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Veterans affairs

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https://www.readbyqxmd.com/read/28317097/engagement-in-advance-care-planning-and-surrogates-knowledge-of-patients-treatment-goals
#1
Terri R Fried, Maria Zenoni, Lynne Iannone, John O'Leary, Brenda T Fenton
OBJECTIVES: A key objective of advance care planning (ACP) is improving surrogates' knowledge of patients' treatment goals. Little is known about whether ACP outside of a trial accomplishes this. The objective was to examine patient and surrogate reports of ACP engagement and associations with surrogate knowledge of goals. DESIGN: Cohort study SETTING: Primary care in a Veterans Affairs Medical Center. PARTICIPANTS: 350 community-dwelling veterans age ≥55 years and the individual they would choose to make medical decisions on their behalf, interviewed separately...
March 20, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28306156/posttraumatic-stress-disorder-antipsychotic-use-and-risk-of-dementia-in-veterans
#2
Elizabeth E Roughead, Nicole L Pratt, Lisa M Kalisch Ellett, Emmae N Ramsay, John D Barratt, Philip Morris, Graeme Killer
OBJECTIVES: To examine the risk of dementia associated with posttraumatic stress disorder (PTSD) and the contribution of antipsychotic use to this risk. DESIGN: Retrospective cohort study SETTING: Australia. Administrative claims data from the Australian Government Department of Veterans' Affairs were used. PARTICIPANTS: Male Vietnam veterans aged 55 to 65 at baseline (2001-02) with no preexisting dementia diagnosis (N = 15,612). MEASUREMENTS: The association between PTSD and dementia was assessed over 12 years of follow-up...
March 17, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28295142/creation-of-an-interprofessional-teledementia-clinic-for-rural-veterans-preliminary-data
#3
Becky B Powers, Marcia C Homer, Natalia Morone, Natali Edmonds, Michelle I Rossi
The teledementia clinic is a new model of care that expands the reach of specialized geriatric and dementia care using clinical video telehealth (CVT) to rural veterans, who frequently lack access to specialty care. The clinic is a Veterans Affairs (VA) Geriatric Research, Education, and Clinical Center clinical demonstration project. It is located in the Pittsburgh VA Healthcare System tertiary referral hospital and serves veterans in affiliated rural community-based outpatient clinics (CBOCs). Rural CBOC primary care providers refer clinic patients, or referral is according to previous cognitive impairment diagnosis in a VAPHS geriatric clinic...
March 10, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28294310/longitudinal-analysis-of-quality-of-diabetes-care-and-relational-climate-in-primary-care
#4
Marina Soley-Bori, Justin K Benzer, James F Burgess
OBJECTIVE: To assess the influence of relational climate on quality of diabetes care. DATA SOURCES/STUDY SETTING: The study was conducted at the Department of Veterans Affairs (VA). The VA All Employee Survey (AES) was used to measure relational climate. Patient and facility characteristics were gathered from VA administrative datasets. STUDY DESIGN: Multilevel panel data (2008-2012) with patients nested into clinics. DATA COLLECTION/EXTRACTION METHODS: Diabetic patients were identified using ICD-9 codes and assigned to the clinic with the highest frequency of primary care visits...
March 10, 2017: Health Services Research
https://www.readbyqxmd.com/read/28291091/impact-of-acute-kidney-injury-in-patients-hospitalized-with-pneumonia
#5
Lakhmir S Chawla, Richard L Amdur, Charles Faselis, Ping Li, Paul L Kimmel, Carlos E Palant
OBJECTIVES: Pneumonia is a common cause of hospitalization and can be complicated by the development of acute kidney injury. Acute kidney injury is associated with major adverse kidney events (death, dialysis, and durable loss of renal function [chronic kidney disease]). Because pneumonia and acute kidney injury are in part mediated by inflammation, we hypothesized that when acute kidney injury complicates pneumonia, major adverse kidney events outcomes would be exacerbated. We sought to assess the frequency of major adverse kidney events after a hospitalization for either pneumonia, acute kidney injury, or the combination of both...
