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1.
J Perianesth Nurs ; 35(4): 353-356, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32561253

RESUMO

Nurses have historically led efforts to improve the health of populations while simultaneously and unselfishly providing care during pivotal moments of national need. The COVID-19 pandemic has placed an unprecedented strain on the US health care system, including severe shortages of hospital beds, supplies, equipment, pharmaceuticals, and healthy frontline clinicians. Perioperative and perianesthesia leaders and clinicians have unique opportunities to provide patient care during the COVID-19 crisis. In this manuscript, we describe the initial changing roles and contributions of perioperative and perianesthesia registered nurses during the COVID-19 pandemic and share recent experiences from a military medical center. Perioperative and perianesthesia nurses are vital to the overall nursing viability of the health care system, as they possess the requisite knowledge and skills to provide expert clinical care in many hospital settings and meet the demands of a global pandemic.


Assuntos
Infecções por Coronavirus/terapia , Hospitais Militares , Enfermagem Perioperatória/organização & administração , Pneumonia Viral/terapia , Competência Clínica , Infecções por Coronavirus/epidemiologia , Humanos , Papel do Profissional de Enfermagem , Pandemias , Pneumonia Viral/epidemiologia , Estados Unidos/epidemiologia
2.
Anaesth Crit Care Pain Med ; 39(3): 361-362, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32360981

Assuntos
Betacoronavirus , Infecções por Coronavirus , Cuidados Críticos/organização & administração , Hospitais Militares/organização & administração , Unidades de Terapia Intensiva/organização & administração , Unidades Móveis de Saúde/organização & administração , Pandemias , Pneumonia Viral , Síndrome do Desconforto Respiratório do Adulto/terapia , Idoso , Anestesia Geral/estatística & dados numéricos , Conversão de Leitos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Cuidados Críticos/estatística & dados numéricos , Despacho de Emergência Médica/organização & administração , Feminino , França/epidemiologia , Hospitais com menos de 100 Leitos , Serviços Hospitalares Compartilhados/organização & administração , Hospitais Gerais/organização & administração , Hospitais Militares/estatística & dados numéricos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/provisão & distribução , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Unidades Móveis de Saúde/estatística & dados numéricos , Doenças Profissionais/prevenção & controle , Pandemias/prevenção & controle , Admissão do Paciente/estatística & dados numéricos , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Utilização de Procedimentos e Técnicas , Respiração Artificial/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/etiologia
3.
Epidemiol Mikrobiol Imunol ; 69(1): 38-41, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32326714

RESUMO

AIMS: To present our experience with pre-exposure prophylaxis (PrEP) at the HIV Center of the Military University Hospital Prague, to characterize a set of PrEP candidates, to assess the efficiency and safety of PrEP and to measure the incidence of sexually transmitted diseases (STDs) in the studied cohort. MATERIAL AND METHODS: In total, 99 PrEP candidates (98 men who have sex with men and one woman) were monitored during an 18-month period. An initial examination included acquiring a history, performing a physical examination, screening for HIV (serology) and other STDs and performing renal function tests. RESULTS: In total, 81 candidates (in the cohort of 99 candidates) received PrEP. During the course of the 18-month period, none of the clients were newly infected with HIV, and no side effects of the provided medication were recorded. A total of 21% of the 99 PrEP candidates were initially tested positive for STDs, including two clients with HIV. A total of 14% of the 81 PrEP clients contracted an STD during the monitoring period. CONCLUSIONS: Experience amassed at the HIV Center of the Military University Hospital Prague over an 18-month period documented the demand for PrEP, assessed PrEP efficacy, indicated good tolerance and suggested that PrEP played a role in the decline in the HIV incidence in the Czech Republic. In addition, several new HIV cases and cases of other asymptomatic STDs were also detected.


Assuntos
Infecções por HIV , Hospitais Militares , Militares , Profilaxia Pré-Exposição , República Tcheca , Feminino , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Hospitais Militares/estatística & dados numéricos , Humanos , Masculino , Minorias Sexuais e de Gênero/estatística & dados numéricos
4.
N Engl J Med ; 382(15): 1420-1429, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32268027

RESUMO

BACKGROUND: Both physical therapy and intraarticular injections of glucocorticoids have been shown to confer clinical benefit with respect to osteoarthritis of the knee. Whether the short-term and long-term effectiveness for relieving pain and improving physical function differ between these two therapies is uncertain. METHODS: We conducted a randomized trial to compare physical therapy with glucocorticoid injection in the primary care setting in the U.S. Military Health System. Patients with osteoarthritis in one or both knees were randomly assigned in a 1:1 ratio to receive a glucocorticoid injection or to undergo physical therapy. The primary outcome was the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year (scores range from 0 to 240, with higher scores indicating worse pain, function, and stiffness). The secondary outcomes were the time needed to complete the Alternate Step Test, the time needed to complete the Timed Up and Go test, and the score on the Global Rating of Change scale, all assessed at 1 year. RESULTS: We enrolled 156 patients with a mean age of 56 years; 78 patients were assigned to each group. Baseline characteristics, including severity of pain and level of disability, were similar in the two groups. The mean (±SD) baseline WOMAC scores were 108.8±47.1 in the glucocorticoid injection group and 107.1±42.4 in the physical therapy group. At 1 year, the mean scores were 55.8±53.8 and 37.0±30.7, respectively (mean between-group difference, 18.8 points; 95% confidence interval, 5.0 to 32.6), a finding favoring physical therapy. Changes in secondary outcomes were in the same direction as those of the primary outcome. One patient fainted while receiving a glucocorticoid injection. CONCLUSIONS: Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1 year than patients who received an intraarticular glucocorticoid injection. (ClinicalTrials.gov number, NCT01427153.).


Assuntos
Glucocorticoides/administração & dosagem , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/reabilitação , Modalidades de Fisioterapia , Feminino , Hospitais Militares , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Militares , Osteoartrite do Joelho/fisiopatologia , Manejo da Dor/métodos , Medição da Dor , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos , Veteranos
5.
Ocul Immunol Inflamm ; 28(3): 424-432, 2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-31009267

RESUMO

BACKGROUND: Causes of uveitis vary upon the epidemiologic, racial, and geographical variations. OBJECTIVE: The objective of the study is to analyze pattern and outcome of uveitis in Phramongkutklao Hospital. METHODS: This is a retrospective study. RESULTS: Rate of uveitis was 580 cases per 100 000 persons including infectious uveitis (20%), idiopathic (36%), and noninfectious (44%). The male-to-female ratio was 1.2:1. Anterior uveitis was the most common (50%) followed by panuveitis (25.6%), posterior uveitis (12.3%), and intermediate uveitis (7.3%). The three most common causes were Behçet's disease, HLA-B27-associated uveitis, and herpetic iridocyclitis. A total of 62 patients (10.6%) suffered from blindness, for which the most diagnostic disease was Behçet's disease. The most common complication was glaucoma (21%). Acute onset, unilateral, posterior uveitis, granulomatous inflammation, and complications differed significantly between the infectious and noninfectious groups (p < 0.001). CONCLUSION: The rate of uveitis was 0.58% and noninfectious uveitis was common. Clinical presentations regarding acute onset, unilateral, posterior uveitis, and granulomatous inflammation suggest infectious causes.


Assuntos
Hospitais Militares/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Uveíte/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criança , Estudos Transversais , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Tailândia/epidemiologia , Tomografia de Coerência Óptica , Uveíte/diagnóstico , Adulto Jovem
6.
Clin Orthop Surg ; 11(4): 388-395, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31788160

