Introduction: Hepatitis C virus (HCV) is primarily transmitted through blood-to-blood contact. Leading health agencies have called for the elimination of HCV as a public health threat, with universal screening considered a part of the strategy. Hepatitis C virus screening among incoming cadets and cadet candidates at the United States Air Force Academy (USAFA) was implemented in 2023. The purpose of this quality improvement project was to determine the results of this screening and the associated fiscal costs, benefits, and harms to make a recommendation for future incoming classes.
Materials and methods: The prevalence of HCV antibody positivity and confirmed HCV infections were calculated among the incoming cadets and cadet candidates at USAFA in summer 2023. Screening was conducted with a highly sensitive HCV total antibody test, and those who screened positive were further tested with a quantitative HCV polymerase chain reaction. The screening and follow-up care costs were calculated, and the potential harm of receiving a false positive notification was considered.
Results: Of the 1,360 persons screened at USAFA in 2023, no confirmed HCV infections were identified. There was one false positive on screening in the cadet population (n = 1,131) and one false positive in the cadet candidate population (n = 229). The fiscal cost of universal HCV screening upon accession of cadets and cadet candidates, including medical follow-up, was at least $5,279. The opportunity cost was minimal because blood was drawn for other mandatory programs, although screening may have caused social and psychological harm to those receiving a false positive notification.
Conclusions: The prevalence of chronic HCV infection among incoming USAFA cadets and cadet candidates was 0%, below the population screening threshold that warrants screening, according to the Centers for Disease Control and Prevention. The harms of screening, including fiscal costs and potential psychological harm to individuals with a false positive screen, likely outweigh the benefits. We recommend against universal HCV screening in 2024 upon accession of USAFA cadets and cadet candidates.
{"title":"Review of the U.S. Air Force Academy Hepatitis C Virus Screening Program to Ensure High-Value Care.","authors":"Devin C Kelly, Bryant Webber","doi":"10.1093/milmed/usae273","DOIUrl":"10.1093/milmed/usae273","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatitis C virus (HCV) is primarily transmitted through blood-to-blood contact. Leading health agencies have called for the elimination of HCV as a public health threat, with universal screening considered a part of the strategy. Hepatitis C virus screening among incoming cadets and cadet candidates at the United States Air Force Academy (USAFA) was implemented in 2023. The purpose of this quality improvement project was to determine the results of this screening and the associated fiscal costs, benefits, and harms to make a recommendation for future incoming classes.</p><p><strong>Materials and methods: </strong>The prevalence of HCV antibody positivity and confirmed HCV infections were calculated among the incoming cadets and cadet candidates at USAFA in summer 2023. Screening was conducted with a highly sensitive HCV total antibody test, and those who screened positive were further tested with a quantitative HCV polymerase chain reaction. The screening and follow-up care costs were calculated, and the potential harm of receiving a false positive notification was considered.</p><p><strong>Results: </strong>Of the 1,360 persons screened at USAFA in 2023, no confirmed HCV infections were identified. There was one false positive on screening in the cadet population (n = 1,131) and one false positive in the cadet candidate population (n = 229). The fiscal cost of universal HCV screening upon accession of cadets and cadet candidates, including medical follow-up, was at least $5,279. The opportunity cost was minimal because blood was drawn for other mandatory programs, although screening may have caused social and psychological harm to those receiving a false positive notification.</p><p><strong>Conclusions: </strong>The prevalence of chronic HCV infection among incoming USAFA cadets and cadet candidates was 0%, below the population screening threshold that warrants screening, according to the Centers for Disease Control and Prevention. The harms of screening, including fiscal costs and potential psychological harm to individuals with a false positive screen, likely outweigh the benefits. We recommend against universal HCV screening in 2024 upon accession of USAFA cadets and cadet candidates.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e11-e14"},"PeriodicalIF":1.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141246857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Duane R Bidwell, Anita Samuel, Ronald M Cervero, Steven J Durning, Sherri L Stephan, Erin L Patel, Marjorie A Bowman, Holly S Meyer
Introduction: Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance.
Materials and methods: Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that operationalizes competencies for more than 200 federal jobs.
Results: The research identified 25 primary competencies within 6 leadership domains. Five of the primary competencies cut across all leadership domains.
