Eisenhower Army Medical Center Research Articles

Is transcutaneous electrical nerve stimulation an effective treatment for low back pain?

Eisenhower Army Medical Center, Fort Gordon, GA The corresponding author is Jason Lanham; [email protected] The authors have no conflicts of interest to disclose. 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.

Fluoxetine use for weight loss in overweight or obese adults

Dwight D. 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.

Profiles After Acute Traumatic Injury: The Non-battle Injury Impact on Readiness at a Single Military Treatment Facility

Physical profiling is critical to the individual medical readiness of all military service members. This classification system provides detailed information about an individual's functional abilities. Profile information is used in determining whether a service member is medically deployable or non-deployable. Limited research has been conducted on the impact of acute traumatic injuries on duty status and profiles in the non-deployed setting. The purpose of this study was to characterize injured service members presenting to a CONUS MTF emergency department whose acute traumatic injury resulted in a profile. A retrospective review of patients who presented to the Dwight D. Eisenhower Army Medical Center emergency department with traumatic injuries from January 1, 2019, to December 31, 2019, was performed. Patients were identified by searching electronic encounter records for trauma-specific ICD-10 codes. Returned patient records were then reviewed for active duty status, branch, age, gender, rank, mechanism, protective equipment, substance use, procedures, and disposition. Profiles of soldiers were reviewed for indication and duration. Patients with profiles were compared to those without profiles. Correlation with age was determined by t-test, correlation with profile length was determined by ANOVA, and correlation with the remaining categorical variables was determined with chi-squared analysis. Eight hundred and thirty-two service members were reviewed. One hundred and eight (13%) soldiers had a profile. Patients were 23.2% female with no difference between the two groups. Patients were an average of 28.7 years old. The most common mechanisms were physical training (PT) (33.1%) and falls (12.9%). Physical training and motor vehicle collisions were more common in the profile group. Combatives and crush injuries of the hand were less common in the profile group. Major procedures were more common in the profile group, and minor procedures were less common. Admissions, quarters, immediate referrals, and release without limitations were more common in the profile group. The mean duration of profiles was 48.9 days, and 7.4% were permanent. Non-battle injuries in the garrison setting are a significant threat to readiness. This analysis of acute traumatic injuries suggests that mechanism of injury was similar to previous reports with PT and falls being most common. Interventions should be targeted at PT and motor vehicle collisions as these were more common in the profile group. This series is also similar to previous reports that extremity injuries are the most common cause of profiles. However, TBIs were more common in our analysis. Further research that encompasses all garrison MTF acute traumatic injuries is needed to define the true impact on readiness and guide development of injury prevention strategies.

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.

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.

Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Active-Duty Service Members Improves Depressive Symptoms.

ObjectivesCurrent research on the efficacy of repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex as a noninvasive therapy for treatment-resistant depression is largely settled science. However, little is known about its efficacy with active-duty service members (ADSMs) with major depressive disorder. In a retrospective chart review, we examined depressive symptom ratings in ADSMs seeking treatment at the US Army Outpatient Behavioral Health Service Clinic at Eisenhower Army Medical Center, Fort Gordon, Ga.MethodsWe reviewed 121 consecutive outpatient charts, which yielded 61 ADSMs who completed a minimum of 20 rTMS sessions for refractory depression, and for whom both pretreatment and posttreatment depressive symptom ratings were available. Pre– and post–Patient Health Questionnaire 9 (PHQ-9) scores were subjected to a paired t test, and Reliable Change Indices were calculated to determine both reliable and clinical significance.ResultsAverage (SD) pretreatment and posttreatment PHQ-9 scores were 15.8 (6.2) and 12.6 (7.6), respectively. Statistically significant reduction in post–PHQ-9 was demonstrated (P < 0.001), with 69% of patients lowering their ratings and 31% demonstrating reliable change (improvement >5.64). Additionally, 20% demonstrated a reliable change that placed them in the nondysfunctional range (post–PHQ-9 <9.6), demonstrating clinical significance.ConclusionsThese data confirm a course of standard rTMS to ADSMs with major depression is promising in reducing depressive symptoms. Given that success and completion rates from this clinic are similar to those reported in civilian populations (80%), rTMS may be an adequate additional treatment or augmentation strategy for refractory depression in ADSMs.

