bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic disclosure and quality of life in palliative care: a systematic review
Authors: Wattanapisit Sanhapan , Wagland Richard , Hunt Katherine 
Published: November 2020

IntroductionPrognostic disclosure is an important component of communication in palliative care. Disclosing information on poor prognosis may affect quality of life (QoL) of palliative care patients. However, the effects of prognostic disclosure on QoL across different cultures and countries are unclear.ObjectiveTo review the effects of prognostic disclosure on QoL of palliative care patients.MethodsA systematic review was conducted across seven databases (AMED, CINAHL plus, Cochrane Library, Medline (via the PubMed interface), Embase, Scopus and Web of Science). All primary studies, of any design, that explored the effects of prognostic disclosure on QoL of adult palliative care patients were eligible.ResultsA total of 1926 records were screened for eligibility. Twenty-five articles were included (11 cross-sectional, 10 cohort, 3 mixed methods and 1 qualitative study). Studies were conducted in 11 countries. Five studies reported the sources of prognostic disclosure, while 20 studies did not. Emotional QoL was the most reported domain among the studies. The effects of prognostic disclosure on emotional aspects, overall QoL and other domains, including symptoms, physical functions, role functions, social functions and cognitive functions, were inconsistent.ConclusionsThe effects of prognostic disclosure on QoL across cultures and countries are inconsistent. Cultural differences are not sufficient to explain the effects. Future research is needed to explore the association between prognostic disclosure and QoL, and develop tools to support clinicians to share prognostic information in the most sensitive and supportive way.
Antimicrobial use at the end of life: a scoping review
Authors: Fairweather Jack , Cooper Lesley , Sneddon Jacqueline , Seaton R Andrew 
Published: November 2020

ObjectiveTo examine antibiotic use in patients approaching end of life, in terms of frequency of prescription, aim of treatment, beneficial and adverse effects and contribution to the development of antimicrobial resistance.DesignScoping reviewData sourcesAn information scientist searched Ovid MEDLINE, Ovid EMBASE, The Cochrane library, PubMed Clinical Queries, NHS Evidence, Epistemonikos, SIGN, NICE, Google Scholar from inception to February 2019 for any study design including, but not limited to, randomised clinical trials, prospective interventional or observational studies, retrospective studies and qualitative studies. The search of Ovid MEDLINE was updated on the 10 June 2020.Study selectionStudies reporting antibiotic use in patients approaching end of life in any setting and clinicians’ attitudes and behaviour in relation to antibiotic prescribing in this populationData extractionTwo reviewers screened studies for eligibility; two reviewers extracted data from included studies. Data were analysed to describe antibiotic prescribing patterns across different patient populations, the benefits and adverse effects (for individual patients and wider society), the rationale for decision making and clinicians behaviours and attitudes to treatment with antibiotics in this patient group.ResultsEighty-eight studies were included. Definition of the end of life is highly variable as is use of antibiotics in patients approaching end of life. Prescribing decisions are influenced by patient age, primary diagnosis, care setting and therapy goals, although patients’ preferences are not always documented or adhered to. Urinary and lower respiratory tract infections are the most commonly reported indications with outcomes in terms of symptom control and survival variably reported. Small numbers of studies reported on adverse events and antimicrobial resistance. Clinicians sometimes feel uncomfortable discussing antibiotic treatment at end of life and would benefit from guidelines to direct care.ConclusionsUse of antibiotics in patients approaching the end of life is common although there is significant variation in practice. There are a myriad of intertwined biological, ethical, social, medicolegal and clinical issues associated with the topic.
Role 2 Afloat in a Type 45 destroyer: return to contingency
Authors: Mellor A , Coltman T , Taylor P , Wilkins E , Jones G , Borrough T , Newlands K , Connor D 
Published: November 2020

