A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

  Subjects -> MILITARY (Total: 106 journals)
The end of the list has been reached or no journals were found for your choice.
Similar Journals
Journal Cover
Military Medicine
Journal Prestige (SJR): 0.373
Citation Impact (citeScore): 1
Number of Followers: 7  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0026-4075 - ISSN (Online) 1930-613X
Published by Oxford University Press Homepage  [419 journals]
  • Correction to: Air Pollution Exposure and the Development of Chronic
           Rhinosinusitis in the Active Duty Population

    • Free pre-print version: Loading...

      PubDate: Tue, 28 Jun 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac185
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Joining the Navy to Become a Physician: The Typical Experience

    • Free pre-print version: Loading...

      Abstract: ABSTRACTIntroductionThe decision to enter the Navy as a physician is a major career choice. However, there are no published studies that address the typical Navy physician’s experience in the Health Professions Scholarship Program (HPSP) and Uniformed Services University of the Health Sciences (USUHS) programs. The purpose of this qualitative study is to describe the typical Navy physician’s experience in the HPSP and USUHS programs.Materials and MethodsAn anonymous online survey containing 47 questions was distributed to 63 Navy HPSP and USUHS physicians who started internships from 2008 to 2015. Participants were chosen by using purposeful, criterion, and snowball sampling methods with whom the author had a professional relationship during his military experience. The survey data were plotted in Excel spreadsheets and graphs according to six sub-research questions. Mean, SD, Likert scale 1-5, and grouping of free text responses were recorded.ResultsA total of 54 out of 63 Navy physicians (85.7%) responded to the survey. Navy physicians got their first-choice residency selection of 67.3% of the time, 34.6% went straight through residency without interruptions, 44.2% answered definitely or probably that military match changed their residency selection compared to them applying for civilian residency, and 46.2% answered definitely or probably that it was more difficult to get into military versus civilian residency. Participants answered definitely or probably that military experience puts them ahead of civilians in terms of leadership (82.7%), prior medical experience (46.2%), and applying for civilian residency (76.2%). Common positive themes of free-text answers included having financial stability, unique life experiences, and serving their country. Common negative themes included lack of career control, lack of knowledge regarding HPSP/USUHS programs, and delay in residency and career.ConclusionsThe principal findings in this study are that most Navy physicians favored paid medical school/financial support, working overseas and in unique operational climates, having unique life experiences, leadership skills, and prior military experience put them ahead of their civilian colleagues, thought the Navy experience was worth it, and would join again if given the opportunity. However, most Navy physicians had a lack of career control due to needs of the Navy, lack of knowledge regarding residency selection, operational billets, and active duty service obligation, had more difficulty getting into a military residency of their choice versus civilians, and had interrupted residency training/training delays. The Navy would possibly benefit from a nationwide HPSP/USUHS physician mentorship program and an educational seminar to increase medical student applicant knowledge, which may improve recruiting and retention.
      PubDate: Wed, 27 Apr 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac117
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • The Hospital Ship as a Strategic Asset in21st Century Foreign Policy and
           Global Health Crises

    • Free pre-print version: Loading...

      Abstract: ABSTRACTIntroductionCurrent U.S. hospital ships—USNS Mercy and Comfort—are old, slow, cumbersome, and indefensible, and due for retirement. As new challenges and new threats emerge in the 21st century, the U.S. Navy should field new afloat medical platforms to potentially deal with both mass casualty scenarios and humanitarian disaster relief in a rapid and tactical manner. New hospital ships should be able to defend themselves with more modern weapons and to be interconnected with encrypted communications. They must be fast, nimble, tactical, defensible, and forward deployed in the risky global commons of the 21st century.Materials and MethodsSystematic review of the literature on hospital ships, U.S. Navy policy, the Geneva Conventions, and current global threat conditions.ResultsHospital ships provide medical support for U.S. forces in conflict and promote goodwill and a positive image of the U.S. abroad. Current hospital ships do not fit the operational paradigm of the current needs for forward deployed and rapidly deliverable operational medicine. There is a need for a new and more capable platform to deliver operational health care in the forward deployed setting.ConclusionsMultiple high-speed medical response vessels—whether reconfigured from an existing ship, or an entirely new platform developed for more robust medical delivery—need to be urgently fielded for future combat operations, humanitarian missions, and participation in cooperative security engagements. These medical platforms need to be able to defend themselves and be tactically interconnected with the Fleet and Fleet Forces.
      PubDate: Thu, 17 Mar 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac061
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • The Effectiveness of a Standardized Ice-Sheet Cooling Method Following
           Exertional Hyperthermia

    • Free pre-print version: Loading...

