Military Medicine最新文献

Introduction: Sexually transmitted infections (STIs) are commonly reported in military populations. Point-of-care tests (POCTs) are commercially available, but their use is variable in the civilian sector. Their use among military providers has not been evaluated. We sought to identify the pattern of use and barriers to using STI POCTs for military obstetrician/gynecologists (OBGYNs).

Materials and methods: We adapted a survey of civilian OBGYNs on patterns of use and barriers to STI POCTs for military OBGYNs. We sent an online questionnaire to 479 military OBGYNs via Army, Air Force, and Navy specialty leaders in May 2023. The questionnaire included 14 demographic questions and up to 52 questions regarding availability, use, and barriers to STI POCTs. The USU Institutional Review Board deemed the study exempt from Institutional Review Board review.

Results: Of the 479 solicited, 117 participated in the survey (24.4%). Of respondents, 64.1% were women and 79.5% non-Hispanic white. Sexually transmitted infections were detected once to twice weekly by 13.0% of respondents and once or twice monthly by 52.8%. The most available STI-related POCTs were wet mount prep (68.7%), rapid HIV (43.3%), and urine dipstick (38.6%). Gram stain was available for 30.3%, the Affirm VPIII (Becton, Dickinson and Company, Franklin Lakes, NJ) for 24.5%, and stat RPR for 16.3%. Economic barriers to using POCTs included cost of the test from manufacturer/distributor (57.9%) and military funding/stocking decisions (10.3%). The greatest barriers to use were the purchasing of an instrument (60.8%) and the interruption to workflow in clinic (57.8%).

Conclusions: Military OBGYNs rely on several STI-related POCTs. Economic factors and interruption to workflow were cited as the most significant barriers to using POCTs for military OBGYNs. Test cost and impact on workflow should be considered in future development and procurement of POCTs for the Military Health System.

Introduction: Post-traumatic stress disorder (PTSD) is a prevalent health condition among members of the military. Although the efficacy of pharmacological and psychiatric interventions for PTSD has been well studied, there are limited data on the effects of omega-3 (n-3) polyunsaturated fatty acid (PUFA) interventions on PTSD. The use of PUFAs shows promise because of their neuroprotective effects. Thus, this systematic review will synthesize the current state of the evidence regarding the effectiveness of PUFA treatment for PTSD.

Materials and methods: Using the PubMed, PsychINFO, Embase, and CINAHL databases, a search of the literature was conducted using the search terms "posttraumatic-stress-disorder, combat disorders, trauma-related-stress-disorder, omega-3, fatty acid, and polyunsaturated fatty acids" to identify articles published from January 1, 2008, to January 1, 2024, that focused on PUFA interventions for PTSD. A total of 281 articles were identified. Following exclusions and quality assessments using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria proposed by Cochrane, 6 randomized controlled trials (RCTs) and preclinical studies were chosen for inclusion, and data were then extracted into a data matrix for final synthesis and analysis.

Results: The RCTs (n = 3) showed no significant effect of PUFAs in the prevention of PTSD symptom onset. Among preclinical studies (n = 3), PUFAs resulted in a significant decrease in anxiety-like behavior and fear memory and an increase in spatial learning and memory. The quality of evidence among the 6 RCTs and preclinical studies using the Cochrane GRADE criteria ranged from low to high.

Conclusions: The results from this systematic review suggest that more evidence is needed before making any recommendations for the clinical use of dietary PUFAs in the management of PTSD symptoms.

Military medical personnel are crucial in providing life-saving care at the point of injury (POI) in challenging environments such as combat zones and disaster areas. This article examines the specialized training US Military medical personnel undergo before deployment and the increasing trend of deploying as part of multinational forces in operations like those in Afghanistan with NATO and non-NATO countries. Integrating medical teams from diverse backgrounds poses significant challenges in maintaining a cohesive and efficient team due to varying trauma management training standards and medical practices among the allied forces. Tactical Combat Casualty Care (TCCC) training and the development of clinical practice guidelines (CPG) by the US Joint Trauma Service have been key strategies by the US Military to standardize care. However, the variation in trauma management training among NATO allies and the differences in medical subspecialties and approaches can lead to inefficiencies and reduced effectiveness in a multinational trauma center setting. For instance, the approach to trauma care can significantly differ between the US and European countries, impacting the interoperability and teamwork in multinational medical teams. To address these challenges, the article highlights the importance of standardized medical training programs that include cultural awareness to enhance the effectiveness of multidisciplinary, multinational medical teams. It also underscores the necessity for standardized international trauma training in the face of increasing global conflicts and the potential for large-scale combat operations. The article discusses the "Trauma Tuesday" program implemented in Kabul, Afghanistan, as an example of how intensive training and simulation exercises can improve team dynamics, knowledge, and skills in trauma management among a diverse team from various nations. The need for ongoing education and developing a standard for managing trauma patients in international teams is emphasized to ensure effective communication and coordination. The article suggests that multinational trauma training can significantly improve team cohesion and critical life-saving skills, essential for future battlefields where access to definitive care may be delayed. Further research is recommended to explore the best methods for achieving effective multinational medical team integration and training standardization.

