Military Medicine最新文献

{"title":"Strategic Aeromedical Evacuations of the French Armed Forces in French Guiana From 2018 to 2020.","authors":"Kévin Arrivé, Jessica Hénard, Valentin Vial, Vanessa Marbac, Carole Ilcinkas, Pierre-Matthieu Astrié, Anne-Laure Ensargueix, Thomas Labrousse, Nathalie André, Kilian Bertho, François Delon","doi":"10.1093/milmed/usae473","DOIUrl":"10.1093/milmed/usae473","url":null,"abstract":"<p><strong>Introduction: </strong>The French Armed Forces are deployed in French Guiana (FG) to protect national territory and ensure the security of strategically important sites. Military health support (MHS) provides medical support for missions in this tropical environment, which is hazardous and where confrontations are possible. MHS must organize tactical and strategic evacuations (Strat-AEs), so that an optimal level of care can be delivered. Overall, Strat-AE activity has been described previously but no specific data related to FG has been reported. The main objective of this study was to provide an overview of military Strat-AEs from FG.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study from January 01, 2018 through 31 December, 2020. All patients who required a military Strat-AE were included, and we collected sociodemographic characteristics, medical information, service-related injuries and illnesses, and the reason for and conditions of evacuation.</p><p><strong>Results: </strong>We analyzed 210 patients and 199 were included. Most were noncommissioned members (63.3%) and belonged to the Army (75.4%) and the Gendarmerie (15.6%). Injury or illness was duty-related in 66.2% of patients. The main cause for evacuation was nonbattle injury (63.3%), followed by illness (27.1%). Battle stress and injury accounted for 9.5%. The main reasons for evacuation were surgical conditions (58.3%), particularly orthopedic (47.2%). Medical (22.1%), psychiatric (18.6%), and dental (1.0%) disorders followed. Most patients were categorized by the flight surgeon as P3 (98.5%), the lowest level of priority, and D4 (82.9%), the lowest level of dependency. The escort used during evacuation was identical to that recommended by the requester in 83.5% of cases. The final destination was mainly a hospital (89.9%). The time lag between injury or onset of illness and the request for evacuation was significantly longer when local health resources were insufficient.</p><p><strong>Conclusion: </strong>The particularity of FG is a local health care system that provided initial care before the evacuation. To reduce the number of Strat-AEs in FG, the risk of nonbattle injury must be lessened and improvements must be made to the local health care system and to the partnership between civilian and military health services.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1449-e1457"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504021","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":"Synopsis of the 2023 U.S. Department of VA and U.S. DoD Clinical Practice Guideline for the Management of Pregnancy.","authors":"Michael Clark, Carrie Kairys, Elizabeth W Patton, Laura Miller, Adam Edward Lang, James Sall, Jennifer Ballard-Hernandez, Lisa Wayman, Sarah Davis-Arnold","doi":"10.1093/milmed/usae517","DOIUrl":"10.1093/milmed/usae517","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This Clinical Practical Guideline provides recommendations based on a systematic review of the evidence to address critical decision points in the management of pregnancy. The guideline is intended to improve patient outcomes and local management of patients who are pregnant. This CPG is based on a systematic review of both clinical and epidemiological evidence and was developed by a panel of multidisciplinary experts. The Work Group provides clear and comprehensive evidence-based recommendations incorporating current information and practices targeting practitioners throughout the DoD and VA Health Care systems. The guideline is intended to improve patient outcomes and local management of patients who are pregnant. This CPG does not address every aspect of routine pregnancy care and is not intended to be a comprehensive guide to all care needed in pregnancy. It also addresses some clinically important and generally accepted standards of pregnancy care interventions that do not have sufficient high-quality evidence to support standalone recommendations. Additionally, it highlights emerging topics that have the potential to impact pregnancy care in the future and identifies gaps in the literature that warrant further research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;The development of all VA/DoD guidelines is directed by the Evidence-Based Practice Guideline Work Group and