      Abstract: ABSTRACTIntroductionExertional heat illnesses remain a major threat to military service members in the United States and around the world. Exertional heat stroke (EHS) is the most severe heat illness, characterized by core hyperthermia and central nervous system dysfunction. Per current Army regulations, iced-sheet cooling (ISC) is the recommended immediate treatment for heat casualties in the field, but concerns have been raised regarding the efficacy of this approach. Thus, the purpose of this study was to quantify the cooling rate of ISC following exertional hyperthermia.Materials and MethodsWe utilized a randomized crossover design with 2 experimental trials. In both trials, exertional hyperthermia was induced by walking (3.5 mph at 5% grade) on a treadmill in an environmental chamber (40 °C, 30% RH) for up to 3 hours or until core body temperature reached 39.2 °C. After the walking portion, individuals either received ISC (experimental trial) or cooling and rested supine in the same environmental conditions for 30 minutes with no ISC (control trial). For ISC, bed sheets soaked in ice water were applied (per Army guidance) at the neck, chest, and groin with another sheet covering the body. Sheets were rotated and resoaked every 3 minutes until core temperature decreased to <38.0 °C.ResultsBy design, participants finished exercise with increased core temperature (38.8 ± 0.39 °C vs. 38.90 ± 0.34 °C, ISC and control trials, P = 1.00). The ISC trial provided significantly (P = .023) greater cooling rates, 0.068 °C/min 95% confidence interval [CI; 0.053, 0.086], compared to the control trial, 0.047 °C/min 95% CI [0.038, 0.056]. Additionally, the time to decrease to less than 38.0 °C was significantly (P = .018) faster in the ISC trial (median = 9.3 minutes) compared to the control trial (median = 26.6 minutes).ConclusionISC increases the cooling rate of those recovering from exertional hyperthermia. With the observed cooling rate, we can extrapolate that ISC would reduce core temperature by ∼2 °C within 30 minutes during a case of EHS. We conclude that ISC provides a safe and effective alternative for the field where cold water immersion resources may not be readily available.
      PubDate: Wed, 16 Mar 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac047
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • A Novel Technique Using Ultrasonic Shears Versus Traditional Methods of
           Reduction of Bilateral Labia Minora Hypertrophy: A Retrospective
           Case-Control Study

    • Free pre-print version: Loading...

      Abstract: ABSTRACTIntroductionTo compare the clinical outcomes of bilateral labia minora hypertrophy reduction using ultrasonic shears versus traditional methods.Materials and MethodsIn this retrospective study, we evaluate the surgical outcomes of 11 women who underwent bilateral labia minora hypertrophy reduction using ultrasonic shears to 14 women who underwent the same procedure using various traditional methods between January 1, 2015 and February 29, 2020 in a single center. The primary outcomes evaluated are total operative time, estimated blood loss, and postoperative pain. Secondary outcomes include postoperative complications and total admission time. The statistical analyses used were exact Wilconxon Rank and Fisher’s exact test.Results25 total bilateral labiaplasty procedures were included in the analysis. 11 procedures were performed using ultrasonic shears and 14 were performed using traditional methods. The mean reduction operative time for the ultrasonic shears technique when compared with traditional methods was 43.25 minutes (22.82 minutes versus 66.07 minutes, P = .0002). A statistically significant but non-clinically significant difference in estimated blood loss was noted. No statistically significant differences existed with postoperative pain score, total admission time, or postoperative complications.ConclusionsUltrasonic shears significantly reduce the time needed for the reduction of bilateral labia minora hypertrophy and therefore should be considered by surgeons as a useful tool in increasing the efficiency of this procedure.
      PubDate: Sat, 05 Mar 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac044
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Comparison of Musculoskeletal Injury and Behavioral Health Diagnoses Among
           U.S. Army Active Duty Servicewomen in Ground Combat and Non-Ground Combat
           Military Occupational Specialties

    • Free pre-print version: Loading...

