Active Military Service Research Articles

Implementation of a Screening and Management of Overweight and Obesity Clinical Practice Guideline in an Ambulatory Care Setting.

Obesity is a rapidly growing health problem reaching epidemic levels around the world (World Health Organization, 2014). According to the World Health Organization, the current incident rate of obesity makes it the leading risk for deaths across the globe. The United States (USA) is amidst in this growing global epidemic. The obesity epidemic is a nondiscriminatory health problem affecting millions of individuals from a variety of backgrounds and social status. One group impacted by this disease is the US military. The health-related consequences of overweight and obesity has increased our military health care expenditures and has a direct impact on our nation's military readiness (Veterans Affairs/Department of Defense, 2014). The purpose of this Doctor of Nursing Practice project was to implement the Veterans Affairs/Department of Defense's Clinical Practice Guideline on Screening and Management of Overweight and Obesity at a military treatment facility in the Midwest. The goal of the project was to reduce the incidence rate of overweight and obese active duty military service members assigned to a military installation in the Midwest. With institutional review board approval, project implementation results were analyzed with descriptive and inferential statistics (paired t- tests). The goal to reduce the incident rate of overweight and obese by 5% was not achieved, but in turn the rate of overweight and obese increased by 1.57% over the 6-mo period. There were decreases in the normal with an increase in the overweight and obesity rate. This inverse outcome was unexpected and concerning. Based on the project's finding, there is a need to address the perceived barriers to maintaining healthy behaviors to plan future activities. An in-depth look at whether there is a knowledge deficit, a perceived lack of self-efficacy, competing life priorities preventing engagement in health promotion behaviors, or some other element influencing the motivation to change would be beneficial to understanding how to curb the growing rate of obesity. The utilization of the transtheoretical model of behavior change would make a sound theoretical framework to base such a new study, focusing on the stages of change as it relates to health promotion behaviors.

Incidence of essential hypertension in young adult males followed for over two decades

BackgroundThe data about the incidence of hypertension in India is scarce and is lacking about hypertension in young adult patients. We studied the incidence of hypertension in a cohort of young adult male military personnel followed for a long duration. MethodsThe data for this retrospective, observational study was derived from the electronic medical records (EMR) of the male service personnel enrolled between 1990 and 2015. All subjects were recruited before 18 years of age in good health without any disease. Hypertension in young adults was defined as the onset of the disease prior to 45 years of age. We calculated the incidence rates as per person years using appropriate statistical methods. ResultsOur study population includes 51,217 participants (median age 33 years, range 17–54) with a mean follow up of 12.5 years, giving a total observation period of 613,925 person-years (py). During the study period, 360 patients developed hypertension, giving an incidence rate of 58.6 per 100,000 py (95% CI 52.8–64.9). The mean age at the time of diagnosis was 33.5±5.7years (range 20–45) with 5.6±3.9years (range 0.3–21yr) of follow up after the diagnosis. Only 16 patients (4.4%) had associated cardiovascular complications attributable to hypertension. ConclusionOur cohort had low incidence rates of hypertension when compared with other studies from abroad. Active military service may offer protection from the hypertension and associated complications.

Art therapy interventions for active duty military service members with post-traumatic stress disorder and traumatic brain injury

ABSTRACTThis paper provides an overview of short and long-term art therapy treatment approaches, used in the USA, for military service members with post-traumatic stress disorder and traumatic brain injury. The described clinical approaches are based on the theoretical foundations and the art therapists’ experiences in providing individualised care for the unique needs of the patient population. The art therapy models and directives are designed to be more therapist-led in the short-term model, moving on to an increasingly patient-led format in the long-term treatment model. The overall objectives of art therapy are: to support identity integration, externalisation, and authentic self-expression; to promote group cohesion; and to process grief, loss, and trauma. In addition, programme evaluation is used in both settings as a means to understand participants’ experiences and the perceived value of art therapy.

