INTRODUCTION:Adjustment disorder is the most prevalent mental health diagnosis in the U.S. military, significantly impacting readiness. There has been a longstanding lack of diagnostic clarity for adjustment disorder; however, recent shifts in diagnostic classification have led to new adjustment disorder assessment tools like the ADNM-20-MIL, designed for military use. The perceived impact and acceptability of such a tool has yet to be assessed in those providing healthcare to U.S. service members. This study used the theory of planned behavior to examine predictors of U.S. military healthcare provider's intent to use the ADNM-20-MIL. MATERIALS AND METHODS:We used a theory of planned behavior-based questionnaire to study the role of providers' (N = 60) attitudes, subjective norms, and perceived behavioral control in predicting their intent to use the proposed ADNM-20-MIL tool in clinical practice. RESULTS:The overall model shows significant fit, indicating the 3 constructs of the theory of planned behavior do impact a provider's intention to use the ADNM-20-MIL in their practice. Attitudes significantly influenced providers' intention to use the ADNM-20-MIL, while subjective norms and perceived behavioral control provided little additional predictive value beyond attitudes alone in this sample. CONCLUSIONS:Study findings indicate that providers' attitudes will drive their intention to incorporate the ADNM-20-MIL into their practice. Integration of this tool into the Military Health System could strengthen standardized assessment and monitoring of adjustment disorder, and bring it in line with the assessment practices established for other common mental health disorders.
INTRODUCTION:Musculoskeletal injuries (MSKIs) are the most common cause of medical discharge from military service, with most directly attributable to physical training and arduous occupational tasks. MSKIs affect (but not limited to) muscles, bones, joints, tendons, ligaments, and/or cartilage. A high proportion of military MSKIs are overuse injuries occurring in the lower limbs. Because of the impact of MSKIs on personnel and the organization, it is imperative that methods of identifying at risk personnel are developed, refined, and implemented. Biomarkers are used within clinical and research settings as indicators or surrogate measures of damage to target tissue. Furthermore, biomarkers can offer an objective insight into MSKIs risk rather relying on self-report methods, which are often reported too late. Numerous risk factors for MSKIs have been identified, several of which represent modifiable health behaviors and therefore may provide targets for intervention. The potential effects of these behaviors on biomarkers may provide a means of identifying those at increased risk or susceptibility to MSKIs, informing early intervention. This review aimed to identify specific and sensitive biomarkers of bone and soft-tissue damage/injury and examines potential associations between biomarker and modifiable health behaviors. MATERIALS AND METHODS:A scoping review was undertaken to assess published evidence of current biomarkers used to assess tissue damage, and potential mechanisms by which changes in health behaviors may ameliorate bone/soft-tissue injuries, within military populations. Following the PRISMA ScR guidelines, relevant literature was identified in peer-reviewed journals that met the following criteria: (1) healthy adults aged between 16 and 60 years with/without work-related MSKIs/disorders; (2) population included military personnel or athletes; (3) studies reporting associations between biomarker of bone or soft-tissue health/injury and presence of bone/soft-tissue injury or medical imaging; (4) study is written in English (Abstract or Structured Summary). RESULTS:A total of 2,973 articles were identified from the initial database search and, after removing duplicates, 2,291 studies were screened. Among these, 33 publications met the eligibility criteria and included in analyses. The review encompasses studies published from 2003 onwards. Most studies were observational prospective cohort studies. The most prevalent biomarker associated with variables of MSKIs, particularly stress fracture risk, was vitamin D (or substrate of vitamin D), which was analyzed in 22 of the identified studies. CONCLUSIONS:This review highlights a range of potential biomarkers for use in military populations, however, it also demonstrates that these biomarkers are often assessed within sub-optimal study designs and often only in relation to stress fracture occurrence. This could have contributed to limited significant associations between biomarker concentration and MSKIs outcomes. The most commonly used biomarker of bone health was vitamin D. The review highlights the importance of contextual factors such as seasonality, sleep status, training load, and smoking status, which can influence biomarker concentrations. Thus, the importance of standardizing biomarker sample collection methods and analyses, as well as measuring other factors affecting biomarker concentrations is discussed. Some studies directly assessed associations between biomarker concentrations and MSKIs outcomes, these were often not the primary purpose of the studies reviewed.
