Mealtime interruptions, assistance and nutritional intake in subacute care

2016 ◽  
Vol 40 (4) ◽  
pp. 415 ◽  
Author(s):  
Judi Porter ◽  
Anita Wilton ◽  
Jorja Collins
Keyword(s):  
Systems Approach ◽  
Nutritional Intake ◽  
Energy Deficit ◽  
Observational Research ◽  
Subacute Care ◽  
Supportive Environment ◽  
Lengths Of Stay ◽  
Hospitalised Patients ◽  
Almost All ◽  
Mealtime Environment

Protected mealtimes is an initiative to support increased nutritional intake for all hospitalised patients, particularly those who are malnourished. The increased focus on maximising independence of patients in the subacute setting may provide a supportive environment for implementing these strategies. The aim of the present study was to gain insight into subacute ward practices at mealtimes under usual conditions (i.e. at baseline) where no protected mealtimes policy was implemented. Participants were patients aged ≥65 years recruited from subacute care facilities at a large healthcare network in Victoria, Australia. Participants were observed at mealtimes and mid meals (i.e. morning tea, afternoon tea and supper) to determine daily energy and protein intake, provision of mealtime assistance and mealtime interruptions. Almost all participants received assistance when it was needed, with positive and negative interruptions experienced by 56.2% and 76.2% of participants, respectively. There was an energy deficit of approximately 2 MJ per day between average intake and estimated requirements. In conclusion, mealtime practices were suboptimal, with particularly high rates of negative interruptions. Protected mealtimes is one strategy that may improve the mealtime environment to support patients’ dietary intake. Prospective studies are needed to evaluate its implementation and effects. What is known about this topic? The mealtime environment on a hospital ward may influence the nutritional intake of patients. Protected mealtimes is a systems approach that aims to minimise negative interruptions and promote positive interruptions to enhance the nutritional intake and nutritional status of patients. Whilst the approach has been widely implemented, further evaluation of its fidelity and effects is required. What does this paper add? This observational research has determined the nutritional intake, provision of assistance and interruptions at mealtimes experienced by a cohort of subacute care patients under usual care conditions. An energy deficit of approximately 2MJ below estimated requirements was identified. Half of the participants received positive interruptions and the majority of participants requiring assistance received it, however the prevalence of negative interruptions was high. This pilot study has enabled a fully powered prospective study to be designed, exploring the implementation of protected mealtimes and its effects on nutritional intake of patients in the subacute setting. What are the implications for practitioners? The energy deficit that exists for patients in subacute care may lead to nutritional decline, and longer lengths of stay. There are opportunities to improve ward practices at mealtimes in the subacute setting to focus on nutritional care.

23 Nutritional Intake and Weight Change in Severely Burned Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S20-S21
Author(s):  
Sandrine O Fossati ◽  
Beth A Shields ◽  
Renee E Cole ◽  
Adam J Kieffer ◽  
Saul J Vega ◽  
...  
Keyword(s):  
Wound Healing ◽  
Mass Loss ◽  
Performance Improvement ◽  
Body Mass ◽  
Total Body Surface Area ◽  
Nutritional Intake ◽  
Energy Deficit ◽  
Body Mass Loss ◽  
Improvement Project ◽  
Burn Care

