Military medicine
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Observational Study
A Lack of Generalizability-Total Knee Demographics in the Active Duty Population.
Age and sex are known demographic risk factors for requiring revision surgery following primary total knee arthroplasty (TKA). Military service members are a unique population with barriers to long-term follow up after surgery. This study aims to compare demographic data between active duty military personnel and a nationwide sample to identify differences that may impact clinical and economic outcomes. ⋯ Patients undergoing TKA in the military are younger and more likely to be male compared to national trends. Current evidence suggests these factors may place them at a significant revision risk in the future. The application of quality metrics based on nationwide demographics may not be applicable to military members within the Military Health System.
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Research and development of military-required innovations are usually funded through the issuance of grants and contracts. The limitations of these funding methods are the a priori specifications and objectives that limit creativity and often do not produce capabilities beyond the desired outcomes or leverage the best ideas and solutions available. This limited engagement of commercial industry to develop military-required innovations usually relies solely on government funding and receipt of proposals from companies whose business model is built on receiving government grants and contracts, with the government owning most of the risks. ⋯ This often under-utilized pathway has several notable strengths such as (1) reduced risks and costs for the military to develop novel capabilities and products; (2) new and novel creative solutions to solve military problems; (3) utilizing a results-oriented approach that funds the successful achievement of acceptance criteria versus funding of potential to achieve; (4) enticing investors by increased competition for a successful product or capability; and (5) delivery of a commercially available, affordable, field-tested, and viable capabilities and products. Prize competitions may be used by any/all federal agencies as authorized by Congressional Public Laws and Federal regulations. The specifics of this pathway for funding pathway and applications for use by medical researchers, developers, and project/program managers are spelled out in the article, along with the regulatory guidance and resources for finding out more about current and past prize competitions.
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Vaccinations are an essential aspect of preventive medicine. In October 2021, the pneumococcal conjugate vaccine-20 (PCV-20) and PCV-15 were authorized for use in adults by the U.S. FDA. In 2022, the Advisory Committee on Immunization Practices (ACIP) subsequently published updated pneumococcal vaccination recommendations that incorporate both PCV-20 and PCV-15. Pneumococcal vaccination is effective in reducing pneumococcal disease, particularly in high-risk patient groups such as those with chronic lung disease; however, the updated dosing schedule for pneumococcal vaccinations can be quite confusing, especially if patients have previously received "older" vaccinations, such as pneumococcal polysaccharide vaccine-23 or PCV-13. The purpose of this quality improvement project was to increase providers' knowledge of current ACIP pneumococcal vaccination recommendations, including indications and dosing schedule, and to improve pneumococcal vaccination rates among eligible adults and children. ⋯ There is a significant knowledge gap regarding ACIP pneumococcal vaccination recommendations among military providers and a low pneumococcal vaccination rate for adults aged 19 to 64 years with asthma at Joint Base-San Antonio MTFs. Focused education sessions were effective in increasing providers' knowledge of updated pneumococcal vaccination recommendations, confidence in recommending vaccines, total number of pneumococcal vaccinations given, and estimated pneumococcal vaccination rate for adults with asthma. The validity of conclusions drawn from our data were limited because of discordant numbers of survey respondents as well as potentially inaccurate estimates of pneumococcal vaccination rates pre- and post-intervention. Despite this, the results warrant continued education of pneumococcal vaccines, indications, and dosing schedules.
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The Department of Defense Medical Examination Review Board (DoDMERB) plays a pivotal role in the assessment of medical fitness for aspiring military officers. A crucial component of this process is the screening audiogram, designed to evaluate hearing capabilities. However, recent observations of high disqualification rates following screening audiograms led to concerns about their accuracy. ⋯ In conclusion, the project underscores the importance of refining medical screening processes to accurately assess candidates' qualifications while retaining the utility of screening audiograms. These efforts not only benefit aspiring military officers but also contribute to maintaining the high standards required for military service.
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Observational Study
Sleep and Military Leaders: Examining the Values, Beliefs, and Quality of Sleep and the Impact on Occupational Performance.
Sleep deprivation is rampant within the military population, and insufficient sleep can lead to physical and mental health problems impacting soldier's readiness and deployability. Past research has shown the importance of leadership's role in subordinates' sleep health. Understanding the values, beliefs, and quality of military leader sleep is essential to the development of effective interventions to optimize occupational performance and overall sleep health. Therefore, the purpose of this study was to examine the military leaders' values, beliefs, and sleep quality and the impact on occupational performance. The authors aimed to (1) identify military leaders' sleep quality and beliefs; (2) explore the relationship between military leaders' sleep quality, beliefs and attitudes about sleep, and impact on occupational performance; and (3) examine the value leaders place on sleep for themselves and subordinates in relation to occupational performance. ⋯ This sample of military leaders was found to perceive themselves as poor-quality sleepers despite demonstrating more functional attitudes and beliefs about sleep and reporting normal-to-mild impairments in daily functioning as a result of daytime sleepiness. Furthermore, findings suggest that leaders' sleep quality and beliefs stand to be further improved, whereas their sleep values need to be consistently demonstrated to subordinates. With a clearer understanding of military leaders' values, beliefs, and sleep quality, future research could focus on implementing and developing holistically based and individualized sleep interventions intended to optimize performance and sleep health.