Military medicine
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Future challenges for the U.S. Department of Defense (DoD) include operating in a contested environment against near-peer adversaries. Providing casualty care in an anti-access/area denial (A2/AD) region would be potentially challenged by impaired logistical ability to reconstitute supplies or adapt to evolving needs. Additive manufacturing (AM), also known as 3D printing, offers an ability to regenerate stocked items as well as modify them or even create novel products de novo. ⋯ This paper encourages further investigation of the use of AM/3D printing downrange to create surgical instruments and medical supplies in austere, A2/AD, and other logistically challenging environments. Not only would this support regeneration of supplies, but also modification and even creation of novel products to adapt to changing needs. If 3D files could be created of common surgical instruments for print on designated resins downrange, and FDA approval obtained, an online library of files could be created for easy access to DoD members across the globe to support our nation's commitment to provide the best possible care for service members any time, any place.
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The American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guideline (CPG) proposes several treatment recommendations regarding sudden sensorineural hearing loss (SSNHL). The treatments for this disorder have been controversial and remain varied. We sought to determine CPG adherence and hearing outcomes of SSNHL within the Military Health System (MHS). ⋯ The MHS is uniquely positioned to evaluate adherence to CPGs on a national and international level given the robust and standardized electronic medical record. Areas identified for improvement include more timely initiation of treatment, standardization of IT steroid dosing, more accurate coding for diagnosis and treatment, and standardization of audiology evaluation.
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Up to 34% of combat trauma injuries are complicated by infection with multidrug-resistant organisms. Overutilization of antibiotics has been linked to increased multidrug-resistant organisms in combat-injured patients. Antimicrobial stewardship efforts at deployed medical treatment facilities have been intermittently reported; however; a comprehensive assessment of antimicrobial stewardship practices has not been performed. ⋯ Antimicrobial stewardship programs in theater are in the early stages of development in theater. Areas identified for improvement are access to expertise, development of a focus on high-impact lines of effort, laboratory support, and the culture of antimicrobial prescribing. Risks can be mitigated through theater level formalization of efforts, expert mentoring through telehealth, and a focus on implementation and adherence and feedback to national guidelines.
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The United States Army Rangers are a unique population whose training requirements are intensive, and physically and mentally demanding. The Functional Movement Screen (FMS) is a movement screening tool designed to assess movement quality and asymmetries in movement with the potential to identify injury risk. This study was a descriptive, cross-sectional investigation examining associations between FMS scores and the various measures of health and performance of active duty soldiers in light infantry units who were involved in the U.S. Army Pre-Ranger Course (PRC). ⋯ Active duty soldiers of a light infantry division achieved FMS scores similar to other military populations tested, and the composite FMS score was related to higher APFT scores, absence of tobacco use, and absence of previous musculoskeletal injuries. Improving PRC candidate healthy habits through highlighting the negative associations between poorer fitness, cigarette tobacco use and movement quality, may reduce injury risk and increase PRC completion potential.
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The effect of evidence-based post-traumatic stress disorder (PTSD) treatments on quality of life (QOL) is not well understood. In light of mixed findings on QOL after PTSD interventions, little is known about why some individuals experience functional and QOL improvements while others do not. This study examined treatment-related changes in depression, anger, and PTSD following cognitive processing therapy (CPT) as potential predictors of QOL change. ⋯ Improvements in QOL may be predicted by different symptoms for men and women following evidence-based PTSD treatment. Our findings suggest that change in depression symptoms is an important predictor of post-treatment QOL among women, while anger symptoms are more influential for men. QOL and functioning is underresearched within the context of PTSD treatment, and this study suggests that these domains should be examined within the context of gender.