Military Health Care Providers Research Articles

Exploring Cybersecurity Challenges and Emerging Trends in Cutting-Edge Technologies

In today's technologically driven landscape, a profound comprehension and adept application of cybersecurity have become non-negotiable. The stakes are high; without fortified defenses, systems, crucial files, data repositories, and virtual assets hang precariously in the balance, vulnerable to a plethora of potential threats. This imperative extends universally; whether it's a cuttingedge tech conglomerate or a modest momandpop shop, the need for robust cybersecurity measures remains unwavering. As the cybersecurity realm continues its relentless evolution, so too does the ingenuity of cyber adversaries, who continually refine and enhance their arsenal of hacking techniques, relentlessly probing for weak points within organizational defenses. This perpetual catandmouse game underscores the indispensable nature of cybersecurity in protecting the interests of military institutions, government agencies, financial enterprises, healthcare providers, and corporate entities alike. These entities serve as custodians of vast reservoirs of data, spanning an array of sensitivities—from confidential financial records and proprietary intellectual property to deeply personal information. Any breach or unauthorized access to such data could unleash a cascade of adverse consequences. Thus, the deployment of comprehensive cybersecurity protocols emerges as a strategic imperative, serving as a bulwark against potential threats and preserving the sanctity of invaluable assets across multifarious sectors of society. Keywords: cyber security, cyber crime, cyber ethics, social media, cloud computing, android apps.

Challenges in organising blood donation camps at remote military base and its impact on blood component quality: A unique helicopter-based whole blood transport experience

BackgroundThere is a huge gap between safe blood supply and clinical demand in India and voluntary blood donation camps (BDSs) are vital to address this gap. The study evaluates the challenges faced in organizing remote setting voluntary BDCs and assess the impact of helicopter-flight on the quality of the whole blood units (WBU) and blood components (BC) prepared. MethodsThis is an observational study in which two voluntary BDCs were organised in remote military-based setting in 2021. Pre-camp activities, camp organisation, community engagement, and transportation logistics were evaluated. All WBU collected were exposed to helicopter-flight for transportation to the main blood centre with cold-chain maintenance. Impact of helicopter-flight on WBU and BC prepared was evaluated by performing extensive quality control (QC) testing. ResultsA total of 123 WBU were collected in both camps with transportation time of 160 and 150minutes for camp-1 and -2 respectively. 123 PRBC, 22 BC-PC, 75 FFP and 48 CRYO units were prepared in-total within recommended time-limits. No haemolysis was detected in WBU, and all BC met QC criteria as per National guidelines. ConclusionsProper pre-camp planning, prior screening of donors, clear collection process policy, feasibility of efficient transport system, regular communication, and maintenance of cold-chain are crucial factors in determining the success of remote BDCs and quality of BC. Our study provides practical recommendations for policymakers, military healthcare providers, transfusion medicine specialists and public health professionals to enhance the effectiveness and sustainability of voluntary blood donation programs in remote settings.

Advancing Readiness Through Military Programs: An Evidence-Based Practice Perspective.

Military nurses comprise the largest percentage of military health care providers. In the current military health care system, they have two roles: (1) Patient care in military treatment facilities (MTFs) and (2) patient care during combat operations. Although in MTFs, the military nurse's roles are similar to those of their civilian counterpart, their roles are unique and varied in the combat operational environment. These combined roles lead to questions regarding readiness training to ensure that nurses are proficient in both MTFs and combat operational settings where treatment requirements may differ. The purpose of this paper is to (1) present the current state of educational readiness programs to maintain a ready medical force that entail formal teaching programs, military-civilian partnerships, and joint exercises of combat simulations, and (2) identify gaps as presented in an evidence-based practice educational panel. On March 11, 2022, TriService Nursing Research Program hosted the virtual First Military Evidence-Based Practice Summit from the Uniformed Services University of the Health Sciences in Bethesda, MD. As part of the summit, an evidence-based practice education panel discussed the availability of current evidence-driven military medical readiness programs and identified gaps in the integration of military readiness for nursing personnel into the Defense Health Agency and Armed Services. The panel participants discussed the separate requirements for training within the MTFs and in combat operational settings. The available training programs identified by the panel were primarily those developed in local MTF settings to meet local needs. Although these programs support the MTFs' peacetime mission, competing roles, limited time, and limited funds contributed to limited preparation of nursing personnel in skills associated with combat-related injuries and illnesses. Prolonged casualty care has become an important focus for the Department of Defense as greater considerations are directed to wartime operations in austere expeditionary environments. Although there is some training available that is specific for prolonged casualty care, the focus has been the adaptation of combat casualty care during contingency operations. A keynote here was the concept that combat casualty care training must include both development of individual skills and integration of the team since maximal care can be achieved only when the individual and the team operate as a unit. A key point was the utility of central repositories for storing information related to training a ready medical force at individual and unit levels and that these repositories could also be used to collect and facilitate the accession of current evidence-based information. Optimal patient care at all levels of the military health system requires training that maximizes individual and unit skills specific to the environment at an MTF or in a combat operational setting. Training must be designed to incorporate evidence-driven knowledge in all military settings with guidance that is specific to the environment. Enhanced communication of evidence-based training and knowledge is an important component of maintaining a ready medical force for broader medical support of combat contingency operations.

