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Fort Belvoir, VA, United States

King C.,Fort Belvoir Community Hospital | Nathan S.D.,Advanced Lung Disease and Lung Transplant Program
Current Opinion in Pulmonary Medicine

PURPOSE OF REVIEW: The interstitial lung diseases (ILDs) frequently result in considerable disability and reduced survival in affected patients. Unfortunately, they are often poorly responsive to available therapies. Comorbidities, both pulmonary and nonpulmonary, frequently accompany ILDs and contribute to adverse outcomes. RECENT FINDINGS: Multiple comorbidities, including gastroesophageal reflux disease, venous thromboembolism, coronary artery disease, sleep-disordered breathing, depression, emphysema, pulmonary hypertension, and lung cancer contribute to the morbidity and mortality of fibrotic lung disease. SUMMARY: The identification and treatment of comorbidities may improve morbidity and potentially impact mortality in patients with ILD. A high index of suspicion and an awareness of the spectrum of comorbidities are important in optimizing outcomes in this group of patients. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Hardin C.A.,Fort Belvoir Community Hospital
Dermatology online journal

The divided or kissing nevus is an unusual congenital melanocytic nevus. By definition, these nevi appear on skin that separates during embryological development. These lesions have been reported on the eyelids, fingers, and rarely the penis. We describe an 18 year old uncircumcised male who presented with an asymptomatic darkly pigmented patch on the glans penis. He reported that the lesion had appeared recently and was enlarging. Physical examination revealed a second symmetric lesion on the adjacent foreskin. Punch biopsy of the lesion on the glans penis showed abundant intradermal melanocytes devoid of mitoses and atypia, consistent with an intradermal melanocytic nevus. Based on the benign histologic nature and clinical exam, the lesion was diagnosed as a divided or kissing nevus of the penis. Proposed treatments include excision and grafting as well as Nd:YAG laser therapy. However, these patients may be safely monitored with regular follow-up skin examinations because there is minimal risk of malignant transformation. Source

Brisson P.,Fort Belvoir Community Hospital
American Journal of Tropical Medicine and Hygiene

Compliance with malaria chemoprophylaxis by military service members (MSMs) is notoriously low, ranging from 30% to 56%. Our objective was to determine the rate of compliance and reasons for non-compliance with malaria chemoprophylaxis among healthy US MSMs in Afghanistan. An eight-question, anonymous online survey was used to collect data regarding the compliance of healthy MSMs with malaria chemoprophylaxis. E-mail surveys were sent to 1,200 MSMs; 528 (44%) MSMs completed the survey. One-time daily doxycycline was the most commonly prescribed chemoprophylaxis (90%); 60% (N = 318) responded that they were compliant with their chemoprophylaxis as prescribed, whereas 40% (N = 221) indicated that they were not compliant. Compliance with daily dosing was 61% and weekly dosing was 38%. The most common reasons for non-compliance were gastrointestinal effects (39%), forgetfulness (31%), and low perception of risk (24%). Malaria chemoprophylaxis compliance by healthy MSMs in Afghanistan is poor. Side effects, forgetfulness, and lack of education are contributing factors. Commanders bear the primary responsibility for the health of their soldiers, and the individual MSM bears personal responsibility; however, additional public health interventions could possibly have a positive impact on prevention. Copyright © 2012 by The American Society of Tropical Medicine and Hygiene. Source

Bynum W.E.,Fort Belvoir Community Hospital | Lindeman B.,Johns Hopkins University
Academic Medicine

Understanding and addressing the issue of learner mistreatment is among the most pressing challenges facing academic medicine today. Despite the fact that residents have a significant influence on the clinical learning environment and may be both recipients and perpetrators of mistreatment, the resident perspective on the issue of learner mistreatment is notably sparse in the medical education literature. In this Commentary, the authors provide a resident response to recent data showing that mistreatment is subjective and may occur on a spectrum from incident-based mistreatment to environmental-based mistreatment. They focus on specific factors from the learning environment that may increase a learner's tendency to feel mistreated or have a suboptimal learning experience, including team cohesion, marginalization, peer-on-peer mistreatment, witnessing mistreatment, hierarchies, interdepartmental mistreatment, acculturation of uncivil behaviors, and residents themselves. This is followed by a discussion of proposed solutions to mitigate the negative impact of these influences and build safe learning environments, collaborative teams, empathic teachers, and resilient learners. © 2016 by the Association of American Medical Colleges. Source

Yancey J.R.,Fort Belvoir Community Hospital | Thomas S.M.,U.S. Air force
American Family Physician

Chronic fatigue syndrome is characterized by debilitating fatigue that is not relieved with rest and is associated with physical symptoms. The Centers for Disease Control and Prevention criteria for chronic fatigue syndrome include severe fatigue lasting longer than six months, as well as presence of at least four of the following physical symptoms: postexertional malaise; unrefreshing sleep; impaired memory or concentration; muscle pain; polyarthralgia; sore throat; tender lymph nodes; or new headaches. It is a clinical diagnosis that can be made only when other disease processes are excluded. The etiology of chronic fatigue syndrome is unclear, is likely complex, and may involve dysfunction of the immune or adrenal systems, an association with certain genetic markers, or a history of childhood trauma. Persons with chronic fatigue syndrome should be evaluated for concurrent depression, pain, and sleep disturbances. Treatment options include cognitive behavior therapy and graded exercise therapy, both of which have been shown to moderately improve fatigue levels, work and social adjustment, anxiety, and postexertional malaise. No pharmacologic or alternative medicine therapies have been proven effective. © 2012 American Academy of Family Physicians. Source

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