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Sample records for army surgical hospital

  1. The mobile Army surgical hospital (MASH): a military and surgical legacy.

    PubMed Central

    King, Booker; Jatoi, Ismalil

    2005-01-01

    Operation Iraqi Freedom was perhaps the last military campaign that will ever utilize the services of a mobile Army surgical hospital (MASH). The Army has now essentially replaced the MASH with combat surgical hospitals (CSH) and forward surgical teams (FST). MASH units were designed as mobile, flexible, forward-deployed military hospitals, providing care for the wounded near the frontlines of the battlefield. These hospitals not only saved thousands of lives during war but also greatly influenced the delivery of trauma and critical care in civilian hospitals. The MASH was made popular by the television series of the 1970s, depicting the 4077th during the Korean War. Although a comical series, these television episodes provided viewers with a glimpse of life in a MASH during time of war. This article chronicles the history of the MASH from its inception during World War II to recent experiences in Operation Iraqi Freedom. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 p656-a PMID:15926641

  2. Training forward surgical teams for deployment: the US Army Trauma Training Center.

    PubMed

    Valdiri, Linda A; Andrews-Arce, Virginia E; Seery, Jason M

    2015-04-01

    Since the late 1980s, the US Army has been deploying forward surgical teams to the most intense areas of conflict to care for personnel injured in combat. The forward surgical team is a 20-person medical team that is highly mobile, extremely agile, and has relatively little need of outside support to perform its surgical mission. In order to perform this mission, however, team training and trauma training are required. The large majority of these teams do not routinely train together to provide patient care, and that training currently takes place at the US Army Trauma Training Center (ATTC). The training staff of the ATTC is a specially selected 10-person team made up of active duty personnel from the Army Medical Department assigned to the University of Miami/Jackson Memorial Hospital Ryder Trauma Center in Miami, Florida. The ATTC team of instructors trains as many as 11 forward surgical teams in 2-week rotations per year so that the teams are ready to perform their mission in a deployed setting. Since the first forward surgical team was trained at the ATTC in January 2002, more than 112 forward surgical teams and other similar-sized Department of Defense forward resuscitative and surgical units have rotated through trauma training at the Ryder Trauma Center in preparation for deployment overseas. PMID:25834016

  3. Pharmaceutical services in a United States Army field hospital.

    PubMed

    Dasher, T

    1985-03-01

    Pharmaceutical services in a United States Army field hospital are described. The field hospital was deployed to Honduras to support United States troops during military exercises. Pharmaceutical services were provided from a large tent near the hospital, which consisted of an emergency treatment facility, two operating rooms, and a small medical-surgical ward. One pharmacist and four technicians provided outpatient pharmaceutical services 10 hours per day, seven days per week; pharmacy personnel were on call at other times. The majority of pharmacy time was spent prepackaging and labeling medications for use by medical teams visiting local villages to provide health care to Honduran natives. The pharmacy's drug distribution, inventory control, and intravenous admixture activities in light of limited personnel and storage space, long supply lines, and lack of an aseptic working area are described. Pharmacist-physician interactions regarding drug therapy and common ailments of United States troops and Honduran natives are also discussed. During a two-month period, the field hospital pharmacy dispensed approximately 24,000 prescriptions. Pharmaceutical services played an important role in the success of the field hospital's mission and provided aid to the population of an impoverished country that might not otherwise have received it. PMID:3985020

  4. Filmless Radiographic System For Army Field Hospitals

    NASA Astrophysics Data System (ADS)

    Siedband, Melvin P.; Grenzow, Frank C.; Gray, James; Heilman, Craig A.; Zhang, Hui L.

    1989-05-01

    Small computers incorporating hard disc memory, multiple high resolution monitors and the small computer systems interface (SCSI) can be used for low-cost filmless radiography. A system has been constructed which can perform all of the functions required of a small clinic or field hospital including scheduling, reporting, image acquisition and display, image annotation, image storage and transmission, and control of peripheral devices. The peripheral devices include an optical card reader/writer, an optical disc reader/writer, a SCSI to DIN/PACS port, an Ethernet port and a SCSI to a long distance telephone/computer port, the Integrated Services Digital Network (ISDN) port. Individual patient optical data cards may be prepared, all images and reports may be archived in a small optical disc in the computer, other image sources may be coupled to the system via the DIN/PACS port, data may be exchanged with the local DIN via the Ethernet port and with distant sites via the ISDN port. The small optical data cards, about the size of a credit card, are used for individual patient images and reports. An independent viewer may be used to display the contents of the cards. The result is a complete "filmless and paperless" medical imaging system. The system was developed on Contract DAMD17-88C-8058 with the US Army Medical Research and Development Command.

  5. [The organization of surgical care in Russian army during 1812 Great Patriotic War].

    PubMed

    Gliantsev, S P

    2012-01-01

    The article considers the characteristics of surgical care to warriors of Russian army during 1812 Great Patriotic War. Such conditions are analyzed as damaging action of French weapons, types of combat wounds, organization and forces of military sanitary service of Russian troops, surgeons' support with means of supplying surgical care to the wounded and arsenal of surgical aids. On the basis of given materials analysis a preliminary conclusion is made that surgical care in Russian army in 1812 not only was on the sufficiently high level but it played a specified role in the victory of Russian weapon. PMID:23350103

  6. Predicting U.S. Army suicides after hospitalizations with psychiatric diagnoses in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

    PubMed Central

    Kessler, Ronald C.; Warner, LTC Christopher H.; Ivany, LTC Christopher; Petukhova, Maria V.; Rose, Sherri; Bromet, Evelyn J.; Brown, LTC Millard; Cai, Tianxi; Colpe, Lisa J.; Cox, Kenneth L.; Fullerton, Carol S.; Gilman, Stephen E.; Gruber, Michael J.; Heeringa, Steven G.; Lewandowski-Romps, Lisa; Li, Junlong; Millikan-Bell, Amy M.; Naifeh, James A.; Nock, Matthew K.; Rosellini, Anthony J.; Sampson, Nancy A.; Schoenbaum, Michael; Stein, Murray B.; Wessely, Simon; Zaslavsky, Alan M.; Ursano, Robert J.

    2014-01-01

    IMPORTANCE The U.S. Army experienced a sharp rise in suicides beginning in 2004. Administrative data show that among those at highest risk are soldiers in the 12 months after inpatient treatment of a psychiatric disorder. OBJECTIVE To develop an actuarial risk algorithm predicting suicide in the 12 months after US Army soldier inpatient treatment of a psychiatric disorder to target expanded post-hospital care. DESIGN, SETTING, AND PARTICIPANTS There were 53,769 hospitalizations of active duty soldiers in 2004–2009 with ICD-9-CM psychiatric admission diagnoses. Administrative data available prior to hospital discharge abstracted from a wide range of data systems (socio81 demographic, Army career, criminal justice, medical/pharmacy) were used to predict suicides in the subsequent 12 months using machine learning methods (regression trees, penalized regressions) designed to evaluate cross-validated linear, nonlinear, and interactive predictive associations. MAIN OUTCOME Suicides of soldiers hospitalized with psychiatric disorders in the 12 months after hospital discharge. RESULTS 68 soldiers died by suicide within 12 months of hospital discharge (12.0% of all Army suicides), equivalent to 263.9 suicides/100,000 person-years compared to 18.5 suicides/100,000 person-years in the total Army. Strongest predictors included socio-demographics (male, late age of enlistment), criminal offenses (verbal violence, weapons possession), prior suicidality, aspects of prior psychiatric inpatient and outpatient treatment, and disorders diagnosed during the focal hospitalizations. 52.9% of post-hospital suicides occurred after the 5% of hospitalizations with highest predicted suicide risk (3,824.1 suicides/100,000 person years). These highest-risk hospitalizations also accounted for significantly elevated proportions of several other adverse post-hospital outcomes (unintentional injury deaths, suicide attempts, re-hospitalizations). CONCLUSIONS AND RELEVANCE The high concentration of risk of suicides and other adverse outcomes might justify targeting expanded post-hospital interventions to soldiers classified as having highest post-hospital suicide risk, although final determination requires careful consideration of intervention costs, comparative effectiveness, and possible adverse effects. PMID:25390793

  7. Surgical Services in Critical Access Hospitals, 2011.

    PubMed

    Weigel, Paula; Ullrich, Fred; Ward, Marcia M; Mueller, Keith J

    2015-01-01

    In this policy brief we describe the types and volume of major surgical services provided in the inpatient and outpatient settings of Critical Access Hospitals (CAHs) in 2011. Major surgical services are those procedures that require use of an operating room (OR), regardless of whether the procedure was inpatient or outpatient. Key Findings (1) CAH discharges of patients having a major surgical procedure that required use of an OR were analyzed from four regionally representative states: Colorado, North Carolina, Vermont, and Wisconsin. The average surgical volume among all CAHs in the sample was 624 procedures per CAH per year, and only 6.8 percent of CAHs performed none. (2) The average portion of all surgery volume performed on an outpatient basis in CAHs is 77 percent. Inpatient procedure volume ranged between 20 percent and 24 percent of total surgical volume across the four states. Most of the research literature on surgery in CAHs focus on inpatient procedures only, thus missing a significant portion of the surgery volume that CAHs perform. (3) The high correlation (0.86, p <0.0001) indicates that the 3:1 ratio of outpatient-to-inpatient surgical volume was relatively consistent across CAHs. (4) Operations on the musculoskeletal system, the eye, and the digestive system accounted for 67 percent on average of all surgical procedures in CAHs. Many surgical procedures are performed on an inpatient and outpatient basis, but some are performed exclusively in one setting. PMID:26415235

  8. The Hospital That Became a College: Sloan U.S. Army General Hospital, Montpelier, Vermont. Norwich University Library Occasional Paper No. 1.

    ERIC Educational Resources Information Center

    Shepard, William A.

    A historical review is presented of Sloan U.S. Army General Hospital, the second largest Union Army hospital in Vermont, which operated from June 1864 to October 1865. Sloan Hospital later became Vermont College, which in 1972 merged with Norwich University. Sloan Hospital operated during the last year and a half of the Civil War and consisted of…

  9. Impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy

    PubMed Central

    Kim, Chul-Gyu; Jo, Sungho; Kim, Jae Sun

    2012-01-01

    AIM: To evaluate the impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy (PD) for periampullary tumors in South Korea. METHODS: Periampullary cancer patients who underwent PD between 2005 and 2008 were analyzed from the database of the Health Insurance Review and Assessment Service of South Korea. A total of 126 hospitals were divided into 5 categories, each similar in terms of surgical volume for each category. We used hospital mortality as a quality indicator, which was defined as death during the hospital stay for PD, and calculated adjusted mortality through multivariate logistic models using several confounder variables. RESULTS: A total of eligible 4975 patients were enrolled in this study. Average annual surgical volume of hospitals was markedly varied, ranging from 215 PDs in the very-high-volume hospital to < 10 PDs in the very-low-volume hospitals. Admission route, type of medical security, and type of operation were significantly different by surgical volume. The overall hospital mortality was 2.1% and the observed hospital mortality by surgical volume showed statistical difference. Surgical volume, age, and type of operation were independent risk factors for hospital death, and adjusted hospital mortality showed a similar difference between hospitals with observed mortality. The result of the Hosmer-Lemeshow test was 5.76 (P = 0.674), indicating an acceptable appropriateness of our regression model. CONCLUSION: The higher-volume hospitals showed lower hospital mortality than the lower-volume hospitals after PD in South Korea, which were clarified through the nationwide database. PMID:22919251

  10. Energy engineering analysis program. Kimbrough Army Community Hospital, Ft. George G, Meade, Maryland. Final report

    SciTech Connect

    1988-12-01

    Mueller Associates, Inc. (MAI) was retained by the Baltimore District of Army Corps of Engineers in September of 1985 to perform energy conservation services at Fort George G. Meade, Maryland. The contract included studies of the following buildings: number 2480 - Kimbrough Army Community Hospital (KACH), number 8472 - Dental Clinic, number 2481 - Barracks, number 2484 - Medical Supply Warehouse. The Scope of this study included the following objectives: Perform a complete energy audit and analysis of the entire Kimbrough Army Community Hospital including the attached Outpatient Clinic. Investigate the feasibility of an Energy Monitoring and Control System (EMCS) for the hospital. Investigate exhaust systems in the Dental Clinic. Investigate window replacement and chilled water temperature of the Barracks. Investigate the feasibility of infra-red heaters, loading dock door seals, and air stratification in the Medical Supply Warehouse. Identify all energy conservation opportunities, including low cost/no cost items and perform complete evaluations of each. Prepare programming documentation for all energy conservation investment program projects including DD Form 1391, a life cycle cost analysis summary sheet with backup calculations, and a Project Development Brochure. Prepare implementation documentation for all justifiable energy conservation opportunities. List and prioritize all recommended energy conservation opportunities.

  11. [Instituting a surgical skills lab at a training hospital].

    PubMed

    Gerdes, B; Hassan, I; Maschuw, K; Schlosser, K; Bartholomäus, J; Neubert, T; Schwedhelm, B; Petrikowski-Schneider, I; Wissner, W; Schönert, M; Rothmund, M

    2006-11-01

    The improvement of surgical skills of trainees in Germany often occurs solely in the operating room. In recent years, several countries have established surgical skills labs as an essential part of surgical education, with the goal of improving and refining surgical skills before clinical application. Several years ago, training units were established by the industry wherein the curricula focused on products of the respective company. Selected training courses are still offered in a few clinics. Presently, laboratories which train the surgical skills of novices in an individually adapted form are lacking. A surgical skills lab with a comprehensive curriculum of training courses was introduced at the University Hospital of Marburg in 2005. The present article describes the development and introduction of such facilities. The authors are convinced that surgical skills labs will become increasingly important in German surgical education for improving patient safety in the operating room. PMID:16917754

  12. HOSPITALIZATION TIME AFTER OPEN APPENDECTOMY BY THREE DIFFERENT SURGICAL TECHNIQUES

    PubMed Central

    XIMENES, Agláia Moreira Garcia; MELLO, Fernando Salvo Torres; de LIMA-JÚNIOR, Zailton Bezerra; FERREIRA, Cícero Faustino; CAVALCANTI, Amanda Dantas Ferreira; DIAS-FILHO, Adalberto Vieira

    2014-01-01

    Background The choice of surgical technique to approach the appendicular stump depends mostly on skill and personal preference of the surgeon or on the protocol used in the service, and the influence of this choice in hospitalization time is not evaluated. Aim To evaluate the relation between surgical technique and postoperative hospitalization time in patients presenting with acute appendicitis. Methods Retrospective analysis of 180 patients who underwent open appendectomy. These where divided into three groups according to surgical technique: conventional appendectomy (simple ligation of the stump), tobacco pouch suture and Parker-Kerr suture. Data where crossed with hospitalization time (until three days, from four to six days and over seven days). Results A hundred and eighty patients with age from 15 to 85 years where included. From these, 95 underwent conventional technique, had an average hospitalization time of 3,9 days and seven had complications (surgical site infection, seroma, suture dehiscence and evisceration). In 67 patients, tobacco pouch suture was chosen and had average hospitalization time of 3,7 days and two complications (infection and seroma). In 18 Parker-Kerr suture was made, with average hospitalization time of 2,6 days, with no complication. Contingency coefficient between the variables hospitalization time and technique was 0,255 and Cramér's V was 0,186. Conclusion There was tendency to larger hospitalization time and larger number of complications in conventional appendectomy, whereas in patients where Parker-Kerr suture was performed, hospitalization time was significantly smaller. PMID:25184769

  13. Surgical and anaesthetic capacity of hospitals in Malawi: key insights

    PubMed Central

    Henry, Jaymie Ang; Frenkel, Erica; Borgstein, Eric; Mkandawire, Nyengo; Goddia, Cyril

    2015-01-01

    Background Surgery is increasingly recognized as an important driver for health systems strengthening, especially in developing countries. To facilitate quality improvement initiatives, baseline knowledge of capacity for surgical, anaesthetic, emergency and obstetric care is critical. In partnership with the Malawi Ministry of Health, we quantified government hospitalssurgical capacity through workforce, infrastructure and health service delivery components. Methods From November 2012 to January 2013, we surveyed district and mission hospital administrators and clinical staff onsite using a modified version of the Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) tool from Surgeons OverSeas. We calculated percentage of facilities demonstrating adequacy of the assessed components, surgical case rates, operating theatre density and surgical workforce density. Results Twenty-seven government hospitals were surveyed (90% of the district hospitals, all central hospitals). Of the surgical workforce surveyed (n = 370), 92.7% were non-surgeons and 77% were clinical officers (COs). Of the 109 anaesthesia providers, 95.4% were non-physician anaesthetists (anaesthesia COs or ACOs). Non-surgeons and ACOs were the only providers of surgical services and anaesthetic services in 85% and 88.9% of hospitals, respectively. No specialists served the district hospitals. All of the hospitals experienced periods without external electricity. Most did not always have a functioning generator (78.3% district, 25% central) or running water (82.6%, 50%). None of the district hospitals had an Intensive Care Unit (ICU). Cricothyroidotomy, bowel resection and cholecystectomy were not done in over two-thirds of hospitals. Every hospital provided general anaesthesia but some did not always have a functioning anaesthesia machine (52.2%, 50%). Surgical rate, operating theatre density and surgical workforce density per 100 000 population was 289.48–747.38 procedures, 0.98 and 5.41 and 3.68 surgical providers, respectively. Conclusion COs form the backbone of Malawi’s surgical and anaesthetic workforce and should be supported with improvements in infrastructure as well as training and mentorship by specialist surgeons and anaesthetists. PMID:25261799

  14. [Reduction of hospital stay in surgical units (author's transl)].

    PubMed

    Vinz, H; Reisig, J; Müller, K H

    1977-01-01

    Reduction of hospital stay increases the surgical efficiency and reduces the danger of bacterial hospitalism. It is to be accomplished by: 1. admittance of patients with regard to the operative capacity; 2. out-patient diagnosis and preoperative anaesthesiologie care; 3. early postoperative discharge; 4. reduction of septic surgery. PMID:919857

  15. Predeployment mass casualty and clinical trauma training for US Army forward surgical teams.

    PubMed

    Pereira, Bruno M T; Ryan, Mark L; Ogilvie, Michael P; Gomez-Rodriguez, Juan Carlos; McAndrew, Patrick; Garcia, George D; Proctor, Kenneth G

    2010-07-01

    Since the beginning of the program in 2002, 84 Forward Surgical Teams (FSTs) have rotated through the Army Trauma Training Center (ATTC) at the University of Miami/Ryder Trauma Center including all those deployed to Iraq and Afghanistan. The purpose of this study was to provide the latest updates of our experience with FSTs at the ATTC. Before deployment, each FST participates in a 2-week training rotation at the ATTC. The rotation is divided into 3 phases. Phase 1 is to refresh FST knowledge regarding the initial evaluation and management of the trauma patient. Phase 2 is the clinical phase and is conducted entirely at the Ryder Trauma Center. The training rotation culminates in phase 3, the Capstone exercise. During the Capstone portion of their training, the entire 20-person FST remains at the Ryder Trauma Center and is primarily responsible for the evaluation and resuscitation of all patients arriving over a 24-hour period. Subject awareness concerning their role within the team improved from 71% to 95%, indicating that functioning as a team in the context of the mass casualty training exercise along with clinical codes was beneficial. The clinical component of the rotation was considered by 47% to be the most valuable aspect of the training. Our experience strongly suggests that a multimodality approach is beneficial for preparing a team of individuals with minimal combat (or trauma) experience for the rigors of medical care and triage on the battlefield. The data provided by participants rotating through the ATTC show that through clinical exposure and simulation over a 2-week period, FST performance is optimized by defining provider roles and improving communication. The mass casualty training exercise is a vital component of predeployment training that participants feel is valuable in preparing them for the challenges that lay ahead. PMID:20613574

  16. Acceptance of the WHO Surgical Safety Checklist among surgical personnel in hospitals in Guatemala city

    PubMed Central

    2012-01-01

    Background Studies have highlighted the effects the use of the WHO Surgical Safety Checklist can have on lowering mortality and surgical complications. Implementation of the checklist is not easy and several barriers have been identified. Few studies have addressed personnel’s acceptance and attitudes toward the WHO Surgical Safety Checklist. Determining personnel’s acceptance might reflect their intention to use the checklist while their awareness and knowledge of the checklist might assess the effectiveness of the training process. Methods Through an anonymous self- responded questionnaire, general characteristics of the respondents (age, gender, profession and years spent studying or working at the hospital), knowledge of the WHO Surgical Safety Checklist (awareness of existence, knowledge of objectives, knowledge of correct use), acceptance of the checklist and its implementation (including personal belief of benefits of using the checklist), current use, teamwork and safety climate appreciation were determined. Results Of the 147 surgical personnel who answered the questionnaire, 93.8% were aware of the existence of the WHO Surgical Safety Checklist and 88.8% of them reported knowing its objectives. More nurses than other personnel knew the checklist had to be used before the induction of anesthesia, skin incision, and before the patient leaves the operating room. Most personnel thought using the WHO Surgical Safety Checklist is beneficial and that its implementation was a good decision. Between 73.7% and 100% of nurses in public and private hospitals, respectively, reported the checklist had been used either always or almost always in the general elective surgeries they had participated in during the current year. Conclusions Despite high acceptance of the checklist among personnel, gaps in knowledge about when the checklist should be used still exist. This can jeopardize effective implementation and correct use of the checklist in hospitals in Guatemala City. Efforts should aim to universal awareness and complete knowledge on why and how the checklist should be used. PMID:22721269

  17. Spinal injury hospitalizations among U.S. Army soldiers deployed to Iraq and Afghanistan.

    PubMed

    Wojcik, Barbara E; Curley, Kenneth C; Szeszel-Fedorowicz, Wioletta; Stein, Catherine R; Humphrey, Rebecca J

    2015-02-01

    This retrospective study examined spinal-related hospitalizations of U.S. Army soldiers deployed to Afghanistan and Iraq. Spinal cord injuries (SCI) and vertebral column injuries (VCI) were identified using International Classification of Disease, 9th Revision, Clinical Modification diagnosis codes. In our study, spinal hospitalizations represented 8.2% of total injury admissions. Risk factors for SCI and VCI incidences were determined using Poisson regression. Lack of previous deployment experience increased risk of having SCI by 33% and VCI by 24% in Iraq (similar increases, but not statistically significant in Afghanistan). Male soldiers had 4.85 times higher risk for SCI in Iraq and 69% higher risk in Afghanistan than female soldiers. In Afghanistan, almost 60% of spinal episodes included traumatic brain injury (TBI), compared to about 40% in Iraq. In both theaters, mild TBI accounted for more than 50% of all TBI-spinal episodes. Sixteen percent of SCI inpatient episodes in Afghanistan and 13% in Iraq were associated with paralysis, with median bed days of 46 and 33 days compared to a median of 6 days in both theaters for nonparalysis spinal injuries. The mortality rate was 2.5 times lower in Afghanistan than in Iraq. PMID:25643390

  18. Re-engineering surgical services in a community teaching hospital.

    PubMed

    Cohen, M M; Wreford, M; Barnes, M; Voight, P

    1997-04-01

    The Grace Hospital Surgical Services redesign project began in December 1995 and concluded in November 1996. It was led by the Chief of Surgery, the Surgical/Anesthesia Services Director, and the Associate Director of Critical Care/Trauma. The project was undertaken in order to radically redesign the delivery of surgical services in the Detroit Medical Center (DMC) Northwest Region. It encompassed the Grace Hospital Main Operating Room (10 operating theatres) and Post-Anesthesia Recovery Unit, and a satellite Ambulatory Surgery Center in Southfield, Michigan. The four areas of focus were materials management, case scheduling, patient flow/staffing, and business planning. The guiding objectives of the project were to improve upon the quality of surgical services for patients and physicians, to substantially reduce costs, and to increase case volume. Because the Grace Surgical Services redesign project was conducted in a markedly open communicative, and inclusive fashion and drew participation from a broad range of medical professionals, support staff, and management, it created positive ripple effects across the institution by raising staff cost-consciousness, satisfaction, and morale. Other important accomplishments of the project included: Introduction of block scheduling in the ORs, which improved room utilization and turnaround efficiencies, and greatly smoothed the boarding process for physicians. Centralization of all surgical boarding, upgrading of computer equipment to implement "one call" surgery scheduling, and enlarging the capacity for archiving, managing and retrieving OR data. Installation of a 23-hour, overnight recovery unit and provision of physician assistants at the Ambulatory Surgery Center, opening the doors to an expanded number of surgical procedures, and enabling higher quality care for patients. Reduction of FTE positions by 27 percent at the Ambulatory Surgery Center. This yielded a total cost reduction of +1.5 million per annum in the annual budget of +10.3 million; Recruited 10 new podiatrists and increased the volume of cases brought to Northwest Region facilities by surgical specialists. This added 100 cases in 1996, and is projected to add 500 cases in 1997. A 14.5 percent reduction in the cost of operating the Surgical Services was achieved. This was accompanied by enhanced staff morale, physician satisfaction and a higher quality of patient care. PMID:10172985

  19. Surgical patients travel longer distances than non-surgical patients to receive care at a rural hospital in Mozambique

    PubMed Central

    Faierman, Michelle L.; Anderson, Jamie E.; Assane, Americo; Bendix, Peter; Vaz, Fernando; Rose, John A.; Funzamo, Carlos; Bickler, Stephen W.; Noormahomed, Emilia V.

    2015-01-01

    Background Surgical care is increasingly recognised as an important component of global health delivery. However, there are still major gaps in knowledge related to access to surgical care in low-income countries. In this study, we compare distances travelled by surgical patients with patients seeking other medical services at a first-level hospital in rural Mozambique. Methods Data were collected on all inpatients at Hospital Rural de Chókwč in rural Mozambique between 20 June 2012 and 3 August 2012. Euclidean distances travelled by surgical versus non-surgical patients using coordinates of each patient's city of residence were compared. Data were analysed using ArcGIS 10 and STATA. Results In total, 500 patients were included. Almost one-half (47.6%) lived in the city where the hospital is based. By hospital ward, the majority (62.0%) of maternity patients came from within the hospital's city compared with only 35.2% of surgical patients. The average distance travelled was longest for surgical patients (42 km) compared with an average of 17 km for patients on all other wards. Conclusions Patients seeking surgical care at this first-level hospital travel farther than patients seeking other services. While other patients may have access to at community clinics, surgical patients depend more heavily on the services available at first-level hospitals. PMID:25135818

  20. 38 CFR 3.358 - Compensation for disability or death from hospitalization, medical or surgical treatment...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... disability or death from hospitalization, medical or surgical treatment, examinations or vocational... Special Purposes § 3.358 Compensation for disability or death from hospitalization, medical or surgical... condition at time of beginning the physical examination as a result of which the disease or injury...

  1. 38 CFR 3.358 - Compensation for disability or death from hospitalization, medical or surgical treatment...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... disability or death from hospitalization, medical or surgical treatment, examinations or vocational... Special Purposes § 3.358 Compensation for disability or death from hospitalization, medical or surgical... condition at time of beginning the physical examination as a result of which the disease or injury...

  2. 38 CFR 3.358 - Compensation for disability or death from hospitalization, medical or surgical treatment...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... disability or death from hospitalization, medical or surgical treatment, examinations or vocational... Special Purposes § 3.358 Compensation for disability or death from hospitalization, medical or surgical... condition at time of beginning the physical examination as a result of which the disease or injury...

  3. A Resource Planning Analysis of District Hospital Surgical Services in the Democratic Republic of the Congo

    PubMed Central

    Sion, Melanie; Rajan, Dheepa; Kalambay, Hyppolite; Lokonga, Jean-Pierre; Bulakali, Joseph; Mossoko, Mathias; Kwete, Dieudonne; Schmets, Gerard; Kelley, Edward; Elongo, Tarcisse; Sambo, Luis; Cherian, Meena

    2015-01-01

    Abstract Background: The impact of surgical conditions on global health, particularly on vulnerable populations, is gaining recognition. However, only 3.5% of the 234.2 million cases per year of major surgery are performed in countries where the world's poorest third reside, such as the Democratic Republic of the Congo (DRC). Methods: Data on the availability of anesthesia and surgical services were gathered from 12 DRC district hospitals using the World Health Organization's (WHO's) Emergency and Essential Surgical Care Situation Analysis Tool. We complemented these data with an analysis of the costs of surgical services in a Congolese norms-based district hospital as well as in 2 of the 12 hospitals in which we conducted the situational analysis (Demba and Kabare District Hospitals). For the cost analysis, we used WHO's integrated Healthcare Technology Package tool. Results: Of the 32 surgical interventions surveyed, only 2 of the 12 hospitals provided all essential services. The deficits in procedures varied from no deficits to 17 services that could not be provided, with an average of 7 essential procedures unavailable. Many of the hospitals did not have basic infrastructure such as running water and electricity; 9 of 12 had no or interrupted water and 7 of 12 had no or interrupted electricity. On average, 21% of lifesaving surgical interventions were absent from the facilities, compared with the model normative hospital. According to the normative hospital, all surgical services would cost US$2.17 per inhabitant per year, representing 33.3% of the total patient caseload but only 18.3% of the total district hospital operating budget. At Demba Hospital, the operating budget required for surgical interventions was US$0.08 per inhabitant per year, and at Kabare Hospital, US$0.69 per inhabitant per year. Conclusion: A significant portion of the health problems addressed at Congolese district hospitals is surgical in nature, but there is a current inability to meet this surgical need. The deficient services and substandard capacity in the surveyed district hospitals are systemic in nature, representing infrastructure, supply, equipment, and human resource constraints. Yet surgical services are affordable and represent a minor portion of the total operating budget. Greater emphasis should be made to appropriately fund district hospitals to meet the need for lifesaving surgical services. PMID:25745120

  4. From Pergamon to Army Base Hospital No. 5: the history and significance of the galea aponeurotica in the evolution of neurosurgery.

    PubMed

    Connor, David E; Chittiboina, Prashant; Nanda, Anil

    2014-08-01

    The authors trace the etymology and historical significance of galea or epicranial aponeurosis. In ancient Greece, galea referred to a helmet worn by soldiers, typically made of animal hide or leather. Throughout antiquity, physicians referred to all soft tissue between the skin and the skull as panniculus, a standard established by Galen of Pergamon. A manual of surgery in the Middle Ages referred to the entire scalp as a "great panicle that is called pericranium." During the early Renaissance, Leonardo da Vinci famously and stylistically analogized the dissection of the cranium with the peeling of an onion. Not until 1724 would the tendinous sheath connecting the frontalis and occipitalis muscles be defined as "Galea tendinosa cranii." By 1741, the convention of referring to the galea as an aponeurosis was well established. Harvey Cushing's wartime experiences at Army Base Hospital No. 5 reinforced the surgical significance of the galea. Operative mortality was significantly diminished due to "closure of the wounds with buried sutures in the galea." This operative nuance was then passed from teacher to pupil and has now become one of the tenets of modern neurosurgical practice. PMID:24926652

  5. [The main field hospitals of the French and Polish armies behind the lines in 1807].

    PubMed

    Srogosz, T

    2000-01-01

    The health requirements of the French and Polish troops fighting in Pomerania, mainly those of General Zajaczek's Observation Corps (Second Legion), forced the interim Polish authorities to establish main field hospitals in the Spring of 1807. Firstly, at M?awa, and then in the former storehouses on the Vistula at Tokary and Dobrzyków. Though the latter were situated in two localities, they nevertheless constituted an administrative whole. Of temporary character, these large hospitals (M?awa was capable of accommodating up to 1000 patients, Tokary and Dobrzyków up to 2000 patients) were closed after the end of hostilities. In spite of the temporary character of the field hospitals, the daily death rate was only several persons (sometimes there were a dozen or so fatalities, which also constituted a small number). During the establishment of the main field hospitals, a number of people demonstrated a degree of organisational talent. These included Józef Wybicki, representative of the Governing Committee and Stanis?aw Breza, director of internal affairs. Later there was Rev. Józef Poniatowski, war commander, also local officials such as Józef Zab?ocki and Teodor Miko?aj Dembowski, as well as representatives of the health service such as Dr. Hiacynt Dziarkowski, and Dr. Micha? Bergonzoni. Other people worth mentioning include the hospital personnel (Colonel Teodor Pretwitz was Commanding Officer of the field hospitals in M?awa, Tokary and Dobrzyków) who helped the sick and wounded soldiers, often under the difficult conditions of supplies and staff shortages. These shortages were a result of the scale of the enterprise, the poor relations between staff members, such as the conflict between Dr. Dziarkowski and Colonel Pretwitz, reservations about the competence of the head doctor Juliusz Szamborski. But most of all these shortages were a result of requisitions ordered by French Commissioners and Ward Heads. In spite of the problems main field hospitals achieved their purpose and gained recognition by high-ranking Polish and French commanding officers, especially General Zajaczek. PMID:11876206

  6. 1 Canadian Field Hospital in Haiti: surgical experience in earthquake relief

    PubMed Central

    Talbot, Max; Meunier, Bethann; Trottier, Vincent; Christian, Michael; Hillier, Tracey; Berger, Chris; McAlister, Vivian; Taylor, Scott

    2012-01-01

    The Canadian Forces’ (CF) deployable hospital, 1 Canadian Field Hospital, was deployed to Haiti after an earthquake that caused massive devastation. Two surgical teams performed 167 operations over a 39-day period starting 17 days after the index event. Most operations were unrelated to the earthquake. Replacing or supplementing the destroyed local surgical capacity for a brief period after a disaster can be a valuable contribution to relief efforts. For future humanitarian operations/disaster response missions, the CF will study the feasibility of accelerating the deployment of surgical capabilities. PMID:22854149

  7. Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario, Canada

    PubMed Central

    Malik, Atiqa; Bell, Chaim M.; Stukel, Thérèse A.; Urbach, David R.

    2016-01-01

    Background The effect of hospital specialization on the risk of hernia recurrence after inguinal hernia repair is not well described. Methods We studied Ontario residents who had primary elective inguinal hernia repair at an Ontario hospital between 1993 and 2007 using population-based, administrative health data. We compared patients from a large hernia specialty hospital (Shouldice Hospital) with those from general hospitals to determine the risk of recurrence. Results We studied 235 192 patients, 27.7% of whom had surgery at Shouldice hospital. The age-standardized proportion of patients who had a recurrence ranged from 5.21% (95% confidence interval [CI] 4.94%–5.49%) among patients who had surgery at the lowest volume general hospitals to 4.79% (95% CI 4.54%–5.04%) who had surgery at the highest volume general hospitals. In contrast, patients who had surgery at the Shouldice Hospital had an age-standardized recurrence risk of 1.15% (95% CI 1.05%–1.25%). Compared with patients who had surgery at the lowest volume hospitals, hernia recurrence among those treated at the Shouldice Hospital was significantly lower after adjustment for the effects of age, sex, comorbidity and income level (adjusted hazard ratio 0.21, 95% CI 0.19–0.23, p < 0.001). Conclusion Inguinal hernia repair at Shouldice Hospital was associated with a significantly lower risk of subsequent surgery for recurrence than repair at a general hospital. While specialty hospitals may have better outcomes for treatment of common surgical conditions than general hospitals, these benefits must be weighed against potential negative impacts on clinical care and the financial sustainability of general hospitals. PMID:26574701

  8. Are hospitals “keeping up with the Joneses”?: Assessing the spatial and temporal diffusion of the surgical robot

    PubMed Central

    Li, Huilin; Gail, Mitchell H.; Braithwaite, R. Scott; Gold, Heather T.; Walter, Dawn; Liu, Mengling; Gross, Cary P.; Makarov, Danil V.

    2015-01-01

    Background The surgical robot has been widely adopted in the United States in spite of its high cost and controversy surrounding its benefit. Some have suggested that a “medical arms race” influences technology adoption. We wanted to determine whether a hospital would acquire a surgical robot if its nearest neighboring hospital already owned one. Methods We identified 554 hospitals performing radical prostatectomy from the Healthcare Cost and Utilization Project Statewide Inpatient Databases for seven states. We used publicly available data from the website of the surgical robot’s sole manufacturer (Intuitive Surgical, Sunnyvale, CA) combined with data collected from the hospitals to ascertain the timing of robot acquisition during year 2001 to 2008. One hundred thirty four hospitals (24%) had acquired a surgical robot by the end of 2008. We geocoded the address of each hospital and determined a hospital’s likelihood to acquire a surgical robot based on whether its nearest neighbor owned a surgical robot. We developed a Markov chain method to model the acquisition process spatially and temporally and quantified the “neighborhood effect” on the acquisition of the surgical robot while adjusting simultaneously for known confounders. Results After adjusting for hospital teaching status, surgical volume, urban status and number of hospital beds, the Markov chain analysis demonstrated that a hospital whose nearest neighbor had acquired a surgical robot had a higher likelihood itself acquiring a surgical robot. (OR=1.71, 95% CI: 1.07–2.72, p=0.02). Conclusion There is a significant spatial and temporal association for hospitals acquiring surgical robots during the study period. Hospitals were more likely to acquire a surgical robot during the robot’s early adoption phase if their nearest neighbor had already done so. PMID:25821720

  9. Lived experiences and challenges of older surgical patients during hospitalization for cancer: An ethnographic fieldwork

    PubMed Central

    Høybye, Mette Terp

    2014-01-01

    This paper explores the lived experiences of older surgical patients’ (aged 74 years and older) experienced challenges during a brief admission to hospital. Age, gender, polypharmacy, and the severity of illness are also factors known to affect the hospitalization process. For an ethnographic study using participant observation and interviews, surgical cancer patients (n = 9, aged 74 years and older) were recruited during admission to a Danish teaching hospital. Using ethnographic strategies of participant observation and interviews, each patient was followed through the course of 1 day during their stay at the hospital. Interviews were carried out with all patients during this time. Three areas of concern were identified as prominent in the patients’ experiences and challenges during their short hospital stay: teeth and oral cavity, eating in a hospital setting, and medication during hospitalization. Short-term hospitalization requires focused collaboration between staff and patient concerning individual challenges from their teeth and oral cavity as support of nutritional needs during surgical treatment for cancer. PMID:24559546

  10. The War of Independence: a surgical algorithm for the treatment of head injury in the continental army.

    PubMed

    Sabourin, Victor M; Shah, Manan; Yick, Frederick; Gandhi, Chirag D; Prestigiacomo, Charles J

    2016-01-01

    The American Revolution was a gruesome warthat resulted in the independence of the United States of America from the British crown and countless casualties to both belligerents. However, from these desperate times, the treatment of traumatic head injury was elucidated, as were the origins of American neurosurgery in the 18th century. During the war, the surgical manual used by military field surgeons was titled Plain Concise Practical Remarks on the Treatment of Wounds and Fractures, by Dr. John Jones. This manual explains the different types of cranial injuries understood at that time as well as the relevant surgical treatment. This article seeks to review the surgical treatment of head injury in the Revolutionary War as outlined by Dr. Jones's manual. PMID:26274994

  11. Electronic medical records and cost efficiency in hospital medical-surgical units.

    PubMed

    Furukawa, Michael F; Raghu, T S; Shao, Benjamin B M

    2010-01-01

    This study examines the impact of electronic medical records (EMRs) on cost efficiency in hospital medical-surgical units. Using panel data on California hospitals from 1998 to 2007, we employed stochastic frontier analysis (SFA) to estimate the relationships between EMR implementation and the cost inefficiency of medical-surgical units. We categorized EMR implementation into three stages based on the level of sophistication. We also examined the effects of specific EMR systems on cost inefficiency. Our SFA models addressed potential bias from unobserved heterogeneity and heteroskedasticity. EMR Stages 1 and 2, nursing documentation, electronic medication administration records, and clinical decision support were associated with significantly higher inefficiency. PMID:20812460

  12. Union Memorial Hospital: an insight to the origin of community-based surgical training.

    PubMed

    Gupta, Vinay K; Heitmiller, Richard F

    2008-01-01

    Community-based surgical training centers comprise almost half of the current ACGME-approved programs. Yet the histories of these community hospital programs have not been defined clearly. University programs were founded with the time-honored mission to deliver patient care, teaching, and research. We feel that early community programs developed with close ties to university programs before diverging in their evolution. As successful university faculty expanded their elective surgical practice, they often admitted patients to private hospitals, most in close proximity to their university hospitals. Many surgeons maintained joint appointments on the university and private hospital staffs, whereas others left the university staff to focus their efforts on their clinical practice. The more prominent clinicians continued to attract students interested in apprenticeships in surgery; and community based training programs developed that focused primarily on patient care and teaching. We review the history of our program that we feel illustrates this process. PMID:18439543

  13. 78 FR 74825 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-10

    ...This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2014 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors......

  14. 38 CFR 3.358 - Compensation for disability or death from hospitalization, medical or surgical treatment...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Compensation for disability or death from hospitalization, medical or surgical treatment, examinations or vocational rehabilitation training (§ 3.800). 3.358 Section 3.358 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION...

  15. 78 FR 9940 - Naugatuck Valley Surgical Center, Department of Saint Mary's Hospital, Waterbury, CT: Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF LABOR Employment and Training Administration Naugatuck Valley Surgical Center, Department of Saint Mary's Hospital, Waterbury, CT: Notice of Affirmative Determination, Regarding Application for Reconsideration By application dated January 16, 2013, the State...

  16. Evaluation of parenteral nutritional support in the surgical and medical wards of a referral teaching hospital

    PubMed Central

    2012-01-01

    Background and purpose Malnutrition is a common problem in patients who are hospitalized in surgical and medical wards. Surgical patients, geriatric populations and individuals with severe illness are more vulnerable to malnutrition during their hospitalization course. The purpose of this study was evaluation of parenteral nutrition services in a referral teaching hospital, Tehran, Iran. Method Medical records of 72 patients who received parenteral nutrition during one year period in different surgical and medical wards of Imam Khomeini hospital were reviewed retrospectively by clinical pharmacists. Criteria for initiation of parenteral nutrition, selection of appropriate formulation and monitoring parameters were assessed based on the American Society of Parenteral and Enteral Nutrition recommendations. Results Based on the patients' anthropometric parameters and serum albumin levels, 4.2%, 75% and 20.8% of the patients were well-nourished, moderately malnourished and severely malnourished respectively at the hospital admission and before nutritional support. Adequate calorie, protein, carbohydrate and lipid supports were achieved in 21.1%, 32.4%, 23.7% and 10.5% of the patients respectively. About 91% of the patients experienced at least one complication of the nutritional support. Conclusion In this evaluation, several errors in assessment, establishing goals, and monitoring of parenteral nutrition regimens have been detected. Approximately all of the patients did not receive to the trace elements supports goals. PMID:23351175

  17. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update

    PubMed Central

    Anderson, Deverick J.; Podgorny, Kelly; BerrĂ­os-Torres, Sandra I.; Bratzler, Dale W.; Dellinger, E. Patchen; Greene, Linda; Nyquist, Ann-Christine; Saiman, Lisa; Yokoe, Deborah S.; Maragakis, Lisa L.; Kaye, Keith S.

    2014-01-01

    PURPOSE Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,”1 published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.2 PMID:24799638

  18. Surgical therapies for corneal perforations: 10 years of cases in a tertiary referral hospital

    PubMed Central

    Yokogawa, Hideaki; Kobayashi, Akira; Yamazaki, Natsuko; Masaki, Toshinori; Sugiyama, Kazuhisa

    2014-01-01

    Purpose To report surgical therapies for corneal perforations in a tertiary referral hospital. Methods Thirty-one eyes of 31 patients (aged 62.4±18.3 years) with surgically treated corneal perforations from January 2002 to July 2013 were included in this study. Demographic data such as cause of corneal perforation, surgical procedures, and visual outcomes were retrospectively analyzed. Results The causes of corneal perforation (n=31) were divided into infectious (n=8, 26%) and noninfectious (n=23, 74%) categories. Infectious causes included fungal ulcer, herpetic stromal necrotizing keratitis, and bacterial ulcer. The causes of noninfectious keratopathy included corneal melting after removal of a metal foreign body, severe dry eye, lagophthalmos, canaliculitis, the oral anticancer drug S-1, keratoconus, rheumatoid arthritis, neurotrophic ulcer, atopic keratoconjunctivitis, and unknown causes. Initial surgical procedures included central large corneal graft (n=17), small corneal graft (n=7), and amniotic membrane transplantation (n=7). In two cases the perforation could not be sealed during the first surgical treatment and required subsequent procedures. All infectious keratitis required central large penetrating keratoplasty to obtain anatomical cure. In contrast, several surgical options were used for the treatment of noninfectious keratitis. After surgical treatment, anatomical cure was obtained in all cases. Mean postoperative best corrected visual acuity was better at 6 months (logMAR 1.3) than preoperatively (logMAR 1.8). Conclusion Surgical therapies for corneal perforations in our hospital included central large lamellar/penetrating keratoplasty, small peripheral patch graft, and amniotic membrane transplantation. All treatments were effective. Corneal perforation due to the oral anticancer drug S-1 is newly reported. PMID:25378903

  19. Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study

    PubMed Central

    Assareh, Hassan; Chen, Jack; Ou, Lixin; Hollis, Stephanie J; Hillman, Kenneth; Flabouris, Arthas

    2014-01-01

    Objectives Despite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals. Setting A large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 2002–2009 in New South Wales, Australia. Participants Patients underwent elective surgery within 2?days of admission, aged between 18 and 90?years, and who were not transferred to another acute care facility; 4?362?624 patients were included. Outcome measures VTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR). Results 2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the highest and those with the lowest rates were significant (between-hospital variation). Smaller hospitals, accommodated in two peer groups, had the lowest overall VTE rates (IRR=0.56:0.33 to 0.95; IRR=0.37:0.23 to 0.61) and exhibited a greater increase (64% and 237% vs 19%) overtime and greater between-hospital variations compared to larger hospitals (IRR=8.64:6.23 to 11.98; IRR=8.92:5.49 to 14.49 vs IRR=3.70:3.32 to 4.12). Mortality among patients with postoperative VTE was 8% and remained stable overtime. No differences in post-VTE death rates and trends were seen between hospital groups; however, larger hospitals exhibited less between-hospital variations (IRR=1.78:1.30 to 2.44) compared to small hospitals (IRR>23). Hospitals performed differently in prevention versus treatment of postoperative VTE. Conclusions VTE incidence is increasing and there is large variation between-hospital and within-hospital peer groups suggesting a varied compliance with VTE preventative strategies and the potential for targeted interventions and quality improvement opportunities. PMID:25280806

  20. [Surgical treatment of simple cysts of the kidney in multiphasic hospital].

    PubMed

    Beliakin, S A; Tsarev, M I; Kochetov, A G; Parshin, V V; Dubrovskikh, S A; Kostin, A A; Korol', V D

    2011-07-01

    The presented work is based on an analysis of survey results and surgical treatment of 418 patients with simple renal cysts during the period from 1995 to 2010. The volume of the cysts ranged from one to 2500 ml. The average volume of the operated cysts was 360.2 +/- 306.7 ml. The abilities of the multiphasic hospital, equipping it with the modern diagnostic and medical equipment, the long experience of work enabled the authors to develop the algorithm of inspection and surgical treatment of the patients with simple renal cysts and to develop practical recommendations, presenting them in logical schemes. PMID:21938900

  1. In-Hospital Cost Analysis of Total Hip Arthroplasty: Does Surgical Approach Matter?

    PubMed

    Petis, Stephen M; Howard, James L; Lanting, Brent A; Marsh, Jacquelyn D; Vasarhelyi, Edward M

    2016-01-01

    The purposes of this study were to determine the impact of surgical approach on costs of total hip arthroplasty (THA) from a hospital perspective and to provide an updated cost estimation of THA. A prospective, microcosting analysis was performed on 118 patients undergoing a THA through an anterior, lateral, or posterior approach. We determined that overall costs (intraoperative costs and hospital stay) were significantly less for the anterior ($7300.22; 95% confidence interval [CI], 7064.49-7535.95) vs lateral ($7853.10; 95% CI, 7577.29-8128.91; P = .031) and anterior vs posterior approach ($8287.46; 95% CI, 7906.42-8668.51; P < .001). A reduction in hospital length of stay when THA was performed through an anterior approach contributed significantly to an overall reduction in costs from a hospital perspective. PMID:26387922

  2. Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia.

