Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces (1996) / Chapter Skim
Currently Skimming:
3: SURVEILLANCE TOOLS CURRENTLY AVAILABLE TO THE MILITARY
3: SURVEILLANCE TOOLS CURRENTLY AVAILABLE TO THE MILITARY
Pages 19-33
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 19... ...
Automated multipurpose databases are increasingly being used for epidemiologic purposes, including surveillance. Such databases are typically assembled by combining patient-level information from two or more separate files originally developed primarily for nonresearch purposes.
|
From page 20... ...
CURRENT MILITARY SURVEILLANCE SYSTEMS The Army Medical Surveillance Activity, the Defense Medical Epidemiology Database' and the Uniformed Services Prescription Database Project (USPDP) are the three automated multipurpose database systems currently in development that can be used to monitor adverse health events and their potential causes.
|
From page 21... ...
Reportable diseases occurring among inpatients and nondeployed personnel are more likely to be reported than are those occurring among military personnel who are deployed for training or duty or who are being treated on an outpatient basis. Notifiable Conditions Reported Through the Army Medical Surveillance System, January 1995 Amebiasis Chancroid Dengue fever Anthrax Chemical agent exposure Diphtheria Arboviralfever, Chlamydia Ehrlichiosis unspecified Cholera Encephalitis Asbestosis Coccidioidomycosis Fatality,trainee Botulism (adult)
|
From page 22... ...
This system reports the dates and results of tests, as well as medical information. USAHDS also maintains the registry of all individuals with confirmed cases of HIV infection, documents clinical evaluations at Army medical treatment facilities, and supplies database support to the Army/Navy Serum Repository.
|
From page 23... ...
Acute Respiratory Disease Surveillance System The information for the ARD Surveillance System is collected only from the Army basic training centers. The data consist of counts of hospital admissions for ARD, throat culture results, and group A beta-hemolytic streptococcuspositive throat culture results.
|
From page 24... ...
Defense Manpower Data Center Complete Army population data (demographic and occupational data) are linked with the Deployment Medical Surveillance System by SSN in a relational database by the Army Medical Surveillance Activity.
|
From page 25... ...
The particular strengths of the Army Medical Surveillance Activity and the proposed Defense Medical Epidemiology Database (described below) include the following: a variety of outcomes databases that are all linkable by SSN; components that are, by and large, already on-line and working; currently generated weekly and monthly reports from the Reportable Disease Surveillance System; and relatively easy addition of surveillance endpoints to the list of reportable diseases.
|
From page 26... ...
Limiting the analysis to active-duty personnel, the 10 most common medications, ranked by therapeutic class and based on the prescriptions filled at 22 Army USPDP sites, are listed in Table 3-1. Strengths and Limitations of USPDP The particular strengths of USPDP include the ability to describe drug use rates and characteristics and to examine health policy changes, drug safety, and drug effectiveness.
|
From page 27... ...
This would be a computerized system maintained by all pharmaceutical dispensers that will enable pharmacists to detect any potential drug interactions among current and newly prescribed medications across the entire military health service system, as well as provide a universal, automated record of the prescriptions that have been dispensed to an individual. In addition to including all of the medical treatment facilities, the Universal Pharmacy Patient Profile would create an electronic profile in a central database and would be accessible on-line by military and civilian pharmacies.
|
From page 28... ...
The Compensation and Pension file includes records of all veterans currently drawing compensation for a military service-connected disability. Although these veterans number some 2 million, the automated medical information available about them is limited; for example, diagnoses are recorded using VA-specific codes rather than International Classification of Disease codes.
|
From page 29... ...
This system is managed jointly by CDC and FDA. Objective of and Data in VAERS The objective of VAERS is to aid in the detection of previously unrecognized reactions to vaccines, to detect any increases in known reactions, to identify preexisting conditions that may promote reactions, and to determine whether particular vaccine lots result in an unusual number or types of reported adverse events.
|
From page 30... ...
MEDWatch: The FDA Medical Products Reporting Program MEDWatch was established in June 1993 to gather information on serious adverse events following the administration of drugs and biologics and on problems with medical devices regulated by FDA (Kessler, 1993~. This system is managed by FDA.
|
From page 31... ...
VAERS = Vaccine Adverse Event Reporting System. Objective of and Data in MED Watch 31 The objectives of MEDWatch are to facilitate the voluntary reporting of serious adverse events and problems with drugs, biologics, and medical devices; to continue monitoring the safety of new drugs and devices; and to aid in the detection of previously unrecognized reactions.
|
From page 32... ...
SUMMARY OF STRENGTHS AND LIMITATIONS OF CURRENT SURVEILLANCE TOOLS The surveillance tools currently available to the military comprise a series of potentially linkable automated databases (Grabenstein et al., 1992~. Opportunities for creating automated multipurpose databases have already been seized, with the Army Medical Surveillance Activity and the USPDP being two examples.
|
From page 33... ...
Given the inherent difficulties in identifying and confirming unknown interactions, the use of surveillance tools cannot ensure success. However, the current surveillance systems with an expanded list of reportable conditions, additional linking of databases, and additional sentinel data from relevant civilian systems-can provide sentinel-event reporting for further investigation by the military.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.