http://cancer-treatment-madurai.com Breast cancer is a type of cancer that starts in the tissues of the breast. Dr.S.G.Balamurugan is one of the best cancer doctor in India, offers low cost breast cancer diagnosis, breast cancer treatments and breast cancer care at Guru Cancer Hospital, Madurai.
http://cancer-treatment-madurai.com Breast cancer is a type of cancer that starts in the tissues of the breast. Dr.S.G.Balamurugan is one of the best cancer doctor in India, offers low cost breast cancer diagnosis, breast cancer treatments and breast cancer care at Guru Cancer Hospital, Madurai.
Report Back from SGO: What's the Latest in Ovarian Cancer?bkling
Dr. Joyce F. Liu, Director of Clinical Research for Gynecologic Oncology at Dana-Farber Cancer Institute, provides a comprehensive update from the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer.
A short history of the Non Commissioned Officer Corps of the United States Army. This presentation was the basis of a professional development program for Soldiers in my platoon with the idea I could hand it to anyone else to present. Many of the slides fail to comply with text limitations and font size established by any reasonable presentation development program, however I knew the groups would be small and the screen large.
Breast cancer affects one in eight women during their lives. Breast cancer kills more women in the United States than any cancer except lung cancer. No one knows why some women get breast cancer, but there are a number of risk factors. Risks that you cannot change include:
Age - the chance of getting breast cancer rises, as a woman gets older
Genes - there are two genes, BRCA1 and BRCA2, which greatly increase the risk. Women who have family members with breast or ovarian cancer may wish to be tested.
Personal factors - beginning periods before age 12 or going through menopause after age 55
Other risks include being overweight, using hormone replacement therapy (also called menopausal hormone therapy), taking birth control pills, drinking alcohol, not having children or having your first child after age 35 or having dense breasts.
Symptoms of breast cancer may include a lump in the breast, a change in size or shape of the breast or discharge from a nipple. Breast self-exam and mammography can help find breast cancer early when it is most treatable. Treatment may consist of radiation, lumpectomy, mastectomy, chemotherapy and hormone therapy.
Men can have breast cancer, too, but the number of cases is small.
Immuno-Oncology: An Evolving Approach to Cancer Care
Review a downloadable slide deck by Thomas F. Gajewski, MD, PhD, covering the most clinically relevant new data reported from Immuno-Oncology: An Evolving Approach to Cancer Care.
Target Audience
This activity is designed to meet the educational needs of oncologists and other healthcare professionals involved in cancer care.
Format: Microsoft PowerPoint (.ppt) | File size: 26.2 MB | Date posted: 6/20/2012
Slide Deck Disclaimer
This slide deck in its original and unaltered format is for educational purposes and is current as of June 2012. All materials contained herein reflect the views of the faculty, and not those of IMER, the CE provider, or the commercial supporter. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. Readers should not rely on this information as a substitute for professional medical advice, diagnosis, or treatment. The use of any information provided is solely at your own risk, and readers should verify the prescribing information and all data before treating patients or employing any therapeutic products described in this educational activity.
Usage Rights
This slide deck is provided for educational purposes and individual slides may be used for personal, non-commercial presentations only if the content and references remain unchanged. No part of this slide deck may be published in print or electronically as a promotional or certified educational activity without prior written permission from IMER. Additional terms may apply. See Terms of Service on IMERonline.com for details.
Current and Novel Immuno-Oncology Drug Evaluation Methods via Humanized Mouse...InsideScientific
Dr. Bin Xie discusses the current immuno-oncology drug development landscape, different humanized mouse models available for drug testing, and the investigation of potential mechanisms via imaging mass cytometry.
Since the first immune checkpoint blocker ipilimumab was approved by the US FDA in 2011, more drug companies have sought to develop their own immune therapy drugs. Humanized peripheral blood mononuclear cell (PBMC) reconstitution in immune deficient mice is becoming a valuable model for evaluating therapeutic antibodies, especially bispecific antibodies (BsAbs), which can mediate immune cells as well as target a tumor antigen.
However, this model has several drawbacks, including a limited dosing window due to graft-versus-host-disease and insufficient natural immune cell infiltration. This has hindered wide application of the model in the development of multiple immune checkpoint inhibitors or immune agonists.
To overcome these issues, LIDE has developed a unique human PBMC/cancer cell co-transfer model which can generate three-dimensional huPBMC-infiltrated tumor tissue for immunotherapy. This model has successfully been used to evaluate the biological function of several signaling proteins and biomarkers in multiple cancers, such as melanoma, breast cancer, and lung cancer.
In this webinar, Dr. Bin Xie discusses the current immuno-oncology drug development landscape, different humanized models available for drug testing, evaluates real-world case studies, and describes the investigation of potential mechanisms by imaging mass cytometry.
Key Topics Include:
- Introduction to immuno-oncology drug development and the importance of using humanized mouse models to address scientific questions
- Evaluation of current IO platforms and new methods from LIDE, including analysis of several case studies
- Understanding the spatiotemporal interaction between tissue-infiltrating immune cells and cancer cells via imaging mass cytometry
This is the command brief for the Pacific USAF. It highlights the perspective of the leadership of the command and the way forward for it in the period ahead.
Interested in setting up a U.S. Air Force Explorers Program in your area? We are a proven Young Adults Air Force or Military Officers Preparatory Program for ages 14-21.
Report Back from SGO: What's the Latest in Ovarian Cancer?bkling
Dr. Joyce F. Liu, Director of Clinical Research for Gynecologic Oncology at Dana-Farber Cancer Institute, provides a comprehensive update from the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer.
A short history of the Non Commissioned Officer Corps of the United States Army. This presentation was the basis of a professional development program for Soldiers in my platoon with the idea I could hand it to anyone else to present. Many of the slides fail to comply with text limitations and font size established by any reasonable presentation development program, however I knew the groups would be small and the screen large.
Breast cancer affects one in eight women during their lives. Breast cancer kills more women in the United States than any cancer except lung cancer. No one knows why some women get breast cancer, but there are a number of risk factors. Risks that you cannot change include:
Age - the chance of getting breast cancer rises, as a woman gets older
Genes - there are two genes, BRCA1 and BRCA2, which greatly increase the risk. Women who have family members with breast or ovarian cancer may wish to be tested.
Personal factors - beginning periods before age 12 or going through menopause after age 55
Other risks include being overweight, using hormone replacement therapy (also called menopausal hormone therapy), taking birth control pills, drinking alcohol, not having children or having your first child after age 35 or having dense breasts.
Symptoms of breast cancer may include a lump in the breast, a change in size or shape of the breast or discharge from a nipple. Breast self-exam and mammography can help find breast cancer early when it is most treatable. Treatment may consist of radiation, lumpectomy, mastectomy, chemotherapy and hormone therapy.
Men can have breast cancer, too, but the number of cases is small.
Immuno-Oncology: An Evolving Approach to Cancer Care
Review a downloadable slide deck by Thomas F. Gajewski, MD, PhD, covering the most clinically relevant new data reported from Immuno-Oncology: An Evolving Approach to Cancer Care.
Target Audience
This activity is designed to meet the educational needs of oncologists and other healthcare professionals involved in cancer care.
Format: Microsoft PowerPoint (.ppt) | File size: 26.2 MB | Date posted: 6/20/2012
Slide Deck Disclaimer
This slide deck in its original and unaltered format is for educational purposes and is current as of June 2012. All materials contained herein reflect the views of the faculty, and not those of IMER, the CE provider, or the commercial supporter. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. Readers should not rely on this information as a substitute for professional medical advice, diagnosis, or treatment. The use of any information provided is solely at your own risk, and readers should verify the prescribing information and all data before treating patients or employing any therapeutic products described in this educational activity.
Usage Rights
This slide deck is provided for educational purposes and individual slides may be used for personal, non-commercial presentations only if the content and references remain unchanged. No part of this slide deck may be published in print or electronically as a promotional or certified educational activity without prior written permission from IMER. Additional terms may apply. See Terms of Service on IMERonline.com for details.
