Military medicine
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There are many unique aspects to the practice of military Infectious Diseases (ID). San Antonio Uniformed Services Health Consortium Infectious Disease (ID) Fellowship is a combined Army and Air Force active duty program. Program leadership thought ID military unique curriculum (MUC) was well integrated into the program. We sought to verify this assumption to guide the decision to formalize the ID MUC. This study describes our strategy for the refinement and implementation of ID specific MUC, assesses the fellow and faculty response to these changes, and provides an example for other programs to follow. ⋯ Military GME programs are required by congress to address the unique aspects of military medicine. Senior fellow knowledge using the spaced interval multiple-choice quizzes did not differ from junior fellow rate, supporting our concern that the ID MUC needed to be enhanced. Enhancement of the MUC experience can be accomplished with minimal increases to curricular and faculty time.
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With the rising costs of cancer care, it is critical to evaluate the overall cost-efficiency of care in real-world settings. In the United States, breast cancer accounts for the largest portion of cancer care spending due to high incidence and prevalence. The purpose of this study is to assess the relationship between breast cancer costs in the first 6 months after diagnosis and clinical outcomes by care source (direct or purchased) in the universal-access US Military Health System (MHS). ⋯ In the MHS, higher breast cancer costs in the first 6 months after diagnosis were associated with lower risk for clinical outcomes in direct care, but not in purchased care. Organizational, institutional, and provider-level factors may contribute to the observed differences by care source. Replication of our findings in breast and other tumor sites may have implications for informing cancer care financing and value-based reimbursement policy.
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Gender disparity in academic medicine has been well described in the civilian sector. This has not yet been evaluated in the military health system where hundreds of female surgeons are practicing. Military service limits factors such as part time work and control over time spent away from family, which are often cited as contributors to the pay and promotion gap in civilian academic medicine. The military has explicit policies to limit discrimination based on gender. Pay between men and women is equal as it is based on rank and time in rank. One would expect to see less disparity in promotion through the academic ranks for military female surgeons given this otherwise equal treatment. This has not previously been objectively tracked or reported. It is beneficial to characterize the military academic medicine gender gap and benchmark against national data to define the academic gender gap and lay the groundwork for future work to identify factors contributing to the observed difference. ⋯ Fewer female surgeons in military medicine hold academic appointment when compared with their counterparts in civilian medicine. Similar to the civilian sector, military academic surgery also demonstrates less likelihood of female representation in higher academic stations. This discrepancy in representation follows a linear trend over the different ranks. This discrepancy has not been previously documented. The military offers a unique opportunity to study the issue of gender imbalance in academic promotion practices given its otherwise equal treatment of males and females. Additional studies will be necessary to understand uniformed female surgeons' barriers to academic advancement.
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This study is the first to our knowledge to examine associations of survey-reported dietary supplement use with medical record diagnoses, rather than retrospective self-reported supplement use at the time of the medical encounter or case reports of adverse events. Dietary supplement (DS) use and adverse events associations in US Navy and Marine Corps personnel remains unknown. This study assessed associations of DS use in active duty (AD) personnel with ICD-9-CM diagnostic codes from outpatient medical encounters from the Military Health System Data Repository (MDR). ⋯ The percentages of service members with diseases in specific ICD-9-CM diagnostic categories were similar to those reported in other studies using military medical data. There is a greater prevalence of dietary supplement use by the service members who participated in this survey compared with the general population, with 73% of US Navy and Marine Corps personnel reporting use of dietary supplements one or more times per week compared to the estimated 50% of all Americans currently using some form of dietary supplement. The DoD ensures the optimal readiness, performance, and health of its military service members, thus future longitudinal evaluation of dietary supplement use by this population will test the preliminary findings of this study.
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The Indo-Asia-Pacific region has the highest incidence of natural disasters world-wide. Since 2000, approximately 1.6 billion people in this region have been affected by earthquakes, volcanos, tsunamis, typhoons, cyclones, and large-scale floods. The aftermath of disasters can quickly overwhelm available resources, resulting in loss of basic infrastructure, shelter, health care, food and water, and ultimately, loss of life.Over the last 12 years, US military forces have collaborated with countries throughout the Indo-Asia-Pacific region to enhance disaster preparedness and management during shipboard global health engagement missions. Military health care personnel are integral in this effort and have planned subject-matter expert exchanges, multidisciplinary conferences, courses, and hyper realistic simulated military-to-military training exercises related to disaster preparedness.Military health care providers are essential not only to providing international education and training, but also to ensuring optimal readiness to respond to future disasters in the Indo-Asia-Pacific region and worldwide. The ability to effectively respond to disasters and collaborate with other nations promotes international stability. Yet, few studies have examined disaster preparedness among US military health care personnel. This study aimed to assess knowledge, skills, and preparedness for disaster management among US military health care personnel preparing to deploy on a global health engagement mission. ⋯ Disaster preparedness among military healthcare personnel could be improved to function optimally for future global health engagement missions. This study expands current understandings of disaster preparedness among US military health care providers and identifies ways to improve and enhance training.