Military medicine and medicine of accidents

The article presents an observe of such parts of military medicine as intensive aid and operative treatment on the place of case, contestation against infectious diseases, preservation of psychic health, medical and social rehabilitation. Were lighted successful activity of military physicians during liquidation of Chernobyl accident (1986), earthquakes in Armenia (1988), railway accident in Bashkiria (1989) and other accidents. Experience of military medicine (particularly using medical units of special purposes) was used in proving of conception of medicine of accidents, and in organization of medical supply of troops in armed conflicts of restricted scale--in effectuating of antiterrorist operations in Northern Caucasus (1994-1996, 1999-2002), in effectuating of peacemaking operation in Kosovo (1999-2003), natural disasters.     

部队呼吸道腺病毒疫情流行病学调查分析

 目的 分析我国部队呼吸道腺病毒暴发疫情的流行特点、暴发原因及临床表现,为有效控制疾病的发生与蔓延提供依据。方法 从PubMed、万方数据库搜集2009-2017年国内公开报道的部队呼吸道腺病毒暴发疫情文献,对疫情暴发的流行病学特征和临床表现进行统计分析。结果 病原分型:7型、55型暴发病例最多,分别占暴发疫情的47.11%(1782/3783)和30.11%(1139/3783)。7型10起,检测数551例,阳性率为54.02%(551/1020);55型5起,检测数1035例,阳性率为90.10%(437/485);时间分布以2013年最多,共发生7起;发病时间主要集中在每年12月至次年3月;河南地区报告最多,共发生4起;主要以新兵为高发人群,共18起是新兵为主的聚集性暴发疫情。呼吸道腺病毒临床表现主要为发热(50.83%~100.00%)、咽部充血(37.91%~100.00%)、咳嗽(48.17%~95.45%)、咽痛(57.14%~87.00%)、咳痰(15.66~85.23%)等症状。结论 呼吸道腺病毒是引起部队暴发疫情的主要病原体之一,提示应加强疫情监测和防控工作,防止疫情的扩大蔓延。     

武警驻南疆某部卫生队2012—2016年疾病谱及成因分析

 目的 了解武警驻南疆部队相关疾病谱,探讨总结部队平时发病规律,为部队疾病防治及科学施训提供必要参考。方法 对武警驻南疆某机动部队卫生队2012—2016年的收治情况进行统计分析,采用回顾性研究方法,对该部卫生队门诊、住院、外诊、转诊等记录在案的病例逐一进行统计,并采用图表结合的方式对统计结果进行描述。结果 该卫生队2012-01-01至2016-12-31累计收治官兵13 531人次,导致官兵患病前五位的系统疾病依次是呼吸系统疾病(7560例;55.9%)、运动系统疾病(2324例;17.2%)、消化系统疾病(1869例;13.8%)、皮肤病及其相关损伤(771例;5.7%)、五官疾病(438例;3.2%)。其中呼吸系统疾病、消化系统疾病、皮肤病及其相关损伤和中暑及中毒四类疾病收治人数随月份呈现明显特点。从病种来看,有23种疾病5年来发病人次低于10例,每年患病人数最多的疾病均是上呼吸道感染(7324例;54.1%)。结论 本研究初步分析出南疆基层部队卫生队的疾病谱特点和发病原因,为基层部队疾病的预防和规范化保障提供了依据,提高了为兵服务的效率,同时也为下一步做好部队卫勤保障及卫生资源的合理配置提供依据。     

Career History Archival Medical and Personnel System

The Career History Archival Medical and Personnel System is a database that provides information on cancer, chronic diseases, occupational and preventive medicine, epidemiological research, and the use of health care in the Navy and Marine Corps. It was created at the Naval Health Research Center for enlisted Navy personnel, and it is being expanded to encompass all military personnel. Its objective is to provide a comprehensive, chronologically ordered database of career and medical events in all active duty military service members and to track career and disease events in order from the date of entry to service to the date service ended. Events include the dates of beginning and ending of each specific military occupation, all assignments to a military units or ships, all hospitalized diseases, and other events. The database contains detailed epidemiological data on more than six million members of the military services. It is the largest known epidemiological database in the United States.     

Expeditionary medicine in Africa: the French experience

The French army is often engaged in stability and support operations in Africa, and its military health service has gained much experience. The goal of this article is to present our military medical management strategies during the two main phases of military action. These situations most often begin with an initial combat phase, with combat casualty care. This consists of first aid, i.e., treatment of bleeding points, followed by battlefield forward medical care, damage control surgery, and resuscitation in forward surgical units. The quieter second phase of peacekeeping operations is dominated by the management of tropical diseases and their prevention, essential for the preservation of the military strength.     

