Military medicine
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With blunt and penetrating trauma to the chest, warfighters frequently suffer from hemothorax. Optimal management requires the placement of a chest tube to evacuate the blood. Malposition of the tube may be a causative factor of inadequate drainage (retained hemothorax). ⋯ Compared to a standard tube, the steerable tube placed along the diaphragm improved pleural fluid drainage volumes by 17%, although this did not reach statistical significance in six trials. These new prototypes represent substantial improvements and were performed according to expectations. We believe that this steerable chest tube and portable suction-infusion pump can be effectively used for warfighters with chest injuries in austere environments.
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Multicenter Study Observational Study
Acute Hearing Deficits associated with Weapons Exposure in Section 734 Blast Overpressure Study (BOS).
This prospective, multi-site, observational study describes ongoing efforts in support of the Fiscal Year 2018 National Defense Authorization Act (NDAA) Section 734 Blast Overpressure Study (BOS) to identify the acute effects impulse and blast exposure have on hearing abilities of the Warfighter in various military training environments. ⋯ Recent discussions on Section 734 studies examining the effects of repetitive blast exposure have indicated that hearing-related issues were a critical problem that needed additional research. Study outcomes provide highly repeatable results across various weapons systems with hazardous blast exposure. This standardized set of hearing assessment tools for evaluating acute effects of noise under field conditions has been critically important in improving our understanding of TTS in prospective human subject research.
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Overweight and obesity trends are on the rise among both civilian and military beneficiaries. The purpose of this narrative review was to evaluate nutrition, behavioral, lifestyle, pharmacotherapy, and alternative approaches to weight management (WM) among adults with a focus toward identifying gaps and evidence-based strategies that could support or enhance current and future WM programming among military adult beneficiaries. ⋯ Reviewers identified several validated tools and techniques to augment and update existing WM programming to improve health and weight outcomes. The review affirmed use of individualized dietary patterns and not a "one-size-fits-all approach" as well as incorporating more comprehensive and team-approached treatments to make the best use of tools and strategies to enhance outcomes.
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Experiences by service members in recent conflicts and training environments illuminate concerns about the possible effects of blast overpressure (BOP) exposure on brain health. Section 734 of the National Defense Authorization Act for Fiscal Year (FY) 2018 (Public Law 115-91) requires that the Secretary of Defense conducts a longitudinal medical study on blast pressure exposure of members of the Armed Forces during combat and training, and the Assistant Secretary of Defense for Health Affairs was assigned responsibility for fulfilling requirements. The study's goal is to improve DoD's understanding of the impact of BOP exposure from weapon systems on service members' brain health and inform policy for risk mitigation, unit readiness, and health care decisions. This article focuses on the activities of the Weapon Systems Line of Inquiry (LOI) and the development of a prototype BOP Tool. ⋯ It is recommended that the DoD revises requirements and policy to improve and standardize safety guidance throughout research, development, testing, and evaluation; acquisition; and training. The validated BOP Tool allows users to generate a scenario to predict BOP exposure and allows service members to modify them during planning for safer training.
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Randomized Controlled Trial
A Randomized Controlled Trial of Precision Nutrition Counseling for Service Members at Risk for Metabolic Syndrome.
Metabolic syndrome (MetS) is a threat to the active component military as it impacts health, readiness, retention, and cost to the Military Health System. The most prevalent risk factors documented in service members' health records are high blood pressure (BP), low high-density lipoprotein cholesterol, and elevated triglycerides. Other risk factors include abdominal obesity and elevated fasting blood glucose. Precision nutrition counseling and wellness software applications have demonstrated positive results for weight management when coupled with high levels of participant engagement and motivation. ⋯ Early signs of progress with weight loss at 6 weeks were not sustained at 12 weeks. DNA-based nutrition counseling was not efficacious for weight loss.