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1

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

PubMed Central

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

King, Booker; Jatoi, Ismalil

2005-01-01

2

Sports and physical training injury hospitalizations in the Army  

Microsoft Academic Search

Introduction: Injuries are the leading health problem in the military services. Sports and physical training activities are an area in which a substantial number of injuries can occur. Although athletic injuries are not often investigated in military populations, the Armed Forces database provides a unique opportunity to investigate sports injuries.Methods: An Army database of all hospital admissions for active duty

Tamara D Lauder; Susan P Baker; Gordon S Smith; Andrew E Lincoln

2000-01-01

3

Development of a Comprehensive Surgical Information System at Madigan Army Medical Center.  

PubMed

The Operative Registry (DA Form 4108) has been the information source for surgical data supporting quality assurance and utilization review efforts at Madigan Army Medical Center. Recently, Madigan's requirements for data and reporting changed. Like other government medical facilities, Madigan began pervasive quality-improvement efforts. This resulted in new ideas to measure hospital performance. Consequently, requirements for surgical data required to support quality and resource management reporting, utilization review, residency review reporting, research and credentialing changed. This article details Madigan's approach to addressing these requirements via development of a comprehensive computing solution. It discusses Madigan's fragmented data environment before system development, and gives the reader perspective on the decision-making process that led to system development rather than purchasing a commercial product. Finally, the article describes how a strong partnership between staff and developers was key to providing a solution that exceeded established goals. PMID:8637644

Westbrook, M L; Dunn, S E; Wilcox-Riggs, S

1996-03-01

4

The MASSACHUSETTS GENERAL HOSPITAL SURGICAL SOCIETY  

E-print Network

. Both had had Har- vard college educations and had their residency programs inter- rupted by two yearsThe MASSACHUSETTS GENERAL HOSPITAL SURGICAL SOCIETY Newsletter THIRD MEETING OF THE MGH SURGICAL, as well as cardiology participate in this center. Significant increases in volume, as well as decreases

Mootha, Vamsi K.

5

Surgical site infections in Italian Hospitals: a prospective multicenter study  

Microsoft Academic Search

BACKGROUND: Surgical site infections (SSI) remain a major clinical problem in terms of morbidity, mortality, and hospital costs. Nearly 60% of SSI diagnosis occur in the postdischarge period. However, literature provides little information on risk factors associated to in-hospital and postdischarge SSI occurrence. A national prospective multicenter study was conducted with the aim of assessing the incidence of both in-hospital

Nicola Petrosillo; Cecilia MJ Drapeau; Emanuele Nicastri; Lorena Martini; Giuseppe Ippolito; Maria Luisa Moro

2008-01-01

6

78 FR 15052 - Naugatuck Valley Surgical Center, Department of Saint Mary's Hospital, Waterbury, Connecticut...  

Federal Register 2010, 2011, 2012, 2013, 2014

...Surgical Center, Department of Saint Mary's Hospital, Waterbury, Connecticut...Surgical Center, a Department of Saint Mary's Hospital, Waterbury, Connecticut...Surgical Center, a Department of Saint Mary's Hospital, Waterbury,...

2013-03-08

7

[Hospital strains of Pseudomonas aeruginosa in the surgical clinic].  

PubMed

Circulation of different antigenic variants of P. aeruginosa in a surgical hospital was studied. In this study the process leading to the formation of pathogenic hospital strains, determined by time and location, from some serovars is demonstrated. The study also established that the department of the hospital where the selection of hospital strains mainly occurred was the resuscitation ward. Some pyoseptic infections of P. aeruginosa etiology with fetal outcome were found to be caused in most cases by hospital strains characteristic of the hospital in the period under study. PMID:1759517

Iskhakova, Kh I; Bazhenov, L G

1991-09-01

8

Investigation of the Integration of Interstitial Building Spaces on Costs and Time of Facility Maintenance for U.S. Army Hospitals  

E-print Network

; and to the Soldiers, Officers, and Civilians with which I have had the privilege to serve and who have helped me to better understand leadership. I am especially grateful to Dr. William Hyman, LTC (Retired) John Sanders, LTC (Retired) Carol Fontanese, Nathan B... West Point, NY Keller Army Community Hospital Northern Fort Lee, VA Kenner Army Health Clinic Northern Fort Meade, MD Kimbrough Ambulatory Care Center Northern Fort Eustis, VA McDonald Army Community Hospital Northern Fort Bragg, NC Womack Army...

Leveridge, Autumn Tamara

2013-04-30

9

Prehospital and emergency care research at the US Army Institute of Surgical Research: enabling the next great leap in combat casualty survival.  

PubMed

Minimizing preventable death continues to be a primary focus of the combat casualty care research community, and of the Army Medical Department as a whole. Toward that end, tremendous successes have been realized in resuscitative surgery, critical care, rehabilitation, preventive medicine, and in our collective ability to project effective medical care into the most austere locations throughout the globe. Innovation in the care rendered outside of theater hospitals or strategic air evacuation conveyances, however, has not kept the same pace. The US military experience in World War II, Korea, and Vietnam served as a prime source for the development of the tactics, techniques, and procedures which spawned modern civilian sector trauma care and emergency medical services. But this ascendance was driven by the dedicated medics, corpsmen, physicians, nurses, and allied health practitioners from those conflicts who left the military for the civilian sector, leaving their replacements, in many cases, to repeat the same mistakes, and to relearn hard lessons that otherwise might have been assimilated had they been effectively captured and integrated into doctrine and training. A prime example of this phenomenon is the recent acknowledgement of the "en route care gap" existing in tactical medical evacuation. The US Army Institute of Surgical Research (USAISR) and the Army emergency medicine community have made a significant commitment toward elucidating the requirements, capability gaps, and a way-forward in search of the development of an integrated prehospital combat casualty care system, nested within the Joint Theater Trauma System. This paper examines specific research programs, concept development, and collaborations with other Army, joint, and civilian center organizations which comprise the USAISR Prehospital and Emergency Care Research Program, including the Remote Damage Control Resuscitation initiative, Emergency Telemedical Direction of Role-I providers, Combat Medical Voice Documentation System, and establishment of the Remote Trauma Outcomes Research Network. PMID:21607910

Gerhardt, Robert T

2011-01-01

10

Surgical Volume, Hospital Quality, and Hospitalization Cost in Congenital Heart Surgery in the United States.  

PubMed

Hospital volume has been associated with improved outcomes in congenital cardiac surgery. However, the relationship between hospital volume and hospitalization cost remains unclear. This study examines the relationship between hospital surgical volume and hospitalization costs, while accounting for measures of quality, in children undergoing congenital heart surgery. A retrospective, repeated cross-sectional analysis was performed, using discharges from the 2006 and 2009 Kids' Inpatient Database. All pediatric admissions (<18 years) with a Risk Adjustment for Congenital Heart Surgery procedure and hospitalization cost/charge data were included. Multivariate, linear mixed regression models were run on hospitalization costs, with and without adjustment for indicators of quality (hospital mortality rate and complication rate). Both medium and high-volume hospitals (200-400 cases/year and >400 cases/year, respectively) were associated with lower odds of mortality but not occurrence of a complication. Hospital mortality was associated with the largest increase in hospitalization costs. High-volume hospitals (>400 cases/year) were associated with the lowest hospitalization costs per discharge ($37,775, p < 0.01) when compared to low-($43,270) and medium($41,085)-volume hospitals, prior to adjusting for quality indicators. However, when adjusting for hospital mortality rate, high-volume hospitals no longer demonstrated significant cost savings. When adjusting for hospital complication rate, high-volume hospitals continued to have the lowest hospitalization costs. High-volume hospitals are associated with a reduction in hospitalization costs that appear to be mediated through improvements in quality. PMID:25099030

Chan, Titus; Kim, Jaewhan; Minich, L LuAnn; Pinto, Nelangi M; Waitzman, Norman J

2014-08-01

11

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

Federal Register 2010, 2011, 2012, 2013, 2014

...Valley Surgical Center, Department of Saint Mary's Hospital, Waterbury, CT: Notice...Valley Surgical Center, Department of Saint Mary's Hospital, Waterbury, Connecticut...December 11, 2012. The Department's Notice of...

2013-02-12

12

Survey of antimicrobial prophylaxis for surgical procedures in Lebanese hospitals.  

PubMed

Antimicrobial prophylaxis (AMP) is an effective measure to prevent the surgical site infection (SSI). This prospective survey of three months describe the adequacy of AMP in 10 acute care hospitals (affiliated to the Lebanese University, Faculty of Medical Sciences) based on international guidelines for only three parameters, digestive, orthopaedic and vascular surgery. Out of 964 surgical procedures, 916 (95%) were eligible for AMP, of which 767 (84%) received one or several antibiotics. Cefazolin was frequently prescribed (49%), followed by beta-lactamase-inhibitor/penicillin (18%), cefuroxime (17%), ceftriaxone (7%) and vancomycin (0.1%). In compliance with current US guidelines on indication, choice of drug, duration and time of first dose administration, AMP was given for only 32% of the procedures. Duration of AMP was < or = 24 hours in 35% and exceeded 48 hours in 57%. A single dose of prophylaxis was given to 26%, 12% receive an additional dose and 62% receive more than 2 doses. The first dose was administered within 30 min before operation in 92% of procedures. We conclude that AMP in Lebanese hospitals was fairly adequate in terms of respecting indications for selected surgical procedures. Improvement could be made by reducing the duration of prophylaxis and avoiding the use of broad-spectrum antibiotics. PMID:15112851

Azzam, Raghida; Hamadé, Nohad; Bedrossian, Nora; Assaad, Chafica

2002-01-01

13

Surgical site infections in Italian Hospitals: a prospective multicenter study  

PubMed Central

Background Surgical site infections (SSI) remain a major clinical problem in terms of morbidity, mortality, and hospital costs. Nearly 60% of SSI diagnosis occur in the postdischarge period. However, literature provides little information on risk factors associated to in-hospital and postdischarge SSI occurrence. A national prospective multicenter study was conducted with the aim of assessing the incidence of both in-hospital and postdisharge SSI, and the associated risk factors. Methods In 2002, a one-month, prospective national multicenter surveillance study was conducted in General and Gynecological units of 48 Italian hospitals. Case ascertainment of SSI was carried out using standardized surveillance methodology. To assess potential risk factors for SSI we used a conditional logistic regression model. We also reported the odds ratios of in-hospital and postdischarge SSI. Results SSI occurred in 241 (5.2%) of 4,665 patients, of which 148 (61.4%) during in-hospital, and 93 (38.6%) during postdischarge period. Of 93 postdischarge SSI, sixty-two (66.7%) and 31 (33.3%) were detected through telephone interview and questionnaire survey, respectively. Higher SSI incidence rates were observed in colon surgery (18.9%), gastric surgery (13.6%), and appendectomy (8.6%). If considering risk factors for SSI, at multivariate analysis we found that emergency interventions, NNIS risk score, pre-operative hospital stay, and use of drains were significantly associated with SSI occurrence. Moreover, risk factors for total SSI were also associated to in-hospital SSI. Additionally, only NNIS, pre-operative hospital stay, use of drains, and antibiotic prophylaxis were associated with postdischarge SSI. Conclusion Our study provided information on risk factors for SSI in a large population in general surgery setting in Italy. Standardized postdischarge surveillance detected 38.6% of all SSI. We also compared risk factors for in-hospital and postdischarge SSI, thus providing additional information to that of the current available literature. Finally, a large amount of postdischarge SSI were detected through telephone interview. The evaluation of the cost-effectiveness of the telephone interview as a postdischarge surveillance method could be an issue for further research. PMID:18328101

Petrosillo, Nicola; Drapeau, Cecilia MJ; Nicastri, Emanuele; Martini, Lorena; Ippolito, Giuseppe; Moro, Maria Luisa

2008-01-01

14

Horizontal strabismus surgical outcomes in a teaching hospital.  

PubMed

Strabismus may result in impaired stereopsis, diplopia, undesirable appearance, amblyopia and negative psychological impact. This study provides epidemiological and surgical outcome information about patients attending University College Hospital Galway requiring strabismus surgery. We report a retrospective analysis of 75 consecutive patients, who underwent horizontal strabismus surgery. Sixty-one (81.3%) patients had clinically significant refractive errors, hyperopia being the most common. Thirty-four (45.3%) patients had amblyopia and nine (12%) required further treatment. A cosmetically acceptable result with a post-operative ocular deviation within 25 prism dioptres of straight (grade 2) was achieved in 70/75 (93.3%) of patients. The overall mean change in ocular deviation per mm of muscle operated was 3.25 prism dioptre/mm. The outcomes of strabismus surgery in an Irish hospital compare very favourably with other jurisdictions. This data will help plan service delivery. PMID:24988834

Idrees, Z; Dooley, I; Fahy, G

2014-06-01

15

The founding of Walter Reed General Hospital and the beginning of modern institutional army medical care in the United States.  

PubMed

When Walter Reed United States Army General Hospital opened its doors in 1909, the Spanish-American War had been over for a decade, World War I was in the unforeseeable future, and army hospital admission rates were steadily decreasing. The story of the founding of Walter Reed, which remained one of the flagship military health institutions in the United States until its 2011 closure, is a story about the complexities of the turn of the twentieth century. Broad historical factors-heightened imperial ambitions, a drive to modernize the army and its medical services, and a growing acceptance of hospitals as ideal places for treatment-explain why the institution was so urgently fought for and ultimately won funding at the particular moment it did. The justifications put forth for the establishment of Walter Reed indicate that the provision of publicly funded medical care for soldiers has been predicated not only on a sense of humanitarian commitment to those who serve, but on principles of military efficiency, thrift, pragmatism, and international competition. On a more general level, the story of Walter Reed's founding demonstrates a Progressive Era shift in health services for U.S. soldiers-from temporary, makeshift hospitals to permanent institutions with expansive goals. PMID:23839016

Adler, Jessica L

2014-10-01

16

Hospital admissions from the Surgical Day Care Centre of Vancouver General Hospital 1977–1987  

Microsoft Academic Search

The admissions to Vancouver General Hospital from its Surgical Day Care Centre were reviewed for the period I977 to 1987.\\u000a The overall mean rate of admission for the period was 0.28 per cent, for surgically-related admissions 0.22 per cent and for\\u000a anaesthesia-related admissions 0.07 per cent. The principal reasons for surgery-related admissions were postoperative bleeding,\\u000a complications, the need for further

Peter F. Fancourt-Smith; Jeffrey Hornstein; Leonard C. Jenkins

1990-01-01

17

Adverse impact of surgical site infections in English hospitals.  

PubMed

Between October 1997 and June 2001, 140 English hospitals participating in the surveillance of surgical site infection (SSI) with the Nosocomial Infection National Surveillance Service (NINSS) reported 2832 SSIs following 67 410 surgical procedures in nine defined categories of surgery. Limb amputation had the highest incidence of SSI with 14.3 SSIs per 100 operations. For all categories of surgery, except knee prosthesis (P=0.128), there was a linear increase in the incidence of SSI when the American National Nosocomial Infections Surveillance risk index increased. Superficial incisional SSI was more common than deep incisional and organ/space SSI, and accounted for more than half of all SSIs for all categories of surgery. The postoperative length of stay (LOS) was longer for patients with SSI, and when adjusted for other factors influencing LOS, the extra LOS due to SSI ranged from 3.3 days for abdominal hysterectomy to 21.0 days for limb amputation, and was at least nine days for the other categories. The additional cost attributable to SSI ranged from pound959 for abdominal hysterectomy to pound6103 for limb amputation. Deep incisional and organ/space SSI combined incurred a greater extra LOS and cost than superficial incisional SSI for all categories of surgery, except limb amputation. The crude mortality rate was higher for patients with SSI for all categories of surgery but, after controlling for confounding, only patients with SSI following hip prosthesis had a mortality rate that was significantly higher than those without SSI [odds ratio (OR)=1.8, P=0.002]. However, the adjusted mortality rate for patients with deep incisional and organ/space SSI compared with those without SSI was significantly higher for vascular surgery (OR=6.8, P<0.001), hip prosthesis (OR=2.5, P=0.005) and large bowel surgery (OR=1.8, P=0.04). This study shows that the adverse impact of SSI differs greatly for different categories of surgery, and highlights the importance of measuring the impact for defined categories rather than for all SSIs and all surgical procedures. PMID:15866006

Coello, R; Charlett, A; Wilson, J; Ward, V; Pearson, A; Borriello, P

2005-06-01

18

Assessment of protocols for surgical-site preparation in a regional network of hospitals.  

PubMed

Surgical-site infection is a preventable adverse event. Implementation of good practices for correct surgical-site preparation can contribute to lessen this safety problem. The objective of this study was to describe the presence and quality of protocols on surgical-site preparation in the Murcia (Spain) regional network of public hospitals. The indicator "existence of protocol for surgical-site preparation" was assessed, as well as the formal quality (expected attributes) and contents (compared to current evidence-based recommendations) of existing documents. Seven of the nine hospitals have a protocol for surgical-site preparation. Opportunities to improve have been identified in relation to the protocols' formal quality and contents. Recommendations related to skin asepsis are incomplete and those related to hair removal contradict existing evidence. Most hospitals have protocols for surgical-site preparation; however, there is great room for improvement, in relation to their expected attributes and to the inclusion of evidence-based recommendations. PMID:22699732

Peñalver-Mompeán, Maria Dolores; Saturno-Hernández, Pedro Jesus; Fonseca-Miranda, Yadira; Gama, Zenewton André da Silva

2012-01-01

19

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

PubMed

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

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

2014-08-01

20

A prospective study of surgical site infections in a pediatric hospital in Mexico City  

Microsoft Academic Search

Background: Pediatric surgical site infection (SSI) rates in the United States range from 2.5% to 4.4%. There is little data regarding their risk factors among children. We quantified SSI rates and identified risk factors of SSI in a tertiary care pediatric teaching hospital in Mexico City. Methods: All neurosurgical, cardiovascular, and general surgical patients who underwent operation between Aug 1,

Juan D. Porras-Hernández; Diana Vilar-Compte; Miguel Cashat-Cruz; Ricardo M. Ordorica-Flores; Eduardo Bracho-Blanchet; Carlos Avila-Figueroa

2003-01-01

21

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

PubMed Central

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

Høybye, Mette Terp

2014-01-01

22

Adjunctive use of monthly physician questionnaires for surveillance of surgical site infections after hospital discharge and in ambulatory surgical patients: Report of a seven-year experience  

Microsoft Academic Search

We report our experience with the use of monthly physician questionnaires, in conjunction with traditional in-house monitoring, for surveillance of surgical site infections (SSIs) in inpatients after hospital discharge and in ambulatory surgical patients (i.e., those not requiring perioperative hospitalization) over a 7-year period (July 1988 to June 1995) involving 156,977 surgical procedures. The mean annual response rate was 73%

Farrin A. Manian; Lynn Meyer

1997-01-01

23

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

PubMed

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

Srogosz, T

2000-01-01

24

[Organization of surgical work in hospitals under special conditions].  

PubMed

A check-list consisting all the importants measures in hospital care for handling all sorts of disasters is described. In those situations the management of organization is primarily more important than medical attendance. The doctor educated in individual medicine overestimates the medical problems. In every hospital a disaster plan should be step up as a precuation. The importance of triage has been confirmed, and several aspects of its planning have been stressed. Excercise and test alarm are necessary to check the set upa organization. PMID:936927

Jekic, M; Jekic, D

1976-01-01

25

Risk factors for surgical site infections diagnosed after hospital discharge  

Microsoft Academic Search

A prospective cohort study on 1103 consecutive patients undergoing general surgery with a follow-up of up to 30 days was undertaken to analyse the risk factors for surgical-site infection (SSI). Relative risks (RRs), crude and multiple-risk factors adjusted for by logistic regression analysis, and their 95% confidence intervals were calculated. One hundred and four patients (9·4%) developed infection, 81 in

M. Lecuona; À. Torres-Lana; M. Delgado-Rodríguez; J. Llorca; A. Sierra

1998-01-01

26

Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge  

Microsoft Academic Search

Although surgical site infections (SSIs) are known to cause substantial illness and costs during the index hospitalization, lit- tle information exists about the impact of infections diagnosed after discharge, which constitute the majority of SSIs. In this study, using patient questionnaire and administrative data- bases, we assessed the clinical outcomes and resource utiliza- tion in the 8-week postoperative period associated

Eli N. Perencevich; Kenneth E. Sands; Sara E. Cosgrove; Edward Guadagnoli; Ellen Meara; Richard Platt

2003-01-01

27

Hospital type- and volume-outcome relationships in esophageal cancer patients receiving non-surgical treatments  

PubMed Central

AIM: To study the “hospital type-outcome” and “volume-outcome” relationships in patients with esophageal cancer who receive non-surgical treatments. METHODS: A total of 6106 patients with esophageal cancer diagnosed between 2008 and 2011 were identified from a national population-based cancer registry in Taiwan. The hospital types were defined as medical center and non-medical center. The threshold for high-volume hospitals was based on a median volume of 225 cases between 2008 and 2011 (annual volume, > 56 cases) or an upper quartile (> 75%) volume of 377 cases (annual volume > 94 cases). Cox regression analyses were used to determine the effects of hospital type and volume outcome on patient survival. RESULTS: A total of 3955 non-surgically treated patients were included in the survival analysis. In the unadjusted analysis, the significant prognostic factors included cT, cN, cM stage, hospital type and hospital volume (annual volume, > 94 vs ? 94). The 1- and 3-year overall survival rates in the non-medical centers (36.2% and 13.2%, respectively) were significantly higher than those in the medical centers (33.5% and 11.3%, respectively; P = 0.027). The 1- and 3-year overall survival rates in hospitals with an annual volume of ? 94 (35.3% and 12.6%, respectively) were significantly higher than those with an annual volume of > 94 (31.1% and 9.4%, respectively; P = 0.001). However, in the multivariate analysis, the hospital type was not statistically significant. Only cT, cN, and cM stages and hospital volume (annual volume > 94 vs ? 94) were independent prognostic factors. CONCLUSION: Whether the treatment occurs in medical centers is not a significant prognostic factor. High-volume hospitals were not associated with better survival rates compared with low-volume hospitals.

Hsu, Po-Kuei; Chen, Hui-Shan; Wang, Bing-Yen; Wu, Shiao-Chi; Liu, Chao-Yu; Shih, Chih-Hsun; Liu, Chia-Chuan

2015-01-01

28

Medical-Surgical/Gero-Psych -Unit Practice Manual Page 1 of 13 John Dempsey Hospital -Department of Nursing  

E-print Network

Guideline Medical-Surgical/Gero-Psych - Unit Practice Manual Page 1 of 13 John Dempsey Hospital - Department of Nursing The University of Connecticut Health Center GUIDELINES FOR: Medical-Surgical be entered whenever possible (all scales, have a 1-10 correlation) , along with #12;Guideline Medical-Surgical

Oliver, Douglas L.

29

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

PubMed Central

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

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

2014-01-01

30

Predictors of hip fracture mortality at a general hospital in South Brazil: an unacceptable surgical delay  

PubMed Central

OBJECTIVE: Hip fractures have been associated with increased mortality in the elderly. Several risk factors such as the time between the insult and the surgical repair have been associated with hip fracture mortality. Nevertheless, the risk of delayed surgical repair remains controversial. Few studies have examined this issue in Brazil. The aim of this study was to study the risk factors for death one year after hip fracture and in-hospital stay at a tertiary hospital in South Brazil. METHODS: A prospective cohort study was carried out from April 2005 to April 2011 at a tertiary university hospital at Santa Maria, Brazil. Subjects admitted for hip fracture who were 65 years of age or older were followed for one year. Information about fracture type, age, gender, clinical comorbidities, time to surgery, discharge, and American Society of Anesthesiologists score were recorded. Death was evaluated during the hospital stay and at one year. RESULTS: Four hundred and eighteen subjects were included in the final analysis. Of these, 4.3% died in-hospital and 15.3% were dead at one year. Time to surgery, American Society of Anesthesiologists score, Ischemic Heart Disease, and in-hospital stay were associated with death at one year in the univariate analysis. The American Society of Anesthesiologists score and time to surgery were one-year mortality predictors in the final regression model. In-hospital death was associated with American Society of Anesthesiologists score and age. CONCLUSION: Time to surgery is worryingly high at the South Brazil tertiary public health center studied here. Surgical delay is a risk factor that has the potential to be modified to improve mortality. PMID:24714833

Ribeiro, Tiango Aguiar; Premaor, Melissa Orlandin; Larangeira, João Alberto; Brito, Luiz Giulian; Luft, Michel; Guterres, Leonardo Waihrich; Monticielo, Odirlei André

2014-01-01

31

Effectiveness in professional organizations: the impact of surgeons and surgical staff organizations on the quality of care in hospitals.  

PubMed Central

In this research, we examine the relative importance of different structural units in a professional organization, the hospital, as they affect organizational effectiveness. The difficulties of measuring effectiveness in a complex professional organization are discussed, and an adjusted measure of surgical outcome is developed. Data are drawn from a prospective study of over 8,000 surgical patients treated by more than 500 surgeons in 15 hospitals throughout the nation. Two different types of analyses are presented, both indicating that hospital features have more impact on surgical outcomes than do surgeon characteristics. The second analysis assesses the relative importance of specific attributes of the hospital, surgical staff organization, and surgeon characteristics on surgical outcomes. PMID:7152960

Flood, A B; Scott, W R; Ewy, W; Forrest, W H

1982-01-01

32

Clinical pharmacists' review of surgical antimicrobial prophylaxis in a tertiary hospital in Abu Dhabi.  

PubMed

Background There is a lack of evidence to support standard of care and concordance with surgical antimicrobial prophylaxis (SAP) guidelines in our setting. There is an opportunity for clinical pharmacists to facilitate this process across all surgical disciplines. Objective To assess adherence of surgeons to SAP guidelines. Method This was a retrospective study of 250 patients who underwent surgery during 2012 in Mafraq Hospital, Abu Dhabi. We evaluated prescribing of SAP, antimicrobial selection, first-dose timing, dose interval, treatment duration and adherence of surgeons to local hospital guidelines. Results We reviewed 250 patients (193 were male and 57 were female, mean age 36 ± 1.2 years); 54 % had elective operations and 46 % underwent emergency surgery. Adherence to hospital guidelines was 32.1 %. Antimicrobial selection, timing of the first dose, dosage interval and treatment duration were concordant with the hospital guidelines in 26, 31 and 40.3 % of cases, respectively. Main barriers to adherence to hospital guidelines were lack of awareness and education. Conclusions The present study indicated poor adherence to the SAP guidelines. The timing of administration of SAP was not appropriate in two-thirds of the patients and more than half received more than three doses of SAP inappropriately. Continuing medical education should target antimicrobial prophylaxis (selection, timing and duration), clinical pharmacy antibiotic services and cyclic auditing. PMID:25488316

El Hassan, Mohamed; Elnour, Asim Ahmed; Farah, Farah Hamad; Shehab, Abdulla; Al Kalbani, Naama M; Asim, Sahar; Shehab, Omer Abdulla; Abdulla, Rauda

2015-02-01

33

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

PubMed Central

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

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

2000-01-01

34

Surgical-site infection surveillance at a small-scale community hospital  

Microsoft Academic Search

Surveillance of surgical-site infection (SSI) is becoming more important given the current situation of increasing antibiotic resistance by microorganisms. It may be difficult to carry out SSI surveillance at small-scale community hospitals because of small staff numbers. We examined whether SSI surveillance could be carried out with a system we devised. Furthermore, we investigated the SSI rateat our small-scale community

Takashi Saito; Yoji Aoki; Kazuo Ebara; Shunichi Hirai; Yasuhiro Kitamura; Yosinobu Kasaoka; Yoshihiro Mori; Yoshitsugu Iinuma; Satoshi Ichiyama; Fumikazu Kohi

2005-01-01

35

Virtual slide telepathology for an academic teaching hospital surgical pathology quality assurance program.  

PubMed

Virtual slide telepathology is an important potential tool for providing re-review of surgical pathology cases as part of a quality assurance program. The University of Arizona pathology faculty has implemented a quality assurance program between 2 university hospitals located 6 miles apart. The flagship hospital, University Medical Center (UMC), in Tucson, AZ, handles approximately 20 000 surgical pathology specimens per year. University Physicians Healthcare Hospital (UPHH) at Kino Campus has one tenth the volume of surgical pathology cases. Whereas UMC is staffed by 10 surgical pathologists, UPHH is staffed daily by a single part-time pathologist on a rotating basis. To provide same-day quality assurance re-reviews of cases, a DMetrix DX-40 ultrarapid virtual slide scanner (DMetrix, Inc, Tucson, AZ) was installed at the UPHH in 2005. Since then, glass slides of new cases of cancer and other difficult cases have been scanned the same day the slides are produced by the UPHH histology laboratory. The pathologist at UPHH generates a provisional written report based on light microscopic examination of the glass slides. At 2:00 pm each day, completed cases from UPHH are re-reviewed by staff pathologists, pathology residents, and medical students at the UMC using the DMetrix Iris virtual slide viewer. The virtual slides are viewed on a 50-in plasma monitor. Results are communicated with the UPHH laboratory by fax. We have analyzed the results of the first 329 consecutive quality assurance cases. There was complete concordance with the original UPHH diagnosis in 302 (91.8%) cases. There were 5 (1.5%) major discrepancies, which would have resulted in different therapy and/or management, and 10 (3.0%) minor discrepancies. In 6 cases (1.8%), the diagnosis was deferred for examination of the glass slides by the reviewing pathologists at UMC, and the diagnosis of another 6 (1.8%) cases were deferred pending additional testing, usually immunohistochemistry. Thus, the quality assurance program found a small number of significant diagnostic discrepancies. We also found that implementation of a virtual slide telepathology quality assurance service improved the job satisfaction of academic subspecialty pathologists assigned to cover on-site surgical pathology services at a small, affiliated university hospital on a rotating part-time basis. These findings should be applicable to some community hospital group practices as well. PMID:19540562

Graham, Anna R; Bhattacharyya, Achyut K; Scott, Katherine M; Lian, Fangru; Grasso, Lauren L; Richter, Lynne C; Carpenter, John B; Chiang, Sarah; Henderson, Jeffrey T; Lopez, Ana Maria; Barker, Gail P; Weinstein, Ronald S

2009-08-01

36

Immediate versus delayed hysterectomy for endometrial carcinoma: surgical morbidity and hospital stay  

SciTech Connect

A retrospective review presented is of the intraoperative complications, postoperative morbidity, and length of hospitalization in 138 patients with stage I endometrial carcinoma treated at Yale-New Haven Hospital from January 1, 1977 to December 31, 1981. One group (stage IA, grade 1) was treated with surgery alone; two groups were treated with preoperative intracavitary radium, followed with either an immediate or a delayed hysterectomy. The three groups were comparable in age, weight, and major preoperative medical problems. The mean estimated blood loss during surgery and transfusion requirements during hospitalization were similar for all three groups. The duration of the surgery in the immediate group was longer than the other two groups. The occurrence of febrile morbidity and major postoperative complications in the three groups was similar, except for bacteriuria, which was significantly more common in the immediate group. The length of the postoperative hospitalization was the same for each group; however, the delayed group as compared with the immediate group had a total hospitalization of two days longer. Hence, in the current study, immediate hysterectomy did not significantly increase the surgical or postoperative morbidity rate, compared with delayed hysterectomy. The single hospital stay in the former treatment group represented cost containment.

Chambers, J.T.; Kapp, D.S.; Lawrence, R.; Kohorn, E.I.; Schwartz, P.E.

1985-02-01

37

Brief Tool to Measure Risk-Adjusted Surgical Outcomes in Resource-Limited Hospitals  

PubMed Central

Objectives To develop and validate a risk-adjusted tool with fewer than 10 variables to measure surgical outcomes in resource-limited hospitals. Design All National Surgical Quality Improvement Program (NSQIP) preoperative variables were used to develop models to predict inpatient mortality. The models were built by sequential addition of variables selected based on their area under the receiver operator characteristic curve (AUROC) and externally validated using data based on medical record reviews at 1 hospital outside the data set. Setting Model development was based on data from the NSQIP from 2005 to 2009. Validation was based on data from 1 nonurban hospital in the United States from 2009 to 2010. Patients A total of 631 449 patients in NSQIP and 239 patients from the validation hospital. Main Outcome Measures The AUROC value for each model. Results The AUROC values reached higher than 90% after only 3 variables (American Society of Anesthesiologists class, functional status at time of surgery, and age). The AUROC values increased to 91% with 4 variables but did not increase significantly with additional variables. On validation, the model with the highest AUROC was the same 3-variable model (0.9398). Conclusions Fewer than 6 variables may be necessary to develop a risk-adjusted tool to predict inpatient mortality, reducing the cost of collecting variables by 95%. These variables should be easily collectable in resource-poor settings, including low- and middle-income countries, thus creating the first standardized tool to measure surgical outcomes globally. Research is needed to determine which of these limited-variable models is most appropriate in a variety of clinical settings. PMID:22987164

Anderson, Jamie E.; Lassiter, Randi; Bickler, Stephen W.; Talamini, Mark A.; Chang, David C.

2014-01-01

38

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

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.

Amon, T.M.

1989-01-01

39

Determinants of Malnutrition and Post-operative Complications in Hospitalized Surgical Patients  

PubMed Central

ABSTRACT The study aimed to determine the nutritional status (NS) of hospitalized surgical patients and investigate a possible association between NS and type of disease, type of surgery and post-operative complications. The gender, age, disease, surgery, complications, length of hospital stay, number of medications, laboratory test results, and energy intake of 388 hospitalized surgical patients were recorded. NS was determined by classical anthropometry. The inclusion criteria were: nutritional status assessment done within the first 24 hours of admission, age ?20 years, and complete medical history. Univariate and multiple Cox's regression analyses were employed to determine which variables were possible risk factors of malnutrition and complications. Malnutrition was more common in males (p=0.017), individuals aged 70 to 79 years (p=0.000), and individuals with neoplasms and digestive tract diseases (p=0.000). Malnourished individuals had longer hospital stays (p=0.013) and required more medications (p=0.001). The risk of malnutrition was associated with age and disease. Individuals aged 70 years or more had a two-fold increased risk of malnutrition (p=0.014; RR=2.207; 95% CI 1.169-4.165); those with neoplasms (p=0.008; RR=14.950; 95% CI 2.011-111.151) and those having digestive tract diseases (p=0.009; RR=14.826; 95% CI 1.939-113.362) had a 14-fold increased risk of malnutrition. Complications prevailed in older individuals (p=0.016), individuals with longer hospital stays (p=0.007), and individuals who died (p=0.002). The risk of complications was associated with age and BMI. In the present study, the risk of malnutrition was associated with age and type of disease; old age and low BMI may increase complications. PMID:25395903

de Aquino, José Luiz Braga

2014-01-01

40

Severe Surgical Site Infection in Community Hospitals: Epidemiology, Key Procedures, and the Changing Prevalence of Methicillin?Resistant Staphylococcus aureus  

Microsoft Academic Search

objective. To characterize the epidemiology of severe (ie, nonsuperficial) surgical site infection (SSI) in community hospitals. methods. SSI data were collected prospectively at 26 community hospitals in the southeastern United States. Two analyses were performed: (1) a study of the overall prevalence rates of SSI and the prevalence rates of SSI due to specific pathogens in 2005 at all participating

Deverick J. Anderson; Daniel J. Sexton; Zeina A. Kanafani; Grace Auten; Keith S. Kaye

2007-01-01

41

Best practices for preventing hospital-acquired pressure injuries in surgical patients.  

PubMed

Hospital-acquired pressure ulcers (HAPUs) and deep tissue injuries (DTIs), while considered to be preventable in most cases continue to affect many patients in acute care facilities. Surgical patients have an especially high risk of developing HAPUs for several reasons, including immobility during the intraoperative and immediate postoperative periods. HAPUs are responsible for significant patient harm in the form of pain, increased susceptibility to infection, and delayed recovery. Perioperative nurses must take a proactive and comprehensive approach to protecting their patients from pressure injuries, including HAPUS and DTIs. PMID:21434513

Cherry, Cecile; Moss, Jacqueline

2011-03-01

42

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

SciTech Connect

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.

Tuenge, Jason R.

2011-01-17

43

Risk factors for surgical site infection in children at the teaching hospital Gabriel Touré, Bamako.  

PubMed

A six-month prospective surveillance study of postoperative surgical site infections (SSIs) was undertaken between January and June 2010 in paediatric patients aged <15 years, in the University Hospital Gabriel Touré, Mali. SSI was documented in 43 out of 352 children (12.2%). SSIs were significantly more common after emergency operations, in patients with a National Nosocomial Infection Surveillance System (NNISS) score of 2 or 3, and in patients operated on by trainee rather than by experienced surgeons. Children with anaemia or malnutrition were significantly more likely to develop infection postoperatively. Patients' sex, duration of preoperative stay and the number of patients in the hospital room were not considered as risk factors for infection (P>0.05). PMID:21945065

Togo, A; Coulibaly, Y; Dembélé, B T; Togo, B; Keita, M; Kanté, L; Traoré, A; Diakité, I; Ouologuem, H; Diallo, G

2011-12-01

44

Incidence of healthcare associated infection in the surgical ICU of a tertiary care hospital  

PubMed Central

Background Healthcare associated infections (HAI) have taken on a new dimension with outbreaks of increasingly resistant organisms becoming common. Protocol-based infection control practices in the intensive care unit (ICU) are extremely important. Moreover, baseline information of the incidence of HAI helps in planning-specific interventions at infection control. Methods This hospital-based observational study was carried out from Dec 2009 to May 2010 in the 10-bedded surgical intensive care unit of a tertiary care hospital. CDC HAI definitions were used to diagnose HAI. Results A total of 293 patients were admitted in the ICU. 204 of these were included in the study. 36 of these patients developed HAI with a frequency of 17.6%. The incidence rate (IR) of catheter-related blood stream infections (CRBSI) was 16/1000 Central Venous Catheter (CVC) days [95% C.I. 9–26]. Catheter-associated urinary tract infections (CAUTI) 9/1000 urinary catheter days [95% C.I. 4–18] and ventilator-associated pneumonias (VAP) 32/1000 ventilator days [95% confidence interval 22–45]. Conclusion The HAI rates in our ICU are less than other hospitals in developing countries. The incidence of VAP is comparable to other studies. Institution of an independent formal infection control monitoring and surveillance team to monitor & undertake infection control practices is an inescapable need in service hospitals. PMID:24600084

Singh, Shivinder; Chaturvedi, R.; Garg, S.M.; Datta, Rashmi; Kumar, Ambikesh

2012-01-01

45

Hashimoto's Thyroiditis: Celebrating the Centennial Through the Lens of the Johns Hopkins Hospital Surgical Pathology Records  

PubMed Central

Hashimoto's thyroiditis is now considered the most prevalent autoimmune disease, as well as the most common endocrine disorder. It was initially described in 1912, but only rarely reported until the early 1950s. To celebrate this centennial, we reviewed the surgical pathology archives of the Johns Hopkins hospital for cases of Hashimoto's thyroiditis, spanning the period from May 1889 to October 2012. Approximately 15,000 thyroidectomies were performed at this hospital over 124 years. The first surgical case was reported in 1942, 30 years after the original description. Then, 867 cases of Hashimoto's thyroiditis were seen from 1942 to 2012, representing 6% of all thyroidectomies. Hashimoto's thyroiditis was the sole pathological finding in 462 cases; it accompanied other thyroid pathologies in the remaining 405 cases. The most commonly associated pathology was papillary thyroid cancer, an association that increased significantly during the last two decades. The most common indication for thyroidectomy was a thyroid nodule that was cytologically suspicious for malignancy. Hashimoto's thyroiditis remains a widespread, intriguing, and multifaceted disease of unknown etiology one century after its description. Advances in the understanding of its pathogenesis and preoperative diagnosis will improve recognition and treatment of this disorder, and may one day lead to its prevention. PMID:23151083

De Remigis, Alessandra; Chuang, Kelly; Dembele, Marieme; Iwama, Akiko; Iwama, Shintaro

2013-01-01

46

Hashimoto's thyroiditis: celebrating the centennial through the lens of the Johns Hopkins hospital surgical pathology records.  

