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1.
Graefes Arch Clin Exp Ophthalmol ; 257(8): 1789-1793, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31129770

RESUMO

PURPOSE: The aim of this study was to use the Ocular Trauma Score (OTS) to review and analyze all the open globe injuries (OGIs) that presented to Brooke Army Medical Center (BAMC) from July 2011 to March 2017, and whether or not the OTS can be used to predict enucleation or evisceration. METHODS: Retrospective chart review was performed through the medical record systems at BAMC for all OGIs from July 2011 to March 2017. This study was not performed on wartime patients. The primary outcome measures were the variables in the OTS and need for enucleation or evisceration. RESULTS: A total of 126 OGIs in 125 patients were identified from July 2011 to March of 2017. A lower calculated OTS was negatively associated with the outcome variables. A total of 25 cases resulted in enucleation or evisceration (19.8%). Of these, 17 underwent enucleation and 8 underwent evisceration. The average OTS for all eyes was 37.15, and the average OTS for eyes resulting in enucleation or evisceration was 22. Retinal detachment (RD), afferent pupillary defect (APD), globe rupture, globe perforation, and presenting visual acuity (VA) were all found to be statistically significant risk factors in patients who underwent enucleation or evisceration. CONCLUSIONS: The present study shows that the OTS and the OTS pre-operative variables can help predict the likelihood that an OGI will ultimately result in enucleation or evisceration. Our study shows that the OTS is a valuable tool to use when evaluating OGI and can help in evidence-based counseling.


Assuntos
Enucleação Ocular , Evisceração do Olho , Ferimentos Oculares Penetrantes/diagnóstico , Hospitais Militares/estatística & dados numéricos , Acuidade Visual , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ferimentos Oculares Penetrantes/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Índices de Gravidade do Trauma , Adulto Jovem
2.
Rev Epidemiol Sante Publique ; 67(4): 261-266, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31060884

RESUMO

BACKGROUND: Hepatitis B is the main cause of liver disease in the world. Chronic hepatitis B may lead to cirrhosis, liver insufficiency or liver cancer. Tunisia is considered as a country with intermediate endemicity, where hepatitis B presents a real public health problem. The aims of this study were to evaluate the prevalence of viral biomarkers of hepatitis B in healthcare personnel; to look for potential risk factors associated with HbS antigen carriage and to evaluate the prevalence of vaccination in this particular population. METHODS: Sero-epidemiological, prospective and descriptive study, among 2411 healthcare personnel in the Military Hospital of Tunis, during a 5-month period from September 2013 to January 2014. RESULTS: Blood samples were collected from 1497 volunteers among the hospital staff. Two hundred and seventy-one individuals had a positive HbC antibody titer (prevalence 18.1%), including 229 who were positive for HbC and HbS antibodies (prevalence 15.3%), 12 positive for only HbC antibody (prevalence 0.8%), and 30 positive for HBsAg (prevalence 2%). Among HbS Ag carriers, 56.6% reported needle stick and sharp object injuries during their professional careers. Among HbS Ag carriers, there were three patients with a history of acute viral hepatitis with jaundice, and 27 patients (90%) who were asymptomatic and were diagnosed during our study. Among healthcare workers in the hospital, 56.1% were immunized through vaccination (positive HbS antibodies without HbC antibodies), of whom 66% had durable protective immunity (HbS antibodies>100mU/mL). Lastly, 25.8% of the hospital workers remained without any protection against hepatitis B (serology entirely negative) and were then offered a complete vaccination. CONCLUSION: Hepatitis B vaccine is the mainstay of hepatitis B prevention. Safe injection practices, blood safety and promoting wider access to monitoring and screening, care and treatment services for hepatitis B are the best guarantees to prevent and control this disease.


