bluuebunny/crossref_metadata_2025_split huggingface dataset:
The psychopharmacological treatment of depression in primary care in the Royal Navy
Authors: Coetzee RH 
Published: February 2021

AbstractDepression is a common mental health condition in the UK Armed Forces. Although psychopharmacology is usually a second line intervention, there is a place for antidepressants in the management of depression in primary care. This article will examine the diagnosis of depression, the indications for starting antidepressants, the choice of anti-depressants and the occupational considerations in the Royal Navy. The aim is to equip General Practitioners (GPs) and General Duties Medical Officers (GDMOs) with the clinical information needed to initiate psychopharmacological treatment for depression where indicated.
Op Patwin Part 2: HMS Illustrious’ medical response to typhoon Haiyan
Authors: Dew A 
Published: February 2021

AbstractOperation PATWIN was the United Kingdom’s (UK) response to the disaster caused by Typhoon Haiyan. The UK deployed a force including HMS DARING and HMS ILLUSTRIOUS and this article describes the medical response including the deployment of a Role 2 medical team and the hosting of a UK civilian medical team UK Med. The deployment followed humanitarian guidelines in UK doctrine and contained in the Oslo guidelines, but demonstrated a unique example of a civilian team supported by the military.
Multiple casualties in the Bastion UK Role 3 hospital: personal reflections on the positive evolution of deployed military hospital care
Authors: Ross RA , Selwood P 
Published: February 2021

AbstractIn this article a snapshot of casualty presentations to the UK Role 3 hospital in Camp Bastion, Afghanistan, will be briefly described. The observations allow reflection on the advances and strength of clinical provision at the time of the incident, written from a medical command perspective.
Eczema and dermatitis in the afloat population: an overview of the assessment and management of the common erythematous skin conditions encountered in adults deployed on afloat platforms
Authors: Lundie A , Turner M 
Published: February 2021

AbstractSkin conditions constitute a large proportion of the workload of deployed medical staff. Dermatology is an area where pattern recognition is key, and making a diagnosis can sometimes be difficult for deployed medical staff, who may have limited experience of dermatology. This article provides a structure to assess patients presenting with skin rashes, as well as a summary of the key features and management of common types of dermatitis that may be encountered when deployed afloat: atopic eczema; irritant contact dermatitis; pompholyx; scabies and plaque psoriasis.
The acutely swollen knee Part 1: Management of atraumatic pathology
Authors: Guyver P M , Arthur C H C , Hand C J 
Published: February 2021

AbstractThe acutely swollen knee is a common presentation of knee pathology in the Emergency Department and the primary care setting whether on board ship, a Regimental Aid Post or Medical Centre. The swollen knee has both traumatic and atraumatic (systemic) causes, all of which can be accurately diagnosed with an understanding of the underlying injury patterns and patho-anatomy. In Part One, we will be examining the management of non-traumatic causes, followed by Part Two, looking at traumatic causes, in the next issue of the Journal. A detailed clinical history combined with thorough clinical examination will establish the diagnosis, or at least the narrow differential diagnosis in the majority of cases. The uses of specialist examination techniques, diagnostic imaging and arthrocentesis can further assist the clinician in confirming the correct diagnosis and thus prescribing the appropriate treatment. This review will endeavour to give a consensus of opinion and structured guidelines in the diagnosis and initial management of patients presenting with acute or recent-onset swelling of the knee related to atraumatic pathology.
The management of lower back pain
Authors: Morrow LJ , Smith S 
Published: February 2021

