Situational Awareness: Forecasting Successful Military Medical Teams

ABSTRACT Introduction Military healthcare providers working in military interprofessional healthcare teams (MIHTs) require situational awareness (SA) to ensure safe and efficacious patient care. This study aimed to explore SA in MIHTs to understand how SA can be reinforced and maintained in MIHTs. The research team set out to answer two questions: “What aspects of individual and team SA are particularly important for MIHTs?” and “How can we enable military healthcare providers to be effective MIHTs members with robust SA?”. Methods This study used Grounded Theory methodology collecting perspectives from 30 study participants from various backgrounds, including 11 different healthcare professions from the U.S. Army, Air Force, and Navy. Each study participant had experiences participating in, leading one, or leading many MIHTs. Data were collected in three cycles and analyzed within each cycle until saturation was reached. Results Five themes were robustly represented in the data set regarding SA: (1) contextually informed adaptability, (2) readiness, (3) trust, (4) communication, and (5) mission focus. Conclusions The urgency often faced by MIHTs brings SA and the principles that underpin SA into sharper focus. The SA themes identified in this research may provide insight into training effectiveness, team strengths and weaknesses, and team performance.

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Delivering patient care during large-scale emergency situations: Lessons from military care providers

PLoS ONE ◽

10.1371/journal.pone.0248286 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248286

Author(s):

Lara Varpio ◽

Karlen Bader-Larsen ◽

Meghan Hamwey ◽

Steven Durning ◽

Holly Meyer ◽

...

Keyword(s):

Military Service ◽

Large Scale ◽

Situational Awareness ◽

Home Front ◽

Theory Approach ◽

Care Providers ◽

Emergency Situations ◽

Military Healthcare ◽

Healthcare Professions ◽

Interprofessional Healthcare

Background Today, physicians are at the front lines of a pandemic response. Military physicians are uniquely trained to excel in such large-scale emergency situations. Civilian physicians can harness military know-how, but it will require research into military healthcare responses—specifically, we need to learn lessons from military interprofessional healthcare teams (MIHTs). Methods This research answers two questions: What are the characteristics of successful MIHTs? Why are those characteristics important to MIHT success in large-scale emergency situations? Using a Grounded Theory approach, 30 interviews were conducted soliciting perspectives from the broadest range of healthcare professionals who had experiences working in and leading MIHTs. Purposive sampling was used to recruit participants broadly across: contexts where MIHTs work; military branches; ranks; genders; and healthcare professions. Data were iteratively collected and analyzed. Results 30 participants were interviewed (18 male (60%); 21 officers (70%); 9 enlisted (30%)) who held various healthcare occupations (medic/tech/corpsman (9); nurse (7); physician (7); dentist (2); occupational therapist (2); chaplain (1); physician’s assistant (1); and psychiatrist (1)). Six characteristics of successful MIHTs that are directly applicable to large-scale emergency situations were identified thatthat clustered into two themes: own your purposes and responsibilities (through mission focus and ethical bearing) and get it done, safely (via situational awareness, adaptability, and leadership with followership). Conclusions This study provides insights, informed by decades of military service and training, to help civilian physicians succeed in large-scale emergency situations. These experiences from the war front can support today’s pandemic responses on the home front.

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Ethical Bearing Is About Our Conduct: Ethics as an Essential Component of Military Interprofessional Healthcare Teams

Military Medicine ◽

10.1093/milmed/usab197 ◽

2021 ◽

Vol 186 (Supplement_3) ◽

pp. 23-28 ◽

Cited By ~ 3

Author(s):

Holly S Meyer ◽

Karlen S Bader-Larsen ◽

Anthony Artino ◽

Lara Varpio

Keyword(s):

