Medical Treatment Facilities Research Articles

Medical Intelligence Team Lessons Learned: Early Activation and Knowledge Product Development Mitigate COVID-19 Threats.

Leadership during the emergence of the novel coronavirus pandemic is complex and involves coordinated efforts between multiple levels of leadership from the medical, installation, local, state, and federal levels. Medical intelligence is critical to successful pandemic threat mitigation. We describe one of the first coronavirus (Coronavirus Disease-2019 (COVID-19)) impacted Department of Defense Medical Treatment Facility's strategic activation of a COVID-19 Medical Intelligence Team (MIT), the products developed, and lessons learned during the pandemic onset. The MIT bridged COVID-19 knowledge and policy gaps by developing and delivering daily intelligence briefings on four domains: epidemiology and infectious disease, healthcare capabilities and infrastructure, policy and regulations, and diagnostics and therapeutic interventions. Twenty-three products were developed and delivered to aid in leadership decision-making and local policy development in the absence of higher-level policy and guidance. Employing MITs in future pandemic response strategy may more effectively mitigate pandemic threats and improve force health protection.

Oral Appliances for OSA Treatment: Meeting the Quadruple Aim.

In order to better treat obstructive sleep apnea (OSA) in a more efficient and cost-effective way, a joint program between dental clinics and the sleep medicine clinic was piloted at Fort Hood, Texas. Obstructive sleep apnea negatively affects soldier readiness and deployability, leading to the need to establish a successful and proven workflow to treat these patients with oral appliance therapy (OAT). We performed a retrospective review of a de-identified data set which included 288 patients from July 2016 to July 2020. Projected cost data were obtained from routinely collected sleep clinic positive airway pressure (PAP) data. Data were analyzed to determine treatment success and potential cost savings using OAT versus continuous positive airway pressure (CPAP). Patient workflow including successes and challenges with the program is summarized. About 85.5% of patients met criteria for successful control of their OSA using OAT as treatment. Five patients did not tolerate OAT and switched back to CPAP. A higher (less severe) O2 nadir on diagnostic polysomnography is moderately correlated with OAT success. Diagnostic Apnea-Hypopnea Index was inversely and weakly correlated with success. Two of the major challenges noted in the program were (1) loss of follow-up and (2) the length of time from oral appliance referral to fitting the oral appliance. If this program was successfully implemented at other Defense Health Agency (DHA) medical treatment facility (MTF) markets nationwide, a potential cost savings of over $500,000/year/MTF could be achieved. Oral appliance therapy has the potential to increase both readiness and deployability for active duty soldiers. Using baseline O2 nadir can help predict success with OAT patients, determining which patients will benefit from this joint program between the dental and medical sleep clinics. Future studies can aim to establish an evidence-based pathway for clinic testing and follow-up. If this patient workflow is implemented properly, there can be significant cost savings army-wide. This all helps The United States Medical Command (MEDCOM) align with the DHA's Quadruple Aim of increased readiness, better health, better care, and lower cost.

Patient Perceptions of Drive-through Medical Treatment Facilities During the COVID-19 Pandemic.

IntroductionThe cumulative burden of coronavirus disease 2019 (COVID-19) on the United States’ healthcare system is substantial. To help mitigate this burden, novel solutions including telehealth and dedicated screening facilities have been used. However, there is limited data on the efficacy of such models and none assessing patient comfort levels with these changes in healthcare delivery. The aim of our study was to evaluate patients’ perceptions of a drive-through medical treatment system in the setting of the COVID-19 pandemic.MethodPatients presenting to a drive-through COVID-19 medical treatment facility were surveyed about their experience following their visit. An anonymous questionnaire consisting of five questions, using a five-point Likert scale was distributed via electronic tablet.ResultsWe obtained 827 responses over two months. Three quarters of respondents believed care received was similar to that in a traditional emergency department (ED). Overall positive impression of the drive-through was 86.6%, and 95% believed that it was more convenient.ConclusionOverall, the drive-through medical system was perceived as more convenient than the ED and was viewed as a positive experience. While representing a dramatic change in the delivery model of medical care, if such systems can provide comparable levels of care, they may be a viable option for sustained and surge healthcare delivery.