Is yoga an effective treatment of urinary incontinence in women?

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.

Tranexamic acid in postpartum hemorrhage: Early administration may decrease death from bleeding

Eisenhower Army Medical Center, GA 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.

Is lactated Ringer's solution superior to normal saline in the management of patients with acute pancreatitis?

Dwight D. Eisenhower Army Medical Center, Augusta, 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.

Factors influencing long-term weight loss after bariatric surgery

BackgroundBariatric surgery provides sustained weight loss and improves comorbidities. However, long term data has shown that patients gradually regain weight after 1 year. Several factors have been associated with poor weight loss after bariatric surgery. ObjectiveOur goal is to investigate factors associated with poor weight loss following laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). SettingMilitary academic medical center. MethodsRetrospective review of 247 patients who underwent laparoscopic SG or RYGB between 2010–2012 at Eisenhower Army Medical Center and followed for 5 years postoperatively. Factors of age, type of surgery, sex, hypertension, depression, and type 2 diabetes (T2D) are analyzed in univariate and multivariate analysis with percent total weight loss (%TWL) and Body Mass Index (BMI) change as primary endpoints measured at 3 and 5 years. ResultsAverage BMI change are maximized at 1 year and decreased at 3 and 5 years post-surgery. Age, diabetes, hypertension and type of surgery significantly influenced weight loss at 3 and 5 years on univariate analysis. However, patients with diabetes, hypertension and sleeve gastrectomy were significantly older than comparable control group. Multivariable analysis showed that age and type of surgery, not diabetes or hypertension, were associated with poor %TWL and BMI change at 3 and 5 years. ConclusionWhile presence of hypertension and diabetes initially appeared to be associated with weight recidivism, their impacts were negligible on multivariable analysis. However, age and sleeve gastrectomy are independent risk factors. Our data can be used to counsel patients on expected weight loss after bariatric surgery.

Combination therapy for hospitalized patients with influenza

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 Army at large or the Department of Defense.

Is exercise an effective treatment for patients with chronic fatigue syndrome?

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 US Army at large, or the US Department of Defense.

At what creatine kinase level is it appropriate to discharge hospitalized patients with exertional rhabdomyolysis?

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 US Army at large, or the US Department of Defense.

Factors that differentiate Traumatic Brain Injury (TBI) patients from Post‐Traumatic Stress Disorder (PTSD) patients among Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans

Traumatic Brain Injury (TBI) has become the “signature wound” of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Due to the increased use of improvised explosive devices by the insurgent forces and the unavoidable facial exposure of our combat troops, even when wearing protective gear, estimates suggest that as many as 20 % to 30 % of returning soldiers may eventually exhibit symptoms of TBI. Post‐Traumatic Stress Disorder (PTSD), as defined by the American Psychiatric Association, is a serious behavioral health disorder, and it has been estimated that 17.1 % of soldiers returning from Iraq, and 11.2 % of those returning from Afghanistan, have experienced major depression, generalized anxiety, and/or PTSD. As a part of the present effort, investigators within the Integrative Systems Biology Program (ISB), at US Army Center for Environmental Health Research (USACEHR), are working with collaborators from the Dwight D. Eisenhower Army Medical Center (DDEAMC) to screen for potential biomarkers associated with neuronal injury. In this pilot study, blood samples were collected at DDEAMC from patients diagnosed with PTSD, TBI, or both, and shared with USACEHR for multi‐omics analysis for identification of candidate genes/proteins distinguishing between TBI and PTSD. The candidate gene/protein approach is viewed as only a first step toward identifying molecular mechanisms that are likely to be involved in the physiologic consequences of TBI/PTSD. Gene expression, DNA methylation, and targeted proteomics analysis have been completed with these samples. Functional pathway predictions indicate possible overlaps of networks enriched by differentially expressed genes and methylated genes. The advancements realized through the current findings need to be validated using larger sample sizes, and it will be important to include a gender/age/ethnicity‐matched control. The results of this research will be leveraged in multiple ways to improve the health and treatment of returning soldiers diagnosed with TBI/PTSD.Support or Funding InformationDISCLAIMERS: Research was conducted in compliance with all Federal Requirements. The views expressed are those of the authors and do not constitute endorsement by the U.S. Army.