A long term follow-up study from India assessing the risk of diabetes mellitus in service population

ObjectiveThe data about the incidence of diabetes is scarce from developing countries. We studied the incidence of type 1 (T1DM) and type 2 DM (T2DM) in a cohort of young military personnel followed for a long duration. MethodsThe data for this descriptive epidemiologic study was derived from the electronic medical records (EMR) of the male service personnel enrolled between 1990 and 2015. All subjects were recruited before 18 years of age in good health and the onset of DM was derived from the EMR. We calculated the incidence rates as per person years using appropriate statistical methods. ResultsOur study population includes 51,217 participants (median age 33 years, range 17–54) with a mean follow up of 12.5 years, giving a cumulative follow up duration of 613,925 person-years (py). A total of 251 patients developed T2DM and 15 patients developed T1DM during the study period. The incidence rate of T2DM was 0.41 per 1000 py and that of T1DM was 2.44 per 100,000 py. ConclusionOur cohort had low incidence rates of diabetes when compared with other studies from India and abroad. Active military service with good life style measures may offer protection from the DM.

The impact of fathers' military deployment on child adjustment. The support needs of primary school children and their families separated during active military service: A pilot study.

Although direct exposure to war-related trauma negatively impacts children's psychological well-being, little is known about this impact within the context of parental military deployment to a combat zone and 'indirect' experience of the effects of armed conflict. This study investigates the impact of father's military deployment to Afghanistan on child well-being in primary schoolchildren and compares measures of adjustment with a matched group of children with fathers deployed on military training (non-combat) deployment. Data were collected within primary schools in 2011-2012 from 52 children aged 8-11 years with fathers deploying to Afghanistan ( n = 26) and fathers deploying on military training ( n = 26) via self-completion of questionnaires assessing symptoms of anxiety, depression, stress and levels of self-esteem. Data were collected in both groups, at pre-, mid- and post-parental deployment. Class teachers and parents (non-deployed) completed a measure of child behaviour and parents completed a measure of parenting stress and general health. Unexpectedly child adjustment difficulties were not significantly raised in children whose parents deployed to Afghanistan. Ratings of behavioural difficulties and depression were low in both groups. However, clinically elevated levels of anxiety and stress symptoms were reported by both groups of children at each stage of deployment. No associations between parental stress, parental mental health and child adjustment were found. High levels of children's anxiety and stress reported during fathers' active military service warrant further investigation. Implications for school and health monitoring and CAMHS community liaison work are discussed.

Outcomes of Medializing Tibial Tubercle Osteotomy With Medial Reefing and Vastus Medialis Obliquus Advancement Coupled With Lateral Retinacular Z-Lengthening for Recurrent Patellar Instability.

Patella-femoral dislocations, although rare, can result in functionally limiting symptoms and limited return to prior activity levels. The purpose of this study is to report outcomes of a three-in-one patellar realignment surgery for treatment of recurrent patellar instability in a young, active duty military population. We conducted a retrospective chart review of all patients who underwent our senior author's three-in-one patellar realignment surgery for recurrent patellar instability in the setting of underlying anatomic malalignment. Our primary outcome measure was the rate of recurrent instability. Secondary outcome measures included rate of return to full unrestricted active duty military service and the functional outcome scores. A total of 13 patients with an average follow-up of 16 months were included in this study. During the follow-up period, there were no reported instability events (either dislocation or subluxation). Three (23%) patients were separated secondary to issues with their operative knee and two additional patients were no longer on active duty at time of final follow-up. Six patients had paired (pre- and postoperative) Single Assessment Numerical Evaluation scores which showed a statistically significant improvement (p < 0.05) between the median pre- and postoperative Single Assessment Numerical Evaluation scores of 45 and 85, respectively. Our study demonstrates that the described patellar realignment procedure is effective at substantially reducing and possibly eliminating the symptoms of recurrent instability and allows a modest return to unrestricted active duty.

