1 Innovations in Care Directorate for Medicine Annual Report 2016
Pediatric Hematology/Oncology
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Pediatric Hematology/Oncology Burris, A. M., Ballew, B. J., Kentosh, J. B., Turner, C. E., Norton, S. A., Giri, N., Alter, B. P., Nellan, A., Gamper, C., Hartman, K. R., & Savage, S. A. (2016). Hoyeraal-Hreidarsson Syndrome due to PARN Mutations: Fourteen Years of Follow-Up. Pediatr Neurol, 56, 62-68.e61. doi:10.1016/ j.pediatrneurol.2015.12.005
Chang, W., Brohl, A. S., Patidar, R., Sindiri, S., Shern, J. F., Wei, J. S., Song, Y. K., Yohe, M. E., Gryder, B., Zhang, S., Calzone, K. A., Shivaprasad, N., Wen, X., Badgett, T. C., Miettinen, M., Hartman, K. R., League-Pascual, J. C., Trahair, T. N., Widemann, B. C., Merchant, M. S., Kaplan, R. N., Lin, J. C., & Khan, J. (2016). Multi-Dimensional Clinomics for Precision Therapy of Children and Adolescent Young Adults with Relapsed and Refractory Cancer: A Report from the Center for Cancer Research. Clin Cancer Res, 22(15), 3810-3820. doi:10.1158/1078-0432.ccr-15-2717
Giamanco, N. M., Cunningham, B. S., Klein, L. S., Parekh, D. S., Warwick, A. B., & Lieuw, K. (2016). Allopurinol Use During Maintenance Therapy for Acute Lymphoblastic Leukemia Avoids Mercaptopurine-related Hepatotoxicity. J Pediatr Hematol Oncol, 38(2), 147-151. doi:10.1097/ mph.0000000000000499
Groomes, C. L., Gianferante, D. M., Crouch, G. D., Parekh, D. S., Scott, D. W., & Lieuw, K. (2016). Reduction of Factor VIII Inhibitor Titers During Immune Tolerance Induction With Recombinant Factor VIII-Fc Fusion Protein. Pediatr Blood Cancer, 63(5), 922-924. doi:10.1002/pbc.25874 Pediatric Subspecialty Adams, D. J., Susi, A., Erdie-Lalena, C. R., Gorman, G., Hisle-Gorman, E., Rajnik, M., Elrod, M., & Nylund, C. M. (2016). Otitis Media and Related Complications Among Children with Autism Spectrum Disorders. J Autism Dev Disord, 46(5), 1636-1642. doi:10.1007/s10803-015-2689-x
Albert, D., Heifert, T. A., Min, S. B., Maydonovitch, C. L., Baker, T. P., Chen, Y. J., & Moawad, F. J. (2016). Comparisons of Fluticasone to Budesonide in the Treatment of Eosinophilic Esophagitis. Dig Dis Sci, 61(7), 1996-2001. doi:10.1007/s10620-016-4110-9
Elrod, M. G., Nylund, C. M., Susi, A. L., Gorman, G. H., Hisle-Gorman, E., Rogers, D. J., & Erdie- Lalena, C. (2016). Prevalence of Diagnosed Sleep Disorders and Related Diagnostic and Surgical Procedures in Children with Autism Spectrum Disorders. J Dev Behav Pediatr, 37(5), 377-384. doi:10.1097/dbp.0000000000000248
Groomes, C. L., Gianferante, D. M., Crouch, G. D., Parekh, D. S., Scott, D. W., & Lieuw, K. (2016). Reduction of Factor VIII Inhibitor Titers During Immune Tolerance Induction With Recombinant Factor VIII-Fc Fusion Protein. Pediatr Blood Cancer, 63(5), 922-924. doi:10.1002/pbc.25874
Gupta, L. J., & May, J. W. (2017). Managing a "New" Murmur in Healthy Children and Teens. Clin Pediatr (Phila), 56(4), 357-362. doi:10.1177/0009922816656623
Hefner, J. N., Howard, R. S., Massey, R., Valencia, M., Stocker, D. J., Philla, K. Q., Goldman, M. D., Nylund, C. M., & Min, S. B. (2016). A Randomized Controlled Comparison of Esophageal Clearance Times of Oral Budesonide Preparations. Dig Dis Sci, 61(6), 1582-1590. doi:10.1007/s10620-015- 3990-4
(2016). Feeding Disorders in Children With Autism Spectrum Disorders Are Associated With Eosinophilic Esophagitis. J Pediatr Gastroenterol Nutr, 63(4), e69-73. doi:10.1097/ mpg.0000000000001282
Shedlock, K., Susi, A., Gorman, G. H., Hisle-Gorman, E., Erdie-Lalena, C. R., & Nylund, C. M. (2016). Autism Spectrum Disorders and Metabolic Complications of Obesity. J Pediatr, 178, 183-187.e181. doi:10.1016/j.jpeds.2016.07.055