      Abstract: ABSTRACTIntroductionThe U.S. Army’s Soldier 2020 program, which started in January 2016, was designed to achieve full integration of women in all military occupational specialties. This study was undertaken to determine differences in risk of musculoskeletal injury and behavioral health (BH) disorders among U.S. Army Active Duty Servicewomen (ADSW) in ground combat military occupational specialties (MOS) versus those in non-ground combat MOS since the start of the program until January 2019.Materials and MethodsUsing healthcare claims data from the Military Health System’s Data Repository we conducted a cross-sectional study on ADSW from January 1, 2016 to January 1, 2019 and categorized them as either ground combat specialists (GCSs) or non-ground combat specialists (NGCSs). We identified all female soldiers in our cohort with a musculoskeletal injury (MSKI) and/or BH diagnosis during the study period. A multivariable logistic regression, adjusted by pregnancy or delivery status, was used to assess risk factors associated with GCS and included soldier age, race, body mass index (BMI), tobacco use, alcohol/substance use, and MSKI and BH status as predictor variables.ResultsA total of 92,443 U.S. Army ADSW were identified, of whom 3,234 (3.5%) were GCS (infantry, field artillery, cavalry/armor, and air defense) and 89,209 (96.5%) were in non-ground combat billets. A large difference was observed when comparing the age of the population by occupation; GCS women were predominantly between the ages of 18-23 years (71.9%), compared to NGCS women aged 18-23 (41.0%). Top MSKI and BH diagnoses for both occupations were joint pain (44.9% GCS, 50.2% NGCS) and adjustment disorders (26.2% GCS, 28.0% NGCS). GCS women had lower odds for musculoskeletal injury (0.86 AOR, 0.79-0.93 CI, P = 0.0002), obesity per BMI classification (0.82 AOR, 0.70-0.97 CI, P = 0.0214), and BH disorders (0.87 AOR, 0.80-0.95 CI, P = 0.0019); and higher odds for tobacco use (1.44 AOR, 1.27-1.63 CI, P < 0.0001), substance use (1.36 AOR, 1.04-1.79 CI, P = 0.0257), and alcohol use (1.18 AOR, 1.02-1.38 CI, P = 0.0308) when compared to NGCS women.ConclusionsWith the increasing focus on soldier medical readiness in today’s U.S. Army, the health of all soldiers is of paramount concern to command groups, unit leaders, and individual soldiers. The integration of women into ground combat military occupational specialties is a relatively new program; further longitudinal research of these groups should follow, focusing on their progression and improvement in soldier readiness, overall health, and the well-being of all servicewomen.
      PubDate: Wed, 02 Feb 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac022
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Active Duty Service Members, Primary Managers, and Administrators’
           Perspectives on a Novel Sleep Telehealth Management Platform in the U.S.
           Military Healthcare System

    • Free pre-print version: Loading...

      Abstract: ABSTRACTIntroductionSleep disorders are common in the military, and there is a gross shortage of sleep specialists in the military health system. The purposes of the present study were to (1) understand perceptions and expectations surrounding sleep telehealth approaches and (2) solicit feedback to optimize and refine a proposed novel sleep telehealth management platform. To accomplish these objectives, we investigated the perceptions, expectations, and preferences of active duty service members (ADSMs) with sleep disorders, primary care managers (PCMs), and administrative stakeholders regarding sleep telehealth management.Materials and MethodsUsing convenience sampling, we conducted five focus groups with 26 ADSMs and 11 individual interviews with PCMs from two military treatment facilities in the U.S National Capital Region and 11 individual interviews with administrative sleep stakeholders (9 military and 2 civilian).ResultsActive duty service members, PCMs, and administrative stakeholders provided insight regarding expectations for sleep telehealth as well as suggestions to optimize the novel sleep telehealth platform. In terms of outcomes, ADSMs expected sleep telehealth to improve sleep and convenience. Primary care managers expected improved sleep and other comorbidities, enhanced operational readiness, and reduced mortalities among their patients. Administrators expected increased access to care, optimized utilization of health services, realized cost savings, reduced accidents and errors, and improved military performance. In terms of the platform, for ADSMs, desired characteristics included delivery of timely clinical reports, improved patient–provider communication, and enhanced continuity of care. For PCMs and administrators,an ideal sleep telehealth solution will improve the diagnosis and triage of sleep patients, save PCM time, be easy to use, and integrate with the electronic health record system.ConclusionThe proposed sleep telehealth platform appealed to nearly all participants as a significant force multiplier to enhance sleep disorder management in the military. Stakeholders offered valuable recommendations to optimize the platform to ensure its successful real-world implementation.
      PubDate: Fri, 28 Jan 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac006
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Evaluation of Two Training Programs Designed to Enhance Performance on the
           Army Combat Fitness Test Among ROTC Cadets

    • Free pre-print version: Loading...

