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Military Medicine Jul 2023In the early 2000s when Tactical Combat Casualty Care was developed, the adoption of prophylactic antibiotic use was not mainstream. Back then, guidelines were...
INTRODUCTION
In the early 2000s when Tactical Combat Casualty Care was developed, the adoption of prophylactic antibiotic use was not mainstream. Back then, guidelines were derivative of civilian trauma guidelines which did not include widespread prophylactic antibiotic use. Current protocols across the DoD have embraced the use of prophylactic antibiotic use before reaching a military treatment facility as evidenced by Tactical Combat Casualty Care guidelines and several Joint Trauma System Clinical Practice Guidelines.This review intends to find trends associated with the use of antibiotics in the military setting and answer the research question: Do current Army doctrine and practices address these issues and how can they be reworked to address them if needed?
MATERIALS AND METHODS
Methods were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary author utilized four databases to locate articles: MEDLINE (EBSCOhost), Cochrane Central Register of Controlled Trials (Wiley), CINAHL Complete (EBSCOhost), and Embase (Elsevier). The following keywords were utilized: "Combat casualty," "antibiotic," "trauma," and "prehospital." This ultimately led to 19 articles included in the review.
RESULTS
Nineteen articles were included in the final review and placed into one of the following categories: Overall antibiotic use, guideline adherence and practices, strains, and infection risk factors. Overall, the Army Health System has shown that there is room for improvement in terms of antibiotic stewardship and training regarding antibiotics.
CONCLUSION
Infectious diseases pose a substantial risk to combat wounded. The Army Health System must anticipate encountering challenges with delivering care to patients suffering infections in addition to serious combat injuries. A systematic review of the literature highlights several areas for improvement, primarily areas involving pathogen surveillance, treatment of pediatric populations, and the Army's operational domain of training.
Topics: Humans; Anti-Bacterial Agents; Military Medicine; Military Personnel; Antibiotic Prophylaxis
PubMed: 35830415
DOI: 10.1093/milmed/usac210 -
Military Medicine Jul 2023Feeding and eating disorders can be difficult to treat and frequently co-occur with other mental health conditions. The last systematic review of eating disorders in a...
INTRODUCTION
Feeding and eating disorders can be difficult to treat and frequently co-occur with other mental health conditions. The last systematic review of eating disorders in a military and veteran population was published in 2015. An updated review is warranted to re-examine the current literature on eating disorders in the active duty and veteran populations.
MATERIALS AND METHODS
A systematic review that described the prevalence, co-occurrence of other disorders and/or events, and health care utilization of U.S. active duty members and veterans was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases and Medical Subject Headings (MeSH) terms used are listed in Appendix A. Each category of the literature was extracted and graded using the Oxford Centre for Evidence-Based Medicine Levels of Evidence.
RESULTS
Twenty-one studies revealed prevalence estimates with varying rates based on demographic information. Trauma exposure is consistently associated with eating disorder development. Individuals diagnosed with eating disorders had greater health care utilization.
CONCLUSIONS
Research on eating disorders in the military and veteran populations has expanded in recent years. Limitations of the evidence included in this review stem from the use of self-reported questionnaires, changes to medical record systems, and limited generalizability to the overall population of patients with eating disorders. Further research should investigate the impact of demographic factors and trauma exposure on the development of an eating disorder within the military and veteran populations.
Topics: Humans; Feeding and Eating Disorders; Veterans; Military Personnel; United States; Prevalence
PubMed: 35788384
DOI: 10.1093/milmed/usac180 -
BMJ Military Health May 2024Body dysmorphic disorder (BDD) and muscle dysmorphia (MD) are common but often underdiagnosed disorders. These disorders have rarely been explored in the context of...
BACKGROUND
Body dysmorphic disorder (BDD) and muscle dysmorphia (MD) are common but often underdiagnosed disorders. These disorders have rarely been explored in the context of military personnel by mental health researchers despite the emphasis on physical fitness in military populations. We conducted a comprehensive systematic literature review on scientific studies of BDD and MD and the accompanying symptoms within the military.
METHODS
We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and used PubMed, Web of Science and PsycINFO as databases with "body dysmorphic disorder," "muscle dysmorphia," "body image," "performance and image enhancing drugs," "anabolic steroid," military personnel," "soldiers," "navy," "air force," "army" and "armed forces" as search terms.