April 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28290938/postconcussive-symptoms-ptsd-and-medical-disease-burden-in-treatment-seeking-oef-oif-ond-veterans
#6
Joah L Williams, Meghan E McDevitt-Murphy, James G Murphy, Ellen M Crouse
INTRODUCTION: The most common psychological and cognitive sequelae associated with deployments to Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom) are mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD). High rates of PTSD are often observed among Veterans with a history of mTBI, and persistent postconcussive symptoms commonly endorsed after mTBI are known to be associated with PTSD. Therefore, this study examined whether PTSD mediates relations between postconcussive symptoms and 2 indices of medical disease burden: 1) the number of disease categories positive for a diagnosis, or system disease burden, and 2) total number of physical diagnoses, or cumulative disease burden...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28290928/indications-of-recruitment-challenges-in-research-with-u-s-military-service-members-a-clinicaltrials-gov-review
#7
Wendy A Cook, Ardith Z Doorenbos
INTRODUCTION: The success of military-relevant health research often depends on recruiting adequate numbers of U.S. military service members as research participants. Researchers have reported difficulties in recruiting service member research participants. Reviews of ClinicalTrials.gov, an online clinical trial registry of publicly and privately sponsored studies, have identified challenges in participant recruitment and barriers to study completion in various research populations. The purpose of this study was to identify indications of difficulty recruiting U...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28290927/understanding-primary-care-behavioral-health-across-military-settings-a-preliminary-comparison-between-deployed-and-in-garrison-care
#8
Ryan R Landoll, Matthew K Nielsen, Kathryn K Waggoner
BACKGROUND: Integrated primary care behavioral health (PCBH) is a growing trend in health care delivery, particularly in the Department of Defense and the Department of Veterans Affairs. This consultative model has been applied within the U.S. Air Force for over 15 years and has demonstrated positive health impacts and patient satisfaction. With extended conflicts and engagements, including Operation Enduring Freedom and Operation Iraqi Freedom, deployment behavioral health care has expanded and positively received, but there is less empirical support of particular models of care in a deployed environment...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28288681/a-study-to-reduce-readmissions-after-surgery-in-the-veterans-health-administration-design-and-methodology
#9
Laurel A Copeland, Laura A Graham, Joshua S Richman, Amy K Rosen, Hillary J Mull, Edith A Burns, Jeff Whittle, Kamal M F Itani, Mary T Hawn
BACKGROUND: Hospital readmissions are associated with higher resource utilization and worse patient outcomes. Causes of unplanned readmission to the hospital are multiple with some being better targets for intervention than others. To understand risk factors for surgical readmission and their incremental contribution to current Veterans Health Administration (VA) surgical quality assessment, the study, Improving Surgical Quality: Readmission (ISQ-R), is being conducted to develop a readmission risk prediction tool, explore predisposing and enabling factors, and identify and rank reasons for readmission in terms of salience and mutability...
March 14, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28288458/gastric-acid-suppression-is-associated-with-an-increased-risk-of-adverse-outcomes-in-inflammatory-bowel-disease
#10
Rajesh Shah, Peter Richardson, Hong Yu, Jennifer Kramer, Jason Ken Hou
BACKGROUND: The intestinal microbiota may influence inflammatory bowel disease (IBD) activity. Histamine 2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) can alter the intestinal microbiota. The aim of this study was to assess the relationship between H2RAs, PPIs, and IBD-related outcomes. METHODS: We conducted a case-control study of IBD patients using the Veterans Health Affairs databases. Cases were defined by their first instance of an IBD-related hospitalization or surgery and the exposure of interest was H2RA or PPI use 30 days prior to the outcome...
March 14, 2017: Digestion
https://www.readbyqxmd.com/read/28288245/addressing-the-opioid-epidemic-in-the-united-states-lessons-from-the-department-of-veterans-affairs
#11
Walid F Gellad, Chester B Good, David J Shulkin
No abstract text is available yet for this article.
March 13, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28288076/impact-of-multisystem-health-care-on-readmission-and-follow-up-among-veterans-hospitalized-for-chronic-obstructive-pulmonary-disease
#12
Seppo T Rinne, Anashua R Elwy, Lori A Bastian, Edwin S Wong, Renda S Wiener, Chuan-Fen Liu
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the most common causes of readmission at Veterans Affairs (VA) hospitals. Previous studies demonstrate worse outcomes for veterans with multisystem health care, though the impact of non-VA care on COPD readmissions is unknown. OBJECTIVE: To examine the association of use of non-VA outpatient care with 30-day readmission and 30-day follow-up among veterans admitted to the VA for COPD. DESIGN: This is a retrospective cohort study using VA administrative data and Medicare claims...
March 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28287932/mental-disorder-prevalence-among-u-s-department-of-veterans-affairs-outpatients-with-spinal-cord-injuries
#13
Scott D McDonald, Melody N Mickens, Lisa D Goldberg-Looney, Brian J Mutchler, Michael S Ellwood, Teodoro A Castillo
OBJECTIVES: Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction...
March 13, 2017: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/28287774/evaluation-of-a-shared-decision-making-intervention-on-the-utilization-of-evidence-based-psychotherapy-in-a-va-outpatient-ptsd-clinic
#14
Jonathan D Hessinger, Melissa J London, Sheila M Baer
The Veterans Health Administration (VHA) has continued to emphasize the availability, access, and utilization of high quality mental health care particularly in the treatment of posttraumatic stress disorder (PTSD). While dissemination and availability of evidence-based psychotherapies (EBPs) have only increased, treatment engagement and utilization have continued to be oft-noted challenges. Administrators, researchers, and individual clinicians have continued to develop and explore novel systemic and individualized interventions to address these issues...