      Abstract: ABSTRACTIntroductionPhysical fitness is foundational to the U.S. Army as a component of combat readiness, and accurate assessment of readiness is imperative for mission success and soldiers’ health and safety. To this end, the Army has developed the Army Combat Fitness Test (ACFT), which more accurately assesses these abilities and may aid development of a more combat-ready force. Reserve Officer Training Corps (ROTC) programs nationwide are often challenged by limited structured training time, as well as access to equipment and training space. Development and/or adaptation of a training program that addresses these limitations would benefit ROTC programs nationally. Therefore, the purpose of this study was to compare a standard military fitness training program to High-Intensity Functional Training (HIFT) in ROTC cadets. We hypothesized that a HIFT program would be more effective than the standard military program developed by the DoD on both ACFT performance and assessment of common Warrior Tasks and Battle Drills (WTBDs).Materials and MethodsThis study was approved by the Institutional Review Board at Colorado State University (CSU). Participants were recruited from CSU’s Army ROTC program. Before and upon completion of the training intervention, participants completed a battery of testing, conducted over three visits. The first visit consisted of body composition assessment and measurement of aerobic capacity (VO2max). Visit 2 was the ACFT, and Visit 3 was a “benchmark test” to assess WTBD performance. Participants then completed 10 weeks of group training. Once weekly, participants completed the Daily Analysis of Life Demands for Athletes (DALDA) survey to monitor the risk of overtraining.Statistical AnalysisResponses to training and survey responses were examined using two-way analysis of variance (time × group) with repeated measures. Baseline characteristics were compared using Student’s t-test to assess pre-intervention differences between groups. Pearson product correlations were used to test relationships between ACFT performance, body composition, and performance on the benchmark assessment. The significance level alpha was set at P < .05.ResultsTwenty-five men and 10 women competed the study (n = 35). Mean age was 19.8 ± 1.3 years, range 18-23. There were no significant changes in absolute or relative VO2max within or between groups. We found no difference in body mass, but did find a small but statistically significant favorable change in body composition, with no difference between groups. Overall ACFT scores and scores in five of the six events increased significantly across both groups, with no significant differences between groups. For the benchmark test, there was no significant difference between pre- and post-intervention benchmark scores, time to completion, 1,600-m ruck time, or accuracy. DALDA survey results indicate no apparent risk for overtraining.ConclusionThree 60-minute sessions per week of moderate-high-intensity training elicited improvements in ACFT scores, with no statistically significant differences between training programs. For this population of ROTC cadets, implementing a structured training program with expert oversight appears to be effective. Based on the successes and unanticipated challenges encountered in this study, training programs that emphasize intensity, train a wide variety of movements, maximize adherence, and are adaptable to a variety of situations are likely to be successful at improving ACFT scores.
      PubDate: Sat, 22 Jan 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac015
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • A Retrospective Review of Emergency Department Visits That May Be
           Appropriate for Management in Non-Emergency Settings

    • Free pre-print version: Loading...

      Abstract: ABSTRACTBackgroundEmergency departments (EDs) continue to struggle with overcrowding, increasing wait times, and a surge in patients with non-urgent conditions. Patients frequently choose the ED for non-emergent medical issues or injuries that could readily be handled in a primary care setting. We analyzed encounters in the ED at the Brooke Army Medical Center—the largest hospital in the Department of Defense—to determine the percentage of visits that could potentially be managed in a lower cost, appointment-based setting.Materials and MethodsWe conducted a retrospective chart review of patients within our electronic medical record system from September 2019 to August 2020, which represented equidistance from the start of the COVID-19 pandemic, resulting in a shift in ED used based on previously published data. Our study also compared the number of ED visits pre-covid vs. post-covid. We defined visits to be primary care eligible if they were discharged home and received no computed tomography imaging, ultrasound, magnetic resonance imaging, intravenous medications, or intramuscular-controlled substances.ResultsDuring the 12 month period, we queried data on 75,205 patient charts. We categorized 56.7% (n = 42,647) of visits as primary care eligible within our chart review. Most primary-care-eligible visits were ESI level 4 (59.2%). The largest proportion of primary-care-eligible patients (28.3%) was seen in our fast-track area followed by our pediatric pod (21.9%). The total number of ED visits decreased from 7,477 pre-covid to 5,057 post-covid visits. However, the proportion of patient visits that qualified as primary care eligible was generally consistent.ConclusionsOver half of all ED visits in our dataset could be primary care eligible. Our findings suggest that our patient population may benefit from other on-demand and appointment-based healthcare delivery to decompress the ED.
      PubDate: Tue, 18 Jan 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usab553
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • The Primary Care Management of Headache: Synopsis of the 2020 U.S.
           Department of Veterans Affairs and U.S. Department of Defense Clinical
           Practice Guideline

    • Free pre-print version: Loading...