Health-related quality of life in active duty military: A secondary data analysis of two randomized controlled trials

BackgroundMilitary service members with lower extremity injuries are at risk for compromised health-related quality of life during rehabilitation. PurposeThe purpose of this secondary data analysis was to examine changes in self-perceived physical and mental health in two clinical trials of military service members during rehabilitation for a lower extremity injury. MethodsThis study is a secondary analysis of existing data from two cohorts of active duty military service members with lower extremity injuries as they participated in separate randomized controlled trials. DiscussionA similar pattern for both physical and mental health was observed in both groups of participants. Perceptions of physical health improved significantly in both studies, whereas mental health perceptions may or may not have declined. ConclusionIncreased attention to mental health may be important during rehabilitation after major and minor lower extremity injuries. Although perceptions of physical health improve, corresponding changes may not occur in mental health perceptions.

“Ready to Be a Normal Person Again”: Occupational Needs of Service Members With Mild Traumatic Brain Injury

Abstract Date Presented 4/1/2017 The purpose of this study is to describe the occupational challenges in daily life faced by active duty military service members who experience persistent symptoms following mild traumatic brain injury. The findings establish needs that fall within each aspect of the occupational therapy domain of practice. Primary Author and Speaker: Alison Cogan Contributing Authors: Maria Devore, Christine Haines, Karla Lepore, Margaret Ryan

Operative Management of Unstable Radial Head Fractures in a Young Active Population.

Radial head and neck fractures are the most common elbow fracture in the general adult population; however, the optimal treatment for radial head fractures remains a topic of ongoing clinical controversy. The purpose of this study was to determine the rate of return to function, complications, and reoperation following operative management of unstable radial head fractures in a young, active patient population with intense upper extremity demands. A military health care database was queried for all US military servicemembers undergoing open reduction with internal fixation (ORIF; Current Procedural Terminology [CPT] code: 24665) and radial head arthroplasty (RHA; CPT code: 24666) between 2010 and 2015. All patients with minimum 2-year follow-up were included. Univariate and chi-square analyses were performed to evaluate the association between potential risk factors and the primary outcome measures. A total of 67 ORIF (n = 69 elbows) and 10 RHA patients were included. The average age was 31 ± 8.0 years. At mean follow-up of 3.5 ± 1.1 years, 90% of patients overall were able to return to active military service, 96% of which with unrestricted upper extremity function. Nearly one-third (31.2%) of patients developed at least 1 postoperative complication. RHA has higher overall complication rates (70% vs 48%) when compared with ORIF, but this finding did not reach statistical significance ( P = .073). However, RHA had significantly higher rates of implant failure (20% vs 2.9%, P = .0498). Seventeen (21%) individuals required reoperation, 5 of which (6.3%) were revision procedures. Dislocation, coronoid fracture, and concomitant ligamentous repair portended a significantly increased risk of sustaining 1 or more complications ( P < .05), while dislocation and requirement for ligamentous repair independently predicted revision surgery ( P < .05). Arthroplasty and ORIF are both viable options for treating unstable radial head fractures in a young, athletic population, offering comparable return to function despite increased complications with RHA.

Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes.

