Special Concerns in Military Families.

Purpose Of Review: Military cultural competence has been recognized as an important factor to delivering effective care to service members, who are a distinct population with unique exposures, and thus with different clinical implications-though only recently has the military service been recognized as a cultural identity that can impact treatment (Meyer et al. Curr Psychiatry Rep. 18:26:1-8, 2016).

Detection of Migrainous Infarction with Formal Visual Field Testing: A Case Report.

Introduction: Cerebrovascular accidents (CVA) of the posterior circulation are a rare complication of migraine, and present with atypical CVA symptomatology.

Case Report: A 49-year-old-male presented with complaint of persistent visual aura and resolved mild cephalgia. His exam corroborated his reported incomplete left inferior quadrantanopia, and was confirmed by immediate formal optometry evaluation.

Strengthening Resiliency During Pacific Partnership Missions: Leadership Matters.

The role of military leaders to promote resilience has never been more relevant. The following case highlights a Navy Nurse Corps Officer's challenges with deployment stressors and building resilience during a ship-based Global Health Engagement. The case also highlights a follow-on project to enhance the resilience of deployed service members.

Incidence Rates of Gynecologic Cancers in the U.S. Active Duty Military Population.

Introduction: Despite an increasing number of female service members, incidence rates of gynecologic cancers (other than cervical cancer) have not been previously documented in the U.S. active duty military population.

Acute Jaundice in a Six-year-old: An Unusual Presentation of Atypical Kawasaki Disease.

Kawasaki disease (KD) is a rare vasculitis of childhood that is critical to recognize and treat due to associated morbidity and mortality. A six-year-old male presented to our emergency department (ED) afebrile but with reported recent fevers. Exam revealed jaundice and erythematous tongue with papules, and laboratory studies indicated a direct hyperbilirubinemia.

Admissions for ambulatory care sensitive conditions on rural islands and their association with patient experience: a multicentred prospective cohort study.

Objectives: The rate of admissions for ambulatory care sensitive conditions (ACSCs) is a key outcome indicator for primary care, and patient experience (PX) is a crucial process indicator. Studies have reported higher rates of admission for ACSCs in rural areas than in urban areas. Whether there is an association between admissions for ACSCs and PX in rural areas has not been examined.

A Case of Central Venous Sinus Thrombosis in a Young Woman.

Altered mental status is a common symptom in emergency department evaluations and may be present in as many as four to ten percent of patients.1 The etiology can be difficult to determine without significant evidence from laboratory, radiographic and physical examination. The diagnostic approach is largely driven by the provider's clinical judgment based on the available history.

Sufficient hepatic artery flow compensates for poor portal vein flow after liver transplantation in patients with portal vein thrombosis.

Objective: Portal vein thrombosis (PVT) does not preclude liver transplantation (LT), but poor portal vein (PV) flow after LT remains a predictor of poor outcomes. Given the physiologic tendency of the hepatic artery (HA) to compensate for low PV flow via vasodilation, we investigated whether adequate HA flow would have a favorable prognostic impact among patients with low PV flow following LT.

Methods: This study included 163 patients with PVT who underwent LT between 2004 and 2015.

Aspirin for primary prevention: USPSTF recommendations for CVD and colorectal cancer.

Patient age, baseline cardiovascular disease risk, bleeding risk, and personal preference regarding aspirin use are key to decision making. A clinical decision tool can help.

Evaluating the Accuracy of the Endoscopic ABC Classification System in Diagnosing Helicobacter pylori-Infected Gastritis.

Aims: Evaluating the accuracy of the modified Endoscopic ABC (Endo ABC) classification with an electronic endoscopy with narrow band imaging without magnification in diagnosing Helicobacter pylori (H. pylori)-infected gastritis.

Methods: A total of 576 patients were enrolled and they underwent modified Endo ABC.

Fluoroscopically Guided vs Landmark-Guided Sacroiliac Joint Injections: A Randomized Controlled Study.

Objectives: To determine the prevalence of intra- and extra-articular sacroiliac joint (SIJ) pain, which injection is more beneficial, and whether fluoroscopy improves outcomes.

