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1.
Transfusion ; 59(S2): 1446-1452, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30980744

RESUMO

The shift toward using a transfusion strategy in a ratio to mimic whole blood (WB) functionality has revitalized WB as a viable option to replace severe blood loss in civilian health care. A military-civilian collaboration has contributed to the reintroduction of WB at Haukeland University Hospital in Bergen, Norway. WB has logistical and hemostatic advantages in both the pre- and in-hospital settings where the goal is a perfectly timed balanced transfusion strategy. In this paper, we describe an event leading to activation of our emergency WB collection strategy for the first time. We evaluate the feasibility of our civilian walking blood bank (WBB) to cover the need of a massive amount of blood in an emergency situation. The challenges are discussed in relation to the different stages of the event with the recommendations for improvement in practice. We conclude that the use of pre-screened donors as a WBB in a civilian setting is feasible. The WBB can provide platelet containing blood components for balanced blood resuscitation in a clinically relevant time frame.


Assuntos
Bancos de Sangue , Doadores de Sangue , Segurança do Sangue , Seleção do Doador , Hospitais Militares , Medicina Militar , Bancos de Sangue/organização & administração , Bancos de Sangue/normas , Segurança do Sangue/métodos , Segurança do Sangue/normas , Seleção do Doador/organização & administração , Seleção do Doador/normas , Feminino , Hospitais Militares/organização & administração , Hospitais Militares/normas , Humanos , Masculino , Medicina Militar/métodos , Medicina Militar/organização & administração , Medicina Militar/normas , Noruega
2.
Int J Health Plann Manage ; 34(2): e1293-e1301, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30924978

RESUMO

BACKGROUND: Over the recent years, clinical governance model has been applied to improve the quality of university and private hospitals in Iran. In addition to university hospitals, military hospitals have an effective role in the preservation and promotion of public health. The challenges of clinical governance implementation have not been investigated in such settings. Hence, the present study objective is to identify the administrative challenges of clinical governance in military and university hospitals of Kerman/Iran METHODS: This qualitative study was carried out through phenomenology in 2017. A sample of managers and experts in the implementation and execution of clinical governance was purposefully selected from three university hospitals and three military hospitals in Kerman, Iran. A total of 39 managers and experts were interviewed, and data were gathered via semistructured interviews with open questions. For data analysis, conventional content analysis method was employed. RESULTS: In this study, five main codes and 17 subcodes were obtained. Main codes were structural challenges, educational challenges, limitations, evaluation, and human resource challenges. CONCLUSIONS: Clinical governance is being implemented hastily with no appropriate structural, financial, and training facilities, ensuing a waste of resources, more difficult work for staff and a negative view of personnel.


Assuntos
Governança Clínica/organização & administração , Hospitais Militares/organização & administração , Hospitais Universitários/organização & administração , Administradores Hospitalares , Humanos , Entrevistas como Assunto , Irã (Geográfico) , Inovação Organizacional , Administração de Recursos Humanos em Hospitais , Melhoria de Qualidade/organização & administração
3.
Sanid. mil ; 75(1): 27-39, ene.-mar. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183702

RESUMO

El Buque de Proyección Estratégica L-61 Juan Carlos I (L-61 JC I) es el buque de mayores dimensiones que ha tenido la Armada española en toda su historia. Puede desarrollar cuatro perfiles de misión: anfibio, portaviones, transporte estratégico y ayuda humanitaria. En todos ellos su capacidad sanitaria Role 2 juega un papel determinante gracias a las importantes prestaciones médicas con las que cuenta el buque. Las maniobras FLOTEX-17 realizadas en el Mar Mediterráneo en junio de 2017 en las que participaron 29 buques y más de 3500 efectivos fue la primera vez que embarcó un Role 2 en el L-61 JC I. El objetivo de este artículo es describir las características técnicas y sanitarias del buque, las lecciones identificadas obtenidas tras las maniobras navales y analizar las semejanzas y diferencias de buques similares de marinas de guerra aliadas


