bluuebunny/crossref_metadata_2025_split huggingface dataset:
The adverse effects of mefloquine in deployed military personnel
Authors: Adshead S 
Published: February 2021

AbstractIntroductionMefloquine (Lariam®) is an effective anti-malarial prescribed to over 35 million travellers world-wide as chemoprophylaxis. However, it has been the subject of increased scrutiny and media attention due to its association with significant neuropsychiatric adverse events. Anecdotal evidence suggests that patient trust in the drug is waning.MethodsA prospective questionnaire-based cohort study of 150 deployed military personnel prescribed mefloquine as anti-malaria chemoprophylaxis. The primary study objective was to assess the rate of adverse reactions. In addition, an audit of mefloquine prescriptions and subsequent patient follow-up was conducted.ResultsAmong a cohort of 111 individuals taking mefloquine, 54% reported at least one adverse effect and 13% required a change in prescription to a second-line anti-malarial, due to significant side-effects. All females prescribed mefloquine reported at least one adverse reaction. There were two cases of clinically significant adverse reactions.ConclusionsThere was a higher rate of adverse events reported amongst deployed military personnel than has been reported among civilian patients. This may be partly due to the stressful environment in which deployed personnel operate.
The recognition and management of body temperature disturbances in Royal Navy personnel
Authors: Angus DJC , Oakley EHN 
Published: February 2021

AbstractThis article discusses hypothermia and hyperthermia, described together as thermal illness. These conditions are seen within the United Kingdom (UK) Armed Forces population at home and abroad and may endanger life, with significant implications for both the individual and the chain of command. Recognition and management from initial presentation to return to duty is discussed and guidance given on occupational considerations.
Shin-splints: Common exercise-related syndromes affecting the lower leg
Authors: Williamson BL , Arthur CHC 
Published: February 2021

AbstractLower leg pain is a common complaint of athletically active individuals, often limiting physical activities. As such, the group of lower leg conditions related to athletic pursuits and physical exercise confer considerable operational implications for the military. Whilst acute injuries to the lower limb are commonly encountered and are clearly of significance, this article focuses instead on chronic conditions related to physical activity. These include insults to bone such as stress fractures and medial tibial stress syndrome, and those related to the soft tissues such as chronic exertional compartment syndrome. In this article we will examine the presentation and management of these conditions.
Musculoskeletal injury patterns associated with military operations
Authors: Scott P J I 
Published: February 2021

AbstractMusculoskeletal injury represents a significant attritional threat to troops on deployment and comprises a significant proportion of aeromedical evacuations from theatre. Whilst the incidence and outcome of battle injury (BI) is increasingly well understood, the picture regarding non-battle injury (NBI) is less clear despite the significantly higher incidence rate. This paper outlines and compares current evidence regarding the incidence, contributing factors and functional outcome of recent operational BI and NBI and highlights the need for further study into UK specific data and demographics.
Acute transfusion reactions: an update
Authors: Scorer T , Doughty H 
Published: February 2021

AbstractOver the last decade the use of blood products by the United Kingdom (UK) military has increased significantly; with the increase in transfusion comes an increased incidence of transfusion-related incidents. Acute transfusion reactions (ATRs) are a common consequence of transfusion, which vary widely in their severity and are likely to be under-reported, although reporting is a regulatory requirement. This paper discusses the importance of identifying ATRs and managing them appropriately. It introduces a flowchart (due to be incorporated in the next version of Joint Service Publication (JSP) 999, Clinical Guidelines for Operations (CGOs)), which is designed to assist the military multi-disciplinary team caring for patients in the operational environment.
Infective skin conditions in an adult sea-going population
Authors: Tanzer J , Macdonald A , Schofield S 
Published: February 2021

