Explosive devices are taking an increasing toll on military personnel and civilians in war zones and in other geographic areas fraught with political conflict. The authors describe blast-related polytrauma and provide a conceptual model for the evaluation and treatment of patients in the postacute setting. Rather than using a sequential approach based on primary symptoms, the authors advocate a parallel approach to patient evaluation based on the mechanism of injury.
Based on a case review of four patients with severe vaginal injury resulting in profuse bleeding, the authors provide a treatment protocol for nonobstetric patients with suspected vaginal laceration. Two patients in this review had severe hypovolemic shock on initial examination. The authors note that few cases can be managed conservatively and that preparedness eliminates dangerous delays and inadequate examination and treatment. Domestic abuse should be considered as a cause of injury and evaluated appropriately.
In an analysis of data obtained from the state of Texas, the authors found that female osteopathic physicians have the most potential to positively influence the future of rural primary care in the United States. The authors suggest that the effects of gender and osteopathic medical training should be studied by policymakers.
While further research is needed, the present study supports the validity of the COMLEX-USA Level 2-PE examination for assessing the clinical skills of future osteopathic physicians.
Stakeholder groups are surveyed regarding standards for a comprehensive clinical skills examination.
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