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Articoli di riviste sul tema "United states, navy, medical care"

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Autore: Grafiati

Pubblicato: 26 luglio 2024

Ultima modifica: 27 luglio 2024

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Galarneau, Michael R., Susan I. Woodruff, Judy L. Dye, Charlene R. Mohrle e Amber L. Wade. "Traumatic brain injury during Operation Iraqi Freedom: findings from the United States Navy–Marine Corps Combat Trauma Registry". Journal of Neurosurgery 108, n. 5 (maggio 2008): 950–57. http://dx.doi.org/10.3171/jns/2008/108/5/0950.

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Object The purpose of this study was to characterize traumatic brain injuries (TBIs) among military personnel (primarily Marines) during the second phase of Operation Iraqi Freedom from early in the medical care chain of evacuation through Landstuhl Regional Medical Center, a Level 4 American hospital in Germany. Methods Data were obtained from the Navy–Marine Corps Combat Trauma Registry (CTR) and included both battle and nonbattle injuries. Follow-up of patients with TBI was conducted to examine the short-term medical and personnel-related effects of TBI among those surviving. Results Those injured in battle were more likely than those not injured in battle to have multiple TBI diagnoses, a greater number of all diagnoses, more severe TBIs, and to be medically evacuated. Intracranial injuries (for example, concussions) were the predominant type of TBI, although skull fractures and open head wounds were also seen. Improvised explosive devices were the most common cause of TBIs among battle injuries; blunt trauma and motor vehicle crashes were the most common causes among nonbattle injuries. Short-term follow-up of surviving patients with TBI indicated higher morbidity and medical utilization among the patients with more severe TBI, although mental conditions were higher among patients with milder TBI. Conclusions Data from the Navy–Marine Corps CTR provide useful information about combatants' TBIs identified early in the combat casualty process. Results may improve clinical care for those affected and suggest strategies for primary prevention. The CTR staff plans to conduct additional follow-up studies of this group of patients with TBI.

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Fluke, Laura M., Ryan D. Restrepo, Howard I. Pryor, James E. Duncan e Kevan E. Mann. "The Surgical Experience aboard USNS COMFORT (T-AH-20) during Operation Continuing Promise 2015". American Surgeon 84, n. 8 (agosto 2018): 1307–11. http://dx.doi.org/10.1177/000313481808400842.

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In 2015, the United States Navy hospital ship (USNS) COMFORT, deployed to 11 Caribbean and Latin American countries over a six-month period to provide humanitarian civic assistance. Personnel from the United States Navy and multiple nongovernmental organizations collaborated to offer surgical and medical care. Data from past deployments aid in planning for future missions by prioritizing finite resources and maximizing care. The data analyzed included all patients evaluated and treated by the Directorate of Surgical Services of the USNS COMFORT between April and September 2015. Comparative and descriptive statistics were performed to analyze patient demographics, surgical subspecialty performing the procedures, types of general and pediatric surgical procedures performed, operative times, and complication rates. Of the 1256 surgical cases performed aboard USNS COMFORT during CP15, 24.8 per cent were general surgery cases, followed by 16 per cent ophthalmology, 10.6 per cent pediatric surgery, 10 per cent plastic surgery, and eight additional specialties with <10 per cent of the cases each. Total operative time was 1253 hours with a total room time of 1896.5 hours. The identified complication rate was 1.99 per cent across all specialties. The USNS COMFORT platform offers the unique capability to provide humanitarian surgical assistance. Reporting these data demonstrate that there is a need for humanitarian assistance and this can be provided safely through the Continuing Promise mission. Future deployments may target resources toward the surgical services with higher volumes, which were general surgery, ophthalmology, pediatric surgery, and plastic surgery.

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Katzman, Joanna, Laura Tomedi, Robin Swift, Erick Castillo, Connie Morrow, Laurie Lutz, Kevin T. Galloway et al. "Extension for Community Healthcare Outcomes (ECHO) Telementoring in the Military: Where We Are Now, Opportunities and Challenges". Military Medicine 186, n. 9-10 (28 agosto 2021): 236–41. http://dx.doi.org/10.1093/milmed/usab010.

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ABSTRACT Introduction In collaboration with the ECHO (Extension for Community Healthcare Outcomes) Institute since 2012, the Army, Navy, and Air Force have developed medical teleECHO programs to address various health and safety issues affecting military personnel. This article describes and compares the current state of military teleECHOs as well as the growth and change over time. Materials and Methods This study evaluated continuing education units (CEUs) offered, average session attendance, and number of spoke sites for current military teleECHO programs across the service branches. Results Between 2012 and 2019, the military teleECHO initiative grew from one program to seven different teleECHO programs, covering topics from pain to diabetes to amputee care. Military ECHOs now provide training to 10 countries and 27 states in the United States. Between October 2018 and September 2019, the military ECHO programs provided a total of 51,769 continuing medical education (CME) hours to a total of 3,575 attendees from 223 spoke sites. Conclusions The military has successfully used the ECHO model to improve the health and safety of active-duty military, retirees, and dependents.

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Lillie, Gregory R. "Resolution of low back and radicular pain in a 40-year-old male United States Navy Petty Officer after collaborative medical and chiropractic care". Journal of Chiropractic Medicine 9, n. 1 (marzo 2010): 17–21. http://dx.doi.org/10.1016/j.jcm.2009.12.006.

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LorÍa-castellanos, J., F. Cruz-vega e E. Gomez-zarate. "(P1-18) Experience of IMSS Medical Equipment in Rescue Efforts in Haiti". Prehospital and Disaster Medicine 26, S1 (maggio 2011): s104—s105. http://dx.doi.org/10.1017/s1049023x11003505.

