Medical journal (Fort Sam Houston, Tex.)最新文献

Background: COVID-19 is a rapidly propagating respiratory virus causing a global pandemic. At the time of development of this study, not much was known about susceptibility to severe illness, especially without other known risk factors. Retrospective research suggested vitamin D level may correlate with severity of illness. This prospective, observational study seeks to determine if vitamin D level at admission is correlated with severity of illness as determined by needing intensive care unit (ICU)-level care within this first 28 days after admission. This study also looked at the relationship of vitamin D level at admission and mortality, need for ventilator, and number of hospital-free, ICU-free, and ventilator-free days in the 28 days after initial admission.

Methods: This study is a prospective, observational study of patients admitted to Brooke Army Medical Center (BAMC), San Antonio, TX, for a diagnosis or complication of COVID-19 illness. A vitamin D level was drawn at admission and chart review was used at the end of 28 days after admission to identify outcome measures. Fisher's Exact test was used for categorical variables, and Kruskal-Wallis test was used for all continuous variables.

Results: Deficient vitamin D level at admission (less than 20ng/mL) was associated with an increased risk of requiring ICU-level care during the 28-day period after initial admission (p=0.028). Secondary outcomes measurements also favored the hypothesis, but none were statistically significant.

Conclusions: This prospective, observational study further strengthens the hypothesis vitamin D level at admission is correlated with severity of illness in COVID-19 illness; however, this small study was limited in its ability to control for confounders. It does not prove causation, nor does it imply vitamin D supplementation will prevent COVID-19 or improve outcomes in COVID-19. Further research should aim to include a larger cohort to better understand the relationship of vitamin D level and severity of illness in COVID-19 disease.

The coronavirus (COVID-19) pandemic has changed the world; and the US military changed with it. Although this virus presents with a wide spectrum of disease progression (no symptoms to acute respiratory distress syndrome leading to death), its impact extends beyond health outcomes. At the time of this study, numerous research and development projects were underway to develop a COVID-19 vaccine or other treatment modalities; however, there were no Federal Drug Administration (FDA) approved vaccines or medical therapeutics that definitively provided a cure. Instead, public health officials relied on non-pharmaceutical interventions (NPI) as a main strategy to contain and mitigate the disease. The US military in partnership with host nation countries, such as the Kingdom of Saudi Arabia, exemplified unity of effort through a coordinated response: mass testing, prompt contact tracing, quarantine, and isolation. One main non-pharmaceutical intervention (NPI) strategy includes social distancing which has been shown to significantly impact pandemic influenza transmission translating to COVID-19 mitigation measures. In the military, strict adherence to quarantine, restriction of movement, and isolation orders can be a challenge since appropriate facilities and resources are limited in deployed and training environments. Further, asymptomatic carriage and transmission of COVID-19 disease (mean incubation time 6.2 days and range of 2-14 days) can complicate quarantine and testing methodologies. Moreover, deployment of the NPI mitigation strategies such as quarantine and isolation in an effective and timely manner is essential to prevent further spread. In essence, quarantine is the prevention, and isolation is the cure. This paper aims to describe how a deployed US Army Role I can effectively utilize NPI and containment strategies during a global pandemic in an austere environment.

Military medicine is immersed in an operational tempo (OPTEMPO), which is unprecedented in modern times. The emergence of the novel corona virus disease 2019 (COVID-19) quickly spread into a global pandemic and has stressed healthcare's infantryman-the frontline healthcare workers-to a potential breaking point. Registered nurses (RNs), doctors, respiratory therapists, medics, and others are experiencing multiple, open ended, short notice deployments, which have not only stressed their clinical skillset, but also their support systems. Understanding the background on OPTEMPO as well as the opportunities and challenges of the COVID-19 response will help leaders plan for future operations.

Background: During the COVID-19 pandemic many bars closed. Simultaneously, many persons experienced stay at home orders linked to an increase in alcohol use. The net impact of these restrictions on the incidence of driving while intoxicated (DWI) events is unclear.