Abstract Introduction Nutrition is crucial for recovery from burn injuries, as severe weight (wt.) loss can lead to impaired immunity and wound healing, infections, skin graft failure, and mortality. Previous studies recommended avoiding more than 10% wt. loss, as this level resulted in increased infection rates. However, wt. loss is often not quantifiable during the critical illness phase, with severe edema masking non-fluid related body wt. changes. Energy (kcal) deficits can be used to estimate wt. loss until the edema has resolved, but previous studies in non-burn patients indicate that actual wt. loss is less than the commonly used 3500 kcal per pound of fat (7700 kcal per kg of fat). The objective of this performance improvement project was to evaluate nutritional intake and the resulting dry wt. change in severely burned patients. Methods This performance improvement project was approved by our regulatory compliance division. We performed a retrospective evaluation on patients with at least 20% total body surface area (TBSA) burns admitted for initial burn care to our intensive care unit over a 7-year period. Patients who died or who had major fascial excisions or limb amputations were excluded. Patients who did not achieve a recorded dry wt. after wound healing were not included in this analysis. Retrospective data were collected, including sex, age, burn size, kcal intake, kcal goal per the Milner equation using activity factor of 1.4, admission dry wt., dry wt. after wound healing (defined as less than 10% TBSA open wound), and days to dry wt. after wound healing. Descriptive statistics and linear regression were performed using JMP. Significance was set at p< 0.05. Results The 30 included patients had the following characteristics: 90% male, 30 ± 11 years old, 45% ± 15% TBSA burn. They received 2720 ± 1092 kcal/day, meeting 68% ± 24% kcal goal, and took approximately 53 ± 30 days from injury to achieve dry wt. after wound healing. These patients had wt. loss of 8 ± 8 kg from the kcal deficit of 69,819 ± 51,704 during this time period. The kcal deficit was significantly associated with wt. change [p < 0.001, R2 = 0.49, wt. change in kg = (-0.000103 x kcal deficit) – 1]. This translates to one kg of body wt. loss resulting from 9709 kcal deficit. Conclusions This performance improvement project found that an energy deficit of approximately 9700 kcal in our patients equates to 1 kg of body mass loss (4400 kcal deficit equates to 1 pound of body mass loss). These findings are similar to wt. loss studies in other patient populations and contrary to the commonly used 3500 kcal per pound of fat (7700 kcal per kg of fat).

scholarly journals Analisis Perencanaan dan Ketersediaan Obat di Kabupaten dan Kota Provinsi Jawa Timur

2019 ◽  
Vol 9 (4) ◽  
pp. 243
Author(s):  
Digdo Suryagama ◽  
Satibi Satibi ◽  
Sumarni Sumarni
Keyword(s):  
Central Government ◽  
Planning System ◽  
Observational Research ◽  
Director General ◽  
Drug Availability ◽  
System Availability ◽  
Average Percentage ◽  
National Indicator ◽  
Almost All ◽  
Procurement System

The problem of drug availability always occurs in District/Municipality every year. Research related to drug management, especially those related to the evaluation of drug availability and the value of damaged/expired drugs, has been carried out in the last ten years. Almost all the research found problems with the availability of the drugs. The Director General of Pharmacy and Medical Devices reported that the percentage of the availability of National Medicines in East Java in 2017 had reached 96.55%, but had not yet described the condition of the availability of medicines in real terms because the calculation did not use data on drug quantity. This study aims to explain the real conditions for the availability of 17 items of national indicator drugs in East Java in 2017, as well as identify problems and information about management that has been running in 2017. This research is an observational research that is descriptive quantitative. The research instrument was in the form of data collection sheets for the availability of 17 drug items in 2017 and interview guidelines. The results showed that the availability of drugs was in excess conditions with an average of 22.5 months. Drug programs held directly by the Central Government often experience excess inventory at the Regency/City Pharmacy Department level but the average percentage of drugs damaged/expired is still in a fairly good range (0-3%). It can be concluded that the availability of drugs in East Java Province in 2017 is influenced by the planning system, procurement system, availability of drugs at the provider level (supply), availability of management information systems and respective regional policies.

scholarly journals Evaluasi Program Sanitasi Total Berbasis Masyarakat Pilar Stop BABS di Puksesmas Kabupaten Probolinggo

2016 ◽  
Vol 4 (2) ◽  
pp. 107
Author(s):  
Farouk Ilmid Davik
Keyword(s):  
Planning Process ◽  
Systems Approach ◽  
Observational Research ◽  
Input Process ◽  
Cross Sectional ◽  
Inhibiting Factor ◽  
Hygiene Behavior ◽  
Cross Sectional Design ◽  
Advocacy Program ◽  
Sanitation Workers

Community Led Total Sanitation (CLTS) is the program of government to reduce the incidence of diarrhea and improve public hygiene behavior through otriggers approach. CLTS consists of five pillars with its main focusis pillar Stop BABS. Goal of this research is to evaluate the implementation of program CLTS (Stop BABS) with a systems approach which conducted of input, process and output in Public Health Center (PHC) in Probolinggodistrict. This is an observational research using with cross sectional design. This research analyzes used descriptive. Population and sample of this research is 26 PHC sanitation workers in Probolinggo. Results of thisresearch showed the planning process was still bad, the implementation of the program was good, recording and reporting was also good, and the process of mentoring and advocacy program was still bad. Inhibiting factor of CLTS program is budget and geographical environment.The implementation of CLTS program (Stop BABS) as a  whole in PHC Probolinggo district still not succeeded. Suggestion for PHC sanitation workers is making plan of  action CLTS program, establishing village-level facilitators CLTS, implementing mentoring and advocacy as well as increase cooperation across sectors and programs.Keywords: CLTS, Evaluation, Management system

scholarly journals ANALISIS PELAKSANAAN PELAYANAN PERSALINAN SELAMA PANDEMI COVID-19 BERDASARKAN PENGETAHUAN DAN SIKAP IBU BERSALIN

