Setting the Stage to Flourish: Supporting LGBTQIA2S+ Graduate Students.

The lived experiences of LGBTQIA2S+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual, Two Spirit) doctoral students remain an area for deeper exploration and understanding in the higher education landscape. Higher education administrators and faculty often focus on the well-being and social integration of undergraduate students where the greatest source of revenue is generated. To this end, our story about how doctoral students can educate faculty in this space is of great significance. The term student-centered is often used generically, but each student's center and lived experience are not the same. To be a true student advocate for the LGBTQIA2S+ population involves vulnerability, unearthing uncomfortable truths, and active listening. Thus, support can be an inherently kind word or one that is empty blanket terminology for being nice. We (the faculty) want to do more than be nice, smile politely, and pretend to understand the student; this takes effort, altruism, character, and the ability to say teach me about your lived experiences. The student has to feel a high level of trust and the depth of fortitude to tell their truths that are often painful and not articulated to more than two or three close others, much less faculty members. This article focuses on the lived experiences of two straight faculty and a doctoral student who is part of the LGBTQIA2S+ community. We share our collective narratives, so that you can build yours.

Home therapies to improve disability, activity, and quality of life in military personnel with subacute low back pain: Secondary outcome analysis of a randomized controlled trial.

BACKGROUND: Low back pain (LBP) is an urgent military health concern with implications for fitness, quality of life (QoL) and disability. PURPOSE: This secondary outcome analysis from a randomized controlled trial (RCT) was to determine if the addition of neuromuscular electrical stimulation core strength training (NMES) or progressive exercise (PEP)in conjunction with primary care management (PCM) was more effective than PCM alone. METHODS: This randomized controlled trial (RCT assigned 128 service members to the three intervention groups. The outcomes included changes in perceived disability (Oswestry Disability Index), health-related quality of life (SF-12v2), pain during activity (Clinical Back Pain Questionnaire), and daily steps walked in service members with subacute LBP. FINDINGS: Over a 9-week intervention, perceived disability, SF-12v2 physical component summary, and activity associated with pain improved in all groups. Home therapies were helpful to reduce perceived disability, QoL and pain during activity in service members with subacute LBP. DISCUSSION: These non-pharmacological options provide other home-managed approaches for those in the subacute LBP phase.

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

BACKGROUND: Military service members with lower extremity injuries are at risk for compromised health-related quality of life during rehabilitation. PURPOSE: The 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. METHODS: This 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. DISCUSSION: A 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. CONCLUSION: Increased 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.

Nonpharmacological Therapies for Musculoskeletal Injury in Military Personnel: A Systematic Review/Meta-Analysis.

