Military medicine
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Musculoskeletal injuries are an endemic amongst U.S. Military Service Members and significantly strain the Department of Defense's Military Health System. The Military Health System aims to provide Service Members, military retirees, and their families the right care at the right time. The Military Orthopedics Tracking Injuries and Outcomes Network (MOTION) captures the data that can optimize musculoskeletal care within the Military Health System. This report provides MOTION structural framework and highlights how it can be used to optimize musculoskeletal care. ⋯ MOTION was established to capture the data that are necessary to improve military medical readiness and optimize medical resource utilization through the systematic evaluation of short- and long-term musculoskeletal injury patient outcomes. The systematic enhancement of musculoskeletal injury care through data analyses aligns with the National Defense Authorization Act (2017) and Defense Health Agency's Quadruple Aim, which emphasizes optimizing healthcare delivery and Service Member medical readiness. This transformative approach to musculoskeletal care can be applied across disciplines within the Military Health System.
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The U.S. Army Occupational Physical Assessment Test (OPAT) is a pre-enlistment physical employment screening assessment developed to place recruits and soldiers into Military Occupational Specialties (MOSs) based on their physical capabilities in order to optimize performance and limit injury. The OPAT consists of the seated power throw (SPT), strength deadlift (SDL), standing long jump, and interval aerobic run. During the scientific validation of the OPAT, two variants of the SPT and two variants of the SDL were used. Although the OPAT was validated using both variants for each test, U.S. Army scientists and policymakers have received queries regarding how these variants compare to each other. Therefore, the purpose of this study was to compare different variants of the SPT and SDL. ⋯ Performing different variants of the SPT and SDL influenced the resulting score. Although these findings do not alter the administration or scoring of the OPAT, they do provide a valuable reference in the event of future inquiries regarding the development of the OPAT.
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Traumatic brain injury (TBI) is a significant health issue among deployed and non-deployed U.S. military service members (SMs). Since 2000, an estimated 413,858 SMs have been diagnosed with at least one TBI. Due to the difficulty in distinguishing new incident TBIs from follow-up TBI-related medical encounters in the Military Health System (MHS), the official TBI case definition also includes an incidence rule considering an individual an incident case only once per lifetime. We sought to examine patterns in medical records of SMs with at least one TBI encounter, in an effort to identify repeat TBIs in individual SMs and to estimate the incidence of repeat TBIs within the study cohort as a whole. ⋯ Probability scores based on statistical modeling can provide reasonable estimates of repeat incidences of TBI using medical billing data when formerly only the first TBI was thought to be measurable. With 100% sensitivity and 69% specificity, application of these models can inform estimates of repeat TBI across the MHS. This effort shows initial success if estimating repeat TBI, and further modeling work is encouraged to increase the predictive characteristics of the models as these efforts show promise in estimating repeat TBI across the MHS.
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Multidrug-resistant (MDR) Gram-negative infections complicate care of combat casualties. We describe the clinical characteristics, resistance patterns, and outcomes of Pseudomonas aeruginosa infections in combat casualties. ⋯ Pseudomonas aeruginosa continues to be a major cause of morbidity, affecting severely injured combat casualties, with emergent antimicrobial resistance upon serial isolation. Among MDR P. aeruginosa, active antimicrobials remain the oldest and most toxic. Despite ongoing efforts, outbreaks are still noted, reinforcing the crucial role of antimicrobial stewardship and infection control.
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External hemorrhage control devices (EHCDs) are effective in reducing the death risk of noncompressible torso hemorrhage (NCTH), but the pressurized area is too large to prevent serious organ damage. This study aims to establish the surface localization strategy of EHCDs based on the anatomical features of NCTH-related arteries through CT images to facilitate the optimal design and application of EHCDs. ⋯ The arterial localization strategy established via anatomical investigation was consistent with the actual situation. The data are necessary for improving EHCD design, precise hemostasis, and EHCD-related collateral injuries.Trial registration: Ratification no. 2019092. Registered November 4, 2020-retrospectively registered, www.chictr.org.cn.