JOURNAL OF MILITARY MEDICINE
Year:2019 | Volume:20 | Issue:6 |Papers Count:16

Background and Aim: Average length of stay (ALOS) is an indirect indicator of resource consumption and a measure of efficiency in hospitals. Therefore, managing the effective organizational aspects can provide opportunities for increasing revenues, reducing costs, improving patient clinical outcomes and quality of care, and increasing profitability. This study aimed to identify organizational factors affecting the ALOS. Methods: This was a systematic review using the PRISMA protocol to search literatures in international (PubMed, Google Scholar, Science Direct) and national (SID, Magiran, and MedLib) databases. According to the PICOS strategy, all published papers were retrieved in English and Persian languages until October 2017 using different combinations of keywords such as length of stay, stay length, stay lengths, hospital stay، hospital stays, organizational factors and the Persian equivalent keywords. Final selected papers were critically appraised with the CASP and PRISMA checklist. Finally, factors affecting ALOS were presented in comparative tables. Results: A total of 127 publications were retrieved in the initial step. After screening, 12 full text publications were carefully reviewed. The most important organizational factors affecting the patient's ALOS were the ratio of nurse: patient, training of the physicians and nurses, the patient's discharge process, the presence of a physician in department, the number of para-clinical requests, inter-departmental coordination, time of the first treatment in the ward after admission, visit times, and admission days. These factors were categorized into four groups of process, service, organizational, and human resource factors. Conclusion: Process and management factors are considered the controllable variables of hospital management, therefore senior managers and decision makers in hospitals can focus on these factors to conduct policy interventions in order to improve productivity and the quality of services.

The injury from multiple conflicts during war and peace affects military personnel, families and their communities. In this regard, Total Force Fitness is an emerging concept that is defined as a state in which the individual, family, and organization can sustain optimal well-being and performance under all conditions. The Total Force Fitness is accomplished by requiring the integrity of its components in the mind and body that can be used in state of war and peace. Charge requires us to seamlessly combine the multiple components of fitness in the mind and the body. Within the category of the mind; spiritual, psychological, behavioral, and social fitness, are included whereas within the category of the body, physical, nutritional, medical, and environmental fitness are included. Physical fitness; addressed through endurance, mobility, strength, and flexibility, is part of military culture. Nutritional fitness refers to the provision and consumption of food in quantities, quality, and proportions sufficient to preserve mission performance and to protect against disease and/or injury. Medical fitness, described as a state of general mental and physical well-being, is determined by medical metrics. Environmental fitness is defined as the ability to perform mission-specific duties in any environment, especially stressfull environments of deployment and war. Psychological fitness is defined as the integration and optimization of mental, emotional and behavioural abilities, in order to optimize performance of military personnel. Spiritual fitness, from the perspective of some people, considered to be distinct from religion, however, is to ensure optimal force readiness and protection and enhancing recovery following combat-related trauma. The role of behavioral fitness on military fitness, including substance abuse (tobacco, alcohol, and illicit drugs) and psychophysical behaviors associated with weight and sleep problems. Social fitness, often used metaphorically, refers to the nature and quality of the emotional bonds of friendship, liking, caring, and closeness among military group members. In addition to the above mentioned components, the role of occupational fitness, which includes areas of stress and social influences, and environmental physical, chemical, and biological stressors, as well as family fitness as a concept for the development and coordination of family-centred programs and resources, to reduce costs and and promote overall family functioning and health, are addressed in the present review. To achieve total force fitness, the individuals and commanders need a simple and integrated approach to monitor and provide the necessary modifications for resilience and performance optimization. It is now abundantly clear that if military personnel are to protect the freedom and security of the nation and the country, the authorities should also go beyond the simple idea of having a healthy body, with a more general view of health and fitness, including both mind and body.

