Department of Allergy and Immunology
The Allergy-Immunology Department includes five services and a Department of Defense⁄Centers for Disease Control Center of Excellence:

• The Allergy, Asthma and Immunization Clinical Service evaluates and treats patients of all ages with allergic and immunologic disorders, and provides adult immunization services and travel immunization for all ages.
• Allergy-Immunology Fellowship Training Program.
• Clinical Laboratory Immunology Fellowship Training Program.
• The tri-service U.S. Army Centralized Allergen Extract Laboratory provides allergen extract vaccines for allergic patients worldwide. The lab’s nationally recognized aerobiological sampling center prepares pollen and mold spore reports for local and national surveillance surveys and media networks.
• The Tri-service Immunization-Allergy Technician Course provides enlisted medics and nurses from all branches of the Department of Defense with comprehensive training in immunization and allergy specialty treatment and patient care.
• The Vaccine Healthcare Center Network, in collaboration with the Centers for Disease Control and Prevention’s National Immunization Program, develops comprehensive clinical services for vaccine safety surveillance, improved reporting of vaccine adverse events, and immunization health care. It also develops and implements educational outreach and continuous performance improvement programs.

Department of Medicine
Cardiology Service
The Cardiology Service provides diagnostic and therapeutic services to infants, children and adults with suspected and known heart disease. The Cardiology Clinic also performs electrocardiograms, treadmill tests, echocardiograms, Doppler studies and other diagnostic procedures. The Coronary Care Unit has the most modern monitoring systems available. It treats cardiac inpatients, while the Cardiac Short-Stay Observation Clinic manages the care of recovery patients who undergo outpatient procedures.

Three computerized, digital cardiac catheterization laboratories diagnose cardiac disease at all age levels. The most frequent diagnostic procedure is coronary arteriography. The laboratories also perform interventional procedures, such as coronary angioplasty, balloon valvuloplasty, directional atherectomy, rotational atherectomy, intravascular stent placement, permanent pacemaker implantation, and radio frequency catheter ablation.

The Cardiology Service’s Coronary Artery Disease Reversal Program, or CADRe, provides comprehensive cardiovascular risk factor modification to adults with known coronary artery disease or those at risk for developing the disease. A clinical team of cardiologists, nurse practitioners, exercise physiologists, dietitians, clinical psychologists, and stress management instructors supervises all aspects of the program.

Endocrinology Service
The Endocrinology Diabetes and Metabolism Service provides expert care to patients with disorders of the thyroid, pituitary and adrenal glands and to patients with diabetes, as well as reproductive and lipid disorders. It also offers an American Diabetes Association-certified patient education program, bone mineral densitometry, and fine needle aspiration biopsies of the thyroid. It is the sole endocrinology fellowship-training program for the Army.

The Diabetes Institute, a section of the Endocrinology Service, enhances medical care to patients with diabetes. It integrates primary care providers and specialists of the system into a disease management team that permits the highest quality of care and education for patients with diabetes mellitus so they will have measurably better outcomes. Physicians, diabetes educators with expertise in managing diabetes, and endocrine nurse practitioners throughout the Walter Reed Health Care System carry out this program.

General Internal Medicine Service
The Walter Reed General Internal Medicine Service provides a broad scope of inpatient and outpatient care to adult military beneficiaries through the General Internal Medicine Primary Care Clinics, Medical Evaluation and Treatment Unit, Wellness Services, Optometry Service, inpatient Consult Service, and the inpatient Medicine Ward. The General Internal Medicine Clinics constitute the adult primary care portal of the Walter Reed Family Health Center and the enrollment site at Walter Reed for TRICARE Prime adults.

In addition to its quality patient care, the General Internal Medicine Service has a major academic focus. It supports the largest internal medicine training program in the Department of Defense, and its staff concentrates on disease prevention and improving health-care outcomes of high-risk patients. Many of its physicians perform clinical research projects, and all are involved in both medical-student and internal-medicine resident education.

Hematology-Oncology Service
The Hematology-Oncology Service provides care to adults with cancer, blood diseases, or both. It is multidisciplinary and is composed of staff hematologist-oncologists, hematology-oncology fellows, nurse practitioners, nurses, pharmacists, laboratory staff, a nutritionist, a case manager and a social worker. The service participates in major research projects through the newly opened Center for the Development of Oncologic Drugs and Therapeutics and as a principle member of Cancer and Leukemia Group B, a national cooperative oncology group.

The service is divided into an outpatient clinic, outpatient chemotherapy section, research section and an inpatient unit. The inpatient unit cares for patients with all types of malignancies and is the home of the Army’s only Blood Stem Cell Transplant Service, a fully accredited autologous transplantprogram.

Infectious Disease Service
The Infectious Disease Service sees adult inpatients and outpatients through referral. The Infectious Disease Clinic treats outpatients for conditions such as unexplained fever, Lyme disease, hepatitis, tuberculosis, HIV or AIDS, syphilis, and other sexually transmitted diseases. The Clinic also advises travelers to foreign countries regarding immunizations and other protective measures to prevent infection. Walter Reed is a Center of Excellence for the treatment of leishmaniasis, a parasitic infection acquired during foreign travel and military deployments.

The service treats inpatients hospitalized for serious conditions such as pneumonia, meningitis, bone and joint infections, tuberculosis, infections of the kidney and bladder, heart and blood infections and encephalitis including West Nile Virus infection. It also provides expertise regarding the prevention and treatment of infections caused by biowarfare agents such as smallpox and anthrax. We work closely with Infection Control and Preventive Medicine to minimize the spread of disease to patients and staff.

Nephrology Service
The Nephrology Service consists of a multidisciplinary team of physicians, nurses, and medical support personnel who provide diagnosis and treatment of kidney diseases. Our services include dialysis, kidney biopsy, transplantation management, and a teaching clinic for patients approaching chronic dialysis. We also have the only Army training program for physician specialists in kidney disease. Please get to know us at our Web site, www.wramc.army.mil⁄departments⁄medicine⁄nephrology⁄.

Pulmonary and Critical Care Medicine Service
The Pulmonary and Critical Care Medicine Service provides patients with the most modern care in adult respiratory diseases, sleep disorders, and intensive care medicine. The service is part of the National Capital Consortium P&CCM Fellowship Program, teaching internists how to become outstanding subspecialists. Our staff includes board certified pulmonologists and intensivists, nurse practitioners, and respiratory therapists. Many are award-winning educators and nationally recognized researchers.

The Pulmonary Disease Service treats a wide variety of breathing disorders for both inpatients and outpatients, including chronic obstructive lung disease, asthma, vocal cord dysfunction, lung cancer, sarcoidosis, sleep disorders, tuberculosis and interstitial lung disease. The service provides pulmonary function, cardiopulmonary exercise, and bronchoprovocation testing; bronchoscopy; and pulmonary health education.

The Sleep Disorders Center provides comprehensive diagnostic testing and treatment for the full range of sleep disorders. P&CCM physicians provide care for critically ill patients in the Medical Intensive Care Unit with a wide variety of disorders including respiratory failure, gastrointestinal bleeding, chest pain, stroke, myocardial infarction and overwhelming infections.

Rheumatology Service
Walter Reed rheumatologists treat more than 100 types of diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, fibromyalgia, and various types of tendinitis. Rheumatologists are internal medicine physicians with specific training and experience in diagnosing and treating arthritis; other diseases of the joints, muscles and bones; and inflammatory conditions of other body parts associated with immune-system abnormalities.

Our staff has broad experience in caring for patients with all categories of rheumatic disease and is well known for doing the medical detective work necessary to discover causes of pain and swelling often associated with immune system abnormalities. As leaders in the field, Walter Reed’s rheumatologists understand the importance of determining the source of patients’ musculoskeletal and immune problems, allowing effective therapy to begin early in the course of their disease.

Department of Neurology
The Department of Neurology provides the most modern diagnosis and management for patients with disorders affecting the brain, spinal cord, peripheral nerves and muscles. The board-certified staff of adult and child neurologists provides outpatient and inpatient care for all ages of patients, including subspecialty services for epilepsy, headaches and migraine; Parkinson’s disease; neuro-ophthalmologic disorders; neuromuscular diseases, dementia and other neurobehavioral disorders; traumatic head injury, and inpatient neurointensive care. Locations include the Adult Neurology Clinic, the Defense Headache Center, Diagnostic Neurophysiology Clinic, National Capital Area Inpatient Neurology Ward and the NCA Child & Adolescent Neurology Clinic.

