Military Medicine最新文献

{"title":"Mitigating Impostor Phenomenon of Onboarding Military Medical Students: A Workshop Utilizing Situated Learning Theory.","authors":"Eungjae Kim, Jinbum Dupont, Steven J Durning, Ryan Landoll, Michael Soh","doi":"10.1093/milmed/usaf068","DOIUrl":"https://doi.org/10.1093/milmed/usaf068","url":null,"abstract":"<p><strong>Introduction: </strong>Impostor phenomenon (IP), where individuals attribute their success to external factors rather than their abilities, is prevalent in competitive environments like medical school. Research on how the onboarding medical school curriculum influences IP is limited, but recent studies suggest that situated learning theory (SLT) may help inform how we approach IP. This study sought the effects of an SLT-focused, specifically communities of practice and legitimate peripheral participation, workshop during orientation week on IP perception among first- and second-year medical students. Second-year students (MS2) facilitated the discussions with first-year students (MS1) about IP and identity formation, aiming to reduce IP through normalization of IP, shared experiences, and strategies to mitigate IP.</p><p><strong>Materials and methods: </strong>A workshop was held during the orientation week at the Uniformed Services University, School of Medicine. The participants were organized into learning pods consisting of 4 students. An MS2 learning pod was paired with an MS1 learning pod to moderate the workshop activity. One MS2 from each learning pod received training to be moderators. Both MS1 and MS2 participants completed pre- and postworkshop surveys, which included the Clance Impostor Phenomenon Scale (CIPS), which was the primary measure of IP.</p><p><strong>Results: </strong>A total of 222 medical students (n = 130 MS1; n = 92 MS2) were included in this study. Before completing the workshop, 53% of participants reported frequent or intense IP experiences versus 43% postworkshop. Overall, 71% of MS1s and 57% of MS2s had decreased (i.e., improved) absolute CIPS score postworkshop, with changes in the range of 1-30. However, 20% of MS1s and 34% of MS2s had increased CIPS score, with a range of 1-24 points. Additionally, proportion of MS1s who strongly disagreed or disagreed that they were admitted to medical school because of luck or chance rather than their skills and abilities increased from 65% before the workshop to 74% afterward. Those who strongly disagreed that they felt like an impostor (or did not belong) on campus also increased from 38% before the workshop to 47% afterward. The percentage of MS1s who strongly agreed or agreed that that comfort levels discussing their own, as well as their peers, IP experiences increased from 66% to 83% and 78% to 87%, respectively. In an open-ended response, participants reported appreciation of the open and safe peer-to-peer discussions as it enabled reflection and normalization of IP, shared best practices and strategies related to reducing IP, and promoted a sense of belonging with fellow military medical students.</p><p><strong>Conclusions: </strong>Using SLT as our guide, our workshop discussed IP in a near-peer and peer-peer setting that facilitated safe conversations that attempted to normalize IP, which then led to a decreased sense of IP for a majority of students. The ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566593","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":"Behavioral Health Outcomes in the 12 Months Following Major Limb Loss Among Active Duty Service Members Treated in the Military Health System, 2001-2017.","authors":"Kalyn C Jannace, Rebecca N Schulz, Tawnee Sparling, Daniel B Cooper, Colin Harrington, Paul F Pasquina","doi":"10.1093/milmed/usaf070","DOIUrl":"https://doi.org/10.1093/milmed/usaf070","url":null,"abstract":"<p><strong>Introduction: </strong>Over 2,100 active duty service members (ADSM) have experienced traumatic limb loss since 2001. Combat-injured ADSMs have over 3 times the odds of developing a behavioral health condition as compared to those with noncombat injuries. Additionally, severity of injury has been associated with increased risk of post-traumatic stress disorder and depression, which increase the risk of suicidal behavior. Despite previous research, studies have not investigated incident behavioral health diagnoses in the 12 months following amputation and the highest-risk subpopulations.</p><p><strong>Materials and methods: </strong>A retrospective cohort study using existing electronic health record data identified ADSMs experiencing major limb loss between 2001 and 2017. Incident behavioral health conditions diagnosed in the 12 months following limb loss were identified. Disorders typically diagnosed in childhood were excluded. Wilcoxon rank-sum tests and chi-squared tests calculated differences between those with and without a diagnosis in the 12 months post-amputation. Logistic regression models calculated odds ratios and 95% CIs measuring the association between significant demographic and amputation characteristics and between post-amputation incident behavior health diagnosis and incident traumatic brain injury (TBI) and incident behavioral health diagnosis for each diagnostic category.