bluuebunny/crossref_metadata_2025_split huggingface dataset:
Various Contract Settings and their Impact on the Cost of Medical Services
Authors: Magnezi Racheli , Dankner R , Kedem R , Reuveni H 
Published: March 2013

ObjectivesThis study analyzes the effect of outsourcing healthcare on career soldiers in the Israel Defense Forces (IDF) in different settings, so as to develop a model for predicting per capita medical costs.MethodsDemographic information and data on healthcare utilization and costs were gathered from three computerized billing database systems: The IDF Medical Corps; a civilian hospital; and a healthcare fund, providing services to 3,746; 3,971; and 6,400 career soldiers, respectively. Visits to primary care physicians and specialists, laboratory and imaging exams, number of sick-leave days, and hospitalization days, were totaled for men and women separately for each type of clinic. A uniform cost was assigned to each type of treatment to create an average annual per capita cost for medical services of career soldiers.ResultsSignificantly more visits were recorded to primary care physician and to specialists, as well as imaging examinations by Leumit Healthcare Services (LHS), than visits and tests in hospitals or in military clinics (p<0.001). The number of referrals to emergency rooms and sick-leave days were lowest in the LHS as compared to the hospital and military clinics (p<0.001). The medical cost per capita/year was lowest in LHS as well.ConclusionsOutsourcing primary care for career soldiers to a civilian healthcare fund represents a major cost effective change, lowest consumption and lower cost of medical care. Co-ayment should be integrated into every agreement with the medical corps.
A review of one year of British Armed Forces mental health hospital admissions
Authors: Finnegan A , Finnegan S , Gamble D 
Published: March 2013

ObjectivesThe paper provides a review of one year of military Mental Health (MH) hospital admissions. This includes an exploration into demographic trends, differences in clinical opinion and how information gained is used to improve the service and ensure appropriate, cost effective care in the optimum environment.MethodsThe sample group is entitled military MH hospital admissions from 1 April 2005 to 31 March 2006. Data was collected on questionnaires with SPSS used for the management and analysis of the quantitative data, with the information exposed to descriptive and inferential statistical analysis.ResultsThere were 344 admissions. The paper contains a detailed review of a number of variables. Depression was the most common diagnosis resulting in 112 (33%) hospital admissions and Post Traumatic Stress Disorder accounted for 23 (7%). There were statistically significant differences that may be attributable to gender with more women admitted with depression and more men with alcohol related disorders. The average length of stay was 21 days, with 48% of patients discharged within 3 weeks. 45% of all returns included significant events reporting that highlighted written evidence of good and poor practice.ConclusionThis study is part of an extensive monitoring programme of military MH hospital admissions. Depression is the most common MH problem leading to hospital admission. The results indicate that Service-personnel have access to a highly responsive service that provides brief assessment and treatment within a safe therapeutic environment. 45% of returns included significant event information that resulted in policy changes, leading to improved patient care and a better interface with the NHS. Bench-marking, both internally between military Departments of Community Mental Health and externally have improved visibility and self awareness leading to better GP induction programmes, PHC educational seminars and the establishment of MH web-pages. The Armed Forces need an effective MH service that is accessible, readily available, non-stigmatised and which positively advocates a duty of care. The results highlight the importance of further studies regarding depression to ensure that the Armed Forces are in a better position to maximise the use of MH resources.
Do Military Uniform and Rank Impact on the Therapeutic Relationship between Military Mental Health Clients and Clinicians?
Authors: Wilson MM , McAllister PD , Hacker Hughes Jamie , Fear NT 
Published: March 2013

ObjectiveTo measure the perceptions of military staff of the impact of wearing military uniform on the therapeutic relationship with mental health clients.MethodA brief questionnaire was distributed to all military clinicians in Departments of Community Mental Health to measure their attitudes.ResultsThere was a 67.9% (n=70) response rate regarding the impact of uniform on the therapeutic relationship. 20% of responses were positive, 31% negative, 37% mixed and 12% gave no answer.ConclusionThere was no clear pre-existing literature on this issue. Overall, the wearing of uniform appeared to be perceived positively positive. There is a need to assess clients’ points of view in future studies.
An Evaluation of the Medical Training Application Service as Experienced by Defence Medical Service Medical Officers
Authors: Owen J P 
Published: March 2013

