Clinical Research and Practice Collaborative: An Evidence-Based Nursing Clinical Inquiry Expansion.

Introduction: Implementation and sustainment of evidence-based practices (EBPs) are common challenges faced by healthcare organizations. The Clinical Research and Practice Collaborative, an evidence-based initiative implemented at a large Military Treatment Facility, addresses EBP implementation and sustainment by expanding the culture of nursing clinical inquiry and broadening nursing research efforts to include EBP. The evidence-based intervention of scheduled, intentional, intraprofessional collaboration between PhD nurse scientists and advanced practice registered nurses as compared to previous methods of spontaneous, consultative collaboration, focuses on developing support for nursing research and EBP initiatives.

Improving Incidental Finding Documentation in Trauma Patients Amidst Poor Access to Follow-up Care.

Background: Incidental findings (IFs) are common among injured patients and create a complex problem with no standardized solution.

Materials And Methods: This is a retrospective review of adult trauma patients admitted to a level I trauma center from January to May 2017. IFs from abdominal, chest, and neck imaging were categorized based on previously published guidelines focused on clinically significant IFs.

Understanding Barriers to HPV Vaccination: Perspectives From Air Force Family Medicine Physicians and Active Duty Air Force Males.

Introduction: Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. The Center for Disease Control Advisory Committee on Immunization Practices (ACIP) has recognized the potential benefits of immunizing young men beginning at age 11 or 12 years and continuing through age 21 years. The maximum age of immunization is extended through age 26 for men who have sex with men, transgender individuals, and immunocompromised men.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a pediatric swine liver injury model: A pilot study.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has not been studied in children. We hypothesized that REBOA was feasible and would improve hemorrhage control and survival time, compared to no aortic occlusion, in a pediatric swine liver injury model.

Methods: Pediatric swine were randomized to Zone 1 REBOA or no intervention (control).

Persistent Opioid Use After Combat Injury and Subsequent Long-term Risk of Abuse: A Retrospective Cohort Study.

Objective: To determine whether persistent opioid use after injury is associated with subsequent long-term development of clinically recognized opioid abuse.

Summary Background Data: Opioid abuse is an epidemic in the United States and trauma can initiate persistent use; however, it remains unclear whether persistent opioid use contributes to the subsequent development of opioid abuse. The care of combat casualties by the Departments of Defense and Veterans Affairs uniquely allows investigation of this long-term outcome.

Plan-Do-Study-Act Cycles Applied to a Longitudinal Research Protocol in a Family Medicine Residency.

Background And Objectives: Barriers to research in family medicine are common. Resident studies are at risk of remaining incomplete. This report describes a process improvement (PI) to optimize survey data collection in a longitudinal research protocol led by family medicine residents.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a swine model of hemorrhagic shock and blunt thoracic injury.

Purpose: While resuscitative endovascular balloon occlusion of the aorta (REBOA) is contraindicated in patients with aortic injuries, this technique may benefit poly-trauma patients with less extreme thoracic injuries. The purpose of this study was to characterize the effects of thoracic injury on hemodynamics during REBOA and the changes in pulmonary contusion over time in a swine model.

Methods: Twelve swine were anesthetized, instrumented, and randomized to receive either a thoracic injury with 5 impacts to the chest or no injury.

Hyperbaric oxygen is still needed in the management and prevention of mandibular necrosis: a response to Mr. Richard Clarke.

Mr. Richard Clarke presents in this Journal his arguments against continued application of hyperbaric oxygen (HBO2) therapy to the pre-extraction neoadjuvant treatment or the treatment of frank mandibular ORN. In the same article he advocates a promising renewed interest in HBO2 as a radiosensitizer.

Renal effects of three endoaortic occlusion strategies in a swine model of hemorrhagic shock.

Introduction: Trauma patients are predisposed to kidney injury. We hypothesized that in shock, zone 3 REBOA would increase renal blood flow (RBF) compared to control and that a period of zone 3 occlusion following zone 1 occlusion would improve renal function compared to zone 1 occlusion alone.

Materials And Methods: Twenty-four anesthetized swine underwent hemorrhagic shock, 45 min of zone 1 REBOA (Z1, supraceliac), zone 3 REBOA (Z3, infrarenal), or no intervention (control) followed by resuscitation with shed blood and 5 h of critical care.

Pharmacokinetics of Tranexamic Acid Given as an Intramuscular Injection Compared to Intravenous Infusion in a Swine Model of Ongoing Hemorrhage.

Introduction: Tranexamic acid (TXA) improves survival in traumatic hemorrhage, but difficulty obtaining intravenous (IV) access may limit its use in austere environments, given its incompatibility with blood products. The bioavailability of intramuscular (IM) TXA in a shock state is unknown. We hypothesized that IM and IV administration have similar pharmacokinetics and ability to reverse in vitro hyperfibrinolysis in a swine-controlled hemorrhage model.

Assessment of risks of feline mismatched transfusion and neonatal isoerythrolysis in the Lyon (France) area.

Objectives: The aims of this study were to update the prevalence of different feline blood types in the Lyon (France) area, as well as to determine the risk of mismatched transfusion (MT) and neonatal isoerythrolysis (NI) in kittens with parents of unknown blood type.

Methods: Blood samples were obtained from blood donor cats and cats admitted to an intensive care unit in Lyon. AB blood typing was performed using an immunochromatographic strip.

US Military Service and Racial/Ethnic Differences in Cardiovascular Disease: An Analysis of the 2011-2016 Behavioral Risk Factor Surveillance System.

Objective: To determine: 1) rates of cardiovascular disease (CVD) among individuals with and without prior US military service; and 2) variation in CVD outcomes by race/ethnicity.

