Military Medicine最新文献

{"title":"A Systematic Review of Competencies for Enhancing Financial Expertise in Military Healthcare.","authors":"Alejandro Fuentes, Colleen M Cooper","doi":"10.1093/milmed/usaf353","DOIUrl":"https://doi.org/10.1093/milmed/usaf353","url":null,"abstract":"<p><strong>Introduction: </strong>The evolving demands of military healthcare require Chief Financial Officers (CFOs) in military medical treatment facilities (MTFs) to possess advanced financial competencies to ensure efficiency and compliance with federal regulations.</p><p><strong>Materials and methods: </strong>This systematic review, conducted using PRISMA guidelines, analyzed studies from PubMed, CINAHL, EMBASE, PsycINFO, and Google Scholar published between 2014 and 2024 to identify CFO competencies in military healthcare, focusing on strategic thinking, business integration, human capital management, digital literacy, and financial management.</p><p><strong>Results: </strong>Ten studies were included, revealing 5 critical competency areas: strategic thinking, business integration, human capital management, digital literacy, and financial management, which informed a unified training framework for military healthcare financial officers across all service branches.</p><p><strong>Conclusions: </strong>A standardized training pathway aligning with these competencies can enhance financial leadership in MTFs, improving resource management and operational readiness within the Defense Health Agency.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulated Aeromedical Evacuation Causes Hippocampal Neuronal Damage in Rats With Acute Lung Injury.","authors":"Chunli Yin, Jingmei He, Weiwei Li, Qiaofan Chen, Yanshu Wang, Shiqi Wang, Lei Liu","doi":"10.1093/milmed/usaf377","DOIUrl":"https://doi.org/10.1093/milmed/usaf377","url":null,"abstract":"<p><strong>Introduction: </strong>Aeromedical rescue plays an important role in the extensive evacuation of war casualties, sudden natural disasters (e.g., earthquakes, tsunamis), major public health events, and special needs across borders and regions. The most prominent environmental consideration in aeromedical evacuation (AE) is the impact of changes in barometric pressure on oxygen delivery and gas expansion. However, the hypobaric and hypoxic environment sustained by critically ill patients in flight can cause lung injury, leading to hypoxemia, which remains one of the few limiting factors for AE. Previous studies have focused primarily on secondary damage to brain and lung tissues during AE, with limited investigations into potential injuries to other organ systems. The purpose of this study was to investigate the effects of hypobaric hypoxia on the brain tissue of rats with acute lung injury (ALI).</p><p><strong>Materials and methods: </strong>Sprague-Dawley (SD) rats with lipopolysaccharide (LPS)-induced ALI were allocated to either a normoxic environment or a simulated AE environment (hypobaric hypoxic conditions). Hematoxylin-eosin staining was used to evaluate brain tissue damage, and single-cell RNA sequencing technology was used to analyze the injured brain tissue.</p><p><strong>Results: </strong>Sprague-Dawley rats with lipopolysaccharide-induced ALI presented with hippocampal neuronal damage after undergoing simulated AE. The analysis of the interaction of neurons with other hippocampal tissue cells suggested that the expression level of NRG1-ErbB4 was significant.</p><p><strong>Conclusion: </strong>This study demonstrated that ALI results in hippocampal neuronal damage after simulated aeromedical treatment in rats. In this study, single-cell RNA sequencing revealed that the NRG1/ErbB4 signaling pathway may play an important role in hippocampal neuronal injury. In contrast to previous studies on secondary injury to lung tissue, this study examined secondary injury to brain tissue caused by simulated AE.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echelon of Care at Time of External Fixation and Infection Risk in Military Combat Casualties.","authors":"Michael D Cobler-Lichter, Jessica M Delamater, Talia R Arcieri, Ana M Reyes, Jonathan D Stallings, Vincente S Nelson, Nicholas Namias, Kirby R Gross, Shawn E Boomsma, Mark D Buzzelli, Jennifer Gurney, Kenneth G Proctor, Paul J Wetstein","doi":"10.1093/milmed/usaf367","DOIUrl":"https://doi.org/10.1093/milmed/usaf367","url":null,"abstract":"<p><strong>Introduction: </strong>Role 2 (R2) U.S. military treatment facilities provide lifesaving far forward damage control resuscitation and surgery. Given the austere conditions at R2s, infection risk is a major concern. We aimed to evaluate the infection rate after external fixation (EF) in military casualties based on where in the evacuation pathway the EF was performed, hypothesizing that lower-echelon EF would be associated with increased infections.