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Experts talk knowledge translation benefits for Military Health System

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Researchers from all over the globe gathered this week at the annual Defense Department Military Health System Research Symposium (MHSRS). Known as the top military medical conference in the world, it is an academic-based venue for professionals to talk, learn and share with each other. The focus of this year’s event was how military medical experts use cutting-edge research to improve care for the warfighter.

Dr. Richard Stoltz, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) acting director, spoke at this year’s MHSRS. Along with colleagues, Stoltz introduced the knowledge translation process developed at DCoE. He focused his discussion on how using a systematic approach and best practices can impact military psychological health challenges.

Why Knowledge Translation?

Once experts capture medical research data, they may use a knowledge transition process to distill the information into regular clinical practice.

For example, groundbreaking research in medicine needs to undergo lengthy processes, from publication to being accepted by medical associations, before health care providers are regularly using this innovation to better treat patients.

On average, it takes more than a decade for providers to adopt new research. Public health organizations, such as the Centers for Disease Control and Prevention and Agency for Healthcare Research and Quality, see the value in speeding this process up. These agencies invested time and developed their own evidence-based knowledge translation processes.

Stoltz believes the Military Health System (MHS) will benefit from embracing knowledge translation best practices and procedures.

“The leaders at these agencies believe that not having a translation process is like leaving for a road trip without a map or GPS,” said Stoltz. “If we develop a clearer map, we will get to our destination more efficiently."

Navy Capt. Mike Colston, former DCoE director, explained the importance of translating research findings to improve medical practices during his May report to Congress.

“This capability provides a standardized process to use psychological health and traumatic brain injury (TBI) research to develop evidence-based practices and consistent standards of health care,” said Colston. “We are optimistic that this process may also herald advancements in MHS practices beyond psychological health and TBI.”

DCoE Process Model Feedback

During his briefing, Stoltz outlined a DCoE standardized, adaptable knowledge translation process model.

He also offered a practical example of the DCoE process with details from a beta test using the popular Virtual Hope Box mobile app. The purpose of the app, a National Center for Telehealth and Technology (T2) product, is to help people coping with stress and negative emotions.

During the test, T2 included knowledge translation best practices into a behavioral health provider workshop at Fort Carson, Colorado, in October 2016. The success of the initial test inspired additional tests.

Dr. Robert Ciulla, T2 mobile health program lead, and his team executed the beta test. Ciulla believes that although they succeeded in improving providers’ understanding of mobile health tech, proactive teamwork is critical to successful implementation.

“A key piece [of knowledge translation] is promoting behavioral change,” Ciulla said. “We’re asking providers to make fundamental changes to the way they approach their clinical practice.”

Provider Feedback

Dr. Kathy McGraw, Deployment Health Clinical Center (DHCC) deputy director, supports using knowledge translation to reduce the gap between research and evidence-based practices. A standard process would reduce the time it takes the military to translate research findings into clinical practice, according to McGraw.

McGraw is also part of the Defense Department and Department of Veteran Affairs Practice-Based Implementation Network. This network is a cadre focused on bridging the gap between mental health research and clinical practice in the military and veteran communities.

“Using standardized processes would save time and better inform us [health care providers] on how to invest our resources,” she said.

There are 9.4 million service members, veterans and family members who rely on the MHS for care. The thoughtful discussions during the symposium reflect how important a knowledge translation process is – especially for warfighters.

“Systematic processes that move research from bench to field within the same system can greatly benefit the MHS,” Stoltz said. “Otherwise, good work and important contributions may get stuck on the sidelines.”

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

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NHRC shares research that supports warfighter readiness at MHSRS

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​KISSIMMEE, Florida – Scientists from the Naval Health Research Center (NHRC) attended the 2017 Military Health System Research Symposium (MHRSRS), Aug. 27-30, to share their latest research that supports the readiness and health of U.S. warfighters.

MHSRS is a scientific meeting focused on the unique medical research needs of the U.S. armed forces. Scientists from across the Department of Defense (DoD), share information about current research initiatives for new treatments and prevention measures for injuries and diseases that improve mission readiness and protect the health of warfighters on and off the battlefield.

“I assumed command two weeks ago and this symposium was the perfect opportunity to learn more about our researchers and their work,” said Capt. Marshall Monteville, NHRC’s commanding officer.  “The presentations on NHRC’s current studies provided valuable insight about the readiness questions and challenges our lab is answering. Our warfighters are operating in an uncertain world and they need to be prepared for whatever threat comes their way. It’s our job, as researchers, to anticipate the threats to their health and readiness to support their preparedness.” 