RESULTS
A total of 20 eligible articles reporting data of 42 952 study participants were used. According to the identified literature, prevalence rates of BDD in the military are ~10% in men and ~20% in women, whereas ~15% of men and ~5% of women may suffer from MD. Further identified related problems in military populations were excessive bodybuilding, the use of anabolic drugs, the intake of stimulants, weight and shape concerns, and weight-control behaviours.
CONCLUSIONS
BDD, MD, as well as the use of anabolic and stimulating drugs, are highly prevalent in military personnel. Despite the importance of these problems in the military, there are no military-specific treatment studies available. A pre-existing focus on physical appearance and fitness might contribute to the decision to pursue a professional military career. The military environment might be a maintaining factor of BDD or MD, but not the ultimate cause of the disorder in an affected individual.
Topics: Humans; Body Dysmorphic Disorders; Military Personnel; Body Image; Anabolic Agents; Body Weight; Female; Male
PubMed: 35675995
DOI: 10.1136/bmjmilitary-2022-002135 -
BMJ Military Health Mar 2024Decay of surgical skills due to paucity of opportunity to operate is a potential threat to patients being cared for by the Defence Medical Services while on operational...
INTRODUCTION
Decay of surgical skills due to paucity of opportunity to operate is a potential threat to patients being cared for by the Defence Medical Services while on operational deployment. Our aim was to review the literature regarding skill decay in the trained surgeon in order to understand how it may affect clinical performance and patient outcomes. We also wished to survey the likely causes of such decay and possible means of mitigation.
METHODS
A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Study bias assessment was also undertaken. Content summaries for the papers included study design and methodology, participant level of experience, measures and magnitude of effect, duration of no practice, and study limitations.
RESULTS
Five papers met the selection criteria. There were insufficient quantitative data on the impact of surgical skill decay on patient outcome, surgeon performance or mitigation strategies, and a meaningful quantitative synthesis could not be undertaken.
CONCLUSIONS
This systematic review of the literature found very little specific evidence confirming or refuting surgical skill decay in trained surgeons, with measurement of decay hampered by the lack of an accepted methodology. Studying this in the deployed setting may offer a firmer evidence base from which to generate policy. Potential mitigation strategies are discussed. ID260846.
Topics: Humans; Military Personnel; Surgeons; Clinical Competence
PubMed: 35589135
DOI: 10.1136/bmjmilitary-2021-001919 -
Human Factors Jan 2024The purpose of this meta-analytic review is to examine the relationship between increased psychological pressure and Use of Force (UOF) behaviours, identifying current... (Meta-Analysis)
Meta-Analysis Review
Negative Consequences of Pressure on Marksmanship May be Offset by Early Training Exposure to Contextually Relevant Threat Training: A Systematic Review and Meta-Analysis.
OBJECTIVE
The purpose of this meta-analytic review is to examine the relationship between increased psychological pressure and Use of Force (UOF) behaviours, identifying current training methodologies and effectiveness of transfer of training interventions in high threat-simulated scenarios.
BACKGROUND
Data from UOF performance within Law Enforcement indicates a low transfer of marksmanship training into real-world UOF, resulting in unnecessary damage to property, personal injury and increased risk to loss of life. This meta-analysis examines both the impact of increased pressure and current training interventions.
METHOD
A meta-analysis was conducted across a wide range of published research to answer the primary research questions.
RESULTS
Increased levels of perceived pressure demonstrated an average decrease in marksmanship accuracy of 14.8%, together with a small increase in incorrect Decision Making (DM) and faster reaction Times (RT). Experience demonstrated a mitigating effect for pressure for marksmanship with a 1.1% increase for every one year of service but no effect on DM or RT. Training interventions utilizing a variety of early contextually relevant exposures to increased pressure improved performance over traditional training on average by 10.6%.
CONCLUSION
The outcomes illustrate the negative effect of pressure on marksmanship and UOF behaviours, and that early exposure to contextually relevant pressure may increase the transfer of training to real-world performance.
APPLICATION
Occupational experience is an important component in reducing the impact of pressure on UOF performance, and transfer of training may be enhanced through training methodologies that combine early exposure to contextually relevant pressure, that may replicate the benefits of experience.
Topics: Humans; Reaction Time; Military Personnel
PubMed: 35387527
DOI: 10.1177/00187208211065907 -
Foot & Ankle Specialist Jun 2024The high incidence of ankle sprain within the military sets the stage for prevalent chronic ankle instability. The purpose of this review was to compare and evaluate...