Trauma THOMPSON: Clinical Decision Support for the Frontline Medic.

U.S. Military healthcare providers increasingly perform prolonged casualty care because of operations in settings with prolonged evacuation times. Varied training and experience mean that this care may fall to providers unfamiliar with providing critical care. Telemedicine tools with audiovisual capabilities, artificial intelligence (AI), and augmented reality (AR) can enhance inexperienced personnel's competence and confidence when providing prolonged casualty care. Furthermore, implementing offline functionality provides assistance options in communications-limited settings. The intent of the Trauma TeleHelper for Operational Medical Procedure Support and Offline Network (THOMPSON) is to develop (1) a voice-controlled mobile application with video references for procedural guidance, (2) audio narration of each video using procedure mentoring scripts, and (3) an AI-guided intervention system using AR overlay and voice command to create immersive video modeling. These capabilities will be available offline and in downloadable format. The Trauma THOMPSON platform is in development. Focus groups of subject matter experts will identify appropriate procedures and best practices. Procedural video recordings will be collected to develop reference materials for the Trauma THOMPSON mobile application and to train a machine learning algorithm on action recognition and anticipation. Finally, an efficacy evaluation of the application will be conducted in a simulated environment. Preliminary video collection has been initiated for tube thoracostomy, needle decompression, cricothyrotomy, intraosseous access, and tourniquet application. Initial results from the machine learning algorithm show action recognition and anticipation accuracies of 20.1% and 11.4%, respectively, in unscripted datasets "in the wild," notably on a limited dataset. This system performs over 100 times better than a random prediction. Developing a platform to provide real-time, offline support will deliver the benefits of synchronous expert advice within communications-limited and remote environments. Trauma THOMPSON has the potential to fill an important gap for clinical decision support tools in these settings.

Survey ofResources inBehavioral Sleep Medicine Across the Department ofDefense, Defense Health Agency.

Insomnia affects approximately 40% of active duty service members and adversely affects health, readiness, and safety. The VA/DoD Clinical Practice Guideline for the management of insomnia recommends cognitive-behavioral treatment of insomnia (CBTI) or its abbreviated version (brief behavioral treatment of insomnia [BBTI]) as the first-line insomnia treatment. The goal of this study was to assess CBTI/BBTI resources at MTFs, perceived facilitators and barriers for CBTI/BBTI, and gaps in these treatments across the Defense Health Agency. Between July and October 2022, we conducted an electronic survey of CBTI/BBTI resources across Contiguous United States and the District of Columbia (CONUS) and Outside Continental United States (OCONUS) MTFs. The survey was distributed to 154 military sleep health care providers from 32 MTFs, and a link to the survey was posted on two online military sleep medicine discussion forums. Fifteen providers from 12 MTFs volunteered to complete a 30-minute qualitative interview to explore their perception of barriers and facilitators of CBTI/BBTI at their facility. Fifty-two of 154 providers (33.8%) at 20 MTFs completed the survey. A majority of providers indicated that hypnotics remain the most common treatment for insomnia at their facility. Sixty-eight percent reported that CBTI/BBTI was available at their facility and estimated that less than 50% of the patients diagnosed with insomnia receive CBTI/BBTI. The main facilitators were dedicated, trained CBTI/BBTI providers and leadership support. Referrals to the off-post civilian network and self-help apps were not perceived as significant facilitators for augmenting insomnia care capabilities. The primary barriers to offering CBTI/BBTI were under-resourced clinics to meet the high volume of patients presenting with insomnia and scheduling and workflow limitations that impede repeated treatment appointments over the period prescribed by CBTI/BBTI protocols. Four primary themes emerged from qualitative interviews: (1) CBTI/BBTI groups can scale access to insomnia care, but patient engagement and clinical outcomes are perceived as inferior to individual treatment; (2) embedding trained providers in primary or behavioral health care could accelerate access, before escalation and referral to a sleep clinic; (3) few providers have the time to adhere to traditional CBTI protocols, and appointment scheduling often does not support weekly or bi-weekly treatment visits; and (4) the absence of quality and/or continuity of care measures dampens providers' enthusiasm for using external referral resources or self-help apps. Although there is a wide recognition that CBTI/BBTI is the first-line recommended insomnia treatment, the limited scalability of treatment protocols, clinical workflow limitations, and scarcity of trained CBTI/BBTI providers limit the implementation of the VA/DoD clinical guideline. Educating and engaging health care providers and leadership about CBTI, augmenting CBTI-dedicated resources, and adapting clinical workflows were identified as specific strategies needed to meet the current insomnia care needs of service members. Developing protocols for scaling the availability of CBTI expertise at diverse points of care, upstream from the sleep clinics, could accelerate access to care. Establishing standardized quality measures and processes across points of care, including for external providers and self-help apps, would enhance providers' confidence in the quality of insomnia care offered to service members.

