré changed surgical history. At that time, it was the custom to treat gunshot wounds by pouring boiling oil into them, often without removing the fragment or bullet. Paré, having run out of this cauterizing mixture, was forced to use a non-abrasive digestive to treat some of his wounded patients. This surgical procedure ultimately proved that gunshot wounds should not be treated by cauterization. Gunpowder weapons, however, had been in use for more than two centuries before Pare&#39;s discovery. During this time undoubtedly many victims wounded with gunshot must have suffered through cauterization. This has given rise to the belief among modern medical historians that the tradition of treating gunshot wounds which Paré corrected was formed and developed during the late Middle Ages. This article takes an opposing viewpoint to that theory. Using both late medieval surgical manuals and examples of gunshot wound treatmen...

Proximal lower limb amputations (trans-femoral) usually leave amputees with significant functional disturbances. This article contains information regarding three pilots with trans-femoral amputations that returned swiftly to continue their aeronautical careers despite their disabilities. Adaptations are needed in the limb prostheses to enable the amputees to access the minimally spaced cockpit.

Introduction: Physical therapy (PT) is a high-volume service that treats musculoskeletal injury and improves return-to-duty rates. Our experience suggests that no-show (NS) and patient cancellation (PC) rates increase the further appointment that is booked in the future, impede access to care, and increase the healthcare delivery costs. The article&#39;s purpose is to examine PT National Capitol Region (NCR) appointment data to inform appointment policies. Methods: We utilized one year of retrospective Military Health System Management and Reporting Tool and Composite Health Care System Ad Hoc Data Pulls to review NCR PT appointment data to evaluate the effect of timing on NS and PC rates. Results: We analyzed 797 new appointments at Walter Reed National Military Medical Center. Data revealed that 16% of patients seen within 10 days NS or PC; 22% of patients seen between 11 and 20 days NS or PC; 28% of patients seen 21 to 30 days NS or PC; and 25% of patients seen over 30 days after...

Introduction Severe lower limb injuries have a negative impact on many aspects of an individual’s life. One rehabilitative option for patients who have undergone limb salvage is the Intrepid Dynamic Exoskeletal Orthosis (IDEO). The IDEO is a custom-made dynamic response device which is used to restore function for patients with a wide variety of injuries. Clinical outcomes were routinely collected on patients fit with IDEOs at the Center for the Intrepid, Brooke Army Medical Center. The purpose of this retrospective study was to analyze the clinical outcomes collection process and the patient outcomes collected as part of routine clinical care. Methods The Brooke Army Medical Center IRB approved this study and granted waivers of informed consent and HIPAA authorization. Electronic medical records were reviewed over an 18-month period from July 2014 to January 2016. Records were examined to obtain the date of IDEO delivery, date of outcomes form completion, responses on the forms, an...

The article describes the intimate relationship between H.M. Queen Elisabeth of Belgium and the great Belgian surgeon Dr. Antoine Depage. The brilliant academic career of Depage was followed during World War I by his prominent role in the 'Océan'-hospital in De Panne at the Flemish coast. His close connection with Queen Elisabeth, working as a nurse in the hospital, resulted in an intimate friendship, which was particularly hearty when Depage lost his wife in 1915, and during his illness in 1923-1925. The letters of Depage, present in the Archives of the Royal Palace, give an insight in this intimate relationship.

Commissioned surgeon of colored volunteers, April 4, 1863, with the rank of Major. Commissioned regimental surgeon on the 7th Regiment of U.S. Colored Troops, October 2, 1863. Brevet Lieutenant Colonel of Volunteers, March 13, 1865, for faithful and meritorious services--mustered out October 13, 1866. So reads the tombstone at Arlington National Cemetery of Alexander Thomas Augusta, the first black surgeon commissioned in the Union Army during the Civil War and the first black officer-rank soldier to be buried at Arlington Cemetery. He was also instrumental in founding the institutions that later became the hospital and medical college of Howard University and the National Medical Association.

