Military medicine
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Pharmacy patient experience within military treatment facilities (MTFs) is a significant indicator of healthcare quality, as hospital admissions correlate with medication use (Budnitz et al., 2006) and pharmacists have a unique opportunity to influence patients' health (Dalton & Byrne, 2017). To improve patient care across the military health system (MHS), we investigated best practices within MTF pharmacies with the highest patient experience scores. ⋯ These findings provide valuable insights to improve public health in military-connected populations through improved patient care practices in pharmacies across the MHS. Initiatives aimed at improving health care for pharmacy patients should prioritize improved communication and structural support for team members to create patient-friendly environments, which enables pharmacists and technicians to connect with patients and positively impact health outcomes. Limitations include lack of comparison data for lower performing pharmacies; future research will explore practices at lower ranking pharmacies to provide insights into communication practices, environments, and staff relationships impacting patient experience scores as well as the role patient demographics (e.g., retirees vs. active duty) and characteristics including facility size play in potential improvements.
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Medical school leaders are seeking strategies to increase the diversity of their student populations. Post-baccalaureate premedical (PBPM) programs are one such pipeline that has supported diversity in medicine. The purpose of this study was to evaluate the Uniformed Services University's (USU's) PBPM program (the Enlisted to Medical Degree Preparatory Program, EMDP2) to determine how well it prepares its learners for the School of Medicine (SOM). ⋯ The EMDP2 appears to prepare medical students on a par with their non-EMDP2 peers. The EMDP2 contributes to USU's commitment to train physicians who represent the nation and its citizens by making medical education available to enlisted service members, a population that closely mirrors the diversity of the nation.
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One of the main avoidable causes of combat-related injury death is extremity hemorrhage. Even with regular training, failure to properly apply a tourniquet is common. In this study, we sought to assess if rescuer's stress and personality traits, along with victim's state of consciousness, had a role to explain tourniquet application failure. ⋯ Combat-related injuries, even simulated, not only involve the rescuer's technical skills but also their ability to deal with stressful external stimuli. Tourniquet application speed seems to be influenced by perceived stress and personality traits of the rescuers. Frequent failures justify repeated training, and one way to pursue improvement could be to develop a personalized pedagogy adapting to the needs of the students according to their current skillset but also their perceived stress and personality determinants. In the pedagogical process (planning, goal setting, teaching, and evaluating), the state of consciousness of the victim seems to be a parameter that needs to be accounted for, but further studies are required to accurately describe its influence.
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Mediastinal masses are a rare finding in the emergency department and typically present with vague chest complaints such as chest discomfort, chest pain, or dyspnea. Rarely do these tumors present with dysrhythmias, and when dysrhythmias are present, they typically arise secondary to endocrine or metabolic effects exerted by the tumor. Here we report a case of a patient who presented to the emergency department with atrial fibrillation with rapid ventricular response, concomitant with a history of recurrent palpitations that were previously aborted with self-induced vagal maneuvers. Upon further investigation, the patient had an anterior mediastinal mass, diagnosed as a thymoma, suspected to be contributing to his presenting dysrhythmia through mass effect.
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Physical fitness is foundational to the U.S. Army as a component of combat readiness, and accurate assessment of readiness is imperative for mission success and soldiers' health and safety. To this end, the Army has developed the Army Combat Fitness Test (ACFT), which more accurately assesses these abilities and may aid development of a more combat-ready force. Reserve Officer Training Corps (ROTC) programs nationwide are often challenged by limited structured training time, as well as access to equipment and training space. Development and/or adaptation of a training program that addresses these limitations would benefit ROTC programs nationally. Therefore, the purpose of this study was to compare a standard military fitness training program to High-Intensity Functional Training (HIFT) in ROTC cadets. We hypothesized that a HIFT program would be more effective than the standard military program developed by the DoD on both ACFT performance and assessment of common Warrior Tasks and Battle Drills (WTBDs). ⋯ Three 60-minute sessions per week of moderate-high-intensity training elicited improvements in ACFT scores, with no statistically significant differences between training programs. For this population of ROTC cadets, implementing a structured training program with expert oversight appears to be effective. Based on the successes and unanticipated challenges encountered in this study, training programs that emphasize intensity, train a wide variety of movements, maximize adherence, and are adaptable to a variety of situations are likely to be successful at improving ACFT scores.