Military Medicine最新文献

{"title":"Military Contributions to Damage Control Training in Civilian Setting.","authors":"Audrey Jarrassier, Gaël De Rocquigny, Pierre Pasquier","doi":"10.1093/milmed/usae530","DOIUrl":"https://doi.org/10.1093/milmed/usae530","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751274","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":"Assessing Attention-Deficit/Hyperactivity Disorder in Post-9/11 Veterans: Prevalence, Measurement Correspondence, and Comorbidity With Posttraumatic Stress Disorder.","authors":"Arielle R Knight, Sahra Kim, Alyssa Currao, Adam Lebas, Madeleine K Nowak, William P Milberg, Catherine B Fortier","doi":"10.1093/milmed/usae539","DOIUrl":"https://doi.org/10.1093/milmed/usae539","url":null,"abstract":"<p><strong>Introduction: </strong>Attention-deficit/hyperactivity disorder (ADHD) is common among Veterans but overlapping symptoms with other prevalent psychiatric disorders (e.g., posttraumatic stress disorder [PTSD]) complicate diagnosis. This study aims to (1) assess the prevalence of ADHD, (2) evaluate the correspondence between ADHD self-report measures, and (3) examine the association between ADHD and PTSD in a sample of combat-deployed post-9/11 Veterans.</p><p><strong>Materials and methods: </strong>A total of 332 combat-deployed post-9/11 Veterans from VA Boston Healthcare System completed the Clinician-Administered PTSD Rating Scale, 2 ADHD self-report questionnaires (Wender Utah Rating Scale-25 and the Adult ADHD Self-Report Scale v1.1), and report of the presence/absence of a historical ADHD diagnosis. Attention-deficit/hyperactivity disorder status via Wender Utah Rating Scale ([WURS-25] criterion standard) was compared to historical ADHD diagnosis and the ASRSv.1.1 screener. Log-binomial regression models assessed the relationship between ADHD and PTSD. This study was reviewed and approved by the VA Boston Institutional Review Board.</p><p><strong>Results: </strong>In all, 12.7% of the sample met criteria for ADHD per the WURS-25. The WURS-25 demonstrated poor sensitivity with historical ADHD diagnosis (27.7%) but adequate specificity (90.3%). Poor sensitivity (60.7%) and specificity (60.8%) were observed between the WURS-25 and the ASRS-v.1.1. The prevalence of ADHD was 2.5 times as high for Veterans with a history of PTSD (Prevalence Ratio [PR] = 2.53, 95% CI: 1.11, 7.28) and over twice as high for those with current PTSD (PR = 2.19, 95% CI: 1.17, 4.38).</p><p><strong>Conclusions: </strong>Attention-deficit/hyperactivity disorder is prevalent in this sample of Veterans and is associated with an increased risk of current and lifetime PTSD. The low correspondence across self-report ADHD measures illustrates the complexity of assessing ADHD in this highly comorbid population. When evaluating ADHD in Veterans, clinicians should carefully consider alternative and contributory symptom etiologies, such as PTSD, to ensure accurate diagnosis and treatment.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739626","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":"Individual and Catchment Area Factors Associated With Breast and Cervical Cancer Screening Within the Military Health System.","authors":"Joel E Segel, Alison Chetlen, Mark Ramos, Nicholas G Zaorsky, Guangqing Chi, Patrick Luan","doi":"10.1093/milmed/usae525","DOIUrl":"https://doi.org/10.1093/milmed/usae525","url":null,"abstract":"<p><strong>Introduction: </strong>Breast and cervical cancer screening is critical to identifying cases at earlier stages in order to begin treatment earlier and improve survival. Screening rates have been shown to vary within the Military Health System (MHS). The goal is to estimate drivers of variation in screening rates within the MHS.</p><p><strong>Materials and methods: </strong>We used 2007-2019 MHS Data Repository Data to examine individual-level and catchment area-level factors associated with 1- and 2-year breast and cervical cancer screening rates. Specifically, we estimated univariate and multivariate association between 1- and 2-year probability of breast and cervical cancer screening rates and age group, marital status, rank, service branch, beneficiary type (service member vs. dependent), race/ethnicity of service members, catchment area fraction of overall care through purchased care and average per capita spending. The project was approved by both the Penn State Institutional Review Board (IRB) and the Defense Health Agency's electronic IRB.</p><p><strong>Results: </strong>Overall, we observed a 45.6% 1 year and a 65.7% 2-year mammography screening rate and a 30.5% 1 year and a 51.9% 2-year Pap testing rate. For breast cancer screening, we found higher screening rates for older (ages 50-64 years), married, service members, more senior ranked women or those married to more senior ranked members, and non-Hispanic Black women in both unadjusted and multivariate analyses. Conversely, we found higher rates of cervical cancer screening for younger, unmarried, more junior ranked women as well as for non-Hispanic Black women. We also found higher rates for both breast and cervical cancer screening in catchment areas with a greater fraction of care delivered through the private sector.