Head Face and Neck Surgical Workload From a Contemporary Military Role 3 Medical Treatment Facility.

Previous analyses of head, face, and neck (HFN) surgery in the deployed military setting have focused on the treatment of injuries using trauma databases. Little has been written on the burden of disease and the requirement for follow-up care. The aim of this analysis was to provide the most comprehensive overview of surgical workload in a contemporary role 3 MTF to facilitate future planning. The operating room database and specialty surgical logbooks from a U.S.-led role 3 MTF in Afghanistan were analyzed over a 5-year period (2016-2020). These were then matched to the deployed surgical TC2 database to identify reasons for treatment and a return to theatre rate. Operative records were finally matched to the deployed Armed Forces Health Longitudinal Technology Application-Theater outpatient database to determine follow up frequency. During this period, surgical treatment to the HFN represented 389/1989 (19.6%) of all operations performed. Surgery to the HFN was most commonly performed for battle injury (299/385, 77.6%) followed by disease (63/385, 16%). The incidence of battle injury-related HFN cases varied markedly across each year, with 117/299 (39.1%) being treated in the three summer months (June to August). The burden of disease, particularly to the facial region, remained constant throughout the period analyzed (mean of 1 case per month). Medical planning of the surgical requirements to treat HFN pathology is primarily focused on battle injury of coalition service personnel. This analysis has demonstrated that the treatment of disease represented 16% of all HFN surgical activities. The presence of multiple HFN sub-specialty surgeons prevented the requirement for multiple aeromedical evacuations of coalition service personnel which may have affected mission effectiveness as well as incurring a large financial burden. The very low volume of surgical activity demonstrated during certain periods of this analysis may have implications for the maintenance of surgical competencies for subspecialty surgeons.

Analysis of Problems Facing to Transgender in the World

The study was carried out since June, 2021. The major objective was to analyze problems facing to transgender in the world. Secondary data and primary data were used. Total 19 articles were downloaded from the net and also different program of the transgender were participated for finding the problems facing to transgender in the world. The review indicates that transgender are facing multiple problems in society. In majority countries they have not issues the National identity card because of this they do not apply for job and have no right for casting the vote in national election and their power is less than the other gender. The parents mostly kick out from the home due to shame in different area of the world. Mostly they live in hotel or in group where other transgender are also present which have also kicked out form their homes. They have no source of income to purchase food for survival of life. So they learn the dance and participated in marriage ceremony and earn the money where sexual harassment problems face to them and sometime the people raped them and kill them. They have no right in the land of parent to lack of national identity card. No medical treatment facilities are available to them. They never avail the facilities of the schooling. Majority transgender face the problem of the AIDs due to sexual harassment in the world. Now a day in some countries of the world rights have been approved by the national assembly. In recent days 15 driving licensees and national identity cards were issued to transgender in Pakistan but still the work is delay for actual operation. Similarly in US 63% population give votes for transgender rights while in all the world transgender are in the problem. In the world majority transgender are poor and below the poverty line. They are teases everywhere in the world but they protest while governments mostly do not give the due rights to them. The parents feel shame when they live there. Anywhere they live in the world people beating and kill them. So, still no country of the world gives due right to them. The number in the world is less and they have no member in the national and provincial assembly, which raise hand for them. So the discussions explain that transgender face the great problem in the world and need the help. They are the creature of God and they have equal right in the world society. Many conferences in the world were arranged for transgender problems solution while still their problems were not solved. On the basis of problems the study recommend that to help at world level of the transgender community and consider them as human being while do not classify them and treated as other human being of the world; Provide special quota to transgender in jobs in the world; Different programs should be launched for their economy uplifting; Give special security to them in the world; Give sustenance, self esteem and freedom servitude to them; Never rape and harass to them; UNO should arranged conferences for their problem solution in the world.

