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Military Medicine
Journal Prestige (SJR): 0.373
Citation Impact (citeScore): 1
Number of Followers: 8  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0026-4075 - ISSN (Online) 1930-613X
Published by Oxford University Press Homepage  [424 journals]
  • Correction to: Sleep Deprived, Injured, Not Seeking Medical Care. A
           Commentary on Elliman Et Al (2022)

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      PubDate: Wed, 12 Oct 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac324
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Safe Administration and Low Healthcare Utilization Following
           Musculoskeletal Corticosteroid Injections by U. S. Military Physical
           Therapists

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      Abstract: ABSTRACTIntroductionMusculoskeletal (MSK) injuries make up a significant proportion of conditions treated by military healthcare providers during wartime. Though many common MSK injuries may benefit from corticosteroid injection (CSI), a shortage of qualified military clinicians has led to diminished access to appropriate care. Longer wait times to receive treatment pose detrimental effects on military readiness and have garnered the attention of military leaders. One solution was the development of advanced training for United States Air Force physical therapists (USAF PTs) to gain clinical privileges in administering CSI. The objectives of this study were to determine in USAF PTs (1) the prevalence of those with privileges to administer CSI; (2) the type and (3) safety of MSK CSI administered; (4) incidence of CSI complications; (5) healthcare utilization following CSI; and (6) barriers to obtaining and practicing CSI privileges.Materials and MethodsUnited States Air Force PTs with CSI privileges received instructions to follow a link to an anonymous Google survey. Electronic medical record reviews were conducted by three USAF PTs to determine the occurrence and severity of CSI complications provided by USAF PTs and advanced healthcare providers (AHPs). The principal investigator conducted further review of the patients’ electronic medical records to calculate healthcare utilization following CSI administered by USAF PTs. A hospital administrator selected cases of similar diagnoses treated with CSI by USAF AHPs. The number selected cases treated by AHPs are similar to the number of CSI cases treated by USAF PTs.ResultsEleven USAF PTs held CSI privileges. No major complications associated with CSI were recorded. Of the 95 CSI cases treated by USAF PTs, 27 (28.4%) reported increased pain compared to 24 (27.9%) of 86 CSI cases treated by AHPs (P = .94). Healthcare utilization for the number of follow-up visits, imaging, and additional laboratory tests following CSI by USAF PTs was lower compared to AHPs (chi-square; P < .0069).ConclusionNine percentage of USAF PTs held CSI privileges. United States Air Force PTs were equally safe as AHPs who administered CSI and associated with a lower rate of healthcare utilization following the intervention. Training USAF PTs to administer CSI could be the standard for all USAF PTs who meet qualification requirements. Adoption of similar training and credentialing policies for civilian PTs warrants further exploration.
      PubDate: Fri, 23 Sep 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usaa556
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • HIV Prevention Research With U.S. Military Service Members: A Systematic
           Review

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      Abstract: ABSTRACTIntroductionWith the goal of maintaining mission readiness, the U.S. Department of Defense monitors a variety of health behaviors among its active duty military service members, including sexual health, HIV, and other sexually transmitted infections. Newer biomedical approaches to HIV prevention and care (e.g., Treatment as Prevention (TasP) via Pre-exposure Prophylaxis (PrEP) and undetectable = untransmissible of antiretroviral therapy (ART/U = U) have evolved over the last few years and are now available. However, the last systematic review on HIV prevention among military populations was published in 2005, calling for the need to provide an update on what HIV prevention research has been conducted with U.S. active duty service members.Materials and MethodsPRISMA guidelines were followed to identify articles that met pre-determined eligibility criteria. Several electronic databases were searched, including PubMed. The review focused on HIV prevention research conducted with the U.S. Military (i.e., active duty service members). Inclusion criteria for articles centered on population (U.S. active duty service members aged 17 years and older), language (published in English), study focus (epidemiological, intervention), study design (descriptive, quasi-experimental, and experimental), date of publication, and research focus. Studies with a descriptive focus to understand HIV-related risk behaviors, use of prevention strategies (e.g., condoms, testing, PrEP), and prescribing practices for uptake of prevention strategies among U.S. military service members (i.e., by providers, uptake from nonproviders) were included. Studies that focused on intervening or changing HIV risk (i.e., interventions) among U.S. military service members were also included.ResultsThe findings in this review were reported based on the PRISMA guidelines. A total of 2,270 articles were identified through electronic databases. Of the 2,270 articles, 809 articles were removed for duplication. Titles and abstracts were reviewed for the remaining 1,461 articles. Of the 1,461 articles, 1,432 were excluded for not meeting the inclusion criteria. In total, 29 studies met the inclusion criteria and were included in this review. Studies were organized into 3 tables based on study focus and target population (e.g., active duty, U.S. Military service members who were providers vs. nonproviders).ConclusionsThe present systematic review describes 29 HIV prevention studies that have been conducted with active duty service members in the U.S. Military since 2000. Overall, most included studies were descriptive, epidemiological studies conducted with active duty service members who were not providers. There were few interventions that reported some success in improving prevention knowledge and condom use. None of the interventions included newer evidence-based strategies of TasP. Although some research had been conducted about PrEP, particularly with providers, there is a clear need for additional studies and interventions to include TasP, given the evidence base of these approaches for reducing acquisition and/or onward transmission of HIV.
      PubDate: Tue, 01 Feb 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac018
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Letter From the Executive Director Dr. John Cho