The department also educates physicians as residents and fellows to become military neurologists and neurology subspecialists, teaches neurologic medicine to Uniformed Services University of the Health Sciences medical students, and conducts a wide variety of clinical research projects.

The department joins with other WRAMC activities to provide some services that either are not available elsewhere in the Department of Defense or are more highly capable than at other sites. These include epilepsy surgery (cerebral surgery and vagus nerve stimulator implantation), comprehensive headache management, and neuromuscular disorder (botulinum toxin, or botox) treatment. The multicenter Defense & Veterans Head Injury Program is centered in the Walter Reed Department of Neurology.

Department of Nursing
Nursing at Walter Reed comprises approximately 1,500 staff members who work in the 15 inpatient nursing units and more than 30 outpatient clinics. Walter Reed nursing provides a continuum of care, in both inpatient and outpatient settings, to service members, retirees, and families. Nursing staff includes both military and civilian registered nurses, licensed practical nurses and assistive personnel.

The Perioperative Nursing Section includes the Operating Room nurses and technicians and Central Material Service that support more than 14 surgical specialties, including cardiothoracic surgery, organ transplantation, neurosurgery, and total joint surgery. The OR incorporates new technologies that include telemedicine and robotic surgery.

The Critical Care Nursing Section, the largest critical care setting in the Army Medical Department, includes three specialty intensive care units and three step-down units. The section delivers such highly specialized care as acute and chronic hemodialysis, pediatric intensive care, post-operative cardiothoracic surgery care, mechanical ventilation, cardiac and intracranial pressure monitoring, and post-anesthesia care.

The Ambulatory Nursing Section offers outpatient services in nearly 30 specialty clinics and the Emergency Department. Specialty clinics include allergy-immunology, pulmonary, cardiology, plastic surgery, otolaryngology, and orthopedics. Nurses in many clinics conduct programs in collaboration with their physician counterparts, such as the HIV Antiretroviral Medication Adherence Program within the Infectious Disease Clinic.

The Surgical Neuroscience Nursing Section hosts the Amputee Center of Excellence for the care of patients who have undergone amputations. This section also cares for patients with traumatic brain injury, general surgery, vascular surgery, transplanted organs, orthopedic injuries, multiple trauma, plastic surgery, and total joint replacements. The staff also cares forpre-operative and outpatient surgery patients and outpatients requiring infusions or transfusions of various medications and blood or blood products.

The Medical Psychiatric Nursing Section includes four distinctive wards: General Medicine, Oncology⁄Hematology, Eisenhower Executive Nursing Suite, and Psychiatry. A new addition in 2003 was the intensive outpatient psychiatric day program. The Oncology Ward serves as the Army-wide referral center for cancer care and for stem cell transplantation services.

The Pediatric Section serves the largest pediatric ward in the Army. It also includes Walter Reed nursing care in the pediatric specialty and general outpatient clinics, such as pediatric hematology and oncology and pediatric sedation.

The Infection Control Section conducts active disease and infection surveillance within the medical center. This section takes the lead in preventing infections associated with health care and provides consultation and education to all staff members to maintain a safe and healthy working environment.

Nursing Performance Improvement activities improve the quality of patient care and develop professional nursing practice at Walter Reed while supporting the organizational vision of being the preeminent military health care facility in the nation. Nursing PI works closely with the Walter Reed Performance Improvement Office to ensure that evaluate issues in patient care thoroughly to prevent recurrence and improve care to our patients.

Nursing Education and Staff Development Service is listed on Page 15, under Clinical Education and Research.

Nursing Research Service is listed on Page 15, under Clinical Education and Research.

