Abstract:
INTRODUCTION:Anorectal diseases, among the most common surgical conditions, are underrepresented in medical training. The Fundamentals of Anorectal Technical Skills course was developed to provide cost-effective formal training in diagnosis of common anorectal conditions and in commonly performed anorectal procedures using the theories of deliberative practice and perceptual and adaptive learning. MATERIALS AND METHODS:First- through third-year general surgery and internal medicine residents and third- and fourth-year medical students participated in a course consisting of didactic instruction and hands on skills stations. The course covered common anorectal conditions, including internal and external hemorrhoids, fissures, condylomata, abscesses, fistula-in-ano, rectal prolapse, pilonidal disease, pruritis ani, and anal and rectal cancer, as well as common procedures such as anoscopy, excision of thrombosed external hemorrhoids, banding of internal hemorrhoids, rigid proctoscopy, incision and drainage of an abscess, administration of local anesthesia, and reduction of rectal prolapse. Before the course, participants completed a questionnaire consisting of demographics; previous anorectal experience, as measured by procedural case volume; confidence diagnosing and treating anorectal conditions; and a clinical knowledge multiple-choice quiz. Immediately following the course, participants took an additional survey reassessing their confidence and testing their clinical knowledge. This study was granted an educational exception by the Institutional Review Board at Walter Reed National Military Medical Center. RESULTS:Forty-three learners participated in this course. Forty-six percent of participants had not participated in any anorectal cases, 26% had participated in 1 to 5 cases, 17% had participated in 6 to 10 cases, 6% had been involved with 11 to15 cases, and 6% had been involved with more than 15 cases. For learners who had no prior experience, 1 to 5 prior cases, or 6 to 10 cases, there were statistically and educationally significant increases in confidence for all diagnoses and procedures. Additionally, there were statistically and educationally significant increases between pre-course and post-course quiz scores for learners who had no prior experience (7.8 ± 2.0 vs. 11.8 ± 2.5, P < 0.01, Cohen's d = 1.8) and for those who had only participated in 1 to 5 cases (11.0 ± 3.7 vs. 14.2 ± 2.0, P = 0.04, Cohen's d = 1.1). The changes in quiz scores for learners who previously had been involved with six or more cases were not statistically significant. CONCLUSION:This course provides a cost-effective training that significantly boosts learners' confidence in diagnosis of common anorectal procedures and confidence in performance of common anorectal procedures, in addition to improving objectively measured anorectal clinical knowledge.
journal_name
Mil Medjournal_title
Military medicineauthors
Kucera WB,Nealeigh MD,Dyke C,Ritter EM,Artino AR,Durning SJ,Sweeney WBdoi
10.1093/milmed/usaa070subject
Has Abstractpub_date
2020-09-18 00:00:00pages
e1794-e1802issue
9-10eissn
0026-4075issn
1930-613Xpii
5823078journal_volume
185pub_type
杂志文章abstract::A retrospective study was performed to evaluate breast imaging in the Wilford Hall Medical Center, the largest medical facility in the U.S. Air Force, from the time period of October 1997 to October 2000, in comparison with its civilian counterparts. The results demonstrate that although Wilford Hall Medical Center br...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed.169.5.361
更新日期:2004-05-01 00:00:00
abstract:INTRODUCTION:Chronic pain and post-traumatic stress disorder (PTSD) comorbidity is prevalent among veterans and is associated with increased levels of pain severity and pain-related disability. An improved understanding of the relationship between these co-occurring disorders, in addition to effective integrated treatm...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.1093/milmed/usaa529
更新日期:2020-12-10 00:00:00
abstract::Many preventable diseases affecting troop strength are directly attributed to disease-carrying insects. The first line of defense against arthropod vectors is the use of personal protective measures. The concurrent application of DEET (N,N-diethyl-m-toluamide) repellent on the skin and permethrin [(3-phenoxy-phenyl)me...