</p><p><strong>Conclusion: </strong>Our finding of higher screening in catchment areas with higher rates of purchased care warrants additional study to understand what factors may drive this result. The differential findings of the association between individual characteristics and breast and cervical cancer screening suggest important differences in these 2 types of screening with potentially different policies required to encourage and enhance breast vs. cervical cancer screening. Finally, our results showing higher screening among non-Hispanic Black women suggests important features of the MHS, such as universal, low-cost sharing coverage may help to reduce racial and ethnic disparities in breast and cervical cancer screening.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739643","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":"Key Insights for the Ethical and Appropriate Use of Artificial Intelligence by Medical Learners.","authors":"Brian Patrick Murray, Darshan S Thota, Carrie Baker, Joshua B Stierwalt","doi":"10.1093/milmed/usae536","DOIUrl":"https://doi.org/10.1093/milmed/usae536","url":null,"abstract":"<p><strong>Introduction: </strong>The rapid advancement and adoption of large language models (LLMs) in various academic domains necessitate an examination of their role in scholarly works by medical learners.This paper seeks to discern the implications of LLM use by medical learners when preparing works for publication. While LLMs possess great potential to revolutionize the academic writing process, they can detract from the learning process when used by students and residents who are still learning how to research, formulate ideas, and write cohesive arguments.</p><p><strong>Materials and methods: </strong>An environmental scan of both traditional evidence-based sources and gray literature was performed to glean best practices of generative AI in medical education. Sources included peer-reviewed journals, open-source websites, and previous publications in this field ranging from 2015 to 2023.</p><p><strong>Results: </strong>We propose several strategies to detect AI involvement: direct inquiry to the learner, assessing the coherence level of the content in contrast to the learner's known capabilities, recognizing patterns of shallow insight or depth, utilizing plagiarism and AI-specific detection tools, and monitoring for fabricated citations-a known pitfall of LLMs.</p><p><strong>Conclusions: </strong>Although LLMs offer potential efficiencies in academic writing, unchecked use can jeopardize the development of essential critical thinking and analytical skills in medical learners. Ultimately, mentors and primary investigators are responsible for ensuring learners are advancing and appropriately utilizing new and emerging technology. This study provides a foundational framework for educators in both responsible use of generative AI and best practices.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751273","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":"Injuries Associated With Mandated Wear of Body Armor in Iraq.","authors":"John Kuckelman, Christopher Mitchell, Fernando Garcia, Travis Breazeale, Roxanne Wallace, Jason Radowsky","doi":"10.1093/milmed/usae529","DOIUrl":"https://doi.org/10.1093/milmed/usae529","url":null,"abstract":"<p><strong>Introduction: </strong>Protective ballistic body armor (BA) may be needed during certain threat postures while deployed. This requirement often adds between 35 and 45lbs of extra weight carried by the service member (SM) for multiple hours during the day. The physical toll of that extra weight and the effect it may have on deployed medical resources has not been clearly characterized in the literature. We sought to evaluate the association of a protective BA wear requirement with musculoskeletal (MSK) complaints and to better characterize how these effects are manifested within the deployed military health care system.</p><p><strong>Material and methods: </strong>All encounters at a Role III Field Hospital were evaluated and queried for MSK injury. Data collected included the SM type, age, gender, MSK anatomy of concern, type of evaluating provider, disposition, and medications rendered. Injuries and outcomes were then compared between two groups; SMs who were seen for MSK complaints while BA was required (October 2023 to March 2024) and those during a period when BA was not required (No-BA = October 2022 to March 2023).