scholarly journals Challenges With Engaging Military Stakeholders for Clinical Research at the Point of Care in the U.S. Military Health System

2021 ◽  
Author(s):  
Daniel I Rhon ◽  
Robert C Oh ◽  
Deydre S Teyhen
Keyword(s):  
Clinical Trials ◽  
Clinical Research ◽  
Health System ◽  
Point Of Care ◽  
Military Training ◽  
Military Health System ◽  
Military Health ◽  
Research Activities ◽  
Key Stakeholders ◽  
The Military

ABSTRACT The DoD has a specific mission that creates unique challenges for the conduct of clinical research. These unique challenges include (1) the fact that medical readiness is the number one priority, (2) understanding the role of military culture, and (3) understanding the highly transient flow of operations. Appropriate engagement with key stakeholders at the point of care, where research activities are executed, can mean the difference between success and failure. These key stakeholders include the beneficiaries of the study intervention (patients), clinicians delivering the care, and the military and clinic leadership of both. Challenges to recruitment into research studies include military training, temporary duty, and deployments that can disrupt availability for participation. Seeking medical care is still stigmatized in some military settings. Uniformed personnel, including clinicians, patients, and leaders, are constantly changing, often relocating every 2-4 years, limiting their ability to support clinical trials in this setting which often take 5-7 years to plan and execute. When relevant stakeholders are constantly changing, keeping them engaged becomes an enduring priority. Military leaders are driven by the ability to meet the demands of the assigned mission (readiness). Command endorsement and support are critical for service members to participate in stakeholder engagement panels or clinical trials offering novel treatments. To translate science into relevant practice within the Military Health System, early engagement with key stakeholders at the point of care and addressing mission-relevant factors is critical for success.

scholarly journals Evaluation of Pharmacogenomics Testing of Cytochrome P450 Enzymes in the Military Health System From 2015 to 2020

2021 ◽  
Vol 187 (Supplement_1) ◽  
pp. 1-8
Author(s):  
Elaine D Por ◽  
Daniel J Selig ◽  
Geoffrey C Chin ◽  
Jesse P DeLuca ◽  
Thomas G Oliver ◽  
...  
Keyword(s):  
Cytochrome P450 ◽  
Health System ◽  
Point Of Care ◽  
Cytochrome P450 Enzymes ◽  
Military Health System ◽  
Military Health ◽  
Patient Demographics ◽  
The Military ◽  
The Relationship

ABSTRACT Pharmacogenomics (PGx) plays a fundamental role in personalized medicine, providing an evidence-based treatment approach centered on the relationship between genomic variations and their effect on drug metabolism. Cytochrome P450 (CYP450) enzymes are responsible for the metabolism of most clinically prescribed drugs and a major source of variability in drug pharmacokinetics and pharmacodynamics. To assess the prevalence of PGx testing within the Military Health System (MHS), testing of specific CYP450 enzymes was evaluated. Data were retrospectively obtained from the Military Health System Management Analysis and Reporting Tool (M2) database. Patient demographics were identified for each test, along with TRICARE status, military treatment facility, clinic, and National Provider Identifier. A total of 929 patients received 1,833 PGx tests, predominantly composed of active duty/guard service members (N = 460; 49.5%), with highest testing rates in the army (51.5%). An even distribution in testing was observed among gender, with the highest rates in Caucasians (41.7%). Of the CYP enzymes assessed, CYP2C19 and CYP2D6 accounted for 87.8% of all PGx CYP testing. The majority of patients were tested in psychiatry clinics (N = 496; 53.4%) and primary care clinics (N = 233; 25.1%), accounting for 56.4% and 24.8% of all tests, respectively. Testing was found to be provider driven, suggesting a lack of a standardized approach to PGx and its application in patient care within the MHS. We initially recommend targeted education and revising testing labels to be more uniform and informative. Long-term recommendations include establishing pharmacy-driven protocols and point-of-care PGx testing to optimize patient outcomes.

scholarly journals Curricular Change and Resiliency in the Era of Coronavirus (COVID-19): The Uniformed Services University of the Health Sciences (USU) Experience

2020 ◽  
Author(s):  
Arnyce R Pock ◽  
Pamela M Williams ◽  
Ashley M Maranich ◽  
Ryan R Landoll ◽  
Catherine T Witkop ◽  
...  
Keyword(s):  
Health System ◽  
Health Sciences ◽  
Lessons Learned ◽  
Organizational Response ◽  
Educational Goals ◽  
Military Health System ◽  
Military Health ◽  
Health Crisis ◽  
Core Curricula ◽  
The Military

ABSTRACT Introduction The Coronavirus (COVID-19) pandemic has presented a myriad of organizational and institutional challenges. The Uniformed Services University of the Health Sciences, like many other front line hospitals and clinics, encountered a myriad of challenges in fostering and sustaining the education of students enrolled at the nation’s only military medical school. Critical to the function of any academic medical institution, but particularly one devoted to the training of future physicians for the Military Health System, was the ability to rapidly adapt, modify, and create new means of keeping medical students engaged in their core curricula and progressing toward full and timely attainment of established educational goals and objectives. Methods This article highlights some of the particular challenges faced by faculty and students during the first 6 months of the COVID-19 pandemic and describes how they were managed and/or mitigated. Results Six key “lessons learned” were identified and summarized in this manuscript. These lessons may be applicable to other academic institutions both within and outside of the Military Health System. Conclusions Recognizing and embracing these key tenets of academic change management can accelerate the generation of a cohesive, organizational response to the next pandemic or public health crisis.

