Military medicine
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In 2012, Norwegian news media reported on cases of brain cancer among Norwegian peacekeeping troops who served in Kosovo, allegedly caused by exposure to depleted uranium fired during airstrikes before the peacekeepers arrived in 1999. A first study followed 6076 military men and women with peacekeeping service in Kosovo during 1999-2011 for cancers and deaths throughout 2011. The study did not support to the idea that peacekeeping service in Kosovo could lead to increased risk of brain cancer or other cancers. However, the average time of follow-up (10.6 years) was rather short for cancer development; therefore the aim of the present study was to evaluate cancer risk and general mortality in an updated cohort after 5 years of additional follow-up. ⋯ The extended follow-up did not give support to the suggestion that peacekeeping service in Kosovo could lead to increased risk of cancer.
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Delivering consistent high quality care in a safe environment is the goal of the modern dental delivery system. Preventable adverse events, however, are still commonplace in dentistry. As has been demonstrated in the medical field, a concerted and persistent effort will be required to objectively understand and begin to eliminate the sources of dental error. In civilian dental practice this effort is hampered by the underreporting of patient safety events in comparison to the medical field. Patient safety reporting in the Military Health System (MHS) is robust and includes dentistry. This provides an important opportunity to analyze these data as the foundation for improvements in dental care and the elimination of preventable harm. The purpose of this article is to review MHS dental patient safety data, identify the primary sources of dental error and describe current initiatives based on the adoption of the High Reliability Organization (HRO) model of care that has been profitably embraced by the medical community. ⋯ Safety initiatives in the dental profession remain immature in comparison to the medical field and the use of an HRO framework is just beginning to emerge in dentistry. The MHS benefits from a robust dental patient safety reporting system when compared to civilian practice in the United States. Review of these data demonstrates that a high priority focus should be the elimination of WSS. Initiatives based on high reliability strategies to address this issue will be discussed. A commitment to reporting and analyzing its performance and adopting the principles and behaviors of HROs will accelerate the MHS goal of providing ever increasing safety and quality in the dental care it provides.
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Improving Clinician Decisions and Communication in Critical Care Using Novel Information Technology.
The electronic medical record (EMR) is presumed to support clinician decisions by documenting and retrieving patient information. Research shows that the EMR variably affects patient care and clinical decision making. The way information is presented likely has a significant impact on this variability. Well-designed representations of salient information can make a task easier by integrating information in useful patterns that clinicians use to make improved clinical judgments and decisions. Using Cognitive Systems Engineering methods, our research team developed a novel health information technology (NHIT) that interfaces with the EMR to display salient clinical information and enabled communication with a dedicated text-messaging feature. The software allows clinicians to customize displays according to their role and information needs. Here we present results of usability and validation assessments of the NHIT. ⋯ The primary findings of these assessments are that clinicians found the NHIT easy to use despite minimal training and experience and that it did not degrade clinician efficiency or decision-making accuracy. These findings are in contrast to common user experiences when introduced to new EMRs in clinical practice.
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Over 1,500 bladder cancers were diagnosed among US Veterans in 2010, the majority of which were non-muscle invasive bladder cancer (NMIBC). Little is known about NMIBC treatment within the Veterans Health Administration. The objective of the study was to assess the quality of care for Veterans with newly-diagnosed NMIBC within Veterans Integrated Service Network (VISN) 02. ⋯ We observed high rates of sampling of detrusor in the first TURBT specimen, utilization of repeat TURBT, and administration of induction and maintenance intravesical BCG for high-risk patients among a regional cohort of US Veterans with NMIBC. While not a comparative study, our findings suggest high quality NMIBC care in VA VISN 02.
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A 25 year-old male presented with penetrating chest trauma to a split forward surgical team located in an austere setting. Due to limited resources and a minimal monitoring in-transit a regional anesthetic was placed for pain control. This is the first description of an Erector Spinae Block utilized in a far forward combat setting.