The role of the medical service in filling up the ranks of personnel combat casualties during war

This article is about the contribution of the Red Army Medical Service made in the process of combat casualty recovery of personnel of the active army in the years of the Great Patriotic war by returning wounded and sick to their ranks after their treatment. The authors show the main organizational measures which provided for creation of a casualty recovery system; describe the contents of information procedures for assuring the wounded and sick traffic control; emphasize the necessity to utilize the experience of the Red Army Medical Service for the development of the combat casualty recovery system in the Armed Forces in case of war.     

Experience in organizing surgical care during the combat operations in the Chechen Republic

In the article the final analysis of organization of surgical care during the local military conflict in northern Caucasus was presented. The real possibilities of different medical units such as single medical company and medical squadron of special assignment was described. Also concrete contents of emergency specialized surgical care and its role in improvement of outcomes in patients with combined combat injuries was reflected. Mortality in this patients was decreased from 25.2 to 12.8%. The defects of surgical care were analyzed and the main ways of improvement of surgical care in local military conflict were presented. In the result of using the principle of moving the medical care closer to the wounded in the whole system of consecutive care the mortality was decreased up to 1.3%.     

Negotiating teams: A levels of analysis approach.

In light of the increasing presence of teams and work groups in organizations and their role in negotiations, the authors outline a framework for understanding the dynamics of negotiating teams. The traditional context of dyadic negotiations (i.e., one-on-one) is used as a point of departure for the analysis. The authors bring together research on negotiation, small group dynamics, and individual social cognition into a coherent framework to analyze negotiating teams. At the heart of the framework are 3 categories of psychological processes, corresponding to different levels of analysis, which highlight the contributions of individual, intragroup, and intergroup processes. These processes are discussed in terms of traditional negotiation concepts, such as integrative and distributive bargaining. Finally, guidance for future research is provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Croatian blood transfusion service in prevention of HIV spread during the war

Beside the war, an unfavorable epidemiological situation and a large number of foreign peace troops that entered the country without having been previously tested for infectious diseases, the number of AIDS cases in our country remained relatively low. The transfusion service played a considerable part in the prevention of HIV infection spread. Although the blood transfusion service was faced with higher demands for blood and blood products, throughout the period of the war not a single blood unit was imported and no single unit of blood components was transfused without having been previously tested for the presence of viral disease markers. Despite enormous economic difficulties, three new diagnostic tests were then introduced in our transfusion practice as a regular procedure: anti-HCV in 1993, anti-HIV 2 in 1994 and anti-HIV 1/0 in 1995.     

Experiences of psychiatry board exam casualties: a survey report

A quantitative study of the regional distribution of serotonin (5-HT) in the forebrain, was performed in adult cats, following brainstem lesions. Seven to 10 days survival times were used to avoid nonspecific variations of the amine levels, as were observed in chronic preparations. Significant decreases of 5-HT levels were found after lesions of the nucleus centralis superior (CS), in hypothalamus, preoptic area, amygdala and hippocampus. After lesions of the nucleus dorsalis raphe (Dr), significant 5-HT decreases were also found in the hypothalamus and hippocampus. There was no change of 5-HT levels after lesions placed in the lateral midbrain, pontine tegmentum, or caudal pontine raphe, contrary to that was reported for chronic lesioned cats. These results suggest that CS and Dr may integrate different serotonergic subsystems and, probably, each one of these subsystems is related to specific functional phenomena.     

The effectiveness of bicyclist helmets: a study of 1710 casualties

During the 1980s, a sustained campaign increased the rates of helmet use of Victorian bicyclists. The efficacy of helmet use was evaluated by comparison of crashes and injuries (AIS-1985) in 366 helmeted (261 Australian Standard approved and 105 non-approved) and 1344 unhelmeted casualties treated from 1987 through 1989 at Melbourne and Geelong hospitals or dying before hospitalization. Head injury (HI) occurred in 21.1% of wearers of approved helmets and in 34.8% of non-wearers (p < 0.001). The AIS scores were decreased for wearers of approved helmets (p < 0.001), face injuries were reduced (p < 0.01), and extremity/pelvic girdle injuries increased (p < 0.001) and the overall risk of HI was reduced by at least 39% and face injury by 28%. When casualties with dislodged helmets were excluded, HI was reduced 45% by approved helmets. Head injury reduction by helmets, although substantial, was less than that found in a similar study in Seattle, Washington.     