Current and Novel Immuno-Oncology Drug Evaluation Methods via Humanized Mouse...InsideScientific
Dr. Bin Xie discusses the current immuno-oncology drug development landscape, different humanized mouse models available for drug testing, and the investigation of potential mechanisms via imaging mass cytometry.
Since the first immune checkpoint blocker ipilimumab was approved by the US FDA in 2011, more drug companies have sought to develop their own immune therapy drugs. Humanized peripheral blood mononuclear cell (PBMC) reconstitution in immune deficient mice is becoming a valuable model for evaluating therapeutic antibodies, especially bispecific antibodies (BsAbs), which can mediate immune cells as well as target a tumor antigen.
However, this model has several drawbacks, including a limited dosing window due to graft-versus-host-disease and insufficient natural immune cell infiltration. This has hindered wide application of the model in the development of multiple immune checkpoint inhibitors or immune agonists.
To overcome these issues, LIDE has developed a unique human PBMC/cancer cell co-transfer model which can generate three-dimensional huPBMC-infiltrated tumor tissue for immunotherapy. This model has successfully been used to evaluate the biological function of several signaling proteins and biomarkers in multiple cancers, such as melanoma, breast cancer, and lung cancer.
In this webinar, Dr. Bin Xie discusses the current immuno-oncology drug development landscape, different humanized models available for drug testing, evaluates real-world case studies, and describes the investigation of potential mechanisms by imaging mass cytometry.
Key Topics Include:
- Introduction to immuno-oncology drug development and the importance of using humanized mouse models to address scientific questions
- Evaluation of current IO platforms and new methods from LIDE, including analysis of several case studies
- Understanding the spatiotemporal interaction between tissue-infiltrating immune cells and cancer cells via imaging mass cytometry
This is the command brief for the Pacific USAF. It highlights the perspective of the leadership of the command and the way forward for it in the period ahead.
Interested in setting up a U.S. Air Force Explorers Program in your area? We are a proven Young Adults Air Force or Military Officers Preparatory Program for ages 14-21.
The 36th CRG and Philippine Relief EffortICSA, LLC
The USAF has developed a unique force package called the crisis response group, which is designed to fly to the challenge of building infrastructure to allow for the throughput of airpower to follow. This is done for both Humanitarian Assistance/Disaster Relief missions and to support military operatons.
In the recent Philippine relief effort, the USMC and the 36th CRG worked closely together at the Tacloban Air Base to put in place an infrastructure to support broader relief efforts, and then within two weeks left to allow the civil authorities to take full charge of the efforts.
In an interview we did with Col. James from AFPAC, the Col. highlighted the central role of the CRG in the USAF role in the Philippine relief effort.
“They deployed to Tacloban and worked to open up the airport to become capable of flowing in support capabilities. They had to set up air traffic control support; they had to work to extend the runway from 4500 feet to more than 8000, they worked with the Filipinos to make sure the kind of safety equipment we needed to maintain sortie rates was available to ensure safety and security. They also focused on getting in the machinery which can facilitate offloading of supplies.
Getting a forklift into play was important as well.”
http://www.sldinfo.com/shaping-an-infrastructure-for-support-the-usaf-flies-to-the-challenge-in-the-philippines/
In these slides, the basic structure of the 36th CRG is outlined along with some of its recent activities.
This briefing from the Air Force Medical Service is directly applicable to civilian and military communities who need to be prepared for managing medical trauma scenarios. This presentation focuses on integrated trauma management systems.
Space Situational Awareness Forum
Following another very successful conference in London in November 2014, Space Situational Awareness 2015 took place in Hyattsville, Maryland in May 2015, with over 60 SSA experts from all over the globe coming together to discuss the most pressing SSA challenges.
With increasing dependence on space-based services, the ability to protect space infrastructure has become essential to our society. Any shutdown of even a part of space infrastructures could have significant consequences for the well-functioning of economic activities and our citizens’ safety, and would impair the provision of emergency services.
However, space infrastructures are increasingly threatened by the risk of collision between spacecraft and more importantly, between spacecraft and space debris. As a matter of fact, space debris has become the most serious threat to the sustainability of certain space activities.
In order to mitigate the risk of collision it is necessary to identify and monitor satellites and space debris, catalogue their positions, and track their movements (trajectory) when a potential risk of collision has been identified, so that satellite operators can be alerted to move their satellites. This activity is known as space surveillance and tracking (SST), and is today mostly based on ground-based sensors such as telescopes and radars.
With a focus on solving the political issues but not ignoring the technical, Space Situational Awareness 2015 the leading gathering of dedicated SSA experts from the USA, Europe and beyond, to discuss and debate the business, political and technical challenges that lie ahead.
Take a look at our previous Space Situation Awareness event…
Who should attend Space Situational Awareness?
Space Situational Awareness 2015 is a community of experts from Government, Space Agencies, Satellite/Spacecraft Operators, Space Lawyers, Space Insurance providers and Defense who are looking to understand and predict the physical location of natural and manmade objects in orbit around the Earth, with the objective of avoiding collisions.
How can you get involved in Space Situational Awareness?
If you feel that you could add to the debate and discussion at Space Situational Awareness, we’d be delighted to hear from you. Please drop us a line on +44(0)7769157787 or email me at adam.plom@coriniumintelligence.com.
The Navy Bureau of Medicine and Surgery is the headquarters command for Navy Medicine. Under the leadership of the Navy Surgeon General, Vice Adm. Adam M. Robinson, Navy Medicine provides high quality, economical health care to beneficiaries in wartime and in peacetime. Highly trained Navy Medicine personnel deploy with Sailors and Marines worldwide - providing critical mission support aboard ship, in the air, and on the battlefield. At the same time, Navy Medicine's military and civilian health care professionals are providing care for uniformed services' family members and retirees at military treatment facilities around the globe. Every day, no matter what the environment, Navy Medicine is ready to care for those in need...anytime, anywhere.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Introduction to the Air Force Medical Service (AFMS)
1. Engagement Guidance
Theme: Introduction to the Air Force Medical Service (AFMS 101)
Purpose: Provide an approved and standardized slide deck to communicate
the AFMS organization, infrastructure, strategies, and mission capabilities
Design: Organized around the AF/SG’s key strategies, which highlights our
three primary strategies to accomplish our integrated mission areas by
addressing strategy, common practice, and culture
Format:
Unclassified
Envisioned Uses:
Serve as a template for executive officers, staff officers, commanders and
chiefs to use when sharing the AFMS message with key audiences
Intent is for slides to be tailored/customized to the particular audience or
venue. While some slides convey duplicate/similar information, this is
intentional to provide multiple options to create your unique briefing
Intended audience include:
Internal and external customers
Stakeholders and employees
Integrity - Service - Excellence 1
2. Headquarters U.S. Air Force
Integrity - Service - Excellence
Introduction to the
Air Force Medical Service
(AFMS)
Rank First Lastname
Position
CAG-v6 (3 Jan 2012)
3. Air Force Medical Service
MISSION: Seamless Health Service Support to
USAF and Combatant Commanders
UPdateTotal Force Personnel Deployed (MOC)
32,487 Active Duty >92K patients moved out of
6,818 Civilians CENTCOM since 10 Oct 01
3,750 Contractors 1,362 medics deployed to 30
15,469 AF Reserve/Guard countries in 49 locations
Update FY11 Homestation (AFMOA/SGHC)
Budget/Infrastructure ~2.5M eligible beneficiaries (AF)
$6.3B (all programs) ~6.5M visits/40K admissions/yr
75 Medical Facilities Investing in our Future
63 CONUS Education & Training
12 OCONUS Research & Development
Air Force Medicine…Delivering “Trusted Care Anywhere!”
Integrity - Service - Excellence 3
4. We’re All In
AF Mission
The mission of the
United States Air Force is
to fly, fight and win…in air,
space and cyberspace
AFMS Mission AFMS Vision
Seamless Health Service World-Class Healthcare
Support to USAF and for Our Beneficiaries
Combatant Commanders Anywhere, Anytime
Through Global Vigilance, Reach, and Power!
