Family physician resource use for inpatient care: a comparison between military medical center and community hospital

OBJECTIVE: Family physicians' use of resources in different inpatient settings has not been explored. The hypothesis is that family physicians use fewer resources in a community hospital than in a medical center. METHODS: Patients consecutively discharged from the family practice services of an academic medical center and a community hospital (5,060) were compared with respect to length of stay, testing, and consultation rate. RESULTS: The military academic medical center had an increased average length of stay, diagnostic testing, and consultations on univariate analysis. However, on multivariate analysis, length of stay was no different but the laboratory testing and consultation rate were higher for the academic center. CONCLUSION: Family physicians at this military academic medical center used more testing and requested consultations more often than those practicing in a community hospital, controlling for patient demographics and illness severity. There may be a culture at the academic center that encourages increased use of resources.     

Trauma care in a military hospital.

The results of a quinquennial audit of trauma care in the Cambridge Military Hospital using the TRISS method is presented. 113 cases were analysed. The mean age was 32 years and the mean Injury Severity Score 16. Twenty-five deaths occurred of which 12 were potentially preventable. Means of reducing the number of preventable deaths are discussed.     

Patients presenting with birth plans in a military tertiary care hospital: a descriptive study of plans and outcomes

OBJECTIVES: This study evaluates what type of patient prepares a birth plan, identifies common requests made, and determines how closely these are followed during labor. METHODS: Patients who were admitted in labor with birth plans during a 3.5-year period were identified. Birth plans were analyzed, and common requests were recorded. Delivery records were reviewed, and outcomes were recorded. This study was approved by the hospital institutional review board. RESULTS: Sixty-seven birth plans with delivery outcomes were available for review. The mean maternal age was 31 years, the median parity was 0, and 70% of patients had a college degree. The most common requests were to walk during labor (84%), to avoid episiotomy (82%), and to have no epidural (62%). Seventy-five percent of patients had spontaneous vaginal deliveries, and 19% had cesarean sections; the epidural use rate was 59%. CONCLUSIONS: Patients with birth plans were generally older and well-educated and, despite plans to avoid an epidural, most patients changed their minds.     

Characteristics of road traffic accident casualties admitted to a tertiary care hospital in Sri Lanka

The mortality and morbidity of road traffic accidents (RTA) is increasing in the South Asian region, including Sri Lanka. Therefore, the demographic factors, types of vehicles involved, and the severity of injuries sustained in RTA was studied. Age, gender, and details of the incident of all patients admitted to hospital following a RTA, between January 2007 and August 2012, were obtained by interview. Following a medico-legal examination, the type and severity of injuries was categorized as, non-grievous, grievous, endangering life or fatal in the ordinary course of nature. Of the 579 RTA casualties examined, 72% were males, 28% females, and 26% were in the 20–29 year age group. There were 44% passengers, 32% drivers, and 20% pedestrians. Of the 440 vehicle occupants, 37% were on motor cycles, 28% in three wheelers, 13% in dual purpose vehicles and 11% in buses. Of the 114 pedestrians, 33% had been struck by motor cycles, 19% by three-wheelers and 17% by dual purpose vehicles. There was at least one soft tissue injury in 84%, whilst 45% had one or more fractures. In 85% of bicycle riders, the injuries were grievous, endangering life or fatal in the ordinary course of nature. A high proportion of young adults sustained grievous injuries due to RTA. Almost two thirds of the casualties resulted from motorcycle or three wheeler accidents. Laws limiting the number of passengers carried, installation of side doors, mandatory use of seat belts in three wheelers, and protective garments for motorcyclists are recommended.     

Psychiatric care of the homeless mentally ill: an opportunity for military psychiatry training

This paper reviews the phenomenon of homelessness in the United States and locally in Washington, D.C. Prevalence data of psychiatric illness in the homeless is presented, as is the formation of a psychiatric service network to treat the homeless mentally ill. Additionally, the author describes the development of an innovative training program in community psychiatry, focusing specifically on issues inherent in understanding the work of the psychiatric resident in community-based training and service delivery. The relevance of this experience to military medicine involves training psychiatric residents to develop service-delivery schemes in times of rapidly expanding mental health needs, such as combat.     

