Trust in Group Decisions: a scoping review.

BACKGROUND: Trust is a critical component of competency committees given their high-stakes decisions. Research from outside of medicine on group trust has not focused on trust in group decisions, and "group trust" has not been clearly defined. The purpose was twofold: to examine the definition of trust in the context of group decisions and to explore what factors may influence trust from the perspective of those who rely on competency committees through a proposed group trust model. METHODS: The authors conducted a literature search of four online databases, seeking articles published on trust in group settings. Reviewers extracted, coded, and analyzed key data including definitions of trust and factors pertaining to group trust. RESULTS: The authors selected 42 articles for full text review. Although reviewers found multiple general definitions of trust, they were unable to find a clear definition of group trust and propose the following: a group-directed willingness to accept vulnerability to actions of the members based on the expectation that members will perform a particular action important to the group, encompassing social exchange, collective perceptions, and interpersonal trust. Additionally, the authors propose a model encompassing individual level factors (trustor and trustee), interpersonal interactions, group level factors (structure and processes), and environmental factors. CONCLUSIONS: Higher degrees of trust at the individual and group levels have been associated with attitudinal and performance outcomes, such as quality of group decisions. Developing a deeper understanding of trust in competency committees may help these committees implement more effective and meaningful processes to make collective decisions.

Changes in Temporary Disability Reporting Following the Implementation of the Army Medical Readiness Transformation.

Introduction: In November 2014, the U.S. Army held a readiness summit to address concerns about the accuracy of medical reporting systems. At the time, soldiers on temporary disability were tracked as a medical readiness classification (MRC) 3A or 3B. MRC 3A soldiers had a medical condition with recovery expected within 30 d and MRC 3B soldiers were expected to take longer than 30 d to recover. Both groups were considered "non-available" and presumably non-deployable. Starting June 1, 2016, with the implementation of the Army Medical Readiness Transformation, soldiers on temporary disability longer than 14 d began to be reported as MRC 3s and are considered "non-deployable." The purpose of this study is to compare the number of soldiers on temporary disability previously reported as MRC 3A and 3B to the number listed as MRC 3 under the new reporting system for a light infantry brigade and to quantify the types and relative percentage of medical conditions leading to temporary disability under the new system. Materials and Methods: This cross-sectional analysis was conducted between January 1 and December 31, 2016 at Fort Carson, Colorado and included all soldiers assigned to Second Brigade, Fourth Infantry Division. We calculated the average number and proportion of soldiers on temporary disability at any one time for the period prior to implementation of the new reporting system (January 1 through May 31, 2016) and compared this to the period after implementation on June 1, 2016. The difference between the two independent proportions was calculated along with the lower and upper limits of the 95% confidence interval for the difference. Results: Between January 1 and May 31, 2016, the average number of soldiers on temporary disability at any one time was 186, accounting for 4.3% of the authorized unit strength. After June 1, 2016, the average number increased to 244 or 5.7%. The difference in the proportion of temporary profiles was 1.4% (95% confidence interval 0.43-2.3%). From June 1 through December 31, 2016, 936 soldiers were placed on temporary disability. The majority was for orthopedic-related conditions (68.6%). Lower extremity (18.3%) and knee (17.5%) conditions were the two most common orthopedic issues. Behavioral health-related conditions (6.9%) and postoperative recovery (5.6%) were the next two most common categories. Conclusion: Implementation of the Army Medical Readiness Transformation resulted in a statistically significant increase in reported "non-deployable" MRC 3 soldiers compared with the previous "non-available" MRC 3A/3B population. One possible reason for this relates to how temporary disability is reported under each system, especially for those soldiers with only mild limitations. Under the new system, musculoskeletal conditions accounted for the majority of disability. Important limitations include small sample sizes, a fluctuating denominator representing authorized unit strength, and that the study did not take into account seasonal variation and the operational cycle for the unit. Future studies should look at those conditions or soldier characteristics that can help guide commanders as they make deployability decisions and how to address wellness and injury prevention to mitigate the risk of soldiers going on temporary disability.

Imaging presentation of complicated diabetic ketoacidosis: a case report.

Spontaneous pneumomediastinum is a fairly uncommon complication of diabetic ketoacidosis. Knowledge of the clinical and radiographic manifestation is important for the proper management of patients since the disease usually follows a benign evolution. We report a case of a 20-year-old soldier who presented with a pneumomediastinum that was initially falsely attributed to a motor vehicular crash.