Military medicine
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Sustained demand for dermatologic care throughout military medicine, in conjunction with increasing dermatologic provider shortages, has led to increase use of teledermatology in military treatment facilities (MTFs). Initially used to aid in the differentiation of suspicious melanocytic lesions, dermoscopy has found increasing clinical utility in an expanding realm of general dermatologic conditions. We demonstrate the use of synchronous teledermoscopy within a remote MTF by repurposing webcam technology already available at most MTFs. ⋯ Two synchronous teledermatology consultations were completed successfully on patients in MTFs with limited subspecialty capabilities. Both cases, with two lesions of concern per case, had 100% concordance between the on-site and teleconsulted dermatologist. Through observing inter-rater agreements between the on-site and remote dermatologists, this small study demonstrates a novel application of technology readily available at most MTFs.
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Since the influenza A/H1N1 pandemic of 2009 to 2010, numerous studies have described the clinical course and outcome of the different subtypes of influenza (A/H1N1, A/H3N2, and B). A recent systematic literature review concluded that there were no appreciable differences in either clinical presentation or disease severity among these subtypes, but study parameters limit the applicability of these results to military populations. We sought to evaluate differences in disease severity among influenza subtypes in a cohort of healthy, primarily outpatient adult U.S. Department of Defense beneficiaries. ⋯ Our study of influenza in a cohort of otherwise healthy, outpatient adult Department of Defense beneficiaries over 5 influenza seasons revealed few differences between influenza A(H1N1), influenza A(H3N2), and influenza B infection with respect to self-reported disease severity or clinical outcomes. This study highlights the importance of routine, active, and laboratory-based surveillance to monitor ongoing trends and severity of influenza in various populations to inform prevention measures.
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A performance improvement project was initiated at Tripler Army Medical Center (TAMC) to decrease the amount of inpatient stays by military beneficiaries at civilian hospitals. Before the start of the project, the transfer process from external emergency rooms was completed by patient administration personnel and residents. This process had a median time to disposition decision of 40 minutes and led to missed opportunities for TAMC to care for military beneficiaries. The goals for the project were to have the median transfer process at less than 30 minutes from first call to time of disposition, to minimize unnecessary transfer denials, and to improve the perception of TAMC transfer process. ⋯ The improved transfer process at TAMC resulted in a decreased median time of transfer request process, increased total transfer requests, and improved relationships with local civilian hospitals. While we acknowledge that each MTF has facility and regional characteristics (such as capability, capacity, military staffing, and degree of availability of civilian healthcare resources) that may contribute to variation from TAMC, the concepts and changes made in the transfer process may be considered a best practice to be adopted by other military facilities to promote the recapture of beneficiaries into the Defense Health Agency system.
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The Veterans Team Recovery Integrative Immersion Process (Vet TRIIP) is a short-term multi-modality complementary, integrative immersion program for veterans with chronic pain, post-traumatic stress, and related symptoms. Geared toward Veterans, active duty servicemembers, family members, and caregivers, Vet TRIIP aims to honor and empower them to create healthy, happy, and productive civilian lives. This study evaluates the program to determine its impact on the quality of life and ways to improve and develop Vet TRIIP. ⋯ Evaluative studies on organizations that support Veterans are useful to gauge the effectiveness and impact. Through this study, Veterans expressed perceived strengths and weaknesses of the program so further development and appropriate services will be provided. Similar studies on the impact of non-profit organizations are encouraged. Vet TRIIP significantly impacts the lives of many through stress and pain reduction, potentially preventing suicide.
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Individuals with obesity have higher rates of mental health disorders, both singly and in combination, than individuals of normal weight. Mental health disorders may negatively impact weight loss treatment outcomes; however, little is known about the mental health burden of individuals using weight loss programs. The current study identifies common mental health diagnostic profiles among participants of MOVE!-the Veterans Health Administration's behavioral weight loss program. ⋯ Efforts to improve patients' engagement in the MOVE! program may need to address barriers to care associated with mental health disorders or incorporate care for both obesity and mental health diagnoses in MOVE! A holistic approach may be particularly important for younger patients who have a higher comorbidity burden and longer care horizons. Future work may address if patient types found in the current study extend to non-VHA obesity treatment seekers.