Assuntos
Biomarcadores/sangue , Pessoal de Saúde/estatística & dados numéricos , Vacinas contra Hepatite B/uso terapêutico , Hepatite B/sangue , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Vacinação/estatística & dados numéricos , Adulto , Anticorpos Antivirais/sangue , Feminino , Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/sangue , Hospitais Militares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Tunísia/epidemiologia , Adulto Jovem
3.
Eur J Clin Pharmacol ; 75(6): 849-857, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30758518

RESUMO

PURPOSE: The individual fall risk of a patient is often multifactorial. Polymedication contributes to an additional risk of fall-risk-increasing adverse reactions (FRIARs). Previous studies have not sufficiently investigated the complexity facing prescribers when balancing the therapeutic benefits of individual drugs against their potential fall risk. METHODS: An expert panel identified drugs with FRIARs based on the Summary of Product Characteristics (SmPC). These FRIARs and other parameters (such as the total number of drugs, dosage, dose adjustments, and drug changes) were then analyzed for their impact on falls in a case-control study using logistic regression. RESULTS: During a 1-year period, 112 (1%) of 11,481 hospital patients experienced at least one fall event. Complete data was available for evaluation from 87 of them (case group). We matched these patients to another 87 patients who had no fall events (control group). FRIAR drugs were more frequently prescribed in the case group (4.26 (Q25-Q75, 3.75-4.78) per patient; p = 0.033) than in the control group (3.48 (2.97-3.99)). Drugs with FRIARs (ß = 0.137; p = 0.035) and the total number of FRIARs (ß = 0.033; p = 0.031) increased the fall risk. The total number of drugs, dosage, dose adjustments, and drug changes showed no influence. CONCLUSIONS: FRIARs were associated with a higher number of falls. To consider FRIARs offers a chance to address the complexity of the individual medication. This data can support future computerized physician order entries with clinical decision support.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Hospitais Militares/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Lista de Medicamentos Potencialmente Inapropriados , Fatores de Risco
4.
Bull Cancer ; 106(3): 226-236, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30509682

RESUMO

INTRODUCTION: Research activity evaluation in French hospitals is based on the number of publications, author position (first, second, third, second-to-last, last, investigator list, and "Other") and journal category (A being the highest category followed by B, C, D, E, and NC). METHODS: The profile of publications over the 2004-2014 period in terms of these indicators was evaluated. Hospitals were classified into six groups according to administrative status. Time trends were analysed by three models. One-way ANOVA followed by Tukey's test was performed. RESULTS: A total of 192886 publications were analysed. The increase in the number of publications ranged from 628% for for-profit private hospitals to 141% for public teaching hospitals. The most frequent category was B for cancer centres (25%), whereas this was E in public teaching (22%) and non-teaching hospitals (28%), in not-for-profit private hospitals (25%), in the military hospital (30%), and in for-profit private hospitals (24%). The first position was the most frequent for public teaching hospitals (38%) and the military hospital (44%), whereas the "Other" position was the most frequent in cancer centres (26%), in public non-teaching hospitals (28%), in not-for-profit private hospitals (27%), and in for-profit private hospitals (29%). DISCUSSION: Different patterns were identified. The author position indicated that all types of hospital are involved in research projects. This study also found that public non-teaching hospitals, not-for-profit private hospitals, for-profit private hospitals, and cancer centres collaborated with other institutions which were often distinguished by publishing in high-category journals.


Assuntos
Bibliometria , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Editoração/estatística & dados numéricos , Análise de Variância , Autoria , Institutos de Câncer/estatística & dados numéricos , França , Hospitais Militares/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Publicações Periódicas como Assunto/estatística & dados numéricos , PubMed/normas , Editoração/tendências
5.
Worldviews Evid Based Nurs ; 16(1): 43-50, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30516340

RESUMO

BACKGROUND: Heart failure (HF) is considered a condition in which a portion of hospital admissions are preventable if timely and appropriate outpatient care management occurs. Facility readmission rates for HF are reportable and subject to penalty. Both military and civilian healthcare systems have fiscal responsibility and are accountable for successful disease management. Therefore, best practices and evidence-based strategies to reduce readmissions are in critical demand. However, translating best evidence into practice can be challenging due to the complexities of the healthcare system. AIMS: This crosswalk paper provides strategies and considerations for nurses planning HF readmission reduction initiatives. METHODS: Insight regarding implementation strategies, challenges, successes, and lessons learned is shared through a framework-guided description of two separate but similar HF readmission reduction projects conducted in military and civilian healthcare facilities. RESULTS: Lessons learned suggest defined and attainable outcomes, multidisciplinary inclusivity, redundancy in roles, greater collaboration, and engagement with stakeholders are most beneficial when initiated before dedicating resources and continuously throughout practice change implementation, maintenance, and sustainment. LINKING EVIDENCE TO ACTION: The authors advocate for interdisciplinary evidence-based practice consortiums to share lessons learned that may promote success potential and optimize return on invested time and efforts in the same or similar initiatives-in this instance, reducing 30-day readmissions for HF patients.


