Military medicine
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The combat penetrating gunshot injury is frequently associated with damage to the liver. Bile leak and external biliary fistula (EBF) are common complications. Biliary decompression is commonly applied for the management of EBF. ⋯ A scheduled ERCP application is an effective approach for the management of EBF, and liver resection could be avoided. A successful biliary decompression was achieved by the transpapillary intervention with the installation of stents. Stent occlusion could be diagnosed in the early post-traumatic period, which is effectively managed by scheduled ERCP as well as stent replacement with a large diameter as close as possible to the place of bile leak.
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Fecal immunochemical testing (FIT) is the most commonly used colorectal cancer (CRC) screening tool worldwide and accounts for 10% of all CRC screening in the United States. Potential vulnerabilities for patients enrolled to facilities within the military health system have recently come to light requiring reassessment of best practices. We studied the impact of a process improvement initiative designed to improve the safety and quality of care for patients after a positive screening FIT given previously published reports of poor organization performance. ⋯ The addition of indication labels and patient navigation after positive screening FIT was associated with 57.1% absolute increase in timely diagnostic colonoscopy. Similar highly reliable systems-based solutions should be adopted for CRC screening, and further implementation for other preventative screening interventions should be pursued.
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Weight status perception (WSP) is the subjective assessment of one's own body weight. It is not correlated with the body mass index (BMI). People practicing sports, including overweight people, tend to perceive themselves as normal weight. The military is in a paradoxical position between the need to gain muscle mass for professional purposes while respecting BMI standards. Using body composition might be more advantageous than using BMI as part of an individual approach in making a decision about fitness to serve. However, measuring body composition is not easy in current practice, and a bridge between WSP and body composition would make it possible to develop a simple assessment tool. ⋯ We were able to show a statistically significant association between WSP and Fat%. Such an association may be of great interest because the measurement of the Fat%, whatever the method used, is not easy in current practice. A replication of the study in the general population would be of great interest, especially since Fat% is closely associated with the incidence of cardiovascular diseases and many cancers.
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Hemorrhage is a major cause of preventable death worldwide, and early identification can be lifesaving. Pulse wave contour analysis has previously been used to infer hemodynamic variables in a variety of settings. We hypothesized that pulse arrival time (PAT), a form of pulse wave contour analysis which is assessed via electrocardiography (ECG) and photoplethysmography (PPG), is associated with hemorrhage volume. ⋯ Findings from this pilot study suggest that PAT and PAT_I may be used to detect blood loss. Because of the simple design of a single-lead ECG and PPG, the technology could be packaged into a very small form factor device for use in austere or resource-constrained environments. Significant inter-subject variability in the relationship between blood loss and PAT highlights the importance of individualized hemodynamic monitoring.
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The surge of SARS-CoV-2-virus infected (COVID-19) patients presenting to New York City (NYC) hospitals quickly overwhelmed and outnumbered the available acute care and intensive care resources in NYC in early March 2020. Upon the arrival of military medical assets to the Javits Convention Center in NYC, the planned mission to care for non-SARS-CoV-2 patients was immediately changed to manage patients with (SARS-CoV-2)COVID-19 and their comorbid conditions.Healthcare professionals from every branch of the uniformed services, augmented by state and local resources, staffed the Javits New York Medical Station (JNYMS) from April 2020. ⋯ This is the first report of the care provided at the JNYMS. Within 2 weeks, this multi-agency effort was able to mobilize to care for over 1,000 SARS-CoV-2 patients with varying degrees of illness in a 1-month period. This was the largest field hospital mobilization in the U.S. medical history in response to a non-wartime pandemic. Its success with huge patient throughput including disposition and low mortality relieved critical overcrowding and supply deficiencies throughout NYC hospitals. The downstream impact likely saved additional hundreds of lives and reduced stress on the system during this healthcare crisis.