adheres to the standards for trustworthy guidelines that were set by the National Academy of Medicine. A patient focus group was convened to assess important aspects of treatment for patients and to gain information about patient values and preferences. The Lewin Group, a contracted third party with expertise in CPG development, facilitated meetings and the development of key questions using the population, intervention, comparison, outcome, timing, and setting format. Consensus was achieved among the Work Group through an iterative process involving discussions on conference calls and in person during the recommendation development meeting. An independent third party, ECRI, conducted the systematic evidence review, which the guideline Work Group then used to develop recommendations using the Grading of Recommendations Assessment, Development and Evaluation system (7-9). The search methods and results are detailed in the full guideline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This CPG provides 28 clinical practice recommendations that cover selected topics that the Work Group deemed had high priority need for evidence-based standards. The recommendations are divided into 3 main categories: routine care, complicated obstetrics, and mental health. An algorithm delineating recommended interventions and appropriate timing of these interventions over the course of the pregnancy and postpartum period was also created.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The CPG is not intended to define standards of care nor address all care needed in pregnancy; it does ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1403-e1410"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key Insights for the Ethical and Appropriate Use of Artificial Intelligence by Medical Learners.","authors":"Brian Patrick Murray, Darshan S Thota, Carrie Baker, Joshua B Stierwalt","doi":"10.1093/milmed/usae536","DOIUrl":"10.1093/milmed/usae536","url":null,"abstract":"<p><strong>Introduction: </strong>The rapid advancement and adoption of large language models (LLMs) in various academic domains necessitate an examination of their role in scholarly works by medical learners.This paper seeks to discern the implications of LLM use by medical learners when preparing works for publication. While LLMs possess great potential to revolutionize the academic writing process, they can detract from the learning process when used by students and residents who are still learning how to research, formulate ideas, and write cohesive arguments.</p><p><strong>Materials and methods: </strong>An environmental scan of both traditional evidence-based sources and gray literature was performed to glean best practices of generative AI in medical education. Sources included peer-reviewed journals, open-source websites, and previous publications in this field ranging from 2015 to 2023.</p><p><strong>Results: </strong>We propose several strategies to detect AI involvement: direct inquiry to the learner, assessing the coherence level of the content in contrast to the learner's known capabilities, recognizing patterns of shallow insight or depth, utilizing plagiarism and AI-specific detection tools, and monitoring for fabricated citations-a known pitfall of LLMs.</p><p><strong>Conclusions: </strong>Although LLMs offer potential efficiencies in academic writing, unchecked use can jeopardize the development of essential critical thinking and analytical skills in medical learners. Ultimately, mentors and primary investigators are responsible for ensuring learners are advancing and appropriately utilizing new and emerging technology. This study provides a foundational framework for educators in both responsible use of generative AI and best practices.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1381-e1385"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying the Volume of Residual Air in Commercial Intravenous Fluids and Assessing the Stability of Airless Intravenous Fluid Containers.","authors":"Lyle Babcock, Hayley Brawley, Christiaan van Nispen, Jason Rall, Jasmine Jaramillo, Michael Rubal, Craig Nowadly","doi":"10.1093/milmed/usae532","DOIUrl":"10.1093/milmed/usae532","url":null,"abstract":"<p><strong>Introduction: </strong>Commercial off-the-shelf (COTS) intravenous fluid (IVF) containers contain residual air, introducing the risk of venous air embolism (VAE). Venous air embolism occurs when air displaces blood flow in vasculature. The danger from residual air is often negligible in terrestrial settings, where gravitational forces generate buoyancy, pushing residual air to the top of the IVF container. However, in microgravity there is no buoyancy to separate liquid and gas layers. We performed experiments to quantify the amount of air in COTS IVF containers (Experiment 1) and identify the variables that affect the stability of sterilely produced airless containers (Experiment 2).