The use of energy beverages is high among the general population and military personnel. Previous studies have reported discrepancies between the actual amount of caffeine in products and the amount of caffeine on stated labels. Thus, the purpose of this study was to examine the content of caffeine listed on the labels of various energy drinks and energy shots. Top-selling energy drinks (n = 9) and energy shots (n = 5) were purchased from retail stores. Three of each of the 14 products were purchased and analyzed for caffeine content by an independent laboratory. Of the 14 products tested, 5 did not provide caffeine amounts on their facts panel-of those, 3 listed caffeine as an ingredient and 2 listed caffeine as part of a proprietary blend. The remaining 9 (of 14) products stated the amounts of caffeine on their labels, all of which were within 15% of the amount indicated on the label. In this study, although the energy beverages that indicated the amount of caffeine it contained had values within ±15% of the amount listed on the label, a potentially acceptable range, this finding is not acceptable with regard to current labeling regulations, which require added ingredients to total 100%.
Exertional rhabdomyolysis (ER) is an uncommon condition with a paucity of evidence-based guidance for diagnosis, management, and return to duty or play. Recently, a clinical practice guideline for diagnosis and management of ER in warfighters was updated by a team of military and civilian physicians and researchers using current scientific literature and decades of experience within the military population. The revision concentrated on challenging and controversial clinical questions with applicability to providers in the military and those in the greater sports medicine community. Specific topics addressed: 1) diagnostic criteria for ER; 2) clinical decision making for outpatient versus inpatient treatment; 3) optimal strategies for inpatient management; 4) discharge criteria; 5) identification and assessment of warfighters/athletes at risk for recurrent ER; 6) an appropriate rehabilitative plan; and finally, 7) key clinical questions warranting future research.
Chronic exertional compartment syndrome is a debilitating condition primarily associated in highly active individuals with an estimated incidence of approximately 1 in 2000 persons/year. The etiology remains unclear to date. The differential diagnosis includes, but is not limited to stress fractures, medial tibial stress syndrome, and popliteal artery entrapment syndrome. Clinical signs and symptoms include pain in the involved compartment with exertion dissipating quickly after activity. Diagnostic tests include intramuscular compartment pressure testing, magnetic resonance imaging, near-infrared spectrometry as well as shear wave electrography. Treatments consist of nonsurgical, surgical, or the combination of the two. Gait retraining and the use of botulinum toxin appear most promising. Diagnostic lidocaine injections are emerging as a prognostic and mapping tool. Minimal invasive surgical options are being utilized allowing quicker return to activity and decreased morbidity. This article reviews the anatomy, clinical signs and symptoms, diagnostics, nonsurgical, and surgical treatments for chronic exertional compartment syndrome.
BackgroundMusculoskeletal (MSK) complaints comprise a large proportion of outpatient visits. However, multiple studies show that medical school curriculum often fails to adequately prepare graduates to diagnose and manage common MSK problems. Current standardised exams inadequately assess trainees’ MSK knowledge and other MSK-specific exams such as Freedman and Bernstein’s (1998) exam have limitations in implementation. We propose a new 30-question multiple choice exam for graduating medical students and primary care residents. Results highlight individual deficiencies and identify areas for curriculum improvement.Methods/ResultsWe developed a bank of multiple choice questions based on 10 critical topics in MSK medicine. The questions were validated with subject-matter experts (SMEs) using a modified Delphi method to obtain consensus on the importance of each question. Based on the SME input, we compiled 30 questions in the assessment. Results of the large-scale pilot test (167 post-clerkship medical students) were an average score of 74 % (range 53% – 90 %, SD 7.8%). In addition, the tool contains detailed explanations and references were created for each question to allow an individual or group to review and enhance learning.SummaryThe proposed MSK30 exam evaluates clinically important topics and offers an assessment tool for clinical MSK knowledge of medical students and residents. It fills a gap in current curriculum and improves on previous MSK-specific assessments through better clinical relevance and consistent grading. Educators can use the results of the exam to guide curriculum development and individual education.
Background: Pain is a common diagnosis in both the civilian and military community. Integrative health practices, such as acupuncture, are often used to treat pain as well as other medical conditions. Medical schools must ensure that their students are aware of what patients are using and how the tools of Integrative Health can be used together with the conventional medical model. Methods: The Uniformed Services University of the Health Sciences (USUHS), The United States' military medical school, is heeding this call in innovative ways. The USUHS uses several means to teach Integrative Health throughout the 4-year medical school experience. A new component, Battlefield Acupuncture, was introduced into the second-year curriculum and was particularly relevant to service personnel. Conclusions: Integrative health modalities introduced to medical students early in their education has been well-received and will prepare them for their medical careers.
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