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Landstuhl Regional Medical Center, Germany

Owens B.D.,United States Military Academy | Campbell S.E.,Landstuhl Regional Medical Center | Cameron K.L.,United States Military Academy
American Journal of Sports Medicine | Year: 2014

Background: While anterior glenohumeral instability has been shown to be common in young athletes, the risk factors for injuryare poorly understood.Purpose/Hypothesis: To determine the modifiable and nonmodifiable risk factors for anterior shoulder instability in a high-riskcohort. The hypothesis was that specific baseline factors would be associated with the subsequent risk of injury.Study Design: Cohort study (prognosis); Level of evidence, 2. an Methods: We conducted a prospective cohort study in which 714 young athletes were followed from June 2006 through May2010. Baseline assessments included a subjective history of instability, physical examination by a sports medicine fellowshiptrained orthopaedic surgeon, range of motion, strength with a handheld dynamometer, and bilateral noncontrast shoulder magneticresonance imaging (MRI). A musculoskeletal radiologist measured glenoid version, glenoid height, glenoid width, glenoidindex (height-to-width ratio), glenoid depth, rotator interval (RI) height, RI width, RI area, RI index, and the coracohumeral interval.Subjects were followed to document all acute anterior shoulder instability events during the 4-year follow-up period. The time toanterior shoulder instability event during the follow-up period was the primary outcome of interest. Univariate and multivariableCox proportional hazards regression models were used to analyze the data.Results: Complete data were available for 714 subjects. During the 4-year surveillance period, there were 39 anterior instabilityevents documented at a mean of 285 days. While we controlled for covariates, significant risk factors of physical examinationwere as follows: apprehension sign (hazard ratio [HR], 2.96; 95% CI, 1.48-5.90; P = .002) and relocation sign (HR, 4.83; 95%CI, 1.75-13.33; P = .002). Baseline range of motion and strength measures were not associated with subsequent injury. Significantanatomic risk factors on MRI measurement were glenoid index (HR, 8.12; 95% CI, 1.07-61.72; P = .043) and the coracohumeralinterval (HR, 1.20; 95% CI, 1.08-1.34; P = .001).Conclusion: This prospective cohort study revealed significant risk factors for shoulder instability in this high-risk population.Physical examination findings of apprehension and relocation were significant while controlling for history of injury. The anatomicvariables of significance were not surprising-tall and thin glenoids were at higher risk compared with short and wide glenoids,and the risk of instability increased by 20% for every 1-mm increase in coracohumeral distance. ©2013 The Author(s). Source

Waibel K.H.,Landstuhl Regional Medical Center
Annals of Allergy, Asthma and Immunology | Year: 2016

Background: Telehealth continues to advance as a health care modality; however, reported experience for synchronous TeleAllergy is limited. Objective: To determine the percentage of new and follow-up visits conducted via TeleAllergy in a hospital-based clinic. Methods: A retrospective study evaluating the first 2 years of a synchronous patient-to-allergist TeleAllergy platform. Results: A total of 112 synchronous TeleAllergy encounters were conducted from January 2014 through December 2015; 66 (59%) of these were new consultations. The mean (SD) age was 26.9 (15.3) years, and 54% of the participants were female. Food allergy (30%), allergic rhinitis (20%), and urticaria (16%) represented the top 3 consultation reasons. Sixteen of 66 patients (24.2%) and 3 of 46 patients (6.5%) attending new and follow-up TeleAllergy visits, respectively, were recommended for an in-person appointment (P = .02). No difference was found between new and follow-up TeleAllergy visits regarding subsequent telephone communication (41% vs 26%, P = .11) or prescriptions ordered (50% vs 33%, P = .08). New TeleAllergy visits were more likely to have more than 1 laboratory test ordered (45% vs 17%, P = .002). On the basis of patient location, the 112 TeleAllergy visits resulted in an estimated savings of 200 workdays or schooldays, US$58,000 in travel-related costs, and 80,000 kilometers not driven. Conclusion: Both new and follow-up visits to the allergist/immunologist were well received by patients and demonstrated significant indirect cost savings, with less than one fourth of the patients recommended for an in-person visit. This appears to be the first systematic assessment of TeleAllergy for new and follow-up patient encounters in a clinic-based allergy/immunology practice. © 2016. Source