</p><p><strong>Results: </strong>Approximately 56% of ADSMs were diagnosed with an incident behavioral health condition in the 12 months following major limb loss. Those diagnosed with a condition were likely to be younger, enlisted ADSMs, and sustaining a combat-related lower extremity amputation. The most common diagnosis was adjustment disorder (31%). Over 41% were also diagnosed with a TBI. Unadjusted odds of a behavioral health condition were 3.3 (95% CI: 2.8-4.0) times higher among those also diagnosed with a TBI.</p><p><strong>Conclusions: </strong>In this study, more than half of ADSMs experiencing major limb loss developed incident behavioral health conditions within the first 12 months. This study highlights the need for awareness of the potentially increased risk of these diagnoses in the acute period following amputation.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557355","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":"Impact of Low-Level Blast Exposure From Military Training and Career Cumulation on Hearing Outcomes.","authors":"Kaela Shea, Oshin Vartanian, Shawn G Rhind, Catherine Tenn, Ann Nakashima","doi":"10.1093/milmed/usaf055","DOIUrl":"https://doi.org/10.1093/milmed/usaf055","url":null,"abstract":"<p><strong>Introduction: </strong>Occupational trades expose military service members to unique sound exposure profiles, distinct in frequency and amplitude to those commonly studied in industrial settings. Characteristics of the energy exposure incurred through blast exposure exercises a distinct mechanism of injury in the auditory system that yield acute and cumulative health impacts. The following paper considers physiological and self-reported data attributed to repeated low-level blast exposure. We focused our analysis to examine objective audiological metrics of blast overpressure damage to quantify the impact of discrete and accumulated blast exposure for military service members.</p><p><strong>Materials and methods: </strong>This study was reviewed and approved by the Human Research Ethics Committee of Defense Research and Development Canada. Data were collected in a cross-sectional, repeated measures observational design. Participants comprised service members who took part in a training course using controlled explosives (n = 46) and an age- and sex-matched control group (n = 42) with noise exposure but no history of blast exposure. Extensive demographic and subjective health data were captured additional to a battery of quantitative health data. Nonlinear mixed effect models with bivariate generalized additive architecture, Friedman's test, and repeated measures ANOVA models were applied.</p><p><strong>Results: </strong>Subjective tinnitus and hearing scores were sensitive to life-time blast overpressure exposure (P = .034) and a delta of low- (2-4 kHz) and high-frequency (4-8 kHz) audiometric threshold averages significantly differentiated by both cumulative (P = .0016) and training course exposure (P = .0142). Furthermore, audiometric values showed progressive increasing variance in high frequencies (>4  kHz) in blast-exposed participants with worsening audiometric outcomes. Variation in high-frequency hearing thresholds may be attributed to differences in energy exposure because of structural differences between individuals or differences in exposure profiles (produced either by diversity in PPE compliance or exposure sources).</p><p><strong>Conclusion: </strong>Military members exposed to blasts in a training environment and accumulated through a career experience adverse hearing and audiometric impacts. However, better measures of hearing injury should be pursued to improve understanding of injury mechanism and injury progression which may inform risk and medical interventions. Blast-induced hearing injuries are dynamic and change over time between acute and chronic phases which are further exacerbated with multiple blast exposures presented consecutively.