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Introductions:Healthcare workers use less tobacco than other working populations. In contrast, US military members use more tobacco than civilians. Military healthcare workers, therefore, represent a unique group with regard to occupational factors that may influence tobacco use.Aims/Methods:Records of workers at a military community hospital were reviewed to describe tobacco use. An anonymous survey assessed impressions of a worksite policy change that prohibited tobacco use anywhere on hospital grounds.Results:Hospital staff included 2,074 professionals. Tobacco use was significantly associated with male sex and being a military enlisted worker. In fact, 37% of male enlisted members used tobacco; fewer than 10% of all other workers used tobacco. Among 232 survey respondents, 61% agreed with tobacco-restrictive worksite policies, but only 33% thought policies were effective. Nearly one-third of tobacco users reported decreasing use in the past year. In multivariable modelling, changing habits in response to worksite policy was the only factor significantly associated with decreased tobacco use.Conclusions:Tobacco use among US military healthcare workers varies markedly by demographic characteristics. Male, military enlisted workers use tobacco at very high rates, paralleling the troops they serve. Implementation of tobacco-restrictive worksite policies is associated with decreased tobacco use in this population.

To describe an intervention among overweight and obese hypertensive patients, encouraging Dietary Approaches to Stop Hypertension (DASH) diet and lifestyle changes, designed and led by a primary care nurse practitioner (NP).A pre- and postintervention quasi-experimental time-series design was implemented over 2 months. Intervention included three group classes and two individual counseling telephone calls. Forty-five hypertensive patients enrolled, with a mean age of 55 years and mean initial BMI of 32. Twenty-six (58%) completed the program. Standard instruments (Rapid Eating Assessment for Patients [REAP] and Partners in Health [PIH] questionnaires) were used to evaluate diet and lifestyle factors before and after the program.Participants had statistically significant improvements in diet and lifestyle scores on both REAP and PIH questionnaires, as well as statistically significant weight loss (average 3.6 pounds lost) over the 2-month intervention period.This NP-led primary care intervention on diet and lifestyle showed early success in improving the health of overweight and obese hypertensive patients. Investment in NP-led diet and lifestyle counseling should be considered among high-risk patients in the primary care setting.

We hypothesize that an anecdotally observed increase in tourniquet breakage and decrease in efficacy may be secondary to environmental exposure during military deployment. This was a study comparing efficacy and breakage of 166 Afghanistan-exposed tourniquets to 166 unexposed tourniquets. Afghanistan exposure was defined as tourniquet carriage by field staff in the operational environment for approximately 6 months. In a controlled environment in the United States, a previously exposed tourniquet was tested on one thigh of each subject, while an unexposed tourniquet was tested on the opposite thigh. We recorded tourniquet efficacy (absence of distal pedal pulse for at least 30 seconds), breakage, and the number of turns required to stop the distal pedal pulse. A Wilcoxon sign-rank test was used to test differences between exposed and unexposed tourniquets. Tourniquets exposed to the environment broke more often (14/166 versus 0/166) and had decreased efficacy (63% versus 91%; p0.001). Three turns were required for most tourniquets to be efficacious. Environmental exposure of military tourniquets is associated with decreased efficacy and increased breakage. In most cases, tourniquets require three turns to stop the distal lower extremity pulse.

Objective To describe outpatient prescription treatment for active-duty military members with posttraumatic stress disorder (PTSD). Medical records were screened for drug-drug interactions with PTSD-related medications and for adverse drug events. Method A retrospective chart review was conducted of the medical records of active-duty service members aged 18 to 65 years who had a diagnosis of PTSD (ICD-9 criteria) and received psychiatric treatment at Naval Hospital Camp Pendleton, Camp Pendleton, California, between October 1, 2010, and October 31, 2010. Prescription medication treatment over a 6-month period (October 1, 2010, through March 31, 2011) was reviewed. Results Among 275 patients, 243 (88.4%) had at least 1 prescription dispensed and 219 (79.6%) had at least 1 PTSD-related medication dispensed. More than 1 PTSD-related medication was dispensed to 153 (55.6%) patients. The most common medication classes dispensed were selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (35.1%), novel antidepressants (15.6%), and anticonvulsants (15.0%). The most frequently dispensed PTSD-related medications were zolpidem: 149 (9.8%), sertraline: 147 (9.7%), gabapentin: 134 (8.8%), prazosin: 111 (7.3%), and trazodone: 110 (7.2%). In the subgroup of 219 patients who received PTSD-related medications, overlapping periods of treatment between an SSRI and another PTSD-related medication occurred in 58 (26.5%) patients. Potential drug-drug interactions with this combination involved 44 (20.1%) patients; no adverse drug events were reported. Among these 44 patients, 55 different potential drug-drug interactions were identified. Conclusions Patients receiving medications for PTSD are frequently treated with SSRIs or SNRIs and are likely to be prescribed more than 1 PTSD-related medication.

Using the proper greeting may be important to help establish rapport between health care providers and their patients. It may be particularly useful for family medicine physicians working in a military medical facility, where military rank and traditions are important. A total of 259 anonymous surveys were collected from patients treated at a military family medicine clinic. Most of the patients who completed the survey preferred to shake hands with their provider, be greeted using only their first name, and preferred that the provider introduce themselves using their last name only. Active duty patients were more likely than civilians to prefer a handshake (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.46-6.39) and officers were more likely to prefer a handshake compared to enlisted service members (OR 3.29; 95% CI 1.18-9.20). Respondents who were older were more likely to prefer a formal introduction by their provider compared to respondents under 35 years old (OR 2.92, 95% CI 1.35-6.31). Although most patients in this facility expressed a preference for how they would like to be greeted, providers are still encouraged to ask their patients how they would prefer to be addressed.