AbstractLower back pain (LBP) is one of the most common musculoskeletal conditions, with an estimated 60-70% of the adult population experiencing a back problem at some point in their lives. It can have a significant social and occupational impact on a patient, and therefore is a major concern to both civilian and military populations. The impact of low back pain in the military setting, regardless of chronicity, can result in considerable restrictions on a patient’s ability to perform his or her job. This may have important ramifications for deployability, medical category and, potentially, a patient’s future career.This article will consider the diagnosis and classification of lower back pain (LBP) in the pre-shore, pre-hospital and hospital settings. It will detail management options including investigations, pain management and referral options; furthermore, the potential occupational implications of lower back pain will be detailed.
Optimising the management of severe Traumatic Brain Injury in the military maritime environment
Authors: Edgar IA , Hadjipavlou G , Smith JE 
Published: February 2021

AbstractSevere Traumatic Brain Injury (sTBI) is a devastating cause of morbidity and mortality, especially among those aged less than 45 years. Advances in clinical practice continue to focus on preventing primary injury through developing ballistic head and eye protection, and through minimising secondary brain injury (secondary prevention).Managing sTBI is challenging in well-developed, well-resourced healthcare systems. Achieving management aims in the military maritime environment poses even greater challenges.Strategies for the management of sTBI in the maritime environment should be in keeping with current best evidence. Provision of specialist interventions for sTBI in military maritime environments may require alternative approaches matched to the skills of the staff and environmental restrictions.
The differential diagnosis and management of headaches in primary care and their relevance in the UK armed forces
Authors: Laird J , Evershed MC 
Published: February 2021

AbstractAs with the general population, headaches are commonly suffered by members of the United Kingdom Armed Forces. These are often managed by patients with over-the-counter medication without the involvement of healthcare professionals. Patients may present to medical teams when deployed because of limited access to over-the-counter medication or because of concerns about the cause of the headache. This article will examine the differential diagnosis and management of headaches in primary care as well as considering the occupational and operational aspects related to the Royal Navy (RN). The aim is to equip General Practitioners (GPs) and General Duties Medical Officers (GDMOs) with the clinical knowledge to diagnose various common forms of headaches and to detect the red flag symptoms that warrant further investigation. This article will also make specific reference to the service person and the impact of headaches on occupational functioning and operational capability.
The treatment of haematemesis and upper gastrointestinal bleeding in United Kingdom Armed Forces and other deployed units
Authors: Woodward Arr , Khan M 
Published: February 2021

AbstractIntroductionUpper Gastro-intestinal (UGI) bleeding is a significant cause of morbidity worldwide. United Kingdom Armed Forces (UKAFs) are not immune to this condition. There is a substantial body of conflicting evidence regarding initial management and risk stratification.AimTo provide the background knowledge and treatment pathways required to assess and manage a patient adequately during the first 24 hours of an episode of UGI bleeding.AssessmentClinical grading of hypovolaemic shock is inaccurate, but is a broad indicator of severity; the Rockall Score must not be used to assess requirement for intervention. Where laboratory assets are available, the Blatchford score is adequate to assess requirements for intervention.ManagementThe principles of hypotensive resuscitation (target systolic blood pressure 90 mmHg for the first hour) hold true for UGI bleeds. In areas where endoscopy is available within four hours, a restrictive pattern of packed Red Blood Cell (pRBC) transfusion may be beneficial. Despite limited evidence of benefit, Proton Pump Inhibitors (PPIs) should be given routinely in UKAFs. Where available, in cases of variceal and non-variceal UGI Haemorrhage without locally available endoscopy, administration of tranexamic acid and somatostatin or octreotide should be considered.
Contraception in sea-going service personnel
Authors: Hawkins DM , Booth R 
Published: February 2021