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557260","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":"Characteristics of the Course of Anemia as a Consequence of Combat Injuries in Military Servicemen Participating in High-Intensity Combat Actions.","authors":"Svitlana A Husieva, Galyna V Osyodlo, Ian P Goncharov, Olena Ya Antonyuk, Andrii V Husiev, Vitalii M Orlov, Ivan А Кmiet, Ilona V Malysh, Sofiia V Ткаchenko, Аnna Ya Hlushko, Vlad Yu Cherevko","doi":"10.1093/milmed/usaf064","DOIUrl":"https://doi.org/10.1093/milmed/usaf064","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;During the full-scale war in Ukraine, the number of military personnel suffering from combat injuries with the development of anemia significantly increased. The work aimed to generalize and study the clinical and hematological characteristics of anemia in service members who received gunshot and blast injuries during combat operations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We examined 264 servicemen within 6 months (main group). They took part in hostilities and received gunshot and shrapnel wounds accompanied by blood loss. The control group consisted of 87 practically healthy service members. Complete blood test was performed on an automatic hematology analyser ABX Micros ES 60 of the company Horiba ABX. We determined the level of ferritin using the enzyme immunoassay method ELISA, the concentration of serum iron using the photometric method, and C-reactive protein (CRP) using the immunoturbidimetric latex method (quantitatively). The studies' results were processed using variational statistics. For each group of patients, the arithmetic mean (M), the standard deviation (Ϭ), and the error of the arithmetic mean (m) were calculated. We used the statistical processing package STATISTICA 10 (Statsoft Inc.).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Isolated injuries accounted for 50.89%, injuries to two or more anatomical areas-49.11%, injuries to limbs and large joints-30.6%, chest-14.66%, abdominal cavity-21.9%, and polytrauma-32.84%. All patients had blood loss, but its degree was not countable. The number of erythrocyte mass transfusions ranged from 2 to 7 (3.5 ± 0.7 on average). A total of 39.42% of victims were delivered in a severe condition, and 60.58% in a moderate condition. We divided the patients into the groups: 1st group (n = 60) where the blood was tested after in 1 month after injury, 2nd (n = 42)-2 months, 3rd (n = 37), 4th (n = 31), 5th (n = 26), and 6th (n = 24) in 3, 4, 5, and 6 months. We observed an initial increase in the number of leukocytes and platelets, and a decrease in the levels of erythrocytes, hemoglobin, MCV, and MCH, an increase in the absolute number of granulocytes and monocytes, and a decrease in the number of lymphocytes. In all, 7.9% of patients were diagnosed with severe anemia, 44.7% with moderate, and 40.4% with mild. The ferritin level exceeded the control group's results almost three times, while the iron content in the blood serum was significantly reduced. The hemoglobin level did not normalize within six months in most service members with anemia (because of severity or complications of the injuries and multiple surgeries). The CRP was elevated for 6 months after injury. Correlation analysis confirmed a positive relationship between the level of hemoglobin, the number of leukocytes, and the level of CRP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We view combat anemia as more than a hematology issue. It needs prompt, coordinated care from various fields. Interventions may inc","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557257","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":"Optimizing Austere Surgical Team Efficiency: An Evaluation of Team Composition During U.S. Air Force Ground Surgical Team Training.","authors":"Robert J Edmonds, Didier N Hirwantwari, Dallas G Hansen","doi":"10.1093/milmed/usaf062","DOIUrl":"https://doi.org/10.1093/milmed/usaf062","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal size of an austere surgical team needed to perform a damage control surgery has not been established, leading to variability in team composition among the myriad of single surgeon surgical teams within the DoD. The Air Force's conventional Ground Surgical Team (GST) includes 6 members; a surgeon, emergency physician, anesthesia provider, nurse, scrub technician, and medical administrator. The purpose of this study was to establish an evidence base for team composition among single-surgeon surgical teams by evaluating whether the addition of a second nurse would lead to an increase in effectiveness during GST phase 1 course simulations.</p><p><strong>Materials and methods: </strong>During the 2nd week, GST phase 1 training course held at Wright Patterson Air Force Base, Ohio, GST students complete 4 high fidelity team-based simulations requiring surgical intervention. The time to first incision was chosen as the primary outcome because of its known impact on patient survival in the unsimulated environment. Secondary outcomes included first full set of vitals, first administration of blood products, and time to call for evacuation. After Institutional Review Board and command approval, baseline control time measurements were obtained during 24 simulations completed by the standard 6-person teams. Time measurements were then obtained during 24 simulations with 7-person teams which included an additional nurse.