Abstract：
OBJECTIVE:This study describes and categorizes the cultural frictions and conflicts within a successfully implemented Internal Medicine Patient-Centered Medical Home (PCMH) clinic at the National Naval Medical Center, and provides lessons learned for combating these concerns. METHODS:A semistructured interview protocol was developed, focusing on unique tenets of the PCMH, benefits of the model, and perceived obstacles to practicing medicine within this delivery system. The interviews included questions regarding efforts to foster team cohesion and impediments within the PCMH, as well as unique influences of the larger organization and the patient population, and lingering concerns about threats to the PCMH's viability. KEY RESULTS:Cultural tensions were revealed in four areas: perceived competing values within PCMH, individual resistance to PCMH values, within-team conflicts threatening the acculturation of PCMH values, and threats to the culture from external stakeholders. CONCLUSIONS:Recommendations for addressing these areas include values clarification and empowerment, training for socialization, realistic job previews, selective personnel retention, team building and conflict resolution mechanisms, and increased senior managerial support.
journal_name
Mil Medjournal_title
Military medicineauthors
Dorrance KA,Ramchandani S,LaRochelle J,Mael F,Lynch S,Grundy Pdoi
10.7205/milmed-d-12-00146subject
Has Abstractpub_date
2013-02-01 00:00:00pages
153-8issue
2eissn
0026-4075issn
1930-613Xjournal_volume
178pub_type
杂志文章abstract：:The U.S. military health care system forms a vast network across thousands of miles to serve patients in the Pacific theater. The medical treatment facilities in the Pacific, however, act independently and do not effectively track patients in the air evacuation system. The patients and the tracking systems are so disc...
journal_title：Military medicine
pub_type： 杂志文章
doi：
更新日期：2001-05-01 00:00:00
abstract：:The rules governing armed conflict are numerous and in many respects complex. In areas that are very complex, experts such as lawyers may be called in to assist, especially in the planning of military action. But the nature and tempo of warfare rarely allows a person in the field to enjoy such a luxury. Therefore, eve...
journal_title：Military medicine
pub_type： 杂志文章
doi：
更新日期：2002-08-01 00:00:00
abstract：:Swimming-induced pulmonary edema (SIPE) is a noncardiogenic form of acute pulmonary edema infrequently described in the general military literature. Its pathophysiology is poorly understood. Treatment is supportive. Knowledge of SIPE is important for the military physician and should remain a top differential for any ...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.1093/milmed/usaa118
更新日期：2020-09-18 00:00:00
abstract：:This report, in an effort to assist in the development of future operational and planning guidelines, presents data from a no-notice exercise involving an aviation brigade in Germany preparing for possible deployment to Bosnia. One hundred twenty-two soldiers (of 918) requested vision screening during predeployment pr...
journal_title：Military medicine
pub_type： 杂志文章
doi：
更新日期：1998-02-01 00:00:00
abstract：:Proper command of medical units is central to their effectiveness. For many years the majority of commands have been available only to physicians. This paper suggests a concept for structuring the way in which individuals are considered suitable for command assignments. In this regard, there is an ongoing process with...
journal_title：Military medicine
pub_type： 杂志文章,评审
doi：
更新日期：1996-06-01 00:00:00
abstract：:The purpose of this study was to investigate an outbreak of tuberculosis (TB) in a bacillus Calmette-Guérin-vaccinated military population and propose an appropriate method of control. We divided 593 subjects into "close contacts" and "non-close contacts" of an index case and examined all subjects by chest X-radiograp...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.7205/milmed.173.4.388
更新日期：2008-04-01 00:00:00
abstract：:A young man presented with a 4-month history of progressive, bilateral tender gynecomastia and underwent a bilateral subcutaneous mastectomy without regard for a possible occult testicular tumor. Following the mastectomy, metastatic testicular cancer was discovered; the patient had an overlooked scrotal mass and a ver...
journal_title：Military medicine
pub_type： 杂志文章
doi：
更新日期：1992-08-01 00:00:00
abstract：:This case study describes the rehabilitation of 10 active duty U.S. soldiers with exertional rhabdomyolysis. The pathophysiology of rhabdomyolysis is discussed. The initial management is concerned with accurate diagnosis and monitoring of laboratory values to prevent complications. Active and passive range of motion, ...
