Lloyd Runser | Uniformed Services University (original) (raw)

Papers by Lloyd Runser

American family physician, 2017

Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It acc... more Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It accounts for 1% to 1.5% of emergency department visits, resulting in high hospital admission rates and significant medical costs. Syncope is classified as neurally mediated, cardiac, and orthostatic hypotension. Neurally mediated syncope is the most common type and has a benign course, whereas cardiac syncope is associated with increased morbidity and mortality. Patients with presyncope have similar prognoses to those with syncope and should undergo a similar evaluation. A standardized approach to syncope evaluation reduces hospital admissions and medical costs, and increases diagnostic accuracy. The initial assessment for all patients presenting with syncope includes a detailed history, physical examination, and electrocardiography. The initial evaluation may diagnose up to 50% of patients and allows immediate short-term risk stratification. Laboratory testing and neuroimaging have a low d...

LGBT health, 2018

This study assessed military healthcare providers' knowledge, clinical practice, and comfort ... more This study assessed military healthcare providers' knowledge, clinical practice, and comfort in caring for active duty (AD) lesbian, gay, and bisexual (LGB) patients. Primary care providers at Fort Bragg, North Carolina were surveyed anonymously. The response rate was 28% (n = 40). Almost two-thirds of the respondents felt comfortable discussing sexual health with AD patients, but only 5% inquired about same-sex sexual activity. Slightly less than one-third reported prior training in LGB healthcare topics and nearly four-fifths desired clear guidance from the Department of Defense regarding the process for screening and documentation of AD same-sex sexual activity. The findings highlight providers' need and desire for training in LGB patient care.

Family medicine, 2017

Encouraging resident scholarly activity has been a longstanding challenge for medical educators. ... more Encouraging resident scholarly activity has been a longstanding challenge for medical educators. The Accreditation Council for Graduate Medical Education (ACGME) has been increasing its emphasis on scholarly activity, forcing programs to evaluate their existing processes. This study sought to evaluate the impact of a scholarly activity point system on the resident scholarly productivity at multiple programs. Five military family medicine residencies evaluated resident outcomes 2 years before and 2 years after the introduction of a scholarly activity point system. Outcome measures included peer-reviewed publications with a resident as first author, peer-reviewed publications with a resident as any author, resident presentation of scholarship at a regional, national, and international conference, IRB-approved protocols with a resident as principal investigator, and IRB-approved protocols with a resident in any role. Four of the five programs experienced substantial increases in nearly...

Family medicine, 2014

Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite... more Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite the variety of SA options, the output of resident presentations and publications remains disappointingly low, and many residents voice frustration with fulfilling the research requirements. A resident-driven process improvement project was undertaken with the goal of achieving a 100% increase of peer-reviewed publications and scholarly presentations by residents with secondary goals of doubling the involvement of staff, residents, and visiting medical or physician assistant students. This project involves (1) increasing awareness of conferences for scholarly submission, (2) assignment of residents in a resident research team to lead efforts, (3) pairing of interns/students with senior mentors with similar interests, (4) faculty to include one resident on all projects, and (5) monthly SA meetings to track research progress, share ideas, and troubleshoot areas of difficulty. Scholarly tot...

Family Medicine, Apr 1, 2014

Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite... more Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite the variety of SA options, the output of resident presentations and publications remains disappointingly low, and many residents voice frustration with fulfilling the research requirements. A resident-driven process improvement project was undertaken with the goal of achieving a 100% increase of peer-reviewed publications and scholarly presentations by residents with secondary goals of doubling the involvement of staff, residents, and visiting medical or physician assistant students. This project involves (1) increasing awareness of conferences for scholarly submission, (2) assignment of residents in a resident research team to lead efforts, (3) pairing of interns/students with senior mentors with similar interests, (4) faculty to include one resident on all projects, and (5) monthly SA meetings to track research progress, share ideas, and troubleshoot areas of difficulty. Scholarly totals were compared between the 2011--2012 and 2012--2013 academic years. The SA goals were achieved on all fronts. The number of resident presentations increased from three to 28 (seven regional, 10 national, and 11 international presentations), and resident peer-reviewed publications increased from two to six when compared to the previous year. Scholarly participation doubled at all levels. The authors recommend that other residencies consider promoting increased resident-to-resident scholarly mentorship, early planning with scheduled timeline, and increasing awareness of SA opportunities yearly.

