Military Medicine最新文献

{"title":"Predictors of Providers' Intention to Use a Military-Adapted Assessment Tool for Adjustment Disorder.","authors":"Jouhayna Bajjani-Gebara, Margaux F Keller, Madison F Clark, Ryan R Landoll, Joan Wasserman","doi":"10.1093/milmed/usag422","DOIUrl":"https://doi.org/10.1093/milmed/usag422","url":null,"abstract":"<p><strong>Introduction: </strong>Adjustment disorder is the most prevalent mental health diagnosis in the U.S. military, significantly impacting readiness. There has been a longstanding lack of diagnostic clarity for adjustment disorder; however, recent shifts in diagnostic classification have led to new adjustment disorder assessment tools like the ADNM-20-MIL, designed for military use. The perceived impact and acceptability of such a tool has yet to be assessed in those providing healthcare to U.S. service members. This study used the theory of planned behavior to examine predictors of U.S. military healthcare provider's intent to use the ADNM-20-MIL.</p><p><strong>Materials and methods: </strong>We used a theory of planned behavior-based questionnaire to study the role of providers' (N = 60) attitudes, subjective norms, and perceived behavioral control in predicting their intent to use the proposed ADNM-20-MIL tool in clinical practice.</p><p><strong>Results: </strong>The overall model shows significant fit, indicating the 3 constructs of the theory of planned behavior do impact a provider's intention to use the ADNM-20-MIL in their practice. Attitudes significantly influenced providers' intention to use the ADNM-20-MIL, while subjective norms and perceived behavioral control provided little additional predictive value beyond attitudes alone in this sample.</p><p><strong>Conclusions: </strong>Study findings indicate that providers' attitudes will drive their intention to incorporate the ADNM-20-MIL into their practice. Integration of this tool into the Military Health System could strengthen standardized assessment and monitoring of adjustment disorder, and bring it in line with the assessment practices established for other common mental health disorders.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911561","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":"From Damage Control Resuscitation to Prolonged Care in Ukraine: Evolution of a Small Unit Training Program, 2023-2025.","authors":"Tom Mallinson, Anna Onderková, Sean Keenan, Aebhric O'Kelly, Vladyslav Chumachenko, Anastasiia Chumachenko, Mykhailo Tielieshev, Antonina Nifantieva, Vitaly Shevel, John Quinn","doi":"10.1093/milmed/usag421","DOIUrl":"https://doi.org/10.1093/milmed/usag421","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Following the immediate application of the principles of Tactical Combat Casualty Care (TCCC), Damage Control Resuscitation (DCR) is central to reducing preventable death in large-scale combat operations (LSCO), particularly where evacuation to damage control surgical capability is delayed. Beginning in 2023, the College of Remote and Offshore Medicine (CoROM) and Tactical Medicine North (TacMed North) implemented the Damage Control Resuscitation Ukraine (DCR-U) course to upskill Ukrainian frontline medics across the continuum from point of injury through prolonged casualty care (PCC). An initial report described the summer 2024 iteration. This article traces the pedagogical and clinical evolution of the program through subsequent iterations in December 2024 and November 2025, with a focus on integrating prolonged care best practices, the lethal diamond of trauma, and nursing-centric frameworks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We conducted a narrative program evaluation using triangulated qualitative data from structured after-action reviews (AARs), faculty field notes, participant feedback, and curriculum documents. A mixed civilian-military approach was applied. The analysis examined changes across 3 domains: (1) curriculum content and time allocation, (2) pedagogy and assessment strategy, and (3) integration of clinical governance and national standards. Iterative modifications were mapped against Joint Trauma System (JTS) Clinical Practice Guidelines (CPGs), the Prolonged Care textbook, and the Prolonged Field Care (PFC) Field Handbook.