INTRODUCTION: Musculoskeletal (MSK) injury is an inherent risk for military personnel that can potentially impact job performance, productivity, and military readiness. Evidence is needed to show the efficacy of nonpharmacological, self-managed therapies to reduce MSK symptoms at common injury sites that are feasible for use during expeditionary operations and home stations. This systematic review and meta-analysis identified, summarized, and synthesized available evidence from randomized and non-randomized trials on the effectiveness of self-managed, home-use therapies to improve pain, muscle strength, and physical performance in military personnel with MSK injuries, when compared to controls. METHODS: The electronic databases of MEDLINE ALL Ovid, Embase.com, Cochrane Library, Scopus, Clinicaltrial.gov, and CINAHL Complete via EBSCO were systematically searched for relevant reports published in English. Utilizing the Covidence platform and consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, multiple reviewers, using pre-determined data fields, screened for eligibility, assessed risk of bias (RoB), and performed data extraction. Evaluation of treatment effectiveness was determined using multilevel mixed-effects meta-analysis. RESULTS: The database and register search yielded 1,643 reports that were screened for eligibility. After screening of titles/abstracts and full texts, 21 reports were identified for evidence synthesis. Of these, two reports were excluded and two described the same study, resulting in a final list of 18 studies (19 reports). For quality assessment, the overall RoB for the 18 studies was categorized as 33.3% low risk, 55.6% with some concerns, and 11.1% high risk. Across the five domains of bias, 70% of the reports were classified as low risk. This systematic review found that the differences in interventions, outcome measures, and design between the studies were associated with a substantial degree of heterogeneity (I2 = 60.74%), with a small overall improvement in outcomes of the interventions relative to their specific control (standard mean difference 0.28; 95% CI, 0.12 to 0.45). There were varying degrees of heterogeneity for individual body regions. This was due, in part, to a small number of studies per bodily location and differences in the study designs. For the neck/shoulder, heterogeneity was moderate, with the clearest positive effect being for physical performance outcomes via other medical devices. For the back, there was substantial heterogeneity between studies, with modest evidence that pain was favorably improved by other medical devices and exercise interventions. For the leg, one study showed a clear large effect for other medical devices (shockwave treatment) on pain with substantial heterogeneity. The best evidence for positive effects was for the knee, with mainly negligible heterogeneity and some benefits from bracing, electrotherapy, and exercise. CONCLUSION: Evidence showed small beneficial effects in pain, strength, and physical performance by individual body regions for some interventions, compared to controls. The best evidence for a positive effect was for the knee. The findings suggest that some benefit may be obtained by including several treatments during deployment in austere environments and prolonged casualty care scenarios of military personnel with MSK injuries. Further research is warranted to better assess the potential benefits of using these treatments during deployments in austere environments as part of an individualized, multimodal approach for MSK injuries.

Electromyostimulation With Blood Flow Restriction for Patellofemoral Pain Syndrome in Active Duty Military Personnel: A Randomized Controlled Trial.

INTRODUCTION: The high prevalence of patellofemoral pain in military service members results in strength loss, pain, and functional limitations during required physical performance tasks. Knee pain is often the limiting factor during high-intensity exercise for strengthening and functional improvement, thus limiting certain therapies. Blood flow restriction (BFR) improves muscle strength when combined with resistance or aerobic exercise and may serve as a possible alternative to high-intensity training during recovery. In our previous work, we showed that Neuromuscular electrical stimulation (NMES) improves pain, strength, and function in patellofemoral pain syndrome (PFPS), which led us to ask whether the addition of BFR to NMES would result in further improvements. This randomized controlled trial compared knee and hip muscle strength, pain, and physical performance of service members with PFPS who received BFR-NMES (80% limb occlusion pressure [LOP]) or BFR-NMES set at 20 mmHg (active control/sham) over 9 weeks. METHODS: This randomized controlled trial randomly assigned 84 service members with PFPS to one of the two intervention groups. In-clinic BFR-NMES was performed two times per week, while at-home NMES with exercise and at-home exercise alone were performed on alternating days and omitted on in-clinic days. The outcome measures included strength testing of knee extensor/flexor and hip posterolateral stabilizers, 30-second chair stand, forward step-down, timed stair climb, and 6-minute walk. RESULTS: Improvement was observed in knee extensor (treated limb, P < .001) and hip strength (treated hip, P = .007) but not flexor over 9 weeks of treatment; however, there was no difference between high BFR (80% LOP) and BFR-sham. Physical performance and pain measures showed similar improvements over time with no differences between groups. In analyzing the relationship between the number of BFR-NMES sessions and the primary outcomes, we found significant relationships with improvements in treated knee extensor strength (0.87 kg/session, P < .0001), treated hip strength (0.23 kg/session, P = .04), and pain (-0.11/session, P < .0001). A similar set of relationships was observed for the time of NMES usage for treated knee extensor strength (0.02/min, P < .0001) and pain (-0.002/min, P = .002). CONCLUSION: NMES strength training offers moderate improvements in strength, pain, and performance; however, BFR did not provide an additive effect to NMES plus exercise. Improvements were positively related to the number of BFR-NMES treatments and NMES usage.

Non-pharmacological Home Therapies for Subacute Low Back Pain in Active Duty Military Personnel: A Randomized Controlled Trial.