Among the keynote speakers was Dr. David Smith, acting principle deputy assistant secretary of defense for health affairs, who told researchers they were the critical human foundation for military medicine’s successes in saving lives on and off the battlefield. 

Researchers from each of NHRC’s core research areas—Operational Readiness and Health, Operational Infectious Diseases, and Military Population Health— are doing their part to advance the success of military medicine and help prepare warfighters for the battlespace of the future, wherever that may be. 

During the symposium, NHRC’s scientists shared their research findings with military medicine colleagues and partners from academia and industry on a broad array of topics during breakout and poster sessions that highlight the innovative work they’re doing, including: 

  • ​New-onset asthma and deployment
  • Adenovirus serotypes
  • Meningococcal disease surveillance
  • Health-related quality of life among combat-injured military
  • Musculoskeletal injury risk
  • Military eye injury rates 
  • Identifying neuromarkers for mTBI in an immersive virtual reality environment

“This is my first Military Health Research Symposium and I am amazed by the breadth and depth of the NHRC research presented,” said Dr. Kenneth Earhart, NHRC’s science director and retired Navy infectious disease physician. “Our scientists have shared their study findings by giving more than 28 presentations across all days and most sessions. It's clear that our scientists are having a profound impact on the readiness, performance, and quality of life of our war fighters and their families.”  

As the DoD’s premier deployment health research center, NHRC’s cutting-edge research and development is used to optimize the operational health and readiness of the nation’s armed forces. In proximity to more than 95,000 active duty service members, world-class universities, and industry partners, NHRC sets the standard in joint ventures, innovation, and translational research.

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

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NHRC research protects U.S. military recruits from respiratory illness

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KISSIMMEE, Fla. – Researchers from the Naval Health Research Center (NHRC) discussed ongoing surveillance for adenovirus, a contagious pathogen that causes respiratory illness, among U.S. military recruits during basic training at the Military Health System Research Symposium (MHRSRS), Aug. 27.

In the mid-1990s, the adenovirus vaccine was discontinued at military recruit training commands throughout the Department of Defense (DoD), resulting in frequent respiratory illness outbreaks. Adenovirus was the most prevalent and widely spread virus in military training environments, infecting up to 80 percent of recruits and resulting in lost training time and increased medical care. 

In 2011, the adenovirus vaccine was reinstated for military recruits after NHRC and the Walter Reed Army Institute of Research conducted a clinical trial that demonstrated its safety and efficacy. According to researchers with NHRC’s operational infectious diseases team, after the live, oral vaccine for adenovirus types 4 and 7 was resumed, rates of adenovirus among recruits declined dramatically—cases went from 250 each week to two, on average. To date, other adenovirus serotypes—3, 14, and 21—that had previously caused illness in recruits have not reemerged.  

Because there was such a dramatic drop in adenovirus-related cases, NHRC researchers wanted to determine if the vaccine provided protection against these other adenovirus serotypes that have not reemerged after vaccination reinstatement. Because the other serotypes were not detected by routine surveillance, they hypothesized the vaccine would provide similar coverage and induce immunity against the other non-vaccine serotypes. 

To test their hypothesis, researchers obtained 100 paired blood serum samples—samples obtained from recruits before and after they received the adenovirus vaccine—to test for changes in the level of antibodies found in the blood produced by the immune system to fight infection after vaccination. Using cell culture based serological microneutralization assays, researchers quantifiably measured antibody endpoint titers, a measure of the amount of antibodies in the blood stream that is believed to be correlative with the body’s immune response. 

Findings revealed that titers in the recruits’ blood before they were vaccinated were low against four of the five adenovirus types—4, 7, 14, and 21. The titers from the second sample, which were taken at least four weeks after the recruits were vaccinated, showed increased protection against the vaccine types 4 and 7, but not against the other three non-vaccine serotypes tested. Even though the vaccine protected against types 4 and 7, there was little evidence that it provided protection against the other adenovirus serotypes. 

Vaccination has dramatically decreased adenovirus-related illness and febrile respiratory rates in recruit population, resulting in less disruption and setbacks to training, reducing both the cost of health care and recruit training to the DoD. To understand why the other serotypes have not emerged among recruits after vaccination resumption and ensure recruits continue to be protected against outbreaks of this illness, researchers say further studies are needed. 