Conclusions: Veteran Health Administration subject-matter experts in educational leadership say the identified competencies are urgently needed, critical for effective leadership, and valuable for distinguishing superior DEO performance. The competencies are relevant to VHA and perhaps other senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. In military training facilities, attending to these competencies can help Designated Institutional Officials responsible for graduate medical education become more credible partners to other hospital leaders and contribute to becoming a high reliability organization. Executives identifying, recruiting, and appointing VHA DEOs and Designated Institutional Officials at military training facilities should consider these competencies when assessing candidates.
导言:退伍军人健康管理局(VHA)医院的指定教育官员(DEOs)是高级教育领导者,负责监督特定机构的所有临床培训。他们每天要优先处理数十项任务和职责,从教育政策和战略到员工管理、财务规划、学员入职以及设施规划和管理。明确该角色的优先能力可以帮助管理人员招聘、任命和评估有能力的人员,并促进有效、高效的绩效:研究人员使用联邦开发的能力分析方法,咨询了一个主题专家小组,利用2013年一项研究中的数据,确定了DEO的优先能力,该研究对200多个联邦职位的能力进行了操作:研究确定了 6 个领导力领域中的 25 项主要能力。结论:退伍军人健康管理局的专题研究发现了 6 个领导力领域中的 25 种主要能力,其中 5 种能力横跨所有领导力领域:退伍军人健康管理局教育领导力方面的主题专家表示,所确定的能力是迫切需要的,是有效领导力的关键,对于区分卓越的 DEO 业绩非常有价值。这些能力与退伍军人健康管理局以及其他负责制定卫生专业教育计划、监督临床培训和管理教育变革的高级学术领导者息息相关。在军事训练设施中,对这些能力的关注可以帮助负责毕业医学教育的指定机构官员成为其他医院领导更可信的合作伙伴,并为成为一个高可靠性的组织做出贡献。在对候选人进行评估时,负责识别、招聘和任命 VHA DEO 和军事培训机构指定机构官员的管理人员应该考虑这些能力。
{"title":"Priority Competencies for Designated Education Officers in the Veterans Health Administration.","authors":"Duane R Bidwell, Anita Samuel, Ronald M Cervero, Steven J Durning, Sherri L Stephan, Erin L Patel, Marjorie A Bowman, Holly S Meyer","doi":"10.1093/milmed/usae239","DOIUrl":"10.1093/milmed/usae239","url":null,"abstract":"<p><strong>Introduction: </strong>Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance.</p><p><strong>Materials and methods: </strong>Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that operationalizes competencies for more than 200 federal jobs.</p><p><strong>Results: </strong>The research identified 25 primary competencies within 6 leadership domains. Five of the primary competencies cut across all leadership domains.</p><p><strong>Conclusions: </strong>Veteran Health Administration subject-matter experts in educational leadership say the identified competencies are urgently needed, critical for effective leadership, and valuable for distinguishing superior DEO performance. The competencies are relevant to VHA and perhaps other senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. In military training facilities, attending to these competencies can help Designated Institutional Officials responsible for graduate medical education become more credible partners to other hospital leaders and contribute to becoming a high reliability organization. Executives identifying, recruiting, and appointing VHA DEOs and Designated Institutional Officials at military training facilities should consider these competencies when assessing candidates.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e5-e10"},"PeriodicalIF":1.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bradley Dengler, Randall McCafferty, Christopher Neal, Randy Bell, Brian J Sonka, Shane Jensen, Matthew D Tadlock, Jan-Michael Van Gent, Remealle A How, Jennifer Gurney
Management of the patient with moderate to severe brain injury in any environment can be time consuming and resource intensive. These challenges are magnified while forward deployed in austere or hostile environments. This Joint Trauma System Clinical Practice Guideline provides recommendations for the treatment and medical management of casualties with moderate to severe head injuries in an environment where personnel, resources, and follow-on care are limited. These guidelines have been developed by acknowledging commonly recognized recommendations for neurosurgical and neuro-critical care patients and augmenting those evaluations and interventions based on the experience of neurosurgeons, trauma surgeons, and intensivists who have delivered care during recent coalition conflicts.
