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Sample records for army surgical hospital

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

    PubMed Central

    King, Booker; Jatoi, Ismalil

    2005-01-01

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

  2. The Falklands war: Army field surgical experience.

    PubMed Central

    Jackson, D. S.; Batty, C. G.; Ryan, J. M.; McGregor, W. S.

    1983-01-01

    In the recent Falklands campaign four Army Field Surgical Teams were deployed in the two phases of the war. They functioned as Advanced Surgical Centres and operated on 233 casualties. There were 3 deaths. The patterns of wounding and the methods of casualty management are discussed and compared with other recent campaigns. Images Fig. 1 PMID:6614760

  3. Blanchfield Army Community Hospital Polypharmacy Clinic.

    PubMed

    Ridderhoff, Kevin J; Hull, Jessica R; Sandberg, Sheila K

    2015-01-01

    The increased use of central nervous system depressants (CNSD) and psychotropics are one of the many factors that contribute to suicidal behavior in soldiers. U.S. Army policy requires medication screening for any soldier prescribed 4 or more medications when at least 1 of the medications is a CNSD or psychotropic. Constant deployments challenged health care provider ability to comply with required screenings, and senior leaders sought proactive intervention to reduce medication risks upon return of the 101 st Airborne Division (Air Assault) from deployment in 2011. A pharmacy-led team established the Polypharmacy Clinic (PC) at Blanchfield Army Community Hospital. Of the 3,999 soldiers assigned, 540 (13.5%) met the initial screening criteria. Success of the pilot program led to the mandatory screening of all other Fort Campbell, Kentucky, brigades. During the first 12 months, 895 soldiers were seen by a clinical pharmacist, and 1,574 interventions were documented. Significant interventions included medication added (121), medication changed (258), medication stopped (164), lab monitoring recommended (172), adverse reaction mitigated (41), therapeutic duplication prevented (61), and drug-drug interaction identified (93). Additionally, 55 soldiers were recommended for temporary duty profiles based on their adverse drug effects. Ten soldiers were recommended for enhanced controlled substance monitoring. Placing soldiers on clinically appropriate medications and removing potentially harmful medications from their possession are examples of how the PC positively impacted the Commanding General's ability to deploy a fully medically ready force. Soldiers consistently remarked favorably on the thorough medication counseling provided at their PC appointments. Innovative notes within the electronic health record summarized relevant findings regarding soldiers' medications, which allowed providers to quickly pinpoint and adjust medication regimens. With each identified high-risk soldier, we decreased the potential for postdeployment medication issues. Additionally, the PC generated over $70,000 in relative value units for the hospital. PMID:25562768

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

    PubMed

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

    2015-04-01

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

  5. Filmless Radiographic System For Army Field Hospitals

    NASA Astrophysics Data System (ADS)

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

    1989-05-01

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

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

    PubMed

    Gliantsev, S P

    2012-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  8. The Army forward surgical team: update and lessons learned, 1997-2004.

    PubMed

    Stinger, Harry; Rush, Robert

    2006-04-01

    Although the U.S. Army stood up two prototype airborne forward surgical teams (FSTs) in the early 1990s, it officially fielded the first 20-man FST in March 1997. Since then, Army FSTs (of which there are now 14 active and 23 reserve) have deployed on numerous combat, peacekeeping, and disaster-relief missions throughout the world. Although initially designed primarily for forward resuscitative surgery in support of short-term, offensive combat operations, the FST has become one of the Army Medical Department's most frequently deployed "long-term" health care facilities, i.e., long-term for the assigned personnel. The purpose of this article was to review the history of the FST, define its mission, delineate pitfalls in its employment and to make personnel and material acquisition recommendations for the future. PMID:16673735

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

    ERIC Educational Resources Information Center

    Shepard, William A.

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

  10. Surgical Safety Checklists May Shorten Hospital Stays, Save Lives

    MedlinePlus

    ... fullstory_157066.html Surgical Safety Checklists May Shorten Hospital Stays, Save Lives Overall health costs fall as ... of death over 90 days and shortened their hospital stay, a new study found. The findings suggest ...

  11. 38 CFR 3.358 - Compensation for disability or death from hospitalization, medical or surgical treatment...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  12. 38 CFR 3.358 - Compensation for disability or death from hospitalization, medical or surgical treatment...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

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

    PubMed

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

    2006-11-01

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

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

    PubMed Central

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

    2014-01-01

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

  15. 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 hospitals’ surgical 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

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

    PubMed

    Vinz, H; Reisig, J; Mller, K H

    1977-01-01

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

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

    PubMed

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

    2015-02-01

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

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

    PubMed Central

    2012-01-01

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

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

    PubMed

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

    1997-04-01

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

  20. [The hospitals constructed in France for the U.S. Army from 1950 to 1967. Organization, location, usage].

    PubMed

    Labrude, Pierre

    2008-01-01

    A few years after the Second World War the US Army was authorized to set up in France a line of communication intended to resupply the occupying forces in Germany. The logistical zone was greatly developed after the creating of Nato in 1949. It was made up of numerous depots and some hospitals built between 1953 and 1960 and placed along the road joining La Rochelle to Kaiserslautern in FRG that is La Rochelle, Poitiers, Chinon, Orléans, Vitry-le-François, Toul, Bar-le-Duc and Verdun. After the departure of US Army in 1966-1967, some of these hospitals were used by the French Army and its Health Service. Except for one of them all were sold and essentially used as hospitals. Nowadays they are disappearing and at the end of 2007 only three buildings are still complete: Toul is used as a hospital, Olivet as barracks and Croix-Chapeau (La Rochelle) as an industrial zone and in complete renewing. PMID:19230435

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

    PubMed

    Adler, Jessica L

    2014-10-01

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

  2. Horizontal strabismus surgical outcomes in a teaching hospital.

    PubMed

    Idrees, Z; Dooley, I; Fahy, G

    2014-06-01

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

  3. Epidemiology of Surgical Site Infection in a Community Hospital Network.

    PubMed

    Baker, Arthur W; Dicks, Kristen V; Durkin, Michael J; Weber, David J; Lewis, Sarah S; Moehring, Rebekah W; Chen, Luke F; Sexton, Daniel J; Anderson, Deverick J

    2016-05-01

    OBJECTIVE To describe the epidemiology of complex surgical site infection (SSI) following commonly performed surgical procedures in community hospitals and to characterize trends of SSI prevalence rates over time for MRSA and other common pathogens METHODS We prospectively collected SSI data at 29 community hospitals in the southeastern United States from 2008 through 2012. We determined the overall prevalence rates of SSI for commonly performed procedures during this 5-year study period. For each year of the study, we then calculated prevalence rates of SSI stratified by causative organism. We created log-binomial regression models to analyze trends of SSI prevalence over time for all pathogens combined and specifically for MRSA. RESULTS A total of 3,988 complex SSIs occurred following 532,694 procedures (prevalence rate, 0.7 infections per 100 procedures). SSIs occurred most frequently after small bowel surgery, peripheral vascular bypass surgery, and colon surgery. Staphylococcus aureus was the most common pathogen. The prevalence rate of SSI decreased from 0.76 infections per 100 procedures in 2008 to 0.69 infections per 100 procedures in 2012 (prevalence rate ratio [PRR], 0.90; 95% confidence interval [CI], 0.82-1.00). A more substantial decrease in MRSA SSI (PRR, 0.69; 95% CI, 0.54-0.89) was largely responsible for this overall trend. CONCLUSIONS The prevalence of MRSA SSI decreased from 2008 to 2012 in our network of community hospitals. This decrease in MRSA SSI prevalence led to an overall decrease in SSI prevalence over the study period. Infect Control Hosp Epidemiol 2016;37:519-526. PMID:26864617

  4. 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... disability resulting from a disease or injury or aggravation of an existing disease or injury suffered as...

  5. 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

  6. 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

  7. 42 CFR 416.75 - Performance of listed surgical procedures on an inpatient hospital basis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... inpatient hospital basis. 416.75 Section 416.75 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... procedures on an inpatient hospital basis. The inclusion of any procedure as a covered surgical procedure under § 416.65 does not preclude its coverage in an inpatient hospital setting under Medicare....

  8. 42 CFR 416.75 - Performance of listed surgical procedures on an inpatient hospital basis.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... inpatient hospital basis. 416.75 Section 416.75 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... on an inpatient hospital basis. The inclusion of any procedure as a covered surgical procedure under § 416.65 does not preclude its coverage in an inpatient hospital setting under Medicare....

  9. [Achievements and challenges in implementing the surgical checklist in a pediatric hospital].

    PubMed

    Dackiewicz, Nora; Viteritti, Laura; Marciano, Beatriz; Bailez, Marcela; Merino, Patricia; Bortolato, Diana; Jaichenko, André; Seminara, Rodolfo; Amarilla, Analía

    2012-12-01

    Patient safety in the operating room is a topic of universal concern. Several studies support the existence of a high percentage of complications and a high mortality rate in surgical procedures (0.5 to 5%). The World Health Organization (WHO) has proposed the implementation of surgical check list in order to improve patient safety in the operating room. In Hospital Garrahan, 9600 surgeries and surgical anesthesia for more than 8000 studies and other invasive procedures are performed per year. WHO checklist adaptation and implementation was considered an institutional priority. We describe difficulties and solutions in implementing the surgical checklist. Surgical team involvement in project planning and development was essential. PMID:23224308

  10. [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 Mława, 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 (Mława 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 Stanisław Breza, director of internal affairs. Later there was Rev. Józef Poniatowski, war commander, also local officials such as Józef Zabłocki and Teodor Mikołaj Dembowski, as well as representatives of the health service such as Dr. Hiacynt Dziarkowski, and Dr. Michał Bergonzoni. Other people worth mentioning include the hospital personnel (Colonel Teodor Pretwitz was Commanding Officer of the field hospitals in Mława, 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

  11. How Does Degree of Rurality Impact the Provision of Surgical Services at Rural Hospitals?

    ERIC Educational Resources Information Center

    Doty, Brit; Zuckerman, Randall; Finlayson, Samuel; Jenkins, Paul; Rieb, Nathaniel; Heneghan, Steven

    2008-01-01

    Context: Rural residents frequently have decreased access to surgical services. Consequences of this situation include increased travel time and financial costs for patients. There are also economic implications for hospitals as they may lose revenue when patients leave the area in order to obtain surgical services. Rural communities vary in size…

  12. 78 FR 9940 - Naugatuck Valley Surgical Center, Department of Saint Mary's Hospital, Waterbury, CT: Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-12

    ... Employment and Training Administration Naugatuck Valley Surgical Center, Department of Saint Mary's Hospital... Assistance (TAA) applicable to workers and former workers of Naugatuck Valley Surgical Center, Department of..., 2013 (78 FR 771). The workers supply medical transcription services. The initial investigation...

  13. 1 Canadian Field Hospital in Haiti: surgical experience in earthquake relief

    PubMed Central

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

    2012-01-01

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

  14. 77 FR 24409 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-24

    ...This document corrects technical errors that appeared in the final rule with comment period published in the Federal Register on November 30, 2011, entitled ``Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical Center Payment; Hospital Value-Based Purchasing Program; Physician Self-Referral; and Patient Notification Requirements in Provider Agreements''......

  15. Design and Implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital.

    PubMed

    Walters, Tessa L; Howard, Steven K; Kou, Alex; Bertaccini, Edward J; Harrison, T Kyle; Kim, T Edward; Shafer, Audrey; Brun, Carlos; Funck, Natasha; Siegel, Lawrence C; Stary, Erica; Mariano, Edward R

    2016-06-01

    The innovative Perioperative Surgical Home model aims to optimize the outcomes of surgical patients by leveraging the expertise and leadership of physician anesthesiologists, but there is a paucity of practical examples to follow. Veterans Affairs health care, the largest integrated system in the United States, may be the ideal environment in which to explore this model. We present our experience implementing Perioperative Surgical Home at one tertiary care university-affiliated Veterans Affairs hospital. This process involved initiating consistent postoperative patient follow-up beyond the postanesthesia care unit, a focus on improving in-hospital acute pain management, creation of an accessible database to track outcomes, developing new clinical pathways, and recruiting additional staff. Today, our Perioperative Surgical Home facilitates communication between various services involved in the care of surgical patients, monitoring of patient outcomes, and continuous process improvement. PMID:26392388

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

    PubMed Central

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

    2016-01-01

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

  17. Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center

    PubMed Central

    Chen, Ming; Chen, Mindy

    2010-01-01

    Mean CDE (cumulative dissipated energy) values were compared for an open hospital- based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil) was used. Mean CDE values showed that surgeons (individual private practice) at the free-standing surgical center were more efficient than surgeons (individual private practice) at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]). CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification. PMID:21151334

  18. 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

  19. 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

  20. [The past and future of surgical clinics of the Mikhailovsky clinical hospital ("Willie Hospital") of the Kirov Military medical academy].

    PubMed

    Samokhvalov, I M; Badalov, V I; Tynyankin, N A; Karev, E A

    2015-07-01

    A brief 140-years history of the Mikhailovsky clinical hospital ("Willie Hospital") of the Kirov Military Medical Academy is presented. Today the department of military surgery, integrated into the system of emergency medical care, locates in historical building of the Kirov Military Medical Academy, and considered as part of multi-field regional center for the treatment of severe combined injuries, and is the only one injury care center of the first level in the Ministry of Defence of the Russian Federation. The hospital admits on treatment more that one million of severe injured patients annually; many patients with severe injuries are transferred from other regional hospitals. Every year more than two thousands of surgical interventions are performed in the hospital. Next renovation of the building is planned in the near future; it should provide further development of new medical technologies in the Kirov Military Medical Academy. PMID:26821461

  1. 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

  2. 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

  3. Surgonomics as a health care financing policy for hospitalized surgical patients.

    PubMed

    Muñoz, E; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L

    1989-05-01

    The Medicare system of prospective payment to hospitals based on diagnostic related groups (DRG) has been severely criticized at a number of levels. Many states are using DRG prospective "All Payor Systems" for reimbursement to hospitals with the federal DRG system as a model. In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers pay by the DRG mode; the state of New York has been All Payor since 1 January 1988. This study simulated DRG All Payor methods on a large sample (N = 17,560) of surgical patients for a two year period, using both federal and New York DRG reimbursement methods currently in effect. Both Medicare and Medicaid patients had, on average, a longer length of stay in the hospital and higher total cost of hospitalization compared with patients from Blue Cross and other commercial payors. Medicare and Medicaid patients also had a greater severity of illness compared with patients from Blue Cross or other payors. All except commercial insurors (that is, Medicaid, Blue Cross and Medicare) had greater financial risk under the DRG All Payor scheme. Results from our study suggest that federal, state and private payors may not be adequately reimbursing health care providers for the care of the hospitalized surgical patient under the DRG prospective scheme of hospital payment. It appears that the financing policy for health care, especially at the federal and state level, could limit both the access and quality of care for surgical patients. PMID:2496483

  4. Length of preoperative hospital stay: a risk factor for reducing surgical infection in femoral fracture cases

    PubMed Central

    Pereira, Hoberdan Oliveira; Rezende, Edna Maria; Couto, Bráulio Roberto Gonçalves Marinho

    2015-01-01

    Objective To analyze infections of the surgical site among patients undergoing clean-wound surgery for correction of femoral fractures. Methods This was a historical cohort study developed in a large-sized hospital in Belo Horizonte. Data covering the period from July 2007 to July 2009 were gathered from the records in electronic medical files, relating to the characteristics of the patients, surgical procedures and surgical infections. The risk factors for infection were identified by means of statistical tests on bilateral hypotheses, taking the significance level to be 5%. Continuous variables were evaluated using Student's t test. Categorical variables were evaluated using the chi-square test, or Fisher's exact test, when necessary. For each factor under analysis, a point estimate and the 95% confidence interval for the relative risk were obtained. In the final stage of the study, multivariate logistic regression analysis was performed. Results 432 patients who underwent clean-wound surgery for correcting femoral fractures were included in this study. The rate of incidence of surgical site infections was 4.9% and the risk factors identified were the presence of stroke (odds ratio, OR = 5.0) and length of preoperative hospital stay greater than four days (OR = 3.3). Conclusion To prevent surgical site infections in operations for treating femoral fractures, measures involving assessment of patients’ clinical conditions by a multiprofessional team, reduction of the length of preoperative hospital stay and prevention of complications resulting from infections will be necessary.

  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

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

  6. 78 FR 43533 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-19

    ...This proposed rule 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 and changes arising from our continuing experience with these systems. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine......

  7. 77 FR 45061 - Hospital Outpatient Prospective and Ambulatory Surgical Center Payment Systems and Quality...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-30

    ...This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2013 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine......

  8. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... ASC surgical procedures performed in hospitals on an outpatient basis. 413.118 Section 413.118 Public... Payment for facility services related to covered ASC surgical procedures performed in hospitals on an... establishes the method for determining Medicare payments for services related to covered ambulatory...

  9. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ASC surgical procedures performed in hospitals on an outpatient basis. 413.118 Section 413.118 Public... Payment for facility services related to covered ASC surgical procedures performed in hospitals on an... establishes the method for determining Medicare payments for services related to covered ambulatory...

  10. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ASC surgical procedures performed in hospitals on an outpatient basis. 413.118 Section 413.118 Public... Payment for facility services related to covered ASC surgical procedures performed in hospitals on an... establishes the method for determining Medicare payments for services related to covered ambulatory...

  11. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ASC surgical procedures performed in hospitals on an outpatient basis. 413.118 Section 413.118 Public... Payment for facility services related to covered ASC surgical procedures performed in hospitals on an... establishes the method for determining Medicare payments for services related to covered ambulatory...

  12. [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 Botlikhskiĭ operation constituted 1:4, Novolakskiĭ (Kadarskiĭ)--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

  13. 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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

    Objectives Despite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals. Setting A large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 20022009 in New South Wales, Australia. Participants Patients underwent elective surgery within 2?days of admission, aged between 18 and 90?years, and who were not transferred to another acute care facility; 4?362?624 patients were included. Outcome measures VTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR). Results 2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the highest and those with the lowest rates were significant (between-hospital variation). Smaller hospitals, accommodated in two peer groups, had the lowest overall VTE rates (IRR=0.56:0.33 to 0.95; IRR=0.37:0.23 to 0.61) and exhibited a greater increase (64% and 237% vs 19%) overtime and greater between-hospital variations compared to larger hospitals (IRR=8.64:6.23 to 11.98; IRR=8.92:5.49 to 14.49 vs IRR=3.70:3.32 to 4.12). Mortality among patients with postoperative VTE was 8% and remained stable overtime. No differences in post-VTE death rates and trends were seen between hospital groups; however, larger hospitals exhibited less between-hospital variations (IRR=1.78:1.30 to 2.44) compared to small hospitals (IRR>23). Hospitals performed differently in prevention versus treatment of postoperative VTE. Conclusions VTE incidence is increasing and there is large variation between-hospital and within-hospital peer groups suggesting a varied compliance with VTE preventative strategies and the potential for targeted interventions and quality improvement opportunities. PMID:25280806

  16. 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

  17. The impact on hospitals of reducing surgical complications suggests many will need shared savings programs with payers.

    PubMed

    Krupka, Dan C; Sandberg, Warren S; Weeks, William B

    2012-11-01

    Reducing the complications that patients experience following surgery has garnered renewed attention from the medical and policy community. Reducing surgical complications is, foremost, critically important for patients. Moreover, in a competitive environment increasingly characterized by transparency of outcomes, the surgical complication rate is an important measure of hospital performance that could strongly influence choices of care and care sites made by patients and payers. However, programs to achieve such improvements can reduce hospital revenues, as reimbursements to treat patients for complications decrease. In this article we examine the business case for hospitals' consideration of programs to reduce surgical complications. We found that if a hospital's surgical inpatient volume is not growing, such a program results in negative cash flow. We also found that if a hospital's surgical volume is growing, and if the hospital can sufficiently reduce the average length-of-stay for surgical patients without complications, the cash flow could be positive. We recommend that hospitals with limited growth prospects that are nonetheless contemplating a surgical complication reduction program establish agreements with payers to share in any savings generated by the program. PMID:23077139

  18. 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

  19. HIV Testing and Epidemiology in a Hospital-Based Surgical Cohort in Malawi

    PubMed Central

    Haac, Bryce E.; Matoga, Mitch; LaCourse, Sylvia M.; Nonsa, Dominic; Hosseinipour, Mina

    2013-01-01

    Background Despite the high prevalence of HIV in adults (11 %) in Malawi, testing among surgical patients is not routine. We examined the feasibility of universal opt-out HIV testing and counseling (HTC) on the surgical wards of Kamuzu Central Hospital in Lilongwe, Malawi, and sought to further delineate the role of HIV in surgical presentation and outcome. Methods We reviewed HTC and surgical admission records from May to October 2011 and compared these data to data collected prospectively on patients admitted from November 2011 through April 2012, after universal HTC implementation. Results Prior to universal HTC, 270 of the 2,606 (10.4 %) surgical admissions were tested; 13 % were HIV-infected. After universal HTC implementation, HTC counselors reviewed 1,961 of the 2,488 admissions (79 %): 310 (16 %) had known status (157 seropositive, 153 seronegative) and 1,651 had unknown status (81 %). Among those with unknown status, 97 % (1,598, of 64 % of all admissions) accepted testing, of whom 9 % were found to be HIV-infected. Patients with longer lengths of stay (LOS) (mean = 11 vs. 5 days, p <0.01) and those who underwent surgical intervention (odds ratio [OR] 2.5; confidence interval [CI] 2.0–3.1) were more likely to have a known status on discharge. HIV was more prevalence in patients with infection and genital/anal warts or ulcers and lower in trauma patients. HIV-positive patients received less surgical intervention (OR 0.69; CI 0.52–0.90), but there was no association between HIV status and length of stay or mortality. Conclusions Universal opt-out HTC on the surgical wards was well accepted and increased the proportion of patients tested. High HIV prevalence in this setting merits implementation of universal HTC. PMID:23652356

  20. Variations in surgical rates in Quebec: does access to teaching hospitals make a difference?

    PubMed Central

    Blais, R

    1993-01-01

    OBJECTIVE: To document the geographic variations in the rates of 10 common surgical procedures in Quebec and to examine the relation between surgical rates and level of access to teaching hospitals. DESIGN: Population-based rates standardized for age and sex were calculated from 1985-88 data from MED-ECHO (the provincial hospital discharge database) for each of the 32 community health districts (départements de santé communautaire [DSCs]) in Quebec. Variation across DSCs was analysed with the use of the ratio of the highest to the lowest rate, the coefficient of variation and the systematic component of variation. On the basis of an urbanization index designed by Statistics Canada, DSCs were classified as having a low, medium, high or very high level of access to teaching hospitals. PATIENTS: All Quebec residents except those whose DSC of residence could not be traced (accounting for no more than 1.7% of patients for any study procedure) and aboriginal people from northern Quebec. SURGICAL PROCEDURES STUDIED: Appendectomy, cesarean section, cholecystectomy, coronary artery bypass grafting (CABG), hysterectomy, inguinal hernia repair, prostatectomy, tonsillectomy with or without adenoidectomy, total hip replacement and varicose vein stripping. RESULTS: There was considerable systematic variation in the surgical rates for all 10 procedures. Cesarean section, the rates of which varied the least, still exhibited almost a twofold variation between the highest and lowest rates. The rates of tonsillectomy varied the most, by a factor of more than five. With a few exceptions there was relatively little relation between the rates of the procedures within the DSCs. The rates of appendectomy, cholecystectomy, hysterectomy and tonsillectomy tended to be lower in the DSCs containing teaching hospitals, whereas the reverse was true for CABG. For the other procedures the relation between the rates and the level of access to teaching hospitals was nonsignificant. CONCLUSIONS: The overall consistency of the observed variations with those of previous studies invites a closer look at the practice patterns and the scientific basis of the clinical decisions associated with procedures showing high variations in rates. The lack of a systematic relation between the surgical rates and the level of access to teaching hospitals challenges the belief that remote regions are underserved with respect to the procedures studied. PMID:8485676

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Allareddy, Veerasathpurush

    2016-03-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2005-12-01

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

  5. Elective surgical patients' narratives of hospitalization: the co-construction of safety.

    PubMed

    Doherty, Carole; Saunders, Mark N K

    2013-12-01

    This research explores how elective surgical patients make sense of their hospitalization experiences. We explore sensemaking using longitudinal narrative interviews (n=72) with 38 patients undergoing elective surgical procedures between June 2010 and February 2011. We consider patients' narratives, the stories they tell of their prior expectations, and subsequent post-surgery experiences of their care in a United Kingdom (UK) hospital. An emergent pre-surgery theme is that of a paradoxical position in which they choose to make themselves vulnerable by agreeing to surgery to enhance their health, this necessitating trust of clinicians (doctors and nurses). To make sense of their situation, patients draw on technical (doctors' expert knowledge and skills), bureaucratic (National Health Service as a revered institution) and ideological (hospitals as places of safety), discourses. Post-operatively, themes of 'chaos' and 'suffering' emerge from the narratives of patients whose pre-surgery expectations (and trust) have been violated. Their stories tell of unmet expectations and of inability to make shared sense of experiences with clinicians who are responsible for their care. We add to knowledge of how patients play a critical part in the co-construction of safety by demonstrating how patient-clinician intersubjectivity contributes to the type of harm that patients describe. Our results suggest that approaches to enhancing patients' safety will be limited if they fail to reflect patients' involvement in the negotiated process of healthcare. We also provide further evidence of the contribution narrative inquiry can make to patient safety. PMID:24331879

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

    PubMed Central

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

    2015-01-01

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

  7. 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

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

    PubMed Central

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

    2015-01-01

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

  9. 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.