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      Pages: 1 - 2
      PubDate: Fri, 16 Dec 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac369
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • After the Trauma: The Role of Rehabilitation Medicine in U.S. DoD Global
           Health Engagement

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      Pages: 3 - 5
      Abstract: ABSTRACTThe U.S. Department of Defense (DoD) possesses significant expertise with rehabilitation of combat injured personnel. This is an area of growing interest with Global Health Engagement (GHE), particularly in countries with active conflict such as Ukraine. Effective rehabilitation can contribute to both development and security, and by leveraging its inherent expertise via rehabilitation-based GHE, the DoD can contribute to these strategic objectives.
      PubDate: Fri, 14 Oct 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac302
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Integrity Demands It

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      Pages: 6 - 7
      Abstract: ABSTRACTGlobal Health Engagements can be more effective if better evaluation is done and if both line and diplomatic leaders are better educated by deploying medical personnel. To achieve better outcomes, these tasks should be a high priority for global health engagements. Integrity demands it.
      PubDate: Sat, 02 Apr 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac088
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Dual-Energy, Dual-Exposure PA and Lateral Chest Radiograph: Not Your
           Father’s Chest X-Ray

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      Pages: 12 - 15
      Abstract: ABSTRACTIn the last two decades, our military and federal health care facilities have transitioned from traditional X-rays exposing film screen systems, developed much like photographic film, to an entirely digital detection system that affords computer processing of images and digital image and report distribution. While health care providers are well aware of the practicality of these advancements, they may not be aware of the improved diagnostic capabilities afforded by these new methods. In this report, we outline how application of physical principles of X-rays, with digital detectors and computer data manipulation, can present images demonstrating chest and heart diseases that were previously not readily visible by traditional film screen systems. More recently, dual-energy, dual-exposure systems have been implemented. This commentary is to educate the medical community so that they may better understand not only the written report but the information on the images being provided, along with potential pitfalls to avoid. Specifically, we demonstrate improved detection of pulmonary nodules and coronary atherosclerosis with the dual-energy technique.
      PubDate: Fri, 22 Jul 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac220
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Developing Military Doctors: An Institutional Approach to Medical Force
           Readiness in Graduate Medical Education

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      Pages: 16 - 20
      Abstract: ABSTRACTMilitary physicians are required to not only meet civilian accreditation standards upon completion of their Graduate Medical Education (GME) training programs but also be proficient in the military-unique aspects of their field, including medical care in austere environments and management of combat casualties. They must also be familiar with the administrative and leadership aspects of military medicine, which are often absent from the training curriculum. The San Antonio Uniformed Services Health Education Consortium Military Readiness Committee, by incorporating questions of military relevance into each GME program’s mandatory Annual Program Evaluation, identified curricular gaps upon which military readiness training objectives and opportunities were developed. These activities included a lecture series on the sustainment of medical and military readiness, an interactive procedural skills training event, trainee involvement in operational pre-deployment exercises, and the development of an elective operational rotation in Honduras. The Military Readiness Committee provides a model for other military GME institutions to develop training goals and opportunities to strengthen the preparedness of their trainees for military service.
      PubDate: Wed, 12 Oct 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac300
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Military Healthcare Ethics: Making It Relevant to the Whole Military Care
           Team