{"title":"A Joint Trauma System Clinical Practice Guideline: Traumatic Brain Injury Management and Basic Neurosurgery in the Deployed Environment.","authors":"Bradley Dengler, Randall McCafferty, Christopher Neal, Randy Bell, Brian J Sonka, Shane Jensen, Matthew D Tadlock, Jan-Michael Van Gent, Remealle A How, Jennifer Gurney","doi":"10.1093/milmed/usae298","DOIUrl":"10.1093/milmed/usae298","url":null,"abstract":"<p><p>Management of the patient with moderate to severe brain injury in any environment can be time consuming and resource intensive. These challenges are magnified while forward deployed in austere or hostile environments. This Joint Trauma System Clinical Practice Guideline provides recommendations for the treatment and medical management of casualties with moderate to severe head injuries in an environment where personnel, resources, and follow-on care are limited. These guidelines have been developed by acknowledging commonly recognized recommendations for neurosurgical and neuro-critical care patients and augmenting those evaluations and interventions based on the experience of neurosurgeons, trauma surgeons, and intensivists who have delivered care during recent coalition conflicts.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"124-134"},"PeriodicalIF":1.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeffrey Kwan, Michael Sikes, Kevin Pak, Michael Skaret, Joshua McCarron, Thomas Mellor, Brian Park, Daryl Fick, Benjamin Fiore
{"title":"Adapting to the Rapidly Changing Landscape of Inflammatory Bowel Disease Management-An Opportunity to Medically Optimize Our Fighting Forces.","authors":"Jeffrey Kwan, Michael Sikes, Kevin Pak, Michael Skaret, Joshua McCarron, Thomas Mellor, Brian Park, Daryl Fick, Benjamin Fiore","doi":"10.1093/milmed/usae355","DOIUrl":"10.1093/milmed/usae355","url":null,"abstract":"","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"33-35"},"PeriodicalIF":1.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hannah S Lyons, Matilde Sassani, Mark Thaller, Andreas Yiangou, Olivia Grech, Susan P Mollan, Duncan R Wilson, Samuel J E Lucas, James L Mitchell, Lisa J Hill, Alexandra J Sinclair
Introduction: Mild traumatic brain injury (TBI) affects a significant number of military personnel, primarily because of physical impact, vehicle incidents, and blast exposure. Post-traumatic headache (PTH) is the most common symptom reported following mild TBI and can persist for several years. However, the current International Classification of Headache Disorders lacks phenotypic characterization for this specific headache disorder. It is important to appropriately classify the headache sub-phenotypes as it may enable more targeted management approaches. This systematic review seeks to identify the most common sub-phenotype of headaches in military personnel with PTH attributed to mild TBI.
Methods: We conducted a systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines, focusing on the military population. PubMed, Web of Science, Cochrane, and Clinicaltrials.gov databases were searched. Abstracts and full texts were independently reviewed by two authors using predefined inclusion and exclusion criteria. Data extraction was performed using a standardized form. The risk of bias was assessed using the Newcastle-Ottawa Scale.
Results: Eight papers related to the military population were included in this review. Migraine was the most commonly reported headache sub-phenotype, with a prevalence ranging from 33 to 92%. Additionally, one military study identified tension-type headaches as the most prevalent headache phenotype. Although not the primary phenotype, one military cohort reported that approximately one-third of their cohort experienced trigeminal autonomic cephalalgias, which were associated with exposure to blast injuries and prior concussions.
Conclusion: This systematic review demonstrated that PTH in the military population frequently exhibit migraine-like features. Tension-type headache and trigeminal autonomic cephalalgias also occur, although less commonly reported. Sub-phenotyping PTH may be important for initiating effective treatment since different phenotypes may respond differently to medications. The study populations analyzed in this systematic review display heterogeneity, underscoring the necessity for additional research features, more stringent criteria and comprehensive recording of baseline characteristics. Characterizing headaches following injury is crucial for an accurate diagnosis to enable effective management and rehabilitation planning for our armed forces.