RESUMO

Background: Hip fractures are a significant cause of morbidity and mortality in the elderly. Fast-track multidisciplinary co-management of these patients, rapid preoperative optimization, early surgery, and expeditious rehabilitation may minimize morbidity and mortality. In this study, we evaluated outcomes of fixation of hip fractures in the elderly patients managed by Geriatric Hip Fracture Program at a military hospital in India. Methods: A total of 114 patients above 60 years of age with hip fractures were enrolled. They were comanaged by a team of specialists and fast-tracked to surgery. Independent ambulation with support of a walker was achieved before discharge to home. Patients were followed up for 1 year. Results: The average age of the 114 patients was 77 years; 24 patients were octogenarian. Eighty-four percent of injuries were due to a domestic fall. Hypertension (41%) and diabetes (22%) were the most common comorbidities. All patients were optimized before surgery. The average delay from injury to admission was 1.7 days (range, 0 to 14 days) and that from admission to surgery was 1.8 days (range, 0 to 19 days). Hence, the average time from injury to surgery was 3.5 days. The length of stay in hospital was, as per rehabilitative milestones achieved, 2 to 5 days in 40% of the patients and 6 to 15 days in 60% of the patients. At 1 year after surgery, 95 patients were independently ambulant (56 patients with support and 39 patients without support). Twenty-three percent of the patients had postoperative complications and eight patients died (7.7%) at 1-year follow-up; 11 patients were lost to follow-up. Conclusions: Elderly hip fracture has a high risk of mortality (14%-58%). Thus, expeditious surgery within 24 hours of admission has been advocated in the Western literature to minimize mortality. Mortality rate at 1 year after surgery remains at 10% to 24%. In our study, even with aggressive co-management, the average delay to hip fracture fixation was more than 3 days; however, the 1-year mortality was relatively low (7.7%). This indicates the importance of preoperative optimization and postoperative rehabilitation for independent ambulation and mortality reduction in the elderly population.


Assuntos
Fixação de Fratura , Fraturas do Quadril/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/mortalidade , Veteranos , Idoso , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica , Fraturas do Quadril/mortalidade , Hospitais Militares , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
J Pak Med Assoc ; 69(12): 1888-1890, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31853122

RESUMO

The objective of this study was to determine the association between Body Mass Index (BMI) and migraine. This prospective study took place from 5th February, 2017 to 5th August, 2017 at a Military Hospital in Rawalpindi. Migraine in subjects was diagnosed according to the ICHD-III criteria by clinicians after taking an informed, written consent from 78 patients and the data was analysed using SPSS 22. Of the 78 patients, 35(44.9%) were males and 43(55.1%) were females. Out of the 78 subjects, 9(11.5%) were underweight, 33(41.0%) were of normal weight, 9(14.10%) were overweight, 19(24.4%) were obese and 7(9.0%) were morbidly obese. The p-value calculated was 0.892 which indicates no significant evidence of any association between BMI and migraine in the survey population reporting at the Rawalpindi Military Hospital. A follow-up study at a national level with much larger sample size will be able to better predict the changing results in our country, because as of now the association between BMI and migraine is debatable.


Assuntos
Índice de Massa Corporal , Transtornos de Enxaqueca , Sobrepeso , Adolescente , Adulto , Peso Corporal/fisiologia , Feminino , Hospitais Militares , Humanos , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Paquistão , Estudos Prospectivos , Adulto Jovem
8.
Pan Afr Med J ; 34: 41, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762908

RESUMO

Acute disseminated encephalomyelitis (ADEM) is a rare cause of encephalitis in adults, characterized by inflammatory lesions in the white substance of the central nervous system (CNS). Initial clinical presentation may mimic severe CNS infection with fever, encephalopathy, seizures, or multiple sclerosis. The purpose of our study was to report the epidemiological, clinical, radiological, therapeutic and evolutionary features of ADEM and to determine the role of MRI sequences in the diagnosis, monitoring and prognosis of this disease. We conducted a retrospective study of the clinical and radiological records of 22 patients with ADEM followed up in the Department of Neurology over a period of 11 years (January 2006- January 2017). These patients underwent medical imaging at the Mohammed V Military Teaching Hospital, de Rabat. The average age of patients was 35 years (12-57 years). A recent infection was found in 31% of patients, while 4% of patients had recently undergone vaccination. Symptoms were dominated by focal neurologic deficit (72%). CT scan was normal in 78%. MRI showed hyperintense subtentorial and supratentorial white substance on FLAIR sequences in 70% of patients, without diffusion restriction in all cases, with enhancement of the lesions in 27% of cases and involvement of the cervical spinal cord in 68% of cases. Clinical and radiological outcome was favorable in all cases.