ObjectivesIn 2007 Defence Medical Service (DMS) Medical Officers (MOs) applying to train within hospital based specialities were selected using the Medical Training Application Service (MTAS). Recognising the problems being reported about MTAS, the Defence Postgraduate Medical Deanery (DPMD) conducted an evaluation in order to assess whether DMS MOs had also experienced problems with the MTAS process.MethodsDMS MO applicants were sent an email questionnaire, requesting both graded (Likert scale) and narrative responses, to gauge their opinion about the application service. The questionnaire covered the technical aspects of the process, the support available and the ability to demonstrate appropriate knowledge and skills.ResultsOnly 42 responses (32%) were received. However, having considered areas of potential bias, the graded questionnaire results and thematic analysis of the narrative responses showed a clear consensus amongst the applicants in many areas. More than three quarters (78%) of DMS applicants criticised the opportunity to record their abilities and achievements, and 91% recorded that the questions were unable to differentiate between candidates. These views were mirrored in the narrative responses, with more than 130 statements covering five topic areas highlighting areas for improvement. Strong support was recorded for the work and advice provide by DPMD in support of the candidates.ConclusionsDMS MOs presented very negative opinions of their experiences of MTAS, highlighting their perceptions that they were unable to record their particular skills and experiences and that the questions were unable to discriminate between specialties. Particular difficulties were reported in presenting non-NHS experiences and skills.
The Battle for Goose Green – The RMO’s view
Authors: Hughes SJ 
Published: March 2013

SummaryBy virtue of the Battalion I serve with, I was the first Task Force Doctor on to the Falklands. On Friday the 21st May, 2 Para made an assault beach landing, thankfully unopposed, on San Carlos beach, the RAP was with them.IntroductionAs 2 Para occupied the Sussex Mountains for six days and on Wednesday 2 May, moved off at last light to Camilla Creek House, 5 miles from Darwin. The Battalion laid up in the area of Camilla Creek during 27 May and early the next morning moved out to create history….
Why Military Personnel Fail to Keep Medical Appointments
Authors: Thornton R , Ballard K 
Published: March 2013

ObjectivesFailure to keep medical appointments, commonly referred to as ‘Did Not Attend’ (DNA), is a frequent problem in both primary and secondary health care and leads to a waste of valuable resources. Although the reasons for DNA within the general population are well documented, little is known about this behaviour amongst people serving in the armed forces. In this paper we report the findings of a questionnaire-based study investigating the reasons why military personnel fail to keep hospital appointments.MethodA postal questionnaire asking questions about the reasons for not attending the appointment and how they perceived the condition for which treatment had been sought, were sent to 167 military patients known to have missed appointments in either a hospital outpatient department or regional rehabilitation unit. 162 controls, who attended appointments, were also sent a questionnaire asking them about factors leading to their appointment and how they perceived the condition that they attended the appointment for. Illness perception was measured using a previously validated Illness perception Questionnaire (IPQ-R). The controls were matched by rank, gender and corps.ResultsThe overall response rate was 51.5%, with 46% response in the DNA group and 55% in the controls.A previous history of hospital DNA (though not DNA in primary care) and attempting to change the appointment date were associated with DNA (p=0.01). Those who received a reminder about the appointment were less likely to DNA (p=<0.001). Although patients who perceived their condition to be less important were more likely to fail to attend their appointment (p=0.01), illness perception as measured on the IPQ-R, was not associated with appointment attendance.The most frequent reasons cited for missed appointments were due to administrative problems, with many (38%) respondents being simply unaware that they had an appointment at all or believing that they had cancelled it (14%). Forgetting the appointment (8%) or mixing up the date (21%) were also cited by respondents as reasons for not attending. Only 11% of respondents gave reasons that were specific to a military population, most frequently being on exercise at the time of their appointment.Demographic differences such as age and gender, and practical factors such as appointment day, distance travelled, method of appointment notification, or type of hospital were not found to be associated with attendance.ConclusionThe most common reasons for not attending appointments were due to administrative error and an inability amongst patients to recall the correct date of the appointment. Whilst efforts to improve attendance through various reminder systems have been found to be effective in the short term at least, improvements in the efficiency of appointment administration is likely to generate a reduction in DNA and in turn will reduce the wastage of resources.
BATLS/BARTS/BBTLS Training for Swedish Armed Forces Medical Personnel – A Ten Year Retrospective Study
Authors: Lundberg Lars , Molde Å , Dalenius E 
Published: March 2013

