scholarly journals Defence Medical Rehabilitation Centre (DMRC) COVID-19 Recovery Service

2021 ◽  
pp. e001681
Author(s):  
Oliver O'Sullivan ◽  
R Barker-Davies ◽  
R Chamley ◽  
E Sellon ◽  
D Jenkins ◽  
...  
Keyword(s):  
Occupational Medicine ◽  
Armed Forces ◽  
Acute Illness ◽  
Medical Rehabilitation ◽  
Rehabilitation Centre ◽  
Operational Effectiveness ◽  
Mortality And Morbidity ◽  
Recovery Service ◽  
Significant Mortality

Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity, with an unknown impact in the medium to long term. Evidence from previous coronavirus epidemics indicates that there is likely to be a substantial burden of disease, potentially even in those with a mild acute illness. The clinical and occupational effects of COVID-19 are likely to impact on the operational effectiveness of the Armed Forces. Collaboration between Defence Primary Healthcare, Defence Secondary Healthcare, Defence Rehabilitation and Defence Occupational Medicine resulted in the Defence Medical Rehabilitation Centre COVID-19 Recovery Service (DCRS). This integrated clinical and occupational pathway uses cardiopulmonary assessment as a cornerstone to identify, diagnose and manage post-COVID-19 pathology.

Neurological rehabilitation following heat illness in the UK Armed Forces

2020 ◽  
pp. bmjmilitary-2020-001602
Author(s):  
Daniel Wilkins ◽  
O O'Sullivan ◽  
J Sayer ◽  
L Penny ◽  
D Roiz de Sa ◽  
...  
Keyword(s):  
Armed Forces ◽  
Medical Rehabilitation ◽  
Heat Illness ◽  
Subjective Symptoms ◽  
Neurological Rehabilitation ◽  
Rehabilitation Centre ◽  
Neurological Sequelae ◽  
Service Policy ◽  
The Uk

Heat illness remains a significant threat to health in the UK Armed Forces despite recent improvements in the prevention of cases. A small number of heat illness survivors develop long-term neurological sequelae. Here we briefly review the background literature and present our experience of treating UK Armed Forces patients with neurological consequences of heat illness. In our cohort of patients, we observed significant improvements in subjective symptoms and objective assessments following a period of neurological rehabilitation at the Defence Medical Rehabilitation Centre. We conclude with recommendations for further research and for the incorporation of screening for neurological disability following heat illness into service policy.

Review of neurological rehabilitation for Multiple Sclerosis in the British Military

2021 ◽  
pp. bmjmilitary-2021-001852
Author(s):  
Oliver O'Sullivan ◽  
L Allsopp ◽  
J Mitchell ◽  
L Price ◽  
K Tourle ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Armed Forces ◽  
Medical Rehabilitation ◽  
Neurological Rehabilitation ◽  
Patient Support ◽  
Rehabilitation Centre ◽  
Occupational Outcomes ◽  
British Military ◽  
Working Age

Multiple sclerosis (MS) is a progressive neurological disorder, classically presenting in working age adults, including those in the Armed Forces. The Defence Medical Rehabilitation Centre (DMRC) Stanford Hall offers vocationally focused neurorehabilitation services for service personnel (SP) with MS, with the goal to minimise disability, maximise independence and remain able to work.This paper has two aims. First, it briefly provides a clinical update of MS, focusing on pathology, presentation, diagnosis and management. Finally, it will describe the role of DMRC and data from the last decade in the management of MS.Our findings suggest not all SP with MS are being referred to DMRC, and some of those who do have significant delays, potentially impacting on patient support, symptom management and occupational outcomes. It is hoped that this paper will improve awareness and recognition of MS for Armed Forces personnel.

scholarly journals MERS-CoV spillover at the camel-human interface

2017 ◽  
Author(s):  
Gytis Dudas ◽  
Luiz Max Carvalho ◽  
Andrew Rambaut ◽  
Trevor Bedford ◽  
Ali M. Somily ◽  
...  
Keyword(s):  
Arabian Peninsula ◽  
Sequence Data ◽  
Full Potential ◽  
Viral Sequence ◽  
Mortality And Morbidity ◽  
Host Tropism ◽  
Human Interface ◽  
Structured Coalescent ◽  
Significant Mortality

AbstractMiddle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus from camels causing significant mortality and morbidity in humans in the Arabian Peninsula. The epidemiology of the virus remains poorly understood, and while case-based and seroepidemiological studies have been employed extensively throughout the epidemic, viral sequence data have not been utilised to their full potential. Here we use existing MERS-CoV sequence data to explore its phylodynamics in two of its known major hosts, humans and camels. We employ structured coalescent models to show that long-term MERS-CoV evolution occurs exclusively in camels, whereas humans act as a transient, and ultimately terminal host. By analysing the distribution of human outbreak cluster sizes and zoonotic introduction times we show that human outbreaks in the Arabian peninsula are driven by seasonally varying zoonotic transfer of viruses from camels. Without heretofore unseen evolution of host tropism, MERS-CoV is unlikely to become endemic in humans.

