Military Medicine最新文献

{"title":"Correction To: Nasal Decolonization in Congregant Settings: Reducing Infection Spread, Cutting Costs, and Improving Operational Readiness.","authors":"","doi":"10.1093/milmed/usaf019","DOIUrl":"https://doi.org/10.1093/milmed/usaf019","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024089","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":"Insights Into the Health of Postpartum Airmen From the U.S. Air Force Fitness Database.","authors":"Melanie J Frost, Danielle K Boeke, Erin M Flerlage, Brittaney R Nores, Eric J Amos, Neal Baumgartner","doi":"10.1093/milmed/usaf006","DOIUrl":"https://doi.org/10.1093/milmed/usaf006","url":null,"abstract":"<p><strong>Introduction: </strong>Physical fitness is an integral part of military readiness, and failure to meet military Physical Fitness Assessment (PFA) standards can severely damage or end careers. Postpartum active duty service members experience a drop in PFA scores and passing rates compared to their pre-pregnancy assessments. Each branch recently extended recovery time to 12 months, but more research is required to see if this change alone is enough to return both active duty and reserve component postpartum personnel to their own preconception PFA outcomes (scores, passing rates, and injury rates) and those of a control group of nullpartum female airmen.</p><p><strong>Materials and methods: </strong>The Air Force Fitness Management System II database contains PFA records including demographic data and PFA outcomes among airmen from the total force: active duty, Air Force Reserve (AFR), and Air National Guard (ANG). We extracted data from 2015 to 2019 for three successive PFAs per individual, consisting of 12,971 records for perinatal Airmen and 308,155 records for nulliparous female airmen. We calculated overall PFA scores, passing rates, and exemption rates for active duty and AFR/ANG postpartum and nullpartum airmen, and then performed regressions to determine if differences between these groups persisted when accounting for demographic and prior physical fitness variables.</p><p><strong>Results: </strong>Although 92% of postpartum airmen scored high enough to pass the PFA, their scores decreased from pretest scores by a larger margin than those for nullpartum airmen. Out of a possible 100 points, postpartum AFR/ANG members' scores decreased more (-4.5 points) than active duty scores (-2.8 points), while nullpartum members' scores decreased by -0.4 and -0.7, respectively. Nullpartum passing rates remained stable but decreased for both active duty and AFR/ANG postpartum airmen (-4% and -8%). Active duty postpartum airmen experienced a larger increase in component exemptions, which may indicate injury, (+8%) than nullpartum female airmen (+6%). These results were maintained when we controlled for age, officer status, previous pregnancies, and prior physical fitness. Compared with active duty nullpartum female airmen, active duty and AFR/ANG postpartum women had lower scores (-3.23, -6.79), and more than twice the odds of failure (2.44 and 5.42 times higher). AFR/ANG generally are less than half as likely to have a component exemption, but active duty postpartum airmen had 29% higher odds of having a component exemption than nullpartum active duty airmen.</p><p><strong>Conclusion: </strong>Even with a 12-month recovery period, postpartum airmen fare worse on all PFA outcome dimensions studied compared to nulliparous airmen and with preconception selves. Perinatal airmen with more experience, education, and access to resources have better PFA outcomes. The U.S. Air Force should consider a comprehensive maternal wellness program including ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024098","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":"Time Is a Tool: Evaluation of a Prolonged Casualty Care Curriculum With a Focus on Temporal Fidelity.","authors":"Amy F Hildreth, Rebekah Cole, Jonathan Henderson, Cynthia Shen","doi":"10.1093/milmed/usaf017","DOIUrl":"https://doi.org/10.1093/milmed/usaf017","url":null,"abstract":"<p><strong>Introduction: </strong>In current and anticipated future conflicts, including large-scale combat operations, medical teams are tasked to provide prolonged casualty care (PCC) or extended patient care that occurs when delays in evacuation exceed the team's capabilities. Although the principles of PCC are often taught to military medical providers using simulation, educators rarely dedicate the time to training required to simulate the prolonged nature of these encounters. Therefore, a lack of knowledge exists regarding which aspects of extended care may be lost in an accelerated training scenario.</p><p><strong>Materials and methods: </strong>To close this knowledge gap within military medical education and training, we modified an existing PCC curriculum at the USU, Operation Gunpowder, to focus on temporal fidelity, extending the length of the simulated encounter to 21 hours. We used a qualitative phenomenological design to explore the students' experiences and perceptions by closely analyzing their assigned reflection papers.