Military medicine
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The USNS Mercy (T-AH 19) on Pacific Partnership 2018 was the first mobile, expeditionary platform to utilize the da Vinci Surgical System. Using a de-identified, web-based survey, the impact of this new technology on Pacific Partnership 2018 on the attitudes of host nation surgeons was examined.
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Muscle strength and muscle endurance are important fitness components related to safe and efficient execution of physically demanding military work. In soldiers, these components are traditionally measured from simple field tests like push-ups, sit-ups, and pull-ups. However, the validity of such muscle fitness field tests is questioned due to reports of low association between test performance and the ability to conduct strength demanding military work (eg, lift and carry tasks). It is therefore necessary to study, develop, and implement more valid field tests, which are still feasible for mass testing in the military. Skeletal muscle mass (SMM) is an important physiological component related to maximal muscle force generation (strength). Thus, an alternative way of validating muscle fitness field tests is by comparisons against SMM. The purpose of the present study was to investigate the association between SMM and performance in five muscle fitness field tests. ⋯ Among the five muscle fitness field tests investigated, the Sargent jump (peak power) and the medicine ball throw demonstrated the strongest correlation coefficients against absolute SMM. Thus, these two tests should be better alternatives for assessing relevant upper and lower body strength and power in soldiers compared with push-ups, pull-ups, and sit-ups. Pull-ups generally demonstrated the strongest correlation against relative SMM. Sit-ups demonstrated low or nonsignificant associations with both absolute and relative SMM. Consequently, the test should be considered for removal from military fitness test batteries or replaced by alternative abdominal tests that are more valid.
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ST elevation myocardial infarction (STEMI) is a high acuity diagnosis that requires prompt recognition and developed system responses to reduce morbidity and mortality. There is a paucity of literature describing active duty (AD) military personnel with STEMI syndromes at military treatment facilities (MTFs). This study aims to describe AD military members with STEMI diagnoses, military treatment facility management, and subsequent military dispositions observed. ⋯ AD personnel represent a small minority of MTF STEMI diagnoses and present with lower risk cardiovascular profiles. AD personnel received standard STEMI management compared to national performance measures, and were deployment ineligible after STEMI diagnoses. Further studies are needed to definitively explore the appropriate military dispositions for members with STEMI diagnoses and acute coronary syndromes.
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At the Naval Medical Center San Diego urology clinic, patients reported waiting for greater than 1 month for an initial consult. A Lean Six Sigma approach was used to improve access to care (ATC) and decrease variation in access by improving scheduling. ⋯ An Lean Six Sigma model was used to improve timeliness of care for our patients, improving the overall quality of their healthcare experience. Simulation software can be used to model the clinic throughput and test alternative scheduling templates. ATC was significantly improved and patient satisfaction was maintained at or above goal thresholds.
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Cunninghamella species are aggressive, opportunistic fungi that are becoming more commonly reported in immunocompromised patients. We present a case of disseminated Cunninghamella sp. infection after stem cell transplant for refractory multiple myeloma with formation of bilateral pleural effusions and an aortic mycetoma. PCR analysis of the patient's aortic mycetoma demonstrated a 90% match to Cunninghamella spp. This case illustrates the potential for severe opportunistic fungal infections in immunocompromised patients that can mimic other disease processes and result in an accelerated demise.