ABSTRACT

Timely implementation to contain infectious diseases (e.g., quarantine, contact tracing, isolation) is critical to curb transmission and safeguard the health and readiness of U.S. Servicemembers. This proactive approach ensures that mission-critical operations remain unaffected. We focus on the collaborative efforts of Servicemembers from the 351st Civil Affairs Command during the Salaknib 2023 exercise in the Philippines. These SMs harnessed readily available cell phone applications to deliver rapid and effective public health messaging, reducing the risk of waterborne diseases. Targeted infographics were created and disseminated through mobile apps widely used by the population. The infographics were powerful tools for conveying critical, visually engaging information, facilitating rapid understanding and compliance with recommended health measures.

Quality of Vision and Patient Satisfaction After Refractive Surgery: A Comparative Analysis of LASIK, SMILE, and PRK

Ryan D, Sia R, Beydoun H, Earls KE, Rodgers SB, Skurski ZP, Rivers BA 24(4). 86

Background: This study assessed patient-reported outcomes (PRO) of active-duty U.S. Military Servicemembers following refractive surgery. Methods: We retrospectively reviewed the medical records of 375 U.S. Servicemembers who underwent LASIK (118 eyes), photorefractive keratectomy (PRK, 550 eyes), or small incision lenticule extraction (SMILE, 82 eyes). Surgeries occurred at the former Walter Reed Army Medical Centers Center for Refractive Surgery or the current FBCHs Warfighter Refractive Eye Surgery Program and Research Center (WRESP-RC) from 2004 to 2019. Preoperative and 6-month postoperative data included “Quality of Vision and Patient Satisfaction Before and After Refractive Surgery” questionnaire. Outcome measures included uncorrected distance visual acuity (UDVA). Results: In this study, 95% LASIK, 94% PRK, and 94% SMILE achieved UDVA 20/20 or better with no between-group differences (P=.308). There were no differences between groups in efficacy (P=.204) or the safety index (P=.066). Postoperative QOV was comparable between groups for far vision (P=.292) and night vision (P=.505). From before to after the operation, far vision significantly improved in LASIK (P=.009) and PRK (P<.001) but not SMILE (P=.384). Postoperative glare was comparable (P=.258). Driving difficulty was significantly different between treatments (P=.025), with significant improvements in PRK and LASIK. There were no significant differences between groups for activity limitations (P=.093) or being bothered by glare, halos, or lack of sharpness of vision (P=.131). Conclusion: This study found comparable or improved PRO six months after LASIK, PRK, and SMILE. All three yielded excellent visual outcomes with minimal visual symptoms, allowing the performance of daily activities with less difficulty and limitation.

ABSTRACT

Background: Fresh whole blood (FWB) is essential for hemorrhagic shock resuscitation, but little literature evaluates medics ability to obtain intravenous (IV) access. Options for IV access include a 16-gauge hypodermic needle attached to the FWB collection bag (straight stick technique [SST]) and an 18-gauge angiocatheter with a saline lock (saline lock technique [SLT]), which may improve access given its confirmatory flash chamber and medic familiarity. Methods: In a prospective, randomized, crossover study, a convenience sample of U.S. Army medics performing FWB transfusion training initiated IV access with SST or SLT for FWB collection to achieve the minimum transfusable volume of 527g. The primary outcome was seconds to achieve minimum transfusable volume. Secondary outcomes included first-attempt IV access success and end-user feedback. Results: Eighteen medics demonstrated a shorter median time to reach the minimum transfusable volume with SST (819.36 [IQR 594.40-952.30] sec) compared with SLT (1148.43 [IQR 890.90-1643.70] sec, P=.002). No sequence or period effects occurred. Compared with SLT, SST demonstrated higher first-attempt IV access success (18, 78% versus 11, 48%; P=.037). Accordingly, most medics reported SLT would perform worse than SST for FWB collection and IV access in tactical environments. Conclusions: Medics achieved minimum transfusable volume faster and higher first-attempt IV access success with SST than SLT. Future studies should compare a 16-gauge SLT and SST, and further evaluate IV access techniques for improved evaluation of medic skills.

The JSOM podcast digs deeper into the articles and subjects that matter to our readers. Our podcast hosts, Captains Alex Merkle and Josh Randles, tackle articles from the journal based on merit, interest, and application for operators in the field. The most recent episode is here! We have also uploaded a bonus episode for our listeners featuring a special interview with Jeff Butler, co-author of Tell Them Yourself: It's Not Your Day to Die."

Current Episode

Our JSOM podcast team will be reviewing the following articles for our newest podcast: 

Advancing Combat Casualty Care Statistics and Other Battlefield Care Metrics by Jud C. Janak, Russ S. Kotwal, Jeffrey T. Howard, Jennifer M. Gurney, Brian J. Eastridge, John B. Holcomb, Stacy S. Shackelford, Robert A. De Lorenzo, Ian J. Stewart, and Edward L. Mazuchowsk (https://www.jsomonline.org/FeatureArticle/2024211Janak.pdf)

Evaluation of a Rebreathing System for use with Portable Mechanical Ventilators by Thomas Blakeman, Maia Smith, and Richard Branson (https://www.jsomonline.org/FeatureArticle/2024234Blakeman.pdf)

The Effect of Critical Task Auto-failure Criteria on Medical Evaluation Methods in the Pararescue Schoolhouse by Ian Richardson, Michael Lauria, Brian Gravano, Jeffrey Swenson, and Stephen Rush (https://www.jsomonline.org/FeatureArticle/2024267Richardson.pdf)

JSOM Guest Author

Advancing Combat Casualty Care Statistics and Other Battlefield Care Metrics author Jud C. Janak will be interviewed by our podcaster team about the article. 

Jud C. Janak, PhD, has over 10 years of experience as an epidemiologist and applied biostatistician in the private sector, public sector, and academia. He has published over 50 peer-reviewed studies on topics related to traumatic injury, accelerated aging, chronic disease, and real-world pharmacoepidemiology. He completed a post-doctoral fellowship at the U.S. Army Institute for Surgical Research where he focused on traumatic brain and genitourinary injuries. He was Director of Epidemiology and Biostatistics for the Department of Defense Joint Trauma System from 2017 to 2020. He also served as the lead epidemiologist for the Military Trauma Preventable Death Working Group. He was an Associate Director of Epidemiology at CorEvitas from 2020 to 2023. His current responsibilities focus on leveraging real-world patient and clinical registry data to study the safety and effectiveness of FDA-approved therapies as a Principal Epidemiologist in the Real-World Data Research and Analytics group at Merative. Dr. Janak received his master’s and doctoral degrees in Epidemiology from the University of Texas Health Science Center School of Public Health.

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