Military medicine
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In ensuring the timely delivery of emergency care to Veterans, Veterans Affairs (VA) offers both emergency care services in its own facilities and, increasingly, purchases care for Veterans in non-VA (community) emergency department (ED) settings. Although in recent years emergency care coverage has become the single largest contributor to VA community care spending, no study to date has examined Veteran decision-making as it relates to ED setting choice. The purpose of this study is to identify and describe reasons why Veterans choose VA versus non-VA emergency care settings. ⋯ Our qualitative results help provide insight into how and why Veterans choose to seek emergency care. As the number of Veterans treated in non-VA EDs continues to rise, VA and non-VA ED providers as well as policy makers may benefit from understanding the challenges Veterans face when making this decision.
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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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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.