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Amy M Kilbourne, Michelle M Barbaresso, Zongshan Lai, Kristina M Nord, Margretta Bramlet, David E Goodrich, Edward P Post, Daniel Almirall, Mark S Bauer
OBJECTIVE: Persons with chronic mental disorders are disproportionately burdened with physical health conditions. We determined whether Life Goals Collaborative Care compared to usual care improves physical health in patients with mental disorders within 12 months. METHODS: This single-blind randomized controlled effectiveness study of a collaborative care model was conducted at a midwestern Veterans Affairs urban outpatient mental health clinic. Patients (N = 293 out of 474 eligible approached) with an ICD-9-CM diagnosis of schizophrenia, bipolar disorder, or major depressive disorder and at least 1 cardiovascular disease risk factor provided informed consent and were randomized (February 24, 2010, to April 29, 2015) to Life Goals (n = 146) or usual care (n = 147)...
October 25, 2016: Journal of Clinical Psychiatry
Marianne Goodman, David Banthin, Nicholas J Blair, Kathryn A Mascitelli, Jaime Wilsnack, Jennifer Chen, Julie W Messenger, M Mercedes Perez-Rodriguez, Joseph Triebwasser, Harold W Koenigsberg, Raymond R Goetz, Erin A Hazlett, Antonia S New
OBJECTIVE: Despite advances in suicide prevention implemented throughout the US Department of Veterans Affairs (VA) including the hiring of Suicide Prevention Coordinators (SPCs) at every VA hospital, enhanced monitoring, and the availability of 24-hour crisis hotline services, suicide by veterans remains a critical problem affecting 20 veterans daily. Few empirically based treatment strategies for suicide prevention for postdeployment military personnel exist. This study aimed to test whether dialectical behavior therapy (DBT), one of the few psychosocial treatments with proven efficacy in diminishing suicidal behavior in individuals with personality disorder, can be applied to veterans irrespective of personality diagnosis...
October 25, 2016: Journal of Clinical Psychiatry
Daniel W Bradford, Joseph Goulet, Marcia Hunt, Natasha C Cunningham, Rani Hoff
OBJECTIVE: Individuals with serious mental illness have increased mortality relative to those without these illnesses. Although cancer is a leading cause of death, few studies have evaluated potential disparities relative to mortality for individuals with serious mental illness who are diagnosed with cancer. In this study, we evaluated mortality after diagnosis of a common malignancy (lung cancer) in a prototypical serious mental illness (schizophrenia). METHODS: Using administrative data in the Veterans Affairs system, we identified 34,664 individuals who were diagnosed with lung cancer between October 1, 2001, and September 30, 2005...
October 25, 2016: Journal of Clinical Psychiatry
Sean Maroney, Carlos Chavez de Paz, Marjunphilip Duldulao, Tracey Kim, Mark E Reeves, Kevork K Kazanjian, Naveenraj Solomon, Carlos Garberoglio
There have been few studies directly comparing the postoperative complications in patients with a diverting ileostomy to patients who were not diverted after low anterior resection (LAR) for rectal carcinoma. This study is a retrospective chart review of all rectal carcinoma patients (99) who underwent a LAR from January 2009 to December 2014 at Loma Linda University Medical Center and Veterans Affairs Loma Linda Healthcare System. A majority of patients were diverted (58% vs 42%). The diverted patients were more likely to have a low tumor location (P < 0...
October 2016: American Surgeon
Daniel J Livorsi, Michihiko Goto, Margaret Carrel, Makoto M Jones, Jennifer McDanel, Rajeshwari Nair, Bruce Alexander, Brice Beck, Kelly K Richardson, Eli N Perencevich
OBJECTIVES: We sought to define regional variations in fluoroquinolone non-susceptibility (FQ-NS) among bloodstream isolates of Escherichia coli across the Veterans Health Administration (VHA) in the United States. METHODS: We analyzed a retrospective cohort of patients managed at 136 VHA hospitals who had a blood culture positive for E.coli between 2003 and 2013. Hospitals were classified based on US Census Divisions, and regional variations in FQ-NS were analyzed...
2016: Antimicrobial Resistance and Infection Control
P Van Epps, D Oswald, P A Higgins, T R Hornick, H Aung, R E Banks, B M Wilson, C Burant, S Graventstein, D H Canaday
BACKGROUND: Upregulation of pro-inflammatory cytokines has not only been associated with increased morbidity and mortality in older adults but also has been linked to frailty. In the current study we aimed to compare the relative relationship of age and frailty on inflammation and thrombosis in older veterans. RESULTS: We analyzed 117 subjects (age range 62-95 years; median 81) divided into 3 cohorts: non-frail, pre-frail and frail based on the Fried phenotype of frailty...
