Military medicine
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Cerebral concussions are a well-recognized issue in military and civilian practice. Although most physicians are well versed in recognizing concussion symptoms, many are not as adept at diagnosing and managing comorbid traumatic optic neuropathy (TON). ⋯ We hereby describe a soldier who sustained a cerebral concussion with an associated unrecognized TON. We review the epidemiology, pathophysiology, diagnosis, and management of TON.
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The primary aim of Reserve Officers' Training Corps (ROTC) programs is to prepare cadets for future military service. To successfully complete one of these programs and perform active duty responsibilities, cadets must be able to complete a variety of physical tasks. Therefore, performing movement screening may be useful for identifying potential movement disparities that could lead to injury. The purpose of this investigation was to determine whether sex-related differences in movement patterns exist on the Functional Movement Screen (FMS). The FMS is a tool that uses seven functional movements to assess movement pattern deficits and asymmetries; deep squat, hurdle step, inline lunge (ILL), shoulder mobility, active straight-leg raise (ASLR), trunk stability pushup (TSPU), and rotary stability. ⋯ Sex differences in the ILL, ASLR, and TSPU may be because of greater mobility in the ankle and hamstrings and reduced upper-body muscle mass for females compared with males. Males performed better than females on the TSPU test. In conclusion, sex-related differences in FMS performance do exist within the ROTC population. Additionally, these differences should be taken into consideration when designing specific exercise programs for ROTC cadets.
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Job satisfaction and retention of military and civilian nurses and physicians who work in military treatment facilities (MTFs) are critical to maintaining quality of care and operational readiness. Civilian nurses and physicians working in MTFs supplement staffing for active duty military nurses and physicians and support operational readiness when military nurses and physicians deploy in wartime crises or humanitarian efforts. Decreased retention of military and civilian nurses and physicians can negatively impact operational readiness and patient care outcomes. Although several factors (e.g., burnout, pay, and leadership) influence job satisfaction and retention among nurses and physicians in both military and civilian healthcare settings, high-quality communication and relationships between nurses and physicians are associated with better job satisfaction and retention. However, little is known about how high-quality communication and relationships affect job satisfaction and retention among nurses and physicians in MTFs. Relational coordination (RC) is a process of high-quality communication supported by relationships of shared knowledge, shared goals, and mutual respect among members of the healthcare team. By strengthening RC, hospital leaders can more effectively achieve desired outcomes. The purpose of this study was to explore how RC influences job satisfaction and intent to stay among nurses, residents, and physicians in an Army hospital, and whether job satisfaction mediated the relationship between RC and intent to stay. ⋯ Our findings suggest that RC is a powerful workplace dynamic that influences job satisfaction and intent to stay, for nurses, residents, and physicians in MTFs. Specifically, we found that RC was positively associated with job satisfaction and intent to stay and that job satisfaction mediates the relationship between RC and intent to stay. We recommend that hospital leaders in MTFs explore interventions to strengthen RC among health professionals by including relational, work process and structural interventions as part of their strategy for retaining military healthcare professionals.
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Guidelines indicate the need to balance the risks of opioid prescribing with the need to adequately manage pain after cesarean section (CS). Although guidelines suggest the need for tailored opioid prescribing, it is unclear whether providers currently tailor opioid prescribing practices given patient-related factors. Thus, research is needed to first understand post-CS pain management and opioid prescribing. The objective of the present study was to identify factors related to CS discharge opioid prescriptions. ⋯ Patient and medical factors were not associated with post-CS opioid prescribing. Larger studies are needed to better elucidate optimal post-CS pain management in the days and months that follow CS. Such findings are needed to better tailor opioid prescribing, consistent with clinical practice guidelines.
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Esophageal adenocarcinoma develops when normal squamous epithelia are replaced by dysplastic intestinal columnar cells in response to chronic gastroesophageal reflux disease (GERD). In addition to squamous cell carcinoma, the two malignancies account for over 95% of esophageal malignancies. ⋯ Upon return to homeport, he was diagnosed with stage III gastroesophageal junction adenocarcinoma. This case emphasizes the difficulty in identifying and diagnosing a rare and dangerous pathology in the resource-limited, operational environment.