Medical Evaluation Board Involvement, Non-Credible Cognitive Testing, and Emotional Response Bias in Concussed Service Members.
Conclusion: Study results are broadly consistent with the prior published studies that documented low to moderately high base rates of noncredible task engagement during neuropsychological evaluations in military and veteran settings. Results are in contrast to prior studies that have suggested involvement in MEB is associated with increased likelihood of poor PVT performances. This is the first to show that MEB involvement did not enhance/strengthen the association between PVT performances and evidence of SVTs. Consistent with prior studies, these results do highlight that the same SMs who fail PVTs also tend to be the on...
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Motor Unit Number Estimate and Isometric Hand Grip Strength in Military Veterans with or Without Muscular Complaints: Reference Values for Longitudinal Follow-up.
Conclusion: To our knowledge, no published study on MUNE reference values of military veteran population has been available. The quantifiable values of both thenar MUNE and IHG strength of military veterans serve as baselines for our longitudinal follow-up of motor neuron function of deployed troops. These reference values are also useful for other laboratories to study veterans' motor system with or without mild CTS. PMID: 29590409 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Stated Pain Levels, Opioid Prescription Volume, and Chronic Opioid Use Among United States Army Soldiers.
Conclusions: The results verified that passive data on the US Army can support a robust COT risk computation in this population. The individual, adjusted risk level requires statistical analyses to be fully understood. Because the same data sources drive current military DSSs, this work provides the potential basis for new, evidence-based decision support resources for military clinicians. The strong, independent impact of increasing opioid prescription counts on the COT risk reinforces the importance of exploring alternatives to opioids in pain management planning. It suggests that changing provider behavior through enhan...
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Wartime Soft Tissue Coverage Techniques for the Deployed Surgeon.
This study is a report of the cases that the orthopedic surgeon encountered while deployed and the various techniques that can be used to manage the complex wounds seen in a deployed setting. Findings: Twelve patients were included in this report and the data are shown. Of the 12 patients, 6 were injured by an improvised explosive device (IED), 4 were injured by a high-velocity gunshot wound (HVGSW), 1 was injured by a gunshot wound (GSW), and 1 was injured in an auto versus pedestrian motor vehicle crash. The wound sizes ranged from 10 to 300 cm2. All patients required more than one irrigation and debridement before w...
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Screening Spirometry in Military Personnel Correlates Poorly with Exercise Tolerance and Asthma History.
CONCLUSION: Spirometry should not be used to screen the military force for the presence of respiratory disorders. In those individuals with a history of asthma, in-depth testing should be performed to fully evaluate any non-specific findings identified during spirometry. PMID: 29590412 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Combat Injury of the Sciatic Nerve - An Institutional Experience.
Conclusion: Early surgery to repair sciatic nerve injury possibly promotes significant pain reduction, reduces narcotic usage and facilitates a long rehabilitation process. Allograft nerve placement is not associated with serious complications. A follow-up period longer than 3 yr would be required and is ongoing to assess the efficacy of our treatment of patients with combat-acquired sciatic nerve injury. PMID: 29590419 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Veteran Experiences Seeking Non-pharmacologic Approaches for Pain.
Conclusion: The veterans in this qualitative study expressed interest in using non-pharmacologic approaches to manage pain, but voiced complex multi-level barriers. Limitations of our study include that interviews were conducted only in five clinics and with seven female veterans. These limitations are minimized in that the clinics covered are diverse ranging to include urban, suburban, and rural residents. Future implementation efforts can learn from the veterans' voice to appropriately target veteran concerns and achieve more patient-centered pain care. PMID: 29590422 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Taking Charge: Moving from Peer to Supervisor.
Authors: Hartzell JD, Singaraju R Abstract Leadership transitions occur frequently, and these times can be challenging for the individual and those they lead. Leaders must develop new knowledge and skills required of the position. Leaders also assume a new formal leadership role over prior peers. This can be a difficult task for junior leaders. The following article illustrates an example case faced by a junior Navy Medical Corps Officer and how one might respond. PMID: 29590426 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Commander's Wellness Program: Assessing the Association Between Health Measures and Physical Fitness Assessment Scores, Fitness Assessment Exemptions, and Duration of Limited Duty.