Advising and assisting an Iraqi Army medical clinic: observations of a U.S. military support mission

Medical civil-military operations are important for deployed military medical units engaged in counter-insurgency missions. There are few reports on military support for a host nation's military medical infrastructure, and we describe an initiative of the 21st Combat Support Hospital in 2010 during the postsurge phase of Operation Iraqi Freedom and Operation New Dawn. The goal was to incrementally improve the quality of care provided by Iraqi 7th Army medical personnel using existing clinic infrastructure and a low budget. Direct bedside teaching to include screening and treatment of ambulatory patients (sick call), focused pharmacy and medical supply system support, medical records documentation, and basic infection control compliance were the objectives. Lessons learned include the requirement to implement culturally relevant changes, maintain focus on system processes, and maximize education and mentorship through multiple modalities. In summary, a combat hospital can successfully implement an advise and assist mission with minimal external resources.     

Experience in organizing epidemic control work in catastrophes

Maintenance of preventive medicine measures is one of the main part of national system of emergency health service in disasters. The priority in this activity belongs to the mobile autonomous units, which take measures for protection of population disaster regions and military personnel from infections diseases.     

军队医院等级评审中药事管理工作成果分析

目的分析济南军区总医院在等级评审中药事管理工作的做法、成效及建议,以供参考。方法重点介绍该 院在军队医院等级评审中,药事管理方面所进行的一系列工作,并分析等级评审前后基本药物及抗菌药物使用情况。结果 评审期间2012年1月-8月,基本药物品种比例及基本药物使用金额比例均明显提高,门诊患者抗菌药物处方比例由26.5% 下降到13. 7%,急诊患者抗菌药物处方比例由54. 5%下降到37. 82%,住院患者抗菌药物使用率由73. 03%下降到49. 60%, 住院患者抗P药物使用强度巳从80DDDs降至30.95DDDS。结论医院等级评审药事管理工作有效地促进了该院基本药物 及抗菌药物的合理应用。     

Clinical value of grading the scintigraphic appearances of tibial stress fractures in military recruits.

PURPOSE: This study evaluated the relation between the scintigraphic appearances of tibial stress fracture in military recruits and the likelihood that they would complete basic military training. MATERIALS AND METHODS: The authors retrospectively reviewed 58 Tc-99m MDP scans of recruits referred for possible tibial stress fracture and graded them according to the criteria of Zwas et al. (1987). Stress fracture appearances were correlated with clinical information such as the duration of rehabilitation and final outcome with regard to completion of the initial basic military training program. RESULTS: Thirty-seven of the 58 patients (64%) had tibial stress fractures, all of which were located in the tibial diaphysis, with most occurring in the middle and lower thirds. Most (23 of 37) patients had stress fractures of grade I or II, and the others had grade III or IV stress fractures. There was no statistical difference in the proportion of patients with bilateral fractures between grades I-II and III-IV. There was no significant difference in the duration of rehabilitation for recruits successfully recovering from grade III-IV fractures compared with grade I-II fracture. There was a greater proportion of patients with lower grade fractures than higher grade fractures (P = 0.0006) who, despite rehabilitation, could not continue training because of unremitting or recurring pain at the fracture site and were medically discharged from military service. CONCLUSIONS: Contrary to expectation, recruits with higher-grade stress fractures were not less likely to complete basic military training compared with recruits with lower grade stress fractures.     

Biomedical research: its mission within the French Military Medical Service.

The French Military Medical Service is organized as a distinct corps to support Army, Navy, and Air Force operations. This complex mission is accomplished through five operational components: (1) direct medical support of the force units; (2) hospital nursing and expertise; (3) biomedical research; (4) biomedical training; and (5) medical supply. Additionally, the French Military Medical Service is committed to humanitarian and civil medical support. Advanced biomedical research, particularly on infectious diseases and treatment of injuries, is actively pursued. Fundamental and applied research is needed to anticipate potential threats and improve medical support and care of French forces. The importance of biomedical research was recognized as necessary to develop technological improvements in rescue operations and to provide the military command with scientifically based advice. Biomedical military research has often been the engine of progress in medicine and surgery. Chief among those developments has been a special emphasis on infectious diseases and wound treatment.     