AbstractRole 2 Afloat (R2A) is an established part of maritime capability whose teams have provided medical support to a number of deployed operations in the recent past. This article describes the capability and constraints of a limited R2A facility embarked on HMS DIAMOND in order to support Royal Marine and Royal Navy boarding teams during Operation LITTEN. The combination of having experienced medical staff, adjusting the medical equipment carried and planning for a limited scenario enabled a bespoke R2A capability to be established on a previously untested platform at short notice. It provides a model for similar future deployments.
The Maritime Medical Emergency Response Team: what do we really need?
Authors: Mercer S J , Khan M A , Hillman C M , Robin J , Matthews J J , Mercer S J 
Published: November 2020

AbstractSince 2006, the Defence Medical Services (DMS) pre-hospital care focus has been the Medical Emergency Response Team (MERT), which has enabled the projection of Damage Control Resuscitation (DCR) to the point of wounding as part of consultant-delivered care. Now in a period of contingency operations, the Royal Navy (RN)’s Role 2 medical capability, Role 2 Afloat (R2A) delivers DCR (including surgery) on a maritime platform. This article will focus on the development of the Maritime MERT component of R2A (termed Maritime In Transit Care (MITC) in Maritime Medical Doctrine) and will discuss the requirements based on experience of and preparation for an operation in 2016. Also discussed are the individual competencies and training required to be part of the Maritime MERT; it is hoped that this will simulate debate around this evolving team.
The unexpected challenges for a doctor in the remote operational military environment
Authors: Swain C S 
Published: November 2020

AbstractThe enclosed environment of a warship amplifies many recognised issues within medical practice, such as medical confidentiality, the conflicts within the doctor-patient relationship, and the impact of social interaction with patients, reflection on which can lead to adaptations in personal working practices within the military setting. Initial concerns about those deploying early on in their career may focus on medical knowledge and ability, but it is important to be aware of the unforeseen, multi-factorial, psychosocial and logistical challenges which are more likely to surface in the remote military environment.
The role of the operating department practitioner on board Role 2 Afloat
Authors: Stables A , Seal G , Mercer S J 
Published: November 2020

AbstractThe Role 2 Afloat (R2A) is the Royal Navy (RN)’s Damage Control Resuscitation (DCR), including Damage Control Surgery, capability at sea. There are currently three operating department practitioners (ODP) in the deployed team. This article describes the role of the ODP in this team and the training which is required to fulfil this role.
Conditions of the external and middle ear: an overview of presentation, management and associated complications
Authors: Shukla R , Easto R , Williams R 
Published: November 2020

AbstractEar, nose and throat (ENT) presentations to primary care are common and frequently affect military patients. Many patients can be managed in primary care with appropriate treatment, but some presentations require appropriate, timely, and occasionally emergency onward referral for hospital management. This paper discusses the management of common otological presentations including otitis externa (OE), acute otitis media, chronic suppurative otitis media (including cholesteatoma), tympanic membrane (TM) perforations and pinna haematoma.
Medical support to Operation CORPORATE
Authors: Penn-Barwell J G , Jolly R , Rickard R 
Published: November 2020

AbstractThis article describes the medical support to Operation CORPORATE, and is derived from a range of sources, including surgical operative logbooks, journals and contemporaneous official reports.Eight hundred and fifty-five surgical procedures were performed by deployed medical units between 14 May and 13 July 1982 in support of Op CORPORATE. The rate peaked on the busiest day, 12 June 1982, when 86 operations were performed. The vast majority of operations were wound management procedures, although 20 laparotomies, four thoracotomies and six craniotomies were also performed. The four forward Role 2 (R2) surgical facilities at Ajax Bay, Teal Inlet, Fitzroy and on board SS CANBERRA collectively performed 354 operations.Argentine and British casualties were evacuated from the area of operations on board three Argentine vessels and three British HECLA-class survey ships. Between them, HMSs HECLA, HYDRA and HERALD made a total of nine 1000-NM journeys between the Falkland Islands and Montevideo, Uruguay, caring for a total of 601 patients. From Montevideo, British casualties were transferred by RAF VC-10 back to the UK.Reflection on how a previous generation supported this operation may inform decision-making when similar challenges are faced in the future.
Femoral neck stress fractures from long distance running: a case series
Authors: Robertson G A J , Arthur C H C 
Published: November 2020