Assuntos
Encefalomielite Aguda Disseminada/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Criança , Encefalomielite Aguda Disseminada/fisiopatologia , Encefalomielite Aguda Disseminada/terapia , Feminino , Hospitais Militares , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
9.
Cerebrovasc Dis ; 48(3-6): 184-192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31775151

RESUMO

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.


Assuntos
Altitude , Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Inibidores do Fator Xa/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Rivaroxabana/uso terapêutico , Trombose dos Seios Intracranianos/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Aclimatação , Adulto , Anticoagulantes/efeitos adversos , Biomarcadores/sangue , Inibidores do Fator Xa/efeitos adversos , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hemoglobinas/metabolismo , Heparina de Baixo Peso Molecular/efeitos adversos , Hospitais Militares , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Paquistão , Estudos Retrospectivos , Fatores de Risco , Rivaroxabana/efeitos adversos , Trombose dos Seios Intracranianos/sangue , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombose dos Seios Intracranianos/etiologia , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/sangue , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Adulto Jovem
10.
Pan Afr Med J ; 33: 188, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692728

RESUMO

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.


Assuntos
Encéfalo/patologia , Oxigenação Hiperbárica/métodos , Lesões por Radiação/diagnóstico por imagem , Corticosteroides/administração & dosagem , Adulto , Idoso , Feminino , Hospitais Militares , Humanos , Neoplasias Laríngeas/radioterapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Marrocos , Neoplasias Nasofaríngeas/radioterapia , Necrose , Inibidores da Agregação de Plaquetas/administração & dosagem , Lesões por Radiação/terapia , Estudos Retrospectivos
11.
Cancer Radiother ; 23(8): 867-873, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31677902

RESUMO

PURPOSE: The primary objective was to determine in our department the progression-free survival rate of patients with solitary bone plasmocytoma and secondarily to evaluate its diagnostic, therapeutic and evolutionary aspects. PATIENTS AND METHODS: This is a retrospective review of 12 patients monitored and treated in the radiotherapy department of the Mohammed-V military medical teaching hospital in Rabat for a solitary bone plasmocytoma between January 2012 and December 2018. The average age of our patients were 53.8 years old (range: 31-72 years old). Pain was the most common telltale sign. The site of the lesions was spinal in four cases, iliac in four cases, mandibular, ribal, humeral and at the level of the astragalus in one case respectively. All patients received radiotherapy. This irradiation was delivered alone in 60% of cases or associated with surgery in 40% of cases. The average dose of radiotherapy was 47.3Gy (range: 45 to 50.4Gy) and this was delivered by a modulated volumetric arc therapy technique in ten patients and conformal tridimensional radiotherapy in two patients. RESULTS: Local control, defined by stability or radiological regression, was obtained in ten patients and four patients progressed to multiple myeloma, two of whom died. The average duration of follow-up was 51 months. CONCLUSION: Radiation therapy is the standard treatment for solitary bone plasmocytoma. It ensures good local control in 90% of cases. The prognosis is affected by progression to multiple myeloma, which justifies rigorous monitoring after treatment and suggests a reflection on the exact place of chemotherapy.


Assuntos
Neoplasias Ósseas/radioterapia , Plasmocitoma/radioterapia , Adulto , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Progressão da Doença , Feminino , Hospitais Militares , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos , Mieloma Múltiplo/etiologia , Mieloma Múltiplo/mortalidade , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/cirurgia , Prognóstico , Intervalo Livre de Progressão , Dosagem Radioterapêutica , Radioterapia Conformacional , Radioterapia de Intensidade Modulada , Estudos Retrospectivos
12.
Medicine (Baltimore) ; 98(43): e17715, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651903

