Science.gov

Sample records for army surgical hospital

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

    PubMed Central

    King, Booker; Jatoi, Ismalil

    2005-01-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... disability or death from hospitalization, medical or surgical treatment, examinations or vocational... Special Purposes § 3.358 Compensation for disability or death from hospitalization, medical or surgical... result of hospitalization, medical or surgical treatment, examination, or vocational...

  3. 38 CFR 3.358 - Compensation for disability or death from hospitalization, medical or surgical treatment...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... disability or death from hospitalization, medical or surgical treatment, examinations or vocational... Special Purposes § 3.358 Compensation for disability or death from hospitalization, medical or surgical... result of hospitalization, medical or surgical treatment, examination, or vocational...

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

    PubMed Central

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

    2015-01-01

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

  5. Continuous Commissioning of the Reynolds Army Community Hospital, Fort Sill, Oklahoma 

    E-print Network

    Turner, W. D.; Baltazar-Cervantes, J. C.; Martinez, J. T.

    2007-01-01

    ® of the Reynolds Army Community Hospital Fort Sill, Oklahoma Joseph T. Martinez Assistant Research Engineer W. Dan Turner, P.E., Ph,D. Professor and Director Juan Carlos Baltazar, Ph,D. Research Associate Energy Systems Laboratory, Texas A&M University...

  6. Point-to-Point Verification of Monitored Sensors at Reynolds Army Clinic and Hospital Final Report 

    E-print Network

    Martinez, J.; Linenschmidt, S.; Turner, D.

    2004-01-01

    A point-to-point verification of the heating, ventilating, and air conditioning (HVAC) system of the Reynolds Army Community Hospital (RACH) in Fort Sill, Oklahoma was done by the Energy Systems Laboratory (ESL) of Texas A&M University. Work began...

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

    SciTech Connect

    1988-12-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-02-01

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

  10. Hospital admissions related to mental disorders in U.S. Army soldiers in Iraq and Afghanistan.

    PubMed

    Wojcik, Barbara E; Akhtar, Fatema Z; Hassell, L Harrison

    2009-10-01

    We conducted a retrospective study of 473,964 U.S. Army soldiers deployed to Iraq and Afghanistan through December 2004 using deployment and admission records. We categorized mental disorder diagnoses using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and identified attempted suicide/ self-inflicted injuries using ICD-9-CM diagnosis codes E950-E959. We estimated and evaluated relative risks (RR) using Poisson regression models. Analysis found 1,948 psychiatric hospitalizations of deployed soldiers. The most common mental problems were mood, adjustment, and anxiety disorders (including post-traumatic stress disorder [PTSD]). RR of mental disorders ranged from 1.6 to 3 for females and 2 to 6 for enlisted soldiers compared to their counterparts. Younger soldiers had 30-60% higher substance abuse disorders. Combat units in Iraq demonstrated higher risk of any mental disorder and anxiety problems compared to combat support units. Younger women had the highest incidence of attempted suicide/ self-inflicted injuries. Further mental disorders surveillance is recommended. PMID:19891211

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

    PubMed Central

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

    2015-01-01

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

  12. Hospital Teaching Intensity, Patient Race, and Surgical Outcomes

    PubMed Central

    Silber, Jeffrey H.; Rosenbaum, Paul R.; Romano, Patrick S.; Rosen, Amy K.; Wang, Yanli; Teng, Yun; Halenar, Michael J.; Even-Shoshan, Orit; Volpp, Kevin G.

    2009-01-01

    Objectives To determine if the lower mortality often observed in teaching-intensive hospitals is due to lower complication rates or lower death rates after complications (failure-to-rescue), and whether the benefits at these hospitals accrue equally to white and black patients, since blacks receive a disproportionate share of their care at teaching-intensive hospitals. Design A retrospective study of patient outcomes and teaching intensity using logistic regression models, with and without adjusting for hospital fixed and random effects. Main Outcome Measures 30-day mortality, in-hospital complications and failure-to-rescue (“FTR”, the probability of death following complications). Setting 3,270 acute care hospitals in the United States. Patients Medicare claims on general, orthopedic and vascular surgery admissions in the U.S. for 2000 – 2005 (N = 4,658,954 unique patients). Results Combining all surgeries, compared to non-teaching hospitals, patients at very major teaching hospitals demonstrated a 15% lower odds of death (P<0.0001), no difference in complications, and a 15% lower odds of death after complications (FTR) (P<0.0001). These relative benefits associated with higher RB ratio were not experienced by black patients, for whom the odds of mortality and FTR are similar at teaching and non-teaching hospitals, a pattern that is significantly different from that of white patients (P<0.0001). Conclusions Survival after surgery is higher at hospitals with higher teaching intensity. Improved survival is due to lower mortality after complications (better FTR), and generally not due to fewer complications. However, this better survival and FTR at teaching intensive hospitals is seen for whites, not for blacks. PMID:19221321

  13. Building Advanced Surgical Capacity at a Hospital in Port-au-Prince, Haiti.

    PubMed

    DeGennaro, Vincent; DeGennaro, Vincent A; Bitar, Marlon; Bitar, Jerry; Thaller, Seth

    2015-06-01

    To improve surgical capacity in developing countries, we must take a multifaceted approach that addresses all aspects of surgery in a hospital. Foreign non-governmental organizations with expertise and resources can play a role in helping to build surgical capacity in developing countries. Episodic surgical missions can contribute to reducing the burden of the disease, but must be coupled with training of local staff to assure capacity for the future. Lack of human resources and proper infrastructure should be addressed as part of the capacity-building process. Longitudinal educational programs improve the training of local staff over time. Scaling up from episodic surgical trips to building and maintaining fully functioning surgical capacity requires sustained and repeated interventions from a large group of stakeholders. Through partnerships with local government and nongovernmental organizations, each partner can amplify the effectiveness of the other to meet the challenges of complex surgical care in low-resource settings. PMID:26080118

  14. [In-patient department technologies in the surgical treatment of outpatients in the conditions of military hospital].

    PubMed

    Andriienko, M M

    2009-01-01

    The study is devoted to a scientific substantiation, development, introduction and management of the system of in-patient department equivalent technologies in surgical treatment of outpatients in the condition of military hospital. The author has shown necessity of wide introduction into practice surgery at pre-hospital stages of military treatment-and-prophylactic service using in-patient equivalent technologies (a day hospital, a hospital in-home, a one-day surgical department) is proved. Components of medical, economic and social efficiency of introduction of a qualitatively new system of surgical treatment provided in outpatient condition of military hospital are presented in the hospital. PMID:20455460

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

    PubMed Central

    Høybye, Mette Terp

    2014-01-01

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

  16. Differences in Mortality for Surgical Cancer Patients by Insurance and Hospital Safety Net Status

    PubMed Central

    Bradley, Cathy J.

    2013-01-01

    Recent research suggests hospitals serving low-income patients have poorer outcomes. However, safety net hospitals (SNHs) offering access to care regardless of insurance coverage may provide better care than low-income patients would otherwise receive. This study considers the association between insurance and mortality among surgical cancer patients and the role of SNHs. We estimate models of 1- and 5-year mortality on insurance, SNH status, patient characteristics, and hospital surgical volume for colorectal and breast cancer patients. Interaction terms between insurance and SNH status estimate how mortality differs by insurance source at SNHs. Medicaid and uninsurance are associated with significantly higher mortality for colorectal cancer patients. There is a statistically significant improvement in mortality for Medicaid colorectal cancer patients treated in SNHs relative to non-safety net hospitals, and a marginally significant improvement for uninsured breast cancer patients treated in SNHs. The results suggest a survival benefit for low-income patients treated in SNHs. PMID:22951313

  17. [Importance of medical treatment in second echelon during war in Croatia, example--war surgical hospital in Garesnica].

    PubMed

    Gveri?, Tugomir; Huljev, Dubravko; Zdilar, Boris; Kolak, Toni; Barisic, Jadranko; Ahmetasovic, Snjezana Gveric; Trajbar, Dubravka; Lojo, Nermin; Sever, Marko

    2009-05-01

    At beginning of 1991, the increasing necessity of emergency surgical treatment of wounded persons in Croatia led to the formation of mobile surgical teams. However, this system was abandoned due to many problems and echelon health division was formed. One of the war surgical hospitals (second echelon) was the War Surgical Hospital Garesnica. In this study, materials of the Croatian War Veterans Ministry, Ministry of Defense, Garesnica War Surgical Hospital and Garesnica Defense Office archive were used. We analyzed the number and localization of wounds, and describe the organization, work and results of the War Surgical Hospital in Garesnica. During the work of the War Surgical Hospital in Garesnica, 909 surgical examinations were performed, 521 wounded were surgically treated (45% civilians and 55% soldiers), 331 wounded were operated on, 5 lethal outcomes were recorded, 68% of wounds were localized on the extremities, 19% on the thorax and abdomen, and 13% on the head end neck. In this article the organization and work of the War Surgical Hospital in Garesnica is described, which had a major role in providing emergency medical care to people wounded in west Slavonia. PMID:19580229

  18. 78 FR 43533 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-19

    ... would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2014 to implement applicable statutory requirements... services paid under the OPPS and those paid under the ASC payment system. In addition, this proposed...

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

    PubMed

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

    2014-08-01

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

  20. [Experience in organizing the surgical work of a garrison hospital in an armed conflict].

    PubMed

    Ulunov, A D; Tatarin, S N; Ivantsov, V A; Teslenko, Iu A; Ismailov, R M; Fokin, Iu N; Lukashov, O V

    2000-02-01

    The authors have summarized organizational experience of surgical work of garrison military hospital strengthened with specialized brigades during the period of armed conflict in Republic of Dagestan (August-September, 1999). From the start of active actions in order to render assistance specialized surgical teams from district military hospital equipped with special kits (at the rate of 7 operations/day during a week) were sent to garrison hospital. In this armed conflict there are features characterising both mine-and-explosive war in Afghanistan and sniper war in Chechen Republic resulting in increase in the number of seriously wounded (up to 46.7%) casualties during Botlikhski? operation constituted 1:4, Novolakski? (Kadarski?)--1:5. Bullet injuries were fatal in 49.4% of the cases, fragmentation (including MET)--50.6%. During 1.5 month of hospital work there were performed 303 surgical interventions. 22.7% of slightly wounded from local garrisons were treated in garrison hospitals. Treatment results--postoperative lethality in gunshot trauma at the given stage constituted 1.1%. PMID:10870437

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

    PubMed Central

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

    2014-01-01

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

  2. [Project "Partnership"--university surgical departments and hospitals for basic and regular medical care. Directing cooperation for the future].

    PubMed

    v Frankenberg, M; Schmitz-Winnenthal, H; Bornemann, T; Köninger, J; Büchler, M W

    2007-04-01

    Over the last 20 years, urgently needed changes in the German health care system have forced hospitals to make a flexible adjustment to rising costs and the single handed, almost unmanageable dynamics of technical innovation in medicine. The partnership between the Salem Hospital and the Heidelberg University Hospital represents a pioneering management concept for the future. The alliance between a university surgical department with a basic peripheral hospital provides large advantages to patients, staff, hospitals and cost carriers. PMID:17187258

  3. Hospital Blood Transfusion Patterns During Major Noncardiac Surgery and Surgical Mortality

    PubMed Central

    Chen, Alicia; Trivedi, Amal N.; Jiang, Lan; Vezeridis, Michael; Henderson, William G.; Wu, Wen-Chih

    2015-01-01

    Abstract We retrospectively examined intraoperative blood transfusion patterns at US veteran's hospitals through description of national patterns of intraoperative blood transfusion by indication for transfusion in the elderly; assessment of temporal trends in the use of intraoperative blood transfusion; and relationship of institutional use of intraoperative blood transfusion to hospital 30-day risk-adjusted postoperative mortality rates. Limited data exist on the pattern of intraoperative blood transfusion by indication for transfusion at the hospital level, and the relationship between intraoperative transfusion rates and institutional surgical outcomes. Using the Department of Veterans Affairs Surgical Quality Improvement Program database, we assigned 424,015 major noncardiac operations among elderly patients (?65 years) in 117 veteran's hospitals, from 1997 to 2009, into groups based on indication for intraoperative blood transfusion according to literature and clinical guidelines. We then examined institutional variations and temporal trends in surgical blood use based on these indications, and the relationship between these institutional patterns of transfusion and 30-day postoperative mortality. Intraoperative transfusion occurred in 38,056/424,015 operations (9.0%). Among the 64,390 operations with an indication for transfusion, there was wide variation (median: 49.9%, range: 8.7%–76.2%) in hospital transfusion rates, a yearly decline in transfusion rates (average 1.0%/y), and an inverse relationship between hospital intraoperative transfusion rates and hospital 30-day risk-adjusted mortality (adjusted mortality of 9.8?±?2.8% vs 8.3?±?2.1% for lowest and highest tertiles of hospital transfusion rates, respectively, P?=?0.02). In contrast, for the 225,782 operations with no indication for transfusion, there was little variation in hospital transfusion rates (median 0.7%, range: 0%–3.4%), no meaningful temporal change in transfusion (average 0.0%/y), and similar risk-adjusted 30-day mortality across all tertiles of hospital transfusion rates. Among patients ?65 years with an indication for intraoperative transfusion, intraoperative transfusion patterns varied widely across hospitals and declined through the 1997 to 2009 study period. Hospitals with higher transfusion rates in these patients have lower risk-adjusted 30-day postoperative mortality rates. PMID:26266384

  4. Concentration and detection of SARS coronavirus in sewage from Xiao Tang Shan Hospital and the 309th Hospital of the Chinese People's Liberation Army.

    PubMed

    Wang, X W; Li, J; Guo, T; Zhen, B; Kong, Q; Yi, B; Li, Z; Song, N; Jin, M; Xiao, W; Zhu, X; Gu, C; Yin, J; Wei, W; Yao, W; Liu, C; Li, J; Ou, G; Wang, M; Fang, T; Wang, G; Qiu, Y; Wu, H; Chao, F; Li, J

    2005-01-01

    A worldwide outbreak of severe acute respiratory syndrome (SARS) had been reported. Over 8439 SARS cases and 812 SARS-related deaths were reported to the World Health Organization from 32 countries around the world up to 5 July 2003. The mechanism of transmission of SARS-CoV has been limited only to close contacts with patients. Attention was focused on possible transmission by the sewage system because laboratory studies showed that patients excreted coronavirus RNA in their stools in Amoy Gardens in Hong Kong. To explore whether the stool of SARS patients or the sewage containing the stool of patients would transmit SARS-CoV or not, we used a style of electropositive filter media particle to concentrate the SARS-CoV from the sewage of two hospitals receiving SARS patients in Beijing, as well as cell culture, semi-nested RT-PCR and sequencing of genes to detect and identify the viruses from sewage. There was no live SARS-CoV detected in the sewage in these assays. The nucleic acid of SARS-CoV was found in the sewage before disinfection from both hospitals by PCR. After disinfection, SARS-CoV RNA could be detected from some samples from the 309th Hospital of the Chinese People's Liberation Army, but not from Xiao Tang Shan Hospital after disinfection. In this study, we found that the virus can survive for 14 days in sewage at 4 degrees C, 2 days at 20 degrees C, and its RNA can be detected for 8 days though the virus had been inactivated. In conclusion, this study demonstrates that the RNA of SARS-CoV could be detected from the concentrates of sewage of both hospitals receiving SARS patients before disinfection and occasionally after disinfection though there was no live SARS-CoV; thus much attention should be paid to the treatment of stools of patients and the sewage of hospitals receiving SARS patients. PMID:16312970

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

    PubMed Central

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

    2000-01-01

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

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

    PubMed Central

    Uhrenfeldt, Lisbeth; Høybye, Mette Terp

    2015-01-01

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

  7. Length of hospital stay in surgical service patients with nosocomial Hemophilus influenzae infections.

    PubMed Central

    Flournoy, D. J.; Hall, L.; Klein, G.; Slater, L. N.

    1989-01-01

    The length of hospitalization was characterized for 24 surgical service patients with nosocomial respiratory tract infections associated with Hemophilus influenzae. The mean number of days were: admission to surgery 8.22; surgery to culture of the nosocomial pathogen 7.00; admission to culture 16.71; admission to discharge 38.75; surgery to discharge 25.48; and culture to discharge 21.42. The length of hospital stay was prolonged for those patients with nosocomial respiratory tract infections related to H influenzae. PMID:2786083

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

    PubMed

    Srogosz, T

    2000-01-01

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

  9. Reliability of Risk-adjusted Outcomes for Profiling Hospital Surgical Quality

    PubMed Central

    Krell, Robert W; Hozain, Ahmed; Kao, Lillian S; Dimick, Justin B

    2014-01-01

    IMPORTANCE Quality improvement platforms commonly use risk-adjusted morbidity and mortality to profile hospital performance. However, given small hospital caseloads and low event rates for some procedures it is unclear whether these outcomes reliably reflect hospital performance. OBJECTIVE To determine the reliability of risk-adjusted morbidity and mortality for hospital performance profiling using clinical registry data. DESIGN Retrospective cohort study SETTING/DATA SOURCE American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2009 PARTICIPANTS All patients who underwent colon resection, pancreatic resection, laparoscopic gastric by pass, ventral hernia repair, abdominal aortic aneurysm (AAA) repair, and lower extremity by pass (n=55,946 patients). MAIN OUTCOMES AND MEASURES Outcomes included risk-adjusted overall morbidity, severe morbidity, and mortality. We assessed reliability (0 to 1 scale, where 0=completely unreliable and 1=perfectly reliable) for all three outcomes. We also quantified the number of hospitals meeting minimum acceptable reliability thresholds (>0.70=good reliability, >0.50=fair reliability) for each outcome. RESULTS For overall morbidity, the most common outcome studied, the average reliability depended on both the sample size (i.e., how high the hospital caseload was) and the event rate (i.e., how frequently the outcome occurred). For example, average reliability for overall morbidity was low for AAA repair (reliability 0.29; sample size of 25 cases/year and event rate of 18%). In contrast, average reliability for overall morbidity was higher for colon resection (reliability 0.61; sample size 114 cases/year and event rate of 27%). Colon resection (38% of hospitals), pancreatic resection (7% of hospitals), and laparoscopic gastric by pass (12%) were the only procedures for which any hospitals met a reliability threshold of 0.70 for overall morbidity. Because severe morbidity and mortality are less frequent outcomes, their average reliability was lower and even fewer hospitals met thresholds for minimum reliability. CONCLUSIONS AND RELEVANCE Most commonly reported outcome measures have low reliability for differentiating hospital performance. This is especially important for clinical registries that sample rather than collect 100% of cases, which can limit hospital case accrual. Eliminating sampling to achieve the highest possible caseloads, adjusting for reliability, and using advanced modeling strategies (e.g., hierarchical modeling) is necessary for clinical registries to increase their benchmarking reliability. PMID:24623045

  10. Patients' Perspectives of Care and Surgical Outcomes in Michigan: An Analysis Using the CAHPS Hospital Survey

    PubMed Central

    Sheetz, Kyle H.; Waits, Seth A.; Girotti, Micah E.; Campbell, Darrell A.; Englesbe, Michael J.