This article challenges conventional theories about the role of medical photography in the early twentieth century. Some scholars argue that the camera intensified the Foucauldian medical gaze, reducing patients to mere pathologies. Others maintain that with the rise of the new modern hospital and its state-of-the-art technologies, the patient fell from view entirely, with apertures pointing toward streamlined operating rooms rather than the human subjects who would go under the knife. The Army Surgeon General&amp;amp;amp;#39;s World War I rehabilitation journal, Carry On: A Magazine on the Reconstruction of Disabled Soldiers and Sailors, problematizes these assumptions. Hoping to persuade a skeptical public that the Army&amp;amp;amp;#39;s new programs in medical rehabilitation for disabled soldiers provided the best means of veteran welfare, the editorial officials at Carry On photographed patients fully clothed, wounds hidden, engaged in everyday activities in order to give the impression that the medical sciences of the day could cure permanent disabilities. In the end, Carry On shows us that medical doctors could, and did, use photography to conceal as well as reveal the reality faced by injured soldiers. In doing so, they (like other Progressive reformers at the time) hoped to persuade the public that rehabilitation had the power to make the wounds of war disappear.

The dynamic nature of modern warfare, including threats and injuries faced by soldiers, necessitates the development of countermeasures that address a wide variety of injuries. Tissue engineering has emerged as a field with the potential to provide contemporary solutions. In this review, discussions focus on the applications of stem cells in tissue engineering to address health risks frequently faced by combatants at war. Human development depends intimately on stem cells, the mysterious precursor to every kind of cell in the body that, with proper instruction, can grow and differentiate into any new tissue or organ. Recent reports have suggested the greater therapeutic effects of the anti-inflammatory, trophic, paracrine and immune-modulatory functions associated with these cells, which induce them to restore normal healing and tissue regeneration by modulating immune reactions, regulating inflammation, and suppressing fibrosis. Therefore, the use of stem cells holds significant pr...

Studies of group debriefing after extreme events have failed to show a significant long-term effect of this technique. However, the heterogeneity of the interventions studied and the length of time between debriefing and its assessment do not allow a proper interpretation of these findings. This study evaluates the immediate effect of debriefing in Israeli soldiers exposed to combat. Six small units (N = 39) have undergone historical group debriefing within 72 hours of exposure. State anxiety, self-efficacy, and combat evaluation were measured before and immediately after the sessions. Debriefing was followed by reduction in anxiety, improvement in self-efficacy, and increased homogeneity of the group. These effects may be attributable to enhancing group cohesion or to a proper beneficial effect of debriefing.

The Forward Resuscitative Surgical System (FRSS) is a small, mobile trauma surgical unit designed to support modern US Marine Corps combat operations. The experience of two co-located FRSS teams during 1 year of service in Operation Iraqi Freedom is reviewed to evaluate the system&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s efficacy. Between March 1, 2004, and February 28, 2005, two FRSS teams and a shock trauma platoon were co-located in a unit designated the Surgical Shock Trauma Platoon (SSTP). Data concerning patient care before and during treatment at the SSTP was maintained prospectively. Prospective determination of outcomes was obtained by e-mail correspondence with surgeons caring for the patients at higher echelons. The Los Angeles County medical center (LAC) trauma registry was queried to obtain a comparable data-base with which to compare outcomes. During the year reviewed there were 895 trauma admissions to the SSTP. Excluding 25 patients pulseless on arrival and 291 minimally injured patients, 559 of 579 (97%) combat casualties survived; 417 casualties underwent 981 operative procedures in the two SSTP operating shelters. There were 79 operative patients with a mean injury severity score of 26 (range, 16-59) and mean revised trauma score of 6.963 (range, 4.21-7.841) who had sustained severe injuries. Ten (12.7%) of these casualties died while 43 of 337 (12.8%) deaths were seen with comparable cases treated at LAC. Small task-oriented surgical units are capable of providing effective trauma surgical care to combat casualties. Further experience is needed to better delineate the balance between early, forward-based surgical intervention and more prolonged initial casualty evacuation to reach more robust surgical facilities.