doi: 10.1093/milmed/164.10.xpmid: N/A
This content is only available as a PDF. Reprint & Copyright © by Association of Military Surgeons of U.S., 1999
MPH, C. Gaydos Joel, MD,;USA, Roberto N. Nang, MC;USA, Leslie G. Huck, VC;USA, Mark G. Kortepeter, MC;USPHS, Sharon L. Ludwig, MD;USA, Eric T. Lund, MC;USA, Julie A. Pavlin, MC;USA, Rodney L. Coldren, MC;USA, Kelly T. McKee, Jr., MC,
doi: 10.1093/milmed/164.10.viiipmid: N/A
This content is only available as a PDF. Reprint & Copyright © by Association of Military Surgeons of U.S., 1999
doi: 10.1093/milmed/164.10.xapmid: N/A
This content is only available as a PDF. Reprint & Copyright © by Association of Military Surgeons of U.S., 1999
USA, Arthur C. Wittich, MC;USA, Robert A. DeSantis, MC;USA, Ernest G. Lockrow, MC
doi: 10.1093/milmed/164.10.671pmid: N/A
Abstract Acute appendicitis is the most common nonobstetrical surgical condition of the abdomen complicating pregnancy. Appendectomy reportedly is performed during pregnancy once for every 1,500 deliveries. Although the incidence of appendicitis occurring in pregnant women is considered to be the same as in nonpregnant women, the signs and symptoms, and the laboratory findings usually associated with appendicitis in the nonpregnant condition, are frequently unreliable during pregnancy. Using the Computer Diagnostic Data System, we completed a retrospective analysis on all appendectomies performed at two Army Medical Activities (MEDDACs) during a 2-year period. With a representative large Army MEDDAC and a representative medium-sized Army MEDDAC studied, the incidence of appendectomy during pregnancy was the same frequency as in previous reports. The only consistent finding in all pregnant patients who underwent appendectomy was right lower quadrant abdominal pain. Presenting signs and symptoms, clinical evaluations, laboratory findings, and surgical management is discussed. No morbidity or mortality occurred during this study. Reprint & Copyright © by Association of Military Surgeons of U.S., 1999
PhD, Anita L. Slusarcick,;(Ret.), Robert J. Ursano, USAF MC;PhD, Carol S. Fullerton,;USN, Michael P. Dinneen, MC
doi: 10.1093/milmed/164.10.675pmid: N/A
Abstract Just before the onset of Operation Desert Storm, health care personnel (N = 250) on board the USNS Comfort reported the occurrence of life events for the preceding year, including before deployment and during the Persian Gulf War. Study participants noted both total and negative life events. The mean number of negative life events during the preceding year was 1.44; a sizable proportion of participants (38%) reported no negative life events during this time. There were no differences in the mean number of total or negative life events by gender, although women checked significantly more life event items related to interpersonal factors and men noted more life events concerning financial issues. Women, nurses, the childless, and lower ranking officers noted significantly greater negative life events during predeployment than deployment. Negative life events were moderately related to anxiety, depression, and post-traumatic stress disorder symptoms. Both research and policy implications are discussed. Reprint & Copyright © by Association of Military Surgeons of U.S., 1999
MC, Joan R. Griffith, USAF;PhD, Karen A. Schwab,;MD, Anita Robinson,;Hemming, Val G.
