Military Medicine最新文献

Introduction: Severe dental injuries on the battlefield affect mission readiness and create financial and logistical issues in providing timely and appropriate care for injured Soldiers. Currently, the Army Dental Specialist (68E) training curriculum does not include any training on the management of traumatic dental injuries. This study aimed to compare knowledge retention and confidence following 2 educational approaches: an educational handout alone versus a handout combined with a 15-minute in-person lecture.

Materials and methods: Two cohorts (n = 34) enrolled in the Preventive Dentistry Specialty Advanced Skill Identifier (X2) program for Dental Specialists at Joint Base San Antonio participated in this study. Each class received a pre-test, educational handout, and a post-test administered 4 weeks later to assess their knowledge retention on the management of dental avulsion at the point of injury. The experimental group also received a 15-minute, in-person, PowerPoint-based lecture with an opportunity to ask clarifying questions of a dental provider.

Results: Both groups exhibited improvement from pre-test to post-test, with the combined study participants' mean overall improvement being 17.4%. There were no statistically significant differences between the Control and Experimental Groups in improvement of pre-test versus post-test scores. The Control Group demonstrated a greater mean score increase, although this difference was not statistically significant. Additionally, the confidence level within the Experimental Group increased significantly compared to the Control Group, despite no significant corresponding difference in score increase between the groups.

Conclusion: Although no significant difference in knowledge gain was observed between educational delivery methods, the findings highlight the need to expand the current curriculum to include training on traumatic dental injuries.

Introduction: Expeditiously predicting outcomes is essential to allocating blood and intensive care resources. We hypothesize the use of external injuries and vital signs collected early after injury will improve artificial intelligence (AI) triage performance of civilian and military patients, compared to benchmark algorithms using only vital signs. To test this, we developed the Field AI Triage (FAIT) tool.

Materials and methods: We leveraged civilian (American College of Surgeons Trauma Quality Improvement Program, TQIP) and military (Department of Defense Trauma Registry, DoDTR) datasets to develop a logistic regression model to guide triage of blunt and penetrating traumatic injuries. Inputs: vital signs and contextual features, including descriptions of injury mechanism and location. Outputs: need for massive transfusion, mechanical ventilation, and ICU utilization. The model was tested with 10-fold cross validation. The primary performance metric was receiver operating characteristic area under the curve (ROC AUC).

Results: Data from 786,957 civilian patients (TQIP) and 8,946 military patients (DoDTR) were used to develop FAIT. For civilian patients, FAIT improved AUC over the vitals-only benchmark: 0.89 ± 0.00 vs. 0.70 ± 0.01 for massive transfusion (401,337 patient subset), 0.90 ± 0.00 vs. 0.65 ± 0.00 for mechanical ventilation, and 0.78 ± 0.00 vs. 0.61 ± 0.01 for ICU admittance. For military patients, performance improvements were of 0.88 ± 0.02 vs. 0.67 ± 0.04 for massive transfusion, 0.90 ± 0.01 vs. 0.76 ± 0.02 for mechanical ventilation, and 0.79 ± 0.01 vs. 0.69 ± 0.02 for ICU admittance. Sensitivity analysis provides insight on feature importance.

Conclusions: FAIT supports assessment at the point of injury and demonstrates significant capability in forecasting resource allocation for civilian and military trauma patients across a wide variety of mechanisms.

Introduction: In 2007, the Office of the Assistant Secretary of Defense issued guidance to routinely monitor post concussive symptoms following mild traumatic brain injury (mTBI). Subsequent clinical practice guidelines published as early as 2009 further underscored the importance of routine symptom monitoring following mTBI using standardized assessments such as the Neurobehavioral Symptom Inventory (NSI), though the NSI was not specifically recommended until 2015. The study objective was to describe the frequency of NSI administration, as documented in the Military Health System (MHS) electronic medical record (EMR), within one year after mTBI diagnosis among post-9/11 Active-Duty Service Members.

Materials and methods: Data for this effort were extracted from the Military Health System (MHS) Data Repository and used to identify Service Members whose first mTBI (i.e., index) was documented between Fiscal Years 2002 and 2021 (index TBI; n = 150,976). Members were excluded from the cohort for a history of a more severe TBI (n = 128,253) and/or a catastrophic injury (e.g., spinal cord injury; n = 3,805). Members were matched with data from completion of the NSI that was contained within the DoD TBI portal. The cohort was further evaluated to determine the frequency of documented NSI administration within one year of the index mTBI date.

Results: Among those with an index mTBI meeting inclusion criteria, 3,351 (2.2%) Service Members had an NSI documented within the EMR. When filtered to NSI surveys completed within 1 year of the index mTBI date, 1,182 (0.78%) NSIs were recorded. The prevalence of a matched NSI increased as time went on, with the highest number administered in 2019.

