Articles: ninos.
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Background Antidepressants are associated with postural hypotension (PH), but it is not typically recognised as a common adverse effect. PH is linked with serious complications in older adults (e.g. falls, stroke, cognitive decline). Randomised Controlled Trials (RCTs) examining antidepressants often exclude older people and do not focus on adverse effects. ⋯ Risk of PH was highest with SSRIs (IRR 4.22, 95% CI: 3.76-4.74), followed by "Other antidepressants" (IRR 2.17 (95% CI: 1.76- 2.68), TCAs (IRR 2.12, 95% CI: 1.79-2.50). Conclusion A striking increased risk of PH was observed with all antidepressants in the first month, particularly SSRIs. Prescribers should be aware of this risk and may consider PH monitoring when initiating antidepressants.
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Management of the patient with moderate to severe brain injury in any environment can be time consuming and resource intensive. These challenges are magnified while forward deployed in austere or hostile environments. This Joint Trauma System Clinical Practice Guideline provides recommendations for the treatment and medical management of casualties with moderate to severe head injuries in an environment where personnel, resources, and follow-on care are limited. These guidelines have been developed by acknowledging commonly recognized recommendations for neurosurgical and neuro-critical care patients and augmenting those evaluations and interventions based on the experience of neurosurgeons, trauma surgeons, and intensivists who have delivered care during recent coalition conflicts.
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As of 2020 Holistic health and fitness (H2F) teams have been embedded into brigades to engage Soldiers in Preventative Mental, Physical, Nutritional, Spiritual, and Sleep Readiness services. This represents a change in Army culture from a focus on testing to one of wellness because of increasing sleep concerns, mental health concerns, and injury rates. Soldier awareness of H2F services, where to find them, how to use them, and command endorsement of H2F professional's services has been limited and not well studied. Most soldiers fall into the Generations Y and Z categories, and this population tends to access information primarily from social media sources. Social media platforms therefore represent potentially effective ways to reach these individuals to increase their awareness of H2F services. ⋯ The use of social media to facilitate soldier awareness and use of H2F mental and sleep readiness services is a viable option for H2F units seeking to enhance their reach in these areas. The project created very little demand on the local therapist's time or to brigade resources and may help increase Soldier accessing of H2F resources online and directly.
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Assessing military medical teams' ability to respond to large-scale mass casualty (MASCAL) events has become a priority in preparing for future conflicts. MASCAL exercises rely on large numbers of simulated patients with limited medical training. Role-players must be appropriately prepared to ensure that medical exercises adequately assess the expected capabilities of military medical units. The Uniformed Services University of the Health Sciences (USUHS) has evaluated future military providers for decades using a large-scale, multiday, immersive simulation called Bushmaster. Despite a robust casualty training system, the fidelity of the portrayals remained limited. ⋯ This improved casualty depiction system was a feasible approach to enhance the fidelity of a MASCAL exercise. It has since been shared with military medical units around the globe to assist with their MASCAL exercises, making future multisite evaluations of this casualty depiction system possible.
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The Special Warfare Training Wing and Special Warfare Human Performance Support Group (HPSG; all-co-authors) were established in fiscal year (FY) 2019 to consolidate and oversee all Air Force Special Warfare (AFSPECWAR) training and provide embedded medical and human performance support to candidates with the goal of improving graduation rates and the longevity of the AFSPECWAR operator. The purpose of this manuscript is to assess the impact of the HPSG on AFSPECWAR graduation rates, musculoskeletal injury (MSKI) incidence, and cost. ⋯ The impact of the HPSG on attrition, MSKI incidence, and cost-of-care was not consistent across all training pipelines; however, taken together, there were no increases in attrition, and the cost of MSKI management was significantly lower.