Assuntos
Insuficiência Cardíaca/complicações , Readmissão do Paciente/normas , Melhoria de Qualidade , Prática Clínica Baseada em Evidências/métodos , Insuficiência Cardíaca/terapia , Hospitalização/estatística & dados numéricos , Hospitais Militares/estatística & dados numéricos , Humanos , New England , Readmissão do Paciente/estatística & dados numéricos , Governança Compartilhada de Enfermagem , Sudoeste dos Estados Unidos , Inquéritos e Questionários , Telemetria/métodos
6.
Mil Med ; 184(5-6): e168-e171, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30534976

RESUMO

INTRODUCTION: The 2010-2011 withdrawal from Iraq included the closure of all fixed-facility military medical resources. Operation INHERENT RESOLVE, the United States-led counter-terrorism mission in Iraq and Syria, subsequently commenced in 2014. With increasing combat operations, the 28th Combat Support Hospital deployed to Iraq to support that mission as a limited footprint unit prototyped after the new modular Army Field Hospital. We describe the non-battle utilization of the emergency medical treatment section. METHODS: We prospectively collected data for this project as part of a performance improvement initiative to track healthcare utilization to guide emergency medical treatment section staffing. The project took place at a combat support hospital near Baghdad, Iraq from July 2016 through January 2017. RESULTS: During this time, the emergency department (ED) averaged 3.5 visits per day totaling 675 non-battle encounters. Most (84.6%) were U.S. military personnel with a median age of 32 (IQR 26-38). The most common procedure performed was point-of-care ultrasound (n = 33). Most patients (96.9%) underwent discharge from the ED. Of the 21 subjects admitted, 6 were for surgical intervention and the remaining for medical or observational indications. The most common chief complaints were musculoskeletal (31.1%, n = 210), respiratory (15.3%, n = 103), and dermatologic (12.0%, n = 81). CONCLUSIONS: Non-battle injuries and illnesses were the predominant reason for ED utilization. Most subjects were discharged back to duty with relatively low-resource utilization. Few visits required procedural interventions.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Militares/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Campanha Afegã de 2001- , Serviço Hospitalar de Emergência/classificação , Serviço Hospitalar de Emergência/organização & administração , Feminino , Hospitais Militares/classificação , Hospitais Militares/organização & administração , Humanos , Guerra do Iraque 2003-2011 , Masculino , Unidades Móveis de Saúde/organização & administração , Unidades Móveis de Saúde/estatística & dados numéricos , Estados Unidos , Guerra/estatística & dados numéricos
9.
Cogn Behav Ther ; 48(1): 77-88, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29932812

RESUMO

Growing research links Traumatic Brain Injury (TBI) with greater posttraumatic stress disorder (PTSD) symptoms. Much of this research has focused on the influence of the presence or severity of a single TBI while neglecting the potential cumulative effects of multiple TBIs incurred across an individual's lifetime on combat-related PTSD. The present study addressed this gap using a sample of 157 military service members and 4 civilian contractors who underwent structured TBI interviews at a military hospital in Iraq and completed the Combat Experiences Scale (CES) and Posttraumatic Checklist - Military (PCL-M). Results indicated that a greater number of lifetime TBIs were associated with greater PTSD symptoms when accounting for the presence and severity of a recent, deployment-related TBI. Additionally, a significant interaction of number of lifetime TBIs and combat exposure emerged, indicating that exposure to combat yielded greater PTSD symptoms among those with multiple lifetime TBIs compared to those with one or zero lifetime TBIs. These data suggest that incurring multiple TBIs may amplify the link between combat exposure and PTSD and underscore the need to screen for lifetime TBI history.


