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Military nurse midwives ride rollercoaster of emotions with their patients

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Air Force Lt. Col. Sarah Martin knows the joy and heartbreak of pregnancy. As a certified nurse midwife (and a mother herself), she gets to experience firsthand the highs and lows experienced by moms and moms-to-be. On one occasion, it struck particularly close to home for the certified nurse midwife consultant to the Air Force Surgeon General and now assigned to Brooke Army Medical Center in San Antonio, Texas.

Martin saw a young couple for their first pregnancy and did an initial routine trimester ultrasound. They were people Martin knew socially – they all lived on the same base.

“But unfortunately, it was not a viable pregnancy,” said Martin. “It was very upsetting, and it’s hard, not only as a provider but as their neighbor, having to break this news.”

Martin said the couple didn’t give up, though. Within a year, the woman came back pregnant, and Martin was able to help them through the pregnancy to a healthy and happy delivery. “Their little boy is three now. So that was very special for me: seeing them through that saddest time in their lives to a successful delivery. Nature finds a way,” she said with a smile.

Martin is one of a small group of providers in the Military Health System – less than 100 in all services worldwide – who are midwives. They specialize in low-risk pregnancy care and delivery, as well as obstetrics/gynecological care. Most patients come in for routine well-woman exams, as well as PAP smears, fertility and contraceptive education, lactation advice and help, and treatments for menopause. If the care women require elevates, midwives work with doctors to transfer that care without gaps. Martin pointed to her own irony that despite being a midwife, she had both of her children by C-section, demonstrating how midwives work with doctors to make sure that patient experience is the priority. She said her midwife was still part of the birthing process.

“We don’t just hand over patients; usually, we’re the first to assist on C-sections,” said Martin, adding her own experience helps her be empathetic to other moms. “I can counsel my patients that if they can’t have their babies naturally, there’s nothing wrong with that. Sometimes, things are beyond our control. But you’ll get through it, you’ll have a healthy baby, and you’ll be healthy. And that’s really the outcome we want.”

TRICARE also covers certified nurse midwife services, provided the midwife is certified by the American Midwifery Certification Board and licensed in the state where they practice, if required by that state. Certified nurse midwifes are independent practitioners who do not require supervision by a physician. However, midwife services by a registered nurse who is not a certified nurse midwife may be covered with a physician's referral and supervision.

Midwife services in the Military Health System have been recognized recently for several achievements. Army Maj. Elizabeth Nutter, a consultant to the Army Surgeon General for the Nurse Midwife Program, was the recipient of the 2016 Kitty Ernst Award from the American College of Nurse-Midwives. The award honors an exceptional, relatively new certified nurse midwife (certified for less than 10 years) who has demonstrated innovative, creative endeavors in midwifery and/or women's health clinical practice, education, administration, or research. Beaumont Army Medical Center at Fort Bliss, Texas, received the International Board of Lactation Consultant Examiners and the International Lactation Consultant Association Care Award, which recognizes maternity and community-based facilities worldwide that hire currently certified breastfeeding consultants.

“It can be very trying, but it also can be very rewarding,” said Martin. “Families rely on you, even when it’s not the outcome they expected or wanted.”


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Women’s Health Month: Time to reset your health care habits

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I was recently a speaker at a women’s leadership symposium and was asked for strategies for proactively managing one’s health when faced with hectic schedules and numerous responsibilities.  I could totally relate and the timing couldn’t be better! October is Women’s Health Month and a great time to remember that we, as women, owe it to ourselves and our loved ones to make our health a priority. Focusing on healthy lifestyle habits, ensuring we get regular checkups and immunizations, and being our own best advocates for care will help us live healthier and happier lives. Throughout October, we will feature stories about important women’s health topics. To start things off, I’m encouraging women to take command of their health by resolving to do three things today that will make a difference in your tomorrows.