Military medicine, 2007

Rural Army community hospitals without gastroenterologists require civilian referrals for esophag... more Rural Army community hospitals without gastroenterologists require civilian referrals for esophagogastroduodenoscopies (EGDs). The goal was to determine whether an endoscopy-trained, military family physician saved health care dollars at an Army community hospital by decreasing outside referrals. We present a chart review of all 95 EGDs performed by a family physician at an Army community hospital between September 2003 and May 2005. The total facility cost was determined by using the cost of personnel, lost clinic hours, equipment, supplies, medications, continuing medical education, missed diagnoses, procedure complications, and need for additional referrals. The potential referral cost was determined by using local civilian endoscopy billing codes and TRICARE reimbursement rates for 2004. The total facility cost was 22,655.65(22,655.65 (22,655.65(238.48 per EGD). The total referral cost would have been 55,614.95(55,614.95 (55,614.95(585.42 per EGD). Using a family physician saved the hospital 32,959.30(32,959.30 (32,959.30(346.94 pe...

Military medicine, 2007

Army community hospitals (ACHs) without gastroenterologists require civilian referrals for colono... more Army community hospitals (ACHs) without gastroenterologists require civilian referrals for colonoscopy. The purpose of this study was to determine whether a colonoscopy-trained, military family physician (FP) saved health care dollars at an ACH by decreasing outside referrals. We present a chart review of all 182 colonoscopies performed by a FP at an ACH from September 2003 to May 2005. The total facility cost was determined using the cost of personnel, lost clinic hours, equipment, supplies, medications, continuing medical education, missed diagnoses, procedure complications, and need for additional studies. The potential referral cost was determined using local civilian colonoscopy billing codes and TRICARE reimbursement rates for 2004. The total facility cost was 53,517.14(53,517.14 (53,517.14(294.05 per colonoscopy). The total referral cost would have been 156,197.60(156,197.60 (156,197.60(858.23 per colonoscopy). Using a FP saved the hospital 102,680.46(102,680.46 (102,680.46(564.18 per colonoscopy). A colonoscopy-trained FP saved sig...

Journal of Surgical Education, 2007

International Journal of STD & AIDS, 2004

A retrospective review was conducted on serum vitamin B12 levels in an HIV-infected outpatient co... more A retrospective review was conducted on serum vitamin B12 levels in an HIV-infected outpatient cohort, many of whom received antiretroviral therapy. B12 levels were obtained at most staging visits (every six months) and when clinically indicated. For each serum B12 level, laboratory values and clinical symptoms were recorded. Thirty-two patients (32/251 or 13%) had at least one low B12 level (<211pg/mL) during the course of their HIV infection. Within two years of their initial HIV presentation, 6/57 patients had a low serum B12. Using multiple linear regression analysis, a higher serum B12 level was significantly associated with higher folate levels, African-American race, and lower mean corpuscular volume. B12 levels increased significantly after initiating antiretroviral therapy (416 vs 535 pg/mL, P=0.04). In conclusion, low serum B12 levels occur commonly among HIV-infected patients, even at early stages without overt symptoms of B12 deficiency. Antiretroviral therapy may increase serum B12 levels.

American Journal of Medical Genetics, 2004

Family medicine, 2014

Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite... more Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite the variety of SA options, the output of resident presentations and publications remains disappointingly low, and many residents voice frustration with fulfilling the research requirements. A resident-driven process improvement project was undertaken with the goal of achieving a 100% increase of peer-reviewed publications and scholarly presentations by residents with secondary goals of doubling the involvement of staff, residents, and visiting medical or physician assistant students. This project involves (1) increasing awareness of conferences for scholarly submission, (2) assignment of residents in a resident research team to lead efforts, (3) pairing of interns/students with senior mentors with similar interests, (4) faculty to include one resident on all projects, and (5) monthly SA meetings to track research progress, share ideas, and troubleshoot areas of difficulty. Scholarly tot...

