Eric Schoomaker

Consortium for Health and Military Performance and American College of Sports Medicine Summit: Utility of Functional Movement Assessment in Identifying Musculoskeletal Injury Risk

Prevention of musculoskeletal injuries (MSKI) is critical in both civilian and military populations to enhance physical performance, optimize health, and minimize health care expenses. Developing a more unified approach through addressing identified movement impairments could result in improved dynamic balance, trunk stability, and functional movement quality while potentially minimizing the risk of incurring such injuries. Although the evidence supporting the utility of injury prediction and return-to-activity readiness screening tools is encouraging, considerable additional research is needed regarding improving sensitivity, specificity, and outcomes, and especially the implementation challenges and barriers in a military setting. If selected current functional movement assessments can be administered in an efficient and cost-effective manner, utilization of the existing tools may be a beneficial first step in decreasing the burden of MSKI, with a subsequent focus on secondary and tertiary prevention via further assessments on those with prior injury history.

Call to Action: “If Not Now, When? If Not You, Who?”

Few imperatives for health care practitioners—physicians, nurses, dentists, physician assistants, chiropractors, acupuncturists, and a myriad of others—have the urgency and gravitas of the charge to relieve pain and ameliorate or end the suffering of our patients. Yet fully 150 years after the first large-scale use of morphine for the treatment of pain in the Crimean War (1853–6) and the American Civil War (1861–5), there has been little progress in the management of pain. While the prevention, mitigation, and management of trauma, epidemic diseases, cardiovascular and renal diseases, malignancies, injuries and diseases associated with childbirth, endocrine disorders, rheumatologic diseases, and other major public health threats have dramatically advanced through a variety of technological breakthroughs and evidence-based approaches, the management of pain has not. The treatment of pain, especially chronic pain management, continues to rely heavily on variations of a century and a half of pharmacological approaches. Never before have the cumulative costs of these seemingly miraculous yet outmoded approaches been more apparent than today. The past decade has seen a sobering rise in complications associated with the use of prescription opioids, alone or in combinations with alcohol and psychotropic drugs. The Centers for Disease Control and Prevention have tracked an alarming increase in hospitalizations, and even deaths, associated with these prescription drugs over the past decade. Deaths from prescription opioids now outnumber deaths from motor vehicle accidents (MVAs) in 29 U.S. states and the District of Columbia [1]. So widespread and costly is this problem that use of these prescription agents, for legitimate reasons or for diversion, now appears to be a gateway practice for people who subsequently turn to illegal opioids such as heroin [2]. As if this vortex of opioid-related problems were not enough, our problems with traditional approaches to pain management do not end with these …

Patients' Use of Active Self‐Care Complementary and Integrative Medicine in Their Management of Chronic Pain Symptoms

In 2011, the Institute of Medicine (IOM) report Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research publicized the ongoing public health crisis of chronic pain, which was costing American society at least

Leadership Education and Development at the Uniformed Services University

560–

A Time for Massage.

635 billion annually. This figure represents the monetary impact of providing health care to pain patients and the cost of this health issue in lost productivity. It does not account for the incalculable toll in human suffering underlying these extraordinary figures. Perhaps the most significant outcome of this landmark report was the call by the authors for a “cultural transformation in the way clinicians and the public view pain and its treatment” [1]. Preceding the IOM report was the militarys own Pain Management Task Force Final Report (May 2010) [2], which was created during what has become the longest military conflict in American history. The PMTF noted that military medicine met and often exceeded civilian standards of pain care but was experiencing many of the same challenges as civilian medicine in dealing with chronic pain conditions, particularly an overreliance on over-the-counter and prescription pain medications. Perhaps a fundamental difference between these two landmark documents was the heightened sense of urgency expressed in the PMTF report as the country was entering its ninth year of war and the challenges of pain management in war wounded were becoming ever more apparent. The military medical response to the recent conflict has been a historic success, …

