Military medicine
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Debridement plays a critical role in wound management. In addition to removing necrotic tissue, debridement can eliminate bacteria frequently harbored within the tissue. This study evaluated a novel debridement method that uses plasma-based radiofrequency technology to remove tissue and bacteria. Coblation is a technology that uses radiofrequency energy to excite the electrolytes in a conductive medium, such as saline, to create a precisely focused plasma. This plasma field contains highly energized particles that possess sufficient energy to break tissue molecular bonds, causing the tissue to dissolve at relatively low temperatures (typically 40 °C to 70 °C). ⋯ Reducing MRSA bacterial infection counts, especially of biofilm-associated organisms, in combination with shrapnel may have important clinical implications, especially for the military personnel. Further research into the use of this technology in wound management is warranted.
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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.