A Study to Determine the Proportionate Number of U.S. Army Retirees, Retiree Family Members, and Active Duty Family Members Living Within the Champus Catchment Area of Martin Army Community Hospital

1988 ◽  
Author(s):  
Robert T. Foster
Keyword(s):  
Catchment Area ◽  
Community Hospital ◽  
Family Members ◽  
Active Duty ◽  
Proportionate Number

Malignant Hyperthermia—A Case From Camp Humphreys, South Korea, and Lessons for the Military Health System

2021 ◽  
Author(s):  
Paige Wren ◽  
Sung Min Chun ◽  
Robert Vietor
Keyword(s):  
South Korea ◽  
Malignant Hyperthermia ◽  
Health System ◽  
Community Hospital ◽  
Active Duty ◽  
Military Health System ◽  
Military Health ◽  
Dantrolene Sodium ◽  
Bilateral Sagittal Split Osteotomy ◽  
The Military

ABSTRACT Although malignant hyperthermia (MH) is a well-known complication of anesthesia, it presents unique considerations in the military health system. In this case report, the authors present a 26-year-old male active duty service member who experienced an MH crisis during a routine bilateral sagittal split osteotomy. The case presented here, which occurred at Brian D Allgood Army Community Hospital at Camp Humphreys, South Korea, highlights the challenges presented when caring for these patients in minimally staffed environments with frequent turnover of staff. The authors discuss the challenges to the military system such as the importance of adequate documentation of MH-susceptible service members, the benefits of rapidly dissolving dantrolene sodium nanosuspension, and the necessity for frequent training of military medical staff in the recognition and management of MH.

Use of Local Community Hospital Data for Surveillance of Antimicrobial Resistance

2006 ◽  
Vol 27 (3) ◽  
pp. 299-301 ◽  
Author(s):  
Susan M. Farner
Keyword(s):  
Streptococcus Pneumoniae ◽  
Confidence Interval ◽  
Catchment Area ◽  
Local Community ◽  
Community Hospital ◽  
Antibiotic Use ◽  
Hospital Data ◽  
Susceptibility Data ◽  
Central Illinois ◽  
Local Antibiotic

We sought to determine whether antimicrobial susceptibility data from a nonteaching community hospital could be used to detect statistically significant local increases in resistance among Streptococcus pneumoniae over a 5-year period. Minimum inhibitory concentrations (MICs) of penicillin and ceftriaxone from 1997-1998 were compared with those from 2000-2001. MICs of penicillin and ceftriaxone for organisms collected in a nonteaching community hospital in central Illinois were used for analysis. The hospital has 224 beds and a catchment area of approximately 40 miles. There were significant increases in MICs of penicillin and ceftriaxone between 1997-1998 and 2000-2001. The MIC of penicillin increased from 0.042 to 0.121 μg/mL (P = .001; 95% confidence interval, -1.713 to -0.388), and the MIC of ceftriaxone increased from 0.028 to 0.071μg/mL (P = .005; 95% confidence interval, -1.353 to -0.188). There were no significant changes in the percentage of S. pneumoniae isolates that were resistant, intermediate, or susceptible to penicillin and ceftriaxone. MIC data from a community hospital can be used to detect local increases in the rate of resistance before antibiogram data show significant changes. This information is important for demonstrating to physicians the need to review local antibiotic use in the attempt to slow the development of resistant organisms in the community.

Family military leave—A growing national trend for employees with active‐duty family members

2008 ◽  
Vol 35 (2) ◽  
pp. 69-74
Author(s):  
William C. Martucci ◽  
Katherine R. Sinatra
Keyword(s):  
Family Members ◽  
Active Duty ◽  
National Trend

Shared Decision-Making During Labor and Birth Among Low-Risk, Active Duty Women in the U.S. Military

2021 ◽  
Author(s):  
Stacey E Iobst ◽  
Angela K Phillips ◽  
Candy Wilson
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Family Members ◽  
Hospital Setting ◽  
Active Duty ◽  
Theory Approach ◽  
Labor And Delivery ◽  
Shared Decision ◽  
Cesarean Birth ◽  
The U.S