Conclusions: Findings suggest relatively infrequent administration and documentation of the NSI following mTBI. System- and individual-level barriers may have played a role in this. Increased understanding regarding barriers and facilitators to administering and documenting the NSI within the EMR are needed to inform future implementation efforts to further measurement-based care among Service Members.

Introduction: Older low-income U.S. veterans experience elevated physical and social vulnerabilities, yet their functional limitations remain understudied. This study estimated the prevalence of activity of daily living (ADL) and instrumental activity of daily living (IADL) limitations and identified associated sociodemographic, health, and psychosocial factors.

Materials and methods: We analyzed nationally representative data from the 2021 National Veteran Homeless and Other Poverty Experiences (NV-HOPE) Study of low-income veterans aged  ≥ 55 years (N = 877; weighted ≈ 7.41 million). Survey-weighted logistic regression models identified factors associated with any ADL or IADL limitation across sociodemographic, health (chronic conditions, depression, anxiety, other mental diagnoses), and social/contextual domains (network size, perceived support, loneliness, housing). Exploratory margins analyses were used to descriptively examine potential differences across sex and race/ethnicity.

Results: Overall, 4.28% reported having at least 1 ADL limitation and 14.98% having at least 1 IADL limitation. ADL limitations were associated with higher anxiety (odds ratio [OR] = 1.32, 95% confidence interval [CI]: 1.04-1.67), "other" race/ethnicity (OR = 3.98, 95% CI: 1.27-12.51), and some college education (OR = 3.43, 95% CI: 1.13-10.46), whereas home ownership was protective (OR = 0.38, 95% CI: 0.16-0.91). IADL limitations were associated with Black (OR = 2.41, 95% CI: 1.12-5.16) and "other" race/ethnicity (OR = 2.61, 95% CI: 1.13-6.05), more chronic conditions (OR = 1.24 per condition, 95% CI: 1.10-1.40), higher anxiety (OR = 1.27, 95% CI: 1.04-1.54), and other mental diagnoses (OR = 2.15, 95% CI: 1.13-4.09); a moderate social network (3-5) was protective (OR = 0.37, 95% CI: 0.16-0.85). Descriptive subgroup analyses indicated that associations between mental health and ADL limitation appeared stronger among women, whereas relationships between depression, anxiety, or loneliness and IADL limitation varied across racial and ethnic groups.

Conclusions: Functional limitations among older low-income veterans are multifactorial, reflecting intersecting demographic, clinical, and social determinants. Findings support integrated care models that combine mental-health screening and social-resource supports. Exploratory subgroup patterns highlight the importance of considering sex and race/ethnicity in identifying low-income veterans most at risk for functional decline and in tailoring prevention and intervention efforts.

Introduction: Adequate provision and equitable utilization of HIV preexposure prophylaxis (PrEP) is crucial to reducing HIV incidence. Nearly all new HIV infections among active duty services members occur among males; Black men are disproportionately affected (>40% of new infections). We investigated the effect of the Coronavirus disease-19 (COVID-19) pandemic on oral PrEP use among beneficiaries of the Military Health System.

Materials and methods: We analyzed demographic and PrEP prescription data from approximately 4.5 million TRICARE Prime beneficiaries aged 18-64 years during the pre-COVID-19 (October 1, 2016-February 28, 2020) and COVID-19 periods (March 1, 2020-September 30, 2022). We compared the characteristics of beneficiaries that initiated PrEP during the pre-COVID to COVID-19 periods.

Results: Overall, 89,761 PrEP prescriptions were issued among 15,658 enrollees out of which 56,779 prescriptions (18.7% of which were new prescriptions) were issued in the pre-COVID-19 period while 32,982 prescriptions (10.8% of which were new prescriptions) were issued during the COVID-19 period. Black beneficiaries represented 20% of PrEP initiations. Percentage of beneficiaries who initiated PrEP (0.25% vs 0.10%) (P < .001) and reductions in PrEP initiation were noted across all demographic stratifications for race, rank, and sex (P < .001). Overall, beneficiaries were 65% less likely to initiate PrEP during the COVID-19 period after adjusting for covariates (adjusted odds ratio (aOR) 0.35; CI 0.33-0.38), potentially because of changes in access, behaviors, or perceived risk. In addition, the cumulative length of PrEP prescriptions (210 days vs 90) (P < .001) declined from pre-pandemic to pandemic period.

Conclusion: Continual efforts to identify those at greatest risk for acquiring HIV, including men who have sex with men, are needed to ensure adequate provision of PrEP to those at greatest risk.

