Wilford Hall Medical Center

BackgroundCurrent guidelines recommend follow-up testing for syphilis to confirm treatment efficacy. Syphilis rates are higher in the United States military compared to the general population. Despite these higher rates of infection, previous data on military blood donors demonstrated less than one-third received a follow-up rapid plasma reagin (RPR) test within one year after diagnosis. It is unknown if this low follow-up rate exists across different military cohorts.Table 1.Demographic Information of 41 Individuals Diagnosed with Syphilis at Joint Base San Antonio January 2022-August 2024Table 2.Factors Associated with Follow-up Rapid Plasma Reagin Test After Syphilis DiagnosisMethodsA retrospective chart review occurred for all active-duty military members with a positive RPR test via reverse algorithm at Joint Base San Antonio between January 2022 and August 2024. Any positive RPR during the study period treated with antimicrobials was considered a true infection. Each chart was reviewed to determine demographic information, testing indication, staging, and follow-up. Patients who received a repeat RPR between 60 days and 365 days were considered to have received a follow-up RPR. A comparison was made between those who received a repeat RPR ordered and those who did not at 365 days. Nominal comparisons were made by Fisher’s Exact Test, and continuous variables were compared by Mann-Whitney U test.ResultsDuring the study period there were 121 detectable RPR tests in 77 individuals, with 41 (33.8%) determined to be new cases of syphilis. Patients were predominantly male and enlisted. Approximately half were living with HIV or receiving HIV pre-exposure prophylaxis (Table 1). The majority (80%) of cases were staged as latent infections. Of the patients with syphilis, 35 (85%) either had at least one year follow-up after diagnosis or had a repeat RPR ordered (Table 2). The majority (74%) of these individuals had a follow-up RPR ordered within a year. Factors associated with receiving a follow-up RPR included older age, living with HIV, receiving HIV pre-exposure prophylaxis, having a history of syphilis, or receiving testing in the infectious diseases clinic. Patients with late latent syphilis had the lowest follow-up rates.ConclusionThis study demonstrated a higher rate of follow-up testing than was previously seen in military blood donors. Future interventions should target those with late latent syphilis, as they had the lowest follow-up testing rates.DisclosuresAll Authors: No reported disclosures

This study describes neonatal hypoglycemia (NH) screening for infants born to mothers without adequate oral glucose tolerance testing (OGTT). In this single-center, retrospective study, authors reviewed live births of term and late-preterm infants at a single military hospital from 2014 to 2021. All mothers without adequate OGTT were identified. Charts were evaluated to assess NH screening practices for infants. Out of 13,338 deliveries, 0.98% (131) of infants were born to mothers without adequate OGTT. One hundred and two of these infants had no other indication for NH screening. Sixty-eight percent (69/102) of these infants were screened with at least one point of care (POC) blood glucose measurement and 61.7% (63/102) were screened with at least three POC glucose measurements. A small percentage of mothers in this population didn't receive adequate OGTT. Sixty-eight percent of the infants born to these mothers were screened for NH.

Intracardiac thrombus can present across a broad clinical spectrum, from incidental findings to life-threatening cardiogenic shock. Management is determined by both the patient’s condition and the thrombus characteristics. Catheter-directed thrombectomy has emerged as a viable treatment option for selected patients. We present two cases of right atrial thrombus managed with catheter-based intervention, accompanied by a detailed discussion of the clinical evaluation, echocardiographic imaging, and management strategies in critically ill patients.

