Military Medicine最新文献

{"title":"Mechanisms of Injury for Traumatic Brain Injury Among U.S. Military Service Members Before and During the COVID-19 Pandemic.","authors":"Tajrina Hai, Yll Agimi, Tesfaye Deressa, Olivia Haddad","doi":"10.1093/milmed/usae492","DOIUrl":"10.1093/milmed/usae492","url":null,"abstract":"<p><strong>Objective: </strong>To understand the mechanisms of injury and demographic risk factors associated with traumatic brain injury (TBI) patients among active and reserve service members in the U.S. Military before and during the COVID-10 pandemic.</p><p><strong>Methods: </strong>Active and reserve service members diagnosed with an incident TBI from January 2019 through September 2021 were selected. Traumatic brain injury patients diagnosed before March 1, 2020 were categorized as pre-COVID (PC), and patients diagnosed on or after March 1, 2020 were categorized as the intra-COVID (IC) group, aligning closely with the date when the World Health Organization officially proclaimed the pandemic. We determined the frequency of causes of injuries associated with TBI separate by sex, age, occupation, and TBI severity. In addition, we conducted multivariate logistic regression analyses to assess the demographic risk factors associated with TBI severity during the PC and IC eras.</p><p><strong>Results: </strong>Our cohort included 48,562 TBI patients: 22,819 (47.0%) diagnosed during the PC era and 25,743 (53.0%) diagnosed during the IC era. The major mechanisms of injury within our TBI cohort were being struck by/against objects, falls/slips/trips, and motor vehicle traffic accidents before and during the pandemic. The most common causes of TBI were not impacted by COVID, but motor vehicle accidents did increase during the IC era. The mechanisms of injury associated with TBI differed by TBI severity: being struck by or against an object caused more mild and moderate TBI; motor vehicle accidents caused more severe TBI; and firearms was a major cause of penetrating TBI. In addition, the percentage of severe TBI because of firearms rose sharply during the IC era. Further, women were more likely to be diagnosed with mild TBI compared to men.</p><p><strong>Conclusion: </strong>Military leaders should consider how different causes of injury are associated with differing TBI severities and how certain demographic groups were vulnerable to specific TBI severities when developing injury prevention programs.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e830-e837"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fully Autonomous Casualty Care on the Future Battlefield.","authors":"Jeremy C Pamplin, Mason H Remondelli, Nathan Fisher, Matthew T Quinn","doi":"10.1093/milmed/usae377","DOIUrl":"10.1093/milmed/usae377","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"81-85"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889769","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 and Provider Opinions Regarding Chaperones for Sensitive Exams.","authors":"Elisabeth M O Coffin, Camille R Suydam, Thomas A O'Hara, Bradley Bandera, Pamela L Burgess","doi":"10.1093/milmed/usae383","DOIUrl":"10.1093/milmed/usae383","url":null,"abstract":"<p><strong>Introduction: </strong>Recommendations for chaperone use during sensitive exams have been left mostly to individual institutions, despite a paucity of data providing guidance. The purpose of this study was to survey patients and medical providers on their attitudes toward chaperone use and explore factors that may influence these attitudes.</p><p><strong>Materials and methods: </strong>A survey was administered at a single tertiary military medical center to providers and patients across multiple specialties, and further sub-analysis of the data were completed. For patients, sub-analysis was done for gender, age, history of sexual abuse, and clinic seen. For providers, sub-analysis was done for provider gender and training status. Before data collection, this study was deemed exempt from institutional review board approval by the Eisenhower Army Medical Center Human Research and Protections Office.</p><p><strong>Results: </strong>A total of 319 patient surveys and 61 provider surveys were collected. Fifty seven percent of patients have no preference regarding chaperone use, 19% prefer having a chaperone, and 24% prefer to not have a chaperone. Female patients and patients with a history of sexual abuse are more likely to prefer a chaperone. Forty two percent of providers always use a chaperone, 79% are more likely to use a chaperone if a patient is of the opposite gender, and 43% select a chaperone based on the gender of the patient. Male providers and providers still in training are more likely to use a chaperone.