    2014-01-01

    Objective To determine the relationship between postoperative morbidity and mortality and patients' perspectives of care. Summary Background Data Priorities in healthcare quality research are shifting to place greater emphasis on patient-centered outcomes. Whether patients' perspectives of care correlate with surgical outcomes remains unclear. Methods Using data from the Michigan Surgical Quality Collaborative clinical registry (2008–2012), we identified 41,833 patients undergoing major elective general or vascular surgery. Our exposure variables were the HCAHPS Total and Base Scores derived from the Hospital Value-Based Purchasing (VBP) Patient Experience of Care Domain. Using multilevel mixed-effects logistic regression models, we adjusted hospitals' rates of morbidity and mortality for patient comorbidities and case mix. We stratified reporting of outcomes by quintiles of hospitals' Total and Base Scores. Results Risk-adjusted morbidity (13.6% to 28.6%) varied widely across hospitals. There were no significant differences in risk-adjusted morbidity rates between hospitals with the lowest versus highest HCAHPS Total Score (24.5% vs. 20.2%, p=0.312). The HCAHPS Base Score, which quantifies sustained achievement or improvement in patients' perspectives of care, was not associated with a reduction in postoperative morbidity over the study period despite an overall decrease of 2.5% for all centers. We observed a similar relationship between HCAHPS Total and Base Scores and postoperative mortality. Conclusions and Relevance Patients' perspectives of care do not correlate with the incidence of morbidity and mortality following major surgery. Improving patients' perspectives and objective outcomes may require separate initiatives for surgeons in Michigan. PMID:24646549

  11. Bacterial air contamination of operating theatres and surgical wards of a university teaching hospital.

    PubMed

    Njoku-Obi, A N; Ojiegbe, G C

    1993-06-01

    A study of the level and significance of air contamination in the four operating theatres and four surgical wards of the University of Nigeria Teaching Hospital, Enugu, Nigeria was carried out. A total of 48 air samples were taken from each of the operating theatres while a total of 36 air samples were taken from each surgical ward, using a "Casella slit Sampler". The means of the bacterial carrying particles per cubic foot of air varied, from theatre to theatre, from 12.29 to 14.29 (in the mornings) and 9.79 to 11.4 (in the evening). Statistically, these differences were insignificant (t-value < 1.96). Recognised pathogens were not recovered from both the air and the fomites in the operating theatres. However, free-living fungi were isolated. The air of the surgical wards showed levels of contamination from 20.39 to 35.28 (in the mornings) and 20.33 to 39.55 (in the evenings) bacterial carrying particles per cu.ft. of air. The differences between the counts in the mornings and evenings were also not statistically significant. Some pathogens were isolated from the air in the wards. The findings indicated that the level of air contamination of the surgical wards influenced the rates of post-operative wound sepsis. PMID:7839891

  12. Registration of surgical adverse outcomes: a reliability study in a university hospital

    PubMed Central

    Visser, Annelies; Gouma, Dirk J; Goslings, J Carel

    2012-01-01

    Objective Accurate registration of adverse surgical outcomes is essential to detect areas for improvement of surgical care quality. One reason for inaccurate adverse outcome registration may be the method to collect these outcomes. The authors compared the completeness of the national complication registry database (LHCR) as used in our hospital with relevant information from other available resources. Design Retrospective reliability analysis. Setting University hospital. Participants From the 3252 patients admitted to the surgical wards in 2010, the authors randomly selected a cohort of 180 cases, oversampling those with adverse outcomes. The LHCR contains adverse outcomes as reported during morning hand-offs or in discharge letters. The authors checked if the number and severity of adverse outcomes recorded in the LHCR agreed with those reported in morning hand-offs, discharge letters and medical and nursing files. Results In 135 of 180 patients, all resources could be retrieved completely. Fourteen per cent of the patients with adverse outcomes were not recorded in the LHCR. Missing adverse outcomes were all reversible without the need for (re)operation, for example, postoperative pain, delirium or urinary tract complications. Only 38% of these adverse outcomes were reported in the morning hand-offs and discharge letters but were best reported in the medical and nursing files. Conclusions Registration of surgical adverse outcomes appears largely depending on the reliability of the underlying sources. For a more complete adverse outcome registration, the authors advocate a better hand-off and additional consultation of the patient's dossier. This extra effort allows for improvement actions to eventually avoid ‘mild’ adverse outcomes patients perceive as important and undesirable. PMID:22637372

  13. Evaluation of Initial Participation in Public Reporting of ACS NSQIP Surgical Outcomes on Medicare’s Hospital Compare Website

    PubMed Central

    Dahlke, Allison; Chung, Jeanette W; Holl, Jane; Ko, Clifford Y; Rajaram, Ravi; Modla, Lynn; Makary, Martin A; Bilimoria, Karl Y

    2015-01-01

    Background In October 2012, The Centers for Medicare and Medicaid Services (CMS) began publicly reporting American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical outcomes on its public reporting website, Hospital Compare. Participation in this CMS-NSQIP initiative is voluntary. Our objective was to compare CMS-NSQIP participating hospitals to ACS NSQIP hospitals that elected not to participate. Study Design Hospital Compare and American Hospital Association Annual Survey data were merged to compare CMS-NSQIP participants to non-participants. Regression models were developed to assess predictors of participation and to assess if hospitals differed on 32 process, 10 patient experience (HCAHPS), and 16 outcome (Hospital Compare & AHRQ) measures. Additionally, performance on two waves of publicly reported ACS NSQIP surgical outcome measures was compared. Results Of the 452 ACS NSQIP hospitals, 80 (18%) participated in CMS-NSQIP public reporting. Participating hospitals had more beds, admissions, operations, and were more often accredited (Commission on Cancer and the Council of Teaching Hospitals (COTH) (P<0.05). Only COTH membership remained significant in adjusted analyses (OR 2.45, 95% CI 1.12–5.35). Hospital performance on process, HCAHPS, and outcome measures were not associated with CMS-NSQIP participation for 54 of 58 measures examined. Hospitals with “better-than-average” performance were more likely to publicly report the Elderly Surgery measure (P<0.05). In wave two, an increased proportion of new participants reported “worse-than-average” outcomes. Conclusions There were few measurable differences between CMS-NSQIP participating and non-participating hospitals. The decision to voluntarily publicly report may be related to the hospital’s culture of quality improvement and transparency. PMID:24468223

  14. [Surgical site infections in hospitals and outpatient settings. Results of the German nosocomial infection surveillance system (KISS)].

    PubMed

    Gastmeier, P; Brandt, C; Sohr, D; Babikir, R; Mlageni, D; Daschner, F; Rüden, H

    2004-04-01

    About 1,000,000 hospital days attributable to surgical site infections can be expected per year in German hospitals. Among the various measures for prevention, surveillance of surgical site infections is strongly recommended. Therefore, beginning in 1997 the National Reference Center for Surveillance of Nosocomial Infections began to establish a hospital infection surveillance system in order to provide data for prevention and control of these infections. The surveillance system (called KISS) documents postoperative surgical site infections in patients undergoing selected indicator procedures. Today we have an overview of 274,050 procedures for a total of 20 operative indicator procedures. A further surveillance component focussing on surgical site infections in outpatient settings has recently been developed (AMBU-KISS). The participating hospitals and outpatient settings regularly receive their infection rates as well as the equivalent data of all hospitals involved in order to assess the position of their own hospital. However, competent and meaningful interpretation of these data is necessary for internal quality management in order to avoid wrong conclusions. The available results demonstrate that this approach can lead to a substantial reduction of surgical site infections. PMID:15205776

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

    SciTech Connect

    Tuenge, Jason R.

    2011-01-17

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

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

    PubMed

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

    2016-01-01

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

  17. Planning and design of a surgical intensive care unit in a new regional hospital.

    PubMed

    Koay, C K; Fock, K M

    1998-05-01

    Critical care unit design has profound effect on work efficiency, infection control and psychology of patients and staff working in the area. A multidisciplinary team was involved in the design and planning of a surgical intensive care unit (SICU) in a new regional hospital. A workgroup consisting of clinicians, nurses, engineers and hospital administrators were involved in its planning. The Hospital Planning Committee oversaw the activities of the workgroup to ensure co-ordination and integration of the unit plan with the hospital plan. The issue on "single room" versus "open unit" patient room design was much debated. "Single room" concept was adopted and the cubicles were arranged radially facing a central station. Access of patients from the operating theatres and wards to the SICU was an important consideration. The design and facilities of various rooms in the SICU are described. New technology such as the automated guided vehicle, pneumatic tube system, floor mounted power column and closed circuit television were some of the useful assets available in the unit. PMID:9777097

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-12-01

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

  1. Emergency room surgical workload in an inner city UK teaching hospital

    PubMed Central

    Mai-Phan, Tuong A; Patel, Bijendra; Walsh, Michael; Abraham, Ajit T; Kocher, Hemant M

    2008-01-01

    Background Emergency admissions may account for over 50% of surgical admissions. The impact on service provision and implications for training are difficult to quantify. We performed a cohort study to analyse these workload patterns. Methods Data on emergency room (ER) surgical admissions over six months was collected including patient demographics, referral sources, diagnosis, operation and length of stay and analysed according to sub-speciality and age-groups. Results There were 1392 (median age 41 (IQR 28–60) years, M:F = 1.7:1) emergency surgical admissions over six months; 45% were under 40 years of age and 48% patients self-referred to the ER. The commonest diagnoses were abscesses (11%), non-specific abdominal pain (9.7%) and neuro-trauma (9.6%). The median length of stay was 4 (IQR 2–8) days; with older (>80 years) patient staying significantly longer than those <40 years of age (median 8 vs 2 two days, P < 0.0001, Kruskal-Wallis test). Vascular patients remained in hospital longer than trauma or general surgery patients (median 14 vs 3 days, P < 0.0001, Kruskal-Wallis test). A high proportion (43.5%) of the patients required operative intervention and service implications of various diagnoses and operative interventions are highlighted. Conclusion With the introduction of shortened training period in Europe and World over, trainees may benefit from increased exposure to trauma and surgical emergencies. Resource planning should be based on more comprehensive, prospective data such as these. PMID:18513422

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

    PubMed Central

    2014-01-01

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

  3. Integration of the clinical engineering specialist at a high complexity children's hospital. Our professional experience at a surgical center

    NASA Astrophysics Data System (ADS)

    Vargas Enríquez, M. J.; Chazarreta, B.; Emilio, D. G.; Fernández Sardá, E.

    2007-11-01

    This document aims to find relating points between the current and future Clinical Engineer professional in order to discuss about the hospital environment, its characteristics and its realities which lead to our professional development. The main aim is to depict our experience through a retrospective analysis based on the underwriting experience and consequently to arrive at conclusions that will support the inclusion and active interaction of the Clinic Engineer Specialist as part of a Hospital's Surgical Center.

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

    PubMed Central

    Batajoo, Hemant; Ghimire, Samikshya; Sathian, Brijesh

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

    Objective To evaluate services in hospitals providing internship training to graduate doctors in Kenya. Methods A survey of 22 internship training hospitals was conducted. Availability of key resources spanning infrastructure, personnel, equipment and drugs was assessed by observation. Outcomes and process of care for pre-specified priority conditions (head injury, chest injury, fractures, burns and acute abdomen) were evaluated by auditing case records. Results Each hospital had at least one consultant surgeon. Scheduled surgical outpatient clinics, major ward rounds and elective (half day) theatre lists were provided once per week in 91%, 55% and 9%, respectively. In all other hospitals, these were conducted twice weekly. Basic drugs were not always available (e.g. gentamicin, morphine and pethidine in 50%, injectable antistaphylococcal penicillins in 5% hospitals). Fewer than half of hospitals had all resources needed to provide oxygen. One hundred and forty-five of 956 cases evaluated underwent operations under general or spinal anaesthesia. We found operation notes for 99% and anaesthetic records for 72%. Pre-operatively measured vital signs were recorded in 80% of cases, and evidence of consent to operation was found in 78%. Blood loss was documented in only one case and sponge and instrument counts in 7%. Conclusions Evaluation of surgical services would be improved by development and dissemination of clear standards of care. This survey suggests that internship hospitals may be poorly equipped and documented care suggests inadequacies in quality and training. Objectif Evaluer les services dans les hôpitaux offrant des stages de formation à des médecins diplômés au Kenya. Méthodes Enquête auprès de 22 hôpitaux offrant des stages de formation. La disponibilité des ressources clés incluant infrastructure, personnel, matériel et médicaments a été évaluée par observation. Les résultats et processus de soins pour des affections prioritaires prédéfinies (blessure à la tête, blessure à la poitrine, fractures, brûlures et maux d'estomac aigus) ont été évalués par l'audit des dossiers des cas. Résultats Chaque hôpital avait au moins un chirurgien consultant. Les cliniques chirurgicales ambulatoires planifiées, les principales tournées dans les chambres d'hospitalisation et des listes d'opérations choisies (demi-journée) ont été fournies une fois par semaine dans 91%, 55% et 9% des cas respectivement. Dans tous les autres hôpitaux, cela a été effectué deux fois par semaine. Les médicaments de base n’étaient pas toujours disponibles (par ex. la gentamicine, la morphine et la péthidine dans 50% des hôpitaux, les pénicillines anti-staphylococciques injectables dans 5%). Moins de la moitié des hôpitaux disposaient de toutes les ressources nécessaires pour fournir de l'oxygène. 145 sur 956 cas évalués ont subi des opérations sous anesthésie générale ou rachidienne. Nous avons retrouvé des notes d'opération pour 99% des cas et des dossiers d'anesthésie pour 72%. Les mesures préopératoires des signes vitaux ont été enregistrées dans 80% des cas et la preuve du consentement pour l'opération a été trouvée dans 78% des cas. La perte de sang a été documentée dans un seul cas et le comptage des éponges et instruments dans 7% des cas. Conclusions L’évaluation des services de chirurgie serait améliorée par le développement et la dissémination de normes de soins claires. Cette étude suggère que les hôpitaux offrant des stages peuvent être mal équipés et les soins enregistrés suggèrent des insuffisances dans la qualité et la formation. Objetivo Evaluar los servicios en hospitales que proveen entrenamiento a m

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

    PubMed Central

    2014-01-01

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

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

    PubMed

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

    2015-12-01

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

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

    PubMed Central

    Galas, A; Kulig, P; Kulig, J

    2014-01-01

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

  9. 77 FR 45061 - Hospital Outpatient Prospective and Ambulatory Surgical Center Payment Systems and Quality...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-30

    ...non-face-to-face work involved in hospital...subsequent illnesses, improve beneficiary outcomes...could improve the quality of care while...information on hospital quality of care. This...beneficiaries to work with their doctors...to discuss the quality of care hospitals...to hospitals to improve the quality...

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

    SciTech Connect

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

    2012-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-06-01

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

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

    PubMed

    Carey, M E

    1996-03-01

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

  14. Surgical Excision of Benign Papillomas Diagnosed with Core Biopsy: A Community Hospital Approach

    PubMed Central

    Rozentsvayg, Eka; Carver, Kristen; Borkar, Sunita; Mathew, Melvy; Enis, Sean; Friedman, Paul

    2011-01-01

    Our goal was to assess the value of surgical excision of benign papillomas of the breast diagnosed on percutaneous core biopsy by determining the frequency of upgrade to malignancies and high risk lesions on a final surgical pathology. We reviewed 67 patients who had biopsies yielding benign papilloma and underwent subsequent surgical excision. Surgical pathology of the excised lesions was compared with initial core biopsy pathology results. 54 patients had concordant benign core and excisional pathology. Cancer (ductal carcinoma in situ and invasive ductal carcinoma) was diagnosed in five (7%) patients. Surgery revealed high-risk lesions in 8 (12%) patients, including atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ. Cancer and high risk lesions accounted for 13 (19%) upstaging events from benign papilloma diagnosis. Our data suggests that surgical excision is warranted with core pathology of benign papilloma. PMID:22191029

  15. 78 FR 43533 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-19

    ...information on hospital quality of care. We believe...beneficiaries to work with their doctors...to discuss the quality of care hospitals...to hospitals to improve the quality of...sections. QIOs work at the grassroots...Territories in order to improve care for Medicare...Attempts to improve quality through...

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

    PubMed Central

    Luksamijarulkul, Pipat; Aiempradit, Natkitta; Vatanasomboon, Pisit

    2014-01-01

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

  17. 78 FR 54842 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-06

    ...40 trastuzumab emtansine, 1 mg. C9736............. Laparoscopy, G2 2,010.57 surgical, radiofrequency ablation of uterine fibroid(s), including intraoperative guidance and monitoring, when performed....

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-07-01

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

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

    PubMed

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

    2016-01-01

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

  1. 77 FR 45061 - Hospital Outpatient Prospective and Ambulatory Surgical Center Payment Systems and Quality...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-30

    ... outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system... the ASC payment system. In addition, we are proposing updates and refinements to the requirements for... Federal Register online database through Federal Digital System (FDsys), a service of the U.S....

  2. 78 FR 74825 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-10

    ... noted in the correcting document published in the Federal Register on September 6, 2013 (78 FR 54842... payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2014 to... payment system. In addition, this final rule with comment period updates and refines the requirements...

  3. 76 FR 74121 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-30

    ... comment period, we describe the changes to the amounts and factors used to determine the payment rates for... Centers for Disease Control CERT Comprehensive Error Rate Testing CLFS Clinical Laboratory Fee Schedule... the Ambulatory Surgical Center (ASC) Payment System 13. Reporting Quality Data for Annual Payment...

  4. 77 FR 68209 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... Therapy, Speech-Language Pathology, and Occupational Therapy Services in Hospitals and CAHs B. Enforcement... application of the supervision regulations to physical therapy, speech-language pathology, and occupational... devices, brachytherapy sources, intraoperative radiation therapy (IORT), brachytherapy composite...

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 false Compensation for disability or death from hospitalization...VETERANS AFFAIRS ADJUDICATION Pension, Compensation, and Dependency and Indemnity Compensation Ratings for Special Purposes §...

  6. 38 CFR 3.358 - Compensation for disability or death from hospitalization, medical or surgical treatment...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2011-07-01 false Compensation for disability or death from hospitalization...VETERANS AFFAIRS ADJUDICATION Pension, Compensation, and Dependency and Indemnity Compensation Ratings for Special Purposes §...

  7. 77 FR 68209 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

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

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

    PubMed Central

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

    2015-01-01

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

  9. Army Ovens 

    E-print Network

    Unknown

    2011-09-05

    This report has been prepared for the United States Army Construction Engineering Research Laboratories (USACERL) located in Champaign, IL by the Energy Systems Laboratory (ESL) of Texas A&M University. The first phase of this study, completed...

  10. Army Staff 

    E-print Network

    Unknown

    2011-08-17

    This report has been prepared for the United States Army Construction Engineering Research Laboratories (CERL) located at Champaign, IL. The report describes the work performed by the Energy Systems Laboratory (ESL) of Texas A&M University System...

  11. 78 FR 54842 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-06

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

  12. 78 FR 74825 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-10

    ...efficiencies in the delivery of quality care. We stated that...comprehensive APCs will improve our ability to accurately...incentives, to monitor the quality of care provided under...incentive for hospitals to improve delivery efficiency...reduced access and lower quality of health care...

  13. 77 FR 217 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-04

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

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

    PubMed Central

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

    2015-01-01

    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. PMID:25688375

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Geller, Stephen A

    2008-08-01

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

  17. Predictors of preoperative anxiety among surgical patients in Jimma University Specialized Teaching Hospital, South Western Ethiopia

    PubMed Central

    2014-01-01

    Background Hospitalization and surgery are critical negative life events that lead to the experience of considerable anxiety in patients. Patients may perceive the day of surgery as the biggest and the most threatening day in their lives. There is paucity of information on predictors of anxiety in the current study area. The main objective of this study is to assess predictors of preoperative anxiety among patients scheduled for surgery in Jimma University Specialized Teaching Hospital. Methods A facility based cross-sectional study was conducted using quantitative data collection technique in Jimma University Specialized Teaching Hospital from February 13 to April 13, 2012 on 239 patients scheduled for surgery. The data were collected by five trained diploma nurses using structured interviewer administered questionnaires that were prepared based on state trait anxiety inventory measurement scale. The quantitative data were entered into SPSS for windows version 16. 0 and descriptive, simple and multiple linear regression analyses were performed. Results A total of 239 patients were enrolled in the study with a response rate of 93.0%. Their mean age was 42.7?±?1.8 years (range 16 to 85 years). Nearly over half 53.6% were females, while 48.1% illiterate, 72.4% Oromo and 56.5% were Muslim followers. Significant preoperative anxiety was seen in 70.3% patients. The most common factors that lead to anxiety were fear of death 38.1% and fear of unknown origin 24.3% and the most common strategy mentioned by patient in reducing anxiety were talking to other patient 79.8% and religious belief. Conclusions In the present study, two third 70.3% of preoperative patients had anxiety. Factors which were positively correlated with anxiety were trait anxiety, single and divorced, time of operation and income. Factors which were shown to reduce anxiety were preoperative anxiety related information provision and afternoon operation. Health professionals working in the hospital should provide anxiety related information for patients. PMID:25189274

  18. Surgical Travellers: Tapestry to Bayeux

    PubMed Central

    Hedley-Whyte, John; Milamed, Debra R

    2014-01-01

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

  19. Pediatric Day Case Surgical Practice at a Tertiary Hospital in Lagos: How Have We Faired?

    PubMed Central

    Elebute, OA; Ademuyiwa, AO; Bode, CO; Idiodi-Thomas, HOI

    2014-01-01

    Background: There has been a gradual increase in the number of patients treated as a day case surgery in our center. This study has been conducted to audit pediatric day case surgery practice at the Lagos University Teaching Hospital. Aims: The aim of the following study is to determine the morbidity and mortality from day case surgery in our center. Subjects and Methods: The type of study was a prospective study over a 2½ year period at the Lagos University Teaching Hospital. The patients scheduled for surgeries were assessed in the pediatric outpatient clinic and information obtained for each of the patients included age, sex, diagnosis and operation planned. Additional information collected included the (1) type of anesthesia (2) post-operative complications and the cadre of the surgeon. The data was analyzed using SPSS version 19 (IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp, USA). Result: A total of 381 patients were operated during the study period. The age range of patients was 2 weeks to 15 years and the mean age was 2.9 years (3.0). There were 338 male patients (88.7%;338/381) and 43 females (11.3%;43/381). Inguinal hernias and hydroceles constituted almost half of the cases treated while 16.0% of cases were undescended testis. There were four morbidities and no mortality. Conclusion: Day case surgery is associated with a low morbidity and no mortality in our center. PMID:25221704

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    Koris, Jacob; Hopkins, Catherine

    2015-01-01

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

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

    PubMed

    Shah, J N

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  4. [Medical support of the 65th Army during the East Prussian offensive operation performed by the 2nd Belorussian Front].

    PubMed

    Shelepov, A M; Leonik, S I; Lemeshkin, R N

    2015-02-01

    Prussian offensive operation performed by the 2nd Belorussian Front. An activity of the medical An activity of the medical service of the 65th Army during the East Prussian offensive operation performed by the 2nd Belorussian Front is a typical example of the medical support of troops during the final stages of World War II. Forms and methods of medical support management, which were developed during the war, haven't lost their importance in modern conditions. These methods include the establishment of specialized surgical and therapeutic field hospital, establishment of medical institutions in the Army, which worked on the evacuation directions and reserve of mobile hospitals and transport, timely extension of the first echelons of the hospital base front to change institutions hospital deployed the army base. A research of experience in organizing medical support of the offensive operations performed during the last year of World War II provides the material for the development of the theory of modern medical support operations and ability to provide on this basis, the continuity of the hospitals, the continuity of qualified and specialized medical care, improve the performance of diagnostic and treatment work. PMID:25920177

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

    PubMed

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

    2014-07-01

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

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

    E-print Network

    Leveridge, Autumn Tamara

    2013-04-30

    fulfillment of the requirements for the degree of MASTER OF SCIENCE Approved by: Chair of Committee, John A. Walewski Committee Members, Ivan D. Damnjanovic D. Kirk Hamilton Head of Department, Mark Burris May 2013 Major Subject: Civil... my committee chair, Dr. John Walewski, and my committee members, Dr. Ivan Damnjanovic and Professor D. Kirk Hamilton, for their guidance and support throughout the course of this research. I want to extend my gratitude to the team at the U.S. Army...

