Military Medicine

Newman, Alissa; Armonda, Al; Braun, Barry

doi: 10.1093/milmed/usac015pmid: 35064262

ABSTRACTIntroductionPhysical fitness is foundational to the U.S. Army as a component of combat readiness, and accurate assessment of readiness is imperative for mission success and soldiers’ health and safety. To this end, the Army has developed the Army Combat Fitness Test (ACFT), which more accurately assesses these abilities and may aid development of a more combat-ready force. Reserve Officer Training Corps (ROTC) programs nationwide are often challenged by limited structured training time, as well as access to equipment and training space. Development and/or adaptation of a training program that addresses these limitations would benefit ROTC programs nationally. Therefore, the purpose of this study was to compare a standard military fitness training program to High-Intensity Functional Training (HIFT) in ROTC cadets. We hypothesized that a HIFT program would be more effective than the standard military program developed by the DoD on both ACFT performance and assessment of common Warrior Tasks and Battle Drills (WTBDs).Materials and MethodsThis study was approved by the Institutional Review Board at Colorado State University (CSU). Participants were recruited from CSU’s Army ROTC program. Before and upon completion of the training intervention, participants completed a battery of testing, conducted over three visits. The first visit consisted of body composition assessment and measurement of aerobic capacity (VO2max). Visit 2 was the ACFT, and Visit 3 was a “benchmark test” to assess WTBD performance. Participants then completed 10 weeks of group training. Once weekly, participants completed the Daily Analysis of Life Demands for Athletes (DALDA) survey to monitor the risk of overtraining.Statistical AnalysisResponses to training and survey responses were examined using two-way analysis of variance (time × group) with repeated measures. Baseline characteristics were compared using Student’s t-test to assess pre-intervention differences between groups. Pearson product correlations were used to test relationships between ACFT performance, body composition, and performance on the benchmark assessment. The significance level alpha was set at P < .05.ResultsTwenty-five men and 10 women competed the study (n = 35). Mean age was 19.8 ± 1.3 years, range 18-23. There were no significant changes in absolute or relative VO2max within or between groups. We found no difference in body mass, but did find a small but statistically significant favorable change in body composition, with no difference between groups. Overall ACFT scores and scores in five of the six events increased significantly across both groups, with no significant differences between groups. For the benchmark test, there was no significant difference between pre- and post-intervention benchmark scores, time to completion, 1,600-m ruck time, or accuracy. DALDA survey results indicate no apparent risk for overtraining.ConclusionThree 60-minute sessions per week of moderate-high-intensity training elicited improvements in ACFT scores, with no statistically significant differences between training programs. For this population of ROTC cadets, implementing a structured training program with expert oversight appears to be effective. Based on the successes and unanticipated challenges encountered in this study, training programs that emphasize intensity, train a wide variety of movements, maximize adherence, and are adaptable to a variety of situations are likely to be successful at improving ACFT scores.

Sico, Jason J; Macedo, Franz; Lewis, Jeffrey; Spevak, Christopher; Vogsland, Rebecca; Ford, Aven; Skop, Karen; Sall, James

doi: 10.1093/milmed/usab490pmid: 35022782

ABSTRACTIntroductionIn June of 2020, the U.S. DVA and DoD approved a new joint clinical practice guideline for assessing and managing patients with headache. This guideline provides a framework to evaluate, treat, and longitudinally manage the individual needs and preferences of patients with headache.MethodsIn October of 2018, the DVA/DoD Evidence-Based Practice Work Group convened a guideline development panel that included clinical stakeholders and conformed to the National Academy of Medicine’s tenets for trustworthy clinical practice guidelines.ResultsThe guideline panel developed key questions, systematically searched and evaluated the literature, created a 1-page algorithm, and advanced 42 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system.ConclusionThis synopsis summarizes the key features of the guideline in three areas: prevention, assessing and treating medication overuse headache, and nonpharmacologic and pharmacologic management of headache.

