Defence Medical Services telemedicine now: a successful pilot of video consultations and instant messaging support to firm base training.

INTRODUCTION: Telemedicine was pioneered in the Defence Medical Services (DMS) in 1998, since then the capabilities within the DMS have not advanced in step with advances in technology. We present our findings of a pilot of remote video consultation via Skype for MODNET during an arduous course held in the UK. METHOD: Combat medical technician sick parades were live streamed via Skype to a Defence Primary Healthcare Medical Centre and medical officer (MO) support was delivered remotely. This process was augmented by the use of Pando for still images of wounds and infection sites in order to enhance decision making and situational awareness. RESULTS: Over a 3-week period, 34 consultations carried out during sick parade required the input from a remote MO, of those 34% required a prescription from an MO. None of the presentations required a face-to-face consultation, and all patients received MO-led care remotely. CONCLUSION: We have successfully demonstrated that video telemedicine consultations are safe, while simultaneously improving patient care, augmenting the distribution of medical assets and reducing costs.

Lessons from the use of telemedicine in the austere military environment and the implications for deployed surgical teams.

Over the last 20 years, there have been significant changes in UK surgical training. Civilian surgical training may no longer prepare military surgeons for the range of skills they require on operations. One method to address gaps in knowledge or experience is to use telemedicine to facilitate specialist consultations from UK-based specialists to deployed medical teams. In the UK Defence Medical Services (DMS), this capability is called real-time clinical support (RTCS). RTCS provides a direct audio-visual link from a deployed location anywhere in the world to a supporting medical specialist in the UK. RTCS is currently delivered via a combination of off-the-shelf hardware and commercially available software. This article will outline the current use of RTCS, with emphasis on deployed surgical teams in austere environments, and discuss the advantages and limitations of this capability. However, it must be emphasised that no technology can be a substitute for clinical training and experience. Although several limitations remain, the authors believe that RTCS offers potential benefits for the DMS and could be an important tool aiding deployed clinicians. It can also be argued that by engaging with the concept now, the DMS can shape future developments in this sphere.

UK medical support to non-combatant evacuation operations.

This review presents the UK Defence Medical Services' involvement in non-combatant evacuation operations (NEOs) in the last two decades. It examines the key medical lessons identified from those operations from publications and witness statements, and discusses key aspects that medical commanders and clinicians should consider in the future, particularly preparation, training and equipping personnel and units for future NEOs. The majority of those UK medical assets that are likely to deploy on NEOs have little or no NEO training and are ill equipped to deal with the common non-battlefield casualties seen in NEOs. Medical management of the elderly, paediatrics, chronic disease and infectious diseases are particular capability gaps.

Enamel diffusion modulated by Er:YAG laser (Part 1)--FRAP.

UNLABELLED: Several studies have demonstrated the caries protective effect of lasers by strengthening enamel crystalline structure. However, the effect of laser on enamel diffusion (ED) remains unclear. OBJECTIVES: This study aimed to quantify the laser-induced alteration of diffusion coefficients (DC) in enamel using fluorescence recovery after photobleaching (FRAP). METHODS: Eleven caries-free enamel sections were characterized morphologically using stereomicroscopy, polarized light microscopy and scanning electron microscopy, before and after laser treatment with Er:YAG laser 50 mJ x 5 s x 5 Hz. With 20 microM fluorescein, DCs were measured (n=11) by FRAP coupled with confocal microscopy. RESULTS: The DCs measured were 2.89+/-0.61 x 10(-7)cm(2)/s and 4.076+/-0.73 x 10(-7)cm(2)/s, at the lased and unlased areas, respectively (p=0.001). CONCLUSIONS: This study has confirmed the reduction of ED as a potential mechanism involved in laser-induced caries prevention. FRAP was demonstrated to be a promising technique for evaluating diffusion-related phenomenon in enamel.

Enamel diffusion modulated by Er:YAG laser (Part 2). Organic matrix.

