Injuries Associated With Mandated Wear of Body Armor in Iraq.

Introduction: Protective ballistic body armor (BA) may be needed during certain threat postures while deployed. This requirement often adds between 35 and 45lbs of extra weight carried by the service member (SM) for multiple hours during the day. The physical toll of that extra weight and the effect it may have on deployed medical resources has not been clearly characterized in the literature.

Behavioral KSA Intervention Class to Boost Positive Airway Pressure Adherence Among Active Duty Military Personnel With Obstructive Sleep Apnea.

Introduction: Obstructive sleep apnea (OSA) is a treatable cause of daytime sleepiness and associated medical problems that can negatively impact soldier readiness and performance. This study examined adherence to positive airway pressure (PAP) by soldiers who were newly diagnosed with OSA and prescribed PAP therapy and participated in a Knowledge, Skills, and Attitudes (KSA) behavioral intervention class.

Materials And Methods: The KSA was a one-time, interactive 90-minute class attended by up to 10 patients per class.

Posterior Interosseous Nerve Palsy in Rheumatoid Arthritis: A Systematic Review.

The purpose of this systematic review is to describe the pathoanatomy, presentation, diagnostic workup, treatment modalities, and outcomes of posterior interosseous nerve (PIN) palsy in patients with rheumatoid arthritis (RA). All reported cases of PIN palsy in patients with RA were reviewed to yield 72 cases of PIN palsy in 70 patients. The male-to-female ratio was 1:2.

Optimizing Advanced Trauma Life Support (ATLS®) to Maximize Readiness.

Introduction: The Army utilizes Individual Critical Task Lists (ICTLs) to track and ensure competency and deployment readiness of its medical service members. ICTLs are the various skills and procedures that the Army has deemed foundational for each area of concentration (AOC)/military occupational specialty (MOS). While many ICTLs involve the patient care that military medical providers regularly provide, some procedures are not as commonly performed.

Admission of Upper Extremity Injuries Presenting to the Emergency Department: An NEISS Study.

Background: Upper extremity injuries account for 36.5% of presentations to the emergency department in the United States. This study seeks to determine current rates of upper extremity injuries that present to the emergency department and the injury characteristics of patients requiring admission.

Profiling of serum factors associated with skin and soft tissue infections as a foundation for biomarker identification.

Background: People living in close quarters, such as military trainees, are at increased risk for skin and soft tissue infections (SSTI), especially those caused by methicillin-resistant (MRSA). The serum immune factors associated with the onset of SSTI are not well understood.

Methods: We conducted a longitudinal study of SSTIs, enrolling US Army trainees before starting military training and following up for 14 weeks.

Resilience and Patient-Reported Outcomes in Patients Undergoing Orthopedic Hand Surgery.

Background: Previous studies have examined the impact of resiliency on postoperative outcomes in other orthopedic domains, but none to date have done so for hand surgery.

Methods: We performed a retrospective analysis of prospectively collected data of patients undergoing hand surgery at a single institution. We included patients with complete preoperative outcomes scores and 6-month follow-up.

A Review of 75th Ranger Regiment Battle-Injured Fatalities Incurred During Combat Operations From 2001 to 2021.

Introduction: The 75th Ranger Regiment is an elite U.S. military special operations unit that conducted over 20 years of sustained combat operations.

Improving visualization in shoulder arthroscopy.

Arthroscopic shoulder procedures are one of the most common procedures used to restore function through minimally invasive techniques. With the demand for shoulder arthroscopic procedures comes the need for safe, effective, and efficient surgery that maximizes patient outcomes while minimizing complications. Many variables contribute to visualization in shoulder arthroscopy including vascular anatomy, blood pressure control, arthroscopic pump systems, turbulence control, epinephrine, and tranexamic acid.

A Review of Intermittent Fasting as a Treatment for Type 2 Diabetes Mellitus.

Background: Introduction: The purpose of this review is to explore intermittent fasting (IF) versus continuous energy restriction as a treatment of Type 2 Diabetes Mellitus (T2DM). The precursor to diabetes is obesity, which currently threatens the Department of Defense's ability to retain and recruit adequate service members. Intermittent fasting may be an adjunct for prevention of obesity and diabetes in the armed forces.

Neuroprotection and Therapeutic Implications of Creatine Supplementation for Brain Injury Complications.

Creatine supplementation has not been researched for Traumatic Brain Injury (TBI) extensively, but studies suggest potential as a neuroprotective agent and potential treatment for brain-injury complications. Patients suffering from TBI experience mitochondrial dysfunction, neuropsychological burden, and deficits in cognitive performance due to malperformance of brain creatine levels, diminished brain Adenosine Triphosphate (ATP) levels, glutamate toxicity, and oxidative stress. In this systemic review, the current available research is reviewed to examine the effects of creatine on common sequalae of TBI within children, adolescents, and mice.

Operative Fractures of the Phalangeal Head and Neck in Children-Does Open Reduction Affect Outcomes?

Background: Closed reduction percutaneous pinning of displaced pediatric phalangeal head and neck fractures is preferred to prevent malunion and loss of motion and function. However, open reduction is required for irreducible fractures and open injuries. We hypothesize that osteonecrosis is more common in open injuries than closed injuries that require either open reduction or closed reduction percutaneous pinning.