INTRODUCTION: Low back pain (LBP) is a major cause of visits to ambulatory care, missed duty time, and disability discharge. The subacute phase of LBP presents an opportune time to prevent chronicity and lessen recurrence. The goal of this randomized controlled trial (RCT) was to determine the relative effectiveness of neuromuscular electrical stimulation (NMES) training and a progressive exercise program (PEP) on improving physical performance, pain, and torso strength in U.S. service members with subacute LBP, compared to standard primary care management (PCM) alone. METHODS: This is an Institutional Review Board-approved protocol for an RCT conducted with active duty military personnel (n = 128) at Fort Campbell, Kentucky, between April 2018 and March 2020. Participants were randomized to receive NMES (n = 43), PEP (n = 42), or PCM (n = 43) for 9 weeks. Outcome measures of physical performance (sit-ups, push-ups, walking, and torso endurance), torso muscle strength (flexion and extension), and pain were assessed at baseline and after 3, 6, and 9 weeks. Analysis was intent-to-treat using linear mixed effects models. A sensitivity analysis was performed to address the protocol deviations that occurred in response to coronavirus disease 2019 pandemic, which required rescheduling 17 in-person study visits to home assessments at 9-week testing. RESULTS: Evidence was found for group differences in physical performance for sit-ups and push-ups, with NMES showing greater improvement than PCM. The two groups showed similar improvements in torso muscle strength, although the NMES groups may show better improvement during early treatment. No group differences in pain levels were observed during the intervention, and all groups improved during the course of the study period. The amount of NMES muscle stimulation was directly related to the level of improvement, which was not the case for the hours reported for PEP exercise. CONCLUSION: In an active duty population with subacute LBP, integrating NMES strength training into the rehabilitation therapy may offer a modest benefit for increasing sit-ups and push-ups and improving torso strength.

Advancing Readiness Through Military Programs: An Evidence-Based Practice Perspective.

INTRODUCTION: Military nurses comprise the largest percentage of military health care providers. In the current military health care system, they have two roles: (1) Patient care in military treatment facilities (MTFs) and (2) patient care during combat operations. Although in MTFs, the military nurse's roles are similar to those of their civilian counterpart, their roles are unique and varied in the combat operational environment. These combined roles lead to questions regarding readiness training to ensure that nurses are proficient in both MTFs and combat operational settings where treatment requirements may differ. The purpose of this paper is to (1) present the current state of educational readiness programs to maintain a ready medical force that entail formal teaching programs, military-civilian partnerships, and joint exercises of combat simulations, and (2) identify gaps as presented in an evidence-based practice educational panel. METHODS: On March 11, 2022, TriService Nursing Research Program hosted the virtual First Military Evidence-Based Practice Summit from the Uniformed Services University of the Health Sciences in Bethesda, MD. As part of the summit, an evidence-based practice education panel discussed the availability of current evidence-driven military medical readiness programs and identified gaps in the integration of military readiness for nursing personnel into the Defense Health Agency and Armed Services. RESULTS: The panel participants discussed the separate requirements for training within the MTFs and in combat operational settings. The available training programs identified by the panel were primarily those developed in local MTF settings to meet local needs. Although these programs support the MTFs' peacetime mission, competing roles, limited time, and limited funds contributed to limited preparation of nursing personnel in skills associated with combat-related injuries and illnesses. Prolonged casualty care has become an important focus for the Department of Defense as greater considerations are directed to wartime operations in austere expeditionary environments. Although there is some training available that is specific for prolonged casualty care, the focus has been the adaptation of combat casualty care during contingency operations. A keynote here was the concept that combat casualty care training must include both development of individual skills and integration of the team since maximal care can be achieved only when the individual and the team operate as a unit. A key point was the utility of central repositories for storing information related to training a ready medical force at individual and unit levels and that these repositories could also be used to collect and facilitate the accession of current evidence-based information. DISCUSSION: Optimal patient care at all levels of the military health system requires training that maximizes individual and unit skills specific to the environment at an MTF or in a combat operational setting. Training must be designed to incorporate evidence-driven knowledge in all military settings with guidance that is specific to the environment. CONCLUSION: Enhanced communication of evidence-based training and knowledge is an important component of maintaining a ready medical force for broader medical support of combat contingency operations.