2021 ◽  
Vol 7 (4) ◽  
pp. 626-633
Author(s):  
Mudyawati Kamaruddin ◽  
Andi Reski Sulpianti ◽  
Haerani Haerani ◽  
Erniawati Erniawati ◽  
Jusni Jusni ◽  
...  
Keyword(s):  
Health Care ◽  
Systems Approach ◽  
Community Health Center ◽  
Newborn Health ◽  
Reproductive Age ◽  
Sufficient Information ◽  
Delivery Services ◽  
The Government ◽  
Almost All ◽  
Pregnant Mothers

Background: Since the Coronavirus disease 2019 (COVID-19) attacked and became an epidemic in practically the whole globe till today, the government has imposed several limitations on almost all regular services, including maternity and newborn health care. This limitation is strictly enforced at the hospital, Community Health Center, and clinic levels. As a result, maternity and newborn health care are among those impacted, in terms of both access and provision. Purpose: The aim of this study was to explain how delivery services were implemented during the CoViD-19 pandemic. Methods: This research examines maternity care at Hospital of Prof. Dr. H.M. Anwar Makkatutu Bantaeng during the CoViD-19 pandemic. The study began with interviews with four midwives to gain an overview of delivery service implementation, followed by data collecting from women who gave birth at the RSUD with the following inclusive criteria: mothers who gave birth at the RSUD between March 2020 and April 2021 and have got delivery services. Meanwhile, moms who gave birth outside of the required timeline while receiving delivery services at the RSUD were excluded from the study. Test sheets, questionnaires, and tape recorders were utilized as research instruments. The analysis was carried out using a systems approach theory.Results: Some factors are apparent in the analysis of the execution of delivery services during the CoViD-19 pandemic. The characteristics of respondents in reproductive age account for 75% of input parameters, while multipara accounts for 25%. Midwives provided delivery services to expectant mothers in order to help them cope with the postpartum period. While the output includes analysis results of maternity mothers' knowledge: 55% have sufficient information, 40% have high knowledge, and 5% have little understanding. During the CoViD-19 pandemic, the attitude of maternity mothers toward delivery services was 27 percent positive, and 80 percent were still regarded sufficient.Conclusion Good knowledge is supported by a positive attitude towards service changes shown by maternity mothers, and that the community already understands the situation of the CoViD-19 pandemic, understands the consequences and effects of not complying with regulations related to the CoViD-19 pandemic.Suggestion It is hoped that further research can be in the form of a follow-up to the analysis of health services in hospitals both in the city and at the regional level which refers to health protocols in the post-CoViD-19 pandemic. Keyword: CoViD-19 Pandemic, Pregnant Mothers, Knowledge, Attitude, Delivery Services ABSTRAK Latar Belakang: Sejak Coronavirus disease 2019 (CoViD-19) menyerang dan menjadi wabah di hampir seluruh dunia hingga saat ini, banyak pembatasan  yang dilakukan oleh pemerintah hampir ke semua layanan rutin termasuk pelayanan kesehatan ibu dan bayi baru lahir. Pembatasan ini diberlakukan baik di pelayanan kesehatan tingkat  Rumah sakit, Pusat Kesehatan Masyarakat maupun tingkat klinik. Akibatnya, pelayanan kesehatan ibu dan bayi baru lahir menjadi salah satu layanan yang terkena dampak, baik dari segi akses maupun pelayanan.Tujuan: Tujuan penelitian ini untuk mengetahui gambaran pelaksanaan pelayanan persalinan selama masa pandemi CoViD-l9.Metode: Penelitian ini merupakan analisis terhadap pelayanan ibu bersalin selama pandemi CoViD-19 di RSUD Prof. Dr. H.M. Anwar Makkatutu Bantaeng. Penelitian diawali dengan wawancara dengan empat bidan untuk mendapatkan gambaran pelaksanaan pelayanan persalinan, dilanjutkan dengan pendataan ibu-ibu yang melahirkan di RSUD tersebut dengan kriteria inklusif sebagai berikut ibu bersalin di bulan Maret 2020 sampai dengan April 2021 dan mendapatkan pelayanan persalinan di RSUD. Sedangkan, ibu bersalin yang diluar rentang waktu ditentukan walaupun mendapatkan pelayanan persalinan di RSUD itu tidak dimasukan dalam sampel.  Alat penelitian yang digunakan berupa lembar tes, kuesioner dan tape recorder. Analisis dilakukan dengan teori pendekatan sistem.Hasil: Analisis pelaksanaan pelayanan persalinan selama masa pandemi CoViD-19 dilihat dari faktor input yaitu karakteristik responden dalam usia subur 75% responden dan 25% multipara. Proses: dilakukan pelayanan persalinan oleh bidan untuk membimbing ibu hamil dalam menghadapi persalinan dan masa nifas. Sedangkan output: hasil analisis pengetahuan dan sikap ibu bersalin. Terdapat 55% berpengetahuan cukup, 40% berpengetahuan baik, dan 5% berpengetahuan kurang. Adapun sikap ibu bersalin yang ditunjukan terhadap pelayanan persalinan selama  pandemi CoViD-19 yang bersikap baik terhadap pelayanan persalinan rumah sakit adalah  27%, dan yang tergolong cukup berpengetahuan adalah 80%.Kesimpulan Pengetahuan yang baik didukung dengan sikap yang positif terhadap perubahan-perubahan pelayanan ditunjukan oleh ibu bersalin, dan bahwa masyarakat sudah paham atas situasi pandemi CoViD-19, paham akan akibat dan efek yang ditimbulkan jika tidak menaati regulasi terkait pandemic CoViD-19.Saran Diharapkan penelitian selanjutnya dapat berupa penindaklanjutan analisis pelayanan kesehatan di Rumah Sakit baik di kota maupun di tingkat daerah yang beracuan pada protokol kesehatan pada masa setelah pandemi CoViD-19. Keyword: Covid-19 Pandemic, Pregnant Mothers, Knowledge, Attitude, Delivery Services 

