Atención a la paciente obstétrica en el contexto de la pandemia de COVID-19 / Obstetric patient care in the context of COVID-19 pandemic

La infección causada por el SARS-CoV-2, tuvo una repercusión negativa en la evolución clínica de un número importante de gestantes y puérperas en todo el mundo. Este trabajo tiene como objetivo, exponer los principales resultados de la organización del proceso de atención a la paciente obstétrica en el contexto de la pandemia por la COVID-19. Está basado en la organización y elementos fundamentales seguidos con las pacientes que ingresaron, por afecciones relacionadas con el aborto, embarazo o puerperio, con sospecha de COVID-19 o con RT-PCR para SARS-CoV-2 positivo, en el año 2020, y las positivas al SARS-CoV-2 en 2021, de las provincias La Habana, Mayabeque y Artemisa, que fueron atendidas en el Hospital Militar Central Dr. Luis Díaz Soto. Se tuvo en cuenta el total de casos ingresados, pacientes confirmadas, ingresos en unidad de cuidados intensivos obstétricos, en servicio de vigilancia intensiva obstétrica, y la evolución clínica Con la organización de la atención médica a las pacientes obstétricas con la COVID-19, se logró el cumplimiento de los protocolos establecidos y la integración multidisciplinaria en el seguimiento de los casos, lo cual contribuyó a la evolución favorable de la mayoría de las pacientes(AU)

The infection caused by SARS-CoV-2 had a negative impact on the clinical evolution of a significant number of pregnant and puerperal women worldwide. The aim of this work is to present the main results of the organization of the obstetric patient care process in the context of the COVID-19 pandemic. It is based on the organization and fundamental elements followed with the patients who were admitted, for conditions related to abortion, pregnancy or puerperium, with suspicion of COVID-19 or with positive RT-PCR for SARS-CoV-2, in the year 2020, and those positive to SARS-CoV-2 in 2021, from Havana, Mayabeque and Artemisa provinces, who were attended at the Central Military Hospital Dr. Luis Díaz Soto. The total number of cases admitted, confirmed patients, admissions to the obstetric intensive care unit, obstetric intensive surveillance service, and clinical evolution were taken into account. With the organization of medical care for obstetric patients with COVID-19, compliance with established protocols and multidisciplinary integration in the follow-up of cases was achieved, which contributed to the favorable evolution of most patients(AU)

A Questionnaire Survey of Personal and Occupational Variables Associated With SARS-COV-2 Infection in Health Care Personnel of the Spanish Central Military Hospital.

INTRODUCTION: Spain is the country with the highest number of health care workers affected by coronavirus disease 2019 (COVID-19) in the world. The aim of this study was to describe the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection in health care worker (HCW) at the Gómez Ulla Military Hospital (HCDGU). MATERIALS AND METHODS: A case-control study was conducted during the first outbreak of COVID 19 at GUMH. The study was extended to the total number of HCW in the hospital who met the inclusion criteria. Health care worker of the HCDGU were civilian and military personnel that included nursing and medicine students of Spanish Military Academy, medicine specialty residents, and nursing residents of Medical Surgical Specialty in Operations (EMQO). A questionnaire of 33 items was prepared. The questionnaire was sent by e-mail to the entire population of study. With this questionnaire personnel were classified into sick (cases) or healthy. RESULTS AND CONCLUSIONS: One hundred fifty professionals answered the questionnaire. Cases were defined as those who tested positive in the diagnostic tests (n = 28, 20.7%) and no cases were those who tested negative (n = 107, 79.3%). Therefore, the percentage of SARS-CoV-2 in the GUMH was 20.7%. Of the total number of cases, 64.3% were men (P < .05), with a mean age of 47.1 years (SD 13.3), a mean BMI of 25.3 (SD 3.8), and 48.2% being overweight. Of the total cases, 59.3% had "A" blood group type and 69.2% were Rh positive. 50% were physicians, 32.1% were nurses, and 17.9% were auxiliary nurses (P < .05). Cases and controls with vitamin D deficiency and who took supplements had a lower risk of suffering COVID-19, with significant differences. Fever, cough, and diarrhea were found in at least 50% of the samples with significant differences.