Perioperative Pressure Injury Prevention Program in a Military Medical Treatment Facility: A Quality Improvement Project.

INTRODUCTION: The incidence of perioperative pressure injuries (PPIs) at a military medical treatment facility (MTF) increased from three PPI events in 2018 to five PPI events in the first half of 2019. The purpose of this quality improvement initiative was to determine whether an evidence-based PPI prevention program introduced during the second half of 2019 reduced pressure injuries compared to the previous 1.5 years that followed the standard of care for perioperative patient positioning. METHODS: We used a multidisciplinary quality improvement PPI prevention approach that included education, Scott Triggers® patient risk assessment, application of a five-layer silicone dressing to at-risk surgical position sites, and feedback via multidisciplinary postoperative rounding. RESULTS: There was an observed decrease in the rate of PPIs from 0.62 to 0.00 per 1,000 patient surgeries during the 26-month period that this protocol was implemented. CONCLUSION: This project was conducted at a major MTF using a multidisciplinary PPI prevention approach that may be of value in reducing PPIs in other settings. This approach seems worthy of further investigation and may be applicable to other military MTFs and in deployed settings.

Outcomes following oesophageal stent insertion for palliation of malignant strictures: A large single centre series.

BACKGROUND: Self-expanding metal stents (SEMS) are an accepted intervention for malignant dysphagia. Stents vary in ease of insertion, removability, migration and occlusion rates. This series reports the complications, morbidity and mortality associated with several SEMS. METHOD: A prospective database of patients undergoing fluoroscopic guided oesophageal stent insertion for malignancy between June 2001 and June 2009 was analysed. Patient demographics, intervention outcomes and tumour variables were correlated with stent failure and patient survival. Multivariate analysis was performed to evaluate predictors for stent failure. RESULTS: Two hundred and seventy-three stents were deployed using nine different types of SEMS. The median Mellow-Pinkas dysphagia score significantly improved from 3 to 1 post-stent insertion (P < 0.001), with a technical success rate of 98%. Stent complications occurred in 95 (36%) patients [recurrent dysphagia n = 49 (19%), migration n = 24 and occlusion n = 25]. Multivariate analysis demonstrates that the covered Niti S stent fails significantly more than the double-layered Niti S stent (OR = 4, P < 0.005). CONCLUSION: Oesophageal stent insertion provides good palliation for malignant dysphagia, however recurrent dysphagia remains a problem. This major complication occurs more frequently with covered Niti S stents than double-layered Niti S stents. This finding may aid the stent choice used in advanced oesophageal malignancy.

Simulation training for advanced airway management for anesthesia and other healthcare providers: a systematic review.

We studied the current literature on human patient simulation for preparing anesthesia and other healthcare providers for advanced airway management. A systematic review was conducted of articles published between 1990 and 2009 on advanced airway management for patients undergoing anesthesia and patients who are not. The search used 4 electronic databases: Cumulative Index to Nursing & Allied Health Literature, MEDLINE, PsycINFO, and Web of Science. We included 34 articles in the analysis; 15 were experimental or quasi-experimental designs, 8 descriptive studies and reports, and 11 analyses of equipment or technique evaluations using simulation. The majority of the studies included simulation education evaluation for a variety of medical, nursing, and allied health providers and students. Only 6 studies addressed the use of simulation as an educational or evaluation tool to enhance training of anesthesia providers in difficult airway management. Those studies included analyses of different types of training and the perceived value of simulated training, and evaluations of equipment. Few studies have analyzed the effects of this modality on trainer skills and patient safety. There is a clear need for well-designed studies to examine these effects.

A pedometer-based intervention to improve physical activity, fitness, and coronary heart disease risk in National Guard personnel.