journal_title：Military medicine
pub_type： 杂志文章
doi：
更新日期：1996-09-01 00:00:00
abstract：:Thousands of military members self-medicate with dietary supplements containing unknown quantities of pharmacologically active compounds. These poorly regulated substances can cause real harm to the military population, especially when they contain stimulants such as caffeine. When taken regularly, caffeine has severa...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.7205/MILMED-D-15-00045
更新日期：2015-08-01 00:00:00
abstract：:Stress fractures are caused by repetitive low-impact activities. It is important to have a high index of suspicion in diagnosing and treating stress fractures early for remodeling to occur. This is a case report of a 19-year-old female military recruit with stress fractures of the right foot. The patient had an extend...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.7205/milmed-d-10-00087
更新日期：2011-01-01 00:00:00
abstract：INTRODUCTION:Amputations are increasingly prevalent because of medical complications associated with diabetes, meningitis, peripheral vascular disease, and neoplasms as well as road traffic accidents and war. The use of ultrasound (U/S) to diagnose the cause of pain in the residual limb of amputees is presented togethe...
journal_title：Military medicine
pub_type： 杂志文章,评审
doi：10.7205/MILMED-D-13-00273
更新日期：2013-12-01 00:00:00
abstract：:Post-traumatic stress disorder (PTSD) is associated with poor health but there is a gap between need and receipt of care. It is useful to understand where to optimally locate in-person care and where video-based PTSD care would be most useful to minimize access to care barriers, care outside the Veterans Affairs syste...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.7205/MILMED-D-13-00177
更新日期：2014-02-01 00:00:00
abstract：:Use of blood products are recommended worldwide as a substitution for whole blood. In the case of war wounds, because of their specificity, this is not possible. We studied prospectively the use of blood and blood products during management of the wounded in a field hospital during the war in Croatia. During a 6-month...
journal_title：Military medicine
pub_type： 杂志文章
doi：
更新日期：1996-02-01 00:00:00
abstract：INTRODUCTION:As the healthcare system shifts from fee-for service toward value-driven healthcare, interest has grown in medication-related quality metrics to evaluate quality and value within the healthcare system. While the Defense Health Agency (DHA) has taken steps to align healthcare quality measures across the ent...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.1093/milmed/usz435
更新日期：2020-06-08 00:00:00
abstract：:The authors describe the case of a giant osteochondroma emanating from the L5 vertebral body and extending into the retroperitoneum of a 40-year-old man, causing low back pain. Osteochondromas are benign bony tumors that typically occur within the appendicular skeleton, although in the sporadic form, up to 4% occur in...
journal_title：Military medicine
pub_type： 杂志文章,评审
doi：10.7205/MILMED-D-14-00239
更新日期：2015-01-01 00:00:00
abstract：INTRODUCTION:The role of testosterone in health and quality of life has become increasingly visible and overtly marketed to the public. Some evidence suggests that testosterone levels in men may be low because of a variety of reasons, including stress and environmental exposures. OBJECTIVE:This study examines trends i...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.7205/MILMED-D-14-00496
更新日期：2015-07-01 00:00:00
abstract：:Military graduate medical education has come under increasing scrutiny in recent years as the size of the military medical force declines. To document the outcomes of military graduate medical education in internal medicine, a cohort of Air Force internal medicine residency graduates from Wright-Patterson Medical Cent...
journal_title：Military medicine
pub_type： 杂志文章
doi：
更新日期：2001-04-01 00:00:00
abstract：:Although Japanese military officials had discovered that an improved diet could prevent beriberi by the late 19th century, their soldiers in the army suffered from beriberi during the Russo-Japanese War and World War II. A change in diet at the end of the Russo-Japanese War solved the problem and the army applied the ...
journal_title：Military medicine
pub_type： 历史文章,杂志文章
doi：10.7205/milmed.171.4.333
更新日期：2006-04-01 00:00:00
abstract：:One hundred six astronaut applicants who had passed initial screening were evaluated for Axis I and Axis II DSM-III-R diagnoses using a structured psychiatric interview. Nine of 106 candidates (8.5%) met diagnostic criteria for six Axis I (including V-code), or Axis II disorders. The use of the NASA structured intervi...