{"title":"Evaluating the Phenotypic Patterns of Post-Traumatic Headache: A Systematic Review of Military Personnel.","authors":"Hannah S Lyons, Matilde Sassani, Mark Thaller, Andreas Yiangou, Olivia Grech, Susan P Mollan, Duncan R Wilson, Samuel J E Lucas, James L Mitchell, Lisa J Hill, Alexandra J Sinclair","doi":"10.1093/milmed/usae353","DOIUrl":"10.1093/milmed/usae353","url":null,"abstract":"<p><strong>Introduction: </strong>Mild traumatic brain injury (TBI) affects a significant number of military personnel, primarily because of physical impact, vehicle incidents, and blast exposure. Post-traumatic headache (PTH) is the most common symptom reported following mild TBI and can persist for several years. However, the current International Classification of Headache Disorders lacks phenotypic characterization for this specific headache disorder. It is important to appropriately classify the headache sub-phenotypes as it may enable more targeted management approaches. This systematic review seeks to identify the most common sub-phenotype of headaches in military personnel with PTH attributed to mild TBI.</p><p><strong>Methods: </strong>We conducted a systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines, focusing on the military population. PubMed, Web of Science, Cochrane, and Clinicaltrials.gov databases were searched. Abstracts and full texts were independently reviewed by two authors using predefined inclusion and exclusion criteria. Data extraction was performed using a standardized form. The risk of bias was assessed using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Eight papers related to the military population were included in this review. Migraine was the most commonly reported headache sub-phenotype, with a prevalence ranging from 33 to 92%. Additionally, one military study identified tension-type headaches as the most prevalent headache phenotype. Although not the primary phenotype, one military cohort reported that approximately one-third of their cohort experienced trigeminal autonomic cephalalgias, which were associated with exposure to blast injuries and prior concussions.</p><p><strong>Conclusion: </strong>This systematic review demonstrated that PTH in the military population frequently exhibit migraine-like features. Tension-type headache and trigeminal autonomic cephalalgias also occur, although less commonly reported. Sub-phenotyping PTH may be important for initiating effective treatment since different phenotypes may respond differently to medications. The study populations analyzed in this systematic review display heterogeneity, underscoring the necessity for additional research features, more stringent criteria and comprehensive recording of baseline characteristics. Characterizing headaches following injury is crucial for an accurate diagnosis to enable effective management and rehabilitation planning for our armed forces.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e90-e98"},"PeriodicalIF":1.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Military medical transport is unique due to its frequent long-distance travel with limited supplies and capabilities. Military neonatal transport is perhaps even more niche, and descriptions in the literature are rare. A military neonatal team transported a 1-month-old former 26-week infant from a forward-deployed non-combat setting. Due to complications in-flight, the infant could only be safely transported from the deployed setting to the refueling stop. This report is a descriptive analysis of the transport, including lessons learned that may help future teams plan for possible complications that can occur during neonatal transports.
{"title":"Operation Baby Drop: Lessons Learned From Military International Air Transport of Critically Ill Neonate.","authors":"Kaitlyn Mullin, Elizabeth Okonek, Jeanne Krick","doi":"10.1093/milmed/usae578","DOIUrl":"https://doi.org/10.1093/milmed/usae578","url":null,"abstract":"<p><p>Military medical transport is unique due to its frequent long-distance travel with limited supplies and capabilities. Military neonatal transport is perhaps even more niche, and descriptions in the literature are rare. A military neonatal team transported a 1-month-old former 26-week infant from a forward-deployed non-combat setting. Due to complications in-flight, the infant could only be safely transported from the deployed setting to the refueling stop. This report is a descriptive analysis of the transport, including lessons learned that may help future teams plan for possible complications that can occur during neonatal transports.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Musculoskeletal pain can be a significant safety risk to aircrew. Flight surgeons are the primary care providers for aircrew and are responsible for safely treating musculoskeletal pain. Certain medical interventions can be used to treat pain while maintaining the ability to fly safely. A previous F-18 Naval Flight Officer presented to the flight surgeon with chronic neck pain seeking noninvasive and nonpharmacological therapy. After one Osteopathic Manual Treatment session using the Fascial Distortion Model (FDM), the patient had improved pain and function. The aircrewman reported an 83% reduction in pain and a 200% improvement in cervical Range of Motion (ROM) immediately following treatment. Neck pain is a common complaint in aircrew. This pain can become an in-flight distraction, thus increasing the risk of aviation mishaps. FDM can decrease pain and increase ROM quickly, without equipment or a large amount of space and without the use of medications that may prohibit an aircrew member from flying. This case study shows the ability to treat a uniformed aircrewman with neck pain while onboard an aircraft. FDM is a technique that can be taught to all flight surgeons. Teaching future flight surgeons FDM techniques can improve the U.S. Navy's resources by decreasing time away from work along with decreasing medical costs. The use of osteopathic manipulation treatment significantly reduced an aircrewman's pain and increased ROM with one treatment while maintaining flight status per current aeromedical waiver guidelines.