  7. Environment US Army Corps

    E-print Network

    US Army Corps of Engineers

    Environment The Corps US Army Corps of Engineers ® April 2012 Vol. 13, No. 2 See Earth Day page 10 of the U.S. Army Corps of Engineers A s we approach Earth Day 2012, it affords us the opportunity to look The U.S. Army Earth Day poster. (Illustration by U.S. Army Environmental Command) and technical

  8. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee.

    PubMed

    Mangram, A J; Horan, T C; Pearson, M L; Silver, L C; Jarvis, W R

    1999-04-01

    EXECUTIVE SUMMARY The "Guideline for Prevention of Surgical Site Infection, 1999" presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.1,2 Part I, "Surgical Site Infection: An Overview," describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis. Part II, "Recommendations for Prevention of Surgical Site Infection," represents the consensus of the Hospital Infection Control Practices Advisory Committee (HICPAC) regarding strategies for the prevention of SSIs.3 Whenever possible, the recommendations in Part II are based on data from well-designed scientific studies. However, there are a limited number of studies that clearly validate risk factors and prevention measures for SSI. By necessity, available studies have often been conducted in narrowly defined patient populations or for specific kinds of operations, making generalization of their findings to all specialties and types of operations potentially problematic. This is especially true regarding the implementation of SSI prevention measures. Finally, some of the infection control practices routinely used by surgical teams cannot be rigorously studied for ethical or logistical reasons (e.g., wearing vs not wearing gloves). Thus, some of the recommendations in Part II are based on a strong theoretical rationale and suggestive evidence in the absence of confirmatory scientific knowledge.It has been estimated that approximately 75% of all operations in the United States will be performed in "ambulatory," "same-day," or "outpatient" operating rooms by the turn of the century.4 In recommending various SSI prevention methods, this document makes no distinction between surgical care delivered in such settings and that provided in conventional inpatient operating rooms. This document is primarily intended for use by surgeons, operating room nurses, postoperative inpatient and clinic nurses, infection control professionals, anesthesiologists, healthcare epidemiologists, and other personnel directly responsible for the prevention of nosocomial infections. This document does not: Specifically address issues unique to burns, trauma, transplant procedures, or transmission of bloodborne pathogens from healthcare worker to patient, nor does it specifically address details of SSI prevention in pediatric surgical practice. It has been recently shown in a multicenter study of pediatric surgical patients that characteristics related to the operations are more important than those related to the physiologic status of the patients.5 In general, all SSI prevention measures effective in adult surgical care are indicated in pediatric surgical care. Specifically address procedures performed outside of the operating room (e.g., endoscopic procedures), nor does it provide guidance for infection prevention for invasive procedures such as cardiac catheterization or interventional radiology. Nonetheless, it is likely that many SSI prevention strategies also could be applied or adapted to reduce infectious complications associated with these procedures. Specifically recommend SSI prevention methods unique to minimally invasive operations (i.e., laparoscopic surgery). Available SSI surveillance data indicate that laparoscopic operations generally have a lower or comparable SSI risk when contrasted to open operations.6-11 SSI prevention measures applicable in open operations (e.g., open cholecystectomy) are indicated for their laparoscopic counterparts (e.g., laparoscopic cholecystectomy). Recommend specific antiseptic agents for patient preoperative skin preparations or for healthcare worker hand/forearm antisepsis. Hospitals should choose from products recommended for these activitie PMID:10196487

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-05-15

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

  11. Serum Vitamin D levels at admission predict the length of intensive care unit stay but not in-hospital mortality of critically ill surgical patients

    PubMed Central

    Alizadeh, Nafiseh; Khalili, Hossein; Mohammadi, Mostafa; Abdollahi, Alireza

    2015-01-01

    Objective: There is few data regarding the correlation between serum Vitamin D level and unfavorable intensive care unit (ICU) outcome in postsurgical patients. In this study, correlation between serum 25(OH)D level and length of ICU stay and in-hospital mortality has been evaluated in critically ill surgical patients. Methods: Serum 25(OH)D has been evaluated in 70 surgical, critically ill patients. Demographic, laboratory, and clinical data of the patients were collected. Correlation between serum 25(OH) D level and duration of ICU stay and hospital mortality was evaluated using two-factor analysis of covariance. Multivariable Cox-regression analysis was used for adjusting the effect of season of blood sampling and type of surgery on the main variables. For all the analyses, P values less than or equal to 0.05 were considered as statistically significant. Findings: Serum 25(OH)D deficiency was identified in 52 (74.3%) of the patients. Patients with serum Vitamin D levels < 30 ng/ml had longer length of ICU stay than those with serum Vitamin D levels ? 30 ng/ml (7.8 ± 5.1 vs. 4.05 ± 2.12 days, P = 0.003). Although hospital mortality was more common in Vitamin D deficient patients than sufficient ones (25% in deficient group versus 22.2% in sufficient group), there was no significant difference regarding hospital mortality rate between the groups. Conclusion: Statistically significant association was found between low 25(OH)D level and increased length of ICU stay in critically ill surgical patients. It could be explained by favorable effects of Vitamin D on immune system functions, reducing tissue dysfunction, and risk of organ failure and overall complications. However, there was no correlation between serum Vitamin D level and patients’ in-hospital mortality. Further, well-designed prospective clinical studies with adequate sample size are needed to evaluate correlation between serum Vitamin D level and mortality in critically ill patients.

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

    PubMed

    2015-11-13

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

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

    PubMed

    Carey, Michael E

    2014-08-01

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

  14. Optimization of surgical supply inventory and kitting

    E-print Network

    Schlanser, Matthew R. (Matthew Ross)

    2013-01-01

    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 ...

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

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

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

  16. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  16. 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

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

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

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

  18. DEPARTMENT OF THE ARMY NATHAN HALE ARMY ROTC BATTALION

    E-print Network

    Royer, Dana

    DEPARTMENT OF THE ARMY NATHAN HALE ARMY ROTC BATTALION UNIVERSITY OF CONNECTICUT 362 FAIRFIELD RD U that will look great on your resume? Army ROTC provides you an opportunity to do both while continuing your education. Army ROTC is offered to students attending any college in Connecticut. Army ROTC classes

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

    PubMed

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

    2015-08-01

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

  20. UNITED STATES ARMY HEALTH PROFESSIONS

    E-print Network

    McQuade, D. Tyler

    UNITED STATES ARMY HEALTH PROFESSIONS SCHOLARSHIP PROGRAM IN MEDICINE, DENTISTRY, VETERINARY MEDICINE, OPTOMETRY, CLINICAL PSYCHOLOGY AND NURSE ANESTHESIA WHAT IS THE ARMY'S HEALTH PROFESSIONS SCHOLARSHIP PROGRAM? The Army offers one of the most generous and comprehensive scholarships in the health

  1. ARMY EQUIPMENT MODERNIZATION

    E-print Network

    US Army Corps of Engineers

    ARMY EQUIPMENT MODERNIZATION STRATEGY Equipping the Total Force to Win in a Complex World.mil #12;#12;iv This page intentionally left blank #12;Army Equipment Modernization Strategy Equipping the Total Force to Win in a Complex World 1 Table of Contents Overview 2 Strategic Environment 5 Equipping

  2. A 4-year analysis of caesarean delivery in a Nigerian teaching hospital: one-quarter of babies born surgically.

    PubMed

    Okezie, A O; Oyefara, B; Chigbu, C O

    2007-07-01

    Between January 2001 and December 2004, a total of 2,922 deliveries were conducted at the University of Nigeria Teaching Hospital , Enugu. Caesarean section accounted for 740 deliveries, an incidence of 25.3%. A total of 62.2% of caesarean sections were done as emergencies, while 37.8% were done as elective procedures and 64.8% were booked patients. Repeat caesarean sections accounted for 59.2% of elective cases and 18.7% of emergency cases. Fetal distress was responsible for 11. 6% of emergency cases, however 35.6% of babies delivered for clinically diagnosed fetal distress had Apgar scores 7 and above. A total of 85.6% of patients were between 25 - 29 years of age; 31% were primigravida, while 54.4% were Gravida 2 - 4. There were seven (0.6%) maternal deaths and 73 (9.2%) stillbirths. It was concluded that reduction of primary caesarean section rate and repeat caesarean rates should be the main target of any strategy to reduce caesarean section rate. Other measures to reduce the caesarean section rate and recommendations are discussed. PMID:17701792

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

    PubMed Central

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

    2015-01-01

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

  4. Abortion - surgical

    MedlinePLUS

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

  5. US Army Corps of Engineers

    E-print Network

    US Army Corps of Engineers

    [!IJ US Army Corps of Engineers AQUATIC PLANT CONTROL RESEARCH PROGRAM MISCELLANEOUS PAPER A-85=or Public Release; Distribution Unlimited Prepared for DEPARTMENT OF THE ARMY US Army Corps of Engineers Washington, DC 20314-1000 Under Contract No. DACW39-81-C-0036 Monitored by Environmental Laboratory US Army

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

    PubMed Central

    2012-01-01

    Background Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting. Methods This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15. Results A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1). Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8%) perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2%) patients were HIV positive with a median CD4+ count of 261 cells/?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

  7. Surgical Technologists

    MedlinePLUS

    ... site or suture a wound. <- Summary Work Environment -> Work Environment About this section Surgical technologists are trained ... communicable diseases and unpleasant sights, odors, and materials. Work Schedules Most surgical technologists work full time. Surgical ...

  8. PROFESSIONAL SOLDIERS A VOLUNTEER ARMY

    E-print Network

    Bushman, Frederic

    PROFESSIONAL SOLDIERS A VOLUNTEER ARMY OR A DRAFT: WHO CAN AND SHOULD PROVIDE BSM SERVICES AND CBT ESTABLISH A NETWORK OF PEER SUPERVISORS #12;HOW DO WE RECRUIT/TRAIN NEW THERAPISTS ? HOW DO WE FIELD AN ARMY

  9. Developing an Army Doctrine Publication

    E-print Network

    Price, Judith M.R.

    2013-05-17

    Army leaders cannot achieve all military objectives single-handedly. Army leaders are realizing that their span of responsibility is greater than their span of control, extending influence is more complex than using authority, and working by, with...

  10. Army Regulation 2001 Environmental Quality

    E-print Network

    US Army Corps of Engineers

    Army Regulation 200­1 Environmental Quality Environmental Protection and Enhancement Headquarters Department of the Army Washington, DC 13 December 2007 UNCLASSIFIED #12;SUMMARY of CHANGE AR 200 the policy regarding Army Program Guidance Memorandum (para 15-1). o Corrects typographical errors throughout

  11. Army Regulation 69012 Civilian Personnel

    E-print Network

    US Army Corps of Engineers

    Army Regulation 690­12 Civilian Personnel Equal Employment Opportunity and Affirmative Action Headquarters Department of the Army Washington, DC 4 March 1988 Unclassified #12;SUMMARY of CHANGE AR 690 opportunity management at Headquarters, Department of the Army (para 1-4); and implements DODD 1440.1. #12

  12. US Army Corps of Engineers

    E-print Network

    US Army Corps of Engineers

    [m]I I 11~11 US Army Corps of Engineers Waterways Experiment Station Technical Report A-98-1 May. --.-- .-- -- -- ...-- --.. Approved For Public Release; Distribution Is Unlimited Prepared for Headquarters, U.S. Army Corps of the Army position, unless so desig- nated by other authorized documents. @ PRINTED ON RECYCLED PAPER #12

  13. Army Regulation 690600 Civilian Personnel

    E-print Network

    US Army Corps of Engineers

    Army Regulation 690­600 Civilian Personnel Equal Employment Opportunity Discrimination Complaints Headquarters Department of the Army Washington, DC 9 February 2004 UNCLASSIFIED #12;SUMMARY of CHANGE AR 690 discrimination complaints. o Requires Army activities to establish an alternative dispute resolution program

  14. US Army Corps of Engineers

    E-print Network

    US Army Corps of Engineers

    (m]I I 11~11 US Army Corps of Engineers Waterways Experiment Station Technical Report A-98-2 July.S. Army Corps of Engineers #12;The contents of this report are not to be used for advertising, publication Department of the Army position, unless so desig- nated by other authorized documents. @ PRINTED ON RECYCLED

  15. Army Strong, Superintendent Savvy

    ERIC Educational Resources Information Center

    Mellon, Ericka

    2011-01-01

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

  16. Korean Army Hat

    E-print Network

    Hacker, Randi

    2013-08-14

    Broadcast Transcript: Here in South Korea, it doesn't matter how famous you are, if you're in the army--and Korean men are required to do about 2 years of military service--you wear your hat. This point was driven home recently when paparazzi...

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

    PubMed

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

    2015-01-01

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

  18. 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.

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

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

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  5. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  11. 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

  12. Surgical smoke.

    PubMed

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

    2009-10-01

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

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

    E-print Network

    Harvey, Roger K.

    2006-05-23

    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 ...

  14. Pamphlet No. Department of the Army

    E-print Network

    US Army Corps of Engineers

    CEHO Pamphlet No. 870-1-18 Department of the Army U.S. Army Corps of Engineers Washington, DC 20314 Army Office of History US Army Corps of Engineers Washington, DC #12;Library of Congress Cataloging-in-Publication Data Casey, Hugh John, 1898-1981. Major General Hugh J. Casey, US Army. p. cm -- (Engineer memoirs

  15. Bronson Methodist Hospital Founded in 1900, today Bronson Methodist Hospital

    E-print Network

    Bronson Methodist Hospital Founded in 1900, today Bronson Methodist Hospital (BMH) is a state provides care in virtually every specialty: cardiology (Heart Hospital at Bronson), general surgical's Hospital at Bronson), and adult critical care services. As a tertiary care center, BMH includes a Level I

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

    PubMed Central

    2014-01-01

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

  17. US Army Corps of Engineersr~,

    E-print Network

    US Army Corps of Engineers

    in federal water resources planning in the decades following World War II, few have exerted more influenceUS Army Corps of Engineersr~, Water Resources People and Issues Interview with Theodore M. Schad for Water R.esources U.S. Army Corps of Engineers Alexandria, Virginia #12;Water Resources People and Issues

  18. US Army Corps of Engineers

    E-print Network

    US Army Corps of Engineers

    . 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

  19. Army Industrial, Landscaping, and Agricultural Water Use

    SciTech Connect

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

    2014-09-18

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

  20. US Army Corps of Engineers BUILDING STRONG

    E-print Network

    US Army Corps of Engineers

    US Army Corps of Engineers BUILDING STRONG® US Army Corps of Engineers BUILDING STRONG® Coastal as workshop) 3 http://cirp.usace.army.mil/workshops/nap12/NAP-Workshop.html #12;Coastal and Hydraulics Laboratory Draft CMS User Manual 4 http://cirp.usace.army.mil/wiki/CMS #12;

  1. US Army Corps of Engineers BUILDING STRONG

    E-print Network

    US Army Corps of Engineers

    US Army Corps of Engineers BUILDING STRONG® US Army Corps of Engineers BUILDING STRONG® Coastal Material CMS-Flow data folder (same as workshop) 3 http://cirp.usace.army.mil/workshops/nap12/NAP-Workshop.html #12;Coastal and Hydraulics Laboratory Draft CMS User Manual 4 http://cirp.usace.army.mil/wiki/CMS #12;

  2. Perioperative Surgical Home: Perspective II.

    PubMed

    Vetter, Thomas R; Jones, Keith A

    2015-12-01

    Healthcare delivery and payment systems in the United States must continue to be reformed to address currently untenably increasing healthcare expenditures, while increasing the quality of care. The Perioperative Surgical Home is a highly patient-centered approach to care, focusing on the standardization, coordination, transitions, and value of care, throughout the perioperative continuum, including after hospital discharge. To increase the value of surgical care, any Perioperative Surgical Home model must translate, implement, and sustain improvements in quality, safety, and satisfaction, plus cost reduction strategies, throughout the perioperative continuum. Healthcare informatics, analytics, decision support, and practice change are central to this effort. PMID:26610629

  3. Process Improvement at Army Installations 

    E-print Network

    Northrup, J.; Smith, E. D.; Lin, M.; Baird, J.

    1997-01-01

    AT ARMY INSTALLATIONS Jearldine Northrup Ed. D. Smith Mike Lin Joyce Baird Materials Engineer Environmental Engineer Chemical Engineer Industrial Engineer USACERL Champaign, IL ABSTRACT Compliance with environmental law is Energy is a significant...

  4. Salvation Army : the next generation

    E-print Network

    Francpourmoi, Salomé

    2010-01-01

    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 ...

  5. Surgical Assisting

    MedlinePLUS

    ... years Military medical training with surgical assistant experience Proof of liability insurance Current CPR/BLS certification Acceptable ... literacy Students also must be able to show proof of successful completion of basic science (college level) ...

  6. Surgical Mesh

    MedlinePLUS

    ... Device Safety Safety Communications Surgical Mesh: FDA Safety Communication Share Tweet Linkedin Pin it More sharing options ... Prolapse and Stress Urinary Incontinence More in Safety Communications Information About Heparin Preventing Tubing and Luer Misconnections ...

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

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

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), 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

  8. Robotic surgical training.

    PubMed

    Ben-Or, Sharon; Nifong, L Wiley; Chitwood, W Randolph

    2013-01-01

    In July 2000, the da Vinci Surgical System (Intuitive Surgical, Inc) received Food and Drug Administration approval for intracardiac applications, and the first mitral valve repair was done at the East Carolina Heart Institute in May 2000. The system is now approved and used in many surgical specialties. With this disruptive technology and accepted use, surgeons and hospitals are seeking the most efficacious training pathway leading to safe use and responsible credentialing.One of the most important issues related to safe use is assembling the appropriate team of professionals involved with patient care. Moreover, proper patient selection and setting obtainable goals are also important.Creation and maintenance of a successful program are discussed in the article focusing on realistic goals. This begins with a partnership between surgeon leaders, hospital administrators, and industry support. Through this partnership, an appropriate training pathway and clinical pathway for success can be outlined. A timeline can then be created with periods of data analysis and adjustments as necessary. A successful program is attainable by following this pathway and attending to every detail along the journey. PMID:23528718

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

    PubMed Central

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

    2014-01-01

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

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

    E-print Network

    US Army Corps of Engineers

    CECW-EH-W Engineer Regulation 1110-2-240 Department of the Army U.S. Army Corps of Engineers-CWH-W Regulation No. 1110-2-240 DEPARTMENT OF THE ARMY U. s. Army Corps of Engineers washington, DC 20314-EH-W Regulation No. 1110-2-240 DEPARTMENT OF THE ARMY u.s. Army Corps of Engineers Washington, DC 20314

  11. Frequently Asked Questions about Surgical Site Infections

    MedlinePLUS

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

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

    PubMed Central

    Vitkovski, Taisia; Bhuiya, Tawfiqul; Esposito, Michael

    2015-01-01

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

  13. Improving surgical weekend handover

    PubMed Central

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

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

  14. Surgical wound sepsis

    PubMed Central

    Cruse, P. J. E.

    1970-01-01

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

  15. Clinical Features and Pattern of Presentation of Breast Diseases in Surgical Outpatient Clinic of a Suburban Tertiary Hospital in South-West Nigeria

    PubMed Central

    Ayoade, Babatunde A; Tade, Adedayo O; Salami, Babatunde A

    2012-01-01

    Objective: To characterize the clinical features and pattern of presentation of breast diseases as observed in our practice. Materials and Methods: A prospective study of 121 consecutive patients with breast complaints presenting in our Surgical Outpatient Clinics. The relevant data were collected by two surgeons using the prescribed forms and was analyzed using Epi Info 2003, Mann-Whitney (test of two groups) Chi-squared and Fishers exact test was used to compare parameters of benign and malignant groups. P value <0.05 was considered as significant. Results: One hundred and nineteen patients were females, two were males. The age range was 14-70 years. Forty two (34.7%) patients were in the 21-30 year age group. The commonest symptoms were breast lump in 111 (91.7%) patients, and breast pain in 28 (23.1%) patients. Breast pain was a significant presenting complaint in patients with breast malignancy (P=.026). On clinical examination 103 (85.1%) patients had palpable lumps, and seven patients were normal. Forty four patients (36.3%) had malignant disease, seventy patients (57.8%) had benign breast diseases and seven were normal. Fifty nine of the 70 benign diseases were fibroadenoma. One hundred and three patients (85%) had appropriate therapy, while 18 patients (14.8%), including eight with malignant disease absconded. Conclusion: In the study, a breast lump was the commonest clinical feature of breast disease. Over 60% of these were benign. Breast pain was a statistically significant presentation in patients with malignant breast disease. One in seven of the patients absconded. PMID:24027385

  16. 78 FR 24735 - Army Education Advisory Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-26

    ...revolutionizing training to strengthen the Army. The agenda will include topics relating to the Army Learning Model that seeks to improve the Army's learning model by leveraging technology without sacrificing standards so the Army can provide...

  17. AUTOMATED ANALYSIS OF VITAL SIGNS TO IDENTIFY PATIENTS WITH SUBSTANTIAL BLEEDING BEFORE HOSPITAL ARRIVAL

    E-print Network

    AUTOMATED ANALYSIS OF VITAL SIGNS TO IDENTIFY PATIENTS WITH SUBSTANTIAL BLEEDING BEFORE HOSPITAL Institute, Telemedicine and Advanced Technology Research Center, US Army Medical Research and Materiel Critical Care, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Division

  18. 32 CFR 651.5 - Army policies.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...balance environmental concerns with mission requirements, technical requirements, economic feasibility, and long-term sustainability of Army operations. While carrying out its mission, the Army will also encourage the wise stewardship of natural...

  19. 32 CFR 651.5 - Army policies.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...balance environmental concerns with mission requirements, technical requirements, economic feasibility, and long-term sustainability of Army operations. While carrying out its mission, the Army will also encourage the wise stewardship of natural...

