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Duan B. Climate, diseases and medicine: the welfare of soldiers during the East Asian War of 1592-1598. Med Hist 2024:1-17. [PMID: 38587001 DOI: 10.1017/mdh.2024.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
This article examines the care provided for the welfare of soldiers by the three combatant countries - China, Korea and Japan - during the East Asian War of 1592-8. Also known as the Imjin War, this large-scale military conflict can also be understood as an encounter between different state cultures and strategies of military medicine. This study focuses on cold-induced injuries, epidemic outbreaks and external wounds suffered during the war. I illuminate provision of prophylactic measures against cold by the Ming state, as well as attempts by the Sino-Chosŏn medical alliance to manage epidemics and treat wounded soldiers. I contrast these measures with the lack of similar centralised support for the Japanese forces, and examine the effect these differences had upon on military outcomes during the war. The difference in the amount of time, efforts and resources that the three combatant states devoted to sick and injured soldiers has implications not only for our understanding of the war but also for illuminating the early modern history of military medicine in East Asia. By exploring East Asian military medicine during and after the Imjin War, this article responds to recent calls for more detailed examination of histories of military medicine in premodern periods and non-European regions.
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Affiliation(s)
- Baihui Duan
- History Department, Lancaster University, Lancaster, LA1 4YT, United Kingdom
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Korona-Bailey J, Janvrin ML, Shaw L, Koehlmoos TP. Assessing mid-career female physician burnout in the military health system: finding joy in practice after the COVID-19 pandemic. BMC Public Health 2024; 24:862. [PMID: 38509564 PMCID: PMC10953201 DOI: 10.1186/s12889-024-18357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Rates of physician burnout increased during the COVID-19 pandemic and are expected to continue to rise. Mid-career physicians, female physicians, and military physicians have all been identified as potentially vulnerable populations to experience burnout. We examine factors associated with physician burnout among this intersectional group through a qualitative key informant interview study. METHODS We developed a semi-structured interview guide using the Institute for Healthcare Improvement's Improving Joy in Work Framework and recruited military, mid-career female physicians who worked in the Military Health System(MHS) during the COVID-19 pandemic, (March 2020 -December 2021). Notes were collated and deductive thematic analysis was conducted. RESULTS We interviewed a total of 22 mid-career female physician participants. Participants were between 30 and 44 years of age and 7 were mothers during the pandemic. Most were White and served in the Army. All participants discussed the importance of building rapport and having a good relationship with coworkers. All participants also described their discontentment with the new MHS GENESIS electronic health record system. An emerging theme was military pride as most participants were proud to serve in and support the military population. Additionally, participants discussed the negative impact from not feeling supported and not feeling heard by leadership. CONCLUSIONS Much like providers in other health systems during the pandemic, MHS physicians experienced burnout. This study allowed us to gather key insights to improve policies for active duty service mid-career female military physicians. Provider inclusion, autonomy, and work culture play critical roles in future systems improvement and workforce retention.
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Affiliation(s)
- Jessica Korona-Bailey
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
- Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Dr, Bethesda, MD, 20817, USA.
| | - Miranda Lynn Janvrin
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Dr, Bethesda, MD, 20817, USA
| | - Lisa Shaw
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Tracey Perez Koehlmoos
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
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Yassin AM, Mohamed M, Dirar M, Ahmed M, Elsir K, Alhadi A. Modified intermittent low negative pressure wound therapy for complex injuries: A case series. Int J Surg Case Rep 2024; 116:109356. [PMID: 38330701 PMCID: PMC10864191 DOI: 10.1016/j.ijscr.2024.109356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Combat wounds can be difficult to manage and can lead to disfigurement and infection. The closure of these wounds is crucial, as delayed closure also increases the risk of further complications. Military medicine has introduced negative pressure wound therapy, which modulates wounds perfectly through the microscopic and macroscopic configurations of the wound environment. It is expensive and not available worldwide, and several modifications using low cast materials were mentioned in literature. METHODS We present a case series of four patients using the previously mentioned modified technique in combat wound management, and discuss the results, outcome, and justification for choosing this modality of treatment. All patients underwent a thorough debridement, followed by a modified negative pressure wound treatment for three weeks, employing readily available medical devices. RESULTS All wounds healed successfully without complication and a simple closure was used to cover the resultant wound. CONCLUSION Modified NPWT with limited resources is capable of promoting healing in conflict-related wounds through multifactorial properties and transforming reconstructive methods from complex to simple procedures in areas with a shortage of medical supplies and surgeons in addition to busy operating rooms.
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Affiliation(s)
- Amin M Yassin
- Department of Plastic Surgery, Elnou Teaching Hospital, Omdurman, Sudan; Sudan Medical Specialization Board (SMSB), Khartoum, Sudan
| | - Momen Mohamed
- Department of Plastic Surgery, Elnou Teaching Hospital, Omdurman, Sudan; Sudan Medical Specialization Board (SMSB), Khartoum, Sudan.
| | - Mohamed Dirar
- Department of Plastic Surgery, Military Hospital Helipad, Omdurman, Sudan
| | - Muhnnad Ahmed
- Department of Plastic Surgery, Elnou Teaching Hospital, Omdurman, Sudan
| | - Khalid Elsir
- Department of Plastic Surgery, Elnou Teaching Hospital, Omdurman, Sudan
| | - Alhadi Alhadi
- Department of Plastic Surgery, Elnou Teaching Hospital, Omdurman, Sudan
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Pomer A, Munigala S, Coles CL, Mitro JP, Schoenfeld AJ, Weissman JS, Koehlmoos TP. The response of the Military Health System (MHS) to the COVID-19 pandemic: a summary of findings from MHS reviews. Health Res Policy Syst 2024; 22:5. [PMID: 38191494 PMCID: PMC10773054 DOI: 10.1186/s12961-023-01093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic caused major disruptions to the US Military Health System (MHS). In this study, we evaluated the MHS response to the pandemic to understand the impact of the pandemic response in a large, national, integrated healthcare system providing care for ~ 9 million beneficiaries. METHODS We performed a narrative literature review of 16 internal Department of Defense (DoD) reports, including reviews mandated by the US Congress in response to the pandemic. We categorized the findings using the Doctrine, Organization, Training, Materiel, Leadership, Personnel, Facilities, and Policy (DOTMLPF-P) framework developed by the DoD to assess system efficiency and effectiveness. RESULTS The majority of the findings were in the policy, organization, and personnel categories. Key findings showed that the MHS structure to address surge situations was beneficial during the pandemic response, and the rapid growth of telehealth created the potential impact for improved access to routine and specialized care. However, organizational transition contributed to miscommunication and uneven implementation of policies; disruptions affected clinical training, upskilling, and the supply chain; and staffing shortages contributed to burnout among healthcare workers. CONCLUSION Given its highly integrated, vertical structure, the MHS was in a better position than many civilian healthcare networks to respond efficiently to the pandemic. However, similar to the US civilian sector, the MHS also experienced delays in care, staffing and materiel challenges, and a rapid switch to telehealth. Lessons regarding the importance of communication and preparation for future public health emergency responses are relevant to civilian healthcare systems responding to COVID-19 and other similar public health crises.
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Affiliation(s)
- Alysa Pomer
- Center for Surgery and Public Health, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, United States of America.
| | - Satish Munigala
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Christian L Coles
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
- Uniformed Services University of Health Sciences, Bethesda, MD, United States of America
| | - Jessica Pope Mitro
- Department of Global and Community Health, George Mason University, Fairfax, VA, United States of America
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, United States of America
- Department of Health Policy and Management, Harvard Medical School, Boston, MA, United States of America
| | - Tracey Perez Koehlmoos
- Uniformed Services University of Health Sciences, Bethesda, MD, United States of America
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Dixon Smith S, Aldington D, Hay G, Kumar A, Le Feuvre P, Moore A, Soliman N, Wever KE, Rice AS. "I did not expect the doctor to treat a ghost": a systematic review of published reports regarding chronic postamputation pain in British First World War veterans. Pain Rep 2023; 8:e1094. [PMID: 37860786 PMCID: PMC10584288 DOI: 10.1097/pr9.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/13/2023] [Accepted: 07/21/2023] [Indexed: 10/21/2023] Open
Abstract
Limb trauma remains the most prevalent survivable major combat injury. In the First World War, more than 700,000 British soldiers received limb wounds and more than 41,000 underwent an amputation, creating one of the largest amputee cohorts in history. Postamputation pain affects up to 85% of military amputees, suggesting that up to 33,000 British First World War veterans potentially reported postamputation pain. This qualitative systematic review explores the professional medical conversation around clinical management of chronic postamputation pain in this patient cohort, its development over the 20th century, and how this information was disseminated among medical professionals. We searched The Lancet and British Medical Journal archives (1914-1985) for reports referring to postamputation pain, its prevalence, mechanisms, descriptors, or clinical management. Participants were First World War veterans with a limb amputation, excluding civilians and veterans of all other conflicts. The search identified 9809 potentially relevant texts, of which 101 met the inclusion criteria. Reports emerged as early as 1914 and the discussion continued over the next 4 decades. Unexpected findings included early advocacy of multidisciplinary pain management, concerns over addiction, and the effect of chronic pain on mental health emerging decades earlier than previously thought. Chronic postamputation pain is still a significant issue for military rehabilitation. Similarities between injury patterns in the First World War and recent Iraq and Afghanistan conflicts mean that these historical aspects remain relevant to today's military personnel, clinicians, researchers, and policymakers.
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Affiliation(s)
- Sarah Dixon Smith
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- The Royal British Legion Centre for Blast Injury Studies, Faculty of Bioengineering, Imperial College London, London, United Kingdom
- The National Archives, Kew, United Kingdom
| | - Dominic Aldington
- Department of Anaesthesia, Royal Hampshire County Hospital, Winchester, United Kingdom
| | - George Hay
- The Commonwealth War Graves Commission, Maidenhead, United Kingdom
| | - Alexander Kumar
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Peter Le Feuvre
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Andrew Moore
- Retired, Newton Ferrers, Plymouth, United Kingdom
| | - Nadia Soliman
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Kimberley E. Wever
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- The Royal British Legion Centre for Blast Injury Studies, Faculty of Bioengineering, Imperial College London, London, United Kingdom
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Singal A, Lipner SR. A review of skin disease in military soldiers: challenges and potential solutions. Ann Med 2023; 55:2267425. [PMID: 37844200 PMCID: PMC10580865 DOI: 10.1080/07853890.2023.2267425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/01/2023] [Indexed: 10/18/2023] Open
Abstract
Introduction: Military soldiers comprised 1,195 million United States active-duty members and 778,000 reserve members in 9/2021. Soldiers are often exposed to drastic climates, environments, and living conditions which may make them more susceptible to cutaneous diseases.Methods: A PubMed search of studies published between 1/1/2002 - 8/30/2022, using MeSH terms: ((("Military Personnel"[Majr]) OR "Military Hygiene"[Majr])) OR "Military Medicine"[Majr]) AND "Skin Diseases"[Majr]), the reference lists of select articles, and other applicable sources were reviewed to identify articles on skin conditions affecting military soldiers and treatment options.Discussion: In this article, we review skin conditions that affect military soldiers in both the deployed and non-deployed settings including infectious diseases, arthropod associated diseases, sexually transmitted infections, ultraviolet radiation related skin disease, acne, diseases of hair and hair follicles, dermatitis, onychocryptosis, and conditions caused by extreme weather conditions and occupational exposures. We also discuss treatment options and prevention methods as they relate to military settings.Conclusion: Dermatological conditions can considerably impact soldiers' wellbeing and military performance, often lead to evacuation of military personnel, and are associated with high financial costs. Cutaneous disease is one of most common reasons for soldiers to seek medical care and may cause significant morbidity. Serving in the military often impacts and limits treatment options.