Patenting medical and surgical techniques: an ethical-legal analysis

Considerable controversy has recently arisen regarding the patenting of medical and surgical processes in the United States. One such patent, viz. for a "chevron" incision used in ophthalmologic surgery, has especially occasioned heated response including a major, condemnatory ethics policy statement from the American Medical Association as well as federal legislation denying patent protection for most uses of a patented medical or surgical procedure. This article identifies and discusses the major legal, ethical and public policy considerations offered by proponents and opponents of such patents. The existing literature divides up into those who favor such patents essentially without qualification, and those who condemn and wish to outlaw them. We advance a compromise position where administrative and legislative action is called for to provide more specific guidelines regarding the patentability of such processes by the Patent and Trademark Office. Our position, in sum, will be that too much is at stake in this complicated area for either the blanket prohibition, or wholesale, uncritical acceptance, of the patenting of medical and surgical processes or techniques.     

Standardized AgNOR analysis: its usefulness in surgical oncology

Smith-Magenis syndrome (SMS) is a multiple congenital anomalies/mental retardation syndrome associated with deletion of band p11.2 of chromosome 17. The deletion is typically detected by high-resolution cytogenetic analysis of chromosomes from peripheral lymphocytes. Fluorescence in situ hybridization (FISH) has been previously used to rule out apparent mosaicism for del(17)(p11.2p11.2) indicated by routine cytogenetics. We now report mosaicism for del(17)(p11.2p11.2) in a child with SMS. The mosaicism had gone undetected during previous routine cytogenetic analysis. FISH analysis of peripheral lymphocytes as well as immortalized lymphoblasts using markers from 17p11.2 revealed that approximately 60% of cells carried the deletion. To our knowledge, this is the first case of SMS associated with mosaicism for del(17)(p11.2p11.2).     

Effects of social support and battle intensity on loneliness and breakdown during combat.

A sample of 382 Israeli soldiers who developed combat stress reactions (CSR) during the 1982 Israel-Lebanon War were compared with groups of carefully matched controls who did not develop CSR. Lack of social support from officers was found to be related to greater feelings of loneliness and greater likelihood of CSR in soldiers. Lack of social support from buddies was found to be related to greater loneliness. Intensity of battle was also found to be related to greater feelings of loneliness and increased likelihood of CSR. A path model was tested and supported. The model suggests that battle intensity and officer support lead to CSR directly and indirectly by causing increased feelings of loneliness. Possible cognitive and psychodynamic explanations for the findings are offered. The limitations of making causal statements from retrospective perceptions are discussed. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transforming Restraining Forces Into Driving Forces: An Example of a Bottom-Up Type of Integration.

This article describes an integration framework in psychotherapy that is significantly different from the known kinds because (a) the integration process is linear and moves in only 1 direction from the practical to the theoretical and (b) the sources for the integration are almost entirely devoid of practical or theoretical component. The demonstration of this type of integration is based on 2 sources of knowledge: (a) practical case examples used mainly by Milton Erickson and his successors, who developed the strategic approach, and (b) theoretical sources of knowledge taken from the Freudian dynamic approach concerning the sublimation mechanism. The kind of integration described here may, after moving from the conceptual framework stage to the validation and establishment stage, provide direction to innovative clinicians who wish to develop a new and effective intervention strategy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Difficulties and complications during surgical treatment of otosclerosis

Orthostatic intolerance can present a very serious limitation to astronauts attempting any functions requiring the upright position. Vasovagal syncope is a common cause of fainting characterized by paradoxic bradycardia and vasodilation in the presence of decreasing arterial pressure. Several mechanisms have been proposed to mediate vasovagal syncope and it seems likely that redundant mechanisms exist both centrally and peripherally which can mediate these responses. Spaceflight alters reflex control of cardiovascular function in several ways which may influence susceptibility to vasovagal syncope provoked by the Bezold-Jarisch reflex.     