High prevalence and intensity of fish nematodes with zoonotic potential in the Brazilian Amazon, including a brief reflection on the absence of human infections

This study aimed to characterize the prevalence, mean abundance, and mean intensity of potential fish-borne zoonotic nematode larvae infecting the predator fish Hoplias aff. malabaricus from the Tapajós River, in the municipality of Santarém, in the Brazilian Amazon. After capture, the specimens of H. aff. malabaricus were analyzed for infection by Contracaecum sp. and Eustrongylides sp. third-stage larvae, and the prevalence, mean abundance, and mean intensity were calculated. A literature search was carried out to clarify the relationship between these indicators and eventual human cases of infection in the Amazon region. Third-stage larvae of nematodes of the Contracaecum and Eustrongylides genera were found in the specimens of H. aff. malabaricus sampled from the Tapajós River. The prevalence of Contracaecum larvae was 100%, while its mean abundance and mean intensity were both 54.8 larvae/fish. The prevalence of Eustrongylides larvae was 62.9%, and its mean abundance and mean intensity were 1.8 and 2.8 larvae/fish, respectively. Despite the high prevalence and intensity values, there are no cases of human infection by these nematode larvae in the Brazilian Amazon reported. The absence of human infections by these nematode larvae in the Brazilian Amazon despite the high prevalence/intensity of Contracaecum and Eustrongylides larvae and the high consumption of fish in the region, is most probably due to the fact that the local populations do not eat raw or undercooked fish. However, it is noteworthy that the absence of zoonotic cases in the region is based only on the examination of the available published papers. A better knowledge of the situation would require surveying hospitals and clinics, and data from the region’s medical treatment facilities. However, the authors consider that cases of human infection, if any, are extremely rare, mainly due to the eating habits of the local population. KEY WORDS: Amazon basin; freshwater fish; public health; parasitic infection; zoonosis.

Characterisation of retained energised fragments from explosive devices in military personnel

IntroductionCharacterising the shapes, dimensions and overall numbers of fragments produced by explosive devices is important for determining methods of potential mitigation, such as personal armour. The aim of this investigation...

Respiratory Viral Pathogens Among U.S. Military Personnel at a Medical Treatment Facility in Hawaii From 2014 to 2019.

Acute respiratory diseases account for a substantial number of outpatient visits and hospitalizations among U.S. military personnel, significantly affecting mission readiness and military operations. We conducted a retrospective analysis of respiratory viral pathogen (RVP) samples collected from U.S. military personnel stationed in Hawaii and tested at Tripler Army Medical Center from January 2014 to May 2019 in order to describe the etiology, distribution, and seasonality of RVP exposure in a military population. Samples were analyzed by viral culture or multiplex PCR. Distribution of respiratory viruses over time was analyzed as well as subject demographic and encounter data. Presenting signs and symptoms were evaluated with each RVP. A total of 2,576 military personnel were tested, of which 726 (28.2%) were positive for one or more RVP. Among positive tests, the three most common viral pathogens detected were influenza A (43.0%), rhinovirus (24.5%), and parainfluenza (7.6%). Symptoms were generally mild and most frequently included cough, fever, and body aches. Our study evaluated respiratory virus prevalence, seasonality, and association with clinical symptoms for military personnel in an urban tropical setting in Oahu, HI, over a 5-year period. We show that viral prevalence and seasonality in Hawaii are distinct from those of the CONUS. Results contribute to the broader understanding of seasonality, clinical manifestation, and demographics of RVP among active duty military personnel stationed in Hawaii.

Review of a Role 2 in Afghanistan: Understanding the Data on Medical and Surgical Volumes in a Deployed Setting.