Assuntos
Conflitos Armados/psicologia , Lesões Encefálicas Traumáticas/epidemiologia , Hospitais Militares/estatística & dados numéricos , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Comorbidade , Feminino , Humanos , Iraque/epidemiologia , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
11.
Can J Surg ; 61(6): S195-S202, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30418004

RESUMO

Background: The Canadian Armed Forces deployed a Role 2 Medical Treatment Facility (R2MTF) to Iraq in November 2016 as part of Operation IMPACT. We compared the multinational interoperability required of this R2MTF with that of similar facilities previously deployed by Canada or other nations. Methods: We reviewed data (Nov. 4, 2016, to Oct. 3, 2017) from the electronic Disease and Injury Surveillance Report and the Daily Medical Situation Report. Clinical activity was stratified by Global Burden of Diseases category, ICD-10 code, mechanism of injury, services used, encounter type, nationality and blood product usage. We reviewed the literature to identify utilization profiles for other MTFs over the last 20 years. Results: In total, 1487 patients were assessed. Of these, 5.0% had battle injuries requiring damage-control resuscitation and/or damage-control surgery, with 55 casualties requiring medical evacuation after stabilization. Trauma and disease non-battle injuries accounted for 44% and 51% of patient encounters, respectively. Other than dental conditions, musculoskeletal disorders accounted for most presentations. Fifty-seven units of fresh frozen plasma and 64 units of packed red blood cells were used, and the walking blood bank was activated 7 times. Mass casualty activations involved coordination of health care and logistical resources from more than 12 countries. In addition to host nation military and civilian casualties, patients from 15 different countries were treated with similar frequency. Conclusion: The experience of the Canadian R2MTF in Iraq demonstrates the importance of multinational interoperability in providing cohesive medical care in coalition surgical facilities. Multinational interoperability derives from a unique relationship between higher medical command collaboration, international training and adherence to common standards for equipment and clinical practice.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Hospitais Militares/estatística & dados numéricos , Cooperação Internacional , Medicina Militar/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Conflitos Armados , Canadá , Hospitais Militares/organização & administração , Humanos , Iraque , Medicina Militar/estatística & dados numéricos , Medicina Militar/tendências , Centro Cirúrgico Hospitalar/organização & administração , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Centro Cirúrgico Hospitalar/tendências , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
12.
Fam Syst Health ; 36(4): 513-517, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30307267

RESUMO

INTRODUCTION: Much of behavioral health care takes place within primary care settings rather than in specialty mental health settings. Access to specialty mental health care can be difficult due to limited access to mental health providers and wait times to receive mental health care. The purpose of this study is to determine patient satisfaction with behavioral health consultation visits that take place within the context of the primary care behavioral health consultation model. Patient likelihood to seek out specialty mental health care services if behavioral health consultation services were not provided was also examined. METHOD: Two primary care clinic systems were examined in this study. The first was a primary care clinic predominately serving low-income patients: 100 individuals participated. The second was primary care in the context of military treatment centers: 539 individuals participated. RESULTS: Results show that 61% of the patients in the low-income primary care clinic would not attend a specialty mental health appointment versus 30% in the military population. DISCUSSION: This study suggests that primary care behavioral health is a patient-centered approach to care and reaches populations that otherwise may not receive behavioral health services. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Medicina do Comportamento/normas , Preferência do Paciente/psicologia , Pacientes/psicologia , Atenção Primária à Saúde/normas , Adulto , Medicina do Comportamento/métodos , Medicina do Comportamento/estatística & dados numéricos , Feminino , Hospitais Militares/organização & administração , Hospitais Militares/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Masculino , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Satisfação do Paciente , Pacientes/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
13.
BMJ Open ; 8(10): e023133, 2018 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-30361405

