Medical Preparedness Research Articles

Distance education influence on medical students readiness for educational and professional self-development

The article presents an analysis of domestic and foreign specialists attitudes regarding modern trends in the development of distance education and the forced transition of all educational organizations to online learning in connection with the COVID-19 pandemic. The article reflects the results of an empirical research aimed at studying the readiness of medical students for educational and professional self-development in the context of distance education.

STATE INSTITUTION «NATIONAL RESEARCH CENTER FOR RADIATION MEDICINE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE» - RESEARCH ACTIVITIES AND SCIENTIFIC ADVANCE IN 2020.

Research activities and scientific advance achieved in 2020 at the State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine» (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. The report presents the results of fundamental and applied research works of the study of radiation effects and health effects of the Chornobyl accident. The report also shows the results of scientific-organizational and health care work, staff training. The Scientific Council meeting of NAMS approved the NRCRM Annual Report.

Latent TB Infection in USSOF: A Refresher and Update

Tuberculosis (TB) causes approximately 2 million deaths annually worldwide, with 2 billion persons estimated to be actively infected with TB. While rates of active TB disease in the US military are low, military service in TB-endemic countries remains an uncommon, but important source of infection. United States Special Operations Forces (USSOF) and enablers often operate in TB-endemic countries and, as an inherent risk of their mission sets, are more likely to have high-risk exposure to TB disease. Military medical authorities have provided excellent diagnostic guidance; the Centers for Disease Control and Prevention (CDC) recently updated preferred regimens for the treatment of latent TB infection (LTBI). This review serves as a refresher and update to the management of LTBI in USSOF to optimize medical readiness through targeted testing and short treatment regimens.

Medical Supervision of Illinois Public and Private High School Athletics

ABSTRACT Background High-school sports participation in the United States has increased over the years with a corresponding increase in the number of injuries. Leading medical and sports organizations nationwide advocate for an increase in proper medical supervision of athletes. Objectives To analyze athletic medical coverage in Illinois high schools and compare differences between public and private Illinois high school. Methods A survey addressing various components of sports medical coverage was distributed in 2018 to all 810 Illinois High School Association (IHSA) high schools to be completed electronically. Results The response rate was 50% (407/810 schools). Of the responding schools, 14% were private high schools and 86% public high schools. An orthopedic surgeon, family doctor, pediatrician, or another type of physician were present on sidelines in 9.2% of private high schools and 8.5% of public high schools. Athletic trainers (ATs) were present on sidelines in 91% of private high schools and in 79% of public high schools. There was 68% of private high schools reporting coaches trained in CPR versus 85% in public high schools. Both private and public high schools had high rates of having written emergency action plans (89% vs 91%), AED on site (100% vs 99%), written concussion management protocols (96% vs 97%). Conclusion Our study found similar rates of high school medical coverage as compared to national studies, with some significant differences found between private and public high schools. Most Illinois high schools had high rates of having written EAPs, concussion management protocols and AEDs on site. Overall, an increase of medical supervision and emergency preparedness is needed, which should come in the form of increasing AT and physician presence alongside community and school engagement for improved implementation of coverage.

Length of Stay Beyond Medical Readiness

Length of Stay Beyond Medical Readiness

CAMPS

Field research in archaeology and biological anthropology exists in many different environments, each with implicit hazards to the well-being of the research team. It is considered standard practice for the principal investigator or academic team leader to be responsible for the well-being of the research team. It is not, however, a common requirement that field team leaders have specific training in how to ensure that the team is well prepared to safeguard its medical and psychological well-being during a field season. The most systematic study of health and safety among anthropology field camps was performed in 1986–87 and published in Current Anthropology (Howell 1988, 1990). The three greatest hazards identified (motor vehicle collisions, malaria, and hepatitis) have been mitigated due to a series of engineering and medical advances; however, hazards still abound. The Combined Anthropology Medical Preparation Survey (CAMPS) reassesses the hazards faced during field research in archaeology and biological anthropology and gauges the desire among field researchers for additional training or resources on medical readiness. As a medical needs assessment, it is intended to serve as a foundation for designing a systematic approach for team leaders to protect the well-being of team members before, during, and after fieldwork.

The Military Orthopedics Tracking Injuries and Outcomes Network: A Solution for Improving Musculoskeletal Care in the Military Health System.