</p><p><strong>Conclusions: </strong>The majority of patients do not have a preference regarding chaperone presence during sensitive exams; however, female gender and history of sexual abuse increase the likelihood of a patient preferring to have a chaperone present. These factors should be considered when creating an institutional policy regarding chaperone use. Future research should focus on homosexual and transgender patient preferences as this has yet to be explored.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e580-e585"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897780","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":"Prognostic Value of ISS and TRISS Scores in Tunisian Terrorism Victims.","authors":"Khadija Bahrini, Houcine Horchani, Sana Boughariou, Aicha Rebai, Mohamed Zakraoui, Imen Naas, Hedi Gharsallah, Iheb Labbene, Mustapha Ferjani, Walid Sallemi, Zied Hajjej, Maha Shimi, Hazem Fourati, Chihebeddine Romdhani","doi":"10.1093/milmed/usae464","DOIUrl":"10.1093/milmed/usae464","url":null,"abstract":"<p><strong>Introduction: </strong>Injuries caused by terrorism attacks are one of the urgent problems of the society and the health system. In this work, we aimed to assess the injury severity score (ISS) and trauma injury severity score (TRISS) in Tunisian military combatants injured during terrorism attacks.</p><p><strong>Materials and methods: </strong>A total of 153 victims of terrorism admitted to the Military Hospital of Tunis between January 2012 and January 2017 were included. Among them, 107 survived and 46 died (43 victims died at the terrorist attack scene and 3 died in the hospital). All dead patients were autopsied. Injury severity scores and TRISSs were then calculated by 2 professors in the anesthesia-resuscitation department, and the agreement level was assessed using the Bland and Altman curve.</p><p><strong>Results: </strong>We obtained a strong agreement between the 2 experts when assessing the TRISS and ISS. Using the Bland and Altman curve, an agreement between the 2 experts was obtained between 0 to 40 and 60 to 75 for the ISS and between 0 to 25 and 75 to 100 for the TRISS. Moreover, we detected a high level of ISS and TRISS, especially in deceased victims compared to survivors (P <.001). To predict mortality, we revealed by the receiver operating characteristic curve high sensitivity and specificity (more than 90%) before day 28 of hospital stay as well as for ISS and TRISS. Regarding the mechanism of injury, patients injured by gunshot have higher ISSs and TRISSs than those injured by explosion (P < .001).</p><p><strong>Conclusions: </strong>Injury severity scores and TRISSs showed a high reliability to predict the mortality rate in Tunisian victims of terrorism.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e628-e633"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469935","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 Schmitt et al. \"Effect of Serial Pregnancies on Physical Fitness\".","authors":"Kirsten A L Morris, Claire Hooks, Lauren Godier-McBard","doi":"10.1093/milmed/usae459","DOIUrl":"10.1093/milmed/usae459","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"104-105"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469938","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":"Fibromyalgia Diagnosis and Treatment Receipt in the U.S. Military Health System.","authors":"Germaine F Herrera, Patricia K Carreño, Ysehak Wondwossen, Alexander G Velosky, Michael S Patzkowski, Krista B Highland","doi":"10.1093/milmed/usae384","DOIUrl":"10.1093/milmed/usae384","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Meta-analytic findings and clinical practice guidance recommend pharmacological (e.g., pregabalin, duloxetine, and milnacipran) and non-pharmacological (e.g., exercise and sleep hygiene) interventions to reduce symptoms and improve quality of life in people living with fibromyalgia. However, some of these therapies may lack robust evidence as to their efficacy, have side effects that may outweigh benefits, or carry risks. Although the annual prevalence of fibromyalgia in active duty service members was estimated to be 0.015% in 2018, the likelihood of receiving a fibromyalgia diagnosis was 9 times greater in patients assigned female than male and twice as common in non-Hispanic Black than White service members. Therefore, the primary goal of this retrospective study is to examine co-occurring conditions and pain-management care receipt in the 3 months before and 3 months after fibromyalgia diagnosis in active duty service members from 2015 to 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Medical record information from active duty service members who received a fibromyalgia diagnosis between 2015 and 2022 in the U.S. Military Health System was included in the analyses. Bivariate analyses evaluated inequities in co-occurring diagnoses (abdominal and pelvic pain, insomnia, psychiatric conditions, and migraines), health care (acupuncture and dry needling, biofeedback and other muscle relaxation, chiropractic and osteopathic treatments, exercise classes and activities, massage therapy, behavioral health care, other physical interventions, physical therapy, self-care management, and transcutaneous electrical nerve stimulation), and prescription receipt (anxiolytics, gabapentinoids, muscle relaxants, non-opioid pain medication, opioids, selective serotonin and norepinephrine inhibitors, and tramadol) across race and ethnicity and assigned sex. Pairwise comparisons were made using a false discovery rate adjusted P value.