Keesler Medical Center

Abstract Background Tuberculosis (TB) leads global infectious diseases that cause mortality. Widely used BCG vaccine protects against TB disease (especially miliary, meningeal forms) but the protection of primary TB is inconclusive. Our objective was to assess the effectiveness of BCG vaccine to prevent primary TB using prospectively collected data in a clinical trial. Methods This study was approved by the USUHS Institutional Review Board. Data from a controlled trial of BCG (Phipps) in American Indian/Alaskan Native (AI/AN) schoolchildren, n=2763, enrolled 1935-8, and a case control trial of 257 newborns in Rosebud SD, Belcourt ND enrolled 1939-40, were reviewed. Before (schoolchildren only) and after BCG vaccination annual intradermal PPD testing and chest radiographs (CXR) were performed through 1947. Inclusion criteria for this analysis were negative PPD and normal CXR prior to vaccination (schoolchildren), received placebo or BCG vaccine, had a follow-up assessment. Exclusion included reactive or undocumented PPD or abnormal CXR prior to immunization. Primary pulmonary TB was defined as hilar adenopathy, lower lobe infiltrates without other identified etiology, +/- pleural effusion. In the control arm, conversion of PPD >10mm was considered in the context of radiographic findings. Severe TB was miliary or meningeal. Cox proportional hazards regression model with hazard ratios (HR) and 95% confidence intervals (95%CI) was performed for outcomes of primary pulmonary TB and severe TB. Results 2731 AI/AN schoolchildren, mean age 7.6 years, were evaluated. 1416 received BCG, 1315 placebo. Primary pulmonary TB occurred in 122 BCG, 302 placebo recipients with a sex, age, region-adjusted Cox proportional HR of 0.34, 95% CI 0.28,0.42 for BCG vaccine. 253 newborns were analyzed; 116 received BCG, 137 placebo. For newborns a sex and region adjusted HR for any TB was reported.CohortPrimary TB adjusted HR (BCG)Severe TB adjusted HR (BCG)Schoolchildren n=27310.34 (95CI 0.28,0.42)0.24 (95CI 0.08, 0.74)Newborn n=2530.36 (95CI 0.13, 0.996)0 cases BCG, 2 cases placebo Conclusion In this heavily TB-exposed AI/AN population, BCG was quite effective in preventing primary pulmonary TB in newborns (64%) or schoolchildren (66%), as well as meningeal or miliary TB (76%). Disclosures Naomi E. Aronson, MD, Wolters Kluwer: royalties for writing for uptodate Lee Harrison, MD, GSK: Advisor/Consultant|Merck: Board Member|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant

BackgroundX (formerly known as Twitter) is a social media platform with a robust online medical education community, including point-of-care ultrasound (POCUS) content.ObjectiveOur study aimed to determine if following curated POCUS education accounts on X translated to improved cardiac image interpretation competency.MethodsWe conducted an unblinded parallel-group randomized controlled trial at three internal medicine residency programs and two medical schools. Participants were third- and fourth-year medical students or internal medicine residents. They followed either 10 POCUS education accounts on X (T) or 10 generic medical accounts on X (C) for three months. Participants took a survey and a 15 multiple-choice question assessment before and after the protocol.ResultsTwenty-nine participants completed the protocol, 13 T and 16 C. Mean changes in image interpretation scores were T: -0.02% and C: +0.02%, which did not significantly differ (p = 0.46). A simple linear regression evaluating for correlation between average time spent on X and change in image interpretation scores among the T participants did not show a significant correlation (R squared – 0.0002, p = 0.96).ConclusionsNatural X exposure to educational POCUS accounts did not result in statistically improved image interpretation scores, but this outcome was likely affected by limited sample size, different participant experiences, and other variables. Data from this novel trial design can better inform future studies on medical education with social media.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-025-07385-3.

We present the case of a 43-year-old active-duty US Air Force service member who experienced an anaphylactic reaction during routine aeroallergen immunotherapy. The patient had a long-standing history of perennial and seasonal allergic rhinoconjunctivitis, with confirmed sensitization to multiple environmental allergens through skin prick and serum-specific IgE testing. He tolerated build-up immunotherapy until reaching the 0.4 mL injections from the maintenance 1:1 volume/volume (1:100 weight/volume) vials, at which point he developed an anaphylactic reaction characterized by vomiting, hypotension, and respiratory distress. He required three intramuscular doses of epinephrine and was transferred to the emergency department. This case underscores the complexities of allergy management in military personnel, particularly those receiving immunotherapy in preparation for deployment. The patient’s severe systemic reaction raises important considerations regarding risk stratification, protocol modification, and implications for operational readiness. Although he was deemed fit for duty after stabilization, this event highlights how environmental allergen exposure and immunotherapy-related complications can impact force health protection. Proactive allergy screening, patient education, and emergency preparedness, especially ensuring access to and proper use of epinephrine auto-injectors, remain essential components of pre-deployment medical planning. This case reinforces the importance of individualized immunotherapy protocols, vigilant monitoring for systemic reactions, and comprehensive contingency planning within military healthcare systems.

This article presents an overview of a novel process improvement project that aimed to enhance the utilization of prolonged exposure for treating posttraumatic stress disorder in behavioral health clinics within the Military Health System (MHS). The MHS is a geographically dispersed medical system encompassing diverse clinics and poses unique challenges to the adoption of evidence-based practices. To address these challenges, the Targeted Assessment and Context-Tailored Implementation of Change Strategies project was developed. Implemented across eight MHS clinics, this project involved conducting a comprehensive needs assessment to identify barriers, developing customized implementation plans for each site, and providing coaching calls and access to a clinic optimization toolkit for the clinic staff. We describe the development of Targeted Assessment and Context-Tailored Implementation of Change Strategies intervention components, including an implementation rubric that documents barriers to evidence-based practice utilization and proposes specific actions based on the underlying causes of these barriers. Additionally, a needs assessment interview tool and an implementation toolkit were developed to identify clinic-level challenges and support the implementation process, respectively. The needs assessment phase of the project involved conducting interviews with clinic staff and leadership, as well as reviewing clinic appointment data to discern trends and patterns in care. The insights gleaned from these interviews were instrumental in formulating tailored implementation plans for increasing the usage of prolonged exposure. Each plan was collaboratively developed with clinic leadership and subsequently put into practice at the site with the support of weekly coaching calls provided by an implementation science expert. Portions of this research project occurred during the COVID-19 pandemic, and we discuss the impact of the pandemic on the implementation of this study. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Blood is critical to expeditionary casualty care. Currently, low-titer O whole blood is the preferred product, because it serves as a universal blood product, but demand is higher than supply. Type-specific whole blood (TSWB) has the potential to address this shortfall and provide an identical clinical benefit to specific patient populations. This study estimates the benefit of TSWB to the expeditionary blood supply. Potential TSWB demand was estimated based on the product demand during the US involvement in Afghanistan (2001-2021). Potential production yield increases were based on blood production at the Keesler AFB Blood Distribution Center (FY2016-FY2023). Including type A TSWB is estimated to increase whole blood production 11.1% monthly. Type-specific whole blood, if available, is expected to be utilized in 20.7% to 35.6% of U.S. Military casualties requiring blood transfusion. Seasonality was found in production (P < .001). Incorporating TSWB is anticipated to meaningfully expand whole blood availability to meet current shortfalls and future expeditionary casualty needs.