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      Pages: 21 - 24
      Abstract: ABSTRACTThis article notes the significant increase in academic papers and policy guidance on the subject of ethical practice in military healthcare over the past two decades. This is usually within the domain of “military medical ethics,” linking medical ethics as applied to the medical profession (doctors) with ethics as applied within the military (primarily from the perspective of officers). This article argues that this, highly elitist, perspective disenfranchises the majority of the military healthcare team who are nurses and allied health professionals and serve across the entire rank spectrum. We suggest that the subject should be reframed under the banner “military healthcare ethics” to include the concepts within military medical ethics but to emphasize the obligations of all military health professionals to comply with legal, regulatory, and ethical guidance for the practice of healthcare in the military environment. We recommend that the subject should be included in the curricula for education and training for all military health professions across their whole career.
      PubDate: Sat, 22 Oct 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac321
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Humanitarian Mission at Home: Walter Reed National Military Medical
           Center’s Experience in Operation Allies Refuge and Operation Allies
           Welcome

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      Pages: 25 - 29
      Abstract: ABSTRACTMilitary medicine has a long history of humanitarian efforts globally, including responses to natural disasters and as planned medical civil action projects. However, ending two decades of war in Afghanistan, Walter Reed National Military Medical Center (WRNMMC) was tasked to receive up to 63 injured patients with less than 96-hour notice on August 27, 2021. As part of Operation Allies Refuge and transition to Operation Allies Welcome, this article highlights the complicated cross-organizational and multidisciplinary response at WRNMMC where ultimately 277 Afghan patients and nonmedical attendants received medical care and other requirements for resettlement. Lessons learned from coordinating the complex short suspense medical, cultural, and logistic efforts are noted as considerations and practical recommendations for future missions.
      PubDate: Fri, 07 Oct 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac281
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Using Contact-Based Education to Reduce Diabetes-Related Stigma Among
           Medical Residents in a Military Health System

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      Pages: 27 - 31
      Abstract: ABSTRACTIntroductionHealthcare provider-related stigma against patients with diabetes is associated with worse doctor–patient relationships and patient self-care. A previous feasibility study showed benefit in using a contact-based education approach to improve attitudes of medical students toward patients with diabetes. We hosted a panel of people who had personal experience with diabetes. The panel was attended by internal medicine residents in a military health system. We compared diabetes-related stigma among the residents before and after the panel.Materials and MethodsPanel participants included a Black male active duty service member diagnosed with type 2 diabetes, a Black veteran with type 2 diabetes, and a White woman with two sons who have type 1 diabetes. During a 1 hour panel for medicine residents, these panelists were asked to discuss their personal experiences with diabetes, common misconceptions regarding diabetes, and what they wish healthcare providers understood about diabetes. The validated Diabetes Attitude Scale-3 (DAS-3) questionnaire, which assesses diabetes-related attitudes based on a five-point Likert scale (strongly agree = 5, strongly disagree = 1), was given to the trainees before and after the panel. The survey also collected demographic information and contained short-answer questions about personal experiences with diabetes and diabetes-related stigma. Survey responses were linked with identifier questions to preserve anonymity.ResultsTwelve participants completed both the pre- and post-panel survey. Seven were female (58%), 10 were White (83%), and eight were from suburban communities (67%). Mean scores improved for all five DAS-3 subscales scores, with the largest improvement in the Patient Autonomy subscale (4.12 to 4.4), followed by Psychosocial Impact of Diabetes Mellitus (4.34 to 4.56), Seriousness of Non-Insulin Dependent Diabetes Mellitus (4.27 to 4.44), Need for Special Training (4.52 to 4.68), and Value of Tight Control (4.07 to 4.10).ConclusionsContact-based education can be considered as a tool for reducing diabetes-related stigma among medical trainees.
      PubDate: Wed, 19 Jan 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usab568
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Emerging Evidence: Gait Retraining Can Reduce Dropout From Basic Military
           Training

