U.S. ARMY

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Future of medicine spotlighted at Madigan Research Day

COL (Ret) Diane Scherr

MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- Whether they focused on increasing survival from abdominal injuries or ectopic pregnancies, or reducing opioid use or infections, the best Madigan Army Medical Center research and quality improvement projects got highlighted as residents, fellows and staff members presented their findings at the 22nd Madigan Research Day on May 3.

"Not only is this a powerhouse for graduate medical education and graduate nursing education, but also a powerhouse of advanced levels of research and consideration," said Col. Thomas Bundt, the Madigan commander.

The day-long event kicked off with a keynote presentation by Rear Adm. Mary Riggs, director of Research and Development for the Defense Health Agency. With the ongoing transition of all of military medicine to DHA's command, the agency will eventually oversee the healthcare for almost 10 million patients.

"We will truly be involved in one of the largest healthcare systems in the world," said Riggs. "You're a part of that and we'll need your talents to continue to increase the efforts to make sure that warfighters are better cared for." 

Madigan is already recognized in the research world for a strong focus on precision medicine and battlefield-related trauma, said Col. (Dr.) Richard Burney, chief of Madigan's Department of Clinical Investigation.

Saving more lives downrange is the focus of research by Capt. (Dr.) Dominic Forte, a Madigan general surgery resident who presented his study on how to better control abdominal bleeding from injuries such as blasts or gunshots. 

"It's a leading cause of preventable death on the battlefield and that's why there's such urgency in addressing it, finding the best way to really improve survival with these injuries," said Forte.

While battlefield medicine currently uses a technique called resuscitative endovascular balloon occlusion of the aorta, or REBOA for short, to stop abdominal bleeding by inserting a balloon into the aorta, the downside is that it completely cuts off all blood flow to vital organs like kidneys and intestines.

Forte's research tested multiple prototypes of a partial REBOA, which inflates enough to adequately control bleeding while still allowing some blood to vital organs. His team is already working on the next step to better define the ideal parameters for such a prototype to get it closer to being used in actual patient care.

National health concerns like the opioid crisis were also being addressed by Madigan staff. Capt. (Dr.) Rowan Sheldon, a Madigan general surgery resident, shared his quality improvement project to reduce post-surgery opioid use. His team developed a standard protocol of giving patients 10 opiate tablets as a starting point for home pain management after surgeries, along with Tylenol and ibuprofen to take on a regular schedule to avoid "chasing the pain" with opioids. Patients said they were satisfied with their pain management, and in fact many did not use all of the opioids they were given.

"This was a comprehensive reform of how we do post-operative pain," said Sheldon. He also presented at the event on a study of mobile thermal imaging for the diagnosis of surgical site infections, as there's a noticeable difference between temperature trends of wounds healing normally and those that are infected. The study's goal is to increase early diagnostic certainty of post-surgical site infections.

Groundbreaking accomplishments to the level of pending patents also got some stage time. 

"A real marker of innovation is the successful submission and acceptance of a patent application, and Madigan in March had two patents that were submitted to the U.S. Patent Office … that's very reflective of the innovation that's occurring at the institution," said Bundt, who added that revenue generated by some patents can serve as a source of funding for future research.

One of those potential patent-holders, Lt. Col. (Dr.) Dennis Fujii, also spoke at Research Day. While his pending patent focuses on ways to diagnose diseased fallopian tubes, the reproductive endocrinology and infertility fellow presented another study on healthy fallopian tubes.

"(Embryos) basically spend the first three days developing in the environment of the fallopian tube and so we feel like more knowledge of that environment will help us to gain more insight, will help us with more targeted improvements in our assisted reproductive technologies, and will also offer information about the environment which could potentially impact other processes," said Fujii.

Another REI fellow, Capt. (Dr.) Jessica Lentscher, shared her research (and pending patent) on tests for ectopic pregnancies, which are located outside of the uterus.

"We're trying to see if there is a better diagnostic test to identify where a pregnancy is located in the early stages of pregnancy," said Lentscher, adding that finding the pregnancy location as early as possible is vital to avoid rupture and to treat women earlier. 

She emphasized an appreciation for her patients who took part in the study.

"I'm really appreciative of all of the patients who have consented to be a part of this study, especially given that this situation is most of the time really disappointing and difficult, but these patients are going above and beyond in hoping to further our knowledge in the care of future generations," Lentscher said. "I'm really thankful for that."

U.S. AIR FORCE

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Col (Ret) Pat Chappell

Air Force Medical Service unveils new model for active duty care

July 2019

In an effort to return more Airmen to duty quicker, the Air Force is rolling out a new medical model to restore the overall readiness of our military.

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Under the new Air Force Medical Reform model, dedicated provider care teams will be aligned to an Operational Medical Readiness Squadron primarily focused on proactively treating active duty Airmen and improving their availability to support the warfighting mission. Care for non-active duty patients, primarily the families of service members and military retirees, will be handled by separate provider teams aligned to a Health Care Operations Squadron.

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“This new structure optimizes both functions and allows us to return airmen back to full mission capability as quickly as possible without decrementing care to our beneficiaries,” said Air Force Lt. Col. Robert Corby, chief of Medical Manpower and Personnel, Office of the Air Force Surgeon General. “Restructuring where care is delivered lets our providers focus on each group to improve the quality of care, create efficiencies, and most importantly, get injured or ill Airmen back into the fight more quickly.”

