Implementation of the Acute Care Clinic Easy Scheduling System at the Brooke Army Medical Center.

INTRODUCTION: Emergency departments (EDs) have continued to struggle with overcrowding, causing delays in patient care and increasing stress on the medical staff and resources. This was further illustrated during the recent coronavirus disease 2019 pandemic, where we saw large unpredictable surges to the ED as hospitals tried to meet the medical needs of patients while trying to minimize the spread of coronavirus disease. A previous study from the Department of Emergency at the Brooke Army Medical Center (BAMC) found that nearly half of the patients presenting to the ED could have been managed in a primary care setting. We sought to pilot an alternate appointment scheduling system, Acute Care Clinic Easy Scheduling System, to allow patients to see and book available appointments while waiting in the ED waiting room. MATERIALS AND METHODS: Our appointment display system was created through collaboration with the BAMC Information Management Division. A Tableau data interface connects to the Composite Health Care System to view available primary appointments across the San Antonio Military Health Care System. These are displayed in real-time on multiple TV screens outside the ED and in the ED waiting room. Patients were provided signage that provides a way to call or use a World Wide Web-based interface to immediately schedule the open appointments within the next 48 hours. Patients voluntarily opted to use this system and may opt to leave the ED if another appointment became available within an acceptable time frame to them. RESULTS: This section is not applicable to this article. CONCLUSIONS: Expansion of the Acute Care Clinic Easy Scheduling System within the Military Health Care System may (1) help reduce ED crowding, (2) improve access to care through a live-tracking system that patients can review and select from, and (3) reduce the number of unfilled primary care appointments. The system in place in the BAMC ED serves as a template for other MTFs to use.

Battle Injury Patterns Sustained Noncombatant Military Occupational Specialty Service Members.

BACKGROUND: The US military has been engaged in the Global War on Terrorism for nearly 2 decades. This asymmetric warfare has exposed many noncombat military occupational specialties (MOS) personnel to combat. We assessed what proportion of casualties were combat versus noncombat MOS personnel. METHODS: This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry (DODTR). We included US military casualties sustaining battle injuries from January 2007 to March 2020 with a documented MOS. We classified each casualty as combat versus noncombat MOS personnel. RESULTS: There were 2,037 casualties who met inclusion for this analysis. Within these groups, there were 1,554 (76%) combat and 483 (24%) noncombat personnel. The median ages were 24 and 25, with more males among the combat MOS personnel (99% versus 93%). Army personnel comprised the largest proportion of both groups (78% versus 75%) with most injured by explosive (73% versus 78%). Median injury severity scores were similar (9 in both groups) as was survival (98% versus 98%). The annual proportion of battle injuries comprised of noncombat MOS personnel fluctuated year-to-year. The proportion of noncombat personnel with a medic in their chain of care was similar to combat personnel (25% versus 26%), as was the proportion undergoing medical evacuation by ground (11% versus 11%) or air (87% versus 86%). All prehospital interventions occurred in similar proportions except for ketamine administration (8% combat versus 3% noncombat MOS personnel). CONCLUSIONS: Our study showed noncombat MOS personnel comprised nearly one in four casualties. Injury patterns were similar between combat and noncombat MOS personnel with nearly identical consumption of resources except for ketamine. More data is necessary on noncombatant MOS personnel battle injury patterns to guide commanders and medical leaders for future mission planning in resource constrained environments.

Role of α-Dystrobrevin in the differentiation process of HL-60 cells.

The α-Dystrobrevin gene encodes at least five different protein isoforms, expressed in diverse tissues. The α-Dystrobrevin-1 isoform (α-Db-1) is a member of the cytoplasmic dystrophin-associated protein complex, which has a C-terminal extension comprising at least three tyrosine residues susceptible to phosphorylation in vivo. We previously described α-Db in stem-progenitor cells and blood neutrophils as playing a scaffolding role and, in association with kinesin and microtubules, α-Db promotes platelet-granule trafficking. Additionally, the microtubules must establish a balanced interaction with the lamina A/C network for appropriate nuclear morphology. Considering that the most outstanding feature during neutrophil differentiation is nuclei lobulation, we hypothesized that α-Db might possess a pivotal function during the neutrophil differentiation process. Western Blot (WB) and confocal microscope assays evidenced a differential pattern expression and a subcellular redistribution of α-Db in neutrophils derived from HL-60 cells. At the end of the differentiation process, we detected an important diminution in the expression of tubulin, kinesin, and α-Db-1. Knockdown of α-Db prevented nuclei lobulation, increased Lamin A/C and syne1 expression and augmented the roughness of derived neutrophil membrane and disturbed filopodia assembly. Our results suggest that HL-60 cells undergo extensive cytoskeletal reorganization including α-Db in order to possess lobulated nuclei when they further differentiate into neutrophils.