Military Medicine

Rodriguez, Christofer A; Mitchell, Jason W

doi: 10.1093/milmed/usac018pmid: 35104342

ABSTRACTIntroductionWith the goal of maintaining mission readiness, the U.S. Department of Defense monitors a variety of health behaviors among its active duty military service members, including sexual health, HIV, and other sexually transmitted infections. Newer biomedical approaches to HIV prevention and care (e.g., Treatment as Prevention (TasP) via Pre-exposure Prophylaxis (PrEP) and undetectable = untransmissible of antiretroviral therapy (ART/U = U) have evolved over the last few years and are now available. However, the last systematic review on HIV prevention among military populations was published in 2005, calling for the need to provide an update on what HIV prevention research has been conducted with U.S. active duty service members.Materials and MethodsPRISMA guidelines were followed to identify articles that met pre-determined eligibility criteria. Several electronic databases were searched, including PubMed. The review focused on HIV prevention research conducted with the U.S. Military (i.e., active duty service members). Inclusion criteria for articles centered on population (U.S. active duty service members aged 17 years and older), language (published in English), study focus (epidemiological, intervention), study design (descriptive, quasi-experimental, and experimental), date of publication, and research focus. Studies with a descriptive focus to understand HIV-related risk behaviors, use of prevention strategies (e.g., condoms, testing, PrEP), and prescribing practices for uptake of prevention strategies among U.S. military service members (i.e., by providers, uptake from nonproviders) were included. Studies that focused on intervening or changing HIV risk (i.e., interventions) among U.S. military service members were also included.ResultsThe findings in this review were reported based on the PRISMA guidelines. A total of 2,270 articles were identified through electronic databases. Of the 2,270 articles, 809 articles were removed for duplication. Titles and abstracts were reviewed for the remaining 1,461 articles. Of the 1,461 articles, 1,432 were excluded for not meeting the inclusion criteria. In total, 29 studies met the inclusion criteria and were included in this review. Studies were organized into 3 tables based on study focus and target population (e.g., active duty, U.S. Military service members who were providers vs. nonproviders).ConclusionsThe present systematic review describes 29 HIV prevention studies that have been conducted with active duty service members in the U.S. Military since 2000. Overall, most included studies were descriptive, epidemiological studies conducted with active duty service members who were not providers. There were few interventions that reported some success in improving prevention knowledge and condom use. None of the interventions included newer evidence-based strategies of TasP. Although some research had been conducted about PrEP, particularly with providers, there is a clear need for additional studies and interventions to include TasP, given the evidence base of these approaches for reducing acquisition and/or onward transmission of HIV.

doi: 10.1093/milmed/usac324pmid: 36222750

This is a correction to: Vincent Mysliwiec, MC, USA (Ret.), Brian A Moore, PhD, Sleep Deprived, Injured, Not Seeking Medical Care. A Commentary on Elliman Et Al (2022), Military Medicine, 2022;, usac156, https://doi.org/10.1093/milmed/usac156 In our Editorial to Elliman et al., 2022, we were in error in our interpretation of the findings regarding treatment seeking in female drill sergeants compared to male drill sergeants. Specifically, that female drill sergeants sought care less frequently than their male counterparts, when in fact there was no difference in the rates of seeking medical care between the genders. This finding remains interesting to us for different reasons. For example, the broader literature of civilian males and females indicates that females are more likely to seek medical care than males. Considering this, we wonder if female service members, in particular drill sergeants, self-select for a more resilient phenotype than do their civilian counterparts; are there subtle factors that discourage them from seeking help as a potential stigma of weakness; or is this finding an artifact of the sample? We encourage future research to consider military unique factors that may influence care-seeking behavior in both male and female service members. Regardless, of the approach, however, we recognize that a dynamic relationship exists between sleep deprivation and injuries, especially among those who are serving in a drill sergeant role. © The Association of Military Surgeons of the United States 2022. All rights reserved. For permissions, please e-mail: [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) © The Association of Military Surgeons of the United States 2022. All rights reserved. For permissions, please e-mail: [email protected].

