Military medicine
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The use of extracorporeal membrane oxygenation (ECMO) for the care of critically ill adult patients has increased over the past decade. It has been utilized in more austere locations, to include combat wounded. The U.S. military established the Acute Lung Rescue Team in 2005 to transport and care for patients unable to be managed by standard medical evacuation resources. In 2012, the U.S. military expanded upon this capacity, establishing an ECMO program at Brooke Army Medical Center. To maintain currency, the program treats both military and civilian patients. ⋯ Utilization of the U.S. military ECMO team has increased exponentially since January 2017. With an increased tempo of transport operations and distance of critical care transport, survival to decannulation and discharge rates exceed national benchmarks as described in ELSO published data. The ability to cannulate patients in remote locations and provide critical care transport to a military medical treatment facility has allowed the U.S. military to maintain readiness of a critical medical asset.
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Occupational disability among military service members is an important target for preventive screening. The specific aim of this study was to quantify disability risk levels among soldiers with selected risk factors (body mass index extremes, poor or absent physical fitness scores, and tobacco and opioid use) and combinations thereof, suggesting priorities for preventive actions. ⋯ We identified marked disability hazard increases, especially in association with opioid use and high body mass index. These factors, in addition to tobacco use and low physical fitness, are potential early prevention targets for clinicians who screen military service members.
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Identifying the cause of palpitations and syncope in the healthy, active duty military population is important. Most often, the causes are benign, but more malignant etiologies should not be overlooked. In this case, we present a 22-year-old active duty female soldier who developed exercise intolerance, palpitations, and ultimately one episode of exercise-induced syncope. ⋯ Sotalol was used as an antiarrhythmic therapy and an automatic implantable cardioverter defibrillator was implanted to reduce the risk of sudden cardiac death. This case represents an uncommon cause of palpitations and syncope. Arrhythmogenic right ventricular cardiomyopathy should be on the differential diagnosis in the active duty population who present with exercise-induced syncope.
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The U.S. Veterans Health Administration (VHA) is changing the way it provides healthcare to a model known as Whole Health (WH). The aim is to shift from a primarily medical/disease-oriented system to a model that focuses on health promotion and disease prevention; utilizes personalized, proactive, and patient-driven care; and emphasizes the use of complementary and integrative health. This investigation aimed to examine referral and utilization patterns in early implementation at tertiary care VHA medical care system. Specific aims were to evaluate (1) referral patterns, (2) initial treatment engagement, and (3) continuity of treatment engagement. ⋯ Implementation of the WH model of care has the potential to transform the way VHA delivers healthcare and improve the health and lives of veterans. However, a shift of this magnitude is likely to face challenges during implementation. This article reports on initial barriers to implementation, which can guide implementation at other sites as well as future investigations. Further research is needed to replicate these results as well as to determine underlying causal factors. However, if replicated, these results indicate that successful implementation of WH, or similar models of care, will require extensive efforts focused on outreach to, and education of, facility providers and certain patient demographic groups. Finally, efforts will be required to enhance treatment engagement.