Military medicine
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To address the ongoing epidemic of sexually transmitted infections (STIs) in the United States, the National Academies of Sciences, Engineering, and Medicine (National Academies) conducted a consensus study on STI control and prevention in the United States to provide recommendations to the Centers for Disease Control and Prevention and the National Association of County and City Health Officials. The culminating report identified military personnel as one of the priority groups that require special consideration given the high prevalence of STIs and their associated behaviors (e.g., concurrent sexual partners and infrequent condom use) that occur during active duty service. Universal health care access, the relative ease and frequency of STI screening, and the educational opportunities within the military are all assets in STI control and prevention. ⋯ The military context must integrate the multilevel domains of influences to guide the effort to fill current gaps and research needs. The Department of Defense, with its large clinical and preventive medicine workforce and its well-established universal health care system, is well positioned to enact changes to shift its current approach to STI prevention, treatment, and control. STI control based on highlighting behavioral, social, cultural, and environmental influences on service members' sexual health and wellness may well drive better STI care and prevention outcomes.
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To determine the efficacy of steroid and hyperbaric oxygen therapy (HBOT) in the setting of acute noise-induced hearing loss. ⋯ Steroids with or without HBOT appear to improve both low and high hearing thresholds following acoustic trauma. Future studies will require inclusion of control groups, precise definition of acoustic trauma intensity and duration, and genetic polymorphisms.
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The Military Health System mission is to provide medical care throughout the globe to service members and beneficiaries. To achieve this mission in the most austere of locations, telemedical support is an essential force multiplier when robust in-person medical support is not feasible. This led to the development of a telemedical solution initially known as the Virtual Critical Care Consultation service which provided tele-critical care assistance to downrange providers. The VC3 system then expanded to include multiple medical specialties available for consultation. The current version of this telemedical solution is the ADvanced VIrtual Support for OpeRational Forces (ADVISOR) program which is a synchronous and asynchronous telemedicine system that was developed to provide 24/7 remote expert support to military clinicians engaged in casualty care in austere and operational environments. ⋯ Based on the collected information, the financial return on investment has exceeded costs and the system is perceived as being valued added for both local caregivers and remote experts. The system appears to help optimize evacuation planning, specifically by downgrading or eliminating unnecessary evacuations.
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Anterior cruciate ligament reconstruction (ACLR) ranks among the most common surgeries performed in civilian as well as military orthopedic settings. Regional anesthesia, and the femoral nerve block (FNB) in particular, has demonstrated efficacy in reducing postoperative pain and opioid use after ACLR, however concerns linger about possible impaired functional outcomes. The purpose of the current investigation was to assess International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) scores at 6 to 12 months after ACLR in patients who did (FNB) and did not (NoFNB) receive a perioperative FNB. ⋯ Active tobacco use may negatively impact short-term subjective patient-reported outcomes after ACLR, as reported by the IKDC-SKF. Lower preoperative scores are also associated with significantly lower postoperative IKDC-SKF scores while the use of a FNB was not associated with lower postoperative scores. The negative association between tobacco use and patient-reported functional outcomes after ACLR lends further support to tobacco cessation programs within the military.
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Vitamin D is critically important to numerous physiologic functions, including bone health. Poor vitamin D status is a common but underrecognized problem that predisposes the military population to stress fracture and completed fracture. This has significant implications for force health protection, warfighter readiness, attrition, and cost. ⋯ This is a major hindrance to military readiness and one that could easily be modified with awareness, prevention, and early treatment. In this commentary, we review the literature on vitamin D deficiency and critically examine the current status of policies and clinical practice related to vitamin D in the military health system. We offer several practical recommendations to increase awareness and readiness while decreasing musculoskeletal injury and the associated costs.