A Mixed-Methods Examination of the Effects of Organizational and Incident Stressors on the Mental Health of Navy Corpsmen

Military healthcare providers experience a unique combination of occupational stressors, which put them at risk for adverse mental health outcomes. However, little attention has been devoted to organizational and incident stressors. The current study used a mixed-methods approach to examine organizational and incident stressors and their associations with mental health symptoms in a sample of Navy corpsmen. Participants completed qualitative interviews assessing workplace stressors, followed by a quantitative questionnaire that assessed organizational stressors, incident stressors, and mental health symptoms (i.e., depression, posttraumatic stress, and anxiety). Qualitative analyses revealed that corpsmen most commonly discussed themes associated with heavy workload, high level of responsibility, long work hours, lack of leadership support, and feelings of burden associated with the responsibility for saving the lives of others. Quantitative analyses revealed that organizational stressors were associated with depression symptoms and incident stressors were associated with posttraumatic stress symptoms. The results indicated that different types of stressors are associated with distinct mental health outcomes and highlighted modifiable contextual factors that could reduce distress among Navy corpsmen. Interventions that address organizational and incident stressors and enhance resilience would ensure that corpsmen are well-prepared to withstand stressors and provide quality care to their patients.

Myotonometry is Capable of Reliably Obtaining Trunk and Thigh Muscle Stiffness Measures in Military Cadets During Standing and Squatting Postures.

Low back and lower extremity injuries are responsible for the highest percentage of musculoskeletal injuries in U.S. Army soldiers. Execution of common soldier tasks as well as army combat fitness test events such as the three-repetition maximum deadlift depends on healthy functioning trunk and lower extremity musculature to minimize the risk of injury. To assist with appropriate return to duty decisions following an injury, reliable and valid tests and measures must be applied by military health care providers. Myotonometry is a noninvasive method to assess muscle stiffness, which has demonstrated significant associations with physical performance and musculoskeletal injury. The aim of this study is to determine the test-retest reliability of myotonometry in lumbar spine and thigh musculature across postures (standing and squatting) that are relevant to common soldier tasks and the maximum deadlift. Repeat muscle stiffness measures were collected in 30 Baylor University Army Cadets with 1 week between each measurement. Measures were collected in the vastus lateralis (VL), biceps femoris (BF), lumbar multifidus (LM), and longissimus thoracis (LT) muscles with participants in standing and squatting positions. Intraclass correlation coefficients (ICCs3,2) were estimated, and their 95% CIs were calculated based on a mean rating, mixed-effects model. The test-retest reliability (ICC3,2) of the stiffness measures was good to excellent in all muscles across the standing position (ICCs: VL = 0.94 [0.87-0.97], BF = 0.97 [0.93-0.98], LM = 0.96 [0.91-0.98], LT = 0.81 [0.59-0.91]) and was excellent in all muscles across the squatting position (ICCs: VL = 0.95 [0.89-0.98], BF = 0.94 [0.87-0.97], LM = 0.96 [0.92-0.98], LT = 0.93 [0.86-0.97]). Myotonometry can reliably acquire stiffness measures in trunk and lower extremity muscles of healthy individuals in standing and squatting postures. These results may expand the research and clinical applications of myotonometry to identify muscular deficits and track intervention effectiveness. Myotonometry should be used in future studies to investigate muscle stiffness in these body positions in populations with musculoskeletal injuries and in research investigating the performance and rehabilitative intervention effectiveness.