Goodrich, Eric

doi: 10.1093/milmed/usac117pmid: 35476073

ABSTRACTIntroductionThe decision to enter the Navy as a physician is a major career choice. However, there are no published studies that address the typical Navy physician’s experience in the Health Professions Scholarship Program (HPSP) and Uniformed Services University of the Health Sciences (USUHS) programs. The purpose of this qualitative study is to describe the typical Navy physician’s experience in the HPSP and USUHS programs.Materials and MethodsAn anonymous online survey containing 47 questions was distributed to 63 Navy HPSP and USUHS physicians who started internships from 2008 to 2015. Participants were chosen by using purposeful, criterion, and snowball sampling methods with whom the author had a professional relationship during his military experience. The survey data were plotted in Excel spreadsheets and graphs according to six sub-research questions. Mean, SD, Likert scale 1-5, and grouping of free text responses were recorded.ResultsA total of 54 out of 63 Navy physicians (85.7%) responded to the survey. Navy physicians got their first-choice residency selection of 67.3% of the time, 34.6% went straight through residency without interruptions, 44.2% answered definitely or probably that military match changed their residency selection compared to them applying for civilian residency, and 46.2% answered definitely or probably that it was more difficult to get into military versus civilian residency. Participants answered definitely or probably that military experience puts them ahead of civilians in terms of leadership (82.7%), prior medical experience (46.2%), and applying for civilian residency (76.2%). Common positive themes of free-text answers included having financial stability, unique life experiences, and serving their country. Common negative themes included lack of career control, lack of knowledge regarding HPSP/USUHS programs, and delay in residency and career.ConclusionsThe principal findings in this study are that most Navy physicians favored paid medical school/financial support, working overseas and in unique operational climates, having unique life experiences, leadership skills, and prior military experience put them ahead of their civilian colleagues, thought the Navy experience was worth it, and would join again if given the opportunity. However, most Navy physicians had a lack of career control due to needs of the Navy, lack of knowledge regarding residency selection, operational billets, and active duty service obligation, had more difficulty getting into a military residency of their choice versus civilians, and had interrupted residency training/training delays. The Navy would possibly benefit from a nationwide HPSP/USUHS physician mentorship program and an educational seminar to increase medical student applicant knowledge, which may improve recruiting and retention.

Phillips, Kimberley J; Banaag, Amanda; Lynch, LeeAnne C; Wu, Hongyan; Janvrin, Miranda; Koehlmoos, Tracey Perez

doi: 10.1093/milmed/usac022pmid: 35106602

ABSTRACTIntroductionThe U.S. Army’s Soldier 2020 program, which started in January 2016, was designed to achieve full integration of women in all military occupational specialties. This study was undertaken to determine differences in risk of musculoskeletal injury and behavioral health (BH) disorders among U.S. Army Active Duty Servicewomen (ADSW) in ground combat military occupational specialties (MOS) versus those in non-ground combat MOS since the start of the program until January 2019.Materials and MethodsUsing healthcare claims data from the Military Health System’s Data Repository we conducted a cross-sectional study on ADSW from January 1, 2016 to January 1, 2019 and categorized them as either ground combat specialists (GCSs) or non-ground combat specialists (NGCSs). We identified all female soldiers in our cohort with a musculoskeletal injury (MSKI) and/or BH diagnosis during the study period. A multivariable logistic regression, adjusted by pregnancy or delivery status, was used to assess risk factors associated with GCS and included soldier age, race, body mass index (BMI), tobacco use, alcohol/substance use, and MSKI and BH status as predictor variables.ResultsA total of 92,443 U.S. Army ADSW were identified, of whom 3,234 (3.5%) were GCS (infantry, field artillery, cavalry/armor, and air defense) and 89,209 (96.5%) were in non-ground combat billets. A large difference was observed when comparing the age of the population by occupation; GCS women were predominantly between the ages of 18-23 years (71.9%), compared to NGCS women aged 18-23 (41.0%). Top MSKI and BH diagnoses for both occupations were joint pain (44.9% GCS, 50.2% NGCS) and adjustment disorders (26.2% GCS, 28.0% NGCS). GCS women had lower odds for musculoskeletal injury (0.86 AOR, 0.79-0.93 CI, P = 0.0002), obesity per BMI classification (0.82 AOR, 0.70-0.97 CI, P = 0.0214), and BH disorders (0.87 AOR, 0.80-0.95 CI, P = 0.0019); and higher odds for tobacco use (1.44 AOR, 1.27-1.63 CI, P < 0.0001), substance use (1.36 AOR, 1.04-1.79 CI, P = 0.0257), and alcohol use (1.18 AOR, 1.02-1.38 CI, P = 0.0308) when compared to NGCS women.ConclusionsWith the increasing focus on soldier medical readiness in today’s U.S. Army, the health of all soldiers is of paramount concern to command groups, unit leaders, and individual soldiers. The integration of women into ground combat military occupational specialties is a relatively new program; further longitudinal research of these groups should follow, focusing on their progression and improvement in soldier readiness, overall health, and the well-being of all servicewomen.

