Military medicine
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This study examined working memory impairment following mild traumatic brain injury (mTBI) among active duty service members charged with criminal offenses. The prevalence of mTBI among service members involved in the military justice system is unknown. Impairments associated with mTBI may affect cognitive processes related to psycholegal capacities, and history of mTBI may have a persuasive appeal when explaining questions of culpability. The degree to which mTBI affects psycholegal abilities through cognitive impairment, however, is unknown. ⋯ This study suggests that a history of mTBI is common among service members charged with criminal offenses. The findings that working memory scores were in the average range among service members with mTBI history may suggest that history of mTBI does not impair psycholegal relevant cognition. More research is needed to clarify how history of mTBI affects service member psycholegal capacities.
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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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In patients with prior myocardial infarction (MI), cardiac rehabilitation (CR) has been shown to reduce all-cause mortality, cardiac mortality, and risk of recurrent MI. Medically supervised cardiac rehab has challenges such as increased patient and center cost, patient transportation issues, patient time commitment, and increased need for resources. Home-based cardiac rehabilitation (HBCR) is an innovative alternative to medically supervised CR which can help to address some of the aforementioned issues. HBCR has been shown to have similar patient outcomes when compared to medically supervised CR; however, implantation efforts and experiences within Veteran Affair (VA) facilities were limited. Thus, we sought to describe our implementation efforts and outcomes of HBCR at our VA medical center, since our VA medical center does not offer an on-site medically supervised CR program. ⋯ HBCR is an effective alternative to facility-based CR. Veterans who completed the program showed improvement in physical capacity and functional status. Compared to those who were eligible but did not complete the program, hospitalization for heart failure was reduced after completing HBCR.
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Altered or abnormal scapular motion has been associated with increased shoulder pain and dysfunction. Fatigue of the scapular stabilizing muscles resulting from repeated arm motion has been reported to alter scapular kinematics, which could result in the clinical assessment of scapular dyskinesis. The purpose of this study was to characterize the effect of repeated arm motion on the development of scapular dyskinesis. The hypothesis was that repeated arm motion will induce a subtle or obvious scapular dyskinesis. ⋯ Repeated shoulder motion increased the frequency of scapular dyskinesis in army ROTC cadets. The cadets that developed scapular dyskinesis also reported greater disability and lower function of the upper extremity. The results provide a link between scapular dyskinesis, upper extremity function, and the strength of the scapular stabilizing muscles. Improving the strength of the scapular stabilizing musculature might reduce the effects of repeated arm motions.
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Muscle strength and muscle endurance are important fitness components related to safe and efficient execution of physically demanding military work. In soldiers, these components are traditionally measured from simple field tests like push-ups, sit-ups, and pull-ups. However, the validity of such muscle fitness field tests is questioned due to reports of low association between test performance and the ability to conduct strength demanding military work (eg, lift and carry tasks). It is therefore necessary to study, develop, and implement more valid field tests, which are still feasible for mass testing in the military. Skeletal muscle mass (SMM) is an important physiological component related to maximal muscle force generation (strength). Thus, an alternative way of validating muscle fitness field tests is by comparisons against SMM. The purpose of the present study was to investigate the association between SMM and performance in five muscle fitness field tests. ⋯ Among the five muscle fitness field tests investigated, the Sargent jump (peak power) and the medicine ball throw demonstrated the strongest correlation coefficients against absolute SMM. Thus, these two tests should be better alternatives for assessing relevant upper and lower body strength and power in soldiers compared with push-ups, pull-ups, and sit-ups. Pull-ups generally demonstrated the strongest correlation against relative SMM. Sit-ups demonstrated low or nonsignificant associations with both absolute and relative SMM. Consequently, the test should be considered for removal from military fitness test batteries or replaced by alternative abdominal tests that are more valid.