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Affiliation(s)
| | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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Clark A, Kulwatno J, Kanovka SS, McKinley TO, Potter BK, Goldman SM, Dearth CL. In situ forming biomaterials as muscle void fillers for the provisional treatment of volumetric muscle loss injuries. Mater Today Bio 2023; 22:100781. [PMID: 37736246 PMCID: PMC10509707 DOI: 10.1016/j.mtbio.2023.100781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023] Open
Abstract
Volumetric muscle loss (VML) represents a devastating extremity injury which leads to chronic functional deficits and disability and is unrecoverable through normal healing pathways. When left untreated, the VML pathophysiology creates many challenges towards successful treatment, such as altered residual muscle architecture, excessive fibrosis, and contracture(s). As such, innovative approaches and technologies are needed to prevent or reverse these adverse sequelae. Development of a rationally designed biomaterial technology which is intended to be acutely placed within a VML defect - i.e., to serve as a muscle void filler (MVF) by maintaining the VML defect - could address this clinical unmet need by preventing these adverse sequelae as well as enabling multi-staged treatment approaches. To that end, three biomaterials were evaluated for their ability to serve as a provisional MVF treatment intended to stabilize a VML defect in a rat model for an extended period (28 days): polyvinyl alcohol (PVA), hyaluronic acid and polyethylene glycol combination (HA + PEG), and silicone, a clinically used soft tissue void filler. HA + PEG biomaterial showed signs of deformation, while both PVA and silicone did not. There were no differences between treatment groups for their effects on adjacent muscle fiber count and size distribution. Not surprisingly, silicone elicited robust fibrotic response resulting in a fibrotic barrier with a large infiltration of macrophages, a response not seen with either the PVA or HA + PEG. Taken together, PVA was found to be the best material to be used as a provisional MVF for maintaining VML defect volume while minimizing adverse effects on the surrounding muscle.
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Affiliation(s)
- Andrew Clark
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Jonathan Kulwatno
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sergey S. Kanovka
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Todd O. McKinley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin K. Potter
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Stephen M. Goldman
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Christopher L. Dearth
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Duong A, Roberts L, Cramm H, Evans MB, Mayhew E, Latimer-Cheung AE, Aiken A, Shirazipour CH. I AM FAMILY: Understanding the adapted sport experiences of family members of military personnel with physical and psychological illnesses and injuries through the lens of the Invictus Games. Psychol Sport Exerc 2023; 68:102457. [PMID: 37665901 DOI: 10.1016/j.psychsport.2023.102457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 09/06/2023]
Abstract
Family are influential actors in adapted sport participation. However, little is known about their experiences with adapted sport. The current study sought to explore the experiences of families in adapted sport through the context of the Invictus Games, an international adapted sport competition for military personnel with physical and psychological illnesses and injuries that is unique in its inclusion of family programming. Family members (n = 21; partners, parents, siblings, and children) of Invictus Games Toronto 2017 competitors participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis. Three themes were identified: recognition of family experiences during service and after onset of disability; creating a sense of belonging; and improving family knowledge and perceptions. This study provides insight regarding how adapted sport events can support the well-being of both individuals with illnesses and injuries and their families.
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Affiliation(s)
- Amber Duong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA; School of Medicine, University of California Irvine, Irvine, USA
| | - Lauren Roberts
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - M Blair Evans
- Department of Psychology, Western University, London, Canada
| | - Emily Mayhew
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Alice Aiken
- School of Physiotherapy, Dalhousie University, Halifax, Canada
| | - Celina H Shirazipour
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
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Le Dault E, Sicard S, Desplans J, Mayet A, Simon F, Aigle L, Savini H, Coton T, Marimoutou C; TAMIDOPEX team. A single dose of ciprofloxacin reduces the duration of diarrhea among service members deployed in Africa. Infect Dis Now 2023; 53:104643. [PMID: 36642099 DOI: 10.1016/j.idnow.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/27/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To assess the effectiveness of the adjunction of a one-gram single dose of ciprofloxacin to a symptomatic treatment for the early treatment of uncomplicated diarrhea during military operations of the French service members in Africa. PATIENTS AND METHODS This phase IV, multicentric, randomized, open-label, controlled trial was conducted in Chad, Mali, and in Central African Republic. A total of 267 French service members having at least one loose stool in the previous 24 hours were enrolled from May 2015 to June 2016. Participants were randomized to receive ciprofloxacin 1 g and a symptomatic treatment (racecadotril 100 mg three times a day and ad libidum oral rehydration solution) or a symptomatic treatment alone. The primary outcome was the duration of the diarrhea. Secondary outcomes were evaluated at the 72-hour endpoint and included recovery status, number of loose stools, frequency and duration of associated symptoms and safety of treatments. RESULTS Among 267 participants, 242 completed the trial. Participants receiving ciprofloxacin and a symptomatic treatment (n = 124) were significantly more likely to be cured at the endpoint than those who only received a symptomatic treatment (118): 94.4 % versus 74.6 % (OR = 5.7; 95 %CI: [2.4-13.6]; p < 10-3). The antibiotic therapy reduced the average diarrhea duration by 30 % (p = 10-4). Fever at inclusion was associated with a longer episode (HR = 0.61; 95 %CI: [0.41-0.89]; p = 0.012). No adverse event of medications was reported. CONCLUSION A single dose of ciprofloxacin was effective and safe in treating uncomplicated diarrhea among service members in Africa.
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Hsu NM, Morris K, Banaag A, Koehlmoos TP. TRICARE Extended Care Health Option Program: Prevalence of pediatric ECHO enrollees and healthcare service utilization in the Military Health System. Disabil Health J 2023:101451. [PMID: 36941191 DOI: 10.1016/j.dhjo.2023.101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/01/2022] [Accepted: 02/17/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The Extended Care Health Option (ECHO) Program is a TRICARE program aimed at reducing the disabling effects of chronic medical conditions for beneficiaries of the Department of Defense (DoD) healthcare program. However, little is known about military-connected children enrolled in the program. OBJECTIVE/HYPOTHESIS The aim of this study was to examine the demographic makeup of pediatric ECHO beneficiaries and their healthcare claims data. This is the first study to evaluate healthcare utilization of this subset of military dependents. METHODS A cross-sectional study was performed evaluating ECHO enrolled pediatric beneficiaries and their health service utilization during 2017-2019. TRICARE claims and military treatment facility (MTF) encounter data were utilized to evaluate health service utilization and identify the most frequently reported ICD-10-CM and CPT codes associated with care for this population. RESULTS Of the 2,001,619 dependents aged 0-26 years who received medical care in the Military Health System (MHS) during 2017-2019, 21,588 individuals (1.1%) were enrolled in ECHO. The majority of encounters (65.4%) were provided in the MTFs. Inpatient visits, therapeutic services, and in-home nursing care were the top utilized private sector care services. Outpatient visits encompassed 94.8% of healthcare encounters, and neurodevelopmental disorders were the top principal diagnoses among ECHO beneficiaries. CONCLUSIONS With the increasing prevalence of children with medical complexity and developmental delay, the pediatric TRICARE beneficiaries eligible for ECHO will likely continue to rise. Improving services and supports for military children with special healthcare needs is needed to maximize their developmental trajectory.
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Affiliation(s)
- Nicole M Hsu
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Kyla Morris
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Amanda Banaag
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Tracey P Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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11
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DeGroot DW, Henderson KN, O'Connor FG. Cooling Modality Effectiveness and Mortality Associate With Prehospital Care of Exertional Heat Stroke Casualities. J Emerg Med 2023; 64:175-180. [PMID: 36806435 DOI: 10.1016/j.jemermed.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/07/2022] [Accepted: 12/13/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Cold-water immersion is the gold standard for field treatment of an exertional heat stroke (EHS) casualty. Practical limitations may preclude this method and ice sheets (bed linens soaked in ice water) have emerged as a viable alternative. Laboratory studies suggest that this is an inferior method; however, the magnitude of hyperthermia is limited and may underestimate the cooling rate in EHS casualties. OBJECTIVE Our aim was to determine the prehospital core cooling rate, need for continued cooling on arrival to the emergency department, and mortality rate associated with ice sheet use. METHODS De-identified retrospective data were obtained from emergency medical services (EMS) and included presence or absence of altered mental status, cooling measures applied prior to EMS arrival, and time and core temperature (Tc; rectal) on-scene and on hospital arrival. Cooling rate was calculated from time and temperature data. Mortality data were obtained from the U.S. Army Combat Readiness Center. RESULTS There were 462 casualties that met inclusion criteria. The cooling rate for the entire sample was 0.07°C ± 0.08°C · min-1. EHS casualties with an observed initial Tc < 39°C had an en route cooling rate of 0.03°C ± 0.04°C · min-1 vs. initial Tc ≥ 39°C cooling rate of 0.16°C ± 0.08°C · min-1. There was one fatality due to EHS, for a mortality rate of 0.20% (95% CI 0.01-1.20%). CONCLUSIONS The cooling rate in EHS casualties with initial Tc ≥ 39°C was approximately double that reported in laboratory studies. The observed mortality rate was comparable with casualties treated with cold-water immersion. Our data suggest that ice sheets provide a viable alternative when practical constraints preclude cold-water immersion.
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Affiliation(s)
- David W DeGroot
- The Army Heat Center, Martin Army Community Hospital, Fort Benning, Georgia
| | - Kaemmer N Henderson
- Oak Ridge Institute for Science and Engineering (in support of The Army Heat Center), Martin Army Community Hospital, Fort Benning, Georgia
| | - Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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12
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Hirschfeld W, Corrado R, Banaag A, Korona-Bailey J, Koehlmoos TP. Identifying prescribing differences of direct oral anticoagulants for atrial fibrillation within the Military Health System. Am Heart J Plus 2023; 26:100258. [PMID: 38510183 PMCID: PMC10945905 DOI: 10.1016/j.ahjo.2023.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 03/22/2024]
Abstract
Background Direct oral anticoagulants (DOACs) are a first-line anticoagulant therapy for eligible patients with atrial fibrillation. Prescribing differences in the Military Health System have not yet been assessed. Methods We conducted a retrospective cross-sectional study using administrative claims data from the Military Health System Data Repository from fiscal years 2018-2019. We identified TRICARE Prime and Prime Plus patients between the ages of 18 and 64 with a diagnosis of atrial fibrillation and a CHA2DS2-VASc score of ≥2. Descriptive statistics and odds of receiving DOACs by gender, age, race, and socioeconomic status were calculated. Results A total of 5289 TRICARE Prime and Prime Plus patients within the Military Health System who carried a diagnosis of atrial fibrillation and a CHA2DS2-VASc ≥2 were identified. Of all patients, 2373 (40.71 %) were prescribed a DOAC whereas 287 (4.92 %) were prescribed warfarin within 90 days of diagnosis of atrial fibrillation. Black patients were significantly less likely to be prescribed a DOAC compared to White patients (adjusted odds ratio [aOR], 0.82; 95 % CI 0.68-0.99), as were females compared to males (aOR, 0.64; 95 % CI 0.52-0.79). Senior officers were significantly more likely to be prescribed a DOAC compared to senior enlisted service members (aOR, 0.64; 95 % CI 0.52-0.79). Conclusions Our study shows that differences exist within the Military Health System in the prescription of DOACs for atrial fibrillation by race, gender, and socio-economic status. These differences cannot be explained by differences in access to insurance or cost of medications.