journal_title：Military medicine
pub_type： 杂志文章
doi：
更新日期：1993-01-01 00:00:00
abstract：:Malignant neoplasms of the bladder are typically transitional cell carcinoma with squamous cell carcinoma and adenocarcinoma comprising nearly all of the remaining cases. Leiomyosarcoma is a rarely seen neoplasm of the bladder with a generally poor prognosis. It is important to distinguish leiomyosarcomas from rhabdom...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.7205/milmed.169.2.155
更新日期：2004-02-01 00:00:00
abstract：:Little attention is given in psychiatry residency programs to preparing graduates to occupy division psychiatry slots. The first part of this paper discusses several guidelines: preparations to make before leaving for a new post; immediate steps to take upon arrival; the place of the Division Mental Health Service in ...
journal_title：Military medicine
pub_type： 杂志文章
doi：
更新日期：1993-10-01 00:00:00
abstract：:The first licensed Haemophilus influenzae type B (Hib) vaccines were of a purified capsular oligosaccharide. Unfortunately, oligosaccharides are poorly immunogenic in younger children and resulted in these vaccines not routinely being used until past the period of peak incidence of Hib disease. Subsequent Hib vaccine ...
journal_title：Military medicine
pub_type： 杂志文章
doi：
更新日期：1990-10-01 00:00:00
abstract：INTRODUCTION:The development of methods that generate individualized assessments of the procoagulant potential of burn patients could improve their treatment. Beyond its role as an essential intermediate in the formation of thrombin, factor (F)Xa has systemic effects as an agonist to inflammatory processes. In this stu...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.1093/milmed/usy397
更新日期：2019-03-01 00:00:00
abstract：:Operations Just Cause and Desert Storm were of relatively brief duration; however, severe wounds were produced that required complex reconstructive procedures. This paper describes the type of wounds managed in theater and subsequently at three U.S. military medical centers. Specific reconstructive techniques included...
journal_title：Military medicine
pub_type： 杂志文章
doi：
更新日期：1995-02-01 00:00:00
abstract：:In a deployment setting, orthopedic and musculoskeletal injuries represent the majority of both combat-related and noncombat-related injuries. To expeditiously and efficiently manage the large influx of patients, our experience revealed the tremendous benefits of having physical therapy colocated with an orthopedic su...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.7205/milmed.171.3.220
更新日期：2006-03-01 00:00:00
abstract：INTRODUCTION:Soldiers are exposed to extreme training regimens in order to optimally prepare for real battle. High attrition rates are a known issue during training courses, especially for elite troops. An underlying factor might be the disbalance between stress/strain and recovery. The aim of this review is to give in...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.1093/milmed/usy274
更新日期：2019-05-01 00:00:00
abstract：OBJECTIVE:To describe the development of the Combat Casualty Critical Care Database, a comprehensive database of critically injured combat casualties to identify potentially modifiable risk factors for morbidity and mortality in this population. METHODS:The Department of Defense's Joint Theater Trauma Registry was que...
journal_title：Military medicine
pub_type： 杂志文章,评审
doi：10.7205/MILMED-D-13-00393
更新日期：2014-04-01 00:00:00
abstract：:Chyle leaks are a rare but potentially fatal complication of head and neck surgery carrying an incidence as high as 8.3%. The development of a chyle leak carries significant morbidity ranging from delayed wound healing to oropharyngeal fistulas. Presented here is a case of a chyle leak that developed following a left ...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.7205/MILMED-D-15-00240
更新日期：2016-09-01 00:00:00
abstract：:Protective gear is mandatory for medical personnel treating casualties in a contaminated environment. In the present study, we assessed the ability of emergency medical technicians to insert an intravenous line in this situation. Sixty emergency medical technicians were randomized to a control group, wearing fatigues,...
journal_title：Military medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1999-10-01 00:00:00
abstract：INTRODUCTION:The U.S. Navy Medicine has a long history of conducting global health missions that foster international diplomacy through medical knowledge exchange with a goal of increasing partner nation's health care capacity. Pacific Partnership is an annual U.S. Navy-sponsored joint operation that enhances medical c...
journal_title：Military medicine
pub_type： 杂志文章
doi：10.1093/milmed/usaa499
更新日期：2021-01-25 00:00:00
