Military medicine
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Review
Standardizing Evidence-Based Practice Review Processes Across the Defense Health Agency Enterprise.
The Defense Health Agency (DHA) Campaign Plan identifies Ready Reliable Care (RRC) as one of the eight strategic initiatives. A critical aspect of RRC is standardizing evidence-based practice (EBP) across Military Health System to include training, technology, equipment, and processes. The TriService Nursing Research Program hosted an EBP Summit to address this expectation. ⋯ Strategic recommendations to address the identified gaps are establishing a TriService Clinical Inquiry Working Group for process and product standardization, identifying EBP champions for each DHA market to educate and facilitate EBP review and submission processes, and establishing EBP review forums led by EBP subject matter experts. The authors suggest funding for program development and evaluation.
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Hospital medicine, a specialty encompassing physicians and advanced practice providers in internal medicine, pediatrics, and family medicine, has been a core and rapidly growing component of civilian health care for the past two decades. More recently, hospitalists have been taking on key roles during surge and contingency planning and operations, most notably during the COVID-19 pandemic which necessitated marked changes in inpatient care across the United States. The military health system has been slower to incorporate hospitalists into clinical care and planning than civilian organizations due to its unique features. ⋯ To demonstrate this capability, we present here the experience of two operational units employing hospitalists for high acuity patient management and two civilian hospitals implementing surge operations during the 2022-2023 "tripledemic" of viral respiratory infections in the United States. Their innovations facilitated the care of higher acuity and higher volume during times when medical care requirements were limited by traditional staffing models. We end by reviewing opportunities and challenges related to expanding hospitalist use within the military health system and describing efforts that are underway to address the challenges.
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War has influenced the evolution of global neurosurgery throughout the past century. Armed conflict and mass casualty disasters (MCDs), including Humanitarian Assistance Disaster Relief missions, require military surgeons to innovate to meet extreme demands. However, the military medical apparatus is seldom integrated into the civilian health care sector. Neurosurgeons serving in the military have provided a pragmatic template for global neurosurgeons to emulate in humanitarian disaster responses. In this paper, we explore how wars and MCD have influenced innovations of growing interest in the resource-limited settings of global neurosurgery. ⋯ War and MCDs have catalyzed significant advancements in neurosurgical care both in the pre-hospital and inpatient settings. Most of these innovations originated in the military and subsequently spread to the civilian sector as military neurosurgeons and reservist civilian neurosurgeons returned from the battlefront or other low-resource locations. Military neurosurgeons have utilized their experience in low-resource settings to make volunteer global neurosurgery efforts in LMICs successful. LMICs have, by necessity, responded to challenges arising from resource shortages by developing innovative, context-specific care paradigms and technologies.
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The QSEN Institute developed the quality and safety education for nurses (QSEN) competencies for both undergraduate and graduate-prepared nurses to support their development of the knowledge, skills, and attitudes needed to deliver safe, quality care. The purpose of this scoping review was to (1) determine the extent of evidence about the current use of QSEN competencies in graduate nursing curricula and (2) determine the application of the QSEN competencies among graduate-prepared nurses in clinical practice. ⋯ Although the QSEN competencies were adopted for use in graduate curricula and practice settings, there is a wide variation in the actual use and application with limited reporting of outcomes. The graduate QSEN competencies can be leveraged to equip nurses with the knowledge, skills, and attitudes to address quality and safety challenges in any nursing environment including the operational environment in deployed and austere settings. This review provides recommendations to address gaps in research, graduate nursing education, and clinical practice.
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Randomized Controlled Trial
Randomized Controlled Trial of a Brief Mindfulness-Based Intervention for Suicidal Ideation Among Veterans.
This study was a preliminary evaluation of a manualized, brief mindfulness-based intervention (MB-SI) for veterans with suicidal ideation (SI), admitted into an inpatient psychiatric unit (IPU). ⋯ Mindfulness-based intervention for suicidal ideation is feasible and safe to implement among veterans during an inpatient psychiatric admission with SI, as it is not associated with increased SI or adverse effects. Preliminary evidence suggests that MB-SI increases veterans' propensity to view experiences with curiosity while disengaging from experience without emotional overreaction. Further, more rigorous research is warranted to determine efficacy of MB-SI.