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Affiliation(s)
- William Hirschfeld
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Richele Corrado
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Amanda Banaag
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement in Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Jessica Korona-Bailey
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement in Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Tracey Perez Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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13
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Reade MC. Whose side are you on? Complexities arising from the non-combatant status of military medical personnel. New Bioeth 2023:10.1007/s40592-022-00168-2. [PMID: 36630051 DOI: 10.1007/s40592-022-00168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Since the mid-1800s, clergy, doctors, other clinicians, and military personnel who specifically facilitate their work have been designated "non-combatants", protected from being targeted in return for providing care on the basis of clinical need alone. While permitted to use weapons to protect themselves and their patients, they may not attempt to gain military advantage over an adversary. The rationale for these regulations is based on sound arguments aimed both at reducing human suffering, but also the ultimate advantage of the nation-state fielding non-combatant staff. However, this is sometimes not immediately apparent to combatant colleagues. Clinicians in the armed force are also military officers, owing a "dual loyalty" that can create conflict if their non-combatant status is not well understood. Historical examples of doctors breaching their responsibilities include prioritisation of combat capability over the rights of individual soldiers (as occurred when scarce medical resources were allocated to soldiers more likely to return to battle in preference to those most likely to die without them), use of physicians to facilitate prisoner interrogation, medical research or treatment to enhance physical performance at the expense of health, application of Medical Rules of Eligibility according to factors other than clinical need, provision of treatment contingent upon support for military objectives, and use of medical knowledge to enhance weapons. However, not being a combatant party to a conflict does not imply that the non-combatant clinician cannot act in the national interest. Indeed, by adhering to the same universal ethics as their civilian colleagues, military clinicians provide optimal care to their own troops, facilitate freedom of action in host nations, and build positive international relationships during the conflict and in the post-conflict state.
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Affiliation(s)
- Michael C Reade
- Medical School, University of Queensland, Brisbane, QLD, Australia.
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14
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Reade MC. Perspective: the top 11 priorities to improve trauma outcomes, from system to patient level. Crit Care 2022; 26:395. [PMID: 36544203 PMCID: PMC9768970 DOI: 10.1186/s13054-022-04243-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Haemorrhage, Airway, Breathing, Circulation, Disability, Exposure/Environmental control approach to individual patient management in trauma is well established and embedded in numerous training courses worldwide. Further improvements in trauma outcomes are likely to result from a combination of system-level interventions in prevention and quality improvement, and from a sophisticated approach to clinical innovation. TOP ELEVEN TRAUMA PRIORITIES Based on a narrative review of remaining preventable mortality and morbidity in trauma, the top eleven priorities for those working throughout the spectrum of trauma care, from policy-makers to clinicians, should be: (1) investment in effective trauma prevention (likely to be the most cost-effective intervention); (2) prioritisation of resources, quality improvement and innovation in prehospital care (where the most preventable mortality remains); (3) building a high-performance trauma team; (4) applying evidence-based clinical interventions that stop bleeding, open & protect the airway, and optimise breathing most effectively; (5) maintaining enough circulating blood volume and ensuring adequate cardiac function; (6) recognising the role of the intensive care unit in modern damage control surgery; (7) prioritising good intensive care unit intercurrent care, especially prophylaxis for thromboembolic disease; (8) conducting a thorough tertiary survey, noting that on average the intensive care unit is where approximately 15% of injuries are detected; (9) facilitating early extubation; (10) investing in formal quantitative and qualitative quality assurance and improvement; and (11) improving clinical trial design. CONCLUSION Dramatic reductions in population trauma mortality and injury case fatality rate over recent decades have demonstrated the value of a comprehensive approach to trauma quality and process improvement. Continued attention to these principles, targeting areas with highest remaining preventable mortality while also prioritising functional outcomes, should remain the focus of both clinician and policy-makers.
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Affiliation(s)
- Michael C. Reade
- grid.1003.20000 0000 9320 7537Medical School, University of Queensland, Level 9 Health Sciences Building, Royal Brisbane and Women’s Hospital, Herston, QLD 4029 Australia ,grid.97008.360000 0004 0385 4044Joint Health Command, Australian Defence Force, Canberra, ACT 2610 Australia
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15
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Elliott CBP, Chambers CS. A historical analysis of vaccine mandates in the United States military and its application to the COVID-19 vaccine mandate. Vaccine 2022; 40:7500-7504. [PMID: 35989135 PMCID: PMC9376337 DOI: 10.1016/j.vaccine.2022.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 06/05/2022] [Accepted: 08/09/2022] [Indexed: 01/28/2023]
Abstract
The Department of Defense has implemented a mandate that all military personnel be vaccinated against COVID-19. This article reviews the historical precedent of vaccine mandates for United States military personnel dating back to the formation of the continental army, as well as previous controversies about vaccine mandates such as the first influenza vaccine mandate and the Anthrax Vaccine Immunization Program. The historical review discusses precedent for the current COVID-19 vaccine mandate and the reception of these vaccine mandates by military personnel. The review then discusses how these historical lessons can inform the present COVID-19 vaccine mandate.
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Affiliation(s)
- Capt Brian P. Elliott
- Department of Internal Medicine, Wright Patterson Medical Center, 4881 Sugar Maple Dr, Wright-Patterson Air Force Base, OH 45433, USA,Department of Internal Medicine and Neurology, Boonshoft School of Medicine, Wright State University, 128 E Apple St, Weber CHE Building, Dayton, OH 45409, USA,Corresponding author at: 4881 Sugar Maple Dr, Wright-Patterson Air Force Base, OH 45433, USA
| | - Col Steven Chambers
- Department of Internal Medicine and Neurology, Boonshoft School of Medicine, Wright State University, 128 E Apple St, Weber CHE Building, Dayton, OH 45409, USA,Pulmonary and Critical Care Consultants, Inc., InterMed Building, 1520 S Main St STE 2, Dayton, OH 45409, USA
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16
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Bowen M, Whiston B, Cooper M. Britain's forgotten military medical school at Fort Pitt, Kent (1860-1863). J Med Biogr 2022; 30:261-269. [PMID: 34152241 DOI: 10.1177/09677720211005130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This article considers the history of Fort Pitt (1780-1922), its military hospital (founded 1814) and, in particular, its Army Medical School (1860-63). The museum and library were the work of the hospital's first directors: Dr David MacLoughlin and Sir James McGrigor, the latter the renowned reformer of military medical education. Central to the foundation of the medical school was Florence Nightingale who visited the site in 1856. The school opened in 1860 with five sets of students attending before it was transferred in 1863 to the Royal Victoria hospital, Netley, Hampshire. Fort Pitt was a "practical" medical school with students attending for 4-9 months of clinical experience. This included "instruction in tropical medicine" delivered by members of the Indian Medical Service. The foundation of a military medical school fulfilled an ambition dating back to at least 1796. Nightingale's role (exerted through Sidney Herbert) was omitted from contemporary newspaper reports. Fort Pitt continued as a military hospital until 1922 when it was converted to a school. The medical school constitutes a landmark in British military medicine, a response to the failure of British medical care in the Crimean war (1853-1856) and a forgotten legacy of Florence Nightingale.
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Affiliation(s)
- Melissa Bowen
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - Benjamin Whiston
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - Max Cooper
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
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17
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Cao YH, Li X, Liu MH, Yang ZN, Gao YY, Wang D. [Association of RAAS gene polymorphisms with susceptibility to essential hypertension in military secret service personnel]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:504-508. [PMID: 35915940 DOI: 10.3760/cma.j.cn121094-20210202-00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To analyze the relationship between renin-angiotensin-aldosterone system (RAAS) gene polymorphisms and susceptibility to essential hypertension (EH) in military secret service personnel. Methods: In October 2019, military secret service personnel (162 people) who were recuperating in a sanatorium from January to December 2017 were selected as the research subjects, all of whom were Han and male. The patients (79 people) who were diagnosed with EH according to the diagnostic criteria of hypertension in the "Chinese Guidelines for the Prevention and Treatment of Hypertension" (2016 Revised Edition) were the case group, and the people with normal blood pressure (83 people) were the control group. Occupational epidemiological investigation was conducted, 5 ml of fasting cubital venous blood was collected, genomic DNA was extracted by phenol-chloroform method, and RAAS gene polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism method. The distribution differences of genotype and allele frequency between groups were compared, and the relationship between genotype, allele frequency and EH was analyzed. Results: The average age of military secret service personnel was (38.2±5.3) years old, and there was no statistical significance in the average age and the age distribution over 40 years old of the case group and the control group (P>0.05) . There were significant differences in the distribution of AGT gene M235T locus, ACE gene I/D polymorphism genotype and allele between the case group and the control group (P<0.05) . The TT genotype with AGT gene M235T locus (OR=3.28, 95%CI: 1.21-8.91) and DD genotype with ACE gene (OR=2.86, 95%CI: 1.17-7.00) were risk factors for EH in military secret service personnel. Conclusion: The TT genotype of AGT gene M235T and the DD genotype of ACE gene may be the susceptibility genotypes of military secret service personnel for EH.
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Affiliation(s)
- Y H Cao
- School of Public Health, North China University of Science and Technology, Tangshan 063000, China
| | - X Li
- Medical Department, Beidaihe Rest and Recuperation Center of PLA, Qinhuangdao 066000, China
| | - M H Liu
- Medical Department, Beidaihe Rest and Recuperation Center of PLA, Qinhuangdao 066000, China
| | - Z N Yang
- Medical Department, Beidaihe Rest and Recuperation Center of PLA, Qinhuangdao 066000, China
| | - Y Y Gao
- Medical Department, Beidaihe Rest and Recuperation Center of PLA, Qinhuangdao 066000, China
| | - D Wang
- Medical Department, Beidaihe Rest and Recuperation Center of PLA, Qinhuangdao 066000, China
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Abstract
Since its establishment in 2014, Military Medical Research has come a long way in becoming a premier journal for scientific articles from various different specialties, with a special emphasis on topics with military relevance. The field of military medicine may be obscure, and may not be readily encountered by the typical clinician on a day-to-day basis. This journal aims not only to pursue excellence in military research, but also keep current with the latest advancements on general medical topics from each and every specialty. This editorial serves to recap and synthesize the existing progress, updates and future needs of military medical excellence, discussing foremostly the unique traits of literature published in this journal, and subsequently presenting the discourse regarding wartime and peacetime medicine, the role of the military in a public health emergency, as well as wound healing and organ regeneration. Special attention have been devoted to military topics to shed light on the effects of Chemical, Biological, Radiological and Explosive (CBRE) warfare, environmental medicine and military psychiatry, topics which rarely have a chance to be discussed elsewhere. The interconnectedness between military combat and soldier physical and mental well-being is intricate, and has been distorted by pandemics such as coronavirus disease 2019 (COVID-19). This journal has come a long way since its first article was published, steadily contributing to the existing knowledge pool on general medical topics with a military slant. Only with continuous research and sharing, can we build upon the work of the scientific community, with hopes for the betterment of patient care.
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19
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Affiliation(s)
- Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 22529, Hamburg, Germany. .,Institute for Microbiology, Virology and Hygiene, University Medicine Rostock, 18057, Rostock, Germany.