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over 3 iterations, the program recorded 104 course completions: 94 main-course learner completions across 6 cohorts and 10 additional train-the-trainer completions. Across successive curriculum phases, DCR-U shifted from a primarily procedure-focused format to a longitudinal, systems-based curriculum emphasizing (a) the lethal diamond (hypothermia, acidosis, coagulopathy, and hypocalcemia), (b) 6-72-hour prolonged care planning, and (c) structured nursing frameworks (HITMAN/SHEEPVOMIT) for trend-based decision-making. Local Ukrainian instructors progressively assumed leadership of skills stations and much of the didactic teaching, supported by international faculty in advisory roles. HITMAN and SHEEPVOMIT became the default assessment and nursing mnemonics for simulated cases, linking tactical decisions to physiologic trends and nursing tasks. The course increasingly targeted mid-level providers and unit-level trainers, embedding a train-the-trainer model for scalability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The evolution of DCR-U from 2023 to 2025 illustrates how DCR training in LSCO can be reframed as a prolonged care and clinical governance intervention rather than a stand-alone skills course. Embedding lethal-diamond resuscitation concepts, PFC nursing mnemonics, and national CPGs allowed Ukrainian partner forces to contextualiz","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911345","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":"Biomarker Targets for Stress Fracture Surveillance and Intervention in Military Personnel: A Scoping Review.","authors":"Sophie J Evans, Madeleine C Warmer, Javier T Gonzalez, Joanne L Fallowfield, James L J Bilzon","doi":"10.1093/milmed/usag409","DOIUrl":"https://doi.org/10.1093/milmed/usag409","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Musculoskeletal injuries (MSKIs) are the most common cause of medical discharge from military service, with most directly attributable to physical training and arduous occupational tasks. MSKIs affect (but not limited to) muscles, bones, joints, tendons, ligaments, and/or cartilage. A high proportion of military MSKIs are overuse injuries occurring in the lower limbs. Because of the impact of MSKIs on personnel and the organization, it is imperative that methods of identifying at risk personnel are developed, refined, and implemented. Biomarkers are used within clinical and research settings as indicators or surrogate measures of damage to target tissue. Furthermore, biomarkers can offer an objective insight into MSKIs risk rather relying on self-report methods, which are often reported too late. Numerous risk factors for MSKIs have been identified, several of which represent modifiable health behaviors and therefore may provide targets for intervention. The potential effects of these behaviors on biomarkers may provide a means of identifying those at increased risk or susceptibility to MSKIs, informing early intervention. This review aimed to identify specific and sensitive biomarkers of bone and soft-tissue damage/injury and examines potential associations between biomarker and modifiable health behaviors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A scoping review was undertaken to assess published evidence of current biomarkers used to assess tissue damage, and potential mechanisms by which changes in health behaviors may ameliorate bone/soft-tissue injuries, within military populations. Following the PRISMA ScR guidelines, relevant literature was identified in peer-reviewed journals that met the following criteria: (1) healthy adults aged between 16 and 60 years with/without work-related MSKIs/disorders; (2) population included military personnel or athletes; (3) studies reporting associations between biomarker of bone or soft-tissue health/injury and presence of bone/soft-tissue injury or medical imaging; (4) study is written in English (Abstract or Structured Summary).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 2,973 articles were identified from the initial database search and, after removing duplicates, 2,291 studies were screened. Among these, 33 publications met the eligibility criteria and included in analyses. The review encompasses studies published from 2003 onwards. Most studies were observational prospective cohort studies. The most prevalent biomarker associated with variables of MSKIs, particularly stress fracture risk, was vitamin D (or substrate of vitamin D), which was analyzed in 22 of the identified studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This review highlights a range of potential biomarkers for use in military populations, however, it also demonstrates that these biomarkers are often assessed within sub-optimal study designs and often only in relation to stress fracture occurrenc","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912969","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":"Mapping the Evidence for Operator Syndrome Among Special Operations Forces: A Scoping Review.","authors":"Tara L Caberwal, Amy S Cecchini, Cristóbal S Berry-Cabán","doi":"10.1093/milmed/usag419","DOIUrl":"https://doi.org/10.1093/milmed/usag419","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Operator Syndrome is an emerging construct proposed to describe the cumulative psychological, physiological, cognitive, and neurobehavioral burden experienced by Special Operations Forces personnel following prolonged exposure to high-intensity operational demands. Despite increasing interest within military