scholarly journals Adapting Mindfulness Training for Military Service Members With Chronic Pain

2019 ◽  
Vol 185 (3-4) ◽  
pp. 385-393 ◽  
Author(s):  
Carrie E Brintz ◽  
Shari Miller ◽  
Kristine Rae Olmsted ◽  
Michael Bartoszek ◽  
Joel Cartwright ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Training Program ◽  
Healthcare Providers ◽  
Active Duty ◽  
Mindfulness Training ◽  
Adaptation Process ◽  
Intervention Protocol ◽  
Military Healthcare ◽  
Military Veteran ◽  
The Military

Abstract Introduction Rates of chronic pain in military personnel are disproportionately high. Chronic pain is often associated with mental health and substance use disorders as comorbid conditions, making treatment of chronic pain complex. Mindfulness-based interventions (MBIs) are a promising behavioral approach to managing chronic pain and psychosocial sequelae. The unique nature of the military context may require adaptations to original MBIs for successful delivery in active-duty military populations. This study adapted the mindfulness-based stress reduction (MBSR) program to create a mindfulness training program that was relevant to active-duty Army personnel experiencing chronic pain. This article delineates the adaptation process employed to modify the MBSR program to the military context and discusses the resulting training program. Materials and Methods The adaptation process consisted of three iterative stages: 1) Drafting the preliminary intervention protocol with recommendations from stakeholders, including military healthcare providers; 2) Refining the preliminary protocol after pretesting the sessions with research team members and a military Veteran advisory committee; and 3) Delivering the preliminary protocol to one cohort of active-duty Soldiers with chronic pain, collecting feedback, and further refining the intervention protocol. Results Military-related adaptations to MBSR addressed three areas: military culture, language and terminology, and practical and logistical factors relevant to implementation in the military setting. This adaptation process resulted in a live, online program with six, weekly, sessions. Feedback from a military Veteran advisory committee resulted in modifications, including increasing military-relevant examples; preliminary testing with the target population resulted in additional modifications, including shortening the sessions to 75 min and structuring discussions more efficiently. Conclusions The adaptation process was successful in generating an engaging mindfulness training program that was highly relevant to the military context. Obtaining input from stakeholders, such as military healthcare providers and active-duty soldiers, and iterative feedback and modification, were key to the process. Moreover, the program was designed to maintain the integrity and core elements of MBIs while adapting to military culture. A future randomized controlled trial design will be used to evaluate the effectiveness of the intervention in improving chronic pain in military personnel. This program is responsive to the military’s call for nonpharmacologic treatments for chronic pain that are easily accessible. If effective, the mindfulness program has the potential for widespread dissemination to complement standard care for Service Members experiencing chronic pain.

scholarly journals Military Healthcare Providers' Knowledge and Comfort Regarding the Medical Care of Active Duty Lesbian, Gay, and Bisexual Patients

LGBT Health ◽  
2018 ◽  
Vol 5 (1) ◽  
pp. 86-90 ◽  
Author(s):  
Caitlyn M. Rerucha ◽  
Lloyd A. Runser ◽  
Juliana S. Ee ◽  
Elizabeth G. Hersey
Keyword(s):  
Medical Care ◽  
Healthcare Providers ◽  
Active Duty ◽  
Military Healthcare ◽  
And Bisexual

scholarly journals The changing landscape of military medical malpractice: from the Feres Doctrine to present

2020 ◽  
Vol 49 (5) ◽  
pp. E7
Author(s):  
Callum D. Dewar ◽  
Jason H. Boulter ◽  
Brian P. Curry ◽  
Dana M. Bowers ◽  
Randy S. Bell
Keyword(s):  
Medical Malpractice ◽  
Healthcare Providers ◽  
Supreme Court Decision ◽  
The United States ◽  
United States Government ◽  
National Defense ◽  
Military Healthcare ◽  
Active Duty Personnel ◽  
The Military ◽  
First Time