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20
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Lewandowski SA, Shaman JL. Heat stress morbidity among US military personnel: Daily exposure and lagged response (1998-2019). Int J Biometeorol 2022; 66:1199-1208. [PMID: 35292853 DOI: 10.1007/s00484-022-02269-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
Heat stress illnesses represent a rising public health threat; however, associations between environmental heat and observed adverse health outcomes across populations and geographies remain insufficiently elucidated to evaluate risk and develop prevention strategies. In particular, military-relevant large-scale studies of daily heat stress morbidity responses among physically active, working-age adults to various indices of heat have been limited. We evaluated daily means, maximums, minimums, and early morning measures of temperature, heat index, and wet bulb globe temperature (WBGT) indices, assessing their association with 31,642 case-definition heat stroke and heat exhaustion encounters among active duty servicemembers diagnosed at 24 continental US installations from 1998 to 2019. We utilized anonymized encounter data consisting of hospitalizations, ambulatory (out-patient) visits, and reportable events to define heat stress illness cases and select the 24 installations with the highest case counts. We derived daily indices of heat from hourly-scale gridded climate data and applied a case-crossover study design incorporating distributed-lag, nonlinear models with 5 days of lag to estimate odds ratios at one-degree increments for each index of heat. All indices exhibited nonlinear odds ratios with short-term lag effects throughout observed temperature ranges. Responses were positive, monotonic, and exponential in nature, except for maximum daily WBGT, minimum daily temperature, temperature at 0600 h (local), and WBGT at 0600 h (local), which, while generally increasing, showed decreasing risk for the highest heat category days. The risk for a heat stress illness on a day with a maximum WBGT of 32.2 °C (90.0 °F) was 1.93 (95% CI, 1.82 - 2.05) times greater than on a day with a maximum WBGT of 28.6 °C (83.4 °F). The risk was 2.53 (2.36-2.71) times greater on days with a maximum heat index of 40.6 °C (105 °F) compared to 32.8 °C (91.0 °F). Our findings suggest that prevention efforts may benefit from including prior-day heat levels in risk assessments, from monitoring temperature and heat index in addition to WBGT, and by promoting control measures and awareness across all heat categories.
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Affiliation(s)
- Stephen A Lewandowski
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD, 20814, USA.
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY, 10032, USA.
| | - Jeffrey L Shaman
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY, 10032, USA
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21
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Worlton TJ, Shwayhat AF, Baird M, Fick D, Gadbois KD, Jensen S, Tadlock MD. US Navy Ship-Based Disaster Response: Lessons Learned. Curr Trauma Rep 2022;:1-9. [PMID: 35529774 DOI: 10.1007/s40719-022-00227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/12/2022]
Abstract
Purpose of Review The US Navy has a long history of responding to disasters around the globe. US Navy ships have unique characteristics and capabilities that determine their capacity for a disaster response. This paper discusses common considerations and lessons learned from three distinct disaster missions. Recent Findings The 2010 earthquake in Haiti had a robust response with multiple US Navy ship platforms. It was best assessed in three phases: an initial mass casualty response, a subacute response, and a humanitarian response. The 2017 response to Hurricane Maria had a significant focus on treating patients with acute needs secondary to chronic illnesses to decrease the burden on the local healthcare system. The COVID-19 response brought distinctive challenges as it was the first mission where hospital ships were utilized in an infectious disease deployment. Summary The first ships to respond to a disaster will need to focus on triage and acute traumatic injury. After this first phase, the ship’s medical assets will need to focus on providing care in a disrupted health care system which most often includes acute exacerbations of chronic disease. Surgeons must be ready to be flexible in their responsibilities, be competent with end-of-life care, and negotiate technical and cultural communication challenges.
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22
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Morte K, Marenco C, Lammers D, DeBarros M, Bingham J. Gender trends of military general surgery residency applicants. Am J Surg 2022:S0002-9610(22)00066-6. [PMID: 35183350 DOI: 10.1016/j.amjsurg.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the fact that women comprise half of medical school graduates, women remain under-represented in General Surgery. We aimed to identify the trend in military general surgery applicants based on gender. METHODS A retrospective review of the Medical Operational Data System (MODS) applicants from 2014 to 2019 was performed. Demographic data included age, gender, average board scores, applied and matched specialty. RESULTS 204 students applied and 167 applicants matched into Army General Surgery programs from 2014 to 2019. The percentage of all students applying to General Surgery was statistically higher in females (13.4% vs 9.0%, p = 0.04), with females matching at a statistically higher rate (77% vs 57%, p = 0.02). Over the last 6 years, 55% of residents in training are men and 45% are women. CONCLUSION Army General Surgery programs have increased the amount of women in training over the last six years. We believe that this will ultimately translate to more female surgeons contributing to military medicine.
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Sharma HS, Lafuente JV, Feng L, Muresanu DF, Menon PK, Castellani RJ, Nozari A, Sahib S, Tian ZR, Buzoianu AD, Sjöquist PO, Patnaik R, Wiklund L, Sharma A. Methamphetamine exacerbates pathophysiology of traumatic brain injury at high altitude. Neuroprotective effects of nanodelivery of a potent antioxidant compound H-290/51. Prog Brain Res 2021; 266:123-193. [PMID: 34689858 DOI: 10.1016/bs.pbr.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Military personnel are often exposed to high altitude (HA, ca. 4500-5000m) for combat operations associated with neurological dysfunctions. HA is a severe stressful situation and people frequently use methamphetamine (METH) or other psychostimulants to cope stress. Since military personnel are prone to different kinds of traumatic brain injury (TBI), in this review we discuss possible effects of METH on concussive head injury (CHI) at HA based on our own observations. METH exposure at HA exacerbates pathophysiology of CHI as compared to normobaric laboratory environment comparable to sea level. Increased blood-brain barrier (BBB) breakdown, edema formation and reductions in the cerebral blood flow (CBF) following CHI were exacerbated by METH intoxication at HA. Damage to cerebral microvasculature and expression of beta catenin was also exacerbated following CHI in METH treated group at HA. TiO2-nanowired delivery of H-290/51 (150mg/kg, i.p.), a potent chain-breaking antioxidant significantly enhanced CBF and reduced BBB breakdown, edema formation, beta catenin expression and brain pathology in METH exposed rats after CHI at HA. These observations are the first to point out that METH exposure in CHI exacerbated brain pathology at HA and this appears to be related with greater production of oxidative stress induced brain pathology, not reported earlier.
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Affiliation(s)
- Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, China
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Preeti K Menon
- Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Ala Nozari
- Anesthesiology & Intensive Care, Massachusetts General Hospital, Boston, MA, United States
| | - Seaab Sahib
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Per-Ove Sjöquist
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ranjana Patnaik
- Department of Biomaterials, School of Biomedical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, India
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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Borghi L, Riva E. Was Aldo Castellani the inventor of combined and polyvalent vaccines? Vaccine 2021; 39:5442-5446. [PMID: 34373123 DOI: 10.1016/j.vaccine.2021.07.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
Italian born and long term resident in England, Sir Aldo Castellani (1874-1971), is usually credited with "several discoveries of great importance in tropical medicine", most notably for his role in determining the aetiology of sleeping sickness and yaws. This contribution tries to highlight his role in the history of vaccinology as a pioneer in the design and use of combined and polyvalent vaccines. In the light of existing data, while acting as Director of the Bacteriological Institute of Colombo (Ceylon) in the decade before the First World War, Castellani was the first to experiment with both different strains of "antigens belonging to the same group" like in his typhoid-paratyphoid vaccine (TAB), as well as the simultaneous use of more pathogens, or part of them, for protection against different diseases, like in his "tetravaccine" (TAB + cholera) and "pentavaccine" (TAB + cholera + Malta fever). At the beginning of the War, based on the results of thousands of vaccinations, he strongly maintained that those combined or mixed vaccines were harmless and effective. The Allied Armies became more and more interested in Castellani's methods. His TAB vaccine was extensively used among the soldiers and his contributions were largely acknowledged especially in the Anglo-Saxon world in the following years, when it was plainly stated that "to Castellani is due the credit of having first proposed, prepared, and used, combined vaccines". The path to widespread use of combination and polyvalent vaccines - which is usually dated back only to the late 1940s - was still long and winding. Castellani himself abandoned that field of research after the War and this is probably why that early history is nowadays often forgotten.
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Affiliation(s)
- Luca Borghi
- History of Medicine, Department of Medicine and Surgery, Università Campus Bio-Medico, Rome, Italy.
| | - Elisabetta Riva
- Virology Section, Department of Medicine and Surgery, Università Campus Bio-Medico, Rome, Italy
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Drüge M, Rafique G, Jäger A, Watzke B. Prevalence of symptoms of body dysmorphic disorder (BDD) and associated features in Swiss military recruits: a self-report survey. BMC Psychiatry 2021; 21:294. [PMID: 34098932 PMCID: PMC8186044 DOI: 10.1186/s12888-021-03288-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Body dysmorphic disorder (BDD), defined as the obsessive idea that some aspect of one's own body or appearance is severely flawed/deformed, is relatively common in the general population and has been shown to have strong associations with mood and anxiety disorders and substance abuse disorders. Furthermore, a previous study on symptoms of BDD among people in the military showed that muscles are an important area of preoccupation. Hence, this study aimed to 1. assess the prevalence of BDD symptoms in Swiss military recruits, 2. specify the areas of preoccupation, and 3. analyze associated features (depression and alcohol/drug abuse). METHOD A total of 126 Swiss male military recruits (age: M = 20.12, SD = 1.09, range: 18-24) were examined using self-report measurements to assess symptoms of BDD, depression, alcohol/drug abuse. RESULTS The results showed that symptoms of BDD were relatively common (9.5% reached the cutoff value for probable BDD, 84% reported some symptoms), with the muscles as the most common area of preoccupation. A positive correlation (r = .38, p < .001) between depressive symptoms and symptoms of BDD was found, thus no correlation between alcohol/drug abuse and symptoms of BDD. CONCLUSION The results indicate a need to develop and implement measures for prevention (e.g. raising awareness among the military) and intervention in this specific population.
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Affiliation(s)
- Marie Drüge
- Department of Psychology, Clinical Psychology and Psychotherapy Research, University of Zurich, Binzmuehlestrasse 14, 8050, Zurich, Switzerland.
| | - Gabriela Rafique
- grid.7400.30000 0004 1937 0650Department of Psychology, Clinical Psychology and Psychotherapy Research, University of Zurich, Binzmuehlestrasse 14, 8050 Zurich, Switzerland
| | - Anne Jäger
- grid.7400.30000 0004 1937 0650Department of Psychology, Clinical Psychology and Psychotherapy Research, University of Zurich, Binzmuehlestrasse 14, 8050 Zurich, Switzerland
| | - Birgit Watzke
- grid.7400.30000 0004 1937 0650Department of Psychology, Clinical Psychology and Psychotherapy Research, University of Zurich, Binzmuehlestrasse 14, 8050 Zurich, Switzerland
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Malik NS, Chernbumroong S, Xu Y, Vassallo J, Lee J, Bowley DM, Hodgetts T, Moran CG, Lord JM, Belli A, Keene D, Foster M, Gkoutos GV. The BCD Triage Sieve outperforms all existing major incident triage tools: Comparative analysis using the UK national trauma registry population. EClinicalMedicine 2021; 36:100888. [PMID: 34308306 PMCID: PMC8257989 DOI: 10.1016/j.eclinm.2021.100888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Natural disasters, conflict, and terrorism are major global causes of death and disability. Central to the healthcare response is triage, vital to ensure the right care is provided to the right patient at the right time. The ideal triage tool has high sensitivity for the highest priority (P1) patients with acceptably low over-triage. This study compared the performance of major incident triage tools in predicting P1 casualty status in adults in the prospective UK Trauma Audit and Research Network (TARN) registry. METHODS TARN patients aged 16+ years (January 2008-December 2017) were included. Ten existing triage tools were applied using patients' first recorded pre-hospital physiology. Patients were subsequently assigned triage categories (P1, P2, P3, Expectant or Dead) based on pre-defined, intervention-based criteria. Tool performance was assessed by comparing tool-predicted and intervention-based priority status. FINDINGS 195,709 patients were included; mortality was 7·0% (n=13,601); median Injury Severity Score (ISS) was 9 (IQR 9-17); 97·1% sustained blunt injuries. 22,144 (11·3%) patients fulfilled intervention-based criteria for P1 status, exhibiting higher mortality (12·8% vs. 5·0%, p<0.001), increased intensive care requirement (52·4% vs 5·0%, p<0.001), and more severe injuries (median ISS 21 vs 9, p<0.001) compared with P2 patients.In 16-64 year olds, the highest performing tool was the Battlefield Casualty Drills (BCD) Triage Sieve (Prediction of P1 status: 70·4% sensitivity, over-triage 70·9%, area under the receiver operating curve (AUC) 0·068 [95%CI 0·676-0·684]). The UK National Ambulance Resilience Unit (NARU) Triage Sieve had sensitivity of 44·9%; over-triage 56·4%; AUC 0·666 (95%CI 0·662-0·670). All tools performed poorly amongst the elderly (65+ years). INTERPRETATION The BCD Triage Sieve performed best in this nationally representative population; we recommend it supersede the NARU Triage Sieve as the UK primary major incident triage tool. Validated triage category definitions are recommended for appraising future major incidents. FUNDING This study is funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre. GVG also acknowledges support from the MRC Heath Data Research UK (HDRUK/CFC/01). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care, or the Ministry of Defence.