</p><p><strong>Materials and methods: </strong>Experiment 1: Residual air was quantified across varying volumes (100, 250, 500, and 1,000 mL), container design, and manufacturer (B. Braun, Baxter, ICU Medical, and Grifols) of 0.9% NaCl COTS IVFs. Each container was assessed for absolute volumes of air, as well as air:fluid ratios normalized to 1,000 mL. Experiment 2: 1,000 mL IVF containers from 3 manufacturers were filled with either (1) 100% saline or (2) 95% saline and 5% air by volume. Containers were stored for 168 days at 25°C or 40 °C. The containers were optically imaged to quantify the accumulation of air within each IVF container.</p><p><strong>Results: </strong>Experiment 1: There was a trend toward larger container sizes and greater absolute volumes of residual air (R2 = 0.964). However, the smallest air:volume ratio occurred in the Baxter 500 mL VIAFLO Container (18.9 ± 3.8 mL air; 2.3% air by volume), whereas the largest ratio occurred in the B. Braun 250 mL EXCEL Container (55.0 ± 9.3 mL; 22.0% air by volume). Experiment 2: By day 168, 6 experimental containers had ruptured and 100% of the surviving containers (30/36) had an increase in air as compared to baseline. Containers placed at 40 °C had a larger increase in air (27.7 ± 6.6 mL) compared to containers stored at 25 °C (7.5 ± 4.1 mL; P < .0001).</p><p><strong>Conclusions: </strong>Residual air has a wide variety of volumes in COTS IVFs. The average amount of residual air is high enough to contribute to clinically significant VAEs, although unlikely to be fatal. If airless IVF containers are produced for exploration missions, a progressive increase in the amount of residual air should be expected. Extremes of temperatures and humidity will increase the reaccumulation of residual air and decrease the shelf-life of airless IVFs.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1485-e1492"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823910","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":"Examination of Gallbladders at Military Treatment Facilities: Is Histologic Analysis Necessary?","authors":"Andrew J Berman, Gregory T Schandler, Douglas B Walton","doi":"10.1093/milmed/usaf024","DOIUrl":"10.1093/milmed/usaf024","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Gallbladder specimens from cholecystectomy procedures are a common specimen evaluated by military pathologists. These are often removed for inflammatory causes. Previous studies show that the incidence of gallbladder carcinoma (GBC) is around 3%. Incidentally identified GBC is even less common at 0.36%. Incidentally found GBCs are of little clinical consequence as most are treated by cholecystectomy alone. We hypothesize that a selective approach to histologic evaluation of gallbladders could save time for pathologists to focus on more complex cancer cases and save money for the Defense Health Agency. We propose that for patients under 50 years of age with no clinical or macroscopic concern for neoplasia, histologic evaluation may be omitted with negligible risk of missing a clinically relevant diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This protocol was determined to be institutional review board exempt. All pathology reports from cholecystectomies from January 1, 1998, to August 11, 2023 were pulled. Key data from these reports were extracted. These data include age, gender, and if there was a clinical or macroscopic concern for neoplasia, macroscopic findings, and histologic findings. Additionally, the patient's active duty status was pulled from Military Health Systems Genesis and the Joint Longitudinal Viewer and included for demographic data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 9,774 cases pulled, 2,063 of these reports underwent data extraction. In total, 63 cases were excluded, and 2,000 cases were sent to the 59th Medical Wing biostatistics department for analysis. In this dataset, there were 8 instances of malignancy, 5 of which were GBC (1 of these 5 arose from an intracholecystic papillary neoplasm), 2 of which were metastatic disease, and 1 a neuroendocrine tumor. The incidence of GBC in our dataset is 0.20%, lower than that of other studies. The sensitivity of a clinical/macroscopic concern to identify malignancy in a patient aged under 50 years is 66.67%. In the 187 cases from the active duty population, there were zero instances of dysplasia or malignancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The sensitivity of a clinical/macroscopic concern for neoplasia in a patient aged under 50 years is