BACKGROUND
The high incidence of ankle sprain within the military sets the stage for prevalent chronic ankle instability. The purpose of this review was to compare and evaluate chronic ankle instability treatment strategies in the military population.
METHODS
Electronic databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews guidelines for English-language, human studies with a military patient population that had been diagnosed with and treated for chronic ankle instability. Exclusion criteria were animal, cadaver, and review studies and case reports.
RESULTS
Eight studies met the inclusion criteria, representing 695 military service members-625 males (89.9%) and 70 females (10.1%)-and 4 treatment strategies: Broström-related procedures, modified Watson-Jones procedure, Colville's technique, and anatomic lateral ligament reconstruction using semitendinosus tendon allograft. The percentage of satisfactory outcomes was 100% for Colville's technique, and ranged from 73.2% to 94.7% for Broström-related procedures and 72% to 80% for the modified Watson-Jones procedure. Mean American Orthopaedic Foot and Ankle Society scores, anterior drawer displacement, talar tilt, and visual analogue scale scores were also reported.
CONCLUSION
This review demonstrates that the Bröstrom procedure has consistently satisfactory outcomes within the military population, and Colville's technique is another promising option for this patient population but would require additional studies to support this claim.
LEVELS OF EVIDENCE
Level IV.
Topics: Female; Humans; Male; Ankle Injuries; Ankle Joint; Chronic Disease; Joint Instability; Military Personnel; Orthopedic Procedures; Treatment Outcome
PubMed: 34991374
DOI: 10.1177/19386400211068239 -
BMJ Military Health Jan 2024Periodontal disease is a prevalent pathology in military personnel worldwide. The objective is to analyse the methodological features of periodontal health research...
INTRODUCTION
Periodontal disease is a prevalent pathology in military personnel worldwide. The objective is to analyse the methodological features of periodontal health research performed in military personnel in their home countries.
METHODS
A PRISMA systematic review of literature was carried out in PubMed, EMBASE and Web of Science databases on military periodontal health studies. Study design type, language, publication date, year, country, size and sample selection, age, sex, military, diagnostic procedure, examiners, periodontal, gingival and oral hygiene index were extracted.
RESULTS
Eighty-eight out of 5355 studies found were selected, published between 1921 and 2020, with samples ranging from 52 to 16 869 individuals, generally not randomised, and consisting mainly of men with a mean age of 25 years. Predominant studies were cross-sectional descriptive studies, carried out in the Army, on American military personnel, and in the English language. Most of the studies used the WHO periodontal probe handled by two or more examiners. The Löe and Silness gingival index and the Silness and Löe plaque index were the most used indexes to assess gingival condition and oral hygiene, respectively. Community Periodontal Index of Treatment Needs was the most widely used periodontal index.
CONCLUSIONS
Research on periodontal health carried out in military populations from the 1920s to the present has been performed from an almost exclusively descriptive approach. Issues such as the characteristics and representativeness of the samples, the epidemiological design and the different gingival-periodontal indexes used may limit the comparability of the study results.
Topics: Male; Humans; Adult; Military Personnel; Periodontal Diseases; Periodontal Index; Military Health
PubMed: 34921095
DOI: 10.1136/bmjmilitary-2021-001977 -
BMJ Military Health Jan 2024Military members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Military members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The purpose of this systematic review with meta-analysis was to assess if prescribed prophylactic footwear or foot orthoses reduced the risk of lower extremity injury in military tactical athletes.
METHODS
MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Defense Technical Information Center databases were searched for randomised controlled trials published at any time that compared foot orthoses or prescribed footwear (to include shock-absorbing insoles and socks) with a placebo intervention or a no-treatment control. Methodological quality was assessed and the number of injuries, population at risk and duration of the study epoch were extracted and relative risk (RR) calculated. An omnibus meta-analysis was performed assessing all prescribed footwear and orthoses intervention studies, with subgroup analyses conducted on studies with similar interventions (ie, basketball athletic shoes, athletic shoes (prescribed by foot type), foot orthoses, shock-absorbing insoles, socks, tropical combat boots).
RESULTS
Of 1673 studies identified, 22 were included. Three of eight studies that employed orthoses demonstrated significantly reduced overuse injuries compared with no-treatment controls (RR range: 0.34-0.68); one study showed neoprene insoles significantly decreased overuse injuries (RR: 0.75). There were no other significant effects in the individual studies and no protective effects observed in the omnibus meta-analysis or in the component subanalyses.