PubMed

Hashimoto's thyroiditis is now considered the most prevalent autoimmune disease, as well as the most common endocrine disorder. It was initially described in 1912, but only rarely reported until the early 1950s. To celebrate this centennial, we reviewed the surgical pathology archives of the Johns Hopkins hospital for cases of Hashimoto's thyroiditis, spanning the period from May 1889 to October 2012. Approximately 15,000 thyroidectomies were performed at this hospital over 124 years. The first surgical case was reported in 1942, 30 years after the original description. Then, 867 cases of Hashimoto's thyroiditis were seen from 1942 to 2012, representing 6% of all thyroidectomies. Hashimoto's thyroiditis was the sole pathological finding in 462 cases; it accompanied other thyroid pathologies in the remaining 405 cases. The most commonly associated pathology was papillary thyroid cancer, an association that increased significantly during the last two decades. The most common indication for thyroidectomy was a thyroid nodule that was cytologically suspicious for malignancy. Hashimoto's thyroiditis remains a widespread, intriguing, and multifaceted disease of unknown etiology one century after its description. Advances in the understanding of its pathogenesis and preoperative diagnosis will improve recognition and treatment of this disorder, and may one day lead to its prevention. PMID:23151083

Caturegli, Patrizio; De Remigis, Alessandra; Chuang, Kelly; Dembele, Marieme; Iwama, Akiko; Iwama, Shintaro

2013-02-01

47

Surgical site infection: Rates, etiology and resistance patterns to antimicrobials among strains isolated at rio de janeiro university hospital  

Microsoft Academic Search

Summary A 6-month prospective surveillance was conducted in the Department of General Surgery of the Rio de Janeiro University Hospital. Postoperative infections were classified according to CDC criteria. This study reports a significant rate (16.9%) in surgical infections detected by surveillance in a series where 45% of surgical interventions were classified as clean. The majority (52.7%) was apparent only after

K. R. N. Santos; L. S. Fonseca; G. P. Bravo Neto; P. P. Gontijo Filho

1997-01-01

48

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

PubMed Central

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.

Mishra, P.H.; Gupta, Shakti

2012-01-01

49

Quality of Surgical Case Notes at Dow University Hospital according to modified ANKLe score  

PubMed Central

Objective: To find out quality of surgical case notes according to modified Adjusted Note keeping and Legibility (ANKLe) score in Dow University Hospital. Methods: For this audit, medical records of all the patients admitted in Dow University Hospital surgery department were reviewed from February 2012 to April 2012. The modified ANKLe score (total 24) is formed by the combination of, the content (out of 20) and legibility (out of 4) to give an overall score out of 24. A score of at least 20 (content score 17/20; legibility score 3/4) is considered as acceptable. It means that a surgical record is legible and the majority of the essential content is recorded. Results: A total of 236 records were evaluated. Overall mean ± standard deviation (SD) of ANKLe score was 18.4± 2.1 out of maximum score of 24. Content and legibility has overall mean scores of 14.4 out of 20 and 3.9 out of 4 respectively. Only two variables, patient’s name and consultant on call were documented in 100% of records while the least documented variable were social history 2 (0.2%). Legibility scoring system provides that 218notes out of total set of 236 notes (that is 92.4% of overall notes) have achieved a score of 4. The benchmark of 80% was achieved in 26.1% for total ANKLe score, 6.8% for contents and 99.1% for legibility. Conclusion: Overall, quality of records is not good but legibility part scores exceptionally high. PMID:24353683

Jawaid, Masood; Bakhtiar, Nighat; Khalique, Abdul; Masood, Zubia

2013-01-01

50

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

PubMed Central

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 m

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

2015-01-01

51

Abdominal surgical site infections: incidence and risk factors at an Iranian teaching hospital  

PubMed Central

Background Abdominal surgical site infections are among the most common complications of inpatient admissions and have serious consequences for outcomes and costs. Different risk factors may be involved, including age, sex, nutrition and immunity, prophylactic antibiotics, operation type and duration, type of shaving, and secondary infections. This study aimed to determine the risk factors affecting abdominal surgical site infections and their incidence at Imam Khomeini, a major referral teaching hospital in Iran. Methods Patients (n = 802) who had undergone abdominal surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. The subjects were followed for 30 days and by a 20-item questionnaire. Data were collected through pre- and post-operative examinations and telephone follow-ups. Results Of the 802 patients, 139 suffered from SSI (17.4%). In 40.8% of the cases, the wound was dirty infected. The average age for the patients was 46.7 years. The operations were elective in 75.7% of the cases and 24.7% were urgent. The average duration of the operation was 2.24 hours, the average duration of pre-operative hospital stay 4.31 days and the average length of (pre- and post-operation) hospital stay 11.2 days. Three quarters of the cases were shaved 12 hours before the operation. The increased operation time, increased bed stay, electivity of the operation, septicity of the wound, type of incision, the administration of prophylactic antibiotic, type of operation, background disease, and the increased time lapse between shaving and operation all significantly associated with SSI with a p-value less than 0.001. Conclusion In view of the high rate of SSI reported here (17.4% compared with the 14% quoted in literature), this study suggests that by reducing the average operation time to less than 2 hours, the average preoperative stay to 4 days and the overall stay to less than 11 days, and approximating the timing of shaving to the operation and substituting cefazolin for cefaluthin when prophylactic antibiotic is to be administered, the SSI may be reduced to a more acceptable level. PMID:15733323

Razavi, Seyd Mansour; Ibrahimpoor, Mohammad; Sabouri Kashani, Ahmad; Jafarian, Ali

2005-01-01

52

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

Microsoft Academic Search

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

ABDALLA O. A. AHMED; ALEX VAN BELKUM; AHMED H. FAHAL; A. E. ABU ELNOR

1998-01-01

53

Prevalence of HIV and Disease Outcomes on the Medical and Surgical Wards at Kamuzu Central Hospital, Lilongwe, Malawi  

PubMed Central

Introduction: The World Health Organization (WHO) recommends HIV Counseling and Testing (HCT) in a range of clinical settings. We describe the characteristics of patients diagnosed with HIV on the medical and surgical wards at a tertiary care hospital in Malawi. Methods: Under the universal opt-out HCT protocol we characterized the number of new HIV/AIDS infections and associated clinical features among hospitalized surgical and medical patients diagnosed during the course of admission. Results: All 2985 and 3959 medical and surgical patients, respectively, admitted between April 2012 and January 2013 were screened for HCT. 62% and 89% of medical and surgical patients, respectively, had an unknown status on admission and qualified for testing. Of the patients with an unknown status, a new HIV diagnosis was made in 20% and 7% of medical and surgical patients, respectively. Of the newly diagnosed patients with a CD4 count recorded, 91% and 67% of medical and surgical patients, respectively, had a count less than 350, qualifying for ART by Malawi ART guidelines. Newly HIV-diagnosed medical and surgical patients had an inpatient mortality of 20% and 2%, respectively. Discussion: While newly diagnosed HIV-positive medical patients had high inpatient mortality and higher rates of WHO stage 3 or 4 conditions, surgical patients presented with less advanced HIV, though still meeting ART initiation guidelines. The medical inpatient wards are an obvious choice for implementing voluntary counseling and testing (VCT), but surgical patients present with less advanced disease and starting treatment in this group could result in more years of life gained. PMID:24505214

Kendig, Claire E.; McCulloch, Denise J.; Rosenberg, Nora E.; Samuel, Jonathan C.; Mabedi, Charles; Shores, Carol G.; Hosseinipour, Mina C.; Matoga, Mitch; Charles, Anthony G.

2013-01-01

54

Microbial Pattern and Antimicrobial Resistance, a Surgeon’s Perspective: Retrospective Study in Surgical Wards and Seven Intensive-Care Units in Two University Hospitals in Cairo, Egypt  

Microsoft Academic Search

Objectives: Significant morbidity and mortality in surgical practice is due to infection with resistant pathogens. Data from Egyptian hospitals may reflect a peculiar pattern. Methods: Retrospective study of antimicrobial susceptibility of 1,064 isolates from patients in surgical zones and intensive-care units (ICUs) in the largest 2 hospitals in Cairo in 2003. Results: The infection rate in surgical wards was 0.41%,

Gamal Moustafa Saied

2006-01-01

55

The increasing number of surgical procedures for female genital fistula in England: Analysis of Hospital Episode Statistics (HES) data.  

PubMed

Abstract The aim of this study was to describe the number and trend of surgical procedures for female genital fistula in England. An online search of Hospital Episode Statistics (HES) data was carried out. Data were available for the 4-year period from 2002-03 until 2005-06. The total number of surgical procedures carried out for female genital fistula steadily increased by 28.7% from 616 in 2002-03 to 793 in 2005-06. The number of surgical procedures performed for rectovaginal fistula exceeded the total number of surgical procedures carried out for vesicovaginal and urethrovaginal fistula in each year of the study period. This pattern needs to be monitored and investigated further. PMID:25020114

Ismail, S I M F

2015-01-01

56

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

PubMed Central

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

2014-01-01

57

The direct cost of care among surgical inpatients at a tertiary hospital in south west Nigeria  

PubMed Central

Introduction This study was conducted to assess the direct cost of care and its determinants among surgical inpatients at university College Hospital, Ibadan. Methods A retrospective review of records of 404 inpatients that had surgery from January to December, 2010 was conducted. Information was extracted on socio-demographic variables, investigations, drugs, length of stay (LOS) and cost of carewith a semi-structured pro-forma. Mean cost of care were compared using t-test and Analysis of variance (ANOVA). Linear regression analysis was used to identify determinants of cost of care. Level of significance of 5% was used. In year 2010 $1 was equivalent to 150 naira ($1=? 150). Results The median age of patients was 30 years with inter-quartile range of 13-42 years. Males were 257(63. 6%). The mean overall cost of care was ?66,983 ± ?31,985. Cost of surgery is about 50% of total cost of care. Patient first seen at the Accident and Emergency had a significantly higher mean cost of care of ß = ?17,207(95% CI: ?4,003 to ?30,410). Neuro Surgery (ß=?36,210), and Orthopaedic Surgery versus General Surgery(ß=?10,258),and Blood transfusion (ß=?18,493) all contributed to cost of care significantly. Increase of one day in LOS significantly increased cost of care by ?2,372. 57. Conclusion The evidence evaluated here shows that costs and LOS are interrelated. Attempt at reducing LOS will reduce the costs of care of surgical inpatient. PMID:25360187

Ilesanmi, Olayinka Stephen; Fatiregun, Akinola Ayoola

2014-01-01

58

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

PubMed Central

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

2014-01-01

59

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

PubMed Central

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

2009-01-01

60

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

PubMed Central

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

Galas, A; Kulig, P; Kulig, J

2014-01-01

61

Improvement of teamwork and safety climate following implementation of the WHO surgical safety checklist at a university hospital in Japan.  

PubMed

With the aim to optimize surgical safety, the World Health Organization (WHO) introduced the Surgical Safety Checklist (SSCL) in 2008. The SSCL has been piloted in many countries worldwide and shown to improve both safety attitudes within surgical teams and patient outcomes. In the study reported here we investigated whether implementation of the SSCL improved the teamwork and safety climate at a single university hospital in Japan. All surgical teams at the hospital implemented the SSCL in all surgical procedures with strict adherence to the SSCL implementation manual developed by WHO. Changes in safety attitudes were evaluated using the modified operating-room version of the Safety Attitudes Questionnaire (SAQ). A before and after design was used, with the questionnaire administered before and 3 months after SSCL implementation. Our analysis revealed that the mean scores on the SAQ had significantly improved 3 months after implementation of the SSCL compared to those before implementation. This finding implies that effective implementation of the SSCL could improve patient outcomes in Japan, similar to the findings of the WHO pilot study. PMID:24170220

Kawano, Takashi; Taniwaki, Miki; Ogata, Kimiyo; Sakamoto, Miwa; Yokoyama, Masataka

2014-06-01

62

[Integrated medical records for surgical services: a new tool for a new hospital model].  

PubMed

According to a modern definition, the patient's medical record is a tool shared by health-care professionals whose purpose is to support the planning, providing and documenting of patient-centred care. The requirements and regulations of medical records, which date back to the sixties, need now be adapted to more recent organisational models based on different levels of care intensity and strongly integrated patient-oriented care approaches designed to create connectivity, alignment and collaboration within and between different professional fields. On this basis, the SS. Cosma and Damiano Hospital Chief Physician endorsed a multiprofessional project providing for the complete reorganisation of surgical activities according to the above-mentioned approach and, at the same time, for the elaboration of an "integrated" medical record, capable of overcoming the traditional separation between medical and nursing documents. This paper presents the results of a long period of complex teamwork consisting in revising and sharing a new medical record model based on principles of professional integration and patient-centredness in health-care provision. PMID:18360986

Terranova, Giuseppina; Cortesi, Elisabetta; Briani, Silvia; Giannini, Raffaella; Bartolomei, Marco; Corsale, Italo; Biscioni, Luca; Caffi, Tiziana; Paganelli, Ilaria; Frugoli, Patrizia; Ammazzini, Daniela

2007-01-01

63

Pseudocyst of Pinna and its Treatment with Surgical Deroofing: An Experience at Tertiary Hospitals  

PubMed Central

Introduction: Pseudocyst of pinna is an uncommon condition hardly encountered in routine ENT practice. The involvement is usually seen in scaphoid, triangular fossa, and antihelix. Medical treatment is ineffective. Various treatments are suggested in the literature. The aims of the paper were to study the clinical characteristic of patients with pseudocysts and to share our experience with surgical deroofing and buttoning as a definitive treatment. Materials and Methods: Twenty-six patients were diagnosed with pseudocyst of the auricle between April 2011 and 2013 in two medical college hospitals. Clinical characteristics were noted. All patients underwent incision and drainage with removal of anterior cartilage leaflet followed by buttoning for 12 days. Results and Observations: Out of 26 patients, only two were females. Involvement of left side was seen more than right one. None had bilateral involvement. Adults in the age group of 31-40 were commonly affected. Most common site of involvement was scaphoid and triangular fossa. The success rate with primary I and D and buttoning was 96%. Conclusions: Pseudocyst of the pinna is a benign condition of unknown etiology affecting the pinna, commonly encountered in middle-aged men. Many modalities of treatment have been recommended in the literature with varied recurrence and failure rates. The best form of treatment with minimum recurrence is incision and drainage with removal of anterior cartilage leaflet with buttoning. PMID:24741423

Khan, Nazir A.; ul Islam, Mudasir; ur Rehman, Ayaz; Ahmad, Shakeel

2013-01-01

64

Surgical Site Infection in General and Thoracic Surgery: Surveillance of 2?663 Cases in a Japanese Teaching Hospital  

Microsoft Academic Search

Purpose  We conducted a prospective survey of 2?663 surgical patients in a Japanese teaching hospital to look for any risk factors\\u000a predisposing to surgical site infection (SSI) other than the National Nosocomial Infection Surveillance (NNIS) System risk\\u000a indices; namely, performance status, operative time, wound classification, and endoscopic use.\\u000a \\u000a \\u000a \\u000a Methods  Our Infection Control Team recorded data for 5 years using the Japanese SSI

Junichi Yoshida; Masahiro Shinohara; Mikimasa Ishikawa; Kenichi Matsuo

2006-01-01

65

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

SciTech Connect

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.

Chien, Chun-Ru [Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Department of Radiation Oncology, China Medical University Hospital, and School of Medicine, China Medical University, Taichung, Taiwan (China); Pan, I-Wen [Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Tsai, Yi-Wen [Center of Health Policy Research and Development, National Health Research Institutes, Miaoli County, Taiwan (China); Institute of Health and Welfare Policy, National Yang-Ming University Hospital, Taipei, Taiwan (China); Tsai, Teressa [Center of Health Policy Research and Development, National Health Research Institutes, Miaoli County, Taiwan (China); Liang, Ji-An [Department of Radiation Oncology, China Medical University Hospital, and School of Medicine, China Medical University, Taichung, Taiwan (China); Buchholz, Thomas A. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Shih, Ya-Chen Tina, E-mail: yashih@mdanderson.org [Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences, University of Texas MD Anderson Cancer Center, Houston, TX (United States)

2012-01-01

66

Postoperative Pain Management among Surgically Treated Patients in an Ethiopian Hospital  

PubMed Central

Background Incidence of postoperative pain has been reported to be between 47–100%. Ineffective postoperative pain management results in tangible and intangible costs. The purpose of this study was to assess the processes and outcomes of pain management in the surgical wards of Jimma University Specialized Hospital, Ethiopia. Methods and Findings A prospective cross sectional study was conducted among 252 postoperative patients during February 13 to April 30, 2012. A contextually modified and validated (Cronbach’s ? coefficient of 0.78) American Pain Society Patient Outcome Questionnaire was used to assess pain experience of patients. Patients’ charts were reviewed to assess the pattern of analgesic use. Incidence of postoperative pain was 91.4%, and remained high over 3 measurements (McNemar’s; p<0.05), and 80.1% of the patients were undertreated. The mean pain intensity, and pain interference on functional status were 6.72±1.44 and 5.61±1.13 on a 10 point Numerical rating scale respectively; both being strongly correlated(r?=?0.86: p<0.001). Pain intensity was varied by ethnicity, education and preoperative information (ANOVA; P<0.05). Only 50% of the patients were adequately satisfied with their pain management. As needed (prn), solo analgesic, null analgesic, and intramuscular orders were noted for 31.3%, 89.29%, 9.7% and 20.1% of the prescription orders respectively. Though under dose, diclofenac and tramadol were the top prescribed medications, and only 57% of their dose was administered. Linear regression model showed that the predictors of satisfaction were sex of an individual and pain interference with functional status. Conclusion Despite patients’ paradoxical high satisfaction with pain management, the majority of patients were inadequately and inappropriately treated. Thus, further research is needed to determine how best to break down current barriers to effective pain management. PMID:25033399

Woldehaimanot, Tewodros Eyob; Eshetie, Tesfahun Chanie; Kerie, Mirkuzie Woldie

2014-01-01

67

Assessment of prolonged hospital stay attributable to surgical site infections using appropriateness evaluation protocol  

Microsoft Academic Search

Background: The accepted standard in estimating the stay prolongation attributable to surgical site infections is the matched-cohort study method (MCS), which is associated with selection bias. The Appropriateness Evaluation Protocol (AEP) has been used to estimate stay prolongation attributable to nosocomial infections but has not been validated specifically for surgical site infections.Aim of the study: To compare estimates of stay

Veronique Merle; Jeanne-Marie Germain; Pierre Chamouni; Herve Daubert; Loetizia Froment; Francis Michot; Paul Teniere; Pierre Czernichow

2000-01-01

68

Spectrum of surgical trauma and associated head injuries at a university hospital in eastern Nepal  

PubMed Central

Background: Trauma is one of the common surgical emergencies presenting at B. P. Koirala Institute of Health Sciences (BPKIHS), Nepal, a tertiary referral center catering to the needs of the population of Eastern Nepal and nearby districts of India. Objective: The objective of this study is to analyze the magnitude, epidemiological, clinical profile and outcome of trauma at B P Koirala Institute of Health Sciences. Materials and Methods: This descriptive case series study includes all patients with history of trauma coming to BPKIHS emergency and referred to the surgery department. We noted the detailed clinical history and examination, demographics, mechanism of injury, nature of injury, time of reporting in emergency, treatment offered (operative or non operative management) and analyzed details of operative procedure (i.e. laparotomy, thoracotomy, craniotomy etc.), average length of hospital stay, morbidity and outcome (according to Glasgow outcome scale). Collected data were analyzed using EpiInfo 2000 statistical software. Results: There were 1848 patients eligible to be included in the study. The mean age of the patients was 28.9 ± 19.3 years. Majority of the patients (38%) belonged to the age group of 21 - 40 years and the male to female ratio was 2.7:1. Most of the trauma victims were students (30%) followed by laborers (27%) and farmers (22%) respectively. The commonest causes of injury were fall from height (39%), road traffic accident (38%) and physical assault (18%); 78% of the patients were managed conservatively and 22% underwent operative management. Postoperative complications were seen in 18%. Wound infection 7.5%, neurological deficit including cerebrospinal fluid (CSF) otrorrhea was seen in 2.2% patients. Good recovery was seen in 84%, moderate disability in 5.2% patients and severe disability in 1.4% patients. The mortally was 6.3% and most of the deaths were related to traumatic brain injuries. Conclusions: In Nepal, trauma-related injury contributes significantly to morbidity and mortality and is the third leading cause of death. There are very few studies on trauma from this country and hence this study will help in understanding the etiology and outcome particularly in the Eastern region of Nepal. PMID:21799609

Bajracharya, A; Agrawal, A; Yam, BR; Agrawal, CS; Lewis, Owen

2010-01-01

69

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

PubMed Central

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

Luksamijarulkul, Pipat; Aiempradit, Natkitta; Vatanasomboon, Pisit

2014-01-01

70

Influence of Japan's New Diagnosis Procedure Combination-Based Payment System on the Surgical Sector: Does it Really Shorten the Hospital Stay?  

Microsoft Academic Search

Purpose  In 2003, the Diagnosis Procedure Combination (DPC)-based payment system was introduced on a trial basis in 82 major Japanese\\u000a hospitals. We analyzed the influence of this system on hospital revenue and expenditure, focusing on whether it reduces the\\u000a length of stay in hospital (LOS), particularly in the surgical sector.\\u000a \\u000a \\u000a \\u000a Methods  We studied 120 patients hospitalized at the University of Tokyo hospital

Hideo Yasunaga; Hiroo Ide; Tomoaki Imamura; Kazukiko Ohe

2006-01-01

71

Immediate versus delayed hysterectomy for endometrial carcinoma: surgical morbidity and hospital stay  

Microsoft Academic Search

A retrospective review presented is of the intraoperative complications, postoperative morbidity, and length of hospitalization in 138 patients with stage I endometrial carcinoma treated at Yale-New Haven Hospital from January 1, 1977 to December 31, 1981. One group (stage IA, grade 1) was treated with surgery alone; two groups were treated with preoperative intracavitary radium, followed with either an immediate

J. T. Chambers; D. S. Kapp; R. Lawrence; E. I. Kohorn; P. E. Schwartz

1985-01-01

72

79 FR 66769 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...  

Federal Register 2010, 2011, 2012, 2013, 2014

...management, low dose brachytherapy, multiple imaging), hospital outpatient visits...and Methodology b. Use of Single and Multiple Procedure Claims c. Calculation and...Services Composite APC (APC 0034) (4) Multiple Imaging Composite APCs (APCs...

2014-11-10

73

Assessment of surgical site infection risk factors at Imam Reza hospital, Mashhad, Iran between 2006 and 2011  

PubMed Central

Background: The present study was conducted to establish the patterns and risk factors of surgical site infections in our institution between 2006 and 2011. Methods: This was a retrospective cross-sectional study. The surgical site infection (SSI) was identified based on the presence of ICD-10-CM diagnostic code in hospital discharge records. By using a standardized data collection form predictor variables including patient characteristics, preoperative, intra-operative and postoperative data were obtained. Results: Ninety five patients fulfilled the inclusion criteria. The patients were admitted for various procedures including both elective (62.1%) and emergency (37.9%) operations. Colectomy (13.7%) was the leading procedure followed by umbilical herniation (12.6) and appendix perforation (12.6%). The mean age was 47.13 years with standard deviation of 19.60 years. Twenty percent were addicted to opium. Midline incision above and below the umbilicus (40%) had the highest prevalence of infection. Most patients (46.3%) had cleancontaminated wounds and 30.5% had contaminated one. The quantitative variables which were also measured include duration of surgery, pre-operative and post-operative hospital stay with the mean of 2.9±1.45 hours, 1.02±1.42 and 7.75±6.75 days respectively. The most antibiotics prescribed post-operatively were the combination of ceftriaxone and metronidazole (51.6%). Conclusion: The contaminated and clean-contaminated wounds are associated with higher rate of SSIs. Also, there was a converse relation between length of surgical incision and rate of SSIs. In overall, we found type of surgery as the main risk factor in developing the SSIs. PMID:25405118

Motie, Mohammad Reza; Ansari, Majid; Nasrollahi, Hamid Reza

2014-01-01

74

Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009  

PubMed Central

Background Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator. Methods We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs) after adjusting for a range of patient and hospital characteristics. Results The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best) and bottom 20% of hospitals (worst) for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals) had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR?=?0.78, 0.57, and 0.61, respectively). Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group. Conclusions The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups highlight the potential for further quality improvement intervention opportunities. PMID:24788787

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

2014-01-01

75

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

PubMed Central

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

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

2013-01-01

76

Is endovascular repair of ruptured abdominal aortic aneurysms associated with improved in-hospital mortality compared with surgical repair?  

PubMed

A best evidence topic in vascular surgery was constructed according to a structured protocol. The question addressed was whether patients with ruptured abdominal aortic aneurysm (AAA) treated with endovascular aneurysm repair (EVAR) have improved in-hospital outcomes compared with conventional surgical repair. The reported search retrieved 1398 reports, of which 6 papers were thought to represent the best available evidence to answer the study question. Three randomized trials were identified. The first was a pilot trial conducted in a single centre in the UK, which recruited 32 patients and found similar 30-day mortality in the patient groups. The second trial, conducted in Netherlands, recruited 116 patients anatomically suitable for EVAR. This trial found no significant difference in the composite of death and severe complications within 30 days of intervention between patients subjected to EVAR and those undergoing open repair (42 vs 47%; absolute risk reduction 5.4%, 95% confidence interval: -13% to +23%). The IMPROVE trial, based on a pragmatic design, demonstrated similar 30-day mortality in the 613 patients randomized to endovascular strategy or open repair (35.4 vs 37.4%, P = 0.62). The average hospital costs within the first 30 days of randomization were similar between the randomized groups, with an incremental cost-saving for the endovascular strategy vs open repair of £1186. Meta-analysis of all three randomized trials in a Cochrane review found no difference in 30-day or in-hospital mortality between EVAR and open repair (odds ratio: 0.91, 95% confidence interval: 0.67-1.22; P = 0.52). In contrast, a systematic review and meta-analysis, mainly of observational, cohort studies, and another large, nationwide study demonstrated EVAR to be associated with improved in-hospital results compared with open repair, as expressed by mortality, severe complications, length of hospital stay and proportion of patients discharged home. Even though randomized trials demonstrate equivalent in-hospital mortality with EVAR and open repair, large-scale, nationwide, observational studies and meta-analyses have shown EVAR to confer improved in-hospital mortality and morbidity in patients with favourable aneurysm morphology stable enough to undergo imaging. Reconfiguration of acute aortic services and establishment of standardized institutional protocols might be advisable for improvements in the management of ruptured AAA. PMID:25281705

Antoniou, George A; Ahmed, Naseer; Georgiadis, George S; Torella, Francesco

2015-01-01

77

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

Federal Register 2010, 2011, 2012, 2013, 2014

...which we refer to as the ``target PCR'') for other hospitals paid under the OPPS. The target PCR is set in advance of the...certain paid service lines while moving affected services from previously...correct OPPS outlier spending target and will continue to...

2013-12-10

78

76 FR 74121 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...  

Federal Register 2010, 2011, 2012, 2013, 2014

...the manual, factors to be considered when making the decision to admit...basket conversion factor for those hospitals...update, we are making all other adjustments...schedule update factor of -0.1 percent...percentage points as required by section...

2011-11-30

79

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

Federal Register 2010, 2011, 2012, 2013, 2014

...for their services as required by section 1833(t...market basket conversion factor for those hospitals that...payment update, we are making all other adjustments...OPD fee schedule update factor of -0.2 percent...percentage points as required by section...

2012-11-15

80

Surgical coronary revascularization and antiarrhythmic therapy in survivors of out-of-hospital cardiac arrest  

Microsoft Academic Search

BackgroundPatients who survive out-of-hospital cardiac arrest are at high risk for recurrent arrest. Coronary artery bypass grafting (CABG) confers a survival advantage, but it is unclear whether antiarrhythmic drugs or an implanted defibrillator confer added benefit. This study was designed to determine predictors for further treatment, survival, and therapeutic internal cardiac defibrillator (ICD) discharge in this patient population.

Abeel A Mangi; Theodore J Boeve; Gus J Vlahakes; Cary W Akins; Alan D Hilgenberg; Jeremy N Ruskin; Brian M McGovern; David F Torchiana

2002-01-01

81

Surgical Treatment of Primary Intracardiac Myxoma: 20-Year Experience in “Shahid Modarres Hospital”—A Tertiary University Hospital—Tehran, Iran  

PubMed Central

Although cardiac tumors are not common they may vary in terms of race and surgical approach in different countries. Method. Patients data of 20 years was collected and evaluated in the “Shahid Modarres Hospital”—a tertiary university hospital—Tehran, Iran. Results. 42 patients with cardiac myxoma (all cases in 20 years) were included in study, 17 males and 25 females, age difference: 13 to 76 years (mean 50.6). Most of patients were in functional classes I, II. 35 patients complained of dyspnea and 3 patients had embolic events. 97.6% of tumors were primary (41 patients) and one tumor was recurrent (2.4%), 85.7% of tumors (36 cases) were located in LA, and 88.1% of tumors (37 cases) were pediculated. 40 patients (95%) had one tumor. In 22 patients (52.3%) after tumor resection septal defects were repaired primarily while in 18 patients (42.8%) the defects were repaired with pericardial patch and In one patient, tumor resected without any septal defect. Mean tumor size was about 5.22?cm (range of 2.2 to 8.2?cm). Postoperatively, 33 patients discharged from hospital without any complication. Discussion. The research reveals that patients' age and gender were similar to that of other studies in other countries while tumor's incidence seems to be higher. 3 patients were diagnosed after remote embolic event and one patient was diagnosed after MI reflecting relatively high tumor complications and late diagnosis. Conclusion. In our study mean time from diagnosis to operation was too long. The patients had more preoperative embolic events and complication. However, size of myxoma and location of that was as same as its rate in the other literature. As recommendation we suggested that in all patients with vague chest pain or remote embolic events cardiac myxomas should be ruled out.

Ansari Aval, Zahra; Ghaderi, Hamid; Tatari, Hassan; Foroughi, Mahnoosh; Mirjafari, Seyedeh Adeleh; Forozeshfard, Mohammad; Fani, Kamal; Khaheshi, Isa

2015-01-01

82

Surgical Revascularization for Acute Coronary Insufficiency: Analysis of Risk Factors for Hospital Mortality  

Microsoft Academic Search

Background. A retrospective study of 444 patients undergoing urgent and emergent coronary artery bypass grafting for acute coronary insufficiency was performed to identify the risk factors for hospital death specifically associated with the clinical severity of the acute coronary insufficiency syndrome.Methods. The patients were divided into three groups—urgent, emergent A, and emergent B—on the basis of the evolution of the

Biagio Tomasco; Antonino Cappiello; Rosario Fiorilli; Archimede Leccese; Raniero Lupino; Antonio Romiti; Ugo F Tesler

1997-01-01

83

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

PubMed

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

Geller, Stephen A

2008-08-01

84

Tuberculous bowel obstruction at a university teaching hospital in Northwestern Tanzania: a surgical experience with 118 cases  

PubMed Central

Background Bowel obstruction resulting from intestinal tuberculosis has been reported to be more prevalent in developing countries including Tanzania. This study was undertaken to describe the clinicopathological profile, surgical management and outcome of tuberculous intestinal obstruction in our local setting and to identify factors responsible for poor outcome among these patients. Methods This was a prospective descriptive study of patients operated for tuberculous intestinal obstruction at Bugando Medical Centre (BMC) in northwestern Tanzania from April 2008 to March 2012. Ethical approval to conduct the study was obtained from relevant authorities. Statistical data analysis was performed using SPSS version 17.0. Results A total of 118 patients with tuberculous intestinal obstruction were studied. The male to female ratio was 1.8: 1. The median age was 26 years (range 11-67 years). The modal age group was 21-30 years. Thirty-one (26.3%) patients had associated pulmonary tuberculosis and 25 (21.2%) patients were HIV positive with a median CD4+ count of 225 cells /?l. Small bowel strictures were the most common operative findings accounting for 72.9% of cases. The ileo-caecal region was the commonest area of involvement in 68 (57.6%) patients. The right hemicolectomy with ileo-transverse anastomosis was the most frequent surgical procedure performed in 66 (55.9%) patients. Postoperatively all the patients received antituberculous drugs for a period of one year. Postoperative complication rate was 37.3% and surgical site infection (SSI) was the most frequent complication in 42.8% of cases. HIV positivity and low CD4+ count were the main predictors of SSI (p?hospital stay was 24 days. Patients who had postoperative complications stayed longer in the hospital and this was statistically significant (p?=?0.011). Mortality rate was 28.8% and it was significantly associated with co-existing medical illness, delayed presentation, HIV positivity, low CD 4 count (<200 cells/?l), ASA class and presence of complications (p?

2013-01-01

85

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

PubMed Central

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

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

2012-01-01

86

Surgical Technologists  

MedlinePLUS

... the average for all occupations. Advances in medical technology have made surgery safer, and more operations are ... universities and hospitals, have accredited programs in surgical technology. Programs range in length from several months to ...

87

Surgical Management of Adenocarcinoma of the Pancreatic Uncinate Process in a Cancer Hospital in Egypt  

PubMed Central

INTRODUCTION Pancreatic carcinoma affecting the uncinate process is a challenging surgical condition. Several considerations affect the management plan, including the need for vascular resection and the ability to achieve a clear margin. METHODS The data of 19 patients who had curative resection for pancreatic adenocarcinoma of the uncinate process were reviewed. Operative mortality and morbidity, and disease-free survival (DFS) were calculated. RESULTS The study population included 13 male and 6 female patients with a mean age of 55 years. Nine patients (47.4%) had stage I disease, seven patients (36.8%) had stage II disease, and three patients (15.8%) had stage III disease. A total of 12 patients had Whipple procedure and 7 patients had total pancreatectomy. In total, there were 9 R0 and 10 R1 resections. Operative mortality rate was 10.5% (2/19), postoperative leakage rate was 21.1% (4/19), and wound sepsis rate was 21.1%. Median DFS was 19.2 months. Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively). Vascular resection and retroperitoneal safety margin status did not affect disease relapse. CONCLUSION Non-metastatic pancreatic adenocarcinoma of the uncinate process should be offered R0 or R1 resection whenever technically feasible.

Roshdy, Sameh; Hussein, Osama; Abdallah, Ahmed; Abdel-Wahab, Khaled; Senbel, Ahmed

2015-01-01

88

Educating the Army's Jedi  

E-print Network

of warfare. Decisions had to be taken regarding how to rebuild the Army, how to equip it for high intensity conventional combat against a Soviet army that outnumbered North Atlantic Treaty Organization (NATO) forces. These events and questions...

Benson, Kevin Charles

2010-09-22

89

Identification and characteristics of imipenem-resistant Acinetobacter baumannii in surgical wards in a Chinese university hospital.  

PubMed

Abstract The aim of this study was to investigate the prevalence and characteristics of imipenem-resistant Acinetobacter baumanni isolated from surgical wards in a university hospital, China. A total of 143 non-duplicate A. baumannii were isolated from 517 inpatients in surgery intensive care units (ICUs), burn wards, and general surgery wards. Of these, 102 isolates of A. baumannii (71.3%) were resistant to imipenem. Among imipenem-resistant isolates, all isolates were resistant to almost all antimicrobial agents except polymyxin E, all isolates were positive for blaOXA-23 and blaOXA-51 in addition to ISAba1, 52 (51%) were positive for blaOXA-58, 8 (7.8%) contained blaVIM-2, which co-harbored with blaOXA-58. Molecular typing revealed the presence of three clones among imipenem-resistant isolates. This study confirmed that A. baumannii strains harboring OXA or VIM type ?-lactamases are widely distributed throughout the surgery wards. The data demonstrate that there was a high prevalence of imipenem-resistant A. baumannii infection in the region. PMID:25622942

Wang, Dalin; Ma, Linlin; Wu, Zhenyu; Li, Mingcheng; Li, Xiaohan; Zhang, Wei; Chen, Kun

2015-03-01

90

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

PubMed Central

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

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

2014-01-01

91

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

92

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

93

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

94

Isolation and antimicrobial susceptibility pattern of Staphylococcus aureus in patients with surgical site infection at Debre Markos Referral Hospital, Amhara Region, Ethiopia  

PubMed Central

Background Staphylococcus aureus, especially Methicillin Resistant Staphylococcus Aureus (MRSA) is a major health problem recognized as the most important nosocomial pathogen, often causing postoperative wound infections. Antibiotic resistance by MRSA has grown to be common, and resistance to almost all antibiotics has been found among these strains. The aim of this study was to determine the prevalence, antimicrobial susceptibility patterns and associated risk factors of S. aureus in patients with surgical site infections in an Ethiopian hospital. Methods A cross-sectional study was conducted from December 1, 2011 to March 30, 2012 among patients with surgical site infections at Debre Markos Referral Hospital, Debre Markos, Ethiopia. All wound swabs obtained from patients with surgical site infections during the study period were cultured on mannitol salt agar media which is selective for S. aureus. Isolated strains of S. aureus were tested for antibiotic susceptibility patterns using standard disc diffusion technique, and interpretation of resistance was done based on Clinical and Laboratory Standard Institute criteria. Univariate and multivariable analyses were used to assess the risk factors. Results Of the 184 surgical patients who had developed surgical site infection, S. aureus was isolated from 73 (39.7%) cases. Out of the 73 isolates of S. aureus, 36 (49.7%) were MRSA. Among the study participants, prevalence of MRSA was found to be 19.6%. The clinical isolates showed >80% level of resistance to ampicillin, amoxicillin, penicillin G, erythromycin, gentamicin and cotrimoxazole whereas <50% level of resistance was observed against clindamycin, oxacillin, tetracycline and vancomycin. MRSA strains showed resistance ranging from 5.6% (vancomycin) to 100% (cotrimoxazole). Of the following risk factors: sex, age, pus consistency, duration of operation, type of surgery, ward and hospital stay, laparotomy type of surgery was identified as a risk factor for infection by S. aureus. Conclusion The prevalence of S. aureus and/or MRSA infection in surgical and gynaecology & obstetrics wards of Debre Markos Referral Hospital was found to be high. The majority of isolates were highly resistant to major antimicrobial agents. PMID:24949197

2014-01-01

95

US Army War College  

NSDL National Science Digital Library

The Strategic Studies Institute is the primary research faculty of the U.S. Army War College, and includes both civilian scholars and uniformed military officers with extensive experience in national security and military affairs. The most common products of the Institute are SSI Studies which deal with topics having strategic implications for the Army, the Department of Defense, and the larger National Security community. Additional information is available on the mission, history, and organization of SSI, plus a link to the U.S. Army Military History Institute. http://carlisle-www.army.mil/usassi/

96

Risk factors for postcesarean surgical site infection 1 1 Dr. Nguyen Thi Thuy, Director of Hungvuong Hospital gave permission to conduct this study in Hungvuong Hospital  

Microsoft Academic Search

Objective: To determine postcesarean complications and identify independent risk factors for surgical site infection.Methods: We studied a cohort of 969 women delivered by cesarean between May and August 1997. Infections were determined by examinations during ward rounds, reviews of laboratory results, and follow-up for 30 days after discharge. Risk factors were identified by multiple logistic regression.Results: Surgical complications were rare.

