Journal of the Royal Army Medical Corps
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Review Meta Analysis
Coupled plasma haemofiltration filtration in severe sepsis: systematic review and meta-analysis.
Coupled plasma filtration and adsorption (CPFA) has been used in the treatment of severe sepsis with the intention of removing the proinflammatory and anti-inflammatory mediators from the systemic circulation. It is believed that this interrupts and moderates the septic cascade, but there is uncertainty about the benefits of this therapy. ⋯ Evidence for CPFA in severe sepsis is sparse, of poor quality and further research is required, however, this meta-analysis noted improvements in survival rates of those patients treated with CPFA.
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Randomized Controlled Trial
An evaluation of combat application tourniquets on training military personnel: changes in application times and success rates in three successive phases.
Haemorrhage from the injured extremity is a significant cause of preventable death in military settings. This study evaluated the effect of training on the efficacy of the combat application tourniquet (CAT) and to define standards for military personnel. ⋯ The results show that the efficacy of CAT application increases with training. Further studies are required to investigate the reasons underlying application failures. This single group prospective randomised study involves level of evidence 4.
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Trauma care delivery in England has been transformed by the development of trauma networks, and the designation of trauma centres. A specialist trauma service is a key component of such centres. The aim of this survey was to determine to which extent, and how, the new major trauma centres (MTCs) have been able to implement such services. ⋯ A large proportion of MTCs still do not have a dedicated major trauma service. Furthermore, the models which are emerging differ from other countries. The relative lack of involvement of surgeons in MTC trauma service provision is particularly noteworthy, and a potential concern. The impact of these different models of service delivery is not known, and warrants further study.
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In 2004, the World Medical Association's International Code of Ethics claimed that 'medical ethics in armed conflict is identical to medical ethics in times of peace'. This paper challenges this notion and suggests that the hostile, austere and diverse environments in which military doctors and nurses serve are significantly more problematic and different to a civilian healthcare environment. It debates that there may be some incompatibility and challenges between following military orders such as the protocols written down in a Medical Rules of Eligibility matrix and professional codes of practice in these environments. This is either where fighting takes place or where the mission is for humanitarian purposes.
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'Palpitations' include a broad range of symptoms relating to the perception of abnormal activity of the heart. They may reflect an underlying arrhythmia or a hyperawareness of normal cardiac activity caused by stress or anxiety. ⋯ Due to the distracting nature of this symptom and the frequently sudden and unheralded onset, a common consequence is medical downgrading. This article will provide a guide to assessing the heterogeneous group presenting with palpitations and how to both establish the cause and identify the correct treatment for each patient in a timely manner.