Samson, Jeremiah Y; Anderson, Danielle N; Hooper, Troy L; Sizer, Phillip S; Hando, Benjamin R; Brismée, Jean-Michel

doi: 10.1093/milmed/usaa556pmid: 36135723

ABSTRACTIntroductionMusculoskeletal (MSK) injuries make up a significant proportion of conditions treated by military healthcare providers during wartime. Though many common MSK injuries may benefit from corticosteroid injection (CSI), a shortage of qualified military clinicians has led to diminished access to appropriate care. Longer wait times to receive treatment pose detrimental effects on military readiness and have garnered the attention of military leaders. One solution was the development of advanced training for United States Air Force physical therapists (USAF PTs) to gain clinical privileges in administering CSI. The objectives of this study were to determine in USAF PTs (1) the prevalence of those with privileges to administer CSI; (2) the type and (3) safety of MSK CSI administered; (4) incidence of CSI complications; (5) healthcare utilization following CSI; and (6) barriers to obtaining and practicing CSI privileges.Materials and MethodsUnited States Air Force PTs with CSI privileges received instructions to follow a link to an anonymous Google survey. Electronic medical record reviews were conducted by three USAF PTs to determine the occurrence and severity of CSI complications provided by USAF PTs and advanced healthcare providers (AHPs). The principal investigator conducted further review of the patients’ electronic medical records to calculate healthcare utilization following CSI administered by USAF PTs. A hospital administrator selected cases of similar diagnoses treated with CSI by USAF AHPs. The number selected cases treated by AHPs are similar to the number of CSI cases treated by USAF PTs.ResultsEleven USAF PTs held CSI privileges. No major complications associated with CSI were recorded. Of the 95 CSI cases treated by USAF PTs, 27 (28.4%) reported increased pain compared to 24 (27.9%) of 86 CSI cases treated by AHPs (P = .94). Healthcare utilization for the number of follow-up visits, imaging, and additional laboratory tests following CSI by USAF PTs was lower compared to AHPs (chi-square; P < .0069).ConclusionNine percentage of USAF PTs held CSI privileges. United States Air Force PTs were equally safe as AHPs who administered CSI and associated with a lower rate of healthcare utilization following the intervention. Training USAF PTs to administer CSI could be the standard for all USAF PTs who meet qualification requirements. Adoption of similar training and credentialing policies for civilian PTs warrants further exploration.

