Military Medicine最新文献

Introduction: Active duty service members (ADSMs) may be at heightened risk for eating disorders (EDs) and sub-clinical disordered eating (DE). ADSMs are also at a high risk for musculoskeletal injury (MSK-I). Given the risk for EDs/DE among ADSMs as well as robust physical requirements of military training, additional research is needed to elucidate links between DE and risk for MSK-I among ADSMs. The aim of the present study was to assess the prevalence of DE and associations with MSK-I among Marine Corps officers entering a 6 month leadership course.

Materials and methods: The current cross-sectional study is part of a large, prospective study, the Initiation of Marine Physiological Assessment of Combat Training (IMPACT) study. Participants completed the Eating Disorder Examination-Questionnaire Short (EDE-QS) and self-reported the presence of a recent (≤6 months) MSK-I upon entry to an officer training course. A logistic regression was used to assess the association between elevated DE (EDE-QS ≥15) and recent MSK-I, adjusting for age, race, sex, and commissioning source.

Results: N = 1,382 officers (11.6% female, MAge: 24.8 ± 2.9 years, 26.6% racial/ethnic minority) completed the questionnaires. Seven percent had elevated DE (EDE-QS score ≥15) (female: 10.6%, male: 6.9%, P = .10); 18.3% self-reported recent MSK-I (female: 26.3%, male: 17.3%; P = .009). Females had 17% greater odds of MSK-I compared to males (aOR: 1.17, 95% CI: 1.03-1.33, P = .02). Moreover, females with elevated DE had greater odds of MSK-I than males with elevated DE (aOR= 1.38); among females, odds of MSK-I were greatest among those with elevated DE (aOR= 1.35).

Conclusions: In this sample of Marine officers, DE was associated with greater odds of a recent MSK-I among women only. Results align with previously reported relationships between DE and skeletal health in female athletes. Prospective research is needed to elucidate the temporal nature of these relationships.

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have become increasingly prevalent and have the potential to delay gastric emptying. The American Society of Anesthesiologists (ASA) released guidance regarding the perioperative management of patients receiving GLP-1 RAs, but it is unclear the extent to which hospitals in the U.S. Military Health System have implemented policies consistent with this guidance.

Methods: A questionnaire was sent to active duty anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) working in the U.S. Military Health System. The questions assessed the presence of institutional GLP-1 RA perioperative policies, adherence to the policy (if applicable), the basis and components of current and recommended future institutional policies, institutional tracking of policy implementation and outcomes, and knowledge, skills, barriers, and continuing medical education goals related to the perioperative management of patients receiving GLP-1 RAs.

Results: The response rate was 32% (N = 265); a little over half of the respondents were anesthesiologists (53%); and respondents' primary practices included over 50 institutions. More than half (54%) indicated that their primary practice location had a GLP-1 RA perioperative policy; 65% of whom indicated that they always followed the policy. In review of practice locations with >1 respondents, there was a lack of perfect agreement across most locations. The most commonly reported basis for the policy was ASA guidance (87%), followed by department leadership (37%). Barriers to any system-wide GLP-1 perioperative management policy included a lack of gastric ultrasound practice and comfort, as well as reported skills and knowledge, pressure not to cancel cases, scheduling problems, and productivity requirements.

Conclusions: Formal policies were reported by most respondents, but inconsistencies within practice locations suggest that local policy implementation could be improved. Commonly reported barriers to future system-wide policy implementation provide data-driven information for system-wide efforts to improve policy success.

Introduction: The storage of reusable medical devices (RMDs) is the final reprocessing phase and the step that directly precedes point-of-care delivery. Reusable medical devices, including surgical tools necessitating sterilization and semicritical devices such as endoscopes, undergo high-level disinfection. The rigorous reprocessing protocols and subsequent storage of RMDs are crucial in preserving their sterility and asepsis. This ensures they are available, clean, and safe for patient use, thereby significantly reducing the risk of surgical site infection. The stringent requirements for RMD storage are a testament to the critical role it plays in patient safety, making it a demanding task for health care organizations (HCOs) to comply with. These challenges are further amplified in austere environments. This integrative review aims to identify optimal storage practices, emphasize the critical importance of RMD storage in the Military Health System, and derive implications for policies and future considerations.

Materials and methods: The authors performed an integrative review and comprehensive literature search in PubMed/MEDLINE, CINAHL, and Embase using the keywords "instrument storage," "surgical instruments," "sterile storage," "sterile wrap," and "flexible endoscope storage." Articles were limited to English from 1980 to 2024. Additionally, the authors reviewed international guidelines to support RMD storage.

Results: The integrative review of 42 articles and 14 guidelines and articles identified 6 central themes supporting RMD storage, which include facility design, environmental considerations, sterile storage packaging systems, considerations for event-related sterile storage, point-of-care delivery, and endoscope storage best practices. The abundance of evidence-based recommendations and guidelines complicates adherence to optimal practices in HCOs, presenting significant challenges in austere environments. Integrating RMD storage considerations into training, exercises, and operations help promote a culture of RMD stewardship to ensure safe surgical and procedural care within the Military Health System.

