Results of a Military Family Medicine Scholarly Activity Training Needs Assessment.

INTRODUCTION: Scholarly activity among family medicine physicians is an important element of military medical readiness, both in terms of required scholarship during training and ongoing scholarship to address ongoing and emergent operational medical threats. Most literature on barriers to scholarly activity are limited to training programs and lack an important element in overcoming barriers-their priority to physicians. This study seeks to address these gaps by identifying prioritized research training needs of military family medicine physicians at all levels of training and practice. MATERIALS AND METHODS: An institutional review board (IRB)-approved, cross-sectional, online survey was conducted from January 22, 2019, to February 7, 2020, using a modified version of the Hennessy-Hicks Training Needs Analysis Questionnaire. Respondents ranked their perceived level of skill and need for training for 20 literature-based elements of research success. They also self-identified research experience, level of training, and service membership. One-way analysis of variance to 95% CI was used to compare differences in self-reported research experience, number of peer-reviewed publications, number of external grants, and number of IRB protocols among services (Army, Navy, and Air Force), primary roles (resident, faculty, clinician, and leadership), and gender. Chi-squared tests were used to compare proportional differences, also to 95% CI. RESULTS: Of 124 respondents, most were members of the Air Force (46%), Navy (24%), or Army (13%), serving in clinician (40%) or faculty (32%) roles. Most respondents (67%) reported three or fewer publications and had never been a primary investigator or co-investigator on an external grant. Of the 34 respondents who identified as a faculty at some point in their career, 26 (77%) reported two or more peer-reviewed publications, and 20 (59%) had fewer than six publications. The faculty had significantly more research experience and peer-reviewed publications than residents, clinicians, or leaders (3.92 vs 2.19, 2.24, and 3.40, respectively, P < .001, η2 = 0.22; 5.11 vs 1.13, 2.12, and 4.33, respectively, P < .001, η2 = 0.25). Gender differences in priority ranking were found, but each gender identified the same top three training needs. Among the top 10 training needs for scholarly activity for military family medicine physicians, 7 may be addressed with specific training modules: (1) obtaining funding/grants for research, (2) accessing research resources (e.g., research administrators and other staff, information, equipment, money, and time), (3) establishing a relationship with research mentors, (4) undertaking health promotion studies, (5) designing a research study, (6) writing reports of your research studies, and (7) using technical equipment, including computer software, to find and organize published research or prepare manuscripts. CONCLUSIONS: Knowledge of military family medicine physicians' prioritized research training needs enables a focused approach to support an essential component of military medical readiness: primary care scholarship. Addressing these needs may begin with raising awareness of military primary care research network resources. Furthermore, a coordinated effort to develop specific training modules to address needs and ongoing research to identify, target training by audience need, and prioritize needs as they change over time are indicated to ensure that military family medicine physicians maintain and develop a flourishing culture of scholarly engagement.

Operation Blood Rain: The Effect of Airdrop on Fresh Whole Blood.

BACKGROUND: Administration of fresh whole blood (FWB) is a life-saving treatment that prolongs life until definitive surgical intervention can be performed; however, collecting FWB is a time-consuming and resource-intensive process. Furthermore, it may be difficult to collect sufficient FWB to treat critically wounded patients or multiple-hemorrhaging casualties. This study describes the effect of airdrop on FWB and explores the possibility of using airdrop to deliver FWB to combat medics treating casualties in the prehospital setting when FDA-approved, cold-stored blood products are not readily available and timely casualty evacuation (CASEVAC) is not feasible. METHODS: Four units of FWB were collected from volunteer donors and loaded into a blood cooler that was dropped from a fixed-wing aircraft under a standard airdrop training bundle (SATB) parachute. A control group of 4 units of FWB was stored in a blood cooler that was not dropped. Baseline and postintervention laboratory samples were measured in both airdropped and control units, including full blood counts, prothrombin time/partial thromboplastin time/international normalized ratio (PT/PTT/INR), pH, lactate, potassium, indirect bilirubin, glucose, fibrinogen, lactate dehydrogenase, and peripheral blood smears. RESULTS: The blood cooler, cooling bags, and all 4 FWB units did not sustain any damage from the airdrop. There was no evidence of hemolysis. All airdropped blood met parameters for transfusion per the Whole Blood Transfusion Clinical Practice Guideline of the Joint Trauma System (JTS). CONCLUSIONS: Airdrop of FWB in a blood cooler with a SATB parachute may be a viable way of delivering blood products to combat medics treating hemorrhaging patients in the prehospital setting, although further research is needed to fully validate the safety of this method of FWB delivery.

Functional neurological disorder: A practical guide to an elusive Dx.

The complexity of this disorder poses a clinical challenge like few others.

A Case of Posterior Nutcracker Syndrome Revealed in the Aerospace Environment.

BACKGROUND: Nutcracker syndrome is caused by a rare anatomic variant where the left renal vein is trapped between the aorta and the superior mesenteric artery. Posterior nutcracker syndrome is an even rarer entity, characterized by the retro-aortic positioning of the renal vein, causing compression between the aorta and spinal vertebrae. Symptoms include microscopic or frank hematuria, flank pain, varicocele, pelvic congestion syndrome, and abdominal pain. A search of the literature did not reveal prior cases of nutcracker syndrome that became symptomatic and diagnosed secondary to the unique stressors of high gravitational force (G force) in the aviation environment.CASE REPORT: A 25-yr-old man training as an F-16 flight test engineer presented with left scrotal/testicular pain, varicocele, and intermittent gross hematuria. After an extensive workup, he was diagnosed with posterior nutcracker syndrome and underwent a left varicocele ligation with spermatic cord denervation. He was eventually able to be returned to flying duties with limitation to non-high performance aircraft.DISCUSSION: This case is particularly unique as its diagnosis was dependent on exposure to high G force conditions that may have otherwise remained asymptomatic without this environmental stressor. Education on the diagnosis of nutcracker syndrome as a differential in the setting of hematuria and pain is an important lesson learned. This case also illustrates the necessity of considering the effects of the stressful environment of high G force on even overall healthy individuals. Fortunately, due to the collaboration of medical-surgical expertise and familiarity with the requirements for operational readiness, this patient was able to resume his aviation career, albeit in a different capacity compatible with his condition.Chung CY, Lytle ME, Clemente Fuentes RW. A case of posterior nutcracker syndrome revealed in the aerospace environment. Aerosp Med Hum Perform. 2021; 92(1):5456.