Military medicine
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The U.S. Department of Defense employs more musicians than any other organization in the USA with over 6,000 musicians employed. Musculoskeletal pathologies, behavioral health disorders, hearing loss, and dystonias account for the majority of reasons a musician seek medical care. The aim of this study is to review recent medical literature documenting occupational hazards in musicians. ⋯ Medical literature suggests several risk factors for multiple disease categories. Practice time and history of PRMD/PRP were both associated with development of PRMD/PRP and focal dystonia. A history of behavioral health disorder was associated with development of focal dystonia. Clinicians should counsel their musician patients on strategies to minimize risks, and additional research is needed to identify specific causes of illnesses in musician populations.
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The Military Health System mission is to provide medical care throughout the globe to service members and beneficiaries. To achieve this mission in the most austere of locations, telemedical support is an essential force multiplier when robust in-person medical support is not feasible. This led to the development of a telemedical solution initially known as the Virtual Critical Care Consultation service which provided tele-critical care assistance to downrange providers. The VC3 system then expanded to include multiple medical specialties available for consultation. The current version of this telemedical solution is the ADvanced VIrtual Support for OpeRational Forces (ADVISOR) program which is a synchronous and asynchronous telemedicine system that was developed to provide 24/7 remote expert support to military clinicians engaged in casualty care in austere and operational environments. ⋯ Based on the collected information, the financial return on investment has exceeded costs and the system is perceived as being valued added for both local caregivers and remote experts. The system appears to help optimize evacuation planning, specifically by downgrading or eliminating unnecessary evacuations.
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Postpartum depression (PPD) is a common perinatal complication. Risk factors previously found to correlate with PPD in civilians include prenatal depression, childcare stress, limited social support, difficult infant temperament, and maternity blues. Previously identified risk factors in military spouses include spouse deployment/redeployment cycles. It is unclear if these previously identified risk factors are also a risk factor for AD women or if the additional stressors associated with being on active duty (AD) are risk factors for PPD. The purpose of this review is to determine if civilian risk factors have been found to put AD women at risk for PPD and to identify unique risk factors for PPD in AD women. ⋯ Few studies have investigated the risk factors for PPD in AD women. It appears that AD women share many risk factors, or variants of those risk factors, for PPD as their civilian and AD spouse counterparts, but there are also unique risks to consider. More work is needed to improve screening and prevention efforts.
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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.