RESUMO

OBJECTIVES: Interventional treatment of patients with acute coronary syndrome (ACS) is surging dramatically in China in recent years, whereas nationwide assessments of the quality of percutaneous coronary intervention (PCI) procedural performance and outcomes are scarce. We aimed to provide an updated and real-world overview of the performance of PCI in patients with ACS since 2011 in China after the China PEACE study from 2001 to 2011. METHODS: In this cross-sectional study, data were extracted from the National Registry of Cardiovascular Intervention in Military Hospitals database to create a national sample of 144 659 patients with ACS undergoing PCI at 117 military hospitals in all regions of China from calendar years 2011-2014. Patient characteristics, procedural performance, PCI outcomes and adverse events and temporal changes were analysed. RESULTS: During 2011-2014, patients with ACS undergoing PCI increased dramatically. Small numbers of high-volume hospitals performed the majority of PCI procedures. However, only half of these patients were adequately covered and proportions for the use of assisted devices and novel medications were relatively small. Radial artery access was still increasing with time. Primary PCIs were performed on 45.4% ST-segment elevation myocardial infarction patients with PCI procedures. 3.8% lesion vessels involve left main artery. Implanted stents, the overall complications and in-hospital mortality were decreasing remarkably. CONCLUSIONS: In Chinese military hospitals, interventional resources were limited with great regional disparities, there are still gaps to be filled to better serve patients with ACS. Our findings can serve as an indispensable supplement to a more comprehensive understanding of the practice of contemporary cardiac intervention in China.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Hospitais Militares/estatística & dados numéricos , Intervenção Coronária Percutânea/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Tex Heart Inst J ; 45(3): 144-150, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-30072850

RESUMO

Glucose-6-phosphate dehydrogenase (G6PD) protects erythrocytes from oxidative stress and hemolysis; G6PD deficiency is the most prevalent enzymopathy. The United States military routinely performs tests to prevent exposing G6PD-deficient personnel to antimalarial drugs that might cause life-threatening hemolytic reactions. In addition, G6PD is a key determinant of vascular function, and its deficiency can lead to impaired nitric oxide production and greater vascular oxidant stress-precursors to atherosclerosis and cardiovascular disease. Using military medical records, we performed a retrospective, cross-sectional study to investigate whether deficient G6PD levels are associated with a higher prevalence of cardiovascular disease than are normal levels, and, if so, whether the relationship is independent of accepted cardiovascular risk factors. We analyzed the medical records of 737 individuals who had deficient G6PD levels and 16,601 who had normal levels. Everyone had been screened at U.S. military medical centers from August 2004 through December 2007. We evaluated our dependent variable (composite cardiovascular disease) at the individual level, and performed binary logistic regression of our independent variable (G6PD status) and control variables (modifiable cardiovascular risk factors). The adjusted odds ratio of 1.396 (95% CI, 1.044-1.867; P <0.05) indicated that G6PD-deficient individuals have 39.6% greater odds of developing cardiovascular disease than do those with normal levels. Early intervention may reduce the incidence of cardiovascular disease in military personnel and civilians who have deficient G6DP levels.


Assuntos
Doenças Cardiovasculares/etiologia , Deficiência de Glucosefosfato Desidrogenase/complicações , Glucosefosfato Desidrogenase/sangue , Hospitais Militares/estatística & dados numéricos , Militares , Adulto , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Deficiência de Glucosefosfato Desidrogenase/enzimologia , Deficiência de Glucosefosfato Desidrogenase/epidemiologia , Humanos , Masculino , Razão de Chances , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia
16.
J Trauma Acute Care Surg ; 85(1): 140-147, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29965942

