Military medicine
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Increasing numbers of emergency department (ED) visits and higher leaving-without-being-seen rates resulted in an evaluation of the contribution of the internal medicine service to the admission process. ⋯ Most medicine admissions took less than an hour from time of MOD consultation to time orders were written. Areas of improvement include expediting discussion with specialists and timely but appropriate ED workup before consultation.
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This study identifies training outcomes and educational preferences of employees who work within the Veterans Health Administration (VHA). Using a longitudinal pre- postsurvey design, 71 employees from one geographic region of VHA healthcare facilities participated in an evaluation of a brief standardized gatekeeper program and a needs assessment on training preferences for suicide and suicide prevention. ⋯ At post-training, 90% of the participants were willing to learn more about suicide, with 88% willing to spend more than 1 hour in future training activities on more advanced topics. This training program can increase the knowledge and abilities of VHA staff to engage, identify, and refer veterans at risk for suicide to appropriate care.
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The results reported in this article are from a larger descriptive study examining the health literacy rates in active duty military personnel receiving health care within a culture of universal access. The purpose of this article is to describe the health literacy skills among a sample of active duty military personnel with comparison to the national population. ⋯ Results indicate that military personnel have adequate health literacy skills although variations were noted on the basis of health training and race/ethnicity. Although the S-TOFHLA was found to be a practical tool for assessing health literacy in a high-tempo health care setting, additional reliability and validity testing is needed.
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We present a 20-year-old previously healthy male who suffered a gunshot wound to the abdomen and underwent multiple surgeries because of abdominal abscess and fistula formation. Pain control was difficult to achieve despite high-dose opioid therapy. Post-traumatic stress disorder was a confounding factor in treating this patient's pain. ⋯ The patient presented to the intensive care unit after a 12-hour operation with an open abdomen and the requirement of mechanical ventilation, sedation, and analgesia. Sedation and analgesia were difficult to achieve and maintain with combinations of extremely high doses of midazolam, lorazepam, propofol, and fentanyl (motor assessment activity scale [MAAS] scores of 5), but profoundly achievable with dexmedetomidine. Dexmedetomidine also improved the patient's mental stability, which resulted in improved patient care through compliance with physicians, nurses, and physical therapists.