bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic Review of Effectiveness of Situated E‐Learning on Medical and Nursing Education
Authors: Feng Jui‐Ying , Chang Yi‐Ting , Chang Hsin‐Yi , Erdley William Scott , Lin Chyi‐Her , Chang Ying‐Ju
Published: March 2013

Objectives

Because of the complexity of clinical situations, traditional didactic education is limited in providing opportunity for student‐patient interaction. Situated e‐learning can enhance learners’ knowledge and associated abilities through a variety of activities. Healthcare providers who interact with virtual patients in designed situations may avoid unnecessary risks and encounters with real patients. However, the effectiveness of situated e‐learning is inconsistent. The purpose of this study is to determine the effectiveness of situated e‐learning in prelicensure and postlicensure medical and nursing education.

Methods

Literature databases of PubMed, Medline, CINAHL, ERIC, and Cochrane Library were searched. The study eligibility criteria included articles published in English, which examined the effectiveness of situated e‐learning on the outcomes of knowledge and performance for clinicians or students in medicine and nursing. Effect sizes were calculated with 95% confidence intervals.

Results

Fourteen articles were included for meta‐analysis. Situated e‐learning could effectively enhance learners’ knowledge and performance when the control group received no training. Compared to traditional learning, the effectiveness of situated e‐learning on performance diminished but still remained significant whereas the effect become insignificant on knowledge. The subgroup analyses indicate the situated e‐learning program significantly improved students’ clinical performance but not for clinicians.

Conclusions

Situated e‐learning is an effective method to improve novice learners’ performance. The effect of situated e‐learning on the improvement of cognitive ability is limited when compared to traditional learning. Situated e‐learning is a useful adjunct to traditional learning for medical and nursing students.
Identification of common synaptic inputs to motor neurons from the rectified electromyogram
Authors: Farina Dario , Negro Francesco , Jiang Ning
Published: March 2013

Key points

Oscillatory drives at the input of a pool of motor neurons are transmitted to the motor neuron output (neural drive to the muscle) in an approximately linear way if these inputs are common to all motor neurons.

The neural drive to the muscle is transformed in the EMG signal that can be thus used to extract information on the oscillatory inputs to motor neurons.

The transmission of oscillatory inputs is closer to a linear transmission for the raw or for the rectified EMG depending on the energy of the raw and rectified motor unit action potentials at the input frequency and on the degree of amplitude cancellation.

Amplitude cancellation negatively influences the effectiveness of EMG rectification in identifying with linear methods oscillatory inputs to motor neurons, so that rectification is preferable over the raw EMG only when the degree of cancellation is low.

Abstract  Oscillatory common inputs of cortical or peripheral origin can be identified from the motor neuron output with coherence analysis. Linear transmission is possible despite the motor neuron non‐linearity because the same input is sent commonly to several neurons. Because of the linear transmission, common input components to motor neurons can be investigated from the surface EMG, for example by EEG–EMG or EMG–EMG coherence. In these studies, there is an open debate on the utility and appropriateness of EMG rectification. The present study addresses this issue using an analytical, simulation and experimental approach. The main novel theoretical contribution that we report is that the spectra of both the rectified and the raw EMG contain input spectral components to motor neurons. However, they differ by the contribution of amplitude cancellation which influences the rectified EMG spectrum when extracting common oscillatory inputs. Therefore, the degree of amplitude cancellation has an impact on the effectiveness of EMG rectification in extracting input spectral peaks. The theoretical predictions were exactly confirmed by realistic simulations of a pool of motor neurons innervating a muscle in a cylindrical volume conductor of EMG generation and by experiments conducted on the first dorsal interosseous and the abductor pollicis brevis muscles of seven healthy subjects during pinching. It was concluded that when the contraction level is relatively low, EMG rectification may be preferable for identifying common inputs to motor neurons, especially when the energy of the action potentials in the low frequency range is low. Nonetheless, different levels of cancellation across conditions influence the relative estimates of the degree of linear transmission of oscillatory inputs to motor neurons when using the rectified EMG.
Funny channel gene mutations associated with arrhythmias
Authors: DiFrancesco Dario
Published: March 2013

Abstract  Many diverse data support a role of the funny current (If) in pacemaking and heart rate control. Among them, clinically relevant applications have special impact, since they translate the concept of funny channel‐based pacemaking into practical developments of potential therapeutic value. For example, the If role in pacemaking is the basis for a pharmacological approach to heart rate control. Ivabradine, a specific f‐channel blocker acting as a ‘pure heart rate reducing’ agent, is used today as a therapeutic tool in chronic stable angina and heart failure. Also, the pacemaking capability of funny channels has been the main rationale behind the development of ‘biological’ pacemakers, whose aim is to eventually replace the electronic pacemakers implanted today. Finally, the role of If in pacemaking implies that dysfunctional funny channels can contribute to rhythm disorders. This consideration has led to the search for inheritable forms of cardiac arrhythmias potentially linked to functional changes of HCN4 channels, the molecular correlates of funny channels. This review addresses recent reports where investigation of families with arrhythmias has allowed the identification of specific HCN4 channel mutations associated with different types of rhythm disorders, specifically with sinus bradycardia. The perspective of future research in this field is also addressed.
High spatiotemporal resolution measurement of regional lung air volumes from 2D phase contrast x‐ray images
Authors: Leong Andrew F. T. , Fouras Andreas , Islam M. Sirajul , Wallace Megan J. , Hooper Stuart B. , Kitchen Marcus J.
Published: March 2013

Purpose:

Described herein is a new technique for measuring regional lung air volumes from two‐dimensional propagation‐based phase contrast x‐ray (PBI) images at very high spatial and temporal resolution. Phase contrast dramatically increases lung visibility and the outlined volumetric reconstruction technique quantifies dynamic changes in respiratory function. These methods can be used for assessing pulmonary disease and injury and for optimizing mechanical ventilation techniques for preterm infants using animal models.

