Military medicine
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The teaching and assessment of clinical skills are critical components of health care provider education, and clinical skill proficiency is essential for safe and successful health care delivery. Medical simulation is being increasingly recognized in health care education as an extremely valuable mechanism for training and assessing clinical skills. As in other high-stakes professions, the use of simulation can enhance the proficiency and efficiency of training while maximizing safety and minimizing risk. ⋯ Results showed that the primary users were graduate medical education physicians-in-training. In addition, survey results demonstrated that users favored simulation-based learning because of the realism of simulated scenarios. The Trauma Simulation Training Center embraces the simulation-based medical education philosophy by actively inviting training program participation, and we realize that more research is needed to determine the effectiveness of this teaching and assessment modality.
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Among U.S. Vietnam War veterans, we assessed whether preinduction cognitive abilities were associated with the risk of developing combat-related post-traumatic stress disorder (PTSD). ⋯ We found significant interactions between preinduction cognitive abilities and severity of combat exposure for the lifetime diagnosis of combat-related PTSD among Army Vietnam War veterans. High levels of combat exposure are likely to exhaust intellectual resources available for coping with stressful life events. Lower scores for cognitive abilities are not uniformly disadvantageous, and this should be considered by military manpower policymakers.
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Partial anomalous pulmonary venous return (PAPVR) is an uncommon congenital abnormality that occurs in 0.4 to 0.7% of postmortem examinations. Ninety percent of these anomalies are associated with an atrial septal defect. Partial anomalous pulmonary venous return occurs more commonly on the right than the left and is manifested by abnormal return of the pulmonary veins to the central venous circulation. ⋯ We submit the case of a recently activated solider who presented with dyspnea on exertion refractory to inhaled corticosteroids and an 8.5-mm solitary pulmonary nodule. Further diagnostic imaging revealed PAPVR. Our case appears to be the first report of a solitary pulmonary nodule as the initial presentation of a right upper lobe PAPVR with return to the superior vena cava in the absence of associated atrial septal defect.
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After years of conflict between Serbia and neighboring Kosovo, a full-blown war started in March 1999 when the Serbian and Yugoslav armies began a statewide military crackdown against ethnic Albanians and the Kosovo Liberation Army. Most ethnic Albanians were displaced to Macedonia or Albania. ⋯ Improvised lifesaving surgeries were performed with kitchen utensils serving as retractors at the field hospital. This article compares the treatment of patients between the two hospitals, and is the first article to date describing the war experience in general at the field hospitals in Kosovo.
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A comparative study was conducted on patients in military hospitals in response to recent studies at veterans hospitals showing the possibility that access to an equal-access health care system may reduce or reverse racial differences in mortality outcomes. Using a cohort study of 14,122 military retirees admitted to military hospitals with any of six common medical diagnoses between October 2000 and September 2004, we evaluated differences in patient and hospital characteristics and evaluated race-specific hospital mortality. Despite long-term equal access to comprehensive medical care, there were significant racial differences in patient- and hospital-level risk factors among male military retirees hospitalized with common medical diagnoses. In unadjusted analyses, risk of hospital mortality was significantly lower in African Americans and other non-Caucasians when compared to Caucasians, but differences disappeared after adjustment for all risk factors.