Percutaneous intramedullary screws have recently become a fixation option for the surgical management of lesser metatarsal fractures. Their advantages over Kirschner (K)-wire fixation include avoidance of pin site complications, fixation stability, and need for removal. To date, there has been limited literature published on their use and safety profile. The purpose of this study is to determine the frequency and extent of flexor tendon disruption associated with percutaneous intramedullary screw fixation for lesser metatarsal fractures. Seven left and right lower extremity cadaver specimens were procured. A cannulated 3.6-mm screw was placed percutaneously in the second through fifth metatarsals (MTs) in a retrograde fashion. The plantar surface of each specimen was then exposed to visualize the flexor tendons. The tendon location relative to the drill hole, incidence of tendon disruption, percentage of tendon disruption, and the distance between the tendon and the drill hole were measured. Overall, 21 of 56 (37.5%) flexor tendons were damaged, 5 (35.7%) in the second MT, 7 (50%) in the third MT, 9 (64.3%) in the fourth MT, and 0 (0%) in the fifth MT. The percentage of tendon disruption for each metatarsal was 15%, 11%, 11%, and 0%, respectively. The mean distance from uninjured tendons to the drill hole was 1.07 mm, 0.94 mm, 0.9 mm, and 2.03 mm, respectively. Across all metatarsals, the majority of flexor tendons were located medial to the drill hole, with the greatest clearance seen in the fifth metatarsal. Percutaneous insertion of intramedullary screws for lesser metatarsal fixation resulted in a 37.5% rate of flexor tendon injury, primarily affecting the fourth metatarsal. Although these disruptions involved 10% to 20% of tendon width, their clinical impact remains uncertain. Adjusting the starting point to a slightly more lateral position, if possible, may minimize the risk of flexor tendon injury. Future studies should assess functional outcomes, plantar plate involvement, and biomechanical consequences of partial tendon injury.

BackgroundThe role of clinician educators has expanded to encompass diverse responsibilities alongside providing competent care and engaging in scholarly activities. Faculty development (FD) programs have emerged as vital tools for equipping educators with teaching skills and career advancement opportunities. However, assessing faculty development programs’ impact on organizational culture remains challenging due to their multifaceted nature. This study explores this gap to understand how faculty development influences organizational culture.MethodsThis qualitative study used a constructivist approach to explore faculty perspectives on the Uniformed Services University of the Health Sciences (USU) Faculty Development Program’s influence on organizational culture. Forty-three faculty members participated in nine semi-structured focus groups, selected for diversity across roles and locations. Interviews were recorded, transcribed, and anonymized to ensure accuracy and participant confidentiality.Data analysisTranscripts were analyzed using thematic analysis. A multidisciplinary team independently reviewed transcripts, identified preliminary codes, and refined themes through iterative consensus building. Coding was organized using memos and grouped into themes. Using information power principles, the team determined that nine focus groups provided sufficient data richness to meet the study’s aims.ResultsThe research team identified and refined four central themes: professionalization, legitimization, the value of community, and leadership impact. The participants reported a greater sense of professionalization through enhanced teaching skills, increased awareness of educational literature, and heightened confidence in their educator roles. The faculty development program fostered a strong community, promoting collaboration, knowledge sharing, and mutual support across specialties and locations. Leadership impact was evident at individual and institutional levels, increasing confidence, mentorship, and organizational support.ConclusionsThis study provides valuable insights into the organizational impact of faculty development programs, shedding light on how such initiatives influence faculty experiences and organizational culture. Future research should explore leadership values, faculty retention, burnout prevention, and the broader value of education within academic institutions.

