scholarly journals MON-583 Identifying Active Duty Military Meal Planning Preferences to Maximize Nutrition Therapy for Obesity

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Philip Clerc ◽  
Jana Wardian
Keyword(s):  
Medical Center ◽  
Smart Phone ◽  
Nutrition Therapy ◽  
Daily Basis ◽  
Active Duty ◽  
Service Members ◽  
Grocery Stores ◽  
Military Health ◽  
Meal Planning ◽  
Cooking Classes

Abstract INTRODUCTION: Obesity rates exceed 30% for active duty service members with vitals in the military health system electronic medical records. Although nutrition therapy is a cornerstone of treatment for all individuals with obesity, it is even more important in active duty service members, who have restrictions for obesity medications and are not eligible to receive bariatric surgery. Among nutrition therapy services, online nutritional cooking classes are the most desired intervention by patients at our institution. We currently do not have this resource available. The aim of this survey was to identify meal planning preferences among active duty service members to guide the development of online nutritional cooking classes. METHODS: Surveys were distributed to active duty service members and/or their spouses at San Antonio Military Medical Center and Wilford Hall Medical Center in the summer of 2019. Data included preferences for time spent cooking each meal, weekly grocery budget, meal size, batch cooking preference, available kitchen equipment, most common meals eaten, and desired features in an online nutritional cooking class. RESULTS: 141 surveys were collected, 77% of whom were active duty service members and 23% of whom were spouses of active duty service members. Most respondents stated they could spend 15 minutes or less on cooking breakfast (65%) and lunch (69%) on a daily basis. The majority of respondents (84%) were willing to batch cook. Half of respondents (50%) were willing to spend $100-$150 on food per week. Over 90% of respondents had to cook for a household of 4 people or less. Of respondents with children, 78% fed children the same meal that they cooked for themselves. About half of respondents had a food processor (55%) and an electronic pressure cooker (52%). Few respondents (14%) shopped for food at specialty grocery stores or farmer’s markets. Half of respondents (50%) preferred a 5–10 minute duration for each online nutritional cooking class. Of the many highly desired features for the classes, the option to watch on a smart phone was the most desired feature (97%). CONCLUSION: This sample of active duty service members and their spouses demonstrated a high degree of congruity for meal planning preferences and requested features for online nutritional cooking classes. Development of online nutritional cooking classes targeted to these preferences may lead to a higher success rate of nutrition therapy than current interventions. DISCLAIMER: The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its Components.

scholarly journals Total Joint Arthroplasty Volume in the Military Health System

2020 ◽  
Vol 185 (7-8) ◽  
pp. e1051-e1056
Author(s):  
Ashley B Anderson ◽  
George C Balazs ◽  
Daniel I Brooks ◽  
Jonathan F Dickens ◽  
Benjamin K Potter
Keyword(s):  
Health System ◽  
Total Joint Arthroplasty ◽  
Active Duty ◽  
Joint Arthroplasty ◽  
Service Members ◽  
Military Health System ◽  
Military Health ◽  
Male Patients ◽  
The Military ◽  
To Receive

ABSTRACT Introduction The relationship between volume and outcome of total knee arthroplasties is a concern in both the civilian and military patient populations. We sought to compare surgeons and hospital procedure volumes performed on military service members and define factors leading to increased civilian referrals. Materials and Methods The Military Health System Data Repository (MDR) contains patient information on all healthcare beneficiary encounters, including care provided both in Military Health System (MHS) facilities and in civilian network facilities. The Military Analysis and Reporting Tool (M2) queried the MDR for all patients between 2011 and 2015 with a CPT code for hip or knee arthroplasty associated with a provider HIPAA taxonomy code for orthopedic surgery. M2 enrollee encounters were used to calculate the total number of arthroplasty procedures performed by both military and civilian orthopedic surgeons on MHS enrollees as well as the incidence rate of arthroplasty procedures. Logistic regression was used to predict which cases were more likely to have been treated at military treatment facilities using patient gender, sponsor service branch, age, and beneficiary category. Results During the study period, a total of 12,627 military facility arthroplasty cases and a total of 142,637 civilian facility arthroplasty cases were performed on TRICARE enrolled patients. The total number of military surgeons performing arthroplasty on TRICARE enrolled patients was 323, while the total number of civilian surgeons performing arthroplasty was 10,245 during the same time period; the number of military surgeons performing arthroplasty on active duty patients was 176, and the total number of civilian surgeons performing arthroplasty on military patients was 1045. Overall, including retirees and activity duty service members, more procedures are performed by civilian network surgeons than military surgeons in all states. In an adjusted model, male patients were slightly more likely to receive care at an military treatment facilitie than female patients (OR = 1.47, 95% CI: 1.41–1.53). Furthermore, with respect to service, patients with Air Force (OR: 1.08, 95% CI: 1.02–1.15) and Navy sponsors (OR: 1.61, 95% CI: 1.51–1.71) were more likely to receive military care than patients with Army sponsors. Conclusions Based on our findings, we recommend the MHS focus attention to recapturing the Army active duty male patients who are more likely to receive care outside of the military healthcare network. Further analysis of the many factors including, but not limited to, referral process for total joint arthroplasty, time to procedure, and facility resources is required, in addition to assessing patient outcomes following the procedures.

