Vasovagal Electrophysiology on 12-Lead ECG After Venipuncture.

Vasovagal syncope is the most common form of syncope seen in young and otherwise healthy active duty service members. Although self-limiting, syncopal events often produce a significant drain of medical resources because of their sudden and often dramatic presentation, which can be associated with traumatic injuries secondary to loss in postural tone. Malignant differential pathologies associated with syncopal presentation need to be ruled out, which in turn further diminishes resources, especially in a deployed environment that is often in austere, remote locations with a lack of readily available medical supplies.

Effects of Obstructive Sleep Apnea and CPAP on Cognitive Function.

Purpose Of Review: Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial upper airway obstruction during sleep. Studies indicate that OSA is an independent risk factor for cognitive decline in older patients. The purpose of this paper is to critically review the recent literature on the cognitive effects of untreated OSA and the benefits of treatment across cognitive domains.

Enhancing behavioral sleep care with digital technology: study protocol for a hybrid type 3 implementation-effectiveness randomized trial.

Background: Insomnia affects almost one in four military service members and veterans. The first-line recommended treatment for insomnia is cognitive-behavioral therapy for insomnia (CBTI). CBTI is typically delivered in-person or online over one-to-four sessions (brief versions) or five-to-eight sessions (standard versions) by a licensed doctoral or masters-level clinician with extensive training in behavioral sleep medicine.

Optimizing Scarce Resource Allocation During COVID-19: Rapid Creation of a Regional Health-Care Coalition and Triage Teams in San Diego County, California.

Successful management of an event where health-care needs exceed regional health-care capacity requires coordinated strategies for scarce resource allocation. Publications for rapid development, training, and coordination of regional hospital triage teams to manage the allocation of scarce resources during coronavirus disease 2019 (COVID-19) are lacking. Over a period of 3 weeks, over 100 clinicians, ethicists, leaders, and public health authorities convened virtually to achieve consensus on how best to save the most lives possible and share resources.

Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation: An Expert Panel Report of the Task Force for Mass Critical Care and the American College of Chest Physicians.

Public health emergencies have the potential to place enormous strain on health systems. The current pandemic of the novel 2019 coronavirus disease has required hospitals in numerous countries to expand their surge capacity to meet the needs of patients with critical illness. When even surge capacity is exceeded, however, principles of critical care triage may be needed as a means to allocate scarce resources, such as mechanical ventilators or key medications.

The relationship between military occupation and diagnosed insomnia following combat deployment.

Study Objectives: Our objective was to investigate the relationship between military occupation and diagnosed insomnia following combat deployment.

Methods: This retrospective cohort study was conducted using existing electronic military databases. Eligible participants were military personnel with a deployment to Iraq, Afghanistan, or Kuwait between 2005 and 2009.

Effect of Obstructive Sleep Apnea on Neurocognitive Performance.

This article reviews the effects of obstructive sleep apnea on neurocognitive performance, proposed mechanisms of cognitive impairment, and the effects of continuous positive airway pressure on performance. Obstructive sleep apnea can affect several domains of neurocognitive performance to include attention and vigilance, memory and learning, psychomotor function, emotional regulation, and executive function. Proposed mechanisms include intermittent hypoxemia, sleep deprivation and fragmentation, hypercapnia, and disruption of the hypothalamic-pituitary-adrenal-axis.

Lung Cancer Screening at a Military Treatment Facility: A Retrospective Review.

Introduction: Lung cancer is the leading cause of cancer death among men and women, accounting for more fatalities than colon, breast, and prostate cancers combined. Smoking causes about 85% of all lung cancers in the United States and is the single greatest risk factor. In 2013, the US Preventive Services Task Force (USPSTF) published initial guidelines for low-dose computed tomography lung cancer screening (LCS) among patients 55-80 years old, with a 30-pack-year history, who are current smokers or who quit within the previous 15 years.

Disasters Resulting from Radiologic and Nuclear Events.

Radiation accidents are rare, but can produce large numbers of casualties with predictable patterns of injury. Casualties may suffer from a wide range of radiation exposures. Triage based on presence or absence of conventional injuries and an accurate assessment of radiation dose based on event history, symptoms, and laboratory testing, is critical.

Augmenting Critical Care Capacity in a Disaster.