For the Relief of Suffering

INTRODUCTION The mission of the Uniformed Services University (USU) is to train, educate, and prepare uniformed services health professionals, officers, and leaders to directly support the Military Health System (MHS), the National Security, and National Defense Strategies of the United States and the readiness of our Armed Forces. USU’s commitment to this mission has not wavered since the school was founded in 1972. When the legislation that established USU was drafted, USU’s supporters in Congress envisioned that its graduates would form the backbone of the MHS. In this way, it was anticipated that USU would serve for the MHS what the Service academies— the U. S. Military Academy, the Naval Academy, the Air Force Academy, and the Coast Guard Academy—played for the nonmedical line. Today, 42 years after USU opened its doors, its 5,000-plus alumni have validated this vision. Over this time span, USU has contributed greatly to the MHS, with growing numbers of physician, nurse, and allied health alumni rising to key roles. Recognizing the Department of Defense’s (DoD) growing interest in leadership training, USU’s faculty and administration recently examined the content, quality, and impact of the training we provide our students to prepare them for the challenges the MHS will face. As we undertook this critical work through a task force charged with adapting and refining the USU Strategic Framework, we asked ourselves how well USU fosters six core leadership attributes required of future military leaders: (1) understand the environment and the effect of all instruments of national power; (2) anticipate and adapt to surprise and uncertainty; (3) recognize change and lead transitions; (4) operate on intent through trust, empowerment, and understanding; (5) make ethical decisions based on the shared values of the medical, nursing, and dental professions balanced with the Profession of Arms; and (6) think critically and strategically in applying health services support to joint warfighting principles and concepts in joint operations. In this manuscript, we describe USU’s approach to leadership development. Our program of instruction and experiential learning is designed to meet the Chairman of the Joint Chiefs of Staff, General Dempsey’s challenge of providing skilled leaders to the MHS to support the mission(s) of the DoD. THE LEADERSHIP CHALLENGE

A conceptual framework for leader and leadership education and development

Conflicts of interest: The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or United States Government. There are no conflicts of interest to report. Disclosure: The Evidence for Massage Therapy (EMT) Working Group (diverse stake-holders making up the steering committee and subject matter experts) contributed to the protocol development and provided input throughout the entire project; all analyses were conducted independently by Samueli Institute. All recommendations set forth in this report were made collectively with the EMT Working Group and Samueli Institute during an expert round table and are based on the evidence revealed through the systematic review and gaps that emerged through the process. The effect of simple human touch, particularly in the alleviation of pain, is one of the oldest approaches to healing known to humankind. There is growing evidence for its efficacy against pain that has been summarized in this series of Pain Medicine , published in the July, August and September issues and highlighting therapeutic massage research. This series of three systematic reviews [1–3] demonstrates good evidence for massage in the management of musculoskeletal … wjonas{at}siib.org

Seven Steps to Establish a Leader and Leadership Education and Development (LEAD) Program

