Military Medicine最新文献

Introduction: Lyme disease is caused by Borrelia burgdorferi sensu lato that is transmitted through the bite of infectious ticks. Within the US active duty military component, Lyme is the most frequently reported vector-borne disease. There have not been reports on Lyme disease prevalence in Central America, but reports of travelers who contracted rickettsiosis after their trip to Honduras suggest a need for an increased tick-borne disease surveillance, including Lyme disease. The aim of this study is to determine the prevalence of Lyme disease in US military personnel deployed to Honduras.

Materials and methods: A retrospective cohort study was designed using pre- and postdeployment sera from 1,640 US military personnel who had been stationed in Honduras for at least 6 months between 2000 and 2021. All postdeployment sera were screened for the presence of IgG antibodies against B. burgdorferi by ELISA (enzyme-linked immunosorbent assay) followed by testing the predeployment sera of individuals with positive postdeployment samples to determine seroconversion.

Results: The postdeployment seropositivity in US military personnel for IgG antibodies against B. burgdorferi was 1.3% (22/1,640) with 0.4% (6/1,640) individuals seroconverted. These results also indicate that 16 US military personnel were exposed to B. burgdorferi before their assignment to Honduras, perhaps because of previous exposure to B. burgdorferi at home.

Conclusion: The 0.4% rate of seroconversion suggested a low-risk threat. Additional testing of potential vectors for B. burgdorferi in the regions would be beneficial to inform active and effective vector control countermeasures in the region to prevent exposure.

Isolated palsy of cranial nerve VI, also known as the abducens nerve, is a condition rarely seen in the obstetric population; however, there is a growing body of literature that suggests an association with pre-eclampsia and hypertensive disorders of pregnancy. We present the sixteenth case documenting this association involving a 30-year-old G1 admitted for induction of labor at 39 weeks gestational age (WGA) subsequently diagnosed with pre-eclampsia with severe features and, after an otherwise uncomplicated vaginal delivery, developed an isolated abducens nerve palsy. While similar cases reviewed in the current body of literature document self-resolution of the palsy, a thorough workup is warranted because of other potentially malignant causes for this presentation. Appropriate management and risk factor counseling are discussed following a review of cases.

Introduction: Human Papillomavirus (HPV) is the most common sexually transmitted infection globally, with millions of new cases reported each year. Human Papillomavirus is associated with cervical, anal, vulva, penile, and esophageal cancer. Cervical cancer is a significant threat to women because of its insidious nature; thus, cervical cancer screening remains crucial for early detection and intervention.The most effective method to protect against HPV-related cancers is through vaccination with the HPV vaccine. The Human Papillomavirus vaccine targets the most common high-risk HPV strains. Vaccination is recommended for both males and females between the ages of 9-26. Vaccination reduces the risk of infection and contributes to the prevention of HPV-related cancers, representing a crucial public health initiative in battling HPV. The active duty military population has low HPV vaccination rates. A visit for a pap smear, the screening for cervical cancer, is an optimal time for providers to discuss the HPV vaccine. This research aims to understand the low HPV vaccination rate among active duty women and whether providers are maximizing opportunities to promote vaccination against HPV.

Materials and methods: A retrospective medical chart review was performed at a single military treatment facility (MTF) of active duty women between the ages of 21-26, who had an abnormal pap smear, and no record of receiving the HPV vaccine. A chart review was conducted for the visit in which the pap smear was performed, as well as the follow-up visit/phone call to discuss the abnormal pap smear results.

Results: Seven hundred fifty-one charts were reviewed from 2005 to 2021 of unvaccinated active duty women with an abnormal pap smear. 46.3% of the abnormal pap smears were low-grade squamous intraepithelial cells (LGSIL), whereas 3.3% were high-grade squamous intraepithelial cells (HGSIL). Of the charts reviewed, 8.3% of the patients noted they had been vaccinated; 13.8% of the charts had documented recommendations for the HPV vaccination; and 77.9% had no documentation regarding the patient's HPV status or recommendation for vaccination.

Conclusion: Although the HPV vaccine is effective in reducing the risk of HPV-related cancers, our results indicate the need for increased awareness and education practices amongst providers in promoting the HPV vaccine.A limitation of the study was that it was conducted at a single MTF. The study was not able to distinguish between provider types or clinic settings. Possible proposals for future studies include evaluating why the HPV vaccination rates amongst the active duty population are low. Pap smears are a prime opportunity for providers to engage in discussion of the importance of the HPV vaccine and encourage adherence.