Methods:

The volumetric reconstruction combines the algorithms of temporal subtraction and single image phase retrieval (SIPR) to isolate the image of the lungs from the thoracic cage in order to measure regional lung air volumes. The SIPR algorithm was used to recover the change in projected thickness of the lungs on a pixel‐by‐pixel basis (pixel dimensions ∼16.2 μm). The technique has been validated using numerical simulation and compared results of measuring regional lung air volumes with and without the use of temporal subtraction for removing the thoracic cage. To test this approach, a series of PBI images of newborn rabbit pups mechanically ventilated at different frequencies was employed.

Results:

Regional lung air volumes measured from PBI images of newborn rabbit pups showed on average an improvement of at least 20% in 16% of pixels within the lungs in comparison to that measured without the use of temporal subtraction. The majority of pixels that showed an improvement was found to be in regions occupied by bone. Applying the volumetric technique to sequences of PBI images of newborn rabbit pups, it is shown that lung aeration at birth can be highly heterogeneous.

Conclusions:

This paper presents an image segmentation technique based on temporal subtraction that has successfully been used to isolate the lungs from PBI chest images, allowing the change in lung air volume to be measured over regions as small as the pixel size. Using this technique, it is possible to measure changes in regional lung volume at high spatial and temporal resolution during breathing at much lower x‐ray dose than would be required using computed tomography.
STIM1 Controls Endothelial Barrier Function Independently of Orai1 and Ca
2+
Entry
Authors: Shinde Arti V. , Motiani Rajender K. , Zhang Xuexin , Abdullaev Iskandar F. , Adam Alejandro P. , González-Cobos José C. , Zhang Wei , Matrougui Khalid , Vincent Peter A. , Trebak Mohamed
Published: March 2013

The calcium sensor STIM1 disrupts the endothelial barrier by coupling the thrombin receptor to the actin cytoskeleton.
Vitamin E Facilitates the Inactivation of the Kinase Akt by the Phosphatase PHLPP1
Authors: Huang Po-Hsien , Chuang Hsiao-Ching , Chou Chih-Chien , Wang Huiling , Lee Su-Lin , Yang Hsiao-Ching , Chiu Hao-Chieh , Kapuriya Naval , Wang Dasheng , Kulp Samuel K. , Chen Ching-Shih
Published: March 2013

Vitamin E suppresses the proliferation of prostate cancer cells by inhibiting the growth-promoting kinase Akt.
Orai Channel Pore Properties and Gating by STIM: Implications from the Orai Crystal Structure
Authors: Rothberg Brad S. , Wang Youjun , Gill Donald L.
Published: March 2013

Crystallographic data enable predictions regarding gating of the store-operated calcium entry channel.
STIMulating Stress Fibers in Endothelial Cells
Authors: Gudermann Thomas , Steinritz Dirk
Published: March 2013

STIM1 contributes to disruption of the endothelial barrier through two different mechanisms.
Coordinating Metabolism
Authors: Ray L. Bryan
Published: March 2013

In addition to its role in stimulating protein and lipid synthesis, the kinase mammalian target of rapamycin stimulates nucleotide biosynthesis.
Blocking Tumor Cell Resistance
Authors: Foley John F.
Published: March 2013

Loss of the tumor suppressor protein PML sensitizes glioblastoma cells to inhibitors of the mammalian target of rapamycin.
Improvised Weapons in Civil Disorder
Authors: Cocks Robert A
Published: March 2013

Military forces engaged in a peacekeeping role may face hostility from civilian populations, and standard training for first-aid and medical response in combat may be inadequate in dealing with such situations. This paper reviews some of the unorthodox and improvised weapons which may be encountered during the management of civil disorder.
Diverse Influences on Parachuting Injuries in Israel
Authors: Bar-Dayan Yosefa , Bar-Dayan Yaron , Weisbroth Moshe , Shemer Joshua
Published: March 2013

Background

Parachuting is known to be relatively safe and has a low injury rate. There are some parameters influencing parachuting casualties. In order to determine the influences of type of jump and parachute, effect of equipment carried, time of jump and wind speed, we conducted a retrospective study at the Parachuting Training Center of Israel, assessing 53832 military parachute jumps.

Methods

Two categories of injuries were defined: major (fractures, dislocation, head trauma, ligamentous tears) and minor (contusion, bruises, sprain injuries).