UNLABELLED: Organic matrix (OM) has been hypothesized as a key player in the laser-induced retardation of enamel diffusion (LRED). OBJECTIVES: Therefore, this study was aimed to quantify the contribution of OM in LRED. METHODS: Four groups of enamel sections (n=10) were assigned to 'normal', 'laser treated', 'OM extracted' and 'laser+OM extraction' groups for measurement of diffusion coefficient (DC) using fluorescence recovery after photobleaching (FRAP) and fluorophores transport study (FTS). Er:YAG laser treatment and OM extraction were performed on respective groups. Sections were characterized with stereomicroscopy and polarized light microscopy. Treatment effects were statistically assessed with a factorial ANOVA. RESULTS: DC measured by FRAP and FTS coupled with confocal microscopy revealed the significant effect of OM (p=0.001) and laser treatment (p<0.01). After OM extraction, the laser effect on diffusion decreased about 34-75%, confirming the significant role of OM in LRED. CONCLUSION: Both FRAP and FTS may be promising tools to quantify enamel DC.

Corneal ulceration in South East Asia. II: a strategy for the prevention of fungal keratitis at the village level in Burma.

AIM: To prove that topical antifungal and antibiotic prophylaxis distributed by grass roots village health workers (VHWs) in Burma is an effective public health intervention for the prevention of post-traumatic microbial keratitis in a population where the majority of ulcers are fungal. METHODS: Three villages in Bago District with a combined population of 16,987 were selected for the study. This defined population was followed prospectively for 12 months by 15 VHWs who were trained to identify post-traumatic corneal abrasions with fluorescein dye and a blue torch and to administer 1% chloramphenicol and 1% clotrimazole ointment three times a day for 3 days to the eyes of individuals who fulfilled the eligibility criteria. RESULTS: During the 12 month period 273 individuals reported to VHWs with an ocular injury and 126 were found to have a corneal abrasion. All 126 were treated with 1% chloramphenicol and 1% clotrimazole ointment three times a day for 3 days, and all healed without sequelae. CONCLUSIONS: Both fungal and bacterial ulcers that occur following traumatic corneal abrasions can be effectively prevented in a village setting by using relatively simple measures that local volunteer public health workers can easily be taught to employ.

The use of personal protective measures in control of malaria in a defined community.

Malaria is one of the main health problems in the non-immune immigrant workers and army personnel of the malaria endemic areas in Myanmar. Due to changes in the vector bionomics and multiresistant strains of P. falciparum, chemoprophylaxis alone is not an effective means of control of malaria in them. So it is envisaged that the combined used of personal protective measures (deltamethrin impregnated bed-nets, scalves and hand-bands) and the chemoprophylaxis will be an effective means of control of malaria in the define group of people. The study also intended to find out the side effects of the deltamethrin and feasibility and acceptability of methods by the users. The study was conducted in Theini Township, Northern Shan State, from March to November 1993. The study population consisted of all ages of both sexes 554 and 440 persons in the test and control groups respectively. At the initial phase of the study, malaria infected persons from both the groups were treated. The experimental group received personal protective measures with impregnation of bed-nets using 25 mg ai/m2 of deltamethrin at 4 monthly intervals and the scarves and hand-bands at twice the concentration of the insecticides at monthly intervals. Chemoprophylaxis was given to both the groups at weekly intervals using age adjusted dosage of Pyrixine tablet (sulfadoxine-pyrimethamine). The parasitological, entomological, and epidemiological indices were collected at two month intervals in both the groups. The study clearly showed the impact of personal protective measures and chemoprophylaxis on malaria infection in the studied subjects. During the study period, the out patient malaria cases of the test group was 6% to 11.2% and that of the control group was 12% to 21.6% in Theini Hospital. The reinfection rate of the test group (0.9 to 4.7%) was also significantly lower than the control group (6.1 to 14.3%) from July to November. Acceptance of the treated bed-nets, scarves and hand-bands was high and good compliance was found in the follow up. The results of the study clearly showed that malaria can be controlled effectively in the defined group of persons for a malaria transmission season by using chemoprophylaxis and personal protective measures.