Cognitive impairment in people with traumatic brain injury (TBI) could affect multiple facets of their daily functioning. Cognitive rehabilitation brings about clinically significant improvement in certain cognitive skills. However, it is uncertain if these improved cognitive skills lead to betterments in other key aspects of daily living. We evaluated whether cognitive rehabilitation for people with TBI improves return to work, independence in daily activities, community integration and quality of life. To evaluate the effects of cognitive rehabilitation on return to work, independence in daily activities, community integration (occupational outcomes) and quality of life in people with traumatic brain injury, and to determine which cognitive rehabilitation strategy better achieves these outcomes. We searched CENTRAL (the Cochrane Library; 2017, Issue 3), MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), and clinical trials registries up to 30 March 2017. We identified all available randomized controlled trials of cognitive rehabilitation compared with any other non-pharmacological intervention for people with TBI. We included studies that reported at least one outcome related to : return to work, independence in activities of daily living (ADL), community integration and quality of life. Two review authors independently selected trials. We used standard methodological procedures expected by Cochrane. We evaluated heterogeneity among the included studies and performed meta-analysis only when we could include more than one study in a comparison. We used the online computer programme GRADEpro to assess the quality of evidence, and generate 'Summary of findings' tables. We included nine studies with 790 participants. Three trials (160 participants) compared cognitive rehabilitation versus no treatment, four trials (144 participants) compared cognitive rehabilitation versus conventional treatment, one trial (120 participants) compared hospital-based cognitive rehabilitation versus home programme and one trial (366 participants) compared one cognitive strategy versus another. Among the included studies, we judged three to be of low risk of bias.There was no difference between cognitive rehabilitation and no intervention in return to work (risk ratio (RR) 1.80, 95% confidence interval (CI) 0.74 to 4.39, 1 study; very low-quality evidence). There was no difference between biweekly cognitive rehabilitation for eight weeks and no treatment in community integration (Sydney Psychosocial Reintegration Scale): mean difference (MD) -2.90, 95% CI -12.57 to 6.77, 1 study; low-quality evidence). There was no difference in quality of life between cognitive rehabilitation and no intervention immediately following the 12-week intervention(MD 0.30, 95% CI -0.18 to 0.78, 1 study; low-quality evidence). No study reported effects on independence in ADL.There was no difference between cognitive rehabilitation and conventional treatment in return to work status at six months' follow-up in one study (RR 1.43, 95% CI 0.87 to 2.33; low-quality evidence); independence in ADL at three to four weeks' follow-up in two studies (standardized mean difference (SMD) -0.01, 95% CI -0.62 to 0.61; very low-quality evidence); community integration at three weeks' to six months' follow-up in three studies (Community Integration Questionnaire: MD 0.05, 95% CI -1.51 to 1.62; low-quality evidence) and quality of life at six months' follow-up in one study (Perceived Quality of Life scale: MD 6.50, 95% CI -2.57 to 15.57; moderate-quality evidence).For active duty military personnel with moderate-to-severe closed head injury, there was no difference between eight weeks of cognitive rehabilitation administered as a home programme and hospital-based cognitive rehabilitation in achieving return to work at one year' follow-up in one study (RR 0.95, 95% CI 0.85 to 1.05; moderate-quality evidence). The study did not report effects on independence in ADL, community integration or quality of life.There was no difference between one cognitive rehabilitation strategy (cognitive didactic) and another (functional experiential) for adult veterans or active duty military service personnel with moderate-to-severe TBI (one study with 366 participants and one year' follow-up) on return to work (RR 1.10, 95% CI 0.83 to 1.46; moderate-quality evidence), or on independence in ADL (RR 0.90, 95% CI 0.75 to 1.08; low-quality evidence). The study did not report effects on community integration or quality of life.None of the studies reported adverse effects of cognitive rehabilitation. There is insufficient good-quality evidence to support the role of cognitive rehabilitation when compared to no intervention or conventional rehabilitation in improving return to work, independence in ADL, community integration or quality of life in adults with TBI. There is moderate-quality evidence that cognitive rehabilitation provided as a home programme is similar to hospital-based cognitive rehabilitation in improving return to work status among active duty military personnel with moderate-to-severe TBI. Moderate-quality evidence suggests that one cognitive rehabilitation strategy (cognitive didactic) is no better than another (functional experiential) in achieving return to work in veterans or military personnel with TBI.

Radial Head Arthroplasty in the Active Duty Military Service Member With Minimum 2-Year Follow-Up

Radial head arthroplasty (RHA) is a viable treatment for complex radial head fracture. Whereas elbow stability and function is typically restored at short- to mid-term follow-up, the outcome in higher-demand populations is not well defined. We sought to characterize the functional and occupational outcomes following RHA in an active duty military population with intense upper extremity demands. We retrospectively reviewed the records of all U.S. military service members undergoing primary RHA from 2010 and 2013 with a minimum of 2-year follow-up. Patient-based, injury-related, and surgical variables were extracted from the military-wide electronic medical record. Functional and occupational outcomes including pain, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire were recorded. The primary outcomes of interest were the rate and level of return to upper extremity activity. Secondary outcome measures included return to duty, complications, and revision surgery. Nineteen patients were included with average age 31 years and median 37 months' follow-up. Ten were Mason III, 6 were part of a terrible triad injury, and the remainder were fracture-dislocations. At an average follow-up of 3.7 years, 15 patients returned to active military duty, and 9 resumed their regular upper extremity military function. At the time of final follow-up, the average DASH score was 13. Seven patients returned to their usual level of sport and exercise, 6 at a reduced level, and 6 did not resume physical exercises secondary to pain or stiffness. Sixteen adverse outcomes among 14 patients included symptomatic heterotopic ossification (5 of 19) and neurological sequelae (4 of 19). Three elected to have a revision procedure at an average of 13 months for heterotopic ossification or loosening. Among active patients with radial head fractures treated with RHA, three-quarters will return to active duty military service, push-ups, and sport; however, half may report an adverse outcome unrelated to the prosthesis and only about half of patients will return to their preinjury level of function. Therapeutic IV.