Results

The overall injury rate was 0.6 percent. The commonest major injuries were ankle fractures and head trauma, while ankle sprain was the most common minor injury. The lowest rate of injury was found in free falls jumpers (0.2 percent) and highest amongst manoeuvres (1.1 percent). The highest injury rate occurred when using an Israeli version of “T-10” military parachute (0.7 percent) and the lowest with free fall parachutes (0.2 percent). Extra equipment carried during jumps caused higher injury rate (0.8 percent) compared to jumps without equipment (0.5 percent) using the “T-10” military parachute. Injury rates were greater at night (1.0 percent) compared to day jumps (0.5 percent). In day jumps commonest major injury was ankle fracture, while in night jumps it was head trauma. The commonest minor injury in day and night jumps was ankle sprain. At wind speed of 0-4 Knots parachuting injuries were higher compared with wind speeds of 5-8, 9-12 and 13-16 Knots with injury rates of 0.8, 0.5 and 0.6 percent respectively.

Conclusions

Diverse factors influence the injury rate in parachuting. Identifying such factors may enable us to change them in order to minimize the number of injured parachutists.
Transient dense flaccid left-sided hemiparesis in a case of heat injury
Authors: World MJ
Published: March 2013

A left flaccid hemiparesis resolving completely over 44 hours occurring in a soldier of 19 years of age following a fitness test is described. This was not associated with any abnormality on magnetic resonance imaging of the brain and was probably an exceptionally rare manifestation of heat-induced neuropraxia.
Normal and Pathological Reactions to Severe. Stress: Their Features and Management
Authors: Alexander David A
Published: March 2013

It is unethical and incompetent to deny the scale and nature of human reactions to trauma. Those who provide care for victims of trauma should be familiar with normal and pathological reactions following trauma and know how to identify those at high risk of developing adverse reactions and problems of adjustment.

Methods of treating and preventing post-traumatic conditions have not been evaluated with sufficient rigour. There are, however, some guiding principles to ensure a rational approach to the management of victims of trauma.

I can sympathise with everything, except suffering. I cannot sympathise with that. It is too ugly, too horrible, too distressing… the less said about life’s sores the better.

(The Picture of Dorian Gray, Oscar Wilde, 1856–1900)
Hyperbaric Oxygen in Trauma and Surgical Emergencies
Authors: MacFarlane Campbell , Cronjé Frans J , Benn Carol-Ann
Published: March 2013

Hyperbaric oxygen therapy (HBO), that is the administration of 100% oxygen delivered under pressure, has a beneficial effect in several surgical conditions. Its use has been assessed and audited and its pharmacological effects demonstrated. It is appropriate for use in several acute surgical conditions as evidence-based therapy. These are:

Gas Gangrene

Crush Injuries, Compartment Syndromes & Acute Traumatic Ischaemias

Enhancement of Healing in Selected Problem Wounds

Exceptional Bloodloss Anaemia

Necrotising Soft Tissue Infections

Compromised Skin Grafts & Flaps

Thermal Burns

HBO therapy suffers from previous inappropriate use, lack of knowledge, and scarce hyperbaric facilities. Hyperbaric therapy, when properly supervised by a physician trained in its use, working closely with a surgeon, and ethically used for appropriate indications, can be a useful adjunct to surgical practice. Military surgeons may be in a situation in which they can utilize HBO in acute surgical conditions and trauma. They are urged to identify HBO facilities, both fixed and portable, and to establish communication with hyperbaric therapy colleagues.
Clinical findings of the second 1000 UK Gulf War Veterans who attended the Ministry of Defence’s Medical Assessment Programme
Authors: Lee HA , Gabriel R , Bale A J , Bolton P , Blatchley NF
Published: March 2013

Objective

To review the diagnoses made in the second 1000 veterans of the Gulf conflict 1990-91 seen in the Ministry of Defence’s Gulf Veterans’ Medical Assessment Programme and to determine the main conditions related to Gulf service.

Design

Case series of 1000 consecutive Gulf veterans who presented to the programme between 25 February 1997 and 19 February 1998.

Subjects

Gulf War veterans.

Main outcome measures

Assessment of the patient’s health status. Diagnosis of medical and psychiatric conditions using ICD-10.

Results

204 patients were unwell. 309 patients had organic disease, of whom 248 were well, 252 had psychiatric conditions which remained active in 173. The remaining 79, now well, had had psychiatric disorders following Gulf service. The principal psychiatric diagnosis was post traumatic stress disorder and the majority arose as a result of Gulf service.