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Has been a tradition of the Mexican Social Security Institute (IMSS) have a great spirit of solidarity with any type of disaster. That is why the early hours of the earthquake in Haiti was appointed to a group of specialists trained in emergency care who participated in the first acts of rescue and stabilization of multiple victims. The first group of six specialists arrived Port au Prince on January 15 fieldwork being allocated in coordination with the rest of the Mexican aid mission in the sector 8 of the city, preferably at the University of Saint Gerard. Among the actions taken by this group were: •Application of 300 doses of immunization.•Tracking and signaling a radius of 3 km in search of survivors and bodies.•Working in conjunction with the group of Topos, the Federal Police and the Navy in the initial care, resuscitation and transfer of 9 people rescued from the rubble.•More than 60 dressings and sutures.•Monitoring and maintenance of health of mission personnel.The second group, consisting of specialists in trauma, reconstructive surgery, anesthesiology, surgical and intensive care nurses, was part of a Field Hospital was established in conjunction with the United States at the place called “Killi Point”, involving a network trauma care in which our doctors surgically intervened the hospital ship “Comfort”. Were to a large number of cases of traumatic amputation, children and adults burned, fractures, crushing limbs and carrying large infections for obvious reasons IMSS staff recognizes the professionalism and capacity of the entire Mexican mission of humanitarian aid to Haiti and the opportunity offered to us to help a sister nation, we reiterate that we are engaged, if required again to respond with the same promptly and sense of humanity shown so far.

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Ulcickas Yood, Marianne, Susan Jick, Catherine Vasilakis-Scaramozza, Bonnie M. K. Donato, Ioannis Tomazos, Gilbert L'Italien, Nicholas Sicignano e Brian L. Feldman. "The Value of Population Based Data to Study Rare Diseases: An Example Using the Department of Defense Healthcare System". Blood 132, Supplement 1 (29 novembre 2018): 5829. http://dx.doi.org/10.1182/blood-2018-99-113497.

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Abstract Background: For patients suffering from rare diseases, accurate and early diagnosis is critical and often lifesaving, whereas misdiagnosis can be fatal. While patient registries are useful and necessary, they may not provide reliable patient population denominators or sufficient longitudinal clinical follow-up. Access to complete and integrated patient records necessary to capture full clinical history can be challenging. Commonly, there is a lack of centralized and continuous care in the health care systems of many countries, including the United States (US). It is also challenging to identify a sufficient number of cases to provide robust results because of the rare nature of these diseases. We describe a healthcare system that can identify patients for research purposes, who have rare diseases, by accessing de-identified electronic clinical details. We used Paroxysmal Nocturnal Hemoglobinuria (PNH) as an example of a rare disease for this abstract. Methods: The Department of Defense (DOD) healthcare system is a US-based, longitudinal electronic health record (EHR) and claims database with health information on approximately 10 million active beneficiaries across the country. We evaluated the feasibility to conduct studies of rare diseases in the DOD healthcare system by assessing the capability to identify patients with PNH and to describe their course of disease and treatment. We used ICD 9/10 diagnosis codes, NDC and HCPCS codes, laboratory data and PNH treatment codes to identify patients with a clinical course consistent with PNH. Patients were classified as definite/likely, probable/possible or unlikely PNH based on the available clinical evidence and then findings were validated against review of patient records by a clinical expert. Individuals classified as unlikely PNH were excluded from the study. The clinical information on these patients will be used to understand the course of PNH in patients with and without treatments and to describe their treatment adherence and disease activity over time. Results: We identified 244 people with a diagnosis or treatment code that was indicative of PNH during years 2007-2017; 71% of the patients had electronic records that covered 10 or more years starting as early as 2003 and extending as far as 2017. From these 244 patients, we identified 73 patients with a definite/likely or probable/ possible PNH diagnosis. An ICD-10 code for PNH or a prescription for eculizumab (PNH treatment) were required, but not sufficient to confirm the presence of PNH. There is no ICD-9 code for PNH. Cases had no other indication for eculizumab use and had to have appropriate symptoms, comorbidities or lab results to be considered a case. Patients with only 1 code for PNH and no treatment were assumed to have unconfirmed disease and were excluded. 27 cases, including those with no eculizumab and a random sample of likely cases, were reviewed to validate the PNH diagnoses in collaboration with DOD treating physicians. Conclusion: The DOD healthcare system is a valuable and cost effective resource for the study of rare diseases in a timely manner. We have demonstrated the ability to identify a validated series of PNH cases that will provide important clinical insights for identifying and treating new PNH cases. This healthcare system provides long patient follow-up, demographics similar to the US population, and access to records in an integrated inpatient, outpatient and ER system that encompasses all patient care. Disclaimer Statement: Research data were derived from an approved Naval Medical Center, Portsmouth, VA IRB protocol (NMCP.2017.0080). The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government. Copyright Notice: CAPT Brian Feldman is a military service member. This work was prepared as part of his official duties. Title 17 U.S.C. 105 provides that 'Copyright protection under this title is not available for any work of the United States Government.' Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties. Disclosures Ulcickas Yood: Alexion Pharmaceuticals, Inc.: Other: Employee of EpiSource, LLC, which was contracted by Alexion Pharmaceuticals, Inc. EpiSource had the final decision on content. . Jick:Alexion Pharmaceuticals, Inc.: Other: Employee of the Boston Collaborative Drug Surveillance Program, which was contracted and paid by Alexion Pharmaceuticals, Inc. to work on a study of PNH using DOD data. . Vasilakis-Scaramozza:Alexion Pharmaceuticals, Inc.: Other: Employee of the Boston Collaborative Drug Surveillance Program, which was contracted and paid by Alexion Pharmaceuticals, Inc. to work on a study of PNH using DOD data.. Donato:Alexion Pharmaceuticals Inc: Employment, Equity Ownership. Tomazos:Alexion Pharmaceuticals, Inc.: Employment, Equity Ownership. L'Italien:Alexion Pharmaceuticals, Inc.: Equity Ownership, Other: Former employee and current stockholder of Alexion Pharmaceuticals, Inc. . Sicignano:Alexion Pharmaceuticals, Inc.: Other: Employee of Health ResearchTx, which has a business relationship with Alexion Pharmaceuticals, Inc.. Feldman:Alexion Pharmaceuticals, Inc.: Other: Employee, Department of Navy, United States Government..