</p><p><strong>Results: </strong>Variation was identified in the ability of both 6-person and 7-person teams to complete the measured tasks during the simulation. The addition of a second nurse had no statistical impact on the time to task completion.</p><p><strong>Conclusions: </strong>The variability in \"time to first incision\" among teams during GST phase 1 course demonstrates that certain teams are more efficient in the management of their simulated patients. This study suggests that the addition of a second nurse on GST will not improve the team's efficiency; however, limitations in the study preclude any definitive conclusion. Further research is needed to identify other factors that may impact team efficiency, such as the addition of a member with a different skillset, improvement in nontechnical skills, or an increase in trauma clinical experience.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557278","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":"What Happens in Vegas: Enlisted Medical Providers Practice to Their Full Clinical Scope in a Civilian Hospital.","authors":"Allison Andersen, Nicole Owens, Anna Murray, James Woods, Anna Prendergast, Jennifer Gurney, Jeremy Kilburn","doi":"10.1093/milmed/usaf056","DOIUrl":"https://doi.org/10.1093/milmed/usaf056","url":null,"abstract":"<p><strong>Background: </strong>The potential of large-scale future conflicts require expertise in field and facility-based care of high patient volumes in Prolonged Casualty Care scenarios. In our experience, a military-civilian partnership that enables Enlisted Medical Providers (EMP) to work at their full scope of practice in civilian hospitals is ideal to train excellent and reliable patient care which improves outcomes and ultimately saves lives.</p><p><strong>Methods: </strong>Creating the opportunity and understanding needed to ensure EMP participation in the Las Vegas Military-Civilian Partnership (LV-MCP) required state legislative changes, discussions with the local governmental and private entities, military and civilian executive leadership buy-in, and institutional culture change.</p><p><strong>Results: </strong>Over 2 years of data collection, 566 EMPs in 8 specialties developed technical skills, decision-making experience, and self-awareness in complex, high-acuity, hands-on patient care environments.</p><p><strong>Conclusion: </strong>The high level of readiness achieved in the LV-MCP can and should be replicated in other markets. This commentary describes the policy, process, and institutional efforts undertaken to achieve EMPs working to their full clinical scope of practice in the LV-MCP hospital and calls for new ways to measure effective expeditionary readiness.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557298","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":"Patient Characteristics to Inform Military Medical Evacuation Decision-Making in Mild Isolated Head Injury.","authors":"Ian F Eisenhauer, Lani L Finck, Julia M Dixon, Steven G Schauer, Matthew D Tadlock, Shaheem de Vries, Hendrick Lategan, Willem Stassen, Craig Wylie, Nee-Kofi Mould-Millman","doi":"10.1093/milmed/usaf058","DOIUrl":"https://doi.org/10.1093/milmed/usaf058","url":null,"abstract":"<p><strong>Introduction: </strong>Management of head trauma in austere military environments is challenging as current head injury scoring systems have limited triage utility in the absence of advanced imaging. Additionally, unlike the recent past, future conflicts will be characterized by limited opportunities for aeromedical evacuation. We hypothesize that safe hospital discharge within 48 h may be an effective surrogate endpoint to identify patients appropriate for averted or delayed evacuation in military settings. To analyze this, we assess mild head-injured patients for associations between clinical factors and serious head injury patterns or hospital discharge within 48 h.</p><p><strong>Materials and methods: </strong>This is a secondary analysis of case data collected in a DoD-funded study, \"EpiC,\" a prospective, multicenter cohort study of major trauma in the Western Cape, South Africa, with median time to definitive care of 12.5 h. Patients aged 18-50 years who presented from March 2021 to October 2023 with mild head injury, defined as lowest Glasgow Coma Scale (GCS) ≥14 in the first 24 h, were eligible. Exclusions include any nonminor injury outside the head (Abbreviated Injury Scale score >1). Serious head injury was defined as nonnasal bone facial fractures, skull fractures, or intracranial injury. Clinical characteristics were evaluated for association with serious head injury or hospital discharge before 48 h, calculated as odds ratios (ORs) with 95% confidence intervals.