  20. 32 CFR 651.5 - Army policies.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...balance environmental concerns with mission requirements, technical requirements, economic feasibility, and long-term sustainability of Army operations. While carrying out its mission, the Army will also encourage the wise stewardship of natural...

  1. 32 CFR 651.5 - Army policies.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... selection of alternatives (40 CFR 1506.1). In accordance with DOD 5000.2.R, the MATDEV is responsible for..., and long-term sustainability of Army operations. While carrying out its mission, the Army will...

  2. 32 CFR 651.5 - Army policies.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... selection of alternatives (40 CFR 1506.1). In accordance with DOD 5000.2.R, the MATDEV is responsible for..., and long-term sustainability of Army operations. While carrying out its mission, the Army will...

  3. 32 CFR 651.5 - Army policies.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... selection of alternatives (40 CFR 1506.1). In accordance with DOD 5000.2.R, the MATDEV is responsible for..., and long-term sustainability of Army operations. While carrying out its mission, the Army will...

  4. 32 CFR 651.5 - Army policies.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... selection of alternatives (40 CFR 1506.1). In accordance with DOD 5000.2.R, the MATDEV is responsible for..., and long-term sustainability of Army operations. While carrying out its mission, the Army will...

  5. 76 FR 12087 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-04

    ...the Army Education Advisory Committee. Dates of Meeting: March 24, 2011. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall, Carlisle Barracks, Pennsylvania 17013. Time of Meeting:...

  6. DEPARTMENT OF THE ARMY U.S. ARMY CORPS OF ENGINEERS

    E-print Network

    US Army Corps of Engineers

    DEPARTMENT OF THE ARMY U.S. ARMY CORPS OF ENGINEERS FINANCE CENTER 5722 INTEGRITY DRIVE MILLINGTON TENNESSEE 38054-5005 CEFC-FD November 4, 2014 To Whom It May Concern: U.S. Army Corps of Engineers can: Checking U.S. Army Corps of Engineers can receive funds via Wire Transfer using the following: Bank Name

  7. Engineer Pamphlet Department of the Army

    E-print Network

    US Army Corps of Engineers

    Before the Civil War .................. 4 Navigation Improvements From the Civil War to World War IICEHO Engineer Pamphlet 870-1-13 Department of the Army U.S. Army Corps of Engineers Washington, DC Development A Brief History by Martin Reuss Paul K. Walker EP 870-1·13 July 1983 US Army Corps of Engineers

  8. 76 FR 66282 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-26

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

  9. 75 FR 7255 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-18

    ... CFR 102-3.150, the following meeting notice is announced: Name of Committee: U.S. Army War College.... Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall, Carlisle... submit a written statement for consideration by the U.S. Army War College Subcommittee....

  10. 76 FR 12087 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-04

    ... 102-3.150, the following meeting notice is announced: Name of Committee: U.S. Army War College.... Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall, Carlisle... public. Interested persons may submit a written statement for consideration by the U.S. Army War...

  11. Army Low Impact Development Technical User Guide

    E-print Network

    US Army Corps of Engineers

    Army Low Impact Development Technical User Guide 4 January 2013 Office Corps of Engineers Engineer Research and Development Center With Support From: The Low Impact Development Center, Inc. #12; #12;Army Low Impact Development Technical User Guide U.S. Army Corps

  12. header for SPIE use Army Research Laboratory

    E-print Network

    Steele, Adam

    header for SPIE use Army Research Laboratory Advanced Displays and Interactive Displays Fedlab engineering results are being readied for transition to various Army customers. In this paper we describe some of the research results along with their potential Army applications. Keywords: Displays, cognitive engineering

  13. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 true Army policy. 631.14 Section 631.14...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL...Activities) and Policy § 631.14 Army policy. (a) Soldiers, military...

  14. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2013-07-01 true Army policy. 631.14 Section 631.14...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL...Activities) and Policy § 631.14 Army policy. (a) Soldiers, military...

  15. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 2013-07-01 false Army policy. 631.14 Section 631.14...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL...Activities) and Policy § 631.14 Army policy. (a) Soldiers, military...

  16. Understanding Reenlistment in the Union Army

    E-print Network

    Understanding Reenlistment in the Union Army during the American Civil War Mario Trottini and John that influenced the reelinst­ ment decision of the volunteers who fought in the Union Army during the American and motivation The creation of the armies that fought the American Civil War was both a monumental and absolutely

  17. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2011-07-01 true Army policy. 631.14 Section 631.14...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL...Activities) and Policy § 631.14 Army policy. (a) Soldiers, military...

  18. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2011-07-01 false Army policy. 631.14 Section 631.14...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL...Activities) and Policy § 631.14 Army policy. (a) Soldiers, military...

  19. U.S. Army Corps of Engineers

    E-print Network

    US Army Corps of Engineers

    U.S. Army Corps of Engineers Office of Water Project Review The Civil Works Review Board Process ­ A Work in Progress C. Lee Ware US Army Corps of Engineers, Headquarters Update 28 August 2013 #12;U.S. Army Corps of Engineers Office of Water Project Review Objective · To discuss Civil Works Review Board

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

    PubMed Central

    Griffiths, DE; Hargrove, R; Clasper, J

    2006-01-01

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

  1. Robert Wood Johnson University Hospital Hamilton

    E-print Network

    Robert Wood Johnson University Hospital Hamilton Located on a beautiful 68-acre campus, Robert Wood Johnson University Hospital Hamilton (RWJ Hamilton) is a private, not-for-profit acute care hospital-foot hospital includes services for medical, surgical, obstetric, cardiac, orthopedic, emergency, and intensive

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

    ERIC Educational Resources Information Center

    Bell, Nicole S.

    2009-01-01

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

  3. Army Precision at Central Headquarters

    ERIC Educational Resources Information Center

    Goldman, Jay P.

    2005-01-01

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

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

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

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

  5. 77 FR 40030 - Army Science Board Summer Study Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-06

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

  6. 78 FR 33074 - Army Science Board Summer Study Session

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-03

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

  7. 77 FR 50089 - Army Education Advisory Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-20

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

  8. 77 FR 11084 - Army Education Advisory Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-24

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

  9. 78 FR 24735 - Army Education Advisory Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-26

    ... Department of the Army Army Education Advisory Committee Meeting AGENCY: Department of the Army, DoD. ACTION... committee meeting: Name of Committee: Army Education Advisory Committee (AEAC). Date of Meeting: Thursday... standards so the Army can provide credible, rigorous, and relevant training and education for its force...

  10. Surgical Risks Associated with Winter Sport Tourism

    PubMed Central

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

    2015-01-01

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

  11. 78 FR 73852 - Army Science Board Winter Plenary Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-09

    ...meeting: Name of Committee: Army Science Board (ASB) Winter Plenary...of the meeting is for the Army Science Board to review the results of...record according to the Army Science Board Bylaws, Article VII, Section 2 and...

  12. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2011-07-01 true Army military real property. 644.326 ...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.326 Army military real property....

  13. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 true Army military real property. 644.326 ...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.326 Army military real property....

  14. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2011-07-01 false Army military leased property. 644.328...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.328 Army military leased property. (a)...

  15. 32 CFR 536.14 - Commanders of major Army commands.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  17. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2013-07-01 true Army military leased property. 644.328...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.328 Army military leased property. (a)...

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

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  19. 32 CFR 536.14 - Commanders of major Army commands.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  20. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 2013-07-01 false Army military leased property. 644.328...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.328 Army military leased property. (a)...

  1. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 2013-07-01 false Army military real property. 644.326 ...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.326 Army military real property....

  2. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 true Army military leased property. 644.328...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.328 Army military leased property. (a)...

  3. CADET HANDBOOK U.S. ARMY CADET COMMAND

    E-print Network

    Stuart, Steven J.

    L CADET HANDBOOK U.S. ARMY CADET COMMAND CADET SUMMER TRAINING 2014 DISTRIBUTION RESTRICTION: THE ARMY LEADER: CHARACTER,PRESENCE, INTELLECT SECTION I: LEADERSHIP DIMENSIONS VIGNETTES ------------------------------------------------------------1-13 CHAPTER 2: ARMY BASICS SECTION I

  4. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2011-07-01 true Army military leased property. 644.328...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.328 Army military leased property. (a)...

  5. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2011-07-01 false Army military real property. 644.326 ...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.326 Army military real property....

  6. 32 CFR 536.14 - Commanders of major Army commands.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  7. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2013-07-01 true Army military real property. 644.326 ...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.326 Army military real property....

  8. Elec 331 -Surgical Instruments Surgical Instruments

    E-print Network

    Pulfrey, David L.

    Elec 331 - Surgical Instruments 1 Surgical Instruments Iron (Fe) · Crystalline Structure ­ Atoms 331 - Surgical Instruments 2 Atomic Structure of Iron Crystal Body Centered Ferrite ( iron) Face · Iron Alloy ­ Fe + Other atoms ­ At least 50% Fe · Stainless steel ­ 11% to 30% Cr ­ Up to 2% C #12;Elec

  9. Infection prevention: the surgical care continuum.

    PubMed

    Barnes, Sue

    2015-05-01

    Lack of careful attention to the increasing complexity of surgical procedures, instrument cleaning and processing, and the transition of surgical and other invasive procedures from the OR to areas outside the traditional hospital OR can contribute to surgical site infection (SSI) risk. Regardless of the location of an intervention, when basic infection prevention measures are applied reliably, even low infection rates can be reduced. To address infection prevention challenges, infection preventionists (IPs) must be well informed regarding infection risk and prevention during surgical and other invasive procedures and the effect a facility type may have on patients' infection risk. The IP must have a solid understanding of surgical asepsis, instrument disinfection, and sterilization to educate and support clinical teams in identifying opportunities for improvement relative to infection prevention. PMID:25946177

  10. Surgical Strategies for Cervical Spinal Neurinomas

    PubMed Central

    ITO, Kiyoshi; AOYAMA, Tatsuro; MIYAOKA, Yoshinari; HORIUCHI, Tetsuyoshi; HONGO, Kazuhiro

    Cervical spinal neurinomas are benign tumors that arise from nerve roots. Based on their location, these tumors can also take the form of a dumbbell-shaped mass. Treatment strategies for these tumors have raised several controversial issues such as appropriate surgical indications and selection of surgical approaches for cervical dumbbell-shaped spinal neurinomas. In this report, we review previous literature and retrospectively analyze cervical spinal neurinoma cases that have been treated at our hospital. Surgical indications and approaches based on tumor location and severity are discussed in detail. Thus, with advances in neuroimaging and neurophysiological monitoring, we conclude that appropriate surgical approaches and intraoperative surgical manipulations should be chosen on a case-by-case basis. PMID:26119900

  11. Surgical video systems.

    PubMed

    1995-11-01

    Surgical video systems (SVSs), which typically consist of a video camera attached to an optical endoscope, a video processor, a light source, and a video monitor, are now being used to perform a significant number of minimally invasive surgical procedures. SVSs offer several advantages (e.g., multiple viewer visualization of the surgical site, increased clinician comfort) over nonvideo systems and have increased the practicality and convenience of minimally invasive surgery (MIS). Currently, SVSs are used by hospitals in their general, obstetric/gynecologic, orthopedic, thoracic, and urologic procedures, as well as in other specialties for which MIS is feasible. In this study, we evaluated 19 SVSs from 10 manufacturers, focusing on their use in laparoscopic applications in general surgery. We based our ratings on the usefulness of each system's video performance and features in helping clinicians provide safe and efficacious laparoscopic surgery. We rated 18 of the systems Acceptable because of their overall good performance and features. We rated 1 system Conditionally Acceptable because, compared with the other evaluated systems, this SVS presents a greater risk of thermal injury resulting from excessive heating at the distal tip of the laparoscope. Readers should be aware that our test results, conclusions, and ratings apply only to the specific systems and components tested in this Evaluation. In addition, although our discussion focuses on the laparoscopic application of SVSs, much of the information in this study also applies to other MIS applications, and the evaluated devices can be used in a variety of surgical procedures. To help hospitals gain the perspectives necessary to assess the appropriateness of specific SVSs to ensure that the needs of their patients, as well as the expectations of their clinicians, will be satisfied, we have included a Selection and Purchasing Guide that can be used as a supplement to our Evaluation findings. We have also included a Glossary of relevant terminology and the supplementary article, "Fiberoptic Illumination Systems and the Risk of Burns or Fire during Endoscopic Procedures," which addresses a safety concern with the use of these devices. While we made every effort to present the most current information, readers should recognize that this is a rapidly evolving technology, and developments occurring after our study was complete may not be reflected in the text. For additional information on topics related to this study, refer to the following Health Devices articles: (1) our Guidance Article, "Surgical Video Systems Used in Laparoscopy," 24(1), January 1995, which serves as an introduction to SVS terminology and includes a discussion of the significance of many SVS specifications; (2) our Evaluation, "Video Colonoscope Systems," 23(5), May 1994, which includes a detailed overview of video endoscopic applications and technology; and (3) our Evaluations of laparoscopic insufflators (21[5], May 1992, and 24[7], July 1995), which address issues related to the creation of a viewing and working space inside the peritoneal cavity to facilitate visualization in laparoscopic procedures. PMID:8750067

  12. 78 FR 18473 - Army Privacy Act Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-27

    ... Register (71 FR 46052), the Department of the Army issued a final rule. This final rule corrects the... Litigation Division when complaints citing the Privacy Act are filed in order to correct the mailing address in Sec. 505.12. The address for notifying the Army Litigation Division of cases citing the...

  13. Engineer Pamphlet Department of the Army

    E-print Network

    US Army Corps of Engineers

    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

  14. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 4 2011-07-01 2011-07-01 false Army policy. 631.14 Section 631.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL INVESTIGATIONS ARMED FORCES DISCIPLINARY CONTROL BOARDS AND OFF-INSTALLATION LIAISON AND OPERATIONS Off-Installation Operations (Military...

  15. Montana State University 1 Military Science -Army

    E-print Network

    Maxwell, Bruce D.

    ROTC scholarship is given to students pursuing degrees in nursing, engineering, the physical sciencesMontana State University 1 Military Science - Army ROTC Army Reserve Officers' Training. By taking the Military Science courses, in addition to their regular major, MSU students are offered

  16. Army Reserve Comprehensive Water Efficiency Assessments

    SciTech Connect

    McMordie Stoughton, Kate; Kearney, Jaime

    2015-04-14

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

  17. Uncommon surgical emergencies in neonatology.

    PubMed

    Angotti, R; Bulotta, A L; Ferrara, F; Molinaro, F; Cerchia, E; Meucci, D; Messina, M

    2014-01-01

    Objective. Over the past decade, multiple factors have changed the pattern of neonatal surgical emergencies. An increase in prenatal screenings and the development of neonatal tertiary care centres have changed the clinical approach to these kids. Materials and methods. Between 1995 to 2011 were retrospectively reviewed 34 patients with diagnosis of uncommon rare neonatal surgical emergencies at our institute. We analyzed: sex, gestational age, weight at birth, primary pathology, prenatal diagnosis, associated anomalies, age and weight at surgery, clinical presentation, start of oral feeding and hospitalization. The follow-up was performed at 6,12, 24 and 36 months. Results. There were 21 male and 13 female. The gestational age ranged between 28 and 36 weeks. The weight at birth ranged between 700 and 1400 grams. Oral feeding was started between 4th and 10th postoperative day. The average hospitalization was about 70.47 days. To date, all patients have finished the followup. They are healthy. Conclusion. The outcome of the patients with uncommon surgical emergencies is different based on the etiology. Overall survival is generally good but is influenced by the associated anomalies. PMID:25669890

  18. Medical Robots Surgical Assistants

    E-print Network

    Pulfrey, David L.

    1 Medical Robots Surgical Assistants · Efficacy of Procedure ­ Accuracy ­ Longevity ­ Invasiveness · Augment human capabilities ­ Enabling new procedures ­ Time under anaesthetic #12;2 Surgical Robots) ­ Sensei (Hansen Medical) Autonomous Surgical Robots Robodoc.com #12;3 Guided Surgical Robots Makosurgical

  19. Simulation in Surgical Education

    PubMed Central

    de Montbrun, Sandra L.; MacRae, Helen

    2012-01-01

    The pedagogical approach to surgical training has changed significantly over the past few decades. No longer are surgical skills solely acquired through a traditional apprenticeship model of training. The acquisition of many technical and nontechnical skills is moving from the operating room to the surgical skills laboratory through the use of simulation. Many platforms exist for the learning and assessment of surgical skills. In this article, the authors provide a broad overview of some of the currently available surgical simulation modalities including bench-top models, laparoscopic simulators, simulation for new surgical technologies, and simulation for nontechnical surgical skills. PMID:23997671

  20. Emergency Surgery Patients Often Wind Up Back in Hospital

    MedlinePLUS

    ... gov/medlineplus/news/fullstory_155670.html Emergency Surgery Patients Often Wind Up Back in Hospital: Study Surgical ... 11, 2015 (HealthDay News) -- Nearly one in five patients who are readmitted to a hospital after having ...

  1. Classification of Surgical Complications

    PubMed Central

    Dindo, Daniel; Demartines, Nicolas; Clavien, Pierre-Alain

    2004-01-01

    Objective: Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers and therapies and over time. Patients and Methods: A classification of complications published by one of the authors in 1992 was critically re-evaluated and modified to increase its accuracy and its acceptability in the surgical community. Modifications mainly focused on the manner of reporting life-threatening and permanently disabling complications. The new grading system still mostly relies on the therapy used to treat the complication. The classification was tested in a cohort of 6336 patients who underwent elective general surgery at our institution. The reproducibility and personal judgment of the classification were evaluated through an international survey with 2 questionnaires sent to 10 surgical centers worldwide. Results: The new ranking system significantly correlated with complexity of surgery (P < 0.0001) as well as with the length of the hospital stay (P < 0.0001). A total of 144 surgeons from 10 different centers around the world and at different levels of training returned the survey. Ninety percent of the case presentations were correctly graded. The classification was considered to be simple (92% of the respondents), reproducible (91%), logical (92%), useful (90%), and comprehensive (89%). The answers of both questionnaires were not dependent on the origin of the reply and the level of training of the surgeons. Conclusions: The new complication classification appears reliable and may represent a compelling tool for quality assessment in surgery in all parts of the world. PMID:15273542

  2. Hospitality Hospitality/Foodservice: TBD

    E-print Network

    Dyer, Bill

    Hospitality Management Hospitality/Foodservice: TBD Food Science: TBD Recreation/Tourism: TBD Culinary Arts/Hospitality NTT: TBD SFBS Sustainable Food & Bioenergy Systems Faculty: Alison Harmon & Campus Restaurant Managed By: Gallatin College Program Director/ Hospitality Management Instructor

  3. 77 FR 21977 - Army Science Board Summer Study Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-12

    ... From the Federal Register Online via the Government Printing Office DEPARTMENT OF DEFENSE Department of the Army Army Science Board Summer Study Meeting AGENCY: Department of the Army, DoD. ACTION... Strategic Directions for Army Science & Technology study and vote on adoption. FOR FURTHER...

  4. Mr. Eric Fanning Acting Secretary of the United States Army

    E-print Network

    US Army Corps of Engineers

    development and integration of the Army Program and Budget. As Chief Management Officer (CMO) of the Army, he, and financial management. He was previously appointed Acting Under Secretary of the Army and Chief Management assistant and principal adviser on matters related to the management and operation of the Army, including

  5. 75 FR 38504 - Army Science Board Plenary Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-02

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

  6. 76 FR 6692 - Radiation Sources on Army Land

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-08

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

  7. 77 FR 66823 - Army Education Advisory Committee Study Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-07

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

  8. 78 FR 69077 - Army Education Advisory Subcommittee Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-18

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

  9. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 true The Army claims mission. 536.6 Section 536...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.6 The Army...

  10. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2014-07-01 false The Army claims mission. 536.6 Section 536...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.6 The Army...

  11. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 2013-07-01 false The Army claims mission. 536.6 Section 536...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.6 The Army...

  12. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2009-07-01 true The Army claims mission. 536.6 Section 536...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.6 The Army...

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

    ERIC Educational Resources Information Center

    Basic Skills Agency, 2007

    2007-01-01

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

  14. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2009-07-01 true The Army claims mission. 536.6 Section 536...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.6 The Army...

  15. DEPARTMENT OF THE ARMY OFFICE OF THE ASSISTANT SECRETARY

    E-print Network

    US Army Corps of Engineers

    DEPARTMENT OF THE ARMY OFFICE OF THE ASSISTANT SECRETARY CIVIL WORKS 108 ARMY PENTAGON Resources Development Act of 2007 requires that project studies conducted by the U.S. Army Corps truly yours, 4 -Jllw~ Jo-Ellen Darcy () A sis nt Secretary of the Army (Civil Works) Enclosures Recycled

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

    ERIC Educational Resources Information Center

    Merrow, John

    2005-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

    Introduction: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty. Methods: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An…

  18. 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

  19. [Pathways for surgical antibiotic prophylaxis].

    PubMed

    Maio, Patrizia

    2003-09-01

    Surgical site infections (SSIs) are a notable cause of hospital morbidity and mortality. Antibiotic prophylaxis has demonstrated a significant reduction in infection rate in clean-contaminated surgery and in clean surgery to a limited extent. To make antibiotic prophylaxis effective it is necessary to choose the right antibiotic, to administer it preoperatively and maintain sufficient serum and tissue levels through the operation. Open issues remain: antibiotic prophylaxis duration in prosthetic surgery, its use in hernia repair, breast surgery and mini-invasive surgery. PMID:14985643

  20. 77 FR 53257 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-31

    ... Printing Office Web page at: http://www.gpo.gov/fdsys/browse/collection.action?collectionCode=FR . Free... hospitals, PPS- exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are...-Exempt Cancer Hospital Quality Reporting Issues. Anita Bhatia, (410) 786-7236, Ambulatory Surgical...

