Military Medicine最新文献

{"title":"Characterization of a Novel Nutrition and Traumatic Brain Injury Data Repository for the U.S. Armed Forces and Beneficiaries, 2017 to 2024.","authors":"Katrina S Monti, Zachary T Colburn, Michael T Fredericks, William R Conkright","doi":"10.1093/milmed/usag416","DOIUrl":"https://doi.org/10.1093/milmed/usag416","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic brain injury (TBI) is a significant U.S. military health concern. Although emerging evidence suggests that nutrition may contribute to TBI outcomes, research on clinical nutrition interventions, especially within military populations, is limited because of a lack of data repositories that integrate the Nutrition Care Process, lifestyle factors, and clinical outcomes.</p><p><strong>Materials and methods: </strong>We established a novel Nutrition and TBI Data Repository, integrating TBI and nutrition care data from military health records spanning from January 1, 2017, to December 31, 2024. Our data repository leverages 12 distinct data sources and includes clinical encounter, laboratory, radiology, and pharmacy data, among others.</p><p><strong>Results: </strong>Our repository contains clinical data for 431,673 patients with TBI and a 1:1 age- and sex-matched control cohort. The patient population is predominantly male (56.2%) and aged 17-41 years (39.5%). Most first-recorded TBIs are classified as mild (72.5%), and for 67.0% of the TBI cohort, mild represents the highest recorded severity. Active component service members make up 19.8% (n = 170,888) of the repository. We report patient counts across 23 health condition categories: 9 chronic health, 4 nutrition-related, 4 lifestyle factors, 3 sleep disorders, and 4 mental health disorders and 10 procedural code categories, including nutrition procedural codes. Overall, the TBI cohort has higher rates of health conditions, lifestyle codes, and nutrition counseling than controls.</p><p><strong>Conclusions: </strong>Our Nutrition and TBI Data Repository is the first of its kind, integrating longitudinal patient-level nutrition care data with TBI outcomes sourced directly from the Military Health System to enable researchers to identify critical knowledge gaps in TBI and nutrition care and explore the role of nutrition in TBI recovery.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881037","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":"Sustained War-Related Emergency Department Presentations and Evolving Civilian Injury Patterns During Recurrent Missile-Related Conflict.","authors":"Yuval Dadon, Amir Nutman, Orit Mazza, Uri Feinstein, Linoy Gabay, Anat Engel","doi":"10.1093/milmed/usag412","DOIUrl":"https://doi.org/10.1093/milmed/usag412","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Prolonged missile-related conflicts may generate evolving civilian injury patterns and continuing war-related presentations to emergency departments. Although mass casualty incidents receive substantial attention in the disaster medicine literature, less is known regarding how civilian injury profiles and war-related emergency department presentations evolve during recurrent and prolonged conflict conditions. Understanding these changes is important for healthcare preparedness and continuity of emergency services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We conducted a retrospective observational study of civilian presentations to a large urban emergency department documented as occurring in the context of 2 conflicts involving attacks by the same regional adversary: June 13-25, 2025, and February 28-April 19, 2026. Demographic characteristics, injury severity, patient disposition, and diagnosis categories were analyzed. Because 4 nearby mass casualty incidents occurred during the first conflict period, an adjusted analysis excluding casualties presenting on mass casualty incident dates was performed to evaluate underlying wartime injury patterns. The second conflict period was additionally divided into early and later phases to assess temporal changes during prolonged conflict exposure. Daily presentation rates were calculated to account for differences in conflict duration. The study was approved by the Institutional Review Board of Edith Wolfson Medical Center (approval no. 0084-26-WOMC, 2026). The requirement for informed consent was waived due to the retrospective nature of the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1,018 war-related civilian ED presentations were included. Period 1 included 418 presentations over 13 days, corresponding to 32.2 presentations per day. After excluding the 4 mass casualty incident dates, 127 presentations occurred over 9 days, corresponding to 14.1 presentations per day. Period 2 included 600 presentations over 51 days, corresponding to 11.8 presentations per day. Initial analyses demonstrated lower injury severity during Period 2; however, after exclusion of mass casualty incident-associated casualties, severity distributions were similar, with mild injuries accounting for 96.1% and 