medicine, the construct remains poorly defined, and its conceptual foundations, assessment approaches, and supporting evidence have not been systematically synthesized. The purpose of this scoping review is to examine how Operator Syndrome has been conceptualized and operationalized within the literature, identify multidimensional constructs associated with Operator Syndrome, and characterize gaps requiring future investigation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Electronic searches were performed in PubMed, PsycINFO, CINAHL, Google Scholar, ProQuest Dissertations and Theses, and the Defense Technical Information Center. Eligible sources were English-language publications between January 2020 and June 2026 that explicitly defined \"Operator Syndrome\" among U.S. military personnel, particularly SOF populations. Data were charted using a standardized extraction process and synthesized descriptively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Six sources met inclusion criteria, consisting of conceptual papers, clinical reviews, and 2 empirical observational investigations. Across the literature, Operator Syndrome was consistently described as a multidimensional construct associated with cumulative exposure to operational stressors including blast exposure, repetitive mild traumatic brain injury, chronic musculoskeletal loading, sleep disruption, and sustained psychological stress. Recurring constructs included neurological, psychological and behavioral, endocrine and metabolic, musculoskeletal and pain, sleep and recovery, fatigue and performance, and operational exposure domains. Allostasis and allostatic load were frequently cited as explanatory frameworks; however, conceptualization, domain structure, and assessment approaches varied substantially across studies. No consensus definition, diagnostic criteria, standardized assessment framework, or independently validated measurement approach was identified. Empirical support was limited to 2 studies originating from the same investigative lineage and utilizing substantially overlapping Special Operations Forces populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Current evidence suggests that Operator Syndrome may represent a useful framework for describing the complex and interacting health burdens experienced by Special Operations Forces personnel. However, substantial overlap exists between Operator Syndrome and established conditions including mild traumatic brain injury, post-traumatic stress disor","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900834","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":"Postgraduate Professional Education Beyond Clinical Training Among Military Physicians: Career Benefits and Association with Likelihood of Retention.","authors":"Paul Um, Julia Romano, Claire Palla, TingLan Ma, Joshua D Hartzell, Steven J Durning, Ting Dong, Sami Abuhamdeh","doi":"10.1093/milmed/usag408","DOIUrl":"https://doi.org/10.1093/milmed/usag408","url":null,"abstract":"<p><strong>Introduction: </strong>Postgraduate professional education (PPE), defined as post-medical school education other than residency and fellowship training, is used within the Military Health System (MHS) to support physician development and offers the potential to promote retention, yet its effectiveness in promoting both of these outcomes remains unclear. This study examined (1) military physicians' perceptions of PPE career utility, and (2) whether PPE was associated with self-reported retention likelihood beyond obligatory commitments.</p><p><strong>Materials and methods: </strong>Data were drawn from the Uniformed Services University (USU) Alumni Survey (N = 1,629/4,724; 34% response rate). Participants reported PPE participation, perceived career utility, and-among active-duty respondents-likelihood of remaining in the military beyond initial commitments. Twenty-eight percent (n = 464) of respondents reported a total of 670 PPEs, most of which were military funded (n = 449, 67%). Inductive content analysis was applied to the free text responses for perceived career utility of PPE.</p><p><strong>Results: </strong>On average, PPE were perceived to be quite useful for respondents' careers (mean = 3.98 on a 5-point scale), with some variation among PPE categories. Content analysis found that PPE was highly useful to participants in the domains of skill acquisition, career progression, and leadership development. Regarding likelihood of retention, respondents with any form of PPE reported a higher likelihood of retention than those without PPE (adjusted M = 3.46 vs. 2.88; P < .001, Cohen's d = 0.41). Retention likelihood varied somewhat by type of PPE. Although both military-funded and non-military-funded PPE at civilian institutions were linked to higher retention than those with no PPE, only military-funded PPE was associated with a statistically significant increase (Cohen's d = 0.41, P = .003). Satisfaction with educational opportunities was also positively associated with likelihood of retention (r = 0.29, P < .001).