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Public versus Private Care in the Military Health System: Evidence From Low Back Pain Patients Mil. Med. (IF 1.2) Pub Date : 2024-03-16 Christopher G Leggett, Rachel O Schmidt, Jonathan Skinner, Jon D Lurie, William Patrick Luan
Introduction There is a longstanding debate about whether health care is more efficiently provided by the public or private sector. The debate is particularly relevant to the Military Health System (MHS), which delivers care through a combination of publicly funded federal facilities and privately contracted providers. This study compares outcomes, treatments, and costs for MHS patients obtaining care
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Preliminary Investigation Into the Effectiveness of Group webSTAIR for Trauma-exposed Veterans in Primary Care Mil. Med. (IF 1.2) Pub Date : 2024-03-05 Jamie S Kim, Annabel Prins, Elizabeth W Hirschhorn, Alison C Legrand, Kathryn S Macia, Sherry S Yam, Marylene Cloitre
Introduction A substantial number of trauma-exposed veterans seen in primary care report significant symptoms of PTSD and depression. While primary care mental health integration (PCMHI) providers have been successful in delivering brief mental health treatments in primary care, few studies have evaluated interventions that combine mobile health resources with PCMHI groups. This pilot study assessed
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Associations Among Environmental Exposures and Physical and Psychiatric Symptoms in a Care-Seeking Sample of U.S. Military Veterans Mil. Med. (IF 1.2) Pub Date : 2024-03-05 Jessica L Morse, Dean T Acheson, Erin Almklov, James O E Pittman, Ariel J Lang, Laurie Lindamer
Introduction Recent research and policy (e.g., the Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act) have highlighted the potential health consequences of toxic environmental exposures. The purpose of the current study was to assess the self-reported prevalence of such exposures among a sample of U.S. military veterans seeking care at a Veterans
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Bronchoalveolar Lavage Fluid Cytology of Deployed Military Personnel With Chronic Respiratory Symptoms From the STAMPEDE III Study Mil. Med. (IF 1.2) Pub Date : 2024-03-02 Joshua M Boster, William J Moore III, Steven T Stoffel, Jess T Anderson, Michael A Gonzales, Mateo C Houle, Robert J Walter, Michael J Morris
Introduction Deployed military personnel may be at risk for developing acute and chronic lung disease. Prior studies of this patient population have revealed that unexplained exertional dyspnea is the most common diagnosis despite an extensive evaluation. There is a concern that an occult disorder may be affecting this population. This study evaluated the role for bronchoalveolar lavage (BAL) fluid
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Hyperventilation During Manual Ventilation Can Be Reduced Using a Novel Ventilator but Not With Education Interventions Mil. Med. (IF 1.2) Pub Date : 2024-03-02 Andrea R Trent, Raymond Fang, Hegang Chen, Curtis C Copeland, Napoleon P Roux, Thomas E Grissom
Introduction Traumatic brain injury (TBI) is the leading cause of combat casualties in modern war with an estimated 20% of casualties experiencing head injury. Since the release of the Brain Trauma Foundation’s Guidelines for the Management of Severe Traumatic Brain Injury in 1995, recommendations for management of TBI have included the avoidance of routine hyperventilation. However, both published
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Cryotherapy-Induced Iatrogenic Frostbite on Distal Digit: Case Report and Review of Management Strategies Mil. Med. (IF 1.2) Pub Date : 2024-03-02 Gehan Pendlebury, Catherine Brahe, Rudy Schmiedecke
Cryotherapy is a widely utilized topical treatment for various dermatological conditions. While generally safe and effective, it carries potential risks, such as frostbite injury. Frostbite, a vascular condition causing skin and tissue freezing, is usually associated with prolonged exposure to freezing environments. Certain populations, like military personnel navigating frigid terrains, face an increased
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Mental and Physical Health-Related Quality of Life Following Military Polytrauma Mil. Med. (IF 1.2) Pub Date : 2024-02-29 Jay R McDonald, Matthew Wagoner, Faraz Shaikh, Erica Sercy, Laveta Stewart, Emma R Knapp, John L Kiley, Wesley R Campbell, David R Tribble
Introduction The long-term impact of deployment-related trauma on mental and physical health-related quality of life (HRQoL) among military personnel is not well understood. We describe the mental and physical HRQoL among military personnel following deployment-related polytrauma after their discharge from the hospital and examine factors associated with HRQoL and longitudinal trends. Materials and