</p><p><strong>Results: </strong>A total of 2,805 encounters were evaluated. Non-SM visits were excluded (455) leaving 2,350 left for evaluation. In all, 969 (41.2%) were identified as encounters for MSK injury. No-BA had significantly fewer visits of MSK injury at 429 (38%) compared to the BA group at 540 (44%, P = .001). Active duty (AD) and National Guard (NG) SMs made up a larger portion of MSK visits in the BA group at 54% and 41%, respectively, compared to 35% Reserve (AR) and 36% NG in the No-BA group (P < .001). Service member were 12 times more likely to require a physical therapy treatment in the BA group (60%) vs. the No-BA (5%, P < .001). Prescriptions of non-steroidal anti-inflammatory medication were more common in the BA group at 11% of all visits compared to 4% in the No-BA group (P < .001). This was also true for muscle relaxers at 1% vs. 3% (P = .008). Shoulder and back injuries represented the largest proportion of MSK areas of concern at 22% and 24%, respectively, with only neck injuries being higher in the BA group at 8.5% vs. 5% (P = .03).</p><p><strong>Conclusions: </strong>Required wear of BA was associated with an increase in MSK visits across all types of US SMs. Shoulder and back injuries were the most common with a significant increase in visits to physical therapy in the BA group. Anti-inflammatory and muscle-relaxing medications were prescribed more frequently in the BA group. A dedicated prospective study would help better elucidate the causality of these associations. Risk-benefit analysis of threat posture, with the knowledge of these health care associations, deserves serious consideration.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739647","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":"Investigation of Military Spouse Suicide.","authors":"Rebekah Cole, Rebecca G Cowan, Elizabeth Pearce, Taqueena Quintana, Xiao Ren","doi":"10.1093/milmed/usae524","DOIUrl":"https://doi.org/10.1093/milmed/usae524","url":null,"abstract":"<p><strong>Background: </strong>Recent statistics released by the Department of Defense have revealed increasing numbers of military spouse suicide. Although past qualitative research has suggested possible reasons for this phenomenon, there is a lack of wide-scale quantitative research regarding suicide within the military spouse population. To fill this gap, we aimed to examine military spouses' perceptions of suicide and their ability to access mental health care. We also aimed to explore the perceptions of sucide within various subgroups of military spouses.</p><p><strong>Materials and methods: </strong>We recruited military spouse participants (officer and enlisted) through social media to complete a 12-item Likert survey focusing on their perception of suicide in the military spouse community, including the threat level of suicide, their own mental health status, barriers and stigmas to accessing mental health care, the view from the spouse's leadership, and the leading causes for military spouse suicide. A total of 141 military spouses participated in our study.</p><p><strong>Results: </strong>Spouses' perception of the main threats to their mental health and suicides in their community were an ongoing sense of loss of control (27.7%), loss of identity (25.5%), difficulty accessing mental health services (19.1%), and fear of seeking mental health services (10.6%). Additionally, 28.3% of participants were moderately concerned, quite concerned, or extremely concerned about their mental health. The participants also believed that the threat of suicides in their community was moderately prevalent (35.5%), quite prevalent (17.7%), and extremely prevalent (5%). There was no difference between spouses of officers or enlisted service members, spouses of service members in the Army, Navy, or Air Force on perceptions of suicide risk prevalence, stigma, participants' concern for themselves, confidence in their ability to access resources, confidence in their ability to help another spouse, or the perceived importance military leaders place on preventing suicide. Spousal tenure was similarly not significantly related to any of the variables of interest.</p><p><strong>Conclusions: </strong>Our military spouse particpants reported elevated perceptions about the prevalence of suicide threats, concern for themselves, and stigma toward accessing mental health resources, as well as low perceived importance placed on spouse suicide prevention by military leadership. The spouses reported moderate confidence in their ability to help another spouse or access suicide prevention resources. Our participants also reported challenges in accessing mental health services and perceived a stigma associated with receiving counseling services. Continued focus and advocacy is needed to ensure military spouses receive the mental health support needed to prevent suicide within this population.