Articles: trauma.
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Alcohol use disorder (AUD) and PTSD have high rates of co-occurrence in U.S. Military Veterans resulting in incrementally worse functional outcomes relative to having either one of these disorders alone. Cognitive dysfunction can impede one's ability to benefit from standard behavioral AUD and PTSD treatments. Cigarette smoking is also highly prevalent among U.S. Military Veterans, and cognitive dysfunction is associated with chronic cigarette use among individuals with AUD and PTSD independently. However, much less is known about to what extent cigarette smoking further impairs cognitive functioning in individuals with both co-occurring AUD and PTSD. ⋯ Overall, results provide evidence for the compounding impact of alcohol use, traumatic stress, and cigarette smoking on cognitive functioning. Impaired cognitive performance on a global level as well as on individual domains of cognitive inhibition and auditory-verbal learning were evident. Cognitive dysfunction may impede a Veteran's ability to benefit from therapeutic treatment, and these cognitive domains may represent potential targets for cognitive training efforts. Further, study results support smoking cessation initiatives and smoke-free policies enacted at Veterans Affairs healthcare facilities and medical centers.
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Initial Assessment of a Regional Military-Civilian Partnership on Trauma Surgery Skills Sustainment.
Trauma surgery skills sustainment and maintenance of combat readiness present a major problem for military general surgeons. The Military Health System (MHS) utilizes the knowledge, skills, and abilities (KSA) threshold score of 14,000 as a measure of annual deployment readiness. Only 9% of military surgeons meet this threshold. Most military-civilian partnerships (MCPs) utilize just-in-time training models before deployment rather than clinical experiences in trauma at regular intervals (skills sustainment model). Our aim is to evaluate an established skills sustainment MCP utilizing KSAs and established military metrics. ⋯ Based on this initial evaluation, a military surgeon taking two calls/month over 12 months through our regional skills sustainment MCP can generate more than 80% of the KSA points required to meet the MHS KSA threshold for deployment readiness, with the majority being CCC-RCs. Intangible advantages of this model include exposure to multiple trauma resuscitations while possibly eliminating just-in-time training and decreasing pre-deployment requirements.
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Although military members often encounter significant atypical stressors while serving, many service members are still reluctant to seek mental health (MH) treatment. Help-seeking behavior for MH needs is a rising concern for active duty Air Force personnel. Conditions such as post-traumatic stress disorder, depression, anxiety, and substance abuse are just a few issues that military members deal with, but things like stigma, attitudes toward MH, and behavioral control might keep these individuals from seeking services. This study utilizes the theory of planned behavior (TPB) to identify better and understand barriers to the help-seeking behavior of active duty Air Force members. ⋯ Findings from this study reveal how attitudes, subjective norms, and perceived behavioral control play an essential role in an active duty Air Force member's decision to seek help for MH concerns. This study suggests that active duty military members are less concerned about the belief that seeking MH care could harm their reputations and more aware of the potential negative reputations of MH clinics. Finally, actionable steps are outlined to better support help-seeking behavior, which might be recommended to better train and encourage military leaders to address the MH needs of themselves and the members of their units.
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The National Defense Authorization Act of 2017 indicated the need for a national strategy to improve trauma care among military treatment facilities (MTFs). Part of the proposed strategy to improve trauma outcomes was to convert identified MTFs into verified trauma centers. The American College of Surgeons (ACS) verifies trauma centers through an evaluation process based on available resources at a facility. It has been proven that trauma centers, specifically those verified by the ACS, have improved trauma outcomes. In 2017, we implemented steps to become a level III trauma program, according to the standards for designation by the state and verification through the ACS. The goal of this retrospective review is to evaluate the impact of this implementation with regard to both patient care and the MTF. ⋯ The establishment of a trauma program in accordance with the standards of the ACS for verification improved metrics of care for trauma patients at our MTF. This implementation as part of the local trauma system also led to increased injury severity seen by the MTF, which enhances readiness for its providers.
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Before the COVID-19 pandemic, a 1-week in-person Clinical Ultrasound Course was taught in African nations as part of a U.S. Department of State-funded program that supports and trains African peacekeepers serving with the United Nations and African Union. In order to maintain active engagement with host nations despite the travel restrictions due to the COVID-19 pandemic, portions of the course were taught virtually in 2021 to providers in Ghana, Senegal, and Rwanda. An abbreviated course was delivered covering the Focused Assessment with Sonography in Trauma (FAST) trauma exam and vascular access. The goal of this study is to assess the effectiveness of the Clinical Ultrasound Course while taught in a virtual classroom. ⋯ Virtual delivery of the Clinical Ultrasound Course was successful. Participants felt more comfortable in all aspects of ultrasound taught during the course and indicated that they were more likely to use ultrasound in clinical practice. This demonstrates that virtual ultrasound teaching is a viable option for international educational programs in the future.