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A Comprehensive Summary of the Meta-Analyses and Systematic Reviews on Platelet-Rich Plasma Therapies for Knee Osteoarthritis Mil. Med. (IF 1.2) Pub Date : 2024-02-29 Emily Mende, Ryan J Love, Jody-Lynn Young
Introduction Osteoarthritis (OA), including that of the knee joint, represents a significant proportion of musculoskeletal injuries in the Canadian Armed Forces (CAF) due to the frequent, high-stress physical activity for which member participation is necessary. Platelet-rich plasma (PRP) is a conservative, autologous treatment that has the potential to relieve symptoms and improve functionality of
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An Augmented Reality Rifle Qualification Test for Return-to-Duty Assessment in Service Members Mil. Med. (IF 1.2) Pub Date : 2024-02-29 Ryan D Kaya, Karissa Hastilow, Kelsey M Owen, Eric M Zimmerman, Anson B Rosenfeldt, Jay L Alberts
Introduction Variability in return-to-duty (RTD) decision-making following mild traumatic brain injury (mTBI) is a threat to troop readiness. Current RTD assessments lack military-specific tasks and quantitative outcomes to inform stakeholders of a service member’s (SM) capacity to successfully perform military duties. Augmented reality (AR), which places digital assets in a user’s physical environment
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A Novel Peritoneal Packing Method for Management of Hyperkalemia During Acute Kidney Injury in Trauma Mil. Med. (IF 1.2) Pub Date : 2024-02-29 Eric M Zimmerman, Ian J Stewart, Todd L Graham, Timothy J Kovacs, Tamaz Guliashvili, Thomas D Golobish, James D Ross
Introduction United States Military operations in resource limited areas are increasing. Furthermore, future peer or near-peer conflicts will require caring for larger numbers of casualties with limited resources. In this setting, traditional renal replacement therapy is not feasible and novel methods are required to address severe acute kidney injury in austere environments lacking definitive therapies
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A Pilot Study Using a Standardized Trauma Assessment Tool After Tactical Combat Casualty Care Course: A Comparison of the United States and Ghana Mil. Med. (IF 1.2) Pub Date : 2024-02-23 Catherine C Polley, Rossi Adu-Gyamfi, Tawfik Mahama-Toure, Fattal Okpoti Konney, Emmanuel Oti-Boateng, Lawrence Nsohlebna Nsoh, Timothy Ballard
Introduction Assessment, monitoring, and evaluation have been a required part of Global Health Engagement but difficult to accomplish. The current assessment, monitoring, and evaluation frameworks require implementation at the start of the project and are not designed to use for already existing programs. Tactical Combat Casualty Care (TCCC) is a standardized course now offered in 89 countries, but
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Medication Trends in the Military: A Comparative Analysis of Prescribing Patterns Among Service Members Seen by a Pharmacist and Implications for Medical Readiness Mil. Med. (IF 1.2) Pub Date : 2024-02-23 Ryan C Costantino, Laura E Gressler, Lee Ann Zarzabal, Cynthia M Vasquez, Richard Juneau
Introduction Medications play a critical role supporting the health of military service members. Little is known about the broad use of medications prescribed to this population. Active duty service members (ADSMs), while often younger and having fewer diagnosed comorbid conditions, face unique health challenges that benefit from pharmacotherapy. Understanding prescribing patterns is instrumental to
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The Association of High-Quality Hospital Use on Health Care Outcomes for Pediatric Congenital Heart Defects in a Universal Health Care System Mil. Med. (IF 1.2) Pub Date : 2024-02-16 Amber El-Amin, Tracey Koehlmoos, Dahai Yue, Jie Chen, Nam Yong Cho, Peyman Benharash, Luisa Franzini
Introduction Congenital heart disease (CHD) has an incidence of 0.8% to 1.2% worldwide, making it the most common birth defect. Researchers have compared high-volume to low-volume hospitals and found significant hospital-level variation in major complications, health resource utilization, and mortality after CHD surgery. In addition, researchers found critical CHD patients at low-volume/non-teaching
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Platelet-Rich Plasma Injections for the Treatment of Degenerative Orthopedic Conditions Mil. Med. (IF 1.2) Pub Date : 2024-02-13 Gary E Means, Peter Muench
Platelet-rich plasma injections for the treatment of degenerative orthopedic conditions have good evidence for safety, pain relief, and functional improvement. The U.S. Military is providing platelet-rich plasma services for military services members and TRICARE beneficiaries. The use of this safe and effective treatment should be continued and expanded.
