Military medicine
-
The Veterans Health Administration (VHA) is a national leader in integrated care, known in the VHA as the Primary Care Mental Health Integration (PCMHI) model. This model is associated with improved quality of services and same-day access for veterans. There has been some recent development of PCMHI/integrated care competencies within VHA and across the nation. To fully implement these competencies, however, PCMHI providers must not only be trained, but their adherence to the PCMHI model must also be assessed. While there have been recent advances, there has been little research that has examined the adherence of PCMHI providers to the model or methods to improve adherence. ⋯ Providing assessment, feedback, and training in the PCMHI model changed the clinical practice of PCMHI providers and resulted in improved adherence. Clinical and research implications are discussed.
-
Review Case Reports
Case Report: Buprenorphine Induction Using Transdermal Buprenorphine in a Veteran With Opioid Use Disorder and Psychosis, Managing Precipitated Withdrawal.
Buprenorphine induction can lead to precipitated opioid withdrawal, even when using novel techniques such as transdermal buprenorphine. Involuntary limb movements are a distressing symptom of precipitated withdrawal that can be difficult to treat. We report a case of a military veteran transitioning from methadone to buprenorphine for the treatment of opioid use disorder (OUD) using small doses of transdermal buprenorphine. ⋯ Despite the known risk of concurrent benzodiazepine and buprenorphine administration, including decreased respiratory rate and death, we present a clinical presentation in which this medication combination may be necessary while under medical supervision. We suggest a stepwise algorithm for pharmacotherapy in patients experiencing involuntary limb movements associated with precipitated withdrawal. To safeguard the success of medication-assisted treatment (MAT) for opioid addiction, clinicians should be aware of potential clinical challenges when managing precipitated opioid withdrawal in patients with complex psychiatric comorbidities.
-
Traumatic brain injuries (TBIs) are life-threatening, and air transport of patients with TBI requires additional considerations. To mitigate the risks of complications associated with altitude, some patients fly with a cabin altitude restriction (CAR) to limit the altitude at which an aircraft's cabin is maintained. The goal of this study was to examine the effects of CARs on patients with TBI transported out of theater via Critical Care Air Transport Teams. ⋯ Patients with TBI who flew with a CAR did not differ in clinical outcomes from those without a CAR.
-
Observational Study
Evaluation of Self-Collection as a Method of Extragenital STI Screening.
The goal of this study is to improve overall screening, detection, and treatment of Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) at our institution. ⋯ Prior to implementation of EGS at our institution, we missed the opportunity to detect a substantial number of GC/CT infections with urogenital screening alone. Our results suggest that self-collection is a reliable method of EGS as compared to provider collection of samples.
-
Contingency operations during the past 18 years have exposed millions of U.S. military service members to numerous combat and operational stressors. Despite this, a relative dearth of literature has focused on the experiences of deployed military medical personnel. As such, the present study aimed to address this gap in the literature by conducting individual and small group interviews with Air Force medical personnel who had recently returned from a deployment to Iraq. Interviews targeted self-reported factors related to psychological risk and resiliency across the deployment cycle, while also seeking recommendations for future military medical personnel preparing for medical deployments. ⋯ Findings from the present study indicate that the military is largely doing a good job preparing Air Force medical providers to deploy. Results of the present study indicate that military medical personnel would benefit from: (1) increased predictability surrounding deployment timelines, (2) improved cross-cultural training, (3) advanced training for atypical injuries in unconventional patient populations, and (4) improvements in postdeployment workplace reintegration. The present research has the potential to positively impact the overall quality of life for deploying military service members and their families; while simultaneously highlighting the successes and shortfalls in the deployment process for U.S. military medical personnel.