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739732","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":"Navigating the Leadership Tightrope: A Case Study in the Art of Following and Supporting.","authors":"Matthew C Pflipsen","doi":"10.1093/milmed/usae538","DOIUrl":"https://doi.org/10.1093/milmed/usae538","url":null,"abstract":"<p><p>Military physicians serve as staff officers where both leading and following are important competencies. Navigating between the two roles is a necessary skill to avoid undermining one's boss and to support the mission. This case describes a deployed junior officer reconciling his role as the lead medical expert while supporting a Commander's decision, highlighting the challenges of followership in situations of disagreement.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716435","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":"Dosimetry as a Lagging Indicator of Occupational Exposure to Nitrous Oxide in Pediatric Sedation: A Collaborative Process Improvement Project With Industrial Hygiene.","authors":"Jennifer S Kicker, Cynthia Y Timbie, Susan L Kline","doi":"10.1093/milmed/usae523","DOIUrl":"https://doi.org/10.1093/milmed/usae523","url":null,"abstract":"<p><strong>Introduction: </strong>Nitrous oxide (N2O) is commonly used in pediatric procedural sedation. It is an attractive option to facilitate intravenous line placement, as it does not extend sedation recovery from subsequently administered agents. Although debate exists regarding health consequences of occupational exposure now that scavenging of exhaled gases is common, cooperation of pediatric patients to maximize engineering controls is not guaranteed and can contribute to repeated exposure over the course of a clinician's career. There is no global consensus on personal exposure limits, but the National Institute for Occupational Safety and Health published U.S. guidelines. A dosimetry survey of our sedation team during a short N2O procedure for intravenous line placement exceeded the National Institute for Occupational Safety and Health Recommended Exposure Limit (REL) of 25 parts per million. We designed a process improvement initiative to reduce occupational exposure below the Recommended Exposure Limit on serial surveys.</p><p><strong>Materials and methods: </strong>A continuous flow, titratable, full-face mask N2O delivery system with scavenging by a central vacuum connection was used. A retrospective chart review of N2O procedures performed before the initial dosimetry survey revealed practice trends in provider behavior during N2O administration. Initiation of N2O gas flow and maintenance of face mask seal on an uncooperative patient were identified as two sources of variability. Two-handed face-masking technique, initiation of N2O gas flow only after masking, and continued masking for 2 min of exhaled scavenging were standardized and socialized as best practices. Subsequent dosimetry surveys of the sedation team were coordinated by Industrial Hygiene.</p><p><strong>Results: </strong>Pre- and post-intervention phases were 17 months each and included 92 and 201 N2O patients, respectively. Six dosimetry surveys occurred in the post phase. Intravenous line placement was the typical procedure surveyed. Dosimetry results for all team members during surveys 1-4 were below the REL, with 14 of 16 samples falling below the level of quantitation. Elevated dosimetry results in survey 5 prompted reevaluation of work practices and equipment. A loose component on the delivery system was discovered, corrected, and incorporated as a pre-procedure check. With no further changes to work practices, dosimetry results were below the REL for survey 6.</p><p><strong>Conclusion: </strong>We layered work practice changes atop engineering controls to reduce occupational exposure levels for medical team members. We utilized dosimetry as a lagging indicator, prompting frequent reassessments of our equipment and processes that we might not otherwise have performed. Pediatric sedation programs are encouraged to consider whether Industrial Hygiene resources might provide synergy to process improvement efforts with inhalational sedation agents.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716431","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":"Utilization of Prognosis Assignment: A Cross-Sectional Survey of Military Periodontists.","authors":"Richard E Sawaya, Noel E Dickens, Keith R Merchant, John H Wilson, Caitlin D Darcey","doi":"10.1093/milmed/usae496","DOIUrl":"https://doi.org/10.1093/milmed/usae496","url":null,"abstract":"<p><strong>Introduction: </strong>Prognosis is a forecast of the likely course of a disease and its future implications on treatment outcomes. The significance of periodontal prognosis in clinical practice is evident by its influence on treatment planning, communication, and in the retrospective evaluation of treatment results. While there are multiple well-known prognosis systems reported in the periodontal dental literature, there is an absence of data on the actual use of prognosis assignment among practicing clinicians. The purpose of this study was to survey military periodontists regarding their utilization of periodontal prognosis and associated systems and to evaluate prognosis' influence on treatment planning as well as its implications on operational dental readiness.