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 13,663 service members received a fibromyalgia diagnosis during the study period. Approximately 52% received a follow-up visit within 3 months of index diagnosis. Most service members received a co-occurring psychiatric diagnosis (35%), followed by insomnia (24%), migraines (20%), and abdominal and pelvic pain diagnoses (19%) fibromyalgia diagnosis. At least half received exercise classes and activities (52%), behavioral health care (52%), or physical therapy (50%). Less commonly received therapies included other physical interventions (41%), chiropractic/osteopathic care (40%), massage therapy (40%), transcutaneous electrical nerve stimulation (33%), self-care education (29%), biofeedback and other muscle relaxation therapies (22%), and acupuncture or dry needling (14%). The most common prescriptions received were non-opioid pain medications (72%), followed by muscle relaxers (44%), opioids (32%), anxiolytics (31%), gabapentinoids (26%), serotonin-norepine","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e666-e674"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971472","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":"Emergency Operable Traumatic Pulmonary Injury at a Level 1 Trauma Center: A Retrospective Descriptive Study.","authors":"Lisa Osborne-Smith, Barry Swerdlow","doi":"10.1093/milmed/usae417","DOIUrl":"10.1093/milmed/usae417","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Despite the use of body armor, emergency operable pulmonary trauma (EOPT) remains a major cause of battlefield morbidity and mortality. While EOPT during military conflicts has some features that distinguish it from EOPT in civilian settings, the 2 occurrences demonstrate overall parallel findings related to presentation, management, and outcome. The goals of the present study were to provide a descriptive analysis of the nature of EOPT and its management at a level 1 trauma center and to determine the associations between EOPT patient demographics and/or patient management and outcome in order to better understand battlefield EOPT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This is a retrospective, descriptive analysis of EOPT at a level 1 trauma center during a recent 9-year period (2012-2020). The Oregon Health & Science University Trauma Registry was searched, and 106 patients met inclusion criteria for the study. Patients with primary cardiac trauma were excluded. Individual electronic medical records were reviewed to obtain descriptive data, and associations were evaluated for statistical significance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In-hospital mortality in this cohort was 17.0%. The most common pulmonary injury associated with EOPT was unilateral diaphragmatic laceration (62.3%), and the most common single operation performed for EOPT was a laparotomy (71.7%) often involving diaphragmatic repair. In the remaining instances of EOPT, a thoracotomy (11.3%), a thoracotomy and a laparotomy (10.4%), or another surgery (6.6%) occurred. The primary indication for EOPT surgery was uncontrolled hemorrhage, and one-third of patients received massive transfusion. One-lung ventilation (OLV) was infrequently employed (8.5%). When OLV was used, it was equally likely to involve a single-lumen endotracheal tube (SLETT) with mainstem bronchus insertion, a SLETT with a bronchial blocker, or a double-lumen endotracheal tube. Time from EOPT to operating room arrival was inversely related to in-hospital mortality. Also, both initial in-hospital endotracheal intubation and low injury severity score were strongly associated with survival in the population studied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The most common indication for EOPT surgery was uncontrolled hemorrhage. The most frequent operation performed for this EOPT cohort was a laparotomy for diaphragmatic repair. A total of 91.5% of EOPT surgery was performed without OLV, an unexpected finding. When OLV occurred, it was equally likely to involve an SLETT with mainstem bronchus insertion, an SLETT with bronchial blocker, or a double-lumen endotracheal tube. The most common indication for OLV was surgical exposure. More extensive injury (expressed as an injury severity score), preadmission endotracheal intubation, and a shorter time from EOPT to operating room arrival were