scholarly journals Relationship Between Body Mass Index and Diagnosis of Obesity in the Military Health System Active Duty Population

2021 ◽  
Author(s):  
Daren Yang ◽  
Alexis Beauvais ◽  
Whitney L Forbes ◽  
Darrick Beckman ◽  
Jason Estes ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Health System ◽  
Body Mass ◽  
Military Service ◽  
Active Duty ◽  
Service Members ◽  
Data Repository ◽  
Military Health System ◽  
Military Health ◽  
The Military

ABSTRACT Objective The overall rate of obesity is rising in the USA; this is also reflected in the military population. It is important that providers appropriately diagnose obesity and discuss treatment options with their patients. The purpose of this study was to investigate diagnosis of obesity compared to documented body mass index (BMI) in the military health system. Methods Institutional review board approval was obtained by the 59th Medical Wing (Lackland Air Force Base, Texas) as an exempt study. This study included active duty military service members aged 18-65 years who sought outpatient care at a military treatment facility from September 2013 to August 2018 with a weight within the range of 31.8-226.8 kg and height between 121.9 and 215.9 cm. Data were collected from the Clinical Data Repository vitals and M2 encounter data to determine the percentage of each sub-population with a diagnosis of obesity according to BMI (≥30 kg/m2) and International Classification of Diseases diagnosis codes. Results Using BMI, 19.2% of female and 26.8% of male service members can be diagnosed with obesity; however, only 42.2% and 35.1%, respectively, with a BMI ≥30 was diagnosed as such. This discrepancy was consistent among all service branches and BMI ranges. Conclusion This study demonstrates that obesity is underdiagnosed compared to BMI. This may result in insufficient resources being provided to patients to reduce weight. Further investigation is warranted to identify causes of underdiagnosis and potential barriers to diagnosis.

Severe Drug-Induced Liver Injury in the Military: A Retrospective Review

2021 ◽  
Author(s):  
Sarah Ordway ◽  
Brett Sadowski ◽  
Kathryn E Driggers ◽  
Ryan Kwok
Keyword(s):  
Liver Injury ◽  
Medical Center ◽  
Active Duty ◽  
Service Members ◽  
Diagnostic Code ◽  
Military Population ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Toxic Liver Injury ◽  
The Military

ABSTRACT Objectives Drug-induced liver injury (DILI) is a significant cause of morbidity and mortality. Establishing a diagnosis is challenging due to the broad differential diagnosis of liver injury. We retrospectively reviewed patients with severe idiosyncratic DILI at Walter Reed National Military Medical Center in order to define the scope and patterns of injury in the military population. Methods Using the military health database, we identified a total of 110 patients who had an International Classification of Disease (ICD)-10 code for toxic liver injury in the electronic medical record at Walter Reed National Military Medical Center between 2016 and 2019. Each patient record was reviewed, and all pertinent data for included patients were recorded into a database for analysis. Results Twenty-seven out of 110 patients with a diagnostic code for toxic liver injury met inclusion criteria for severe idiosyncratic DILI. Nine cases were caused by supplements, including 5 active duty service members using synthetic anabolic steroids or preworkout supplements. The majority of patients were men and one-third were serving on active duty. The ranges of liver enzyme elevation and patterns of liver injury widely varied. Conclusion Military service members are at particularly high risk for DILI given the frequent use of over-the-counter and other unregulated strength- and performance-enhancing supplements. These injuries not only have significant medical consequences but can profoundly impact military readiness and mission capability. Diagnosis of DILI among active duty service members requires a strong index of suspicion, and inquiry regarding all ingestions is crucial. Educating physicians, providers, and policy makers on the risks of supplement-induced liver injury among service members is crucial. These data will facilitate additional studies exploring susceptibility to severe idiosyncratic DILI among the military population.