97.0% of presentations, respectively. Diagnosis distributions differed significantly between periods (P &lt; .001). Extremity injuries increased from 31.9% to 44.2% and peaked during the early phase of Period 2 at 48.2%, before declining to 34.8% during the later phase. Psychological/anxiety-related presentations decreased from 11.8% to 0.8%, while multiregion trauma reached 9.9% during the later phase of Period 2. War-related presentations continued throughout the prolonged second conflict period despite the absence of nearby missile impacts or formal mass casualty incident activation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Civilian wartime injury profiles evolved across recurrent missil","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875453","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":"Utilizing Point-of-Care Ultrasound and Tourniquet Placement for Expedited Diagnosis and Management of Intravenous Cannula Breakage: A Case Report.","authors":"Bar Lossos, Sharon Einav, Sami Gendler, Or Assouline","doi":"10.1093/milmed/usaf617","DOIUrl":"10.1093/milmed/usaf617","url":null,"abstract":"<p><p>The breakage of an intravenous (IV) cannula represents a rare complication associated with peripheral IV cannulation, a prevalent procedure in the civilian and military prehospital setting. Intravenous cannula breakage can lead to further complications including infection, migration, and subsequent embolization. Although fast identification and extraction are essential management components, there are no consensual guidelines for the proper management of this complication. In this report, we present a case involving a 19-year-old soldier who presented to the emergency department following the rupture of an IV cannula during military training. Subsequently, embolization of the cannula fragment occurred because of the patient's discomfort and noncompliance with venous tourniquet usage. This case report delineates the actions taken both on-site and upon the patient's arrival in the emergency room, including the utilization of point-of-care ultrasound as an expedient diagnostic tool for identifying the fragmented cannula swiftly. Additionally, we provide a review of the management approaches detailed in existing literature, with a specific emphasis on the use of venous tourniquet placement as a potential measure for avoiding complications.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e2190-e2193"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828003","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":"Veterans' Perspectives on Serious Illness Communication About Lung Disease Progression.","authors":"Allison V Lange, Caroline Tietbohl, Robert P Klocko, David B Bekelman, Anuj B Mehta","doi":"10.1093/milmed/usag066","DOIUrl":"10.1093/milmed/usag066","url":null,"abstract":"<p><strong>Introduction: </strong>Serious illness communication (SIC) is a series of complex, iterative conversations between patients, their caregivers, and clinicians in which a patient's understanding of their illness, preferences, values, and medical decisions are addressed. An essential part of SIC for patients with chronic lung disease is communication about lung disease progression. How patients interpret clinician communication about lung disease progression is unknown. This study sought to understand how patients experience communication about the future of lung disease and how this influences a patient's understanding of their disease.</p><p><strong>Materials and methods: </strong>Semi-structured interviews. Transcripts were analyzed using content analysis. Participants were veterans and had chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and/or pulmonary hypertension.</p><p><strong>Results: </strong>Twenty-two patients were approached and completed interviews. Participants were a mean age of 71 years; female, 9%; white, 64%; and non-Hispanic, 86%. Four themes emerged. (1) Gaps in understanding of lung disease: Participants did not know about future exacerbations of lung disease. (2) Burden: Participants did not want to burden family members, which motivated a desire for information about how to manage their lung disease and plan for future care needs. (3) Mistrust: Participants were mistrustful about a potential link between military exposures and lung disease. (4) Information needs: Participants wanted information about daily life, causes of lung disease, test results, and time remaining.</p><p><strong>Conclusions: </strong>There are information needs among veterans with chronic lung disease regarding exposures, causes of lung disease, and managing lung disease. Future work should explore how to address veterans' unmet SIC needs.