Complicaciones de la COVID -19 en un paciente hipertenso / Complications of the COVID-19 in a hypertensive patient

Introducción: La rápida expansión de la COVID-19 hizo que la Organización Mundial de la Salud, el 30 de enero de 2020, la declarara emergencia sanitaria y la reconoció como pandemia el 11 de marzo del mismo año. Objetivo: Describir la evolución clínica de un paciente hipertenso, afectado por la COVID-19. Caso clínico: Se trata de un paciente de 49 años de edad, hipertenso, afectado por la COVID-19, atendido en el Hospital Militar Dr. "Joaquín Castillo Duany", quien durante su estancia en la unidad de cuidados intensivos, sufrió graves complicaciones tales como: síndrome de distrés respiratorio agudo, neumonía asociada a la ventilación artificial mecánica y tromboembolismo pulmonar. La demora en acudir al centro hospitalario, la hipertensión arterial y el tratamiento previo con inhibidores de la enzima convertidora de la angiotensina, figuraron entre las variables presentes en este paciente, las cuales incidieron posiblemente de manera negativa en su evolución. Conclusión: Con el tratamiento intensivo, la estrategia ventilatoria y de anticoagulación empleadas, evolucionó favorablemente hasta su egreso hospitalario(AU)

Introduction: The rapid expansion of COVID-19 caused the World Health Organization, on January 30, 2020, to declare it a health emergency and recognized it as a pandemic on March 11 of the same year. Objective: To describe the clinical evolution of a hypertensive patient, affected by COVID-19. Clinical case: This is a 49-year-old patient, hypertensive, affected by COVID-19, treated at the Dr. "Joaquín Castillo Duany" Military Hospital, who during his stay in the intensive care unit, suffered serious complications such as: acute respiratory distress syndrome, pneumonia associated with mechanical artificial ventilation, and pulmonary thromboembolism. The delay in going to the hospital, arterial hypertension, and previous treatment with angiotensin-converting enzyme inhibitors, were among the variables present in this patient, which possibly had a negative impact on his evolution. Conclusion: With intensive treatment, the ventilatory and anticoagulation strategy used, evolved favorably until his hospital discharge(AU)

Impact of the implementation of a therapy dog program on burn center patients and staff.

Animal-assisted interventions have been implemented in both inpatient and outpatient settings and have demonstrated positive outcomes on patients and hospital staff. Animal-assisted interventions have not been previously reported in any burn center. A therapy dog program was established at our burn center with the intent of improving duration and quality of rehabilitation sessions and physical therapy. Satisfaction surveys were distributed to patients and staff. After one year, 14 patient surveys and 23 staff surveys were collected. Implementation of this program was feasible and patients worked with the therapy dogs in all environments of the burn center: outpatient, ward, and ICU. Most patients reported improved pain and anxiety after working with the therapy dogs. All patients reported that they would like more sessions with the therapy dogs. All staff members were satisfied or very satisfied with their therapy dog visit and all enjoyed having the therapy dogs present. Most reported an improved mood after seeing the therapy dogs and wanted that additional therapy dog visits. One year after the implementation of the therapy dog program, we have demonstrated feasibility, acceptability, and desirability of this type of program at our burn center. Given the paramount importance of rehabilitation in the recovery of burn patients, further investigation into therapy should be performed and longer term outcomes assessed.

Evaluación acupuntural en el control de la presión intraocular en el glaucoma crónico simple / Acupunctural Assessment for Intraocular Pressure Control of Chronic Simple Glaucoma