AbstractInfective skin conditions represent a significant element of the caseload for sea-going and shore-side clinicians. They are common within the wider military setting due to the frequent requirement to live in close proximity to others in conditions which favour the spread of skin and soft tissue infections (SSTI) (1, 2). Within the UK civilian population, 24% of individuals see their family doctor for skin conditions each year, accounting for 13 million primary care consultations annually. Of these, almost 900,000 were referred to dermatologists in England in 2009-2010 and resulted in 2.74 million secondary care consultations (3).Several recent articles have highlighted the problem of Panton-Valentine Leukocidin Staphylococcus aureus (PVL-SA) infection and carriage in sailors on submarines, and soldiers deployed to Afghanistan (4, 5). However, the majority of published articles relate to land-based military personnel. This article aims to provide an overview of the most common infective skin conditions presenting among Naval personnel (based on the authors’ experience), illustrated by several case studies, together with an approach to their diagnosis and management.
Operation PATWIN: HMS DARING’s experience of providing humanitarian disaster relief following super-Typhoon Haiyan.
Authors: Butterworth S J 
Published: February 2021

AbstractSuper-Typhoon Haiyan struck the Philippines on 7 November 2013. The initial reports estimated 10 000 fatalities and four million displaced persons. As the United Kingdom’s initial response to this disaster, HMS DARING was diverted from her deployment to take part in humanitarian aid, named Operation PATWIN. This article will outline the medical aspects of the relief effort undertaken and aim to identify any lessons that may inform future operations.
The operational role of the Royal Marines Band Service during the contingency era: lessons from Op GRITROCK
Authors: Brisley CR , Duggan A 
Published: February 2021

AbstractThe Royal Marines Band Service (RMBS) deploys in support of the Royal Naval Medical Service in a variety of operational roles. This article describes the roles that RMBS personnel performed whilst deployed on board RFA ARGUS during the recent Operation GRITROCK. The article is divided into five main sections, each describing one aspect of the work that RMBS ranks were asked to undertake: casualty handling; working within Primary Casualty Receiving Facility (PCRF) departments; personal protective equipment (PPE) monitoring and drills; temperature monitoring; and last, but not least, musical support. This will provide the reader with an insight into what the RMBS have achieved whilst deployed on board ARGUS and also what skills they are able to bring, both to contingency operations and operations in the medical environment.
PCRF Pathology, OP GRITROCK – A biomedical scientist’s perspective
Authors: Robinson JP 
Published: February 2021

AbstractThe Primary Casualty Receiving Facility (PCRF) Pathology Department was deployed on Operation GRITROCK from October 2014 to April 2015 to support the medical treatment facility on RFA ARGUS. The department deployed with enhanced microbiology capability and effectively became the microbiology reference laboratory for the Joint Operations Area (JOA). A platelet apheresis capability was delivered in the maritime environment for the first time on an active operation.
Medical supply on contingency military operations: experience from Operation GRITROCK
Authors: Robinson JP 
Published: February 2021

AbstractMedical supply during military operations has the ability to affect the efficacy of the operation being undertaken, either negatively or positively. An appropriately-managed maritime platform with a robust medical supply chain during transit and on arrival in theatre is the main aim. A secure supply chain will reduce any implications that logistics may have with regard to capability, and negate the effects of deficiencies of short shelf life items occurring over time and during use in high tempo operations.
Nurse-delivered focused echocardiography to determine intravascular volume status in a deployed maritime critical care unit
Authors: Hutchings S , Bisset L , Cantillon L , Keating-Brown P , Jeffreys S , Muzvidziwa C , Richmond E , Rees P 
Published: February 2021

