bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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 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.
Clinical Findings In 111 Ex-Porton Down Volunteers
Authors: Lee Harry A , Gabriel Roger , Bale Amanda J , Welch Dawn 
Published: March 2013

ObjectiveTo 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.MethodsData 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.ResultsThe 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.ConclusionOn 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.
Paediatric Casualties During OP TELIC
Authors: Gurney I 
Published: March 2013

AimTo audit all paediatric attendances to a British Army Field Hospital during warfighting.PopulationAll 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).MethodA retrospective analysis of A&E attendance register, A&E clinical records, and A&E trainees’ logbooks from the department of 34 Field Hospital.ResultsSeventy 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.ConclusionsRecognition 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

ObjectivesTo 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.MethodsA 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.ResultsThe 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.ConclusionsFemale 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

ObjectivesTo 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).MethodsAll 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.ResultsThe 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.ConclusionThe 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.
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

BackgroundHuman 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 presentationWe 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.RecommendationsMedical 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

ObjectiveIn 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.MethodsSimilar 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.ResultsTwo 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.ConclusionAs 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.
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

ObjectiveThis study investigated the types of presentations; time lines and disposal of patients from the international, local and military community in Southern Iraq.MethodsAll presentations to the Emergency Department (ED) were clinically and demographically coded and entered onto an electronic database.ResultsDuring the period studied the emergency department dealt with 1455 new presentations of which 75% were UK Armed Forces personnel.ConclusionsThis represented a busy period in the field hospitals time in Iraq and offered valuable training to emergency medicine trainees in an unusual environment.
Are Soldiers at Increased Risk of Third Molar Symptoms when on Operational Tour in Iraq? A Prospective Cohort Study
Authors: Breeze J , Gibbons AJ 
Published: March 2013

ObjectivePain associated with third molar (wisdom) teeth is a common cause of morbidity for soldiers in the United Kingdom and on operational deployments. This study compared the incidence of third molar symptoms between soldiers serving in Iraq and soldiers stationed in barracks in Northern Ireland and assessed if pre-deployment screening could be improved.MethodData was collected in a prospective cohort study over five consecutive months. Dental officers recorded each time an Army soldier presented with third molar related symptoms.Results1% of soldiers in Iraq had third molar related symptoms in this time compared to 1.4% of those stationed in Northern Ireland. The range of pathologies and teeth affected were similar between locations. In both locations approximately 40% of teeth that caused problems had been symptomatic before and 13 -16% had untreated decay.ConclusionsThis study suggests that soldiers experience a lower incidence of symptoms related to third molars when in Iraq compared to Northern Ireland (P<0.033) possibly due to pre-deployment treatment. If ideal pre-deployment screening of third molars was carried out and National Institute of Clinical Excellence guidelines applied 38% of the Operation Telic group of patient’s problems could have been prevented.
Analysis of the Initial 100 Scans from the First CT Scanner Deployed by the British Armed Forces in A Land Environment.
Authors: O’Reilly David , Kilbey J 
Published: March 2013

AimsTo examine usage of the first CT scanner installed in a UK field hospital, BMH Shaibah, over a 13 month period.MethodsAll request forms and reports for the first 100 studies were analysed retrospectively.ResultsAn average of 7.7 scans per month was performed. Trauma was the most common indication followed by urinary symptoms and headache. Significant pathology was diagnosed in many cases.ConclusionA deployed CT scanner can make a significant contribution to the capability of a field hospital, shaping both the management and disposal of patients. A more easily deployable scanner will be needed in future.
UK Defence Medical Services Guidance for the Use of Recombinant Factor VIIA (RFVIIA) in the Deployed Military Setting
Authors: Hodgetts TJ , Kirkman E , Mahoney PF , Russell R , Thomas R , Midwinter M 
Published: March 2013

Use of recombinant Factor VIIa (rFVIIa) for trauma is currently an ‘off label’ use.There are reports of rFVIIa contributing to the successful outcome of military trauma patients. This paper sets out the current position of the UK Defence Medical Services with regard to using rFVIIa in military trauma.
An Unusual Case of Sinusitis
Authors: Lamb LEM , Richards P , Edgar JDM 
Published: March 2013