Musculoskeletal injury outcomes: 2-year retrospective service evaluation of a UK defence primary care rehabilitation facility (PCRF)

2020 ◽  
pp. jramc-2019-001229 ◽  
Author(s):  
Peter James Scott
Keyword(s):  
Primary Care ◽  
Performance Indicator ◽  
Armed Forces ◽  
Musculoskeletal Injury ◽  
Medical Rehabilitation ◽  
Patellar Tendinopathy ◽  
Muscle Injuries ◽  
Rehabilitation Centre ◽  
Rehabilitation Facility ◽  
Knee Trauma

IntroductionMusculoskeletal injury represents the leading cause of medical discharge from the UK Armed Forces. This study evaluates effectiveness of care provision within a large primary care rehabilitation facility (PCRF) against directed defence best practice guidelines (BPGs)MethodsAll new patient electronic records from January to July 16 were interrogated to identify demographics, causation, injury pathology, timelines and outcomes.Results393 eligible records (81.9% male) were identified. 17.6% were officers, 32.8% were seniors and 49.6% were juniors. The average age was 35.1 years (mode 30). The average wait to treatment was 8.3 days with 75.6% key performance indicator compliance. 47.3% were repeat injuries. The average care timeline was 117.1 days with 8.7 average treatment sessions needed. 30 remained under care at 2 years. 17.8% accessed hydrotherapy and 44% underwent exercise remedial instructors care. 14.2% of individuals required concurrent DCMH care (15.9% male and 26.8% female). 28.5% required multidisciplinary injury assessment clinic intervention with 74.1% compliance against BPGs. 2.9% used the Defence Medical Rehabilitation Centre. Common pathologies were low back pain (LBP) (n=67), upper limb (UL) soft tissue (n=40) and knee trauma (n=38). LBP had the highest recurrence rates (71.6%). Anterior knee pain took the longest (173.1 days) but had the best outcome on discharge. Ankles and lower limb muscle injuries had the best outcomes. Patella tendinopathy and knee trauma had the poorest outcome on discharge. LBP and patellar tendinopathy had the lowest fully fit rates at 2 years (56.7% and 53.8%, respectively). At 2 years, 58.2% of individuals achieved full fitness (60.7% men and 46.4% women), rising to 64% and 55%, respectively, when including those retained with limitations.ConclusionsThe PCRF was generally compliant with BPGs, achieving good functional outcomes on discharge. Women were disproportionally represented, had higher concurrent DCMH attendance and poorer overall long-term outcomes. Repeat injury rates were significantly high.

scholarly journals MERS-CoV spillover at the camel-human interface

eLife ◽  
2018 ◽  
Vol 7 ◽  
Author(s):  
Gytis Dudas ◽  
Luiz Max Carvalho ◽  
Andrew Rambaut ◽  
Trevor Bedford
Keyword(s):  
Arabian Peninsula ◽  
Sequence Data ◽  
Full Potential ◽  
Viral Sequence ◽  
Mortality And Morbidity ◽  
Host Tropism ◽  
Human Interface ◽  
Structured Coalescent ◽  
Significant Mortality

Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus from camels causing significant mortality and morbidity in humans in the Arabian Peninsula. The epidemiology of the virus remains poorly understood, and while case-based and seroepidemiological studies have been employed extensively throughout the epidemic, viral sequence data have not been utilised to their full potential. Here, we use existing MERS-CoV sequence data to explore its phylodynamics in two of its known major hosts, humans and camels. We employ structured coalescent models to show that long-term MERS-CoV evolution occurs exclusively in camels, whereas humans act as a transient, and ultimately terminal host. By analysing the distribution of human outbreak cluster sizes and zoonotic introduction times, we show that human outbreaks in the Arabian peninsula are driven by seasonally varying zoonotic transfer of viruses from camels. Without heretofore unseen evolution of host tropism, MERS-CoV is unlikely to become endemic in humans.