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Eggleston, Heather, Nina Shoemaker, Christina Gariepy, Julie Norton, Kelsey Beauman, Aaron Kim, Christine Fedorchuk, James Roberts, Frederic Poly e Renee Laird. "Immunopathogenesis of Campylobacter jejuniinfection in a small animal model". Journal of Immunology 210, n. 1_Supplement (1 maggio 2023): 82.17. http://dx.doi.org/10.4049/jimmunol.210.supp.82.17.

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Abstract We set out to develop and characterize a small animal model of Campylobacter jejuni(CJ) infection that recapitulates human campylobacteriosis. Adult C57BL/6J mice are rendered susceptible to colonization and disease by pre-treatment with a zinc deficient diet and a broad-spectrum antibiotic cocktail. We have established this model with four strains with diverse capsular serotypes and flagellar groups, two key virulence factors for CJ pathogenesis. We measured colonization, weight loss, diarrhea, fecal inflammatory markers, and cytokine production by mesenteric lymphocytes and splenocytes. Diarrhea containing visible mucous and/or blood and degree of weight loss vary in severity depending on the strain and dose. Interestingly, we identified an inverse relationship between inoculum dose and levels of fecal inflammatory markers, with lower inoculum doses inducing significantly higher inflammation. We also observed production of IFNγ and IL-17 at day 9 post infection and despite no decrease in CJ colonization, IFNγ and IL-17 levels decreased by day 21 with a subsequent increase in IL-10 production. We also observed higher levels of IFNγ and IL-17 in mice challenged with strain CG8486 relative to those challenged with strain 81–176 pointing to potential strain differences. These differences observed were more striking in mesenteric lymphocytes versus splenocytes, indicating that local cellular responses differed from systemic responses. We have developed a model of inflammatory diarrhea in adult mice that exhibits hallmarks of CJ infection and further identified significant shifts in cytokine expression associated with the duration of infection, bacterial strain utilized, and therapeutic treatment. Research reported in this presentation is supported by Navy work unit number: 6000.RAD1.DA3.A0308 and CARB-X. CARB-X’s funding for this project is sponsored by the Cooperative Agreement Number IDSEP160030 from ASPR/BARDA and by awards from Wellcome Trust, the UK Global Antimicrobial Resistance Innovation Fund (GAMRIF) funded by the UK Government Department of Health and Social Care (DHSC) and the Bill & Melinda Gates Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of CARB-X or any of its funders. Disclaimers: The views expressed in this work are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. F. Poly is an employee of the U.S. Government. This work was prepared as part of official duties. Title 17 U.S.C. §105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.The animal study protocol was reviewed and approved by the Naval Medical Research Center IACUC in compliance with all applicable Federal regulations governing the protection of animals in research.

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Folaron, Irene, Mark W. True, William H. Kazanis, Jana L. Wardian, Joshua M. Tate, Sky D. Graybill, Philip G. Clerc e Craig R. Jenkins. "Diabetes by Air, Land, and Sea: Effect of Deployments on HbA1c and BMI". Military Medicine 185, n. 3-4 (17 ottobre 2019): 486–92. http://dx.doi.org/10.1093/milmed/usz311.

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Abstract Introduction Service members (SMs) in the United States (U.S.) Armed Forces have diabetes mellitus at a rate of 2–3%. Despite having a chronic medical condition, they have deployed to environments with limited medical support. Given the scarcity of data describing how they fare in these settings, we conducted a retrospective study analyzing the changes in glycated hemoglobin (HbA1c) and body mass index (BMI) before and after deployment. Materials and Methods SMs from the U.S. Army, Air Force, Navy, and Marine Corps with diabetes who deployed overseas were identified through the Military Health System (MHS) Management Analysis and Reporting Tool and the Defense Manpower Data Center. Laboratory and pharmaceutical data were obtained from the MHS Composite Health Care System and the Pharmacy Data Transaction Service, respectively. Paired t-tests were conducted to calculate changes in HbA1c and BMI before and after deployment. Results SMs with diabetes completed 11,325 deployments of greater than 90 days from 2005 to 2017. Of these, 474 (4.2%) SMs had both HbA1c and BMI measurements within 90 days prior to departure and within 90 days of return. Most (84.2%) required diabetes medications: metformin in 67.3%, sulfonylureas in 19.0%, dipeptidyl peptidase-4 inhibitors in 13.9%, and insulin in 5.5%. Most SMs deployed with an HbA1c < 7.0% (67.1%), with a mean predeployment HbA1c of 6.8%. Twenty percent deployed with an HbA1c between 7.0 and 7.9%, 7.2% deployed with an HbA1c between 8.0 and 8.9%, and 5.7% deployed with an HbA1c of 9.0% or higher. In the overall population and within each military service, there was no significant change in HbA1c before and after deployment. However, those with predeployment HbA1c < 7.0% experienced a rise in HbA1c from 6.2 to 6.5% (P < 0.001), whereas those with predeployment HbA1c values ≥7.0% experienced a decline from 8.0 to 7.5% (P < 0.001). Those who deployed between 91 and 135 days had a decline in HbA1c from 7.1 to 6.7% (P = 0.010), but no significant changes were demonstrated in those with longer deployment durations. BMI declined from 29.6 to 29.3 kg/m2 (P < 0.001), with other significant changes seen among those in the Army, Navy, and deployment durations up to 315 days. Conclusions Most SMs had an HbA1c < 7.0%, suggesting that military providers appropriately selected well-managed SMs for deployment. HbA1c did not seem to deteriorate during deployment, but they also did not improve despite a reduction in BMI. Concerning trends included the deployment of some SMs with much higher HbA1c, utilization of medications with adverse safety profiles, and the lack of HbA1c and BMI evaluation proximal to deployment departures and returns. However, for SMs meeting adequate glycemic targets, we demonstrated that HbA1c remained stable, supporting the notion that some SMs may safely deploy with diabetes. Improvement in BMI may compensate for factors promoting hyperglycemia in a deployed setting, such as changes in diet and medication availability. Future research should analyze in a prospective fashion, where a more complete array of diabetes and readiness-related measures to comprehensively evaluate the safety of deploying SMs with diabetes.

