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Future of medicine at Madigan Research Day

Research and quality improvement projects highlighted

Rear Adm. Mary Riggs, director of Research and Development for the Defense Health Agency, gives the keynote speech at the 22nd Madigan Research Day at Madigan Army Medical Center May 3. Photo credit: Ryan Graham

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Whether they focused on increasing survival from abdominal injuries or ectopic pregnancies, or reducing opioid use or infections, the best Madigan Army Medical Center research and quality improvement projects got highlighted as residents, fellows and staff members presented their findings at the 22nd Madigan Research Day May 3.

"Not only is this a powerhouse for graduate medical education and graduate nursing education, but also a powerhouse of advanced levels of research and consideration," said Col. Thomas Bundt, the Madigan commander.

The day-long event kicked off with a keynote presentation by Rear Adm. Mary Riggs, director of Research and Development for the Defense Health Agency. With the ongoing transition of all of military medicine to DHA's command, the agency will eventually oversee the healthcare for almost 10 million patients.

"We will truly be involved in one of the largest healthcare systems in the world," said Riggs. "You're a part of that and we'll need your talents to continue to increase the efforts to make sure that warfighters are better cared for."

Madigan is already recognized in the research world for a strong focus on precision medicine and battlefield-related trauma, said Col. (Dr.) Richard Burney, chief of Madigan's Department of Clinical Investigation.

Saving more lives downrange is the focus of research by Capt. (Dr.) Dominic Forte, a Madigan general surgery resident who presented his study on how to better control abdominal bleeding from injuries such as blasts or gunshots.

"It's a leading cause of preventable death on the battlefield and that's why there's such urgency in addressing it, finding the best way to really improve survival with these injuries," said Forte.

While battlefield medicine currently uses a technique called resuscitative endovascular balloon occlusion of the aorta, or REBOA for short, to stop abdominal bleeding by inserting a balloon into the aorta, the downside is that it completely cuts off all blood flow to vital organs like kidneys and intestines.

Forte's research tested multiple prototypes of a partial REBOA, which inflates enough to adequately control bleeding while still allowing some blood to vital organs. His team is already working on the next step to better define the ideal parameters for such a prototype to get it closer to being used in actual patient care.

National health concerns like the opioid crisis were also being addressed by Madigan staff. Capt. (Dr.) Rowan Sheldon, a Madigan general surgery resident, shared his quality improvement project to reduce post-surgery opioid use. His team developed a standard protocol of giving patients 10 opiate tablets as a starting point for home pain management after surgeries, along with Tylenol and ibuprofen to take on a regular schedule to avoid "chasing the pain" with opioids. Patients said they were satisfied with their pain management, and in fact many did not use all of the opioids they were given.

"This was a comprehensive reform of how we do post-operative pain," said Sheldon. He also presented at the event on a study of mobile thermal imaging for the diagnosis of surgical site infections, as there's a noticeable difference between temperature trends of wounds healing normally and those that are infected. The study's goal is to increase early diagnostic certainty of post-surgical site infections.

Groundbreaking accomplishments to the level of pending patents also got some stage time.

"A real marker of innovation is the successful submission and acceptance of a patent application, and Madigan in March had two patents that were submitted to the U.S. Patent Office ... that's very reflective of the innovation that's occurring at the institution," said Bundt, who added that revenue generated by some patents can serve as a source of funding for future research.

One of those potential patent-holders, Lt. Col. (Dr.) Dennis Fujii, also spoke at Research Day. While his pending patent focuses on ways to diagnose diseased fallopian tubes, the reproductive endocrinology and infertility fellow presented another study on healthy fallopian tubes.

"(Embryos) basically spend the first three days developing in the environment of the fallopian tube and so we feel like more knowledge of that environment will help us to gain more insight, will help us with more targeted improvements in our assisted reproductive technologies, and will also offer information about the environment which could potentially impact other processes," said Fujii.

Another REI fellow, Capt. (Dr.) Jessica Lentscher, shared her research (and pending patent) on tests for ectopic pregnancies, which are located outside of the uterus.

"We're trying to see if there is a better diagnostic test to identify where a pregnancy is located in the early stages of pregnancy," said Lentscher, adding that finding the pregnancy location as early as possible is vital to avoid rupture and to treat women earlier.

She emphasized an appreciation for her patients who took part in the study.

"I'm really appreciative of all of the patients who have consented to be a part of this study, especially given that this situation is most of the time really disappointing and difficult, but these patients are going above and beyond in hoping to further our knowledge in the care of future generations," Lentscher said. "I'm really thankful for that."

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