Military surgeon最新文献

{"title":"Leadership Lessons From the Field: Leading Others to Cope With Death.","authors":"Jamie Geringer, S. Durning","doi":"10.1093/milmed/usac128","DOIUrl":"https://doi.org/10.1093/milmed/usac128","url":null,"abstract":"All healthcare leaders will inevitably face patient death and dealing with loss. While leaders have different preparation for this, many lack comfort and confidence navigating death, whether it be of a patient, family member, or colleague. Learning how to support others in dealing with death is a fundamental leadership skill.","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42273478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Survey Among Cadets at the United States Military Academy on Knowledge and Wearing of Permethrin-Treated Uniforms and the Risk of Tick-Borne Diseases.","authors":"Alyssa H Chellaraj, Dylan J Nun, Jason Y Johnson, Kiley A Sweet, Alex M Burgess, Galina M Gordon, Skyler A Chauff, Benjamin M Millican, Canden J Wilkinson, Silas A Davidson","doi":"10.1093/milmed/usac131","DOIUrl":"10.1093/milmed/usac131","url":null,"abstract":"<p><strong>Introduction: </strong>The Army uses permethrin-treated uniforms as the primary method to protect soldiers from tick-borne diseases. Permethrin binds strongly to fabric and provides long-term protection against many blood-feeding arthropods. However, protection decreases if the uniforms are not washed and cared for according to label instructions. This study was conducted among cadets at the United States Military Academy (USMA) at West Point, NY, to determine what the cadets know about permethrin and how they care for and wear their uniforms. West Point is in an area with high rates of tick-borne disease transmission. A survey was developed to determine what cadets know about the threat of tick-borne diseases and if they wear and maintain their uniforms in a manner that effectively maintains permethrin levels.</p><p><strong>Materials and methods: </strong>A 16-question survey was developed and submitted to the local review board for approval. The study was classified as human subjects research according to 32CFR219 and met the requirements for exempt status under 32CFR219.104(d)(2)(i). After receiving approval, a hard copy survey was distributed among cadets with efforts to sample at least 50 members from each cadet class.</p><p><strong>Results: </strong>A total of 319 cadets provided responses to the survey questions, representing more than 7% of the cadet population at the USMA. The results showed most cadets knew their uniforms were treated with permethrin, but less than half knew there are specific instructions attached to their uniforms describing how the uniforms should be laundered. From the cadets who knew there were instructions, most admittedly did not follow the instructions. Sixteen percent of cadets said they had dry-cleaned their uniforms. This is a process known to remove most of the permethrin. The majority of cadets viewed the risk of tick-borne disease at West Point to be moderate or lower.</p><p><strong>Conclusions: </strong>This study provides a basic understanding of the wear patterns of permethrin-treated uniforms among cadets at the USMA. It is also one of the few studies to measure knowledge and uniform-wearing behavior among service members since the Army switched to factory-treated uniforms in 2013. The results indicate that compliance with uniform laundry and care instructions is low. This information is useful to develop training plans and educate cadets how they can wear and take care of their permethrin-treated uniforms to better protect themselves from tick-borne diseases.</p>","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48229763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Just Culture to Improve Patient Safety.","authors":"John S Murray, Joan Clifford, Stacey Larson, Jonathan K Lee, Gary L Sculli","doi":"10.1093/milmed/usac115","DOIUrl":"10.1093/milmed/usac115","url":null,"abstract":"<p><strong>Introduction: </strong>The number of deaths in the United States related to medical errors remains unacceptably high. Further complicating this situation is the problem of underreporting due to the fear of the consequences. In fact, the most commonly reported cause of underreporting worldwide is the fear of the negative consequences associated with reporting. As health care organizations along the journey to high-reliability strive to improve patient safety, a concerted effort needs to be focused on changing how medical errors are addressed. A paradigm shift is needed from immediately assigning blame and punishing individuals to one that is trusting and just. Staff must trust that when errors occur, organizations will respond in a manner that is fair and appropriate.</p><p><strong>Materials and methods: </strong>An extensive review of the literature from 2017 until January 2022 was conducted for the most current evidence describing the principles and practices of \"just culture\" in health care organizations. Additionally, recommendations were sought on how health care organizations can go about implementing \"just culture\" principles.</p><p><strong>Results: </strong>Twenty sources of evidence on \"just culture' were retrieved and reviewed. The evidence was used to describe the concept and principles of \"just culture\" in health care organizations. Furthermore, five strategies for implementing \"just culture\" principles were identified.