0493 ARE SPLIT-NIGHT POLYSOMNOGRAMS APPROPRIATE FOR PATIENTS IN HIGH-RISK PROFESSIONS?

According to the AASM guidelines, split-night polysomnography (SN-PSG) is an acceptable alternative to full-night PSG (FN-PSG) and may be considered in patients who demonstrate an apnea-hypopnea index (AHI) ≥20/hr within the first two hours of the study. While the literature supports SN-PSGs as an accurate approximation of moderate-to-severe obstructive sleep apnea (OSA), there remains the potential to misclassify the severity of sleep disordered breathing utilizing this diagnostic modality. Risks associated with the misclassification of OSA severity may be significant in high-risk professions such as the military, pilots, and commercial drivers. The purpose of our study was to determine the accuracy of SN-PSGs in a cohort of high-risk professionals. We conducted a retrospective review of active duty military service members undergoing FN-PSG. FN-PSG data (AHI, ARI, SpO2 nadir) were processed to obtain partial-night data for the first 2- and 3-hours of recording. Three-hundred consecutive patients were included in the study. Within our cohort, 79% were male with a mean age of 37.6 ± 8.4 years and mean BMI of 28.5 ± 3.3 kg/mm2. Mean AHI for FN-PSG and 3-hour SN-PSG were 16.2 ± 17/hr and 16.7 ± 19/hr, respectively. Of our cohort, 112 patients (37%) would have qualified for a SN-PSG based upon the first 3-hour recording. Of those patients, 81 (72%) were appropriately classified as either moderate or severe OSA; however, 31 patients (28%) were misclassified. Of the 24 patients misclassified as moderate OSA on SN-PSG, 18 (75%) were observed to have mild OSA on FN-PSG while 6 patients (25%) demonstrate severe disease. Of the 7 patients misclassified as severe OSA on SN-PSG, all had moderate OSA on FN-PSG. In our cohort, while there was general agreement between FN-PSG and SN-PSG, 3-hour SN-PSGs misclassified a significant portion of the cohort’s severity of disease. This may be an important consideration when evaluating high-risk professionals.

‘To become again our brethren’: desertion and community during the American Revolutionary War, 1775-83

Desertion from active military service has always been a contentious action, especially in times of war. Deserters in the eighteenth century were routinely castigated as poor patriots or traitorous subjects. Recently, scholars have begun to analyse in greater depth how and why desertions occurred, and have demonstrated that political considerations were less important than issues of identity and interest. However, in the context of the American Revolutionary War, historians have focused on the relationship between deserters and the military, arguing that soldiers who left their posts were less integrated into the camp community. This article suggests that the act of desertion was often more than a protest against conditions or discipline, but instead was shaped by a deserter's connections with civil society rather than the military community.