Forces and duration of impact, and grip tightness during the tennis stroke

Most previous cost-benefit analyses of fluoridation programs have been retrospective in approach and have biased their results in favor of fluoridation. This study performed a prospective cost-benefit analysis of fluoridating a segment of the water supply for Houston, Texas, and explicitly introduced and evaluated the time pattern of the costs and benefits. It was shown that neglect of the time structure of the costs and benefits would significantly bias the results. A benefit-cost ratio of 1.51 and a net present value (or "social profit") of $1,102,970 were found. The results are biased downwards and should be considered a lower bound. Thus the results indicate an investment in a fluoridation program by Houston would be a socially profitable one.     

Aortoiliac stent deployment versus surgical reconstruction: analysis of outcome and cost

PURPOSE: The purpose of this study is to compare complication rate, primary patency, and cost of stent deployment with direct surgical reconstruction for the treatment of severe aortoiliac occlusive disease. METHODS: From March 1, 1992, to May 31, 1996, 119 patients receiving treatment for aortoiliac occlusive disease were analyzed after exclusions. Sixty-five patients had stent deployment and 54 patients had surgical reconstruction. Data were evaluated within and between the groups by univariate and multivariate logistic regression, life-table, t-test, and cross tabulation with chi2 analysis. RESULTS: There was no significant difference between the groups with regard to demographic features or presenting symptoms (all p values > 0.07). Incidence of procedure-related complications was similar (p = 0.30). However, there were more systemic complications in the surgery group (15 versus 2; RR = 5.5, p < 0.01) and more vascular complications in the stent group (16 versus 3; RR = 12, p < 0.002). Incidence and type of late complications were not appreciably different (all p values > 0.05). Cumulative primary patency rate of bypass grafts was significantly better than stented iliac arteries at 18 months (93% versus 77%), 30 months (93% versus 68%) and 42 months (93% versus 68%); p = 0.002, log rank. Multivariate analysis identified female gender (RR = 4.6, p = 0.03), ipsilateral SFA occlusion (RR = 5.6, p = 0.01), procedure-related vascular complication (RR = 9.7, p = 0.002), and hypercholesterolemia (RR = 5.0, p = 0.02) as independent predictors of bypass graft or stent thrombosis. Mean total hospital cost per limb treated did not differ significantly between surgery and stent deployment groups ($9383 versus $8626, respectively; p = 0.66, t-test). CONCLUSIONS: Treatment of severe aortoiliac occlusive disease by surgical reconstruction or stent deployment has a similar complication rate. Mean hospital cost per limb treated is essentially equal. However, cumulative primary patency rate of bypass grafts is superior to stents. Therefore, considering the elements of cost and patency, surgical revascularization has greater value. The benchmark for cost-effective treatment of severe aortoiliac occlusive disease is direct surgical reconstruction.     

Plantar neuroma: analysis of results following surgical excision in 145 patients

Few series deal with the long-term results of surgical exision of plantar neuromas. The results of a study with a 21.5 month average follow-up are presented. Of 145 patients undergoing surgery from 1970 to 1973, 85 returned for examination and roentgenograms. There were 13% with unsatisfactory results and 21.3% with some pain remaining. Caution should therefore be used in assuring patients of complete relief.     

Expanding the role of the neonatal transport nurse: nurse-led teams

Nottingham neonatal service provides a unit-based interhospital transport programme for the stabilization and transportation of critically III neonates within the Trent region. The transport nurse is responsible and accountable for providing optimum care for infants in conjunction with a registrar. The quality of care received by the neonate requiring emergency transfer could be further enhanced by a team of two specifically trained transport nurses.     

Trait configurations in self-managed teams: A conceptual examination of the use of seeding for maximizing and minimizing trait variance in teams.

In this article, the authors argue that there is no one best way to make placement decisions on self-managed teams. Drawing from theories of supplementary and complementary fit, they develop a conceptual model that suggests that (a) maximization principles should be applied to extroversion variance (i.e., complementary fit), (b) minimization principles should be applied to conscientiousness variance (i.e., supplementary fit), and (c) extroversion variance and conscientiousness variance interact to influence team performance. They also argue that previous research has underestimated the effect of extroversion and conscientiousness variance on performance because of suboptimal design. The authors, therefore, present an alternative method for making team placement decisions (i.e., seeding) that can be used to maximize or minimize variance in teams. (PsycINFO Database Record (c) 2010 APA, all rights reserved)