Conclusions: The Commander's Wellness Program should be scoped to those interventions targeting BMI, composite fitness score, sleep, and tobacco use. Although neither self-reported physical activity nor nutritional habits were associated with the outcomes, it is still worthwhile to include related interventions in the Commander's Wellness Program because of the finding in other studies of a consistent association between the overall number of health risks and productivity outcomes. PMID: 29590427 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Personality Factors and Their Impact on PTSD and Post-traumatic Growth is Mediated by Coping Style Among OIF/OEF Veterans.
Conclusion: This study demonstrated that coping style mediated relationships between personality traits and post-trauma outcomes. Our findings are subject to the limitations of the self-report and cross-sectional nature of the data. Longitudinal studies, preferably incorporating coping-oriented interventions, could convincingly demonstrate the impact of coping style on PTSD and PTG. As coping styles can be modified, our findings nonetheless suggest that coping-oriented clinical intervention has potential to reduce PTSD symptoms and promote positive growth following trauma exposure. PMID: 29590428 [PubMed - as supplied ...
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Testing Mediators of Reduced Drinking for Veterans in Alcohol Care Management.
Conclusions: Findings suggest that ACM may be effective in changing drinking patterns partially due to an increase in treatment engagement. Future research may benefit from evaluating the specific factors that underlie increased treatment engagement. The current study provides evidence that alcohol use disorder interventions should aim to increase treatment engagement and reduce barriers to care. PMID: 29590436 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Recommendations for Counseling and Education of Service Members on Endemic African Cutaneous Kaposi Sarcoma: A Case Study.
We report a case of Endemic African Cutaneous Kaposi Sarcoma (EACKS) on the lower extremity of an immunocompetent 31-yr-old male service member from Cameroon. Diagnosis was made using clinical and histologic findings. The service member was treated with local radiation therapy with resolution of his tumor. The goal of this article is to educate practitioners to counsel susceptible service members and leadership on the risk of developing EACKS when traveling to Sub-Saharan Africa, monitor for disease development, and guide in the diagnosis and treatment of patients with this rare disease. PMID: 29590438 [PubMed - as sup...
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Faith in the Common Ground.
Authors: Cullison H PMID: 29590442 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Extremely Delayed Diagnosis of Type II Hereditary Angioedema: Case Report and Review of the Literature.
We present a case with extremely late diagnosis of type II hereditary angioedema (HAE). Given recent advances in HAE treatment, we want to bring physician awareness to this condition and aid in earlier detection. HAE is a disorder associated with episodes of angioedema of the face, larynx, lips, abdomen, or extremities. Late diagnosis of HAE can lead to significant morbidity and is severely impairing due to recurring attacks. The diagnosis of HAE is ordinarily made during childhood and adolescence. Delayed diagnoses in early and middle adulthood have been documented in the literature. Gastrointestinal symptoms are common f...
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Atlantoaxial Instability in a Patient with Neck Pain and Ankylosing Spondylitis.
Authors: Lyons C, Ross M, Elliott R, Tall M Abstract The purpose of this report is to describe the evaluation and treatment of a patient with neck pain and ankylosing spondylitis who had underlying atlantoaxial instability. The patient was a 31-yr-old man diagnosed with ankylosing spondylitis 1 yr prior who was referred to a physical therapist for the treatment of chronic, worsening low back and hip pain. He also had secondary complaints of neck, upper back, and shoulder pain. The patient worked as a military pilot. As part of the patient's physical examination, a Sharp-Purser test was performed, which was positive...
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Staying Power: Does the Uniformed Services University Continue to Meet Its Obligation to the Nation's Health Care Needs?
Conclusion: Following our 45th anniversary, we provide continuing evidence that USU is keeping its contract with society. We provide evidence that USU continues to meet its obligation to the nation's health care needs by producing high-quality physicians who serve the country in multiple ways after their military obligation is complete, thus extending the definition of staying power. Our study is not without limitations. First, we could not precisely define the cohort to exclude graduates who still had service obligations. Second, the AMA Physician Masterfile had some missing data fields, so nonresponse or misclassificatio...
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Estimates of Tibial Shock Magnitude in Men and Women at the Start and End of a Military Drill Training Program.
