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Veterans, community integration

Brittany L Cornwell, Laurie M Brockmann, Elaine C Lasky, Jennifer Mach, John F McCarthy
OBJECTIVES: The Veterans Health Administration (VHA) has achieved substantial national implementation of primary care-mental health integration (PC-MHI) services. However, little is known regarding program characteristics, variation in characteristics across settings, or associations between program fidelity and performance. This study identified core elements of PC-MHI services and evaluated their associations with program characteristics and performance. METHODS: A principal-components analysis (PCA) of reports from 349 sites identified factors associated with PC-MHI fidelity...
March 15, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
Ann E Vandenberg, Katharina V Echt, Lawanda Kemp, Gerald McGwin, Molly M Perkins, Anna K Mirk
Suboptimal prescribing persists as a driver of poor quality care of older veterans and is associated with risk of hospitalization and emergency department visits. We adapted a successful medication management model, Integrated Management and Polypharmacy Review of Vulnerable Elders (IMPROVE), from an urban geriatric specialty clinic to rural community-based clinics that deliver primary care. The goals were to promote prescribing quality and safety for older adults, including reduced prescribing of potentially inappropriate medications (PIMs)...
March 2018: Journal of the American Geriatrics Society
Gabrielle H Saunders, Charlotte Morse-Fortier, Daniel J McDermott, Jay J Vachhani, Leslie D Grush, Susan Griest, M Samantha Lewis
BACKGROUND: The ability to manage hearing aids is crucial for successful outcomes and for maintaining hearing aid use. It is therefore important to have a tool that can effectively identify which hearing aid management skills are lacking so that the audiologist can provide additional education and training on that skill. Such a tool can also provide useful quantitative data for researchers. PURPOSE: To collect normative data (Experiment 1) and assess inter- and intrarater reliability (Experiment 2) for a hearing aid management assessment tool known as the Hearing Aid Skills and Knowledge (HASK) test...
March 2018: Journal of the American Academy of Audiology
Katiah Llerena, Sonya Gabrielian, Michael F Green
Homeless persons with psychosis are particularly susceptible to unsheltered homelessness, which includes living on the streets, in cars, and other places not meant for human habitation. Homeless persons with psychosis have distinct barriers to accessing care and comprise a high-need and hard-to-serve homeless subpopulation. Therefore, this study sought to understand unsheltered homelessness in persons with psychosis and its relationship to cognitive impairment, clinical symptoms, and community functioning, examined both categorically and dimensionally...
February 24, 2018: Schizophrenia Research
Azadeh Leland, Kamran Tavakol, Joel Scholten, Alex V Libin, Debra Mathis, David Maron, Simin Bakhshi
Introduction: Optimal community reintegration is an integral part of the clinical management of patients with mild traumatic brain injury. Background/Objective: We sought the contribution and inter-relation of such variables as balance, executive function, and affective regulation to the community reintegration of veterans with mTBI. Methods: We examined the statistical relationship among the above variables by conducting a series of objective evaluations to assess the balance, gait, executive function, affective regulation, and scores representing the patients' issues with community reintegration...
December 2017: Medical Archives
Joseph M Currier, Ryon C McDermott, Wesley H McCormick, Marc C Churchwell, Lori Milkeris
BACKGROUND: There is consensus that struggles with religious faith and/or spirituality likely contribute to risk for suicidal behavior in military populations. However, a lack of longitudinal information has limited the ability to clarify the temporal associations between these variables. METHODS: This study examined cross-lagged associations between key types of spiritual struggles (divine, morality, ultimate meaning, interpersonal relations, and doubting) and indices of risk for suicidal behavior (suicidal ideation and probability of future attempt) in a community sample of veterans who completed assessments spaced apart by six months...
