Citations

Abstract Winters, JD, Heebner, NR, Johnson, AK, Poploski, KM, Royer, SD, Nagai, T, Randall, CA, Abt, JP, and Lephart, SM. Altered physical performance following advanced special operations tactical training. J Strength Cond Res 35(7): 1809–1816, 2021—The purpose of this study was to determine how the unique challenges of specific military tactical training phases influence overall physical performance characteristics. Broad jump, 5-10-5, 300-yd shuttle, percent body fat (%BF), anaerobic power (AP) and anaerobic capacity (AC), maximal oxygen uptake (V̇ o 2 max), isokinetic knee extension/flexion strength, shoulder internal/external rotation strength, and trunk extension/flexion strength were collected on 73 United States Marine Corps Forces Special Operations Command (MARSOC) students (age: 27.4 ± 3.8 years, height: 178.7 ± 6.6 cm, and body mass: 85.8 ± 9.4 kg) at the beginning of (P1), in between (P2), and at the completion of 2 distinct tactical training phases (P3). Linear mixed models were used to analyze within-subject performance changes over the 3 time points, and post hoc Bonferroni pairwise comparisons analyzed performance changes between each testing time point. There were significant changes in broad jump ( p < 0.0001), 5-10-5 agility time ( p < 0.001), %BF ( p = 0.011), AP ( p < 0.0001), V̇ o 2 max ( p = 0.001), and both right and left shoulder internal rotation strength ( p = 0.004 and p = 0.015, respectively) between P1 and P2. There were also significant changes in 300-yd shuttle run time ( p = 0.001), AP ( p < 0.0001), AC ( p < 0.0001), left knee extension strength ( p = 0.006), trunk flexion strength ( p < 0.0001), and left shoulder external rotation strength (0.027) between P2 and P3. Identifying the effect that specific tactical training phases may have on physical performance will allow for the development of effective phase-specific evidence-based human performance programs, reducing performance deficits and thereby reducing the risk of injury.

Abstract BACKGROUND Stereotactic radiosurgery (SRS) is a common treatment modality for vestibular schwannoma (VS), with a role in primary and recurrent/progressive algorithms. At our institution, routine magnetic resonance imaging (MRI) is obtained at 6 and 12 mo following SRS for VS. OBJECTIVE To analyze the safety and financial impact of eliminating the 6-mo post-SRS MRI in asymptomatic VS patients. METHODS A prospectively maintained SRS database was retrospectively reviewed for VS patients with 1 yr of post-treatment follow-up, 2005 to 2015. Decisions at 6-mo MRI were binarily categorized as routine follow-up vs clinical action —defined as a clinical visit, additional imaging, or an operation as a direct result of the 6-mo study. RESULTS A total of 296 patients met screening criteria, of whom 53 were excluded for incomplete follow-up and 8 for NF-2. Nine were reimaged prior to 6 mo due to clinical symptoms. Routine 6-mo post-SRS MRI was completed by 226 patients (76% of screened cohort), following from which zero instances of clinical action occurred. When scaled using national insurance database-derived financials—which estimated the mean per-study charge for MRI of the brain with and without contrast at $1767—the potential annualized national charge reduction was approximated as $1 611 504. CONCLUSION For clinically stable VS, 6-mo post-SRS MRI does not contribute significantly to management. We recommend omitting routine MRI before 12 mo, in patients without new or progressive neurological symptoms. If extrapolated nationally to the more than 100 active SRS centers, thousands of patients would be spared an inconvenient, nonindicated study, and national savings in health care dollars would be on the order of millions annually.

Background Hyperkalemia has been associated with increased mortality in patients with myocardial infarction, but few data exist regarding hyperkalemia in cardiac intensive care unit ( CICU ) patients. We hypothesize that hyperkalemia is associated with increased mortality in unselected CICU patients. Methods and Results We retrospectively reviewed a historical cohort of 9681 CICU patients admitted from January 2007 to December 2015. Hyperkalemia was defined as admission potassium ≥5.0 mEq/L and hypokalemia as admission potassium <3.5 mEq/L. Multivariate logistic regression was used to determine predictors of in‐hospital mortality. Postdischarge survival was assessed using Kaplan–Meier analysis and Cox proportional hazards models. The mean age of included patients was 67±15 years, with 36% females, and in‐hospital mortality was 9%. Hyperkalemia occurred in 1187 (12.3%) and hypokalemia occurred in 719 (7.4%) patients. Both patients with hyperkalemia (unadjusted odds ratio, 2.85; 95% CI, 2.40–3.39; P <0.001) and patients with hypokalemia (unadjusted odds ratio, 2.31; 95% CI, 1.85–2.88; P <0.001) were at increased risk of unadjusted in‐hospital mortality. After adjustment for illness severity and renal function, only patients with hyperkalemia demonstrated increased risk of in‐hospital death (adjusted odds ratio, 1.44; 95% CI, 1.11–1.87; P =0.006). Among hospital survivors, only patients with hyperkalemia had lower postdischarge survival by Kaplan–Meier analysis ( P <0.001). After adjustment for illness severity and renal function, hospital survivors with admission hyperkalemia remained at increased risk for postdischarge mortality (adjusted hazard ratio, 1.20; 95% CI, 1.08–1.34; P <0.001). Conclusions Hyperkalemia on CICU admission is associated with higher in‐hospital and postdischarge mortality, independent of renal function and illness severity. These findings emphasize the importance of potassium abnormalities as a risk predictor in patients admitted to the CICU .