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Nonpharmacological Therapies for Musculoskeletal Injury in Military Personnel: A Systematic Review/Meta-Analysis Mil. Med. (IF 1.2) Pub Date : 2024-02-12 Laura A Talbot, Lin Wu, Christopher H Morrell, David F Bradley, Vanessa J Ramirez, Ross M Scallan, Pilar D Zuber, Kayla Enochs, Jesse Hillner, Mathias Fagan, E Jeffrey Metter
Introduction Musculoskeletal (MSK) injury is an inherent risk for military personnel that can potentially impact job performance, productivity, and military readiness. Evidence is needed to show the efficacy of nonpharmacological, self-managed therapies to reduce MSK symptoms at common injury sites that are feasible for use during expeditionary operations and home stations. This systematic review and
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Chlamydial Proctitis Mimicking Inflammatory Bowel Disease in a Young Active Duty Sailor With Undiagnosed Human Immunodeficiency Virus Infection: A Case Report Mil. Med. (IF 1.2) Pub Date : 2024-02-12 Logan Oliver, Kevin Pak, Adam Maier, Brett Sadowski
Proctitis is an inflammation of the lining of the rectum that can be either acute or chronic in presentation. Symptoms include rectal bleeding, constipation, rectal discharge, rectal pain, and tenesmus. It is commonly associated with inflammatory bowel diseases (IBDs) such as ulcerative colitis and Crohn’s disease. However, it is important to consider the infectious causes of proctitis such as the
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Disparities in Demographics in Hip Arthroplasty Between U.S. Active Duty Military and the ACS-NSQIP Clinical Registry Mil. Med. (IF 1.2) Pub Date : 2024-02-12 Vivek M Abraham, Joshua M Junge, Greg Booth, Aaron A Olsen, George C Balazs, Ashton H Goldman
Introduction Patient demographics, such as sex and age, are known risk factors for undergoing revision following primary total hip arthroplasty (THA). The military population is unique because of the increased rates of primary and secondary osteoarthritis of the hip. Treatment options are limited for returning patients to their line of duty; however, THA has been shown to be an effective option. The
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Cervical Disc Displacement in Military Pilots Mil. Med. (IF 1.2) Pub Date : 2024-02-09 Patrick J Tansey, Cory F Janney, Daniel C Jupiter, Matthew Henriques, Pouya Alijanipour, Patrick B Morrissey
Introduction Cervical disc displacement (CDD) may disqualify pilots from flying and have a profound impact on military unit capability. The objective of this retrospective database review is to characterize the incidence and demographic predictors of symptomatic cervical spine disc displacement in pilots of fixed- and rotary-wing aircraft and ground-based controls. Materials and Methods The Defense
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When a Critically Ill Child is Oceans Away From a PICU: A Military Pediatric CCAT Mission Mil. Med. (IF 1.2) Pub Date : 2024-02-08 Kevin M Brinkman, Luke Zabrocki, Noelle Cadotte, Renée I Matos
A 4-year-old former 26-week premature male presented to the U.S. Naval Hospital Guam emergency department in respiratory failure secondary to human metapneumovirus requiring urgent intubation. His condition was complicated by a bradycardic arrest requiring 15 minutes of resuscitation before the return of circulation. He was admitted to the adult intensive care unit and was managed via pediatric telecritical
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The Impact of Military Tobacco Control Policy: A Systematic Review Mil. Med. (IF 1.2) Pub Date : 2024-02-08 Muhamad Arham Bin Hashim, Khairul Fikri Bin Sebri, Muhammad Faiz Bin Mohd Hanim, Diyana Shereen Binti Anwar, Nawwal Alwani Binti Mohd Radzi, Ahmad Farhan Bin Ahmad Fuad, Budi Aslinie Binti Md Sabri
Introduction Tobacco use is synonymous with the military. Despite that military personnel are trained to follow commands, opportunities exist to implement various tobacco control strategies. We conducted a systematic review to evaluate the impact of tobacco control policy employed in military settings. Materials and Methods We searched for published English articles in Medline, Web of Science, Scopus
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Quantitative Analysis of Condition-based Limited Duty Duration of Musculoskeletal Conditions Mil. Med. (IF 1.2) Pub Date : 2024-02-08 Christopher S Smith, Laura Yoon, Julia N Zuppke, Mike Zundel
Introduction Musculoskeletal injuries affect nearly a million service members annually within the DoD, ultimately costing the U.S. Military half a billion dollars in direct patient costs and a significant loss to fleet readiness as many members are assigned days on limited duty (LIMDU) until they are deemed medically fit to return to duty (RTD). The new approach implemented by Navy Medicine in 2022
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Impact of Overseas Deployment on Fatty Liver and Metabolic Diseases Among Korean Soldiers Mil. Med. (IF 1.2) Pub Date : 2024-02-08 Chang In Han, Jaejun Lee
Background The prevalence of metabolic diseases is increasing worldwide and is influenced by multiple environmental, psychological, and dietary factors. As overseas deployment (OD) of Korean soldiers brings about changes in these factors, this study aimed to explore the impact of OD on metabolic diseases. Materials and Methods We collected paired health checkup data of Korean soldiers between January