</p><p><strong>Conclusions: </strong>Improving patient safety requires that high-reliability organizations strive to ensure that the culture of the organization is trusting and just. In a trusting and just culture, adverse events are recognized as valuable opportunities to understand contributing factors and learn rather than immediately assign blame. Moving away from a blame culture is a paradigm shift for many health care organizations yet critically important for improving patient safety.</p>","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45189499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combat-Related Invasive Fungal Wound Infections.","authors":"Ret Carlos J Rodriguez, A. Ganesan, Faraz Shaikh, M. L. Carson, William P. Bradley, T. Warkentien, D. Tribble","doi":"10.1093/milmed/usab074","DOIUrl":"https://doi.org/10.1093/milmed/usab074","url":null,"abstract":"INTRODUCTION\u0000During Operation Enduring Freedom in Afghanistan, an outbreak of combat-related invasive fungal wound infections (IFIs) emerged among casualties with dismounted blast trauma and became a priority issue for the Military Health System.\u0000\u0000\u0000METHODS\u0000In 2011, the Trauma Infectious Disease Outcomes Study (TIDOS) team led the Department of Defense IFI outbreak investigation to describe characteristics of IFIs among combat casualties and provide recommendations related to management of the disease. To support the outbreak investigation, existing IFI definitions and classifications utilized for immunocompromised patients were modified for use in epidemiologic research in a trauma population. Following the conclusion of the outbreak investigation, multiple retrospective analyses using a population of 77 IFI patients (injured during June 2009 to August 2011) were conducted to evaluate IFI epidemiology, wound microbiology, and diagnostics to support refinement of Joint Trauma System (JTS) clinical practice guidelines. Following cessation of combat operations in Afghanistan, the TIDOS database was comprehensively reviewed to identify patients with laboratory evidence of a fungal infection and refine the IFI classification scheme to incorporate timing of laboratory fungal evidence and include categories that denote a high or low level of suspicion for IFI. The refined IFI classification scheme was utilized in a large-scale epidemiologic assessment of casualties injured over a 5.5-year period.\u0000\u0000\u0000RESULTS\u0000Among 720 combat casualties admitted to participating hospitals (2009-2014) who had histopathology and/or wound cultures collected, 94 (13%) met criteria for an IFI and 61 (8%) were classified as high suspicion of IFI. Risk factors for development of combat-related IFIs include sustaining a dismounted blast injury, experiencing a traumatic transfemoral amputation, and requiring resuscitation with large-volume (>20 units) blood transfusions. Moreover, TIDOS analyses demonstrated the adverse impact of IFIs on wound healing, particularly with order Mucorales. A polymerase chain reaction (PCR)-based assay to identify filamentous fungi and support earlier IFI diagnosis was also assessed using archived formalin-fixed, paraffin-embedded tissue specimens. Although the PCR-based assay had high specificity (99%), there was low sensitivity (63%); however, sensitivity improved to 83% in tissues collected from sites with angioinvasion. Data obtained from the initial IFI outbreak investigation (37 IFI patients) and subsequent TIDOS analyses (77 IFI patients) supported development and refinement of a JTS clinical practice guideline for the management of IFIs in war wounds. Furthermore, a local clinical practice guideline to screen for early tissue-based evidence of IFIs among blast casualties at the Landstuhl Regional Medical Center was critically evaluated through a TIDOS investigation, providing additional clinical practice support. Through a collaboration with th","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":"187 Supplement_2 1","pages":"34-41"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43000535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Department of Defense Trauma Registry Infectious Disease Module Impact on Clinical Practice.","authors":"D. Tribble, M. Spott, Stacey A Shackleford, J. Gurney, Bg Clinton K Murray","doi":"10.1093/milmed/usac050","DOIUrl":"https://doi.org/10.1093/milmed/usac050","url":null,"abstract":"BACKGROUND\u0000The Joint Trauma System (JTS) is a DoD Center of Excellence for Military Health System trauma care delivery and the DoD's reference body for trauma care in accordance with National Defense Authorization Act for Fiscal Year 2017. Through the JTS, evidence-based clinical practice guidelines (CPGs) have been developed and subsequently refined to standardize and improve combat casualty care. Data are amassed through a single, centralized DoD Trauma Registry to support process improvement measures with specialty modules established as the registry evolved. Herein, we review the implementation of the JTS DoD Trauma Registry specialty Infectious Disease Module and the development of infection-related CPGs and summarize published findings on the subsequent impact of the Infectious Disease Module on combat casualty care clinical practice and guidelines.