Journal of the Royal Army Medical Corps最新文献

{"title":"Myopericarditis: recognition and impact in the military population.","authors":"Jessica R Bailey,&nbsp;A Loftus,&nbsp;R J C Allan","doi":"10.1136/jramc-2018-001056","DOIUrl":"https://doi.org/10.1136/jramc-2018-001056","url":null,"abstract":"<p><p>We present a case of a fit and well British Army officer with sudden-onset chest pain following a viral illness, on a background of arduous skiing over an 8-week period. This resulted in a 6-month downgrade with no clearly defined plan for return to full fitness and deployability. The diagnosis and differentiation of myopericarditis from other causes of chest pain is reviewed. The treatment and management of myopericarditis is summarised and commentary is made on the paucity of evidence underpinning the return to fitness guidelines. The impact of this condition primarily affecting young fit individuals, commonly exacerbated by viral illness and arduous activity, is discussed in the context of individual employability and operational capability in a military setting.</p>","PeriodicalId":17327,"journal":{"name":"Journal of the Royal Army Medical Corps","volume":"165 6","pages":"451-453"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jramc-2018-001056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36679766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of supplemental oxygen in emergency patients: a systematic review and recommendations for military clinical practice.","authors":"Laura Cottey,&nbsp;S Jefferys,&nbsp;T Woolley,&nbsp;J E Smith","doi":"10.1136/jramc-2018-001076","DOIUrl":"https://doi.org/10.1136/jramc-2018-001076","url":null,"abstract":"<p><strong>Introduction: </strong>Supplemental oxygen is a key element of emergency treatment algorithms. However, in the operational environment, oxygen supply poses a challenge. The lack of high-quality evidence alongside emerging technologies provides the opportunity to challenge current guidelines. The aim of this review was to appraise the evidence for the administration of oxygen in emergency patients and give recommendations for its use in clinical practice.</p><p><strong>Methods: </strong>A critical review of the literature was undertaken to determine the evidence for emergency supplemental oxygen use.</p><p><strong>Results: </strong>Based on interpretation of the limited available evidence, five key recommendations are made: pulse oximetry should be continuous and initiated as early as possible; oxygen should be available to all trauma and medical patients in the forward operating environment; if peripheral oxygen saturations (SpO₂) are greater than or equal to 92%, supplemental oxygen is not routinely required; if SpO₂ is less than 92%, supplemental oxygen should be titrated to achieve an SpO₂ of greater than 92%; and if flow rates of greater than 5 L/min are required, then urgent evacuation and critical care support should be requested.</p><p><strong>Conclusion: </strong>Oxygen is not universally required for all patients. Current guidelines aim to prevent hypoxia but with potentially conservative limits. Oxygen should be administered to maintain SpO₂ at 92% or above. New areas for research, highlighted in this review, may provide a future approach for oxygen use from point of injury to definitive care.</p>","PeriodicalId":17327,"journal":{"name":"Journal of the Royal Army Medical Corps","volume":"165 6","pages":"416-420"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jramc-2018-001076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36787098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influenza syndromic surveillance and vaccine efficacy in the UK Armed Forces, 2017-2018.","authors":"Mark Andrew Dermont,&nbsp;T Elmer","doi":"10.1136/jramc-2018-001067","DOIUrl":"https://doi.org/10.1136/jramc-2018-001067","url":null,"abstract":"<p><strong>Introduction: </strong>This paper describes the first ever analysis of health data to report influenza vaccine uptake and the effectiveness of the vaccine in preventing general practice presentations for influenza-like illness (ILI) in the UK Armed Forces (UK AF). This was undertaken during the 2017-2018 influenza season.</p><p><strong>Methods: </strong>Clinical Read codes for ILI and influenza vaccinations were used to generate reports for the period from September 2017 to April 2018. Using a methodology adapted from Public Health England's (PHE) in hours syndromic surveillance, the ILI rate for the UK AF was calculated. Subsequent analysis explored vaccination uptake in target groups and compared the relative risk (RR) of ILI in vaccinated versus unvaccinated Service Personnel (SP).</p><p><strong>Results: </strong>4234 SPs had a record of ILI between September 2017 and April 2018, with a peak rate of 216 cases per 100 000 PAR. The absolute risk reduction for reporting ILI in vaccinated versus unvaccinated SP was 0.4% (p=0.0031), and the RR was statistically significant at 15% (95% CI 5% to 23 %) lower than in the non-vaccinated PAR. The number needed to vaccinate (NNV) to prevent one presentation of ILI was 241 (95% CI 145 to 714). The 8153 vaccinations recorded for the untrained strength equate to approximately 38% of overall training throughput and 65% of all Army SP recorded as being in phase 1 training at some point during this period.