Volume 22 No. 3

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Diagnosis and management of acute promyelocytic leukemia in an active duty Air Force space operator


A 38 year-old United States Air Force active duty male in excellent health presented to the flight medicine clinic with a two week history of shortness of breath, fatigue, and unexplained bruising. Initial laboratory analysis was significant for pancytopenia with evidence of immature cells suggestive of leukaemia. The patient was admitted to hospital for emergency workup. Bone marrow biopsy and molecular analysis confirmed the diagnosis of acute promyelocytic leukaemia (APL). Induction therapy consisting of all-trans retinoic acid (ATRA) plus arsenic was promptly initiated and complete remission achieved after 35 days of treatment. Acute promyelocytic leukaemia, an extremely aggressive subtype of acute myeloid leukaemia, was considered to be one of the most deadly forms of cancer prior to the introduction of effective ATRA- based therapy in the late 1990s. Drawing parallels with the aviation environments’ crew resource management (CRM), we discuss the importance of team work and collaboration in military medical resource management (MMRM). Because the military health care infrastructure in the United States is complex and relies heavily on civilian medical services, the implementation of MMRM is important to ensure good outcomes in cases that require rapid diagnosis and treatment such as APL.

By Benjamin Eovaldi , Harry Albaugh , John Hyman and Daniel Greenwald In   Issue Volume 22 No. 3 .

Who Cares for the Carers? Literature Review of Compassion Fatigue and Burnout in Military Health Professionals


The Dunt Review1 into mental health services in the Australian Defence Force (ADF) enabled significant investment in programs and initiatives across the defence environment in Australia. The subsequent attention to long standing mental health issues for our veteran community is both timely and admirable, and has indeed begun to address mental health stigma, education and community support around this country. Arguably, the overwhelming focus of these programs has been on Post-Traumatic Stress Disorder as it relates to the physical and mental trauma of operational deployment. However, this paper will attempt to redirect at least some of this focus onto potential issues of compassion fatigue in uniformed health professionals arising from their care of traumatised (physical and/or psychological) clients. The paper will also highlight burnout as a similar possible consequence of stressful defence health work/life experience.

This literature review based paper identified myriad peer reviewed references relating to research and programs for international healthcare systems and overseas forces on these conditions. However, at least within the published domain, very little can be identified for the Australian military context or in the ADF’s current mental health strategies to specifically address these mental health issues for our uniformed health professionals.

This paper introduces these relevant concerns for the broader military/veteran’s health peer group, leadership and academic audience to consider as worthy of greater attention in Defence and Veteran’s Affairs research and policy agendas.

The paper will encompass:

1. An introduction, background and definitions of ‘Compassion Fatigue’, being vicarious traumatisation of clinicians as a consequence of caring for traumatised people.
2. A similar discussion of Burnout’ as a wider but still significant workforce issue that reduces the quality of care provided to patients, and the morale, quality of life and physical and mental health of sufferers.
3. A brief outline of a ‘Four Stages of Burnout’ model, being (1) Physical, Mental and Emotional Exhaustion, (2) Shame and Doubt, (3) Cynicism and Callousness and finally (4) Failure, Helplessness and Crisis.
4. Identified issues for military health services from compassion fatigue and burnout as identified in the literature.
5. Recommendations that individual practitioners and the defence health organisation should consider to address issues identified.

By Kerry Clifford In   Issue Volume 22 No. 3 .

Narrative Review of Barriers to the Secondary Prevention of Sexually Transmitted Infections: Implications for the Military Context and Current Research Gaps


This paper presents a narrative review of research on barriers to the secondary prevention of sexually transmitted infections (STIs) in primary care, such as STI screening and treatment, from the perspective of individuals and health care providers. Limited work has been conducted on barriers to secondary prevention in the military context. However, research in other contexts shows that the success of secondary prevention may depend on knowledge about STIs, perceptions of risk or stigma attached to STIs, the availability of time and resources to seek testing and treatment, and the quality of exchanges between health care providers and their patients. For individuals, additional considerations may include their concern for health, fear of a positive diagnosis, and inconveniences associated with the screening process. As most studies in this area have been conducted in a civilian context, it is recommended that research be conducted on military personnel and health care providers to assess: knowledge and perceptions of STI risks, their impacts on health, and ways they can be prevented; the stigma and social norms associated with STIs; the availability and accessibility of testing; and the factors that influence the quality of patient–provider interactions in the military health care context.

By Kimberley Watkins and Jennifer E.C. Lee In   Issue Volume 22 No. 3 .

The Competency of the Military Fitness Training Leaders in the Hellenic Army


Background: The Military Fitness Training Leader (MFTL) is considered a parameter that affects the efficiency of the Hellenic Army Physical Readiness Training (APRT).

Purpose: The competencies of 5 different types of Greek MFTLs were assessed and compared according to the opinions of the Regular Army Personnel.

Material and Methods: ANOVA corrected by post hoc comparisons were used to compare the selected opinions coming from 2864 survey questionnaires. The statistical significance was indicated up to 0.05 to compare the differences for all 5 types MFTLs graded by 3 different groups: Senior Officers, Junior Officers, and Non- Commissioned Officers/Permanent Enlisted Soldiers.

