The Sum is Greater Than the Parts: Aligning Graduate Allied and Medical Health Education at a Training Institution.

Analysis of military Graduate Medical Education (GME) remains in the discussion forefront as resources continue to face scrutiny along with military-specific obligation challenges. The Military Health System Quadruple Aim of Better Care, Better Health, Lower Cost, and Increased Readiness continues to drive debate of the right approach to both GME and Graduate Allied Health education. In this paper, we expand the discussion beyond traditional physician-focused GME and include the military's highly trained allied health specialists. Graduate Allied Health medical providers provide quality and effective medical care to the military's service members and dependents. These specialists also carry a significant deployment and operational medicine footprint complimenting core physician medical specialties delivering cost-efficient, optimal patient care and providing a ready force. This paper addresses GME and GAH interprofessionalism, institutional culture endorsement, patient safety, increasing demand, research productivity, and encouraging physician retention altogether benefiting the Military Health System. This institution's support for the interprofessional GME model works well, expanding physician and GAH specialists' professional application and knowledge while garnering mutual respect across all medical disciplines ultimately benefiting all.

The Impact of Graduate Medical Education on Scholarly Activity at a Military Medical Treatment Facility.

INTRODUCTION: Graduate medical education (GME) faculty and trainees have required scholarly activities to meet accreditation requirements. The impact of this contribution to the Military Health System, especially regarding innovations in military medicine, has not been previously examined. This study measured the contribution of GME in published manuscripts from a tertiary military medical center. MATERIALS AND METHODS: Utilizing the Scopus database, published manuscripts from the primary military GME institutions for the San Antonio Uniformed Services Health Education Consortium were identified from 2008 to 2018. Manuscripts were sorted based on the number of citations in Scopus and analyzed for their overall impact in medicine to include military unique topics. RESULTS: A total of 3,700 manuscripts were identified through Scopus and based on a 10 citation minimum, 1,365 manuscripts were further analyzed; 1,152 (84.4%) included authors with GME affiliation and 554 (40.6%) had direct applicability to unique aspects of military medicine. The mean number of citations per manuscript was 39.2 ± 63.6; Mean Cite Score was 2.97 ± 2.14 and Field Weighted Citation Index of 2.22 ± 3.27. Analysis of number of citations (10-19; 20-39; or >40) did not show any significant differences in Cite Score or military relevance, whereas the percentage of military relevant articles remained consistent yearly. CONCLUSIONS: These findings highlight the importance of military medical research and addressing specific medical needs of the warfighter. Graduate medical education in a tertiary Military Health System facility has enormous impact in scholarly activity, in particular the importance related to military medicine topics that emphasize combat casualty care and military readiness.

Youngest presenting patient with dystonia 24 and review of the literature.

Dystonia 24 was first reported in 2000 as an autosomal dominant cause of dystonia caused by variants in the ANO3 gene. Although many adults have been described with dystonia 24, since 2014, an increasing number of children have also been reported. Dystonia 24 should also be considered in the differential of a child with unexplained dystonia.

Group Education and Multidisciplinary Management for Chronic Headaches Among Adolescents in a Military Treatment Facility: A Retrospective Chart Review.

OBJECTIVE: To assess the effect of group education on the frequency of chronic headaches among adolescents. BACKGROUND: Chronic headaches are a common problem among adolescents with significant psychosocial morbidity. Brief education on lifestyle interventions to decrease headache frequency has established benefits among adult patients but is less proven among adolescents. METHODS: This study is a chart review examining our experience with a group education program for 155 adolescents, aged 12-17 years old, enrolled in the U.S. military medical system with at least 3 months of chronic headaches who were referred to a headache evaluation clinic. The primary outcome of our study was self-reported number of days with a headache in the previous 30 days based on patient recall. We used a paired samples t-test to measure the change in headache frequency between the frequency reported at the headache class and follow-up more than 6 months after the class. RESULTS: Most of the adolescents seen in the program were female (114/155 [73.5%]) and suffered from migraine headaches (108/155 [69.8%]). Severe headache-related disability was reported by 40.6% of subjects (63/155). Subjects reported an average of 19 days with headache during the previous 30 days. Females and patients with higher headache-related disability reported a higher number of days with headache. Participation in the group education was associated with an 11.5 (SD 11.9, P < .001) day decrease in the frequency of headaches during the previous 30 days at follow-up at least 6 months after the class, with largest decline seen in patients with the highest level of migraine-related disability at baseline. CONCLUSION: Based on our retrospective chart review study, group education on headache evaluation and lifestyle management has potential as an effective, low-cost intervention for treatment of chronic headaches among adolescents.

Increased Intracranial Pressure in a Boy with Gorham-Stout Disease.

Gorham-Stout disease (GSD), also known as vanishing bone disease, is a rare disorder, which most commonly presents in children and young adults and is characterized by an excessive proliferation of lymphangiomatous tissue within the bones. This lymphangiomatous proliferation often affects the cranium and, due to the proximate location to the dura surrounding cerebrospinal fluid (CSF) spaces, can result in CSF leaks manifesting as intracranial hypotension with clinical symptoms to include orthostatic headache, nausea, and vertigo. We present the case of a boy with GSD and a known history of migraine headaches who presented with persistent headaches due to increased intracranial pressure. Although migraine had initially been suspected, he was eventually diagnosed with intracranial hypertension after developing ophthalmoplegia and papilledema. We describe the first known instance of successful medical treatment of increased intracranial pressure in a patient with GSD.

Evaluation of a real-time fluorescent PCR assay for rapid detection of Group B Streptococci in neonatal blood.

Streptococcus agalactiae (Group B Streptococcus: GBS) is the major causative agent of neonatal sepsis. Neonates at risk for GBS infections are empirically administered broad-spectrum antibiotics for at least 48 h pending blood culture results. A rapid assay to expedite detection of GBS would facilitate initiation of specific antibiotic therapy. Conversely, expeditious proof of absence of infection will avoid unnecessary antibiotic use. Using the LightCycler, we evaluated a hybridization probe polymerase chain reaction (PCR) assay to detect GBS-specific cfb gene target DNA sequence in blood specimens. Both sensitivity and specificity of the real-time PCR assay was 100%. The assay demonstrated 100% specificity when tested against 26 non-GBS bacteria. This method is capable of detecting as few as approximately 100 copies or 10 pg of GBS genomic DNA. This real-time PCR method is rapid, sensitive, and specific for the detection of GBS in neonatal blood samples and holds great promise in its utility in the diagnostic laboratory.