low, identifying only 2 of 3 malignancies in our dataset. However, the case that would have been missed under our proposed guidelines was from metastatic disease of a previously known metastatic malignancy. We consider that if a selective histologic evaluation is established, a history of malignancy should be a qualifier for evaluation regardless of any other factors. A selective approach to histologic evaluation of gallbladders could save our institution $4,716 to $5,240 annually. Additional studies, incorporating prior malignancy as a qualifier, are warranted to further evaluate the potential for harm in patients aged under 50 years and a number needed to harm should be established prior to any ch","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1524-e1528"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024095","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 Characteristics and Procedural Volume at an Overseas Military Treatment Facility Emergency Department: Effects of the COVID-19 Pandemic and Implications on Clinical Skill Sustainment.","authors":"Martin A C Manoukian, Connor E Maguire, Tyler R Lopachin, Derek A Benham, Raj C Singaraju","doi":"10.1093/milmed/usaf039","DOIUrl":"10.1093/milmed/usaf039","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Future conflicts against near-peer competitors require proficient physicians to mitigate operational morbidity and mortality. Recent literature suggests that current patient demographics and staffing models may not sustain the combat care skills of military physicians. However, skill sustainment at overseas military treatment facilities located within foreign countries has not been examined. This article investigates patient characteristics and procedural performance rates within the U.S. Naval Hospital Okinawa Emergency Department (USNHO-ED), providing novel insight into the skill sustainment provided to U.S. Military physicians stationed in a foreign country.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;An automated retrospective chart review of patients triaged within the USNHO-ED from January 2018 to June 2022 was performed. Patient census, emergency severity index (ESI) triage scores, patient disposition, and procedures of interest were recorded. Procedures of interest included: \"endotracheal intubation,\" \"arterial line placement,\" \"central line placement,\" \"dislocation reduction,\" \"procedural sedation,\" \"cardioversion,\" \"thoracostomy,\" \"blood product transfusion,\" \"lumbar puncture,\" \"paracentesis,\" \"arthrocentesis,\" and \"joint injection.\" Monthly procedure rates and procedure rates per 1,000 patients were calculated. Procedure rates for individual physicians with greater than 500 patient encounters were calculated. Variation in patient characteristics and procedural rates during the COVID-19 pandemic was investigated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The USNHO-ED triaged 128,696 patients and performed 865 procedures of interest during the study period. In total, 5,020 patients were triaged as ESI 1/2, 34,179 patients were triaged as ESI 3, and 89,499 patients were triaged as ESI 4/5. A total of 122,881 patients were discharged from the emergency department. The procedures performed most often were procedural sedation (4.02 per month, 2.06 per 1,000 patients), dislocation reduction (3.41 per month, 1.75 per 1,000 patients), lumbar puncture (1.94 per month, 0.99 per 1,000 patients), and endotracheal intubation (1.21 per month, 0.62 per 1,000 patients). All other procedures were performed less than once per month and 0.5 instances per 1,000 patients. Over half of physicians with at least 500 encounters did not perform a blood product transfusion, thoracostomy, central line placement, arterial line placement, cardioversion, or paracentesis. Rates for many procedures were lower than those seen at civilian institutions. During the COVID-19 pandemic, the daily census was lower, patients were more often triaged to higher ESI 1-3, and the admission rate was higher. Procedural sedations per month, as well as procedural sedations, dislocation reductions, and blood product transfusions per 1,000 patients, increased during the COVID-19 pandemic. No other temporal procedural variation occurred. Pediatric patients were mo","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1706-e1714"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399480","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":"Hypothermia and the Global War on Terror: 18 Years of Minimal Progress, but Also Recent Opportunities for Improvement.","authors":"Antoine Vuong, Arwad Alkahwaji, Sandrine Pons, Christophe Martinaud, Pierre