Strategic Projection Ship L-61 Juan Carlos I (L-61 JC I) is the largest ship that the Spanish Navy has had in its history. This warship can develop four mission profiles: amphibian, aircraft carrier, strategic transport and humanitarian aid. In all of them, Role 2 medical capacity and capability plays a decisive role thanks to the important medical benefits available in the ship. FLOTEX-17 maneuvers carried out in the Mediterranean Sea in June 2017 with the participation of 29 warships and more than 3,500 navy members was the first time that a Role 2 was shipped in the L-61 JC I. The purpose of this article is to describe warship technical and medical characteristics, lessons identified after the naval maneuvers and analyze the similarities and differences of similar warships of allied navies


Assuntos
Humanos , Medicina Naval/organização & administração , Medicina Naval/normas , Navios/normas , Hospitais Militares/normas , Saneamento de Navios , Unidades Hospitalares/organização & administração , Unidades Hospitalares/normas , Hospitais Militares/organização & administração , Número de Leitos em Hospital/normas , Espanha , Reino Unido , França , Alemanha , Itália , Estados Unidos
4.
J R Army Med Corps ; 165(3): 176-179, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30127067

RESUMO

This is the second of two articles that considers the medical planning implications of large-scale defensive military operations. This paper describes a unified approach to theatre level health services support planning based on four phases: collection, hospitalisation, evacuation and reception. It highlights the need for a modular and agile system of medical capability building blocks that can be grouped together for specific military medical challenges. It also reintroduces the concepts of mass casualty and the medical reserve. These two papers are designed to encourage debate around how we should be organised to face the new challenges of health services support in potential peer-on-peer military operations.


Assuntos
Conflitos Armados , Serviços Médicos de Emergência/organização & administração , Hospitais Militares/organização & administração , Medicina Militar/organização & administração , Humanos , Militares , Modelos Organizacionais
5.
J R Army Med Corps ; 165(3): 173-175, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30127068

RESUMO

This is the first of two articles that considers the medical planning implications of large-scale defensive military operations. This paper considers the military context and planning factors that may require a medical plan that is different from that seen in recent counterinsurgency operations. The scale and complexity of the challenge is likely to require a greater level of decentralisation and a more sophisticated approach to medical planning at the strategic and operational levels.


Assuntos
Hospitais Militares/organização & administração , Medicina Militar/organização & administração , Planejamento de Assistência ao Paciente/organização & administração , Conflitos Armados , Humanos , Militares
8.
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.
Sanid. mil ; 74(4): 260-262, oct.-dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-182309

RESUMO

La misión principal del Royal Centre for Defence Medicine es proporcionar apoyo sanitario a las operaciones militares, actuando como último escalón sanitario con capacidad de Role 4 en Reino Unido. Además, proporciona atención secundaria y especializada para miembros de las Fuerzas Armadas Británicas. Es un centro de formación para el personal sanitario militar y un núcleo de investigación médica militar


The mission of the Royal Centre for Defence Medicine is to provide medical support to all military operations, acting as the last echelon of treatment; in its capacity as the Role 4 hospital in the United Kingdom (UK). In addition, it provides secondary care and specialist opinions for members of the UK Armed Forces. It is a training centre for defence medical personnel, and a focus for military medical research


Assuntos
Instalações Militares/organização & administração , Hospitais Militares/organização & administração , Serviços Hospitalares , Instalações Militares/história , Hospitais Militares/história , Medicina Militar , Inglaterra
10.
Sanid. mil ; 74(4): 266-273, oct.-dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-182311

RESUMO

La Sanidad Militar es una parte esencial dentro del organigrama de cualquier ejército. Dentro de España, ha sido desarrollada hasta nuestros días, con un impulso forzado durante los conflictos bélicos, especialmente la Guerra Civil (1936-1939). Con unos claros antecedentes, derivados de su propia historia y experiencias, la Sanidad Militar durante la Guerra Civil desarrolló y puso en práctica nuevas técnicas sanitarias como el "Método Español". Junto a lo anterior, una de las mayores innovaciones de orígen español será la invención, en 1920, del autogiro de Juan de la Cierva. Predecesor de los helicópteros, esta aeronave fue puesta al servicio de la Aviación Sanitaria europea y mundial. Todas las innovaciones, militares y sanitarias, surgidas en España durante el conflicto civil, tendrán un reflejo y aplicación en los diferentes países europeos, sobre todo en la II Guerra Mundial. Dicha contribución generalmente ha pasado desapercibida dentro de nuestras fronteras, pero no así en ámbito internacional donde son ampliamente reconocidas personalidades como Juan de la Cierva o el Doctor J. Trueta i Raspall


