A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study.

We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road's characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.

Advanced Metrics for Assessing Holistic Care: The "Epidaurus 2" Project.

In response to the challenge of military traumatic brain injury and posttraumatic stress disorder, the US military developed a wide range of holistic care modalities at the new Walter Reed National Military Medical Center, Bethesda, MD, from 2001 to 2017, guided by civilian expert consultation via the Epidaurus Project. These projects spanned a range from healing buildings to wellness initiatives and healing through nature, spirituality, and the arts. The next challenge was to develop whole-body metrics to guide the use of these therapies in clinical care. Under the "Epidaurus 2" Project, a national search produced 5 advanced metrics for measuring whole-body therapeutic effects: genomics, integrated stress biomarkers, language analysis, machine learning, and "Star Glyphs." This article describes the metrics, their current use in guiding holistic care at Walter Reed, and their potential for operationalizing personalized care, patient self-management, and the improvement of public health. Development of these metrics allows the scientific integration of holistic therapies with organ-system-based care, expanding the powers of medicine.

Holism at the National Intrepid Center of Excellence (NICoE).

Traumatic brain injury and posttraumatic stress disorder are the signature injuries of the Iraq and Afghanistan wars. Holistic medicine (comprising multispecialty care integration, patient/family-centered care, wellness interventions, and the construction of architectural "healing environments") has much to offer these patients. In this work we describe the architecture and holistic medicine programming of the National Intrepid Center of Excellence (NICoE), a new clinical research center for traumatic brain injury and posttraumatic stress disorder in the Military Health System. Architecture and clinical process are united in a "design/care continuum" for optimal healing. A groundbreaking institution, the NICoE foreshadows many trends in national healthcare for the 21st century.

The Epidaurus Project: holism in Department of Defense health facilities.

The Epidaurus Project, an advanced initiative in holistic (or whole-person) medicine, has operated in the Military Health System (MHS) since 2001. Its purpose has been to engage prominent civilian authorities on evidence-based building design, family-centered approaches, interdisciplinary care integration, and wellness, to optimize outcomes in the MHS. Over the past decade, many of the Epidaurus idea sets have been incorporated into MHS facility designs and therapeutic programs. The MHS owes a debt of gratitude to the numerous civilian thought leaders who participated in this project.

Holistic Care in the US Military I-The Epidaurus Project: An Initiative in Holistic Medicine for the Military Health System, 2001-2012.

This article describes the history and findings of the Epidaurus Project, a Uniformed Services University-affiliated project to bring holistic care and evidence-based design into the Military Health System (MHS). A distinguished group of civilian thought leaders contributed. The 2005 Base Realignment and Closure process offered a chance to implement the Epidaurus agenda. A new integrated healthcare delivery system, centered around the Walter Reed National Military Medical Center at Bethesda, Maryland, was the result. These facilities will be templates for a new generation of MHS "healing environments" and a model for innovative systems of healthcare nationwide. The Epidaurus Project represents a significant collaboration between civilian medicine and the military in times of war.

Este artículo describe la historia y los hallazgos del Proyecto Epidaurus, un proyecto en colaboración con la Uniformed Services University (Universidad de Servicios Uniformados), para incorporar la medicina holística y el diseño basado en la evidencia en el Military Health System (Sistema de Salud Militar). A ello contribuyó un grupo distinguido de líderes intelectuales civiles. El proceso de Realineamiento y Cierre de Bases del 2005 ofreció una oportunidad para implementar el programa Epidaurus. El resultado fue un sistema nuevo e integrado de asistencia sanitaria, centrado alrededor del Walter Reed National Military Medical Center de Bethesda. Estas instalaciones serán el modelo para una nueva generación de "entornos de salud" MHS y para sistemas de asistencia sanitaria innovadores a nivel nacional. El Proyecto Epidaurus representa una colaboración destacada entre la medicina civil y los militares en tiempos de guerra.

A tuberculosis event on a Navy assault ship.

A tuberculosis event occurred on a U.S. Navy amphibious assault ship in September 2003. The event was signaled by a jump in monthly purified protein derivative positivity rates. A baseline new reactor rate of 0 to 1% suddenly jumped to 6.3%, prompting screening of the entire crew and embarked Marines. Ultimately, a total of 31 Navy and 17 Marine new reactors was identified. This represented 2.4% of the Navy crew and 1.2% of embarked Marines. Only 1 of 31 Navy cases involved an officer. Two Navy, male, enlisted berthing areas showed a statistically significantly increased odds ratio for infection risk. Despite intensive investigation, no active case of tuberculosis was ever identified. After treatment of new reactors with isoniazid, the ship's monthly new reactor rate returned to baseline. This case illustrates the principles and pitfalls of respiratory disease control at sea.