Background and Aim: Blindness is one of the permanent physical damage that is found frequently in war survivors. In monocular blind veterans, preservation and care of the remaining eye is very important. This study aimed to investigate diseases and disorders of both eyes of monocular blind veterans. Methods: A total of 1820 monocular blind veterans from 19 provinces of Iran were surveyed between 2010 and 2016. Demographic data including age, gender, marital status, injury rate, associated injuries, educational level and employment status were collected. After examination of the veterans’ eyes, diseases of the both eyes and eyelid disorders were recorded by an ophthalmologist. Furthermore, treatment plans were provided to each patients. Results: The mean age of 1820 participants was 45. 8 ± 7. 8 years. About two-thirds (73. 6%) of participants had injuries other than blindness. More than half (54. 2%) of the blind eyes had diseases, the most frequent of which was phthisis bulbi (11. 0%). A total of 405 (22. 2%) of the non-blind eyes were healthy. The frequencies of diseases in non-blind eyes were as follows: refractive error, 620 (34. 1%); presbyopia, 533 (29. 3%); cataract, 62 (3. 4%); glaucoma, 32 (1. 7%); and others, 168 (9. 3%). Except for the glaucoma, these diseases were associated with age (P<0. 05). Entropion (13. 1%) and incomplete eyelid closure (9. 8%) were the most common eyelid disorders. The majority of the blind (93. 7%) and non-blind (94. 3%) eyes needed follow-up in the next year of the study. Conclusion: In monocular blind veterans, the most frequent diseases and disorders of the blind eyes, nonblind eyes and eyelids were phthisis bulbi, refractive errors and entropion, respectively. Regarding the importance of preserving the vision of non-blind eyes and the frequency of diseases in both eyes of these veterans, periodic examination is necessary.

Background and Aim: The optimal monitoring of multiple trauma patients remains as a challenge. There are various invasive and non-invasive methods for monitoring hemodynamic status that affect the clinical outcome of multiple trauma patients. The present study compares eFAST (Extended Focused Assessment with Sonography in Trauma) with clinical (such as pressure and pulse) and paraclinical data (such as VBG, lactate and hemoglobin) to assess the response to treatment or worsening of the status of the patient with multiple traumas in the emergency department. The study also sought to assess whether ultrasound can provide more accurate and faster data regarding response to treatment or worsening of the status of a patient with multiple traumas. Methods: The present study is a comparative study of diagnostic methods in multiple trauma patients over 14 years of age (male/female) who referred to the Emergency Department of hospitals from January 2018 and who have undergone an ultrasound evaluation. Demographic and clinical data was collected from all patients. Subsequently, these patients were monitored by ultrasound evaluation of the heart, IVC and lungs. For all patients, clinical findings such as pressure and pulse, and paraclinical methods such as VBG, lactate and hemoglobin were also recorded. Finally, ultrasound findings were compared with clinical and paraclinical findings using appropriate statistical methods. Results: The mean age of 310 patients with multiple trauma due to traffic accidents was 36± 11. 5 years, and 67. 7% (210) were male. The mean of IVC, EF, BE, hematocrit, hemoglobin, lactate, systolic and diastolic blood pressure, respiratory rate, heart rate, blood pH, blood PCO2, and HCO3 were significantly correlated with the deterioration of the patient according to eFAST (P <0. 05). There was a significant relationship between mean IVC with different hemodynamic variables in patients with worsening eFAST. In this study, the development of eFAST from one space (initial eFAST) to other spaces (eFAST 6 hours later) or lack of fluid in the initial eFAST, and then fluid recording in one or more spaces at eFAST 6 hours later, was considered to be a deterioration in the patient's condition. In this condition, 80 patients with multiple trauma were registered. Conclusion: The significance of positive (abnormal) eFAST association with different hemodynamic variables for assessing the response to treatment or deterioration of patient's condition, indicates that the hemodynamic monitoring of multiple trauma patients is reliable by ultrasonography in the emergency department. Therefore, eFAST and repeated eFAST can be used as a preliminary diagnostic tool in multiple trauma patients, in order to take the necessary therapeutic measures, and to avoid wasting time and increasing the cost to the patient, exposure to radiation and side effects of intensive action.

