Military medicine
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Anal cancer is a rare malignancy with an estimated 8,580 new cases each year in the USA where hematochezia, a common condition, is often the initial presenting sign. We describe a 51-year-old woman who presented with painful hematochezia, with a delayed diagnosis of anal cancer in the setting of missed and misdiagnosed digital rectal exams in an otherwise low-risk patient. This case highlights the importance of maintaining a broad differential diagnosis for hematochezia and the utility of thorough physical exams.
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The Department of Defense spends more than $3 billion annually on medical costs of lifestyle-related morbidity. Military service members and veterans engage in unhealthy behaviors at a higher rate than the civilian population. Lifestyle medicine may mitigate lifestyle-related chronic diseases and increase medical readiness in the U.S. Military. However, patients' perspectives in a military community regarding a lifestyle medicine-based approach to health care have not been studied. The purpose of this study was to assess the knowledge and attitudes of and interest in lifestyle medicine-based care within a military community. ⋯ Despite an overall low level of awareness of lifestyle medicine, most respondents expressed interest in a lifestyle medicine approach to health care, with food/nutrition and sleep ranked as the most important domains. Lower levels of education may be a potential barrier to patient willingness to engage in lifestyle medicine care. Service members in combat arms occupational specialties may represent a potential target population for smoking cessation interventions. Further research with a larger sample more proportionately inclusive of all military service branches is needed.
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Early identification of patients with coronavirus disease 2019 (COVID-19) who are at risk for hospitalization may help to mitigate disease burden by allowing healthcare systems to conduct sufficient resource and logistical planning in the event of case surges. We sought to develop and validate a clinical risk score that uses readily accessible information at testing to predict individualized 30-day hospitalization risk following COVID-19 diagnosis. ⋯ The prediction tool developed in this study demonstrated that it could identify patients with COVID-19 who are at risk for hospitalization. This could potentially inform clinicians and policymakers of patients who may benefit most from early treatment interventions and help healthcare systems anticipate capacity surges.
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The optimal length of Family Medicine Residency is unknown. As part of the American Board of Family Medicine 4-year Length of Training (LoT) pilot project, Naval Hospital Jacksonville (NHJ) maintained a dual-track 3- and 4-year Family Medicine Residency, graduating seven 4-year residents over consecutive 4 years of the LoT program. One measure of success regarding the impact of 4-year residents on program outcomes is scholarly output during residency. ⋯ An observed benefit of a 4-year Family Medicine Residency was a marked increase in scholarly output at this program.
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The demands of operational deployment mean that defense force personnel must be dentally fit. Although medical evacuation for dental causes should be avoided, dental emergencies are a major non-combat-related contributor to withdrawal from deployment. Information on the oral health status of recruits and officer cadets entering the New Zealand Defence Force (NZDF) is scarce, yet it is useful for service and workforce planning. We investigated oral health status and its associations in new recruits and officer cadets entering the NZDF over a 13-month period. ⋯ Recruits' oral health was acceptable, but potentially problematic third molars were common, indicating a need for careful assessment (and their possible removal) before operational deployment.