\u0000\u0000\u0000METHODS\u0000The DoD Trauma Registry Infectious Disease Module was developed in collaboration with the Infectious Disease Clinical Research Program (IDCRP) Trauma Infectious Disease Outcomes Study (TIDOS). Infection-related information (e.g., syndromes, antibiotic management, and microbiology) were collected from military personnel wounded during deployment June 1, 2009 through December 31, 2014 and medevac'd to Landstuhl Regional Medical Center in Germany before transitioning to participating military hospitals in the USA.\u0000\u0000\u0000RESULTS\u0000To support process improvements and reduce variation in practice patterns, data collected through the Infectious Disease Module have been utilized in TIDOS analyses focused on assessing compliance with post-trauma antibiotic prophylaxis recommendations detailed in JTS CPGs. Analyses examined compliance over three time periods: 6 months, one-year, and 5 years. The five-year analysis demonstrated significantly improved adherence to recommendations following the dissemination of the 2011 JTS CPG, particularly with open fractures (34% compliance compared to 73% in 2013-2014). Due to conflicting recommendations regarding use of expanded Gram-negative coverage with open fractures, infectious outcomes among patients with open fractures who received cefazolin or expanded Gram-negative coverage (cefazolin plus fluoroquinolones and/or aminoglycosides) were also examined in a TIDOS analysis. The lack of a difference in the proportion of osteomyelitis (8% in both groups) and the significantly greater recovery of Gram-negative organisms resistant to aminoglycosides or fluoroquinolones among patients who received expanded Gram-negative coverage supported JTS recommendations regarding the use of cefazolin with open fractures. Following recognition of the outbreak of invasive fungal wound infections (IFIs) among blast casualties injured in Afghanistan, the ID Module was refined to capture data (e.g., fungal culture and histopathology findings, wound necrosis, and antifungal management) needed for the TIDOS team to lead the DoD outbreak investigation. These data captured through the In","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":"187 Supplement_2 1","pages":"7-16"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44546875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IDCRP Trauma-Related Infection Research.","authors":"D. Tribble","doi":"10.1093/milmed/usab508","DOIUrl":"https://doi.org/10.1093/milmed/usab508","url":null,"abstract":"","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":"187 Supplement_2 1","pages":"2-6"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45786971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidrug-Resistant and Virulent Organisms Trauma Infections: Trauma Infectious Disease Outcomes Study Initiative.","authors":"K. Mende, K. Akers, Stuart D. Tyner, J. Bennett, M. Simons, D. Blyth, Ping Li, L. Stewart, D. Tribble","doi":"10.1093/milmed/usab131","DOIUrl":"https://doi.org/10.1093/milmed/usab131","url":null,"abstract":"INTRODUCTION\u0000During the wars in Iraq and Afghanistan, increased incidence of multidrug-resistant (MDR) organisms, as well as polymicrobial wounds and infections, complicated the management of combat trauma-related infections. Multidrug resistance and wound microbiology are a research focus of the Trauma Infectious Disease Outcomes Study (TIDOS), an Infectious Disease Clinical Research Program, Uniformed Services University, research protocol. To conduct comprehensive microbiological research with the goal of improving the understanding of the complicated etiology of wound infections, the TIDOS MDR and Virulent Organisms Trauma Infections Initiative (MDR/VO Initiative) was established as a collaborative effort with the Brooke Army Medical Center, Naval Medical Research Center, U.S. Army Institute of Surgical Research, and Walter Reed Army Institute of Research. We provide a review of the TIDOS MDR/VO Initiative and summarize published findings.\u0000\u0000\u0000METHODS\u0000Antagonism and biofilm formation of commonly isolated wound bacteria (e.g., ESKAPE pathogens-Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.), antimicrobial susceptibility patterns, and clinical outcomes are being examined. Isolates collected from admission surveillance swabs, as part of infection control policy, and clinical infection workups were retained in the TIDOS Microbiological Repository and associated clinical data in the TIDOS database.\u0000\u0000\u0000RESULTS\u0000Over the TIDOS study period (June 2009 to December 2014), more than 8,300 colonizing and infecting isolates were collected from military personnel injured with nearly one-third of isolates classified as MDR. At admission to participating U.S. military hospitals, 12% of wounded warriors were colonized with MDR Gram-negative bacilli. Furthermore, 27% of 913 combat casualties with ≥1 infection during their trauma hospitalization had MDR Gram-negative bacterial infections. Among 335 confirmed combat-related extremity wound infections (2009-2012), 61% were polymicrobial and comprised various combinations of Gram-negative and Gram-positive bacteria, yeast, fungi, and anaerobes. Escherichia coli was the most common Gram-negative bacilli isolated from clinical workups, as well as the most common