Introduction: Nursing workforce characteristics, such as staffing and specialized training, are integral to the delivery of high-quality patient care in the intensive care unit (ICU). Nurse staffing is defined as the number of nurses per patient but also skill-mix (combination of registered nurses and other nursing support staff) and expertise of available nurses for the specific patient population each shift. When nurse staffing is suboptimal the risk of adverse patient outcomes and patient mortality increases. In addition, existing research has established the importance of staffing ICUs with interprofessional teams-registered nurses (RNs), physicians, and respiratory therapists (RTs). Yet, shifting characteristics of the nursing workforce- such high turnover and a more novice workforce- are still under studied and may impact the interprofessional team and its ability to collaborate effectively.

Materials and methods: This study is an analysis of previously collected qualitative data from 9 ICUs within a single academic medical system in the US. Participants (RNs, physicians, RTs, and other ICU providers) working in study ICUs across 4 hospitals were purposively sampled and interviewed individually. Thematic analysis was used to analyze interview transcripts; 2 researchers coded each transcript independently. Consensus on any coding disagreement was reached through discussions at research team meetings. Once all data was coded, the team iteratively reviewed the data and codes and generated themes that focused on the primary research question of this analysis: how nursing workforce characteristics influence the interprofessional team.

Results: Our final sample included RNs (n = 11), RTs (n = 4), physicians (n = 4), and a dietician (n = 1). Three interconnected themes were identified in the analysis: (1) The effects of a transition to a more novice nursing workforce in ICUs extends beyond nurse staffing to the interprofessional team and their ability to provide care; (2) Staffing decisions do not incorporate interprofessional team needs, leading to decreased collaboration and disruptions in patient care; and (3) Adequate nurse staffing and additional support can balance increased burden on the interprofessional team. These themes highlight how nurse workforce characteristics can influence the interprofessional team in adult ICUs in a post-COVID era.

Conclusions: Characteristics of the nursing workforce, such as nurse experience and expertise, have downstream effects on interprofessional team members and their ability to deliver care in the ICU. A multi-pronged approach, which includes adequate support staff for nursing, increased retention of experienced ICU nurses, and improving communication across professions, is vital to improve interprofessional team collaboration and allow ICU teams to provide the best care possible to their patients.

Introduction: Military dental providers often operate in environments with extreme temperature gradients. The purpose of this study was to analyze the effect of simulated storage in extreme cold conditions on 8 medications-4 local anesthetics (2% Lidocaine with 1:100,000 epinephrine, 0.5% Marcaine with 1:200,000 epinephrine, 4% Articaine with 1:100,000 epinephrine, 3% Polocaine), 2 pain medications (Acetaminophen 325 mg, Ibuprofen 800 mg), and 2 antibiotics (Amoxicillin 500 mg, Azithromycin 500 mg), who are commonly used by the military for dental treatment.

Materials and methods: Medications were subjected to simulated freeze-thaw (FT) conditions (MIL-STD-810H), using an environmental chamber to expose any tendency for degradation. The medications were cycled through 13 hours at -10 °C and 11 hours at 4 °C for 28 days, to simulate springtime FT conditions experienced by Kyiv, Ukraine. Samples were analyzed at 0, 7, 14, 21, and 28 days under both environmental stress and room temperature (RT) conditions. Liquid chromatography-mass spectrometry (LC-MS) was completed with electrospray ionization interface and triple quadrupole mass analyzer. Each medication was used as an internal standard (IS) for the other and response factors determined for each. All drugs and their respective IS were measured in multiple reaction monitoring in electrospray positive ionization. Room temperature data from each time point were compared to the respective environmentally stressed drug data using T-tests adjusted via Bonferroni's method (α = 0.01). Parametric first-order autoregressive moving-average repeated-measures analysis of variance using maximum likelihood was performed using the "MIXED" procedure in SAS v9.4 to determine if concentrations were affected by time and environmental stress (α = 0.05).

Results: Lidocaine, Polocaine, Acetaminophen, and Azithromycin concentrations were affected by time and environmental stressing. All other medication concentrations were affected by time but not by environmental stressing.

Conclusions: Utilization and/or storage of commonly used local anesthetics, antibiotics, and pain medications in these climate conditions may experience concentration changes who may affect their efficacy in treating dental-related conditions.

Introduction: Few publicly available statistics or studies exist regarding the racial and ethnic composition of U.S. Military medical providers and their specialties. The absence of data limits the ability to investigate outcomes for underrepresented minority (URM) military medical providers and the effects of provider-patient racial and ethnic concordance. Given these conditions, the overall objective of this study was to understand career and military achievements for URM graduates of -Uniformed Services University of the Health Sciences (USU) School of Medicine (SOM).