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Affiliation(s)
- Nabeela S. Malik
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- 212 (Yorkshire) Field Hospital, Endcliffe Hall, Endcliffe Vale Road, Sheffield S10 3EU, UK
- Corresponding author at: NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK.
| | - Saisakul Chernbumroong
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Yuanwei Xu
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - James Vassallo
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Justine Lee
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- NHS England London, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Douglas M. Bowley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Timothy Hodgetts
- Army Health, Army Headquarters, Monxton Road, Andover SP11 8HT, UK
| | - Christopher G Moran
- NHS England London, Skipton House, 80 London Road, London SE1 6LH, UK
- Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK
| | - Janet M Lord
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Damian Keene
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Mark Foster
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Georgios V Gkoutos
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
- MRC Health Data Research UK (HDR UK), Midlands Site, B15 2TT UK
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Ponsin P, Swiech A, Poyat C, Alves F, Jacques AE, Franchin M, Raynaud L, Boutonnet M. Strategic air medical evacuation of critically ill patients involving an intensive care physician: A retrospective analysis of 16 years of mission data. Injury 2021; 52:1176-1182. [PMID: 33082029 DOI: 10.1016/j.injury.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Strategic medical evacuation (MEDEVAC) allows airborne repatriation of soldiers injured or sick on missions to their national territory. The aim of this study was to describe the epidemiology of strategic MEDEVAC performed by intensive care physicians (ICP) and to analyze the role of the ICP in the management of critical care situations in flight. METHODS All soldiers who had high or medium dependency conditions and who benefited from a strategic MEDEVAC with an ICP on board between 1 January 2001 and 30 November 2017 were included in this epidemiological retrospective study. RESULTS A total of 452 soldiers were repatriated; the causes of repatriation were either trauma (n = 245; 54%) or medical pathologies (n = 207; 46%). Two hundred and seventy-six (61%) evacuations were performed within 48 h. The median annual number of strategic MEDEVAC with an ICP was 26 [20-32]. One hundred and fifty-five (34%) patients were mechanically ventilated and 103 (23%) received catecholamines. The median SAPS II score was 13 [8-24]. One hundred and seventy-eight adverse events were identified, of which 123 (69%) related to a worsening of the patient's clinical condition and 30 (20%) related to a technical problem. Forty-seven (20%) patients who initially appeared stable worsened during the flight. No deaths occurred on board, however, and no flights had to be diverted due to an uncontrolled care situation. CONCLUSION The results suggested that the presence of an ICP ensured a continued high-level care for patients with serious trauma and medical injuries, due to the medical and aeronautical expertise that resulted from the theoretical and practical training of the personnel on board. Based on these results, lessons regarding future MEDEVAC flights could be learned in order to continue to improve patient outcome.
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Affiliation(s)
- Pauline Ponsin
- Burn Treatment Center, Percy Military Teaching Hospital, Clamart, France.
| | - Astrée Swiech
- Department of Anesthesiology and Intensive care, Percy Military Teaching Hospital, Clamart, France
| | - Chrystelle Poyat
- Department of Anesthesiology and Intensive care, Percy Military Teaching Hospital, Clamart, France.
| | - François Alves
- Department of Anesthesiology and Intensive Care, Sud Francilien Teaching Hospital, Corbeil-Essonnes, France
| | | | - Marylin Franchin
- 2ème Centre Medical des Armées, 12ème Antenne Médicale, French Army Medical Service, Villacoublay, France.
| | - Laurent Raynaud
- Department of Anesthesiology and Intensive care, Bégin Military Teaching Hospital, Saint-Mandé, France.
| | - Mathieu Boutonnet
- Department of Anesthesiology and Intensive care, Percy Military Teaching Hospital, Clamart, France
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Liu GD, Wang N, Wang HM, Li X, Shao JJ, Liu ZF, Jiang M, Wang L, Wang ZK, Li M, Cao XY, Wang J, Zhang R, Chen YD. Military medical research on internal diseases in modern warfare: new concepts, demands, challenges, and opportunities. Mil Med Res 2021; 8:20. [PMID: 33712087 PMCID: PMC7953602 DOI: 10.1186/s40779-021-00313-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 03/05/2021] [Indexed: 12/25/2022] Open
Abstract
Battlefield internal medicine aims at the treatment of combatants and noncombatants with various internal diseases on the battlefield. The military medical research on battlefield internal diseases focuses on the pathogenesis, clinical management, and prevention of internal diseases under military war conditions. In both wartime and peacetime, the soldiers suffer from more internal diseases than surgical wounds. With the introduction of high-tech weapons, including chemical, physical, and biological agents, a large number of special internal illnesses and casualties will appear in future wars. The battles often occur in special environments, such as high or low temperatures, plateau or polar areas, and micro- or hyper-gravity. The current theories of battlefield internal medicine are mainly derived from wars decades ago and cannot meet the needs of military medical support under the conditions of modern warfare. Therefore, the military medical research on battlefield internal medicine should be based on contemporary military situations, focus on the purpose of treating battlefield internal diseases, and adhere to the actual needs of the troops in peacetime and wartime. We should investigate the pathogenesis of battlefield internal diseases and explore the threats that may arise in future wars to ensure the advancement of battlefield internal medicine. This review highlights new concepts, demands, challenges, and opportunities for the further development of military medical research on battlefield internal medicine.
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Affiliation(s)
- Guang-Dong Liu
- Division of Health Services, Chinese PLA General Hospital & Chinese PLA Medical School, Beijing, 100853, China
| | - Nan Wang
- Division of Health Services, Chinese PLA General Hospital & Chinese PLA Medical School, Beijing, 100853, China
| | - Hai-Ming Wang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Xin Li
- Department of Health Services, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jun-Jie Shao
- The First Clinical Medical College of Inner Mongolia Medical University, Hohhot, 010059, China
| | - Zi-Fan Liu
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Min Jiang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Lin Wang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Zi-Kai Wang
- Department of Gastroenterology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Meng Li
- Department of Hematology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xue-Ying Cao
- Department of Nephrology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiang Wang
- Department of Respiratory and Intensive Medicine, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ran Zhang
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China.
| | - Yun-Dai Chen
- Department of Cardiovascular Medicine, Chinese PLA General Hospital & Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China.
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Lall M, Datta K, Iyengar MRA, Shakya A, Kanitkar M. M3: The military medicine module: A focussed competency-based program. Med J Armed Forces India 2021; 77:S99-S106. [PMID: 33612939 PMCID: PMC7873731 DOI: 10.1016/j.mjafi.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Military medicine is a unique and specific field for the armed forces doctors providing skill-based training on military specific injuries and diseases arising due to the unique occupational conditions. The current study retrospectively studied the planning and implementation of the military medicine module which was carried out with the aim of imparting the requisite skills to military doctors. METHODS The study was a qualitative research, carried over two years, 2017-2019. The study population included two batches of recently graduated medical doctors about to be commissioned . The methodology included needs assessment and gap analysis which was carried out by consulting experts from the tri services. Feedback was taken by medical education experts from both the batches using surveys, and modifications were done after brainstorming with experts keeping feedback in mind. RESULTS There was an improvement in the rating scores and an improved performance by participants was seen in the competencies. CONCLUSION In conclusion the module was developed and implemented keeping in mind the important skills that military physicians need to learn through training as these are not been taught in any educational syllabus. To achieve such skills and capabilities, gap analysis is essential and programs should be implemented keeping scope for modification depending on the feedback after brainstorming. Feedback remains important in development of such modules and hence should be collected anonymously.
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Affiliation(s)
- Mahima Lall
- Resource Faculty, NMCRC for Medical Education Technologies, AFMC Pune & Professor, Dept of Microbiology, AFMC Pune, India
| | - Karuna Datta
- Convener, NMCRC for Medical Education Technologies, Coordinator, Dept of Medical Education & Professor, Dept of Sports Medicine, AFMC, Pune, India
| | | | - Ashwani Shakya
- Training Officer, Armed Forces Medical College, Pune, India
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You W, Galassi FM, Varotto E, Henneberg M. Genghis Khan's death (AD 1227): An unsolvable riddle or simply a pandemic disease? Int J Infect Dis 2021; 104:347-8. [PMID: 33444749 DOI: 10.1016/j.ijid.2020.12.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/29/2020] [Indexed: 11/21/2022] Open
Abstract
The article examines Genghis Khan's death from the historico-medical perspective. Although several etiologies have been proposed over the years, most of these at a closer look appear to be later inventions by historians. A reassessment of the available evidence suggests instead bubonic plague as the most likely clinical scenario. Genghis Khan's death is also a reflection on the impact of pandemic diseases on leadership in ancient times as well as nowadays.
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31
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Peng Y, Lyu LY, Ma B. [Advances in the research of application of virtual reality technology in war trauma treatment training]. Zhonghua Shao Shang Za Zhi 2020; 36:515-8. [PMID: 32594716 DOI: 10.3760/cma.j.cn501120-20190425-00215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As an important medical support component for the army to preserve and enhance combat effectiveness and minimize the reduction rate of combat personnel, war trauma treatment has been highly valued. Modern war puts forward higher requirements for the pertinence, practicality, and efficiency of war trauma treatment training. With the comprehensive development of national defense and military modernization, the contradiction between the increasing demand of modern war medical service and the relatively backward training mode of war trauma treatment becomes more and more prominent. As a new practical technology, virtual reality technology can simulate the elements of war trauma treatment in a panoramic manner, enabling the trainees to have a real sense of the battlefield in the four-dimensional space of high simulation, which has unique advantage in the field of war trauma treatment training. At present, the western developed countries represented by the the United States of America have applied virtual reality technology in the field of war trauma treatment training and achieved gratifying training results through the actual combat tests. This paper reviews the application of virtual reality technology in the field of war trauma treatment training at home and abroad, in order to provide a new idea and method for improving the level of war trauma treatment training in our army.