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      Pages: 30 - 31
      PubDate: Wed, 23 Nov 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac349
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Response Letter: Running Gait Training Improves Outcomes at USAF Basic
           Military Training

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      Pages: 32 - 33
      PubDate: Wed, 23 Nov 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac350
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Nirmatrelvir Plus Ritonavir for COVID-19: The First Step Is Getting the
           Name Right

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      Pages: 34 - 35
      PubDate: Sat, 19 Nov 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac359
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Understanding PaxlovidTM Effectiveness in Military Populations

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      Pages: 36 - 36
      PubDate: Sat, 19 Nov 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac361
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Invited Accompanying Editorial for Manuscript Entitled, “Battlefield
           Pain Assessment and Patterns of Palliation: A Review of Casualties that
           Received Pain Management before Reaching Role 2 in Afghanistan” by MAJ
           Ian Laurence Hudson

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      Pages: 37 - 39
      PubDate: Fri, 15 Jul 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac215
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • An Examination of Factors That Influence Receipt of Reproductive Health
           Screenings Among Female Veterans

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      Pages: 42 - 48
      Abstract: ABSTRACTIntroductionAs the number of women veterans grows, so does the need to ensure they receive timely health care, including preventive reproductive health screenings such as cervical cancer screenings and mammograms. However, little is known about the rates of reproductive health screenings among veterans and what factors may be related to screening. The objectives of this cross-sectional study were to (1) understand healthcare treatment-seeking experiences among women veterans, (2) determine the rate of adherence to screening guidelines for cervical and breast cancers, and (3) examine potential correlates of adherence to clinical reproductive health screening guidelines.Materials and MethodsWomen veterans completed an electronically administered survey, which assessed personal characteristics, psychological health symptoms, military service history, health insurance status, healthcare-seeking experiences (e.g., barriers to and satisfaction with care), and receipt of cervical and breast cancer screenings. Multivariable logistic regression identified factors associated with adherence to clinical guidelines for cervical and breast cancer screening.ResultsOf the 90 women (mean age = 38.78; SD = 12.19) who participated, 64 (71.10%) reported meeting all age-applicable screening guidelines. The most common barriers to obtaining women’s healthcare were availability of convenient appointment times, finding time in your schedule to make and go to an appointment, and long wait times for appointments. Multivariable logistic regression revealed veterans without a regular women’s health provider were less likely to adhere to guidelines than those with a regular provider (OR = 0.16; 95% CI, 0.04-0.57).DiscussionMany women veterans are unable to receive reproductive health screenings; continued efforts are needed to determine how to increase adherence in this unique population.
      PubDate: Mon, 28 Feb 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac036
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Color Vision Testing, Standards, and Visual Performance of the U.S.
           Military