Determining Clinical Priorities Using a Clinical Practice Guideline Deconstruction Tool: COVID-19 in Austere Operational Environments.

The Joint Trauma System (JTS) publishes Clinical Practice Guidelines (CPGs) used by military and civilian healthcare providers worldwide. With the expansion of CPG development in recent years, there was a need to collate, sort, and deconflict existing and new guidance using systematic methodology both within and across CPGs. This need became readily apparent at the start of the COVID-19 pandemic when guidelines were rapidly developed and fielded in deployed environments. To meet the needs of deploying units requesting immediate and concise guidance for managing COVID-19, JTS developed the CPG entitled Management of Covid-19 in Austere Operational Environments. By applying a deconstruction process to organize clinical recommendations across multiple categories, JTS was able to present clear clinical recommendations across "role of care" and "scope of practice." The use of a deconstruction process supported the rapid socialization of the CPG and may have improved clinical understanding among deployed medical teams.

Askeri Personelde Kardiyovasküler Risk Faktörlerinin Değerlendirilmesi: Türkiye’de Yapılan Bir Araştırma

Background: Cardiovascular (CV) risk factors are associated with high morbidity and mortality rates; however, prevalence data for Turkish military members are unknown. Aim: This study determines how common cardiovascular risk factors are among military members in the Corps Command Military Unit and how they relate to socio-demographic parameters. Materials and Methods: A cross-sectional research was conducted with 25222 active-duty individuals. A questionnaire was used to assess cardiovascular risk factors. This study included patients with more than two risk factors or current cardiac complaints. ECGs, echocardiograms, and biochemical testing were performed. Results: The study employed 835 individuals with an average age of 19.43±2.12 years. 19.6% of them had hypertension, 5.6% had dyslipidemia, 39.6% were smokers, 2.4% had diabetes mellitus, and 9.8% had a positive family history. Physical activity frequency was not observed in 54% of the patients before enlisting in the military. There was a significant positive correlation between smoking and mental stress (r=1.07, p<0.001). Conclusion: In terms of cardiovascular risk, hypertension and smoking were found to be the most prevalent among the Corps command staff. Therefore, this study provides compelling evidence that military healthcare providers should conduct annual periodic checks on those at risk for cardiovascular diseases.

Military Medical Provider Perspectives During the New York COVID-19 Response.

The response to the coronavirus disease 2019 pandemic in New York City (NYC) included unprecedented support from the DoD-a response limited primarily to medical and public health response on domestic soil with intact infrastructure. This study seeks to identify the common perspectives, experiences, and challenges of DoD personnel participating in this historic response. This is a phenomenological qualitative study of 16 military health care providers who deployed to NYC in March 2020. This study was approved by the Institutional Review Board at the USU (No. DBS.2020.123). All participants served on either the United States Naval Ship Comfort or at the Javits Center. We conducted semi-structured interviews exploring the participants' experiences while deployed to NYC. These interview scripts were then independently coded by five research team members. We identified four common themes and 12 subthemes from the participants' responses. The themes (subthemes) were lack of preparation (unfamiliar mission and inadequate resources); confusion about integration with civilian health care (widespread, dynamic situation, and NYC overwhelmed), communication challenges (overall, misunderstanding and miscommunication resulting in tension, and patient handoffs); and adaptation and success (general, military-civilian liaison service, positive experience, and military support necessity). This study provides unique insight into the DoD's initial response to the coronavirus disease 2019 pandemic in NYC. Using this experiential feedback from the DoD's pandemic responders could aid planners in improving the rapidity, effectiveness, and safety of military and civilian health care system integrations that may arise in the future.

Safe Administration and Low Healthcare Utilization Following Musculoskeletal Corticosteroid Injections by U. S. Military Physical Therapists.

Musculoskeletal (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. United 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. Eleven 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). Nine 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.

Adaptation and Testing of a Military Version of the Measure of Moral Distress for Healthcare Professionals.

