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[On the centenary of the birth of Honored Scientist, active member of the Academy of Medical Sciences of the USSR and Major General of the Medical Service, Prof. B.S. Doĭnikov].
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Pharmacy practice in the United States Army.
The current status of pharmaceutical services in the United States Army Medical Department is described. The mission of the Army Medical Department is to ensure the health of the soldier during times of peace and war. Of the 225 commissioned pharmacy officers currently on active duty, 156 are assigned to U.S. Army medical centers and community hospitals in the United States, and 29 are stationed at hospitals in Europe, Korea, Panama, and Japan. Army pharmacy officers are supported by 879 Army-trained pharmacy technicians and 319 civilian pharmacists employed by the Army. Army Medical Department hospital pharmacies provide inpatient and ambulatory-care services as well as specialized nuclear pharmacy, oncology, investigational drug, and materials development services. Pharmacy officers assigned to the Pharmacy Branch of the U.S. Army Academy of Health Sciences conduct 17-week technician training programs six times a year and provide other pharmacy courses and continuing education programs. The U.S. Army Allergen Extract Laboratory dispenses diagnostic and immunotherapy agents by mail in response to prescriptions submitted by military allergy clinics. Pharmacy officers may be deployed with field hospitals during times of combat or for extended training exercises in places such as Egypt, Grenada, and Honduras. Pharmacy officers may also be assigned to three- or four-year tours of duty in Army hospitals located in Europe. In the future, the emphasis of Army pharmacy practice will be on the expansion of clinical pharmaceutical services and the development of advanced interactive communication systems, quality assurance programs, and peer-review programs.
Legal aspects of clinical trials in Israel.
Clinical trials were mainly the concern of medical ethics until the first code on this subject was laid down in a judgment given by a military tribunal in Nuremberg in 1947. In 1964 the World Medical Association adopted the Declaration of Helsinki, which was revised in 1975, regarding clinical trials and research. The Declaration of Helsinki and the developments in the pharmacological and pharmaceutical sciences led to legislation regarding clinical trials and human experimentation. In Israel it is forbidden to use any drug that is not registered. In order to register a drug, evidence of quality, safety and efficacy is necessary, and the means by which these factors are proved is the clinical trial, which demands appropriate legislation. Developments in various medical fields, as well as new treatment techniques, brought about the need for more comprehensive legislation on experimentation on human beings and embryos. In Israel, this field is covered by two enactments, the first on drugs and the second on any other experimentation on human beings. However, these enactments are frame laws, which lay down the rule that no clinical trial may be carried out without the prior approval of the Ministry of Health. They also state the minimum conditions to be met, and provide the Ministry with the authority to add any conditions at any time, as well as the right to stop the trial. The Declaration of Helsinki serves as the minimal legal basis for clinical trials. Some legal problems relating to the clinical trial remain unsolved and are left to the discretion of the Ministry of Health. The author makes some observations and suggestions with regard to matters of consent, incompetents as subjects, the right of withdrawal, and the power of the Ministry.
[The Military Medical Academy--the national property of Russia].
Article by the Chief of the Academy has been based on its history of 200 years. One of the oldest establishments of medical education has played a great role in the development of the national and world medicine. Among the Academy graduates of highest merit was N. I. Pirogov, a famous surgeon, who marked a new age in the medical science and education and introduced important innovations in the casualty treatment on the battlefield. He was the first to apply ether anaesthesia and plaster bandage and to have women taking care of the wounded on the theater of operations. Academy graduates S. P. Botkin, G. F. Lang and F. I. Komarov had founded their own schools of therapy. E. N. Pavlovskiĭ developed a study on the focus nativeness of infection and parasite disease process. Every year the Academy scientists implement more than 150 research projects for the government, ministries and different agencies, defend up to 75 theses on 30 specialties, conduct more than 20 national and international conferences, symposiums and meetings. For the last 35 years the Academy has been training medical doctors, scientists and healthcare specialists for 35 countries in Europe, Asia, Africa and Latin America.
Uruguay's military physicians. Cogs in a system of state terror.
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[The periods of actual bed occupancy per year and the length of stay of surgical patients in the hospital].
Taking into account the lack of science-reasonable data about average number of days of bed capacity in year and average number of days of various patient treatment in the hospital, the attempt is undertaken to substantiate these parameters in reference to DM of RF central military medicine institutions. In result of lead research it was established, that average terms of bed capacity in central military hospitals during the last 5 years were 310 days. Average patient terms of treatment differ essentially depending on age and contingent, that is necessary to take into account to define hospital bed requirement norms.
Needs assessment for advanced practice nurses for the uniformed services.
