Military medicine
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Post-traumatic stress disorder (PTSD) is associated with an increased risk of cardiovascular and metabolic diseases and physical inactivity. Cardiorespiratory fitness (CRF), which is modifiable by physical activity, is a strong independent predictor of cardiometabolic health. However, the relationship between CRF and cardiometabolic health in veterans with PTSD is unknown. Thus, this study aimed to explore the cross-sectional relationships among CRF, indices of cardiometabolic health (ie, HbA1c, blood lipids, blood pressure, waist-hip ratio, and body mass index), and PTSD severity in veterans with PTSD. ⋯ These preliminary findings suggest that CRF and by proxy physical activity may be important factors in understanding the increased risk of cardiovascular and metabolic disease associated with PTSD.
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The 2017 Joint Trauma System Clinical Practice Guideline for Pain, Anxiety, and Delirium (JTS CPG) provides an evidence-based framework for managing pain, anxiety, and delirium in combat settings. In this study, we evaluate the use of multimodal analgesia and assess pain outcomes, as indicated by the JTS CPG, at the combat support hospital (CSH). ⋯ This report indicates that acute pain service teams integrated in a CSH can feasibly implement JTS CPGs using a team-based approach. Given the military's emphasis on managing complex pain and disability among survivors beginning in the combat environment, it is imperative that innovations and best practices, like the JTS CPG, be assessed in the combat setting.
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We examine the current status of the military relevance of opioids, their use and misuse in military and veteran populations, the national security consequences of opioid use in our military age population, public health implications, and military, veteran, and government solutions for opioid addiction. ⋯ Given increasing rates of opioid addiction and death, viable solutions are universally needed. Successful intervention measures should be widely shared between military, veteran, and civilian healthcare and public health communities. Increased collaboration between these groups could inculcate successful programs to prevent and decrease opioid use. Results received from recent military and veterans' programs for prescription and electronic medical record (EMR) monitoring and data sharing may also prove useful for civilian healthcare providers and hospital systems. Future evaluations from ongoing federally funded programs to the states for addiction surveillance and intervention may help create measures to address the proliferation of opioid addiction with increased death rates. Anticipated results from these federal efforts should help inform opioid programs in military and veterans' health systems.
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Case Reports
Recurrent Herpes Gladiatorum: Should we be Screening Our Service Members Prior to Close Combat Training?
A 19-year-old active duty Marine presented to clinic with a history of a reoccurring vesicular rash on left side of his forehead. The lesion was cultured and identified as herpes simplex virus 1 (HSV-1). Herpes gladiatorum is a recurrent cutaneous infection caused by HSV-1 and spread by skin-to-skin contact. ⋯ Outbreaks of herpes gladiatorum have been observed in the high school and collegiate wrestling community for years and to prevent the spread, screening, and treatment guidelines have been implemented by governing bodies of these organizations. Active duty members who participate in the Marine Corps Martial Arts Program and the Army and US Air Force Combatives programs are exposed to similar conditions; however, no uniform screening or treatment protocol exists. To minimize the spread of skin infections, we propose adopting a uniform screening procedure and implementing a standardized form to assist primary care providers in the evaluation and treatment of herpes gladiatorum and other communicable skin diseases commonly seen in close combat training.
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Empty bullet-related ocular injuries (EBOI) are rare and may result in unfavorable visual outcomes due to both open globe and closed globe injuries. To our knowledge, no reports of such injuries in terms of outcomes have been previously described in the literature. The aim of this study was to describe the treatment performed and ocular outcomes of such injuries. ⋯ The prognosis of EBOI is unpredictable and is dependent on the severity of ocular damage. The best treatment option is prevention of EBOI with protective eyewear.