Military medicine
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Wrong site peripheral nerve blocks are included in the National Quality Forum and Joint Commission's category of "never event." Multiple attempts have been made by various groups in an effort to eliminate these events. Prior attempts to eliminate these never events include the Regional Block Preprocedural Checklist provided by the American Society of Regional Anesthesia (ASRA) taskforce. Following a series of errors involving anticoagulation prior to regional anesthesia, our department saw a need for a more comprehensive checklist. ⋯ The LAST Double Check is a more comprehensive checklist with the aim of preventing errors associated with wrong site blocks, anticoagulation administration, and care team coordination. This checklist covers areas of the patient history that are routinely reviewed prior to regional anesthesia administration and did not contribute to delay in arrival to the operating room.
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We assessed potential racial or ethnic differences in the degree to which veterans with pharmaceutically treated hypertension report experiences with their primary care system that are consistent with optimal chronic illness care as suggested by Wagner's Chronic Care Model (CCM). ⋯ Non-Hispanic African Americans with pharmaceutically treated hypertension report that the primary care system more closely approximates the Wagner CCM than non-Hispanic White patients.
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Highly skilled swimmers and aquatically adaptable service members such as U. S. Navy Divers, Sea, Air and Land (SEAL) Teams, and Explosive Ordnance Disposal (EOD) technicians, die every year from drowning. ⋯ This Clinical Practice Guideline (CPG) provides an overview of drowning and associated conditions based on the best available current medical evidence. Unlike basic life support and advanced cardiac life support protocols, rescue breathing should be initiated prior to chest compressions to re-expand water-filled alveoli. These guidelines should be used as a standardized framework to guide first responders, prehospital emergency medical service personnel, and medical department personnel in evaluating, diagnosing, and managing common in water pathologies.
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The current evolution of surgical practices is increasingly trending toward hyper-specialization. For military surgeons, their practice in France does not differ from their civilian counterparts. In contrast, in external operations, they have to deal with specific war injuries in austere conditions. They are also required to take care of local populations. Therefore, specific training is necessary, and the French Military Health Service Academy (Ecole du Val-de-Grâce) Paris has set up a specific training called Advanced Course for Deployment Surgery (ACDS) in 2007. The aim of this study is to assess the relevance of this teaching regarding pathologies encountered during current conflicts. ⋯ The large variety and technical nature of the performed operations requires the training of highly qualified military orthopedic surgeons with both experience in war surgery and management of after-effects and complications. Orthopedists are also required to carry out procedures dealing with neurosurgery, general, and/or vascular surgery on missions. These data highlight the complexity of military surgeons' training along with the hyper-specialization of the civilian medical world. For more than 10 yr, French military surgeons have benefited from a training program called ACDS to meet these objectives. This initial training seems to be appropriated adapted in view of the managed pathologies.
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Immunoglobulin A associated vasculitis (IgAV), formerly called Henoch-Schönlein purpura, is a small vessel vasculitis which typically presents with upper and lower extremity palpable purpura and abdominal pain. It is the most common vasculitis in children, and is less common in adults. However, newer evidence suggests the incidence within the adult population is higher than previously reported. ⋯ There is no clear consensus in current literature for whether to obtain lesional or perilesional biopsies. Such recommendations could be particularly advantageous for adults given the abnormal lesions. This case study addresses the incidence of IgAV within the adult population, diagnostic criteria, long-term sequalea of IgAV, and the importance of a proper biopsy sight when making the diagnosis.