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e2021-e2029"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147307576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of the Joint Critical Care Advanced Support Team in Sustaining Net-Neutral Patient Flow Through Hawaii During a Large-Scale Combat Operation Event in the Indo-Pacific Theater.","authors":"Kazuma Nakagawa, Derek M Sorensen, William R Smith, Paul J D Roszko, Andrew D Goodrich","doi":"10.1093/milmed/usag171","DOIUrl":"10.1093/milmed/usag171","url":null,"abstract":"<p><p>The Joint Critical Care Advanced Support Team maintains Hawaii's limited critical care capacity during Indo-Pacific Large-Scale Combat Operations, ensuring a net-neutral patient flow. This military-civilian effort ensures that critical care patients receive timely life-saving care while stabilized patients are moved to the Continental United States, preserving Hawaii's healthcare balance.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"154-157"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147776130","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":"\"Prove Yourself, Jane\": Medical Student 55-Word Story Reflections of Initial Clerkship Experiences.","authors":"Elyse Fiore Pierre, Ryan M Sanborn, Annabelle Bailey, Austin Chin, Kamryn McKenzie, Amy McDonald, Heather MacEwen, Adam K Saperstein","doi":"10.1093/milmed/usag173","DOIUrl":"10.1093/milmed/usag173","url":null,"abstract":"<p><p>In the following curated selection of thoughtfully distilled 55-word stories, military medical students from the Uniformed Services University Class of 2026 thoughtfully reflect on the intense and challenging patient care and professional experiences which comprise the \"hidden curriculum\" within their initial year of clinical clerkships.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"151-153"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775965","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 Short- and Long-Term Outcomes of Laser Hair Removal for the Management of Pseudofolliculitis Barbae in a Military Population.","authors":"Shena Kravitz, Jacqueline Jones, Emily Raffetto, Michael Stanley, Sunghun Cho","doi":"10.1093/milmed/usaf611","DOIUrl":"10.1093/milmed/usaf611","url":null,"abstract":"<p><strong>Introduction: </strong>Pseudofolliculitis barbae (PFB) is an inflammatory follicular disorder caused by shaving in individuals who have naturally curly hair. PFB is commonly seen in the United States Military, where Service Members (SM) are required to shave their facial hair to maintain strict grooming standards. Laser hair removal (LHR) is effective at treating PFB and is an accepted alternative to a shaving waiver.</p><p><strong>Materials and methods: </strong>50 patients previously treated for PFB with LHR were identified in the electronic medical record system at Walter Reed National Military Medical Center. All 50 participants were active duty of various ranks and branches during their treatment. LHR treatment series were considered complete after 4-6 sessions separated by 4-8 weeks of LHR with either the Nd: YAG or Alexandrite lasers. Time interval for the search was between January 2017 and June 2021. The authors conducted a phone survey in June 2021. Participants were asked various questions to assess the long-term effectiveness of LHR and subsequent hair regrowth after their LHR treatment. Participants' overall satisfaction with LHR as a PFB treatment modality and impact on military service was queried.</p><p><strong>Results: </strong>Of the 50 participants (74% identified as Black), 88% were satisfied with LHR. Immediately post-treatment, 70% of participants noted ≥ 75% reduction in PFB lesions, allowing 96% of all participants to resume shaving. PFB recurred in 84% of participants, with 56% of these noting recurrence within 6 months. After treatment, 64% of participants reported patchy hair growth, which became more uniform over time. Notably, PFB influenced 24% of participants' decisions to remain in the military.</p><p><strong>Conclusions: </strong>LHR is an effective management option for PFB, significantly reducing disease burden and enabling shaving in most military patients. However, recurrence is common, often within six months, necessitating maintenance treatments. Patients require thorough counseling on outcomes and expectation management, including the high likelihood of recurrence and the potential for patchy hair growth. Lastly, educating SM about PFB and LHR during recruitment and basic training may help to increase awareness of this condition and treatment options.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e1810-e1816"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917880","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":"Over 10 Years of Tuberculosis-Understanding the Manifestations, Epidemiology and Clinical Characteristics of Tuberculosis Cases at a United States Military Hospital.","authors":"Justen T Despain, John L Kiley, Mary B Ford","doi":"10.1093/milmed/usag031","DOIUrl":"10.1093/milmed/usag031","url":null,"abstract":"<p><strong>Introduction: </strong>Tuberculosis (TB) causes significant morbidity and mortality worldwide. Diagnosing TB in service members can be a challenge given the overall low incidence but increased risk of exposure that accompanies military travel, training and activities. Here we describe clinical features, risk factors, and characteristics of initial diagnoses of TB at the largest Department of Defense hospital.