  1. U.S. Army Modernizes Munitions Plants

    ERIC Educational Resources Information Center

    Environmental Science and Technology, 1972

    1972-01-01

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

  2. AMERICA'S ARMY By Margaret Davis, Russell Shilling,

    E-print Network

    Zyda, Michael

    -playing teens has been ideal. The integrity displayed by American soldiers in the deserts and cities of Iraq beloved of young men are represented with authority and gusto. With AA, the Army again speaks to teens

  3. 76 FR 66282 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-26

    ...15, 2011. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall...Designated Federal Officer, Dept. of Academic Affairs, 122 Forbes Avenue, Carlisle, PA 17013. At any point, however, if...

  4. 76 FR 72914 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-28

    ...14, 2011. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall...Designated Federal Officer, Dept. of Academic Affairs, 122 Forbes Avenue, Carlisle, PA 17013. At any point, however, if...

  5. Energy Design Guides for Army Barracks: Preprint

    SciTech Connect

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

    2008-08-01

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

  6. 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

    ...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...

  7. 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

    2012-07-01

    ... 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...

  8. 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

    2014-07-01

    ... 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...

  9. 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

    ...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...

  10. Assuring structural integrity in Army systems

    NASA Technical Reports Server (NTRS)

    1985-01-01

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

  11. High and low surgical rates: risk factors for area residents.

    PubMed Central

    Roos, N P; Roos, L L

    1981-01-01

    Patterns of surgical practice, the type of operations performed, and risk characteristics of elderly patients brought to surgery are examined in areas with differing surgical rates. This population-based analysis covering Manitoba's 56 rural hospital areas uses discharge claims filed routinely with the provincial Health Services Commission. One and a half times as much surgery was performed in high rate areas (115.2 procedures per 1,000 elderly) as in low rate areas (74.7 procedures/1,000). Since surgical case mix varied little between high and low rate areas, the rate variation means that place of residence strongly influences exposure to major surgical procedures. In similar fashion, the proportion of surgical cases classified as high-risk does not vary with the surgical rate. High risk patients resident in high surgical rate areas are more likely to come to surgery than are their counterparts in low rate areas. Further analyses of nonsurgical hospitalization, of three common elective procedures, and of area characteristics were carried out. The surgical selection process, not characteristics of the population residing in the area, appears to determine the rate at which high and low risk patients come to surgery. Our research clearly suggests that high surgical rates carry with them the risk of excess surgical deaths. PMID:7235097

  12. Early analysis of the United States Army's telemedicine orthopaedic consultation program.

    PubMed

    Blank, Elizabeth; Lappan, Charles; Belmont, Philip J; Machen, M Shaun; Ficke, James; Pope, Richard; Owens, Brett D

    2011-01-01

    Telemedicine is a recent development, designed to assist patients with limited physical access to expert subspecialty medical care. The United States Army has established a telemedicine program, consisting of e-mail consultations from deployed health care providers to subspecialty consultants. Orthopaedic surgery became a participating consultant group in July 2007. The goal of this study is to describe the Army's telemedicine orthopaedic program and to review its progress and achievements. All consults initiated from July 2007 through April 2009 were reviewed. A total of 208 consults were received by the telemedicine orthopaedic consultation program. Predominant regions of origin were Iraq, Navy Afloat, and Afghanistan. The Army accounted for the majority of consults. Prevalent musculoskeletal complaints were fracture, sprain, neuropathy, and tendon injury. Of the 74 fracture consultations, hand and wrist fractures were most common. Symptomatic treatment or casting/splinting were the most common recommended treatments for all orthopaedic consults. Of the 170 consults requesting specific treatment recommendations for patients who likely otherwise would have been evacuated for further evaluation, surgical intervention or medical evacuation was only recommended in 25% and 16% of the consultations, respectively. The novel Army telemedicine orthopaedic consultation program developed for combat-deployed service members provides expert treatment recommendations for a variety of musculoskeletal injuries. Deployed health care providers located in austere combat environments can better determine both the necessity of medical evacuation and appropriate treatments for service members with musculoskeletal injuries when aided by orthopaedic surgery consultants, thereby limiting the number of unnecessary medical evacuations. PMID:21477534

  13. Shared radiology services in multiple hospitals

    NASA Astrophysics Data System (ADS)

    Wilson, Dennis L.; Goldburgh, Mitchell M.

    1997-05-01

    A network of hospitals is planned that will be able to share radiology services. The hospitals and clinics involved will be related in four different ways: (1) Outlying clinics using a hospital radiology service; (2) Multiple cooperating radiology services with one administration; (3) Multiple cooperating radiology services with separate administrations; (4) Shared archive services on the network. The expected operation in each of the scenarios is discussed including an estimate of the amount of shared traffic between the providers. The services provided by a single administration will result in the largest sharing of radiology exams and the greatest utilization of the communication network. Separate administrations are expected to share patients and exams much less frequently. The network archive can be used to reduce the cost of an installation with somewhat reduced archive performance. The sharing of services is facilitated by an effective interaction between the separate imaging systems. A shared administration means that one database can be used to organize data flow and workflow around the hospitals. The interaction of two databases when there are two separate administrations changes the level of cooperation that is possible. A distributed PACS will be installed in several hospitals: clinics associated with the DeWitt Hospital at Ft. Belvoir, Virginia; The DeWitt Army Hospital at Ft. Belvoir, Virginia; Walter Reed Army Medical Center, Bethesda, Maryland; National Naval Medical Center, Bethesda, Maryland. DeWitt, its clinics and Walter Reed Army Medical Center are under one administration. The National Naval Medical Center is under a separate administration. The ability to cooperate in providing radiology services across these institutions will be established and the level of sharing across the institutions will be measured. The archive node will provide archive services for those hospitals without an archive, will provide archive services for those radiological exams that are older than are retained on local archives, and will provide a backup archive in case of catastrophic failure at a hospital.

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

    E-print Network

    US Army Corps of Engineers

    States Army North (Fifth Army) from April 2009 through October 2011. Growing up as a son of an Air Force in OPERATIONS DESERT SHIELD and DESERT STORM during the first Gulf War; as a Regimental Executive Officer of the Air Force's 93rd Air Control Wing, he participated in OPERATION DESERT FOX, OPERATION DESERT THUNDER

  15. 76 FR 56406 - Science and Technology Reinvention Laboratory Demonstration Project; Department of the Army; Army...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-13

    .... SUMMARY: On March 7, 2011 (76 FR 12508-12548), DoD published notice of approval of a personnel management... the Army; Army Research, Development and Engineering Command; Tank Automotive Research, Development and Engineering Center (TARDEC); Correction AGENCY: Office of the Deputy Assistant Secretary...

  16. Occupational outcomes in soldiers hospitalized with mental health problems

    PubMed Central

    Fear, Nicola T.; Greenberg, Neil; Hull, Lisa; Wessely, Simon

    2009-01-01

    Background Little is known about the longer term occupational outcome in UK military personnel who require hospital-based treatment for mental health problems. Aims To examine the documented occupational outcomes following hospital-based treatment for mental health problems within the British Army. Methods Hospital admission records were linked to occupational outcome data from a database used for personnel administration. Results A total of 384 records were identified that were then linked to occupational outcome after an episode of hospitalization. Seventy-four per cent of those admitted to hospital with mental health problems were discharged from the Army prematurely, and 73% of the discharges occurred in the first year following hospitalization. Discharge from the Army was associated with holding a junior rank, completing <5 years military service, having a combat role, being male and receiving community mental health team treatment prior to admission. Conclusions Hospitalization for a mental health problem in a military context is associated with a low rate of retention in service. Outcome was not influenced greatly by duration of hospital stay; however, those who reported receiving individual rather than group-based therapy while in hospital appeared to do better. PMID:19666961

  17. Draft guideline for the prevention of surgical site infection, 1998--CDC. Notice.

    PubMed

    1998-06-17

    This notice is a request for review of and comment on the Draft Guideline for the Prevention of Surgical Site Infection, 1998. The guideline consists of two parts: Part 1. "Surgical Site Infection, an Overview" and Part 2. "Recommendations for the Prevention of Surgical Site Infections", and was prepared by the Hospital Infection Control Practices Advisory Committee (HICPAC), the Hospital Infection Program (HIP), the National Center for Infectious Diseases (NCID), CDC. PMID:10180281

  18. Surgical time outs in a combat zone.

    PubMed

    Harrington, Jason W

    2009-03-01

    AORN supports the Joint Commission's requirements and guidelines to promote correct site surgery, including preoperative verification, site marking, and conducting and documenting a surgical time out. This article highlights the success of a well-implemented surgical time out policy and procedure at a two-bed combat support hospital in northern Iraq. Policy implementation, training, documentation, and quality management chart checks prevented any incidence of wrong site surgery through the completion of more than 900 procedures on more than 400 patients during a 15-month period. PMID:19269378

  19. Bot armies as threats to network security

    NASA Astrophysics Data System (ADS)

    Banks, Sheila B.; Stytz, Martin R.

    2007-04-01

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

  20. 2D electronic materials for army applications

    NASA Astrophysics Data System (ADS)

    O'Regan, Terrance; Perconti, Philip

    2015-05-01

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

  1. Army Energy and Water Reporting System Assessment

    SciTech Connect

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

    2011-09-01

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

  2. 75 FR 24930 - Fort Bliss (Texas) Army Growth and Force Structure Realignment Final Environmental Impact...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-06

    ...of the Army Fort Bliss (Texas) Army Growth and Force Structure Realignment Final...the availability of the Fort Bliss Army Growth and Force Structure Realignment FEIS...improvements at Fort Bliss to support Army growth and force structure realignment....

  3. 78 FR 22527 - Army Science Board Request for Information on Technology and Core Competencies

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-16

    ...Department of the Army Army Science Board Request for Information on Technology and Core...of the Army requests information on science and technology (S...from this request for information. The Army Science Board is...

  4. A systems perspective on army health and discipline

    E-print Network

    Fosmoe, Kristofer D

    2015-01-01

    Healthy and Disciplined Soldiers provide a unique competitive advantage to the United States Army that cannot be replaced by the acquisition of technological weapons systems. The United States Army system for managing ...

  5. 77 FR 50089 - Army Education Advisory Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-20

    ...an instructor-centric to a learner-centric paradigm required by the Army 2020 learning environment. The agenda will include topics relating to Army Learning Model 2015 and support to essential proficiencies and professional development...

  6. 77 FR 27209 - Army Education Advisory Subcommittee Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-09

    ...development of the United States Army War College. General deliberations leading to provisional findings will be referred to the Army Education Advisory Committee for deliberation by the Committee under the open-meeting rules. FOR...

  7. 77 FR 4026 - Army Education Advisory Subcommittee Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-26

    ...development of the United States Army War College. General deliberations leading to provisional findings will be referred to the Army Education Advisory Committee for deliberation by the Committee under the open-meeting rules. FOR...

  8. 78 FR 33074 - Army Science Board Summer Study Session

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-03

    ...recommendations for the FY13 Army Science Board Reports. 6. Agenda: The board will present findings and recommendations for deliberation and votes on the following four studies: Army Science and Technology Core Competencies study 2013--This study...

  9. 78 FR 23759 - Army Education Advisory Subcommittee Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-22

    ...development of the United States Army War College. General deliberations leading to provisional findings will be referred to the Army Education Advisory Committee for deliberation by the Committee under the open-meeting rules. FOR...

  10. The U.S. Army and the lessons of history 

    E-print Network

    Shugart, David Adams

    1997-01-01

    The United States Army values history as a practical tool. This organizational belief was no more apparent than during its preparation, execution, and assessment of World War I. After the Great War, the Army's leadership held review boards...

  11. 75 FR 19302 - Radiation Sources on Army Land

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-14

    ...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...

  12. Letterkenny Army Depot: Finance Innovations Support Lean Six Sigma Success

    E-print Network

    Harvey, Roger K.

    2006-09-15

    As a result of significant dollar savings to the Army and U.S. taxpayers, Letterkenny Army Depot received widespread public recognition in 2005. The depot received a public sector Shingo Prize for applying Lean principles ...

  13. American Pediatric Surgical Association

    MedlinePLUS

    ... Curricula Membership + Members Join APSA Careers Surgical Practice Management In Memoriam About APSA + APSA Mission Awards APSA Leadership Committees Alliances APSA Foundation Third-Party Advertising Disclaimer ...

  14. 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.

  15. THE U.S. ARMY CORPS OF ENGINEERS AND NATURAL RESOURCES MANAGEMENT

    E-print Network

    US Army Corps of Engineers

    #12;THE U.S. ARMY CORPS OF ENGINEERS AND NATURAL RESOURCES MANAGEMENT ON ARMY INSTALI.JATIONS 1941 in Publication Data Arnold, James R. The U.S. Army Corps of Engineers and natural resources management on army concerns, The u.s. Army Corps of Engineers and Natural Resources Management on Army Installations, 1941

  16. An examination of the US Army's Environmental Ethic 

    E-print Network

    Danner, Benton Allen

    1997-01-01

    In this thesis I argue that the best justification for an environmental ethic for the US Army is one which is based on an anthropocentric or humanistic approach, and I evaluate the Armys Environmental Ethic in light of this. I then consider the Army...

  17. 2015240 Years of Selfless Service to the Nation ARMY POSTURE

    E-print Network

    US Army Corps of Engineers

    Response and Prevention (SHARP) Program 35 Maintaining the Premier All Volunteer Army 37 Ready mission to stem the tide of the Ebola virus. In response to regional instability in the Middle East, Army Control Act's (BCA) arbitrary funding mechanism ­ that has seen the Army budget drop in nominal terms

  18. 32 CFR 651.14 - Integration with Army planning.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Integration with Army planning. 651.14 Section 651.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) ENVIRONMENTAL QUALITY ENVIRONMENTAL ANALYSIS OF ARMY ACTIONS (AR 200-2) National Environmental Policy Act and the Decision Process § 651.14 Integration...

  19. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Army civil works lands. 644.416 Section 644.416 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL... works lands. The Secretary of the Army is authorized to exchange lands acquired for river and harbor...

  20. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Army civil works lands. 644.416 Section 644.416 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL... works lands. The Secretary of the Army is authorized to exchange lands acquired for river and harbor...

  1. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Army civil works lands. 644.416 Section 644.416 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL... works lands. The Secretary of the Army is authorized to exchange lands acquired for river and harbor...

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

    EPA Science Inventory

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

  3. 32 CFR 651.14 - Integration with Army planning.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  4. Flagging vigilance: the post-Vietnam "Hollow Army

    E-print Network

    Lee, Robert Matthew

    2001-01-01

    This thesis is an evaluation of the United States Army as it existed in the years following its evacuation from Southeast Asia and its transition from a predominantly conscript army to the all-volunteer concept in 1973. The post-Vietnam army...

  5. 32 CFR 644.329 - Army civil works real property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2011-07-01 true Army civil works real property. 644.329...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.329 Army civil works real property. (a)...

  6. Instruction Report A-96-1 US Army Corps

    E-print Network

    US Army Corps of Engineers

    WES Instruction Report A-96-1 May 1996 US Army Corps of Engineers Waterways Experiment Station is Unlimited Prepared for Headquarters, U.S. Army Corps of Engineers #12;The contents of this report are not to be construed as an official Department of the Army position, unless so desig- nated by other authorized

  7. 32 CFR 644.329 - Army civil works real property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2011-07-01 false Army civil works real property. 644.329...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.329 Army civil works real property. (a)...

  8. a Miscellaneous Paper A-96-1 US Army Corps

    E-print Network

    US Army Corps of Engineers

    A-96-1 June 1996 US Army Corps of Engineers Waterways Experiment Station Aquatic Plant Control for Headquarters, U.S. Army Corps of Engineers #12;The contents of this report are not to be used for advertising for Control of Hydrilla by Michael D. Netherland, Judy F. Shearer U.S. Army Corps of Engineers Waterways

  9. m Technical Report A-94-3 US Army Corps

    E-print Network

    US Army Corps of Engineers

    m Technical Report A-94-3 May 1994 US Army Corps of Engineers Waterways Experiment Station Aquatic ~ Prepared for Headquarters, U.S. Army Corps of Engineers #12;The contents of this report are not to be used Stewart U.S. Army Corps of Engineers Waterways Experiment Station 3909 Halls Ferry Road Vicksburg, MS

  10. U.S. ARMY GARRISON FORT WAINWRIGHT QUARTERLY UPDATE FOR

    E-print Network

    U.S. ARMY GARRISON FORT WAINWRIGHT QUARTERLY UPDATE FOR ALASKA NATIVE TRIBES January 2013, Issue 30 This is a quarterly update on United States Army Garrison Fort Wainwright activities and issues of interest Teasdale--a retired Major from the U.S. Army, a staff member with the Northway Village tribe, and the host

  11. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  12. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2011-07-01 false Army civil works lands. 644.416 Section...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property and Easement Interests § 644.416 Army civil works lands. The Secretary...

  13. m Technical Report A-95-1 US Army Corps

    E-print Network

    US Army Corps of Engineers

    m Technical Report A-95-1 June 1995 US Army Corps of Engineers Waterways Experiment Station Aquatic Release; Distribution Is Unlimited ~ Prepared for Headquarters, U.S. Army Corps of Engineers #12;The (L.f.) Royle and Myriophyllum spicatum L. by Harvey L. Jones U.S. Army Corps of Engineers Waterways

  14. ERDCTR-14-2 Army Net Zero Program

    E-print Network

    US Army Corps of Engineers

    ERDCTR-14-2 Army Net Zero Program Composting Assessment for Organic Solid Waste at Fort Polk is unlimited. #12;The US Army Engineer Research and Development Center (ERDC) solves the nation's toughest, geospatial sciences, water resources, and environmental sciences for the Army, the Department of Defense

  15. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 false Utilization of Army bands. 508.1 Section 508.1 National...Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS...CIVILIAN BANDS § 508.1 Utilization of Army bands. (a) General....

  16. Miscellaneous Paper A-95-1 US Army Corps

    E-print Network

    US Army Corps of Engineers

    -- -- --- --- --- Miscellaneous Paper A-95-1 March 1995 US Army Corps of Engineers Waterways for Headquarters, U.S. Army Corps of Engineers #12;The contents of this report are not to be used for advertising in Submersed Aquatic Plants: A Review by Susan L. Sprecher, Michael D. Netherland U.S. Army Corps of Engineers

  17. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  18. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  19. Instruction Report A-99-1 US Army Corps

    E-print Network

    US Army Corps of Engineers

    WES Instruction Report A-99-1 July 1999 US Army Corps of Engineers Waterways Experiment Station Is Unlimited Prepared for Headquarters, U.S. Army Corps of Engineers #12;The contents of this report are not to be construed as an official Department of the Army position, unless so desig- nated by other authorized

  20. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  1. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 true Army civil works lands. 644.416 Section...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property and Easement Interests § 644.416 Army civil works lands. The Secretary...

  2. m Technical Report A-96-6 US Army Corps

    E-print Network

    US Army Corps of Engineers

    -96-6 April 1996 US Army Corps of Engineers Waterways Experiment Station Aquatic Plant Control; Distribution Is Unlimited Prepared for Headquarters, U.S. Army Corps of Engineers #12;The contents. Smith, John W. Barko U.S. Army Corps of Engineers Waterways Experiment Station 3909 Halls Ferry Road

  3. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 2013-07-01 false Army civil works lands. 644.416 Section...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property and Easement Interests § 644.416 Army civil works lands. The Secretary...

  4. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2011-07-01 true Army civil works lands. 644.416 Section...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property and Easement Interests § 644.416 Army civil works lands. The Secretary...

  5. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2013-07-01 true Army civil works lands. 644.416 Section...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property and Easement Interests § 644.416 Army civil works lands. The Secretary...

  6. 32 CFR 644.329 - Army civil works real property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2013-07-01 true Army civil works real property. 644.329...Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE...Property in Excess Status § 644.329 Army civil works real property. (a)...

  7. Army Senior Fellows Program Info Page Name (Last, First, MI)

    E-print Network

    US Army Corps of Engineers

    Army Senior Fellows Program Info Page Name (Last, First, MI): Home Mailing Address: Duty Location equivalency) Major Army Command or Independent Reporting Activity: Click HERE for the list of MACOMs and IRAs Indicate Highest Educational Level: (Check One): Baccalaureate Masters Ph.D Juris Doctor Army Training

  8. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  9. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  10. One Team Destined For Greatness US Army Corps of Engineers

    E-print Network

    Johnson, Eric E.

    One Team Destined For Greatness US Army Corps of Engineers BUILDING STRONG® Upper Rio Grande Water Operations Model (URGWOM) URGWOM Project Manager Amy Louise January 10, 2013 #12;US Army Corps of Engineers? Memorandum of Understanding Ongoing Development Projects Future Development & Use 2 #12;US Army Corps

  11. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  12. Pattern Formation and Optimization in Army Ant Raids

    E-print Network

    Delgado, Jordi

    Pattern Formation and Optimization in Army Ant Raids Ricard V. Sol´e , Eric Bonabeau Jordi Delgado, Pau Fern´andez Jesus Mar´in Keywords self-organization, army ants, pattern formation, optimization Abstract Army ant colonies display complex foraging raid patterns involving thousands of individuals

  13. TECHNICAL NOTE Nine novel microsatellite markers for the army ant

    E-print Network

    Pierce, Naomi E.

