关于加快转变空军卫勤保障力生成模式的理论思考

目的探讨加快空军卫勤保障力生成模式转变的理论基础。方法分析空军卫勤保障力生成要素和促进保障力生成模式转变的动因。结果论证提出了以转变思想观念为导向,以全面建设现代空军卫勤为契机,以空军科技创新为引擎,以创新型人才建设为导引,以空军卫生信息化建设为先导,大力推进空军卫勤保障力生成模式转变的理论思考。结论理清空军卫勤保障力生成模式转变的理论基础,为加快空军卫勤保障力生成模式转变提供理论支持。     

About development of medical maintenance of military air forces in modern conditions

The authors prove the necessity of transformation of medical service of Air Force of all levels within the framework of the realization of program "Development of medical supply of Armed Forces of Russian Federation 2008-2012". Goals, functions of different elements of medical service, responsibilities of performers are developed. These goals have fundamental differences from previous one. New organizational structure of medical service of Air Forces and criteria of the estimation of its effectiveness are suggested. Offers of further optimization of organizational medical structure and improvement of medical supply of Air Forces are developed.     

The role of the flight surgeon in Greece

From 1915 [corrected], the first time a flight surgeon participated in an aeromedical evacuation, to the present, the role has become more fundamental by working in wars and operations, experiencing search and rescue aeromedical evacuations from mass accidents or motor accidents, treating seriously ill individuals, and caring for wounded victims of attacks either at the scene or at the hospital. The improvements in cognitive and technological standards of medical science and in the education available have contributed in upgrading the role of flight surgeons; however, their presence in flight is considered essential in 20-60% of aeromedical evacuations, with the remainder of the flights being covered by paramedical personnel. In the Greek territory, the development of Air Force medicine began with the U.S. education of Panagiotis Korombilis, founder of the Center for Flight Crew Health Examination in 1936. In 1976, the Air Force Medical Center was established in the General Air Force Hospital while the educational and medical work of Air Force physicians led to the development of Air Force Medicine and supported Olympic Airways and Military Air Force development, which provides aircraft and personnel for patient aeromedical evacuations. An organized aeromedical evacuation system based on the National Health System, however, began operating in 1982 and was upgraded in 1994. Currently, the flight surgeon's work remains important in supporting the Military Air Force by offering regular examinations at the Air Force Medical Center for all personnel flying on civil and military aircrafts, and by educating all the Greek territory and Cypriot Air Force surgeons (of the National Emergency Assistance Center and the Military Services) at the Air Force Medical Center. Their presence at Air Force bases is important, as is their support of the overall well-being of flight personnel, their assistance in upholding the territory's future by improving aircraft and equipment and by purchasing search-rescue aeromedical evacuation helicopters and hospital aeromedical transportation aircraft capable of transporting seriously ill patients, their promotion of collaboration with other countries in educating Air Force surgeons, and in support of valuable human life according to the Hippocratic Oath.     

美国空军的医疗保障体系

借鉴与学习美国空军医疗保障体系与先进理念,以及稳定航空军医队伍的有效手段.主要引用美国空军两个网络资料,文献4篇,军标1个.这些资料表明,美国空军高层已形成共识——良好的医疗服务是飞行安全与战斗力的重要保障.因此,每年预算庞大的经费,以维持75个医疗中心、医院、诊所或医疗站的专一而高效地运转.而军事人员通用医疗保险制度(TRICARE)使三军人员就近就诊,大幅节省费用.全球搜救、空运医疗服务系统和分级健康维护与治疗,构成完备的医疗保障体系.航空军医则是保障空军全体官兵健康的重要前哨,通过分级培训与较高待遇,使航空军医在专业与生活水平两方面均能不断提升,有效地稳定了这支队伍.美国TRICARE制度可以借鉴,稳定航空军医队伍的手段值得学习.     

The Air Force Nurse Intern Program

The Air Force Nurse Intern Program is a 5-month-long introduction to Air Force nursing for BSN-prepared graduate nurses. The program is designed to facilitate the transition from civilian nursing student to practicing Air Force Nurse Corps Officer. After attending Military Indoctrination for Medical Service Officers, newly commissioned nurses attend the program at one of 10 Air Force medical centers before going to their permanent duty stations. Preceptors guide and instruct the interns at each of four clinical rotation sites. The author, a former nurse intern, describes some of the many opportunities available to nurse interns.     

Aviation medicine in the United Kingdom: early years, 1911-1918

This is the first of three brief papers that summarize the history of aviation medicine in the Royal Air Force. Just as the generals and politicians were slow to appreciate the potential of the airplane, so the medical establishment was slow in understanding that the flight environment involved medical and physiological challenges. This note outlines the development of research to support British military aviators up to the formation of the Royal Air Force in 1918.     

