Military medicine
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Brachytherapy, with external beam radiation, increases survival in the treatment of locally advanced cervical cancer (LACC). In 2016, Robin et al. reported only 44% of patients received standard-of-care (SOC) brachytherapy in the USA. The Pacific Island Health Care Project has provided humanitarian medical care to women from the U.S. Associated Pacific Islands (USAPI) for three decades at Tripler Army Medical Center (TAMC), a military health care system (MHS) facility. We evaluated whether this underserved and understudied patient population received SOC treatment for LACC at TAMC. ⋯ Women with cervical cancer from USAPI in the PIHCP program treated at TAMC received significantly higher rates of SOC radiation treatment than the U.S. population on average. This highlights the ability of PIHCP, through the MHS, to deliver SOC treatment for cervical cancer to an otherwise underserved patient population.
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The Department of Defense spends more than $3 billion annually on medical costs of lifestyle-related morbidity. Military service members and veterans engage in unhealthy behaviors at a higher rate than the civilian population. Lifestyle medicine may mitigate lifestyle-related chronic diseases and increase medical readiness in the U.S. Military. However, patients' perspectives in a military community regarding a lifestyle medicine-based approach to health care have not been studied. The purpose of this study was to assess the knowledge and attitudes of and interest in lifestyle medicine-based care within a military community. ⋯ Despite an overall low level of awareness of lifestyle medicine, most respondents expressed interest in a lifestyle medicine approach to health care, with food/nutrition and sleep ranked as the most important domains. Lower levels of education may be a potential barrier to patient willingness to engage in lifestyle medicine care. Service members in combat arms occupational specialties may represent a potential target population for smoking cessation interventions. Further research with a larger sample more proportionately inclusive of all military service branches is needed.
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Early identification of patients with coronavirus disease 2019 (COVID-19) who are at risk for hospitalization may help to mitigate disease burden by allowing healthcare systems to conduct sufficient resource and logistical planning in the event of case surges. We sought to develop and validate a clinical risk score that uses readily accessible information at testing to predict individualized 30-day hospitalization risk following COVID-19 diagnosis. ⋯ The prediction tool developed in this study demonstrated that it could identify patients with COVID-19 who are at risk for hospitalization. This could potentially inform clinicians and policymakers of patients who may benefit most from early treatment interventions and help healthcare systems anticipate capacity surges.
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The optimal length of Family Medicine Residency is unknown. As part of the American Board of Family Medicine 4-year Length of Training (LoT) pilot project, Naval Hospital Jacksonville (NHJ) maintained a dual-track 3- and 4-year Family Medicine Residency, graduating seven 4-year residents over consecutive 4 years of the LoT program. One measure of success regarding the impact of 4-year residents on program outcomes is scholarly output during residency. ⋯ An observed benefit of a 4-year Family Medicine Residency was a marked increase in scholarly output at this program.
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Cancers of unknown primary (CUP) are defined as histologically confirmed metastatic cancers that do not have an identified primary site of origin despite an appropriate diagnostic workup. Although accessibility to and quality of medical care influence diagnosis of cancer including CUP, previous studies describing CUP have generally been conducted in patients with various accessibilities to care. This study aimed to describe the demographic, histologic, and temporal trend characteristics of CUP patients in the DoD Cancer Registry of the Military Health System (MHS), which provides universal health care access, reducing the potential effects of accessibility to care on research results. ⋯ The proportion and trends of CUP in the ACTUR were generally consistent with other descriptive CUP studies. This study provides a description of CUP in a health care system with universal access in the USA and provides a foundation for future studies on CUP.