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

    PubMed

    Kessler, D M

    2001-01-01

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

  11. Internal quality assurance activities of a surgical pathology department in an Australian teaching hospital.

    PubMed Central

    Zardawi, I M; Bennett, G; Jain, S; Brown, M

    1998-01-01

    AIM: To assess the role of a quality assurance programme in improving the service provided by a surgical pathology department. METHODS: A continuous internal quality assurance study of the activities of an anatomical pathology department in an Australian teaching hospital was undertaken over a five year period. This addressed all steps involved in the production of a surgical pathology report. These were addressed in an open forum which included technical, scientific, clerical, and medical staff. Minor errors not needing immediate action were discussed and incorporated into laboratory practice. For major discrepancies with potential implications for patient management supplementary reports were issued and the relevant clinician informed of the outcome. RESULTS: Comprehensive peer review of 8.9% of the total workload of the department (3530 cases) and all the frozen sections (916 cases) over a period of five years, beginning in 1991, led to comments on some aspects of the original report by the reviewer in 19.6% of the cases. The great majority of the comments were minor, concerning issues related to the microscopic findings (4%), macroscopic description (3.1%), clerical aspects (3%), typographical errors (3%), coding errors (2.7%), technical errors including poor sections and incorrect labelling (1.7%), inadequate clinical history (1.2%), and incomplete or incomprehensible diagrams (0.9%). In two cases (0.05%) the original report did not state proximity of the tumour to surgical margins and in three of the frozen sections (0.3%) the original diagnosis was incorrect. However, in these cases the frozen section assessment did not alter the overall management of the cases. CONCLUSIONS: This study highlights the importance of a review system in detecting errors in surgical pathology reporting. Recognition of the fact that surgical pathology is not infallible has improved the end product. It has also minimised interobserver variability in the department, resulting in a uniform approach among the pathologists to macroscopic description, specimen sampling, special stains, and histological reporting. PMID:9930076

  12. 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

  13. The changing distribution of a major surgical procedure across hospitals: were supply shifts and disequilibrium important?

    PubMed

    Friedman, B; Elixhauser, A

    1995-01-01

    This paper describes and analyzes the changing distribution across hospitals in the U.S. of total hip replacement surgery (THR) for the period 1980-1987. THR is one of the most costly single procedures contributing to health care expenses. Also, the use of THR exhibits a particularly high degree of geographic variation. Recent research pointed to shifts in demand as one plausible economic explanation for increasing use of THR. This paper questions whether shifts in supply may have been large enough to explain changes in patient mix and the relationship of patient mix to the number of procedures performed at a particular hospital. In addition, the relationship between total use of THR and the local availability of orthopaedic surgeons as well as the average allowable Medicare fee for standardized physician services is analyzed. These relationships might yield evidence to support a scenario of induced demand beyond the optimum for patients' welfare, or evidence of supply increase within a disequilibrium scenario. This study, using data for all THR patients in a large sample of hospitals, tends to reject the formulation of a market with independent supply and demand shifts where the supply shifts were the dominant forces. Hospitals with a larger number of THRs performed did not see a higher percentage of older, sicker, and lower income patients. It was more likely that demand shifts generated increases in capacity for surgical services. Moreover, there was little evidence for a persistent disequilibrium and only weak evidence for inducement. Also, we found little evidence that hospitals responded to financial incentives inherent in the Medicare payment system after 1983 to select among THR candidates in favour of those with below average expected cost. We did observe increased concentration over time of THR procedures in facilities with high volume--suggesting plausible demand shifts towards hospitals with a priori quality and cost advantages or who obtained those advantages with a high volume of patients. PMID:8528432

  14. Operative Exposure of a Surgical Trainee at a Tertiary Hospital in Kenya

    PubMed Central

    Ojuka, Daniel Kinyuru; Macleod, Jana; Nyabuto, Catherine Kwamboka

    2015-01-01

    Background. Psychomotor domain training requires repetitive exposure in order to develop proficiency in skills. This depends on many training factors in any training institution. Objective. This study sought to look at the operative exposure of surgical trainees in a tertiary hospital in a developing country. Design and Setting. This was a six-month retrospective study performed in one surgical firm at Kenyatta National Hospital. Patients and Methods. The files of all patients admitted to the unit at that time were retrieved. The demographics, diagnosis at admission, need for surgery, and cadre of operating surgeon among others were recorded. Scientific Package for Social Sciences (SPSS) version 17.0 was used for data entry and analysis. Results. The study cohort was 402 patients of the 757 patients admitted in the study period. The average age was 36.7 years, a female to male ratio of 1 : 2.5. The majority (69.7%) of patients required surgery. Trauma was the most common reason for admission (44.5%). Year 2 residents received the most clinical exposure. Consultant was available in only 34.5% of the cases. Conclusion. The junior residents performed the vast majority of procedures with an unsatisfactory amount of supervision from the senior residents and faculty. PMID:26473168

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

    PubMed Central

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

    2013-01-01

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

  16. 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

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

    PubMed Central

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

    2012-01-01

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

  18. 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

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

    SciTech Connect

    Kneessy, A.D.

    1981-05-01

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

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

    PubMed Central

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

    2012-01-01

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

  1. Surgical management of Diabetic foot ulcers: A Tanzanian university teaching hospital experience

    PubMed Central

    2011-01-01

    Background Diabetic foot ulcers (DFUs) pose a therapeutic challenge to surgeons, especially in developing countries where health care resources are limited and the vast majority of patients present to health facilities late with advanced foot ulcers. A prospective descriptive study was done at Bugando Medical Centre from February 2008 to January 2010 to describe our experience in the surgical management of DFUs in our local environment and compare with what is known in the literature. Findings Of the total 4238 diabetic patients seen at BMC during the period under study, 136 (3.2%) patients had DFUs. Males outnumbered females by the ratio of 1.2:1. Their mean age was 54.32 years (ranged 21-72years). Thirty-eight (27.9%) patients were newly diagnosed diabetic patients. The majority of patients (95.5%) had type 2 diabetes mellitus. The mean duration of diabetes was 8.2 years while the duration of DFUs was 18.34 weeks. Fourteen (10.3%) patients had previous history of foot ulcers and six (4.4%) patients had previous amputations. The forefoot was commonly affected in 60.3% of cases. Neuropathic ulcers were the most common type of DFUs in 57.4% of cases. Wagner's stage 4 and 5 ulcers were the most prevalent at 29.4% and 23.5% respectively. The majority of patients (72.1%) were treated surgically. Lower limb amputation was the most common surgical procedure performed in 56.7% of cases. The complication rate was (33.5%) and surgical site infection was the most common complication (18.8%). Bacterial profile revealed polymicrobial pattern and Staphylococcus aureus was the most frequent microorganism isolated. All the microorganisms isolated showed high resistance to commonly used antibiotics except for Meropenem and imipenem, which were 100% sensitive each respectively. The mean hospital stay was 36.24 ± 12.62 days (ranged 18-128 days). Mortality rate was 13.2%. Conclusion Diabetic foot ulceration constitutes a major source of morbidity and mortality among patients with diabetes mellitus at Bugando Medical Centre and is the leading cause of non-traumatic lower limb amputation. A multidisciplinary team approach targeting at good glycaemic control, education on foot care and appropriate footware, control of infection and early surgical intervention is required in order to reduce the morbidity and mortality associated with DFUs. Due to polymicrobial infection and antibiotic resistance, surgical intervention must be concerned. PMID:21943342

  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. Misdiagnosis and Quality of Management in Paediatric Surgical Patients Referred to a Tertiary Care Hospital

    PubMed Central

    Cazares-Rangel, Joel; Zalles-Vidal, Cristian; Davila-Perez, Roberto

    2014-01-01

    Background: The literature on diagnosis and management prior to transfer paediatric surgical patients to a tertiary care center is scarce. In referral centers, it is common to receive patients previously subjected to inadequate or inappropriate health care. Aim: Analyze the prevalence of misdiagnosis and quality of management in patients before being referred and factors related to misdiagnosis and inadequate management. Design: Prospective, longitudinal, comparative study between patients with appropriate and inappropriate submission diagnosis and between patients with adequate or inadequate treatment. Setting: Third level care hospital, Mexico City. Participants: Newborn to adolescents referred to Paediatric Surgery Department. Intervention(s): None. Main Outcome Measure(s): Misdiagnosis and quality of management prior to being referred. Result: Two hundred patients were evaluated. Correlation between submission diagnosis and final diagnosis showed that 70% were correct and 30% incorrect; 48.5% were properly managed and 51.5% inappropriately managed. Incorrect diagnosis was more frequent when referred from first-or second-level hospitals and in inflammatory conditions. Patients referred by paediatricians had a higher rate of adequate management. Conclusion: We present the frequency of incorrect diagnosis and inadequate patient management in a highly selected population. Sample size should be increased as well as performing these studies in other hospital settings in order to determine whether the results are reproducible. PMID:24959495

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

    PubMed Central

    Mishra, P.H.; Gupta, Shakti

    2012-01-01

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

  5. A Randomized Stepped Care Intervention Trial Targeting Posttraumatic Stress Disorder for Surgically Hospitalized Injury Survivors

    PubMed Central

    Zatzick, Douglas; Jurkovich, Gregory; Rivara, Frederick P.; Russo, Joan; Wagner, Amy; Wang, Jin; Dunn, Chris; Lord, Sarah Peregrine; Petrie, Megan; O’Connor, Stephen S.; Katon, Wayne

    2013-01-01

    Objective To test the effectiveness of a stepped care intervention model targeting posttraumatic stress disorder (PTSD) symptoms after injury. Background Few investigations have evaluated interventions for injured patients with PTSD and related impairments that can be feasibly implemented in trauma surgical settings. Methods The investigation was a pragmatic effectiveness trial in which 207 acutely injured hospitalized trauma survivors were screened for high PTSD symptom levels and then randomized to a stepped combined, care management, psychopharmacology, and cognitive behavioral psychotherapy intervention (n = 104) or usual care control (n = 103) conditions. The symptoms of PTSD and functional limitations were reassessed at one-, three-, six-, nine-, and twelve-months after the index injury admission. Results Regression analyses demonstrated that over the course of the year after injury, intervention patients had significantly reduced PTSD symptoms when compared to controls (group by time effect, CAPS, F(2, 185) = 5.50, P < 0.01; PCL-C, F(4, 185) = 5.45, P < 0.001). Clinically and statistically significant PTSD treatment effects were observed at the six-, nine-, and twelve-month post-injury assessments. Over the course of the year after injury, intervention patients also demonstrated significant improvements in physical function (MOS SF-36 PCS main effect, F(1, 172) = 9.87, P < 0.01). Conclusion Stepped care interventions can reduce PTSD symptoms and improve functioning over the course of the year after surgical injury hospitalization. Orchestrated investigative and policy efforts could systematically introduce and evaluate screening and intervention procedures for PTSD at United States trauma centers. (Trial Registration: clinicaltrials.gov identifier: NCT00270959) PMID:23222034

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

    PubMed Central

    2016-01-01

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

  7. Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Uganda

    PubMed Central

    2013-01-01

    Background Surgical site infections (SSIs) are difficult to treat and are associated with substantially longer hospital stay, higher treatment cost, morbidity and mortality, particularly when the etiological agent is multidrug-resistant (MDR). To address the limited data in Uganda on SSIs, we present the spectrum of bacteria isolated from hospitalized patients, the magnitude and impact of MDR bacterial isolates among patients with SSIs. Methods A descriptive cross sectional study was conducted from September 2011 through April 2012 involving 314 patients with SSIs in the obstetrics & gynecology, general surgery and orthopedic wards at Mulago National Hospital in Kampala, Uganda. Wound swabs were taken and processed using standard microbiological methods. Clinico-demographic characteristics of patients were obtained using structured questionnaires and patients’ files. Results Of the 314 enrolled patients with SSIs (mean age 29.7 ±13.14 years), 239 (76.1%) were female. More than half of the patients were from obstetrics and gynecology (62.1%, 195/314). Of 314 wound swabs taken, 68.8% (216/314) were culture positive aerobically, yielding 304 bacterial isolates; of which 23.7% (72/304) were Escherichia coli and 21.1% (64/304) were Staphylococcus aureus. More than three quarters of Enterobacteriaceae were found to be extended spectrum beta lactamase (ESBL) producers and 37.5% of S. aureus were Methicillin resistant S. aureus (MRSA). MDR occurred in 78.3% (238/304) of the isolates; these were more among Gram-negative bacteria (78.6%, 187/238) compared to Gram-positive bacteria (21.4%, 51/238), (p-value < 0.0001, χ2 = 49.219). Amikacin and imepenem for ESBL-producing Enterobacteriacea and vancomycin for MRSA showed excellent performance except that they remain expensive drugs in Uganda. Conclusion Most SSIs at Mulago National Hospital are due to MDR bacteria. Isolation of MRSA and ESBL-producing Enterobacteriaceae in higher proportions than previously reported calls for laboratory guided SSIs- therapy and strengthening of infection control surveillance in this setting. PMID:23890206

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

    PubMed Central

    2014-01-01

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

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

    PubMed

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

    1991-10-01

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

  10. 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

  11. [Analysis of some variables in patients with hydatidosis surgically treated at the Regional Hospital of Valdivia, Chile, 1976-1986].

    PubMed

    Ernst, S; Rodríguez, E; Murúa, A; Ramírez, G

    1989-01-01

    A survey of surgically treated cases of hydatidosis in the province of Valdivia, Chile, was done. Data were provided by the Regional Hospital of Valdivia, and a period of eleven years was covered (1976-1986). Disease, treatment and related data from each patient were consigned. For the analysis, the information was grouped according to: sex, age, cyst location, condition of the cyst, concomitance with another pathology, condition at time of discharge, hospitalization period and number of repeat hospitalizations. In the period studied, 197 cases of hydatidosis were surgically treated. The sex distribution was 53.3% for males and 46.7 for females; the age group 10-19 years was the most affected by the disease (19.3%). The most frequent locations of hydatid cysts were the liver (58.9%) and lungs (36.5%); the 38.6% of the patients showed complicated cysts, mainly with bacterial infections (11.7%); also, 20% of the cases presented a concomitant liver-related pathology. After the operation, 153 (77.7%) clinically recovered and 27 (13.7%) non-recovered patients left the hospital and 7 (3.5%) cases died while hospitalized. The average hospitalization period was 29 days. During 1976-1986, 24 patients were rehospitalized. PMID:2629769

  12. 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

  13. Preoperative fasting times in elective surgical patients at a referral Hospital in Botswana

    PubMed Central

    Abebe, Worknehe Agegnehu; Rukewe, Ambrose; Bekele, Negussie Alula; Stoffel, Moeng; Dichabeng, Mompelegi Nicoh; Shifa, Jemal Zeberga

    2016-01-01

    Introduction Adults and children are required to fast before anaesthesia to reduce the risk of regurgitation and aspiration of gastric contents. However, prolonged periods of fasting are unnecessary and may cause complications. This study was conducted to evaluate preoperative fasting period in our centre and compare it with the ASA recommendations and factors that influence fasting periods. Methods This is a cross-sectional study of preoperative fasting times among elective surgical patients. A total numbers of 260 patients were interviewed as they arrived at the reception area of operating theatre using questionnaire. Results Majority of patients (98.1%) were instructed to fast from midnight. Fifteen patients (5.8%) reported that they were told the importance of preoperative fasting. The mean fasting period were 15.9±2.5 h (range 12.0-25.3 h) for solids and 15.3±2.3 h (range 12.0-22.0 h) for liquids. The mean duration of fasting was significantly longer for patients operated after midday compared to those operated before midday, p<0.001. Conclusion The mean fasting periods were 7.65 times longer for clear liquid and 2.5 times for solids than the ASA guidelines. It is imperative that the Hospital should establish Preoperative fasting policies and teach the staff who should ensure compliance with guidelines.

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

    PubMed Central

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

    2015-01-01

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

  15. 42 CFR 416.75 - Performance of listed surgical procedures on an inpatient hospital basis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Performance of listed surgical procedures on an..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM AMBULATORY SURGICAL SERVICES Scope of Benefits for Services Furnished Before January 1, 2008 § 416.75 Performance of listed surgical...

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

    PubMed

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

    2015-10-01

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

  17. Association of Hospital Participation in a Quality Reporting Program with Surgical Outcomes and Expenditures for Medicare Beneficiaries

    PubMed Central

    Osborne, Nicholas H.; Nicholas, Lauren H.; Ryan, Andrew M.; Thumma, Jyothi R.; Dimick, Justin B.

    2015-01-01

    Importance The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) provides feedback to hospitals on risk-adjusted outcomes. It is not known if NSQIP participation improves outcomes and reduces costs relative to non-participating hospitals. Objective To evaluate the association of enrollment and participation in the ACS-NSQIP with outcomes and Medicare payments compared to control hospitals that did not participate in this program. Design Quasi-experimental study using national Medicare data (2003 to 2012) for patients undergoing general and vascular surgery. A difference-in-difference analytic approach was used to evaluate whether participation in ACS-NSQIP was associated with improved outcomes and reduced Medicare payments compared to non-participating hospitals that were otherwise similar. Control hospitals were selected using propensity score matching (2 control hospitals for each ACS-NSQIP hospital). Setting and Participants 263 hospitals participating in ACS NSQIP and 526 non-participating hospitals and a total of 1,226,479 patients undergoing general and vascular surgical procedures Main Outcome Measures 30-day mortality, serious complications (e.g. pneumonia, myocardial infarction, or acute renal failure and a length of stay > 75th percentile), reoperation and readmission within 30 days. Hospital costs were assessed using price-standardized Medicare payments during hospitalization and 30 days post-discharge. Results After accounting for patient factors and preexisting time trends toward improved outcomes, there were no statistically significant improvements in outcomes at 1-, 2- or 3-years after (vs before) enrollment in ACS-NSQIP. For example, in analyses comparing outcomes at 3-years after (vs. before) enrollment, there were no statistically significant differences in risk-adjusted 30-day mortality (4.3% vs. 4.5%, Relative risk [RR] 0.96, 95% CI, 0.89–1.03), serious complications (11.1% vs. 11.0%, RR 0.96, 95% CI, 0.91–1.00), re-operations (0.49% vs. 0.45%, RR 0.97, 95%CI, 0.77–1.16), or readmissions (13.3% vs. 12.8%, RR 0.99, 95% CI, 0.96–1.03). There were also no differences at 3-years after (vs. before) enrollment in mean total Medicare payments ($40, 95% CI −$268–348), or payments for the index admission (−$11, 95% CI, −$278, $257), hospital readmission ($245, 95% CI, −$231, $721), or outliers (−$86, 95% CI, −$1666, $1495). Conclusions and Relevance With time, hospitals had progressively better surgical outcomes but enrollment in a national quality reporting program was not associated with the improved outcomes or lower Medicare payments among surgical patients. Feedback on outcomes alone may not be sufficient to improve surgical outcomes. PMID:25647205

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

    PubMed Central

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

    2015-01-01

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

  19. 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

  20. 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.

  1. 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

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

    PubMed

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

    2015-01-01

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

  3. 42 CFR 416.75 - Performance of listed surgical procedures on an inpatient hospital basis.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Performance of listed surgical procedures on an..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) AMBULATORY SURGICAL SERVICES Scope of Benefits for Services Furnished Before January 1, 2008 § 416.75 Performance of listed...

  4. 42 CFR 416.75 - Performance of listed surgical procedures on an inpatient hospital basis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Performance of listed surgical procedures on an..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) AMBULATORY SURGICAL SERVICES Scope of Benefits for Services Furnished Before January 1, 2008 § 416.75 Performance of listed...

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2016-01-01

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

  7. 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

  8. Variation in Performance of Candidate Surgical Quality Measures for Muscle Invasive Bladder Cancer by Hospital Type

    PubMed Central

    Corcoran, Anthony T.; Handorf, Elizabeth; Canter, Daniel; Tomaszewski, Jeffrey J.; Bekelman, Justin E.; Kim, Simon P; Uzzo, Robert G.; Kutikov, Alexander; Smaldone, Marc C.

