Medical Treatment Facilities Research Articles

Breast cancer: do the current policies mean anything?

Aim Breast cancer remains one of the most prevalent malignancies globally with a high mortality rate. South Africa has a number of policies in place designed to ensure that minimum delays are experienced by patients from first symptom to initial treatment. This study was initiated to determine where the longest delays occurred during the patient’s journey, from the first symptom to the first treatment. This information, combined with the existing policy, identifies shortfalls in the breast cancer diagnostic and treatment pathways that must be addressed. Methods A cross-sectional study was undertaken in the Department of Medical Oncology, University of Pretoria/Steve Biko Academic Hospital between April 2020 and August 2021, analysing six timelines from first symptom to first treatment in patients with newly diagnosed breast cancer. Data was obtained by the researchers from the patients on their first visit relating to the delays experienced from first symptom to final biopsy. Clinical information was obtained from the patients’ source records once a treatment decision had been reached and treatment started where applicable. Results The longest delays experienced were between the patients’ first visit to any medical facility to date of diagnostic biopsy. Delays due to COVID-19 were in the minority with 13/79 (16.4%) patients reporting having experienced COVID-19 related delays. Key Area 2 of the Breast Cancer Prevention and Control Policy makes provision for patients to be referred directly to a regional/tertiary/quaternary medical facility for further screening, diagnosis and treatment within 21-60 days from the first visit. In the study’s cohort, a mean of four months from first visit to diagnostic biopsy was recorded. Overall delays of longer than 12 months due to non-representative biopsies (range 1-3) were recorded in three patients. Twenty-nine patients (36.7%) presented to three medical facilities prior to diagnostic biopsy with 10/79 (12.6%) and 1/79 (1.2%) presenting to four and five institutions, respectively, before the diagnostic biopsy. Conclusions The delays patients experienced highlights the lack of knowledge about the urgency and correct referral of suspected malignancy cases. Despite the number of promulgated policies relating to fast track systems via specialist breast units, fiscal and human capital deficiencies negatively impact the attempts to diagnose and treat patients timeously and increase survival.

Approaches to the strategic management of the development of medical treatment facilities

The article examines the main approaches to the strategic management of the development of medical treatment facilities and determines that the modern health care system needs comprehensive strategic measures that will contribute to increasing the effectiveness of the management of the strategic development of medical facilities. The market of medical institutions is an important component in the structure of the market of medical services, evidence of this is the intensive development and expansion of not only medical, but also cosmetic services, improving their quality and level of service. Therefore, there is an urgent need to determine the essence of managing the strategic development of medical institutions. The main achievements of foreign and domestic science in the medical field, the strategic planning of its development and the application of the principles of strategic management of medical institutions became the theoretical and methodological basis of the research. The formation and development of strategic management is an important part of corporate management not only of a manufacturing enterprise, but also of health care institutions as a whole. Without effective medical care, citizens are not interested in solving secondary problems, because the issue of preserving and maintaining health always comes first. With the spread of market development priorities, the management of medical institutions is gaining importance. The study analyzes different approaches to strategic management, such as innovation management, resource management, implementation of digital technologies and patient orientation. Special attention is paid to practical aspects of strategy implementation, including assessment of the external and internal environment, development of strategic plans, optimization of operations and risk management. The research results are intended to suggest ways to increase the competitiveness of medical institutions and the quality of the services provided by them, which will contribute to their sustainable development in the conditions of modern challenges in the field of health care.

Ethical Issues Regarding Dermatopathology Care for Service-Members: A Review.

Dermatologic care within the military faces unique ethical challenges. Service members are stationed across nationally and globally diverse settings, and therefore, dermatologic care rendered ranges from within resource-rich, advanced military medical treatment facilities to austere, resource-limited, deployed field environments. Additionally, military service members are often at unique risk for dermatologic disease, given occupational, environmental, and geographic exposures not commonly faced by their civilian counterparts. This review explores topics in dermatoethics via case analyses of ethical considerations within the scope of dermatologic care for military service members.

