Military medicine
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Retaining lessons learned from Critical Care Air Transport (CCAT) missions is essential given the recent decrease in operational currency among CCAT personnel. The objective of this case series was to identify and analyze logistical lessons learned from recent critical care transports involving foreign medical treatment facilities with sufficient detail for the CCAT community to incorporate these lessons into future readiness and sustainment training. The provider from each mission submitted a mission narrative with lessons learned. ⋯ Post-mission lessons learned included the need for written communication to disseminate information to the CCAT community. This case series described logistical challenges that present during transport missions involving foreign hospitals. This published series will enable dissemination to the en route care community for possible incorporation into future training.
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The Military Health System (MHS) overhauled its previous Electronic Health Records (EHRs) system. The MHS is in need of modernizing its healthcare system to improve patient safety and coordination of care between the MHS and Veterans Affairs. In 2015, the DoD awarded Cerner, Leidos, and Accenture a $4.3 billion EHR contract for a commercialized off-the-shelf system model to be used by more than 146,000 end users. This exploratory case study looked to access socio-technical barriers and facilitators to EHR implementation specifically in the military. ⋯ This research identified three strategic recommendations for the MHS to consider: hire clinical informaticists, parallel EHR implementation, and enhance EHR training. This research also informed a Socio-Technical Leadership Framework for EHR Implementation to guide MHS leaders during health information technology implementation. Although significant health information technology changes may occur only once every few years, having issues during implementation impacts mission success, overall threatening the vital role that the MHS provides to national defense.
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Traumatic brain injury (TBI) is a significant health issue among deployed and non-deployed U.S. military service members (SMs). Since 2000, an estimated 413,858 SMs have been diagnosed with at least one TBI. Due to the difficulty in distinguishing new incident TBIs from follow-up TBI-related medical encounters in the Military Health System (MHS), the official TBI case definition also includes an incidence rule considering an individual an incident case only once per lifetime. We sought to examine patterns in medical records of SMs with at least one TBI encounter, in an effort to identify repeat TBIs in individual SMs and to estimate the incidence of repeat TBIs within the study cohort as a whole. ⋯ Probability scores based on statistical modeling can provide reasonable estimates of repeat incidences of TBI using medical billing data when formerly only the first TBI was thought to be measurable. With 100% sensitivity and 69% specificity, application of these models can inform estimates of repeat TBI across the MHS. This effort shows initial success if estimating repeat TBI, and further modeling work is encouraged to increase the predictive characteristics of the models as these efforts show promise in estimating repeat TBI across the MHS.
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External hemorrhage control devices (EHCDs) are effective in reducing the death risk of noncompressible torso hemorrhage (NCTH), but the pressurized area is too large to prevent serious organ damage. This study aims to establish the surface localization strategy of EHCDs based on the anatomical features of NCTH-related arteries through CT images to facilitate the optimal design and application of EHCDs. ⋯ The arterial localization strategy established via anatomical investigation was consistent with the actual situation. The data are necessary for improving EHCD design, precise hemostasis, and EHCD-related collateral injuries.Trial registration: Ratification no. 2019092. Registered November 4, 2020-retrospectively registered, www.chictr.org.cn.