Musculoskeletal injuries are an endemic amongst U.S. Military Service Members and significantly strain the Department of Defense's Military Health System. The Military Health System aims to provide Service Members, military retirees, and their families the right care at the right time. The Military Orthopedics Tracking Injuries and Outcomes Network (MOTION) captures the data that can optimize musculoskeletal care within the Military Health System. This report provides MOTION structural framework and highlights how it can be used to optimize musculoskeletal care. MOTION established an internet-based data capture system, the MOTION Musculoskeletal Data Portal. All adult Military Health System patients who undergo orthopedic surgery are eligible for entry into the database. All data are collected as routine standard of care, with patients and orthopedic surgeons inputting validated global and condition-specific patient reported outcomes and operative case data, respectively. Patients have the option to consent to allow their standard of care data to be utilized within an institutional review board approved observational research study. MOTION data can be merged with other existing data systems (e.g., electronic medical record) to develop a comprehensive dataset of relevant information. In pursuit of enhancing musculoskeletal injury patient outcomes MOTION aims to: (1) identify factors which predict favorable outcomes; (2) develop models which inform the surgeon and military commanders if patients are behind, on, or ahead of schedule for their targeted return-to-duty/activity; and (3) develop predictive models to better inform patients and surgeons of the likelihood of a positive outcome for various treatment options to enhance patient counseling and expectation management. This is a protocol article describing the intent and methodology for MOTION; thus, to date, there are no results to report. MOTION was established to capture the data that are necessary to improve military medical readiness and optimize medical resource utilization through the systematic evaluation of short- and long-term musculoskeletal injury patient outcomes. The systematic enhancement of musculoskeletal injury care through data analyses aligns with the National Defense Authorization Act (2017) and Defense Health Agency's Quadruple Aim, which emphasizes optimizing healthcare delivery and Service Member medical readiness. This transformative approach to musculoskeletal care can be applied across disciplines within the Military Health System.

The linkage between medical student readiness for interprofessional learning and interest in community medicine

ObjectivesThe purpose of this study is to investigate the relationship between medical student readiness for interprofessional learning and interest in community medicine prior to incorporating community-oriented interprofessional education into the curriculum. MethodsA questionnaire was administered to students at Nagasaki University School of Medicine in Japan during each of three consecutive years (N=2244). The Readiness for Interprofessional Learning Scale (RIPLS) was administered in addition to a questionnaire to evaluate interest in community medicine. The Kruskal-Wallis and Steel-Dwass tests were used to determine differences between school years. Correlation between the RIPLS score and interest in community medicine was evaluated with Spearman's rank correlation coefficient. Relationships between RIPLS score and demographic parameters, and interest in community medicine were evaluated with multiple linear regression analysis. ResultsEighty-four percent (1891/2244) of students responded. The RIPLS score was highest in school year 1, followed by year 6, year 5, year 3, and years 4 and 2. Interest in community medicine correlated with the RIPLS score (rs = 0.332, p < 0.001), but less in year 1 (rs = 0.125, p = 0.002) than in other years. RIPLS score was significantly associated with gender, age, school year, interest in community medicine, but not the year that the survey was conducted. ConclusionsCommunity-oriented interprofessional education has the potential to improve attitudes towards interprofessional learning. When introducing this promising education into the curriculum from year 1, attracting students' interest in community medicine should be considered.

COVID-19 threat and frontline paediatric care professionals.

COVID-19 threat and frontline paediatric care professionals.

The Role of Dentists in COVID-19 Is Beyond Dentistry: Voluntary Medical Engagements and Future Preparedness.

The emergence of the highly infectious novel coronavirus SARS-CoV-2 has led to a global COVID-19 pandemic. Since the outbreak of COVID-19, worldwide healthcare systems have been severely challenged. The rapid and explosive surge of positive cases has significantly increased the demand for medical care. Herein we provide a perspective on the role dentists can play in voluntary medical assistance and future preparedness for a similar pandemic. Though dentists and physicians have different scopes of practice, their trainings share many similarities. Hence, dental professionals, with their knowledge of basic human science and sterile surgical techniques, are an invaluable resource in the COVID-19 pandemic response. Overall, it is commendable that many dentists have risen to the challenge in the fight against COVID-19. For example, in Singapore, National Dental Centre Singapore (NDCS) deployed dental clinicians as well as volunteers from research laboratories to screen for suspected cases, provide consultations as well as conduct swabbing operations. Dental practice will be considerably changed in the post-COVID-19 era. There is a greater need to have refresher courses for practicing dentists on new infection control strategies. Moreover, the curriculum in dental schools should be expanded to include competencies in pandemic and disaster relief. In addition, voluntary medical work should be made a part of the community dentistry curriculum. This volunteerism will leave a positive impact on developing the careers of young dentists. Hence, the contribution of dentists beyond dental practice in this pandemic situation will be appreciated by future generations.