EVALUATING WASTEWATER TREATMENT EFFICIENCY OF MEDICAL CENTERS IN BINH DUONG PROVINCE

This paper presents a comprehensive analysis of the wastewater management system implemented at a medical center located within the Bau Bang Industrial Park in Binh Duong province, Vietnam. With a staff of 166 and 60 beds, the facility operates in accordance with TCVN 4470:2012 General Hospital design standards, serving a diverse range of water demands including domestic, medical, and auxiliary requirements. The wastewater management system is meticulously designed to handle both rainwater and wastewater separately. Rainwater is efficiently collected through surface and roof drainage networks, while domestic and medical wastewater undergo discrete collection processes. The medical center's wastewater treatment facility, operating at a capacity of 100 m³/day, employs a multistage treatment process to ensure compliance with stringent regulatory standards (QCVN 28:2010/BTNMT, column B, K = 1). This process includes preliminary treatment, anaerobic and aerobic biological treatment, membrane filtration, and disinfection. The facility consistently meets quality parameters outlined in QCVN 28:2010/BTNMT, exhibiting effective removal rates for organic pollutants, suspended solids, ammonia, phosphates, and pathogens. Furthermore, the medical center demonstrates commendable environmental stewardship through its stormwater drainage infrastructure, which integrates seamlessly with the local drainage network, safeguarding against environmental contamination. Overall, the wastewater management practices at the medical center exemplify best practices in environmental management within the healthcare sector. This study provides valuable insights into the design, implementation, and performance evaluation of wastewater treatment systems in industrial settings, contributing to the global discourse on sustainable wastewater management practices.

Advancing Military Medical Planning in Large Scale Combat Operations: Insights From Computer Simulation and Experimentation in NATO's Vigorous Warrior Exercise 2024.

The ongoing conflict in Ukraine from Russian invasion presents a critical challenge to medical planning in the context of multi-domain battle against a peer adversary deploying conventional weapon systems. The potential escalation of preventable morbidity and mortality, reaching a scale unprecedented since World War II, underscores the paramount importance of effective phases of care from Point of Injury (PoI)/Point of Wounding (PoW) or Point of Exposure (PoE) to Role 1 (R1) and Role 2 (R2) echelons of care.The NATO Vigorous Warrior (VW) Live Exercise (LIVEX) serves as a strategic platform for NATO and its partners, providing an opportunity to challenge operational concepts, experiment, innovate life-saving systems, and foster best practices across the Alliance. This study delineates the strategic application of the VW LIVEX platform for the adaptation of the computational simulation software Simulation for the Assessment and Optimization of Medical Disaster Management (SIMEDIS) within the context of Large-Scale Combat Operations (LSCO). The SIMEDIS computer simulator plays a pivotal role by furnishing real-time insights into the evolving injury patterns of patients, employing an all-hazards approach. This simulator facilitates the examination of temporal shifts in medical timelines and the ramifications of resource scarcity against both morbidity and mortality outcomes. The VW LIVEX provides a unique opportunity for systematic validation to evaluate the results of the computer simulator in a realistic setting and identify gaps for future concepts of operations. We report the process and methodologies to be evaluated at the VW LIVEX in far forward and retrospective medical support operations. Using the SIMEDIS simulator, we can define battlefield scenarios for varied situations including artillery, drone strikes, and Chemical, Biological, Radiological, Nuclear, and explosive (CBRNe) attacks. Casualty health progressions versus time are dependent on each threat. Mortality is computed based on the concepts found in Tactical Combat Casualty Care (TCCC) of "self-aid"/"buddy-aid" factoring in the application or absence of definitive traumatic hemorrhage control and on the distribution policy of victims to medical treatment facilities through appropriate Command and Control (C2) ("Scoop and Run" versus "Stay and Play"). The number of medical supplies available along with the number of transport resources and personnel are set and are scalable, with their effect on both morbidity and mortality quantified.Concept of Medical Operations can be optimized and interoperability enhanced when shared data are provided to C2 for prospective medical planning with retrospective data. The SIMEDIS simulator determines best practices of medical management for a myriad of injury types and tactical/operational situations relevant to policy making and battlefield medical planning for LSCO. The VW LIVEX provides a Concept Development and Experimentation platform for SIMEDIS refinement and conclusive insights into medical planning to reduce preventable morbidity and mortality. Recommending further iterations of similar methodologies at other NATO LIVEXs for validation is crucial, as is information sharing across the Alliance and partners to ensure best practice standards are met.

