A Multidisciplinary Approach to Screen Deployment-Limiting Health Conditions.

INTRODUCTION: Disease non-battle injuries (DNBIs) are responsible for the majority of hospital admissions for soldiers in combat since the Vietnam War The U.S. Army prepares soldiers to deploy through a multistage process known as the Soldier Readiness Program (SRP). The current processes are reactive and address deployment-limiting health conditions (DLHCs) and the need for intervention and/or medical waivers late in the SRP process. This may compromise the quality and efficiency of pre-deployment medical clearance and result in DNBI medical evacuation from theater, which is costly and reduces the effectiveness of the unit. Implementation of a proactive and standardized screening process focused on behavioral health-related medical evacuations and psychotropic medication use will facilitate timely and effective interventions to improve readiness. METHODOLOGY: The primary objective of this proof-of-concept (POC) study was to develop a standardized and sustainable process, known as the deployment-limiting medication (DLM) surveillance process, to screen soldiers for DLHCs that prevent mobilization. The A-3 performance improvement model was utilized to identify the root causes of limitations with the current medical SRP and to develop solutions. This process utilized the DLHC tool, a report created by the Defense Health Agency, as a basis to identify soldiers that require continued chart review based on prescription fill history. The results of the report were further assessed using published deployment eligibility standards and focused on psychotropic medications. Secondary measures [included] validation of the DLHC tool by assessing the accuracy of the DLHC report. This was determined by the proportion of soldiers screened who actually required intervention and/or waivers per deployment policy. This study took place within an Infantry Brigade Combat Team (IBCT). RESULTS: From August 2019 to March 2020, 959 soldiers in the IBCT were screened under the DLM surveillance process for DLHCs related to mental health and psychotropic medication use. The percentage of completed screenings of psychotropic-related DLHCs in the IBCT reached 100% after 3 months of implementing this POC study. After thorough chart review, a total of 421 soldiers met criteria for a medical intervention and/or waiver with 8% of these soldiers identified with a preexisting medical profile. The DLHC tool's ability to use medication history to accurately predict the need for an intervention and/or medical waiver was 59% (654/1,112 medications). Soldiers identified using the DLM surveillance process that did not meet criteria predominately involved antidepressant, anticonvulsant, and central nervous system DLHC categories. If the psychotropic-related DLHC categories are optimized in future reports, the report's accuracy may be increased to 90% while decreasing the time to complete the monthly review. CONCLUSION: The DLM surveillance measures were successfully incorporated into the SRP process to proactively screen for DLHCs. Early identification of DLHCs allowed for proper identification of medical intervention and/or waiver needs and may decrease deployment complications. This process may help to improve a soldier's deployability and improve overall readiness of the IBCT.

Nutcracker syndrome in adolescent with perineal pain: An interesting case of an adolescent with perineal pain due to pelvic congestion from nutcracker syndrome with relief after balloon venoplasty and sclerotherapy.

Nutcracker phenomenon is the descriptor for a patient's anatomy whenever the left renal vein becomes compressed between the abdominal aorta and the superior mesenteric artery. Nutcracker syndrome is the terminology used when the nutcracker phenomenon is accompanied by symptoms including pain (abdominal, flank, pelvic), hematuria, and orthostatic proteinuria. Diagnosis can be made with Doppler ultrasound, venography, computed tomography, or magnetic resonance imaging. This case demonstrates some of the typical findings of nutcracker syndrome. The limited clinical features and interesting imaging findings, in addition to the young age of the patient, make this a notable case.