Integrity - Service - Excellence
5. Alignment of Priorities
Air Force AFMS
Continue to Strengthen the Deliver Best Medical Reliability
Nuclear Enterprise for the Nuclear Mission
Partner with Joint and Coalition Enhance Full Spectrum Medical
Team to Win Today’s Fight Capabilities to Support
Winning Today’s Fight
Develop and Care for Airmen Implement Patient-Centered Care
and their Families to Sustain Healthy and
Resilient Airmen & Families
Modernize our Air, Space, & Advance Medical Capabilities
Cyber Inventories, through Research &
Organizations & Training Infrastructure Recapitalization
Recapture Acquisition Build Interoperability & Medical
Excellence Acquisition Expertise
Integrity - Service - Excellence 5
6. Joint, Coalition, & Interagency Team
Provide Opportunity for Innovation
Mis-Information
JOINT Cooperation
COALITION
Inter-
INTER-
AGENCY Operability
Collaboration
SYNERGY
Integrity - Service - Excellence
7. Operational
Command Structure
Command
& Control
Manpower
Secretary of
the Air Force
Chief of Staff of
the Air Force
Major Command
NAF
Commanders
Wing Commanders
Medical
Treatment Facilities
AIR FORCE MAJOR COMMANDS (MAJCOMs)
Command & Control With Seamless Total Force
Integration Across MAJCOMs
Integrity - Service - Excellence 7
9. Scope Of Operations
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Curacaco Monrovia Jolo
Baghdad Mosul
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Balad Camp Victory
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42,000 AFMS Personnel
63 Facilities in 34 States, DC, And Guam
12 Medical Treatment Facilities In 7 Countries
1,362 AF Medics Deployed In 30 Countries In 49 Different Locations
Integrity - Service - Excellence
10. Medical Treatment Facilities
(MTFs)
63 MTFs in 34 states, the District of Columbia, and Guam
McChord
AFB Fairchild
AFB Malmstrom Minot AFB
AFB Grand Forks AFB
Mountain Home AFB Hanscom AFB
Ellsworth AFB
Beale AFB
FE Warren AFB McGuire AFB
Travis AFB Hill AFB
Offutt AFB Dover AFB
Buckley AFB Wright Patterson
AFB Andrews AFB
USAF Academy Bolling AFB
Whiteman AFB
Nellis AFB Peterson AFB Scott AFB
Vandenberg AFB McConnell AFB Langley AFB
Edwards AFB Seymour Johnson AFB
Kirtland AFB Vance AFB
Los Angeles AFB Pope AFB
Luke AFB Tinker AFB
Cannon AFB Little Rock AFB Shaw AFB
Altus AFB
Davis-Monthan AFB Sheppard AFB Columbus AFB Charleston AFB
Holloman AFB Dyess AFB Robins AFB
Barksdale AFB Maxwell AFB
Goodfellow AFB
Eglin AFB Moody AFB
Eielson AFB Keesler AFB
Tyndall AFB
Laughlin AFB Hurlburt Patrick AFB
Elmendorf AFB Hickam AFB Randolph AFB Field AFB
Lackland AFB MacDill AFB
Integrity - Service - Excellence
11. Forward Operating Locations &
Overseas Military Treatment Facilities
Ramstein
Lakenheath Landstuhl
RAF Croughton Pirmesens
Mildenhall Spangdahlem
Asbgabat Kadena
Lajes Yokota
Pristina Manas Misawa
Aviano Incirlik Bagram
Kandahar Osan
Kuwait Kabul Kunsan
Qatar Khost
Honduras Eskan Village Andersen
Curacaco Djibouti
Monrovia Jolo
Manta City Bogota
Baghdad Mosul
Peru Balad Camp Victory
Kirkuk Basrah-Magal
Tallil/Ali Al Ramadi
Al Taji
AFMS Operates 12 Military Treatment Facilities In 7 Countries (blue)
1,362 AF Medics Deployed In 30 Countries in 49 Different Locations
>92K Patients Moved From CENTCOM Since 10 Oct 2001
Integrity - Service - Excellence
12. FY11 Budget
Dollars & MilCon AFMS FY11 Budget Execution ($ Billion)*
DHP
Office of the Secretary
of Defense
(OSD)
Operations &
Operations &
Maintenance, MILCON, $0.
OASD(HA) $3.056
Management 165
Health Affairs
$2.554B
Air Force AFMOA
Surgeon General Provides direct reach- War Reserve
(AF/SG) back capability for Materiel, $0.0
clinical processes,
resource execution, and Military 67
Major Command
administrative Personnel, $ Procurement,
management supporting
Surgeons medical activities
3.002 $0.056
(MAJCOM/SG) PAD 07.13, Jan 2008
RDT&E, $0.0
40
Medical Treatment Facility
Aligned with Local Mission(s)
* End of Year Execution as of 30 Sep 2011
Integrity - Service - Excellence 12
13. Air Force Medical Service
FY12 Personnel Authorizations
Active Guard Reserve
Facility Commanders 77 89 46
Medical Corps (MC) 3,776 507 547
Dental Corps (DC) 960 89 170
Nurse Corps (NC) 3,447 870 1,583
Medical Service Corps (MSC) 1,040 426 425
Biomedical Sciences Corps (BSC) 2,411 422 404
Officers (subtotal) 11,711 2,314 3,129
Enlisted Corps (subtotal) 19,714 3,673 6,959
Civilian – Defense Health Program (DHP) 6,818 - -
Contractors 3,750 - -
Line Officers - DHP Funded 279 - -
Line Enlisted - DHP Funded 1,885 - -
TOTAL 42,457 6,229 9,007
*As of 1 Dec 11 Integrity - Service - Excellence
14. Personnel by
Component & Corps
Manpower Active Duty Personnel
Guard Reserve
Line- 11% 16% Nurse
DHP Medical
Corps, 3,447,
1% Corps, 3,776,
11%
11%
Contract
6% Biomedical
Sciences
Enlisted Corps, 2,411,
Officers Corps 8%
19% 19,714
Civilian-
64%
DHP Medical
12% Service
Enlisted Corps, 1040,
35% Dental 3%
Corps
960
Defense Health Program (DHP) 3%
Integrity - Service - Excellence 14
15. Office of the Surgeon General
Leadership Team
Lt Gen Green
Maj Gen Travis CMSgt Cole
MAJCOM
SG Staff
Surgeon General
Deputy Surgeon Chief Medical
General Enlisted Force
(SG1) (SG3) (SG8) Strategic (AFMSA)* (AFMOA)**
Medical Force Health Care Medical Plans, AF Medical AF Medical
Development Operations Programs & Budget Support Agency Operations Agency
Maj Gen Col Brig Gen Brig Gen Brig Gen
Siniscalchi Collier Miller Carroll Ediger
*AFMSA includes Acquisitions, IM/IT, & Modernization Divisions **AFMOA is the operational execution arm working w/MTFs
Integrity - Service - Excellence 15
16. Our Framework For The Success…
Strategies
Overlapping
Mission Areas Transform Deployable Capability
Rapid Response to Any Worldwide Contingency
Fit
Force Build Patient-Centered Care
Continuity & Prevention to Optimize Health
Invest in Education, Training & Research
Sustain Our Future Capabilities
Strategy Common Practice Culture
Integrity - Service - Excellence
17. Our People are the Key to Success
…at Home and Deployed
HOME AF Medics Sustain GLOBAL
STATION OPERATIONS
Full Spectrum Operations
Readiness is Job # 1
We exist to deploy clinically current medics and
keep AF personnel deployable for global operations
Delivering Home Station Healthcare Underpins Readiness
Peacetime care sustains clinical skills and continuity to do Job #1
Integrity - Service - Excellence 17
19. Aeromedical Evacuation:
The Lifeline Home
Scott
Ramstein
Andrews
EUCOM
Travis
Wilford Hall
Kadena CENTCOM
PACOM Hickam
C-17 Empty Air Ambulance Airborne ICU
Transport Aircraft Cargo Hold Configuration Capability
Continuing or increasing levels of care…
from point of injury to resuscitation to definitive care!