An assessment was made of the need for advanced practice nurses (APNs) in the uniformed services of the Department of Defense and the United States Public Health Service. The purpose of the assessment was to determine the role of the Graduate School of Nursing (GSN) at the Uniformed Services University of the Health Sciences in educating APNs for the uniformed services. The assessment focused on three categories of APNs: certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and nurse practitioners (NPs). The assessment found that current authorizations for APNs in the three military services exceeded inventory by 192 APNs: 148 CRNAs, 4 CNMs, and 40 NPs. In addition, losses through attrition in fiscal year 1993 were 154 APNs: 97 CRNAs, 7 CNMs, and 50 NPs. Thus, there is a need for educational support to prepare APNs for the uniformed services. The GSN can usefully supplement other educational programs in meeting this need.
Neurologic health outcomes and Agent Orange: Institute of Medicine report.
The National Academy of Sciences' Institute of Medicine conducted an independent scientific investigation to evaluate the strength of evidence for human health effects among veterans exposed to herbicides used in Vietnam and to suggest future research recommendations. Neurologic domains where multiple studies had been performed in military, occupational, or environmental situations were (1) cognitive and neuropsychiatric effects, (2) motor/coordination dysfunction and other central nervous system disorders, and (3) peripheral neuropathy. In all categories, no strong evidence established an association between herbicides used in Vietnam and clinical neurologic disorders. Methodologic weaknesses, long durations between exposure and assessments, and poor exposure measures limited many studies. The committee concluded that the available evidence was insufficient to determine an association between neurologic disorders and exposure to herbicides used in Vietnam. Neurotoxicologic studies available did not suggest strong biological plausibility for neurologic alterations related to herbicide exposure. Furthermore, given the large uncertainties in the epidemiologic studies reviewed and inadequate control for important confounders, the committee could not quantify a degree of risk for neurologic disorders from herbicide exposure likely to be experienced by Vietnam veterans. Although not part of the neurologic report, the risk of brain tumors was considered in the cancer analysis, and the committee concluded that there is limited/suggestive evidence of no association between exposure to herbicides and brain tumors.
Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution.
OBJECTIVES: To discover whether post-combat syndromes have existed after modern wars and what relation they bear to each other. DESIGN: Review of medical and military records of servicemen and cluster analysis of symptoms. DATA SOURCES: Records for 1856 veterans randomly selected from war pension files awarded from 1872 and from the Medical Assessment Programme for Gulf war veterans. MAIN OUTCOME MEASURES: Characteristic patterns of symptom clusters and their relation to dependent variables including war, diagnosis, predisposing physical illness, and exposure to combat; and servicemen's changing attributions for post-combat disorders. RESULTS: Three varieties of post-combat disorder were identified-a debility syndrome (associated with the 19th and early 20th centuries), somatic syndrome (related primarily to the first world war), and a neuropsychiatric syndrome (associated with the second world war and the Gulf conflict). The era in which the war occurred was overwhelmingly the best predictor of cluster membership. CONCLUSIONS: All modern wars have been associated with a syndrome characterised by unexplained medical symptoms. The form that these assume, the terms used to describe them, and the explanations offered by servicemen and doctors seem to be influenced by advances in medical science, changes in the nature of warfare, and underlying cultural forces.
Overview of overseas humanitarian, disaster, and civic aid programs.
The U.S. Department of Defense (DoD) conducts humanitarian assistance missions under the Overseas Humanitarian Disaster and Civic Aid program for the statutory purposes of training military personnel, serving the political interests of the host nation and United States, and providing humanitarian relief to foreign civilians. These purposes are undertaken via the humanitarian assistance (HA), humanitarian and civic assistance, and excess property donation programs. DoD conducts over 200 such projects annually at a direct cost of approximately 27 million dollars in fiscal year 2001. Although varying by year and command, as many as one-half of these projects involve aspects of health care. These range from short-term patient care to donation of medical supplies and equipment excess to the needs of the DoD. Despite the considerable resources invested and importance of international actions, there is presently no formal evaluation system for these HA projects. Current administrative staffing of these programs by military personnel is often by individuals with many other duties and responsibilities. As a result, humanitarian projects are often inadequately coordinated with nongovernmental organizations, private volunteer organizations, or host-nation officials. Nonmedical military personnel sometimes plan health-related projects with little or no coordination with medical experts, military or civilian. After action reports (AARs) on these humanitarian projects are often subjective, lack quantitative details, and are devoid of measures of effectiveness. AARs are sometimes inconsistently completed, and there is no central repository of information for analysis of lessons learned. (The approximate 100 AARs used in the conduct of these studies are available for official use in the Learning Resources Center, Uniformed Services University of Health Sciences.) Feedback from past humanitarian projects is rare and with few exceptions; DoD-centric projects of a similar design are often repeated. Critical reviews to determine whether other kinds of projects might be more effective are rarely conducted. Recommendations for improving the effectiveness of DoD HA under Overseas Humanitarian Disaster and Civic Aid programs include: ensuring adequate staffing to meet the complex, dynamic nature of humanitarian missions and measuring the effectiveness of each project in mandatory, standardized AARs. For medical HA projects, application of public health strategies would compliment the patient care approach of the majority of medical projects to date. This offers possibilities for enhancing host nation infrastructure, allowing improvements beyond the short period of most military humanitarian projects.
