Effect of Serial Pregnancies on Physical Fitness.

Introduction: Pregnancy has a profound impact on physical fitness, and delivery does not allow for rapid return to peak performance levels as physiologic changes can persist for greater than 1 year postpartum. Multiple studies across all military services have documented decrements in physical performance with pregnancy among women. The purpose of this study was to determine the impact of serial pregnancies on physical fitness and body composition in a cohort of Army women.

Seasonality and Climatic Factors Associated With Human Rhinovirus/Enterovirus Nasopharyngeal Sample Positivity on Oahu, Hawai'i, 2016-2019.

Introduction: Globally, human rhinoviruses/enteroviruses (HRVs/ENTs), indistinguishable on many widely available molecular platforms, are among the leading causes of the common cold. Geographic and climatic factors impact the peak activity of these viruses. In temperate climates, the peak activity of HRV occurs during autumn and spring whereas that of ENT occurs during autumn and summer.

Using Reminder Letters to Improve Adherence to Routine Hemoglobin A1C Testing in Adults with Diabetes.

The American Diabetes Association (ADA) recommends hemoglobin A1C (A1C) goals of < 7% for most non-pregnant adults and < 8% for adult patients with extensive or life-limiting comorbidities. A1C testing is indicated every 3-months for patients not meeting goals to assess glycemic control, adjust medications, suggest lifestyle changes, and offer counseling. However, many patients do not adhere to routine testing.

Pre-Pregnancy Physical Fitness, Body Mass Index and Gestational Weight Gain as Risk Factors for Cesarean Delivery: A Study of Active Duty Women.

Introduction: The World Health Organization considers the optimal rate of delivery by Cesarean among healthy nulliparous women to be <15%. In 2020, the rate of primary Cesarean delivery (CD) in the US among nulliparous women with singleton, vertex pregnancies was 26%. An enhanced understanding of factors associated with women undergoing CD may assist in reducing this rate.

Effect of SARs-CoV-2 pandemic on infection prevention behaviors and bacterial burden of high touch surfaces in a medical/surgical setting.

This study aimed to determine the longitudinal efficacy of ultraviolet germicidal disinfection (UV-C) in a non-terminal disinfection context. Moreover, factors influencing enhanced infection prevention behaviors during the SARS-CoV-2 pandemic were evaluated. Sixty nursing staff from three medical/surgical wards in a large military hospital were recruited for a survey and microbiological sampling of high-touch surfaces (stethoscope, personal electronic device, common access card, and hospital ID badge) and portable medical equipment (wheelchairs and mobile commodes).

Prospective Results of the Modified Glide Path Technique for Improved Syndesmotic Reduction During Ankle Fracture Fixation.

Background: Malreduction after syndesmotic stabilization occurs in as many as 52% of cases and has been shown to detrimentally affect clinical outcomes. We propose that the modified Glide Path technique reduces the occurrence of syndesmotic malreduction.

Methods: This study is a prospective series comparing 16 patients reduced with the modified Glide Path technique with a retrospectively reviewed series of 25 patients reduced with a traditional technique using fluoroscopy and a clamp.

Increasing Faculty Participation and Mentorship in Quality Improvement with an Experiential Four-Hour Workshop.

Background: Graduate medical education programs lack enough faculty trained in quality improvement (QI). A major barrier to increasing the number of faculty competent in QI is insufficient time to engage in training. Research is missing on the effectiveness of short faculty development workshops to teach academic faculty QI principles and promote participation and mentorship in QI projects.

Aerodigestive clinic reduces emergency department and primary care utilization and increases access to ancillary and specialty care.

Objective: The study aimed to evaluate the effect of the aerodigestive clinic (ADC) on healthcare utilization.

Study Design: Retrospective quality improvement project; before and after.

Setting: The ADC at Tripler Army Medical Center (TAMC) in Honolulu, HI.

Persons tested for SAR-CoV-2 at a military treatment facility in Hawaii.

Health inequalities based on race are well-documented, and the COVID-19 pandemic is no exception. Despite the advances in modern medicine, access to health care remains a primary determinant of health outcomes, especially for communities of color. African-Americans and other minorities are disproportionately at risk for infection with COVID-19, but this problem extends beyond access alone.

Updated Review of the Pacific Asynchronous Telehealth System's Impact on Military Pediatric Teleconsultations.

The Pacific Asynchronous TeleHealth (PATH) system is an asynchronous provider-to-provider teleconsultation platform utilized by military medical facilities throughout the Western Pacific Region. This study focused on PATH utilization for pediatric cases and its impact on patient transfers and cost avoidance. This retrospective analysis reviewed PATH cases from March 2017 to February 2020 for patients aged 0-17 years.

Correlation of stress radiographs to injuries associated with lateral ankle instability.

Background: Stress radiographs have demonstrated superior efficacy in the evaluation of ankle instability.

Aim: To determine if there is a degree of instability evidenced by stress radiographs that is associated with pathology concomitant with ankle ligamentous instability.