The U.S. forward military surgical assets have deployed throughout the Iraq and Afghanistan theaters of operations to maintain surgical support for injured service members in compliance with the "golden hour" as specified in the Gates Memorandum. The support of evacuation times of less than 60 minutes to a surgical capability has resulted in smaller surgical teams being deployed to an increased number of locations. Over the last 5 years, the combat trauma patient encounters have decreased. Although some Role2 medical treatment facilities (MTFs) maintain a medical mission, most of them are set up to provide trauma care. The largest and busiest Role2 MTF is located near Kabul and serves the NATO population. The aims of this review are to examine the epidemiological data of the largest Role2 MTF in theater, to examine damage control surgical capability optimization in a facility with a largely medical mission, and to analyze what this may mean in the context of surgical skill atrophy. As part of a performance improvement project, a retrospective review of prospectively collected data at the Hamid Karzai NATO Role2 MTF was conducted. Four years of clinical and epidemiological data were reviewed. Independent source verification of the records was conducted by validating records via comparison to the ancillary services' records. When available, data on other MTFs in Afghanistan were used for comparison. Descriptive statistics were used to analyze demographics, evacuations, surgeries, and admissions. Over the studied period, 0.7% of patients were seen for battle injuries. The average number of patients seen was 636 per month with 184 per month in 2016 and a steady increase to 805 per month in 2019. The operative volume was a mean of 2.8 surgeries per month with a median of 2 surgeries per month (orthopedic and general surgery combined). Other Role2 facilities were on average seeing even fewer operative patients, although there were some treating more operative patients. From available data, no other Role2 MTFs were treating close to as many total patients (all types combined). The two Role3 facilities evaluated saw significantly more operative patients at an average of 53 surgeries per month. The ratio of operative cases per surgeon is substantially higher at these Role3 facilities, when compared to Role2 facilities, although still significantly lower than would be expected at an U.S. Level 1 trauma center. This is consistent with other larger epidemiological studies on forward MTF workload. The vast majority of patient care is related to treatment of disease and preventative medicine. Only 0.7% of the large volume of patient visits evaluated were for battle injuries. There is a scarcity of both surgical and trauma patients, with a more pronounced reduction at Role2 compared to Role3 facilities. This is especially evident here with a facility that has such a large patient population but low trauma or surgical patient volume. Sustaining trauma and surgical skills for both surgeons and trauma teams with a paucity of trauma patients is a significant concern.

10-years follow-up of patients with stomach cancer - diagnostic defects & dyspepsia as the earliest “alarm symptom”; results of the ”RADIUS” program (“early diagnosis of stomach cancer in dyspepsia”)

In 2019, a retrospective analysis of medical records for 10 previous years (2019-2009) was conducted for 426 patients with confirmed malignant neoplasm (MN) of the stomach registered in 125 outpatient and polyclinic medical and preventive treatment facilities in 12 cities of the Russian Federation. The average age of patients at the time of diagnosis was 61.9 years, the life expectancy after diagnosis being 2.2 years. In 67.4% of patients the diagnosis was made at stages III and IV of the disease. All patients had a history of any upper digestive tract pathology. The record of H. pylori c examination was detected in 16.9% of patients, all of them with positive results. In 64,3% of esophagogastroduodenoscopy (EGDS) protocols there were visible changes in the gastric mucosa. Dynamic EGDS control was performed irregularly. During the whole period of observation, an average of 2.5 biopsies per patient were taken during EGDS. In the clinical diagnosis of “chronic gastritis” morphological examination was performed in 70.0% of patients. Classical “warning signs” were registered on the average 2.4 years before the diagnosis of gastric cancer. Dyspepsia syndrome was registered 4.6 years before cancer verification. The correlation between dyspepsia and the timing of cancer diagnosis was confirmed. Thus, the dyspepsia syndrome can be categorized as “early warning signs”. For the diagnosis of gastric adenocarcinoma, 3D correlation analysis showed a correlation between the number of biopsy samples taken, the number of “warning signs” and the number of years lived after the diagnosis of malignant neoplasms.

Characteristics of burn casualties treated at role 2 in Afghanistan.