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Long, Glenn, Gareth Jones, David Roper, Yasmin Eaton e Amy Howells. "The Royal Navy Operating Department Practitioner: Perioperative care on land and sea". Journal of Perioperative Practice 30, n. 6 (16 settembre 2019): 176–82. http://dx.doi.org/10.1177/1750458919864826.

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Royal Navy Operating Department Practitioners are employed in a number of different roles, during peacetime, humanitarian aid operations and periods of war. In recent times, Royal Navy Operating Department Practitioners have deployed on active operations in addition to working in NHS hospitals at home in the United Kingdom. This article will explore the different avenues and experiences of Operating Department Practitioners who are currently serving in the Royal Navy. The reader will then also gain an insight into the different echelons of care provided by the Defence Medical Services to the United Kingdom Armed Forces and Allied Nations. The article will then consider the unique experiences available to Royal Navy Operating Department Practitioners in this multi-faceted role which offers the opportunity to explore work patterns in different environments.

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Bennett, Brad L., David P. Gray e David A. Wynkoop. "The United States Navy Medical Service Corps: The Golden Anniversary 1947–1997". Military Medicine 162, n. 8 (1 agosto 1997): 513–14. http://dx.doi.org/10.1093/milmed/162.8.513.

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Hutcheson, Allen. "Hospice Care in the United States". Primary Care: Clinics in Office Practice 38, n. 2 (giugno 2011): 173–82. http://dx.doi.org/10.1016/j.pop.2011.03.002.

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Oppenheimer, Gerald. "Medical Care of Infants in the United States:". Trends in History 4, n. 2-3 (14 luglio 1988): 103–28. http://dx.doi.org/10.1300/j265v04n02_06.

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Shapiro, Robert Y., e John T. Young. "The Polls: Medical Care in the United States". Public Opinion Quarterly 50, n. 3 (1986): 418. http://dx.doi.org/10.1086/268994.

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Kereiakes, Dean J., e James T. Willerson. "The United States Cardiovascular Care Deficit". Circulation 109, n. 7 (24 febbraio 2004): 821–23. http://dx.doi.org/10.1161/01.cir.0000119802.71603.a0.

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Gimbel, Ronald W., Christy J. W. Ledford e Mark B. Stephens. "Medical Education in the United States". Social Marketing Quarterly 18, n. 4 (8 novembre 2012): 293–302. http://dx.doi.org/10.1177/1524500412466074.

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Social marketing has a long and robust history in health education and public health. Social marketing strategies are designed to promote desired behaviors in high-priority health-related areas. Most prior initiatives have utilized an “orientation to consumer needs” in program design and delivery. Traditional social marketing campaigns have targeted patients or specific segments of the public, rather than physicians and other healthcare providers, to deliver health-related messages. This commentary explores an emerging opportunity for the social marketing and medical education communities to collaborate and influence social change of medical students, interns, and residents – an “undiscovered” but influential consumer market. The authors offer a primer on the medical education environment as it relates to social marketing strategies for healthcare providers. Key themes and emerging needs in medical education are outlined. In particular, four major areas for collaboration with the social marketing community are highlighted. These include: emphasis on social accountability, use of technology in education and medical practice, alignment with changes in health care delivery, and future directions in the health care workforce. In addition, four practical strategies for meaningful collaborations between medical education and social marketing leadership are presented. The medical education environment is an ideal platform for social marketing techniques to influence the behavior of developing physicians.

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Shattuck, Nita, e Panagiotis Matsangas. "0213 Sleep and well-being of culinary specialists on United States Navy ships". SLEEP 46, Supplement_1 (1 maggio 2023): A94. http://dx.doi.org/10.1093/sleep/zsad077.0213.

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Abstract Introduction In the US Navy, “galley workers” are those sailors involved in cooking and preparing meals and maintaining the overall cleanliness and hygiene of the galley spaces and messdecks. These sailors begin their workday in the ship’s kitchen in the early morning, working until late in the evening, typically sleeping at night. The purpose of the current study was to assess the fatigue levels, work/rest patterns, health-related behaviors, and well-being of galley workers on US Navy ships while underway. Methods In this longitudinal field assessment, 80 fit-for-duty US Navy galley workers performed their normal duties on 11 surface ships. Participants wore actigraphs, and completed activity logs and questionnaires to include four standardized tools (Pittsburgh Sleep Quality Index – PSQI; Epworth Sleepiness Scale – ESS; Insomnia Severity Index – ISI; Profile of Mood States – POMS). Results Galley workers had a median age of 25 (IQR=11.8) years and most of them were male (68, 85.0%). Most galley workers reported drinking caffeinated beverages (60, 80.0%), with nicotine or tobacco products used by 22 (29.3%) participants. In terms of working out, 46 (61.3%) reported having an exercise routine. The typical schedule of the galley workers included sleeping at night with work hours extending from around 6:00 AM till 8:00 PM. Specifically, they slept on average 6.57±0.85 hours/day (~29% slept < 6 hours/day) and worked 12.8±2.43 hours/day (25% worked >14.5 hours/day). Approximately 84% were classified as poor sleepers, ~57% had excessive daytime sleepiness, and ~38% had elevated insomnia symptoms. Compared to adult norms for the POMS total and subscales scores, the mood of galley workers was worse in terms of total mood disturbance (84.1%), tension-anxiety (71.4%), anger-hostility (79.4%), vigor-activity (77.8%), fatigue (68.3%), and confusion-bewilderment (73.0%). Conclusion Galley workers on USN ships are chronically sleep-deprived and work long hours. To ameliorate the detrimental effects of these issues on sailor well-being, leaders should consider adopting strategies to improve sailor well-being. For example, appropriately timed short naps during the day, use of caffeine, and exposure to bright light may be viable methods to incorporate into the daily schedule of galley workers to alleviate the effects of their arduous work schedules. Support (if any)

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Shattuck, N. L., e P. Matsangas. "0776 Differences in Well-Being in Dayworkers Compared to Shift Workers: A Study of United States Navy Sailors". Sleep 43, Supplement_1 (aprile 2020): A295. http://dx.doi.org/10.1093/sleep/zsaa056.772.