ObjectiveThe British BATLS/BARTS concept was introduced in Sweden in 1998. Perceived changes within the student group, regarding purposes for taking the course and previous trauma training were the subject of the study.MethodsRecords from all Swedish courses during 1998-2007 were examined and analyzed.ResultsIn all, 61 courses with a total of 1254 students were conducted. Among the participants were 295 doctors, 764 nurses, 176 medical orderlies and 19 belonging to other categories. The course has by time become a pre-mission course. Also, a large number of the students now have previous (often civilian) trauma life support training.ConclusionWhen the British BATLS/BARTS concept was introduced in Sweden ten years ago, the general level of trauma training among medical personnel was inadequate for the wartime needs of the Armed Forces. Today, the majority of individuals selected for international service already have previous trauma life support training. This has led to the courses now being aimed mainly at improving their knowledge of the tactical medical skills particular to the environment in which they will serve.
Prolonged Incarceration: Effects on Hostages of Terrorism
Authors: Busuttil Walter 
Published: March 2013

BackgroundIn recent years there has been an explosion in the publicity surrounding hostage taking. There have been many well-publicized hostage, prisoner of war and politically motivated incarcerations. Increasingly hostages are being paraded on television and sometimes even films of executions posted on the internet. Hostage taking has usually occurred in countries where there has been political strife and war, especially, in recent years, in Iraq and Afghanistan, most recently involving British Royal Navy Personnel in Iran and a British journalist in Palestine.AimsThe aim of this paper is to review the adult literature regarding hostage taking with a view to highlighting the most likely psychiatric disorders that can develop during such an experience. This will aid planning and implementation of hostage rehabilitation and family reintegration post release. This paper will help build insight into the experiences and potential clinical presentations of those held hostage under conditions of torture and threat of death. It presents a framework of needs allowing the planning of rehabilitation including how to manage the family and the media.ConclusionsFurther specific research is needed in order to assess the full needs of those released from prolonged incarceration held under threat of death. This will allow better planning for, and delivery of, rehabilitation of those released.
The Civil and Military Medical Response to Natural Disasters
Authors: Dowlen Henry , Nicol E , Mozumder A 
Published: March 2013

This article explores the topic of military involvement in disaster response. This was debated during a conference held at the Royal Society of Medicine, through presentations on experiences and procedures within both the military and civilian roles. The conference was run jointly by the Haywood Club Tri-Service Medical Society and the Catastrophes & Conflict Forum of the Royal Society of Medicine on 20th April 2007.Issues of collaboration and accountability are seen as key themes of disaster response, within which the military can have a role, but which needs to be carefully administered in order to avoid an inappropriate response with an associated political fallout.This article does not represent the official stance of government or any of the agencies therein.
Which Quality and Outcomes Framework (QOF) Clinical Indicators are Applicable for British Forces Germany Health Service (BFG HS) Primary Care?
Authors: Heuvel HGJ van den , Simpson RG 
Published: March 2013