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The Value of Strength as a Predictor of Musculoskeletal Injury in Canadian Armed Forces Basic Infantry Candidates Mil. Med. (IF 1.2) Pub Date : 2024-02-08 Eric Robitaille, Tara Reilly, Scott Heipel, Hollie Buttici, Etienne Chasse, Hans Christian Tingelstad
Introduction Musculoskeletal injuries (MSKI) impact military organizations by threatening their operational readiness, warranting investigation into relevant factors to inform risk reduction strategies. While several self-reported and physical performance measures have been associated with MSKI among military personnel, few have been validated and none have been reported in Canadian basic infantry
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Suspected Mal de Debarquement Syndrome: A Case Report Highlighting the Difficulty in Diagnosis and Management Mil. Med. (IF 1.2) Pub Date : 2024-02-08 Nathan M Tommas, Meagan Ferguson
MdDS is syndrome of oscillating vertigo following cessation of passive motion. The pathogenesis of this disorder is not well understood, but functional imaging studies suggest cortical connectivity dysfunction in feedback loops of the vestibulo-ocular system and visuo-spatial system. Patients go through multiple appointments and often specialist referrals before being diagnosed. After diagnosis, optimal
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Incidence and Risk Factors for Bone Stress Injuries in United States Air Force Special Warfare Trainees Mil. Med. (IF 1.2) Pub Date : 2024-02-07 Andrew S Johnson, Jean-Michel Brismée, Troy L Hooper, Courtney N Hintz, Benjamin R Hando
Objectives To determine (1) the incidence rate of lower extremity (LE) bone stress injuries (BSIs) in United States Air Force Special Warfare (AFSPECWAR) trainees during the first 120 days of training, and (2) factors associated with sustaining a LE BSI. Design Retrospective cohort study. Methods AFSPECWAR Airmen (n = 2,290, mean age = 23.7 ± 3.6 years) entering an intensive 8-week preparatory course
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The Fascial Distortion Model in Military Aircrew with Chronic Neck Pain: A Case Study Mil. Med. (IF 1.2) Pub Date : 2024-02-01 Allison J Fullenkamp
Musculoskeletal pain can be a significant safety risk to aircrew. Flight surgeons are the primary care providers for aircrew and are responsible for safely treating musculoskeletal pain. Certain medical interventions can be used to treat pain while maintaining the ability to fly safely. A previous F-18 Naval Flight Officer presented to the flight surgeon with chronic neck pain seeking noninvasive and
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Examining the Intersection of Strategic Thinking and Continuous Process Improvement Through the Lens of Military Medical Education to Build a Novel Model Mil. Med. (IF 1.2) Pub Date : 2024-02-01 Melanie M Lazarus, Ruth L Bush, Sara McNeil
In 2020, the U.S. Air Force School of Aerospace Medicine hired its first civilian dean since its founding in 1918, tasked with building the school’s first strategic plan to modernize and improve the institution. Using a combination of military continuous process improvement and academic strategic thinking, the dean produced a highly successful strategic plan. However, its resource-heavy and time-consuming
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Stability of One-Step Spray-on Splint for Lower Extremity Fractures During Splinting, MEDEVAC, and Impact Mil. Med. (IF 1.2) Pub Date : 2024-01-31 C Grace P Hobayan, Nathaniel A Bates, John Heyniger, Kenan Alzouhayli, Franco Piscitani, Clifton R Haider, Christopher Felton, Adam T Groth, Kevin D Martin
Introduction Military transport can induce whole-body vibrations, and combat almost always involves high impact between lower extremities and the ground. Therefore, robust splinting technology is necessary for lower extremity fractures in these settings. Our team compared a novel one-step spray-on foam splint (FastCast) to the current military standard structured aluminum malleable (SAM) splint. Materials
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Disguised Among the Sea: The Implications of Artificial Islands on Casualty Care in the Indo-Pacific Mil. Med. (IF 1.2) Pub Date : 2024-01-31 Ryan M Leone, Mason H Remondelli, Jason B Brill, Jay B Baker
As reported in the 2022 Biden-Harris National Security Strategy, China is perceived as the primary U.S. competitor with the intent and means to become the world’s greatest superpower. China’s efforts, which are at odds with America’s ambition to maintain its global influence, are complemented by ostensibly harmless “gray zone tactics,” defined as coercive geopolitical, economic, military, and cyber
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Return to Sport and Duty in French Military Personnel after Medial Opening Wedge High Tibial Osteotomy Mil. Med. (IF 1.2) Pub Date : 2024-01-31 Bernard de Geofroy, Lucas Chateau, Olivier Barbier, Thomas Demoures, Sébastien Coste, Laurent Mathieu, Nicolas de L’Escalopier, Camille Choufani
Introduction Medial opening wedge high tibial osteotomy (MOWHTO) is a surgical option for medial femorotibial osteoarthritis, which preserves articular cartilage by correcting the extra-articular deformities of the lower limbs that cause osteoarthritis. This is an increasingly popular treatment in a population with high functional demand, such as the French military population. The aim of this study