Moral distress is well-documented among civilian critical care nurses and adversely affects patient outcomes, care delivery, and retention of health care providers. Despite its recognized significance, few studies have addressed moral distress in military critical care nurses. To refine and validate an instrument to assess moral distress in military critical care nurses. This study examined moral distress in military critical care nurses (N = 245) using a new instrument, the Measure of Moral Distress for Healthcare Professionals-Military (MMD-HP-M). The psychometric properties of the refined scale were assessed by use of descriptive statistics, tests of reliability and validity, exploratory factor analysis, correlations, and qualitative analysis of open-ended responses. Initial testing showed promising evidence of instrument performance. The Cronbach α (0.94) suggested good internal consistency of the instrument for the overall sample. Scores for the MMD-HP items and the MMD-HP-M items showed a strong, significant correlation (α= 0.78, P < .001). Unique attributes of military nursing that contribute to moral distress included resource access, futile care, and austere conditions. Exploratory factor analysis established a new military-centric factor for question items associated with inadequate training for patient care, providing care in resource-limited settings, and personal exhaustion. These results will help guide specific, targeted interventions to reduce the negative effects of moral distress on our military health care providers, especially in terms of readiness for the next global pandemic and retention of these invaluable personnel.

Clinical Consensus on Diagnosis and Treatment of Patients with Chronic Exertional Compartment Syndrome of the Leg: A Delphi Analysis

AimDefining universally accepted guidelines for the diagnosis and treatment of chronic exertional compartment syndrome (CECS) is hampered by the absence of high-quality scientific research. The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS of the leg in civilian and military patient populations.MethodsAn international expert group was queried using the Delphi technique with a traditional three-round electronic consultation. Results of previous rounds were anonymously disclosed in the questionnaire of rounds 2 and 3, if relevant. Consensus was defined as > 70% positive or negative agreement for a question or statement.ResultsThe panel consisted of 27 civilian and military healthcare providers. Consensus was reached on five essential key characteristics of lower leg CECS. The panel achieved partial agreement regarding standardization of the diagnostic protocol, including muscle tissue pressure measurements. Consensus was reached on conservative and surgical treatment regimens. However, the experts did not attain consensus on their approach of postoperative rehabilitation and preferred treatment approach of recurrent or residual disease. A summary of best clinical practice for the diagnosis and management of CECS was formulated by experts working in civilian and military healthcare facilities.ConclusionThe Delphi panel reached consensus on key criteria for signs and symptoms of CECS and several aspects for conservative and surgical treatment. The panel did not agree on the role of ICP values in the diagnostic process, postoperative rehabilitation guidelines protocol, or the preferred treatment approach for recurrent or residual disease. These aspects serve as a first attempt to initiate simple guidelines for clinical practice.

Identifying and mitigating moral injury risks in military behavioral health providers

ABSTRACT The term “moral injury” was initially used to describe the multifaceted pain that service members feel after perpetrating, witnessing, or failing to prevent acts that conflict with their moral codes. More recently the term has been used to describe healthcare providers’ pain stemming from their experiences serving on the frontlines of the healthcare system when: a medical error causes serious harm to patients, systems continuously impede their abilities to provide proper care, or providers assess that they have acted in ways that conflict with their professional ethics or oaths to “do no harm.” This article explores moral injury risk at the intersection of military service and healthcare by examining challenges that military behavioral healthcare providers face. Leveraging moral injury definitions previously applied to service members (personal or witnessed transgressions) and in two healthcare contexts (“second victim” to adverse client outcomes and system-driven moral distress), as well as literature on ethical challenges in military behavioral health, this paper uncovers situations that may amplify military behavioral health providers’ risks for moral injury. It concludes by offering policy and practice recommendations germane to military medicine aimed at alleviating pressures military behavioral healthcare providers face and mitigating moral injuries’ potential ripple effects on provider wellness, retention and care quality.

Online Virtual Patient Cases vs. Weekly Classroom Lectures in an Internal Medicine Clerkship: Effects on Military Learner Outcomes.