January 30, 2018: Journal of Affective Disorders
Kelly R Reveles, Eric M Mortensen, Jim M Koeller, Kenneth A Lawson, Mary Jo V Pugh, Sarah A Rumbellow, Jacqueline R Argamany, Christopher R Frei
STUDY OBJECTIVE: Prior studies have identified risk factors for recurrent Clostridium difficile infection (CDI), but few studies have integrated these factors into a clinical prediction rule that can aid clinical decision making. The objective of this study was to derive and validate a CDI recurrence prediction rule to identify patients at risk for first recurrence in a national cohort of veterans. DESIGN: Retrospective cohort study. DATA SOURCE: Veterans Affairs Informatics and Computing Infrastructure...
February 2, 2018: Pharmacotherapy
Elizabeth E Van Voorhees, Linda Resnik, Erin Johnson, Thomas O'Toole
Homelessness among veterans has dropped dramatically since the expansion of services for homeless veterans in 2009, and now engaging homeless veterans in existing programs will be important to continuing to make progress. While one promising approach for engaging homeless veterans in care is involving peer mentors in integrated services, posttraumatic stress disorder (PTSD) may diminish the effects of peer mentorship. This mixed methods study examined how interpersonal and emotional processes in homeless veterans with and without PTSD impacted their capacity to engage in relationships with peer mentors...
January 25, 2018: Psychological Services
Jessica P Young, Carol E Achtmeyer, Kara M Bensley, Eric J Hawkins, Emily C Williams
BACKGROUND: Effective behavioral and pharmacological treatments are available and recommended for patients with alcohol use disorders (AUD) but rarely received. Barriers to receipt and provision of evidence-based AUD treatments delivered by specialists may be greatest in rural areas. METHODS: A targeted subanalysis of qualitative interview data collected from primary care providers at 5 Veterans Affairs clinics was conducted to identify differences in provider perceptions and practices regarding AUD treatment across urban and rural clinics...
January 23, 2018: Journal of Rural Health
Azadeh Leland, Kamran Tavakol, Joel Scholten, Debra Mathis, David Maron, Simin Bakhshi
Background: This study focussed on the effect of dual versus single tasking on balance, gait and cognition in veterans with mild traumatic brain injury (mTBI). We examined the correlation between these parameters, with responses to questions on community reintegration activities. Method: 22 male and female veterans (aged 19-65) walked along a narrow and 6.1-meter long path, both at their self-selected and fastest but safe pace under single and dual tasking conditions...
December 2017: Materia Socio-medica
Jack Tsai, Margaret Middleton, Jennifer Villegas, Cindy Johnson, Randye Retkin, Alison Seidman, Scott Sherman, Robert A Rosenheck
Medical-legal partnerships-collaborations between legal professionals and health care providers that help patients address civil legal problems that can affect health and well-being-have been implemented at several Veterans Affairs (VA) medical centers to serve homeless and low-income veterans with mental illness. We describe the outcomes of veterans who accessed legal services at four partnership sites in Connecticut and New York in the period 2014-16. The partnerships served 950 veterans, who collectively had 1,384 legal issues; on average, the issues took 5...
December 2017: Health Affairs
Sara S Johnson, Deborah A Levesque, Lynne E Broderick, Dustin G Bailey, Robert D Kerns
BACKGROUND: Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. OBJECTIVE: The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans...
October 17, 2017: JMIR Medical Informatics
Octaviana Hemmy Asamsama, Leah Squires, Alpha Tessema, Ephrem Rae, Karen Hall, Rush Williams, Debra Benator
This study represents one of the few exploring the effectiveness of an integrated HIV nurse navigation program on engagement and virologic outcomes. A navigator provided individualized care management (eg, pillbox renewals), intensive outreach, and collaboration with existing support systems (eg, families, community programs). Clinical data from the Veterans Affairs (VA) Medical Center site of a longitudinal, observational study of HIV in the District of Columbia (DC) cohort were used for comparison (N = 706)...