Methods and material: We conducted a retrospective observational analysis using publicly reported data regarding police traffic encounters. We analyzed changes in DWI encounters in the San Antonio, TX metropolitan area before (1-14 October 2020) versus after (15-28 October 2020) bars reopened during the COVID-19 pandemic. We made these comparisons by comparing medians and through regression modelling to control for potential confounders.

Results: During the study period, 16,609 police traffic encounters met inclusion criteria. Of these, 353 were DWI encounters, 594 were officer traffic stop encounters, 14,565 were traffic related encounters, 113 were wrong way driver encounters, and 984 were other traffic violations. In the before and after analysis, there was no difference in the daily median numbers of DWI encounters (12 versus 10, p=0.461), wrong way driver incidents (3 versus 2, p=0.328), or other traffic violations (34 versus 35, p=0.854). The multivariable regression model similarly identified no change in the daily incidence of DWI encounters (p=0.281).

Conclusions: We detected no change in the incidence of DWI encounters immediately following the reopening of bars in the San Antonio metropolitan area.

The principle of medical triage, where patients are sorted into categories to guide the order in which they receive treatment, dates back to Baron Dominique Jean Larrey, the surgeon general of Napolean's armies. The concept evolved with military conflicts throughout the 19th century, was subsequently adapted to situations off the battlefield, and is now widely practiced where resources are limited.2 Military medical providers are taught triage principles early in their careers and its use is routinely integrated into military training scenarios and operational planning.

Background: Since March of 2020, thousands of National Guard service members have played a key role in the domestic response to COVID-19, ranging from medical support, health screening, decontamination, personal protective equipment (PPE) training, and more. As a result of these missions, there was a hypothesized potential increase in COVID-19 exposure risk.

Objectives: Assess COVID-19 transmission rates and mortality rates in the US population compared to the National Guard.

Methods: Six months of retrospective data were assessed with analysis of a snapshot in time for pandemic data on 29 July 2020. Potential relationships between National Guard COVID-19 response personnel, cumulative US COVID-19 cases, National Guard COVID-19 cases, and National Guard COVID-19 fatalities were assessed.

Results: No evidence of correlations exist between the number of National Guard personnel supporting the COVID-19 response and the number of deaths in the National Guard due to COVID-19 (p=0.547), and the number of National Guard COVID-19 cases and the number of deaths in the National Guard due to COVID-19 (p=0.214). The number of COVID-19 cases in the US was positively correlated to the number of deaths in the US due to COVID-19 (rs=0.947, p is less than.001).

Conclusions: Though much of the data could not be reported due to operational security (OPSEC) and capabilities, activities, limitations, and intentions (CALI) concerns, the data herein demonstrate National Guard service members are significantly less likely to suffer COVID-19 related mortality compared to US civilians. Since the National Guard adheres the same medical and physical fitness standards as set by their parent service (Army and Air Force), it follows overall levels of medical readiness and fitness should start with a higher baseline. Age, medical screening, PPE, and physical fitness requirements have likely contributed to this phenomenon. These results should empower National Guard service members to feel more confident in their roles as they continue to support the COVID-19 response efforts.

The scope of this article is limited to the actions and experiences of the Landstuhl Regional Medical Center (LRMC) Clinical Engineering Branch (CEB) when planning and executing the COVID-19 response at the only US military Role 4 medical treatment facility (MTF) in Europe between 1 February and 1 May 2020. Aspects of the COVID-19 response extended throughout the Regional Health Command; therefore, the full breadth and scope of the total response is far too great to expound within this account alone. The entire medical staff, along with an innumerable number of partners, were immensely engaged in the response and performed remarkably well given the rapidly developing pandemic. It is a testament to the agility of Army Medicine and the robustness of the American and European health systems to develop such a complicated medical response in such a short amount of time.

Background: In March 2020, a Fort Carson brigade combat team established Task Force (TF) Contain in response to the Coronavirus Disease 2019 (COVID-19) pandemic. We offer a descriptive analysis of the TF Contain execution.

Methods: This study comprises a descriptive analysis of the design and execution of COVID-19 response by an infantry brigade combat team. Specific analyses include patient flow and mitigation measures; task organization; and definition of commander decision points as associated with separate lines of effort.