Integrity - Service - Excellence 19
20. Aeromedical Evacuation:
Total Force Effort!
Critical component of AF Global Mobility
Joint, interoperable, and interdependent ANG: 10 AE Squadrons
Modular A/E units / CCATT
Modular MASFs and CASFs
Aircraft independent Percentage
Engaged in
AD: 4 AE Squadrons Today's Fight
AFRC: 18 AE Squadrons
Over 92K Wounded Warriors Transported Home To The Best Care!
Integrity - Service - Excellence 20
21. Continuous Advances in
Casualty Care
WWII
30% Learning From Coalition Partners, We
Leveraged Trauma Registry Data To
Build Innovative Solutions
> 80 Patients Moved as of Nov 11
Combat Mortality Rate
Korea
25% Tactical Critical Care Evacuation Team (TCCET)
Vietnam
24%
INTERFLY AGREEMENT
Applying Lessons Learned From the C-17
*AeroSpace Interoperability Council
Persian
Gulf
24% Creating a “patient staging” continuum
Modular Aeromedical Staging Capability (MASC)
OIF/OEF New CASF Activated at SAMMC
<10%
Re-engineering Global Patient Staging
Expeditionary IOperations eEvolvingxtoe Save eLives Globally
ntegrity - S rvice - E c llenc
22. In Pursuit of Lighter &
Leaner Medical Response
Humanitarian Assistance Health Response Team (HRT)
Rapid Response Team (HARRT)
Airlift Deployment Requirements:
Earthquakes
Indonesia < 24 HRS +
C-17’s
Rapid Response Medical Capabilities:
Emergency, Resuscitative, & Surgical Care
Earthquakes
Chile T+0 hrs Operational
Results:
Immediate Care
< 20 min
ER
Earthquakes < 2 hrs
Haiti OR & ICU
< 3 hrs
T+3 hrs
Pursuing Perfection in Medical Response Capability
Integrity - Service - Excellence
23. Building Partnerships and
Partnership Capacity
AFRC
ANG PACOM
AFRICOM SOUTHCOM
CENTCOM EUCOM
Integrity - Service - Excellence 23
25. National Health Reform and Military
Health System Quadruple Aim
READY (Readiness): Enabling a medically
ready force and a ready medical force;
transform deployed capabilities
BETTER CARE (Experience of Care): patient
centered care; providing patients with care
they want, when they want it, and where it is
most convenient; safe care
BETTER HEALTH (Population Health): Improving
quality and health outcomes for a defined
population; preventive and precision care
BEST VALUE (Per Capita Cost): managing the cost of
providing care; direct and indirect costs or savings;
value in terms of service, quality, safety; capitalizing
on technology integration or the right reasons
AFMS Imperatives Align With Quadruple Aim
Integrity - Service - Excellence
26. Delivering World Class Care:
A “Day” in the Life of the AFMS
Maintaining Currency Through Homestation Care
17,808 Outpatient Visits 109 Inpatient Admissions
50 Surgery Procedures 41,408 Prescriptions Filled
21 Babies Delivered 20,477 Lab Procedures
6,365 Dental Encounters 5,374 Rad Procedures
Delivering the Benefit and Providing Compassionate Care
Integrity - Service - Excellence 26
27. Medical Home Performance
Index (MHPI)
Objective: recognize and
reward strong performance
and significant improvement
in AF Medical Home
Focus outcomes:
Satisfied patients
High continuity of care
Consistent application of
appropriate preventive
measures
Coordinated, effective
management of disease
AF Surgeon General’s target: “Reward Outcomes”
Integrity - Service - Excellence 27
28. MHPI BLUF
IAW AF/SG Direction, MHPI is designed to use financial and non-
financial incentives linked to Patient-centered performance
improvements
Financial incentives are focused on
Improving Patient Satisfaction
Increasing Continuity
Improving HEDIS
Decreasing ED/UCC Utilization
Non-Financial incentives will recognize superior performance
and innovative care practices and encourage teamwork
Supports Medical Home Panel Mission and PCMH imperatives to
transform Primary Care capabilities through the provision of
patient-centered, effective and appropriate medical care
Integrity - Service - Excellence 28
30. AFMS Strategies – Medical Home
Family Health Clinics Implemented – 69
DATE MAJCOM MTF Purpose
Enrolled FH Population – 661,461
29 Nov AETC Altus PCMH SC Visit
Pediatric Clinics Implemented – 35 30 Nov AFMC Tinker PCMH SC Visit
Seymour
Enrolled Population – 112,461 6 Dec ACC
Johnson
PCMH SC Visit
6 Dec AETC Vance PCMH visit #2
Total Population Enrolled –773,887 PCMH GO Visit
6 Dec USAFE Lackenheath
82% of AFMS Enrollment 8 Dec AMC MacDill PCMH SC Visit
94% FH Enrollment 7 Dec USAFE
RAF Croughton
PCMH GO Visit
48% Pediatric Enrollment 8 Dec USAFE RAF Upwood PCMH GO Visit
12 Dec USAFE Ramstein PCMH GO Visit
13 Dec USAFE Spangdahlem PCMH GO Visit
14 Dec USAFE Geilenkirchen PCMH GO Visit
15 Dec AFGSC Whiteman PCMH SC Visit
Effective 1 Dec11
1/5/2012 Integrity - Service - Excellence 30
Data from DSS enrollment numbers Sep 11
31. Incentive Distribution
Timeline
Example: Incentive to be distributed quarterly based on previous
quarter’s performance (3 month lag)
Q4 Q1 Q2 Q3
Payout Payout Payout Payout
Q1 Data Compiled Q2 Data Compiled Q3 Data Compiled Q4 Data Compiled
Q1 Q2 Q3 Q4 Q1
Fiscal Year 1 Fiscal Year 2
Integrity - Service - Excellence 31
32. Measures
Measure Weight Goal Definitions
Roll-up (Average ) of SDA questions 1,3,4,5, and 6.
Satisfaction Measure: Patients answering either a 4 or 5 on a 5-point
10% 95%
w/visit Likert scale / Total responses.
Average of FHT “Team” continuity from patient
Continuity perspective. Number of empanelled patient visits with
40% 90% team / total number of empanelled patient PC visits
(Team)
(excludes T-Con and non-count visits)
Average of the HEDIS composite from FHI Push Report
(Diabetes LDL Screening, Diabetes LDL Control,
HEDIS Diabetes HbA1C Screening, Diabetes HbA1C Control,
30% 4 Asthma Meds, Colorectal Screening, Cervical Cancer
Average
Screening, Breast Cancer Screening) (max 5 points)
(BGA* pts only)
ED visits with Emergency E&M and BIA MEPRS for DC
or Place of Service = 23 for network. UC visit without
ED/UC Emergency E&M and BHI MEPRS for DC or Place of
20% <3/100/mo Service = 20 for network.
