Military Medicine

Journal Information
ISSN / EISSN: 00264075 / 1930613X
Total articles ≅ 28,876

Latest articles in this journal

Published: 26 November 2022
Abstract:
Dear Editor, we would like to share ideas on the publication “Addressing Persistent Vaccine Hesitancy in a Military Community Through a Physician-Led Intervention.” Despite this, Glendening et al. found that people who trusted doctors the most were more likely to be vaccine hesitant, and they came to the conclusion that this underlines the significance of the information that trusted doctors should give their patients and may point to future strategies for addressing vaccine hesitancy. Keep in mind, however, that a person’s decision to get vaccinated against coronavirus disese 2019 (COVID-19) may be impacted by a number of circumstances, including the location and scope of the epidemic. A larger investigation, as Glendening et al. suggested, could be beneficial. Nonetheless, a new longitudinal study model should be employed to investigate the influence of COVID-19 and COVID-19 vaccine–linked variables.
Mark Hinton, Olivia Metcalf, Tracey Varker, , Violette McGaw, Loretta Watson, Julia Fredrickson, Lucinda Johnson, David Forbes, Andrea Phelps, et al.
Published: 26 November 2022
Abstract:
Introduction: A range of evidence-based treatments are available for PTSD. However, many veterans with PTSD do not engage in these treatments. Concurrently, various novel PTSD treatments with little or no evidence based are increasingly popular among veterans. This qualitative study explored the expectations, experiences, and perceptions of help-seeking veterans with PTSD to improve understanding of how these veterans make treatment decisions. Materials and Methods: Fifteen treatment-seeking veterans with PTSD participated in the study. Participants took part in semi-structured interviews. Data were analyzed using interpretative phenomenological analysis. Results: A number of themes and subthemes emerged from the data, providing a detailed account of the factors that influenced participants’ treatment decisions. Most participants were in an acute crisis when they made the initial decision to seek treatment for their PTSD. In choosing a specific treatment, they tended to follow recommendations made by other veterans or health professionals or orders or directions from their superiors, health providers, or employers. Few participants actively considered the scientific evidence supporting different treatments. Participants had a strong preference for treatment provided by or involving other veterans. They reported finding PTSD treatments helpful, although some were not convinced of the value of evidence-based treatments specifically. Many participants reported negative experiences with treatment providers. Conclusions: These findings will inform strategies to improve engagement of veterans in evidence-based PTSD treatments and advance progress toward veteran-centered care.
, Ilan Kutz, Gabriela Levi, Erez Lang, Ilia Beberashvili, Shai Efrati
Published: 26 November 2022
Abstract:
PTSD is common among veteran combatants. PTSD is characterized by brain changes, for which available treatments have shown limited effect. In a short-term study, we showed that hyperbaric oxygen therapy (HBOT) induced neuroplasticity and improved clinical symptoms of veterans with treatment-resistant PTSD. Here, we evaluated the long-term clinical symptoms of the participants of that study. Veterans from our short-term study were recruited 1 or more years after completing HBOT. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and self-reported questionnaires were administered at a single site visit. Changes in clinical scores between long-term, short-term, and pretreatment evaluations were analyzed. Of the 28 participants who received HBOT during or following the short-term study, 22 agreed to participate in the current study. At a mean of 704 ± 230 days after completing the HBOT course, the mean CAPS-5 score (26.6 ± 14.4) was significantly better (lower) than at the pre-HBOT evaluation (47.5 ± 13.1, P < .001) and not statistically different from the short-term evaluation (28.6 ± 16.7, P = .745). However, for the CAPS-5 subcategory D (cognition and mood symptoms), the mean score was significantly better (lower) at long-term than at short-term evaluation (7.6 ± 5.1 vs. 10.0 ± 6.0, P < .001). At the long-term compared to the pretreatment evaluation, higher proportions of the participants were living with life partners (10 (46%) vs. 17 (77%), P = .011) and were working (9 (41%) vs. 16 (73%), P = .033). Decreases were observed between pretreatment and the long-term follow-up, in the number of benzodiazepine users (from 10 (46%) to 4 (18%), P = .07) and in the median (range) cannabis daily dose (from 40.0 g (0-50) to 22.5 g (0-30), P = .046). The beneficial clinical effects of HBOT are persistent and were not attenuated at long-term follow-up of about 2 years after completion of HBOT. Additional long-term effects of the treatment were observed in social function and in decreased medication use.