BackgroundCommon Variable Immunodeficiency (CVID) is the commonest form of severe antibody deficiency. It is characterized by reduced levels of IgG (<400mg/dL) and low IgA and/or IgMlevels, recurrent bacterial infections, impaired antibody responses despite the presence of B Cells and normal or near normal T immunity in 60% of patients. There is a high mortality from infections without treatment. The main stay treatment is to replace the immunoglobulins.Case PresentationWe describe a British soldier with a 10 year history of recurrent chest infections, sinusitis and otitis media. He repeatedly presented 2 to 3 times a year complaining of either a green nasal discharge or a cough productive of yellow/green sputum. He presented three years ago with severe sinusitis which resulted in investigations highlighting hypogammaglobulinaemia. Subsequently he was started on immunoglobulin therapy with Flebogamma 40g three weekly.RecommendationsDespite being a relatively rare condition, CVID when diagnosed, can be easily treated and improve patients' prognosis. Medical Officers should be aware of the condition as a differential diagnosis for individuals presenting with recurrent infections.
“What Else is There to Do?” – A Qualitative Study of the Barriers to Soldiers Stopping Smoking
Authors: Owers Russell C , Ballard KD 
Published: March 2013

ObjectivesTo investigate the impact of Army life on soldiers’ motivation for stopping smoking.MethodA two stage study using a questionnaire to identify smokers in a British Army infantry battalion of 560 soldiers based in the United Kingdom with either a low or high intention to quit smoking, followed by semi-structured interviews of a purposive sample of 18 respondents.Results31.3%of soldiers were current smokers. In addition to recognised barriers to stopping smoking, the interview data revealed structural and cultural barriers, some of which are unique to the Army. Structural barriers included an increased opportunity to smoke in terms of time, place, and cost. Cultural barriers included peer pressure, the smoking norm, and a lack of discouragement from the ‘regimental family’. These barriers to stopping smoking often arise from established British Army values and standards. For example, the need for punctuality requires early arrival at destinations, which in turn, provides an increased time opportunity to smoke. Other attitudes that the Army wishes to encourage, such as building teamwork and interdependence, can also be enhanced through smoking.ConclusionWhilst the numerous, previously identified barriers to stopping smoking exist within and outside the armed forces, specific additional barriers arise from the structure and culture of the Army. Changes in the structure of daily life within the Army may reduce the barriers to stop smoking. Army clinicians also play an important part in soldiers’ stopping smoking and an increased understanding of the specific barriers to stopping smoking may help them to support soldiers more effectively.
Viral Gastroenteritis Outbreaks in Deployed British Troops During 2002-7
Authors: Bailey Mark S , Gallimore CI , Lines LD , Green AD , Lopman BA , Gray JJ , Brown DWG 
Published: March 2013

ObjectivesThe aim of this study was to see what lessons could be learnt from the suspected viral gastroenteritis outbreaks that have occurred in deployed British troops during 2002-7.MethodEpidemiological and laboratory data from identifiable outbreaks were reviewed, including epidemic curves and the results of PCR testing for enteropathic viruses.ResultsThe epidemic curves of outbreaks varied predictably in accordance with the size of the population at risk and whether this population was constant or expanding. Of 11 outbreaks identified, 10 (91%) had a proven viral cause and 10 (91%) occurred in Iraq. Of 84 enteropathic viruses identified, 61 (73%) were noroviruses and these included both unknown strains and those that were common in the UK and Europe. Of the 10 viral outbreaks, 3 (30%) occurred in medical units, 5 (50%) were associated with large-scale relief in place (RiP) deployments and 5 (50%) involved >3 different viruses, which is strongly suggestive of food or water contamination.ConclusionThese findings can help to predict future viral gastroenteritis outbreaks and target improved prevention strategies appropriately. However, more systematic studies are now required.