</p><p><strong>Results: </strong>We identified four themes from the students' reflection papers: (1) Recognized effects of fatigue, (2) navigated resource limitations, (3) realized the value of teamwork, and (4) noted the importance of communication and documentation. These themes revealed benefits of incorporating temporal fidelity into PCC training, including self-awareness of personal limits and possible strategies to mitigate fatigue when medical or operational mission requirements dictate sleep deprivation. Future studies are needed to determine other training scenarios that would benefit from adherence to temporal fidelity.</p><p><strong>Conclusions: </strong>Wars and disasters require medical providers trained in PCC. Future educational activities aimed at teaching PCC should continue to incorporate temporal fidelity to help teach these valuable lessons.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008411","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":"Gender and Race Differences in Rates of PTSD Service Connection: Results From a Nationally Representative Panel of OEF/OIF/OND Veterans.","authors":"Maureen Murdoch, Barbara Ann Clothier, Siamak Noorbaloochi, Aliya Rachel Webermann","doi":"10.1093/milmed/usaf007","DOIUrl":"https://doi.org/10.1093/milmed/usaf007","url":null,"abstract":"<p><strong>Background: </strong>Department of Veterans Affairs disability benefits for post-traumatic stress disorder (PTSD), also known as \"service connection,\" have been shown to reduce homelessness and poverty, increase mental health engagement, and improve clinical outcomes. However, gender and race disparities in PTSD service connection have been described in Vietnam and post-Vietnam era Veterans.</p><p><strong>Methods: </strong>Post-traumatic stress disorder service connection outcomes were assessed in a nationally representative, randomly selected, gender-stratified, prospective panel of 960 Veterans who served during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Using weighted logistic regression, we assessed the effects of male versus female gender and Black versus non-Black race on odds of PTSD service connection after controlling for other known predictors using Veterans Affairs administrative data. A secondary analysis supplemented administrative data with self-reported data in a subset of 410 Veterans.</p><p><strong>Results: </strong>A total of 56.3% of men and 45.2% of women (P = .001) received PTSD service connection. In all, 51.1% of Black men versus 57.5% of non-Black men received PTSD service connection (P = .26), while 35.4% of Black women and 50.8% of non-Black women received PTSD service connection (P = .001). The mean total service connection rating, which determines base monthly compensation, was 69.4% ± 28.1 for men receiving PTSD service connection and 49.1% ±31.5 for men denied PTSD service connection (P <.001). The mean total service connection rating for women receiving PTSD service connection was 70.8% ±20.7 compared to 49.7% ± 27.4 for women denied PTSD service connection (P <.001). Disproportionate combat exposures explained the gender difference in PTSD service connection (effect size modification = 15.4%), but we could not identify a mediating confounder for the inverse association between Black race and PTSD service connection in women.</p><p><strong>Conclusion: </strong>Women were less likely to receive PTSD service connection compared to men; this difference was nearly completely mediated by gender differences in combat exposure. Black women were less likely than non-Black women to receive PTSD service connection, but we could not identify a plausible mechanism to explain this finding. On net, the base compensation package was lower for Veterans denied PTSD service connection than for those receiving PTSD service connection.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008351","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":"Pneumococcal and Herpes Zoster Vaccination Rates Among U.S. Veterans With Chronic Inflammatory Disease on Biologic Medications: A Quality Improvement Project.","authors":"Venusa Phomakay, Sandeep Gupta, Melanie Swims, Debendra Pattanaik","doi":"10.1093/milmed/usaf009","DOIUrl":"https://doi.org/10.1093/milmed/usaf009","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with chronic inflammatory diseases are often treated with pharmacologic therapies that target the immune system and have an increased risk of infection. These risks can be reduced by vaccination against common pathogens. This quality improvement project aimed to increase pneumococcal and herpes zoster vaccination rates in patients with chronic inflammatory disease on biologic immunosuppressive therapy.