Characterization of initial ankle-foot prosthesis prescription patterns in U.S. Service members following unilateral transtibial amputation.

Introduction: The purpose of this study was to explore relationships between patient-specific characteristics and initial ankle-foot prosthesis prescription patterns among U.S. Service members with unilateral transtibial limb loss. Methods: A retrospective review of health records identified 174 individuals with unilateral transtibial limb loss who received care at Walter Reed National Military Medical Center between 2001 and 2019. We examined patient-specific factors such as demographics, participant duty status at injury and amputation, amputation etiology, and timing between injury, amputation, and initial prescription. The type of first prescribed ankle-foot prosthesis was categorized as energy storing and return - nonarticulating, energy storing and return - articulating, or computer controlled. Results: Sex, amputation etiology, time from injury to initial prescription, and time from amputation to initial prescription differed by type of initial ankle-foot prosthesis prescription. Service members with shorter intervals between injury-initial prescription and amputation-initial prescription, and those injured by combat blast, were more likely to receive a non-articulating device. Incorporating sex, time from injury-initial prescription, time from amputation-initial prescription, and amputation etiology as predictors of prosthesis type, we were able to correctly classify 72% of all first prostheses prescribed. Discussion: Patient-specific characteristics such as sex, the time between injury-initial prescription, time from amputation-initial prescription and amputation etiology are essential characteristics that influence initial ankle-foot prosthesis prescription patterns in U.S. Service members.

Evaluation of the Impact of the Wound Treatment Associate (WTA) Education Program on Practice and Quality Patient Outcomes.

PURPOSE: The Wound Treatment Associate (WTA) program is an education offering of the WOCN Society. This evidence-based continuing education program prepares nurses to serve as a unit-based resource for nursing staff. The WTA program is approved by the American Nurses Credentialing Association (ANCC) for 32.25 contact hours and aimed at licensed health care personnel. This article focuses on the impact of this education program, in particular a reduction in hospital-acquired pressure injury (HAPI) in acute care and decrease in visits per episode (VPE) and supply costs in home health. METHODS: Surveys were sent to all course participants to date to fulfill the summative evaluation requirement for ANCC approval to determine the perception of improvement in knowledge, skills, and practice. An additional survey was developed and reviewed by members to send to WTA program course coordinators. RESULTS: Participants (n = 153) reported an increase in confidence in knowledge and skills about wound care and use in nursing practice. The number of respondents to the course coordinator survey was lower (n = 48). Coordinators did report a reduction in pressure injuries in acute care. Home health respondents noted a decrease in VPE and reduction in the cost of supplies. Data reported on abstracts and posters suggested positive impacts of pressure injury prevention programs in acute and home health care. CONCLUSIONS: Although there are limitations to the aforementioned reporting, incorporating the WTA program into pressure injury prevention programs and wound treatment programs showed a reduction in HAPIs in acute care and decreased VPE and supply costs in home health.

Caring for the Veteran, military and family member nursing competencies: Strategies for integrating content into nursing school curricula.

In the United States, one in every 15 persons is a Veteran (U. S. Department of Veterans Affairs, 2016; U. S. News & World Report, 2017). An estimated 27% of these Veterans receive healthcare through the Veteran's Health Administration (VHA), leaving 73% to seek care in civilian hospitals (Bagalman, 2014). Realistically, most nurses in the United States will care for military members, Veterans or family members in a variety of healthcare systems and settings. Nurse educators are positioned to lead efforts in providing nursing students with the knowledge necessary to provide competent care and serve as advocates for our nation's heroes. Recent military deployments and news about the VHA have increased awareness of this population. This article describes competency development resulting from an academic-practice partnership experience between two baccalaureate programs and a national military medical center. Project SERVE, Students' Education Related to the Veteran Experience, utilizes a didactic-experiential model consisting of activities designed to teach students core concepts, including understanding military culture, poly-trauma, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and issues facing families and care-givers. This article includes competencies, delineating the Knowledge, Skills, Attitudes, and resources for the provision of care to the Veteran population. The authors offer strategies to integrate care of Veterans, and military/family members content into nursing programs and replicate similar experiences. Opportunities for future development, challenges, faculty resources for curricular inclusion, and student reflections of the experience are presented.

Development of an evidence-based pressure ulcer program at the National Naval Medical Center: nurses' role in risk factor assessment, prevention, and intervention among young service members returning from OIF/OEF.

Since the beginning of the wars in Iraq and Afghanistan, the incidence of pressure ulcers from various causes has increased. This article discusses the knowledge nurses need to care for casualties returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) who may be at risk for developing pressure ulcers. This article also describes the development of an evidence-based pressure ulcer awareness program for young adults aged 18 to 35 years at a military treatment facility that receives casualties from OIF/OEF. This evidence-based program enables nurses to rapidly assess casualties for risk factors and initiate nursing interventions to mitigate the development of pressure ulcers. Improving the detection of pressure ulcers among the young OIF and OEF casualties may, in turn, reduce mortality and morbidity among these service members.

Combat Wound Initiative program.

The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care.