As the DoD’s premier deployment health research center, NHRC’s cutting-edge research and development is used to optimize the operational health and readiness of the nation’s armed forces. In proximity to more than 95,000 active duty service members, world-class universities, and industry partners, NHRC sets the standard in joint ventures, innovation, and translational research.

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

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Annual consent for automatic prescription refills begins Sept. 1

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Beginning Sept. 1, 2017, Express Scripts will need annual consent from patients who want to receive automatic refills of their maintenance medications enrolled in TRICARE Pharmacy Home Delivery. This means that just before one of your prescriptions runs out of refills, Express Scripts will reach out to you to know if you would like your doctor to be contacted to renew the prescription and if you’d like to continue in the Automatic Refill program. If not, Express Scripts will not refill your prescription.

“This new process gives beneficiaries more control over their medications and keeps the convenience of automatic refills,” said Amy Aldighere, Express Scripts Sr. Director – DoD Program Management. “It also makes it easier to opt out of the Auto Refill program and helps to prevent beneficiaries from receiving medications that they no longer need or shouldn’t receive.”

What to Expect

When the last refill of a medication enrolled in the Automatic Refill program ships, Express Scripts will reach out to you by telephone and/or email (depending on the preference you indicated) and ask the following:

  • Would you like Express Scripts to reach out to your doctor for a new prescription?
  • Do you want to keep your medication enrolled in the Auto Refill program?

How to Respond

Express Scripts will not re-enroll your medication unless they hear from you. You have several ways to respond:    

  • Online at
  • Via the automated phone call from Express Scripts
  • By calling an Express Scripts Patient Care Advocate (PCA) at 1-877-363-1303

If Express Scripts does not receive your consent within 10 days of reaching out to you, they will remove your medication from the Auto Refill program. However, re-enrolling is simple. You can re-enroll your medication at any time online, or through a PCA.

For more information or if you have questions, go to the Express Scripts website. You can also call Express Scripts at 1-877-363-1303 to speak with a PCA. 

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Studies seek to improve everyday life after injury, amputation

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Dealing with the ups and downs after an amputation or injury can be difficult and frustrating. From the effects of prosthetics on the energy and strength of a person to the influence on daily tasks, researchers look for answers that lead to solutions. During this week’s Military Health System Research Symposium in Kissimmee, Florida, experts share insight into the growing area of research studying different aspects of everyday life after an injury.

Dr. Brittney Mazzone, a research physical therapist with the Extremity Trauma and Amputation Center of Excellence, or EACE, and the Naval Medical Center San Diego, studied tobacco and alcohol use among 120 service members, all males with an average age of 26, one year before and one year after a below-knee amputation.

“We did have significant findings for both tobacco and alcohol use,” said Mazzone, while speaking at the Military Health System Research Symposium Aug. 28. For tobacco use, 42.7 percent reported using the product before the procedure and the number increased to 57.5 after. Alcohol use was reported in 50.4 percent of subjects before the amputation, whereas the number increased to 68.6 percent after. While this study was small in sample size, the study will expand from 120 to 2,000 service members, with an additional focus on different types of amputations.

“It’s already known that these habits can be detrimental to one’s health,” said Mazzone, who stressed that tobacco use can lead to complications after an amputation, including failure to heal. Alcohol can increase risk for musculoskeletal conditions, heart and liver diseases, and diabetes. It can also lead to complications after an amputation, including poor wound healing, infection, sepsis, pneumonia, bleeding, longer hospital stays, and possibly admission into an intensive care unit, said Mazzone. Having this kind of information can show where service members and veterans may need additional support to lead healthier lives. Programs, such as UcanQuit2 and That Guy are available to help service members and veterans quit tobacco and alcohol use.

Researchers also reported on other studies related to recovery from amputation or limb injury. Jill Cancio, an occupational therapist with EACE, studied the validity of a hand-function exercise for patients who have a hand injury. The study involved subjects doing a test including about 20 everyday tasks, such as putting pills into a pill box, folding clothes, and packing a suitcase, with their dominant or non-dominant hand.

“Hand functions affect all aspects of one’s life,” said Cancio. “Understanding individual hand function can assist therapists with the process of determining relevant treatment approaches and realistic treatment outcomes.”

Research suggests that the dominant and non-dominant hands each function differently during task performance, said Cancio. Because of these differences, it’s important for rehabilitation professionals to separately assess their abilities. The study shows a ‘suitcase-packing activity’ has validity in recognizing and diagnosing functional abilities after a hand injury. Future research can use this information to focus on more specific groups, such as patients with amputations, said Cancio.

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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