Department of Obstetrics and Gynecology
The Department of Obstetrics and Gynecology includes four divisions:

• The Division of Gynecology provides general gynecological surgical services in addition to outpatient specialty and preventive medicine services. Our staff physicians are all skilled in traditional surgical procedures as well as the newer, minimally invasive techniques such as laser surgery, laparoscopy and hysteroscopy. Many of these procedures are performed as same-day surgery, meaning most patients will not require hospital admission. All of the Gynecology staff is board certified or eligible in the specialty of Obstetrics and Gynecology. The WRAMC Gynecology Clinic provides both primary gynecologic health care and specialty gynecology referral services. Additionally, we provide outpatient obstetrical care for patients, with inpatient delivery at the National Naval Medical Center in Bethesda. Patients can have their outpatient care from either one of our staff obstetrician-gynecologists or a certified nurse midwife. Our desire is to have our patients followed by a single provider for the duration of their outpatient obstetrical care.
• The Division of Gynecologic Oncology provides complete, comprehensive, and current care to our patients with gynecologic malignancies. We are a founding member of the Gynecologic Oncology Group, a multi-institutional cooperative cancer treatment group dedicated to the study and treatment of gynecologic malignancies sponsored by the National Cancer Institute. We offer more than 80 clinical and basic-sciencerelated research protocols. Because of our outstanding research and outcomes driven patient care, the division is recognized nationally as a Center of Excellence in Gynecologic Oncology.
• The Division of Reproductive Endocrinology and Infertility diagnoses and treats pituitary prolactinomas, hypothalamic disease, hypothyroidism, primary and secondary amenorrhea, osteoporosis, insulin resistance, menopause, menstrual disorders, dysfunctional uterine bleeding, polycystic ovary syndrome, pelvic pain, hirsutism and contraception. We provide the full range of diagnostic and therapeutic protocols for female and male infertility. Surgical therapy includes laparoscopic and open tubal anastomosis, laparoscopic treatment of ovarian, tubal and pelvic disease, myomectomy, and hysteroscopic management of uterine disease. With co-payment through the ART Institute of Washington at Walter Reed, active duty couples receive treatment with cutting-edge technology such as in-vitro fertilization, intracytoplasmic sperm injection, and assisted hatching. Pregnancy rates are consistently in the top 10 percent nationally.
• The Division of Female Pelvic Medicine and Reconstructive Surgery provides complete diagnostics and comprehensive conservative and surgical therapy to patients with pelvic floor dysfunction. Pelvic floor dysfunction includes urinary incontinence and voiding dysfunction, fecal incontinence and defecatory dysfunction, pelvic organ prolapse, sexual dysfunction and pelvic pain. We offer minimally invasive approaches as well as standard vaginal and abdominal approaches to pelvic floor reconstruction. The division also provides expertise in pelvic floor neurophysiology and offers comprehensive electrodiagnostic testing of the pelvis. A dedicated pelvic floor physical therapist is available to help manage pelvic floor disorders.

Department of Orthopaedicsand Rehabilitation
The Department of Orthopaedics and Rehabilitation provides comprehensive musculoskeletal care to more than 250,000 beneficiaries. The department offers clinical medicine and orthopaedic surgery, educates and trains future health care providers for the military, and conducts research that furthers the world’s understanding of musculoskeletal medicine and surgery. It has its own Orthotic and Prosthetic Laboratory that constructs artificial limbs and braces by prescription.

The department comprises four services:

• The Orthopaedic Surgery Service offers initial and follow-up care in the General Orthopaedic Clinic and sub-specialized care and surgery by board-certified orthopaedic surgeons in eight other specialties that include foot and ankle, hand surgery, oncology, pediatrics, shoulder, spine, sports medicine and total joint replacement. Walter Reed is the orthopaedic surgery tertiary referral center for the East Coast and Europe.
• The Physical Medicine and Rehabilitation Service provides care through a multi-disciplinary team approach that includes nursing, social work, speech therapy and psychiatry. Conditions commonly treated include back and neck pain, sports injuries and musculoskeletal disorders, stroke, chronic pain conditions, limb amputations and pediatric disabilities. Physical Medicine and Rehabilitation takes over where other specialists leave off to develop comprehensive treatment plans to manage these difficult conditions.
• The Occupational Therapy Service provides assessment and rehabilitation to maximize daily life functioning, improve physical and psychosocial abilities and promote health maintenance and injury prevention. Board certified and credentialed providers and neuromusculoskeletal evaluators treat patients with orthopaedic, neurological and psychosocial impairments. Occupational therapists and assistants use rehabilitation to train patients in activities of daily living, exercise, visual-motor and perceptual skills, and functional behavior activities. In addition, they provide adaptive equipment training and fabricate upper extremity orthotics to promote function and improve occupational performance.
• The Physical Therapy Service consists of a team of physical therapists and assistants who offer comprehensive inpatient and outpatient care to maximize physical functioning and relieve pain. Board-certified specialists provide neuromusculoskeletal assessment, acute and chronic pain relief, and extensive pre-operative and post-operative rehabilitation. Specialty programs in geriatrics and pediatrics aim to meet the needs of our diverse beneficiary population. The service also offers classes on back care, weight loss and other wellness subjects. Schedules are listed in the medical center newspaper, Stripe.