Medical malpractice suits within the military have historically been limited by the Feres Doctrine, a legal precedent arising from a Supreme Court decision in 1950, which stated that active-duty personnel cannot bring suit for malpractice against either the United States government or military healthcare providers. This precedent has increasingly become a focus of discussion and reform as multiple cases claiming malpractice have been dismissed. Recently, however, the National Defense Authorization Act of 2020 initiated the first change to this precedent by creating an administrative body with the sole purpose of evaluating and settling claims of medical malpractice within the military’s $50 billion healthcare system. This article seeks to present the legal history related to military malpractice and the Feres Doctrine as well as discuss the potential future implications that may arise as the Feres Doctrine is modified for the first time in 70 years.

scholarly journals Effect of Using an Exercise and Nutrition Secure Email Message on the Implementation of Health Promotion in a Large Health Care System

2019 ◽  
Vol 17 (2) ◽  
pp. 62-66
Author(s):  
Travis M. Combest ◽  
Allison Howell ◽  
Harjinder Kumar ◽  
Samer Koutoubi ◽  
Karen Cieslewicz ◽  
...  
Keyword(s):  
Health Promotion ◽  
Medical Information ◽  
Healthcare Providers ◽  
Overweight And Obesity ◽  
Portion Sizes ◽  
Military Healthcare ◽  
Secure Email ◽  
Email Message ◽  
The Military ◽  
Health Promotion Message

Background and Program: Secure email messaging is used to provide timely communication between healthcare providers and patients with medical information and education. There have been increasing rates of overweight and obesity among military healthcare patients. To address this issue, we utilized a secure email messaging system that is primarily used for medication refills. This commentary demonstrates the extent to which the message was viewed and how much the message was liked. Preliminary Results: Of the 16,020 individuals emailed, 7,011 participants (43.8%) opened the email, and 1,023 patients (14.6% of those who opened it) completed the survey. Satisfaction rate for the health promotion message was 77.2%. Participants reported an intent to eat more fruit and vegetables (49.6%), decrease portion sizes (38.8%), and increase physical activity (51.1%), while 33.6% reported having no intent to change. Conclusion: The majority were satisfied with the health promotion message. This email method enables a single provider to have increased contact with patients. It is unknown if this message reached higher risk or harder to reach participants, a patient subset that could benefit most from this type of communication. This study is unique in that to our knowledge it is the first one to use secure email messaging in the military healthcare system for health promotion.

Health and Service-related Impact of Sexual and Stalking Victimization During United States Military Service on LGBT Service Members

2020 ◽  
pp. 088626052097031
Author(s):  
Cary Leonard Klemmer ◽  
Ashley C. Schuyler ◽  
Mary Rose Mamey ◽  
Sheree M. Schrager ◽  
Carl Andrew Castro ◽  
...  
Keyword(s):  
United States ◽  
Military Service ◽  
The United States ◽  
Active Duty ◽  
Service Members ◽  
United States Military ◽  
Service Outcomes ◽  
Study Participants ◽  
The Military ◽  
Stalking Victimization

Prior research among military personnel has indicated that sexual harassment, stalking, and sexual assault during military service are related to negative health sequelae. However, research specific to LGBT U.S. service members is limited. The current study aimed to explore the health, service utilization, and service-related impact of stalking and sexual victimization experiences in a sample of active-duty LGBT U.S. service members ( N = 248). Respondent-driven sampling was used to recruit study participants. U.S. service members were eligible to participate if they were 18 years or older and active-duty members of the U.S. Army, U.S. Navy, U.S. Marine Corps, or U.S. Air Force. This study included a sizeable portion of transgender service members ( N = 58, 23.4%). Sociodemographic characteristics, characteristics of military service, health, and sexual and stalking victimization in the military were assessed. Regression was used to examine relationships between health and service outcomes and sexual and stalking victimization during military service. Final adjusted models showed that experiencing multiple forms of victimization in the military increased the odds of visiting a mental health clinician and having elevated somatic symptoms, posttraumatic stress disorder symptomatology, anxiety, and suicidality. Sexual and stalking victimization during U.S. military service was statistically significantly related to the mental and physical health of LGBT U.S. service members. Interventions to reduce victimization experiences and support LGBT U.S. service members who experience these types of violence are indicated. Research that examines the role of LGBT individuals’ experiences and organizational and peer factors, including social support, leadership characteristics, and institutional policies in the United States military is needed.