ObjectivesTo determine which QOF clinical indicators are applicable for BFG HS primary care.MethodIn depth cross-sectional survey of BFG HS general practitioners. Participants were requested to assess all 19 QOF clinical domains (80 clinical indicators) and to indicate to what extent these were applicable for BFG HS (Likert scale 1 – 5). Response rate was documented. Cronbach’s alpha reliability was calculated and a comparison of the mean responses of training and non-training practices was made.ResultsThe response rate was 80% (28/35). Cronbach’s alpha was 0.91. The mean score for both training practices and non-training practices was 3.9. Based on the mean score the applicable indicators were (in descending order): Hypothyroidism (mean 4.6, 95% confidence interval 4.5 - 4.8), Hypertension (4.6, 4.5- 4.8), Asthma (4.3, 4.2- 4.5), Diabetes mellitus (4.3, 4.2- 4.3), Obesity (4.1, 4.0- 4.2), Chronic Heart Disease (4.1, 3.9- 4.2), Epilepsy (4.0, 3.9- 4.2) and Smoking (4.0, 3.7- 4.2). Problematic were (descending means): Cancer (3.9, 3.6- 4.2), Stroke and TIA (3.8, 3.7- 4.0), Atrial fibrillation (3.6, 3.3- 3.8), Learning disabilities (3.5, 3.1- 4.0), Chronic kidney disease (3.5, 3.3- 3.8), Chronic Obstructive Pulmonary Disease (3.5, 3.3- 3.7), Mental health (3.5, 3.3- 3.6), Heart failure (3.4, 3.1- 3.7), Depression (3.2, 2.8- 3.5) and Palliative care (3.2, 2.7- 3.6). Not applicable was Dementia (2.4, 2.0- 2.8).ConclusionThis study shows that several but not all QOF clinical indicators are applicable in BFG HS. Therefore QOF cannot be directly transferred to BFH HS and an adapted quality framework is required.
Early Treatment with Nebulised Salbutamol Worsens Physiological Measures and Does Not Improve Survival Following Phosgene Induced Acute Lung Injury
Authors: Grainge C , Brown R , Jugg Bronwen , Smith AJ , Mann TM , Jenner J , Rice P , Parkhouse DA 
Published: March 2013

ObjectivesTo examine the effectiveness of nebulised salbutamol in the treatment of phosgene induced acute lung injury.MethodUsing previously validated methods, 12 anaesthetised large white pigs were exposed to phosgene (Ct 1978 ± 8 mg min m-3), established on mechanical ventilation and randomised to treatment with either nebulised salbutamol (2.5mg per dose) or saline control. Treatments were given 1, 5, 9, 13, 17 and 21 hours following phosgene exposure. The animals were followed to 24 hours following phosgene exposure.ResultsSalbutamol treatment had no effect on mortality and had a deleterious effect on arterial oxygenation, shunt fraction and heart rate. There was a reduction in the number of neutrophils from 24.0% ± 4.4 to 12.17% ± 2.1 (p<0.05) in bronchoalveolar lavage, with some small decreases in inflammatory mediators in bronchoalveolar lavage but not in plasma.ConclusionNebulised salbutamol treatment following phosgene induced acute lung injury does not improve survival, and worsens various physiological parameters including arterial oxygen partial pressure and shunt fraction. Salbutamol treatment reduces neutrophil influx into the lung. Its sole use following phosgene exposure is not recommended.
Are IVC Filters Required in Combat Support Hospitals?
Authors: Parent Philippe , Trottier VJF , Bennett DR , Charlebois PB , Schieff TD 
Published: March 2013

BackgroundHaemorrhagic shock from traumatic injuries is now often treated using a damage control resuscitation strategy that transfuses packed red blood cells, plasma and platelets in a 1:1:1 ratio, early use of activated recombinant factor VII and transfusion of fresh whole blood. These therapies are aimed at promoting thrombosis in injured vessels. Such patients are at high risk for thrombotic complications and thromboprophylaxis is necessary, but frequently impossible to use in the early phase of care.Case presentationWe describe the case of an Afghan civilian worker who suffered a vertical shear pelvic fracture with massive bleeding in a pedestrian/truck collision that was treated with a damage control resuscitation strategy, and who later suffered a severe pulmonary embolus. The potential use of a temporary inferior vena cava [IVC] filters is discussed.RecommendationsCare providers and policy makers must recognize that the increased use of prothrombotic strategies of resuscitation will likely increase the incidence of thrombotic complications in the high risk population of severely injured patients in combat support hospitals. Monitoring the incidence of these complications and development of strategies for prevention and treatment are required to avoid undermining the positive outcomes of damage control resuscitation. These strategies could include supplying combat support hospitals with the equipment and training necessary for placement of temporary IVC filters under fluoroscopic guidance.
Operational Morbidity Analysis: Ophthalmic Presentations During Operation Telic
Authors: Ollerton JE , Hodgetts TJ 
Published: March 2013