March 13, 2017: Psychological Services
https://www.readbyqxmd.com/read/28287769/increased-utilization-of-prolonged-exposure-and-cognitive-processing-therapy-over-time-a-case-example-from-a-large-veterans-affairs-posttraumatic-stress-disorder-clinic
#15
Natalie E Hundt, Juliette M Harik, Karin E Thompson, Terri L Barrera, Shannon Reynolds Miles
Prior single-site and regional studies have documented difficulties in implementing prolonged exposure (PE) and cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) into practice in Veterans Affairs (VA) Medical Centers, estimating that between 6% and 13% of VA patients with PTSD receive PE or CPT (Lu, Plagge, Marsiglio, & Dobscha, 2016; Mott et al., 2014; Shiner et al., 2013). However, these studies examined data from fiscal years 2008-2012, and therefore may not reflect more recent utilization patterns...
March 13, 2017: Psychological Services
https://www.readbyqxmd.com/read/28284926/moderate-short-term-local-hyperglycemia-attenuates-forearm-endothelium-dependent-vasodilation-after-transient-ischemia-reperfusion-in-human-volunteers
#16
Thomas J Ebert, Jutta Novalija, Jill A Barney, Toni D Uhrich, Shahbaz R Arain, Julie K Freed, Paul S Pagel
OBJECTIVE: Acute hyperglycemia causes endothelial dysfunction in diabetic patients, abolishes ischemic pre- and postconditioning, and is an independent predictor of adverse outcome after myocardial infarction in nondiabetic patients. Its effects on endothelial-dependent vasodilation are controversial in healthy subjects. The authors studied the effect of moderate short-term local hyperglycemia on forearm endothelium-dependent vasodilation in healthy volunteers. DESIGN: Randomized, crossover, blinded, 2-visit, pilot design...
December 2, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28280351/regional-variation-in-post-stroke-multidisciplinary-rehabilitation-care-among-veteran-residents-in-community-nursing-homes
#17
Huanguang Jia, Qinglin Pei, Charles T Sullivan, Diane C Cowper Ripley, Samuel S Wu, W Bruce Vogel, Xinping Wang, Douglas E Bidelspach, Jennifer L Hale-Gallardo, Barbara E Bates
INTRODUCTION: Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors' functional recovery and daily living activities. The US Department of Veterans Affairs (VA) places veterans needing post-acute institutional care in private community nursing homes (CNHs). These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans' health services as well as the geographic variation of the service utilization...
2017: Journal of Multidisciplinary Healthcare
https://www.readbyqxmd.com/read/28276866/performance-validity-and-processing-speed-in-a-va-polytrauma-sample
#18
Lee Ashendorf, Erika L Clark, Michael A Sugarman
OBJECTIVE: While recognition memory has been the primary tool for the assessment of performance validity in neuropsychological evaluations, some consideration has also been given to embedded measures from other cognitive domains, including processing speed. The present study evaluated the classification accuracy of several speed-based measures in a Veterans Affairs Medical Center Polytrauma sample. METHOD: The present sample consisted of 114 military veterans (Mean age = 35...
February 10, 2017: Clinical Neuropsychologist
https://www.readbyqxmd.com/read/28275473/effect-of-coronary-artery-bypass-graft-surgery-on-left-ventricular-systolic-function
#19
Ryan J Koene, Jessica V Kealhofer, Selcuk Adabag, Kairav Vakil, Viorel G Florea
BACKGROUND: Changes in left ventricular (LV) systolic function in response to coronary artery bypass grafting (CABG) have not been fully assessed. METHODS: Between January 2001 and December 2014, 2,838 consecutive patients underwent isolated CABG at the Minneapolis Veterans Affairs Health Care System. Of these, 375 had echocardiographic assessment of LV function before (within 6 months) and after (3 to 24 months) CABG and were included in this analysis. RESULTS: While the mean LV ejection fraction (LVEF) did not change following CABG [(49±13)% vs...
February 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28274680/a-retrospective-review-of-insulin-requirements-in-patients-using-u-500-insulin-hospitalized-to-a-veterans-affairs-hospital
#20
Rohit Kedia, Cyrus Desouza, Lynette M Smith, Vijay Shivaswamy
AIMS: The aim of this study was to compare the changes in the total daily dose (TDD) of insulin of patients on U-500 insulin; before hospitalization, during hospitalization and six weeks after discharge. METHODS: A retrospective chart review of veterans with type 2 diabetes receiving U-500 insulin in the ambulatory setting and who were admitted between 2012 and 2015 was performed. During hospitalization, patients were transitioned to receive U-100 insulin (detemir or glargine for basal and aspart for bolus)...
February 21, 2017: Journal of Diabetes and its Complications
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