rate/100
Integrity - Service - Excellence 32
33. Maximum Possible
Quarterly Earnings
Measure Weight MTF A MTF B
Improvement Sustainment Improvement Sustainment
Potential Quarterly
100%
Payout $9,400 $19,100 $47,200 $95,800
Satisfaction w/visit 10% $940 $1,910 $4,720 $9,580
40% $3,760 $7,640 $18,880 $38,320
Continuity (Team)
30% $2,820 $5,730 $14,160 $28,740
HEDIS Average
ED/UC rate/100 20% $1,840 $3,820 $9,440 $19,160
Integrity - Service - Excellence 33
34. Innovation & Insight to
Recapture Care
Delivering Patient-Centered Care To Our
Beneficiaries
Creating Currency Opportunities To Support Travis AFB, CA Langley AFB, VA
Readiness
Allowing Medics To Practice Full Scope Of
Care
Tackling Per Capita Cost Through Targeted Nellis AFB, NV Elmendorf AFB, AK
Investments
Eglin AFB, FL Keesler AFB, MS
WPAFB, OH
Specialty Hospitals Focused on Currency and Recapture
Integrity - Service - Excellence 34
35. Establishing Partnerships to
Enhance Capabilities
Physician/Dentist Education (GME/DME)
Stand alone programs
Masters with civilian universities
Integrated/affiliated with Federal partners
Nurse Education (Transition Program)
New sites include: Cincinnati, OH & Scottsdale, AZ
Nurse Enlisted Commissioning Program (NECP)
USAF Dental Hygiene Program
Research
Partnerships are Vital Tools to Build & Sustain Medical Services
Integrity - Service - Excellence 35
36. Operating Room Throughput and
Modernization Road Map
Tomorrow
Metrics Standardized
Parameters Of Throughput Now Uniform
Standard Scheduling Software & Method Defined
9 Platforms Evaluated
Today
Improved Throughput = Improved Currency
Seizing The Future Today Through Modernization
Integrity - Service - Excellence 36
37. E-Health Initiatives
MEDICAL AND MODELING AND
SIMULATION
Integrity - Service - Excellence 37
38. eHIP Background
eHealth Initiatives Project
(eHIP)
10 initiatives in various
stages of maturity using
electronic media
Three overarching goals:
Activate patients to
achieve their health needs
and goals
Optimize PCMH operations
Recapture specialty care
eHIP Co-Champions:
AF/SG and AFMOA/CC
Integrity - Service - Excellence 38
39. Leveraging Medical Informatics
DATA INFORMATION KNOWLEDGE WISDOM CHANGE
Better Care
TMDS Clinical
Through
Practice
Evidence Based
Guidelines
DEERS Practice
CarePoint Medication Better Health
PDTS Health
Alerts Enhanced Patient
Services Registries
Data Safety
$ / M2 Warehouse
User Home Best Value
(HSDW)
Interfaces Sensors Healthy Behavior
DMHRS
i Better Care
Expedited
EHR Test Results Improved Patient
Experience
Decision Support is No Longer Just for Our Providers
Integrity - Service - Excellence
40. Transforming Data Into
Knowledge
Ready Better Health Better Care
Patients receiving Diabetic patient
massive infusions of > educated on
10 pints experienced “remote
mortality of 33% monitoring”
glucometer
Clinical Study
Readings
Practice registry MTF calls
automatically
Guideline to identify patient to
sent to
developed trends discuss
healthcare
management
team
Conclude infusing
whole blood
Uncontrolled sugar
reduced mortality
levels Identified
to less than 20%
Using Informatics to Accelerate Change in Practice Patterns & Behavior
Integrity - Service - Excellence 40
42. Building Our Capabilities
Goals
Increase Capacity and
Department Currency of Staffs
of
Defense Build “Win-Win”
Partnerships in Training,
Research and Development
Trained Recapture Care
CIVILIAN Current
ACADEMIA
HOSPITALS Deployable Effects
Improves Quality of Care
More Patient Choices
Retains Providers
VETERANS
AFFAIRS
Reduces Cost
Saves Lives
Coordinated Care to Deliver Expertise and Value
Integrity - Service - Excellence 42
43. Enduring
Academic Partnerships
Physician/Dentist Education (GME/DME)
Stand alone and integrated programs
Masters with civilian universities
Integrated/affiliated with Federal partners
Advanced Education General Dentistry- 91 slots/yr
Dental Specialty certificate/Masters program opportunities
Nurse Education (Transition Program)
188 trained students in FY11
New sites include: Ohio and Arizona
Nurse Enlisted Commissioning Program (NECP)
45 per year with school of their choice
Research USAF Dental Hygiene Program
10 scholarships per year
Diabetes
Trident Technical College (SC)
Telepathology
St. Petersburg College (FL)
Teleradiology
Education & Research – Absolutely Critical to
Building & Sustaining the AFMS!
Integrity - Service - Excellence 43
44. A
do
le
s
A ce
n
er
os t M
60%
65%
70%
75%
80%
85%
90%
95%
100%
pa e
A ce dic
l le i
rg Me ne
y d
Im i c
m i ne
un
A o lo
A
ne g
ne sth y
st es
he ia
si
a
C
a CC
AF RATE
C rdi
yt ol
op og
NAT'L RATE
at y
D h
ia De ol o
gn rm g
y
E ost ato
m ic lo
er R
ge a gy
nc dio
y lo
g
E Me y
nd d
o ic
F cri i ne
am n
o
i ly lo
G M gy
as e
tr di
G oi n cin
en te e
er st
a in
H l S al
em u
In e rg e
fe O ry
ct n
io co
us lo
In g
100% pass rate
te Di s y
rn ea
al s
M e
18 specialties with
N ed
eo ic
na i ne
t
N olo
ep g
hr y
o
N Ne l og
uc u y
le ro
ar lo
M gy
ed
ic
in
O O e
ph b
th G
al yn
m
Board Pass Rates: AF vs. National Average
O ol
rth og
Integrity - Service - Excellence
O o y
to pe
la
ry dic
ng s
Combined Aeromedical-Family Medicine initiative
ol
P og
at y
ho
P log
ed y
ia
P tric
sy s
P ch
ul
m ia tr
o y
R na
he ry
Restoration of GME programs at Keesler AFB after Katrina
um C
at C
ol
og
U y
ro
lo
gy
BRAC integration & maturation of civilian-military partnerships
(GME) Success
Graduate Medical Education
Expansion of GME sites- Nellis, UC-Davis, Portsmouth, Ft Belvoir
44
45. Health Professions Scholarship Program (HPSP)
and Financial Assistance Program (FAP) Fill Rates
AF Census by Year
100% 1,666
1,599
80%
1,298
60%
HPSP/FAP
40%
20%
0%
2006 2007 2008 2009 2010 2011
Following the increased resourcing of student-based accession sources across
the FYDP, the AFMS is approaching 100% in HPSP and FAP annual census.
Integrity - Service - Excellence
46. Civilian Trauma
Collaboration
BALTIMORE CINCINNATI ST LOUIS UC- Davis
Sustaining Trauma
Center for Sustainment of Trauma And
And Resuscitation
Readiness Skills
Skills-Program
(C-STARS) (STARS-P)
Trauma & Surgical Skills (Baltimore) Travis/UC Davis MC
Advanced CCATT (Cincinnati) W-P/Miami Valley
Trauma Skills (St. Louis) Luke/Scottsdale HC &
Maricopa County
Nellis/Univ. MC
Keeping Medics Ready Through Civilian Partnerships & Programs
Integrity - Service - Excellence 46
47. 711 HPW & USAFSAM
Wright-Patterson AFB, OH
Research
Modeling & Simulation of UAS Operators
Stress & Fatigue Survey of RPA Community
JSF/F-35 Life Support System Testing & Development
Education & Training
Attended 6-wk European Air Gp Adv Aerospace Med Course
Defense Institute of Medical Operations (DIMO)
To date, 7000 foreign medics trained from 124 countries
Adv Aerospace Medicine for International Med Officers
(AAMIMO)
110 countries have participated…37 students became SG equivalents
Exchange Officer Programs
Fostering Interoperability, Integration, & Ultimately…SYNERGY!
Integrity - Service - Excellence 47
48. Modernization
Enroute Expeditionary Force Health Health Human Operational
Care Medicine Protection Informatics Performance Medicine
Supports Full Spectrum of Medical Care
Mission Product Lines
Provide policy, guidance, Medical Requirements
resources, and oversight to Strategic Medical Acquisitions
Medical Innovations
integrate technology and
Clinical Research Projects
deliver enhanced solutions to Medical Technology Development
the AFMS, our warfighters, and Medical Technology Testing
the beneficiary community Medical IM/IT Services, Operations
Delivering The Future Today…One Project At A Time!
