Military medicine
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Ongoing studies are investigating the potential link between deployment to Operation Iraqi Freedom and Operation Enduring Freedom and relationship to increases in pulmonary disease. While increases in certain diseases such as asthma and airway hyperreactivity are well established, data on other chronic pulmonary diseases such as sarcoidosis have not been defined. ⋯ Based on this analysis of Army sarcoidosis patients, there was no difference in the rates of sarcoidosis diagnosis in deployed and nondeployed soldiers. Spirometry values, total lung capacity, and radiographic staging did not show significant differences between deployment groups.
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Up to 34% of combat trauma injuries are complicated by infection with multidrug-resistant organisms. Overutilization of antibiotics has been linked to increased multidrug-resistant organisms in combat-injured patients. Antimicrobial stewardship efforts at deployed medical treatment facilities have been intermittently reported; however; a comprehensive assessment of antimicrobial stewardship practices has not been performed. ⋯ Antimicrobial stewardship programs in theater are in the early stages of development in theater. Areas identified for improvement are access to expertise, development of a focus on high-impact lines of effort, laboratory support, and the culture of antimicrobial prescribing. Risks can be mitigated through theater level formalization of efforts, expert mentoring through telehealth, and a focus on implementation and adherence and feedback to national guidelines.
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Chronic pain affects over 100 million American adults. The prevalence of chronic pain is even higher among U.S. military personnel. Approximately 44% of active duty military experience pain upon returning from deployment compared with 26% of the general public who experience chronic pain. The high prevalence of chronic pain within the Military Health System is compounded by limited access to chronic pain specialists, specifically with regard to patients at remote military treatment facilities (MTFs). Thus, when compared to personnel at tertiary care MTFs, they often have decreased access to care and experience increased time away from their mission to receive care. Since 2009, Walter Reed National Military Medical Center (WRNMMC) has been using telemedicine to extend chronic pain consults to remote MTFs within the National Capital Region (NCR). The goal of this study was to determine if patients referred to the WRNMMC Telepain Program reported improvements in subjective measures associated with accessing care. To accomplish this, we surveyed a convenience sample of patients using the service to determine if participation: (1) improved pain, (2) improved quality of life, (3) decreased travel time, (4) improved access to care, and (5) decreased time away from work. ⋯ The majority of pain specialists within the Military Health System are located at major military medical centers, the most of which are distant from surrounding MTFs. Prior to the development of the WRNMMC Telepain service, personnel at remote MTFs had to endure extended time away from their mission to receive care. The majority of patients that participated in the NCR Telepain program reported a positively perceived impact on pain, access to care, quality of life, transportation burden, and time away from work. In conclusion, The NCR Telepain team of providers have worked together to successfully establish a viable Telepain program at WRNMMC, one that will continue to be further improved and successful in the future.
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There is a nation-wide gap between the prevalence of mental illness and the availability of psychiatrists. This places reliance on primary care providers (PCPs) to help meet some of these mental health needs. Similarly, the US Army expects its PCPs to be able to manage common mental illnesses such as anxiety and depression. Therefore, PCPs must be able to close their psychiatric skills gaps via lifelong learning. ⋯ Our psychotropic decisional tool illustrates a novel algorithmic approach for operationalizing the management of depression and anxiety. Similar approaches can improve the skills of a variety of PCPs in the management of psychiatric disorders. Further studies in the military operational setting are needed to assess the effects of similar educational interventions on access to behavioral health care, suicidal behaviors, and unit medical readiness.
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Minor mental health problems among service members deployed in combat areas are relatively common, but social support is a protective factor. With the advent of digital communication, as well as more frequent family separations, a stable family support system may be more important than before. In this exploratory study, we aimed to test the relationship between perceived family support and the development of minor psychiatric symptoms during a 4-month naval counter piracy mission in the Gulf of Aden. ⋯ The results indicate that naval deployment is associated with a small increase in minor mental health problems and that having a high degree of family support buffers this effect. Efforts to increase support among military families may positively influence the wellbeing of naval sailors during combat missions.