</p><p><strong>Results: </strong>We identified 2031 patients among whom: the mechanism of injury was blunt in 60%, penetrating in 30%, and both in 11%. A total of 87% of patients were discharged within 48 h. Among patients with blunt head injury, factors most strongly associated with ≤48-h discharge include GCS of 15 (89.3% of patients, OR 5.73, 95% CI 3.84-8.54) and negative or no ordered head imaging (89.3% of patients, OR 13.96, 95% CI 9.58-20.33). Combinations of factors including GCS of 14 and SBP >160 (1.6% of patients, OR 0.14, 95% CI 0.06-0.35) or SBP < 100 (2.2% of patients, OR 0.35, 95% CI 0.15-0.83) were less likely to be discharged by 48 h.</p><p><strong>Conclusions: </strong>In a military-relevant, austere, prolonged-care, civilian trauma setting, we identified factors associated with discharge after 48 h or an abnormal computed tomography head. We believe that further evaluation of individual and combinations of clinical factors may prove beneficial in imaging and transport decision-making in remote military settings.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557280","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":"A Low-Dose Oxytocin Protocol Decreases Quantitative Blood Loss in Elective Cesarean Sections: A Single-Center, Retrospective Cohort Study.","authors":"Courtney R Hood, Brian J Baxter, Alyssa R Puccia, Michael S Patzkowski","doi":"10.1093/milmed/usae545","DOIUrl":"https://doi.org/10.1093/milmed/usae545","url":null,"abstract":"<p><strong>Introduction: </strong>The prophylactic use of oxytocin after cesarean delivery has been shown to reduce maternal blood loss by 40 to 50%, yet there remains significant clinical deviation in how the medication is dosed. In January, 2021, the Defense Health Agency issued Procedural Instruction 6025.35 entitled Guidance for Implementation of the Postpartum Hemorrhage Bundle. This directive established a set of processes and procedures for the risk assessment and treatment of postpartum hemorrhage, including a new standardized oxytocin protocol for vaginal and cesarean deliveries. The purpose of this study was to compare quantitative blood loss after elective cesarean deliveries using the new standardized oxytocin protocol versus the historically unregimented, high-dose strategy. A secondary outcome was the incidence of postpartum hemorrhage, defined as quantitative blood loss greater than 1 l at the time of calculation.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study compared quantitative blood loss in healthy parturients undergoing elective cesarean deliveries under neuraxial anesthesia that received either high-dose oxytocin (40 international units [IU]) given over an unregulated amount of time via wide open IV infusion (Group H), or a low-dose oxytocin protocol (Group L): 3 IU of oxytocin administered over 3 min, with a second 3 IU bolus if inadequate tone, then oxytocin infused at 18 IU/h for 1 h followed by 3.6 IU/h for 3 h. Exclusion criteria included failed labor induction converted to cesarean delivery, high-risk pregnancy (placental abnormalities, maternal bleeding disorders, gestational hypertension, and pre-eclampsia), those who received general anesthesia, and multiple gestation pregnancies.</p><p><strong>Results: </strong>Sixty-two patients were included for analysis in Group H, and thirty-seven in Group L. A multivariate linear regression model controlling for patient age, gestational age at time of delivery, cesarean section indication, and hemorrhagic medications given found the regimen of oxytocin a patient received did not predict their blood loss (R2 = 0.08, adjusted R2 of -0.003, P = .48). Additionally, the low-dose group had less blood loss by estimated marginal means (769 mL, 95% CI, 526-1011, versus 944 ml, 95% CI, 724-1164, P = .14). The incidence of postpartum hemorrhage was 21.0% in Group H and 13.5% in Group L, P = .09.</p><p><strong>Conclusions: </strong>This study concludes the low-dose oxytocin protocol released in the Defense Health Agency hemorrhage bundle does not correlate with increased blood loss due to uterine atony when compared to a high-dose strategy for an elective, low-risk cesarean delivery. Future research should be aimed at capturing the side effect profile of this oxytocin dosing strategy, quantitative blood loss analyses in high-risk patients, and its effect on blood transfusion rates.