RESUMO

A few studies have compared patients who were directly admitted with patients who were transferred to a tertiary facility for an appendectomy. However, there have been no reports of an association between the time to transfer and outcome in patients who underwent an appendectomy. As the only tertiary military hospital in South Korea, we occasionally encountered patients who were delayed for transfer due to the military environment. We hypothesize that patients with a longer time to transfer have a worse outcome. This study aimed to evaluate the relationship between the time to transfer and the outcome of patients who underwent an appendectomy.Patients who underwent appendectomy in the tertiary military hospital in South Korea from May 2015 to April 2017 were analyzed retrospectively. The groups were divided by the time for the transfer. Four hours was used as the cut-off point to divide the early and delayed transfer groups. Time from symptom onset to hospitalization, time from diagnosis to surgery, and time from hospitalization to surgery were also analyzed to assess the effect of time for the transfer.A total of 449 patients were analyzed: 293 with direct admission, 110 with early transfer, and 46 with delayed transfer. The time required for transfer was more critical for delaying appendectomy than the time from hospital admission to surgery. There was no difference in outcomes among the groups. When patients were compared according to the perforation, no differences were found in time from hospitalization to surgery, time from diagnosis to surgery, and presence of transfer. Multivariate analysis showed that a greater than 72 hours delay from symptom onset to hospitalization was associated with perforation (odds ratio = 12.61; 95% confidence interval: 3.84-41.40; P < .001).Even if a long transfer time is necessary, an appendectomy can be performed safely if patients were administered antibiotics immediately after diagnosis.


Assuntos
Apendicite/cirurgia , Hospitais Militares , Transferência de Pacientes/estatística & dados numéricos , Tempo para o Tratamento , Apendicectomia , Progressão da Doença , Feminino , Humanos , Masculino , República da Coreia , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
13.
PLoS One ; 14(10): e0223497, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31584991

RESUMO

BACKGROUND: Military anesthesia meets unique logistical, technical, tactical, and human constraints, but to date limited data have been published on anesthesia management during military operations. OBJECTIVE: This study aimed to describe and analyze French anesthetic activity in a deployed military setting. METHODS: Between October 2015 and February 2018, all patients managed by Sainte-Anne Military Hospital anesthesiologists deployed in mission were included. Anesthesia management was described and compared with the same surgical procedures in France performed by the same anesthesia team (hernia repair, lower and upper limb surgeries). Demographics, type of surgical procedure, and surgical activity were also described. The primary endpoint was to describe anesthesia management during the deployment of forward surgical teams (FST). The secondary endpoint was to compare anesthesia modalities during FST deployment with those usually used in a military teaching hospital. RESULTS: During the study period, 1547 instances of anesthesia were performed by 11 anesthesiologists during 20 missions, totaling 1237 days of deployment in nine different theaters. The majority consisted of regional anesthesia, alone (43.5%) or associated with general anesthesia (21%). Compared with France, there was a statistically significant increase in the use of regional anesthesia in hernia repair, lower and upper limb surgeries during deployment. The majority of patients were civilians as part of medical support to populations. CONCLUSION: In the context of an austere environment, the use of regional anesthesia techniques predominated when possible. These results show that the training of military anesthetists must be complete, including anesthesia, intensive care, pediatrics, and regional anesthesia.


Assuntos
Anestesia , Medicina Militar , Militares , Adulto , Países em Desenvolvimento , Feminino , França , Hospitais Militares , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Militar/estatística & dados numéricos , Razão de Chances , Sistema de Registros , Estudos Retrospectivos , Adulto Jovem
14.
Pan Afr Med J ; 33: 156, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565118

RESUMO

Cardiac manifestations develop in the majority of patients with systemic lupus erythematosus (SLE) at some time during the course of their disease. This study was designed to assess cardiac abnormalities in patients with SLE by echocardiography and to compare the 2 groups of patients with and without cardiac manifestations. It was a transversal, descriptive study, conducted in the Internal Medicine Department at the Military Hospital of Tunis from January 2016 to June 2018. Eighty lupus patients, diagnosed on the basis of ACR (American college of rheumatology) criteria, were enrolled in the study and were evaluated by standard echocardiography with color Doppler. Out of 80 patients 42 (52%) had abnormal echocardiographic findings. Pericardial effusion was found in 55%, valvular abnormalities in 52% and 38% had pulmonary hypertension. Patients with pleural effusion (45 vs 15%) were more vulnerable to cardiac involvement as well as renal impairment (57 vs 44%). The difference, however, were not statistically significant (p>0.05) in the renal involvement. Active disease with low complement (80%) was associated with higher frequency of cardiac involvement than disease in remission (64%) but the result was not statistically significant (p=0.11). Cardiac abnormalities are very common in lupus patients even when clinically asymptomatic form. Echocardiography is an excellent non-invasive tool for cardiac evaluation. Their research must be systematic with echocardiography in order to reduce subsequent cardiac morbidity and mortality among the lupus patients.