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Abstract Introduction On United States Navy (USN) ships, most sailors are shift workers, required to support 24/7 operations. However, ~15% of the ship’s company are solely dayworkers who do not work in shifts. It is often assumed that the quality of life for dayworkers is better than that of shift workers. This study compared the well-being of dayworkers with that of shift workers. Methods Longitudinal, naturalistic observations were made of sailors (N=926; 18-59 years of age, ~80% males, ~84% enlisted personnel) on seven US Navy ships while performing their normal underway duties. Sleep-related attributes (actigraphy, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index), mood (Profile of Mood States), and work/rest patterns were assessed. Results Dayworkers (DW; n=98) were on average older (p=0.001) and more senior (p=0.001) than shift workers (SW). Of the dayworkers, 31% reported elevated daytime sleepiness (SW:45.5%; p=0.008), 64.2% were poor sleepers (SW:82.6%; p<0.001), and 26.3% had ISI score≥15 (SW:24.8%; p=0.782). Also, 13.8% of the dayworkers had ESS>10 and ISI≥15 (SW:16.8%; p=0.626).Dayworkers had better mood (Total Mood Disturbance, anger/hostility, vigor, fatigue; all p<0.050), slept more (7.03±0.74hrs sleep/day; SW:6.52±1.03hrs; p<0.001) and had more consolidated sleep (1.1±0.3 sleep episodes/day; SW:1.4±0.6; p<0.001). Yet, split sleep was commonplace for both groups (DW:~62%; SW:~92%).The two groups do not differ (all p>0.300) in their use of caffeinated beverages (82%-86%), use of nicotine products (30%-36%), or having a regular exercise routine (69%-75%). In both groups, ~9% of sailors drank caffeinated beverages, used nicotine products and did not have an exercise routine (p=0.999). Dayworkers worked 10.1 hours/day, i.e., 1.7 hours/day less than watchstanders (p<0.001). Conclusion Quality of life of dayworkers is a bit better when compared to shift workers, but sleep-related issues are evident in almost all US Navy sailors. Living and working on a naval vessel takes a toll on almost everyone aboard. A culture change is required! Support Supported by the Naval Medical Research Center’s Advanced Medical Development Program, the US Navy 21st Century Sailor Office, and the US Navy OPNAV N1.

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Shattuck, N. L., e P. Matsangas. "0821 Gender Differences in Sailor Well-Being, Sleep-Related Behaviors, and Psychomotor Vigilance Performance in the United States Navy". Sleep 43, Supplement_1 (aprile 2020): A313. http://dx.doi.org/10.1093/sleep/zsaa056.817.

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Abstract Introduction Approximately 18% of US Navy sailors are females. Research has shown gender-related differences in the prevalence of sleep disorders in active duty personnel (Foster et al., 2017). Specifically, insomnia, depression, and anxiety are more prevalent in females, while obstructive sleep apnea is more prevalent in males. We have studied the sleep patterns and fatigue levels of crew members on more than 30 US Navy ships. The current study focuses on gender differences in well-being, sleep-related behaviors, and psychomotor vigilance performance of sailors in the US Navy. Methods Using a longitudinal, naturalistic observation paradigm, data were collected from crewmembers on nine USN ships while performing their normal underway duties. Participants (N=1,056) tended to be young (on average 27 years of age), predominantly male (80.6%), and enlisted (84.8%). We assessed average daytime alertness (Epworth Sleepiness Scale), insomnia symptoms (Insomnia Severity Index), mood (Profile of Mood States), and sleep quality (Pittsburgh Sleep Quality Index). Sleep was assessed with actigraphy and logbooks. Sailors performed a 3-minute version of the Psychomotor Vigilance Task (PVT), which was built into their wrist-worn actigraph. Results Compared to males, female sailors reported more depressive symptoms (p=0.042) and less vigor (p<0.001). Females slept more (daily sleep duration: p<0.001) but their sleep was split into more episodes than their male counterparts (p=0.029). Fewer females reported a regular exercise routine (p=0.033). In addition, females report consuming fewer energy drinks (p=0.007), and using fewer nicotine products (p=0.013). Lastly, consistent with findings from civilian populations, female sailors had slower reaction times on the PVT (p<0.001) and experienced more lapses combined with false starts (p<0.001) than their male counterparts. Conclusion Compared to their male peers, female sailors tend to report higher levels of depression and lower levels of vigor. They experience more pronounced split sleep, are less likely to report having an exercise routine, and have poorer performance on the PVT. Fewer females report using energy drinks and nicotine products. Support This research was supported by the Naval Medical Research Center’s Advanced Medical Development Program, the US Navy 21st Century Sailor Office, and the US Navy OPNAV N1.

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Starfield, Barbara. "Primary Care in the United States". International Journal of Health Services 16, n. 2 (aprile 1986): 179–98. http://dx.doi.org/10.2190/0dj6-7lp0-9eww-66fb.