First, get to the heart of the matter! Heart disease accounts for about one in every four deaths in women each year, making it the leading cause of death for women in the United States, according to the Centers for Disease Control and Prevention. But you can take steps to reduce your risk through healthier habits and lifestyle changes such as limiting alcohol consumption, saying no to smoking, eating plenty of vegetables and fruits, getting quality sleep, reducing stress, and exercising. As a bonus, these same habits reduce the risk of developing diabetes, chronic lower respiratory diseases, and other chronic conditions. Check out the resources TRICARE offers, including tools to help you quit smoking, as well as tools on health.mil to help you focus on your physical fitness and weight management.

Second, don’t slack off on preventive care, including regular checkups, cancer screenings including colonoscopies, and reproductive health care. TRICARE covers well-woman exams annually for women younger than 65. This can include breast exams, pelvic exams, and Pap smears as needed. Keeping up with immunizations is another essential preventive measure. Your doctor will advise you on scheduling immunizations during your regular checkups.

Finally, be a strong advocate for your own health. Some time ago, I was at my doctor’s office discussing a recurring issue I was having. Despite being a physician and hospital commander at the time, he doubted my problem because a lab result had not yet been added to my record. This kind of dismissal of a patient’s concerns undermines health care delivery. Which is why we, at the Defense Health Agency, are committed to ensuring that every member of our beneficiary population of 9.4 million people gets personalized, responsive, and respectful care. By taking charge of your wellness and lifestyle habits, and clearly expressing your health concerns and questions, you become an active partner with your provider in staying healthy.

Women’s Health Month can be your starting point to reset your habits – and make lifelong differences in your health and wellness.  Let’s take command of our health!


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The development of a nanofibrous scaffold for the recruitment of fibroblast during wound healing

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KISSIMMEE, Florida – A researcher from the Naval Medical Research Unit – San Antonio (NAMRU-SA) shared findings on the fabrication and characterization of a novel nanofibrous scaffold that could potentially improve wound healing by enhancing wound closure, promoting hemostasis, and acting as a temporary physical barrier against debris and microbial pathogens during the Military Health System Research Symposium (MHSRS), August 27 – 30. 

“Combat wounds are a unique challenge to the military health system,” said Capt. Jonathan Stahl, Principal Investigator, Craniofacial Health and Restorative Medicine, Biomaterials and Epidemiology Department. “Extended evacuation times, unique infections, and the complexity of wound injuries can greatly complicate the wound healing process and significantly worsen patient prognosis.” 

Stahl and a team of researchers developed a polymer nanofiber scaffold produced from naturally available polymers by using a high-voltage fabrication technique called electrospinning. In addition to the nanofibrous scaffold, a biological functional growth factor was incorporated as a method to improve cellular recruitment during wound healing. Through the results of the research, it was demonstrated that it was possible to significantly improve cell function and recruitment by using the scaffold. 

“Overall, electrospun scaffolds such as this one are promising candidates for the development of advanced, specialized wound dressings for clinical use. This has the potential to reduce hospital stays and increase the rate of warfighters returned to service after injury,” said Stahl. 

The research findings suggested a higher cellular migration can be promoted through the release of a (blood) platelet-derived growth factor (PDGF) from a nanofibrous scaffold. According to Stahl, PDGF is an important first step in the development of a wound dressing capable of improving cellular recruitment at the site of healing, which could potentially lead to faster wound closure and better patient outcomes in terms of aesthetics and function. 

MHSRS is the Department of Defense's (DoD) premier scientific meeting; a unique collaborative opportunity for military medical care providers, DoD scientists, academia and industry to exchange information on research advancements and health care developments in the areas of combat casualty care, military operational medicine, clinical and rehabilitative medicine and military infectious disease research program. 

The Naval Medical Research Center’s eight laboratories, including NAMRU-SA, are engaged in a broad spectrum of activity from basic science in the laboratory to field studies at sites in austere and remote areas of the world to operational environments. 