Conclusion

796 (80%) veterans were well. There were 309 (31%) patients with organic disease. 252 (25%) veterans had psychiatric conditions of which 173 (69%) had an active diagnosed disorder and post traumatic stress disorder was the predominant condition. The pattern of disease is similar to that seen in NHS practice. We found, like others, no evidence to support a unique Gulf War syndrome. Post conflict illnesses have many common features.
Assessing Exposures in the United Kingdom’s Armed Forces - A Review of Systems that Collect Data Useful for Exposure Assessment
Authors: Capleton AC , Short SD , Rushton L
Published: March 2013

The ability to assess the exposure of individuals or groups is a critical element in any effective health surveillance system, as it provides the opportunity to identify the causes of ill health, the levels of exposure resulting in ill health and, through controlling exposures, to protect the health of Service personnel. As part of a wider programme to enhance the health surveillance capabilities of the Defence Medical Services, a project was undertaken to assess the collection and retention of data for exposure assessment in the United Kingdom’s Armed Forces. The systems investigated include those for health, safety and environment policy, personnel and pay, medical records, environmental and occupational monitoring and historical records. It was found that the use of many systems for exposure assessment would be hampered by inconsistencies in the data collected, poor accessibility and linkage, and variability in the retention of the data. This paper highlights some of the problems that limit the usefulness of the record systems for exposure assessment and summarizes the principal recommendations made for enhancing the systems to better facilitate health surveillance.
The Euthanasia Debate
Authors: Harris NM
Published: March 2013

Debates about the moral dilemmas of euthanasia date back to ancient times. Many of the historical arguments used for and against the practice remain vu I id today. Indeed, any form of discussion on the subject often provokes emotive responses, both from members of the medical profession and the general public.

For this reason alone, the issue will continue to be debated at all levels of society. There are, however, other factors that ensure euthanasia will remain a subject of major controversy within medical, legal and governmental bodies.

Firstly, the act of euthanasia itself is illegal, yet in its passive form occurs on a daily basis in many of our hospitals (1). Secondly, medical advances have made it possible to artificially prolong the life of an increasing number of patients far beyond what was possible only a few years ago. Furthermore, we must all contend with the reality that financial constraints are an important consideration in modern health care provision. Finally, there is an ethical difficulty in interpreting the concept of a patient’s right, or autonomy, versus the rights and duty of a doctor.

Before attempting to answer the questions posed by these issues, it is important to have some accurate definitions of both euthanasia and of the concept of morality. According to the House of Lords Select Committee on Medical Ethics, the precise definition of euthanasia is “a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering” (2). The term can be further divided into voluntary and involuntary euthanasia. The former is said to occur if a competent patient makes an informed request for a life terminating event and the latter can be used if a patient does not give informed and specific consent for such treatment. It is the occurrence of involuntary euthanasia which forms one of the main arguments against legalisation. This is discussed in greater detail below.

Euthanasia is frequently separated into active and passive forms. A number of authors consider these terms to be misleading and unhelpful. They are, however, used in the literature and in discussion and consequently should be understood. Active euthanasia takes place if deliberate steps are taken to end a patient’s life; this would include administration of potassium containing compounds to induce cardiac arrest, a practice that is illegal in this country. Passive euthanasia is the withholding of treatments necessary for the continuance of life. Whether the administration of increasingly necessary, albeit toxic doses of opioid analgesia is regarded as active or passive euthanasia is a matter of moral interpretation, but in order to pacify doctors’ consciences, it is usually regarded as a passive measure. Many people, therefore, regard it as an acceptable facet of good professional practice.
Spinal Injuries Caused By The Acceleration Of Ejection
Authors: Lewis ME
Published: March 2013

The speed and altititude at which modern military aircraft operate are such that escape can only be achieved by some means of forcibly propelling the aircrew clear of the aircraft. The most common method of doing this is by use of an ejection seat. The use of such seats, whilst generally life saving, exposes aircrew to forces that may be at the limits of human tolerance. Each phase of the ejection sequence is associated with characteristic injury patterns and of particular concern is the occurrence of spinal compression fractures, which are caused by the upward acceleration of the ejection seat. Thorough investigation of aircrew who eject is necessary and magnetic resonance imaging of the spines of these aircrew is now becoming mandatory. Aircrew who sustain stable anterior wedge compression fractures usually require no invasive treatment, but are prevented from flying aircraft fitted with ejection seats for 3-4 months.
Lisfranc fracture dislocations - An important and easily missed fracture in the emergency department
Authors: Sharma D , Khan F
Published: March 2013

Two case reports are presented of Lisfranc fractures. There have been many incidents of missed injury in the past and the radiographs are reproduced here together with the important radiographic features. Early diagnosis and orthopaedic referral are necessary because operative treatment is often required.
An Anomalous Median Nerve Avoiding Injury In A Gunshot Wound To The Antecubital Fossa
Authors: Garner JP , Price BA
Published: March 2013

We report the case of a 19 year old man who received a gunshot wound to the soft tissues of his left elbow. He presented with an ischaemic hand due to transection of the brachial artery bifurcation anterior to the elbow joint. He was spared an associated median nerve injury by an anomalous course of the nerve through the antecubital fossa.
Spontaneous Foreign Body Extrusion Following Perforating Eye Injury
Authors: Bourne RRA , Parulekar M , Bacon AS , MacLaren RE
Published: March 2013

A structured approach to the management of a perforating ballistic eye injury is illustrated in this case, where initial treatment was limited to simple corneal wound closure and antibiotic prophylaxis. A pellet had passed completely through the globe but the retina remained attached, and it was decided to manage the case conservatively. Two retained foreign bodies were extruded spontaneously some months after the injury when suture removal and delayed cataract surgery led to a virtually perfect visual outcome. The patient has had no further complications at least three years after initial injury. The manage-ment of this civilian case illustrates some basic concepts in treating ballistic eye injuries that may be applicable in a military setting.
Tetanus Immunisation In Hypersensitive Individuals
Authors: Williams A N , Kabuubi J B L , Owen J P , Wells J
Published: March 2013