Abstract Introduction There is a high incidence of poor sleep quality in active-duty servicemembers. Deployment exposure is a commonly explored causal factor for poor sleep. However, more recent research highlights the importance of non-deployment factors, with one study reporting the “birth of child/adoption” as commonly contributing to poor sleep. This is consistent with previous research reporting parenthood as a significant factor in poor sleep quality, especially in parents of children with sleep problems. However, no previous research has considered the impact of pediatric sleep problems on parental sleep quality in American military families. Methods A chart review was completed for children (age 0-12) referred to a military sleep center. Chart review (N=34) included documentation of parental global Pittsburgh Sleep Quality Index (PSQI) scores, reported frequency of parental sleep disturbance attributed to the child’s sleep problem, and active-duty status of the parent. Results Both active-duty and dependent-spouse parents reported poor sleep quality (M: 7.94 and 11.41 respectively), but dependent spouses had significantly worse global PSQI scores (p< 0.01). Both active-duty and dependent-spouse parents reported that their child’s sleep problem disturbed their sleep, on average, 1-2 nights/week (M: 2.12 and 2.82 respectively). However, dependent spouses were significantly more likely to report 3+ nights/week (p< 0.01). To date, mean follow-up global PSQI scores for all parents showed significant improvement (p< 0.01), with a decrease by 6.3 points (M: baseline PSQI 11.75 and follow-up PSQI 5.5). Additionally, frequency of parental sleep disturbance attributed to the child’s sleep problem significantly decreased to less than once a week (p=0.02). Conclusion The presence of pediatric sleep problems contributes to poor sleep quality for both active-duty and dependent-spouse parents. However, pediatric sleep problems may disproportionately affect dependent spouses. Additionally, parental sleep quality significantly improved upon treatment of the child’s sleep problem. This suggests that targeting pediatric sleep disturbances may be an important component of addressing active-duty servicemember sleep quality. Limitations included small follow-up sample size (n=8) and inability to determine further demographic information of parents. Because sleep is an important component of military readiness, military leadership should consider further research into the impact of pediatric sleep disturbances on servicemember sleep quality. Support (if any) None

INTRODUCTION: Prior studies show differences in posterior compartment structures on magnetic resonance imaging (MRI) between resting and straining in patients with pelvic organ prolapse when compared to age- and parity-matched controls (Lewicky-Gaupp 2010). Further, nulliparous older women (>70) have larger resting levator bowl volume than younger women (<40) (Swenson 2020). OBJECTIVE: In this MRI measurement technique development pilot study, we perform a detailed analysis of the posterior compartment structures at rest and with straining in young, nulliparous subjects without prolapse symptoms and compare these MRI measurements to their POP-Q measurements. METHODS: Six OBGYN physicians from differing institutions and career stages met weekly to learn pelvic floor MRI measurement techniques. Using an MRI biorepository, mid-sagittal images were analyzed at rest and with straining in nulliparous subjects aged <40 years without prolapse symptoms. We utilized 3D Slicer software (slicer.org) to measure posterior vaginal wall length (PVW), urogenital hiatus (UGH), levator hiatus (LH), levator plate length (LP), and levator bowl volume (LBV). Six independent evaluators, five of which were novices, performed measurements that were averaged, and interrater reliability was assessed using the intraclass correlation coefficient (ICC). Statistical analysis was performed using Python; independent t-test and Pearson correlation were utilized. RESULTS: Eleven subjects were available for analysis. Table 1 shows demographic characteristics. Compared with resting measurements, UGH (p<.001), LH (p<.001), and LBV (p<.001) increased with straining without significant change in LP or PVW length. There was a strong positive correlation between MRI posterior fornix location and PVW length (r=.77, p<.001). There was a strong negative correlation between MRI cervix location and POP-Q C (r= −0.70, p=.01) and MRI posterior fornix and POP-Q D (r=−0.697, p=.02). ICC was .95 indicating excellent interrater reliability (Figure 1). CONCLUSIONS: MRI allows visualization of real-time changes within the same subject and provides insight into the biomechanics of the pelvic floor beyond what can be learned from textbooks and cadaveric dissections. In young, nulliparous women without prolapse symptoms, MRI reveals dynamic changes in posterior compartment structures between rest and strain. During straining, there is relaxation of the pelvic floor shown by increased UGH, LH, and LBV. Although straining did not change the length of LP or PWV, it likely changed the orientation of the levator plate, as evidenced by the increase in LBV. The strong correlations between MRI measurement and POP-Q measures reflect that these measures describe the same phenomenon. The ICC for this study showed excellent interrater reliability, demonstrating that targeted education and training in pelvic MRI analysis produces precise and accurate measurement results among novice learners (Table 2).