T he nation currently struggles with one of the most insidious and erosive health epidemics in its history—an epidemic of poorly managed pain that has spawned an opioid crisis. In fact, the health system in this country is immersed in an epidemic of epidemics with each issue spawning other new health crises. This complex emergency involves the misuse and abuse of chronic prescription opioids and opiates, as well as heroin and other illegal street drugs. The crisis has had second-order effects including hepatitis C from needle sharing, in addition to destroyed families and the staggering loss of human potential derived from the increasing prevalence of addiction or the criminal consequences of addiction and chronic use. It is critically important to retrace the causes of this blossoming Bperfect storm^ of destructive social and health trends. The Centers of Disease Control and Prevention (CDC) have attributed them to poorly managed chronic pain. The magnitude of the national problems emanating from poorly managed chronic pain cannot be understated. Accidental deaths from drug overdoses, half of which now are from prescription opioids, are staggering in number. Between 1999 and 2015 over 183,000 people died from overdoses of these prescription opioids. 4 Prescription opioid deaths are approaching 20,000 a year; in 2016, combined prescription and illicit drug deaths—many of which can be attributed to gateway use of prescription opioids—topped 64,000. Just a few years of these ghastly losses exceed the number of American combat deaths in 15 years of fighting in Iraq and Afghanistan, the U.S. toll from the ten-year war in Vietnam and all of the American non-combat deaths in World War I when the most lethal modern epidemic—the Spanish Flu—was the leading killer. We are fast approaching the peak deaths from the HIV/ AIDS epidemic that occurred in the mid-1990s. These facts had not gone unrecognized by the Departments of Defense (DoD) and Veterans Affairs (VA). For over a decade, close cooperation between the DoD and VA communities in medical research, medical practice, and policy development have resulted in a shared perspective of the centrality of effective acute and chronic pain management and the need to combine efforts to find best practices and co-develop tools to address pain. This institutional insight began in the mid2000s during the peak of fighting in Iraq and Afghanistan when unprecedented survival from combat wounds, training and other injuries, and serious illnesses was being realized through a concerted effort to improve the protection, lifesaving measures, and recovery and rehabilitation of uniformed service members and veterans. Attending these improvements in survival and recovery of patients was the development of persistence of often crippling chronic pain—pain too often managed with potent psychotropic drugs and narcotics alone. A variety of internal reports and media stories made clear that many untoward effects of drug treatment were occurring, including accidental overdoses—even deaths—suicides, long-term addictions, and disability. The VA was the first to begin a comprehensive campaign to improve pain management. The DoD followed soon thereafter. In 2009–2010, the Office of the Army Surgeon General, united with the Navy and Air Force medical services, partnered with the VA in reviewing the extent of problems in managing pain and to adopt a more Bwhole-person^ approach that examined all existing evidence-based approaches and modalities that could be applied. The focus was on the wellbeing of the patient and return to optimal function. The result was the publication in 2010 of a PainManagement Task Force Report and the creation of a DoD pain management strategy to implement the report’s 109 recommendations. The recommendations fell into four broad categories: tools and infrastructure for advancing pain management—including a robust research program; a full spectrum of best practices—including complementary and integrative approaches—to address the continuum of acute and chronic pain; a patient and provider focus to manage pain with the goal of improve function; and synchronizing a culture of pain awareness, education, and proactive intervention. The PMTFReport was followedwithin a year by a landmark Institute of Medicine Report, Relieving Pain in America—A Blueprint for Transforming Prevention, Care, Education and Research. It closely mirrored the DoD report and called for a major cultural shift in how pain was understood, prevented, mitigated, and managed. The past decade since these collective efforts were begun has seen a remarkable degree of formal and informal interagency cooperation as well as public-private partnership in the synchronization of a comprehensive approach to both Published online April 9, 2018

Assessing the Quality, Efficacy, and Effectiveness of the Current Evidence Base of Active Self‐Care Complementary and Integrative Medicine Therapies for the Management of Chronic Pain: A Rapid Evidence Assessment of the Literature

ABSTRACT Conceptual frameworks for Leader and Leadership Education and Development guide the curriculum and assessment of students, faculty, and programs. This commentary defines leader and leadership and presents a leadership conceptual framework that includes four ‘C’ elements (FourCe) – Character, Competence, Context, and Communication – across four levels of psychosocial interaction – Personal, Interpersonal, Team, and Organizational (PITO). This FourCe-PITO framework delineates elements of leadership, considers interactions of these elements, guides curriculum content, and is the basis for assessments. The application of this framework is discussed for all levels of education.

Movement therapies for the self-management of chronic pain symptoms.

Despite long-standing debates about whether leaders are born or made, current thinking within the leadership field is that leaders can be developed. In the arena of health and healthcare, developing effective, value-driven and outcome-focused leaders is critical to address the many challenges facing systems that promote and maintain health as well as focus on healthcare delivery and practices. Effective health and healthcare leaders are needed to set thoughtful policies; educate the public about primary prevention strategies; identify best practices (administrative and clinical); allocate healthcare resources wisely; address healthcare needs and disparities; focus on optimal clinical outcomes and value in the delivery of care; and encourage individuals to engage in behaviors that enhance well-being. This chapter presents seven steps to establish a Leader and Leadership Education and Development (LEAD) program. These steps were based on the authors’ experience establishing a LEAD program at the Uniformed Services University of the Health Sciences (USU) where physicians, advanced practice nurses, dentists, psychologists, and scientists are trained for the Army, Navy, Air Force, and Public Health Service, and civilians are trained to become scientists, academicians, and clinicians with a focus on national service and health. These same steps also could be used as a guide to establish programs that educate and develop leaders for other professions and careers.