</p><p><strong>Materials and methods: </strong>The Department of Defense Trauma Registry (DoDTR) was retrospectively reviewed from 2003 to 2024. Non-U.S. military patients, deaths, and burns were excluded. Lower-echelon EF was defined as the first EF performed at R2, or Role 3 (R3) in cases of R2 bypass. Infection was defined as any one of seventeen infectious complications recorded in the DoDTR. We evaluated the independent association of lower-echelon EF on both wound infection (WI) and overall infection using multiple regression.</p><p><strong>Results: </strong>In 6,115 patients, 2,529 met inclusion criteria, of whom 646 (25.5%) developed postoperative infection. 19.0% of all EFs were placed at R2, 67.7% at R3, 5.4% at Role 4 (R4), and 7.8% at R4-Continental United States (R4c). Overall infection rate after EF was 19.2% for R2, 24.9% for R3, 19.8% for R4, and 38.8% for R4c (25.5% overall). Wound infection was the most common infectious complication at (8.6% after EF at R2, 14.5% for R3, 15.3% for R4, and 24.5% for R4C, 15.2% overall). On adjusted analysis, higher-echelon EF was independently associated with WI and overall infection: adjusted odds ratio of 1.718 (97.5% CI, 1.311-2.250), and 1.514 (97.5% CI, 1.208-1.899), respectively.</p><p><strong>Conclusions: </strong>For U.S. military casualties, lower-echelon external fixation is associated with decreased infection despite the austere setting. Although this study is unable to elucidate the specific factor(s) responsible for this association, it highlights the need to maintain orthopedic expertise close to point-of-injury and for future work to identify the specific characteristics of either the patients who receive lower-echelon EF, their injuries, or the EFs at the Role 2 and Role 3 facilities themselves that are responsible for this association.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Relevant Occupational Tasks Performed by the Brazilian Air Force Firefighters.","authors":"Willian C Botta, José M M P Santos, Robin M Orr, João P Borin","doi":"10.1093/milmed/usaf374","DOIUrl":"https://doi.org/10.1093/milmed/usaf374","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to identify content-valid occupational tasks performed by Brazilian Air Force (BAF) firefighters to support the development of Physical Employment Standards (PES).</p><p><strong>Materials and methods: </strong>A 3-step validation process was applied: (1) scenario development, (2) subject matter expert (SME) judgment, and (3) task quantification. Seven SMEs identified 5 operational scenarios and 33 critical tasks, which were rated based on importance, frequency, and physical demand. Tasks with a Content Validity Index above 0.86 were retained. In the final step, 164 active duty firefighters rated 27 tasks using a Likert scale.</p><p><strong>Results: </strong>Tasks involving victim removal and load carriage were rated among the most important and physically demanding, and forest firefighting tasks were the most frequently performed. Inter-rater reliability was high across all domains.</p><p><strong>Conclusion: </strong>This systematic approach provides a foundation for future PES development, contributing to improved readiness, safety, and targeted physical training programs for BAF firefighters.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and Obesity in U.S. Military Service Members and Veterans: A Systematic Review.","authors":"Shawnice L Shankle, Laureen H Smith","doi":"10.1093/milmed/usaf376","DOIUrl":"https://doi.org/10.1093/milmed/usaf376","url":null,"abstract":"<p><strong>Introduction: </strong>High body mass index (BMI) and depression are significant chronic health concerns in adult populations, including in the U.S. Military. This systematic review examines the published literature on the relationship between high BMI and depressive symptoms among U. S. service members (SMs) and veterans from the most recent wars.</p><p><strong>Materials and methods: </strong>A structured literature review published from 2012 to 2022 used established systematic review guidelines. Sixteen primary research studies from the last 10 years were examined using healthcare and social sciences databases. The studies included BMI and depressive symptoms as variables. Studies measured the relationship between BMI and depressive symptoms among those with military service during the Gulf War or Post-9/11 eras.</p><p><strong>Results: </strong>Four studies used SMs alone, 11 used veterans, and 1 used both. Nine studies found a relationship between high BMI and depressive symptoms, with 3 reporting the relationship only in specific sub-groups (e.g., specific BMI categories). Seven studies found no relationship. Mixed findings and varied study quality indicate a nuanced relationship. SMs and veterans have high BMIs and depressive symptoms at rates comparable to their civilian counterparts.