Introducción: El glaucoma es una enfermedad con elevada prevalencia a nivel mundial, que afecta la visión. De no ser tratada a tiempo conduce a la ceguera y determina cambios en las esferas psíquica, social y laboral de quien la padece. Objetivo: Evaluar la eficacia de la acupuntura en el control de la tensión ocular en el glaucoma crónico simple mediante la caracterización demográfica según sexo, edad y color de la piel, la descripción de la respuesta clínica de los pacientes al tratamiento y la identificación de reacciones adversas. Métodos: Se realizó un estudio cuasiexperimental antes y después en 60 pacientes atendidos en el Hospital Militar Central "Dr. Luis Díaz Soto" en el período de septiembre de 2015 a agosto de 2016 que cumplieron con los criterios de inclusión. Por método aleatorio simple se conformaron dos grupos que mantuvieron su tratamiento farmacológico habitual, a uno de los cuales se le agregó la acupuntura. Se utilizaron las variables sexo, edad, color de la piel, presión intraocular y reacciones adversas. Resultados: Se obtuvo una reducción significativa de la presión intraocular en ambos ojos de forma simultánea con el tratamiento acupuntural y no se produjeron reacciones adversas al aplicar esta técnica. Conclusiones: El tratamiento acupuntural fue eficaz en la reducción de la presión intraocular en el glaucoma crónico simple.

Introduction: Glaucoma is a disease that affects vision, and accounting for a high prevalence worldwide. If not treated timely, it leads to blindness and determines changes in the psychic, social and occupational spheres of the person who suffers from it. Objective: To assess the efficacy of acupuncture for controlling ocular tension in chronic simple glaucoma, by means of demographic characterization according to sex, age and skin color, description of the patients' clinical response to treatment, and the identification of adverse reactions. Methods: A two-stage (before and after) quasiexperimental study was carried out with 60 patients, who met the inclusion criteria and were treated at Dr. Luis Díaz Soto Central Military Hospital, in the period from September 2015 to August 2016. Two groups were formed using the simple randomization method; one of them was added acupuncture apart from usual pharmacological treatment. The variables analyzed were sex, age, skin color, intraocular pressure and adverse reactions. Results: A significant reduction in intraocular pressure was obtained in both eyes simultaneously using acupuncture treatment. There were no adverse reactions when applying this technique. Conclusions: Acupuncture treatment was effective in reducing intraocular pressure in chronic simple glaucoma.

Efectividad del tratamiento homeopático de la hipertensión arterial / Effectiveness of Homeopathic Treatment against Arterial Hypertension

Introducción: La hipertensión arterial es una de las enfermedades más comunes y afecta en el mundo a 800 millones de personas (20 %) de la población adulta mundial. En Cuba existen aproximadamente 215 hipertensos por cada 1000 habitantes, mientras que en Holguín 199 por cada 1000 habitantes padecen esa enfermedad. Objetivo: Evaluar la efectividad de la homeopatía en el tratamiento de la hipertensión arterial teniendo en cuenta los antecedentes patológicos personales, la clasificación de los pacientes según el grado de hipertensión arterial al iniciar y al concluir el estudio, así como el diagnóstico miasmático de cada uno. Método: Se realizó una investigación con diseño cuasiexperimental en el Hospital Militar "Fermín Valdés Domínguez" de Holguín en el período comprendido desde febrero de 2014 hasta febrero de 2016. El universo de estudio estuvo constituido por 243 pacientes diagnosticados con hipertensión arterial que asistieron a la consulta de Medicina Tradicional y Natural del Hospital Militar de Holguín. La muestra del estudio fue intencionada y quedó constituida por 217 pacientes de ambos sexos, mayores de 20 años. Luego de la repertorización de cada paciente, se trató a cada uno con el medicamento homeopático resultante de este proceso. Resultados: Se redujeron las cifras tensionales a niveles donde se consideran hipertensos controlados y hasta menores de 120/80 mm Hg en el 89,4 % de los pacientes tratados. Conclusiones: La homeopatía se considera un tratamiento eficaz para la hipertensión arterial.

Introduction: Arterial hypertension is one of the most common diseases and affects 800 million people, 20% of the world's adult population. In Cuba, there are near 215 hypertensive patients per 1000 inhabitants; while, in Holguín, 199 per 1000 inhabitants suffer from this disease. Objective: To assess the effectiveness of homeopathy in treating arterial hypertension, by taking into account the patients' individual pathological history, their classification according to degree of arterial hypertension at the beginning and at the end of the study, as well as each patient's miasmatic diagnosis. Method: A research with a quasiexperimental design was carried out, in the period from February 2014 to February 2016, at Fermín Valdés Domínguez Military Hospital in Holguín. The study universe consisted of 243 patients diagnosed with arterial hypertension who attended the traditional and natural medicine consultation at the Military Hospital in Holguín. The study sample was intentional and consisted of 217 patients of both sexes, aged over 20 years. After repertorization of each patient, they were treated with the homeopathic medicament resulting from this process. Results: Blood pressure figures were reduced to levels for which they are considered to be controlled hypertensive patients and even less than 120/80 mmHg in 89.4% of the patients treated. Conclusions: Homeopathy is considered an effective treatment for arterial hypertension.