Conclusions: This study provides the first estimates of tibial shock magnitude during military drill training in the field. The high values suggest that military drill is a demanding activity and this should be considered when developing and evaluating military training programs. Further exploration is required to understand the response of the lower limb to military drill training and the etiology of these responses in the development of lower limb stress fractures. PMID: 29590455 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Diagnosing IgA Vasculitis in the Active Duty Population: The Importance of Early Diagnosis and Proper Biopsy Site Selection.
Authors: Flood D, Barber B, Miletta NR Abstract Immunoglobulin A associated vasculitis (IgAV), formerly called Henoch-Schönlein purpura, is a small vessel vasculitis which typically presents with upper and lower extremity palpable purpura and abdominal pain. It is the most common vasculitis in children, and is less common in adults. However, newer evidence suggests the incidence within the adult population is higher than previously reported. This case study demonstrates an adult military recruit presenting with new onset IgAV shortly after basic training. He noted a preceding upper respiratory tract infection,...
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Accuracy of Bioelectrical Impedance Analysis in Estimated Longitudinal Fat-Free Mass Changes in Male Army Cadets.
Authors: Langer RD, Matias CN, Borges JH, Cirolini VX, Páscoa MA, Guerra-Júnior G, Gonçalves EM Abstract Introduction: Bioelectrical impedance analysis (BIA) is a practical and rapid method for making a longitudinal analysis of changes in body composition. However, most BIA validation studies have been performed in a clinical population and only at one moment, or point in time (cross-sectional study). The aim of this study is to investigate the accuracy of predictive equations based on BIA with regard to the changes in fat-free mass (FFM) in Brazilian male army cadets after 7 mo of military tra...
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Disability Rating, Age at Death, and Cause of Death in U.S. Veterans with Service-Connected Conditions.
This study used information from the VETSNET file, which is a snapshot of selected items from the Veterans Benefits Administration corporate database. We also used the National Death Index (NDI) for Veterans which is part of the VA Suicide Data Repository. In VETSNET, there were 758,324 Veterans who had a service-connected condition and died between the years 2004 and 2014. Using the scrambled social security number to link the two files resulted in 605,493 (80%) deceased Veterans. Age at death, sex, and underlying cause of death were obtained from the NDI for Veterans and military service characteristics and types of disa...
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Tinnitus and Associated Handicaps in the French Mountain Artillery: Assessment by the Tinnitus Handicap Inventory.
Conclusion: Despite a mild tinnitus handicap, the percentage of people concerned by tinnitus in this regiment is higher (19%) than that in the estimated percentage of general population of European countries (about 10%). It should be of interest to replicate this type of study from other regiments and from other countries. Education and good fitting of hearing protection for prevention of acoustic trauma sequelae should still be encouraged. PMID: 29590475 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Building Capacity for Complementary and Integrative Medicine Through a Large, Cross-Agency, Acupuncture Training Program: Lessons Learned from a Military Health System and Veterans Health Administration Joint Initiative Project.
Conclusion: The ATACS program provided a foundational template to increase CIM across the MHS and VHA. The lessons learned in the program's implementation will aid future CIM training programs and improve program evaluations. Future work is needed to determine the most efficient means of improving CIM credentialing and privileging procedures, standardizing and adopting uniform CIM EHR codes and documentation, and examining the effectiveness of CIM techniques in real-world settings. PMID: 29590483 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Psychological Flexibility and Set-Shifting Among Veterans Participating in a Yoga Program: A Pilot Study.
Conclusions: In a small uncontrolled sample, psychological flexibility and set-shifting predicted changes in PTSD symptoms in veterans participating in a clinical yoga program, which supports findings from prior research. Future research should include an active comparison group and record frequency of yoga practiced outside formal sessions. PMID: 29590487 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 29, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Letter from the Editor-in-Chief.
Authors: Rothwell SW PMID: 29566203 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 28, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

TeleHealth in the Modern Era of Military Medical Consultation.
Authors: McNicholas JE PMID: 29546338 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Hyperbaric Oxygen Therapy as an Adjunct for Treating an Individual with Poorly Healing Bilateral Mandibular Fractures Suspect of Developing Towards Osteomyelitis: A Case Report and Clinical Experience.
