Military Medicine最新文献

Objective: To evaluate the validity of the Wireless Automated Hearing Test System (WAHTS) in comparison to clinically acquired unmasked air conduction thresholds.

Design: A cross-sectional study comparing WAHTS and manual audiometry thresholds, with participants at Clinic 1 completing WAHTS followed by manual audiometry, and those at Clinic 2 completed manual audiometry first, followed by WAHTS, both on the same day.

Study sample: Ninety-three thresholds from 28 participants at Clinic 1 and 112 thresholds from 24 participants at Clinic 2 were analyzed. Participants were U.S. Service Members and represented a range of ages and hearing difficulties.

Results: The mean absolute difference between repeated WAHTS measurements was 2.21 dB (SD = 2.52 dB). Correlation coefficients for WAHTS and clinical thresholds were 0.95 (R2 = 0.91) at Clinic 1 and 0.94 (R2 = 0.94) at Clinic 2. Kappa agreement within ±10 dB was 90% at Clinic 1 and 87% at Clinic 2. Bland-Altman analysis indicated a slight bias, with WAHTS thresholds averaging 2-3 dB better than clinical thresholds.

Conclusions: Wireless Automated Hearing Test System demonstrated strong agreement with clinical audiometry, supporting its use for unmasked threshold evaluations. Its portability and accuracy suggest potential for expanding access to hearing health care, particularly in remote or resource-limited environments.

The Joint Trauma System and Armed Services Blood Program have collaborated to develop a Clinical Practice Guideline for the use of Type A Whole Blood to expand the availability of whole blood in the operational environment. This MPO Minute discusses the rationale, key considerations, and recommendations outlined in the CPG.

As healthcare systems evolve to integrate digital technologies, the Military Health System (MHS) faces unique challenges requiring specialized expertise in health informatics. Health informatics enables the optimization of workflows, enhances patient safety, and supports operational readiness by transforming data into actionable insights. This manuscript discusses the critical role informaticists play in supporting the mission of the MHS by improving clinical outcomes, facilitating health data interoperability, and advancing medical research. Despite their pivotal role, the informatics workforce across the military services is inconsistently tracked, leading to significant gaps in resource allocation and strategic planning. Quantitative estimates suggest that while the Navy and Air Force have recognized informaticists through specific qualification designators and special experience identifiers, formal designation and dedicated billets remain limited, particularly in the Army. Barriers such as budget constraints, reliance on collateral duties, and lack of unified policy frameworks impede progress. To address these challenges, this article recommends establishing formal informatics subspecialties, developing standardized education pathways, and designating specific billets across the Services. It also proposes a vision where informaticists are embedded throughout the MHS, enabling predictive health models, interoperability with Veterans Affairs systems, and real-time decision support in deployed environments. Investing in a robust informatics workforce is not merely a technological enhancement but a strategic imperative essential for maintaining force health, medical readiness, and national security.

Introduction: In deployed military settings, ensuring consistent access to durable medical equipment (DME) remains a significant challenge due to logistical and supply chain limitations. This study retrospectively reviews the clinical use of 3D-printed upper extremity orthoses fabricated out of necessity at Al Udeid Air Base (AUAB), Qatar, in response to such shortages. Devices were implemented during routine care and assessed through provider documentation and photographic evidence. Although representative of logistics-supported Role 2s, the results may not fully extend to forward combat Role 2s without adaptations.

Materials and methods: A retrospective chart review was conducted for patients treated with 3D-printed orthotic splints between March and July 2024 at AUAB. Printers included a FormLabs 3B+ SLA and Creality CR-6 MAX FDM device, using Formlabs Draft V2 resin and Overture PLA filament. Devices were fabricated using an open-source design to meet immediate clinical needs, with print times of 1-2 h per splint. Variables extracted included splint type, application site, patient tolerance, and clinical utility as documented in the medical record.

Results: Multiple splint designs were fabricated, including an en bloc thumb spica, a heat-moldable flat PLA splint, and a series of DIP extension splints for mallet finger injuries. The en bloc splint, printed using SLA resin, provided satisfactory fit and comfort with a stockinette liner and adjustable securing mechanisms (Figure 1). A flat PLA-based splint was customized at bedside through heat molding (Figure 2 and 3). Finger extension splints were printed in batch-scaled sizes and used for 8-week immobilization in 1 patient with a soft tissue mallet deformity (Figure 4). All splints were well tolerated, functionally effective, and enabled continuity of duty with minimal limitation. Compared to plaster, 3D prints offered better ventilation and durability.