      Abstract: ABSTRACTIntroductionIn June of 2020, the U.S. DVA and DoD approved a new joint clinical practice guideline for assessing and managing patients with headache. This guideline provides a framework to evaluate, treat, and longitudinally manage the individual needs and preferences of patients with headache.MethodsIn October of 2018, the DVA/DoD Evidence-Based Practice Work Group convened a guideline development panel that included clinical stakeholders and conformed to the National Academy of Medicine’s tenets for trustworthy clinical practice guidelines.ResultsThe guideline panel developed key questions, systematically searched and evaluated the literature, created a 1-page algorithm, and advanced 42 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system.ConclusionThis synopsis summarizes the key features of the guideline in three areas: prevention, assessing and treating medication overuse headache, and nonpharmacologic and pharmacologic management of headache.
      PubDate: Wed, 12 Jan 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usab490
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Letter From the Executive Director Dr. John Cho

    • Free pre-print version: Loading...

      Pages: 227 - 229
      PubDate: Sat, 06 Aug 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac237
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Leadership Lessons From the Field: Leading Others to Cope With Death

    • Free pre-print version: Loading...

      Pages: 230 - 232
      Abstract: ABSTRACTAll 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.
      PubDate: Fri, 20 May 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac128
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Severe Acute Respiratory Syndrome Coronavirus 2 Vaccines: A Historical
           Viral Vaccine Perspective

    • Free pre-print version: Loading...

      Pages: 233 - 234
      Abstract: ABSTRACTSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are a remarkable scientific achievement. The perspective on past viral vaccine performance and viral characteristics, such as incubation period, can help with messaging and instilling vaccine confidence. Protection against mild infection occurs in the short term (months), but the persistence of protection against severe disease will likely endure longer.
      PubDate: Wed, 30 Mar 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac087
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Am I Prepared' The Fears of a Military Resident

    • Free pre-print version: Loading...

      Pages: 235 - 236
      Abstract: ABSTRACTThe stress of residency has led to continued emphasis on developing resiliency in residents, but what does that mean' When the heartbreak of medicine tries to keep us from moving forward, sometimes all we can do is take a pause.
      PubDate: Fri, 27 May 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac138
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Army Reserve Participation in Tropic Care 2018: An Innovative Readiness
           Training to Assess Unit Defense Support of Civil Authorities Response

    • Free pre-print version: Loading...

      Pages: 237 - 239
      Abstract: ABSTRACTCoronavirus disease 2019 highlighted the Army Reserve as a key partner in Defense Support of Civil Authorities (DSCA). Tropic Care, an Innovative Readiness Training mission, led by the 1984th U.S. Army Hospital, served as a venue to train on unit Mission Essential Task Lists while providing an initial assessment on its DSCA response capability.
      PubDate: Fri, 15 Jul 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac214
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Ethical Responsibilities of a Military to the Social Determinants of
           Health of its Service Members

    • Free pre-print version: Loading...

      Pages: 252 - 256
      Abstract: ABSTRACTA military exists in a unique position. It is an organization in which active duty members knowingly join or are conscripted into service with the understanding that there is an increased risk of mental and/or bodily harm as compared to many other occupations. However, while the nature of the profession can inherently be dangerous, it does not follow that its members be placed at undue excess risk if that risk can be reasonably avoided or reduced. Social determinants of health are one example of influences under a military’s purview that impact health outcomes and well-being. Although the U.S. Military performs well across many health equity measures, disparities persist and require attention and redress. Military policies and practices deeply impact members’ lives during and after service, and the durability and profundity of these effects establish the ethical grounds upon which any military policy should be structured. The ethical obligation is fortified by the extent of control a military exercises over its personnel. Taken together, these factors necessitate a concerted effort by militaries to remain cognizant of the ethical impacts of their policies and practices and to ensure focus remains on the well-being and readiness of its personnel. As such, militaries have ethical responsibilities to promote healthy social determinants of health among their service members via policies and public health measures.
      PubDate: Wed, 06 Apr 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usab554
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • It Would Take Combat Relevance to Put a Chiropractor in Khakis— This Is
           Why That Has Not Happened

    • Free pre-print version: Loading...

      Pages: 257 - 260
      Abstract: ABSTRACTThe purpose of this article is to challenge the premise of a recent commentary suggesting that chiropractors should become commissioned officers. An overview of the early practice guidelines and current scientific evidence for the use of spine and peripheral manipulation is provided. The Military Health System is designed to support military operations and currently includes a large contingent of active duty musculoskeletal healthcare experts to include sports medicine–trained family physicians, orthopedic surgeons, physician assistants/associates, doctors of physical therapy/physical therapists, occupational therapists, and podiatrists. The evidence is clear that it is not in the best interest of our military services to commission alternative practitioners whose practices are out of step with the rest of medicine.
      PubDate: Mon, 11 Apr 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac098
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Opioid Prescription Reduction after Dentoalveolar Surgery—A Success
           Story in the Recruit Training Environment

    • Free pre-print version: Loading...

