U.S. Army Medical Department journal最新文献

{"title":"Real time interrater reliability of a novel musculoskeletal readiness screening tool.","authors":"Mark D Thelen,&nbsp;Shane L Koppenhaver,&nbsp;Shanee E Allen,&nbsp;Michael U Bolduc,&nbsp;Riley K Quan,&nbsp;Anne E Sidwell","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Military service members receive regular screenings for a variety of health conditions, but a field-expedient and military-specific screening tool that identifies an individual's risk for injury has not yet been identified. The purpose of this study is to describe the conduct of a novel musculoskeletal readiness screening tool (MRST) and evaluate the real-time interrater reliability of the MRST when scored by raters with differing levels of medical experience.</p><p><strong>Materials/methods: </strong>This study included a convenience sample of 40 active duty military participants (30 male, 10 female, mean age 29.3±6.9 years) without any current musculoskeletal injury or pain at the time of enrollment. The MRST consisted of 5 physical performance tests and one self-report question as follows: (1) weight-bearing lunge (WBL), (2) overhead squat, (3) closed kinetic chain upper extremity stability test (CKCUEST), (4) eyes closed forward step down, (5) repeated tuck jump, and (6) individual perceived level of risk for MSK injury. Three raters (a board certified physical therapist with 15 years of experience, a physical therapy student with less than one year didactic training, and a physical therapy technician with approximately 10 years of experience) independently scored each event as 0, 1, or 2 based on the quality of the participant's performance. This scoring system allows for a cumulative score ranging from 0 to 12, with lower scores thought to indicate higher risk for future injury. Descriptive, reliability, and chance-corrected agreement statistics were calculated using IBM SPSS. This study was approved by the Brooke Army Medical Center Institutional Review Board at Fort Sam Houston, Texas.</p><p><strong>Results: </strong>The mean composite MRST score for all graders was 7.79±1.41. Among all 3 raters the overall reliability was moderate (ICC (2,1)=0.75 (0.62, 0.85)). Chance-corrected agreement values for the individual events ranged from slight to almost perfect as follows: WBL (κ=0.33-0.44), overhead squat (κ=0.57-0.65), CKCUEST (κ=0.89-1.0), eyes-closed forward step down (κ=0.10-0.42), repeated tuck jump (κ=0.39-0.61), individual perceived level of risk for MSK injury (κ=1.0).</p><p><strong>Conclusions: </strong>The MRST showed moderate interrater reliability for the overall composite score with varied levels of agreement for individual events scores. Future research should investigate test-retest reliability and interrater reliability among medical personnel from different disciplines.</p>","PeriodicalId":88789,"journal":{"name":"U.S. Army Medical Department journal","volume":" 3-17","pages":"43-51"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35623950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sandfly fever in Afghanistan-a sometimes overlooked disease of military importance: a case series and review of the literature.","authors":"John W Downs,&nbsp;Daniel T Flood,&nbsp;Nicholas H Orr,&nbsp;Jason A Constantineau,&nbsp;James W Caviness","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Sandfly fever, sometimes known as pappataci fever or Phlebotomus fever, is a vector transmitted viral illness with a history of affecting naïve military formations that travel through or fight in areas in which the infection is endemic. We present a series of 4 hospitalized cases of sandfly fever (2 presumptive, 2 laboratory confirmed) that were admitted to a Role 3 hospital in Afghanistan for evaluation and treatment following medical evacuation from a forward area for marked fevers and malaise. Laboratory evaluation of these cases was significant for leukopenia and thrombocytopenia, consistent with historical descriptions of sandfly fever. In the correct geographic and clinical setting, the finding of mild leukopenia among a cluster of febrile patients should prompt the clinician to at least consider a diagnosis of sandfly fever. A cluster investigation conducted by preventive medicine personnel identified numerous other presumed cases of sandfly fever in this forward special operations camp. Response efforts emphasized enforcement of standard vector-borne disease control measures by operational leadership in order to limit effect on tactical operations. We review historical instances of sandfly fever affecting military operations, and present a review of clinical presentation, transmission, management, and prevention.</p>","PeriodicalId":88789,"journal":{"name":"U.S. Army Medical Department journal","volume":" 3-17","pages":"60-66"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35623951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Core temperature responses of military working dogs during training activities and exercise walks.","authors":"Catherine O'Brien,&nbsp;Anthony J Karis,&nbsp;William J Tharion,&nbsp;Heather M Sullivan,&nbsp;Reed W Hoyt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Heat strain is common in military working dogs (MWDs), but can be mitigated by limiting duration of activity to avoid overheating and allowing sufficient time for recovery. To determine work/rest times for MWDs, temperature responses during training must be characterized. This study measured body core temperature of 48 MWDs at Lackland Air Force Base, San Antonio, TX. Twenty-four MWDs in training for patrol