Formal Nutritional Education Improves Weight Loss in Bariatric Patients Following Laparoscopic Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) is an increasingly performed procedure in the bariatric surgery armamentarium. This study evaluates our experience with LSG at Dwight D. Eisenhower Army Medical Center (DDEAMC) during the time period of 2008-2010. We found that the inclusion of formal nutritional education significantly increased our weight loss results following LSG. This is a retrospective review from our LSG caseload from 2008 to 2010. During that time, we performed 159 LSG. In our review, we performed comparative data of all operative years during 2008-2010 for up to 3years postoperatively. Our main focus was in regard to weight loss as measured by percentage of excess body weight loss (%EWL), percentage of total weight loss (%TWL), and percentage of excess BMI loss (%EBL). We also evaluated the effect of LSG on diabetes mellitus (DM) and hypertension (HTN) postoperatively. We found an improvement in our %EWL, %TWL, and %EBL rates in our LSG cases following the inclusion of formal nutritional education. There was a mean increase in %EWL of 15%, %TWL of 7%, and %EBL of 21%, which were statistically significant, that was present at all postoperative years of follow-up. We determined the only variable that changed in our bariatric program starting in 2010 was the inclusion of formal nutritional education. We also found a statistically significant improvement in resolution of HTN with the inclusion of formal nutritional education. The addition of formal nutritional education can enhance weight loss following bariatric surgery. We have shown a significant improvement in weight loss results following LSG with the implementation of formal nutritional education; this is the only study to our knowledge evaluating formal nutritional education and LSG.

Eric K. Johnson, MD, FACS, FASCRS.

Dr. Eric K. Johnson is a staff colon and rectal surgeon at Madigan Army Medical Center, Fort Lewis, WA. Eric was born in Baumholder, Germany. He received bachelor of science in biology from the University of Maryland, College Park, Maryland, and MD from the University of Maryland, Baltimore, MD. He did his General Surgery Residency training at Eisenhower Army Medical Center in Augusta, Georgia. He then completed a Colon and Rectal Residency at the Georgia Colon and Rectal Surgical Clinic in Atlanta, GA. Eric then served as Chief of Colorectal Surgery at Eisenhower Army Medical Center for 6 years. In 2011, he joined the staff at Madigan Army Medical Center. During his Army career, Dr. Johnson spent multiple deployments as a staff surgeon in Iraq and Afghanistan. He has been promoted to the rank of Colonel and he has been awarded several military decorations including the Meritorious Service Medal and the Bronze Star. Dr. Johnson is an associate professor of surgery at the Uniformed Services University of the Health Sciences in Bethesda, MD, and a clinical assistant professor of surgery at the University of Washington School of Medicine in Seattle, WA. He is board certified in General and Colon and Rectal Surgery. He teaches military surgical residents and medical students on a daily basis and is an active participant in multiple surgical societies. His contributions to the medical literature include 48 peer-reviewed publications and 7 book chapters. He has also made multiple presentations at national meetings. Eric, his wife, Amy; and his three daughters, Emily, Abigail, and Molly, live in Gig Harbor, WA. When not working, he participates in sky diving and mountain climbing. As a retired USAF surgeon, I can appreciate the dedication and sacrifices of the dedicated individuals in our armed services. We owe our freedoms and societal options to all of those who have served our country. Dr. Johnson and several of his colleagues, who remain on active duty, have contributed to this issue. Their service and contributions merit our acknowledgment and gratitude. On behalf of the readers and staff of Clinics of Colon and Rectal Surgery, I sincerely thank Dr. Eric K. Johnson for serving as a guest editor and for providing us with a superb issue on biologicals in colon and rectal surgery.