Thach Son Tran; Silom Jamulitrat; Virasakdi Chongsuvivatwong; Alan Geater

2000-01-01

97

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.  

PubMed

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare. We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. PMID:22937544

2012-08-31

98

Evaluation of current practices in surgical antimicrobial prophylaxis in primary total hip prosthesis--a multicentre survey in private and public French hospitals.  

PubMed

Deep wound infection is a rare but dreaded postoperative complication after total hip prosthesis (THP) procedures but its incidence can be reduced by systemic antimicrobial prophylaxis. The objective of the present study was to evaluate whether antimicrobial prophylaxis for elective primary THP in patients without any history of hip infection, in orthopaedic wards, participating on a voluntary basis, in French public hospitals and private institutions, complies with published guidelines. Three types of data were collected from anaesthetic and surgical records (November 2000-January 2001) in participating hospitals: (1) administrative data on the hospitals and orthopaedic wards, (2) data on patients, (3) data on compliance of practices with five critical criteria derived from published French guidelines. These criteria concerned administration of prophylaxis, choice of antimicrobial agent, dose of first injection, timing of administration and total length of prophylaxis. Thirty institutions sent data files on 1257 THPs to the coordination centre. Compliance exceeded 80% for all criteria except one (interval between first and second injection). Cumulative compliance with the five criteria was 66.9%. Major compliance failures were an inappropriate interval between the first injection and incision, and total antimicrobial prophylaxis exceeding 48 h. Cumulative compliance was 87.9% in teaching hospitals, 61.8% in general hospitals and 67.7% in private institutions (P<1 x 10(-6)). It was slightly higher when the annual number of interventions was > or =100 (69.4 versus 62.3%; P<0.02). Although the protocol for antimicrobial prophylaxis in THP was clear and easy, one-third of practices did not conform with all five standards. Knowledge of the results by the participating institutions should encourage them to set up working groups to draft care protocols for THP and other surgical interventions, in order to improve practice and perhaps reduce costs. PMID:15003668

Quenon, J-L; Eveillard, M; Vivien, A; Bourderont, D; Lepape, A; Lathelize, M; Jestin, C

2004-03-01

99

U.S. Army Says Goodbye to MASH  

NSDL National Science Digital Library

Last U.S. MASH Unit Handed Over to Pakistanhttp://www.npr.org/templates/story/story.php?storyId=5219020Mission to quake-ravaged Kashmir is farewell for MASHhttp://www.usatoday.com/news/world/2006-02-15-mash-farewell_x.htmKorean War 50th Anniversary [Macromedia Flash Player]http://korea50.army.mil/index.htmlKorean War Casualty Listshttp://www.archives.gov/research/korean-war/casualty-lists/index.htmlM*A*S*H Television Show Guidehttp://www.tv.com/m-a-s-h/show/119/summary.htmlIn a remote valley in Pakistan this Thursday, the United States Army said farewell to the last remaining Mobile Army Surgical Hospital (MASH) unit. These tremendously helpful and durable units were best known as a result of the very popular television show set during the Korean War, which featured a wise-cracking cast that included Alan Alda, Loretta Swit, and Harry Morgan. This particular MASH unit had been stationed in northern Pakistan for four months helping give medical aid to the thousands of people affected by the October 8th earthquake that devastated the region. The ArmyâÂÂs decision to donate the unit to Pakistan was part of a broader change in their medical operations, namely one that places a premium on the âÂÂcombat support hospitalâ system. This system is inherently more flexible, and utilizes surgical squads that can go out into the field. Most of the Pakistani medical staff scheduled to take over the MASH unit had never seen the television show of the same name, but one of the spokesmen for the Pakistani Army, Major Farooq Nasir, mentioned that he had seen the show. He remarked, âÂÂIt was a nice comedy. They didnâÂÂt behave like that here. They were quite seriousâÂÂ.The first link will take visitors to a news article from The Guardian that discusses the last MASH unit. The second link leads to a National Public Radio feature about the MASH units, and includes a brief interview with Rear Admiral Michael LeFever about the handover of the unit to Pakistan. The third link leads to some additional news coverage provided by USA TodayâÂÂs Paul Wiseman. The fourth link leads to a site created by the Department of Defense to provide information about the 50th Anniversary of the Korean War. The fifth link leads to a site provided by the National Archives, which allows users to search casualty lists from the Korean War. The final link will take users to a site created by TV.com that provides information about the television show MASH, complete with cast biographies and episode summaries.

2006-01-01

100

Outcomes of a postdischarge surveillance system for surgical site infections at a Midwestern regional referral center hospital  

Microsoft Academic Search

Background: Postdischarge surveillance has been reported in the literature as one method for detecting surgical site infections (SSIs) that more traditional methods of surveillance (review of readmission data, monitoring of microbiology, radiology, pharmacy antibiotic usage reports, and medical record review) fail to include. Methods: This article describes a postdischarge surveillance program that used surgeon questionnaires and was implemented at a

Cynthia L. Fields

1999-01-01

101

Surgical site infections in patients undergoing major operations in a university hospital: Using standardized infection ratio as a benchmarking tool  

Microsoft Academic Search

Background: Because patterns of infection acquired in patients undergoing operation are ever changing, it is an essential part of nosocomial infection surveillance programs to periodically document the epidemiologic features of infection in these patients. This study was conducted with the primary intention of describing the incidence and risk factors of the surgical site infection (SSI). Methods: We performed a prospective

Montha Na Narong; Somchit Thongpiyapoom; Nonglak Thaikul; Silom Jamulitrat; Nongyao Kasatpibal

2003-01-01

102

WVU Healthcare Employee Donates to Pediatric Ophthalmology Lacy Fisher, surgical technician at Ruby Hospital, has been assisting our ophthalmologists for  

E-print Network

from pediatric strabismus to cornea transplants. Lacy loves her work and the patients she cares for years old. Because Lacy wanted to do something special for the children cared for in pediatric on a child's face like a stuffed toy." "Lacy's contributions to the quality of care we provide our surgical

Mohaghegh, Shahab

103

A Simple Novel Model to Predict Hospital Mortality, Surgical Site Infection, and Pneumonia in Elderly Patients Undergoing Operation  

Microsoft Academic Search

Background\\/Aims: Predicting models of operative morbidity and mortality in the geriatric population are important in the prevention of adverse surgical outcomes. Methods: A retrospective review of medical records was performed for patients over 80 years of age who underwent gastrointestinal surgery from 1998 to 2008. Results: 215 patients were identified with a mean age of 83.7 years. Overall morbidity and

Ting-Shuo Huang; Fu-Chang Hu; Chung-Wei Fan; Chun-Hui Lee; Shyh-Chuan Jwo; Huang-Yang Chen

2010-01-01

104

Army Regulation 2550 Information Management: Records  

E-print Network

Army Regulation 25­50 Information Management: Records Management Preparing and Managing of Army Records Information Management System record numbers after the office symbol on Army Information Management: Records Management Preparing and Managing Correspondence *Army Regulation 25

US Army Corps of Engineers

105

Optimization of surgical supply inventory and kitting  

E-print Network

This project centered on inventory optimization for operative custom surgical packs and soft good supplies for Massachusetts General Hospital (MGH), a 947-bed medical center. Custom surgical packs are used in every surgical ...

Schlanser, Matthew R. (Matthew Ross)

2013-01-01

106

This publication is available at Army Knowledge Online (https://armypubs.us.army.mil/doctrine/index.html).  

E-print Network

nation's wars. It will outline ARSOF's requirement to provide in the nation's defense unequalled Surgical and integrated use of military information support, cyber, and civil affairs operations. The relevance of Army our nation's wars, maintaining alliances, building partner nation capacity, developing surrogate

US Army Corps of Engineers

107

Table 74. Percent and Number of Vietnam and Non-Vietnam Veterans Reporting Hospitalization Since Discharge From the Army for Conditions Classified as Cardiovascular Diseases (ICD-9, 390-459), and Odds Ratios, by Type of Condition  

E-print Network

Discharge From the Army for Conditions Classified as Cardiovascular Diseases (ICD-9, 390-459), and Odds the six entry characteristics. b Model 2 contains the six entry characteristics, cigarette smoking Diseases (ICD-9, 390-459), and Odds Ratios, by Type of Condition Multivariate Results Vietnam Non

108

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

109

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

110

Letterkenny Army Depot: The Army Teaches Business a Lesson in Lean Six Sigma  

E-print Network

Letterkenny Army Depot: The Army Teaches Business a Lesson in Lean Six Sigma is a case study of Letterkenny Army Depot, one of five Army maintenance depots. Letterkenny recapitalizes missiles, HMMWV's, generators, and other ...

Harvey, Roger K.

2006-05-23

111

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

112

Army Transformation and the Junior Officer Exodus  

Microsoft Academic Search

This article examines the elevated rate of voluntary attrition from the junior officer corps of the United States Army between 1995 and 2001 to consider how it relates to the army’s vision of the future. There was a conflict between the army’s need for numbers of officers in the short term (to overcome the captain deficit) and its need for

Mark R. Lewis

2004-01-01

113

December 2009 ARMY MEDICAL LOGISTICS  

E-print Network

Logistics Management Center .............................................................. 1-6 Section IV........................................................... 1-8 Section V -- Synchronizing Medical Logistics for Army Health System Support.................................................................................2-5 Medical Logistics Management Center

US Army Corps of Engineers

114

Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; physician-owned hospitals: data sources for expansion exception; physician certification of inpatient hospital services; Medicare Advantage organizations and Part D sponsors: CMS-identified overpayments associated with submitted payment data. Final rule with comment period.  

PubMed

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 2015 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. In this document, we also are making changes to the data sources permitted for expansion requests for physician-owned hospitals under the physician self-referral regulations; changes to the underlying authority for the requirement of an admission order for all hospital inpatient admissions and changes to require physician certification for hospital inpatient admissions only for long-stay cases and outlier cases; and changes to establish a formal process, including a three-level appeals process, to recoup overpayments that result from the submission of erroneous payment data by Medicare Advantage (MA) organizations and Part D sponsors in the limited circumstances in which the organization or sponsor fails to correct these data. PMID:25387387

2014-11-10

115

US Army Corps of Engineers  

E-print Network

. The engineers organized the first U.S. Army tank units and developed chemical warfare munitions and defensive equipment. Armored units and chemical warfare became so important that the Army in 1918 created a separate Tank Corps and a Chemical Warfare Service. Brigadier General Amos Fries, a career engineer officer

US Army Corps of Engineers

116

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

PubMed Central

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/?l. 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/?l), 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

2012-01-01

117

Army Industrial, Landscaping, and Agricultural Water Use  

SciTech Connect

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.

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

2014-09-18

118

Salvation Army : the next generation  

E-print Network

The Salvation Army thrift stores are retail entities in the center of neighborhoods which collect and resell used objects. Although historically dear to many, it seems that the physical condition, market visibility, and ...

Francpourmoi, Salomé

2010-01-01

119

US Army Corps of Engineers  

E-print Network

from HQUSACE. Publications are provided in portable document format (PDF). #12;DEPARTMENT OF THE ARMY of embankments, excavated slopes, and natural slopes in soil and soft rock. Methods for analysis of slope

US Army Corps of Engineers

120

National Hospital Discharge Survey  

Cancer.gov

The National Hospital Discharge Survey (NHDS), which has been conducted annually since 1965, collects data from a sample of approximately 270,000 inpatient records acquired from a national sample of about 500 hospitals. Only hospitals with an average length of stay of fewer than 30 days for all patients, general hospitals, or children's general hospitals are included in the survey. Information collected includes diagnoses, surgical and nonsurgical procedures, prescription and over-the-counter drugs, immunizations, allergy shots, anesthetics, and dietary supplements.

121

Intendedness of pregnancy among active duty women in the U.S. Army  

Microsoft Academic Search

Objective. The objective of this study was to determine the prevalence of unintended pregnancy and the association between social and demographic factors among a population of active duty women in the U.S. Army giving birth to viable infants at a U.S. Army hospital at Fort Hood, Texas. Prevalence of unintended pregnancy in this group was 50.9% (95% CI 44.0 to

Michael Harley Custer

1999-01-01

122

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

123

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

Federal Register 2010, 2011, 2012, 2013, 2014

...Secretary Science and Technology Reinvention Laboratory...Army Research, Development and Engineering Command; Tank Automotive Research, Development and Engineering...S. Army Tank Automotive Research, Development and...

2011-09-13

124

Surgical site infection surveillance  

Microsoft Academic Search

Surgical site infection (SSI) is the third most commonly reported nosocomial infection and accounts for 14–16% of all nosocomial infections among hospital inpatients. A successful SSI surveillance programme includes standardized definitions of infection, effective surveillance methods and stratification of the SSI rates according to risk factors associated with the development of SSI. Surveillance with feedback of information to surgeons and

E. T. M. Smyth; A. M. Emmerson

2000-01-01

125

76 FR 12087 - Army Educational Advisory Committee  

Federal Register 2010, 2011, 2012, 2013, 2014

...Army War College Subcommittee of the Army Education Advisory Committee. Dates of Meeting...and staff and faculty; table and examine online College issues; assess resident and distance education programs, self- study techniques,...

2011-03-04

126

75 FR 7255 - Army Educational Advisory Committee  

Federal Register 2010, 2011, 2012, 2013, 2014

...Army War College Subcommittee of the Army Education Advisory Committee. Date of Meeting...and staff and faculty; table and examine online College issues; assess resident and distance education programs, self- study techniques,...

2010-02-18

127

ATTENTION OF DEPARTMENT OF THE ARMY  

E-print Network

with the memorandum while: a. minimizing impact on the war effort, deployed forces, pre-deployment training Command U.S. Army Cyber Command U.S. Army Installation Management Command United States Africa Command

US Army Corps of Engineers

128

Water conservation opportunities at Army installations  

SciTech Connect

This paper reviews aspects of water conservation at Army installations describing the current status and usage on installations and unique attributes pertinent to Army conditions. It also describes a model water conservation analysis at one installation.

Scholze, R.J.

1997-06-01

129

Army Regulation 2550 Information Management: Records  

E-print Network

Army Regulation 25­50 Information Management: Records Management Preparing and Managing Information Management: Records Management Preparing and Managing Correspondence *Army Regulation 25 Agency, ATTN: Records Management Division (TAPC­PDD­RP), 6000 6th Street, Fort Belvoir, VA 22060

US Army Corps of Engineers

130

Sustainability: Preserving Choice for the Army  

E-print Network

Sustainability: Preserving Choice for the Army Friday, October 19, 2012 12:00 - 1:30 p.m. (lunch will be provided) Wrigley Hall, Room 481 Richard Kidd Deputy Assistant of the Army, Energy and Sustainability infrastructure. The development of Army-wide sustainability principles coupled with investments, training

Hall, Sharon J.

131

US Army Corps of Engineers  

E-print Network

US Army Corps of Engineers Graphic Standards Manual EP 310-1-6 Revised 9/94 ® #12;CECW -CO Pamphlet Information GRAPHIC STANDARDS MANUAL EP 310-1-6 Change 1 1 June 2006 1. This Change 1 to EP 310-1-6, September of Engineers Chief of Staff #12;The guidance provided within this Graphic Standards Manual was developed

US Army Corps of Engineers

132

The Army's Continuing Education Model  

ERIC Educational Resources Information Center

Goals, courses, delivery systems, faculty, instructional materials and methods, and students of the Army continuing education program are described. Characteristics adaptable to civilian alternative higher education are summarized, including: credit for life experience or by examination, ad hoc faculty, performance testing, and student incentives.…

Schoenfeld, Clay

1977-01-01

133

ANTBIRDS PARASITIZE FORAGING ARMY ANTS  

Microsoft Academic Search

In the tropical forests of Central and South America, army ants of the Eci- tonini tribe, and the numerous animals that follow them through the understory, share a complex relationship that has far-reaching effects on population dynamics and community structure. Although considerable study has been made of various participants in this re- lationship, no research has explicitly examined the nature

Peter H. Wrege; Martin Wikelski; James T. Mandel; Thomas Rassweiler; Iain D. Couzin

2005-01-01

134

[Surgical indications in aspecific pneumopathies].  

PubMed

A degree course lecture based on a review of the relevant literature and experience gained at a 1000-bed lung hospital (S. Luigi Hospital, Orbassano) is presented in a shortened form. Attention is drawn to the revival of discarded techniques due to anaesthesiological and medical advances. This has considerably extended the surgical indications. PMID:673214

Dei Poli, G; Mello Teggia, P; Smrekar, E; Mastroianni, V

135

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

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

2014-01-01

136

Medicare program; hospital outpatient prospective payment system and CY 2007 payment rates; CY 2007 update to the ambulatory surgical center covered procedures list; Medicare administrative contractors; and reporting hospital quality data for FY 2008 inpatient prospective payment system annual payment update program--HCAHPS survey, SCIP, and mortality. Final rule with comment period and final rule.  

PubMed

This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system, and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and the Deficit Reduction Act (DRA) of 2005. In this final rule with comment period, we describe changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2007. In addition, this final rule with comment period implements future CY 2009 required reporting on quality measures for hospital outpatient services paid under the prospective payment system. This final rule with comment period revises the current list of procedures that are covered when furnished in a Medicare-approved ambulatory surgical center (ASC), which are applicable to services furnished on or after January 1, 2007. This final rule with comment period revises the emergency medical screening requirements for critical access hospitals (CAHs). This final rule with comment period supports implementation of a restructuring of the contracting entities responsibilities and functions that support the adjudication of Medicare fee-for-service (FFS) claims. This restructuring is directed by section 1874A of the Act, as added by section 911 of the MMA. The prior separate Medicare intermediary and Medicare carrier contracting authorities under Title XVIII of the Act have been replaced with the Medicare Administrative Contractor (MAC) authority. This final rule continues to implement the requirements of the DRA that require that we expand the "starter set" of 10 quality measures that we used in FY 2005 and FY 2006 for the hospital inpatient prospective payment system (IPPS) Reporting Hospital Quality Data for the Annual Payment Update (RHQDAPU) program. We began to adopt expanded measures effective for payments beginning in FY 2007. In this rule, we are finalizing additional quality measures for the expanded set of measures for FY 2008 payment purposes. These measures include the HCAHPS survey, as well as Surgical Care Improvement Project (SCIP, formerly Surgical Infection Prevention (SIP)), and Mortality quality measures. PMID:17133695

2006-11-24

137

The Scottish Women's Hospitals for Foreign Service - the Girton and Newnham Unit, 1915-1918.  

PubMed

The Scottish Women's Hospitals for Foreign Service were established shortly after the outbreak of the First World War. Opportunities were limited for medical women prior to the war and during it they were unable to obtain a commission in the Royal Army Medical Corps, hence the formation of these voluntary all-women units. The Girton and Newnham Unit, under the leadership of Dr L McIlroy, served with distinction in France, Serbia and Greece, demonstrating clinical competence in the management of the emergency medical and surgical problems associated with warfare, areas usually off-limits to women doctors. They were severely tested but showed endurance and resilience in the running of their hospital in the most difficult of conditions. PMID:25516907

Morrison, E; Parry, C

2014-12-01

138

ETL wins Army Lab Prize  

NASA Astrophysics Data System (ADS)

The U.S. Army Engineer Topographic Laboratories (ETL), located in Fort Belvoir, Va., was awarded the 1981 Department of the Army Most Improved Laboratory of the Year Award for ETL's scientific and technical achievements in mapping, military geographic information, and geographic intelligence systems.ETL, the largest topographic research and development organization of its kind in the world, specializes in mapping, geodesy, point positioning, and military geographic information. ETL addresses the full range of development from basic research to a final product in the topographic sciences. In addition, scientists at the laboratory have interpreted feedback from satellites, such as Landsat, to help pinpoint and improve ecological imbalance in some areas. ETL engineers are developing electronic systems to measure dams, while other ETL staff members are designing a pseudo-radar system for the Pershing II missile.

139

Army ground robotics research program  

NASA Astrophysics Data System (ADS)

The U.S. Army is undergoing a transformation from Cold War era "heavy" forward-deployed forces arrayed against a monolithic known enemy to lighter, more flexible, U.S.-based forces able to rapidly engage in a full spectrum of military operations. Unmanned systems can potentially contribute towards achieving this goal of a highly capable and flexible ground force. To support this effort, the U.S. Army Research Laboratory has undertaken a long-term research program to support technology development for unmanned ground vehicle systems. Over the course of the past year, this multifaceted effort has made significant technical strides, demonstrating sufficient technological maturity to potentially enable incorporation of semi-autonomous unmanned vehicles into the initial fielding of Future Combat Systems (FCS), while successfully conducting additional research directed toward improved capabilities for later increments of FCS and Land Warrior systems.

Bornstein, Jonathan A.; Shoemaker, Chuck M.

2003-09-01

140

Army Precision at Central Headquarters  

ERIC Educational Resources Information Center

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…

Goldman, Jay P.

2005-01-01

141

Utility of Compact Ultrasound in a Mass Surgical Selection Program in Africa: Experience of a Sonologist at the MV Africa Mercy Hospital Ship's Screening Day.  

PubMed

Compact ultrasound (US) was introduced in an austere setting with no other available imaging for an annual mass surgical screening day. Compact US examinations were performed on 25 patients from more than 7000 potential patients, as deemed possibly useful by the screening surgeons. Of the 20 patients with recorded data, compact US was helpful in 14 of 20 as a decision-making tool, obviating computed tomography for preoperative planning. Compact US was helpful in most cases, saving resources (computed tomography), technologist time, and radiation risk in this select population. PMID:25614408

Harris, Robert D; Parker, Gary

2015-02-01

142

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

ERIC Educational Resources Information Center

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…

Bell, Nicole S.

2009-01-01

143

Surgical Airway  

PubMed Central

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

Patel, Sapna A; Meyer, Tanya K

2014-01-01

144

LIEUTENANT GENERAL PERRY L. WIGGINS United States Army North (Fifth Army)  

E-print Network

the United States, Europe, Latin America and the Middle East. He is an accomplished aviator and is qualifiedLIEUTENANT GENERAL PERRY L. WIGGINS Commander, United States Army North (Fifth Army) and Senior Officer Advanced Course, Command and General Staff College, and the United States Army War College, where

US Army Corps of Engineers

145

DEPARTMENT OF THE ARMY U.S. ARMY CORP.S OF ENGINEERS  

E-print Network

DEPARTMENT OF THE ARMY U.S. ARMY CORP.S OF ENGINEERS 441 G STREET, NW WASHINGTON, DC 20314 the U.S. Army Corps ofEngineers (Corps) and The Nature Conservancy (TNC) which focuses on modifying dated 19 May 2010 on the Sustainable Rivers Project (SRP). The SRP is a successful collaboration between

US Army Corps of Engineers

146

32 CFR 581.1 - Army Disability Review Board.  

Code of Federal Regulations, 2011 CFR

...2011-07-01 2009-07-01 true Army Disability Review Board. 581.1 Section 581.1 National...DEPARTMENT OF THE ARMY PERSONNEL PERSONNEL REVIEW BOARD § 581.1 Army Disability Review Board. (a) General provisions...

2011-07-01

147

32 CFR 581.1 - Army Disability Review Board.  

Code of Federal Regulations, 2010 CFR

...2010-07-01 2010-07-01 true Army Disability Review Board. 581.1 Section 581.1 National...DEPARTMENT OF THE ARMY PERSONNEL PERSONNEL REVIEW BOARD § 581.1 Army Disability Review Board. (a) General provisions...

2010-07-01

148

77 FR 40030 - Army Science Board Summer Study Meeting  

Federal Register 2010, 2011, 2012, 2013, 2014

...please contact Mr. Justin Bringhurst at justin.bringhurst@us.army.mil or (703) 617-0263 or Carolyn German at carolyn.t.german@us.army.mil or (703) 617-0258. SUPPLEMENTARY INFORMATION: None. Brenda S. Bowen, Army...

2012-07-06

149

Prevalence of methicillin-resistant Staphylococcus aureus in elective surgical patients at a public teaching hospital: an analysis of 1039 patients.  

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of postoperative surgical site infections (SSIs). It is unclear, however, whether asymptomatic colonization or nosocomial acquisition of MRSA results in postoperative SSI. We conducted a retrospective review of patients screened for MRSA between May 2008 and October 2010 at our institution. End points included rates of MRSA infection, SSI, and the cost of routine MRSA screening of patients undergoing elective surgery. Of the 1039 patients screened preoperatively, 48 (4.6%) tested positive for MRSA by nasal or oral swab, whereas 991 (95.4%) tested negative. Forty-five (93.8%) MRSA-positive patients received vancomycin or linezolid and three (6.25%) received cefazolin perioperatively. Three (6.25%) MRSA-positive patients developed postoperative SSIs. Two required rehospitalization for intravenous antimicrobials, whereas a third patient required removal of infected abdominal mesh. Twenty (2.02%) MRSA-negative patients and four (5.26%) unscreened patients developed non-MRSA SSIs. Regardless of MRSA status, none of 609 patients who had a laparoscopic procedure or inguinal hernia repair developed SSI. Twenty-two patients needed to be screened to obtain one positive test. The role of MRSA screening and longer perioperative coverage for MRSA-positive patients undergoing complex elective procedures remains to be determined. PMID:23025949

Manunga, Jesse; Olak, Jemi; Rivera, Carmen; Martin, Maureen

2012-10-01

150

Salvation Army Programs in Rural Areas.  

ERIC Educational Resources Information Center

Describes services of the Salvation Army's network of rural local service units. Discusses relationship between local units, community agencies, and regional Service Extension Departments. Provides examples of individuals who received aid coordinated by local volunteers where formal social services were unavailable. Emphasizes Salvation Army's…

Ricken, William

1987-01-01

151

U.S. Army Corps of Engineers  

E-print Network

U.S. Army Corps of Engineers Alaska District APPLICANT: Port of Anchorage Department of the Army Permit Evaluation and Decision Document APPLICATION NO.: POA-2003-502-N WATERWAY: Ship Creek Administration (MARAD) in cooperation with the Municipality of Anchorage, Port of Anchorage, proposes to expand

US Army Corps of Engineers

152

Engineer Pamphlet Department of the Army  

E-print Network

of Building Air Bases in the Negev: The U.S. Army Corps of Engineers in Israel, 1979­1982 (1992), Buffalo Soldiers, Braves, and Brass: The Story of Fort Robinson, Nebraska (1993), and On the Trail of the Buffalo Soldier: Biographies of African Americans in the U.S. Army, 1866­1917 (1995). He and Theresa L. Krause

US Army Corps of Engineers

153

Situation Desperate: U.S.Army Engineer  

E-print Network

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Federal Disaster Measures During Reconstruction . . . . . . . 17 Humanitarian ServicesSituation Desperate: U.S.Army Engineer Disaster Relief Operations, Origins to 1950 Leland R. Johnson SituationDesperate:U.S.ArmyEngineerDisasterReliefOperations,Originsto1950·LelandR.Johnson EP 870

US Army Corps of Engineers

154

Army Space Systems For Terrestrial Applications  

NASA Astrophysics Data System (ADS)

Army combat forces involved in global military operations require knowledge of the terrain and accurate positioning and navigation capability to effectively perform their missions. Combat critical data from satellite-based systems to augment ground and airborne data collection, processing, and dissemination systems are crucial for the delivery and use of the needed information and intelligence in near-real time. The Army is developing ground-based testbed systems to utilize terrain and weather data collected from space-based platforms to enhance Army commanders' battlefield capabilities, and is researching new applications for the NAVSAT Global Positioning System and the Defense Advanced Research Projects Agency-sponsored (DARPA) LIGHTSAT program that are unique to the Army. In addition, the Army is designing experiments to be conducted on the Space Shuttle.

Dickerman, Ronald L.; Gomez, Richard B.

1988-04-01

155

[Post-surgical neuropathic pain].  

PubMed

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

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

2009-01-01

156

The Reliability and Validity of the Self-Reported Drinking Measures in the Army’s Health Risk Appraisal Survey  

PubMed Central

Background The reliability and validity of self-reported drinking behaviors from the Army Health Risk Appraisal (HRA) survey are unknown. Methods We compared demographics and health experiences of those who completed the HRA with those who did not (1991–1998). We also evaluated the reliability and validity of eight HRA alcohol-related items, including the CAGE, weekly drinking quantity, and drinking and driving measures. We used Cohen’s ? and Pearson’s r to assess reliability and convergent validity. To assess criterion (predictive) validity, we used proportional hazards and logistical regression models predicting alcohol-related hospitalizations and alcohol-related separations from the Army, respectively. Results A total of 404,966 soldiers completed an HRA. No particular demographic group seems to be over- or underrepresented. Although few respondents skipped alcohol items, those who did tended to be older and of minority race. The alcohol items demonstrate a reasonable degree of reliability, with Cronbach’s ? = 0.69 and test-retest reliability associations in the 0.75–0.80 range for most items over 2- to 30-day interims between surveys. The alcohol measures showed good criterion-related validity: those consuming more than 21 drinks per week were at 6 times the risk for subsequent alcohol-related hospitalization versus those who abstained from drinking (hazard ratio, 6.36; 95% confidence interval=5.79, 6.99). Those who said their friends worried about their drinking were almost 5 times more likely to be discharged due to alcoholism (risk ratio, 4.9; 95% confidence interval=4.00, 6.04) and 6 times more likely to experience an alcohol-related hospitalization (hazard ratio, 6.24; 95% confidence interval=5.74, 6.77). Conclusions The Army’s HRA alcohol items seem to elicit reliable and valid responses. Because HRAs contain identifiers, alcohol use can be linked with subsequent health and occupational outcomes, making the HRA a useful epidemiological research tool. Associations between perceived peer opinions of drinking and subsequent problems deserve further exploration. PMID:12766628

Bell, Nicole S.; Williams, Jeffrey O.; Senier, Laura; Strowman, Shelley R.; Amoroso, Paul J.

2007-01-01

157

Incidence of Major Tendon Ruptures and Anterior Cruciate Ligament Tears in US Army Soldiers  

Microsoft Academic Search

Background: Although a rare event, the prevalence of major tendon rupture has increased in recent decades. Identification of risk factors is important for prevention purposes.Hypothesis: Race is a risk factor for major tendon ruptures.Study Design: Cohort study (prevalence); Level of evidence, 2.Methods: All patients admitted for surgical management of a rupture of a major tendon at Womack Army Medical Center,

Daniel W. White; Joseph C. Wenke; Dan S. Mosely; Sally B. Mountcastle; Carl J. Basamania

2007-01-01

158

Surgical Planning Laboratory Image Gallery  

NSDL National Science Digital Library

The Surgical Planning Laboratory of the Department of Radiology at Brigham and Women's Hospital and Harvard Medical School has a virtual treasure chest of visual anatomical information available at its web site. The SPL offers of series of over 60 MPEG movies on topics such as neurosurgery, multiple sclerosis, the brain, abdominal surgery, flow analysis, and thoracic surgery, among others.

159

Army Recruiters: "Counseling" High-Schoolers to Death  

ERIC Educational Resources Information Center

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…

Merrow, John

2005-01-01

160

Army Basic Skills Provision: Whole Organisation Approach/Lessons Learnt  

ERIC Educational Resources Information Center

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…

Basic Skills Agency, 2007

2007-01-01

161

Quality in Government: The Army Intern Intake Survey.  

ERIC Educational Resources Information Center

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…

Ungvarsky, Diane M.; Lilienthal, Richard A.

162

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

163

US Army Corps of EngineersR  

E-print Network

RReesseeaarrcchh PPoolliiccyyPPrraaccttiiccee #12;iiInstitute for Water Resources 2009 Annual Report IWR Headquarters - National Laboratories Partnership.................................. Sandia National LaboratoryUS Army Corps of EngineersR ANNUAL REPORT ACTIVITIES OF THE INSTITUTE FOR WATER RESOURCES FISCAL

US Army Corps of Engineers

164

PREPARING THE ARMY FOR JOINT OPERATIONS  

Microsoft Academic Search

The National Security Strategy states that the military, which had been struc- tured for operations against the massive armies of the Warsaw Pact, must be transformed to handle new adversaries. The administration wants a broad portfolio of military capabilities, including \\

Bruce Pirnie

165

MECHANIZATION STUDY OF THE ARMY DOCUMENTATION AND INFORMATION RETRIEVAL SYSTEM, U.S. ARMY LIBRARY, WASHINGTON, D.C.  

ERIC Educational Resources Information Center

THE OBJECTIVES OF THE ARMY STUDY DOCUMENTATION AND INFORMATION RETRIEVAL SYSTEM (ASDIRS) ARE TO PROVIDE A CENTRAL LIBRARY OF ARMY STUDIES READILY ACCESSIBLE IN THE PENTAGON. AT THE PRESENT TIME, A BIBLIOGRAPHIC QUARTERLY CATALOG OF ARMY STUDIES AND A PERMUTED DESCRIPTOR/TITLE INDEX ARE PROVIDED. THE CATALOG OF ARMY STUDIES IS PRODUCED USING AN IBM…

KERSHAW, G.A.; AND OTHERS

166

Assuring structural integrity in Army systems  

NASA Technical Reports Server (NTRS)

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.

1985-01-01

167

Army dependents: childhood illness and health provision.  

PubMed

This small qualitative study explored attitudes of a group of Army wives to childhood illness and their expectations of health provision. The author's practice serves a population mainly comprising of Army dependents where GP attendance rates are double the national average. Two focus groups were organised using health visitor groups attached to the practice. Transcripts were examined to produce a framework for semi-structured interviews with nine mothers, who were selected by purposive sampling. Mothers were asked about symptoms, coping, social problems, decisions to take action, health provision and support. Data were analysed and sorted, using the principles of grounded theory, into four main themes: attitude to child's illness, coping, Army culture and accessibility to health services. Many Army wives appear to suffer from high levels of stress. It seemed that the coping ability of the mother was affected by the constant turbulence and isolation of Army life. While mothers displayed a knowledge of common illnesses, they had fears of the unknown and of life threatening illnesses. They sometimes managed childhood illness at home owing to lack of transport. The author concluded that some Army wives suffer from stress and lack confidence in their mothering skills when their children are ill, which may be due, in part, to the constant cycle of postings and isolation from family and services. They need easily accessible health facilities and information regarding these services. Communication should be encouraged between civilian services and the Army. It appears that Army dependents require more support from their GP practice than the average civilian family, offering opportunity for nurses and health visitors to provide alternative and proactive services. PMID:15984561

Giles, Sarah

2005-06-01

168

32 CFR 655.10 - Oversight of radiation sources brought on Army land by non-Army entities (AR 385-10).  

Code of Federal Regulations, 2012 CFR

... 2011-07-01 true Oversight of radiation sources brought on Army land by non-Army...CONTINUED) ENVIRONMENTAL QUALITY RADIATION SOURCES ON ARMY LAND § 655.10 Oversight of radiation sources brought on Army land by...

2012-07-01

169

32 CFR 655.10 - Oversight of radiation sources brought on Army land by non-Army entities (AR 385-10).  

Code of Federal Regulations, 2014 CFR

... 2013-07-01 true Oversight of radiation sources brought on Army land by non-Army...CONTINUED) ENVIRONMENTAL QUALITY RADIATION SOURCES ON ARMY LAND § 655.10 Oversight of radiation sources brought on Army land by...

2014-07-01

170

32 CFR 655.10 - Oversight of radiation sources brought on Army land by non-Army entities (AR 385-10).  

Code of Federal Regulations, 2011 CFR

...2011-07-01 false Oversight of radiation sources brought on Army land by non-Army...CONTINUED) ENVIRONMENTAL QUALITY RADIATION SOURCES ON ARMY LAND § 655.10 Oversight of radiation sources brought on Army land by...

2011-07-01

171

32 CFR 655.10 - Oversight of radiation sources brought on Army land by non-Army entities (AR 385-10).  

Code of Federal Regulations, 2013 CFR

...2013-07-01 false Oversight of radiation sources brought on Army land by non-Army...CONTINUED) ENVIRONMENTAL QUALITY RADIATION SOURCES ON ARMY LAND § 655.10 Oversight of radiation sources brought on Army land by...

2013-07-01

172

Hospitality Management Hospitality Management  

E-print Network

of the global hospitality industry. Academic Offerings HOSPITALITY AND FOOD SERVICE MANAGEMENT MINOR HOSPITALITY AND FOOD SERVICE MANAGEMENT MINOR Students pursuing programs in other areas of study may choose a minor Service Operations 4 OR NSD 225 Nutrition in Health 3 12 credits needed: HPM 300 Selected Topics: Advanced

McConnell, Terry

173

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

Microsoft Academic Search

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 multivariate Cox models controlling for age, race, education,

Nicole S. Bell

2009-01-01

174

Predicting Surgical Site Infections in Real-Time Akpene Gbegnon  

E-print Network

Predicting Surgical Site Infections in Real-Time Akpene Gbegnon University of Iowa Hospitals City, IA 52242 1-319-384-7359 john-cromwell@uiowa.edu ABSTRACT Surgical site infections (SSIs Sciences]: Medical Information Systems General Terms Experimentation Keywords Surgical Site Infections

Street, Nick

175

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

ERIC Educational Resources Information Center

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…

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

176

Air Force | Army | Marine Corps Navy & Coast Guard General of the Air Force/Army  

E-print Network

Air Force | Army | Marine Corps Navy & Coast Guard O-10 General of the Air Force/Army (Reserved for Wartime) Fleet Admiral (Reserved for Wartime) General Admiral | Commandant of the Coast Guard O-9 Corps Navy & Coast Guard WarrantOfficers No Warrant Officer Rank Warrant Officer 1 Chief Warrant Officer

177

Bot armies as threats to network security  

NASA Astrophysics Data System (ADS)

"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.

