Military medicine
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Service Members and military beneficiaries face complex and ill-structured challenges, including suicide, sexual violence, increasing health care costs, and the evolving coronavirus pandemic. Military and other government practitioners must identify effective programs, policies, and initiatives to preserve the health and ensure the readiness of our Force. Both research and program evaluation are critical to identify interventions best positioned to prevent disease, protect the public's health, and promote health and well-being within our ranks to retain a medically ready force and reduce the global burden of disease. ⋯ These facilitators of successful evaluations can be summarized as: collaboration with engaged stakeholders who understand the value of evaluation, evaluation studies aligned with larger strategic priorities, agile methodology, thoughtful evaluation planning, and effective communication with stakeholders. We wholeheartedly recommend and encourage program evaluation at every opportunity, and we anticipate the call for evaluation and evidence-informed decisions to continually increase. Our hope is that others - to include partners and stakeholders within and external to the military - will be able to leverage and apply this information, especially the identified best practices, in their evaluation efforts to ensure success.
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Maintaining accurate race and ethnicity data among patients of the Veterans Affairs (VA) healthcare system has historically been a challenge. This work expands on previous efforts to optimize race and ethnicity values by combining multiple VA data sources and exploring race- and ethnicity-specific collation algorithms. ⋯ Combining multiple sources to generate race and ethnicity values improves data accuracy among VA patients. Based on the overall agreement with self-reported data, we recommend using non-missing values from sources in the following order to fill in race values-SHEP, CMS, CDW, MedSAS, and VADIR-and in the following order to fill in ethnicity values-SHEP, CDW, MedSAS, VADIR, and CMS.
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Virtual health and secure messaging gained newfound relevance in medicine during the coronavirus disease (COVID)-19 pandemic. For a military trainee health care clinic located on Joint Base San Antonio, the McWethy Troop Medical Clinic (TMC), implementation of virtual health and secure messaging services meant decreased risk of COVID-19 exposure for trainees and clinical staff. ⋯ In defining the challenges, successes, and future implications for virtual health and secure messaging at the McWethy TMC, key lessons emerge for other military trainee clinics. The key concepts explored in this article are virtual health and secure messaging.
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Hepatitis B is a potentially deadly infection that can be acquired by exposure to infectious human blood or body fluids. While service members and others at occupational risk are routinely vaccinated to prevent hepatitis B, non-responders to this vaccine are at continued risk. Heplisav-B is a newer vaccine that may offer additional protection to those at risk. ⋯ Ideally, all service members and other at-risk workers should be protected from hepatitis B. This case series suggests that prior non-responders are likely to gain protection from hepatitis B with Heplisav-B vaccination. A prospective trial is warranted for further evaluation of this potential indication.
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Healthcare organizations across the United States have begun the journey to high reliability as one method for improving patient safety. Being a High Reliability Organization (HRO) requires constant vigilance for ensuring the delivery of system-wide excellence in patient quality and safety. Establishing a foundation for high reliability requires the engagement of personnel across the organization from frontline staff to executive leadership. ⋯ However, we believe this is easier said than done. The purpose of this article is to describe the importance of psychological safety along the journey to becoming an HRO. Additionally, strategies for promoting a psychologically safe work environment are provided.