Military medicine
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Protective ballistic body armor (BA) may be needed during certain threat postures while deployed. This requirement often adds between 35 and 45lbs of extra weight carried by the service member (SM) for multiple hours during the day. The physical toll of that extra weight and the effect it may have on deployed medical resources has not been clearly characterized in the literature. We sought to evaluate the association of a protective BA wear requirement with musculoskeletal (MSK) complaints and to better characterize how these effects are manifested within the deployed military health care system. ⋯ Required wear of BA was associated with an increase in MSK visits across all types of US SMs. Shoulder and back injuries were the most common with a significant increase in visits to physical therapy in the BA group. Anti-inflammatory and muscle-relaxing medications were prescribed more frequently in the BA group. A dedicated prospective study would help better elucidate the causality of these associations. Risk-benefit analysis of threat posture, with the knowledge of these health care associations, deserves serious consideration.
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Nitrous oxide (N2O) is commonly used in pediatric procedural sedation. It is an attractive option to facilitate intravenous line placement, as it does not extend sedation recovery from subsequently administered agents. Although debate exists regarding health consequences of occupational exposure now that scavenging of exhaled gases is common, cooperation of pediatric patients to maximize engineering controls is not guaranteed and can contribute to repeated exposure over the course of a clinician's career. There is no global consensus on personal exposure limits, but the National Institute for Occupational Safety and Health published U.S. guidelines. A dosimetry survey of our sedation team during a short N2O procedure for intravenous line placement exceeded the National Institute for Occupational Safety and Health Recommended Exposure Limit (REL) of 25 parts per million. We designed a process improvement initiative to reduce occupational exposure below the Recommended Exposure Limit on serial surveys. ⋯ We layered work practice changes atop engineering controls to reduce occupational exposure levels for medical team members. We utilized dosimetry as a lagging indicator, prompting frequent reassessments of our equipment and processes that we might not otherwise have performed. Pediatric sedation programs are encouraged to consider whether Industrial Hygiene resources might provide synergy to process improvement efforts with inhalational sedation agents.
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Military physicians serve as staff officers where both leading and following are important competencies. Navigating between the two roles is a necessary skill to avoid undermining one's boss and to support the mission. This case describes a deployed junior officer reconciling his role as the lead medical expert while supporting a Commander's decision, highlighting the challenges of followership in situations of disagreement.
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Prognosis is a forecast of the likely course of a disease and its future implications on treatment outcomes. The significance of periodontal prognosis in clinical practice is evident by its influence on treatment planning, communication, and in the retrospective evaluation of treatment results. While there are multiple well-known prognosis systems reported in the periodontal dental literature, there is an absence of data on the actual use of prognosis assignment among practicing clinicians. The purpose of this study was to survey military periodontists regarding their utilization of periodontal prognosis and associated systems and to evaluate prognosis' influence on treatment planning as well as its implications on operational dental readiness. ⋯ Kwok and Caton and McGuire periodontal prognosis systems were utilized by the majority of respondents but differed in utilization by military service branch. Respondents considered periodontal presentation severity and treatment outcome predictability the most important factors when assigning a prognosis. There was minimal influence between operational dental readiness and periodontal prognosis. Future research will evaluate prognosis system utilization in a broader population and will assess the impact of system standardization in education and clinical practice.
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Active duty service members (ADSMs) of the U.S. Armed Forces are uniquely at risk for musculoskeletal injuries (MSKIs) of the Head/Neck region, including the eye and face, from training with head gear, donning Kevlar, operating aircraft, and maintaining sitting or standing postures for prolonged durations. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Head/Neck MSKIs across the Services from fiscal years (FYs) 2016 to 2021. ⋯ This retrospective, descriptive study established prevalence/incidence, health care utilization, and PC costs for Head/Neck MSKIs across the services from FY16-21, emphasizing the burden of Head/Neck MSKIs among the U.S. Armed Forces, with PC costs amounting to $42,912,940 in FY21 alone.