</p><p><strong>Conclusions: </strong>PPE appears to support physicians' perceived professional development and is associated with modest increases in retention, but it represents only 1 of many factors associated with retention within the MHS.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900892","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":"Identification of Critical Non-Technical Skills to Optimize Austere Resuscitative Surgical Team Training.","authors":"Lane L Frasier, Hampton McClendon, Dallas G Hansen","doi":"10.1093/milmed/usag417","DOIUrl":"https://doi.org/10.1093/milmed/usag417","url":null,"abstract":"<p><strong>Introduction: </strong>Many adverse events in health care can be attributed to lapses in communication, situational awareness, or decision-making, collectively known as non-technical skills (NTS). Research on military interprofessional health care team (MIHT) research and care in low- and middle-income countries (LMICs) demonstrates that teams in these environments with limited or variable resources demonstrate specific non-technical behaviors to overcome challenges unique to these clinical contexts. However, behaviors specific to austere and resuscitative and surgical care (ARSC) teams are not well-described in the literature to guide curriculum development or team training. We sought to identify role-specific non-technical behaviors observed during high-fidelity ARSC simulations and anchor these to validated NTS assessment rubrics, with the ultimate goal of creating a conceptual framework for both instructors and students and a shared understanding of role-specific optimal non-technical performance.</p><p><strong>Materials and methods: </strong>The ground surgical team (GST) is the Air Force's conventional 6-person ARSC. Students attending GST training complete a total of 6 high-fidelity simulations which closely replicate the austere environment. The non-technical performance for each team member was evaluated during 4 of these simulations utilizing validated rubrics including non-technical skills for surgeons (NOTSS), anesthetists' non-technical skills (ANTS), and scrub practitioners' non-technical skills (SPLINTS). Instructors kept field notes including descriptions of student behaviors justifying each score. After 17 months of evaluation, field notes were collated and role- and ARSC-specific examples of optimal and poor performance were identified and mapped onto subcategories of assessment rubrics.</p><p><strong>Results: </strong>A total of 360 individual NTS evaluations were completed for 15 teams (6 individuals per team) across 60 simulations. Themes of effective and ineffective behaviors were identified for each team role and categorized within the framework of the role-specific rubric.</p><p><strong>Conclusions: </strong>Austere surgical environments are substantially different than non-deployed clinical spaces. Although important in all clinical contexts, optimal non-technical performance is even more crucial for ARSC personnel. Mapping ARSC- and role-specific behaviors onto validated non-technical performance rubrics creates a scaffold for curriculum development and consistent performance assessment by cadre. The behaviors identified can serve as an important educational tool while preparing teams for this environment. Further research will evaluate the impact of non-technical skills training on team behavior and determine the extent to which these findings are applicable to other ARSC teams across the military.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900890","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":"Evaluating the Risks, Safety, and Reliability of Large Language Models in Military Medicine.","authors":"Darshan Thota, David Alt, Sriram Venkatesan, Jesus Caban","doi":"10.1093/milmed/usag413","DOIUrl":"https://doi.org/10.1093/milmed/usag413","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the performance of Large Language Models (LLMs) within the Military Health System (MHS), specifically assessing for bias, hallucinations, and safety risks.</p><p><strong>Methods: </strong>In late 2024, 47 clinicians across 13 military treatment facilities evaluated 8 blinded LLMs. Using standardized clinical vignettes, 835 conversations were reviewed for demographic bias, hallucinations, classification errors, and safety risks.</p><p><strong>Results: </strong>Demographic bias was present in 82 conversations (9.8%), hallucinations in 85 (10.2%), classification errors in 19 (2.3%), and safety risks in 78 (9.3%). Classification errors were linked to military-specific jargon. Safety risks were most prominent in overdose, critical care, and psychiatric scenarios.