Characterization of Wrist Conditions in Active-Duty Service Members at a Major Medical Center: A Retrospective Review

2020 ◽  
Vol 74 (4_Supplement_1) ◽  
pp. 7411505258p1
Author(s):  
James Contessa ◽  
Brandon Stanely ◽  
Chelsea Truax ◽  
Jamie Bell ◽  
Brian Gregg ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Medical Center ◽  
Active Duty ◽  
Service Members ◽  
Major Medical Center

scholarly journals Common Symptoms of Mild Traumatic Brain Injury and Work Functioning of Active-Duty Service Members with a History of Deployment

2021 ◽  
Vol 18 (15) ◽  
pp. 8079
Author(s):  
Patrick Richard ◽  
Nilam Patel ◽  
Daniel Gedeon ◽  
Regine Hyppolite ◽  
Mustafa Younis
Keyword(s):  
Health System ◽  
Brain Injuries ◽  
Active Duty ◽  
Emergency Department Visits ◽  
Service Members ◽  
Data Repository ◽  
Work Functioning ◽  
Military Health System ◽  
Military Health ◽  
The Military

This study used data from the Military Health System Data Repository to examine the association between mild traumatic brain injuries (mTBI) and work functioning such as work duty limitations, hospital emergency room visits and inpatient admissions for active-duty service members (ADSMs). Further, this study assessed the role that common symptoms of mTBI play in work functioning. Multivariate results showed that having a mTBI diagnosis is not a major factor that results in being “released with work duty limitations”. However, findings from these regression models also showed that the interaction of mTBI with cognitive and linguistic symptoms resulted in odds of 3.63 (CI: 1.40–9.36, p < 0.01) for being “released with work duty limitations” and odds of 4.98 (CI: 1.16–21.39, p < 0.05) for having any emergency department visits compared to those with no diagnosis of mTBI and none of these symptoms. Additionally, the interaction of mTBI with sleep disturbance and chronic pain showed odds of 2.72 (CI: 1.31–5.65, p < 0.01) and odds of 11.56 (CI: 2.65–50.44, p < 0.01) for being “released with work duty limitations” compared to those with no diagnosis of TBI and none of these symptoms, respectively. Further research is needed to investigate the association between mTBI and duration of time off work to provide a comprehensive understanding of the effect of mTBI on work functioning in the Military Health System.

scholarly journals Opioid Use Patterns Among Active Duty Service Members and Civilians: 2006–2014

2017 ◽  
Vol 183 (3-4) ◽  
pp. e157-e164 ◽  
Author(s):  
William Kazanis ◽  
Mary J Pugh ◽  
Claudina Tami ◽  
Joseph K Maddry ◽  
Vikhyat S Bebarta ◽  
...  
Keyword(s):  
Health System ◽  
Forecast Model ◽  
Active Duty ◽  
Service Members ◽  
Opioid Use ◽  
Military Health System ◽  
Opioid Prescription ◽  
Military Health ◽  
Use Patterns ◽  
The Military

Abstract Introduction Between 2001 and 2009, opioid analgesic prescriptions in the Military Health System quadrupled to 3.8 million. The sheer quantity of opioid analgesics available sets the stage for issues related to misuse, abuse, and diversion. To address this issue, the Department of Defense implemented several directives and clinical guidelines to improve access to appropriate pain care and safe opioid prescribing. Unfortunately, little has been done to characterize changing patterns of opioid use in active duty service members (ADSM), so little is known about how combat operations and military health care policy may have influenced this significant problem. We examined changes in opioid use for ADSM between 2006 and 2014, compared trends with the civilian population, and explored the potential role of military-specific factors in changes in opioid use in the Military Health System. Materials and Methods After obtaining Institutional Review Board approval, administrative prescription records (Pharmacy Data Transaction Records) for non-deployed ADSM were used to determine the number of opioid prescriptions dispensed each year and the proportion of ADSM who received at least one prescription per month between 2006 and 2014. Based on the observation and the literature, we identified December 2011 as the demarcation point (the optimal point to identify the downturn in opioid use) and used it to compare opioid use trends before and after. We used an autoregressive forecast model to verify changes in opioid use patterns before and after 2011. Several interrupted time series models examined whether military system-level factors were associated with changes in opioid use. Results Between 2006 and 2014, 1,516,979 ADSM filled 7,119,945 opioid prescriptions, either in military treatment facilities or purchased through TRICARE. Both active duty and civilian populations showed signs of decreasing use after 2011, but this change was much more pronounced among ADSM. The forecast model showed a significant difference after 2011 between the projected and actual proportion of ADSM filling an opioid prescription, confirming 2011 as a point of divergence in opioid use. Interrupted time series models showed that the deflection point was associated with significant decreases. A significant increase of 0.261% in opioid prescriptions was seen for every 1,000 wounded in action service members in a given month. Troops returning from Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn did not appear to influence the rates of use. Even after accounting for returning troops from Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn and wounded in action counts, the deflection point was associated with a lower proportion of ADSM who filled an opioid prescription, leading to a decrease of 1.61% by the end of the observation period (December 2014). Conclusion After December 2011, opioid use patterns significantly decreased in both civilian and ADSM populations, but more so in the military population. Many factors, such as numbers of those wounded in action and the structural organization of the Military Health System, may have caused the decline, although more than likely the decrease was influenced by many factors inside and outside of the military, including policy directives and cultural changes.