ABSTRACT Introduction The cesarean birth rate of 24.7% in the Military Health System (MHS) is lower than the national rate of 31.7%. However, the MHS rate remains higher than the 15-19% threshold associated with optimal maternal and neonatal outcomes. For active duty servicewomen, increased morbidity associated with cesarean birth is likely to affect the ability to meet the demands of assigned missions. Several decision-points occur during pregnancy and after the onset of labor that can affect the likelihood of cesarean birth including choice of provider, choice of hospital, timing of admission, and type of fetal monitoring. Evidence suggests the overuse of labor interventions may be associated with cesarean birth. Shared decision-making (SDM) is a strategy that can be used to carefully consider the risks, benefits, and alternatives of each labor intervention and is shown to be associated with positive patient outcomes. Most existing evidence explores SDM as an interaction that occurs between women and their providers. Few studies have explored the role of stakeholders such as spouses, family members, friends, labor and delivery nurses, and doulas. Furthermore, little is known about the process of SDM during labor and childbirth in the hospital setting, particularly for active duty women in the U.S. military. The purpose of this study was to propose a framework that explains the process of SDM during labor and childbirth in the hospital setting for active duty women in the U.S. military. Materials and Methods A qualitatively driven mixed-methods approach was conducted to propose a framework that explains the process of SDM during labor and childbirth in the hospital setting for active duty women in the U.S. military. Servicewomen were recruited from September 2019 to April 2020. Semi-structured interviews were analyzed using a constructivist grounded theory approach. Participants also completed the SDM Questionnaire (SDM-Q-9). Results Interviews were conducted with 14 participants. The sample included servicewomen from the Air Force (n = 7), Army (n = 4), and Navy (n = 3). Two participants were enlisted and the remainder were officers. Ten births occurred at military treatment facilities (MTFs) and six births took place at civilian facilities. The mean score on the SDM Questionnaire was 86.7 (±11.6), indicating a high level of SDM. Various stakeholders (e.g., providers, labor and delivery nurses, doulas, spouses, family members, and friends) were involved in SDM at different points during labor and birth. The four stages of SDM included gathering information, identifying preferences, discussing options, and making decisions. Events that most often involved SDM were deciding when to travel to the hospital, deciding when to be admitted, and selecting a strategy for pain management. Military factors involved in SDM included sources of information, selecting and working with civilian providers, and delaying labor interventions to allow time for an active duty spouse to travel to the hospital. Conclusions SDM during labor and birth in the hospital setting is a multi-stage process that involves a variety of stakeholders, including the woman, members of her social and support network, and healthcare professionals. Future research is needed to explore perspectives of other stakeholders involved in SDM.

Capgras Syndrome: Possibly More Common Among the Maori of New Zealand

2000 ◽  
Vol 34 (5) ◽  
pp. 865-868 ◽  
Author(s):  
Catherine Mackirdy ◽  
Debbie Shepherd
Keyword(s):  
New Zealand ◽  
Rural Area ◽  
Catchment Area ◽  
Family Members ◽  
European Population ◽  
Cannabis Use ◽  
Psychotic Illness ◽  
History Of ◽  
Capgras Syndrome ◽  
The City

Objective: The report describes an apparently greater incidence of Capgras syndrome among the Maori population compared with the European population, in the most easterly catchment area served by Tauranga Hospital in New Zealand's Bay of Plenty. Method: Over the last year we have become aware of five cases of Capgras syndrome in our catchment area. This area (population nearly 21 000) consists of a rapidly expanding new suburb of the city of Tauranga and a rural area extending 55 km east of the city. These figures were compared with those of the westerly catchment area served by Tauranga Hospital, where the psychiatric team is not aware of any examples of Capgras syndrome among their population. The 1996 census figures were obtained in order to calculate a population ethnicity breakdown. Results: Five cases of Capgras syndrome were identified in the most easterly catchment area where 19% of the population identified as Maori, 75% as European and 6% as other or non-specified. All of the cases occurred in Maori patients. This compares with no identified cases of Capgras syndrome in the most westerly catchment area where 12% of the population identified as Maori, 87% as European and 1% as other or non-specified. Four out of five cases were female. Two cases had a history of cannabis use. Three cases had exhibited dangerous behaviour towards family members. Conclusions: There is an apparently greater incidence of Capgras syndrome among the New Zealand Maori population compared with the European population in the most easterly catchment area served by Tauranga Hospital. In our population Capgras syndrome is a common, not rare, feature of psychotic illness, and the cases support a previously reported association of this syndrome with dangerousness.

scholarly journals Civilian-military Collaboration: Department of Defense data in the BioSense Platform

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Jessica Deerin ◽  
Jean-Paul Chretien ◽  
Paul E. Lewis
Keyword(s):  
Department Of Defense ◽  
Family Members ◽  
Active Duty ◽  
Surveillance Program ◽  
Age Group ◽  
Diagnosis Codes ◽  
Time Period ◽  
Control And Prevention ◽  
Military Treatment Facility ◽  
Clinic Visits