A sick child day care unit in a military hospital

Sick child day care units have been developed to provide care for children who are excluded from day care because of illness. We implemented a sick child day care unit at a military hospital. In the first year of operation, 526 children were admitted to the unit, with a daily average of 1.9 children and a range of 0-9 children. The most common admission diagnoses were: otitis media (21.3%), upper respiratory infection (19.4%), gastroenteritis (10.6%), and viral syndrome (10.5%). A sick child day care unit in a military hospital can provide a useful service to dependent children, their parents, and the military.     

Accuracy of death certification in two tertiary care military hospitals

To determine the number and type of errors in death certifications, death certificates and corresponding postmortem examination results for 98 patients were analyzed at two tertiary care military hospitals. Of the 98 death certificates, errors were found in 36 (37%). The most prevalent type of error was the use of a nonspecific diagnosis as the underlying cause of death (22 of 36 errors, 61%). No errors were found in the listed manner of death. Given the high prevalence of errors found in death certification, recommendations are made to ensure the proper completion of death certificates. In addition, it is suggested that for patients who are to undergo postmortem examination, the immediate, any intermediate, and the underlying cause of death may be listed as "pending" so that the clinician can use the autopsy results in the completion of the death certificate.     

Tuberculosis skin test conversion rates evaluated at an overseas military hospital

As a result of a perceived increase in purified protein derivative skin test converters, purified protein derivative skin testing of hospital staff and epidemiological evaluation were undertaken. A possible common source of tuberculosis exposure was identified and evaluated. This patient was skin test positive but never provided prophylactic treatment in Spain, and normal case management procedures failed. The Andalusia region, where the naval base is located, has a reported rate of about 15 new tuberculosis cases per 100,000 persons per year, whereas the rate for the entire country of Spain is 22 per 100,000 persons. More than half of the new cases of tuberculosis reported in Spain come from this region. As a result of this work, improved personal prevention programs were instituted and hospital and base orientation regarding the unique risk of tuberculosis in this region was improved.     

拓展医疗市场提升军队医院服务品牌

作为一所军队医院在做好为军服务的同时,积极参与地方卫生事业,努力为驻地老百姓服务,近几年来我院在西部地区就拓展医疗市场,提升服务品牌做了一些探索。 1 形势与挑战 1．1 医疗市场潜力巨大随着人民生活水平的日益提高,人民卫生需求也在不断增长。不但越来越多的人选择到医院看病,而且健康需求已经从简单的看病治病发展到健康保健、医     

某三级甲等医院医务人员锐器伤发生情况调查

 目的 了解某三级甲等医院医务人员锐器伤发生情况,发现危险因素,提出预防与控制措施,降低锐器伤发生率。方法 采用问卷调查法,对某三级甲等医院2017-04医务人员发生锐器伤情况进行回顾性调查。结果 在调查的1184名医务人员中,发生锐器伤19人,锐器伤发生率为1.60%。不同工作类别医务人员发生锐器伤差异有统计学意义,护士锐器伤发生率高于医技人员;不同性别、工作年限医务人员发生锐器伤差异无统计学意义。锐器伤高发科室为普通病房,占78.95%;高发操作环节为静脉/皮下注射,占36.84%;高发器具为一次性注射器,占36.84%。结论 2017-04某医院锐器伤发生人群集中在护士,发生场所集中在普通病房,发生时机集中在静脉/皮下注射,发生器具集中在一次性注射器,应加强对高危人群、高发环节的监管,规范操作,降低锐器伤发生率。     

A cluster of disseminated coccidioidomycosis cases at a US military hospital

We recently evaluated a cluster of cases of disseminated coccidioidomycosis referred to the Naval Medical Center San Diego. Between March and June of 2002, seven cases were diagnosed and treated. In a 5-year record review (March 1997-February 2002), we found only seven cases of disseminated disease attributable to Coccidioides immitis at the same institution. This report of seven cases over a 3-month period represents a 20-fold increase in the number of complicated C. immitis infections. All cases were non-Caucasians, had disseminated disease to bone and/or skin without meningeal involvement, and had a delay of 1.5 to 6 months from symptom onset until the diagnosis of coccidioidomycosis. Four of our cases occurred in previously healthy, young active duty members, emphasizing the importance of this mycosis in U.S. military personnel.     