Conclusions: 3D printing enabled the timely fabrication of upper extremity orthoses during a period of equipment shortage at a deployed military medical facility. These devices were created to fulfill immediate clinical needs and were retrospectively evaluated using documentation from routine patient care. This study highlights the real-world feasibility of using 3D printing in constrained settings to deliver personalized orthopedic support when conventional DME is unavailable. Printers are moderately robust but sensitive to dust, temperature, and motion; ruggedized models and IP-compliant designs are recommended for austere use. Costs may exceed traditional initially but offer logistics savings. Multi-specialty applications justify deployment. Although limited by its retrospective design and absence of formal outcome tracking, the findings demonstrate the potential for 3D printing to reduce supply chain dependence, support operational autonomy, and enhanc

Introduction: Glucose dysregulation is a significant obesity-related comorbidity known to impair both mental and physical performance. Glycated hemoglobin (HbA1c), a measure of average glucose regulation over 2-3 months, is elevated in over a third of American adults, indicating prediabetes (5.7-6.4%) or type 2 diabetes mellitus (≥ 6.5%). However, the 'fit-fat' concept suggests that physical activity may mitigate the adverse effects of adiposity on metabolic health.

Materials and methods: This study investigated the relationship between relative body fat (%BF), HbA1c, and maximal oxygen uptake (V.O2max) as a surrogate measure of physical activity, in 216 physically active military personnel (188 men, 28 women).

Results: In men, fat mass (FM) was significantly, but weakly, inversely associated with HbA1c (β = -0.008, 95% CI [-0.015 to 0.000], SE = 0.004, P = 0.048), a finding that warrants further investigation. Maximal oxygen uptake was not significantly associated with HbA1c in either men or women. The variance explained by these models was low. Cluster analysis identified 3 distinct clusters with differing profiles of adiposity and fitness, but no significant differences in HbA1c were observed between them (F(2, 213) = 0.72, P = 0.488).

Conclusions: In this physically active military population, normal mean HbA1c levels (5.2%) suggest that regular physical activity may mitigate the adverse effects of adiposity on glucose homeostasis. These findings support the 'fit-fat' concept and suggest that current fitness standards may be sufficient to maintain metabolic health. Therefore, inclusion of HbA1c testing in annual physical readiness standards may not be warranted in young, physically active service members.

Introduction: Traumatic brain injuries (TBIs) are associated with substantial morbidity and mortality. We examined characteristics and outcomes among military personnel with battlefield-related penetrating TBI (pTBI) compared to closed TBI (cTBI) and non-head injuries (without cranial injuries).

Materials and methods: Military personnel admitted to participating U.S. military hospitals (2009-2014) were classified based on injury patterns: pTBI, cTBI (head Abbreviated Injury Scale [AIS] ≥3), and non-head (≥1 non-head injury AIS ≥3). Propensity score and inverse probability of treatment weighting (IPTW) were used to assess associations with mortality, hospital stay, and infection burden.

Results: The study population included 106 pTBI patients, 259 cTBI patients, and 715 patients with non-head injuries. Patients with pTBIs were more severely injured with differing injury mechanisms compared to the other 2 groups. Patients with pTBIs had more critical care requirements versus both cTBI and non-head injury patients (P < .05) and longer hospitalization (median 27 days vs. 22; P = .041) compared to cTBI patients. More central nervous system (CNS) infections were diagnosed among patients with pTBIs (11.3%) versus cTBIs (1.2%) and non-head injuries (0.7%; P < .001). Although the overall proportion of patients who developed non-CNS infections was not significantly different between the TBI groups, there was a higher proportion among pTBI versus non-head injury patients (53.8% vs. 40.8%; P = .012). Patients with pTBIs also had less skin and soft-tissue infections and more pneumonia compared to non-head injury patients (P < .05). There was no significant difference in the proportion of mortality between the pTBI and cTBI patients (7.6% vs. 3.1%); however, it was higher compared to patients with non-head injuries (1.0%; P < .001). Sustaining any TBI (penetrating or closed) was associated with greater risk of mortality compared to non-head injuries (risk ratio: 3.71; 95% CI, 1.83-7.55).

Conclusions: Patients with pTBIs are critically injured with substantial critical care requirements and morbidity. Between patients with pTBIs and cTBIs, there was not a significant difference in non-CNS infection burden or mortality, but pTBI patients did have longer hospitalization. When compared to severely injured military personnel with non-head injuries using propensity scores and IPTW analysis, sustaining a TBI (penetrating or closed) was not associated with having more non-CNS infections or a longer hospital stay. This may be a result of the high injury severity (median of 26) and relative occurrence of polytrauma in the total population. Patients with TBIs (penetrating or closed) did have a greater risk of mortality compared to patients with non-head injuries.