Military medicine
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The purpose of this quality improvement (QI) project was to evaluate outcomes across Veterans Health Administration (VHA) hospital facilities engaged in an enterprise-wide implementation of a high-reliability organization (HRO) framework. ⋯ The results of this QI project will inform further refinements to VHA's efforts to implement HRO principles and practices in the nation's largest integrated health system. In addition, the implementation practices may inform other large-scale, multi-level efforts to improve quality and patient safety.
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Acute coronary syndrome (ACS) is a rare cause of chest pain in adolescents and young adults. Kawasaki disease (KD) is an uncommon illness, but coronary artery aneurysms secondary to KD are implicated in approximately 5% of cases of ACS in young adults. Patients with KD may present with catastrophic coronary disease at a young age and thus early recognition of this disease process and lifelong follow-up is essential. ⋯ This case demonstrates the importance of screening after a childhood diagnosis of KD, specifically when caring for the tactical athlete. It also highlights the impact that social determinants of health can have on patient outcomes. Finally, it demonstrates the importance of communication and coordination between military and civilian medical centers across the globe driving the care of our deployed injured and ill active-duty military personnel.
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The military employs a wide variety of training paradigms to prepare a ready medical force. Simulation-based training is prominently used in the military for all roles of care to provide the knowledge, skills, and abilities needed to render care from the battlefield to the hospital. The purpose of this scoping review is to synthesize the body of research in military healthcare simulation, highlight trends in the literature, and identify research gaps. ⋯ Participant populations were inclusive of all the services and roles of care, suggesting appropriate representation of the broad military healthcare community. The majority of literature has studied physical simulations, such as manikins or task trainers. Few studies employed augmented or virtual reality as the training intervention, likely because of the nascency of the technology. Trauma care was the focus of 65% of the studies; this is attributable to the criticality of trauma care within battlefield medicine and casualty response. Related to study outcomes, participant reactions, such as usability and user acceptance, and immediate learning outcomes were heavily studied. Retention and behavioral changes were rarely studied and represent a significant research gap. Future research assessing mixed reality technologies would be beneficial to determine whether the technology warrants inclusion in programs of instruction. Finally, studies with outcome measures including long-term knowledge and skills retention, behavioral change, or patient outcomes are strongly recommended for future research.
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To understand the mechanisms of injury and demographic risk factors associated with traumatic brain injury (TBI) patients among active and reserve service members in the U.S. Military before and during the COVID-10 pandemic. ⋯ Military leaders should consider how different causes of injury are associated with differing TBI severities and how certain demographic groups were vulnerable to specific TBI severities when developing injury prevention programs.