INTRODUCTION:Following the immediate application of the principles of Tactical Combat Casualty Care (TCCC), Damage Control Resuscitation (DCR) is central to reducing preventable death in large-scale combat operations (LSCO), particularly where evacuation to damage control surgical capability is delayed. Beginning in 2023, the College of Remote and Offshore Medicine (CoROM) and Tactical Medicine North (TacMed North) implemented the Damage Control Resuscitation Ukraine (DCR-U) course to upskill Ukrainian frontline medics across the continuum from point of injury through prolonged casualty care (PCC). An initial report described the summer 2024 iteration. This article traces the pedagogical and clinical evolution of the program through subsequent iterations in December 2024 and November 2025, with a focus on integrating prolonged care best practices, the lethal diamond of trauma, and nursing-centric frameworks. MATERIALS AND METHODS:We conducted a narrative program evaluation using triangulated qualitative data from structured after-action reviews (AARs), faculty field notes, participant feedback, and curriculum documents. A mixed civilian-military approach was applied. The analysis examined changes across 3 domains: (1) curriculum content and time allocation, (2) pedagogy and assessment strategy, and (3) integration of clinical governance and national standards. Iterative modifications were mapped against Joint Trauma System (JTS) Clinical Practice Guidelines (CPGs), the Prolonged Care textbook, and the Prolonged Field Care (PFC) Field Handbook. RESULTS:Over 3 iterations, the program recorded 104 course completions: 94 main-course learner completions across 6 cohorts and 10 additional train-the-trainer completions. Across successive curriculum phases, DCR-U shifted from a primarily procedure-focused format to a longitudinal, systems-based curriculum emphasizing (a) the lethal diamond (hypothermia, acidosis, coagulopathy, and hypocalcemia), (b) 6-72-hour prolonged care planning, and (c) structured nursing frameworks (HITMAN/SHEEPVOMIT) for trend-based decision-making. Local Ukrainian instructors progressively assumed leadership of skills stations and much of the didactic teaching, supported by international faculty in advisory roles. HITMAN and SHEEPVOMIT became the default assessment and nursing mnemonics for simulated cases, linking tactical decisions to physiologic trends and nursing tasks. The course increasingly targeted mid-level providers and unit-level trainers, embedding a train-the-trainer model for scalability. CONCLUSIONS:The evolution of DCR-U from 2023 to 2025 illustrates how DCR training in LSCO can be reframed as a prolonged care and clinical governance intervention rather than a stand-alone skills course. Embedding lethal-diamond resuscitation concepts, PFC nursing mnemonics, and national CPGs allowed Ukrainian partner forces to contextualize DCR within their emerging standards, while the progressive localization of instruction supports sustainability. Future work should formalize pre-course competency benchmarks, longitudinal outcome measurement, and integration with Ukraine's national prehospital training standards.