American family physician, 2017

Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It acc... more Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It accounts for 1% to 1.5% of emergency department visits, resulting in high hospital admission rates and significant medical costs. Syncope is classified as neurally mediated, cardiac, and orthostatic hypotension. Neurally mediated syncope is the most common type and has a benign course, whereas cardiac syncope is associated with increased morbidity and mortality. Patients with presyncope have similar prognoses to those with syncope and should undergo a similar evaluation. A standardized approach to syncope evaluation reduces hospital admissions and medical costs, and increases diagnostic accuracy. The initial assessment for all patients presenting with syncope includes a detailed history, physical examination, and electrocardiography. The initial evaluation may diagnose up to 50% of patients and allows immediate short-term risk stratification. Laboratory testing and neuroimaging have a low d...

LGBT health, 2018

This study assessed military healthcare providers' knowledge, clinical practice, and comfort ... more This study assessed military healthcare providers' knowledge, clinical practice, and comfort in caring for active duty (AD) lesbian, gay, and bisexual (LGB) patients. Primary care providers at Fort Bragg, North Carolina were surveyed anonymously. The response rate was 28% (n = 40). Almost two-thirds of the respondents felt comfortable discussing sexual health with AD patients, but only 5% inquired about same-sex sexual activity. Slightly less than one-third reported prior training in LGB healthcare topics and nearly four-fifths desired clear guidance from the Department of Defense regarding the process for screening and documentation of AD same-sex sexual activity. The findings highlight providers' need and desire for training in LGB patient care.

Family medicine, 2017

Encouraging resident scholarly activity has been a longstanding challenge for medical educators. ... more Encouraging resident scholarly activity has been a longstanding challenge for medical educators. The Accreditation Council for Graduate Medical Education (ACGME) has been increasing its emphasis on scholarly activity, forcing programs to evaluate their existing processes. This study sought to evaluate the impact of a scholarly activity point system on the resident scholarly productivity at multiple programs. Five military family medicine residencies evaluated resident outcomes 2 years before and 2 years after the introduction of a scholarly activity point system. Outcome measures included peer-reviewed publications with a resident as first author, peer-reviewed publications with a resident as any author, resident presentation of scholarship at a regional, national, and international conference, IRB-approved protocols with a resident as principal investigator, and IRB-approved protocols with a resident in any role. Four of the five programs experienced substantial increases in nearly...

Family medicine, 2014

Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite... more Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite the variety of SA options, the output of resident presentations and publications remains disappointingly low, and many residents voice frustration with fulfilling the research requirements. A resident-driven process improvement project was undertaken with the goal of achieving a 100% increase of peer-reviewed publications and scholarly presentations by residents with secondary goals of doubling the involvement of staff, residents, and visiting medical or physician assistant students. This project involves (1) increasing awareness of conferences for scholarly submission, (2) assignment of residents in a resident research team to lead efforts, (3) pairing of interns/students with senior mentors with similar interests, (4) faculty to include one resident on all projects, and (5) monthly SA meetings to track research progress, share ideas, and troubleshoot areas of difficulty. Scholarly tot...

Family Medicine, Apr 1, 2014

Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite... more Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite the variety of SA options, the output of resident presentations and publications remains disappointingly low, and many residents voice frustration with fulfilling the research requirements. A resident-driven process improvement project was undertaken with the goal of achieving a 100% increase of peer-reviewed publications and scholarly presentations by residents with secondary goals of doubling the involvement of staff, residents, and visiting medical or physician assistant students. This project involves (1) increasing awareness of conferences for scholarly submission, (2) assignment of residents in a resident research team to lead efforts, (3) pairing of interns/students with senior mentors with similar interests, (4) faculty to include one resident on all projects, and (5) monthly SA meetings to track research progress, share ideas, and troubleshoot areas of difficulty. Scholarly totals were compared between the 2011--2012 and 2012--2013 academic years. The SA goals were achieved on all fronts. The number of resident presentations increased from three to 28 (seven regional, 10 national, and 11 international presentations), and resident peer-reviewed publications increased from two to six when compared to the previous year. Scholarly participation doubled at all levels. The authors recommend that other residencies consider promoting increased resident-to-resident scholarly mentorship, early planning with scheduled timeline, and increasing awareness of SA opportunities yearly.