FINANCIAL, ECONOMIC, ENVIRONMENTAL AND SOCIAL DETERMINANTS FOR UKRAINIAN REGIONS DIFFERENTIATION BY THE VULNERABILITY LEVEL TO COVID-19

Abstract. According to the COVID-19 pandemic, the Ukrainian regions significantly differ in the population’s vulnerability to this infection. Specific patterns (combinations) of factors identify the reasons for regional differentiation of morbidity and mortality from COVID-19. They were accumulated over a long period and formed the so-called «retrospective portraits of the region’s vulnerability to COVID-19» for each region. The main purpose of the study is to define such combinations of financial, economic, environmental and social factors causing many deaths and morbidity from COVID-19 among the population of different Ukrainian regions. The study is based on a constructed spatial nonlinear model. According to the step-by-step algorithm, individual factor variables are gradually added / removed from the model specifications by the Aitken method depending on their correlation with morbidity and mortality from COVID-19 in the region until the model’s specification with the highest adequacy by p-value and t-statistics is formed. The nonlinear multifactorial regression equations regarding the dependence of the resulting indicator (the level of morbidity and mortality of the region from COVID-19) on variables — 23 indicators of social, economic, environmental and financial development of each Ukrainian region and Kyiv are built for the creation of the «retrospective portraits of the region’s vulnerability to COVID-19». Besides, the correlation matrices and correlation pleiades are formed. Based on a correlation matrix, the multicollinearity test is performed using the Farrar — Glauber algorithm. The Durbin — Watson method checks residuals for autocorrelation. The heteroskedasticity test is performed using the Spearman rank correlation test. The empirical analysis results show that migration, population size, the environmental situation in the region, a significant index of medical institutions readiness for qualitative patient care during the pandemic and citizens’ income dynamics mostly affect the incidence of COVID-19 and the number of deaths. The retrospective research results can help create road maps of individual regions to overcome the future epidemiological influence effects. Keywords: COVID-19, epidemiological threats, retrospective portraits of regional vulnerability to COVID-19, step-by-step nonlinear regression, morbidity, regional morbidity differentiation, pandemic, multicollinearity, heteroskedasticity. JEL Classіfіcatіon С21, С51, C 31, C12, I15, I18, R58, R11 Formulas: 17; fig.: 3; tabl.: 2; bibl.: 36.

Geographically based risk assessment of sleep disorders and disease states impacting medical readiness across active duty army installations from military medical databases in fiscal year 2017

BackgroundThe impact of sleep disorders on active duty Soldiers’ medical readiness is clinically significant. Sleep disorders often present high comorbidity with disease states impacting readiness ranging from obesity and drug dependence. Patient data generated from military health databases can be accessed to examine such relationships. The current study performed a risk assessment of sleep disorders, obesity, tobacco use, and substance abuse based on geographical distribution of active duty Army installations through a comprehensive analysis of the Office of the Army Surgeon General Health of the Force report, specifically for Fiscal Year 2017, which summarizes data collected during 2016. MethodsHealth incidences (percent active duty per installation) were queried from the Health of the Force Fiscal Year 2017 (n = 471,000; 85.5% male, >70% between 18 and 34). Nonparametric ranked tests identified active duty Army installations at low risk (green; <25% percentile relative to mean rank), moderate risk (amber; 25%–50% percentile relative to mean rank), and high risk (red; >75% percentile relative to mean rank). Pearson's correlations determined extent of generalized comorbidity of sleep disorders with obesity, tobacco use, and substance abuse across all installations. ResultsLarge combat arms and training installations of the Southern U.S. were at highest risk for sleep disorder. Mean rank comparisons for sleep disorders versus obesity (P = .306), tobacco use (P = .378), and substance abuse (P = .591) did not differ for each installation. There was a high degree of generalized comorbidity of diagnosed sleep disorder with obesity (P < .001; r2 = 0.963), tobacco use (P < .001; r2 = 0.928), and substance abuse (P < .001; r2 = 0.968). ConclusionsThese risk assessments mirror geographical risk data from civilian populations which is surprising because there is a large degree of inter-individual variability in geographical origin, race/ethnicity, and socioeconomic statuses within a single Army installation. Nevertheless, these data demonstrate strong geographical influences on medical readiness in active duty Soldiers comparable to civilian sectors.