Role 2 medical treatment facilities (MTFs) are frequently located in austere settings and have limited resources. A dedicated assessment of burn casualties treated at this level of care has not been performed. Therefore, the objective of this study was to characterize burn casualties presenting to role 2 MTFs in Afghanistan, along with the procedures they required, complications, and mortality to begin understanding the resources consumed by their care. We identified burn casualties from the Department of Defense Trauma Registry (DODTR). The inclusion criteria were (1) experienced burn injuries in Afghanistan between October 2005 and April 2018 and (2) had documentation of treatment at role 2 in the DODTR. We excluded casualties with only first-degree burns, not otherwise specified burns, or only corneal burns. Casualty demographics, injury characteristics, procedures, and outcomes were reported. We identified 453 burn casualties with a median (interquartile range) Injury Severity Score of 10 (4-22) and percent total body surface area burned of 11 (5-30). There were 123 casualties (27.2%) with inhalation injury, and the casualties experienced 3,343 additional traumatic injuries and needed 2,530 procedures. Casualties with documentation of resuscitation information received a median (interquartile range) of 1.9 (0.7-3.7) L of crystalloid fluids. Complications were documented in 53 casualties (11.7%). Final mortality was reported in 36 casualties (8.0%), and mortality at role 2 MTFs was reported in 7 casualties (1.5%). Burn casualties had many injuries and needed many procedures, including those related to airway management, resuscitation, and wound care. Given the urgency of these procedures, ensuring that there is enough equipment and supplies will be important in the future. Although infrequent, some casualties experienced complications. Factors that may influence resuscitation include injury severity, concomitant traumatic injuries, and available supplies. Obtaining more contextual information on the patient care environment will be useful going forward. Epidemiological, level III.

Challenges, Strategies, and Recommendations for the Huge Surge in Plastic and Medical Waste during the Global COVID-19 Pandemic with Circular Economy Approach

After December 2019, the globe was affected by a new coronavirus (SARS-CoV-2) that causes severe respiratory illnesses, which is responsible for increasing environmental problem consequences related to the extra consumption of medical waste and single-use plastics (such as personal protective equipment (PPE) and packaging plastics). Although the consumption of these plastics protects our life during this crisis, it is pivotal to move toward plastic recycling processes and environmentally friendly and sustainable alternatives, like bio-based degradable plastics with a circular economy perspective. This review article collected scattered information and provided a future perspective on how worldwide COVID-19 disruption can perform as a catalyst to improve plastic and medical waste management. Additionally, this paper illustrates the most effective disinfection technologies for COVID-19 wastes, such as high/low heat technologies and chemical disinfection, and PPE reusing processes, including dry heat, vaporized hydrogen peroxide, ozone, and UV light during the outbreak. In this vein, medical waste treatment facilities must be more automatic, with a minimum of personnel involved. Moreover, some recent valid guidelines from different international organizations and countries, future outlook, and practical recommendations that could be effective during this epidemic or even in the post-pandemic world for plastic and medical waste management were provided. Ultimately, governments should improve their waste management because of the potential of pathogen transmission or increased plastic and medical waste generation and try to enhance the environmental knowledge of society. People also should revise their viewpoints on plastic consumption by elevating sustainable behaviors, abandoning old habits, and adjusting to novel ones.

A Need to Revise Human Exposure Limits for Ultraviolet UV-C Radiation†.

The COVID‐19 pandemic has greatly heightened interest in ultraviolet germicidal irradiation (UVGI) as an important intervention strategy to disinfect air in medical treatment facilities and public indoor spaces. However, a major drawback of UVGI is the challenge posed by assuring safe installation of potentially hazardous short‐wavelength (UV‐C) ultraviolet lamps. Questions have arisen regarding what appear to be unusually conservative exposure limit values in the UV‐C spectral band between 180 and 280 nm. We review the bases for the current limits and proposes some adjustments that would provide separate limits for the eye and the skin at wavelengths less than 300 nm and to increase both skin and eye limits in the UV‐C below 250 nm.

Triage Decisions in the Context of COVID-19: Old Burden, New Challenge-The Structured Approach for Intensive Care Unit Triage (SAINT) Protocol.