Department of Pathologyand Area Laboratory Services
The Department of Pathology provides a full range of medical laboratory services in both anatomic and clinical pathology. It is accredited by the College of American Pathologists and the American Association of Blood Banks. The various laboratories serve the needs of the clinical departments and services at Walter Reed and are a major reference-testing site for medical facilities throughout the North Atlantic Regional Medical Command. The department hosts a pathology residency training program, the Department of Defense fellowship in blood banking, the Army medical technology training program and a Phase II program for medical laboratory technicians.

The Infectious Disease Laboratory is certified by the Centers for Disease Control and Prevention Laboratory Response Network at Level B with confirmatory capability for biothreat organisms. This laboratory is also an integral part of the tri-service infectious disease fellowship.

The Blood Bank and Blood Donor Center collects and processes blood and blood products to support an active blood transfusion service. It is licensed by the Food and Drug Administration. The Blood Bank also serves as an integral component of the hospital’s bone marrow transplant program.

Department of Pediatrics
The Department of Pediatrics at Walter Reed Army Medical Center and its integrated partner at the National Naval Medical Center offer the entire range of primary care and subspecialty services in pediatric medicine.

Walter Reed is the designated Center of Excellence for subspecialty pediatrics in the National Capital Area and offers care in developmental pediatrics, endocrinology, cardiology, critical care, hematology-oncology, gastroenterology, nutrition, infectious disease, nephrology, neurology, pulmonary medicine, and general pediatric and subspecialty surgery.

Walter Reed’s 29-bed unit is the only comprehensive pediatric inpatient facility in the National Capital Area. In addition, a four-bed Pediatric Intensive Care Unit offers the latest in critical care services to children.

Department of Pharmacy
The Department of Pharmacy at Walter Reed Army Medical Center provides a variety of functions for patients and the medical staff regarding medication therapy. The department is composed of the following services: Pharmacy Administration; Ambulatory Care Pharmacy, Acute and Critical Care Pharmacies, Clinical Pharmacy, Hematology-Oncology Pharmacy, Nuclear Pharmacy, Pharmacy Supply and Support, Clinical Research Pharmacy, and Pharmacy Informatics.

The pharmacy fills approximately 55,000 outpatient prescriptions a month and prepares more than 30,000 intravenous medications monthly. Using innovative technology and staff resources, the department has become a leader in the military pharmacy community

The department offers three accredited residency programs to train graduate pharmacists, many of whom request Walter Reed Pharmacy as their first choice as a training site. The department maintains affiliation agreements with several colleges of pharmacy, where many Walter Reed pharmacists are clinical adjunct faculty members. Many of the department’s clinical pharmacists also work in expanded practice roles to improve medication therapies throughout the facility.

Preventive Medicine Service
The Preventive Medicine Service consists of the Community Health Nursing Section and the Occupational Health Clinic – both described under ‘‘Health Care Services” – and the Environmental Health and Health Physics Sections.

The Environmental Health Section provides a variety of services to prevent and control disease throughout the Military District of Washington, including water quality surveillance; food service and child care service sanitation inspections; pest surveillance, and swimming pool sanitation inspections. The section also monitors the heat stress index at the Walter Reed installation and, on request, training for food sanitation, heat or cold injury prevention, and field sanitation teams.

