Military medicine
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Over 1,500 bladder cancers were diagnosed among US Veterans in 2010, the majority of which were non-muscle invasive bladder cancer (NMIBC). Little is known about NMIBC treatment within the Veterans Health Administration. The objective of the study was to assess the quality of care for Veterans with newly-diagnosed NMIBC within Veterans Integrated Service Network (VISN) 02. ⋯ We observed high rates of sampling of detrusor in the first TURBT specimen, utilization of repeat TURBT, and administration of induction and maintenance intravesical BCG for high-risk patients among a regional cohort of US Veterans with NMIBC. While not a comparative study, our findings suggest high quality NMIBC care in VA VISN 02.
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Lyme arthritis is the most common manifestation of late Lyme disease in children. Lyme disease is known to be endemic to Japan, but is rarely diagnosed. ⋯ This case highlights the importance of obtaining a travel history from military members and their families who frequently relocate due to military orders. Military medical providers must be aware of tropical and travel-related illnesses and infections that may have been acquired at a prior duty station.
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Maxillofacial and neck trauma from penetrating injuries present unique challenges for anesthesia providers and surgeons. In the austere conditions of a combat setting these challenges may be amplified due to limited resources and injury severity. ⋯ The authors of this paper present the successful emergency management of a traumatized airway from a severe maxillofacial and neck-penetrating wound. A stepwise team approach using strong communication and a global mental model facilitated definitive airway management in this case allowing for safe transport to definitive care.
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Resilience is a psychometric construct of a patient's ability to recover from adversity and has been used to predict outcomes but its use in orthopedics has been limited. The purpose of this study was to examine the association between resilience and outcomes. ⋯ Active-military patients with high preoperative resilience appear to have significantly better early postoperative outcomes following sports knee surgery in terms of PROMIS-43, KOOS, and IKDC. There was also a lower rate of changing MOS secondary to sports knee surgery in patients with high resilience.
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There is mixed evidence regarding how posttraumatic stress disorder (PTSD) symptom clusters are associated with sexual dysfunction (SD), and most studies to date have failed to account for potentially confounding variables. Our study sought to explore the unique contribution of PTSD symptom clusters on (a) lack of sexual desire or pleasure, and (b) pain or problems during sexual intercourse, after adjusting for comorbidities and medication usage. ⋯ Sexual dysfunction is prevalent among male treatment-seeking CAF personnel and veterans. Results suggest that PTSD symptoms are differentially associated with sexual desire or pleasure concerns. Assessing sexual function among CAF personnel and veterans seeking treatment for PTSD is critical in order to treat both conditions and improve overall functioning.