</p><p><strong>Materials and methods: </strong>This quality improvement project was developed and implemented at the Veteran Affairs (VA) hospital in Memphis, TN. A VA data warehouse query was used to identify veterans with an active prescription for a biologic immunosuppressant over 2 phases (phase 1 and phase 2) of the project. Clinical pathway and VA electronic medical record, e.g., Computerized Patient Record System order set for various biological agents and vaccines, were developed by the investigators over a period of 3 months before the activation of phase 1 and was approved by the Memphis VA Medical Center Pharmacy and Therapeutics Committee. The pathway and the order set were developed for providers prescribing biologic therapies to include a review of patient immunization status and the option to order vaccines before initiation of biologics. When a provider used the order set to order the biologic, the appropriate vaccine and laboratory tests were recommended on the order set to educate the provider to take the appropriate actions necessary before the medication was started. Charts of Veterans included in the study were reviewed to assess vaccination rates before and after the QI project implementation for each phase. Phase 1 occurred over a 1-year period (October 2018 to October 2019) and sought to increase pneumococcal vaccination (PV) rates in patients on biologic therapies compared to the preintervention period. Recombinant zoster vaccine was not included in this phase as it was not readily available at the Memphis VA Medical Center at that time. Phase 2 (November 2019 to April 2022) sought to increase pneumococcal and herpes zoster vaccination rates.</p><p><strong>Results: </strong>During phase 1, pneumococcal vaccination rates improved from a 41% preintervention rate to 66% (P < .01). During phase 2, 73% of patients completed their pneumococcal vaccination series and 58% received PCV13, PPSV23 and at least 1 dose of Shingrix, compared to 30% in the preintervention period (P < .01).</p><p><strong>Conclusions: </strong>Provider education, clinical pathway, and Computerized Patient Record System order set can improve vaccination rates in patients with chronic inflammatory diseases on biologic immunosuppressive therapy.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008396","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":"Artificial Intelligence Decision Support Systems in Resource-Limited Environments to Save Lives and Reduce Moral Injury.","authors":"Lindsey Umlauf, Michael Remley, Christopher Colombo, Jeremy Pamplin","doi":"10.1093/milmed/usaf010","DOIUrl":"https://doi.org/10.1093/milmed/usaf010","url":null,"abstract":"<p><p>Future military conflicts are likely to involve peer or near-peer adversaries in large-scale combat operations, leading to casualty rates not seen since World War II. Casualty volume, combined with anticipated disruptions in medical evacuation, will create resource-limited environments that challenge medical responders to make complex, repetitive triage decisions. Similarly, pandemics, mass casualty incidents, and natural disasters strain civilian health care providers, increasing their risk for exhaustion, burnout, and moral injury. As opposed to exhaustion and burnout, which can be mitigated with appropriate rest cycles and changes in workload, moral injury is a long-lasting and impairing condition with cognitive, emotional, behavioral, social, and spiritual repercussions. Exhaustion and burnout experienced by providers during COVID-19 correlated with increased disengagement and the desire to leave the health care field. Telemedicine and telementoring expands access to medical expertise, thereby reducing an inexperienced provider's stress levels and uncertainty and improving their confidence in care delivery. Artificial Intelligence Decision Support Systems (AIDeSSAIDeSS) may represent the next phase in clinical decision support systems across the continuum of care. These systems may help address both the anticipated scale of casualties in large-scale combat operations and the critical expertise gaps during future pandemics, mass casualty events, and natural disasters. This study advocates for urgent research at the intersection of high-stress, resource-limited care contexts that may cause moral injury in health care providers and the potential for AIDeSS to reduce that risk. Understanding these dynamics may yield strategies to mitigate psychological distress in medical responders, increase patient survival, and improve the health of our medical systems.