Military Treatment Centers Research Articles

Objective Inadequacy of Military Treatment Center Surgical Cases to Prepare for Combat Casualty Care

Objective Inadequacy of Military Treatment Center Surgical Cases to Prepare for Combat Casualty Care

Current challenges in military trauma readiness: Insufficient relevant surgical case volumes in military treatment facilities.

The management of battlefield trauma requires a specific skill set, which is optimized by regular trauma experience. As military casualties from the prolonged conflicts in the Middle East decrease, challenges exist to maintain battlefield trauma readiness. Military surgeons must therefore depend on the Military Health System. The purpose of the study was to evaluate the frequency of surgical cases relevant to deployed combat casualty care performed at military treatment facilities (MTFs). Combat casualty care relevant cases (CCC-RCs) were defined as emergent, open surgical cases in which the patient required a blood transfusion. Case logs from four military treatment centers with surgical residency training programs were used. Twenty-four months of case records between January 1, 2017, and January 1, 2019, were included to determine total numbers of CCC-RCs at each institution. The results were compared with San Antonio Military Medical Center's, the Department of Defense's only American College of Surgeons-verified level 1 trauma center. Fifty-one trauma/general surgeons and six vascular surgeons case logs were examined. Thirty (0.3%) of 10,529 cases performed by trauma/general and vascular surgeons over the 2-year study period were considered CCC-RCs. These results were in contrast to San Antonio Military Medical Center, which had a significantly higher proportion of CCC-RCs (113 of 320 cases, 35.3%, p < 0.0001). A cross-section of MTF surgical case complexity demonstrates a lack of cases considered to be CCC-RCs. At the MTFs evaluated, surgical case surrogates for combat trauma and combat casualty care is close to zero. These data are potentially representative of other military treatment centers, which focus on beneficiary care. For readiness purposes, MTFs that care primarily for Tricare beneficiaries without a significant trauma population should not be considered meaningful sources of CCC-RCs for trauma/general and vascular surgeons. Therapeutic/care management study, level V.

Distal femoral osteotomy in a young symptomatic population: Outcomes correlate to concomitant pathology

BackgroundThere is a paucity of literature describing distal femoral osteotomies (DFO) in regards to complications and outcomes with previously studied cohorts containing primarily older, arthritic subjects. There has been no study to date focusing on younger, pre-arthritic patients. MethodsAll service members indicated for distal femoral osteotomy for coronal plane malalignment were isolated from military treatment centers between 2007 and 2013. Demographic and surgical variables were extracted, and perioperative complications, clinical course, and return to military function were extracted using clinical notes and radiographs. ResultsA total of 22 knees in 19 patients were identified at an average 3.2 year follow-up, with the exclusion of 16 individuals. Statistical analysis revealed worse outcomes associated with smoking, over correction, breach of the medial cortex, and prior surgeries. Overall 58% of patients left the military as the result of knee dysfunction despite an average improvement in visual analog scores (VAS) from 4.0 to 1.9 (p = 0.004). ConclusionsWhile offloading the lateral compartment improves symptoms at short to midterm follow-up preventing progression to arthroplasty, young active duty military members have suboptimal return to duty rates.

To go or not go: Patient preference in seeking specialty mental health versus behavioral consultation within the primary care behavioral health consultation model.

Much of behavioral health care takes place within primary care settings rather than in specialty mental health settings. Access to specialty mental health care can be difficult due to limited access to mental health providers and wait times to receive mental health care. The purpose of this study is to determine patient satisfaction with behavioral health consultation visits that take place within the context of the primary care behavioral health consultation model. Patient likelihood to seek out specialty mental health care services if behavioral health consultation services were not provided was also examined. Two primary care clinic systems were examined in this study. The first was a primary care clinic predominately serving low-income patients: 100 individuals participated. The second was primary care in the context of military treatment centers: 539 individuals participated. Results show that 61% of the patients in the low-income primary care clinic would not attend a specialty mental health appointment versus 30% in the military population. This study suggests that primary care behavioral health is a patient-centered approach to care and reaches populations that otherwise may not receive behavioral health services. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Gynecologic Health Consequences of Chlamydia trachomatis Infection in Military Servicewomen.

Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the United States. Within the U.S. military, the age- and race-adjusted chlamydia infection rates among female service members are consistently higher than civilian rates, with a 20% annual acquisition rate among young active-duty women. The sequelae of chlamydia disproportionately impact women in terms of severity and cost. Untreated chlamydia progresses to pelvic inflammatory disease in 40% of cases, and is a leading cause of fallopian tube damage and pelvic adhesive disease resulting in ectopic pregnancy, tubal infertility, and acute and chronic pelvic pain. Tubal infertility is among the leading indications for in vitro fertilization (IVF) nationally and rates among couples undergoing IVF at military treatment centers are double the national average. Collectively, chlamydia infection represents a significant resource burden to the military health care system and, in view of the serious gynecologic health sequelae, a significant threat to the readiness of servicewomen. In this review, we discuss the gynecologic impact of chlamydia infection within the military, the critical gaps for research funding, and opportunities for intervention.

Inappropriate bradycardia in Ebola virus disease.

As part of French assistance for the outbreak of Ebola virus disease in west Africa, a military treatment center for infected healthcare workers was deployed in Conakry, Guinea. Although some cases of bradycardia have been reported since the first Ebola outbreak, they have never been documented to our knowledge. We studied heart rhythm in patients with Ebola virus disease to analyze inappropriate bradycardia and discuss its mechanism. Nine patients who tested positive for Ebola were admitted in March 2015. Baseline clinical data were noted at admission and twice a day during follow-up, and laboratory analyses (with troponin testing) were performed. At admission, patients had no or moderate tachycardia (pulse=82±27 bpm). Among them, a 32-year-old midwife admitted on her fourth day of symptoms had marked bradycardia: 43 bpm. ECG showed sinus bradycardia with no conduction disturbances or repolarization anomalies; findings were similar for the three other patients with bradycardia (<60 bpm). During follow-up, her pulse gradually increased, as it did for the other three; all four recovered. Despite several factors likely to promote tachycardia, we observed no or only moderate tachycardia in all patients with Ebola. In our study, ECG recorded sinus rhythm, without significant node dysfunction or atrioventricular block. In the absence of any evidence of myocarditis, we discuss the possibility of a central nervous system cause, associated with encephalitis. We observed relative or marked bradycardia in our patients infected with Ebola. We hypothesize that its causal mechanism was encephalitis.

From War Injured to the Elderly, Brain Injuries Are on the Rise for Vision Rehabilitation Practitioners

Serving growing population of adults with brain injury and related visual impairments provides our field with unprecedented challenges, but also new opportunities for growth, professional expansion, and collaboration with professionals from a wide range of rehabilitative services. Whether they are returning service members from wars in Iraq and Afghanistan; adults injured in motor vehicle accidents, falls, or other trauma; or survivors of stroke or other brain injury, these presenting patients are forcing us to rethink some of our rehabilitation strategies and adapt our methods to meet their complex needs. Rehabilitation training, particularly traditional methods of teaching special skills needed by people who are visually impaired (that is, who are blind or have low vision), often relies on use of cognitive processes such as attention, memory, and auditory processing. Although each brain injury is unique and multifaceted in its effect on rehabilitation learning, performance of these skills may be most challenging to a person with a brain injury (Lew, 2005). Nevertheless, a growing body of research and collaborative teamwork with other professionals treating brain injury give us many tools for working with an individual with such an injury. The future is exciting for those of us who work in blind or vision rehabilitation, and we all have a chance to make a positive impact on a substantial population. CALLING ALL SERVICE PROVIDERS Medical treatment is improving rate of survival among those wounded by war or trauma, but survivors often live with multiple disabilities, including traumatic brain injuries (TBIs) that can result in vision loss. As number of individuals with brain injury-related vision loss increases, all levels of vision rehabilitation service providers will need to be involved in working with this population, especially as returning service members with brain injuries and vision issues who are served at military treatment centers and network of Department of Veterans Affairs (VA) facilities will begin dispersing into their home communities. Veterans are not only group of individuals with brain injuries and related visual impairments that will soon be overwhelming health care. Adults in general population are living longer, but with age-related health conditions that may affect brain or vision. The chance of having a stroke approximately doubles for each decade of life after age 55. Heart or artery disease, diabetes, obesity, and hypertension are more common with age and are major risk factors for stroke, which can damage brain and vision (American Heart Association, 2010). Not only are individuals living longer, but number of individuals living into old age is rapidly increasing as well. In United States and around world, aging of populations is unprecedented, pervasive, and enduring, and this growing cohort of elderly individuals will require more rehabilitative and health services than ever before (United Nations Department of Economic and Social Affairs, 2002). According to a United Nations report (2002), persons 65 years or older numbered about 39.6 million in 2009, and they represented 12.9% of U.S. population (about one in every eight Americans). By 2030, there will be about 72.1 million older persons (that is, 19% of U.S. population-more than twice number in 2000). The sheer number of people reaching ages associated with increased health risks suggests there will be ubiquitous opportunities to interact with and serve a population with brain injury and vision impairment (Administration on Aging, 2010; Ghusn, Stevens, & Atassi, 1998). DEFINING TBI AND ABI Brain injury is receiving more press and research attention as the signature wound of war[s] in Iraq and Afghanistan (Oakie, 2005), but terms involving brain injury are often used imprecisely or are misunderstood in popular literature. …

