The effects of a prolonged exposure workshop with and without consultation on provider and patient outcomes: a randomized implementation trial.

Background: Prolonged exposure therapy (PE) is an evidence-based treatment for posttraumatic stress disorder (PTSD) that is underutilized in the military health system. Standard workshop training in PE may not be sufficient to alter provider behavior, but post-workshop consultation requires significant resources. Therefore, it is important to determine the incremental utility of post-workshop consultation.

Association of Strength Following Achilles Tendon Repair With Return to Same Level of Play in High-Level Athletes.

Background: Rupture of the Achilles tendon is a common injury and the ability to return to the same level of sporting activity after treatment is an important outcome for patients. The objective of the current study was to examine the relationship between ankle strength and the ability to return to previous level of play following operative repair of an Achilles tendon rupture.

Methods: Patients aged 18 to 50 years at a minimum 1 year postoperation from surgical repair of an Achilles tendon returned for a study visit.

"Your Finger or Mine?"-Patient Preferences in the Collection of Fecal Occult Blood Testing in the Emergency Department.

Introduction: There are a number of presenting Emergency Department complaints that may necessitate the testing of stool for the presence of blood. A provider-performed digital rectal examination is frequently performed solely for the collection of stool for a fecal occult blood testing (FOBT). With increased emphasis on patient autonomy and shared decision-making, it is appropriate to consider patient preferences with regard to who performs the invasive collection of stool.

Improving Endotracheal Cuff Inflation Pressures: An Evidence-Based Project in a Military Medical Center.

Poor management of endotracheal tube cuff pressures occurs in more than 50% of all general anesthetics, leading to tracheal ischemia, tracheal rupture, sore throats, recurrent laryngeal nerve palsy, tracheal stenosis, microaspiration, and/or inadequate ventilation. General endotracheal anesthesia is common practice throughout the world. Endotracheal tube cuffs are filled with a fluid (gas or liquid) to a safe and adequate pressure of 20 to 30 cm HO to protect the lung parenchyma from aspiration while also ensuring positive pressure can be generated to oxygenate/ventilate patients.

Gold-Induced Cytokine (GOLDIC) Injection Therapy in Patient with Plantar Fasciosis: A Case Report.

A novel technique of cultivating autologous blood with gold particles; then separating the gold particles and cells from the serum and injecting the conditioned serum into affected plantar fascia. A first-time report of the safety and efficacy in treatment of recalcitrant plantar fasciosis in an Olympic equestrian. A single patient with clinical signs, symptoms and ultrasound evidence of plantar fasciosis was treated with four intra-ligamentous GOLDIC injection therapy.

Sepsis: Diagnosis and Management.

Guidelines published in 2016 provide a revised definition of sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection. The guidelines define septic shock as sepsis with circulatory, cellular, and metabolic dysfunction that is associated with a higher risk of mortality. The measurement of serum lactate has been incorporated into the latest septic shock definition.

Operational Virtual Health Modalities Increased Combat Power for 1st Squadron, 2nd Cavalry Regiment During the Enhanced Forward Presence Mission.

Introduction: Virtual Health (VH) is posited to be a force multiplier for Military Medicine, delivering digital healthcare to the point of need for the warfighter. To date, there are no studies on the impact of both synchronous and asynchronous VH modalities during a deployment. VH usage by the 1st Squadron, 2nd Cavalry Regiment (1/2 CR) during a 6 month deployment to rural Poland was evaluated prospectively to identify mission days saved for Commanders.

Neuro-Ophthalmic Injuries With Systemic Neurologic Injury or Traumatic Brain Injury in Operation Iraqi Freedom and Operation Enduring Freedom.

Background: To analyze the final visual acuity (VA) of neuro-ophthalmologic injuries (NOI) in combat ocular trauma and to study the association of NOI with systemic neurologic injury (SNI) and traumatic brain injury (TBI).

Methods: The Walter Reed Ocular Trauma Database was reviewed. Inclusion criteria were any US service member and Department of Defense civilians who suffered NOI, SNI, or TBI in Operation Iraqi Freedom or Operation Enduring Freedom.

Influenza Vaccination, Self-reported Illness, and Obstacles for Vaccination Among the 2010 ROTC Warrior Forge Cadet Cohort.

Introduction: This study evaluates a large cohort of college students after the 2009-2010 pandemic H1N1 influenza season. The objective was to assess influenza vaccination status, influenzalike illnesses (ILIs), and other characteristics associated with attaining immunizations.

Methods: This study was conducted during the summer 2010 the Reserve Officer Training Corps Leadership Development and Assessment Course involving 6272 college students.

Antibiotic Practice Patterns for Extremity Wound Infections among Blast-Injured Subjects.

