Health coaching and genetic risk testing in primary care: Randomized controlled trial.

Objective: Accessible interventions are needed to prevent coronary heart disease (CHD) and Type 2 diabetes (T2D). This prospective, randomized, controlled trial evaluated remote health coaching (HC), genetic risk testing (GRT), or both added to standardized risk assessment (SRA) in at-risk military primary care patients.

Method: Using a 2 × 2 factorial longitudinal design, 200 Air Force at-risk participants provided primary outcomes at baseline, 3-, 6- (HC endpoint), and 12-months.

Postpartum Opioid Use among Military Health System Beneficiaries.

Objective: The aim of the study is to evaluate the prevalence and factors associated with opioid prescriptions to postpartum patients among TRICARE beneficiaries receiving care in the civilian health care system versus a military health care facility.

Study Design: We evaluated postpartum opioid prescriptions filled at discharge among patients insured by TRICARE Prime/Prime Plus using the Military Health System Data Repository between fiscal years 2010 to 2015. We included women aged 15 to 49 years old and excluded abortive pregnancy outcomes and incomplete datasets.

The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for non-traumatic cardiac arrest: A review.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been proposed as a novel approach to managing non-traumatic cardiac arrest (NTCA). During cardiac arrest, cardiac output ceases and perfusion of vital organs is compromised. Traditional advanced cardiac life support (ACLS) measures and cardiopulmonary resuscitation are often unable to achieve return of spontaneous circulation (ROSC).

Zone 3 REBOA does not provide hemodynamic benefits during nontraumatic cardiac arrest.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be a novel intervention to improve cardiopulmonary resuscitation (CPR) quality during cardiac arrest. Zone 1 supraceliac aortic occlusion improves coronary and cerebral blood flow. It is unknown if Zone 3 occlusion distal to the renal arteries offers a similar physiologic benefit while maintaining blood flow to organs above the point of occlusion.

Targeted Assessment and Context-Tailored Implementation of Change Strategies (TACTICS) to increase evidence based psychotherapy in military behavioral health clinics: Design of a cluster-randomized stepped-wedge implementation study.

Background: Despite efforts by the U.S. Department of Defense to train behavioral health (BH) providers in evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), numerous barriers limit EBP implementation.

Push-Dose Vasopressin for Hypotension in Septic Shock.

Background: Peri-intubation cardiac arrest and hypotension in patients with septic shock occur often in the emergency department (ED) and ultimately lead to worse clinical outcomes. In recent years, the use of push-dose, or bolus-dose, vasopressors in the ED have become common practice for transient hypotension and bridging to continuous infusion vasopressors. Push-dose epinephrine and phenylephrine are the agents used most frequently in this scenario.

Evidence of vaccinia dissemination despite lack of major reaction following smallpox vaccination.

Following vaccinia vaccination, vesicle formation at the site occurs in 95% of primary vaccinees and is thought to indicate virus replication and vaccine efficacy. Little is known about virus replication and immune response in those who do not develop a vesicle. We used PCR to detect vaccinia in various sites following receipt of the smallpox vaccine in those with and without vesicle formation.

Resuscitation and Evacuation from Low Earth Orbit: A Systematic Review.

Introduction: Provision of critical care and resuscitation was not practical during early missions into space. Given likely advancements in commercial spaceflight and increased human presence in low Earth orbit (LEO) in the coming decades, development of these capabilities should be considered as the likelihood of emergent medical evacuation increases.

Methods: PubMed, Web of Science, Google Scholar, National Aeronautics and Space Administration (NASA) Technical Server, and Defense Technical Information Center were searched from inception to December 2018.

A Preliminary Study of U.S. Air Force Pilot Perceptions of the Pilot-Flight Surgeon Relationship.

Introduction: Flight surgeons play a vital role in U.S. Air Force aviation operations by ensuring that pilots are medically prepared to meet the demands of military aviation.

Comparison of a ferret model with an inanimate simulator for training novices in techniques for intubating neonates.

Simulators for neonatal intubation training have improved, prompting us to compare a state-of-the-art simulator with live ferrets for training novice family-medicine residents in this crucial skill. After a scripted didactic presentation, we used a crossover study design and randomly assigned residents to receive simulator or live ferret training, after which they repeated the procedure by using the opposite method. Participants were asked to report their level of confidence and competence before and after each training session and the usefulness of each training method.

Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock.

Background: Noncompressible torso hemorrhage is the leading cause of potentially preventable death on the modern battlefield. The objective of this study is to characterize resuscitative aortic balloon occlusion (BO) compared to thoracotomy with aortic clamping in a model of hemorrhagic shock.

Methods: A total of 18 swine (3 groups; 6 animals/group) were used in this study.

Abdominal twists and turns: part 2, solid visceral torsions with pathologic correlation.

Objective: The solid abdominal viscera are secured in place by various suspensory ligaments. Laxity or incomplete development of these anchoring ligaments can lead to hypermobility and predispose the patient to torsion-related ischemic pathology. The clinical symptoms of solid visceral intraabdominal torsions are nonspecific.

Abdominal twists and turns: part I, gastrointestinal tract torsions with pathologic correlation.

Objective: The gastrointestinal tract is secured in place by various suspensory ligaments. Laxity or incomplete development of these anchoring ligaments can lead to hypermobility and predispose the patient to torsion-related ischemic pathology. A prompt diagnosis is necessary to avoid life-threatening consequences of prolonged visceral ischemia.

Quality of life after sleeve gastrectomy and adjustable gastric banding.