中美空军飞行学员医学选拔对照实证研究——神经精神系统疾病

目的 对比中美空军招收飞行学员医学选拔标准中神经精神系统部分的异同点,为我军飞行学员医学选拔标准的修改提出合理建议. 方法 统计2012~2015 年招飞医学选拔定选中进行神经内科检查的学员,并将不合格学员参比美军标准重新进行分类. 结果 因神经内科体检不合格的学员共123名,占总人数的1 .1%,但参比美军标准重新进行分类后,不合格人数为13人,占10 .6%,合格人数为24人,占19 .5%,其余86人需进一步检查以明确,占69.9%;两个标准的淘汰率具有显著性差异(P<0.001). 结论 中美招飞医学选拔标准中神经精神系统部分具有一定的差异,在标准修订时可适当借鉴美军标准.     

中美空军飞行学员医学选拔对照实证研究——男性乳腺疾病

目的 分析近年空军招飞定选中男性乳腺疾病分布,对比中美招飞医学选拔标准,以期为我军招飞医学选拔体系的完善提供支持.方法 回顾分析空军医学选拔中心近年招飞定选受检者男性乳腺疾病数据,运用美军招飞标准再次分析,对比中美招飞医学选拔标准差异.结果 2012—2015年受检者中检出男性乳房发育症(gynecomastia,GYN)12例,淘汰3例;男性乳腺增生6例,淘汰1例,男性乳腺疾病的患病淘汰率为22.22%.运用美军标准后3例被淘汰男性GYN受检者全部合格,1例被淘汰乳腺增生受检者由于资料不全难以判定.结论 中美招飞医学选拔男性乳腺疾病标准存在差异,美军招飞医学选拔标准更重视疾病对飞行的影响,结合我国青少年身体状况并借鉴国外招飞医学选拔标准才能制订出科学完善的空军招飞医学选拔体系.     

Ambulatory care teams: the dehassling of Air Force medicine

Lack of complete outpatient medical records is a chronic problem. Most facilities are only able to find 60% to 70% of records for appointments. Many records have incomplete laboratory and x-ray information. A program utilizing Ambulatory Care Teams (ACTS) was tested at the Air Force hospital at Carswell AFB. Records were pulled 48 hours prior to appointments, and the day prior to the appointment clinics endeavored to locate 100% of the records and reports. During a 1-year test period the staff at Carswell was able to produce or account for 98.2% of all medical records for more than 102,000 scheduled appointments.     

Quality of deployment surveillance data in southwest Asia.

The Global Expeditionary Medical System (GEMS), formerly known as Desert Care II, provides clinical data on every medical encounter that occurs at U.S. Air Force medical treatment facilities in theater. After 22 months of surveillance from March 1997 to January 1999, 59,026 records were generated from 27,305 active duty members. A random sample of 273 individuals were reviewed for four key fields: chief complaint, diagnosis, International Classification of Diseases, 9th Revision, code, and disease and nonbattle injury category. The vast majority (> 99%) of records were consistently classified and reported. An unrelated subset of all cases categorized as "Medical/Other" seen at Prince Sultan Air Base (5,640 records) also were analyzed. Reassignment was made in 19% of cases into other categories, suggesting that further refinement of disease and nonbattle injury reporting is needed for effective deployment medical surveillance. Overall, this electronic data-gathering system has high internal validity, consistency, and reliability for service members in the deployed U.S. Air Force setting.     

Effect of a computerized online grading system on patient satisfaction in a military primary health care setting

Patient satisfaction is gaining recognition as an important determinant of the quality of medical care. We conducted an analysis to evaluate the effect of a computerized online system that comparatively displays grades of patient satisfaction among primary care military infirmaries. Fifteen Israel Air Force primary care infirmaries served as the intervention group, and 130 Israel Defense Force infirmaries were the control group. Baseline patient satisfaction was surveyed in all infirmaries. In the intervention group only, infirmaries were resurveyed at 3-month intervals during a 1-year period. Satisfaction scores were continuously displayed on an intranet site in a comparative graphical manner by using the computerized system, available only to the intervention group. At the endpoint, patient satisfaction improved in both groups. However, the magnitude of improvement in the intervention group was significantly greater, in comparison with the control group. The most pronounced improvement was noted in availability of service (intervention group, 57.9% at baseline vs. 66.0% at endpoint, p < 0.001; control group, 67.5% vs. 69.6%, p < 0.025). We conclude that the use of this computerized system in conjunction with promotional efforts resulted in significant improvements in patient satisfaction.     

Air Force expeditionary medical support unit at the Houston floods: use of a military model in civilian disaster response

From June 6 to 10, 2001, Tropical Storm Allison delivered 40 inches of rain to the city of Houston, Texas. Nine of the city's hospitals were closed or severely curtailed services as a result of the flooding. All area hospitals were full to capacity, intensive care unit beds were unavailable, and patient wait times for emergency department care were 18 to 21 hours. Emergency department and intensive care unit congestion placed the entire emergency medical system of Houston in jeopardy. In response to a Federal Emergency Management Agency request, the Air Force deployed a 25-bed expeditionary medical support field hospital to Houston on June 13, 2001. The expeditionary medical support unit treated its first patient only 3.5 hours after arrival and was fully operational 8 hours later. During its 11-day stay, the facility treated 1,036 patients, including 312 ambulance arrivals, 48 inpatients, and 33 intensive care unit patients, and performed 33 dental procedures and 16 operations.     