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557353","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":"Multidisciplinary Case Review Committee: Comprehensive Referral Source for Evaluation and Treatment of High-Risk Exertional Injuries Fostering Safe and Expeditious Return to Duty Decisions.","authors":"Francesca Cariello, Melissa Rittenhouse, Josh Kazman, Mark Haigney, M Alaric Franzos, Glen Cook, Jeffrey C Leggit, Francis G O'Connor","doi":"10.1093/milmed/usaf060","DOIUrl":"https://doi.org/10.1093/milmed/usaf060","url":null,"abstract":"<p><strong>Introduction: </strong>Exertion-related injuries (ERIs) affect Service Members (SM) worldwide with a direct impact on force readiness. Recent evidence has identified that the diagnostic coding of heat-related clinical illnesses can be subjective and prone to errors. Furthermore, ERIs, often have complex presentations impacting multiple organ systems. Optimal management, including establishing the correct diagnosis and plan for return to duty or disability evaluation system referral, frequently requires the expertise of multiple clinical specialties.</p><p><strong>Materials and methods: </strong>This manuscript describes the function and process of the Consortium for Health and Military Performance (CHAMP) Multidisciplinary Case Review Committee (MDCRC), a multi-disciplinary clinical resource specifically focused on assisting clinicians with complex ERIs. To illustrate how the MDCRC works, we include methodology, and descriptive and inferential analysis of all MDCRC-referred cases.</p><p><strong>Results: </strong>The MDCRC has evaluated 205 SM with complex exertional illness presentations; exertional rhabdomyolysis (ER; 53%), exertional heat illness (34%), exertional collapse associated with sickle cell trait (ECAST; 5%), cardiomyopathy (6%), or other exertion-related conditions. Most SMs (72%) successfully returned to duty within 3 months, but there was a very wide range of duty restriction durations, especially for SM with ER (median: 3 months; interquartile range: 1, 8) and ECAST (median: 12; IQR: 3, 18). Duty restrictions were longer for younger SM (<26 vs ≥26 years: risk ratio [RR]: 1.49, 95% CI: 0.98, 2.29) and history of multiple ERIs (RR: 1.69; 95% CI: 1.07, 2.62).</p><p><strong>Conclusions: </strong>The MDCRC is a coordinated and comprehensive resource for all military health care practitioners and SM providing the most up-to-date evidence based clinical expertise for ERIs. MDCRC assists with proper diagnosis, facilitates expedited evaluations to optimize return to duty decisions, and increases SM readiness. MDCRC may be especially crucial for providers who have limited resources and experience in treating SM with ERIs.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557265","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":"Innovative Algorithm for Incidence of Leukemia and Lymphoma in the U.S. Military Health Care System.","authors":"Scott W Penney, Nora L Watson, Daniel I Brooks, Susan L Whiteway, Anne B Warwick, Richard C Zanetti, Lauren M Vasta","doi":"10.1093/milmed/usaf054","DOIUrl":"https://doi.org/10.1093/milmed/usaf054","url":null,"abstract":"<p><strong>Introduction: </strong>There is limited research on cancer incidence in pediatric and adolescent/young adult patients using health care claims data and no standard algorithm for such a query. This study aimed to establish an algorithm to estimate incidence rates for multiple cancer types from 2013 to 2017 within the Military Health System and compare them to rates reported from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program.</p><p><strong>Methods: </strong>The Military Health System Data Repository was queried by International Classification of Diseases 9 and 10 codes using look-back-periods to identify incident cases of leukemia and lymphoma diagnoses. Age-specific incidence rates within the Military Health System were compared to SEER incidence rates using standardized incidence ratios (SIRs).</p><p><strong>Results: </strong>Military Health System incidences derived from our algorithm were similar to SEER incidences for all evaluated cancers in primary analyses. For pediatric dependents: Acute lymphoblastic leukemia (ALL) SIR 1.01 (95% CI, 0.91-1.12), acute myeloid leukemia (AML) 1.10 (95% CI, 0.86-1.36), Hodgkin's lymphoma 0.93 (95% CI, 0.73-1.16), and non-Hodgkin's lymphoma (NHL) 1.07 (95% CI, 0.88-1.28). For adult dependents: ALL SIR 1.09 (95% CI, 0.79-1.43), AML 1.19 (95% CI, 0.86-1.59), Hodgkin's lymphoma 1.19 (95% CI, 1.00-1.40), and NHL 0.85 (95% CI, 0.66-1.06). For active duty patients: ALL SIR 1.38 (95% CI, 0.96-1.87), AML 1.35 (95% CI, 0.94-1.84), Hodgkin's lymphoma 1.23 (95% CI, 1.01-1.48), and NHL 0.88 (95% CI, 0.67-1.12).</p><p><strong>Discussion: </strong>Pediatric incidence rates were similar when compared to SEER rates for leukemia and lymphoma type, suggesting that this algorithm may be used to capture the burden in the military pediatric population and serve as a research tool to evaluate cancer epidemiology and patient outcomes.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557263","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}