Military medicine
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The USNS COMFORT (T-AH-20) deployed in support of Enduring Promise 2018 (EP-18) for an 11-week humanitarian mission providing care to the residents of four host nations in Central and South America. The COMFORT provides the capability of providing medical, dental, and surgical care in humanitarian aid missions.
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The objective of this study was to determine the utility of the Community Balance and Mobility scale (CB&M) among service members presenting with mild traumatic brain injury (mTBI), to compare the results against well-established balance assessments, and to find a new military-specific CB&M cut score to help differentiate those with and without mTBI. ⋯ All objective measures distinguish participants with mTBI from controls, ranging from fair to excellent. The recommended CB&M cut score of 81.5 allows for good variance, standard deviation, and reduced risk of ceiling or floor effects. Further examination of the recommended CB&M cut score is warranted for use in the mTBI civilian populations.
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The treatment and resolution of psychological traumas during military deployments directly supports medical readiness and the military mission and potentially prevents symptom progression to post-traumatic stress disorder (PTSD). However, current evidence-based trauma-focused psychotherapies can be difficult to employ during military contingency operations due to various barriers. Deployed military behavioral health providers need an effective, trauma-focused intervention that is suitable for the operational environment. In this retrospective case series, we describe how a therapeutic intervention based on accelerated resolution therapy (ART), an emerging trauma-focused psychotherapy, was pivotal in the treatment of acute stress reactions in eight deployed U.S. Army soldiers. ⋯ Based on these encouraging preliminary findings, the authors recommend that behavioral health providers who are preparing to deploy become familiar with ART or related interventions in order to develop the confidence and the skills that are needed to provide timely and effective trauma-focused care for deployed soldiers.
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Infections with multidrug resistant organisms that spread through nosocomial transmission complicate the care of combat casualties. Missions conducted to review infection prevention and control (IPC) practices at deployed medical treatment facilities (MTFs) previously showed gaps in best practices and saw success with targeted interventions. An IPC review has not been conducted since 2012. Recently, an IPC review was requested in response to an outbreak of multidrug resistant organisms at a deployed facility. ⋯ Despite successes, ongoing challenges with optimal deployed IPC were noted. Recommendations for improvement include strengthening IPC culture, accountability, predeployment training, and stateside support for deployed IPC assets. Variability in IPC practices may occur from rotation to rotation, and regular reassessment is required to ensure that successes are sustained through times of turnover.
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Physician burnout is of growing concern in the medical community and in emergency medicine (EM) in particular. It is unclear whether higher levels of burnout are associated with poorer academic or clinical performance. EM residency in military environments compared to civilian residencies has unique considerations related to additional military-specific training and operational requirements, which may contribute to burnout. The prevalence and effects of burnout on military EM resident physicians have not been investigated. ⋯ In a small study of military EM resident physicians, level of burnout as measured by the MBI-HSS is similar to other EM populations including civilian residents and practicing physicians, though it was much higher than that of military orthopedic residents. No relationship between presence or absence of burnout and academic performance as measured by the ABEM-ITE was found.