journal_title:Military medicine
pub_type: 杂志文章,评审
doi:
更新日期:1998-05-01 00:00:00
abstract::In field operational environments, the gynecologic health needs of women may be difficult to provide because of the lack of a small, lightweight, durable, inexpensive gynecologic examination table. Such a table already exists, in pieces, in the inventory of most field-deploying units of battalion aid station size or l...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1997-10-01 00:00:00
abstract:UNLABELLED:U.S. Marines perform mission tasks under heavy loads which may compromise performance of combat tasks. However, data supporting this performance decrement are limited. PURPOSE:The aim of this study was to determine the effects of load on performance of combat-related tasks. METHODS:Subjects (N=18) ran a mo...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-14-00432
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Superficial fungal foot infection is one of the most important dermatological diseases currently affecting military personnel. Many Thai naval rating cadets are found to suffer from superficial fungal foot infections and their sequels. OBJECTIVE:To investigate prevalence, potent risk factors, responding pat...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.1093/milmed/usx187
更新日期:2018-09-01 00:00:00
abstract::3,4-Methylenedioxymethamphetamine, or "Ecstasy," is a drug commonly used at "rave" parties to heighten energy and intimacy. Although its complications have been well described in Europe, including less common side effects such as hepatic failure and rhabdomyolysis, physicians in the United States have less experience ...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:2002-02-01 00:00:00
abstract:OBJECTIVE:This study examined soldier attitudes about postdeployment mental health screening, treatment, barriers to care, strategies for overcoming barriers, and settings, personnel and timing for conducting postdeployment mental health screening. METHODS:Deploying soldiers participated in a voluntary anonymous surve...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed.173.6.563
更新日期:2008-06-01 00:00:00
abstract::A Department of Veterans Affairs (DVA) inpatient psychiatry program treating Vietnam veterans for symptoms of posttraumatic stress disorder provided day and evening treatment programs. The evening program, besides treating psychiatric trauma, incorporated the DVA mission of assisting patients with vocational rehabilit...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1990-08-01 00:00:00
abstract::Despite significant advances in hearing protection and compliance with protective standards, military personnel are still subject to noise-induced hearing loss in many combat and combat support operations. Although the Army has experienced a decrease of some 15% in primary hearing loss disability cases since 1986, a f...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:2003-06-01 00:00:00
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journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVE:Altered body structures that occur with the loss of a lower limb can impact mobility and quality of life. Specifically, biomechanical changes that result from wearing a prosthesis have been associated with an increased risk of falls or joint degeneration, as well as increased energy demands. While previous st...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-16-00356
更新日期:2017-07-01 00:00:00
abstract:INTRODUCTION:Veterans with mental illness tend to have shorter life spans and suboptimal physical health because of a variety of factors. These factors include poor nutrition, being overweight, and smoking cigarettes. Nonphysical contributors that may affect quality of life are the stigma associated with mental illness...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-16-00405
更新日期:2017-09-01 00:00:00
abstract:INTRODUCTION:Military personnel with a diagnosis of asthma report increased respiratory symptoms in the deployment and post-deployment periods. The long-term effect of deployment on pulmonary function in this population is unknown. This study sought to determine the effect of deployment on post-deployment pulmonary fun...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.1093/milmed/usaa558
更新日期:2020-12-21 00:00:00
abstract:INTRODUCTION AND SCOPE OF THE PROBLEM:Surgical site infections (SSIs) are associated with increased length of hospital stays, poor patient outcomes, and increased health care costs making prevention of SSI a high priority for the U.S. Military Health Care System. The focus of this project was to develop and pilot a pre...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.1093/milmed/usz186
更新日期:2020-06-19 00:00:00
abstract::Despite two decades of concerted federal government effort and the expenditure of billions of dollars, the war on cancer, as judged by mortality, is not going well. However, the mortality yardstick by which progress against cancer is often measured should be reassessed based upon current concepts of carcinogenesis. Th...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1994-04-01 00:00:00
abstract:OBJECTIVES:Endotracheal intubation (ETI) is an important skill for all emergency providers; our ability to train and assess our learners is integral to providing optimal patient care. The primary aim of this study was to assess the inter-rater reliability (IRR) and discriminant validity of a novel field ETI assessment ...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-15-00570