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008376","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":"Response to Disguised Among the Sea: The Implications of Artificial Islands on Casualty Care in the Indo-Pacific.","authors":"Samantha J Jennings, Marie F Chiong","doi":"10.1093/milmed/usaf013","DOIUrl":"https://doi.org/10.1093/milmed/usaf013","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024099","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":"Implementation of Military Onboarding for Medical Students and its Effect on Student Confidence in the Health Professions Scholarship Program.","authors":"Andreanna E Bowers, Ethan O'Boyle, Rahul Garg, James Lyons","doi":"10.1093/milmed/usae432","DOIUrl":"https://doi.org/10.1093/milmed/usae432","url":null,"abstract":"<p><strong>Introduction: </strong>Health Professions Scholarship Program (HPSP) medical students typically enter the military with minimal military experience, commissioning specifically for the scholarship. During medical school, the only required training is a 5- to 6-week officer training course, which is neither specific to medicine nor guaranteed to be at the beginning of school, since it can be taken at any time. This lack of prior experience can lead to decreased confidence and understanding of the HPSP, specifically the medical school timeline leading up to the military match process and overall military. Our study investigated the effect of implementing a new military-specific orientation module on improving students' confidence and specific knowledge about the HPSP and military training.</p><p><strong>Materials and methods: </strong>Two current HPSP students gave a 1-h presentation on the following topics: medical school reimbursements and finances, active duty training, military training, deferrals, the medical school timeline, and the types of medical residencies available associated with the HPSP. The orientation was held for first- and second-year medical students who were either enrolled or interested in the HPSP. The study participants (n = 21) completed a pre- and post-survey that assessed case-based knowledge (12 questions) and students' confidence levels regarding the program (1 question each for the HPSP, overall military, and medical school timeline leading to the residency match). The pre- and post-survey results were analyzed using Fisher's exact test to assess the change in students' confidence and knowledge change after the presentation.</p><p><strong>Results: </strong>The program significantly improved students' confidence in understanding the HPSP (P = .0004), military (P = .003), and medical school timeline leading to the residency match (P = .002). Our study also significantly improved participants' knowledge regarding reimbursements for medical school supplies (P = .041) and board exams (P = .001), active duty definition (P = .039), and deferment because of failure (P = .010) or fellowship (P = .025).</p><p><strong>Conclusion: </strong>Overall, the students felt more confident regarding the HPSP and showed improved knowledge after the orientation program. We found higher baseline knowledge regarding active duty tours, which their coordinators communicate well with HPSP students. Similar orientation programs could effectively improve the onboarding process of incoming HPSP students and those interested in applying for HPSP across multiple medical schools. Such programs can improve long-term student satisfaction and the duration of service following the minimum service commitments. Future research with a larger sample size and prospective design is needed to understand the long-term effects of this increased confidence on overall program satisfaction and military career.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008356","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":"Response to Response-Letter to Editor. Nasal Decolonization in Congregate Settings: Reducing Infection Spread, Cutting Costs and Improving Operational Readiness.","authors":"Gale S Pollock","doi":"10.1093/milmed/usae476","DOIUrl":"https://doi.org/10.1093/milmed/usae476","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008407","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":"Rare Case of Immediate Postoperative Acute Gout Flare Associated With Surgical Management of Facial Abscess of Odontogenic Origin-Case Report.","authors":"Nikoletta Vargas, Mana Saraghi","doi":"10.1093/milmed/usaf001","DOIUrl":"https://doi.org/10.1093/milmed/usaf001","url":null,"abstract":"<p><p>Gout is caused by monosodium urate crystal deposition within joints and periarticular structures. It is characterized by the typical arthritis symptoms such as pain, swelling, and redness usually involving the first metatarsophalangeal joint. Recurrent attacks of gout are common, especially after major surgical procedures during which intense cell turnover takes place and can lead to hyperuricemia and accumulation of monosodium urate crystals. However, there is insufficient evidence about the re-occurrence of gout in patients after surgical interventions in the head and neck area. This case report is the first to describe an immediate acute gout episode after surgical management of a facial abscess involving multiple spaces, associated with severely decayed, nonrestorable lower left molars, in a 58-year-old male patient with a history of gout. It furthermore describes prophylactic measures to prevent the occurrence of gout flares in similar cases.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008403","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}