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Heart Rate Variability Biofeedback as a Treatment for Military PTSD: A Meta-Analysis Mil. Med. (IF 1.2) Pub Date : 2024-01-30 Jordan Kenemore, Grant Benham, Ruby Charak, Juventino Hernandez Rodriguez
Introduction Emerging research has provided tentative support for the use of heart rate variability biofeedback (HRVB) as a treatment for several psychological disorders, with meta-analyses providing compelling evidence for HRVB as a promising treatment for anxiety, depression, and PTSD. Given the prevalence of PTSD in military veterans and the comparatively lower benefit and higher attrition rate
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Aerosolized Particulate Matter and Blunting of Ciliary Dynamic Responses: Implications for Veterans and Active Duty Military in Southwest Asia Mil. Med. (IF 1.2) Pub Date : 2024-01-30 Alan D Workman, Robert J Lee, Noam A Cohen
Introduction Respiratory diseases such as chronic rhinosinusitis and asthma are observed at increased rates in active duty and veteran military members, and they are especially prevalent in individuals who have been deployed in Southwest Asia during Operation Iraqi Freedom and Operation Enduring Freedom. Particulate matter, specifically the fine-grain desert sand found in the Middle East, may be a
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An Assessment of Clinical Accuracy of Vital Sign–based Triage Tools Among U.S. and Coalition Forces Mil. Med. (IF 1.2) Pub Date : 2024-01-29 Tate E Vernon, Michael D April, Andrew D Fisher, Julie A Rizzo, Brit J Long, Steven G Schauer
Introduction Early appropriate allocation of resources for critically injured combat casualties is essential. This is especially important when inundated with an overwhelming number of casualties where limited resources must be efficiently allocated, such as during mass casualty events. There are multiple scoring systems utilized in the prehospital combat setting, including the shock index (SI), modified
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Evaluation of Gender Disparity in Tactical Combat Casualty Care Mil. Med. (IF 1.2) Pub Date : 2024-01-22 Shanna R Vaughan, Timothy Ballard, Pamela Ward-Demo, Leslie Vojta, Anwar E Ahmed, Amy Costello
Introduction Women comprise nearly 19% of the U.S. military and now serve in almost all operational roles, increasing their risk of combat trauma and injuries.3 Data from the Joint Trauma Registry during Operation Enduring Freedom shows that battle-injured females had a higher case fatality rate at 36% compared to their male counterparts at 17%.1 The Tactical Combat Casualty Care curriculum is used
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What We Know About Homeless Veterans With Other-than-honorable and Punitive Discharges: Data From the Grant and Per Diem (GPD) Program Mil. Med. (IF 1.2) Pub Date : 2024-01-22 Eric Jutkowitz, Ellen McCreedy, Christopher Halladay, Jack Tsai
Introduction The U.S. DVA Grant and Per Diem (GPD) program funds community agencies to provide housing and case management services to Veterans experiencing homelessness. GPD is one of the few VA programs that can enroll Veterans with Other-than-Honorable (OTH) military discharges. The characteristics of OTH Veterans and their outcomes in GPD are unknown. Materials and Methods We linked the Homeless
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Expedited Provisionalization of a Missing Crown: A Case Report Mil. Med. (IF 1.2) Pub Date : 2024-01-21 Andrew S Ryser, Steven E Handel, Jennifer V Sabol, Katie M Senkiw
Provisional restorations are required in fixed prosthodontics to protect a prepared tooth until a definitive restoration can be delivered. A patient sought treatment at a prosthodontics practice to replace a missing provisional crown until definitive treatment could be performed once the patient returned from a field exercise. This case report describes a novel way to provide a provisional restoration
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Dynamics of the Oral Microbiome During Initial Military Training at Fort Benning, Georgia Mil. Med. (IF 1.2) Pub Date : 2024-01-20 Kristina K Zudock, Robert Player, Amanda Ernlund, Collin M Timm, Caroline E English, Michael W Ellis, David R Tribble, D. Scott Merrell, Jason W Bennett, Eugene V Millar
Introduction Military trainees are at increased risk for infectious disease outbreaks because of the unique circumstances of the training environment (e.g., close proximity areas and physiologic/psychologic stress). Standard medical countermeasures in military training settings include routine immunization (e.g., influenza and adenovirus) as well as chemoprophylaxis [e.g., benzathine penicillin G (Bicillin)
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Race Does Not Affect Rates of Surgical Complications at Military Treatment Facility Mil. Med. (IF 1.2) Pub Date : 2024-01-19 Erin West, Laurinda Jackson, Howard Greene, Donald J Lucas, Kyle D Gadbois, Pamela M Choi
Introduction Racial minorities have been found to have worse health care outcomes, including perioperative adverse events. We hypothesized that these racial disparities may be mitigated in a military treatment facility, where all patients have a military service connection and are universally insured. Materials and Methods This is a single institution retrospective review of American College of Surgeons