Electroacupuntura en el tratamiento del síndrome afectivo depresivo a nivel neurótico leve-moderado / Electroacupuncture for Treating Affective-Depressive Syndrome at a Mild to Moderate Neurotic Level

Introducción: La depresión es una enfermedad mental que causa notable deterioro del funcionamiento físico, social y laboral. La búsqueda de nuevas alternativas de tratamiento ha llevado al campo de la medicina tradicional, con buenos resultados. Objetivo: Evaluar la respuesta terapéutica a la electroacupuntura de pacientes con síndrome afectivo-depresivo a nivel neurótico leve y moderado. Métodos. Se realizó estudio cuasiexperimental, longitudinal, prospectivo, en 47 pacientes del Hospital Militar Central "Dr. Carlos J. Finlay, se aplicó el tratamiento en Yintang, VG20 y otros puntos según desequilibrio energético". Resultados: El grupo se caracterizó por ser adultos, con predominio femenino (55,3 %) y de piel blanca (59,6 %). El tiempo promedio de evolución fue 4,5 meses con intensidad moderada en el 95,7 %. Los diagnósticos tradicionales más frecuentes fueron el estancamiento del Qi de hígado y el ascenso del fuego de hígado (40,4 %, respectivamente). Conclusiones: No se detectaron diferencias significativas en el puntaje de la Escala de Hamilton al inicio y al final en relación con las características demográficas, tiempo de evolución, grado de la depresión y diagnóstico tradicional. Se demostró efectividad clínica y seguridad con el uso de la electroacupuntura en pacientes con síndrome afectivo-depresivo a nivel neurótico leve o moderado.

Introduction: The depression is a mental illness that causes notable deterioration of the physical, social and labor operation. The search of new treatment alternatives has led to the field of the traditional medicine, with good results. Objective: Evaluating the therapeutic answer to the electro acupuncture in patients with Affective Syndrome - Depressive at light and moderate neurotic level Methods: A quasi-experimental study was carried out, longitudinal, prospective in 47 patients at the Central Military Hospital Dr. Carlos J. Finlay". Yintang, VG20 and other points according to energy imbalance were used. Results: The group was characterized for being adults, with feminine average (55.3%) and of white skin (59.6%). The time evolution average was 4,5 months with intensity moderated in 95.7%. The most frequent traditional diagnoses were the Stagnation of the liver Qi and the Ascent of the liver fire (40.4 % respectively). Significant differences were not detected in the intensity of the depression determined for characteristic demographic or traditional diagnosis (p> 0.05). Conclusions: No differences were detected in the Hamilton scale score at the beginning and at the end in relation to the demographic characteristics, time of evolution, degree of depression and traditional diagnosis. Clinical effectiveness and safety demonstrated with the use of electroacupuncture

Utility of Hyperbaric Oxygen Therapy for Acute Acoustic Trauma: 20 years' Experience at the Japan Maritime Self-Defense Force Undersea Medical Center

Introduction: Acute acoustic trauma, which is a kind of sensorineural hearing loss, is caused by acoustic overstimulation. Hyperbaric oxygen therapy (HBOT) is reported to be effective against acute acoustic trauma. Objective: We aimed to evaluate the efficacy of HBOT against acoustic hearing loss based on our 20 years of experience with such cases. Methods: Patients who were treated with HBOT for acute acoustic trauma between April 1997 and August 2017 were evaluated in this study. Thirty-five patients with a mean age of 25.7 ± 9.2 (range: 16­48) years were included. Thirty-nine out of 70 ears (35 patients) were damaged. We investigated the initial level of hearing loss; the extent to which hearing recovered; subjective symptoms, such as tinnitus and aural fullness; and the treatment administered. Results: The planned HBOT was completed in 37 of 39 ears. Twenty-six of the 37 ears (70.2%) displayed improved hearing, and 31 of the 37 ears (83.9%) exhibited symptom improvement. Twenty-three (76.7%) and 26 (86.7%) of the 30 ears treated with steroids demonstrated improvements in hearing and subjective symptoms, respectively. Conclusion: A combination of HBOT and steroids should be considered as a treatment for acute acoustic trauma in cases involving symptoms such as tinnitus and aural fullness (AU)

Cerebral Venous Thrombosis at High Altitude: Analysis of 28 Cases.

