Military medicine
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The U.S. Naval Ship COMFORT has performed six humanitarian assistance and disaster relief mission since 2007. This paper describes the surgical volume per surgical specialty for five missions spanning 19 countries. ⋯ As volume in military treatment facilities declines, alternative sources of surgical volume for military surgeons are being examined. This paper highlights the historical volume which can inform future personnel planning requirements of U.S. Naval Ship COMFORT missions. With the exception of orthopedic surgery, surgical volume has remained consistent over the last decade. For future best practice, historical case data should be used to determine staffing needs on hospital ships and case logs and operating procedures and follow-up protocols should be standardized.
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The U.S. Navy routinely deploys aircraft carriers and amphibious assault ships throughout the world in support of U.S. strategic interests, each with an embarked single surgeon team. Surgeons and their teams are required to participate in lengthy pre-deployment shipboard certifications before each deployment. Given the well-established relationship of surgeon volume to patient outcome, we aim to compare the impact of land vs. maritime deployments on Navy general surgeon practice patterns. ⋯ Surgeons are a critical component of combat causality care teams. In this analysis, we have demonstrated that both land- and maritime-based U.S. Navy surgeons have prolonged periods away from clinical care before and during deployments; for shipboard surgeons, this deficit is large and may negatively impact patient outcomes in the deployed maritime environment. The authors describe this discrepancy and provide practical doctrinal solutions to close this readiness gap.
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Chronic pain is a debilitating problem that disproportionately affects military veterans. We completed a qualitative study that identified 20 research priorities of Canadian veterans living with chronic noncancer pain. The aim of this study was to establish the generalizability of these priorities. ⋯ Our survey established research priorities among Canadian veterans living with chronic noncancer pain. These findings should be considered by granting agencies when formulating calls for proposals and by researchers who wish to undertake research that will address the needs of military veterans living with chronic pain.
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Routinely faced with potentially traumatizing situations, resilience is critical for military physicians. However, related studies are limited in scope. The current study distinctively combines hyper-realistic immersion training for military medical students with emotional intelligence and hardiness measures. With self-reflection shown to improve performance, qualitative inquiry was concurrently conducted in a mixed methodology approach to provide a uniquely comprehensive perspective on the resilience training needs of this population. ⋯ This unique pilot study showed that quantitative and qualitative results aligned, supporting the finding that a safe trauma-related training environment can improve the confidence and resilience in military medical students. The goal of this training was to promote resilience and mitigate trauma. Results demonstrate improved self-efficacy and enhanced commitment. Increases in self-awareness and confidence made participants more inclined to see their worth and strengthened their sense of duty as described in their qualitative responses. Pervasive gains suggest that the training aligned well with its purpose, and the methods employed enhanced participant experience. Long-term follow-up studies are needed to assess outcome sustainability.
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Active duty flight crew plays a critical role in military operations. The occupational demands of the flying environment require a certain level of medical suitability. Additionally, such an environment could be more hazardous for certain populations. While the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the World Health Organization strongly support exclusive breastfeeding for the health benefit of both the mother and the child in the first 6 months of life, the aeromedical implications of lactating are not widely discussed. Breastfeeding is inherently challenging for many women, in part because of the frequent emptying required to maintain breastmilk supply and avoid complications such as engorgement, clogged ducts, and mastitis. This pilot study evaluated the experiences of individuals concurrently breastfeeding while on active duty Naval flying status to (1) assess whether these individuals experience frequent challenges or complications associated with lactating and (2) establish the need for future expanded studies. ⋯ This study hypothesizes that occupational demands associated with aviation result in a decreased ability to maintain exclusive breastfeeding, an increased risk for engorgement and clogged ducts, and a higher likelihood of early weaning among Naval aviators. It included only the perspectives of Naval officers, thereby lacking the input of enlisted aircrew on flight status, who comprise a large population of active duty flyers. The responses, although limited by a lack of controls and survey limitations, indicate that a future study to expand understanding of the aeromedical implications on lactating individuals would be valuable for improving workplace support and the ultimate success of lactating women in meeting their breastfeeding goals.