</p><p><strong>Conclusions: </strong>The relative risk reduction (RRR) for vaccinated personnel was modest and lower than reported elsewhere, but closely compares with ILI rates included in a 2018 Cochrane review. The small RRR and large NNV do not support widening the population of UK AF eligible to receive influenza vaccine. Regimental Medical Officers (RMOs) seeking advice on whether to vaccinate other groups of SP should be aware that this approach offers questionable clinical benefit. The ILI surveillance methodology used in this work could be adapted for syndromic surveillance of other infectious diseases.</p>","PeriodicalId":17327,"journal":{"name":"Journal of the Royal Army Medical Corps","volume":"165 6","pages":"395-399"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jramc-2018-001067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37030092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operation RUMAN and Hurricane IRMA: planning, execution and recovery.","authors":"Andrew M Nelstrop","doi":"10.1136/jramc-2018-001138","DOIUrl":"https://doi.org/10.1136/jramc-2018-001138","url":null,"abstract":"<p><p>Operation RUMAN was the UK response in the Autumn of 2017 to the Category 5 Hurricane IRMA, which affected the British Overseas Territories in the Caribbean. The Joint Operations Area (JOA) spanned an archipelago of Islands over 1000 nm across, stretching logistical and medical doctrinal clinical timelines in a rapidly changing and generally high risk medical environment. Despite significant challenges and a relatively suboptimal start line position, the Operation was a success from a medical perspective, with lower than expected dNBI rates. This paper, written from the medical Operational in-Theatre HQ perspective, charts the phases of Operation RUMAN during Planning, Execution and Recovery. It examines the context and lessons that arose from the Operation RUMAN that could inform future fast-moving Humanitarian Aid and Disaster Relief Operations.</p>","PeriodicalId":17327,"journal":{"name":"Journal of the Royal Army Medical Corps","volume":"165 6","pages":"431-435"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36836867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A tribute to the Journal of the Royal Army Medical Corps","authors":"A. Macmillan","doi":"10.1136/jramc-2019-001348","DOIUrl":"https://doi.org/10.1136/jramc-2019-001348","url":null,"abstract":"Issue 1, Volume 1 of the Journal of the Royal Army Medical Corps appeared at the end of July 1903 and was the realisation of a hope for many years ([Figure 1][1]). The need for such a journal had long been recognised by medical officers in the Army. Indeed, as long ago as 1864, the year after the","PeriodicalId":17327,"journal":{"name":"Journal of the Royal Army Medical Corps","volume":"165 1","pages":"383 - 387"},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jramc-2019-001348","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43843603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards the future: The final issue of the journal of the Royal Army Medical Corps 1903-2019","authors":"J. Breeze","doi":"10.1136/jramc-2019-001372","DOIUrl":"https://doi.org/10.1136/jramc-2019-001372","url":null,"abstract":"Every successful scientific and medical journal needs to adapt to its circumstances: its place in time, in the scientific order of things and its place in the society that it serves. In the 116 years of continuous print publication since its introduction in 1903, the Journal of The Royal Army","PeriodicalId":17327,"journal":{"name":"Journal of the Royal Army Medical Corps","volume":"165 1","pages":"381 - 382"},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jramc-2019-001372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42341342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interests and concerns of the Army Medical Services as reflected by the publications in the Journal of the Royal Army Medical Corps 1903–2019","authors":"T. Barker","doi":"10.1136/jramc-2019-001314","DOIUrl":"https://doi.org/10.1136/jramc-2019-001314","url":null,"abstract":"Introduction The Journal of the Royal Army Medical Corps (JRAMC) is published with the aim of propagating current knowledge and expertise while also acting as institutional memory for the practice of medicine within the military. This work aimed to examine how the interests of the JRAMC, and by inference the Army Medical Services, have changed over time as reflected by the articles published in the journal. Methods A text mining analysis of the titles of all published articles in the JRAMC between 1903 and 2019 was performed. The most commonly used terms were identified and their relative frequency over the decades analysed to identify trends. Article content and contemporary events were compared with the observed trends to identify explanatory events and themes of interest. Results Medical topics of interest centred around specific infectious diseases, particularly during the early/mid-20th century, and trauma and battle injury. The medical specialties of surgery, anaesthetics and mental health were all well represented in nearly all decades, while primary care only came to prominence as a named specialty from the 1960s