Military medicine
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Anterior cruciate ligament reconstruction (ACLR) ranks among the most common surgeries performed in civilian as well as military orthopedic settings. Regional anesthesia, and the femoral nerve block (FNB) in particular, has demonstrated efficacy in reducing postoperative pain and opioid use after ACLR, however concerns linger about possible impaired functional outcomes. The purpose of the current investigation was to assess International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) scores at 6 to 12 months after ACLR in patients who did (FNB) and did not (NoFNB) receive a perioperative FNB. ⋯ Active tobacco use may negatively impact short-term subjective patient-reported outcomes after ACLR, as reported by the IKDC-SKF. Lower preoperative scores are also associated with significantly lower postoperative IKDC-SKF scores while the use of a FNB was not associated with lower postoperative scores. The negative association between tobacco use and patient-reported functional outcomes after ACLR lends further support to tobacco cessation programs within the military.
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Vitamin D is critically important to numerous physiologic functions, including bone health. Poor vitamin D status is a common but underrecognized problem that predisposes the military population to stress fracture and completed fracture. This has significant implications for force health protection, warfighter readiness, attrition, and cost. ⋯ This is a major hindrance to military readiness and one that could easily be modified with awareness, prevention, and early treatment. In this commentary, we review the literature on vitamin D deficiency and critically examine the current status of policies and clinical practice related to vitamin D in the military health system. We offer several practical recommendations to increase awareness and readiness while decreasing musculoskeletal injury and the associated costs.
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The Psychological Health Center of Excellence conducted a rapid review of the literature to investigate the effectiveness of behavioral health treatments (i.e., evidence-based psychotherapy and psychiatry) delivered in person compared to telehealth (TH; i.e., video teleconference and telephone). ⋯ Based on evidence from 22 RCTs, the use of TH platforms, including video conference and telephone modalities, generally produces similar outcomes as face-to-face provision of psychotherapy and psychiatry services.
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Airway obstruction is the second leading cause of preventable death on the battlefield. Video laryngoscopy has improved airway management in the emergency setting for several decades, and technology continues to improve. Current technology in the supply chain is cost-prohibitive to incorporate at Role 1 facilities, which is where many intubations occur by novice intubators. The i-view is a novel video laryngoscopy device that is handheld, inexpensive, and disposable. The aim of this study was to determine if the i-view is suitable based on performance assessments by physician assistant trainees and survey feedback. ⋯ All physician assistant trainees successfully and rapidly performed endotracheal intubation using the disposable i-view video laryngoscope. Study participants rated the device as easy to use and desirable for deployment. Further research is necessary to validate this novel device in the clinical setting before recommending dissemination to the deployed military medical force sets, kits, and outfits.
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Lack of high-quality cardiopulmonary resuscitation (CPR) and effective team communication during cardiovascular emergencies could lead to poor patient outcomes and adverse events. Studies have shown that CPR psychomotor skills declined 3 months and plateaued up to 6 months after the completion of CPR training. The Urgent Care Clinic (UCC) interprofessional staff did not receive consistent training on CPR and teamwork skills beyond what was received from the biannual American Red Cross (ARC) Basic Life Support (BLS) training and semiannual Resuscitative Care Function mock cardiac arrest. Most participants took their last CPR training for more than 6 months (n = 12, 67%), between 3 and 6 months (n = 2, 11%), and within the last 3 months before the pre-intervention period (n = 4, 22%). The purpose of the project was to form an interprofessional team to lead the development and implementation of a theory- and evidence-based simulation-based training program to improve CPR and teamwork skills while enhancing patient safety and emergency medical readiness in the hospital and UCC. ⋯ Our results demonstrated that the participants' ARC BLS scores and UCC's team perceptions have increased after in situ simulation-based training. We did not assess the ideal time for re-training. We recommend a 3- to 6-month post-training assessment to determine the optimal time for a CPR and teamwork refresher training. A high-fidelity simulation-based program with trained facilitators that assess the healthcare providers' CPR and teamwork skills could enhance the delivery of high-quality CPR and execution of effective teamwork skills in their workplace.