Conclusion: Although surgical teams' capabilities are crucial in delivering effective care in a dynamic environment, the management and storage of RMDs are equally essential. Numerous organizations have outlined rigorous guidelines for HCOs to comply with, which can be intensified in austere conditions. Ultimately, a commitment to integrating the literature and developing the groundwork for clinical practice guidelines can improve the safe storage of RMDs in both standard and austere environments.

Concussions are a common form of mild traumatic brain injury characterized by a transient alteration of cerebral function leading to a range of physical, cognitive, and emotional symptoms. Postconcussive symptoms (PCSs) usually resolve in about a week but can persist in 10% to 15% of patients. If left untreated, PCS can profoundly affect a patient's life. The authors present a case of a previously healthy patient who dealt with residual headaches and anxiety for 10 months after a head injury. She was treated with osteopathic manipulative treatment (OMT), which helped resolve her headaches and her anxiety. The OMT techniques applied during treatment included balanced ligamentous tension, myofascial release, and osteopathy in the cranial field techniques. OMT is a nonpharmacological, noninvasive treatment that can benefit patients suffering with PCS. The authors would like to increase the awareness of clinicians and researchers for OMT's potential positive outcomes for PCS, as part of a multifactorial approach to care.

The balance of operational readiness and maintaining a healthy recruitment force presents increasing challenges within the DoD. Chronic preventable diseases, such as overweight and obesity, along with musculoskeletal injuries, are threats to recruitment and retention. Novel approaches are needed and leaders are in a unique position to serve a key role in influencing nutrition readiness. Leader-Inspired Nutrition (LIN) is a proposed framework that equips leaders with strategies for building a culture of health. Leader-Inspired Nutrition provides an approach leaders can leverage within units to improve health and performance. The LIN framework was developed from relevant and evidence-based information through collaboration with key nutrition subject matter experts and leaders. The 7 core pillars of LIN are to integrate nutrition basics, model top-down nutrition behaviors, promote a performance-focused food environment, integrate dietary supplements knowledge, consider economic factors that affect nutrition choices, evaluate Total Force Fitness impact, and promote utilization of DoD wellness resources. Each pillar provides leaders with a practical approach to engaging service members while encouraging nutrition readiness. As leaders engender trust and serve as role models, the adoption of the LIN framework in their units can guide and foster a culture of health within the DoD. Leader-Inspired Nutrition will assist leaders in building shared communities through healthful nutrition and mealtime experiences and serve to shape military nutrition policies that affect readiness within the DoD. This commentary describes the concept of LIN, the elements and principles of LIN, and how leaders can inspire service members to maximize performance to support nutrition readiness.

Introduction: Children are among the most vulnerable populations affected by armed conflicts, yet there is limited data on the preparedness of military medical personnel to care for pediatric combat trauma casualties in austere or large-scale combat operations. This study aimed to assess the confidence, training needs, and resource requirements of military medical providers who have managed pediatric patients during deployment.

Materials and methods: This IRB-exempt, cross-sectional mixed-methods study used a survey created via a modified Delphi method with input from subject matter experts. The survey was distributed to active duty and reservist physicians, nurses, medics, and corpsmen who had previously deployed to combat environments. Respondents answered Likert-style questions anonymously on the SurveyMonkey platform. Data were analyzed using Welch's t-test, with statistical significance defined as P < .05. Qualitative data were coded into discrete themes and summarized.

Results: A total of 84 respondents participated in the survey. Only 27% reported feeling confident or very confident in resuscitating pediatric casualties. Health care providers with prior exposure to pediatric patients reported significantly higher confidence in pediatric trauma resuscitation (P = .02). Key factors contributing to low confidence included difficulty with pediatric medication dosing, anatomical and physiological differences, lack of experience, and insufficient pediatric-specific equipment during deployment. Nearly all respondents with prior pediatric combat trauma experience expressed a desire for additional pediatric-specific predeployment training, with nearly half (47%) advocating for more robust military-civilian trauma center partnerships. Furthermore, 59% of respondents felt they lacked adequate emotional support following negative pediatric events and recommended stronger post-traumatic event debriefing and support mechanisms.

Conclusions: Many recently deployed military medical providers reported low confidence in resuscitating pediatric patients in the combat environment, because of drug dosing, anatomic and physiologic differences, and inexperience. Regardless of specialty, almost all providers requested additional pediatric training to improve baseline preparedness. These results can guide future predeployment training and inform policy to reduce unnecessary pediatric mortality on the battlefield.

Introduction: Oral health is a crucial factor for service safety among military pilots, but studies specifically on pilots are still very few in Finland. The aim of this study was to assess the oral health status of military student pilots compared to other conscripts of the same age group.