colonizing MDR secondary to extended-spectrum β-lactamase resistance. Assessment of 479 E. coli isolates collected from wounded warriors found 188 pulsed-field types (PFTs) from colonizing isolates and 54 PFTs from infecting isolates without significant overlap across combat theaters, military hospitals, and study years. A minority of patients with colonizing E. coli isolates developed subsequent infections with the same E. coli strain. Enterococcus spp. were most commonly isolated from polymicrobial wound infections (53% of 204 polymicrobial cultures). Patients with Enterococcus infections were severely injured with a high proportion of lower extremity amputations and ge","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":"187 Supplement_2 1","pages":"42-51"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42547599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DoD-VA Trauma Infection Research Collaboration.","authors":"Jay McDonald, S. Liang, Ping Li, L. Stewart, D. Tribble","doi":"10.1093/milmed/usab482","DOIUrl":"https://doi.org/10.1093/milmed/usab482","url":null,"abstract":"BACKGROUND\u0000In the aftermath of wars, there is a surge in the number of wounded service members who leave active duty and become eligible for healthcare through the Department of Veterans Affairs (VA). Collaborations between the Department of Defense (DoD) and VA are crucial to capture comprehensive data and further understand the long-term impact of battlefield trauma. We provide a summary of the development, methodology, and status of an effective collaboration between the Infectious Disease Clinical Research Program and the St. Louis VA Health Care System with the multicenter, observational Trauma Infectious Disease Outcomes Study (TIDOS), which examines the short- and long-term outcomes of deployment-related trauma.\u0000\u0000\u0000METHODS\u0000As part of TIDOS, wounded service members who transitioned to participating military hospitals in the United States (2009-2014) were given the opportunity to enroll in a prospective follow-up cohort study to continue to capture infection-related data after their hospital discharge. Enrollees in the TIDOS cohort who left military service and received health care through the VA also had the option of consenting to have relevant VA medical records abstracted and included with the study data. Infections considered to be complications resulting from the initial trauma were examined.\u0000\u0000\u0000RESULTS\u0000Among 1,336 TIDOS enrollees, 1,221 (91%) registered and received health care through the VA with 633 (47%) consenting to follow-up using VA records and comprising the TIDOS-VA cohort. Of the first 337 TIDOS-VA cohort enrollees, 38% were diagnosed with a new trauma-related infection following hospital discharge (median: 88 days; interquartile range: 18-351 days). Approximately 71% of the infections were identified through DoD sources (medical records and follow-up) and 29% were identified through VA electronic medical records, demonstrating the utility of DoD-VA collaborations. The TIDOS DoD-VA collaboration has also been utilized to assess intermediate and long-term consequences of specific injury patterns. Among 89 TIDOS-VA cohort enrollees with genitourinary trauma, 36% reported sexual dysfunction, 21% developed at least one urinary tract infection, 14% had urinary retention/incontinence, and 8% had urethral stricture. The rate of urinary tract infections was 0.05/patient-year during DoD follow-up time and 0.07/patient-year during VA follow-up time.\u0000\u0000\u0000CONCLUSIONS\u0000Wider capture of infection-related outcome data through the DoD-VA collaboration provided a clearer picture of the long-term infection burden resulting from deployment-related trauma. Planned analyses include assessment of osteomyelitis among combat casualties with amputations and/or open fractures, evaluation of mental health and social factors related to injury patterns, and examination of health care utilization and cost in relation to infectious disease burdens.","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":"187 Supplement_2 1","pages":"17-24"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43970530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IDCRP Combat-Related Extremity Wound Infection Research.","authors":"Joseph L. Petfield, Louis R. Lewandowski, L. Stewart, C. Murray, D. Tribble","doi":"10.1093/milmed/usab065","DOIUrl":"https://doi.org/10.1093/milmed/usab065","url":null,"abstract":"INTRODUCTION\u0000Extremity trauma is the most common battlefield injury, resulting in a high frequency of combat-related extremity wound infections (CEWIs). As these infections are associated with substantial morbidity and may impact wounded warriors long after initial hospitalization, CEWIs have been a focus of the Infectious Disease Clinical Research Program (IDCRP). Herein, we review findings of CEWI research conducted through the IDCRP and discuss future and ongoing analyses.\u0000\u0000\u0000METHODS\u0000Military personnel with deployment-related trauma sustained between 2009 and 2014 were examined in retrospective analyses through the observational Trauma Infectious Disease Outcomes Study (TIDOS). Characteristics of wounded warriors with ≥1 open extremity wound were assessed, focusing on injury patterns and infection risk factors. Through a separate trauma-associated osteomyelitis study, military personnel with combat-related open fractures of the long bones (tibia, femur, and upper extremity) sustained between 2003 and 2009 were examined to identify osteomyelitis risk factors.