Military medicine
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A positive therapeutic relationship is characterized by trust and mutually perceived genuineness. It is positively associated with patients' adherence to treatment, satisfaction, and health outcomes. When service members with a history of mild traumatic brain injury (mTBI) present to rehabilitation clinics with nonspecific symptoms, a disparity between their experience of disability and clinical expectations of mTBI may disrupt the establishment of a positive therapeutic relationship between patients and providers. The objectives of this study are to (1) explore disparities between military service members and rehabilitation clinicians about the clinical diagnosis and illness experience of mTBI and (2) identify barriers to the establishment of a positive therapeutic relationship. ⋯ This study extended previous research on therapeutic relationships by examining the situation of mTBI rehabilitation services for military service members. The findings reinforce the best practice recommendations of acknowledging patients' experiences, addressing the presenting symptoms and problems, and encouraging progressive return to activity following mTBI. Acknowledgment of and attention to patients' illness experience by rehabilitation clinicians is necessary and important for supporting a positive therapeutic relationship and ultimately to optimize patients' health outcomes and reduce disability.
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Multi-domain operational combat environments will likely restrict key components of current behavioral health (BH) service delivery models. Combat teams in far-forward outposts or extended missions may need to rely on their own internal assets to manage combat and operational stress reactions for extended periods of time. As such, combat medics are expected to take on additional responsibilities as providers of BH support for isolated teams. As they receive limited BH training, medics require additional training to sufficiently respond to combat and operational stress reactions in their assigned teams. This study provided combat medics with a BH training and a mobile application-based support tool that would assist them in identifying and responding to BH concerns in their soldiers. The current analysis examines pre- to post-training changes in attitudes related to utilizing BH skills. ⋯ A larger proportion of medics believed it was within their scope of work and felt confident in assessing BH problems, and a smaller proportion believed it is within their scope of work and felt confident in applying interventions. The training increased most medics' confidence to administer interventions for BH and team communication issues. Similar training programs can help medics serve as support for a wide variety of circumstances when the brigade's mental health teams are inaccessible. Additionally, the Medic AIRE app expanded the ability to evaluate and provide interventions without extensive training in treatment modalities or BH conditions. This concept shows promise for providing medics with actionable tools when training time is limited such as during preparation for extended deployments.
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Observational Study
Surgical Experiences From a French Forward Surgical Team on Board of the Landing Helicopter Deck MISTRAL.
Onboard surface ships like destroyers and frigates, there is ROLE 1, whereas on a three-landing helicopter deck (LHD) and aircraft carrier, there is ROLE 2, with a surgical team. At sea, evacuation takes more time than on any other theater of operation. It also costs more money, so we wanted to analyze how many patients have been maintained onboard, thanks to ROLE 2. Moreover, we wanted to analyze the surgical activities on the LHD MISTRAL ROLE 2. ⋯ We have shown that using ROLE 2 aboard the LHD MISTRAL decreases the use of Medical Evacuation. It also helps to perform surgery under better conditions for our sailors. Doing everything to keep sailors onboard seems to be an important point.
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Following graduate medical education duty hour reform, many programs have migrated to a night float model to achieve duty hour compliance. This has led to increased focus on optimizing nighttime education. A 2018 internal program evaluation of the newborn night rotation revealed that most pediatric residents received no feedback and perceived little didactic education during their four-week, night float rotation. One hundred percent of resident respondents were interested in increased feedback, didactics, and procedural opportunities. Our objective was to develop a newborn night curriculum to ensure timely formative feedback, enhance trainee didactic experience, and guide formal education. ⋯ As resident schedules evolve, there is an increased need for focused didactics during the night shift. The results and feedback from this resident-led and multimodal curriculum suggest that it is a valuable tool to improve knowledge and confidence for future pediatricians.
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Meloidae are distributed in temperate and arid regions but are also common in subtropical and tropical savannahs. These insects contain cantharidin, a vesicant substance that can cause poisoning by ingestion and dermatitis by direct contact. ⋯ These outbreaks of burn-like lesions, although clinically benign, can place a considerable burden on the medical activity of health care facilities. The diagnosis of Meloidae dermatitis is exclusively anamnestic and clinical and requires reported contact with the insect. The treatment protocol is that of standard burn care, and the best preventive measure is to avoid bright white lights. Military personnel, foreign workers, and travelers venturing into the Sahel should be warned of the risks associated with these beetles.