Karris B.C.,United States Naval Hospital |
Capobianco M.,Naval Medical Center |
Wei X.,Naval Hospital |
Ross L.,Naval Medical Center
Journal of Psychiatric Practice | Year: 2017
High frequency repetitive transcranial magnetic stimulation (rTMS) was approved by the US Food and Drug Administration in 2008 to treat major depressive disorder in those who did not respond to at least 1 antidepressant trial. Previous studies have shown that both high frequency rTMS to the left dorsolateral prefrontal cortex (DLPFC) and low frequency rTMS to the right DLPFC have antidepressant efficacy in treatment-resistant depression. Although rTMS has been widely used in the treatment of depression, very few studies of rTMS in patients with depersonalization disorder (DPD) have been published so far. DPD involves persistent or recurrent experiences of unreality and feelings of detachment causing distress or functional impairment while insight remains intact. The prevalence of DPD is approximately 1% to 2%. Studies of the pharmacological treatment of DPD are limited, and medications have proven to be of limited benefit. We present the case of a 30-year-old man with major depressive disorder and DPD who did not respond to pharmacotherapy. After the patient was treated with low frequency rTMS to the right DLPFC followed by high frequency rTMS to the left DLPFC, there was a significant reduction in his depersonalization symptoms. Given its effectiveness in our patient, the use of both low frequency rTMS to the right DLPFC and high frequency rTMS to the left DLPFC for treatment of DPD should be further explored. © 2017 Wolters Kluwer Health, Inc. All rights reserved.
News Article | October 29, 2016
The National Trust for Historic Preservation today unveiled its 2016 list of America’s 11 Most Endangered Historic Places, an annual list that spotlights important examples of the nation’s architectural and cultural heritage that are at risk of destruction or irreparable damage. More than 270 sites have been on the list over its 29-year history, and in that time, fewer than five percent of listed sites have been lost. The National Trust’s 29th annual list includes historic places in America’s urban areas at a time when cities across the nation are experiencing a resurgence. Millions of Americans—especially younger people—are choosing to relocate to urban areas, with many opting to live in distinctive, character-rich older and historic neighborhoods. Preservation is playing a key role in this trend, and our research suggests that older buildings are one of the most powerful tools we have for the continued revitalization of our nation’s urban centers. Through its ReUrbanism work, the Trust is highlighting the importance of adaptability and preservation of historic buildings to meet the challenges faced by communities, and this focus is reflected in several sites on this year’s 11 Most Endangered Historic Places list, including: “For nearly 30 years, our list of America’s 11 Most Endangered Historic Places has called attention to threatened one-of-a-kind treasures throughout the nation and galvanized local communities to help save them,” said Stephanie Meeks, president of the National Trust for Historic Preservation. “This year’s list elevates important threatened historic places in our nation’s cities at a time when more than 80 percent of Americans live in urban areas. We know that preservation is an essential part of the current urban renaissance and that old buildings contribute to the sustainability and walkability of our communities. Historic buildings are also powerful economic engines that spur revitalization, meet a broad range of human needs, and enhance the quality of life for us all. With thoughtful and creative policy approaches and tools, we can tap the full potential of these important places and secure a foundation for a stronger and more vibrant future.” While bringing attention to urban sites, the 2016 list also includes places that reflect the broader diversity of America’s historic places, from Bears Ears in Southeastern Utah to the James River at Jamestown, Virginia. Members of the public are invited to learn more about what they can do to support these 11 historic places and hundreds of other endangered sites at http://www.SavingPlaces.org/11Most The 2016 list of America's 11 Most Endangered Historic Places (in alphabetical order): Austin’s Lions Municipal Golf Course – Austin, Texas. Widely regarded as the first municipal golf course in the South to desegregate, “Muny” is an unheralded civil rights landmark facing development pressure. Azikiwe-Nkrumah Hall at Lincoln University – Lincoln, Pa. The oldest building on the campus of the first degree-granting institution in the nation for African Americans, this hallowed building currently stands empty and faces an uncertain future. Bears Ears – Southeastern Utah. The 1.9 million-acre Bears Ears cultural landscape features a world-class collection of archaeological sites, cliff dwellings, petroglyphs, and ancient roads that illuminate 12,000 years of human history yet is now threatened by looting, mismanaged recreational use, and energy development. Charleston Naval Hospital District – North Charleston, S.C. The historic district played a prominent role during WWII as a primary re-entry point for American servicemen injured in Europe and