Virtual patient cases (VPCs), a type of simulated, interactive electronic learning, are a potentially important tool for military health care providers in austere or pandemic settings to maintain skills but need more validation. Our military internal medicine clerkship is spread across military treatment facilities around the country and has 15 weekly live student lectures, but students randomly miss the first, second, or third 5 weeks due to their psychiatry clerkship. We hypothesized that VPCs would be an adequate replacement for lost lectures. We compared live lectures to a web-based VPC and analyzed the academic outcomes of 734 students from 2015 to 2022. Using our end-of-clerkship Script Concordance Test (SCT) as the primary outcome, there was no significant difference in performance between the 2 learning methods (VPC, 63.9% correct; lectures 63.2%, P = .27). After controlling for gender, baseline knowledge, and the total number of VPCs completed, there was still not a statistically significant difference between teaching methods (F(1,728) = 0.52, P = .47). There was also no significant differences in all other clerkship outcomes including National Board of Medical Examiner and Objective Structured Clinical Examination scores. VPCs appear noninferior at teaching clinical reasoning as measured by SCT. VPCs might be substituted for traditional, live lectures in clerkships when time or other resources are limited, in austere environments such as military deployments, or during conditions limiting interpersonal contact such as pandemics but are not a complete substitution for in-person learning.

Suicide-Specific Training Experiences and Needs Among Military Mental Health Providers

Background Military suicide rates have risen over the past two decades, with a notable spike in recent years. To address this issue, military mental health providers must be equipped with the skills required to provide timely and effective care; yet little is known about the suicide-specific training experiences or needs of these professionals. Methods Thirty-five mental health care providers who treat active duty personnel at military treatment facilities participated in this mixed-methods study. All participants completed a survey assessing training and clinical experiences, comfort and proficiency in working with patients at risk for suicide, and perceived barriers to obtaining suicide-specific training. A sub-set of participants (n = 8) completed a telephone interview to further describe previous experiences and perceived challenges to obtaining training. Results The majority of participants (79.4%) had 6+ years of clinical experience, had a patient who had attempted suicide (85.3%), and completed at least one suicide-related training since finishing their education (82.4%). Survey results showed the leading barrier to enrolling in suicide-specific trainings was perceived lack of training opportunities (40.7% reported it was a barrier “quite often” or more), followed by lack of time (25%). Interview results revealed lack of time, location and logistical issues, and low perceived need for additional training among providers could impede enrollment. Conclusions Study results identified several modifiable barriers to receiving suicide-specific continuing education among military mental health providers. Future efforts should develop accessible training programs that can be easily integrated into routine clinical operations to mount the best defense against suicide. HIGHLIGHTS Military mental health providers report significant experience and relatively high degrees of comfort and proficiency working with patients at high risk for suicide. Most providers reported receiving training in suicide assessment and screening; few reported prior training in management of suicidality. Study results identified several modifiable barriers to receiving suicide-prevention continuing education among military mental health care providers; future efforts should seek to develop accessible training programs that can be easily integrated into routine clinical operations to mount the best defense against suicide.

MP58-16 DOES VETERAN STATUS MITIGATE RACIAL DISPARITIES IN PROSTATE CANCER SCREENING? ANALYSIS OF PROSTATE-SPECIFIC ANTIGEN SCREENING PATTERNS IN THE 2018 BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM DATA

You have accessJournal of UrologyCME1 May 2022MP58-16 DOES VETERAN STATUS MITIGATE RACIAL DISPARITIES IN PROSTATE CANCER SCREENING? ANALYSIS OF PROSTATE-SPECIFIC ANTIGEN SCREENING PATTERNS IN THE 2018 BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM DATA Khalid Alkhatib, Muhieddine Labban, Logan Briggs, David-Dan Nguyen, Peter Herzog, Alexander P. Cole, Austin Haag, and Quoc-Dien Trinh Khalid AlkhatibKhalid Alkhatib More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Logan BriggsLogan Briggs More articles by this author , David-Dan NguyenDavid-Dan Nguyen More articles by this author , Peter HerzogPeter Herzog More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , Austin HaagAustin Haag More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Limited data exist on prostate cancer screening behaviors in U.S. military veterans who receive universal access to care through the Veterans Health Administration or regular civilian care facilities. We sought to analyze the effect of veteran status on prostate-specific antigen (PSA) screening to examine the effect of veteran status on receipt of prostate-specific antigen (PSA) screening and more specifically whether access to the Veterans Health System mitigates racial disparities in PSA screening. METHODS: A cross-sectional analysis of non-Hispanic White (NHW) and non-Hispanic Black (NHB) men aged 55-69 who responded to the PSA screening survey was conducted using the 2018 Behavioral Risk Factor Surveillance System data. A bivariate analysis and a complex weighted multivariable logistic regression model were used to evaluate predictors of PSA screening, including the interaction between race and veteran status. an institutional review board waiver was obtained. RESULTS: Screening prevalence was higher among veterans (43.2%, 95% confidence interval (CI) 41.6% - 44.9%) versus non-veterans (39.6%, 95% CI 38.66% - 40.45%), p<0.001. Among non-veterans, the prevalence of PSA screening was significantly lower in NHB (34.1%, 95% CI 31.1% - 37.1%) versus NHW (40.3%, 95% CI 39.3% - 41.2), p<0.001. Among veterans, NHB men had a significant higher screening prevalence (48.4%, 95% CI 42.9% - 53.9%) versus NHW men (42.3%, 95% CI 40.5% - 44.1), p=0.037. We found that veteran status (OR 1.1, CI 1.01 – 1.20, p=0.030) and NHB race (OR 1.28, CI 1.11 – 1.47, p<0.001) were significantly associated with receipt of PSA screening (Table 1). A significant positive interaction was found between veteran status and race (pint=0.030). CONCLUSIONS: Veteran status and NHB race were found to be independent predictors of PSA screening. The interaction between veteran status and race suggests that access to health coverage available to veterans may mitigate racial differences in prostate cancer screening behaviors. Alternatively, differential preventive cancer screening behaviors among military health care providers may explain the differences. Further studies are needed to translate such findings into the civilian health care system. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e998 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Khalid Alkhatib More articles by this author Muhieddine Labban More articles by this author Logan Briggs More articles by this author David-Dan Nguyen More articles by this author Peter Herzog More articles by this author Alexander P. Cole More articles by this author Austin Haag More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF DownloadLoading ...