Background: With the addition of laparoscopic vertical sleeve gastrectomy (SG) to the bariatric surgery procedural toolkit, patients desiring a restrictive bariatric procedure often choose between adjustable gastric banding (LAGB) and SG. One study compared quality of life after these 2 procedures and found no difference. The purpose of our study was to re-evaluate the postoperative quality of life in LAGB and SG patients at a military teaching hospital in the United States.

The impact of ischemic intervals on neuromuscular recovery in a porcine (Sus scrofa) survival model of extremity vascular injury.

Background: Despite advances in revascularization following extremity vascular injury, the relationship between time to restoration of flow and functional limb salvage is unknown. The objectives of this study are to describe a large animal survival model of hind limb ischemia/reperfusion and define neuromuscular recovery following increasing ischemic periods.

Methods: Sus scrofa swine (N = 38; weight, 87 ± 6.

Temporal changes of aortic neck morphology in abdominal aortic aneurysms.

Objectives: This study characterized temporal changes in the infrarenal aortic aneurysm neck in patients with small, untreated abdominal aortic aneurysms (AAA).

Methods: Patients with infrarenal AAA who had contrast-enhanced computed tomography (CT) scans separated by >6 months were identified and their images reviewed. Infrarenal neck diameter and length were measured along with aneurysm diameter.

Endovascular treatment of a blunt aortic injury in Iraq: extension of innovative endovascular capabilities to the modern battlefield.

Background: The management of blunt descending thoracic aortic injury remains controversial. Despite emerging evidence touting the advantage of endovascular repair in civilian trauma, there have been no reports on the application of this management strategy in the austere environment of war. We provide a case report from the 332nd EMDG/Air Force Theater Hospital, Balad Air Base, Iraq.

A systematic approach for preoperative rhinoplasty planning.

There is ample instructive literature on preoperative analysis of the rhinoplasty patient available to the present day provider. However, the literature does show a paucity of instruction to convert the preoperative analysis into a surgical plan of action. The purpose of this article is to provide a systematic approach to preoperative planning once the analysis has been done.

Methods of detection of first recurrence in patients with stage I/II primary cutaneous melanoma after sentinel lymph node biopsy.

Background: An understanding of the methods of detection of recurrent melanoma after sentinel lymph node biopsy (SLNB) is essential for the coordination of a rational plan of follow-up.

Methods: Clinical stage I/II melanoma patients who underwent SLNB from 1991 to 2004 were identified from a prospectively maintained single-institution database. Detection of recurrence by self (awareness of symptoms or abnormal physical findings) or physician (discovered on routine physical or scheduled test) and timing of clinic visit were recorded.

Diagnosis and management of lipomatous tumors.

Lipomatous tumors range from benign lipomas to high-grade liposarcomas. Liposarcomas are classified into five histologic subtypes: well-differentiated, dedifferentiated, myxoid, round cell, and pleomorphic, which differ in outcomes and patterns of recurrence. Surgical resection is the mainstay of curative treatment; however, large, high grade liposarcomas may benefit from multimodality treatment with chemotherapy and radiation.

Maxillofacial trauma treatment protocol.

The management of complex maxillofacial injuries sustained in modern warfare or terrorist attack has presented military surgeons with a new form of injury pattern previously not discussed in the medical literature. The unique wounding characteristics of the IED, the portability of the weapon platform, and the relative low cost of development make it an ideal weapon for potential terrorist attacks. If potential future terrorist attacks in the United States follow the same pattern as the incidents currently unfolding in the Middle East, civilian practitioners will be required to manage these wounds early for primary surgical intervention and late for secondary and tertiary reconstructive efforts.

CCL3L1 and CCR5 influence cell-mediated immunity and affect HIV-AIDS pathogenesis via viral entry-independent mechanisms.

Although host defense against human immunodeficiency virus 1 (HIV-1) relies mainly on cell-mediated immunity (CMI), the determinants of CMI in humans are poorly understood. Here we demonstrate that variations in the genes encoding the chemokine CCL3L1 and HIV coreceptor CCR5 influence CMI in both healthy and HIV-infected individuals. CCL3L1-CCR5 genotypes associated with altered CMI in healthy subjects were similar to those that influence the risk of HIV transmission, viral burden and disease progression.

3-Dimensional magnetic resonance genitography: a different look at cloacal malformations.

Purpose: Standard contrast genitography and endoscopy have been the cornerstone of preoperative investigation of anatomy in complex cloacal malformations. In many cases standard genitography is ambiguous and lengthy endoscopy may be required to define the anatomy. Nonenhanced magnetic resonance imaging lacks definition of the nondistended common channel and confluence.

Validations of a portable home sleep study with twelve-lead polysomnography: comparisons and insights into a variable gold standard.

Objectives: Accurate and timely diagnosis for patients with obstructive sleep apnea (OSA) is imperative. Unfortunately, growing interest in this diagnosis has resulted in increased requests and waiting times for polysomnography (PSG), as well as a potential delay in diagnosis and treatment. This study evaluated the accuracy and viability of utilizing SNAP (SNAP Laboratories, LLC, Wheeling, Illinois), a portable home sleep test, as an alternative to traditional PSG in diagnosing OSA.

Does obstructive sleep apnea affect aerobic fitness?

Objectives: We sought to determine whether patients with obstructive sleep apnea (OSA) had an objective change in aerobic fitness during cycle ergometry compared to a normal population. The most accurate test of aerobic fitness is measurement of maximum oxygen consumption (VO2max) with cycle ergometry.

Methods: We performed a retrospective cohort analysis (247 patients with OSA) of VO2max from annual cycle ergometry tests compared to a large control group (normative data from 1.