Homelessness following disability-related discharges from active duty military service in Afghanistan and Iraq

BackgroundMany dynamics in the relationship among military service-related disabilities, health care benefits, mental health disorders, and post-deployment homelessness among US Veterans are not well understood. ObjectivesDetermine whether Veterans with a disability-related discharge from military service are at higher risk for homelessness, whether Veterans Health Administration (VHA) service-connected disability benefits mitigates that risk, and whether risks associated with discharge type, service-connected disability, or the interaction between them vary as a function of mental health disorders. MethodsRetrospective cohort study of 364,997 Veterans with a disability-related or routine discharge and initial VHA encounter between 2005 and 2013. Logistic regression and survival analyses were used to estimate homelessness risk as a function of discharge status, mental health disorders, and receipt of VHA disability benefits. ResultsDisability-discharged Veterans had higher rates of homelessness compared to routine discharges (15.1 verses 9.1 per 1000 person-years at risk). At the time of the first VHA encounter, mental health disorders were associated with differentially greater risk for homelessness among Veterans with a disability discharge relative to those with a routine discharge. During the first year of VHA service usage, higher levels of disability benefits were protective against homelessness among routinely-discharged Veterans, but not among disability-discharged Veterans. By 5-years, disability discharge was a risk factor for homelessness (AOR = 1.30). ConclusionsIn the long-term, disability discharge is an independent risk factor for homelessness. While VHA disability benefits help mitigate homelessness risk among routinely-discharged Veterans during the early reintegration period, they may not offer sufficient protection for disability-discharged Veterans.

No clinically meaningful weight changes in a young cohort following total joint arthroplasty at 3-year follow-up.

Total joint arthroplasty (TJA) is one of the most successful operations. There is little in the literature regarding weight change following TJA, particularly in a young cohort. Retrospective analysis of 181 primary total hip arthroplasty (THA) and 185 primary total knee arthroplasty (TKA) patients was conducted. We reviewed preoperative and post-operative weights and post-operative body mass index at 3 and 6 months, 1 year, 2 and 3 years. We evaluated expected versus actual weight gain, and performed subgroup analyses of obese versus non-obese patients and active duty versus civilian patients. We used a minimal clinically meaningful weight change from baseline of ≥5%. One hundred and fifty-one (41.3%) patients were active duty military service members with the mean age of 53 ± 11.1 years. In TKA patients, statistically significant differences were found in mean weights at 3 months (-1.8%, P ≤ 0.0001) and 2 years (+1.9%, P = 0.0006). In THA patients, statistically significant weight gains were found at 6 months (+1.1%, P = 0.006). For obese TKA patients, significant weight changes were observed at 3 months (-2.5%, P ≤ 0.0001), and none in the obese THA group. There were no statistical or clinically meaningful weight changes in the non-obese TKA or THA groups. There was a clinically meaningful weight gain in active duty TKA patients at 3 years (5.18%, P = 0.17). Despite a theoretical ability to lose weight following TJA, patients maintain their preoperative weight following TJA. We found a clinically meaningful weight gain at 3 years post-operatively only in active duty TKA patients. Overall, however, we found no clinically significant weight changes following TJA at 3-year follow-up.

The effect of military deployment on mental health

Public concern about soldiers’ mental health has increased over the last decade. Yet the large literature on the mental health problems of returning soldiers relies primarily on self-reported measures that may suffer from non-response bias, usually refers to older conflicts, and focuses mainly on specific diagnoses such as PTSD. Another challenge is that the differences between soldiers and non-soldiers are not necessarily causal, instead possibly reflecting an underlying propensity towards active military service. Using the objective measures of hospitalizations and the purchase of mental health medication, this paper is the first to investigate the effect of recent military deployments on a broader measure of mental health, for a full population of Danish soldiers and a comparison group of eligible men. We exploit a panel of Danish health administrative records and use propensity score matching process, using unique observables such as ability tests. Matching is helpful in both reducing the selection bias from observables and determining pre- and post-deployment period for the comparison group. Then, we estimate the effect of deployment in a difference-in-differences setting, controlling for time trends and other omitted variables affecting both groups. Overall, we find a significant and long-lasting adverse effect of military deployment on soldiers’ mental health, regardless of the comparison groups and underlying assumptions.

Conscientious objection in healthcare, referral and the military analogy

An analogy is sometimes drawn between the proper treatment of conscientious objectors in healthcare and in military contexts. In this paper, I consider an aspect of this analogy that has...

Experiences of Veterans Transitioning to Postsecondary Education.