    PubMed Central

    Bickler, S. W.; Sanno-Duanda, B.

    2000-01-01

    INTRODUCTION: There is a paucity of published data on the type of conditions that require surgery among children in sub-Saharan Africa. Such information is necessary for assessing the impact of such conditions on child health and for setting priorities to improve paediatric surgical care. METHODS: Described in the article is a 29-month prospective study of all children aged < 15 years who were admitted to a government referral hospital in the Gambia from January 1996 to May 1998. RESULTS: A total of 1726 children were admitted with surgical problems. Surgical patients accounted for 11.3% of paediatric admissions and 34,625 total inpatient days. The most common admission diagnoses were injuries (46.9%), congenital anomalies (24.3%), and infections requiring surgery (14.5%). The diagnoses that accounted for the greatest number of inpatient days were burns (18.8%), osteomyelitis (15.4%), fractures (12.7%), soft tissue injuries (3.9%), and head injuries (3.4%). Gambian children were rarely admitted for appendicitis and never admitted for hypertrophic pyloric stenosis. The leading causes of surgical deaths were burns, congenital anomalies, and injuries other than burns. DISCUSSION: Prevention of childhood injuries and better trauma management, especially at the primary and secondary health care levels, should be the priorities for improving paediatric surgical care in sub-Saharan Africa. Surgical care of children should be considered an essential component of child health programmes in developing countries. PMID:11143193

  3. Care interaction adding challenges to old patients’ well-being during surgical hospital treatment

    PubMed Central

    Uhrenfeldt, Lisbeth; Høybye, Mette Terp

    2015-01-01

    Today, hospitals offer surgical treatment within a short hospital admission. This brief interaction may challenge the well-being of old patients. The aim of this study was to explore how the well-being of old hospitalized patients was affected by the interaction with staff during a fast-track surgical treatment and hospital admission for colon cancer. We used an ethnographic methodology with field observations and unstructured interviews focusing on one patient at a time (n=9) during a full day; the hours ranging from 7:45 a.m. to 8 p.m. Participants were between 74 and 85 years of age and of both sexes. The study was reported to the Danish Data Protection Agency with reference number (2007-58-0010). The encounter between old patients and the staff was a main theme in our findings elucidating a number of care challenges. The identified care challenges illustrated “well-being as a matter of different perspectives,” “vulnerability in contrast to well-being,” and “staff mix influencing the care encounter.” The experience of well-being in old cancer patients during hospital admission was absent or challenged when staff did not acknowledge their individual vulnerability and needs. PMID:26499314

  4. Antibiotics Use Patterns for Surgical Prophylaxis Site Infection in Different Surgical Wards of a Teaching Hospital in Ahvaz, Iran

    PubMed Central

    Alavi, Seyed Mohammad; Roozbeh, Fatemeh; Behmanesh, Farzaneh; Alavi, Leila

    2014-01-01

    Background: Despite the effectiveness of prophylactic antimicrobials to prevent surgical site infection the use of antibiotic prophylaxis is often inappropriate. Objectives: The current study aimed to determine the pattern of prophylactic antibiotic use in a teaching hospital affiliated to Jundishapur University of Medical Sciences, Ahvaz, Iran. Patients and Methods: The current descriptive study included 8586 patients who received prophylactic antibiotics before surgery from April 2011 to March 2012, in Razi Hospital affiliated to Jundishapur University of Medical Sciences. Indications for antibiotic use, proper or inappropriate antibiotics, an antibiotic or combination of antibiotics, dosage and length of treatment for each patient based on the infectious disease textbook (Mandel's Principle and practice of infectious diseases) definitions were administrated. Results: Of the total 8586 patients who took antibiotics for preventive purposes, 4815 (56%) required antimicrobial prophylaxis, and 3771 (44%) patients did not. Of the 4815 patients who received prophylaxis, 86.9% received it appropriately, 13.1% received it inappropriately; 8.2% received inappropriate dosage, and 9.5% received antibiotic longer than 24 hours. Conclusions: The current study revealed that 44% of those who received prophylaxis did not need it. In the patients who received antibiotics, the most common mistakes were antibiotic selection followed by prolonged prophylaxis (> 24 hours) and excess dose. PMID:25774270

  5. Study of the cost-savings potential of the Military - Civilian Health Services Partnership Program in the nuclear medicine and radioimmunoassay services at Ireland Army Community Hospital, Fort Knox, Kentucky. Master's thesis, July 1987-July 1988

    SciTech Connect

    Amon, T.M.

    1989-01-01

    Using workload data for Calendar Year 1987, a cost savings analysis was performed on the following three options (involving the Nuclear Medicine Department at Ireland Army Community Hospital); (1) Elimination of Radioimmunoassay Internal Service, (2) Civilian Military Health Service Partnership Program and (3) Fixed price contract for Nuclear Medicine Services. This study revealed the Civilian-Military Health Services Partnership Program would potentially generate the greatest cost savings and recommended that it be implemented in other areas throughout the Army Medical Department.

  6. Is There an Increasing Regionalization of Surgical Repair of Craniosynostosis Procedures Into Teaching Hospitals? Implications of Regionalization.

    PubMed

    Allareddy, Veerasathpurush

    2016-03-01

    Objective The objective of the present study is to examine whether surgical repairs for craniosynostosis have been regionalized to teaching hospitals over the 8-year period from 2003 to 2010. Design Retrospective analysis of hospital discharge database. Setting Nationwide Inpatient Sample for years 2003 to 2010. All patients aged up to 3 years who had a surgical repair for craniosynostosis were selected. Interventions Surgical repair for craniosynostosis. Main Outcome Measures Performance of surgery in a teaching hospital. Results During the study period (years 2003 to 2010), a total of 19,417 patients aged up to 3 years underwent a surgical repair for craniosynostosis. The number of surgical procedures increased during the study period. It ranged from 1628 procedures in year 2003 to 3001 procedures during 2010. Data show that 83.3% of all procedures in 2003 were performed in teaching hospitals; whereas, 97.5% of procedures in 2010 were performed in teaching hospitals. Following adjustment for patient-level factors, year 2010 was associated with increased odds of having the surgical procedures performed in a teaching hospital as opposed to a nonteaching hospital when compared with year 2003 (odds ratio = 10.43, 95% confidence interval, 1.10 to 98.98; P = .04). Conclusions An increasing proportion of surgical repairs of craniosynostosis are performed in teaching hospitals, suggesting there is an increasing concentration of these complex surgical procedures in select centers. As more longitudinal data become available, the relative benefits and drawbacks associated with regionalization of surgical repairs of craniosynostosis should be examined. PMID:26068385

  7. Occurrence of Deep Vein Thrombosis among Hospitalized Non-Surgical Japanese Patients

    PubMed Central

    Hanzawa, Kazuhiko; Ota, Satoshi; Nakamura, Mashio; Sato, Koichi; Ikura, Maiko; Suzuki, Takeo; Kaise, Toshihiko; Nakajima, Hiromu; Ito, Masaaki

    2015-01-01

    Objective: To estimate the frequency of deep vein thrombosis (DVT) among non-surgical inpatients, and to evaluate the D-dimer assay as a screening tool for DVT. Methods: Subjects were non-surgical inpatients aged 20 years or older who had been bedridden for at least 24 hours and had moderate-to-high risk factors for DVT. We assessed the presence of DVT by venous ultrasonography. Patients who received a diagnosis of venous thromboembolism (VTE) before admission, who had symptoms or findings of VTE at admission, or who had surgery or trauma within the past 3 months before admission were excluded. Results: DVT was confirmed in 96 of 525 patients (18.3%). In a logistic regression analysis, longer duration of hospitalization, higher D-dimer value, and history of cancer surgery were significantly associated with the occurrence of DVT. The D-dimer assay showed high sensitivity (96.1%) and high negative predictive value (97.6%). Conclusion: Non-surgical inpatients with a long-term hospitalization or history of cancer surgery have a risk for DVT, and need to be considered for added DVT preventive measures as recommended in the prevention guidelines. In addition, the D-dimer assay is beneficial for the screening of DVT in medical practice. PMID:26421068

  8. Long-term survival of surgically treated hip fracture in an Australian regional hospital.

    PubMed

    McLeod, K; Brodie, M P; Fahey, P P; Gray, R A

    2005-12-01

    This study was undertaken to identify factors influencing outcome in elderly patients operated for hip fracture. In particular, this study examined factors related to mortality at least 30 months post-fracture. Hospital records and death registrations were analysed for 463 patients aged 60 or more years treated for hip fracture at a Queensland regional hospital between 1997 and 2001. The overall mortality for surgically treated patients was 13.7% at 100 days and 24.9% at one year Patient factors including age, gender, health status and place of residence were the predominant influences on mortality. Non-patient and process factors including delay to surgery, type of operation and type of anaesthetic had minimal impact on mortality. No major determinants of length of hospital stay were identified. Patient health status was the main determinant for surgical delay. Our results confirm the persistently high mortality in this group of patients, and suggest that the main determinants of outcome are patient- rather than process-related. PMID:16398380

  9. Minimally Invasive Versus Open Lumbar Fusion: A Comparison of Blood Loss, Surgical Complications, and Hospital Course

    PubMed Central

    Patel, Amar A.; Zfass-Mendez, Matthew; Lebwohl, Nathan H.; Wang, Michael Y.; Green, Barth A.; Levi, Allan D.; Vanni, Steven; Williams, Seth K.

    2015-01-01

    Background Perioperative blood loss is a frequent concern in spine surgery and often necessitates the use of allogeneic transfusion. Minimally invasive technique (MIS) is an option that minimizes surgical trauma and therefore intra-operative bleeding. The purpose of this study is to evaluate the blood loss, surgical complications, and duration of inpatient hospitalization in patients undergoing open posterolateral lumbar fusion (PLF), open posterior lumbar interbody fusion (PLIF) with PLF, or MIS transforaminal lumbar interbody fusion (MIS TLIF). Methods Operative reports and perioperative data of patients undergoing single-level, primary open PLF (n=41), open PLIF/PLF (n=42), and MIS TLIF (n=71) were retrospectively evaluated. Patient demographics, operative blood loss, use of transfusion products, complications, and length of stay were tabulated. Patient data was controlled for age, BMI, and gender for statistical analysis. Results Patients undergoing open PLF and open PLIF/PLF respectively experienced a significantly higher blood loss (p<0.001), higher volume of blood transfusion (p<0.001), higher volume of cell saver transfusion (p<0.001), and more surgical complications (dural injury, wound infections, screw malposition) (p=0.02) than those undergoing MIS TLIF. There was no statistically significant difference in duration of hospital stay (p=0.11). Conclusions MIS TLIF provides interbody fusion with less intraoperative blood loss and subsequently a lower transfusion rate compared to open techniques, but this did not influence length of hospital stay. MIS TLIF is at least as safe as open techniques with respect to dural tear, wound infection, and screw placement. Level of Evidence Level III, Therapeutic PMID:26361455

  10. LED Surgical Task Lighting Scoping Study: A Hospital Energy Alliance Project

    SciTech Connect

    Tuenge, Jason R.

    2011-01-17

    Tungsten-halogen (halogen) lamps have traditionally been used to light surgical tasks in hospitals, even though they are in many respects ill-suited to the application due to the large percentage of radiant energy outside the visible spectrum and issues with color rendering/quality. Light-emitting diode (LED) technology offers potential for adjustable color and improved color rendition/quality, while simultaneously reducing side-effects from non-visible radiant energy. It also has the potential for significant energy savings, although this is a fairly narrow application in the larger commercial building energy use sector. Based on analysis of available products and Hospital Energy Alliance member interest, it is recommended that a product specification and field measurement procedure be developed for implementation in demonstration projects.

  11. Patient, Surgery, and Hospital Related Risk Factors for Surgical Site Infections following Total Hip Arthroplasty

    PubMed Central

    Triantafyllopoulos, Georgios; Memtsoudis, Stavros; Poultsides, Lazaros A.

    2015-01-01

    Surgical site infections (SSI) following total hip arthroplasty (THA) have a significantly adverse impact on patient outcomes and pose a great challenge to the treating surgeon. Therefore, timely recognition of those patients at risk for this complication is very important, as it allows for adopting measures to reduce this risk. This review discusses literature reported risk factors for SSI after THA. These can be classified into patient-related factors (age, gender, obesity, comorbidities, history of infection, primary diagnosis, and socioeconomic profile), surgery-related factors (allogeneic blood transfusion, DVT prophylaxis and coagulopathy, duration of surgery, antibiotic prophylaxis, bearing surface and fixation, bilateral procedures, NNIS index score, and anesthesia type), and hospital-related factors (duration of hospitalization, institution and surgeon volume, and admission from a healthcare facility). All these factors are discussed with respect to potential measures that can be taken to reduce their effect and consequently the overall risk for infection. PMID:26075298

  12. Wills Eye Hospital and surgical network: successful pre-positioning strategies for payment reduction and managed care pressures.

    PubMed

    Kessler, D M

    2001-01-01

    Through strategic clinical diversification, political activism, and bold expansion, Wills Eye Hospital, a teaching specialty surgical hospital, survives ravages of sudden onslaughts of managed care payment reductions while maintaining autonomy. Slack inpatient resources were re-utilized to create unique programs attractive to regional managed care organizations. Advocacy and lobbying for short-term favorable treatment from Medicare bought the Hospital valuable time and positioning. Building out a regional network of ambulatory surgical centers assures the growth and access to market required for Wills to maintain its autonomy in a managed care contracting environment. PMID:11372488

  13. Analysis of wounds incurred by U.S. Army Seventh Corps personnel treated in Corps hospitals during Operation Desert Storm, February 20 to March 10, 1991.

    PubMed

    Carey, M E

    1996-03-01

    One hundred and forty-three soldiers who received ballistic injury were actively treated at U.S. Army Seventh Corps hospitals during Operation Desert Storm. Ninety-five percent were wounded by fragments, 5% by bullets. Many had wounds of several body parts, including 17.3% who received a head wound; 4.3% a neck wound; 5.8% a chest wound; 9.3% an abdominal wound; and 90% who had extremity wounds. Three hospital deaths occurred--a 2.1% mortality rate. Only two soldiers sustained a brain wound; in both, the missile entered below the skull area protected by the Kevlar helmet. One brainwounded individual was treated and lived; the other died from hemorrhage and shock from concomitant traumatic lower-extremity amputations. The current U.S. helmet appears to provide significant protection from fragmenting ordnance as does the armored vest. Hemorrhage from proximal extremity wounds caused hospital deaths. Treatment of such wounds will have to be improved to reduce future combat mortality. PMID:8606402

  14. Antibiotic Susceptibility Pattern of Aerobic and Anaerobic Bacteria Isolated From Surgical Site Infection of Hospitalized Patients

    PubMed Central

    Akhi, Mohammad Taghi; Ghotaslou, Reza; Beheshtirouy, Samad; Asgharzadeh, Mohammad; Pirzadeh, Tahereh; Asghari, Babak; Alizadeh, Naser; Toloue Ostadgavahi, Ali; Sorayaei Somesaraei, Vida; Memar, Mohammad Yousef

    2015-01-01

    Background: Surgical Site Infections (SSIs) are infections of incision or deep tissue at operation sites. These infections prolong hospitalization, delay wound healing, and increase the overall cost and morbidity. Objectives: This study aimed to investigate anaerobic and aerobic bacteria prevalence in surgical site infections and determinate antibiotic susceptibility pattern in these isolates. Materials and Methods: One hundred SSIs specimens were obtained by needle aspiration from purulent material in depth of infected site. These specimens were cultured and incubated in both aerobic and anaerobic condition. For detection of antibiotic susceptibility pattern in aerobic and anaerobic bacteria, we used disk diffusion, agar dilution, and E-test methods. Results: A total of 194 bacterial strains were isolated from 100 samples of surgical sites. Predominant aerobic and facultative anaerobic bacteria isolated from these specimens were the members of Enterobacteriaceae family (66, 34.03%) followed by Pseudomonas aeruginosa (26, 13.4%), Staphylococcus aureus (24, 12.37%), Acinetobacter spp. (18, 9.28%), Enterococcus spp. (16, 8.24%), coagulase negative Staphylococcus spp. (14, 7.22%) and nonhemolytic streptococci (2, 1.03%). Bacteroides fragilis (26, 13.4%), and Clostridium perfringens (2, 1.03%) were isolated as anaerobic bacteria. The most resistant bacteria among anaerobic isolates were B. fragilis. All Gram-positive isolates were susceptible to vancomycin and linezolid while most of Enterobacteriaceae showed sensitivity to imipenem. Conclusions: Most SSIs specimens were polymicrobial and predominant anaerobic isolate was B. fragilis. Isolated aerobic and anaerobic strains showed high level of resistance to antibiotics. PMID:26421133

  15. Screening of Diabetic Foot in Surgical Inpatients: A Hospital-Based Study in Saudi Arabia

    PubMed Central

    Elsharawy, Mohamed A.; Hassan, Khairi; AlAwad, Naif; Kredees, Ali; Almulhim, Abdelmohsen

    2012-01-01

    Previous reports found that identification of diabetic patients at high risk of foot ulcers, and managing the risk factors early, lower extremity amputations could be prevented. The aim of this study is to determine the value of screening diabetics in estimating the risk of foot ulceration among surgical inpatients. This is a prospective study on all diabetic patients admitted to the surgical department, King Fahd Hospital of the University, Saudi Arabia, during the year 2011. Patients were screened for the presence of diabetic foot. They were classified according to the international working group on the diabetic foot into four grades [0 (lowest risk patients), 1, 2, 3 (highest risk patients)]. During the study period, 391 patients had diabetes mellitus (DM), of these 73 (19%) had active ulcer and were excluded from the study and the rest were screened. Grade 0 was in 174 (54.5%) patients, the rest were grades 1, 2, and 3. There was significant difference between low-risk groups (grades 0, 1) and high-risk groups (grades 2, 3) as regards age, smoking and duration of DM. This study indicates that prevalence of diabetic patients with risk of foot ulceration in surgical inpatients was high. Routine screening of diabetic foot is recommended specially in old patients. PMID:24293979

  16. Community teaching hospital surgical experience with adult intussusception: Study of nine cases and literature review

    PubMed Central

    El-Sergany, Amr; Darwish, Alex; Mehta, Pratik; Mahmoud, Ahmed

    2015-01-01

    Introduction Although more commonly thought of as a surgical problem affecting children, surgeons evaluating the adult acute abdomen should remain vigilante in diagnosing intussusception. In this case series, we reviewed 6 years of medical records at a community teaching hospital in order to analyze the etiology, presentation, and management of nine cases of adult intussusception. Presentation of cases Most of the patients in our series shared symptoms of nausea, vomiting, and abdominal pain. Computed tomography scan was crucial in distinguishing adult intussusception from other causes of acute abdomen. Eight patients underwent operative exploration, five of whom underwent bowel resection. One patient’s symptoms resolved with no surgical intervention. All nine patients had excellent outcomes. Discussion Although detailed history and physical examination are essential in all cases of acute abdomen, CT scan findings of “target” signs are pathognomonic of intussusception. Laparoscopy should be strongly considered in select cases. Current literature suggests that reduction may be performed before resection if the lesion meets certain stringent parameters. The primary concern with regards to reduction before resection is potential embolization of malignant cells. Colonic intussusception is almost always treated with resection without reduction, while small intestinal intussusception could be treated by reduction before resection, if the small bowel lead points are less likely to be malignant. Conclusion Intussusception is a rare but serious etiology of the acute abdomen in adults. Each case should be evaluated independently according to the specific type of lead-point lesion. Excellent outcomes may be anticipated with prompt diagnosis and surgical treatment. PMID:25989258

  17. Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis.

    PubMed

    Dasenbrock, Hormuzdiyar H; Liu, Kevin X; Devine, Christopher A; Chavakula, Vamsidhar; Smith, Timothy R; Gormley, William B; Dunn, Ian F

    2015-12-01

    OBJECT Although the length of hospital stay is often used as a measure of quality of care, data evaluating the predictors of extended hospital stay after craniotomy for tumor are limited. The goals of this study were to use multivariate regression to examine which preoperative characteristics and postoperative complications predict a prolonged hospital stay and to assess the impact of length of stay on unplanned hospital readmission. METHODS Data were extracted from the National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2013. Patients who underwent craniotomy for resection of a brain tumor were included. Stratification was based on length of hospital stay, which was dichotomized by the upper quartile of the interquartile range (IQR) for the entire population. Covariates included patient age, sex, race, tumor histology, comorbidities, American Society of Anesthesiologists (ASA) class, functional status, preoperative laboratory values, preoperative neurological deficits, operative time, and postoperative complications. Multivariate logistic regression with forward prediction was used to evaluate independent predictors of extended hospitalization. Thereafter, hierarchical multivariate logistic regression assessed the impact of length of stay on unplanned readmission. RESULTS The study included 11,510 patients. The median hospital stay was 4 days (IQR 3-8 days), and 27.7% (n = 3185) had a hospital stay of at least 8 days. Independent predictors of extended hospital stay included age greater than 70 years (OR 1.53, 95% CI 1.28%-1.83%, p < 0.001); African American (OR 1.75, 95% CI 1.44%-2.14%, p < 0.001) and Hispanic (OR 1.68, 95% CI 1.36%-2.08%) race or ethnicity; ASA class 3 (OR 1.52, 95% CI 1.34%-1.73%) or 4-5 (OR 2.18, 95% CI 1.82%-2.62%) designation; partially (OR 1.94, 95% CI 1.61%-2.35%) or totally dependent (OR 3.30, 95% CI 1.95%-5.55%) functional status; insulin-dependent diabetes mellitus (OR 1.46, 95% CI 1.16%-1.84%); hematological comorbidities (OR 1.68, 95% CI 1.25%-2.24%); and preoperative hypoalbuminemia (OR 1.78, 95% CI 1.51%-2.09%, all p ? 0.009). Several postoperative complications were additional independent predictors of prolonged hospitalization including pulmonary emboli (OR 13.75, 95% CI 4.73%-39.99%), pneumonia (OR 5.40, 95% CI 2.89%-10.07%), and urinary tract infections (OR 11.87, 95% CI 7.09%-19.87%, all p < 0.001). The C-statistic of the model based on preoperative characteristics was 0.79, which increased to 0.83 after the addition of postoperative complications. A length of stay after craniotomy for tumor score was created based on preoperative factors significant in regression models, with a moderate correlation with length of stay (p = 0.43, p < 0.001). Extended hospital stay was not associated with differential odds of an unplanned hospital readmission (OR 0.97, 95% CI 0.89%-1.06%, p = 0.55). CONCLUSIONS In this NSQIP analysis that evaluated patients who underwent craniotomy for tumor, much of the variance in hospital stay was attributable to baseline patient characteristics, suggesting length of stay may be an imperfect proxy for quality. Additionally, longer hospitalizations were not found to be associated with differential rates of unplanned readmission. PMID:26621410

  18. Compliance with Surgical Care Improvement Project Measures and Hospital-Associated Infections Following Hip Arthroplasty

    PubMed Central

    Wang, Zhong; Chen, Foster; Ward, Michael; Bhattacharyya, Timothy

    2012-01-01

    Background: Hospital compliance with the Surgical Care Improvement Project (SCIP) measures has increased recently for patients undergoing hip arthroplasty. However, reductions in postoperative infections were less than expected, and concern remains about complications associated with prophylaxis against venous thromboembolism (VTE). We sought to examine the association between hospital adherence to SCIP measures and postoperative infections. Methods: We conducted an observational study of 17,714 patients who underwent hip replacement in 2008 at 128 New York state hospitals. These hospitals were divided into less compliant and highly compliant groups, on the basis of their levels of compliance compared with the median value of compliance with SCIP measures. From the New York State Department of Health annual report, we collected the confirmed postoperative infections at the facility level. From the Healthcare Cost and Utilization Project state inpatient database, we identified incidences of postoperative infections at the patient level, using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Results: During 2008, mean hospital compliance increased from 93.5% to 96.0% for the infection prevention measure and from 91.4% to 97.5% for the VTE prevention measure. Higher adherence to infection prevention measures was not associated with a significant reduction in infection (p ≥ 0.09 for all). Hospitals that were at least 97% compliant with the SCIP VTE-2 measure (patients receiving VTE prophylaxis around the time of surgery) reported significantly higher infection rates compared with less compliant hospitals (1.60% versus 0.93%; p < 0.001). Similarly, patients from highly compliant hospitals (for the VTE-2 measure) were at significant risk of postoperative infection (adjusted odds ratio, 1.50; 95% confidence interval, 1.07 to 2.12; p = 0.02). Conclusions: Targeting complete compliance with SCIP infection prevention measures was not associated with additional reductions in infection outcomes following hip replacement. Furthermore, significant risk of postoperative infections may result from increased perioperative use of VTE prophylactics. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. PMID:22740029

  19. Incidence of adverse events in an integrated US healthcare system: a retrospective observational study of 82,784 surgical hospitalizations

    PubMed Central

    2014-01-01

    Background Many health care facilities have developed electronic reporting systems for identifying and reporting adverse events (AEs), so that measures can be taken to improve patient safety. Although several studies have examined AEs in surgical settings, there has not previously been a systematic assessment of the variations in adverse event rates among different types of surgery, nor an identification of the particular types of AEs that are most common within each surgical category. Additionally, this study will identify the AE severity level associated with each of the AE category types. Methods This retrospective observational study was conducted at three Midwestern hospitals that are part of a large integrated healthcare system. Data from 2006 through 2009 were analyzed to determine the rates of reported adverse events (per 1,000 hospitalizations involving a surgical procedure) for 96 categories of surgery as classified according to the ICD-9-CM procedural coding system. Univariate and bivariate summary statistics were compiled for AEs by type, severity, and patient age. Results During the four-year study period, there was a total of 82,784 distinct hospitalizations involving at least one surgical procedure at these three hospitals. At least one adverse event was reported at 5,368 (6.5%) of those hospitalizations. The mean rate of AEs among all surgical procedure groups was 82.8 AEs per 1,000 hospitalizations. Adverse event rates varied widely among surgical categories with a high of 556.7 AEs per 1,000 hospitalizations for operations on the heart and pericardium. The most common type of adverse event involved care management, followed by medication events and events related to invasive procedures. Conclusions Detecting variations in AEs among surgical categories can be useful for surgeons and for hospital quality assurance personnel. Documenting the specific AE incidence rates among the most common types of surgical categories, and determining AE severity and age distributions within surgical categories will enable officials to better identify specific patient safety needs and develop appropriately targeted interventions for improvement. PMID:24932219

  20. Army occupational health and AEJA (Army Environmental Hygiene Agency)

    SciTech Connect

    Kneessy, A.D.

    1981-05-01

    The Army Environmental Hygiene Agency (AEHA) recently celebrated 38 years of continuous service in support of occupational health programs of the Army. This report briefly reviews its historical development, examine some of its current occupational and industrial hygiene programs, and touches on future program efforts. The Army Industrial Hygiene Laboratory, conducts surveys and investigations concerning occupational health hazards in Army-owned and operated industrial plants, arsenals and depots, and privately owned and operated ordnance explosive establishments. The end of World War II was the beginning of the nuclear age and attendant Medical Department responsibilities for radiation protection programs beyond the traditional concern for x-ray protection. The US Army has undertaken the demilitarization of obsolete and excess chemical munitions. The Medical Systems Safety and Health Branch is tasked to survey Army hospitals within the United States, to identify and recommend corrective action for safety and health hazards. At present, a continuing study is underway to evaluate the waste anesthetic gases to operating room personnel in Army hospitals. Noise-induced hearing loss is considered the most widespread occupational injury incurred by DA personnel.

  1. Study of patient satisfaction in a surgical unit of a tertiary care teaching hospital

    PubMed Central

    Mishra, P.H.; Gupta, Shakti

    2012-01-01

    Background The hospitals have evolved from being an isolated sanatorium to a place with five star facilities. Patients and their relatives coming to the hospital not only expect world-class treatment, but also other facilities to make their stay comfortable in the hospital. This change in expectation has come due to tremendous growth of media and its exposure, as well as commercialization and improvement in facilities. The aim of this study was to evaluate the level of patient/relatives satisfaction at tertiary care teaching hospital and feedback from them for improvement of the same. Methods The study was conducted by 1. Review of available national and international literature on the subject. 2. Carrying out survey amongst 50 patients and their relatives at one of the surgical unit by using structured questionnaire. 3. By analyzing the data using appropriate statistical methods. Results Eighty two percent people were satisfied with the service at admission counter while 81% were satisfied with room preparation at the time of admission. The nursing services satisfied 80% of people while 92% were satisfied with explanation about disease and treatment by doctor. The behavior of nurses, doctors and orderlies satisfied 92, 92 and 83% of people. The cleanliness of toilets satisfied only 49% while diet services satisfied 78% of people. Conclusion The five major satisfiers were behavior of doctors, explanation about disease and treatment, courtesy of staff at admission counter, behavior and cooperation of nurses. The five major dissatisfiers were cleanliness of toilets, quality of food, explanation about rules and regulation, behavior of orderlies and sanitary attendant and room preparedness. PMID:25983455

  2. Open Conservative Surgical Management of Cystic Echinococcosis in a Tertiary Care Hospital, Nepal

    PubMed Central

    Batajoo, Hemant; Ghimire, Samikshya; Sathian, Brijesh

    2015-01-01

    Background: Cystic echinococcosis (CE) or hydatid disease caused by E. granulosus in Nepal is amenable to surgical treatment. Aim: Aim of the study is to evaluate the efficacy of surgical treatment of CE, by open partial pericystectomy with albendazole as adjuvant. Materials and Methods: Material of this prospective study were the consecutive series of 33 patients operated for CE, over a period of 8 years, at a single centre. Clinical examination, ultrasonography (USG) and computed tomography (CT) were used for establishing diagnosis. Patients were prescribed perioperative albendazole. Povidone iodine 10% (betadine)was used as contact scolicidal agent during operation. Cysts were evacuated from livers, lungs, retroperitoneum by partial pericystectomy. CE of mesentery was completely excised. Descriptive statistics was obtained using EPI- info windows version soft ware. Results: A total of 33 patients were operated for CE; 24 were females and 9 males. Age ranged from 4 years to 80 years. Organs/ site involved were: liver – 24, lungs – 4, combined liver and lungs – 2, retroperitoneum - 2 and mesentery – 1. Complication – bile leak for 2 weeks in an operated CE of liver. There was no mortality. Hospital stay (in days) was – mean 14 (range 7to21). Follow up for 3 years (average 2years) showed no recurrence. Conclusion: Evacuation of CE by partial pericystectomy is an effective, safe and simple procedure, and gives excellent cure rate with perioperative albendazole therapy. PMID:26393161

  3. The experience of the intensive care unit in a British Army field hospital during the 2003 Gulf conflict.

    PubMed

    Roberts, M J; Fox, M A; Hamilton-Davies, C; Dowson, S

    2003-12-01

    Over the last few years the Surgeon General's Department has overseen a major update in equipment scales for medical units in the field; anaesthesia and intensive care. This is to meet the aspiration of the Defence Chiefs, that injured servicemen on active service should receive the same standard of care as available in the United Kingdom. This paper discusses the experiences of the Intensive Care Unit operating within a Field Hospital both during the initial war fighting phase and subsequent peace keeping phase of the 2003 Gulf conflict (OP TELIC). Observations are made on patient activity, treatment strategy, and equipment adequacy. PMID:15015801

  4. Factors Affecting Length of Hospital Stay and Mortality in Infected Diabetic Foot Ulcers Undergoing Surgical Drainage without Major Amputation

    PubMed Central

    2016-01-01

    This study aimed to investigate factors affecting length of hospital stay and mortality of a specific group of patients with infected diabetic foot ulcer who underwent surgical drainage without major amputation, which is frequently encountered by orthopedic surgeons. Data on length of hospital stay, mortality, demographics, and other medical information were collected for 79 consecutive patients (60 men, 19 women; mean age, 66.1 [SD, 12.3] yr) with infected diabetic foot ulcer who underwent surgical drainage while retaining the heel between October 2003 and May 2013. Multiple linear regression analysis was performed to determine factors affecting length of hospital stay, while multiple Cox regression analysis was conducted to assess factors contributing to mortality. Erythrocyte sedimentation rate (ESR, P=0.034), glycated hemoglobin (HbA1c) level (P=0.021), body mass index (BMI, P=0.001), and major vascular disease (cerebrovascular accident or coronary artery disease, P=0.004) were significant factors affecting length of hospital stay, whereas age (P=0.005) and serum blood urea nitrogen (BUN) level (P=0.024) were significant factors contributing to mortality. In conclusion, as prognostic factors, the length of hospital stay was affected by the severity of inflammation, the recent control of blood glucose level, BMI, and major vascular disease, whereas patient mortality was affected by age and renal function in patients with infected diabetic foot ulcer undergoing surgical drainage and antibiotic treatment. PMID:26770047

  5. Factors Affecting Length of Hospital Stay and Mortality in Infected Diabetic Foot Ulcers Undergoing Surgical Drainage without Major Amputation.

    PubMed

    Kim, Tae Gyun; Moon, Sang Young; Park, Moon Seok; Kwon, Soon-Sun; Jung, Ki Jin; Lee, Taeseung; Kim, Baek Kyu; Yoon, Chan; Lee, Kyoung Min

    2016-01-01

    This study aimed to investigate factors affecting length of hospital stay and mortality of a specific group of patients with infected diabetic foot ulcer who underwent surgical drainage without major amputation, which is frequently encountered by orthopedic surgeons. Data on length of hospital stay, mortality, demographics, and other medical information were collected for 79 consecutive patients (60 men, 19 women; mean age, 66.1 [SD, 12.3] yr) with infected diabetic foot ulcer who underwent surgical drainage while retaining the heel between October 2003 and May 2013. Multiple linear regression analysis was performed to determine factors affecting length of hospital stay, while multiple Cox regression analysis was conducted to assess factors contributing to mortality. Erythrocyte sedimentation rate (ESR, P=0.034), glycated hemoglobin (HbA1c) level (P=0.021), body mass index (BMI, P=0.001), and major vascular disease (cerebrovascular accident or coronary artery disease, P=0.004) were significant factors affecting length of hospital stay, whereas age (P=0.005) and serum blood urea nitrogen (BUN) level (P=0.024) were significant factors contributing to mortality. In conclusion, as prognostic factors, the length of hospital stay was affected by the severity of inflammation, the recent control of blood glucose level, BMI, and major vascular disease, whereas patient mortality was affected by age and renal function in patients with infected diabetic foot ulcer undergoing surgical drainage and antibiotic treatment. PMID:26770047

  6. Surgical emergencies in Ireland. An audit of the emergency surgical caseload of an Irish district general hospital.

    PubMed

    Davies, M G; Shine, M F; Lennon, F

    1991-10-01

    Emergency cases are an increasing part of the workload of a general surgical unit. Little accurate quantitative data is presently available on the nature and impact of this workload on a typical district general surgical service. This study reports the results of a prospective one year audit of the emergency cases dealt with by a typical Irish district general surgical service. The general surgical service admitted 2,278 patients acutely, which represented 58% of the total number of admissions to the service. Eighteen patients required immediate transfer for specialist neurosurgical (11), vascular (6) or plastics (1) treatment. Of those cases admitted 1,396 (61.3%) were males and 882 (38.7%) were females. There were 1,786 (78%) adults and 492 (21.6%) paediatric cases. Abdominal pain (48.0%), head injury (23.8%) and urological problems (11.0%) accounted for the majority of the caseload. Within the abdominal pain group, the pre-dominant diagnoses were non-specific abdominal pain (36.0%), appendicitis (19.5%), cholecystitis/obstructive jaundice (10.8%) and peptic ulcer disease (10.0%). There were 456 emergency operations performed, representing 19.5% of all the inpatient general surgical procedures. 328 (72%) of these were performed out of normal working hours. Only 12% of the procedures were major. The commonest operations were appendicectomy (51%), abscess drainage (13%), wound toilet (13%) and laparotomy (11%). The emergency peri-operative mortality was 1.1%. The positive appendicectomy rate was 92%. PMID:1810893

  7. Outcome of pyometra in female dogs and predictors of peritonitis and prolonged postoperative hospitalization in surgically treated cases

    PubMed Central

    2014-01-01

    Background One of the most common diseases in intact bitches is pyometra– a potentially life-threatening disease associated with a variety of clinical and laboratory findings. The aims of the present study were to describe complications of the disease and to investigate clinically useful indicators associated with peritonitis and/or prolonged postoperative hospitalization. Results A retrospective study was performed using records from 356 bitches diagnosed with pyometra during the years 2006–2007 at the University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden. Of the 356 bitches, 315 were surgically treated by ovariohysterectomy, 9 were medically treated and 32 were euthanized without treatment. In the surgically treated bitches, univariable associations between clinical and laboratory data, risk for prolonged hospitalization (? 3 days) and/or signs of peritonitis, were analyzed by Chi-square and Fisher’s exact test. Logistic regression models were used to assess multivariable associations. The most common complication observed in surgically treated bitches was peritonitis (40 bitches), followed by urinary tract infection (19 bitches), wound infection (8 bitches), uveitis (6 bitches), and cardiac arrhythmia (5 bitches). Leucopenia and fever/hypothermia were associated with increased risk for peritonitis (18-fold and three-fold, respectively). Moderate to severe depression of the general condition, pale mucous membranes and leucopenia were associated with increased risk (seven-fold, three-fold, and over three-point-five-fold, respectively) for prolonged postoperative hospitalization. Conclusions Several clinically useful indicators were identified. Leucopenia was the most important marker, associated with 18-fold increased risk for peritonitis and an over three-point-five increased risk for prolonged hospitalization. Fever/hypothermia, depression and pale mucous membranes were associated with increased risk for peritonitis and/or prolonged hospitalization. The results of the present study may be valuable for identifying peritonitis and predicting increased morbidity in surgically treated bitches with pyometra. PMID:24393406

  8. Implementation of the WHO Surgical Safety Checklist in an Ethiopian Referral Hospital

    PubMed Central

    2014-01-01

    Background The WHO Surgical Safety Checklist has a growing evidence base to support its role in improving perioperative safety, although its impact is likely to be directly related to the effectiveness of its implementation. There remains a paucity of documented experience from low-resource settings on Checklist implementation approaches. We report an implementation strategy in a public referral hospital in Addis Ababa, Ethiopia, based on consultation, local leadership, formal introduction, and supported supervision with subsequent audit and feedback. Methods Planning, implementation and assessment took place from December 2011 to December 2012. The planning phase, from December 2011 until April 2012, involved a multidisciplinary consultative approach using local leaders, volunteer clinicians, and staff from non-governmental organisations, to draw up a locally agreed and appropriate Checklist. Implementation in April 2012 involved formal teaching and discussion, simulation sessions and role play, with supportive supervision following implementation. Assessment was performed using completed Checklist analysis and staff satisfaction questionnaires at one month and further Checklist analysis combined with semi-structured interviews in December 2012. Results and discussion Checklist compliance rates were 83% for general anaesthetics at one month after implementation, with an overall compliance rate of 65% at eight months. There was a decrease in Checklist compliance over the period of the study to less than 20% by the end of the study period. The ‘Sign out’ section was reported as being the most difficult section of the Checklist to complete, and was missed completely in 21% of cases. The most commonly missed single item was the team introduction at the start of each case. However, we report high staff satisfaction with the Checklist and enthusiasm for its continued use. Conclusion We report a detailed implementation strategy for introducing the WHO Surgical Safety Checklist to a low-resource setting. We show that this approach can lead to high completion rates and high staff satisfaction, albeit with a drop in completion rates over time. We argue that maximal benefit of the Surgical Safety Checklist is likely to be when it engenders a conversation around patient safety within a department, and when there is local ownership of this process. PMID:24678854

  9. Uppsala University Hospital 300 years—a survey of the surgical development

    PubMed Central

    2009-01-01

    Professor Lars Roberg, the initiator of the Nosocomium Academicum (1708), our first university hospital in Sweden, claimed that ‘no-one who does not understand surgery is a completely trained doctor’. However, it was not until the end of 19th century that modern surgery was born. The Academic Hospital was opened in 1867, and at the turn of that century Uppsala had a flourishing period under the influence of Karl Gustav Lennander, professor of surgery. In 1889 he performed the first appendectomy in Scandinavia. At the end of the 19th century the surgical tree began to branch out. In Uppsala gynaecology and obstetrics was the first to be an independent speciality (1891). It was followed by ophthalmology (1894) with Allvar Gullstrand as professor and head of the department. Gullstrand received the Nobel Prize in medicine in 1911. A separate department for diseases of the ear, nose, and throat was founded in 1916 with the Nobel laureate Robert Bárány as head. Thoracic surgery began in Uppsala in the 1940s with lung surgery and was separated from general surgery in 1958 with Viking Olov Björk as head of the department. Björk introduced open heart surgery in Uppsala. In 1951 reconstructive plastic surgery was organized by Tord Skoog, who devoted special interest to operations for cleft lip and palate surgery. Neurosurgery was established in 1962, and Uppsala has held a prominent position in the development of modern neurointensive care. During the 1970s general surgery became subspecialized into gastrointestinal, endocrine, and vascular surgery. At the same time fracture surgery was transferred to the orthopaedists, and urological surgery became an independent speciality. Transplantation surgery was introduced in Uppsala in 1967, when Professor Lars Thorén performed the first kidney transplantation. Today Uppsala has a leading position in transplantation of pancreatic islets cells. PMID:19242867

  10. Uppsala University Hospital 300 years--a survey of the surgical development.

    PubMed

    Johansson, Henry

    2009-01-01

    Professor Lars Roberg, the initiator of the Nosocomium Academicum (1708), our first university hospital in Sweden, claimed that 'no-one who does not understand surgery is a completely trained doctor'. However, it was not until the end of 19th century that modern surgery was born. The Academic Hospital was opened in 1867, and at the turn of that century Uppsala had a flourishing period under the influence of Karl Gustav Lennander, professor of surgery. In 1889 he performed the first appendectomy in Scandinavia. At the end of the 19th century the surgical tree began to branch out. In Uppsala gynaecology and obstetrics was the first to be an independent speciality (1891). It was followed by ophthalmology (1894) with Allvar Gullstrand as professor and head of the department. Gullstrand received the Nobel Prize in medicine in 1911. A separate department for diseases of the ear, nose, and throat was founded in 1916 with the Nobel laureate Robert Bárány as head. Thoracic surgery began in Uppsala in the 1940s with lung surgery and was separated from general surgery in 1958 with Viking Olov Björk as head of the department. Björk introduced open heart surgery in Uppsala. In 1951 reconstructive plastic surgery was organized by Tord Skoog, who devoted special interest to operations for cleft lip and palate surgery. Neurosurgery was established in 1962, and Uppsala has held a prominent position in the development of modern neurointensive care. During the 1970s general surgery became subspecialized into gastrointestinal, endocrine, and vascular surgery. At the same time fracture surgery was transferred to the orthopaedists, and urological surgery became an independent speciality. Transplantation surgery was introduced in Uppsala in 1967, when Professor Lars Thorén performed the first kidney transplantation. Today Uppsala has a leading position in transplantation of pancreatic islets cells. PMID:19242867

  11. Implementation of the WHO Surgical Safety Checklist and surgical swab and instrument counts at a regional referral hospital in Uganda - a quality improvement project.

    PubMed

    Lilaonitkul, M; Kwikiriza, A; Ttendo, S; Kiwanuka, J; Munyarungero, E; Walker, I A; Rooney, K D

    2015-12-01

    The World Health Organization (WHO) Surgical Safety Checklist is a cost-effective tool that has been shown to improve patient safety. We explored the applicability and effectiveness of quality improvement methodology to implement the WHO checklist and surgical counts at Mbarara Regional Referral Hospital in Uganda between October 2012 and September 2013. Compliance rates were evaluated prospectively and monthly structured feedback sessions were held. Checklist and surgical count compliance rates increased from a baseline median (IQR [range]) of 29.5% (0-63.5 [0-67.0]) to 85.0% (82.8-87.5 [79.0-93.0]) and from 25.5% (0-52.5 [0-60.0]) to 83.0% (80.8-85.5 [69.0-89.0]), respectively. The mean all-or-none completion rate of the checklist was 69.3% (SD 7.7, 95% CI [64.8-73.9]). Use of the checklist was associated with performance of surgical counts (p value < 0.001; r(2) = 0.91). Pareto analysis showed that understaffing, malfunctioning and lack of equipment were the main challenges. A carefully designed quality improvement project, including stepwise incremental change and standardisation of practice, can be an effective way of improving clinical practice in low-income settings. PMID:26558855

  12. [Mortality of neonatal surgical emergencies at the Gynecology-Obstetric and Pediatric hospital of Yaounde, Cameroon].

    PubMed

    Mouafo Tambo, F F; Chiabi, A; Ngowe Ngowe, M; Ze Minkande, J; Andze, O G; Sosso, M A

    2011-04-01

    From July 2005 to November 2009, 38 neonates with surgical emergencies died in the neonatal unit of the Gyneco Obstetric and Pediatric Hospital Yaounde. The mortality rate of these emergencies was 43.1%, and those within the age group of 1 to 7 days were the most affected with a sex ratio of 1.2. The mean delay before consultation was 3.7 days. Half of the neonates had a birth weight of less than 2,500 g and 7 cases (18.4%) were premature. A medicalised ambulance was used for transfer to our unit in only half of the neonates. The main disorders were those affecting the digestive tract in 42.1% of our series. In 50% of our cases, there were associated malformations and 28 cases (73.7%) did not undergo surgery. Malnutrition and infection were the main complications in 60% of the cases. The authors discuss this deplorable situation and suggest recommendations for improvement. PMID:21695891

  13. Dietary inflammatory index as a potential determinant of a length of hospitalization among surgical patients treated for colorectal cancer

    PubMed Central

    Galas, A; Kulig, P; Kulig, J

    2014-01-01

    Background/objectives: Inflammation is a central process responsible for health outcomes among surgical patients. Immunonutrition has been investigated as a promising modifying factor; however, inflammatory properties of habitual diet have not yet been investigated. The purpose of this study was to describe inflammatory properties of diet measured by the dietary inflammatory index (DII) among surgical patients treated for colorectal cancer and to link inflammatory properties of habitual diet with a duration of hospitalization. Subjects/methods: A follow-up study among colorectal cancer patients treated surgically was performed in Krakow, Poland. In total, 689 patients were recruited for the study. Habitual diet was assessed using a standardized semiquantitative food frequency questionnaire. Overall, 23 dietary items (including macro-and micronutrients) were used to calculate individuals' DII. Gender, age, marital status, body mass index, smoking status, lifetime physical activity, taking vitamin supplements, number of chronic diseases, cancer site, Duke's staging and surgery type were considered as potential covariates. Results: Participants were aged 58 years, with the average hospitalization time of 11 days. Higher DII (meaning diet with higher anti-inflammatory properties) was negatively associated with the duration of hospitalization (univariable linear regression: b=?0.59; P=0.005). Multivariable logistic regression has shown the decrease of the risk of longer stays (>7 days) among patients with the DII >?4.25, but only among younger (?60 years) patients, irrespective of Duke's staging. Conclusions: The DII might be used as a potential predictor of longer hospitalization among colorectal cancer patients treated surgically. The study provides evidence for the role of dietary-related low-grade inflammation among surgical patients. PMID:25005677

  14. The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy

    PubMed Central

    Sivarajan, Ganesh; Taksler, Glen B.; Walter, Dawn; Gross, Cary P.; Sosa, Raul E.; Makarov, Danil V.