onwards. India, France, Egypt and wider Africa were the most commonly cited geographical regions, although there were spikes of interest associated with specific conflicts in the Falklands, Bosnia, Afghanistan and Iraq. Conclusion The interests of the JRAMC have changed considerably over the years primarily driven by the geopolitical interests of Britain—in particular its colonial interests and the conflicts it has been involved in, but also by medical advances seen in contemporary society.","PeriodicalId":17327,"journal":{"name":"Journal of the Royal Army Medical Corps","volume":"165 1","pages":"421 - 430"},"PeriodicalIF":0.0,"publicationDate":"2019-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jramc-2019-001314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43404825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trainees and Reserve Service: maximising opportunities and avoiding pitfalls: a surgical perspective.","authors":"J. Whitaker, M. Denning, N. Malik, R. F. Cordell, A. Macmillan, D. Bowley","doi":"10.1136/jramc-2019-001324","DOIUrl":"https://doi.org/10.1136/jramc-2019-001324","url":null,"abstract":"Reservists play an important role within the Defence Medical Services (DMS); from 2006 to 2014 in Afghanistan, 40% of DMS hospital-based personnel were reservists.[1][1] Deployed Reservists helped achieve ‘exemplary’ trauma care in Afghanistan with incremental improvements in injury-related","PeriodicalId":17327,"journal":{"name":"Journal of the Royal Army Medical Corps","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jramc-2019-001324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42902344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scapular winging on Exercise Cambrian Patrol: three soldiers in three days - an occupational risk?","authors":"Samuel Green,&nbsp;H Hodgson,&nbsp;J Bobrowski","doi":"10.1136/jramc-2018-001071","DOIUrl":"https://doi.org/10.1136/jramc-2018-001071","url":null,"abstract":"<p><p>Exercise CAMBRIAN PATROL is an internationally recognised, arduous patrolling exercise held annually in Mid-South Wales. The 2017 iteration of the exercise generated three uncommon shoulder injuries in three consecutive days, all of which were thought to have a similar aetiology. This article presents a case series of three instances of scapular winging in soldiers carrying heavy weight. We review the relevant anatomy and pathophysiology of long thoracic nerve injury and discuss management strategies of scapular winging. Occupational health considerations are reviewed, with respect to carrying large amounts of weight over distance and difficult terrain within the armed forces, along with discussion of a novel weight distribution system (VIRTUS) which has recently been brought into service by the British Army.</p>","PeriodicalId":17327,"journal":{"name":"Journal of the Royal Army Medical Corps","volume":"165 5","pages":"371-373"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jramc-2018-001071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37068761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Energy availability and nutrition during a Special Force Qualification Course (Q-Course).","authors":"Patrick Mullie,&nbsp;P Clarys,&nbsp;W De Bry,&nbsp;P Geeraerts","doi":"10.1136/jramc-2018-001059","DOIUrl":"https://doi.org/10.1136/jramc-2018-001059","url":null,"abstract":"<p><strong>Introduction: </strong>The Special Forces (SF) are an elite military group usually engaged in physically demanding field operations, resulting among others in high daily energy requirements. Optimising energy supply and nutritional requirements is therefore mandatory for success. The aim of this study was to estimate energy availability and nutrition during a Qualification Course (Q-Course) for Belgian SF.</p><p><strong>Methods: </strong>21 participants recorded all foods and beverages consumed during four days in a structured food diary. Energy expenditure was measured with an accelerometer and fat mass measured with quadripolar impedance. Energy availability was calculated by the following formula: (energy intake by foods and beverages - energy expenditure for physical activity)/kg FFM/day (FFM, fat-free mass).</p><p><strong>Results: </strong>The mean (SD) total energy expenditure was 4926 kcal/day (238), with a minimum of 4645 kcal/day and a maximum of 5472 kcal/day. The mean (SD) total energy consumption was 4186 kcal/day (842), giving an energy balance ranging from -2005 kcal/day to 1113 kcal/day. The mean (SD) energy availability was 17 kcal/kg FFM/day, with a minimum of 1 kcal/kg FFM/day and a maximum of 44 kcal/kg FFM/day. The mean (SD) intake of carbohydrates was 6.8 g/kg body weight/day (1.5).</p><p><strong>Conclusions: </strong>During this studied Q-Course, energy intake was not optimal as demonstrated by an overall negative energy balance and low energy availability. High interindividual variations in energy intake were found, highlighting the importance of providing SF members nutritional education.</p>","PeriodicalId":17327,"journal":{"name":"Journal of the Royal Army Medical Corps","volume":"165 5","pages":"325-329"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jramc-2018-001059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36679763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}