Military Medicine最新文献

{"title":"Traumatic Incarceration of a Right Inguinal Hernia Due to a Deceleration Injury Following Airborne Operations: A Case Report.","authors":"Alec K Donohue, Elizabeth I Andersen, Adam Jared Kaplan","doi":"10.1093/milmed/usaf483","DOIUrl":"https://doi.org/10.1093/milmed/usaf483","url":null,"abstract":"<p><p>Anterior abdominal wall hernias are a common and well-described surgical pathology occurring in an estimated 5%-10% of the population. Here, we describe a patient found to have acute incarceration of omentum through a patent processus vaginalis (PPV) secondary to a high-energy deceleration injury following airborne operations. Many studies and meta-analyses have been performed to examine the association between occupational risk factors, patient factors, and precipitating events leading to acute hernia and found insufficient evidence to support a causal link between single strenuous events and acute hernia formation. This case underscores the need to consider occult inguinal hernia in high-energy trauma, particularly with a PPV, to enable timely diagnosis and intervention.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200254","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":"Letter From the Chief Executive Officer Dr John Cho.","authors":"Helen Harris","doi":"10.1093/milmed/usaf447","DOIUrl":"https://doi.org/10.1093/milmed/usaf447","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192052","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":"Air, Iron and Plastic: U.S Military Legacy to Pulmonary Support Medicine.","authors":"Patricia Weinstein, Chase Goldberg, Marvin Campos, Joanna Tao, Rahim Hirani, Mill Etienne","doi":"10.1093/milmed/usaf464","DOIUrl":"https://doi.org/10.1093/milmed/usaf464","url":null,"abstract":"<p><p>During the Korean War, the U.S. Air Force developed the \"flying lung\" for aeromedical evacuation of polio patients requiring respiratory support. Decades later, the COVID-19 pandemic prompted the use of 3D printing for the production of scalable respiratory devices. These examples showcase how military innovations have advanced respiratory care.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186280","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":"End-of-Life Care in the Austere Military Environment.","authors":"Jason David, Stevan Fairburn, Hayden Fogle, Nicholas Dulin, Russell Day","doi":"10.1093/milmed/usaf436","DOIUrl":"https://doi.org/10.1093/milmed/usaf436","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Throughout the Global War on Terror (GWOT), the U.S. military built a revolutionary capacity to deliver life-saving care-even in austere environments-through rapid evacuation, far-forward providers and resources, and advances in prehospital and trauma-critical care. However, the operational reality of future Large Scale Combat Operations (LSCO), as evidenced by wars in Ukraine, Sudan, and Gaza, will be marked by high casualty rates and limited medical resources. The number of patients with non-survivable injuries because of operational constraints such as inability to evacuate, massive demand on medial supplies and providers, or unsecure medical infrastructure will increase the number of casualties classified as \"expectant.\" The article provides guidance for medical and non-medical leaders on recognizing the imminently dying, triaging appropriately, and maintaining morale and dignity under extreme conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This is a narrative review informed by current military doctrine, clinical palliative and hospice care literature, and other published works on austere palliative care medicine. It integrates guidance from Tactical Combat Casualty Care (TCCC), Prolonged Casualty Care (PCC), the Joint Trauma System (JTS), and civilian palliative standards. It also explores how medical providers must shift from curative to comfort-focused care, often without formal palliative training, and how end-of-life care protocols must be integrated into doctrine, triage systems, and commander education. We offer pragmatic guidance on clinical decision-making, communication strategies with both medical and non-medical leaders, and the delivery of pain relief, emotional support, and dignity at the end of life-even in forward-deployed, under-resourced settings. No institutional review board approval was required, as this is a non-human-subjects literature-based review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This review emphasizes that end-of-life care must be recognized as a doctrinally supported component of military medicine. Recognition of imminent death based on clinical signs, rather than lab diagnostics, is critical in resource-limited settings. Effective communication with commanders and patients requires reframing \"Leave No One Behind\" to include dignity and pain relief at the end of life. Clinical management of the expectant patient goes beyond simple pain management; doctrinal guidance should be updated to better reflect this. Psychological support for providers, unit members, and families plays a key role in reducing moral injury and preserving cohesion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;End-of-life care in austere military environments is a moral obligation and a mission-critical capability. Current gaps in doctrine, training, and command understanding threaten to leave providers