Increasing the efficiency of mechanical ventilators during pandemics through additive manufacturing.

The COVID-19 pandemic tested medical facilities’ readiness in terms of the number of available mechanical ventilators. Most countries raced to stock up on ventilators, which created a surge in demand and short in supply. Furthermore, other means of coping with the demand were proposed, such as using additive manufacturing. The purpose of this paper was to test whether the addition of 3D-printed splitters would help deliver required tidal volume to each patient, while supporting four patients on a single ventilator for 24 hours on pressure mode at 25-cm H2O, and to determine whether a fifth patient can be ventilated. The ventilation of four human lungs was simulated using 3D printed parts, a single ventilator, four test-lungs, and standard tubing. Peak pressure, positive end-expiratory pressure, total tidal volume, individual tidal volume, total minute volume, and individual tidal volume data were collected. Usage of a 3D printed small size splitter enabled a 26% increase in individual tidal volume compared to standard tubing and a series of two-way splitters. The ventilator was able to supply the required pressure and tidal volume for 24 hours. A single ventilator with a four-way splitter can ventilate four patients experiencing respiratory failure for at least 24 hours without interruption. The equipment cannot sustain ventilating a fifth patient owing to minute volume limitation. This study expands on an earlier study that tested similar circuitry and reveals that the desired individual tidal volume is achieved. However, further research is required to provide the monitoring ability of individual patient parameters and prevention of cross-contamination.

Progress and Future Directions of the NCAA-DoD Concussion Assessment, Research, and Education (CARE) Consortium and Mind Matters Challenge at the US Service Academies.

Despite the significant impact that concussion has on military service members, significant gaps remain in our understanding of the optimal diagnostic, management, and return to activity/duty criteria to mitigate the consequences of concussion. In response to these significant knowledge gaps, the US Department of Defense (DoD) and the National Collegiate Athletic Association (NCAA) partnered to form the NCAA-DoD Grand Alliance in 2014. The NCAA-DoD CARE Consortium was established with the aim of creating a national multisite research network to study the clinical and neurobiological natural history of concussion in NCAA athletes and military Service Academy cadets and midshipmen. In addition to the data collected for the larger CARE Consortium effort, the service academies have pursued military-specific lines of research relevant to operational and medical readiness associated with concussion. The purpose of this article is to describe the structure of the NCAA-DoD Grand Alliance efforts at the service academies, as well as discuss military-specific research objectives and provide an overview of progress to date. A secondary objective is to discuss the challenges associated with conducting large-scale studies in the Service Academy environment and highlight future directions for concussion research endeavors across the CARE Service Academy sites.

The association between nutrition and behavioural health in a US Army population.

The relationship between nutrition and behavioural health (BH) outcomes has been established in the literature. However, the relationship between nutrition and anxiety is unclear. Furthermore, the relationship between nutrition and BH outcomes has not been examined in a US Army Soldier population. This study sought to understand the relationship between Soldiers' nutritional intake and anxiety as well as depression. This cross-sectional study utilised multivariable logistic regression analyses to examine the relationship between nutritional intake and BH outcomes. The study utilised data collected in 2018 during a BH epidemiological consultation conducted at one Army installation. Participants were 7043 US Army Soldiers at one Army installation. Of the Soldiers completing the survey, 12 % (n 812) screened positive for anxiety and 11 % (n 774) for depression. The adjusted odds of anxiety were significantly higher among Soldiers who reported low fruit intake compared with Soldiers who reported high fruit intake (adjusted OR (AOR) 1·36; 95 % CI 1·04, 1·79). The adjusted odds of depression were higher for Soldiers who reported low fruit intake (AOR 1·35; 95 % CI 1·01, 1·79) and/or low green vegetable intake (AOR 1·37; 95 % CI 1·02, 1·83). Lastly, the adjusted odds of depression were lower for Soldiers who reported low sugary drink intake (AOR 0·62; 95 % CI 0·48, 0·81). This study is the first to examine the important connection between nutritional intake and anxiety and depression at a US military installation. The information learned from this study has implications for enhancing Soldiers' nutritional knowledge and BH, ultimately improving Soldiers' health and medical readiness.