Introduction: The purpose of the United States Military Academy (USMA) at West Point, NY is to provide the nation with leaders of character who serve the common defense. Use of nicotine products, a preventable cause of disability and death, adversely impacts adolescent brain development, academic focus, wound healing, sleep, athletic performance, and military readiness. Violating regulations and addictive behavior are incompatible with USMA's mission. This study was conducted to help address these issues by better identification of their extent and nature and to generate support for ongoing, comprehensive tobacco/nicotine prevention/cessation programs for students at USMA, its preparatory school, and elsewhere, in order to improve health, mission readiness, and future leadership while reducing healthcare costs for the Department of Defense and the Veterans Administration.

Materials and methods: To determine the prevalence and characteristics of nicotine use in the USMA Corps of Cadets (ages 17-22 at entry), anonymous convenience surveys were administered to each class upon arrival and before graduation, approximately four years later. Survey data yielded numbers and percentages of current, former, and never users, and were analyzed using logistic regression in R software. Analyses showed trends in types of products used. The IRB approved this project with exempt status.

Results: Each class year independently exhibited about a threefold increase in the prevalence of nicotine use from arrival to departure, with a concurrent trend of product preferences shifting toward greater use of smokeless products, possibly nicotine pouches. The increasing odds ratio of being a nicotine-user versus non-user suggests an association between the USMA environment and nicotine use.

Conclusions: This is the only study of its kind, containing original data about nicotine use among students at a U.S. military service academy. Improved data collection and sustained use of multiple intervention points could enhance future research and be a model for prevention and cessation of nicotine use during military training anywhere, reversing existing trends in order to improve mission readiness, behavioral/physical/fiscal health, and leadership through ongoing study and program improvement.

Introduction: Graduate degree programs in Health Professions Education (HPE) are one method of addressing the challenges associated with transitioning from being a full-time clinician to an educator, leader, and scholar of health professionals. Although previous research has focused on the individual benefits of HPE, such as increased self-efficacy and professional identity, little is known about the organizational impact - specifically on faculty retention rates. This study investigated whether participating in and earning a graduate degree from an HPE program influenced alumni decisions to remain in the Military Health System (MHS).

Materials and methods: We conducted an anonymous electronic survey of alumni who graduated with a Masters or PhD in HPE from the Uniformed Services University between 2017 and 2024. The survey asked questions about the HPE degree's contribution to their desire to stay in the MHS and included open-ended questions to elaborate on responses. Descriptive statistics were calculated, and thematic analysis assessed the qualitative data to identify key themes and subthemes.

Results: Forty recent graduates responded to the survey for a 71% response rate. A majority of active duty military (n = 24/36, 66.7%) and MHS civilian (n = 3/4, 75%) respondents indicated that the HPE degree contributed to their desire to stay in the MHS. Over half of active duty alumni (n = 20/36, 55.6%) stated they had or would stay longer than their current commitment, with nearly half (n = 16/35, 45.7%) attributing this decision at least partially to the degree program and a further 23% (n = 8/35) saying they were unsure. Thematic analysis revealed 3 themes representing mechanisms linking the HPE degree to retention: increased job opportunities (e.g., selection for next academic leadership positions), enhanced job satisfaction (via improved self-efficacy and community integration), and strengthened organizational loyalty and influence (e.g., feelings of gratitude toward the MHS and increased belief in the power to make an organizational impact).

Conclusions: Participation in the graduate HPE degree programs positively influenced the retention of health professional faculty by providing pathways to academic leadership, improving professional competence and satisfaction, and fostering organizational commitment. These findings suggest that investing in advanced HPE degrees is an important strategic tool for healthcare organizations seeking to cultivate and retain high-performing health professional faculty, educational leaders, and scholars.

Introduction: Spirituality is a recognized component of the DoD Chairman of the Joint Chief of Staff's Total Force Fitness Framework. Although it is often considered akin to religiosity, the Total Force Fitness framework took care to consider components not centered on a theist perspective. Spirituality is considered an adaptive interpersonal characteristic for human flourishing and functioning. It is therefore commonly supposed that spirituality supports resilience, and that spirituality and resilience should be correlated. This study presents data investigating this hypothesis.

Materials and methods: A cohort of 452 junior officers (81.46% [n = 334] male; 25.69 ± 4.67 years old) in the U.S. Marine Corps completed an online survey including spirituality (Special Operations Command Spiritual Fitness Scale, SFS), and resilience (Ego-Resiliency Scale, ER89) metrics. The SFS was constructed to capture the elements of spiritual fitness as outlined in the Chairman of the Joint Chiefs of Staff Instruction 3405.01.

Results: Four procedures for quantifying correlation were implemented. All four found a moderate positive correlation between elements of spirituality and resilience.

Conclusion: The results supported the hypothesis that personal spirituality is related to resilience in military personnel. Replication and longitudinal design of these constructs and their complexities will bolster ongoing military resilience and spirituality programs.