The Impact of Age Demographics on Interpreting and Applying Population-Wide Infection Fatality Rates for COVID-19

2021 ◽  
Author(s):  
Matthew R. MacLeod ◽  
D. Gregory Hunter
Keyword(s):  
Situational Awareness ◽  
Armed Forces ◽  
Healthcare Operations ◽  
Operational Effectiveness ◽  
Term Care ◽  
Task Forces ◽  
Canadian Armed Forces ◽  
Canadian Population ◽  
The Impact

The ongoing coronavirus disease 2019 (COVID-19) pandemic affects the Canadian Armed Forces (CAF) and its members in multiple ways. As the CAF manages its own healthcare system for its members, it must consider the impact of COVID-19 not only on the operational effectiveness of its workforce but also on its healthcare operations. Furthermore, given that the CAF has deployed task forces in support of other government departments, including into long-term care facilities that are experiencing outbreaks, it is important for the CAF to maintain situational awareness of the outbreak in the Canadian population generally. In providing analytical support to the CAF on these questions, we focused on establishing the applicability of estimates of COVID-19 infection fatality rates (IFRs) from the literature to the CAF and to the Canadian public. This paper explores how the age-dependent effects of COVID-19 must be taken into account when comparing estimates based on countries with very different age profiles, such as China and Italy. Furthermore, it explores how varying age structures within a country (e.g., within a subnational jurisdiction, or within a given working population) should affect how analysts apply estimates of IFR to scenarios involving those specific populations.

MODERN PROBLEMATICS AND ANALYSIS OF EFFICIENCY OF APPLICATION OF DIFFERENT APPROACHES TO DESTRUCTION OF INFORMATION ON MAGNETIC MEDIA

2019 ◽  
Vol 2 (12) ◽  
pp. 154-164
Author(s):  
O. Semenenko ◽  
O. Vodchyts ◽  
V. Koverga ◽  
R. Lukash ◽  
O. Lutsenko
Keyword(s):  
Armed Forces ◽  
Information Storage ◽  
Storage Device ◽  
Magnetic Media ◽  
Long Term Storage ◽  
Physical Impact ◽  
And Storage ◽  
Term Storage

The introduction and active use of information transmission and storage systems in the Ministry of Defense (MoD) of Ukraine form the need to develop ways of guaranteed removal of data from media after their use or long-term storage. Such a task is an essential component of the functioning of any information security system. The article analyzes the problems of guaranteed destruction of information on magnetic media. An overview of approaches to the guaranteed destruction of information on magnetic media of different types is presented, and partial estimates of the effectiveness of their application are given by some generally accepted indicators of performance evaluation. The article also describes the classification of methods of destruction of information depending on the influence on its medium. The results of the analysis revealed the main problems of application of software methods and methods of demagnetization of the information carrier. The issue of guaranteed destruction of information from modern SSD devices, which are actively used in the formation of new systems of information accumulation and processing, became particularly relevant in the article. In today's conditions of development of the Armed Forces of Ukraine, methods of mechanical and thermal destruction are more commonly used today. In the medium term, the vector of the use of information elimination methods will change towards the methods of physical impact by the pulsed magnetic field and the software methods that allow to store the information storage device, but this today requires specialists to develop new ways of protecting information in order to avoid its leakage.

Repeated Occupational Exposure to Low-level Blast in the Canadian Armed Forces: Effects on Hearing, Balance, and Ataxia

2021 ◽  
Author(s):  
Ann Nakashima ◽  
Oshin Vartanian ◽  
Shawn G Rhind ◽  
Kristen King ◽  
Catherine Tenn ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Occupational Exposure ◽  
Armed Forces ◽  
Cross Sectional ◽  
Low Level ◽  
Additional Information ◽  
Adverse Health Effects ◽  
Blast Overpressure ◽  
Blast Exposure