doi: 10.1093/milmed/164.10.683pmid: N/A
Abstract Objective: To describe the nature of the health care delivered to dependent adolescents throughout the military and compare services provided in adolescent medicine clinics with those provided in other medical departments and clinics. Method: Questionnaires were sent to physicians in pediatrics, internal medicine, family practice, primary care, emergency care, and adolescent medicine at 101 randomly selected military treatment facilities. A subsample of experts was selected to provide facility-specific, informed, representative information on the care provided to adolescents. Results: Sixty-six percent (N = 345) of physicians returned completed questionnaires, providing information on 100% of the facilities sampled. More than half of responders felt that adolescents avoided care in their department. Two-thirds of all physicians, and three-fourths of the expert subsample, believed that adolescents are best served within adolescent medicine clinics. The expert subsample reported that adolescents served in facilities with adolescent medicine clinics received broader services. Only 28% of the facilities sampled provided any specialized adolescent medicine services. Conclusion: The military health care system has made progress in providing care to adolescent dependents, but reaching larger numbers of adolescents requires additional efforts. Reprint & Copyright © by Association of Military Surgeons of U.S., 1999
USA, Paul G. Welch, MC;CNN, David K. Oliver, RN;USA, Sidney J. Swanson, MC;USAg, Christina L. Yuan, MC;USA, Paul G. Welch, MC
doi: 10.1093/milmed/164.10.688pmid: N/A
Abstract The Military Health Services System is undergoing tremendous changes paralleling those seen in the civilian health care system. Many of the same problems and frustrations are being encountered in the military as it builds TRICARE, one of the largest managed care systems in the country. This paper describes how a team of multidisciplinary subspecialty providers established an Infusion Service for Walter Reed Army Medical Center to fulfill customer needs brought about by system changes in the medical center. Policy and operations were directed toward addressing patient and provider frustrations. Organ transplantation ward length of stay shortened significantly in association with the establishment of this Infusion Service. Peritoneal Dialysis Clinic staff productivity improved. Organizational factors and values affecting patient outcomes and health system reform are discussed. Lessons learned from this project are identified and presented as suggestions that can be used in planning and executing changes throughout the Military Health Services System. Reprint & Copyright © by Association of Military Surgeons of U.S., 1999
doi: 10.1093/milmed/164.10.693pmid: N/A
Abstract This article describes the responsibilities and objectives of the pharmacy officer for the U.S. Army Medical Materiel Center, Europe. Pharmacists' experiences and knowledge offer advantages in the ordering, storage, and distribution of medical materiel. Exploitation of new technology and a customer-focused attitude encourage a working environment that capitalizes on pharmaceutical expertise. The use of temperature monitors, enhanced automation opportunities, expired drug return credits, and other customer-focused initiatives exemplify pharmacists' value to military medical logistics organizations. An overview of the pharmaceutical pipeline to U.S. military and State Department customers in the European theater is provided. Reprint & Copyright © by Association of Military Surgeons of U.S., 1999
USA, Jeffrey L. Jackson, MC;MPH, Eme Y. Cheng, MBA;USA, David L. Jones, MC;MSc, Gregg Meyer, MD
doi: 10.1093/milmed/164.10.701pmid: N/A
Abstract Background: Our goal was to compare the demographics and discharge diagnoses between civilian and military health care systems. Methods: One year (1997) of data from the Retrospective Case Mix Adjustment System from the Military Health Services System were compared with the most recent (1994) civilian National Hospital Discharge Survey data. Results: Military and civilian inpatient age (52.5 and 52.9 years), gender (54% and 59% female), and ethnic distributions (military: 71% white, 16% African American, 3% Asian American, 10% other; civilian: 65% white, 12% African American, 2.6% Asian American, 1.2% Native American, 18% unclassified) were similar. There were similar rank orderings of diagnosis-related groupings (Spearman's rank correlation = 0.72) and procedures performed during hospitalization (Spearman's ρ = 0.74), although the military inpatients yielded a higher proportion associated with pregnancy and strenuous activity (traumatic joint disorders and hernias) than their civilian counterparts. Conclusion: The practice content of military and civilian inpatients appear to be more similar than different. Reprint & Copyright © by Association of Military Surgeons of U.S., 1999
MC, Julie A. Plumbley, USAF;MC, Jack B. Shelton, Jr., USAF;MT(ASCP)SBB, Indra N. Bowlus,;MC, Bruce G. Ensign, USAF
doi: 10.1093/milmed/164.10.705pmid: N/A
Abstract The objective of the study was to determine the frequency of unexpected antibodies in a population of Air Force personnel thought to be representative of the population involved in combat situations. Recipients of blood transfusions in combat situations may not be screened for the presence of unexpected (non-A, non-B) antibodies. The records of the Wilford Hall Medical Center/59th Medical Defense Wing Donor Center and Transfusion Medicine Laboratory were reviewed for the calendar years 1995 and 1996 to determine the frequency of unexpected antibodies in this center's donor population, the vast majority of whom are Air Force basic trainees. The frequency of unexpected antibodies in the basic trainee donor population was 4/10,000. Clinically significant antibodies were present in 2/10,000. Because this donor pool probably represents the potential population of combat casualties, this information is reassuring in assessing the risks associated with blood transfusion in combat situations. Reprint & Copyright © by Association of Military Surgeons of U.S., 1999
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