Psychological Risk Factors for Delayed Recovery Among Active Duty Service Members Seeking Treatment for Musculoskeletal Complaints at a Navy Shore-Based Military Medical Treatment Facility.

Musculoskeletal injuries (MSIs) are a leading cause of separation from the U.S. Navy. Data have shown that several psychological responses to MSI are associated with treatment outcomes. Yellow flags are maladaptive psychological responses to injury and predict delayed recovery, whereas pink flags indicate resilience after MSI and are associated with good treatment outcomes. Identifying these factors in patients with MSI would permit early targeted care to address factors that may delay their readiness for deployment and enhance factors that support recovery. Active duty service members with MSI who reported to physical therapy outpatient services at a naval hospital were recruited for the study. Yellow flags were assessed at baseline as part of a larger study. Participants completed the Fear Avoidance Beliefs Questionnaire (with two subscales, physical activity and work), the Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. Clinically relevant cut-off scores were used to indicate risk factors of delayed recovery. Pink flags were assessed with the Pain Self-Efficacy Questionnaire and a measure of positive outcome expectations for recovery. Two hundred and ninety participants responded to some or all of the questionnaires. Of these, 82% exceeded the cut-off scores on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire, and 39% did so on the work subscale. Pain catastrophizing exceeded the cut-off in only 4.9% of the sample. Forty-three percent of these exceeded the cut-off for the anxiety subscale of the Hospital Anxiety and Depression Scale; 27% exceeded the cut-off on the depression subscale of the Hospital Anxiety and Depression Scale. Additionally, 54% endorsed scores greater than 40 on the Pain Self-Efficacy Questionnaire, and 53% endorsed a high score on the positive outcome expectations. A substantial portion of the sample endorsed elevated scores on one or more indicators of delayed recovery from MSI. Most participants showed a fear of physical activity, and approximately half reported pain-related distress (anxiety and depression). In addition, feelings of self-efficacy and positive outcome expectations of treatment were endorsed by only about half of the participants, indicating that the remaining half did not report adaptive responses to MSI. Early identification of these risk factors will allow for targeted treatment approaches that incorporate these yellow flags into treatment and support a psychologically informed approach to physical therapy. This approach is likely to reduce delayed recovery and improve deployment readiness.

Adaptive Leadership and Burnout in Military Healthcare Workers During a Global Health Pandemic.