Stark, C. M., Nylund, C. M., Gorman, G. H., & Lechner, B. L. (2016). Primary renal magnesium wasting: an unusual clinical picture of exercise-induced symptoms. Physiol Rep, 4(8). doi:10.14814/phy2.12773
82 Readiness Home sweet home—MAJ Paul Clark, MD, Medical Director of the Medical Intensive Care Unit (MICU) and members of the 10th Combat Surgical Hospital return from their five-month deployment to Kuwait in support of Operation Spartan Shield. Ernest J Lubin, Jr Senior Enlisted Leader Directorate for Medicine MSG
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Home sweet home—MAJ Paul Clark, MD, Medical Director of the Medical Intensive Care Unit (MICU) and members of the 10th Combat Surgical Hospital return from their five-month deployment to Kuwait in support of Operation Spartan Shield.
Numerous personnel in the Directorate for Medicine were involved in various activities to support not only the global war on terror but also a variety of other readiness activities. Fourteen Army and four Navy enlisted and officers were deployed with operational brigades, combat support hospitals and naval platforms throughout the year to a range of locales and countries, including the Army training centers in Louisiana and California; Europe, the Middle East, South America and South Korea. They provided the breadth of care from everyday sick call for minor concerns to subspecialty and trauma care at the combat
support hospitals. These providers, medics and corpsmen ensured that, no matter the location, our Soldiers, Sailors and Airmen received only the best care available.
In addition, seven Directorate for Medicine physicians provided medical support to traveling Congressional delegations (CODELs) to a multitude of countries on five different continents. With only a small bag of medicines and a supply backpack with emergency supplies, they ensured the safety and highest level of medical care for the Congressional members and their staff in even the most distant locations.
As the country prepared for the election in November 2016,
Directorate personnel prepared to provide seamless and thorough medical care for the subsequent Presidential Inauguration in January 2017. Preparation for service on this international stage required significant coordination and multiple rehearsals to prepare for every contingency, all of which resulted in a flawless, but virtually unseen operation throughout the day.
Along with the breadth of operational support, every day throughout the Directorate, personnel are training, updating supplies and materials, and seeking new information to ensure that all uniformed personnel are ready and able to provide support to the line at a moment’s notice. No doubt, the Directorate for Medicine will continue to sustain, if not increase, its support for the line in 2017.
Conducting MEDEVAC training in Iraq with a flight crew.
stabilization of a Soldier during care under fire.
Army DMS Personnel Deployed in 2016 SFC Jamie Chau MAJ Paul Clark MAJ Michael Crimmins CPT Derek Forsthoefel CPT Blair Glasgo LTC (P) Brian Hemann LTC Jeffrey Lackey MAJ Joseph Louden MAJ Juan Martinez-Ross LTC Stephen Olson LTC Paresh Patel
MAJ Witzard Seide MAJ Brett Theeler MAJ Christopher Tracy
Navy DMS Personnel Deployed in 2016 HM2 Martin Adesu HM2 Byron Blackmon CDR Gerard Demers HN Frederick Robinson
CODELs in 2016 COL Jess Edison CPT Derek Forsthoefel
CDR Todd Gleeson COL Stuart McCarver MAJ Megan McKinnon LCDR Karl Nadolsky
LTC Toihunta Stubbs
MD, Chief of Medicine at WRB, lower right, meets with members of the Kuwaiti medical staff in Kuwait to foster more cooperative military efforts in the delivery of healthcare.