Banks, Sheila B.; Stytz, Martin R.

2007-04-01

178

Surgical Technician  

NSDL National Science Digital Library

Viven Thomas was African American determined to make something of himself during the time of segregation, Alfred Blalock, a surgeon at Johns Hopkins Hospital. Thomas, initially hired as a janitor, was soon promoted by Blalock to learn the complexities of surgery, eventually becoming a trainer of novice surgeons and a major force in the advancement of African Americans in medicine.

Institutes, John H.

179

ARMI National Atlas for Amphibian Distributions  

NSDL National Science Digital Library

This site, from The Amphibian Research and Monitoring Initiative (ARMI), is a compilation of current and historic records of amphibian occurrences. The atlas is organized taxonomically. There are separate sections for frogs and toads, and salamanders and newts. The location of each species is mapped separately. The ARMI Atlas is meant to be an educational tool for people wanting to learn or teach others about amphibians. It can also serve as a reference for habitat managers and researchers, identifying areas where more research is needed, as well as providing information about research that has previously been done.

180

Infection Most Likely Cause of Hospital Readmission After Surgery  

MedlinePLUS

... experienced during their first hospitalization. Readmissions, and especially surgical site infections, are a significant problem and cause a lot ... total number of patients affected is," Leape said. Surgical site infections occurred in about 5,500 patients in this ...

181

75 FR 19302 - Radiation Sources on Army Land  

Federal Register 2010, 2011, 2012, 2013, 2014

...rule, ``ionizing radiation source'' means any...would require a specific Nuclear Regulatory Commission (NRC) license or Army Radiation Authorization (ARA...proponent for the Army Radiation Safety Program is revising...regulation to reflect the Nuclear Regulatory...

2010-04-14

182

U.S. Army Medical Research Institute of Infectious Diseases  

MedlinePLUS

... you for your interest in the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID). The dedicated members ... site provides an introduction to the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) and contains official ...

183

U.S. Army High Energy Laser (HEL) technology program  

Microsoft Academic Search

The US Army is investing in Solid State Laser (SSL) technology to assess counter rocket, artillery, and mortar (C-RAM) and counter unmanned aerial vehicle (C-UAV) capabilities of solid state based HEL systems, as well as other potential applications for HELs of interest to the Army. The Army HEL program thrust areas are systematically moving the technology forward toward weaponization, including

Michael J. Lavan; John J. Wachs

2011-01-01

184

A Study of the Army's Advanced Civilian Schooling Programs.  

ERIC Educational Resources Information Center

The purpose of the study is to review the official and unofficial U.S. Army policy toward graduate level education at civilian institutions. Particular attention is paid to: (1) the Army's advanced civilian schooling programs; (2) whether the Army receives a reasonable return on its financial and manpower expenditures on these programs; (3) what…

King, Joseph S.

185

Assessing Black Enlisted Participation in the Army  

ERIC Educational Resources Information Center

Assesses black enlisted participation in the Army through a presentation of trend data showing the distribution of blacks across the enlisted rank structure, and the assignment of blacks by military occupational specialities. The unequal distribution of blacks across ranks decreases over time but remains not noticeable. Blacks are under…

Butler, John Sibley

1976-01-01

186

US Army Corps of EngineersR  

E-print Network

Resources i 2010 Annual Report Table of Contents Section Page BACKGROUND 1 IWR CENTERS 1 National Capital of Reclamation Partnership 23 Oak Ridge National Laboratories Partnership 23 Sandia National Laboratory 23US Army Corps of EngineersR ANNUAL REPORT ACTIVITIES OF THE INSTITUTE FOR WATER RESOURCES FISCAL

US Army Corps of Engineers

187

The Army's High Priority Physical Fitness Program.  

ERIC Educational Resources Information Center

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…

Drews, Fred R.

1984-01-01

188

Army Regulation 6701 Uniform and Insignia  

E-print Network

March 2014-- o Notifies Soldiers of which portions of the regulation are punitive and violations Executive Officer, Program Executive Office Soldier, and U.S. Army Natick Soldier Research, Development and females (para 3-2). o Updates tattoo and brand policy (para 3-3). o Updates jewelry policy to limit

US Army Corps of Engineers

189

Women Soldiers: On Joining the Army.  

ERIC Educational Resources Information Center

In this paper, differences in the backgrounds and attitudes of men and women enlisted in the Army are found to be significant. Women tend to be older, better educated, and less desperate to escape from the complexities and dilemmas of civilian life than male enlistees. (Author/WI)

Gottlieb, David

1978-01-01

190

HEADQUARTERS CHANGE 1 DEPARTMENT OF THE ARMY  

E-print Network

. The early days of the Korean war were nothing short of disastrous, as U.S. soldiers were routed by a poorly July 1950, U.S. troops, who were unprepared for the physical demands of war, were sent to battle equipped, but well-trained, North Korean People's Army. As American soldiers withdrew, they left behind

de Lijser, Peter

191

Engineer Pamphlet Department of the Army  

E-print Network

Compiled by K. Alan Snyder Office of History United States Army Corps of Engineers Fort Belvoir, Virginia of Engineers Archives, ATTN: CEHO-S-H, Kingman Building, Fort Belvoir, Virginia 22060-5577. Interested the Arthur Maass Papers, and Dr. Martin K. Gordon, who provided technical expertise and counsel during

US Army Corps of Engineers

192

Recommended lighting maintenance practices for Army installations  

Microsoft Academic Search

A well-maintained lighting system contributes to workforce efficiency and safety. This report recommends routine lighting maintenance practices (primarily relamping and fixture cleaning) for Army installations. The recommendations are derived from consideration of a comparative economic analysis, current maintenance practices in the military and nonmilitary sectors, and information obtained from industry trade and professional associations. Most common sources of interior and

Kedl

1987-01-01

193

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

194

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

195

Increasing Patient Safety and Surgical Team Communication by Using a Count\\/Time Out Board  

Microsoft Academic Search

Communication and collaboration in patient care settings is vital for promoting the best possible patient outcomes. The counting of sponges, sharps, and instruments, and the surgical time out before the start of any surgical procedure are opportunities for the surgical team to address patient safety risks. Personnel in the surgical services department at St Luke's Episcopal Hospital, Houston, Texas, implemented

Elizabeth Morell Edel

2010-01-01

196

Surgical Planning Laboratory  

NSDL National Science Digital Library

As a laboratory within the Brigham and Women's Hospital, the Surgical Planning Laboratory (SPL) does research and development in image processing algorithms, software systems, and medical applications. While visitors with an interest in these matters will appreciate the sections of this site that provide details on this work, visitors from the health sciences will also appreciate the educational materials offered in the "Resources" area even more. In the "Training and Tutorials" area, visitors can learn more about medical imaging through a self-paced tutorial. Moving on, the "Image Gallery" area contains over forty medical images that can be useful for those who are looking to learn about identifying various neurological conditions. Finally, the site also has a database of publications created by members of the research team at the SPL.

197

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

PubMed Central

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

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

198

32 CFR 655.10 - Use of radiation sources by non-Army entities on Army land (AR 385-11).  

Code of Federal Regulations, 2010 CFR

... 2010-07-01 true Use of radiation sources by non-Army entities on Army land (AR...CONTINUED) ENVIRONMENTAL QUALITY RADIATION SOURCES ON ARMY LAND § 655.10 Use of radiation sources by non-Army entities on Army land...

2010-07-01

199

Surgical Site Infections: Reanalysis of Risk Factors  

Microsoft Academic Search

Background. Surgical site infections (SSI) are the most common nosocomial infection in surgical patients, accounting for 38% of all such infections, and are a significant source of postoperative morbidity resulting in increased hospital length of stay and increased cost. During 1986–1996 the Center for Disease Control and Prevention's National Nosocomial Infections Surveillance system reported 15,523 SSI following 593,344 operations (2.6%).

Debra L. Malone; Thomas Genuit; J. Kathleen Tracy; Christopher Gannon; Lena M. Napolitano

2002-01-01

200

Automation impact study of Army Training Management  

SciTech Connect

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.

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

201

U.S. Army Corps of Engineers  

NSDL National Science Digital Library

The U.S. Army Corps of Engineers has a long and distinguished history which can be traced back to 1775 when the Continental Congress organized an army with a chief engineer and two assistants. Today the Corps has over 37,000 dedicated civilians and soldiers delivering services in more than 130 countries worldwide. The website provides a veritable cornucopia of these activities, divided into thematic sections that include Missions, Locations, Careers, and Library. On the homepage, visitors can make their way through the Most Requested area, which includes items like Hurricane Sandy, Civil Works Plan, and numerous others. In the Missions area, visitors can learn about everything from domestic civil works programs to operations in Afghanistan and Iraq. Persons looking for Corps projects in certain regions can use the interactive Locations map to do so. The site is rounded out by the Media area, which features fact sheets, videos, and other items. [KMG

202

Risk of surgical site infection in patients undergoing orthopedic surgery.  

PubMed

This study aimed to identify risk factors associated with surgical site infections in orthopedic surgical patients at a public hospital in Minas Gerais, Brazil, between 2005 and 2007. A historical cohort of 3,543 patients submitted to orthopedic surgical procedures. A descriptive analysis was conducted and surgical site infection incidence rates were estimated. To verify the association between infection and risk factors, the Chi-square Test was used. The strength of association of the event with the independent variables was estimated using Relative Risk, with a 95% confidence interval and p<0.05. The incidence of surgical site infection was 1.8%. Potential surgical wound contamination, clinical conditions, time and type of surgical procedure were statistically associated with infection. Identifying the association between surgical site infection and these risk factors is important and contributes to nurses' clinical practice. PMID:22249670

Ercole, Flávia Falci; Franco, Lúcia Maciel Castro; Macieira, Tamara Gonçalves Rezende; Wenceslau, Luísa Cristina Crespo; de Resende, Helena Isabel Nascimento; Chianca, Tânia Couto Machado

2011-01-01

203

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

PubMed

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

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

2008-12-01

204

Heritage of Army Audiology and the Road Ahead: The Army Hearing Program  

PubMed Central

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

Gates, Kathy; Ciliax, Donald

2008-01-01

205

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

206

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

207

Guidelines for surgical procedures after liver transplantation.  

PubMed Central

OBJECTIVE: The first purpose of this study is to identify the types and incidences of surgical procedures in patients who have previously undergone liver transplantation, with particular focus on the complication rates and the lengths of hospital stay. The second purpose is to present the management guidelines for patients with liver transplants at the preoperative, intraoperative, and postoperative stages of surgical procedure. SUMMARY BACKGROUND DATA: The surgical literature on this issue is scant, and with the growing liver transplant patient population it is not unlikey for any surgery specialist to have to operate on a patient who has undergone liver transplantation. METHODS: A sample of 409 patients with available hospital records, with a minimum of a 2-year follow-up, and with telephone access for interviews was chosen. Type of surgery, time from the liver transplant, hospital stay, immunosuppressive regimen, and complications were recorded. RESULTS: A large proportion of patients (24.2%) underwent some type of surgical procedure 2 to 10 years after liver transplantation. The authors demonstrate that most of the elective procedures can be safely carried out without an increased incidence of complication and without longer hospital stay than the general population. Conversely, emergent procedures are plagued by a greater incidence of complications that not only affect the function of the liver graft but may risk the life of the patient. PMID:9563551

Testa, G; Goldstein, R M; Toughanipour, A; Abbasoglu, O; Jeyarajah, R; Levy, M F; Husberg, B S; Gonwa, T A; Klintmalm, G B

1998-01-01

208

Surgical management of laryngotracheal stenosis in adults  

Microsoft Academic Search

The purpose was to evaluate the outcome following the surgical management of a consecutive series of 26 adult patients with laryngotracheal stenosis of varied etiologies in a tertiary care center. Of the 83 patients who underwent surgery for laryngotracheal stenosis in the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Lausanne, Switzerland, between 1995 and 2003, 26

Mercy George; Florian Lang; Philippe Pasche; Philippe Monnier

2005-01-01

209

Steam Sterilization of Cordless Surgical Instruments  

Microsoft Academic Search

This project was undertaken to evaluate the effectiveness of different sterilization procedures on a new line of cordless surgical drills and driver\\/reamers which have recently come onto the commercial market. The procedures include both conventional and flash steam sterilization protocols. The study demonstrated that the new line of cordless instruments can be easily and quickly sterilized by normal hospital sterilization

Dezso K. Merenyi; Lucy Brown; Neil S. Rothman; Robert Austin Milch; Edward M. Soffen

1981-01-01

210

Underestimation of surgical site infection rates in obstetrics and gynecology  

Microsoft Academic Search

Background: With the increasing volume of same-day operations and shortened hospital stays, it becomes more likely that a significant percentage of surgical site infections will occur after these patients' discharges.Methods: To document the true incidence of postdischarge surgical site infection, surveillance was undertaken in a group of obstetric and gynecologic patients. The study consisted of two parts. (1) A questionnaire

Denise Gravel-Tropper; Catherine Oxley; Ziad Memish; Gary E. Garber

1995-01-01

211

Risk Factors for Surgical Site Infection after Major Breast Operation  

Microsoft Academic Search

BACKGROUND: Understanding surgical site infection (SSI) risk factors after breast operation is essential to develop infection-prevention strategies and improve surgical outcomes. METHODS: Weperformedaretrospectivecase-controlstudywithsubjectsselectedfromacohortofmastectomy, breast reconstruction, and reduction surgical patients between January 1998 and June 2002 at a university-affiliated hospital. SSI cases within 1 year after operation were identified using ICD- 9-CM diagnosis codes for wound infection and complication or positive

Margaret A Olsen; Jill R Dietz; Keith E Brandt; Rebecca Aft; Ryan Matthews; Jennie Mayfield; Victoria J Fraser

212

[Sanitary reform in the British army: introducing knowledge about practical healthcare].  

PubMed

This paper focuses on the development of healthcare and health instruction in the British army in the late nineteenth to twentieth centuries. Knowledge of health, nutrition and cooking could be just as important for men as for women, even though men did not have so many opportunities to know about these things in civilian life. In fact, the greatest chance for men to learn about healthcare was in military service. Its necessity, especially regarding personal care, was acknowledged at the time of the Crimean war, although it took a long time to put improvements into practice. Cookery developed as an effective way to deliver practical knowledge about health to soldiers; indeed, cooking and healthcare instruction became a part ofArmy regulations and medical officers expected that the instruction given would translate into useful common sense for later life. Cookery education started as training for hospital cooks; later it extended to individual cooking for troops in the field. For many young men, therefore, joining the armed forces provided a unique opportunity to alter their unhealthy life style, not only for the sake of the Army but for their own benefit and that of society at large. PMID:19048810

Akiyama, Yuriko

2008-03-01

213

A Targeted E-Learning Program for Surgical Trainees to Enhance Patient Safety in Preventing Surgical Infection  

ERIC Educational Resources Information Center

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…

McHugh, Seamus Mark; Corrigan, Mark; Dimitrov, Borislav; Cowman, Seamus; Tierney, Sean; Humphreys, Hilary; Hill, Arnold

2010-01-01

214

Surgical Planning Laboratory Anatomy Browser  

NSDL National Science Digital Library

The Surgical Planning Laboratory (SPL) of the Department of Radiology at Brigham and Women's Hospital and Harvard Medical School has made a virtual treasure chest of visual anatomical information available at its web site. Highlights of the site include the Brain Atlas datasets: complex java applets that allow users to see parts of a schematic brain and heart. Users can rotate the images, and either click on parts of the images or on a listing of anatomical names and have those parts of the images labelled.

215

Department of the Army U.S. Army Corps of Engineers  

E-print Network

.................................................................... 11 From Homefront to Battlefront in the Korean War ................... 12 Solving Problems for MACV the United States Army Corps of Engineers' many contributions to the American na- tion in peace and war in Peace and War ................................................ 15 Dust Control in Vietnam

US Army Corps of Engineers

216

Officials of the Army Ballistic Missile Agency  

NASA Technical Reports Server (NTRS)

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.

1956-01-01

217

Surgical training in Guyana: the next generation  

PubMed Central

Summary 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

Cameron, Brian H.; Martin, Carlos; Rambaran, Madan

2015-01-01

218

Utilization of Facilities of a University Hospital  

PubMed Central

The lengths of hospital stay among adult inpatients discharged during 1962 from the medical and surgical specialty departments of a large urban university-affiliated general hospital have been examined. Data are shown comparing the durations of hospitalization of patients who had a private physician directly responsible for their hospital care (private patients) and of those who did not (staff patients). The relation between the lengths of stay of private patients and those of staff patients varied considerably from one hospital department to another. On the medical services, staff patients had longer hospital stays than did private patients, a discrepancy that could not be accounted for by differences between the two groups in age, race, sex, or source of payment for hospitalization and it is being studied further. A major cause of the apparent difference in lengths of hospitalization between private and staff surgical patients proved to be inconsistencies in the criteria used to define the terms “hospital admission” and “inpatient” among various patient groups. Some of the possible effects of variations in the definition of these terms and of the terms “medical patients” and “surgical patients” in hospital-use studies are discussed. Images Fig. 1 PMID:5915337

McCorkle, Lois P.

1966-01-01

219

Regional programs for surgical bone banking.  

PubMed

The findings of a survey of 12 regional programs engaged in collection, storage, and distribution of surgical bone grafts are described in this report. In approximately one year, 1944 grafts (mostly femoral heads) were collected. The overall discard rate for the grafts was 30%. An unacceptable medical history, and laboratory evidence of positive screening tests for hepatitis B surface antigen and human immunodeficiency virus (HIV) antibodies accounted for 34.0%, 3.4%, and 1.2% of the discard rate, respectively. Eighty-seven percent of the grafts were used for three surgical procedures, i.e., revision hip surgery, spinal fusions, and treatment of nonunited fractures. The practices and experiences of the regional program described in this report of surgical bone collection and transplantation appear to be similar to those previously described for the community-hospital-based institutional programs. Regional programs represent an alternative approach to institutional programs in surgical bone banking. PMID:2295187

Kakaiya, R M; Jackson, B

1990-02-01

220

32 CFR Appendix G to Part 623 - Continental US Army Boundaries  

Code of Federal Regulations, 2010 CFR

...2010-07-01 true Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense...AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623—Continental US Army...

2010-07-01

221

78 FR 21919 - Finding of No Significant Impact and Final Programmatic Environmental Assessment for Army 2020...  

Federal Register 2010, 2011, 2012, 2013, 2014

...Environmental Assessment for Army 2020 Force Structure Realignment AGENCY: Department of the...FNSI) for implementation of force structure realignment to reduce the Army active...Environmental Assessment for Army 2020 Force Structure Realignment (PEA), supporting...

2013-04-12

222

Commentary on "The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)": Army STARRS: a Framingham-like study of psychological health risk factors in soldiers.  

PubMed

Although historically the Army suicide rate has been significantly lower than the civilian rate, in 2004, the suicide and accidental death rates began trending upward. By 2008, the Army suicide rate had risen above the national average (20.2 per 100,000). In 2009, 160 active duty Soldiers took their lives, making suicide the third leading cause of death among the Army population. If accidental death, frequently the result of high-risk behavior, is included, then more Soldiers died by their own actions than in combat in 2009. The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) was thus created in 2009 to begin to address these problems. The Army STARRS project is a large consortium of seven different studies to develop data-driven methods for mitigating or preventing suicide behaviors and improving the overall mental health and behavioral functioning of Army Soldiers during and after their Army service. The first research articles from the Army STARRS project were published in late 2013 and early 2014. This work has already begun to outline important facets of risk in the military, and it is helping to drive an empirically derived approach to improvements in understanding mental disorders and risk behavior and to improve prevention and support of mental health and resilience. The Framingham Heart Study, started in the 1940s, marked a watershed event in utilizing large cross-sectional and prospective longitudinal collaborative research to identify and understand risk factors for cardiovascular disease. The Army STARRS project, through its collaborative, prospective, and robust innovative design and implementation, may provide the beginning of a similar scientific cohort in mental disorders. The work of this project will help understand biological and psychological aspects of military service, including those leading to suicide. When coupled with timely feedback to Army leadership, it permits near real-time steps to diagnose, mitigate, and manage emerging mental health issues and the root causes of risk and resilience in Army Soldiers, with potential impact extending across many traumatized populations-not unlike a parallel process that has markedly improved survival and recovery from physical combat wounds. PMID:24865196

Ressler, Kerry J; Schoomaker, Eric B

2014-01-01

223

A study in transfer learning: leveraging data from multiple hospitals to enhance hospital-specific  

E-print Network

approach jointly incorporated data from all hospitals while seeking a solution in the target space. Results on data accessed from large national registries (eg, the American College of Surgeons National Surgical

Horvitz, Eric

224

Surgical Site Infections in Breast Surgery: Case-control Study  

Microsoft Academic Search

The purpose of this study was to estimate the frequency of surgical site infections (SSIs) and identify associated risk factors for each type of breast surgery at a cancer hospital. We used a nested case-control design. Between February 1, 2000 and July 31, 2000, all breast surgeries performed were recorded on a daily basis. After hospital discharge, we evaluated patients

Diana Vilar-Compte; Benedicte Jacquemin; Carlos Robles-Vidal; Patricia Volkow

2004-01-01

225

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

226

Muscle strength as a predictor of loss of functional status in hospitalized patients  

Microsoft Academic Search

OBJECTIVE: The incidence of protein-calorie malnutrition in hospitalized adult patients can reach 30% to 50% and adversely affect clinical outcome. We evaluated the efficacy of muscle strength to predict functional derangement and detect early changes in nutrition status in hospitalized patients.METHODS: Patients hospitalized at medical and surgical wards from two different hospitals in Santiago, Chile, were studied during their hospital

Jennifer Humphreys; Pia de la Maza; Sandra Hirsch; Gladys Barrera; Vivien Gattas; Daniel Bunout

2002-01-01

227

ERDCTR-14-2 Army Net Zero Program  

E-print Network

ERDCTR-14-2 Army Net Zero Program Composting Assessment for Organic Solid Waste at Fort Polk/client/default. #12;Army Net Zero Program ERDC TR-14-2 April 2014 Composting Assessment for Organic Solid Waste for other technical reports published by ERDC, visit the ERDC online library at http://acwc.sdp.sirsi.net

US Army Corps of Engineers

228

The Irish republican army: An assessment of sectarianism  

Microsoft Academic Search

Although the Irish Republican Army (IRA) has been active for more than 25 years, interpretations of the motivation of the IRA are varied. For some, it is a sectarian organization engaged in a tit?for?tat campaign with Protestant paramilitaries in Northern Ireland. For others, it is a guerrilla army waging a military campaign against the British presence in Northern Ireland. This

Robert W. White

1997-01-01

229

FM 6-22 (FM 22-100) Army Leadership  

E-print Network

FM 6-22 (FM 22-100) Army Leadership Competent, Confident, and Agile OCTOBER 2006 DISTRIBUTION and complex security environment we face. FM 6-22 is the Army's keystone field manual on leadership. It establishes leadership doctrine and fundamental principles for all officers, noncommissioned officers

US Army Corps of Engineers

230

Discourses of Gender in the Contemporary British Army  

Microsoft Academic Search

This article is about the discourses of gender which circulate within debates about the inclusion of women in the British Army. Drawing on material from elite policy debates within the British Ministry of Defence, Army, and Parliament, the article uses a methodology informed by theories of discourse analysis to examine how the figures of the male and female soldier are

Rachel Woodward; Patricia Winter

2004-01-01

231

Space Support Elements: Embedded Space Expertise in Army Modular Forces  

Microsoft Academic Search

The Army's Future Force, serving as part of the Joint Force, will be adaptable and lethal, leveraging the extraordinary capabilities of space. Army Modular Forces will routinely exploit the overhead constellations of national, commercial and military space and near-space platforms. They will rely on knowledge-based networks that are vertically and horizontally integrated from strategic to tactical levels. Warfighters will have

2005-01-01

232

New Tools and Metrics for Evaluating Army Distributed Learning. Monograph  

ERIC Educational Resources Information Center

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.…

Straus, Susan G.; Shanley, Michael G.; Yeung, Douglas; Rothenberg, Jeff; Steiner, Elizabeth D.; Leuschner, Kristin J.

2011-01-01

233

Showdown: An interactive exercise bike for the army  

Microsoft Academic Search

In this paper we describe the design and implementation of Showdown, which is a game-like application for army soldiers. The application uses an exercise bike for the interaction with the user. The goal of the application is to create an activity which allows soldiers to train themselves physically and mentally. It was designed to fit into the army environment in

Amine Rhor; Naveen Sethi; Steven Fokkinga

234

U.S. Army Corps of Engineers Chief Counsel's  

E-print Network

of over 24 million acres of property and providing real estate services for the Army, Air Force, building and operating water resources and other civil works projects including navigation, flood control. Non-federal sponsors share in the cost of civil works projects. #12;The U.S. Army Corps of Engineers

US Army Corps of Engineers

235

Quality of ROTC Accessions to the Army Officer Corps.  

ERIC Educational Resources Information Center

Comparisons are made of the groups of Army officers that were procured through various programs and of various categories within the Army Reserve Officers' Training Program (ROTC). The criterion for these comparisons was the final course grades in the Officer Basic Courses (OBC) of the 13 career branches. Two samples were studied; one sample…

Gilbert, Arthur C. F.; And Others

236

THE U.S. ARMY CORPS OF ENGINEERS  

E-print Network

of this disaster, the Army Corps of Engineers joined the team headed by the United States Coast Guard to mount that must be considered and overcome when confronting a disaster of this magnitude. The Exxon Valdez.S. forces during the Gulf War and a history of the Army's role in the reconstruction of Kuwait. l

US Army Corps of Engineers

237

Explaining Recent Army and Navy Minority Recruiting Trends. Research Brief  

ERIC Educational Resources Information Center

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…

Steinberg, Paul

2009-01-01

238

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.

239

Organizational Determinants of Work Outcomes and Quality Care Ratings Among Army Medical Department Registered Nurses  

PubMed Central

The Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and several single-item measures were administered to registered nurses (RNs) working within 23 U.S.-based Army Medical Department (AMEDD) hospitals. Data were analyzed with logistic regression for nested data. Unfavorable nursing practice environments had a substantial association with job dissatisfaction (OR 13.75, p < .01), emotional exhaustion (OR 12.70, p < .01), intent to leave (OR 3.03, p < .01), and fair to poor quality of care (OR 10.66, p < .01). This study provides the first system-wide analyses of nursing practice environments in AMEDD hospitals in the U.S. Similar to findings in civilian samples, poor quality work environments are associated with less favorable RN work outcomes and quality of care ratings. PMID:20151409

Patrician, Patricia A.; Shang, Jingjing; Lake, Eileen T.

2010-01-01

240

Timing of vancomycin prophylaxis for cardiac surgery patients and the risk of surgical site infections  

Microsoft Academic Search

Background: Increased incidence of methicillin-resistant Staphylococcus species has required some hospitals to choose vancomycin for surgical prophylaxis. Guidelines for appropriate timing of vanco- mycin prophylaxis state that the infusion should begin within 120 min before the first surgical incision. However, no studies have investigated the proper timing of vancomycin prophylaxis in relationship to surgical site infections (SSI). The objective of

Kevin W. Garey; Thanh Dao; Hua Chen; Paresh Amrutkar; Nandan Kumar; Margaret Reiter; Layne O. Gentry

2006-01-01

241

Lower Mortality in Magnet Hospitals  

PubMed Central

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

McHugh, Matthew D.; Kelly, Lesly A.; Smith, Herbert L.; Wu, Evan S.; Vanak, Jill M.; Aiken, Linda H.

2014-01-01

242

Lower Mortality in Magnet Hospitals  

PubMed Central

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 to 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 vs. 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 (OR 0.86, 95% CI 0.76-0.98, p=0.02) and 12% lower odds of failure-to-rescue (OR 0.88, 95% CI 0.77-1.01, p=0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions Magnet hospitals have lower mortality than is fully accounted for by measured characteristics of nursing. Magnet recognition likely both identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes. PMID:23047129

McHugh, Matthew D.; Kelly, Lesly A.; Smith, Herbert L.; Wu, Evan S.; Vanak, Jill M.; Aiken, Linda H.

2012-01-01

243

[Military hospital in Komsomolsk-on-Amur celebrates 80th anniversary].  

PubMed

In March of 1934 the Revolutionary Military Council of the Special Far Eastern Red Army decided to deploy a military hospital in the city of Komsomolsk-on-Amur which has been under construction. In June of 1934 there was a connection with the local hospital of Dalpromstroy, located in the barracks, with a total of 60 beds. This hospital began to serve all city construction workers and solders without any exception. June 11, 1934 is considered the day of the hospital foundation. The article presents a brief outline of the hospital's history from 2010 to the present time--Branch number 2 301st District of Military clinical Hospital. PMID:25286579

Nagut, N N; Zakharchuk, L F

2014-06-01

244

Home laundering of soiled surgical scrubs: Surgical site infections and the home environment  

Microsoft Academic Search

An increasing number of hospitals have implemented programs that permit their operating room (OR) personnel to launder their soiled “scrubs” at home. Not only have they not experienced an increase in the incidence of surgical site infections (SSIs), but they have also found the policy to be financially rewarding. Whereas the Association of periOperative Registered Nurses (AORN) opposes the practice,

Nathan L. Belkin

2001-01-01

245

Update on Glycopeptide Use in German University Hospitals  

Microsoft Academic Search

Background: A previous study has shown considerable variation in glycopeptide use from 1992 through 1994 among four university hospitals in southern Germany. Active antimicrobial management in one of the hospitals was associated with the containment of glycopeptide consumption in the medical and surgical service at Materials and Methods: Hospital pharmacy records from 1998 through 2000 were evaluated. The number of

W. V. Kern; C. Gonnermann; E. Strehl

2004-01-01

246

Reengineering the Army Officer Personnel Management System for the 21st century  

Microsoft Academic Search

In 1996, the US Army Chief of Staff, General D. Reimer created a task force to reengineer the Army Officer Personnel Management System (OPMS) for the 21st century integrated with the army leader development system. His guidance included the requirement to examine alternate career paths in both the operational and institutional army and to define “success” for the officer corps

D. H. Ohle; H. F. T. Hoffman; G. C. Gardner; R. Hernandez; M. L. McGinnis

1998-01-01

247

Development of aeronautical engines by the Army and Navy  

NASA Technical Reports Server (NTRS)

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.

1921-01-01

248

DEPARTMENT OF THE ARMY OFFICE OF THE ASSISTANT SECRETARY  

E-print Network

COMMAND U.S. FORCES KOREA U.S. SOUTHERN COMMAND U.S. AFRICA COMMAND JOINT SPECIAL OPERATIONS COMMAND U/SOUTHERN EUROPEAN TASK FORCE U.S. ARMY SPECIAL OPERATIONS COMMAND MILITARY SURFACE DEPLOYMENT AND DISTRIBUTION

US Army Corps of Engineers

249

78 FR 73852 - Army Science Board Winter Plenary Meeting  

Federal Register 2010, 2011, 2012, 2013, 2014

...DoD. ACTION: Notice of open meeting...study titled, ``Creating an Innovation Culture in the Army'' in an open session and begin work on the...Fiscal Year 2013 ``Creating an Innovation Culture'' Study. The...

2013-12-09

250

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

Federal Register 2010, 2011, 2012, 2013, 2014

...large marble sarcophagus, the adjacent marble slabs, and the potential replacement marble stone for the sarcophagus already gifted to the Army. [ssquf] ``Explore'' Subcommittee: Recommendations Section 60 Mementos study and improving the quality...

2012-02-17

251

78 FR 69077 - Army Education Advisory Subcommittee Meeting Notice  

Federal Register 2010, 2011, 2012, 2013, 2014

...for the members of the public to present their issues for review and discussion. FOR FURTHER INFORMATION CONTACT: For information, please contact Dr. Robert Savukinas, at robert.savukinas@us.army.mil. Written submissions are to...

2013-11-18

252

78 FR 33074 - Army Science Board Summer Study Session  

Federal Register 2010, 2011, 2012, 2013, 2014

...predictive analysis and the related potential human and ethical dimensions. Planning for Climate Change study 2013--This study considers the most likely climate change scenarios and assesses how the changes might change the way the Army fights,...

2013-06-03

253

Flagging vigilance: the post-Vietnam "Hollow Army"  

E-print Network

to recruit or retain sufficient manpower. The problem was exacerbated by the army's need to ensure that the forward- deployed units in Europe, Korea, and Panama were sufficiently manned to meet the United States' Cold War conunitments, Those units were... to the poor quality of life it afforded its soldiers. The chapter will examine several aspects of the typical soldier's life including housing conditions, pay, and benefits and argue that the army's problems in these areas drove many soldiers out...

Lee, Robert Matthew

2001-01-01

254

US Army remotely piloted vehicle supporting technology program  

NASA Technical Reports Server (NTRS)

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.

Gossett, T. D.

1981-01-01

255

U.S. Army Corps of Engineers Publications  

NSDL National Science Digital Library

From the United States Army Corps of Engineers comes this index of engineering documents that includes technical manuals, engineering instructions, public works, and technical bulletins, among other resources. This valuable index unites collections from a number of different Army Corps of Engineers offices and divisions. Many of the documents come as full-text searchable PDF files and include graphs and charts. This is a good resource for teachers and students of civil engineering and includes a wealth of resources.

256

Specialty and Full-Service Hospitals: A Comparative Cost Analysis  

PubMed Central

Objective To compare the costs of physician-owned cardiac, orthopedic, and surgical single specialty hospitals with those of full-service hospital competitors. Data Sources The primary data sources are the Medicare Cost Reports for 1998–2004 and hospital inpatient discharge data for three of the states where single specialty hospitals are most prevalent, Texas, California, and Arizona. The latter were obtained from the Texas Department of State Health Services, the California Office of Statewide Health Planning and Development, and the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. Additional data comes from the American Hospital Association Annual Survey Database. Study Design We identified all physician-owned cardiac, orthopedic, and surgical specialty hospitals in these three states as well as all full-service acute care hospitals serving the same market areas, defined using Dartmouth Hospital Referral Regions. We estimated a hospital cost function using stochastic frontier regression analysis, and generated hospital specific inefficiency measures. Application of t-tests of significance compared the inefficiency measures of specialty hospitals with those of full-service hospitals to make general comparisons between these classes of hospitals. Principal Findings Results do not provide evidence that specialty hospitals are more efficient than the full-service hospitals with whom they compete. In particular, orthopedic and surgical specialty hospitals appear to have significantly higher levels of cost inefficiency. Cardiac hospitals, however, do not appear to be different from competitors in this respect. Conclusions Policymakers should not embrace the assumption that physician-owned specialty hospitals produce patient care more efficiently than their full-service hospital competitors. PMID:18662170

Carey, Kathleen; Burgess, James F; Young, Gary J

2008-01-01

257

Relation of Surgical Volume to Outcome in Eight Common Operations  

PubMed Central

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

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

258

Medicare Payment: Surgical Dressings and Topical Wound Care Products  

PubMed Central

Medicare patients' access to surgical dressings and topical wound care products is greatly influenced by the Medicare payment system that exists in each site of care. Qualified healthcare professionals should consider these payment systems, as well as the medical necessity for surgical dressings and topical wound care products. Scientists and manufacturers should also consider these payment systems, in addition to the Food and Drug Administration requirements for clearance or approval, when they are developing new surgical dressings and topical wound care products. Due to the importance of the Medicare payment systems, this article reviews the Medicare payment systems in acute care hospitals, long-term acute care hospitals, skilled nursing facilities, home health agencies, durable medical equipment suppliers, hospital-based outpatient wound care departments, and qualified healthcare professional offices. PMID:25126477

Schaum, Kathleen D.

2014-01-01

259

Medicare Payment: Surgical Dressings and Topical Wound Care Products.  

PubMed

Medicare patients' access to surgical dressings and topical wound care products is greatly influenced by the Medicare payment system that exists in each site of care. Qualified healthcare professionals should consider these payment systems, as well as the medical necessity for surgical dressings and topical wound care products. Scientists and manufacturers should also consider these payment systems, in addition to the Food and Drug Administration requirements for clearance or approval, when they are developing new surgical dressings and topical wound care products. Due to the importance of the Medicare payment systems, this article reviews the Medicare payment systems in acute care hospitals, long-term acute care hospitals, skilled nursing facilities, home health agencies, durable medical equipment suppliers, hospital-based outpatient wound care departments, and qualified healthcare professional offices. PMID:25126477

Schaum, Kathleen D

2014-08-01

260

The 'New Model' Armies of Africa?: The British Military Advisory and Training Team and the Creation of the Zimbabwe National Army  

E-print Network

) deployed to Zimbabwe. By February of 1981, elements of the newly created army mutinied against the government and were defeated at the Battle of Bulawayo by what had formerly been the Rhodesian Army’s 1st Battalion, Rhodesian African Rifles.1 Only a... homeland of Matabeland in 1 Luise White, “‘Whoever Saw a Country with Four Armies?’: The Battle of Bulawayo Revisited,” Journal of Southern African Studies 33 (September 2007), 619-631. 2 January...

Whitaker, Blake

2014-03-05

261

Hospital fundamentals.  

PubMed

Under the current system, orthopaedic trauma surgeons must work in some form of hospital setting as our primary service involves treatment of the trauma patient. We must not forget that just as a trauma center cannot exist without our services, we cannot function without their support. As a result, a clear understanding of the balance between physicians and hospitals is paramount. Historical perspective enables physicians and hospital personnel alike to understand the evolution of hospital-physician relationship. This process should be understood upon completion of this chapter. The relationship between physicians and hospitals is becoming increasingly complex and multiple forms of integration exist such as joint ventures, gain sharing, and co-management agreements. For the surgeon to negotiate well, an understanding of hospital governance and the role of the orthopaedic traumatologist is vital to success. An understanding of the value provided by the traumatologist includes all aspects of care including efficiency, availability, cost effectiveness, and research activities. To create effective and sustainable healthcare institutions, physicians and hospitals must be aligned over a sustained period of time. Unfortunately, external forces have eroded the historical basis for the working relationship between physicians and hospitals. Increased competition and reimbursement cuts, coupled with the increasing demands for quality, efficiency, and coordination and the payment changes outlined in healthcare reform, have left many organizations wondering how to best rebuild the relationship. The principal goal for the physician when partnering with a hospital or healthcare entity is to establish a sustainable model of service line management that protects or advances the physician's ability to make impactful improvements in quality of patient care, decreases in healthcare costs, and improvements in process efficiency through evidence-based practices and protocols. PMID:24918827

Althausen, Peter L; Hill, Austin D; Mead, Lisa

2014-07-01

262

CULTIVATING NETWORKS: IMPLEMENTING SURGICAL  

E-print Network

i CULTIVATING NETWORKS: IMPLEMENTING SURGICAL TELEMEDICINE Margunn Aanestad THE INTERVENTIONAL OF MATHEMATICS AND NATURAL SCIENCES, UNIVERSITY OF OSLO #12;ii CULTIVATING NETWORKS: IMPLEMENTING SURGICAL single site use: the challenges of growing networks 38 6.2.2 Micro- and macro-level design in use 39 6

Sahay, Sundeep

263

Surgical Technology Program Guide.  