and detection activities participated under a range of ambient temperatures in August (27°C-32°C), October (22°C-26°C) and March (approximately 13°C). These MWDs swallowed a telemetric thermometer pill to measure continuous gastrointestinal tract temperature (Tgi). Twenty-four kennel MWDs participated in July (25°C-29°C). In these dogs rectal temperature (Tre) was measured manually during a standard exercise walk. For the MWDs in training, Tgi before the first activity was 38.5±0.5°C (mean±SD) and final Tgi was 39.8±0.6°C after sessions that lasted 13.1±4.9 minutes (5.4 to 26.3 minutes). Peak Tgi, 0.4±0.4°C above final Tgi, occurred 8 to 12 minutes into recovery. Before beginning a second activity 40 to 165 minutes later, Tgi was within 0.5°C of initial values for 80% of dogs. For the kennel MWDs, Tre was 39.0±0.8°C (37.7°C to 40.7°C) at the start and 40.1±0.6°C at the end of the 21.3±2.8 minute walk. The continuous increase in core temperature during activity of both groups of MWDs indicates that limiting exercise duration is important for minimizing risk of overheating in MWDs. The observation of continued increase in Tgi to a peak after exercise ends suggests that for MWDs suspected of overheating temperature should be monitored for at least 15 minutes postexercise to ensure recovery.</p>","PeriodicalId":88789,"journal":{"name":"U.S. Army Medical Department journal","volume":" 3-17","pages":"71-78"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35623954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An evaluation of the significance of individual endogenous risk factors and medical and orthopaedic conditions on physical fitness in military executives.","authors":"Christoph Schulze,&nbsp;Michael Becker,&nbsp;Suzanne Finze,&nbsp;Christoph Holtherm,&nbsp;Jens Hinder,&nbsp;Andreas Lison","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>As part of occupational health promotion in the Bundeswehr (military services of the Federal Republic of Germany), top-ranking executives were offered a medical examination and training program. The participants were subjected to retrospective evaluation. The aim of this study was to determine to what extent risk factors for the development of internal and orthopaedic conditions are present in military executives and how these factors affect physical fitness. To collect their medical history, a total of 122 male subjects answered a questionnaire aimed at evaluating private and occupational stress factors. This process was followed by an internal and orthopaedic examination. A lactate performance test (treadmill or bicycle ergometry) was conducted. The results showed that the presence of hypertension correlates with reduced fitness. While orthopaedic conditions had no negative influence on executives' fitness, high body mass index and waist circumference, mental stress, and older age did. It is recommended that executives undergo professionally guided endurance and weight training on a regular basis in order to prevent the development of internal and orthopaedic conditions.</p>","PeriodicalId":88789,"journal":{"name":"U.S. Army Medical Department journal","volume":" 3-17","pages":"105-110"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35624959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A descriptive analysis of data from the Department of Defense Joint Trauma System Prehospital Trauma Registry.","authors":"Steven G Schauer,&nbsp;Michael D April,&nbsp;Jason F Naylor,&nbsp;Joshua J Oliver,&nbsp;Cord W Cunningham,&nbsp;Andrew D Fisher,&nbsp;Russ S Kotwal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The active battlefield is an environment of chaos and confusion. Depending on the scale of combat, the chaos and confusion often extend into the prehospital combat setting with multiple personnel and units involved in the chain of care of casualties. The chaos of the prehospital combat setting has led to limitations in the availability of data for performance improvement and research. The Department of Defense (DoD) Joint Trauma System (JTS) Prehospital Trauma Registry (PHTR) was developed in conjunction with the updated Tactical Combat Casualty Care (TCCC) card and a TCCC after action report (AAR), and currently serves as the prehospital repository and module of the DoD Trauma Registry (DoDTR). We conducted a descriptive analysis of data from the DoDTR PHTR.</p><p><strong>Methods: </strong>The JTS collected trauma-associated data which comprise the PHTR are consolidated from TCCC cards and TCCC AARs. Where possible (requires 2 patient identifiers), JTS linked data from the PHTR module to other modules in the DoDTR to maximize availability of prehospital data and gain additional information regarding clinical outcomes.</p><p><strong>Results: </strong>From January 2013 through September 2014, there were 705 patients available for research, of which 94.8% (668/705) had data from TCCC AARs, 3.3% (23/705) had data from TCCC cards, and 2.0% (14/705) had data available from DoDTR collection forms. There were one or more of the following data points per subject: pulse rate (77.4%, n=546), blood pressure (75.9%, n=535), respiratory rate (76.5%, n=539), pulse oximetry (61.8%, n=436), mental status (96.0%, n=677) and pain score (24.5%, n=173). Only 42.4% (647/1,527) of vital sign metrics had an associated time stamp. Documented interventions included limb tourniquets, of which only 27.3% (113/414) had an associated documentation of application time. Only 27.0% (190/705) of patients in the PHTR could be linked to the DoDTR due to missing identifiers.