AbstractFemoral neck stress fractures (FNSFs) comprise 3% of all sport-related fractures, and 8% of military stress fractures. They are associated with significant morbidity; if they develop subsequent avascular necrosis of the femoral head, from late detection and fracture displacement, they require a total hip replacement in a young active individual.Knowledge of the different patterns of FNSFs, their varying presentations and their different management techniques is key for sports and military health professionals involved in the care of these injuries, to ensure optimal treatment and outcome.We report four cases of FNSFs from long distance running. Three of the four athletes returned to long distance running following their injury at mean of 7 months; however, despite two athletes participating in marathon running pre-injury, none returned to marathon running post-injury.All clinicians involved with such patients should always remain vigilant for FNSFs in any patient who presents with exercise-related hip or groin pain.
Chronic exertional compartment syndrome: diagnosis, investigation, management and return to training
Authors: Thomas R L , Hemingway R , Keenan A , Wood A 
Published: November 2020

AbstractExercise-induced leg pain is a frequent presenting complaint in military recruits. This has several causes, including chronic exertional compartment syndrome (CECS). The pathophysiology of CECS is debated, but it involves pressure increases in particular compartments and reduced compliance in the epimyseal fascia. Its morbidity and poor outcomes with conservative management lead to extended rehabilitation times, and ultimately to a loss of recruits from training. It has been described in various compartments of the upper and lower limbs, but is most frequently encountered in the leg. It is a condition often encountered in the military recruit, and within this demographic is less common than other causes of exertional lower leg pain. However, its debilitating nature and complicated investigative pathway can cause difficulties, and have notable occupational consequences. This article aims to review the evidence surrounding its diagnosis, treatment, prognosis and the implications for the military patient.
A model for testing topical haemostatic dressings for peripheral extremity haemorrhage following amputation
Authors: Welch M , Barratt J , Martin S , Wright C 
Published: November 2020

AbstractAimsTo assess the viability of a peripheral extremity amputation and haemorrhage model for testing topical haemostatic dressings, and secondarily to test whether a topical haemostatic dressing would arrest bleeding and maintain haemostasis without a tourniquet in this model.MethodsAn animal model was used during proof of principle model development. Bilateral through-elbow amputations were performed on a single swine under anaesthetic and treated with application of Celox Rapid topical haemostatic dressing (Celox gauze) to the stump after 30 seconds of free bleeding. Following initial haemostasis, the wound sites were bandaged using standard trauma dressings. Vital signs were monitored throughout the study.ResultsThe animal survived and, in both amputations, haemorrhage was successfully controlled. There was no evidence of re-bleeding during the 30 minutes post-injury or following removal of the packed Celox gauze from the wound sites.ConclusionTopical haemostatic dressings could be considered alongside tourniquets for use as a primary treatment of peripheral extremity haemorrhage due to traumatic amputation. It may be useful in prolonged field care where evacuation is delayed or where tourniquet alone does not provide adequate haemorrhage control.
Non-visible haematuria in a military setting
Authors: O’Brien D , Houlberg K 
Published: November 2020

AbstractAsymptomatic non-visible haematuria is a common finding at routine military medical examinations. This article briefly reviews the possible causes, which include malignancy, structural causes, exertion haematuria, hereditary nephritis, thin basement membrane disease (TBMD), immunoglobulin A nephropathy (IgAN), tuberculosis (TB) and schistosomiasis. This paper discusses how these conditions may affect potential military recruits as well as currently serving members of the Armed Forces, and offers a general approach to the management of a patient with non-visible haematuria.
Alcohol-related liver disease
Authors: Freshwater D A , Micklewright S 
Published: November 2020

AbstractAlcohol-related liver disease (ARLD) is the most prevalent cause of advanced liver disease in Europe. The spectrum of disease includes alcohol use disorders, alcohol withdrawal, steatosis, alcoholic hepatitis and cirrhosis of the liver. This article describes these clinical presentations and outlines the appropriate management of alcohol-related liver disease, as well as providing a framework for the management of alcohol use disorders.
Is nutrition in the trauma patient optimally managed?
Authors: Segaran E , Khan M A 
Published: November 2020

