Articles: health.
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Because of the diverse backgrounds of their healthcare professionals, Ukrainian military medicine needs expanded and enhanced military medical training to increase their readiness in the war against Russia. During March 2023, eight Ukrainian healthcare professionals participated in Operation Gunpowder, a high-fidelity prolonged casualty care simulation conducted by the USU as a part of its Military Unique Curriculum. In order to evaluate their experiences, we interviewed each healthcare professional and analyzed the data to determine common themes. ⋯ After experiencing the prolonged casualty care simulation training, the Ukrainian participants believed Operation Gunpowder to be a valuable training tool due to its ability to help them overcome the current challenges they are facing in their war against Russia. They described how they would integrate similar training in Ukraine, and follow-up correspondence revealed the success of these efforts. Other universities and institutions are likewise called to use their knowledge and resources to help train Ukrainian health professionals using simulation-based training or other education modalities.
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Research finds that experiencing psychological stress can be associated with engaging in less physical activity, a critical contributor to operational readiness and overall health and well-being. As navy personnel tend to engage in lower levels of physical activity than other military personnel, the purpose of this study was to examine the relationship between stress and physical activity in the Royal Canadian Navy (RCN) and identify moderators of this relationship. ⋯ The findings of this study support a complex relationship between experiencing stress and engaging in physical activity, which showed varying patterns based on BMI classification. Although the cross-sectional nature of the data precludes any inferences about the direction of these effects, the results suggest that some members of the RCN are more at risk of experiencing decrements in physical activity. Future research should examine the types of physical activity supports and incentives that are needed to ensure that navy personnel derive the benefits of an active lifestyle, especially in times of stress.
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The Veterans Health Administration (VHA) established the Airborne Hazards and Open Burn Pit Registry (AHOBPR) in 2014 to address exposure concerns for veterans who have served in military operations in Southwest Asia and Afghanistan. By 2021, over 236,086 veterans completed the online questionnaire and 60% requested an AHOBPR examination. Of those requesting an exam, only 12% had an exam recorded in their medical record. This article summarizes barriers and facilitators to delivering AHOBPR exams and shares lessons learned from facilities who have successfully implemented burn pit exams for veterans. ⋯ Gaps across many VHA facilities to provide AHOBPR exams may be understood as stemming from organizational issues related to clear delegation of responsibility and staffing issues. VHA facilities that wish to increase AHOBPR exams for veterans may need additional administrative and medical staff.
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Developing the clinical reasoning skills necessary to becoming an astute diagnostician is essential for medical students. While some medical schools offer longitudinal opportunities for students to practice clinical reasoning during the preclinical curriculum, there remains a paucity of literature fully describing what that curriculum looks like. As a result, medical educators struggle to know what an effective clinical reasoning curriculum should look like, how it should be delivered, how it should be assessed, or what faculty development is necessary to be successful. We present our Introduction to Clinical Reasoning course that is offered throughout the preclinical curriculum of the Uniformed Services University of the Health Sciences. The course introduces clinical reasoning through interactive lectures and 28 case-based small group activities over 15 months.The curriculum is grounded in script theory with a focus on diagnostic reasoning. Specific emphasis is placed on building the student's semantic competence, constructing problem lists, comparing and contrasting similar diagnoses, constructing a summary statement, and formulating a prioritized differential diagnosis the student can defend. Several complementary methods of assessment are utilized across the curriculum. These include assessments of participation, knowledge, and application. The course leverages clinical faculty, graduate medical education trainees, and senior medical students as small group facilitators. Feedback from students and faculty consistently identifies the course as a highly effective and engaging way to teach clinical reasoning. ⋯ Our Introduction to Clinical Reasoning course offers students repeated exposure to well-selected cases to promote their development of clinical reasoning. The course is an example of how clinical reasoning can be taught across the preclinical curriculum without extensive faculty training in medical education or clinical reasoning theory. The course can be adapted into different instructional formats to cover a variety of topics to provide the early learner with sequential exposure and practice in diagnostic reasoning.
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During the coronavirus disease of 2019 (COVID-19) pandemic, routine childhood immunization rates dropped dramatically across the world, and the Military Health System (MHS) was no exception. In the MHS, which is a large, universally covered, low-to-no-cost health system, the immunization rates with the measles, mumps, and rubella (MMR) vaccine remain below the rate necessary to prevent community transmission of measles. We aimed to improve childhood immunization rates in the MHS with an expansive quality improvement project. ⋯ Measles, mumps, and rubella immunization rates within the MHS remained below commercial health system rates and below public health standards required for herd immunity despite various countermeasures throughout the COVID-19 pandemic. Immunization rates increased with age, suggesting that children within the MHS eventually catch up despite potential barriers.