Army Nurse Corps Coronavirus Disease (COVID-19) Lessons Learned

ABSTRACT A new strain of coronavirus (COVID-19) emerged in 2020 changing the way the nation looked, worked and lived. In response to this unprecedented COVID-19 pandemic, the Army Nurse Corps (ANC) reexamined our capabies and agility to respond to a new and rapidly evolving environment. Maintaining the pivot to readiness, providing sustainable support and protecting our most valuable asset-our people-were and continues to be in the forefront of leaders’ thoughts as we faced this invisible adversary. With every new challenge, lessons learned provide an opportunity to re-examine challenges and successes of the response to COVID-19. Organizational restructuring, balancing risks, expanding capabilities and educational platforms were reassessed and adjusted to fill the needs of the environment as they evolved. The year 2020 will stand throughout history as another example where our readiness, resilience, and flexibility as an Army Nurse Corps was tried and tested. We demonstrated our ability to adapt and overcome-displaying our willingness to stand up as part of the Army Medicine Team and face an unknown adversary to protect the nation we vowed to serve.

Development and Validation of a Malaysian Blood Donor’s Satisfaction Questionnaire

Objective: To develop and validate a questionnaire which evaluates the blood donors’ satisfaction. Background: In Malaysia, blood procurement relies mainly on voluntary non- remunerated donors. Hence, it is important to ensure the satisfaction of the blood donors in order to increase retention. Methods: This study was conducted among blood donors who attended blood donation and understood the Malay language. Non-Malaysian and illiterate donors were excluded. The questionnaire was developed by the transfusion medicine team. Content validity was established by content reviewers, while face validity was examined in the cognitive debriefing stage. For the 18- item questionnaire, 90 respondents were required based on the 1:5 ratio. A retest was performed in two weeks’ time. Results: One hundred and thirty-seven participants responded in the first phase, while 103 responded after two weeks. The five domains were: technical, interpersonal, accessibility/ convenience, physical experience and overall satisfaction. The Kaiser-Meyer-Olkin (KMO) value was 0.896, with significant Bartlett’s Test of Sphericity (P < 0.001). The factor loadings ranged from 0.729 to 0.953. The Cronbach alpha values of the five domains ranged from 0.814 to 0.955 and the intraclass correlation coefficient ranged from 0.663 to 0.847. Conclusion: The Malaysian blood donor’s satisfaction (M-BDS) questionnaire is a reliable and valid tool suitable for the assessment of blood donor’s satisfaction in blood donation centres.

A Descriptive Study of Sports Chiropractors

BACKGROUND:This paper describes the education and case management profile of sports chiropractors with the Federation of International Sports Chiropractors (FICS) postgraduate qualification: International chiropractic sport science practitioner (ICSSP). The ICSSP is the predominant international sports chiropractic qualification.METHODS:A 39-item web-based survey examining practitioner, practice and clinical management characteristics was distributed via email to all sports chiropractors who hold an ICSSP (n = 240) in 2015. RESULTS:The survey response rate was 64% (n = 154). The average age of the chiropractors was 31-40 years, just over three quarters were male and have been in practice for 5-10 years. The majority of respondents were based in North America.Sports chiropractors treat a wide range of musculoskeletal conditions with multimodal care (active and passive) and treat professional, semi-professional and Olympic athletes. Sports chiropractors have referral and co-management relationships with a range of conventional and allied health providers.CONCLUSIONS: There is often a lack of knowledge and misinformation about the background of sports chiropractors. This study refutes a number of commonly held misbeliefs, and describes a workforce that is well educated, treat high-level athletes, utilise a multimodal approach to management, treat a wide variety of non-spinal musculoskeletal conditions, frequently prescribe rehabilitative exercise, and refer to and co-manage with other members of the sports medicine team.Trial registration: This study was approved by the RMIT University, SEH College Human Ethics Advisory Network (ASEHAPP 52-14 AMES)

Inflammatory bowel disease in pregnancy: Developing a multidisciplinary care pathway in East London

Objectives Evaluate the management of pregnant women with inflammatory bowel disease. Method We collected data from maternity records for women with IBD who gave birth at The Royal London Hospital between January 2018 and February 2019. Results Twenty-three pregnancies were identified where 8/23 (35%) women had a peri-conception flare and 7/23 (30%) had a flare during pregnancy. Two women received pre-conception counselling. The obstetric medicine team reviewed a patient on average three times and the gastroenterologists twice, during pregnancy. Nine women (39%) gave birth pre-term. Mean birthweight was lower in the group with active disease at conception compared with those in remission (2173 g vs. 2807 g, p = 0.03). Conclusions Women with IBD should all receive pre-conception counselling to reduce the risk of pregnancy complications. By developing a multidisciplinary care pathway for pregnant women with IBD (which includes a joint obstetric/gastroenterology clinic), this will ensure care is standardised throughout the pregnancy and puerperium.

105 Implementation of a Burn Resource Team for Initial Debridement and Burn Management in a Pediatric Burn Center

Introduction Each year, approximately 700 patients are treated at our verified pediatric burn center. Previously, all patients were fast tracked through the Emergency Department (ED) or directly admitted to the burn unit and received intravenous (IV) morphine and midazolam for analgesia. Although the process was efficient (goal &lt; 120 minutes), this strategy resulted in some patients being unable to tolerate wound debridement due to inadequate sedation. As a process improvement initiative, a burn resource team, consisting of experienced nurses was created. As part of the new process, all patients are initially evaluated and treated in the ED. The Pediatric Emergency Medicine team provides procedural sedation utilizing ketamine, allowing the resource team to assess, debride, and dress the wounds. The objective was to maintain efficiency with time to debridement and dressing application, while concurrently utilizing improved patient sedation. Methods Door to debridement time and sedation/analgesia for first debridement was retrospectively reviewed for each group. The pre-implementation group included 148 patients from May 2018 – April 2019. The post- implementation group included 163 patients from August 2019-July 2020. Specific inclusion criteria were age &lt; 18 years and TBSA ≤ 5%. Results Of the 148 patients in the pre-implementation group, 82 patients (56%) received morphine and midazolam for their analgesia. These patients had a mean TBSA of 1.5% (0.25 - 5%). 38 patients (26%) received only morphine with a mean TBSA of 1.25% (0.25 - 4%). 14 patients (9%) received hydrocodone with a mean TBSA of 0.75% (0.25 - 2.25%). The additional 14 patients (9%) received an alternate analgesic with a mean TBSA of 0.75% (0.25 - 1%). Average door to debridement time for this group was 97 minutes. In the post implementation group, 94 of the 163 patients (58%) received ketamine sedation. These patients had a mean TBSA of 2 % (0.25 - 5%). 49 patients (30%) received Intranasal fentanyl and/or midazolam with a mean TBSA of 1% (0.25 - 4%). 13 patients (8%) received hydrocodone with a mean TBSA of 1% (0.5 - 3%). The additional 7 patients (4%) received alternate analgesics with a mean TBSA of 1 % (0.5 - 2%). Average door to debridement time for this group was 92 minutes. Conclusions The implementation of a burn resource team and administration of procedural sedation utilizing ketamine in the ED has improved sedation and analgesia for burn patients and marginally decreased time to debridement. There have been noticeable improvements in the consistency of the process as well as improved collaboration between the ED and burn teams.