The Health Physics Section ensures that radiation doses are maintained as low as reasonably achievable by monitoring radioactive material inventories, transportation, administration and disposal; monitoring employee radiation exposures; surveying radioactive materials and radiation equipment; and providing radiation safety training. The section also staffs the Radiological Advisory Medical Team for the Department of Defense.

The Industrial Hygiene Office provides services for the National Capital Area to recommend controls for chemical, physical, and biological hazards in the workplace; increase productivity; reduce work related absenteeism; and promote a healthier workplace.

Department of Radiology
The Department of Radiology at Walter Reed Army Medical Center provides the highest quality diagnostic and therapeutic interventions available anywhere. Our department is equipped with state of the art imaging equipment in computed tomography, magnetic resonance imaging, and ultrasound and is fully capable of providing the full spectrum of radiology services to our beneficiaries.

Our Digital Imaging Network Picture Archiving and Communication System allows our radiology subspecialists to review and provide consultation on images acquired throughout the region and overseas. The American Board of Radiology certifies all of our faculty members, and fellowship-trained physicians with particular interest and expertise in those areas represent all major subspecialties of radiology. In addition, we are a major training site for radiology physicians and technologists for the Army and Navy. We perform and interpret approximately 130,000 studies annually.

Our department also offers an electron-beam heart-view coronary artery screening program and is now opening a virtual-colonoscopy colon-screening program. These are the only programs of their kind in the Department of Defense.

Our Diagnostic Radiology Service provides MRI and MRI spectroscopy, MRI of the breast, multi detector computed tomography, ultrasonography as well as vascular and interventional radiology procedures.

The evaluation and treatment of disease of women takes place in our modern Women’s Imaging Center.

The Nuclear Medicine Service offers all standard nuclear medicine studies and many unique procedures and therapies not offered at other military facilities.

The Radiation Therapy Service offers external beam radiation treatments for benign and malignant tumors in adults and children in all body sites. The service is the only one in the Army that offers stereotactic radiosurgery and radiotherapy treatments for central nervous system lesions.

Department of Surgery
Army Audiology and Speech Center
The Army Audiology and Speech Center, established in 1947, is the Department of Defense’s largest and most diverse center for evaluation, rehabilitation and research in disorders of speech-language, hearing and balance. The center provides a wide range of clinical diagnostic and rehabilitative services for more than 20,000 patients a year with communication and balance disorders.

The AASC dispenses hearing aids for active-duty and retired patients with hearing problems, and provides minor hearing aid repairs. The pediatric audiology program identifies hearing loss in pediatric patients, and provides services to parents, educators and health professionals necessary to foster normal speech and language development. The AASC has a comprehensive balance lab for evaluating dizziness and balance disorders. It is a cochlear implant center, providing services for identifying, implanting, and rehabilitating patients who need a cochlear implant. AASC is also a leader in force health protection, managing the Army Hearing Conservation Program for National Capital Region and providing consultative services for the Army’s North Atlantic Region.

AASC speech-language pathologists evaluate and treat patients with swallowing, neurological, fluency, and voice disorders. The center has one of the most extensive swallowing and voice labs available and provides the only services of its kind in the Department of Defense. Speech-language pathologists assist teams throughout Walter Reed in managing patients withswallowing disorders, craniofacial anomalies, tracheotomy and head injury.

AASC is also the only Department of Defense facility that conducts clinical research for communication disorders. Areas of research include hearing aid benefit and clinical trials, auditory perception and processing, and speech perception and processing. The clinical impact of this research program has improved assessment of speech and voice disorders, documented the efficacy of current hearing aid technology, and developed tools to assess fitness for duty.

Cardiothoracic Surgery Service
This National Capital Region Specialized Treatment Service provides comprehensive surgical services to patients who need heart or lung surgery. It does more than 250 cardiac operations per year and an equal number of general thoracic surgical procedures. They include coronary artery bypass surgery, both with the use of cardiopulmonary bypass and beating heart; all arterial revascularizations with the use of internal mammary artery, radial artery and gastroepiploic artery; valvular repair and replacement; aortic reconstruction; complex congenital repairs; minimally invasive vein harvesting; and video-assisted thoracic surgical procedures including sympathectomy for hyperhidrosis palmaris bilateralis, VATS lobectomy and minimally invasive treatment of a host of pleural diseases, both benign and malignant. Newer technologies include the use of a fully robotic surgical system to perform telepresence robotic cardiothoracic surgery.