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      Pages: 49 - 57
      Abstract: ABSTRACTIntroductionColor vision deficiency (CVD) is a disqualifying condition for military special duty occupations. Color vision testing and standards vary slightly among the U.S. military branches. Paper-based pseudoisochromatic plates (PIPs) remain a screening tool. Computer-based color vision tests (CVTs), i.e., the Cone Contrast Test (CCT), the Colour Assessment and Diagnosis (CAD) test, and the Waggoner Computerized Color Vision Test (WCCVT), are now replacing the Farnsworth Lantern Test (FALANT) and its variants to serve as a primary or secondary test in the U.S. Armed Forces. To maintain consistency in recruitment, performance, and safety, the study objectives were to examine military color vision testing, passing criteria, and color discrimination performance.MethodsStudy participants were 191 (17% female) students, faculty, and staff of the U.S. Air Force Academy and the Naval Aerospace Medical Institute. All subjects performed six CVTs, and 141 participants completed two additional military relevant color discrimination tasks. Friedman non-parametric test and Wilcoxon signed-rank post hoc test with Bonferroni adjusted P values were used to compare CVTs and standards. Analysis of variance and Bonferroni adjusted post hoc test were used to describe effects on color discrimination performance.ResultsThe Heidelberg Multicolor—Moreland and Rayleigh (HMC-MR) anomaloscope diagnosed 58 CVD (30.4%). There were no statistically significant differences in identifying red–green CVD by the HMC-MR, CCT, CAD, WCCVT, and PIP tests (P = .18), or classifying deutan, protan, and normal color vision (CVN) by the HMC-MR and the CVT (P = .25). Classification of tritan CVD was significantly different depending on which CVT was used (P < .001). Second, overall passing rates were 79.1% on the CAD (≤6 standard normal unit (SNU)), 78.5% on the combined PIP/FALANT, 78.0% on the CCT (≥55%), and 75.4% on the WCCVT (mild) military standards. The CVTs and the PIP/FALANT standards were not significantly different in number of personnel selected, but CAD and CCT passed significantly more individuals than WCCVT (P = .011 and P = .004, respectively). The previous U.S. Air Force standard (CCT score ≥75%) passed significantly fewer individuals relative the U.S. Navy pre-2017 PIP/FALANT or the current CVT standards (P ≤ .001). Furthermore, for those who failed the PIP (<12/14), the FALANT (9/9 or ≥16/18) agreed with the CVTs on passing the same CVN (n = 5); however, it also passed moderate-to-severe CVD who did not pass WCCVT (n = 6), CCT (n = 3), and CAD (n = 1). Lastly, moderate/severe CVD were significantly slower and less accurate than the “mild” CVD or CVN in the two color discrimination tasks (P < .001). In comparison to CVN in the in-cockpit display color discrimination task, mild CVD (CCT ≥55% and <75%) were significantly slower by 1,424 ± 290 milliseconds in reaction time (P < .001) while maintaining accuracy.ConclusionsCVTs are superior to paper-based PIP in diagnosing, classifying, and grading CVD. Relative to the PIP/FALANT standard in personnel selection, the current U.S. military CVT passing criteria offer comparable passing rates but are more accurate in selecting mild CVD. Nevertheless, military commanders should also consider specific operational requirements in selecting mild CVD for duty as reduced job performance may occur in a complex color critical environment.
      PubDate: Wed, 30 Mar 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac080
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Part I: Background and Clinical Considerations for Stress Fractures in
           Female Military Recruits

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      Pages: 86 - 92
      Abstract: ABSTRACTIntroductionStress fractures (SFx) represent a significant proportion of musculoskeletal injuries in military recruits internationally. Incidence rates as high as 40% have been reported, varying by country and branch of military cohorts. Tibial SFx are the most common, followed by other lower extremity sites, and are related to the emphasis on running during training. SFx disproportionately affect female recruits, similarly to a disparity demonstrated in female athletes.MethodsA literature review of articles relevant to our review was conducted using PubMed, utilizing keywords stress fracture, military, recruits, diagnosis, management, treatment, prevention, epidemiology, background, and/or female. Articles older than 10 years old (prior to 2010) were not considered. Review articles were considered, but if a research article was cited by a review, the research was included directly. Articles with primary military data, members of the military as subjects, especially when female recruits were included, were strongly considered for inclusion in this review.ResultsSFx can cause medical morbidity and financial burden and can require discharge from military service. SFx management in the military has cost the United States approximately $100 million annually, which may be underestimated due to lost duty hours or medical discharge with resulting compensation. However, SFx incidence rates have been demonstrated to be reducible with concerted efforts in military cohorts.ConclusionThis review, Part I of a two-part series, provides updated information for multidisciplinary management of SFx in female military recruits. There are many similarities to management in athletes, but unique nuances of the military recruit require specific knowledge to reduce the high incidence rates of injury.
      PubDate: Sun, 27 Feb 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac034
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Part II: Risk Factors for Stress Fractures in Female Military Recruits