    2014-01-01

    Objective To test the association between hospital type and performance of candidate quality measures for treatment of muscle invasive bladder cancer (MIBC) using a large national tumor registry. Proposed quality measures include receipt of neoadjuvant chemotherapy, timely treatment, adequate lymph node dissection, and continent urinary diversion. Methods Using the National Cancer Database (NCDB), patients with stage ≥II urothelial carcinoma treated with radical cystectomy (RC) from 2003–2010 were identified. Hospitals were grouped by type and annual RC volume: community, comprehensive low volume (CLV), comprehensive high volume (CHV), academic low volume (ALV), and academic high volume (AHV) groups. Logistic regression models were used to test the association between hospital group and performance of quality measures, adjusting for year, demographic, and clinical/pathologic characteristics; generalized estimating equations were fitted to the models to adjust for clustering at the hospital level. Results 23,279 patients underwent RC at community (12.4%), comprehensive (CLV: 38%; CHV: 5%), and academic (ALV: 17%; AHV: 28%) hospitals. While only 0.8% (n=175) of patients met all 4 quality criteria, 61% of patients treated at AHV hospitals met ≥2 quality metric indicators compared to ALV (45%), CHV (44%), CLV (38%), and community (37%) hospitals (p<0.001). Following adjustment, patients were more likely to receive ≥2 quality measures when treated at AHV (OR 2.4 [CI 2.0–2.9]), ALV (OR 1.3 [CI 1.1–1.6]), and CHV (OR 1.3 [CI 1.03–1.7]) hospitals compared to community hospitals. Conclusions Patients undergoing RC at AHV hospitals were more likely to meet quality criteria. However, performance remains low across hospital types, highlighting the opportunity to improve quality of care for MIBC. PMID:24447637

  9. 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 < 0.001) and "frequency of events reported" (63.7% vs 60.7%, P = 0.001) of surgical units were higher than those of other units. However, the communication openness (38.7% vs 42.5%, P < 0.001) of surgical units was lower than in other units. Medical workers in surgical units reported more events than those in other units, and more respondents in the surgical units assess "patient safety grade" to be good/excellent. Three dimensions were considered as strengths, whereas 5 other dimensions were considered to be weaknesses in surgical units. Six dimensions have potential to aid in improving events reporting and patient safety grade. Appropriate working times will also contribute to ensuring patient safety. Medical staff with longer years of experience reported more events.Surgical units outperform the nonsurgical ones in overall perception of safety and the number of events reported but underperform in the openness of communication. Four strategies, namely deepening the understanding about patient safety of supervisors, narrowing the communication gap within and across clinical units, recruiting more workers, and employing the event reporting system and building a nonpunitive culture, are recommended to improve patient safety in surgical units in the context of 1 hospital. PMID:26166083

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

    PubMed Central

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

    2015-01-01

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

  11. Surgical Treatment of Rhinogenic Contact Point Headache: An Experience from a Tertiary Care Hospital.

    PubMed

    Peric, Aleksandar; Rasic, Dejan; Grgurevic, Ugljesa

    2016-04-01

    Introduction Even in the absence of inflammatory disease, facial pain often results from pressure of two opposing nasal mucosa surfaces. Objectives The objective of this study is to assess the efficacy of surgical treatment of contact point headache. Methods Our study enrolled patients with unilateral facial pain and without nasal/paranasal sinus disease. We confirmed the presence of mucosal contact by nasal endoscopy and by computed tomography. Forty-two subjects with the three most common anatomical variations underwent complete evaluation: 17 with concha bullosa (CB), 11 with septal deviation (SD), and 14 with septal spur (SS). All participants were treated by topical corticosteroid, adrenomimetic, and antihistamine. The patients without improvement were treated surgically. We assessed the severity of pain using a Visual Analogue Score (VAS) before surgical treatment and one, six, twelve, and twenty-four months after. Results The patients with SS had more severe facial pain in comparison with patients with CB (p = 0.049) and SD (p = 0.000). The subjects with CB had higher degree of facial pain than the ones with SD (p = 0.001). After an unsuccessful medical treatment and surgical removal of mucosal contacts, the decrease of headache severity was more intense in patients with CB and SS (p = 0.000) than in the patients with SD (p = 0.01). Conclusion Our results suggest that topical medications have no effects and that surgical removal of mucosal contacts could be effective in the treatment of contact point headache. The results of surgical treatment were better in cases of facial pain caused by SS and CB, than in those caused by SD. PMID:27096023

  12. Surgical Treatment of Rhinogenic Contact Point Headache: An Experience from a Tertiary Care Hospital

    PubMed Central

    Peric, Aleksandar; Rasic, Dejan; Grgurevic, Ugljesa

    2016-01-01

    Introduction Even in the absence of inflammatory disease, facial pain often results from pressure of two opposing nasal mucosa surfaces. Objectives The objective of this study is to assess the efficacy of surgical treatment of contact point headache. Methods Our study enrolled patients with unilateral facial pain and without nasal/paranasal sinus disease. We confirmed the presence of mucosal contact by nasal endoscopy and by computed tomography. Forty-two subjects with the three most common anatomical variations underwent complete evaluation: 17 with concha bullosa (CB), 11 with septal deviation (SD), and 14 with septal spur (SS). All participants were treated by topical corticosteroid, adrenomimetic, and antihistamine. The patients without improvement were treated surgically. We assessed the severity of pain using a Visual Analogue Score (VAS) before surgical treatment and one, six, twelve, and twenty-four months after. Results The patients with SS had more severe facial pain in comparison with patients with CB (p = 0.049) and SD (p = 0.000). The subjects with CB had higher degree of facial pain than the ones with SD (p = 0.001). After an unsuccessful medical treatment and surgical removal of mucosal contacts, the decrease of headache severity was more intense in patients with CB and SS (p = 0.000) than in the patients with SD (p = 0.01). Conclusion Our results suggest that topical medications have no effects and that surgical removal of mucosal contacts could be effective in the treatment of contact point headache. The results of surgical treatment were better in cases of facial pain caused by SS and CB, than in those caused by SD. PMID:27096023

  13. 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

  14. 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...

  15. Risk-assessment models for predicting venous thromboembolism among hospitalized non-surgical patients: a systematic review.

    PubMed

    Huang, Wei; Anderson, Frederick A; Spencer, Frederick A; Gallus, Alexander; Goldberg, Robert J

    2013-01-01

    Venous thromboembolism (VTE) prophylaxis is suboptimal in American hospitals despite long-standing evidence-based recommendations. Data from observational studies indicate a lower uptake of effective prophylaxis in patients hospitalized with medical versus surgical conditions. Reluctance to use prophylaxis in medical patients has been attributed to difficulty in identifying at-risk patients and balancing risks of bleeding against occurrence of VTE. Several risk-assessment models (RAMs) have been proposed to assist physicians in identifying non-surgical patients who need prophylaxis. We conducted a systematic review of published RAMs, based on objective criteria, to determine whether any RAM is validated sufficiently to be employed in clinical practice. We identified 11 RAMs, six derived from primary data and five based on expert opinion. The number, types, and strength of association of VTE risk predictors were highly variable. The variability in methods and outcome measurement precluded pooled estimates of these different models. Published RAMs for VTE lack generalizability and adequate validation. As electronic health records become more ubiquitous, validated dynamic RAMs are needed to assess VTE risk at the point-of-care in real time. PMID:22826096

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2011-01-01

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

  18. [Surgical complications occurring during hospitalization of patients with anorexia nervosa--literature review and a discussion of three cases].

    PubMed

    Zerańska, Maria; Tomaszewicz-Libudzic, Celina; Jagielska, Gabriela; Komender, Jadwiga

    2002-01-01

    Anorexia nervosa (a.n.) is a mental disorder connected with the high mortality coming up to 18%. The death causes are suicide and somatic complications resulting from cachexy, laxatives and diuretics abuse, which occurs in some patients and from vomiting provocation. The digestive tract complications are considered to be the death causes in a.n, as well. Among the surgical complications, which usual occur in the initial period of the intensive nutrition the most serious and frequent ones are oesophageal rupture in the course of vomiting provocation (Boerhaave's syndrome) and the syndrome of compression of the horizontal part of the duodenum, by the mesentery (superior mesenteric artery syndrome) leading to the gastrectasia and possible gastric necrosis and perforation. In this paper the review of the current literature concerning the digestive tract complications in a.n. has been made. Also, the courses of the diseases and the complications requiring surgical intervention in 3 patients treated between 1998 and 2000 in the Department of Child Psychiatry and the Department of Cardiosurgery of the Medical University of Warsaw have been discussed. The patients developed segmental enteritis, gastrectasia caused by the superior mesenteric artery syndrome and small intestine strangulation. The early surgical intervention in the latter case and the proper maintenance treatment in two other ones allowed to avoid more serious complications. The authors postulate profound analysis of the abdominal complaints from the point if view of surgical complications in anorectic patients in the initial period of their hospital treatment and consideration of the complete parenteral hyperalimentation in the extremely debilitated to avoid life threatening digestive tract complications. PMID:12298187

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

    PubMed

    Kuiv, H; Saar, T; Ress, M

    1996-01-01

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

  20. Impact of a major hurricane on surgical services in a university hospital.

    PubMed

    Norcross, E D; Elliott, B M; Adams, D B; Crawford, F A

    1993-01-01

    Hurricane Hugo struck Charleston, South Carolina, on September 21, 1989. This report analyzes the impact this storm had upon surgical care at a university medical center. Although disaster planning began on September 17, hurricane damage by high winds and an 8.7-foot tidal surge led to loss of emergency power and water. Consequently, system failures occurred in air conditioning, vacuum suction, steam and ethylene oxide sterilization, plumbing, central paging, lighting, and refrigeration. The following surgical support services were affected. In the blood bank, lack of refrigeration meant no platelet packs for 2 days. In radiology, loss of electrical power damaged CT/MRI scanners and flooding ruined patient files, resulting in lost information. In the intensive care unit, loss of electricity meant no monitors and hand ventilation was used for 4 hours. In the operating room, lack of temperature and humidity control (steam, water, and suction supply) halted elective surgery until October 2. Ground and air transportation were limited by unsafe landing sites, impassable roads, and personnel exhaustion. Surgical planning for a major hurricane should include: 1) a fail-safe source of electrical power, 2) evacuation of as many critically ill patients as possible before the storm, 3) cancellation of all elective surgery, and 4) augmented ancillary service staffing with some, although limited, physician support. PMID:8480928

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

    PubMed Central

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

    2014-01-01

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

  2. Modeling Hospital-Acquired Pressure Ulcer Prevalence on Medical-Surgical Units: Nurse Workload, Expertise, and Clinical Processes of Care

    PubMed Central

    Aydin, Carolyn; Donaldson, Nancy; Stotts, Nancy A; Fridman, Moshe; Brown, Diane Storer

    2015-01-01

    Objective This study modeled the predictive power of unit/patient characteristics, nurse workload, nurse expertise, and hospital-acquired pressure ulcer (HAPU) preventive clinical processes of care on unit-level prevalence of HAPUs. Data Sources Seven hundred and eighty-nine medical-surgical units (215 hospitals) in 2009. Study Design Using unit-level data, HAPUs were modeled with Poisson regression with zero-inflation (due to low prevalence of HAPUs) with significant covariates as predictors. Data Collection/Extraction Methods Hospitals submitted data on NQF endorsed ongoing performance measures to CALNOC registry. Principal Findings Fewer HAPUs were predicted by a combination of unit/patient characteristics (shorter length of stay, fewer patients at-risk, fewer male patients), RN workload (more hours of care, greater patient [bed] turnover), RN expertise (more years of experience, fewer contract staff hours), and processes of care (more risk assessment completed). Conclusions Unit/patient characteristics were potent HAPU predictors yet generally are not modifiable. RN workload, nurse expertise, and processes of care (risk assessment/interventions) are significant predictors that can be addressed to reduce HAPU. Support strategies may be needed for units where experienced full-time nurses are not available for HAPU prevention. Further research is warranted to test these finding in the context of higher HAPU prevalence. PMID:25290866

  3. 77 FR 217 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-04

    ... Outpatient Prospective Payments System (76 FR 74562) and the correlating preamble language (76 FR 74570..., 2011 (76 FR 74122), make the following corrections: A. Outpatient Prospective Payment System and..., Hospital Value-Based Purchasing (VBP) Program Issues. SUPPLEMENTARY INFORMATION: I. Background In FR...

  4. 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...

  5. [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

  6. 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

  7. Surgical travellers: tapestry to Bayeux.

    PubMed

    Hedley-Whyte, John; Milamed, Debra R

    2014-09-01

    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

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

    PubMed Central

    Kurt, Engin; Ucar, Muharren; Atac, Adnan

    2016-01-01

    Objective: To determine how far the information given by the physicians for the informed consent prior to the surgical intervention is comprehended by the patients. Methods: The study was carried out between July 1st, 2012 and July 1st, 2013 at Gulhane Medical Faculty. A total of 400 patients, who were in the third postoperative day after various surgical procedures (orthopedics, urology, ophthalmology, plastic surgery and breast surgery), were included in the study. Results: Of all the patients, 73.5% stated that the operative information was provided by physicians, whereas 22.7% claimed that no information was given in this regard. The patients who knew the name of the disease was 78%, while 18.3% did not know. Of all the patients, 25.7% knew the name of the operation, in contrast to of 52.3% who did not know it. About 12.5% of patients stated that they were not informed about the likely complications during the surgery, whereas 13.7% of patients reported that they were not informed about the post-operative complications. Conclusion: The verbal information and the written texts, different approaches such as drawings and visual materials (i.e. video’s and photographs) should be considered while providing information to the patients. While doing so the level of education of the community should also be taken into account. PMID:27022376

  9. 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

  10. Cross-infection of gentamicin-methicillin-resistant Staphylococcus aureus in a male surgical ward at Rajavithi General Hospital.

    PubMed

    Rahule, S; Naidoo, J; Surapatana, N; Yosapol, P

    1992-03-01

    Between January and December 1987, gentamicin-methicillin-resistant strains of Staphylococcus aureus (GMRSA) were isolated from 7 patients in a male surgical ward at Rajavithi General Hospital. Six patients developed significant infection which included sepsis (2), pneumonia (1), infection in the eye, ear and wound (1), wound infection (2), and one patient had GMRSA isolated from his sputum. The strains were untypable with standard phage type and were resistant to methicillin, gentamicin, amikacin, kanamycin, streptomycin, tetracycline, erythromycin and chloramphenicol, but susceptible o vancomycin and cotrimoxazole. GMRSA were also isolated from bed-rail and the used rubber gloves left in the affected room. The GMRSA strains contained 5 plasmids of molecular weight of 18, 11, 2, 1.8 and 1.7 Md. The 2Md plasmid coded for chloramphenicol resistance and the 1.8 Md plasmid for erythromycin resistance. PMID:1402496

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

    2010-01-01

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

  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. The results of the three-month co-operation between a German and a Greek surgical team in a role II military hospital in Afghanistan

    PubMed Central

    Gourgiotis, Stavros; Triantafyllou, Christos; Karamitros, Athanasios; Thinnes, Katrin; Thüringen, Wolfgang; Schmidt, Roland

    2012-01-01

    Background and Aim: There are a lot of unique challenges for the military medical personnel assigned to Afghanistan. We evaluate the results of the co-operation between a German and a Greek surgical team during a 3-month period in a role II hospital. Materials and Methods: Patients who were admitted to the role II German hospital of Kunduz were evaluated. We reviewed the type of diseases, mechanism and location of injuries, management, types of surgical procedures, blood supply, and outcome. Results: The data included 792 ISAF patients, 18 NGOs patients, and 296 local patients. Out of them, 71.6% of the patients were ISAF personnel; 51 patients underwent a surgical operation; 35 of them were operated in an emergency base. Fifty-five surgical procedures were performed. In 22 (43.1%) of these patients, orthopedic procedures were performed, while in the rest 29 (56.9%) patients the operations were of general surgery interest. Gunshot injuries were the main mechanism of injury for locals, whereas ISAF personnel were usually presented with injuries after IEDs and rocket attacks. A total number of 11 patients were transferred to role III military hospitals for further treatment within 24 hours. Conclusions: The co-operation between surgical teams from different countries, when appropriately trained, staffed, and equipped, can be highly effective in a combat environment. PMID:22416153

  15. Maxillofacial Fractures Surgically Managed at Aalesund Hospital between 2002 and 2009.

    PubMed

    Helgeland, Espen; Dahle, Ida Marie; Leira, Jan Inge; Loro, Lado Lako

    2015-12-01

    This study analyses the demographics, etiology, and complications in patients operated for maxillofacial fractures by oral and maxillofacial surgeons at the Aalesund Hospital between 2002 and 2009. A total of 188 fractures in 139 patients were studied. The male-to-female ratio was 3.6:1 and the mean age was 35.7 ± 17.2 years. Males were significantly younger than females (p < 0.05). Mandibular (52.7%) and zygomatic complex fractures (33.5%) were the most frequent. Most patients (41.7%) sustained their injuries as a result of interpersonal violence (IPV) followed by falls (25.9%) and traffic accidents (15.8%). Significantly more males were victims of IPV (p < 0.05). Almost half of the female cohort sustained their injuries from falling. More than half of those who sustained their injuries between midnight and morning were intoxicated. The majority of cases were treated by open reduction and internal fixation (56.8%). Posttraumatic and postoperative complications were seen in 25% of the patients, with infection (8.6%) occurring most frequently. Mandibular and zygomatic complex fractures were the most frequent in our study. IPV in association with alcohol and drugs was a major cause of maxillofacial fractures, especially among young adult males. Falls were the predominant cause of fractures among females. PMID:26576237

  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, Quartermaster Store House, Northwest Corner of East I Avenue & North Twelfth 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, Artesian Well, East McCloskey Avenue, East of Building No. 231, Aurora, Adams County, CO

  18. 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

  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), showing south and east sides. - Fitzsimons General Hospital, Ice Plant, Southwest Corner of East I Avenue & North Thirteenth 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 and east sides. - Fitzsimons General Hospital, Storage Sheds, Northeast Corner of West Pennington Avenue & North Eighth 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 and east sides. - Fitzsimons General Hospital, Nurses Quarters No. 3, Northwest Corner of West Harlow Avenue & North Seventh 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, Greenhouse, West Pennington Avenue, East of Building No. 139, 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), showing south and west sides. - Fitzsimons General Hospital, Salvage Building, Northeast Corner of East I Avenue & North Page Street, Aurora, Adams County, CO

  6. 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

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

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

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

  9. 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

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

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

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

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

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

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

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

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

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), south side. - Fitzsimons General Hospital, Tubercular Ward, Southwest Corner of East Bushnell Avenue & South Page 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' Garage, East of Building No. 121, Aurora, Adams County, CO

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

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

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

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

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

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

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

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

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

  19. Photocopy of photograph in 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

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

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

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

  1. 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

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

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

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

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

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

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

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

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

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

  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 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

  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 east sides. - Fitzsimons General Hospital, Post Exchange Garage, North Eighth Street, North of Building No. 143, 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), probably south side. - Fitzsimons General Hospital, Officers' Garage, West Pennington Avenue, West of Building 129, Aurora, Adams County, CO

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

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

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

  11. 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

  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). - Fitzsimons General Hospital, Storehouse, East Harlow Avenue, immediately South of Building 201, Aurora, Adams County, CO

  13. 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

  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), showing west side. - Fitzsimons General Hospital, Fire Equipment House, North Page Street, North of Building No. 228, Aurora, Adams County, CO

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

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

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

  16. Photocopy of photograph in 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

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

    Fabbretti, G

    2010-06-01

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

  19. Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care?

    PubMed Central

    2012-01-01

    Background Subspecialisation within general surgery has today reached further than ever. However, on-call time, an unchanged need for broad surgical skills are required to meet the demands of acute surgical disease and trauma. The introduction of a new subspecialty in North America that deals solely with acute care surgery and trauma is an attempt to offer properly trained surgeons also during on-call time. To find out whether such a subspecialty could be helpful in Sweden we analyzed our workload for emergency surgery and trauma. Methods Linköping University Hospital serves a population of 257 000. Data from 2010 for all patients, diagnoses, times and types of operations, surgeons involved, duration of stay, types of injury and deaths regarding emergency procedures were extracted from a prospectively-collected database and analyzed. Results There were 2362 admissions, 1559 emergency interventions; 835 were mainly abdominal operations, and 724 diagnostic or therapeutic endoscopies. Of the 1559 emergency interventions, 641 (41.1%) were made outside office hours, and of 453 minor or intermediate procedures (including appendicectomy, cholecystectomy, or proctological procedures) 276 (60.9%) were done during the evenings or at night. Two hundred and fifty-four patients were admitted with trauma and 29 (11.4%) required operation, of whom general surgeons operated on eight (3.1%). Thirteen consultants and 11 senior registrars were involved in 138 bowel resections and 164 cholecystectomies chosen as index operations for standard emergency surgery. The median (range) number of such operations done by each consultant was 6 (3–17) and 6 (1–22). Corresponding figures for senior registrars were 7 (0–11) and 8 (1–39). Conclusion There was an uneven distribution of exposure to acute surgical problems and trauma among general surgeons. Some were exposed to only a few standard emergency interventions and most surgeons did not operate on a single patient with trauma. Further centralization of trauma care, long-term positions at units for emergency surgery and trauma, and subspecialisation in the fields of emergency surgery and trauma, might be options to solve problems of low volumes. PMID:22985447

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

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

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

  1. 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

  2. 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

  3. Minimal inhibitory concentration of microorganisms causing surgical site infection in referral hospitals in North of Iran, 2011-2012

    PubMed Central

    Alikhani, Ahmad; Babamahmoodi, Farhang; Foroutan Alizadegan, Laleh; Shojaeefar, Arman; Babamahmoodi, Abdolreza

    2015-01-01

    Background: A surgical site infection (SSI) is the most common nosocomial infection after surgery and is the third most common infection in hospitalized patients. The aim of this study was to asses minimum inhibitory concentration (MIC) of the causing agents of SSI and antimicrobial susceptibility patterns. Methods: This cross-sectional study was done in three referral hospitals in North of Iran during 2011-2012. The samples were taken one month after orthopedic, abdominal, cesarean section surgery and coronary artery bypass graft (CABG) in patients with scores compatible to SSIs criteria. The sample was sent for bacteriologic culture and MIC determination for positive cases by broth microdilution method. The data were collected and analyzed. Results: From 103 positive cases S. aureus, E.coli and coagulase negative staphylococci were the most common isolated agents as 29.12%, 23.3% and 21.3%, respectively. S. aureus was sensitive to vancomycin (70%), amikacin (70%) and teicoplanin (76.6%) and cogulase negative staphylococci was sensitive to vancomycin (68.1%) and teicoplanin (72.6%) and E.coli to amikacin (95.83%) and imipenem and meropenem (66.66%). P.aeroginosa showed no sensitivity to cefepime and was sensitive to imipenem (93.75%) and meropenem (81.25%). Conclusion: The most important point is worrisome problem of the increased MIC of S. aureus to vancomycin that causes difficult use in the treatment of staphylococcal SSIs. In spite of resistance of micro-organisms to cephalosporins, gram negative organisms had low MIC to carbapenemes especially P.aeroginosa although the rate of its MIC is increasing. PMID:26221495

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

    PubMed Central

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

    2014-01-01

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

  5. Predominance of multi-drug resistant bacterial pathogens causing surgical site infections in Muhimbili national hospital, Tanzania