</p><p><strong>Conclusions: </strong>The PHTR data capture was suboptimal with many patients lacking documentation of vital signs and procedural details. Future efforts to improve prehospital data capture will require ownership and enforcement by unit leadership.</p>","PeriodicalId":88789,"journal":{"name":"U.S. Army Medical Department journal","volume":" 3-17","pages":"92-97"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35623957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of a military regional multispecialty synchronous telehealth platform and the importance of the dedicated patient presenter.","authors":"Kirk H Waibel,&nbsp;Stephanie J Garner,&nbsp;Irfan Bojicic,&nbsp;Robin Smith","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Implementing a successful multispecialty synchronous telehealth program requires identifying and overcoming numerous barriers. One key aspect of synchronous telehealth involves the telehealth presenter; however, the impact that a dedicated patient presenter has supporting routine multispecialty synchronous telehealth is unknown.</p><p><strong>Methods: </strong>We conducted a retrospective review of telehealth encounters conducted from a single regional medical center over a two-year period to 12 outlying health clinics which provided one of 3 levels of patient presenter support: category 1 locations had a dedicated telehealth registered nurse, category 2 locations had a nondedicated registered nurse or licensed vocational nurse, and category 3 locations were supported by an Army medic (military occupational specialty 68W).</p><p><strong>Results: </strong>A total of 4,032 telehealth encounters occurred from January 2014 to December 2015 involving 26 distinct specialties located within a single regional medical center and 12 outlying health clinics which supported 60,232 beneficiaries. The 3 category 1 locations (3/12, 25%) supported the most telehealth encounters per month compared to either category 2 or category 3 locations (P<.0001). Category 1 and category 2 locations averaged a 239% and 122% year-to-year growth, respectively. Category 3 locations averaged a year-to-year decline of 11.7%.</p><p><strong>Comment: </strong>This is the first study of which we are aware that has compared different patient presenter levels and evaluated its effect on telehealth activity. Regional medical centers initiating a multispecialty synchronous telehealth program should strongly consider hiring, educating, and placing dedicated presenters at patient originating sites.</p>","PeriodicalId":88789,"journal":{"name":"U.S. Army Medical Department journal","volume":" 2-17","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35357834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Placement and replacement rates of amalgam and composite restorations on posterior teeth in a military population.","authors":"Benjamin D Owen,&nbsp;Peter H Guevara,&nbsp;William Greenwood","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Replacement rates of direct dental restorations have been reported to be 37% to 70%, occupying a large proportion of a general dentist's time. Variations in the rate of initial placement and replacement of direct dental restorations may be associated with material placed (amalgam or composite), age, caries risk of the patient, and other factors. The purpose of this research was to clarify where the majority of patient care time is spent as a restorative Army dentist regarding either the initial placement or replacement of failed restorations; and how the location, caries risk, and material used (amalgam or composite) affects replacement rates.</p><p><strong>Methods: </strong>This retrospective cross-sectional study gathered data from 600 randomly selected military patient dental records. All paper records were reviewed and cross checked with the digital record and digital x-ray databases. Record review was limited to all direct dental restorations placed in the posterior dentition within the past 2 years (March 2011 to March 2013). Statistical analysis was accomplished using chi-square tests and logistic regression analyses.</p><p><strong>Results: </strong>Of the 600 charts reviewed, 525 were male, 75 were female, with an average age of 26 years (SD=6), ranging from 17 to 54 years. A third of the patients were classified as high, moderate, and low caries risk, respectively. The total number of posterior direct dental restorations placed was 2,117. Initial restorations totaled 1,429 (67.5%), and replacement restorations placed totaled 688 (32.5%). Four hundred forty-one of the 688 direct dental restorations replaced were amalgam (64%), the 247 remaining direct restorations replaced were composite (36%). Mandibular first molar dental restorations were replaced the most often (23.1%) while mandibular first premolar restorations were replaced the least often (0.9%). Older patients were more likely to have replacement of an existing restoration.</p><p><strong>Conclusions: </strong>Military dentists spend about one-third (32.5%) of their time replacing existing direct dental restorations. The majority of direct dental restorations placed and replaced were amalgam. No significant difference was found between composite and amalgam restorations. Location was shown to be significant with first molars and second molar restorations failing with the highest frequency. There was no significant difference found between male and female patients. As patient's age increased, the number of replacement restorations also increased.