Subject(s)
Hospitalization , Hospitals, Military , Military Personnel , Mobile Health Units , Adolescent , Adult , Cellulitis/epidemiology , Communicable Diseases/epidemiology , Databases, Factual , Female , Fever/epidemiology , Gastroenteritis/epidemiology , Heat Stress Disorders/epidemiology , Humans , Iraq , Iraq War, 2003-2011 , Length of Stay , Male , Middle Aged , Seizures/epidemiology , Syncope/epidemiology , United Kingdom , Young AdultABSTRACT
OBJECTIVES: To assess the clinical, occupational and financial outcomes of a new Clinical Aviation Medicine Service (CAMS) for UK military personnel. METHODS: Consecutive patients over a 2 year period were included. Predictors of flying restrictions at referral and final outcome following consultation were modelled using logistic regression. National Health Service (NHS) Payment by Results tariffs and Defence capitation data were used to assess the financial impact of the service. RESULTS: Eight hundred and sixteen new referrals (94.5% male, median age 45 years (range 19-75)) were received and 1025 consultations performed. Cardiovascular disease was the commonest reason for referral. CAMS clinical activity cost at NHS tariff was £453 310 representing a saving of £316 173 (£137 137 delivery cost). In total, 310/816 (38%) patients had employment restrictions on referral and 49.0% of this group returned to full employment following their initial consultation. Compared with cardiology, general medicine and respiratory patients were more likely to have been occupationally restricted prior to referral (50 vs. 35%, OR 1.81; 95% CI 1.18-2.76, P values=0.006 and 53 vs. 35%, OR 2.12; 95% CI 1.15-3.90, P values = 0.016, respectively). Overall 581/816 (71.2%) of patients returned to unrestricted employment while 98/816 (12.0%) were unable to continue in any aircrew role. The service saved 7000 lost working days per year at an estimated occupational saving of â¼£1 million per annum. CONCLUSIONS: This bespoke service has allowed rapid, occupationally relevant clinical care to be delivered with both time and financial savings. The model may have significant occupational and financial relevance for other environmental and occupational medical organizations.
Subject(s)
Aerospace Medicine/economics , Coronary Artery Disease/diagnosis , Military Personnel , Occupational Diseases/diagnosis , Pilots , Referral and Consultation/economics , Adult , Aerospace Medicine/trends , Aged , Cohort Studies , Coronary Angiography/economics , Coronary Artery Disease/economics , Coronary Artery Disease/therapy , Cost-Benefit Analysis , Employment , Female , Humans , Male , Middle Aged , Occupational Diseases/economics , Occupational Diseases/therapy , Outcome Assessment, Health Care , Return to Work/economics , Risk Assessment , United Kingdom , Young AdultSubject(s)
Diabetes Mellitus, Type 1/chemically induced , Isotretinoin/adverse effects , Keratolytic Agents/adverse effects , Kidney Transplantation , Acne Vulgaris/complications , Acne Vulgaris/drug therapy , Administration, Oral , Adult , Diabetes Mellitus, Type 1/therapy , Female , Graft Rejection/complications , Graft Rejection/drug therapy , Humans , Immunosuppressive Agents/adverse effectsABSTRACT
Four out of 6 goats from a small British goat herd gave birth to weak or stillborn kids. All were seropositive for Toxoplasma gondii. The parasite was isolated from the tissues of one kid and the milk of one goat. Concurrently, one of the goatowner's sons developed a mononucleosis-like illness with serological evidence of current toxoplasma infection. Investigation of the family showed past infection in the other son, but both parents were seronegative. The source of infection for both boys appeared to be the consumption of unpasteurized goat's milk.