Cases of active tuberculosis (TB) in the U.S. Military have fallen over the last century in large part due to improved screening and treatment options. The subset of multidrug-resistant TB (MDR-TB) is almost nonexistent within the U.S. Military. We present a case of MDR-TB in an active duty U.S. Military health care worker and discuss several considerations for treatment that may present challenges for U.S. Military medical practitioners. A 30-year-old active duty Soldier was referred to Army public health services after a bronchoscopy sample was positive for Mycobacterium tuberculosis complex. Sputum smears were negative for acid-fast bacilli, suggesting lower risk for community spread. One month after initiation of the standard 4-drug regimen for active TB, genetic susceptibility testing found the patient's M. tuberculosis isolate to be resistant to rifampin, isoniazid, and pyrazinamide. Contact investigation efforts among co-workers and family members fortunately found no new interferon-gamma release assay conversions. Coordination of public health assets to ensure a successful treatment regimen occurred across varied local, state, and federal agencies. Atypical medications required coordination with the FDA for procurement. An extensive surveillance plan for medication adverse effects was required. Finally, questions of public health authority versus patient autonomy arose requiring multidisciplinary input and ethical discussions.

Background: Obstetrics and gynecology (OBGYN) is becoming increasingly competitive among medical specialties. As a result, many medical schools have frameworks to help their students increase their competitiveness to maximize chances of a successful match. However, "boot camps" have traditionally been geared toward the transition to intern year and not to sub-internships during the fourth year of medical school. We aimed to develop a boot camp for rising fourth-year medical students planning to apply into OBGYN before the initiation of their sub-internships and interview season.

Methods: Sixteen students enrolled in this course led by faculty OBGYNs at our institution. We utilized a combination of mentorship, coaching, and education to achieve applicant success. The curriculum included formal lectures, surgical skills training, and focused feedback from our applicant development committee.

Results: Our response rate was 100% and 94% for the pre-intervention and post-intervention survey, respectively. Before the intervention, the majority of participants felt either neutral (47.4%) or unprepared (21.1%) regarding their knowledge before their sub-internships. However, after the intervention, all reported feeling more prepared for their rotations. All respondents either agreed (60%) or strongly agreed (40%) that the course increased their confidence in performing well on audition rotations. Our match rate increased from 62% for the class of 2022 (before this intervention) to 75% for the class of 2023.

Discussion: In light of the increasing residency match competitiveness, it is crucial to investigate programs that can assist students in developing stronger applications. This reproducible intervention utilizes few resources and can be implemented at most medical schools to better support their OBGYN applicants.

Introduction: A light-weight pneumatic-powered knee exoskeleton could augment mobility and lifting capabilities for a variety of occupational settings. However, added weight/bulkiness and artificially produced knee extension torque could compromise sensorimotor characteristics.

Materials and methods: Ten healthy participants conducted 3 visits within 10 days to the biomechanics laboratory. Participants were asked to complete the following tasks on each visit: single-leg balance, single-leg drop-landing, and select functional movement tasks. Balance characteristics (the ground reaction forces variability and center-of-pressure velocity) were derived from force plates while knee flexion angles during drop-landing and functional movement tasks were captured using a motion capture system. Descriptive statistics as well as paired t-tests or Wilcoxon signed-rank tests were used to compare between conditions. Significance was set at P < .05 a priori.

Results: During single-leg balance, the ground reaction force variabilities were significantly increased (P = .013-.019) and the center of pressure velocity was decreased (P = .001-.017) when wearing knee exoskeleton. During single-leg drop-landing, the exoskeleton condition showed lower knee flexion angles at the initial contact (P = .004-.021) and peak (P = .006-.010). Additionally, the peak vertical ground reaction force was higher in the exoskeleton condition (P = .007). During functional movement tasks, the exoskeleton condition showed less knee flexion range-of-motion during the overhead squat (P = .007-.033) and hurdle step-over (P = .004-.005).

Conclusions: Participants exhibited stiffer landing technique with the exoskeleton. Given that these compromised sensorimotor characteristics have been associated with musculoskeletal injury risk, modifications to exoskeletons to promote softer landing and greater knee flexion range-of-motion during dynamic activities may be warranted.