ABSTRACT Introduction Recently, there has been increasing concern about the adverse health effects of long-term occupational exposure to low-level blast in military personnel. Occupational blast exposure occurs routinely in garrison through use of armaments and controlled blast detonations. In the current study, we focused on a population of breaching instructors and range staff. Breaching is a tactical technique that is used to gain entry into closed spaces, often through the use of explosives. Materials and Methods Initial measurements of blast overpressure collected during breaching courses found that up to 10% of the blasts for range staff and up to 32% of the blasts for instructors exceeded the recommended 3 psi exposure limit. Using a cross-sectional design, we used tests of balance, ataxia, and hearing to compare a sample of breachers (n = 19) to age-and sex-matched military controls (n = 19). Results There were no significant differences between the two groups on the balance and ataxia tests, although the average scores of both groups were lower than would be expected in a normative population. The prevalence of hearing loss was low in the breacher group (4 of 19), and hearing thresholds were not significantly different from the controls. However, the prevalence of self-reported tinnitus was significantly higher in the breacher group (12 of 19) compared with the controls (4 of 19), and all breachers who were identified as having hearing loss also reported tinnitus. Conclusions Our results suggest that basic tests of balance, ataxia, and hearing on their own were not sensitive to the effects of long-term occupational exposure to low-level blast. Some of the blast exposure levels exceeded limits, and there was a significant association of exposure with tinnitus. Future studies should supplement with additional information including exposure history and functional hearing assessments. These findings should be considered in the design of future acute and longitudinal studies of low-level blast exposure.

Tetralogy of Fallot: stent palliation or neonatal repair?

2021 ◽  
pp. 1-9
Author(s):  
Adeolu Banjoko ◽  
Golnoush Seyedzenouzi ◽  
James Ashton ◽  
Fatemeh Hedayat ◽  
Natalia N. Smith ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Hospital Length Of Stay ◽  
Mortality And Morbidity

Abstract Surgical repair of Tetralogy of Fallot has excellent outcomes, with over 90% of patients alive at 30 years. The ideal time for surgical repair is between 3 and 11 months of age. However, the symptomatic neonate with Tetralogy of Fallot may require earlier intervention: either a palliative intervention (right ventricular outflow tract stent, ductal stent, balloon pulmonary valvuloplasty, or Blalock-Taussig shunt) followed by a surgical repair later on, or a complete surgical repair in the neonatal period. Indications for palliation include prematurity, complex anatomy, small pulmonary artery size, and comorbidities. Given that outcomes after right ventricular outflow tract stent palliation are particularly promising – there is low mortality and morbidity, and consistently increased oxygen saturations and increased pulmonary artery z-scores – it is now considered the first-line palliative option. Disadvantages of right ventricular outflow tract stenting include increased cardiopulmonary bypass time at later repair and the stent preventing pulmonary valve preservation. However, neonatal surgical repair is associated with increased short-term complications and hospital length of stay compared to staged repair. Both staged repair and primary repair appear to have similar long-term mortality and morbidity, but more evidence is needed assessing long-term outcomes for right ventricular outflow tract stent palliation patients.

Surgery Combined With Peritonectomy Procedures and Intraperitoneal Chemohyperthermia in Abdominal Cancers With Peritoneal Carcinomatosis: A Phase II Study

2003 ◽  
Vol 21 (5) ◽  
pp. 799-806 ◽  
Author(s):  
O. Glehen ◽  
F. Mithieux ◽  
D. Osinsky ◽  
A.C. Beaujard ◽  
G. Freyer ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Complete Resection ◽  
Morbidity Rate ◽  
Term Survival ◽  
Mortality And Morbidity ◽  
Peritonectomy Procedures ◽  
Experienced Team

Purpose: To evaluate the tolerance of peritonectomy procedures (PP) combined with intraperitoneal chemohyperthermia (IPCH) in patients with peritoneal carcinomatosis (PC), a phase II study was carried out from January 1998 to September 2001. Patients and Methods: Fifty-six patients (35 females, mean age 49.3) were included for PC from colorectal cancer (26 patients), ovarian cancer (seven patients), gastric cancer (six patients), peritoneal mesothelioma (five patients), pseudomyxoma peritonei (seven patients), and miscellaneous reasons (five patients). Surgeries were performed mainly on advanced patients (40 patients stages 3 and 4 and 16 patients stages 2 and 1) and were synchronous in 36 patients. All patients underwent surgical resection of their primary tumor with PP and IPCH (with mitomycin C, cisplatinum, or both) with a closed sterile circuit and inflow temperatures ranging from 46° to 48°C. Three patients were included twice. Results: A macroscopic complete resection was performed in 27 cases. The mortality and morbidity rates were one of 56 and 16 of 56, respectively. The 2-year survival rate was 79.0% for patients with macroscopic complete resection and 44.7% for patients without macroscopic complete resection (P = .001). For the patients included twice, two are alive without evidence of disease, 54 and 47 months after the first procedure. Conclusion: IPCH and PP are able to achieve unexpected long-term survival in patients with bulky PC. However, one must be careful when selecting the patients for such an aggressive treatment, as morbidity rate remains high even for an experienced team.

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