Army Medical Department Research Articles

Home sleep study equivalent to conventional sleep study in most patients with suspected obstructive sleep apnea

Dwight D Eisenhower Army MC FMR, Fort Gordon, GA The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.

Do acupuncture and acupressure have a role in induction of labor in noncomplicated pregnancies at term?

Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department, the U.S. Army at large, or the U.S. Department of Defense.

To mag or not to mag?

Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.

Letterman General Hospital during World War I

When the United States entered World War I on April 6, 1917, the Army Medical Department operated only four general hospitals and was in many ways unprepared for the scale and nature of the conflict ahead. This article examines the war's impact on Letterman General Hospital in San Francisco, which was the largest of the four hospitals before the war. In addition to tripling in capacity, Letterman incorporated many of the Medical Department's new services, the most significant concerning orthopedics and physical rehabilitation. The army's embrace of the ethic of rehabilitation was part of a major change in how the government managed care and compensation for those wounded in war—a change that marked a shift, continuing to this day, in how both state and society understand the relationship between disability and citizenship. After the war, Letterman incorporated new requirements for treating veterans in support of the country's evolving veterans’ health care system, which at times was unable to provide the full level of care the government had pledged and that many veterans had come to expect.

Poor Soldier Medical Readiness In The Year Following Return To Unrestricted Duty After Musculoskeletal Injury

Not all Soldiers cleared for full unrestricted duty are without injury just because they do not seek medical attention. Using medical care-seeking as proxy for medical readiness & deployability has limitations. Efficient injury detection & long-term management can improve if surveillance begins before patients make decisions to seek care. PURPOSE: 1) determine proportion of Soldiers reporting new or recurring injuries for which they did not seek medical care, & 2) report perceived ability to perform full military duty when injured & not seeking care. METHODS: This was a secondary analysis of a cohort of Soldiers (n=469) recently cleared to return to full duty (RTFD) without limitations. Monthly adaptive text messages queried about any new or recurrent injuries for 1 yr after clearance to RTFD after spine or lower extremity injury. Presence of MSK pain, care-seeking behavior, & perceived ability to perform military duties were assessed. RESULTS: 424 soldiers had at least 1 response over the 1-yr follow-up & a mean response rate of 45.5% (at least 5 months). 315 participants reported injury-related MSK pain at least once. Of those, 276 (87.6%) reported not seeking care during at least 1 pain episode. When care was not sought, 89 (32.2%) reported it affecting their ability to perform military duties. On at least one occasion, 127 individuals believed they would not pass an annual fitness test due to pain, deconditioning, or fear of injury. CONCLUSIONS: Soldiers do not always seek care for MSK injuries, & thus, many are not confident in their ability to complete military duties. Early indicators & improved surveillance strategies could identify problematic injuries before they reach a threshold of needing to seek care. Equally important is the ability to predict which individuals can self-manage without adversely affecting ability to perform military duties. This research was supported by the Department of Defense Military Operational Medicine Research Program under program number (W81XWH-13-MOMJPC5-IPPEHA). The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, the Department of Defense, or the U.S.Government.

Aspirin for primary prevention? No thank you!

Dwight David Eisenhower Army Medical Center, Family Medicine Residency Fort Gordon, GA The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department, the Army at large or the Department of Defense.

U.S. Army Medical Corps Recruitment, Job Satisfaction, and Retention: Historical Perspectives and Current Issues.

This study was conducted to identify and understand the current factors affecting recruitment, job satisfaction, and retention of U.S. Army Medical Corps officers and provide historical background to understand if the current factors are dissimilar. An anonymous, voluntary questionnaire was sent to U.S. Army Medical Corps officers, and responses were tabulated and analyzed. Historical research was conducted and historical analysis applied. Recruiting, job satisfaction, and retention among Army Medical Corps Officers have been problematic throughout the 50-year history of the all-volunteer force. Recruiting has largely been of medical students, with very limited numbers of direct accessions. At times, satisfactory overall numbers have camouflaged shortages in key go-to-war specialties. Also, satisfactory numbers in a specialty have sometimes camouflaged problems in depth of experience. Satisfaction has been seen as a problem but apparently only studied informally and/or episodically. Retention has largely been addressed through service obligations, followed by monetary bonuses, although these have to be across the Department of Defense, limiting service flexibility. There has never been consistent, longitudinal sampling of opinion among Medical Corps Officers to allow senior leaders to influence the Department of Defense policy. A recent (2016) study provides substantial data but should be repeated rather than being isolated. As the situation in the Department of Defense and Army Medical Department changes, with more focus on go-to-war specialties, the Army needs to better measure opinion among Medical Corps Officers to inform policy. These studies should be conducted regularly to generate reliable information on trends and allow prioritization of effort to areas that hamper recruiting, undermine satisfaction, and prevent retention.

More Is Not Better with Vitamin D in Healthy Adults

Dwight David Eisenhower Army Medical Center Fort Gordon, GA The author declares no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.

Survival of the fittest?

Dwight David Eisenhower Army Medical Center, Family Medicine Residency Fort Gordon, GA The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.