ERIC Educational Resources Information Center

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…

Georgia Univ., Athens. Dept. of Vocational Education.

264

Update on the epidemiology and prevention of surgical site infections  

Microsoft Academic Search

Surgical site infections contribute significantly to the morbidity and mortality of the individual patient and impose a burden\\u000a on the health care resources of the community. With the shift toward streamlined hospitalizations and ambulatory surgery,\\u000a a majority of surgical site infections are being diagnosed after discharge. There are several tools available for identifying\\u000a and risk stratifying patients that include the

Tae Chong; Robert Sawyer

2002-01-01

265

Aggressive Management of Surgical Emergencies  

PubMed Central

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

Bengmark, Stig

2006-01-01

266

Elec 331 -Surgical Instruments Surgical Instruments  

E-print Network

Alloys - Substitutional Atoms · Same size as Fe · Positions normally occupied by Fe. #12;Elec 331 - Surgical Instruments 3 Alloys - Interstitial Atoms · Smaller than Fe · Occupy gaps · Greater solubility in Austenite (larger gaps) · Precipitate out during cooling Iron Alloy Atoms Substitutional Atoms · Chromium

Pulfrey, David L.

267

Renkioi: a forgotten Crimean War hospital and its significance.  

PubMed

Renkioi Civil Hospital was built late in the Crimean War (1854-6) in Turkey on the Dardanelles. Designed by Isambard Kingdom Brunel, its prefabricated structure was a brilliant engineering innovation. As a civil hospital for military patients, it was staffed by experienced civilian doctors, thereby relieving the shortage of military doctors. Renkioi is remembered as an astonishing early prefabricated structure. However the war was soon to end and it was never used to near capacity. Thus, its other successful features are largely forgotten. It demonstrated the advantages of a doctors, rather than a military officer, being in complete command of a hospital and this was later accepted by the army. Renkioi also showed how infection could be reduced by able staff in a well administered, properly designed hospital with good sanitation. After the war, Dr. Edmund Parkes, its Medical Superintendent, became the first Professor of Hygiene at the new Army Medical School, ensuring that "the prevention of disease and the promotion of health" became the first function of the Army Medical Services. PMID:15822250

Silver, C P

2004-12-01

268

A targeted e-learning program for surgical trainees to enhance patient safety in preventing surgical infection  

Microsoft Academic Search

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.\\u000aMETHODS: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An educational Web site was developed targeting deficiencies highlighted in the

Seamus M McHugh; Mark Corrigan; Borislav D Dimitrov; Seamus Cowman; Sean Tierney; Hilary Humphreys; Arnold DK Hill

2010-01-01

269

Characterization of aerosols produced by surgical procedures  

SciTech Connect

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.

Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K. [Inhalation Toxicology Research Institute, Albuquerque, NM (United States); Turner, R.S. [Lovelace Health Systems, Albuquerque, NM (United States)

1994-07-01

270

Toward fluorescence detection of protein residues on surgical instruments  

NASA Astrophysics Data System (ADS)

Prion proteins are the infectious agents that cause Creutzfeldt-Jakob Disease (CJD) in humans. These proteins are particularly resistant to normal sterilization procedures, and the theoretical risk of prion transmission via surgical instruments is of current public and professional concern. We are currently investigating fluorescence methods for the detection of proteins on surfaces, with a view to developing an optical-fiber-based system for routine, online monitoring of residual protein contamination on surgical instruments, in hospital sterilization departments. This paper presents preliminary results on the detection of femtomole amounts of fluorescently labelled protein on surgical steel and discusses some of the problems involved in the detection of fluorescence from metal samples.

Richardson, Patricia R.; Jones, Anita C.; Baxter, Robert L.; Baxter, Helen C.; Whittaker, A. Gavin; Campbell, Gaynor A.

2004-06-01

271

Urogynecologic Surgical Mesh Implants  

MedlinePLUS

... Repair UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse: FDA ... Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse (July 2011) (PDF - 243KB) ...

272

Incontinence Treatment: Surgical Treatments  

MedlinePLUS

... Stories Who We Are Contact Us Donate Incontinence Treatment: Surgical Treatments Jump to Topic Lifestyle changes Dietary changes Medication ... July 8, 2014 at 09:36:27 AM Treatment Lifestyle Changes Dietary Tips Medication Bowel Management Biofeedback ...

273

Surgical site infection surveillance after open gastrectomy and risk factors for surgical site infection  

Microsoft Academic Search

Surgical site infection (SSI) surveillance was examined in gastric cancer patients who had undergone an open gastrectomy between\\u000a 1997 and 2003 at Keio University Hospital in Tokyo, Japan. National Nosocomial Infections Surveillance (NNIS) reports and\\u000a several studies have discussed SSI risk factors, but only open gastrectomy was analyzed by regression analysis. The purpose\\u000a of this study was to examine these

Eiko Imai; Masakazu Ueda; Kent Kanao; Koichi Miyaki; Tetsuro Kubota; Masaki Kitajima

2005-01-01

274

Conceptual Design for the Amphibian Research and Monitoring Initiative (ARMI)  

NASA Astrophysics Data System (ADS)

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.

Battaglin, W. A.; Langtimm, C. A.; Adams, M. J.; Gallant, A. L.; James, D. L.

2001-12-01

275

Surgical Tools Recognition and Pupil Segmentation for Cataract Surgical Process  

E-print Network

generation of Computer-Assisted- Surgical (CAS) systems based on information from the Operating Room (OR) has of cataract surgery videos, to detect eight surgical phases. Keywords. Computer vision, video analysis, BagSurgical Tools Recognition and Pupil Segmentation for Cataract Surgical Process Modeling David

Boyer, Edmond

276

Army ground robotics technology development and experimentation program  

NASA Astrophysics Data System (ADS)

In the past year, the U.S. Army has committed to a paradigm shift in the way future ground military operations will be conducted. Increased emphasis upon the deployability of future forces has focused efforts towards reducing the weight, volume, and logistics requirements for proposed tactical systems. Extensive use of unmanned systems offer a potential means to achieve these goals, without reducing the lethality or survivability of this future ground combat force. To support this vision, the U.S. Army has embarked upon a concerted effort to develop required technology and demonstrate its maturity with the goal of incorporating this technology into the Future Combat Systems and the Objective Force.

Bornstein, Jonathan A.; Brendle, Bruce E., Jr.; Shoemaker, Chuck M.

2001-09-01

277

Dr. von Braun and Army Ballistics Missile Agency (ABMA) Group  

NASA Technical Reports Server (NTRS)

This photograph of Dr. von Braun, shown here to the left of General Bruce Medaris, was taken in the fall of 1959, immediately prior to Medaris' retirement from the Army. At the time, von Braun and his associates worked for the Army Ballistics Missile Agency in Huntsville, Alabama. Those in the photograph have been identified as Ernst Stuhlinger, Frederick von Saurma, Fritz Mueller, Hermarn Weidner, E.W. Neubert (partially hidden), W.A. Mrazek, Karl Heimburg, Arthur Rudolph, Otto Hoberg, von Braun, Oswald Lange, Medaris, Helmut Hoelzer, Hans Maus, E.D. Geissler, Hans Heuter, and George Constan.

1959-01-01

278

Holmium:YAG surgical lasers.  

PubMed

"Holmium:YAG (Ho:YAG)" is the shorthand name for a family of solid-state lasers that use the doping element holmium in a laser crystal (e.g., YAG [yttrium-aluminum-garnet]) and that emit energy at approximately 2.1 microns. This wavelength is relatively new to medicine and has been used in laser surgery for only about the last six years. Like the carbon dioxide (CO2) laser when it was first used clinically, the Ho:YAG laser is poised for rapid and wide-spread use. Ho:YAG lasers, like CO2 lasers, offer precise cutting with minimal damage to adjacent tissue; however, unlike CO2 lasers, they also offer fiberoptic delivery (which is ideal for endoscopic use) and the ability to treat tissue in a liquid-filled environment (e.g., saline, blood). The initial specialty for which the Ho:YAG laser was used was arthroscopic surgery, especially diskectomy. Today, it is effectively used in many surgical specialties, including general surgery, urology, laparoscopy, neurosurgery, lithotripsy, angioplasty, orthopedic surgery (which includes procedures such as meniscectomy, bone sculpting [may also be performed in plastic surgery], and some experimental surgery, such as cartilage shrinking to tighten loose joints), and dentistry. Because of its broad range of potential applications, it has been called the "Swiss Army Knife" of lasers. High-powered Ho:YAG lasers, which enable surgeons to work more quickly and cut more smoothly, have been made available only within the last three years (units offering > 20 W) to 18 months (units offering > 60 W). Because of this rapid increase, high-powered units are still relatively expensive, and it is not yet clear whether maximum power outputs will continue to increase or whether the cost of higher-power units will begin to come down. Although low-power and high-power Ho:YAG lasers can be used for the same procedures, their different ranges of possible clinical techniques make them better suited to different applications: low-power units are preferable for small-joint and some head-and-neck surgeries or for office use, and high-power units are more suitable for use in major surgery, such as gastrointestinal surgery or surgery in large joints. This evaluation includes two units at both ends of the Ho:YAG power spectrum--one 10 W and one 60 W--and thus provides a guide to evaluating other Ho:YAG lasers that are currently available or that will be entering the market.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7782226

1995-03-01

279

DEPARTMENT OF THE ARMY OFFICE OF TtiE ASSISTANT SECRETARY  

E-print Network

or Defense provided that Civilian employees, unless exempted from the furlough or governed by special rules SURFACE DEPLOYMENT AND DISTRIBUTION COMMAND U.S. ARMY SPACE AND MISSILE DEFENSE COMMAND/ARMY FORCES

US Army Corps of Engineers

280

The potential of America's Army, the video game as civilian-military public sphere  

E-print Network

The US Army developed multiplayer online First Person Shooter video game, America's Army, was examined as the first instance of an entirely state-produced and directed enterprise leveraging video game popular culture. ...

Li, Zhan, 1979-

2004-01-01

281

Integrating the Army Geospatial Enterprise : synchronizing geospatial-intelligence to the dismounted soldier  

E-print Network

The Army's Geospatial Enterprise (AGE) has an emerging identity and value proposition arising from the need to synchronize geospatial information activities across the Army in order to deliver value to military decision ...

Richards, James E., S.M. Massachusetts Institute of Technology

2010-01-01

282

32 CFR 516.43 - Release of Army and other agency records.  

Code of Federal Regulations, 2010 CFR

... true Release of Army and other agency records. 516.43 Section 516.43 National Defense Department of Defense (Continued... Release of Records in Connection with Litigation § 516.43 Release of Army and other agency records....

2010-07-01

283

32 CFR 516.14 - Service of process on DA or Secretary of Army.  

Code of Federal Regulations, 2010 CFR

... National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS LITIGATION Service of Process § 516.14 Service of process on DA or Secretary of Army. The Chief,...

2010-07-01

284

Fluid resuscitation strategies in the Israeli army.  

PubMed

Medical training in the Israel Defense Forces (IDF) is currently based on the principles of the Advanced Trauma Life Support course of the American College of Surgeons termed Military Trauma Life Support. The Advanced Trauma Life Support guidelines provide a systematic standardized approach to the treatment of trauma casualties that has been very successful in civilian trauma. On the battlefield, however, these guidelines have been modified according to the combat environment. The factors that influence these changes are tactical considerations, availability and level of training of medical personal, direct enemy fire, medical equipment limitations, means of transportation of casualties, and the variable transportation time from the front line to the first medical echelon. The basic strategy of the IDF is to bring the military physician or paramedic and airlifted surgical units as close as possible to the front line, to minimize evacuation time. Also, evacuation helicopters that land in the combat zone close to the front line, sometimes under direct fire, usually have a military physician on board. The dilemma of "scoop and run" or "stay and stabilize" in hemorrhagic shock has been solved in the IDF toward early rapid evacuation of casualties to a surgical unit. Immediately after airway and breathing have been secured, if evacuation time is less than 1 hour, the intravenous line and fluid resuscitation is started en route to the medical facility. When evacuation time is longer than 1 hour, an intravenous line is always started before evacuation. In controlled hemorrhagic shock, where the source of bleeding has been controlled and evacuation time is less than 1 hour, fluid resuscitation with lactated Ringer's solution or normal saline is started, to achieve normalization of hemodynamic parameters. When evacuation time exceeds 60 minutes, colloids such as Hemaccel or hydroxyethyl starch are added. In uncontrolled hemorrhagic shock, where internal bleeding has temporarily stopped because of hypotension, vasoconstriction, and thrombus formation, aggressive fluid resuscitation with lactated Ringer's solution to achieve normal hemodynamic parameters is prohibited, because it may induce internal rebleeding and hemodynamic decompensation. When evacuation time exceeds 60 minutes, the use of crystalloids and colloids is indicated. If brain injury is suspected, fluid resuscitation should be aimed toward normalization of hemodynamic parameters. PMID:12768101

Krausz, Michael M

2003-05-01

285

Academic Hospitality  

ERIC Educational Resources Information Center

Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

Phipps, Alison; Barnett, Ronald

2007-01-01

286

Aggressive surgical palliation for advanced girdle tumours  

PubMed Central

Background: The surgical management of advanced, incurable, malignant disease presents particular ethical and technical challenges. The clear goal is palliation and the surgical futility must be avoided. This case series presents some particular challenges in end-of-life surgery. Materials and Methods: Fifteen patients referred with advanced malignant disease involving a limb girdle were reviewed. Results: In one case, a patient pleaded for surgery after initially requesting a delay to seek treatment from a Chinese Traditional Herbalist. The increase in tumour bulk led to problems with surgery and the patient died in a hospital a few weeks later. This case illustrates ‘futility’ not recognized and encountered. The remaining 14 patients exhibited positive palliation with improved quality of dying and appreciation expressed by patients, relatives and staff. Conclusion: In selected cases, with a skilled and experienced surgical team, patients with advanced malignant disease can still benefit from aggressive surgical palliation. The margin of error is small between palliation being attempted and futility being achieved. This considerably adds to the challenge of end-of-life surgery. PMID:22754147

Burd, Andrew; Wong, K. C.; Kumta, Shekhar M.

2012-01-01

287

Surgical Delay for Acute Type A Dissection With Malperfusion  

Microsoft Academic Search

Background. An acute type A aortic dissection is considered a surgical emergency. Review of the risk factors for a type A dissection showed that preoperative malperfusion was associated with a 22% (2\\/9) intraoperative mortality and an 89% (8\\/9) hospital mortality. Intraoperative deaths were secondary to pulmonary failure resulting from capillary leak; the remaining patients died of multiorgan failure resulting from

G. Michael Deeb; David M Williams; Steven F Bolling; Leslie E Quint; Hilary Monaghan; Jennifer Sievers; Dean Karavite; Michael Shea

1997-01-01

288

Advances in the surgical repair of ruptured abdominal aortic aneurysms  

Microsoft Academic Search

Over the past two decades, the mortality rate for elective repair of infrarenal abdominal aortic aneurysms has improved to an acceptable level (<5%). However, surgical results of ruptured abdominal aortic aneurysms have remained fairly constant with about 50% in hospital mortality rates. Growing experience with the use of the left retroperitoneal exposure for elective aortic surgery allowed the authors to

R. C Darling; J. A Cordero; B. B Chang; D. M Shah; P. S. K Paty; W. E Lloyd; R. P Leather

1996-01-01

289

Trauma Pod: a semi-automated telerobotic surgical system  

Microsoft Academic Search

Background The Trauma Pod (TP) vision is to develop a rapidly deployable robotic system to perform critical acute stabilization and\\/or surgical procedures, autonomously or in a teleoperative mode, on wounded soldiers in the battlefield who might otherwise die before treatment in a combat hospital could be provided.

Pablo Garcia; Jacob Rosen; Chetan Kapoor; Mark Noakes; Greg Elbert; Michael Treat; Tim Ganous; Matt Hanson; Joe Manak; Chris Hasser; David Rohler; Richard Satava

2009-01-01

290

The Army Medical Department Medical Library and Information Network (AMEDD MEDLI-NET)  

Microsoft Academic Search

Army medical libraries have a long tradition of service to both the Army and the national health community. The Army Medical Department Medical Library and Information Network (AMEDD MEDLI-NET) is a consortium of thirty-nine biomedical, research, technical, and academic libraries in the U.S. Army Medical Command (MEDCOM). This article provides an overview of the AMEDD MEDLI-NET and its support of

Ann Russell Potter; Marcia I. Batchelor; Judy M. Krivanek; Robert J. Mohrman; Beverly Rakowitz; Linda Requena; Mabel A. Trafford

2004-01-01

291

An innovative method to evaluate the suture compliance in sealing the surgical wound lips  

Microsoft Academic Search

Background and aim: The increasing number of surgical procedures performed with local anesthesia, followed by immediate patient discharge from the hospital, emphasizes the need for a tight waterproof suture that is ca- pable of maintaining its tensile strength in the postoperative phase when the wound tumescence, edema due to the anesthetic drug, and surgical trauma disappear. Moreover, the issue of

Farid Saleh; Beniamino Palmieri; Danielle Lodi; Khalid Al-Sebeih

292

Cost and efficacy of surgical ligation versus transcatheter coil occlusion of patent ductus arteriosus  

Microsoft Academic Search

Objective: The purpose of this study was to compare cost and efficacy of surgical closure of patent ductus arteriosus using new critical pathway methods with outpatient transcatheter coil occlusion of patent ductus arteriosus. Methods: Surgical techniques included a transaxillary, muscle-sparing horacotomy, triple ligation of the patent ductus arteriosus, no chest tube, and discharge from the hospital within 24 hours. Transcatheter

John A. Hawkins; L. LuAnn Minich; Lloyd Y. Tani; Jane E. Sturtevant; Garth S. Orsmond; Edwin C. McGough

1996-01-01

293

Retrospective surgical incidence and case distribution of cystic echinococcosis in Jordan between 1994 and 2000  

Microsoft Academic Search

A retrospective follow-up study on the surgical incidence of cystic echinococcosis (CE) was carried out in major governmental, military and private hospitals throughout Jordan between 1994 and 2000. A total of 472 cases were recorded over the 7-year period and an overall mean annual surgical incidence (MASI) of 2.3 per 100,000 inhabitants was estimated. The highest number of surgical cases

Khaled M. Al-Qaoud; Philip S. Craig; Sami K. Abdel-Hafez

2003-01-01

294

Human cystic echinococcosis in the West Bank of Palestine: surgical incidence and seroepidemiological study  

Microsoft Academic Search

The surgical incidence of cystic echinococcosis (CE) due to Echinococcus granulosus was investigated in hospitals of the West Bank, Palestinian Authority between January 1990 and December 1997. Serum samples from school-children in Yata town, which showed the highest surgical incidence, were tested for anti-hydatid antibodies. A total of 390 surgically confirmed cases were recorded throughout the 8-year period, with an

N. Abu-Hasan; M. Daragmeh; K. Adwan; K. Al-Qaoud; S. Abdel-Hafez

2002-01-01

295

Surgical scar endometriosis.  

PubMed

Endometriosis is a common disorder in females of reproductive age. Surgical scar endometrioma after cesarean section develops in 1-2% of patients, and usually presents as a tender and painful abdominal wall mass. The diagnosis is suggested by pre or perimenstrual pelvic pain and is often established only by histology. In this retrospective observational cohort study, we reviewed the medical records of five patients with a histopathological diagnosis of scar endometriosis. A scar mass was found on a previous Pfannenstiel incision in four patients and in a median cesarean section in one patient. The mean age at diagnosis (38.6 years, median 38) was older than reported elsewhere. A histological examination of the surgical specimen confirmed the diagnosis of endometriosis in all cases. During the follow-up period (mean 34.6 months), local recurrence (n = 1) and pelvic recurrence (n = 1) were treated surgically. Surgery is the treatment of choice for surgical scar endometriosis. Excision with histologically proven free surgical margins of 1 cm is mandatory to prevent recurrence. As scar endometriosis may be associated with pelvic localization, explorative abdominal laparoscopy may be indicated to exclude the intraperitoneal spread of the disease in symptomatic patients. PMID:23307296

Mistrangelo, Massimiliano; Gilbo, Nicholas; Cassoni, Paola; Micalef, Salvatore; Faletti, Riccardo; Miglietta, Claudio; Brustia, Raffaele; Bonnet, Gisella; Gregori, Gianluca; Morino, Mario

2014-04-01

296

32 CFR 552.25 - Entry regulations for certain Army training areas in Hawaii.  

Code of Federal Regulations, 2010 CFR

...regulations for certain Army training areas in Hawaii. 552.25 Section 552.25 National...Regulations for Certain Army Training Areas in Hawaii § 552.25 Entry regulations for certain Army training areas in Hawaii. (a) Purpose. (1) This...

2010-07-01

297

32 CFR 552.25 - Entry regulations for certain Army training areas in Hawaii.  

Code of Federal Regulations, 2014 CFR

...regulations for certain Army training areas in Hawaii. 552.25 Section 552.25 National...Regulations for Certain Army Training Areas in Hawaii § 552.25 Entry regulations for certain Army training areas in Hawaii. (a) Purpose. (1) This...

2014-07-01

298

32 CFR 552.25 - Entry regulations for certain Army training areas in Hawaii.  

Code of Federal Regulations, 2011 CFR

...regulations for certain Army training areas in Hawaii. 552.25 Section 552.25 National...Regulations for Certain Army Training Areas in Hawaii § 552.25 Entry regulations for certain Army training areas in Hawaii. (a) Purpose. (1) This...

2011-07-01

299

32 CFR 552.25 - Entry regulations for certain Army training areas in Hawaii.  

Code of Federal Regulations, 2013 CFR

...regulations for certain Army training areas in Hawaii. 552.25 Section 552.25 National...Regulations for Certain Army Training Areas in Hawaii § 552.25 Entry regulations for certain Army training areas in Hawaii. (a) Purpose. (1) This...

2013-07-01

300

32 CFR 552.25 - Entry regulations for certain Army training areas in Hawaii.  

Code of Federal Regulations, 2012 CFR

...regulations for certain Army training areas in Hawaii. 552.25 Section 552.25 National...Regulations for Certain Army Training Areas in Hawaii § 552.25 Entry regulations for certain Army training areas in Hawaii. (a) Purpose. (1) This...

2012-07-01

301

Male and Female Soldiers' Beliefs about the "Appropriateness" of Various Jobs for Women in the Army.  

ERIC Educational Resources Information Center

A study was conducted to (1) document the expanding role of women in the U.S. Army and (2) determine whether soldiers in 1974 believed that certain military jobs were appropriate for women and whether those beliefs were related to respondent sex, rank, and expectation of leaving the army before retirement. An examination of army records revealed…

Savell, Joel M.; And Others

302

G93-1145 Management of the Army Cutworm and Pale Western Cutworm  

Microsoft Academic Search

This NebGuide describes the life cycle of the army cutworm and pale western cutworm, and provides recommendations for management.The army cutworm, Euxoa auxiliaris, and the pale western cutworm, Agrotis orthogonia, are sporadic pests that are distributed throughout the Great Plains. The army cutworm can be found throughout Nebraska, but is more common in the western half of the state. Because

Gary L. Hein; John B. Campbell; Stephen D. Danielson; James A. Kalisch

1993-01-01

303

Comprehensive Soldier Fitness: A Vision for Psychological Resilience in the U.S. Army  

Microsoft Academic Search

The stress and strain on the U.S. Army's community due to nearly a decade of protracted war is well documented in the press and in scientific literature. In response, the Army's Comprehensive Soldier Fitness (CSF) program is a preventive program that seeks to enhance psychological resilience among all members of the Army community, which includes soldiers, family members, and Department

George W. Casey

2011-01-01

304

Comprehensive Soldier Fitness: A Vision for Psychological Resilience in the U.S. Army  

ERIC Educational Resources Information Center

The stress and strain on the U.S. Army's community due to nearly a decade of protracted war is well documented in the press and in scientific literature. In response, the Army's Comprehensive Soldier Fitness (CSF) program is a preventive program that seeks to enhance psychological resilience among all members of the Army community, which includes…

Casey, George W., Jr.

2011-01-01

305

ATTP 4-0.1 (FM 100-10-1) Army Theater Distribution  

E-print Network

ATTP 4-0.1 (FM 100-10-1) Army Theater Distribution May 2011 DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited. Headquarters, Department of the Army #12;This publication Digital Library at (www.train.army.mil). #12;*ATTP 4-0.1 (FM 100-10-1) Distribution Restriction: Approved

US Army Corps of Engineers

306

The US Army National Guard's Mobile Training Simulators Location and Routing Problem  

E-print Network

#12;The US Army National Guard's Mobile Training Simulators Location and Routing Problem Katta G, NM-88002-5502, e-mail: djang@trac.wsmr.army.mil April 25, 2000 Abstract For training National Guard units, the US Army National Guard will eld 21 combat vehicle training simulators called Mobile Trainers

Murty, Katta G.

307

The US Army National Guard's Mobile Training Simulators Location and Routing Problem  

E-print Network

#12; The US Army National Guard's Mobile Training Simulators Location and Routing Problem Katta G, NM­88002­5502, e­mail: djang@trac.wsmr.army.mil April 25, 2000 Abstract For training National Guard units, the US Army National Guard will field 21 combat vehicle training simulators called Mobile

Murty, Katta G.

308

The WHO surgical safety checklist: survey of patients’ views  

PubMed Central

Background Evidence suggests that full implementation of the WHO surgical safety checklist across NHS operating theatres is still proving a challenge for many surgical teams. The aim of the current study was to assess patients’ views of the checklist, which have yet to be considered and could inform its appropriate use, and influence clinical buy-in. Method Postoperative patients were sampled from surgical wards at two large London teaching hospitals. Patients were shown two professionally produced videos, one demonstrating use of the WHO surgical safety checklist, and one demonstrating the equivalent periods of their operation before its introduction. Patients’ views of the checklist, its use in practice, and their involvement in safety improvement more generally were captured using a bespoke 19-item questionnaire. Results 141 patients participated. Patients were positive towards the checklist, strongly agreeing that it would impact positively on their safety and on surgical team performance. Those worried about coming to harm in hospital were particularly supportive. Views were divided regarding hearing discussions around blood loss/airway before their procedure, supporting appropriate modifications to the tool. Patients did not feel they had a strong role to play in safety improvement more broadly. Conclusions It is feasible and instructive to capture patients’ views of the delivery of safety improvements like the checklist. We have demonstrated strong support for the checklist in a sample of surgical patients, presenting a challenge to those resistant to its use. PMID:25038036

Russ, Stephanie Jane; Rout, Shantanu; Caris, Jochem; Moorthy, Krishna; Mayer, Erik; Darzi, Ara; Sevdalis, Nick; Vincent, Charles

2014-01-01

309

Surgical outcomes in women with ovarian cancer  

PubMed Central

Objective We sought to assess whether the specialty of the surgeon or the hospital involved in the initial management of women with ovarian cancer determined the likelihood of unnecessary repeated abdominal surgery and long-term patient survival. Methods We conducted a population-based study involving women in Ontario, Canada, who had epithelial ovarian cancer treated initially with abdominal surgery between January 1996 and December 1998. We documented incident surgical cases using hospital contact data and the Ontario Cancer Registry. We obtained data on patient characteristics, clinical findings, surgical techniques and perioperative care from electronic administrative data records and patient charts. We performed regression analyses to assess the influence of surgeon and hospital specialization and of case volumes on the likelihood of repeat surgery and survival. We controlled for stage of disease and other factors associated with these outcomes. We also examined the relation between the adequacy of surgery and adjuvant chemotherapy with survival. Results A total of 1341 women met our inclusion criteria. Our analysis showed that repeat surgery was associated with the surgeon's discipline, younger patient age, well-differentiated tumours and early stage of disease. However, survival was not associated with the surgeon's discipline; rather, it was associated with advanced patient age, increasing comorbidities, advanced stage of disease, poorly differentiated tumours, urgent surgery and adjuvant chemotherapy. We observed a trend between inadequate surgery and a decreased likelihood of survival. Conclusion Further study is needed to understand patterns of repeat surgery for ovarian cancer. Improved quality of operative reporting is required to classify surgical adequacy. PMID:18841223

Elit, Laurie M.; Bondy, Susan J.; Paszat, Lawrence P.; Holowaty, Eric J.; Thomas, Gillian M.; Stukel, Therese A.; Levine, Mark N.

2008-01-01

310

The Development of Professionalism in the Victorian Army  

Microsoft Academic Search

The professionalization of the armed forces was often met by resistance among elite military groups, which rejected the demands of technological development. Resistance to attempts by civil authority to increase military effectiveness reinforced traditionalist, heroic self-images. This approach was exemplified by the 19th century British army. Resistance to professionalism, however, led to inward reflection and the development of an expertise

Gwyn Harries-Jenkins

1975-01-01

311

Tiocfaidh ár Mná: Women in the Provisional Irish Republican Army  

Microsoft Academic Search

This article seeks to answer the question of who were the women of the Provisional IRA and to assess any demographic patterns of PIRA involvement. We use a multi-method approach to describe the many roles and functions of female members of the Provisional Irish Republican Army from 1970 to 1998. Drawing on a sample of 61 convicted or deceased PIRA

Mia Bloom; Paul Gill; John Horgan

2011-01-01

312

The provisional Irish republican army: Command and functional structure  

Microsoft Academic Search

The Provisional Irish Republican Army (PIRA) has long been regarded as one of the most highly organised and sophisticated terrorist groups the world has seen. The command and functional structure of this large, hierarchically?organised movement is outlined here. The adaptability of the PIRA is noteworthy as demonstrated through a major structural and functional reorganisation accentuated by external pressures. While the

John Horgan; Max. Taylor

1997-01-01

313

Tiocfaidh ár Mná: Women in the Provisional Irish Republican Army  

Microsoft Academic Search

This article seeks to answer the question of who were the women of the Provisional IRA and to assess any demographic patterns of PIRA involvement. We use a multi-method approach to describe the many roles and functions of female members of the Provisional Irish Republican Army from 1970 to 1998. Drawing on a sample of 61 convicted or deceased PIRA

Mia Bloom; Paul Gill; John Horgan

2012-01-01

314

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...

315

US army chemical corps Vietnam veterans health study: preliminary results  

Microsoft Academic Search

The long-term health consequences of exposure to phenoxyherbicides used in Vietnam has been a great concern to the veterans. In addition to the Air Force Ranch Hand personnel, Army Chemical Corps personnel who served in Vietnam are thought to have had some of the highest herbicide exposures. The Department of Veterans Affairs commenced a study of veterans who served in

Han K. Kang; Nancy A. Dalager; Larry L. Needham; Donald G. Patterson; Genevieve M. Matanoski; Sukon Kanchanaraksa; Peter S. J. Lees

2001-01-01

316

ERDC/ELTR-12-25 Army Range Technology Program  

E-print Network

ERDC/ELTR-12-25 Army Range Technology Program Large-Scale Physical Separation of Depleted Uranium-Scale Physical Separation of Depleted Uranium from Soil Steven Larson, Victor Medina, John Ballard, Chris Griggs) at Yuma Proving Ground (YPG) to evaluate this technique for removal of depleted uranium (DU) metal from

US Army Corps of Engineers

317

Implementation of Systems Engineering Concepts in Army Training.  

ERIC Educational Resources Information Center

A review of systems engineering concepts as applied to training programs at Army training schools was conducted. It was concluded that through systems engineering, the programs are being reoriented toward actual job requirements, reducing the "nice-to-know" and focusing on the "need-to-know." Since the programs are being constructed by personnel…

Ricketson, D. Schley; And Others

318

76 FR 6692 - Radiation Sources on Army Land  

Federal Register 2010, 2011, 2012, 2013, 2014

...reflect changes in the NRC rule. The second individual wanted to know if the rule covered radon. The Army explained that the rule does not cover radon. The final rule corrects one typographical error in the Authority section of 32 CFR part...

2011-02-08

319

Master Resilience Training in the U.S. Army  

ERIC Educational Resources Information Center

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…

Reivich, Karen J.; Seligman, Martin E. P.; McBride, Sharon

2011-01-01

320

Army hypersonic compact kinetic-energy missile laser window design  

Microsoft Academic Search

The U.S. Army Aviation and Missile Command, Aviation and Missile Research, Engineering, and Development Center (AMRDEC) is currently developing the Compact Kinetic Energy Missile (CKEM) which achieves hypersonic velocities at sea level. The system incorporates guidance to the target and requires active guidance technology. CKEM\\

Gerald W. Russell; Stephen C. Cayson; Michael M. Jones; Wendy Carriger; Robert R. Mitchell; Forrest A. Strobel; Michael Rembert; David A. Gibson

2003-01-01

321

Extragalactic Planetary Nebulae: One of the Universe's Swiss Army Knives  

E-print Network

4/19/2010 1 Extragalactic Planetary Nebulae: One of the Universe's Swiss Army Knives John Feldmeier the "Ring" Nebula #12;4/19/2010 2 History of Planetary Nebulae (PN) · First discovered in 1764 by Charles of the nebula are emitted in these lines! How do we explain Nebulium? - 2 #12;4/19/2010 4 Planetary Nebulae

Feldmeier, John

322

Compassion Fatigue: What Is the Level Among Army Chaplains?  

Microsoft Academic Search

Army chaplains assigned to Fort Bragg, NC, units were explored for compassion fatigue with contributory factors, compassion satisfaction, and burnout. The Compassion Fatigue Process developed by Charles Figley was used as the framework of the study. The sample consisted of 69 individuals. Findings indicated a low level of compassion fatigue and burnout, and approximately average level of compassion satisfaction. However,

Della W. Stewart

2012-01-01

323

Soldier to Civilian: Army Education and Postwar New Zealand Citizenship  

ERIC Educational Resources Information Center

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…

Brickell, Chris

2010-01-01

324

Learning Organization Dimensions of the Sri Lanka Army  

ERIC Educational Resources Information Center

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…

Dahanayake, Nishada Dhananjaya; Gamlath, Sharmila

2013-01-01

325

Effectiveness of Interactive Videodisc in Army Communications Training.  

ERIC Educational Resources Information Center

This report presents the results of RAND research conducted at the U.S. Army Signal Center, Fort Gordon, Georgia, to evaluate the effectiveness of an interactive videodisc (IVD) system used to facilitate training in a variety of military occupational specialities. The objectives of the study were to: (1) develop a methodology for assessing the…

Winkler, John D.; Polich, J. Michael

326

Suicide in the Army National Guard: An Empirical Inquiry  

ERIC Educational Resources Information Center

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,…

Griffith, James

2012-01-01

327

U.S. Army Corps of Engineers Regulatory Program  

E-print Network

U.S. Army Corps of Engineers Regulatory Program Headquarters Section 10 of the Rivers and Harbors Act of 1899 33 U.S.C. 403 That the creation of any obstruction not affirmatively authorized river, or other water of the United States, outside established harbor lines, or where no harbor lines

US Army Corps of Engineers

328

U.S. Army Corps of Engineers Regulatory Program  

E-print Network

U.S. Army Corps of Engineers Regulatory Program Headquarters Section 9 of the Rivers and Harbors Act of 1899 33 U.S.C. 401 That it shall not be lawful to construct or commence the construction of any bridge, dam, dike, or causeway over or in any port, roadstead, haven, harbor, canal, navigable river

US Army Corps of Engineers

329

Hospital Greenspace Ninewells Hospital, Dundee  

E-print Network

. Getting Started ­ Project Steering Group Forestry Commission Scotland, NHS Tayside, Dundee City Council and population health and well-being, as well as sustainability and biodiversity4 . Certain natural environments in Scotland. The purpose of the pilot was to demonstrate that by greening hospital grounds you can connect

330

Surgical bleeding in microgravity  

NASA Technical Reports Server (NTRS)

A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd

1993-01-01

331

O-chlorobenzylidene malononitrile (CS riot control agent) associated acute respiratory illnesses in a U.S. Army Basic Combat Training cohort.  

PubMed

Acute respiratory illnesses (ARIs) are among the leading causes for hospital visits in U.S. military training populations and historically peak during U.S. Army Basic Combat Training (BCT) following mandatory exposure to the riot control agent o-chlorobenzylidene malononitrile (CS). This observational prospective cohort studied the association between CS exposures and ARI-related health outcomes in 6,723 U.S. Army recruits attending BCT at Fort Jackson, South Carolina from August 1 to September 25, 2012 by capturing and linking the incidence of ARI before and after the mask confidence chamber to CS exposure data. Recruits had a significantly higher risk (risk ratio = 2.44; 95% confidence interval = 1.74, 3.43) of being diagnosed with ARI following exposure to CS compared to the period of training preceding exposure, and incidence of ARI after CS exposure was dependent on the CS exposure concentration (p = 0.03). There was a significant pre-/postexposure ARI difference across all CS concentration levels (p < 0.01), however, no significant differences were detected among these rate ratios (p = 0.72). As CS exposure is positively associated with ARI health outcomes in this population, interventions designed to reduce respiratory exposures could result in decreased hospital burden and lost training time in the U.S. Army BCT population. PMID:25003867

Hout, Joseph J; White, Duvel W; Artino, Anthony R; Knapik, Joseph J

2014-07-01

332

Perioperative nurse training in cardiothoracic surgical robotics.  

PubMed

The exponential growth of OR technology during the past 10 years has placed increased demands on perioperative nurses. Proficiency is required not only in patient care but also in the understanding, operating, and troubleshooting of video systems, computers, and cutting edge medical devices. The formation of a surgical team dedicated to robotically assisted cardiac surgery requires careful selection, education, and hands-on practice. This article details the six-week training process undertaken at Sarasota Memorial Hospital, Sarasota, Fla, which enabled staff members to deliver excellent patient care with a high degree of confidence in themselves and the robotic technology. PMID:11795058

Connor, M A; Reinbolt, J A; Handley, P J

2001-12-01

333

Virtual Hospital  

NSDL National Science Digital Library

Provided and maintained by the University of Iowa Health Care, the Virtual Hospital is designed as a "medical reference and health promotion tool for health care providers and patients." To that end, the site offers current and authoritative medical information for patients and professional and pedagogical information for health care providers. The former includes patient educational briefs browseable by organ system or by a topical list, a collection of peer-reviewed and annotated Web resources, an internal search engine, and archives of a column offering medical advice to middle-aged users. Resources in the health care provider section include several digital libraries aimed at certain specialties (Pediatrics, Pediatric Radiology, Family Medicine, and Medical Student); multimedia textbooks and teaching files grouped by organ system; lectures and publications; and clinical practice guidelines. Additional resources at the site include links to the Virtual Children's and Virtual Naval Hospitals, an internal search engine, and online continuing education courses.