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Misuse of Tourniquets in Ukraine may be Costing More Lives and Limbs than they Save Mil. Med. (IF 1.2) Pub Date : 2024-01-19 Rom A Stevens, Michael S Baker, Ostap B Zubach, Michael Samotowka
Hands-on training and social media sites have heavily emphasized the use of tourniquets to treat limb injuries during the Ukraine war. Tourniquet overuse or misuse can lead to significant tragedy—limb loss, physiologic complications, and even death. Casualty evacuation in Ukraine often exceeds 6 hours, and the liberal use of limb tourniquets may have unintentionally increased morbidity. Tourniquet
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When Taking Pay off the Table: A Qualitative Study of Gender Equity for Academic Leaders in the US Military Mil. Med. (IF 1.2) Pub Date : 2024-01-19 Elizabeth V Schulz, Tasha R Wyatt, TingLan Ma, Lauren A Maggio
Introduction Although gender inequity persists globally in academic leadership positions, the United States Military has equitable pay and, in academic pediatrics, has equitable gender representation in leadership positions. To better understand how the US Military framework affects physician leaders, pediatricians were interviewed to illuminate the factors that facilitated their success and what barriers
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Physical Fitness Tests in the Army—Legitimate Diversity or Randomness? Mil. Med. (IF 1.2) Pub Date : 2024-01-10 Andrzej Tomczak
In this article, I present my views on the diversified approaches to assess the physical fitness of soldiers within selected armies worldwide. I discussed the related common features and paradoxes associated with these approaches. For the comparative analysis, national diversity was taken into account and subjective selection of the physical fitness tests conducted in the armies of the United States
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Refractory Osteomyelitis in a Military Service Member Resolved With Adjunctive Hyperbaric Oxygen Therapy Mil. Med. (IF 1.2) Pub Date : 2024-01-10 Jeffrey Spiro, Michael Gedestad, Piotr Wisniewski
Refractory osteomyelitis is typically defined as a chronic infection that persists or recurs despite definitive surgical management and antibiotic therapy. Cases often involve complex wounds or fractures and can be challenging to treat, resulting in multiple courses of broad-spectrum antibiotic therapy and numerous surgeries over periods of months to years. Adjuncts to improve resolution of these complicated
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Post-COVID-19 Condition in Military Personnel Mil. Med. (IF 1.2) Pub Date : 2024-01-10 Stuart Hitchcock, Samantha A Cintron, Lalon Kasuske, Francisco J. Diaz, Janet Pierce
Introduction During the COVID-19 pandemic, a significant number of individuals experienced persistent symptoms, collectively termed post-COVID-19 condition (PCC) by the World Health Organization. While civilian prevalence has been extensively studied, little is known about PCC in military personnel. This article highlights the need for increased awareness, documentation, and research on PCC within
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Point of Use Treatment for Medical Devices: From Bedside to Battlefield Mil. Med. (IF 1.2) Pub Date : 2024-01-10 Gina L Eberhardt, Bethany I Atwood, Joshua D Smith
Introduction Point of use (POU) treatment is a critical first step of medical device reprocessing. Reusable instruments and flexible endoscopes require a minimum of terminal sterilization or high-level disinfection, neither of which can be guaranteed if POU is performed incorrectly. Compliance considerations for POU include hospital accreditation readiness, unique austere surgical mission requirements
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Ukrainian Healthcare Professionals’ Experiences During Operation Gunpowder: Implications for Increasing and Enhancing Training Partnerships Mil. Med. (IF 1.2) Pub Date : 2024-01-02 Jonathan T Shumaker, Cynthia Shen, Rebekah Cole
Because of the diverse backgrounds of their healthcare professionals, Ukrainian military medicine needs expanded and enhanced military medical training to increase their readiness in the war against Russia. During March 2023, eight Ukrainian healthcare professionals participated in Operation Gunpowder, a high-fidelity prolonged casualty care simulation conducted by the USU as a part of its Military
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The Empire Strikes Back: A Chemical Warfare Burn 100 Years after the First World War Ending Mil. Med. (IF 1.2) Pub Date : 2023-12-29 Alvise Montanari, Alfio Luca Costa, Bruno Azzena
During the First World War, the territories that constituted the front line in North East Italy were the theaters of intense shelling. The military tactics of the time involved the use not only of conventional ammunition but also of special ammunition containing asphyxiating and blistering compounds. However, the technology of the time did not guarantee a high explosion rate, leaving a considerable
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The Manikin We Owe Mil. Med. (IF 1.2) Pub Date : 2023-12-23 Hada Fong-Ha Ieong
This poem is to provide narratives written by a student of Hospital Corpsman Basic program, describing experiences throughout the training and expressing hope in Navy Medicine. It was originally performed as a spoken-word poem at graduation in 2023 and was adopted for reading enjoyment.