    TECHNICAL NOTE Nine novel microsatellite markers for the army ant Simopelta pergandei (subfamily Simopelta (subfamily Ponerinae) army ants are specialized predators of other ants in New World tropical forests. Although they show a striking convergence in overall life-history with the well known army ants

  14. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  15. m Technical Report A-94-2 US Army Corps

    E-print Network

    US Army Corps of Engineers

    - - - - -- - - ----- ---- -- m Technical Report A-94-2 May 1994 US Army Corps of Engineers JOHN D -- -- --~;:=== . ======= =--~=~ =~ .==' ---=.- ....- - Approved For Public Release; Distribution Is Unlimited ~ Prepared for Headquarters. U.S. Army Corps.S. Army Corps of Engineers Waterways Experiment Station 3909 Halls Ferry Road Vicksburg, MS 39180

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

    E-print Network

    Stewart, Michael David

    2010-04-23

    RAISING A PRAGMATIC ARMY: Officer Education at the U.S. Army Command and General Staff College, 1946 - 1986 By Michael D. Stewart Department of History, University of Kansas Professor Theodore A. Wilson, Advisor This ...

  17. 32 CFR 635.22 - Reserve component, U.S. Army Reserve, and Army National Guard personnel.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... false Reserve component, U.S. Army Reserve, and Army National Guard personnel. 635.22 Section 635...pursuant to official orders (Federal status for National Guard) Reserve and National Guard personnel will be reported as...

  18. 32 CFR 635.22 - Reserve component, U.S. Army Reserve, and Army National Guard personnel.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... true Reserve component, U.S. Army Reserve, and Army National Guard personnel. 635.22 Section 635...pursuant to official orders (Federal status for National Guard) Reserve and National Guard personnel will be reported as...

  19. 76 FR 56406 - Science and Technology Reinvention Laboratory Demonstration Project; Department of the Army; Army...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-13

    ...DEPARTMENT OF DEFENSE Office of the Secretary Science and Technology Reinvention Laboratory Demonstration Project; Department of the Army...Occupational Families indicated: a. Engineering & Science: 0810 Civil Engineer Series. b....

  20. Relation of Surgical Volume to Outcome in Eight Common Operations

    PubMed Central

    Khuri, Shukri F.; Daley, Jennifer; Henderson, William; Hur, Kwan; Hossain, Monir; Soybel, David; Kizer, Kenneth W.; Aust, J. Bradley; Bell, Richard H.; Chong, Vernon; Demakis, John; Fabri, Peter J.; Gibbs, James O.; Grover, Frederick; Hammermeister, Karl; McDonald, Gerald; Passaro, Edward; Phillips, Lloyd; Scamman, Frank; Spencer, Jeannette; Stremple, John F.

    1999-01-01

    Objective To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity. Summary Background Data In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes. Literature data to support this assumption in intermediate-complexity operations are either limited or controversial. Methods The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used. Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA). Results Eight major surgical procedures (68,631 operations) were analyzed. No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found. Conclusions In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk-adjusted 30-day stroke rate from CEA. Volume of surgery in these operations should not be used as a surrogate for quality of surgical care. PMID:10493488

  1. US Army Corps of Engineers BUILDING STRONG

    E-print Network

    US Army Corps of Engineers

    , sons and daughters. Iraq Water Treatment Plant Japan District Employee Fort Campbell Deconstruction #12 of critical commodities. Our lakes and dams play a critical role in generating power for homes and businesses Environmental Restoration Flood Fighting BUILDING STRONG® #12;Braddock Dam, Pittsburgh District The U.S. Army

  2. US Army Corps of Engineers BUILDING STRONG

    E-print Network

    US Army Corps of Engineers

    · Problem Statement and Approach · Sediment Budget · GenCade Calibration · Sand Management Options at EastUS Army Corps of Engineers BUILDING STRONG® Developing a Sand Management Plan for Galveston Island Beach · Large-Scale Beach Fill · GenCade Alternatives · Sand Management Alternatives and Plan · Beach

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

    ERIC Educational Resources Information Center

    Drews, Fred R.

    1984-01-01

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

  4. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) Soldiers, military and/or Department of the Army Civilian (DAC) police performing off-installation... areas OCONUS. (b) Military and/or DAC police assigned to off-installation operations have the sole... and/or DAC police accompanying civilian law enforcement officers remain directly responsible to,...

  5. 75 FR 7255 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-18

    ...11, 2010. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command Conference Room, Root Hall...their statement to the Designated Federal Officer at USAWC, 122 Forbes Avenue, Carlisle, PA, at any point; however, if a...

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

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

    Photocopy of plan (in U.S. Army office of Army Engineers plans and drawings, Fort Hancock and Sandy hook proving ground, record group 7, drawer 44, Cartographic and Architectural branc, The National Archives, Washington, DC), 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

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

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

    Photocopy of plan (in U.S. Army office of Army Engineers plans and drawings, Fort Hancock and Sandy hook proving ground, record group 7, drawer 44, Cartographic and Architectural branc, The National Archives, Washington, DC) 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

  8. Accelerating surgical training and reducing the burden of surgical disease in Haiti before and after the earthquake.

    PubMed

    DeGennaro, Vincent A; DeGennaro, Vincent A; Kochhar, Amit; Nathan, Nirmal; Low, Christopher; Avashia, Yash J; Thaller, Seth R

    2012-11-01

    In general, university-based global health initiatives have tended to focus on expanding access to primary care. In the past, surgical programs may have been characterized by sporadic participation with little educational focus. However, there have been some notable exceptions with plastic surgery volunteer missions. We offer another model of regularly scheduled surgical trips to rural Haiti in plastic and general surgery. The goal of these trips is to reduce the burden of surgical disease and ultimately repair every cleft lip/palate in Haiti. Another principal objective is to accelerate the training of American residents through increased case load and personal interaction with attending surgeons in a concentrated period. Diversity of the case load and the overall number of surgeries performed by residents in a typical surgical trip outpaces the experiences available during a typical week in an American hospital setting. More importantly, we continue to provide ongoing training to Haitian nurses and surgeons in surgical techniques and postoperative care. Our postoperative complication rate has been relatively low. Our follow-up rates have been lower than 70% despite intensive attempts to maintain continued communication with our patients. Through our experiences in surgical care in rural Haiti, we were able to quickly ramp up our trauma and orthopedic surgical care immediately after the earthquake. Project Medishare and the University of Miami continue to operate a trauma and acute care hospital in Port au Prince. The hospital provides ongoing orthopedic, trauma, and neurosurgical expertise from the rotating teams of American surgeons and training of Haitian surgeons in modern surgical techniques. We believe that surgical residencies in the United States can improve their training programs and reduce global surgical burden of disease through consistent trips and working closely with country partners. PMID:23154377

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

    PubMed

    Bernier, Francie

    2013-01-01

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

  10. Standardising fast-track surgical nursing care in Denmark.

    PubMed

    Hjort Jakobsen, Dorthe; Rud, Kirsten; Kehlet, Henrik; Egerod, Ingrid

    Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care. PMID:24820811

  11. Deriving DICOM surgical extensions from surgical workflows

    NASA Astrophysics Data System (ADS)

    Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.

    2007-03-01

    The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

  12. Compare Hospitals

    MedlinePLUS

    ... visit Hospital Safety Score Home Employers & Purchasers Policy Leadership Hospitals Patients Licenses & Permissions About Leapfrog Search 2015 ... fare, resources used in caring for patients, and leadership and structures that promote patient safety. The Leapfrog ...

  13. Aggressive Management of Surgical Emergencies

    PubMed Central

    Bengmark, Stig

    2006-01-01

    Increasing evidence suggests that two factors significantly influence outcome in a surgical emergency – premorbid health and the degree of inflammation during the first 24 h following trauma. Repeat observations suggest that the depth of post-trauma immunoparalysis reflects the height of early inflammatory response. Administration to surgical emergencies, as was routine in the past, of larger amounts of fluid and electrolytes, fat, sugar and nutrients seems counterproductive as it increases immune dysfunction, impairs resistance to disease and, in fact, increases morbidity. Instead, strong efforts should be made to limit the obvious superinflammation, which occurs during the first 24 h after trauma and, thereby, reduce the subsequent immuno-paralysis. paralysis. Several approaches show efficacy in limiting early superinflammation such as strict control of blood glucose, avoida nce of stored blood when possible, supply of antioxidants, live lactic acid bacteria and plant fibres. This review focuses mainly on use of live lactic acid bacteria and plant fibres, often called synbiotics. Encouraging experience is reported from clinical trials in liver transplantation, severe pancreatitis and extensive trauma. Immediate control of inflammation by enteral nutrition and supply of antioxidants, lactic acid bacteria and fibres is facilitated by feeding tubes, introduced as early as possible on arrival at the hospital. PMID:17132308

  14. Lower Mortality in Magnet Hospitals

    PubMed Central

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

    2014-01-01

    Background Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. Objectives To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations. Method and Study Design Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences. Results Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76–0.98; P = 0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77–1.01; P = 0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes. PMID:24022082

  15. Understanding hospitality.

    PubMed

    Patten, C S

    1994-03-01

    Bridging patient/"customer" issues and business aspects can be aided through developing a specific nursing basis for hospitality. The ancient practice of hospitality has evolved into three distinct levels: public, personal and therapeutic. Understanding these levels is helpful in integrating various dimensions of guest relations programs in hospitals into a more comprehensive vision. Hospitality issues must become a greater part of today's nursing management. PMID:8134046

  16. Performance improvement initiative: prevention of surgical site infection (SSI)

    PubMed Central

    Ng, Wai Khuan; Awad, Nawal

    2015-01-01

    Mafraq Hospital performs an average of 10,000 surgeries every year. The impact of having high volume high risk surgical procedures calls for the need to ensure safe surgery and a prevention of surgical site infection (SSI). SSI represents a significant portion of healthcare-associated infections (HAIs). The impact on morbidity, mortality, and cost of care has resulted in identifying the need to reduce SSI as a top priority to prevent healthcare associated infections. The good news is that the majority of SSIs are preventable. Mafraq Hospital performs a range of surgical procedures that covers 14 surgical specialties. The infection prevention and control team performs surveillance for SSI for all patients who undergo operative procedure included in Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) Operative Procedure Category (40 surgical procedures). Out of the 40 CDC NHSN listed, 33 operative procedures were performed at Mafraq Hospital, of which 17 were reported with SSI for 2013 and 2014. Surgical site infection has implicated an increase average length of stay from seven to 10 additional postoperative hospital days and additional costs of AED 10,000 to AED 100,000/SSI depending on procedure and pathogen. A multidisciplinary team was formed to develop and implement measures to reduce/eliminate surgical site infection, as well as evaluate and monitor compliance. Hence a group of multidisciplinary teams were initiated to analyse the results, find out the gaps, and implement a quality improvement project to correct the deficits. Recommendations for appropriate improvement measures were formed on evidence-based international guidelines from the Institute for Healthcare Improvement (IHI) and CDC. Evidence based practice supports that many of the causes of surgical site infection can be prevented with proper medical attention and care.

  17. Optimization of surgical outcomes with prehabilitation.

    PubMed

    Santa Mina, Daniel; Scheede-Bergdahl, Celena; Gillis, Chelsia; Carli, Francesco

    2015-09-01

    The concept of preparing surgical candidates with various modalities designed to increase physical, physiological, metabolic, and psychosocial reserves is known as prehabilitation. Prehabilitation has garnered significant attention in recent years as evidence grows describing benefits to clinical and quality of life outcomes. Recent research examining hospital length of stay and readmission rates provides promising findings with respect to the value of prehabilitation in economic and sustainable healthcare models. The role of prehabilitation across the surgical experience exploits common surgical wait-times and the teachable moment that many patients experience upon the identification of a surgical requirement to improve the pre-, peri-, and postoperative experience. Prehabilitation incorporates numerous systemic and regional approaches to conditioning the surgical candidate. These include exercise, nutrition, education, and/or psychosocial approaches that are intended to improve preoperative fitness and preparedness. Importantly, this also promotes and facilitates health behaviour changes not only preoperatively but during the postoperative period and over the long-term. In this paper, we briefly review the historical and current perspectives on prehabilitation and comment on opportunities for greater clinical and empirical understanding in this field. PMID:26300015

  18. Orthopedic Surgery in Rural American Hospitals: A Survey of Rural Hospital Administrators

    ERIC Educational Resources Information Center

    Weichel, Derek

    2012-01-01

    Rural American residents prefer to receive their medical care locally. Lack of specific medical services in the local community necessitates travel to a larger center which is less favorable. This study was done to identify how rural hospitals choose to provide orthopedic surgical services to their communities. Methods: All hospitals in 5 states…

  19. Characterization of aerosols produced by surgical procedures

    SciTech Connect

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K.; Turner, R.S.

    1994-07-01

    In many surgeries, especially orthopedic procedures, power tools such as saws and drills are used. These tools may produce aerosolized blood and other biological material from bone and soft tissues. Surgical lasers and electrocautery tools can also produce aerosols when tissues are vaporized and condensed. Studies have been reported in the literature concerning production of aerosols during surgery, and some of these aerosols may contain infectious material. Garden et al. (1988) reported the presence of papilloma virus DNA in the fumes produced from laser surgery, but the infectivity of the aerosol was not assessed. Moon and Nininger (1989) measured the size distribution and production rate of emissions from laser surgery and found that particles were generally less than 0.5 {mu}m diameter. More recently there has been concern expressed over the production of aerosolized blood during surgical procedures that require power tools. In an in vitro study, the production of an aerosol containing the human immunodeficiency virus (HIV) was reported when power tools were used to cut tissues with blood infected with HIV. Another study measured the size distribution of blood aerosols produced by surgical power tools and found blood-containing particles in a number of size ranges. Health care workers are anxious and concerned about whether surgically produced aerosols are inspirable and can contain viable pathogens such as HIV. Other pathogens such as hepatitis B virus (HBV) are also of concern. The Occupational Safety and Health funded a project at the National Institute for Inhalation Toxicology Research Institute to assess the extent of aerosolization of blood and other tissues during surgical procedures. This document reports details of the experimental and sampling approach, methods, analyses, and results on potential production of blood-associated aerosols from surgical procedures in the laboratory and in the hospital surgical suite.

  20. 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

  1. Multiscale Surgical Telerobots

    SciTech Connect

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  2. Toward fluorescence detection of protein residues on surgical instruments

    NASA Astrophysics Data System (ADS)

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

    2004-06-01

    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.

  3. Augmented reality in surgical procedures

    NASA Astrophysics Data System (ADS)

    Samset, E.; Schmalstieg, D.; Vander Sloten, J.; Freudenthal, A.; Declerck, J.; Casciaro, S.; Rideng, Ø.; Gersak, B.

    2008-02-01

    Minimally invasive therapy (MIT) is one of the most important trends in modern medicine. It includes a wide range of therapies in videoscopic surgery and interventional radiology and is performed through small incisions. It reduces hospital stay-time by allowing faster recovery and offers substantially improved cost-effectiveness for the hospital and the society. However, the introduction of MIT has also led to new problems. The manipulation of structures within the body through small incisions reduces dexterity and tactile feedback. It requires a different approach than conventional surgical procedures, since eye-hand co-ordination is not based on direct vision, but more predominantly on image guidance via endoscopes or radiological imaging modalities. ARIS*ER is a multidisciplinary consortium developing a new generation of decision support tools for MIT by augmenting visual and sensorial feedback. We will present tools based on novel concepts in visualization, robotics and haptics providing tailored solutions for a range of clinical applications. Examples from radio-frequency ablation of liver-tumors, laparoscopic liver surgery and minimally invasive cardiac surgery will be presented. Demonstrators were developed with the aim to provide a seamless workflow for the clinical user conducting image-guided therapy.

  4. Biocompatibility of surgical implants

    NASA Technical Reports Server (NTRS)

    Kaelble, D. H.

    1979-01-01

    Method of selecting biocompatible materials for surgical implants uses fracture mechanic relationships and surface energies of candidate materials in presence of blood plasma. Technique has been used to characterize 190 materials by parameters that reflect their biocompatibility.

  5. Guide to Surgical Specialists

    MedlinePLUS

    ... also deal with the liver, urinary, and female reproductive systems if they are involved with primary intestinal disease. ... focus for this specialty is on the female reproductive system, including performing surgical procedures, managing the care of ...

  6. 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) ...

  7. Smart surgical tool

    NASA Astrophysics Data System (ADS)

    Huang, Huan; Yang, Lih-Mei; Bai, Shuang; Liu, Jian

    2015-02-01

    A laser-induced breakdown spectroscopy (LIBS) guided smart surgical tool using a femtosecond fiber laser is developed. This system provides real-time material identification by processing and analyzing the peak intensity and ratio of atomic emissions of LIBS signals. Algorithms to identify emissions of different tissues and metals are developed and implemented into the real-time control system. This system provides a powerful smart surgical tool for precise robotic microsurgery applications with real-time feedback and control.

  8. 75 FR 34714 - Updated Record of Decision (ROD) for Revised Army Growth and Force; Structure Realignment Decisions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-18

    ... Department of the Army Updated Record of Decision (ROD) for Revised Army Growth and Force; Structure... Department of the Army announces the availability of an updated ROD for Army Growth and Force Structure... Army growth and force structure realignment. The Army's decision at the time grew the Army by...

  9. Energy Design Guides for Army Barracks

    SciTech Connect

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

    2008-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Sen, Surajit; Shanahan, Linda

    2008-03-01

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

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

    PubMed

    Akiyama, Yuriko

    2008-03-01

    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

  12. [An apothecary from the Cévennes region on the rolls of Oriental Pyrenees Army in 1793].

    PubMed

    Guibert, Marie-Sophie

    2015-01-01

    In 1793 during the french Revolution, the decret of February 23rd orders a big recruitment of 300 000 people. The city of Alès (Cevennes) has to supply ninety-seven soldiers to establish the battalion of the Gard. They will be allocated to the "Armée des Pyrénées-Orientales" (Army of the Eastern Pyrenees) which is going to defend the border with Spain. These armies have to face the influx of wounded persons but especially the devastation of the epidemics. Besides the soldiers, are enlisted the officers of health, the doctors, the surgeons and the pharmacists. So the city of Alès indicates to be of use to this army the youngest of the doctors, freshly honed of the university of Montpellier and two old pharmacists (51 y. and 61 y. old). They were allocated to the hospital of Narbonne where they worked to fight against the epidemics, in particular by the disinfection of rooms. The oldest of them succumbed to the disease. Two others, safe and sound income in their home town, played a notables' role. PMID:25807665

  13. 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

  14. 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

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

    PubMed Central

    Gates, Kathy; Ciliax, Donald

    2008-01-01

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

  16. The Army Family Team Building Program: Facilitating a Transformative Learning Process--An Intrinsic Case Study

    ERIC Educational Resources Information Center

    Gall, Joseph A.

    2009-01-01

    This study sought to understand how the Army Family Team Building program influences self-reliance and self-sufficiency in Army spouses as they integrate into the Army community. The purpose of the Army Family Team Building program is to empower Army spouses with knowledge and skills, which foster well-being and improve quality of life. The…

  17. Volume XVIII, No. 6 A publication of the U.S. Army Installation Management Command

    E-print Network

    US Army Corps of Engineers

    Volume XVIII, No. 6 A publication of the U.S. Army Installation Management Command November/December 2006 U.S. Army Installation Management Command In this issue: Annual Report Summaries Army activates publication of the U.S. Army Installation Management Command, under AR 360-1, The Army Public Affairs Program

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

    PubMed

    Collingham, Lizzie

    2009-09-01

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

  19. Improving the surgical hot clinic

    PubMed Central

    Hubbard, Thomas; Thomas, Rhys

    2014-01-01

    Ambulatory care is an underdeveloped concept in the setting of emergency surgery, however it is recognised that many institutions will need to develop this service to cope with increased time and financial pressures.[1] There is increased emphasis on ambulatory care pathways for a variety of medical conditions.[2] Risk management is important in managing patients with acute abdominal pain in an outpatient setting and senior doctor support is essential. While the patient remains in the community, effective communication with the patient's primary care provider improves patient safety and satisfaction.[3] This quality improvement project identified current service provision of ambulatory care for surgical patients in the hot clinic at Croydon University Hospital with subsequent consultation with the surgical department to identify problems arising from the throughput of patients. Guidelines were then updated incorporating solutions to the identified issues which were then validated by the department of general surgery. Post intervention measurement identified a decrease in patients whose principal assessment and management was made by a senior house officer level doctor through the hot clinic patient journey from 26% to 9% (64% decrease), indicating an increase in registrar and/or consultant involvement in managing the hot clinic. The number of patients attending hot clinic that had effective discharge liaison (in the form of a formal letter) to the GP increased from 18% to 68% (250% increase). In conclusion, the introduction of updated guidelines effected a safer and more effective ambulatory hot clinic to perform closer to full capacity, providing improved patient care for the local population.

  20. [Stress urinary incontinence. Its surgical management].

    PubMed

    Neri Ruz, E S; Azcona Arteaga, F J

    1991-10-01

    Ninety eight patients with stress urinary incontinence treated surgically at Central Military Hospital, were studied. We analyzed the risk factors as age, weight, height, parity, menopause age, and previous medical and surgical procedures. They were divided in two groups. The Group I, vaginal approach, with 35 patients and Group II, retropubic surgery, with 63 patients. There were no differences both groups regarding age, weight, height, parity and menopausal age. The most frequent illness associated with stress urinary incontinence, was pelvic floor relaxation. The complications were 17.1% and 33.3%, respectively. The efficacy of Burch is procedure for the management of stress urinary incontinence, with a success rate of 84.1% versus 62.1% in the vaginal approach, was confirmed. PMID:1752448

  1. Surgical Intervention for Penile Methamphetamine Injections

    PubMed Central

    Gaither, Thomas W.; Osterberg, E. Charles; Awad, Mohannad A.; Breyer, Benjamin N.