Occupational burnout among healthcare workers has continued to climb, impacting workforce well-being, patient safety, and retention of qualified personnel. Burnout in military healthcare workers, who have had the added stress of increased deployments, remains unknown. Although certain leadership styles have been associated with lower rates of burnout, the association between adaptive leadership and burnout in military healthcare has not previously been described. The aim of this study is to examine the role of adaptive leadership in burnout among military healthcare workers following the Coronavirus Disease 2019 (COVID-19) pandemic. A convenience sampling of military healthcare workers employed at a military medical treatment facility between March 2020 and March 2023 was anonymously surveyed using an online link, which included demographics, the Maslach-Burnout Inventory Health Services Survey (MBI-HSS), the Adaptive Leadership with Authority Scale, and the Pandemic Experiences and Perceptions Survey. Data were analyzed for associations. Structural equation modeling (SEM) was performed using MPlus 8.0, which included demographics, all three subscales that contribute to burnout (emotional exhaustion, depersonalization, and personal accomplishment [PA]), adaptive leadership (indicated by a subscale mean), and COVID impact and COVID risk perception. Of the 365 participants analyzed, 88.5% had high emotional exhaustion, and 80.4% had high depersonalization. Burnout was significantly associated with adaptive leadership (r = -0.302, P < .001), COVID impact (r = 0.208, P < .001), and COVID risk perception (r = 0.174, P < .001). A total of 93.0% scored high in at least one subscale of the MBI-HSS (i.e., emotional exhaustion ≥27, depersonalization ≥10, or PA ≤33), although 78 (21.8%) met the complete definition of burnout, because of the overwhelmingly high levels of PA (77.8% reported high PA). In the SEM model, burnout was significantly and negatively predicted by adaptive leadership (b = -0.28, SE = 0.05, Standardized b = -0.31, P < .001). Burnout was also significantly and positively predicted by COVID impact (b = 0.25, SE = 0.09, Standardized b = 0.17, P = .028) and health professions' perception of risk (b = 0.15, SE = 0.07, Standardized b = 0.14, P = .008). Together, this model explained 17% of the total variance in health professions' reported burnout. The findings of burnout in this military healthcare worker population were higher than have previously been described in healthcare workers or other military personnel, and the significant associations between adaptive leadership and burnout suggest the protective role of adaptive leadership in healthcare systems to address burnout. Implementing adaptive leadership training or selecting leaders with more adaptive leadership skills may be beneficial in a health care system where employee burnout is prevalent, especially during periods stressed by adaptive problems. This may be especially important in military healthcare when active duty service obligations preclude attrition in the presence of additional stressors such as deployments and Federal Emergency Management Agency responses. Further research is needed to determine whether this intervention is successful at reducing healthcare burnout.

Nurse Attrition: Content Analysis of Free-Text Responses From Two Military Nursing Practice Environment Surveys.

Staff nurse attrition negatively impacts readiness of the warfighter and the health and wellbeing of all beneficiaries of the Military Health System (MHS). To promote the retention of a robust nursing workforce, a complete understanding of nurses' perceptions regarding their intent to leave is necessary. The purpose of this study was to explore the free-text responses of 1,438 nurses working among military medical treatment facilities for factors influencing their intent to leave, as an indicator of potential turnover, or attrition. This study employed thematic analysis to investigate the qualitative responses from the 2016 and 2018 Military Nursing Practice Environment Surveys. The study was determined to be exempt from Institutional Review Board review through the Womack Army Medical Center's Human Research Protection Program. Findings indicate that leadership and management (n = 647), staffing (n = 353), career opportunities (n = 345), staff outcomes (n = 247), culture (n = 153), quality of care (n = 99), patient care barriers (n = 86), non-patient care activities (n = 79), lack of formal professional development (n = 75), and area or care environment (n = 67) were among the top factors influencing staff nurse intent to leave, respectively. Our findings support the evaluation of retention strategies using implementation science for nurses and nurse resource personnel (e.g., nursing assistants, technicians, medics, and corpsman) to ensure a robust nursing work force throughout the MHS. Staff nurses and resource personnel working among military treatment facilities and embedded in units supporting combat and humanitarian missions ensure access to care and health promotion of the warfighter and all MHS beneficiaries.