INTRODUCTION:Accurate and comprehensive medical documentation is essential to safe, effective patient care, particularly in austere environments where patients transition rapidly between teams, locations, and levels of capability. In Role 2 environments, where casualties move from point of injury through damage control resuscitation, surgery, and prolonged casualty care, information loss during transitions poses a persistent threat to patient safety. Despite the existence of Joint Trauma System (JTS) Clinical Practice Guidelines and standardized documentation tools, variability in documentation practices persists within Role 2 settings. This quality improvement (QI) project sought to evaluate whether targeted documentation and handoff training could improve self-reported provider confidence and documentation performance during a simulated operational exercise. MATERIALS AND METHODS:This 2-part QI initiative was conducted within a Role 2 military medical unit preparing for a battalion-level certification exercise. Part I consisted of targeted training for providers, nurses, and corpsmen on JTS documentation requirements and structured handoff tools (MIST, I-PASS, SBAR). Participants completed pre- and post-training surveys assessing self-reported ability and confidence across 4 competency domains. Part II evaluated documentation during a 5-day field exercise. A stratified random sample of 55 simulated casualty charts (of 100 total) was audited using a structured tool aligned with JTS key performance indicators to assess completeness, accuracy, and clinical relevance. Descriptive statistics were used to summarize findings. The project was reviewed and determined to meet criteria for quality improvement rather than human subjects research. RESULTS:Forty-four personnel participated in the training intervention. Self-reported confidence and perceived ability improved significantly across all 4 domains (P < .05), with the largest improvement observed in participants' ability to identify and mitigate documentation and handoff errors. During the certification exercise, overall documentation compliance was 51%, and overall JTS compliance was 56%. Frequent deficiencies included missing reassessment vital signs, incomplete allergy documentation, absent provider orders, incomplete anesthesia records, and failure to update DD3019 forms following surgery. CONCLUSIONS:This QI project established a formal baseline of documentation performance within a Role 2 unit and demonstrated that targeted training improved provider confidence but did not fully translate into consistent documentation practice during operational simulation. These findings highlight the gap between perceived competence and field execution in austere military environments. Sustained improvement will likely require repeated training cycles, integrated audit and feedback, workflow optimization, and leadership reinforcement. Strengthening documentation and structured handoffs has important implications for patient safety, trauma system performance improvement, and operational readiness across Role 2 settings.
INTRODUCTION:Military medics are often tasked to train other medics. While there is ample content of what to train, there exists a lack of trainer education or emphasis on how to train others effectively. Current military medical training is highly variable, often relying on anecdotal methods, with limited evaluation of training effectiveness. Although the importance of readiness training is well recognized, little attention has been devoted to identifying evidence-based approaches for training military medics. This narrative review sought to synthesize available evidence on training methods for military medics on skills performed in Role 1 or Role 2 settings. MATERIALS AND METHODS:A narrative review using systematic search and screening methods was conducted. A research librarian searched multiple databases using the MeSH terms "clinical education" and "military." The articles were reviewed by the 6-person team using the Appraisal Tool Selection Algorithm and appraised for quality using the Pre-Appraised Evidence Appraisal Tool, © 2025 Johns Hopkins Health System, with permission. RESULTS:From 1,222 screened articles, 44 met inclusion and quality criteria for final synthesis. Two overarching themes emerged: training methods and training evaluation. Training methods varied by audience, design, and modality. Many studies developed training methods centered around the audience, whether individual or team-focused. Training design and content was variably informed by the utilization of clinical practice guidelines, literature reviews, needs assessments, and expert opinion. Most studies employed multimodal approaches combining didactic instruction with hands-on or simulation-based practice. Training evaluation included both subjective and objective measures, including self-efficacy, knowledge testing, time to task completion, graded simulations, and clinical practice volume. CONCLUSIONS:This review highlights significant variability in how military medical readiness training is designed, delivered, and evaluated. Evidence suggests that effective training should be designed for the target audience, grounded in adult learning theories, multimodal, and evaluated using a combination of subjective and objective measures. Limitations to the articles utilized for this review include heterogeneous study designs, reliance on short-term outcomes, and weak generalizability. Addressing gaps in educator preparation, evaluation rigor, and policy for prioritization of training may improve the effectiveness of military medical readiness training. Future research should focus on validating objective evaluation tools, assessing skill retention, and optimizing team-based training to enhance operational readiness and force capability.