To compare the effects of a pedometer-based behavioral intervention (Fitness for Life [FFL] program) and a traditional high-intensity fitness (TRAD) program on physical activity (PA), Army Physical Fitness Test (APFT), and coronary heart disease risk factors in Army National Guard members who failed the APFT 2-mile run. From a pool of 261 Army National Guard, a total of 156 were randomized to TRAD or FFL for 24 weeks consisting of a 12-week progressive conditioning program followed by 12 weeks of maintenance. For both groups, the total APFT score and 2-mile run time/score improved from baseline to 12 weeks (FFL: down 7.4%, p = 0.03; TRAD: down 5%, p = 0.08) but at 24 weeks they had regressed toward baseline. PA improved modestly and coronary risk profile changed minimally in both groups. A pedometer-based exercise intervention had results similar to a high-intensity program for improving PA, APFT, and 2-mile run times/score. Neither group sustained the improved run times over the 12 weeks of maintenance.

Neonatal Aeromedical Evacuation During COVID-19: An Interview With Captain Danielle James.

During the coronavirus-19 pandemic, limited information existed about the risks and consequences of severe acute respiratory syndrome coronavirus 2 infection associated with maternal transmission to neonates. With rapidly evolving evidence, Air Force Neonatal Intensive Care Unit nurses at U.S. Naval Hospital Okinawa, Japan, adapted their standard operating procedures to safeguard their at-risk neonatal patients. This interview describes an Air Force NICU nurse's view of neonatal transport and nursing care during the coronavirus-19 pandemic.

History of the Military Nurse Corps and the 1918 Influenza Pandemic: Lessons for the 2019 Coronavirus Pandemic.

During World War I, the 1918 influenza pandemic struck the fatigued combat troops serving on the Western Front. Medical treatment options were limited; thus, skilled military nursing care was the primary therapy and the best indicator of patient outcomes. This article examines the military nursing's role in the care of the soldiers during the 1918 flu pandemic and compares this to the 2019 coronavirus pandemic.

Influence of Self-managed Rehabilitation on Work Efficiency in Active Duty Military With a Knee Injury.

INTRODUCTION: Knee injuries associated with intense physical training are one of the most frequent injuries associated with medical encounters for military members. The purpose of this study was to evaluate four approaches to physiotherapy rehabilitation and their effects on work efficiency in active duty military with a knee injury. The four groups included neuromuscular electrical stimulation (NMES), walking with a weighted vest (WALK), combined NMES/Walk, and standard physiotherapy rehabilitation. All groups received standard physiotherapy rehabilitation.We have previously reported that quadriceps muscle strength improved over 18 weeks in the study for the three interventions relative to standard rehabilitation alone. This report presents results from an examination of work efficiency as evaluated during a step test while measuring oxygen utilization. METHODS: A randomized controlled trial was conducted, with repeated outcome measures of work efficiency assessed at baseline, 3, 6, 12, and 18 weeks. The sample consisted of 67 active duty service members between the ages of 18 and 50 years with a knee injury. Participants were randomized to one of the four approaches to physiotherapy rehabilitation: (1) NMES was applied to the quadriceps muscle four times per week, for 30 minutes (15 minutes to each leg), consisting of 15 quadriceps muscle contractions per leg; (2) graduated strength walking using a weighted vest (WALK) was for 30 minutes, 3 to 4 days a week; (3) combined NMES with strength walking received both the NMES therapy and the weighted vest walking; and (4) standard physiotherapy consisted of progressive exercise with the number and type of sessions not controlled by the study. All four groups received the standard physiotherapy for a knee injury. The primary outcome was work efficiency, as measured by oxygen utilization during a 2-minute self-paced step test over 18 weeks. The primary analysis used repeated measures, linear mixed-effects models with a random effect for subject. RESULTS: Both the number of steps performed and gross work efficiency improved during the study for all three intervention groups. For gross work efficiency, standard rehabilitation improved 12%, WALK showed a 19% improvement, NMES increased by 24%, and the NMES/Walk group improved by 40%. CONCLUSIONS: All groups showed improved submaximal exercise efficiency based on oxygen utilization, with the intervention groups showing a greater improvement in work efficiency as compared to standard rehabilitation. Knee injuries can be problematic for active duty members because of reduced mobility leading to deconditioning and associated declines in work efficiency. Rehabilitative programs, including those described in this study, may minimize loss of work efficiency and fitness and promote a quicker recovery.