RESUMO

BACKGROUND: Approximately 4.5% of surgical procedures performed at Role 2 (R2) (forward surgical) and Role 3 (R3) (theater) medical treatment facilities can be classified as neurosurgical. These procedures are foreign to the routine daily practice of the military general surgeon. The purpose of this study was to examine the neurosurgical workload in Iraq and Afghanistan in order to inform the future predeployment neurosurgical training needs of nonneurosurgical providers. METHODS: Retrospective analysis of the Department of Defense Trauma Registry for all R2 and R3 medical facilities, from January 2002 to May 2016. The 103 neurosurgical International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes identified were grouped by anatomic location. Select groups were further subdivided. Data analysis used Stata version 14 (College Station, TX). RESULTS: A total of 7,509 neurosurgical procedures were identified. The majority (7,244 [96.5%]) occurred at R3 theater hospitals. Cranial procedures were the most common at both R2 (120, 45.3%) and R3 (4,483 [61.9%]), with craniotomy/craniectomy the most frequent procedure. Spine procedures were performed almost exclusively at R3, with 61.1% being fusions/stabilizations and 26.9% being spinal decompression alone. Neurosurgical caseload was variable over the 15-year study period, dropping to almost zero in 2016. CONCLUSIONS: Neurosurgical procedures were performed primarily at larger R3 theater hospitals where neurosurgeons were assigned if present in theater; however, more than 100 cranial procedures were performed at forward R2 where neurosurgeons were not deployed. Considering that neurosurgeons are not everywhere available within the war zone, deploying general surgeons should have familiarity with trauma neurosurgery. LEVEL OF EVIDENCE: Epidemiologic study, level III; Care Management, level IV.


Assuntos
Militares/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Lesões Relacionadas à Guerra/cirurgia , Carga de Trabalho/estatística & dados numéricos , Afeganistão , Hospitais Militares/estatística & dados numéricos , Humanos , Iraque , Medicina Militar/estatística & dados numéricos , Sistema de Registros , Estudos Retrospectivos , Estados Unidos , United States Department of Defense , Lesões Relacionadas à Guerra/epidemiologia
17.
BMC Infect Dis ; 18(1): 249, 2018 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-29855354

RESUMO

BACKGROUND: Ethiopia is one of the world health organization defined higher tuberculosis (TB) burden countries where the disease remains a massive public health threat. This study aimed to identify the prevalence and associated factors of multidrug-resistant tuberculosis (MDR-TB) using all armed force and civilian TB attendants in a tertiary level armed force hospital, where data for MDR-TB are previously unpublished. METHODS: Cross-sectional study was conducted from September 2014 to August 2015 in a tertiary level Armed Force Referral and Teaching Hospital (AFRTH), Ethiopia. Armed force members (n = 251) and civilians (n = 130) which has been undergone TB diagnosis at AFRTH were included. All the specimens collected were subjected to microscopic smear observation, culture growth and drug susceptibility testing. Data were analyzed using statistical package for social sciences following binary logistic regression and Chi-square. P-values < 0.05 were considered statistically significant. RESULTS: Among 381 TB patients, 355 (93.2%) new and 26 (6.8%) retreatment cases were identified. Culture and smear positive TB cases were identified in 297 (77.9%) and 252 (66.1%) patients, respectively. The overall prevalence of MDR-TB in AFRTH was found 1.8% (1.3% for armed force members and 0.5% for civilian patients) all of which were previously TB treated cases. The entire treatment success rates were 92.6% achieved highest in the armed force (active and pension) than the civilian patients. The failure and dead cases were also found 2.5 and 4.6%, respectively. Using bivariate analysis, category of attendants and TB contact history were strong predictors of MDR-TB in armed force and civilian patients. Moreover, human immunodeficiency virus (HIV) infection also identified a significant (OR = 14.6; 95% CI = 2.3-92.1; p = 0.004) predicting factor for MDR-TB in armed force members. However, sex, age and body mass index were not associated factor for MDR-TB. CONCLUSIONS: In AFRTH, lower prevalence of MDR-TB was identified in armed force and civilian patients that were significantly associated with category of attendants, HIV infection and TB contact history. Considering armed force society as one segment of population significantly helps to plan a better MDR-TB control management, especially for countries classified as TB high burden country.


Assuntos
Hospitais Militares , Hospitais de Ensino , Centros de Atenção Terciária , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais Militares/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Mycobacterium tuberculosis/isolamento & purificação , Fatores de Risco , Centros de Atenção Terciária/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto Jovem
18.
Mil Med ; 183(11-12): e555-e563, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29788111