</p><p><strong>Conclusion: </strong>Failure to generate an accurate response can delay decision-making and increase cognitive burden and risk. Confidently incorrect responses are particularly dangerous. Although LLMs can generate useful clinical information, they remain vulnerable to biases and factual errors. Human oversight, training, and model tuning are necessary before utilizing military data.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886892","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 Medical Training for Role 1 and Role 2 Combat Casualty Care Skills: A Narrative Review.","authors":"Jennifer L Patton, Kiffin R Smallegan, Emily R Latimer, Anna R Prendergast, Gary J Jimenez Pena, Angela K Phillips","doi":"10.1093/milmed/usag411","DOIUrl":"https://doi.org/10.1093/milmed/usag411","url":null,"abstract":"<p><strong>Introduction: </strong>Military medics are often tasked to train other medics. While there is ample content of what to train, there exists a lack of trainer education or emphasis on how to train others effectively. Current military medical training is highly variable, often relying on anecdotal methods, with limited evaluation of training effectiveness. Although the importance of readiness training is well recognized, little attention has been devoted to identifying evidence-based approaches for training military medics. This narrative review sought to synthesize available evidence on training methods for military medics on skills performed in Role 1 or Role 2 settings.</p><p><strong>Materials and methods: </strong>A narrative review using systematic search and screening methods was conducted. A research librarian searched multiple databases using the MeSH terms \"clinical education\" and \"military.\" The articles were reviewed by the 6-person team using the Appraisal Tool Selection Algorithm and appraised for quality using the Pre-Appraised Evidence Appraisal Tool, © 2025 Johns Hopkins Health System, with permission.</p><p><strong>Results: </strong>From 1,222 screened articles, 44 met inclusion and quality criteria for final synthesis. Two overarching themes emerged: training methods and training evaluation. Training methods varied by audience, design, and modality. Many studies developed training methods centered around the audience, whether individual or team-focused. Training design and content was variably informed by the utilization of clinical practice guidelines, literature reviews, needs assessments, and expert opinion. Most studies employed multimodal approaches combining didactic instruction with hands-on or simulation-based practice. Training evaluation included both subjective and objective measures, including self-efficacy, knowledge testing, time to task completion, graded simulations, and clinical practice volume.</p><p><strong>Conclusions: </strong>This review highlights significant variability in how military medical readiness training is designed, delivered, and evaluated. Evidence suggests that effective training should be designed for the target audience, grounded in adult learning theories, multimodal, and evaluated using a combination of subjective and objective measures. Limitations to the articles utilized for this review include heterogeneous study designs, reliance on short-term outcomes, and weak generalizability. Addressing gaps in educator preparation, evaluation rigor, and policy for prioritization of training may improve the effectiveness of military medical readiness training. Future research should focus on validating objective evaluation tools, assessing skill retention, and optimizing team-based training to enhance operational readiness and force capability.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887230","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":"Past-Year Co-Use of Alcohol and Opioid and Suicidal Behaviors in U.S. Adults with Prior Military Service.","authors":"Ava C Santiago, Anwar E Ahmed, Jangho Yoon, Karl C Alcover","doi":"10.1093/milmed/usag388","DOIUrl":"https://doi.org/10.1093/milmed/usag388","url":null,"abstract":"<p><strong>Introduction: </strong>Alcohol use and opioid use independently increase the risk of suicidal behaviors. These substances are also frequently used concurrently, yet the extent to which their co-use contributes to suicidal behaviors at the population level remains insufficiently understood. This gap is particularly relevant among adults with prior military service, who experience elevated burdens of chronic pain, opioid exposure, and mental health comorbidities. We therefore examined whether past-year alcohol-opioid co-use was associated with suicidal behaviors among U.S. adults and assessed whether these associations differed by military service status and across pre- and post-COVID-19 periods.