Military medicine
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The U.S. Army is updating the physical fitness assessment for soldiers to the six-event Army Combat Fitness Test (ACFT). A paucity of data regarding the ACFT maximum deadlift (MDL) event, especially in military populations, has increased concern over the objectivity of the test. The reliability of scoring the MDL has not been established. It is unknown if grader professional experience impacts the reliability of scoring, and if so, what level of experience is required for reliable assessment. Performance and assessment of the MDL could impact military occupational selection, promotion, and retention within the Army. The purposes of this study were to determine the inter- and intra-rater reliabilities of raters with varying degrees of professional experience on scoring the MDL and to determine the relationships between load lifted, overall lift success, sex, and body mass index (BMI). ⋯ Inter-rater reliability of the six raters ranged from poor to substantial, while intra-rater reliability ranged from moderate to excellent. Compared to a reference standard, inter-rater reliability ranged from poor to substantial. The wide range in consistency demonstrated in this study, both between and within raters, brings into question the current subjective methods used to grade the MDL. More research is needed to understand the most feasible, valid, and reliable way to assess performance standards like the MDL that may affect a soldier's career progression.
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Although compensation is often the only factor considered with military medical retention, retention has been shown to have many other important factors. Maximizing the retention of military medical personnel not only decreases the cost of recruiting them but also maintains the institutional knowledge of military medicine needed to conduct military medical operations. This study used a recent retention survey of U.S. Army physician assistants (PAs) to understand military medical retention needs. ⋯ The belief a service member can reach their career goals in the military is critical for retention. Using Army Techniques Publication 6-22.1 as a guide, leaders can help subordinates meet their career goals, and this may be the most important task a leader can accomplish to improve their unit's retention. Strengths of this study include the high response rate of 33.6% and results demonstrating the importance of growth counseling which is already part of Army doctrine. Weaknesses include the use of secondary cross-sectional data which impair the ability to derive conclusions from the data. Future studies should explore how training programs for military leaders in growth counseling can help subordinates find their career goals in the military and the effect on military retention.
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Over the last 200 years, the "medic" has demonstrated its value at the point of injury care. Unfortunately, when medics leave military service with their medical skills, they have limited direct employment options available to them without added educational requirements. Fortunately, the Veterans Health Administration's (VHA) innovation of the Intermediate Care Technician (ICT) Program has a solution for that problem. This article will look at the Veterans Affairs' creation of the ICT Program, investigate its origins, evaluate where it is today through the lens of the WHO Task-Shifting Model for healthcare system implementation, and address the ICT Programs' potential for tomorrow. ⋯ The VHA ICT Program demonstrates to the U.S. Healthcare System a validated and reliable program to address healthcare worker shortages, reduce healthcare costs, increase access to care, and manage increasing demand for healthcare.
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The U. S. DoD has identified firearm suicide prevention as a key operational priority. ⋯ The Summit identified 10 recommendations to enhance firearm suicide prevention messaging and interventions in the U. S. military, including (1) repeal or amend prohibitions on questioning service members about personal firearms; (2) develop, examine, and use common language for firearm injury prevention; (3) implement a universal approach to training on comprehensive firearm injury prevention; (4) encourage leadership across disciplines and levels; (5) aim for broad culture change; (6) support innovative research; (7) consider various outcome measures; (8) promote "cultural competence" for better communication; (9) reduce territorialism; and (10) develop creative partnerships. Ultimately, these recommendations can facilitate productive partnerships with a shared goal: to develop, test, and implement strategies that standardize lethal means safety and reduce firearm suicides and other firearm injuries or harm among service members.
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Physical therapists in the military are allowed some of the widest scope-of-practice privileges in the USA. These privileges include ordering imaging, making direct referrals, and serving as direct-access providers. This independent functioning model may help contribute to more efficient and effective patient care. ⋯ Both of the prior mentioned cases resulted in successful outcomes, with patients returning to their prior level of function. In the military healthcare setting, physical therapists have a unique set of practice privileges that can contribute to timely patient management, improved patient satisfaction, and more efficient and effective care. This healthcare model may be considered in civilian settings in the future as well.