AbstractFocused echocardiography is increasingly used by clinicians to guide fluid resuscitation. The UK Defence Medical Services (DMS) have adopted focused echocardiography as a tool to guide flow assessment and resuscitation in deployed critical care. We aimed to explore whether two focused echo techniques, namely Inferior Vena Cava (IVC) and Left Ventricular Outflow Tract Velocity Time integer (LVOT VTi) respiratory variability could be taught to a group of critical care nurses without previous exposure to ultrasound imaging. After a five-week program of training, validation was carried out on healthy volunteers. The mentor, an accredited focused echo trainer, and six nurses performed a total of forty-eight scans on eleven volunteers. The mentor and students acquired subcostal long axis views of the IVC and apical five chamber views using a high frequency linear ultrasound probe. Mean values from three measurements were obtained for IVC diameter and LVOT VTi. Minimum and maximum values were recorded for both variables across a full respiratory cycle. Echo images were saved and at least two images for each student were reviewed offline by an accredited echo-training supervisor. In all cases students were able to obtain adequate echo windows. There was good correlation between values recorded by the mentor and students for both IVC diameter (r=0.90, p<0.001) and LVOT VTi (r=0.77, p<0.001). Bland Altman analysis showed good correlation with minimal bias for VTi measurements. There was some increase in bias for IVC measurements below 1.2 cm. In summary, we found that these skills for assessing intravascular volume status could be acquired in a relatively short time by specialist nurses without previous experience, and that results were comparable to those produced by an experienced practitioner.
Medical reconnaissance for the Defence Medical Services Dhaulagiri Expedition 2016
Authors: Winchester J , Coombs B 
Published: February 2021

AbstractThe formation of a clear and well-informed medical plan is critical to the safe planning and execution of any expedition in remote locations. We performed a reconnaissance of medical facilities in Nepal in March 2015 prior to a large Defence Medical Services (DMS) expedition to the Dhaulagiri area in 2016. Visiting relevant medical facilities in person provides invaluable information and experience of what healthcare services may be relied upon in managing an expedition casualty, in scenarios ranging from minor illness to major trauma. We describe the principles, practice and level of detail required for performing such a medical reconnaissance and illustrate this with examples of our findings from Nepal.
Exercise HIMALAYAN SERPENT: feedback article
Authors: France K , Mellor A 
Published: February 2021

AbstractExercise HIMALAYAN SERPENT was open to junior doctors from the United Kingdom (UK) Armed Forces and aimed to educate potential expedition doctors on aspects of high altitude and wilderness medicine as well as conducting adventurous training (AT) and medical research. This was the first time such an exercise had been undertaken and this article explores the views of those junior doctors taking part to assess whether the exercise met the aims and objectives it set out.
The management of unexplained collapse in service age personnel
Authors: Martin AS , Edgar IA , Walker J 
Published: February 2021

AbstractUnexplained collapse is a common presentation to medical practitioners, with a wide range of differential diagnoses making assessment problematic. Without a methodical approach to the patient presenting with unexplained collapse, potentially life-threatening conditions may not be recognised, whilst benign presentations can be over-investigated. This article will review the assessment, differential diagnosis and management of unexplained collapse, whilst considering the impact in the military environment.
A brown dog tick (Rhipicephalus sanguineus) bite at sea
Authors: Stachow E 
Published: February 2021

AbstractMedical Officers (MOs) and Medical Branch Ratings (MBRs) must maintain an awareness of the risk of vector-borne diseases among deployed personnel.Personnel working in the maritime environment may not expect to be at risk of tick bites, as ticks typically occupy habitats with dense vegetation such as forests or scrub land. However, tick-borne pathogens can cause serious and sometimes fatal disease, and therefore the risk of tick bites and associated diseases should be recognised.We present a case of a tick bite in a member of a ship’s company eight days after leaving port. The tick was identified as a brown dog tick (Rhipicephalus sanguineus), a species known to thrive indoors. We describe several important tick-borne diseases which can be transmitted byR. sanguineusand explore best practice for tick removal and aftercare. Finally, we outline the appropriate management of suspected tick-borne disease in deployed personnel in the maritime environment.
The end for the ‘Roman Sandal’: an observational study of methods of securing chest drains in a deployed military setting
Authors: Howes RJ , Calder A , Hollingsworth A , Jones A 
Published: February 2021