Materials and methods: The data were collected during the oral health examinations of the annual class of the Pilot Reserve Officer Course students at the beginning of their duty at the Air Force Academy (N = 38). A voluntary random sample of conscripts' oral health data (N = 574) collected from the 8 largest garrisons was used as a peer group. The study included males born between 2000 and 2002. The examinations were conducted in accordance with the WHO guidelines. Values of decayed (DT), missing, and filled teeth as well as the combined decayed, missing, and filled teeth value were recorded along with Basic Erosive Wear Examination scoring and Community Periodontal Index. The study was designed in accordance with the STROBE guidelines.

Results: The proportion of student pilots without any decayed teeth (DT = 0) was 42.1% with third molars and 44.7% without third molars. Among other conscripts, the proportions were 29.1% and 30.8%, respectively. Mean DT values among student pilots were 1.16 (third molars included) and 1.11 (third molars not included) (P = .543), and among other conscripts 1.10 and 1.00 (P = .429), respectively.The mean decayed, missing, and filled teeth values were 2.50 among student pilots and 3.34 among others (third molars included), and 2.18 and 3.10 (without third molars), respectively (P = .289 and .211).The proportion of student pilots with at least moderate erosive tooth wear (Basic Erosive Wear Examination sum > 2) was 68.4%, while for other conscripts it was 22.1% (P = .000). None of the student pilots fell into Community Periodontal Index class 3 or 4, whereas 9.9% of other conscripts did (P = .006).

Conclusions: The student pilots exhibited good overall oral health, which differed from that of other conscripts, mainly in terms of erosive changes. Continuous monitoring is crucial, as maintaining optimal oral health is vital for reducing the risk of barodontalgia and thus improving flight safety. Therefore, it is important to be aware that those who aspire to be military pilots are at an increased risk of erosive changes to their teeth.

Background: The U.S. military utilizes small, forward deployed surgical teams to provide Role 2 surgical care in austere environments. These small teams are intended to be able to perform damage control resuscitation and surgery in the event of a mass casualty incident. Our team set out to demonstrate a proof of concept evolution by utilizing 2 operating rooms concurrently with a single certified registered nurse anesthetist and single surgeon to maximize the temporal efficiency of care by performing 4 elective surgical cases staggered in 2 rooms while deployed on an amphibious warship.

Materials and methods: The surgical component of the Fleet Surgical Team is composed of a single general surgeon, a certified registered nurse anesthetist (acting as an independent practitioner), an operating room registered nurse, a critical care registered nurse, 5 surgical technicians, and 2 general duty corpsmen (consider these individuals roughly equivalent to a licensed practical nurse). Four elective surgical cases were selected to be performed on the USS Wasp while underway on the same date, divided between 2 adjacent operating suites to replicate the logistics of overlapping surgical care required during a mass casualty event.

Results: The average surgical care overlap time during the 3 turnover periods was 33 min. The total time saved over the course of the 4 case day, when factoring in both surgical care overlap time and natural turnover time, was 2 h and 33 min.

Conclusions: In the setting of multiple injured combat patients, this time saved is enough for an additional damage control trauma operation. When time is the critical factor in preventing both morbidity and mortality, the ability of a deployed surgical team to coordinate concurrent surgical care is of paramount importance. This report can act as a template for future austere surgical teams who encounter multiple simultaneous surgical casualties.

Introduction: Traumatic brain injury (TBI) is a significant health issue among veterans and poses a substantial risk for pituitary injury. Consensus guidelines recommend that patients who have sustained a TBI should undergo a baseline pituitary hormonal evaluation after the primary brain insult. Patients with abnormal screening test results or with symptoms of hypopituitarism should be referred to endocrinology for a full assessment. Currently, there are no reported data on the screening rates of hypopituitarism in veterans with TBI. This pilot study was conducted to determine the frequency of screening for hypopituitarism in veterans with TBI in a primary care clinic setting.

Materials and methods: We conducted a single-center retrospective cohort study of patients with a diagnosis of TBI who were seen by their primary care physicians at the Minneapolis Veteran Affairs Health Care System over a 1-year period. A random sample was generated using computerized random generator software of patient data, including demographics, TBI-related information, and pituitary hormone levels, which were collected from the panel of primary care providers. We used 2 sets of screening criteria, one by Ghigo et al. published in 2005, and the second by Tan et al. published in 2017, to define hypopituitarism screening adequacy in our cohort of TBI patients. Institutional Review Board approval was obtained.

Results: None of the 50 patients who met the criteria for screening based on the 2005 recommendations were screened for hypopituitarism. Only 2 of the 26 patients who met the criteria for screening based on the more recent 2017 recommendations were screened for hypopituitarism.

Conclusion: We report that the screening rate for hypopituitarism in TBI patients is exceedingly low in the primary care setting, even with the less rigorous newer screening recommendations. Measures should be taken to improve screening of hypopituitarism to decrease morbidity and improve the quality of life in patients with a history of TBI.