更新日期:2016-11-01 00:00:00
abstract::A case series of 417 consecutive ward admissions onboard the USS Forrestal (CV59) is presented. During the 1-year study period, the inpatient ward was open for 260 days while the ship was underway, including workups and extended Mediterranean deployment. The case series displays the variety of clinical inpatient care ...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1995-06-01 00:00:00
abstract::Before 2011, Army commanders were unable to achieve complete visibility of soldiers possessing temporary medical limitations. The creation of time-limited definitions and technical categorization of this group, now known as the medically not ready (MNR) population, eventually allowed its quantification. With heightene...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-14-00131
更新日期:2014-11-01 00:00:00
abstract::This investigation assessed the extent to which various health factors are associated with difficulties initiating and maintaining sleep (DIMS) and nightmares among Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans reporting a trauma (combat, noncombat, or a trauma before service). Veterans (N = 20...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed-d-09-00123
更新日期:2010-08-01 00:00:00
abstract::Patients are referred to the endodontist to have root canal therapy performed to treat pulpal and periradicular diseases. Routinely, the only radiograph to accompany the patient is the periapical radiograph. This radiograph is inadequate in the detection of asymptomatic pathosis that may be present in other areas of t...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:2003-07-01 00:00:00
abstract::The objective of this study was to determine whether there was a relationship between levels of particulate matter with an aerodynamic diameter of less than 10 microns (PM10) and upper respiratory disease (URD) rates in soldiers deployed to Bosnia in 1997 and 1998. PM10 levels were divided into quartiles and upper and...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:2002-04-01 00:00:00
abstract::The elderly military beneficiary is a valued, high-risk, high-cost, and complex individual with unique medical needs. Attention to common geriatric syndromes (such as incontinence) and quality end-of-life care is critical in this population. Care of older adults is part of every adult medical and surgical specialty an...
journal_title:Military medicine
pub_type: 杂志文章,评审
doi:10.7205/milmed-d-09-00067
更新日期:2010-02-01 00:00:00
abstract::Mindfulness meditation training has been shown to reduce stress and improve short-term memory for military personnel. However, no studies have investigated the effects of in-person and virtual world (VW) mindfulness training on Post-Traumatic Stress Disorder (PTSD) or Attention Deficit Hyperactivity Disorder (ADHD) sy...
journal_title:Military medicine
pub_type: 杂志文章
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更新日期:2018-03-01 00:00:00
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journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/MILMED-D-16-00022
更新日期:2017-03-01 00:00:00
abstract::This study examines the attitudes of 176 Israel Defense Forces officers toward combat stress reaction (CSR) in four areas: (1) the degree of personal responsibility the officer accepts for the treatment of the CSR casualty; (2) the type of treatment the officer views as most effective for CSR; (3) the officer's willin...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1989-09-01 00:00:00
abstract::Recently, pyogenic vertebral osteomyelitis has been documented following transcolonic passage of bullets lodging in or near the vertebral column. It is becoming more recognized that foreign body missiles are not as sterile as was once thought--especially after passage through the gastrointestinal tract--and that this ...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1989-02-01 00:00:00
abstract::This article examines the history of battlefield tourniquets. The tourniquet, if used properly, is perhaps the leading lifesaving device available to soldiers in the field. However, tourniquet use has been surrounded throughout history by controversy and dogma which continue today. Only after examining the historical ...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.7205/milmed.171.5.352
更新日期:2006-05-01 00:00:00
abstract::The U.S. Army Special Forces Medic, Military Occupational Specialty 18D, is a unique, enlisted, medical asset. The training of the 18D is demanding, lengthy, and selective. The 18D is trained to independently assess, and provide acute and long-term medical care for, a variety of medical conditions in support of the Sp...
journal_title:Military medicine
pub_type: 杂志文章
doi:
更新日期:1992-02-01 00:00:00
abstract:Introduction:The education of health professionals and the assessment of their long-term goals are essential. Additionally, in the military health system (MHS), such programs also have the goals of improving readiness, providing high-quality care and meeting the needs and challenges of the MHS. The Uniformed Services U...
journal_title:Military medicine
pub_type: 杂志文章
doi:10.1093/milmed/usy158
更新日期:2019-01-01 00:00:00