Frontotemporal dementia affecting a U.S. Air Force officer

We present the case of a 51-year-old former U.S. Air Force officer who developed marked behavioral and personality changes over a 9-year period, ultimately leading to his discharge from the Air Force at a rank below that which he achieved during service. Clinical diagnostic features, neuropsychological testing and neuroimaging together confirmed a diagnosis of frontotemporal dementia. This form of presenile dementia is discussed with reference to his case.     

The problems of assessment of the high noise impact on the experts of the Air Force

Air Force specialists are exposed to high intensity noise levels exceeded the maximum permissible levels. Infrasound as a productive factor in accordance with the general technical requirements (OTT) Air Force-86 is not included in the list of standardized factors. The adverse acoustic environment makes the risk of occupational (sensorineural deafness) and professionally-related diseases of the nervous and cardiovascular systems. The system of physical fitness for military service in the Air Force and serving in the Air Force with high-intensity sources of noise, the system of treatment and preventive measures for adverse effects of noise and the procedure for examination of persons with diseases caused by the influence of noise are needed to be reviewed in accordance with the existing state legislative frameworks.     

航空供氧生理学的研究与应用

简要概述了航空医学研究所建所40年来航空供氧生理学研究的发展，重点阐述了近10年的研究成果，并对航空供氧生理研究设备和鉴定方法的发展作了介绍。资料来源为已发表的有关研究论文和课题档案资料。着重介绍已应用的研究成果和鉴定试验设备、方法。分供氧生理学基础研究、各型号供氧装备卫生保障研究、高空供氧装备生理学研究、低总压简化供氧装备研究、鉴定试验方法及设备等几部分进行综述。     

中美空军飞行学员医学选拔对照实证研究--扁平足

目的：探讨中美两军飞行学员选拔扁平足医学标准的不同,并对我军标准改革提供一种思路。方法调查2012—2015年我军招飞定选体检中扁平足淘汰率与综合评定（简称综评）合格率,对比我军与美军飞行学员选拔扁平足医学标准,并进行实证研究。结果2012—2015年我军招飞定选体检因扁平足淘汰52例,占骨科疾病淘汰人数的26.40%,扁平足患者综评合格人数为87例,占骨科疾病综评合格人数的37.18%。中美两军关于扁平足医学选拔标准主要区别在于美军标准注重功能,无形态方面要求,我军标准仅有形态学要求。按照美军标准,我军因扁平足淘汰的52例中43例合格,9例不合格;我军扁平足患者综评合格的87例中79例合格,8例不合格。结论招飞定选体检中,因扁平足淘汰的人数较多。我军扁平足医学选拔标准与美军标准差别较大,我军实施的综评机制中考虑功能因素,将是一种较为合理的机制。     

中美空军飞行学员医学选拔对照实证研究--视网膜格样变性

目的：通过对比中美招收飞行学员医学选拔标准中关于视网膜格样变性的要求,分析2012—2015年空军招飞定选学员体检数据,为我军招飞体检标准完善积累数据和资料。方法对比中美招飞医学选拔标准,参照美军标准重新判定近4年招飞定选阶段格样变性淘汰学员体检数据,探讨我军标准的不足。结果参考美军标准,我军招飞定选中部分被淘汰的学员可能具备执行飞行任务的能力,即存在误淘现象。近4年共检出并淘汰66例视网膜格样变性学员,其中11例学员可能被误淘,比例为16.7%。结论我军在《空军招收飞行学员体格检查标准（试行）》中,缺少关于视网膜格样变性的详细标准。应当参考美军标准完善我军现行标准,并长期跟踪入选的学员成飞比例,进而为我军制定更为成熟、完善、合理的招飞标准积累数据和依据。     

Tri-service optometry productivity findings and benchmark recommendation

OBJECTIVE: The 2005 Tri-Service Relative Value Unit (RVU) Production for Optometric Services is examined and used as a basis to provide military leadership with a realistic, evidence-based benchmark recommendation. METHODS: The Fiscal Year 2005 RVU Production for Optometric Services was collected. Statistical analysis was performed to determine the mean RVU per patient per clinic for each military service. The results were used to develop a global benchmark. RESULTS: The tri-service RVU per patient per clinic was determined to be 1.33 RVU or 1.45 RVU depending on the method of calculation. Navy and Air Force optometry clinics had higher average RVU outputs compared to that of the Army. Statistical analysis revealed that the Army's RVU production was significantly different from the other services, while the Navy and Air Force did not have significant differences in their means. CONCLUSIONS: A benchmark of 1.45 RVU per patient translates into a daily RVU benchmark recommendation of 18.85.     

人-机-环境系统工程中航空卫生保障工作是重要环节（摘要）

高性能战斗机是一个复杂的人-机-环境系统,航卫保障对保持和提高飞行员能力素质具有重要意义。在空军的军事训练中,需要加强专业训练措施,进一步密切人一机结合。因此,建议抓紧建立新的航空卫生保障内容标准体系并完善航空卫生的保障体制。