Assuntos
Ecocardiografia/métodos , Cardiopatias/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/etiologia , Hospitais Militares , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/epidemiologia , Derrame Pericárdico/etiologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Tunísia
15.
Artigo em Inglês | MEDLINE | ID: mdl-31574899

RESUMO

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.


Assuntos
Terapia Assistida com Animais , Cães , Enfermeiras e Enfermeiros/psicologia , Estresse Ocupacional/prevenção & controle , Adulto , Animais , República Tcheca , Feminino , Hospitais Militares , Humanos , Hidrocortisona/análise , Estresse Ocupacional/metabolismo , Saliva/química
16.
Hand Surg Rehabil ; 38(6): 358-363, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31550553

RESUMO

Microsurgery is an unusual procedure in the theatres of military operations. We sought to analyze the state of microsurgical practices in the French medical treatment facilities (MTFs) deployed around the world in the 21st century. A retrospective study was conducted among all patients who were operated on in French forward surgical facilities between 2003 and 2015. Those who underwent microsurgical procedures for nerve injury, vascular injury, or extremity reconstruction were included. Only early vascular results were assessed. Among the 2589 patients operated on for an extremity injury during the study period, 56 (2.1%) were included, with the group composed of 29 patients with isolated nerve injuries, 28 patients with nerve and arterial injuries, and two patients with isolated arterial injuries, mostly at the hand level. Nerve procedures predominantly consisted of direct suturing, although autografting and nerve transfers were also performed. Thirteen microvascular repairs were carried out, including nine cases of proximal or digital revascularization; revascularization was successful in six of the nine cases. These procedures were completed by orthopedic surgeons trained in microsurgery, mostly under loupes magnification. Routine nerve repair in the field seems to be specific to French MTFs. Salvage of amputated or devascularized fingers in the combat zone had never been reported before. Such emphasizes the need to train deployed orthopedic surgeons to perform microsurgical procedures and to equip all MTFs with basic microsurgical sets and magnification means.


Assuntos
Extremidades/cirurgia , Microcirurgia/estatística & dados numéricos , Serviços de Saúde Militar , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Procedimentos Ortopédicos/estatística & dados numéricos , Adulto , Artérias/lesões , Artérias/cirurgia , Extremidades/lesões , Feminino , Fraturas Ósseas/cirurgia , França , Hospitais Militares , Humanos , Masculino , Unidades Móveis de Saúde , Cirurgiões Ortopédicos/estatística & dados numéricos , Traumatismos dos Nervos Periféricos/cirurgia , Reimplante , Estudos Retrospectivos
17.
BMC Health Serv Res ; 19(1): 656, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500620

RESUMO

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.


Assuntos
Qualidade de Vida , Autoeficácia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Hospitais Militares , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Militar , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/psicologia , Tailândia , Resultado do Tratamento
18.
Nurs Hist Rev ; 28(1): 93-126, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31537723

RESUMO

During the Korean War (1950-1953) the Norwegian government sent a mobile army surgical hospital (MASH) to support the efforts of the United Nations (UN) Army. From the first, its status was ambiguous. The US-led military medical services believed that the "Norwegian Mobile Army Surgical Hospital" (NORMASH) was no different from any other MASH; but both its originators and its staff regarded it as a vehicle for humanitarian aid. Members of the hospital soon recognized that their status in the war zone was primarily that of a military field hospital. Yet they insisted on providing essential medical care to the local civilian population as well as trauma care to UN soldiers and prisoners of war. The ambiguities that arose from the dual mission of NORMASH are explored in this article, which pays particular attention to the experiences of nurses, as expressed in three types of source: their contemporary letters to their Matron-in-Chief; a report written by one nurse shortly after the war; and a series of oral history interviews conducted approximately 60 years later. The article concludes that the nurses of NORMASH experienced no real role-conflict. They viewed it as natural that they should offer their services to both military and civilian casualties according to need, and they experienced a sense of satisfaction from their work with both types of patient. Ultimately, the experience of Norwegian nurses in Korea illustrates the powerful sense of personal agency that could be experienced by nurses in forward field hospitals, where political decision-making did not impinge too forcefully on their clinical and ethical judgment as clinicians.