AimThis paper analyses all ophthalmic attendances to a deployed emergency department (ED) in Iraq to identify patterns of injury to optimise patient care, plan equipment tables for future operations and emphasise need for prevention of ocular morbidity.MethodsThe Academic Department of Military Emergency Medicine at the Royal Centre for Defence Medicine in Birmingham maintains an electronic database with details on all attendances to the emergency departments deployed on Operations. This Operational Emergency Department Attendance Register (OpEDAR) was searched for all patients with medical classification of Ophthalmology over a 52 month period between 1 March 2003 and 30 June 2007.ResultsDuring this period 30,195 patients were seen in the ED on Operation Telic and are available for analysis. Patients with ophthalmic complaints account for 5.3% of all presentations to the ED and rank as the 7th most common reason for attendance.ConclusionThis paper identifies patterns of injury to enable future planning of equipment tables and identifies the need for prevention of injury wherever possible. Implications on days lost from full active duty for the injured can be extrapolated. More data needs to be collated on the use of eye protection and the relevance of contact lenses in deployed personnel with eye injuries.
The Joint Theatre Clinical Case Conference (JTCCC): Clinical governance in action
Authors: Willdridge DJ , Hodgetts TJ , Mahoney PF , Jarvis L 
Published: March 2013

ObjectivesTo quantify the type and nature of the lessons and issues arising from the Joint Theatre Clinical Case Conference.MethodsAn evaluation of all JTCCC minutes from inception on 30 Mar 07 to 05 Jun 08 (n=61) was performed in Jul 08. Each separate issue (n=207) was assigned a NATO ‘J’ category and further sub-divided into clinical and non-clinical issues. Detail of whether the issues were raised for information only, or required action to be taken was recorded, as was the outcome of this action.ResultsA wide range of clinical and non-clinical issues (J1-J8), were identified. 23% (47) of the 207 issues were raised for information only. 77% (160) issues required action to be taken. 109 were closed within 3 weeks. 23 took more than 3 weeks to close. Eight weeks after the study period 28 issues were still being actively resolved. 85% of JTCCC teleconferences had full participation from both theatres. Technical difficulties and/or the treatment of casualties prevented the participation of one or both theatres on 9 occasions.ConclusionsJTCCC supports deployed clinicians and enables rapid resolution of issues affecting combat casualty care. It is limited by its focus on UK casualties only. Although intended as a Clinical Governance tool the evidence of this review is that JTCCC has wider effects in a number of clinical and non-clinical areas.
Managing Pain on the Battlefield: An Introduction to Continuous Peripheral Nerve Blocks
Authors: Hunter J G 
Published: March 2013

ObjectiveTo determine the strength of evidence supporting the battlefield use of Continual Peripheral Nerve Blocks (CPNBs).MethodsPublication review identifying 380 potentially relevant papers.ResultsCPNBs have been well trialled and are used routinely in civilian hospitals. The procedure is not without acute and chronic complications related to agents used, catheters themselves and infection risks. These techniques are being used increasingly in military field hospitals to manage pain, however research concerning their use on the battlefield is limited and further trials are required to confidently conclude efficacy.ConclusionCPNBs are just one component within military medicine of a rapidly evolving polymodal system of pain management. Common combat wounds, namely traumatic amputations, are compatible with this technique, however current evidence concerning their battlefield use is limited. Extensive UK military trials are ongoing and the results of which are expected to clarify questions regarding complication rate and efficacy.