军人皮肤病患者住院情况分析

目的探讨东南沿海部队皮肤病防治重点,为科学制定卫勤保障计划提供依据。方法回顾性分析2001年1月1日—2010年12月31日期间福州总医院Oracle数据库中军人皮肤病住院患者病种分布、所占比例及主要病种住院天数等,应用单因素方差分析+SNK法、秩和检验进行统计学分析。结果住院军人皮肤病可分为5大类18个病种。感染性皮肤病占39.46%,变态反应性皮肤病占34.98%,红斑鳞屑性皮肤病占20.63%。全部军人皮肤病住院患者、感染性皮肤病军人患者、变态反应性皮肤病军人患者的平均住院天数分别为(19.94±17.14)d、(13.89±8.23)d和(18.32±16.85)d,三者之间比较无统计学差异。然而,红斑鳞屑性皮肤病军人患者的平均住院天数为(33.36±22.38)d,高于全部军人皮肤病患者的平均住院天数。结论东南沿海部队皮肤病的防治重点是感染性皮肤病、变态反应性皮肤病和红斑鳞屑性皮肤病第三类皮肤疾病。     

Spontaneous rupture of the spleen: ultrasound patterns, diagnosis and follow-up

Spontaneous rupture of the spleen is an extremely rare complication usually of infectious diseases or disorders of the haematopoietic system and has been described mostly in case reports. The incidence, symptoms, causes, therapy, and prognosis are poorly defined. From July 1985 to January 2000 41 patients with spontaneous splenic rupture were diagnosed by abdominal ultrasound and confirmed by splenectomy (n=12), CT (n=15), and ultrasound follow up (n=26). An ultrasound grading system was retrospectively established based on the degree of splenic injury (grade 0-2=low grade injury, grade 3=high grade injury) and correlated with surgical procedures. 30 day mortality rate was studied in relation to underlying disorders, ultrasound grades and treatment decisions. 21 patients had underlying malignant disorders (group I) and 20 patients had benign diseases (group II). Between group I and II we observed a highly significant difference in 30 day mortality rates (n=7; 38.1% vs n=1; 5%, p<0.01), but no significant difference in high grade injury rate (n=3; 14.3% vs n=2; 10.0%; p=ns) and surgical treatment rate (n=5; 23.8% vs n=7; 35.0%; p=ns). Depending on ultrasound grades the surgical procedures were 0% for grade 0, 16.7% for grade 1, 30.4% for grade 2, and 60% for grade 3. There were no significant differences between patients, who died within the first 30 days (n=9) and those who survived more than 30 days (n=32) regarding high grade splenic injury rate (n=0; 0% vs n=5; 15.6%; p=ns), and surgical treatment rate (n=2; 22.2% vs n=10; 31.2%; p=ns). Spontaneous rupture of the spleen is an extremely rare event. It is associated with a high mortality rate within 30 days in patients with malignant disease. Sonomorphologic grading is helpful for treatment decisions. 30 day mortality rate is correlated with neither ultrasound grades, nor surgical treatment rates.     

A sick child day care unit in a military hospital

Sick child day care units have been developed to provide care for children who are excluded from day care because of illness. We implemented a sick child day care unit at a military hospital. In the first year of operation, 526 children were admitted to the unit, with a daily average of 1.9 children and a range of 0-9 children. The most common admission diagnoses were: otitis media (21.3%), upper respiratory infection (19.4%), gastroenteritis (10.6%), and viral syndrome (10.5%). A sick child day care unit in a military hospital can provide a useful service to dependent children, their parents, and the military.     

MRI cervical spine findings in asymptomatic fighter pilots

MRI of the cervical spine for evaluation concerning degenerative lesions was performed on asymptomatic experienced military high performance aircraft pilots (mean age 42 yr with mean accumulated flying time of 2600 h), and for comparison on age-matched controls without military flying experience. Young military high performance aircraft pilots (mean age 23 yr with 220 h of flying per person) were also examined. There were significantly more osteophytes, disk protrusions, compressions of the spinal cord and foraminal stenoses in the experienced pilots than in the age-matched controls. Low frequency of low grade degenerative lesions was found in the young and inexperienced pilots.     

某三级甲等综合医院2000-2010年军人心理门诊疾病谱调查

 目的 分析综合医院心理科军人门诊的病种分布特征与变化趋势,为部队心理卫生工作提供参考依据.方法 选取2000 -2010年间某医院军人心理门诊首诊资料完整者共888例,对所有资料进行统计分析.结果 军人精神类疾病前5位分别是F41(其他焦虑障碍)、F32(抑郁发作)、F51(非器质性睡眠障碍)、F45(躯体形式障碍)、F99(未特指的精神障碍);一般心理问题前5位依次为心理筛查轻度问题、婚恋问题、人际关系、家庭问题、性问题.结论 军人心理门诊量呈上升趋势,焦虑、抑郁仍是防治重点,婚恋家庭问题的解决是降低心理问题发生率的有效路径.     