An Interdisciplinary Dashboard to Streamline Medication Processing at Patient Discharge: A Quality Improvement Initiative.

INTRODUCTION: The purpose of this quality improvement project was to develop and evaluate the use of an electronic medication request dashboard to reduce the amount of time required for medication processing and decrease time lost to workflow interruptions during patient discharge. Delayed discharges are associated with increased health care costs and adverse patient outcomes. Processing of medication requests at discharge contributes to these delays and to workflow interruptions for nursing and pharmacy staff at the project site. Electronic dashboards have been successfully implemented in multiple medical settings to streamline patient processing and enhance communication. MATERIALS AND METHODS: The Human Protections Office at Carl R. Darnall Army Medical Center (Fort Hood, TX) reviewed and approved the project with a non-human research determination. A multi-disciplinary workgroup with representatives from nursing, pharmacy, and health information technology (HIT) was formed to develop the dashboard. Based on a logic flow diagram of the desired communication, HIT created a medication request form and status dashboard using SharePoint and Nintex workflows. The dashboard was implemented for a 30-day pilot on a 25-bed medical/surgical nursing unit. The time required for medication processing, the time from discharge order to patient exit, the number of phone calls between nursing and pharmacy, and the usability of the medication request process were measured before and after implementation. The results were analyzed with descriptive statistics and evaluated for statistical significance with a P value ≤.05. RESULTS: With implementation of the dashboard, the average medication processing time decreased from 125 minutes to 48 minutes (P < .0001), and the average patient discharge time decreased from 137 minutes to 117 minutes (P = .002). The usability score of the medication request process increased from 40 to 87 for nursing (P < .0001) and from 62 to 85 for pharmacy (P = .003). The total number of voice calls between nursing and pharmacy decreased from 1,115 to 434, while the total time on voice calls decreased from 33 hours and 50 minutes to 13 hours and 19 minutes (P < .0001). CONCLUSIONS: The electronic dashboard is an effective method to enhance interdisciplinary communication during patient discharge and significantly reduces medication processing times. However, despite the medication processing time decreasing by over an hour, the discharge time only decreased by 20 minutes. Additional investigation is needed to evaluate other contributors to delayed discharge. A key limitation of this study was the convenience sampling used over a 30-day pilot on a single unit. The process has since been adopted by the entire hospital, and additional analysis could better reveal the impact to the organization. This communication system shows high usability and reduces phone call interruptions for both nursing and pharmacy staff. Additionally, this technology could easily be applied to other communication pathways or request processes across military medicine.

Reducing Setup and Turnover Times in the OR With an Innovative Sterilization Container: Implications for the COVID-19 Era Military Medicine.

INTRODUCTION: The global 2019 coronavirus pandemic (COVID-19) is setting unprecedented demands on the nation and the military and surgical services. Surgical demands include a large backlog of surgical cases, strain on available resources, and the need for additional measures to prevent exposure. The purpose of this project was to evaluate the feasibility, duration, adverse events, and potential gains associated with using a Turbett Sterilization Pod (TSP) for total joint replacements. MATERIALS AND METHODS: A multidisciplinary team used the Plan-Do-Study-Act model to guide this project. A time-motion study was completed in the operating room (OR) to measure the average time required to set up surgical instrumentation for total joint replacement cases that required 12 or more instrument trays. We compared the amount of time it took to complete the setting up of instrumentation using the traditional method versus the TSP method. The traditional method consisted of unwrapping each surgical tray, checking for holes in the blue wrapper, and placing the tray on the back table. In the case of the TSP, the door of the pod was opened, and the instrument trays were transferred directly to the back table. We measured the time the staff took to perform the task using each of these methods. RESULTS: When compared to the traditional method, the use of the TSP resulted in improved turnover time, decreased room setup time, reduced environmental waste, and eliminated both the effect of damage to wrappers and the time previously spent wrapping surgical trays. CONCLUSION: The TSP minimizes the time needed by the staff to set up an OR suite for a total joint replacement, therefore permitting them to focus more on direct patient care. This time improvement suggests that all surgical specialties, including those requiring greater than 12 traditional instrument sets, may experience reduced turnover time between cases. The use of the TSP is one means to help rectify the OR backlog brought on by COVID-19.