    2015-01-01

    Introduction The rapid diffusion of the surgical robot has been controversial because of the technology’s high costs and its disputed marginal benefit. Some, however, have suggested that adoption of the robot may have improved care for patients with renal malignancy by facilitating partial nephrectomy, an underutilized, technically challenging procedure believed to be less morbid than radical nephrectomy. We sought to determine whether institutional acquisition of the robot was associated with increased utilization of partial nephrectomy. Methods We used all payer data from 7 states to identify 21,569 nephrectomies. These patient-level records were aggregated to the hospital-level then merged with the American Hospital Association Annual Survey and publicly available data on timing of robot acquisition. We used a multivariable difference-in-difference model to assess at the hospital-level whether robot acquisition was associated with an increase in the proportion of partial nephrectomy, adjusting for hospital nephrectomy volume, year of surgery, and several additional hospital-level factors. Results In the multivariable-adjusted differences-in-differences model, hospitals acquiring a robot between 2001 and 2004 performed a greater proportion of partial nephrectomy in both 2005 (29.9% increase) and 2008 (34.9% increase). Hospitals acquiring a robot between 2005 and 2008 also demonstrated a greater proportion of partial nephrectomy in 2008 (15.5% increase). In addition, hospital nephrectomy volume and urban location were also significantly associated with increased proportion of partial nephrectomy. Conclusions Hospital acquisition of the surgical robot is associated with greater proportion of partial nephrectomy, an underutilized, guideline-encouraged procedure. This is one of the few studies to suggest robot acquisition is associated with improvement in quality of patient care. PMID:25494234

  15. Pharmaceutical services in the United States Army.

    PubMed

    Williams, R F; Moran, E L; Bottaro, S D; Dydek, G J; Caouette, M L; Thomas, J D; Echevarria, R

    1997-04-01

    The status of pharmaceutical services in the United States Army is described. The Army Medical Department (AMEDD) has 157 commissioned pharmacy officers and 399 civilian pharmacists working in the United States and overseas. Pharmaceutical services are provided from fixed medical treatment facilities on Army installations and, during war and other field operations, field hospitals. Reductions in personnel and facility closures have helped align the AMEDD with the size of the Army's activeduty force, but there has been only a 15% reduction in the number of eligible beneficiaries. Measures such as the interservice TRICARE program have been implemented to help meet the continued high demand for pharmaceutical services cost-effectively. Army pharmacy is similar to civilian pharmacy, except that Army hospitals often include high-volume outpatient pharmacies not usually found in civilian institutions. Pharmacists are being given direct patient care roles on multidisciplinary teams. Army pharmacists participate in field exercises so that they will be prepared to provide services under combat conditions. The AMEDD trains its own pharmacy technicians in a highly structured 18-week course. A triservice Pharmacoeconomic Center (PEC) has been established with the goal of providing prescribers with the tools for making cost-effective decisions about drug therapy, including a formulary. Army pharmacy officers have broad opportunities to further their education and training. In preparing for the next century, Army pharmacists need to continue to prove their value to the AMEDD, the Army, and the Department of Defense. PMID:9099343

  16. An Early Warning Score Predicts Risk of Death after In-hospital Cardiopulmonary Arrest in Surgical Patients.

    PubMed

    Stark, Alexander P; Maciel, Robert C; Sheppard, William; Sacks, Greg; Hines, O Joe

    2015-10-01

    In-hospital cardiopulmonary arrest can contribute significantly to publicly reported mortality rates. Systems to improve mortality are being implemented across all specialties. A review was conducted for all surgical patients >18 years of age who experienced a "Code Blue" event between January 1, 2013 and March 9, 2014 at a university hospital. A previously validated Modified Early Warning Score (MEWS) using routine vital signs and neurologic status was calculated at regular intervals preceding the event. In 62 patients, the most common causes of arrest included respiratory failure, arrhythmia, sepsis, hemorrhage, and airway obstruction, but remained unknown in 27 per cent of cases. A total of 56.5 per cent of patients died before hospital discharge. In-hospital death was associated with American Society of Anesthesiologists status (P = 0.039) and acute versus elective admission (P = 0.003). Increasing MEWS on admission, 24 hours before the event, the event-day, and a maximum MEWS score on the day of the event increased the odds of death. Max MEWS remained associated with death after multivariate analysis (odds ratio 1.39, P = 0.025). Simple and easy to implement warning scores such as MEWS can identify surgical patients at risk of death after arrest. Such recognition may provide an opportunity for clinical intervention resulting in improved patient outcomes and hospital mortality rates. PMID:26463280

  17. Quality of surgical care in hospitals providing internship training in Kenya: a cross sectional survey.

    PubMed Central

    Mwinga, Stephen; Kulohoma, Colette; Mwaniki, Paul; Idowu, Rachel; Masasabi, John; English, Mike

    2015-01-01

    Objective To evaluate services in hospitals providing internship training to graduate doctors in Kenya. Methods A survey of 22 internship training hospitals was conducted. Availability of key resources spanning infrastructure, personnel, equipment and drugs was assessed by observation. Outcomes and process of care for pre-specified priority conditions (head injury, chest injury, fractures, burns and acute abdomen) were evaluated by auditing case records. Results Each hospital had at least one consultant surgeon. Scheduled surgical outpatient clinics, major ward rounds and elective (half day) theatre lists were provided once per week in 91%, 55% and 9%, respectively. In all other hospitals, these were conducted twice weekly. Basic drugs were not always available (e.g. gentamicin, morphine and pethidine in 50%, injectable antistaphylococcal penicillins in 5% hospitals). Fewer than half of hospitals had all resources needed to provide oxygen. One hundred and forty-five of 956 cases evaluated underwent operations under general or spinal anaesthesia. We found operation notes for 99% and anaesthetic records for 72%. Pre-operatively measured vital signs were recorded in 80% of cases, and evidence of consent to operation was found in 78%. Blood loss was documented in only one case and sponge and instrument counts in 7%. Conclusions Evaluation of surgical services would be improved by development and dissemination of clear standards of care. This survey suggests that internship hospitals may be poorly equipped and documented care suggests inadequacies in quality and training. Objectif Evaluer les services dans les hôpitaux offrant des stages de formation à des médecins diplômés au Kenya. Méthodes Enquête auprès de 22 hôpitaux offrant des stages de formation. La disponibilité des ressources clés incluant infrastructure, personnel, matériel et médicaments a été évaluée par observation. Les résultats et processus de soins pour des affections prioritaires prédéfinies (blessure à la tête, blessure à la poitrine, fractures, brûlures et maux d'estomac aigus) ont été évalués par l'audit des dossiers des cas. Résultats Chaque hôpital avait au moins un chirurgien consultant. Les cliniques chirurgicales ambulatoires planifiées, les principales tournées dans les chambres d'hospitalisation et des listes d'opérations choisies (demi-journée) ont été fournies une fois par semaine dans 91%, 55% et 9% des cas respectivement. Dans tous les autres hôpitaux, cela a été effectué deux fois par semaine. Les médicaments de base n’étaient pas toujours disponibles (par ex. la gentamicine, la morphine et la péthidine dans 50% des hôpitaux, les pénicillines anti-staphylococciques injectables dans 5%). Moins de la moitié des hôpitaux disposaient de toutes les ressources nécessaires pour fournir de l'oxygène. 145 sur 956 cas évalués ont subi des opérations sous anesthésie générale ou rachidienne. Nous avons retrouvé des notes d'opération pour 99% des cas et des dossiers d'anesthésie pour 72%. Les mesures préopératoires des signes vitaux ont été enregistrées dans 80% des cas et la preuve du consentement pour l'opération a été trouvée dans 78% des cas. La perte de sang a été documentée dans un seul cas et le comptage des éponges et instruments dans 7% des cas. Conclusions L’évaluation des services de chirurgie serait améliorée par le développement et la dissémination de normes de soins claires. Cette étude suggère que les hôpitaux offrant des stages peuvent être mal équipés et les soins enregistrés suggèrent des insuffisances dans la qualité et la formation. Objetivo Evaluar los servicios en hospitales que proveen entrenamiento a médicos graduados en Kenia. Métodos Estudio en 22 hospitales universitarios con entrenamiento de médicos residentes. Se evaluó mediante observación la disponibilidad de recursos claves, incluyendo infraestructura, personal, equipamiento y medicamentos. Se evaluaron los resultados y procesos de cuidados para condiciones prioritarias especificadas previamente (traumatismo craneoencefálico, lesión torácica, fracturas, quemaduras y abdomen agudo) mediante la auditoría de historias clínicas. Resultados Cada hospital tenía al menos un cirujano consultor. Se entregaban una vez por semana las listas de intervenciones quirúrgicas programadas en clínicas ambulatorias, en las rondas de visitas a las principales salas y las cirugías electivas (medio día) en 91%, 55% y 9% de los hospitales, respectivamente. En los demás hospitales se llevaban a cabo dos veces por semana. Los medicamentos básicos no estaban siempre disponibles (ej. gentamicina, morfina y meperidina en 50%, penicilina anti-estafilocócica inyectable 5% de los hospitales). Menos de la mitad de los hospitales tenían todos los recursos necesarios para proveer oxígeno. En 145 de 956 casos evaluados se llevó a cabo la cirugía con anestesia general o intradural. Encontramos apuntes quirúrgicos para un 99% y registros de la anestesia para el 72%. Se tenían registros de los signos vitales pre-quirúrgicos en un 80% de los casos y evidencia del consentimiento del paciente a ser intervenido en un 78%. Se documentaba pérdida de sangre solo en un caso y conteo de esponjas e instrumental en un 7%. Conclusiones La evaluación de los servicios quirúrgicos podría mejorarse mediante el desarrollo y la diseminación de estándares de cuidados precisos. Este estudio sugiere que los hospitales universitarios podrían estar mal equipados y los cuidados documentados sugieren que existen deficiencias tanto a nivel calidad como en el entrenamiento. PMID:25348925

  18. Variation in hospital resource use and cost among surgical procedures using topical absorbable hemostats

    PubMed Central

    Martyn, Derek; Meckley, Lisa M; Miyasato, Gavin; Lim, Sangtaeck; Riebman, Jerome B; Kocharian, Richard; Scaife, Jillian G; Rao, Yajing; Corral, Mitra

    2015-01-01

    Background Adjunctive hemostats are used to assist with the control of intraoperative bleeding. The most common types are flowables, gelatins, thrombins, and oxidized regenerated celluloses (ORCs). In the US, Surgicel® products are the only US Food and Drug Administration-approved ORCs. Objective To compare the outcomes of health care resource utilization (HRU) and costs associated with using ORCs compared to other adjunctive hemostats (OAHs are defined as flowables, gelatins, and topical thrombins) for surgical procedures in the US inpatient setting. Patients and methods A retrospective, US-based cohort study was conducted using hospital inpatient discharges from the 2011–2012 calendar years in the Premier Healthcare Database. Patients with either an ORC or an OAH who underwent a cardiovascular procedure (valve surgery and/or coronary artery bypass graft surgery), carotid endarterectomy, cholecystectomy, or hysterectomy were included. Propensity score matching was used to create comparable groups of ORC and OAH patients. Clinical, economic, and HRU outcomes were compared. Results The propensity score matching created balanced patient cohorts for cardiovascular procedure (22,718 patients), carotid endarterectomy (10,890 patients), cholecystectomy (6,090 patients), and hysterectomy (9,348 patients). In all procedures, hemostatic agent costs were 28%–56% lower for ORCs, and mean hemostat units per discharge were 16%–41% lower for ORCs compared to OAHs. Length of stay and total procedure costs for patients treated with ORCs were lower for carotid endarterectomy patients (0.3 days and US$700) and for cholecystectomy patients (1 day and US$3,350) (all P<0.001). Conclusion Costs and HRU for patients treated with ORCs were lower than or similar to patients treated with OAHs. Proper selection of the appropriate hemostatic agents has the potential to influence clinical outcomes and treatment costs. PMID:26604807

  19. Radiation Therapy After Breast-Conserving Surgery: Does Hospital Surgical Volume Matter? A Population-Based Study in Taiwan

    SciTech Connect

    Chien, Chun-Ru; Pan, I-Wen; Tsai, Yi-Wen; Tsai, Teressa; Liang, Ji-An; Buchholz, Thomas A.; Shih, Ya-Chen Tina

    2012-01-01

    Purpose: To examine the association between hospital surgical volume and the use of radiation therapy (RT) after breast-conserving surgery (BCS) in Taiwan. Methods and Materials: We used claims data from the National Health Insurance program in Taiwan (1997-2005) in this retrospective population-based study. We identified patients with breast cancer, receipt of BCS, use of radiation, and the factors that could potentially associated with the use of RT from enrollment records, and the ICD-9 and billing codes in claims. We conducted logistic regression to examine factors associated with RT use after BCS, and performed subgroup analyses to examine whether the association differs by medical center status or hospital volumes. Results: Among 5,094 patients with newly diagnosed invasive breast cancer who underwent BCS, the rate of RT was significantly lower in low-volume hospitals (74% vs. 82%, p < 0.01). Patients treated in low-volume hospitals were less likely to receive RT after BCS (odds ratio = 0.72, 95% confidence interval = 0.62-0.83). In addition, patients treated after the implementation of the voluntary pay-for-performance policy in 2001 were more likely to receive RT (odds ratio = 1.23; 95% confidence interval = 1.05-1.45). Subgroup analyses indicated that the high-volume effect was limited to hospitals accredited as non-medical centers, and that the effect of the pay-for-performance policy was most pronounced among low-volume hospitals. Conclusions: Using population-based data from Taiwan, our study concluded that hospital surgical volume and pay-for-performance policy are positively associated with RT use after BCS.

  20. Common isolation of New Delhi metallo-beta-lactamase 1-producing Enterobacteriaceae in a large surgical hospital in Vietnam.

    PubMed

    Tran, H H; Ehsani, S; Shibayama, K; Matsui, M; Suzuki, S; Nguyen, M B; Tran, D N; Tran, V P; Tran, D L; Nguyen, H T; Dang, D A; Trinh, H S; Nguyen, T H; Wertheim, H F L

    2015-06-01

    This study sought to monitor the presence of carbapenem-resistant Enterobacteriaceae (CRE) and the proportion New Delhi metallo-beta-lactamase 1 (NDM-1)-producing bacteria between August 2010 and December 2012 in a surgical hospital in Vietnam. We identified 47 CRE strains from a total of 4,096 Enterobacteriaceae isolates (1.1 %) that were NDM-1-positive from 45 patients admitted to 11 different departments, with the majority being from the urology department. The NDM-1 gene was found in seven different species. Genotyping revealed limited clonality of NDM-1-positive isolates. Most of the isolates carried the NDM-1 gene on a plasmid and 17.8 % (8/45) of those were readily transferable. We found five patients at admission and one patient at discharge with NDM-1-positive bacteria in their stool. From 200 screening environmental hospital samples, five were confirmed to be NDM-1-positive and included Acinetobacter species (n?=?3) and Enterobacter aerogenes (n?=?2). The results reveal that NDM-1-producing Enterobacteriaceae are commonly isolated in patients admitted to a Vietnamese surgical hospital and are also detected in the hospital environment. PMID:25732142

  1. Mobile emergency (surgical) hospital: Development and application in medical relief of "4.20" Lushan earthquake in Sichuan Province, China.

    PubMed

    Cheng, Bin; Shi, Ruo-Fei; Du, Ding-Yuan; Hu, Ping; Feng, Jun; Huang, Guang-Bin; Cai, An-Ning; Yin, Wei; Yang, Rong-Gang

    2015-01-01

    In the 21st century, natural disasters and emergencies occur frequently worldwide, which leads to the loss of hundreds of thousands of lives as well as the direct and indirect economic losses. China has a vast territory frequently struck by natural disasters. However, the reality is not optimistic. Poor organization and management during the rescue actions, the lack of large-scale, systematic medical rescue equipment were all great barriers to the outcomes. Mobile hospitals are expected to provide better health care. We were inspired by the concept of mobile hospital. Chongqing Emergency Medical Center, has set up trauma care system since 1988, in which prehospital care, intensive care, and in-hospital treatment is fully integrated. As a major advantage, such a system provided assurance of "golden hour" rescue treatment. Providing mobile intensive care and prehospital surgical service for severe trauma patients could reduce mortality significantly. Based on the civilian experiences in Chongqing Emergency Medical Center, the mobile emergency (surgical) hospital was developed. PMID:26169086

  2. A Retrospective Case Series of Surgical Implant Generation Network (SIGN) Placement at the Afghan National Police Hospital, Kabul, Afghanistan.

    PubMed

    Ertl, Christian W; Royal, David; Arzoiey, Humayoon Abdul; Shefa, Azizullah; Sultani, Salim; Mosafa, Mohammed Omar; Sadat, Safiullah; Zirkle, Lewis

    2016-01-01

    In Afghanistan, adequate and cost-effective medical care for even routine conditions is lacking; especially for complex injuries like long-bone fractures. The Surgical Implant Generation Network (SIGN) intramedullary nail is used for treatment of long-bone fractures from blunt injuries and does not require imaging. We are reporting for the first time results of the SIGN intramedullary nail at the Afghan National Police Hospital, a tertiary care facility in Kabul. 71 records from the SIGN Online Surgical Database were reviewed for gender, age, date of injury, implant date, patient's home of record, and type/ mechanism of injury. Mean age was 26.7 years, all but one being male; time from injury to implant ranged 1 to 401 days, with mean of 40.6 days. Long-bone fractures from motor vehicle accidents remained constant, and war injuries peaked in summer. Follow-up is limited because of security and financial burdens of travel. However, personal communication with Afghan National Police Hospital surgeons suggests that patients included in the current study have not experienced any adverse outcomes. While it remains to be seen if the SIGN Online Surgical Database will facilitate more comprehensive outcome studies, our results provide support for the efficacy of SIGN nails in treating long-bone fractures from war injuries. PMID:26741473

  3. [Hysterectomies at the Conakry university hospitals: social, demographic, and clinical characteristics, types, indications, surgical approaches, and prognosis].

    PubMed

    Baldé, I S; Sy, T; Diallo, B S; Diallo, Y; Mamy, M N; Diallo, M H; Bah, E M; Diallo, T S; Keita, N

    2014-01-01

    The objectives of this study were to calculate the frequency of hysterectomies at the Conakry university hospitals (Donka Hospital and Ignace Deen Hospital), describe the women's social, demographic, and clinical characteristics, and identify the key indications, the surgical techniques used, and the prognosis. This was a 2-year descriptive study, retrospective for the first year (May 2011-April 2012) and prospective for the second (May 2012-April 2013), of 333 consecutive hysterectomies performed in the obstetrics and gynecology departments of these two hospitals. Hysterectomy is one of the surgical procedures most commonly performed in these departments (following cesarean deliveries), with frequency of 4.4% interventions. The profile of the women undergoing this surgery was that of a woman aged younger than 49 years (61%), married (75.7%), multiparous (33%), of childbearing age (61%), and with no history of abdominal or pelvic surgery (79.6%). Nearly all hysterectomies were total (95%, compared with 5% subtotal; the approach was abdominal in 82.25% of procedures and vaginal in 17.75%. The most common indication for surgery was uterine fibroids (39.6%), followed by genital prolapse (22.2%), and obstetric emergencies (17.8%). The average duration of surgery was 96 minutes for abdominal and 55 minutes for vaginal hysterectomies. The principal intraoperative complication was hemorrhage (12.31%), and the main postoperative complication parietal suppuration (21.02%). The average length of hospital stay was 10.3 days for abdominal hysterectomies and 7.15 days for vaginal procedures. We recorded 14 deaths for a lethality rate of 4.2%; most of these deaths were associated with hemorrhagic shock during or after an obstetric hysterectomy (93%). Hysterectomy remains a common intervention in developing countries. Its indications are common during the pregnancy and postpartum period, with high morbidity and mortality rates. Improving obstetric coverage could reduce its indications. PMID:24922591

  4. Microbial Contamination on Used Surgical Masks among Hospital Personnel and Microbial Air Quality in their Working Wards: A Hospital in Bangkok

    PubMed Central

    Luksamijarulkul, Pipat; Aiempradit, Natkitta; Vatanasomboon, Pisit

    2014-01-01

    Objective To assess the relationship of bacterial and fungal contamination on used surgical masks worn by the hospital personnel and microbial air quality in their working wards. Methods This is a cross-sectional study of 230 used surgical masks collected from 214 hospital personnel, and 215 indoor air samples collected from their working wards to culture for bacterial and fungal counts. This study was carried out at the hospital in Bangkok. Group or genus of isolated bacteria and fungi were preliminarily identified by Gram’s stain and lacto-phenol cotton blue. Data were analyzed using paired t-test and Pearson’s correlation coefficient at the significant level of p<0.050. Results Means and standard deviation of bacterial and fungal contamination on inside area of the used masks were 47 ± 56 and 15 ± 9 cfu/ml/piece, and on outside area were 166 ± 199 and 34 ± 18 cfu/ml/piece, respectively, p<0.001. The bacterial and fungal contamination on used masks from hospital personnel working in the male and female medical wards and out-patient department, as well as the bacterial and fungal counts of the indoor air sample collected from the same area were relatively higher than the other wards. The predominant isolated bacteria and fungi contaminated on inside and outside areas of the used masks and air samples were similar (Staphylococcus spp. and Aspergillus spp.; respectively). For its relationship, results found that bacterial and fungal counts in air samples showed significantly positive correlation with the bacterial contamination load on outside area of the used masks, r=0.16, p=0.018 and r=0.21, p=0.003, respectively. Conclusion High bacterial contamination on outside area of the used masks was demonstrated, and it showed a significant correlation with microbial air quality of working wards. PMID:25337311

  5. 38 CFR 3.358 - Compensation for disability or death from hospitalization, medical or surgical treatment...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... injury will be the condition which the specific medical or surgical treatment was designed to relieve. (2... or if its use is implicit in the performance of some task or operation the trainee must learn...

  6. Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients

    PubMed Central

    2011-01-01

    Background Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts. Methods A retrospective analysis was conducted using Premier's Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery) during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions) was examined, and hospital costs and length of stay (LOS) were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary least squares (OLS) regression, adjusting for demographics, hospital characteristics, and other baseline characteristics. Models using generalized estimating equations (GEE) were also used to measure the impact of bleeding-related complications on costs while accounting for the effects related to the clustering of patients receiving care from the same hospitals. Results A total of 103,829 cardiac, 216,199 vascular, 142,562 non-cardiac thoracic, 45,687 solid organ, 362,512 general, 384,132 reproductive organ, 246,815 knee/hip replacement, and 107,187 spinal surgeries were identified. Overall, the rate of bleeding-related complications was 29.9% and ranged from 7.5% to 47.4% for reproductive organ and cardiac, respectively. Overall, incremental LOS associated with bleeding-related complications or transfusions (unadjusted for covariates) was 6.0 days and ranged from 1.3 to 9.6 days for knee/hip replacement and non-cardiac thoracic, respectively. The incremental cost per hospitalization associated with bleeding-related complications and adjusted for covariates was highest for spinal surgery ($17,279) followed by vascular ($15,123), solid organ ($13,210), non-cardiac thoracic ($13,473), cardiac ($10,279), general ($4,354), knee/hip replacement ($3,005), and reproductive organ ($2,805). Conclusions This study characterizes the increased hospital LOS and cost associated with bleeding-related complications and/or transfusions occurring as a consequence of surgery, and supports implementation of blood-conservation strategies. PMID:21627788

  7. Quantifying the Diversity and Similarity of Surgical Procedures Among Hospitals and Anesthesia Providers.

    PubMed

    Dexter, Franklin; Ledolter, Johannes; Hindman, Bradley J

    2016-01-01

    In this Statistical Grand Rounds, we review methods for the analysis of the diversity of procedures among hospitals, the activities among anesthesia providers, etc. We apply multiple methods and consider their relative reliability and usefulness for perioperative applications, including calculations of SEs. We also review methods for comparing the similarity of procedures among hospitals, activities among anesthesia providers, etc. We again apply multiple methods and consider their relative reliability and usefulness for perioperative applications. The applications include strategic analyses (e.g., hospital marketing) and human resource analytics (e.g., comparisons among providers). Measures of diversity of procedures and activities (e.g., Herfindahl and Gini-Simpson index) are used for quantification of each facility (hospital) or anesthesia provider, one at a time. Diversity can be thought of as a summary measure. Thus, if the diversity of procedures for 48 hospitals is studied, the diversity (and its SE) is being calculated for each hospital. Likewise, the effective numbers of common procedures at each hospital can be calculated (e.g., by using the exponential of the Shannon index). Measures of similarity are pairwise assessments. Thus, if quantifying the similarity of procedures among cases with a break or handoff versus cases without a break or handoff, a similarity index represents a correlation coefficient. There are several different measures of similarity, and we compare their features and applicability for perioperative data. We rely extensively on sensitivity analyses to interpret observed values of the similarity index. PMID:26678472

  8. What Does a Hospital Survey on Patient Safety Reveal About Patient Safety Culture of Surgical Units Compared With That of Other Units?

    PubMed

    Shu, Qin; Cai, Miao; Tao, Hong-Bing; Cheng, Zhao-Hui; Chen, Jing; Hu, Yin-Huan; Li, Gang

    2015-07-01

    The objective of this study was to examine the strengths and weaknesses of surgical units as compared with other units, and to provide an opportunity to improve patient safety culture in surgical settings by suggesting targeted actions using Hospital Survey on Patient Safety Culture (HSOPSC) investigation.A Hospital Survey on Patient Safety questionnaire was conducted to physicians and nurses in a tertiary hospital in Shandong China. 12 patient safety culture dimensions and 2 outcome variables were measured.A total of 23.5% of respondents came from surgical units, and 76.5% worked in other units. The "overall perceptions of safety" (48.1% vs 40.4%, P?surgical units were higher than those of other units. However, the communication openness (38.7% vs 42.5%, P?surgical units was lower than in other units. Medical workers in surgical units reported more events than those in other units, and more respondents in the surgical units assess "patient safety grade" to be good/excellent. Three dimensions were considered as strengths, whereas 5 other dimensions were considered to be weaknesses in surgical units. Six dimensions have potential to aid in improving events reporting and patient safety grade. Appropriate working times will also contribute to ensuring patient safety. Medical staff with longer years of experience reported more events.Surgical units outperform the nonsurgical ones in overall perception of safety and the number of events reported but underperform in the openness of communication. Four strategies, namely deepening the understanding about patient safety of supervisors, narrowing the communication gap within and across clinical units, recruiting more workers, and employing the event reporting system and building a nonpunitive culture, are recommended to improve patient safety in surgical units in the context of 1 hospital. PMID:26166083

  9. What Does a Hospital Survey on Patient Safety Reveal About Patient Safety Culture of Surgical Units Compared With That of Other Units?

    PubMed Central

    Shu, Qin; Cai, Miao; Tao, Hong-bing; Cheng, Zhao-hui; Chen, Jing; Hu, Yin-huan; Li, Gang

    2015-01-01

    Abstract The objective of this study was to examine the strengths and weaknesses of surgical units as compared with other units, and to provide an opportunity to improve patient safety culture in surgical settings by suggesting targeted actions using Hospital Survey on Patient Safety Culture (HSOPSC) investigation. A Hospital Survey on Patient Safety questionnaire was conducted to physicians and nurses in a tertiary hospital in Shandong China. 12 patient safety culture dimensions and 2 outcome variables were measured. A total of 23.5% of respondents came from surgical units, and 76.5% worked in other units. The “overall perceptions of safety” (48.1% vs 40.4%, P < 0.001) and “frequency of events reported” (63.7% vs 60.7%, P = 0.001) of surgical units were higher than those of other units. However, the communication openness (38.7% vs 42.5%, P < 0.001) of surgical units was lower than in other units. Medical workers in surgical units reported more events than those in other units, and more respondents in the surgical units assess “patient safety grade” to be good/excellent. Three dimensions were considered as strengths, whereas 5 other dimensions were considered to be weaknesses in surgical units. Six dimensions have potential to aid in improving events reporting and patient safety grade. Appropriate working times will also contribute to ensuring patient safety. Medical staff with longer years of experience reported more events. Surgical units outperform the nonsurgical ones in overall perception of safety and the number of events reported but underperform in the openness of communication. Four strategies, namely deepening the understanding about patient safety of supervisors, narrowing the communication gap within and across clinical units, recruiting more workers, and employing the event reporting system and building a nonpunitive culture, are recommended to improve patient safety in surgical units in the context of 1 hospital. PMID:26166083

  10. 77 FR 68209 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... inpatient admission was not medically necessary. In the CY 2013 OPPS/ASC proposed rule (77 FR 45155 through... Hospitals and CAHs through 2013, exactly as finalized for 2012. We recently issued a final rule (77 FR...

  11. Efficacy of Parenteral Nutrition Supplemented With Glutamine Dipeptide to Decrease Hospital Infections in Critically Ill Surgical Patients

    PubMed Central

    Estívariz, Concepción F.; Griffith, Daniel P.; Luo, Menghua; Szeszycki, Elaina E.; Bazargan, Niloofar; Dave, Nisha; Daignault, Nicole M.; Bergman, Glen F.; McNally, Therese; Battey, Cindy H.; Furr, Celeste E.; Hao, Li; Ramsay, James G.; Accardi, Carolyn R.; Cotsonis, George A.; Jones, Dean P.; Galloway, John R.; Ziegler, Thomas R.

    2011-01-01

    Background Nosocomial infections are an important cause of morbidity and mortality in the surgical intensive care unit (SICU). Clinical benefits of glutamine-supplemented parenteral nutrition may occur in hospitalized surgical patients, but efficacy data in different surgical subgroups are lacking. The objective was to determine whether glutamine-supplemented parenteral nutrition differentially affects nosocomial infection rates in selected subgroups of SICU patients. Methods This was a double-blind, randomized, controlled study of alanyl-glutamine dipeptide-supplemented parenteral nutrition in SICU patients requiring parenteral nutrition and SICU care after surgery for pancreatic necrosis, cardiac, vascular, or colonic surgery. Subjects (n = 59) received isocaloric/isonitrogenous parenteral nutrition, providing 1.5 g/kg/d standard glutamine-free amino acids (STD-PN) or 1.0 g/kg/d standard amino acids + 0.5 g/kg/d glutamine dipeptide (GLN-PN). Enteral feedings were advanced as tolerated. Nosocomial infections were determined until hospital discharge. Results Baseline clinical/metabolic data were similar between groups. Plasma glutamine concentrations were low in all groups and were increased by GLN-PN. GLN-PN did not alter infection rates after pancreatic necrosis surgery (17 STD-PN and 15 GLN-PN patients). In nonpancreatic surgery patients (12 STD-PN and 15 GLN-PN), GLN-PN was associated with significantly decreased total nosocomial infections (STD-PN 36 vs GLN-PN 13, P < .030), bloodstream infections (7 vs 0, P < .01), pneumonias (16 vs 6, P < .05), and infections attributed to Staphylococcus aureus (P < .01), fungi, and enteric Gram-negative bacteria (each P < .05). Conclusions Glutamine dipeptide-supplemented parenteral nutrition did not alter infection rates following pancreatic necrosis surgery but significantly decreased infections in SICU patients after cardiac, vascular, and colonic surgery. PMID:18596310

  12. The effect of hospital infection control policy on the prevalence of surgical site infection in a tertiary hospital in South-South Nigeria

    PubMed Central

    Brisibe, Seiyefa Fun-Akpa; Ordinioha, Best; Gbeneolol, Precious K.

    2015-01-01

    Background: Surgical site infections (SSIs) are a significant cause of morbidity, emotional stress and financial cost to the affected patients and health care institutions; and infection control policy has been shown to reduce the burden of SSIs in several health care institutions. This study assessed the effects of the implementation of the policy on the prevalence of SSI in the University of Port Harcourt Teaching Hospital, Nigeria. Patients and Methods: A review of the records of all Caesarean sections carried out in the hospital, before and 2 years after the implementation of the infection control policy was conducted. Data collected include the number and characteristics of the patients that had Caesarean section in the hospital during the period and those that developed SSI while on admission. Results: The proportion of patients with SSI decreased from 13.33% to 10.34%, 2 years after the implementation of the policy (P-value = 0.18). The implementation of the policy did not also result in any statistically significant change in the nature of the wound infection (P-value = 0.230), in the schedule of the operations (P-value = 0.93) and in the other predisposing factors of the infections (P-value = 0.72); except for the significant decrease in the infection rate among the un-booked patients (P-value = 0.032). Conclusion: The implementation of the policy led to a small decrease in SSI, due to the non-implementation of some important aspects of the WHO policy. The introduction of surveillance activities, continuous practice reinforcing communications and environmental sanitation are recommended to further decrease the prevalence of SSI in the hospital. PMID:26229228

  13. Surgical treatment of acute infective endocarditis at Tartu University Hospital 1984-1993.

    PubMed

    Kuiv, H; Saar, T; Ress, M

    1996-01-01

    Acute infective endocarditis was surgically treated in 42 patients (36 male, 6 female), aged 6-66 (mean 43.9) years. The causal microorganism was identified in 26 cases (61.9%) and the portal of entry in 12. The main indication for surgery was cardiac failure. In 23 cases (54.7%) only the aortic valve was affected. The mean NYHA function class was 3.35 preoperatively and 1.85 postoperatively. All typical surgical findings were preoperatively recognized at echocardiography. Twenty-six ball-type and 16 tilting disk valves were inserted. The early mortality was 4.7% (2 cases), due to low cardiac output and bleeding. High early postoperative morbidity (23%), possibly resulted from too long interval from onset of disease to surgery, viz. 1-18 (mean 6.3) months. It is concluded that timely operation for acute infective endocarditis is effective. PMID:8857680

  14. Orthopaedic surgical treatment delays at a tertiary hospital in sub Saharan Africa: Communication gaps and implications for clinical outcomes

    PubMed Central

    Ifesanya, Adeleke O.; Ogundele, Olumuyiwa J.; Ifesanya, Joy U.

    2013-01-01

    Background: Delay in surgical treatment is a source of distress to patients and an important reason for poor outcome. We studied the delay before carrying out scheduled operative orthopaedic procedures and the factors responsible for it. Materials and Methods: This prospective study was carried out between March 2011 and December 2012. Temporal details of the surgical procedures at our hospital were recorded in a proforma including the patients’ perception of the causes of the delay to surgery. Based on the urgency of the need for surgery, patients were classified into three groups using a modification of the method employed by Lankester et al. Data was analyzed using the Statistical Package for the Social Sciences, version 17.0. Predictors of surgical delay beyond 3 days were identified by logistic regression analysis. Results: Two hundred and forty-nine patients with a mean age 36.2 ± 19.2 years and M:F ratio 1.3 were recruited. 34.1% were modified Lankester group A, 45.4% group B and 20.5% group C. 47 patients (18.9%) had comorbidities, hypertension being the commonest (22 patients; 8.8%). Median delay to surgery was 4 days (mean = 17.6 days). Fifty percent of emergency room admissions were operated on within 3 days, the figure was 13% for other admissions. Lack of theatre slot was the commonest cause of delay. There was full concordance between doctors and patients in only 70.7% regarding the causes of the delay. In 15.7%, there was complete discordance. Logistic regression analysis confirmed modified Lankester groups B and C (P = 0.003) and weekend admission (P = 0.016) as significant predictors of delay to surgery of >3 days. Conclusion: Promptness to operative surgical care falls short of the ideal. Theatre inefficiency is a major cause of delay in treating surgical patients in our environment. Theatre facilities should be expanded and made more efficient. There is a need for better communication between surgeons and patients about delays in surgical treatment. PMID:24665159

  15. 77 FR 217 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-04

    ..., Hospital Value-Based Purchasing (VBP) Program Issues. SUPPLEMENTARY INFORMATION: I. Background In FR Doc. 2011-28612 of November 30, 2011 (76 FR 74122), (hereinafter referred to as the CY 2012 OPPS/ASC final... they had been included in the CY 2012 OPPS/ASC final rule with comment period (76 FR 74122)...

  16. 78 FR 54842 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-06

    ... 2014 Changes for the Hospital Outpatient Prospective Payments System (78 FR 43692) and the correlating preamble language (78 FR 43689). As noted previously, because the OPPS is a budget neutral system, and... within the system. The corrections to this impact table (78 FR 43692) relative to the impact...

  17. Surgical Audit of Patients with Ileal Perforations Requiring Ileostomy in a Tertiary Care Hospital in India

    PubMed Central

    Verma, Hemkant; Pandey, Siddharth; Sheoran, Kapil Dev; Marwah, Sanjay

    2015-01-01

    Introduction. Ileal perforation peritonitis is a frequently encountered surgical emergency in the developing countries. The choice of a procedure for source control depends on the patient condition as well as the surgeon preference. Material and Methods. This was a prospective observational study including 41 patients presenting with perforation peritonitis due to ileal perforation and managed with ileostomy. Demographic profile and operative findings in terms of number of perforations, site, and size of perforation along with histopathological findings of all the cases were recorded. Results. The majority of patients were male. Pain abdomen and fever were the most common presenting complaints. Body mass index of the patients was in the range of 15.4–25.3 while comorbidities were present in 43% cases. Mean duration of preoperative resuscitation was 14.73 + 13.77 hours. Operative findings showed that 78% patients had a single perforation; most perforations were 0.6–1 cm in size and within 15 cm proximal to ileocecal junction. Mesenteric lymphadenopathy was seen in 29.2% patients. On histopathological examination, nonspecific perforations followed by typhoid and tubercular perforations respectively were the most common. Conclusion. Patients with ileal perforations are routinely seen in surgical emergencies and their demography, clinical profile, and intraoperative findings may guide the choice of procedure to be performed. PMID:26247059

  18. Quality of an Informed Consent Prior to a Surgical Intervention? Experience of a Teaching Hospital

    PubMed Central

    Kurt, Engin; Ucar, Muharren; Atac, Adnan

    2016-01-01

    Objective: To determine how far the information given by the physicians for the informed consent prior to the surgical intervention is comprehended by the patients. Methods: The study was carried out between July 1st, 2012 and July 1st, 2013 at Gulhane Medical Faculty. A total of 400 patients, who were in the third postoperative day after various surgical procedures (orthopedics, urology, ophthalmology, plastic surgery and breast surgery), were included in the study. Results: Of all the patients, 73.5% stated that the operative information was provided by physicians, whereas 22.7% claimed that no information was given in this regard. The patients who knew the name of the disease was 78%, while 18.3% did not know. Of all the patients, 25.7% knew the name of the operation, in contrast to of 52.3% who did not know it. About 12.5% of patients stated that they were not informed about the likely complications during the surgery, whereas 13.7% of patients reported that they were not informed about the post-operative complications. Conclusion: The verbal information and the written texts, different approaches such as drawings and visual materials (i.e. video’s and photographs) should be considered while providing information to the patients. While doing so the level of education of the community should also be taken into account.

  19. Surgical pathology in the 20th century at the Mount Sinai Hospital, New York.

    PubMed

    Geller, Stephen A

    2008-08-01

    How did the education of surgical pathology, and pathology in general, differ at Mount Sinai? Passing the examination of the American Board of Pathology was never the focus of the department. Learning criteria or quoting references was de-emphasized, but mastery of macroscopic pathology was required, supported in both word and action by two brilliant surgical pathologists, Otani and Kaneko, and by two extraordinary medical pathologists, Klemperer and Popper. Meticulous microscopy emphasized pattern rather than reliance on lists of discrete features. Otani developed a regular "problem case" meeting for a community of pathologists, made up of alumni and other interested pathologists, as well as active department members. These monthly sessions provided the highest level of "continuing medical education." Otani and Kaneko unequivocally believed in learning from cases, and Mount Sinai residents were fortunate both in the one-to-one teaching and in the wealth of material, in all systems, that came to surgical pathology. Outstanding pathologists who came from Mount Sinai settled throughout the country and provided the highest level of diagnoses, but, with the exception of Bernard Wagner, Emanuel Rubin, Fiorenzo Paronetto, Richard Horowitz, Michael Gerber, Marc Rosenblum, Bruce Wenig, Jaishree Jagirdar, Swan Thung, Cesar Moran, Hideko Kamino, Philip LeBoit, Alberto Marchevsky, and others, there were relatively few academic leaders. Otani and Kaneko did not have national reputations. Klemperer, although world renowned, was relatively unassuming, and his disciples numbered almost as many nonpathologists as pathologists. Popper did establish a major center for liver pathology, with students coming from around the world, but did not particularly promote general surgical pathology. Can the Mount Sinai approach still be applied? The decline in the numbers of autopsies performed, the demands for rapid turnaround time, the de-emphasis of gross pathology as newer technologies (eg, immunohistochemistry, cytogenetics, molecular pathology) gain place, the increasing tendency to select investigators, including basic scientists, as teaching department chairs and the financial constraints requiring increasing use of nonphysician workers all speak to the relegation of the Otani-Kaneko era to history. Is this a loss to Pathology? It is certainly a style of practice that has been lost. However, there is no reason to bemoan the state of Pathology in the beginning years of the 21st century. Pathology practice is outstanding at many medical centers throughout the world, including at Mount Sinai under the very able and creative leadership of Alan Schiller, who has presided over great enhancements of the department in both anatomic and clinical pathology, including significant advances in the study of diseases by molecular methods. Surgical Pathology at Mount Sinai has been led by James Strauchen, a renowned hematopathologist recruited by Schiller's predecessor, Jerome Kleinerman, and is currently directed by Ira Bleiweiss, a student of Kaneko. Other techniques and technologies have, to a degree, compensated for some of the changes since the Otani-Kaneko years and it is almost certain that advances in molecular pathology will allow for increasing sophistication in establishing diagnoses, and likely even grading and staging, probably even on blood, rather than tissue, samples. The science of Pathology will advance, as the art declines. Those who learned at Mount Sinai during the Otani-Kaneko years will, however, very likely tell you that they were privileged to have learned Pathology there and, especially, to have learned a distinct philosophy of Pathology under the guidance of caring, thoughtful, and especially gifted pathologists. PMID:19007103

  20. Surgical Travellers: Tapestry to Bayeux

    PubMed Central

    Hedley-Whyte, John; Milamed, Debra R

    2014-01-01

    The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC. Surgical Consultants, now Major Generals, Brigadiers or Full Colonels in the British and U.S. Armies stationed in the UK, prepared for the invasion of Europe. The allocation of medical, surgical, nursing and auxiliary responsibilities was delineated. Liaison with the RAF and US Army Air Force was close as it was with the proposed leaders, Ulstermen Brooke and Montgomery. Montgomery chose Arthur Porritt as Surgeon in Chief to Supreme Headquarters Allied Expeditionary Force (SHAEF), and Eisenhower, General Albert W. Kenner. Just after D-Day, Porritt met Ian Fraser, who had waded in on Arromanches Beach. The triage and evacuation plans for Allied casualties had been controversial, particularly as regards Landing Ship Tanks (LSTs). The dispute with the Hood-selected surgeons on one side, against medical and surgical deployment of LSTs, and Admiral Ernest King and Winston Churchill on the other, favouring LST use for surgery and evacuation. King and Churchill were correct but total Allied air superiority allowed wide use of many of the Allies' Dakotas; 10,000 DC-3s were eventually in service. Supported by forty Allied combat planes to each Luftwaffe, the dispute about Landing Ship Tank use in about a fortnight became moot. The multifaceted role of the Princess Royal in the Emergency Medical Services of the United Kingdom and her close liaison with the Consultant Surgeons was of great value to the Allies. PMID:25484466

  1. Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals

    PubMed Central

    Eskicioglu, Cagla; Gagliardi, Anna R.; Fenech, Darlene S.; Forbes, Shawn S.; McKenzie, Marg; McLeod, Robin S.; Nathens, Avery B.

