Military medicine
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Pneumonia is a major cause of hospital admissions and deaths worldwide. Our aim was to examine the trends in admissions for pneumonia in the Department of Veterans Affairs (VA). We examined data for the fiscal years 2002 through 2007 on patients aged 65 years and older hospitalized with pneumonia by using VA administrative databases. ⋯ However, length of hospital stay and 30- and 90-day mortality decreased during this period. The proportion of patients admitted to the intensive care unit remained relatively constant, but fewer received mechanical ventilation; there was substantial increase in noninvasive ventilation. In the VA, pneumonia-related admissions are being managed more effectively even as the overall number of admissions remains stable.
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This report describes the development and initial validation of the Response to Stressful Experiences Scale (RSES), a measure of individual differences in cognitive, emotional, and behavioral responses to stressful life events. We validated this instrument with active-duty and reserve components of military and veterans samples (N = 1,014). The resulting 22-item scale demonstrated sound internal consistency (alpha = 0.91-0.93) and good test-retest reliability (r = 0.87). ⋯ Associations with other measures supported convergent, discriminant, and concurrent validity. In separate military samples, the RSES accounted for unique variance in posttraumatic stress disorder symptoms above and beyond existing scales measuring resilience-related constructs, thereby demonstrating incremental validity. The RSES provides a brief, reliable, and valid measure of individual differences in cognitive, emotional, and behavioral responses to life's most stressful events.
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The deployment of several medical units at the beginning of Operation Iraqi Freedom (OIF) significantly affected the staffing at William Beaumont Army Medical Center (WBAMC). We theorized that the resultant shortage of medical personnel adversely affected the outcome of trauma patients treated at our facility. ⋯ Since the beginning of OIF, WBAMC has been limiting in its volume of trauma patients, but this has not affected the outcomes.
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From 2001 to 2006, the Army deployed over 717,000 personnel to Iraq and Afghanistan, with over 15,000 troops wounded. Little is known about the impact of military and demographic factors, particularly deployment, occupation, and pre-existing medical status, on disability retirement. ⋯ The reasons for increased risk among some groups are unknown. The decreased risk associated with deployment probably reflects a "healthy warrior effect," whereas the increased risk for combat arms may reflect combat exposures among the deployed and more rigorous training among the nondeployed.
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The purpose of this project was to create a teaching module and evaluation tool for the prehospital assessment of patients with head injuries using the Full Outline of UnResponsiveness (FOUR) Score scale. The teaching module consisted of an overview of brain injury scales, general characteristics of the Glasgow Coma Scale (GCS) and the FOUR Score, demonstrations of the FOUR Score, and evaluation of the teaching module by participants. Participants determined that the FOUR Score is a viable alternative to the GCS, but took longer time to assess patients. Development of a more rapidly obtained FOUR Score, called the EMBR, is one option that may make this a viable alternative to the GCS.