[Main military-and-clinical hospital in the system of medical support of the Russian Federation's Armed Forces].
Burdenko N.N. MMCH is the main hospital, a scientific-and-methodological center of medical service concerning prophylaxis-and-treatment spheres, the main clinical base of the State istitute of increasing doctors' qualification of RF MD and a military-and-medical faculty of the Moscow medical academy by Sechenov I.M. The hospital has the greatest experience of treatment of the wounded, sick and injured in all wars and armed conflicts with the participation of the Russian army. In the hospital's staff there is a unique flying surgical-and-reanimation laboratory "Skalpel" for urgent evacuation of the wounded from armed conflicts' centers. Almost all types of high technology medical care are provided in the hospital. About 6500 of the wounded and the sick obtain such treatment every year; 70-80% of the sick having treatment in the hospital are from the group of the most severe and complex patients. The hospital has the highest scientific and methodological level among hospitals of the Russian Federation's Armed Forces: 48 doctors and 141 candidates of medical science, those include 21 professors and 12 docents. It is the main base for new medical equipment and drugs testing to the interest of all medical service of the RF AF.
Contributions of the biological sciences to human welfare. 3. Clinical medicine.
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Historical perspective on asbestos: policies and protective measures in World War II shipbuilding.
Current public health consequences of poorly controlled utilization of asbestos in the past can be traced back, in part, to decisions made 45 or more years ago. This paper focuses on the extensive use of asbestos as a fireproofing and insulating material in shipbuilding in the 1940s, when World War II industrial expansion brought about a hitherto unprecedented rise in the amount of asbestos utilized. Twenty years after World War II, asbestos diseases began to manifest themselves, affecting thousands of shipyard workers as well as other workers who had been exposed in the 1940s and during the postwar period. By scrutinizing past actions, the paper argues that social forces, as well as science and technology, affect the setting of priorities and the determination of policy regarding needed but hazardous materials.
Who wrote the book of life? Information and the transformation of molecular biology, 1945-55.
This paper focuses on the opening of a discursive space: the emergence of informational and scriptural representations of life and hereditiy and their self-negating consequences for the construction of biological meaning. It probes the notion of writing and the book of life and shows how molecular biology's claims to a status of language and texuality undermines its own objective of control. These textual significations were historically contingent. The informational representations of heredity and life were not an outcome of the internal cognitive momentum of molecular biology; they were not a logical necessity of the unravelling of the base-pairing of the DNA double-helix. They were transported into molecular biology still within the protein paradigm of the gene in the 1940s and permeated nearly every discipline in the life and social sciences. These information-based models, metaphors, linguistic, and semiotic tools which were central to the formulation of the genetic code were transported into molecular biology from cybernetics, information theory, electronic computing, and control and communication systems--technosciences that were deeply embedded with the military experiences of World War II and the Cold War. The information discourse thus became fixed in molecular biology not because it worked in the narrow epistemic sense (it did not), but because it positioned molecular biology within postwar discourse and culture, perhaps within the transition to a post-modern information-based society.
[Quantification in psychiatry: from psychometrics to quantitative psychiatry].
The development of quantitative techniques to analyse psychopathological states is reviewed from the XVIIIth Century till today. As far as back as the XIXth Century, Quetelet, Louis and Galton introduced and advocated the use of quantitative methods in medical and psychological sciences. The advent of psychometry dates back 1905, when Alfred Binet published his Intelligence Scale. The construction of instruments like Wechsler and MMPI scales in the forties starts using psychometry in psychiatry. At end of World War II, historical factors (selection and guidance of military recruits) in conjunction with technical advancements (beginning of psychopharmacology, multivariate statistics development and first computers arrival) favor the growth of quantitative psychopathology that further takes four great different courses: 1. Psychometry proper, 2. Symptom-quantifying assessment scales such as BPRS or Hamilton scales, 3. New nosological models constructed using quantified psychopathological data and mathematical procedures, 4. Diagnostic systems relying on operationalized criteria based on psychopathological quantification, such as DSM III.
[Bayrullah Efendi-a physician of Tanzimat (reformation) period - his life and works].
Hayrullah Efendi, one of the prominent officials of the Reformation Period (Tanzimat 1839) was born in Istanbul in 1817 and died in Tahran in the year 1866, when he was the ambassador of the Ottoman Empire there. He started his education as a student of theology (Islamic studies), later started to study medicine and was graduated from the military medical school, "Mekteb-i Tibbiye-i Adlilye-i-Sahane", in 1844. Retiring from the military service, he served as a member of the Committee of Agriculture (Ziraat Meclisi), Board of General Educations (Meclis-i Maarif-i Umumiye) Supreme Council of Justice (Meclis-i Vâlâ-yi Ahkâm-i Adliye), wise president of Council Educations and Sciences called "Encümen-i Dâniş", Dean of Medical School "Mekteb-i Tibbiye", and head of the Sixth Department of the Municipal Organization. In addition to his works on medicine, science, history and literature, Hayrullah Efendi is also the writer of the first play in Turkish.