RESUMO

Introduction: Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are two of the signature injuries in military service members who have been exposed to explosive blasts during deployments to Iraq and Afghanistan. Acute stress disorder (ASD), which occurs within 2-30 d after trauma exposure, is a more immediate psychological reaction predictive of the later development of PTSD. Most previous studies have evaluated service members after their return from deployment, which is often months or years after the initial blast exposure. The current study is the first large study to collect psychological and neuropsychological data from active duty service members within a few days after blast exposure. Materials and Methods: Recruitment for blast-injured TBI patients occurred at the Air Force Theater Hospital, 332nd Air Expeditionary Wing, Joint Base Balad, Iraq. Patients were referred from across the combat theater and evaluated as part of routine clinical assessment of psychiatric and neuropsychological symptoms after exposure to an explosive blast. Four measures of neuropsychological functioning were used: the Military Acute Concussion Evaluation (MACE); the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); the Headminder Cognitive Stability Index (CSI); and the Automated Neuropsychological Assessment Metrics, Version 4.0 (ANAM4). Three measures of combat exposure and psychological functioning were used: the Combat Experiences Scale (CES); the PTSD Checklist-Military Version (PCL-M); and the Acute Stress Disorder Scale (ASDS). Assessments were completed by a deployed clinical psychologist, clinical social worker, or mental health technician. Results: A total of 894 patients were evaluated. Data from 93 patients were removed from the data set for analysis because they experienced a head injury due to an event that was not an explosive blast (n = 84) or they were only assessed for psychiatric symptoms (n = 9). This resulted in a total of 801 blast-exposed patients for data analysis. Because data were collected in-theater for the initial purpose of clinical evaluation, sample size varied widely between measures, from 565 patients who completed the MACE to 154 who completed the CES. Bivariate correlations revealed that the majority of psychological measures were significantly correlated with each other (ps ≤ 0.01), neuropsychological measures were correlated with each other (ps ≤ 0.05), and psychological and neuropsychological measures were also correlated with each other (ps ≤ 0.05). Conclusions: This paper provides one of the first descriptions of psychological and neuropsychological functioning (and their inter-correlation) within days after blast exposure in a large sample of military personnel. Furthermore, this report describes the methodology used to gather data for the acute assessment of TBI, PTSD, and ASD after exposure to an explosive blast in the combat theater. Future analyses will examine the common and unique symptoms of TBI and PTSD, which will be instrumental in developing new assessment approaches and intervention strategies.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Militares/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adolescente , Adulto , Traumatismos por Explosões/complicações , Traumatismos por Explosões/diagnóstico , Lesões Encefálicas Traumáticas/etiologia , Explosões , Feminino , Hospitais Militares/organização & administração , Hospitais Militares/estatística & dados numéricos , Humanos , Iraque , Guerra do Iraque 2003-2011 , Masculino , Pessoa de Meia-Idade , Militares/psicologia , Testes Neuropsicológicos/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/etiologia
19.
Mil Med ; 183(11-12): e596-e602, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29659947

RESUMO

Introduction: The objective of this study is to review available data on pediatric thoracic trauma seen at U.S. military treatment facilities in Iraq and Afghanistan and describe the scope of injuries, patterns seen, and associated mortality. The results were compared with adults injured in Iraq and Afghanistan and other reports of pediatric thoracic trauma in the literature. Materials and Methods: The investigators received approval from the Uniformed Services University of the Health Sciences' institutional review board before the study. The Joint Theatre Trauma Registry was queried for all patients with an ICD-9 code for thoracic trauma. Two-tailed Student's t-test, Mann-Whitney rank sum, χ2, ANOVA, or multiple logistic regression was used as indicated. Results: There were 955 patients under the age of 18 yr, just over 12% of all thoracic trauma. Penetrating injuries were common (73.6%), including gunshot wounds. The most common pediatric diagnoses were contusions (45%), pneumothorax (40%), and rib and/or sternal fractures (18%). The overall mortality for children was 15.2% compared with 13.8% and 9% for civilian adults and Coalition members with thoracic trauma, respectively. Mortality was inversely related to age among pediatric patients. Children under 2 yr of age had the highest mortality (25.1%). Patients under 12 yr of age were more likely to die than those between 12 and 18 (OR 2.02, 95% CI 1.27-3.22) yr. Thoracic vascular injuries and cardiac injuries resulted in the highest mortality among pediatric patients. The presence of a hemothorax was independently associated with an increased risk for mortality (OR 1.78, 95% CI 1.06-2.99) as was a concomitant head injury (OR 2.17, 95% CI 1.33-3.54). There was a 2.7% incidence of burns among pediatric patients with a high associated mortality (46.2%). Nearly one-half of all the children identified required a transfusion (47%). Conclusion: Penetrating injuries predominated and these children commonly required a transfusion. Mortality was inversely related to age. Children with a hemothorax or a concomitant head injury had significant increases in mortality. Children with thoracic injury as the result of a burn suffered the highest mortality.