scholarly journals Health practitioner practices and their influence on nutritional intake of hospitalised patients

2019 ◽  
Vol 6 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Andrea P. Marshall ◽  
Tahnie Takefala ◽  
Lauren T. Williams ◽  
Alan Spencer ◽  
Laurie Grealish ◽  
...  
Keyword(s):  
Nutritional Intake ◽  
Health Practitioner ◽  
Hospitalised Patients

scholarly journals Elucidating effective ways to identify and treat malnutrition

2005 ◽  
Vol 64 (3) ◽  
pp. 305-311 ◽  
Author(s):  
Rebecca J. Stratton
Keyword(s):  
Nutritional Support ◽  
Positive Impact ◽  
Gastrointestinal Surgery ◽  
The Elderly ◽  
Nutritional Intake ◽  
Artificial Nutrition ◽  
Complication Rates ◽  
Hospitalised Patients ◽  
Patients At Risk ◽  
Feeding Methods

There is a clear rationale for elucidating effective ways of identifying and treating disease-related malnutrition (DRM), given the physiological and financial consequences of this common condition and its treatability. Evidence indicates the efficacy of nutritional support methods (oral, tube and intravenous) in increasing total nutritional intake while having little effect on appetite, satiety, appetite mediators (e.g. leptin) and voluntary food intake. When used as the only source of nutrition, artificial nutrition can effectively maintain nutritional intake, and yet many patients find enteral or parenteral feeding alone is unable to relieve distressing appetite sensations, and unusual temporal patterns (including dissociation between hunger and desire to eat) occur. Despite the positive impact of these feeding methods on intake, controversy about whether nutritional support can affect patient outcome has remained. Systematic reviews and meta-analyses indicate that improvements in function and clinical (mortality, complication rates) outcome can occur in a number of patient groups (including hospitalised patients, the elderly, patients who have had gastrointestinal surgery, patients at risk of pressure ulcers). In order to target those patients who will benefit from nutritional support, and overcome the ongoing problem of poor detection and recognition of DRM, simple routine screening to identify risk followed by practical evidence-based treatment is recommended.