We report on a case of an officer cadet who was inadvertently allowed to commence training with a history suggestive of hypersensitivity to tetanus immunisation and who, eventually, successfully underwent a graduated immunisation regimen. This case combines a search for good evidence with the extraordinary complexities of military medical management and the law. It is a lesson in all three.
Injuries Of The Sterno-Clavicular Joint In Backpackers
Authors: Shoaib A , Mehraj Q , Jepson F
Published: March 2013

Anterior sterno-clavicular dislocation, or fracture dislocation, as a result of carrying a backpack has not previously been described. We describe two cases, and reflect on the factors that may have led to the injuries, noting that the current PLCE (personal load carrying equipment) may also increase the risk of this condition. The condition is one that carries a grading of U8 (unfit for service), and is one that Medical Officers should be aware of, as it has serious implications for a continuing military career.
A Drill-free Bone Screw For Intermaxillary Fixation In Military Casualties
Authors: Gibbons AJ , Baden JM , Monaghan AM , Dhariwal DK , Hodder SC
Published: March 2013

Drill-free bone screws are a simple and quick method of establishing intermaxillary fixation requiring a minimum amount of specialist training or equipment. These screws offer significant advantages over other methods of intermaxillary fixation and are well suited for use in military casualties.
Dealing With The Disturbed Soldier In Primary Care
Authors: Carter PA , Willman AS , Kuber A
Published: March 2013

Medical Officers are often called to review violent or disturbed soldiers in barracks or in their homes.

Management of the acutely disturbed soldier differs from the acutely disturbed civilian in that, whilst drug therapy will be largely similar, application of the Mental Health Acts (1) varies depending on the soldier’s situation and, in some cases, the Acts do not apply at all. In addition, the rules on the arrest and detention of soldiers have changed considerably since the introduction of Human Rights legislation (2).
The Evolution Of Casualty Evacuation In The 20th Century (Part 4) – An International Perspective
Authors: Bricknell MCM
Published: March 2013

This is the fourth in a series of papers that review the evolution of the military casualty evacuation during the 20th Century. The previous three papers have looked at the British Army system. This paper looks at the organisation of army medical services from the United States, Israel, Russia and Croatia and compares these with the British Army system reported in the previous papers. All national army medical services have evolved organisations to reduce the time lag between injury and surgery for their wounded. The paper will show that there are some fundamental differences in the organisation of medical units to achieve this aim. Helicopters are almost universally used for the evacuation of seriously ill casualties when this is practicable.
The Trends Of Vasectomy Reversal In The Forces
Authors: Shah ZH , Ganta SB , Morgans BT
Published: March 2013

A reversal of a vasectomy is required in about 3% of men who undergo vasectomy (1). We set out to examine the relationships between the age at which vasectomy was performed and the interval before subsequent reversal within the context of the armed forces. Thirty seven patients were identified from hospital records, as having undergone a reversal of vasectomy in the preceding two years, and thirty one sets of notes were available for inspection. Ages at vasectomy and at reversal were recorded and, where stated in the notes, if there had been a change in partner prior to the reversal request. Twelve (39%) men were under the age of thirty years at the time of their vasectomy, with a mean time to reversal of 4.4 years. Nineteen (61%) were over the age of thirty years at time of the vasectomy and their mean time to reversal was 7.2 years. Where recorded, the reason for requesting a reversal was a change in partner in 90% of men.

Men who had their vasectomies before reaching the age of thirty were more likely to undergo reversal in a significantly shorter period of time when compared to those over thirty years. The disseminated criteria for vasectomy should be adhered to and appropriate preoperative counselling by surgeons may be useful.
Poland’s Syndrome And Military Personnel
Authors: Phaltankar PM , Langdon J , Clasper J
Published: March 2013

We describe three cases of undiagnosed Poland’s syndrome in Army personnel and discuss their fitness according to the PULHHEEMS system. This syndrome has variable clinical features that include unilateral chest wall and upper limb abnormalities. The syndrome is not hereditary and is of unknown origin. If the syndrome was diagnosed prior to enlistment the potential recruit would normally be graded P8, and unfit to enlist. However, these individuals had managed to pass routine medical examination as well as successfully complete basic training. The suitability of continuation in the army of personnel with Poland’s syndrome is discussed.
The Evolution Of Casualty Evacuation In The 20th Century (Part 5) - Into The Future
Authors: Bricknell MCM
Published: March 2013

This is the final part of a series of papers that review the evolution of the military casualty evacuation system in the 20th Century. This paper draws together the themes that have been presented in the previous papers to describe the mandatory functions of such a system. The forward surgical hospital is the key treatment node if wounded soldiers are to have the maximum chance of survival. Suggestions are made for the minimum size, organisation and clinical capability of such a military medical unit. However, the majority of military casualties are likely to be less seriously injured or non-trauma cases. The casualty evacuation system must also have sufficient capacity to accommodate these patients.
Clinical Findings In 111 Ex-Porton Down Volunteers
Authors: Lee Harry A , Gabriel Roger , Bale Amanda J , Welch Dawn
Published: March 2013

Objective

To determine whether the health of Porton Down volunteers (PDV) has suffered as a result of their participation in medical trials, during which they were exposed to single low dose concentrations of chemical warfare agents.