</p><p><strong>Conclusion: </strong>High BMI and depressive symptoms among SM and veterans could have consequences for personal health, healthcare systems, and national security. Little is understood about the complexity of relationship between high BMIs and depressive symptoms among military and veteran populations. Delivering evidence-based tailored care for SMs and veterans experiencing these conditions requires more research, especially intervention-based studies. Effective policies to ensure the holistic health of SMs and veterans are needed to secure the health and fitness of the warfighters in the U.S. Military.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Impostor Phenomenon During Pre-Clerkship Period in Military Medical School.","authors":"Eungjae Kim, Jinbum Dupont, Steven J Durning, Jezreelyn Bulaklak, Abigail Crosier, Michael Soh","doi":"10.1093/milmed/usaf373","DOIUrl":"https://doi.org/10.1093/milmed/usaf373","url":null,"abstract":"<p><strong>Purpose: </strong>impostor phenomenon (IP) is defined as an experience where individuals attribute their success to chance or luck and not to their mastery of skills, which is commonly experienced within competitive environments such as medical school. Building on a prior study on IP during onboarding, the purpose of this study is to examine IP experiences throughout the pre-clerkship curriculum and provide insights into the possible evolution of IP during the initial 16 months of a military medical school.</p><p><strong>Materials and methods: </strong>The study participants were second-year medical students at a military medical school who had previously participated in an initial IP study at the beginning of their first year of medical school. Researchers conducted semi-structured interviews in December 2023 to explore how students' experience with the IP changed after their pre-clerkship education, and qualitative thematic analysis was conducted. Scores from the Clance Impostor Phenomenon Scale (CIPS) during onboarding and at the end of the pre-clerkship period were compared.</p><p><strong>Results: </strong>Researchers interviewed 21 of the original 29 matriculated military medical students who completed the initial study. Fifteen students (71.4%) reported frequent or intense IP experiences on the CIPS indicating that IP remained present in the study sample. Average CIPS scores from onboarding and end of pre-clerkship were 68.3 and 68.1, respectively, suggesting that the intensity of IP remained stable. Thematic analysis of interview transcripts identified 6 themes that influenced students' experience with IP: academic progress, military medical expectations, self-comparison, relationship dynamics and building relationships, extracurricular engagement and roles, and navigating uncertainty. Theme saturation was reached at n = 15.</p><p><strong>Conclusion: </strong>Although the intensity of IP remained relatively stable from onboarding to the end of pre-clerkship, the underlying themes driving IP evolved as students transitioned into active participation in undergraduate medical training. Similar to the initial IP study, situated learning theory continued to offer a valuable framework for understanding these shifts, particularly through relationships with peers and upperclassmen. Future research incorporating mixed methods could further clarify how qualitative shifts in IP correspond to variations in CIPS scores. As participants advance into clerkship rotations, we anticipate continued evolution in IP experiences, warranting further longitudinal exploration.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Treatment of a Sports-Related Morel Lavallée Lesion With Point-of-Care Ultrasound: A Case Study.","authors":"Ellis Bronstein, Savannah Kounelis-Wuillaume, Colby MaGill, Jeffrey C Leggit","doi":"10.1093/milmed/usaf378","DOIUrl":"https://doi.org/10.1093/milmed/usaf378","url":null,"abstract":"<p><p>Morel-Lavallée lesions (MLLs) are closed degloving injuries that result in inter-fascial hemolymphatic collections. These lesions develop as a result of shearing forces in the deep fascial planes and often arise in the context of significant high-velocity traumas. However, they are often underdiagnosed, especially in the case of atypical presentations such as sports or low-impact injuries. Here we present a case of MLL following a fall from a bike at low speed that resulted in a large area of soft-tissue ecchymosis and swelling that would not resolve following conservative treatment. Point-of-care ultrasound (POCUS) was used to diagnose and guide interventional treatment via ultrasound-guided drainage of the fluid collection. This case is informative as it serves as a reminder for providers to always consider MLL in the differential diagnosis of soft tissue injuries. It additionally demonstrates how POCUS can help identify and assist in management of MLLs in the primary care setting.