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Epstein D, Markovitz E, Nakdimon I, Guinzburg A, Aviram E, Gordon B, Shapira S, Sharon S, Steinfeld Y, Miller A, Lipsky AM. Injuries associated with the use of ejection seats: a systematic review, meta-analysis and the experience of the Israeli Air Force, 1990-2019. Injury 2020; 51:1489-1496. [PMID: 32430195 DOI: 10.1016/j.injury.2020.04.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION All modern military jet aircraft are equipped with rocket-assisted ejection systems. Jet aircraft operate in the majority of the conflict regions throughout the world, and in nearly all modern countries during peacetime. Civilian and military emergency services may be called upon to treat aircrews that have ejected and should be familiar with the common injury patterns associated with aircraft ejection. METHODS A systematic review and meta-analysis of the literature were undertaken using the preferred reporting for systematic reviews and meta-analyses (PRISMA) methodology. Peer-reviewed journal and conference papers published between 1 January 1971 and 15 June 2019 were included. Our primary outcomes of interest were mortality and major injury rates. The I2 test was used to assess heterogeneity among the included studies, and data were pooled under random effects models. In addition, all ejection cases in the Israeli Air Force (IAF) between 1990 and 2019 were studied. The data were manually extracted from the accident records and the electronic medical records system. RESULTS We identified 14 studies that included 1710 aircrew ejections. Heterogeneity was high (I2>75%). Pooled mean mortality and major injury rates were 10.5% (95% CI 6.8-14.8%) and 29.8% (95% CI 20.1-40.6%), respectively. The major injuries included spinal fractures (61.6%), extremity trauma (27.3%), and head trauma (8.9%). During the IAF study period, a total of 37 aircrew ejected from 26 IAF aircraft. The fatality rate was 5.4% and 18.9% suffered major injuries. CONCLUSIONS Although ejection is lifesaving, it is associated with unique injury patterns that should be addressed during clinical evaluation. Because of their high prevalence, spinal precautions are paramount until spinal injury can be ruled out, generally by advanced imaging. Looking forward, injury patterns will continue to evolve in parallel with improving ejection seat systems.
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Affiliation(s)
- Danny Epstein
- Medical Corps, Israeli Defense Forces, Tel-Hashomer, Israel; Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel.
| | - Eden Markovitz
- The Israeli Air Force Aero Medical Center, Tel-Hashomer, Israel
| | - Idan Nakdimon
- The Israeli Air Force Aero Medical Center, Tel-Hashomer, Israel
| | | | - Eliad Aviram
- Medical Corps, Israeli Defense Forces, Tel-Hashomer, Israel
| | - Barak Gordon
- Medical Corps, Israeli Defense Forces, Tel-Hashomer, Israel; The Israeli Air Force Aero Medical Center, Tel-Hashomer, Israel
| | | | - Saar Sharon
- Medical Corps, Israeli Defense Forces, Tel-Hashomer, Israel
| | - Yaniv Steinfeld
- Orthopedic Surgery Division, Hillel Yaffe Medical Center, Hadera, Israel
| | - Asaf Miller
- Medical Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel
| | - Ari M Lipsky
- Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel
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Suda AJ, Höppchen I. [Terror awareness of 5th year medical students in the Mannheim reformed curriculum medicine plus]. Unfallchirurg 2020:10.1007/s00113-020-00808-4. [PMID: 32347370 DOI: 10.1007/s00113-020-00808-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The treatment of gunshot wounds and wounds caused by explosive devices as used in terrorist attacks is not currently an issue for education in most medical faculties; however, because of the increasing number of terrorist attacks in Germany and Europe this is becoming more important. The aim of this study was to evaluate the knowledge of dealing with and treatment of patients as victims of terrorist attacks of 5th year medical students at the Mannheim Medical Faculty of Heidelberg University prior to and after a specific seminar. METHODS All students offered to participate voluntarily. Before the seminar a questionnaire with six questions about previous knowledge on terror awareness was distributed. After the seminar another almost identical questionnaire with six questions was distributed and completed by the students. RESULTS A total of 97 medical students agreed to take part in the study of whom 53 were female. The mean age was 25.4 years (SD 2.75 years). After the seminar the students wanted to statistically significantly intensify the topic and believed that hospitals should be prepared for the treatment of victims of terrorism. CONCLUSION With the seminar "Military Medicine", which was held as part of the Mannheim reformed curriculum of medicine (MaReCuM plus) in the 5th year, the interest of medical students could be significantly increased. This study could show for the first time that terrorist attacks and the resulting injuries have significant relevance for medical students. Consideration of this topic in all medical school curricula would be justified.
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Affiliation(s)
- Arnold J Suda
- AUVA Unfallkrankenhaus Salzburg, Akademisches Lehrkrankenhaus der Paracelsus Universität, Doktor-Franz-Rehrl-Platz 5, 5010, Salzburg, Österreich.
- Medizinische Fakultät Mannheim der Universität Heidelberg, Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Isabel Höppchen
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Marsilius-Arkaden, Turm West. Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
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Reuter M, Kruger DH. Approaches to optimize therapeutic bacteriophage and bacteriophage-derived products to combat bacterial infections. Virus Genes 2020; 56:136-149. [PMID: 32036540 PMCID: PMC7223754 DOI: 10.1007/s11262-020-01735-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/18/2020] [Indexed: 12/14/2022]
Abstract
The emerging occurrence of antibiotic-resistant bacterial pathogens leads to a recollection of bacteriophage as antimicrobial therapeutics. This article presents a short overview of the clinical phage application including their use in military medicine and discusses the genotypic and phenotypic properties of a potential "ideal" therapeutic phage. We describe current efforts to engineer phage for their improved usability in pathogen treatment. In addition, phage can be applied for pathogen detection, selective drug delivery, vaccine development, or food and surface decontamination. Instead of viable phage, (engineered) phage-derived enzymes, such as polysaccharide depolymerases or peptidoglycan-degrading enzymes, are considered as promising therapeutic candidates. Finally, we briefly summarize the use of phage for the detection and treatment of "Category A priority pathogens".
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Affiliation(s)
- Monika Reuter
- Institute of Virology, Helmut-Ruska-Haus, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Detlev H. Kruger
- Institute of Virology, Helmut-Ruska-Haus, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
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Gu GL, Duan FX, Zhang Z, Wei XM, Cui L, Zhang B. Must pilots permanently quit flying career after treatment for colorectal cancer? - Medical waiver for Air Force pilots with colorectal cancer: Three case reports. World J Clin Cases 2020; 8:790-797. [PMID: 32149062 PMCID: PMC7052549 DOI: 10.12998/wjcc.v8.i4.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/09/2019] [Accepted: 12/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) could seriously threaten the physical and mental health of pilots. Shall they end their flying after treatment of CRC? With this study, we investigated the possibility of a gradual medical waiver for such pilots to fly aircrafts again after treatment of CRC.
CASE SUMMARY We analyzed the medical waiver and clinical data of 3 pilots with CRC, who had accepted the treatment at the Department of General Surgery, Air Force Medical Center (formerly, Air Force General Hospital) between 2013 and 2018. All 3 cases underwent a series of comprehensive treatment courses, including radical resection of CRC, sequential radiotherapy, and chemotherapy. The follow-up results were satisfactory. After passing through the high-risk period of recurrence and metastasis of CRC, they all were given a medical waiver for flying again. Medical observation showed that their flying operations were safe.
CONCLUSION The CRC treatment shall follow the guidelines for diagnosis and treatment and should simultaneously protect the combating capabilities of pilots as much as possible. It is safe for pilots with CRC, who are continuously monitored under medical observation after passing through the high-risk period of recurrence and metastasis, to undertake military flight missions again.
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Affiliation(s)
- Guo-Li Gu
- Department of General Surgery, Air Force Medical Center, PLA, Beijing 100142, China
| | - Fu-Xiao Duan
- Department of General Surgery, the General Hospital of Northern Theater Command PLA, Shenyang 110016, Liaoning Province, China
| | - Zhi Zhang
- Department of General Surgery, Air Force Medical Center, PLA, Beijing 100142, China
| | - Xue-Ming Wei
- Department of General Surgery, Air Force Medical Center, PLA, Beijing 100142, China
| | - Li Cui
- Department of Aviation Diseases, Air Force Medical Center, PLA, Beijing 100142, China
| | - Bo Zhang
- Department of Medical Research, Air Force Medical Center, PLA, Beijing 100142, China
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Wynn-Jones W, Koehlmoos TP, Tompkins C, Navathe A, Lipsitz S, Kwon NK, Learn PA, Madsen C, Schoenfeld A, Weissman JS. Variation in expenditure for common, high cost surgical procedures in a working age population: implications for reimbursement reform. BMC Health Serv Res 2019; 19:877. [PMID: 31752866 PMCID: PMC6873455 DOI: 10.1186/s12913-019-4729-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 11/07/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In the move toward value-based care, bundled payments are believed to reduce waste and improve coordination. Some commercial insurers have addressed this through the use of bundled payment, the provision of one fee for all care associated with a given index procedure. This system was pioneered by Medicare, using a population generally over 65 years of age, and despite its adoption by mainstream insurers, little is known of bundled payments' ability to reduce variation or cost in a working-age population. This study uses a universally-insured, nationally-representative population of adults aged 18-65 to examine the effect of bundled payments for five high-cost surgical procedures which are known to vary widely in Medicare reimbursement: hip replacement, knee replacement, coronary artery bypass grafting (CABG), lumbar spinal fusion, and colectomy. METHODS Five procedures conducted on adults aged 18-65 were identified from the TRICARE database from 2011 to 2014. A 90-day period from index procedure was used to determine episodes of associated post-acute care. Data was sorted by Zip code into hospital referral regions (HRR). Payments were determined from TRICARE reimbursement records, they were subsequently price standardized and adjusted for patient and surgical characteristics. Variation was assessed by stratifying the HRR into quintiles by spending for each index procedure. RESULTS After adjusting for case mix, significant inter-quintile variation was observed for all procedures, with knee replacement showing the greatest variation in both index surgery (107%) and total cost of care (75%). Readmission was a driver of variation for colectomy and CABG, with absolute cost variation of $17,257 and $13,289 respectively. Other post-acute care spending was low overall (≤$1606, for CABG). CONCLUSIONS This study demonstrates significant regional variation in total spending for these procedures, but much lower spending for post-acute care than previously demonstrated by similar procedures in Medicare. Targeting post-acute care spending, a common approach taken by providers in bundled payment arrangements with Medicare, may be less fruitful in working aged populations.
