A Bifactor Evaluation of Self-Report and Clinician-Administered Measures of PTSD in Veterans.

The PTSD Checklist for DSM-5 (PCL-5) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) are two of the most widely used and well-validated PTSD measures providing total and subscale scores that correspond with DSM-5 PTSD symptoms. However, there is little information about the utility of subscale scores above and beyond the total score for either measure. The current study compared the proposed DSM-5 four-factor model to a bifactor model across both measures using a sample of veterans (N = 1,240) presenting to a Veterans Affairs (VA) PTSD specialty clinic. The correlated factors and bifactor models for both measures evidenced marginal-to-acceptable fit and were retained for further evaluation. Bifactor specific indices suggested that both measures exhibited a strong general factor but weak lower-order factors. Structural regressions revealed that most of the lower-order factors provided little utility in predicting relevant outcomes. Although additional research is needed to make definitive statements about the utility of PCL-5 and CAPS-5 subscales, study findings point to numerous weaknesses. As such, caution should be exercised when using or interpreting subscale scores in future research.

A survey of the incidence of defibrillator damage during double sequential external defibrillation for refractory ventricular fibrillation.

Background: Double Sequential External Defibrillation (DSED) is a proposed treatment strategy for patients in refractory VF (RVF) during out-of-hospital cardiac arrest (OHCA). Defibrillator damage employing DSED is a theoretical concern expressed by defibrillator manufacturers yet the incidence of damage during resuscitation remains unknown. Objective: We sought to explore the incidence of defibrillator damage employing DSED for RVF during OHCA. Methods: We conducted a survey of EMS agencies, authors of previous publications, EMS medical directors, base hospital medical oversight groups, and defibrillator manufacturers to assess the incidence of defibrillator damage during DSED. Our survey focused on the frequency of DSED use, number of shocks used during DSED, technique used to employ DSED (simultaneous or sequential), and the incidence of defibrillator damage during DSED. We specifically targeted groups that were known to be using DSED in clinical practice. Results: Our survey response rate was 50% (65/129): 61% (34/56) EMS medical directors, 60% (6/10) authors, 100% (8/8) base hospitals, 33% (1/3) defibrillator manufacturers, 31% (16/52) paramedic services. In our case-based analysis the overall incidence of defibrillator damage was 0.4%. The incidence of defibrillator damage based on total number of DSED shocks was estimated between 0.11% and 0.22%. All reported cases of defibrillator damage occurred using a simultaneous defibrillation technique. Conclusion: When DSED is employed using either a sequential or simultaneous technique the rate of defibrillator damage appears to be exceedingly low. Further high-quality evidence is required to determine the impact of DSED on patient centered outcomes, but the incidence of defibrillator damage should not limit it use. Defibrillator damage should continue to be monitored in future trials and clinical practice.

Total force fitness: the military family fitness model.

The military lifestyle can create formidable challenges for military families. This article describes the Military Family Fitness Model (MFFM), a comprehensive model aimed at enhancing family fitness and resilience across the life span. This model is intended for use by Service members, their families, leaders, and health care providers but also has broader applications for all families. The MFFM has three core components: (1) family demands, (2) resources (including individual resources, family resources, and external resources), and (3) family outcomes (including related metrics). The MFFM proposes that resources from the individual, family, and external areas promote fitness, bolster resilience, and foster well-being for the family. The MFFM highlights each resource level for the purpose of improving family fitness and resilience over time. The MFFM both builds on existing family strengths and encourages the development of new family strengths through resource-acquiring behaviors. The purpose of this article is to (1) expand the military's Total Force Fitness (TFF) intent as it relates to families and (2) offer a family fitness model. This article will summarize relevant evidence, provide supportive theory, describe the model, and proffer metrics that support the dimensions of this model.