Military medicine
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Vasovagal syncope is the most common form of syncope seen in young and otherwise healthy active duty service members. Although self-limiting, syncopal events often produce a significant drain of medical resources because of their sudden and often dramatic presentation, which can be associated with traumatic injuries secondary to loss in postural tone. ⋯ We present a case of vasovagal syncope experienced by a 20-year-old sailor shortly after venipuncture and the 12-lead electrocardiogram captured shortly after presentation. This case highlights the unique electrophysiology during a vasovagal episode and the impact a relatively benign condition has on medical operations in the operational setting.
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Observational Study
Pre-task Intrinsic Cortical Activity in Novice and Experienced Military Specialists: A Cross-sectional Study.
Neuroscience studies brain dynamics through the analysis of electrical signals. Cortical activity estimated by electroencephalography brings accurate information about perceptions of human behavior. The examination of resting states in relation to subsequent behaviors indicates that intrinsic cortical activity (ICA) has implications for decision-making processes, especially when inserted in the context of military activities and associated with stress. The objective of this study was to compare the absolute alpha power (AAP) in the ICA in the pre-task moment of novice specialized military (NG) with experienced (ExpG), associating with the level of stress. ⋯ The AAP in ExpG was significantly higher than that in NG, indicating a lower level of cortical activity and greater efficiency in sensory, motor, and visual tasks.
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Primary mediastinal large B-cell lymphoma (PMBCL) is a rare, non-Hodgkin, B-cell lymphoma thought to originate from thymic B cells, which occurs primarily in young adults such as in the active duty population. Primary mediastinal large B-cell lymphoma (PMBCL) presents as a large mediastinal mass, posing risks to the cardiopulmonary safety of patients and challenging the routine approach to diagnosis. We describe a case of a 23-year-old male sailor who presented to sick call on his ship while in port with shortness of breath, night sweats, 50-pound weight loss, and pruritic punched-out lesions on all extremities. ⋯ Empiric high-dose dexamethasone was initiated before a formal diagnosis due to his significant risk for cardiopulmonary compromise. Following diagnosis and two cycles of chemotherapy, the patient was transferred to a medical oncology facility in the continental USA. This case demonstrates the need to educate all military providers to recognize the presentation of mediastinal masses in active duty service members and the importance of urgently escalating these patients to higher levels of care in order to avoid life-threatening complications.
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Multicenter Study
Quasi-experimental Controlled Study on the Effect of Autism Resource Clinic Guardian Attendance at a Military Treatment Facility.
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that requires multidisciplinary care. Evidence-based practice indicates that early intervention may improve long-term ASD outcomes. The Autism Resource Clinic (ARC) provides an educational session for guardians empowering them to build a personalized ASD team for their child. We examined the impact of guardian attendance of an ARC at a Military Treatment Facility on time to initiation of patient services and guardian stress level. ⋯ Although ARC did not influence time to initiation of patient services or guardian stress level, attendance of ARC was associated with more frequent use of Applied Behavioral Analysis services and county early intervention services. This pilot study is unique as it targets guardians of ASD patients within military treatment facilities. Study limitations include data collection during the coronavirus disease 2019 pandemic, sequential evaluation of experimental and control groups, sample size and generalizability. A large, multicenter, randomized controlled trial is required to better assess the impact of this educational opportunity among military populations.
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The Military Health Care System trains approximately 1,500 resident physicians in over 100 specialties. In addition to requirements for their specific program, active duty military trainees must complete military-specific trainings that vary by the branch of service. Excessive training requirements could contribute to physician burnout and/or negatively affect patient care. Therefore, the objective of this study was to quantify the time active duty resident physicians dedicate to this training, stratified by the branch of service. ⋯ Annually, active duty resident physicians spend the equivalent of more than two work days completing additional training requirements on multiple platforms. Standardizing training requirements and platforms across the Military Health Care System and aligning required trainings with job responsibilities could free up additional time for patient care, potentially decreasing fatigue and burnout.