AbstractThe right to make an informed choice about contraception should be afforded to every individual serving within the United Kingdom (UK) Armed Forces. This article looks at the responsibilities and approach that healthcare professionals should take within a Primary Care setting, summarises the common contraceptive options available, discusses the associated advantages and disadvantages of each technique, and considers operational factors in a military environment that combine to influence the final contraceptive choice an individual makes.Case StudyA 19-year old Able Rate joined the Royal Navy (RN) and at her joining medical it was noted that she had been on Microgynon™ combined oral contraceptive pill for approximately three years. During this time, her menstrual periods remained light; she never experienced adverse effects, demonstrated good compliance, and was happy to remain on this contraceptive regimen.Over the course of the next eighteen months, she was reviewed by a number of Medical Officers and Civilian Medical Practitioners on a quarterly basis, with Microgynon™ re-prescribed on each occasion. The appropriate Defence Medical Information Capability Programme (DMICP) template was used, with weight, smoking status, compliance and any issues or comments documented accordingly. In December 2010, a discussion regarding long-acting reversible contraception (LARC) was documented for the first time. The patient agreed to give LARC some thought and a review appointment was made for one month. She was subsequently started on the progestogen-only pill Cerazette™. It was noted by the consulting doctor that both the patient’s mother and grandmother had a positive history of cerebrovascular events and the combined oral contraceptive pill was discontinued.Upon review at two months, the patient reported that she was content on Cerazette™ and wished to continue with this medication. She was amenorrhoeic, highly compliant, had given up smoking and her weight and blood pressure were stable. However, due to supply issues, it was explained that Cerazette™ was no longer a viable option for her. She had no plans to start a family, and was keen to investigate other contraceptive options. Furthermore, she expressed a particular desire to remain amenorrhoeic, as she was due to deploy overseas in the coming months, and not only wanted to avoid the inconvenience of having her period, but also felt it preferable not to have to take a daily pill when considering the constantly changing time zones. She subsequently had the etonogestrel-releasing subdermal implant Nexplanon™ fitted without complication. She has remained amenorrhoeic throughout and this form of long-acting reversible contraception has particularly suited her busy working role and active lifestyle.
Vitamin D deficiency as a suspected causative factor in the failure of an immediately placed dental implant: a case report
Authors: Bryce G , MacBeth N 
Published: February 2021

AbstractAimTo discuss the influence of Vitamin D defi ciency in the osseointegration process of a dental implant by way of a case report.SummaryA 29-year-old soldier attended clinic with a fractured mandibular premolar (tooth 44) that was traumatised following head trauma related to the detonation of an Improvised Explosive Device (IED) whilst serving on operational duty. The tooth was deemed unsalvageable and was extracted with immediate placement of a dental implant. The patient experienced no problems but at assessment, five months post-operatively, no osseo-integration of the implant was found. Concurrent medical investigations revealed that he was severely Vitamin D deficient and that this may have contributed to the implant failure.ConclusionVitamin D deficiency may play a role in the failure of osseointegration in dental implants. The assessment of vitamin D status in patients who have been in long-term hospital care or rehabilitation should be considered, prior to the placement of dental implants.
Non-organic hearing loss in United Kingdom military personnel
Authors: Bailey K , Pearson C , Clack J 
Published: February 2021

AbstractNon-organic hearing loss (NOHL) is a condition in which there is audiometric discrepancy between the real hearing threshold and the measured threshold of the patient, in the absence of any organic disease. It can, rarely, be the manifestation of a somatoform disorder when it is known as conversion deafness. We present a case of conversion deafness diagnosed following a five-year period of apparent fluctuating unilateral hearing loss, and discuss the diagnosis, clinical and occupational considerations of managing this condition in a military environment.
A modern-day solution to a 100-yearold problem: the use of a bespoke offloading brace in the rehabilitation of ‘Deck-Slap’ and other high-energy lower limb injuries
Authors: Osborne MA , Jarvis HL , Bennett N , Phillip RD 
Published: February 2021