Africa. Now threatened by a proposed rail line, this important historic resource is at risk of being largely destroyed. Delta Queen – Houma, La. This steamboat was built in 1926 and today is among the last of her kind. Federal legislation that would enable this prestigious ship to return to overnight passenger cruising remains a key piece to securing the Delta Queen’s sustainability and future. El Paso’s Chihuahuita and El Segundo Barrio Neighborhoods – El Paso, Texas. These historic neighborhoods form the core of El Paso’s cultural identity, but their homes and small businesses are threatened by demolition. Historic Downtown Flemington – Flemington, N.J. Historic buildings at the core of the town that hosted the ‘Trial of the Century,’ the Charles Lindbergh baby kidnapping trial, are threatened by a development proposal that would demolish the iconic Union Hotel along with three other adjacent historic buildings. James River - James City County, Va. Jamestown, America’s first permanent English settlement, was founded along the banks of the James River in 1607. The river and landscape, also named to this list by the Trust in 2013, remain threatened by a proposed transmission line project that would compromise the scenic integrity of this historic area. Milwaukee’s Mitchell Park Domes - Milwaukee, Wis. A beloved Milwaukee institution for generations, a unique engineering marvel and a highly significant example of midcentury modern architecture, the Milwaukee Domes are facing calls for their demolition. San Francisco Embarcadero – San Francisco, Calif. The City by the Bays’ iconic waterfront is beloved by residents and visitors alike, but needs long-term planning to address the dual natural threats of sea level rise and seismic vulnerability. Sunshine Mile – Tucson, Ariz. This two-mile corridor on Tucson’s Broadway Boulevard features one of the most significant concentrations of historic mid-century modern architecture in the Southwest. This unique collection of properties face threats from a transportation project that would require demolition. Follow us on Twitter at @savingplaces and join the conversation using the hashtag #11Most America’s 11 Most Endangered Historic Places has identified more than 270 threatened one-of-a-kind historic treasures since 1988. Whether these sites are urban districts or rural landscapes, Native American landmarks or 20th-century sports arenas, entire communities or single buildings, the list spotlights historic places across America that are threatened by neglect, insufficient funds, inappropriate development or insensitive public policy. The designation has been a powerful tool for raising awareness and rallying resources to save endangered sites from every region of the country. At times, that attention has garnered public support to quickly rescue a treasured landmark; while in other instances, it has been the impetus of a long battle to save an important piece of our history. The National Trust for Historic Preservation, a privately funded nonprofit organization, works to save America’s historic places. http://www.SavingPlaces.org
Mitsikostas D.D.,Naval Hospital |
Chalarakis N.G.,Naval Hospital |
Mantonakis L.I.,Naval Hospital |
Delicha E.-M.,Naval Hospital |
And 2 more authors.
European Journal of Neurology | Year: 2012
Background: Nocebo refers to adverse effects (AEs) generated by negative expectations that medical treatment will likely harm instead of heal and can be assessed in placebo-controlled randomized clinical trials (RCTs). We examined AEs following placebo administration in RCTs for fibromyalgia (FM), a condition characterized by patients' poor medication adherence, which may affect outcome and/or increase healthcare costs. Methods: Following a systematic Medline search for RCTs for FM pharmacologic treatment published between 2001 and 2010, we assessed percentages of placebo-treated patients reporting at least one AE or discontinuing because of placebo intolerance and searched for factors influencing nocebo's extent. Percentages were compared with those revealed by similar meta-analyses of RCTs for multiple sclerosis and primary headaches. Results: Data were extracted from 16 RCTs fulfilling search criteria. Of 2026 placebo-treated patients, 67.2% (95%CI: 51.0-81.5%) reported at least one AE, and 9.5% (95%CI: 8.3-10.9%) discontinued placebo treatment because of intolerance. AEs in placebo arms corresponded quantitatively and qualitatively to those in active drug arms (ρ>0.88, P<0.0001). Younger age and larger placebo arm size were associated with increased dropout rates. Patients with depression were more likely to withdraw from trials. Nocebo dropouts in FM trials were fourfold and twofold higher than in RCTs for multiple sclerosis treatment and migraine preventive treatment, respectively. Conclusions: Nocebo is remarkably prevalent in FM patients participating in RCTs. Because nocebo contributes to drug intolerance and treatment failure in clinical practice, identification of predisposing factors and efforts to prevent nocebo by educating these patients appropriately may be important for FM outcome. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.
Ralston M.E.,Naval Hospital |
Ralston M.E.,Uniformed Services University of the Health Sciences |
Day L.T.,LAMB Hospital |
Slusher T.M.,University of Minnesota |
And 2 more authors.
The Lancet | Year: 2013
Nearly all global mortality in children younger than 5 years (99%) occurs in developing countries. The leading causes of mortality in children younger than 5 years worldwide, pneumonia and diarrhoeal illness, account for 1•396 and 0•801 million annual deaths, respectively. Although important advances in prevention are being made, advanced life support management in children in developing countries is often incomplete because of limited resources. Existing advanced life support management guidelines for children in limited-resource settings are mainly empirical, rather than evidence-based, written for the hospital setting, not standardised with a systematic approach to patient assessment and categorisation of illness, and taught in current paediatric advanced life support training courses from the perspective of full-resource settings. In this Review, we focus on extension of higher quality emergency and critical care services to children in developing countries. When integrated into existing primary care programmes, simple inexpensive advanced life support management can improve child survival worldwide.
Liarakos V.S.,Netherlands Institute for Innovative Ocular Surgery |
Liarakos V.S.,Naval Hospital |
Dapena I.,Netherlands Institute for Innovative Ocular Surgery |
Ham L.,Netherlands Institute for Innovative Ocular Surgery |
And 2 more authors.
Archives of Ophthalmology | Year: 2013
Objective: To define various Descemet graft unfolding techniques in Descemet membrane endothelial keratoplasty. Methods: In a retrospective analysis, the surgical videos of 100 consecutive Descemet membrane endothelial keratoplasty cases with at least 6 months of follow-up were evaluated and categorized. The Descemet graft unfolding methods were categorized into 4 basic techniques and 3 auxiliary techniques. Results: All Descemet membrane endothelial keratoplasty surgical procedures could be completed using (a combination of ) 4 Descemet graft unfolding techniques: (1) standardized no-touch graft unfolding using a double roll, (2) carpet unrolling while fixating 1 graft edge (Dirisamer technique), (3) small air bubble-assisted unrolling (Dapena maneuver), (4) the single sliding cannula maneuver. Additional maneuvers included turning over the graft when oriented upside down (flushing); manual graft centration with a cannula; and bubble bumping to unfold peripheral inward folds. In 73% of surgical procedures, technique 1 was used, while a combination of techniques was used in 44% and auxiliary techniques in 62%. None of the techniques showed a correlation with the best-corrected visual acuity, endothelial cell density, or postoperative complication rate (P > .10). Conclusions: Descemet membrane endothelial keratoplasty may be further facilitated by using controlled techniques for unfolding the Descemet graft inside the recipient anterior chamber, either as stand-alone techniques or used in various combinations. ©2013 American Medical Association. All rights reserved.
Clark G.W.,U.S. Army |
Pope S.M.,Naval Hospital |
Jaboori K.A.,U.S. Army
American Family Physician | Year: 2015
Seborrheic dermatitis is a common skin condition in infants, adolescents, and adults. The characteristic symptoms—scaling, erythema, and itching—occur most often on the scalp, face, chest, back, axilla, and groin. Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of the lesions. The skin changes are thought to result from an inflammatory response to a common skin organism, Malassezia yeast. Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body. Because of possible adverse effects, anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors should be used only for short durations. Several over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents. Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis. © 2015 American Academy of Family Physicians.
Fargo M.V.,U.S. Army |
Latimer K.M.,Naval Hospital
American Family Physician | Year: 2012
The prevalence of benign anorectal conditions in the primary care setting is high, although evidence of effective therapy is often lacking. In addition to recognizing common benign anorectal disorders, physicians must maintain a high index of suspicion for inflammatory and malignant disorders. Patients with red flags such as increased age, family history, persistent anorectal bleeding despite treatment, weight loss, or iron deficiency anemia should undergo colonoscopy. Pruritus ani, or perianal itching, is managed by treating the underlying cause, ensuring proper hygiene, and providing symptomatic relief with oral antihistamines, topical steroids, or topical capsaicin. Effective treatments for anal fissures include onabotulinumtoxinA, topical nitroglycerin, and topical calcium channel blockers. Symptomatic external hemorrhoids are managed with dietary modifications, topical steroids, and analgesics. Thrombosed hemorrhoids are best treated with hemorrhoidectomy if symptoms are present for less than 72 hours. Grades I through III internal hemorrhoids can be managed with rubber band ligation. For the treatment of grade III internal hemorrhoids, surgical hemorrhoidectomy has higher remission rates but increased pain and complication rates compared with rubber band ligation. Anorectal condylomas, or anogenital warts, are treated based on size and location, with office treatment consisting of topical trichloroacetic acid or podophyllin, cryotherapy, or laser treatment. Simple anorectal fistulas can be treated conservatively with sitz baths and analgesics, whereas complex or nonhealing fistulas may require surgery. Fecal impaction may be treated with polyethylene glycol, enemas, or manual disimpaction. Fecal incontinence is generally treated with loperamide and biofeedback. Surgical intervention is reserved for anal sphincter injury. © 2012 American Academy of Family Physicians.
Lake M.G.,Us Naval Hospital |
Krook L.S.,Naval Hospital |
Cruz S.V.,Us Naval Hospital
American Family Physician | Year: 2013
Prolactinomas and nonfunctioning adenomas are the most common types of pituitary adenomas. Patients with pituitary adenomas may present initially with symptoms of endocrine dysfunction such as infertility, decreased libido, and galactorrhea, or with neurologic symptoms such as headache and visual changes. The diagnosis may also be made following imaging done for an unrelated issue in an asymptomatic patient; this is termed a pituitary incidentaloma. Oversecretion of hormones from a dysfunctional pituitary gland may result in classic clinical syndromes, the most common of which are hyperprolactinemia (from oversecretion of prolactin), acromegaly (from excess growth hormone), and Cushing disease (from overproduction of adrenocorticotropic hormone). In the diagnostic approach to a suspected pituitary adenoma, it is important to evaluate complete pituitary function, because hypopituitarism is common. Therapy for pituitary adenomas depends on the specific type of tumor, and should be managed with a team approach to include endocrinology and neurosurgery when indicated. Dopamine agonists are the primary treatment for prolactinomas. Small nonfunctioning adenomas and prolactinomas in asymptomatic patients do not require immediate intervention and can be observed. © 2013 American Academy of Family Physicians.
Lee C.,Samueli Institute |
Crawford C.,Samueli Institute |
Hickey A.,Naval Hospital
Pain Medicine (United States) | Year: 2014
Objectives: Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care complementary and integrative medicine (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. Methods: A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature (REAL©) methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A panel of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Results: Following key database searches, 146 randomized controlled trials were included in the review, 54 of which investigated mind-body therapies, as defined by the authors. Conclusions: This article summarizes the current evidence, quality, efficacy, and safety of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement. © 2014 American Academy of Pain Medicine.
Hart B.,Naval Hospital
Undersea and Hyperbaric Medicine | Year: 2012
Osteomyelitis is an infection of bone or bone marrow, usually caused by pyogenic bacteria or mycobacteria. Refractory osteomyelitis is defined as a chronic osteomyelitis that persists or recurs after appropriate interventions have been performed or where acute osteomyelitis has not responded to accepted management techniques . To date, no randomized clinical trials examining the effects of hyperbaric oxygen (HBO2) therapy on refractory osteomyelitis exist. However, the substantial majority of available animal data, human case series and non-randomized prospective trials suggest that the addition of HBO2 therapy to routine surgical and anti-biotic management in previously refractory osteomyelitis is safe and improves the ultimate rate of infection resolution. Consequently, HBO2 therapy should be considered an American Heart Association (AHA) Class II recommendation in the management of refractory osteomyelitis. More specifically, in uncomplicated extremity osteomyelitis or cases where significant patient morbidity or mortality is not likely to occur, HBO2 therapy can be considered an AHA Class Ilb treatment. For patients with more severe Ciemy-Mader Class 3B or 4B disease, adjunctive HBO2 therapy should be considered an AHA Class Ha intervention. Additional consideration must also be given to patients with osteomyelitis involving the spine, skull, sternum or other bony structures associated with a risk for high morbidity or mortality. In these patients, HBO2 therapy may be considered an AHA Class Ha intervention prior to undergoing extensive surgical debridement. Finally, for osteomyelitis in the subset of patients with associated Wagner Grade 3 or 4 diabetic ulcers, adjunctive HBO2 should be rgarded as an AHA Class I intervention. In most cases, the best clinical results are obtained when HBO2 therapy is administered in conjunction with culture-directed antibiotics and scheduled to begin soon after thorough surgical debridement. HBO2 therapy is ordinarily delivered on a daily basis for 90-120 minutes using 2.0-3.0 atmospheres of absolute pressure (ATA). Recommendation of a specific treatment pressure is not supported by data. Where clinical improvement is seen, the present regimen of antibiotic and HBO2 therapy should be continued for approximately four to six weeks. Typically, 20-40 postoperative HBO 2 sessions will be required to achieve sustained therapeutic benefit. In cases where extensive surgical debridement or removal of fixation hardware may be relatively contraindicated (e.g., cranial, spinal, sternal or pediatric osteomyelitis), a trial of limited debridement, culture-directed antibiotics and HBO2 therapy prior to more radical surgical intervention provides a reasonable chance for osteomyelitis cure. Again, a course of four to six weeks of combined HBO2 and antibiotic therapy should be sufficient to achieve the desired clinical results. In contrast, if prompt clinical response is not noted or osteomyelitis recurs after this initial treatment period, then continuation of the existing antibiotic and HBO2 treatment regimen is unlikely to be effective. Instead, clinical management strategies should be reassessed and additional surgical debridement and/or modification of antibiotic therapy implemented without delay. Subsequently, reinstitution of HBO 2 therapy will help maximize the overall chances for treatment success. Copyright © 2012 Undersea & Hyperbaric Medical Society, Inc.