Methods

Data were obtained from a self-selected series of ex-Porton Down volunteers who attended the MOD’s Porton Down Volunteers’ Medical Assessment Programme (PDVMAP). One hundred and eleven men attended with a mean age of 62 (range 37-81) years. Information obtained was analysed to determine whether clinical diagnoses and symptoms reported had any relationship to chemical exposures.

Results

The diagnoses were not unusual for UK nationals with a mean age of 62 years. The majority of volunteers went to Porton Down in the 1950s and then had a mean age of 19. The mean time between volunteers attending Porton Down and coming to MAP was 42 years. We found no correlation between chemical exposures and later development of established diagnoses, a latent period of 30 years.

Conclusion

On a clinical basis, no evidence was found to support the hypothesis that participation in Porton Down trials produced any long-term adverse health effects or unusual patterns of disease compared to those of the general population of the same age.
An Outbreak Of Campylobacteriosis Amongst Directing Staff And Students At The Infantry Training Centre, Brecon, Wales, March 2004
Authors: Hennessy EP
Published: March 2013

A cohort study was undertaken to determine the source of an outbreak of gastrointestinal illness affecting a number of military personnel at ITC, Brecon during the period 19-30 March 2004. Of 105 soldiers on a field training exercise over the period 15-19 March 2004, 36 subsequently developed symptoms. Nine patients had Campylobacter sp identified in their stool. Water was provided from a single source. This water was used for washing, shaving, drinking and the preparation of rations. Although not statistically significant, epidemiological investigation suggests that the water may have been the vehicle of infection.
Hypertonic Saline
Authors: Smith J E , Hall M J
Published: March 2013

The optimal fluid for the resuscitation of critically ill and injured patients remains the subject of considerable controversy. Hypertonic crystalloid solutions such as hypertonic saline provide rapid volume expansion, have an acceptable safety profile, and are easy to store and transport. Recent meta-analyses suggest a trend toward increased survival in patients given hypertonic saline, and it has been suggested that they may have particular benefit in certain groups of patients such as hypovolaemic head injury patients. This short review examines the physiological and experimental evidence supporting the use of hypertonic saline in fluid resuscitation.
Training Injuries – How Clinicians Can Help Commanders Avoid Them
Authors: Cordell R F
Published: March 2013

The aim of this paper is to reflect on the proceedings of three training injuries symposia run by the British Army’s training organization from 2001 to 2003. The essence of the presentations are reproduced, highlighting the role of medical staff in advising commanders on how injuries might be prevented. The importance of placing the emphasis on prevention rather than rehabilitation as a means of reducing the impact of training injuries is first examined. Pre-employment medical selection standards, the design of training courses, nutrition, smoking, training injuries among women, heat injury and the psycho-social environment are then all reviewed. Finally, the outcome of workshop discussion groups are presented as practical guidance for medical officers and other clinicians, advising commanders on how training injuries amongst their personnel might be minimised.
EX SAIF SEREEA II - The Field Hospital Clinical Report
Authors: Bricknell MCM , Wright LA
Published: March 2013

This paper places on record the clinical activity of the hospital facilities run by 22 Field Hospital on Exercise SAIF SEREEA II in Oman from August to November 2001. There were 1322 episodes of illness resulting in a hospital admission. The mean rate of admission was 1.96 patients per thousand per day (SD 13.62). The main causes of admission were gastrointestinal illness, conditions related to the heat and injuries. The reporting of health service utilisation data is an important duty of medical personnel during overseas deployments in order to add to the dataset available for the estimation of medical workload for future operations.
Paediatric Casualties During OP TELIC
Authors: Gurney I
Published: March 2013

Aim

To audit all paediatric attendances to a British Army Field Hospital during warfighting.

Population

All patients <16-years-old who presented to 34 Field Hospital Accident & Emergency (A&E) Department during warfighting phase of OP TELIC (27 Mar 03 to 01 May 03).

Method

A retrospective analysis of A&E attendance register, A&E clinical records, and A&E trainees’ logbooks from the department of 34 Field Hospital.

Results

Seventy eight children were treated, mean age 7.9 years. 65.4% were male and 34.6% female. Children accounted for 2.9% of all patients (total attendances 2720) and 32.9% of noncoalition patients (non-coalition attendances 237). 44 (56%) children had burns as the principal injury; 7 (9%) had shrapnel injuries, 5 (6%) had blunt trauma from a road traffic accident. Only one child had GSW. 17% of attendances were related to ‘medical’ complaints rather than trauma. 78% of children required transfer to a specialist facility.

Conclusions

Recognition of the potential for paediatric casualties is required to facilitate appropriate planning, training and equipping of medical units deployed on future operations.
Gender Differences In The Cause Of Low Back Pain In British Soldiers
Authors: Strowbridge N F
Published: March 2013

Objectives

To explore gender differences in the cause of low back pain in a population of military personnel who are expected to undertake high levels of sport, exercise and physical military training.

