Military medicine
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The Military Health System directly supports the National Security and Defense Strategy priorities of modernizing capabilities, enhancing lethality, supporting alliances, building partnerships, and implementing reform. Trauma medicine training programs with partner nations is a key lever that can be pulled, using a risk-based decision-making process, to scale up efforts toward these national priorities.
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The DoD has a specific mission that creates unique challenges for the conduct of clinical research. These unique challenges include (1) the fact that medical readiness is the number one priority, (2) understanding the role of military culture, and (3) understanding the highly transient flow of operations. Appropriate engagement with key stakeholders at the point of care, where research activities are executed, can mean the difference between success and failure. ⋯ Military leaders are driven by the ability to meet the demands of the assigned mission (readiness). Command endorsement and support are critical for service members to participate in stakeholder engagement panels or clinical trials offering novel treatments. To translate science into relevant practice within the Military Health System, early engagement with key stakeholders at the point of care and addressing mission-relevant factors is critical for success.
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Many active duty service members and their health care providers feel that the current body mass index (BMI) standard for diagnosing obesity, BMI ≥30 kg/m2, may unfairly overclassify as obese those with higher muscle mass. Unfortunately, a closer look at the data available for service members repeatedly demonstrates the exact opposite: we are actually underestimating the rates of obesity in service members using current BMI cutoffs when compared with body fat mass as measured by either dual-energy X-ray absorptiometry or bioelectrical impedance analysis as the gold standard. Using a lower BMI threshold and refining positive results via history, exam, labs, and/or more specific measurements of body composition would more accurately estimate body fat percentage in active duty service members while remaining convenient and scalable. Given the current obesity epidemic in our nation, this suggests the critical need for new approaches to screening, as well as treatment, of overweight and obesity in our military to improve service readiness.
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Case Reports
Treatment of Mal de Debarquement Syndrome in a Computer-Assisted Rehabilitation Environment.
Individuals with mal de debarquement syndrome (MdDS) describe symptoms of swaying, rocking, and/or bobbing after sea or air travel. These symptoms may be because of maladaptation of the vestibulo-ocular reflex (VOR) to roll of the head during rotation. Dai and colleagues have developed a treatment paradigm that involves passive roll of the patient's head while watching optokinetic stripes, resulting in adaption of the VOR and improvement of MdDS. ⋯ Her Global Rating of Change was +7 (on a 15-point scale of -7 to +7). She had returned to her prior level of function. This case report is the first to describe use of the CAREN for effective treatment of MdDS by replicating the treatment paradigm developed by Dai and colleagues.
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Amidst a constrained supply of novel therapeutics for the outpatient treatment of mild-to-moderate COVID-19, clinicians face new challenges, especially among those practicing at overseas military treatment facilities. Although prescribers may be unfamiliar with these medications, appropriate use necessitates detailed query of patient symptomatology and familiarization with each drug's side effect profile. Risk stratification also requires careful consideration to patient-specific comorbidities and immunization status for determining whom to treat and how. In recognition of these complexities, a stepwise guide is provided here to aid clinicians in their management of outpatients with mild-to-moderate COVID-19.