Air Force Hospital Research Articles

Fernando Valderrábano, MD 1942 - 2001

Fernando Valderrábano died of cancer on September 6, 2001, at the age of 59. He graduated in medicine from the University Complutense of Madrid in 1965 and trained in nephrology at the Hospital Puerta de Hierro in Madrid. In 1969 he moved to the Hospital Gregório Merañon in Madrid. Eventually he became director of nephrology services, which he had founded, and full professor of medicine/nephrology at the University Complutense of Madrid. Fernando Valderrábano was a member of many respected national and international professional societies. He was president of the Spanish Society of Nephrology, a council member of the European Renal Association-European Dialysis Transplant Association (ERA-EDTA) from 1988 to 1991, member (1991-1994) and chairman (1994-1997) of the ERA-EDTA registry, and president of the ERA-EDTA Congress 1999 in Madrid. He also was a member of the International Society of Nephrology's Commission on Global Advancement of Nephrology. Fernando Valderrábano received many awards, including honorary membership in the Societies of Nephrology of Portugal (1989), Chile (1990), Argentina (1991), Cuba (1992), Uruguay (1993), Spain (1993), Columbia (1994), Bulgaria (1995), and Venezuela (1996). He received the Golden Medal of the Argentinian Society of Nephrology, the International Distinguished Medal of the National Kidney Foundation, and the Merit Medal of the Spanish Air Force Hospital. He also received the award of the Spanish Society of Nephrology for the best paper published in the journal “Nefrologia” (1991) and the award of the Portuguese Society of Nephrology for the best paper published in “Revista Portuguesa de Nefrologia e Hipertensão” (1995). Fernando Valderrábano was a subject editor for Nephrology Dialysis Transplantation and also the Journal of Nephrology. He served for many years as a reviewer for the American Journal of Kidney Diseases and also was a member of the AJKD editorial board from 1994 to 1999. Dr Valderrábano published more than 300 articles in national and international medical journals. He was editor of eight books in nephrology and wrote 28 chapters in different books and textbooks. His main scientific activities were dedicated to the fields of renal anemia and the quality of life of patients with chronic renal failure. Before he died, Dr Valderrábano completed an in-depth review on “Quality of Life in End-Stage Renal Disease Patients,” which appeared in the September 2001 issue of AJKD. Many of his outstanding professional activities were dedicated to Latin America. We have lost an oustanding nephrologist, an engaging personality, and a great friend that we will never forget. We will miss Fernando Valderrábano.

Liver Biopsy in Psoriatic Arthritis to Detect Methotrexate Hepatotoxicity

The use of methotrexate in the treatment of psoriatic arthritis is associated with risk of hepatotoxicity. However, monitoring of liver-associated enzymes often lacks sensitivity, and guidelines for serial liver biopsies in psoriatic arthritis are not yet well established. We performed a retrospective review of all patients with psoriatic arthritis receiving methotrexate who were enrolled in the disease-modifying anti-rheumatic drug clinics (DMARD clinics) at the Air Force and Army hospitals in San Antonio, Texas. Information was obtained regarding methotrexate regimen, liver-associated enzyme results, and liver biopsy results. Thirty psoriatic arthritis patients were taking methotrexate in the DMARD clinics. Seventeen patients had a total of 21 biopsies. Biopsies were performed for surveillance dictated by cumulative dose. Liver biopsies were graded on Roenigk scale of I-IV where I is mild steatosis, II is moderate steatosis, IIIa is mild fibrosis, IIIb is severe fibrosis, and IV is cirrhosis. Ten biopsies were grade I, 5 were grade II, 5 were grade IIIa, 1 was grade IIIb, and none were grade IV. In this very small retrospective study, regular monitoring of liver-associated enzymes did not correlate with histologic deterioration in our patients. Until prospective studies are performed, we suggest that routine liver biopsies are necessary to monitor for methotrexate hepatotoxicity in psoriatic arthritis.

Acute Pain Management Services: A Comparison Between Air Force and U.S. Hospitals

The purpose of this descriptive study was to assess the prevalence of acute pain management services (APMS) in Air Force medical facilities. There are no published reports on the current status of Air Force pain programs. This study used a telephone survey to all facilities worldwide that house an anesthesia department. Anesthesia providers in charge of pain services or department chiefs were interviewed from December 1996 to May 1997. Respondents were asked questions related to the initiation of a formal APMS, components, and familiarity with the Agency for Health Care Policy and Research guidelines on pain management. Data analysis described current practices and used chi 2 analysis to compare results with a national study of U.S. hospitals. Air Force anesthesia departments (45%) had established as many acute pain services as U.S. hospitals (42%). Formal pain programs are becoming more prevalent in Air Force hospitals. These findings suggest an increased awareness of the need for pain management and future establishment of pain programs.

