对战时关键外科专科准备工作的全球军事卫生参与任务进行评估。

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Military Medicine Pub Date : 2024-11-05 DOI:10.1093/milmed/usae242
Joseph Aryankalayil, Margaret Shields, Michael Baird, Rathnayaka M K D Gunasingha, W Michael Pullen, Mark Johnson, Jamie Fitch, Ian Uber, Tamara Worlton
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引用次数: 0

摘要

导言:大约在过去 20 年中,军事治疗设施(MTF)的手术量一直在逐渐减少。知识、技能和能力(KSA)临床准备计划使用一种称为 KSA 指标的工具将手术量和准备状态联系起来。然而,军事医疗任务在多大程度上促进了关键战时专科的战备状态还没有使用该指标进行过评估:在本研究中,我们使用 2018 年和 2019 年美国海军舰艇(USNS)"舒适 "号任务的手术病例日志进行了回顾性分析。综合病例日志数据按年份、外科医生、手术和地点进行了分类。分析的重点是提供详细的描述性统计数字,包括与这些任务期间实施的手术类型有关的百分比。2018 年的任务为期 11 周,支持在厄瓜多尔、秘鲁、哥伦比亚和洪都拉斯开展的活动。美国海军 "舒适 "号2019年的任务为期6个月(2019年6月至11月),访问了中美洲、南美洲和加勒比海地区的12个国家:使用 KSA 分数对跨度为 6 个月的 2019 年任务病例日志进行了评估,以评估准备情况,并与同一日历年内 6 个月的 MTF KSA 值进行比较。2019 年,美国海军 "舒适 "号上的骨科医生的 KSA 总分为 44006 分,但美国海军 "舒适 "号 6 个月的任务只贡献了 5364 分(占年度总分的 12%)。与每位外科医生各自的 MTF 实践相比,"舒适 "号上的普通外科实践产生的 KSA 分数较低(表 III)。对普外科医生记录的病例进行分析后还发现,在这些任务中,外科手术的多样性极少,90% 以上的病例都是疝修补术或腹腔镜胆囊切除术(表 I)。此外,2018 年和 2019 年进行的手术总数中有 35% 是通过腹腔镜进行的:通过对 2019 年美国海军 "舒适 "号任务的手术数据进行分析,并与外科医生在各自 MTF 的工作情况进行比较,发现医院船任务在加强手术准备能力(以 KSA 分数衡量)方面的益处有限。然而,这并不是对全球卫生参与(GHE)本身价值的反思,而是对利用全球卫生参与支持外科手术准备的方式的回顾。军事外科医生参与全球卫生参与是加强与伙伴国关系、提高军事医疗部队互操作性、增强伙伴国医疗能力的更大战略的一部分。KSA 评分提供了一个很好的工具,可用于比较明显不同的 GHE 任务的准备度量,并为未来的前瞻性研究提供机会,以提高病例量、多样性并最终改善准备度。
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Evaluation of a Military Global Health Engagement Mission for Critical Wartime Surgical Specialty Readiness.

Introduction: Surgical volume at Military Treatment Facilities (MTFs) has been gradually decreasing for roughly the past 2 decades. The Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program linked surgical volume and readiness using a tool known as the KSA metric. However, the extent to which military medical missions contribute to the readiness of critical wartime specialties has not been evaluated using this metric.

Methods: In this study, a retrospective analysis was conducted using the surgical case logs from the US Naval Ship (USNS) Comfort missions in 2018 and 2019. The comprehensive case log data were categorized by year, surgeon, procedure, and location. The analysis focused on providing detailed descriptive statistics, including percentages pertaining to the types of procedures performed during these missions. The 2018 mission was 11 weeks in duration, and supported activities in Ecuador, Peru, Colombia, and Honduras. The USNS Comfort mission in 2019 lasted 6 months (June-November 2019), and visited 12 countries in Central America, South America, and the Caribbean.

Results: The 2019 mission case log, spanning 6 months, was evaluated using the KSA score in order to assess readiness and compare against 6 months of MTF KSA values within the same calendar year. In 2019, the orthopedic surgeon aboard the USNS Comfort had a total KSA score of 44,006, but the 6-month USNS Comfort mission only contributed 5,364 points (12% of the annual score). The general surgery practice aboard the USNS Comfort produced lower KSA scores compared to each surgeon's respective MTF practice (Table III). Analyzing the cases logged by general surgeons also highlights minimal surgical diversity during these missions, with more than 90% of cases being hernia repairs or laparoscopic cholecystectomies (Table I). In addition, 35% of total procedures performed in 2018 and 2019 were performed laparoscopically.

Conclusions: The analysis of operative data from the 2019 USNS Comfort mission, in comparison with the surgeons' work at their respective MTFs, reveals limited benefit in the ability of hospital-ship missions to bolster surgical readiness as measured by the KSA score. However, this is not a reflection on the value of Global Health Engagement (GHE) itself but a review of the way in which it is leveraged to support surgical readiness. Military surgeons participate in GHE as part of a larger strategy to strengthen relationships with partner nations, improve military medical force interoperability, and bolster partner nation medical capacity and capabilities. The KSA score offers an excellent tool to compare readiness metrics across significantly different GHE missions, and facilitates the opportunity for future prospective studies to improve case volume, diversity, and ultimately readiness.

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来源期刊
Military Medicine
Military Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
2.20
自引率
8.30%
发文量
393
审稿时长
4-8 weeks
期刊介绍: Military Medicine is the official international journal of AMSUS. Articles published in the journal are peer-reviewed scientific papers, case reports, and editorials. The journal also publishes letters to the editor. The objective of the journal is to promote awareness of federal medicine by providing a forum for responsible discussion of common ideas and problems relevant to federal healthcare. Its mission is: To increase healthcare education by providing scientific and other information to its readers; to facilitate communication; and to offer a prestige publication for members’ writings.
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