334

Guide to Surgical Specialists  

MedlinePLUS

... Medicare Parts A & B Physician Quality Reporting System Health Care Reform Hospital Value-Based Purchasing Regulatory Issues Electronic Health ... Medicare Parts A & B Physician Quality Reporting System Health Care Reform More in Regulatory Issues State Legislation State Legislation ...

335

Allocation of surgical procedures to operating rooms.  

PubMed

Reduction of health care costs is of paramount importance in our time. This paper is a part of the research which proposes an expert hospital decision support system for resource scheduling. The proposed system combines mathematical programming, knowledge base, and database technologies, and what is more, its friendly interface is suitable for any novice user. Operating rooms in hospitals represent big investments and must be utilized efficiently. In this paper, first a mathematical model similar to job shop scheduling models is developed. The model loads surgical cases to operating rooms by maximizing room utilization and minimizing overtime in a multiple operating room setting. Then a prototype expert system which replaces the expertise of the operations research analyst for the model, drives the modelbase, database, and manages the user dialog is developed. Finally, an overview of the sequencing procedures for operations within an operating room is also presented. PMID:8522909

Ozkarahan, I

1995-08-01

336

Surgical Instrument Restraint in Weightlessness  

NASA Technical Reports Server (NTRS)

Performing a surgical procedure during spaceflight will become more likely with longer duration missions in the near future. Minimal surgical capability has been present on previous missions as the definitive medical care time was short and the likelihood of surgical events too low to justify surgical hardware availability. Early demonstrations of surgical procedures in the weightlessness of parabolic flight indicated the need for careful logistical planning and restraint of surgical hardware. The consideration of human ergonomics also has more impact in weightlessness than in the conventionall-g environment. Three methods of surgical instrument restraint - a Minor Surgical Kit (MSK), a Surgical Restraint Scrub Suit (SRSS), and a Surgical Tray (ST) were evaluated in parabolic flight surgical procedures. The Minor Surgical Kit was easily stored, easily deployed, and demonstrated the best ability to facilitate a surgical procedure in weightlessness. Important factors in this surgical restraint system include excellent organization of supplies, ability to maintain sterility, accessibility while providing secure restraint, ability to dispose of sharp items and biological trash, and ergonomical efficiency.

Campbell, Mark R.; Dawson, David L.; Melton, Shannon; Hooker, Dona; Cantu, Hilda

2000-01-01

337

Surgical team mapping: implications for staff allocation and coordination.  

PubMed

Perioperative team membership consistency is not well researched despite being essential in reducing patient harm. We describe perioperative team membership and staffing across four surgical specialties in an Australian hospital. We analyzed staffing and case data using social network analysis, descriptive statistics, and bivariate correlations and mapped 100 surgical procedures with 171 staff members who were shared across four surgical teams, including 103 (60.2%) nurses. Eighteen of 171 (10.5%) staff members were regularly shared across teams, including 12 nurses, five anesthetists, and one registrar. We found weak but significant correlations between the number of staff (P < .001), procedure start time (P < .001), length of procedure (P < .05), and patient acuity (P < .001). Using mapping, personnel can be identified who may informally influence multiple team cultures, and nurses (ie, the majority of team members in surgery) can lead the development of highly functioning surgical teams. PMID:25645040

Sykes, Mark; Gillespie, Brigid M; Chaboyer, Wendy; Kang, Evelyn

2015-02-01

338

CPAP Use in a Hospital or Surgical Setting  

MedlinePLUS

... or having outpatient surgery. ? To use your own mask and headgear, and your own CPAP equipment set ... pressure, if the facility cannot provide an identical mask and CPAP equipment with similar or better functionality. ? ...

339

[The Jewish Hospital in Budapest under the Nazi occupation (1944-1945)].  

PubMed

On March 19, 1944 the German army invaded and occupied Hungary. The Waffen-SS soldiers captured the buildings of the Jewish community in Budapest, including the famous and important Jewish hospital on Szabolcs Street, founded in 1802. The Jewish hospital moved into a school belonging to the Jewish community on 44 Wesselényi Street. The hospital personnel managed to smuggle out medical equipment, and operating rooms were transferred into this central, temporary medical location. Other hospitals were founded, some inside the ghetto, others outside. The Judenrat supplied these hospitals with medical equipment obtained through contributions from Jews. The temporary hospitals admitted sick patients and a great number of those injured as a result of the war in Budapest. These hospitals operated with poor equipment. Surgeries were sometimes performed on kitchen tables, and medical equipment was sterilized by burning the synagogue's benches and library books. As of December 1944, there was no electricity in the hospitals. Thus doctors were forced to operate by the light of candles and flashlights. Nevertheless, they managed to save numerous lives. In spite of the terrible conditions under which the medical staff worked, they were committed to their mission, and their courage deserves appreciation. Ghetto Budapest was liberated by the Red army on 18th January, 1945. Thousands of Jews were released from the temporary hospitals. PMID:18300630

Weisskopf, Varda

2008-01-01

340

Surgical Technology Curriculum.  

ERIC Educational Resources Information Center

This curriculum guide contains materials for a 10-month postsecondary program to educate qualified adults to function as surgical technicians in association with surgeons and nurses in operating rooms and delivery rooms. The program provides for both a didactic and a clinical component. Contents include general information, a listing of major…

Connecticut State Dept. of Education, Hartford. Div. of Vocational-Technical Schools.

341

Surgical treatment of obesity  

Microsoft Academic Search

Obesity is very prevalent. Most treatments fail owing to hard-wired survival mechanisms, linking stress and appetite, which have become grossly maladaptive in the industrial era. Antiobesity (bariatric) surgery is a seemingly drastic, efficacious therapy for this serious disease of energy surfeit. Technical progress during the last two decades has greatly improved its safety. The surgical principles of gastric restriction and\\/or

Erik Näslund; John G Kral

2007-01-01

342

Ancient Egyptian surgical heritage.  

PubMed

Egyptian medicine influenced the medicine of neighboring cultures, including the culture of ancient Greece. From Greece, its influence spread onward, thereby affecting Western civilization significantly. The oldest extant Egyptian medical texts are six papyri: The Edwin Smith Surgical Papyrus and the Ebers Medical Papyrus are famous. PMID:21208098

Saber, Aly

2010-12-01

343

Surgical wound care - closed  

MedlinePLUS

... Skin glue Proper wound care can help prevent infection and reduce scarring as your surgical wound heals. ... When you come home after surgery, you may have a dressing on your ... don't catch on clothing Protect the area as it heals Soak ...

344

Minor surgical manipulations  

Microsoft Academic Search

ExtractMadam:– There is increasing community concern over minor surgical manipulations of animals. People are questioning our rights to dock tails. to castrate domestic species, to earmark and to brand for other than therapeutic reasons. The develvetting of deer remains remarkably unchallenged in this country, although there is widespread doubt in the western world about the claimed efficacy of the product

Gabrielle George

1985-01-01

345

Promoting Inter-Professional Teamwork and Learning--The Case of a Surgical Operating Theatre  

ERIC Educational Resources Information Center

Hospitals, and surgical operating theatres (OTs) in particular, are environments in which inter-professional teamwork and learning are essential to secure patient safety and effective practice. However, it has been revealed in many studies that inter-professional collaborative work in hospital organisations faces many challenges and constraints.…

Collin, Kaija; Paloniemi, Susanna; Mecklin, Jukka-Pekka

2010-01-01

346

Deceased donor renal transplantation at army hospital research and referral: Our experience  

PubMed Central

Context: In India, there are a large number of end-stage renal disease (ESRD) patients waiting for renal transplant. Deceased donor organ transplantation (DDOT) is the possible solution to bridge the disparity between organ supply and demand. The concept of expanded criteria donors (ECDs) was developed to combat the huge discrepancy between demand and organ availability. However, ECD kidneys have a higher propensity for delayed graft function (DGF), and therefore worse long-term survival. We present our experience of deceased donor renal transplantation. Aims: We report single centre experience on DDOT including ECDs vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr), rejection episodes, and delayed graft function in 44 DDOT Materials and Methods: Between August 1998 and April 2011, 44 renal transplants from 35 deceased donors were performed, of which 37.2% were expanded criteria donors. Results were analyzed in terms of age of donor, terminal SCr, graft ischemia time, graft function, post-transplant complications, and graft and patient survival. All recipients received sequential triple drug immunosuppression and induction with rabbit antithymocyte globulin (rATG). The induction is commenced by giving first dose of rATG intraoperatively (dose 1.5 mg/kg) and subsequent rATG infusions were administered daily for a minimum of 5 and maximum of 7 doses depending on initial graft function. Results: We have been able to achieve a mean cold ischemia time of 6.25 ± 2.55 h due to the coordinated team efforts. Delayed graft function occurred in 34% patients and 31.8% had prolonged drainage. There were no urinary leaks. Seven (16%) patients had biopsy-proven rejection episodes, all of which were reversed with treatment. Two patients underwent graft nephrectomy. One of these was due to hyperacute rejection and another due to anastomotic hemorrhage. One-year graft survival was 92.4% and the patient survival was 83.8%. Conclusion: Deceased donor renal transplants have satisfactory graft function and patient survival despite the high incidence of delayed graft function. Retrieving kidneys from marginal donors can add to the donor pool. PMID:23956510

Swami, Yogesh Kumar; Singh, Dharam Vir; Gupta, Sanjay K.; Pradhan, Aditya A.; Rana, Yajvender P. S.; Harkar, Sandeep; Wani, M. Shafi

2013-01-01

347

ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2002  

Microsoft Academic Search

Results of the 2002 ASHP nation- al survey of pharmacy practice in hospital settings that pertain to dispensing and ad- ministration are presented. A stratified random sample of pharmacy directors at 1101 general and children's medical-surgical hospitals in the United States were surveyed by mail. SMG Market- ing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn

CRAIG A. PEDERSEN; PHILIP J. SCHNEIDER; DOUGLAS J. SCHECKELHOFF

348

[Evaluation of a face model for surgical education].  

PubMed

The complex anatomy of the human face requires a high degree of experience and skills in surgical dressing of facial soft tissue defects. The previous education contains literature studies and supervision during surgery, according to surgical spectrum of the educating hospital. A structured education including a training of different surgical methods on a model and slow increase of complexity could improve considerably the following education related to the patient.During a cooperative project, the 3?di GmbH and the Department of Otolaryngology at the Friedrich-Schiller-University Jena developed a face model for surgical education that allows the training of surgical interventions in the face. The model was used during the 6th and 8th Jena Workshop for Functional and Aesthetic Surgery as well as a workshop for surgical suturation, and tested and evaluated by the attendees.The attendees mostly rated the work-ability of the models and the possibility to practice on a realistic face model with artificial skin very well and beneficial. This model allows a repeatable and structured education of surgical standards, and is very helpful in preparation for operating facial defects of a patient. PMID:21913151

Schneider, G; Voigt, S; Rettinger, G

2011-09-01

349

Chimpanzees prey on army ants at Seringbara, Nimba Mountains, Guinea: Predation patterns and tool use characteristics.  

PubMed

Chimpanzees are renowned for their use of foraging tools in harvesting social insects and some populations use tools to prey on aggressive army ants (Dorylus spp.). Tool use in army ant predation varies across chimpanzee study sites with differences in tool length, harvesting technique, and army ant species targeted. However, surprisingly little is known about the detailed ecology of army ant predation. We studied army ant predation by chimpanzees (Pan troglodytes verus) at the Seringbara study site in the Nimba Mountains, Guinea (West Africa), over 10 years (2003-2013). We investigated chimpanzee selectivity with regards to army ant prey species. We assessed the temporal variation in army ant-feeding and examined whether army ant predation was related to rainfall or ripe fruit availability. Moreover, we examined whether chimpanzees showed selectivity regarding plant species used for tool manufacture, as well as the relationship between tool species preference and tool collection distance. Lastly, we measured tool properties and investigated the use of tool sets and composite tools in army ant predation. Seringbara chimpanzees preyed on one army ant species (D. nigricans) more often than expected based on encounter rates, which may be explained by the overlap in altitudinal distribution between chimpanzees and D. nigricans. Army ant predation was not related to rainfall or fruit availability. Chimpanzees were selective in their choice of tool materials and collected their preferred tool species (Alchornea hirtella) from greater distances than they did other species. Lastly, Seringbara chimpanzees used both tool sets and composite tools (tree perch) in army ant predation. Tool types (dig vs. dip) differed in width and strength, but not length. Tool composites were found at 40% of ant-feeding sites. Our study sheds new light on the ecology of army ant predation and provides novel insights into chimpanzee selection of army ant prey and tool species. Am. J. Primatol. © 2014 Wiley Periodicals, Inc. PMID:25315798

Koops, Kathelijne; Schöning, Caspar; McGrew, William C; Matsuzawa, Tetsuro

2014-10-14

350

Adult Partial Hospitalization JOHN DEMPSEY HOSPITAL  

E-print Network

." The Adult Partial Hospitalization Program is a day treatment program specifically designed for the diagnosisAdult Partial Hospitalization Program JOHN DEMPSEY HOSPITAL CONTACT US For further information.uchc.edu. The Adult Partial Hospitalization Program is available Monday through Friday from 9 a.m. to 2:05 p.m. OUR

Oliver, Douglas L.

351

Further results of incorporating innovative procedures in a surgical residency.  

PubMed

The instruction in precipitously advancing surgical technologies remains a real challenge to every surgery program. Our institution's ongoing experience with an identified center for student and resident education and clinical investigation provides an option for addressing these needs in a general surgery residency. Over the past 8 years, we have developed and described previously the Center for Advanced Surgical Technologies (CAST) in a joint undertaking of the Department of Surgery and the Norton Hospital, an affiliated hospital on our medical school campus. The idea behind this program has been to focus and develop high-quality skills in the hospital in many areas of advanced technology. CAST has subsequently provided a vehicle for excellent clinical research as well as the development of specially focused advanced surgical technologies, fellowships, and a large number of publications that have often focused on new, advanced methods for imaging surgical disease and minimal access treatment. This program has had a very positive impact on the general surgery residency as a whole and has permitted a steadily advancing agenda of new technologies, while relegating recently emerged but perfected technologies into the central aspect of our accredited general surgery residency. PMID:16034508

Kehdy, Farid J; Allen, Jeffrey W; Vitale, Gary C; Polk, Hiram C

2005-06-01

352

Surgical Treatment of Hashimoto's with Thyroid Microcarcinoma.  

PubMed

The aim of this study is to explore the surgical strategies for treating Hashimoto's disease complicated with thyroid microcarcinoma. We analyzed the clinical data of 25 patients with Hashimoto's disease with thyroid microcarcinoma who were treated in our hospital from January 1995 to September 2011. The incidence of Hashimoto's disease with thyroid microcarcinoma was 9.8 % (25/256) in our hospital. Amongst them, 19 patients had papillary thyroid carcinoma and six had follicular thyroid carcinoma. There were 24 cases (96 %) confirmed by the frozen section examination and one (4 %) after surgery. One patient did not undergo remedial surgery. The surgical approaches were determined based on preoperative examinations and intraoperative frozen pathology, including thyroid lobe and isthmus resection with contralateral lobe subtotal resection in 19 cases, and bilateral subtotal thyroid lobectomy in one case. Central lymph node dissection was conducted for all patients except one who was not diagnosed until after the surgery. No recurrence occurred during the follow-up (range: 6 months to 17 years) and all patients have survived to date. The preoperative diagnosis rate of Hashimoto's disease with thyroid cancer (in particular thyroid microcarcinomas) is low. Preoperative palpation, color Doppler ultrasound, fine needle aspiration, and the frozen section examination are helpful to improve the diagnosis rate of Hashimoto's disease with thyroid microcarcinoma. Surgery procedure is the most effective approach. PMID:25433724

Tao, Liu; Xi-Lin, H; Xiang-Dong, M

2014-11-30

353

Surgical training in primary care: consensus recommendations by the Association of Surgeons in Training.  

PubMed

Health service reconfigurations may result in increasing numbers of minor surgical procedures migrating from secondary care in hospitals to primary care in the community. Procedures may be performed by General Practitioners with a specialist interest in Surgery, or secondary care Surgeons who are sub-contracted to perform procedures in the community. Surgical training in such procedures, which are currently hospital based, may therefore be adversely affected unless surgical training also takes advantage of these opportunities. There is potential for surgical trainees to benefit from training in the community setting. ASiT supports the development of formal surgical training in the community setting for junior surgical trainees, providing high standards of patient care and training provision are ensured. Anticipated problems relating to the migration of surgical services to the community relate to the availability and quality assurance of training opportunities in primary care, its funding, including exposure to issues of indemnity cover for trainees, and also the release of surgical trainees from hospital duties in order to attend these training opportunities. These consensus recommendations set out a framework through which both patient care and training remain at the forefront of these continued service reconfigurations. PMID:25200963

Gokani, V J; Ferguson, H J M; Fitzgerald, J E F; Beamish, A J

2014-11-01

354

The development of postgraduate surgical training in Guyana  

PubMed Central

Background Like many developing countries, Guyana has a severe shortage of surgeons. Rather than rely on overseas training, Guyana developed its own Diploma in Surgery and asked for assistance from the Canadian Association of General Surgeons (CAGS). This paper reviews the initial results of Guyana’s first postgraduate training program. Methods We assisted with program prerequisites, including needs assessment, proposed curriculum, University of Guyana and Ministry of Health approval, external partnership and funding. We determined the outputs and outcomes of the program after 2 years, and we evaluated the impact of the program through a quantitative/qualitative questionnaire administered to all program participants. Results Five residents successfully completed the 2-year program and are working in regional hospitals. Another 9 residents are in the training program. Twenty-four modules or short courses have been facilitated, alternating Guyanese with visiting Canadian surgical faculty members coordinated through CAGS. A postgraduate structure, including an Institute for Health Sciences Education and Surgical Postgraduate Education Committee, has been developed at the Georgetown Public Hospital Corporation (GPHC). An examination structure similar to Canada’s has been established. Hospital staff morale is greater, surgical care is more standardized and academic opportunities have been enhanced at GPHC. Four regional hospitals have welcomed the new graduates, and surgical services have already improved. Canadian surgeons have a greater understanding of and commitment to surgical development in low-income countries. Conclusion Guyana has proven that, with visiting faculty assistance, it can mount its own postgraduate training suitable to national needs and will provide a career path to encourage its own doctors to remain and serve their country. PMID:20100407

Cameron, Brian H.; Rambaran, Madan; Sharma, Deen P.; Taylor, Robert H.

2010-01-01

355

Ontological Modelling of Surgical Knowledge  

Microsoft Academic Search

Computer Assisted Surgery seeks data from various sources related to surgical knowledge, which is mostly represented in the form of discrete databases. However, databases serve as data storage mechanism rather than knowledge representation system. As CAS is becoming more common for various types of surgical interventions, there is a need for representation, storage and processing of surgical knowledge in a

Raj Mudunuri; Oliver Burgert; Thomas Neumuth

2009-01-01

356

The Army Special Operations Forces Role in Force Projection  

Microsoft Academic Search

ABSTRACT AUTHOR:,Jack C. Zeigler Jr. TITLE: The Army Special Operations Forces Role in Force Projection FORMAT:,Strategy Research Project DATE:,07 April 2003, PAGES: 30,CLASSIFICATION: Unclassified President George W. Bush summarized,his National Security Strategy in a speech,to West Point cadets in June 2002 when he stated, “If we wait for threats to fully materialize, we will have waited too long. In the

Colonel Jack; C. Zeigler

357

Army Simulation Program Balances Agile and Traditional Methods With Success  

Microsoft Academic Search

The One Semi-Automated Forces (OneSAF) Objective System is the next generation simulation system planned to provide the U. S. Army with an entity-level simulation to serve three modeling and simulation domains. Software development of the OneSAF application has been conducted in a highly robust systems engineering environment based on commercial and gov-ernment best practices. The OneSAF program has tailored techniques

Doug J. Parsons

358

Controversies in Surgical Staging of Endometrial Cancer  

PubMed Central

Endometrial cancer is the most common gynaecological malignancy and its incidence is increasing. In 1998, international federation of gynaecologists and obstetricians (FIGO) required a change from clinical to surgical staging in endometrial cancer, introducing pelvic and paraaortic lymphadenectomy. This staging requirement raised controversies around the importance of determining nodal status and impact of lymphadenectomy on outcomes. There is agreement about the prognostic value of lymphadenectomy, but its extent, therapeutic value, and benefits in terms of survival are still matter of debate, especially in early stages. Accurate preoperative risk stratification can guide to the appropriate type of surgery by selecting patients who benefit of lymphadenectomy. However, available preoperative and intraoperative investigations are not highly accurate methods to detect lymph nodes and a complete surgical staging remains the most precise method to evaluate extrauterine spread of the disease. Laparotomy has always been considered the standard approach for endometrial cancer surgical staging. Traditional and robotic-assisted laparoscopic techniques seem to provide equivalent results in terms of disease-free survival and overall survival compared to laparotomy. These minimally invasive approaches demonstrated additional benefits as shorter hospital stay, less use of pain killers, lower rate of complications and improved quality of life. PMID:20613992

Seracchioli, R.; Solfrini, S.; Mabrouk, M.; Facchini, C.; Di Donato, N.; Manuzzi, L.; Savelli, L.; Venturoli, S.

2010-01-01

359

Surgical Device Engineering  

NSDL National Science Digital Library

This unit focuses on teaching students about the many aspects of biomedical engineering (BME). Students come to see that BME is a broad field that relies on concepts from many engineering disciplines. They also begin to understand some of the special considerations that must be made when dealing with the human body. Activities and class discussions encourage students to think as engineers to come up with their own solutions to some of medical challenges that have been solved throughout the history of BME. Class time iincludes brainstorming and presenting ideas to the class for discussion. Specific activities include examination of the material properties and functions of surgical instruments and prosthetics, a simulation of the training experience of a surgical resident, and an investigation of the properties of fluid flow in vascular tissue.

Techtronics Program

360

Spacecraft surgical scrub system  

NASA Technical Reports Server (NTRS)

Ease of handling and control in zero gravity and minimizing the quantity of water required were prime considerations. The program tasks include the selection of biocidal agent from among the variety used for surgical scrub, formulation of a dispensing system, test, and delivery of flight dispensers. The choice of an iodophore was based on effectiveness on single applications, general familiarity among surgeons, and previous qualification for space use. The delivery system was a choice between the squeeze foamer system and impregnated polyurethane foam pads. The impregnated foam pad was recommended because it is a simpler system since the squeeze foamer requires some applicator to effectively clean the skin surfaces, whereas the form pad is the applicator and agent combined. Testing demonstrated that both systems are effective for use as surgical scrubs.

Abbate, M.

1980-01-01

361

Surgical adjuvant chemotherapy.  

PubMed

The evidence that the principles of surgical adjuvant chemotherapy developed in experimental animal systems also apply to a variety of neoplastic diseases in man has been clearly demonstrated. Micrometastatic disease can be eradicated with effective chemotherapy in several diseases. Prolongation of disease-free interval, if not cure, is now possible in diseases in which curative surgery alone or in combination with radiotherapy does not achieve these goals. The previously fatal childhood solid tumors--Wilms', Ewings' sarcoma, embryonal rhabdomyosarcoma--are curable in a high percentage of patients appropriately treated with combinations of surgery, radiotherapy, and chemotherapy. The prolongation of the disease-free interval in osteogenic sarcoma has permitted consideration of entirely new surgical approaches for this tumor in which radical amputation has traditionally been employed. The spectacular results achieved in the treatment of Stage II breast cancer may potentially save hundreds of thousands of lives in the coming decade. Clinically recognizable metastatic disease is rarely curable by any currently available treatment modality. The prolongation of disease-free intervals and production of cures when surgical adjuvant chemotherapy is employed may be partly explained by relatively more circulation, and thus drug delivery to each tumor cell, more favorable cellular kinetics, and a healthier and more immunocompetent host who is better able to withstand drug effects on normal tissues, and to participate in tumor destruction. Cures of certain patients with neoplastic diseases using surgical adjuvant chemotherapy has increased the incentive to learn more about new and old drugs and their effective use alone and in combination. Chemotherapy, in appropriate combinations with surgery, radiotherapy, and immunotherapy, may well be more efficacious in many clinical situations than the traditional use of single-modality treatment. The data presented in this paper relate solid evidence that the possibility of cure in a variety of neoplastic diseases is real. PMID:193434

Perloff, M; Holland, J F

1977-01-01

362

Power and energy research at the Army Research Laboratory  

NASA Astrophysics Data System (ADS)

The requirement for power and energy in a modernized, highly digital and network-centric Army is growing exponentially. In addition to the ongoing demand for improved soldier portable power sources, the need for more electric capabilities for combat and unmanned platforms and the requirements of emerging Operational Energy doctrine are driving development of high density, energy efficient power technologies. The Army Research Laboratory (ARL) is addressing these needs through developing a number of underpinning power and energy component technologies at the fundamental research level. ARL is leveraging core expertise in microelectronics and micro-electro-mechanical systems (MEMS), energy conversion, energy storage, and wideband gap materials and devices to advance selected niche areas that address military demands beyond commercial needs in partnership with the Army Research, Development and Engineering centers (RDECs), other services, other agencies, industry, and academia. The technologies under development can be broadly characterized under power generation and energy conversion, energy storage, power distribution, and thermal management. This discussion outlines progress, approach and the way ahead for ARL efforts.

Shaffer, Edward C.; Wood, Mark C.

2012-06-01

363

High-performance IR detector modules for Army applications  

NASA Astrophysics Data System (ADS)

Since many years AIM delivers IR-modules for army applications like pilotage, weapon sights, UAVs or vehicle platforms. State-of-the-art 640x512, 15?m pitch detector modules are in production in manifold configurations optimized for specific key requirements on system level. This is possible due to a modular design, which is best suited to meet the diversity of system needs in army applications. Examples are optimization of detector-dewar length for gimbal applications, size weight and power reduction for UAVs or lifetime enhancement for vehicle platforms. In 2012 AIM presented first prototypes of megapixel detectors (1280x1024, 15?m pitch) for both spectral bands MWIR and LWIR. These large format detector arrays fulfill the demand for higher spatial resolution, which is requested for applications like rotorcraft pilotage, persistent surveillance or tasks like determination of threat level in personnel targets. Recently, a new tactical dewar has been developed for the 1280x1024 detector arrays. It is designed to withstand environmental stresses and, at the same time, to quest for a compact overall package. Furthermore, the idea of a modular design will be even more emphasized. Integration of different cooler types, like AIM's SX095 or rotary integral, will be possible without modification of the dewar. The paper will present development status of large format IR-modules at AIM as well as performance data and configuration considerations with respect to army applications.

Lutz, H.; Breiter, R.; Rutzinger, S.; Schallenberg, T.; Wendler, J.; Ziegler, J.

2013-06-01

364

Factors associated with physical aggression among US Army soldiers.  

PubMed

There are a growing number of studies that have approximated levels of aggression and associated outcomes among combat veterans returning from Iraq and Afghanistan using brief screening assessments. However, further research to evaluate the relative role of combat exposures and overt physical behaviors is required to further elucidate potential associations between military service, combat deployment, and overt physical aggression. The purpose of the current study was to assess the prevalence of self-reported physical aggression in a sample of US Army soldiers using an adaptation of the Revised Conflict Tactics Scale (CTS2), and examine factors associated with higher levels of aggression. A population-based cross-sectional study was conducted at a single US Army Installation within a sample of active duty US Army soldiers (n = 6,128) from two large units. Anonymous surveys were collected 6 months following deployment to measure overt aggressive behaviors, posttraumatic stress disorder, anxiety, depression, traumatic brain injury, and misuse of alcohol. There were a relatively higher number of minor and severe physical overt aggressive actions reported among soldiers who previously deployed, notably highest among deployed soldiers reporting the highest levels of combat intensity. Soldiers screening positive for the misuse of alcohol were also significantly more likely to report relatively higher levels of physical aggression. This study quantified overt aggressive behaviors and associated factors, showing increasing combat exposures may result in increased physical aggression. Clinicians treating service members returning from combat may consider assessing relative levels of combat. PMID:22898873

Gallaway, Michael Shayne; Fink, David S; Millikan, Amy M; Bell, Michael R

2012-01-01

365

Starting a General Surgery Program at a Small Rural Critical Access Hospital: A Case Study from Southeastern Oregon  

ERIC Educational Resources Information Center

Context: Surgical services are frequently unavailable in rural American communities. Therefore, rural residents often must travel long distances to receive surgical care. Rural hospitals commonly have difficulty providing surgical services despite potential economic benefits. Purpose: The purpose of this project was to identify the key challenges…

Doty, Brit Cruse; Heneghan, Steven; Zuckerman, Randall

2007-01-01

366

Surgical embolectomy for acute massive pulmonary embolism  

PubMed Central

Objective: Acute massive pulmonary embolism (PE) is associated with significant mortality rate despite diagnostic and therapeutic advances. The aim of this study was to analyze our clinical outcomes of patients with acute massive PE who underwent emergency surgical pulmonary embolectomy. Methods: This retrospective study included 13 consecutive patients undergoing emergency surgical pulmonary embolectomy for acute massive PE at our institution from March 2000 to November 2013. The medical records of all patients were reviewed for demograhic and preoperative data and postoperative outcomes. All patients presented with cardiogenic shock with severe right ventricular dysfunction confirmed by echocardiography, where 4 (30.8%) of the patients experienced cardiac arrest requiring cardiopulmonary resuscitation before surgery. Results: The mean age of patients was 61.8 ± 14 years (range, 38 to 82 years) with 8 (61.5%) males. The most common risk factors for PE was the history of prior deep venous thrombosis (n = 9, 69.2%). There were 3 (23.1%) in-hospital deaths including operative mortality of 7.7% (n = 1). Ten (76.9%) patients survived and were discharged from the hospital. The mean follow-up was 25 months; follow-up was 100% complete in surviving patients. There was one case (7.7%) of late death 12 months after surgery due to renal carcinoma. Postoperative echocardiographic pressure measurements demonstrated a significant reduction (P < 0.001). At final follow-up, all patients were in New York Heart Association class I and no readmission for a recurrent of PE was observed. Conclusion: Surgical pulmonary embolectomy is a reasonable option and could be performed with acceptable results, if it is performed early in patients with acute massive PE who have not reached the profound cardiogenic shock or cardiac arrest.

Yavuz, Senol; Toktas, Faruk; Goncu, Tugrul; Eris, Cuneyt; Gucu, Arif; Ay, Derih; Erdolu, Burak; Tenekecioglu, Erhan; Karaagac, Kemal; Vural, Hakan; Ozyazicioglu, Ahmet

2014-01-01

367

Guideline implementation: surgical attire.  

PubMed

Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. PMID:25645036

Cowperthwaite, Liz; Holm, Rebecca L

2015-02-01

368

Surgical Multidisciplinary Rounds: An Effective Tool for Comprehensive Surgical Quality Improvement.  

PubMed

An analysis of outcomes, quality, and survey data was carried out to evaluate the impact of surgical multidisciplinary rounds (SMDR) at a community teaching hospital. Surgical inpatients were reviewed over a 4-year period. Real-time changes to clinical care, documentation, and programs were enacted during the rounds. SMDR contributed to reductions in length of stay (6.1 to 5.1 days), postoperative respiratory failure (15.5% to 6.8%), deep venous thrombosis/pulmonary embolism (2.8% to 2.3%), cardiac complications (7.0% to 1.6%), and catheter-associated urinary tract infection (5.2% to 1.5%), and increased Surgical Care Improvement Program All-or-None compliance (95.6% to 98.7%). Additionally, SMDR increased awareness of Accreditation Council for Graduate Medical Education core competencies among surgical residents and was associated with enhanced job satisfaction among participants. Twice-weekly SMDR is an effective care paradigm that has changed culture, improved care coordination, and facilitated rapid, sustained process improvement along multiple patient safety indicators and core measures. PMID:25210093

Counihan, Timothy; Gary, Monique; Lopez, Enrique; Tutela, Sharyl; Ellrodt, Gray; Glasener, Richard

2014-09-10

369

Preliminary assessment report for Virginia Army National Guard Army Aviation Support Facility, Richmond International Airport, Installation 51230, Sandston, Virginia  

SciTech Connect

This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Virginia Army National Guard (VaARNG) property in Sandston, Virginia. The Army Aviation Support Facility (AASF) is contiguous with the Richmond International Airport. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The PA is designed to characterize the site accurately and determine the need for further action by examining site activities, quantities of hazardous substances present, and potential pathways by which contamination could affect public health and the environment. The AASF, originally constructed as an active Air Force interceptor base, provides maintenance support for VaARNG aircraft. Hazardous materials used and stored at the facility include JP-4 jet fuel, diesel fuel, gasoline, liquid propane gas, heating oil, and motor oil.

Dennis, C.B.

1993-09-01

370

Surgical Management of Diabetic Retinopathy  

PubMed Central

Surgery for late complications of proliferative diabetic retinopathy remains the cornerstone of management even in patients who have received optimal laser photocoagulation and medical therapy. With improvisation in the surgical techniques and development of micro-incision surgical techniques for vitrectomy, the indications for surgical intervention are expanding to include diabetic macular edema with a greater number of patients undergoing early intervention. This review describes the current indications, surgical techniques, adjunctive anti-vascular endothelial growth factor therapy, surgical outcomes, and postoperative complications of pars plana vitrectomy for proliferative diabetic retinopathy and macular edema. PMID:24339677

Gupta, Vishali; Arevalo, J. Fernando

2013-01-01

371

Prevention of retained surgical items.  

PubMed

Reduction in retained surgical items is an important part of any operating room patient-safety effort. Any item used in an operation can result in a retained surgical item, but sponges are the most frequent and the abdomen is the most common location. Retained sponges can cause significant morbidity, and the costs associated with both prevention and treatment of retained surgical items, including legal costs, can be considerable. This review will examine counting, teamwork, radiography, and new technology as methods used to prevent retained surgical items. Even though none of these techniques individually is likely to completely prevent retained surgical items, when used together the numbers can be reduced. PMID:22069210

Feldman, David L

2011-01-01

372

Raising a Pragmatic Army: Officer Education at the U.S. Army Command and General Staff College, 1946-1986  

E-print Network

operations and “improve the officer?s competence in his profession.”1 Historian William Skelton has observed, “an intellectual component is central to a professional orientation: a claim to the exclusive control of a body of specialized knowledge essential... and Abuse of Military History,” Parameters 11 (March 1981): 9-14. 2 William Skelton, An American Profession of Arms: The Army Officer Corps, 1784-1861 (Lawrence, KS: University Press of Kansas, 1992), 88. 3 Samuel P. Huntington, The Soldier and the State...

Stewart, Michael David

2010-04-23

373

Comparing the treatment results of proximal humerus fracture based on surgical or nonsurgical methods  

PubMed Central

Background: A common type of Humerus fractures is about proximal. This study aimed to compare the results of surgical and non-surgical methods in treatment the Fracture of Proximal Humerus for decisions based on high-performance and less side effect. Materials and Methods: This prospective clinical trial study was done on 114 patients 30-80 years old with proximal humerus fracture referred to the Isfahan hospital universities (Ayatollah Kashani and Al Zahra hospitals) in 2007-2012. They were divided into two groups of 57 and treated surgically or non-surgically. The self provided questionnaires were used to assess the consequences of the side effects. The patients returned for trial check up during 6 weeks, 3 months, 6 months and one year after intervention. Result: In two parts fracture with displacement, nonsurgical treatment had lead to more complications rather than surgical treatment. In three-parts fracture non-union was seen in nonsurgical method in 6 weeks and in surgical method in 3, 6 months and one year after treatment, malunion was seen more in nonsurgical method rather than surgical method. In four-part fracture none-union results was seen more in nonsurgical method in 6 weeks, 3 months and one year and in surgical method in 6 months after treatment, mal union was seen more in nonsurgical method rather than surgical method. Conclusion: The surgery in three and four parts fractures had fewer complications in the patients under 50 but not in the elders.

Nouraei, Mohammad Hadi; Majd, Davoud Amirian; Zamani, Fereshteh

2014-01-01

374

Advanced information processing system: The Army fault tolerant architecture conceptual study. Volume 1: Army fault tolerant architecture overview  

NASA Technical Reports Server (NTRS)

Digital computing systems needed for Army programs such as the Computer-Aided Low Altitude Helicopter Flight Program and the Armored Systems Modernization (ASM) vehicles may be characterized by high computational throughput and input/output bandwidth, hard real-time response, high reliability and availability, and maintainability, testability, and producibility requirements. In addition, such a system should be affordable to produce, procure, maintain, and upgrade. To address these needs, the Army Fault Tolerant Architecture (AFTA) is being designed and constructed under a three-year program comprised of a conceptual study, detailed design and fabrication, and demonstration and validation phases. Described here are the results of the conceptual study phase of the AFTA development. Given here is an introduction to the AFTA program, its objectives, and key elements of its technical approach. A format is designed for representing mission requirements in a manner suitable for first order AFTA sizing and analysis, followed by a discussion of the current state of mission requirements acquisition for the targeted Army missions. An overview is given of AFTA's architectural theory of operation.

Harper, R. E.; Alger, L. S.; Babikyan, C. A.; Butler, B. P.; Friend, S. A.; Ganska, R. J.; Lala, J. H.; Masotto, T. K.; Meyer, A. J.; Morton, D. P.

1992-01-01

375

Preliminary assessment report for Army Aviation Support Facility No. 3, Installation 13307, Hunter Army Airfield, Savannah, Georgia. Installation Restoration Program  

SciTech Connect

This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Georgia Army National Guard property located on Hunter Army Airfield (HAA) near Savannah, Georgia, known as Army Aviation Support Facility (AASF) No. 3. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The principal objective of the PA is to characterize the site accurately and determine the need for further action by examining site activities, types and quantities of hazardous substances utilized, the nature and amounts of wastes generated or stored at the facility, and potential pathways by which contamination could affect public health and the environment. This PA satisfies, for the AASF No. 3 property, requirements of the Department of Defense Installation Restoration Program (IRP). The scope of this assessment is limited to the facilities and past activities contained within the area now occupied by AASF No. 3. However, this assessment report is intended to be read in conjunction with a previous IRP assessment of HAA completed in 1992 (USATHAMA 1992) and to provide comprehensive information on AASF No. 3 for incorporation with information contained in that previous assessment for the entirety of HAA.

Kolpa, R.; Smith, K.

1993-07-01

376

[General surgery in Paramaribo University Hospital].  

