The Posttraumatic Stress Disorder (PTSD) Checklist: Military Version (PCL-M) is a 17-item, self-report measure of PTSD symptomatology in military veterans and provides one total score and four subscale scores for older veterans’ PTSD (re-experiencing, avoiding, numbing, and hyperarousal symptoms). Study subjects are 456 male veterans over 55-years old with deployed experiences selected from a larger survey data by Veterans’ Affairs Canada (VAC). This study found that overall scale reliability was excellent with alpha of .93 and subscale alphas ranging from .81 to .90. Confirmatory Factor Analysis (CFA) confirmed the best fit of four first-order factor models. Criterion validity was confirmed through significant associations of the PCL-M scores with well-established measures of depression, substance abuse, and general health indices. The PCL-M is recommended as a reliable and valid tool for the clinical and empirical assessment of screening PTSD symptomatology, specifically related to older veterans military experiences.
This study examined a cohort of students attending the Uniformed Services University regarding their attitudes toward medical care in underserved populations. Using the previously validated Medical Student Attitudes Toward the Underserved (MSATU), repeated measures analysis of variance showed that student attitudes toward care in underserved populations was less favorable than limited national data at entry and declined over time (Mean MSATU total score Year 1: 46.2 [SD 10.95]; Year 4: 41.7 [SD 12.3] p < 0.01). Differences in medical school debt, exposure to underserved populations, and the definition of "service" in the context of active duty military status might explain some of our findings. Providing broad service learning opportunities within the curriculum could increase student exposure to underserved populations and strengthen the social contract between community and institution.
Introduction
Prolonged field care for junctional wounds is challenging and involves limb movement to facilitate transport. No studies to date have explored the efficacy of gauze products to limit rebleeding in these scenarios.
Materials and Methods
We randomly assigned 48 swine to QuikClot Combat Gauze, ChitoGauze, NuStat Tactical, or Kerlix treatment groups (12 each) and then inflicted a severe groin injury by utilizing a modified Kheirabadi model of a 6-mm femoral artery punch followed by unrestricted bleeding for 60 seconds. We reassessed rebleed following limb movement at 30 minutes of stabilization and 4 hours after stabilization.
Results
Swine treated with Combat Gauze proved to have the lowest incidence of rebleeding, and conversely, NuStat Tactical had the highest incidence of rebleeding at wounds after limb movement. Importantly, rebleeds occurred at a rate of 25%-58% across all swine treatment groups at 30 minutes postinjury and 0%-42% at 270 minutes postinjury demonstrating that limb movements universally challenge hemostatic junctional wounds.
Conclusions
Our findings highlight the difficulty of controlling hemorrhage from junctional wounds with hemostatic gauze in the context of prolonged field care and casualty transport. Our research can guide selection of hemorrhage control gauze when patients have prolonged field extraction or difficult transport. Our data demonstrates the frequency of junctional wound rebleeding after movement and thus the importance of frequent patient reassessment.
Introduction: Allergic fungal sinusitis (AFS) is a relatively uncommon cause of sinus pain and congestion. Extreme cases may require specialty evaluation and surgical treatment.
Case Report: In this case, an otherwise healthy young man presented to the emergency department with sinus pain and congestion for two weeks and was admitted to surgery for resection of his AFS.
Conclusion: This case demonstrates how a thorough history and physical exam can help catch potentially serious diseases, such as allergic fungal sinusitis, from the frequently benign chief complaint of sinus pain.
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