Engaging Stakeholders to Optimize Sleep Disorders’ Management in the U.S. Military: A Qualitative Analysis

2021 ◽  
Author(s):  
Moaz Abdelwadoud ◽  
Jacob Collen ◽  
Hillary Edwards ◽  
C Daniel Mullins ◽  
Sophia L Jobe ◽  
...  
Keyword(s):  
Primary Care ◽  
Sleep Disorders ◽  
Structured Interview ◽  
Active Duty ◽  
Service Members ◽  
Military Health ◽  
Care Managers ◽  
Sleep Management ◽  
The Military ◽  
The U.S

ABSTRACT Introduction Sleep disorders’ are highly prevalent among U.S. active duty service members (ADSMs) and present well-documented challenges to military health, safety, and performance. In addition to increased need for sleep medicine services, a major barrier to effective sleep management has been a lack of alignment among patients, health providers, and economic-decision-makers. To address this gap in knowledge, the purpose of the present study was to engage diverse stakeholders vested in improving sleep disorders’ management in the military. Materials and Methods We elicited feedback from ADSMs with sleep disorders (five focus group discussion, n = 26) and primary care managers (PCMs) (11 individual semi-structured interview) in two military treatment facilities (MTFs) in the National Capitol Region, in addition to national level military and civilian administrative stakeholders (11 individual semi-structured interview) about their experiences with sleep disorders’ management in U.S. MTFs, including facilitators and barriers for reaching a definitive sleep diagnosis, convenience and effectiveness of sleep treatments, and key desired outcomes from interventions designed to address effectively sleep disorders in the U.S. military health care system (MHS). Recordings from focus groups and semi-structured interviews were transcribed verbatim and analyzed using QSR International’s NVivo 12 software using inductive thematic analysis. The study was approved by Walter Reed National Military Medical Center Department of Research Programs. Results Active duty service members with sleep disorders often fail to recognize their need for professional sleep management. Whereas PCMs identified themselves as first-line providers for sleep disorders in the military, patients lacked confidence that PCMs can make accurate diagnoses and deliver effective sleep treatments. Active duty service members cited needs for expeditious treatment, educational support and care coordination, and support for obtaining sleep treatments during deployment. Challenges that PCMs identified for effective management include insufficient time during routine care visits, delays in scheduling testing procedures, and limited number of sleep specialists. Primary care managers suggested offering evidence-based telehealth tools and enhanced care coordination between PCMs and specialists; standardized medical education, materials, and tools; patient preparation before appointments; self-administered patient education; and including behavioral sleep specialists as part of the sleep management team. For administrative stakeholders, key outcomes of enhanced sleep management included (1) improved resource allocation and cost savings, and (2) improved ADSM safety, productivity, and combat effectiveness. Conclusion Current military sleep management practices are neither satisfactory nor maximally effective. Our findings suggest that solving the military sleep problem will require sustained effort and ongoing collaboration from ADSM patients, providers, and health systems leaders. Important potential roles for telehealth and technology were identified. Future research should seek to enhance implementation of sleep management best practices to improve outcomes for patients, providers, MHS, and the military as a whole.

Development of a Functional Impairment Scale for Active Duty Service Members and Veterans

2009 ◽  
Author(s):  
Brian Marx ◽  
Paula Schnurr ◽  
Paola Rodriguez ◽  
Darren Holowka ◽  
Carole Lunney ◽  
...  
Keyword(s):  
Functional Impairment ◽  
Active Duty ◽  
Service Members
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