    2012-01-01

    Background A gap exists between the best evidence and practice with regards to surgical site infection (SSI) prevention. Awareness of evidence is the first step in knowledge translation. Methods A web-based survey was distributed to 59 general surgeons and 68 residents at University of Toronto teaching hospitals. Five domains pertaining to SSI prevention with questions addressing knowledge of prevention strategies, efficacy of antibiotics, strategies for changing practice and barriers to implementation of SSI prevention strategies were investigated. Results Seventy-six individuals (60%) responded. More than 90% of respondents stated there was evidence for antibiotic prophylaxis and perioperative normothermia and reported use of these strategies. There was a discrepancy in the perceived evidence for and the self-reported use of perioperative hyperoxia, omission of hair removal and bowel preparation. Eighty-three percent of respondents felt that consulting published guidelines is important in making decisions regarding antibiotics. There was also a discrepancy between what respondents felt were important strategies to ensure timely administration of antibiotics and what strategies were in place. Checklists, standardized orders, protocols and formal surveillance programs were rated most highly by 75%–90% of respondents, but less than 50% stated that these strategies were in place at their institutions. Conclusion Broad-reaching initiatives that increase surgeon and trainee awareness and implementation of multifaceted hospital strategies that engage residents and attending surgeons are needed to change practice. PMID:22617541

  2. Patient safety in surgical environments: Cross-countries comparison of psychometric properties and results of the Norwegian version of the Hospital Survey on Patient Safety

    PubMed Central

    2010-01-01

    Background How hospital health care personnel perceive safety climate has been assessed in several countries by using the Hospital Survey on Patient Safety (HSOPS). Few studies have examined safety climate factors in surgical departments per se. This study examined the psychometric properties of a Norwegian translation of the HSOPS and also compared safety climate factors from a surgical setting to hospitals in the United States, the Netherlands and Norway. Methods This survey included 575 surgical personnel in Haukeland University Hospital in Bergen, an 1100-bed tertiary hospital in western Norway: surgeons, operating theatre nurses, anaesthesiologists, nurse anaesthetists and ancillary personnel. Of these, 358 returned the HSOPS, resulting in a 62% response rate. We used factor analysis to examine the applicability of the HSOPS factor structure in operating theatre settings. We also performed psychometric analysis for internal consistency and construct validity. In addition, we compared the percent of average positive responds of the patient safety climate factors with results of the US HSOPS 2010 comparative data base report. Results The professions differed in their perception of patient safety climate, with anaesthesia personnel having the highest mean scores. Factor analysis using the original 12-factor model of the HSOPS resulted in low reliability scores (r = 0.6) for two factors: "adequate staffing" and "organizational learning and continuous improvement". For the remaining factors, reliability was ≥ 0.7. Reliability scores improved to r = 0.8 by combining the factors "organizational learning and continuous improvement" and "feedback and communication about error" into one six-item factor, supporting an 11-factor model. The inter-item correlations were found satisfactory. Conclusions The psychometric properties of the questionnaire need further investigations to be regarded as reliable in surgical environments. The operating theatre personnel perceived their hospital's patient safety climate far more negatively than the health care personnel in hospitals in the United States and with perceptions more comparable to those of health care personnel in hospitals in the Netherlands. In fact, the surgical personnel in our hospital may perceive that patient safety climate is less focused in our hospital, at least compared with the results from hospitals in the United States. PMID:20860787

  3. Benchmarking the Use of a Rapid Response Team by Surgical Services at a Tertiary Care Hospital

    PubMed Central

    Barocas, Daniel A; Kulahalli, Chirag S; Ehrenfeld, Jesse M; Kapu, April N; Penson, David F; You, Chaochen (Chad); Weavind, Lisa; Dmochowski, Roger

    2015-01-01

    BACKGROUND Rapid response teams (RRT) are used to prevent adverse events in patients with acute clinical deterioration, and to save costs of unnecessary transfer in patients with lower-acuity problems. However, determining the optimal use of RRT services is challenging. One method of benchmarking performance is to determine whether a department's event rate is commensurate with its volume and acuity. STUDY DESIGN Using admissions between 2009 and 2011 to 18 distinct surgical services at a tertiary care center, we developed logistic regression models to predict RRT activation, accounting for days at-risk for RRT and patient acuity, using claims modifiers for risk of mortality (ROM) and severity of illness (SOI). The model was used to compute observed-to-expected (O/E) RRT use by service. RESULTS Of 45,651 admissions, 728 (1.6%, or 3.2 per 1,000 inpatient days) resulted in 1 or more RRT activations. Use varied widely across services (0.4% to 6.2% of admissions; 1.39 to 8.73 per 1,000 inpatient days, unadjusted). In the multivariable model, the greatest contributors to the likelihood of RRT were days at risk, SOI, and ROM. The O/E RRT use ranged from 0.32 to 2.82 across services, with 8 services having an observed value that was significantly higher or lower than predicted by the model. CONCLUSIONS We developed a tool for identifying outlying use of an important institutional medical resource. The O/E computation provides a starting point for further investigation into the reasons for variability among services, and a benchmark for quality and process improvement efforts in patient safety. PMID:24275072

  4. Major Harvey Cushing's difficulties with the British and American armies during World War I.

    PubMed

    Carey, Michael E

    2014-08-01

    This historical review explores Harvey Cushing's difficulties with both the British and American armies during his World War I service to definitively examine the rumor of his possible court martial. It also provides a further understanding of Cushing the man. While in France during World War I, Cushing was initially assigned to British hospital units. This service began in May 1917 and ended abruptly in May 1918 when the British cashiered him for repeated censorship violations. Returning to American command, he feared court martial. The army file on this matter (retrieved from the United States National Archives) indicates that US Army authorities recommended that Cushing be reprimanded and returned to the US for his violations. The army carried out neither recommendation, and no evidence exists that a court martial was considered. Cushing's army career and possible future academic life were protected by the actions of his surgical peers and Merritte Ireland, Chief Surgeon of the US Army in France. After this censorship episode, Cushing was made a neurosurgical consultant but was also sternly warned that further rule violations would not be tolerated by the US Army. Thereafter, despite the onset of a severe peripheral neuropathy, probably Guillian Barré's syndrome, Cushing was indefatigable in ministering to neurosurgical needs in the US sector in France. Cushing's repeated defying of censorship regulations reveals poor judgment plus an initial inability to be a "team player." The explanations he offered for his censorship violations showed an ability to bend the truth. Cushing's war journal is unclear as to exactly what transpired between him and the British and US armies. It also shows no recognition of the help he received from others who were instrumental in preventing his ignominious removal from service in France. Had that happened, his academic future and ability to train future neurosurgical leaders may have been seriously threatened. Cushing's foibles notwithstanding, all realized that he contributed greatly to both British and US war neurosurgery. United States Army surgeons who operated upon brain wounds in France recognized Cushing as their leader. PMID:24949679

  5. A Prospective Review of Hip Fracture Subtypes, Surgical Procedure, Cognitive Status, and Analgesia Use Across 4 Australian Hospitals

    PubMed Central

    Mak, Jenson C. S.; Lattouf, Ihab; Narushevich, Alexei; Lai, Charles; O’Rourke, Fintan; Shen, Qing; Chan, Daniel K. Y.; Cameron, Ian D.

    2011-01-01

    Objectives: To correlate analgesia use among patients with hip fracture requiring surgery with hip fracture subtype, cognitive status, and type of surgery in the postacute period. Design and Participants: Prospective review of patients with hip fractures requiring surgical intervention. A total of 415 patients (mean age: 81.2 ± 9.1 years, 74.3% women) presented with 195 subcapital fractures (39 undisplaced, 156 displaced) and 220 trochanteric fractures (136 stable, 84 unstable) requiring surgery. Setting: Inpatient orthopedic units in 4 Australian hospitals. Measurements: The primary outcome measures were mean analgesia usage (oral morphine equivalent) for 4 defined time intervals and total amount 36 hours following surgery. Results: Patients with subtrochanteric fractures required more analgesia compared with displaced-subcapital, undisplaced-subcapital, basicervical, stable-pertrochanteric, and unstable-pertrochanteric fractures in the 24 to 36 hours following operation (24.7 vs 11.3 vs 8.8 vs 12.1 vs 7.6 vs 9.7, P = .001). Total analgesia requirements were higher in patients treated with an intramedullary nail, increasing by 1.3- to 3.3-fold in the 36 hours postsurgery. Patients with cognitive impairment utilized markedly less analgesia at all time periods measured. At 24 to 36 hours, higher levels of analgesia were noted in patients with higher premorbid level of mobility (P = .015) and activities of daily living function (P = .007). Conclusion: Important differences in utilization of analgesia following hip fracture across readily defined clinical groups exist. Proactive pain management for those with cognitive impairment, certain hip fracture subtypes, and surgical procedures may enable early functional mobility and other activities. PMID:23569669

  6. Risk management: correct patient and specimen identification in a surgical pathology laboratory. The experience of Infermi Hospital, Rimini, Italy.

    PubMed

    Fabbretti, G

    2010-06-01

    Because of its complex nature, surgical pathology practice is prone to error. In this report, we describe our methods for reducing error as much as possible during the pre-analytical and analytical phases. This was achieved by revising procedures, and by using computer technology and automation. Most mistakes are the result of human error in the identification and matching of patient and samples. To avoid faulty data interpretation, we employed a new comprehensive computer system that acquires all patient ID information directly from the hospital's database with a remote order entry; it also provides label and request forms via-Web where clinical information is required before sending the sample. Both patient and sample are identified directly and immediately at the site where the surgical procedures are performed. Barcode technology is used to input information at every step and automation is used for sample blocks and slides to avoid errors that occur when information is recorded or transferred by hand. Quality control checks occur at every step of the process to ensure that none of the steps are left to chance and that no phase is dependent on a single operator. The system also provides statistical analysis of errors so that new strategies can be implemented to avoid repetition. In addition, the staff receives frequent training on avoiding errors and new developments. The results have been shown promising results with a very low error rate (0.27%). None of these compromised patient health and all errors were detected before the release of the diagnosis report. PMID:21171512

  7. Improving the quality of the surgical preoperative assessment in a district general hospital

    PubMed Central

    Koris, Jacob; Hopkins, Catherine

    2015-01-01

    At Leicester General Hospital, England, patients are assessed by a team of junior doctors for elective colorectal and hepatobiliary procedures. After a number of same day cancellations, a large discrepancy was identified between the findings at the preoperative assessment clinic and the anaesthetic assessment on the day of surgery. After a multidisciplinary meeting was held, three interventions were decided on with an aim to bring the preoperative assessment in line with the anaesthetic assessment. Firstly, a set of guidelines was written and introduced for the junior doctors to use as a reference when assessing patients. Secondly, a proforma was designed specifically to prompt users to include essential details which were being missed in the assessment, having audited 100 patients' notes. Thirdly, a preoperative investigation “calculator” was recommended for each patient to simplify compliance with the National Institute for Health and Care Excellence (NICE) guidance for preoperative assessment. Before and after each intervention was introduced, a cohort of 50 patients were followed looking for differences in findings in the history, examination, investigations, and fitness for surgery between the preoperative assessment in clinic and the anaesthetic assessment on the day of surgery. Initially 68% of patients were compliant for details in the history, 76% for examination, 32% for choice of preoperative investigations, and 100% for fitness for surgery decision. After all three interventions had been introduced, 96% of patients were compliant for history, 94% for examination findings, 88% had the correct choice of preoperative investigations, and 100% had the same decision on fitness for surgery. The interventions described proved to be cheap and effective methods of improving the quality of the preoperative assessment, bringing it in line with the anaesthetic assessment and reducing the risk of same day cancellations.

  8. In-Hospital and 4-Year Clinical Outcomes Following Transcatheter Versus Surgical Closure for Secundum Atrial Septal Defect in Adults

    PubMed Central

    Chen, Tien-Hsing; Hsiao, Yuan-Chuan; Cheng, Chia-Chi; Mao, Chun-Tai; Chen, Dong-Yi; Tsai, Ming-Lung; Yang, Teng-Yao; Lin, Yu-Sheng

    2015-01-01

    Abstract Atrial septal defect (ASD) closure is major therapy for patients with secundum ASD. Although surgical closure (SC) and transcatheter closure (TC) are usually performed in such patients, data on the long-term outcomes comparing TC and SC in adults are limited. Data on the participants of this cohort study were retrieved from Taiwan's National Health Insurance Research Database from 2004 to 2011. Secundum ASD patients?>?18 years of age who underwent TC or SC were initially enrolled, and those with associated comorbidities were excluded. After propensity score matching, the clinical outcomes between the TC and SC groups were analyzed. There were 595 patients recruited in the TC group and 308 patients in the SC group. The SC group had a higher incidence of systemic thromboembolism (P?hospitalization, and similar phenomena could also be seen in a around 4-year follow-up period after the procedures (systemic thromboembolism (P?hospitalization. The adult secundum ASD patients had lower incidence rates of systemic thromboembolism, ischemic stroke, and all-cause mortality after TC than those after SC in the 4-year follow-up after procedures. Transcatheter ASD closure should therefore be given priority PMID:26402807

  9. Validation of a whole slide imaging system for primary diagnosis in surgical pathology: A community hospital experience

    PubMed Central

    Buck, Thomas P.; Dilorio, Rebecca; Havrilla, Lauren; O’Neill, Dennis G.

    2014-01-01

    Guidelines for validating whole slide imaging (WSI) for primary diagnosis in surgical pathology have been recommended by an expert panel commissioned by the College of American Pathologists. The implementation of such a system using these validation guidelines has not been reported from the community hospital setting. The objective was to implement a WSI system, validate each pathologist using the system and run the system in parallel with routine glass slide interpretation. Six pathologists re-reviewed approximately 300 previously diagnosed specimens each, divided equally between glass slides and digital images (scanned at ×20). Baseline intraobserver discordance rates (glass to glass) were calculated and compared to discordance rates between the original glass slide interpretation and the reviewed digital slide interpretation. A minimum of 3 months was used as the washout period. After validation, a subset of daily cases was diagnosed in parallel using traditional microscopy (TM) and WSI over an 8-month period. The TM and WSI discordance rates ranged from 3.3% to 13.3% and 2.1% to 10.1%, respectively. There was no statistically significant difference among the pathologists. The parallel study yielded similar rates of discordances. In our laboratory, after appropriate implementation and training, there was no difference between the WSI and TM methods. PMID:25535591

  10. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover), south sides. - Fitzsimons General Hospital, Officer Recreation Building, West Harlow Avenue, immediately East of Building 118, Aurora, Adams County, CO

  11. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover), south and east sides. - Fitzsimons General Hospital, Post Exchange Garage, North Eighth Street, North of Building No. 143, Aurora, Adams County, CO

  12. Photocopy of photograph from the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from the Fitzsimons Army Medical Center real property book (green cloth cover), showing east side and north sides. - Fitzsimons General Hospital, Transformer House, North Page Street, immediately North of Building No. 217, Aurora, Adams County, CO

  13. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover). - Fitzsimons General Hospital, Semi-Infirmary Turbercular Ward, Northwest Corner of Charlie Kelly Boulevard & South Hickey Street, Aurora, Adams County, CO

  14. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover). - Fitzsimons General Hospital, Storehouse, East Harlow Avenue, immediately South of Building 201, Aurora, Adams County, CO

  15. Photocopy of print in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of print in the Fitzsimons Army Medical Center Real Property Book (green cloth cover), probably south side. - Fitzsimons General Hospital, Female Dormitory, Southeast Corner of West McCloskey Avenue & North Seventh Street, Aurora, Adams County, CO

  16. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), east and south sides. - Fitzsimons General Hospital, Workshop Building, East Harlow Avenue, immediately East of Building No. 529, Aurora, Adams County, CO

  17. Photocopy of photograph from the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from the Fitzsimons Army Medical Center real property book (green cloth cover), probably southwest side. - Fitzsimons General Hospital, Operating Pavilion, West McAfee Avenue, East of Building No. 507, Aurora, Adams County, CO

  18. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover), probably south side. - Fitzsimons General Hospital, Officers' Garage, West Pennington Avenue, West of Building 129, Aurora, Adams County, CO

  19. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover). - Fitzsimons General Hospital, Artesian Well, East McCloskey Avenue, East of Building No. 231, Aurora, Adams County, CO

  20. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), east and north sides. - Fitzsimons General Hospital, Wagon Shed with Office, Southeast Corner of East J Avenue & North Tenth Street, Aurora, Adams County, CO

  1. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover), south side. - Fitzsimons General Hospital, Office Building, Northwest Corner of West McCloskey Avenue & North Tenth Street, Aurora, Adams County, CO

  2. Photocopy of print from the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of print from the Fitzsimons Army Medical Center Real Property Book (green cloth cover). - Fitzsimons General Hospital, Tool House, West Pennington Avenue, North of Building No. 140, Aurora, Adams County, CO

  3. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), showing west side. - Fitzsimons General Hospital, Fire Equipment House, North Page Street, North of Building No. 228, Aurora, Adams County, CO

  4. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), south and east sides. - Fitzsimons General Hospital, Nurses' Quarters, Southwest Corner of West Harlow Avenue, & South Eighth Street, Aurora, Adams County, CO

  5. Photocopy of photograph from the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from the Fitzsimons Army Medical Center real property book (green cloth cover), showing east side. - Fitzsimons General Hospital, Transformer House, North Page Street, immediately North of Building No. 216, Aurora, Adams County, CO

  6. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover). - Fitzsimons General Hospital, Greenhouse, West Pennington Avenue, East of Building No. 139, Aurora, Adams County, CO

  7. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth clover), west side. - Fitzsimons General Hospital, Motor Transport Dispatcher's Office, Northeast Corner of East Harlow Avenue & North Tenth Street, Aurora, Adams County, CO

  8. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover) south and east sides. - Fitzsimons General Hospital, Nurses' Garage, East of Building No. 121, Aurora, Adams County, CO

  9. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), east and south sides. - Fitzsimons General Hospital, Pharmacy & Prophylactic Station, Northwest Corner of West McAfee Avenue & South Eighth Street, Aurora, Adams County, CO

  10. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover), east side. - Fitzsimons General Hospital, Shops Building, Northwest Corner of West Pennington Avenue, & North Tenth Street, Aurora, Adams County, CO

  11. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), showing south side. - Fitzsimons General Hospital, Laboratory Annex, Northwest Corner of East McCloskey Avenue & North Twelfth Street, Aurora, Adams County, CO

  12. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover), south and east sides. - Fitzsimons General Hospital, Nurses Quarters No. 3, Northwest Corner of West Harlow Avenue & North Seventh Street, Aurora, Adams County, CO

  13. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), west and north sides of the southern wing. - Fitzsimons General Hospital, Laundry, Southeast corner of East Harlow Avenue & South Twelfth Street, Aurora, Adams County, CO

  14. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), south side. - Fitzsimons General Hospital, Tubercular Ward, Southwest Corner of East Bushnell Avenue & South Page Street, Aurora, Adams County, CO

  15. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover), south and east sides. - Fitzsimons General Hospital, Storage Sheds, Northeast Corner of West Pennington Avenue & North Eighth Street, Aurora, Adams County, CO

  16. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), showing south and east sides. - Fitzsimons General Hospital, Ice Plant, Southwest Corner of East I Avenue & North Thirteenth Street, Aurora, Adams County, CO

  17. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), south side. - Fitzsimons General Hospital, Infirmary, Northwest Corner of East Bushnell Avenue & South Page Street, Aurora, Adams County, CO

  18. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), showing south and west sides. - Fitzsimons General Hospital, Power House, Northwest Corner of East Harlow Avenue & North Page Street, Aurora, Adams County, CO

  19. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), probably south and west sides. - Fitzsimons General Hospital, Nurses' Quarters, Southeast Corner of West McAfee Avenue & South Hickey Street, Aurora, Adams County, CO

  20. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), showing south and west sides. - Fitzsimons General Hospital, Salvage Building, Northeast Corner of East I Avenue & North Page Street, Aurora, Adams County, CO

  1. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover), looking east. - Fitzsimons General Hospital, Tennis Courts, Northeast Corner of East McCloskey Avenue & North Hickey Street, Aurora, Adams County, CO

  2. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover). - Fitzsimons General Hospital, Post Exchange Garage, Northwest Corner of West Pennington Avenue & North Eighth Street, Aurora, Adams County, CO

  3. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover) - Fitzsimons General Hospital, Quartermaster Store House, Northwest Corner of East I Avenue & North Twelfth Street, Aurora, Adams County, CO

  4. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover), probably south and west sides. - Fitzsimons General Hospital, Utilities Storeroom, West Pennington Avenue, East of Building No. 145, Aurora, Adams County, CO

  5. Photocopy of photograph in Fitzsimons Army Medial Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medial Center Real Property Book (green cloth cover), south and west sides. - Fitzsimons General Hospital, Officers Quarters, Northeast Corner of West Harlow Avenue & North Seventh Street, Aurora, Adams County, CO

  6. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover). - Fitzsimons General Hospital, Ambulent Tubercular Ward, Southeast Corner of East Bushnell Avenue & South Hickey Street, Aurora, Adams County, CO

  7. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), showing southwest corner of building 732. - Fitzsimons General Hospital, Storehouses, Northwest Corner of East Harlow Avenue & North Thirteenth Street, Aurora, Adams County, CO

  8. Photocopy of photograph from Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from Fitzsimons Army Medical Center real property book (green cloth cover), south and west sides. - Fitzsimons General Hospital, Gymnasium, Northeast Corner of East Harlow Avenue & North Page Street, Aurora, Adams County, CO

  9. Photocopy of photograph from the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from the Fitzsimons Army Medical Center real property book (green cloth cover). - Fitzsimons General Hospital, Semi-Infirmary Tubercular Ward, Southeast Corner of East Harlow Avenue & South Page Street, Aurora, Adams County, CO

  10. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), north side. - Fitzsimons General Hospital, Administration Building, Southeast Corner of West McAfee Avenue & South Eighth Street, Aurora, Adams County, CO

  11. 42. Post Engineer Office, Presidio of San Francisco, Letterman Army ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    42. Post Engineer Office, Presidio of San Francisco, Letterman Army Hospital, X-Ray Department and Second Floor Plan, X-Ray Department Plan, Building 1006. no date. BUILDING 1006. - Presidio of San Francisco, Letterman General Hospital, Building No. 27, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

  12. 41. Post Engineer Office, Presidio of San Francisco, Letterman Army ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    41. Post Engineer Office, Presidio of San Francisco, Letterman Army Hospital, First Floor Plan, Main Laboratory Section and Plan, Building 1006. no date BUILDING 1006. - Presidio of San Francisco, Letterman General Hospital, Building No. 27, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

  13. 21. Post Engineer Office, Presidio of San Francisco, Letterman Army ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. Post Engineer Office, Presidio of San Francisco, Letterman Army Hospital. EKG Cardiology Clinic, Building 1049. December 1955. BUILDING 1049. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

  14. Army thermophotovoltaic efforts

    NASA Astrophysics Data System (ADS)

    Kruger, John S.; Guazzoni, Guido; Nawrocki, Selma J.

    1999-03-01

    A presentation and description of the several efforts in Thermophotovoltaic (TPV) Energy Conversion for power generation supported/monitored by the Army is provided with their more recent technical status and results. The efforts are related to small business (SBIR, STTR) contracts, academic research grants (MURI), and contracts awarded as the result of specialized solicitations. This paper covers a number of Army potential uses of the TPV power generation and is an attempt to give a more cohesive and integrated picture of the various military interests in TPV. With the exception of low power (<10 W) units, all Army potential uses of TPV power sources will demand operation with logistically available fuels.

  15. [Near-infrared spectroscopy for the detection of traumatic intracranial hemorrhage: Feasibility study in a German army field hospital in Afghanistan].

    PubMed

    Braun, T; Kunz, U; Schulz, C; Lieber, A; Willy, C

    2015-08-01

    Traumatic brain injury (TBI) is one of the most common causes of death in ordinary accidents, natural disasters, or warfare. The gold standard for diagnosis of TBI is the CT scan; a delay of diagnostics or medical care is the strongest independent predictor of mortality of TBI patients--particularly in the case of a surgically treatable intracranial hematoma. The proper classification of these patients is of major importance in situations where a CT is not accessible. A portable screening device that uses near-infrared spectroscopy (NIRS) technology allows a preliminary estimate of an intracranial hematoma. This study assessing practicability shows that the use of the device in a military medical rescue center (Kunduz, Afghanistan) is easy to learn and can be repeatedly used even under emergency room conditions. The technique can be applied in penetrating and blunt TBIs in the absence of an immediately available CT scan in rural areas, preclinically, under mass casualty conditions (e.g., in disaster situations) as well as in humanitarian crises or war zones. Nevertheless, further studies to assess the validity of this device are necessary. PMID:24435101

  16. Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients

    PubMed Central

    Cheng, Keping; Li, Jiawei; Kong, Qingfang; Wang, Changxian; Ye, Nanyuan; Xia, Guohua

    2015-01-01

    Background The purpose of this study was to identify risk factors for surgical site infection (SSI) in a teaching hospital. Methods A prospective study was initiated to investigate risk factors for SSI at a university-affiliated tertiary care center from July 2013 to December 2014. The chi-square test for categorical variables was used to determine the significance of association, whereas the multivariate logistic regression model was used to examine independent risk factors for SSI. Results A total of 1,138 patients met the inclusion criteria, in whom 36 cases of infection occurred during the hospitalization period and two cases occurred after discharge. Univariate analysis showed that SSI was associated with the type of operation, wound classification, volume of blood loss, blood transfusion, American Society of Anesthesiology score before surgery, risk index, duration of surgery, diabetes, cancer, gastrointestinal catheter, urinary catheter, postoperative drainage, and preprocedural white blood cell count. Multivariate analysis identified six independent parameters correlating with the occurrence of SSI: diabetes (odds ratio [OR] 6.400; 95% confidence interval [CI] 2.582–15.866; P=0.000); cancer (OR 2.427; 95% CI 1.028–5.732; P=0.043); preprocedural white blood cell count more than 10×109/L (OR 6.988; CI 3.165–15.425; P=0.000); wound classification (clean contaminated [OR: 7.893; CI: 2.244–27.762; P=0.001]; contaminated [OR: 7.031; CI: 1.652–29.922; P=0.008]; dirty [OR: 48.778; CI: 5.418–439.164; P=0.001]); operative duration more than 120 minutes (OR 4.289; CI 1.773–10.378; P=0.001); and postoperative drainage (OR 3.957; CI 1.422–11.008; P=0.008). Conclusion Our data suggest that all these risk factors could be regarded as potential indicators of SSI and that relevant preventive measures should be taken to reduce SSI and improve patient outcomes. PMID:26316722

  17. Taking Specialist Surgical Services to the Rural District Hospitals at One Forth Cost: A Sustainable 'Return on Investment' Public Health Initiative of Patan Hospital, Patan Academy of Health Sciences, Nepal.

    PubMed

    Shah, J N

    2015-01-01

    The inequitable distribution and centralization of resources and services in urban area persists around the world, more so in developing countries. The challenge to meet the health needs of rural population requires health policy makers, government and concerned organization to put extra efforts. Such efforts require innovative, feasible and sustainable strategies to address the social justice of people living in districts away from capital and urban cities. At Patan Academy of Health Sciences, the medial school curriculum is designed to address these issues. Together with health professionals from Patan Hospital, the main teaching hospital on which the academy evolved, have initiated strategies to bring specialist services, starting with surgical services to remote district hospitals to serve the need of rural population. This initiative is 'desirable, doable and feasible'. Further more, this can be modified for replication and promotion by other academic institutions, central hospitals and government health system. PMID:26643841

  18. Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study

    PubMed Central

    Sivasubramaniam, Vinothan; Patel, Hitesh C; Ozdemir, Baris A; Papadopoulos, Marios C

    2015-01-01

    Objectives Low back pain (LBP), from degenerative lumbar spine disease, represents a significant burden on healthcare resources. Studies worldwide report trends attributable to their country's specific demographics and healthcare system. Considering England's specific medico-socioeconomic conditions, we investigate recent trends in hospital admissions and procedures for LBP, and discuss the implications for the allocation of healthcare resources. Design Retrospective cohort study using Hospital Episode Statistics data relating to degenerative lumbar spine disease in England, between 1999 and 2013. Regression models were used to analyse trends. Outcome measures Trends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay. Results Hospital admissions and procedures have increased significantly over the study period, from 127.09 to 216.16 and from 24.5 to 48.83 per 100?000, respectively, (p<0.001). The increase was most marked in the oldest age groups with a 1.9 and 2.33-fold increase in admissions for patients aged 60–74 and ?75?years, respectively, and a 2.8-fold increase in procedures for those aged ?60?years. Trends in hospital admissions were characterised by a widening gender gap, increasing mean patient age, and decreasing mean hospital stay (p<0.001). Trends in procedures were characterised by a narrowing gender gap, increasing mean patient age (p=0.014) and decreasing mean hospital stay (p<0.001). Linear regression models estimate that each hospital admission translates to 0.27 procedures, per 100?000 (95% CI 0.25 to 0.30, r 0.99, p<0.001; r, Pearson's correlation coefficient). Hospital admissions are increasing at 3.5 times the rate of surgical procedures (regression gradient 7.63 vs 2.18 per 100?000/year). Conclusions LBP represents a significant and increasing workload for hospitals in England. These trends demonstrate an increasing demand for specialists involved in the surgical and non-surgical management of this disease, and highlight the need for services capable of dealing with the increased comorbidity burden associated with an ageing patient group. PMID:26671956

  19. Surgical audit: do numbers provide good training?

    PubMed

    Crate, I D; Griffiths, C L

    1996-06-01

    There has been a growing realisation that good resource planning requires effective measurement of surgical workload by good surgical audit. This paper examines the general surgical workload at the Army's tertiary referral centre, utilising the ratio of operative workload expressed as Intermediate Equivalents to total Service Equivalent Value of a Surgical team. A suggested format to enable inclusion of specialist non-surgical therapies is proposed. The limitations of "number crunching" when assessing the value of higher surgical training are discussed. PMID:8819034

  20. [A surgical safety checklist implementation: experience of a start-up phase of a collaborative project in hospitals of Catalonia, Spain].

    PubMed

    Secanell, Mariona; Orrego, Carola; Vila, Miquel; Vallverdú, Helena; Mora, Núria; Oller, Anna; Bańeres, Joaquim

    2014-07-01

    Surgical patient safety is a priority in the national and international quality healthcare improvement strategies. The objective of the study was to implement a collaborative intervention with multiple components and to evaluate the impact of the patient surgical safety checklist (SSC) application. This is a prospective, longitudinal multicenter study with a 7-month follow-up period in 2009 based on a collaborative intervention for the implementation of a 24 item-SSC distributed in 3 different stages (sign in, time out, sign out) for its application to the surgical patient. A total number of 27 hospitals participated in the strategy. The global implementation rate was 48% (95%CI, 47.6%-48.4%) during the evaluation period. The overall compliance with all the items of the SSC included in each stage (sign in, time out, sign out) was 75,1% (95%CI, 73.5%-76.7%) for the sign in, 77.1% (95%CI, 75.5%-78.6%) for the time out and 88.3% (95%CI, 87.2%-89.5%) for the sign out respectively. The individual compliance with each item of the SSC has remained above 85%, except for the surgical site marking with an adherence of 67.4% (95%CI, 65.7%-69.1%)] and 71.2% (95%CI, 69.6%-72.9%)] in the sign in and time out respectively. The SSC was successfully implemented to 48% of the surgeries performed to the participating hospitals. The global compliance with the SSC was elevated and the intervention trend was stable during the evaluation period. Strategies were identified to allow of a higher number of surgeries with application of the SSC and more professional involvement in measures compliance such as surgical site marking. PMID:25128355

  1. Beyond Volume: Hospital-Based Healthcare Technology for Better Outcomes in Cerebrovascular Surgical Patients Diagnosed With Ischemic Stroke: A Population-Based Nationwide Cohort Study From 2002 to 2013.

    PubMed

    Kim, Jae-Hyun; Park, Eun-Cheol; Lee, Sang Gyu; Lee, Tae-Hyun; Jang, Sung-In

    2016-03-01

    We examined whether the level of hospital-based healthcare technology was related to the 30-day postoperative mortality rates, after adjusting for hospital volume, of ischemic stroke patients who underwent a cerebrovascular surgical procedure.Using the National Health Insurance Service-Cohort Sample Database, we reviewed records from 2002 to 2013 for data on patients with ischemic stroke who underwent cerebrovascular surgical procedures. Statistical analysis was performed using Cox proportional hazard models to test our hypothesis.A total of 798 subjects were included in our study. After adjusting for hospital volume of cerebrovascular surgical procedures as well as all for other potential confounders, the hazard ratio (HR) of 30-day mortality in low healthcare technology hospitals as compared to high healthcare technology hospitals was 2.583 (P < 0.001). We also found that, although the HR of 30-day mortality in low healthcare technology hospitals with high volume as compared to high healthcare technology hospitals with high volume was the highest (10.014, P < 0.0001), cerebrovascular surgical procedure patients treated in low healthcare technology hospitals had the highest 30-day mortality rate, irrespective of hospital volume.Although results of our study provide scientific evidence for a hospital volume/30-day mortality rate relationship in ischemic stroke patients who underwent cerebrovascular surgical procedures, our results also suggest that the level of hospital-based healthcare technology is associated with mortality rates independent of hospital volume. Given these results, further research into what components of hospital-based healthcare technology significantly impact mortality is warranted. PMID:26986122

  2. Nasal Carriage of Staphylococcus aureus and Epidemiology of Surgical-Site Infections in a Sudanese University Hospital

    PubMed Central

    Ahmed, Abdalla O. A.; van Belkum, Alex; Fahal, Ahmed H.; Elnor, A. E. Abu; Abougroun, El Sir A. M.; VandenBergh, Marjolein F. Q.; Zijlstra, Ed E.; Verbrugh, Henri A.

    1998-01-01

    Surgical site infections (SSI) due to Staphylococcus aureus among 256 male and 158 female patients (mean age, 28 years) undergoing elective surgery at the Soba University Hospital (Khartoum, Sudan) were studied. During an 11-month study period all patients were analyzed for nasal carriage of S. aureus at the time of admission. Follow-up of the development of SSI proceeded until 4 weeks after the operations. In addition, nasal swabs were obtained periodically during the same period from 82 members of the staff. In order to discriminate autoinfection from cross infection, bacterial isolates were typed by random amplification of polymorphic DNA (RAPD), pulsed-field gel electrophoresis (PFGE) of DNA macrorestriction fragments, and restriction fragment length polymorphism analysis of the protein A and coagulase genes. Preoperative cultures revealed the presence of S. aureus in the noses of 98 patients (24%). The overall number of postsurgical wound infections in the entire group was 57 (14%), 24 of which were due to S. aureus. Only 6 of the 98 nasal S. aureus carriers suffered from wound infections by the same species. In these six cases the infecting strain could not be genetically discriminated from the nasal inhabitant, substantiating autoinfection. However, nasal carriage of S. aureus is not a significant risk factor for the development of SSI in this setting (6 of 98 patients with autoinfection versus 18 of 316 patients [414 ? 98 patients] with cross infection; P = 0.81), most probably due to the fact that noncarriers are at a significant and relatively large risk for acquiring an independent S. aureus SSI. The other S. aureus strains causing SSI showed a high degree of genetic heterogeneity, demonstrating that it is not an epidemic strain that is causing the SSI. Among the staff personnel screened, 47.4% did not carry S. aureus in the nose at any time during the study period, whereas 13.2% persistently carried a single strain in the nose. Another 39.5% could be classified as intermittent carriers. When strains derived from staff personnel were genetically typed, it was demonstrated that most of the strains represented genetic variants clearly differing from the isolates causing SSI. On the other hand, possible cross colonization among staff personnel and even cross infection from staff personnel to patients or from patient to patient were demonstrated in some cases, but epidemic spread of a single strain or a few clonally related strains of S. aureus could be excluded. PMID:9817883

  3. Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures in a Community-Based Health Care Organization

    PubMed Central

    Yian, Edward; Zhou, Hui; Schreiber, Ariyon; Sodl, Jeff; Navarro, Ron; Singh, Anshuman; Bezrukov, Nikita

    2016-01-01

    Context: Surgical treatment for proximal humerus fractures has increased exponentially. Recent health care policies incentivize centers to reduce hospital readmission rates. Better understanding of risk factors for readmission and early mortality in this population will assist in identifying favorable risk-benefit patient profiles. Objective: To identify incidence and risk factors of 30-day hospital readmission rate and 1-year mortality rate after open surgery of proximal humerus fractures. Design: Retrospective cohort analysis from Kaiser Permanente Southern California Region database. Methods: Using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes, all operative proximal humerus fractures were validated. Hospital readmission, one-year mortality, and demographic and medical data were collected. A logistic regression test was performed to assess potential risk factors for outcomes. Results: From 1387 surgical patients, the 30-day all-cause readmission rate was 5.6%. Forty percent of hospital read-missions were due to surgery-related reasons. Severe liver disease (odds ratio [OR], 3.48, 95% confidence interval [CI] = 1.42–8.55) and LACE (length of stay, acuity of admission, comorbidities, and number of Emergency Department visits in the previous 6 months) index score ? 10 (OR, 4.47, 95% CI = 2.54–7.86) were independent risk factors of readmission on multivariate analysis. The 1-year mortality rate was 4.86%. Multivariate analysis showed length of hospital stay (OR 1.11, 95% CI = 1.05–1.19), cancer (OR 3.38, 95% CI = 1.61–7.10), 30-day readmission (OR 3.31, 95% CI = 1.34–8.21), and Charlson comorbidity index greater than or equal to 4 (OR 13.94, 95% CI = 4.40–44.17) predicted higher mortality risk. Conclusion: After open treatment of proximal humerus fractures, there was a 5.6% all-cause 30-day hospital readmission rate. Surgical complications accounted for 40% of read-missions. Severe liver disease and LACE score correlated best with postoperative 30-day readmission risk. Length of hospital stay, preexisting cancer, 30-day readmission, and Charlson comorbidity index were predictive of 1-year mortality. PMID:26824962

  4. Effects of live music therapy sessions on quality of life indicators, medications administered and hospital length of stay for patients undergoing elective surgical procedures for brain.

    PubMed

    Walworth, Darcy; Rumana, Christopher S; Nguyen, Judy; Jarred, Jennifer

    2008-01-01

    The physiological and psychological stress that brain tumor patients undergo during the entire surgical experience can considerably affect several aspects of their hospitalization. The purpose of this study was to examine the effects of live music therapy on quality of life indicators, amount of medications administered and length of stay for persons receiving elective surgical procedures of the brain. Subjects (N = 27) were patients admitted for some type of surgical procedure of the brain. Subjects were randomly assigned to either the control group receiving no music intervention (n = 13) or the experimental group receiving pre and postoperative live music therapy sessions (n = 14). Anxiety, mood, pain, perception of hospitalization or procedure, relaxation, and stress were measured using a self-report Visual Analog Scale (VAS) for each of the variables. The documented administration of postoperative pain medications; the frequency, dosage, type, and how it was given was also compared between groups. Experimental subjects live and interactive music therapy sessions, including a pre-operative session and continuing with daily sessions until the patient was discharged home. Control subjects received routine hospital care without any music therapy intervention. Differences in experimental pretest and posttest scores were analyzed using a Wilcoxon Matched-Pairs Signed-Rank test. Results indicated statistically significant differences for 4 of the 6 quality of life measures: anxiety (p = .03), perception of hospitalization (p = .03), relaxation (p = .001), and stress (p = .001). No statistically significant differences were found for mood (p > .05) or pain (p > .05) levels. Administration amounts of nausea and pain medications were compared with a Two-Way ANOVA with One Repeated Measure resulting in no significant differences between groups and medications, F(1, 51) = 0.03; p > .05. Results indicate no significant differences between groups for length of stay (t = .97, df = 25, p > .05). This research study indicates that live music therapy using patient-preferred music can be beneficial in improving quality of life indicators such as anxiety, perception of the hospitalization or procedure, relaxation, and stress in patients undergoing surgical procedures of the brain. PMID:18959455

  5. A polymicrobial outbreak of surgical site infections following cardiac surgery at a community hospital in Florida, 2011–2012

    PubMed Central

    Nguyen, Duc B.; Gupta, Neil; Abou-Daoud, Alison; KleKamp, Benjamin G.; Rhone, Chaz; Winston, Tiffany; Hedberg, Trevor; Scuteri, Ana; Evans, Charlotte; Jensen, Bette; Moulton-Meissner, Heather; Török, Thomas; Berríos-Torres, Sandra I.; Noble-Wang, Judith; Kallen, Alexander

    2015-01-01

    We describe an outbreak of 22 sternal surgical site infections following cardiac surgery, including 4 Gordonia infections. Possible operation room environmental contamination and suboptimal infection control practices regarding scrub attire may have contributed to the outbreak. PMID:24679572

  6. Army Strong, Superintendent Savvy

    ERIC Educational Resources Information Center

    Mellon, Ericka

    2011-01-01

    Brigadier General Anthony "Tony" Tata of the U.S. Army had one of those "ah-ha" moments in April 2006 when, on the eve of an operation he was heading in Afghanistan, an Al Qaeda rocket shattered a nearby school. The attack killed a teacher and seven students and wounded dozens more. The rocket incident eventually nudged Tata toward a new mission:…

  7. [Mortality in the surgical unit of a general hospital. Study of 27 postoperative deaths among patients operated on during 1990-1492].

    PubMed

    Proye, C; Martinot, J C; Triboulet, J P; Carnaille, B; Sautier, M; Dromer, D; Camp, D

    1991-11-01

    This study takes in account all post operative deaths during the year 1990 in one surgical Professorial unit of Lille academic hospital (France). During this year, 1492 consecutive patients underwent surgery. The mean age of deceased patients was 63.7 years. 15 died after emergency procedure and 12 after elective surgery. Lastly 2 patients died without any operation. The most common condition encountered in those cases was oesophageal carcinoma, thereafter gastric or duodenal complicated peptic ulcer, and finally colonic carcinoma and diverticular disease. 13 patients had neoplasia (45%). From a critical point of view, 14 patients died after surgical indication or procedure of questionable legitimacy. The comparison with a similar study conducted five years ago and the analysis of these charts allow us to reaffirm some basic principles of surgery. PMID:1761598

  8. Costs and in-hospital outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement in commercial cases using a propensity score matched model.

    PubMed

    Minutello, Robert M; Wong, S Chiu; Swaminathan, Rajesh V; Feldman, Dmitriy N; Kaple, Ryan K; Horn, Evelyn M; Devereux, Richard B; Salemi, Arash; Sun, Xuming; Singh, Harsimran; Bergman, Geoffrey; Kim, Luke K

    2015-05-15

    The aim of this study was to compare in-hospital cost and outcomes between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). TAVI is an effective treatment option in patients with symptomatic aortic stenosis who are at high risk for traditional SAVR. Several studies using trial data or outside United States registry data have addressed TAVI cost issues, although there is a paucity of cost data involving commercial cases in the United States. Using Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Nationwide Inpatient Sample files, a propensity score-matched analysis of all commercial TAVI and SAVR cases performed in 2011 was conducted. Overall hospital cost and length of stay, as well as procedural complications, were compared between the 2 matched cohorts: 595 TAVI patients were matched to 1,785 SAVR patients in a 1:3 ratio. There was no difference in mean ($181,912 vs $196,298) or median ($152,993 vs $155,974) hospital cost between TAVI and SAVR (p = 0.60). The TAVI group had significantly shorter lengths of hospital stay than the SAVR group (mean 9.76 vs 12.01 days, p <0.001). There was no difference in postprocedural in-hospital death or stroke, but TAVI patients were more likely to have bleeding complications, to have vascular complications, and to require pacemakers. In conclusion, when analyzing in-hospital cost of commercial TAVI and SAVR cases using the Nationwide Inpatient Sample data set, TAVI is an economically satisfactory alternative to SAVR and results in an approximately 2-day shorter length of stay during the index hospitalization. PMID:25784513

  9. Parma Hospital raises awareness of new outpatient surgical center. Thanks to continuing coverage, the patients are lining up.

    PubMed

    Botvin, Judith D

    2003-01-01

    Parma Community General Hospital, Parma, Ohio, opened a new ambulatory surgery center Jan. 20 with an awareness-generating campaign. The SurgiCenter was promoted with print advertising in the local newspapers, backed up by the hospital's newsletter, Informed--sent quarterly to 100,000 homes. The response has been beyond expectations. PMID:12774715

  10. The Influence of Hospital Volume on Circumferential Resection Margin Involvement: Results of the Dutch Surgical Colorectal Audit.

    PubMed

    Gietelink, Lieke; Henneman, Daniel; van Leersum, Nicoline J; de Noo, Mirre; Manusama, Eric; Tanis, Pieter J; Tollenaar, Rob A E M; Wouters, Michel W J M

    2016-04-01

    This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume (<20 cases/year) was independently associated with a higher risk of CRM involvement (odds ratio = 1.54; 95% CI: 1.12-2.11). PMID:25790120

  11. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review. Final rule with comment period; final rule.

    PubMed

    2015-11-13

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports. PMID:26567438

  12. Army Strong, Superintendent Savvy

    ERIC Educational Resources Information Center

    Mellon, Ericka

    2011-01-01

    Brigadier General Anthony "Tony" Tata of the U.S. Army had one of those "ah-ha" moments in April 2006 when, on the eve of an operation he was heading in Afghanistan, an Al Qaeda rocket shattered a nearby school. The attack killed a teacher and seven students and wounded dozens more. The rocket incident eventually nudged Tata toward a new mission:…

  13. New technology in U.S. Army health care: the role of laparoscopic cholecystectomy.

    PubMed

    Swann, S W; Bowersox, J C

    1992-09-01

    In the near future, laparoscopic cholecystectomy could become one of the most frequently performed surgical procedures in U.S. military hospitals. To determine the best way to implement this new technology in the U.S. Army Health Services Command (HSC), we have assessed the safety, efficacy, and health consequences of laparoscopic cholecystectomy. Approximately 2,800 open cholecystectomies are performed annually in HSC hospitals, 11% of them on active duty personnel. If cholecystectomies were performed using laparoscopic surgical techniques on active duty patients who meet currently accepted indications, 3,360 personnel duty days lost to convalescence and 7,048 days of limited duty (time on physical profiles) would be recouped. Applying the procedure to other beneficiaries (dependents and retired service members) would result in a potential annual savings of 11,000 hospital bed days. If implemented using stringent criteria for training and certification, these savings could be achieved with no increase in patient morbidity or mortality and with significant improvement in patient outcome. PMID:1302477

  14. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... been furnished by an ASC in the same geographic area. (c) Payment principle. The aggregate amount of... of time beginning with the first day of a hospital's cost reporting period that begins on or...

  15. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... been furnished by an ASC in the same geographic area. (c) Payment principle. The aggregate amount of... of time beginning with the first day of a hospital's cost reporting period that begins on or...

  16. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... been furnished by an ASC in the same geographic area. (c) Payment principle. The aggregate amount of... of time beginning with the first day of a hospital's cost reporting period that begins on or...

  17. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... been furnished by an ASC in the same geographic area. (c) Payment principle. The aggregate amount of... of time beginning with the first day of a hospital's cost reporting period that begins on or...

  18. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... been furnished by an ASC in the same geographic area. (c) Payment principle. The aggregate amount of... of time beginning with the first day of a hospital's cost reporting period that begins on or...

  19. The Prevalence of HIV in Cancer Patients at the Surgical Oncology Unit of Donka University Hospital of Conakry (Guinea)

    PubMed Central

    Traore, Bangaly; Bah, Thierno Souleymane; Traore, Fode Amara; Sow, Mamadou Saliou; Diane, Solomana; Keita, Mamady; Cisse, Mohamed; Koulibaly, Moussa; Camara, Naby Daouda

    2015-01-01

    Aim. To determine the prevalence of HIV infection among patients seen at the surgical oncology unit of Donka (Conakry, Guinea). Method. We conducted a retrospective and descriptive study of HIV infection in cancer patients from May 2007 to December 2012. Social characteristics (age, gender, marital status, and education) and immune status (HIV type, CD4 count) were reviewed. Results. Out of 2598 cancer patients, 54 (2.1%) tested positive for HIV. There were 11 (20.4%) defining AIDS and 43 (79.6%) nondefining AIDS cancers. The most frequent cancers were breast (14) (26.0%), non-Hodgkin lymphoma (6) (11.1%), liver (6) (11.1%), eye and annexes (6) (11.1%), and cervical cancer (5) (9.3%). These patients were female in 34 (63.0%) and had a median age of 39 years and body mass index was 20,3?Kg/m2. They were unschooled in 40 (74.1%) and married in 35 (64.8%). CD4 count showed a median of 317?cells/mL. Antiretroviral treatment was performed in 40 (74.1%). Conclusion. HIV prevalence is higher in patients in our unit of surgical oncology. Breast cancer was the most common in this association. A national survey of a large sample is needed to determine the true prevalence and impact of HIV on cancer prognosis. PMID:26770197

  20. Army orthopaedic surgery residency program directors' selection criteria.

    PubMed

    Orr, Justin D; Hoffmann, Jeffrey D; Arrington, Edward D; Gerlinger, Tad L; Devine, John G; Belmont, Philip J

    2015-01-01

    Factors associated with successful selection in U.S. Army orthopaedic surgical programs are unreported. The current analysis includes survey data from all Army orthopaedic surgery residency program directors (PDs) to determine these factors. PDs at all Army orthopaedic surgery residency programs were provided 17 factors historically considered critical to successful selection and asked to rank order the factors as well as assign a level of importance to each. Results were collated and overall mean rankings are provided. PDs unanimously expressed that performance during the on-site orthopaedic surgery rotation at the individual program director's institution was most important. Respondents overwhelmingly reported that Steps 1 and 2 licensing exam scores were next most important, respectively. Survey data demonstrated that little importance was placed on letters of recommendation and personal statements. PDs made no discriminations based on allopathic or osteopathic degrees. The most important factors for Army orthopaedic surgery residency selection were clerkship performance at the individual PD's institution and licensing examination score performance. Army PDs consider both USMLE and COMLEX results, because Army programs have a higher percentage of successful osteopathic applicants. PMID:25988694

  1. Knowledge, Practice, and Associated Factors towards Prevention of Surgical Site Infection among Nurses Working in Amhara Regional State Referral Hospitals, Northwest Ethiopia

    PubMed Central

    Teshager, Freahiywot Aklew; Engeda, Eshetu Haileselassie; Worku, Workie Zemene

    2015-01-01

    Knowledge and practice of nurses about surgical site infections (SSIs) are not well studied in Ethiopia. This paper contains findings about Northwest Ethiopian nurses' knowledge and practice regarding the prevention of SSIs. The main objective of the study was to assess knowledge, practice, and associated factors of nurses towards the prevention of SSIs. The study was done using a questionnaire survey on randomly selected 423 nurses who were working in referral hospitals during the study period. The study showed that more than half of the nurses who participated in the survey had inadequate knowledge about the prevention of SSIs. Moreover, more than half of them were practicing inappropriately. The most important associated factors include lack of training on evidence based guidelines and sociodemographic variables (age, year of service, educational status, etc.). Training of nurses with the up-to-date SSIs guidelines is recommended. PMID:26788549

  2. [Prognosis of acute intestinal intussusception in infants at the national hospital of Niamey (Niger). Eleven cases treated surgically].