Effectiveness of a specific trauma training on war-related truncal injury management: A pre-post study

BackgroundNon-Compressible Torso Hemorrhage (NCTH) is the leading cause of preventable death in combat casualty care. To enhance the French military surgeons' preparedness, the French Military Health Service designed the Advanced Course for Deployment Surgery (ACDS) in 2008. This study evaluates behavioral changes in war surgery practice since its implementation. MethodsData were extracted from the OPEX® registry, which recorded all surgical activity during deployment from 2003 to 2021. All patients treated in French Role 2 or 3 Medical Treatment Facilities (MTFs) deployed in Afghanistan, Mali, or Chad requiring emergency surgery for NCTH were included. The mechanism of injury, severity, and surgical procedures were noted. Surgical care produced before (Control group) and after the implementation of the ACDS course (ACDS group) were compared. ResultsWe included 189 trauma patients; 99 in the ACDS group and 90 in the Control group. Most injuries were combat-related (88 % of the ACDS and 82 % of the Control group). The ACDS group had more polytrauma (42% vs. 27 %; p= 0.034) and more e-FAST detailed patients (35% vs. 21 %; p= 0.044). Basics in surgical trauma care were similar between both groups, with a tendency in the ACDS group toward less digestive diversion (n= 6 [6 %] vs. n= 12 [13 %]; p= 0.128), more temporary closure with abdominal packing (n= 17 [17 %] vs. n= 10 [11 %]; p= 0.327), and less re-operation for bleeding (n= 0 [0 %] vs. n= 5 [6 %]; p= 0.046). ConclusionThe French model of war trauma course succeeded in keeping specialized surgeons aware of the basics of damage control surgery. The main improvements were better use of preoperative imaging and better management of seriously injured patients.

Physiological and radiological parameters predicting outcome from penetrating traumatic brain injury treated in the deployed military setting

IntroductionPenetrating traumatic brain injury (TBI) is the most common cause of death in current military conflicts, and results in significant morbidity in survivors. Identifying those physiological and radiological parameters associated...

Cost-benefit analysis with return on investment of clinical pharmacists in the Military Health System.

The Defense Health Agency comprises more than 700 military medical, dental, and veterinary facilities and provides care to more than 9.6 million beneficiaries. As medication experts, pharmacists identify opportunities to optimize medication therapy, reduce cost, and increase readiness to support the Defense Health Agency's mission. The Tripler Pilot Project and the Army Polypharmacy Program were used to establish a staffing model of 1 clinical pharmacist for every 6,500 enrolled beneficiaries. No large-scale cost-benefit study within the military health care system has been done, which documents the number of clinical interventions and uses established cost-avoidance (CA) data, to determine the cost-benefit and return on investment (ROI) for clinical pharmacists working in the medical treatment facilities. To validate the patient-centered medical home staffing model across the military health care system using the Tripler Pilot Project results to provide a cost-benefit analysis with an ROI. The secondary goal is to describe the interventions, staffing levels, and US Department of Defense-specific requirements impacting the provision of clinical pharmacy. A retrospective analysis of 3 years of encounters by clinical pharmacists in which an intervention was documented in the Tri-Service Workflow (TSWF) form as part of the electronic health record was completed. The analysis used 6 steps to assign CA intervention types and to prevent duplication and overestimation of the ROI. The absolute number of clinical pharmacists was determined using workload criteria defined as at least 20 encounters per month for at least 3 months of each calendar year. The number of clinical pharmacist full-time employees (FTEs) was determined by dividing the number of total active months by 12 months. Attrition was calculated comparing the presence of a unique provider identification between calendar years. The ROI range was calculated by dividing the CA by the total cost of clinical pharmacists using the variables' raw and extrapolated CA based on percentage of documentation template usage and the active clinical pharmacist calculation (absolute and FTE-based). Between January 1, 2017, and December 31, 2019, a total of 1,069,846 encounters by clinical pharmacists were documented in the electronic health record. The TSWF Alternative Input Method form was used by pharmacists to document 616,942 encounters. Forty-three percent of TSWF documented encounters had at least 1 CA intervention. The absolute number of clinical pharmacists associated with a documented encounter in any medical treatment facility ranged from 404 in 2017 to 374 in 2018 and the clinical pharmacist FTEs ranged from 324 in 2017 to 314 in 2019. Annual attrition rates for clinical pharmacists ranged from 15% to 20% (58 to 81 clinical pharmacists) annually. The total CA range was $329,166,543-$534,014,494. The ROI range was between $2 and $4 per dollar spent. This analysis demonstrated that ambulatory care clinical pharmacists in the Military Health System bring value through a positive ROI. Our study also identified a potential shortage of clinical pharmacists within the Air Force and Navy branches impacting medication management. This can have a negative impact on the readiness of service members, one of the leading priorities of the US Department of Defense.