scholarly journals BOARDING TIME AND PATIENT SATISFACTION AT THE EMERGENCY DEPARTMENT

2019 ◽  
Vol 7 (2) ◽  
pp. 7
Author(s):  
Uswatun Hasanah ◽  
Nurul Jannatul Firdausi
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
General Hospital ◽  
Simple Random Sampling ◽  
Observational Research ◽  
Chi Square ◽  
Cross Sectional ◽  
Average Patient ◽  
Almost All

Background: Delays of inpatient transfer from the Emergency Department (ED) will affect delayed care, overcrowd at ED, and patient’s disappointment. Such patient transfer delay from the Emergency Departement (ED) also occurs at Haji General Hospital, Surabaya.Aims: This study analyzed the relationship  between inpatient boarding time from Emergency Departement (ED) and patient satisfaction at Haji General Hospital, Surabaya.Methods: This was an observational research using a cross-sectional approach. The population was 980 ED patients who decided to be hospitalized. Out of 980 ED patients, the study only involved 83 respondents selected by simple random sampling. The instruments used were observational sheet and questionnaires to collect data which were then analyzed with a chi-square test.Results: Average boarding time was 142 minutes 25 seconds (minimum = 60 minutes; maximum = 290 minutes). Almost all respondents (81.3%) were satisfied about fast boarding time. Inpatient boarding time at the Emergency Departement (ED) was significantly related to patient satisfaction (p = 0.058 <α = 0.1). The faster inpatients move to ED, the more satisfied they are.Conclusion: The average patient boarding time from the Emergency Departement (ED) to Inpatient Unit was slow. Respondents were satisfied with the quality of services even though patient boarding time was slow. The hospital should pay more attention to evaluate the minimal standard of boarding time, ensure the availability of beds,  and improve the quality of facilities and services to enhance patient satisfaction. Keywords: Boarding time, Emergency Department, Inpatient, Satisfaction.

scholarly journals Electronic prescribing systems as tools to improve patient care: a learning health systems approach to increase guideline concordant prescribing for venous thromboembolism prevention

2021 ◽  
Author(s):  
S. Gallier ◽  
A. Topham ◽  
P. Nightingale ◽  
M. Garrick ◽  
I. Woolhouse ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Systems Approach ◽  
Electronic Prescribing ◽  
Low Molecular Weight ◽  
Vte Prophylaxis ◽  
Face To Face ◽  
Guideline Compliance ◽  
Hospitalised Patients

AbstractBACKGROUNDVenous thromboembolism (VTE) causes significant mortality and morbidity in hospitalised patients. In England, reporting the percentage of patients with a completed VTE risk assessment is mandated, but this does not include whether that risk assessment resulted in appropriate prescribing. Full guideline compliance (an assessment and action) is rarely reported. Education, audit and feedback enhance guideline compliance but electronic prescribing systems(EPS) can mandate guideline-compliant actions. We hypothesised that EPS-based interventions would increase full VTE guideline compliance more than other interventions.METHODSAll admitted patients within University Hospitals Birmingham NHS Foundation Trust were included for analysis between 2011-2020. The proportion of patients who received a fully compliant risk assessment and action was assessed over time. Interventions included face-to-face feedback based on measured performance (an individual approach) and mandatory risk assessment and prescribing rules into an EPS (a systems approach).RESULTSData from all 235,005 admissions and all 5503 prescribers were included in the analysis. Face-to-face feedback improved full VTE guideline concordance from 70% to 77% (p=<0.001). Changes to the EPS to mandate assessment with prescribing rules increased full VTE compliance to 95% (p=<0.001). Further amendments to the EPS system to reduce erroneous VTE assessments slightly reduced full compliance to 92% (p<0.001), but this was then maintained including during changes to the low molecular weight heparin used for VTE prophylaxis.DISCUSSION/ CONCLUSIONAn EPS-systems approach was more effective in improving sustained guideline-compliant VTE prevention. Non-compliance was still not eradicated despite this mandated system and requires further research.FUNDINGHDR-UK Hub PIONEERSummary BoxWhat is already known?Hospitalised patients are at an increased risk of venous thromboembolism (VTE), which can lead to significant morbidity and mortality. Risk factors for VTE are well known, there are established screening criteria and there is an effective prophylactic therapy, using low molecular weight heparin where indicated. Since 2010, NHS England has mandated the reporting of the percentage of patients with a completed VTE risk assessment. However, it does not automatically follow that completing a risk assessment leads to the appropriate action (prescribing and administering VTE prophylaxis where indicated). Currently it is unclear what percentage of patients have a guideline compliant VTE risk assessment and an associated action, or how full guideline compliance can be improved.What does this paper add?First, this paper describes that a VTE risk assessment does not always lead to full VTE guideline compliance (an appropriate prescription and administration of heparin where indicated). This is currently not part of mandated reporting but potentially could lead to patient harm. Second, that Electronic Health Systems (EHS) can capture and interrogate guideline-associated risk assessments and prescribing, and be used to improve full guideline compliance, through a combination of individual feedback to prescribing outliers and mandated prescribing rules. These EPS-assisted systems are robust, and sustain guideline compliance through personnel and formulary changes.