Cho, John M

doi: 10.1093/milmed/usac369pmid: 36525523

Happy New Year and best wishes to you and your family for a 2023 filled with good health, happiness, and joy. I am looking forward to personally greeting you at our in-person 2023 AMSUS Annual Meeting, at the Gaylord National Resort and Convention Center, National Harbor, MD, 13–16 February. Due to COVID-19, the last time we held an in-person Annual Meeting was in December 2019, over three-and-a-half years ago. This edition of the “Letter From the Executive Director” will highlight what you can expect to see and experience at the Annual Meeting. I will also share noteworthy leadership changes among the greater AMSUS community. Our theme for this year’s AMSUS Annual Meeting is “Healthcare Collaboration: Meeting the Challenges of Today and Tomorrow.” The Honorable Shereef Elnahal, MD, Under Secretary for Health, U.S. Department of Veterans Affairs (VA), will serve as Honorary Co-chair of the 2023 AMSUS Annual Meeting and President of the Executive Advisory Council (EAC). During my recent office call with Dr. Elnahal, he shared his interest in promoting even greater collaboration among EAC members, particularly between the VA and the Department of Defense. It will be an honor to introduce Secretary Elnahal and hear his opening comments. I also will have the pleasure and honor of introducing keynote speaker and AMSUS Life Member Major General (retired) Gerald Harmon, MD, Immediate Past President, Board of Trustees, American Medical Association. Dr. Harmon will share his insights on best ways to tackle America’s most pressing health care challenges and how collaboration between civilian and federal health professionals is essential to mission success. It is worth noting a few additional changes for our Opening Ceremonies, which start the afternoon of Monday, 13 February. Major General (retired) Phil Volpe, Chairman of the AMSUS Board of Directors (BoD), will join us for a few comments on behalf of the board. He leads the BoD in their important and strategic role to ensure AMSUS’s success and long-term viability. I look forward to having him share his valuable insights with all who are committed to the advancement of federal health. In addition, the AMSUS Annual Awards will be held during the Opening Ceremonies plenary sessions. It is an exciting change, which allows our worthy honorees to receive recognition from a larger group of their peers and leadership. Another positive change for the Annual Meeting is plans to offer continuing medical education/continuing education credits for as many of our plenary presentations as possible. What will not change are plenary sessions from our federal health leadership. The Under Secretary of Health, VA; Acting Assistant Secretary of Defense for Health Affairs; Director, Defense Health Agency; Joint Staff Surgeon; President of Uniformed Services University; the Assistant Secretary for Health, Department of Health and Human Services; the 21st U.S. Surgeon General; Director of the Office of Health Security and Chief Medical Officer of the Department of Homeland Security; and the Army, Navy, Air Force/Space Force Surgeon Generals will be on hand to lead their respective sessions. In addition to presentations from our federal health leaders, this year’s breakout sessions have been scheduled in 1-hour increments to make it easier for attendees to earn continuing medical education/continuing education for all the presentations they wish to attend. The standardized hour-long sessions ensure presentations do not overlap in time, thereby negating the ability to earn both sessions’ credits. Changes in the agenda also have made it possible to add additional networking opportunities at the AMSUS Annual Meeting. Beyond the traditional Welcome Reception in the Exhibit Hall on Monday evening, networking opportunities have been created by offering continental breakfasts in the Exhibit Hall two mornings and a robust poster presentation networking hour on Wednesday afternoon, 15 February. I am excited for the changes AMSUS has made this year to add greater value for our Annual Meeting attendees. Of course, much of the value of our Annual Meeting is thanks to our AMSUS EAC, Executive Advisory Board (EAB), Sustaining Members (SM), BoD, and AMSUS staff. As I share the importance of these groups to our mission to advance federal health care, I will note recent changes. The AMSUS EAC consists of the nation’s top federal health care leadership from four cabinet-level departments, namely the VA, Department of Defense, Department of Homeland Security, and Department of Health and Human Services. As in previous years, 2022 included several important transitions within the AMSUS EAC. Our new EAC members are the Honorable Shereef Elnahal, MD, Under Secretary of Health, VA; Ms. Seileen Mullen, Acting Assistant Secretary of Defense for Health Affairs; and Major General (retired) (Dr.) Jonathan Woodson, President of Uniformed Services University. A special congratulations to Lieutenant General Ron Place, MD, for serving 3 years as the Director, Defense Health Agency. His replacement had not been identified at the time of submission for this article. Thank you to all our AMSUS EAC leaders for your selfless service to the nation, and welcome and congratulations to our new AMSUS EAC leaders. The AMSUS EAB serves as the corporate thought leadership group for AMSUS, consisting of our most strategic and important corporate partners. Jason Lamb, Vice President, Director of Government Accounts, Intuitive, and current Chairman of the EAB, will join Bill Cahill, Express Scripts, as an EAB Past Chairman. Thank you, Jason, for your steadfast leadership and dedication. As of this writing, we are pleased to announce John Perez, Head, Military and Veterans Affairs, Johnson & Johnson (J & J), will join as the 10th EAB member. John Perez and J & J will join Humana Military, Health Net Federal Services, Express Scripts, Intuitive, Philips, Bristol Myers Squibb—Veterans Community Network, DLH, Emergent Biosolutions, and Oracle-Cerner. Thank you, EAB members, for your leadership and partnership, and welcome John Perez and J & J! AMSUS Sustaining Members (AMSUS-SM) include 163 corporate members, eight of whom have supported AMSUS since inception of the AMSUS-SM group 70 years ago. This year’s AMSUS-SM reception during the 2023 Annual Meeting will be in recognition of their 70-year partnership with AMSUS. As we close out 2022, Vice Chair Tammy Anderson, Becton Dickinson, will replace Winston Churchill, Lexicon Pharmaceuticals Inc., as the new Chair of the AMSUS-SM group. Current Secretary-Treasurer Danny Giffin, Stryker, will assume the role as the AMSUS-SM Vice Chairman. Winston Churchill will replace Matt King, Foundation Medicine Inc., as the Immediate Past Chair, AMSUS-SM. Thank you, AMSUS-SM leaders, for your leadership and passion in supporting AMSUS and our federal health professionals. Each AMSUS-SM member is commended for your commitment to advancing federal medicine’s impact on improving health for all Americans. As previously mentioned, the AMSUS BoD plays an important and strategic role in ensuring the success and long-term viability of AMSUS. In June 2022, we thanked Navy Captain (retired) Kathy Beasley and Air Force Colonel (retired) Phil Samples for their leadership while completing 3 years of dedicated service to the AMSUS BoD. Board Chair Major General (retired) (Dr.) Phil Volpe was re-elected to another 3-year term, while Dr. Althea Green, PhD, former Command Sergeant Major of the U.S. Army Medical Command, was re-elected. We also welcomed Major General (retired) (Dr.) Rich Stone and Air Force Colonel (retired) George Jones to the AMSUS BoD. Thank you, AMSUS BoD, for generously sharing your knowledge, insights, and wisdom, especially with me. Our success at AMSUS is directly attributable to our knowledgeable, resolute, and loyal staff. In 2022, we were blessed to have Colonel (retired) Bill Moran join AMSUS as our Executive Officer and Assistant to the Deputy Executive Director. Bill brings a wealth of military and corporate knowledge, which we will put to great use over the coming years. Welcome Bill! Again, Happy New Year and see you at the 2023 AMSUS Annual Meeting! © The Association of Military Surgeons of the United States 2022. All rights reserved. For permissions, please e-mail: [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) © The Association of Military Surgeons of the United States 2022. All rights reserved. For permissions, please e-mail: [email protected].