The Determinants of Career Intent Among Physicians at a U.S. Air Force Hospital

The research reported in this paper attempts to explain variation in career intent among physicians at a U.S. Air Force hospital. A causal model which comes from the research of Price-Mueller and their colleagues is used to explain career intent. The model is estimated with data collected from Wilford Hall Medical Center, the U.S. Air Force's tertiary-care center. Data were collected by questionnaires and from records. The variables are assessed with widely used organizational measures which are generally valid and reliable. Data are analyzed by ordinary least squares regression analysis. Seven variables are the most important in explaining career intent: organizational commitment, job satisfaction, search behavior, opportunity, met expectations, positive affectivity, and promotional chances. The causal model that has been tested primarily for female employees in civilian hospitals was found to operate just as well among male physicians in a military hospital. Forty-one percent of the variance in career intent is explained in this study.

Review of Clinical Use of Sertraline by Family Practice Physicians in a Small Air Force Hospital

The clinical use of sertraline for 1 year in a family practice clinic in a small Air Force hospital was reviewed. Retrospective chart review showed that 85% of patients receiving five or more prescriptions for sertraline had a diagnosis of depression; the remainder were treated for chronic pain or dysthymia. The patients in the review needed dose increases (above the recommended starting dose of 50 mg qd) in nearly 50% of the cases. Clinicians using sertraline for the treatment of affective illness in the primary care setting should be aware of the likelihood for dose increases to achieve maximal clinical benefit.

Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer

purpose: To determine the long-term impact of medical and surgical treatment of well differentiated papillary and follicular thyroid cancer. methods: Patients with papillary and follicular cancer (n = 1,355) treated either in U.S. Air Force or Ohio State University hospitals over the past 40 years were prospectively followed by questionnaire or personal examination to determine treatment outcomes. Outcomes were analyzed by Kaplan-Meier survival curves and Cox proportional-hazard regression model. results: Median follow-up was 15.7 years; 42% (568) of the patients were followed for 20 years and 14% (185) for 30 years. After 30 years, the survival rate was 76%, the recurrence rate was 30%, and the cancer death rate was 8%. Recurrences were most frequent at the extremes of age (<20 and >59 years). Cancer mortality rates were lowest in patients younger than 40 years and increased with each subsequent decade of life. Thirty-year cancer mortality rates were greatest in follicular cancer patients, who were more likely to have adverse prognostic factors: older age, larger tumors, more mediastinal node involvement, and distant metastases. When patients with distant metasteses at diagnosis were excluded, follicular and papillary cancer mortality rates were similar (10% versus 6%, P not significant [NS]). In a Cox regression model that excluded patients who presented with distant metastases, the likelihood of cancer death was (1) increased by age ≥40 years, tumor size ≥1.5 cm, local tumor invasion, regional lymph-node metastases, and delay in therapy ≥12 months; (2) reduced by female sex, surgery more extensive than lobectomy, and 131I plus thyroid hormone therapy; and (3) unaffected by tumor histologic type. Following 131I therapy given only to ablate normal thyroid gland remnants, the recurrence rate was less than one third the rate after thyroid hormone therapy alone ( P <0.001). No patient treated in this way with 131I has died of thyroid cancer. Low 131I doses (29 to 50 mCi) were as effective as high doses (51 to 200 mCi) in controlling tumor recurrence (7% versus 9%, P = NS). Following 131I therapy, whether given for thyroid remnant ablation or cancer therapy, recurrence and the likelihood of cancer death were reduced by at least half, despite the existence of more adverse prognostic factors in patients given 131I. At 30 years, the cumulative cancer mortality rate following 131I therapy, regardless of the reason for its use, was one third that in patients not so treated ( P = 0.03). conclusion: Over the long term, for tumors ≥1.5 cm that are not initially metastatic to distant sites, near-total thyroidectomy followed by 131I plus thyroid hormone therapy confers a distinct outcome advantage. This therapy reduces tumor recurrence and mortality sufficiently to offset the augmented risks incurred by delayed therapy, age ≥40 at the time of diagnosis, and tumors that are much larger than 1.5 cm, multicentric, locally invasive, or regionally metastatic.

