The weapons of mass destruction-civil support team PA.

ABSTRACT: The weapons of mass destruction-civil support team (WMD-CST) physician associate/assistant (PA) is an autonomous PA who balances military and civilian roles to achieve mission success and support the safety of the US public. This article by multiple WMD-CST PAs across the nation describes the WMD-CST PA profession and how traditional PA roles continue to advance.

Update on Current Concepts of Blood Flow Restriction in the Perioperative Period of Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament tears or ruptures are common orthopedic injuries. Anterior cruciate ligament reconstruction (ACLR) is an orthopedic procedure allowing for earlier return to sports, improved maintenance of lifestyle demands, and restored knee stability and kinematics. A perioperative rehabilitative adjunct recently gaining interest is blood flow restriction (BFR), a method in which temporary restriction of blood flow to a chosen extremity is introduced and can be used as early as a few days postoperative. There has been increasing investigation and recent literature regarding BFR. This review synthesizes current concepts of BFR use in the ACLR perioperative period. [Orthopedics. 2023;46(6):e333-e340.].

Combating Fentanyl: National Guard Physician Assistants on the Front Lines of America's War Against Synthetic Opioids.

There is a significant threat to global health security due to synthetic opioids, illicitly manufactured fentanyl (IMF), and nefarious uses of pharmaceutical based agents (PBA). Since 2014, increased distribution of synthetic opioids including IMF into the US through China, India, and Mexico has resulted in devastating consequences to the average street drug user. Additionally, clandestine lab operations for pill manufacturing and distribution have increased, along with unintentional drug overdoses due to drugs being laced with fentanyl or some other synthetic opioid derivative. Naloxone has been shown to be an effective and useful tool for reversing signs and symptoms of synthetic opioid overdose, though additional doses may be required depending on the analog. In addition to the risk of overdose in US civilians, other state actors have utilized fentanyl and its analogs as incapacitants resulting in significant numbers of casualties. The National Guard Weapons of Mass Destruction-Civil Support Teams (WMD-CST) have been on the front lines supporting federal law enforcement agencies with hazard identification and assessment. Physician Assistants (PA) are assigned to these units and provide the necessary skills and expertise to keep on scene personnel safe. This article aims to dispel some of the rumors and myths surrounding fentanyl in an effort to educate first receivers, first responders, and hospital providers. Lastly, this article provides a review of synthetic opioid production, overdose, hazards, treatment/countermeasures, decontamination for responders, and the potential use of synthetic opioids as WMDs.

"You're O.K. Anesthesia": Closed Reduction of Displaced Pediatric Forearm and Wrist Fractures in the Office Without Anesthesia.

BACKGROUND: Angulated wrist and forearm fractures are among the most common pediatric fractures, and they often require closed reduction with anesthesia. There are several issues associated with pediatric anesthesia including the low but non-zero risk of significant complications, increased physician and staff time and effort, and increased cost. Despite these issues, there have not been any studies to prove that using anesthesia results in better outcomes or higher caregiver satisfaction in comparison to performing closed reductions without anesthesia. The purpose of this study was to evaluate the quality of closed reductions of angulated pediatric wrist and forearm fractures and to determine caregiver satisfaction with an anesthesia-free reduction technique. METHODS: This study included 54 pediatric patients with closed, angulated fractures of the radius or combined radial and ulnar shafts. All closed reductions were performed by a single pediatric fellowship-trained orthopaedic surgeon in the office setting without any anesthesia. Radiographs were obtained to assess the quality of the reduction. At the first follow-up visit, caregivers were asked about their interim use of pain medications. Caregivers were later surveyed about patient use of analgesics and their satisfaction with an anesthesia-free reduction technique. RESULTS: The average age of the 54 patients in this study was 9 years (1.8 to 16.8 y). Thirty-three fractures were combined radial and ulnar forearm shaft fractures, 18 were distal radius fractures, and 3 were radial shaft fractures. ≤10 degrees of residual angulation was achieved in 98% of patients. Nine percent (5/54) of the patients used ibuprofen or acetaminophen for pain control. Seventy eight percent (42/54) of the caregivers responded to the telephone and email surveys. All responding caregivers stated that the patients returned to full function and had satisfactory outcomes. Ninety eight percent (41/42) of the caregivers stated they would choose the same anesthesia-free reduction technique again. CONCLUSIONS: Closed reduction of angulated pediatric wrist and forearm fractures in the office without anesthesia can achieve satisfactory reductions and high caregiver satisfaction while eliminating the risks and complications associated with pediatric anesthesia. LEVEL OF EVIDENCE: Level IV Case series.

National Guard Response to COVID-19: A Snapshot in Time during the Pandemic.