    2015-01-01

    Methamphetamine is a central nervous system stimulant and is the second most commonly used illicit drug after cannabis. Methamphetamine use for sexual pleasure is well documented. In this case report, we describe two cases presenting to our urban county hospital associated with complications related to penile injection of methamphetamine. Both patients developed penile abscesses and required urgent surgical incision and drainage. Penile abscesses represent a rare complication associated with IV drug administration into the penile corpora. Resultant penile abscesses require broad-spectrum antibiotics and surgical drainage. Further understanding of methamphetamine abuse along with the role it plays in sexual enhancement would be an invaluable addition to understanding of the rationale behind this self-administered stimulant. Drainage of penile abscesses associated with IV drug users may be hazardous to healthcare providers who are at risk from a needle stick injury. PMID:26451272

  2. [Field realities: surgical activities in an isolated medical station].

    PubMed

    Suils, J; Bertrand, S

    1989-01-01

    The authors, general practitioners graduate at the Tropical Medicine Institute (Le Pharo-Marseille-France), report on their surgical activities for 22 months in the isolated medical post of Kaedi (Mauritania). They put emphasis on the necessity of a multidisciplinary teaching and training before any posting in this type of hospital, not important enough to receive specialized practitioners. PMID:2622325

  3. Predictive Surgical Simulation of Aorta Reconstruction in Cardiac Surgery

    E-print Network

    Leow, Wee Kheng

    Predictive Surgical Simulation of Aorta Reconstruction in Cardiac Surgery Hao LI a,1 , Wee Kheng, Singapore b Dept. of Surgery, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. Abstract. This paper proposes a method for performing predictive simulation of complex cardiac surgery. It computes

  4. Surgical bleeding in microgravity

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

    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.

  5. The WHO surgical safety checklist: survey of patients’ views

    PubMed Central

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

    2014-01-01

    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

  6. The NASA/Army Autonomous Rotorcraft Project

    NASA Technical Reports Server (NTRS)

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

    2002-01-01

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

  7. Collaborative practice model: Madigan Army Medical Center.

    PubMed

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

    2012-09-01

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

  8. Nonfatal Suicidal Behaviors in U.S. Army Administrative Records, 2004–2009: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

    PubMed Central

    Ursano, Robert J.; Kessler, Ronald C.; Heeringa, Steven G.; Cox, Kenneth L.; Naifeh, James A.; Fullerton, Carol S.; Sampson, Nancy A.; Kao, Tzu-Cheg; Aliaga, Pablo A.; Vegella, Patti; Mash, Holly Herberman; Buckley, Christina; Colpe, Lisa J.; Schoenbaum, Michael; Stein, Murray B.

    2015-01-01

    Objective Although the U.S. Army suicide rate is known to have risen sharply over the past decade, information about medically documented, nonfatal suicidal behaviors is far more limited. Here we examine trends and sociodemographic correlates of suicide attempts, suspicious injuries, and suicide ideation among regular Army soldiers. Methods Data come from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Historical Administrative Data Study (HADS), which integrates administrative records for all soldiers on active duty during the years 2004 through 2009 (n = 1.66 million). Results We identified 21,740 unique regular Army soldiers with a nonfatal suicidal event documented at some point during the HADS study period. There were substantial increases in the annual incidence rates of suicide attempts (179–400/100,000 person-years) and suicide ideation (557–830/100,000 person-years), but not suspicious injuries. Using hierarchical classification rules to identify the first instance of each soldier's most severe behavior, we found increased risk of all outcomes among those who were female, non-Hispanic White, never married, lower-ranking enlisted, less educated, and of younger age when entering Army service. These sociodemographic associations significantly differed across outcomes, despite some patterns that appear similar. Conclusion Results provide a broad overview of nonfatal suicidal trends in the U.S. Army during 2004 through 2009 and demonstrate that integration of multiple administrative data systems enriches analysis of the predictors of such events. PMID:26168022

  9. [Pulmonary Echinococcosis: Surgical Aspects].

    PubMed

    Eichhorn, M E; Hoffmann, H; Dienemann, H

    2015-10-01

    Pulmonary cystic echinococcosis is a very rare disease in Germany. It is caused by the larvae of the dog tapeworm (echinococcus granulosus). The liver is the most affected organ, followed by the lungs. Surgery remains the main therapeutic approach for pulmonary CE. Whenever possible, parenchyma-preserving lung surgery should be preferred over anatomic lung resections. To ensure best therapeutic results, surgery needs to be performed under precise consideration of important infectiological aspects and patients should be treated in specialised centres based on interdisciplinary consensus. In addition to surgical aspects, this review summarises special infectiological features of this disease, which are crucial to the surgical approach. PMID:26351761

  10. U.S. Army Social Media Registration Checklist The U.S. Army Social Media directory is a manually processed directory. By submitting your link to the directory,

    E-print Network

    US Army Corps of Engineers

    U.S. Army Social Media Registration Checklist The U.S. Army Social Media directory is a manually Support Staff (IOSS) courses 3500 and 1500 are strongly recommended. U.S. Army social media sites must that are published on the U.S. Army's social media directory must be unlocked and publically accessible via Internet

  11. U.S. ARMY CORPS OF ENGINEERS -HEADQUARTERS REGULATORY COMMUNITY OF PRACTICE http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits.aspx

    E-print Network

    US Army Corps of Engineers

    U.S. ARMY CORPS OF ENGINEERS - HEADQUARTERS ­ REGULATORY COMMUNITY OF PRACTICE http://www.usace.army.mil/Missions/CivilWorks/RegulatoryProgramandPermits.aspx The U.S. Army Corps of Engineers announces the process to request evaluation of specific wetland plant collaborating federal agencies--the U.S. Army Corps of Engineers, the Environmental Protection Agency, the U

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

    E-print Network

    Gassmann, Jaime Nicole Noble

    2010-08-30

    This dissertation examines the emotional labor of Army wives as they volunteer in Army-mandated family-member support groups in each unit called Family Readiness Groups (FRGs). Since its inception, the Army has relied ...

  13. 32 CFR 536.12 - Commanding General, U.S. Army Medical Command.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... false Commanding General, U.S. Army Medical Command. 536.12 Section...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.12...

  14. 32 CFR 553.17 - Persons ineligible for burial in an Army national cemetery.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...true Persons ineligible for burial in an Army national cemetery. 553.17 Section 553...of Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES ARMY NATIONAL CEMETERIES § 553.17...

  15. 32 CFR 536.12 - Commanding General, U.S. Army Medical Command.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2009-07-01 true Commanding General, U.S. Army Medical Command. 536.12 Section...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.12...

  16. 33 CFR 211.16 - Scope and application of Army Regulations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 false Scope and application of Army Regulations. 211.16 Section 211... CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE REAL ESTATE... § 211.16 Scope and application of Army Regulations. (a) AR...

  17. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2014-07-01 false Army Advisory Panel on ROTC Affairs. 562...Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES RESERVE OFFICERS' TRAINING CORPS § 562.8 Army Advisory Panel on ROTC Affairs....

  18. 32 CFR 536.1 - Purpose of the Army Claims System.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 false Purpose of the Army Claims System. 536.1 Section 536...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.1 Purpose...

  19. 32 CFR 623.6 - Reimbursement for loan of Army materiel.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 false Reimbursement for loan of Army materiel. 623.6 Section 623.6 National...Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL § 623.6 Reimbursement for...

  20. 32 CFR 623.6 - Reimbursement for loan of Army materiel.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 false Reimbursement for loan of Army materiel. 623.6 Section 623.6 National...Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL § 623.6 Reimbursement for...

  1. 32 CFR 553.17 - Persons ineligible for burial in an Army national cemetery.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...true Persons ineligible for burial in an Army national cemetery. 553.17 Section 553...of Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES ARMY NATIONAL CEMETERIES § 553.17...

  2. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 true Army Advisory Panel on ROTC Affairs. 562...Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES RESERVE OFFICERS' TRAINING CORPS § 562.8 Army Advisory Panel on ROTC Affairs....

  3. 32 CFR 536.12 - Commanding General, U.S. Army Medical Command.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... false Commanding General, U.S. Army Medical Command. 536.12 Section...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.12...

  4. CDC Recommendations to the U.S. Army for Protecting Public Health During

    E-print Network

    CDC Recommendations to the U.S. Army for Protecting Public Health During Chemical Weapons to the U.S. Army for Protecting Public Health During Chemical Weapons Elimination: Annual Report, Fiscal.......................................................................................................................................................13 U.S. Army's Response to Recommendations

  5. 32 CFR 623.6 - Reimbursement for loan of Army materiel.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2009-07-01 true Reimbursement for loan of Army materiel. 623.6 Section 623.6 National...Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL § 623.6 Reimbursement for...

  6. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 2013-07-01 false Army Advisory Panel on ROTC Affairs. 562...Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES RESERVE OFFICERS' TRAINING CORPS § 562.8 Army Advisory Panel on ROTC Affairs....

  7. 75 FR 59235 - Federal Advisory Committee; Army National Cemeteries Advisory Commission

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-27

    ...Secretary Federal Advisory Committee; Army National Cemeteries Advisory Commission...it is establishing the charter for the Army National Cemeteries Advisory Commission...Defense, through the Under Secretary of the Army, independent advice and...

  8. 32 CFR 552.38 - Acquisition of maneuver agreements for Army commanders.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Acquisition of maneuver agreements for Army commanders. 552.38 Section 552...Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES... Acquisition of maneuver agreements for Army commanders. (a) Authorization....

  9. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2009-07-01 true Army Advisory Panel on ROTC Affairs. 562...Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES RESERVE OFFICERS' TRAINING CORPS § 562.8 Army Advisory Panel on ROTC Affairs....

  10. 32 CFR 536.1 - Purpose of the Army Claims System.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 false Purpose of the Army Claims System. 536.1 Section 536...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.1 Purpose...

  11. 32 CFR 536.12 - Commanding General, U.S. Army Medical Command.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 true Commanding General, U.S. Army Medical Command. 536.12 Section...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.12...

  12. 33 CFR 211.16 - Scope and application of Army Regulations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 false Scope and application of Army Regulations. 211.16 Section 211... CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE REAL ESTATE... § 211.16 Scope and application of Army Regulations. (a) AR...

  13. 32 CFR 552.38 - Acquisition of maneuver agreements for Army commanders.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Acquisition of maneuver agreements for Army commanders. 552.38 Section 552...Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES... Acquisition of maneuver agreements for Army commanders. (a) Authorization....

  14. 33 CFR 334.1325 - United States Army Restricted Area, Kuluk Bay, Adak, Alaska.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 2014-07-01 false United States Army Restricted Area, Kuluk Bay, Adak, Alaska... CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE DANGER ZONE...REGULATIONS § 334.1325 United States Army Restricted Area, Kuluk Bay, Adak,...

  15. 32 CFR 623.6 - Reimbursement for loan of Army materiel.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 true Reimbursement for loan of Army materiel. 623.6 Section 623.6 National...Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL § 623.6 Reimbursement for...

  16. 32 CFR 552.38 - Acquisition of maneuver agreements for Army commanders.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Acquisition of maneuver agreements for Army commanders. 552.38 Section 552...Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES... Acquisition of maneuver agreements for Army commanders. (a) Authorization....

  17. 32 CFR 553.17 - Persons ineligible for burial in an Army national cemetery.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...true Persons ineligible for burial in an Army national cemetery. 553.17 Section 553...of Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES ARMY NATIONAL CEMETERIES § 553.17...

  18. 32 CFR 536.1 - Purpose of the Army Claims System.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 2009-07-01 true Purpose of the Army Claims System. 536.1 Section 536...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.1 Purpose...

  19. 32 CFR 536.1 - Purpose of the Army Claims System.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 2009-07-01 true Purpose of the Army Claims System. 536.1 Section 536...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.1 Purpose...

  20. 33 CFR 334.1325 - United States Army Restricted Area, Kuluk Bay, Adak, Alaska.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 2012-07-01 false United States Army Restricted Area, Kuluk Bay, Adak, Alaska... CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE DANGER ZONE...REGULATIONS § 334.1325 United States Army Restricted Area, Kuluk Bay, Adak,...

  1. 33 CFR 334.1325 - United States Army Restricted Area, Kuluk Bay, Adak, Alaska.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 2011-07-01 false United States Army Restricted Area, Kuluk Bay, Adak, Alaska... CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE DANGER ZONE...REGULATIONS § 334.1325 United States Army Restricted Area, Kuluk Bay, Adak,...

  2. 33 CFR 211.16 - Scope and application of Army Regulations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 false Scope and application of Army Regulations. 211.16 Section 211... CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE REAL ESTATE... § 211.16 Scope and application of Army Regulations. (a) AR...

  3. 32 CFR 552.38 - Acquisition of maneuver agreements for Army commanders.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Acquisition of maneuver agreements for Army commanders. 552.38 Section 552...Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES... Acquisition of maneuver agreements for Army commanders. (a) Authorization....

  4. 33 CFR 211.16 - Scope and application of Army Regulations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 false Scope and application of Army Regulations. 211.16 Section 211... CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE REAL ESTATE... § 211.16 Scope and application of Army Regulations. (a) AR...

  5. 32 CFR 536.12 - Commanding General, U.S. Army Medical Command.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2009-07-01 true Commanding General, U.S. Army Medical Command. 536.12 Section...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.12...

  6. 32 CFR 553.17 - Persons ineligible for burial in an Army national cemetery.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...false Persons ineligible for burial in an Army national cemetery. 553.17 Section 553...of Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES ARMY NATIONAL CEMETERIES § 553.17...

  7. 33 CFR 334.1325 - United States Army Restricted Area, Kuluk Bay, Adak, Alaska.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 2013-07-01 false United States Army Restricted Area, Kuluk Bay, Adak, Alaska... CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE DANGER ZONE...REGULATIONS § 334.1325 United States Army Restricted Area, Kuluk Bay, Adak,...

  8. 32 CFR 536.1 - Purpose of the Army Claims System.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 2010-07-01 true Purpose of the Army Claims System. 536.1 Section 536...Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.1 Purpose...

  9. 32 CFR 552.38 - Acquisition of maneuver agreements for Army commanders.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Acquisition of maneuver agreements for Army commanders. 552.38 Section 552...Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES... Acquisition of maneuver agreements for Army commanders. (a) Authorization....

  10. 32 CFR 623.6 - Reimbursement for loan of Army materiel.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2009-07-01 true Reimbursement for loan of Army materiel. 623.6 Section 623.6 National...Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL § 623.6 Reimbursement for...

  11. 32 CFR 553.17 - Persons ineligible for burial in an Army national cemetery.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...false Persons ineligible for burial in an Army national cemetery. 553.17 Section 553...of Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES ARMY NATIONAL CEMETERIES § 553.17...

  12. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2009-07-01 true Army Advisory Panel on ROTC Affairs. 562...Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES RESERVE OFFICERS' TRAINING CORPS § 562.8 Army Advisory Panel on ROTC Affairs....

  13. 77 FR 30376 - Amendment of Restricted Area R-2101; Anniston Army Depot, AL

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-23

    ...of Restricted Area R-2101; Anniston Army Depot, AL AGENCY: Federal Aviation Administration...of restricted area R-2101, Anniston Army Depot, AL, by removing the abbreviation...for restricted area R-2101, Anniston Army Depot, AL, and inserting the...

  14. 75 FR 22756 - Federal Advisory Committee; United States Army Science Board; Charter Renewal

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-30

    ...Federal Advisory Committee; United States Army Science Board; Charter Renewal AGENCY...renewing the charter for the United States Army Science Board (hereafter referred to as...recommendations on matters relating to the Army's scientific, technical,...

  15. Surgical Instrument Restraint in Weightlessness

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

    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.

  16. [Surgical therapy of pleural empyema with tauroline].

    PubMed

    Bieselt, R

    1997-01-01

    Empyema continues to be a significant problem in spite of improved surgical techniques and the use of new, more potent antimicrobial agents. This report describes our experience in the treatment of empyema at the Clemens Hospital in Münster, Germany, from 1990 to 1996. Basic to conservative treatment are closed drainage with intensive irrigation and instillation of Taurolin, a chemotherapeutic agent against bacterias, yeasts and mycetes. This treatment has been employed since 1990 and given 86 patients with just empyema or in combination with decortication. The superiority of this method to other methods of treatment is discussed on the basis of our results. PMID:9333707

  17. Toward strategies for cost containment in surgical patients.

    PubMed Central

    Drucker, W R; Gavett, J W; Kirshner, R; Messick, W J; Ingersoll, G

    1983-01-01

    The University of Rochester, Department of Surgery, in response to an experimental community-wide limit on hospital budgets, studied high-cost general surgical patients as a potential source of leverage for containment of hospital costs. It was found that a small number of patients impact significantly on hospital costs. In 1980, 3935 patients at Strong Memorial Hospital (SMH) had at least one contact with a general surgical patient care or intensive care unit; 261 patients (6.6%) had total 1980 charges of more than $20,000 each. They contributed 32% of the total of both general surgical charges and patient days. A subset of 2021 patients was selected to represent more precisely the general surgical patient. The 85 high-cost patients (4.2%) of this subset were chosen for intensive study. These patients generated a significant and disproportionate per cent of total (2021) general surgical charges (26.8%) and hospital days (27.6%). Average total charges were more than 8 times those of the complementary general surgical subset (1936). Nineteen of the 85 patients (22.3%) died in the hospital and 42 patients (49.4%) were dead within 2 1/2 years. Forty patients (of the 85) were then further identified as "complex", based on multiple, usually unrelated, illnesses and multiple annual admissions. Tending to be elderly with poor prognoses, 60% of them had died by April 1983. The major criterion of complexity was the lack of a well-focused medical problem; the cure for one problem simply relinquished primacy to another. A parallel study of hospital ancillary procedures disclosed a similar high-cost pattern. Of approximately 4000 ancillary procedures, 100 (2.5%) had annual charges of $100,000 or over, accounting for two-thirds of total 1980 ancillary charges. Roughly 20% of a single patient's ordered procedures accounted for 80% of the patient's ancillary charges, thus allowing concentrated study of a relatively small number of charges. Means for cost containment may be applied logically to the high-cost patient and particularly toward the complex patient. The complex patient is especially suited for consideration, since it is postulated that these patients are endemic to all general hospitals and to all clinical services. Strategies to be developed should include: 1) a managerial system in which physicians have an incentive to contain costs, 2) an online data system, 3) an accurate, efficient way to identify prospective high-cost and complex patients and, 4) awareness by physicians, patients, and society that less expensive modes of diagnosis and therapy are an appropriate response to rationed health resources. PMID:6412640

  18. EACTS expert consensus statement for surgical management of pleural empyema.

    PubMed

    Scarci, Marco; Abah, Udo; Solli, Piergiorgio; Page, Aravinda; Waller, David; van Schil, Paul; Melfi, Franca; Schmid, Ralph A; Athanassiadi, Kalliopi; Sousa Uva, Miguel; Cardillo, Giuseppe

    2015-11-01

    Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce hospital costs, morbidity and mortality. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research. The European Association for Cardio-Thoracic Surgery (EACTS) Thoracic Domain and the EACTS Pleural Diseases Working Group established a team of thoracic surgeons to produce a comprehensive review of available scientific evidence with the aim to cover all aspects of surgical practice related to its treatment, in particular focusing on: surgical treatment of empyema in adults; surgical treatment of empyema in children; and surgical treatment of post-pneumonectomy empyema (PPE). In the management of Stage 1 empyema, prompt pleural space chest tube drainage is required. In patients with Stage 2 or 3 empyema who are fit enough to undergo an operative procedure, there is a demonstrated benefit of surgical debridement or decortication [possibly by video-assisted thoracoscopic surgery (VATS)] over tube thoracostomy alone in terms of treatment success and reduction in hospital stay. In children, a primary operative approach is an effective management strategy, associated with a lower mortality rate and a reduction of tube thoracostomy duration, length of antibiotic therapy, reintervention rate and hospital stay. Intrapleural fibrinolytic therapy is a reasonable alternative to primary operative management. Uncomplicated PPE [without bronchopleural fistula (BPF)] can be effectively managed with minimally invasive techniques, including fenestration, pleural space irrigation and VATS debridement. PPE associated with BPF can be effectively managed with individualized open surgical techniques, including direct repair, myoplastic and thoracoplastic techniques. Intrathoracic vacuum-assisted closure may be considered as an adjunct to the standard treatment. The current literature cements the role of VATS in the management of pleural empyema, even if the choice of surgical approach relies on the individual surgeon's preference. PMID:26254467

  19. The automated Army ROTC Questionnaire (ARQ)

    NASA Technical Reports Server (NTRS)

    Young, David L. H.

    1991-01-01

    The Reserve Officer Training Corps Cadet Command (ROTCCC) takes applications for its officer training program from college students and Army enlisted personnel worldwide. Each applicant is required to complete a set of application forms prior to acceptance into the ROTC program. These forms are covered by several regulations that govern the eligibility of potential applicants and guide the applicant through the application process. Eligibility criteria changes as Army regulations are periodically revised. Outdated information results in a loss of applications attributable to frustration and error. ROTCCC asked for an inexpensive and reliable way of automating their application process. After reviewing the process, it was determined that an expert system with good end user interface capabilities could be used to solve a large part of the problem. The system captures the knowledge contained within the regulations, enables the quick distribution and implementation of eligibility criteria changes, and distributes the expertise of the admissions personnel to the education centers and colleges. The expert system uses a modified version of CLIPS that was streamlined to make the most efficient use of its capabilities. A user interface with windowing capabilities provides the applicant with a simple and effective way to input his/her personal data.

  20. Electronic voice communications improvements for Army aircraft

    NASA Astrophysics Data System (ADS)

    Mayer, M. S.