    PubMed Central

    2014-01-01

    Background Surgical site infections (SSIs) remain a common and widespread problem contributing to a significant morbidity and mortality, attributed partly by the increase in antimicrobial resistance among the etiological agents. This study was done to determine the spectrum of bacterial isolates and their susceptibility patterns causing SSIs at Muhimbili National Hospital, Tanzania. Methods This descriptive cross sectional study was conducted between September, 2011 and February, 2012. Pus swabs or pus were cultured on blood agar (Oxoid, UK) and MacConkey agar (Oxoid, UK) and incubated aerobically at 37°C for 18–24 hours. Bacterial identification was done using API 20E and VITEK and antimicrobial susceptibility was determined by Kirby Bauer disc diffusion. Results Of the 100 patients, from whom wound swabs were collected, 90 (90%) had positive aerobic bacterial growth. A total of 147 pathogenic bacteria were isolated, including 114 (77.5%) gram negative and 33(22.5%) gram positive organisms. The most prevalent bacterial species were Pseudomonas aeruginosa (16.3%), followed by Staphylococcus aureus (12.2%) and Klebsiella pneumoniae (10.8%). Of the 18 S. aureus , 8 (44%) were methicillin resistant Staphylococcus aureus (MRSA) and three of them (17%) were carrying both MRSA and induced clindamycin resistance (ICR). Extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae were observed in 23 (79.3%) of the 29 isolates tested. Majority of Escherichia coli 12 (92.3%) and K. pneumoniae 11 (69%) isolates were ESBL producers. About 63% (93/147) were multiple-drug resistance (MDR) isolates, and the overall MDR among Gram positive and Gram negative bacteria was 60.6% (20/33) and 61.4%, (73/114), respectively. The prevalence of MDR for E. coli, A. baumannii and P. stuartii was 100% each. Majority (97%) of the Gram negative bacteria were resistant to more than four categories (classes) of antibiotics. Conclusion A high proportion (63%) of the isolates causing SSIs in this tertiary hospital were MDR, of which (90%) were resistant to more than four classes of antibiotics. In the light of these findings, an urgent and significant change in antibiotic prescription policy is required at this National hospital. PMID:25100042

  6. [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

  7. Nurse Level of Education, Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-Sectional Study

    PubMed Central

    Rahman, Hamzah Abdul; Jarrar, Mu’taman; Don, Mohammad Sobri

    2015-01-01

    Background and Objective: Nursing knowledge and skills are required to sustain quality of care and patient safety. The number of nurses with Bachelor degrees in Malaysia is very limited. This study aims to predict the impact of nurse level of education on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. Methodology: A cross-sectional survey by questionnaire was conducted. A total of 652 nurses working in the medical and surgical wards in 12 private hospitals participated in the study. Multistage stratified simple random sampling performed to invite nurses working in small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals to participate in the study. This allowed nurses from all shifts to participate in this study. Results: Nurses with higher education were not significantly associated with both quality of care and patient safety. However, a total 355 (60.9%) of respondents who participated in this study were working in teaching hospitals. Teaching hospitals offer training for all newly appointed staff. They also provide general orientation programs and training to outline the policies, procedures of the nurses’ roles and responsibilities. This made the variances between the Bachelor and Diploma nurses not significantly associated with the outcomes of care. Conclusions: Nursing educational level was not associated with the outcomes of care in Malaysian private hospitals. However, training programs and the general nursing orientation programs for nurses in Malaysia can help to upgrade the Diploma-level nurses. Training programs can increase their self confidence, knowledge, critical thinking ability and improve their interpersonal skills. So, it can be concluded that better education and training for a medical and surgical wards’ nurses is required for satisfying client expectations and sustaining the outcomes of patient care. PMID:26153190

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

    PubMed Central

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

    2015-01-01

    Background The purpose of this study was to identify risk factors for surgical site infection (SSI) in a teaching hospital. Methods A prospective study was initiated to investigate risk factors for SSI at a university-affiliated tertiary care center from July 2013 to December 2014. The chi-square test for categorical variables was used to determine the significance of association, whereas the multivariate logistic regression model was used to examine independent risk factors for SSI. Results A total of 1,138 patients met the inclusion criteria, in whom 36 cases of infection occurred during the hospitalization period and two cases occurred after discharge. Univariate analysis showed that SSI was associated with the type of operation, wound classification, volume of blood loss, blood transfusion, American Society of Anesthesiology score before surgery, risk index, duration of surgery, diabetes, cancer, gastrointestinal catheter, urinary catheter, postoperative drainage, and preprocedural white blood cell count. Multivariate analysis identified six independent parameters correlating with the occurrence of SSI: diabetes (odds ratio [OR] 6.400; 95% confidence interval [CI] 2.58215.866; P=0.000); cancer (OR 2.427; 95% CI 1.0285.732; P=0.043); preprocedural white blood cell count more than 10109/L (OR 6.988; CI 3.16515.425; P=0.000); wound classification (clean contaminated [OR: 7.893; CI: 2.24427.762; P=0.001]; contaminated [OR: 7.031; CI: 1.65229.922; P=0.008]; dirty [OR: 48.778; CI: 5.418439.164; P=0.001]); operative duration more than 120 minutes (OR 4.289; CI 1.77310.378; P=0.001); and postoperative drainage (OR 3.957; CI 1.42211.008; P=0.008). Conclusion Our data suggest that all these risk factors could be regarded as potential indicators of SSI and that relevant preventive measures should be taken to reduce SSI and improve patient outcomes. PMID:26316722

  9. 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

  10. Surgical audit: do numbers provide good training?

    PubMed

    Crate, I D; Griffiths, C L

    1996-06-01

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

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

    PubMed Central

    2014-01-01

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

  12. [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

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

    PubMed

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

    2016-03-01

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

  14. A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries

    PubMed Central

    Aveling, Emma-Louise; McCulloch, Peter; Dixon-Woods, Mary

    2013-01-01

    Objective Bold claims have been made for the ability of the WHO surgical checklist to reduce surgical morbidity and mortality and improve patient safety regardless of the setting. Little is known about how far the challenges faced by low-income countries are the same as those in high-income countries or different. We aimed to identify and compare the influences on checklist implementation and compliance in the UK and Africa. Design Ethnographic study involving observations, interviews and collection of documents. Thematic analysis of the data. Setting Operating theatres in one African university hospital and two UK university hospitals. Participants 112 h of observations were undertaken. Interviews with 39 theatre and administrative staff were conducted. Results Many staff saw value in the checklist in the UK and African hospitals. Some resentment was present in all settings, linked to conflicts between the philosophy behind the checklist and the realities of local cultural, social and economic contexts. Compliance—involving use, completeness and fidelity—was considerably higher, though not perfect, in the UK settings. In these hospitals, compliance was supported by established structures and systems, and was not significantly undermined by major resource constraints; the same was not true of the low-income context. Hierarchical relationships were a major barrier to implementation in all settings, but were more marked in the low-income setting. Introducing a checklist in a professional environment characterised by a lack of accountability and transparency could make the staff feel jeopardised legally, professionally, and personally, and it encouraged them to make misleading records of what had actually been done. Conclusions Surgical checklist implementation is likely to be optimised, regardless of the setting, when used as a tool in multifaceted cultural and organisational programmes to strengthen patient safety. It cannot be assumed that the introduction of a checklist will automatically lead to improved communication and clinical processes. PMID:23950205

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2008-01-01

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

  17. [The chief surgeon Claude Louis Sommé (1772-1855) French military physician, surgeon of Antwerp hospital].

    PubMed

    Tricot, Jean-pierre

    2015-01-01

    Claude Louis Sommé was born in Paris in 1772. After surgical studies between 1790 and 1792, he successfully embraced a military career in the armies of Napoleon at different fronts and in several hospitals. In 1806 he submitted his doctoral thesis at the Special Medical School of Strasburg, Dissertation upon Pain. The same year he presented his dismissal from he imperial armies and became chief-surgeon at the St Elisabeth hospital of Antwerp where he stayed on duty until his death in 1855. Sommé wrote a lot of medical books: surgical, anatomical and physiological. After the battle of Waterloo one third of the injured soldiers were transferred to Antwerp and were attended in his department. He also played an important role as a professor at the Primary Medical School of Antwerp. Sommé also created the botanical garden of Antwerp, close to the hospital. PMID:27029134

  18. 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

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

    PubMed

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

    1991-11-01

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

  20. 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:…

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

    PubMed

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

    2016-04-01

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

  2. Peer-to-peer nursing rounds and hospital-acquired pressure ulcer prevalence in a surgical intensive care unit: a quality improvement project.

    PubMed

    Kelleher, Alyson Dare; Moorer, Amanda; Makic, MaryBeth Flynn

    2012-01-01

    We conducted a quality improvement project in order to evaluate the effect of nurse-to-nurse bedside "rounding" as a strategy to decrease hospital-acquired pressure ulcers (HAPU) in a surgical intensive care unit. We instituted weekly peer-to-peer bedside skin rounds in a 17-bed surgical intensive care unit. Two nurses were identified as skin champions and trained by the hospital's certified WOC nurse to conduct skin rounds. The skin champion nurses conducted weekly peer-to-peer rounds that included discussions about key elements of our patients' skin status including current Braden Scale for Pressure Sore Risk score, and implementation of specific interventions related to subscale risk assessment. If a pressure ulcer was present, the current action plan was reevaluated for effectiveness. Quarterly HAPU prevalence studies were conducted from January 2008 to December 2010. Nineteen patients experienced a HAPU: 17 were located on the coccyx and 2 on the heel. Ten ulcers were classified as stage II, 3 PU were stage IV, 5 were deemed unstageable, and 1 was classified as a deep tissue injury. The frequency of preventive interventions rose during our quality improvement project. Specifically, the use of prevention surfaces increased 92%, repositioning increased 30%, nutrition interventions increased 77%, and moisture management increased 100%. Prior to focused nursing rounds, the highest HAPU prevalence rate was 27%. After implementing focused nursing rounds, HAPU rates trended down and were 0% for 3 consecutive quarters. PMID:22415120

  3. Knowledge about complementary, alternative and integrative medicine (CAM) among registered health care providers in Swedish surgical care: a national survey among university hospitals

    PubMed Central

    2012-01-01

    Background Previous studies show an increased interest and usage of complementary and alternative medicine (CAM) in the general population and among health care workers both internationally and nationally. CAM usage is also reported to be common among surgical patients. Earlier international studies have reported that a large amount of surgical patients use it prior to and after surgery. Recent publications indicate a weak knowledge about CAM among health care workers. However the current situation in Sweden is unknown. The aim of this study was therefore to explore perceived knowledge about CAM among registered healthcare professions in surgical departments at Swedish university hospitals. Method A questionnaire was distributed to 1757 registered physicians, nurses and physiotherapists in surgical wards at the seven university hospitals in Sweden from spring 2010 to spring 2011. The questionnaire included classification of 21 therapies into conventional, complementary, alternative and integrative, and whether patients were recommended these therapies. Questions concerning knowledge, research, and patient communication about CAM were also included. Result A total of 737 (42.0%) questionnaires were returned. Therapies classified as complementary; were massage, manual therapies, yoga and acupuncture. Alternative therapies; were herbal medicine, dietary supplements, homeopathy and healing. Classification to integrative therapy was low, and unfamiliar therapies were Bowen therapy, iridology and Rosen method. Therapies recommended by > 40% off the participants were massage and acupuncture. Knowledge and research about CAM was valued as minor or none at all by 95.7% respectively 99.2%. Importance of possessing knowledge about it was valued as important by 80.9%. It was believed by 61.2% that more research funding should be addressed to CAM research, 72.8% were interested in reading CAM-research results, and 27.8% would consider taking part in such research. Half of the participants (55.8%) were positive to learning such therapy. Communication about CAM between patients and the health care professions was found to be rare. Conclusion There is a lack of knowledge about CAM and research about it among registered health care professions in Swedish surgical care. However, in contrast to previous studies the results revealed that the majority perceived it as important to gain knowledge in this field. PMID:22498305

  4. Which Kind of Provider’s Operation Volumes Matters? Associations between CABG Surgical Site Infection Risk and Hospital and Surgeon Operation Volumes among Medical Centers in Taiwan

    PubMed Central

    Yu, Tsung-Hsien; Tung, Yu-Chi; Chung, Kuo-Piao

    2015-01-01

    Background Volume-infection relationships have been examined for high-risk surgical procedures, but the conclusions remain controversial. The inconsistency might be due to inaccurate identification of cases of infection and different methods of categorizing service volumes. This study takes coronary artery bypass graft (CABG) surgical site infections (SSIs) as an example to examine whether a relationship exists between operation volumes and SSIs, when different SSIs case identification, definitions and categorization methods of operation volumes were implemented. Methods A population-based cross-sectional multilevel study was conducted. A total of 7,007 patients who received CABG surgery between 2006 and 2008 from19 medical centers in Taiwan were recruited. SSIs associated with CABG surgery were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) codes and a Classification and Regression Trees (CART) model. Two definitions of surgeon and hospital operation volumes were used: (1) the cumulative CABG operation volumes within the study period; and (2) the cumulative CABG operation volumes in the previous one year before each CABG surgery. Operation volumes were further treated in three different ways: (1) a continuous variable; (2) a categorical variable based on the quartile; and (3) a data-driven categorical variable based on k-means clustering algorithm. Furthermore, subgroup analysis for comorbidities was also conducted. Results This study showed that hospital volumes were not significantly associated with SSIs, no matter which definitions or categorization methods of operation volume, or SSIs case identification approaches were used. On the contrary, the relationships between surgeon’s volumes varied. Most of the models demonstrated that the low-volume surgeons had higher risk than high-volume surgeons. Conclusion Surgeon volumes were more important than hospital volumes in exploring the relationship between CABG operation volumes and SSIs in Taiwan. However, the relationships were not robust. Definitions and categorization methods of operation volume and correct identification of SSIs are important issues for future research. PMID:26053035

  5. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature

    PubMed Central

    George, Bernard

    2007-01-01

    Foramen magnum meningiomas are challenging tumors, requiring special considerations because of the vicinity of the medulla oblongata, the lower cranial nerves, and the vertebral artery. After detailing the relevant anatomy of the foramen magnum area, we will explain our classification system based on the compartment of development, the dural insertion, and the relation to the vertebral artery. The compartment of development is most of the time intradural and less frequently extradural or both intraextradural. Intradurally, foramen magnum meningiomas are classified posterior, lateral, and anterior if their insertion is, respectively, posterior to the dentate ligament, anterior to the dentate ligament, and anterior to the dentate ligament with extension over the midline. This classification system helps to define the best surgical approach and the lateral extent of drilling needed and anticipate the relation with the lower cranial nerves. In our department, three basic surgical approaches were used: the posterior midline, the postero-lateral, and the antero-lateral approaches. We will explain in detail our surgical technique. Finally, a review of the literature is provided to allow comparison with the treatment options advocated by other skull base surgeons. PMID:17882459

  6. 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

  7. 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

  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). 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

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

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

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

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

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

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property book (green cloth cover), 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

  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 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

  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), 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

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

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

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

  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), 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

  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). 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

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

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

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

  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), 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

  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 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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  1. 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

  2. Prevalence of obstructive sleep apnea in surgical patients presenting to a tertiary care teaching hospital in India: A preliminary study

    PubMed Central

    Agrawal, Sanjay; Gupta, Ravi; Lahan, Vivekanand; Mustafa, Ghulam; Kaur, Uttamjot

    2013-01-01

    Background: Obstructive sleep apnea (OSA) is often not diagnosed in patients presenting for surgical procedures thereby increasing the incidence of adverse perioperative course. Early diagnosis of this disease is important in modifying anesthetic management as well as utilizing specific means which may decrease the complications and improve the patient outcome. Methods: Patients greater than eighteen years of age, ASA I-III scheduled for elective surgical procedures under anesthesia were randomly selected. Their demographic data, diagnosis and nature of surgery were noted in a semi-structured performa. They were then screened for the presence of OSA with the help of a STOP BANG questionnaire. Results: This study included two hundred four patients randomly selected. Slight female predominance was seen in this sample (55.4%). Mean age of the subjects was 42.7 years (SD=15.08). 24.5% subjects were at high risk for OSA (STOP-BANG>3) with a male predominance (72% versus 37% in low risk group; X2=18.62; P<0.001). High risk OSA subjects had higher prevalence of cardiovascular risk factors (57% vs. 11.7% in low risk group; X2=33.35; P<0.001). Similarly, this group had a higher prevalence of asthma and chronic obstructive pulmonary disease (COPD) (14% versus 3.8% in low risk group; X2=6.54; P=0.03). Prevalence of diabetes mellitus (22%) and hypothyroidism (6%) was also higher in this group (5.2% and 1.9% in low risk group respectively; X2=15.42; P<0.001). Conclusion: High degree of suspicion and knowledge of association of OSA and medical diseases may help in detection of such cases and decrease the rate of perioperative complications thus improving patients safety. PMID:23956715

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

    PubMed Central

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

    2013-01-01

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

  4. High prevalence of methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala, Uganda

    PubMed Central

    2011-01-01

    Background There is limited data on Methicillin resistant Staphylococcus aureus (MRSA) in Uganda where, as in most low income countries, the routine use of chromogenic agar for MRSA detection is not affordable. We aimed to determine MRSA prevalence among patients, healthcare workers (HCW) and the environment in the burns units at Mulago hospital, and compare the performance of CHROMagar with oxacillin for detection of MRSA. Results One hundred samples (from 25 patients; 36 HCW; and 39 from the environment, one sample per person/item) were cultured for the isolation of Staphylococcus aureus. Forty one S. aureus isolates were recovered from 13 patients, 13 HCW and 15 from the environment, all of which were oxacillin resistant and mecA/femA/nuc-positive. MRSA prevalence was 46% (41/89) among patients, HCW and the environment, and 100% (41/41) among the isolates. For CHROMagar, MRSA prevalence was 29% (26/89) among patients, HCW and the environment, and 63% (26/41) among the isolates. There was high prevalence of multidrug resistant isolates, which concomitantly possessed virulence and antimicrobial resistance determinants, notably biofilms, hemolysins, toxin and ica genes. One isolate positive for all determinants possessed the bhp homologue which encodes the biofilm associated protein (BAP), a rare finding in human isolates. SCCmec type I was the most common at 54% prevalence (22/41), followed by SCCmec type V (15%, 6/41) and SCCmec type IV (7%, 3/41). SCCmec types II and III were not detected and 10 isolates (24%) were non-typeable. Conclusions Hyper-virulent methicillin resistant Staphylococcus aureus is prevalent in the burns unit of Mulago hospital. PMID:21899769

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

    PubMed Central

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

    2016-01-01

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

  6. Robotics In Manufacturing: Army View

    NASA Astrophysics Data System (ADS)

    Michel, F. J.

    1983-05-01

    (Figure 1) This is an outline of my presentation today. The U. S. Army has a dual interest in the use of robots, namely: 1. As a substitute for or an extension of the soldier in the battlefield, and 2. in the factories that make Army materiel, or - as we call it -the the production base. The Production Base can again be divided into three separate segments, i.e., the Army owned and operated facilities or GOG6s, such as Rock Island and Watervliet arsenals, and not to be overlooked, the depot operations. There the Army manufactures gun tubes and other related parts for artillery weapons and repairs and overhauls them. A second category is the Army owned and contractor operated facilities or GOCOs,such as the ammunition plants, the tank plants at Lima, Ohio and Warren, Michigan and the Stratford Engine Plant in Connecticut where gas turbines for helicopter and the Abrams tank are manufactured. The last category covers the industrial base, that is those factories which are not only operated but also owned by the contractor himself also referred to as COCOs. You can see from this description that the Army is supported by a base which produces a diversified line of products. Therefore, the task of technology development and technology insertion is considerably more complex than what one encounters in the average U. S. Manufacturing organization.

  7. 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... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF DEFENSE Department of the Army 32 CFR Part 505 Army Privacy Act Program AGENCY: Department of the Army, DoD....

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

    PubMed

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

    2015-10-15

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    Kumar, Sunil; Chaudhary, Sujata

    2009-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  13. 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

  14. The evolution of casualty evacuation in the British Army in the 20th century (Part 2)--1918 to 1945.

    PubMed

    Bricknell, M C M

    2002-09-01

    This is the second in a series of papers that examine the evolution of the military casualty evacuation chain during the 20th century. The Spanish Civil War demonstrated to the world the revolutionary tactic of 'Blitzkrieg' developed by the Germans. This and the experience of the British Expeditionary Force in 1940 emphasised the need for mobility in forward medical units. The campaign in the Western Desert led to the creation of a number of new units such as the Field Surgical Unit and the Field Transfusion Unit which were introduced across the British Army as a result of the findings of the Hartgill Committee. The aeroplane transformed the evacuation chain from CCSs to base hospitals and beyond. PMID:12469437

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

    PubMed

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

    2016-02-01

    The number of total hip replacements taking place across the UK continues to grow. In an ageing population, with people placing greater demands on their prostheses, the number of peri-prosthetic fractures is increasing. We studied the economic impact this has on a large teaching hospital. All patients with peri-prosthetic femoral fracture in a 7.5year period were identified. Radiographic and case note analysis was performed. Costings from the finance departments were obtained. 90 cases were identified, 58 female and 32 male, with a mean age of 76 (range: 38-91). 89 of the cases were managed surgically, 66% undergoing revision and 33% receiving open reduction and internal fixation. According to the Vancouver Classification, 3% were Type A, 79% Type B and 18% Type C. The mean length of stay was 43days. The mean cost of management was £31,370 (range: £6885-£112,327). Patients with type C fractures had the highest mean length of stay at 53 days and mean cost of £33,417. Including rehabilitation costs, our study illustrated a mean cost of £31,370, roughly four times the current basic NHS tariff of £8552. Although implant costs are greater, treatment with revision where appropriate allows earlier weight bearing, reduced length of stay and lower overall cost. PMID:26689495

  16. 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. ...

  17. Suicide in the US Army

    PubMed Central

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

    2012-01-01

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

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

    PubMed

    2014-11-10

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2015 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. In this document, we also are making changes to the data sources permitted for expansion requests for physician-owned hospitals under the physician self-referral regulations; changes to the underlying authority for the requirement of an admission order for all hospital inpatient admissions and changes to require physician certification for hospital inpatient admissions only for long-stay cases and outlier cases; and changes to establish a formal process, including a three-level appeals process, to recoup overpayments that result from the submission of erroneous payment data by Medicare Advantage (MA) organizations and Part D sponsors in the limited circumstances in which the organization or sponsor fails to correct these data. PMID:25387387

  19. Army ground robotics research program

    NASA Astrophysics Data System (ADS)

    Bornstein, Jonathan A.

    2002-07-01

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

  20. 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/μl. 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/μl), 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

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

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

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

  2. 76 FR 72914 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-28

    ....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:...

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

    PubMed

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

    2016-03-01

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

  4. 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:...