AbstractThe fields of civilian and military trauma management have evolved over the years into a multidisciplinary approach, extending beyond immediate lifesaving resuscitation to definitive treatment and rehabilitation. Despite advances in the field of trauma, some aspects of the injured patient’s care, including the provision of adequate nutritional support, continue to represent a significant challenge. This article endeavours to provide an overview of the problems faced in managing nutrition in a trauma patient, and the relevance to the military operational context.
The United States Military Mountain Medicine Course and its relevance to the United Kingdom armed forces
Authors: Mackey J 
Published: November 2020

AbstractWorking in mountainous terrain, often at high altitude, presents a unique set of challenges to military medical personnel both in deployed roles and on adventurous training expeditions. Courses such as the increasingly popular Diploma in Mountain Medicine can provide clinicians with the knowledge and skills required to work in this environment. This article describes the current provision of mountain medicine education in the United Kingdom (UK). It also details the United States Military Mountain Medicine course as an example of military specific mountain medicine training and its relevance to UK armed forces medical personnel.
Ajax Bay
Authors: Jolly R T 
Published: November 2020

SummaryAs a result of fierce aerial attacks on the fleet supporting the landing force on Friday, 21 May 1982, SS CANBERRA was ordered to sail from San Carlos Water. Elements of her medical organisation were hurriedly put ashore into a deserted refrigeration plant at Ajax Bay. Three weeks later they had treated over 650 battle casualties, performed 210 operations under general anaesthetic, and been bombed by Argentinian aircraft. Despite appalling circumstances, their results were a triumphant success. As Officer Commanding Medical Squadron, Commando Logistics Regiment RM, the author was in charge at Ajax Bay throughout the land phase of hostilities.
Upper limb reconstructive transplantation in military recipients
Authors: Fries C A , Stark H L , Tuder D , Iyer S , Gorantla V S , Davis M R , Rickard R F 
Published: November 2020

AbstractLessons from conflict have contributed to military medical advances which have significantly improved the survivability of critically injured servicemen and women. However, survival following such severe combat polytrauma is often associated with devastating tissue loss and functional deficits that challenge conventional reconstruction. Despite recent advances, upper extremity prosthetic alternatives lack the fidelity to restore the complex intrinsic and sensory function of the human hand. Upper Limb Reconstructive Transplantation, or Vascularised Composite Allotransplantation (VCA), is currently an experimental procedure offering superior anatomical and functional outcomes compared to prostheses.Military candidates for VCA usually enjoy high pre-morbid fitness, mental health resilience and support, and relatively rich provision of rehabilitation. However, co-morbidities of polytrauma, such as traumatic brain injury and post-traumatic stress disorder, may have an impact on outcomes.Since 1998, over 120 upper limb transplants have been performed worldwide. Of these, six have been performed on servicemen and women across three continents. The morbidity and mortality associated with the requirement for lifelong immunosuppression, however, continues to skew the risk-benefit considerations of these promising procedures when compared to prostheses. Thus, although the technical surgical feasibility of upper limb and other VCA such as face, abdominal wall, uterus and penis transplants has been established over the past decade, these procedures remain restricted to recipients fulfilling stringent inclusion criteria.We review the current state of VCA in military recipients, and summarise ongoing collaborative VCA research conducted by British and American military medical teams.
Hypokalaemic ECG changes secondary to intramuscular adrenaline after a snake bite in Sierra Leone
Authors: Williams A 
Published: November 2020

AbstractThis case report describes a young UK military medic who suffered a snakebite while working in Sierra Leone. He was given intramuscular adrenaline (epinephrine) and was subsequently found to have hypokalaemia, hypoglycaemia and a wide pulse pressure. His ECG showed changes typical of moderate hypokalaemia.
In-situ simulation: a review of Role 2 Afloat team training in HMS QUEEN ELIZABETH during WESTLANT 18
Authors: Bott G , Matthews J J 
Published: November 2020

