Military medicine
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Military sexual trauma (MST) has been associated with long-term negative outcomes such as increased rates of cardiovascular disease, post-traumatic stress disorder (PTSD), and suicidal thoughts and behaviors. While evidence supports the effectiveness of psychotherapeutic approaches as treatments for MST and related PTSD symptoms, these interventions have limited impact, attributed to perceived stigma with high dropout rates in female Veterans. Complementary and integrative health (CIH) interventions provide an alternative that may be more acceptable and can help transition Veterans into mental health treatments. Although evidence supports the utility of individual CIH interventions to be both effective and acceptable treatments for MST-related PTSD amongst female Veterans, there are limited evaluations of interventions that combine multiple CIH modalities, specifically in populations of at-risk female Veterans with histories of suicidal ideation or behavior. Thus, this quality improvement (QI) project aimed to assess the impact of a multimodal CIH intervention on mental and physical health symptoms specifically in female at-risk Veterans with MST. ⋯ The results of this QI evaluation add to the growing body of evidence demonstrating that CIH interventions can be effective in attenuating mental health symptom-related MST and particularly within female Veteran populations at-risk for suicide, underscoring the potential importance of investigating integration of multiple CIH interventions for treatment of at-risk populations in future clinical research studies.
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The Veterans Health Administration (VHA) Epilepsy Centers of Excellence (ECoE) was established in 2008 to provide specialized care for veterans with epilepsy. Although established more than a decade ago, there has been no systematic evaluation of the ECoE's performance in key mission areas. We evaluated their performance in several key mission areas-clinical care, research, education, and outreach-since inception to evaluate their success in meeting the initial mandate. ⋯ Our analysis reveals progressive growth and improvements in the ECoE mission areas of clinical care, research, education, and outreach. Clinical utilization data have shown growth since inception, while also leading to lower mortality rates and lower costs per patient, fulfilling the organizational mandate to improve the care of veterans with epilepsy. There is substantial activity in research, education, and outreach. The ECoE governance hierarchy aims to facilitate smooth resource allocation both regionally and for the key mission areas. Our findings can help policymakers assess and prioritize future ECoE initiatives, while other clinical care organizations can seek to model their care based on the ECoE.
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The first class at USUHS took its initial course in medical ethics in 1977. I directed this course until recently when COVID first emerged. In this piece, I review what these students were taught during the last 5 of 8 class sessions involving the military, genetic, reproduction, student ethics, and the Holocaust. I discuss here the content of these sessions, the rationales of these contents, key lessons learned, and future directions and challenges. This review provides readers with information regarding some of the faculty brought in to provide these lectures, and key points they emphasized. It also summarizes the more subtle points regarding ethics that it was hoped students would gain and use throughout their medical careers and lifetimes. ⋯ Medical ethics is now taught in all medical schools but at USUHS this education must include traditional core medical topics and military medical issues as well. A challenge posed throughout the course was whether to emphasize what ethical and professional behaviors would be expected of students in their later military careers or to challenge them to engage in original analysis of ethical questions that had no self-evident answers. The decision was made in most cases to encourage students having materials to discuss and debate in their discussion groups, especially since they would learn what was expected of them in their military roles from multiple other sources. The priming for these discussions in the presentations seemingly succeeded in engaging the students and in provoking relevant debate throughout all of these cases. This learning is highly important in that in the future in both medicine and the military new unanticipated ethical issues will continue to arise. Since there will be no self-evident best ethical answers to these issues, those tasked with and thus seeking to resolve them will have to depend on having the optimal ethical skills for approaching and resolving these issues. This course sought to initiate this process, engaging these students and moving them hopefully to want to increase their skills in analyzing ethical dilemmas as they continue to progress throughout their military careers.
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The first class at USUHS took its initial course in medical ethics in 1977. I directed this course until recently when COVID first emerged. In this piece, I review what these students were taught during the first 3 of 8 class sessions involving children, end-of-life care, and rersearch. This review provides readers with information regarding some of the faculty brought in to provide these lectures, and key points they emphasized. It also summarizes the more subtle points regarding ethics that it was hoped students would gain and use throughout their medical careers and lifetimes. ⋯ Medical ethics is now taught in all medical schools but at USUHS this education must include traditional core medical topics and military medical issues as well. A challenge posed throughout the course was whether to emphasize what ethical and professional behaviors would be expected of students in their later military careers or to challenge them to engage in original analysis of ethical questions that had no self-evident answers. The decision was made in most cases to encourage students to discuss and debate controversial issues in their discussion groups, especially since they would learn what was expected of them in their military roles from multiple other sources. The priming for these discussions in the presentations seemingly succeeded in engaging the students and in provoking relevant debate throughout all of these cases. This learning is highly important in that in the future in both medicine and the military new unanticipated ethical issues will continue to arise. Since there will be no self-evident best ethical answers to these issues, those tasked with and thus seeking to resolve them will have to depend on having the optimal ethical skills for approaching and resolving these issues. This course sought to initiate this process, engaging these students and moving them hopefully to want to increase their skills in analyzing ethical dilemmas as they continue to progress throughout their military careers.
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The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on physical fitness in previously healthy adults is not well understood. In this study, we assess the impact of SARS-CoV-2 infection on the physical fitness test (PT) scores of Air Force basic trainees. ⋯ SARS-CoV-2 infection was associated with an increased risk of PT failure as well as conversion from a passing to failing test score. There were no differences in second test failure rates in symptomatic compared to asymptomatic trainees. A key confounder to the data was the effect deconditioning had on fitness during isolation.