Military medicine
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During the wars in Iraq and Afghanistan, increased incidence of multidrug-resistant (MDR) organisms, as well as polymicrobial wounds and infections, complicated the management of combat trauma-related infections. Multidrug resistance and wound microbiology are a research focus of the Trauma Infectious Disease Outcomes Study (TIDOS), an Infectious Disease Clinical Research Program, Uniformed Services University, research protocol. To conduct comprehensive microbiological research with the goal of improving the understanding of the complicated etiology of wound infections, the TIDOS MDR and Virulent Organisms Trauma Infections Initiative (MDR/VO Initiative) was established as a collaborative effort with the Brooke Army Medical Center, Naval Medical Research Center, U.S. Army Institute of Surgical Research, and Walter Reed Army Institute of Research. We provide a review of the TIDOS MDR/VO Initiative and summarize published findings. ⋯ The TIDOS MDR/VO Initiative provides comprehensive and detailed data of major microbial threats associated with combat-related wound infections to further the understanding of wound etiology and potentially identify infectious disease countermeasures, which may lead to improvements in combat casualty care.
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Extremity trauma is the most common battlefield injury, resulting in a high frequency of combat-related extremity wound infections (CEWIs). As these infections are associated with substantial morbidity and may impact wounded warriors long after initial hospitalization, CEWIs have been a focus of the Infectious Disease Clinical Research Program (IDCRP). Herein, we review findings of CEWI research conducted through the IDCRP and discuss future and ongoing analyses. ⋯ Forthcoming studies will examine the effectiveness of common antibiotic regimens for managing extremity deep soft-tissue infections to improve clinical outcomes of combat casualties and support development of clinical practice guidelines for CEWI treatment. The long-term impact of extremity trauma and resultant infections will be further investigated through both Department of Defense and Veterans Affairs follow-up, as well as examination of the impact on comorbidities and mental health/social factors.
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The Joint Trauma System (JTS) is a DoD Center of Excellence for Military Health System trauma care delivery and the DoD's reference body for trauma care in accordance with National Defense Authorization Act for Fiscal Year 2017. Through the JTS, evidence-based clinical practice guidelines (CPGs) have been developed and subsequently refined to standardize and improve combat casualty care. Data are amassed through a single, centralized DoD Trauma Registry to support process improvement measures with specialty modules established as the registry evolved. Herein, we review the implementation of the JTS DoD Trauma Registry specialty Infectious Disease Module and the development of infection-related CPGs and summarize published findings on the subsequent impact of the Infectious Disease Module on combat casualty care clinical practice and guidelines. ⋯ To improve combat casualty care outcomes and mitigate high-consequence infections in future conflicts, particularly in the event of prolonged field care, expansion, refinement, and a mechanism for sustainability of the DoD Trauma Registry Infectious Disease Module is needed to include real-time surveillance of infectious disease trends and outcomes.
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Military leaders are concerned that active duty members' fear of career impact deters mental health (MH) treatment-seeking. To coalesce research on the actual and perceived consequences of MH treatment on service members' careers, this systematic review of literature on the U.S. Military since 2000 has been investigating the following three research questions: (1) is the manner in which U.S. active duty military members seek MH treatment associated with career-affecting recommendations from providers? (2) Does MH treatment-seeking in U.S. active duty military members impact military careers, compared with not seeking treatment? (3) Do U.S. active duty military members perceive that seeking MH treatment is associated with negative career impacts? ⋯ Despite considerable efforts to destigmatize MH treatment-seeking, a substantial proportion of service members believe that seeking help will negatively impact their careers. On one hand, these perceptions are somewhat backed by reality, as seeking MH treatment is associated with a higher likelihood of being involuntarily discharged. On the other hand, correlational designs cannot establish causality. Variables that increase both treatment-seeking and discharge could include (1) adverse childhood experiences; (2) elevated psychological problems (including both [a] the often-screened depression, anxiety, and posttraumatic stress problems and [b] problems that can interfere with military service: personality disorders, psychotic disorders, and bipolar disorder, among others); (3) a history of aggressive or behavioral problems; and (4) alcohol use and abuse. In addition, most referrals are self-directed and do not result in any career-affecting provider recommendations. In conclusion, the essential question of this research area-"Does seeking MH treatment, compared with not seeking treatment, cause career harm?"-has not been addressed scientifically. At a minimum, longitudinal studies before treatment initiation are required, with multiple data collection waves comprising symptom measurement, treatment, and other services obtained, and a content-valid measure of career impact.
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The incidence of human papillomavirus (HPV) related cancers is growing in the United States. Active duty service members (ADSM) have higher rates of HPV infection than civilians and are therefore at greater risk of developing HPV-related cancers. The purpose of this commentary is to examine the burden of HPV-related cancers in ADSM. ⋯ S. ADSM are presented, including a literature review of military-focused studies on HPV vaccination and cervical cancer screenings. We provide directions for future research, interventions, and policy recommendations to improve HPV-related cancer prevention among ADSM.