scholarly journals Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rachel Sayko Adams ◽  
Esther L. Meerwijk ◽  
Mary Jo Larson ◽  
Alex H. S. Harris
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Chronic Pain ◽  
Veterans Health Administration ◽  
First Year ◽  
Veterans Health ◽  
Health Administration ◽  
Military Health System ◽  
Military Health ◽  
The Military

Abstract Background Chronic pain presents a significant burden for both federal health care systems designed to serve combat Veterans in the United States (i.e., the Military Health System [MHS] and Veterans Health Administration [VHA]), yet there have been few studies of Veterans with chronic pain that have integrated data from both systems of care. This study examined 1) health care utilization in VHA as an enrollee (i.e., linkage to VHA) after military separation among soldiers with postdeployment chronic pain identified in the MHS, and predictors of linkage, and 2) persistence of chronic pain among those utilizing the VHA. Methods Observational, longitudinal study of soldiers returning from a deployment in support of the Afghanistan/Iraq conflicts in fiscal years 2008–2014. The analytic sample included 138,206 active duty soldiers for whom linkage to VHA was determined through FY2019. A Cox proportional hazards model was estimated to examine the effects of demographic characteristics, military history, and MHS clinical characteristics on time to linkage to VHA after separation from the military. Among the subpopulation of soldiers who linked to VHA, we described whether they met criteria for chronic pain in the VHA and pain management treatments received during the first year in VHA. Results The majority (79%) of soldiers within the chronic pain cohort linked to VHA after military separation. Significant predictors of VHA linkage included: VHA utilization as a non-enrollee prior to military separation, separating for disability, mental health comorbidities, and being non-Hispanic Black or Hispanic. Soldiers that separated because of misconduct were less likely to link than other soldiers. Soldiers who received nonpharmacological treatments, opioids/tramadol, or mental health treatment in the MHS linked earlier to VHA than soldiers who did not receive these treatments. Among those who enrolled in VHA, during the first year after linking to the VHA, 49.7% of soldiers met criteria for persistent chronic pain in VHA. Conclusions The vast majority of soldiers identified with chronic pain in the MHS utilized care within VHA after military separation. Careful coordination of pain management approaches across the MHS and VHA is required to optimize care for soldiers with chronic pain.

scholarly journals An Analysis of International Military Health Systems Using the Military Medical Corps Worldwide Almanac

2020 ◽  
Author(s):  
Ryan M Leone ◽  
Zenobia Homan ◽  
Antonin Lelong ◽  
Lutz Bandekow ◽  
Martin Bricknell
Keyword(s):  
Health Systems ◽  
Organizational Structures ◽  
Healthcare Systems ◽  
Medical Community ◽  
Medical Services ◽  
Medical Systems ◽  
Military Health ◽  
Military Healthcare ◽  
The Military