    PubMed

    Harouna, Y; Tardivel, G; Abdou, I; Gamatie, Y; Mariama, S; Bia, M

    1997-01-01

    In order to precise the different prognosised factors of the acute intestinal invagination of the nursling, authors hereby report results of a prospective study lead in the department of general surgery during the period of January 1989 to August 1990. Eleven nursling have been operated during that period. The study of their files showed that the standard clinical triad of the acute intestinal invagination theoretically taught in the schools of health sciences, is never definitive. The diagnostic lateness and indeed therapeutic and the lack of adequate means of pediatric resuscitation constituted the main prognosised factors of this affection. The clinical board of the patients is that of an advanced occlusion or that of a serious peritonis. The surgical operation often consisted in an intestinal resection. The immediate mortality was heavy: 55%. The authors hereby stress the necessity of a training-informing-sensitizing of the health staff in the primary sanitary facilities and the populations. PMID:9264747

  3. Factors Associated with Total Inpatient Costs and Length of Stay among Veterans with Lower Extremity Amputation during the Surgical Hospitalization

    PubMed Central

    Kurichi, Jibby E.; Vogel, W. Bruce; Kwong, Pui L.; Xie, Dawei; Bates, Barbara E.; Stineman, Margaret G.

    2013-01-01

    Objective To identify patient- and facility-level factors associated with total inpatient costs and length of stay (LOS) among veterans with lower extremity amputation. Design Patient data for 1,536 veterans were compiled from 9 databases from the Veterans Health Administration between October 1, 2002, and September 30, 2003. Linear mixed models were used to identify factors associated with the natural logarithm of total inpatient costs and LOS. Results Statistically significant factors associated with both higher total inpatient costs and longer LOS included admission by transfer from another hospital, systemic sepsis, arrhythmias, chronic blood loss anemia, fluid and electrolyte disorders, weight loss, specialized inpatient rehabilitation, and larger hospital bed sizes. Device infection, coagulopathy, solid tumor without metastasis, CARF accreditation, and Medicare Wage Index were only associated with higher total inpatient costs. Factors only associated with longer LOS included older age, not being married, previous amputation complication, congestive heart failure, deficiency anemias, and paralysis. Conclusions Most drivers of total inpatient costs were similar to those that increased LOS with a few exceptions. These findings may have implications for projecting future health care costs, and thus could be important in efforts to reducing costs, understanding LOS, and refining payment and budgeting policies. PMID:23117271

  4. Photocopy of post card from Fitzsimons Army Medical Center Public ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of post card from Fitzsimons Army Medical Center Public Affairs Office, building 120. Photograph by Rocky Mountain photo. CO was no copyrighted and is , therefore, in the public domain. - Fitzsimons General Hospital, Memorial Tablet, West McAfee, South of Building No. 524, Aurora, Adams County, CO

  5. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover). Photograph of south side before perpendicular wing added. - Fitzsimons General Hospital, Carpenter Shop Building, Southwest Corner of West I Avenue, & North Tenth Street, Aurora, Adams County, CO

  6. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover). Photograph taken before Sept. 29, 1934 when the revised Real Property form on building 257 was completed. - Fitzsimons General Hospital, Building 257, North side of East O'Neill Avenue, between Tenth & Twelfth Streets, Aurora, Adams County, CO

  7. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), north and east sides of the east/west wing. - Fitzsimons General Hospital, General Mess & Kitchen, Southwest Corner of East McAfee Avenue & South Twelfth Street, Aurora, Adams County, CO

  8. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property book (green cloth cover), showing east and most of south sides. - Fitzsimons General Hospital, Assembly Hall School, Northeast Corner of West McCloskey Avenue & North Tenth Street, Aurora, Adams County, CO

  9. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover). Photograph taken before Sept. 29, 1934 when the revised Real Property form on building 256 was completed. - Fitzsimons General Hospital, Building 256, North side of East O'Niell Avenue, between Tenth & Twelfth Streets, Aurora, Adams County, CO

  10. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), probably west and north sides. - Fitzsimons General Hospital, Officer Patient's Mess & Kitchen, Northeast Corner of West McAfee Avenue & South Hickey Street, Aurora, Adams County, CO

  11. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), showing part of east side and most of north side. - Fitzsimons General Hospital, Quartermaster's Storehouse, Southwest Corner of East I Avenue & North Twelfth Street, Aurora, Adams County, CO

  12. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), south and north sides. - Fitzsimons General Hospital, Physiotherapy & Electrocardiograph Department Building, North of Building No. 516, East of corridor connecting Building No. 511 to Building No. 515, Aurora, Adams County, CO

  13. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), south and west sides of buildings no. 719, now the north wing of building no. 508. - Fitzsimons General Hospital, Nurses' Mess & Kitchen, Nurses' Recreation, West McAfee Avenue, North of Building 507, Aurora, Adams County, CO

  14. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), east and south sides of building no. 715, now the south wing of building no. 508. - Fitzsimons General Hospital, Nurses' Mess & Kitchen, Nurses' Recreation, West McAfee Avenue, North of Building 507, Aurora, Adams County, CO

  15. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), south side. - Fitzsimons General Hospital, Red Cross Building, South Eighth Street Bounded by West McAfee Avenue on South & West Harlow Avenue on North, Aurora, Adams County, CO

  16. Photocopy of photograph from Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from Fitzsimons Army Medical Center real property book (green cloth cover), showing building 225's west and a north sides. This photograph is included because it shows how the west side of building 221 looked before the corridor between buildings 220 and 221 was added and because building 225 was built to the same plan as building 221. - Fitzsimons General Hospital, Hospital Corps Barracks, East Harlow Street, East of Building No. 220, Aurora, Adams County, CO

  17. Erectile Dysfunction Among Men Attending Surgical Outpatients Department in a Tertiary Hospital in South-Western Nigeria

    PubMed Central

    Takure, Augustine O; Adebayo, Sikiru A; Okeke, Linus I; Olapade-Olaopa, Emiola Oluwabunmi; Shittu, Olayiwola B

    2016-01-01

    Background: Erectile dysfunction is becoming a public health issue with high incidences reported in community studies. Objective: To evaluate the characteristics and outcome of treatment in men with erectile dysfunction in a tertiary center in Ibadan southwestern Nigeria. Methods: Data of men with erectile dysfunction was retrieved between July 2004 and June 2014 and analyzed using SPSS version 16 statistical software. Results: Eighty-nine men with erectile dysfunction were managed which constituted 2% of all urological cases seen during the study period. Their median and mean ages were 39 years and 39.6 ± 1.2SD (range 19-76 years). The peak age incidence at 30-44 years was 41.6% and reduced with increasing age after 65 years to 4.5%. The etiologies were psychogenic in 55%, organic in 27%, idiopathic in 17% and 1% was familial. 67.5%, 31.5% and 3.4% were married, single and separated respectively. Seventy percent neither smoked cigarette nor drank alcohol, 21.3% drank alcohol and 9% took both alcohol and smoked cigarette. Seventy seven and half percent of men presented within 5 years of their symptom. The treatments offered were PDE type 5 inhibitors alone or in combination with psychotherapy or modification of medications. The outcome of these treatments ranged from 89% to 91% success rate. Conclusion: The number of men with erectile dysfunction managed in the tertiary hospital is very low though the outcome of treatment is within acceptable range. Increase public enlightenment may encourage increase hospital patronage and access to the available treatments for erectile dysfunction. PMID:27013856

  18. Comparison of Inhospital Outcomes of Surgical Aortic Valve Replacement in Hospitals With and Without Availability of a Transcatheter Aortic Valve Implantation Program (from a Nationally Representative Database).

    PubMed

    Singh, Vikas; Badheka, Apurva O; Patel, Samir V; Patel, Nileshkumar J; Thakkar, Badal; Patel, Nilay; Arora, Shilpkumar; Patel, Nish; Patel, Achint; Savani, Chirag; Ghatak, Abhijit; Panaich, Sidakpal S; Jhamnani, Sunny; Deshmukh, Abhishek; Chothani, Ankit; Sonani, Rajesh; Patel, Aashay; Bhatt, Parth; Dave, Abhishek; Bhimani, Ronak; Mohamad, Tamam; Grines, Cindy; Cleman, Michael; Forrest, John K; Mangi, Abeel

    2015-10-15

    We hypothesized that the availability of a transcatheter aortic valve implantation (TAVI) program in hospitals impacts the overall management of patients with aortic valve disease and hence may also improve postprocedural outcomes of conventional surgical aortic valve replacement (SAVR). The aim of the present study was to compare the inhospital outcomes of SAVR in centers with versus without availability of a TAVI program in an unrestricted large nationwide patient population >50 years of age. SAVRs performed on patients aged >50 years were identified from the Nationwide Inpatient Sample (NIS) for the years 2011 and 2012 using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. SAVR cases were divided into 2 categories: those performed at hospitals with a TAVI program (SAVR-TAVI) and those without (SAVR-non-TAVI). A total of 9,674 SAVR procedures were identified: 4,526 (46.79%) in the SAVR-TAVI group and 5,148 (53.21%) in SAVR-non-TAVI group. The mean age of the study population was 70.2 ± 0.1 years with majority (53%) of the patients aged >70 years. The mean Charlson's co-morbidity score for patients in SAVR-TAVI group was greater (greater percentage of patients were aged >80 years, had hypertension, congestive heart failure, renal failure, and peripheral arterial disease) than that of patients in SAVR-non-TAVI group (1.6 vs 1.4, p <0.001). The propensity score matching analysis showed a statistically significant lower inhospital mortality (1.25% vs 1.72%, p = 0.001) and complications rate (35.6% vs 37.3%, p = 0.004) in SAVR-TAVI group compared to SAVR-non-TAVI group. The mean length of hospital stay was similar in the 2 groups the cost of hospitalization was higher in the SAVR-TAVI group ($43,894 ± 483 vs $41,032 ± 473, p <0.0001). Having a TAVI program was a significant predictor of reduced mortality and complications rate after SAVR in multivariate analysis. In conclusion, this largest direct comparative analysis demonstrates that SAVRs performed in centers with a TAVI program are associated with significantly lower mortality and complications rates compared to those performed in centers without a TAVI program. PMID:26297512

  19. Simple interventions can greatly improve clinical documentation: a quality improvement project of record keeping on the surgical wards at a district general hospital.

    PubMed

    Glen, Peter; Earl, Naomi; Gooding, Felix; Lucas, Emily; Sangha, Nicole; Ramcharitar, Steve

    2015-01-01

    Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk. The aim of this quality improvement project was therefore to improve the standard of documentation, the labelling of notes and the overall filing. A baseline audit was firstly undertaken assessing the notes within the busiest surgical ward. A number of variables were assessed, but notably, only 12% (4/33) of the case notes were found to be without loose pages. Furthermore, less than half of the pages with entries written within the last 72 hours contained adequate patient identifiers on them. When assessing these entries further, the designation of the writer was only recorded in one third (11/33) of the cases, whilst the printed name of the writer was only recorded in 65% (21/33) of the entries. This project ran over a 10 month period, using a plan, do study, act methodology. Initial focus was on simple education. Afterwards, single admission folders were introduced, to contain only information required for that admission, in an attempt to streamline the notes and ease the filing. This saw a global improvement across all data subsets, with a sustained improvement of over 80% compliance seen. An educational poster was also created and displayed in clinical areas, to remind users to label their notes with patient identifying stickers. This saw a 4-fold increase (16%-68%) in the labelling of notes. In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care. PMID:26734440

  20. Simple interventions can greatly improve clinical documentation: a quality improvement project of record keeping on the surgical wards at a district general hospital

    PubMed Central

    Glen, Peter; Earl, Naomi; Gooding, Felix; Lucas, Emily; Sangha, Nicole; Ramcharitar, Steve

    2015-01-01

    Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk. The aim of this quality improvement project was therefore to improve the standard of documentation, the labelling of notes and the overall filing. A baseline audit was firstly undertaken assessing the notes within the busiest surgical ward. A number of variables were assessed, but notably, only 12% (4/33) of the case notes were found to be without loose pages. Furthermore, less than half of the pages with entries written within the last 72 hours contained adequate patient identifiers on them. When assessing these entries further, the designation of the writer was only recorded in one third (11/33) of the cases, whilst the printed name of the writer was only recorded in 65% (21/33) of the entries. This project ran over a 10 month period, using a plan, do study, act methodology. Initial focus was on simple education. Afterwards, single admission folders were introduced, to contain only information required for that admission, in an attempt to streamline the notes and ease the filing. This saw a global improvement across all data subsets, with a sustained improvement of over 80% compliance seen. An educational poster was also created and displayed in clinical areas, to remind users to label their notes with patient identifying stickers. This saw a 4-fold increase (16%-68%) in the labelling of notes. In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care. PMID:26734440

  1. Medical errors and consequent adverse events in critically ill surgical patients in a tertiary care teaching hospital in Delhi

    PubMed Central

    Kumar, Sunil; Chaudhary, Sujata

    2009-01-01

    Background: Medical errors and adverse events (AE), though common worldwide, have never been studied in India. We believe that though common these are under reported. Aim: The aim of this study was to study medical errors and consequent AE in patients presenting with trauma and bowel perforation peritonitis. Methods: Five hundred and eighty-six consecutive patients with trauma or peritonitis, presenting to surgery emergency of UCMS-GTBH, were prospectively studied using review form (RF) 1 and 2. AE was defined as an outcome not expected to be part of the illness. RF 1 was filled for all and indicated if AE was present or not. RF2 was filled when RF 1 indicated presence of AE; it further confirmed the occurrence of AE and pointed to the type of medical error and resultant disability. All results were expressed as percentage. Results: There were 500 (85%) males. Mean age of the patients was 31 years. There were 332 patients with peritonitis and 254 with trauma. AE and its consequences were present in 185 (31.5%) and 183 (31.2%) patients, respectively. Consequences were as follows: disability – 157 (85%), increased hospital stay and/or increased visits in the OPD – 28 (15.3%) and both-101 (55.2%) patients. Disabilities were: death – 62 (40%), temporary disability – 90 (58%) and permanent disability – 05 (3.1%) patients. AE in 133 (71.8%) patients was definitely (level of confidence 6) due to error in healthcare management. All AE were considered preventable. Error of omission accounted for AE in 122 (65.9%) patients. System and operative errors were the commonest, 84.3% and 82.7%, respectively. One hundred and sixty-seven (90%) patients had multiple errors. Conclusions: The study proves that medical errors and AE are a serious problem in our set-up and calls for immediate system improvement. PMID:19561965

  2. Drug utilisation and off-label use of medications in anaesthesia in surgical wards of a teaching hospital

    PubMed Central

    Patil, Amol E; Shetty, Yashashri C; Gajbhiye, Snehalata V; Salgaonkar, Sweta V

    2015-01-01

    Background and Aims: When a drug is used in a way that is different from that described in regulatory body approved drug label, it is said to be ‘off label use’. Perioperative phase is sensitive from the point of view of patient safety and off-label drug use in this setup can prove to be hazardous to patient. Hence, it was planned to assess the pattern of drug utilisation and off-label use of perioperative medication during anaesthesia. Methods: Preoperatively, demographic details and adverse events check list were filled from a total of 400 patients from general surgery, paediatric surgery and orthopaedics departments scheduled to undergo surgery. The perioperative assessment form was assessed to record all prescriptions followed by refilling of adverse events checklist in case record form. World Health Organization (WHO) prescribing indicators were used for analysis of drug utilisation data. National Formulary of India 2011 was used as reference material to decide off-label drug use in majority instances along with package insert. Results: A total of 3705 drugs were prescribed to the 400 participants and average number of drugs per patient was 9.26 ± 3.33. Prescriptions by generic name were 68.07% whereas 85.3% drugs were prescribed from hospital schedule. Off-label drugs overall formed 20.19% of the drugs prescribed. At least one off-label drug was prescribed to 82.5% of patients. Inappropriate dose was the most common form of off-label use. There was 1.6 times greater risk of occurrence of adverse events associated with the use of off-label drugs. Conclusion: Prescription indicators were WHO compliant. Off-label drug use was practiced in anaesthesia department with questionable clinical justification in some instances. PMID:26755837

  3. Predicting emergency coronary artery bypass graft following PCI: application of a computational model to refer patients to hospitals with and without onsite surgical backup

    PubMed Central

    Syed, Zeeshan; Moscucci, Mauro; Share, David; Gurm, Hitinder S

    2015-01-01

    Background Clinical tools to stratify patients for emergency coronary artery bypass graft (ECABG) after percutaneous coronary intervention (PCI) create the opportunity to selectively assign patients undergoing procedures to hospitals with and without onsite surgical facilities for dealing with potential complications while balancing load across providers. The goal of our study was to investigate the feasibility of a computational model directly optimised for cohort-level performance to predict ECABG in PCI patients for this application. Methods Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry data with 69 pre-procedural and angiographic risk variables from 68 022 PCI procedures in 2004–2007 were used to develop a support vector machine (SVM) model for ECABG. The SVM model was optimised for the area under the receiver operating characteristic curve (AUROC) at the level of the training cohort and validated on 42 310 PCI procedures performed in 2008–2009. Results There were 87 cases of ECABG (0.21%) in the validation cohort. The SVM model achieved an AUROC of 0.81 (95% CI 0.76 to 0.86). Patients in the predicted top decile were at a significantly increased risk relative to the remaining patients (OR 9.74, 95% CI 6.39 to 14.85, p<0.001) for ECABG. The SVM model optimised for the AUROC on the training cohort significantly improved discrimination, net reclassification and calibration over logistic regression and traditional SVM classification optimised for univariate performance. Conclusions Computational risk stratification directly optimising cohort-level performance holds the potential of high levels of discrimination for ECABG following PCI. This approach has value in selectively referring PCI patients to hospitals with and without onsite surgery. PMID:26688738

  4. 76 FR 70710 - Army National Cemeteries Advisory Commission (ANCAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-15

    ... Department of the Army Army National Cemeteries Advisory Commission (ANCAC) AGENCY: Department of the Army... the Army announces the following committee meeting: Name of Committee: Army National Cemeteries... first-come basis. FOR FURTHER INFORMATION CONTACT: Lieutenant Colonel Renea Yates;...

  5. 76 FR 72914 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-28

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF DEFENSE Department of the Army Army Educational Advisory Committee AGENCY: Department of the Army, DoD. ACTION... 102-3.150, the following meeting notice is announced: Name of Committee: U.S. Army War...

  6. 78 FR 18473 - Army Privacy Act Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-27

    ... Register (71 FR 46052), the Department of the Army issued a final rule. This final rule corrects the... Department of the Army 32 CFR Part 505 Army Privacy Act Program AGENCY: Department of the Army, DoD. ACTION... Litigation Division when complaints citing the Privacy Act are filed in order to correct the mailing...

  7. The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study.

    PubMed

    Jones, Andrew R; Williams, Tim; Paringe, Vishal; White, Simon P

    2016-02-01

    The number of total hip replacements taking place across the UK continues to grow. In an ageing population, with people placing greater demands on their prostheses, the number of peri-prosthetic fractures is increasing. We studied the economic impact this has on a large teaching hospital. All patients with peri-prosthetic femoral fracture in a 7.5year period were identified. Radiographic and case note analysis was performed. Costings from the finance departments were obtained. 90 cases were identified, 58 female and 32 male, with a mean age of 76 (range: 38-91). 89 of the cases were managed surgically, 66% undergoing revision and 33% receiving open reduction and internal fixation. According to the Vancouver Classification, 3% were Type A, 79% Type B and 18% Type C. The mean length of stay was 43days. The mean cost of management was ÂŁ31,370 (range: ÂŁ6885-ÂŁ112,327). Patients with type C fractures had the highest mean length of stay at 53 days and mean cost of ÂŁ33,417. Including rehabilitation costs, our study illustrated a mean cost of ÂŁ31,370, roughly four times the current basic NHS tariff of ÂŁ8552. Although implant costs are greater, treatment with revision where appropriate allows earlier weight bearing, reduced length of stay and lower overall cost. PMID:26689495

  8. Abortion - surgical

    MedlinePLUS

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  9. Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting

    PubMed Central

    2012-01-01

    Background Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting. Methods This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15. Results A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1). Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8%) perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2%) patients were HIV positive with a median CD4+ count of 261 cells/ÎĽl. The perforation-surgery interval was more than 72 hours in 90(86.5%) patients. The majority of patients (84.6%) had single perforations and ileum was the most common part of the bowel affected occurring in 86.2% of cases. Simple closure of the perforations was the most commonly performed procedure accounting for 78.8% of cases. Postoperative complication rate was 39.4% and surgical site infection was the most frequent complication in 55.5% of cases. Mortality rate was 23.1% and it was statistically significantly associated with delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (< 200 cells/ÎĽl), high ASA classes (III-V), delayed operation, multiple perforations, severe peritoneal contamination and presence of postoperative complications (P < 0.001). The median overall length of hospital stay was 28 days. Conclusion Typhoid intestinal perforation is still endemic in our setting and carries high morbidity and mortality. This study has attempted to determine the factors that statistically influence mortality in typhoid perforation in our environment. Appropriate measures focusing at these factors are vital in order to deliver optimal care for these patients in this region. PMID:22401289

  10. Suicide in the US Army

    PubMed Central

    Lineberry, Timothy W.; O'Connor, Stephen S.

    2012-01-01

    Suicide in the US Army is a high-profile public health problem that is complex and poorly understood. Adding to the confusion surrounding Army suicide is the challenge of defining and understanding individuals/populations dying by suicide. Data from recent studies have led to a better understanding of risk factors for suicide that may be specifically associated with military service, including the impact of combat and deployment on increased rates of psychiatric illness in military personnel. The next steps involve applying these results to the development of empirically supported suicide prevention approaches specific to the military population. This special article provides an overview of suicide in the Army by synthesizing new information and providing clinical pearls based on research evidence. PMID:22958991

  11. Army utilities privatization - heating systems

    SciTech Connect

    1996-11-01

    The purpose of this paper is to present Army strategy for modernizing and improving the efficiency and reliability of providing utility services at our installations. The utilities infrastructure is old, inefficient and generally in fair to poor condition. Army installations of the 21st century will rely more heavily than ever before on the private sector to provide services that are not essential Army missions. Army utilities maintenance and repair (M&R) activities have historically not competed well for resources against other core missions. The funding for M&R has been less than one percent of the Plant Replacement Value. Total plant and distribution system modernization have been the rare exceptions. The installations find it increasingly more difficult to obtain the needed repair parts and services to keep operating. It is getting harder to staff operations with skilled employees. The environmental and safety requirements of the past 25 years have had adverse impacts on the installations ability to operate effectively. Our installations have used a variety of innovative means to keep their old systems operating. However, there has been no central Army direction to the installations on any preferred course of action - till now. The Army has determined that private sector participation in all phases of the utility (gas, electric, water, waste water and heating) systems is essential to meet mission requirements on a reliable basis. We already contract for a large number and type of services required at the installations. One out of four installations contracts with local municipal or investor owned utilities for water supply and sewage disposal. An even greater number contract out their solid waste collection and disposal. Installations have always purchased their wholesale electrical and natural gas energy from utility companies.

  12. Army ground robotics research program

    NASA Astrophysics Data System (ADS)

    Bornstein, Jonathan A.

    2002-07-01

    The U.S. Army has committed to a paradigm shift in the way future ground military operations will be conducted. It envisions highly mobile, lethal, and survivable forces that seamlessly combine manned and unmanned elements. To support this vision, the U.S. Army Research Laboratory, together with an alliance of government, industrial and academic organizations, has embarked upon a concerted research program focusing upon development of the technologies required for autonomous ground mobility by unmanned systems. This paper will discuss technical activities of the past year and research directions for the future.

  13. Postoperative Complications, In-Hospital Mortality and 5-Year Survival After Surgical Resection for Patients with a Pancreatic Neuroendocrine Tumor: A Systematic Review.

    PubMed

    Jilesen, Anneke P J; van Eijck, Casper H J; In't Hof, K H; van Dieren, S; Gouma, Dirk J; Nieveen van Dijkum, Els J M

    2016-03-01

    Studies on postoperative complications and survival in patients with pancreatic neuroendocrine tumors (pNET) are sparse and randomized controlled trials are not available. We reviewed all studies on postoperative complications and survival after resection of pNET. A systematic search was performed in the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE from 2000-2013. Inclusion criteria were studies of resected pNET, which described postoperative complications separately for each surgical procedure and/or 5-year survival after resection. Prospective and retrospective studies were pooled separately and overall pooled if heterogeneity was below 75 %. The random-effect model was used. Overall, 2643 studies were identified and after full-text analysis 62 studies were included. Pancreatic fistula (PF) rate of the prospective studies after tumor enucleation was 45 %; PF-rates after distal pancreatectomy, pancreatoduodenectomy, or central pancreatectomy were, respectively, 14-14-58 %. Delayed gastric emptying rates were, respectively, 5-5-18-16 %. Postoperative hemorrhage rates were, respectively, 6-1-7-4 %. In-hospital mortality rates were, respectively, 3-4-6-4 %. The 5-year overall survival (OS) and disease-specific survival (DSS) of resected pNET without synchronous resected liver metastases were, respectively, 85-93 %. Heterogeneity between included studies on 5-year OS in patients with synchronous resected liver metastases was too high to pool all studies. The 5-year DSS in patients with liver metastases was 80 %. Morbidity after pancreatic resection for pNET was mainly caused by PF. Liver resection in patients with liver metastases seems to have a positive effect on DSS. To reduce heterogeneity, ISGPS criteria and uniform patient groups should be used in the analysis of postoperative outcome and survival. PMID:26661846

  14. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), apparently showing west side of building 732. In 1921, buildings 732 and 733 were combined and it is assumed that this photograph, which was taken after 1921, shows the section added to make buildings 732 and 733 once continuous building. - Fitzsimons General Hospital, Storehouses, Northwest Corner of East Harlow Avenue & North Thirteenth Street, Aurora, Adams County, CO

  15. 76 FR 66282 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-26

    ... CFR 102-3.150, the following meeting notice is announced: Name of Committee: U.S. Army War College....S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall, Carlisle... continued growth and development of the United States Army War College. FOR FURTHER INFORMATION CONTACT:...

  16. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Army policy. 631.14 Section 631.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL...-Installation Operations (Military Patrols and Investigative Activities) and Policy § 631.14 Army policy....

  17. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Army policy. 631.14 Section 631.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL...-Installation Operations (Military Patrols and Investigative Activities) and Policy § 631.14 Army policy....

  18. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Army policy. 631.14 Section 631.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL...-Installation Operations (Military Patrols and Investigative Activities) and Policy § 631.14 Army policy....

  19. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Army policy. 631.14 Section 631.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL...-Installation Operations (Military Patrols and Investigative Activities) and Policy § 631.14 Army policy....

  20. The evolution of military neurosurgery in the Turkish army.

    PubMed

    Izci, Yusuf

    2010-05-01

    The history of neurosurgery in the Turkish army is not long and complex. Neurosurgery was first practiced in the Ottoman army by Cemil Pasha, who was a general surgeon. After the fall of the Ottoman Empire, the Republic of Turkey was established and modern neurosurgical procedures were applied at the Gulhane Military Medical Academy (GMMA). Maj. Zinnur Rollas, M.D., was the founder of the Department of Neurosurgery at GMMA in 1957. A modern neurosurgical program and school was established in 1965 by Col. Hamit Ziya Gokalp, M.D., who completed his residency training in the US. Today, 26 military neurosurgeons are on active duty in 11 military hospitals in Turkey. All of these neurosurgeons work in modern clinics and operating theaters. In this paper, military neurosurgery in the Turkish army is reported in 3 parts: 1) the history of neurosurgery in the Turkish military, 2) the Department of Neurosurgery at the GMMA, and 3) the duties of a military neurosurgeon in the Turkish army. PMID:20568932

  1. Army Precision at Central Headquarters

    ERIC Educational Resources Information Center

    Goldman, Jay P.

    2005-01-01

    William "Rob" Roberts wasn't thinking about working as a professional educator, much less running a major school system, when he decided he'd had enough of formal schooling himself at age 19. Rather, he dreamed of big adventures, flying combat aircraft for the military. When he discovered the U.S. Army didn't insist on two years of college, only…

  2. Army Precision at Central Headquarters

    ERIC Educational Resources Information Center

    Goldman, Jay P.

    2005-01-01

    William "Rob" Roberts wasn't thinking about working as a professional educator, much less running a major school system, when he decided he'd had enough of formal schooling himself at age 19. Rather, he dreamed of big adventures, flying combat aircraft for the military. When he discovered the U.S. Army didn't insist on two years of college, only…

  3. 77 FR 9633 - Army National Cemeteries Advisory Commission (ANCAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-17

    ... Department of the Army Army National Cemeteries Advisory Commission (ANCAC) AGENCY: Department of the Army... Army announces the following committee meeting: Name of Committee: Army National Cemeteries Advisory...: Lieutenant Colonel Renea Yates; renea-yates@us.army.mil or 571.256.4325. SUPPLEMENTARY INFORMATION:...

  4. Quality of referrals for elective surgery at a tertiary care hospital in a developing country: an opportunity for improving timely access to and cost-effectiveness of surgical care

    PubMed Central

    Gyedu, Adam; Baah, Emmanuel Gyasi; Boakye, Godfred; Ohene-Yeboah, Michael; Otupiri, Easmon; Stewart, Barclay T

    2015-01-01

    Introduction A disproportionate number of surgeries in low- and middle-income countries (LMICs) are performed in tertiary facilities. The referral process may be an under-recognized barrier to timely and cost-effective surgical care. This study aimed to assess the quality of referrals for surgery to a tertiary hospital in Ghana and identify ways to improve access to timely care. Methods All elective surgical referrals to Komfo Anokye Teaching Hospital for two consecutive months were assessed. Seven essential items in a referral were recorded as present or absent. The proportion of missing information was described and evaluated between facility, referring clinician type and whether or not a structured form was used. Results Of the 643 referrals assessed, none recorded all essential items. The median number of missing items was 4 (range 1 – 7). Clinicians that did not use a form missed 5 or more essential items 50% of the time, compared with 8% when a structured form was used (p=0.001). However, even with the use of a structured form, 1 or 2 items were not recorded for 10% of referrals and up to 3 items for 45% of referrals. Conclusion Structured forms reduce missing essential information on referrals for surgery. However, proposing that a structured form be used is not enough to ensure consistent communication of essential items. Referred patients may benefit from referrer feedback mechanisms or electronic referral systems. Though often not considered among interventions to improve surgical capacity in LMICs, referral process improvements may improve access to timely surgical care. PMID:25659222

  5. Role of Gymnastics in the Army School of Physical Training

    PubMed Central

    Griffiths, DE; Hargrove, R; Clasper, J

    2006-01-01

    INTRODUCTION As a result of a single spinal injury seen at Frimley Park Hospital, we reviewed the injuries recorded at the Army School of Physical Training since December 1996. PATIENTS AND METHODS This was a retrospective review of all acute accidents and injuries recorded in the Accident Book since its inception. RESULTS Over 75% of the injuries that were serious enough to result in soldiers having their training terminated were as a direct result of gymnastic events such as vaulting, trampolining and somersaults. These events were also responsible for most of the small number of career-threatening injuries. CONCLUSIONS This raises questions about the inclusion of gymnastic events in course training programmes, especially when considering its relevance to army training in general. PMID:17002850

  6. Surgical smoke.

    PubMed

    Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man

    2009-10-01

    Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown. PMID:19892630

  7. In the 'Grey Battalion': Launceston General Hospital nurses on active service in World War I.

    PubMed

    Harris, Kirsty

    2008-01-01

    Nearly fifty nurses from the Launceston General Hospital served with the Australian Army Nursing Service or the British nursing service during World War I. These nurses served in countries that included Egypt, France, India, Greece, Italy and England. They worked in various roles including as a surgical team nurse close to the front working under fire; nursing on hospital ships carrying the wounded; or managing wards overrun with patients on ships at Gallipoli in 1915, whilst dealing with a lack of hospital necessities. This case study, of one group of nurses, shows that their experiences reflected the skills and roles needed to be a military nurse of the time, significantly different to the skills required to nurse in Australia. PMID:20027738

  8. [Surgical devices].

    PubMed

    Ruhin, B; Zamojciowna, N; Louvel, B; Goudot, P

    2011-02-01

    Surgical devices mean the whole surgical department i.e., working space, useful tools for its good process and respect of its rules for the users. That working space obeys to strict rules relating to its conception, its building or the behaviour of people in that space. Working tools (furniture, material and surgical tools) have to respect requirements of the surgical team and the patients. The local rules respect will warrant optimal quality and efficiency. We will successively present architectural imperative rules and will detail arrangement of the surgeons preparing room and the real surgical space. PMID:21276996

  9. 76 FR 56406 - Science and Technology Reinvention Laboratory Demonstration Project; Department of the Army; Army...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-13

    .... SUMMARY: On March 7, 2011 (76 FR 12508-12548), DoD published notice of approval of a personnel management... the Army; Army Research, Development and Engineering Command; Tank Automotive Research, Development... 9, 2010. FOR FURTHER INFORMATION CONTACT: TARDEC: Mr. Gregory Berry, U. S. Army Tank...

  10. 77 FR 50089 - Army Education Advisory Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-20

    ... Department of the Army Army Education Advisory Committee Meeting AGENCY: Department of the Army, DoD. ACTION... following committee meeting: Name of Committee: Army Education Advisory Committee (AEAC). Date of Meeting... following address: Army Education Advisory Committee, Designated Federal Officer, ATTN: ATTG-OPS-EO...

  11. 77 FR 11084 - Army Education Advisory Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-24

    ... Department of the Army Army Education Advisory Committee Meeting AGENCY: Department of the Army, DoD. ACTION... following committee meeting: Name of Committee: Army Education Advisory Committee (AEAC). Date of Meeting... following address: Army Education Advisory Committee, Designated Federal Officer, Attn: ATTG-OPS-EI...

  12. 78 FR 60864 - Army Science Board Fall Plenary Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-02

    ... Department of the Army Army Science Board Fall Plenary Meeting AGENCY: Department of the Army, DoD. ACTION... following committee meeting: Name of Committee: Army Science Board (ASB) Fall Plenary Session. Date... Science Board members to review and deliberate on the FY14 Army Science Board study reports. Agenda:...

  13. 77 FR 21977 - Army Science Board Summer Study Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-12

    .... Purpose: Hear the preliminary findings of the Strategic Directions for Army Science and Technology and... Strategic Directions for Army Science & Technology study and vote on adoption. FOR FURTHER INFORMATION... Department of the Army Army Science Board Summer Study Meeting AGENCY: Department of the Army, DoD....

  14. 77 FR 40030 - Army Science Board Summer Study Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-06

    ... Department of the Army Army Science Board Summer Study Meeting AGENCY: Department of the Army, DoD. ACTION... following committee meeting: Name of Committee: Army Science Board (ASB). Date(s) of Meeting: July 26, 2012...: Adopt the findings and recommendations for the following studies: Strategic Direction for Army...

  15. 78 FR 33074 - Army Science Board Summer Study Session

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-03

    ... Department of the Army Army Science Board Summer Study Session AGENCY: Department of the Army, DoD. ACTION... following committee meeting: 1. Name of Committee: Army Science Board (ASB). 2. Date: Wednesday, July 17..., Colorado 80903-1685. 5. Purpose of Meeting: The purpose of the meeting is for Army Science Board members...

  16. Racial/Ethnic Differences in Receipt of Timely Adjuvant Therapy for Older Women with Breast Cancer: Are Delays Influenced by the Hospitals Where Patients Obtain Surgical Care?

    PubMed Central

    Freedman, Rachel A; He, Yulei; Winer, Eric P; Keating, Nancy L

    2013-01-01

    Objective To examine whether hospitals where patients obtain care explain racial/ethnic differences in treatment delay. Data Source Surveillance, Epidemiology, and End Results data linked with Medicare claims. Study Design We examined delays in adjuvant chemotherapy or radiation for women diagnosed with stage I–III breast cancer during 1992–2007. We used multivariable logistic regression to assess the probability of delay by race/ethnicity and included hospital fixed effects to assess whether hospitals explained disparities. Principal Findings Among 54,592 women, black (11.9 percent) and Hispanic (9.9 percent) women had more delays than whites (7.8 percent, p < .0001). After adjustment, black (vs. white) women had higher odds of delay (odds ratio = 1.25, 95 percent confidence interval = 1.10–1.42), attenuated somewhat by including hospital fixed effects (OR = 1.17, 95 percent CI = 1.02–1.33). Conclusions Hospitals are the important contributors to racial disparities in treatment delay. PMID:23663229

  17. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover). In that book, this photograph appears for building 706 was renumbered 353 and subsequently 202. The building in the photograph resembles building 204 more than it does building 202, but all Fitzsimons Real Property records indicate that the building in the photograph, showing west side, is early photograph of building 202. - Fitzsimons General Hospital, Motor Transport Garage, Northwest Corner of East Harlow Avenue, & North Twelfth Street, Aurora, Adams County, CO

  18. 76 FR 12087 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-04

    ... briefings; conduct discussions with the Commandant and staff and faculty; table and examine online College... 102-3.150, the following meeting notice is announced: Name of Committee: U.S. Army War College.... Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall,...

  19. 75 FR 7255 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-18

    ... briefings; conduct discussions with the Commandant and staff and faculty; table and examine online College... CFR 102-3.150, the following meeting notice is announced: Name of Committee: U.S. Army War College.... Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall,...

  20. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 4 2011-07-01 2011-07-01 false Army policy. 631.14 Section 631.14 National...-Installation Operations (Military Patrols and Investigative Activities) and Policy § 631.14 Army policy. (a... safeguard the health and welfare of Soldiers. (4) When the type of offenses or the number of...

  1. Education and Training in the Army.

    ERIC Educational Resources Information Center

    Westmoreland, W. C.

    Higher education and the military have much in common: both are vitally concerned with youth and in preparing young people for effective functioning in society. The army is heavily involved in education and training; in addition to West Point, there is an Army school system which consists of 2 colleges, 20 branch schools, and 11 specialist…

  2. Army Representativeness: The National Longitudinal Study.

    ERIC Educational Resources Information Center

    Purcell, Agnes C.; And Others

    This report provides graphical comparisons among four Army-relevant groups as to thirteen indices of representativeness. The four groups break the 1972 high school seniors down according to whether or not they planned to enter the Army and again according to whether or not they had done so within eighteen months. The thirteen indices extend beyond…

  3. 32 CFR 651.5 - Army policies.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... ENVIRONMENTAL ANALYSIS OF ARMY ACTIONS (AR 200-2) Introduction § 651.5 Army policies. (a) NEPA establishes broad federal policies and goals for the protection of the environment and provides a flexible framework for... each level. (4) Use of the scoping and public involvement processes to limit the analysis of issues...

  4. 32 CFR 651.5 - Army policies.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... ENVIRONMENTAL ANALYSIS OF ARMY ACTIONS (AR 200-2) Introduction § 651.5 Army policies. (a) NEPA establishes broad federal policies and goals for the protection of the environment and provides a flexible framework for... each level. (4) Use of the scoping and public involvement processes to limit the analysis of issues...

  5. 32 CFR 651.5 - Army policies.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... ENVIRONMENTAL ANALYSIS OF ARMY ACTIONS (AR 200-2) Introduction § 651.5 Army policies. (a) NEPA establishes broad federal policies and goals for the protection of the environment and provides a flexible framework for... each level. (4) Use of the scoping and public involvement processes to limit the analysis of issues...

  6. 32 CFR 651.5 - Army policies.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... ENVIRONMENTAL ANALYSIS OF ARMY ACTIONS (AR 200-2) Introduction § 651.5 Army policies. (a) NEPA establishes broad federal policies and goals for the protection of the environment and provides a flexible framework for... each level. (4) Use of the scoping and public involvement processes to limit the analysis of issues...

  7. Army Industrial, Landscaping, and Agricultural Water Use

    SciTech Connect

    McMordie Stoughton, Kate; Loper, Susan A.; Boyd, Brian K.

    2014-09-18

    The Pacific Northwest National Laboratory conducted a task for the Deputy Assistant Secretary of the Army to quantify the Army’s ILA water use and to help improve the data quality and installation water reporting in the Army Energy and Water Reporting System.

  8. Efficacy and safety of haloperidol prophylaxis for delirium prevention in older medical and surgical at-risk patients acutely admitted to hospital through the emergency department: study protocol of a multicenter, randomised, double-blind, placebo-controlled clinical trial

    PubMed Central

    2014-01-01

    Background Delirium is associated with substantial morbidity and mortality rates in elderly hospitalised patients, and a growing problem due to increase in life expectancy. Implementation of standardised non-pharmacological delirium prevention strategies is challenging and adherence remains low. Pharmacological delirium prevention with haloperidol, currently the drug of choice for delirium, seems promising. However, the generalisability of randomised controlled trial results is questionable since studies have only been performed in selected postoperative hip-surgery and intensive care unit patient populations. We therefore present the design of the multicenter, randomised, double-blind, placebo-controlled clinical trial on early pharmacological intervention to prevent delirium: haloperidol prophylaxis in older emergency department patients (The HARPOON study). Methods/Design In six Dutch hospitals, at-risk patients aged 70 years or older acutely admitted through the emergency department for general medicine and surgical specialties are randomised (n = 390) for treatment with prophylactic haloperidol 1 mg or placebo twice daily for a maximum of seven consecutive days. Primary outcome measure is the incidence of in-hospital delirium within seven days of start of the study intervention, diagnosed with the Confusion Assessment Method, and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for delirium. Secondary outcome measures include delirium severity and duration assessed with the Delirium Rating Scale Revised 98; number of delirium-free days; adverse events; hospital length-of-stay; all-cause mortality; new institutionalisation; (Instrumental) Activities of Daily Living assessed with the Katz Index of ADL, and Lawton IADL scale; cognitive function assessed with the Six-item Cognitive Impairment Test, and the Dutch short form Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be contacted by telephone three and six months post-discharge to collect data on cognitive- and physical function, home residency, all-cause hospital admissions, and all-cause mortality. Discussion The HARPOON study will provide relevant information on the efficacy and safety of prophylactic haloperidol treatment for in-hospital delirium and its effects on relevant clinical outcomes in elderly at-risk medical and surgical patients. Trial registration EudraCT Number: 201100476215; ClinicalTrials.gov Identifier: NCT01530308; Dutch Clinical Trial Registry: NTR3207 PMID:25168927

  9. 32 CFR 635.22 - Reserve component, U.S. Army Reserve, and Army National Guard personnel.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 4 2011-07-01 2011-07-01 false Reserve component, U.S. Army Reserve, and Army...) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL INVESTIGATIONS LAW ENFORCEMENT REPORTING Offense Reporting § 635.22 Reserve component, U.S. Army Reserve, and Army National Guard personnel....

  10. 32 CFR 635.22 - Reserve component, U.S. Army Reserve, and Army National Guard personnel.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Reserve component, U.S. Army Reserve, and Army...) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL INVESTIGATIONS LAW ENFORCEMENT REPORTING Offense Reporting § 635.22 Reserve component, U.S. Army Reserve, and Army National Guard personnel....

  11. 32 CFR 635.22 - Reserve component, U.S. Army Reserve, and Army National Guard personnel.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Reserve component, U.S. Army Reserve, and Army...) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL INVESTIGATIONS LAW ENFORCEMENT REPORTING Offense Reporting § 635.22 Reserve component, U.S. Army Reserve, and Army National Guard personnel....

  12. 32 CFR 635.22 - Reserve component, U.S. Army Reserve, and Army National Guard personnel.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Reserve component, U.S. Army Reserve, and Army...) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL INVESTIGATIONS LAW ENFORCEMENT REPORTING Offense Reporting § 635.22 Reserve component, U.S. Army Reserve, and Army National Guard personnel....

  13. 32 CFR 635.22 - Reserve component, U.S. Army Reserve, and Army National Guard personnel.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Reserve component, U.S. Army Reserve, and Army...) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL INVESTIGATIONS LAW ENFORCEMENT REPORTING Offense Reporting § 635.22 Reserve component, U.S. Army Reserve, and Army National Guard personnel....

  14. Dental care needs of Army recruits.

    PubMed Central

    Parker, W A; Mangelsdorff, A D; Brunner, D G

    1983-01-01

    To determine the prevalence amng current U.S. Army recruits of dental conditions requiring treatment, an assessment was done of the dental care needs of a 3 percent sample (N = 5,613) of incoming recruits at all seven U.S. Army reception stations that operate under a dental treatment planning concept. Both the treatment needs of the total sample and of each Army component--that is, Regular, Reserve, and National Guard forces--were quantified. The results indicated that the requirement for dental care among Army recruits currently being processed for training is approximately the same as it was for such recruits at the time that the Selective Service System draft was in effect, although the types of care needed have changed. Like the draft-based recruits, current Army recruits enter active-duty status with a substantial backlog of unmet dental care needs. PMID:6867262

  15. Health and Occupational Consequences of Spouse Abuse Victimization among Male U.S. Army Soldiers

    ERIC Educational Resources Information Center

    Bell, Nicole S.

    2009-01-01

    Little is known about health and occupational outcomes of male spouse abuse victims. In all, 11,294 male spouse abuse victims with a history of spouse abuse perpetration, 3,277 victims without prior spouse abuse perpetration, and 72,855 nonvictims and nonperpetrators were followed for 12 years to assess army attrition and hospitalization risk. In…

  16. Surgical Airway

    PubMed Central

    Patel, Sapna A; Meyer, Tanya K

    2014-01-01

    Close to 3% of all intubation attempts are considered difficult airways, for which a plan for a surgical airway should be considered. Our article provides an overview of the different types of surgical airways. This article provides a comprehensive review of the main types of surgical airways, relevant anatomy, necessary equipment, indications and contraindications, preparation and positioning, technique, complications, and tips for management. It is important to remember that the placement of a surgical airway is a lifesaving procedure and should be considered in any setting when one “cannot intubate, cannot ventilate”. PMID:24741501

  17. Modeling of Army Research Laboratory EMP simulators

    SciTech Connect

    Miletta, J.R.; Chase, R.J.; Luu, B.B. ); Williams, J.W.; Viverito, V.J. )

    1993-12-01

    Models are required that permit the estimation of emitted field signatures from EMP simulators to design the simulator antenna structure, to establish the usable test volumes, and to estimate human exposure risk. This paper presents the capabilities and limitations of a variety of EMP simulator models useful to the Army's EMP survivability programs. Comparisons among frequency and time-domain models are provided for two powerful US Army Research Laboratory EMP simulators: AESOP (Army EMP Simulator Operations) and VEMPS II (Vertical EMP Simulator II).

  18. Male parentage in army ants.

    PubMed

    Kronauer, Daniel J C; Schöning, Caspar; Boomsma, Jacobus J

    2006-04-01

    In most social insects workers do not mate, but have retained the ability to produce haploid eggs that can develop into viable male offspring. Under what circumstances this reproductive potential is realized and how the ensuing worker-queen conflict over male production is resolved, is an area of active research in insect sociobiology. Here we present microsatellite data for 176 males from eight colonies of the African army ant Dorylus (Anomma) molestus. Comparison with worker genotypes and inferred queen genotypes from the same colonies show that workers do not or at best very rarely reproduce in the presence of the queen. Queens of D. (A.) molestus are known to be highly multiply mated. This implies that workers are on average more closely related to queen sons than to other workers' sons, so that our results are consistent with predictions from inclusive fitness theory. It remains unknown, however, whether worker sterility is maintained by active worker policing or by self-restraint. PMID:16599973

  19. Energy Design Guides for Army Barracks: Preprint

    SciTech Connect

    Deru, M.; Zhivov, A.; Herron, D.

