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This study was conducted to investigate the impact of deployment on the psychological health status, level of alcohol consumption, and use of psychological health resources of postdeployed Army Reserve (AR) soldiers. Data were collected from 51,078 postdeployed AR soldiers via DD Form 2900 to detect existing psychological and medical issues. As predicted, findings indicate that AR soldiers screened 7 or more months post redeployment are significantly more likely than those screened 3 to 6 months post redeployment to screen positive for moderate (chi2 (1, N = 44,319) = 15.75, p < 0.001) and severe (chi2 (1, N = 44,319) = 7.82, p < 0.05) functional impairment and PTSD (chi2 (1, N = 51,017) = 14.43, p < 0.001). Present findings are consistent with previous research, suggesting that adverse psychological health issues can be detected during their mild stages and resolved to prevent further degradation when screenings are performed according to military policy.

IntroductionImmobilisation in the intensive care unit (ICU) leads to muscle weakness and is associated with increased costs and long-term functional disability. Previous studies showed early mobilisation of medical ICU patients improves clinical outcomes. The Surgical ICU Optimal Mobilisation Score (SOMS) trial aims to test whether a budget-neutral intervention to facilitate goal-directed early mobilisation in the surgical ICU improves participant mobilisation and associated clinical outcomes.Methods and analysisThe SOMS trial is an international, multicentre, randomised clinical study being conducted in the USA and Europe. We are targeting 200 patients. The primary outcome is average daily SOMS level and key secondary outcomes are ICU length of stay until discharge readiness and ‘mini’ modified Functional Independence Measure (mmFIM) at hospital discharge. Additional secondary outcomes include quality of life assessed at 3 months after hospital discharge and global muscle strength at ICU discharge. Exploratory outcomes will include: ventilator-free days, ICU and hospital length of stay and 3-month mortality. We will explore genetic influences on the effectiveness of early mobilisation and centre-specific effects of early mobilisation on outcomes.Ethics and disseminationFollowing Institutional Review Board (IRB) approval in three institutions, we started study recruitment and plan to expand to additional centres in Germany and Italy. Safety monitoring will be the domain of the Data and Safety Monitoring Board (DSMB). The SOMS trial will also explore the feasibility of a transcontinental study on early mobilisation in the surgical ICU.ResultsThe results of this study, along with those of ancillary studies, will be made available in the form of manuscripts and presentations at national and international meetings.RegistrationThis study has been registered at clinicaltrials.gov (NCT01363102).

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Six-monthly blood monitoring is performed for patients with psoriasis-prescribed biological drugs at most UK centres. This has significant healthcare cost implications, creates a burden on patient time and has a considerable environmental impact. We aimed to investigate blood abnormalities in patients prescribed biologics in our centre, to determine whether the monitoring frequency could be reduced. We reviewed the records of patients with psoriasis prescribed a biologic drug who attended the clinic between September and October 2022 and collected blood result data from the preceding 2 years. Normal ranges were determined by electronic health record ranges. In total, 102 patients were included (male : female ratio 47 : 55, median age 48.5 years). Adalimumab (n = 39), ustekinumab (n = 36) and risankizumab (n = 13) were the most prescribed biologics. Ten patients were prescribed oral systemic therapy (six methotrexate and four acitretin). The median blood monitoring interval was 5 months. Overall, blood abnormalities were present in 38 of 102 patients (37.2%). Transaminitis was most common (n = 23, all ≤ 80 U L−1): ten had documented liver disease and two were coprescribed methotrexate. Two patients had abnormalities requiring immediate retesting (acute kidney injury and new anaemia) and 36 had mild abnormalities. Fourteen patients had developed abnormalities since commencing biologic therapy [neutrophilia, n = 2; neutropenia, n = 1 (adalimumab); lymphopenia, n = 1 (ustekinumab); transaminitis, n = 8; thrombocytosis, n = 2; thrombocytopenia, n = 1; anaemia n = 1; low urea, n = 1; raised creatinine, n = 1]. Despite abnormalities present in 37% of patients, the majority were mildly deranged and only 14 patients developed the abnormality after commencing biologic therapy. Many of these patients have multiple long-term conditions, monitored in other clinics. None of the blood abnormalities detected was directly attributed to commencing the biologic or prompted stopping biologic therapy. Our data support that a more targeted and coordinated approach to blood monitoring could be adopted and should be formally assessed. Applying sustainable healthcare coalition and government vehicle emission figures to findings from a survey of patients with psoriasis prescribed a biologic in our department, we estimate an annual carbon saving of &gt; 850 kg CO2 equivalents (CO2e) for patient travel alone if monitoring for patients with no specific risk factors became annual. When considering addition factors, such as building energy and consumables disposal, this saving could rise to &gt; 6400 kg CO2e. Up to 60% of patients miss work to attend appointments and, for a minority, earnings are consequently lost (outpatient survey data). Evidently, more targeted monitoring could substantially reduce carbon emissions, disruption to employment and associated healthcare costs. Further evaluation through larger studies is required to ensure ongoing safe prescribing with personalized blood monitoring.

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