Pasquier","doi":"10.1093/milmed/usae498","DOIUrl":"10.1093/milmed/usae498","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"208-209"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469931","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":"A Description of the Dental Health and Treatment of Ukraine Military at U.S. Army Clinics in Germany.","authors":"Andres M Mendoza, John W Simecek, Paul M Colthirst, Timothy A Mitchener","doi":"10.1093/milmed/usae480","DOIUrl":"10.1093/milmed/usae480","url":null,"abstract":"<p><strong>Introduction: </strong>Since the start of the Russo-Ukrainian war, most reports have focused on trauma and combat conditions. Trauma care is essential; however, disease and nonbattle injuries (DNBIs) also burden armies and reduce combat effectiveness. Dental emergencies (DEs) account for a substantial portion of DNBI, but there is limited information on Ukrainian military dental readiness. In September 2023, investigators were informed that Ukrainian military personnel were treated for DEs at 2 dental clinics in Germany.</p><p><strong>Materials and methods: </strong>The investigators requested deidentified data from the Corporate Dental System (CDS), which is a repository for dental treatment records utilized by the U.S. Army. The data request captured DE treatment performed for Ukrainian military personnel in Germany from January 1, 2023, to September 20, 2023. The CDS report on DE encounters included the following: Gender, age, procedure codes, and provider narratives. This study was approved by the U.S. Army Institute of Surgical Research Institutional Review Board as research not involving human subjects and provided Log Number H-24-030nh.</p><p><strong>Results: </strong>The CDS report captured 408 Ukrainian military DE encounters. A total of 360 Ukrainian military personnel were treated for DE during the 9-month reporting period in 2023. Oral surgery was the most common DE treatment category and accounted for 55.8% (N = 201) of DE procedures. Restorative dentistry procedures accounted for 18.1% of DE procedures. Of the 27 multiple category treatments, 25 had oral surgery procedures as one of the treatments. Restorative dentistry procedures were performed in 19 of the multiple category cases.</p><p><strong>Conclusions: </strong>The DEs in the Ukrainian military cohort suggest that chronic, untreated dental disease has progressed without routine care for years. The assertion that caries has progressed to a nonrestorable condition is supported by the distribution that 63% of all DE visits included oral surgery treatment. Based on the distribution of dental treatment, US dental officers must be proficient in oral surgery and prosthodontic care.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1543-e1548"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetry as a Lagging Indicator of Occupational Exposure to Nitrous Oxide in Pediatric Sedation: A Collaborative Process Improvement Project With Industrial Hygiene.","authors":"Jennifer S Kicker, Cynthia Y Timbie, Susan L Kline","doi":"10.1093/milmed/usae523","DOIUrl":"10.1093/milmed/usae523","url":null,"abstract":"<p><strong>Introduction: </strong>Nitrous oxide (N2O) is commonly used in pediatric procedural sedation. It is an attractive option to facilitate intravenous line placement, as it does not extend sedation recovery from subsequently administered agents. Although debate exists regarding health consequences of occupational exposure now that scavenging of exhaled gases is common, cooperation of pediatric patients to maximize engineering controls is not guaranteed and can contribute to repeated exposure over the course of a clinician's career. There is no global consensus on personal exposure limits, but the National Institute for Occupational Safety and Health published U.S. guidelines. A dosimetry survey of our sedation team during a short N2O procedure for intravenous line placement exceeded the National Institute for Occupational Safety and Health Recommended Exposure Limit (REL) of 25 parts per million. We designed a process improvement initiative to reduce occupational exposure below the Recommended Exposure Limit on serial surveys.</p><p><strong>Materials and methods: </strong>A continuous flow, titratable, full-face mask N2O delivery system with scavenging by a central vacuum connection was used. A retrospective chart review of N2O procedures performed before the initial dosimetry survey revealed practice trends in provider behavior during N2O administration. Initiation of N2O gas flow and maintenance of face mask seal on an uncooperative patient were identified as two sources of variability. Two-handed face-masking technique, initiation of N2O gas flow only after masking, and continued masking for 2 min of exhaled scavenging were standardized and socialized as best practices. Subsequent dosimetry surveys of the sedation team were coordinated by Industrial Hygiene.