Background and Aim: Obesity is considered as a risk factor for testosterone lowering, and low testosterone is a predictor for diabetes mellitus development. The current study compares the quality of life and blood glucose control in type 2 diabetic patients with and without hypogonadism. Methods: In this case-control study, 93 male patients with hypogonadism and diabetes who were diagnosed by ADAM questioners and low testosterone level, and 67 patients with diabetes but without hypogonadism were compared in terms of anthropometric, lipid and glycemic control and quality of life. Results: Demographic data were matched in two groups. The anthropometric parameters (waist circumference and body mass index) were significantly higher in hypogonadal patients than patients without hypogonadism (P=0. 001 and P=0. 024 respectively). Dyslipidemia (P=0. 001), fasting blood sugar (P=0. 003) and HbA1c (P=0. 02) were higher and quality of life was lower (P=0. 002) in hypogonadal patients than patients without hypogonadism. Conclusion: Male patients with hypogonadism and diabetes had lower quality of life and less appropriate blood and lipid control, compared with patients with diabetes without hypogonadism.

Background and Aim: Quiet eye is a technique reported to improve outcomes in various tasks requiring human visual attention. The aim of this study was to investigate the effect of quiet eye training on improving the performance of novice military shooters. Methods: This randomized controlled clinical trial was conducted on 30 undergraduate military science students aged 18 to 23 years who were studying in of 2016‒ 17. They were selected from a military university and were randomized to one of two groups of control and intervention. The intervention group received quiet eye training for six weeks, along with shooting training (two sessions per week). The control group participated only in shooting training during this period. The SCATT system was used to evaluate the shooter's performance preand post-test. Results: The mean± SD age of the 30 novice military shooters included in the study was 19. 8± 4. 7 years for the control group and 20. 12± 7. 02 years for the intervention group. The mean± SD shooting background (history) was 8. 54± 6. 82 months for the control group and 7. 93± 4. 35 estnoo sh nom intervention group. The eye training intervention was effective in improving the shooters’ performance and its sub-components of (p<0. 05). There was a significant difference between control and intervention group in the earned score (F=46. 53, P=0. 01), the average aiming point fluctuations (F=26. 62, P=0. 02), the horizontal aiming point fluctuations (F=7. 07, P=0. 01), and the vertical aiming point fluctuations (F=76. 21, P=0. 01). Conclusion: The quiet eye training program is an appropriate method to improve performance level of novice military shooters. Therefore, in order to improve the level of perceptual-cognitive readiness and processes performance of the shooters, it is necessary to provide the quiet eye training program to military shooters.

Background and Aim: Research shows that the family life of those in military occupations, and the effects of military occupations on marital relationships is considered important. The present research seeks to study the relationship between differentiation of self and early maladaptive schemes with the components of family function in couples of military families residing in Tehran. Methods: The research utilized quantitative research methodologies and, based on the purpose, this study was descriptive and correlational. The research population included all married women in military families in Tehran, Iran in 2017, that among whom, 325 married housewives women were selected by non-probability convenience sampling methods after considering inclusion and exclusion criteria. Information gathering tools included Selfdifferentiation Questionnaire, Family Assessment Device (FAD), Young Schema Questionnaire-Short Form (SQ – SF). Descriptive statistics (average and standard deviation) and inferential statistics (Pearson correlation and multivariate regression analysis) have been used for determining correlation and predictive power between the early maladaptive schemas and differentiation with family functioning. Results: 325 married women housewives were investigated in military families in Tehran with an average age of 46. 4 years. The relationship between the components of the early maladaptive schemas and the family functioning components is statistically significant (P<0. 01) and also the relationship between differentiation and family functioning components in is statistically significant (P<0. 01). Conclusion: It is recommended that families should be more careful about the formation of patterns in childhood so that positive steps can be taken to form a well-functioning family in the future. With regard to the significance of the relationship between differentiation and family function, one can conclude that the mental health of a person depends on the level of separation from this system of governing the family, which is called differentiation, that is, the higher the level of differentiation, the greater the impact on family function and on improvements in mental health in married women in military families.