Xiaoning Yuan, Veronika Pav, Courtney Colahan, Matthew E Miller, Nelson A Hager, Paul F Pasquina, Steven P Cohen, Brad M Isaacson
Published: 26 November 2022
Abstract:
Introduction: Low back pain (LBP) has accounted for the most medical encounters every year for the past decade among Active Duty Service Members (ADSMs) of the U.S. Armed Forces. The objectives of this retrospective, descriptive study were to classify LBP by clinical category (Axial, Radicular, and Other) and duration (Acute, Subacute, and Chronic) and examine the LBP-related health care utilization, access to care, and private sector costs for ADSMs over a 2-year follow-up period. Materials and Methods: The Military Health System Data Repository was queried in fiscal year 2017 for all ADSMs (ages 18-62) with outpatient encounters documented with any of 67 ICD-10 diagnosis codes indicative of LBP. A 1-year clean period before the first (index) outpatient LBP encounter date was used to ensure no recent history of LBP care. Patients were eligible if continuously enrolled and on active duty for 1 year before and 2 years following the index visit. Patients were excluded for non-musculoskeletal causes for LBP, red flags, or acute trauma within 4 weeks of the index visit and/or systemic illness or pregnancy anytime during the clean or follow-up period. Results: A total of 52,118 ADSMs met the inclusion criteria, and the cohort was classified by duration of LBP symptoms as Acute [17,916 (34.4%)], Subacute [4,119 (7.9%)], and Chronic [30,083 (57.7%)]. Over 2-year follow-up, 419,983 outpatient visits were recorded, with the majority occurring at MTFs [363,570 (86.6%)]. 13,237 (25.4%) of ADSMs in the total cohort were documented with no other LBP-related visits beyond their index encounter. In contrast, the Chronic cohort comprised the highest number of encounters [371,031 (89.2% of total encounters)], including 86% of imaging studies performed for LBP, and accounted for $9,986,606.17 (94.9%) of total private sector costs over the 2-year follow-up period. Interventional pain procedures ($2,983,767.50) and physical therapy ($2,298,779.07) represented the costliest categories in the private sector for the Chronic cohort, whereas Emergency Department ($283,307.43) and physical therapy ($137,035.54) encounters were the top contributors to private sector costs for the Acute and Subacute cohorts, respectively. Overall reliance on the private sector was highest for specialty care, including 10,721 (75.4%) interventional pain procedures and 306 (66.4%) spine surgeries. Conclusions: Uncovering current trends in health care utilization and access to care for ADSMs newly presenting with LBP is vital for timely and accurate diagnosis, as well as early intervention to prevent progression to chronic LBP and to minimize its negative impact on military readiness and quality of life. This retrospective, descriptive study highlights the burden of chronic LBP on health care utilization and costs within the Military Health System, including reliance on the private sector care, amounting to $10,524,332.04 over the study period.
, Megan L Bohan,
Published: 25 November 2022
Abstract:
Introduction: Tactical Combat Casualty Care guidelines recommend packing junctional wounds with gauze, applying direct pressure for 3 minutes, and then securing with an external pressure dressing. This method is time-consuming, which can be problematic in a combat environment. Alternatively, the iTClamp has documented efficacy and rapid application. However, no studies have evaluated device application by military prehospital medical providers, such as Navy corpsmen, or their user experience with the device. Materials and Methods: Research data derived from a protocol were approved by the Naval Medical Center Portsmouth’s Institutional Review Board in compliance with all applicable federal regulations governing the protection of human subjects. Navy corpsmen with the current Tactical Combat Casualty Care certification applied the iTClamp or standard pressure dressing on a manikin model of femoral hemorrhage in a crossover study design. Each participant used both devices in a randomized fashion. Time to application was recorded, and participants completed Likert scale surveys to evaluate both devices for preference, ease of use, and physical assessment. A repeat assessment was performed 1 month later to assess skill atrophy. Repeated-measures ANOVA was used to compare application time. Likert scale survey data were analyzed using Mann–Whitney and Wilcoxon tests to compare survey data within and between time points, respectively. Results: The application of the iTClamp was more than twice as fast as the application of pressure dressings at both the initial and follow-up evaluations. There was no statistically significant difference in application times between the first evaluation and the 30-day assessment of either device, indicating no atrophy in skill. While 65% and 52% of the participants expressed preference in for the iTClamp in their surveys during the initial and follow-up respective visits, the difference in preference was not statistically significant for either the initial or the follow-up survey. Open-ended survey responses yielded both perceived advantages and disadvantages for each treatment option. Conclusions: In austere or hostile environments, speed of treatment and extrication can have significant implications for the safety of both the patient and the medical providers. Hemorrhage control interventions must be both effective and easy to use for a prehospital provider to ensure its efficacy in a live battlefield situation. The iTClamp is small, simple, and fast to use, but its wide adoption in the field may be based on limitations perceived by participants, including narrow indications for use. However, based on our findings, it is reasonable to field the iTClamp depending on provider preference.
