Military medicine
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Annually, 300,000 soldiers are rendered medically nondeployable because of musculoskeletal injuries (MSKIs). Of this population, nearly 10,000 (3.3%) involve injuries to the hip. Factors related to these injuries impose significant healthcare, financial, and readiness burdens on the Army system, degrading overall mission readiness. The purpose of this retrospective study was to assess for correlation between increased anterior pelvic tilt and a lower likelihood for return to duty/return to run (RTD/RTR) in active duty personnel who underwent hip arthroscopy for femoroacetabular impingement (FAI), thus identifying increased anterior pelvic tilt as a potential prognostic indicator for RTD/RTR. ⋯ Statistical analysis confirmed the correlation between an increased amount of anterior pelvic tilt and a lower odds of RTD and RTR after hip arthroscopy for FAI in active duty U.S. Army personnel. This information can be used in patient counseling to better inform shared decision-making, provide more thorough informed consent, and help determine the optimal timing for surgical intervention, thus contributing to better stewardship of medical resources and decreasing the ever-growing financial healthcare burden. These findings will spur future research to consider the causes and optimal treatment of anterior pelvic tilt, positively impacting the culture of Army medicine by focusing on preventive and targeted treatments in order to preserve and grow the force.
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The Uniformed Services University is known for its dual mission of preparing military medical officers for operational readiness and leadership roles. The Joint Expeditionary Medical Officer (JEMO) project is a novel internal program that was initiated in 2022 and aims to fortify and evaluate the essential Knowledge, Skills, and Abilities (KSAs) within the School of Medicine's Molecules to Military Medicine curriculum that are pivotal for the development of a deployment-ready military medical officer. The JEMO-KSA program identifies and deliberately develops a core set of mission-critical skills during the course of students' undergraduate medical education. ⋯ The JEMO project represents a significant stride toward optimizing the readiness of military medical officers by systematically identifying, strengthening, and assessing vital operational skills and abilities. With an ongoing commitment to excellence, the project envisages creating an even more robustly structured curriculum that is continually refined to address current operational readiness, setting a new standard for military medical education. While challenges such as accurately measuring the impact of integrated KSAs and continuously updating them to meet evolving military needs remain, the forward momentum associated with the JEMO project will help facilitate the development of military medical officers who have the KSAs to actively support mission success while simultaneously enhancing the overall effectiveness of military health care.
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Total knee arthroplasty (TKA) is one of the most performed surgical operations in the United States. Managing postoperative pain after TKA is of vital importance, as it is positively associated with outcome measures related to recovery of function and quality of life. Two commonly used methods to control postoperative pain are regional anesthesia (RA), consisting of a single or a combination of peripheral nerve and epidural blocks, and pain medication, such as opioids. Our retrospective analysis sought to better understand whether revision versus primary TKA impacted previously discovered disparities in perioperative pain management and use of RA at the Atlanta Veterans Affairs Health Care System (AVAHCS). Before data collection, we hypothesized that revision TKA would have a higher proportion of Black and older patients and that revision TKA patients would have lower postoperative pain scores. ⋯ Sociodemographic disparities in pain management have been reported in all healthcare systems, including the VAHCS. This moderately sized retrospective study, conducted at a single veterans affairs site, yielded several noteworthy findings. One finding of particular interest was that, despite Black patients reporting higher baseline and 24-hour postoperative pain scores, they were prescribed fewer opioids at discharge. Our results highlight the presence of clinically significant disparities in perioperative TKA pain management, emphasizing the need for continuous investigation and focused mitigation efforts among Veterans.