2016: Immunity & Ageing: I & A
Shuab Omer, Lorraine D Cornwell, Ankur Bakshi, Eric Rachlin, Ourania Preventza, Todd K Rosengart, Joseph S Coselli, Scott A LeMaire, Nancy J Petersen, Greg Pattakos, Faisal G Bakaeen
Little is known about the frequency and clinical implications of postoperative atrial fibrillation in military veterans who undergo coronary artery bypass grafting (CABG). We examined long-term survival data, clinical outcomes, and associated risk factors in this population. We retrospectively reviewed baseline, intraoperative, and postoperative data from 1,248 consecutive patients with similar baseline risk profiles who underwent primary isolated CABG at a Veterans Affairs hospital from October 2006 through March 2013...
October 2016: Texas Heart Institute Journal
Jennifer C Reneker, Kyra Weems, Vincent Scaia
This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT) students, 21-33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Akron, Ohio, USA...
October 25, 2016: Journal of Educational Evaluation for Health Professions
Michael D Nevarez, Johanna C Malone, Dorene M Rentz, Robert J Waldinger
OBJECTIVE: Identifying adaptive ways to cope with extreme stress is essential to promoting long-term health. Memory systems are highly sensitive to stress, and combat exposure during war has been shown to have deleterious effects on cognitive processes, such as memory, decades later. No studies have examined coping styles used by combat veterans and associations with later-life cognitive functioning. Defenses are coping mechanisms that manage difficult memories and feelings, with some more closely related to memory processes (e...
October 7, 2016: Comprehensive Psychiatry
Feng Su, Pamela K Green, Kristin Berry, George N Ioannou
: Black race and Hispanic ethnicity were associated with lower rates of sustained virologic response (SVR) to interferon (IFN)-based treatments for chronic hepatitis C virus (HCV) infection whereas Asian race was associated with higher SVR rates compared to white patients. We aimed to describe the association between race/ethnicity and effectiveness of new direct-acting antiviral (DAA) regimens in the Veterans Affairs (VA) healthcare system nationally. We identified 21,095 HCV-infected patients (11,029 [52%] white, 6,171 [29%] black, 1,187 [6%] Hispanic, 348 [2%] Asian/Pacific Islander/American Indian/Alaska Native [Asian/PI/AI/AN] and 2,360 [11%] declined/missing race or ethnicity) who initiated antiviral treatment with regimens containing sofosbuvir (SOF), simeprevir + sofosbuvir (SMV+SOF), ledipasvir/sofosbuvir (LDV/SOF) or paritaprevir/ombitasvir/ritonavir/dasabuvir (PrOD), during the 18-month period from 01/01/2014 to 06/30/2015...
October 24, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Gregory P Beehler, Kaitlin R Lilienthal
The Primary Care Behavioral Health (PCBH) model of integrated primary care is challenging to implement with high fidelity. The Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) was designed to assess provider adherence to essential model components and has recently been adapted into a quality improvement toolkit. The aim of this pilot project was to gather preliminary feedback on providers' perceptions of the acceptability and utility of the PPAQ toolkit for making beneficial practice changes...
October 24, 2016: Psychological Services
Elie A Saade, Nuntra Suwantarat, Trina F Zabarsky, Brigid Wilson, Curtis J Donskey
BACKGROUND: Recent reports suggest that infections due to fluoroquinolone-resistant Escherichia coli (E. coli) are an increasingly common complication of transrectal biopsy of the prostate (TBP) in the United States. A better understanding of the magnitude and scope of these infections is needed to guide prevention efforts. Our objective is to determine whether the incidence of infections due to fluoroquinolone-resistant E. coli after TBP has increased nationwide in the Veterans Affairs Health Care System and to identify risk factors for infection...
2016: Pathogens & Immunity
Ann E Vandenberg, Melissa Stevens, Katharina V Echt, S Nicole Hastings, James Powers, Alayne Markland, Ula Hwang, William Hung, Stephanie Belbis, Camille P Vaughan
The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUiPPED) program aimed to reduce potentially inappropriate medication prescribing to older adults at 5 VAMCs.
April 2016: Federal Practitioner: for the Health Care Professionals of the VA, DoD, and PHS
Ken M Kunisaki, Dennis E Niewoehner, Gary Collins, Bitten Aagaard, Nafisah B Atako, Elzbieta Bakowska, Amanda Clarke, Giulio Maria Corbelli, Ernest Ekong, Sean Emery, Elizabeth B Finley, Eric Florence, Rosa M Infante, Cissy M Kityo, Juan Sierra Madero, Daniel E Nixon, Ellen Tedaldi, Jørgen Vestbo, Robin Wood, John E Connett
BACKGROUND: Observational data have been conflicted regarding the potential role of HIV antiretroviral therapy (ART) as a causative factor for, or protective factor against, COPD. We therefore aimed to investigate the effect of immediate versus deferred ART on decline in lung function in HIV-positive individuals. METHODS: We did a nested substudy within the randomised, controlled Strategic Timing of Antiretroviral Treatment (START) trial at 80 sites in multiple settings in 20 high-income and low-to-middle-income countries...