Integrity - Service - Excellence 48
49. Shaping the Future of Military Healthcare
Synergy- Patient-Centered
Joint & Coalition Care
Organizational Precision
Agility Healthcare
Technology
Integration
Working Together, Achieving Success Through A Common Vision
Integrity - Service - Excellence
50. Mission Ready Medics
Serving Proudly
Doctrinally Aligned
Healthy, Fit Force
Resilient Families
Operationally Focused Medics
Joint, Interoperable, Interdependent…Mission Effective!
Results
The Trust of Our All Volunteer Force
The Trust of Our Nation to Care for Its Sons & Daughters
Integrity - Service - Excellence
Integrated and Synergistic: The Joint, Coalition, & Interagency TeamThe Air Force is a part of a much bigger team doing the nation’s businessWe Organize, Train and Equip our Airmen to support joint, interagency and coalition partnersIn doing so, we must maintain interoperability as well as become an interdependent forceAll these organizations are our allies in this war on terror…we must seek to partner with them at every opportunity Jointness: Jointness refers to the mutual support and doctrinal understanding that must exist within all military services. Jointness is a state of mind as well as a statement of fact. It predisposes those who share its goals to emphasize the unique capabilities of the Nation's military services in planning and operations that are by design, from beginning to end, synergistic, cooperative, and interdependent. We are an integral part of a Joint team; jointness is really about synergy of the parts” Joint Connotes activities, operations, organizations, etc., in which elements of two or more Military Departments participate. To improve, we must build partnerships and interoperability to advance cradle to grave health deliveryThe best form of C2: collaboration and coordination As an AFMS we can expect to participate in more joint operations The AFMS has proven to be a vital partner within the USAF and with Joint Forces. Our vision confirms…and our record of performance demonstrates…we can and will provide quality healthcare and health service support anywhere in the world at anytime to support all of our military family, be they active duty, retired, or a family member. Let’s talk about our vision of the future and highlights of current operations.
Unified Combatant Commands (UCC): HQsRegional Responsibilities:United States Africa Command (USAFRICOM): Kelley Barracks, Stuttgart-Mohringen, GEUnited States Central Command (USCENTCOM): MacDill AFB, Tampa, FLUnited States European Command (USEUCOM): Patch Barracks, Stuttgart-Vaihingen, GEUnited States Pacific Command (USPACOM): Camp H. M. Smith, Honolulu, HIUnited States Northern Command (USNORTHCOM): Peterson AFB, Colorado Springs, COUnited States Southern Command (USSOUTHCOM): Doral(Miami), FLFunctional Responsibilities:United States Joint Forces Command (USJFCOM): Norfolk, VAUnited States Special Operations Command (USSOCOM): MacDill AFB, Tampa, FLUnited States Strategic Command (USSTRATCOM): Offutt AFB, Omaha, NEUnited States Transportation Command (USTRANSCOM): Scott AFB, ILOur mission is to provide seamless health services support to AF and Combatant Commanders, leveraging our joint capabilities to provide “Trusted Care Anywhere!”
AF Medical Service operates a total of 75 medical facilities throughout the world. We have 63 military treatment facilities (MTFs) in 34 states (including AK, HI) , the District of Columbia, and the US Territory of Guam.
Although our Command and Control system is through the Line (from the Wing Commander to the MAJCOM/CC to CSAF) , our budget dollars and MILCON funding comes from OASD(HA) Health Affairs. Our FY11 operating budget was $6.3B dollars allocated across the 6 areas.
Our integrated and overlapping mission areas of Fit Force, Casualty Care, and Resilient Families capture the three unique and dynamic environments in which the AFMS operates. Our homestation care to our beneficiaries underpins our readiness, builds resilient families and supports our Combatant Commanders by keeping our warfighters healthy and ready to deploy. In the deployed setting, AF medics provide both routine care and life-saving casualty care for our Joint and coalition forces. Additionally, AF medics also operate across the full spectrum of operations to include disaster response, humanitarian assistance, and partnership building with other nations. As a result, AF medics must be highly skilled and adaptable to operate in any environment under any condition. The relationship between Strategy, Common Practice and Cultureis the foundation of our framework for the future. Our Strategy ensures that we are properly aligned to achieve our vision. Our Common Practice reduces variability, improves organizational efficiency, and ensures we deliver the best care across the enterprise. Ultimately, through our Strategy and Common Practice, we create the environment and build the Culture that will enable us to sustain our high performing patient-centered organization and continue to deliver “Trusted Care Anywhere”. The three strategies to achieve our vision include:Transform deployable CapabilityBuild Patient-Centered CareInvest in Education, Training, and Research StrategyMust have plan for the present, near future and distant futureMust analyze risk, operational requirements, and future threats/demandsMust leverage personnel, resources, and partnerships for mission accomplishmentMust integrate Strategy, Culture, and Common Practice to create a sustainable organization Common PracticeReducing variability so that our customers get the same great service/outcome every time…no matter where they receive their careApplying EBM/lessons learned to deliver the best care CulturePatient Centered CareOur People are our most important resource and enable mission successContinuous improvement/learning organization Live each day…with the simple goal of making a difference some else’s life…a passion to simply leave your office, your next patient, the world better than you found it
Our People are the Key to Success: The AFMS exists to support the Combat Commanders both at home and abroad by deploying clinically current medics and keeping AF personnel mission ready for global operationsThe key to mission success is “Our People”…with all the technology in the world…nothing can replace the dedicated professional men and women who take care of our countries most precious resource. Additionally, through effective knowledge transfer, we are applying state-of-the-art procedures developed stateside to our global operations…with life-saving results. Similarly, our deployed care operations provide valuable lessons learned which in turn positively impact home station health care delivery. Through this cycle…our innovations can be sustained.