The military health is an essential part within the organization of any army. In Spain, it has been developed to the present day, with momentum forced during armed conflicts, especially the Civil War (1936-1939). With a clear background, derived from its own history and experiences, the military health during the Civil War developed and implemented new sanitary techniques such as the "Spanish method". Along with the above, one of the major innovations of Spanish origin was the invention, in 1920, of Juan de la Cierva's autogiro. Predecessor of the helicopters, this aircraft was at the service of European health and global aviation. All the innovations, both military and health, arising in Spain during the civil conflict, had a reflection and application in different European countries, especially during World War II. This contribution has generally gone unnoticed within our borders, but not at international level where Juan de la Cierva or Doctor J. Trueta i Raspall are widely-recognized figures


Assuntos
Humanos , História do Século XX , Medicina Militar/história , Hospitais Militares/história , Hospitais Militares/organização & administração , Lesões Relacionadas à Guerra/história , Guerras e Conflitos Armados/história , Guerra/história , Atividades Militares/história , Distúrbios de Guerra/história , I Guerra Mundial
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.
J Perioper Pract ; 28(11): 300-301, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30375276

RESUMO

The Role 2 Afloat (R2A) is the Royal Navy (RN)'s Damage Control Resuscitation (DCR), including Damage Control Surgery, capability at sea. There are currently three operating department practitioners (ODP) in the deployed team. This article describes the role of the ODP in this team and the training which is required to fulfil this role.


Assuntos
Anestesistas/organização & administração , Hospitais Militares/organização & administração , Papel do Profissional de Enfermagem , Salas Cirúrgicas/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Ressuscitação/enfermagem , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Unidades Móveis de Saúde/organização & administração , Inovação Organizacional , Ressuscitação/métodos , Reino Unido
14.
Int J Health Care Qual Assur ; 31(6): 575-586, 2018 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-29954270

RESUMO

Purpose A sentinel event is an unexpected occurrence resulting in death or serious physical or psychological injury or the risk thereof. The purpose of this paper is to investigate the influencing factors of sentinel events in the emergency department of a military hospital in Tehran to find out some of the effective solutions. Design/methodology/approach In this qualitative study with content analysis approach, 20 hospital healthcare personnel participated as participants from the fields of medicine and nursing. Purposive random sampling and semi-structured interviews were used for data collection. Atlas.ti software version 5.2 was used for data analysis. Findings Four themes and 32 subthemes were identified by numerous revisions and combining the codes. The four main themes of sentinel events were: causes, incidence barriers, cause prevention solutions, and barriers' improvement solutions. Moreover, these main factors were related to these issues: staff and patients' education, communication, assessment, patients and their companions, employee rights, leadership, care continuum, human factors, physical environment, information management and medication use. Some solutions were also suggested according to these factors and a policy was recommended. Practical implications Hospital managers and authorities should try to find the main causes of sentinel events by periodical analysis to find ways to prevent them in the future, using logical and reasonable solutions. Originality/value This study confirms that strategies to reduce the sentinel events in emergency departments should focus on empowerment of all staff.


Assuntos
Atitude do Pessoal de Saúde , Serviço Hospitalar de Emergência/organização & administração , Hospitais Militares/organização & administração , Recursos Humanos em Hospital/psicologia , Qualidade da Assistência à Saúde/organização & administração , Adulto , Comunicação , Serviço Hospitalar de Emergência/normas , Meio Ambiente , Feminino , Hospitais Militares/normas , Humanos , Capacitação em Serviço , Entrevistas como Assunto , Irã (Geográfico) , Liderança , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas
16.
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
17.
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
18.
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
19.
Mil Med ; 183(11-12): e494-e499, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29635539