Assuntos
Hospitais Militares/história , Guerra da Coreia , Unidades Móveis de Saúde/história , Socorro em Desastres/história , História do Século XX , Humanos , Enfermagem Militar/história , Noruega , República da Coreia
19.
Biomedica ; 39: 86-95, 2019 05 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31529851

RESUMO

Introduction: In Colombia, there are about 500,000 members in the national armed forces who consult military health institutions. In this population, methicillin-resistant Staphylococcus aureus (MRSA) has become a high-incidence pathogen. Objective: The aim of this study was to characterize patients with MRSA bacteremia in the Hospital Militar Central between 2012 and 2015. Materials and methods: This was an observational descriptive study with a retrospective review of clinical histories of hospitalized patients older than 18 years of age with positive blood cultures for methicillin-resistant S. aureus. The identification of the patients was made using the Whonet system, version 5.6. Results: From cultures positive for S. aureus, 24.8% were methicillin-resistant strains, with a higher prevalence in active military personnel. A similar frequency was observed for community-acquired MRSA bacteremias and those acquired at the hospital, with the community phenotype being the most frequent in both groups. The main infectious focus related to the development of bacteremia was soft tissue, followed by pulmonary tissue. There were higher complication rates in nosocomial bacteremias; 34.9% of the patients had prolonged stays attributable to complications triggered by the bacteremia. Conclusions: Active military personnel was the most affected population by MRSA, with a similar frequency in community-acquired and nosocomial bacteremias. The main infectious focus was soft tissue. Taking into account these data, studies that establish the prevalence of skin infections by MRSA should be carried out.


Assuntos
Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Adolescente , Adulto , Idoso , Bacteriemia/epidemiologia , Colômbia/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/epidemiologia , Hospitais Militares/estatística & dados numéricos , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Cutâneas Estafilocócicas/epidemiologia , Infecções Cutâneas Estafilocócicas/microbiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
20.
Ann Surg Oncol ; 26(12): 3838-3845, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31410609

RESUMO

BACKGROUND: Survival disparities between African American women (AAW) and European American women (EAW) with invasive breast cancer may be attributable, in part, to access to or quality of medical care. In this study, we evaluated surgical disparities between AAW and EAW treated within an equal-access military treatment facility (MTF). METHODS: All AAW (N = 271) and EAW (N = 628) with Stage I-III breast cancer who had their initial diagnosis performed at Murtha Cancer Center at Walter Reed National Military Medical Center were identified. Differences in surgical interval (time between diagnosis and definitive breast surgery) and surgical procedures were evaluated using χ2 and Student t-tests while survival was analyzed using Kaplan-Meier survival estimates and log-rank tests. A P value < 0.05 was used to define significance. RESULTS: Surgical intervals did not differ significantly between populations with an average of 36.3 days in AAW and 33.9 days in EAW. Frequency of the percentage of women undergoing reexcision, mastectomy, and prophylactic removal of the contralateral breast did not differ significantly between populations. Likewise, frequency of sentinel lymph node biopsy and 5-year survival were not significantly different between AAW compared to EAW. DISCUSSION: Surgical intervals and procedures were similar between AAW and EAW treated within an equal-access MTF. These data demonstrate that the availability of quality surgical care to all patients with stage I-III breast cancer may eliminate survival disparities between AAW and EAW, emphasizing the importance of equalizing access to breast care.


Assuntos
Afro-Americanos/estatística & dados numéricos , Neoplasias da Mama/cirurgia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades em Assistência à Saúde , Hospitais Militares/estatística & dados numéricos , Mastectomia/mortalidade , Adulto , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida
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