Abstract‘Deck-Slap’ is an injury pattern first described at the Battle of Jutland; it is still relevant today, with anti-vehicle mines a significant threat to Coalition troops. The effect of a device exploding beneath a vehicle produces a wave of high energy that is rapidly transmitted through the steel floor; this causes significant axial loading of lower limbs often resulting in severe fractures (notably of the calcaneum). Recent advancements in orthopaedic surgery have allowed for limbs that were destined for immediate amputation following significant trauma to be salvaged. However, despite intense rehabilitation, many of these salvaged limbs have subsequently gone on to delayed amputation, as functional outcomes are often poor. Technologically advanced prosthetic devices are available that afford good quality of life and allow for increased activity levels; these devices are, however, expensive to procure and maintain. This report describes a United Kingdom (UK) Armed Forces soldier who suffered a typical ‘deck-slap’ injury in Afghanistan with subsequent limb salvage. The use of the Bespoke Off-loading Brace (BOB) is discussed. The results presented here indicate that the biomechanical function of a patient with this type of injury improves when wearing the BOB. Further studies are needed to assess long-term clinical outcomes and the functional benefit of the device as a viable and cost-effective alternative to delayed limb amputation.
Preparing applications for specialty and general practice training in the Defence Medical Services
Authors: Rawlinson K , Stanning AJ 
Published: February 2021

AbstractThe specialty training application process can be a challenging time, and adequate preparation is essential. With the resources available, and with appropriate guidance from colleagues, experiences gained as a General Duties Medical Officer (GDMO) can be used to produce a highly competitive application. This paper aims to to provide guidance for Medical Officers (MOs) applying for specialty training.
The diagnosis and management of psychogenic non-epileptic seizures in the UK Armed Forces
Authors: Baker L D , Craner M , Coetzee R H 
Published: February 2021

AbstractPsychogenic non-epileptic seizures (PNES) is a disorder that mimics epilepsy, but does not have the associated organic changes or abnormal neuronal discharge foci in the brain. In this article the diagnosis, management and clinical considerations of managing this condition in the UK Armed Forces are considered. The occupational and operational considerations for the military environment are also discussed.
The emergence of vascular surgery as a separate specialty: implications for the military
Authors: Ablett D 
Published: February 2021

AbstractVascular surgery is evolving from being a sub-specialty of general surgery to becoming a separate surgical specialty. This will have implications in terms of the training, skill-set and workload of surgeons working in the NHS. There are implications for the military too, as a deploying trauma team must have both general and vascular surgical capabilities. This article explores the reasons for the changes occurring and discusses the wider implications.
The new NEMOs - changes to initial medical officer training
Authors: McMenemy L , Laird J 
Published: February 2021

AbstractIt is desirable that a Royal Navy Medical Officer is not only medically competent but also a proficient Naval Officer with an ethos common to all Officers, irrespective of specialty or branch. In 2012 Britannia Royal Naval College (BRNC), in conjunction with the Institute of Naval Medicine (INM), modified the New Entry Medical Officer (NEMO) training course to comprise an initial phase at BRNC (15 weeks) followed by a second phase at INM (16 weeks). This is in contrast to the traditional training delivered at INM and Fort Blockhouse prior to joining BRNC for 7 weeks. The following article is a reflection of this experience.
Devising a training programme and reviewing the lessons identified during contingency operations on board the Role 3 Maritime platform
Authors: Clarkson AM 
Published: February 2021

AbstractThe deployment of the Primary Casualty Receiving Facility (PCRF) to Sierra Leone in October 2014 in support of Operation GRITROCK was a contingency operation that required a very specific training programme. This article discusses the training and how it evolved beyond its original remit into a programme used as a management tool to meet the needs of the staff. The result was the implementation of a comprehensive package from which lessons can be drawn and used when planning future operations.
Platelet apheresis in a deployed maritime environment: experiences from Operation GRITROCK
Authors: Robinson MA , Bailey MJ 
Published: February 2021

AbstractWhen the Primary Casualty Receiving Facility (PCRF) on Royal Fleet Auxiliary (RFA) ARGUS deployed to Operation GRITROCK in October 2014, platelet apheresis had yet to be proven as a sustainable and usable capability for improving provision of blood products on a maritime platform. This paper explores the difficulties encountered by nurses tasked with setting up this capability once deployed and the requirements needed to ensure that this capability is maintained for future operations.
From RAF to RN – the transition from Princess Mary’s RAF Nursing Service (PMRAFNS) to Queen Alexandra’s Royal Naval Nursing Service (QARNNS)
Authors: Masawi S K 
Published: February 2021