{"title":"The Fascial Distortion Model in Military Aircrew with Chronic Neck Pain: A Case Study.","authors":"Allison J Fullenkamp","doi":"10.1093/milmed/usae008","DOIUrl":"10.1093/milmed/usae008","url":null,"abstract":"<p><p>Musculoskeletal pain can be a significant safety risk to aircrew. Flight surgeons are the primary care providers for aircrew and are responsible for safely treating musculoskeletal pain. Certain medical interventions can be used to treat pain while maintaining the ability to fly safely. A previous F-18 Naval Flight Officer presented to the flight surgeon with chronic neck pain seeking noninvasive and nonpharmacological therapy. After one Osteopathic Manual Treatment session using the Fascial Distortion Model (FDM), the patient had improved pain and function. The aircrewman reported an 83% reduction in pain and a 200% improvement in cervical Range of Motion (ROM) immediately following treatment. Neck pain is a common complaint in aircrew. This pain can become an in-flight distraction, thus increasing the risk of aviation mishaps. FDM can decrease pain and increase ROM quickly, without equipment or a large amount of space and without the use of medications that may prohibit an aircrew member from flying. This case study shows the ability to treat a uniformed aircrewman with neck pain while onboard an aircraft. FDM is a technique that can be taught to all flight surgeons. Teaching future flight surgeons FDM techniques can improve the U.S. Navy's resources by decreasing time away from work along with decreasing medical costs. The use of osteopathic manipulation treatment significantly reduced an aircrewman's pain and increased ROM with one treatment while maintaining flight status per current aeromedical waiver guidelines.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e421-e425"},"PeriodicalIF":1.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ashna Manhas, Casey Genevieve Arnold, Allison Marie Bush
Acute liver injuries (ALIs) are caused by a wide range of etiologies, and determining the cause can often be challenging. Detailed history taking is essential in patients with liver injuries to promptly determine the underlying source of injury and for timely treatment and prognosis. A 27-year-old active duty man presented to the emergency department (ED) with jaundice. On medication reconciliation, he only reported taking acetaminophen for a recent upper respiratory infection. The patient had an ALI and was treated with N-acetyl cysteine for presumed acetaminophen toxicity. Initially, his liver-associated enzymes (LAEs) improved, but 2 weeks after discharge, he returned to the ED upon referral from ship medical for jaundice and worsening liver injury. Repeated query into the patient's history revealed that he was using a testosterone booster supplement for 6 months preceding initial hospitalization. After evaluation of other etiologies for liver injury returned negative, drug-induced liver injury from the testosterone booster was determined to be the underlying etiology. With discontinuation of the supplement, his liver injury improved. Hepatotoxicity is a major concern in supplement use; however, it is largely underreported. Supplements are often not recognized or reported as medications by patients, leading to failure to identify them as potential toxicants. This case highlights the importance of including supplement education and questioning in the evaluation of ALI and maintaining a high index of suspicion when other common etiologies of liver disease are negative.
急性肝损伤(ALIs)由多种病因引起,确定病因往往具有挑战性。肝损伤患者必须详细询问病史,以便及时确定潜在的损伤源,及时治疗和预后。一名 27 岁的现役军人因黄疸到急诊科就诊。经核对用药,他只报告最近因上呼吸道感染服用了对乙酰氨基酚。患者出现了急性呼吸道感染,因推测对乙酰氨基酚中毒而接受了 N-乙酰半胱氨酸治疗。起初,他的肝脏相关酶(LAEs)有所改善,但出院两周后,他因黄疸和肝损伤恶化经船医转诊返回急诊室。对患者病史的反复询问发现,他在初次住院前的 6 个月里一直在使用睾酮增强剂。在对肝损伤的其他病因进行评估后,结果显示为阴性,因此确定睾酮增强剂导致的药物性肝损伤是根本病因。停用该增效剂后,他的肝损伤有所好转。肝毒性是使用营养补充剂的一个主要问题,但报告的情况却很少。补充剂通常不被患者视为药物或作为药物进行报告,导致无法将其识别为潜在的毒物。本病例强调了在评估 ALI 时纳入补充剂教育和询问的重要性,以及在其他常见肝病病因阴性时保持高度怀疑的重要性。
