Military medicine
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Point-of-care ultrasound (POCUS) is an integral aspect of critical care and emergency medicine curriculums throughout the country, but it has been slow to integrate into internal medicine residency programs. POCUS has many benefits for internal medicine providers, guiding diagnostic decisions and aiding in procedures. Additionally, POCUS is a convenient and portable resource specifically for internal medicine providers in the military when practicing in deployed or critical care settings. Critical care and emergency medicine clinicians are excellent resources to lead these courses. We sought to develop a new POCUS curriculum for internal medicine residents within the Naval Medical Center Portsmouth Internal Medicine Residency program with the support of emergency medicine and critical care medicine staff to lead and oversee the training. The project's aim was to increase internal medicine resident confidence with POCUS by 20% and proficiency with POCUS as evidenced by pretest and posttest analysis by 10%. ⋯ A curriculum comprised of a 9-hour workshop followed by a longitudinal hands-on experience can provide improvement in internal medicine resident POCUS knowledge and confidence. This model emphasizes the benefit of emergency and critical care cooperation for ultrasound training and provides an emphasis on medicine-relevant scans and longitudinal training.
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Randomized Controlled Trial
The Effect of Preoperative Behavioral Intervention on Pain, Anxiety, Opioid Use, and Function in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Study.
To evaluate the efficacy of preoperative cognitive-behavioral psychoeducation (CBE) for improved pain, anxiety, opioid use, and postoperative function in total knee arthroplasty (TKA) patients. ⋯ A cognitive-behavioral approach to preoperative education may improve postoperative pain, anxiety, and function while decreasing opioid use among TKA patients. Findings from this pilot study support further research to examine similar interventions among distinct surgical populations and encourage further evaluation on the effects of CBE to enhance health and healthcare delivery.
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Recent epidemiological evidence shows that shoulder and upper-arm complaints impose a substantial burden on the armed forces of the United States and create significant challenges for all components of the physical fitness domain of total force fitness. Clinicians, epidemiologists, and health-services researchers interested in shoulder and upper-arm injuries and their functional limitations rarely have objective, validated criteria for rigorously evaluating diagnostic practices, prescribed treatments, or the outcomes of alternative approaches. We sought to establish and quantify patient volume, types of care, and costs within the Military Health System (MHS) in assessing and managing active duty members with nonoperative shoulder and upper-arm dysfunction. ⋯ Nearly 1 in 20 active duty military service members presented for nonoperative care of shoulder and/or upper-arm dysfunction during FY2014. Further examinations of the etiology and potential impact of shoulder/upper-arm dysfunction on force readiness are clearly warranted, as are additional studies directed at identifying best practices for preventing injury-related dysfunction and determining best practices for the treatment of shoulder dysfunction to optimize service member fitness and force readiness.
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To assess gaps in human papillomavirus (HPV) knowledge and current attitudes toward HPV vaccination among active duty soldiers at Fort Bragg, NC, and to evaluate the impact of the instruction intervention on knowledge and attitudes regarding HPV vaccination. ⋯ Results among soldiers demonstrated a lack of knowledge regarding HPV infection, its long-term effects, and preventive measures available among this population of active duty members. Assessment results also illustrated education about HPV infection and vaccination positively impacts soldiers' knowledge and attitudes toward HPV vaccination.
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Virtual patient cases (VPCs), a type of simulated, interactive electronic learning, are a potentially important tool for military health care providers in austere or pandemic settings to maintain skills but need more validation. Our military internal medicine clerkship is spread across military treatment facilities around the country and has 15 weekly live student lectures, but students randomly miss the first, second, or third 5 weeks due to their psychiatry clerkship. We hypothesized that VPCs would be an adequate replacement for lost lectures. ⋯ VPCs appear noninferior at teaching clinical reasoning as measured by SCT. VPCs might be substituted for traditional, live lectures in clerkships when time or other resources are limited, in austere environments such as military deployments, or during conditions limiting interpersonal contact such as pandemics but are not a complete substitution for in-person learning.