Medical Examination And Medical Standards

The U.S. Department of Defense (DoD) faces short-term and long-term challenges in selecting and recruiting an enlisted force to meet personnel requirements associated with diverse and changing missions. The DoD has established standards for aptitudes/abilities, medical conditions, and physical fitness to be used in selecting recruits who are most likely to succeed in their jobs and complete the first term of service (generally 36 months). In 1999, the Committee on the Youth Population and Military Recruitment was established by the National Research Council (NRC) in response to a request from the DoD. One focus of the committee's work was to examine trends in the youth population relative to the needs of the military and the standards used to screen applicants to meet these needs. When the committee began its work in 1999, the Army, the Navy, and the Air Force had recently experienced recruiting shortfalls. By the early 2000s, all the Services were meeting their goals; however, in the first half of calendar year 2005, both the Army and the Marine Corps experienced recruiting difficulties and, in some months, shortfalls. When recruiting goals are not being met, scientific guidance is needed to inform policy decisions regarding the advisability of lowering standards and the impact of any change on training time and cost, job performance, attrition, and the health of the force. Assessing Fitness for Military Enlistment examines the current physical, medical, and mental health standards for military enlistment in light of (1) trends in the physical condition of the youth population; (2) medical advances for treating certain conditions, as well as knowledge of the typical course of chronic conditions as young people reach adulthood; (3) the role of basic training in physical conditioning; (4) the physical demands and working conditions of various jobs in today's military services; and (5) the measures that are used by the Services to characterize an individual's physical condition. The focus is on the enlistment of 18- to 24-year-olds and their first term of service.

A guide to the techniques and analysis of clinical data. Each of the seventeen sections begins with a drawing and biographical sketch of a seminal contributor to the discipline. After an introduction and historical survey of clinical methods, the next fifteen sections are organized by body system. Each contains clinical data items from the history, physical examination, and laboratory investigations that are generally included in a comprehensive patient evaluation. Annotation copyrighted by Book News, Inc., Portland, OR

Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.

To be asked to prepare a second edition of a book is heartening for any author or editor. Apart from the opportunity to make the corrections and amendments which are inevitable in a practical manual there is also the possibility to make additions which enhance its usefulness. Above all a further edition usually means that the book has been found to be accept able to a large number of readers and has fulfilled a need. This is indeed the case with Offshore Medicine, which in its description of the medical aspects of offshore work has provided a unique guide to the occupational health of a new industry. The rapid development of offshore exploration for gas and oil which began in the 1960s created a whole new range of related industries. Most attention was focused on the problems of deep diving in the North Sea because of the great expansion of the diving industry, its technological advances and the high mortality of divers in the early years. Diving, however, is only a fraction of the total endeavour concerned with the offshore industry. The much larger population of workers offshore who man the rigs and barges, the toolpushers, helicop ter pilots, crane drivers, scaffolders and roustabouts, geologists and so on, so sympathetically described by A. Alvarez in his recent book Off shore, A North Sea Journey, and the harsh and difficult conditions in which they often have to work are sometimes forgotten.

In response to a request by the Health Care Financing Administration (HCFA), the Institute of Medicine proposed a study to examine definitions of serious or complex medical conditions and related issues. A seven-member committee was appointed to address these issues. Throughout the course of this study, the committee has been aware of the fact that the topic addressed by this report concerns one of the most critical issues confronting HCFA, health care plans and providers, and patients today. The Medicare+Choice regulations focus on the most vulnerable populations in need of medical care and other services-those with serious or complex medical conditions. Caring for these highly vulnerable populations poses a number of challenges. The committee believes, however, that the current state of clinical and research literature does not adequately address all of the challenges and issues relevant to the identification and care of these patients.