Military medicine
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Cases of active tuberculosis (TB) in the U. S. Military have fallen over the last century in large part due to improved screening and treatment options. ⋯ Atypical medications required coordination with the FDA for procurement. An extensive surveillance plan for medication adverse effects was required. Finally, questions of public health authority versus patient autonomy arose requiring multidisciplinary input and ethical discussions.
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The main goal of this study was to assess the feasibility of a head-mounted display (HMD) providing telemedicine neurosurgical support during a decompressive craniectomy by a military surgeon who is isolated from readily available neurosurgical care. The secondary aim was to assess the usability perceived by the military surgeon and to evaluate technical aspects of the head-mounted display. ⋯ It is feasible to provide telemedicine neurosurgical support with a HMD during a decompressive craniectomy performed by a non-neurosurgically trained military surgeon. All military surgeons showed competence in performing a decompressive craniectomy after receiving a standardized concise lecture. The use of a HMD clearly demonstrated the potential to improve the quality of these neurosurgical procedures performed by military surgeons.
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Since the War in Afghanistan began in 2001, service members have faced significant health effects related to service during war, with female-designated service members facing unique challenges. Numerous high-quality review articles have been published on the health and care of female-designated service members and veterans. Given the increasing volume of literature, we completed an overview of reviews on the health and health care of female-designated military populations. Our objective was to conduct an overview of reviews on the obstetrics and gynecologic health and health care of female-designated military populations since 2000 to understand female-specific health consequences of military service during war and make clinical recommendations. ⋯ Female-designated military populations serving during periods of war face unique health challenges that should be considered in screening practices and the delivery of trauma informed care. Further research and reviews are needed for female-specific oncology, fertility, abortion access, and sexual and non-binary and expansive gender identities to better capture female-designated service member and veteran health during wartime and beyond.
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Detection of occult hemorrhage (OH) before progression to clinically apparent changes in vital signs remains an important clinical problem in managing trauma patients. The resource-intensiveness associated with continuous clinical patient monitoring and rescue from frank shock makes accurate early detection and prediction with noninvasive measurement technology a desirable innovation. Despite significant efforts directed toward the development of innovative noninvasive diagnostics, the implementation and performance of the newest bedside technologies remain inadequate. This poor performance may reflect the limitations of univariate systems based on one sensor in one anatomic location. It is possible that when signals are measured with multiple modalities in multiple locations, the resulting multivariate anatomic and temporal patterns of measured signals may provide additional discriminative power over single technology univariate measurements. We evaluated the potential superiority of multivariate methods over univariate methods. Additionally, we utilized machine learning-based models to compare the performance of noninvasive-only to noninvasive-plus-invasive measurements in predicting the onset of OH. ⋯ Multivariate ensemble machine learning-based approaches for the prediction of hemodynamic instability appear to hold promise for the development of effective solutions. In the lower body negative pressure multivariate hemorrhage model, predictions based only on noninvasive measurements performed comparably to those using both invasive and noninvasive measurements.