An increasing number of U.S. military veterans are entering postsecondary education with problems attributed to deployed military service. The primary objective of this research was to describe the lived experiences of student veterans transitioning from active military service to postsecondary education. Phenomenological interviews were performed with 13 student veterans who had transitioned from military deployment to postsecondary education. An overall essential meaning of "emerging in college culture" was manifested from three themes, supported by rich textural and structural descriptions of student veterans' experiences: (1) repurposing military experiences for life as a student veteran, (2) reconstructing civilian identity, and (3) navigating postsecondary context and interactions. These findings highlight implications that may facilitate occupational therapists' efforts in supporting the needs of student veterans.

Effect of Stellate Ganglion Block on Specific Symptom Clusters for Treatment of Post-Traumatic Stress Disorder.

This study assessed which symptoms are most impacted following stellate ganglion block (SGB) used to treat post-traumatic stress disorder (PTSD) symptoms. 30 active military service members with combat-related PTSD self-referred to their physician and psychologist. Patients were offered a SGB as part of their treatment program. Primary outcome was the magnitude of change for the 17 items on the PTSD Checklist-Military (PCL-M), which was administered the week before SGB, 1 week after SGB, and 2 to 4 months later. Mean PCL-M score decreased from 49 at baseline to 32, 1 week after the procedure (p < 0.001). 2 to 4 months after SGB, patients maintained an average PCL-M of 32. Patients reported greatest improvement in the first week after SGB for the following symptoms: irritability or angry outbursts, difficulty concentrating, and sleep disturbance. 2 to 4 months later, patients reported greatest improvement in the following: feeling distant or cut off, feeling emotionally numb, irritability or angry outbursts, and difficulty concentrating. SGB is a safe procedure that may provide extended relief for all clusters of PTSD symptoms. As a result of the significant reduction in hyperarousal and avoidance symptoms observed, this study supports incorporation of SGB into PTSD treatment plans.

The Success of Hip Arthroscopy in an Active Duty Population

To examine the outcomes of arthroscopic treatment of the hip in a young, active military population. Specifically, the ability to return to duty was the prime indicator of success. In addition, an objective evaluation of various demographic and surgery-related variables was performed to identify predictors for success or failure of treatment in this military population. A retrospective chart review was undertaken to ascertain the results of hip arthroscopy at a single academic military medical center. A total of 206 patients underwent 223 hip arthroscopies during a 13-year period (2000-2013). Of these, 159 patients met the inclusion criteria, which included active duty military service and at least 12-month follow-up. Veterans Affairs Beneficiaries, active duty dependents, and those with less than 12months of follow-up were excluded. Surgeries were performed by 1 of 5 fellowship-trained orthopaedic surgeons. Data were collected from the Armed Forces Health Longitudinal Technology Application, Electronic profiling system, and Physical Evaluation Board. A total of 159 patients were available for the study, 102 males and 57 females. The average age of the patients overall was 30.9 ± 8.3years (range, 18-52years). Junior enlisted, which is considered entry level, made up 64.2% of the subjects. The most common diagnosis was femoroacetabular impingement, and the most common procedure performed was acetabuloplasty. Twenty-two percent of patients underwent evaluation by the medical retention board after hip arthroscopy and were separated from military service. Seventy-eight percent of soldiers were maintained on active duty after hip arthroscopy. The overall complication rate was 15.7%, with a major complication rate of 1.25% defined as femoral neck fracture, abdominal compartment syndrome, osteonecrosis, deep vein thrombosis and/or pulmonary embolus, and septic arthritis. Univariate analysis of risk factors showed the presence of a complication to be a significant predictor for failure to return to active duty (odds ratio [OR] 4.04, P= .0035) as was senior noncommissioned officer rank (OR 0.20, P= .0347). Multivariate analysis showed only the presence of a complication to be a significant predictor for failure to return to active duty (OR 3.71, P= .0083). Hip arthroscopy in a military population is effective in treating multiple causes and retaining soldiers on active duty status. Complications of any kind from surgery or postoperatively are significant predictors of medical separation and may warrant earlier initiation of a medical evaluation board. Level IV, therapeutic case series.