ABSTRACTIntroductionThe medical treatment facilities (MTF) represent the equivalent of the healthcare system in the home countries, but they face the limitations of an outpost at the end of the supply chain. The capabilities are limited, and the necessary effort to extend the treatment capacity is tremendous. Algorithms based on scientific evidence or at least profound medical expertise are a tool to facilitate the decision-making process in triage under difficult circumstances. The aim of this article is to present a protocol that regards the specific entities military MTF abroad have to deal with in context of the COVID-19 pandemic.Material and MethodsTo prepare our own health system within the Resolute Support mission, an interdisciplinary team of consultants and nurses located at the multinational role 2E, Camp Marmal, Mazar-e-Sharif, Afghanistan, individually reviewed medical databases and the current literature concerning triage on intensive care units. The identified literature was evaluated by all authors. In the next step, an adapted flow chart for triage on intensive care unit in MTF abroad was set up on the basis of existing triage tools found in the reviewed literature.ResultsThe authors created the “Structured Approach for Intensive Care Unit Triage (SAINT)” protocol. It is an approach that fits to the specific entities (e.g., limited medical resources in the whole system, limited intensive care unit capabilities for long-term stay or organ replacement therapy, etc.) that determine the framework of the special military health system abroad.ConclusionsThe presented triage protocol may be a tool for medical personnel to facilitate the difficult task of triaging. It provides guidance along patient-centered criteria like individual medical, ethical, and legal issues while taking into account the available resources. Future studies are needed to investigate the effectiveness of the SAINT protocol.

The Impact of Graduate Medical Education on Scholarly Activity at a Military Medical Treatment Facility.

Graduate medical education (GME) faculty and trainees have required scholarly activities to meet accreditation requirements. The impact of this contribution to the Military Health System, especially regarding innovations in military medicine, has not been previously examined. This study measured the contribution of GME in published manuscripts from a tertiary military medical center. Utilizing the Scopus database, published manuscripts from the primary military GME institutions for the San Antonio Uniformed Services Health Education Consortium were identified from 2008 to 2018. Manuscripts were sorted based on the number of citations in Scopus and analyzed for their overall impact in medicine to include military unique topics. A total of 3,700 manuscripts were identified through Scopus and based on a 10 citation minimum, 1,365 manuscripts were further analyzed; 1,152 (84.4%) included authors with GME affiliation and 554 (40.6%) had direct applicability to unique aspects of military medicine. The mean number of citations per manuscript was 39.2 ± 63.6; Mean Cite Score was 2.97 ± 2.14 and Field Weighted Citation Index of 2.22 ± 3.27. Analysis of number of citations (10-19; 20-39; or >40) did not show any significant differences in Cite Score or military relevance, whereas the percentage of military relevant articles remained consistent yearly. These findings highlight the importance of military medical research and addressing specific medical needs of the warfighter. Graduate medical education in a tertiary Military Health System facility has enormous impact in scholarly activity, in particular the importance related to military medicine topics that emphasize combat casualty care and military readiness.

Treating osteoarticular infections in a Role 2 in Chad: a bacterial epidemiological study

IntroductionThe treatment of osteoarticular infections in Africa is a medical and surgical challenge due to the difficulties in managing antibiotic therapy after the surgical procedure. The objectives of this study...

Research on The Production of Social Space in National Tourism Community Which Depends on Computer Technology

The “community” ethnic tourism in minority areas of rich and colorful tourism landscape, refreshing air environment, health and safety of food, such as connotation rich ecological culture as the main resources and the backing, equipped with corresponding health medical treatment, sports and leisure facilities, yangxin, adjustment function to cultivate one’s morality, anti-aging, for the purpose of tourism, vacation, spa, health care, pension and other activities. It is the minority cultural heritage of forestry areas a new mode of health industry, new forms and new ideas, not only conforms to the acquisition of general secretary of promoting overall economic reform, optimize the industrial structure, foster new forms, new business model’s important speech spirit, but also for expanding domestic demand, increase employment, economy is a new important growth point.

Facing COVID-19: Early Recognition and Triage Tool for Medical Treatment Facilities With Limited Resources.

