The Carl R. Darnall Army Medical Center is a United States Department of Defense medical facility at Fort Hood, Texas. It provides medical care to servicemembers and their families, along with veterans and their dependents, in and around the largest U.S. military installation in the world. Named after inventor of water chlorination Brigadier General Carl Rogers Darnall, MD., the core of the medical center is a state of the art 947,000-square-foot hospital. The facility opened in 2016, and includes a full primary care and emergency medical facility, including a level III trauma center, and specialized care in obstetrics and gynaecology, orthopedics, and behavioral health. The hospital provides treatment to nearly 3,000 patients daily. The medical center is one of the largest in the Military Health System, comprising more than 105 buildings in addition to the main facility, spread over Fort Hood, three local communities, and a clinic at the Red River Army Depot in Bowie County, Texas, outside of Texarkana. The medical center and its outlying facilities are staffed nearly entirely by uniformed servicemembers of the U.S. Army, however in 2019, the administrative control of the facility was shifted from United States Army Medical Command to the Defense Health Agency, an integrated joint Department of Defense combat support agency. All patients of the facility are insured and billed through Tricare, the health insurance system of the DoD. The medical center is led by Colonel Richard G. Malish.S.S.S..
This review summarizes the history and current landscape of fecal microbiota transplantation (FMT), with an emphasis on use of the therapy for Clostridioides difficile infection (CDI), inflammatory bowel disease (IBD), and irritable bowel syndrome (IBS). We clarify indications, evidence, and current recommendations for FMT—highlighting major advances and minor setbacks that have led to the state of FMT in 2025. After decades of steady progress, the U.S. Food and Drug Administration (FDA) approved the first FMT-based therapies: fecal microbiota, live-jslm and fecal microbiota spores, live-brpk—in 2022 and 2023, respectively. The 2024 American Gastroenterological Association (AGA) Practice Guideline on Fecal Microbiota-Based Therapies for Select Gastrointestinal Diseases made specific recommendations for conventional FMT and these FDA-approved therapies for multiple CDI presentations, as well as for IBD and IBS. Conventional FMT remains an option for CDI; however, OpenBiome’s halt of shipped, frozen FMT preparations on December 31, 2024, has made access more challenging in 2025. Although first reported almost seventy years ago, extensive efforts over the last two decades have placed FMT in routine algorithms for many patients with CDI. While understanding of the intestinal microbiome’s role in other gastrointestinal conditions is expanding, and FMT may modulate these pathways, additional evidence is needed before FMT becomes routine outside CDI.
INTRODUCTION:Cricothyroidotomy is a rarely performed, but lifesaving procedure. It is imperative that surgeons and the medical teams they work with can execute the steps required to successfully perform a cricothyroidotomy. As a procedure that is dependent on tactile feedback and expeditious execution, surgical teams require training models that can meet these needs for successful performance of a cricothyroidotomy when met with a patient who cannot intubate and cannot ventilate. Cadaveric, animal, and adequate synthetic training models are preferred but are not commonly available in deployed environments. Herein, we present a simple, inexpensive, and reproducible cricothyroidotomy training model built using supplies available in any hospital, including deployed medical facilities. MATERIALS AND METHODS:Cricothyroidotomy models were built using spirometer tubing, rolls of tape, and latex roll bandaging. A voluntary training session was held at a deployed military medical facility and was open to all hospital personnel and coalition force members. Participating members completed an anonymous survey detailing their level of experience performing cricothyroidotomy as well as their self-assessment of knowledge of steps, instruments, and overall confidence performing cricothyroidotomy on a 5-point Likert scale. A brief didactic session was held reviewing steps of the cricothyroidotomy, then each participant performed a timed cricothyroidotomy on the model and completed a post-training survey documenting level of confidence with the procedure post-training and an overall assessment of the model using a 5-point Likert scale. Participants repeated a timed cricothyroidotomy on the same model 4 weeks later. Pre and post-training confidence levels were compared using the Wilcoxon signed-rank test; time to cannulation between first and second attempts 4 weeks later were compared using the paired samples t test. This study underwent formal IRB review and was granted exempt status, as it did not involve patients and collected anonymous survey data from voluntary participants. RESULTS:Thirty-two soldiers, including American healthcare professionals and coalition force medics, completed the training. Self-assessment of confidence in performing cricothyroidotomy on a 5-point Likert scale improved from a mean of 2.78 to 3.63 pre and post-training, respectively (P < .005). Mean time to cannulation improved from a mean of 101.6 ± 60.7 seconds on first attempt to 62.6 ± 24.8 seconds on second attempt 4 weeks later. Mean overall rating of usefulness of the model by participants was 4.77 on a 5-point Likert scale, indicating a perception that the model was overall very useful for training. CONCLUSION:A simple, portable, and inexpensive cricothyroidotomy training model can be built with common hospital supplies available even in austere deployed environments. This model is suitable for hands-on practice and can increase level of confidence as well as speed in performing cricothyroidotomy. The realism of the model is limited by the simplicity of the materials, however, it is adequate in instances where cadaver and animal tissue are unavailable. Future study could evaluate equally portable and inexpensive training options for deployed soldiers, including 3D models.