Common Finger Injuries: Treatment Guidelines for Emergency and Primary Care Providers.

Introduction: Finger and hand injuries are among the most common musculoskeletal conditions presenting to emergency departments and primary care providers. Many rural and community hospitals may not have immediate access to an orthopedic surgeon on-site. Furthermore, military treatment facilities, both within the continental United States and in austere deployment environments, face similar challenges.

A Confirmatory Factor Analysis of the 'Return to Duty Readiness Questionnaire'.

The Readiness to Return to Duty Questionnaire (RDRQ) is a recently developed screening instrument for detecting fear-avoidance behavior in a military musculoskeletal pain population. The RDRQ was developed based on the Fear-Avoidance Model which postulates four factors resulting in overall fear-avoidance behavior. While research investigating the factor structure of the RDRQ does not exist, research investigating the factor structure of other measures of fear avoidance have found evidence of one and two factor solutions.

Can Military Role 1 Practitioners Maintain Their Skills Working at Civilian Level 1 Trauma Centers: A Retrospective, Cross-Sectional Study.

Background: Introduction: Military Role 1 practitioners have difficulty maintaining skill competency by working solely in military medical treatment facilities. Recognizing this, the Army Medical Department has renewed focus on physician specialty-specific Individual Critical Task Lists (ICTL) and is increasing the number of military-civilian partnerships, wherein small military treatment teams work full-time in civilian trauma centers. Yet, data to validate this approach is lacking.

A Pilot Medic-based Assessment of the Novel Handheld LifeFlow Device for Rapid Infusion of Blood Products.

Introduction: Uncontrolled hemorrhage remains the leading cause of preventable death in the prehospital, combat setting. Treatment guidelines emphasize immediate hemorrhage control and early resuscitation with whole blood or blood products. Current methods for the delivery of blood products are often insufficient to provide trauma resuscitation.

Perforating Calcinosis Cutis as a Complication of Intraosseous Fluid Infusion in the Setting of a Near-Drowning Event.

Iatrogenic calcinosis cutis represents a subset of calcinosis cutis resulting secondary to treatments or procedures. We present the first report of calcinosis cutis resulting from the intraosseous infusion and one of a few cases with associated transepidermal elimination. A previously healthy 2-year-old female presented with a new-onset unilateral shin rash 1 week following hospitalization for a near-drowning event.

Development and validation of a military fear avoidance questionnaire.

Chronic pain due to musculoskeletal injury is one of the leading causes of disability and reduced combat readiness in the U.S. Army.

A Descriptive Analysis of the Execution of the Expert Field Medical Badge Competition with Mitigation Measures during the COVID-19 Pandemic.

Objective: Introduction: In September 2020, the 2nd Stryker Brigade Combat Team of the 4th Infantry Division at Fort Carson, CO, executed an Expert Field Medical Badge (EFMB) event, unique in its implementation of Coronavirus Disease 2019 (COVID-19) mitigation measures. We conducted a descriptive analysis of our experience to inform future EFMB events.

Methods: We planned and resourced the EFMB competition in accordance with the Army Medical Department Center and School Pamphlet 350-10.

Disease Progression of WHIM Syndrome in an International Cohort of 66 Pediatric and Adult Patients.

Warts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome (WS) is a combined immunodeficiency caused by gain-of-function mutations in the C-X-C chemokine receptor type 4 (CXCR4) gene. We characterize a unique international cohort of 66 patients, including 57 (86%) cases previously unreported, with variable clinical phenotypes. Of 17 distinct CXCR4 genetic variants within our cohort, 11 were novel pathogenic variants affecting 15 individuals (23%).

Barriers and Potential Solutions to Implementing Evidence-Based PTSD Treatment in Military Treatment Facilities.

Introduction: Prolonged exposure therapy is an effective treatment for posttraumatic stress disorder that is underutilized in health systems, including the military health system. Organizational barriers to prolonged exposure implementation have been hypothesized but not systematically examined. This multisite project sought to identify barriers to increasing the use of prolonged exposure across eight military treatment facilities and describe potential solutions to addressing these barriers.

Inter- and Intra-Rater Reliabilities of the Army Combat Fitness Test Three-Repetition Maximum Deadlift Event Among Raters of Varying Professional Experience.

Introduction: The U.S. Army is updating the physical fitness assessment for soldiers to the six-event Army Combat Fitness Test (ACFT).

Implementation of a Multidisciplinary "Code Hip" Protocol is Associated with Decreased Time to Surgery and Improved Patient Outcomes.

Background: The purpose of this study is to report outcomes data based on the implementation of a "Code Hip" protocol, a multidisciplinary approach to the care of fragility hip fracture patients focussing on medical optimization and early operative intervention. We hypothesized that implementation of this protocol would decrease time from presentation to surgical intervention and improve outcomes based on short term post-operative data.

Methods: A retrospective chart review was performed on all patients aged greater than 65 years old with a fragility hip fracture from October 2015 through June 2018.

Cervical Ripening and Induction of Labor.

Induction of labor is a common obstetric procedure, and approximately one-fourth of pregnant patients undergo the procedure. Although exercise and nipple stimulation can increase the likelihood of spontaneous labor, sexual intercourse may not be effective. Acupuncture has been used for labor induction; however, it has not been shown to increase vaginal delivery rates.