Zapobieganie chorobom psychicznym na szczeblu Korpusu

Paper delivered on December 19, 1945 at the Conference of Polish Military Physicians in Bologna [1,2]. The subject of the paper is prophylaxis of mental disorders in the 2nd Polish Corps in Italy, from the end of the war (May 1945) till the evacuation of the Corps to the United Kingdom (autumn 1946). Both organisation of the psychiatric support and preventive procedure rules for the most frequent forms of psychiatric and behaviour disorders are presented in the unique environment of the post‑war disarray, unclear political situation and uncertainty of the soldiers’ personal future. The role of the Centre for the Exhausted, forms of therapy, as well as non‑medical preventive strategies designed to reduce referrals to the psychiatric hospitals, evacuations to the rear and discharges from the armed forces are described. The paper, published in 1946 in the “Conference Proceedings” that was not widely available, fills the gap in knowledge on psychiatric prophylaxis in the Polish Armed Forces in the West and evokes doctor Konstanty Świder (1908–1965), a meritorious military psychiatrist, forgotten in the post‑war Poland. Both the original terminology and spelling were maintained in the reprint of the paper.

Military Medical Students’ Perspectives on Medical Education in the COVID-19 Era

ABSTRACT In response to the COVID pandemic, Uniformed Services University (USU) suspended clerkships. As the nation’s military medical school, USU had to keep students safe while still preparing them to be military physicians. In this commentary, we, a group of USU students, explore what this experience taught us about military medicine.

What do environment-related illnesses tell us about the character of military medicine and future clinical requirements?

Extreme environments present medical and occupational challenges that extend beyond generic resuscitation, to formulating bespoke diagnoses and prognoses and embarking on management pathways rarely encountered in civilian practice. Pathophysiological complexity and clinical uncertainty call for military physicians of all kinds to balance intuition with pragmatism, adapting according to the predominant patterns of care required. In an era of smaller operational footprints and less concentrated clinical experience, proposals aimed at improving the systematic care of Service Personnel incapacitated at environmental extremes must not be lost to corporate memory. These general issues are explored in the particular context of thermal stress and metabolic disruption. Specific focus is given to the accounts of military physicians who served on large-scale deployments into the heat of Iraq and Kuwait (Operation TELIC) and Oman (Exercise SAIF SAREEA). Generalisable insights into the enduring character of military medicine and future clinical requirements result.

COVID-19 Crisis: The Pandemic Highlights the Unique Training and Skills of Military Physicians Afforded by Military-Specific Graduate Medical Education

ABSTRACT Military physicians trained in military Graduate Medical Education programs are uniquely prepared to lead in austere and chaotic environments based on formal and informal curricula taught in military treatment facilities. The coronavirus disease-2019 pandemic highlighted this reality when military-trained physician leaders were challenged to lead change directly from the front.

Best Medical Advice: Providing Medical Leadership in Uncertain Times

ABSTRACT Military physicians must often balance medical and operational priorities when providing advice to operational commanders. This case describes how a Navy Medical Corps Officer serving with a Marine Corps helicopter squadron during the initial stages of the COVID-19 pandemic helped manage risk.

Use of Intranasal Analgesia in Military Setting: a French Cross Sectional Survey

Background For military physicians, practice in tactical and austere environments, particularly during deployments, requires optimized pain management. Several recent studies have shown a definite interest in the intranasal (IN) route for analgesia. Few published series show efficacy and variable times of action depending on the drug used (ketamine, sufentanil and fentanyl), with exceptional side effects. The aim of this study is to evaluate the medical practice of the French Military Health Service (FMHS) physicians.Methods We carried out a declarative and multicentric survey from January 15, 2020, to April 14, 2020. The surveyed population was the physicians of the FMHS, 727 working in medical units and 55 in emergency departments (EDs) in France and overseas. Results In all, 259 responses were collected, giving a 33% return rate; 77.6% of physicians reported being familiar with the IN route for analgesia. However, only 18.4% had already used it. Physicians trained in emergency medicine and assigned to highly operational units were more familiar with this route and used it more frequently. The most common drug used was ketamine (51%). Finally, 90% of respondents expressed an interest in training and use of intranasal analgesia. ConclusionsIf a majority of physicians from the FMHS are familiar with IN analgesia, only few use it in practice. Therefore, specific training is suitable to improve this knowledge and homogenize guidelines. Having been the subject of numerous studies in progress in civilian and military medicine, the IN route seems to be a promising solution for remote and austere environments.