Healthcare Providers ◽

Speaking Up ◽

Moral Compass ◽

Healthcare Teams ◽

Ability To Act ◽

Ethical Conflicts ◽

Military Members ◽

Military Healthcare ◽

Interprofessional Healthcare ◽

The Right

ABSTRACT Introduction The need to maintain medical ethical standards during conflict and peace has been the source of considerable academic discourse. Although still an unsolved challenge, scholars have made significant contributions to the literature, constructing categorizations that can help military providers contend with ethical conflicts. However, insights into the ethical comportment of military interprofessional healthcare teams (MIHTs) have yet to be reported. Materials and Methods This interview-based study collected insights from 30 military healthcare providers who participated in and/or led MIHTs. Altogether, participants represented 11 health professions, both officers and enlisted military members, and the U.S. Army, Navy, and Air Force. Following Grounded Theory methodology, data were collected and analyzed in iterative cycles until theme saturation was reached. Results The research team identified two themes of ethical bearing that enable MIHT success in and across care contexts. One theme of successful ethical bearing is “raising concerns,” referring to speaking up when something needs to be addressed. The other is “making compromises,” where individuals have to make sacrifices (e.g., lack of equipment, non-sterile environment, etc.) to give patient care. Conclusions These data suggest that effective MIHTs have a collective moral compass. This moral compass is the team’s ability to judge what is ethically right and wrong, as well as the team’s willingness and ability to act accordingly—to consistently “do the right thing.” There is a collective moral compass, and while the team may not all agree on what exactly is true north—they are all bending that way.

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Management challenges in patients with comorbid COVID-19 associated delirium and serious mental illness – A case series

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217420985979 ◽

2021 ◽

pp. 009121742098597

Author(s):

Saba Syed ◽

Michael Couse ◽

Rashi Ojha

Keyword(s):

Mental Illness ◽

Serious Mental Illness ◽

Healthcare Providers ◽

Case Series ◽

Retrospective Chart Review ◽

Active Management ◽

The Novel ◽

Psychiatric Facility ◽

Medical Teams ◽

Novel Coronavirus

Background There is still a lot unknown about the novel Coronavirus Disease 19 (COVID-19) and its effects in humans. This pandemic has posed several challenging clinical situations to healthcare providers. Objective We hope to highlight the distinctive challenges that COVID-19 presents in patients with serious mental illness and what steps primary medical teams can take to co-manage these patients with the psychiatry consultants. Methods We present a retrospective chart review of four patients who were on psychotropic polypharmacy and admitted to our hospital from the same long-term psychiatric facility with COVID-19 delirium and other associated medical complications. Results We illustrate how the primary medical teams and psychiatrists collaborated in clinical diagnosis, treatment, and management. Conclusions Patients with serious mental illness and COVID-19 infection require active collaboration between primary medical teams and psychiatrists for diagnostic clarification, reduction of psychotropic polypharmacy to avoid adverse effects and drug-drug interactions, prevention of psychiatric decompensation, and active management of agitation while balancing staff and patient safety concerns.

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Diminishing Reality: Potential Benefits and Risks

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181321651103 ◽

2021 ◽

Vol 65 (1) ◽

pp. 164-168

Author(s):

I. Murph ◽

M. McDonald ◽

K. Richardson ◽

M. Wilkinson ◽

S. Robertson ◽

...

Keyword(s):

Augmented Reality ◽

Situational Awareness ◽

Relevant Information ◽

Attentional Focus ◽

Primary Task ◽

Training Methods ◽

Cognitive Aids ◽

Potential Benefits ◽

Study Participants ◽

Completion Times

Within distracting environments, it is difficult to maintain attentional focus on complex tasks. Cognitive aids can support attention by adding relevant information to the environment, such as via augmented reality (AR). However, there may be a benefit in removing elements from the environment, such as irrelevant alarms, displays, and conversations. De-emphasis of distracting elements is a type of AR called Diminished Reality (DR). Although de-emphasizing distraction may help focus on a primary task, it may also reduce situational awareness (SA) of other activities that may become relevant. In the current study, participants will assemble a medical ventilator during a simulated emergency while experiencing varying levels of DR. Participants will also be probed to assess secondary SA. We anticipate that participants will have better accuracy and completion times in the full DR conditions but their SA will suffer. Future applications include the design of future DR systems and improved training methods.