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

    PubMed

    Izci, Yusuf

    2010-05-01

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

  6. Combined surgical-orthodontic treatment: how did it evolve and what are the best practices now?

    PubMed

    Proffit, William R; White, Raymond P

    2015-05-01

    It has been 50 years since the landmark presentation by Hugo Obwegeser at Walter Reed Army Hospital. At that conference, Professor Obwegeser offered American surgeons techniques to correct facial skeletal deformities with access through intraoral incisions. As important advances in surgical technique and anesthesia evolved for the surgical procedures, a major contribution by American orthodontists in collaboration with surgeons was the creation of a common diagnostic, planning, and treatment scheme for use by both clinician groups in the treatment of dentofacial deformities, the skeletal and dental problems of the most severely affected 5% of the population. This article summarizes what American orthodontists and surgeons have learned in the late 20th and early 21st centuries, and forecasts what might be the future of treatment for patients with dentofacial deformities. PMID:25925650

  7. Army ground robotics research program

    NASA Astrophysics Data System (ADS)

    Bornstein, Jonathan A.; Shoemaker, Chuck M.

    2003-09-01

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

  8. 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…

  9. 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

  10. [The seven wounds Ernst Jünger at the time of the Great War. Reflection of the health service of the imperial army].

    PubMed

    Ségal, Alain; Ferrandis, Jean-Jacques

    2012-01-01

    Thanks to Ernt Junger's amazing career--and despite his many injuries--we have a great view of the German Imperial Army's sanitary corps. This can be observed from the actions of the stretcher-bearers to German hospitals in general, and with the organization of their sanitary transport, as well as their medico-surgical concerns. We can see, therefore, that very few differences existed with the French medico-surgical structures except for the fact that,from the very beginning, Imperial medical warfare was able to adjust to the changes from field to trench situations. Thanks to its adaptable system of triage, and its ability to offer the most coherent medico-surgical choices and options, it was possible to save time. It enabled surgical actions in places that were close to the battlefield. Furthermore, we have been able to find out about the personal experience of an exceptional 20th century writer who later became a great European citizen. PMID:23038865

  11. Reconstruction of Punitive Ear Amputations in Uganda: A Unique Surgical Burden of Disease.

    PubMed

    Dusseldorp, Joseph; Hodges, Andrew; Patel, Anup; Marchac, Alexandre; Firmin, Françoise

    2015-06-01

    Over the course of 12 months, a plastic surgical team from Paris, France, undertook 2 intensive ear reconstruction missions with plastic surgeons from the CoRSU Rehabilitation Hospital in Uganda. A cohort of over 30 adult women was assessed having been subjected to ear amputations by members of the Lords Resistance Army in Northern Uganda in the 1990s. The patients were identified, mobilized, and transferred to Kampala for surgery by a charitable arm of the Watoto Church, known as Living Hope. The surgical team performed 15 ear reconstruction cases during the first 1-week mission and 16 ear reconstruction cases during the second 1-week mission. All cases were reconstructed successfully using the 2-stage autologous auricular reconstruction method advocated by the senior author (FF). Local skin was used to cover the costal cartilage framework in the first stage without need for temporo-parietal fascial flaps. Technical challenges included the older age of patients and ossified costal cartilage, high prevalence of HIV positivity, bilateral amputation, and difficulty of surgical follow-up. The main modifications to standard practice were routine pre-op testing of the costal cartilage, pre-op viral load and CD4 count screening in HIV-positive patients, simultaneous bilateral first-stage ear reconstruction, prolonged hospital stay, and implementation of routine surgical counting procedures. PMID:26080156

  12. 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

  13. Surgical education in Greece.

    PubMed

    Kostakis, Alkiviadis; Mantas, Dimitris

    2008-10-01

    Nowadays, many important changes to residents' education are being introduced, including the regulation of working hours, the waiting time to start specialization, the training programs in new technologies, the heterogeneity of trainers and educational centers, and the existence of many different subspecializations. In Greece we have not yet established all the arrangements needed to meet the European Community's legislation concerning working hours apart from the extremely long waiting time to begin surgical training. There is an enormous heterogeneity among hospitals that provide surgical specialties, but there is no educational program that all residents have to follow to complete their training. Only in major university or general hospitals are the residents enrolled in a specific educational program and complete an adequate number of surgical procedures. With respect to training in new technologies, there is a lack of experienced surgical departments around Greece that provide this type of education to all residents. Of course, efforts have been made to meet the international educational criteria and there are many major general hospitals that can provide an adequate and up-to-date surgical education, although much still needs to be done to meet the international standards. PMID:18553044

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

    PubMed Central

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

    2015-01-01

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

  15. Aviation medicine and the Army.

    PubMed

    Vyrnwy-Jones, P; Thornton, R

    1984-10-01

    The purpose of this short series of articles is not to present the reader with a vast amount of technical data, soon to be forgotten, but to provide some items of general interest from the past, present, and future of Army aviation. Obviously there will be a concentration on medical matters, but the aim is to give the reader a feel for the rapid progress being made in helicopter design and the likely problems we may face in the future. The first article serves as an introduction to the series and three further articles will cover various aspects of the speciality. The second will be concerned with AAC helicopter accidents and will include accident investigation, crashworthiness and the contribution made by pilot error. The third article will cover major environmental problems of helicopters, particularly noise, vibration and thermal stress. The fourth article will examine ways in which microprocessors and modern technology will affect future helicopter and ancillary equipment development; for instance, a helicopter with no external windows has been suggested, 'The Iron Cockpit'. The fifth article will be concerned with the clinical aspects of Army Aviation medicine. PMID:6396409

  16. [The army of the East and health services].

    PubMed

    Guivarc'h, Marcel

    2007-01-01

    A medical disaster due to the failure of a plan intended to free Belfort by an army of 90 000 men, formed by Bourbaki in Nevers, joined in Besancon by 40 000 men from Lyon and from Dijon. Envisaged in three days, the regrouping lasts three weeks. A gigantic railway blocking, by an icy cold, leaves in the trains of the soldiers without food, of the horses without irons nor fodder. A third of manpower is from the start inapt for the fights. The utter exhaustion of the men don't make possible to exploit the success of Villersexel's battle (January 9), nor to cross Lizaine. The medical army officers joined those of the civil ambulances formed in South-east, and that of Pamard. The care given with delay on the covered with snow ground, in precarious shelters or encumbered hospitals, is summary. Cold, gelures, walk feet, infection, associated variola, are the cause of a high mortality: 8 500 died, and much of casualties. Ordered by Bourbaki, the dramatic routed to Switzerland by Pontarlier and the Cluse collar, under the Prussian shells will add 15 000 killed. The Swiss ones collect sick and wounded in 200 ambulances along the border, and on 87 000 men to be disarmed in 9 000 hospitalize. Pamard will remain until March 18 at the Pontarlier' hospital. PMID:18175609

  17. 78 FR 60864 - Army Science Board Fall Plenary Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-02

    ... record that vote for record according to the Army Science Board bylaws, Article VII, Section 2. Committee... Department of the Army Army Science Board Fall Plenary Meeting AGENCY: Department of the Army, DoD. ACTION... following committee meeting: Name of Committee: Army Science Board (ASB) Fall Plenary Session....

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  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). 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

  3. An Analysis of the Army Officer Student.

    ERIC Educational Resources Information Center

    Fullerton, Leroy Robert

    This study evaluated the advantages of formal higher education in establishing a second career for retired Army officers. Primary sources of data were Army officer students and recently retired officers. These were among the conclusions: (1) high response to the survey showed interest in, and career-related importance attached to, higher…

  4. Army Representativeness: The National Longitudinal Study.

    ERIC Educational Resources Information Center

    Purcell, Agnes C.; And Others

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

  5. 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.

  6. Army applications for multispectral windows

    NASA Astrophysics Data System (ADS)

    Hall, John M.

    1997-06-01

    The achievement of the Army's goal, 'Own the Night,' has evolved over the last few years to include mastery of the entire optical spectrum from 0.4 microns through 12 microns. This requires the integration of lasers, FLIR (forward looking infrared) sensors, CCD cameras and image intensifiers, and direct view optical assemblies, all on a single platform. The problem faced with such integration is to provide the functionality in a small, lightweight package. Common aperture optics may be a solution, but common apertures require the use of low-cost, hardened, multi-spectral windows. The general requirements for multi-spectral systems and lessons learned from the RAH-66 Comanche program are discussed.

  7. US Army blood program: 2025 and beyond.

    PubMed

    Gonzales, Richard; Taylor, Audra L; Atkinson, Andrew J; Malloy, Wilbur W; Macdonald, Victor W; Cap, Andrew P

    2016-03-01

    In preparing to support the Army in 2025 and beyond, the Army Blood Program remains actively engaged with the research and advanced development of blood products and medical technology to improve blood safety and efficacy in conjunction with the US Army Medical Research and Materiel Command. National and International Blood Bank authorities have noted that the US Army research and development efforts in providing new blood products and improving blood safety operate on the cutting edge of technology and are transformational for the global blood industry. Over the past 14 years, the Army has transformed how blood support is provided and improved the survival rate of casualties. Almost every product or process developed by or for the military has found an application in treating civilian patients. Conflicts have many unwanted consequences; however, in times of conflict, one positive aspect is the identification of novel solutions to improve the safety and efficacy of the blood supply. PMID:27001366

  8. 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

  9. 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…

  10. 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

  11. Surgical Airway

    PubMed Central

    Patel, Sapna A; Meyer, Tanya K

    2014-01-01

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

  12. Male parentage in army ants.

    PubMed

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

    2006-04-01

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

  13. 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)

  14. 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.

  15. 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.

  16. 78 FR 23759 - Army Education Advisory Subcommittee Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-22

    ... 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.... General deliberations leading to provisional findings will be referred to the Army Education...

  17. 77 FR 27209 - Army Education Advisory Subcommittee Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-09

    ... 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.... General deliberations leading to provisional findings will be referred to the Army Education...

  18. 77 FR 4026 - Army Education Advisory Subcommittee Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-26

    ... 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.... General deliberations leading to provisional findings will be referred to the Army Education...

  19. 77 FR 66823 - Army Education Advisory Committee Study Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-07

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

  20. 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...

  1. 78 FR 38956 - Army Education Advisory Subcommittee; Meeting Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-28

    ... 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... Army Education Advisory Committee for deliberation by the Committee under the open- meeting rules....

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

    ERIC Educational Resources Information Center

    Ungvarsky, Diane M.; Lilienthal, Richard A.

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

  3. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  4. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  5. 32 CFR 536.14 - Commanders of major Army commands.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  7. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  8. 32 CFR 536.6 - The Army claims mission.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  9. 75 FR 38504 - Army Science Board Plenary Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-02

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

  10. 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...

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

    ERIC Educational Resources Information Center

    KERSHAW, G.A.; AND OTHERS

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

  12. Surgical Technologists

    MedlinePlus

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

  13. 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...

  14. Typology of Army Families: Coping Styles of Successful, Career Army Families.

    ERIC Educational Resources Information Center

    Smith, Russell C.

    The active duty Army has approximately 400,000 families who on a daily basis interact with the largest military system in the world. An all-pervasive culture unto itself, the Army affects the lives of each one of these people. This research was begun in order to look at the effects which this lifestyle has and how individuals and families…

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

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

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

  17. Surgical therapy for pulmonary hydatidosis.

    PubMed

    Taha, A M; Shabb, B; Nassar, H

    1996-01-01

    Surgical treatment of pulmonary hydatidosis varies from one country to another. Whereas some reports describe marsupialization of the residual cavity others favor capitonnage (imbrication) to decrease complications and hospital stay. Post operative complications and hospital stay were compared in a retrospective study of 53 patients treated surgically at the American University Hospital over a period of 10 years. Forty eight cysts were treated by evacuation after chemical sterilization. Fifteen were marsupialized and 33 were imbricated. Five were excised with lung parenchyma, 5 were delivered intact and one cyst was treated by lobectomy. There was no postoperative mortality. There was no statistical difference in the hospital stay or the complication rate between the marsupialized and imbricated cases. Both imbrication and marsupialization are equally effective methods of treatment of pulmonary hydatid cysts. Anatomic resection is rarely required. PMID:8912091

  18. Improving surgical inpatient ward lists in a large acute hospital: a simple yet effective process to save the time of junior house officers

    PubMed Central

    Kenny, Ross; Johnston, Carolyn; Qureshi, Imran

    2014-01-01

    In order for the smooth running of a surgical firm, an effective ward list must be created, updated, and edited each day, often by junior medical personnel. Ward lists are used by various healthcare professionals including consultants, specialist nurses, and pharmacists. Over time ward inpatient lists can become increasingly difficult to use and lacking in vital information. Baseline measurement revealed the extent of the problem with junior house officers spending on average 95 minutes per day maintaining the ward list. After a period of research and learning, a bespoke inpatient list was created containing all of the vital information required. Criteria to fulfil included being straightforward to manipulate, easy to input new patients and aesthetically pleasing. After a trial period with modifications, an improved inpatient ward list was successfully implemented. Post-intervention data collection revealed a reduction of 42 minutes per day on average spent maintaining the list, with a 100% increase in satisfaction, and reduction in problems encountered from daily to weekly. Following this success, the general surgery weekend handover list was improved using the same prototype. This led to a saving of 8 minutes per day on average and increased doctor satisfaction. The process of creating an effective, easy to use, and useful inpatient ward list can lead to large amount of time saved each day for the staff responsible for its management. This time can then be reinvested on clinical duties, or education, to further improve the healthcare service we provide. PMID:26734290

  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. 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

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

    PubMed Central

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

    1988-01-01

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

  2. 2D electronic materials for army applications

    NASA Astrophysics Data System (ADS)

    O'Regan, Terrance; Perconti, Philip

    2015-05-01

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

  3. Army Reserve Comprehensive Water Efficiency Assessments

    SciTech Connect

    McMordie Stoughton, Kate; Kearney, Jaime

    2015-04-14

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

  4. 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.

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

    PubMed

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

    1993-09-01

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

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

    PubMed

    Raschka, Ch; Raschka, S; Peikert, T

    2009-12-01

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

  7. Improving surgical weekend handover

    PubMed Central

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

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

  8. 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

  9. 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 ...

  10. Violence against surgical residents.

    PubMed Central

    Barlow, C B; Rizzo, A G

    1997-01-01

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

  11. U.S. Army Signal School.

    ERIC Educational Resources Information Center

    Army Signal Center and School, Fort Monmouth, NJ.

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

  12. Army Training Technology Transfer: A Systems Model.

    ERIC Educational Resources Information Center

    Freda, Jon S.

    Innovations in training technology must be transferred from the researcher to the user to be effective. This system concept paper presents a framework for the establishment of an Army training technology transfer program, as well as suggestions to improve the acceptance and use of training research products. Training technology transfer is defined…

  13. Dental Therapy Assistant: Attitudes of Army Dentists.

    ERIC Educational Resources Information Center

    Heid, Theodore H.; Bair, Jeffrey H.

    The U. S. Army Dental Corps has implemented a formal program based on the concept that dental care can be more efficiently and effectively provided with treatment teams composed of one dental officer, two dental therapy assistants, one basic assistant, and the shared support of other auxiliary personnel. Such a team will use three dental treatment…

  14. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) 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,...

  15. 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…

  16. Handbook on Volunteers in Army Community Service.

    ERIC Educational Resources Information Center

    Department of the Army, Washington, DC.

    This handbook has been prepared for the purpose of offering guidance and assistance in the development and administration of a volunteer program within Army Community Service. It contains eight chapters. Chapter 1 is the Introduction. Chapter 2, Volunteers Are Partners and Team Members, considers the importance of attitudes, agreement on volunteer…

  17. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) 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,...

  18. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) 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,...

  19. 32 CFR 631.14 - Army policy.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) 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,...

  20. 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,...

  1. 75 FR 7255 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-18

    ... Subcommittee of the Army Education Advisory Committee. Date of Meeting: March 11, 2010. Place of Meeting: U.S... issues; assess resident and distance education programs, self- study techniques, assemble a working ] group for the concentrated review of institutional policies and a working group to address...

  2. 76 FR 12087 - Army Educational Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-04

    ... Subcommittee of the Army Education Advisory Committee. Dates of Meeting: March 24, 2011. Place of Meeting: U.S... issues; assess resident and distance education programs, self- study techniques, assemble a working group for the concentrated review of institutional policies and a working group to address...

  3. 32 CFR 536.14 - Commanders of major Army commands.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... CLAIMS AGAINST THE UNITED STATES The Army Claims System § 536.14 Commanders of major Army commands... claims personnel in obtaining qualified expert and technical advice from command units and...

  4. 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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2013-12-01

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

  7. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  8. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  9. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  10. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  11. 32 CFR 644.328 - Army military leased property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  12. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  13. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  14. 32 CFR 644.416 - Army civil works lands.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  15. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  16. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  17. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  18. 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...

  19. 32 CFR 581.1 - Army Disability Review Board.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  20. 32 CFR 581.1 - Army Disability Review Board.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Army Disability Review Board. 581.1 Section 581.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY PERSONNEL PERSONNEL REVIEW BOARD § 581.1 Army Disability Review Board. (a) General provisions—(1) Constitution, purpose, and jurisdiction of review board. (i) The...

  1. 32 CFR 581.1 - Army Disability Review Board.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  2. 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 Publishing Office DEPARTMENT OF DEFENSE Department of the Army Army Science Board Summer Study Meeting AGENCY: Department of the Army, DoD. ACTION: Notice of open meeting. SUMMARY: Pursuant to the Federal Advisory Committee Act of 1972 (5...

  3. 32 CFR 643.112 - Army exchange activities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  4. 21 CFR 880.2740 - Surgical sponge scale.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgical sponge scale. 880.2740 Section 880.2740 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Monitoring Devices § 880.2740 Surgical sponge scale....

  5. Automation impact study of Army Training Management

    SciTech Connect

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

    1988-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  7. Dental population health measures: supporting Army transformation.

    PubMed

    Chaffin, Jeffrey

    2003-03-01

    General Eric K. Shinseki, Chief of Staff of the Army, has initiated the transformation of the Army with the goals of making the force more lethal, agile, and versatile. A key component to the transformation is deploying healthier soldiers that will result in the ability to decrease the amount of deployed medical support. This article describes two new population health measures the U.S. Army Dental Command is implementing to support the transformation. The new program will make it mandatory for dental providers to assess caries and tobacco risk at all active duty soldiers' annual dental examinations. These measures will allow the dental personnel to identify who is at risk for future disease and then to plan appropriate prevention strategies for those individual soldiers. These aggregate corporate data will allow dental leaders to target prevention services to the units with a high percentage of tobacco users. These new measures and the resultant prevention strategies can increase the readiness of our forces and can result in a healthier and mission-ready force. PMID:12685688

  8. 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.

  9. 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

  10. 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.

  11. Health profile of Danish army personnel.

    PubMed

    Dahl, S; Kristensen, S

    1997-06-01

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

  12. Quality of Pharmaceutical Care in Surgical Patients

    PubMed Central

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

    2014-01-01

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

  13. A quantification of the physiological demands of the army emergency responder in the Australian army.

    PubMed

    Tofari, Paul J; Laing Treloar, Alison K; Silk, Aaron J

    2013-05-01

    The Australian Defence Force is reviewing the physical demands of all employment categories in the Australian Army to establish valid and legally defensible assessments. The current assessments, performed in physical training attire, are not specific to job demands. Moreover, the fitness standards decrease based on age and are lower for females, and as job requirements are constant, these assessments are counterintuitive. With regard to the Army Emergency Responder employment category, tasks of physical demand in the present study were selected through consultation with subject-matter experts. Participants consisted of 10 qualified Army Emergency Responder soldiers and three noncareer firefighters under instruction. Real-life firefighting scenarios were witnessed by researchers and helped form task simulations allowing measurement of heart rate and oxygen consumption. Peak oxygen consumption ranged from 21.8 ± 3.8 to 40.0 ± 3.4 mL kg(-1) min(-1) during cutting activities and a search and rescue task, respectively, representing values similar to or higher than the current entry standards. Manual handling tasks were also assessed, with the heaviest measured being two soldiers lifting a 37.7-kg Utility Trunk to 150 cm. The findings provide a quantitative assessment of the physiological demands of Army Emergency Responders, and highlight the need for change in current fitness assessments. PMID:23756005

  14. Surgical education in Mexico.

    PubMed

    Cervantes, Jorge

    2010-05-01

    Surgical education in Mexico basically follows the same model as in the United States, with a selection process resembling the matching program. There is a 4-year training period during which residents in their third year spend 4 months as the sole surgeon in a rural community. During the senior year they are entitled to an elective period in a place of their choosing. After completion of the 4 years, residents have to present a thesis and undergo an oral examination before getting a university diploma. They are then encouraged to pass the written and oral examination of the Mexican Board of Surgery before they are fully certified to enter practice in a public or private hospital. PMID:19603225

  15. 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

  16. Surgical treatment of thymoma

    PubMed Central

    Mehran, Reza; Ghosh, Rishi; Maziak, Donna; ORourke, Keith; Shamji, Farid

    2002-01-01

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

  17. 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.

  18. 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.

  19. 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

  20. [Tuberculous peritonitis in emergency surgical care].

    PubMed

    Dantsig, I I

    1998-01-01

    The paper presents 5 cases of histologically verified tuberculous peritonitis followed up by the author in 1994-1996. All patients were admitted to hospital and undergone surgical intervention for emergency indications. The main symptoms were intoxication, abdominal pain and enlargement. Two typical cases are described. Tuberculous peritonitis is recommended to be included into the differential diagnostic list of acute surgical abdominal diseases. PMID:9613188

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

    PubMed

    Ressler, Kerry J; Schoomaker, Eric B

    2014-01-01

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

  2. 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

  3. 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

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

  4. 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…

  5. 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

  6. Perspectives on history: Army dietitians in the European, North African, and Mediterranean theaters of operation in World War II.

    PubMed

    Hodges, P A

    1996-06-01

    World War II necessitated the mobilization of hundreds of dietitians to serve in military hospitals in the United States and in theaters of war all over the globe. Although initially military dietitians had civilian status, on December 22, 1942, Congress passed Public Law 828, which authorized military status for Army dietitians with relative rank in the Medical Department for the duration of the war and 6 months thereafter. This article chronicles the role of Army dietitians who supported the allied troops in military hospitals in England, Europe, and North Africa during World War II. Recollections of military dietitians who served in the war are included to illustrate the circumstances under which these professionals lived and the dedication with which they worked. PMID:8655909

  7. Occupational differences in US Army suicide rates

    PubMed Central

    Kessler, R. C.; Stein, M. B.; Bliese, P. D.; Bromet, E. J.; Chiu, W. T.; Cox, K. L.; Colpe, L. J.; Fullerton, C. S.; Gilman, S. E.; Gruber, M. J.; Heeringa, S. G.; Lewandowski-Romps, L.; Millikan-Bell, A.; Naifeh, J. A.; Nock, M. K.; Petukhova, M. V.; Rosellini, A. J.; Sampson, N. A.; Schoenbaum, M.; Zaslavsky, A. M.; Ursano, R. J.