As of 15 Nov 2011 // Since 10 Oct 2001: > 92K patients moved AFCENT Reports 92% Survival Rate Aug 10 – Jul 11Tactical Critical Care Evacuation Team, or “TCCET” is a mission specific medical personnel and equipment package to execute inter-facility movement of post op, ICU-level casualties between forward surgical teams (FST) and theater hospitals via rotary-wing or tactical fixed wing aircraftTCCET: Fast-tracked concept development, equipment build, operational and safe-to-fly testing, and training of 2 teams (primary and alternate) in less than 9 months-- TCCET designed to fill the critical care gap with personnel OT&E to provide the critical care support necessary to maintain the continuum of care en route-- First team deployed (3 pax) June 2011 for 179 days, in place co-located with rotary-wing transportation assets at multiple OEF locations; ALREADY FLYING MISSIONS; As of 15 Nov 11 80 patients movedInterfly agreement with Canada, United Kingdom, Australia, and New Zealand. Our interoperability was the foundation of a unique operation involving two critical care teams…one CCATT from the US and one CCAST from the UK working side-by-side in the back of a HC-130P. INTERFLY AGREEMENT (Only for C-17s at this time...ASIC is looking to expand to other air frames like C-130/Chinook)Partners provide more options to bring our heroes home with “Interfly” on US/UK C-17s Expands capability of critical care patient movement; Increases capability to respond to worst case eventOvercame equipment approval challenges; CCATT Equipment has UK OEC clearance /waiver to fly US equipment on UK C-17sCCAST Equipment: Feb ‘10 approval for flight on US C-17s; Teams to share ideas common practices & exploit interoperability opportunities
It started in PACAF with the deployment of our newly Humanitarian Assistance Rapid Response Team to respond to the earthquake in Indonesia in Oct 2009. The HARRT was a tremendous success providing medical care to those affected by the7.6-magnitude earthquake: Total Patients:1945, Acute care: 1224, Minor surgery: 36, PrevMed encounter: 32, Prescription filled: 3519Earthquake (Haiti) Jan – Feb: Additional lessons learned…Earthquake (Chile) Feb – Mar: After these three HA missions in less than 6 months…we challenged ourselves…and asked “Can we do better?” How about Care upon arrival…1st patient in less than 1 hour, 1st surgery in less than 4 hours. EMEDS WAY AHEAD: Force Development Evaluation (FDE) Feb 2011, Travis AFB - ACC (SG), Travis (MDG/CRG), HAF/SG3, pilot units, AFMESA, C-NAFs, NHRC, & Combat Camera participation – COMPLETEFA-HUM 11 (SOUTHCOM) Apr 2011, Trinidad & Tobago – ACC (SG), Travis (MDG/PA), McGuire CRG, & AFMESA participation – COMPLETE FY11/12 – build nine (9) additional EMEDS HRTs Personnel and equipment packages FY14 – strategic/POM review of all EMEDS platformsFurther notes:-EMEDS HRT (Healthcare Response Team) is a medical only package. MDG+CRG teams at Travis; built on PACAF CRG HARRT and Operational AARs and successfully exercised in Apr 11. BOS support remains an A4/A7 responsibility. ACC/SGX and HAF/SGX are engaging with A4/A7 to develop a BOS capability scaled to support EMEDS-HRT, although we do not know what the pkg will look like, from HARRT, operational lessons learned, plus exercise, it is projected the BOS + HRT will be logistically supported for movement on two C-17s. Transition from Alaska Shelters to UtilisAK Shelter Compatible; Decreased Build Time Joint Program Testing w/ Collective Protection Developing “Portable” Functional Supply System (ER/OR/ICU/Peds/GYN/etc)Improved Storage/ShippingSecure/Weather Proof Versus Triwalls/RopakStandardized Packing Portable Drawer Modules
The AFMS has always conducted BP missions and is committed to further synchronize its effort to support ACS’ highly mobile, rapid, flexible, robust and integrated mission.Building Partnerships (BP) became a USAF core function in 2008; BP is now a Joint Capability Area (JCA) (one of 9 JCAs); SecAF & CSAF signed the AF Global Partnership Strategy (AFGPS) in Dec 2008. AFGPS establishes ends, ways and means to support CCDR objectives. Medical is listed under SSTR mean. For example, to Generate Goodwill or Gain Access, we conduct MEDCAP/DENCAP. To Build Trust, we conduct Subject Matter Expert Exchanges (SMEE). We establish Influence---conduct Train-the-trainer courses/share medical operating procedures and doctrine. Develop Capable Partner—Aerospace Medicine exchanges. Directly Intervene—HA/DR (HARRT)Global Health Engagement is one of the means the Air Force uses to partner with other nations to achieve health security cooperation, building partnerships and partner capacity objectives through health related activities and exchanges. Global health engagement activities allow for the AF Medical Service and Partner Nation (PN) armed forces, or foreign civilian authorities or agencies to build trust and confidence, share information, coordinate mutual activities, and maintain influence and achieve interoperability with PN. The Air Force uses the full spectrum of health capabilities and disciplines in both Mil-Mil and Mil-Civ engagement activities to build partner capacity, support security cooperation, and meet humanitarian objectives. Health engagement activities may include training, mentoring, planning, consultation, direct healthcare, and exercises in conjunction with national and international partners. Specific Health Engagement may include: Mil-Mil and Mil-Civ consultation and training in public health and preventive medicine, disaster/outbreak response, combat casualty care, aeromedical evacuation, expeditionary medical support, exercises, disease surveillance, medical and dental civic action programs, force health protection, veterinary medicine, health system, and medical logistics, facilities, and equipment repair. For FY09, our air components conducted over 40 missions treating over 100,000 patients. In addition, they conducted 3,500 optometry and 4,000 dental exams, and performed approximately 5,000 dental extractions. We also saw over 11,000 pediatric patients. Furthermore, our medics trained over 1,200+ host nation or partner nation medics. The Defense Institute for Medical Operations conducted 21 mobile courses, which resulted in the training of 850 foreign medics. Air Components are globally engaged: Medical Civic Action Programs; US Military Medical Training; Coalition Engagements; Theater Security Cooperation; Medical Readiness Training and Exercise
The Military Health System’s Quadruple Aim highlights the 4 priorities of our healthcare system….In the fall of 2009, MHS leaders recognized that our plan is consistent with the concept of the Triple Aim proposed by the Institute for Healthcare Improvement (IHI) in October of 2007. The Triple Aim was intended to describe the kind of results that could be achieved when all of the elements of a true health care system worked together to serve the needs of a population. The MHS is a system dedicated to the health of the military family, and it seemed reasonable to adopt the Triple Aim with the addition of one key element – readiness. Readiness reflects our core mission and reason for being; it is first among our aims.ReadinessEnsuring that the total military force is medically ready to deploy and that themedical force is ready to deliver health care anytime, anywhere in support of the full range of military operations,including humanitarian missionsPopulation HealthImproving the health of a population by encouraging healthy behaviors and reducing the likelihood of illness throughfocused prevention and the development of increased resilienceExperience of CareProviding a care experience that is patient and family centered, compassionate, convenient, equitable, safe and always ofthe highest qualityResponsibly Managing the Total Health Care CostsCreating value by focusing on quality, eliminating waste, and reducing unwarranted variation; considering the total costof care over time, not just the cost of an individual health care activity
Data date range: FY11 Denominator: FY11 (excludes weekends & holidays) (AFMOA/SGHC)Outpatient Encounters FY11Treatment DMIS Service F&G (MTF & ERSAs)MEPRS1 = ‘B’ Appt Status Cd <> ‘6’ (No Tcons)Source: SADR, M2Surgery ProceduresCY107 Currency MTFsSourced from Dr. Mark Boston / Dr. JenningsBabies DeliveredFY11Treatment DMIS Service F&G (MTF & ERSAs)Source of Admission = ‘L’ (Live Birth within MTF)Source: SIDR, M2Inpatient AdmissionsFY11Treatment DMIS Service F&G (MTF & ERSAs)Source: SIDR, M2Prescriptions FilledFY11Treatment DMIS Service F&G (MTF & ERSAs)Source: PDTS, M2Lab ProceduresFY11Treatment DMIS Service F&G (MTF & ERSAs)MEPRS1, Ordering = ‘B’ (Excludes MH, Dental, etc.)Source: Ancillary Services, Lab, M2Rad ProceduresFY11Treatment DMIS Service F&G (MTF & ERSAs)MEPRS1, Ordering = ‘B’ (Excludes MH, Dental, etc.)Source: Ancillary Services, Rad, M2Dental (AFMOA/SGD)
Institute for Health Care Improvement developed Triple Aim to focus improvement of care delivered in all areasMHS has adapted to develop QUADRUPLE AIM, with key component of readiness addedEnabling a medically ready force, a ready medical force, and resiliency of all MHS personnel.Improving quality and health outcomes for a defined population. Advocating and incentivizing healthy behaviors. Managing the cost of providing care for the population. Eliminate waste and reduce unwarranted variation; reward outcomes, not outputs. All metrics should sonehow point back to the Quadruple Aim
- The measures chosen are central to the concept of PCMH and already in use. They are all currently being tracked via a PCMH push report through the SG EGL website.* While Team satisfaction is measured, the MHPI “Satisfaction” measurement only includes Patient Satisfaction.
As of Dec 2011
MHPI uses standard PCMH Push Report measures. Data is already available and scores are the average of the three monthly scores for each measures. HEDIS is the exception where we use the last month of the period as the snapshot for HEDIS Composite score. MHPI Scores are heavily averaged and weighted and are used as a means to award incentive funds.
MTFs A and B are actual PCMH sites and the data is real.