Methods: We performed a cross-sectional study of the 2011-2016 Behavioral Risk Factor Surveillance System during 2018-2019. Groups with (n=369,844) and without (n=2,491,784) prior service were compared overall, and by race/ethnicity.

Resuscitative Endovascular Balloon Occlusion of the Aorta: Review of the Literature and Applications to Veterinary Emergency and Critical Care.

While hemorrhagic shock might be the result of various conditions, hemorrhage control and resuscitation are the corner stone of patient management. Hemorrhage control can prove challenging in both the acute care and surgical settings, especially in the abdomen, where no direct pressure can be applied onto the source of bleeding. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a promising replacement to resuscitative thoracotomy (RT) for the management of non-compressible torso hemorrhage in human trauma patients.

Resuscitative endovascular balloon occlusion of the aorta induced myocardial injury is mitigated by endovascular variable aortic control.

Background: The cardiac effects of resuscitative endovascular balloon occlusion of the aorta (REBOA) are largely unknown. We hypothesized that increased afterload from REBOA would lead to cardiac injury, and that partial flow using endovascular variable aortic control (EVAC) would mitigate this injury.

Methods: Eighteen anesthetized swine underwent controlled 25% blood volume hemorrhage.

Impact of High Volume Energy Drink Consumption on Electrocardiographic and Blood Pressure Parameters: A Randomized Trial.

Background Energy drinks have been linked to an increase in emergency room visits and deaths. We aim to determine the impact of energy drinks on electrocardiographic and hemodynamic parameters in young healthy volunteers. Methods and Results A randomized, double-masked, placebo-controlled, crossover study was conducted in healthy volunteers.

Assessing the Accuracy of Casting and Additive Manufacturing Techniques for Fabrication of a Complete Palatal Coverage Metal Framework.

Purpose: To provide information regarding the accuracy of additive manufacturing in comparison to conventional casting, specifically for fabrication of complete palatal coverage metal frameworks.

Materials And Methods: Three additive manufacturing techniques were tested: selective laser melting (SLM), electron beam melting (EBM), and computer-aided design/cast (CADcast), with conventional casting as the control. Both the SLM and EBM groups were tested pre- and post-finishing, for a total of six test groups (n = 10/group).

A prospective evaluation of thromboelastometry (ROTEM) to identify acute traumatic coagulopathy and predict massive transfusion in military trauma patients in Afghanistan.

Background: Hemorrhage is the leading cause of preventable trauma-related mortality and is frequently aggravated by acute traumatic coagulopathy (ATC). Viscoelastic tests such as rotational thromboelastometry (ROTEM) may improve identification and management of ATC. This study aimed to prospectively evaluate changes in ROTEM among combat casualties during the first 24 hours and compare the capabilities of our conventional clotting assay (international normalized ratio [INR], >1.

Zones matter: Hemodynamic effects of zone 1 vs zone 3 resuscitative endovascular balloon occlusion of the aorta placement in trauma patients.

Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a therapy for hemorrhagic shock to limit ongoing bleeding and support proximal arterial pressures. Current REBOA algorithms recommend zone selection based on suspected anatomic location of injury rather than severity of shock. We examined the effects of Zone 1 versus Zone 3 REBOA in patients enrolled in the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) Registry.

Multimodal Analgesia and Opioid Use in Critically Ill Trauma Patients.

Background: Opioids are the mainstay of pain management in critically ill trauma patients. However, the risks of opioid use mandate a different approach. Multimodal analgesia employs a combination of opioid and nonopioid agents using different mechanisms that have synergistic effects in treating pain.

Expanded genetic carrier screening in clinical practice: a current survey of patient impressions and attitudes.

Purpose: Expanded genetic carrier screening (ECS) is an important part of gynecological practice and preconception planning. We evaluated the awareness and attitudes among women regarding ECS and factors that may influence decision-making in a family planning context.

Methods: A 32-question survey in an academic university practice was given to 521 women who were either currently pregnant (n = 108), undergoing gynecologic care who were considering future fertility (n = 308), and considering or receiving fertility treatment (n = 105).

Dipeptidyl Peptidase-4 Inhibitors and Inflammatory Bowel Disease Risk: A Meta-analysis.

Background: Dipeptidyl peptidase 4 (DPP-4) inhibitors are a popular second-line treatment for type 2 diabetes mellitus. Several studies have reported on the association between DPP-4 inhibitors and the risk of developing inflammatory bowel disease (IBD), with conflicting results.

Objective: This meta-analysis aims to elucidate the risk for IBD with DPP-4 inhibitor therapy.

Development and validation of algorithms to identify newly diagnosed type 1 and type 2 diabetes in pediatric population using electronic medical records and claims data.

Purpose: To develop and validate algorithms to classify diabetes type in newly diagnosed pediatric patients with DM.

Method: Data from the United States Department of Defense health system were used to identify patients aged 10 to 18 years with incident DM. Two independent sets of 200 children were randomly sampled for algorithm development and validation.

Extracorporeal potassium binding for the management of hyperkalemia in an anephric model of crush injury.

Background: Potassium-binding polymers have shown promising results in an anephric porcine hyperkalemia model. The benefits of the polymer in a clinically relevant injury model remain unknown. We hypothesized that potassium-binding cartridges would control serum potassium concentration in a porcine hemorrhagic shock model with supraceliac aortic occlusion and a limb crush injury.

The effect of standing variants of the seated position on lumbar intersegmental angulation and spacing: a radiographic study of 20 asymptomatic subjects.

Background: Pain while sitting is the primary complaint of many patients with lumbar spinal ailments, including those with discogenic low back pain and lumbar disc herniations. There has been little basic research on the different mechanical stresses that different sitting positions place on the spine. To demonstrate the effect of different sitting positions on lumbar intersegmental relationships.