, Matthew Scott, Paul Patterson, Bonnie Jordan, Daniel Roy, Eric Flake
Published: 25 November 2022
Abstract:
Military families face many unique challenges, including frequent separations, demanding work hours, and relocations. The HealthySteps (HS) program may offset these challenges utilizing the expertise of a nonclinical child development specialist called a HS specialist who offers enhanced well-child visits (WCVs), support between visits, and connections to community resources. Our study sought to identify the impact of the military HS pilot program on the timeliness of WCVs, immunizations, routine behavioral and developmental screenings, and referrals to community resources within the first 15 months of life (MOL). We retrospectively reviewed charts of 26 HS-enrolled and 26 randomly selected age-matched non-HS–enrolled children from age 2 to 15 MOL. Demographic variables obtained include child’s gender, child’s birth order, mother’s age, active duty parent’s rank classification, and active duty parent’s gender. We examined five outcomes measures aligning with the American Academy of Pediatrics health supervision, immunization, and screening recommendations and National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set measures: (1) completed six or more WCVs in the first 15 MOL, (2) completed developmental screening at the 9-month WCV, (3) up to date on vaccinations at 15 MOL, (4) completed three or more postpartum depression (PPD) screens in the first 6 MOL, and (5) the total number of documented referrals to community resources within the first 15 MOL. Chi-square analysis and independent t-tests were used to compare the groups. There was no statistical significance (P > .05) between the HS-enrolled and control groups for all five demographic variables. A significantly higher percentage of children in the HS-enrolled group received PPD screening compared to the control group (96% vs. 73.1%, P = .021). The HS-enrolled group had a higher mean number of community resource referrals at 15 MOL of 2.46 (SD = 1.14) vs. the control group with a mean of 0.19 (SD = 0.49). None of the other outcomes showed a statistically significant difference between groups. The results of this study indicate the positive impacts of the military HS program on referrals to community resources and PPD screening, reflecting the HS specialist focus on the family unit. Limitations of this study include the small population size and limited demographic information resulting from the retrospective nature of the study and pilot status of the HS program. Larger prospective studies are needed to clarify the true impact of the HS program in the military health system.
Jamie L Myers, Hui Xia, Manuel Y Caballero, Sandra Valtier, G Jilani Chaudry
Published: 24 November 2022
Abstract:
Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder characterized by hyperglycemia of varying degrees. Genetic and lifestyle variations are known to influence the onset and severity of T2DM. Among the genetic variations reported to confer susceptibility to the disease are certain single nucleotide polymorphisms (SNPs). Here, we report the analysis of 18 such SNPs in a military community cohort of 716 subjects, comprising 477 diabetic and 239 control subjects. The population studied included active-duty military personnel, veterans, and their families. The SNPs analyzed in this work occur in nine different genes, comprising six interleukin (IL) genes (IL1A, IL1B, IL4, IL6, IL10, and IL18), fatty acid amide hydrolase (FAAH) gene, and cannabinoid receptors 1 and 2 genes (CNR1, CNR2). The products of these genes are players in different conditions, including inflammation, a process linked with diabetes. The T2DM and control (no diabetes) DNA samples were acquired from an archived sample repository (Center for Advanced Molecular Detection, 59th Medical Wing, U.S. Air Force, Joint Base San Antonio [JBSA]-Lackland, TX). The blood samples had been previously collected from gender- and race-mixed cohorts under a protocol approved by the 59th Medical Wing Institutional Review Board. Single nucleotide polymorphism (SNP) genotyping was done by real-time Polymerase Chain Reaction (PCR) using TaqMan assay reagents. The statistical analysis software 9.3 (SAS 9.3) was used for statistical analyses to reveal associations between the SNP genotypes and T2DM. Out of the 18 SNPs analyzed, six showed statistically significant association with T2DM in the overall cohort (P < .05). The odds ratio for these associations varied from 1.57 to 3.16. The rs16944 T/T homozygous genotype (IL1B) showed the strongest association with T2DM, with P = .005. In the White cohort, five of these six SNPs and one other, rs806368 (cannabinoid receptor 1), associate with T2DM. However, the gender-specific analysis of the White cohort revealed only two SNP associations with T2DM in the female cohort, rs16944 (IL1B) and rs2295632 (FAAH), both also showing association in the overall mixed cohort. Likewise, four SNPs showed T2DM association in the White male cohort, with rs187238 (IL18) being uniquely significant in this group. The IL1B SNP rs16944 showed consistent statistically significant association with T2DM and therefore is likely a promising biomarker for T2DM. We note, however, that this association in a generic sense may be with the inflammatory process that accompanies T2DM and not per se with T2DM.