Evaluation of an educational intervention for military tobacco users.

This study evaluated the short-term effect of a one-time tobacco hazard education intervention on tobacco use and intention to quit among military tobacco users. Of the 151 Army infantry soldiers who received the intervention, 60 (40%) participated in a 1-month follow-up survey. Respondents' reported pre-intervention tobacco habits included 51% smoking, 22% smokeless tobacco use, and 27% both. A one-group, posttest-only design demonstrated a decline in tobacco use in more than half of tobacco users: 14% quit, and 37% decreased use. However, 46% stayed the same, and 3% increased use. A statistically significant difference in tobacco use existed among the three subgroups of tobacco users (p = 0.004). Smokeless-tobacco-only users were more likely to quit than smoking-only or combined users. Eighty percent had positive thoughts or actions toward quitting tobacco use after the intervention. Results suggest that a one-time tobacco education intervention can positively influence tobacco use in the short term and motivate tobacco users toward quitting.     

Kerosene-a toddler's sin: A five years study at tertiary care hospital in western India

Acute kerosene poisoning is a preventable health problem in children perceived mainly in developing countries. It influences socioeconomic and cultural status of country due to its contribution in morbidity and mortality. As kerosene is widely used as household energy source in India at rural areas as well as urban, it accounts for significant number of poisoning cases mainly accidental in manner. As there are only handful studies from India on kerosene poisoning in children, we planned this study to evaluate incidence of kerosene poisoning in Western Indian population and its clinico-epidemiotoxicological profile. In this retrospective cross-sectional study, we collected data of all the cases of kerosene poisoning diagnosed during five years from 2009 to 2013 at Shri Krishna hospital situated at Karamsad, Gujarat state of Western India. We observed among total 42 cases, all victims were under 3 years of age. Evening in summer months, rural areas, storage of kerosene in household containers, inadequate parental supervision and door-to-hospitalization period emerged as most serious associated factors. Fever, cough, vomiting, tachypnoea and leucocytosis were commonest manifestations while pneumonia was the most common complication. Signs of central nervous system involvement, leucocytosis and vomiting were significantly correlated with pneumonia. Deaths occurred due to pneumonia. Early diagnosis and treatment of pneumonia may reduce mortality and recommendations are made to reduce the incidence of kerosene poisoning.     

Pattern of deaths in paediatric population- An autopsy based study done at a tertiary care hospital in New Delhi

The study was done retrospectively at Lady Hardinge Medical College, New Delhi to assess the pattern of Paediatric deaths among total paediatric autopsies conducted from year 2019–2021. All Deaths among the individuals less than 18 years of age were studied and statistical analysis was done. During the three-year study period from year 2019–2021, 41.2% were females and 58.8% were males in total 17 paediatric autopsies conducted in the year 2019. 60% female, 40% male among total 15 cases in the year 2020 and 58.3% female, 41.7% male among total 12 cases of paediatric autopsies conducted in the year 2021. On distribution of number of cases in a particular year of study as per the manners of paediatric autopsy cases conducted from year 2019–2021, 40% accidental deaths were recorded in 2019 and 2020 each. The accidental deaths were recorded in 20% cases in the year 2021 among total cases of paediatric autopsy done. Total number of homicidal deaths recorded was 50%, 12.5% and 37.5% in 2019, 2020 and 2021, respectively. The natural cause of death was in 38.5% cases in the year 2019; 46.2% and 15.4% were died of natural cause in the 2020 and 2021, respectively. Total number of suicidal deaths recorded was 25% in 2019 and 2020 each year and 50% in 2021. Out of total number of cases 23% and 21% were having history of hospital deaths and fall from height, respectively. Out of the total cases of paediatric autopsy done 16% cases each were died due to asphyxia deaths and septic shock. The cerebral damage was cause of death in 14% cases and 11% cases each were died of craniocerebral damage and haemorrhagic shock. The bilateral pneumonitis was cause of death in 7% cases and 5% cases each were died of strangulation, aspiration pneumonia, poisoning.