Ready Reliable Care: The Defense Health Agency’s approach to high reliability

In its everyday actions, high reliability is the overarching framework guiding the Military Health System (MHS), comprised of the Defense Health Agency (DHA), the three Military Medical Departments and the Uniformed Services University. The High Reliability Organisation (HRO) framework, branded Ready Reliable Care (RRC) in the MHS, is based on process design, building culture and structures that promote safety, and improving outcomes to optimise HRO maturity. HROs achieve top outcomes and remain largely error free despite operating in complex or high-risk environments. Operations in HROs are characterised by repeatable processes that are regularly evaluated for change and improvement in collaboration with other affected areas of the organisation. DHA looks to other top health systems for leading HRO practices and characteristics to adapt and implement with the goal of achieving top outcomes in standardising processes; improving team communication; eliminating redundancies and gaps; and elevating the quality of care, safety and access for our beneficiaries. As part of that HRO journey, the DHA seeks to achieve system effectiveness across units through analysis, innovation and the sharing of information and knowledge. RRC provides a unified lens through which functional areas can learn from past experiences to build on and mature interoperable HRO capabilities that support service members and facilitate a consistent, safe, quality patient experience across the DHA. The DHA aims to ensure system maturity by conducting an assessment that will guide the development of capabilities needed to advance HRO principles and behaviours. In conjunction with functional subject matter experts, DHA developed an RRC Military Medical Treatment Facility (MTF) Maturity Index-Model to assess organisational HRO maturity at inpatient medical centres and community hospitals. The capability components of the RRC MTF Maturity Index-Model will align existing DHA and trusted national data sources and benchmarks to determine the current phase of RRC maturity at individual MTFs and across the system. Adaptation of this maturity index-model by other healthcare systems is possible and could provide other health systems with a tool to measure maturity of these healthcare systems as HROs.

Healthcare-seeking behaviours of patients with acute respiratory infection: a cross-sectional survey in a rural area of southwest China

ObjectivesThis study aimed to assess the healthcare-seeking behaviour and related factors of people with acute respiratory symptoms in the rural areas of central and western China to estimate the disease...

Đánh giá sự hài lòng của người bệnh khám ngoại trú tại khoa khám bệnh Bệnh viện Quân dân Y 16, năm 2023

The study aimed to evaluate the satisfaction of outpatients at the Department of Examination - Military Hospital 16 in 2023. The design of a cross-sectional descriptive study was collected on 147 outpatients by quantitative interview method, using the checklist of the Ministry of Health according to Decision 3869/QD-BYT. Research results show that the average overall satisfaction score is 4.09 ± 0.71 points, with 78.9% satisfied (including very satisfied and satisfied). Satisfaction results according to the following aspects: Accessibility (74.15%), Medical examination and treatment procedures (80.14%), Medical examination and treatment facilities (75.94%), Thai Behavior and professional capacity of medical staff (89.29%), Service delivery results (81.29%). Some factors related to satisfaction indicated in the study are female gender, using health insurance and average personal income ≥5 million/month, the difference is statistically significant with p&lt;0.05. Research results show that the satisfaction status of outpatients at the Outpatient Department is lower than the hospital's expectations and compared with other studies, especially in terms of Accessibility and Medical examination and treatment facilities.

Convergent and Discriminant Validity of the Blast Exposure Threshold Survey in United States Military Service Members and Veterans.