Conclusion: The patient completed 30 hyperbaric oxygen treatments and 30 d of intravenous antibiotics. Clinically, the patient responded well and showed healed intraoral wounds and an objective decrease in erythrocyte sedimentation rate over the course of treatment. Unfortunately, on serial imaging the patient showed to have fibrous non-bony union of left fracture site. Even though the patient will need a final definitive plate for his fracture, it will be performed from an extraoral approach with no evidence of underlying infection. PMID: 29546339 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Post-Smallpox Vaccination Skin Eruption in a Marine.
Authors: Kramer TR Abstract This case report examines a vesiculopustular reaction which occurred in a young Marine 9 d after receiving the smallpox vaccination. Review of the CDC guidelines, ACAM2000 package insert, and literature surrounding the smallpox vaccine reveals several well-established adverse cutaneous reactions associated with vaccination. These dermatologic reactions are typically mild and self-limited, but do have the potential to be life threatening - especially in those with immunocompromise. Unfortunately, the correct diagnosis can often be difficult to make, as many of these rashes share similar c...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Characteristics of Combat-Associated Small Bowel Injuries.
This study seeks to provide the largest reported review of the characteristics of combat-associated small bowel injuries. Materials and Methods: The Department of Defense Trauma Registry was queried for U.S. Armed Forces members who sustained hollow viscus injuries in the years 2007-2012 during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Concomitant injuries, procedures, and complications were delineated. Fisher's exact test was used to analyze the relationship of bowel injury pattern to rates of repeat laparotomy, fecal diversion, and complications. Results: One hundred seventy-one service members ha...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Monitoring VHA Optometric Eye Exam Services, Nation-Wide, 2014-2016.
Conclusion: Veteran patients who made at least one VHA optometric eye exam service visit, nation-wide, increased from 2014 to 2016. Data showed that Veteran patients in the older age groups (age 55 and greater) used optometric eye exam services differently when compared with Veterans in the younger age groups. This difference may invite consideration of the differing optometric needs of these two, broad groups of eligible Veterans in order to expand access to VHA optometric clinical services. PMID: 29546420 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

An Evaluation of Navy En Route Care Training Using a High-Fidelity Medical Simulation Scenario of Interfacility Patient Transport.
Authors: DeForest CA, Blackman V, Alex JE, Reeves L, Mora A, Perez C, Maddry J, Selby D, Walrath B Abstract Introduction: Military prehospital and en route care (ERC) directly impacts patient morbidity and mortality. Provider knowledge and skills are critical variables in the effectiveness of ERC. No Navy doctrine defines provider choice for patient transport or requires standardized provider training. Frequently, Search and Rescue Medical Technicians (SMTs) and Navy Nurses (ERC RNs) are tasked with this mission though physicians have also been used. Navy ERC provider training varies greatly by professional role. H...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Isolated Common Femoral Artery Injury Resulting from Blunt Military Trauma.
We report an unusual case of isolated femoral artery injury due to blunt trauma during military service with following review of literature. PMID: 29547892 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

An Emergency Department Presentation of Secondary Syphilis.
Authors: Sarkisian SA, Brillhart D Abstract In the United States, the rate of primary and secondary syphilis has increased by 18% in 2016, the highest rate since 1993. These patients can often present to the emergency department (ED) in various stages. Although syphilis is well described in the literature, there is a paucity of ED reports of atypical cases. A 22-yr-old male presented to the ED complaining of neck pain. The patient was found to have right-sided tender cervical lymphadenopathy causing neck pain. A thorough physical exam revealed diffuse lymphadenopathy. Without an obvious infectious etiology, the pat...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Measuring Use of Evidence-Based Psychotherapy for PTSD in VA Residential Treatment Settings with Clinician Survey and Electronic Medical Record Templates.
Conclusion: Following a FY15 mandate, EMR templates documenting EBP delivery were widely used by therapists working in VA residential PTSD programs. EBP receipt measured using EMR templates was consistent with therapist self-report of EBT delivery. There were several patient-level predictors of EBP receipt and therapist-level predictors of EBP delivery. However, therapists most likely to deliver EBPs were clustered at a limited number of sites. PMID: 29547909 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Medical Attrition from Commanders Training in the Israeli Defense Forces (IDF): A Cross-sectional Study on 23,841 Soldiers.