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A Literature Review of Medical Record Keeping by Foreign Medical Teams in Sudden Onset Disasters

Prehospital and Disaster Medicine ◽

10.1017/s1049023x15000102 ◽

2015 ◽

Vol 30 (2) ◽

pp. 216-222 ◽

Cited By ~ 17

Author(s):

Anisa J. N. Jafar ◽

Ian Norton ◽

Fiona Lecky ◽

Anthony D. Redmond

Keyword(s):

Literature Review ◽

Medical Record ◽

Medical Records ◽

Sudden Onset ◽

World Health ◽

Publication Type ◽

Data Set ◽

Record Keeping ◽

Medical Teams

AbstractBackgroundMedical records are a tenet of good medical practice and provide one method of communicating individual follow-up arrangements, informing research data, and documenting medical intervention.MethodsThe objective of this review was to look at one source (the published literature) of medical records used by foreign medical teams (FMTs) in sudden onset disasters (SODs). The published literature was searched systematically for evidence of what medical records have been used by FMTs in SODs.FindingsThe style and content of medical records kept by FMTs in SODs varied widely according to the published literature. Similarly, there was great variability in practice as to what happens to the record and/or the data from the record following its use during a patient encounter. However, there was a paucity of published work comprehensively detailing the exact content of records used.InterpretationWithout standardization of the content of medical records kept by FMTs in SODs, it is difficult to ensure robust follow-up arrangements are documented. This may hinder communication between different FMTs and local medical teams (LMTs)/other FMTs who may then need to provide follow-up care for an individual. Furthermore, without a standard method of reporting data, there is an inaccurate picture of the work carried out. Therefore, there is not a solid evidence base for improving the quality of future response to SODs. Further research targeting FMTs and LMTs directly is essential to inform any development of an internationally agreed minimum data set (MDS), for both recording and reporting, in order that FMTs can reach the World Health Organization (WHO) standards for FMT practice.JafarAJN, NortonI, LeckyF, RedmondAD. A literature review of medical record keeping by foreign medical teams in sudden onset disasters. Prehosp Disaster Med. 2015;30(2):1-7.

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Symbol Digit Modalities Test Variant in a Smartphone App for Persons With Multiple Sclerosis: Validation Study (Preprint)

10.2196/preprints.18160 ◽

2020 ◽

Author(s):

Pim van Oirschot ◽

Marco Heerings ◽

Karine Wendrich ◽

Bram den Teuling ◽

Marijn B Martens ◽

...

Keyword(s):

Multiple Sclerosis ◽

Construct Validity ◽

Validation Study ◽

Intraclass Correlation ◽

Study Participant ◽

Smartphone App ◽

Retest Reliability ◽

Matched Group ◽

Test Retest Reliability ◽

Study Participants

BACKGROUND The decline of cognitive processing speed (CPS) is a common dysfunction in persons with multiple sclerosis (MS). The Symbol Digit Modalities Test (SDMT) is widely used to formally quantify CPS. We implemented a variant of the SDMT in MS sherpa, a smartphone app for persons with MS. OBJECTIVE The aim of this study was to investigate the construct validity and test-retest reliability of the MS sherpa smartphone variant of the SDMT (sSDMT). METHODS We performed a validation study with 25 persons with relapsing-remitting MS and 79 healthy control (HC) subjects. In the HC group, 21 subjects were matched to the persons with MS with regard to age, gender, and education and they followed the same assessment schedule as the persons with MS (the “HC matched” group) and 58 subjects had a less intense assessment schedule to determine reference values (the “HC normative” group). Intraclass correlation coefficients (ICCs) were determined between the paper-and-pencil SDMT and its smartphone variant (sSDMT) on 2 occasions, 4 weeks apart. Other ICCs were determined for test-retest reliability, which were derived from 10 smartphone tests per study participant, with 3 days in between each test. Seven study participants with MS were interviewed regarding their experiences with the sSDMT. RESULTS The SDMT scores were on average 12.06% higher than the sSDMT scores, with a standard deviation of 10.68%. An ICC of 0.838 was found for the construct validity of the sSDMT in the combined analysis of persons with MS and HC subjects. Average ICCs for test-retest reliability of the sSDMT for persons with MS, the HC matched group, and the HC normative group were 0.874, 0.857, and 0.867, respectively. The practice effect was significant between the first and the second test of the persons with MS and the HC matched group and trivial for all other test-retests. The interviewed study participants expressed a positive attitude toward the sSDMT, but they also discussed the importance of adapting a smartphone cognition test in accordance with the needs of the individual persons with MS. CONCLUSIONS The high correlation between sSDMT and the conventional SDMT scores indicates a very good construct validity. Similarly, high correlations underpin a very good test-retest reliability of the sSDMT. We conclude that the sSDMT has the potential to be used as a tool to monitor CPS in persons with MS, both in clinical studies and in clinical practice.