</p><p><strong>Methods: </strong>A 19-question internet survey was disseminated to military periodontists in the U.S. Air Force, Army, and Navy via their respective Periodontal Consultants to the Surgeon Generals. The survey inquired on provider-specific demographic information, the provider's favored periodontal prognosis system, when and how prognosis is applied, and on the relationship between prognosis and operational dental readiness.</p><p><strong>Results: </strong>Fifty-five percent (n = 65 out of 120) of eligible survey participants completed the survey. Army (94.4%, n = 17) and Air Force (72.2%, n = 13) respondents preferred utilizing the Kwok and Caton periodontal prognosis system compared to 37.9% (n = 11) of Navy periodontists. Most respondents assigned prognosis at multiple time points in a patient's overall course of treatment (68%, n = 44), identified the severity of the periodontal presentation and the predictability of treatment outcomes as the most important factors involved in assigning a prognosis (82%, n = 55), and indicated that periodontal prognosis did not influence their dental readiness classification and vice versa.</p><p><strong>Conclusions: </strong>Kwok and Caton and McGuire periodontal prognosis systems were utilized by the majority of respondents but differed in utilization by military service branch. Respondents considered periodontal presentation severity and treatment outcome predictability the most important factors when assigning a prognosis. There was minimal influence between operational dental readiness and periodontal prognosis. Future research will evaluate prognosis system utilization in a broader population and will assess the impact of system standardization in education and clinical practice.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687380","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":"Capturing and Categorizing the Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A Comprehensive Methodology.","authors":"Veronika Pav, Xiaoning Yuan, Brad Isaacson, Wendy Funk, Ben Hando","doi":"10.1093/milmed/usae245","DOIUrl":"https://doi.org/10.1093/milmed/usae245","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal injuries (MSKIs) represent the most common, costly, and impactful medical conditions affecting active duty service members (ADSMs) of the United States Armed Forces. Inconsistent, variable MSKI surveillance methods and often incompletely described criteria for cohort selection, injuries, incidence, and prevalence have limited efforts to observe longitudinal trends, identify gaps in care, or highlight specific military branches or sites that could benefit from enhanced MSKI intervention protocols. The purpose of this manuscript is to present a comprehensive, well-documented, and reproducible framework for capturing and categorizing MSKI burden, healthcare utilization, and private sector costs for ADSMs across a 12-year period spanning the International Classification of Diseases, 10th Revision, Clinical Modification transition.</p><p><strong>Methods: </strong>This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Upper Extremity, Lower Extremity, Spine, and Head/Neck MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities, private sector care (PC) claims, and theater medical data from October 1, 2010 to September 30, 2021 (Fiscal Years 10-21), using the Military Health System Data Repository. Utilization associated with MSKIs per body region in the direct care and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC MSKI-associated costs were captured per year and categorized by service, body region, and setting.</p><p><strong>Conclusions: </strong>MSKI surveillance research in ADSMs has been impacted by variable, often incompletely described methods. While our approach is not without limitations, our aim was to present a well-documented, reproducible methodology for MSKI investigation in military personnel. By presenting a comprehensive blueprint for capturing and categorizing MSKI care in U.S. service members, our goal is for this methodology to enhance the efforts of researchers, public health officials, and Military Health System leaders to combat MSKIs, the primary medical threat to military readiness.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":"189 Supplement_4","pages":"70-77"},"PeriodicalIF":1.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682112","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}