Bmj Military Health最新文献

{"title":"Clinical, tactical and strategic benefits of a UK Spray Dried Plasma production capability.","authors":"Matt Ellington, E Barnard, L Bower, S Huish, L Green, P Moor, T Woolley, R Cardigan","doi":"10.1136/military-2024-002875","DOIUrl":"https://doi.org/10.1136/military-2024-002875","url":null,"abstract":"<p><p>UK experience from recent conflicts in Iraq and Afghanistan has resulted in improvements in clinical care of injured patients. Resuscitation and blood transfusion is an area that has seen some of the greatest changes. The ongoing war in Ukraine has highlighted the challenges of medical support to Large-Scale Combat Operations (LSCO), one of which is the ability to deliver blood-based resuscitation near to the point of wounding.Plasma is a key aspect of damage control resuscitation and balanced blood transfusion strategies. It is supported by a strong evidence base, which also demonstrates that early administration improves patient outcomes. Conventional plasma transfusion using thawed fresh frozen plasma (FFP) has logistical constraints that preclude its expedient use in the prehospital environment.Temperature-controlled storage, and transport, of sufficient FFP to support LSCO is unrealistic, and temporary campaigns to increase civilian plasma donations signal a combat intent and could compromise Operational Security.Dried plasma components are stable in storage at ambient temperature. They are easily and quickly reconstituted to produce a plasma component with clinically acceptable clotting and coagulation profiles. The UK has access to dried plasma from two European allies, but availability is very limited and use is off-licence. The ongoing UK dried plasma project will provide clinical, tactical and strategic benefits to UK and allied armed forces in future conflicts.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789115","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":"Use of nicotine products and withdrawal support among personnel of the Finnish Defence Forces.","authors":"Maria Danielsson, A Lammi, P Sandström, S Siitonen, J-P Ruohola, J Ollgren, L Pylkkänen, T Vasankari","doi":"10.1136/military-2024-002924","DOIUrl":"https://doi.org/10.1136/military-2024-002924","url":null,"abstract":"<p><strong>Introduction: </strong>While the health hazards of smoking are well known, the harmful effects of smokeless tobacco (snus) and other nicotine products remain less familiar. This study investigates the prevalence and habits of tobacco use among Finnish Defence Forces (FDF) personnel, focusing on the use of snus and preferred withdrawal support.</p><p><strong>Methods: </strong>An electronic questionnaire survey was conducted among FDF personnel in 2014 and 2020. The response rates were 18% in 2014 (n=2386) and 27% in 2020 (n=3373). The study examined demographic factors, smoking, snus and e-cigarette use, and preferences for withdrawal support.</p><p><strong>Results: </strong>Daily smoking decreased significantly from 14% in 2014 to 6% in 2020, while daily snus use increased from 8% to 11%. E-cigarette use remained low (<1% in 2020). The highest prevalence of snus use was among military personnel working with conscripts. About a quarter of snus users (27%) used snus with a nicotine content of 11-20 mg/g and 30% used snus with a nicotine content of 21-30 mg/g. Preferred withdrawal support included nicotine replacement therapy or medication provided by the employer. A significant number of both smokers and snus users did not receive advice to quit from healthcare professionals.</p><p><strong>Conclusions: </strong>Tobacco use among FDF personnel shows a decrease in smoking but an increase in snus use. There is a need for targeted cessation support programmes, with an emphasis on professional advice and employer-provided nicotine replacement therapy. Increased involvement of healthcare professionals in advising quitting could significantly enhance cessation rates.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774546","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 SHADER model: forward surgical teams managing high-intensity, low-frequency military surgery incidents.","authors":"David N Naumann, A M Rennie, B M Lomas, T S G Short, C Tunstall, J Burns, R Chauhan, D M Bowley, T Stansfield","doi":"10.1136/military-2025-002954","DOIUrl":"https://doi.org/10.1136/military-2025-002954","url":null,"abstract":"<p><strong>Introduction: </strong>The UK Defence Medical Services (UK DMS) surgical teams have been deployed in small, low resource, remote mobile Role 2 (R2) facilities globally to provide Damage Control Resuscitation and Surgery for combat casualties. It is vital that commanders understand the expected workload for specific operations for planning and training and sustainment of high-quality surgical capability. The current study examined the surgical workload from a complete forward UK DMS R2 facility deployment to better inform future operations of this nature.</p><p><strong>Methods: </strong>A retrospective observational study was undertaken using a prospectively collected Operative Department Logbook to determine the number and type of procedures undertaken during a complete deployment between September 2019 and March 2024 (including 18 deployments of 3 months each). Patient and operative details were collected, including the indication (trauma or non-trauma), and compared between Trauma & Orthopaedic (T&O) and General & Vascular (G&V) surgeons.