    2008-08-01

    The U.S. Army Corps of Engineers and NREL are developing target energy budgets and design guides to achieve 30% energy savings. This paper focuses the design guide for one type of barracks called unaccompanied enlisted personal housing.

  20. U.S. Army Medical Department

    MedlinePLUS

    ... of motivation and angry outbursts. Developing healthy coping skills and avoiding over-committing are essential to remain ... My Health Stories Image-3 Excerpt-7 Army Leader Tests the Peformance Triad Theresa Saville shares her ...

  1. U.S. Army Modernizes Munitions Plants

    ERIC Educational Resources Information Center

    Environmental Science and Technology, 1972

    1972-01-01

    Headquartered at Joliet, Illinois, the Army Ammunition Procurement and Supply Agency aims to mechanize and clean up its manufacturing facilities. Six go-co (government owned - contractor operated) plants involved in the modernization program are described. (BL)

  2. 42 CFR 482.51 - Condition of participation: Surgical services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Optional Hospital Services § 482.51 Condition of participation: Surgical services. If the hospital provides... of practice. If outpatient surgical services are offered the services must be consistent in...

  3. 42 CFR 482.51 - Condition of participation: Surgical services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Optional Hospital Services § 482.51 Condition of participation: Surgical services. If the hospital provides... of practice. If outpatient surgical services are offered the services must be consistent in...

  4. 42 CFR 482.51 - Condition of participation: Surgical services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Optional Hospital Services § 482.51 Condition of participation: Surgical services. If the hospital provides... of practice. If outpatient surgical services are offered the services must be consistent in...

  5. 42 CFR 482.51 - Condition of participation: Surgical services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Optional Hospital Services § 482.51 Condition of participation: Surgical services. If the hospital provides... of practice. If outpatient surgical services are offered the services must be consistent in...

  6. 42 CFR 482.51 - Condition of participation: Surgical services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Optional Hospital Services § 482.51 Condition of participation: Surgical services. If the hospital provides... of practice. If outpatient surgical services are offered the services must be consistent in...

  7. Photocopy of plan (in U.S. Army office of Army Engineers ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of plan (in U.S. Army office of Army Engineers plans and drawings, Fort Hancock and Sandy hook proving ground, record group 7, drawer 44, Cartographic and Architectural branc, The National Archives, Washington, DC) , Ordnance Dept. U.S. Army, proposed addition to dock at Sandy Hook, 1918 Ordnance wharf and boathouse - U.S. Coast Guard Sandy Hook Station, Western Docking Structure, West of intersection of Canfield Road & Hartshorne Drive, Highlands, Monmouth County, NJ

  8. Assuring structural integrity in Army systems

    NASA Technical Reports Server (NTRS)

    1985-01-01

    The object of this study was to recommend possible improvements in the manner in which structural integrity of Army systems is assured. The elements of a structural integrity program are described, and relevant practices used in various industries and government organizations are reviewed. Some case histories of Army weapon systems are examined. The mandatory imposition of a structural integrity program patterned after the Air Force Aircraft Structural Integrity Program is recommended and the benefits of such an action are identified.

  9. Surgical Mesh

    MedlinePLUS

    ... Devices Medical Device Safety Safety Communications Surgical Mesh: FDA Safety Communication Share Tweet Linkedin Pin it More ... and for how long? Reporting complications to the FDA In order to help FDA learn more about ...

  10. Surgical Technologists

    MedlinePLUS

    ... in place during the procedure, or set up robotic surgical equipment. Technologists also may handle specimens taken ... sterilization techniques, how to set up technical or robotic equipment, and preventing and controlling infections. In addition ...

  11. A simple measure to improve the rates of thromboprophylaxis prescription post surgical fixation of neck of femur fractures in a district general hospital

    PubMed Central

    Sinha, Pranab; Najefi, Ali-Asgar; Hambidge, John

    2014-01-01

    Neck of femur (NOF) fractures are a major public health concern because of the ageing population and higher incidence of fragility fractures. NOF fractures are associated with high mortality and morbidity rates, and there is a high risk of venous thromboembolism (VTE) after hip fractures (Ref 1). Therefore thromboprophylaxis is vital. Current NICE guidelines advocate 28 – 35 days of thromboprophylaxis after NOF fractures (Ref 1, 2). It came to our attention that patients post NOF fixation were getting variable prescriptions in regards to their thromboprophylaxis. Therefore a retrospective study on prescription of thromboprophylaxis was conducted from October 2012 to February 2013 within the trauma and orthopaedics department at Queens Hospital, Romford. Data was collected on all NOF fractures from electronic discharge summaries. Basic descriptive statistics were used to analysis the data. There were 110 cases of NOF fractures during this period. 100 patients were included since two were discounted as they were already on long term anticoagulants and eight patients died in hospital. No thromboprophylaxis was prescribed for 15 patients (15%). Three patients (3%) were prescribed less than 28 days (mean 14 days, range (14 – 14 days)). 69 patients (69%) received 28 - 35 days of thromprophylaxis, whilst five patients (5%) received more than 35 days (mean 42 days, range 40 – 42 days). Formal departmental teaching and presentation of the findings was given after the initial study and a small label with the message, ‘POST NOF #: 28-35 days Enoxaparin’, was attached to the back of all the junior doctor work phones. After the intervention, data was collected from the period of 7th of January to 7th of February 2013. The second study showed that 50 patients were admitted with NOF fractures in this time period. Four patients died in hospital and three patients were discounted as they were on Warfarin. Two patients were not prescribed thromboprophylaxis (5%). 34 (79%) patients received 28 - 35 days, whereas seven patients (16%) received 42 days of thromboprophylaxis. The older patients with multiple co-morbidities and reduced mobility are at high risk of developing thromboembolism post NOF fixation. Our initial study identified inadequate prescription of thromboprophylaxis post NOF fractures. After introduction of simple measures such as the reminder label attached to phones, our repeat study found that there was improvement in prescription rates. Our study highlights that simple measures can increase awareness and improve patient safety.

  12. 77 FR 66823 - Army Education Advisory Committee Study Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-07

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF DEFENSE Department of the Army Army Education Advisory Committee Study Meeting AGENCY: Department of the Army, DoD... following committee meeting: Name of Committee: Army Education Advisory Committee (AEAC). Date(s) of...

  13. 32 CFR 536.14 - Commanders of major Army commands.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Commanders of major Army commands. 536.14 Section 536.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.14 Commanders of major Army...

  14. Army Recruiters: "Counseling" High-Schoolers to Death

    ERIC Educational Resources Information Center

    Merrow, John

    2005-01-01

    This article deals with Army recruitment in high schools. Students get to ask questions and hear stories about life In the Army from a soldier of the year, officers, and recruiters. Some brave students will even get a physical taste of life in the Army. According to an Army officer, the primary reason why recruiters go on high school campuses is…

  15. Army Basic Skills Provision: Whole Organisation Approach/Lessons Learnt

    ERIC Educational Resources Information Center

    Basic Skills Agency, 2007

    2007-01-01

    The Army began working in partnership with the Basic Skills Agency in 2000. This was formalised with the establishment of the Basic Skills Agency's National Support Project for the Army (2001) that contributes to the raising of basic skills standards in the Army by advising on, and assisting with, the development of the Army's basic skills policy…

  16. 32 CFR 536.14 - Commanders of major Army commands.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Commanders of major Army commands. 536.14 Section 536.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.14 Commanders of major Army...

  17. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true The Army claims mission. 536.6 Section 536.6 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.6 The Army claims mission. (a) Promptly...

  18. 32 CFR 536.14 - Commanders of major Army commands.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Commanders of major Army commands. 536.14 Section 536.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.14 Commanders of major Army...

  19. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false The Army claims mission. 536.6 Section 536.6 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.6 The Army claims mission. (a) Promptly...

  20. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false The Army claims mission. 536.6 Section 536.6 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.6 The Army claims mission. (a) Promptly...

  1. 32 CFR 536.14 - Commanders of major Army commands.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Commanders of major Army commands. 536.14 Section 536.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.14 Commanders of major Army...

  2. 32 CFR 536.14 - Commanders of major Army commands.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Commanders of major Army commands. 536.14 Section 536.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.14 Commanders of major Army...

  3. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true The Army claims mission. 536.6 Section 536.6 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.6 The Army claims mission. (a) Promptly...

  4. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true The Army claims mission. 536.6 Section 536.6 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.6 The Army claims mission. (a) Promptly...

  5. 76 FR 6692 - Radiation Sources on Army Land

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-08

    .... Background In the April 14, 2010, issue of the Federal Register (75 FR 19302), the Army issued a proposed..., 2007 (72 FR 55864) that became effective on November 30, 2007. The Army received no comments on its... Department of the Army 32 CFR Part 655 RIN 0702-AA58 Radiation Sources on Army Land AGENCY: Department of...

  6. Quality in Government: The Army Intern Intake Survey.

    ERIC Educational Resources Information Center

    Ungvarsky, Diane M.; Lilienthal, Richard A.

    The development of the Army Intern Intake Survey (AIIS) is described. The AIIS focuses on the Army civilian intern program, a vehicle for entry-level employees to progress in Army civilian jobs, which produces a profile of past and current interns. The AIIS will identify changes in intern quality over time and will make comparisons of Army interns…

  7. 78 FR 69077 - Army Education Advisory Subcommittee Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-18

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF DEFENSE Department of the Army Army Education Advisory Subcommittee Meeting Notice AGENCY: Department of the Army, Do... Army Education Advisory Committee for deliberation by the Committee under the open-meeting...

  8. 75 FR 38504 - Army Science Board Plenary Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF DEFENSE Department of the Army Army Science Board Plenary Meeting AGENCY: Department of the Army, DoD. ACTION: Notice... committee meeting: Name of Committee: Army Science Board (ASB). Date(s) of Meeting: July 21, 2010....

  9. Utility of telepathology as a consultation tool between an off-site surgical pathology suite and affiliated hospitals in the frozen section diagnosis of lung neoplasms

    PubMed Central

    Vitkovski, Taisia; Bhuiya, Tawfiqul; Esposito, Michael

    2015-01-01

    Background: Increasingly, as in our institution, operating rooms are located in hospitals and the pathology suite is located at a distant location because of off-site consolidation of pathology services. Telepathology is a technology which bridges the gap between pathologists and offers a means to obtain a consultation remotely. We aimed to evaluate the utility of telepathology as a means to assist the pathologist at the time of intraoperative consultation of lung nodules when a subspecialty pathologist is not available to directly review the slide. Methods: Cases of lung nodules suspicious for a neoplasm were included. Frozen sections were prepared in the usual manner. The pathologists on the intraoperative consultation service at two of our system hospitals notified the thoracic pathologist of each case after rendering a preliminary diagnosis. The consultation was performed utilizing a Nikon™ Digital Sight camera and web-based Remote Medical Technologies™ software with live video streaming directed by the host pathologist. The thoracic pathologist rendered a diagnosis without knowledge of the preliminary interpretation then discussed the interpretation with the frozen section pathologist. The interpretations were compared with the final diagnosis rendered after sign-out. Results: One hundred and three consecutive cases were included. The frozen section pathologist and a thoracic pathologist had concordant diagnoses in 93 cases (90.2%), discordant diagnoses in nine cases (8.7%), and one case in which both deferred. There was an agreement between the thoracic pathologist's diagnosis and the final diagnosis in 98% of total cases including 8/9 (88.9%) of the total discordant cases. In two cases, if the thoracic pathologist had not been consulted, the patient would have been undertreated. Conclusions: We have shown that telepathology is an excellent consultation tool in the frozen section diagnosis of lung nodules. PMID:26605120

  10. [Post-surgical neuropathic pain].

    PubMed

    Shaladi, Ali Muftah; Saltari, Maria Rita; Crestani, Francesco; Piva, Bruno

    2009-01-01

    The traumatic lesions during surgical interventions often turn into a persistent pain. Pain persists in the location of surgical intervention for a long time, beyond the usual course of natural healing of an acute pain and it is different from that suffered preoperatively. It is usually a chronic pain and it is associated to lesions of the central or peripheral nervous system. Pain is usually described as burning or tingling, or electric shock-like; it can be continuous or parossistic, often associated to paraesthesia, iperalgesia and allodinya. If circumstances preclude the surgical revision, the treatment of post-surgical neuropathic pain is based on drugs, according to the guidelines. The drugs of choice are the tricyclic antidepressants, the serotonin and adrenaline re-uptake selective inhibitors (SSRI), local antiepileptics of new generation (gabapentin, pregabalin) and topical anaesthetics. Drugs of second line are: opioid analgesics, tramadol; drugs of third line are: mexiletine, antagonist of NMDA receptor and capsaicine. The post-surgical neuropathic pain is often resistant to the pharmacologic treatment; for this reason the spinal cord neuromodulation can be applied only after careful selection of the patients according to the international guidelines. The incidence of post-surgical neuropathic pain in the Pain Units is approximately 20% of the patients admitted to hospital. Therefore it is necessary a greater attention for the post-surgical analgesia, adopting appropriate surgical techniques in order to avoid the onset of the post-surgical neuropathic pain. PMID:19725479

  11. Low-level colonization of hospitalized patients with methicillin-resistant coagulase-negative staphylococci and emergence of the organisms during surgical antimicrobial prophylaxis.

    PubMed Central

    Kernodle, D S; Barg, N L; Kaiser, A B

    1988-01-01

    By use of techniques that have been developed to detect small numbers of methicillin-resistant staphylococci, we cultured samples from the nares and subclavian and inguinal areas of 29 patients before and after cardiac surgery and 10 patients before and after coronary angioplasty. Methicillin-resistant coagulase-negative staphylococci were recovered before the surgical or angioplasty procedure from 74% of patients. The quantitative recovery of methicillin-resistant isolates before cardiac surgery or coronary angioplasty was compared with the number of methicillin-resistant staphylococci detected at the same site 3 days after the procedure. In cardiac surgery patients (who received antibiotic prophylaxis), 17 of the 28 sites (61%) in which low-level colonization with methicillin-resistant strains was detected preoperatively contained high levels of methicillin-resistant staphylococci postoperatively. In contrast, coronary angioplasty patients (who did not receive antibiotic prophylaxis) did not have any of the 14 sites containing low levels of methicillin-resistant strains before angioplasty emerge to harbor high levels of methicillin-resistant staphylococci after angioplasty. Methicillin-resistant coagulase-negative staphylococci from each site in which high levels of methicillin-resistant staphylococci emerged postoperatively were paired with preoperative isolates from the same site. Identical antibiograms and plasmid profile patterns were demonstrated for seven of the pre- and postoperative isolate pairs, suggesting that the high levels of methicillin-resistant coagulase-negative staphylococci detected on the skin or in the nares after cardiac surgery were derived from methicillin-resistant organisms present at the site preoperatively in much smaller numbers. Images PMID:2966607

  12. Medicare and Medicaid programs: hospital outpatient prospective payment and ambulatory surgical center payment systems and quality reporting programs; Hospital Value-Based Purchasing Program; organ procurement organizations; quality improvement organizations; Electronic Health Records (EHR) Incentive Program; provider reimbursement determinations and appeals. Final rule with comment period and final rules.

    PubMed

    2013-12-10

    : This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2014 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Hospital Value-Based Purchasing (VBP) Program. In the final rules in this document, we are finalizing changes to the conditions for coverage (CfCs) for organ procurement organizations (OPOs); revisions to the Quality Improvement Organization (QIO) regulations; changes to the Medicare fee-for-service Electronic Health Record (EHR) Incentive Program; and changes relating to provider reimbursement determinations and appeals. PMID:24340777

  13. Army Distance Learning: Potential for Reducing Shortages in Army Enlisted Occupations.

    ERIC Educational Resources Information Center

    Shanley, Michael G.; Leonard, Henry A.; Winkler, John D.

    The potential of distance learning (DL) to expedite the U.S. Army's efforts to redress personnel shortages in Army enlisted occupations was studied by evaluating how DL-based training strategies might affect skill shortages in the following occupations: helicopter repairer; electronic switching system operator; microwave systems…

  14. Army Distance Learning: Potential for Reducing Shortages in Army Enlisted Occupations.

    ERIC Educational Resources Information Center

    Shanley, Michael G.; Leonard, Henry A.; Winkler, John D.

    The potential of distance learning (DL) to expedite the U.S. Army's efforts to redress personnel shortages in Army enlisted occupations was studied by evaluating how DL-based training strategies might affect skill shortages in the following occupations: helicopter repairer; electronic switching system operator; microwave systems…

  15. [Analysis of non-confraternity sports accidents in the surgical department of a former district hospital during the period of 2 years].

    PubMed

    Raschka, Ch; Raschka, S; Peikert, T

    2009-12-01

    This epidemiological study analyses all n = 1,659 outpatient and inpatient non-confraternity sports accidents treated during a 2-year period in a former district hospital. The largest share with 40.6% is soccer, followed by cycling (15%), general fitness sports (7.6%), outdoor sports (6.5%), winter sports (5.5%), and riding (5.2%). Soccer injuries rise steadily until the age of 30. Of 86 horse riding accidents a total of 68 involved women, but only 18 men (ratio 8 : 2). 53% of the horse riding accidents among women concern the age group between 10 and 20 years. 70.6% (79%) of the athletes under (over) 20 years were male, 29.4% (21%) female (p < 0.05). Topographically the lower extremities represent the most affected body region in all sports (runners 84.4%, soccer players 60.2%). Most accidents occur on a Sunday. The most common diagnosis is contusion, most commonly in martial arts (60.8%), followed by horse riding (51%). There is an astonishing dominance of soccer accidents given the fact that this study records all athletes, not just club athletes, unlike insurance studies. Important preventive measures would be a comprehensive biological training prophylaxis and the provision of communication of age-specific accident prevention proposals for the mainly affected sports. PMID:20052829

  16. Surgical complications of ascariasis.

    PubMed

    Ochoa, B

    1991-01-01

    Over the past 25 years (1963-1988), a total of 311 children under 12 years of age were admitted to the Pediatric Surgical Service of the San Vicente de Paúl University Hospital, Medellín, Colombia, with complications resulting from infection with Entamoeba histolytica or Ascaris lumbricoides. In this group, the abdominal complications produced by ascariasis numbered 145, and included intestinal obstruction (n = 107), perforation of the appendix (n = 10), and migration of the parasite to the biliary tree or to the peritoneal cavity (n = 28). Evaluation of the living conditions of a significant subgroup of our patients confirms that intestinal parasitism is an endemic condition prevailing in nations that exhibit deep social and economic imbalance, where large sectors of the population remain deprived of the basic services of education, health, housing, and recreation. Massive infestation in children may give rise to grave complications that demand expert surgical care. Third World surgeons practicing in general hospitals that take care of patients of low economic capacity are usually familiar with the diagnosis and management of this pathology; surgeons who practice in the industrialized nations will only occasionally face such problems. The greater mobility of today's societies and the rather massive migrations that take place in current times have resulted in an increasing incidence of these entities in the hospital populations of the large urban centers of these nations. It is for the surgeons practicing in such centers that the information presented herein may be of greater value. PMID:2031358

  17. Bot armies as threats to network security

    NASA Astrophysics Data System (ADS)

    Banks, Sheila B.; Stytz, Martin R.

    2007-04-01

    "Botnets", or "bot armies", are large groups of remotely controlled malicious software. Bot armies pose one of the most serious security threats to all networks. Botnets, remotely controlled and operated by botmasters or botherders, can launch massive denial of service attacks, multiple penetration attacks, or any other malicious network activity on a massive scale. While bot army activity has, in the past, been limited to fraud, blackmail, and other forms of criminal activity, their potential for causing large-scale damage to the entire internet; for launching large-scale, coordinated attacks on government computers and networks; and for large-scale, coordinated data gathering from thousands of users and computers on any network has been underestimated. This paper will not discuss how to build bots but the threats they pose. In a "botnet" or "bot army", computers can be used to spread spam, launch denial-of-service attacks against Web sites, conduct fraudulent activities, and prevent authorized network traffic from traversing the network. In this paper we discuss botnets and the technologies that underlie this threat to network and computer security. The first section motivates the need for improved protection against botnets, their technologies, and for further research about botnets. The second contains background information about bot armies and their key underlying technologies. The third section presents a discussion of the types of attacks that botnets can conduct and potential defenses against them. The fourth section contains a summary and suggestions for future research and development.

  18. Surgical wound sepsis

    PubMed Central

    Cruse, P. J. E.

    1970-01-01

    With the help of a surgical nurse and using data-processing techniques, a prospective clinical study was conducted to determine the wound infection rate in two hospitals in Calgary. The overall sepsis rate was 5.2% and the clean wound rate 3.5%. The latter is the more meaningful figure as it allows for comparison between hospitals, specialties and individuals and is a good guide for hospital morbidity reviews. The groundwork for succeeding wound infection is laid in the operating theatre, and it is believed that wound infection would be reduced more by attention to Halsted's principles than by more rigid aseptic techniques. It is estimated that wound sepsis costs the Province of Alberta 1.5 million dollars per year for hospitalization alone. This amounts to roughly $1 per person per year. The annual cost of a prospective study such as the present one is approximately $7000. This is equivalent to the cost of hospitalizing 24 patients with infected wounds for one week (at $300 per week). One dividend of a prospective study is an associated reduction in infection rate. This reduction more than pays for the cost of the program. PMID:5414538

  19. Improving surgical weekend handover

    PubMed Central

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

    Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unified weekend list ordering all surgical patients by ward and bed number was introduced. Discrepancies in the layout of each team's weekday list necessitated the design of a new weekday list to match the weekend list to facilitate the easy transfer of information between the two lists. A colour coding system was also used to highlight specific jobs. Prior to this improvement project only 7.1% of those polled were satisfied with the existing system, after a series of interventions satisfaction increased to 85.7%. The significant increase in overall satisfaction with surgical handover following the introduction of the unified weekend list is promising. Locating patients and identifying jobs is easier and weekend ward rounds can conducted in a more logical and timely fashion. It has also helped facilitate the transition to consultant ward rounds of all surgical inpatients at the weekends with promising feedback from a recent consultants meeting. PMID:26734294

  20. Frequently Asked Questions about Surgical Site Infections

    MedlinePLUS

    ... quirĂşrgico" [PDF - 217 KB] October 2008 Supplement of Infection Control and Hospital Epidemiology (Volume 29, Number S1) Guideline for the Prevention of Surgical Site Infection, 1999 Top of page Print page Get email ...

  1. Consultation and referral patterns from a teaching hospital emergency department.

    PubMed

    Cortazzo, J M; Guertler, A T; Rice, M M

    1993-09-01

    The objective of this study was to describe consultation and referral patterns from a military emergency department (ED). The design of the study consisted of a prospective analysis of consultations and referrals from Madigan Army Medical Center ED during April 1990, an Army Medical Center with multiple residencies, including emergency medicine (EM). Patient population included active and retired military personnel, their families, and civilian emergency medical system-transported patients. ED visits averaged 60,000 per year. The overall rate of consultation and referral was 39.9%; 10.7% were consultations, whereas 29.2% were referrals. PGY-2 and -3 EM residents consultation rates were higher than average. Of all ED visits, 19.7% resulted in consultations or referrals to surgical services, 13.6% to medical services, and 2.8% to pediatrics. ED patients frequently are referred to or result in consultations with non-EM physicians. Differences in consultation by level of training and the impact of consultation on consulting services both deserve further investigation. Review of EM resident use of consultation and referral may focus evaluation of ED care in teaching hospitals. PMID:8395848

  2. 2D electronic materials for army applications

    NASA Astrophysics Data System (ADS)

    O'Regan, Terrance; Perconti, Philip

    2015-05-01

    The record electronic properties achieved in monolayer graphene and related 2D materials such as molybdenum disulfide and hexagonal boron nitride show promise for revolutionary high-speed and low-power electronic devices. Heterogeneous 2D-stacked materials may create enabling technology for future communication and computation applications to meet soldier requirements. For instance, transparent, flexible and even wearable systems may become feasible. With soldier and squad level electronic power demands increasing, the Army is committed to developing and harnessing graphene-like 2D materials for compact low size-weight-and-power-cost (SWAP-C) systems. This paper will review developments in 2D electronic materials at the Army Research Laboratory over the last five years and discuss directions for future army applications.

  3. Army Reserve Comprehensive Water Efficiency Assessments

    SciTech Connect

    McMordie Stoughton, Kate; Kearney, Jaime

    2015-04-14

    The Army Reserve has partnered with the Pacific Northwest National Laboratory (PNNL) to develop comprehensive water assessments for numerous Army Reserve Centers in all five regions including the Pacific islands and Puerto Rico, and at Fort Buchanan and Fort Hunter Liggett. The objective of these assessments is to quantify water use at the site, and identify innovative water efficiency projects that can be implemented to help reduce water demand and increase efficiency. Several of these assessments have focused on a strategic plan for achieving net zero water to help meet the Army’s Net Zero Directive . The Army Reserve has also leveraged this approach as part of the energy conservation investment program (ECIP), energy savings performance contracts (ESPCs), and utility energy service contracts (UESCs). This article documents the process involved.

  4. Violence against surgical residents.

    PubMed Central

    Barlow, C B; Rizzo, A G

    1997-01-01

    Violence against hospital personnel is underreported (less than one in five assaults), and accurate statistics as to the rate of violence against hospital personnel are thus difficult to establish. In the psychiatric discipline, an abundance of information has been published regarding violence in the health care setting, but few studies have examined violence outside psychiatric hospitals or by patients not diagnosed with psychiatric ailments. Using a survey that elicits information about workplace violence, we sought to gauge the prevalence of violent acts affecting general hospital workers who treat victims of violence on a daily basis. The survey was completed by a cohort of surgical staff nationwide (475 responses from 57 residency programs). Two hundred and eighty residents reported having witnessed one or more physical attacks, and 179 reported having been attacked. Violent acts were more likely to be committed in a public hospital than a private institution (P = 0.05). As shown in previous research, most attacks occurred in the emergency room (P = 0.01); the wards and parking lot were next in frequency. Women residents were more likely than men to call hospital security to intervene in a potentially violent situation (P = 0.04), and junior residents (postgraduate years 1-4) were more likely to be attacked than senior residents (> or = 5 years) (P = 0.04). The attacker was most likely to be a young black male between ages 19 and 30 (P = 0.01). We found no statistical relationship between the attacker and the victim regarding sex or race. Of the 475 respondents, 470 reported that they carry a gun themselves or know someone in the hospital environment who carries a gun. Images Figure 1. PMID:9291743

  5. Army Energy and Water Reporting System Assessment

    SciTech Connect

    Deprez, Peggy C.; Giardinelli, Michael J.; Burke, John S.; Connell, Linda M.

    2011-09-01

    There are many areas of desired improvement for the Army Energy and Water Reporting System. The purpose of system is to serve as a data repository for collecting information from energy managers, which is then compiled into an annual energy report. This document summarizes reported shortcomings of the system and provides several alternative approaches for improving application usability and adding functionality. The U.S. Army has been using Army Energy and Water Reporting System (AEWRS) for many years to collect and compile energy data from installations for facilitating compliance with Federal and Department of Defense energy management program reporting requirements. In this analysis, staff from Pacific Northwest National Laboratory found that substantial opportunities exist to expand AEWRS functions to better assist the Army to effectively manage energy programs. Army leadership must decide if it wants to invest in expanding AEWRS capabilities as a web-based, enterprise-wide tool for improving the Army Energy and Water Management Program or simply maintaining a bottom-up reporting tool. This report looks at both improving system functionality from an operational perspective and increasing user-friendliness, but also as a tool for potential improvements to increase program effectiveness. The authors of this report recommend focusing on making the system easier for energy managers to input accurate data as the top priority for improving AEWRS. The next major focus of improvement would be improved reporting. The AEWRS user interface is dated and not user friendly, and a new system is recommended. While there are relatively minor improvements that could be made to the existing system to make it easier to use, significant improvements will be achieved with a user-friendly interface, new architecture, and a design that permits scalability and reliability. An expanded data set would naturally have need of additional requirements gathering and a focus on integrating with other existing data sources, thus minimizing manually entered data.

  6. Mobile surgical skills education unit: a new concept in surgical training.

    PubMed

    Shaikh, Faisal M; Hseino, Hazem; Hill, Arnold D K; Kavanagh, Eamon; Traynor, Oscar

    2011-08-01

    Basic surgical skills are an integral part of surgical training. Simulation-based surgical training offers an opportunity both to trainees and trainers to learn and teach surgical skills outside the operating room in a nonpatient, nonstressed environment. However, widespread adoption of simulation technology especially in medical education is prohibited by its inherent higher cost, limited space, and interruptions to clinical duties. Mobile skills laboratory has been proposed as a means to address some of these limitations. A new program is designed by the Royal College of Surgeons in Ireland (RCSI), in an approach to teach its postgraduate basic surgical trainees the necessary surgical skills, by making the use of mobile innovative simulation technology in their own hospital settings. In this article, authors describe the program and students response to the mobile surgical skills being delivered in the region of their training hospitals and by their own regional consultant trainers. PMID:21826041

  7. [Department of training of physicians (for Missile Forces and Army) of Military-medical academy n. a. S.M.Kirov celebrates the 70th anniversary].

    PubMed

    Shvets, V A; Tsvetkov, S A; Ovchinnikov, D V; Deev, R V

    2012-10-01

    The article is dedicated to the history of the one of educational units of the Kirov Medical Academy. Department of training of physicians (for Missile Forces and Army) traces its origins to 1942 published in the resolution of the State Committee of Defense of the USSR, but in fact is the successor to hospital schools in the land and the Admiralty hospitals. PMID:23213776

  8. The Army's High Priority Physical Fitness Program.

    ERIC Educational Resources Information Center

    Drews, Fred R.

    1984-01-01

    This article explores the importance of physical fitness in the United States Army. The development of expanded fitness assessment and programs is related to health and the prevention of coronary heart disease. Improved physical training programs, improved nutrition, and fundamental research are necessary for maintaining a highly fit and healthy…

  9. U.S. Army Signal School.

    ERIC Educational Resources Information Center

    Army Signal Center and School, Fort Monmouth, NJ.

    The U. S. Army Signal School at Fort Monmouth, New Jersey, provides military education and appropriate practical training for Armed Forces men and women to prepare them for positions in communications-electronics activities and familiarize them with the application of doctrine, tactics, logistics, and electronic techniques pertinent to the…

  10. Predictors of Suicide and Accident Death in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

    PubMed Central

    Schoenbaum, Michael; Kessler, Ronald C.; Gilman, Stephen E.; Colpe, Lisa J.; Heeringa, Steven G.; Stein, Murray B.; Ursano, Robert J.; Cox, Kenneth L.

    2014-01-01

    IMPORTANCE The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multicomponent study designed to generate actionable recommendations to reduce Army suicides and increase knowledge of risk and resilience factors for suicidality. OBJECTIVES To present data on prevalence, trends, and basic sociodemographic and Army experience correlates of suicides and accident deaths among active duty Regular Army soldiers between January 1, 2004, and December 31, 2009, and thereby establish a foundation for future Army STARRS investigations. DESIGN, SETTING, AND PARTICIPANTS Analysis of trends and predictors of suicide and accident deaths using Army and Department of Defense administrative data systems. Participants were all members of the US Regular Army serving at any time between 2004 and 2009. MAIN OUTCOMES AND MEASURES Death by suicide or accident during active Army service. RESULTS The suicide rate rose between 2004 and 2009 among never deployed and currently and previously deployed Regular Army soldiers. The accident death rate fell sharply among currently deployed soldiers, remained constant among the previously deployed, and trended upward among the never deployed. Increased suicide risk was associated with being a man (or a woman during deployment), white race/ethnicity, junior enlisted rank, recent demotion, and current or previous deployment. Sociodemographic and Army experience predictors were generally similar for suicides and accident deaths. Time trends in these predictors and in the Army’s increased use of accession waivers (which relaxed some qualifications for new soldiers) do not explain the rise in Army suicides. CONCLUSIONS AND RELEVANCE Predictors of Army suicides were largely similar to those reported elsewhere for civilians, although some predictors distinct to Army service emerged that deserve more in-depth analysis. The existence of a time trend in suicide risk among never-deployed soldiers argues indirectly against the view that exposure to combat-related trauma is the exclusive cause of the increase in Army suicides. PMID:24590048

  11. Photocopy of plan (in U.S. Army office of Army Engineers ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of plan (in U.S. Army office of Army Engineers plans and drawings, Fort Hancock and Sandy hook proving ground, record group 7, drawer 44, Cartographic and Architectural branc, The National Archives, Washington, DC) from Talcott, T.M.R., plot of a survey of site, Fort at Sandy Hook, NJ, 1859-1860 Detail of engineer's wharf - U.S. Coast Guard Sandy Hook Station, Western Docking Structure, West of intersection of Canfield Road & Hartshorne Drive, Highlands, Monmouth County, NJ

  12. Photocopy of plan (in U.S. Army office of Army Engineers ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of plan (in U.S. Army office of Army Engineers plans and drawings, Fort Hancock and Sandy hook proving ground, record group 7, drawer 44, Cartographic and Architectural branc, The National Archives, Washington, DC), cartographer unknown, title unknown, March 28, 1892 1890 lifesaving station shown near fort and beach, no boathouse near engineer's wharf - U.S. Coast Guard Sandy Hook Station, Western Docking Structure, West of intersection of Canfield Road & Hartshorne Drive, Highlands, Monmouth County, NJ

  13. Design of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

    PubMed Central

    Kessler, Ronald C.; Colpe, Lisa J.; Fullerton, Carol S.; Gebler, Nancy; Naifeh, James A.; Nock, Matthew K.; Sampson, Nancy A.; Schoenbaum, Michael; Zaslavsky, Alan M.; Stein, Murray B.; Ursano, Robert J.; Heeringa, Steven G.

    2014-01-01

    The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi-component epidemiological and neurobiological study designed to generate actionable evidence-based recommendations to reduce U.S. Army suicides and increase basic knowledge about the determinants of suicidality. This report presents an overview of the designs of the six component Army STARRS studies. These include: an integrated study of historical administrative data systems (HADS) designed to provide data on significant administrative predictors of suicides among the more than 1.6 million soldiers on active duty in 2004–2009; retrospective case-control studies of suicide attempts and fatalities; separate large-scale cross-sectional studies of new soldiers (i.e., those just beginning Basic Combat Training [BCT], who completed self-administered questionnaires [SAQ] and neurocognitive tests and provided blood samples) and soldiers exclusive of those in BCT (who completed SAQs); a pre-post deployment study of soldiers in three Brigade Combat Teams about to deploy to Afghanistan (who completed SAQs and provided blood samples) followed multiple times after returning from deployment; and a platform for following up Army STARRS participants who have returned to civilian life. DoD/Army administrative data records are linked with SAQ data to examine prospective associations between self-reports and subsequent suicidality. The presentation closes with a discussion of the methodological advantages of cross-component coordination. PMID:24318217

  14. Field procedures in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

    PubMed Central

    Heeringa, Steven G.; Gebler, Nancy; Colpe, Lisa J.; Fullerton, Carol S.; Hwang, Irving; Kessler, Ronald C.; Naifeh, James A.; Nock, Matthew K.; Sampson, Nancy A.; Schoenbaum, Michael; Zaslavsky, Alan M.; Stein, Murray B.; Ursano, Robert J.

    2014-01-01

    The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi-component epidemiological and neurobiological study of unprecedented size and complexity designed to generate actionable evidence-based recommendations to reduce U.S. Army suicides and increase basic knowledge about determinants of suicidality by carrying out coordinated component studies. A number of major logistical challenges were faced in implementing these studies. The current report presents an overview of the approaches taken to meet these challenges, with a special focus on the field procedures used to implement the component studies. As detailed in the paper, these challenges were addressed at the onset of the initiative by establishing an Executive Committee, a Data Coordination Center (the Survey Research Center [SRC] at the University of Michigan), and study-specific design and analysis teams that worked with staff on instrumentation and field procedures. SRC staff, in turn, worked with the Office of the Deputy Under Secretary of the Army (ODUSA) and local Army Points of Contact (POCs) to address logistical issues and facilitate data collection. These structures, coupled with careful fieldworker training, supervision, and piloting contributed to the major Army STARRS data collection efforts having higher response rates than previous large-scale studies of comparable military samples. PMID:24038395

  15. 32 CFR 581.1 - Army Disability Review Board.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Army Disability Review Board. 581.1 Section 581.1... § 581.1 Army Disability Review Board. (a) General provisions—(1) Constitution, purpose, and jurisdiction of review board. (i) The Army Disability Review Board (called the review board in this section) is...

  16. 32 CFR 581.1 - Army Disability Review Board.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Army Disability Review Board. 581.1 Section 581.1... § 581.1 Army Disability Review Board. (a) General provisions—(1) Constitution, purpose, and jurisdiction of review board. (i) The Army Disability Review Board (called the review board in this section) is...

  17. 32 CFR 581.1 - Army Disability Review Board.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Army Disability Review Board. 581.1 Section 581.1... § 581.1 Army Disability Review Board. (a) General provisions—(1) Constitution, purpose, and jurisdiction of review board. (i) The Army Disability Review Board (called the review board in this section) is...

  18. 32 CFR 581.1 - Army Disability Review Board.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Army Disability Review Board. 581.1 Section 581... REVIEW BOARD § 581.1 Army Disability Review Board. (a) General provisions—(1) Constitution, purpose, and jurisdiction of review board. (i) The Army Disability Review Board (called the review board in this section)...

  19. 32 CFR 581.1 - Army Disability Review Board.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Army Disability Review Board. 581.1 Section 581... REVIEW BOARD § 581.1 Army Disability Review Board. (a) General provisions—(1) Constitution, purpose, and jurisdiction of review board. (i) The Army Disability Review Board (called the review board in this section)...

  20. THE CHALLENGE OF MOLDS FOR THE U.S. ARMY

    EPA Science Inventory

    The US Army and all armies have been interested in molds since there were armies. The most obvious interest was human infections by molds like trench foot. Then there were losses of military animals and contamination of their fodder, most notably the Soviet loss of thousands o...

  1. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Army civil works lands. 644.416 Section 644.416 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal Disposal of Fee-Owned Real Property and Easement Interests § 644.416 Army...

  2. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Army civil works lands. 644.416 Section 644.416 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal Disposal of Fee-Owned Real Property and Easement Interests § 644.416 Army...

  3. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Utilization of Army bands. 508.1 Section 508.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS COMPETITION WITH CIVILIAN BANDS § 508.1 Utilization of Army bands. (a)...

  4. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Army civil works lands. 644.416 Section 644.416 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal Disposal of Fee-Owned Real Property and Easement Interests § 644.416 Army...

  5. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Utilization of Army bands. 508.1 Section 508.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS COMPETITION WITH CIVILIAN BANDS § 508.1 Utilization of Army bands. (a)...

  6. 78 FR 64205 - Army Science Board Fall Plenary Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-28

    ... published in the Federal Register on October 2, 2013 (78 FR 60864) has been cancelled due to the Government Furlough and will be rescheduled at a later date. Due to the lapse of appropriations, the Department of... Department of the Army Army Science Board Fall Plenary Meeting AGENCY: Department of the Army, DoD....

  7. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 4 2011-07-01 2011-07-01 false Army military leased property. 644.328 Section 644.328 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military leased property. (a) Department of the Army command installations or parts thereof held by...

  8. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Army military leased property. 644.328 Section 644.328 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military leased property. (a) Department of the Army command installations or parts thereof held by...

  9. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Army military leased property. 644.328 Section 644.328 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military leased property. (a) Department of the Army command installations or parts thereof held by...

  10. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Army military leased property. 644.328 Section 644.328 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military leased property. (a) Department of the Army command installations or parts thereof held by...

  11. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Army military leased property. 644.328 Section 644.328 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military leased property. (a) Department of the Army command installations or parts thereof held by...

  12. 32 CFR 651.14 - Integration with Army planning.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Integration with Army planning. 651.14 Section 651.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) ENVIRONMENTAL QUALITY ENVIRONMENTAL ANALYSIS OF ARMY ACTIONS (AR 200-2) National Environmental Policy Act and the Decision Process § 651.14 Integration...

  13. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Army civil works lands. 644.416 Section 644.416 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal Disposal of Fee-Owned Real Property and Easement Interests § 644.416 Army...

  14. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Army exchange activities. 643.112 Section 643.112 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE Additional Authority of Commanders § 643.112 Army exchange activities. Use of...

  15. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 4 2011-07-01 2011-07-01 false Army civil works lands. 644.416 Section 644.416 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal Disposal of Fee-Owned Real Property and Easement Interests § 644.416 Army...

  16. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Army exchange activities. 643.112 Section 643.112 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE Additional Authority of Commanders § 643.112 Army exchange activities. Use of space and...

  17. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Army exchange activities. 643.112 Section 643.112 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE Additional Authority of Commanders § 643.112 Army exchange activities. Use of space and...

  18. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 4 2011-07-01 2011-07-01 false Army exchange activities. 643.112 Section 643.112 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE Additional Authority of Commanders § 643.112 Army exchange activities. Use of...

  19. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Army exchange activities. 643.112 Section 643.112 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE Additional Authority of Commanders § 643.112 Army exchange activities. Use of space and...

  20. An Assessment of Drug Education-Prevention Programs in the U. S. Army. Army Research Institute Technical Paper 261.

    ERIC Educational Resources Information Center

    Cook, Royer F.; Morton, Anton S.

    In recent years the Army has been concerned about the widespread use of psychoactive drugs by all classes of young people and the effects of this use on the Army. In order to curb this use among soldiers the Army initiated a comprehensive program to prevent and control the abuse of alcohol and drugs. Prevention was considered to include education,…

  1. Automation impact study of Army Training Management

    SciTech Connect

    Sanquist, T.F.; Schuller, C.R.; McCallum, M.C.; Underwood, J.A.; Bettin, P.J.; King, J.L.; Melber, B.D.; Hostick, C.J.; Seaver, D.A.

    1988-01-01

    The main objectives of this impact study were to identify the potential cost savings associated with automated Army Training Management (TM), and to perform a cost-benefit analysis for an Army-wide automated TM system. A subsidiary goal was to establish baseline data for an independent evaluation of a prototype Integrated Training Management System (ITMS), to be tested in the fall of 1988. A structured analysis of TM doctrine was performed for comparison with empirical data gathered in a job analysis survey of selected units of the 9ID (MTZ) at Ft. Lewis, Washington. These observations will be extended to other units in subsequent surveys. The survey data concerning staffing levels and amount of labor expended on eight distinct TM tasks were analyzed in a cost effectiveness model. The main results of the surveys and cost effectiveness modelling are summarized. 18 figs., 47 tabs.

  2. Energy Design Guides for Army Barracks

    SciTech Connect

    Deru, M.; Zhivov, A.; Herron, D.

    2008-01-01

    The Energy Policy Act of 2005 requires federal facilities to be built to achieve 30% energy savings over the 2004 International Energy Code or American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 90.1-2004, as appropriate. The Engineer Research and Development Center of the U.S. Army Corps of Engineers and the National Renewable Energy Laboratory (NREL) are developing target energy budgets and design guides with a prescriptive path to achieve 30% energy savings over a baseline built to the minimum requirements of ANSI/ASHRAE/IESNA Standard 90.1-2004. This project covers eight building types in 15 U.S. climate zones. The building types include barracks, administrative buildings, a maintenance facility, a dining facility, a child development center, and an Army reserve center. All the design guides will be completed by the end of 2008. This paper focuses on the design guide for one type of barracks called unaccompanied enlisted personal housing (UEPH). The UEPH buildings are similar to apartment buildings with double occupancy units. For each building type, a baseline was established following typical Army construction and ASHRAE Standard 90.1 Appendix G modeling rules. Improvements in energy performance were achieved for the envelope using the NREL optimization platform for commercial buildings and previous ASHRAE design guides. Credit was also taken for tightening the building envelope by using proposed envelope leakage rates from ASHRAE and the Army. Two HVAC systems, including a dedicated outdoor air system, were considered. The final results achieved 29% site energy savings in two climates and greater than 30% site energy savings in all other climates. Results of this study were implemented in the Army's standard RFP process for new UEPH barracks construction in late 2007. New UEPH design/construction begun in 2008 and beyond will require the contractor to design and construct a UEPH facility that meets the target energy budget developed in this study using either a custom design or the design guide's prescriptive path developed as part of this study.

  3. Battles between an insurgent army and an advanced army - focus on strategy

    NASA Astrophysics Data System (ADS)

    Sen, Surajit; Shanahan, Linda

    2008-03-01

    Detailed and aggregate analyses of the outcome of past battles focusing on rates of troop losses or on the ratios of forces on each side is at the heart of present knowledge about battles. Here we present non-equilibrium statistical mechanics based studies of possible outcomes of well matched strategic battles by a ``blue'' army against insurgency based attacks by well matched opponents in a ``red'' army in red territory. We assume that the red army attacks with randomly varying force levels to potentially confuse and drive the blue's strategies. The temporal evolution of the model battles incorporate randomness in the deployment of the reds and hence possess attendant history dependence. Our results reveal that while unpredictable events play a major role in battles, a balance between risk of exposure in a battlefield and the use of short range intelligence is needed in determining whether one side can decimate the other, and hence force a battle to end.

  4. 'We did the best we could'--the United States Army nurses of Ie Shima.