OBJECTIVE:To evaluate the performance of Large Language Models (LLMs) within the Military Health System (MHS), specifically assessing for bias, hallucinations, and safety risks. METHODS:In late 2024, 47 clinicians across 13 military treatment facilities evaluated 8 blinded LLMs. Using standardized clinical vignettes, 835 conversations were reviewed for demographic bias, hallucinations, classification errors, and safety risks. RESULTS:Demographic bias was present in 82 conversations (9.8%), hallucinations in 85 (10.2%), classification errors in 19 (2.3%), and safety risks in 78 (9.3%). Classification errors were linked to military-specific jargon. Safety risks were most prominent in overdose, critical care, and psychiatric scenarios. CONCLUSION:Failure to generate an accurate response can delay decision-making and increase cognitive burden and risk. Confidently incorrect responses are particularly dangerous. Although LLMs can generate useful clinical information, they remain vulnerable to biases and factual errors. Human oversight, training, and model tuning are necessary before utilizing military data.
INTRODUCTION:Alcohol use and opioid use independently increase the risk of suicidal behaviors. These substances are also frequently used concurrently, yet the extent to which their co-use contributes to suicidal behaviors at the population level remains insufficiently understood. This gap is particularly relevant among adults with prior military service, who experience elevated burdens of chronic pain, opioid exposure, and mental health comorbidities. We therefore examined whether past-year alcohol-opioid co-use was associated with suicidal behaviors among U.S. adults and assessed whether these associations differed by military service status and across pre- and post-COVID-19 periods. MATERIALS AND METHODS:We conducted a repeated cross-sectional analysis of adults aged ≥18 years using 2014-2023 data from the National Survey on Drug Use and Health (n = 544,488; 19,047 with prior military service). Past-year suicidal behaviors were defined as ideation, planning, or attempt. Substance use groups were categorized as alcohol-only, opioid-only, alcohol-opioid co-use, or neither. Year-specific multivariable logistic regression models adjusted for sociodemographic and clinical covariates were pooled using random-effects meta-analysis. Analyses were stratified by pandemic period (2014-2019 vs. 2020-2023). Interaction terms and marginal effects assessed effect modification by military service. RESULTS:Among adults without prior military service, alcohol-opioid co-use (adjusted OR = 1.61, 95% CI, 1.37-1.90) and opioid-only use (aOR = 1.59, 95% CI, 1.27-2.00) were associated with suicidal behaviors after full adjustment. Among adults with prior military service, co-use was significant in minimally adjusted models but attenuated after full adjustment. Stratified analyses indicated stronger associations for co-use during the COVID-19 period, particularly among those with prior military service. Interaction analyses showed limited evidence of effect modification by military status after adjustment. CONCLUSIONS:Alcohol-opioid co-use is associated with increased odds of suicidal behaviors in U.S. adults, with variation across military service status and pandemic periods. These findings highlight the importance of considering polysubstance use and contextual stressors in understanding suicide risk.
Research results in the epidemiology of burn injuries indicate a predominance of male victims, who tend to have deeper tissue damage. It can be assumed that this pattern is maintained at certain degrees of burns, in particular, when exposed to one of the most common thermal factors – an open flame. The main causes of these burns were the ignition of wooden materials during fires and campfires, the ignition of flammable liquids (gasoline, solvents, etc.), and household gas. The proportion of male victims with grade IIIA burns was 2.1 times higher than that of females due to more frequent contact with flammable liquids. The average age of victims increased with increasing severity of injury. Men were 1.8 times more likely to be injured while intoxicated than women. In cases of grade IV tissue damage, the relative proportion of male victims was 2.9 times higher. The average length of hospital stay increased significantly with increasing tissue damage depth and showed no statistically significant differences by gender. The overwhelming majority of adverse outcomes (88.3 %) were recorded in patients with fourth-degree burns, with equal frequency among men and women (42.9 ± 4.5 % and 36.9 ± 7.1 %; P > 0.05). Burns were sustained in 36.7 % of patients while intoxicated, with a 1.8-fold higher prevalence among men. As the severity of burn injury increased, so did the average age of the victims and the duration of hospital treatment. The majority (88.3 %) of fatalities were due to fourth-degree burns, with no significant differences in incidence between genders.