      Pages: 261 - 263
      Abstract: ABSTRACTGiven the public health toll exacted by the Opioid Crisis, it is important for providers in all disciplines to examine their opioid prescribing patterns to see where opioid reduction strategies can be effectively employed. Limiting the impact of the Opioid Crisis on active duty service members is a critical component of maintaining a ready fighting force. One avenue for reducing the potential for opioid diversion and abuse is developing and implementing non-opioid postsurgical pain management strategies that both provide adequate pain relief and also ensure an expedient return to full duty. Dentoalveolar surgeries performed by oral and maxillofacial surgeons to maintain operational dental readiness are a good example of common procedures necessitating post-procedural pain medications and convalescent days impacting availability for full duty. The providers at US Navy Recruit Training Command’s oral surgery clinic undertook a process improvement initiative to reduce opioid prescriptions after dentoalveolar surgery. This change was accompanied by a concerted education effort aimed at both providers and patients on the benefits of avoiding opioids as well as the importance of strict adherence to a standardized medication dosing regimen for efficacious non-opioid pain control consisting of maximum doses of ibuprofen and acetaminophen taken every six hours. No increase in convalescent time off and no increase in postoperative visits related to pain control were noted. In our experience, eliminating routine post-procedure opioids for dentoalveolar surgery was a viable strategy for reducing the potential for opioid diversion and abuse among our patients with no negative impact on the operational and training tempo of the associated command.
      PubDate: Thu, 21 Apr 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac103
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Exploring the Predeployment Phase of an Antarctic Expedition and the
           Brazilian Pre-Antarctic Training

    • Free pre-print version: Loading...

      Pages: 264 - 271
      Abstract: ABSTRACTIn Antarctica, human access and presence are complex and require detailed planning and preparation in advance. The personnel of National Antarctic Programs (NAPs, i.e., scientists and support personnel, including military, civilians, and mountaineers) stay in different isolation, confinement, and extreme (ICE) environments such as ships, research stations, and scientific summer camps. Antarctica imposes harsh conditions that influence physiological and psychological responses impacting health, mood, and physical and cognitive performances. In this context, we argue why people should prepare in advance for staying in Antarctica and what to expect in ICE environments. We also spotlighted recommendations shared by different NAPs participant guides, including predeployment training. Next, we present a case study of the Brazilian Pre-Antarctic Training (PAT), a theoretical-practical training that provides technical and logistical information and assesses the adaptability and physical capacity of researchers and military personnel to perform fundamental activities in a polar environment. We evaluated and compared the individual’s mood at the beginning and the end of the PAT week and observed group-specific mood changes depending on the sex, functions, and the facilities that participants accessed. Finally, we proposed that conducting training before staying in Antarctica, besides promoting conditions to better plan the voyage and knowledge of the region, can contribute to dealing with the possible mood swings during expeditions and even promote positive affect. Therefore, the psychophysiological effects of PAT are topics for further investigations.
      PubDate: Thu, 23 Jun 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac154
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • The Case for Medicine-Pediatrics Training in the U.S. Military

    • Free pre-print version: Loading...

      Pages: 272 - 273
      Abstract: ABSTRACTResidency programs in the combined specialty of Internal Medicine-Pediatrics (Med-Peds) are not offered in the military graduate medical education system despite existing in the civilian sector for over 50 years. This residency consists of 4 years of training and results in the development of board-certified internists and pediatricians who can care for patients from infancy to death. This versatility, combined with an emphasis on the transition from childhood to adulthood, would be valuable to the Military Health System. Med-Peds physicians could serve in a variety of settings depending on the needs of the military: in the outpatient clinic, in the hospital, or in an operational setting. Specifically, Med-Peds doctors could operate as critical care extenders in austere or operational environments to patients of all ages. This could improve outcomes of pediatric casualties in war because of specific training in both medical and pediatric intensive care units. Med-Peds physicians would integrate seamlessly into the Military Health System to work alongside family medicine doctors, internists, and pediatricians to provide high-quality primary care to service members; this may also allow for the increased flexibility of the medical corps. As there are already military residency programs in pediatrics and internal medicine, the required infrastructure for such a training program exists. The addition of this residency may also lead to more interest in military medicine from prospective applicants to medical school. This essay uses personal experience to explain how the addition of this specialty to the military would benefit the medical mission domestically and abroad.
      PubDate: Sat, 02 Jul 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac181
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Cost–Benefit Analysis of Novel Antiviral Ritonavir in the Active
           Duty U.S. Military Population

    • Free pre-print version: Loading...