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      Pages: 93 - 99
      Abstract: ABSTRACTIntroductionStress fractures (SFx) represent a significant proportion of injuries in military recruits internationally. Stress fractures disproportionately affect female recruits, a disparity that has similarly been consistently demonstrated in female athletes. Stress fractures result in medical morbidity, financial burden, and medical discharge from military service. This review presents current literature regarding SFx risk factors to identify and/or mitigate in this high-risk population.MethodsA literature review was conducted using PubMed to find relevant articles. We utilized keywords stress fracture, military, recruits, female, risk factors, modifiable, non-modifiable, overuse, nutrition, and/or prevention. Articles older than 10 years (published before 2010) were not considered. Review articles were considered, but if a research article was cited by a review, the research was included directly. Articles with primary military data, members of the military as subjects, especially when female recruits were included, were strongly considered for inclusion in this review.ResultsModifiable risk factors for SFx include nutritional deficiency, especially of iron, vitamin D, and possibly calcium, poor physical fitness, suboptimal training programming for injury development and recovery, load carriage, and military footwear. Non-modifiable risk factors include female sex, greater height, lower weight and body mass index in females but lower or higher weight and body mass index in males, lower body fat percentage, and lower bone mineral density. In addition, menstrual dysfunction, low energy availability, later age at menarche, and iron deficiency pose unique risks to female recruits. Preventive measures include leadership education, programs with recovery considerations, and risk factor screening.ConclusionThis review, Part II of a two-part series, guides multidisciplinary management of military recruits, especially females, who are at risk for developing SFx. Unique nuances of the military recruit require specific knowledge to reduce high incidence rates of injury internationally.
      PubDate: Sun, 27 Feb 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac033
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Patterns of Palliation: A Review of Casualties That Received Pain
           Management Before Reaching Role 2 in Afghanistan

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      Pages: 108 - 116
      Abstract: ABSTRACTIntroductionBattlefield pain management changed markedly during the first 20 years of the Global War on Terror. Morphine, long the mainstay of combat analgesia, diminished in favor of fentanyl and ketamine for military pain control, but the options are not hemodynamically or psychologically equivalent. Understanding patterns of prehospital analgesia may reveal further opportunities for combat casualty care improvement.Materials and MethodsUsing Department of Defense Trauma Registry data for the Afghanistan conflict from 2005 to 2018, we examined 2,402 records of prehospital analgesia administration to assess temporal trends in medication choice and proportions receiving analgesia, including subanalysis of a cohort screened for an indication with minimal contraindication for analgesia. We further employed frequency matching to explore the presence of disparities in analgesia by casualty affiliation.ResultsProportions of documented analgesia increased throughout the study period, from 0% in 2005 to 70.6% in 2018. Afghan casualties had the highest proportion of documented analgesia (53.0%), versus U.S. military (31.9%), civilian/other (23.3%), and non-U.S. military (19.3%). Fentanyl surpassed morphine in the frequency of administration in 2012. The median age of those receiving ketamine was higher (30 years) than those receiving fentanyl (26 years) or nonsteroidal anti-inflammatory drugs (23 years). Among the frequency-matched subanalysis, the odds ratio for ketamine administration with Afghan casualties was 1.84 (95% CI, 1.30-2.61).ConclusionsWe observed heterogeneity of prehospital patient care across patient affiliation groups, suggesting possible opportunities for improvement toward an overall best practice system. General increase in documented prehospital pain management likely reflects efforts toward complete documentation, as well as improved options for analgesia. Current combat casualty care documentation does not include any standardized pain scale.
      PubDate: Tue, 13 Sep 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac211
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • An Unusual Presentation of Pulmonary Edema During an Ice Dive at Altitude

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      Pages: 392 - 397
      Abstract: ABSTRACTMilitary diving operations occur in a wide range of austere environments, including high-altitude environments and cold weather environments; however, rarely do both conditions combine. Ice diving at altitude combines the physiologic risks of diving, a hypothermic environment, and a high-altitude environment all in one. Careful planning and consideration of the potential injuries and disease processes affiliated with the aforementioned physiologic risks must be considered. In this case report, we describe a Navy diver who became obtunded secondary to hypoxia during an ice dive at 2,987 m (9,800 ft) elevation and was subsequently diagnosed with high-altitude pulmonary edema. Further consideration of the environment, activities, and history does not make this a clear case, and swimming-induced pulmonary edema which physiologically possesses many overlaps with high-altitude pulmonary edema may have contributed or been the ultimate causal factor for the diver’s acute response.
      PubDate: Fri, 08 Apr 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac081
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Traumatic Optic Neuropathy: The Forgotten Concussion