Conclusion: The attrition rate from commanders training in the IDF is low, and at this point, however, due to lack of uniform criteria for attrition, it cannot serve as an objective measure. We suggest measuring and discussing overuse injury rates (which is the most frequent cause of attrition), instead. Based on our results, we recommend an implementation of a better medical screening policy in order to reduce the re-injury rates during commanders training. PMID: 29547914 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Platinum 5 min in TCCC: Analysis of Junctional and Extremity Hemorrhage Scenarios with a Mathematical Model.
Conclusion: Thus the immediacy of intervention in terms of application of a tourniquet is clearly emphasized by the simulation, that is, the window of opportunity for a life-saving intervention, especially in a combat setting, is significantly smaller than the symbolic "platinum five minutes" might suggest. With respect to the 3-min window of opportunity identified in the simulations the effective application of these devices in a TCCC setting appears questionable. Given these observations, further research and development into solutions that allow the timely identification of a junctional bleeding problem and ap...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Causes of Death in Military Working Dogs During Operation Iraqi Freedom and Operation Enduring Freedom, 2001-2013.
Conclusions: Our study is the most comprehensive to date that reports causes of death of MWDs deployed to OIF and OEF. However, limitations in the available data lessen the potential of our results to inform improvements in training and point of injury medical care. Better documentation in VTRs and systematic data collection into an official MWD trauma registry could lead to improved training and facilitate further development and evaluation of guidelines to improve care of wounded MWDs in future conflicts. PMID: 29547926 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Return-to-Learn: A Post-Concussion Academic Recovery Program at the U.S. Air Force Academy.
Authors: Johnson BR, McGinty GT, Jackson JC, Ramsey TM, Hjalber M, Hill CCTE, D'Lauro CJ PMID: 29547933 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Developing a Measure to Assess Emotions Associated with Never Being Deployed.
We examined the Non-Deployment Emotions (NDE) questionnaire, a novel four-item measure of guilt, unit value, unit camaraderie, and unit connectedness in a sample of never-deployed male and female US Army Reserve/National Guard (USAR/NG) soldiers (N = 174). Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing survey-based study examining the health of USAR/NG soldiers and their partners. The protocol was approved by the Institutional Review Board at the State University of New York at Buffalo. The relationship between each of the items was examined by calculating correlation and al...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Effects of Riot Control Training on Systemic Microvascular Reactivity and Capillary Density.
Authors: Pereira F, de Moraes R, Van Bavel D, De Lorenzo A, Tibirica E Abstract Introduction: The main aim of the present study is to evaluate the effects of strenuous exercise, related to special military training for riot control, on systemic microvascular endothelial function and skin capillary density. Materials and Methods: Endothelium-dependent microvascular reactivity was evaluated in the forearm skin of healthy military trainees (age 23.4 ± 2.3 yr; n = 15) using laser speckle contrast imaging coupled with cutaneous acetylcholine (ACh) iontophoresis and post-occlusive reactive hyperemia (PORH). Fu...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Has Current French Training for Military Orthopedic Surgeons Deployed in External Operations Been Appropriately Adapted?
Discussion: The large variety and technical nature of the performed operations requires the training of highly qualified military orthopedic surgeons with both experience in war surgery and management of after-effects and complications. Orthopedists are also required to carry out procedures dealing with neurosurgery, general, and/or vascular surgery on missions. These data highlight the complexity of military surgeons' training along with the hyper-specialization of the civilian medical world. For more than 10 yr, French military surgeons have benefited from a training program called ACDS to meet these objectives. This ini...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Prevalence of Pain Diagnoses and Burden of Pain Among Active Duty Soldiers, FY2012.
Conclusion: These data provide a deeper understanding of pain diagnoses and burden of pain among active duty soldiers. A substantial proportion of soldiers with pain diagnoses were seen for pain self-reported as only mild, or that did not result in significant restrictions in military duty limitations. However, given the prevalence of multiple pain diagnoses and common reports of moderate or severe pain and long duration, complex interventions may be required to minimize the effect of pain on force readiness. This encounters-based analysis is likely an underestimate of presence of pain, and does not include contextual fact...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Psychosocial Risk Factors and Other Than Honorable Military Discharge: Providing Healthcare to Previously Ineligible Veterans.
Conclusion: These findings elucidate potential factors associated with veterans with OTH discharges, particularly substance abuse and criminal justice involvement. Results also indicate higher incidence of risk factors that often accompany suicidal ideation and should be a highlighted component of healthcare delivery to this vulnerable cohort of veterans. PMID: 29547949 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Collaboration Needed on Human Performance Optimization for Combat Athletes.