Cough is one of the most common symptoms experienced by a general practitioner and a general practitioner. The greatest difficulties for practicing physicians are caused by cases of chronic cough and its complicated course. The range of diseases and pathological conditions accompanied by cough symptoms is extremely wide. This requires both deep theoretical knowledge and practical experience from the clinician in choosing a rational diagnostic search algorithm and optimal therapeutic tactics. This article is devoted to the problems of pathogenesis, classification, diagnostic approach and therapeutic tactics in cough syndrome.
Infectious complications remain the leading cause of mortality and prolonged hospitalisation in military personnel sustaining mine-explosive trauma (MET). The aim of this study was to analyse the current spectrum of infectious complications of MET, evaluate the aetiological structure of wound pathogens, and determine rational principles of antimicrobial prophylaxis and therapy. A systematic review of 18 scientific publications from 2012–2025 was performed. Infectious complications were found to develop in 27–35 % of combat casualties and in 52 % of those sustaining traumatic amputations. In contemporary conflicts, the dominant pathogens are multidrug-resistant Gram-negative bacteria– Acinetobacter baumannii, Klebsiellapneumoniae, and Pseudomonas aeruginosa – with carbapenem resistance rates reaching 73–90 %. The cornerstone of antimicrobial prophylaxis remains prompt cefazolin administration per TCCC protocol; radical wound debridement is essential for infection prevention. The spread of multidrug-resistant organisms from conflict zones constitutes a global epidemiological threat.
The article presents a comparative assessment of the technical and operational characteristics of flexible immobilization splints available on the market of the Republic of Belarus. The relevance of using these tools at the prehospital stage in modern armed conflicts is substantiated. The results of an X-ray examination confirming the X-ray negativity of all tested samplesarepresented. It is concluded that it is expedient to prioritize purchases of local products (OJSC «Svetlogorsk-Khimvolokno») within the framework of the import substitution program.
Kawasaki syndrome (SC) is an acute systemic disease involving small and medium-sized arteries with the development of proliferative vasculitis. The main number of cases are children under 1 to 5 years of age, while the disease is extremely rare in children in the first months of life. Currently, there is an increase in IC all over the world. The problems of diagnosis of SC are associated with the rare occurrence and absence of pathognomonic symptoms and laboratory criteria of the disease, which leads to underdiagnosis of the latter. SC can pose a threat to the patient’s life and health not only in the acute period, but also after many years, which is associated with the risk of coronary artery aneurysms in patients who have not received adequate pathogenetic therapy, namely, the administration of intravenous immunoglobulins (IVIG). Meanwhile, timely diagnosis and administration of IVIG can reduce the risk of aneurysm formation from 25 % to 4 %. As is known, the presence of coronary artery aneurysms suggests life-threatening complications in the form of thrombosis and/or stenosis, which can lead to ischemia and sudden death at a young age. At the same time, the awareness of doctors of the therapeutic profile regarding the UK is insufficient. The article considers a case of Kawasaki disease in a three-month-old child, analyzes in detail the course of the pathological process.
This ar ticle examines respondents’ satisfaction with the provision of psychiatric care in outpatient and inpatient settings for patients at high risk of aggressive behavior, with the results varying depending on the level of care provided. The main reasons for dissatisfaction with the organization of specialized medical care for patients with psychiatric problems were staffing (21.4 %), the lack of an effective system for preventing and monitoring aggressive actions of patients (21.5 %), insufficiently effective interaction between organizational structures of psychiatric care and law enforcement agencies (18.4 %) and social services (11.7 %), and the lack of interdepartmental programs for long-term support and reintegration of patients into society (14.7 %), the rating and values of which depended on the level of psychiatric care provided.
