Military medicine
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Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. ⋯ Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.
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Language and cultural barriers are associated with poor health outcomes. Communication is arguably the most important variable associated with a successful educational and training Global Health Engagement (GHE) and often unrecognized even when attempts are made to address this barrier. Madagascar's GHE activity improved after the addition of local Malagasy translation to fully translated official French instruction.
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Interventions that encourage good nutrition-related behaviors in the dining environment can potentially influence the health of large numbers of military personnel. Thus, the Army has studied the effectiveness of implementing nutrition education and dining facility (DFAC) changes that included healthier recipes, revised menus, and population-specific point-of-choice labeling, but successful intervention implementation largely depends on the foodservice employees' understanding, knowledge, and desire to sustain changes. This phenomenological, qualitative study aimed to better understand common barriers to the implementation and sustainment of DFAC-based nutrition interventions at two U.S. Army DFACs. ⋯ A lack of foodservice staff training and education is a significant contributor to implementation barriers. Future interventions should increase engagement with foodservice employees during intervention planning and implementation phases with a structured and tailored nutrition education and culinary skill training program. Addressing these barriers may enhance staff morale and promote intervention adherence.
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Operation Bushmaster, a 5-day high-fidelity medical practicum bringing together fourth-year medical students, graduate nursing students, international students, and physicians and other medical professionals in emergency and operational medicine from across the world, is the capstone event of the Uniformed Services University of the Health Sciences's Military Unique Curriculum. It is designed to simultaneously test students' medical knowledge, leadership skills, and grace under fire. For many students, this experience represents one of the first times that they concurrently inhabit the dual roles of military officer and (soon-to-be) physician. This is likely the most "tactical" and stressful military simulation that many students have experienced. ⋯ One of the resulting themes, "the military physician," met our criteria for a threshold concept, in that it was transformative, integrative, and troublesome. Before Bushmaster, many of the students saw themselves simply as medical students rather than as almost doctors. Following the field practicum, some identified more strongly with the role of military physician, while others continued to overestimate the amount of time remaining to complete the transformation from student to doctor or to integrate the roles of physician and military officer. Moreover, we identified the entirety of Bushmaster as a threshold experience. This work serves to further describe the liminal space in which military medical students reside on their journey to physician, as well as the moment of realization by many that becoming a military physician encompasses more than simply the sum of the roles of physician and military officer.
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A military soldier sustained a blast injury in Afghanistan, resulting in amputations and hemipelvectomy. He developed New Delhi metallo-beta-lactamase-producing E. coli bacteremia, soft-tissue infection, and sacral osteomyelitis. ⋯ He was successfully treated with tigecycline and cefiderocol. Cefiderocol is a novel siderophore-based cephalosporine developed to treat serious infections, including those caused by carbapenem-resistant Enterobacterales.