Sleep Deprivation and Self-Harm Associated With Excessive Gaming: A Case Report.

Excessive gaming may be associated with sleep deprivation and self-harm. One active duty member committed self-injurious behavior to avoid work-related consequences. It was discovered that the patient participated in a video-gaming binge throughout an entire 72-hour weekend liberty. The patient experienced severe sleep deprivation to the point where he overslept and failed to report to work. He injured himself and fabricated a robbery and assault to avoid disciplinary consequences. Military health care providers should consider excessive gaming in patients presenting with sleep issues, self-harm, and disciplinary problems. As the prevalence of gaming increases, the military leadership should be aware that excessive gaming can degrade force readiness.

Differences in Ethical Viewpoints among Civilian–Military Populations: A Survey among Practitioners in Two European Countries, Based on a Systematic Literature Review

Civilian–military collaboration in humanitarian crises has been encouraged globally; however, little is known about their diverse ethical viewpoints towards challenging and critical situations, which may cause difficulties in the partnership, and influence the outcomes of their mutual activities. The aim of this study was to identify the diversity of viewpoints and ethical decision-making during exceptional circumstances among civilian and military populations from two different countries, each with diverse background and healthcare organization structures. Possible scenarios, based on a systematic review of the literature, were introduced to Swedish and Polish civilian and military healthcare providers. Variations in the participants’ viewpoints and approaches to ethical decision-making were analyzed according to their characteristics, organizational belonging, and nationality. There were differences between both populations but also within the military and civilian groups, respectively. One significant factor influencing ethical viewpoints was participants’ nationality. Differences in ethical viewpoints between multiagency organizations should be considered in planning and implementation of future transdisciplinary and international collaboration in disaster and emergency management. Further studies and renewed educational initiatives are necessary to validate these differences and to navigate civilian–military as well as other multinational partnerships.

Development and Validation of the Barriers to Care Scale: Assessing Access to Care among Canadian Armed Forces Health Care Providers

Military health care providers (HCPs) under-access health services. Measures aimed at assessing barriers to care are either limited in scope, do not address barriers to physical healthcare, or are not grounded in theory. The current study developed and validated a measure of barriers to care based on an existing theoretical framework. Forty focus groups were conducted with 182 Canadian Armed Forces (CAF) HCPs across Canada focusing on barriers to accessing care. Focus group content was used to develop 52 unique barrier items. The Barriers to Care scale was completed by 1033 CAF HCPs. The sample was randomly split so that both an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) could be conducted. The identified factors were correlated with intent to access care to assess concurrent validity. Results of the EFA and CFA (CFI = .84; TLI = .84; SRMR = .08; RMSEA = .07) suggested an eight-factor model. The alphas of the eight subscales were excellent (> .85). All subscales significantly and negatively correlated with intent to access care. The findings suggest a promising first step toward creating a theory-based, valid, and reliable measure for assessing barriers to care.