Military Medicine最新文献

Introduction: Unavailability and delays to mental health care are a significant problem that can lead to worsening psychological symptoms and less effective treatments. Within the intensive outpatient setting, pre-enrollment care is recommended to address delays to care. Although pre-enrollment care is intended to support at-risk individuals awaiting program entry, there remains a lack of clarity regarding structure, implementation, and impact on clinical outcomes. This article examines the impact of a pre-enrollment group on the access to care and outcomes of participants in a Military Treatment Facility Intensive Outpatient Program (IOP).

Materials and methods: This retrospective Quality Improvement (QI) project examined access to care and outcome data from participants in an IOP during calendar year 2023. Groups of patients who did and did not receive the pre-enrollment group were compared before and after treatment using repeated-measures analysis of variance.

Results: Analysis showed pre-enrollment group patients showed more improvement in both anxiety and depression symptoms over IOP treatment. Additional analysis by diagnostic group showed that these effects differed depending on the patient's primary diagnosis. Among patients with a trauma-related diagnosis engagement in pre-enrollment group was protective against increased anxiety and depressive symptoms although patients with a chronic adjustment disorder diagnosis showed a more significant decrease in both anxiety and depression symptoms. Finally, delay to care was generally associated with worse outcomes, which engagement in pre-enrollment decreased, although therapeutic alliance positively influenced treatment response.

Conclusions: This QI project demonstrates that engagement in pre-enrollment care can reduce delays to treatment and improve behavioral health outcomes. These findings support formalizing pre-enrollment programming as a core component of IOPs.

Introduction: Within Military Treatment Facilities, military nurses face significant challenges in maintaining clinical readiness. These challenges are because of low patient volume, limited patient acuity, and a lack of training opportunities to reinforce knowledge and skills. As a result, nurses often fall between the skills they are required to have and those they have acquired-a sizeable gap with real-world implications. The purpose of this literature review is to examine the use of military-civilian partnerships as a viable means to sustain combat-relevant nursing skills and readiness.

Materials and methods: The question developed to guide this literature review was: In military nursing, how does participation in a military-civilian partnership, compared to no participation, affect clinical readiness? With the support of a medical librarian, searches were conducted in PubMed and EBSCO databases. All retrieved articles underwent a 3-step review process (title, abstract, and full-text).

Results: Out of 134 articles identified, 6 were included in the final synthesis of this review. Findings indicate that embedded and short, frequent rotational models provide greater combat-like clinical exposure compared to the military treatment facility. In addition, cross-unit rotations, the utilization of readiness-aligned skill trackers, and strong leadership engagement offer a robust experience.

Conclusion: A proactive approach to enhance nursing readiness is through the prioritization of quality clinical exposure in addition to an adequate quantity of experiences. This can be achieved through the use of military-civilian partnerships. By leveraging such relationships, the nursing force can remain trained and postured for effective care delivery in Large-Scale Combat Operations.

Surgical site infection of orthopedic trauma patients is common and tends to be treated with optimal therapy after an organism is identified from intraoperative cultures. However, delayed presentation and multidrug resistance can lead to complications. In our case, we investigate a delayed presentation of Mycobacterium abscessus orthopedic hardware infection in a patient with a forearm fracture secondary to a motor vehicle accident. Six weeks after stabilization of the fracture, purulence from an iliac crest bone graft donor site was noted. Further investigation led to the diagnosis of M. abscessus infection of both the graft donor and recipient sites in the forearm. After a multitude of surgeries, including orthopedic hardware removal from the forearm, and concurrent antibiotic therapy of amikacin, imipenem, tedizolid, and omadacycline, the patient was deemed medically cleared of her infection. Rapid-growing nontuberculous mycobacterium (RGNTM) are rare infections of trauma patients that warrant further clinical investigation into best management practices. This has implications for both civilian and military battlefield-related trauma infections. This case serves as an example of successful multi-disciplinary management through appropriately aggressive surgery and tailored antibiotic therapy.

Introduction: Each military service has independently developed austere resuscitative and surgical care (ARSC) team training courses that vary in use, content, duration, tactical exposure, and clinical emphasis. A 2020 Department of Defense Inspector General audit identified training deficits for ARSC teams. To close this gap, we developed ARSC curriculum standards for the Joint Force.