Laparoscopic Sleeve Gastrectomy: Outcomes at a Military Training Center

Laparoscopic sleeve gastrectomy (LSG) has gained support as a single-staged and stand-alone bariatric procedure. Reports of excess weight loss of 35 to 83 per cent, reduction in comorbidities, and decreased operative morbidity have garnered support for LSG. This study represents an initial outcome analysis of LSG performed solely at a military treatment center. This study is a retrospective analysis of all patients receiving LSG at Dwight D. Eisenhower Army Medical Center from September 2007 to December 2009. The patients were planned for a stand-alone procedure. One hundred and fifteen patients received LSG over this time period with a mean body mass index of 45.5 +/- 6.2 (range 35.1-58.3). The average age was 47.4 +/- 12.5 years. Diabetes mellitus was seen in 47 per cent and 68 per cent of patients had hypertension. The mean and median length of operation was 124 +/- 48 and 115.5 minutes. The mean percentage of excess weight loss was 16.6 +/- 6.40 per cent at 1 month, 31.5 +/- 7.6 per cent at 3 months, 41.2 +/- 13.9 per cent at 6 months, and 53.7 +/- 12.5 per cent at 1 year from surgery. One or more of patient's preoperative diabetic or hypertensive medications were improved postoperatively in 18.7 per cent and 16.3 per cent, respectively. Incidence of major complications occurred in 4.35 per cent of patients in this study to include four leaks (3.4%), one death (0.87%), and 10 readmissions. Midterm analysis of outcomes related to LSG as a single-stage bariatric procedure is promising as long-term outcome data is collected; the efficacy of this procedure as a sole bariatric procedure will continue to be borne out.

Improving Influenza Vaccination in Dialysis Facilities

The End-Stage Renal Disease Network 5 sought to improve the influenza vaccination rate for the period September 1, 2008, to January 31, 2009, through an awareness campaign, coupled with primary data collection in the form of a tracking tool prepopulated with patient names. The latter served as a reminder to staff to determine the immunization status of patients and offer the influenza vaccination, as appropriate. Targets for the intervention were all facilities and their prevalent hemodialysis and peritoneal dialysis patients, with the exclusion of military treatment centers, Veterans Health Administration hospitals, and prisons. The majority of eligible network facilities (86.9%) participated in the project to achieve an overall adult influenza vaccination rate of 82.6% (95% confidence interval = 82.1%, 83.2%), greatly exceeding the project goal of 64.5% and representing substantial progress toward the 2010 goal of 90%. The initiative is reported here using the Standards for Quality Improvement Reporting Excellence (SQUIRE).