B y th e Number s The Directorate for Medicine The Directorate for Medicine is comprised of four departments and two branch clinics—the Departments of Emergency Medicine, Medicine, Neurology and Pediatrics; and primary care branch clinics at the Pentagon and Uniformed Services University. It also provides pulmonary- related Critical Care support to the Medical Intensive Care Unit (the MICU), and through the Warrior Care service the Directorate provides both primary and specialty care to wounded, ill and injured members of the Army, Marines, Navy, Air Force, Coast Guard and US Public Health Service. It is the largest of the directorates at Walter Reed Bethesda.
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Staff providers (MD, PA, NP) 313 Interns, residents and fellows 228 Licensed practical nurses 100 Registered nurses 206 Enlisted staff 213
Civilians 467 Active duty service members 638 Contract staff 296
1,544,839 1,577,043 2014 2015 2016 Total Directorate Productivity in RVUs
Walter Reed National Military Medical Center Walter Reed Bethesda is the world’s largest military medical center, providing care and services to over 1 million beneficiaries per year. Located on 243 acres and with more than 2.4 million square feet of clinical space, it serves as the flagship of military medicine. Its primary mission is to ensure the readiness of, and to provide care for, members of the Uniformed Services and their families. It also provides care for the President and Vice President of the United States, members of Congress and justices of the Supreme Court. In addition, when authorized, it provides care for foreign military and embassy personnel as well. Walter Reed Bethesda is a designed Level II trauma center.
243 acres 236 bed capacity 13,125 admissions less births 1,315 total births 4.51 days average length of stay 30,244 total emergency department visits 7,100 total staff members (approximate)
DiLorenzo Tricare Health Clinic
The Pentagon Pentagon Tri-Service Dental Clinic
The Pentagon Occupational Health Clinics Carderock
Bethesda Uniformed Services University Family Health Center
Bethesda Mission statement: We are the flagship of our Military Health System. We ensure patient- friendly access to high-quality healthcare for all we are privileged to serve, while setting the standard in readiness, education and research.
P eo ple Department of Emergency Medicine Team Ssgt Marc Allen Ana Irizarry Paulette Crull CDR Jared Scott LTC Paresh Patel LCDR Eric Brantley Pris Joyner LTC Bruce Weathers Nicole Jackson CPT John Witt Michelle DeVito
CAPT Joel Anthony Nations, MD Director for Medicine COL Katherine Kimball-Eayrs, MD Deputy Director LTC Kimberly Bell, RN Deputy Director MSG Ernest Lubin, Jr Senior Enlisted Leader Dante Dizon Health System Administrator Lance Wise Health Systems Specialist LT Clement Francis, RN PCMH and Primary Care Jacqueline Millender Executive Assistant
Department of Neurology Team MAJ Jonathan Smith HM1 Frederick Turner Nakeia Temoney CPT Henry Biemann LTC Nathan Tagg SFC William Lawson William Young MAJ Kedrick Drakes Frank Abram Department of Pediatrics Team COL Martin Weisse HM1 Jeffery Bozeman LTC Castaneda Sierocka Philip Rogers CDR Jill Emerick Kimberly Campbell LTC Dina Parekh COL Thomas Newton LTC Autumn Richards Lauren Perry Tiffany James CAPT Gregory Gorman Diana Do Kenneth Montgomery LTC Amy Thompson Department of Medicine Team LTC (P) Brian Hemann, MD Chief of Medicine Theresa Lavoie, RN Assistant Chief CDR Todd Gleeson, MD Assistant Chief HMC Corey McCloud Senior Enlisted Leader Brian Vazzano, MBA, MHA Health System Administrator Candice Randolph Executive Assistant
02 Table of Contents 04 Letter 06 Department of Emergency Medicine 14 Department of Medicine 42 Department of Neurology 48 Department of Pediatrics 60 Branch Clinics 66 Educatio n 72 Research 80 Readiness 86 Publications 90 Facts 92 People Afternoon sunlight filters over the entryway to the America Building and Todd Krasovertz’s painting, “Corpsman Up,” which honors Navy corpsmen and an anthem composed in 2006 by Maj. Brian Dix, USMC, Director of the US Marine Drum and Bugle Corps; the anthem itself was inspired by the heroic actions of Navy corpsmen serving wounded Marines in Iraq, and is in tune with the key medical readiness mission of Walter Reed Bethesda and Uniformed Services University.
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