Introduction: We examined antibiotic management of combat-related extremity wound infections (CEWI) among wounded U.S. military personnel (2009-2012).

Impact of Doxycycline as Malaria Prophylaxis on Risk of Influenza-Like Illness among International Travelers.

Travelers are often at risk for both influenza-like illness (ILI) and malaria. Doxycycline is active against pathogens causing ILI and is used for malaria prophylaxis. We evaluated the risk factors for ILI, and whether the choice of malaria prophylaxis was associated with ILI.

Irp2 regulates insulin production through iron-mediated Cdkal1-catalyzed tRNA modification.

Regulation of cellular iron homeostasis is crucial as both iron excess and deficiency cause hematological and neurodegenerative diseases. Here we show that mice lacking iron-regulatory protein 2 (Irp2), a regulator of cellular iron homeostasis, develop diabetes. Irp2 post-transcriptionally regulates the iron-uptake protein transferrin receptor 1 (TfR1) and the iron-storage protein ferritin, and dysregulation of these proteins due to Irp2 loss causes functional iron deficiency in β cells.

Association of Time Since Injury to the First Clinic Visit With Recovery Following Concussion.

Importance: Recovery after concussion varies, with adolescents taking longer (approximately 30 days) than adults. Many factors have been reported to influence recovery, including preinjury factors, perceptions about recovery, comorbid conditions, and sex. However, 1 factor that may play a role in recovery but has received little attention from researchers is the timeliness of clinical evaluation and care.

Trauma Embolic Scoring System in military trauma: a sensitive predictor of venous thromboembolism.

Introduction: Clinical decision support tools capable of predicting which patients are at highest risk for venous thromboembolism (VTE) can assist in guiding surveillance and prophylaxis decisions. The Trauma Embolic Scoring System (TESS) has been shown to model VTE risk in civilian trauma patients. No such support tools have yet been described in combat casualties, who have a high incidence of VTE.

After the Battlefield: Infectious Complications among Wounded Warriors in the Trauma Infectious Disease Outcomes Study.

Introduction: During recent wars in Iraq and Afghanistan, improved survivability in severe trauma corresponded with a rise in the proportion of trauma-related infections, including those associated with multidrug-resistant organisms (MDROs). Significant morbidity was reported in association with the infections. There is also concern regarding potential long-term impacts of the trauma-related infectious complications.

Intimate Partner Violence Screening and Intervention: The American College of Preventive Medicine Position Statement.

The purpose of this paper is to produce a position statement on intimate partner violence (IPV), a major sociomedical problem with recently updated evidence, systematic reviews, and U.S. Preventive Services Task Force guidelines.

Arthroscopic Repair of 270- and 360-Degree Glenoid Labrum Tears: A Systematic Review.

Purpose: To review the current literature available and evaluate the efficacy of arthroscopic repair of 270° and 360° labral tears, as well as the complication rates associated with such. In addition, we intend to investigate whether consistent clinical findings can be observed in these patients.

Methods: This review is registered in the PROSPERO database.

Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial.

Importance: This is the first multisite, randomized clinical trial of stellate ganglion block (SGB) outcomes on posttraumatic stress disorder (PTSD) symptoms.

Objective: To determine whether paired SGB treatments at 0 and 2 weeks would result in improvement in mean Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total symptom severity scores from baseline to 8 weeks.

Design, Setting, And Participants: This multisite, blinded, sham-procedure, randomized clinical trial used a 2:1 SGB:sham ratio and was conducted from May 2016 through March 2018 in 3 US Army Interdisciplinary Pain Management Centers.

Management of Diabetes in Patients Undergoing Bariatric Surgery.

Purpose Of Review: The number of bariatric surgeries for patients with type 1 or type 2 diabetes continues to grow. Clinicians are challenged to choose therapies that reach glycemic targets without inducing adverse effects in post-bariatric patients without published guidelines. This review evaluates data supporting the best strategies for diabetes management in patients undergoing bariatric surgery.

Educate, Try, and Share: A Feasibility Study to Assess the Acceptance and Use of Reiki as an Adjunct Therapy for Chronic Pain in Military Health Care Facilities.

Introduction: Reiki, a biofield energy therapy, continues to struggle in finding its permanent place among the portfolio of complementary and alternative medicine modalities in many military health care facilities. Although it has been shown to help in the management of pain, lack of knowledge and limited first-hand experience impact its foothold. The purpose of this feasibility study was to (1) educate participants about the concept of Reiki, (2) give participants the opportunity to experience six Reiki therapy sessions and subsequently assess outcomes on chronic pain, and (3) assess participants' impression of and willingness to continue using and recommending Reiki therapy as adjunct for the treatment of chronic pain.

Ossification of the Posterior Longitudinal Ligament: Surgical Approaches and Associated Complications.

Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries.