Transforming Healthcare to Ensure Readiness
The Soldier is lying in rubble and debris following the blast, trying to determine a source of his injury. The blast was disorienting. What type of injury was sustained? Where are his injuries? Does he need medical evacuation?
Seconds matter to saving this life.
During an emergency situation such as this, there is one major difference between hearing "Let me go and get you help" and "I'm here to help." The difference is readiness.
For Army Medicine, readiness is the first priority. For the Congressionally Directed Medical Research Programs, readiness is transforming healthcare.
Readiness is not only being prepared for the physical and emotional injuries sustained in combat, it goes far beyond the battlefield. The CDMRP supports innovative and impactful research to transform healthcare. This means supporting all areas that affect our Service Members and being the voice that says "I'm here to help," regardless of the situation.
The veteran sitting in the doctor's office following a routine screening and being told they found cancer.
The Soldier sitting in a helicopter flying into a war-torn country, not completely focused on the mission due to a child at home facing the challenges that come with autism.
An entire family disconnected from each other as a result of how the scars of war brought substance abuse into their home.
These are only a few examples of focus areas to which the CDMRP is committed for investing in high-impact research for support. As these examples show, in order to maintain readiness, support must go beyond the battlefield and into the home. Our Service Members require support during and after military service, in addition to support for their family and loved ones. The CDMRP works to fill critical research gaps in all areas that support our Service Members and the American public.
"Focusing on the health and wellbeing of our Service Members and their families is the priority of the CDMRP. The best way to ensure readiness and protection is to invest in research," said Col. Wanda Salzer, CDMRP director.
TRAUMATIC BRAIN INJURY
Recent military conflicts in Afghanistan and Iraq have shown a major increase in traumatic brain injuries. One of the major ways the CDMRP is transforming healthcare is by investing in groundbreaking research for an advanced understanding of TBI, to enhance safety measures and provide therapies and treatments. TBI is still highly misunderstood. While the U.S. Food and Drug Administration has cleared devices that assess cognitive function and help determine the need for imaging following head injury, the FDA has not cleared any medical drugs or devices that are specifically intended to diagnose or treat mild, moderate or severe TBI.
"Since 2000, there have been over 375,000 TBIs (mild, moderate, severe) identified in our military Service Members. Of those injuries, over 80 percent are classified as mild TBI," said Dr. Dwayne Taliaferro, health science program manager. "TBI has a significant impact on readiness."
"The current DOD Clinical Practice Guideline recommends rest and progressive return to full activity. Following the CPG typically results in seven to 10 days of unavailability," Taliaferro continued. "Those with persistent symptoms, disability, repeat TBI, or polytrauma will require additional days, months, years or separation from service. To help mitigate this issue, the CDMRP manages a number of research efforts to better understand, improve the diagnosis, treat and manage TBI."
To support the need for TBI research and solutions, the CDMRP released the TBI Endpoints Development, TED, funding opportunity to move the field forward. Awarded to the University of California San Francisco in 2014, the TED team is leveraging its DOD, National Institutes of Health, philanthropic, and industry-funded research networks and infrastructure to achieve the research objectives. In addition, the TED Initiative brings together several TBI study datasets containing thousands of TBI subjects, in order to harmonize and curate data into a large Metadataset with the goal of identifying candidate clinical outcome assessments and biomarkers.
"The team seeks to validate candidate outcome assessments and biomarkers, and where appropriate, enter into FDA's qualification process to become drug development tools in support of clinical trials," explained Taliaferro. "The effort has already made an impact. They have received the TBI field's first ever letter of support from the FDA's Center for Drug Evaluation and Research to continue evaluation of neuroimaging biomarkers for TBI."
Another notable project that CDMRP is funding for TBI research is the Concussion Assessment, Research and Education consortium, which is a three-year study that began in September 2014. Taliaferro explained that the consortium has enrolled nearly 40,000 male and female student athletes/cadets from 30 colleges and Military Service Academies. The consortium has two sections: a Longitudinal Clinical Study Core (University of Michigan) which conducts neurocognitive and behavioral assessments on all enrolled athletes, and an Advanced Research Core (Medical College of Wisconsin) which conducts a deep dive at six of the CSC sites.
"The CARE consortium will allow scientists to observe the trajectory of mild TBI from injury, to recovery, or disability. Findings from CARE will certainly be translated to improve our understanding and management of concussion and the role other factors such as subconcussive events may play. Data from this study has already resulted in revised service academy and National Collegiate Athletic Association return-to-play guidelines," said Taliaferro.
Along with TBI research, psychological health is a current health concern in need of advanced research.
"The prevalence of insomnia among active duty Service Members has been gradually growing since 2005 and can occur as a primary or secondary condition. The diagnosis is often associated with environmental and occupational risk factors such as military personnel on rotating night shift work, stress, and frequent moves, including deployments," said Dr. Holly Campbell-Rosen, health sciences program manager.
"Dr. Daniel Taylor of the University of North Texas, in collaboration with the South Texas Research Organization Network Guiding Studies on Trauma And Resilience consortium, examined the comparative efficacy of in-person cognitive behavior therapy for insomnia, unguided internet-delivered cognitive-behavior therapy for insomnia, and a minimal contact control condition in active duty Service Members stationed at Fort Hood, Texas."
Campbell-Rosen explained that the internet-delivered cognitive behavior therapy was as good as in-person cognitive behavior therapy in most cases of insomnia, indicating the applicability of an internet-based therapy for insomnia. The in-person therapy was an already established, widely used therapy, although it had not yet been tested in active-duty Service Members.
These results demonstrate an effective treatment for insomnia in an active-duty military population, providing another example of research supporting readiness, with the ability to improve sleep health and overall wellbeing.
"The CDMRP interacts and supports the Joint Program Committees and Service advanced developers to hone in on the critical medical needs and capability gaps that our Service Members face at home station and in austere environments," said Dr. Ray Santullo, health science program manager. "That critical feedback defines the research task areas and mechanisms in our funding opportunities provided to the intra- and extramural research communities. Representatives from the Service components, NIH and the Department of Veterans Affairs are well represented on our programmatic panels, and their expertise guides our planning and funding recommendations."
READY MILITARY FORCE
TBI and psychological health showcase only a few research projects on which the CDMRP is focusing. Currently, there are 31 focus areas ranging from bone marrow failure and kidney cancer, to spinal cord injury and lupus. Each focus area will have numerous projects, resulting in hundreds of potential products or therapies.
"As an organization, the CDMRP funds and manages research that directly benefits the Warfighter. We help generate tools and techniques that target the military-service unique threats that could reduce our Service Members' ability to stay in the fight, or get back into the fight sooner. We also fund and manage research that targets diseases and conditions that could impact the Warfighter or his/her family," said Taliaferro.
"The impact on the Warfighter's family cannot be understated," he added. "There is a saying from the Army that applies to all of our services: 'The strength of the services derives from the Warfighter, and the strength of our Warfighter derives from his/her family.' This creates a ready military force."