In support of the Navy, Marine Corps, and joint U.S. warfighters, researchers study infectious diseases; biological warfare detection and defense; combat casualty care; environmental health concerns; aerospace and undersea medicine; medical modeling, simulation and operational mission support; and epidemiology and behavioral sciences. 

NAMRU-SA’s mission is to conduct medical, dental, and biomedical research, which focuses on ways to enhance the health, safety, performance, and operational readiness of Navy and Marine Corps personnel and addresses their emergent medical and dental problems in routine and combat operations.

Disclaimer: Re-published content may have been edited for length and clarity. Read original post.


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Training, technological synergy likely the key to future battlefield care scenarios

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The first slide on the screen during Maj. Doug Powell's panel presentation on prolonged field care at the 2017 Military Health System Research Symposium in Kissimmee, Florida, features a blank, colorless slate without any pictures, graphics or images. Instead, there's just a single quote.

"It's not about the technology," the slide reads, "It's about the people."

For Powell and the rest of the investigators diving head first into the Army's newly-retooled commitment to prolonged field care–the number one capability gap according to a recent Army Capabilities Needs Analysis–the quote doubles as both a mantra and a mission statement.

"We carry around one of the greatest and most powerful computers of all time in our pockets every day," said Powell, holding up his cell phone to the audience, "and we use it to play 'Candy Crush.'"

He added, "We can do better."

Given that desire for a more complete, more mature fusion of technology and Warfighter, Powell's presentation focused chiefly on the burgeoning telemedicine requirements for prolonged field care in future battlefield scenarios. Products that are flexible, scalable, reliable and convenient are specifically targeted for deployment in the dense, urban settings that experts say will likely dominate combat environments in the coming years.

The presentation highlighted advanced development efforts such as an Air Force Pararescue-Jumper project called BATDOK (Battlefield Airmen Trauma Distributed Observation Kit), which is a cell phone application intended for use on Android platforms. Wireless sensors placed on the patient send aggregated vitals to the computer screen, providing PJs the ability to make emergency medical decisions. Like a cell phone, the device can be set for three kinds of alerts: Auditory, tactical or visual. The alerts notify the PJ not only to which patient is in danger, but also his or her vitals.

Situational awareness for receiving field hospitals is also important to provide medical staff on the ground with information that can help them prepare to receive and immediately treat patients. This need is being addressed by an advanced development effort at the U.S. Army Medical Research and Materiel Command called the Medical Hands-free Ultra-wideband Broadcast system. The MEDHUB's distinction is its patient care focus and operational situational awareness capability. The goal is to keep the medic or flight paramedic focused for performing life-saving tasks for multiple patients, unencumbered from documentation. The MEDHUB is designed to automatically capture, store and forward data to the receiving field hospital -- without adding any burden to the medic. Key components are individual wearable vital sign monitors that record vitals and provide littered or ambulatory status through accelerometers; peripherals to capture patient weight; and an end-user device, such as a tablet or phone, that captures and stores the data.

"Prolonged field care is not a skillset. It's a situation you find yourself in," said Lt. Col. Andre Cap, Chief of Blood Research at the U.S. Army Institute of Surgical Research in San Antonio, Texas.

For Cap, the synergy of man and machine in future far-forward environments isn't complete without first addressing the existing training gaps in the prolonged field care discipline. To that end, concepts such as a dedicated emphasis on critical care techniques and prolonged resuscitation efforts are incorporated into current medical training regimens. Additionally, leadership has instituted a pilot program focused around those concepts at Fort Bragg, North Carolina.

"We are still fighting the new war with the tools from the old war," said Cap, "and that has to change."

Both Cap and Powell say that moving forward current capabilities gaps in prolonged field care will include a dedication to the concept of universal interoperability among technological devices, as well as the development of an on-demand, on-call marketplace for continuous communication regardless of location.

Still, the immediate focus remains on strengthening current training, development and execution processes, all while paying special attention to the integration needed to succeed on the future battlefield.