</p><p><strong>Results: </strong>There were 35 patients who had surgery. The median age was 25 (IQR 22-31), and 33/35 (94%) were male. There were 20/35 (57%) procedures following trauma, and the remainder were for non-trauma emergencies. 11/35 (31%) patients were injured by gunshot or blast mechanism. No mass casualty situations within the Area of Operations, nor outbreaks of infectious diseases within the deployed forces occurred during the time period. More procedures were undertaken by G&V specialists than T&O for (20 vs 16, respectively, with one combined procedure). However, the operations were less likely to be for a trauma indication as a proportion of their workload (6/20 (29%) <i>vs</i> 15/16 (93%), respectively; p<0.001).</p><p><strong>Conclusions: </strong>This remote, forward R2 deployment was characterised by low volume of surgical workload, but a requirement for high readiness and competency in major trauma surgery. This represents a challenge for training and currency that must be addressed for optimal surgical care in ongoing and future operations.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711649","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":"Lion bite: infectious considerations.","authors":"Megan Booth, M Ogunjimi","doi":"10.1136/military-2024-002942","DOIUrl":"https://doi.org/10.1136/military-2024-002942","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711648","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":"Reach-back to subject matter experts improves healthcare quality, influences the decision to evacuate and reduces costs: an observational study of the UK Defence Medical Services Deployed Telemedicine System.","authors":"Richard J Booker, A Hunter, D Sharpe, M Claydon, O Bartels, D N Naumann","doi":"10.1136/military-2024-002941","DOIUrl":"https://doi.org/10.1136/military-2024-002941","url":null,"abstract":"<p><strong>Introduction: </strong>The UK Defence Medical Services (DMS) have used the medical instant messaging application Pando (Forward Clinical, London) since 2019. This application is used to deliver a deployed telemedicine system comprising a wide range of specialist advice teams. We report an 18-month evaluation of workload, user experience and military effect.</p><p><strong>Methods: </strong>Server data pertaining to the 'Ask Advice' function from 1 January 2023 to 30 June 2024 were analysed retrospectively. During the same period, a voluntary online, anonymous survey was offered to all requestors of advice, evaluating the impact of advice on evacuation decision-making, estimations of costs saved and healthcare quality.</p><p><strong>Results: </strong>There were 833 eligible advice conversations during the study period. The three most frequently consulted specialties were trauma and orthopaedics, hand surgery, and ear, nose and throat. There were 274 responses to the survey. 168/274 (61%) responses reported that telemedicine had changed the evacuation priority. 102/274 (37%) responses reported cost savings and 245/274 (89%) responses said that the quality of healthcare was improved.</p><p><strong>Conclusions: </strong>The DMS Deployed Telemedicine System is used most days, and users report improvement in healthcare quality for patients. There has been a meaningful impact on the decision to evacuate service persons, with the likelihood of significant cost savings. Benefits may be realised during warfighting activity if assured bearers and bandwidth can be provisioned to military medical services.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701857","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":"'I never thought of myself as a veteran': written reflections on veteran identity by ex-servicewomen in Wales.","authors":"Lauren Rose Godier-McBard, E Fleet, A D Adams","doi":"10.1136/military-2024-002914","DOIUrl":"https://doi.org/10.1136/military-2024-002914","url":null,"abstract":"<p><strong>Introduction: </strong>Although over 2 50 000 women in England and Wales have served in the armed forces, veteran research has historically focused on men, with only 2% of international studies including women. This study examines how veteran identity, defined as the significance of military service to one's self-concept, shapes ex-servicewomen's connection to the veteran community.</p><p><strong>Methods: </strong>Qualitative written reflections were collected from 21 ex-servicewomen. Participants reflected on their perception of what constitutes a veteran, and whether the term 'veteran' formed part of their identity. The researchers employed reflexive thematic analysis, using NVivo V.14.</p><p><strong>Results: </strong>Participants generally understood the official UK government definition of a veteran. Additionally, women's understanding of the meaning of the term veteran was related to someone having served in the military, having shared core values relating to military service and preconceived associations of the term veteran with men, older age and particular conflicts. In relation to their own veteran identity, results indicate that while some participants experienced a sense of pride and belonging tied to their veteran identity, others struggled with feelings of unworthiness, especially if they had shorter service periods or non-combat roles. Many participants also described a delayed identification with veteran status due to stereotypical perceptions and negative in-service experiences.