Military medicine
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The Army Combat Fitness Test (ACFT) is the fitness assessment used by the Army launched in April of 2022. The ACFT consists of six physically demanding motor movements that parallel to the stressors experienced by the modern-day combat soldier. The aim of this study is to determine the efficacy of a 12-week virtual exercise program on the individual and their overall ACFT scores. ⋯ The TRX Elite ACFT Kit which includes one suspension trainer, four varying resistance bands, and on-demand access to a stepwise 12-week virtual exercise program was deemed effective by increasing the overall mean ACFT scores among participants. From a practitioner's perspective, the TRX Elite ACFT Kit should be widely distributed to all Army units and recruiting commands to provide vital assistance for recruits and soldiers to train and prepare for the ACFT. Moreover, given the ease and portability of the TRX Elite ACFT Kit, recruits and soldiers will be able to effectively train anytime, anywhere.
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Initial Assessment of a Regional Military-Civilian Partnership on Trauma Surgery Skills Sustainment.
Trauma surgery skills sustainment and maintenance of combat readiness present a major problem for military general surgeons. The Military Health System (MHS) utilizes the knowledge, skills, and abilities (KSA) threshold score of 14,000 as a measure of annual deployment readiness. Only 9% of military surgeons meet this threshold. Most military-civilian partnerships (MCPs) utilize just-in-time training models before deployment rather than clinical experiences in trauma at regular intervals (skills sustainment model). Our aim is to evaluate an established skills sustainment MCP utilizing KSAs and established military metrics. ⋯ Based on this initial evaluation, a military surgeon taking two calls/month over 12 months through our regional skills sustainment MCP can generate more than 80% of the KSA points required to meet the MHS KSA threshold for deployment readiness, with the majority being CCC-RCs. Intangible advantages of this model include exposure to multiple trauma resuscitations while possibly eliminating just-in-time training and decreasing pre-deployment requirements.
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Military trainees are at an increased risk of stress fractures. Vitamin D availability is known to play an important role in both fracture prevention and healing. The purpose of this investigation was to assess 25-hydroxy vitamin D (25(OH)D) levels in soldiers with confirmed lower extremity stress fractures and assess the predictors of fracture location. ⋯ Overall, 74% of patients in military training with lower extremity stress fractures had insufficient or deficient levels of 25(OH)D, highlighting a persistent area of concern in this population. Patients with femoral neck and tibial shaft stress fractures had significantly lower BMI than patients with foot and ankle stress fractures. This suggests that in stress fracture-prone patients, BMI may play a role in predicting fracture location.
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With increasing global unrest and military physician shortages potentially leading to a surgeon draft, we sought to evaluate the readiness of graduating general surgery residents to care for casualties of war. ⋯ Graduating general surgery residents has limited exposure to wartime critical skills due to a significant reduction in open vascular, head and neck, thoracic, and operative trauma cases. As the threat of global war persists and new graduates continue to deploy worldwide, residency training must be augmented to ensure adequate preparation in case a surgeon draft is required to fulfill demand for military surgeons.
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Pulmonary embolism (PE) is associated with significant rates of morbidity and mortality. Management of PE is complex, and adverse patient events are not uncommon. Brooke Army Medical Center (BAMC) is among several select institutions that have implemented multidisciplinary pulmonary embolism response teams (PERTs) to improve PE outcomes. PERT structure varies among institutions and often involves specialty expertise from a variety of departments within the hospital. PE response teams aim to improve the diagnosis and treatment for patients with acute PE. Here, we report our initial experience with this intervention. ⋯ To our knowledge, this is the first report describing the successful implementation of a PERT at a military treatment facility to guide the evaluation, management, and treatment of PE. The implementation of the PERT improved the appropriate diagnostic evaluation for patients with intermediate-risk PE and reduced the use of non-guideline-based catheter-directed thrombolysis. This initiative serves as an example of what could be applied across other military treatment facilities within the Defense Health Agency.