{"title":"Underreporting Supplements: A Case of Drug-induced Liver Injury Due to a Testosterone Booster.","authors":"Ashna Manhas, Casey Genevieve Arnold, Allison Marie Bush","doi":"10.1093/milmed/usae136","DOIUrl":"10.1093/milmed/usae136","url":null,"abstract":"<p><p>Acute liver injuries (ALIs) are caused by a wide range of etiologies, and determining the cause can often be challenging. Detailed history taking is essential in patients with liver injuries to promptly determine the underlying source of injury and for timely treatment and prognosis. A 27-year-old active duty man presented to the emergency department (ED) with jaundice. On medication reconciliation, he only reported taking acetaminophen for a recent upper respiratory infection. The patient had an ALI and was treated with N-acetyl cysteine for presumed acetaminophen toxicity. Initially, his liver-associated enzymes (LAEs) improved, but 2 weeks after discharge, he returned to the ED upon referral from ship medical for jaundice and worsening liver injury. Repeated query into the patient's history revealed that he was using a testosterone booster supplement for 6 months preceding initial hospitalization. After evaluation of other etiologies for liver injury returned negative, drug-induced liver injury from the testosterone booster was determined to be the underlying etiology. With discontinuation of the supplement, his liver injury improved. Hepatotoxicity is a major concern in supplement use; however, it is largely underreported. Supplements are often not recognized or reported as medications by patients, leading to failure to identify them as potential toxicants. This case highlights the importance of including supplement education and questioning in the evaluation of ALI and maintaining a high index of suspicion when other common etiologies of liver disease are negative.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e453-e455"},"PeriodicalIF":1.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jill E Brown, Kayla M Hudson, Anne M Rompalo, Charlotte A Gaydos
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.
导言:性传播感染(STIs)在军队人群中很常见。护理点检测(POCT)可在市场上买到,但在民用领域的使用情况却不尽相同。目前尚未对其在军队提供者中的使用情况进行评估。我们试图确定军队妇产科医生(OBGYN)使用 STI POCT 的模式和障碍:我们改编了一项关于军队妇产科医生使用 STI POCT 的模式和障碍的民间妇产科医生调查。我们于 2023 年 5 月通过陆军、空军和海军专业负责人向 479 名军事妇产科医生发送了一份在线问卷。问卷包括 14 个人口统计学问题和多达 52 个有关 STI POCT 的可用性、使用情况和障碍的问题。美国南加州大学机构审查委员会认为该研究免于机构审查委员会审查:在征集到的 479 位受访者中,有 117 位(24.4%)参与了调查。在受访者中,64.1% 为女性,79.5% 为非西班牙裔白人。13.0%的受访者每周检测一到两次性传播感染,52.8%的受访者每月检测一到两次。最常见的性传播感染相关 POCT 是湿装片预处理(68.7%)、快速 HIV 检测(43.3%)和尿液浸量尺(38.6%)。有 30.3% 的人可使用革兰氏染色法,24.5% 的人可使用 Affirm VPIII(Becton, Dickinson and Company, Franklin Lakes, NJ),16.3% 的人可使用 stat RPR。使用 POCT 的经济障碍包括制造商/经销商提供的检测成本(57.9%)和军方的资金/库存决定(10.3%)。使用的最大障碍是购买仪器(60.8%)和中断临床工作流程(57.8%):结论:军队妇产科医生依赖多种与性传播感染相关的 POCT。经济因素和工作流程中断被认为是军队妇产科医生使用 POCT 的最大障碍。在未来为军事卫生系统开发和采购 POCTs 时,应考虑测试成本和对工作流程的影响。
{"title":"Patterns of Use and Barriers to STI Point-of-care Tests for Military Obstetrician Gynecologists.","authors":"Jill E Brown, Kayla M Hudson, Anne M Rompalo, Charlotte A Gaydos","doi":"10.1093/milmed/usae283","DOIUrl":"10.1093/milmed/usae283","url":null,"abstract":"<p><strong>Introduction: </strong>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).</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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%).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e15-e19"},"PeriodicalIF":1.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141246777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kathryn A Capple, Elizabeth A Kostas-Polston, Mary B Engler, Choang Lai, Erika Sivarajan Froelicher
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.
{"title":"Efficacy of Polyunsaturated Fatty Acids as a Treatment for Post-traumatic Stress Disorder: A Systematic Review.","authors":"Kathryn A Capple, Elizabeth A Kostas-Polston, Mary B Engler, Choang Lai, Erika Sivarajan Froelicher","doi":"10.1093/milmed/usae319","DOIUrl":"10.1093/milmed/usae319","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":"e74-e81"},"PeriodicalIF":1.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}