    PubMed

    Bernier, Francie

    2013-01-01

    During World War II, Army Nurses of the 156th Army Evacuation Hospital delivered care while under attack, demonstrated incredible bravery, endured extreme hardships, and unknowingly defined advanced nursing practice as we know it today. First Lieutenant Edythe (Goldstein) Pallin, BS, RN, was a 23-year old registered nurse who served in the Pacific and was stationed near the front lines on the remote island of Ie Shima in the Ryukyu Island Chain near Okinawa. This article, as told to Edythe's daughter, draws heavily on her memories and her military photo album stored in the attic of her home for over 50 years. Edythe only acknowledges her military experience by saying, "We did the best we could." Yes, these nurses not only did the best they could, they also changed nursing from a subservient position to an independent practice long before nurses even understood their professional possibilities. Edythe passed away October 26, 2012. PMID:23734553

  5. Photocopy of plan (in U.S. Army office of Army Engineers ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of plan (in U.S. Army office of Army Engineers plans and drawings, Fort Hancock and Sandy hook proving ground, record group 7, drawer 44, Cartographic and Architectural branc, The National Archives, Washington, DC) Gillespie, G.L., map of a portion of Sandy Hook, NJ showing condition of beach in vicinity of dynamite gun emplacements, 1894 Engineer's wharf - U.S. Coast Guard Sandy Hook Station, Western Docking Structure, West of intersection of Canfield Road & Hartshorne Drive, Highlands, Monmouth County, NJ

  6. Photocopy of plan (in U.S. Army office of Army Engineers ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of plan (in U.S. Army office of Army Engineers plans and drawings, Fort Hancock and Sandy hook proving ground, record group 7, drawer 44, Cartographic and Architectural branc, The National Archives, Washington, DC), U.S. Engineer Office, New York District, Harbor Defenses of New York Mine Boathouse, location plan and elevations, Fort Hancock, New Jersey, July 1943 Detail of western docking structure - U.S. Coast Guard Sandy Hook Station, Western Docking Structure, West of intersection of Canfield Road & Hartshorne Drive, Highlands, Monmouth County, NJ

  7. Heritage of army audiology and the road ahead: the Army Hearing Program.

    PubMed

    McIlwain, D Scott; Gates, Kathy; Ciliax, Donald

    2008-12-01

    Noise-induced hearing loss has been documented as early as the 16th century, when a French surgeon, Ambroise Paré, wrote of the treatment of injuries sustained by firearms and described acoustic trauma in great detail. Even so, the protection of hearing would not be addressed for three more centuries, when the jet engine was invented and resulted in a long overdue whirlwind of policy development addressing the prevention of hearing loss. We present a synopsis of hearing loss prevention in the US Army and describe the current Army Hearing Program, which aims to prevent noise-induced hearing loss in soldiers and to ensure their maximum combat effectiveness. PMID:18923117

  8. Quality of Pharmaceutical Care in Surgical Patients

    PubMed Central

    de Boer, Monica; Ramrattan, Maya A.; Boeker, Eveline B.; Kuks, Paul F. M.; Boermeester, Marja A.; Lie-A-Huen, Loraine

    2014-01-01

    Background Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements. Objective To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements. Methods For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients. Results Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%). Conclusions This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced. PMID:25006676

  9. Surgical treatment of thymoma

    PubMed Central

    Mehran, Reza; Ghosh, Rishi; Maziak, Donna; O’Rourke, Keith; Shamji, Farid

    2002-01-01

    Objective To describe experience with the surgical treatment of thymoma. Design A retrospective study. Setting A teaching hospital at the University of Ottawa. Patients Over 25 years, 42 consecutive patients (22 men, 20 women) who had a thymoma requiring operation. Interventions Thymectomy. Outcome measures Age, sex, association with myasthenia gravis, presence of a paraneoplastic syndrome, extent of surgical resection, tumour size, histologic features of the tumour, clinical staging of the thymoma and short- and long-term outcome after surgery. Results The mean (and standard deviation) age of the patients was 52.8 (12.5) years. Thirteen patients had myasthenia gravis. With respect to tumour staging, 24 patients had stage I, 7 had stage II and 11 had stage III disease. Three patients were lost to follow-up. Radiotherapy was used as an adjunct to surgical treatment in 83% of patients with stages II and III disease. Fifty-one percent of patients available for follow-up survived 175.1 months, and the cumulative 5- and 10-year overall survival rates were 87.3% and 81.4% respectively. Only 1 patient died of metastatic thymoma. Complete or partial remission of myasthenia gravis was seen in 10 (77%) affected patients. Mixed cellular histologic features and a tumour size of less than 115 cm3 were more commonly seen with stage I disease. Conclusions Thymomas are characterized by slow growth and prolonged survival even in patients with invasive disease as long as the tumour is resected completely and treatment is accompanied by radiotherapy. PMID:11837917

  10. Army Research Concerns in Engine Sealing

    NASA Technical Reports Server (NTRS)

    Bill, Robert C.

    1991-01-01

    The Army Propulsion Directorate is primarily concerned with small engine technology, where sealing performance is most critical. Tip leakage and secondary flow losses have a much greater performance impact on small engine aero-components than on large engines. A brief survey and critique of presently employed sealing concepts is presented. Some recent new research thrusts that show promise for substantial improvement are discussed. An especially promising approach for small engine applications is brush seals. Brush seal concepts are being considered for outer air seal and secondary airflow system seal locations.

  11. The NASA/Army Autonomous Rotorcraft Project

    NASA Technical Reports Server (NTRS)

    Whalley, M.; Freed, M.; Takahashi, M.; Christian, D.; Patterson-Hine, A.; Schulein, G.; Harris, R.

    2002-01-01

    An overview of the NASA Ames Research Center Autonomous Rotorcraft Project (ARP) is presented. The project brings together several technologies to address NASA and US Army autonomous vehicle needs, including a reactive planner for mission planning and execution, control system design incorporating a detailed understanding of the platform dynamics, and health monitoring and diagnostics. A candidate reconnaissance and surveillance mission is described. The autonomous agent architecture and its application to the candidate mission are presented. Details of the vehicle hardware and software development are provided.

  12. Results of NASA/Army transmission research

    NASA Technical Reports Server (NTRS)

    Coy, John J.; Townsend, Dennis P.; Coe, Harold H.

    1988-01-01

    Since 1970 the NASA Lewis Research Center and the U.S. Army Aviation Systems Command have shared an interest in advancing the technology for helicopter propulsion systems. In particular, that portion of the program that applies to the drive train and its various mechanical components are outlined. The major goals of the program were (and continue to be) to increase the life, reliability, and maintainability, reduce the weight, noise, and vibration, and maintain the relatively high mechanical efficiency of the gear train. Major historical milestones are reviewed, significant advances in technology for bearings, gears, and transmissions are discussed, and the outlook for the future is presented. The reference list is comprehensive.

  13. Collaborative practice model: Madigan Army Medical Center.

    PubMed

    Nielsen, Peter E; Munroe, Michelle; Foglia, Lisa; Piecek, Roxanne I; Backman, Mary Paul; Cypher, Rebecca; Smith, Denise C

    2012-09-01

    In 2007, Madigan Army Medical Center implemented a new maternity care delivery model, integrating obstetricians and certified nurse-midwives (CNMs) in a collaborative practice. The change was driven by multiple factors, including patient preference, changes in the resident workweek, and low provider satisfaction. This article describes the elements of successful collaboration, including the structure, effective teamwork principles, role of the CNM in resident education, and preliminary data on mode of delivery, the number of CNM-supervised resident births, and procedures, such as episiotomy and epidural use. PMID:22963699

  14. Officials of the Army Ballistic Missile Agency

    NASA Technical Reports Server (NTRS)

    1956-01-01

    Hermann Oberth (forefront) with officials of the Army Ballistic Missile Agency at Huntsville, Alabama in 1956. Left to right: Dr. Ernst Stuhlinger (seated); Major General H.N. Toftoy, Commanding Officer and person responsible for 'Project Paperclip,' which took scientists and engineers out of Germany after World War II to design rockets for American military use. Many of the scientists later helped to design the Saturn V rocket that took the Apollo 11 astronauts to the Moon. Dr. Eberhard Rees, Deputy Director, Development Operations Division Wernher von Braun, Director, Development Operations Division.

  15. Health profile of Danish army personnel.

    PubMed

    Dahl, S; Kristensen, S

    1997-06-01

    The purpose of the present study was to delineate a health profile of professional Danish army personnel. Two-hundred twenty officers, noncommissioned officers, and gunners on active duty at Varde Barracks, housing the South Jutland Artillery Regiment and the Danish Army Artillery School, were asked about their physical and psychological health, interpersonal relations, and working conditions as well as their dietary, drinking, and smoking habits. Measurements were made of resting pulse rate, blood pressure, height, weight, waist and hip girth, and pulmonary function. The ratio of waist-to-hip girth and body mass index (BMI) were calculated. Psychological well-being was evaluated using the 12-item version of the General Health Questionnaire (GHQ). Psychosomatic symptoms were frequently reported, but very few of those surveyed appeared to have psychiatric disorders as measured by the GHQ. Also, somatic health problems were frequently reported, the most frequent being lower-back pain, mild chest pain, and sensory disorders. Differences in interpretation and reporting of "lasting health problems" may explain the relatively high score for this question. The interpersonal relations, both upward and downward in the hierarchy rank order, received high scores. Compared with the general population, alcohol consumption was very low, whereas smoking-in particular heavy smoking-was much more frequent among professional Danish army personnel. Lung function testing showed significantly poorer mean values of forced expiratory volume in 1st second of expiration and mean forced expiratory flow 25 to 75% of forced vital capacity among smokers compared with nonsmokers, although the mean values for the whole group of both smokers and nonsmokers were well above reference values for all lung function parameters. The frequency of moderately overweight individuals (25 < BMI < or = 30) was significantly higher among the male army personnel than in the general population, whereas this was not the case for obesity (BMI > 30). Abdominal obesity, regarded as an independent risk factor for the development of ischemic heart disease, stroke, diabetes, hypertension, and all-cause mortality, was present in 5%, and 3% belonged to the highest-risk group by having a low BMI as well as abdominal obesity. PMID:9183168

  16. Surgical Risks Associated with Winter Sport Tourism

    PubMed Central

    Sanchez, Stéphane; Payet, Cécile; Lifante, Jean-Christophe; Polazzi, Stéphanie; Chollet, François; Carty, Matthew J; Duclos, Antoine

    2015-01-01

    Background Mass tourism during winter in mountain areas may cause significant clustering of body injuries leading to increasing emergency admissions at hospital. We aimed at assessing if surgical safety and efficiency was maintained in this particular context. Methods We selected all emergency admissions of open surgery performed in French hospitals between 2010 and 2012. After identifying mountain areas with increasing volume of surgical stays during winter, we considered seasonal variations in surgical outcomes using a difference-in-differences study design. We computed multilevel regressions to evaluate whether significant increase in emergency cases had an effect on surgical mortality, complications and length of stay. Clustering effect of patients within hospitals was integrated in analysis and surgical outcomes were adjusted for both patient and hospital characteristics. Results A total of 381 hospitals had 559,052 inpatient stays related to emergency open surgery over 3 years. Compared to other geographical areas, a significant peak of activity was noted during winter in mountainous hospitals (Alps, Pyrenees, Vosges), ranging 6-77% volume increase. Peak was mainly explained by tourists’ influx (+124.5%, 4,351/3,496) and increased need for orthopaedic procedures (+36.8%, 4,731/12,873). After controlling for potential confounders, patients did not experience increased risk for postoperative death (ratio of OR 1.01, 95%CI 0.89-1.14, p = 0.891), thromboembolism (0.95, 0.77-1.17, p = 0.621) or sepsis (0.98, 0.85-1.12, p = 0.748). Length of stay was unaltered (1.00, 0.99-1.02, p = 0.716). Conclusion Surgical outcomes are not compromised during winter in French mountain areas despite a substantial influx of major emergencies. PMID:25970625

  17. Porridge and peas: C. Stanton Hicks and Australian army rations.

    PubMed

    Collingham, Lizzie

    2009-09-01

    In 1942 Australian troops came back from fighting the Japanese in New Guinea exhausted and malnourished. The army rations of bully beef and biscuits were insufficiently rich in vitamins to sustain men in combat in tropical conditions. The nutritionist C. Stanton Hicks was one of a vast army of scientists who worked behind the scenes to maximize the war effort. He made it his mission to improve the army diet. He set up the Australian Army Catering Corps, invented combat ration packs and tried to introduce vitamin-rich foods into the soldiers' diet. Two of his more idiosyncratic innovations were wheat porridge and Tasmanian blue peas. PMID:19539373

  18. Electronic voice communications improvements for Army aircraft

    NASA Astrophysics Data System (ADS)

    Mayer, M. S.

    1982-08-01

    The communications systems on all Army aircraft flying today are based on design concepts that are over 50-years old. We have designed a totally modern, state-of-the-art communications system for Army aircraft, and have published two new specifications which contain many of the modern test procedures required to accurately test and evaluate the various components of the communication system. As a first step in the development of new test procedures, we evaluated both ASA and ANSI standards and found them lacking. The components of the new state-of-the-art communications system will include, as a minimum: high impedance DC powered noise canceling microphones (using piezoelectric ceramic, electret, or PVF2 diaphragms); earphone elements designed and tested to have flat frequency response when inside the circumaural earcup of the hearing protective device; and intercoms which replace positive peak-clipping with fast-acting AGC circuits and expander/compander circuits for maximum output signal without distortion, even under conditions of extremes stress. In the future, audio signals in the microphone will be converted into the digital mode or directly into the optical spectrum for high efficiency, and secure communications inside the aircraft. The savings in weight and security improvements will be considerable.

  19. Surgical video systems.

    PubMed

    1995-11-01

    Surgical video systems (SVSs), which typically consist of a video camera attached to an optical endoscope, a video processor, a light source, and a video monitor, are now being used to perform a significant number of minimally invasive surgical procedures. SVSs offer several advantages (e.g., multiple viewer visualization of the surgical site, increased clinician comfort) over nonvideo systems and have increased the practicality and convenience of minimally invasive surgery (MIS). Currently, SVSs are used by hospitals in their general, obstetric/gynecologic, orthopedic, thoracic, and urologic procedures, as well as in other specialties for which MIS is feasible. In this study, we evaluated 19 SVSs from 10 manufacturers, focusing on their use in laparoscopic applications in general surgery. We based our ratings on the usefulness of each system's video performance and features in helping clinicians provide safe and efficacious laparoscopic surgery. We rated 18 of the systems Acceptable because of their overall good performance and features. We rated 1 system Conditionally Acceptable because, compared with the other evaluated systems, this SVS presents a greater risk of thermal injury resulting from excessive heating at the distal tip of the laparoscope. Readers should be aware that our test results, conclusions, and ratings apply only to the specific systems and components tested in this Evaluation. In addition, although our discussion focuses on the laparoscopic application of SVSs, much of the information in this study also applies to other MIS applications, and the evaluated devices can be used in a variety of surgical procedures. To help hospitals gain the perspectives necessary to assess the appropriateness of specific SVSs to ensure that the needs of their patients, as well as the expectations of their clinicians, will be satisfied, we have included a Selection and Purchasing Guide that can be used as a supplement to our Evaluation findings. We have also included a Glossary of relevant terminology and the supplementary article, "Fiberoptic Illumination Systems and the Risk of Burns or Fire during Endoscopic Procedures," which addresses a safety concern with the use of these devices. While we made every effort to present the most current information, readers should recognize that this is a rapidly evolving technology, and developments occurring after our study was complete may not be reflected in the text. For additional information on topics related to this study, refer to the following Health Devices articles: (1) our Guidance Article, "Surgical Video Systems Used in Laparoscopy," 24(1), January 1995, which serves as an introduction to SVS terminology and includes a discussion of the significance of many SVS specifications; (2) our Evaluation, "Video Colonoscope Systems," 23(5), May 1994, which includes a detailed overview of video endoscopic applications and technology; and (3) our Evaluations of laparoscopic insufflators (21[5], May 1992, and 24[7], July 1995), which address issues related to the creation of a viewing and working space inside the peritoneal cavity to facilitate visualization in laparoscopic procedures. PMID:8750067

  20. Nonfatal Suicidal Behaviors in U.S. Army Administrative Records, 2004–2009: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

    PubMed Central

    Ursano, Robert J.; Kessler, Ronald C.; Heeringa, Steven G.; Cox, Kenneth L.; Naifeh, James A.; Fullerton, Carol S.; Sampson, Nancy A.; Kao, Tzu-Cheg; Aliaga, Pablo A.; Vegella, Patti; Mash, Holly Herberman; Buckley, Christina; Colpe, Lisa J.; Schoenbaum, Michael; Stein, Murray B.

    2015-01-01

    Objective Although the U.S. Army suicide rate is known to have risen sharply over the past decade, information about medically documented, nonfatal suicidal behaviors is far more limited. Here we examine trends and sociodemographic correlates of suicide attempts, suspicious injuries, and suicide ideation among regular Army soldiers. Methods Data come from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Historical Administrative Data Study (HADS), which integrates administrative records for all soldiers on active duty during the years 2004 through 2009 (n = 1.66 million). Results We identified 21,740 unique regular Army soldiers with a nonfatal suicidal event documented at some point during the HADS study period. There were substantial increases in the annual incidence rates of suicide attempts (179–400/100,000 person-years) and suicide ideation (557–830/100,000 person-years), but not suspicious injuries. Using hierarchical classification rules to identify the first instance of each soldier's most severe behavior, we found increased risk of all outcomes among those who were female, non-Hispanic White, never married, lower-ranking enlisted, less educated, and of younger age when entering Army service. These sociodemographic associations significantly differed across outcomes, despite some patterns that appear similar. Conclusion Results provide a broad overview of nonfatal suicidal trends in the U.S. Army during 2004 through 2009 and demonstrate that integration of multiple administrative data systems enriches analysis of the predictors of such events. PMID:26168022

  1. Infection prevention: the surgical care continuum.

    PubMed

    Barnes, Sue

    2015-05-01

    Lack of careful attention to the increasing complexity of surgical procedures, instrument cleaning and processing, and the transition of surgical and other invasive procedures from the OR to areas outside the traditional hospital OR can contribute to surgical site infection (SSI) risk. Regardless of the location of an intervention, when basic infection prevention measures are applied reliably, even low infection rates can be reduced. To address infection prevention challenges, infection preventionists (IPs) must be well informed regarding infection risk and prevention during surgical and other invasive procedures and the effect a facility type may have on patients' infection risk. The IP must have a solid understanding of surgical asepsis, instrument disinfection, and sterilization to educate and support clinical teams in identifying opportunities for improvement relative to infection prevention. PMID:25946177

  2. The Army Family Team Building Program: Facilitating a Transformative Learning Process--An Intrinsic Case Study

    ERIC Educational Resources Information Center

    Gall, Joseph A.

    2009-01-01

    This study sought to understand how the Army Family Team Building program influences self-reliance and self-sufficiency in Army spouses as they integrate into the Army community. The purpose of the Army Family Team Building program is to empower Army spouses with knowledge and skills, which foster well-being and improve quality of life. The…

  3. The Army Family Team Building Program: Facilitating a Transformative Learning Process--An Intrinsic Case Study

    ERIC Educational Resources Information Center

    Gall, Joseph A.

    2009-01-01

    This study sought to understand how the Army Family Team Building program influences self-reliance and self-sufficiency in Army spouses as they integrate into the Army community. The purpose of the Army Family Team Building program is to empower Army spouses with knowledge and skills, which foster well-being and improve quality of life. The…

  4. [An apothecary from the Cévennes region on the rolls of Oriental Pyrenees Army in 1793].

    PubMed

    Guibert, Marie-Sophie

    2015-01-01

    In 1793 during the french Revolution, the decret of February 23rd orders a big recruitment of 300 000 people. The city of Alčs (Cevennes) has to supply ninety-seven soldiers to establish the battalion of the Gard. They will be allocated to the "Armée des Pyrénées-Orientales" (Army of the Eastern Pyrenees) which is going to defend the border with Spain. These armies have to face the influx of wounded persons but especially the devastation of the epidemics. Besides the soldiers, are enlisted the officers of health, the doctors, the surgeons and the pharmacists. So the city of Alčs indicates to be of use to this army the youngest of the doctors, freshly honed of the university of Montpellier and two old pharmacists (51 y. and 61 y. old). They were allocated to the hospital of Narbonne where they worked to fight against the epidemics, in particular by the disinfection of rooms. The oldest of them succumbed to the disease. Two others, safe and sound income in their home town, played a notables' role. PMID:25807665

  5. Uncommon surgical emergencies in neonatology.

    PubMed

    Angotti, R; Bulotta, A L; Ferrara, F; Molinaro, F; Cerchia, E; Meucci, D; Messina, M

    2014-01-01

    Objective. Over the past decade, multiple factors have changed the pattern of neonatal surgical emergencies. An increase in prenatal screenings and the development of neonatal tertiary care centres have changed the clinical approach to these kids. Materials and methods. Between 1995 to 2011 were retrospectively reviewed 34 patients with diagnosis of uncommon rare neonatal surgical emergencies at our institute. We analyzed: sex, gestational age, weight at birth, primary pathology, prenatal diagnosis, associated anomalies, age and weight at surgery, clinical presentation, start of oral feeding and hospitalization. The follow-up was performed at 6,12, 24 and 36 months. Results. There were 21 male and 13 female. The gestational age ranged between 28 and 36 weeks. The weight at birth ranged between 700 and 1400 grams. Oral feeding was started between 4th and 10th postoperative day. The average hospitalization was about 70.47 days. To date, all patients have finished the followup. They are healthy. Conclusion. The outcome of the patients with uncommon surgical emergencies is different based on the etiology. Overall survival is generally good but is influenced by the associated anomalies. PMID:25669890

  6. Quinine substitutes in the confederate army.

    PubMed

    Hasegawa, Guy R

    2007-06-01

    During the Civil War, the unreliable supply and high cost of quinine forced the Confederate Army to use alternative treatments for malaria. Many quinine substitutes were mentioned in the literature of the time, but relatively few were advocated by Confederate officials and even fewer are described in surviving records. Medical supply officers often issued substitute remedies when quinine was requisitioned. Most alternative treatments were made from indigenous plants such as dogwood, willow (a constituent of which gave rise to aspirin), and tulip tree. High hopes were held for Georgia bark, which was thought to be closely related to cinchona, from which quinine was derived. Documentation of the effectiveness of quinine substitutes is scanty but is most plentiful for the external application of turpentine. The quinine substitutes were generally considered useful but not as effective as quinine. The Confederate Surgeon General's Office was active in seeking out and supplying troops with quinine substitutes. PMID:17615851

  7. Posttraumatic Stress Disorder Among Army Nurse Corps Vietnam Veterans.

    ERIC Educational Resources Information Center

    Stretch, Robert H.; And Others

    1985-01-01

    Investigated posttraumatic stress disorder (PTSD) among Army nurse veterans. Analysis of questionnaire data (N=712) revealed a current PTSD rate for Vietnam veteran nurses of 3.3 percent. This rate is comparable to that found among nonnurse active duty Army Vietnam veterans and is much lower than estimates for civilian Vietnam veterans.…

  8. 32 CFR 644.329 - Army civil works real property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Army civil works real property. 644.329 Section 644.329 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal Procedure for Placing Real Property in Excess Status § 644.329...

  9. Explaining Recent Army and Navy Minority Recruiting Trends. Research Brief

    ERIC Educational Resources Information Center

    Steinberg, Paul

    2009-01-01

    Between 2000 and 2007, the representation of blacks among high-quality Army recruits declined, while in the Navy, black representation remained stable; the representation of Hispanics among high-quality recruits in both the Army and Navy grew during this period. RAND researchers identified factors that explain these recruiting trends and found…

  10. Soldier Education in the British Army, 1920-2007

    ERIC Educational Resources Information Center

    Beach, Jim

    2008-01-01

    This article surveys the history of compulsory education for soldiers' career advancement in the British army. It begins with an examination of the organizational context before analyzing the rationale, syllabus, teaching and assessment of soldier education. It concludes that for members of the army education organization their self-perception as…

  11. 32 CFR 644.329 - Army civil works real property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Army civil works real property. 644.329 Section 644.329 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal Procedure for Placing Real Property in Excess Status § 644.329...

  12. 32 CFR 644.329 - Army civil works real property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Army civil works real property. 644.329 Section 644.329 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal Procedure for Placing Real Property in Excess Status § 644.329...

  13. New Tools and Metrics for Evaluating Army Distributed Learning. Monograph

    ERIC Educational Resources Information Center

    Straus, Susan G.; Shanley, Michael G.; Yeung, Douglas; Rothenberg, Jeff; Steiner, Elizabeth D.; Leuschner, Kristin J.

    2011-01-01

    Distributed learning (DL) is a key element of the Army's training strategy, and the Army has ambitious goals for expanding the future use of DL and for changing how it is developed and delivered. Program-level evaluation of DL can play an essential role in accomplishing those goals and in identifying strategic directions for the overall program.…

  14. 20. Photocopy of original drawing by US Army Engineer District, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    20. Photocopy of original drawing by US Army Engineer District, Corps of Engineers, 1964 (original in possession of NYC Economic Development Corp.) REPAIRS OF SPALLED CONCRETE-PIERS 2,3, AND 4 - Brooklyn Army Supply Base, Pier 2, Brooklyn, Kings County, NY

  15. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... PUBLIC RELATIONS COMPETITION WITH CIVILIAN BANDS § 508.1 Utilization of Army bands. (a) General... Secretary of Defense. The authority to determine whether the use of an Army band at a public gathering is... Forces, veterans, and patriotic organizations. (3) At public rallies and parades intended to...

  16. 32 CFR 644.329 - Army civil works real property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Army civil works real property. 644.329 Section 644.329 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal Procedure for Placing Real Property in Excess Status § 644.329...

  17. Posttraumatic Stress Disorder Among Army Nurse Corps Vietnam Veterans.

    ERIC Educational Resources Information Center

    Stretch, Robert H.; And Others

    1985-01-01

    Investigated posttraumatic stress disorder (PTSD) among Army nurse veterans. Analysis of questionnaire data (N=712) revealed a current PTSD rate for Vietnam veteran nurses of 3.3 percent. This rate is comparable to that found among nonnurse active duty Army Vietnam veterans and is much lower than estimates for civilian Vietnam veterans.…

  18. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Army military real property. 644.326 Section 644.326 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military real property. Military real property, including industrial real property, under the control...

  19. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 4 2011-07-01 2011-07-01 false Army military real property. 644.326 Section 644.326 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military real property. Military real property, including industrial real property, under the control...

  20. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Army military real property. 644.326 Section 644.326 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military real property. Military real property, including industrial real property, under the control...

  1. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Army military real property. 644.326 Section 644.326 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military real property. Military real property, including industrial real property, under the control...

  2. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Army military real property. 644.326 Section 644.326 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military real property. Military real property, including industrial real property, under the control...

  3. 75 FR 19302 - Radiation Sources on Army Land

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-14

    ... final rule which establishes requirements for the expanded definition of byproduct material. 72 FR 55864... was made in a separate rulemaking for 10 CFR Part 110 (April 20, 2006; 71 FR 20336). The Department of... Department of the Army 32 CFR Part 655 RIN 0702-AA58 Radiation Sources on Army Land AGENCY: Department of...

  4. Achieving Competence: Army-VOTEC School Partnership Pilot Studies.

    ERIC Educational Resources Information Center

    Stout, Mary W.

    To reduce Army training costs, the Training and Doctrine Command (TRADOC) investigated use of training at civilian secondary and postsecondary vocational-technical (VOTEC) institutions as an alternative to initial job training in Army service schools. Three models were used in the pilot study: the preservice training model in which…

  5. Correlates of Military Satisfaction and Attrition Among Army Personnel.

    ERIC Educational Resources Information Center

    Allen, John P.; Bell, D. Bruce

    A study determined relationships between Army organizational variables and levels of soldier satisfaction and assessed correlates of attrition and battalion effectiveness ratings. It was based on a secondary analysis of data collected in the Army Life-78 Study, which considered relationships of organizational climate and unit effectiveness.…

  6. eArmyU Improves Educational Access for Soldiers.

    ERIC Educational Resources Information Center

    Brotherton, Phaedra

    2002-01-01

    Describes how the Army's venture into distance learning, eArmyU, is proving to be a big success, with more than 12,000 soldiers enrolled since it began a year ago. Soldiers are lining up for the program that offers free tuition, a laptop, and Internet access. But historically black colleges and universities may be missing out due to distance…

  7. The quality of surgical clerkships.

    PubMed

    Holden, W D

    1985-06-01

    Many of the contours of a surgical clerkship can be designed, implemented, and evaluated with varying degrees of objectivity. The recently established Association for Surgical Education and its expanding membership have performed in an excellent fashion in addressing the objectives, content, process, and evaluation of surgical clerkships. There are several factors that influence the quality of a clerkship that are not readily subjected to measurement but that have a significant impact on the environment and conduct of clerkships. Criticism, mainly from the academic community, has been directed recently to distortions of the learning process and the continuing use of traditional teaching methods that do not serve medical educational programs and students optimally. More attention should be paid to the principle that a surgical clerkship should be designed to provide an elemental comprehension of the major surgical diseases irrespective of how the students will select multiple specialties for their careers. The quality of a clinical teaching program is influenced in a realistic way by the quality of care provided to the patients. The image of the staff, especially the resident staff, plays an important role in affecting students' incentives, the development of self-discipline, their attitudes toward patients and families, and the ultimate selection of careers. As much responsibility as possible for the diagnosis of disease and the care of patients should be given to students under close supervision and always with the best interests of the patients in mind. The environment of medical schools and teaching hospitals is changing rapidly. The corporate practice of medicine will have an impact on the quality of surgical clerkships, we hope not adversely. PMID:4002120

  8. Heritage of Army Audiology and the Road Ahead: The Army Hearing Program

    PubMed Central

    Gates, Kathy; Ciliax, Donald

    2008-01-01

    Noise-induced hearing loss has been documented as early as the 16th century, when a French surgeon, Ambroise Paré, wrote of the treatment of injuries sustained by firearms and described acoustic trauma in great detail. Even so, the protection of hearing would not be addressed for three more centuries, when the jet engine was invented and resulted in a long overdue whirlwind of policy development addressing the prevention of hearing loss. We present a synopsis of hearing loss prevention in the US Army and describe the current Army Hearing Program, which aims to prevent noise-induced hearing loss in soldiers and to ensure their maximum combat effectiveness. PMID:18923117

  9. TMAP [Teleoperated Mobile Antiarmor Platform]: The Army`s near term entree to battlefield robotics

    SciTech Connect

    Simmons, R.K.

    1988-05-01

    TMAP is a remotely operated battlefield system consisting of a 750-pound all terrain vehicle, remotely operated by a solider over a fiber optic communication link 4 km long. Using state-of-the-art automation and robotic technology, Martin Marietta Aero and Naval Systems is developing a modular prototype system under contract to Sandia National Laboratories. The Army Material developer is the Missile Command (MICOM) at Huntsville, Alabama; the Combat Developer is the Infantry School (USAIS) at Ft. Benning, Georgia. With the weapons removed by Congress in December 1987, the O & O is being rewritten for a ``Tactical Multipurpose Automated Platform`` (TMAP) instead of the original Teleoperated Mobile Antiarmor Platform. With minimal modification the modular TMAP system can be used in many applications (eg., antiarmor or antiair weapons, mine detection, medical support). System acceptance and Army evaluation testing is scheduled for summer and fall of 1988. 9 figs., 2 tabs.

  10. Should surgical outcomes be published?

    PubMed

    Chou, Evelyn; Abboudi, Hamid; Shamim Khan, Mohammed; Dasgupta, Prokar; Ahmed, Kamran

    2015-04-01

    Despite publishing surgical outcomes being a positive step forwards in the progression of England's healthcare system, it has no doubt been faced with criticism and reservations. This review article aims to discuss the pros and cons of publishing individual surgical outcomes, as well as the challenges faced. Publishing outcomes requires data from a number of sources such as national clinical audits, hospital episode statistics, patient-reported outcomes, registers and information from revalidation. As yet, eight surgical specialties have begun publishing their data, including cardiac (coronary artery bypass graft, valve and aortic surgery), endocrine (thyroidectomy, lobectomy, isthmusectomy), orthopaedic (hip and knee replacement), urological (full and partial nephrectomies, nephroureterectomy), colorectal (bowel tumour removal), upper gastrointestinal (stomach cancer and oesophageal cancer removal, bariatric surgery), ear, nose and throat surgery (larynx, oral cavity, oropharynx, hypopharynx and salivary gland cancer removal), as well as vascular surgery (abdominal aortic aneurysm, carotid endarterectomy). However, not all procedures have been addressed. Despite the controversy surrounding the topic of publishing surgical outcomes, the advantages of reporting outcomes outweigh the disadvantages, and these challenges can be overcome, to create a more reliable, trustworthy and transparent NHS. Perhaps one of the main challenges has been the difficulty in collecting large amounts of clinically significant data able to quantify the performance of surgeons. PMID:25899023

  11. The Women's Army Auxiliary Corps: A Compromise to Overcome the Conflict of Women Serving in the Army

    ERIC Educational Resources Information Center

    Permeswaran, Yashila

    2008-01-01

    Though people now take the idea of women in the military for granted, in the 1940s it was a vigorously debated suggestion. Men protected their country; women stayed at home. Because of the conflict over whether women should serve in the army, Congress compromised by creating the Women's Army Auxiliary Corps (WAAC). This article describes the…

  12. Differential Validity of the Army Aptitude Areas for Predicting Army Job Training Performance of Blacks and Whites. Technical Paper 312.

    ERIC Educational Resources Information Center

    Maier, Milton H.; Fuchs, Edmund F.

    Validation studies were conducted on nine revised aptitude areas of the Army Classification Battery (ACB) to determine whether ACB scores provided an equitable indication of the qualifications of blacks and whites for training in major groups of Army jobs. The aptitude areas were: combat, field artillery, electronics repair, operators and food,…

  13. Report of the Department of the Army Board to Review Army Officer Schools. Volume I. Summary And Recommendations.

    ERIC Educational Resources Information Center

    Department of the Army, Washington, DC.

    The purpose of the Board was to determine adequacy and appropriateness of current Army school system and education and individual school training of Army officers in light of responsibilities confronting military establishment for the foreseeable future and to recommend changes in academic program during the next decade to make greatest…

  14. Differential Validity of the Army Aptitude Areas for Predicting Army Job Training Performance of Blacks and Whites. Technical Paper 312.

    ERIC Educational Resources Information Center

    Maier, Milton H.; Fuchs, Edmund F.

    Validation studies were conducted on nine revised aptitude areas of the Army Classification Battery (ACB) to determine whether ACB scores provided an equitable indication of the qualifications of blacks and whites for training in major groups of Army jobs. The aptitude areas were: combat, field artillery, electronics repair, operators and food,…

  15. Emergency Surgery Patients Often Wind Up Back in Hospital

    MedlinePLUS

    ... nih.gov/medlineplus/news/fullstory_155670.html Emergency Surgery Patients Often Wind Up Back in Hospital: Study ... readmitted to a hospital after having emergency general surgery are there because they developed a surgical site ...

  16. The surgical treatment of gastroduodenal Crohn's disease.

    PubMed Central

    Shepherd, A. F.; Allan, R. N.; Dykes, P. W.; Keighley, M. R.; Alexander-Williams, J.

    1985-01-01

    Crohn's disease can affect any part of the gastrointestinal tract. Gastroduodenal involvement is uncommon and was not recognised until 1949 (1). Since then approximately 200 cases have been described in several series in the world literature. This paper describes the clinical presentation and surgical management of ten patients treated in the Birmingham General Hospital between 1970 and 1984. PMID:4073768

  17. [Pathways for surgical antibiotic prophylaxis].

    PubMed

    Maio, Patrizia

    2003-09-01

    Surgical site infections (SSIs) are a notable cause of hospital morbidity and mortality. Antibiotic prophylaxis has demonstrated a significant reduction in infection rate in clean-contaminated surgery and in clean surgery to a limited extent. To make antibiotic prophylaxis effective it is necessary to choose the right antibiotic, to administer it preoperatively and maintain sufficient serum and tissue levels through the operation. Open issues remain: antibiotic prophylaxis duration in prosthetic surgery, its use in hernia repair, breast surgery and mini-invasive surgery. PMID:14985643

  18. Nutritional assessment of surgical patients.

    PubMed

    Brown, C S; Stegman, M R

    1988-10-01

    In order to test the sensitivity and specificity of the East Orange Nutritional Screening Form (EONSF), nutritional assessments were performed on a random sample of 10% of general medical/surgical admissions at a large midwestern veteran's administration hospital. Patients were followed until discharge to determine if they met the standard criteria of additional nutritional support. The tool correctly identified patients at nutritional risk (sensitivity) 95% of the time and patients not at nutritional risk (specificity) 89% of the time. It proved to be an effective, low-cost tool for identifying patients at risk and for planning appropriate nutritional strategies. PMID:3146037

  19. Surgical handicraft: teaching and learning surgical skills.

    PubMed

    Barnes, R W

    1987-05-01

    Surgeons choose their profession with a strong desire to excel at manual therapeutic skills. Although we mime our mentors, we have often received the torch of technique in the absence of a systematic program to optimally develop our manual dexterity. The operating room is the ultimate arena to refine one's technical ability, but a surgical skills laboratory should assume increasing importance in introducing the trainee to the many nuances of the fine manual motor skills necessary for optimal surgical technique. Surgical educators should address the science of surgical handicraft in a manner similar to the science of preoperative and postoperative surgical principles that have been espoused over the past 40 years. Although it has been euphemistically said that "you can teach a monkey to operate," few of us have broken the process down into the basic elements to accomplish such a goal. In view of the increasing complexity of operations and equipment, the constraints on animal laboratories and teaching caseloads, and the mounting economic and medico-legal pressures, the development of optimal surgical skills should be a major objective of every surgical training program. By developing novel programs and scientifically evaluating the results of such endeavors, surgical faculties may find increased academic rewards for being a good teacher. PMID:3578661

  20. Designing and implementing the Army Nursing Leader Academy.

    PubMed

    Dunemn, Kathleen; Hopkins-Chadwick, Denise L; Connally, Tina; Bramley, Kelly

    2011-01-01

    In 2008, the Chief of the Army Nurse Corps directed a thorough review of existing training programs available to and provided for Army Nursing personnel for the development of full-spectrum leaders for Army Nursing. The review provided the gap analysis necessary to restructure courses provided by the Department of Nursing Science at the Army Medical Department Center and School. This new grouping of courses is referred to as the Army Nursing Leader Academy. The Army Nursing Leader Academy is the first of its kind in that it addresses career-long learning of all Army Nursing by focusing on building skills, knowledge, and behaviors to produce sustainable, full-spectrum leaders. The Nursing Leader Academy consists of a series of sequential nurse leader development courses combined with a web based resource center. Grounded in the Patient CaringTouch System, guided by nurse competencies, and gauged by the Leader Capabilities Map, the Nursing Leader Academy provides learning that is relevant and timely designed to reinforce enterprise values and culture to ensure readiness for successive roles and positions. Full implementation of the Nursing Leader Academy will include the evidence-based elements of formal schooling, coaching, self-development, functional/technical (competency attainment), and professional experiences. PMID:22124867

  1. Renewable Energy Opportunities for the Army

    SciTech Connect

    Solana, Amy E.; States, Jennifer C.; Chvala, William D.; Weimar, Mark R.; Dixon, Douglas R.

    2008-08-13

    The Department of Defense (DoD) has a goal of obtaining 25% of its domestic electricity from renewable sources by 2025, and also must meet federal renewable energy mandates and schedules. This report describes the analyses undertaken to study the renewable resource potential at 15 Army sites, focusing on grid-connected generation of electricity. The resources analyzed at each site include solar, wind, geothermal, biomass, waste-to-energy, and ground source heat pumps (GSHPs). For each renewable generation resource, an assessment was completed to determine the level of resource availability, and the price at which that resource would be available for electricity generation. Various design alternatives and available technologies were considered in order to determine the best way to utilize each resource and maximize cost-effective electricity generation. Economic analysis used multiple funding options, including investment by an independent power producer (IPP), Energy Savings Performance Contract (ESPC), and Energy Conservation Investment Program (ECIP), and considered tax incentives, renewable energy credits, and other economic factors to reveal the most realistic costs possible. Where resource options proved to be economically viable, implementation approaches were recommended. The intention was to focus each installation’s efforts on realistic projects, moving them from initial assessment through the design and financing to implementation. Many Army sites enjoy very low costs of electricity, limiting the number of cost-effective renewable energy options where resources are available. Waste-to-energy was often a viable option due to the additional revenue gathered from transferred tipping fees. GSHPs were also commonly cost-effective options for replacement in inefficient buildings. Geothermal, wind, and solar resources are found to be more available in certain parts of the country over others, reducing overall potential for use. Wind is variable and often most available in remote areas far from transmission lines, greatly increasing costs. Capital costs for solar energy are high, and the resource is also variable. Table 1 shows which resources are promising for each installation studied. Not all analyses are complete at this point, so some resource potential is still unknown.

  2. A Targeted E-Learning Program for Surgical Trainees to Enhance Patient Safety in Preventing Surgical Infection

    ERIC Educational Resources Information Center

    McHugh, Seamus Mark; Corrigan, Mark; Dimitrov, Borislav; Cowman, Seamus; Tierney, Sean; Humphreys, Hilary; Hill, Arnold

    2010-01-01

    Introduction: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty. Methods: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An…

  3. A Targeted E-Learning Program for Surgical Trainees to Enhance Patient Safety in Preventing Surgical Infection

    ERIC Educational Resources Information Center

    McHugh, Seamus Mark; Corrigan, Mark; Dimitrov, Borislav; Cowman, Seamus; Tierney, Sean; Humphreys, Hilary; Hill, Arnold

    2010-01-01

    Introduction: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty. Methods: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An…

  4. His own private hospital

    PubMed Central

    Jones, D

    1997-01-01

    Dr. Brian Day had a simple solution when it became increasingly difficult to book operating room time in Vancouver. He built his own hospital. The Cambie Surgical Centre, which treats patients from BC and around the world, has 2 main operating rooms, 10 recovery beds and 5 private rooms for extended stays. "What I've done," says Day, "is say that if there are no operating rooms at UBC, I'll build my own." PMID:9269202

  5. Image enhancement technology research for army applications

    NASA Astrophysics Data System (ADS)

    Schwering, Piet B. W.; Kemp, Rob A. W.; Schutte, Klamer

    2013-06-01

    Recognition and identification ranges are limited to the quality of the images. Both the received contrast and the spatial resolution determine if objects are recognizable. Several aspects affect the image quality. First of all the sensor itself. The image quality depends on the size of the infrared detector array and the sensitivity. Second, also the intervening atmosphere, in particular over longer ranges, has an impact on the image quality. It degrades the contrast, due to transmission effects, as well as it influences the resolution, due to turbulence blur, of the image. We present studies in the field of infrared image enhancement. Several techniques are described: noise reduction, super resolution, turbulence compensation, contrast enhancement, stabilization. These techniques operate in real-time on COTS/MOTS platforms. They are especially effective in the army theatre, where long horizontal paths, and short line-of-sight limited urban operations are both present. Application of these techniques on observation masts, such as on military camp sites, and on UAVs and moving ground vehicles are discussed. Examples will be presented from several trials in which these techniques were demonstrated, including the presentation of test results.

  6. Surgical training in Guyana: the next generation.

    PubMed

    Cameron, Brian H; Martin, Carlos; Rambaran, Madan

    2015-02-01

    The pioneering surgical training partnership between the Canadian Association of General Surgeons (CAGS) and the University of Guyana has successfully graduated 14 surgeons since 2006. The association has recruited 29 surgeons who have made 75 teaching visits to Guyana, and CAGS involvement has been critical to providing local credibility to the program, organizing the curriculum structure and developing rigorous examinations. The program is now locally sustained, with graduates leading a number of clinical hospital programs. The initial diploma qualification is being reassessed, as other specialties have introduced postgraduate Master of Medicine degree programs. Many graduates are pursuing additional training opportunities overseas, and almost all of those remaining in Guyana have returned to the tertiary centre from the regional hospitals. The program has succeeded in training surgeons and raising the standards of surgical care in Guyana, but broader health system efforts are necessary to retain surgeons in outlying regional hospitals. PMID:25621909

  7. 75 FR 34714 - Updated Record of Decision (ROD) for Revised Army Growth and Force; Structure Realignment Decisions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-18

    ...The Department of the Army announces the availability of an updated ROD for Army Growth and Force Structure Realignment. This ROD explains that the Army has modified previous decisions made in December 2007 to support Army growth and force structure realignment. The Army's decision at the time grew the Army by six Infantry Brigade Combat Teams (IBCTs), eight active component support brigades,......

  8. 77 FR 27209 - Army Education Advisory Subcommittee Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-09

    .... General deliberations leading to provisional findings will be referred to the Army Education Advisory Committee for deliberation by the Committee under the open-meeting rules. FOR FURTHER INFORMATION...

  9. 78 FR 38956 - Army Education Advisory Subcommittee; Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-28

    ... items on July 31 and August 1. Deliberations leading to provisional findings will be referred to the Army Education Advisory Committee for deliberation by the Committee under the open- meeting rules....

  10. 78 FR 23759 - Army Education Advisory Subcommittee Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-22

    .... General deliberations leading to provisional findings will be referred to the Army Education Advisory Committee for deliberation by the Committee under the open-meeting rules. FOR FURTHER INFORMATION...

  11. 77 FR 4026 - Army Education Advisory Subcommittee Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-26

    .... General deliberations leading to provisional findings will be referred to the Army Education Advisory Committee for deliberation by the Committee under the open-meeting rules. FOR FURTHER INFORMATION...

  12. 78 FR 73852 - Army Science Board Winter Plenary Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-09

    ... FY13 study titled, ``Creating an Innovation Culture in the Army'' in an open session and begin work on... Culture'' Study. The ASB board members will cast a vote to accept the results of this study and...

  13. Development of aeronautical engines by the Army and Navy

    NASA Technical Reports Server (NTRS)

    1921-01-01

    Different aircraft engines are categorized as being of interest to only the Army or Navy or to both armed services. A listing of the different engines is presented along with some statistics, namely, horsepower.

  14. Improved maintenance management for Army central energy plants. Final report

    SciTech Connect

    Bowman, L.V.; Moshage, R.E.

    1994-09-01

    One important way for the U.S. Army to reduce installation operating costs is to improve maintenance operations and management practices at central energy facilities. Significant monetary savings and improvements in overall operating efficiency can be achieved by implementing a preventive or predictive maintenance program. The benefits are realized in the form of improved plant efficiency, lower maintenance costs, and less downtime. When an improved maintenance program is properly established and supported, the benefits can continue indefinitely in the form of hard savings. This report provides an overview of methods and tools available to Army central energy plant managers for improving maintenance operations and management, and offers guidelines for comparing the cost-effectiveness of different approaches. It is shown that most Army central energy plants could meet a 5-year payback deadline by implementing a preventive maintenance program. Many Army facilities could also expect a 5-year payback on a predictive maintenance program, even though the startup costs are greater.

  15. [The Central Military Hospital of the People's Commissariat for Defence during the Great Patriotic War].

    PubMed

    Simonenko, V B; Abashin, V G; Polovinka, V S

    2014-05-01

    The article is devoted to activity of the Central Military Hospital of the People's Commissariat for Defence during the Great Patriotic War. The research is based on declassified orders of PCD and orders of the chef of hospital. Authors presented the role of the hospital in organization of medical aid for officers of PCD, members of their families, Red Army soldiers, junior and senior Red Army commanders; the role of the hospital in organization of medical facilities for combat army; medical supply for evacuation of family members of PCD's officers ( en route and in evacuation places); delivery of child health care to children of officers of PCD in the hospital and education in kindergartens of PCD. PMID:25286563

  16. High and low surgical rates: risk factors for area residents.

    PubMed Central

    Roos, N P; Roos, L L

    1981-01-01

    Patterns of surgical practice, the type of operations performed, and risk characteristics of elderly patients brought to surgery are examined in areas with differing surgical rates. This population-based analysis covering Manitoba's 56 rural hospital areas uses discharge claims filed routinely with the provincial Health Services Commission. One and a half times as much surgery was performed in high rate areas (115.2 procedures per 1,000 elderly) as in low rate areas (74.7 procedures/1,000). Since surgical case mix varied little between high and low rate areas, the rate variation means that place of residence strongly influences exposure to major surgical procedures. In similar fashion, the proportion of surgical cases classified as high-risk does not vary with the surgical rate. High risk patients resident in high surgical rate areas are more likely to come to surgery than are their counterparts in low rate areas. Further analyses of nonsurgical hospitalization, of three common elective procedures, and of area characteristics were carried out. The surgical selection process, not characteristics of the population residing in the area, appears to determine the rate at which high and low risk patients come to surgery. Our research clearly suggests that high surgical rates carry with them the risk of excess surgical deaths. PMID:7235097

  17. 78 FR 24735 - Army Education Advisory Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-26

    ...Pursuant to the Federal Advisory Committee Act of 1972 (5 U.S.C., Appendix, as amended), the Sunshine in the Government Act of 1976 (U.S.C. 552b, as amended) and 41 Code of the Federal Regulations (CFR 102-3.140 through 160, the Department of the Army announces the following committee meeting: Name of Committee: Army Education Advisory Committee (AEAC). Date of Meeting: Thursday, May 30, 2013,......