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In the United States many of the cardinal features of primary care are absent. Medical practitioners usually do not provide services to a defined panel of patients and are not distributed according to the extent or type of health needs in the population or to population size. Findings from research indicate the benefits of longitudinally, comprehensiveness, first contact care, and coordination. Some of the new developments in the organization and financing of services may facilitate the attainment of some of these characteristics, but the implementation of even a rudimentary primary care system will require a greater commitment to the training of primary care personnel and better deployment of resources. In the absence of a societal commitment to a health system based upon levels of care and community orientation, a research agenda to determine the benefits and costs of various alternative approaches is suggested.

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MacLaren, Robert, John W. Devlin, Steven J. Martin, Joseph F. Dasta, Maria I. Rudis e CA Bond. "Critical Care Pharmacy Services in United States Hospitals". Annals of Pharmacotherapy 40, n. 4 (aprile 2006): 612–18. http://dx.doi.org/10.1345/aph.1g590.

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WHITE, JOSEPH. "Markets and Medical Care: The United States, 1993?2005". Milbank Quarterly 85, n. 3 (settembre 2007): 395–448. http://dx.doi.org/10.1111/j.1468-0009.2007.00494.x.

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Carson, Michael P., Kenneth K. Chen e Margaret A. Miller. "Obstetric medical care in the United States of America". Obstetric Medicine 10, n. 1 (12 novembre 2016): 36–39. http://dx.doi.org/10.1177/1753495x16677403.

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The current models of obstetric medical care utilized in the United States, how those models fit in with the overall care system, and ways to increase the role of obstetric internists will be reviewed.

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Owen, Mindy. "Medical Tourism Inbound to the United States for Care". Professional Case Management 14, n. 5 (settembre 2009): 263–64. http://dx.doi.org/10.1097/ncm.0b013e3181baddfe.

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Rosner, Fred. "The Rationing of Medical Care in the United States". Chest 105, n. 4 (aprile 1994): 984–85. http://dx.doi.org/10.1378/chest.105.4.984.

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Dalen, James E., e Kenneth J. Ryan. "United States Medical School Expansion: Impact on Primary Care". American Journal of Medicine 129, n. 12 (dicembre 2016): 1241–43. http://dx.doi.org/10.1016/j.amjmed.2016.05.021.

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Vold Pepper, Patricia, e Douglas K. Owens. "Cost-Effectiveness of the Pneumococcal Vaccine in the United States Navy and Marine Corps". Clinical Infectious Diseases 30, n. 1 (gennaio 2000): 157–64. http://dx.doi.org/10.1086/313601.

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Muller, John G., W. Garry Rudolph, Jonathan M. Lieske, Jose E. Hernandez, Moore H. Jan e Gosia Kubiak. "Changes in B-Readings Over Time in the United States Navy Asbestos Medical Surveillance Program". Journal of Occupational and Environmental Medicine 49, n. 2 (febbraio 2007): 194–203. http://dx.doi.org/10.1097/jom.0b013e31802df12c.

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Gobaud, A. N., C. A. Haley, J. W. Wilson, R. Bhavaraju, A. Lardizabal, B. J. Seaworth e N. D. Goswami. "Multidrug-resistant tuberculosis care in the United States". International Journal of Tuberculosis and Lung Disease 24, n. 4 (1 aprile 2020): 409–13. http://dx.doi.org/10.5588/ijtld.19.0515.

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BACKGROUND: To examine the utilization of the Tuberculosis (TB) Centers of Excellence (COE) medical consultation service and evaluate how these services were being employed for patients in relation to multidrug-resistant TB (MDR-TB).METHODS: Medical consults are documented in a secure database. The database was queried for MDR-TB consultations over the period 1 January 2013–31 December 2017. All were analyzed to assess provider type, center, setting, year of call, and type of patient (pediatric vs. adult). A subgroup was randomly selected for thematic analysis.RESULTS: The centers received 1560 MDR-TB consultation requests over this period. Providers requesting consults were primarily physicians (55%). The majority of requests were from public health departments (64%) and for adult patients (80%). Four major topic areas emerged: 1) initial management of MDR-TB, 2) MDR-TB longitudinal treatment and complications, 3) management of persons exposed to MDR-TB, and 4) MDR-TB treatment completion.CONCLUSIONS: Analysis of these consultations provides insight into the type of expert advice about MDR-TB that was provided. These findings highlight topics where increased medical training and education may help to improve MDR-TB-related practices.

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Klein, Rudolf. "Comparing the United States and United Kingdom: contrasts and correspondences". Health Economics, Policy and Law 7, n. 4 (ottobre 2012): 385–91. http://dx.doi.org/10.1017/s1744133112000199.

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AbstractThe conventionally antithetical stereotypes of the United Kingdom and United States health care systems needs to be modified in the case of the elderly. Relative to the rest of the population, the over-65s in the United States are more satisfied with their medical care than their UK counterparts. There is also much common ground: shared worries about the quality of elderly care and similar attitudes towards assisted death. Comparison is further complicated by within country variations: comparative studies should take account of the fact that even seemingly polar models may have pools of similarity.

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Simon, Steven R., e Gordon T. Moore. "Managed care and graduate medical education in the United States". Medical Education 33, n. 11 (novembre 1999): 797–98. http://dx.doi.org/10.1046/j.1365-2923.1999.00555.x.

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Jacobs, Lawrence R., Robert Y. Shapiro e Eli C. Schulman. "Poll Trends: Medical Care in the United States-an Update". Public Opinion Quarterly 57, n. 3 (1993): 394. http://dx.doi.org/10.1086/269384.

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Tao, Guoyu, William J. Kassler e David B. Rein. "Medical Care Expenditures for Genital Herpes in the United States". Sexually Transmitted Diseases 27, n. 1 (gennaio 2000): 32–38. http://dx.doi.org/10.1097/00007435-200001000-00007.

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Tehrani, Ali Bonakdar, Steven R. Feldman, Fabian T. Camacho e Rajesh Balkrishnan. "Patient Satisfaction with Outpatient Medical Care in the United States". Health Outcomes Research in Medicine 2, n. 4 (novembre 2011): e197-e202. http://dx.doi.org/10.1016/j.ehrm.2011.09.001.

