Military medicine
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To date, there is no evidence concerning the emergency surgical management of severe trauma patients (STP) with severe traumatic brain injury (STBI) presenting a life-threatening intracranial hematoma and a concomitant extra-cranial noncompressible active bleeding. Current guidelines recommend stopping the extra-cranial bleeding first. Nevertheless, the long-term outcome of STP with STBI mainly depends from intracranial lesions. Thus, we propose a combined damage-control surgical strategy aiming to reduce the time spent with intracranial hypertension and to hasten the admission in the intensive care unit. The main objective of the study is to evaluate the benefits of combined cranial and extra-cranial surgery of STP on the long-term outcome. ⋯ Performing combined life-saving cranial and extra-cranial surgery is feasible and safe as long as the trauma teams are trained according to the principles of damage control. It may be beneficial for the neurologic prognostic of STP with STBI requiring cranial and extra-cranial surgery.
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It has been 20 years since the September 11, 2001 terrorist attacks on America. The ongoing military conflicts in this region are the longest sustained conflicts in U. S. history. ⋯ S. military conflict in history. Advances in the military equipment, tactics, and healthcare programs perhaps mitigated casualties and suffering among Iraq/Afghanistan veterans compared to previous wars. The estimated causality differences across various military conflicts are not meant to minimize the significant contributions and sacrifices made by this new generation of military warriors but to help us gain perspective on military conflicts over the past century as we recognize the 20th anniversary of 9/11.
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Pharmacy patient experience within military treatment facilities (MTFs) is a significant indicator of healthcare quality, as hospital admissions correlate with medication use (Budnitz et al., 2006) and pharmacists have a unique opportunity to influence patients' health (Dalton & Byrne, 2017). To improve patient care across the military health system (MHS), we investigated best practices within MTF pharmacies with the highest patient experience scores. ⋯ These findings provide valuable insights to improve public health in military-connected populations through improved patient care practices in pharmacies across the MHS. Initiatives aimed at improving health care for pharmacy patients should prioritize improved communication and structural support for team members to create patient-friendly environments, which enables pharmacists and technicians to connect with patients and positively impact health outcomes. Limitations include lack of comparison data for lower performing pharmacies; future research will explore practices at lower ranking pharmacies to provide insights into communication practices, environments, and staff relationships impacting patient experience scores as well as the role patient demographics (e.g., retirees vs. active duty) and characteristics including facility size play in potential improvements.
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Physical fitness is foundational to the U.S. Army as a component of combat readiness, and accurate assessment of readiness is imperative for mission success and soldiers' health and safety. To this end, the Army has developed the Army Combat Fitness Test (ACFT), which more accurately assesses these abilities and may aid development of a more combat-ready force. Reserve Officer Training Corps (ROTC) programs nationwide are often challenged by limited structured training time, as well as access to equipment and training space. Development and/or adaptation of a training program that addresses these limitations would benefit ROTC programs nationally. Therefore, the purpose of this study was to compare a standard military fitness training program to High-Intensity Functional Training (HIFT) in ROTC cadets. We hypothesized that a HIFT program would be more effective than the standard military program developed by the DoD on both ACFT performance and assessment of common Warrior Tasks and Battle Drills (WTBDs). ⋯ Three 60-minute sessions per week of moderate-high-intensity training elicited improvements in ACFT scores, with no statistically significant differences between training programs. For this population of ROTC cadets, implementing a structured training program with expert oversight appears to be effective. Based on the successes and unanticipated challenges encountered in this study, training programs that emphasize intensity, train a wide variety of movements, maximize adherence, and are adaptable to a variety of situations are likely to be successful at improving ACFT scores.
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Mediastinal masses are a rare finding in the emergency department and typically present with vague chest complaints such as chest discomfort, chest pain, or dyspnea. Rarely do these tumors present with dysrhythmias, and when dysrhythmias are present, they typically arise secondary to endocrine or metabolic effects exerted by the tumor. Here we report a case of a patient who presented to the emergency department with atrial fibrillation with rapid ventricular response, concomitant with a history of recurrent palpitations that were previously aborted with self-induced vagal maneuvers. Upon further investigation, the patient had an anterior mediastinal mass, diagnosed as a thymoma, suspected to be contributing to his presenting dysrhythmia through mass effect.