</p><p><strong>Results: </strong>Pre- and post-intervention phases were 17 months each and included 92 and 201 N2O patients, respectively. Six dosimetry surveys occurred in the post phase. Intravenous line placement was the typical procedure surveyed. Dosimetry results for all team members during surveys 1-4 were below the REL, with 14 of 16 samples falling below the level of quantitation. Elevated dosimetry results in survey 5 prompted reevaluation of work practices and equipment. A loose component on the delivery system was discovered, corrected, and incorporated as a pre-procedure check. With no further changes to work practices, dosimetry results were below the REL for survey 6.</p><p><strong>Conclusion: </strong>We layered work practice changes atop engineering controls to reduce occupational exposure levels for medical team members. We utilized dosimetry as a lagging indicator, prompting frequent reassessments of our equipment and processes that we might not otherwise have performed. Pediatric sedation programs are encouraged to consider whether Industrial Hygiene resources might provide synergy to process improvement efforts with inhalational sedation agents.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1765-e1771"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Military Nurses' Deployment Experiences: A Qualitative Metasynthesis.","authors":"Mollie F Christiansen, Whitney Tice, Stephanie Kessinger, Heather Coats","doi":"10.1093/milmed/usae543","DOIUrl":"10.1093/milmed/usae543","url":null,"abstract":"<p><strong>Introduction: </strong>Military medical personnel, including nurses, face a wide array of emotional and psychological issues while deployed. Understanding the challenges military nurses face in the deployed setting may prove useful in effectively preparing nurse leaders for future disaster responses in the military and civilian sectors. The purpose of this metasynthesis is to answer the following research question: What are the experiences of U.S. military and allied nurses deployed to medical facilities in combat operations and support areas since 9/11/2001?</p><p><strong>Methods: </strong>A qualitative metasynthesis was conducted to determine commonality of combat-related deployment experiences for U.S. military and allied nurses. After development of the research question, this metasynthesis included 4 steps: (1) perform structured literature search, (2) critical appraisal, (3) reciprocal translation, and (4) synthesize findings. Studies were limited to the years 2004-2023 to focus the search on Operation Enduring Freedom and Operation Iraqi Freedom-related deployments. Reference review of studies retrieved through database search also contributed to the final sample. Screening criteria included: (1) qualitative or mixed methods studies, (2) sample comprised of U.S. or allied country medical/nursing personnel, and (3) care primarily occurring in a fixed facility located in Iraq, Afghanistan, or Kuwait. Studies focusing on reintegration after deployment or air evacuation personnel/nonfixed facility settings were excluded. A total of 11 studies met inclusion criteria. Critical appraisal was conducted on all studies. Data analysis utilized an inductive and iterative process. Reciprocal translation and meta-ethnographic techniques were used to identify words/phases that contained significant meaning and to identify themes/subthemes. Themes formed that described commonalities across nurses' experiences.</p><p><strong>Results: </strong>Three primary themes arise from critical examination of military nurses' deployment experiences: (1) \"care in a combat zone,\" (2) \"leadership in a combat zone,\" and (3) \"personhood.\" The subthemes address experiences or concerns related to an individual participant's role as a \"care giver,\" \"leader,\" or \"person.\" The 3 themes formed by this qualitative metasynthesis represent a holistic view of a military nurse in a deployed setting.</p><p><strong>Conclusions: </strong>Military nurses' deployment experiences relate to their multiple role(s) as a clinician, officer, and human being. By better understanding military nurses' past deployment experiences and related themes, nurse leaders and individuals can better prepare for supporting staff in future combat operations. The complexities of \"caring,\" \"leading,\" and \"personhood\" may contribute to emotional distress among deployed military medical personnel.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1432-e1439"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828786","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}