Results: TF Contain defined separate teams to address each component of the COVID-19 response, each assigned to subordinate battalions. Team Trace augmented the installation medical activity tracing interviews and data collection. Team Isolation provided lodging and life support; whereas, Team Transportation provided movement assets for soldiers requiring restriction of movement related to COVID-19. Team Clean executed disinfection operations at geographic locations determined to be associated with transmission events. Team Oversight enforced standards of mask wear and social distancing throughout the installation. Team Overflow analyzed installation infrastructure for contingency planning in the event more facilities became necessary for soldiers in isolation or quarantine. Finally, Team Testing augmented medical department activity (MEDDAC) medical manpower to staff providers and medics for support testing operations.

Conclusions: Few personnel assigned to this organization had pre-existing experience or training related to infectious disease prevention or epidemiology. Nevertheless, this organization demonstrated the capacity of the military decision-making and operations processes to build robust procedures in response to public health threats.

Introduction: Introduction: Healthcare is a dynamic and complex system predisposed to adverse events caused by human and technical errors. The ability of multidisciplinary clinicians to effectively communicate clinical information influences healthcare quality. Authority gradients, culture, and organizational hierarchy frequently constrict communication and contribute to surgical adverse events. Hierarchy is especially pronounced in military medicine, where military status, rank, and professional roles potentially create barriers to communication.

Methods: We used an exploratory, prospective, cross-sectional design to determine how the social structure of military surgical teams influences group (network) communication effectiveness. Using a social network questionnaire, we surveyed members of surgical teams concerning their close-working relationships with other team members and perceptions of their communication effectiveness. We addressed the following research question: In surgical teams, how do the status (indegree) and influence (outdegree) of its individual members impact communication within the team?

Results: We surveyed 50 surgical teams comprised of 45 clinicians and found that for close-working relationship networks communication effectiveness improved with lower concentrations of status and higher concentrations of influence. Network indegree (i.e., status) (β=-0.893, p=.019) had a larger impact than outdegree (i.e., influence) (β=0.617, p=.015), indicating status had a larger effect on communication effectiveness than influence. Put simply, our results show communication improves when there is more equality of status in the surgical team. Paradoxically, communication improves when there are higher concentrations of network influence among surgical team members.

Conclusions: Inequality in surgical team networks has paradoxical effects on communication effectiveness. The impact of network structure on organizational behavior is of high interest to the military and provides essential insights into clinicians' ability to communicate in a highly complex and task-based environment. Communication will likely improve in surgical teams through methods to foster equality of team member status and promote surgical leadership. Military medical policies could both amplify the positive effects and mitigate the negative effects of network inequality.

Purpose: Transcorneal freezing is a common technique used in rabbits to induce damage to the corneal endothelium. Previous studies have been performed with a range of freezing temperatures, times, and rabbit ages. Here, we aimed to characterize the aged rabbit endothelium after transcorneal freezing to establish an innate corneal endothelial cell regrowth rate and propose it as a mechanism for evaluation of therapeutic efficacy in rabbit models.

Methods: Central corneas of anesthetized New Zealand White rabbits (n=3) aged 18-24 months were exposed to nitrous oxide cooled probes for 30 seconds. Animals were assessed by in vivo confocal microscopy, applanation tonometry, specular microscopy, optical coherence tomography, and histology. The contralateral eye acted as a control. Images were taken immediately before and after injury and on days 2, 4, 7, 11, and 14.

Results: Following transcorneal freezing, there was a significant decrease in corneal endothelium density and a temporary increase in corneal thickness. Endothelial density decreased by 95% immediately after injury compared to controls and showed linear recovery over 14 days, reaching a 38% reduction by day 14. There was a significant increase in pleomorphism across all time points post-injury. Conversely, corneal thickness increased two days post injury but recovered at all later time points. Intraocular pressure was not affected throughout.

Conclusions: This corneal endothelium injury platform is ideal for injury and therapeutic research as it can be rapidly performed, and has minimal impact on corneal thickness and intraocular pressure. Due to innate rabbit endothelial regrowth, it is vital to establish corneal endothelial recovery rate before evaluating therapeutics for efficacy in this model system.