AbstractThe maiden deployment of HMS QUEEN ELIZABETH (WESTLANT 18) was supported by a Role 2 Afloat (R2A) team. This deployment enabled the first of class fixed wing flying trials for the F35-B Lightning and gave the deployed team the opportunity to establish the R2A capability within the Carrier Strike Group. During the deployment the team engaged in continuous medical education and training. This paper describes the experience of the team utilising in-situ simulation techniques, which had not been used before on a R2A deployment. In particular, a high fidelity in-situ simulation exercise (Ex POSEIDON) was enabled with the support of the US Navy, and the lessons identified from this are described.
Ebola Virus Disease - clinical manifestations, management and future therapies
Authors: O’Brien D , O’Shea M K , Fletcher T E 
Published: November 2020

AbstractThe largest epidemic of Ebola Virus Disease in recorded human history occurred in West Africa in 2014 and resulted in significant morbidity and mortality. The causative pathogen, Ebola virus, is readily transmitted through contact with the body fluids of infected individuals and from the bodies of those who have died from the disease. In its early stages, the illness is characterised by non-specific symptoms that mimic many other endemic infectious diseases in countries with limited healthcare resources. These factors contributed to the rapid spread of the outbreak, which required an international response in which the UK Armed Forces played an important role. This review describes the clinical presentation, lessons learned from managing the West African outbreak, and potential future treatments.
Efficacy of pre-hospital fracture manipulation following ketamine administration: the experience of a single civilian air ambulance trust
Authors: Follows A , James R H , Vassallo J 
Published: November 2020

AbstractAimsLimb fractures are common in pre-hospital care and can be associated with significant haemorrhage and neurovascular compromise. The pre-hospital management of these injuries centres around reduction and splinting. The aim of this study was to quantify the effectiveness of pre-hospital reduction of displaced fractures or dislocations and the incidence of the need for further manipulation in the emergency department.MethodsA three-year retrospective database analysis was conducted for all patients sustaining limb injuries who were attended by a single air ambulance and subsequently conveyed to the regional major trauma centre. Only patients who received ketamine, either as an analgesic or sedative, were included. Pre-hospital clinical records and emergency department (ED) notes were examined to determine outcomes.ResultsOver the study period, 122 patients sustained a limb injury and received ketamine; ED notes were available for 96 (78.7%). Of these, the majority (n=51, 41.8%) received ketamine for analgesia with n=10 (8.2%) receiving it to facilitate manipulation. The principal indication for pre-hospital manipulation was neurovascular compromise (n=7, 70.0%). Of those undergoing manipulation pre-hospital, the majority (n=7, 70.0%) required further manipulation in the ED.ConclusionPre-hospital manipulation by our regional air ambulance is a relatively low frequency event and in those undergoing a manipulation, a high proportion require further intervention in the ED or operative intervention within the acute phase of care.
Medical leadership and management for military clinicians
Authors: Cottey L , Lillington C , Frost E 
Published: November 2020

AbstractThe development of medical leadership and management skills is an essential requirement for the progression of Defence Medical Services personnel in both military and medical training. This review will summarise how military experience can contribute to achieving medical leadership and management competencies and will signpost further opportunities and resources available. While it specifically focuses on doctors, this article has relevance to all Defence Healthcare Professionals.
How do you solve a problem like… missing data? Lessons from the PAin SoluTions In the Emergency Setting (PASTIES) trials
Authors: Smith J E , Creanor S , Rockett M , Ewings P 
Published: November 2020

AbstractWhen studies measure the effect of a treatment longitudinally over time, multiple data points are generated, but are sometimes incomplete. This may affect studies in a range of different settings, including studies on military patients. When analysing the data from such a study, one of the challenges is how to deal with missing data points in the final analysis. This article describes the possible different ways of dealing with missing data points in such a context, and outlines some pragmatic methods used for handling missing pain scores in the recent PAin SoluTions In the Emergency Setting (PASTIES) trials.