unsupported and patients inadequately cared for in future conflicts. This review explores the complexities of","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176740","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":"Military-Civilian Partnerships Augment Civilian Disaster Response for the National Disaster Medical System.","authors":"L T C Michael S Clemens, David W Callaway, Kylie H Klemann, M A J Travis I Hallquist, C P T Mikayla Y Hamilton, C P T Brianna M Barkley, L T C Louis K Haase, Brian Sutton, Ashley Britton Christmas, M A J Rachel E Bridwell","doi":"10.1093/milmed/usaf401","DOIUrl":"https://doi.org/10.1093/milmed/usaf401","url":null,"abstract":"<p><strong>Introduction: </strong>Military-Civilian Partnerships are a growing solution to both sustain military medical skills and share crisis response lessons learned. These partnerships often receive support from the Administration for Strategic Preparedness and Response (ASPR), which also oversees the National Disaster Medical System (NDMS). Given the unique austere medical training and geographic dispersion of military personnel across the country, these military-civilian partnerships hold potential untapped utility for the NDMS. The United States Army Special Operations Command (USASOC) and Advocate Health maintain a military civilian partnership (MCP) for the sustainment of mission critical wartime medical readiness skills.</p><p><strong>Materials and methods: </strong>The military civilian partnership utilized a developmental \"crawl, walk, and run\" approach through didactics, clinical integration, and joint training exercises in order to integrate military personnel into a real-world NDMS response.</p><p><strong>Results: </strong>The United States Army Special Operations Command-Advocate Health military-civilian partnership demonstrated the inaugural utilization of an MCP during a domestic disaster response to Hurricane Helene in October 2024. The mobilized team included emergency medicine, nursing, anesthesia, and surgery while providing resuscitative and surgical support over 6 days.</p><p><strong>Conclusions: </strong>Military personnel are uniquely trained in mass casualties, austere medicine, and medical operations planning that hold the potential to support the NDMS in a federal response to a homeland disaster. This pilot program suggests that there are robust future opportunities to improve resilience of the domestic disaster system. Ongoing efforts should be directed towards formalizing the processes to incorporate military-civilian partnerships in disaster response, scaling MCP disaster training nationally, and exercising the movement of combat casualties en masse to civilian trauma centers.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176674","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":"Firearm Access Among Military-Connected Youth: A Systematic Review.","authors":"Ian F Eisenhauer, Jennifer Paruk, Stephen J Cozza, Sarah Limbacher, Julia Finn, Ben Harnke, Kathleen M Flarity, Marian E Betz, Ashley Brooks-Russell, Ian H Stanley","doi":"10.1093/milmed/usaf470","DOIUrl":"https://doi.org/10.1093/milmed/usaf470","url":null,"abstract":"<p><strong>Introduction: </strong>Youth with a parent in the U.S. military are more likely than their peers without a parent in the military to report suicidal ideation, plans, and attempts. Firearm access increases risk for suicide mortality among youth; yet, an understanding of firearm access and behaviors among military-connected youth is lacking. The objective of this study is to evaluate firearm access, carrying, and storage among military-connected youth and identify differences with non-military-connected youth.</p><p><strong>Materials and methods: </strong>We conducted a systematic review of peer-reviewed articles and abstracts published through January 31, 2025, focusing on firearm access, carrying, and storage among military-connected youth. We searched Ovid MEDLINE(R), PsycInfo, Embase, Web of Science, Google Scholar, and the reference lists from the assembled articles. This study was approved by the Colorado Multiple Institutional Review Board.</p><p><strong>Results: </strong>We identified 7 studies that examined firearm carrying among military-connected youths, 0 studies examining firearm access, and 0 studies examining firearm storage. Although findings were mixed, most studies indicated an increased risk of firearm carrying among military-connected youths compared with their peers, particularly in the context of parental deployment.</p><p><strong>Conclusions: </strong>Current evidence suggests that military-connected youth may be at increased risk for firearm carrying, which portends higher risk for firearm injury, including suicide. However, there are substantial gaps in the literature, particularly regarding firearm access and storage. Future study of military-connected youth should prioritize comprehensive data collection, to inform and optimize effective interventions designed to benefit military-connected youth.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213082","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":"The Relationship Between Mental Health and Employment Status Among United States Veterans: A Systematic Review.","authors":"Elise V Bailey, Erik J Hansen, Kavita Mosalpuria, Fernando A Wilson","doi":"10.1093/milmed/usaf452","DOIUrl":"https://doi.org/10.1093/milmed/usaf452","url":null,"abstract":"<p><strong>Introduction: </strong>Post-9/11 U.S. veterans experience disproportionately high rates of mental health conditions. They are also more likely than non-veterans to be unemployed. Many studies have examined potential relationships between those phenomena. We aimed to systematically review this literature.