Is zinc effective at providing symptomatic relief for upper respiratory tract infections?

Dwight D. Eisenhower Army Medical Center Augusta, GA 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 US Army at large, or the Department of Defense.

Military Inpatient Residential Treatment of Substance Abuse Disorders: The Eisenhower Army Medical Center Experience

Opened in 2009, the Dwight D. Eisenhower Army Medical Center Inpatient Residential Treatment Facility (RTF) is the largest and most well-established inpatient substance use disorder treatment facility in the Department of Defense. The RTF is a 28-day inpatient treatment program that employs evidence-based practices and is based on Alcoholics/Narcotics Anonymous principles that are incorporated with a hybrid of military daily structure regime including early morning physical training. Family involvement is encouraged. The RTF is staffed by a multidisciplinary team specializing in addictions and admits Active/Activated Service Members (SMs) from all Service branches, typically those who have failed other military/civilian substance use disorder programs. Eighty-seven percent of SMs referred to the program successfully commenced, with continuous sobriety observed in over half of SMs 6 months later, and 1 year relapse rates comparable to other alcohol treatment programs. Limitations of our program evaluation efforts, lessons learned, and recommendations for the way ahead are shared.

Effect of the degree of reverse Trendelenburg position on intraocular pressure during prone spine surgery: a randomized controlled trial

Background contextPostoperative vision loss complicates an estimated 1 in 1,100 prone spine surgical cases. This complication has been attributed to ischemic optic neuropathy, with one proposed reason being perioperative elevations in intraocular pressure (IOP). Previous research has studied the effects of table inclination on IOP in awake volunteers; however, the effects in spine surgery patients have not been investigated for reverse Trendelenburg positioning using a prospective, randomized controlled study design. PurposeTo assess the effect of table inclination on IOP in patients undergoing prone spine surgery. Study designSingle-center, prospective randomized controlled study. Patient sampleNineteen patients with no history of eye pathology, undergoing prone spine surgery at Dwight D. Eisenhower Army Medical Center, were randomly assigned to a table position: neutral, 5°, or 10° of reverse Trendelenburg. Outcome measuresIntraocular pressure, mean arterial pressure (MAP), estimated blood loss, fluid resuscitation, and ophthalmologic complication were assessed before and after induction and at incremental times during surgery, beginning at 30 minutes, 60 minutes, and 60-minute increments thereafter. MethodsMultivariate analyses evaluated surgical time, IOP, MAP, estimated blood loss, and fluid resuscitation as a function of table inclination to determine the effect of patient positioning on identified risk factors for postoperative vision loss. ResultsSurgical times ranged from 33 to 325 minutes. A rapid increase in IOP was noted after prone positioning, with continued increases as time elapsed. The neutral group exhibited statistically higher IOP compared with the 5° reverse Trendelenburg group after 60 minutes and the 10° group through 60 minutes of surgery. The trend continued through 120 minutes; however, because of a lack of power, we were unable to determine the statistical significance. There were no statistically significant differences between the 5° and 10° reverse Trendelenburg groups. ConclusionsReverse Trendelenburg positioning elicits decreased IOP compared with prone positioning for surgery times less than 120 minutes. Ten degrees of reverse Trendelenburg attenuate the rise in IOP during prone spine surgery superiorly in comparison with 5°. No significant complications were associated with reverse Trendelenburg positioning.