Elmendorf – Increased AccessOutpatient Visits +40%, Surgery +40%Eglin – Increased Surgical CapabilitySpecialty Surgery GrowthAdding Medical SpecialtiesLangley – Addition/Expansion $114M in Projects On-GoingNellis – Newest Medical CenterFamily Medicine ResidencySurgery Residency PlannedTravis – Surgical Recapture118% increase in Neurosurgery New Cardiac/Vascular Services
GME: Since early 1970’s, many AF GME programs have been affiliated with civilian universities. Advantages: civilian faculty stability, exposure to diverse educators, broad spectrum clinical teaching sites. Master Affiliations with UTSA, Wright State Univ, Univ of MS, Univ Nebraska, St Louis University, UC Davis: they serve as sponsoring institutions for residencies. In addition, some of our stand alone residency programs have agreements for rotations at civilian sites. The AF has also integrated/affiliated with Army and Navy GME programs and has rotations at VA hospitals. Each service retains their specific identity within the integrated structure. The use of simulation labs is expanding. Expanding available teaching seats to 241. More specific examples include: Physician/Dental Education (GME/DME) Stand alone programsMaster Affiliations with UTSA, Wright State , U Miss, UC- Davis, Univ Neb, St Louis UnivIntegrated/affiliated with Army, Navy, USU & VA programs 84 Advanced Education General Dentistry-1 slots/yr Dental Specialty certificate/Masters program opportunities Nurse Education (Transition Program)11 sites; 166 trained in FY08; Increasing to 241 in FY09Sites Include: Cincinnati, OH & Scottsdale Healthcare, AZ Nurse Enlisted Commissioning Program (NECP)50 per year Nursing School of their Choice ResearchDiabetes: UPMC, WHMCTelepathology: UPMC, Keesler AFB, Eglin AFBTeleradiology: UPMC, WHMC, WPAFB, MacDill AFB, Scott AFB USAF Dental Hygiene Program10 Scholarships/year
In many of our larger facilities, we have launched our Surgical Optimization Initiative, conducting process improvement evaluations with the goals of improving OR efficiency and throughput, enhancing surgical teamwork, and eliminating waste and redundancy.
Leveraging Technology via Applied Clinical Epidemiology (ACE) - Deliver Best Evidence-Based Medicine To The Hands That Need It! Transform Health through Personalized MedicineReduce generalization risk when applying best evidence Shorten timeline of evidence discovery to evidence in clinicPopulation-based screening guidelines must not preclude targeting prevention to those that carry the preponderance of risk.Target our resources most effectively—prevent rather than treat—give the right patient, the right treatment, at the right time CarePoint: Data Transparency & Simplified ReportsWeb-based application which leverages the MHS Population Health PortalIt provides near real-time data to expedite evidence-based preventionEnables targeted prevention directly to the provider and patient. “Transforming Data into Actionable Information”Personal Health Record and Secure Messaging Improves ContinuityPersonalizing care with patient-provider communication optionsWeb-based Microsoft HealthVaultPilot test at Elmendorf AFBPatients selected by presence of select medical conditionsPatients control their own health and wellness record Benefits:Improved communication & relations; provider can coach the patientEmpowers patient to achieve ownership for outcomes and health Reduces ‘phone tag’, frustration, and unnecessary visitsImproves utilization of clinic health team to focus on patient care
Over the past decade, the military medical community has seen a dramatic growth in the volume of data collected within our system. This data represents a treasure trove of information that can be translated into knowledge and used for decision support. As we move forward with improving provider decision support systems like CarePoint, we must not forget about our patients. By Integrating WiFi and remote sensing devices or mobile applications with medication alerts or patient information, we can transform data into wisdom and ultimately change.
Our Joint Theater Trauma Registry is a great example of how we have used technology to build a database which has provided critical insights into how we manage our casualties. These lessons learned have been translated into clinical practice guidelines and are now being used across the DoD and have been shared with our civilian counterparts. Advances in remote monitoring and improvements with patient provider communication systems hold great potential for improving disease management thus supporting both better care and better health.
GME: Since early 1970’s, many AF GME programs have been affiliated with civilian universities. Advantages: civilian faculty stability, exposure to diverse educators, broad spectrum clinical teaching sites. Master Affiliations with UTSA, Wright State Univ, Univ of MS, Univ Nebraska, St Louis University, UC Davis: they serve as sponsoring institutions for residencies. In addition, some of our stand alone residency programs have agreements for rotations at civilian sites. The AF has also integrated/affiliated with Army and Navy GME programs and has rotations at VA hospitals. Each service retains their specific identity within the integrated structure. The use of simulation labs is expanding. Expanding available teaching seats to 241. More specific examples include: Physician/Dental Education (GME/DME) Stand alone programsMaster Affiliations with UTSA, Wright State , U Miss, UC- Davis, Univ Neb, St Louis UnivIntegrated/affiliated with Army, Navy, USU & VA programs Advanced Education General Dentistry- 91 slots/yr Dental Specialty certificate/Masters program opportunities Nurse Education (Transition Program)188 trained in FY11Sites Include: Cincinnati (OH); Lackland AFB;Scottsdale Healthcare (AZ); and Miami (FL) * Nurse Enlisted Commissioning Program (NECP)45 Graduates in FY11*Nursing School of their Choice ResearchDiabetes: UPMC, WHMCTelepathology: UPMC, Keesler AFB, Eglin AFBTeleradiology: UPMC, WHMC, WPAFB, MacDill AFB, Scott AFB
6 week long European Air Group Advanced Aerospace Medicine Course; in fact, this was the first time a USAF flight surgeon was able to attend this course, and did so by utilizing a British "training slot" in the course, which they graciously gave to us. Numerous international physicians, nurses, aerospace physiologists, and enlisted technicians coming to USAFSAM for training in our all of our courses, which certainlygreatly increases "...interoperability, integration, interdependence", hence: synergy. And there is also the USAFSAM Defense Institute of Medical Operations (DIMO) that travels to many countries around the world, providing training for a variety of operational medical subjects, again building interoperability, integration, interdependence, hence: synergy.ALL of these are "good news" stories, including the graduation this week of the Advanced Aerospace Medicine for International Medical Officers (AAMIMO) Course which is celebrating its 50th anniversary, being the 50th course of its kind, the 1st class graduating in 1960. More than 110 countries have participated in this course, and of its graduates, 37 have gone on to become the Surgeon General equivalent of their nation's military, as well as countless others who have gone on to serve in very senior ranking positions within their nation's military health service.
Modernization: Mission: Provide policy, guidance, resources, and oversight to integrate technology and deliver enhanced solutions to the AFMS, our warfighters, and the beneficiary community Six Modernization Thrust Areas(MTAs) are identified and codified in FY12-17 MPPG, based on the capabilities needed to support AFMS strategies. MTAs provide a key organizational mechanism to seek balance, continuity, and integration of the modernization portfolioEnroute Care: Continuum of care during transport of patients from point of injury to point of definitive care Expeditionary Medicine: Improving care during contingency ops; medical countermeasures against combat/operational stressorsForce Health Protection: Prevention of recognition injury/illness & the early or detection of emerging threats Health Informatics: Enriched IT service quality and effectiveness at MTFs Health Performance: Enhancing performance of Airmen in challenging environments Operational Medicine: Definitive patient care/treatment in-garrison
Shaping the Future of Military HealthcareDefinition of an "imperative": a philosophical concept that implies an obligation. For example, we have an obligation to deliver patient centered healthcare under a medical home construct or strategy via FHI as a key means. An imperative is and how we will support our priorities and shape our approach to our mission.Specifically, to assure success today and tomorrow, we are focused on the following theme:Patient-Centered Care: Patients want someone who cares with reliable and universally accessible information that allows active participation in their health care.Technology Integration: Our AFMS must continually monitor all (not just medical) technologies; understand how they will influence our AFMS mission, and rapidly integrate them.Synergy-Integration – Joint, Coalition, and Interagency: We must build partnerships and interoperability to advance cradle to grave health delivery. Precision Healthcare: We must minimize the cycle time from implementation of evidence-based medicine to common practice, and create incentives for prevention. Organizational Agility – Light, Lean, and Life Saving Capabilities: An organization that is able to respond, adapt, and influence changing environments quickly through agile processes as seen by changing approaches to acquisitions, facilities, technology; changing approaches to programming process, policy, and law. Process to adapt to changes, influence, changes, funding processes within the fiscal year, to respond between POM cycles.