Reid Fisher
Published: 23 November 2022
Abstract:
In 2015, we were blessed with the opportunity to build a sports medicine program through embedded athletic trainers within the United States Air Force’s (USAF) Basic Military Training (BMT). The outcomes from that work were published in 2021. Faced with approximately 800 incoming trainees a week who had varying degrees of running experience, the recurrent influx of common running injuries week by week developed three essential questions: (1) what are the best current treatments to resolve complaints in time to support on-time graduation, (2) what can be done to help prevent recurrence, and (3) can something be done to prevent these injuries in the first place? The literature is replete with works of others discussing systemic approaches to resolving iliotibial band dysfunction, patellofemoral pain syndrome, compartment syndrome, and bone stress injuries. Through their guidance, we treated our patients with considerable effect reducing injuries resulting in time out of training potentially leading to attrition. Common threads from those studies and support by Maj Nathaniel Nye and Lt Col Mark Cucuzzella lead us to find connected themes for intervention. Much like LTC Zimmermann and Dr. Bakker discuss, we found gait retraining that intentionally targeted multiple running constructs which provided resolution to our patients. The short duration of USAF BMT meant resolving a fourth question which was how can we retrain running gait faster. Operationalizing the approach of increased cadence, core activation, and gluteal activation through a motor learning sequence established a pathway to achieve running forms touted in injury management literature within a single 1-hour session with notable outcomes. This article speaks to the third question in which we sought to curtail the worst running traits of slow cadence, fully extended knees at initial contact, and poorly controlled knee adduction moments to see if significant injury presentation could be ameliorated. It just so happened that we did this in groups of 50 with as many as three groups in a session.
Stephanie McWhorter, Cynthia Simon-Arndt, Lori Carlson
Published: 23 November 2022
Abstract:
Introduction: U.S. Navy Medicine’s temporary limited duty (LIMDU) program is the primary vehicle for managing the medical care and subsequent career outcomes of the ill and injured active component (AC) Sailors and Marines to ensure a medically ready force. Before the LIMDU Sailor and Marine Readiness Tracker System (SMART) came online, it was very difficult to examine LIMDU program administration metrics, patients’ experiences during LIMDU, and their subsequent health and career outcomes. This study examined the LIMDU patient population’s demographic, military career, and LIMDU-specific characteristics; identified characteristics that differed significantly by military service; and evaluated potentially modifiable factors associated with patient outcomes. Materials and Methods: A comprehensive SMART extract was used to identify all AC Sailors and Marines in active LIMDU status between October 1, 2016, and September 30, 2019. The SMART extract was merged with comprehensive administrative military personnel data by patient identifiers to create a longitudinal dataset and to conduct descriptive statistics, bivariate, and multivariate logistic regression analyses for this study. The sample included 26,591 AC Sailors and Marines with complete SMART and military personnel records who ended LIMDU on or before September 30, 2019. Results: During the study’s 3-year period, Navy Medicine’s rate of initial LIMDU entry by AC personnel increased each year from 2,041 in FY2017 to 2,424 in FY2019 per 100,000 personnel. At the time of initial entry, most LIMDU patients were male (76%), E4–E6 paygrades (54%), and had a single diagnosis recorded in their SMART records (66%). Pain patients (23%) constituted the largest diagnostic group, followed closely by musculoskeletal patients (23%), and then mental and behavioral health patients (20%). Variables that might reflect administration practices of the program did not differ significantly by service, suggesting good internal standardization of LIMDU administration across Navy Medicine. However, bivariate and multivariate analyses identified significant differences by service for almost all personal demographic, LIMDU-specific, and post-LIMDU military career sample characteristics measured at the last LIMDU close date or later. Study results suggested that the Navy and Marine Corps referred Sailors and Marines to start LIMDU for different medical reasons; to receive care from different military treatment facilities; to close LIMDU with different final actions; and to experience different post-LIMDU career outcomes. Conclusion: Navy Medicine’s SMART data is an important new resource for LIMDU program evaluation and population-level patient research, despite the data limitations and concerns identified and addressed by this study. The study results provide a baseline empirical understanding about the LIMDU patient population. Further research is necessary to interrogate the validity of these results over a longer period and to initiate other lines of inquiry. While the construction of the larger project’s LIMDU patient population longitudinal dataset required a significant initial investment, future dividends from ongoing work are anticipated. Results derived from verified SMART data will benefit Navy Medicine, operational commands, and LIMDU patients alike by informing continuing efforts to improve patient health and career outcomes, identify and implement best clinical and administrative practices, and optimize force readiness.
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