A medical readiness model of health assessment or well-being in first-increment air combat command medical personnel.

We used a medical readiness model of health assessment based on the Neuman systems model, a comparative-descriptive design, to assess the health or state of well-being of Air Combat Command medical personnel. Group I consisted of 636 personnel actively participating in medical readiness training, and group II consisted of 127 personnel assigned to a medical treatment facility that recently returned from overseas deployment. In group I, statistically significant differences in developmental, psychological, and sociocultural elements of health varied according to military rank, mobility status, or previous overseas deployment experience. The spiritual element of health differed statistically in both groups according to military rank. The uncertainties of mobility status, lack of previous deployment experience, and contrasts in military rank increased stress. Recommendations include realistic mobility training concentrating on essential job performance elements, leadership providing clear and open channels of communication, and dealing effectively with the emotional impact of humanitarian assistance missions.

The effect of epidural analgesia on the second stage of labor.

A retrospective review of 202 randomly selected records of parturient labors examined the relationship between cervical dilation at epidural analgesia administration and length of the second stage of labor. The epidural group received bupivacaine 0.11% or 0.125% with sufentanil 1 to 2 micrograms/mL using a Bard Patient Controlled Anesthesia II pump. Labor management and outcomes were compared with a nonepidural group who chose unmedicated childbirth, intravenous narcotics, or pudendal block. A significant inverse correlation was found between cervical dilation at epidural administration and second-stage length in labors that did not use oxytocin. However, linear regression explained only 13.5% of the variance, leaving 86.5% unexplained. In labors in the epidural group that used oxytocin, cervical dilation at epidural administration was not correlated with second-stage length. The epidural group experienced a significantly longer mean length of the second stage. Labors in the epidural group were 3.5 times more likely to have oxytocin induction or augmentation and 4.5 times more likely to experience instrument-assisted delivery. There were no significant differences in Apgar scores between the two infant groups.