  18. US Army remotely piloted vehicle supporting technology program

    NASA Technical Reports Server (NTRS)

    Gossett, T. D.

    1981-01-01

    Essential technology programs that lead to the full scale engineering development of the Aquila Remotely Piloted Vehicle system for U.S. Army are described. The Aquila system uses a small recoverable and reusable RPV to provide target acquisition, designation, and aerial reconnaissance mission support for artillery and smart munitions. Developments that will provide growth capabilities to the Aquila RPV system, as well as future RPV mission concepts being considered by the U.S. Army are presented.

  19. 21 CFR 880.2740 - Surgical sponge scale.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... the patient during surgery. (b) Classification. Class I (general controls). The device is exempt from...) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Monitoring... powered device used to weigh surgical sponges that have been used to absorb blood during surgery so...

  20. Drinking and Spouse Abuse Among U.S. Army Soldiers

    PubMed Central

    Bell, Nicole S.; Harford, Thomas; McCarroll, James E.; Senier, Laura

    2005-01-01

    Background This study examines the relationship between typical weekly drinking and perpetration of spouse abuse as well as the relationship between the perpetrator’s typical weekly drinking and alcohol use during the abuse event among U.S. Army male soldiers. Methods Cases include all active duty, male, enlisted Army spouse abusers identified in the Army’s Central Registry who had also completed an Army Health Risk Appraisal Survey (HRA) between 1991 and 1998 (N = 9534). Cases were matched on sex, rank, and marital status with 21,786 control subjects who had also completed an HRA. Results In multivariate logistic regression models, heavy drinkers (22 or more drinks per week) were 66% more likely to be spouse abusers than were abstainers (odds ratio 1.66; 95% confidence interval 1.40–1.96). In addition, self-reported moderate and heavy drinkers were three times as likely and light drinkers (1–7 drinks per week) were twice as likely as nondrinkers to be drinking during the time of the abuse event. Conclusion Self-reported heavy drinking is an independent risk factor for perpetration of spouse abuse among male, enlisted Army soldiers. Even 5 years or more after ascertainment of typical drinking habits, there is a significant association between self-reported heavy drinking and alcohol involvement at the time of the spouse abuse event. Personnel who work with perpetrators and victims of spouse abuse should be trained carefully to query about current and typical drinking patterns. PMID:15608606

  1. 32 CFR 536.1 - Purpose of the Army Claims System.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Purpose of the Army Claims System. 536.1 Section 536.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.1 Purpose of the Army Claims System....

  2. 77 FR 25952 - Oregon Army National Guard, Camp Rilea, Clatsop County, OR; Danger Zone

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-02

    ... Department of the Army, Corps of Engineers 33 CFR Part 334 Oregon Army National Guard, Camp Rilea, Clatsop County, OR; Danger Zone AGENCY: U.S. Army Corps of Engineers, DoD. ACTION: Notice of proposed rulemaking and request for comments. SUMMARY: The U.S. Army Corps of Engineers is proposing to establish a...

  3. 32 CFR 536.1 - Purpose of the Army Claims System.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Purpose of the Army Claims System. 536.1 Section 536.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.1 Purpose of the Army Claims System....

  4. The Professional Environment in Army Laboratories and Its Effect on Scientific and Engineering Performance.

    ERIC Educational Resources Information Center

    National Academy of Sciences - National Research Council, Washington, DC. Board on Army Science and Technology.

    In response to a 1982 request by the U.S. Department of the Army, the National Research Council's Board on Army Science and Technology established the Committee on Army Manpower to investigate the professional environments and use of civilian and military scientists/engineers in Army laboratories. The committee's primary objective was to identify…

  5. 32 CFR Appendix G to Part 623 - Continental US Army Boundaries

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623—Continental US Army...

  6. 32 CFR Appendix G to Part 623 - Continental US Army Boundaries

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623—Continental US Army...

  7. 32 CFR Appendix G to Part 623 - Continental US Army Boundaries

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623—Continental US Army...

  8. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES... of views between the U.S. Army Training and Doctrine Command, the Department of the Army, and...

  9. 32 CFR Appendix G to Part 623 - Continental US Army Boundaries

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623—Continental US Army...

  10. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES... of views between the U.S. Army Training and Doctrine Command, the Department of the Army, and...

  11. 32 CFR Appendix G to Part 623 - Continental US Army Boundaries

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623—Continental US Army...

  12. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES... of views between the U.S. Army Training and Doctrine Command, the Department of the Army, and...

  13. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES... of views between the U.S. Army Training and Doctrine Command, the Department of the Army, and...

  14. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES... of views between the U.S. Army Training and Doctrine Command, the Department of the Army, and...

  15. 32 CFR 623.3 - Submission of requests for loan of Army materiel.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Submission of requests for loan of Army materiel. 623.3 Section 623.3 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL § 623.3 Submission of requests for loan of Army materiel. (a) General. (1) Loan requests will be...

  16. Brain metastases secondary to breast cancer: treatment with surgical resection and stereotactic radiosurgery.

    PubMed

    Tolentino, Paul J

    2009-01-01

    Intracerebral metastases are a serious complication for a significant proportion of cancer patients. Successful management may involve multiple treatments including surgical resection, whole-brain radiotherapy (WBRT), and stereotactic radiosurgery (SRS). We report the successful treatment of a solitary brain metastasis using a combination of surgical resection and SRS at Southeast Missouri Hospital, a community hospital that serves a primarily rural population. PMID:20063515

  17. Surgical Lasers In Gynecology

    NASA Astrophysics Data System (ADS)

    Schellhas, Helmut F.; Barnes, Alfonso E.

    1982-12-01

    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  18. Anastomosis: a craft workshop for surgical trainees.

    PubMed

    Allen, P I

    1990-12-01

    Surgery is a very personal exercise and no two surgeons use an identical technique. Traditionally, operative expertise has been acquired through a system of apprenticeships. Pettigrew has shown that operative performance is the main factor in determining postoperative complications and therefore the length of hospital stay, and surgical journals have recently returned to technique as a topic of debate. Certain skills, such as knot tying, can be learned and tested outside the operating theatre, and this has been extended to craft workshops dealing with more complex procedures, including fracture fixation. This article describes an anastomosis workshop held in New Zealand recently for general surgical trainees. PMID:2268209

  19. [Military history of evacuation hospital No 3457 and the head of this hospital -- Porfirii Ivanovich Zabolotnyi].

    PubMed

    PoddubnyÄ­, M V

    2014-05-01

    The article is devoted to publication of an archive document "History of evacuation hospital AN 3457". This archive document was found in one of the deserted country house in Sumy Oblast, Ukraine. 32 pages of text is bright and eloquent testimony of the period of the Great Patriotic War. Hospital was founded in 1941 in Sumy Oblast and then was deployed in Siberia, in the region of the Far North, again in Ukraine and in Hungary. Army medical officer Porfirii Zabolotnyi was the chef of evacuation hospital during this period. PMID:25286566

  20. [DXA imaging: the multifunction Swiss army knife?].

    PubMed

    Gonzalez Rodriguez, E; Favre, L; Lamy, O; Pralong, F; Hans, D

    2015-03-18

    The significant progress on the quality and resolution of the images obtained by "Dual X-ray Absorptiometry" or DXA has permitted on one hand to improve some existing features and on the other to develop new ones, significantly refining the care of our patients in various pathologies. For example, by improving the prediction of fracture risk by indirect analysis of micro- and macro-architecture of the bone, by looking for markers of associated bone diseases (research vertebral fractures or atypical femoral fractures), or by assessing the metabolic status by the measurement of body composition. With the best performing DXA devices we will soon be able, in clinical routine, to determine bone age, to estimate cardiovascular risk (by measuring the calcification of the abdominal aorta) or to predict the progression of joint osteoarthritis and its evolution after surgical management. PMID:25962225

  1. Compare Hospitals

    MedlinePLUS

    ... visit Hospital Safety Score Home Employers & Purchasers Policy Leadership Hospitals Patients Licenses & Permissions About Leapfrog Search 2015 ... fare, resources used in caring for patients, and leadership and structures that promote patient safety. The Leapfrog ...

  2. 1. 1943 Plan View of 'Fort Lewis Station Hospital, Section ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. 1943 Plan View of 'Fort Lewis Station Hospital, Section No. 5.' Drawn by V. Steinbrueck for J.C. Boespflug Construction Co. July 23, 1943. HABS 8x10' negative was made from an 8.5 x 11' copy on card stock in the collection of the Community Library, Madigan Army Medical Center, Fort Lewis, WA. - Madigan Hospital, Bounded by Wilson & McKinley Avenues & Garfield & Lincoln Streets, DuPont, Pierce County, WA

  3. Is the British Army medical grading functional assessment tool effective?

    PubMed

    Mackie, Isobel

    2015-12-01

    Decision Support Aids (DSAs) have been widely used throughout industry and one (known as Table 7) is available to support British Army Medical Officers (MOs) grade soldiers against the Joint Medical Employment Standards. It is unknown how useful this DSA is in practice. An electronic questionnaire was distributed to British Army MOs working within Defence Primary Care facilities enquiring about MOs views on the usefulness of the DSA. Although the response rate was low, informative data were obtained. Between a half and a third of respondents felt that their judgement was affected in the application of the grading system when there were career implications to the grading MOs felt that the DSA allowed subjectivity in the grading. The results of this research suggest that although minor changes to Table 7 may improve service provision, an improvement in training in the application of Table 7 would be of greater benefit to the quality of occupational health service provision in the British Army. PMID:26621810

  4. CDRP - Funded Institutions - Daniel Freeman Memorial Hospital

    Cancer.gov

    Centinela Freeman Regional Medical Center Memorial Campus is owned and operated by Memorial Campus local hospital administrtors, physicians and community leaders. Memorial Campus is a 358-bed acute care community hospital offering a wide array of greatly needed medical and surgical services, including cancer treatment, obstetrics, neonatal intensive care, pediatrics, neurology, neurosurgery, acute rehabilitation and emergency room services. Memorial Campus continues the hospital's almost 50-year mission of service to the Inglewood community since it acquired the facility in 2001.

  5. Deriving DICOM surgical extensions from surgical workflows

    NASA Astrophysics Data System (ADS)

    Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.

    2007-03-01

    The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

  6. Conceptual Design for the Amphibian Research and Monitoring Initiative (ARMI)

    NASA Astrophysics Data System (ADS)

    Battaglin, W. A.; Langtimm, C. A.; Adams, M. J.; Gallant, A. L.; James, D. L.

    2001-12-01

    In 2000, the President of the United States (US) and Congress directed Department of Interior (DOI) agencies to develop a program for monitoring trends in amphibian populations on DOI lands and to conduct research into causes of declines. The U.S. Geological Survey (USGS) was given lead responsibility for planning and implementing the Amphibian Research and Monitoring Initiative (ARMI) in cooperation with the National Park Service (NPS), Fish and Wildlife Service, and Bureau of Land Management. The program objectives are to (1) establish a network for monitoring the status and distribution of amphibian species on DOI lands; (2) identify and monitor environmental conditions known to affect amphibian populations; (3) conduct research on causes of amphibian population change and malformations; and (4) provide information to resource managers, policy makers, and the public in support of amphibian conservation. The ARMI program will integrate research efforts of USGS, other Federal, and non-federal herpetologists, hydrologists, and geographers across the Nation. ARMI will conduct a small number (~20) of intensive research efforts (for example, studies linking amphibian population changes to hydrologic conditions) and a larger number (~50) of more generalized inventory and monitoring studies encompassing broader areas such as NPS units. ARMI will coordinate with and try to augment other amphibian inventory studies such as the National Amphibian Atlas and the North American Amphibian Monitoring Program. ARMI will develop and test protocols for the standardized collection of amphibian data and provide a centrally managed database designed to simplify data entry, retrieval, and analysis. ARMI pilot projects are underway at locations across the US.

  7. Preferred emission factor techniques for army emission inventories

    SciTech Connect

    Polyak, L.M.; Robinson, D.L.; Alden, S.A.; Hopp, P.L.; Ruff, T.E.

    1997-12-31

    The Clean Air Act Amendments of 1990 (CAAA-90) present an unprecedented regulatory challenge to the Department of the Army and the entire US business community. Unlike previous legislation, which focused heavily on the substantive or emission control aspects of air quality management, this round of Amendments focused equal attention on the administrative aspects of air pollution control. Specifically, each new Title of the CAAA-90 is underpinned, either explicitly or implicitly, with the need to perform an emission inventory. The emission inventory is an implied prerequisite for determining the applicability of any of the emission control requirements of the 1990 Amendments, and it is the explicit center piece of the Title 5 operating permit program. Although the emission inventory is little more than a formal accounting of the number and type of emission sources and their associated air emissions, the resource requirements for preparing and maintaining the inventory can be substantial. The average contractor cost for preparing an initial emission inventory at an Army installation was over $100,000. Record keeping to support the inventory, and the annual inventory updates required for the Title 5 permit program will only expand these costs. In an effort to assist the Army community with the ongoing obligation to prepare these emission inventories, the US Army Center for Health Promotion and Preventive Medicine (USACHPPM) has compiled a list of preferred emission inventory techniques for the various emission sources found at Army installations. The USACHPPM guidance identifies emission sources most likely to be found at an Army installation, as well as the most effective and preferred emission factors associated with these sources. This guidance is designed to be widely disseminated, and may have relevant applications in the non-military community.

  8. Surgical Technology Program Guide.

    ERIC Educational Resources Information Center

    Georgia Univ., Athens. Dept. of Vocational Education.

    This surgical technology program guide presents the standard curriculum for technical institutes in Georgia. The curriculum addresses the minimum competencies for a surgical technology program. The program guide is designed to relate primarily to the development of those skills needed by individuals in the field to provide services in the…

  9. [Surgical treatment of epistaxis].

    PubMed

    Jakubiszyn, J; Kochanowski, B; Rekucki, T

    1999-01-01

    The authors present 17 patients with nose bleeding who had to be treated surgically, because conservative procedures turned out unsuccessful. Causes of bleeding, types of conservative procedures, as well as types of operations are described. Surgical treatment was fully efficacious in 12 patients (70%). PMID:10391038

  10. Compact networked radars for Army unattended ground sensors

    NASA Astrophysics Data System (ADS)

    Wikner, David A.; Viveiros, Edward A.; Wellman, Ronald; Clark, John; Kurtz, Jim; Pulskamp, Jeff; Proie, Robert; Ivanov, Tony; Polcawich, Ronald G.; Adler, Eric D.

    2010-04-01

    The Army Research Laboratory is in partnership with the University of Florida - Electronics Communications Laboratory to develop compact radar technology and demonstrate that it is scalable to a variety of ultra-lightweight platforms (<10 lbs.) to meet Army mission needs in persistent surveillance, unattended ground sensor (UGS), unmanned systems, and man-portable sensor applications. The advantage of this compact radar is its steerable beam technology and relatively long-range capability compared to other small, battery-powered radar concepts. This paper will review the ongoing development of the sensor and presents a sample of the collected data thus far.

  11. Army Reserve Expands Net Zero Energy, Water, Waste

    SciTech Connect

    Solana, Amy E.

    2015-04-14

    In 2012, the Army initiated a Net Zero (NZ) program to establish NZ energy, water, and/or waste goals at installations across the U.S. In 2013, the U.S. Army Reserve expanded this program to cover all three categories at different types of Reserve Centers (RCs) across 5 regions. Projects identified at 10 pilot sites resulted in an average savings potential from recommended measures of 90% for energy, 60% for water, and 83% for waste. This article provides results of these efforts.

  12. Surgical management of tracheocutaneous fistula.

    PubMed

    Drezner, D A; Cantrell, H

    1998-07-01

    Tracheocutaneous fistula (TCF) is a complication of tracheotomy that adds a difficult and bothersome aspect to the patient's care and may exacerbate respiratory disease. Closure of the fistula is recommended, but complications associated with fistula closure include pneumothorax and respiratory compromise. Several surgical approaches have been advocated in the literature. We reviewed the operative techniques and outcomes of TCF closures performed at Cooper Hospital/University Medical Center between February 1990 and April 1995. Direct, or flap, closure of large tracheocutaneous fistulas was associated with significant complications and morbidity. Therefore, the closure technique was modified so that we now recommend, in patients with large tracheocutaneous fistulas (a defect of the anterior tracheal wall of > or = 4 mm diameter), excision of the fistula, replacement of the tracheotomy tube and healing by second intention after a short recannulation period. No complications have occurred since the closure technique was adopted. PMID:9693468

  13. [The historical experience of therapeutic service in the Army and Navy during the Great Patriotic War].

    PubMed

    Ovchinnikov, Yu V

    2015-05-01

    The author presents the experience of therapeutic services of the army and navy during the Great Patriotic War (1941-1945) and its importance for the present. This experience became a-general methodological framework-for the development of principles for the organization of work of military physicians in a modern warfare and the application of new weapons. The history of development, aims and objectives of the new section of Military Medicine--the Military Field Therapy as a unified system of organization and delivery of health care to servicemen based on the principles of a unified military field medical doctrine. A problem of organization of new health facilities (hospitals, hospital databases), their acquisition of trained personnel, especially the structure of internal medicine in the war years, the treatment and the early rehabilitation of wounded and sick, between the military and civilian medical institutions-is highlighted. There is an information that 90.6%, or more than 6.5 million soldiers and officers who were treated in hospitals with various diseases, were returned to duty. The experience of the medical service in World War II and the actual demand and is now planning for a package of measures aimed at further improvement of the health status of military-personnel. PMID:26513860

  14. Pancreatic Resection Results in a Statewide Surgical Collaborative

    PubMed Central

    Healy, Mark A.; Krell, Robert W.; Abdelsattar, Zaid M.; McCahill, Laurence E.; Kwon, David; Frankel, Timothy L.; Hendren, Samantha; Campbell, Darrell A.; Wong, Sandra L.

    2016-01-01

    Background A strong relationship between hospital caseload and adverse outcomes has been demonstrated for pancreatic resections. Participation in regional surgical collaboratives may mitigate this phenomenon. This study sought to investigate changes over time in adverse outcomes after pancreatectomy across hospitals with different caseloads in a statewide surgical collaborative. Methods The study investigated patients undergoing pancreatic resection from January 2008 to August 2013 at Michigan Surgical Quality Collaborative (MSQC) hospitals (1007 patients in 19 academic and community hospitals). Risk-adjusted rates of major complications, mortality, and failure to rescue were compared between hospitals based on caseloads (low, medium, and high) in early (2008–2010) and later (2011–2013) periods. Finally, the degree to which different complications explained changes in hospital outcome variation was assessed. Results Adjusted rates of major complications and mortality decreased over time, driven largely by improvements at low-caseload hospitals. In 2008–2010, risk-adjusted major complication rates were higher for low-caseload than for high-caseload hospitals (27.8 vs. 17.8 %; p = 0.02). However, these differences were attenuated in 2011–2013 (22.2 vs. 20.0 %; p = 0.74). Similarly, adjusted mortality rates were higher in low-caseload hospitals in 2008–2010 (6.2 vs. 0.8 %; p = 0.02), but these differences were attenuated in 2011–2013 (3.3 vs. 1.1 %; p = 0.18). Variation in major complications decreased, largely due to decreased variation in “medical” complication rates, with less change in surgical-site complications. Conclusion Participation in regional quality collaboratives by lower-volume hospitals can attenuate the volume–outcome relationship for pancreatic surgery. Continued work in collaboratives with an emphasis on technical and intraoperative aspects of care may improve overall quality of care. PMID:25820999

  15. 75 FR 2463 - Continuing Contract for Civil Works Project Managed by the United States Army Corps of Engineers...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-15

    ... Project Managed by the United States Army Corps of Engineers Clauses AGENCY: U.S. Army Corps of Engineers, Department of the Army, DoD. ACTION: Proposed rule; request for comments. SUMMARY: The U.S. Army Corps of... line of the message. Mail: U.S. Army Corps of Engineers, Attn: CECT-P (Robin A. Baldwin), 441 G...

  16. Relation of Surgical Volume to Outcome in Eight Common Operations

    PubMed Central

    Khuri, Shukri F.; Daley, Jennifer; Henderson, William; Hur, Kwan; Hossain, Monir; Soybel, David; Kizer, Kenneth W.; Aust, J. Bradley; Bell, Richard H.; Chong, Vernon; Demakis, John; Fabri, Peter J.; Gibbs, James O.; Grover, Frederick; Hammermeister, Karl; McDonald, Gerald; Passaro, Edward; Phillips, Lloyd; Scamman, Frank; Spencer, Jeannette; Stremple, John F.

    1999-01-01

    Objective To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity. Summary Background Data In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes. Literature data to support this assumption in intermediate-complexity operations are either limited or controversial. Methods The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used. Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA). Results Eight major surgical procedures (68,631 operations) were analyzed. No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found. Conclusions In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk-adjusted 30-day stroke rate from CEA. Volume of surgery in these operations should not be used as a surrogate for quality of surgical care. PMID:10493488

  17. Anesthetic technique and surgical convalescence.

    PubMed

    Kehlet, H

    1989-01-01

    This brief review presents an update of studies on postoperative fatigue and convalescence and the way in which they are affected by anesthetic technique. Development of postoperative fatigue is related to the degree of surgical trauma, but not to general anesthesia, and it cannot be predicted from age, sex, duration of surgery, or preoperative assessment of various nutritional parameters. Postoperative fatigue correlates with deterioration in nutritional status and impaired adaptability of heart rate to orthostatic stress and bicycle exercise. Decreases in muscle performance and endurance are associated with postoperative fatigue, but psychological factors such as preoperative degree of anxiety do not appear to be important factors. Pain relief with regional anesthetics does not improve postoperative fatigue after abdominal surgery; however, no studies are available that evaluate the effects of regional analgesia with concomitant inhibition of the stress response. Controlled studies suggest that the use of regional anesthesia with local anesthetics reduces duration of hospitalization and time to ambulation. Further studies are needed to define the relative roles of immobilization, impaired nutritional intake, and surgical stress response in the pathogenesis of postoperative fatigue. PMID:2652969

  18. Aggressive Management of Surgical Emergencies

    PubMed Central

    Bengmark, Stig

    2006-01-01

    Increasing evidence suggests that two factors significantly influence outcome in a surgical emergency – premorbid health and the degree of inflammation during the first 24 h following trauma. Repeat observations suggest that the depth of post-trauma immunoparalysis reflects the height of early inflammatory response. Administration to surgical emergencies, as was routine in the past, of larger amounts of fluid and electrolytes, fat, sugar and nutrients seems counterproductive as it increases immune dysfunction, impairs resistance to disease and, in fact, increases morbidity. Instead, strong efforts should be made to limit the obvious superinflammation, which occurs during the first 24 h after trauma and, thereby, reduce the subsequent immuno-paralysis. paralysis. Several approaches show efficacy in limiting early superinflammation such as strict control of blood glucose, avoida nce of stored blood when possible, supply of antioxidants, live lactic acid bacteria and plant fibres. This review focuses mainly on use of live lactic acid bacteria and plant fibres, often called synbiotics. Encouraging experience is reported from clinical trials in liver transplantation, severe pancreatitis and extensive trauma. Immediate control of inflammation by enteral nutrition and supply of antioxidants, lactic acid bacteria and fibres is facilitated by feeding tubes, introduced as early as possible on arrival at the hospital. PMID:17132308

  19. Lower Mortality in Magnet Hospitals

    PubMed Central

    McHugh, Matthew D.; Kelly, Lesly A.; Smith, Herbert L.; Wu, Evan S.; Vanak, Jill M.; Aiken, Linda H.

    2014-01-01

    Background Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. Objectives To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations. Method and Study Design Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences. Results Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76–0.98; P = 0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77–1.01; P = 0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes. PMID:24022082

  20. Accelerating surgical training and reducing the burden of surgical disease in Haiti before and after the earthquake.

    PubMed

    DeGennaro, Vincent A; DeGennaro, Vincent A; Kochhar, Amit; Nathan, Nirmal; Low, Christopher; Avashia, Yash J; Thaller, Seth R

    2012-11-01

    In general, university-based global health initiatives have tended to focus on expanding access to primary care. In the past, surgical programs may have been characterized by sporadic participation with little educational focus. However, there have been some notable exceptions with plastic surgery volunteer missions. We offer another model of regularly scheduled surgical trips to rural Haiti in plastic and general surgery. The goal of these trips is to reduce the burden of surgical disease and ultimately repair every cleft lip/palate in Haiti. Another principal objective is to accelerate the training of American residents through increased case load and personal interaction with attending surgeons in a concentrated period. Diversity of the case load and the overall number of surgeries performed by residents in a typical surgical trip outpaces the experiences available during a typical week in an American hospital setting. More importantly, we continue to provide ongoing training to Haitian nurses and surgeons in surgical techniques and postoperative care. Our postoperative complication rate has been relatively low. Our follow-up rates have been lower than 70% despite intensive attempts to maintain continued communication with our patients. Through our experiences in surgical care in rural Haiti, we were able to quickly ramp up our trauma and orthopedic surgical care immediately after the earthquake. Project Medishare and the University of Miami continue to operate a trauma and acute care hospital in Port au Prince. The hospital provides ongoing orthopedic, trauma, and neurosurgical expertise from the rotating teams of American surgeons and training of Haitian surgeons in modern surgical techniques. We believe that surgical residencies in the United States can improve their training programs and reduce global surgical burden of disease through consistent trips and working closely with country partners. PMID:23154377

  1. Surgical treatment of flail chest and rib fractures.

    PubMed

    Fowler, T Ty; Taylor, Benjamin C; Bellino, Michael J; Althausen, Peter L

    2014-12-01

    Despite significant advances in critical care management, flail chest remains a clinically significant finding, with a mortality rate of up to 33%. Nonsurgical management is associated with prolonged ventilator support, pneumonia, respiratory difficulties, and lengthy stays in the intensive care unit, as well as chronic pain from nonunion and malunion of the bony thorax. Treatment with aggressive pulmonary toilet, ventilator support, and different modalities of pain control remains the benchmark of care. However, several recent randomized controlled studies of surgical intervention of flail chest have demonstrated an improvement in the number of ventilator days, intensive care unit and hospital stays, incidence of pneumonia, and respiratory function and hospital costs, as well as faster return to work. The success of these surgical constructs compared with those of historical attempts at open fixation is largely the result of modern plating technology and improvement in surgical approaches. Clinical evidence continues to grow regarding proper indications and techniques for surgical stabilization of flail chest. PMID:25425610

  2. Surgical treatment of traumatic multiple intracranial hematomas

    PubMed Central

    Yang, Chaohua; Li, Qiang; Wu, Cong; Zan, Xin; You, Chao

    2014-01-01

    Objective: To summarize our experience with the surgical treatment of traumatic multiple intracranial hematomas (TMIHs) and discuss the surgical indications. Methods: We analyzed the clinical data of 118 patients with TMIHs who were treated at the West China Hospital in Sichuan University, Chengdu, China between October 2008 and October 2011, including age, gender, cause of injury, diagnosis, treatment, and outcomes. Results: Among the 118 patients, there were 12 patients with different types of hematomas at the same site, 69 with one hematoma type in different compartments, and 37 with different types of hematomas in different compartments. In total, 106 patients had obliteration of basal cisterns, and 34 had a simultaneous midline shift ?5 mm. Eighty-nine patients underwent single-site surgery, 19 had 2-site surgeries, and 10 patients did not undergo surgery. Based on the Glasgow Outcome Scale 6 months post-injury, 41 patients had favorable outcomes, and 77 had unfavorable outcomes. Basal cisterns obliteration was a strong indicator for surgical treatment. Single- or 2-site surgery was not related to outcome (p=0.234). Conclusion: Obliteration of the basal cisterns is a strong indication for surgical treatment of TMIHs. After evacuation of the major hematomas, the remaining hematomas can be treated conservatively. Most patients only require single-site surgical treatment. PMID:25274591

  3. Optimization of surgical outcomes with prehabilitation.

    PubMed

    Santa Mina, Daniel; Scheede-Bergdahl, Celena; Gillis, Chelsia; Carli, Francesco

    2015-09-01

    The concept of preparing surgical candidates with various modalities designed to increase physical, physiological, metabolic, and psychosocial reserves is known as prehabilitation. Prehabilitation has garnered significant attention in recent years as evidence grows describing benefits to clinical and quality of life outcomes. Recent research examining hospital length of stay and readmission rates provides promising findings with respect to the value of prehabilitation in economic and sustainable healthcare models. The role of prehabilitation across the surgical experience exploits common surgical wait-times and the teachable moment that many patients experience upon the identification of a surgical requirement to improve the pre-, peri-, and postoperative experience. Prehabilitation incorporates numerous systemic and regional approaches to conditioning the surgical candidate. These include exercise, nutrition, education, and/or psychosocial approaches that are intended to improve preoperative fitness and preparedness. Importantly, this also promotes and facilitates health behaviour changes not only preoperatively but during the postoperative period and over the long-term. In this paper, we briefly review the historical and current perspectives on prehabilitation and comment on opportunities for greater clinical and empirical understanding in this field. PMID:26300015

  4. Surgical treatment of hepatoblastoma.

    PubMed

    Meyers, Rebecka L; Czauderna, Piotr; Otte, Jean-Bernard

    2012-11-01

    Surgical resection remains the cornerstone of cure in hepatoblastoma (HB). Meticulous review of contrast enhanced CT/MR imaging facilitates PRETEXT and POST-TEXT grouping to determine optimal timing and desired extent of liver resection. Excellent knowledge of liver anatomy is essential and the dissection must ensure protection of the vascular inflow and outflow to the remaining liver at all times. Referral to a liver specialty center in advanced cases may facilitate resectability. Potential surgical complications include bleeding, vascular injury, cardiac arrest, liver failure, and bile leak. The risk of complications can be minimized with preoperative planning, appropriate referral, and precise surgical technique. PMID:22887704

  5. Multiscale Surgical Telerobots

    SciTech Connect

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  6. Learning Organization Dimensions of the Sri Lanka Army

    ERIC Educational Resources Information Center

    Dahanayake, Nishada Dhananjaya; Gamlath, Sharmila

    2013-01-01

    Purpose: This study intends to investigate the extent to which the Sri Lanka Army can be described as a learning organization. Design/methodology/approach: The main tool of analysis used was the Dimensions of the Learning Organization Questionnaire (DLOQ) developed by Marsick and Watkins, with the exclusion of the sections on financial and…

  7. Desiccant-based dehumidification for Army facilities. Final report

    SciTech Connect

    Cler, G.L.

    1992-11-01

    The U.S. Army maintains over 1 billion square feet of conditioned space worldwide. Due to increased loads from electronic equipment, higher occupancy levels, and increased requirements for outdoor ventilation make-up air, many facilities are not able to maintain the desired occupant comfort level for temperature and humidity. Army building managers need to be able to better control conditioned space in the most cost-effective manner. Desiccant-based dehumidification is one option that can help achieve cost-effective space conditioning. This report describes the operating characteristics of desiccant-based systems and explains the different types of equipment and operating cycles. The report includes the results of computer simulation case studies and describes the advantages of desiccant-based equipment for humidity control. A desiccant-based system can be a very cost effective method of dehumidifying building ventilation air streams. The simulation conducted for this research compared using a small chiller or a desiccant system for the dehumidification process. Annual savings of the desiccant system over the chiller system ranged from $3200 to $6200; the payback periods ranged from 6 13 months. Army building managers should consider desiccant systems both for new construction and when additional cooling.... Army facilities, Cation, Desiccant-based dehumidification, Cost effectiveness.

  8. Master Resilience Training in the U.S. Army

    ERIC Educational Resources Information Center

    Reivich, Karen J.; Seligman, Martin E. P.; McBride, Sharon

    2011-01-01

    The U.S. Army Master Resilience Trainer (MRT) course, which provides face-to-face resilience training, is one of the foundational pillars of the Comprehensive Soldier Fitness program. The 10-day MRT course is the foundation for training resilience skills to sergeants and for teaching sergeants how to teach these skills to their soldiers. The…

  9. Soldier to Civilian: Army Education and Postwar New Zealand Citizenship

    ERIC Educational Resources Information Center

    Brickell, Chris

    2010-01-01

    New Zealand's army education schemes were established in 1943, following overseas practice, with several objectives in mind. Those on active service often suffered from boredom, and the schemes' libraries, movies and study courses offered one means of boosting flagging spirits. At the same time, military personnel needed to be prepared for an…

  10. 2007 NCTE Presidential Address: Where Ignorant Armies Clash by Night

    ERIC Educational Resources Information Center

    Yatvin, Joanne

    2008-01-01

    This article presents the text of Joanne Yatvin's presidential address, delivered at the NCTE Annual Convention in New York City in November 2007. The title of her presidential address, "Where Ignorant Armies Clash by Night," was taken from Matthew Arnold's (1867) poem "Dover Beach." Yatvin states that the federal government has usurped the right…

  11. The Army Marches forward with CD-ROM.

    ERIC Educational Resources Information Center

    Pozo, Leo; O'Connor, Mary Ann

    1992-01-01

    Describes three applications of CD-ROM technology for publishing and distribution of U.S. Army forms and automation of the AD PAM 25-30, a microfiche index to the publications and forms. The production, field test, and evaluation phases of the project are discussed. Several lessons learned are summarized. (MES)

  12. Integration of New Technology in Army Libraries. Appendices.

    ERIC Educational Resources Information Center

    DAMANS and Associates, Rockville, MD.

    Eight appendices provide information related to a study which was conducted to determine the feasibility of introducing new automatic techniques to Army library technical processing activities; to examine and recommend appropriate systems and configurations for library automation; and to determine costs of implementing the recommendations. The…

  13. Integration of New Technology in Army Libraries. Appendices.

    ERIC Educational Resources Information Center

    DAMANS and Associates, Rockville, MD.

    Eight appendices provide information related to a study which was conducted to determine the feasibility of introducing new automatic techniques to Army library technical processing activities; to examine and recommend appropriate systems and configurations for library automation; and to determine costs of implementing the recommendations. The…

  14. Learning Organization Dimensions of the Sri Lanka Army

    ERIC Educational Resources Information Center

    Dahanayake, Nishada Dhananjaya; Gamlath, Sharmila

    2013-01-01

    Purpose: This study intends to investigate the extent to which the Sri Lanka Army can be described as a learning organization. Design/methodology/approach: The main tool of analysis used was the Dimensions of the Learning Organization Questionnaire (DLOQ) developed by Marsick and Watkins, with the exclusion of the sections on financial and…

  15. Assessing the Performance of the Army Reserve Components School System.

    ERIC Educational Resources Information Center

    Winkler, John D.; And Others

    The operation of the U.S. Army's Reserve Components (RC) school system was assessed. Three areas were identified that were fundamental to the system where organizational changes could make a difference. First, the project assessed training requirements and school delivery of courses. In serving a sizable training requirement for reclassification…

  16. Net Zero Ft. Carson: making a greener Army base

    EPA Science Inventory

    The US Army Net Zero program seeks to reduce the energy, water, and waste footprint of bases. Seventeen pilot bases aim to achieve 100% renewable energy, zero depletion of water resources, and/or zero waste to landfill by 2020. Some bases are pursuing Net Zero in a single secto...

  17. Suicide in the Army National Guard: An Empirical Inquiry

    ERIC Educational Resources Information Center

    Griffith, James

    2012-01-01

    Since 2004, suicides in the U.S. military have risen, most notably in the Army National Guard (ARNG). Data used in this study were obtained for suicides occurring from 2007 to 2010 and for a random sample of nonsuicides from the general ARNG population. Of the military-related variables considered, a few showed relationships to suicide. Rather,…

  18. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover). Photograph taken before Sept 29, 1934 when the revised Real Property form on building 255 was completed. - Fitzsimons General Hopital, Building 255, North side of East O'Niell Avenue, between Tenth & Twelfth Streets, Aurora, Adams County, CO

  19. 32 CFR 644.329 - Army civil works real property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... civil works real property. (a) Fee-owned land and easements. (1) Action by Division/District Engineer (DE). When the DE is of the opinion that real property acquired in fee or easement for a civil works... 32 National Defense 4 2011-07-01 2011-07-01 false Army civil works real property. 644.329...

  20. The United States School Garden Army. Bulletin, 1919, No. 26

    ERIC Educational Resources Information Center

    Francis, J. H.

    1919-01-01

    The name of the United States School Garden Army was adopted in March, 1918. The work of the organization is an expansion of work undertaken by the Bureau of Education in 1914. The scale upon which it was done was limited by the finances that could be secured for it. The acute demand for food production growing out of the war conditions made…

  1. Master Resilience Training in the U.S. Army

    ERIC Educational Resources Information Center

    Reivich, Karen J.; Seligman, Martin E. P.; McBride, Sharon

    2011-01-01

    The U.S. Army Master Resilience Trainer (MRT) course, which provides face-to-face resilience training, is one of the foundational pillars of the Comprehensive Soldier Fitness program. The 10-day MRT course is the foundation for training resilience skills to sergeants and for teaching sergeants how to teach these skills to their soldiers. The…

  2. 32 CFR 581.2 - Army Discharge Review Board.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... provide opinions and guidance on legal matters relating to ADRB functions. (2) Medical consultant of the ADRB. An officer of the Army Medical Corps assigned to the ADRB to provide opinions and guidance on medical matters relating to ADRB functions. (3) Video tape hearing. A hearing conducted by an ADRB...

  3. 32 CFR 581.2 - Army Discharge Review Board.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... provide opinions and guidance on legal matters relating to ADRB functions. (2) Medical consultant of the ADRB. An officer of the Army Medical Corps assigned to the ADRB to provide opinions and guidance on medical matters relating to ADRB functions. (3) Video tape hearing. A hearing conducted by an ADRB...

  4. 32 CFR 581.2 - Army Discharge Review Board.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... provide opinions and guidance on legal matters relating to ADRB functions. (2) Medical consultant of the ADRB. An officer of the Army Medical Corps assigned to the ADRB to provide opinions and guidance on medical matters relating to ADRB functions. (3) Video tape hearing. A hearing conducted by an ADRB...

  5. 32 CFR 581.2 - Army Discharge Review Board.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... provide opinions and guidance on legal matters relating to ADRB functions. (2) Medical consultant of the ADRB. An officer of the Army Medical Corps assigned to the ADRB to provide opinions and guidance on medical matters relating to ADRB functions. (3) Video tape hearing. A hearing conducted by an ADRB...

  6. 32 CFR 581.2 - Army Discharge Review Board.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... provide opinions and guidance on legal matters relating to ADRB functions. (2) Medical consultant of the ADRB. An officer of the Army Medical Corps assigned to the ADRB to provide opinions and guidance on medical matters relating to ADRB functions. (3) Video tape hearing. A hearing conducted by an ADRB...

  7. 2007 NCTE Presidential Address: Where Ignorant Armies Clash by Night

    ERIC Educational Resources Information Center

    Yatvin, Joanne

    2008-01-01

    This article presents the text of Joanne Yatvin's presidential address, delivered at the NCTE Annual Convention in New York City in November 2007. The title of her presidential address, "Where Ignorant Armies Clash by Night," was taken from Matthew Arnold's (1867) poem "Dover Beach." Yatvin states that the federal government has usurped the right…

  8. Landsat and multispectral imagery utilization in the U. S. Army

    SciTech Connect

    Krieger, R.H. Jr. )

    1992-03-01

    The developing use of multispectral imagery (MSI) by the U.S. Army, in particular that produced by Landsat and SPOT, is discussed. The role of MSI in operations Desert Shield and Desert Storm is emphasized. Ongoing projects for future military uses of MSI are addressed.

  9. General surgery at rural Tennessee hospitals: a survey of rural Tennessee hospital administrators.

    PubMed

    Cofer, Joseph B; Petros, Tommy J; Burkholder, Hans C; Clarke, P Chris

    2011-07-01

    Rural communities face an impending surgical workforce crisis. The purpose of this study is to describe perceptions of rural Tennessee hospital administrators regarding the importance of surgical services to their hospitals. In collaboration with the Tennessee Hospital Association, we developed and administered a 13-item survey based on a recently published national survey to 80 rural Tennessee hospitals in August 2008. A total of 29 responses were received for an overall 36.3 per cent response rate. Over 44 per cent of rural surgeons were older than 50 years of age, and 27.6 per cent of hospitals reported they would lose at least one surgeon in the next 2 years. The responding hospitals reported losing 10.4 per cent of their surgical workforce in the preceding 2 years. Over 53 per cent were actively recruiting a general surgeon with an average time to recruit a surgeon of 11.8 months. Ninety-seven per cent stated that having a surgical program was very important to their financial viability with the mean and median reported revenue generated by a single general surgeon being $1.8 million and $1.4 million, respectively. Almost 11 per cent of the hospitals stated they would have to close if they lost surgical services. Although rural Tennessee hospitals face similar difficulties to national rural hospitals with regard to retaining and hiring surgeons, slightly more Tennessee hospitals (54 vs 36%) were actively attempting to recruit a general surgeon. The shortage of general surgeons is a threat to the accessibility of comprehensive hospital-based care for rural Tennesseans. PMID:21944341

  10. Characterization of aerosols produced by surgical procedures

    SciTech Connect

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K.; Turner, R.S.

    1994-07-01

    In many surgeries, especially orthopedic procedures, power tools such as saws and drills are used. These tools may produce aerosolized blood and other biological material from bone and soft tissues. Surgical lasers and electrocautery tools can also produce aerosols when tissues are vaporized and condensed. Studies have been reported in the literature concerning production of aerosols during surgery, and some of these aerosols may contain infectious material. Garden et al. (1988) reported the presence of papilloma virus DNA in the fumes produced from laser surgery, but the infectivity of the aerosol was not assessed. Moon and Nininger (1989) measured the size distribution and production rate of emissions from laser surgery and found that particles were generally less than 0.5 {mu}m diameter. More recently there has been concern expressed over the production of aerosolized blood during surgical procedures that require power tools. In an in vitro study, the production of an aerosol containing the human immunodeficiency virus (HIV) was reported when power tools were used to cut tissues with blood infected with HIV. Another study measured the size distribution of blood aerosols produced by surgical power tools and found blood-containing particles in a number of size ranges. Health care workers are anxious and concerned about whether surgically produced aerosols are inspirable and can contain viable pathogens such as HIV. Other pathogens such as hepatitis B virus (HBV) are also of concern. The Occupational Safety and Health funded a project at the National Institute for Inhalation Toxicology Research Institute to assess the extent of aerosolization of blood and other tissues during surgical procedures. This document reports details of the experimental and sampling approach, methods, analyses, and results on potential production of blood-associated aerosols from surgical procedures in the laboratory and in the hospital surgical suite.

  11. Performance improvement initiative: prevention of surgical site infection (SSI)

    PubMed Central

    Ng, Wai Khuan; Awad, Nawal

    2015-01-01

    Mafraq Hospital performs an average of 10,000 surgeries every year. The impact of having high volume high risk surgical procedures calls for the need to ensure safe surgery and a prevention of surgical site infection (SSI). SSI represents a significant portion of healthcare-associated infections (HAIs). The impact on morbidity, mortality, and cost of care has resulted in identifying the need to reduce SSI as a top priority to prevent healthcare associated infections. The good news is that the majority of SSIs are preventable. Mafraq Hospital performs a range of surgical procedures that covers 14 surgical specialties. The infection prevention and control team performs surveillance for SSI for all patients who undergo operative procedure included in Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) Operative Procedure Category (40 surgical procedures). Out of the 40 CDC NHSN listed, 33 operative procedures were performed at Mafraq Hospital, of which 17 were reported with SSI for 2013 and 2014. Surgical site infection has implicated an increase average length of stay from seven to 10 additional postoperative hospital days and additional costs of AED 10,000 to AED 100,000/SSI depending on procedure and pathogen. A multidisciplinary team was formed to develop and implement measures to reduce/eliminate surgical site infection, as well as evaluate and monitor compliance. Hence a group of multidisciplinary teams were initiated to analyse the results, find out the gaps, and implement a quality improvement project to correct the deficits. Recommendations for appropriate improvement measures were formed on evidence-based international guidelines from the Institute for Healthcare Improvement (IHI) and CDC. Evidence based practice supports that many of the causes of surgical site infection can be prevented with proper medical attention and care. PMID:26732804

  12. Orthopedic Surgery in Rural American Hospitals: A Survey of Rural Hospital Administrators

    ERIC Educational Resources Information Center

    Weichel, Derek

    2012-01-01

    Rural American residents prefer to receive their medical care locally. Lack of specific medical services in the local community necessitates travel to a larger center which is less favorable. This study was done to identify how rural hospitals choose to provide orthopedic surgical services to their communities. Methods: All hospitals in 5 states…

  13. General Surgery Programs in Small Rural New York State Hospitals: A Pilot Survey of Hospital Administrators

    ERIC Educational Resources Information Center

    Zuckerman, Randall; Doty, Brit; Gold, Michael; Bordley, James; Dietz, Patrick; Jenkins, Paul; Heneghan, Steven

    2006-01-01

    Context: Hospitals play a central role in small rural communities and are frequently one of the major contributors to the local economy. Surgical services often account for a substantial proportion of hospital revenues. The current shortage of general surgeons practicing in rural communities may further threaten the financial viability of rural…

  14. Orthopedic Surgery in Rural American Hospitals: A Survey of Rural Hospital Administrators

    ERIC Educational Resources Information Center

    Weichel, Derek

    2012-01-01

    Rural American residents prefer to receive their medical care locally. Lack of specific medical services in the local community necessitates travel to a larger center which is less favorable. This study was done to identify how rural hospitals choose to provide orthopedic surgical services to their communities. Methods: All hospitals in 5 states…

  15. General Surgery Programs in Small Rural New York State Hospitals: A Pilot Survey of Hospital Administrators

    ERIC Educational Resources Information Center

    Zuckerman, Randall; Doty, Brit; Gold, Michael; Bordley, James; Dietz, Patrick; Jenkins, Paul; Heneghan, Steven

    2006-01-01

    Context: Hospitals play a central role in small rural communities and are frequently one of the major contributors to the local economy. Surgical services often account for a substantial proportion of hospital revenues. The current shortage of general surgeons practicing in rural communities may further threaten the financial viability of rural…

  16. 32 CFR 623.6 - Reimbursement for loan of Army materiel.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) Hourly rate for the use of Army aircraft. (6) Petroleum, oil, and lubricants (POL) (including aviation...) Charges for the use of Army motor vehicles and watercraft except POL and per diem costs (paragraph (b)...

  17. 32 CFR 623.6 - Reimbursement for loan of Army materiel.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) Hourly rate for the use of Army aircraft. (6) Petroleum, oil, and lubricants (POL) (including aviation...) Charges for the use of Army motor vehicles and watercraft except POL and per diem costs (paragraph (b)...

  18. 78 FR 22527 - Army Science Board Request for Information on Technology and Core Competencies

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-16

    .... The Terms of Reference (TOR) provided by the Office of the Secretary of the Army directs the Army... Competencies.'' In accordance with the TOR, this study will analyze the current RDECOM portfolio and...

  19. Urogynecologic Surgical Mesh Implants

    MedlinePLUS

    ... term reinforcement to the repair site. As the material degrades, new tissue growth is intended to provide strength to the repair. Surgical mesh can be used for urogynecologic procedures, including repair of pelvic organ prolapse (POP) and stress urinary incontinence ( ...

  20. Biocompatibility of surgical implants

    NASA Technical Reports Server (NTRS)

    Kaelble, D. H.

    1979-01-01

    Method of selecting biocompatible materials for surgical implants uses fracture mechanic relationships and surface energies of candidate materials in presence of blood plasma. Technique has been used to characterize 190 materials by parameters that reflect their biocompatibility.