Military medicine
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Mediastinal masses can be challenging to the surgical team and anesthetic considerations vary according to the location, pathology, surgical approach, and patient comorbidities. We report the case of a 21 cm symptomatic intrathoracic teratoma in a postpartum patient with a history of poliomyelitis. Significant challenges were presented for anesthetic induction, potential extracorporeal membrane oxygenation, and the use of neuraxial pain techniques and neuromuscular blockade. This case report demonstrates techniques to safely manage a patient with a large symptomatic mediastinal mass and potential neuromuscular disease.
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Perinatal and postpartum depression are common, affecting 13% to 24% of pregnant women through the first year postpartum. Depression screening is recommended by the American College of Obstetrics and Gynecology as an effective and low-cost intervention to improve patient outcomes; however, no nationwide screening rate is reported in the literature. This study was designed to assess the rate and effectiveness of screening in a major military medical center. ⋯ First trimester screening rates are excellent; however, 28-week and postpartum screening rates need improvement. Standardization of clinic screening procedures may be necessary to increase the screening rates. Veterans Affairs patients and dependent daughters have a higher-than-average risk for depression and should be monitored closely. This study demonstrates that a universal postpartum depression screening program is an important part of obstetric care.
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Although there is increasing awareness of brachial plexopathy secondary to rucksack use, isolated mononeuropathies have been less well described. Three cases of mononeuropathy secondary to rucksack use in military personnel are presented, including injuries to the long thoracic and spinal accessory nerves. We also review several different factors in the proper construction, components, and fitting of the rucksack that should be considered in order to prevent rucksack palsy and provide a concise suggestion for rucksack use and education.
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Healthcare workers have never faced a medical crisis that compares to the coronavirus disease-2019 pandemic. This modern-day pandemic fight draws parallels to a war. Because of these similarities, it would make sense that the experiences frontline providers have when transitioning to a normal healthcare routine would emulate experiences service members voice when reintegrating home from a battlefield. ⋯ Integrated, proactive programming is needed utilizing evidence-based resiliency training from professional organizations such as the National Alliance on Mental Illness, the Department of Health and Human Services' Substance Abuse and Mental Health Services Administration, as well as the existing Department of Defense programs. The Veterans Affairs has the backbone to develop and offer these programs and make a positive difference with Employee Whole Health efforts. Organized, evidence-based programming such as second victim education, mindfulness, and other personal skill building could be key to improving the lifelong well-being of our caregivers.
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Although the benefits of employment for veterans with mental health conditions are well-known, the effect of veterans' employment on a health system has not been evaluated. The purpose of this study was to evaluate the effect of veterans' employment (versus unemployment) on subsequent health care utilization in the Veterans Health Administration (VHA). ⋯ VHA's investment in employment services for veterans with mental health and substance use disorders could reduce health care utilization system wide.