The Blast Exposure Threshold Survey (BETS) is a recently developed and promising new self-report measure of lifetime blast exposure (LBE). However, there are no studies that have examined the psychometric properties of the BETS, which currently limits its clinical utility. The purpose of this study was to examine the convergent and discriminant validity of the BETS by comparing the BETS Generalized Blast Exposure Value (GBEV) to six variables hypothesized to be associated with LBE (i.e., single-item LBE, combat exposure, years in the military, number of combat deployments, and military occupation specialty [MOS]) and three variables hypothesized not to be associated with LBE (i.e., age at the time of injury, estimated pre-morbid Full-Scale Intelligence Quotient [FSIQ], and resilience). Participants were 202 United States service members and veterans prospectively enrolled from three military medical treatment facilities (68.7%) and via community recruitment initiatives (31.3%). Participants completed the BETS, Combat Exposure Scale (CES), Deployment Risk and Resiliency Inventory-2 Combat Experiences (DRRI-2 CE), Traumatic Brain Injury-Quality of Life Resilience scale, and a brief structured interview. For some analyses, participants were classified into two blast risk MOS groups: high (n = 89) and low (n = 94). The BETS GBEV was not significantly correlated with all three non-blast related variables (rs = 0.01 to rs = -0.12). In contrast, GBEV was significantly (p < 0.001) associated with all blast-related variables; single-item LBE (rs = 0.76), CES (rs = 0.58), number of combat deployments (rs = 0.53), DRRI-2 CE (rs = 0.48), and high blast risk MOS (r = 0.36, medium effect size). However, a stronger relationship was found between the blast-related variables and three modified GBEV scores when excluding some small weapons categories; single-item LBE (rs = 0.80-0.82), CES (rs = 0.64-0.67), number of combat deployments (rs = 0.56), DRRI-2 CE (rs = 0.51-0.53), and high blast risk MOS (r = 0.42-0.49, medium-large effect size). This is the first study to examine the psychometric properties of the BETS. Overall, these results offer support for the convergent and discriminant validity of the BETS. In order to ensure that the BETS can be confidently used as a valid and reliable measure of LBE, more research is needed to further examine the psychometric properties of the test, particularly with regard to the establishment of test-retest reliability.

The future of military medical evacuation: literature analysis focused on the potential adoption of emerging technologies and advanced decision-analysis techniques

A fundamental component of any military medical support system is medical evacuation. The main goal of evacuation is to reduce mortality among critically injured combat casualties. To achieve this goal, several decision problems including, the location of medical treatment facilities, relocation, dispatching, and routing have to be effective across all levels (tactical, operational, and strategic). This study concentrates on the three key types of medical evacuation (MEDEVAC) systems—forward, tactical, and strategic—and the related decision problems. Even though, over the last few years, some review papers have discussed the different topics of MEDEVAC systems (e.g., the evolution of MEDEVAC, evacuation timelines, and types of injuries), no research has been conducted on the full range (i.e., total care pathway) of MEDEVAC systems and the adoption of emerging technologies to improve future MEDEVAC. In this paper, a systematic review of the literature is described, including the decision problems involved in the total military medical evacuation process. This paper also reviews forecast challenges of future MEDEVAC and potential emerging technologies, concepts, and advanced decision-analysis methods to tackle these challenges. In future MEDEVAC processes, emerging technologies and concepts will be important to support improved medical capability; however, military planners will also need to adopt advanced decision-support techniques to efficiently employ these technologies.

Perioperative Pressure Injury Prevention Program ina Military Medical Treatment Facility: A Quality Improvement Project.