\u0000\u0000\u0000RESULTS\u0000Among 1,271 wounded warriors with ≥1 open extremity wound, 16% were diagnosed with a CEWI. When assessed by their most severe extremity injury (i.e., amputation, open fracture, or open soft-tissue wound), patients with amputations had the highest proportion of infections (47% of 212 patients with traumatic amputations). Factors related to injury pattern, mechanism, and severity were independent predictors of CEWIs during initial hospitalization. Having a non-extremity infection at least 4 days before CEWI diagnosis was associated with reduced likelihood of CEWI development. After hospital discharge, 28% of patients with extremity trauma had a new or recurrent CEWI during follow-up. Risk factors for the development of CEWIs during follow-up included injury pattern, having either a CEWI or other infection during initial hospitalization, and receipt of antipseudomonal penicillin for ≥7 days. A reduced likelihood for CEWIs during follow-up was associated with a hospitalization duration of 15-30 days. Under the retrospective osteomyelitis risk factor analysis, patients developing osteomyelitis had higher open fracture severity based on Gustilo-Anderson (GA) and the Orthopaedic Trauma Association classification schemes and more frequent traumatic amputations compared to open fracture patients without osteomyelitis. Recurrence of osteomyelitis was also common (28% of patients with open tibia fractures had a recurrent episode). Although osteomyelitis risk factors differed between the tibia, femur, and upper extremity groups, sustaining an amputation, use of antibiotic beads, and being injured in the earlier years of the study (before significant practice pattern changes) were consistent predictors. Other risk factors included GA fracture severity ≥IIIb, blast injuries, foreign body at fracture site (with/without orthopedic implant), moderate/severe muscle damage and/or necrosis, and moder","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":"187 Supplement_2 1","pages":"25-33"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45319063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SARS-CoV-2 Vaccine Acceptance Disparity Among Israeli Defense Forces Personnel.","authors":"Galina Shapiro, Maxim Bez, Tomer Talmy, Josef Daniel Shakargy, Ariel Furer, Erez Karp, David Segal","doi":"10.1093/milmed/usac122","DOIUrl":"10.1093/milmed/usac122","url":null,"abstract":"<p><strong>Introduction: </strong>Promoting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine acceptance and uptake became necessary to achieve a high vaccination rate and subsequently herd immunity. Although the Israeli population has been largely acceptant of the SARS-CoV-2 vaccine, vaccine hesitancy has remained a major concern, especially in younger adults. We hypothesized that young adults who refused SARS-CoV-2 vaccination differed from those who have been adherent and could be characterized. Studying this specific population and recognizing individuals within this group who might be more probable to refuse vaccination can enable to target measures to further promote vaccination acceptance.</p><p><strong>Methods: </strong>We conducted a cross-sectional comparison in a study population comprised of 17,435 Israeli Defense Forces (IDF) personnel who were SARS-CoV-2 vaccine eligible. This group included 14,834 vaccinated and 2,601 nonvaccinated individuals. Patient characteristics including occupational parameters, demographic features, psychotechnical grading (an intelligence assessment score), education level, and medical background were collected.</p><p><strong>Results: </strong>The median age was 20.57 years and almost 80% were males. At the time of data collection, most individuals (85.1%, n = 14,834) have been vaccinated. Officers and noncommissioned officers were more likely to be vaccinated compared with regular soldiers (96%, and 90.2% vs. 83.3% respectively, P < .001), as well as combat battalions stationed personnel compared to their peers in rear and administrative units (89.4% vs. 78.4%, P < .001). Socioeconomic clusters were also associated with vaccination adherence, with 92.9% vs. 79.5% vaccination rates in the highest and lowest clusters, respectively (P < .001). Younger age, no previous immigration status, higher education level, and higher psychotechnical grades were also found associated with an increased likelihood of being vaccinated (P < .001).</p><p><strong>Conclusions: </strong>In a large cohort of enlisted IDF personnel, disparity in SARS-CoV-2 vaccine adherence was found to be related to multiple socioeconomic, educational, and military service-related variables. Although some differences were substantial, others were small and of questionable public health significance. Acknowledging these differences may enable community leaders, health care providers, and administrators to target specific populations in order to further promote SARS-CoV-2 vaccination acceptance.</p>","PeriodicalId":86137,"journal":{"name":"Military surgeon","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48523442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}