Authors: McBratney CM, de la Motte SJ PMID: 29547953 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Chronic Pulmonary Blastomycosis Mimicking Pulmonary Tuberculosis.
We describe a rare case of chronic pulmonary blastomycosis complicated by large pulmonary cavitation in a young service member who was misdiagnosed with active pulmonary tuberculosis. Case Presentation: A 25-year-old active duty male presented to his primary care provider with complaints of hemoptysis, fatigue, weight loss, and fever. Computed tomography chest with contrast identified a large cavitary lesion in the right upper lobe (RUL). The patient was admitted to an outside hospital and he underwent bronchoscopy with transbronchial biopsies and bronchoalveolar lavage of the RUL. Histology and cultures were unremarkable ...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Lower Preterm Birth Rates but Persistent Racial Disparities in an Open-Access Health Care System.
The objectives of this study are to determine the rate of preterm birth in the MHS from 2006 to 2012 compared with national rates and to analyze the impact of demographic factors on preterm birth in a universal access health care system. Methods: A cohort of infants born in 2006-2012 was formed from the MHS M2 database. International Classification of Disease - Ninth Revision (ICD-9) codes were used to define prematurity. Preterm births were linked to military parent's demographic data. Calculated MHS preterm birth rates were compared with U.S. national data using the Pearson chi-square test and comparison via standard...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Biological Response to Stress During Battlefield Trauma Training: Live Tissue Versus High-Fidelity Patient Simulator.
Authors: Peng HT, Tenn C, Vartanian O, Rhind SG, Jarmasz J, Tien H, Beckett A, LT-SIM study group Abstract Introduction: Tactical Combat Casualty Care (TCCC) training imposes psychophysiological stress on medics. It is unclear whether these stress levels vary with the training modalities selected. It is also unclear how stress levels could have an impact on medical performance and skill uptake. Materials and Methods: We conducted a pilot study to compare the effects of live tissue (LT) with a high-fidelity patient simulator (SIM) on the level of stress elicited, performance, and skill uptake during battlefield ...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Absence of a Link Between Childhood Parental Military Service on Depression and Anxiety Disorders Among College Students.
Conclusion: These findings continue to draw attention to potential health disparities associated with growing up in a military household. However, these results also suggest that children of military families exhibit significant resilience and that parental military service may not be a reliable predictor of mental health issues among college students after accounting for the influence of demographic factors. These findings may have implications for health care providers who treat dependents of military service members. PMID: 29547979 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Are Navy Weight Management Programs Ensuring Sailor Physical Readiness? An Analysis at Naval Medical Center San Diego.
Conclusions: To improve the WMPs at NMCSD, the findings in this report support the following recommendations: (1) maximize the SS program, (2) increase utilization of FEP, and (3) increase the participation and training of Assistant Command Fitness Leaders. WMPs navy-wide may benefit from incorporating similar program improvements to increase physical readiness of service members and, therefore, support command mission success. PMID: 29547984 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Pupillometer Use: Validation for Use in Military and Occupational Medical Surveillance and Response to Organophosphate and Chemical Warfare Agent Exposure.
Authors: Mease L, Sikka R, Rhees R Abstract Introduction: To analyze the effectiveness and suitability of pupillometer use in military and occupational medicine, specifically when pupil size is measured as part of medical surveillance. Pupil size is the most sensitive physical exam finding in vapor exposure to substances that inhibit acetylcholinesterase, such as nerve agent (chemical warfare) and organophosphates (used in agriculture). Pupillometer use permits real-time, accurate pupil measurements, which are of significant value in occupational setting where exposure to organophosphates is suspected and in dynami...
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Estimating a Change from TRICARE to Commercial Insurance Plans.
Conclusion: This article outlined a method of identifying two particular sources of that uncertainty: the extent to which people will receive care outside of MTFs and the extent to which the MTFs can adjust to reductions in demand. For one particular option, we demonstrate that the potential savings from changing the system depends on increasing the share of costs paid by beneficiaries - particularly working-age retirees - and on DoD's ability to reduce excess capacity in the system. PMID: 29547994 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - March 22, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research