Materials and methods: A work group of Tri-Service appointed multidisciplinary subject matter experts (SMEs) reviewed available Role 2 and ARSC training courses to identify common curricular elements, best practices, and training gaps. Through an iterative process, these findings were incorporated into a standard curriculum organized into modules subdivided into terminal learning objectives (TLOs) and enabling learning objectives (ELOs), which were validated against Service doctrinal ARSC capability requirements.

Results: Curricula from 12 different courses were identified and reviewed. Most prepared teams for Counter Insurgency operations characterized by short holding times and rapid aeromedical evacuation. Eighty-two clinical and nonclinical common curricular best practices were identified. Only four courses had 50% or more of SME-recommended curricular elements. Identified curricular gaps included prolonged holding (0% of courses), definitive austere surgical care (0%), austere critical care (25%), simulated tactical exposure (25%), night operations familiarization (37.5%), and simulated operational environment (62.5%). Ten modules were created comprised of 20 TLOs and 259 ELOs incorporating curricular best practices and identified gaps.

Conclusion: Military medicine is preparing surgical teams for the war just fought, not the future fight and lacks a joint standard for training Role 2/ARSC surgical teams, which is a risk to force and to mission. We close this gap by creating the first Joint Role 2 forward surgical/ARSC curriculum.

One of the most critical skills a psychology-intern can possess is the ability to make accurate mental health dispositions. Through reflection of my own lessons learned, I hope to impart knowledge of the different types of dispositions and encourage curiosity and frequent consultation among trainees.

Introduction: Military units must prepare for combat and casualties in cold-weather environments that will produce unique medical intervention and evacuation requirements. An early technology demonstration of a cold-weather casualty evacuation (CASEVAC) Ecosystem (version 0.5), composed of a Casualty Protection Unit (CPU) and a tent shelter, has been engineered to provide a "bubble of warmth" that provides for rapid environmental sheltering with active heating of the casualty. The system also serves as an environmental shelter for a casualty care practitioner to perform their duties safely. This contrasts with the non-insulated design of the traditional plastic rescue litter (SKED), which does not provide any additional sheltering from cold weather. The purpose of this study was to compare human physiological responses during CASEVAC transport with the SKED and CPU systems during cold-weather military field training. Specifically, this study compared heart rate, skin temperature, and core temperature of simulated human casualties and medical team members during CASEVAC transport with the SKED and CPU systems.

Materials and methods: Twenty-five military personnel (all male; mean ± SD age: 24 ± 3 year; height: 181 ± 7 cm; weight: 84.4 ± 14.6 kg) volunteered for the study. Teams consisting of one medic and 4 litter bearers worked to simulate casualty treatment at a point of injury, package the casualty in the respective CASEVAC transport system, and then haul the casualty 400 m from the point of injury to their respective casualty collection points over snow-covered ground.

Results: Casualty core (SKED: 37.1 ± 0.2 °C, CPU: 36.9 ± 0.4 °C) and skin (SKED: 31.3 ± 0.9 °C, CPU: 30.2 ± 0.7 °C) temperature did not reveal any significant differences between CASEVAC systems, nor were there any differences between packaging (SKED: 7.3 ± 4.4 minute, CPU: 5.0 ± 2.8 minute; P = .46) or transport (SKED: 12.0 ± 2.9 minute, CPU: 9.5 ± 2.1 minute; P = .13) times between systems.

Conclusions: Findings suggest that the CASEVAC Ecosystem was not inferior to the SKED system, given there were no differences in heat loss protection performance, packaging times, and transport efficiency between systems. It is anticipated that further development and testing of the novel CASEVAC Ecosystem system will benefit from this study's outcomes to improve heat loss protection performance for casualties.

Introduction: Potential exposures to toxicants during military deployment may increase the risk of developing cancer. This study was undertaken to determine whether there is an association of cancer risk with post-9/11 deployment.

Materials and methods: This is a cohort study of U.S. veterans who enlisted in the military after September 11, 2001, and enrolled in the Veteran Affairs (VA). The primary outcome was incident cases of cancer. Deployment was determined by identification on the Operation Enduring Freedom and Operation Iraqi Freedom roster managed by the VA and Department of Defense. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to measure risk of the outcome associated with the exposure in a logistic regression model adjusted for sex, race and ethnicity, and age at enlistment. To assess potential effect measure modification, analyses were stratified by branch of military and rank. Institutional Review Board approval and a waiver of consent were obtained.