Materials and methods: Contingency table statistical analysis was conducted to determine differences in career and military achievements for URM and non-URM graduates. The critical value of significance was set at 0.05 for chi-square tests. If the cell count was lower than 5, we reported Fisher's exact test result. For groups with less than 5 participants, racial/ethnic categories were combined so as to preserve as much data as possible. Finally, we adjusted the critical value of statistical significance using Bonferroni's correction method to avoid an inflated Type I error rate.

Results: There was a statistically significant association between race and ethnicity and the highest rank achieved to date (χ2 = 17.175 [P = .002]), and spending 7 or more consecutive days on a humanitarian mission as a physician (χ2 = 9.027 [P = .003]). In each of these instances, by comparing the expected count of graduates to the observed count, the proportion of URM graduates achieving specific military milestones was lower than that of non-URM graduates.

Conclusions: Few statistically significant differences in career and military achievements among URM and non-URM USU SOM graduates were found in this study. However, significant associations, highest rank achieved to date and 7 days or more on a humanitarian mission, are important for building pathways to leadership. Factors such as access to URM faculty mentors, presence of social networks of URM peers, and inclusive policies and programs have been demonstrated to help mitigate each of these points of disparity. These resources serve to build service members' portfolios of career, leadership, and military accomplishments once they have matriculated into medical school and well into their military and medical careers.

Introduction: Submarines are challenging environments, where accidents, with fatalities, continue to occur. Nonetheless, available studies suggest low rates of post-traumatic stress disorder (PTSD) following submarine-specific accidents. In September 2023, 7 sailors were washed overboard from a South African submarine, resulting in 3 fatalities. The surviving crew received immediate defusing and ongoing counselling. This study investigated the psychological impact of the accident, assessing post-trauma stress responses at 2 time points.

Materials and methods: Mental health screenings at 7 weeks and 7 months post-accident involved 75 submariners (32 exposed and 43 non-exposed). Measures included sociodemographic information and mental health history, and psychological scales of adjustment, mood, and PTSDs. Data were examined using Chi-square, t-tests, and regression analyses.

Results: At 7 weeks, 31% of the exposed group met criteria for adjustment disorder, and 19% for major depressive and PTSDs. Previous trauma exposure and family-work interface concerns were significant risk factors. By 7 months, most severe responses had resolved, except for 5 cases associated with pre-accident multiple recent losses or other psychosocial stressors.

Conclusion: Severe post-trauma stress responses declined significantly within 7 months. Early screening was useful to identify submariners requiring additional support and the later screening suggested that readiness assessments should extend beyond 6 months post-accident. The study highlighted the importance of early psychological support, and the protective roles of resilience and pre-accident mental health, in reducing poor outcomes in the event of accidents at sea.

Objective: Physician assistants/associates (PAs) serve as commissioned medical officers in the uniformed services, supporting readiness, global health operations, and domestic response. Despite their critical contributions, limited data exist to inform strategic workforce planning, recruiting, and retention efforts.

Materials and methods: A cross-sectional quantitative analysis was conducted using a 2023 national workforce dataset. We compared the demographic and employment characteristics of PAs on active duty with those not on active duty (N=12,146), using descriptive statistics and bivariate analysis (Pearson chi-square tests for categorical variables and Mann-Whitney tests for continuous variables).

Results: The PA Professional Profile data identified 12,146 PAs who reported their armed forces status, with 2,508 (20.6%) indicating they were on active duty, although 9,639 (79.4%) were inactive (retired and veterans). As of 2023, 2,508 active duty PAs served in the Army (52.0%), Air Force (25.8%), Navy/Marines (20.1%), USPHS/NOAA (5.9%), and Coast Guard (3.0%). In terms of demographics, PAs in active duty report a median age of 41, with 29.9% female and 11.6% indicating Hispanic/Latinx ethnicity. Compared to PAs not on active duty, PAs on active duty were more likely to complete a postgraduate fellowship/residency (17.6% vs. 13.9%). Over half of active duty PAs participate in telemedicine. More than a third (37.2%) of active duty PAs report symptoms of burnout, compared to 30.1% of PAs not on active duty.

Conclusions: PAs occupy unique roles in the U.S. government's uniformed services. Federal agencies should enhance PA retention initiatives by addressing workload demands, aligning compensation with responsibilities, expanding leadership and fellowship opportunities, and incorporating flexible, nonclinical career pathways into retention packets. Such strategies are essential to sustain a resilient, skilled, mission-ready uniformed PA workforce.