Eumycetoma: A Perspective for Military Primary Care

ABSTRACT This is a case report of a 42-year-old woman who presented to a clinic with a history of progressive left foot and ankle swelling. She had a suspected history of myectoma, but had never been officially diagnosed despite repeated cultures and debridements over the course of decades. The inciting event occurred approximately 30 years prior in her home country of Belize. Her wound culture revealed Scedosporium apiospermum as the causative agent. Treatment included surgical debridement and oral antifungal therapy. This case represents an interesting adjunct to the differential diagnosis for military physicians, as mycetomas are prevalent in many of the areas where our forces are deployed and may only present after the service member has left active service because of its naturally indolent course.

A Methodology for Estimating the Cost of Educating Military Physicians at the Uniformed Services University

Introduction The Department of Defense (DoD) operates a large, multi-channeled physician accession pipeline to maintain a professional workforce of over 10,000 active duty physicians. The Uniformed Services University (USU) operates the nation’s only federal medical school providing trained doctors to the Army, Navy, Air Force, and Public Health Service. Although the school serves an essential purpose, policymakers question the cost of operating the University’s medical school. One challenge is to develop reproducible and transparent costing methods that can be used to evaluate the University’s value and efficiency. Methods This work proposes a replicable methodology for estimating the cost per student-year at USU. Using detailed data from USU encompassing facility use, budgeting and expenditures, and faculty and student rosters, we break out and attribute costs to the University’s component schools. Using faculty and staff time-use surveys, we further break out education-related personnel costs from other University activities such as research and service. We can then calculate the School of Medicine’s annual cost to educate a uniformed physician. Results In Fiscal Year 2017, it cost the DoD approximately $253,000 per year (more than $1 million dollars total over a 4-year curriculum) to directly educate a physician though the USU School of Medicine. Data from the following Fiscal Year show that education costs grew a modest 2.1% per student-year. Conclusions This work provides a foundational framework and approach to estimate the costs of accessioning a physician at USU. This methodology can be replicated for subsequent value analyses of physician accession and retention as budgetary pressures change to match the DoD operating environment. Uniformed Services University’s costs should be periodically reassessed against those of alternative accession sources.

“Road Rash” and Dizziness: A Case of Hemodynamically Significant Topical Clonidine Toxicity

ABSTRACT Clonidine is a central alpha-2 agonist well known to produce a syndrome of bradycardia and hypotension in overdose. However, few examples of overt clinical clonidine toxicity secondary to cutaneous absorption have been reported. We report a case of unintentional systemic clonidine toxicity in an adult because of a compounded preparation of clonidine applied to a degraded skin barrier. A 35-year-old male suffered a motorcycle accident 48 hours before presentation resulting in an abrasion to his distal left leg. On the day of presentation, he self-treated the wound by repeated application of a family member’s pain-relieving cream. Later he was found confused and unable to stand by a family member. The family member recognized the thick visible coat of cream as the likely cause and decontaminated the patient while calling 911. Prehospital vitals were notable for a blood pressure of 80/30 mm Hg and heart rate of 38 beats per minute. In the emergency department, the patient was resuscitated with intravenous fluids with resultant normalization of blood pressure. Upon later review, the cream was determined to have been created by a local compounding pharmacy for the use in neuropathic pain and was labeled to contain clonidine, lidocaine, ketamine, and gabapentin. Cutaneous absorption of the pain cream was greatly increased because of loss of skin integrity. Military physicians and compounding pharmacies should ensure that patients are aware of the proper application of compounded creams and the potential risk for systemic toxicity with overuse or degraded skin.