Military medicine
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A substantial proportion of adults in the U.S. criminal justice system are military veterans. Justice-involved veterans are of particular public concern given their service to the country and the high rates of health and social problems in the general veteran population. This article describes the development of a national research agenda for justice-involved veterans. ⋯ The intent of sharing this research agenda is to spur stakeholders to conduct, collaborate, and support further study in these areas.
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During exercises or operations, there may be times when U.S. medical capabilities are not available and the next best or only option may be to use partner nation (PN) or host nation capabilities. Joint Publication 4-02 Joint Health Services states that "medical planners should always consider the quality, suitability, and availability of multinational and host-nation support." It is normal practice for medical planners to survey PN medical capabilities as part of the pre-deployment planning process. Currently, medical capability surveys are not conducted in a consistent and systematic manner across the DoD global health engagement enterprise. The lack of a systematic approach undermines medical operations planners' ability to conduct efficient and adequate pre-deployment surveys. ⋯ There are significant inconsistencies in the types of capabilities and services documented and how the quality of the capabilities and services is characterized. These inconsistencies can be attributed, in part, to the absence of information that explicitly confirmed whether or not the facility had a capability. Such variation results in obscured or incomplete depictions of facility capabilities, thereby undermining the ability of medical planners to coordinate effective medical readiness for engagements, exercises, or real-life operations. Guidance and survey templates could support better-informed decision-making by including information about survey methods and documenting the lack of confirmatory information. The DoD enterprise should consider how guidance and a standard survey template could improve the relevance, accuracy, and efficiency of data collection and reporting.
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Prolonged exposure therapy is an effective treatment for posttraumatic stress disorder that is underutilized in health systems, including the military health system. Organizational barriers to prolonged exposure implementation have been hypothesized but not systematically examined. This multisite project sought to identify barriers to increasing the use of prolonged exposure across eight military treatment facilities and describe potential solutions to addressing these barriers. ⋯ The findings highlight the numerous organizational-level barriers to implementing evidence-based psychotherapy in the military health system and offer potential solutions that may be helpful in addressing the barriers.
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Medical assistance to populations (MAP) is a rich and varied activity, but it is not well known, and its modalities are inconsistent and unclear, particularly in the pediatric field; they can confront the military doctor with difficult management issues. Today, a military doctor deployed in foreign operations (FOs) does not know if he will perform MAP. He does not know how it will be carried out, nor if it will include a pediatric component. Finally, he does not know what difficulties he will face and therefore cannot prepare himself effectively. The primary objective of this work is to describe the modalities of MAP in FO, with an emphasis on the pediatric activity. The secondary objective is to develop a template for a post-session MAP registry. ⋯ MAP in FO is an activity in which modalities are very variable depending on the theater. Practitioners must have a solid theoretical and practical preparation beforehand, particularly in pediatrics. Keeping a specific activity register is an essential basis for judiciously adapting human and material resources dedicated to this activity. Future studies should aim to investigate more precisely the difficulties encountered.
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Combined pulmonary fibrosis and emphysema (CPFE) is a clinical syndrome of upper-zone-predominant emphysema on high-resolution CT and a peripheral and basal-predominant diffuse pulmonary fibrosis. Multiple occupational and inhalational exposures have been associated with CPFE. ⋯ S. veteran, who developed CPFE after a prolonged, intense exposure to trichloroethylene as an aircraft maintenance worker. We believe that this may be another example of occupational-associated CPFE.