OBJECTIVE: An association between cerebral venous sinus thrombosis (CVST) and high altitude has been previously proposed, but limited published data exist to support this association. We investigated 28 cases of CVST occurring at high altitude and sought to describe patient demographics, altitude and acclimatization, hematological laboratory findings, neuroimaging, treatment, and prognosis in these cases. METHODS: Twenty-eight cases of symptomatic CVST occurring at high altitude were identified between the months of August 2017 and December 2018, in collaboration with Military Hospital, Rawalpindi and Combined Military Hospital, Skardu (Pakistan). Follow-up visits were performed at 1 and 6 months. RESULTS: Twenty-seven (96%) of the patients were males, and the mean age was 33 years. In total, 32.1% were smokers. The mean NIHSS score on presentation was 5.5. 85.7% of the cases occurred at altitude higher than 8,000 feet. On average 107.8 days were spent at a high altitude prior to CVST. Totally, 71.4% had acclimatized for >2 weeks. The mean hemoglobin (Hb) value was 16.7 g/dL and 50% had d-dimer levels higher than 1,000 ng/mL. On MRI, 25% showed signs of hemorrhage and 14.3% showed infarcts. Treatments provided include low-molecular-weight heparin and Rivaroxaban and were associated with good outcomes. CONCLUSION: CVST is not uncommon at high altitude (>8,000 feet). It is predominantly a male disease. Most patients have high Hb and high D-dimer levels. The overall outcome was good.

[Management of cerebral radionecrosis: experience in the Department of Neurology at the Mohammed V Military Teaching Hospital]. / Prise en charge de la radionécrose cérébrale: expérience du Service de Neurologie de l'Hôpital Militaire d'Instruction Mohammed V.

Brain radionecrosis is a rare but life-threatening complication of external-beam radiotherapy for ENT cancers, in particular of the nasopharynx, and for brain tumors. Very few studies were conducted on this complication in the African population as well as in the Maghreb population. Therefore our study aims to describe the demographic, clinical, paraclinical, therapeutic and evolutionary features of cerebral radionecrosis in the Department of Neurology at the Mohammed V Military Teaching Hospital in Rabat over a period of 18 years (2000-2017). The study involved 4 women and 13 men, with an average age of 50 years. The mean time between the end of the radiotherapy and the onset of neurological signs was 28 months. Systematic Brain MRI, sometimes complemented by spectro-MRI, allowed the diagnosis in 100% of cases. Etiologically, this complication occurred after radiotherapy for nasopharyngeal carcinoma and cancer of the larynx in all cases. Fifteen patients were treated with a combination of: bolus application of corticosteroids, platelet aggregation inhibitors associated with hyperbaric oxygen therapy with good evolution of two patients in whom oxygen therapy was contraindicated due to a lung problem and ENT cancer, received a combination of bolus application of corticosteroids and platelet aggregation inhibitors with unchanged evolution. These results demonstrate the importance of early diagnosis in patients with potentially serious conditions, in particular neuropsychiatric conditions, as well as of treatment combining bolus application of corticosteroids and hyperbaric oxygen therapy because this is the best guarantee of a favorable outcome, without omitting the crucial role of preventive measures.

Canine-Assisted Therapy Improves Well-Being in Nurses.