我军医疗机构口腔卫生服务经济和军事效益评价

目的进行我军不同类型医疗机构口腔科经济和军事效益的评价,为有关部门制定政策卫生提供参考。方法利用通信调查问卷了解我军医疗机构口腔科资源现况和服务现况,采用比率分析法来分析我军医疗机构口腔科提供口腔卫生服务的经济效益和军事效益。结果共获取我军不同类型的医疗机构口腔科有效问卷43个,我军各类医院口腔科以师医院平均每口腔医师和每卫技人员(人)业务年病人(人)最多,每牙科椅年收入(万元)则以军区总医院和驻军医院为高。军事效益以师医院最高,军区总医院最低。结论我军各类医院口腔科必须以军事效益为目标,因此,应采取措施调整结构,加强师医院口腔科建设,提高我军口腔卫生服务的军事效益。     

Grading of reflux by radionuclide cystography

Over a three-year period, radionuclide cystography (RC) was performed on 145 patients. Of these, 31 nephroureteral units in 25 patients demonstrated vesicoureteral reflux by RC and also by radiographic cystography (XC). The RC and XC studies were performed within three months of one another. The grading of reflux was determined by RC and then compared with that of XC using the criteria for grading as established by the International Reflux Study Committee (IRSC). Of 18 nephroureteral units in 14 patients with grade II reflux by XC, 14 were similarly graded by RC (78%). Of five nephroureteral units in five patients with grade III reflux by XC, the correlation by RC was 100%. However, when grades II and III were combined into a single category of low-grade reflux, the correlation achieved between the two cystographic techniques was 100%. Of five nephroureteral units in four patients with grade IV reflux by XC, the correlation was 60%, and in three units in two patients with grade V reflux the correlation was 100%. When grades IV and V are combined into a category of high-grade reflux, a correlation of 100% is achieved. When the reflux is graded into the five IRSC categories, the overall unequivocal correlation between the two studies is 80%. However, when only two categories are used (low grade = grades II and III, and high grade = grades IV and V), a correlation of 100% is obtained.     

驻高原藏区某医院2014－2016年住院武警官兵疾病谱分析

 目的 分析驻高原藏区医院2014－2016年住院武警官兵疾病谱,为当地武警官兵的疾病防治工作提供依据。方法 调阅驻高原藏区某医院病例库中2014－2016年住院官兵的病案数据,按照国际疾病分类(ICD-10)进行系统分析。结果 各系统疾病构成中,排在前6位的依次是消化系统疾病(20.25%),骨骼肌肉结缔组织疾病(16.55%),损伤、中毒和外因的某些其他后果(16.37%),呼吸系统疾病(13.73%),皮肤和皮下疾病(11.27%),泌尿生殖系统疾病(9.51%)。单病种中,胃肠炎、关节损伤、骨折、扁桃体炎、皮疹类、泌尿系结石为各年份住院官兵的多发病种。结论 消化系统疾病、骨骼肌肉结缔组织疾病、损伤、中毒和外伤等防治是驻高原藏区地区部队卫生工作的重点,同时要重视呼吸系统、皮肤及皮下疾病、泌尿生殖系统疾病的防治,以及搞好相应健康宣教工作,有助于保障官兵健康,减少非战斗减员。     

Skin disease in military personnel

Skin disease, disease of the musculoskeletal system, and respiratory infections are the most frequent reasons for military personnel to seek medical care. The Oslo Military Clinic serves all of the military personnel in Oslo and the surrounding region, including officers and civilian employees. From September 1996 to May 1997, 1,360 patients were diagnosed and treated by the author, and the data are included in the following study. Upper respiratory disease was the primary reason for seeking medical attention in 26% of the patients, 21% visited the clinic because of disease or pain in the musculoskeletal system, and 16% suffered from a skin disease. Apart from the low number of female patients, the patient population and the disease spectrum observed in the military clinic are very similar to those in a general medical practice. Among the 222 patients suffering from a cutaneous disease, eczema (42 patients), allergy (excluding dermatitis) (34 patients), acne vulgaris (23 patients), and sexually transmitted diseases (28 patients) were the most prevalent processes. Other less prevalent skin diseases were fungal infections, herpes simplex infection, nevi, common warts, and superficial bacterial skin infections. Skin diseases seen in one patient only included erysipelas, herpes zoster, dermatitis herpetiformis, and Ehlers-Danlos syndrome. Good clinical skills in dermatology are of paramount importance in military medicine, and if possible, the military should appoint a dermatologist to its medical team to rapidly diagnose and treat the large number of patients with skin disorders.