ObjectiveThe Department of Defense data is available to NationalSyndromic Surveillance Program (NSSP) users to conduct syndromicsurveillance. This report summarizes the demographic characteristicsof DoD health encounter visits.IntroductionThe DoD provides daily outpatient and emergency room data feedsto the BioSense Platform within NSSP, maintained by the Centersfor Disease Control and Prevention. This data includes demographiccharacteristics and diagnosis codes for health encounter visits ofMilitary Health System beneficiaries, including active duty, activeduty family members, retirees, and retiree family members. NSSPfunctions through collaboration with local, state, and federal publichealth partners utilizing the BioSense Platform, an electronic healthinformation system.MethodsDoD data was pulled from the BioSense Platform through aRStudio server on October 11, 2016, querying data from November1, 2015 to September 30, 2016. Appointment type and beneficiarycategory data was not available in BioSense until November 1, 2015.Appointment type was categorized into clinic visits and telephoneconsults. Demographic characteristics (age group, gender, beneficiarycategory) are stratified by appointment type.ResultsDuring the time period of November 1, 2015 to September 30, 2016,data were received from 452 clinics. There is a military treatmentfacility located in 45 states and a military treatment facility mayhave one to 12 clinics. There were a total of 86,840,632 healthcareencounter records. The age group, 25-44 years, accounted for 39.4%of the medical encounters; the mean age was 33.9 (SD=19.1). Malesaccounted for 55.6% of the medical encounters. For the time periodfrom November 1, 2015 to September 30, 2016, 78.9% of medicalencounters were clinic visits. The remaining medical encounterswere telephone consults. Of the clinic visits, 53.7% of the medicalencounters were for active duty personnel.ConclusionsThis report highlights the DoD data available to NSSP users forcollaborative syndromic surveillance efforts, promoting a communityof practice. It is important to understand the population demographicsand limitations to the DoD data when conducting syndromicsurveillance.

P4636Major gastrointestinal haemorrhage of patients with ongoing anticoagulants presented to the emergency department of a community hospital: four-year survey

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Conti ◽  
N Renzi ◽  
G Bini ◽  
A Covelli ◽  
M Mazzucchelli ◽  
...  
Keyword(s):  
Catchment Area ◽  
Community Hospital ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Gastrointestinal Haemorrhage ◽  
Upper Tract ◽  
Pharmacological Approach ◽  
Short Term Mortality ◽  
Area Under Roc Curve ◽  
Sensitivity Specificity

Abstract Objective To look for outcomes of patients (pts) with major gastrointestinal haemorrhage (mGIH) and ongoing anticoagulants out of four-year survey of community hospital with catchment area 197,722 inhabitants, of whom 15,267 with Warfarin (W) and 10,397 with direct oral anticoagulants (DOACs). DOACs were available for prescription in the catchment area since 4 years (dabigatran and rivaroxaban), 3 years (apixaban), and 2 years (edoxaban). Methods Haemorrhage (n=1,919) were submitted to propensity score matching for major bleeding; mGIH were enrolled and stratified according to ongoing W or DOACs. Primary endpoint was one-month death. Results Out of 476 mGIH, 73 pts received anticoagulants; 22 DOACs and 51 W; p=0.0006. Of note mGIH on W accounted for 2.7% (51/1,919) per year of pts, and 0.08% (51/15,267) of the catchment area. Conversely, mGIH on DOACs accounted as follows: dabigatran (n=10/476) 0.53%, rivaroxaban (n=6/476) 0.32%, apixaban (n=5/476) 0.35%, and edoxaban (n=1/476) 0.11% per year of pts; p=0.117. Rate of mGIH and DOACs versus (vs) rate of mGIH and W as follows: less than (−) 5 fold (2.7x100/0.53) of dabigatran vs W, p=0.004; −8 fold (2.7x100/0.32) of rivaroxaban vs W, p=0.0002; −7 fold (2.7x100/0.35) of apixaban vs W; p=0.ehz745.10188, and −25 fold (2.7x100/0.11) of edoxaban vs W; p=0.ehz745.101801. However no difference versus the catchment area per year (0.723): 0.07% (10/3,373) dabigatran, 0.04% (6/4,046) rivaroxaban, 0.08% (5/2,141) apixaban, 0.06% (1/839) edoxaban. Overall, one-month death accounted for 10/476 (2.1%). Of note 236 mGI were from the upper tract and 240 from the lower tract. Among upper tract, 10 pts received DOACs (4 dabigatran, 4 rivaroxaban, 2 apixaban, and 0 edoxaban) and 21 received W. One-month death was 0/10 DOACs versus 1/21 W, p=0.483. Among lower tract, 12 pts received DOACs (6 dabigatran, 2 rivaroxaban, 3 apixaban, and 1 edoxaban) and 30 pts received W; one-month death was 0 for every groop. Anticoagulant reversal treatment was given to 6/22 (27%) pts with DOACs versus 18/51 (35%) with W, p=0.014; transfusion to 6/22 (27%) versus 11/51 (22%), respectively, p=0.306; admission 19/22 (86%) versus 42/51 (82%), respectively, p=0.004. Sensitivity/specificity ratio of variables and biomarkers for aggressive pharmacological approach were obtained by area under ROC curve (AUC) >0.50. PTT value >37 sec (AUC 0.57) showed sensitivity 15%, specificity 90%; INR value >1.4 (0.50), sens 15%, spec 80%. In addition, warfarin (0.49) sens 15%, spec 80%; age ≥75 years (0.48) sen 60%, spec 40%. Gastrointestinal bleeding: flow-chart. Conclusion Out of four-year survey, pts with ongoing DOACs were less likely to have mGIH when compared to W. Patients with W were more likely to receive reversal tratment; pts with DOACs were more likely to undergo admission. Short-term mortality of pts with W was higher than DOACs. Aggressive pharmacological approach should be driven by PTT, INR, ongoing warfarin, and older age.

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