Prescription Patterns of Sedative Hypnotic Medications in the Military Health System.

Study Objectives: To evaluate prevalence of sedative hypnotic medications and their potential indication among active duty service members (ADSM) and non-ADSM receiving care in the Military Health System (MHS).

Methods: Using a retrospective cohort study design, we extracted data on sedative hypnotic medications (benzodiazepine receptor agonists, benzodiazepines, sedating antidepressants, and melatonin receptor agonist) dispensed from January 2009 to December 2015. Prevalence was defined as ≥ 1 dispensing per patient per year whereas chronic episode was categorized as ≥ 90 days of continuous therapy.

A 10-Year Retrospective Review of Nephrolithiasis in the Navy and Navy Pilots.

Purpose: Little is known about the incidence of nephrolithiasis in the United States Navy. Navy pilots must be kidney stone-free and are often referred for treatment of small asymptomatic stones. The primary objectives of this study were to determine the incidence of nephrolithiasis and computerized tomography, proportion undergoing treatment and incidence of stone related mishaps in Navy pilots compared with other Navy personnel.

The Effects of Chewing Betel Nut with Tobacco and Pre-pregnancy Obesity on Adverse Birth Outcomes Among Palauan Women.

The small Pacific Island nation of Palau has alarmingly high rates of betel nut with tobacco use and obesity among the entire population including pregnant women. This study aimed to determine the effects of betel nut with tobacco use and pre-pregnancy obesity on adverse birth outcomes. This study used retrospective cohort data on 1171 Palauan women who gave birth in Belau National Hospital in Meyuns, Republic of Palau between 2007 and 2013.

Post-Prostatectomy Male Sling Revision and Early Results.

Introduction: Male slings are an accepted form of therapy in the incontinent man with a reported 55% to 80% success rate. Failed slings may be salvaged by performing a retensioning surgical sling revision procedure. The procedure is performed through a perineal incision that partially exposes the cicatrix containing the sling.

Hawaii state legislator views on e-cigarettes and likelihood of legislative action.

Objective: To examine perspectives on e-cigarette use and regulations in Hawaii through key informant interviews with state legislators.

Background: E-cigarette use is rapidly increasing, with sales in 2013 topping $1 billion in the United States, but e-cigarettes are still a largely unregulated industry. Although e-cigarettes are thought by most to be a healthier alternative to traditional cigarettes, long-term health effects are not yet known.

Dyslipidemia is associated with an increased risk of nephrolithiasis.

The pathophysiology of nephrolithiasis is multifactorial. Obesity, diabetes mellitus and hypertension are implicated in its formation. Dyslipidemia (DLD) recently has received attention as well.

Determinants of renal functional decline after open partial nephrectomy: a comparison of warm, cold, and non-ischemic modalities.

Introduction: Renal functional decline after partial nephrectomy (PN) may be related to a variety of nonmodifiable and modifiable factors, including ischemia time (IT) and modality. We sought to determine the impact of these factors on renal functional degeneration after PN.

Materials And Methods: Multicenter retrospective analysis (n = 347) was performed, identifying patients who underwent open PN using warm, cold, and non-ischemic techniques.

Minimal incision laparoscopy assisted open pediatric pyeloplasty.

Minimal incision laparoscopy-assisted open pyeloplasty (MILAP) incorporates elements of open pyeloplasty (OP) and single incision laparoscopy to improve technical ease and cosmetic outcomes. Six MILAP procedures were performed using a single transumbilical incision through which the ureteropelvic junction (UPJ) is mobilized with standard laparoscopic instrumentation. The UPJ is brought extracorporeally through a 1-cm flank incision, and a traditional Anderson-Hynes open pyeloplasty is performed.

Impact of tumour morphology on renal function decline after partial nephrectomy.

Objective: To examine the association of renal morphology with renal function after partial nephrectomy (PN).

Patients And Methods: We conducted a multi-institutional retrospective analysis of 322 PNs performed between 2003 and 2011. The RENAL nephrometry score for each lesion was determined and the estimated glomerular filtration rate (eGFR) was calculated preoperatively and at last follow-up.

Comparison of transrectal and transvaginal hybrid natural orifice transluminal endoscopic surgery partial nephrectomy in the porcine model.

Objective: To compare the feasibility of porcine transrectal (TR) and transvaginal (TV) hybrid natural orifice transluminal endoscopic surgery (NOTES) partial nephrectomy (PN), as NOTES nephrectomy has recently been performed in the porcine model.

Materials And Methods: A total of 10 female pigs (weight 45 kg) underwent TR (n = 5) or TV (n = 5) NOTES PN. The pneumoperitoneum was created by a periumbilical 12-mm trocar, through which a laparoscope was advanced for intra-abdominal visualization.

RENAL nephrometry score is associated with complications after renal cryoablation: a multicenter analysis.

Objective: To analyze outcomes and complications of percutaneous (PRC) and laparoscopic renal cryoablation (LRC) using the radius, endophytic, nearness to collecting system, anterior/posterior, and location (RENAL) nephrometry system.

Methods: Retrospective multicenter analysis of 154 consecutive patients who underwent either ultrasound-guided LRC (n = 88) or computed tomography (CT)-guided PRC (n = 66) from March 2003 to December 2011. RENAL score and demographics were compared to postoperative complications (Clavien).

Impact of statins on nephrolithiasis in hyperlipidemic patients: a 10-year review of an equal access health care system.

Aim: To investigate the impact of statin medications on urinary stone formation in hyperlipidemic patients.

Material And Methods: We searched outpatient military electronic health records from the Southwestern United States to identify adult patients with hyperlipidemia and urolithiasis. Military facilities serve active duty members, retirees, and their immediate family members.

Changes in urine parameters after desert exposure: assessment of stone risk in United States Marines transiently exposed to a desert environment.

Purpose: Living in a desert environment has been associated with a higher incidence of kidney stone formation, likely because of concentrated urine output, higher production of vitamin D and genetic predisposition. We determined the changes in urinary parameters after a group of United States Marines temporarily transitioned from a temperate environment to a desert environment.

Materials And Methods: A total of 50 Marines completed a questionnaire and performed 3, 24-hour urine collections before mobilization to the desert, after 30 days in the desert and 2 weeks after returning from the desert.

Delayed lower urinary tract symptoms and erectile dysfunction after acute episode of coccidioidal meningitis.

We present an interesting case of a 27-year-old male with coccidioidal meningitis who developed permanent erectile dysfunction (ED) and lower urinary tract symptoms 3 months after initiation of therapy. The patient presented to the urology clinic with a complaint of a weak stream, urinary urgency and frequency, as well as enuresis which were only moderately controlled with anti-cholinergics. His ED responded well to phosphodiesterase-5 inhibitors.

Expanded medical home model works for children in foster care.

The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates.These children used the health care system more effectively and cost-effective as reflected in the higher utilization rates of primary care and well-child visits and lower utilization of emergency room care for children with chronic conditions.

Demographics of Men Receiving Vasectomies in the US Military 2000-2009.

Background: We hypothesize that there is a higher incidence of vasectomy within the military at a younger age based on this equal access health care system.

Materials And Methods: A review of the CHAMPS military database was conducted for men receiving vasectomies from 2000 to 2009. Age at vasectomy, number of children, race, religion, and marital status were recorded and incidence was computed.

Developing an effective medication soldier readiness process.

With the ever high operation tempo that our Armed Forces experience, it is imperative that military providers understand their soldiers' medication needs and how to ensure that those medications are properly processed by the supporting military pharmacy. Without a definitive plan, the surgeons responsible for soldiers' health will fail. This article outlines the experiences of the 4th Infantry Division and Darnall Army Community Hospital while preparing the 4th Infantry Division soldiers for deployment in support of Operation Iraqi Freedom 2005-2007.

Pulmonary abnormalities on high-resolution CT demonstrate more rapid decline than FEV1 in adults with cystic fibrosis.

Background: FEV1 may remain stable while high-resolution CT (HRCT) appearances deteriorate in children with cystic fibrosis (CF). However, spirometry results commonly decline in older age groups.

Objectives: To compare the rate of decline in HRCT abnormalities and spirometry results over time in an adult cohort with CF.

Hyperpolarized 3helium magnetic resonance ventilation imaging of the lung in cystic fibrosis: comparison with high resolution CT and spirometry.

The purpose of this study was to compare hyperpolarized 3helium magnetic resonance imaging (3He MRI) of the lungs in adults with cystic fibrosis (CF) with high-resolution computed tomography (HRCT) and spirometry. Eight patients with stable CF prospectively underwent 3He MRI, HRCT, and spirometry within 1 week. Three-dimensional (3D) gradient-echo sequence was used during an 18-s breath-hold following inhalation of hyperpolarized 3He.

Thin-section CT in patients with cystic fibrosis: correlation with peak exercise capacity and body mass index.

Purpose: To evaluate whether thin-section chest computed tomographic (CT) findings correlate with exercise capacity, body mass index (BMI), dyspnea, and leg discomfort in patients with cystic fibrosis (CF).

Materials And Methods: Institutional ethics committee approval was obtained, and patients provided written informed consent. Twenty-two patients (13 male and nine female patients; mean age, 22 years +/- 5.

Improving access to health care for foster children: the Illinois model.

Children in foster care have lower health status than do their peers and limited access to health care. The Illinois Department of Children and Family Services developed HealthWorks, a separate primary care preferred provider system for children in foster care. This study compared claims data for children in HealthWorks with children not enrolled in HealthWorks and with children in Aid to Families with Dependent Children (AFDC) who had never entered foster care.

Extreme illness exaggeration in pediatric patients: a variant of Munchausen's by Proxy?

Reported cases of Munchausen by Proxy Syndrome in children suggest common psychosocial features for child and family. The possibility is explored that these same features are also present in a subgroup of children with documented, but very mild, illness. Suggestions for the diagnosis and management of this problem are offered, emphasizing a multidisciplinary team approach.