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Maxillofacial Surgery in Ukraine During a War: Challenges and Perspectives—A National Survey Mil. Med. (IF 1.2) Pub Date : 2023-12-23 Palyvoda Roman, Kaniura Olexandr, Vares Yan, Fedirko Igor, Uhryn Myron, Chepurnyi Yurii, Snäll Johanna, Shepelja Alla, Kopchak Andrii, Kalashnikov Danilo
Introduction The invasion of Ukraine by Russian troops on February 24, 2022, and the beginning of the full-scale war had huge humanitarian consequences. The major challenges facing the Ukrainian health care system included the disruption of medical infrastructure and logistics, the termination of the supply of expendable materials, significant migration, and a dramatic increase in high-velocity blast
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Young Man With Primary Mucinous Cell Carcinoma of the Eyelid: 36 Month Follow Up Mil. Med. (IF 1.2) Pub Date : 2023-12-23 Sama S Alazawi, Vienna G Katana
Primary cutaneous mucinous carcinoma (PCMC) is a malignant adnexal tumor that masquerades as a benign periocular lesion. We present a case of a 29-year-old male with an eyelid PCMC misdiagnosed as a chalazion. He underwent Mohs microscopic surgery for definitive treatment, with no recurrence at his 36 month follow up. Given the rarity and poorer prognosis in younger patients, a high index of suspicion
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Criminogenic Needs and Legal Problem Severity Among Legal System Involved Veterans Mil. Med. (IF 1.2) Pub Date : 2023-12-23 Molly A Bowdring, Kathryn S Macia, Paige M Shaffer, David Smelson, Daniel M Blonigen
Background Many veterans seeking behavioral health services have history of criminal–legal involvement. Research on criminogenic needs of legal system involved veterans is burgeoning. However, most research has relied on cross-sectional examinations and the vast majority of prior work has focused assessment on just one criminogenic need per study. Methods The present study evaluated seven key criminogenic
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Using Military Screening Questions to Anonymously Recruit Post-9/11 Era Service Members and Veterans Using Online Survey Methods Mil. Med. (IF 1.2) Pub Date : 2023-12-23 Hallie S Tannahill, Rebecca K Blais
Introduction The ability to collect data on posttraumatic reactions following military sexual trauma is impacted by data collection methods, such that under-reporting can occur when data are believed to be identifiable. This may be especially true for topics that are sensitive, including sexual trauma. Ensuring participation from service members using non-identifiable methods is challenging when service
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When Patient Portals Break Bad News Mil. Med. (IF 1.2) Pub Date : 2023-12-23 Eleanor Iodice, Emily Penick, Stuart S Winkler
Electronic patient portals facilitate communication between providers and patients, but they can complicate the art of breaking bad news. Nearly half of oncology patients will view their diagnosis on a patient portal before speaking with a provider. Physicians and advanced practice providers receive training on how to deliver bad news in person and over the telephone. This is done in an empathetic
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Leading Graduate Medical Education in the Face of Uncertainty Mil. Med. (IF 1.2) Pub Date : 2023-12-23 Matthew Bradley, Brian Reamy
Leading through uncertainty poses significant challenges. The COVID-19 pandemic, the Afghanistan withdrawal, and the implementation of a new electronic medical records system led to massive shortages of health care workers throughout the Military Health System (MHS). This case describes the leadership challenges of a surgical residency program director during uncertain times.