Ophthalmology Service
The Ophthalmology Service at Walter Reed is a modern, well-equipped unit that features a full range of general and specialty services. The Eye Clinic treats patients with a wide range of disease processes, ranging from strabismus in children to cataracts and macular diseases in adults. The service uses the latest surgical techniques to rehabilitate vision for patients from all over the world.

World-renowned consultants support a strong and experienced staff in corneal and external disease, pediatric ophthalmology, oculoplastic surgery, orbital disease and surgery, neuro-ophthalmology, vitreo-retinal diseases, glaucoma, cataract surgery and laser refractive surgery. Future military ophthalmologists are trained through the nationally accredited Walter Reed residency program.

The service’s Center for Refractive Surgery provides the latest in laser refractive surgery while investigating research questions applicable to the military.

Organ Transplant Service
Walter Reed’s Organ Transplant Service is the Army’s Specialized Treatment Service center for renal transplants. It has provided transplantation services to patients with end-stage renal disease for more than 30 years and is now the Department of Defense’s only solid-organ transplant program. The service also performs pancreas transplantation for patients with Type 1 diabetes and renal failure, and liver transplantation for patients with end-stage liver disease.

The Organ Transplant Service is a multi-disciplinary team consisting of transplant surgeons and physicians, nurse coordinators, social workers, pharmacists, and immunologists who combine efforts to provide optimum care for this complex patient group. The service also provides surgical and urologic care for patients with end-stage organ disease. Care of both hemodialysis and peritoneal dialysis access in cooperation with the Interventional Radiology Service has increasingly become a specialty of the service.

The service has expanded its research activities dramatically by collaborating with the National Institutes of Health to develop new immunosuppressive therapies. Several exciting protocols have shown great promise in preventing rejection. The liver transplant team provides transplantation at Georgetown University Medical Center in Washington and includes pediatrics and living-related donation.

Plastic Surgery Service
The Plastic and Reconstructive Surgery Service at Walter Reed is the largest and busiest in the military health care system. The service provides plastic surgery to correct deformities caused by trauma, birth defects, and cancer treatment. Plastic surgeons see their own patients and assist other surgeons by performing immediate reconstructions in conjunction with other surgical procedures.

The Plastic Surgery Clinic provides appointments for general reconstructive problems. In addition, a weekly cleft lip⁄palate and craniofacial clinic offers a multidisciplinary evaluation for children with birth defects of the head and neck. Plastic surgeons also are actively involved in the Comprehensive Breast Center, offering breast reconstruction to patients with breast cancer.

Telemedicine
The Telemedicine Directorate develops and manages information management technologies that extend the reach of Walter Reed specialty health care to patients throughout the North Atlantic Regional Medical Command and around the world. Using research-proven protocols and image-capture devices such as digital cameras and video-teleconferencing equipment, technicians in seven states and at 10 overseas sites take clinical images of patients or their x-rays. They transmit those images by satellite or land line to Walter Reed, where specialists review them and give advice to the referring physician. Current clinical applications for remote consultation in the region include dermatology, podiatry, sleep medicine, gastroenterology, cardiology, child and adult psychiatry, pathology, and radiation-oncology tumor board management.

In addition, the directorate provides the regional medical command with a well-established distance-learning program using both the Internet and video-teleconferencing equipment. This program transmits about 500 clinical lectures per year throughout the region. The research program for the directorate includes more than 70 funded projects that cover a broad range of clinical specialties.

The directorate also provides centralized support to the region with Internet Web-based programming. The Walter Reed Web site, www.wramc.army.mil, has more than 200,000 pages of content, with clinical material for both patients and providers.

Sites in the United States having telemedicine links to Walter Reed include 16 U.S. Army installations; the National Naval Medical Center at Bethesda, Md.; and the Pentagon.

Current and previous overseas locations include Iraq, Afghanistan, Kuwait, Bosnia, Croatia, El Salvador, Haiti, Honduras, Macedonia, Panama, Somalia, and Sweden, as well as Landstuhl Regional Medical Center, Germany.