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Affiliation(s)
- W. Wynn-Jones
- Centre for Surgery and Public Health, Brigham and Women’s Hospital, 1620 Tremont Street, 1 Brigham Circle, Boston, MA 02120 USA
| | - T. P. Koehlmoos
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20184 USA
| | - C. Tompkins
- Heller Graduate School, Brandeis University, 415 South St., Waltham, MA 02354 USA
| | - A. Navathe
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - S. Lipsitz
- Division of General Internal Medicine and Center for Surgery and Public Health, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - N. K. Kwon
- Centre for Surgery and Public Health, Brigham and Women’s Hospital, Boston, USA
| | - P. A. Learn
- Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - C. Madsen
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - A. Schoenfeld
- Department of Orthopaedic Surgery Center for Surgery and Public health Brigham and Women’s Hospital Harvard Medical School, Boston, USA
| | - J. S. Weissman
- (Health Policy) Harvard Medical School, Center for Surgery and Public Health, Boston, USA
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Kollock RO, Lyons M, Sanders G, Hale D. The effectiveness of the functional movement screen in determining injury risk in tactical occupations. Ind Health 2019; 57:406-418. [PMID: 30393251 PMCID: PMC6685800 DOI: 10.2486/indhealth.2018-0086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Injures are common in workers engaged in tactical occupations. Research suggests that the functional movement screen (FMS) may provide practitioners the ability to identify tactical athletes most at risk for injury. However, there exists controversy as to the effectiveness of the FMS as a tool for classifying injury risk. The purpose of the meta-analysis was to determine the predictive value of the FMS in determining injury risk in workers engaged in tactical occupations. We searched MEDLINE, Military and Government Collection (EBSCO), National Institute for Occupational Safety and Health Technical Information Center and PubMed databases for articles published between January 2000 and October 2017 [corrected]. Ten studies met the inclusion criteria. Multiple random-effects model meta-analyses were conducted, with an odds ratio as the effects metric. FMS cut-off score, occupation, injury type and sex were used as moderators for the analyses. The odds of injury were greatest for tactical athletes with FMS scores ≤14. Personnel scoring ≤14 had almost 2 times the odds of injury as compared to those scoring >14. However, the magnitude of the effects were small; thus the relationship between FMS cut scores and injury prediction does not support its use as a sole predictor of injury.
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Affiliation(s)
- Roger O Kollock
- Department of Kinesiology and Rehabilitative Sciences, The University of Tulsa, USA
| | - Madeline Lyons
- Department of Kinesiology and Rehabilitative Sciences, The University of Tulsa, USA
| | - Gabe Sanders
- Department of Kinesiology and Health, Northern Kentucky University, USA
| | - Davis Hale
- Department of Kinesiology and Rehabilitative Sciences, The University of Tulsa, USA
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Mior S, Sutton D, Cancelliere C, French S, Taylor-Vaisey A, Côté P. Chiropractic services in the active duty military setting: a scoping review. Chiropr Man Therap 2019; 27:45. [PMID: 31338157 PMCID: PMC6628474 DOI: 10.1186/s12998-019-0259-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background Musculoskeletal injuries are one of the most prevalent battle and non-battle related injuries in the active duty military. In some countries, chiropractic services are accessed to manage such injuries within and outside military healthcare systems; however, there is no recent description of such access nor outcomes. This scoping review aimed to synthesize published literature exploring the nature, models, and outcomes of chiropractic services provided to active duty military globally. Method We employed scoping review methodology. Systematic searches of relevant databases, including military collections and hand searches were conducted from inception to October 22, 2018. We included peer-reviewed English literature with qualitative and quantitative designs, describing chiropractic practice and services delivered to active duty military worldwide. Paired reviewers independently reviewed all citations and articles using a two-phase screening process. Data from relevant articles were extracted into evidence tables and sorted by study type. Results were descriptively analyzed. Results We screened 497 articles and 20 met inclusion criteria. Chiropractic services were commonly provided on-base only in the US. Services were accessed by physician referral and commonly after initiation or non-response to other care. Use of scope of practice was determined by the system/facility, varying from intervention specific to comprehensive services. Back pain with and without radiculopathy accounted for most complaints. Treatment outcomes were reported primarily by case reports. However, two recent randomized trials reported improved pain, disability, and satisfaction when adding chiropractic care to usual medical care compared to usual medical care alone in management of low back pain. Specific reaction time measures in special operation forces military did not improve after chiropractic care compared to wait-list control. Conclusions Our scoping review found the majority of published articles described chiropractic services in the active duty military in the US setting. Recent RCTs suggest a benefit of including chiropractic care to usual medical care in managing back pain in active duty military. Yet despite reported benefits in Australia, Canada, and the US, there is a need for further qualitative, descriptive, and clinical trial data worldwide to inform the role of chiropractic services in active duty military.
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Affiliation(s)
- Silvano Mior
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Deborah Sutton
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Daphne To
- Department of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Carolina Cancelliere
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada
| | - Simon French
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Level 3, 17 Wally’s Walk, North Ryde, NSW 2109 Australia
| | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Pierre Côté
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada
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Madenci AL, Armstrong LB, Kwon NK, Jiang W, Wolf LL, Koehlmoos TP, Ricca RL, Weldon CB, Haider AH, Weil BR. Incidence and risk factors for sepsis after childhood splenectomy. J Pediatr Surg 2019; 54:1445-1448. [PMID: 30029846 DOI: 10.1016/j.jpedsurg.2018.06.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Children who have undergone splenectomy may develop impaired immunologic function and heightened risk of overwhelming postsplenectomy infection. We sought to define the long-term rate of and risk factors for postsplenectomy sepsis. METHODS We leveraged the Military Health System Data Repository, a nationally representative claims database including >3 million children registered as dependents of members of the United States Armed Services (2005-2014). Inclusion criterion was splenectomy at age 18 years or prior. The primary outcome was hospitalization for sepsis. RESULTS Among 195 children who underwent splenectomy, 7% (n = 13) were hospitalized with sepsis, with an incidence of 1.8 (95% CI = 1.0-3.1) events per 100 person-years. The median time to sepsis was 224 days (IQR = 109-606) and 38% (5/13) of events occurred within the first postsplenectomy year. The postsplenectomy mortality rate was 1% (n = 3). After adjusting for underlying diagnosis, older age at splenectomy (HR = 0.90 per year, 95% CI = 0.81-0.99) was associated with decreased hazard of sepsis. CONCLUSIONS In a contemporary national cohort, the prevalence of postsplenectomy sepsis was 7% (1.8 events per 100 person-years). Although most presented during the first year after splenectomy, many (62%) sepsis events occurred later, suggesting that postsplenectomy immunologic dysfunction persists beyond one year. The immunologic consequences of asplenia must continue to be acknowledged, as postsplenectomy sepsis remains a serious concern. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Arin L Madenci
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States; Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; The Center for Surgery and Public Health, Boston, MA, United States.
| | - Lindsey B Armstrong
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Wei Jiang
- The Center for Surgery and Public Health, Boston, MA, United States
| | - Lindsey L Wolf
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; The Center for Surgery and Public Health, Boston, MA, United States
| | - Tracey P Koehlmoos
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Robert L Ricca
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Christopher B Weldon
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Adil H Haider
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; The Center for Surgery and Public Health, Boston, MA, United States
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
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D'Angelo M, Welder M, Chauhan R, Kearns MJ. Future Trends in Trauma Care: Through the Lens of the Wounded How Lessons from the Battlefield May Be Used at Home. Anesthesiol Clin 2019; 37:183-193. [PMID: 30711231 DOI: 10.1016/j.anclin.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The coordinated terrorist attacks of 2001 thrust the United States and its allies to war. Through an evolving battlefield, the paradigm of large fixed medical facilities advanced to become nimble surgical and resuscitative platforms, able to provide care far forward. Innovations like tactical combat casualty care, evacuation, fresh whole-blood administration, freeze-dried plasma, and forward surgical care military medicine helped reduce combat mortality to its lowest levels in history. Through the account of a young wounded marine wounded in Iraq, this article examines how innovations on the battlefield saved casualties and explores how these techniques may be applied at home.
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Affiliation(s)
- Matthew D'Angelo
- Nurse Anesthesia Program, Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Matthew Welder
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Ravi Chauhan
- Royal Centre of Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, UK
| | - Michel J Kearns
- Department of Anesthesiology, Medical Corps, U.S. Navy, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
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Takkar P, Prabhakar R. Stress fractures in military recruits: A prospective study for evaluation of incidence, patterns of injury and invalidments out of service. Med J Armed Forces India 2019; 75:330-334. [PMID: 31388239 DOI: 10.1016/j.mjafi.2018.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/13/2018] [Indexed: 10/27/2022] Open
Abstract
Background Stress fractures (SFs) occur because of repetitive submaximal stresses to the bone over a period of time. SFs cause an economic loss to the organization and to the individuals who get invalided out of army because of SFs. This study was conducted to determine the incidence, distribution, onset of SFs, and invalidment patterns due to SFs. Methods This prospective study was carried out among recruits undergoing training at training centres in a cantonment of Central India. The recruits enrolled were followed up through their training period for occurrence of SF. On occurrence of SF, the clinical features, site of bone involved, and the weeks of completed military training were noted. The SFs were graded into four grades based on clinicoradiological features and managed accordingly. Results A total of 8974 recruits were enrolled into the study, of which 208 recruits suffered SFs. The commonest bone involved was the tibia (86.5%), commonest site being the proximal one-third of the tibia shaft (46.2%). Average week of developing SF was the 15th week of training. Seven recruits were invalided out of army because of SFs, the commonest cause being femoral neck SFs. Conclusion Prevention is the best approach for SFs. It is suggested to increase the intensity of training gradually over the first 16 weeks and recruits are to be given a training pause at around the 12th week for healing of stressed bones just before the peak time of occurrence of SFs. Femoral neck SFs are the commonest SFs responsible for invalidment of recruits.
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Affiliation(s)
- Puneet Takkar
- Senior Registrar & OC Tps, Military Hospital Jabalpur, MP, India
| | - Rajat Prabhakar
- Graded Specialist (Surgery), Military Hospital Jabalpur, MP, India
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Wernecke S, Lührs J, Hossfeld B. [The Strategic-Aeromedical-Evacuation-System of the German Armed Forces : Long-distance air transport as a challenge for intensive care nurses]. Med Klin Intensivmed Notfmed 2019; 114:752-8. [PMID: 30721333 DOI: 10.1007/s00063-019-0535-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 10/27/2022]
Abstract
This article presents the German Armed Forces Strategic Aeromedical Evacuation system. The following factors are described in detail: the path of alert, the used aircrafts, the medical equipment, the medical care personnel with its associated training as well as the aeronautical and medical issues. This military system for long haul intensive care transport offers many medical possibilities in critical care repatriations from deployment areas, as well as disaster relief missions. It has been successfully proven in numerous military and civil operations and continues to have high recognition among all military allies until today. Different priorities and readiness levels build the base for flexible use of various aircraft types and associated personnel, so that almost every scenario can be covered. The ever-changing tasks and needs of the German armed forces require constant adjustment of this air transport system. For the specialist nurse the intensive care of a patient during air transport is a technical and physical challenge.
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Wooten NR, Brittingham JA, Sumi NS, Pitner RO, Moore KD. Behavioral Health Service Use by Military Children During Afghanistan and Iraq Wars. J Behav Health Serv Res 2019; 46:549-569. [PMID: 30627946 DOI: 10.1007/s11414-018-09646-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Medical claims were analyzed from 2810 military children who visited a civilian emergency department (ED) or hospital from 2000 to 2014 with behavioral health as the primary diagnosis and TRICARE as the primary/secondary payer. Visit prevalence was estimated annually and categorized: 2000-2002 (pre-deployment), 2003-2008 (first post-deployment), 2009-2014 (second post-deployment). Age was categorized: preschoolers (0-4 years), school-aged (5-11 years), adolescents (12-17 years). During Afghanistan and Iraq wars, 2562 military children received 4607 behavioral health visits. School-aged children's mental health visits increased from 61 to 246 from pre-deployment to the second post-deployment period. Adolescents' substance use disorder (SUD) visits increased almost 5-fold from pre-deployment to the first post-deployment period. Mental disorders had increased odds (OR = 2.93, 95% CI 1.86-4.61) of being treated during hospitalizations than in EDs. Adolescents had increased odds of SUD treatment in EDs (OR = 2.92, 95% CI 1.85-4.60) compared to hospitalizations. Implications for integrated behavioral health and school behavioral health interventions are discussed.