Methods: A retrospective review of 87 consecutive patients aged 18-74 who had stress radiographs performed at a single institution between 2014 and 2020 was performed.

Implementing total-dose ferumoxytol in lieu of split-dose ferumoxytol.

Background: Ferumoxytol is Food and Drug Administration-approved as two 510 mg infusions. Retrospective and prospective reviews have established that a single 1020 mg infusion is as efficacious and safe as two 510 mg infusions.

Objectives: To transition our preferred intravenous iron infusion practice from two 510 mg infusions to a single 1020 mg ferumoxytol infusion.

The effect of pregnancy and the duration of postpartum convalescence on the physical fitness of healthy women: A cohort study of active duty servicewomen receiving 6 weeks versus 12 weeks convalescence.

Introduction: Pregnancy profoundly affects cardiovascular and musculoskeletal performance requiring up to 12 months for recovery in healthy individuals.

Objective: To assess the effects of extending postpartum convalescence from 6 to 12 weeks on the physical fitness of Active Duty (AD) soldiers as measured by the Army Physical Fitness Test (APFT) and Body Mass Index (BMI).

Methods: We conducted a retrospective study of AD soldiers who delivered their singleton pregnancy of ≥ 32weeks gestation at a tertiary medical center.

The prevalence of M. tuberculosis among acid fast bacilli cultures from military health system and veterans affairs beneficiaries in Hawaii and the Pacific Islands from 2002 to 2019.

The prevalence of tuberculosis among military health system (MHS) and Veterans Affairs (VA) beneficiaries in Hawaii and the Pacific Islands has not been previously reported. Our analysis evaluates the prevalence of M. tuberculosis (MTB) among acid fast bacilli culture(s) (AFB) tested at Tripler Army Medical Center (TAMC) on Oahu, HI and describes demographic factors associated with positive samples.

Respiratory Viral Pathogens Among U.S. Military Personnel at a Medical Treatment Facility in Hawaii From 2014 to 2019.

Introduction: Acute respiratory diseases account for a substantial number of outpatient visits and hospitalizations among U.S. military personnel, significantly affecting mission readiness and military operations.

Limited impact of an ultraviolet disinfection intervention on hygienic behaviors of nursing staff in a military hospital.

Ultraviolet disinfection (UV-C), though effective, has not been thoroughly evaluated at the level of the clinical end user. We assessed behavioral outcomes related to environmental hygiene among 60 nursing staff in a medical-surgical section after introduction of a UV-C tool aimed at disinfecting 4 high-touch surfaces, and we noted limited changes.

A Longitudinal Evaluation of the Bacterial Pathogens Colonizing Chronic Non-Healing Wound Sites at a United States Military Treatment Facility in the Pacific Region.

Purpose: The biology of chronic wounds is complex and many factors act concurrently to impede healing progress. In this study, the dynamics of microflora changes and their antibiotic susceptibility patterns were evaluated longitudinally over 30 days using data from 28 patients with a total of 47 chronic lower extremity wounds.

Materials And Methods: In this study, colonized wound isolates were characterized using cultural, biochemical, and VITEK 2 methods.

Respiratory Viral Pathogens in Children Evaluated at Military Treatment Facilities in Oahu, Hawaii From 2014 to 2018: Seasonality and Climatic Factors.

Five-year retrospective analysis of respiratory viruses in children less than 18 years old at Tripler Army Medical Center and outlying clinics in Oahu. Respiratory syncytial virus and influenza A showed pronounced seasonality with peaks from September to December and December to March, respectively. Results provide a better understanding of the timing of viral preventive strategies in Oahu.

Single Embryo Transfer Versus Double Embryo Transfer: A Cost-Effectiveness Analysis in a Non-IVF Insurance Mandated System.

Introduction: Because of increased morbidity seen in multiple gestations, the American Society of Reproductive Medicine recommends transfer of blastocysts one at a time for most patients. While cost-effectiveness models have compared single embryo transfer (SET) versus double embryo transfer (DET), few incorporate maternal and neonatal morbidity, and none have been performed in U.S.

Impacts of rTMS on Refractory Depression and Comorbid PTSD Symptoms at a Military Treatment Facility.

Introduction: Repetitive transcranial magnetic stimulation (rTMS) as a treatment for depression has been studied for over two decades. Repetitive TMS was approved by the Food and Drug Administration in 2008 for the treatment of depression after at least one failed trial of an antidepressant medication of adequate dose and duration. This study evaluated whether rTMS treatments may be associated with measurable improvements in depression and post-traumatic stress disorder (PTSD) symptoms for treated military beneficiaries in Hawaii suffering from depression.

Ureteral injuries in colorectal surgery and the impact of laparoscopic and robotic-assisted approaches.

Background: Ureteral injury is a feared complication in colorectal surgery that has been increasing over the past decade. Some have attributed this to an increased adoption of minimally invasive surgery (MIS), but the literature is hardly conclusive. In this study we aim to further assess the overall trend of ureteral injuries in colorectal surgery, and investigate propensity adjusted contributions from open and MIS to include robotic-assisted surgery.