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Emergency General Surgery Volume Within Military Treatment Facilities (2016-2023).","authors":"Kyle Patrick Apilado, Kevin Chuang, Jacob H Cole, Christian L Coles, Andrew J Schoenfeld, Tracey Perez Koehlmoos","doi":"10.1093/milmed/usaf360","DOIUrl":"https://doi.org/10.1093/milmed/usaf360","url":null,"abstract":"<p><strong>Background: </strong>Emergency General Surgery (EGS) procedures are vital and high-risk interventions. Delivery of these procedures in military treatment facilities (MTFs) is important to beneficiaries of the U.S. Military Health System (MHS). Organizational changes, including consolidation of MTFs under the Defense Health Agency and personnel reductions, in conjunction with the COVID-19 pandemic, have led to concerns about potential declines in care quality. We assessed whether clinical outcomes remained consistent or were negatively influenced by the healthcare administrative changes and the COVID-19 pandemic.</p><p><strong>Materials and methods: </strong>Claims data from the MHS Data Repository and ICD-10 diagnosis codes were used to identify patients, 18-64, admitted to U.S.-based MTFs between fiscal years 2016 and 2023 with an EGS condition. The main predictor was hospital EGS volume categorized into volume-based quartiles. Outcomes were 30-day mortality, complications, and readmissions. Patients were stratified into 2 time periods (FY 2016-2019 and FY 2020-2023) based on index admission date. Multivariable logistic regression models were used to assess the relationship between MTF volume and clinical outcomes.</p><p><strong>Results: </strong>113,626 EGS encounters treated across 40 MTFs were identified. Adjusted analyses showed that compared to the highest volume MTFs of 2016-2019, MTFs in the lower middle quartiles (LMQ) and upper middle quartiles (UMQ) of 2016-2019 (OR: 0.67; OR: 0.67) and LMQ of 2020-2023 (OR: 0.70) had a significantly decreased likelihood of 30-day mortality. Compared to 2016-2019's highest volume MTFs, the lowest volume MTFs of 2016-2019 were significantly less likely to experience complications (OR: 0.67), while MTFs from the UMQ of 2016-2019 (OR: 1.10) and all quartiles of 2020-2023 (OR: 1.22; OR: 1.61; OR: 1.43; OR: 1.27) were significantly more likely to develop complications. Patients treated at MTFs in the LMQ and UMQ of 2016-2019 (OR: 0.78; OR: 0.70) and those in the lowest and middle quartiles of 2020-2023 (OR: 0.67; OR: 0.71; OR: 0.76) had a significantly lower likelihoods of readmission compared to the highest volume MTFs of 2016-2019.</p><p><strong>Conclusion: </strong>The likelihood of 30-day complications among all MTF quartiles in 2020-2023 was significantly higher compared to MTFs in 2016-2019. However, EGS patients treated in low-volume MTFs experienced similar, if not improved, clinical outcomes of mortality and readmissions compared to those treated in high-volume MTFs.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic Abscess Caused by Aggregatibacter kilianii in an Immunocompetent Active Duty Male, Case Report.","authors":"Jackson T Watkins, Jake A Cresta, Michael A Boatwright","doi":"10.1093/milmed/usaf303","DOIUrl":"https://doi.org/10.1093/milmed/usaf303","url":null,"abstract":"<p><p>Bacterial translocation from normal oral flora, such as Aggregatibacter spp., can rarely lead to endocarditis, bloodstream infections, and abscesses. We present a case of an immunocompetent active duty service member with a hepatic abscess from a presumed routine dental hygiene cleaning with Aggregatibacter kilianii bacteremia. Aggregatibacter kilianii is a relatively novel species, closely related to the well-reported Aggregatibacter aphrophilus but genetically distinct. This appears to be one of the first described cases of a hepatic abscess caused by this species.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cranial Nerve Six Palsy Occurring in PreEclampsia: A Case Report.","authors":"Laura Chachula, Christopher Rogers, Randal Cieslak","doi":"10.1093/milmed/usaf337","DOIUrl":"https://doi.org/10.1093/milmed/usaf337","url":null,"abstract":"<p><p>Isolated palsy of cranial nerve VI, also known as the abducens nerve, is a condition rarely seen in the obstetric population; however, there is a growing body of literature that suggests an association with pre-eclampsia and hypertensive disorders of pregnancy. We present the sixteenth case documenting this association involving a 30-year-old G1 admitted for induction of labor at 39 weeks gestational age (WGA) subsequently diagnosed with pre-eclampsia with severe features and, after an otherwise uncomplicated vaginal delivery, developed an isolated abducens nerve palsy. While similar cases reviewed in the current body of literature document self-resolution of the palsy, a thorough workup is warranted because of other potentially malignant causes for this presentation. Appropriate management and risk factor counseling are discussed following a review of cases.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}