    2016-01-01

    Background Civilian suicide rates vary by occupation in ways related to occupational stress exposure. Comparable military research finds suicide rates elevated in combat arms occupations. However, no research has evaluated variation in this pattern by deployment history, the indicator of occupation stress widely considered responsible for the recent rise in the military suicide rate. Method The joint associations of Army occupation and deployment history in predicting suicides were analysed in an administrative dataset for the 729 337 male enlisted Regular Army soldiers in the US Army between 2004 and 2009. Results There were 496 suicides over the study period (22.4/100 000 person-years). Only two occupational categories, both in combat arms, had significantly elevated suicide rates: infantrymen (37.2/100 000 person-years) and combat engineers (38.2/100 000 person-years). However, the suicide rates in these two categories were significantly lower when currently deployed (30.6/100 000 person-years) than never deployed or previously deployed (41.2–39.1/100 000 person-years), whereas the suicide rate of other soldiers was significantly higher when currently deployed and previously deployed (20.2–22.4/100 000 person-years) than never deployed (14.5/100 000 person-years), resulting in the adjusted suicide rate of infantrymen and combat engineers being most elevated when never deployed [odds ratio (OR) 2.9, 95% confidence interval (CI) 2.1–4.1], less so when previously deployed (OR 1.6, 95% CI 1.1–2.1), and not at all when currently deployed (OR 1.2, 95% CI 0.8–1.8). Adjustment for a differential ‘healthy warrior effect’ cannot explain this variation in the relative suicide rates of never-deployed infantrymen and combat engineers by deployment status. Conclusions Efforts are needed to elucidate the causal mechanisms underlying this interaction to guide preventive interventions for soldiers at high suicide risk. PMID:26190760

  8. The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

    PubMed Central

    Ursano, Robert J.; Colpe, Lisa J.; Heeringa, Steven G.; Kessler, Ronald C.; Schoenbaum, Michael; Stein, Murray B.

    2014-01-01

    Importance/Objective Although the suicide rate in the U.S. Army has traditionally been below age-gender matched civilian rates, it has climbed steadily since the beginning of the Iraq and Afghanistan conflicts and since 2008 has exceeded the demographically matched civilian rate. The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multicomponent epidemiological and neurobiological study designed to generate actionable evidence-based recommendations to reduce Army suicides and increase knowledge about risk and resilience factors for suicidality and its psychopathological correlates. This paper presents an overview of the Army STARRS component study designs and of recent findings. Design/Setting/Participants/Intervention Army STARRS includes six main component studies: (1) the Historical Administrative Data Study (HADS) of Army and Department of Defense (DoD) administrative data systems (including records of suicidal behaviors) for all soldiers on active duty 2004–2009 aimed at finding administrative record predictors of suicides; (2) retrospective case-control studies of fatal and nonfatal suicidal behaviors (each planned to have n = 150 cases and n = 300 controls); (3) a study of new soldiers (n = 50,765 completed surveys) assessed just before beginning basic combat training (BCT) with self-administered questionnaires (SAQ), neurocognitive tests, and blood samples; (4) a cross-sectional study of approximately 35,000 (completed SAQs) soldiers representative of all other (i.e., exclusive of BCT) active duty soldiers; (5) a pre-post deployment study (with blood samples) of soldiers in brigade combat teams about to deploy to Afghanistan (n = 9,421 completed baseline surveys), with sub-samples assessed again one, three, and nine months after returning from deployment; and (6) a pilot study to follow-up SAQ respondents transitioning to civilian life. Army/DoD administrative data are being linked prospectively to the large-scale survey samples to examine predictors of subsequent suicidality and related mental health outcomes. Main outcome measures Measures (self-report and administratively recorded) of suicidal behaviors and their psychopathological correlates. Results Component study cooperation rates are comparatively high. Sample biases are relatively small. Inefficiencies introduced into parameter estimates by using nonresponse adjustment weights and time-space clustering are small. Initial findings show that the suicide death rate, which rose over 2004–2009, increased for those deployed, those never deployed, and those previously deployed. Analyses of administrative records show that those deployed or previously deployed were at greater suicide risk. Receiving a waiver to enter the Army was not associated with increased risk. However, being demoted in the past two years was associated with increased risk. Time in current deployment, length of time since return from most recent deployment, total number of deployments, and time interval between most recent deployments (known as dwell time) were not associated with suicide risk. Initial analyses of survey data show that 13.9% of currently active non-deployed regular Army soldiers considered suicide at some point in their lifetime, while 5.3% had made a suicide plan, and 2.4% had attempted suicide. Importantly, 47–60% of these outcomes first occurred prior to enlistment. Prior mental disorders, in particular major depression and intermittent explosive disorder, were the strongest predictors of these self-reported suicidal behaviors. Most onsets of plans-attempts among ideators (58.3–63.3%) occurred within the year of onset of ideation. About 25.1% of non-deployed U.S. Army personnel met 30-day criteria for a DSM-IV anxiety, mood, disruptive behavior, or substance disorder (15.0% an internalizing disorder; 18.4% an externalizing disorder) and 11.1% for multiple disorders. Importantly, three-fourths of these disorders had pre-enlistment onsets. Conclusions Integration across component studies creates strengths going well beyond those in conventional applications of the same individual study designs. These design features create a strong methodological foundation from which Army STARRS can pursue its substantive research goals. The early findings reported here illustrate the importance of the study and its approach as a model of studying rare events particularly of national security concern. Continuing analyses of the data will inform suicide prevention for the U.S. Army. PMID:24865195

  9. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Army military real property. 644.326 Section 644.326 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military real property. Military real property, including industrial real property, under the control...

  10. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Army military real property. 644.326 Section 644.326 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military real property. Military real property, including industrial real property, under the control...

  11. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 4 2011-07-01 2011-07-01 false Army military real property. 644.326 Section 644.326 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military real property. Military real property, including industrial real property, under the control...

  12. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Army military real property. 644.326 Section 644.326 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military real property. Military real property, including industrial real property, under the control...

  13. 32 CFR 644.326 - Army military real property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Army military real property. 644.326 Section 644.326 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL... military real property. Military real property, including industrial real property, under the control...

  14. 20. Photocopy of original drawing by US Army Engineer District, ...

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

    20. Photocopy of original drawing by US Army Engineer District, Corps of Engineers, 1964 (original in possession of NYC Economic Development Corp.) REPAIRS OF SPALLED CONCRETE-PIERS 2,3, AND 4 - Brooklyn Army Supply Base, Pier 2, Brooklyn, Kings County, NY

  15. Cultural Assimilator for Training Army Personnel in Racial Understanding.

    ERIC Educational Resources Information Center

    Hart, Roland J.; And Others

    A cultural assimilator was developed to teach white junior officers about black culture in the army. Scenarios involving misunderstandings between blacks and whites in the army were presented, and respondents were asked to identify "correct" reasons for the misunderstandings. In the first of three field tests respondents showed evidence of…

  16. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... PUBLIC RELATIONS COMPETITION WITH CIVILIAN BANDS § 508.1 Utilization of Army bands. (a) General... Secretary of Defense. The authority to determine whether the use of an Army band at a public gathering is... Forces, veterans, and patriotic organizations. (3) At public rallies and parades intended to...

  17. Posttraumatic Stress Disorder Among Army Nurse Corps Vietnam Veterans.

    ERIC Educational Resources Information Center

    Stretch, Robert H.; And Others

    1985-01-01

    Investigated posttraumatic stress disorder (PTSD) among Army nurse veterans. Analysis of questionnaire data (N=712) revealed a current PTSD rate for Vietnam veteran nurses of 3.3 percent. This rate is comparable to that found among nonnurse active duty Army Vietnam veterans and is much lower than estimates for civilian Vietnam veterans.…

  18. Correlates of Military Satisfaction and Attrition Among Army Personnel.

    ERIC Educational Resources Information Center

    Allen, John P.; Bell, D. Bruce

    A study determined relationships between Army organizational variables and levels of soldier satisfaction and assessed correlates of attrition and battalion effectiveness ratings. It was based on a secondary analysis of data collected in the Army Life-78 Study, which considered relationships of organizational climate and unit effectiveness.…

  19. 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.…

  20. 32 CFR 581.1 - Army Disability Review Board.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... review, at the request of any officer retired or released from active service, without pay, for physical... 32 National Defense 3 2010-07-01 2010-07-01 true Army Disability Review Board. 581.1 Section 581.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY PERSONNEL PERSONNEL REVIEW...

  1. 32 CFR 581.1 - Army Disability Review Board.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... review, at the request of any officer retired or released from active service, without pay, for physical... 32 National Defense 3 2011-07-01 2009-07-01 true Army Disability Review Board. 581.1 Section 581.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY PERSONNEL PERSONNEL REVIEW...

  2. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... PUBLIC RELATIONS COMPETITION WITH CIVILIAN BANDS § 508.1 Utilization of Army bands. (a) General... Secretary of Defense. The authority to determine whether the use of an Army band at a public gathering is... Forces, veterans, and patriotic organizations. (3) At public rallies and parades intended to...

  3. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... PUBLIC RELATIONS COMPETITION WITH CIVILIAN BANDS § 508.1 Utilization of Army bands. (a) General... Secretary of Defense. The authority to determine whether the use of an Army band at a public gathering is... Forces, veterans, and patriotic organizations. (3) At public rallies and parades intended to...

  4. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... PUBLIC RELATIONS COMPETITION WITH CIVILIAN BANDS § 508.1 Utilization of Army bands. (a) General... Secretary of Defense. The authority to determine whether the use of an Army band at a public gathering is... Forces, veterans, and patriotic organizations. (3) At public rallies and parades intended to...

  5. 32 CFR 508.1 - Utilization of Army bands.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... PUBLIC RELATIONS COMPETITION WITH CIVILIAN BANDS § 508.1 Utilization of Army bands. (a) General... Secretary of Defense. The authority to determine whether the use of an Army band at a public gathering is... Forces, veterans, and patriotic organizations. (3) At public rallies and parades intended to...

  6. eArmyU Improves Educational Access for Soldiers.

    ERIC Educational Resources Information Center

    Brotherton, Phaedra

    2002-01-01

    Describes how the Army's venture into distance learning, eArmyU, is proving to be a big success, with more than 12,000 soldiers enrolled since it began a year ago. Soldiers are lining up for the program that offers free tuition, a laptop, and Internet access. But historically black colleges and universities may be missing out due to distance…

  7. Achieving Competence: Army-VOTEC School Partnership Pilot Studies.

    ERIC Educational Resources Information Center

    Stout, Mary W.

    To reduce Army training costs, the Training and Doctrine Command (TRADOC) investigated use of training at civilian secondary and postsecondary vocational-technical (VOTEC) institutions as an alternative to initial job training in Army service schools. Three models were used in the pilot study: the preservice training model in which…

  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. Solar energy applications at Army ammunition plants

    NASA Astrophysics Data System (ADS)

    Lowry, A. P.; Moy, S. M.

    1982-06-01

    The Army Ammunition Plants use significant quantities of fossil fuels. To reduce dependence on these scarce, costly, and non-renewable fuels, a study was conducted to investigate potential solar energy applications at the AAPs. Solar energy is a low-level energy source which is best applied to low temperature applications. It can be used at the AAPs to preheat boiler feedwater, provide hot air for dry-houses, provide domestic hot water and heat for administration buildings, and provide hot water for manufacturing processes such as metal cleaning, phosphating, and X-ray film processing. Use of the flat plate collectors, evacuated tube collectors, or solar ponds with the possible addition of a heat pump, offers reasonably economical means of applying solar technology to AAP needs.

  10. Quinine substitutes in the confederate army.

    PubMed

    Hasegawa, Guy R

    2007-06-01

    During the Civil War, the unreliable supply and high cost of quinine forced the Confederate Army to use alternative treatments for malaria. Many quinine substitutes were mentioned in the literature of the time, but relatively few were advocated by Confederate officials and even fewer are described in surviving records. Medical supply officers often issued substitute remedies when quinine was requisitioned. Most alternative treatments were made from indigenous plants such as dogwood, willow (a constituent of which gave rise to aspirin), and tulip tree. High hopes were held for Georgia bark, which was thought to be closely related to cinchona, from which quinine was derived. Documentation of the effectiveness of quinine substitutes is scanty but is most plentiful for the external application of turpentine. The quinine substitutes were generally considered useful but not as effective as quinine. The Confederate Surgeon General's Office was active in seeking out and supplying troops with quinine substitutes. PMID:17615851

  11. [SURGICAL HAND WASHING: HANDSCRUBBING OR HANDRUBBING].

    PubMed

    Santacatalina Mas, Roser; Peix Sagues, Ma Teresa; Miranda Salmerón, Josep; Claramunt Jofre, Marta; López López, Alba; Salas Marco, Elena

    2016-02-01

    The importance of protocols for preoperative antisepsis of the hands is given by the risk of transferring bacteria from the hands of the surgical team to the patient during surgery and it is relationship with infection of surgical wound site (SSI). Careful surgical scrub reduces the number of bacteria on the skin, but does not eliminate them completely, remaining transient microorganisms on hands after the surgical scrub. There fore if micropuncture in surgical gloves occurs, the correct preoperative preparation of hands and double gloving will be essential to reduce the risk of bacterial transmission to patients. The protocols for surgical hand antisepsis are two: Surgical scrub with antiseptic soap (hand scrubbing). Surgical scrub by rubbing alcohol (handrubbing). The hand antisepsis by rubbing with an alcohol solution has proved to be significantly more effective compared to soap solutions. We must also see that in surgical hand antisepsis with soap, you must rinse them with water. And often hospitals' taps and keys are contaminated by Pseudomonas spp., including P. aeuinosa. PMID:27101645

  12. 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

  13. TMAP [Teleoperated Mobile Antiarmor Platform]: The Army`s near term entree to battlefield robotics

    SciTech Connect

    Simmons, R.K.

    1988-05-01

    TMAP is a remotely operated battlefield system consisting of a 750-pound all terrain vehicle, remotely operated by a solider over a fiber optic communication link 4 km long. Using state-of-the-art automation and robotic technology, Martin Marietta Aero and Naval Systems is developing a modular prototype system under contract to Sandia National Laboratories. The Army Material developer is the Missile Command (MICOM) at Huntsville, Alabama; the Combat Developer is the Infantry School (USAIS) at Ft. Benning, Georgia. With the weapons removed by Congress in December 1987, the O & O is being rewritten for a ``Tactical Multipurpose Automated Platform`` (TMAP) instead of the original Teleoperated Mobile Antiarmor Platform. With minimal modification the modular TMAP system can be used in many applications (eg., antiarmor or antiair weapons, mine detection, medical support). System acceptance and Army evaluation testing is scheduled for summer and fall of 1988. 9 figs., 2 tabs.

  14. 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

  15. Compare Hospitals

    MedlinePlus

    ... Talking to Your Doctor Hospital Ratings and reports Survey Content Reports on Hospital Performance How Our Ratings are Used ... and Tools Talking to Your Doctor Hospital Ratings Survey Content Reports on Hospital Performance How Our Ratings are Used ...

  16. 75 FR 22757 - Federal Advisory Committee; Army Education Advisory Committee; Charter Renewal

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-30

    ... of the Secretary Federal Advisory Committee; Army Education Advisory Committee; Charter Renewal... renewing the charter for the Army Education Advisory Committee (hereafter referred to as the Committee... include the U.S. Army's joint professional military education programs, educational policies,...

  17. Differential Validity of the Army Aptitude Areas for Predicting Army Job Training Performance of Blacks and Whites. Technical Paper 312.

    ERIC Educational Resources Information Center

    Maier, Milton H.; Fuchs, Edmund F.

    Validation studies were conducted on nine revised aptitude areas of the Army Classification Battery (ACB) to determine whether ACB scores provided an equitable indication of the qualifications of blacks and whites for training in major groups of Army jobs. The aptitude areas were: combat, field artillery, electronics repair, operators and food,…

  18. 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…

  19. Report of the Department of the Army Board to Review Army Officer Schools. Volume I. Summary And Recommendations.

    ERIC Educational Resources Information Center

    Department of the Army, Washington, DC.

    The purpose of the Board was to determine adequacy and appropriateness of current Army school system and education and individual school training of Army officers in light of responsibilities confronting military establishment for the foreseeable future and to recommend changes in academic program during the next decade to make greatest

  20. The quality of surgical clerkships.

    PubMed

    Holden, W D

    1985-06-01

    Many of the contours of a surgical clerkship can be designed, implemented, and evaluated with varying degrees of objectivity. The recently established Association for Surgical Education and its expanding membership have performed in an excellent fashion in addressing the objectives, content, process, and evaluation of surgical clerkships. There are several factors that influence the quality of a clerkship that are not readily subjected to measurement but that have a significant impact on the environment and conduct of clerkships. Criticism, mainly from the academic community, has been directed recently to distortions of the learning process and the continuing use of traditional teaching methods that do not serve medical educational programs and students optimally. More attention should be paid to the principle that a surgical clerkship should be designed to provide an elemental comprehension of the major surgical diseases irrespective of how the students will select multiple specialties for their careers. The quality of a clinical teaching program is influenced in a realistic way by the quality of care provided to the patients. The image of the staff, especially the resident staff, plays an important role in affecting students' incentives, the development of self-discipline, their attitudes toward patients and families, and the ultimate selection of careers. As much responsibility as possible for the diagnosis of disease and the care of patients should be given to students under close supervision and always with the best interests of the patients in mind. The environment of medical schools and teaching hospitals is changing rapidly. The corporate practice of medicine will have an impact on the quality of surgical clerkships, we hope not adversely. PMID:4002120

  1. Do specialty hospitals promote price competition?

    PubMed

    Berenson, Robert A; Bazzoli, Gloria J; Au, Melanie

    2006-01-01

    Policy makers continue to debate the correct public policy toward physician-owned heart, orthopedic and surgical specialty hospitals. Do specialty hospitals offer desirable competition for general hospitals and foster improved quality, efficiency and service? Or do specialty hospitals add unneeded capacity and increased costs while threatening the ability of general hospitals to deliver community benefits? In three Center for Studying Health System Change (HSC) sites with significant specialty hospital development--Indianapolis, Little Rock and Phoenix--recent site visits found that purchasers generally believe specialty hospitals are contributing to a medical arms race that is driving up costs without demonstrating clear quality advantages. PMID:16465700

  2. 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

  3. Physical fitness profile of Army ROTC cadets.

    PubMed

    Thomas, David Q; Lumpp, Samantha A; Schreiber, Jamee A; Keith, James A

    2004-11-01

    One role of Army Reserved Officer's Training Corps (ROTC) programs is to physically prepare cadets for the demands of a military career. Cadets participate in physical training 3 days per week as part of their military science curriculum. Limited research has been conducted on the fitness level of ROTC cadets; therefore, the purpose of this study was to profile the physical fitness status of a cadre of ROTC cadets. Forty-three cadets (30 men and 13 women) performed Army Physical Fitness Test (APFT) assessments (2-mile run, 2-minute maximum push-ups and sit-ups) and clinical assessments of fitness (Bruce protocol Vo(2)max, underwater weighing, and 1 repetition maximum [1RM] bench press tests). Mean +/- standard deviations were calculated to provide the physical fitness profile for each parameter. Male cadets (21 +/- 2.2 years; height 177.4 +/- 6.6 cm; mass 79.2 +/- 9.4 kg) scored 49.6 +/- 6.1 ml.kg(-1).min(-1) for Vo(2)max, 14.8 +/- 4.2% fat, 86.5 +/- 24.9 kg 1RM bench press, 2-mile run of 13.97 +/- 1.4 minutes, 70.5 +/- 12.8 sit-ups, and 60.2 +/- 13.2 push-ups. Female cadets (20 +/- 2.4 years; height 165.1 +/- 8.0 cm; mass 63.5 +/- 10.0 kg) scored 40.8 +/- 3.9 ml.kg(-1).min(-1) for Vo(2) max, 23.9 +/- 3.8% fat, 35.3 +/- 8.2 kg 1RM bench press, 2-mile run of 17.0 +/- 1.6 minutes, 65.0 +/- 12.9 sit-ups, and 33.3 +/- 11.2 push-ups. The mean scores were above the 83rd percentile on all APFT items and average (percent fat) to above average (Vo(2)max and men's bench press scores) when compared with peer-age and sex-corrected norms. Only the women's bench press score was below average. With the exception of the women's bench press, these ROTC cadets possessed average to above average levels of fitness. PMID:15574107

  4. Renewable Energy Opportunities for the Army

    SciTech Connect

    Solana, Amy E.; States, Jennifer C.; Chvala, William D.; Weimar, Mark R.; Dixon, Douglas R.

    2008-08-13

    The Department of Defense (DoD) has a goal of obtaining 25% of its domestic electricity from renewable sources by 2025, and also must meet federal renewable energy mandates and schedules. This report describes the analyses undertaken to study the renewable resource potential at 15 Army sites, focusing on grid-connected generation of electricity. The resources analyzed at each site include solar, wind, geothermal, biomass, waste-to-energy, and ground source heat pumps (GSHPs). For each renewable generation resource, an assessment was completed to determine the level of resource availability, and the price at which that resource would be available for electricity generation. Various design alternatives and available technologies were considered in order to determine the best way to utilize each resource and maximize cost-effective electricity generation. Economic analysis used multiple funding options, including investment by an independent power producer (IPP), Energy Savings Performance Contract (ESPC), and Energy Conservation Investment Program (ECIP), and considered tax incentives, renewable energy credits, and other economic factors to reveal the most realistic costs possible. Where resource options proved to be economically viable, implementation approaches were recommended. The intention was to focus each installations efforts on realistic projects, moving them from initial assessment through the design and financing to implementation. Many Army sites enjoy very low costs of electricity, limiting the number of cost-effective renewable energy options where resources are available. Waste-to-energy was often a viable option due to the additional revenue gathered from transferred tipping fees. GSHPs were also commonly cost-effective options for replacement in inefficient buildings. Geothermal, wind, and solar resources are found to be more available in certain parts of the country over others, reducing overall potential for use. Wind is variable and often most available in remote areas far from transmission lines, greatly increasing costs. Capital costs for solar energy are high, and the resource is also variable. Table 1 shows which resources are promising for each installation studied. Not all analyses are complete at this point, so some resource potential is still unknown.

  5. The surgical treatment of gastroduodenal Crohn's disease.

    PubMed Central

    Shepherd, A. F.; Allan, R. N.; Dykes, P. W.; Keighley, M. R.; Alexander-Williams, J.

    1985-01-01

    Crohn's disease can affect any part of the gastrointestinal tract. Gastroduodenal involvement is uncommon and was not recognised until 1949 (1). Since then approximately 200 cases have been described in several series in the world literature. This paper describes the clinical presentation and surgical management of ten patients treated in the Birmingham General Hospital between 1970 and 1984. PMID:4073768

  6. Guidelines for surgical procedures after liver transplantation.

    PubMed Central

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

    1998-01-01

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

  7. Surgical centre delights patients and staff.

    PubMed

    2008-10-01

    Excellent teamworking and a spirit of co-operation have characterised the design, construction and, over the past year, operation of a new pound 25 million PFI-funded Surgical Centre at Kingston Hospital, Surrey, to be run under a 30-year concession by special purpose vehicle and Costain / John Laing consortium Prime Care Solutions (Kingston Ltd). Health Estate Journal reports. PMID:18988613

  8. Image enhancement technology research for army applications

    NASA Astrophysics Data System (ADS)

    Schwering, Piet B. W.; Kemp, Rob A. W.; Schutte, Klamer

    2013-06-01

    Recognition and identification ranges are limited to the quality of the images. Both the received contrast and the spatial resolution determine if objects are recognizable. Several aspects affect the image quality. First of all the sensor itself. The image quality depends on the size of the infrared detector array and the sensitivity. Second, also the intervening atmosphere, in particular over longer ranges, has an impact on the image quality. It degrades the contrast, due to transmission effects, as well as it influences the resolution, due to turbulence blur, of the image. We present studies in the field of infrared image enhancement. Several techniques are described: noise reduction, super resolution, turbulence compensation, contrast enhancement, stabilization. These techniques operate in real-time on COTS/MOTS platforms. They are especially effective in the army theatre, where long horizontal paths, and short line-of-sight limited urban operations are both present. Application of these techniques on observation masts, such as on military camp sites, and on UAVs and moving ground vehicles are discussed. Examples will be presented from several trials in which these techniques were demonstrated, including the presentation of test results.