Background and Aim: Job burnout is one of the occupational hazards among employees, especially nurses. It can negatively affect the performance. This study was conducted to develop and validate the job burnout questionnaire of military nurses. Methods: The present study was carried out in two steps in year of 2017. In the first stage, with the qualitative content analysis approach, first, the concept of burnout was explained by military nurses employed in the armed forces medical centers, and then the initial items were extracted and the questionnaire was developed. In the second stage, cross-sectional descriptive study was conducted for face and content validity. Construct validity was done using exploratory factor analysis with the participation of 351 military nurses. Reliability of the questionnaire was determined by using the internal consistency (Cronbach’ s alpha) and its stability through the test-retest (intracluster correlation test). Results: 50 items were extracted from qualitative content analysis and related scientific literature. After performing face and content validity (qualitative and quantitative), 34 items were remained. The construct validity of the questionnaire through exploratory factor analysis led to the elimination of eleven items and thus the 25 items in seven factors (occupational burnout related to the nature of nursing profession, management aspects, the organizational regulations, professional values, Work Load in Nursing, motivational aspects and militarism) that explained 57. 56% of the total variance were remained. The reliability of the tool with Cronbach’ s alpha was 0. 912 and its stability was obtained through test-retest (ICC = 0. 967). Conclusion: Military nurses' job burnout questionnaire have appropriate psychometric properties such as reliability and validity; also it has simple scoring and is easy to be used by nurses.

Background and Aim: Quality function deployment (QFD) is a method used to evaluate and plan the quality of products and services. It is based on the satisfaction of customers, translating their needs into measurable characteristics. This study aimed to evaluate the quality of surgery service in a military hospital. Methods: This is a cross-sectional descriptive-analytical study carried out in a military hospital in Tehran, Iran in 2016. A researcher-made questionnaire was confirmed valid for data collection by experts. A total of 106 surgery patients were selected as study population. Results: The most important demands of patients (voice of customer) were "nursing assistance" and then "providing proper information to the patient and patient companions". "Suitable equipment-tools and surgical ward space" were the lowest in terms of patient's demands. Among the service elements, the "number of complaints per month" was the most important service element (0. 55) and "compliance with the infection control guidelines" was determined as the least important element of the service (0. 14). Conclusion: The current quality control model developed in this study can be a general guide to evaluate the quality of services provided by the operating room and other wards of a military hospital.

Background and Aim: Morning exercise is a branch of outdoor workouts which has been given special emphasis on military centers. The current study was aimed to assess the effect of morning activities on mental health of the students and employees at NAJA (Disciplinary Force of the Islamic Republic of Iran). Methods: In this descriptive survey, 250 employees and students from NAJA (Shahid Dastghib NAJA Training Center, Jahrom, Iran) were chosen using an availability sampling method. Morning exercise sessions were performed three times per week, with each exercise session lasting for 45 to 60 minutes with an intensity of 60-50%. For data collection, the depression, anxiety and stress questionnaire (DASS) and the mental health questionnaire were used in pre-test and post-test. Results: A total of 250 employees and students from NAJA with an average age of 32 years were included. 94. 4% of the participants were single. There was a significant relationship between morning exercises and a reduction in level of depression, anxiety and stress (P≤ 0. 05). There was also a significant relationship between morning exercises and increasing general health level as well as controlling stress level of employees and students in a positive way (P≤ 0. 05). Conclusion: Morning exercises in military centers could affect psychological features and consequently lead to a better mental and health state if conducted on a regular basis with proper standards and intensity factors.

Background and Aim: Increasing productivity and job performance is a basic concern for managers. Intellectual capital can provide proper context for human resource productivity and job performance enhancement. The purpose of the present study is to determine the relationship between intellectual capital with human resource productivity and job performance. Methods: The statistical population includes staff of a military hospital in Tehran, Iran in 2018. A total of 253 people were selected using a simple random sampling method. In order to collect data, intellectual capital (Bontis), productivity (Taylor and Brent) and Paterson's job performance questionnaires were used. The reliability and validity of instruments were measured using Cronbach's alpha and CFA. Data analysis was performed using structural equation modelling method with Lisrel software. Results: Intellectual capital has a positive and significant effect on human resource productivity (β =0. 512, t=4. 415) and job performance (β =0. 831, t=5. 510). Furthermore, all predictive factors of intellectual capital positively and significantly predict the criterion variable i. e. human resource productivity and job performance. Among intellectual capital elements, human capital and structural capital respectively has the strongest correlation with human resource productivity and job performance. Conclusion: Improvement of intellectual capital and its dimensions (structural, human and relational capital) can lead to enhancement of human resource productivity and job performance. Hospital managers may make staff feel worthy by coordinating job descriptions and job qualifications. The findings of this study provide theoretical implications and insights for hospital managers.