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      Pages: 398 - 400
      Abstract: ABSTRACTCerebral concussions are a well-recognized issue in military and civilian practice. Although most physicians are well versed in recognizing concussion symptoms, many are not as adept at diagnosing and managing comorbid traumatic optic neuropathy (TON). Traumatic optic neuropathy typically follows cerebral concussions but is often not diagnosed as its symptoms are attributed to brain injury or the presence of altered consciousness impedes its recognition. We hereby describe a soldier who sustained a cerebral concussion with an associated unrecognized TON. We review the epidemiology, pathophysiology, diagnosis, and management of TON.
      PubDate: Fri, 18 Mar 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac060
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • A Diagnosis You Cannot Afford to MIS-C: Multisystem Inflammatory Syndrome
           in Children Within the Active Duty Population

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      Pages: 401 - 403
      Abstract: ABSTRACTMultisystem inflammatory syndrome in children (MIS-C), which is associated with coronavirus disease 2019 (COVID-19) and occurs in the immediately post-infectious period, has never-before been reported within the active duty population. It typically affects children, aged 5-13 years, but has been shown to affect those up to 20 years old. We present an 18-year-old active duty male that arrived at a military treatment facility emergency department with headache, neck pain, and shock without evidence of meningoencephalitis on cerebrospinal fluid analysis and with a negative COVID-19 test. He developed significant abdominal pain and cardiomyopathy. Chest computed tomography showed evidence of ground glass infiltrates, and repeat testing was positive for the COVID-19 virus. Multisystem inflammatory syndrome in children (MIS-C) was diagnosed and treated with a rapid improvement in the patient’s condition. It is a rare but potentially fatal condition that has been shown to affect patients up to the age of 20, encompassing a large part of the junior enlisted population. Multisystem inflammatory syndrome in children (MIS-C) can lead to death, yet mimic other diseases leading to delay of care. Thus, it should be considered when faced with the appropriate constellation of symptoms.
      PubDate: Thu, 07 Apr 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac091
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Esophageal Adenocarcinoma in an Active Duty Sailor: A Case Report

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      Pages: 404 - 406
      Abstract: ABSTRACTEsophageal adenocarcinoma develops when normal squamous epithelia are replaced by dysplastic intestinal columnar cells in response to chronic gastroesophageal reflux disease (GERD). In addition to squamous cell carcinoma, the two malignancies account for over 95% of esophageal malignancies. This case describes a sailor deployed onboard an aircraft carrier who initially presented with typical GERD symptoms and later developed multifactorial weight loss confounded by the operational environment. Upon return to homeport, he was diagnosed with stage III gastroesophageal junction adenocarcinoma. This case emphasizes the difficulty in identifying and diagnosing a rare and dangerous pathology in the resource-limited, operational environment.
      PubDate: Thu, 31 Mar 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac096
      Issue No: Vol. 188, No. 1-2 (2022)
       
  • Novel Use of Seraph-100™ Blood Purification Therapy in Heat Stroke

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      Pages: 407 - 409
      Abstract: ABSTRACTThe Seraph-100™ is a purification filter that blunts cytokine storm, providing a more favorable environment to establish immune homeostasis. We present a novel case of compassionate use of Seraph filter in a young, healthy active duty service member with heat injury-induced massive inflammatory response. The patient is a previously healthy 26-year-old male with altered mental status, tachycardia, fever to 40.3 °C, and hypotension after losing consciousness during a 4-mile run. He had a history of one heat injury in college and took no medications or supplements. Initial workup demonstrated hemoconcentration, leukocytosis, and hyperkalemia. He was intubated, received isotonic crystalloid fluid, and was admitted to the intensive care unit. The patient developed vasopressor-resistant shock and multiorgan failure with rhabdomyolysis requiring continuous renal replacement therapy. The addition of the Seraph resulted in improved hemodynamic stability, decreased inflammatory markers, and improved organ function. Approximately 1 week after the final Seraph treatment, the patient had an abrupt massive lower gastrointestinal bleed and was transitioned to comfort care by family. We present the novel use of Seraph in the setting of multiorgan failure and hyperinflammatory state due to heat injury. The patient’s vasopressor refractory distributive shock was believed to be secondary to heat stroke-induced massive inflammatory response, leading to a trial of Seraph therapy. This case demonstrates that the Seraph filter has the potential to improve hemodynamic instability and reduce cytokine storm in nonsepsis patients.
      PubDate: Mon, 16 May 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac124
      Issue No: Vol. 188, No. 1-2 (2022)
       
 
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