Said Powell, "Whatever we eventually give to the people in the field, I want to make sure it works with what they already have."

The MHSRS is the DoD's premier scientific annual meeting, which combines three previous conferences, including the former Advanced Technology Applications for Combat Casualty Care Conference; the Air Force Medical Service Medical Research Symposium; and the Navy Medicine Research Conference. By combining these conferences into one event, the meeting serves as a critical strategy session for leaders to set future milestones for the Department of Defense's deployment-related medical research programs, centered on the needs of the Warfighter.

Disclaimer: Re-published content may have been edited for length and clarity. Read original post.


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From the classroom to the fight: Preparing for surgical care on the battlefield

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For surgical care on the battlefield, the difference between life and death comes down to time, resources, and training. Preparing for the unique circumstances of an austere setting can pose a challenge for the most experienced health care professionals used to working in hospital settings. But thanks to research advancements in surgical care training, realistic preparation for surgery in a war zone has improved.

Downrange surgical care has improved the survival of combatants as the specialty has grown over the last 15 years of war, said Army Reserve Maj. Matthew D’Angelo, assistant professor and interim associate dean for faculty affairs at the Uniformed Services University of Health Sciences’ Graduate School of Nursing

“We know surgical care saves lives, but unfortunately there’s a barrier of getting those injured folks into the clinical setting,” said D’Angelo, speaking at the Military Health System Research Symposium Aug. 27.

Bringing expeditionary resuscitation and surgical teams directly to the battlefield reduces time and distance, increasing chances for survival. Made up of experienced surgeons, physicians, and nurses with specialties ranging from general surgery to emergency room care, the teams are equipped to provide crucial surgery procedures out in the field.

Since competency of skills can be context-related, being successful in a modern hospital setting may not translate into the same success in an austere environment, said D’Angelo. The curriculum is designed to educate and help health care providers adapt to a tactical setting. The team is trained to perform resuscitation, damage control surgery, triage and emergency room care, critical care transport, and prolonged field care.

“They work in a brick-and-mortar facility, so there are some challenges to these types of teams,” said D’Angelo. “How do we take someone who is from a military treatment facility and orient them to the austere locations?”

To help teams learn to work together quickly and adjust to the special operations forces mission, MEDCOM reached out to the U.S. Army Medical Department Center and School. Its division of predeployment medicine came up with a 21-day training platform. The program is broken down into eight days of pre-requisite ERST training and 13 days of ERST training. The first seven days of ERST training focuses on equipment and team development. The last six days are primarily field exercises, which allow teams to work hands-on with equipment in a tactical setting.

Calling the curriculum “developmental,” D’Angelo described the scenario- and problem-based training experienced by students at Joint Base San Antonio, Texas. As the course’s difficulty gradually builds each day, teams face more challenges and must work together.

From the clinical side of surgical care, experts provided updates on current research to address various aspects of surgical procedures. Navy Lt. Luke Johnson, a general surgery resident at Walter Reed National Military Medical Center, said the goal of his project was to look at the use of tranexamic acid, or TXA, for traumatic combat injuries.

By the end of the study, all massive transfusion patients were given the solution. The data show TXA was successful, but overusing it can increase risk for complications. Researchers continue their search for solutions to curb excessive bleeding in traumatic combat injuries and to reduce the risk of complications.

The Military Health System Research Symposium brings together medical providers, researchers, and senior leaders to share research and health care advancements. The symposium highlights research for combat casualty care, operational medicine, clinical and rehabilitative medicine, and infectious diseases.


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Did you know?

The issuance or replacement of military service medals, awards and decorations must be requested in writing.

Requests should be submitted in writing to the appropriate military service branch division of the NPRC. Standard form (SF 180), available through the VA, is recommended to submit your request. Generally, there is no charge for medal or award replacements. For more information, or for the mailing address of the military branch office to submit your request to, call 1-86-NARA-NARA (1-866-272-6272) or visit the NPRC website at www.archives.gov