AbstractI transferred from the Royal Air Force to the Royal Navy (RN) on 10 July 2014. I would like to share my experiences as a junior RN Officer during Op GRITROCK, looking at some of the similarities and differences between the two Services and their deployed environments: maritime and air.
A practical guide to expedition medical planning
Authors: Wilkins D , Handford C , Nicol A 
Published: February 2021

AbstractExpedition medical planning is integral in ensuring participant safety and maximising the likelihood of achieving the expedition aims. The task of producing a medical plan will often fall to a medical officer of limited experience. The aim of this article is to provide a concise, practical guide to aid junior medical officers (MOs) in forming a robust and pragmatic medical plan.
Lessons learned while undertaking high altitude medical research in the Himalayas
Authors: Mackey J , Mellor A 
Published: February 2021

AbstractUndertaking medical research during military adventurous training expeditions presents a unique set of challenges to medical personnel, and for those considering doing so in the future the task may seem daunting. This article details some of the challenges faced whilst undertaking high altitude research on a recent Defence Medical Services (DMS) adventurous training expedition to the Dhaulagiri circuit in Nepal. By discussing what led to some of the problems encountered, how they were overcome, and in some instances how they could have been avoided in the first place, it is hoped that the article will act as a guide for others who plan on undertaking future research in a similar environment.
A systematic review of the use of tourniquets and topical haemostatic agents in conflicts in Afghanistan and Iraq
Authors: Mawhinney AC , Kirk SJ 
Published: February 2021

AbstractIntroductionThe recent conflicts in Afghanistan and Iraq have seen increased use of tourniquets and topical haemostatic agents in the management of battlefield trauma. The aim of this paper is to review the available evidence for their efficacy and continued use.MethodsA systematic review of the medical literature published as a consequence of conflicts in Iraq in Afghanistan was conducted to determine the clinical outcomes from the use of tourniquets and haemostatic agents for haemorrhage control in limb extremity injury.ResultsStudies were retrospective cohort or prospective observational studies by design. None were eligible for meta-analysis and control groups were rarely available for ethical reasons. Despite methodological limitations, tourniquets were shown to save lives if applied prior to the onset of shock or in a pre-hospital setting. Topical haemostatic agents were shown to be useful adjuncts in haemorrhage control with small numbers of complications.ConclusionIn the military setting, tourniquet use in extremity trauma improves survival when used prior to the onset of shock. Topical haemostatic agents provide additional means of haemorrhage control, though further studies to identify the most effective types are necessary. Adequate training and protocols for use must be implemented to prevent complications through use.
The Ship’s Doctor in the Royal Navy - 100 years of tradition and progress
Authors: McMenemy L , Bennett PM , Stapley SA 
Published: February 2021

AbstractThe changing role of the Senior Service over the past century through numerous militarily heterogeneous environments and operations has necessitated an evolution in the role of the deployed Medical Officer. However: versatility, specialist knowledge, caring for a wide and varied patient population of friendly and enemy forces, and the dual role of being an officer as well as a doctor, have remained consistent. Identifiable changes in military medical officer training, the shape of the Defence Medical Services, and modern advances in treatment and communication have evolved the Ship’s Doctor role from the pre-Second World War setting of a contracted Naval Medical Service, through growth, to a shrinking cadre again in a return to the contingency operations of today. Still, the role today remains attractive to a subset of doctors looking for something more from their medical practice; as the nature of conflict changes, so too will the role of the Ship’s Doctor. The ongoing requirement for flexibility and versatility will remain. Medical Officers will continue to meet the need to provide high quality care to their patients and, as has always been the case, will continue to be drawn to the Service’s principal appeal of an exciting world-wide role with the potential for unique experiences.