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Telemedicine Improves Performance of a Two-Incision Lower Leg Fasciotomy by Combat Medics: A Randomized Controlled Trial Mil. Med. (IF 1.2) Pub Date : 2023-12-23 Pieter W Stark, Boudewijn L S Borger van der Burg, Thijs T C F van Dongen, MARNALG Casper, 1 Wouter, Rigo Hoencamp
Introduction The primary aim of this randomized controlled trial was to assess if a head-mounted display (HMD) providing telemedicine support improves performance of a two-incision lower leg fasciotomy by a NATO special operations combat medic (combat medic). Materials and Methods Thirty-six combat medics were randomized into two groups: One group performed a two-incision lower leg fasciotomy with
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World War I and the Origins of Blood Transfusion for the Trauma Patient Mil. Med. (IF 1.2) Pub Date : 2023-12-23 Joseph R Danford
The use of blood transfusion to treat hemorrhagic shock is a relatively new treatment with its origins in World War I. Due to the severity and nature of injuries seen, World War I provided the stimulus to propel medicine forward and accept whole blood transfusion for the trauma patient.
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Exploring Impostor Phenomenon During Onboarding Into a Military Medical School Mil. Med. (IF 1.2) Pub Date : 2023-12-18 Eungjae Kim, Steven J Durning, Jinbum Dupont, Jezreelyn Bulaklak, Abigail Crosier, Michael Soh
Introduction Impostor phenomenon (IP) is an experience where an individual believes that their success was because of chance or luck and was not associated with the mastery of skills. There is a gap in the literature in understanding what role, if any, onboarding (e.g., orientation weeks) into a military medical school plays into student experiences with IP. For many, onboarding serves as the first
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Post-Traumatic Osteoarthritis, Psychological Health, and Quality of Life After Lower Limb Injury in U.S. Service Members Mil. Med. (IF 1.2) Pub Date : 2023-12-18 Shawn Farrokhi, Brittney Mazzone Gunterstockman, Brad D Hendershot, Elizabeth Russell Esposito, Cameron T McCabe, Jessica R Watrous
Introduction The aims of this project were to assess (1) the prevalence and timing of post-traumatic osteoarthritis (PTOA) after a traumatic lower limb injury, (2) the risk of PTOA based on injury type, and (3) the association of PTOA with psychological health and quality of life (QoL). Materials and Methods The Wounded Warrior Recovery Project (WWRP) database and the Expeditionary Medical Encounters
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Long-Term Consequences of Spirometry During Military Routine Medical Examinations on Smoking Cessation Compared to Minimal Advice Mil. Med. (IF 1.2) Pub Date : 2023-12-18 Anne Perisse, Marie-Cécile Dao, Damien Butty, Clement Derkenne, France Charton, Nathalie Fabre, Anais Grosset-Janin, Manon Lutringer, Aurore Chanet, Elie Diop, Claire Attia, Anne Coudert, Audrey Courson, Gaelle Maillot, Anne-Sophie Augen, Pierre Bagary, Emilie Sahuguet, Odile Remond, Nicolas Paleiron, Olivier Bylicki
Background Smoking kills 8 million people a year worldwide. It is the most prevalent cause of death in France by cancer, cardiovascular, or respiratory diseases. Minimal advice consists in asking patients who smoke if they are interested in quitting. It is effective in reducing smoking. The French High Health Authority recommends its systematic use with patients, whatever their reason for seeking treatment
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Tube Thoracostomy Complications in Patients With ARDS Requiring ECMO: Worse in COVID-19 Patients? Mil. Med. (IF 1.2) Pub Date : 2023-12-12 Robert B Laverty, Kelly M Ivins-O’Keefe, Alexandra M Adams, Meaghan J Flatley, Michal J Sobieszczyk, Phillip E Mason, Valerie G Sams
Introduction The incidence and management outcomes of COVID-19 patients with acute respiratory distress syndrome (ARDS) on veno-venous extracorporeal membrane oxygenation (V-V ECMO) requiring chest tubes are not well-described. This study sought to explore differences in tube thoracostomy rates and subsequent complications between patients with and without COVID-19 ARDS on V-V ECMO. Materials and Methods
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Extending Air Force Physical Fitness Postpartum Dwell Time Improves Maternal Physical Readiness Mil. Med. (IF 1.2) Pub Date : 2023-12-12 Minette S.R Herrick, Weiwen Chai
Introduction Research suggests women are more likely to fail their military physical fitness assessment in the immediate postpartum period than in the prenatal period. In 2015, the United States Air Force physical fitness postpartum testing dwell time increased from 6 months to 12 months postpartum. The primary aim of this study was to assess if Air Force active duty women’s physical readiness, as