PubMed

Specific health problems in Surinam include high prevalence of infections, mostly gastrointestinal infections in young children, malaria and injuries due to violence. The public health care and medical and surgical training are hampered by a lack of funds, as are most things in the country. Relatively much of the surgery in Paramaribo University Hospital in 1991-1998 was performed because of complications of a diabetic foot (128.17%) and breast lesions (76.10%). No scientific research is being carried out either in the hospital or at the faculty of Anton de Kom University. Retrospective registration of operations may give a new impulse to scientific research. PMID:10608979

Konsten, J; Ketele, P O; Girjasing, R; Kootstra, G

1999-11-27

377

Surgical Treatment of Atrial Myxomas  

PubMed Central

Twenty atrial myxomas were resected in 20 patients with the use of cardiopulmonary bypass, from the beginning of July 1966 through the end of June 1985, at Severance Hospital, Seoul, Korea. Nineteen patients had left atrial myxomas; 1 had a right atrial myxoma. Left atrial myxomas arose from the intra-atrial septum in 17 patients and from the left atrial appendage in 2 patients. The right atrial myxoma arose from the fossa ovalis. The 13 female and 7 male patients ranged in age from 14 to 63 years. Symptoms most often reported on presentation were those associated with mitral valve obstruction; other symptoms were associated with systemic embolization. The 1st 4 patients were tested with angiocardiography alone, and 3 of these were misdiagnosed. The last 16 were tested by angiocardiography, M-mode echocardiography, and 2-dimensional echocardiography, alone or in various combinations, and there were no further misdiagnoses. In our experience, 2-dimensional echocardiography was the most accurate method of diagnosing cardiac tumors. In 19 patients, surgical approach was through a median sternotomy; in the 20th patient, approach was through a left thoracotomy, due to a preoperative misdiagnosis of mitral stenosis. No intraoperative embolizations or deaths occurred. On follow-up of 17 patients during periods ranging from 6 months to 6 years, we had no late deaths, and only 2 patients suffered late complications: 1 had sudden right hemiparesis caused by an embolus 4 months after surgery (this improved upon conservative treatment); and 1 had a recurrence of tumor 3 years after surgery (the new myxoma was successfully resected). We conclude that patients who have undergone complete excision of benign myxomas now have an excellent prognosis, with minimal risk of intraoperative embolization and late recurrence. We conclude also that 2-dimensional echocardiography is an extremely accurate tool both in early diagnosis of intracardiac myxomas and in late follow-up after resection. (Texas Heart Institute Journal 1989;16:81-6) Images PMID:15227218

Cho, Bum Koo; Lee, Doo Yun; Pezzella, A. Thomas; Hong, Sung Nok; Hong, Pill Whoon

1989-01-01

378

Surgical treatment of endometriosis.  

PubMed

In this review, the pitfalls that still exist with the surgical treatment of endometriosisassociatedpelvic pain have been discussed and the best evidence regarding various aspects of surgical techniques have been reviewed. When laparoscopy is performed to evaluate a woman with pelvic pain symptoms, it is important she be counseled that the primary function of the surgery is to confirm the presence (and allow surgical treatment) of endometriosis, and that it is not the penultimate diagnostic modality for her pelvic pain. There are many etiologies of pelvic pain that present with symptoms resembling those of endometriosis-associated pelvic pain that are not diagnosable with laparoscopy, such as interstitial cystitis and irritable bowel syndrome. It is unfortunate that many women are left with the belief that if a laparoscopy fails to provide a diagnosis of a pain generator, then it means there are no diagnoses other than that the “pain is in her head,” often disparagingly termed “supratentorial” byclinicians. In fact, the pain-related diagnoses that are amenable to and possibly require a laparoscopy are quite limited, a group of diagnoses that this author terms the “dirty dozen” because there are just 12, and only the first 4 have good evidence to clearly associate them with chronic pelvic pain:1. Endometriosis 2. Ovarian remnant syndrome 3. Pelvic inflammatory disease 4. Tuberculous salpingitis 5. Adhesions 6. Benign cystic mesothelioma 7. Postoperative peritoneal cysts 8. Adnexal cysts (nonendometriotic)9. Chronic ectopic pregnancy 10. Endosalpingiosis 11. Residual accessory ovary 12. Hernias: ventral, inguinal, femoral, spigelian.I would argue that diagnostic laparoscopy in modern gynecology has a limited, if any role, and that when laparoscopy is planned for women with chronic pelvic pain, it should be with a very high suspicion of a diagnosis and with plans to treat the disease operatively. In this era, a negative diagnostic laparoscopy should be a rare event. PMID:22134016

Howard, Fred M

2011-12-01

379

Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes  

PubMed Central

AIM: To investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries (BDIs). METHODS: The study patients were enrolled from the pancreatobiliary units of a tertiary teaching hospital for the treatment of BDIs after hepatobiliary tract surgeries, excluding operations for liver transplantation and malignancies, from January 1999 to August 2010. A total of 5167 patients underwent operations, and 77 patients had BDIs following surgery. The primary end point was the treatment success rate according to different types of BDIs sustained using endoscopic or percutaneous hepatic approaches. The type of BDI was defined using one of the following diagnostic tools: endoscopic retrograde cholangiography, percutaneous transhepatic cholangiography, computed tomography scan, and magnetic resonance cholangiography. Patients with a final diagnosis of BDI underwent endoscopic and/or percutaneous interventions for the treatment of bile leak and/or stricture if clinically indicated. Patient consent was obtained, and study approval was granted by the Institutional Review Board in accordance with the legal regulations of the Human Clinical Research Center at the Seoul National University Hospital in Seoul, South Korea. RESULTS: A total of 77 patients were enrolled in the study. They were divided into three groups according to type of BDI. Among them, 55 patients (71%) underwent cholecystectomy. Thirty-six patients (47%) had bile leak only (type 1), 31 patients had biliary stricture only (type 2), and 10 patients had both bile leak and biliary stricture (type 3). Their initial treatment modalities were non-surgical. The success rate of non-surgical treatment in each group was as follows: BDI type 1: 94%; type 2: 71%; and type 3: 30%. Clinical parameters such as demographic factors, primary disease, operation method, type of operation, non-surgical treatment modalities, endoscopic procedure steps, type of BDI, time to diagnosis and treatment duration were evaluated to evaluate the prognostic factors affecting the success rate. The type of BDI was a statistically significant prognostic factor in determining the success rate of non-surgical treatment. In addition, a shorter time to diagnosis of BDI after the operation correlated significantly with higher success rates in the treatment of type 1 BDIs. CONCLUSION: Endoscopic or percutaneous hepatic approaches can be used as an initial treatment in type 1 and 2 BDIs. However, surgical intervention is a treatment of choice in type 3 BDI. PMID:24944484

Eum, Young Ook; Park, Joo Kyung; Chun, Jaeyoung; Lee, Sang-Hyub; Ryu, Ji Kon; Kim, Yong-Tae; Yoon, Yong-Bum; Yoon, Chang Jin; Han, Ho-Seong; Hwang, Jin-Hyeok

2014-01-01

380

Surgical management of spasticity.  

PubMed

Intractable and severe spasticity in childhood has the ability to impact on the quality of life, function and care of the child. Where medical and physical measures have proved insufficient, a surgical approach may be pursued. Irrespective of the underlying pathology, intrathecal baclofen will reduce spasticity in a controllable and reversible fashion, whereas selective dorsal rhizotomy is reserved for the management of bilateral cerebral palsy due to early birth. Owing to the potential for complications of intrathecal baclofen and the permanence of selective dorsal rhizotomy, careful selection and preparation are required to produce satisfactory results. PMID:24432100

Roberts, Andrew

2013-11-01

381

Plastic surgery in a rural African hospital: spectrum and implications.  

PubMed Central

A review of general surgical work undertaken at a large bush hospital in Africa revealed a high proportion (16-19%) of reconstructive/plastic cases. The reasons for this are discussed, together with the feasibility of current reconstructive techniques in such a situation in the developing world. The implications for future surgical planning and the training of surgeons for developing countries are discussed. PMID:3947014

Goodacre, T. E.

1986-01-01

382

Telemedicine in the U.S. Army: case reports from Somalia and Croatia.  

PubMed

Recent advances in information systems technology improved the abilities of U.S. Army physicians in Somalia and Croatia to obtain clinical consults from U.S. Army Medical Centers in Germany and Washington, D.C. Through commercial satellite transmission of voice, facsimile, and high-resolution still, digital images, the Remote Clinical Communications System (RCCS) has expanded the Army Medical Department's means to provide better healthcare to our armed forces. This paper describes the RCCS technology and illustrates, through specific case reports, how this telemedicine system helped the Army Medical Department accomplish its mission during overseas deployments. PMID:10165326

Crowther, J B; Poropatich, R

1995-01-01

383

The 1991 Department of the Army Service Response Force exercise: Procedural Guide SRFX-91  

SciTech Connect

This procedural guide was written to assist the US Army in planning for a chemical emergency exercise at Tooele Army Depot in Utah. The roles of various members of the emergency response community are described for various accident scenarios, and the relationships between the various responders are identified. For the June 1991 exercise at Tooele, the emergency response community includes the command structure at Tooele Army Depot; the US Army Service Response Force and other Department of Defense agencies; emergency response personnel from Tooele, Salt Lake, and Utah counties and municipal governments; the Utah Comprehensive Emergency Management Agency and other state agencies; and various federal agencies.

Madore, M.A.; Thomson, R.S.; Haffenden, R.A.; Baldwin, T.E.; Meleski, S.A.

1991-09-01

384

Asking Questions: Information Needs in a Surgical Intensive Care Unit Madhu C. Reddy M.S.1  

E-print Network

Asking Questions: Information Needs in a Surgical Intensive Care Unit Madhu C. Reddy M.S.1 , Wanda-rich environment of hospitals, health-care providers face challenges in addressing their various information needs. Through a study of a patient-care team in a terti- ary care Surgical Intensive Care Unit (SICU), we

Dourish,Paul

385

Pilferage of controlled substances in hospitals.  

PubMed

The incidence of pilferage of controlled substances and the systems of monitoring and surveillance of controlled substances in hospitals were studied. A questionnaire was mailed to a random samples of 285 pharmacy directors in short-term medical and surgical hospitals nationwide. Of the 162 respondents, 103 (64%) reported at least one documented or suspected case of pilferage in the past year. These 103 hospitals reported 352 separate incidence of controlled substances theft involving 11,285 dosage units. Drug diversion occurred in 76% of the hospitals with more than 100 beds and in only 28% of the hospitals with less than 100 beds. Nurses were implicated in 69% of the incidents; pharmacists and pharmacy technicians in 12%; housekeeping personnel in 4.7%; unit-ward clerks in 3.5%; and physicians in 2.4%. These incidents most frequency involved: meperidine, morphine, cocaine, oxycodone, hydromorphone, propoxyphene, pentazocine, diazepam, and codeine products. Larger hospitals, those with more frequent inventory audits, those that disperse controlled substances throughout their drug stock, and those that have more pharmacy personnel involved in the distribution of controlled substances all had a relatively higher incidence of pilferage. It was concluded that a substantial amount of pilferage of controlled substances occurs in hospitals and that more stringent methods of control and surveillance are needed. PMID:7258197

Hoover, R C; McCormick, W C; Harrison, W L

1981-07-01

386

Disposable products in the hospital waste stream.  

PubMed Central

Use of disposable products in hospitals continues to increase despite limited landfill space and dwindling natural resources. We analyzed the use and disposal patterns of disposable hospital products to identify means of reducing noninfectious, nonhazardous hospital waste. In a 385-bed private teaching hospital, the 20 disposable products of which the greatest amounts (by weight) were purchased, were identified, and total hospital waste was tabulated. Samples of trash from three areas were sorted and weighed, and potential waste reductions from recycling and substituting reusable items were calculated. Business paper, trash liners, diapers, custom surgical packs, paper gowns, plastic suction bottles, and egg-crate pads were among the 20 top items and were analyzed individually. Data from sorted trash documented potential waste reductions through recycling and substitution of 78, 41, and 18 tonnes per year (1 tonne = 1,000 kg = 1.1 tons) from administration, the operating room, and adult wards, respectively (total hospital waste was 939 tonnes per year). We offer specific measures to substantially reduce nonhazardous hospital waste through substitution, minimization, and recycling of select disposable products. Images PMID:1595242

Gilden, D. J.; Scissors, K. N.; Reuler, J. B.

1992-01-01

387

Surgical Scar Revision: An Overview  

PubMed Central

Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods. PMID:24761092

Garg, Shilpa; Dahiya, Naveen; Gupta, Somesh

2014-01-01

388

Asking Questions: Information Needs in a Surgical Intensive Care Unit  

Microsoft Academic Search

Even in the information-rich environment of hospitals, health-care providers face challenges in addressing their various information needs. Through a study of a patient-care team in a terti- ary care Surgical Intensive Care Unit (SICU), we expanded our understanding of health-care providers' information needs in two important ways. First, the study focused on a patient-care team instead of individual health-care providers.

Madhu C. Reddy; Wanda Pratt; Paul Dourish; M. Michael

2002-01-01

389

Surgical treatment of perianal and perineal hidradenitis suppurativa  

Microsoft Academic Search

Conclusion  One hundred four patients who had perianal and perineal hidradenitis suppurativa were treated with early, extensive and complete\\u000a surgical excision; longterm results were excellent, hospital stays were short, and the recurrence rate was low. All wounds\\u000a were allowed to heal by secondary granulation. No antibiotics were administered, there was no split-thickness skin grafting,\\u000a and a diverting colostomy was used in

Joseph P. Thornton; Herand Abcarian

1978-01-01

390

[The surgical treatment of extrahepatic bile duct lithiasis].  

PubMed

Data concerning operative treatment of 227 patients with lithiasis of the extrahepatic biliary ducts, covering an eleven-year period (1985 to 1995 inclusive), are presented. In all cases diagnosis and operation are done in the Second Surgical Clinic at the Medical University--State University Hospital "Alexandrovska"--Sofia. By type the surgical interventions are distributed as follows: external drainage of hepaticocholedochus--122 cases (53.74 per cent), choledochoduodenostomy 69 (30.39 per cent) and transduodenal papillosphincterotomy 36 (15.85 per cent). Fifteen patients develop postoperative complications (6.60 per cent), and in five patients the outcome is fatal with postoperative lethality amounting to 2.20 per cent. The basic indications for the various types of surgical interventions are established. PMID:9974032

Maruf, M; Baev, S

1998-01-01

391

Epidemiology and prevention of surgical site infections after cardiac surgery.  

PubMed

Deep sternal wound infection is the major infectious complication in patients undergoing cardiac surgery, associated with a high morbidity and mortality rate, and a longer hospital stay. The most common causative pathogen involved is Staphylococcus spp. The management of post sternotomy mediastinitis associates surgical revision and antimicrobial therapy with bactericidal activity in blood, soft tissues, and the sternum. The pre-, per-, and postoperative prevention strategies associate controlling the patient's risk factors (diabetes, obesity, respiratory insufficiency), preparing the patient's skin (body hair, preoperative showering, operating site antiseptic treatment), antimicrobial prophylaxis, environmental control of the operating room and medical devices, indications and adequacy of surgical techniques. Recently published scientific data prove the significant impact of decolonization in patients carrying nasal Staphylococcus aureus, on surgical site infection rate, after cardiac surgery. PMID:23988675

Lepelletier, D; Bourigault, C; Roussel, J C; Lasserre, C; Leclère, B; Corvec, S; Pattier, S; Lepoivre, T; Baron, O; Despins, P

2013-10-01

392

Pensions and Retirement Among Black Union Army Veterans  

PubMed Central

I examine the effects of an unearned income transfer on the retirement rates and living arrangements of black Union Army veterans. I find that blacks were more than twice as responsive as whites to income transfers in their retirement decisions and 6 to 8 times as responsive in their choice of independent living arrangements. My findings have implications for understanding racial differences in rates of retirement and independent living at the beginning of the twentieth century, the rise in retirement prior to 1930, and the subsequent convergence in black-white retirement rates and living arrangements. PMID:21179379

Costa, Dora L.

2010-01-01

393

Consolidation of data base for Army generalized missile model  

NASA Technical Reports Server (NTRS)

Data from plume interaction tests, nose mounted canard configuration tests, and high angle of attack tests on the Army Generalized Missile model are consolidated in a computer program which makes them readily accessible for plotting, listing, and evaluation. The program is written in FORTRAN and will run on an ordinary minicomputer. It has the capability of retrieving any coefficient from the existing DATAMAN tapes and displaying it in tabular or plotted form. Comparisons of data taken in several wind tunnels and of data with the predictions of Program MISSILE2 are also presented.

Klenke, D. J.; Hemsch, M. J.

1980-01-01

394

America's Atomic Army: The Historical Archaeology of Camp Desert Rock  

SciTech Connect

Established in 1951, Camp Desert Rock served as the training ground for America's 'Atomic Army'. For the next six years, U.S. ground troops traveled to the Nevada desert to participate in military maneuvers during atmospheric atomic weapons testing. Nearly 60,000 soldiers received physical and psychological training in atomic warfare. Abandoned when atmospheric testing ended, Camp Desert Rock was dismantled and its buildings moved to other locations. Today, the camp appears as a sterile expanse of desert marked by rock-lined tent platforms, concrete foundations, and trash scatters. Although visually unimposing, the site is rich with the history of America's nuclear testing program.

Susan R. Edwards

2007-11-02

395

[Aspects of development of surgical service of modem Navy].  

PubMed

The article is devoted to the aspects of a current state of surgical service in the Navy, prospects of development of professianl training for navy surgeons, formation of modern training comlex, united electronic library, containig the issues about combat surgical trauma, software technologies, realizing of the application methodology during the process of training and practical activity for the development of the training system for surgeons of Navy and improvement of effectiveness. Formation of normative technical documents, regulating activity of navy surgians is also among the expectations. The authors also touched on the issues of development of modern technologies in bone grafting with the help of domestic implants based on the osteoinductive nanostructured nonorganic matrices (titanium) with defined structure and composition. Department of navy and hospital surgery participate in this debelopment. Due to increased amount of oncologic patients, it was decided to establish the Cancer Center of the Ministry of Defense based on department of navy and hospital surgery of the Kirov Military Medical Academy. It makes possible to perform the following procedures: canser surgery; surgical repair; plastic repair of major vessels, bone and soft tissue grafting, removal of residual cancer cells with the help of loco-regional methods of hyperthermic intracavitary and intravascular chemoperfusion; diagnostics and treatment of recurrent tumors (surgical and radiation treatment, systemic chemotherapy, loco-regional chemoembolization. Each of the given methods help to develop and improve the innovation technologies. PMID:24000638

Kabanov, M Iu; Ga?dash, A A; Rukhliada, N V; Solov'ev, I A; Titov, R V; Utochkin, A P; Smirnov, S I; Smolin, N V; Tiurin, M V

2013-06-01

396

[Croatian guidelines for perioperative enteral nutrition of surgical patients].  

PubMed

Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals. PMID:25327004

Zeli?, Marko; Bender, Darija Vranesi?; Keleci?, Dina Ljubas; Zupan, Zeljko; Cicvari?, Tedi; Maldini, Branka; Durut, Iva; Raheli?, Velimir; Skegro, Mate; Majerovi?, Mate; Perko, Zdravko; Susti?, Alan; Madzar, Tomislav; Kovaci?, Borna; Kekez, Tihomir; Krznari?, Zeljko

2014-01-01

397

Factors influencing the diagnostic accuracy and management in acute surgical patients  

PubMed Central

AIM: To evaluate the diagnostic accuracy (DA) in acute surgical patients admitted to a District General Hospital. METHODS: The case notes of all acute surgical patients admitted under the surgical team for a period of two weeks were reviewed for the data pertaining to the admission diagnoses, relevant investigations and final diagnoses confirmed by either surgery or various other diagnostic modalities. The diagnostic pathway was recorded from the source of referral [general practitioner (GP), A and E, in-patient] to the correct final diagnosis by the surgical team. RESULTS: Forty-one patients (23 males) with acute surgical admissions during two weeks of study period were evaluated. The mean age of study group was 61.05 ± 23.24 years. There were 111 patient-doctor encounters. Final correct diagnosis was achieved in 85.4% patients. The DA was 46%, 44%, 50%, 33%, 61%, 61%, and 75% by GP, A and E, in-patient referral, surgical foundation year-1, surgical senior house officer (SHO), surgical registrar, and surgical consultant respectively. The percentage of clinical consensus diagnosis was 12%. Surgery was performed in 48.8% of patients. Sixty-seven percent of GP-referred patients, 31% of A and E-referred, and 25% of the in-patient referrals underwent surgery. Surgical SHO made the most contributions to the primary diagnostic pathway. CONCLUSION: Approximately 85% of acute surgical patients can be diagnosed accurately along the diagnostic pathway. Patients referred by a GP are more likely to require surgery as compared to other referral sources. Surgical consultant was more likely to make correct surgical diagnosis, however it is the surgical SHO that contributes the most correct diagnoses along the diagnostic pathway. PMID:25429324

Sajid, Muhammad Shafique; Hollingsworth, Thaddeus; McGlue, Mike; Miles, William FA

2014-01-01

398

75 FR 9102 - Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States...  

Federal Register 2010, 2011, 2012, 2013, 2014

...Recovery of Cost of Hospital and Medical Care...Authority AGENCY: Department of Justice. ACTION...delegated to heads of departments and agencies of...the furnishing of hospital, medical, surgical...delegated to the departments and agencies of...the furnishing of hospital, medical,...

2010-03-01

399

Surgical robot system for single-port surgery with novel joint mechanism.  

PubMed

Single-port surgery is a new surgical method performed by inserting several surgical tools and a laparoscope through an umbilical incision. Compared with conventional laparoscopic surgery, the smaller incision in this procedure produces a lower amount of trauma, which leads to shorter hospitalization. However, with the current laparoscopic tools and surgical robots, the surgeon must overcome several difficulties, such as a limited range of motion and collisions between the surgical instruments and the laparoscope. This paper proposes a new surgical robot system for single-port surgery that uses a novel joint mechanism. The proposed joint mechanism is suitable for surgical instruments with multiple degrees of freedom (DOF). Thus, it can prevent hysteresis of the joint and achieve more accurate motion with a large force. A 6-DOF surgical instrument with this joint mechanism can avoid collisions between surgical tools or arms and approach the surgical target more easily than a conventional straight surgical tool. The external arm with 2-DOF passive joints can extend the workspace of the system during surgery. Preliminary tests and validations were performed with a prototype of the system. PMID:23358948

Shin, Won-Ho; Kwon, Dong-Soo

2013-04-01

400

Improving Prediction of Surgical Site Infection Risk with Multilevel Modeling  

PubMed Central

Background Surgical site infection (SSI) surveillance is a key factor in the elaboration of strategies to reduce SSI occurrence and in providing surgeons with appropriate data feedback (risk indicators, clinical prediction rule). Aim To improve the predictive performance of an individual-based SSI risk model by considering a multilevel hierarchical structure. Patients and Methods Data were collected anonymously by the French SSI active surveillance system in 2011. An SSI diagnosis was made by the surgical teams and infection control practitioners following standardized criteria. A random 20% sample comprising 151 hospitals, 502 wards and 62280 patients was used. Three-level (patient, ward, hospital) hierarchical logistic regression models were initially performed. Parameters were estimated using the simulation-based Markov Chain Monte Carlo procedure. Results A total of 623 SSI were diagnosed (1%). The hospital level was discarded from the analysis as it did not contribute to variability of SSI occurrence (p ?=?0.32). Established individual risk factors (patient history, surgical procedure and hospitalization characteristics) were identified. A significant heterogeneity in SSI occurrence between wards was found (median odds ratio [MOR] 3.59, 95% credibility interval [CI] 3.03 to 4.33) after adjusting for patient-level variables. The effects of the follow-up duration varied between wards (p<10?9), with an increased heterogeneity when follow-up was <15 days (MOR 6.92, 95% CI 5.31 to 9.07]). The final two-level model significantly improved the discriminative accuracy compared to the single level reference model (p<10?9), with an area under the ROC curve of 0.84. Conclusion This study sheds new light on the respective contribution of patient-, ward- and hospital-levels to SSI occurrence and demonstrates the significant impact of the ward level over and above risk factors present at patient level (i.e., independently from patient case-mix). PMID:24835189

Saunders, Lauren; Perennec-Olivier, Marion; Jarno, Pascal; L’Hériteau, François; Venier, Anne-Gaëlle; Simon, Loïc; Giard, Marine; Thiolet, Jean-Michel; Viel, Jean-François

2014-01-01

401

Science Nation: Surgical Robots  

NSDL National Science Digital Library

The da Vinci Surgical System has two main components. On top of the operating table is a device that has four arms. It looks like a giant insect that hovers right on top of the patient. Those arms are inserted into the patient through small incisions. In the simplest terms, it's really virtual reality crossing paths with surgery. The surgeon views a magnified 3-D high-resolution image of the operative site. The surgeon puts his hands in levers and as his hands move the levers, those levers translate his movements into precise movements by the arms of the robot. The surgeon "sees" and can "feel" movement and force of things like cutting and stitching as he watches it in 3-D.

402

Hospital Charges of Potentially Preventable Pediatric Hospitalizations  

PubMed Central

Objectives Reducing the number of preventable hospitalizations represents a possible source of healthcare savings. However, the current literature lacks a description of the extent of potentially preventable pediatric hospitalizations. The study objectives are to (1) identify the charges and (2) demographic characteristics associated with potentially preventable pediatric hospitalizations. Methods Secondary analysis of the 2006 Kids’ Inpatient Database (weighted N=7,558,812). ICD-9-CM codes for 16 previously validated pediatric ambulatory care-sensitive (ACS) conditions identified potentially preventable hospitalizations; seven additional conditions reflected updated care guidelines. Outcome variables included number of admissions, hospitalization days, and hospital charges. Demographic and diagnostic variables associated with an ACS condition were compared with regression analyses using appropriate person-level weights. Results Pediatric ACS hospitalizations totaled $4.05B in charges and 1,087,570 hospitalization days in 2006. Two respiratory conditions—asthma and bacterial pneumonia—comprised 48.4% of ACS hospital charges and 46.7% of ACS hospitalization days. In multivariate analysis, variables associated with an ACS condition included: male gender (OR: 1.10; 95% CI: 1.07–1.13); race/ethnicity of black (OR: 1.22; 95% CI: 1.16–1.27) or Hispanic (OR: 1.12; 95% CI: 1.06–1.18); and emergency department (ED) as admission source (OR: 1.37; 95% CI: 1.27–1.48). Conclusions Respiratory conditions comprised the largest proportion of potentially preventable pediatric hospitalizations, totaling as much as $1.96B in hospital charges. Children hospitalized with an ACS condition tend to be male, non-white, and admitted through the ED. Future research to prevent pediatric hospitalizations should examine targeted interventions in the primary care setting, specifically around respiratory conditions and minority populations. PMID:22922047

Lu, Sam; Kuo, Dennis Z.

2014-01-01

403

Product and equipment strategies for surgical services.  

PubMed

One of the most difficult challenges a materiel manager can face is designing different programs to support materiel management services for specific clinical and ancillary areas of the hospital. While basic service standards for purchasing and logistic services should exist for all areas, a large part of how effective a materiel management department is depends on customized program development. In other words, fine tuning services to major customers, such as the Operating Room, can mean the difference between simply filling supply orders and aggressive cost control. This article reviews how Baystate Medical Center (Springfield, MA) maintains consistency in standardizing materiel services while adapting to the requirements of individual departments, such as Surgical Services. PMID:10144004

Mauro, C

1995-07-01

404

MEMS-based phased arrays for army applications  

NASA Astrophysics Data System (ADS)

The Army Aviation and Missile Research, Development, and Engineering Center (AMRDEC) initiated a research and development project several years ago to develop Micro Electro-Mechanical Systems (MEMS)-based phased arrays to provide rapid beam steering for sensors, optical and Radio Frequency (RF) missile seekers, and RF communication links. In particular, the joint AMRDEC/Army Research Laboratory (ARL) project, which leverages low-cost phased array components developed under the Defense Advanced Research Projects Agency (DARPA) Low Cost Cruise Missile Defense (LCCMD) project, is developing RF switches, phase shifters, and passive phased sub-arrays to provide a fast scanning capability for pointing, acquisition, tracking, and data communication; and rugged, optical MEMS-based phased arrays to be employed in small volume, low-cost Laser Detection and Ranging (LADAR) seekers. The current status of the project is disclosed in this paper. Critical technical challenges, which include design and fabrication of the RF switches and phase shifters, design and fabrication of micro lens arrays, control of beam steering, scanning angular resolution and array losses, are discussed. Our approach to overcoming the technical barriers and achieving required performance is also discussed. Finally, the validity of a MEMS technology approach against competing low cost technologies is presented.

Ruffin, Paul B.; Holt, James C.; Mullins, James H.; Hudson, Tracy; Rock, Janice

2007-04-01

405

Exploiting social media for Army operations: Syrian crisis use case  

NASA Astrophysics Data System (ADS)

Millions of people exchange user-generated information through online social media (SM) services. The prevalence of SM use globally and its growing significance to the evolution of events has attracted the attention of the Army and other agencies charged with protecting national security interests. The information exchanged in SM sites and the networks of people who interact with these online communities can provide value to Army intelligence efforts. SM could facilitate the Military Decision Making Process by providing ongoing assessment of military actions from a local citizen perspective. Despite potential value, there are significant technological barriers to leveraging SM. SM collection and analysis are difficult in the dynamic SM environment and deception is a real concern. This paper introduces a credibility analysis approach and prototype fact-finding technology called the "Apollo Fact-finder" that mitigates the problem of inaccurate or falsified SM data. Apollo groups data into sets (or claims), corroborating specific observations, then iteratively assesses both claim and source credibility resulting in a ranking of claims by likelihood of occurrence. These credibility analysis approaches are discussed in the context of a conflict event, the Syrian civil war, and applied to tweets collected in the aftermath of the Syrian chemical weapons crisis.

Kase, Sue E.; Bowman, Elizabeth K.; Al Amin, Tanvir; Abdelzaher, Tarek

2014-05-01

406

The US Army Foreign Comparative Test fuel cell program  

NASA Astrophysics Data System (ADS)

The US Army RDECOM initiated a Foreign Comparative Test (FCT) Program to acquire lightweight, high-energy dense fuel cell systems from across the globe for evaluation as portable power sources in military applications. Five foreign companies, including NovArs, Smart Fuel Cell, Intelligent Energy, Ballard Power Systems, and Hydrogenics, Inc., were awarded competitive contracts under the RDECOM effort. This paper will report on the status of the program as well as the experimental results obtained from one of the units. The US Army has interests in evaluating and deploying a variety of fuel cell systems, where these systems show added value when compared to current power sources in use. For low-power applications, fuel cells utilizing high-energy dense fuels offer significant weight savings over current battery technologies. This helps reduce the load a solider must carry for longer missions. For high-power applications, the low operating signatures (acoustic and thermal) of fuel cell systems make them ideal power generators in stealth operations. Recent testing has been completed on the Smart Fuel Cell A25 system that was procured through the FCT program. The "A-25" is a direct methanol fuel cell hybrid and was evaluated as a potential candidate for soldier and sensor power applications.

Bostic, Elizabeth; Sifer, Nicholas; Bolton, Christopher; Ritter, Uli; Dubois, Terry

407

Effect of Formalin Fixation on Surgical Margins in Breast Cancer Surgical Specimen  

PubMed Central

Margin analysis in breast surgery is an important predictor of local recurrence and can have vital impact on the postoperative treatment planning. Objective. The aim was to assess the mean reduction in the closest tumor-free surgical margin in millimeters of breast cancer specimens following formalin fixation. Materials and Methods. We conducted a cross-sectional study at the Aga Khan University Hospital from March 30, 2010 to January 20, 2011. One hundred consecutive breast tumour surgical specimens which had macroscopically visible tumour were included. The cancer type included both in situ and invasive cancers. Excluded were the patients who had previous surgery or systemic/radiation therapy. The closest tumor-free margin was recorded and compared with the margin after formalin fixation. P value of <0.05 was considered significant. Results. The mean age of our 100 patients was 53 years with the majority of the patients having undergone mastectomy for predominantly invasive ductal carcinoma. Following formalin fixation, the mean reduction of the closest tumor-free margin was noted as 2.14?mm which was found statistically significant. Conclusion. Considerable shrinkage of tumor-free surgical margins of breast cancer specimen was noted after formalin fixation. This inference can have implications on the postoperative management plan. PMID:25349738

Zaidi, Masooma; Khan, Shaista; Farooqi, Najiha Bilal; Abbas, Kashif; Idrees, Romana

2014-01-01

408

PrimaryChildrensHospital  

Cancer.gov

Located in the foothills of the Wasatch Mountains, Primary Children's Hospital is the children's hospital for Utah, Idaho, Wyoming, Nevada, and Montana. Our 289-bed hospital is equipped and staffed to care for children with complex illness and injury. Primary Children's is owned by Intermountain Healthcare and is the pediatric specialty teaching hospital for the University Of Utah School of Medicine.

409

Measuring Rural Hospital Quality  

ERIC Educational Resources Information Center

Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…

Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid

2004-01-01

410

Development and Use of Baseline Monthly Utility Models for Eight Army Installations Around the United States  

E-print Network

to clean data from one Army base provided by USACERL. The objectives of the current study were: (1) to evaluate the methodology when used with monthly mean temperature data and "uncleaned" data available from a central Army database; and (2) to prepare a...

Reddy, T. A.; Saman, N. F.; Claridge, D. E.; Haberl, J. S.; Turner, W. D.

1996-01-01

411

Quality of Life as Perceived by 30 Year Old Army Veterans. Technical Paper No. 263.  

ERIC Educational Resources Information Center

An intensive investigation of the impact Army service has had on the quality of life for a representative sample of young Americans is analyzed in terms of possible improvement in Army personnel procedures. A total of 166 men (of a potential 200) and 49 women (of a potential 50) were interviewed. The information from these interviews; a review of…

Wilson, Sandra Reitz; And Others

412

The Effects of Head-Supported Mass on the Risk of Neck Injury in Army Personnel  

Microsoft Academic Search

hroughout the evolution of military helmet systems, the amount of head-supported mass (HSM) worn by Army personnel has steadily increased. The U.S. Army Aeromedical Research Laboratory is working to establish recommended limits and guidelines for HSM that can be worn safely by soldiers. To support this effort, crash sled tests were conducted at APL's Impact Biomechanics Facility. These tests, simulating

Andrew C. Merkle; Michael Kleinberger; O. Manuel Uy

413

Printing Services APD provides printing services for Army customers through the Defense Logistics  

E-print Network

Printing Services APD provides printing services for Army customers through the Defense Logistics) or a DD Form 282 (DOD Printing Requisition/Order) to the APD Printing Support Branch (usarmy.pentagon.hqda- apd.mbx.printing-management-branch@mail.mil). Army customers outside of OA22 need to submit a DD Form

US Army Corps of Engineers

414

Learning under Conditions of Hierarchy and Discipline: The Case of the German Army, 1939-1940  

ERIC Educational Resources Information Center

To survive in and adapt to dynamic, turbulent, and complex environments, organizations need to engage in learning. This truism is particularly relevant for army organizations in times of war and armed conflict. In this article a case of army operations during World War II is analyzed on the basis of Ortenblad's integrated model of the learning…

Visser, Max

2008-01-01

415

US Army Weapon Systems Human-Computer Interface (WSHCI) style guide, Version 1  

SciTech Connect

A stated goal of the U.S. Army has been the standardization of the human computer interfaces (HCIS) of its system. Some of the tools being used to accomplish this standardization are HCI design guidelines and style guides. Currently, the Army is employing a number of style guides. While these style guides provide good guidance for the command, control, communications, computers, and intelligence (C4I) domain, they do not necessarily represent the more unique requirements of the Army`s real time and near-real time (RT/NRT) weapon systems. The Office of the Director of Information for Command, Control, Communications, and Computers (DISC4), in conjunction with the Weapon Systems Technical Architecture Working Group (WSTAWG), recognized this need as part of their activities to revise the Army Technical Architecture (ATA). To address this need, DISC4 tasked the Pacific Northwest National Laboratory (PNNL) to develop an Army weapon systems unique HCI style guide. This document, the U.S. Army Weapon Systems Human-Computer Interface (WSHCI) Style Guide, represents the first version of that style guide. The purpose of this document is to provide HCI design guidance for RT/NRT Army systems across the weapon systems domains of ground, aviation, missile, and soldier systems. Each domain should customize and extend this guidance by developing their domain-specific style guides, which will be used to guide the development of future systems within their domains.

Avery, L.W.; O`Mara, P.A.; Shepard, A.P.

1996-09-30

416

The Roles of Women in the Army and Their Impact on Military Operations and Organizations.  

ERIC Educational Resources Information Center

Problems inherent in the expanded utilization of female soldiers in the U.S. Army are numerous. Attitudes of a wide sample of Army personnel, men and women, enlisted and officer, were surveyed pertaining to those problems. Some problems such as uniforms, billeting, assignments, and training are obvious and with proper planning can and will be…

Batts, John H.; And Others

417

GRIZZLY BEAR USE OF ARMY CUTWORM MOTHS IN THE YELLOWSTONE ECOSYSTEM  

Microsoft Academic Search

The ecology of alpine aggregations of army cutworm moths (Euxoa auxiliaris) and the feeding behavior of grizzly bears (Ursus arctos horribilis) at these areas were studied in the Yellowstone ecosystem from 1988 to 1991. Army cutworm moths migrate to mountain regions each summer to feed at night on the nectar of alpine and subalpine flowers, and during the day they

STEVEN P. FRENCH; MARILYNN G. FRENCH; RICHARD R. KNIGHT

418

Educating the U.S. Army: Arthur L. Wagner and Reform, 1875-1905.  

ERIC Educational Resources Information Center

Arthur Lockwood Wagner, who graduated from West Point in 1876, was one of the best known and most influential U.S. Army officers of his day. An intellectual and educator, Wagner was instrumental in some of the most critical reforms in U.S. Army history. He advocated enhanced military education, adopting modern combat techniques, holding…

Brereton, T. R.

419

One surgeon's Army experience with "wound shock" from Pearl Harbor to the present.  

PubMed

The Army has had extensive experience in the study and treatment of shock, beginning with the American Civil War and continuing to the present. This is the story of one Army surgeon's experience, both in research and treatment of shock, from Pearl Harbor to the present. PMID:19780369

Hardaway, Robert M

2009-09-01

420

The Army's Search for Tomorrow--Why Not a Domestic Service Corps.  

ERIC Educational Resources Information Center

The document reviews the basic question whether the Army could administer a modern day version of the Civilian conservation Corps (Domestic Service Corps) without reducing its contribution to the national defense effort. The Domestic Service Corps (DSC) would combine unemployed youth and Army managerial talent to resolve the urban and…

Putnam, Carl M.

421

Prior Health Care Utilization Patterns and Suicide among U.S. Army Soldiers  

ERIC Educational Resources Information Center

Suicides among U.S. Army soldiers are increasing and, in January 2009, outpaced deaths due to combat. For this study, 1,873 army suicides identified through death, inpatient, and emergency room records were matched with 5,619 controls. In multivariate models, older, male, White, single, and enlisted soldiers with a prior injury (OR = 2.04, 95% CI…

Bell, Nicole S.; Harford, Thomas C.; Amoroso, Paul J.; Hollander, Ilyssa E.; Kay, Ashley B.

2010-01-01

422

Suicide in the U.S. Army: Epidemiological and Periodic Aspects.  