Improving lives not just saying no to substances: Evaluating outcomes for a young people's substance use team trained in the AMBIT approach.

Adaptive Mentalization Based Integrative Therapy (AMBIT) is a systemic, mentalization based intervention designed for young people with multiple problems including mental health problems. The purpose of this paper is to examine the impact of this approach both on clinical and functional outcomes for young people seen by a specialist young people's substance use service between 2015 and 2018. About 499 cases were seen by the service during this period. Substance use outcomes were obtained for 383 cases using the Treatment Outcome Profile (TOP). Cannabis and alcohol use were the key substance use problems for 81% and 63% respectively. Functional outcomes using the AMBIT Integrative Measure (AIM) were obtained for 100 cases covering domains of daily living, socio-economic context, peer relationships and mental health. At treatment end, cannabis use reduced significantly (t = 10.78; df = 311; p = .00; Cohen's d ES.61 as did alcohol use (t = 6.938; df = 242; p = .000; ES 0.44). Functional improvements were shown in five out of seven domains with highly significant total functional improvements on key problems selected by the client (t = 14.01; df = 99; p = .000; ES1.34). Measuring functional as well as clinical outcomes appears to reflect more accurately the overall benefit of the service to clients.

Electrical Stimulation Therapies for Active Duty Military with Patellofemoral Pain Syndrome: A Randomized Trial.

INTRODUCTION: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal disorder among military service members that causes knee pain, quadriceps strength loss, and impaired motor performance in otherwise healthy individuals. PFPS poses a threat to the health, fitness, and subsequent readiness of the total force. The goal of rehabilitation for military service members with PFPS is to regain physical capacity of strength and function and to reduce pain, in order to restore readiness in this population. The randomized controlled trial reported here compared an active home exercise program (HEP) alone with three different electrical stimulation treatment regimens implemented concurrently with HEP postulated improvements in lower extremity strength and physical functional performance while also reducing pain in active duty military diagnosed with PFPS. MATERIALS AND METHODS: After baseline testing, 130 active duty military members with PFPS were randomized to 1 of 4 treatment groups: (1) neuromuscular electrical stimulation (NMES) with HEP; (2) transcutaneous electrical nerve stimulation (TENS) with HEP; (3) combined NMES/TENS with HEP; (4) active HEP only. The primary outcome measure was degree of change in knee flexion and extension strength over 9 weeks. Secondary outcomes were physical functional performance and knee pain. The primary analyses used repeated measures, linear mixed-effects models with a random effect for subject, time as a continuous variable, group as a categorical variable, and a group and time interaction to test for differences in change over time among the groups. RESULTS: All three electrical stimulation treatment groups improved in knee extension strength in the PFPS limb to a greater extent than the HEP alone group over the 9-week treatment period. The NMES and NMES/TENS groups improved to a greater extent than the HEP alone group in knee flexion strength in the PFPS limb. The reported pain improved over time for all treatment groups with no significant group differences. All three stimulation groups performed better on the 6-min walk test than the HEP alone group. CONCLUSION: The findings from this study showed that all three electrical stimulation with HEP treatment groups showed greater improvement in strength compared to the HEP alone group. These findings could offer alternative forms of rehabilitation for AD military with PFPS as these treatment regimens can be easily implemented at home station or during deployment.