Telemedicine Proof of Concept and Cost Savings During Underway Naval Operations.

Objectives: With military service members stationed around the world aboard ships and remote fixed facilities, subspecialty care frequently occurs outside of the TRICARE network, the health care program of the United States Department of Defense Military Health System, including foreign hospitals. Furthermore, usage aboard U.S. Navy ships has been limited in scope. This has direct costs associated with the medical care rendered and indirect costs such as difficulty navigating medical systems, access to records, and appropriate follow-up. Telemedicine has expanded access to otolaryngologic care where coverage has been deficient, with overall costs that are not well defined. This study aims to demonstrate the ability of consult management aboard a deployed U.S. Navy ship and to determine the direct costs associated with the use of an HIPAA-compliant, store-and-forward telemedicine system available to overseas medical providers to obtain specialty consultation at a tertiary care military treatment facility. Study Design: Retrospective case series. Methods: We reviewed consults submitted through the system from February 2018 to May 2018. Consult management was performed remotely by a deployed otolaryngologist in various locations underway and in port in the Pacific Rim. The direct cost associated with each consult was compared with the cost had the patient been treated in the host nation. Results: During the deployment, there were eight consults submitted and directed to a neurotologist/skull base surgeon for an opinion. The estimated cost for treating these patients overseas was $124,037, while the estimated cost of retaining the patients in the Military Health System was $27,330. Extrapolated to a 12-month period, the cost savings of this program could be over $400,000. Conclusions: Telemedicine consultation has the ability to be initiated and managed remotely-expanding access to subspecialty physicians by service members stationed around the world. Furthermore, it has the potential for substantial cost savings within the military health care system along with intangible benefits that sustain the military health care system downstream.

Hair-thread tourniquet syndrome: a case report and review of treatment.

Hair-thread tourniquet syndrome (HTTS) is caused by circumferential constriction of an appendage, usually by hair or thread, leading to obstruction of circulation and ischemia. Although not rare, this entity is not discussed extensively in the Dermatology literature. We present a case of HTTS and discuss the demographics and etiology, and review the most current treatment methods.

Treatment of focal axillary hyperhidrosis using a long-pulsed Nd:YAG 1064 nm laser at hair reduction settings.

BACKGROUND AND OBJECTIVE: Axillary hyperhidrosis is a rather common idiopathic disorder of the eccrine sweat glands, which can interfere with daily activities and cause significant social distress. The effects of 1064 nm laser hair reduction on sweat production in a pilot study in patients with focal axillary hyperhidrosis are described. STUDY DESIGN/MATERIALS AND METHODS: In a prospective, case-controlled, randomized pilot study, one axilla from six different subjects with axillary hyperhidrosis was treated with monthly laser hair reduction sessions using the 1064 nm Nd:YAG laser at typical settings. The contralateral axilla acted as a control. Subjects were asked to subjectively classify improvement of axillary sweating using a Global Assessment Questionnaire (GAQ) weekly after each treatment. Qualitative evaluation of sweating was also performed using a modified starch iodine test monthly after each treatment. In addition, prior to the first treatment and at one month following the final treatment, a punch biopsy was performed on the treatment axilla to assess for histologic changes to the eccrine gland and surrounding structures. RESULTS: Statistically significant improvements in subjective ratings of sweating using the GAQ compared to baseline were observed. Objective improvements in sweating with modified starch iodine testing comparing treated versus non-treated axillae were also seen for at least nine months in selected subjects. No significant differences in pre- and post-treatment biopsies were noted on routine histology. CONCLUSIONS: Laser hair reduction using the 1064 nm Nd:YAG at laser hair removal settings provides subjective and objective improvements in patients with focal axillary hyperhidrosis.

Functional improvements in traumatic scars and scar contractures using an ablative fractional laser protocol.

BACKGROUND: Reports describing the use of ablative fractional resurfacing (AFR) for cosmetic improvements in skin dyschromia, rhytides, and textural irregularities are becoming increasingly common in the literature. However, the is little mention of its functional impact on patients with traumatic scars and scar contractures. We present our experience treating scars with AFR, highlighting four illustrative cases and providing a review on possible mechanisms. METHODS: Up to three ablative fractional carbon dioxide laser treatments were performed at 1-month to 2-month intervals on four patients with functional deficits related to refractory scar contractures. Treatments were individualized and began as early as 2 months after injury or final reconstructive surgery. Cases were performed in the outpatient clinic using topical anesthetic supplemented by forced air cooling. Postprocedure care included diluted-vinegar compresses two to three times daily and application of ointment over the treatment area for approximately 3 days after the procedure. Postprocedure pain was minimal, and all patients were allowed to resume physical therapy as early as the day of treatment. RESULTS: AFR was well tolerated without serious complications. Durable and cumulative improvements in range of motion or overall skin functionality were noted in all patients. AFR can be surgery sparing and facilitated earlier return to full or modified activities based on associated injuries. CONCLUSION: AFR is a novel, well tolerated, and effective complement to traditional rehabilitative management for patients with traumatic scars and scar contractures. Potential paradigm shifts include earlier initiation of treatment and a focus on functional improvements.