Military medicine
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This review critiques Johns Hopkins professor Leonard Rubenstein's Perilous Medicine: The Struggle to Protect Health Care from the Violence of War, and offers the reader a military medical officer's perspective on these important concepts. Rubenstein's tome is essential reading for military officers who must understand how the laws of armed conflict and the ideals of humanitarian protection apply in twenty-first-century conflict. This review adds that military officers may, at times, need to also consider a less ideal but more consequential framework.
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As the combat operational tempo of the military conflicts in Iraq and Afghanistan has declined over the last decade, there has been a decrease in the number of patients requiring acute limb salvage. In their place, a growing population of patients with persistent functional deficits, pain, and inadequate soft tissue coverage stemming from prior limb salvage strategies have returned to our institution seeking revision surgery. Herein, we examine our institution's evolving surgical approach to extremity reconstruction from 2011 through 2019, culminating in the development of our limb restoration concept. We also discuss the impact of this orthoplastic approach on the acute management of complex extremity trauma and its role in providing sustained surgical readiness during interwar years. ⋯ Limb restoration is a collaborative orthoplastic approach that utilizes state-of-the-art surgical techniques for treating complex extremity trauma. Although limb restoration originally developed in response to managing the long-term sequelae of combat extremity trauma, the concept can be adapted to the acute management setting. Moreover, limb restoration provides military surgeons with a means for maintaining critical war-time surgical skills during the current low casualty rate era. Level of Evidence: V, therapeutic.
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Graves' disease (GD) is the most common cause of hyperthyroidism in the clinic, accounting for about 85% of all hyperthyroidisms. However, hyperthyroidism combined with OH has been rarely reported in the international community. We analyzed the clinical characteristics and pathogenesis of GD combined with orthostatic hypotension. ⋯ The main clinical manifestations of both two patients with hyperthyroidism were vertigo during postural changes or activities and relief from supine position and blood volume supplementation. Considering the lack of blood volume, the symptoms were alleviated after symptomatic treatment. The possibility of hyperthyroidism combined with orthostatic hypotension should be taken into consideration in clinical diagnosis and treatment.
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There are approximately 1.5 million U.S. military-dependent children. However, little is known about mental health referrals for these youths. This study sought to examine the type of mental health treatment referrals made by primary care providers for child military-dependent beneficiaries receiving care in the direct (within Military Treatment Facilities) and private care (civilian-fee-for service facilities) sectors of the Military Health System. ⋯ For attention- and mood-related disorders, but not anxiety- or conduct-related disorders, direct care providers were more likely than private sector care providers to prescribe psychotropic medications. Inconsistencies of provider referrals within and outside of the Military Health System should be elucidated to determine the impact on outcomes.
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The Impact Stratification Score (ISS) is a measure of the impact of chronic low back pain (LBP) consisting of nine Patient-Reported Outcomes Measurement Information System (PROMIS-29) items, but no studies have examined the ISS or its association with psychological symptoms in military samples. This study examines longitudinal associations between psychological symptoms and the ISS among military service members. ⋯ Psychological symptoms consistently and prospectively predict the impact of LBP as measured by the ISS among service members undergoing pain treatment. The ISS may also be associated with future anxiety but not depression. PROMIS-29 anxiety and depression items may be useful adjunctive measures to consider when using the ISS to support LBP treatment planning and monitoring with service members.