As nursing is one of the most stressful occupations worldwide, its management warrants more attention to identify possible ways to cope with its pressures. This study aims to evaluate whether animal-assisted therapy (AAT) with the presence of a dog affects the stress level of nurses. As a stress biomarker, we used salivary cortisol level testing. Twenty female nurses (mean age: 30) in physical medicine (PMR) (n = 11) and the department of internal medicine and long-term care (IM < C) (n = 9). On each of the three observed days, saliva was collected at 10 a.m. and then again after 50 min. The first sampling was performed during a normal working process without a break (Condition A), the second was carried out during a normal working process with a break of choice (Condition B), and the third sampling was performed during a normal working process with a break with AAT (Condition C). All participants were enrolled in all three interventional conditions in a randomized order. The results demonstrated the effect of a reduction of cortisol levels in Condition C, where AAT was included (p = 0.02) only in nurses recruited from the IM < C department. By way of explanation, nurses from the PMR department already showed low cortisol levels at baseline. We propose including AAT with a dog in healthcare facilities where nurses are at a high risk of stress.

The effectiveness of military hospital-based drug treatment program (PMK) when compared with the traditional community-based drug treatment program (FAST).

BACKGROUND: In Thailand, two community-based drug treatment approaches are common. The first one is the traditional community-based treatment program (FAST) which brings the principles of community therapy as a guideline for treatment. The second one is the military hospital-based drug treatment program (PMK), derived from the basic military training, the Buddhist Twelve Steps, CBT and the Minnesota Rehabilitation Model. This study aimed to investigate and compare the efficacy of PMK vs. FAST. METHOD: The experiment was conducted from January-March 2016 at the rehabilitation center for patients with drug addiction in Thailand. Quasi-experimental methods were introduced, and ASSIST, WHOQOL-BRIEF-THAI and self-efficacy interview form were applied. After completing the drug rehabilitation program at a total duration of 120 days, the researcher continued at follow up times at 3 and 6 months. RESULTS: Compared with baseline scores, both programs significantly reduced the severity of drugs and increased self-efficacy at 6-month follow-up. PMK had better improved scores in the relationship and environment dimensions of quality of life at 3-month follow-up (P = 0.026, 0.006). The mean quality of life scores in PMK at 3 and 6 months showed better results than mean scores at baseline (P = < 0.001). CONCLUSION: Both community-based programs in Thailand significantly reduced the severity of drugs and increased self-efficacy scores at 6-month follow-up. PMK and FAST has not shown any significant difference in treatment outcome results in the aspects of self-efficacy and reduced severity of drugs used. However, PMK had significant positive effects on the quality of life.

Development and Prospective Validation of a Machine Learning-Based Risk of Readmission Model in a Large Military Hospital.

BACKGROUND: Thirty-day hospital readmissions are a quality metric for health care systems. Predictive models aim to identify patients likely to readmit to more effectively target preventive strategies. Many risk of readmission models have been developed on retrospective data, but prospective validation of readmission models is rare. To the best of our knowledge, none of these developed models have been evaluated or prospectively validated in a military hospital. OBJECTIVES: The objectives of this study are to demonstrate the development and prospective validation of machine learning (ML) risk of readmission models to be utilized by clinical staff at a military medical facility and demonstrate the collaboration between the U.S. Department of Defense's integrated health care system and a private company. METHODS: We evaluated multiple ML algorithms to develop a predictive model for 30-day readmissions using data from a retrospective cohort of all-cause inpatient readmissions at Madigan Army Medical Center (MAMC). This predictive model was then validated on prospective MAMC patient data. Precision, recall, accuracy, and the area under the receiver operating characteristic curve (AUC) were used to evaluate model performance. The model was revised, retrained, and rescored on additional retrospective MAMC data after the prospective model's initial performance was evaluated. RESULTS: Within the initial retrospective cohort, which included 32,659 patient encounters, the model achieved an AUC of 0.68. During prospective scoring, 1,574 patients were scored, of whom 152 were readmitted within 30 days of discharge, with an all-cause readmission rate of 9.7%. The AUC of the prospective predictive model was 0.64. The model achieved an AUC of 0.76 after revision and addition of further retrospective data. CONCLUSION: This work reflects significant collaborative efforts required to operationalize ML models in a complex clinical environment such as that seen in an integrated health care system and the importance of prospective model validation.

Effectiveness of a Self-Care Toolkit for Surgical Breast Cancer Patients in a Military Treatment Facility.