Methods

A prospective study of trained British soldiers, with symptomatic low back pain, referred to the Colchester Garrison Sports Injury and Rehabilitation Centre over a four year period.

Results

The study demonstrates that 928 (17.8%) of the 5214 referrals were for new cases of low back pain. The incidence of low back pain in female soldiers is higher than their male counterparts with an odds ratio of 3.17 (95% CI 2.31 – 4.35). There was a highly significant cross gender difference in low back pain caused by activities in the following categories: military physical training (OR 2.65, 95% CI 1.70 – 4.02), work or occupation (OR 2.49, 95% CI 1.56 – 3.87) and off-duty pursuits (OR 2.91, 95% CI 1.72 – 4.72). There was no cross gender difference in low back pain caused by sport, road traffic accidents or activities pre-dating military service.

Conclusions

Female soldiers are significantly more likely to suffer low back pain as a result of physical military training, their occupation, or off-duty activities. Sporting activities do not cause low back pain in women to a greater extent than men. By demonstrating the scale of the problem and by determining of the cause of injury, it should now be possible to propose methods of effective intervention to reduce injury, implement those interventions and audit effectiveness.
Diagnosis And Outcome Of Psychiatric Referrals To The Field Mental Health Team, 202 Field Hospital, Op Telic I
Authors: Scott JN
Published: March 2013

Objectives

To assess referrals to a Field Hospital Mental Health Team (FMHT), assign a diagnosis, provide appropriate treatment, and decide whether suitable for safe return to unit in theatre (RTU), or evacuation home on psychiatric grounds (evac).

Methods

All documented referrals to the FMHT of 202 Field Hospital during the Op Telic 1 study period of 17 March (day 1) to 23 July 2003 (day 129) were included. Data were collected on rank, gender, diagnosis, outcome (whether RTU or evac), and whether TA before mobilisation. Diagnosis was assigned by ICD-10 criteria.

Results

The FMHT documented 170 cases, 12 of whom were seen twice and one on three occasions, resulting in 184 referrals, all of whom were British. The commonest diagnosis was adjustment reaction (F43), accounting for 68% of all cases (n=116). These were divided between chiefly theatre-related (n=77) or chiefly home-related (n=39) reactions. The majority (94%) of these cases were RTU. Referrals where the diagnosis was a Depressive disorder (F32, n=23) or Intentional self-harm (by sharp object, X78, n=7) were evacuated. Outcome was similar for Regular and TA personnel, with on average 72% of cases RTU. The majority of cases seen were ORs, reflecting their numbers in theatre. Only 14 NCOs and 14 officers were referred. Thirteen of the latter were TA before mobilisation. Gender was not associated with outcome, or TA status, but was associated with rank, in that significantly more female officers were referred. The FMHT role tasks emerged as (a) psychiatric triage and treatment, (b) psychological support of hospital staff, and (c) welfare and pastoral care liaison.

Conclusion

The utility of the psychiatric management model employed, built upon previous military medical doctrines, was tested in a modern theatre of conflict, and seemed to prove its worth.
Specialist Physiotherapists In Orthopaedic Triage - The Results Of A Military Spinal Triage Clinic
Authors: Heywood J W
Published: March 2013

Changes in professional boundaries have allowed many of the tasks traditionally undertaken by doctors to be delegated to Nurses and Allied Health professionals. The employment of an appropriately experienced specialist physiotherapist in orthopaedic clinics in the NHS to triage patients is well established. This paper examines the background, establishment and outcomes of the use of a Physiotherapist Extended Scope Practitioner (ESP) in the Orthopaedic Department at the Royal Hospital Haslar, Gosport. The ESP post at RH Haslar has evolved in the five years since its implementation in 2000. All military patients referred to RH Haslar Orthopaedic Department with spinal, predominantly low back, pain are assessed in the Military Spinal Triage Clinic. The Physiotherapist ESP case-manages patients with access to radiological and haematological investigations and onward referral to other specialities as appropriate. Between July 2003 and December 2004, 235 new patients were assessed. Only 25 patients required review by the consultant spinal surgeon and 5 were referred to non-spinal orthopaedic consultants with shoulder/hip pathology. A total of 18 patients were referred to Pain Clinic and 3 patients to Rheumatology, indicating that nearly 90% (n=210) of patients who would previously have been reviewed by a consultant spinal surgeon could be managed by a Physiotherapist ESP. The waiting time to spinal surgery has reduced from approximately 8 months to between 6 and 16 weeks. An appropriately trained specialist physiotherapist is clinically and economically appropriate to manage patients in an Orthopaedic Department. This has important implications for optimising patient management and additionally supports the wider clinical employment of senior military physiotherapists.
Critical Care Delivery: The Experience Of A Civilian Terrorist Attack
Authors: Shirley PJ
Published: March 2013

It has been recognised for some time that a terrorist incident was threatened in the UK and it has been noted previously in the JRAMC that the locations for terrorist atrocities are likely to be more diverse than previously experienced (1). July 7th 2005 witnessed the first terrorist suicide bombing on the UK mainland, targeting the public transport system in London. These attacks were unprecedented in both scale and intensity but they were anticipated in London. However there were clear difficulties, relating to multiple sites, their location underground and early problems with communication (2). This article highlights some of the experiences and learning points of the Intensive Care Medicine Service at the Royal London Hospital (RLH) in the wake of the July 7th bombings. The RLH was the single biggest receiver of casualties (195); seven of whom were admitted to the Intensive Care Unit.

