Military medicine
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As we transition to an interwar period, combat-related injuries are at their lowest levels in over a decade, yet we must continue to maintain our surgical skills and train new surgeons. During the recent wars, the importance of the treatment and care for amputations and complex extremity injuries became apparent. This study compares the number of these procedures performed during the treatment of civilian and military orthopaedic trauma patients at a Department of Defense Level I trauma center over the past 9 years. The need to evaluate this unique system is further highlighted by the recent recommendation from the National Academies of Sciences, Engineering, and Medicine's to combine civilian and military trauma systems. ⋯ Fluctuations in the military cohort's data mirrors surges in operational activity, whereas the civilian cohort demonstrates a higher and more predictable number of tibia fractures; with reliability and numbers being important factors in training new surgeons and maintaining surgical skills. Although this study focused on specific orthopaedic trauma cases deemed essential to combat casualty care, it highlights the universal reality facing U.S. Military Medicine: as combat trauma continues to decline, military medicine as a whole will have to look elsewhere for critical trauma experience. This study confirmed military case volumes fluctuate with operational demands and evaluated one method of supplementing the declining combat trauma volumes with a local civilian trauma mission. This indicates not only the need for a system that is able to quickly adapt to the increased patient load, but also depicts how little reliability there is within the system in terms of perpetuating physician experience when the civilian trauma mission is not considered.
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There is little research investigating exposures that occurred during war or conflict and the resulting influence on semen quality. We examined the associations between military service and semen quality among U.S. Veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operational New Dawn. ⋯ Veterans who were older, Hispanic or Black, or diagnosed with post-traumatic stress disorder or major depression were more likely to have lower sperm quality. Longitudinal studies are needed to better characterize the influence of military-specific exposures on semen quality parameters.
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Observational Study
Study of the Association Between Serum Vitamin D Levels and Prostate Cancer.
Vitamin D has been suggested as a marker for prostate cancer risk, but prior study results are conflicting. This study evaluated the association of prostate cancer diagnosis with vitamin D levels as well as with each of the following variables of interest: age, race group, military service, smoking status, and alcohol use. ⋯ Among the documented risk factors for prostate cancer from the available data, age, military service, and race group were significantly associated with prostate cancer diagnosis. Further study on a larger cohort with prostate cancer is needed to better assess for associations.
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This performance improvement (PI) project was conducted to recommend improvements for pain reassessment workflow and policies at a large military primary care clinic. The Joint Commission survey identified inconsistent pain reassessment practices at the facility in 2012. A review of the literature reveals that pain reassessment procedures can be affected by unclear organizational policies, poorly designed documentation procedures, and redundant or inefficient workflow practices. This PI project was designed to assess pain reassessment compliance rates, associated documentation, and clinic workflow, and to identify opportunities for improvement. ⋯ Recommendations for improvement included possible extension of the 30-minute time requirement, development of a template for pain reassessment documentation in the EMR, standardizing hand off and admission/discharge processes, and designing an electronic or manual dashboard to indicate pain reassessment times. Future PI projects in other military clinics would benefit from use of the SA perspective to review clinic policies, EMR documentation, and workflow analysis. Further analysis will be needed to evaluate the impact of these improvements.
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Intensivist physician involvement has been shown to improve outcomes for critically ill patients. Unfortunately, the number of Intensivists nationally is unable to meet the current demand. Similar to the civilian community, the Navy critical care workforce is limited by available resources. ⋯ The value of care increased through both enhanced quality, and the cost savings associated with decreasing network disengagements. Leveraging new technology to provide remote care for our sickest beneficiaries has been proven a successful solution to the dilemma of limited Intensivist staffing. Leadership should consider TCC as a tool to extend Intensivist expertise to all of our small hospitals, and should explore the application of synchronous telehealth within the operational environment where similar staffing challenges exist.