associated with increased odds ratios for mortality. A better understanding of the nature of EOPT ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e609-e615"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291242","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":"Precision Medicine Approach Using Triple Combination Antifungal Therapy for Fusarium Brain Abscesses and Endocarditis in an Adult Burn Patient.","authors":"Evan L Barrios, Zachary Drabick, John Rodriguez, Brenda G Fahy, Amalia L Cochran, Ian R Driscoll, Andrea M Munden","doi":"10.1093/milmed/usae284","DOIUrl":"10.1093/milmed/usae284","url":null,"abstract":"<p><p>We report a management strategy for disseminated Fusarium solani fungal infection in an adult 35% total body surface area burn patient with brain abscesses and concomitant pulmonic valve endocarditis resulting in the longest survival reported in a burn patient. Early in his hospital course, the patient was diagnosed with a Fusarium burn wound infection with concomitant fungemia and was treated with a prolonged course of intravenous (IV) antifungal monotherapy. Shortly thereafter, he developed focal neurologic deficits and was found to have brain abscesses on MRI. He underwent emergent craniotomy with debridement, and triple antifungal therapy was initiated. Transesophageal echocardiography demonstrated pulmonic valve vegetations, which resolved with triple antifungal therapy. Disseminated Fusarium solani infection is quite rare with mortality approaching 100%. Given the rarity of this disease process, there are no established antifungal treatment guidelines. However, this patient survived for approximately 1 year after diagnosis with treatment including source control via craniotomy and debridement coupled with prolonged courses of combination antifungal therapy (given the near pan-resistance of his fungal infection). Pharmacogenomic testing was utilized to establish the patient's metabolism of voriconazole and dosing adjusted accordingly to improve the efficacy of the combination therapy. To our knowledge, an adult burn patient surviving this length of time after Fusarium brain abscesses with disseminated infection has not been previously described.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e869-e872"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141246783","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":"Combat-Relevant Anesthesia Fellowships Help Sustain the Army's Multidomain Medical Force.","authors":"Jonathan Custer","doi":"10.1093/milmed/usae508","DOIUrl":"10.1093/milmed/usae508","url":null,"abstract":"<p><p>In the community of Army Nurse Anesthetists, there is an underutilized potential for Combat-Relevant Fellowship training that, if enthusiastically encouraged and taken advantage of, would proffer many benefits to the Military Health System and the beneficiaries of its care. Most importantly, increased access to and encouragement for participation in these fellowships for Nurse Anesthetists would act as a tool for skill sustainment, denying any potential for skill degradation or readiness gaps in preparation for the next-generation war. These fellowships would also augment the already robust breadth, quality, and safety of Army Nurse Anesthetists' combat and noncombat anesthesia care, potentially increase Return-To-Duty rates, potentially expedite casualty clearance of the battlefield, increase the often-limited access to advanced pain management care for chronic pain patients in Military Treatment Facilities, increase the retention rates of Nurse Anesthetists, augment the military anesthesia community's knowledge-base, and help to advance the art of anesthesia as a whole. To triumph against the anticipated rigors of the future war's multidomain operational environment, we are duty bound to continually improve and strive to be the best versions of ourselves as soldiers, as professionals, and as communities. This paper will explore the untapped utility of Combat-Relevant Fellowships for Army Nurse Anesthetists.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"72-76"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604721","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":"Joint Trauma System: Behind the Scenes.","authors":"Jennifer Gurney, Matthew D Tadlock, Jan-Michael Van Gent","doi":"10.1093/milmed/usaf014","DOIUrl":"10.1093/milmed/usaf014","url":null,"abstract":"<p><p>The Joint Trauma System was created out of a crucial need for the integration of battlefield medicine. The Joint Trauma System supports the execution and advancement of combat casualty care throughout the continuum of care by medical and nonmedical providers, leaders, and commanders at all levels.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e464-e466"},"PeriodicalIF":1.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409081","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}