Smolinski, George; Licina, Derek

doi: 10.1093/milmed/usac302pmid: 36239577

ABSTRACTThe U.S. Department of Defense (DoD) possesses significant expertise with rehabilitation of combat injured personnel. This is an area of growing interest with Global Health Engagement (GHE), particularly in countries with active conflict such as Ukraine. Effective rehabilitation can contribute to both development and security, and by leveraging its inherent expertise via rehabilitation-based GHE, the DoD can contribute to these strategic objectives.

Waller, Stephen G

doi: 10.1093/milmed/usac088pmid: 35366315

ABSTRACTGlobal Health Engagements can be more effective if better evaluation is done and if both line and diplomatic leaders are better educated by deploying medical personnel. To achieve better outcomes, these tasks should be a high priority for global health engagements. Integrity demands it.

Boswell, Gilbert E; Wolfgramm, Sione T; Fong, Raynard K; Hawley, Daniel B

doi: 10.1093/milmed/usac220pmid: 35866566

ABSTRACTIn the last two decades, our military and federal health care facilities have transitioned from traditional X-rays exposing film screen systems, developed much like photographic film, to an entirely digital detection system that affords computer processing of images and digital image and report distribution. While health care providers are well aware of the practicality of these advancements, they may not be aware of the improved diagnostic capabilities afforded by these new methods. In this report, we outline how application of physical principles of X-rays, with digital detectors and computer data manipulation, can present images demonstrating chest and heart diseases that were previously not readily visible by traditional film screen systems. More recently, dual-energy, dual-exposure systems have been implemented. This commentary is to educate the medical community so that they may better understand not only the written report but the information on the images being provided, along with potential pitfalls to avoid. Specifically, we demonstrate improved detection of pulmonary nodules and coronary atherosclerosis with the dual-energy technique.

Wellington, Trevor; Hunninghake, John C; Nelson, Vincente S; Nelson, Alexis E; Sjulin, Tyson J; Chin, Eric; Pope, Necia M; True, Mark W; Markelz, Ana Elizabeth

doi: 10.1093/milmed/usac300pmid: 36222603

ABSTRACTMilitary physicians are required to not only meet civilian accreditation standards upon completion of their Graduate Medical Education (GME) training programs but also be proficient in the military-unique aspects of their field, including medical care in austere environments and management of combat casualties. They must also be familiar with the administrative and leadership aspects of military medicine, which are often absent from the training curriculum. The San Antonio Uniformed Services Health Education Consortium Military Readiness Committee, by incorporating questions of military relevance into each GME program’s mandatory Annual Program Evaluation, identified curricular gaps upon which military readiness training objectives and opportunities were developed. These activities included a lecture series on the sustainment of medical and military readiness, an interactive procedural skills training event, trainee involvement in operational pre-deployment exercises, and the development of an elective operational rotation in Honduras. The Military Readiness Committee provides a model for other military GME institutions to develop training goals and opportunities to strengthen the preparedness of their trainees for military service.

Lin, Chiu-Yi; Bricknell, Martin C M; Brockie, Alan F; Kelly, Janet Clair

doi: 10.1093/milmed/usac321pmid: 36271919

ABSTRACTThis article notes the significant increase in academic papers and policy guidance on the subject of ethical practice in military healthcare over the past two decades. This is usually within the domain of “military medical ethics,” linking medical ethics as applied to the medical profession (doctors) with ethics as applied within the military (primarily from the perspective of officers). This article argues that this, highly elitist, perspective disenfranchises the majority of the military healthcare team who are nurses and allied health professionals and serve across the entire rank spectrum. We suggest that the subject should be reframed under the banner “military healthcare ethics” to include the concepts within military medical ethics but to emphasize the obligations of all military health professionals to comply with legal, regulatory, and ethical guidance for the practice of healthcare in the military environment. We recommend that the subject should be included in the curricula for education and training for all military health professions across their whole career.

Robinson, Sara L; Campbell, Wesley R; Patel, Leela R; Blickle, John G; Goetzman, Henry J; Hemphill, Ashleigh; Mehlhaff, Krista M; Farren, Kristen C; Valdez, Alicia D; Khan, Joetta; Sessom, Eric A; Blaylock, Jason M; Lee, Rachel U