Brooke Army Medical Center (BAMC) is the United States Army's premier medical institution. Located on Fort Sam Houston, BAMC, a 425-bed Academic Medical Center, is the Department of Defense's largest facility and only Level 1 Trauma Center. BAMC is also home to the Center for the Intrepid, an outpatient rehabilitation facility. The center is composed of ten separate organizations, including community medical clinics, centered around the Army's largest in-patient hospital. BAMC is staffed by more than 8,000 Soldiers, Airmen, Sailors, Civilians, and Contractors providing care to wounded Service Members and the San Antonio Community at-large.
Hyperthyroidism is a diagnosis existing along a spectrum of severity. Patients present with a variety of signs and symptoms: tachycardia, elevated heart rate, anxiety, changes in mental status, gastrointestinal disturbances, and hyperthermia. Management of subclinical hyperthyroidism and thyrotoxicosis without thyroid storm is heavily dependent on outpatient evaluation. Thyroid storm is the most severe form of hyperthyroidism with the highest mortality. Management of thyroid storm follows a stepwise approach, with resuscitation and detection of the precipitating cause being paramount. Special attention should be paid to cardiac function in patients with thyroid storm before treatment, as these patients may develop cardiac collapse.
Retirees and dependents represent demographically and clinically distinct beneficiary groups within the Military Health System (MHS). We assessed whether beneficiary status influences perioperative outcomes, healthcare utilization, and weight loss after bariatric surgery. We conducted a retrospective cohort study of adults undergoing sleeve gastrectomy or Roux-en-Y gastric bypass from 01/01/2022 to 12/31/2024 at a single military treatment facility. Outcomes were stratified by beneficiary status (retiree versus dependent). Propensity scores incorporating demographic, clinical, and procedural factors were used to construct overlap weights, yielding covariate balance comparable to randomized allocation. Overlap-weighted logistic and linear regression models assessed the independent association between beneficiary status and postoperative outcomes. Sex interaction terms evaluated effect modification. A female-only 1:1 propensity score-matched analysis served as a sensitivity analysis to address marked sex imbalance between groups. Among 281 patients, 123 (43.8
IntroductionThe United States Antarctic Program relies on a civilian-military partnership for medical evacuation (MEDEVAC). An attempt to comprehensively analyze US aeromedical evacuations from Antarctica, reconciling both civilian and Department of Defense records across multiple seasons, has not been described previously.MethodsWe retrospectively analyzed Antarctic MEDEVACs from 2015 to 2023 using United States Antarctic Program MEDEVAC records and Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) movement data. Deidentified aeromedical evacuation records involving a patient within/from Antarctica or labeled "Operation Deep Freeze" were obtained from the TRAC2ES database. National Science Foundation records were extracted in person at the University of Texas Medical Branch (UTMB). The authors extracted deidentified medical data, including medical history, diagnosis, medical treatments, destination, and enroute interventions. Datasets were reconciled using dates, origin/destination, diagnosis category, and narratives.ResultsSixty-nine TRAC2ES records and 93 UTMB records were included in the final analysis (n=162). Linkage identified 126 distinct movements: 36 cross-source matches, 33 TRAC2ES only, and 57 UTMB only. Patterns of MEDEVACs demonstrated austral-summer clustering with limited winter-over activity. The most common indication was musculoskeletal conditions (35 records), followed by gastrointestinal (18), genitourinary/reproductive (16), cardiac (15), neurologic (12), and respiratory (11) categories.ConclusionThis study suggests that the National Science Foundation, Department of Defense, and UTMB work cooperatively to transport patients with a wide variety of medical pathologies out of Antarctica. Dual-source reconciliation improves visibility across the evacuation continuum. Findings align with experience with disease nonbattle injuries in austere environments.
SIGNIFICANCE/BACKGROUND:Although research and evidence-based practice are widely regarded as foundational to high quality patient care, little is known about the evidence-based practice and research competencies of ambulatory care nurses. AIMS:The aim of this study was to measure the self-perceived evidence-based practice and research competencies and learning needs of ambulatory care nurses. METHODS:In 2024, a national sample of 2790 ambulatory care nurses participated in an online cross-sectional structured survey measuring evidence-based practice and research competencies. Respondents rated their competency using the EBP Capability Beliefs Scale and the Application of Knowledge and Skills subscale from the Research Competencies Assessment Instrument for Nurses (RCAIN). Results were compared across practice settings, job roles, and subspecialties. RESULTS/FINDINGS:Higher education levels correlated with higher scores in both evidence-based practice and research competencies. After controlling for education level, nurses from specialty or procedural areas scored higher in evidence-based practice competencies than nurses from all other work environments. Direct care nurses scored lower than nurses in all other roles in research competencies. Statistically significant correlations were also found between evidence-based practice competencies and the type of organization where a nurse worked. LINKING EVIDENCE TO ACTION:Findings indicate EBP and research competencies must be increased among ambulatory care nurses. Leadership support and resource allocation are critical for EBP development. Among ambulatory care nurses, those in direct care roles may have the greatest opportunities to develop EBP and research competencies. Nurses with limited exposure to EBP and research should be encouraged to engage in professional development activities on these topics. Education and EBP mentorship for ambulatory care nurses should be tailored to the ambulatory care environment where possible, to make it relatable to learners.
Rural and underserved communities continue to face barriers to timely and accurate healthcare due to shortages of specialists, limited diagnostic infrastructure, and geographic isolation. Artificial intelligence (AI)-driven diagnostic tools, including machine learning (ML) algorithms, telehealth platforms, and clinical decision support systems, have the potential to address these challenges. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Web of Science, and Embase were searched for studies published between January 2010 and April 2025 that evaluated AI-based diagnostic interventions in rural or low-resource settings. Findings were synthesized thematically to assess diagnostic performance, healthcare access, efficiency, and implementation factors. Twenty-six studies met the inclusion criteria, including observational studies, implementation case reports, and systematic reviews. Overall, AI tools were associated with improved diagnostic accuracy, reduced turnaround times, and enhanced access to services through mobile and telehealth applications. Commonly reported barriers included limited digital infrastructure, gaps in provider training, data privacy concerns, and regulatory uncertainty, while enabling factors included community trust, integration with existing health systems, and supportive policy environments. AI-driven diagnostics therefore show considerable promise for reducing inequities in rural healthcare, although successful implementation will require context-specific strategies, sustained infrastructure investment, and strong ethical and regulatory oversight.