scholarly journals BOARDING TIME AND PATIENT SATISFACTION AT THE EMERGENCY DEPARTMENT

2019 ◽  
Vol 7 (2) ◽  
pp. 7
Author(s):  
Uswatun Hasanah ◽  
Nurul Jannatul Firdausi
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
General Hospital ◽  
Simple Random Sampling ◽  
Observational Research ◽  
Chi Square ◽  
Cross Sectional ◽  
Average Patient ◽  
Almost All

Background: Delays of inpatient transfer from the Emergency Department (ED) will affect delayed care, overcrowd at ED, and patient’s disappointment. Such patient transfer delay from the Emergency Departement (ED) also occurs at Haji General Hospital, Surabaya.Aims: This study analyzed the relationship  between inpatient boarding time from Emergency Departement (ED) and patient satisfaction at Haji General Hospital, Surabaya.Methods: This was an observational research using a cross-sectional approach. The population was 980 ED patients who decided to be hospitalized. Out of 980 ED patients, the study only involved 83 respondents selected by simple random sampling. The instruments used were observational sheet and questionnaires to collect data which were then analyzed with a chi-square test.Results: Average boarding time was 142 minutes 25 seconds (minimum = 60 minutes; maximum = 290 minutes). Almost all respondents (81.3%) were satisfied about fast boarding time. Inpatient boarding time at the Emergency Departement (ED) was significantly related to patient satisfaction (p = 0.058 <α = 0.1). The faster inpatients move to ED, the more satisfied they are.Conclusion: The average patient boarding time from the Emergency Departement (ED) to Inpatient Unit was slow. Respondents were satisfied with the quality of services even though patient boarding time was slow. The hospital should pay more attention to evaluate the minimal standard of boarding time, ensure the availability of beds,  and improve the quality of facilities and services to enhance patient satisfaction. Keywords: Boarding time, Emergency Department, Inpatient, Satisfaction.

Neither Catapults nor Atomic Bombs

Vulcan ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 45-61
Author(s):  
David Zimmerman
Keyword(s):  
Industrial Revolution ◽  
Systems Approach ◽  
Armed Forces ◽  
Technological Determinism ◽  
Military Technology ◽  
French Writer ◽  
Military Systems ◽  
The Many ◽  
Definition Of ◽  
Almost All

Kelly Devries in “Catapults are not atomic bombs”—and in fact, of almost all of those who have joined the fray to, once and for all, kill off simplistic technological determinism—may have thrown out the baby with the bathwater. One aspect linking most of these anti-determinists is their temporal focus which is almost exclusively on pre-industrial revolutions in military technology. Furthermore, their views of the importance (or more accurately, the lack thereof) of technology in war is one that has ceased to apply to the world since the mid-nineteenth century. Technological determinism is not a disease of bad historical writing, but something that must be carefully applied in studying the technological systems of armed forces, regardless of time periods or geographic locations. We need to apply a definition of determinacy related to the systems theory that French writer Jacques Ellul proposed in The Technological Society. Here examples of military systems since the Industrial Revolution are covered and then this systems approach is applied to the pre-modern period. The approach moves us away from the radical assumptions of earlier determinists to show that technology is determinant, but only one of the many determinant factors that influence battles, campaigns, and wars. The study of military technology is central to any study of war, and we must not be afraid to move beyond a merely descriptive approach that appears to be promoted by the anti-determinists.

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