Waibel K.H.,Landstuhl Regional Medical Center
Vaccine | Year: 2015

Immunoglobulin (Ig) E antibodies to galactose-α-1,3-galactose (α-Gal) are associated with delayed anaphylaxis to mammalian food products and gelatin-based foods (Commins et al., J Allergy Clin Immunol 2009;123:426; Caponetto et al., J Allergy Clin Immunol Pract 2013;1:302). We describe a patient with α-Gal allergy who successfully tolerated the live zoster vaccine and we review anaphylactic reactions reported to this vaccine. Our patient, who tolerated a vaccine containing the highest gelatin content, is reassuring but continued safety assessment of gelatin-containing vaccines for this patient cohort is recommended as there are multiple factors for this patient cohort that influence the reaction risk. © 2015 . Source

Martin D.,Landstuhl Regional Medical Center
Southern Medical Journal | Year: 2011

This review evaluates the current understanding of the benefits and risks of physical activity and exercise on the gastrointestinal system. A significant portion of endurance athletes are affected by gastrointestinal symptoms, but most symptoms are transient and do not have long-term consequences. Conversely, physical activity may have a protective effect on the gastrointestinal system. There is convincing evidence that physical activity reduces the risk of colon cancer. The evidence is less convincing for gastric and pancreatic cancers, gastroesophageal reflux disease, peptic ulcer disease, nonalcoholic fatty liver disease, cholelithiasis, diverticular disease, irritable bowel syndrome, and constipation. Physical activity may reduce the risk of gastrointestinal bleeding and inflammatory bowel disease, although this has not been proven unequivocally. This article provides a critical review of the evidence-based literature concerning exercise and physical activity effects on the gastrointestinal system and provides physicians with a better understanding of the evidence behind exercise prescriptions for patients with gastrointestinal disorders. Well-designed prospective randomized trials evaluating the risks and benefits of exercise and physical activity on gastrointestinal disorders are recommended for future research. Copyright © 2011 by The Southern Medical Association. Source

Jones A.,Landstuhl Regional Medical Center | Jones A.,U.S. Army | Ingram M.V.,U.S. Army
Clinical Neuropsychologist | Year: 2011

Using a relatively new statistical paradigm, Optimal Data Analysis (ODA; Yarnold & Soltysik, 2005), this research demonstrated that newly developed scales for the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and MMPI-2 Restructured Form (MMPI-2-RF) specifically designed to assess over-reporting of cognitive and/or somatic symptoms were more effective than the MMPI-2 F-family of scales in predicting effort status on tests of cognitive functioning in a sample of 288 military members. ODA demonstrated that when all scales were performing at their theoretical maximum possible level of classification accuracy, the Henry Heilbronner Index (HHI), Response Bias Scale (RBS), Fake Bad Scale (FBS), and the Symptom Validity Scale (FBS-r) outperformed the F-family of scales on a variety of ODA indexes of classification accuracy, including an omnibus measure (effect strength total, EST) of the descriptive and prognostic utility of ODA models developed for each scale. Based on the guidelines suggested by Yarnold and Soltysik for evaluating effect strengths for ODA models, the newly developed scales had effects sizes that were moderate in size (37.66 to 45.68), whereas the F-family scales had effects strengths that ranged from weak to moderate (15.42 to 32.80). In addition, traditional analysis demonstrated that HHI, RBS, FBS, and FBS-R had large effect sizes (0.98 to 1.16) based on Cohen's (1988) suggested categorization of effect size when comparing mean scores for adequate versus inadequate effort groups, whereas F-family of scales had small to medium effect sizes (0.25 to 0.76). The MMPI-2-RF Infrequent Somatic Responses Scale (F S) tended to perform in a fashion similar to F, the best performing F-family scale. © 2011 Psychology Press. Source

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