</p><p><strong>Materials and methods: </strong>We conducted a repeated cross-sectional analysis of adults aged ≥18 years using 2014-2023 data from the National Survey on Drug Use and Health (n = 544,488; 19,047 with prior military service). Past-year suicidal behaviors were defined as ideation, planning, or attempt. Substance use groups were categorized as alcohol-only, opioid-only, alcohol-opioid co-use, or neither. Year-specific multivariable logistic regression models adjusted for sociodemographic and clinical covariates were pooled using random-effects meta-analysis. Analyses were stratified by pandemic period (2014-2019 vs. 2020-2023). Interaction terms and marginal effects assessed effect modification by military service.</p><p><strong>Results: </strong>Among adults without prior military service, alcohol-opioid co-use (adjusted OR = 1.61, 95% CI, 1.37-1.90) and opioid-only use (aOR = 1.59, 95% CI, 1.27-2.00) were associated with suicidal behaviors after full adjustment. Among adults with prior military service, co-use was significant in minimally adjusted models but attenuated after full adjustment. Stratified analyses indicated stronger associations for co-use during the COVID-19 period, particularly among those with prior military service. Interaction analyses showed limited evidence of effect modification by military status after adjustment.</p><p><strong>Conclusions: </strong>Alcohol-opioid co-use is associated with increased odds of suicidal behaviors in U.S. adults, with variation across military service status and pandemic periods. These findings highlight the importance of considering polysubstance use and contextual stressors in understanding suicide risk.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887240","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":"Establishing and Improving Role 2 Documentation Performance: A 2-Part Quality Improvement Initiative.","authors":"Allison Dilan","doi":"10.1093/milmed/usag418","DOIUrl":"https://doi.org/10.1093/milmed/usag418","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Accurate and comprehensive medical documentation is essential to safe, effective patient care, particularly in austere environments where patients transition rapidly between teams, locations, and levels of capability. In Role 2 environments, where casualties move from point of injury through damage control resuscitation, surgery, and prolonged casualty care, information loss during transitions poses a persistent threat to patient safety. Despite the existence of Joint Trauma System (JTS) Clinical Practice Guidelines and standardized documentation tools, variability in documentation practices persists within Role 2 settings. This quality improvement (QI) project sought to evaluate whether targeted documentation and handoff training could improve self-reported provider confidence and documentation performance during a simulated operational exercise.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This 2-part QI initiative was conducted within a Role 2 military medical unit preparing for a battalion-level certification exercise. Part I consisted of targeted training for providers, nurses, and corpsmen on JTS documentation requirements and structured handoff tools (MIST, I-PASS, SBAR). Participants completed pre- and post-training surveys assessing self-reported ability and confidence across 4 competency domains. Part II evaluated documentation during a 5-day field exercise. A stratified random sample of 55 simulated casualty charts (of 100 total) was audited using a structured tool aligned with JTS key performance indicators to assess completeness, accuracy, and clinical relevance. Descriptive statistics were used to summarize findings. The project was reviewed and determined to meet criteria for quality improvement rather than human subjects research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-four personnel participated in the training intervention. Self-reported confidence and perceived ability improved significantly across all 4 domains (P &lt; .05), with the largest improvement observed in participants' ability to identify and mitigate documentation and handoff errors. During the certification exercise, overall documentation compliance was 51%, and overall JTS compliance was 56%. Frequent deficiencies included missing reassessment vital signs, incomplete allergy documentation, absent provider orders, incomplete anesthesia records, and failure to update DD3019 forms following surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This QI project established a formal baseline of documentation performance within a Role 2 unit and demonstrated that targeted training improved provider confidence but did not fully translate into consistent documentation practice during operational simulation. These findings highlight the gap between perceived competence and field execution in austere military environments. Sustained improvement will likely require repeated training cycles, integrated audit and feedback, workflow optimization, and leader","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887987","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}