INTRODUCTION:The focused assessment with sonography in trauma (FAST) is the most important ultrasound exam in the operational environment, yet its sensitivity for diagnosis of solid organ injury is limited. Contrast-enhanced FAST (cFAST) augments the diagnostic power of the FAST exam of parenchymal and vascular injuries, and it rivals CT. Studies on cFAST have not used handheld ultrasound systems found in the combat environment. METHODS:As part of a methodsdesign process for a cFAST study, the authors tested six hand-held and portable ultrasound systems for their ability to visualize contrast enhancement: Philips Lumify, Butterfly IQ3, GE Vscan Air, Fujifilm Sonosite Edge II, Fujifilm Sonosite M-Turbo, and GE Venue (cart-based comparator). None had dedicated "contrast" settings. Device settings were adjusted to minimize gain and maintain a mechanical index below .3. Three standardized patients received .02mL to .11mL intravenous boluses of perflutren (Definity) followed by a 10mL saline flush. The right upper quadrant was scanned to assess contrast visualization in the kidney. RESULTS:Contrast enhancement was visualized on only one handheld device (GE Vscan Air) and the GE Venue (cart-based comparator). No enhancement was seen with the others. CONCLUSIONS:Most handheld and portable ultrasound systems currently used in deployed medical settings failed to visualize contrast. While the GE Vscan Air shows promise, further investigation is necessary to determine whether system modifications, software upgrades, or dosing adjustments can enable cFAST capability in the far-forward environment. Reliable handheld-based cFAST methods will advance research and implementation of this technology in military trauma care.
Background: Loose body removal and debridement remain common indications for elbow arthroscopy. Purpose: To (1) identify trends in elbow arthroscopy versus open procedures for loose body removal and debridement among American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination candidates and (2) compare the use of elbow arthroscopy among candidates with different fellowship training backgrounds. Study Design: Cohort study; Level of evidence, 3. Methods: A search of the ABOS Part II Oral Examination case list database was performed for elbow arthroscopy and open debridement Current Procedural Terminology codes between 2011 and 2021. Cases were stratified according to fellowship training data found in the ABOS Part II case list database. Annual rates of elbow procedures, patient demographics, surgeon geographic location, and complications were collected. Statistically significance was determined using chi-square testing, Fisher exact test or 2-tailed t test ( P < .05). Results: A total of 1443 procedures, 1147 (79.5%) arthroscopic and 296 (20.5%) open, were identified and included. A decrease in arthroscopic cases was observed while open cases remained steady. Arthroscopic cases were performed in a younger patient population (39 ± 18.5 vs 41.7 ± 17.3 years respectively; P = .02). The plurality of cases were performed by sports medicine fellowship–trained surgeons (n = 506; 35.1%), followed by hand and upper extremity fellowship–trained surgeons (n = 440; 30.5%) and shoulder and elbow fellowship–trained surgeons (n = 365; 25.3%). Sports medicine fellowship–trained surgeons performed the greatest proportion of arthroscopic cases (n = 482/506; 95.3%). In general, complication rates were lower following arthroscopic versus open procedures (surgical complications: 8.6% vs 27.7%, P < .001; readmissions: 0.7% vs 2.0%, P = .04; reoperations: 1.6% vs 3.7%, P = .02). Specifically, commonly associated complications including arthrofibrosis and nerve injury were also lower following arthroscopic procedures (stiffness/arthrofibrosis: 29.3% vs 34.1%, P < .001; nerve injuries: 1.7% vs 5.1%, P < .001). Conclusion: In this study of patients treated by ABOS Part II Oral Examination candidates, with the largest population of patients undergoing elbow arthroscopy to date, rates of elbow arthroscopy have decreased over the past decade, although surgeons with sports medicine, hand and upper extremity, and/or shoulder and elbow fellowship training demonstrate a proclivity toward arthroscopic rather than open procedures. Overall rates of complication were lower following arthroscopic approaches in this cohort of surgeons.