OBJECTIVE: To assess whether a self-care toolkit (SCT) provided to breast cancer patients undergoing surgery could mitigate distress and lessen symptoms associated with surgery. DESIGN: One hundred women with breast cancer, planning to undergo initial surgery, were randomly assigned to either one of two groups: treatment as usual (TAU; n = 49) or TAU with the addition of an SCT (n = 51). The SCT contained an MP3 player with audio-files of guided mind-body techniques (breathing, progressive muscle relaxation, meditation, guided imagery, and self-hypnosis) and acupressure antinausea wristbands. Anxiety, pain, nausea, sleep, fatigue, global health, and quality of life (QOL) were assessed using validated outcome measures. Two inflammatory blood markers (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) were measured serially. Data were collected at baseline (T1), immediately before surgery (T2), within 10 h postoperatively (T3), and ∼2 weeks postsurgery (T4). SETTINGS: Numerous studies have shown that psychological distress associated with a cancer diagnosis can affect pain perception and QOL. RESULTS: Between T1 and T4, there were significant between-group differences in Patient-Reported Outcomes Measurement Information System (PROMIS)-57 scores of Pain Interference, Fatigue, and Satisfaction with Social Roles, favoring the SCT group compared with TAU (p = 0.005, p = 0.023, and p = 0.021, respectively). There was a significant mean change in Defense and Veterans Pain Rating Scale (DVPRS) scores from T2 to T3, with the SCT group having significantly smaller increases in postoperative pain (p = 0.008) and in postoperative ESR (p = 0.0197) compared with the TAU group. Clinically significant reductions in anxiety occurred in the SCT group during the main intervention period. CONCLUSION: These results suggest that using the SCT in the perioperative period decreased pain perceptions, fatigue, and inflammatory cytokine secretion.

El cuidado de la salud del Ejército de los Andes del general San Martín / The health care of the Army of Andes of General San Martín

A través de la revisión de documentos históricos y otras fuentes bibliográficas, y desde la perspectiva de la enfermería, se describen los recursos y prácticas sanitarias con que contaba el equipo de salud que acompañó al cuerpo del Ejército de los Andes al mando del general José de San Martín desde el inicio del cruce de los Andes el 19 de enero en las Provincias Unidas del Río de la Plata, hasta finalizada la batalla de Chacabuco, en la Capitanía General de Chile, el 12 de febrero de 1817. Este trabajo nos permite conocer el trabajo de los primeros sanitarios militares que asistieron en el cuidado de los soldados de los ejércitos patrios y contribuir así a difundir la historia de la Medicina Argentina. (AU)

Through the review of historical documents and other bibliographic sources, and from the perspective of nursing, we describe the health resources and practices held by the health team that accompanied the Army of Los Andes under the command of General José de San Martín, from the start of crossing Los Andes on January 19th in the Provincias Unidas del Río de la Plata, to finish in the battle of Chacabuco, in the General Captaincy of Chile on February 12th, 1817. This work allows us to know the work of the first military health professionals who assisted in the care of the soldiers of the patriotic armies and contribute to spread the history of the Argentine Medicine. (AU)

Changes in female veterans' neck pain following chiropractic care at a hospital for veterans.

OBJECTIVE: To determine if U.S. female veterans had demonstrable improvements in neck pain after chiropractic management at a Veterans Affairs (VA) hospital. METHODS: This was a retrospective cross-sectional study of medical records from female veterans attending a VA chiropractic clinic for neck pain from 2009 to 2015. Paired t-tests were used to compare baseline and discharge numeric rating scale (NRS) and Neck Bournemouth Questionnaire (NBQ) scores with a minimum clinically important difference (MCID) set at a 30% change from baseline. RESULTS: Thirty-four veterans met the inclusion criteria and received a mean of 8.8 chiropractic treatments. For NRS, the mean score improvement was 2.7 (95%CI, 1.9-3.5, p < .001). For the NBQ, the mean score improvement was 13.7 (95%CI, 9.9-17.5, p < .001). For the MCID, the average percent improvement was 45% for the NRS and 38% for the NBQ. CONCLUSION: Female veterans with neck pain experienced a statistically and clinically significant reduction in NRS and NBQ scores.

Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial.