Assuntos
Traumatismos Torácicos/complicações , Adolescente , Campanha Afegã de 2001- , Afeganistão/epidemiologia , Afeganistão/etnologia , Criança , Pré-Escolar , Feminino , Hospitais Militares/organização & administração , Hospitais Militares/estatística & dados numéricos , Humanos , Incidência , Lactente , Iraque/epidemiologia , Iraque/etnologia , Guerra do Iraque 2003-2011 , Masculino , Pediatria/estatística & dados numéricos , Estudos Retrospectivos , Traumatismos Torácicos/epidemiologia , Traumatismos Torácicos/etnologia
20.
Mil Med ; 183(11-12): e348-e353, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29635286

RESUMO

Introduction: A safe, easy-to-use, permanently bonded antiseptic that does not require post-exposure bioload reduction but maintains effectiveness over time would have far-reaching implications across multiple industries. Health care is one such arena, particularly in austere military settings where resources are at a premium. MicrobeCare XLP (MicrobeCare, Buffalo Grove, IL, USA) is a commercially available spray-on agent that is advertised to covalently bond to surfaces and provide a long-lasting antimicrobial coating inhospitable to >99.99% of surface microorganisms. A pilot study was devised to gather baseline data regarding product efficacy and laboratory parameters before consideration of extended investigations and military utilization. The product manufacturer recommends bioload reductions before product application, following product application, and after each pathogenic exposure. To investigate the product's efficacy in circumstances more closely simulating a military operational setting in which post-pathogenic exposure bioload reduction would not be possible, this step was deliberately excluded from the test sequences. Materials and Methods: Using autoclaved surgical forceps, growth of Staphylococcus aureus and Acinetobacter baumannii was evaluated in a controlled manner under multiple conditions. Test variations included duration of submersion in the MicrobeCare XLP solution and air-drying and a second autoclave sterilization. Control and treated forceps were exposed to a bacterial suspension and air-dried before being submerged in sterile saline and vortex mixed. The saline solution was serially diluted and plated on tryptic soy agar (TSA) II plates. Plates were incubated for 24 h and bacterial colony-forming units (CFU)/mL were counted. Results: Statistical significance was defined according to the American Society for Testing and Materials (ASTM) International passing criteria of 3 Log10 or 99.9% reduction of microorganisms. Additionally, p-values were calculated using two-tailed unpaired two-sample t-tests with unequal variance with a threshold of 0.05. In the S. aureus tests, none of the reduction calculations met the ASTM International passing criteria. In addition, the difference between the means of the colony counts in the MicrobeCare XLP-treated forceps and untreated control forceps was not statistically significant (p-value 0.109). Conversely, in the A. baumannii tests, each of the percent reduction calculations met the ASTM International passing criteria; the difference between the means of the colony counts in the treatment and control groups was statistically significant (p-value 0.008). Conclusion: In these independent tests, MicrobeCare XLP effectively prevented growth of A. baumannii but had unpredictable results suppressing S. aureus. These results may relate to inherent properties of the bacteria or autoclave exposure, although the manufacturer asserts that the coating withstands such degradation. Additional testing could be performed using a broader range of microorganisms and exposure to varying conditions including other sterilization methods.


Assuntos
Infecções por Acinetobacter/prevenção & controle , Desinfetantes/normas , Infecções Estafilocócicas/prevenção & controle , Guerra , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/patogenicidade , Desinfetantes/uso terapêutico , Desenho de Equipamento/normas , Hospitais Militares/organização & administração , Hospitais Militares/estatística & dados numéricos , Humanos , Projetos Piloto , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/patogenicidade , Esterilização/métodos , Esterilização/normas
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