  9. Surgical management of temporomandibular joint ankylosis.

    PubMed

    Maki, Mohammed Hashim; Al-Assaf, Dhuha A

    2008-11-01

    Ankylosis of the temporomandibular joint (TMJ) is one of the causes of persistent and progressive limitation of mouth opening. It usually requires to be corrected surgically; an intervention not without complications. This study was conducted in a central surgical hospital in Iraq (Baghdad) in the era hallmarked by shortage of nearly all facilities needed to accomplish solutions for a surgical task. The surgical procedure is displayed along with modifications, complications, and follow-up protocol. Fifteen patients (21 joints) have been treated surgically for TMJ ankylosis of different severities. All patients were treated at the Department of Oral and Maxillofacial Surgery, Specialized Surgical Hospital-Baghdad Medical City, Iraq. The study was carried out in the period between 1998 and 2002 (inclusive). Patients' ages ranged between 4 and 52 years. In addition to the clinical diagnoses, further evaluation of the ankylosis area was assisted by the use of orthopantomography and spiral computerized scanning (axial, coronal sections, and three-dimensional views). Maximal incisal opening was registered before and after surgery for further follow-up evaluation. Al-Kayat and Bramely approach is advocated to expose the joint area. All 21 joints were operated through blind nasoendotracheal intubation general anesthesia. Computed tomography scans, wide exposures, aggressive resections, proper interposition materials, strict postoperative physiotherapy, and good family and patient compliance all may decrease the possibility of relapse and offer better results. Early management of TMJ ankylosis is important if more damage in orofacial structures and consolidation of bony union are to be avoided. PMID:19098556

  10. [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

  11. Nutritional assessment of surgical patients.

    PubMed

    Brown, C S; Stegman, M R

    1988-10-01

    In order to test the sensitivity and specificity of the East Orange Nutritional Screening Form (EONSF), nutritional assessments were performed on a random sample of 10% of general medical/surgical admissions at a large midwestern veteran's administration hospital. Patients were followed until discharge to determine if they met the standard criteria of additional nutritional support. The tool correctly identified patients at nutritional risk (sensitivity) 95% of the time and patients not at nutritional risk (specificity) 89% of the time. It proved to be an effective, low-cost tool for identifying patients at risk and for planning appropriate nutritional strategies. PMID:3146037

  12. 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…

  13. 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

  14. Plowman v. U.S. Department of the Army.

    PubMed

    1988-10-19

    A former civilian employee of the U.S. Army brought suit against the Army and his former supervisor, alleging that he was forced to resign his position after testing positive for the human immunodeficiency virus (HIV). The plaintiff asserted that the Army had breached his employment contract. Additionally, his supervisor had violated his right to privacy and his Fourth Amendment right to be secure in his person from unreasonable searches and seizures, and had intentionally inflicted emotional distress. In granting the defendants' motion to dismiss the suit, the District Court held that: (1) the employee served by appointment and therefore the Army could not be held liable for breach of contract; and (2) his former supervisor was not liable for breach of the plaintiff's privacy or Fourth Amendment rights. PMID:11648181

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

    NASA Astrophysics Data System (ADS)

    Lavan, Michael J.; Wachs, John J.

    2011-11-01

    The US Army is investing in Solid State Laser (SSL) technology to assess counter rocket, artillery, and mortar (C-RAM) and counter unmanned aerial vehicle (C-UAV) capabilities of solid state based HEL systems, as well as other potential applications for HELs of interest to the Army. The Army HEL program thrust areas are systematically moving the technology forward toward weaponization, including solid state laser technologies, advances in beam control technology, and conducting major demonstrations. The High Energy Laser Mobile Demonstrator (HELMD) will be a major step toward demonstrating HEL weapon capability to the soldier. The US Army will continue to pursue technologies that enable more compact systems compatible with, for example, a Stryker tactical vehicle as a crucial part of our strategy to provide a capability to the warfighter that can maneuver with the force.

  16. 78 FR 33074 - Army Science Board Summer Study Session

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-03

    .... Planning for Climate Change study 2013--This study considers the most likely climate change scenarios and assesses how the changes might change the way the Army fights, not just tactically but also considering...

  17. Development of aeronautical engines by the Army and Navy

    NASA Technical Reports Server (NTRS)

    1921-01-01

    Different aircraft engines are categorized as being of interest to only the Army or Navy or to both armed services. A listing of the different engines is presented along with some statistics, namely, horsepower.

  18. 78 FR 73852 - Army Science Board Winter Plenary Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-09

    ... FY13 study titled, ``Creating an Innovation Culture in the Army'' in an open session and begin work on... Culture'' Study. The ASB board members will cast a vote to accept the results of this study and...

  19. [Choledochal cysts: surgical treatment].

    PubMed

    Gogolja, D; Visnjić, S; Milić, Z; Tomić, K; Car, A; Roić, G; Fattorini, I

    2000-03-01

    The excision of the choledochal cyst with bile drainage through intestinal conduit is a standard operative procedure in the surgical management of choledochal cysts. During the last eight years five patients have been treated with this operation at the University Children's Hospital in Zagreb. All the patients were girls aged from two months to twelve years. The classical triad of pain, jaundice and abdominal mass was observed in only one patient, an eight-year-old girl. The only symptom in infancy was jaundice. Diagnosis was made by abdominal ultrasound, bibliography, CT scan with hepatotropic contrast and in older children by ERCP. Four cysts were type Todani I, and one cyst was Todani type II. The complete excision of the choledochal cyst with the Roux-Y jejunal conduit without antireflux valve was performed. There was neither operative morbidity nor mortality. Three months postoperatively the control ultrasonography and liver laboratory tests were without abnormalities. The routine control which followed did not show episodes of cholangitis, lithiasis, lipid malabsorption, blood clotting abnormalities or growth failure. The complete excision of the cyst with Roux-Y hepaticoenterostomy is an operative treatment with good results in infancy and childhood. PMID:10932533

  20. Surgical training in Guyana: the next generation

    PubMed Central

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

    2015-01-01

    Summary The pioneering surgical training partnership between the Canadian Association of General Surgeons (CAGS) and the University of Guyana has successfully graduated 14 surgeons since 2006. The association has recruited 29 surgeons who have made 75 teaching visits to Guyana, and CAGS involvement has been critical to providing local credibility to the program, organizing the curriculum structure and developing rigorous examinations. The program is now locally sustained, with graduates leading a number of clinical hospital programs. The initial diploma qualification is being reassessed, as other specialties have introduced postgraduate Master of Medicine degree programs. Many graduates are pursuing additional training opportunities overseas, and almost all of those remaining in Guyana have returned to the tertiary centre from the regional hospitals. The program has succeeded in training surgeons and raising the standards of surgical care in Guyana, but broader health system efforts are necessary to retain surgeons in outlying regional hospitals. PMID:25621909

  1. US Army remotely piloted vehicle supporting technology program

    NASA Technical Reports Server (NTRS)

    Gossett, T. D.

    1981-01-01

    Essential technology programs that lead to the full scale engineering development of the Aquila Remotely Piloted Vehicle system for U.S. Army are described. The Aquila system uses a small recoverable and reusable RPV to provide target acquisition, designation, and aerial reconnaissance mission support for artillery and smart munitions. Developments that will provide growth capabilities to the Aquila RPV system, as well as future RPV mission concepts being considered by the U.S. Army are presented.

  2. [Classification of surgical interventions in Germany].

    PubMed

    Stausberg, J

    1998-01-01

    Today different classification systems are used in Germany for the standardization and coding of surgical procedures. On January 1, 1995, the German Minister of Health introduced a new classification system called "Operationenschlüssel nach section 301 SGB V" (OPS-301) for surgical procedures performed in hospitals. The standardization by the OPS-301 is limited to inpatients. In outpatient care, surgical procedures are coded by two billing systems: EBM and GOA. Thus, the situation is characterized by coding systems that are used in parallel which are to some extent incompatible. This leads to avoidable workload and lower quality of the documented data. The general goal is the development of a new classification system which on the one hand should be able to provide different views depending on the questions. On the other hand the system should integrate the different views through a clear and consistent structure of surgical procedures. PMID:9931716

  3. Serving within the British Army: research into mental health benefits.

    PubMed

    Finnegan, Alan; Finnegan, Sara; McGee, Paula; Ashford, Robert; Simpson, Robin

    The mental health (MH) of soldiers remains extremely newsworthy and is regularly featured in high profile media forums that focus on post-traumatic stress disorder. However, the authors feel that there are distinct benefits to serving within the Army, and that it provides effective occupational medical, MH and welfare support. This research study explores potential benefits and stressors of being in the Army and provides an overview of Army mental health services (AMHS) through the perspectives of AMHS personnel, 84% of which were nurses. The study indicated that the Army can provide a protective community, sharing a bond based on common values and experiences. The Army can provide soldiers with career opportunities that are not available in civilian life, and there are opportunities to develop an employment profile, enhanced by internal and external educational training, and encapsulated within a progressive career pathway. The Army can also be seen to offer an escape route, preventing soldiers entering a life of crime, and supplying the stable family these soldiers had never experienced. The provision of leadership, within an environment where soldiers are valued and stigma is not tolerated can potentially shield against MH problems. PMID:22067839

  4. Nostalgia in the Army (17th-19th Centuries).

    PubMed

    Battesti, Michèle

    2016-01-01

    People died from nostalgia in the army in the 17th-19th centuries. The term 'nostalgia', created by the doctor Johannes Hofer (1669-1752), from Mulhouse, came from the Germanic Heimweh, or 'homesickness'. It affected the young people enrolled in the army, such as Swiss mercenaries. Longing for their native land, they were consumed by an ongoing desire to return home. If it was impossible to do so, they sank into 'a sadness accompanied with insomnia, anorexia and other unpleasant symptoms' that could lead to death. Nostalgia became classified as a disease during the last quarter of the 18th century and ravaged the French army during the Revolution and the Napoleonic wars. However, as soon as the wars ended, it ceased to exist in the army (except the colonial army). It was removed from the nosology in the first half of the 19th century. Rapidly explained as an example of a misdiagnosis or a confusion between 'connection and cause', nostalgia needs to be assessed in regard to the medical debate between 'alienists' and 'organicists'. Creating much concern, nostalgia needs to be considered in the historical context of a society destabilized by modernity, with some individuals uprooted by the sudden transition from civil society to military life. It raises questions about the role that the army played in the creation of the French national union. Nostalgia may have also covered psychic traumatisms later designated as combat fatigue, war neurosis, or post-traumatic stress disorder. PMID:27035922

  5. Drinking and Spouse Abuse Among U.S. Army Soldiers

    PubMed Central

    Bell, Nicole S.; Harford, Thomas; McCarroll, James E.; Senier, Laura

    2005-01-01

    Background This study examines the relationship between typical weekly drinking and perpetration of spouse abuse as well as the relationship between the perpetrators typical weekly drinking and alcohol use during the abuse event among U.S. Army male soldiers. Methods Cases include all active duty, male, enlisted Army spouse abusers identified in the Armys Central Registry who had also completed an Army Health Risk Appraisal Survey (HRA) between 1991 and 1998 (N = 9534). Cases were matched on sex, rank, and marital status with 21,786 control subjects who had also completed an HRA. Results In multivariate logistic regression models, heavy drinkers (22 or more drinks per week) were 66% more likely to be spouse abusers than were abstainers (odds ratio 1.66; 95% confidence interval 1.401.96). In addition, self-reported moderate and heavy drinkers were three times as likely and light drinkers (17 drinks per week) were twice as likely as nondrinkers to be drinking during the time of the abuse event. Conclusion Self-reported heavy drinking is an independent risk factor for perpetration of spouse abuse among male, enlisted Army soldiers. Even 5 years or more after ascertainment of typical drinking habits, there is a significant association between self-reported heavy drinking and alcohol involvement at the time of the spouse abuse event. Personnel who work with perpetrators and victims of spouse abuse should be trained carefully to query about current and typical drinking patterns. PMID:15608606

  6. Hyperspectral imager development at Army Research Laboratory

    NASA Astrophysics Data System (ADS)

    Gupta, Neelam

    2008-04-01

    Development of robust compact optical imagers that can acquire both spectral and spatial features from a scene of interest is of utmost importance for standoff detection of chemical and biological agents as well as targets and backgrounds. Spectral features arise due to the material properties of objects as a result of the emission, reflection, and absorption of light. Using hyperspectral imaging one can acquire images with narrow spectral bands and take advantage of the characteristic spectral signatures of different materials making up the scene in detection of objects. Traditional hyperspectral imaging systems use gratings and prisms that acquire one-dimensional spectral images and require relative motion of sensor and scene in addition to data processing to form a two-dimensional image cube. There is much interest in developing hyperspectral imagers using tunable filters that acquire a two-dimensional spectral image and build up an image cube as a function of time. At the Army Research Laboratory (ARL), we are developing hyperspectral imagers using a number of novel tunable filter technologies. These include acousto-optic tunable filters (AOTFs) that can provide adaptive no-moving-parts imagers from the UV to the long wave infrared, diffractive optics technology that can provide image cubes either in a single spectral region or simultaneously in different spectral regions using a single moving lens or by using a lenslet array, and micro-electromechanical systems (MEMS)-based Fabry-Perot (FP) tunable etalons to develop miniature sensors that take advantage of the advances in microfabrication and packaging technologies. New materials are being developed to design AOTFs and a full Stokes polarization imager has been developed, diffractive optics lenslet arrays are being explored, and novel FP tunable filters are under fabrication for the development of novel miniature hyperspectral imagers. Here we will brief on all the technologies being developed and present highlights of our research and development efforts.

  7. Incontinence Treatment: Surgical Treatments

    MedlinePlus

    ... Treatment Lifestyle Changes Dietary Tips Medication Bowel Management Biofeedback Surgical Treatments Newer Treatment Options Tips on Finding ... changes Dietary changes Medication Bowel management/retraining program Biofeedback therapy Surgical treatments Newer procedures or devices Tips ...

  8. 78 FR 21919 - Finding of No Significant Impact and Final Programmatic Environmental Assessment for Army 2020...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-12

    ... Army 2020 Force Structure Realignment AGENCY: Department of the Army, DoD. ACTION: Notice of... Impact (FNSI) for implementation of force structure realignment to reduce the Army active duty end... Programmatic Environmental Assessment for Army 2020 Force Structure Realignment (PEA), supporting studies,...

  9. 32 CFR Appendix G to Part 623 - Continental US Army Boundaries

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623—Continental US Army...

  10. 32 CFR Appendix G to Part 623 - Continental US Army Boundaries

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623—Continental US Army...

  11. 32 CFR Appendix G to Part 623 - Continental US Army Boundaries

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623—Continental US Army...

  12. 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...

  13. 32 CFR Appendix G to Part 623 - Continental US Army Boundaries

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623—Continental US Army...

  14. 32 CFR 553.7 - Design and layout of Army national cemeteries.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Design and layout of Army national cemeteries. 553.7 Section 553.7 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES ARMY NATIONAL CEMETERIES § 553.7 Design and layout of Army national cemeteries. (a) General cemetery...

  15. 32 CFR Appendix G to Part 623 - Continental US Army Boundaries

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Continental US Army Boundaries G Appendix G to Part 623 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL Pt. 623, App. G Appendix G to Part 623Continental US Army...

  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... of views between the U.S. Army Training and Doctrine Command, the Department of the Army, and...

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

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES... of views between the U.S. Army Training and Doctrine Command, the Department of the Army, and...

  18. 32 CFR 562.8 - Army Advisory Panel on ROTC Affairs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Army Advisory Panel on ROTC Affairs. 562.8 Section 562.8 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY ORGANIZED RESERVES... of views between the U.S. Army Training and Doctrine Command, the Department of the Army, and...

  19. 32 CFR 623.3 - Submission of requests for loan of Army materiel.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Submission of requests for loan of Army materiel. 623.3 Section 623.3 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY SUPPLIES AND EQUIPMENT LOAN OF ARMY MATERIEL § 623.3 Submission of requests for loan of Army materiel. (a) General. (1) Loan requests will be...

  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...

  1. 21 CFR 880.2740 - Surgical sponge scale.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Monitoring... powered device used to weigh surgical sponges that have been used to absorb blood during surgery so that, by comparison with the known dry weight of the sponges, an estimate may be made of the blood lost...

  2. Brain metastases secondary to breast cancer: treatment with surgical resection and stereotactic radiosurgery.

    PubMed

    Tolentino, Paul J

    2009-01-01

    Intracerebral metastases are a serious complication for a significant proportion of cancer patients. Successful management may involve multiple treatments including surgical resection, whole-brain radiotherapy (WBRT), and stereotactic radiosurgery (SRS). We report the successful treatment of a solitary brain metastasis using a combination of surgical resection and SRS at Southeast Missouri Hospital, a community hospital that serves a primarily rural population. PMID:20063515

  3. Surgical Lasers In Gynecology

    NASA Astrophysics Data System (ADS)

    Schellhas, Helmut F.; Barnes, Alfonso E.

    1982-12-01

    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  4. [Military history of evacuation hospital No 3457 and the head of this hospital -- Porfirii Ivanovich Zabolotnyi].

    PubMed

    Poddubnyĭ, M V

    2014-05-01

    The article is devoted to publication of an archive document "History of evacuation hospital AN 3457". This archive document was found in one of the deserted country house in Sumy Oblast, Ukraine. 32 pages of text is bright and eloquent testimony of the period of the Great Patriotic War. Hospital was founded in 1941 in Sumy Oblast and then was deployed in Siberia, in the region of the Far North, again in Ukraine and in Hungary. Army medical officer Porfirii Zabolotnyi was the chef of evacuation hospital during this period. PMID:25286566

  5. Caring for burn patients at the United States Institute of Surgical Research: the nurses' multifaceted roles.

    PubMed

    Serio-Melvin, Maria; Yoder, Linda H; Gaylord, Kathryn M

    2010-06-01

    Nursing plays a critical role in the comprehensive burn care delivered at the US Army Institute of Surgical Research, otherwise known as the US Army's Burn Center serving the Department of Defense. This center serves as a model for burn units nationally and internationally. It also provides a challenging and innovative work environment for military and civilian nurses. Nurses in the Burn Center contribute to innovations in acute, rehabilitative, and psychological care for patients with burns. This article provides an overview of the complex nursing care provided to burn patients treated at the Burn Center. PMID:20510707

  6. Surgical checklists: the human factor

    PubMed Central

    2013-01-01

    Background Surgical checklists has been shown to improve patient safety and teamwork in the operating theatre. However, despite the known benefits of the use of checklists in surgery, in some cases the practical implementation has been found to be less than universal. A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre staff towards a modified version of the World Health Organisation (WHO) surgical checklist with relation to: beliefs about levels of compliance and support, impact on patient safety and teamwork, and barriers to the use of the checklist. Methods Using the theory of planned behaviour as a framework, 14 semi-structured interviews were conducted with theatre personnel regarding their attitudes towards, and levels of compliance with, a checklist. Based upon the interviews, a 27-item questionnaire was developed and distribute to all theatre personnel in an Irish hospital. Results Responses were obtained from 107 theatre staff (42.6% response rate). Particularly for nurses, the overall attitudes towards the effect of the checklist on safety and teamworking were positive. However, there was a lack of rigour with which the checklist was being applied. Nurses were significantly more sensitive to the barriers to the use of the checklist than anaesthetists or surgeons. Moreover, anaesthetists were not as positively disposed to the surgical checklist as surgeons and nurse. This finding was attributed to the tendency for the checklist to be completed during a period of high workload for the anaesthetists, resulting in a lack of engagement with the process. Conclusion In order to improve the rigour with which the surgical checklist is applied, there is a need for: the involvement of all members of the theatre team in the checklist process, demonstrated support for the checklist from senior personnel, on-going education and training, and barriers to the implementation of the checklist to be addressed. PMID:23672665

  7. Is the British Army medical grading functional assessment tool effective?

    PubMed

    Mackie, Isobel

    2015-12-01

    Decision Support Aids (DSAs) have been widely used throughout industry and one (known as Table 7) is available to support British Army Medical Officers (MOs) grade soldiers against the Joint Medical Employment Standards. It is unknown how useful this DSA is in practice. An electronic questionnaire was distributed to British Army MOs working within Defence Primary Care facilities enquiring about MOs views on the usefulness of the DSA. Although the response rate was low, informative data were obtained. Between a half and a third of respondents felt that their judgement was affected in the application of the grading system when there were career implications to the grading MOs felt that the DSA allowed subjectivity in the grading. The results of this research suggest that although minor changes to Table 7 may improve service provision, an improvement in training in the application of Table 7 would be of greater benefit to the quality of occupational health service provision in the British Army. PMID:26621810

  8. Response bias, weighting adjustments, and design effects in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

    PubMed

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

    2013-12-01

    The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi-component epidemiological and neurobiological study designed to generate actionable recommendations to reduce US Army suicides and increase knowledge about determinants of suicidality. Three Army STARRS component studies are large-scale surveys: one of new soldiers prior to beginning Basic Combat Training (BCT; n = 50,765 completed self-administered questionnaires); another of other soldiers exclusive of those in BCT (n = 35,372); and a third of three Brigade Combat Teams about to deploy to Afghanistan who are being followed multiple times after returning from deployment (n = 9421). Although the response rates in these surveys are quite good (72.0-90.8%), questions can be raised about sample biases in estimating prevalence of mental disorders and suicidality, the main outcomes of the surveys based on evidence that people in the general population with mental disorders are under-represented in community surveys. This paper presents the results of analyses designed to determine whether such bias exists in the Army STARRS surveys and, if so, to develop weights to correct for these biases. Data are also presented on sample inefficiencies introduced by weighting and sample clustering and on analyses of the trade-off between bias and efficiency in weight trimming. PMID:24318218

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

    NASA Astrophysics Data System (ADS)

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

    2001-12-01

    In 2000, the President of the United States (US) and Congress directed Department of Interior (DOI) agencies to develop a program for monitoring trends in amphibian populations on DOI lands and to conduct research into causes of declines. The U.S. Geological Survey (USGS) was given lead responsibility for planning and implementing the Amphibian Research and Monitoring Initiative (ARMI) in cooperation with the National Park Service (NPS), Fish and Wildlife Service, and Bureau of Land Management. The program objectives are to (1) establish a network for monitoring the status and distribution of amphibian species on DOI lands; (2) identify and monitor environmental conditions known to affect amphibian populations; (3) conduct research on causes of amphibian population change and malformations; and (4) provide information to resource managers, policy makers, and the public in support of amphibian conservation. The ARMI program will integrate research efforts of USGS, other Federal, and non-federal herpetologists, hydrologists, and geographers across the Nation. ARMI will conduct a small number (~20) of intensive research efforts (for example, studies linking amphibian population changes to hydrologic conditions) and a larger number (~50) of more generalized inventory and monitoring studies encompassing broader areas such as NPS units. ARMI will coordinate with and try to augment other amphibian inventory studies such as the National Amphibian Atlas and the North American Amphibian Monitoring Program. ARMI will develop and test protocols for the standardized collection of amphibian data and provide a centrally managed database designed to simplify data entry, retrieval, and analysis. ARMI pilot projects are underway at locations across the US.

