Optimizing Virtual Health Technologies Through a Performance-based Readiness Model: Lessons From the Field Deployment of National Emergency Tele-Critical Care Network.

INTRODUCTION: The advancement of the Army's National Emergency Tele-Critical Care Network (NETCCN) and planned evolution to an Intelligent Medical System rest on a digital transformation characterized by the application of analytic rigor anchored and machine learning.The goal is an enduring capability for telecritical care in support of the Nation's warfighters and, more broadly, for emergency response, crisis management, and mass casualty situations as the number and intensity of disasters increase nationwide. That said, technology alone is unlikely to solve the most pressing issues in operational medicine and combat casualty care. MATERIALS AND METHODS: A total performance system (TPS) creates opportunities to address vulnerabilities and overcome barriers to success. As applied during the NETCCN project, the TPS captures the best performance-centric information and know-how, increasing the potential to save lives, improve readiness, and accomplish missions. RESULTS: The purpose of this project was to apply a performance-based readiness model to aid in the evaluation of Army telehealth technologies. Through various user-facing surveys, polls, and reporting techniques, the project aimed to measure the perceived value of telehealth technologies within a sample of the project team member population. By providing a detailed approach to the collection of lessons learned, researchers were able to determine the importance of information and methods versus a focus on technology alone. The use of an emoji-based feedback assessment indicated that most lessons learned were helpful to the project team. CONCLUSIONS: Through the NETCCN TPS, we have been able to address product-related measures, knowledge of product efficacy, project metrics, and many implementation considerations that can be further investigated by setting and engagement type. Through the Technology in Disaster Environments learning accelerator, it was possible to rapidly acquire, process, organize, and disseminate best practices and learnings in near real time, providing a critical feedback and improvement loop.

Rehabilitating the Injured/Ill Worker to Maximum Medical Improvement (MMI).

The concepts associated with work disability are not identical to those associated with medical disability. In addition to a worker's medical condition, the resultant functional limitations, and loss of participation in society, the injured or ill worker must often navigate a complex administrative system that often seems adversarial. This process is made less adversarial with the willingness to participate of knowledgeable clinicians. This article informs the interested clinician in regard to the unique aspects of work disability, including the issues of work accommodations, restrictions, and fitness for duty; prolonged work disability; and other return-to-work considerations at maximum medical improvement.

Rehabilitation of the Complex Burn Patient with Multiple Injuries or Comorbidities.

Patients with complex burn injuries require interdisciplinary rehabilitation to maximize their functional recovery. Successful rehabilitation from burn injuries starts with addressing the loss of the protective, mechanical, and cosmetic function of the skin and underlying structures. However, other injuries, particularly to the nervous and musculoskeletal systems, need to be identified and managed as part of the rehabilitation plan. Burn injuries can cause losses of functional mobility, self-care skills, psychological well-being, and community participation, which require comprehensive rehabilitation interventions throughout the recovery process.

Publish or perish?: physician research productivity during residency training.

OBJECTIVE: The aim of this study was to describe the rate and the types of resident physician peer-reviewed publications. Variables of interest include the type of publications, subject matter, external funding, study design, and quality of research by resident physicians published while in training. DESIGN: This is a retrospective cohort study of physicians who passed part II of the American Board of Physical Medicine & Rehabilitation certification examination in 2007 and 2008 (N = 654). RESULTS: The percentage of resident physicians with at least one publication during the study period was 19.9% (2007 cohort) and 16.3% (2008 cohort). Case reports (31%) and review articles (21%) represented more than half of all publications. There was no statistical difference in the publication rates between the allopathic and osteopathic physicians and between the size and the type of residency program. The publications in the American Journal of Physical Medicine & Rehabilitation (17.8%) and the Archives of Physical Medicine & Rehabilitation (15.2%) accounted for more than 30% of published research. External funding was identified in 39% of the articles. Thirteen percent of the articles had no subsequent citations. CONCLUSIONS: One in five resident physical medicine and rehabilitation physicians were identified as having peer-reviewed publications during residency. The typical resident physician publication was found to be a clinically focused case report or review article published in a rehabilitation-targeted journal. Existing resident research requirements and resident research programs may need to be reevaluated in light of these findings.

Anthropometric measurements, job strain, and prevalence of musculoskeletal symptoms in female medical sonographersf.

OBJECTIVE: Principal components analysis (PCA) was used to explore the relationship between anthropometric measurements, job strain and work organization factors and the prevalence of musculoskeletal symptoms/occupational injuries in medical sonographers. METHODS: A cross-sectional survey of twenty-six female sonographers at a tertiary medical center completed a standardized symptom questionnaire and underwent anthropometric measurement. First aid events and OSHA reportable injuries were abstracted from employee health records. RESULTS: 96% of subjects reported some type of musculoskeletal symptoms within the past year, with shoulders (73%), low back (69%) and wrist/hand symptoms (54%) reported most often. PCA identified seven domains among the predictive variables: physical size, job strain, time on job, abdominal girth, work pace/variability, movement during study, and time spent standing. The magnitude and direction of effect for predicting musculoskeletal symptoms varied by symptom location. Abdominal girth was consistently associated with increased likelihood of reporting symptoms. CONCLUSION: Sonographers work in a high demand/low control environment. Future studies of sonographers may need to include measures of both physical size and job strain. Reducing risk factors for one anatomical location may increase the risk at another location in this population.

Separating deployment-related traumatic brain injury and posttraumatic stress disorder in veterans: preliminary findings from the Veterans Affairs traumatic brain injury screening program.

OBJECTIVE: Traumatic brain injury in returning Iraq and Afghanistan combat veterans has been the subject of numerous articles by the popular press and congressional inquires. Recent research has questioned the accuracy of the traumatic brain injury diagnosis in veterans with depression and/or posttraumatic stress disorder and the validity of the Veterans Affairs traumatic brain injury screening tool to identify traumatic brain injury in returning combat veterans. DESIGN: Medical records of all combat veterans in the Veterans Affairs Connecticut Healthcare System who both screened positive for traumatic brain injury and received clinical evaluation for traumatic brain injury during the first year of the Veterans Affairs traumatic brain injury screening program were reviewed to explore the relationship between posttraumatic stress disorder and self-reported symptoms attributed to deployment-related traumatic brain injury. RESULTS: Ninety-four combat veterans identified from positive traumatic brain injury screens were seen in the Veterans Affairs Connecticut Healthcare System from April 1, 2007, to March 30, 2008. Eighty-five percent of the veterans with positive screens met the American Congress of Rehabilitation Medicine definition of probable traumatic brain injury. Symptom reporting was similar for veterans with and without a history of traumatic brain injury. Veterans with both posttraumatic stress disorder and traumatic brain injury were more likely to report falling as a mechanism of injury and indicated that they had suffered a head injury during deployment (P

The relationships between lost work time and duration of absence spells: proposal for a payroll driven measure of absenteeism.

OBJECTIVE: To propose a standard measure of absenteeism (the work lost rate [WLR]) be included in future research to facilitate understanding and allow for translation of findings between scientific disciplines. METHODS: Hourly payroll data derived from "punch clock" reports was used to compare various measures of absenteeism used in the literature and the application of the proposed metric (N = 4000 workers). RESULTS: Unpaid hours and full absent days were highly correlated with the WLR (r = 0.896 to 0.898). The highest percentage of unpaid hours (lost work time) is captured by absence spells of 1 and 2 days duration. CONCLUSION: The proposed WLR metric captures: 1) The range and distribution of the individual WLRs, 2) the percentage of subjects with no unpaid hours, and 3) the population WLR and should be included whenever payroll data is used to measure absenteeism.