Democratizing Access to Neurosurgical Medical Education: National Efforts in a Medical Student Training Camp During Coronavirus Disease 2019

BackgroundNational medical student surveys amidst the coronavirus disease 2019 (COVID-19)–driven subinternship cancellations have demonstrated the need for supplemental, standardized subspecialty medical education, mentorship, and career planning nationally. We have presented the first live, cross-institutional virtual medical student subspecialty training camp to deliver standardized neurosurgical educational content to medical students during the COVID-19 pandemic, and its results on medical student anxiety and perceptions of neurosurgery.MethodsThe online training camp used a video conferencing platform that was open to all medical students. A post-training camp survey was administered.ResultsA total of 305 medical students registered for the event from 107 unique U.S. medical schools. Of the 305 medical students, 108 reported intending to apply to neurosurgery residency in 2021. The top medical student objectives for the training camp were program networking and mentorship. Of the 305 participants, 121 (39.7%) completed the post-training survey. Of the respondents, 65.0% reported improved neurosurgical knowledge, 79.8% reported decreased anxiety about subinternships and interviews, 82.5% reported increased enthusiasm about neurosurgery, and 100% desired a future annual virtual training camp because of the increased accessibility and decreased cost. This was especially important for students at institutions without home subspecialty programs and those with financial burdens.ConclusionsCOVID-19–driven innovations in medical education have accelerated changes that may have long been necessary. This virtual structure improved resource usage and scalability compared with in-person training, maintained social distancing, and democratized access to standardized, specialized content not often available through traditional medical curricula. Even as a supplement to in-person events, the virtual training camp model could be implemented by national medical societies, which might significantly increase medical students' preparedness for, and education in, neurosurgery and other subspecialties.

11 “Green Means Go”: Creation of a Discharge Checklist Tool for Patients with Bronchiolitis

Abstract Background A consistent and predictable discharge process is difficult to achieve, yet essential for good patient flow, appropriate resourcing, and safe patient care. At our institution, physicians predicted the estimated discharge date (EDD) for patients with bronchiolitis with 70.5% accuracy (January – March 2019). A key driver of this unpredictability is a lack of consensus on “medical discharge readiness” criteria across providers, which also has impacts on communication within the health care team and with patients and families. Objectives 1. To improve the ability to predict discharge date for patients with bronchiolitis by implementing a standardized medical discharge criteria checklist tool for one month (April 2019). 2. To more fully engage nurses in their patients’ care by improving transparency and accuracy of information about discharge. 3. To increase patient and family satisfaction with the discharge process. Design/Methods Meetings with key stakeholders determined drivers of discharge. Data on national practice variation in the management of patients with bronchiolitis was reviewed and informed the creation of a set of medical discharge criteria. Criteria were reviewed and accepted by the Division of Pediatric Medicine and presented to key stakeholders for feedback. Patient inclusion and exclusion criteria were developed. Feedback on the intervention was sought via surveys to physicians, nurses and patients/families. Results There was significant improvement (70.5% to 92.3%) in accuracy of predicting EDD with use of the medical discharge criteria checklist tool. There was also a reduction in length of stay. There were no patient bounce-backs to ED or patient readmissions. There was high satisfaction and support of the checklist tool from nursing and caregivers. Conclusion The development of standardized medical discharge criteria for patients with bronchiolitis is a safe and effective way to improve predictability, transparency, communication and patient flow, while enhancing engagement of the health care team and patient and family satisfaction. Its use is also associated with a reduced length of stay. Future directions include integrating the checklist tool into the electronic health record and moving towards a nurse-facilitated discharge process. Exploring and addressing non-medical barriers to discharge should also be a priority.

Painful Subjects

Painful Subjects

Gynecologic SURGRETE, New Horizons Guyana 2019: An Experience of a Lifetime for Global Health Engagement and Medical Readiness.

Gynecologic SURGRETE, New Horizons Guyana 2019: An Experience of a Lifetime for Global Health Engagement and Medical Readiness.

Fighting acne for the fighting forces.

Acne vulgaris is one of the most common dermatologic diseases, ranging from comedonal or inflammatory papules to large, painful, disfiguring cysts. Numerous treatment approaches are available, each with their own risks and benefits that must be weighed when selecting the best option for an individual patient. Active-duty military servicemembers face additional levels of complexity when pursuing acne therapy. Untreated acne may interfere with their assigned duties, while various therapies also may limit their medical readiness and fitness for duty. We present a review of various acne treatment modalities with a focus on the military population. Additionally, we present a case in which the pulsed dye laser (PDL) was successfully used to treat inflammatory acne in an active-duty servicemember to highlight the use of PDL as an available and effective treatment option for acne in this population.