Military medicine
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The purpose of this article is to provide a historical perspective on the commissioning of chiropractors within the U. S. Military and to propose a pathway by which this can be accomplished. ⋯ Chiropractic physicians serving within military medicine and veteran health care facilities routinely manage common and complex neurological and musculoskeletal injuries sustained by combat and non-combat servicemen and women. Patient satisfaction with chiropractic services within both the active duty and veteran population is high and routinely sought after. Chiropractic inclusion in the medical corps or medical service corps within the DoD is long overdue.
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Recently, there has been increasing concern about the adverse health effects of long-term occupational exposure to low-level blast in military personnel. Occupational blast exposure occurs routinely in garrison through use of armaments and controlled blast detonations. In the current study, we focused on a population of breaching instructors and range staff. Breaching is a tactical technique that is used to gain entry into closed spaces, often through the use of explosives. ⋯ Our results suggest that basic tests of balance, ataxia, and hearing on their own were not sensitive to the effects of long-term occupational exposure to low-level blast. Some of the blast exposure levels exceeded limits, and there was a significant association of exposure with tinnitus. Future studies should supplement with additional information including exposure history and functional hearing assessments. These findings should be considered in the design of future acute and longitudinal studies of low-level blast exposure.
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Complex facial lacerations are frequently encountered in the combat environment. Trauma with soft-tissue loss of the periorbital region offers particular challenges in terms of operative reconstruction. Cicatricial changes in the sub-acute phase can lead to eyelid malposition and lagophthalmos. ⋯ This case demonstrates the viability of simultaneous full-thickness skin grafting with concomitant amniotic membrane grafting for the acute reconstruction of periorbital trauma with eyelid anterior lamella tissue loss. An excellent cosmetic and functional outcome was attained. By providing acute reconstruction, the risk of damage secondary to cicatricial periorbital changes may be avoided.
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Observational Study
Validation of a Machine Learning Model for Early Shock Detection.
The objectives of this study were to test in real time a Trauma Triage, Treatment, and Training Decision Support (4TDS) machine learning (ML) model of shock detection in a prospective silent trial, and to evaluate specificity, sensitivity, and other estimates of diagnostic performance compared to the gold standard of electronic medical records (EMRs) review. ⋯ We successfully validated an ML model to detect circulatory shock in a prospective observational study. The model used only vital signs and showed moderate performance compared to the gold standard of clinician EMR review when applied to an ICU patient cohort.
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The coronavirus disease 2019 (COVID-19) is a viral respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has led to one of the world's largest infectious disease outbreaks. COVID-19 first emerged in Wuhan, Hubei, China, in December 2019, and the emergence was especially concerning to the U.S. Forces Korea (USFK) stationed in the Republic of Korea (ROK, South Korea), which remains vital to peace and security of the East Asian region. The first wave of cases emerged in South Korea from China before a globally established response, which forced USFK into a challenging position to combat a novel virus with countless unknowns regarding effective control and portended impact. ⋯ In successfully executing the operation, USFK imparts three main lessons for future outbreaks. First, a military command should execute a health response similar to how it executes combat operations against a battlefield enemy. Second, the command should maintain flexibility to new changes or risks that alter courses of action. And finally, engagement with the local community, host nation, and international partners should not be compromised when formulating strategies. The USFK's immediate recognition of the public health threat by all levels of leadership and medical personnel enabled a unique and highly effective Operation Kill the Virus that engaged all members of the community, both local and international.