      Pages: 274 - 275
      PubDate: Wed, 05 Jan 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usab552
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • COVID-19 Vaccine Acceptance Among Defense Force Personnel: Correspondence

    • Free pre-print version: Loading...

      Pages: 276 - 276
      PubDate: Wed, 08 Jun 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac140
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Letter in Response to “Top 10 Research Priorities for U.S. Military En
           Route Combat Casualty Care”

    • Free pre-print version: Loading...

      Pages: 277 - 278
      PubDate: Mon, 11 Jul 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac145
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • SARS-CoV-2 Vaccine Acceptance Disparity Among Israeli Defense Forces
           Personnel: Answer to a Commentary

    • Free pre-print version: Loading...

      Pages: 279 - 279
      PubDate: Fri, 27 May 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac141
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Response to Letter to the Editor on “Top 10 Research Priorities for U.S.
           Military En Route Combat Casualty Care”

    • Free pre-print version: Loading...

      Pages: 280 - 280
      Abstract: Defense Combat Casualty Care Research ProgramJPC-6
      PubDate: Mon, 11 Jul 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac146
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • A Commentary

    • Free pre-print version: Loading...

      Pages: 281 - 283
      PubDate: Thu, 17 Mar 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac062
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Joining the Navy to Become a Physician: Nothing Typical About It

    • Free pre-print version: Loading...

      Pages: 284 - 285
      Abstract: ABSTRACTJoining the military and entering a career in medicine are both intensely personal decisions. Individually, becoming a physician or a naval officer requires people to join a profession, represented by the oaths of each group. Both require hard work, demanding schedules, and dedication. Those entering into the Medical Corps will combine these roles. To optimize finding a fulfilling career, students interested in joining the medical corps should identify mentors, which helps them create the career path they want and aids in their self-reflection to discover their motivations and expectations, finally “Semper Gumby.” My own path fulfilled my desire to serve and passion for medicine but more importantly afforded me the opportunity to pursue fellowship, gain expertise in academic medicine, and construct a network of mentors, colleagues, and friends around the globe.
      PubDate: Wed, 27 Apr 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac121
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Overall Safety and Risks Associated with Blood Flow Restriction Therapy: A
           Literature Review

    • Free pre-print version: Loading...

      Pages: 1059 - 1064
      Abstract: ABSTRACTIntroductionBlood flow restriction therapy (BFRT) is used in scenarios ranging from muscle building in athletic performance to decreasing recovery time in postoperative orthopedic rehabilitation. The efficacy of BFRT for treating diseases has been increasingly researched; however, there has been less literature focused on establishing the safety of this therapy.Materials and MethodsAn extensive literature review pertaining to BFRT and any deleterious events related to its usage was completed by searching multiple databases, including PubMed, EMBASE, and Cochrane Library using the terms “blood flow restriction therapy” or “KAATSU.”ResultsTen case reports, five case series, two national surveys, two questionnaires, six randomized controlled studies, and one systematic review were included. A total of 1,672 individuals reported an adverse event following BFRT use out of 25,813 individuals. Commonly reported adverse events were numbness, dizziness, subcutaneous hemorrhage, and rhabdomyolysis. There were unique adverse effects of this therapy reported in individuals with comorbid conditions, such as hypertension and thoracic outlet syndrome, which included isolated cases of central retinal vein occlusion and Paget–Schroeder syndrome.ConclusionBlood flow restriction provides tremendous opportunity with a potential for accelerated exercise rehabilitation and injury prevention. This modality could be used in the military setting to help injured active duty personnel expeditiously return to deployable status. Further prospective randomized controlled trials are warranted to further support BFRT safety; however, from this literature review, it can be concluded that BFRT can be utilized safely in the proper patient population when administered by qualified professionals who have undergone the appropriate training.
      PubDate: Sat, 12 Mar 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac055
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Effect of Exercise Training Programs on Physical Fitness Domains in
           Military Personnel: A Systematic Review and Meta-Analysis

    • Free pre-print version: Loading...