Abstract Introduction A number of organizations publish comparisons of civilian health systems between countries. However, the authors were unable to find a global, systematic, and contemporary analysis of military healthcare systems. Although many databases exist for comparing national healthcare systems, the only such compilation of information for military medical systems is the Military Medical Almanac. A thorough review of the Almanac was conducted to understand the quality of information provided in each country’s profile and to develop a framework for comparing between countries. This information is valuable because it can facilitate collaboration and lesson sharing between nations while providing a structured source of information about a nation’s military medical capabilities for internal use. Materials and Methods Each of the 142 profiles (submitted by 132 countries) published in the Almanac were reviewed. The information provided was extracted and aggregated into a spreadsheet that covered the broader categories of country background, force demographics, beneficiary populations, administration and oversight, physical structures and capabilities, research capabilities, and culture and artifacts. An initial sample of 20 countries was evaluated to test these categories and their subsections before the rest of the submissions were reviewed. Clear definitions were revised and established for each of the 69 subcategories. Qualitative and quantitative data were compiled in the spreadsheet to enable comparisons between entries. Results Significant variation was found in how information was presented in country profiles and to what extent this was comparable between submissions. The most consistently provided information was in the country background, where the categories ranged from 90.15% to 100% completion across submissions. There was inconsistency in reporting of the numbers and types of healthcare workers employed within military medical services. Nearly 25% of nations reported providing medical care to family members of service members, but retirees, veterans, reservists, and law enforcement personnel were also mentioned. Some countries described organizational structures, military medical education institutions, and humanitarian operations. A few reported military medical research capabilities, though each research domain was present in 25% or less of all submissions. Interestingly, cultural identities such as emblems were present in nearly 90% of profiles, with many countries also having badges, symbols, and mottos. Conclusions The Military Medical Almanac is potentially a highly valuable collection of publicly available baseline information on military medical services across the world. However, the quality of this collection is highly dependent on the submission provided by each country. It is recommended that the template for collecting information on each health system be refined, alongside an effort to increase awareness of the value of the Almanac as an opportunity to raise the international profile of each country’s military medical system. This will ensure that the Almanac can better serve the international military medical community.

Evolution of Ray's Theory of Bureaucratic Caring

2021 ◽  
Vol 25 (3) ◽  
pp. 159-175
Author(s):  
Marilyn A. Ray
Keyword(s):  
Healthcare System ◽  
Well Being ◽  
Theoretical Development ◽  
Military Healthcare ◽  
The Military ◽  
Health And Well Being ◽  
Military Healthcare System ◽  
Holistic Science ◽  
Ethical Caring ◽  
Bureaucratic Organizations

An overview and evolution of caring and the theory of bureaucratic caring and interpretations of its central categories are described. Data and models representing its theoretical development, the concept of bureaucracy, and emergence of the theory as a holographic theory are included. Central tenets in the new sciences are explored along with Bohm's corresponding ideas of explicate and implicate orders (holistic science) and spiritual-ethical caring. The theory has broad implications for increasing the knowledge of caring inter-professionally, improving the health and well-being of people, and transforming healthcare bureaucratic organizations nationally and globally, with application in the military healthcare system.

What Would it Take to Put a Chiropractor in Khakis? Effecting Chiropractors as Commissioned Officers in the U.S. Military—A Historical Brief

2021 ◽  
Author(s):  
James P Barassi
Keyword(s):  
Military Medicine ◽  
Active Duty ◽  
Health Care Facilities ◽  
Musculoskeletal Injuries ◽  
Government Employees ◽  
Care Facilities ◽  
Medical Service Corps ◽  
The Military ◽  
Veteran Health Care ◽  
The U.S

ABSTRACT The purpose of this article is to provide a historical perspective on the commissioning of chiropractors within the U.S. Military and to propose a pathway by which this can be accomplished. A comprehensive review of Congressional actions proposed and enacted, and historical documents to create a chronology of actions that influence and support a proposed pathway for commissioning. The authority to commission chiropractors within the U.S. Military has long been provided to the Secretary of Defense, but it has never been acted upon despite decades of legislation. Chiropractors currently serve within the DoD as contractors or government employees; however, the direct association with the military in terms of commissioning has remained elusive. Musculoskeletal injuries are statistically one of the most prevalent combat-related injury classifications within the active duty military and subsequent veteran population. Chiropractic physicians serving within military medicine and veteran health care facilities routinely manage common and complex neurological and musculoskeletal injuries sustained by combat and non-combat servicemen and women. Patient satisfaction with chiropractic services within both the active duty and veteran population is high and routinely sought after. Chiropractic inclusion in the medical corps or medical service corps within the DoD is long overdue.

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