</p><p><strong>Materials and methods: </strong>Acid-fast bacilli cultures positive for Mycobacterium tuberculosis at Brooke Army Medical Center were reviewed identifying TB cases between 2010 and 2023. Epidemiologic, clinical, and microbiologic data were collected from medical records. Only patients with initial diagnosis at Brooke Army Medical Center (BAMC) were included.</p><p><strong>Results: </strong>Twenty-nine patients (65% non-U.S. born) were diagnosed with TB, primarily pulmonary. Latent tuberculosis infection was the most common comorbidity (33%), followed by diabetes and lung disease (21% and 17%). Cough and sputum production were the most frequent symptoms (59%, 48%); 24% were asymptomatic at diagnosis. Acid fast bacilli (AFB) smear positive patients were older with higher rates of classic TB symptoms. Median number of sputum cultures was 4; 58% were collected at least 8 hours apart; 41% had one collected before 10 AM. Only 75% of samples included TB nucleic acid amplification testing (NAAT).</p><p><strong>Conclusions: </strong>Acid fast bacilli smear negative patients tended to be younger, asymptomatic, have more chronic lung disease, extrapulmonary disease, prior latent tuberculosis infection (LTBI), and longer time from symptoms to treatment highlighting the diagnostic difficulty of these cases. Patients with sputum negative disease and extrapulmonary TB had more days between symptom onset and treatment than AFB sputum positive TB cases. Half of AFB smear negative active duty patients were also TB NAAT negative. Care should be taken when evaluating young, asymptomatic active duty patients with high-risk histories and features for tuberculosis. More research is needed to enhance initial diagnostic evaluation and testing and evaluation for TB in civilian and military population.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e2085-e2092"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157681","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":"Cross-sectional Comparison of Social Drivers of Health in The Million Veteran Program and Behavioral Risk Factor Surveillance System (2011-2023).","authors":"April R Williams, Serena C Houghton, Yanping Li, David Gagnon, Yuk-Lam Ho, Kelly Cho, John Michael Gaziano, Stacey B Whitbourne, Xuan-Mai T Nguyen","doi":"10.1093/milmed/usag030","DOIUrl":"10.1093/milmed/usag030","url":null,"abstract":"<p><strong>Introduction: </strong>Social drivers of health (SDOH) influence health, but there are few comparisons of SDOH and health among users of the Veterans Health Administration (VHA) and the broader Veteran community to support using SDOH variables in Veteran research. The objectives were to compare SDOH and health status between 2 cohorts of U.S. Veterans who independently participated in research programs that collected similar SDOH and general health information: the Department of Veterans Affairs (VA) Million Veteran Program (MVP) and the Behavioral Risk Factor Surveillance System (BRFSS).</p><p><strong>Materials and methods: </strong>Survey data for U.S. Veterans were collected 2011-2023 from MVP (N = 563,973) and BRFSS (N = 684,422) for demographics, health status, geography, education, income, employment, partnership status, household size, and social support. Cohorts were compared using standard mean differences (SMD) and sex-stratified Poisson models adjusting for age, race, and ethnicity. Absolute risk, risk differences, and risk ratios of favorable versus unfavorable SDOH for having better general health were reported.</p><p><strong>Results: </strong>Differences were small (SMD < 0.50) between the cohorts for demographics, general health, and all SDOH, except social support (females SMD: 0.89; males SMD: -0.73). Respective MVP and BRFSS differences for better health between favorable and unfavorable SDOH were significant, but small, for size of household among females, and all SDOH except geography among males. For both cohorts, SDOH risk ratios for better general health were greater than one, except household size among female MVP participants.</p><p><strong>Conclusions: </strong>SDH among two large research programs of U.S. Veterans were similar and indicate that favorable SDOH are protective for general health. Considering social context will be useful in studies to improve understanding of risk, prevention and personalized treatment of disease among Veterans.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e2093-e2099"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Edge Advantage: Why Computational Efficiency Matters for Artificial Intelligence in Military Medicine.","authors":"Jeremy C Pamplin, Jeremy C Pamplin","doi":"10.1093/milmed/usag323","DOIUrl":"10.1093/milmed/usag323","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"178-181"},"PeriodicalIF":1.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592607","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}