The article describes the symptoms of mental disorder called simulation. It is shown that in patients in clinical picture it is not just a deliberate simulation, but а way to get rid of the exhressed anxiety, which they themselves are unable to cope with. Certain (specific) parallels with obessive-compulsive disorder are performed.
As the opioid crisis continues to impact communities, developing an effective treatment for opioid addiction is a critical public health challenge. This study aims to explore the use of opioid agonists for the treatment of opioid addiction and examine potential controversies surrounding it. T rea tm e nt of O U D with medication such as Methadone and Buprenorphine has been proven to be effective in the treatment of overdose of opioids. The mechanism of action for these opioid agonists are primarily focused on maintenance of the opioid addiction and detoxification. In the United States Buprenorphine is used for office based treatment, whereas Methadone is provided only in the Opioid usage overdose treatment facility centers. H o w e v er, many s tatistical analyses found that opioid agonist treatment for OUD, can pose a major risk for the public health and safety, potentially causing more harm to the patient than the OUD itself. It is crucial to address the issues of misuse and stigma of medication associated with medication assisted treatment in order to optimize patient care of individuals with OUD.
Introduction. As of 01.01.2024, 379,510 patients with diabetes were under medical supervision in the Republic of Belarus, including 19,252 with type 1 diabetes and 356,396 with type 2 diabetes. The annual increase in the number of patients is 5.0–8.0 %. The aim of the work is to compare the dental status of patients with type 1 and type 2 diabetes. Materials and methods. A retrospective analysis of outpatient dental records of patients undergoing outpatient follow-up with an endocrinologist for type 1 and type 2 diabetes mellitus was performed. Patients with type 1 diabetes mellitus (19 patients) made up group 1, which was divided into two subgroups 1.1. – type 1 diabetes without complications (9 patients), 1.2. – type 2 diabetes with complications (10 people); with type 2 diabetes mellitus (20 patients) – group 2, which It was also divided into two subgroups 2.1. – Type 2 diabetes without complications (10 patients), 2.2. – Type 2 diabetes with complications (10 patients). Results. It was de termined that destructive changes in the periodontium with tooth loss prevail in patients with type 2 diabetes, and a greater number of foci of chronic odontogenic infection were identified, which may indicate a greater lesion of the bone structures of the maxillofacial region in people with type 2 diabetes mellitus compared with patients with type 1 diabetes. Conclusion . The revealed facts should be taken into account when planning therapeutic and preventive measures for patients of this category.
The article presents modern ideas about traumatic illness – the concept and definitions, classification, the main mechanisms in the development of the disease, approaches to diagnosis and the basic principles of the organization of medical care at the stages of medical evacuation. Co ncepts such as «visceral pathology in the wounded and affected of wartime» and «visceral pathology of wartime» should be distinguished and distinguished. It is also necessary to understand and highlight the role of a general practitioner in the treatment of visceral pathology in the wounded and those affected by traumatic illness. New periods have now been identified, pathogenesis, methods and techniques in early diagnosis and stage-by- stage treatment of traumatic illness have been supplemented. D ue to the frequent cases of attacks using unmanned aerial vehicles and precision weapons on residential and industrial facilities in the Russian Federation, the number of injured and injured has increased. The ongoing tense situation near the state border of the Republic of Belarus with an increasing likelihood of such incidents on our territory requires good training of medical workers in the knowledge of visceral pathology in traumatic illness.
This ar ticle examines the dynamic provision of inpatient medical care to patients with chronic obstructive pulmonary disease in Minsk healthcare facilities. From 2021 to 2024, the number of hospitalized patients with chronic obstructive pulmonary disease increased more than threefold. From 2017 to 2024, the average length of stay for patients with chronic obstructive pulmonary disease increased by 7.14 % (from 13.47 to 14.43 days). This increase in the average length of stay for patients with chronic obstructive pulmonary disease may indicate a predominance of patients with more severe forms of the disease, requiring longer inpatient treatment, and entails increased healthcare costs and an economic burden on the state.
