Military medicine
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Military trauma provides a unique pattern of injuries due to the high velocity, high kinetic energy ammunition utilized, and the high prevalence of blast injury. To further complicate this, military trauma often occurs in austere environments with limited logistical support. Therefore, military medical providers are forced to learn nonstandard techniques and when necessary, practice a level of improvisation not commonly seen in other medical fields. ⋯ The medical provider was forced to utilize nonstandard devices such as an improvised junctional tourniquet which used a rock to focus the devices pressure. They also adapted their basic understanding of surgical procedures to conduct a vascular cutdown procedure for wound exposure and effectively pack an otherwise non-compressible wound to a major artery. Despite a significant loss of equipment, the medic and their team were able to successfully care for a number of patients in this mass casualty scenario.
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Vaccinations are an essential aspect of preventive medicine. In October 2021, the pneumococcal conjugate vaccine-20 (PCV-20) and PCV-15 were authorized for use in adults by the U.S. FDA. In 2022, the Advisory Committee on Immunization Practices (ACIP) subsequently published updated pneumococcal vaccination recommendations that incorporate both PCV-20 and PCV-15. Pneumococcal vaccination is effective in reducing pneumococcal disease, particularly in high-risk patient groups such as those with chronic lung disease; however, the updated dosing schedule for pneumococcal vaccinations can be quite confusing, especially if patients have previously received "older" vaccinations, such as pneumococcal polysaccharide vaccine-23 or PCV-13. The purpose of this quality improvement project was to increase providers' knowledge of current ACIP pneumococcal vaccination recommendations, including indications and dosing schedule, and to improve pneumococcal vaccination rates among eligible adults and children. ⋯ There is a significant knowledge gap regarding ACIP pneumococcal vaccination recommendations among military providers and a low pneumococcal vaccination rate for adults aged 19 to 64 years with asthma at Joint Base-San Antonio MTFs. Focused education sessions were effective in increasing providers' knowledge of updated pneumococcal vaccination recommendations, confidence in recommending vaccines, total number of pneumococcal vaccinations given, and estimated pneumococcal vaccination rate for adults with asthma. The validity of conclusions drawn from our data were limited because of discordant numbers of survey respondents as well as potentially inaccurate estimates of pneumococcal vaccination rates pre- and post-intervention. Despite this, the results warrant continued education of pneumococcal vaccines, indications, and dosing schedules.
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The success of deep-learning algorithms in analyzing complex structured and unstructured multidimensional data has caused an exponential increase in the amount of research devoted to the applications of artificial intelligence (AI) in medicine in the past decade. Public release of large language models like ChatGPT the past year has generated an unprecedented storm of excitement and rumors of machine intelligence finally reaching or even surpassing human capability in detecting meaningful signals in complex multivariate data. Such enthusiasm, however, is met with an equal degree of both skepticism and fear over the social, legal, and moral implications of such powerful technology with relatively little safeguards or regulations on its development. ⋯ Finally, barriers to implementation are addressed along with potential solutions. The end state is not that rising military physicians are technical experts in AI; but rather that they understand how they can leverage its rapidly evolving capabilities to prepare for a future where AI will have a significant role in clinical care. The overall goal is to develop trained clinicians that can leverage these technologies to improve the Military Health System.
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Many facets of military life are contributors to child health including frequent mobility, family separation, and increased risk to parental physical and mental health, as well as strong social networks and military support systems; yet, there has not been an examination of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) among military children. ⋯ This study complements and extends previous research that has taken a deficit approach and focused exclusively on the hardships faced by children in military families. The findings from this study may be instructive for child welfare advocates and policymakers as they intervene in communities with programming that promotes PCEs among children and adolescents.
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Shoulder injuries account for approximately 8% to 24% of all musculoskeletal injuries in the military. Recently, a change was made to service-specific physical fitness tests. Knowledge of relative shoulder labral injury rates before and after this change would help guide future directions and preventive strategies. However, we found no previous literature evaluating the rates of labral injury among United States Military branch personnel by enlistment status (enlisted versus officer), gender, age, or race. ⋯ With knowledge of injury patterns in specific military populations, initiatives may be taken to identify at-risk service members with the goal of informing future preventive strategies.