ABSTRACTIntroductionCoronavirus Disease 2019 (COVID-19) is spreading all over the world. Health systems around the globe have to deal with decreased capabilities and exhausted resources because of the surge of patients. The need to identify COVID-19 patients to achieve a timely opportunity to treat and isolate them is an ongoing challenge for health care professionals everywhere. A lack of testing capabilities forces clinicians to make the crucial initial decision on the basis of clinical findings and routine diagnostic laboratory test. This article reviews the current literature and presents a new adapted protocol for diagnosing and triaging COVID-19 patients. A special emphasis lies on the stepwise approach guiding the medical provider to a triage decision that is suitable for the individual patient and the situation of the local medical treatment facility.Materials and MethodsOn March 30, 2020, a PubMed based literature research on COVID-19 following the preferred reporting items for systematic reviews and meta-analyses guidelines was performed. A diagnostic and triage tool for COVID-19 was designed based on the major findings in the reviewed literature.ResultsAfter a selection process, focusing on the topics “epidemiology,” “clinical characteristics,” and “diagnostic tools,” 119 out of a total amount of 1,241 publications were selected to get an overview of the growing evidence.ConclusionsThe designed Early Recognition and Triage Tool enables the medical provider to use the applicable modules of the protocol for capabilities of the local setting to get the most appropriate diagnostic and triage done. The tool should give guidance for the initial approach until specific testing for the COVID-19 virus is available.

Clinical Readiness Program: Refocusing the Military Health System

The Military Health System serves to globally provide health services and trained medical forces. Military providers possess variable levels of deployment preparedness. The aim of the Clinical Readiness Program is to develop and assess the knowledge, skills, and abilities (KSAs) needed for combat casualty care. The Clinical Readiness Program developed a KSA metric for general and orthopedic surgery. The KSA methodology underwent a proof of concept in six medical treatment facilities. The KSA metric feasibly quantifies the combat relevance of surgical practice. Orthopedic surgeons are more likely than general surgeons to meet the threshold. Medical treatment facilities do not provide enough demand for general surgery services to achieve readiness. The Clinical Readiness Program identifies imbalances between the health care delivery and readiness missions. To close the readiness gap, the Military Health System needs to recapture high KSA value procedures, expand access to care, and/or partner with civilian institutions.

Objective Dual-Task Turning Measures for Return-to-Duty Assessment After Mild Traumatic Brain Injury: The ReTURN Study Protocol

Determining readiness for duty after mild traumatic brain injury (mTBI) is essential for the safety of service members and their unit. Currently, these decisions are primarily based on self-reported symptoms, objective measures that assess a single system, or standardized physical or cognitive tests that may be insensitive or lack ecological validity for warrior tasks. While significant technological advancements have been made in a variety of assessments of these individual systems, assessments of isolated tasks are neither diagnostically accurate nor representative of the demands imposed by daily life and military activities. Emerging evidence suggests that complex tasks, such as dual-task paradigms or turning, have utility in probing functional deficits after mTBI. Objective measures from turning tasks in single- or dual-task conditions, therefore, may be highly valuable for clinical assessments and return-to-duty decisions after mTBI. The goals of this study are to assess the diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation of objective, dual-task turning measures within an mTBI population. These goals will be accomplished over two phases. Phase 1 will enroll civilians at three sites and active-duty service members at one site to examine the diagnostic accuracy and predictive capacity of dual-task turning outcomes. Phase 1 participants will complete a series of turning tasks while wearing inertial sensors and a battery of clinical questionnaires, neurocognitive testing, and standard clinical assessments of function. Phase 2 will enroll active-duty service members referred for rehabilitation from two military medical treatment facilities to investigate the responsiveness to rehabilitation of objective dual-task turning measures. Phase 2 participants will complete two assessments of turning while wearing inertial sensors: a baseline assessment prior to the first rehabilitation session and a post-rehabilitation assessment after the physical therapist determines the participant has completed his/her rehabilitation course. A variable selection procedure will then be implemented to determine the best task and outcome measure for return-to-duty decisions based on diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation. Overall, the results of this study will provide guidance and potential new tools for clinical decisions in individuals with mTBI.Clinical Trial Registration: clinicaltrials.gov, Identifier NCT03892291.