Tapia, Ashley D; Howard, Jeffrey T; Bebo, Natasha L; Pfaff, James A; Chin, Eric J; Trueblood, Wesley A; April, Michael D; Long, Brit J; Long, Adrianna N; Fernandez, William G; Schauer, Steven G

doi: 10.1093/milmed/usab553

Le, Thuan H; Lockrow, Ernest G; Endicott, Scott P

doi: 10.1093/milmed/usac044pmid: 35247056

ABSTRACTIntroductionTo compare the clinical outcomes of bilateral labia minora hypertrophy reduction using ultrasonic shears versus traditional methods.Materials and MethodsIn this retrospective study, we evaluate the surgical outcomes of 11 women who underwent bilateral labia minora hypertrophy reduction using ultrasonic shears to 14 women who underwent the same procedure using various traditional methods between January 1, 2015 and February 29, 2020 in a single center. The primary outcomes evaluated are total operative time, estimated blood loss, and postoperative pain. Secondary outcomes include postoperative complications and total admission time. The statistical analyses used were exact Wilconxon Rank and Fisher’s exact test.Results25 total bilateral labiaplasty procedures were included in the analysis. 11 procedures were performed using ultrasonic shears and 14 were performed using traditional methods. The mean reduction operative time for the ultrasonic shears technique when compared with traditional methods was 43.25 minutes (22.82 minutes versus 66.07 minutes, P = .0002). A statistically significant but non-clinically significant difference in estimated blood loss was noted. No statistically significant differences existed with postoperative pain score, total admission time, or postoperative complications.ConclusionsUltrasonic shears significantly reduce the time needed for the reduction of bilateral labia minora hypertrophy and therefore should be considered by surgeons as a useful tool in increasing the efficiency of this procedure.

Wickwire, Emerson M; Abdelwadoud, Moaz; Collen, Jacob; Edwards, Hillary; Labra, Christian; Capaldi, Vincent F; Williams, Scott G; Manber, Rachel; Assefa, Samson Z; Drake, Christopher L; Albrecht, Jennifer S; Bevan, Jeffrey; Mahoney, Alexandra; Tatum, Eileen D;

doi: 10.1093/milmed/usac185pmid: 35776075

This is a correction to: Trevor Elam, MC, USN, Sorana Raiculescu, MSc, Shyam Biswal, PhD, Zhenyu Zhang, PhD, Michael Orestes, MC, USA, Murugappan Ramanathan, MD, Air Pollution Exposure and the Development of Chronic Rhinosinusitis in the Active Duty Population, Military Medicine, 2022; usab535, https://doi.org/10.1093/milmed/usab535 In the originally published version of this manuscript, there were errors in the author list. Zhenyu Zhang should be in last position, instead of fourth position, in the author list. The second author’s name should read “Sorana Raiciulescu” instead of “Sorana Raiculescu.” “Jr” was omitted after Murugappan Ramanathan. A note explaining that Dr. Zhang and Dr. Ramanathan share senior authorship was also omitted. These errors have been corrected. Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US. This work is written by (a) US Government employee(s) and is in the public domain in the US. Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Baker, Michael S; Baker, Jacob B; Burkle, Frederick M