    1982-08-01

    The communications systems on all Army aircraft flying today are based on design concepts that are over 50-years old. We have designed a totally modern, state-of-the-art communications system for Army aircraft, and have published two new specifications which contain many of the modern test procedures required to accurately test and evaluate the various components of the communication system. As a first step in the development of new test procedures, we evaluated both ASA and ANSI standards and found them lacking. The components of the new state-of-the-art communications system will include, as a minimum: high impedance DC powered noise canceling microphones (using piezoelectric ceramic, electret, or PVF2 diaphragms); earphone elements designed and tested to have flat frequency response when inside the circumaural earcup of the hearing protective device; and intercoms which replace positive peak-clipping with fast-acting AGC circuits and expander/compander circuits for maximum output signal without distortion, even under conditions of extremes stress. In the future, audio signals in the microphone will be converted into the digital mode or directly into the optical spectrum for high efficiency, and secure communications inside the aircraft. The savings in weight and security improvements will be considerable.

  1. 20. Photocopy of original drawing by US Army Engineer District, ...

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

    20. Photocopy of original drawing by US Army Engineer District, Corps of Engineers, 1964 (original in possession of NYC Economic Development Corp.) REPAIRS OF SPALLED CONCRETE-PIERS 2,3, AND 4 - Brooklyn Army Supply Base, Pier 2, Brooklyn, Kings County, NY

  2. Soldier Education in the British Army, 1920-2007

    ERIC Educational Resources Information Center

    Beach, Jim

    2008-01-01

    This article surveys the history of compulsory education for soldiers' career advancement in the British army. It begins with an examination of the organizational context before analyzing the rationale, syllabus, teaching and assessment of soldier education. It concludes that for members of the army education organization their self-perception as…

  3. Organisation of the Jacobite army, 1745-1746 

    E-print Network

    McCann, Jean E.

    1963-01-01

    , were, because of its very nature, denied to the Jacobite army of 1745/6. The methods, however, by which the problems of recruitment, discipline and finance were solved by the rebel army were often to play a decisive part in the fate of the rebellion...

  4. THE U.S. ARMY CORPS OF ENGINEERS

    E-print Network

    US Army Corps of Engineers

    of this disaster, the Army Corps of Engineers joined the team headed by the United States Coast Guard to mount a massive cleanup effort. This was the first time the Corps and the Coast Guard had worked together and the Coast Guard had responsibility for the cleanup operations and played a larger role than the Army Corps

  5. 32 CFR 644.329 - Army civil works real property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Army civil works real property. 644.329 Section... PROPERTY REAL ESTATE HANDBOOK Disposal Procedure for Placing Real Property in Excess Status § 644.329 Army civil works real property. (a) Fee-owned land and easements. (1) Action by Division/District...

  6. 32 CFR 644.329 - Army civil works real property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Army civil works real property. 644.329 Section... PROPERTY REAL ESTATE HANDBOOK Disposal Procedure for Placing Real Property in Excess Status § 644.329 Army civil works real property. (a) Fee-owned land and easements. (1) Action by Division/District...

  7. 32 CFR 644.329 - Army civil works real property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Army civil works real property. 644.329 Section... PROPERTY REAL ESTATE HANDBOOK Disposal Procedure for Placing Real Property in Excess Status § 644.329 Army civil works real property. (a) Fee-owned land and easements. (1) Action by Division/District...

  8. 75 FR 19302 - Radiation Sources on Army Land

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-14

    ... final rule which establishes requirements for the expanded definition of byproduct material. 72 FR 55864... was made in a separate rulemaking for 10 CFR Part 110 (April 20, 2006; 71 FR 20336). The Department of... Department of the Army 32 CFR Part 655 RIN 0702-AA58 Radiation Sources on Army Land AGENCY: Department of...

  9. Explaining Recent Army and Navy Minority Recruiting Trends. Research Brief

    ERIC Educational Resources Information Center

    Steinberg, Paul

    2009-01-01

    Between 2000 and 2007, the representation of blacks among high-quality Army recruits declined, while in the Navy, black representation remained stable; the representation of Hispanics among high-quality recruits in both the Army and Navy grew during this period. RAND researchers identified factors that explain these recruiting trends and found…

  10. New Tools and Metrics for Evaluating Army Distributed Learning. Monograph

    ERIC Educational Resources Information Center

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

    2011-01-01

    Distributed learning (DL) is a key element of the Army's training strategy, and the Army has ambitious goals for expanding the future use of DL and for changing how it is developed and delivered. Program-level evaluation of DL can play an essential role in accomplishing those goals and in identifying strategic directions for the overall program.…

  11. Morphological phylogeny of army ants and other dorylomorphs (Hymenoptera: Formicidae)

    E-print Network

    Brady, Seán

    Morphological phylogeny of army ants and other dorylomorphs (Hymenoptera: Formicidae) S E A´ N G of ants comprises the three subfamilies of army ants (Aenictinae, Dorylinae, Ecitoninae) together the newly discovered male caste of Lepta- nilloidinae. We used ant taxa from Leptanillinae, Myrmeciinae

  12. Surgical smoke evacuation systems.

    PubMed

    1997-04-01

    Surgical smoke evacuation systems are high-flow vacuum sources used to capture, at the surgical site, the smoke aerosols and gases generated during the use of lasers and electrosurgical units (ESUs). In this study, we evaluated 16 evacuation systems, from 10 suppliers, designed and marketed for use in the operating room for general surgery. For our testing, we focused on the performance of the systems (particularly their ability to capture smoke particles under simulated surgical conditions) and their ease of use and quality of construction. We also examined the projected costs of each system over a seven-year life cycle. We rated the systems separately for two different evacuation applications (1) general-purpose applications, for which the system would, in many cases, be used with a handheld nozzle (the traditional capture device used with these systems), and (2) ESU-pencil-based evacuation applications only, for which the system would always be used with a pencil-based wand. (We report on ESU-pencil-based smoke evacuation wands in a separate Evaluation in this issue.) While we found most units to be Acceptable, we did rate two units Acceptable-Not Recommended for both applications and one unit Unacceptable for general-purpose applications. In addition to our findings for the evaluated models, this study features several sections providing generic information and guidance about smoke evacuation technology. The Technology Overview describes the basics: what these systems do and how they do it. The Technology Management Guide, "Clearing the Air-Should Surgical Smoke Be Evacuated?," discusses the issues healthcare facilities should consider when determining whether, when, and how surgical smoke should be evacuated. Finally, the Selection, Purchasing, and Use Guide offers guidance on how facilities can most effectively implement this technology, from identifying models that will meet their needs to ensuring that the systems are used properly to provide adequate staff protection. PMID:9134439

  13. [da Vinci surgical system].

    PubMed

    Watanabe, Gou; Ishikawa, Norihiro

    2014-07-01

    The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years. PMID:25138939

  14. Vet Hospital 

    E-print Network

    Unknown

    2011-08-17

    there appears to be a substantial difference in terms of EHRs implementation and adoption among hospitals with different organizational characteristics and by end-users in different job categories, little has been studied about the relationship between EHR...

  15. The deployment of information systems and information technology in field hospitals.

    PubMed

    Crowe, Ian R J; Naguib, Raouf N G

    2010-01-01

    Information systems and related technologies continue to develop and have become an integral part of healthcare provision and hospital care in particular. Field hospitals typically operate in the most austere and difficult of conditions and have yet to fully exploit related technologies. This paper addresses those aspects of healthcare informatics, healthcare knowledge management and lean healthcare that can be applied to field hospitals, with a view to improving patient care. The aim is to provide a vision for the deployment of information systems and information technology in field hospitals, using the British Army's field hospital as a representative model. PMID:21095762

  16. Hospital philanthropy.

    PubMed

    Smith, Dean G; Clement, Jan P

    2013-01-01

    It remains an open question whether hospital spending on fundraising efforts to garner philanthropy is a good use of funds. Research and industry reports provide conflicting results. We describe the accounting and data challenges in analysis of hospital philanthropy, which include measurement of donations, measurement of fundraising expenses, and finding the relationships among organizations where these cash flows occur. With these challenges, finding conflicting results is not a surprise. PMID:23614267

  17. 32 CFR 635.22 - Reserve component, U.S. Army Reserve, and Army National Guard personnel.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...copy of the DA Form 3975 will also be forwarded to Chief, Army Reserve/Commander, United States Army Reserve Command, AFRC-JAM, 1404 Deshler Street, Fort McPherson, GA 30330. The forwarding correspondence will reflect this regulation as the...

  18. 32 CFR 635.22 - Reserve component, U.S. Army Reserve, and Army National Guard personnel.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...copy of the DA Form 3975 will also be forwarded to Chief, Army Reserve/Commander, United States Army Reserve Command, AFRC-JAM, 1404 Deshler Street, Fort McPherson, GA 30330. The forwarding correspondence will reflect this regulation as the...

  19. 32 CFR 635.22 - Reserve component, U.S. Army Reserve, and Army National Guard personnel.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...copy of the DA Form 3975 will also be forwarded to Chief, Army Reserve/Commander, United States Army Reserve Command, AFRC-JAM, 1404 Deshler Street, Fort McPherson, GA 30330. The forwarding correspondence will reflect this regulation as the...

  20. The Women's Army Auxiliary Corps: A Compromise to Overcome the Conflict of Women Serving in the Army

    ERIC Educational Resources Information Center

    Permeswaran, Yashila

    2008-01-01

    Though people now take the idea of women in the military for granted, in the 1940s it was a vigorously debated suggestion. Men protected their country; women stayed at home. Because of the conflict over whether women should serve in the army, Congress compromised by creating the Women's Army Auxiliary Corps (WAAC). This article describes the…

  1. The Digital Patient Push Using Location to Streamline the Surgical Journey S. Mukherjee1

    E-print Network

    Peng, Xiaohong

    was designed to avoid medical errors and improve hospital efficiency by automating surgical patient management) and enhance hospital resource utilisation. The paper also describes how the information is secured during the dissemination and manipulation processes in the distributed and wireless environments. The system design has

  2. 3D printing surgical instruments: Are we there yet?

    PubMed Central

    Rankin, Timothy M.; Giovinco, Nicholas A.; Cucher, Daniel J.; Watts, George; Hurwitz, Bonnie; Armstrong, David G.

    2015-01-01

    Background The applications for rapid prototyping have expanded dramatically over the last 20 years. In recent years, additive manufacturing has been intensely investigated for surgical implants, tissue scaffolds, and organs. There is, however, scant literature to date that has investigated the viability of 3D printing of surgical instruments. Materials and Methods Using a fused deposition manufacturing (FDM) printer, an army/ navy surgical retractor was replicated from polylactic acid (PLA) filament. The retractor was sterilized using standard FDA approved glutaraldehyde protocols, tested for bacteria by PCR, and stressed until fracture in order to determine if the printed instrument could tolerate force beyond the demands of an operating room. Results Printing required roughly 90 minutes. The instrument tolerated 13.6 kg of tangential force before failure, both before and after exposure to the sterilant. Freshly extruded PLA from the printer was sterile and produced no PCR product. Each instrument weighed 16g and required only $0.46 of PLA. Conclusions Our estimates place the cost per unit of a 3D printed retractor to be roughly 1/10th the cost of a stainless steel instrument. The PLA Army/ Navy is strong enough for the demands of the operating room. Freshly extruded PLA in a clean environment, such as an OR, would produce a sterile, ready to use instrument. Due to the unprecedented accessibility of 3D printing technology world wide, and the cost efficiency of these instruments, there are far reaching implications for surgery in some underserved and less developed parts of the world. PMID:24721602

  3. Managing critical care casualties on the Navy's hospital ships.

    PubMed

    Boren, Denise; Forbus, Ronald; Bibeau, Patrice; McKenzie, Robin; McKinsey, Karen

    2003-06-01

    In this article, a history of the hospital ships was recounted. Recent missions were described in terms of the ship and crew's capability based on education and mock training exercises. Patient flow was described and a case scenario was presented to illustrate surgically intensive management of critical care casualties. Finally, thoughts on the future of hospital ships were discussed. PMID:12755184

  4. Renkioi: a forgotten Crimean War hospital and its significance.

    PubMed

    Silver, C P

    2004-12-01

    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

  5. [The Marburg surgical curriculum - improving the attraction of medical education by teaching central surgical competence].

    PubMed

    Schwarting, T; Ruchholtz, S; Josephs, D; Oberkircher, L; Bartsch, D K; Fendrich, V

    2012-04-01

    The quality of medical education is an ongoing challenge due to the continuing changes of the health-care politics and general social conditions. At many German university hospitals the dominating picture is overfilled courses, lack of hands-on practice, reduced patient contact and the dull provision of theoretical, abstract knowledge. The reformed surgical curriculum at the University of Marburg university hospital is used to demonstrate that, in spite of large student numbers, a practice-oriented, small-group training at a high didactic level is possible. The surgical training courses are organized in detail and coordinated. Course contents and structure are media available in print and online versions for both students and teachers and thus fulfill not only transparency needs but also contemporary requirements. The strategy of a practice- and patient-oriented, small-group training is followed strictly in the surgical curriculum. In addition, accompanying tutorial possibilities for individual study in an up-to-date learning center are offered. Here the students have the opportunity to intensify knowledge acquired in previous or future courses with numerous attractive education means. Continuous evaluation of the individual training courses at the end of each semester not only document motivation of the students but also serve to continuously improve the training concepts. PMID:22495485

  6. Mentoring in surgical training.

    PubMed

    Rashid, Prem; Narra, Maruthi; Woo, Henry

    2015-04-01

    Surgical mentors have helped trainees develop fulfilling and academically productive careers, while supervisors are formally assigned to impart skills and oversee training. This paper reviews the comparative roles of the supervisor and mentor and how they overlap, while exploring the impact of the 'unknown' mentor. While the supervisor's role in directing the student is formally recognized, the mentee will personally select a mentor who successfully models the career and life balance to which the mentee aspires. The unknown mentor is known only to the mentee. The mentee's commitment to communicating with both mentor and supervisor is crucial to success. Better processes can be used to guide the mentor relationship. Confusion between the two roles - mentor and supervisor - is due to their complementary nature as well as an overlap in roles. Both remain essential to the growth and development of the surgical trainee. The unknown mentor could give detached advice and guidance to the student, while acting as a positive role model. PMID:25649003

  7. Examination of Process Implementation of Evidence-based Design Initiatives on United States Army Medical Construction 

    E-print Network

    Marsh, Glenn Edward

    2011-08-08

    /surgical and postpartum nursing units in general hospitals and revised bed clearances with bedside documentation areas in critical-care-unit single-patient room design. Both documents recommend the inclusion of hand-washing sinks, though neither specifies... Construction NFPA National Fire Protection Association PMD Project Management Division PPD Planning & Programming Division ROI Return On Investment SEPSII Space Equipment Planning System II TMA TRICARE Management Activity UFC Unified Facilities...

  8. Allergy to Surgical Implants.

    PubMed

    Pacheco, Karin A

    2015-01-01

    Surgical implants have a wide array of therapeutic uses, most commonly in joint replacements, but also in repair of pes excavatum and spinal disorders, in cardiac devices (stents, patches, pacers, valves), in gynecological implants, and in dentistry. Many of the metals used are immunologically active, as are the methacrylates and epoxies used in conjunction with several of these devices. Allergic responses to surgical components can present atypically as failure of the device, with nonspecific symptoms of localized pain, swelling, warmth, loosening, instability, itching, or burning; localized rash is infrequent. Identification of the specific metal and cement components used in a particular implant can be difficult, but is crucial to guide testing and interpretation of results. Nickel, cobalt, and chromium remain the most common metals implicated in implant failure due to metal sensitization; methacrylate-based cements are also important contributors. This review will provide a guide on how to assess and interpret the clinical history, identify the components used in surgery, test for sensitization, and provide advice on possible solutions. Data on the pathways of metal-induced immune stimulation are included. In this setting, the allergist, the dermatologist, or both have the potential to significantly improve surgical outcomes and patient care. PMID:26362550

  9. Surgical site infection and prevention guidelines: a primer for Certified Registered Nurse Anesthetists.

    PubMed

    Diaz, Valerie; Newman, Johanna

    2015-02-01

    Each year 500,000 surgical site infections occur in the US. Surgical site infections are the second most common healthcare-associated infections resulting in readmissions, prolonged hospital stays, higher medical costs, and increased morbidity and mortality. Surgical site infections are preventable in most cases by following evidence-based guidelines for hand hygiene, administration of prophylactic antibiotics, and perioperative patient temperature management. As attention to issues of healthcare quality heightens, the demands for positive surgical patient outcomes are intensifying. The Certified Registered Nurse Anesthetist can provide transparent high-quality care by implementing evidence-based guidelines for timely and appropriate antibiotic use, maintenance of normothermia, and hand washing. PMID:25842636

  10. Laparoscopic and robotic surgical training in urology.

    PubMed

    Hoznek, András; Katz, Ran; Gettman, Matthew; Salomon, Laurent; Antiphon, Patrick; de la Taille, Alexandre; Yiou, René; Chopin, Dominique; Abbou, Clément-Claude

    2003-04-01

    The most important change in urology during the past decade was the development of minimally invasive surgery, particularly laparoscopy. However, the main drawback of laparoscopy is a steep learning curve, which results from the significant changes in the surgical environment. Although laparoscopy can provide important advantages for the patient, including decreased length of hospitalization, decreased analgesic requirement, and a shortened postoperative convalescence, one concern has been whether laparoscopic techniques should be learned solely in the operating room. For example, sports, music, and aviation are practiced before an actual performance is ever undertaken. In this review, the advantages and limitations of all available training modalities in minimally invasive surgery are described. Testing basic laparoscopic skills on inanimate models, becoming familiar with the principles of dissection and hemostasis on living animals, and studying surgical anatomy on cadavers should be considered as indispensable and complementary elements for laparoscopic training in the future. In addition, telementoring with the help of modern image processing and virtual reality eventually may become the basis of tomorrow's surgical instruction. PMID:12648430

  11. The development of postgraduate surgical training in Guyana

    PubMed Central

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

    2010-01-01

    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

  12. Designing and implementing the Army Nursing Leader Academy.

    PubMed

    Dunemn, Kathleen; Hopkins-Chadwick, Denise L; Connally, Tina; Bramley, Kelly

    2011-01-01

    In 2008, the Chief of the Army Nurse Corps directed a thorough review of existing training programs available to and provided for Army Nursing personnel for the development of full-spectrum leaders for Army Nursing. The review provided the gap analysis necessary to restructure courses provided by the Department of Nursing Science at the Army Medical Department Center and School. This new grouping of courses is referred to as the Army Nursing Leader Academy. The Army Nursing Leader Academy is the first of its kind in that it addresses career-long learning of all Army Nursing by focusing on building skills, knowledge, and behaviors to produce sustainable, full-spectrum leaders. The Nursing Leader Academy consists of a series of sequential nurse leader development courses combined with a web based resource center. Grounded in the Patient CaringTouch System, guided by nurse competencies, and gauged by the Leader Capabilities Map, the Nursing Leader Academy provides learning that is relevant and timely designed to reinforce enterprise values and culture to ensure readiness for successive roles and positions. Full implementation of the Nursing Leader Academy will include the evidence-based elements of formal schooling, coaching, self-development, functional/technical (competency attainment), and professional experiences. PMID:22124867

  13. Prevention of surgical site infections.

    PubMed

    Hedrick, Traci L; Anastacio, Melissa M; Sawyer, Robert G

    2006-04-01

    In the current era of pay-for-performance standards, the incidence of surgical site infections is increasingly becoming an institutional marker of quality assurance. Surgical site infections lead to increased morbidity and mortality in the surgical population and contribute to an already rising healthcare cost. As a result, the surgical community goes to great lengths to prevent this costly and occasionally lethal complication. Many practices are evidence based, however, many are not. In this article, the most commonly used preventive strategies in practice today and the evidence behind each are reviewed. In addition, an overview of the epidemiology, pathophysiology and microbiology of surgical site infections will be provided. PMID:16597204

  14. 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. ? ...

  15. Acute Gout in Hospitalized patients in Sarawak General Hospital.

    PubMed

    Teh, C L; Chew, K F; Ling, G R

    2014-06-01

    we performed a prospective study of all hospitalized patients with a diagnosis of Gout in Sarawak General hospital from 1st July 2011 to 1st July 2012. There were a total of 126 patients in our study of which 112 (88.9%) were males. The majority of our patients were from the indigenous populations (71.7%). They have a mean age of 60.0 ± 14.2 years. Most of our patients were overweight (68%) with comorbities of hypertension (78.6%), Chronic Kidney Failure (48.4%), Type II diabetes Mellitus (30.2%), dyslipidemia (27.8%) and Ischaemic heart disease (11.9%). Polyarticular gouty arthritis was the main presenting pattern during hospitalization (88.1%). The mean length of stay for our patients was 9.8 ± 6.0 days which was significantly longer than the mean length of stay for other patients without gout (p<0.05). Only 17 patients had gout on admission and the majority developed gout during hospitalizations. Our patients were admitted respectively for medical problems (45.4%), surgical problems (28.6%) and orthopaedic problems (9.2%). Colchicine (73.8%) and steroid (40.5%) were the main stays of treatment for our patients. Our hospitalized gout patients were complicated patients with multiple comorbidities. PMID:25326353

  16. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES RESERVE OFFICERS' TRAINING CORPS § 562.8 Army Advisory Panel on ROTC Affairs. (a) The Army Advisory...

  17. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES RESERVE OFFICERS' TRAINING CORPS § 562.8 Army Advisory Panel on ROTC Affairs. (a) The Army Advisory...

  18. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES RESERVE OFFICERS' TRAINING CORPS § 562.8 Army Advisory Panel on ROTC Affairs. (a) The Army Advisory...

  19. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES RESERVE OFFICERS' TRAINING CORPS § 562.8 Army Advisory Panel on ROTC Affairs. (a) The Army Advisory...

  20. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES RESERVE OFFICERS' TRAINING CORPS § 562.8 Army Advisory Panel on ROTC Affairs. (a) The Army Advisory...