AbstractIntroductionThere is ongoing debate regarding the optimal method of securing chest drains in trauma patients. Various courses describe methods for chest drain insertion, but little has been published to identify the best method to secure the drain.AimThis article aims to examine differences in approach to securing chest drains and the security of the methods used.MethodWhilst in a deployed medical treatment facility, 26 clinicians from various specialties and nationalities were asked to secure a pre-placed drain. A 32F drain was placed in a manikin and the clinicians were given a chance to prepare their equipment. They were given a choice of suture and their attempts were observed by one of the researchers. The attempts were timed and photographed. A second researcher, who had not observed the technique, then assessed the security of the drain.Results15/26 clinicians used a ‘Roman Sandal’ technique with 5/26 proving to be insecure. Other techniques used showed no failure. The rate of consultant‐secured failure was 12.5% compared to 40% for registrars and 33% for General Duties Medical Officers.ConclusionsThe type of suture used made no difference, but the traditional ‘Roman Sandal’ method was insecure. Knots tied close to the skin and those that bit into the drain were shown to be most effective.
Molecular weight of Hydroxyethyl Starch Molecules influences Coagulation Profile measured by thrombelastography
Authors: Felfernig M , Virmani S , Weintraud M , Oberndorfer U , Zimpfer M , Veen H , Blaicher A M 
Published: February 2021

SummaryBackgroundThe consensus about the ideal intravenous fluid in trauma patients remains open. However, hypertonic saline and hydroxyethyl starch (HES) seems to have advantages in terms of immuno-modulatory and haemodynamic effects. Nevertheless clotting abnormalities are frequently reported in association with the use of HES. We investigated the influence of light, medium and heavy molecular weight (MW) hydroxyethyl starch (HES) on coagulation in 29 healthy subjects.MethodsRinger’s lactate (RL) served as a control solution. Thrombelastography using Haemoscope’s Thrombelastograph® (TEG®) hemostasis system was used to assess the effect of HES polymers and RL. TEG analysis was performed using recalcified native whole blood both with and without the addition of platelet activating factor IV (PAF IV) before and immediately after infusion of one of the
solutions.ResultsInfusion of RL or one of the three HES solutions exerts an anticoagulant effect as demonstrated by a increase in clot formation time (R) and a decrease in maximum amplitude (MA), and the angle. The addition of PAF IV reversed these changes.ConclusionsThis data indicate clear evidence of platelet activity per se or platelet interaction with the plasmatic coagulation system. Key words: Coagulation, thrombelastography, platelets, hydroxyethyl-starch
Aggressive Soft Tissue Infections and Amputation in Military Trauma Patients
Authors: Penn-Barwell JG , Fries CA , Sargeant ID , Bennett PM , Porter K 
Published: February 2021

AbstractDue to the nature of IED injuries, during the conflicts in Iraq and Afghanistan The traditional, two-stage amputation for unsalvageable combat lower limb injuries has evolved into a strategy of serial debridement and greater use of plastic surgical techniques in order to preserve residual limb length. This study aimed to characterise the current treatment of lower limb loss with particular focus on the impact of specific wound infections. The UK military trauma registry and clinical notes were reviewed for details of all lower limb amputation identifying: 51 patients with 70 lower limb amputations. The mean number of debridements per stump prior to closure was 4.1 (95% CI 3.5-4.7). A final more proximal amputation level was required in 21 stumps (30%). Recovery of A. hydrophillia from wounds was significantly associated with a requirement for a more proximal amputation level (p=0.0038) and greater number of debridements (p=0.0474) when compared to residual limb wounds without A. hydrophillia.
Surgical Training in Camp Bastion, Afghanistan
Authors: Fries CA , Rickard RF 
Published: February 2021