October 20, 2016: Lancet Respiratory Medicine
Kirsha S Gordon, E Jennifer Edelman, Amy C Justice, David A Fiellin, Kathleen Akgün, Stephen Crystal, Mona Duggal, Joseph L Goulet, David Rimland, Kendall J Bryant
Black and Hispanic (minority) MSM have a higher incidence of HIV than white MSM. Multiple sexual partners, being under the influence of drugs and/or alcohol during sex, having a detectable HIV-1 RNA, and non-condom use are factors associated with HIV transmission. Using data from the Veterans Aging Cohort Study, we consider minority status and sexual orientation jointly to characterize and compare these factors. White non-MSM had the lowest prevalence of these factors (p < 0.001) and were used as the comparator group in calculating odds ratios (OR)...
October 22, 2016: AIDS and Behavior
Gregory P Beehler, Paul R King, Christina L Vair, Julie Gass, Jennifer S Funderburk
The VA has integrated psychologists and other licensed mental health providers, known collectively as co-located collaborative care (CCC) providers, into patients' primary care medical homes to improve mental health services for veterans. However, it is unclear if CCC providers are routinely using mental health measures as part of evidence-based, coordinated care. This study aimed to determine the prevalence and predictors of CCC provider utilization of brief, validated measures. A retrospective review of VA electronic medical records from 8403 veterans diagnosed with depression, posttraumatic stress disorder, or anxiety disorder was conducted...
October 21, 2016: Journal of Clinical Psychology in Medical Settings
Julia Diehle, Samantha K Brooks, Neil Greenberg
PURPOSE: Previous research has mainly focused on veterans' mental health problems, especially on posttraumatic stress disorder (PTSD). Less is known about the impact that the veteran's experienced potentially traumatic events (PTEs) might have on their significant others. Therefore, we reviewed the scientific literature to find out what is known about the prevalence of secondary traumatic stress (STS) in significant others of veterans. METHODS: We systematically searched Pubmed, PsycINFO, Embase, Cochrane Library and PILOTS for relevant articles...
October 21, 2016: Social Psychiatry and Psychiatric Epidemiology
Joan K Monin, Natalie Mota, Becca Levy, John Pachankis, Robert H Pietrzak
OBJECTIVES: Objectives were to: (a) identify the mental health needs of older and younger sexual minority and heterosexual U.S. veterans and (b) examine whether sexual minority status confers vulnerability or resiliency in older adulthood. Support and trauma exposure were examined as potential mechanisms for age by sexual orientation differences. METHODS: Participants were a nationally representative sample of 3,095 U.S. veterans (ages 21 to 96 years). Measures included demographics, military characteristics, sexual orientation (lesbian, gay, or bisexual; LGB), social support, trauma, and mental health indicators (lifetime and present depression and post-traumatic stress disorder (PTSD); lifetime anxiety and suicidal ideation)...
September 23, 2016: American Journal of Geriatric Psychiatry
Elizabeth A Sternke, Kathleen Abrahamson, Matthew J Bair
Clinician empathy is a well-documented component of effective patient/provider communication. Evidence surrounding the association between patient perspectives on clinician empathy and perception of pain management is currently limited, particularly among patients with chronic pain and depression. The aim of this study was to analyze patients' perspectives on the emergent theme of empathy and describe how patients construct their experiences and expectations surrounding empathic interactions. A secondary analysis of focus group data was designed using grounded theory methodology...
October 18, 2016: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Karen H Wang, Joseph L Goulet, Constance M Carroll, Melissa Skanderson, Samah Fodeh, Joseph Erdos, Julie A Womack, Erica A Abel, Harini Bathulapalli, Amy C Justice, Marcella Nunez-Smith, Cynthia A Brandt
BACKGROUND: Healthcare mobility, defined as healthcare utilization in more than one distinct healthcare system, may have detrimental effects on outcomes of care. We characterized healthcare mobility and associated characteristics among a national sample of Veterans. METHODS: Using the Veterans Health Administration Electronic Health Record, we conducted a retrospective cohort study to quantify healthcare mobility within a four year period. We examined the association between sociodemographic and clinical characteristics and healthcare mobility, and characterized possible temporal and geographic patterns of healthcare mobility...
October 21, 2016: BMC Health Services Research
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