BACKGROUND: Since March of 2020, thousands of National Guard service members have played a key role in the domestic response to COVID-19, ranging from medical support, health screening, decontamination, personal protective equipment (PPE) training, and more. As a result of these missions, there was a hypothesized potential increase in COVID-19 exposure risk. OBJECTIVES: Assess COVID-19 transmission rates and mortality rates in the US population compared to the National Guard. METHODS: Six months of retrospective data were assessed with analysis of a snapshot in time for pandemic data on 29 July 2020. Potential relationships between National Guard COVID-19 response personnel, cumulative US COVID-19 cases, National Guard COVID-19 cases, and National Guard COVID-19 fatalities were assessed. RESULTS: No evidence of correlations exist between the number of National Guard personnel supporting the COVID-19 response and the number of deaths in the National Guard due to COVID-19 (p=0.547), and the number of National Guard COVID-19 cases and the number of deaths in the National Guard due to COVID-19 (p=0.214). The number of COVID-19 cases in the US was positively correlated to the number of deaths in the US due to COVID-19 (rs=0.947, p is less than.001). CONCLUSIONS: Though much of the data could not be reported due to operational security (OPSEC) and capabilities, activities, limitations, and intentions (CALI) concerns, the data herein demonstrate National Guard service members are significantly less likely to suffer COVID-19 related mortality compared to US civilians. Since the National Guard adheres the same medical and physical fitness standards as set by their parent service (Army and Air Force), it follows overall levels of medical readiness and fitness should start with a higher baseline. Age, medical screening, PPE, and physical fitness requirements have likely contributed to this phenomenon. These results should empower National Guard service members to feel more confident in their roles as they continue to support the COVID-19 response efforts.

Cervical Ossification of the Posterior Longitudinal Ligament (OPLL) in Native Hawaiians and/or Polynesians: A 3-year Retrospective Demographic and Descriptive Pilot Study.

Ossification of the posterior longitudinal ligament (OPLL) is a disease characterized by the replacement of the posterior longitudinal ligament with ectopic bone and cartilage. Historically, the disease was described as highly prevalent in Japanese and other Asian populations. However, recent studies suggest OPLL may have a higher prevalence in non-Asian communities than previously believed. To date, there are no demographic or epidemiologic studies examining OPLL in Native Hawaiian or Polynesian communities. The purpose of this study was to review the demographics and comorbidities of a cohort of patients with OPLL from the author's institution, designated as either Native Hawaiian and/or Polynesian (NHP) or Non-Native Hawaiian and/or Polynesian (NNHP). Demographic findings from this study were similar to previous literature demonstrating higher rates of OPLL in men and older patients with an average age of 56 years in the NHP group and 65 years in the NNHP group. There were no statistically significant differences in the rates of type II diabetes mellitus, coronary vascular disease, chronic kidney disease, or hypertension between NHP and NNHP groups. The NHP group exhibited statistically higher rates of obesity when compared to the NNHP group. Obesity's risk in the development or progression of OPLL in the NHP population has not been examined and requires additional investigation. This study serves as a beginning for further demographic and epidemiologic investigations into OPLL in Native Hawaiian and Polynesian communities to facilitate improved identification of those at risk and guide diagnosis and treatment of these patients.

Using buprenorphine to treat patients with opioid use disorder.

The US opioid epidemic is a complex problem that has resulted in legislative actions to make treatment more accessible to patients. Physician assistants (PAs) have taken an active role in expanding their scope of practice to keep up with treatment needs. This article describes opioid use disorder in the United States, treatment gaps, safe treatment with buprenorphine, and PA prescriptive authority.

The aeromedical physician assistant.

The US Army aeromedical physician assistant (PA) serves aviation units in regards to crewmember medical readiness. All PAs are graduates of a 6-week flight surgeon course. They are responsible for conducting nearly 40% of the annual US Army flight physicals. This unique training and deployment illustrates the growing adaptability of PAs to assume a greater role in military medicine.

Are the phytoestrogens genistein and daidzein anti-herbivore defenses? A test using the gypsy moth (Lymantria dispar).

Phytoestrogens are compounds that have moderate estrogenic or anti-estrogenic activity toward mammals. Although genistein and daidzein, the main phytoestrogens of soybean, have been the subject of thousands of studies that address their benefit to human health, relatively little is known about their benefits to plants that produce them. It has been suggested that genistein and daidzein protect plants against arthropod herbivores, but direct tests of this hypothesis are rare. In this study, we evaluated the effect of genistein and daidzein on the survivorship, growth, and fecundity of the gypsy moth, a generalist insect herbivore that does not encounter phytoestrogens in its normal diet. We compared survivorship, egg-to-pupa growth rate, and 4th instar performance of gypsy moth caterpillars on artificial diets containing no phytoestrogen, genistein, daidzein, or a combination of genistein and daidzein. Our results indicate that genistein and daidzein do not decrease survivorship, growth, or fecundity of this insect herbivore. Therefore, it seems unlikely that the primary function of these compounds in aboveground plant tissues is anti-herbivore defense.