Comparison of Nurse-Midwife and Physician Birth Outcomes in the Military Health System

2021 ◽  
pp. 152715442199407
Author(s):  
Lynette Hamlin ◽  
Lindsay Grunwald ◽  
Rodney X. Sturdivant ◽  
Tracey P. Koehlmoos
Keyword(s):  
Health System ◽  
Birth Outcomes ◽  
Health Care Systems ◽  
Vaginal Birth ◽  
Data Repository ◽  
Military Health System ◽  
Provider Type ◽  
Pregnancy Risk ◽  
Military Health ◽  
The Military

The purpose of this study is to identify the socioeconomic and demographic characteristics of women cared for by Certified Nurse-Midwives (CNMs) versus physicians in the Military Health System (MHS) and compare birth outcomes between provider types. The MHS is one of America’s largest and most complex health care systems. Using the Military Health System Data Repository, this retrospective study examined TRICARE beneficiaries who gave birth during 2012–2014. Analysis included frequency of patients by perinatal services, descriptive statistics, and logistic regression analysis by provider type. To account for differences in patient and pregnancy risk, odds ratios were calculated for both high-risk and general risk population. There were 136,848 births from 2012 to 2014, and 30.8% were delivered by CNMs. Low-risk women whose births were attended by CNMs had lower odds of a cesarean birth, induction/augmentation of labor, complications of birth, postpartum hemorrhage, endometritis, and preterm birth and higher odds of a vaginal birth, vaginal birth after cesarean, and breastfeeding than women whose births were attended by physicians. These results have implications for the composition of the women’s health workforce. In the MHS, where CNMs work to the fullest scope of their authority, CNMs attended almost 4 times more births than our national average. An example to other U.S. systems and high-income countries, this study adds to the growing body of evidence demonstrating that when CNMs practice to the fullest extent of their education, they provide quality health outcomes to more women.

Survival in Pediatric, Adolescent, and Young Adult Patients With Sarcoma in the Military Health System: Comparison With the SEER Population

2021 ◽  
Vol 43 (6) ◽  
pp. e832-e840
Author(s):  
Lauren M. Vasta ◽  
Richard C. Zanetti ◽  
Ashley B. Anderson ◽  
Kangmin Zhu ◽  
Benjamin K. Potter ◽  
...  
Keyword(s):  
Young Adult ◽  
Health System ◽  
Adult Patients ◽  
Adolescent And Young Adult ◽  
Military Health System ◽  
Military Health ◽  
The Military

A description of barriers and facilitators to childhood vaccinations in the military health system

2012 ◽  
Vol 24 (12) ◽  
pp. 716-725 ◽  
Author(s):  
John Connors ◽  
Elena Arushanyan ◽  
Gregory Bellanca ◽  
Ruth Racine ◽  
Andrew Hoeffler ◽  
...  
Keyword(s):  
Health System ◽  
Barriers And Facilitators ◽  
Military Health System ◽  
Military Health ◽  
The Military

scholarly journals Diagnostic Evaluation of Hypoglycemia Due To an Insulinoma in a Deployed Infantryman: Significance of Neuroglycopenia and the Role of the Military Health System

2021 ◽  
Author(s):  
Samuel T Olatunbosun ◽  
Ayodeji F Alaketu ◽  
Joseph H McDermott ◽  
Al M Elsayed von Bayreuth
Keyword(s):  
Health System ◽  
Rare Condition ◽  
Service Member ◽  
Hyperinsulinemic Hypoglycemia ◽  
Suspected Case ◽  
Military Health System ◽  
Military Population ◽  
Military Health ◽  
The Military

ABSTRACT Insulinoma, the prototype of endogenous hyperinsulinemic hypoglycemia, is a very rare condition, with an incidence of four cases per million person-years. Its rate of occurrence in the U.S. military population is unknown. Two cases of insulinomas involving active duty service members have been published. However, there has been no reported case of an insulinoma in a deployed service member. We report the case of a 21-year-old infantryman with clinical hypoglycemia of insidious onset, manifesting with overt neuroglycopenic symptoms during his deployment as a combatant soldier, and the ultimate diagnosis of an insulinoma as the underlying cause. The series of multiple clinical evaluations and the unique circumstances leading to the formal evaluation of the patient’s hypoglycemia and treatment are chronicled. The significance of neuroglycopenia and the diagnostic approach to any suspected case of hypoglycemia, the potential challenges and opportunities, and educational aspects of evaluation and management of the insulinoma are elaborated. The potential role of the Military Health System in facilitating the detection and treatment of this rare condition in the service member is discussed as well.

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