IntroductionSurgical trauma care on operations is delivered by consultants. The DMS presently delivers training to surgeons to enable them to deliver this care as newly-qualified consultants. Deploying as a trainee is one of many training evolutions available to achieve this competency. This paper describes the process involved in trainees deploying, and the training received by the first author (CAF) during a recent deployment.MethodsPre-deployment training and the process for gaining recognition of training time by the GMC are described. All surgical procedures performed by the first author were recorded prospectively, together with the level of supervision.ResultsThe first author performed 210 procedures in 124 operations on 87 patients in a seven week deployment. This was prospectively recognised for training by the GMC. All procedures were supervised by consultant trainers. Procedures included trauma surgical procedures and those under the specialties of Plastic Surgery, Orthopaedic Surgery and General Surgery.ConclusionsDeploying on operations as a trainee is invaluable in preparing DMS juniors for their future roles as consultants in the DMS. Training is received not only in a breadth of surgical and resuscitative procedures, beyond a trainee’s “base specialty”, but also in other critical aspects of deployments including Crew Resource Management.
Delay in Diagnosis of Neck of Femur Stress Fracture in a Female Military recruit.
Authors: Thomas R , Wood AM , Watson J , Arthur CHC , Nicol AM 
Published: February 2021

AbstractWe report the delay in diagnosis of a Neck of Femur (NOF) stress fracture in mixed sex basic military training. Stress fractures are common in military training with the incidence reported as ranging between 3.2-31%. NOF stress fractures, whilst only representing around 8% of stress fractures are associated with a high morbidity. It is imperative that medical officers looking after military recruits have a sound knowledge of the potential signs, symptoms and presentation of these injuries. Medical officers should always remains vigilant for stress fractures especially in mixed military training.
The management of acute musculoskeletal pain
Authors: Bone J , Beard D 
Published: February 2021

AbstractMusculoskeletal pain is a common presentation in military patients. If not managed effectively it can have a detrimental effect on both the individual and the ship/unit. This article aims to examine how to thoroughly assess a military patient presenting with acute musculoskeletal pain; to provide the practitioner with a framework for effective pain history taking, and to help identify and exclude rare but serious causes of pain – ‘red and yellow flag concepts’. Key management steps and appropriate interventions for managing acute, benign musculoskeletal pain are discussed and related to the varying environments where the patient may be encountered.
The Royal Naval Medical Services: delivering medical operational capability. The ‘black art’ of Medical Operational Planning
Authors: Faye M 
Published: February 2021

AbstractThis article looks to dispel the mysteries of the ‘black art’ of Medical Operational Planning whilst giving an overview of activity within the Medical Operational Capability area of Medical Division (Med Div) within Navy Command Headquarters (NCHQ) during a period when the Royal Naval Medical Services (RNMS) have been preparing and reconfiguring medical capability for the future contingent battle spaces. The rolling exercise program has been used to illustrate the ongoing preparations taken by the Medical Operational Capability (Med Op Cap) and the Medical Force Elements to deliver medical capability in the littoral and maritime environments.
Penetrating brain injury: a case of survival following blast fragmentation injuries to the head
Authors: McKinlay J , Smith JE 
Published: February 2021

AbstractWe present a case of penetrating head injuries caused by blast fragmentation, along with other serious injuries (including to the arms, face and neck), where a good recovery was made despite an Injury Severity Score (ISS) of 75. We suggest that survival and outcome are reliant on several factors and cannot be predicted from ISS, velocity of penetrating injury or presenting Glasgow Coma Scale (GCS) alone.
The management of acute shortness of breath in young adults
Authors: Ahuja V Y , Freshwater D 
Published: February 2021

AbstractShortness of breath (SOB), or dyspnoea, is a common presenting symptom in acute care, responsible for 8% of all 999 calls to the ambulance service and ranking as the third most common type of emergency call (1). It may be associated with significant pathology, so prompt identification and appropriate management are therefore imperative. Although a formal diagnosis guides risk stratification, prognostication and treatment, it must not delay resuscitation. Rather, the management of an acutely short of breath (ASOB) patient must follow an algorithm incorporating simultaneous assessment and resuscitation. This article discusses both of these aspects in some detail, as well as key features in the history and the differential diagnosis, before concluding with some consideration of how the different operational environments in which such patients can present may affect their management.