The incidence of perioperative pressure injuries (PPIs) at a military medical treatment facility (MTF) increased from three PPI events in 2018 to five PPI events in the first half of 2019. The purpose of this quality improvement initiative was to determine whether an evidence-based PPI prevention program introduced during the second half of 2019 reduced pressure injuries compared to the previous 1.5 years that followed the standard of care for perioperative patient positioning. We used a multidisciplinary quality improvement PPI prevention approach that included education, Scott Triggers® patient risk assessment, application of a five-layer silicone dressing to at-risk surgical position sites, and feedback via multidisciplinary postoperative rounding. There was an observed decrease in the rate of PPIs from 0.62 to 0.00 per 1,000 patient surgeries during the 26-month period that this protocol was implemented. This project was conducted at a major MTF using a multidisciplinary PPI prevention approach that may be of value in reducing PPIs in other settings. This approach seems worthy of further investigation and may be applicable to other military MTFs and in deployed settings.

Management ofCombat Casualties during Aeromedical Evacuation from a Role 2 to a Role 3 Medical Facility.

Emergent clinical care and patient movements through the military evacuation system improves survival. Patient management differs when transporting from the point-of-injury (POI) to the first medical treatment facility (MTF) versus transporting from the Role 2 to the Role 3 MTF secondary to care rendered within the MTF, including surgery and advanced resuscitation. The objective of this study was to describe care provided to patients during theater inter-facility transports and compare with pre-hospital transports (POI to first MTF). We performed a retrospective chart review of patients with the Role 2 to the Role 3 transports in Afghanistan and Iraq from 2007 to 2016. Data collected included procedures and events at the MTF and during transport. We compared the intra-theater transport data (Role 2 to Role 3) to data from a previous study evaluating pre-hospiital transports (POI to first MTF). We reviewed the records of 869 Role 2 to Role 3 transport patients. Role 2 to Role 3 transports were longer in duration compared to POI transports (39 minutes vs. 23 minutes) and were more likely to be staffed by advanced personnel (nurses, physician assistants, and physicians) (57% vs. 3%). The sample primarily consisted of military-aged males (mean age 27 years) who suffered from explosive or blunt force injuries. Procedures performed during each phase of care reflected the capabilities of the teams and locations. Pain and cardiac events were more common in POI evacuations compared to the Role 2 to Role 3 transports, but documentation of respiratory events, hemodynamic events, neurologic events, and equipment failure was more common during the Role 2 to Role 3 transports. Survival rates were slightly higher among the Role 2 to Role 3 cohort (98% vs. 95%, difference 3% [95% confidence interval of the difference 1-5%]). Inter-facility transports (Role 2 to Role 3) are longer in duration, transport more complex patients, and are staffed by more advanced level provider types compared to transports from POI.

Nine years of surgical activity in the deployed French military role 2 medical treatment facility in Mali

IntroductionIn January 2013, France launched a military operation in Mali, which ended in August 2022. This study aimed to analyse the global activity performed by a surgical team within the...

DIAGNOSE OF MENTAL ILLNESS USING FORWARD CHAINING AND CERTAINTY FACTOR

The prevalence of mental disorders in Indonesia is increasingly significant, as seen from the 2018 Riskesdas data. Riskesdas records mental, emotional health problems (depression and anxiety) as much as 9.8%. This shows an increase when compared to the 2013 Riskesdas data of 6%. Based on these data, it can be said that many people still suffer from mental disorders. Meanwhile, the number of medical personnel, medicines and public treatment facilities for people with mental disorders is still limited. In addition, the lack of public awareness, concern and knowledge about mental health causes a lack of public interest in consulting a psychologist, so people tend to self-diagnose. One solution for self-diagnosis is to use an expert system. This study developed an expert system using the forward chaining method and certainty factor. Based on the research conducted, the results are as follows. First, the expert-based system that has been developed can help provide the results of a diagnosis that is carried out before there are complaints and will be detected early by efforts to increase awareness of the prevention of mental illness and reduce the tendency to self-diagnose. Second, applying the forward chaining method and certainty factor to this expert system can produce an accuracy rate of 95.918%. An expert has also validated these results; in this study, the expert was a psychologist at a hospital in Yogyakarta.