</p>","PeriodicalId":88789,"journal":{"name":"U.S. Army Medical Department journal","volume":" 2-17","pages":"88-94"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35310014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Martial arts-based high intensity interval training as a component of warfighter rehabilitation and tactical athlete fitness.","authors":"Gavin L Mills,&nbsp;Anthony E Johnson","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":88789,"journal":{"name":"U.S. Army Medical Department journal","volume":" 2-17","pages":"44-52"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35309527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of US combat veterans (2001-2011) who remain on active duty after upper extremity amputations.","authors":"Sara H Kift,&nbsp;Taylor J Bates,&nbsp;Nathan A Franklin,&nbsp;Anthony E Johnson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>Return to duty following traumatic amputations has been extensively studied in those with lower extremity amputation. As upper extremity amputations occur less frequently, the issue of return to duty for those with upper extremity amputations has received relatively little research. The purpose of this study was to determine the rate at which service members remain on active duty at least one year after having sustained traumatic upper extremity amputations during Operation Iraqi Freedom, Operation Enduring Freedom, and other overseas contingency operations of the Global War on Terrorism.</p><p><strong>Design: </strong>Retrospective.</p><p><strong>Setting: </strong>Military, Academic Level 1 trauma center.</p><p><strong>Patients: </strong>One hundred eighteen patients who sustained combat-related upper extremity amputations between October 2001 and December 2011.</p><p><strong>Intervention: </strong>Data was obtained from the medical record for these 118 patients.</p><p><strong>Main outcome measurements: </strong>Percentage of service member remaining on active duty one year following an upper extremity amputation, and evaluation of demographic and injury related factors associated with retention.</p><p><strong>Results: </strong>The overall rate for the upper extremity amputees studied at one year from injury who remained on active duty was 47%. Officers were more likely to remain on active duty than their enlisted counterparts (P=.021) and patients who sustained burns were also more likely to remain on active duty than patients with similar amputation types without concomitant burn injuries (P=.039).</p><p><strong>Conclusions: </strong>The rate of service members with traumatic upper extremity amputations who were still on active duty status 1-year postinjury was 47%. The presence of burns and rank were significant factors when examining retention on active duty. Further study on war casualties who sustain upper-extremity traumatic amputations with and without burns is required to optimize outcomes in this population.</p>","PeriodicalId":88789,"journal":{"name":"U.S. Army Medical Department journal","volume":" 2-17","pages":"57-61"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35309528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of smokeless tobacco on surface roughness of dental restorations.","authors":"Shani O Thompson,&nbsp;Gerald D Griffin,&nbsp;Nicole Meyer,&nbsp;Manuel Pelaez","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Clinical relevance: </strong>Surface alterations of dental restorations can result in increased plaque biofilm. This leads to increased risk of premature restoration failure. Smokeless tobacco, in common use by some US military personnel, represents a potential source for surface alteration. If smokeless tobacco causes an untoward effect, selection of a more resistant restorative material could increase restoration longevity, thus minimizing lost work time and costs associated with replacement of failed restorations.</p><p><strong>Purpose: </strong>Comparatively assess the effect of smokeless tobacco/salivary substitute mixture on altering surface roughness of amalgam, composite resin, and resin modified glass ionomer (RMGI) restorations.</p><p><strong>Materials and methods: </strong>Sixty cubic restorations (3 groups of 20) were fabricated using a 4 mm by 3 mm Teflon mold. One examiner assessed the restorations at time points representing zero days, one day, one week, 2 weeks, one month, and 3 months. The data obtained were collected using a surface profilometer, measured in micrometers. Data were statistically analyzed using 2-way analysis of variance (ANOVA) test. A difference was significant if P< .05.</p><p><strong>Results: </strong>Confidence levels with a 95% overall rating received a clinically acceptable classification. The 2-way ANOVA test detected significant differences between baseline, one day, one week, 2 weeks, one month, and 3-month data for surface roughness (P<.05). With respect to time and restoration type, results proved statistically significant with P<.0001. All restorations were statistically significant with respect to change in surface roughness with RMGIs showing the greatest surface roughness alteration.</p><p><strong>Conclusion: </strong>Smokeless tobacco mixed with a salivary substitute altered restoration surface roughness over time. Resin-modified glass isonomer restorations demonstrate the greatest alteration of surface roughness, with amalgam restorations showing the least. Amalgam remains the preferential restorative material in patients who use smokeless tobacco.</p>","PeriodicalId":88789,"journal":{"name":"U.S. Army Medical Department journal","volume":" 2-17","pages":"80-87"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35310012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}