Does colchicine prevent episodes of recurrent pericarditis in patients who have suffered from acute pericarditis?

Carl R. Darnall Army Medical Center Family Practice Residency Program, Ft. Hood, TX The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.

What is the best CDS in children?

Blanchfield Army Community Hospital, Fort Campbell, KY Womack Army Medical Center, Fort Bragg, NC The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.

Does the “HCG diet” provide additional weight loss compared with a low-calorie diet alone?

Carl R. Darnall AMC FMR, Fort Hood, TX The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the U. Army Medical Department, the Army at large, or the Department of Defense.

How accurate is the Hunter Serotonin Toxicity Criteria for diagnosing serotonin syndrome?

Carl R. Darnall Army Medical Center, Fort Hood, TX The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department, the Army at large, or the Department of Defense.

Methylphenidate results in improvement in apathy, cognition, and function in elderly male patients with mild Alzheimer's dementia

DD Eisenhower Army Medical Center, Fort Gordon, GA The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.

Claudin‐1 responsiveness through modulation of the inflammatory status in the Caco‐2 model epithelium.

The use of hydrocortisone in association with indomethacin is a known risk factor for spontaneous intestinal perforation (SIP) in extremely low birthweight infants. While hypoxia, inflammation, and hydrocortisone have been found to independently alter both tight junction functionality and formation, the concomitant effects of inflammation, hydrocortisone, and indomethacin have yet to be well defined. Through the use of the Caco‐2‐BBe cell line as an in vitro model of the intestinal epithelial barrier, we tested the effects of the pro‐inflammatory agents TNF and IFNγ and the anti‐inflammatory agents indomethacin and hydrocortisone on barrier integrity and tight junction protein expression. Confocal imaging and cellular ATP analysis after 24 and 48 hours of exposure to the inflammatory agents both showed no significant changes in cellular proliferation or ATP synthesis, respectively. Western blot analysis found that claudin‐1 protein expression and localization is affected by inflammatory cytokines. Live cell confocal imaging of eGFP‐claudin‐1 Caco‐2 cells found that addition of pro‐inflammatory agents or the addition of anti‐inflammatory agents resulted in rapid dynamic junctional reorganization. When both the pro‐ and anti‐inflammatory agents were added, this pattern of reorganization was also seen. However, the concomitant effects of the combined pro‐ and anti‐inflammatory agents resulted in a profound inability to recapitulate its original claudin‐1 configuration. The lack of an effect on cellular proliferation and ATP synthesis paired with the alterations in claudin‐1 protein levels and localization suggests that claudin‐1 may be a potential target in better understanding the progression of spontaneous intestinal perforation.Competing Interest StatementAll authors have indicated they have no potential conflicts of interest to disclose. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force and Army, Department of Defense or the U.S. Government.Support or Funding InformationTrinity University Biology Department

Can d-dimer testing reliably exclude the diagnosis of cerebral venous thrombosis?

Madigan Army Medical Center, Ft. Lewis, WA The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department, the Army at large or the Department of Defense.

What is the efficacy of OTC antitussives for children with a viral URI?

Carl R. Darnall Army Medical Center, Fort Hood, TX The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.

How effectively does topical anesthesia reduce pain in pediatric patients undergoing a needle-requiring procedure?

Family Medicine Residency at Madigan Army Medical Center, Tacoma, WA The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department, the Army at large or the Department of Defense.

Combat medic testing of a novel monitoring capability for early detection of hemorrhage.

Current out-of-hospital protocols to determine hemorrhagic shock in civilian trauma systems rely on standard vital signs with military guidelines relying on heart rate and strength of the radial pulse on palpation, all of which have proven to provide little forewarning for the need to implement early intervention prior to decompensation. We tested the hypothesis that addition of a real-time decision-assist machine-learning algorithm, the compensatory reserve measurement (CRM), used by combat medics could shorten the time required to identify the need for intervention in an unstable patient during a hemorrhage profile as compared with vital signs alone. We randomized combat medics from the Army Medical Department Center and School Health Readiness Center of Excellence into three groups: group 1 viewed a display of no simulated hemorrhage and unchanging vital signs as a control (n = 24), group 2 viewed a display of simulated hemorrhage and changing vital signs alone (hemorrhage; n = 31), and group 3 viewed a display of changing vital signs with the addition of the CRM (hemorrhage + CRM; n = 22). Participants were asked to push a computer key when they believed the patient was becoming unstable and needed medical intervention. The average time of 11.0 minutes (95% confidence interval, 8.7-13.3 minutes) required by the hemorrhage + CRM group to identify an unstable patient (i.e., stop the video sequence) was less by more than 40% (p < 0.01) compared with 18.9 minutes (95% confidence interval, 17.2-20.5 minutes) in the hemorrhage group. The use of a machine-learning monitoring technology designed to measure the capacity to compensate for central blood volume loss resulted in reduced time required by combat medics to identify impending hemodynamic instability. Diagnostic, level IV.

A needle alternative for VTE treatment in active cancer

Dwight David Eisenhower Army Medical Center, Fort Gordon, GA The author declares no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.