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ASSESSMENT OF LIPID PROFILE AMONG PATIENTS OF NON-DIABETIC CHRONIC KIDNEY DISEASE AT TERTIARY CARE CENTRE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i11.753 ◽

2019 ◽

Vol 3 (11) ◽

Author(s):

Dr Bakul Gupta

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Lipid Profile ◽

Chronic Renal Disease ◽

Tertiary Care ◽

Study Participant ◽

P Value ◽

Additional Risk Factor ◽

Study Participants

Background: Various studies have shown the association between dyslipidemia and cardio-vascular risk among patients of chronic renal disease but the association non-significant than patients with normal renal function. There was lack of evidence exists because patients with chronic renal disease were excluded from the major clinical studies where the association with that target dyslipidemia treatment was being evaluated Material & Methods: The present prospective study was conducted among the patients of Chronic Kidney Disease above 18 years of age and diagnosed on the basis of history, detailed clinical examination, and biochemical and sonological examination based upon National Kidney Foundation (NKF) criteria were enrolled into the study. Clearance from hospital ethics committee was taken before start of study. Written informed consent was taken from each study participant. Results: In the present study out of total study participants of chronic kidney disease 46% were in the 3rd stage of CKD, 38% were in the 4th stage of CKD and 16% were in the 5th stage of CKD. Out of total study participants of chronic kidney disease, 82% were managed by conservative treatment and 18% were being managed by hemodialysis. Out of total study participants of chronic kidney disease, 38% had normal lipid profile while 62% patients had dyslipidemia. We found statistically significant (p value < 0.05) association between dyslipidemia and hemodialysis and association between dyslipidemia and stages of chronic kidney disease was statistically non- significant (p value > 0.05). Conclusion: We concluded from the present study that dyslipidemia is significantly associated as an additional risk factor in patients of Chronic Kidney Disease. We found significant association of hemodialysis with abnormal lipid profile. Key words: Chronic kidney disease, dyslipidemia, hemodialysis.

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Suitability of Customer Relationship Management Systems for the Management of Study Participants in Biomedical Research

Methods of Information in Medicine ◽

10.3414/me12-02-0012 ◽

2013 ◽

Vol 52 (04) ◽

pp. 340-350 ◽

Cited By ~ 8

Author(s):

O. Rienhoff ◽

T. G. Schulze ◽

S. Y. Nussbeck ◽

J. Schwanke

Keyword(s):

Customer Relationship Management ◽

Biomedical Research ◽

Relationship Management ◽

Study Participant ◽

Requirements Analysis ◽

Customer Relationship ◽

Management Systems ◽

Quality Of Data ◽

Suitability Evaluation ◽

Study Participants

SummaryBackground: Longitudinal biomedical research projects study patients or participants over a course of time. No IT solution is known that can manage study participants, enhance quality of data, support re-contacting of participants, plan study visits, and keep track of informed consent procedures and recruitments that may be subject to change over time.. In business settings management of personal is one of the major aspects of customer relationship management systems (CRMS).Objectives: To evaluate whether CRMS are suitable IT solutions for study participant management in biomedical research.Methods: Three boards of experts in the field of biomedical research were consulted to get an insight into recent IT developments regarding study participant management systems (SPMS). Subsequently, a requirements analysis was performed with stake-holders of a major biomedical research project. The successive suitability evaluation was based on the comparison of the identified requirements with the features of six CRMS.Results: Independently of each other, the interviewed expert boards confirmed that there is no generic IT solution for the management of participants. Sixty-four requirements were identified and prioritized in a requirements analysis. The best CRMS was able to fulfill forty-two of these requirements. The non-fulfilled requirements demand an adaption of the CRMS, consuming time and resources, reducing the update compatibility, the system’s suitability, and the security of the CRMS.Conclusions: A specific solution for the SPMS is favored instead of a generic and commercially-oriented CRMS. Therefore, the development of a small and specific SPMS solution was commenced and is currently on the way to completion.

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