The Defence Medical Services have tri-service representation (both regular and reserve) at the RLH in Emergency Medicine and Pre-hospital Care, Surgical Services and Intensive Care Medicine.
African Trypanosomiasis In A British Soldier
Authors: Croft AM , Jackson CJ , Friend HM , Minton EJ
Published: March 2013

Background

Human African trypanosomiasis (sleeping sickness) is a parasitic infection transmitted by day-biting tsetse flies. The diagnostic gold standard is microscopy of blood, lymph node aspirates or CSF. The disease is invariably fatal, if not treated. There are over 300 000 new cases of sleeping sickness each year, and approximately 100,000 deaths.

Case presentation

We describe a British soldier who acquired trypanosomiasis in Malawi. He gave no history of a painful insect bite but presented with classical early signs of sleeping sickness (a primary chancre, regional lymphadenopathy, circinate erythema and a cyclical fever pattern). His condition worsened in the next week and trypanosomes were observed in a blood sample. He was aeromedically evacuated to Johannesburg, where Stage One Trypanosoma brucei rhodesiense infection was confirmed; he also had renal and liver failure, pancytopenia and heart block. He was treated with intravenous suramin. He recovered fully over the next 5 months.

Recommendations

Medical officers deploying to eastern and southeastern Africa must be familiar with the common presenting signs and symptoms of T b rhodesiense sleeping sickness, and should have access to a reliable local microscopy service at all times. Confirmed sleeping sickness requires immediate transfer to a tertiary diagnostic and treatment centre, where suramin (for T b rhodesiense infection) or pentamidine (for T b gambiense) and also melarsoprol (for Stage Two disease) must be immediately available.
BATLS/BARTS Training in Lithuania
Authors: Molde Å , Milasius S , Lundberg L
Published: March 2013

Objective

In order to train medical personnel properly for future international missions the Lithuanian Armed Forces decided to adopt BATLS/BARTS as a basic course for military pre-hospital trauma care. This decision was based upon the increasing Lithuanian participation in international missions as a part of multinational units. Another important reason was the personal experience of the course concept acquired in Sweden in 2001 by five Lithuanian medical officers.

Methods

Similar to the way BATLS/BARTS was introduced in Sweden, a regular Swedish course (as given in Sweden for own units prior to international missions) was given in Lithuania. The faculty consisted of three experienced instructors from Sweden, and the two Lithuanianmedical officers who had previously taken the BATLS course and the BATLS instructor course in Sweden.

Results

Two BATLS/BARTS courses have been given in Kaunas, Lithuania. A total number of eight medical officers, nine military nurses, five medics, three civilian doctors and four medical students have taken the course. Some of these (fourmedical officers, twomilitary nurses and two medics) have later been deployed to Afghanistan, Iraq and Kosovo, where the Lithuanian units have been collaborating with British, Danish, Polish and Czech-Slovakian units.

Conclusion

As internationalmissions becomemultinational, it is essential there is full confidence in the level of training and preparedness among all units working together. One way to achieve this is through bi – or multinational training as described in this paper.
Respiratory Protection for Health Care Workers
Authors: Greaves I , Byers M
Published: March 2013

Chemical, Biological, Radiological and Nuclear incidents are rare, but the likelihood of any medical facility having to deal with contaminated or contagious casualties is not, Health Care Workers (HCW) often being exposed to infectious or toxic substances. Although medical staff routinely take measures to protect themselves against exposure to infection by wearing protective clothing, they rarely consider the inhalational route as a threat. This paper presents a series of cases where HCW’s have been exposed to toxic or infectious material through the respiratory route, discusses standards of respiratory protection and describes how this risk can be mitigated to protect medical personnel.
Attendances at a Field Hospital emergency department during operations in Iraq November 2003 to March 2004 (Operation Telic III)
Authors: Reavley PDA , Black JJM
Published: March 2013

Objective

This study investigated the types of presentations; time lines and disposal of patients from the international, local and military community in Southern Iraq.

Methods

All presentations to the Emergency Department (ED) were clinically and demographically coded and entered onto an electronic database.

Results

During the period studied the emergency department dealt with 1455 new presentations of which 75% were UK Armed Forces personnel.

Conclusions

This represented a busy period in the field hospitals time in Iraq and offered valuable training to emergency medicine trainees in an unusual environment.
New and Emerging Concepts in Travel Medicine
Authors: Lamb L , Nicol Ed
Published: March 2013

The following article summarises the proceedings of the Travel Medicine Study Day run by the Haywood Club Tri-Service Medical Society at the Medical Society of London on 23 November 2006. The event was attended by over 50 serving and retired DMS personnel, including nurses, MSO’s and medical officers and included talks on the historical contribution of the military medical services to the evolution of tropical medicine, the changing face of worldwide illness and insights into the behaviour of travellers that may increase their risk of illness.