Results: There were 1,777,583 veterans who met inclusion criteria: 832,897 (47%) deployed and 944,686 (53%) nondeployed. Among deployed and nondeployed, a total of 3,986 and 2,885 veterans developed cancer, respectively. Deployed veterans had a higher risk of developing transitional cell carcinoma (OR 1.19; 95% CI 1.01-1.39, P = 0.03), head and neck cancer (OR 1.17; 95% CI 1.02-1.35, P = 0.03), and breast cancer (in females) (OR 1.13; 95% CI 1.00-1.27, P = 0.04) compared to nondeployed veterans.

Conclusions: Post-9/11 deployment was associated with a modest increased risk of specific cancers. However, analyses were limited by the incomplete nature of retrospective data, including the lack of details on specific toxicants and potential confounders. Our findings underscore the need for prospective and comprehensive documentation of military exposures.

Introduction: Medical readiness is essential to sustaining operational capability in U.S. Air Force (USAF) aircrew. However, mental health care-seeking is often delayed or avoided due to perceived career consequences, leading to potential decrements in individual and unit-level readiness. Aviation peer support programs, widely adopted in global civil aviation, offer a non-clinical, confidential intervention to reduce stigma and facilitate early help-seeking. This report presents the first known implementation of an aviation-specific peer support program in a USAF operational flying unit.

Materials and methods: A provisional peer support program was launched at the 86th Operations Group (86 OG), Ramstein Air Force Base, Germany. A multidisciplinary working group led the design and implementation, drawing from civilian aviation peer support models and adapting for the military context. Peer supporters were selected based on interpersonal credibility and trained in nonclinical support using the Mayday Model. From November 2024 to July 2025, peer interactions were recorded in a secure, de-identified database, with contact characteristics (defined as a documented interaction between a peer supporter and a program user) summarized using descriptive statistics. A focused group discussion among program leads was conducted to synthesize lessons learned across implementation phases. The activity was approved by the 86 OG and determined not to constitute human subjects' research.

Results: A total of 81 peer contacts were recorded, including 28 repeat users. Most contacts (79%) related to well-being and family stressors. No contacts met criteria requiring escalation for suicidality, homicidality, or operational risk. Peer supporters referred users to a wide range of support services, with 77% of contacts resulting in at least one referral. Lessons learned emphasized the importance of command endorsement, stakeholder engagement, recurrent training, and program visibility in sustaining peer support within the operational environment.

Conclusions: Aviation peer support can be established and maintained within a USAF flying unit and may represent a promising approach to reduce health care avoidance, enhance resilience, and preserve readiness. Further investigation is warranted to assess clinical and safety outcomes.

Clinical trial registration: None.

Introduction: Military personnel require higher mental toughness to cope with volatile, uncertain, complex, and ambiguous environments. Recruit mental toughness was assessed before and after basic military training (BMT) to determine whether there are differences in mental toughness between recruits allocated to Combat Arms or All Corps, and whether BMT provides a setting conducive to altering recruit mental toughness.

Materials and methods: Three hundred and fifteen recruits (males: n = 270, females: n = 45) volunteered to participate in this study. Recruits were grouped according to their allocated Army employment category: Combat Arms or All Corps. The mental toughness questionnaire 48 was administered to recruits in week 1 (Pre) and week 12 (Post) of BMT. Body mass, aerobic fitness, and absolute and relative lower body strength were recorded in week 1 and week 8, aligning with the physical training schedule.

Results: On-time completion of training was attained in 79% of all recruits and 21% were classified as off pathway (i.e., delayed or discharged). At Pre, Combat Arms recorded higher predicted VO2max (3.9 mL-1·kg-1·min-1), absolute (37 kgf) and relative (0.5 kgf-1ˑBM-1) isometric mid-thigh pull, and Confidence (Interpersonal) (0.8) values compared with All Corps (p < 0.05). For recruits who completed BMT, there were no between-group differences for changes in mental toughness (p > 0.05). Instead, there was a mean decline in recruit global mental toughness (-5) following BMT, because of declines in dimensions: Commitment (-2.6), Confidence (Abilities) (-1.1), Control (Life) (-0.9) and Control (Emotion) (-0.7) (p < 0.05).

Conclusions: Enlisted Army employment category (Combat Arms or All Corps), initial mental toughness and physical fitness did not influence changes in recruit mental toughness following BMT. Instead, BMT was associated with a mean decline in global mental toughness because of a decrease in several subscales linked to motivation, sense of control, and self-belief.