</p><p><strong>Materials and methods: </strong>Articles published between September 2001 and September 2021 were identified using PubMed, Web of Science, and Google Scholar. These studies were cohort, cross-sectional, mixed methods, or qualitative studies that reported associations between mental health status or diagnoses and employment and were published in English. Primary mental health conditions of interest were post-traumatic stress disorder (PTSD), alcohol use disorder, bipolar disorder, depression, and other mood, psychiatric, or eating disorders. Two authors screened identified articles for inclusion, and disagreements were resolved by a third author.</p><p><strong>Results: </strong>Twenty-eight articles met inclusion criteria. Three reported PTSD to be positively associated with unemployment, although 7 found null results. Seven of 9 studies examining depression found positive associations between depression and unemployment, with 2 studies showing null findings. One study reported impaired job performance among veterans with alcohol or substance use disorder, but 2 studies on alcohol use disorder reported no significant association with unemployment. Study methodologies varied significantly, including in their populations, employment definitions, and choice of potential confounders.</p><p><strong>Conclusions: </strong>The review suggests a relationship between depression and employment status, but evidence for relationships between other conditions and employment status is mixed, which may be because of significant methodological differences between individual studies. Future work should address this by using a generalizable sample of post-9/11 veterans, a standardized definition of unemployment, and base the statistical model on a theoretical framework describing the relationship between mental health and employment.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176717","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":"Military Healthcare Providers' Intent to Diagnose Adjustment Disorder.","authors":"Candy Wilson, Angela K Phillips, Dawnkimberly Hopkins, Joan Wasserman, Ryan Landoll, Margaux Finn Keller, Jouhayna Bajjani-Gebara","doi":"10.1093/milmed/usaf468","DOIUrl":"https://doi.org/10.1093/milmed/usaf468","url":null,"abstract":"<p><strong>Introduction: </strong>This study explored healthcare providers' intentions to diagnose Adjustment Disorder (AjD) in Active Duty Service Members (ADSMs) within the U.S. military, utilizing the Theory of Planned Behavior (TPB) as a guiding framework.</p><p><strong>Materials and methods: </strong>Focusing on 3 key TPB constructs-attitudes, subjective norms, and perceived behavioral control-we conducted interviews with fifty healthcare providers experienced in caring for ADSMs. Initial coding involved categorizing data according to these theoretical constructs. This was followed by inductive and deductive thematic analysis to identify emergent themes within each construct.</p><p><strong>Findings: </strong>Under the Attitudes construct, themes included patient-focused attitudes, clinician-focused attitudes, and an overarching spectrum of attitudes. Perceived Behavioral Control themes consisted of diagnostic criteria, military policies, and command involvement. Finally, Subjective Norms themes included formal and informal training, patient motivation, and military duty.</p><p><strong>Conclusions: </strong>Our aim was to enhance understanding of diagnostic practices for AjD in this unique context. Recognizing the inherent adjustment that is required for military service, providers demonstrated confidence in diagnosing AjD, but also expressed a clear need for ongoing education and training surrounding this disorder. Providers identified younger, enlisted individuals at their first duty station as the most frequently diagnosed demographic, with adaptation to military expectations as a primary stressor. Varying perspectives on AjD's diagnostic validity were observed, with some viewing it as a necessary diagnosis, while others considered it an overused placeholder diagnosis. Providers underscored the complexity of AjD's diagnostic criteria, the impact of military policies on accession and retention, and the influence of military leadership as key factors in their intent to diagnose AjD. Moreover, while confident in their ability, providers valued peer review and discussions for accurate diagnosis and consideration of ADSMs' career implications. Overall, our findings highlight the nuanced considerations within military mental health, particularly regarding AjD diagnosis.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176764","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":"Can Baseline Recruit Characteristics Predict Actual Injuries Sustained During New Zealand Army Basic Training?","authors":"Narelle Hall, Suzanne Kuys, Mark Brown, Belinda Beck, Michael Steele, Jacques Rousseau, Maria Constantinou","doi":"10.1093/milmed/usaf443","DOIUrl":"https://doi.org/10.1093/milmed/usaf443","url":null,"abstract":"<p><strong>Introduction: </strong>Certain army recruits entering basic training may be at heightened risk of injury. It is unknown if risk factors for lower limb injuries could be identified upon entry to basic training for New Zealand Army recruits. This study investigates if personal, lifestyle and physical performance characteristics reported at entry to training could identify recruits who go on to sustain a lower limb musculoskeletal injury during New Zealand Army basic training.