Military medicine
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Office hysteroscopy has become a cornerstone of modern gynecologic care through the advent of advanced technology and emphasis on an efficient healthcare system. In 2017, Medicare announced an increase in office hysteroscopy reimbursement by 237%, giving an incentive for gynecologists to move from the operating room into the clinic. The U.S. military medical system needs more cost-effective and efficient healthcare, given that the cost of military healthcare increased by 130% between 2000 and 2012 (accounting for 10% or $52 billion of the Department of Defense budget). Within our institution, we have moved to conducting a regularly scheduled outpatient hysteroscopy clinic. Increased healthcare costs, decreased available operating room time, and efforts to boost patient and provider satisfaction drove the change. ⋯ Compared to traditional operating room hysteroscopy, we were able to demonstrate reduced costs with increased reimbursement while performing the same scope of care for patients undergoing office hysteroscopy. Decreased total time in performing office hysteroscopy suggests the potential benefit of increased patient and provider satisfaction. Our study indicated substantial incentive for military gynecologists to incorporate office hysteroscopy into their practice given the increased relative value units generated. Our office hysteroscopy protocol is discussed to encourage other military facilities to follow in our footsteps.
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There is limited investigation of how military personnel evaluate their deployment experiences. An understanding of their perceptions would help unit psychologists to advise commanders on ways to improve the deployment experience (and therefore mental well-being) of personnel. This study examined the interplay between deployment overall ratings, personnel characteristics and positive and negative deployment experiences in aid of such understanding. ⋯ Military leadership is corroborated as a negative experience of military deployment, while a new finding indicates that intrinsic rewards are a common feature in positive evaluations of deployment. Leadership is a factor that Defence Forces can address to improve the deployment experience. The study strength is the range and size of the sample, with a limitation the potential for recall bias (the data were collected, on average, 5 years postdeployment). Future research should replicate this type of analysis to build a picture of the experiences and evaluations of personnel from a range of different deployments.
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The COVID-19 outbreak posed a threat to the readiness of military forces as well as their ability to fulfill missions. Seeing that military forces have been encountering similar challenges, we found it eminent to share the Israeli Defense Force (IDF) Northern Command's (NC) preliminary experience. ⋯ Despite the limited availability of laboratory testing for COVID-19 our actions enabled us to lead a strict risk-management policy while maintaining most of the available workforce.
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Pneumothorax is a condition where air exists in the chest cavity, outside the lung. The causes of pneumothorax are numerous and determining the etiology can aid in treatment and prevent recurrence. We describe a 47-year-old female patient with past medical history of endometriosis who presented to the emergency room with recurrent right sided pneumothorax, its onset correlating with onset of menses. ⋯ A biologic mesh was affixed to the diaphragm after which mechanical and chemical pleurodesis were performed. She tolerated the procedure well and has been symptom free since. Herein, we review the pathophysiology, diagnosis, and treatment strategies for catamenial pneumothorax in the hopes of increasing awareness and understanding of this rare cause of spontaneous pneumothorax.
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Diabetes is one of the most common chronic conditions in the United States and has a cost burden over $120 billion per year. Readmissions following hospitalization for diabetes are common, particularly in minority patients, who experience greater rates of complications and lower quality healthcare compared to white patients. This study examines disparities in diabetes-related readmissions in the Military Health System, a universally insured, population of 9.5 million beneficiaries, who may receive care from military (direct care) or civilian (purchased care) facilities. ⋯ Our findings suggest that universal access to healthcare alleviates disparities for black patients, while Native America/Alaskan Native populations may still be at risk of disparities associated with readmissions among diabetic patients in both the closed direct care system and the civilian fee for service purchased care system.