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The model is based on a pilot the 366th Medical Group, Mountain Home Air Force Base, Idaho began in summer 2018. The group reorganized into two squadrons with the goal of returning Airmen to duty as quickly as possible. The pilot initially launched as part a wing-wide initiative for the 366th Fighter Wing. Since the initial rollout, the 366th MDG has seen promising results.

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“We had more than 400 Airmen on the base who were considered “non-mission capable” when we launched in March 2018,” said Air Force Col. Steven Ward, the 366th MDG commander. “In six months, we reduced that number by nearly one-fourth. Our provider teams focused relentlessly on getting Airmen back into the fight.”

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Provider teams were able to holistically treat Airmen instead of waiting for an Airman to seek out care. They visit with Airmen in their duty locations to understand the personal and workplace challenges they face, and partner with unit leaders to proactively manage Airmen’s care and minimize downtime.

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“It was a real culture change for our provider teams, focusing just on Airmen and building relationships with their assigned squadron and leadership,” said Ward. “That narrow focus really helps providers get to know their patients and solve health problems before they can negatively affect the mission.”

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The renewed focus on readiness and returning Airmen to duty goes hand-in-hand with other reform efforts within the Air Force Medical Service and the Military Health System. Corby emphasized cooperation with the Defense Health Agency, as they assume a larger role at Military Treatment Facilities.

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“As we become a more integrated enterprise, it’s very important for us to learn from each other,” said Corby. “The current version of Air Force Medical Reform isn’t final. It will continue to evolve as we roll it out to other locations, and get a better understanding of each Active Duty population’s specific needs.”

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The AFMS plans to initially rollout the new medical organization model to 43 Air Force MTF within the continental United States. Medical centers, hospitals, ambulatory surgical centers, graduate medical education facilities, overseas MTFs, and limited scope facilities will not initially move to the new organizational model. The next phase of Medical Health System reforms will administratively transition the MTFs of all military services to DHA responsibility Oct. 1, 2019.

U.S. NAVY

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CDR (Ret) Susan Tussey

USNS Comfort completes medical mission in Peru

July 2019

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The hospital ship USNS Comfort completed its medical mission in Peru, the second of twelve stops in Central America, South America and the Caribbean during a closing ceremony, July 14.

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During the ceremony in Callao, U.S. and Peruvian military and government officials spoke of the commitment between the partner nations and the symbol of goodwill that Comfort brought to the citizens of Peru.

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“This morning the mission ended with expected success, having seen a great number of patients and provided medical services to the community in general,” said Vice Adm. Manuel Váscones, chief of staff of the Peruvian Navy. “The commitment of cooperation that the governments of the United States and Peru have undertaken only reaffirms the solid bilateral relations that allow the execution of humanitarian efforts like this mission.”

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During Comfort’s five-day mission in Callao, 320 medical professionals of the United States Navy and five partner nations, to include local Peruvian medical professionals, provided care for more than 4,560 patients and performed more than 100 surgeries aboard the ship. In a first side-by-side medical mission with a partner nation, Peru provided concurrent medical care aboard the B.A.P. Tacna.

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“We aren’t only partners, but also friends,” said the honorable Krishna R. Urs, U.S. Ambassador to Peru. “In the last five years the United States Department of Defense, through programs of capability, interchange, counternarcotic activities, peace operations, and humanitarian assistance has cooperated with the Peruvian government to improve the lives of Peru’s people.”

Comfort’s mission is accomplished through the efforts of medical as well as non-medical personnel. The entire Comfort team is comprised of military and civilian personnel from the United States and partner nations including Argentina, Brazil, Canada, Costa Rica, Mexico, and Peru, as well as several non-governmental organizations, creating a dynamic team capable of delivering a variety of services.

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This marks the Comforts’ seventh deployment to the region since 2007. At each of the upcoming stops, the embarked medical teams will provide care aboard the Comfort and at two land-based medical sites, helping to relieve pressure on national medical systems strained partly by an increase in Venezuelan migrants. 

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This deployment is part of the U.S. Southern Command’s Enduring Promise initiative and reflects the United States’ ongoing commitment to friendship, partnership, and solidarity with partner nations in the Caribbean, Central America and South America.

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U.S. PUBLIC HEALTH

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CAPT (Ret) Angela Martinelli

July 2019

The U.S. Public Health Service Commissioned Corps is an elite team of more than 6,000 well-trained, highly qualified public health professionals dedicated to delivering the nation's public health promotion and disease prevention programs and advancing public health science. Driven by a passion for public service, these men and women serve on the frontlines in the nation's fight against disease and poor health conditions. As one of America's seven uniformed services, the Commissioned Corps fills essential public health leadership and service roles within the nation's federal government agencies and programs.

The mission of the U.S. Public Health Service Commissioned Corps is to protect, promote, and advance the health and safety of our Nation. The Commissioned Corps achieves its mission through:

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• Rapid and effective response to public health needs

• Leadership and excellence in public health practices

• Advancement of public health science

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The Commissioned Corps emergency response teams are trained and equipped to respond to public health crises and national emergencies such as natural disasters, disease outbreaks, or terrorist attacks, both here and overseas. Officers have responded to emergencies such as the Ebola response in West Africa, Hurricane Katrina, the earthquake in Haiti, and the Deepwater Horizon oil spill.