Importance: It is critically important to evaluate the effect of nonpharmacological treatments on low back pain and associated disability. Objective: To determine whether the addition of chiropractic care to usual medical care results in better pain relief and pain-related function when compared with usual medical care alone. Design, Setting, and Participants: A 3-site pragmatic comparative effectiveness clinical trial using adaptive allocation was conducted from September 28, 2012, to February 13, 2016, at 2 large military medical centers in major metropolitan areas and 1 smaller hospital at a military training site. Eligible participants were active-duty US service members aged 18 to 50 years with low back pain from a musculoskeletal source. Interventions: The intervention period was 6 weeks. Usual medical care included self-care, medications, physical therapy, and pain clinic referral. Chiropractic care included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies. Main Outcomes and Measures: Coprimary outcomes were low back pain intensity (Numerical Rating Scale; scores ranging from 0 [no low back pain] to 10 [worst possible low back pain]) and disability (Roland Morris Disability Questionnaire; scores ranging from 0-24, with higher scores indicating greater disability) at 6 weeks. Secondary outcomes included perceived improvement, satisfaction (Numerical Rating Scale; scores ranging from 0 [not at all satisfied] to 10 [extremely satisfied]), and medication use. The coprimary outcomes were modeled with linear mixed-effects regression over baseline and weeks 2, 4, 6, and 12. Results: Of the 806 screened patients who were recruited through either clinician referrals or self-referrals, 750 were enrolled (250 at each site). The mean (SD) participant age was 30.9 (8.7) years, 175 participants (23.3%) were female, and 243 participants (32.4%) were nonwhite. Statistically significant site × time × group interactions were found in all models. Adjusted mean differences in scores at week 6 were statistically significant in favor of usual medical care plus chiropractic care compared with usual medical care alone overall for low back pain intensity (mean difference, -1.1; 95% CI, -1.4 to -0.7), disability (mean difference, -2.2; 95% CI, -3.1 to -1.2), and satisfaction (mean difference, 2.5; 95% CI, 2.1 to 2.8) as well as at each site. Adjusted odd ratios at week 6 were also statistically significant in favor of usual medical care plus chiropractic care overall for perceived improvement (odds ratio = 0.18; 95% CI, 0.13-0.25) and self-reported pain medication use (odds ratio = 0.73; 95% CI, 0.54-0.97). No serious related adverse events were reported. Conclusions and Relevance: Chiropractic care, when added to usual medical care, resulted in moderate short-term improvements in low back pain intensity and disability in active-duty military personnel. This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines. However, study limitations illustrate that further research is needed to understand longer-term outcomes as well as how patient heterogeneity and intervention variations affect patient responses to chiropractic care. Trial Registration: ClinicalTrials.gov Identifier: NCT01692275.

Utilization of Manipulative Treatment for Spine and Shoulder Conditions Between Different Medical Providers in a Large Military Hospital.

OBJECTIVE: To describe the use of manipulative treatment for shoulder and spine conditions among various provider types. DESIGN: Retrospective observational cohort. SETTING: Single military hospital. PARTICIPANTS: Consecutive sample of patients (N=7566) seeking care for an initial spine or shoulder condition from January 1 to December 31, 2009. INTERVENTIONS: Manipulative treatment (eg, manual therapy, spinal and joint manipulation). MAIN OUTCOME MEASURE: Manipulation treatment was identified with procedure billing codes in the medical records. Spine and shoulder conditions were identified by using the International Classification of Diseases, 9th Revision codes. All data were abstracted from the Department of Defense Military Health System Management and Analysis Tool. RESULTS: Of 7566 total patients seeking care, 2014 (26.6%) received manipulative treatment at least once, and 1883 of those received this treatment in a military facility (24.7%). Manipulative treatment was used most often for thoracic conditions and least often for shoulder conditions (50.8% and 24.2% of all patients). There was a total of 6706 unique medical visits with a manipulative treatment procedure (average of 3.3 manipulative treatment procedure visits per patient). CONCLUSIONS: Manipulative treatment utilization rates for shoulder and spine conditions ranged from 26.6% to 50.2%. Chiropractors used manipulation the most and physical therapists the least.