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Schnittker, Jason, e Mehul Bhatt. "The Role of Income and Race/Ethnicity in Experiences with Medical Care in the United States and United Kingdom". International Journal of Health Services 38, n. 4 (ottobre 2008): 671–95. http://dx.doi.org/10.2190/hs.38.4.f.

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Inequalities in experiences with medical care are well-known in the United States, but little is known about the shape of such inequalities in other countries. This study compares a broad spectrum of experiences in the United States and United Kingdom. Furthermore, it focuses on two of the most important dimensions of inequality, race/ethnicity and income, and two of the most widely discussed system-level factors, health insurance and emphasis on primary care. Two general conclusions are reached. First, there are broad income-based inequalities in medical care in both the United States and United Kingdom. These inequalities persist even after controlling for health insurance, including private medical insurance in the United Kingdom. Race is also related to experiences with medical care, although the effects of race are more particular and contingent than are those for income. In particular, the mapping of racial/ethnic inequality differs considerably between the United States and United Kingdom, reflecting their different sociocultural climates. Second, the health care system, especially primary care, plays a limited role in ameliorating inequalities in care, but plays a strong role in elevating the average level of quality within a country. Because inequalities in medical care reflect broader social processes, they are durable across very different health care systems and contexts.

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Navarro, Vicente. "The Politics of Health Care Reforms in U.S. Presidential Elections". International Journal of Health Services 38, n. 4 (ottobre 2008): 597–606. http://dx.doi.org/10.2190/hs.38.4.a.

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This article analyzes why people in the United States have major problems in accessing medical care that are due to financial constraints. The author suggests that the cause of these problems is the way in which medical care and elections are funded in the United States, with private sources being the largest component in the funding of both activities. The article includes a comparison of funding of the electoral process in the United States with similar electoral processes in the countries of the European Union, and postulates that privatization of the funding of U.S. elections (primary and general) is responsible for privatization of the funding of medical care—the root of people's problem in paying for their medical care. Privatization of election funding gives undue power to the economic, financial, and professional groups that dominate medicine in the United States.

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Thomas, R. J., D. E. Conwill, D. E. Morton, T. J. Brooks, C. K. Holmes e W. B. Mahaffey. "Penicillin Prophylaxis for Streptococcal Infections in United States Navy and Marine Corps Recruit Camps, 1951-1985". Clinical Infectious Diseases 10, n. 1 (1 gennaio 1988): 125–30. http://dx.doi.org/10.1093/clinids/10.1.125.

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Crocker, Rebecca M. "The Impact of Binational Barriers to Medical Care on the Care-Seeking Practices of Mexican Immigrants". Qualitative Health Research 31, n. 6 (15 febbraio 2021): 1043–55. http://dx.doi.org/10.1177/1049732321992041.

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Barriers to health care access faced by Mexican immigrants in the United States have been well-documented, including lack of insurance, fear of deportation, and language barriers. However, little is known about this population’s care-seeking experiences before migration. In this article, I use a life-course approach to explore binational isolation from health care and the ways in which early-life experiences pattern Mexicans’ care-seeking practices in the United States. This ethnographic research project took place in Tucson, Arizona, between 2013 and 2014 and used semistructured interviews with service providers and first-generation Mexican immigrants. The majority of participants faced significant barriers to medical care in Mexico, which resulted in low rates of care utilization and heavy reliance on lay modalities. Immigrants faced an even broader array of barriers to care in the United States, and their lack of prior health care access further discouraged care utilization and compromised their medical care experiences after migration.

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Lall, Rakesh, Vijay K. Jain e W. Brad Johnson. "Contemporary Norms for the Coopersmith Self-Esteem Inventory-Adult Form". Perceptual and Motor Skills 82, n. 3_suppl (giugno 1996): 1136–38. http://dx.doi.org/10.2466/pms.1996.82.3c.1136.

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422 medical personnel employed by the United States Navy were administered the Adult Form of the Coopersmith Self-esteem Inventory. In comparison to Coopersmith's 1981 normative sample, the current sample was substantially larger, geographically heterogeneous, and more reflective of the current national population. Analysis suggests small but consistent increases in mean self-esteem scores across all subgroups. Nonetheless, data from the current study are quite consistent with the findings from Coopersmith's 1981 normative sample.

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Borrelli, Eric, Zachary Babcock e Stephen Kogut. "Costs of medical care for mesothelioma". Rare Tumors 11 (gennaio 2019): 203636131986349. http://dx.doi.org/10.1177/2036361319863498.

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Malignant mesothelioma is a rare and devastating form of cancer with an increasing economic burden. We sought to describe the direct cost burden of mesothelioma to the US health system. A systematic literature review was performed to locate published estimates of the medical cost of mesothelioma. In addition, we performed an analysis of hospital discharge data from the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We also reviewed publicly available legal settlements. We found that published estimates of the cost of medical care for mesothelioma are sparse, and differ with respect to nation, timeframe, and types of cost included. For the year 2014 in the United States, we estimated a mean cost per mesothelioma hospitalization of US$24,124 (95% confidence interval: US$20,819–US$28,983) and a total cost for hospital care of US$44,214,835. In conclusion, we found that reports describing the direct medical cost of care for mesothelioma in the United States are lacking, yet the per-patient cost of care is substantial, as evidenced by analyses of inpatient care and legal settlements.

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Van Aalst-Cohen, Emily S., Raine Riggs e Ira R. Byock. "Palliative Care in Medical School Curricula: A Survey of United States Medical Schools". Journal of Palliative Medicine 11, n. 9 (novembre 2008): 1200–1202. http://dx.doi.org/10.1089/jpm.2008.0118.