  10. Incontinence Treatment: Surgical Treatments

    MedlinePlus

    ... in Children Signs & Symptoms Symptoms of Incontinence Diarrhea Treatment Lifestyle Changes Dietary Tips Medication Bowel Management Biofeedback Surgical Treatments Newer Treatment Options Tips on Finding a Doctor ...

  11. 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

  12. Army Reserve Expands Net Zero Energy, Water, Waste

    SciTech Connect

    Solana, Amy E.

    2015-04-14

    In 2012, the Army initiated a Net Zero (NZ) program to establish NZ energy, water, and/or waste goals at installations across the U.S. In 2013, the U.S. Army Reserve expanded this program to cover all three categories at different types of Reserve Centers (RCs) across 5 regions. Projects identified at 10 pilot sites resulted in an average savings potential from recommended measures of 90% for energy, 60% for water, and 83% for waste. This article provides results of these efforts.

  13. Behavioral Health Competence: An Exploration of Army Reserve Occupational Therapists

    PubMed Central

    Arthur, Paul B.; DeCleene, Kate

    2014-01-01

    The behavioral health competence of Army Reserve Occupational Therapists (OT) was examined by electronic survey to determine current levels of competence and highlight pre-deployment training needs. Results indicated that while Army Reserve OTs report high levels of behavioral health competence, many questions regarding diagnosis, assessment, evaluation, treatment planning, intervention, and progress arose throughout deployment. OT’s often relied on skills from Level II fieldwork education and entry-level didactic education for competency. Perceived competencies may be compromised by curriculum changes in entry-level education, available fieldwork settings, and a lack of adequate training currently available prior to deployment. PMID:25368437

  14. [The historical experience of therapeutic service in the Army and Navy during the Great Patriotic War].

    PubMed

    Ovchinnikov, Yu V

    2015-05-01

    The author presents the experience of therapeutic services of the army and navy during the Great Patriotic War (1941-1945) and its importance for the present. This experience became a-general methodological framework-for the development of principles for the organization of work of military physicians in a modern warfare and the application of new weapons. The history of development, aims and objectives of the new section of Military Medicine--the Military Field Therapy as a unified system of organization and delivery of health care to servicemen based on the principles of a unified military field medical doctrine. A problem of organization of new health facilities (hospitals, hospital databases), their acquisition of trained personnel, especially the structure of internal medicine in the war years, the treatment and the early rehabilitation of wounded and sick, between the military and civilian medical institutions-is highlighted. There is an information that 90.6%, or more than 6.5 million soldiers and officers who were treated in hospitals with various diseases, were returned to duty. The experience of the medical service in World War II and the actual demand and is now planning for a package of measures aimed at further improvement of the health status of military-personnel. PMID:26513860

  15. Southern hospitality.

    PubMed

    Parsons, H

    1992-03-01

    Self Memorial Hospital's hostesses are the embodiment of a patient-oriented service philosophy instituted by Bob Borland when he created the $5-million-a-year Hospitality Services department. PMID:10117979

  16. Surgical resection of a giant cardiac fibroma.

    PubMed

    Stamp, Nikki L; Larbalestier, Robert I

    2016-05-01

    A 42-year-old woman presented to a regional hospital emergency room with palpitations and was found to be in ventricular tachycardia. Chest radiography demonstrated a massively enlarged cardiac silhouette. Echocardiography and cardiac magnetic resonance imaging demonstrated a mass within the left ventricular free wall, consistent with a cardiac fibroma. The patient proceeded to have surgical resection of the mass. Left ventricular function was preserved postoperatively. PMID:25690433

  17. 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.

  18. [Coproductive teamwork in surgical cancer treatment].

    PubMed

    Konishi, Toshiro; Harihara, Yasushi; Furushima, Kaoru

    2013-04-01

    With regard to surgical treatment of cancer, there is a strong demand for safe treatment with few errors: treatment must be based on transparency, understandability, and rationality. There is also demand for treatment which is quick, efficient and not wasteful. Rather than maintaining our current pyramidal system which has doctors standing as authorities at the top, there is a need for a flat, non-authoritarian system at every level and section of the hospital. As we change methodology, electronic medical records and clinical pathways will be important tools. Among the surgical department's treatment team in our hospital, there are many branches at work on peri-operative management aside from operations; There are teams for infection control (ICT), nutrition support (NST), decubitus and stoma management, rehabilitaion, and chemotherapy, and team cooperation after discharge from hospital. In addition, the collaborative and coproductive team focusing on pain releif and palliative care in terminal phase (PCT) is important. Having introduced each of the parts of team treatment within the setting of the surgical department, the need now for strong leadership from young and brightful surgeons is also emphasized. PMID:23848009

  19. Pancreatic Resection Results in a Statewide Surgical Collaborative

    PubMed Central

    Healy, Mark A.; Krell, Robert W.; Abdelsattar, Zaid M.; McCahill, Laurence E.; Kwon, David; Frankel, Timothy L.; Hendren, Samantha; Campbell, Darrell A.; Wong, Sandra L.

    2016-01-01

    Background A strong relationship between hospital caseload and adverse outcomes has been demonstrated for pancreatic resections. Participation in regional surgical collaboratives may mitigate this phenomenon. This study sought to investigate changes over time in adverse outcomes after pancreatectomy across hospitals with different caseloads in a statewide surgical collaborative. Methods The study investigated patients undergoing pancreatic resection from January 2008 to August 2013 at Michigan Surgical Quality Collaborative (MSQC) hospitals (1007 patients in 19 academic and community hospitals). Risk-adjusted rates of major complications, mortality, and failure to rescue were compared between hospitals based on caseloads (low, medium, and high) in early (2008–2010) and later (2011–2013) periods. Finally, the degree to which different complications explained changes in hospital outcome variation was assessed. Results Adjusted rates of major complications and mortality decreased over time, driven largely by improvements at low-caseload hospitals. In 2008–2010, risk-adjusted major complication rates were higher for low-caseload than for high-caseload hospitals (27.8 vs. 17.8 %; p = 0.02). However, these differences were attenuated in 2011–2013 (22.2 vs. 20.0 %; p = 0.74). Similarly, adjusted mortality rates were higher in low-caseload hospitals in 2008–2010 (6.2 vs. 0.8 %; p = 0.02), but these differences were attenuated in 2011–2013 (3.3 vs. 1.1 %; p = 0.18). Variation in major complications decreased, largely due to decreased variation in “medical” complication rates, with less change in surgical-site complications. Conclusion Participation in regional quality collaboratives by lower-volume hospitals can attenuate the volume–outcome relationship for pancreatic surgery. Continued work in collaboratives with an emphasis on technical and intraoperative aspects of care may improve overall quality of care. PMID:25820999

  20. Surgical management of tracheocutaneous fistula.

    PubMed

    Drezner, D A; Cantrell, H

    1998-07-01

    Tracheocutaneous fistula (TCF) is a complication of tracheotomy that adds a difficult and bothersome aspect to the patient's care and may exacerbate respiratory disease. Closure of the fistula is recommended, but complications associated with fistula closure include pneumothorax and respiratory compromise. Several surgical approaches have been advocated in the literature. We reviewed the operative techniques and outcomes of TCF closures performed at Cooper Hospital/University Medical Center between February 1990 and April 1995. Direct, or flap, closure of large tracheocutaneous fistulas was associated with significant complications and morbidity. Therefore, the closure technique was modified so that we now recommend, in patients with large tracheocutaneous fistulas (a defect of the anterior tracheal wall of > or = 4 mm diameter), excision of the fistula, replacement of the tracheotomy tube and healing by second intention after a short recannulation period. No complications have occurred since the closure technique was adopted. PMID:9693468

  1. Integration of New Technology in Army Libraries. Appendices.

    ERIC Educational Resources Information Center

    DAMANS and Associates, Rockville, MD.

    Eight appendices provide information related to a study which was conducted to determine the feasibility of introducing new automatic techniques to Army library technical processing activities; to examine and recommend appropriate systems and configurations for library automation; and to determine costs of implementing the recommendations. The…

  2. 32 CFR 644.517 - Clearance of Army lands.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... ordnance contaminated excess Army military real property is placed upon and remains with the using command. That command, after completion of the clearance work, will furnish the DE a “Statement of Clearance” (Appendix E, AR 405-90) and a record of the clearance work performed. In addition to the Statement...

  3. 32 CFR 644.517 - Clearance of Army lands.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... ordnance contaminated excess Army military real property is placed upon and remains with the using command. That command, after completion of the clearance work, will furnish the DE a “Statement of Clearance” (Appendix E, AR 405-90) and a record of the clearance work performed. In addition to the Statement...

  4. 32 CFR 644.517 - Clearance of Army lands.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... ordnance contaminated excess Army military real property is placed upon and remains with the using command. That command, after completion of the clearance work, will furnish the DE a “Statement of Clearance” (Appendix E, AR 405-90) and a record of the clearance work performed. In addition to the Statement...

  5. 32 CFR 644.517 - Clearance of Army lands.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... ordnance contaminated excess Army military real property is placed upon and remains with the using command. That command, after completion of the clearance work, will furnish the DE a “Statement of Clearance” (Appendix E, AR 405-90) and a record of the clearance work performed. In addition to the Statement...

  6. 32 CFR 644.517 - Clearance of Army lands.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... ordnance contaminated excess Army military real property is placed upon and remains with the using command. That command, after completion of the clearance work, will furnish the DE a “Statement of Clearance” (Appendix E, AR 405-90) and a record of the clearance work performed. In addition to the Statement...

  7. Effectiveness of Interactive Videodisc in Army Communications Training.

    ERIC Educational Resources Information Center

    Winkler, John D.; Polich, J. Michael

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

  8. 2007 NCTE Presidential Address: Where Ignorant Armies Clash by Night

    ERIC Educational Resources Information Center

    Yatvin, Joanne

    2008-01-01

    This article presents the text of Joanne Yatvin's presidential address, delivered at the NCTE Annual Convention in New York City in November 2007. The title of her presidential address, "Where Ignorant Armies Clash by Night," was taken from Matthew Arnold's (1867) poem "Dover Beach." Yatvin states that the federal government has usurped the right…

  9. An Army for Action: A Domestic Assistance Program. Monograph.

    ERIC Educational Resources Information Center

    Chant, Robert J.

    The monograph provides an overview of the DOD Domestic Action program with emphasis on the Army's specific social and economic conditions within our society. The study centers around an examination of the concept of using military resources in conjunction with other federal agencies to help resolve selected hard-core domestic problems. Opposing…

  10. Dr. von Braun Surrenders to U.S. Army

    NASA Technical Reports Server (NTRS)

    1945-01-01

    Dr. Wernher von Braun surrenders to U.S. Army Counterintelligence persornel of the 44th Infantry Division in Ruette, Bavaria on May 2, 1945. Left to right are Charles Stewart, CIC agent; Dr. Herbert Axster; Dieter Huzel; Dr. von Braun (arm in cast); Magnus von Braun (brother); and Hans Lindenberg.

  11. Dimensions of the Army Recruiter and Guidance Counselor Job.

    ERIC Educational Resources Information Center

    Borman, Walter C.; And Others

    This research used multidimensional scaling (MDS) and a clustering technique described by Ward and Hook to discover the underlying dimensionality of tasks associated with the Army recruiter and guidance counselor jobs. Within the project a recruiter/guidance counselor task list was developed and 101 USAREC personnel familiar with these two jobs…

  12. Suicide in the Army National Guard: An Empirical Inquiry

    ERIC Educational Resources Information Center

    Griffith, James

    2012-01-01

    Since 2004, suicides in the U.S. military have risen, most notably in the Army National Guard (ARNG). Data used in this study were obtained for suicides occurring from 2007 to 2010 and for a random sample of nonsuicides from the general ARNG population. Of the military-related variables considered, a few showed relationships to suicide. Rather,

  13. 32 CFR 581.2 - Army Discharge Review Board.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... provide opinions and guidance on legal matters relating to ADRB functions. (2) Medical consultant of the ADRB. An officer of the Army Medical Corps assigned to the ADRB to provide opinions and guidance on medical matters relating to ADRB functions. (3) Video tape hearing. A hearing conducted by an ADRB...

  14. 32 CFR 581.2 - Army Discharge Review Board.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... provide opinions and guidance on legal matters relating to ADRB functions. (2) Medical consultant of the ADRB. An officer of the Army Medical Corps assigned to the ADRB to provide opinions and guidance on medical matters relating to ADRB functions. (3) Video tape hearing. A hearing conducted by an ADRB...

  15. 32 CFR 581.2 - Army Discharge Review Board.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... provide opinions and guidance on legal matters relating to ADRB functions. (2) Medical consultant of the ADRB. An officer of the Army Medical Corps assigned to the ADRB to provide opinions and guidance on medical matters relating to ADRB functions. (3) Video tape hearing. A hearing conducted by an ADRB...

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

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

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover). Photograph taken before Sept 29, 1934 when the revised Real Property form on building 255 was completed. - Fitzsimons General Hopital, Building 255, North side of East O'Niell Avenue, between Tenth & Twelfth Streets, Aurora, Adams County, CO

  17. Reinforcement Management; An Approach to Motivating Army Trainees.

    ERIC Educational Resources Information Center

    Cassileth, Barrie

    To study the effectiveness of reinforcement management (contigency management) as applied to a military program of instruction already in operation, 335 students in an Army clerk-typist course in which self-paced instruction is used were given points for successive approximations to desired learning behavior. The points were exchangeable later for…

  18. Learning Organization Dimensions of the Sri Lanka Army

    ERIC Educational Resources Information Center

    Dahanayake, Nishada Dhananjaya; Gamlath, Sharmila

    2013-01-01

    Purpose: This study intends to investigate the extent to which the Sri Lanka Army can be described as a learning organization. Design/methodology/approach: The main tool of analysis used was the Dimensions of the Learning Organization Questionnaire (DLOQ) developed by Marsick and Watkins, with the exclusion of the sections on financial and

  19. Assessing the Performance of the Army Reserve Components School System.

    ERIC Educational Resources Information Center

    Winkler, John D.; And Others

    The operation of the U.S. Army's Reserve Components (RC) school system was assessed. Three areas were identified that were fundamental to the system where organizational changes could make a difference. First, the project assessed training requirements and school delivery of courses. In serving a sizable training requirement for reclassification…

  20. The United States School Garden Army. Bulletin, 1919, No. 26

    ERIC Educational Resources Information Center

    Francis, J. H.

    1919-01-01

    The name of the United States School Garden Army was adopted in March, 1918. The work of the organization is an expansion of work undertaken by the Bureau of Education in 1914. The scale upon which it was done was limited by the finances that could be secured for it. The acute demand for food production growing out of the war conditions made

  1. Integration of New Technology in Army Libraries. Appendices.

    ERIC Educational Resources Information Center

    DAMANS and Associates, Rockville, MD.

    Eight appendices provide information related to a study which was conducted to determine the feasibility of introducing new automatic techniques to Army library technical processing activities; to examine and recommend appropriate systems and configurations for library automation; and to determine costs of implementing the recommendations. The

  2. Master Resilience Training in the U.S. Army

    ERIC Educational Resources Information Center

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

    2011-01-01

    The U.S. Army Master Resilience Trainer (MRT) course, which provides face-to-face resilience training, is one of the foundational pillars of the Comprehensive Soldier Fitness program. The 10-day MRT course is the foundation for training resilience skills to sergeants and for teaching sergeants how to teach these skills to their soldiers. The…

  3. Suicide in the Army National Guard: An Empirical Inquiry

    ERIC Educational Resources Information Center

    Griffith, James

    2012-01-01

    Since 2004, suicides in the U.S. military have risen, most notably in the Army National Guard (ARNG). Data used in this study were obtained for suicides occurring from 2007 to 2010 and for a random sample of nonsuicides from the general ARNG population. Of the military-related variables considered, a few showed relationships to suicide. Rather,…

  4. Net Zero Ft. Carson: making a greener Army base

    EPA Science Inventory

    The US Army Net Zero program seeks to reduce the energy, water, and waste footprint of bases. Seventeen pilot bases aim to achieve 100% renewable energy, zero depletion of water resources, and/or zero waste to landfill by 2020. Some bases are pursuing Net Zero in a single secto...

  5. New Directions in the Army's Basic Skills Education Program (BSEP).

    ERIC Educational Resources Information Center

    Pilgrim, Mark T.

    The Army has given to the Training and Doctrine Command the task of developing four Basic Skills Education Program (BSEP) curricula to provide functional, job-related basic skills training. These would be Military Occupational Specialty (MOS) Baseline Skills, English-as-a-Second Language (ESL), Military Life Coping Skills, and Learning Strategies.…

  6. Learning Organization Dimensions of the Sri Lanka Army

    ERIC Educational Resources Information Center

    Dahanayake, Nishada Dhananjaya; Gamlath, Sharmila

    2013-01-01

    Purpose: This study intends to investigate the extent to which the Sri Lanka Army can be described as a learning organization. Design/methodology/approach: The main tool of analysis used was the Dimensions of the Learning Organization Questionnaire (DLOQ) developed by Marsick and Watkins, with the exclusion of the sections on financial and…

  7. 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

  8. 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

  9. 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

  10. Medicare Payment: Surgical Dressings and Topical Wound Care Products

    PubMed Central

    Schaum, Kathleen D.

    2014-01-01

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

  11. Dependents' Education. Educational Assistance and Opportunities Information for Army Family Members. Department of the Army Pamphlet No. 352-2.

    ERIC Educational Resources Information Center

    Department of the Army, Washington, DC.

    Information on educational assistance and opportunities for family members of active duty, retired, or deceased Army service members is provided. Eligibility and types of benefits and programs described are grouped in the following categories: educational financial aid for family members of veterans; educational opportunities for active duty

  12. Making the surgical beds go around.

    PubMed

    Fletcher, J P; Hodges, B

    1999-12-01

    A planned surgical admission is a major event for a patient and, when cancelled, not only causes great distress to the patient and relatives but is also a frustrating waste of resources if a fully staffed operating theatre lies idle. At Westmead Hospital, a bed management team was established with the appointment of a Clinical Nurse Consultant as Bed Manager to co-ordinate admissions in conjunction with all staff involved in the processing of surgical patients. Despite a reduced number of available surgical beds, throughput was maintained with a significantly reduced number of cancelled booked cases, which decreased to zero and have remained so since the end of 1995. It has been found that it is possible to achieve a situation where all booked surgical patients can be admitted as planned while still providing for emergency patients. This requires a co-ordinated approach with an emphasis on teamwork led by a dedicated Bed Manager working with medical and nursing staff on surgical wards together with the bookings office, pre-admission clinic, operating theatre and anaesthetics department. PMID:10619147

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

    PubMed Central

    Ng, Wai Khuan; Awad, Nawal

    2015-01-01

    Mafraq Hospital performs an average of 10,000 surgeries every year. The impact of having high volume high risk surgical procedures calls for the need to ensure safe surgery and a prevention of surgical site infection (SSI). SSI represents a significant portion of healthcare-associated infections (HAIs). The impact on morbidity, mortality, and cost of care has resulted in identifying the need to reduce SSI as a top priority to prevent healthcare associated infections. The good news is that the majority of SSIs are preventable. Mafraq Hospital performs a range of surgical procedures that covers 14 surgical specialties. The infection prevention and control team performs surveillance for SSI for all patients who undergo operative procedure included in Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) Operative Procedure Category (40 surgical procedures). Out of the 40 CDC NHSN listed, 33 operative procedures were performed at Mafraq Hospital, of which 17 were reported with SSI for 2013 and 2014. Surgical site infection has implicated an increase average length of stay from seven to 10 additional postoperative hospital days and additional costs of AED 10,000 to AED 100,000/SSI depending on procedure and pathogen. A multidisciplinary team was formed to develop and implement measures to reduce/eliminate surgical site infection, as well as evaluate and monitor compliance. Hence a group of multidisciplinary teams were initiated to analyse the results, find out the gaps, and implement a quality improvement project to correct the deficits. Recommendations for appropriate improvement measures were formed on evidence-based international guidelines from the Institute for Healthcare Improvement (IHI) and CDC. Evidence based practice supports that many of the causes of surgical site infection can be prevented with proper medical attention and care. PMID:26732804

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

    ERIC Educational Resources Information Center

    Savell, Joel M.; And Others

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

  15. 32 CFR 644.475 - Excessing Army military and Air Force property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Excessing Army military and Air Force property. 644.475 Section 644.475 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... the Related Land) § 644.475 Excessing Army military and Air Force property. The procedures for...

  16. 32 CFR 644.475 - Excessing Army military and Air Force property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Excessing Army military and Air Force property. 644.475 Section 644.475 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... the Related Land) § 644.475 Excessing Army military and Air Force property. The procedures for...

  17. 75 FR 52733 - Record of Decision (ROD) for Fort Bliss Army Growth and Force Structure Realignment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-27

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF DEFENSE Department of the Army Record of Decision (ROD) for Fort Bliss Army Growth and Force Structure Realignment... alternative described in the Fort Bliss Army Growth and Force Structure Realignment Final Environmental...

  18. 33 CFR 334.140 - Chesapeake Bay; U.S. Army Proving Ground Reservation, Aberdeen, Md.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 3 2013-07-01 2013-07-01 false Chesapeake Bay; U.S. Army Proving Ground Reservation, Aberdeen, Md. 334.140 Section 334.140 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE DANGER ZONE AND RESTRICTED AREA REGULATIONS § 334.140 Chesapeake Bay; U.S. Army...

  19. 32 CFR 552.25 - Entry regulations for certain Army training areas in Hawaii.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Entry regulations for certain Army training areas in Hawaii. 552.25 Section 552.25 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS AND NATIONAL CEMETERIES REGULATIONS AFFECTING MILITARY RESERVATIONS Entry Regulations for Certain Army Training Areas...

  20. A Theory-Based Approach to Reading Assessment in the Army. Technical Report 625.

    ERIC Educational Resources Information Center

    Oxford-Carpenter, Rebecca L.; Schultz-Shiner, Linda J.

    Noting that the United States Army Research Institute for the Behavioral and Social Sciences (ARI) has been involved in research on reading assessment in the Army from both practical and theoretical perspectives, this paper addresses practical Army problems in reading assessment from a theory base that reflects the most recent and most sound…