ERIC Educational Resources Information Center

Presents overview of suicide in the United States Army, including epidemiology of army suicides and temporal aspects of those suicides compared with the data for the United States as a whole. Documents some of the changes in contemporary military suicide rates compared to those of the past century. Examined cycles in the number of suicides by day…

Rothberg, Joseph M.; Jones, Franklin D.

1987-01-01

423

77 FR 30376 - Amendment of Restricted Area R-2101; Anniston Army Depot, AL  

Federal Register 2010, 2011, 2012, 2013, 2014

...the using agency releases R-2101 during periods when...action amends Title 14, Code of Federal Regulations...designation for restricted area R-2101, Anniston Army...21 [Amended] * * * * * R-2101 Anniston Army Depot...5-22-12; 8:45 am] BILLING CODE...

2012-05-23

424

Risk management and its practical application: lessons from the British Army  

Microsoft Academic Search

This study explores, using predominately qualitative data, the risk management approaches of British Army officers in operational theatre. Risks within an operational context are particularly challenging for the British Army to manage due to external constraints such as its adherence to various rules of engagement and international conventions such as the Geneva Convention that consists of treaties that clearly articulate

Neil Trewin; Udechukwu Ojiako; Johnnie Johnson

2010-01-01

425

The Department of the Army Social Work Service Management Information System (family advocacy)  

Microsoft Academic Search

The Social Work Service Management Information System (SWSMIS) is an automated clinical case record and case management system for the Department of the Army and the US Army Medical Command (MEDCOM) Family Advocacy Program (FAP). Development is ongoing at the European Medical Command (ERMC) and moved to the continental United States (CONUS) in August 1998. If accepted by the US

K. Ekwurzel

1998-01-01

426

PATROLLING THE HOMEFRONT: THE EMOTIONAL LABOR OF ARMY WIVES VOLUNTEERING IN FAMILY READINESS GROUPS  

E-print Network

' contributions to the success of their husbands' careers in a two-for-one career pattern--two workers for one paycheck. The Army made such expectations official when in 1988 it began to require volunteer labor to run each unit's FRG. The Army tasks FRGs...

Gassmann, Jaime Nicole Noble

2010-08-30

427

Midgard Worms: Sudden Nasty Surprises from a Large Resilient Zombie Army  

Microsoft Academic Search

Future network intruders will probably use a zombie army to deliver many different attacks, rather than recruiting a new army per attack. We describe a Midgard Worm, which can build an extremely resilient and scalable overlay network to deliver attack code quickly. The worm's master could disseminate a 1-megabyte exploit or upgrade to a million zombies from any zombie in

Peter Reiher; Jun Li; Geoff Kuenning

2004-01-01

428

Midgard Worms: Sudden Nasty Surprises from a Large Resilient Zombie Army  

E-print Network

1 Midgard Worms: Sudden Nasty Surprises from a Large Resilient Zombie Army Peter Reiher reiher University of Oregon Harvey Mudd College Abstract Future network intruders will probably use a zombie army. The worm's master could disseminate a 1-megabyte exploit or upgrade to a million zombies from any zombie

Li, Jun

429

Victims of child abuse and neglect in the U.S. army  

Microsoft Academic Search

Objective: The two main objectives of the study were: (1) to contrast child maltreatment victim rates in U.S. Army and civilian populations; (2) to identify the demographic characteristics of Army children at increased risk for the following types of child maltreatment: major physical abuse, minor physical abuse, emotional maltreatment, sexual maltreatment, and neglect.Method: This study presents a descriptive analysis of

Nancy K. Raiha; David J. Soma

1997-01-01

430

38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...  

Code of Federal Regulations, 2014 CFR

...1151(a) for additional disability or death due to hospital care, medical or surgical...1151(a) for additional disability or death due to hospital care, medical or surgical...respect to claims alleging disability or death due to compensated work therapy,...

2014-07-01

431

38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...  

Code of Federal Regulations, 2012 CFR

...1151(a) for additional disability or death due to hospital care, medical or surgical...1151(a) for additional disability or death due to hospital care, medical or surgical...respect to claims alleging disability or death due to compensated work therapy,...

2012-07-01

432

38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...  

Code of Federal Regulations, 2013 CFR

...1151(a) for additional disability or death due to hospital care, medical or surgical...1151(a) for additional disability or death due to hospital care, medical or surgical...respect to claims alleging disability or death due to compensated work therapy,...

2013-07-01

433

Teaching and Assessing Surgical Competence  

E-print Network

Teaching and Assessing Surgical Competence: Applications for Ophthalmic Residents and Practicing Form b) Specific Cataract Formative Feedback Form c) Surgical Consent Formative Feedback Form d) Dr program and leads the University of Iowa education task force. The ACGME identified his Web site (go

Casavant, Tom

434

Surgical considerations for pulmonary actinomycosis  

Microsoft Academic Search

Background. Diagnosis and treatment of pulmonary actinomycosis is difficult without surgical intervention.Methods. Thirteen patients (10 men, 3 women; mean age, 62 years) underwent pulmonary resection and were given a pathologic diagnosis of pulmonary actinomycosis at our institution between 1976 and 2001. To clarify when pulmonary actinomycosis should be suspected in patients and the role of surgical intervention, we reviewed preoperative

Shunsuke Endo; Fumio Murayama; Tsutomu Yamaguchi; Shin-ichi Yamamoto; Shin-ichi Otani; Noriko Saito; Yasunori Sohara

2002-01-01

435

Assessment of changes in body water by bioimpedance in acutely ill surgical patients  

Microsoft Academic Search

Objective: To evaluate the relationship between changes in body bioelectrical impedance (BI) at 0.5, 50 and kHz and the changes in body weight, as an index of total body water changes, in acutely ill surgical patients during the rapid infusion of isotonic saline solution.Design: Prospective clinical study.Setting: Multidisciplinary surgical ICU in a university hospital.Patients: Twelve male patients treated for acute

R. L. Chioléro; L. J. Gay; J. Cotting; C. Gurtner; Y. Schutz

1992-01-01

436

Competition among hospitals.  

PubMed

The traditional view of hospital competition has posited that hospitals compete primarily along 'quality' dimensions, in the form of fancy equipment to attract admitting physicians and pleasant surroundings to entice patients. Price competition among hospitals is thought to be non-existent. This paper estimates the effects of various hospital market characteristics on hospital prices and expenses in an attempt to determine the form of hospital competition. The results suggest that both price and quality competition are greater in markets that are less concentrated, although the net effect of the two on prices is insignificant. It appears, therefore, that, despite important distortions, hospital markets are not immune to standard competitive forces. PMID:10291477

Noether, M

1988-09-01

437

75 FR 53264 - Restricted Area in Cape Fear River and Tributaries at Sunny Point Army Terminal, Brunswick County...  

Federal Register 2010, 2011, 2012, 2013, 2014

...its tributaries at Sunny Point Army Terminal, Brunswick...buoys. There are no other changes proposed for this restricted...offloading at the Sunny Point Army Terminal. In the...we are publishing this change to the restricted...

2010-08-31

438

Safety-net hospitals.  

PubMed

Vulnerable populations, who have difficulty accessing the health care system, primarily receive their medical care from hospitals. Policy makers have struggled to ensure the survival of "safety-net hospitals," hospitals that provide a disproportionate share of care to these patient populations. The objective of this article is to develop measures to guide analysis and policy for urban safety-net hospitals. The authors developed three safety-net measures: the socioeconomic status of hospital service area, Medicaid intensity, and uncompensated care burden and its market share. Cluster analysis was used to identify break points that distinguish a safety-net hospital from a non-safety-net hospital. The measures developed were stable and independent, but a data-driven binary assignment of hospitals to a "safety-net" category was not supported. These analyses call into question the empirical basis for distinguishing a specific group of hospitals as safety-net hospitals. PMID:18640951

Zwanziger, Jack; Khan, Nasreen

2008-08-01

439

The Intensive Care Unit, Belfast City Hospital THE Intensive Care Unit (ICU) in the Belfast City Hospital was opened on 1st  

E-print Network

September, 1978. The object of this paper is to present an audit of the first two years work. The ICU is a four-bedded unit which was intended to provide support for the needs of the acute services of the South Belfast Group. The main hospitals are the Belfast City Hospital (1116 beds) and the Musgrave Park Hospital (700 beds). A breakdown of the bed complements is shown in Table 1. It can be seen that there are a total of 600 beds providing acute medical, surgical and gynaecological care. Patients requiring specialised investigations or surgical intervention for cardio-thoracic or neurosurgical problems are referred directly

unknown authors

440

A review of wide surgical excision of hidradenitis suppurativa  

PubMed Central

Background Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disorder that involves the infundibular terminal follicles in areas rich of apocrine glands. It can be associated with fistulating sinus, scarring and abscesses formation. Hidradenitis suppurativa is a challenging aspect and requires a proper treatment plan which may involve different specialties. We present herein the option of surgical treatment involving wide surgical excision and methods of reconstruction as well as the rate of recurrence. Furthermore, review of the literature regarding surgical treatment of hidradenitis suppurativa is provided. Methods A retrospective analysis reviewed 50 operative procedures for 32 patients in 5 anatomical sites. These anatomical sites have been divided to 23 sites involving the axilla, 17 sites involving the inguinal region and 8 sites involving the perianal/perineal area, 1 site involving the gluteal region and 1 site involving the trunk region. Results Twenty six patients (81, 25 %) showed no recurrence after surgery and the average time of hospital stay period was 5 days. Recurrence was observed only in 6 patients (18, 75 %). Conclusion Elimination of the acute inflammatory process should occur in advance, including the use of antibiotics and minor surgeries such as abscess drainage with proper irrigations. After stabilizing the acute phase, wide surgical excision is recommended. Herein, planning of surgical reconstruction should be initiated to achieve the best outcome and consequently decreasing the risk of recurrence and complications after surgery. PMID:22734714

2012-01-01

441

Thriving on Chaos: The Development of a Surgical Information System  

PubMed Central

Hospitals present unique challenges to the computer industry, generating a greater quantity and variety of data than nearly any other enterprise. This is complicated by the fact that a hospital is not one homogenous organization, but a bundle of semi-independent groups with unique data requirements. Therefore hospital information systems must be fast, flexible, reliable, easy to use and maintain, and cost-effective. The Surgical Information System at Rush Presbyterian-St. Luke's Medical Center, Chicago is such system. It uses a Sequent Balance 21000 multi-processor superminicomputer, running industry standard tools such as the Unix operating system, a 4th generation programming language (4GL), and Structured Query Language (SQL) relational database management software. This treatise illustrates a comprehensive yet generic approach which can be applied to almost any clinical situation where access to patient data is required by a variety of medical professionals.

Olund, Steven R.

1988-01-01

442

Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial  

PubMed Central

Background Surgical site infections are the most common hospital-acquired infections among surgical patients. The administration of surgical antimicrobial prophylaxis reduces the risk of surgical site infections . The optimal timing of this procedure is still a matter of debate. While most studies suggest that it should be given as close to the incision time as possible, others conclude that this may be too late for optimal prevention of surgical site infections. A large observational study suggests that surgical antimicrobial prophylaxis should be administered 74 to 30 minutes before surgery. The aim of this article is to report the design and protocol of a randomized controlled trial investigating the optimal timing of surgical antimicrobial prophylaxis. Methods/Design In this bi-center randomized controlled trial conducted at two tertiary referral centers in Switzerland, we plan to include 5,000 patients undergoing general, oncologic, vascular and orthopedic trauma procedures. Patients are randomized in a 1:1 ratio into two groups: one receiving surgical antimicrobial prophylaxis in the anesthesia room (75 to 30 minutes before incision) and the other receiving surgical antimicrobial prophylaxis in the operating room (less than 30 minutes before incision). We expect a significantly lower rate of surgical site infections with surgical antimicrobial prophylaxis administered more than 30 minutes before the scheduled incision. The primary outcome is the occurrence of surgical site infections during a 30-day follow-up period (one year with an implant in place). When assuming a 5% surgical site infection risk with administration of surgical antimicrobial prophylaxis in the operating room, the planned sample size has an 80% power to detect a relative risk reduction for surgical site infections of 33% when administering surgical antimicrobial prophylaxis in the anesthesia room (with a two-sided type I error of 5%). We expect the study to be completed within three years. Discussion The results of this randomized controlled trial will have an important impact on current international guidelines for infection control strategies in the hospital. Moreover, the results of this randomized controlled trial are of significant interest for patient safety and healthcare economics. Trial registration This trial is registered on ClinicalTrials.gov under the identifier NCT01790529. PMID:24885132

2014-01-01

443

Thermal ecology of the neotropical army ant Eciton burchellii.  

PubMed

I explored the thermal ecology of Eciton burchellii, a New World army ant, in primary forest and forest fragments in the Atlantic lowlands of Costa Rica in 2002 and 2003. My primary objective was to determine whether high surface temperatures in pastures surrounding forest fragments posed a thermal barrier to ant colonies within those fragments; secondarily, I assessed whether thermal gradients within continuous moist forest were sufficient to elicit avoidance reactions from foraging colonies. E. burchellii colonies in forest fragments avoided entering open pasture in full sun (51.3 degrees C) on 100% of all edge interactions; however, edges were readily crossed where artificial shaded areas had previously been installed. Ant raids in primary forest avoided artificially established temperatures >43 degrees C but tolerated 45.5 degrees C in the presence of prey baits. Captive ants held at 43 degrees C survived 18.5 min; at temperatures of 51.3 degrees C survival time was only 2.8 min. Ants running on established foraging trails increased running velocity by 18% when substrate temperature was raised from 28.4 degrees to 38.0 degrees C, and they abandoned trails at temperatures >43 degrees C. The standard deviation (s) of temperatures on active raid trails in continuous forest was 2.13 degrees C, while nearby systematic sampling revealed a greater background standard deviation of 4.13 degrees C. E. burchellii colonies in this region appear to be living surprisingly near their upper limits of thermal tolerance. The heat of open pastures alone is sufficient to prevent their exiting forest fragments, or entering similarly hot areas within continuous forest. Shaded vegetative corridors are sufficient to permit mobility between isolated fragments, and their preservation should be encouraged. Despite views that tropical lowland moist forests have an essentially homogenous microclimate, army ants appear to avoid local hot spots on the forest floor, steering daily foraging trails to follow cooler routes than would be expected by chance. As deforestation remakes tropical landscapes worldwide, it is important to consider the thermal consequences of these actions and their effect on keystone organisms such as army ants. Changes in global climate patterns are likely to affect even evergreen tropical systems whose organisms may be sensitive to finer microclimatic variation than previously suspected. PMID:16826991

Meisel, Joe E

2006-06-01

444

75 FR 53197 - Restricted Area in Cape Fear River and Tributaries at Sunny Point Army Terminal, Brunswick County...  

Federal Register 2010, 2011, 2012, 2013, 2014

...River and Tributaries at Sunny Point Army Terminal, Brunswick County...and its tributaries at Sunny Point Army Terminal, Brunswick County...those buoys. There are no other changes proposed for this restricted...and offloading at the Sunny Point Army Terminal. DATES:...

2010-08-31

445

Surgical force detection probe  

NASA Technical Reports Server (NTRS)

The development progress of a precision electro-mechanical instrument which allows the detection and documentation of the forces and moment applied to human tissue during surgery (under actual operation room conditions), is reported. The pen-shaped prototype probe which measures 1/2 inch in diameter and 7 inches in length was fabricated using an aerodynamic balance. The aerodynamic balance, a standard wind tunnel force and moment sensing transducer, measures the forces and the moments transmitted through the surgeon's hand to the human tissue during surgery. The prototype probe which was fabricated as a development tool was tested successfully. The final version of the surgical force detection probe will be designed based on additional laboratory tests in order to establish the full scale loads. It is expected that the final product will require a simplified aerodynamic balance with two or three force components and one moment component with lighter full scale loads. A signal conditioner was fabricated to process and display the outputs from the prototype probe. This unit will be interfaced with a PC-based data system to provide automatic data acquisition, data processing, and graphics display. The expected overall accuracy of the probe is better than one percent full scale.

Tcheng, Ping; Roberts, Paul; Scott, Charles; Prass, Richard

1991-01-01

446

Surgical therapy for diabesity.  

PubMed

Type 2 diabetes mellitus affects more than 170 million people worldwide. Because this disease is strongly linked to obesity, the term "diabesity" has been coined to describe the confluence of the 2 disease processes. Bariatric surgery has been performed for many years to achieve sustained weight loss in the morbidly obese population. As a secondary effect, a remarkable improvement in glycemic control is commonly achieved postoperatively. This has led to substantial interest in the use of bariatric procedures to treat type 2 diabetes mellitus. Surgical procedures in common use include the adjustable gastric band, the Roux-en-Y gastric bypass, the biliopancreatic diversion with duodenal switch, and the sleeve gastrectomy. Additionally, several investigational procedures including the ileal interposition and duodenal-jejunal bypass have been proposed as primary interventions for type 2 diabetes mellitus. These operations achieve their metabolic effects through a combination of volume restriction, intestinal bypass, and hormonal changes. As more data become available on the positive effect of bariatric procedures on type 2 diabetes mellitus, the use of such operations may grow. Bariatric surgery may ultimately become a major tool in the long-term treatment of type 2 diabetes mellitus. This manuscript presents an extensive review of the literature supporting these concepts. PMID:20960546

Arroyo, Kervin; Kini, Subhash U; Harvey, John E; Herron, Daniel M

2010-01-01

447

Complications of diverticular disease: surgical laparoscopic treatment  

PubMed Central

Surgical treatment of complicated colonic diverticular disease is still debatable. The aim of our study was to evaluate the outcome of laparoscopic colon resection in patients with diverticulitis and with complications like colon-vescical fistula, peridiverticular abscess, perforation or stricture. All patients underwent laparoscopic colectomy within 8 years period. Main data recorded were age, sex, return of bowel function, operation time, duration of hospital stay, ASA score, body mass index (BMI), early and late complications. During the study period, 33 colon resections were performed for diverticulitis and complications of diverticulitis. We performed 5 associated procedures. We had 2 postoperative complications; 1 of these required a redo operation with laparotomy for anastomotic leak and 3 patients required conversion from laparoscopic to open colectomy. The most common reasons for conversion were related to the inflammatory process with a severe adhesion syndrome. Mean operative time was 229 minutes, and average postoperative hospital stay was 9,8 days. Laparoscopic surgery for complications of diverticular disease is safe, effective and feasible. Laparoscopic colectomy has replaced open resection as standard surgery for recurrent and complicated diverticulitis in our institution. PMID:24979103

ANANIA, G.; VEDANA, L.; SANTINI, M.; SCAGLIARINI, L.; GIACCARI, S.; RESTA, G.; CAVALLESCO, G.

2014-01-01

448

Preoperative Prevalence of Staphylococcus aureus in Cardiothoracic and Neurological Surgical Patients  

PubMed Central

Methicillin-resistant Staphylococcus aureus (MRSA) is a global cause of both hospital and community-acquired infection. This retrospective, observational study determined the prevalence of MRSA carriers in cardiothoracic and neurological surgical patients presenting to an outpatient preoperative assessment center in Columbus, OH. Aggressive skin and soft-tissue infection may be caused by MRSA with potentially fatal complications. Cardiothoracic and neurological surgical patients are at high risk for surgical-site infection. Results indicated that 4.25% of the sample carried MRSA and 25.25% carried methicillin-sensitive S. aureus. PMID:25405147

Kapoor, Ritu; Barnett, Christopher J.; Gutmann, Rebecca M.; Yildiz, Vedat O.; Joseph, Nicholas C.; Stoicea, Nicoleta; Reyes, Stephan; Rogers, Barbara M.

2014-01-01

449

[Loss of domain-a surgeon's challenge : Surgical approach to an enormous scrotal hernia].  

PubMed

We report on the one-stage procedure surgical approach to an enormous scrotal hernia bearing the whole small bowel and part of the large bowel as a loss of domain situation. Using a mesh-based component separation abdominal wall technique according to Ramirez we managed to retrieve the hernia content into the abdominal cavity allowing reduction of the resulting intra-abdominal pressure. We present our surgical approach in detail and report on the postoperative process based on focused intensive care surveillance and specific surgical complication management leading to hospital discharge of the patient on postoperative day 57. PMID:24996383

Philipp, M; Förster, S; Klar, E

2014-11-01

450

21 CFR 878.4580 - Surgical lamp.  

Code of Federal Regulations, 2012 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4580 Surgical lamp. (a) Identification. A surgical lamp (including a...

2012-04-01

451

21 CFR 878.4040 - Surgical apparel.  

Code of Federal Regulations, 2011 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel. (a) Identification. Surgical apparel are...

2011-04-01

452

21 CFR 878.4040 - Surgical apparel.  

Code of Federal Regulations, 2014 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel. (a) Identification. Surgical apparel are...

2014-04-01

453

21 CFR 878.4580 - Surgical lamp.  

Code of Federal Regulations, 2010 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4580 Surgical lamp. (a) Identification. A surgical lamp (including a...

2010-04-01

454

21 CFR 878.4580 - Surgical lamp.  

Code of Federal Regulations, 2013 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4580 Surgical lamp. (a) Identification. A surgical lamp (including a...

2013-04-01

455

21 CFR 878.4580 - Surgical lamp.  

Code of Federal Regulations, 2011 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4580 Surgical lamp. (a) Identification. A surgical lamp (including a...

2011-04-01

456

21 CFR 878.4040 - Surgical apparel.  

Code of Federal Regulations, 2012 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel. (a) Identification. Surgical apparel are...

2012-04-01

457

21 CFR 878.4040 - Surgical apparel.  

Code of Federal Regulations, 2010 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel. (a) Identification. Surgical apparel are...

2010-04-01

458

21 CFR 878.4580 - Surgical lamp.  

Code of Federal Regulations, 2014 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4580 Surgical lamp. (a) Identification. A surgical lamp (including a...

2014-04-01

459

21 CFR 878.4040 - Surgical apparel.  

Code of Federal Regulations, 2013 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel. (a) Identification. Surgical apparel are...

2013-04-01

460

Surgical robotics through a keyhole: from today's translational barriers to tomorrow's "disappearing" robots.  

PubMed

In the last century, engineering advances have transformed the practice of surgery. Keyhole surgical techniques offer a number of advantages over traditional open approaches including less postoperative pain, fewer wound complications, and reduced length of stay in hospital. However, they also present considerable technical challenges, particularly to surgeons performing new operative approaches, such as those through natural orifices. Advances in surgical robots have improved surgical visualization, dexterity, and manipulation consistency, thus greatly enhancing surgical performance and patient care. Clinically, however, robotic surgery is still in its infancy, and its use has remained limited to relatively few operations. In the paper, we will discuss the economic-, clinical-, and research-related factors that may act as barriers to the widespread utilization and development of surgical robots. In overcoming these barriers through a synergistic effort of both engineering and medicine, we highlight our future vision of robotic surgery, in both the short and long term. PMID:23372075

Marcus, Hani; Nandi, Dipankar; Darzi, Ara; Yang, Guang-Zhong

2013-03-01

461

THE UNIVERSITY OF CONNECTICUT HEALTH CENTER JOHN DEMPSEY HOSPITAL  

E-print Network

, durable medical equipment providers, and repair / maintenance personnel. HCIRs may be present in clinical provided by the hospital and will wear appropriate personal protective apparel. They will also wear procedure, as described in item # 10 of the Authorization for Medical-Surgical Procedure form HCH-127. 6

Oliver, Douglas L.

462

U.S. Army Engineer Institute for Water Resources  

NSDL National Science Digital Library

The U.S. Army Engineer Institute for Water Resources (IWR) was created "to provide forward-looking analysis and research in developing methodologies to aid the Civil Works program." Their website is well-organized, and the homepage features a "How Do I"" set of links that will swiftly direct visitors to areas about IWR history, contact information, projects, and publications. The "Latest News and Project Highlights" is a good place to start, as it contains information about recent workshop projects, new fact sheets on IWR projects, and recent policy statements. Policy types will want to click on the "Publications" area straight away to read reports on environmental investments, alternative dispute resolution, and dam safety. Other visitors may wish to look at the "Featured Projects" area, which includes dredging data materials, details on harbor maintenance, and their hydrologic modeling system.

463

Battling the Internet Water Army: Detection of Hidden Paid Posters  

E-print Network

We initiate a systematic study to help distinguish a special group of online users, called hidden paid posters, or termed "Internet water army" in China, from the legitimate ones. On the Internet, the paid posters represent a new type of online job opportunity. They get paid for posting comments and new threads or articles on different online communities and websites for some hidden purposes, e.g., to influence the opinion of other people towards certain social events or business markets. Though an interesting strategy in business marketing, paid posters may create a significant negative effect on the online communities, since the information from paid posters is usually not trustworthy. When two competitive companies hire paid posters to post fake news or negative comments about each other, normal online users may feel overwhelmed and find it difficult to put any trust in the information they acquire from the Internet. In this paper, we thoroughly investigate the behavioral pattern of online paid posters bas...

Chen, Cheng; Srinivasan, Venkatesh; Zhang, Xudong

2011-01-01

464

Exceptionally high levels of multiple mating in an army ant  

NASA Astrophysics Data System (ADS)

Most species of social insects have singly mated queens, although there are notable exceptions. Competing hypotheses have been proposed to explain the evolution of high levels of multiple mating, but this issue is far from resolved. Here we use microsatellites to investigate mating frequency in the army ant Eciton burchellii and show that queens mate with an exceptionally large number of males, eclipsing all but one other social insect species for which data are available. In addition we present evidence that suggests that mating is serial, continuing throughout the lifetime of the queen. This is the first demonstration of serial mating among social hymenoptera. We propose that high paternity within colonies is most likely to have evolved to increase genetic diversity and to counter high pathogen and parasite loads.

Denny, A. Jay; Franks, Nigel R.; Powell, Scott; Edwards, Keith J.

465

Remedial action suitability for the Cornhusker Army Ammunition Plant site  

SciTech Connect

Numerous Department of Defense (DOD) sites across the nation are contaminated with explosive wastes due to munitions production during World War II, Korean Conflict and Vietnam Conflict. Production activities included explosives manufacturing, loading, packing, assembling, machining, casting and curing. Contaminants often present at these sites include TNT, RDX, HMX, Tetryl 2,4-DNT, 2,6-DNT, 1,3-DNB, 1,3,5-TNB and nitrobenzene. The Cornhusker Army Ammunition Plant (CAAP) is one such DOD site that has been determined to be contaminated with explosives. The CAAP is located approximately 2 miles west of the City of Grand Island in Hall County, Nebraska. The plant produced artillery, bombs, boosters, supplementary charges and various other experimental explosives. The purpose of this paper is to provide an overview of the site background, review of the remedial alternatives evaluation process and rationale behind the selection of present remedial action.

Nonavinakere, S.; Rappa, P. III [Plexus Scientific Corp., Annapolis, MD (United States)

1995-12-31

466

Strategic Studies Institute: United States Army War College  

NSDL National Science Digital Library

The Strategic Studies Institute (SSI) is "the U.S. Army's institute for geostrategic and national security research and analysis." The Institute's staff includes research professors, military officers, and a variety of support staff affiliates. SSI's publications are distributed widely to strategic leaders across the Department of Defense, the media, and major colleges and universities. Visitors to their website will find topical sections prominently featured, and they include "Regional Issues", "Strategic Issues", and "Featured Papers". New visitors will want to breeze through the "Featured Papers" to get a sense of their work. Recently, this area has featured timely white papers and research briefs like "An All Hazards Training Center for a Catastrophic Emergency" and "India's Strategic Defense Transformation: Expanding Global Relationships". Moving on, visitors can sort through the "Strategic Issues" section as they see fit. Here they will find timely commentary on matters that include landpower sustainment, military change, and homeland security.

467

Surgical management of prostate cancer.  

PubMed

Surgery remains a mainstay in the management of localized prostate cancer. This article addresses surgical aspects germane to the management of men with prostate cancer, including patient selection for surgery, nerve-sparing approaches, minimization of positive surgical margins, and indications for pelvic lymph node dissection. Outcomes for men with high-risk prostate cancer following surgery are reviewed, and the present role of neoadjuvant therapy before radical prostatectomy is discussed. In addition, there is a review of the published literature on surgical ablative therapies for prostate cancer. PMID:24188255

Wright, Jonathan L; Izard, Jason P; Lin, Daniel W

2013-12-01

468

Caffeine use among active duty US Army soldiers.  

PubMed

Eighty-percent of the US adult population regularly consumes caffeine, but limited information is available on the extent and patterns of use. Caffeine use is a public health issue and its risks and benefits are regularly considered in scientific literature and the lay media. Recently, new caffeine-containing products have been introduced and are widely available on Army bases and are added to rations to maintain cognitive performance. This study surveyed caffeine consumption and demographic characteristics in 990 US Army soldiers. Data were weighted by age, sex, rank, and Special Forces status. Total caffeine intake and intake from specific products were estimated. Logistic regression was used to examine relationships between caffeine use and soldier demographic and lifestyle characteristics. Eighty-two percent of soldiers consumed caffeine at least once a week. Mean daily caffeine consumption was 285 mg/day (347 mg/day among regular caffeine consumers). Male soldiers consumed, on average, 303 mg/day and females 163 mg/day (regular consumers: 365 mg/day for male soldiers, 216 mg/day for female soldiers). Coffee was the main source of caffeine intake. Among young males, energy drinks were the largest source of caffeine intake, but their intake was not greater than older males. Regression analysis indicated an association of higher caffeine intake with male sex, white race, and tobacco use (P<0.01). Most soldiers consume caffeine in levels accepted as safe, but some consume greater quantities than recommended, although definitive information on safe upper limits of caffeine intake is not available. Labels of caffeine-containing products should provide caffeine content so individuals can make informed decisions. PMID:22709816

Lieberman, Harris R; Stavinoha, Trisha; McGraw, Susan; White, Alan; Hadden, Louise; Marriott, Bernadette P

2012-06-01

469

Hospitable Classrooms: Biblical Hospitality and Inclusive Education  

ERIC Educational Resources Information Center

This paper contributes to a Christian hermeneutic of special education by suggesting the biblical concept of hospitality as a necessary characteristic of classroom and school environments in which students with disabilities and other marginalized students can be effectively incorporated into the body of the classroom. Christian hospitality, seen…

Anderson, David W.

2011-01-01

470

Exploratory Use of Microaerosol Decontamination Technology (PAEROSOL) in Enclosed, Unoccupied Hospital Setting  

SciTech Connect

The goal of this study was to validate the previously observed high biological kill performance of PAEROSOL, a semi-dry, micro-aerosol decontamination technology, against common HAI in a non-human subject trial within a hospital setting of Madigan Army Medical Center (MAMC) on Joint Base Lewis-McChord in Tacoma, Washington. In addition to validating the disinfecting efficacy of PAEROSOL, the objectives of the trial included a demonstration of PAEROSOL environmental safety, (i.e., impact to hospital interior materials and electronic equipment exposed during testing) and PAEROSOL parameters optimization for future deployment.

Rainina, Evguenia I.; McCune, D. E.; Luna, Maria L.; Cook, J. E.; Soltis, Michele A.; Demons, Samandra T.; Godoy-Kain, Patricia; Weston, J. H.

2012-05-31

471

The application of hospitality elements in hospitals.  

PubMed

In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority. PMID:23424818

Wu, Ziqi; Robson, Stephani; Hollis, Brooke

2013-01-01

472

U.S. Army weapon systems human-computer interface style guide. Version 2  

SciTech Connect

A stated goal of the US Army has been the standardization of the human computer interfaces (HCIs) of its system. Some of the tools being used to accomplish this standardization are HCI design guidelines and style guides. Currently, the Army is employing a number of HCI design guidance documents. While these style guides provide good guidance for the command, control, communications, computers, and intelligence (C4I) domain, they do not necessarily represent the more unique requirements of the Army`s real time and near-real time (RT/NRT) weapon systems. The Office of the Director of Information for Command, Control, Communications, and Computers (DISC4), in conjunction with the Weapon Systems Technical Architecture Working Group (WSTAWG), recognized this need as part of their activities to revise the Army Technical Architecture (ATA), now termed the Joint Technical Architecture-Army (JTA-A). To address this need, DISC4 tasked the Pacific Northwest National Laboratory (PNNL) to develop an Army weapon systems unique HCI style guide, which resulted in the US Army Weapon Systems Human-Computer Interface (WSHCI) Style Guide Version 1. Based on feedback from the user community, DISC4 further tasked PNNL to revise Version 1 and publish Version 2. The intent was to update some of the research and incorporate some enhancements. This document provides that revision. The purpose of this document is to provide HCI design guidance for the RT/NRT Army system domain across the weapon systems subdomains of ground, aviation, missile, and soldier systems. Each subdomain should customize and extend this guidance by developing their domain-specific style guides, which will be used to guide the development of future systems within their subdomains.

Avery, L.W.; O`Mara, P.A.; Shepard, A.P.; Donohoo, D.T.

1997-12-31

473

Advanced information processing system: The Army fault tolerant architecture conceptual study. Volume 2: Army fault tolerant architecture design and analysis  

NASA Technical Reports Server (NTRS)

Described here is the Army Fault Tolerant Architecture (AFTA) hardware architecture and components and the operating system. The architectural and operational theory of the AFTA Fault Tolerant Data Bus is discussed. The test and maintenance strategy developed for use in fielded AFTA installations is presented. An approach to be used in reducing the probability of AFTA failure due to common mode faults is described. Analytical models for AFTA performance, reliability, availability, life cycle cost, weight, power, and volume are developed. An approach is presented for using VHSIC Hardware Description Language (VHDL) to describe and design AFTA's developmental hardware. A plan is described for verifying and validating key AFTA concepts during the Dem/Val phase. Analytical models and partial mission requirements are used to generate AFTA configurations for the TF/TA/NOE and Ground Vehicle missions.

Harper, R. E.; Alger, L. S.; Babikyan, C. A.; Butler, B. P.; Friend, S. A.; Ganska, R. J.; Lala, J. H.; Masotto, T. K.; Meyer, A. J.; Morton, D. P.

1992-01-01

474

Baseline Report for the Fort Hood Army Base: Sept. 1, 2002 - Aug. 31, 2003  

E-print Network

ESL-TR-03/12-02 BASELINE REPORT FOR THE FORT HOOD ARMY BASE: SEPT. 1 ST , 2002 TO AUG. 31 ST , 2003 A Research Project for the U.S. Army C.E.R.L. and the Ft. Hood Energy Office Jeff S. Haberl, Ph.D., P... Baseline Report, p. 1 December 2003 Energy Systems Laboratory, Texas A&M University PREFACE This report is the 2002/2003 baseline report for a multi-year Research Project performed for the U.S. Army Construction Engineering Research Laboratory...

Haberl, J. S.; Baltazar-Cervantes, J. C.; Liu, Z.; Claridge, D. E.; Turner, W. D.

2003-01-01

475

Transcatheter Versus Surgical Closure of Atrial Septum Defect: A Debate from a Developing Country  

PubMed Central

Introduction: This study compares the effectiveness and cost of trans-catheter verses surgical closure of secundum atrial septum defect (ASD). ASD accounts for 10% of congenital cardiac defects. Trans-catheter closure of secundum ASD is increasingly used as the primary intervention. Surgical repair is advised in a proportion of secundum type defects which are unsuitable for device closure. Methods: We reviewed the clinical course of 176 patients who underwent closure of isolated secundum ASD. The patients were assigned to either the device or surgical group depending upon the treatment they received. Successful closure was assessed immediately after the procedure. The following outcomes were studied: mortality, morbidity, hospital stay, and costs. Results: Ninety five patients were in the surgical group and 81 patients were in the group undergoing device closure. The median age was 14.0 years (range 1.1-61.0) for surgical group and 24.0 years (range 0.5-68.0) for the device group. The mortality in both groups was 0. The procedure success rate was 100% for the surgical group and 96.3% for the device group. The complication rate was 13.7% for surgical group and 7.4% for the device group. The mean length of hospital stay was 5.0 ± 2.7 days for surgical group and 3.0 ± 0.4 days for device group. The procedure cost for surgery was found to be 12.3% lower than that of trans-catheter closure. Conclusion: Successful closure is achieved by both methods. Trans-catheter closure results in lower rate of complication and hospital stay but the cost of the procedure tends to be higher than surgery. PMID:25610550

Siddiqui, Waleed T; Usman, Tariq; Atiq, Mehnaz; Amanullah, Muhammad Muneer

2014-01-01

476

[Safe surgery checklist: analysis of the safety and communication of teams from a teaching hospital].  

PubMed

This study aimed to apply the WHO surgical safety checklist in the surgical specialties of a university hospital and to evaluate the opinion of the team regarding the influence of its application on the safety of the surgical process and on the interpersonal communication of the team. It is a descriptive, analytical qualitative field study conducted in the surgical center of a university hospital Data were collected by applying the checklist in a total of 30 surgeries. The researcher conducted its application in three phases, and then members of the surgical team were invited to voluntarily participate in the study, signifying their agreement to participate by signing an informed consent form and answering guiding questions. Bardin's Content Analysis Method was used to organize and analyze the data. The subjects did not notice any changes in their interpersonal communication when using the checklist; however, they gave suggestions and reported that its use provided greater safety to the procedure. PMID:23781726

Pancieri, Ana Paula; Santos, Bruna Pegorer; de Avila, Marla Andréia Garcia; Braga, Eliana Mara

2013-03-01

477

Characteristics of uveitic glaucoma and evaluation of its surgical treatment  

PubMed Central

Purpose To investigate the characteristics of uveitic glaucoma (UG) and evaluate surgical treatments. Methods This study examined a retrospective, nonrandomized comparative interventional case series of 105 UG patients (141 eyes) followed between April 1, 2001 and July 30, 2014 at the outpatient clinic of Tohoku University Hospital. The study group included 47 patients (47 eyes) who underwent glaucoma surgery: trabeculectomy, trabeculotomy, and trabectome surgery. The analysis used Kaplan–Meier life tables, with surgical failure defined as intraocular pressure ?21 mmHg or the need for additional glaucoma surgery. Results UG patients represented 9.73% of our database of glaucoma patients. The mean follow-up period was 40.32±32.53 months. Seventy-one patients had granulomatous uveitis (67.62%) and 34 had nongranulomatous uveitis (32.38%). The causes of uveitis included sarcoidosis (n=25), Behçet’s disease (n=11), Vogt–Koyanagi–Harada disease (n=9), Posner–Schlossman syndrome (n=12), herpes simplex virus infectious uveitis (n=7), acute anterior uveitis (n=5), intermediate uveitis (n=4), scleritis (n=4), inflammatory bowel disease (n=4), varicella zoster virus uveitis (n=2), and others (n=6). An additional 16 patients were diagnosed with idiopathic UG. Surgical success rates were 82.86% for trabeculectomy, 62.50% for trabeculotomy, and 75.00% for trabectome. Significant risk factors for surgical failure included male sex (P=0.02), age less than 45 years (P=0.0009), nongranulomatous uveitis (P=0.04), and postoperative inflammation (P=0.01). Conclusion Young male patients with nongranulomatous uveitis had a significant risk of sur