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Affiliation(s)
- Nikki R Wooten
- College of Social Work, Hamilton College, University of South Carolina, Columbia, SC, 29208, USA.
| | | | - Nahid S Sumi
- Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Ronald O Pitner
- College of Social Work, Hamilton College, University of South Carolina, Columbia, SC, 29208, USA
| | - Kendall D Moore
- Department of Psychology, University of South Carolina, Columbia, USA
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Abstract
Historians tend to view public health as a quintessentially modern phenomenon, enabled by the emergence of representative democracies, centralised bureaucracies and advanced biomedicine. While social, urban and religious historians have begun chipping away at the entrenched dichotomy between pre/modernity that this view implies, evidence for community prophylactics in earlier eras also emerges from a group of somewhat unexpected sources, namely military manuals. Texts composed for (and often by) army leaders in medieval Latin Europe, East Rome (Byzantium) and other premodern civilisations reflect the topicality of population-level preventative healthcare well before the nineteenth century, thereby broadening the path for historicising public health from a transregional and even global perspective. Moreover, at least throughout the Mediterranean world, military manuals also attest the enduring appeal of Hippocratic and Galenic prophylactics and how that medical tradition continued for centuries to shape the routines and material culture of vulnerable communities such as armies.
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Riddle MS, Connor P, Porter CK. Montezuma’s revenge - the sequel: The one-hundred year anniversary of the first description of “post-infectious” irritable bowel syndrome. World J Gastroenterol 2018; 24:5076-5080. [PMID: 30568385 PMCID: PMC6288650 DOI: 10.3748/wjg.v24.i45.5076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/28/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
One-hundred years have passed since the original description of the commonly described phenomenon of persistent abdominal symptoms being triggered by an acute enteric infection. This first account was generated out of astute observations by Sir Arthur Hurst in World War I. Additional descriptions followed from military and non-military practitioners adding the evidence which has transitioned this recognized condition from association to causation. While mechanistic understanding is an area of active pursuit, this historical accounting of a centuries progress highlights important advances and contributions of military medicine and scientists to advances benefiting global populations.
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Affiliation(s)
- Mark S Riddle
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20814, United States
| | - Patrick Connor
- Military Enteric Disease Group, Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham Research Park, Birmingham B15 2SQ, United Kingdom
| | - Chad K Porter
- Department of Enteric Diseases, Naval Medical Research Center, Silver Spring, MD 20910, United States
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Dietrich EJ, Leroux T, Santiago CF, Helgeson MD, Richard P, Koehlmoos TP. Assessing practice pattern differences in the treatment of acute low back pain in the United States Military Health System. BMC Health Serv Res 2018; 18:720. [PMID: 30223830 PMCID: PMC6142362 DOI: 10.1186/s12913-018-3525-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/05/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acute low back pain is one of the most common reasons for individuals to seek medical care in the United States. The US Military Health System provides medical care to approximately 9.4 million beneficiaries annually. These patients also routinely suffer from acute low back pain. Within this health system, patients can receive care and treatment from physicians, or physician extenders including physician assistants and nurse practitioners. Given the diversity of provider types and their respective training programs, it would be informative to evaluate variation in care delivery, adherence to clinical guidelines, and differences within the MHS among a complex mix of provider types. METHODS This study was a retrospective, cross-sectional quantitative analysis that examined variations in treatment between provider types within the Military Health System in 2015 for treatment of acute low back pain using administrative data. In addition to descriptive and summary statistics, binomial logistic regression models were used to assess variation in practice patterns among physicians and mid-level practitioners for prescribing of non-steroidal anti-inflammatory, opioids, plain radiography, computed tomography, and magnetic resonance imaging. RESULTS With regard to prescribing practices, results indicated that the odds of receiving non-steroidal anti-inflammatory prescriptions increased significantly for both physician assistants and nurse practitioners when compared to physicians. For basic radiological referrals, odds increased significantly for ordering plain radiography for physician assistants and nurse practitioners when compared to physicians. For more advanced imaging, odds significantly decreased for ordering computed tomography (CT) and slightly decreased for magnetic resonance for physician assistants, nurse practitioners and physician residents compared to the physician group. Additionally this study discovered differences in the prescribing patterns between provider categories. Both contractors and civilians had higher odds of prescribing opioids compared to active duty providers. CONCLUSIONS As physician assistants and nurse practitioners continue to gain popularity as physician extenders in the US and in addressing provider shortages for the Military Health System, further research should be conducted to determine what impact, if any, the differences found in this study have on patient outcomes. In addition, provider type warrants further investigation to determine if labor mix and outsourcing decisions within a single payer system impacts health delivery and value based care.
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Affiliation(s)
- Erich J Dietrich
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 21779, USA.
| | - Todd Leroux
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 21779, USA
| | - Carla F Santiago
- Naval Hospital Okinawa, Chatan, , Nakagami District, , Okinawa Prefecture, 904-0103, Japan
| | | | - Patrick Richard
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 21779, USA
| | - Tracey P Koehlmoos
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 21779, USA
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Ramdhan RC, Rai R, Brooks KN, Iwanaga J, Loukas M, Tubbs RS. Dominique Jean Larrey (1766-1842) and His Contributions to Military Medicine and Early Neurosurgery. World Neurosurg 2018; 120:96-99. [PMID: 30172978 DOI: 10.1016/j.wneu.2018.08.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022]
Abstract
Dr. Dominique Jean Larrey was a pioneer in the field of military surgery. His creative innovation and drive to improve the quality of medical services available to those injured during war guided his achievements in medicine. Dr. Larrey has often been referred to as "the father of emergency medical services" and "the father of modern military medicine." His contributions to medicine continue to live on in common procedures and healthcare systems today, such as aspiration of pericardial effusion and drainage of hemothorax and empyema. Based on his own writings, he treated multiple cases of intracranial injury, making him an early, but often forgotten, pioneer of neurosurgery.
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Affiliation(s)
- Rebecca C Ramdhan
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - Rabjot Rai
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | | | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA.
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies; Seattle Science Foundation, Seattle, Washington, USA
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Saha B, Krishna Kumar H, Borgohain MP, Thummer RP. Prospective applications of induced pluripotent stem cells in military medicine. Med J Armed Forces India 2018; 74:313-320. [PMID: 30449915 DOI: 10.1016/j.mjafi.2018.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/12/2018] [Indexed: 12/31/2022] Open
Abstract
Soldiers involved in combat operations worldwide may be subjected to a wide array of tissue-specific injuries of varying degrees, thereby undergoing complicated medical treatments and prolonged rehabilitations. In many cases involving inadequate recovery, soldiers are further mentally traumatized as they can no longer serve their beloved country. In addition, many severe injuries can lead to soldiers being incapacitated for life and unable to perform even the most basic day-to-day activities. Present therapy for combat injuries is majorly aimed at alleviating pain and limiting further tissue damage from secondary infections. Cell-based therapy using stem cells is a promising tissue regenerative source, which will help our soldiers to recuperate from the severe injuries, and in some cases, even continue their service for the country after complete recovery. In this context, we would like to discuss the yet fully untapped potential of induced pluripotent stem cells (iPSCs) in regenerative medicine on the battlefield. In this review, we shall try to explore the rationale behind the use of these cells for military medicine, as well as the conventional and novel approaches to produce them for therapeutic applications. We shall also attempt to elucidate the evolving trends of battlefield injuries throughout history and the ongoing research on regeneration of tissues of specific interest using iPSCs and their potential role in combat medicine in the future. Additionally, we shall also discuss the concept of stem cell bio-banking for military personnel as a personalized safeguard against crippling and traumatic combat injuries.
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Affiliation(s)
- Bitan Saha
- Laboratory for Stem Cell Engineering and Regenerative Medicine, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - H Krishna Kumar
- Laboratory for Stem Cell Engineering and Regenerative Medicine, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Manash P Borgohain
- Laboratory for Stem Cell Engineering and Regenerative Medicine, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Rajkumar P Thummer
- Laboratory for Stem Cell Engineering and Regenerative Medicine, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
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Julien C, Laroche J, Deledalle FX, Brocq FX, Fournier R, Rivière P, Lechevallier E, Savoie PH. [Result of treatment of urinary lithiasis for professional aptitude]. Prog Urol 2018; 28:329-335. [PMID: 29705059 DOI: 10.1016/j.purol.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/11/2018] [Accepted: 03/15/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Military people are inapt for presence of urinary stones. In this specific population, the treatment of stones is even more aggressive than for the general population without recommendation. The final decision about aptitude is the responsibility of the military doctor. Whereas, ureteroscopy has its place there and must done by any urologist. METHODS The purpose of this study was to estimate the results of treatments by ureteroscopy in this population. Success was defined by the complete absence of fragment visualized in the imaging of control operating comment and so the end of the inaptitude time. RESULTS Between 2009 and 2016, forty-two were treated for ureteral or renal calculi. The population comprises of 93% men, 35 years old on average. The stones were mainly multiple (more 2) and the medium size is 5mm; sixteen (42.9%) was at the left and eight (19%) was bilateral. In 78.8% (78) of the cases there was a stone in renal position whose 50% (39) still at the lower calyx. In total, 5% of the patients were stone-free in 2 sessions on average. The average deadline of inaptitude of the initial consultation in the resumption of work was of 6 months. In 4% of the cases there was a complication operating rank 4. CONCLUSION This study confirms the feasibility, the weak harmlessness of ureteroscopy and the lesser deadline of inaptitude. Every urologist can treat this specific population. The patient must be informed and accept the treatment because of excluding referential. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- C Julien
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France.
| | - J Laroche
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - F-X Deledalle
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - F-X Brocq
- Centre d'expertise médicale du personnel naviguant (CEMPN) de Toulon, H.I.A Ste-Anne, CEMPN, BP 600, 83800 Toulon cedex 9, France
| | - R Fournier
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - P Rivière
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - E Lechevallier
- Service d'urologie, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - P-H Savoie
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
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Datta R, Khanna S. Leadership challenges in multinational medical peacekeeping operations: Lessons from UNIFIL Hospital. Med J Armed Forces India 2018; 73:414-419. [PMID: 29386722 DOI: 10.1016/j.mjafi.2017.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022] Open
Abstract
Commanding a military multinational and multilingual healthcare facility can be a formidable task with very little margin for error. The authors were in leadership positions of UNIFIL Hospital, unique in its diversity of both staff and clientele. Experience about the challenges faced and methods adopted to overcome them will be shared. Troops from diverse backgrounds differ in their competency, and also in their attitudinal approach to situations. It is imperative for the medical commanders to identify these differences, and work towards harnessing individual strengths to form a cohesive unit. Frequent rotation of team members and thereby difficulty in adapting to new environment makes the tasks more challenging. Challenges can be broadly categorized in those dealing with functional roles (providing medical support) and command and control issues. Linguistic challenges especially in situations where professionals have to work as a coordinated unit remains a major challenge. The threat of medical errors arising out of misunderstandings is very real. Gender sensitization is essential to avoid potential unpleasant situations. Interpersonal conflict can easily go out of hand. The leadership has to be more direct and deliberate relying less on hierarchy and more on direct communication. A strict enforcement of UN standards for equipment and competence, frequent joint medical drills help to overcome interoperability issues and develop mutual confidence. Leadership in multinational UN hospitals is a demanding task with its peculiar set of challenges. A systematic and deliberate approach focused on mutual respect, flexibility and direct leadership can help medical commanders in such situations.
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Affiliation(s)
- Rakesh Datta
- Professor, Department of ENT, Armed Forces Medical College, Pune 411040, India
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