Military medicine, 2007

Rural Army community hospitals without gastroenterologists require civilian referrals for esophag... more Rural Army community hospitals without gastroenterologists require civilian referrals for esophagogastroduodenoscopies (EGDs). The goal was to determine whether an endoscopy-trained, military family physician saved health care dollars at an Army community hospital by decreasing outside referrals. We present a chart review of all 95 EGDs performed by a family physician at an Army community hospital between September 2003 and May 2005. The total facility cost was determined by using the cost of personnel, lost clinic hours, equipment, supplies, medications, continuing medical education, missed diagnoses, procedure complications, and need for additional referrals. The potential referral cost was determined by using local civilian endoscopy billing codes and TRICARE reimbursement rates for 2004. The total facility cost was 22,655.65(22,655.65 (22,655.65(238.48 per EGD). The total referral cost would have been 55,614.95(55,614.95 (55,614.95(585.42 per EGD). Using a family physician saved the hospital 32,959.30(32,959.30 (32,959.30(346.94 pe...

Military medicine, 2007

Army community hospitals (ACHs) without gastroenterologists require civilian referrals for colono... more Army community hospitals (ACHs) without gastroenterologists require civilian referrals for colonoscopy. The purpose of this study was to determine whether a colonoscopy-trained, military family physician (FP) saved health care dollars at an ACH by decreasing outside referrals. We present a chart review of all 182 colonoscopies performed by a FP at an ACH from September 2003 to May 2005. The total facility cost was determined using the cost of personnel, lost clinic hours, equipment, supplies, medications, continuing medical education, missed diagnoses, procedure complications, and need for additional studies. The potential referral cost was determined using local civilian colonoscopy billing codes and TRICARE reimbursement rates for 2004. The total facility cost was 53,517.14(53,517.14 (53,517.14(294.05 per colonoscopy). The total referral cost would have been 156,197.60(156,197.60 (156,197.60(858.23 per colonoscopy). Using a FP saved the hospital 102,680.46(102,680.46 (102,680.46(564.18 per colonoscopy). A colonoscopy-trained FP saved sig...

Journal of Surgical Education, 2007

International Journal of STD & AIDS, 2004

A retrospective review was conducted on serum vitamin B12 levels in an HIV-infected outpatient co... more A retrospective review was conducted on serum vitamin B12 levels in an HIV-infected outpatient cohort, many of whom received antiretroviral therapy. B12 levels were obtained at most staging visits (every six months) and when clinically indicated. For each serum B12 level, laboratory values and clinical symptoms were recorded. Thirty-two patients (32/251 or 13%) had at least one low B12 level (<211pg/mL) during the course of their HIV infection. Within two years of their initial HIV presentation, 6/57 patients had a low serum B12. Using multiple linear regression analysis, a higher serum B12 level was significantly associated with higher folate levels, African-American race, and lower mean corpuscular volume. B12 levels increased significantly after initiating antiretroviral therapy (416 vs 535 pg/mL, P=0.04). In conclusion, low serum B12 levels occur commonly among HIV-infected patients, even at early stages without overt symptoms of B12 deficiency. Antiretroviral therapy may increase serum B12 levels.

American Journal of Medical Genetics, 2004

Family medicine, 2014

Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite... more Scholarly activity (SA) is a fundamental component of family medicine residency training. Despite the variety of SA options, the output of resident presentations and publications remains disappointingly low, and many residents voice frustration with fulfilling the research requirements. A resident-driven process improvement project was undertaken with the goal of achieving a 100% increase of peer-reviewed publications and scholarly presentations by residents with secondary goals of doubling the involvement of staff, residents, and visiting medical or physician assistant students. This project involves (1) increasing awareness of conferences for scholarly submission, (2) assignment of residents in a resident research team to lead efforts, (3) pairing of interns/students with senior mentors with similar interests, (4) faculty to include one resident on all projects, and (5) monthly SA meetings to track research progress, share ideas, and troubleshoot areas of difficulty. Scholarly tot...