RESUMO

Introduction: Mortality is reduced in hospitals staffed with intensivists, however, many smaller military hospitals lack intensivist support. Naval Hospital Camp Pendleton (NHCP) is a Military Treatment Facility (MTF) that operates a 6-bed Intensive Care Unit (ICU) north of its referral center, Naval Medical Center San Diego (NMCSD). To address a gap in NHCP on-site intensivist coverage, a comprehensive Tele-Critical Care (TCC) support system was established between NHCP and NMCSD. To examine the initial impact of telemedicine on surgical ICU patients, we compare NHCP surgical ICU admissions before and after TCC implementation. Materials and methods: Patient care by remote intensivist was achieved utilizing video teleconferencing technology, and remote access to electronic medical records. Standardization was promoted by adopting protocols and mandatory intensivist involvement in all ICU admissions. Surgical ICU admissions prior to TCC implementation (pre-TCC) were compared to those following TCC implementation (post-TCC). Results: Of 828 ICU admissions, 21% were surgical. TCC provided coverage during 35% of the intervention period. Comparing pre-TCC and post-TCC periods, there was a significant increase in the percentage of surgical ICU admissions [15.3 % vs 24.6%, p = 0.01] and the average monthly APACHE II score [4.1vs 6.5, p = 0.03]. The total number of surgical admissions per month also increased [3.9 vs 6.3, p = 0.009]. No adverse outcomes were identified. Conclusion: Implementation of TCC was associated with an increase in the scope and complexity of surgical admissions with no adverse outcomes. Surgeons were able to safely expand the surgical services offered requiring perioperative ICU care to patients who previously may have been transferred. Caring for these types of patients not only maintains the operational readiness of deployable caregivers but patient experience is also enhanced by minimizing transfers away from family. Further exploration of TCC on surgical case volume and complexity is warranted.


Assuntos
Cuidados Críticos/métodos , Centro Cirúrgico Hospitalar/normas , Telemedicina/métodos , APACHE , Idoso , California , Cuidados Críticos/tendências , Feminino , Hospitais Militares/organização & administração , Hospitais Militares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Centro Cirúrgico Hospitalar/tendências , Telemedicina/tendências
20.
Mil Med ; 183(9-10): e624-e632, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29547984

RESUMO

INTRODUCTION: The obesity epidemic in the USA includes active duty service members in the military and effects physical readiness. At the Naval Medical Center San Diego command, the Health & Wellness Department is charged with administering the Weight Management Programs (WMP) for sailors in the San Diego area to ensure military physical readiness requirements. The optimal allocation of personnel and resources to manage these programs is paramount for mission success. We analyzed the cost and effectiveness of the WMPs for the active duty population stationed at Naval Medical Center San Diego (NMCSD) with the intent of offering potential recommendations for program optimization. METHODS: As an approved quality improvement program, the cost and effectiveness of the WMP, namely Fitness Enhancement Program (FEP) and ShipShape (SS), for the active duty population stationed at NMCSD were analyzed from 2013 to 2014 by utilizing various official sources. Data analysis included reviewing historical data for trends and developing a budgetary analysis to include Direct Labor Hour rates and opportunity costs. Interviews were conducted with key staff and participants in the WMPs to determine essential aspects and potential beneficial changes to the programs. Overall results were evaluated to identify potential opportunities for program expansion and improvement. RESULTS: Data analysis revealed that the FEP is producing a 78% success rate, with approximately 30% of the enrolled personnel actively participating. Concurrently, the SS program at NMCSD is producing a 71% success rate with 90% course completion rate. This success rate is significantly higher than the national SS average of 34%. Furthermore, our cost analysis revealed that the SS program a significantly higher return on investment. Interviews conducted of key staff and participants yielded several commonalities regarding key factors involved with WMPs success or needed improvements. CONCLUSIONS: To improve the WMPs at NMCSD, the findings in this report support the following recommendations: (1) maximize the SS program, (2) increase utilization of FEP, and (3) increase the participation and training of Assistant Command Fitness Leaders. WMPs navy-wide may benefit from incorporating similar program improvements to increase physical readiness of service members and, therefore, support command mission success.


Assuntos
Hospitais Militares/estatística & dados numéricos , Militares/estatística & dados numéricos , Aptidão Física , Programas de Redução de Peso/normas , California/epidemiologia , Hospitais Militares/organização & administração , Humanos , Entrevistas como Assunto/métodos , Obesidade/epidemiologia , Pesquisa Qualitativa , Programas de Redução de Peso/estatística & dados numéricos
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