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Kusoski, Carolyn, Jennifer Booth, Stephanie Salch, Harrison Jozefczyk e Julie Kennerly-Shah. "Costs associated with United States pharmacopeia compliant infusion clinics". Journal of Oncology Pharmacy Practice 28, n. 1 (14 ottobre 2021): 141–48. http://dx.doi.org/10.1177/10781552211048871.

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Purpose As costs continue to rise in oncology, a strategy that has been implemented to limit these costs is use of alternative sites of care. However, there are differences in regulatory standards between common sites of care such as freestanding infusion clinics and hospital outpatient departments. The costs associated with United States Pharmacopeia compliance were evaluated in order to better understand the cost of universally compliant hospital outpatient departments. Methods Annual operational costs associated with United States Pharmacopeia compliance were estimated for a 30-chair infusion clinic with United States Pharmacopeia <797> and <800> pharmacy cleanrooms for non-hazardous and hazardous drugs, respectively. Annual United States Pharmacopeia compliance costs included: competency assessments, personal protective equipment, closed system transfer devices, labels, cleaning supplies, and environmental monitoring. One-time costs included initial cleanroom construction and renovations. Published information and benchmarks provided baseline assumptions for patient volume, staffing, and unit costs. If no published data was available, prices were estimated based on a similarly sized clinic. Results Recurring annual costs for a 30-chair fully compliant infusion clinic were calculated to be $785,207. One-time costs associated with initial construction and renovations were estimated to be $1,365,207–$1,535,207 and $965,207–$1,005,207, respectively. Conclusions Costs associated with increased operational oversight and regulatory standards are a major contributing factor to the facility fee of hospital outpatient departments. Ultimately, all sites of care share in the goal to provide optimal patient care while considering all aspects of patient care, including cost. Therefore, a move towards consistent regulatory standards across all settings would aid in preventing discrepancies in care.

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Cutler, David M., Kaushik Ghosh, Kassandra L. Messer, Trivellore Raghunathan, Allison B. Rosen e Susan T. Stewart. "A Satellite Account for Health in the United States". American Economic Review 112, n. 2 (1 febbraio 2022): 494–533. http://dx.doi.org/10.1257/aer.20201480.

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This paper develops a satellite account for the US health sector and measures productivity growth in health care for the elderly population between 1999 and 2012. We measure the change in medical spending and health outcomes for a comprehensive set of 80 conditions. Medical care has positive productivity growth over the time period, with aggregate productivity growth of 1.5 percent per year. However, there is significant heterogeneity in productivity growth. Care for cardiovascular disease has had very high productivity growth. In contrast, care for people with musculoskeletal conditions has been costly but has not led to improved outcomes. (JEL E01, H51, I10)

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Nicholson, Craig A. "Surgical training in the United States". Bulletin of the Royal College of Surgeons of England 89, n. 2 (1 febbraio 2007): 56–57. http://dx.doi.org/10.1308/147363507x171285.

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Surgical education in the United States has developed along with the graduate medical education (GME) system. Changes in health care delivery and payment systems, changes in the practice and specialisation of surgery, attempts to improve the system of graduate medical training and even generational changes among those entering surgical training have influenced and changed the way surgeons are trained in the US. Although a thorough examination of these factors and their influence on surgical training is beyond the scope of this brief review, some of these influences and our current surgical training system will be described.

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Shehane, Richard, Steve Miller, Luke Suber e Miranda Chakos. "Treatment of Acute Psychosis with Second-Generation Antipsychotics in a Patient with Left Temporal Lobe Lesion". Case Reports in Psychiatry 2018 (2018): 1–3. http://dx.doi.org/10.1155/2018/9839252.

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We present a case of rapid onset severe psychosis followed by suicide attempt in a United States Navy sailor. Investigation revealed a left temporal lobe brain mass suspicious for low-grade glioma. After hospitalization and medical management with olanzapine and lurasidone the patient’s psychosis improved. The purpose of this paper is to add to the existing case reports that suggest a relationship between temporal lobe lesions and psychiatric illness, specifically psychosis. In addition, this case adds insight into the effectiveness of medical therapy for brain tumor patients that are not immediate candidates for neurosurgical intervention.

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Dovey, S., M. Weitzman, G. Fryer, L. Green, B. Yawn, D. Lanier e R. Phillips. "The Ecology of Medical Care for Children in the United States". PEDIATRICS 111, n. 5 (1 maggio 2003): 1024–29. http://dx.doi.org/10.1542/peds.111.5.1024.

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Jeffe, Donna B., Alison J. Whelan e Dorothy A. Andriole. "Primary Care Specialty Choices of United States Medical Graduates, 1997–2006". Academic Medicine 85, n. 6 (giugno 2010): 947–58. http://dx.doi.org/10.1097/acm.0b013e3181dbe77d.

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Richards, Michael J., Jonathan R. Edwards, David H. Culver e Robert P. Gaynes. "Nosocomial infections in medical intensive care units in the United States". Critical Care Medicine 27, n. 5 (maggio 1999): 887–92. http://dx.doi.org/10.1097/00003246-199905000-00020.

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Druss, Benjamin G., e Robert A. Rosenheck. "Mental Disorders and Access to Medical Care in the United States". American Journal of Psychiatry 155, n. 12 (dicembre 1998): 1775–77. http://dx.doi.org/10.1176/ajp.155.12.1775.

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Mariotto, Angela B., Lindsey Enewold, Jingxuan Zhao, Christopher A. Zeruto e K. Robin Yabroff. "Medical Care Costs Associated with Cancer Survivorship in the United States". Cancer Epidemiology Biomarkers & Prevention 29, n. 7 (10 giugno 2020): 1304–12. http://dx.doi.org/10.1158/1055-9965.epi-19-1534.

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Faria, Miguel A. "Enhancing medical care in the United States via health savings accounts". Surgical Neurology 64, n. 3 (settembre 2005): 276–77. http://dx.doi.org/10.1016/j.surneu.2005.01.010.

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