Military medicine
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The transient nature of military life coupled with environmental and psychosocial stressors increase the risk for alcohol misuse and abuse among active duty (AD) military service members and recent epidemiological studies demonstrate high rates of heavy drinking among AD personnel. Over the past decade, Department of Defense health care systems have observed increases in the utilization of substance use services among military personnel demobilizing from Operation Enduring Freedom and Operation Iraqi Freedom. Given the high rates of heavy drinking and increased use of substance use services in this population of AD personnel, the purpose of this study was to investigate how to best translate and implement an effective alcohol abuse prevention intervention tool (screening, brief intervention, and referral to treatment [SBIRT]) used in civilian populations to a military emergency department (ED) setting. ⋯ Results of this formative research study clearly indicate the implementation and translation of SBIRT into a military medical setting require attention to issues related to confidentiality, the veracity of alcohol reporting, as well as use of civilians over AD military personnel to deliver the SBIRT intervention. Furthermore, most participants expressed support for the SBIRT model and felt it could be implemented, with caveats, into a military health care setting such as an ED.
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Strict blackout discipline is extremely important for all military units. To be able to effectively determine wound characteristics and perform the necessary interventions at nighttime, vision and light restrictions can be mitigated through the use of tactical night vision goggles (NVGs). The lamp of the classical laryngoscope (CL) can be seen with the naked eye; infrared light, on the other hand, cannot be perceived without the use of NVGs. The aim of the study is to evaluate the safety of endotracheal intubation (ETI) procedures in the dark under tactically safe conditions with modified laryngoscope (ML) model. ⋯ Considering this finding, we still strongly recommend that it would be relatively safer to open the ML blade inside the mouth and to perform the procedures under a PL. In chaotic environments where it might become necessary to provide civilian health services for humanitarian aid purposes (Red Crescent, Red Cross, etc.) without NVGs, we believe that it would be relatively safer to open the CL blade inside the mouth and to perform the procedures under a PL.
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According to the Defense and Veterans Brain Injury Center and the Armed Forces Health Surveillance Center, the number of soldiers who have sustained a traumatic brain injury (TBI) has risen dramatically over the past decade. Studies have shown that brain damage can be exacerbated if blood loss occurs (often occurring in polytrauma). As blood supply is critical for brain function and survival, TBI patients must be properly resuscitated to maintain blood volume, blood pressure, and cerebral perfusion. Recent studies have suggested that blood loss can damage the vascular endothelium and enhance blood-brain barrier (BBB) permeability. Brain endothelial cells and the tight junctions between them are key structural components of the BBB. As the BBB is critical for isolating the brain from potential pathogens and for regulating the influx of molecules into the brain, evaluation of resuscitation fluids for their efficacy to improve BBB function has clinical relevance. Although whole blood and fresh frozen plasma (FFP) contain the essential coagulation factors, ions, and other factors, the transport and storage of these products in remote, austere environments can be challenging. The use of spray-dried plasma (SDP) has several advantages including storage at ambient temperature, can be readily reconstituted before use, and infectious materials can be inactivated during the drying process. In this study, we compared FFP and SDP for their effects on blood pressure, cerebral blood flow, BBB integrity, and markers of endothelial cells and tight junction proteins, in TBI animals with blood loss. ⋯ These preclinical results show that resuscitation with SDP may be superior to FFP, and support the further evaluation of this product as a resuscitation fluid for polytrauma patients with TBI.
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This case study describes the application of a commercially available, custom myoelectric elbow-wrist-hand orthosis (MEWHO), on a veteran diagnosed with chronic stroke with residual left hemiparesis. The MEWHO provides powered active assistance for elbow flexion/extension and 3 jaw chuck grip. It is a noninvasive orthosis that is driven by the user's electromyographic signal. Experience with the MEWHO and associated outcomes are reported. ⋯ Custom myoelectric orthoses offer an exciting opportunity for individuals diagnosed with a variety of neurological conditions to make advancements toward their recovery and independence, and warrant further research into their training effects as well as their use as assistive devices.
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Observational Study
Evaluation of a Novel Field Expedient Musculoskeletal Readiness Screening Tool in an Army Basic Training Population.
Musculoskeletal injuries present a significant challenge to military readiness accounting for over 29% of ambulatory medical visits and 25 million limited duty days across the U.S. Army. Although U.S. Military Health Systems perform periodic general health and deployment assessments, there is no validated tool to determine when a service member is at increased risk of sustaining a musculoskeletal injury. ⋯ The MRST shows potential as a tool for identifying service members at higher risk for sustaining a musculoskeletal injury. Further research is needed to assess the validity, reliability, and responsiveness of this novel screening tool.