CONCLUSIONS
Prescribed footwear and orthoses do not appear to have a prophylactic effect on lower quarter musculoskeletal injuries in military members and cannot be recommended at this time.
Topics: Humans; Military Personnel; Foot Orthoses; Leg Injuries; Cumulative Trauma Disorders; Lower Extremity; Athletes
PubMed: 34785586
DOI: 10.1136/bmjmilitary-2021-001955 -
BMJ Military Health Jan 2024Smoke-free legislation has been instrumental in reducing secondhand smoke (SHS) exposure in public places. However, the evidence of the impact of institutional...
INTRODUCTION
Smoke-free legislation has been instrumental in reducing secondhand smoke (SHS) exposure in public places. However, the evidence of the impact of institutional smoke-free policies in settings such as healthcare and defence is weaker. Specifically, the literature on the effect of smoke-free policies in military settings has not yet been synthesised.
METHODS
This review aimed to identify, critically appraise and synthesise the available evidence to evaluate the effect of defence smoke-free policies on SHS exposure. Eight electronic databases (eg, EMBASE, MEDLINE) were searched from inception to June 2020. We included English-language studies on smoke-free policies introduced in a defence setting, assessing their impact on SHS exposure (primary outcome) and healthcare utilisation, smoking behaviours and defence efficiency (secondary outcomes). Risk of bias was assessed using ROBINS-I. Synthesis without meta-analysis was conducted using vote counting of direction of effect.
RESULTS
The search retrieved 4503 citations of which eight met inclusion criteria; two controlled and six uncontrolled before-and-after studies. The evidence, although low-quality, from one study indicated reduced SHS exposure following the introduction of a defence smoke-free policy. For secondary outcomes the review found mixed results, with the quit rate being the one outcome favouring smoke-free policies. The cumulative confidence of evidence is uncertain and therefore reliable conclusions cannot be drawn from these studies.
CONCLUSIONS
A research gap exists for high-quality studies on the impact of defence smoke-free policies which should use comparators and, if possible, randomisation. Policy-makers should introduce institutional smoke-free policies in defence settings within an evaluative framework to generate such evidence.
Topics: Humans; Smoke-Free Policy; Tobacco Smoke Pollution; Military Personnel; Smoking; Administrative Personnel
PubMed: 33990381
DOI: 10.1136/bmjmilitary-2021-001795 -
BMJ Military Health Aug 2023The UK has no legislation protecting employees' access to breastfeeding facilities. Without specific breastfeeding policy, provisions to access workplace facilities can...
INTRODUCTION
The UK has no legislation protecting employees' access to breastfeeding facilities. Without specific breastfeeding policy, provisions to access workplace facilities can be inconsistent and negatively impact employees' breastfeeding duration, retention and morale, particularly servicewomen who work in varied and demanding military environments. This is an important policy area for the British Army to retain talented and trained soldiers.
METHODS
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement principles, PubMed, Embase, CINAHL and Pro-Quest Databases were searched for studies relevant to accessing appropriate breastfeeding facilities in UK workplaces and high-income countries' Armed Forces. Factors acting as barriers and enablers to accessing facilities were identified. UK government and Armed Forces' websites were searched for grey literature on existing policies and guidance for accessing facilities.
RESULTS
Barriers and enablers to access from 16 studies were described by three thematic areas: attitudes to breastfeeding, facility provisions and use of facilities. Factors which employers could influence included specific breastfeeding policy, universal workplace education, existence of suitable facilities and individualised breastfeeding plans. The key areas for policy development identified were clearly defined responsibilities; individualised risk assessments and breastfeeding plans; appropriate, but flexible, facility provision and access; signposting of relevant workplace accommodations; and physical fitness provisions.
CONCLUSIONS
Five recommendations are presented: development, implementation and evaluation of breastfeeding policy; universal workplace breastfeeding education; the need for breastfeeding risk assessments and plans based on individual breastfeeding practice; written minimal and ideal standards for breastfeeding facilities and access, which considers workplace locations; and exceptions from deployment and physical fitness testing.
Topics: Female; Humans; Breast Feeding; Military Personnel; Workplace; Risk Assessment
PubMed: 33593752
DOI: 10.1136/bmjmilitary-2020-001724