Military medicine
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The prevalence of tobacco use in the Veteran population and among Veterans Health Administration patients remains high, resulting in significant health and economic consequences. This problem has generated many tobacco research studies and clinical interventions, which often rely upon tobacco use status data previously recorded in electronic health records (EHR). Therefore, the consistency and reliability of these data are critical. The Veterans Health Administration uses an extensive EHR system where tobacco use status can be documented either as free text (FT) or as health factors (HF). The current literature assessing the reliability of HF and FT data is limited. This analysis evaluated the agreement between HF and FT tobacco use status data. ⋯ Agreement between HF and FT data that document the tobacco use statuses of Veterans varied because of implausible data. HF data had fewer implausible tobacco use statuses, but FT data were recorded more frequently. Although HF and FT data can be reasonably relied upon to determine the tobacco use statuses of Veterans, researchers and clinicians must be aware of implausible data and consider methods to overcome this limitation. Future studies should investigate the ways of improving the consistency of EHR documentation by health care providers and benchmark HF and FT data against a gold standard like biochemical verification to determine accuracy.
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Aneurysms and pseudoaneurysms of the visceral arteries are a rare pathology with a prevalence of 0.1-2% in the general population, most common in men. Despite low prevalence, visceral aneurysms pose a significant threat to the patient's health and life; a ruptured superior mesenteric branch aneurysm carries mortality rates of 10-25% and up to 30-90%. This article presents a case of a 50-year-old former active duty soldier and veteran of a military combat mission in Afghanistan, during which he sustained a traumatic injury resulting from a mine explosion under a vehicle. ⋯ An angiotomography performed at 1 year of endovascular treatment confirmed good effects of the embolization procedure and coagulation of the aneurysm. Visceral aneurysms are a rare vascular pathology but are associated with significant morbidity and mortality rates. The incidence of ruptured aneurysms is probably underestimated as some patients may be operated on for acute abdominal symptoms, e.g., bowel obstruction.
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Risk factors for gastric cancer in the United States are not well understood, especially in populations with a low proportion of immigrants. We conducted a matched case-control study in a Veteran Affairs Medical Center to identify risk factors for gastric cancer. ⋯ The high proportion of late-stage gastric cancer diagnoses highlights the need for improved risk stratification as well as screening and surveillance protocols in the U.S. population. Racial disparities among veterans in an equal-access system necessitate further investigation into the etiology of these disparities.
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Appendectomy is the treatment of choice for acute appendicitis. The procedure can be performed open or laparoscopically. However, laparoscopy is not available on military missions abroad. It is unclear whether treatment outcomes differ between the two surgical approaches. ⋯ Open appendectomy can be considered equivalent in outcome to the laparoscopic procedure and thus can be performed on military missions abroad without compromising outcome. Military surgeons must continue to be trained and confident in open appendectomy.
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The present study's central aim was to examine two questions: (1) Will there be differences in mental health outcomes between medics and non-medics who sought help at the Israeli Combat Reaction Unit (CRU)? (2) Will there be differences in mental health outcomes between combatants and non-combatants? ⋯ The elapsed time to seek help for non-MCs was explained by their reluctance to seek help, not being combatants, and being medics who are portrayed as resilient. Recommendations for encouraging this subgroup to seek help were given.