Military medicine
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High intensity functional training (HIFT) programs are designed to address multiple fitness domains, potentially providing improved physical and mental readiness in a changing operational environment. Programs consistent with HIFT principals such as CrossFit, SEALFIT and the US Marine Corps' High Intensity Tactical Training (HITT) are increasingly popular among military personnel. The goal of HIFT programs is to produce high levels of cardiorespiratory fitness, endurance and strength that exceed those achieved by following current physical activity recommendations. ⋯ Given the unique benefits of HIFT, we recommend that these programs become the standard for military physical training. Despite the promise of HIFT fitness programs, questions remain about implementing these programs in the military context. For instance, no large scale randomized trials comparing traditional military physical training with HIFT programs on both health and injury outcomes have been conducted. Such a trial could identify key elements from both types of programs which should be incorporated in future approaches to military fitness training. Also, research regarding the optimal ways of implementing HIFT to maximize both GPP and combat oriented physical skills is lacking. It is likely that an approach to HIFT training which promotes GPP for all personnel along with specialized elements selected on the basis of individual occupation demands would be maximally disseminable in the military.
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Extremity injuries contribute a significant amount to the overall disability of combat-injured soldiers. Tracking patient outcomes allows military health care providers to gain a better understanding of the disability associated with various injury patterns. ⋯ There is a growing body of evidence demonstrating the importance of a multidisciplinary approach to optimize outcomes in patients following severe extremity trauma. Tracking the outcomes of these interventions longitudinally will ultimately provide the military surgeon with an evidence-based plan to treat severe combat-related extremity injuries, leading to optimal care for future combat injured patients. "However beautiful the strategy, you should occasionally look at the results."-Winston Churchill.
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High-energy lower extremity trauma is a consequence of modern war and it is unclear if limb amputation or limb salvage enables greater recovery. To improve function in the injured extremity, a passive dynamic ankle-foot orthosis, the Intrepid Dynamic Exoskeletal Orthosis (IDEO), was introduced with specialized return to run (RTR) therapy program. Recent research suggests, these interventions may improve function and return to duty rates. ⋯ Moderate evidence supported development of four EESs regarding IDEO use with specialized therapy. Following high-energy lower extremity trauma and limb salvage, use of IDEO with RTR therapy can enable return to duty, return to recreation and physical activity, and decrease pain in some high-functioning patients. In higher functioning patients following limb salvage or trauma, IDEO use improved agility, power and speed, compared with no-brace or conventional bracing alternatives.
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The Bridging Advanced Developments for Exceptional Rehabilitation (BADER) Consortium began in September 2011 as a cooperative agreement with the Department of Defense (DoD) Congressionally Directed Medical Research Programs Peer Reviewed Orthopaedic Research Program. A partnership was formed with DoD Military Treatment Facilities (MTFs), U. S. ⋯ BADER's Clinical Research Core (CRC) staff, who are embedded within each of the MTFs, have supported an additional 37 non-BADER Consortium-funded projects. Additional key research support infrastructures that expedite the process for conducting multisite clinical trials include an omnibus Cooperative Research and Development Agreement and the NIH Clinical Trials Database. A 2015 Defense Health Board report highlighted the Consortium's vital role, stating the research capabilities of the DoD Advanced Rehabilitation Centers are significantly enhanced and facilitated by the BADER Consortium.
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Endotracheal intubation (ETI) is an important skill for all emergency providers; our ability to train and assess our learners is integral to providing optimal patient care. The primary aim of this study was to assess the inter-rater reliability (IRR) and discriminant validity of a novel field ETI assessment tool using a checklist-derived performance score (PS) and critical failure (CF) rate. ⋯ The novel field ETI assessment tool has excellent reliability among trained raters and discriminates between experienced ETI providers (EPs) and less experienced ETI performers using PSs, CFs, and GRSs on a fresh cadaveric model.