Military medicine
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Tele-Intensive Care Unit (tele-ICU) is care provided to critically ill patients by remote clinicians using audio, and video communications and network resources to access real-time patient information from physiologic monitors and the electronic medical record. Tele-ICU has been demonstrated in civilian healthcare to reduce mortality, improve care quality and safety, decrease intensive care unit (ICU) length of stay (LOS) and ventilator days, and save money. General Leonard Wood Army Community Hospital (GLWACH) is a small medical treatment facility with limited resources with respect to subspecialists and ancillary services. ⋯ These findings support the implementation of tele-ICU in the MHS as a cost-effective method to sustain readiness amongst critical care clinicians and improve safety culture in MHS hospitals.
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Interest in moral injury has burgeoned over the last decade as an increasing number of professionals recognize that current conceptualizations of trauma are not sufficient to explain some of the challenges that military service members face. The Moral Injury Events Scale (MIES) was the first instrument developed to measure exposure to military events that could produce moral injury (Nash et al., 2013). Two previously published validation studies that focused on service members still in uniform reveal some discrepancies regarding the scale's factor structure. Bryan and colleagues (2016) documented a three-factor solution (i.e., transgressions-others, transgressions-self, and betrayal), while Nash and colleagues (2013) noted a two-factor solution (i.e., perceived transgressions and perceived betrayals). ⋯ The factor structure identified in the present study aligns with current theoretical conceptualizations of moral injury. The inability to distinguish between event and reaction items and the lack of impact on the factor structure when event items were removed from the model suggest the MIES is more accurately described as a measure of moral pain as compared to a measure of potentially morally injurious experiences (PMIEs). Given that all events associated with moral injury have impinged upon welfare, justice, rights, and fairness considerations, one could argue that little would be gained by focusing attention on the development of a measure of PMIEs. Given the lack of convergence in factor structure across samples, future directions may profit from a focus on further clarifying the temporal stability of the MIES factor structure.
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Veterans of the 1991 Gulf War were potentially exposed to a mixture of stress, chemicals and radiation that may have contributed to the persistent symptoms of Gulf War Illness (GWI). The genotoxic effects of some of these exposures are mediated by the DNA nucleotide excision repair (NER) pathway. We hypothesized that individuals with relatively low DNA repair capacity would suffer greater damage from cumulative genotoxic exposures, some of which would persist, causing ongoing problems. ⋯ We suggest that the observed elevations in DNA repair capacity and NER gene expression are indicative of a "hormetic," i.e., induced or adaptive protective response to battlefield exposures. Normally such effects are short-term, but in these individuals this response has resulted in a long-term metabolic shift that may also be responsible for the persistent symptoms of GWI.
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Transcranial electrical stimulation (tES) as a method of cognitive enhancement in both diseased and healthy individuals has gained popularity. Its potential for enhancing cognition in healthy individuals has gained the interest of the military. However, before it being implemented into military training or operational settings, further work is needed to determine its efficacy and safety. Although a considerable amount of literature exists, few studies have specifically evaluated its use in enhancing cognition relative to operational, military tasks. Therefore, in a first step to evaluate its efficacy, we completed a systematic literature review of studies using transcranial direct current stimulation (tDCS), a type of tES, to enhance cognitive processes in healthy individuals. ⋯ The conclusions to be drawn from this systematic literature review include the identification of a brain region for targeting with stimulation to enhance a broad range of cognitive constructs applicable to military tasks, as well as stimulation parameters for duration and intensity. The dorsolateral prefrontal cortex was most frequently targeted in the studies that found enhanced performance across several cognitive constructs. Stimulation intensities of 2 mA and durations of 20 minutes or longer appeared frequently as well. Although several parameters were identified, further work is required before this type of technology can be recommended for operational use.
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Although HIV pre-exposure prophylaxis (PrEP) is available at no cost to personnel in the United States (U.S.) military, uptake has been lower than expected. An online survey was conducted assessing current knowledge, perceptions, and attitudes of primary care providers in the U.S. Navy. ⋯ Although Navy providers were supportive of the provision of PrEP by the military, knowledge gaps remain. Training to address the knowledge deficit as well as improving sexual history taking are potential areas to target in implementing PrEP in primary care specialties.