      Pages: 1065 - 1073
      Abstract: ABSTRACTIntroductionPhysical training is important to prepare soldiers for the intense occupational demands in the military. However, current physical training may not address all fitness domains crucial for optimizing physical readiness and reducing musculoskeletal injury. The effects of nontraditional military physical training on fitness domains have been inconsistently reported, which limits the design of the ideal training program for performance optimization and injury prevention in the military. The aim of this systematic review was to identify the effects of exercise training on various fitness domains (i.e., aerobic fitness, flexibility, muscular endurance, muscular power, muscular strength, and occupationally specific physical performance) that contribute to occupational performance and musculoskeletal injury risk in military personnel.MethodsAn extensive literature search was conducted in January 2021 and was subsequently updated in July 2021 and December 2021. Included studies consisted of comparative groups of healthy military personnel performing traditional and nontraditional military physical training with at least one assessment representative of a fitness domain. Study appraisal was conducted using the PEDro scale. Meta-analysis was conducted via forest plots, standard mean difference (SMD, effect size), and intertrial heterogeneity (I2).ResultsFrom a total of 7,350 records, 15 studies were identified as eligible for inclusion in this review, with a total of 1,613 participants. The average study quality via the PEDro score was good (5.3/10; range 4/10 to 6/10). Nontraditional military physical training resulted in greater posttraining values for muscular endurance (SMD = 0.46; P = .004; I2 = 68%), power (SMD = 1.57; P < .0001; I2 = 90%), strength via repetition maximum testing (SMD = 1.95; P < .00001; I2 = 91%), and occupationally specific physical performance (SMD = 0.54; P = .007; I2 = 66%) compared to the traditional group. There was no significant difference for aerobic fitness (SMD = −0.31; P = .23; I2 = 86%), flexibility (SMD = 0.58; P = .16; I2 = 76%), and muscular strength via maximal voluntary contraction (SMD = 0.18; P = .28; I2 = 66%) between training groups.ConclusionsThe current systematic review identified that nontraditional military physical training had a greater posttraining effect on muscular endurance, power, strength measured via repetition maximum, and occupationally specific physical performance compared to traditional military physical training. Overall, these findings suggest that nontraditional military physical training may be beneficial in optimizing occupational performance while potentially reducing musculoskeletal injury risk.
      PubDate: Sat, 05 Mar 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usac040
      Issue No: Vol. 187, No. 9-10 (2022)
       
  • Severe Trauma Patients Requiring Undelayable Combined Cranial and
           Extra-Cranial Surgery: A Proof-of-Concept Monocentric Study

    • Free pre-print version: Loading...

      Pages: 1127 - 1135
      Abstract: ABSTRACTIntroductionTo date, there is no evidence concerning the emergency surgical management of severe trauma patients (STP) with severe traumatic brain injury (STBI) presenting a life-threatening intracranial hematoma and a concomitant extra-cranial noncompressible active bleeding. Current guidelines recommend stopping the extra-cranial bleeding first. Nevertheless, the long-term outcome of STP with STBI mainly depends from intracranial lesions. Thus, we propose a combined damage-control surgical strategy aiming to reduce the time spent with intracranial hypertension and to hasten the admission in the intensive care unit. The main objective of the study is to evaluate the benefits of combined cranial and extra-cranial surgery of STP on the long-term outcome.Materials and MethodsWe retrospectively searched through the database of STBI of a level 1 trauma center facility (Sainte-Anne Military Teaching Hospital, Toulon, France) from 2007 until 2021 looking for patients who benefited from combined cranial and extra-cranial surgery in an acute setting.ResultsThe research yielded 8 patients. The mean age was 35 years old (±14) and the male to female sex ratio was 1.7/1. The trauma mechanism was a fall in 50% of the cases and a traffic accident in 50% of the cases. The median Glasgow coma scale score was 8 (IQR 4) before intubation. The median Injury Severity Score was 41 (IQR 16). Seven patients (88%) presented hypovolemic shock upon admission. Six patients (75%) benefited from damage-control laparotomy among, whom 4 (67%) underwent hemostatic splenectomy. One patient benefited from drainage of tension pneumothorax, and one patient benefited from external fixator of multiple limb fractures. Seven patients (88%) benefited from decompressive craniectomy for acute subdural hematoma (5 patients) or major brain contusion (2 patients). One patient (12%) benefited from craniotomy for epidural hematoma. Three patients presented intraoperative profound hypovolemic shock. Six patients (75%) presented a favorable neurologic outcome with minor complications from extra-cranial surgeries and 2 patients died (25%).ConclusionPerforming combined life-saving cranial and extra-cranial surgery is feasible and safe as long as the trauma teams are trained according to the principles of damage control. It may be beneficial for the neurologic prognostic of STP with STBI requiring cranial and extra-cranial surgery.
      PubDate: Mon, 17 Jan 2022 00:00:00 GMT
      DOI: 10.1093/milmed/usab555
      Issue No: Vol. 187, No. 9-10 (2022)
       
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
 


Your IP address: 100.25.42.211
 
Home (Search)
API
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-