The Relationship between Demographic Variables and Intent to Stay in the Military: Medical Personnel in a U.S. Air Force Hospital

This study tested empirically the relationships between eleven demographic variables and intent to stay in the U.S. Air Force, used as a proxy for turnover. The research reported here was conducted among military medical personnel at Wilford Hall Medical Center, Lackland Air Force Base, Texas. Data were collected by questionnaire and from records. Ordinary least squares regression analysis was used to estimate the effects of the eleven demographic variables upon intent to stay in the U.S. Air Force. The results support three of Price's empirical generalizations regarding the relationships between demographic variables (occupation, education, and age) and turnover; add two new generalizations (rank and gender); and do not support one relationship (length of service). The research yielded no data supporting or not supporting Price's two generalizations pertaining to blue-collar employees.

Preparation for Desert Storm: Expansion of an Overseas Air Force Hospital Pharmacy to Handle Casualties

The planning and execution for contingency pharmacy services in support of Operations Desert Shield/Desert Storm in an overseas Air Force Medical Center are described. These operations presented the staff with far different challenges than the contingency support plan that had been in place for several years. That plan focused medical operations based on armed conflict in Central Europe. With conflict now imminent in the Persian Gulf, over 8 hours flying time away from our facility, our priorities and mission changed tremendously. This conflict demanded prompt action by the Department of Pharmacy to ensure comprehensive services in support of Operations Desert Shield/Desert Storm without interruption of services to the local military community. Pharmacy planning focused on four basic areas: (1) supply requirements, (2) contingency staffing requirements, (3) expansion of inpatient pharmacy services, and (4) modifications to outpatient pharmacy services. A modified contingency plan assured professional pharmaceutical services for over 3,000 patients suffering injuries in the 12 months American forces were deployed to the Persian Gulf.

Delegation of clinical dietetic tasks in military and civilian hospitals: Implications for practice

The purposes of our research were two-fold: to determine perceptions of the quality of task performance and to identify dietetic personnel currently performing clinical dietetic tasks in military and civilian hospitals. Questionnaires were returned from 309 dietitians and 208 dietetic support personnel at 151 military and civilian hospitals (73% response overall). For tasks completed by support personnel, no task was rated as having optimum quality, 1 was rated as highly acceptable, 6 as acceptable, 19 as somewhat unacceptable, and 4 as unacceptable. Current performance ratings indicated that 1 task was performed solely by dietitians, 21 were completed by dietitians with assistance, 6 were completed jointly by dietitians and support personnel, 2 were completed by support personnel with supervision by dietitians, and no task was completed independently by support personnel. Tasks were grouped into four categories: basic clinical dietetics (11 tasks), intermediate and in-depth clinical dietetics (12 tasks), outpatient nutrition clinic (5 tasks), and nutrition education (community) (4 tasks). Quality scores for the US Air Force (USAF) hospitals were higher for all task categories except intermediate and in-depth clinical dietetic tasks. The quality scores of support personnel were higher than those of dietitians for all task categories. The USAF performance scores indicated significantly more involvement of support personnel. Generally, the performance scores of dietitians increased with experience; the scores of support personnel decreased with experience. Correlations between quality and performance ratings for individual tasks revealed low to moderate relationships. Our results suggest that additional delegation of tasks to dietetic support personnel may be possible without negatively affecting perceptions of the quality of task outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

The Epidemiology of Tuberculosis in the U.S. Air Force, 1987

In preparation for a major revision of the Air Force tuberculosis (TB) prevention and control program, we reviewed tuberculosis cases treated at Air Force hospitals and the U.S. Air Force tuberculin skin testing program for 1987. The highest rates of active TB cases and infection were observed in the Pacific overseas region. Active tuberculosis cases occurred most frequently in white male retirees and in Asian dependent females. Nineteen cases (9% of total TB cases) occurred in children under the age of 5. Only 46-60% of individuals with a positive Purified Protein Derivative-Tuberculin were placed on isoniazid (INH) chemoprophylaxis. Flying status personnel were less likely to have either active disease or TB infection than non-flying active duty members. Based upon these findings, Air Force tuberculosis prevention and control program efforts should de-emphasize screening of low risk active duty populations and stress timely reporting and case finding, compliance with therapy, and initiation of INH chemoprophylaxis in accordance with existing guidelines. Young children who are contacts of active TB cases should receive special emphasis.

Supplementary oxygen and the laryngeal mask airway

AnaesthesiaVolume 45, Issue 9 p. 792-793 Free Access Supplementary oxygen and the laryngeal mask airway P.J. Broadway, P.J. Broadway The Princess Mary's Royal Air Force Hospital, Akrotiri BFPO 57Search for more papers by this authorP. Royle, P. Royle The Princess Mary's Royal Air Force Hospital, Akrotiri BFPO 57Search for more papers by this author P.J. Broadway, P.J. Broadway The Princess Mary's Royal Air Force Hospital, Akrotiri BFPO 57Search for more papers by this authorP. Royle, P. Royle The Princess Mary's Royal Air Force Hospital, Akrotiri BFPO 57Search for more papers by this author First published: September 1990 https://doi.org/10.1111/j.1365-2044.1990.tb14478.xCitations: 14AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume45, Issue9September 1990Pages 792-793 RelatedInformation

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.