January 1, 2017: Journal of the International Association of Providers of AIDS Care
Amy L Mochel, Nancy D Henry, Debra Saliba, Ciaran S Phibbs, Joseph G Ouslander, Vincent Mor
Studies have shown that hospitalizations of nursing home (NH) residents lead to complications and poorer quality of life. The Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement (QI) Program assists licensed NH staff in avoiding such hospitalizations. INTERACT aims to improve the management of acute changes in residents' conditions by providing tools to help staff recognize subtle changes in condition, improve communication, and implement QI strategies. INTERACT has been vetted by national clinical leaders and experts in long term care (LTC)...
October 5, 2017: Geriatric Nursing
Alison B Hamilton, Elizabeth M Yano
In this commentary, we respond to the commentary provided by Goodman and Sanders Thompson regarding our paper on multilevel stakeholder engagement in a VA implementation trial of evidence-based quality improvement (EBQI) in women's health primary care. We clarify our overall approach to engagement (comprised of both symbolic and engaged participation, according to the authors' classification rubric), highlighting that symbolic participation is of more import and value than the authors suggest, especially in the context of a hierarchical healthcare system...
September 2017: Translational Behavioral Medicine
Max Gray, Joyce Chung, Fatima Aguila, T Gavin Williams, Jeffrey K Teraoka, Odette A Harris
OBJECTIVE: To determine the effect of the established polytrauma/traumatic brain injury (TBI) infrastructure on immediate posttreatment functional gains, the long-term sustainability of any gains, and participation-related community reintegration outcomes in a baseline cohort of patients 8 years postadmission. DESIGN: Retrospective review and prospective repeated measures of an inception cohort. SETTING: Polytrauma rehabilitation center (PRC)...
September 1, 2017: Archives of Physical Medicine and Rehabilitation
Ann Elizabeth Montgomery, Meagan C Cusack, Sonya Gabrielian
OBJECTIVES: Little research has assessed the nature of veterans' departures from permanent supportive housing (PSH), which may be of positive valence (e.g., moving into more independent housing). This study aimed to identify participants appropriate for "graduation" from PSH and how to support their transitions. METHOD: This mixed methods study used qualitative data from PSH program staff, 445 PSH participants' responses to a survey assessing their experiences and administrative records, and qualitative data from a subsample of 10 participants who graduated from the program...
August 31, 2017: Psychiatric Rehabilitation Journal
Terry K Crowe, Victoria Sánchez, Alyse Howard, Brenna Western, Stephanie Barger
BACKGROUND: This study explored the dynamics of veteran/service dog partnerships by gathering the perspectives of veterans with a history of post-traumatic stress disorder and/or traumatic brain injury. METHODS: Exploratory qualitative methods (focus groups and individual interviews) were used to investigate veteran/service dog relationships related to community involvement, family and friend relationships, self-care, work, and leisure. Nine male veterans, Paws, and Stripes program graduates participated...
August 13, 2017: Disability and Rehabilitation
S Akeya Harrold, Julian Libet, Charlene Pope, Joy A Lauerer, Emily Johnson, Barbara J Edlund
AIMS AND OBJECTIVES: Individuals with severe mental illness (SMI), experience increased mortality-20 years greater disparity for men and 15 years greater disparity for women-compared to the general population (Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442). Numerous factors contribute to premature mortality in persons with SMI, including suicide and accidental death (Richardson RC, Faulkner G, McDevitt J, Skrinar GS, Hutchinson D, Piette JD...
August 1, 2017: Perspectives in Psychiatric Care
Bella Etingen, Sara M Locatelli, Scott Miskevics, Sherri L LaVela
PURPOSE: The objectives of this study were to examine differences in social participation among Veterans with spinal cord injuries/disorders with and without post-traumatic stress disorder, and determine if lower social participation was independently associated with having post-traumatic stress disorder. METHODS: A cross-sectional mailed national survey was sent to a national sample of Veterans with spinal cord injuries/disorders who received prior-year Veterans Affairs healthcare...
July 26, 2017: Disability and Rehabilitation
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