Military medicine
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The U.S. DVA Grant and Per Diem (GPD) program funds community agencies to provide housing and case management services to Veterans experiencing homelessness. GPD is one of the few VA programs that can enroll Veterans with Other-than-Honorable (OTH) military discharges. The characteristics of OTH Veterans and their outcomes in GPD are unknown. ⋯ The GPD program serves hundreds of homeless Veterans with OTH and Punitive discharges every year, but they seem to be at greater risk for negative health and psychosocial outcomes and do not have the same access to VA services as other Veterans. These findings may inform policy considerations about expanding VA care and opportunities for community providers to serve Veterans with OTH and Punitive discharges.
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Comparative Study
Comparing Capabilities of Simulation Modalities for Training Combat Casualty Care: Perspectives of Combat Medics.
Combat casualty care requires learning a complex set of skills to treat patients in challenging situations, including resource scarce environments, multiple casualty incidents, and care under fire. To train the skills needed to respond efficiently and appropriately to these diverse conditions, instructors employ a wide array of simulation modalities. Simulation modalities for medical training include manikins, task trainers, standardized patient actors (i.e., role players), computer or extended reality simulations (e.g., virtual reality, augmented reality), cadavers, and live tissue training. Simulation modalities differ from one another in multiple attributes (e.g., realism, availability). The purpose of this study was to compare capabilities across simulation modalities for combat casualty care from the perspective of experienced military medics. ⋯ The study furthers our understanding of simulation modalities for medical training by providing insight from combat medics on the benefits, limitations, and considerations for implementing different modalities depending on the training context. These results may be helpful to instructors in selecting modalities for their programs.
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Case Reports
Fulminant Heterotopic Ossification of the Lower Extremity After Gunshot Injury and Blunt Trauma: A Case Report.
Traumatic heterotopic ossification (HO) of the lower extremity is relatively rare but is of major importance in clinical practice. They are defined as posttraumatic abnormal formations of bone within soft tissue outside of the skeletal system. This article describes the clinical case of a 31-year-old male patient who suffered 2 traumatic events within 12 months-a gunshot wound in the lumbar spine/gluteal region followed by a severe traumatic brain injury with intracranial hemorrhage in a traffic accident as a pedestrian. ⋯ After 4 years of follow-up, the patient showed significant improvement. In HO treatment, prophylactic local radiotherapy (pre- and postoperative radiation with a local single dose of 7 Gy) and postoperative administration of nonsteroidal anti-inflammatory drugs are often recommended. For therapeutic purposes, surgical resection is still indicated for pronounced cases.
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Most research on suicide attempts among U.S. service members has been focused on risk factors that occur during service. There is an important gap in our understanding of premilitary factors, such as personality characteristics, that may be associated with future suicide attempt risk during service. Of particular importance is identifying risk factors for the 1/3 of suicide attempters who never receive a mental health diagnosis (MH-Dx)-and therefore are not identified as having a mental health problem in the military healthcare system-prior to their suicide attempt. ⋯ Optimism and Sociability, assessed prior to entering U.S. Army service, are consistently associated with future suicide attempt during service, even after adjusting for other important risk factors. While Sociability is equally associated with suicide attempt among those with and without a MH-Dx, Optimism is specifically associated with suicide attempt among soldiers not identified in the mental healthcare system. Risk differences across time in service suggest that Optimism and Sociability interact with stressors and contextual factors in particular developmental and Army career phases.
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Neuroendocrine tumors (NET) are rare malignancies that contain neural and endocrine cells with a median age of diagnosis of 63 years. NETs are typically located in the gastrointestinal (GI) tract, the pancreas, or the lungs. Within the GI tract, the most common locations for NETs are the small bowel, appendix, or rectum. ⋯ NETs arising from the left side of the colon are very uncommon. While most NETs are well-differentiated by histology and are slow growing, 7% are poorly differentiated and usually progress rapidly. While rare, it is vital to be vigilant for this reason We present such a case of poorly differentiated metastatic NET of the sigmoid colon in a young active duty service member.