</p><p><strong>Materials and methods: </strong>Recruits' baseline personal (age, sex, and BMI), lifestyle (history of smoking and previous injury) and physical performance characteristics (2.4 km timed run outcome, ankle range of motion using the weight-bearing dorsiflexion lunge test and lower limb dynamic control using the Y Balance Test) were collected at entry to basic training. Backwards stepwise logistic regression analyses were undertaken to determine if baseline variables predicted the occurrence of an injury during basic training and to determine the optimal model of prediction. Significance was set to 0.10. This study was approved by Commander of TRADOC NZDF February 2012 and from Griffith University Human Research Ethics Committee May 2012 (PES/36/11/HREC).</p><p><strong>Results: </strong>In total 248 recruits, 228 males and 20 females, were eligible to participate in the study. Forty-six (18.5%) recruits had missing data thus, 202 (81.5%) remained for analysis. There were 114 recruits who reported one or more injuries, and 88 recruits reported no injury. Two variables were associated with injury risk in the final model: passing the 2.4 km timed run and Y Balance Test average normalized posterolateral reach for the right limb. This model accurately predicted 60.9% of recruits with 36 correctly assigned as not injured and 87 correctly assigned as injured.</p><p><strong>Conclusions: </strong>This study identified that 2 physical performance characteristics were associated with lower limb injury in New Zealand Army recruits commencing basic training; not passing the entry 2.4 km timed run, and low right posterolateral Y Balance Test score for lower limb dynamic neuromuscular control. These findings suggest that physical performance screening may be used to identify recruits at high risk of injury entering training so that mitigation measures could be implemented to lower future injury risk.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176648","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":"Clinical Performance of 3D-Printed Provisional Dental Crowns.","authors":"Thomas W Hardison, Dwayne R Gentry, James J Renda, Joshua A Vess, Terrell M Mitchell, Joseph L Gedge, Christopher J Raimondi, Adam J Wallum, Michele F Schantz, Jeremiah T Gossett, Airton D Soares, Kraig S Vandewalle","doi":"10.1093/milmed/usaf435","DOIUrl":"https://doi.org/10.1093/milmed/usaf435","url":null,"abstract":"<p><strong>Introduction: </strong>Recent advancements in additive manufacturing technology have introduced novel materials and fabrication techniques for provisional dental crowns, offering potential benefits for indirect crown fabrication in resource-limited environments, such as deployed military settings. The U.S. Food and Drug Administration (FDA) has recently cleared 3D-printed dental crown materials for provisionalization of prepared teeth; however, no clinical studies have been conducted to evaluate their performance. This study aimed to assess the short-term clinical performance of a 3D-printed provisional crown material (Temporary CB Resin, Formlabs) compared to a traditional direct provisional crown material (Integrity, Dentsply Sirona). Additionally, this study sought to explore the notional feasibility or proof of concept of incorporating additive manufacturing in deployed environments.</p><p><strong>Materials and methods: </strong>A crossover design was employed, in which each patient received both an indirect 3D-printed and a direct provisional crown on the same tooth. Qualitative assessments were performed using a modifiedFederation Dentaire Internationale (FDI) criteria for restorative materials at the time of placement and after a minimum of 2 months of wear. Quantitative wear analysis was conducted by superimposing baseline and 2-month digital scans using spatial analysis software.</p><p><strong>Results: </strong>At baseline, the 3D-printed provisional material exhibited significantly superior surface luster and anatomic form compared to the direct provisional material. After 2 months, the 3D-printed material demonstrated significantly better surface luster and periodontal response but showed increased fracture rates and loss of retention compared to the direct provisional material. No significant differences in volumetric wear were observed between the 2 materials.</p><p><strong>Conclusions: </strong>The 3D-printed material, Temporary CB Resin, presents a viable alternative to the direct provisional material, Integrity. However, increased attention to occlusal adjustments and cementation techniques may be required to mitigate the risk of dislodgement and fracture, particularly for extended provisionalization periods. Additive manufacturing shows promise in deployed settings; however, significant workflow optimization is necessary for practical implementation.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182169","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}