A health care facility must develop a comprehensive disaster plan that has a provision for critical care services. Mass critical care requires surge capacity: augmentation of critical care services during a disaster. Surge capacity involves staff, supplies, space, and structure.

Effects of Insomnia and Depression on CPAP Adherence in a Military Population.

Initial self-reported depression and insomnia prior to the diagnosis and treatment of obstructive sleep apnea with continuous positive airway pressure therapy did not reliably predict short- and long-term adherence in a sample of active-duty military and veteran patients.

Comparative meta-analysis of prazosin and imagery rehearsal therapy for nightmare frequency, sleep quality, and posttraumatic stress.

Study Objective: In this meta-analysis, we compare the short-term efficacy of prazosin vs. IRT on nightmares, sleep quality, and posttraumatic stress symptoms (PTSS).

Methods: Reference databases were searched for randomized controlled trials using IRT or prazosin for nightmares, sleep disturbance, and/or PTSS.

Medication effects on sleep and breathing.

Sleep respiration is regulated by circadian, endocrine, mechanical and chemical factors, and characterized by diminished ventilatory drive and changes in Pao2 and Paco2 thresholds. Hypoxemia and hypercapnia are more pronounced during rapid eye movement. Breathing is influenced by sleep stage and airway muscle tone.

Plasmapheresis in the management of severe hypertriglyceridemia.

Plasmapheresis can benefit a variety of critically ill patients. A woman with diabetic ketoacidosis and severe hypertriglyceridemia was treated with plasmapheresis when conventional treatments did not markedly reduce her triglyceridemia. The patient was admitted to a medical intensive care unit because of diabetic ketoacidosis with severe lipemia.

Chronic obstructive pulmonary disease and vascular disease delay timeliness of early stage lung cancer resectional surgery.

Introduction: Lung cancer remains the leading cause of cancer death in the United States and worldwide. Timeliness to diagnosis and referral for resectional surgery is key to successful management for early stage disease.

Methods: We investigated the contribution of medical co-morbidities in the timeliness to resectional surgery for non-small cell lung cancer (NSCLC).

The immune response and its therapeutic modulation in bronchiectasis.

Bronchiectasis (BC) is a chronic pulmonary disease with tremendous morbidity and significant mortality. As pathogen infection has been advocated as a triggering insult in the development of BC, a central role for the immune response in this process seems obvious. Inflammatory cells are present in both the airways as well as the lung parenchyma, and multiple mediators of immune cells including proteases and cytokines or their humoral products are increased locally or in the periphery.

Population characterization, histological evaluation, and timeliness of care of surgical nonsmall cell lung cancer patients in a military academic medical center.

Unlabelled: Lung cancer remains a major medical impediment in which early diagnosis and timely treatment are key factors in its management. This study evaluated nonsmall cell lung cancer (NSCLC) patients in a large military medical center to determine the timeliness to diagnosis and curative surgery in comparison with published guidelines. A retrospective record review of tumor registry NSCLC surgery cases at Navy Medical Center San Diego (NMCSD) from 2004 to 2009 was conducted.

Recognizing asthma mimics and asthma complications.

Asthma is a chronic inflammatory disorder of the airways characterized by airflow obstruction, bronchial hyperreactivity, and underlying inflammation. Two common reasons asthmatics fail standard therapy are incorrect diagnosis and failure to recognize underlying contributing factors. A correct diagnosis of asthma is of great importance to military practitioners since misdiagnosis or uncontrolled asthma affects an individual's operational readiness or determines whether one can receive a medical waiver to enlist in military service.

A case of severe exercise-induced rhabdomyolysis associated with a weight-loss dietary supplement.

In response to questions about the safety of ephedra-based dietary products, ephedra-free products are now available. Many contain synephrine, a sympathomimetic amine with structural similarities to ephedra. We present a 22-year-old, previously healthy, African American male with sickle cell trait who developed rhabdomyolysis after ingestion of a synephrine-containing dietary supplement.

Autonomic function in sleep apnea patients: increased heart rate variability except during REM sleep in obese patients.

The objective of this study was to examine heart rate variability (HRV) among sleep stages in obstructive sleep apnea (OSA) patients. The study was retrospective within subjects and examined the sleep stages and HRV in relation to OSA, age, body mass index (BMI), and sex. Data collected during diagnostic polysomnograms were used in this study.