Tru‐cut Prostatic Biopsy: a Complication

British Journal of UrologyVolume 60, Issue 5 p. 464-464 Tru-cut Prostatic Biopsy: a Complication D. J. JONES, Corresponding Author D. J. JONES Surgical Division. Royal Air Force Hospital, ElySurgical Division. Royal Air Force Hospital, Ely CB6 I DNSearch for more papers by this author D. J. JONES, Corresponding Author D. J. JONES Surgical Division. Royal Air Force Hospital, ElySurgical Division. Royal Air Force Hospital, Ely CB6 I DNSearch for more papers by this author First published: November 1987 https://doi.org/10.1111/j.1464-410X.1987.tb05016.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume60, Issue5November 1987Pages 464-464 RelatedInformation

Spontaneous mediastinal emphysema

Several cases of spontaneous mediastinal emphysema have been seen and treated at two Air Force Hospitals. All have responded to nonsurgical treatment, and have been returned to normal duty or school.

Survey of Pharmacy Services in United States Air Force Hospitals

Survey of Pharmacy Services in United States Air Force Hospitals

Do Edicts Have Any Effect on Circumcision Rate?

To the Editor: The literature continues to be replete with the continuing discussion(argument?) about the practice of routine neonatal circumcision. Although it is easy to find opinions, often emotionally stated, a search of the literature failed to reveal any current reference to the actual frequency of this procedure. For this reason it seems appropriate to report the incidence of neonatal circumcision in U.S. Air Force hospitals. During calendar year 1974 there were 16,400 male

A Pediatric Nurse-Practitioner for the Neonate

We have been impressed with the relative laxity in the care of newborns between delivery and first observation by a pediatrician. Especially during this critical period of transition, careful monitoring is required. A program for the training of a neonatal nurse practitioner (NNP), therefore, was developed at a regional Air Force hospital and 14 registered nurses and one licensed practical nurse have since been trained. Formal instruction consisted of 24 hours of cribside activity including presentation of factual material, demonstration of physical findings and discussion of pathophysiology.

Major ocular trauma seen in a Royal Air Force Hospital during an 18-month period in peace-time

<h2>Summary</h2> Ten cases of penetrating and three cases of non-penetrating eye injuries seen in a Royal Air Force Hospital in peace-time are reported. Enucleation was necessary in 3 of those with penetrating injuries and vision of 6/12 or better was achieved in 6. In one case, where there was delay in obtaining specialist advice, secondary glaucoma and lens opacities developed. The importance of early referral to specialist units, is emphasized. The success of the Royal Air Force in instituting industrial eye protection is noted.

A Four-Year Study of the Internship in United States Air Force Hospitals: An Objective Measurement of Gain in Clinical Competence

A Four-Year Study of the Internship in United States Air Force Hospitals: An Objective Measurement of Gain in Clinical Competence

Hypokalaemic paralysis during pregnancy.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 77, Issue 2 p. 180-181 HYPOKALAEMIC PARALYSIS DURING PREGNANCY M. J. Phillips, Consultant in Pathology Royal Air Force Hospital, Changi, SingaporeSearch for more papers by this authorC. R. Newman, Consultant in Medicine Royal Air Force Hospital, Changi, Singapore Princess Alexandra's Royal Air Force Hospital, Wroughton, Wiltshire.Search for more papers by this authorP. A. Mounfield, Senior Specialist in Obstetrics and Gynaecology Royal Air Force Hospital, Changi, SingaporeSearch for more papers by this author M. J. Phillips, Consultant in Pathology Royal Air Force Hospital, Changi, SingaporeSearch for more papers by this authorC. R. Newman, Consultant in Medicine Royal Air Force Hospital, Changi, Singapore Princess Alexandra's Royal Air Force Hospital, Wroughton, Wiltshire.Search for more papers by this authorP. A. Mounfield, Senior Specialist in Obstetrics and Gynaecology Royal Air Force Hospital, Changi, SingaporeSearch for more papers by this author First published: February 1970 https://doi.org/10.1111/j.1471-0528.1970.tb03503.x AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume77, Issue2February 1970Pages 180-181 RelatedInformation