doi: 10.1093/milmed/usac061pmid: 35296889

ABSTRACTIntroductionCurrent U.S. hospital ships—USNS Mercy and Comfort—are old, slow, cumbersome, and indefensible, and due for retirement. As new challenges and new threats emerge in the 21st century, the U.S. Navy should field new afloat medical platforms to potentially deal with both mass casualty scenarios and humanitarian disaster relief in a rapid and tactical manner. New hospital ships should be able to defend themselves with more modern weapons and to be interconnected with encrypted communications. They must be fast, nimble, tactical, defensible, and forward deployed in the risky global commons of the 21st century.Materials and MethodsSystematic review of the literature on hospital ships, U.S. Navy policy, the Geneva Conventions, and current global threat conditions.ResultsHospital ships provide medical support for U.S. forces in conflict and promote goodwill and a positive image of the U.S. abroad. Current hospital ships do not fit the operational paradigm of the current needs for forward deployed and rapidly deliverable operational medicine. There is a need for a new and more capable platform to deliver operational health care in the forward deployed setting.ConclusionsMultiple high-speed medical response vessels—whether reconfigured from an existing ship, or an entirely new platform developed for more robust medical delivery—need to be urgently fielded for future combat operations, humanitarian missions, and participation in cooperative security engagements. These medical platforms need to be able to defend themselves and be tactically interconnected with the Fleet and Fleet Forces.

Caldwell, Aaron R; Saillant, Michelle M; Pitsas, Dina; Johnson, Audrey; Bradbury, Karleigh E; Charkoudian, Nisha

doi: 10.1093/milmed/usac047pmid: 35294018

ABSTRACTIntroductionExertional heat illnesses remain a major threat to military service members in the United States and around the world. Exertional heat stroke (EHS) is the most severe heat illness, characterized by core hyperthermia and central nervous system dysfunction. Per current Army regulations, iced-sheet cooling (ISC) is the recommended immediate treatment for heat casualties in the field, but concerns have been raised regarding the efficacy of this approach. Thus, the purpose of this study was to quantify the cooling rate of ISC following exertional hyperthermia.Materials and MethodsWe utilized a randomized crossover design with 2 experimental trials. In both trials, exertional hyperthermia was induced by walking (3.5 mph at 5% grade) on a treadmill in an environmental chamber (40 °C, 30% RH) for up to 3 hours or until core body temperature reached 39.2 °C. After the walking portion, individuals either received ISC (experimental trial) or cooling and rested supine in the same environmental conditions for 30 minutes with no ISC (control trial). For ISC, bed sheets soaked in ice water were applied (per Army guidance) at the neck, chest, and groin with another sheet covering the body. Sheets were rotated and resoaked every 3 minutes until core temperature decreased to <38.0 °C.ResultsBy design, participants finished exercise with increased core temperature (38.8 ± 0.39 °C vs. 38.90 ± 0.34 °C, ISC and control trials, P = 1.00). The ISC trial provided significantly (P = .023) greater cooling rates, 0.068 °C/min 95% confidence interval [CI; 0.053, 0.086], compared to the control trial, 0.047 °C/min 95% CI [0.038, 0.056]. Additionally, the time to decrease to less than 38.0 °C was significantly (P = .018) faster in the ISC trial (median = 9.3 minutes) compared to the control trial (median = 26.6 minutes).ConclusionISC increases the cooling rate of those recovering from exertional hyperthermia. With the observed cooling rate, we can extrapolate that ISC would reduce core temperature by ∼2 °C within 30 minutes during a case of EHS. We conclude that ISC provides a safe and effective alternative for the field where cold water immersion resources may not be readily available.