Military medicine
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Sense of coherence (SOC) refers to the psychosocial aspects and origins of health. Sense of coherence is related to physical and psychological health and quality of life. Military studies on SOC are commonly related to military deployment or operations, military training, and military fitness. Sense of coherence is assessed using a self-report scale. The total score of the scale indicates the level of SOC. Psychometric research studies over 2 past decades, however, suggest that the SOC scale is a multidimensional measure, and the latent factors should be considered as separate dimensions of SOC. Thus far, there are no previous factorial structure studies of the SOC scale in military contexts or in military populations. The dimensions of SOC have not been investigated in relation to mental health and subjective well-being of soldiers, military personnel, or military recruits/conscripts. ⋯ SOC among conscripts is a 2-dimensional model. The experience of recovery from past mental health problems is related to a stronger motivational dimension (meaningfulness towards life), which shows upon obligatory military service and training. Sense of coherence motivational aspect may be useful when training recruits. Demographic variables, such as economic situation, family structure, and parents' employment, should be considered when assessing past and/or present mental health problems and SOC.
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Massive transfusion protocols (MTPs) ensure the timely and life-saving delivery of blood products to patients who are rapidly exsanguinating. Although essential, MTPs are also highly resource-intensive. Effective MTP implementation must balance the resources of the hospital with the needs of the patient population that they serve, as well as avoid instances of unjustified activations. Toward this goal, we implemented a set of policy improvements to our institution's MTP aimed at ensuring appropriate clinical activation. ⋯ In summary, we developed an MTP tailored to the needs of our Veterans Affairs Medical Center, providing a reliable system for blood product administration to patients with real massive transfusion requirements while reducing unjustified MTP activations. We credit the reduction in MTP activations mainly to improved education and training of clinicians, which, in turn, changed their ordering behaviors. Fewer unjustified MTP activations decrease the potential for wastage of resources such as blood and blood components and preserves work hours of staff for patients with true transfusion needs. We believe our strategy may have a widespread and compounding effect on improving blood stewardship nationwide, given our trainees' propensity to work at medical centers across the country and educate future trainees of their own.
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Acute anterior cruciate ligament (ACL) injuries can be disabling because of prolonged rehabilitation process following surgical reconstructions. Rates of ACL injuries among military service members are close to 10 times greater than the general civilian population, likely because of the operation tempo and the unique physical requirements. Studies debated functional testing requirements for return to sports, but no study investigated the impact of functional training and re-injury rates following ACL reconstruction and their association with functional testing outcomes and time to return to full duty in United States Naval Academy (USNA) Midshipmen. Therefore, the purpose of this study was to review all ACL reconstructions with and without meniscal injury at USNA, the functional training and testing, timing of return to military training, and associations with postoperative re-injury rates. ⋯ Postoperative injuries and complications following ACLR can delay the ability to return to duty by twice as long, consequently effecting military manpower capability. A functional training and testing program resembling both an athletic and military/operational environment can reduce re-injury and complication rates, resulting in faster return-to-duty rates. Future studies should assess the impact of military rehabilitation participation following ACLR and functional testing protocols to assess physical readiness of Midshipmen to return to full duty. Additionally, methods to assess psychological readiness to return to duty should be further investigated.
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Female sterilization is a common form of contraception in the United States. On June 24, 2022, the United States Supreme Court eliminated the federal standard protecting a woman's right to abortion via Dobbs v. Jackson Women's Health Organization. Since that time, there have been anecdotal increases in sterilization requests across the country, although there are no publications demonstrating this change. This study hypothesized that there would be increased female sterilization rates at a Texas military hospital post-Dobbs decision due to state restrictions as compared with a Washington military hospital. ⋯ The reproductive health of military medical beneficiaries at one military hospital was significantly impacted by the Dobbs v. Jackson Women's Health Organization decision. Rates of female sterilization increased significantly. In addition, patients choosing permanent sterilization were younger and were less likely to use alternative, reversible contraceptive methods prior to surgery. This study demonstrates a significant change in contraceptive choices toward methods that incur greater surgical risks and potential for regret, as well as greater financial costs to the military health system.
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Regional anesthesia, specifically fascia iliaca compartment blocks (FICB), is highly effective in managing pain, especially in military settings. However, a significant barrier to its implementation is the lack of provider confidence in performing ultrasound-guided procedures. This study evaluates the ability of physician assistant (PA) students, who are often first-line providers in austere locations, to identify the fascia iliaca compartment (FIC) using point-of-care ultrasound (POCUS) after a brief training session and assesses their retention of this skill over a 60- to 90-day period. ⋯ This study demonstrates that PA students can accurately identify the FIC using POCUS after a brief training session. However, there was a significant decline in skill retention over a 60- to 90-day period, underscoring the need for continuous education and practice to sustain proficiency. Further research with larger sample sizes and diverse settings is needed to develop effective training protocols and ensure long-term retention of U.S.-guided procedural skills.