</p><p><strong>Conclusions: </strong>This study aligns with previous evidence that ex-servicewomen struggle to identify with the term veteran. Both stereotypical societal perceptions of who a veteran is, often older men with combat experience and longer terms of service, and negative military experiences were factors related to women's non-identification or delayed identification with their veteran identity. This study underscores the importance of peer support opportunities for ex-servicewomen. For some, engaging with other ex-servicewomen and participating in the veteran community was a factor in developing connection to being a veteran, which they previously had not identified with.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694186","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":"Influence of military preventive policy for recruit training on COVID-19 seroconversion: the IMPACT-COVID-19 study.","authors":"Michael John Stacey, P Ferentinos, F Koivula, I T Parsons, R M Gifford, D Snape, A Nicholson-Little, S Faustini, N P Walsh, L E Lamb, M K O'Shea, A G Richter, J P Greeves, J O'Hara, D Woods","doi":"10.1136/military-2024-002940","DOIUrl":"https://doi.org/10.1136/military-2024-002940","url":null,"abstract":"<p><strong>Introduction: </strong>Recruitment and training is vital to maintaining the size, deployability and effectiveness of armed forces, but was threatened early in the COVID-19 pandemic. Reports suggested asymptomatic seroconversion driving SARS-CoV-2 transmission in young adults. Potential association between lower vitamin D status and increased infection risk was also highlighted. We aimed to prospectively determine seroconversion and test the hypothesis that this would vary with vitamin D supplementation in representative populations.</p><p><strong>Methods: </strong>Two cohorts were recruited from Yorkshire, Northern England. Infantry recruits received daily oral vitamin D (1000 IU for 4 weeks, followed by 400 IU for the remaining 22 weeks of training) in institutional countermeasures to facilitate ongoing training/co-habitation. Controls were recruited from an un-supplemented University population, subject to social distancing and household restrictions. Venous blood samples (baseline and week 16) were assayed for vitamin D and anti-SARS-CoV-2 spike glycoprotein antibodies, with additional serology (weeks 4, 9, 12) by dried blood spot. The impact of supplementation was analysed on an intention-to-treat basis in volunteers completing testing at all time points and remaining unvaccinated against SARS-CoV-2. Variation in seroconversion with vitamin D change was explored across, and modelled within, each population.</p><p><strong>Results: </strong>In the military (n=333) and University (n=222) cohorts, seroconversion rates were 44.4% vs 25.7% (p=0.003). At week 16, military recruits showed higher vitamin D (60.5±19.5 mmol/L vs 53.5±22.4 mmol/L, p<0.001), despite <50% supplementation adherence. A statistically significant (p=0.005) effect of negative change in vitamin D (%) on seroconversion in recruits (OR of 0.991 and 95% CI of 0.984 to 0.997) was not evidenced in the University cohort.</p><p><strong>Conclusion: </strong>Among unvaccinated populations, SARS-CoV-2 infection of infantry recruits was not reduced by institutional countermeasures, versus civilians subject to national restrictions. Vitamin D supplementation improved serum levels, but the implementation did not have a clinically meaningful impact on seroconversion during military training.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694187","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":"Advancing military medical research and training in the Saudi Armed Forces: a call to action.","authors":"Mohammed G Alkhathami, Y A Al Naam, E M Al Zahrani","doi":"10.1136/military-2023-002528","DOIUrl":"10.1136/military-2023-002528","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"184"},"PeriodicalIF":1.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487625","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":"Influence of employment characteristics on seeking help for mental health conditions in the UK Defence Medical Services.","authors":"Toby James Holland, A Simms, D Lamb, K King","doi":"10.1136/military-2023-002570","DOIUrl":"10.1136/military-2023-002570","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"185-186"},"PeriodicalIF":1.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138292104","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":"COVID-19 mRNA vaccination and myocarditis/pericarditis in the setting of active surveillance at a military treatment facility.","authors":"Richelle L Homo, D J Colby, M L Romo, S Moreland, H Follen, B Hernandez, D Robinson, K Liesemer, M Paudel, T A Crowell, A Martin, I F Armendi, E Martinez-Bucki, J Bay, P Faestel, R Sainato","doi":"10.1136/military-2023-002599","DOIUrl":"10.1136/military-2023-002599","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"187-188"},"PeriodicalIF":1.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399867","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}