Patients And Methods: This patient- and evaluator-blinded comparative effectiveness study randomized 125 participants with SIJ pain from April 30, 2014, through December 12, 2017, to receive fluoroscopically guided injections into the joint capsule (group 1) or "blind" injections to the point of maximum tenderness using sham radiographs (group 2). The primary outcome was average pain on a 0 to 10 scale 1 month after injection.

HSV Hepatitis in Pregnancy: A Review of the Literature.

Importance: Herpes simplex virus (HSV) hepatitis is a rare condition with a high mortality rate. Immunocompromised individuals, including pregnant women, are the most susceptible. When primary infection occurs during pregnancy, risk for disseminated HSV is greatly increased.

MicroRNA Profile Differences in Neonates at Risk for Cerebral Palsy.

Background: MicroRNAs; miRs are used as biomarkers in the diagnosis of several diseases. Cerebral palsy; CP, resulting from perinatal brain injury, cannot be diagnosed until 18-24 months old. Biomarkers to predict CP and assess response to investigational therapies are needed.

Simulation Training for Operational Medicine Providers (STOMP): Impact of a Comprehensive Skills-Based Curriculum for Military General Medical Officers.

Introduction: A standardized training curriculum designed for general medical officers (GMO) titled Simulation Training for Operational Medicine Providers (STOMP) was recently developed to educate and improve GMOs' procedural skills through directed feedback prior to assuming duties in an operational environment. This study aimed to determine the impact this novel curriculum had on GMOs'confidence levels in 21 core privileges covering eight different subspecialties while stationed at Naval Medical Center Portsmouth (NMCP).

Materials And Methods: A cohort study from 2015 to 2017 was designed to address our specific aim to examine if the implementation of the STOMP curriculum increased GMOs' confidence levels.

Assessing practice pattern differences in the treatment of acute low back pain in the United States Military Health System.

Background: Acute low back pain is one of the most common reasons for individuals to seek medical care in the United States. The US Military Health System provides medical care to approximately 9.4 million beneficiaries annually.

State of emergency contraception in the U.S., 2018.

Emergency contraception is indicated in instances of unprotected sexual intercourse, including reproductive coercion, sexual assault, and contraceptive failure. It plays a role in averting unintended pregnancies due to inconsistent use or non-use of contraception. Options for emergency contraception vary by efficacy as well as accessibility within the U.

High Rate of Undiagnosed Obstructive Sleep Apnea in Patients Undergoing Total Joint Arthroplasty.

This study described the incidence and severity of obstructive sleep apnea (OSA) and determined the sensitivity and specificity of the STOP-BANG Questionnaire in patients undergoing total joint arthroplasty (TJA) at a military academic medical center. All subjects completed the questionnaire and an unattended sleep study preoperatively. Incidence and severity of OSA (apnea-hypopnea index [AHI] ≥ 5) was calculated.

Population-based Risk Factors for the Development of Degenerative Disk Disease.

Study Design: This is a retrospective case control study.

Objective: Identify risk factors and assess their relative impact on the development of degenerative disk disease (DDD).

Summary Of Background Data: DDD is responsible for widespread disability in the civilian and military population.

All-Inside Anterior Cruciate Ligament Reconstruction as a Salvage for Small or Attenuated Hamstring Grafts.

Anterior cruciate ligament (ACL) tears represent one of the most common sports-related injuries in the young population. There are multiple studies showing higher failure rates in the younger population with an allograft supporting the routine use of an autograft. In addition, higher failure rates have been shown with grafts narrower than 8 mm in diameter.

Primary intestinal-type adenocarcinoma of the oral tongue: Case report and review of histologic origin and oncologic management.

Background: Primary intestinal-type adenocarcinoma (ITAC) of the oral tongue is an extremely uncommon malignancy with only 3 cases reported in the literature. This high-grade malignancy originates from metaplasia of minor salivary glands.

Methods: A 40-year-old man presented with a gradually enlarging midline oral tongue mass, odynophagia, and dysphagia.

Simulation Training for Operational Medicine Providers (STOMP): Design and Implementation of a Novel Comprehensive Skills-Based Curriculum for Military General Medical Officers.

Background: Fifty percent of graduating U.S. Navy post-graduate year (PGY)-1 physicians will practice in the operational environment before returning to residency training.