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Biomedical subjects

A D Mangelsdorff

Publications and source records attributed to A D Mangelsdorff.

At least 19 recordsLinked to original sources
PubMed1999

Reserve components' perceptions and changing roles.

This article reviews the historical background of Reserve and National Guard forces, total force policy, types of reserve personnel, perceptions and attitudes of reservists, morale and unit cohesion, perceived preparedness for mobilization, mobilizations and demobilizations, current downsizing and reorganizations, operations other than war, and readiness. The majority of the studies report reservists' perceptions and attitudes. Because the majority of the Army's war-making capability is found in the reserves, how well the reserves function has national security implications.

Attitude↗
PubMed1998

Senior executive behaviors for the Army Dental Care System of the 21st century.

Challenges will most likely confront the Army Dental Care System as it moves into the next century. Like any other learning organization, the Army dental care system must develop a continuous stream of dynamic leaders to direct its evolution if it wants to survive. Using the Delphi method, the investigators surveyed senior dental leaders to determine the attitudes and behaviors believed to be required to perform successfully as commanders, residency directors, and senior staff officers. The essential executive behaviors appear to be consistent: be honest, act with integrity, be accountable for your actions, be dedicated to mission accomplishment, and perform your duty with care and compassion. Relying solely on ratings assigned to the behaviors, discriminant function analyses could predict proper group membership with an accuracy of 79.4%. When demographic information was included, prediction accuracy improved to 96.7%.

Adult↗
PubMed1997

Vision 21 Delphi panel: senior Army Medical Service Corps Officers' vision of behaviors for success of future Medical Service Corps officers.

A Delphi study was conducted of Army senior Medical Service Corps leaders (O6s) to identify the expected behaviors and competencies needed to ensure that junior officers will achieve successful careers as Medical Service Corps officers in the 21st century. A Delphi mailing was conducted in two phases. In the first iteration, 41 behaviors were identified to be of importance. In the second mailing, the 41 behaviors were rated for relative importance on a 7-point bipolar rating scale (1 = unimportant, 7 = most important). Comparisons were made between the ratings of administrative and biomedical scientific/technical (BS/T) series. Discriminant models developed to compare demographics between administrative and BS/T officers indicated that administrative officers had more time in grade, years of service, and professional military education, whereas BS/T officers reported significantly more civilian education. Minor differences among the two groups emerged for behavior ratings; however, the final priority order of behaviors reflected a high degree of consensus from both groups.

Clinical Competence↗
PubMed1994

Screening alcohol abuse potential among Army reservists with the Short Michigan Alcoholism Screening Test.

The Short Michigan Alcoholism Screening Test was psychometrically useful in screening a sample of 560 reservists from a midwest general hospital unit. The most conservative estimate of alcohol abuse potential was 11.3%, with possibly 6.6% having symptoms of alcohol dependence. Comparisons with active duty military, Army, and civilian samples suggest that prevalence of abuse in the Reserve sample is similar to that of the combined military, but lower than that of the Army. Future research and policy choices are highlighted.

Alcoholism↗
PubMed1994

Patient attitudes and utilization patterns in Army medical treatment facilities.

In Section 733 of the National Defense Authorization Act for Fiscal Years 1992 and 1993, Congress directed the Department of Defense to study the military medical care system. When the Congressionally directed study findings become available, baseline data will be needed for comparison. From 1989 to 1992, patient satisfaction surveys were conducted of eligible beneficiaries who might seek health care in Army military medical treatment facilities (MMTFs). Regression models were developed to predict overall quality of care. Most of the beneficiaries are generally satisfied with the Army health care system. However, care provided by CHAMPUS, private, or other sources is rated more satisfying than that in MMTFs. Retired personnel were most satisfied, whereas active duty dependents were the least satisfied group.

Adult↗
PubMed1993

A survey of Army medical department reserve personnel mobilized in support of Operation Desert Storm.

Surveys from 3,930 Army medical reservists mobilized in support of the Health Services Command mission during Operation Desert Shield/Storm were collected as units were demobilized from April to June, 1991. A survey questionnaire addressed questions related to factors associated with mobilization and intentions to remain in or leave reserve service after demobilization. Results were grouped according to rank, years of service, occupational specialty, and reserve category. Survey items used 6-point Likert scales to rate 38 items. Stepwise multiple regression models were developed to predict criterion items.

Attitude of Health Personnel↗
PubMed1990

The prevalence of symptoms in medical outpatients and the adequacy of therapy.

Common symptoms account for substantial patient disability and health services utilization. To determine the prevalence of 15 symptoms and the adequacy of therapy, 500 medical outpatients were surveyed. The 410 respondents indicated which symptoms were "major problems" and what therapy, if any, had been helpful. Each symptom was present in at least 10% of patients, with the most prevalent symptoms being fatigue (33%) and back pain (32%). Patients were clustered into three groups: (1) 140 were asymptomatic or monosymptomatic, (2) 135 reported 2 or 3 symptoms, and (3) 135 had 4 or more symptoms. The majority (77%) of these symptoms had been previously reported to a physician. Whereas 80% of patients with pain syndromes and gastrointestinal complaints had obtained some therapeutic benefit, only 39% of the individuals with fatigue, dyspnea, dizziness, insomnia, sexual dysfunction, depression, and anxiety reported any relief. Better therapy is needed for these common outpatient complaints.

Adult↗
PubMed1989

Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome.

PURPOSE AND PATIENTS AND METHODS: Many symptoms in outpatient practice are poorly understood. To determine the incidence, diagnostic findings, and outcome of 14 common symptoms, we reviewed the records of 1,000 patients followed by house staff in an internal medicine clinic over a three-year period. The following data were abstracted for each symptom: patient characteristics, symptom duration, evaluation, suspected etiology of the symptom, treatment prescribed, and outcome of the symptom. Cost estimates for diagnostic evaluation were calculated by means of the schedule of prevailing rates for Texas employed by the Civilian Health and Medical Program of the Uniformed Services for physician reimbursement. RESULTS: A total of 567 new complaints of chest pain, fatigue, dizziness, headache, edema, back pain, dyspnea, insomnia, abdominal pain, numbness, impotence, weight loss, cough, and constipation were noted, with 38 percent of the patients reporting at least one symptom. Although diagnostic testing was performed in more than two thirds of the cases, an organic etiology was demonstrated in only 16 percent. The cost of discovering an organic diagnosis was high, particularly for certain symptoms, such as headache ($7,778) and back pain ($7,263). Treatment was provided for only 55 percent of the symptoms and was often ineffective. Where outcome was documented, 164 (53 percent) of 307 symptoms improved. Three favorable prognostic factors were an organic etiology (p = 0.006), a symptom duration of less than four months (p = 0.009), and a history of two or fewer symptoms (p = 0.001). CONCLUSION: The classification, evaluation, and management of common symptoms need to be refined. Diagnostic strategies emphasizing organic causes may be inadequate.

Ambulatory Care↗
PubMed1988

Chronic fatigue in primary care. Prevalence, patient characteristics, and outcome.

Although fatigue is one of the most common complaints in ambulatory care, research has been minimal. Of the 1159 consecutive patients surveyed in two adult primary-care clinics, 276 (24%) indicated that fatigue was a major problem. Fatigue was more prevalent in women than in men (28% vs 19%). Extensive clinical, laboratory, psychometric, and functional data were gathered for 102 fatigued patients and 26 controls. Laboratory testing was not useful in detecting unsuspected medical conditions or in determining the cause of fatigue. Depression or somatic anxiety or both were suggested by screening psychometric instruments in 82 fatigued patients (80%) compared with three controls (12%). Global dysfunction was marked, as reported by patients on the Sickness Impact Profile. The mean score on the Sickness Impact Profile of 11.3 for fatigued patients is similar to that reported for patients with major medical illnesses. After one year of follow-up, only 29 fatigued patients (28%) had improved. The high prevalence, persistence, and functional consequences of fatigue mandate a search for effective therapy.

Adult↗
PubMed1986

Prospective randomized evaluation of antishock MAST in post-traumatic hypotension.

During an 18-month period, among 35,000 injured patients presenting to an urban trauma center, more than 3,500 were admitted, and 1,500 underwent surgery on the General Surgical Service. Three hundred fifty-two patients with prehospital systolic blood pressures of less than 90 mm Hg were randomized on an alternate day basis to receive treatment with 'MAST' (163 patients) or 'No-MAST' (189 patients). Age, mechanism of injury, prehospital management times, prehospital trauma scores, prehospital fluids administered, Injury Severity Scores, emergency center treatment, operative protocol, and calculated probability of survival were virtually identical for both groups. Eighty-eight per cent of the injuries were produced by penetrating wounds. The predominant injury area was the abdomen in 40%, the thorax in 37%, and the extremities in 13%. There was no statistically significant difference in evaluation and outcome data between the groups. Within a controlled catchment, only 2.5% of injured patients and 22% of those undergoing operation qualified for prehospital use of MAST. We conclude that for penetrating trauma with prehospital times of 30 minutes or less, MAST provide no advantage with regard to survival, length of hospital stay, or reduced hospital costs.

Adult↗
PubMed1985

Lessons learned and forgotten: the need for prevention and mental health interventions in disaster preparedness.

Human beings have been subjected to the effects of both natural and man-made disasters for centuries. How humans have coped with catastrophes has been recorded through history. This review proceeds from an examination of the efforts in legislation and disaster research through a brief history of war-time experiences and treatment of combat stress reactions. As warfare changed, so did the ability of soldiers to cope. Likewise, treatment interventions to restore soldiers to effectiveness evolved with the changes in warfare. The treatment principles developed in war and the concepts recognized from the stress literature can be integrated to understand how the treatment interventions work. Examples of the delivery of mental health services are reviewed. The lesson learned during war were often forgotten after the war. It was not until the 1970s that the need for prevention and planning for mental health interventions during and after disasters was legislated. Research efforts are now focusing on planning, implementing interventions, and following survivors/victims for posttraumatic effects.

Combat Disorders↗
PubMed1982

Analysis of the posterior palatal seal and the palatal form as related to the retention of complete dentures.

Dislodging forces were applied at three different locations--anterior, posterior, middle--on acrylic resin bases of uniform thickness. The influence of different posterior palatal seals and the form of the palate were evaluated. A Pearson statistical correlation analysis was performed to correlate these factors. The findings were as follows: 1. The anterior attachment needed for greatest amount of force to dislodge the base; the posterior attachment needed the least. 2. The middle attachment showed more variability of the forces needed to dislodge the bases. It was influenced by the form of the palate, the type of posterior palatal seal, and the weight of the bases. 3. The middle location is the most reliable region for testing the retention of complete dentures. 4. The form of the palate has direct influence on the retention of complete dentures and will aid in the selection of the type of posterior palatal seal needed.

Denture Bases↗
PubMed1982

The transmission and interpretation of emergency department radiographs.

Twenty-five radiographic studies representative of the spectrum of trauma cases that might present to an emergency department were selected from actual cases presenting at Brooke Army Medical Center (BAMC) in San Antonio, Texas. The studies were then transmitted from a local television studio via satellite back to BAMC and three other Army hospitals. A panel of 29 physicians (11 radiologists, 7 emergency physicians, and 11 others from various specialty areas) viewed the images on commercial grade television sets and attempted to make a diagnosis. The diagnostic accuracy of the radiologists (86%) was significantly better than that of the other two groups (77% each). However, given the overall expense of a teleradiology network, this difference in accuracy - especially when translated into clinically significant errors - might not justify the establishment of such a network in terms of cost-effectiveness.

Emergency Medicine↗
PubMed1982

A model for dental workload measurement.

The primary purpose of the study was to develop a model that would provide an efficient and standardized approach to workload reporting in a non-fee (HMO-like) dental care system. The model was also designed to predict the dental personnel resource requirements in the system as the overall dental needs of the population were already known. To accomplish this, a set of 246 task/procedures representing the broad scope of dental practice was developed. For each task/procedure, a Best Time-weighted Estimate (BTE) in terms of average expected man-minutes of work required for accomplishment was developed from over 35,000 actual time measurements on patient visits to 29 US Army dental clinics located throughout the United States. Because of the nature of the specific task/procedure data, it was necessary to use four different mathematical models to produce statistically optimal BTEs. It was concluded that, cumulatively the BTEs developed for each task/procedure evaluated could be used as a basis for both the development of a Dental Care Composite Unit workload measure and the determination of overall dental personnel resource requirements in a non-free dental care system.

Dental Care↗