Systemic lupus erythematosus (SLE) is the classical immune-complex disease. Involvement of vital organs, particularly the kidneys and brain, accounts for significant morbidity and mortality. A number of imaging tools are currently available for evaluation of inflammatory conditions. By targeting the increased glucose uptake of infiltrating granulocytes and tissue macrophages, positron emission tomography with fluorine-18 fluorodeoxyglucose ([(18) F]FDG PET/CT) has been shown to delineate inflammation with high sensitivity. Because activated lymphocytes have increased glucose metabolism, [(18) F]FDG PET has been successfully used to visualize large concentrations of these cells in lymphoid organs where antigen presentation and lymphocyte activation occur. Widespread increased FDG uptake in lymph nodes of patients with active SLE, as well as increased thymic uptake, has been described. The most prevalent and dramatic PET/CT finding in neuropsychiatric SLE (NP-SLE) patients is parieto-occipital hypometabolism. In conclusion, PET/CT has become an excellent ancillary tool to assess disease activity and prognosis in SLE patients.

Approximately 1 million gay and lesbian Americans are veterans. With the repeal of the "Don't Ask, Don't Tell," the Veterans Affairs (VA) health care system is focusing on the unique needs of lesbian, gay, bisexual, and transgender (LGBT) veterans. As a result of research in the private sector documenting stigmatizing attitudes and discrimination toward LGBT individuals in health care settings, the Institute of Medicine and The Joint Commission published recommendations for responding to the needs of LGBT individuals. However, minimal research has examined the unique needs of LGBT veterans and their experiences in VA. This 2-site (Oklahoma City, OK; Houston, TX), mixed-methods study included 202 VA providers and 58 LGBT veterans. Experiences at VA, comfort in providing/receiving care, barriers LGBT veterans face in coming to VA, and recommendations for making VA more welcoming were assessed. Six focus groups and 6 individual interviews were conducted with veterans, and providers completed anonymous surveys. Less than one third of LGBT veterans and providers viewed VA as welcoming to LGBT veterans. Half of providers indicated they do not assess sexual orientation with any of their patients. Furthermore, half of providers reported that they do not alter their treatment plans even if they know the veteran is lesbian, gay, or bisexual. Many constructive suggestions regarding how VA

Introduction Sexual health is an important aspect of human existence associated with disease and overall health. Despite these associations and the existence of medical treatments to improve sexual function, sexual health is often overlooked in health care. Recent combat veterans may be particularly vulnerable to sexual health issues due to their deployment-related health issues such as mental health conditions, prescription medications use, and psychosocial challenges. Aim This study assesses the sexual health issues of recent combat veterans seeking care at a Veterans Affairs Medical Center (VAMC) documented in the primary care and mental health notes from the first 6 months of care. Main Outcome Measures Documentation of sexual health issues in the progress notes (coded into categories), primary care vs. mental health care visit note, initial vs. follow-up visit notes, and templated vs. non-templated text. Methods This is a retrospective chart review of the first 158 consecutive patients seen for an initial assessment in the VAMC post-deployment clinic. Medical records were reviewed and text of sexual health issues and relevant patient and care characteristics were abstracted and coded into variables. Results Almost 25% of patients had documented sexual health issues in the first 6 months of care. We coded 52 separate sexual health issues into 13 distinct categories. Overall, most sexual health issues were documented in mental health care notes, in non-templated text, and at follow-up visits. The use of templated text appeared to drive the documentation of low libido (the most common sexual health issue) in mental health care notes. Conclusions Sexual health issues are prevalent in recent combat veterans seeking care at a VAMC, but patterns of documentation suggest that they may be under-reported or incompletely addressed. A more systematic and provider-initiated approach to assessment of sexual health may promote fuller discussion of sexual health issues and optimize management.