MRD Monthly Waterfront Meeting Minutes

March 26, 2014

I.  Introduction

  1. HMCM NAFUS:
  2. Autoinjectors: Do not destroy autoinjector currently onboard your command
  3. 6000.1 has been completed and signed off
  4. Link will be placed on website
  5. 2003 version is now outdated
  6. E-9 board convenes on Monday (due date Friday)
  7. HMCS Valencia:
  8. Information from HMC Borja- BMET at MRD- 48NOV Heat Stress Monitor
  9. Do not send your monitors to the Calibration Lab: MIP 4361/082- annual check- machine designed to be calibrated at command each time
  10. TMIP Ships: Security PUSH from SPAWAR: memo needs completion- obtain from MRD SMIs: give package to IT to train to run the program
  11. HMC Sarsozo:
  12. Attendance sheet / POC listing / CME sheet- sign all
  13. All information from meeting on website
  14. NEPMU-5 Next TriService Food Code Update
  15. April 15-16 email Mr. Roberto 556-8560
  16. HMC Montalvo:
  17. May 27-30th: 25 CEU’s – open to all providers
  18. SWMI Dining in: April 4th for HMCs

II.  CME Lecture

  1. LCDR Nelson Saldua: Orthopedic Spine Surgeon from NMCSD
  2. GMO 10 years prior USS JFK
  3. Indications from Surgery
  4. Spondylolisthesis: Cut and Dry Surgery: Rare
  5. Goals for Lecture:
  6. Discuss surgical management for common lumbar spine pathologies
  7. Literature based review of the expected clinical outcome after surgery
  8. Facilitate communication between referring providers and our clinic
  9. What is the best working definition of lumbar disc herniation with radiculopathy
  10. Must be DERMATOMAL (not just down a leg, ensure over a dermatome)
  11. If non-dermatomal, unlikely to get better with surgery
  12. Most Common Nerves/Discs Involved
  13. L4-S1
  14. Ask about bowel or bladder changes- r/o Cauda Equina
  15. ODI score: Post-Surgical 10 question exam: 100 point score: higher, the worse the pain/symptoms
  16. Literature:
  17. Outcomes of Lumbar Microdiscectomy in a Young, Active Population
  18. Case Series 197 patients
  19. ODC decreased by 32%
  20. Return to active duty rate 84%
  21. Surgical Versus Nonoperative Treatment Lumbar Disc Herniation
  22. Surgical group better than non-surgical group at 8-years
  23. Disc Herniation with only Low Back Pain
  24. Rate of Return to Military Active Duty after Single Level Lumbar Interbody Fusion (not much better with arthroplasty)
  25. 55% return to active duty rate (flip of a coin)
  26. Predictive Factors (Age: older do better, Rank: 85% to 40% more likely to return higher to lower enlisted) for positive return to active duty
  27. Fusions need revision every 15-20 years à with younger active duty patients, clinical outcomes will do poorly long term with surgery
  28. Lumbar Spinal Stenosis
  29. Symptoms better leaning forward / hunching over
  30. These patients do well with lumbar decompression
  31. Literature shows at 4 years, patients are doing well
  32. Overall
  33. Patients (per VA guidelines) to send to surgery:
  34. Significant nerve root impingement or spinal stenosis present

III.  Clinical Practice Guidelines

  1. LT Gilman
  2. Competency For Duty Evals
  3. Completed by Medical Officers in port
  4. Do Not Require Laboratory Studies Unless Requested by CO
  5. NMCSD ER does not completed during working hours
  6. Reminder: Always contact ER before sending patient for evaluation
  7. Hepatitis B Screening
  8. Documentation of Immunity Required (Hep B Surface Antibody)
  9. If no immunity documented, start series and then re-check in 25 months
  10. Hepatitis C and HIV
  11. Hepatitis C required every 5 years
  12. HIV required every 2 years
  13. Special Cases
  14. If someone tests positive for STI, re-test for Hep C and HIV
  15. If someone receives orders OCONUS, Hep C and HIV testing required within 1 year
  16. Dive Physicals Contacts
  17. Please see attachments: EOD vs DIVE/DOME DIVE vs SPECWAR
  18. Operational Medicine Symposium: 27-30May: HMC Montalvo
  19. Primary Care Symposium 9 May: CDR Keller