Results: The Senior Officers scored the “Officer” as the best MFTL and the “Physical Education Graduate” as the highest contributors to the APRT’s effectiveness. Junior Officers and Non-Commissioned Officers/Permanent Enlisted Soldiers scored the “Physical Education Graduate” as being more useful as MFTL, although being seldom applied to APRT programs. The Officers’ military experience and leadership specialisation combined with the Physical Education Graduate’s professionalisation has been revealed as the main characteristics of an effective profile for a MFTL.

Conclusion: The results, reinforced by similar research in the field, indicate that the Hellenic army should focus on creating professional standards to achieve a more efficient MFTL training program.

Conflict of Interest: There were no financial or personal conflicts of interest for this study. The results of the present study do not constitute endorsement of the product by the author or the Journal.

Key Words: Army Physical Readiness Training, Regular Army Personnel, Military Fitness Training Leader, Army Organisation Efficiency, Survey Questionnaire.

By Dr. Kontodimaki Vasiliki In   Issue Volume 22 No. 3 .

A study of alcohol consumption in a cohort of military nurses


Background: Alcohol consumption in defence populations exceeds those of civilians across all age groups with stress associated with operational deployments thought to be a contributing factor. Civilian nurses drinking patterns mirror those of the general population, however alcohol consumption in military nurses as a discrete group has yet to be studied.

Purpose: This investigation aimed to examine alcohol consumption in a cohort of military nurses.
Material and methods: A cross-sectional study of a sample of 44 defence nurses from the United Kingdom, Australia and New Zealand extracted from a large electronic longitudinal survey.

Results: Over 20% of respondents consumed more than the recommended daily limit for their gender with over 24% of females exceeding safe daily consumption rates. Fifteen per cent drank more than their recommended weekly limit. Defence nurses in their fifties and sixties drank every day more often and consumed more drinks over a week than younger nurses.

Conclusion: Many respondents drank more than is recommended with older nurses engaged in higher alcohol consumption. Older nurses have been exposed to military drinking cultures for longer and are more likely to have deployed and experienced the stressors associated with this. Loss or impairment of individuals in this select group has the potential to impact disproportionately upon health capability. The study results highlight the need for further research with this population given the small sample size.

Key words: military, defence, nurses, alcohol, drinking

By Maree Sheard , Annette Huntington and Jean Gilmour In   Issue Volume 22 No. 3 .

Randomised double-blind, placebo- controlled trial of iron supplementation attenuates fatigue and declining iron stores for female officers-in-training


Background: Physical training by female military trainees can put them at risk of iron deficiency and inferior health and performance.

Purpose: To determine the effect of iron supplementation on iron status, fitness, fatigue, and leisure activities. Material and Methods: In this randomised, double-blind, placebo-controlled trial, female officers-in-training were randomly allocated to treatment (n = 25, 18 mg iron) or placebo tablets (n = 24). Outcomes were iron status, fitness, fatigue, and leisure activity at baseline, seven weeks and 13 weeks.

Results: Ferritin declined by midpoint in the placebo group (P = 0.001). There was a treatment effect in the second half of the trial in emotional fatigue (-4.2 to -0.6 95% CI, P = 0.04). There was a negative relationship with iron intake for emotional fatigue (OR 0.61; 0.44 to 0.87 95% CI; P = 0.006) and positive for vigour (OR 1.51; 1.08 to 2.11 95%CI; P = 0.016) and small negative association between initial dietary iron intake and initial serum ferritin (0.2 to 9.2 μg/L 95% CI; P = 0.042).

Conclusion: Officer training affects iron status and iron supplementation improves indicators of iron status and emotional fatigue in female officers-in-training.

By Christine K Booth , Julia E Carins and Iain K Robertson In   Issue Volume 22 No. 3 .

Glimpses of future battlefield medicine – the proliferation of robotic surgeons and unmanned vehicles and technologies

Introduction The rescue of severely wounded soldiers,  while under fire, is itself a major cause  of  military  death and traumatic injury.1 Some  sources  estimate  that up to 86% of battlefield deaths occur after the first 30 minutes post-injury.1,2 Hence life saving training techniques3  and  treatments,  and  more   recently, the application of robotic surgical systems  (RSS; Fig.1),… Read more »

By Gary Martinic In   Issue Volume 22 No. 3 .

Letter to the editor

Dear Editor Recently, while reading Sherwin Nuland’s Doctors: The Biography of Medicine in relation to the impacts on medicine of Rene Laennec’s invention of the stethoscope, Nuland writes about four milestones in a medical student’s education.1 First is the introduction to the cadaver. Second is buying your first stethoscope at the medical society bookshop. Third… Read more »

By John Frith In   Issue Volume 22 No. 3 .

Inside this edition

As we completed the final touches on the September 2014 Journal, I was fortunate to receive an e-mail from Michael Dowsett, one of the former Directors General Naval Health  Service,  who  reminded  that it was the 100th Anniversary of an important Navy health event from the beginning on the First World War. A short summary… Read more »

In   Issue Volume 22 No. 3 .