Military medicine
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Strengthening Abortion Training: A Dilation and Evacuation Checklist in Military Resident Education.
A dilation and evacuation (D&E) is a safe and effective option for patients undergoing a second trimester abortion. Recent legislation and geographic restrictions threaten patients' access to this surgical procedure, prompting a call to action to strengthen abortion training. This quality improvement project aimed to assess if a standardized lecture and checklist would improve military trainee knowledge and comfort with performing D&Es. ⋯ Use of an evidence-based checklist significantly improves resident knowledge and comfort with performing second trimester D&Es. In a post Dobbs environment, the military is an appropriate proxy for larger society and training programs need to develop alternatives and adjuncts to clinical training.
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Case Reports
Delayed Pressure Urticaria Associated With Altitude Chamber Training Responsive to Cyclosporine and Omalizumab.
Delayed pressure urticaria (DPU) is a subset of chronic inducible urticaria. It is characterized by the formation of wheals anytime between 30 minutes and 24 hours after stimulus exposure of localized pressure application. In this case report, we discuss a military flight crew member with no significant past medical history who developed DPU following rapid decompression in an altitude chamber. ⋯ Control of symptoms was achieved through combination treatment of a second-generation antihistamine, a leukotriene receptor antagonist, and an immunosuppressant (cyclosporine). His waiver to return to flight status was denied while on cyclosporine. He was transitioned to a monoclonal antibody that binds free immunoglobin E (omalizumab) with resolution of symptoms and was cleared to return to active duty.
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Primary cutaneous mucinous carcinoma (PCMC) is a malignant adnexal tumor that masquerades as a benign periocular lesion. We present a case of a 29-year-old male with an eyelid PCMC misdiagnosed as a chalazion. He underwent Mohs microscopic surgery for definitive treatment, with no recurrence at his 36 month follow up. Given the rarity and poorer prognosis in younger patients, a high index of suspicion is crucial for biopsying periocular lesions that fail conservative therapy.
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Mal de Débarquement Syndrome (MdDS) is a poorly understood vestibular disorder that frequently affects military personnel exposed to motion during transportation and deployment. It is characterized by a persistent sensation of motion often experienced after disembarking from a ship or other mode of transportation. ⋯ The unique conditions of military service, including frequent travel, long flights, maritime deployments, and high-stress environments, make the military well suited to study MdDS. Increased awareness and understanding of MdDS is crucial for everyone in the military-from medical personnel responsible for the diagnosis and treatment of MdDS to commanders who must consider the operational impact of impaired personnel.
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One in four U.S. service members endorses food insecurity. The Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an invaluable, underutilized resource that can increase access to nutritious food for families with children under 5 years of age. Our research sought to evaluate military family perceptions and engagement with the WIC program. ⋯ Our findings suggest that unique circumstances related to military family life create a profound need for programs addressing food support, such as WIC. Interventions to improve WIC enrollment among military families need to be rooted in broad outreach efforts, not targeted at specific ranks, branches, or ages. Specific recommendations include increasing information dissemination, universally screening military families for WIC, decreasing logistical burdens, and involving military leadership.