Research, Innovation Month spotlights studies conducted at Walter Reed Leave a comment

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By Bernard S. Little
WRNMMC Command Communications

Food insecurity for military families is a concern. Abscess incision and drainage procedure training for medical students can be a challenge, with trainees often missing opportunities to perform or learn the procedure.
These were just two of a number of issues researched and tackled by participants in Walter Reed’s Department of Research Programs’ (DRP) annual poster competition, which kicked off 2023 Research and Innovation Month activities on May 1 at the medical center.
The competition, named in honor of the late Dr. Paul Florentino, highlights investigative efforts concerning evidence-based practice, patient- and family-centered care, and performance and quality improvement.
Florentino’s career took him from his work as an Air Force flight surgeon to deputy commander of medical services at the former National Naval Medical (NNMC) Center, a predecessor of Walter Reed National Military Medical Center (WRNMMC). He helped guide the integration of NNMC and the former Walter Reed Army Medical Center to form WRNMMC. He was a major contributor in shifting the paradigm of care at the hospital from being primarily physician driven to physician, patient and family-centered, acknowledging the pivotal involvement of the patient and the patient’s family in care. The poster competition continues his legacy and is open to any WRNMMC department or team that initiates research, innovation, or process improvement to benefit patient- and family-centered care.
Dr. Lester Lactorte, Institutional Review Board (IRB) chair for Walter Reed’s DRP, said the events during Research and Innovation Month showcase “novel military research conducted by active-duty service members and federal civilian employees at Walter Reed and across the National Capital Region (NCR).” He added that the “scientific curiosity and thirst for knowledge” of those who conducted the research “will spearhead the development of novel medical solutions, better patient care, research and readiness.”
In addition to the poster competition, other events held during Research and Innovation Month include: the case report presentations; research symposium; and the 38th Annual Navy-Wide Academic Research Competition. The latter competition, between WRNMMC, Naval Medical Center Portsmouth, Virginia, and Naval Medical Center San Diego, will be May 16. Host of the competition rotates between the three medical centers, and Portsmouth hosts this year’s event with participants from WRNMMC and San Diego competin virtually.
The Research Award Recognition Ceremony will be May 24 at Walter Reed.

Food insecurity

During the presentations for the poster competition, Air Force Capt. (Dr.) Sidney Zven explained his research investigating food insecurity and the impact of WIC enrollment in military families. According to recent government statistics, around one out of four service members have suffered some form of food insecurity recently. This equates to approximately 286,000 service members and their families whom at some point in the last few years, found difficulty putting food on their table.
Zven stated WIC, the government’s program that aims to safeguard the health of women, infants and children who are at nutrition risk, is “not optimally utilized” by military families who would benefit from enrollment, and “military pediatricians and obstetricians are not familiar with WIC’s eligibility criteria or enrollment process” to brief military families during their appointments. He explained a multi-faceted approach with not only providers, but also the service members’ units and chain of command becoming familiar with WIC to better inform those who may be at risk of food insecurity about the program so it can be fully optimized by military beneficiaries who qualify for it.

Peds endoscopy counseling

Army Capt. (Dr.) Janet Jang explained her work for improving outpatient pediatric endoscopy counseling through use of an educational patient handout. She said the handout “was associated with significantly improved pre-endoscopy counseling quality but did not improve levels of procedural anxiety” of those she surveyed.
“Routine utilization of educational endoscopy materials should be offered during initial procedure discussion and counseling,” she concluded.

Peds nutrition

Air Force Maj. (Dr.) Nathan Kolasinski’s research also focused on nutrition. His work, titled “Evaluation of a Novel, Evidence-Based Pediatric Nutrition Status Screening Protocol at a Tertiary Care Military Medical Center,” investigated acute malnutrition among pediatric inpatients.
“Malnutrition is common among children and associated with increased morbidity and mortality,” Kolasinski stated. He added, “the Pediatric Nutrition Status Screening Form enabled determination of the acute malnutrition status of each admitted child and assignment of a nutrition-related diagnosis if applicable.
“The prevalence of acute malnutrition in our study population was greater than expected based on previous domestic studies, suggesting either a population-specific effect and/or worsening trends nationally,” Kolasinki shared. “Accurately assigning a nutrition-related diagnosis enables appropriate, targeted outpatient intervention,” he added.

WIC awareness

Air Force Capt. (Dr.) Amy Davis also researched increasing timely WIC enrollment for eligible military families. She shared that “families are eligible for WIC during pregnancy, but eligibility is often not recognized until well after a child is born, if at all.”
Davis stated that her research results “support the need for earlier and more consistent WIC screening. Standardized use of screening tools and increased awareness may facilitate enrolling families in WIC in a timely manner and help to combat food insecurities throughout the entire Military Health System.”

Nursing education

Army Capt. (Dr.) Alexander Pastino researched the use of quick response (QR) codes as an educational resource for nursing staff. He explained that the anesthesia staff recognized a lack of understanding among nursing staff for a specific automated pump used by the military to deliver anesthetic medication to peripheral nerve catheters and epidurals. He stated that following the use of quick response codes, the intervention led to a 50-percent reduction in nursing competency-related pump errors. The QR code learning guide was made readily available on the pump and in medication rooms, he added.
“Reduction in pump-related errors led to improved patient outcomes with no harm events during the 30-day study period of the primary intervention,” Pastino shared. He added peer-to-peer teaching may have also influenced a “positive impact of countermeasures on safe and effective patient care.”

Abscess trainer

Army Capt. (Dr.) Anthony Lucido explained his team’s work in developing and implementing “a novel abscess trainer in [graduate medical education, GME].” He shared that abscess incision and drainage (I&D) procedure is a requirement for primary care and surgical training by the Accreditation Council for GME. I&D are typically performed in acute care settings, with trainees often missing opportunities to perform or learn the procedure. A simulation model is necessary to address this deficiency and provide an opportunity for continued learning. Despite this necessity, no viable simulation option currently exists.”
Lucido said 87 GME trainees in the NCR used the abscess model his team developed. The trainees completed pre and post surveys. According to the surveys, he said the confidence scores of trainees for doing I&D procedures after using the model increased. “The preparedness scores showed a statistically significant improvement, and trainees reported the abscess model was realistic and beneficial,” he added.

Reducing radiation

Navy Lt. Cmdr. (Dr.) John LoVoi researched split bolus urography reduction, or radiation dose reduction, and its impact in low-risk patients 50 and under. He explained that “split-bolus computed tomography urography (CTU) technique is a reasonable alternative to triple-phase CTU technique in the appropriate population,” and his project’s aim was to reduce total radiation dose to low-risk patients ages 50 and under, being evaluated with CTU for microscopic hematuria.
LoVoi concluded that the benefits of the split bolus technique not only reduced the risk of radiation induced secondary malignancies and radiation side effects, but also reduces scatter radiation, decreasing the risk to radiation techs and medical providers.
Research and education, in addition to patient care, form the foundation of Walter Reed National Military Medical Center, according to retired Army Col. (Dr.) Clifton Yu, deputy director for the Department of Education, Training and Research.
WRNMMC’s Vision states its goal is “to be the first choice for our beneficiaries and staff as the world’s premier military medical center for health, readiness, education and research.”

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