Military medicine
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Review Meta Analysis
Forward Surgical Teams as a Model for Humanitarian Orthopedic Surgical Care: A Review of Current Literature.
Orthopedic trauma is a significant portion of global burden of disease in low- and middle-income countries (LMICs). This has led the World Health Organization to advocate for increased surgical intervention in LMICs. The two largest barriers to orthopedic surgical care for LMICs are cost of procedure and geographic access to centers with appropriate surgical capabilities. There is no current consensus on how to structure surgical interventional teams. The overall objective of this study is to describe the composition of a forward surgical team (FST), including its abilities and limitations. It is hypothesized that an FST is an effective model for orthopedic surgical relief efforts in LMICs. ⋯ FSTs are effective models for humanitarian orthopedic surgery in LMICs. FSTs were designed to treat orthopedic trauma, the largest burden of orthopedic care in LMICs. Efficient use of limited equipment allows FSTs to be cost effective for funding sources and highly mobile to reduce the geographic barrier to care. Further research is needed to determine the cost to operate an FST and ethical consideration for military intervention for foreign humanitarian aid.
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In the United States, firearm suicide represents a major cause of preventable, premature death among veterans. The purpose of this systematic review was to characterize the body of literature on veteran firearm suicide and identify areas for future research, which may facilitate the development of firearm suicide interventions in Veterans Health Administration (VHA) and non-Veterans Health Administration clinical settings. ⋯ This systematic review highlights an urgent need to produce higher quality evidence and new data with standard definitions that are critical to inform clinical practice and enhance public health measures to reduce firearm suicide among veterans.
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It is estimated that sailors who are assigned to surface ships and submarines are deployed for more than 1 year across their careers and they spend 15% to 23% of their time away from home. Research suggests that shipboard sailors experience rates of behavioral health issues similar to those with ground combat experiences. Despite the rigorous operational tempo and the unique shipboard environment experienced by these service members, little military health research has examined the health outcomes of sailors serving aboard ships. The objectives of this study were to develop an evidence map of the peer-reviewed literature to (1) identify potential threats to the health and readiness of shipboard sailors, (2) identify health and performance issues experienced by this population, and (3) identify gaps in the current peer-reviewed published literature on shipboard health and performance. ⋯ The evidence map identified various gaps in the research pertaining to the health and performance of shipboard sailors. These gaps included a lack of research on the risk factors for common health and performance issues experienced by sailors and on the relationship between stressors of shipboard life and sailors' health, performance, and readiness. The results of this evidence map should be used to inform the development, implementation, and evaluation of interventions to improve the shipboard environment and/or the preventive health behaviors used by sailors while underway or deployed.
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Randomized Controlled Trial
Botulinum Toxin Type A for the Treatment of Post-traumatic Headache: A Randomized, Placebo-Controlled, Cross-over Study.
Botulinum toxin type A (BoNT/A) is an approved treatment for chronic migraine and has been shown to be effective in reducing number, days, and severity of headache in other headache disorders. Whether botulinum toxin is a safe and effective treatment specifically for post-traumatic headache (PTH), however, is unknown. This study sought to determine whether treatment with BoNT/A improved symptoms of PTH in military veterans. ⋯ Treatment with BoNT/A clinically and significantly improved the frequency and pain severity of PTH compared to placebo in military veterans. Limitations of the study include subject dropout, adherence to documenting variables daily in the dairy, and only one treatment of BoNT/A. Strengths include the cross-over study design, which demonstrated that BoNT/A was effective regardless of treatment order. This dataset is the first prospective study to evaluate BoNT/A as an intervention for symptoms of PTH and provides evidence that larger-scale and multiple treatment studies evaluating BoNT/A for this headache type are warranted.
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Review Case Reports
Fatal Isoniazid Hepatotoxicity in the Deployed Environment.
Deployed clinicians have limited resources at their disposal to augment medical decision-making and management. All deploying personnel undergo predeployment medical assessment to evaluate their fitness for deployment. The purpose of predeployment screening is to allow for anticipation of medical needs that may arise which could challenge the available medical resources in an expeditionary environment. ⋯ Isoniazid is not specifically mentioned as a disqualifying medication, though it is well known to have the potential of causing drug-induced liver injury. Here, a case of fatal isoniazid-induced drug-induced liver injury in a deployed setting is presented with a review of current latent tuberculosis infection literature. Our goal is for the reader to form their own opinion whether or not isoniazid should be used in the forward environment.