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Veterans affairs

Eric B Elbogen, H Ryan Wagner, Mira Brancu, Nathan A Kimbrel, Jennifer C Naylor, Cindy M Swinkels, John A Fairbank
Introduction: In response to a strong focus on suicide prevention for all veterans, the Department of Veterans Affairs (VA) recently revised policy to provide emergency mental healthcare for veterans who received Other Than Honorable (OTH) discharges from the military. This current study takes a preliminary step toward identifying demographic, historic, military, clinical, and social characteristics of veterans with OTH discharges. Materials and Methods: N = 1,172 Iraq/Afghanistan-era veterans were evaluated between 2005 and 2016 in the multi-site VA Mid-Atlantic Mental Illness, Research, Education and Clinical Center (MIRECC) Study of Post-Deployment Mental Health (PDMH Study)...
March 14, 2018: Military Medicine
Brian Shiner, Christine Leonard Westgate, Vanessa Simiola, Richard Thompson, Paula P Schnurr, Joan M Cook
Objective: Available studies on implementation of evidence-based psychotherapy (EBP) for patients attending Department of Veterans Affairs (VA) residential post-traumatic stress disorder (PTSD) programs rely on therapist self-report of EBP delivery. Patient-level data on receipt of EBP are needed both to corroborate therapist self-report and to understand patient factors that predict receipt of EBPs for PTSD. Materials and Methods: We identified 159 therapists from 38 VA residential PTSD programs who responded to a survey about EBP implementation during the 2015 fiscal year (FY15)...
March 14, 2018: Military Medicine
Amy C Justice, Kirsha S Gordon, Melissa Skanderson, Eva Jennifer Edelman, Kathleen M Akgün, Cynthia L Gibert, Vincent Lo Re, David Rimland, Julie A Womack, Christina M Wyatt, Janet P Tate
BACKGROUND: HIV-positive individuals (HIV+) on antiretrovirals commonly take enough other medications to cross a threshold for polypharmacy but little is known about associated outcomes. We asked whether non-antiretroviral polypharmacy is associated with hospitalization and mortality and whether associations differ by HIV status. METHODS: Data on HIV+ and uninfected individuals in the US Veterans Affairs Healthcare System were analyzed. Eligible HIV+ were on antiretrovirals with suppressed HIV-1 RNA and uninfected individuals received at least one medication...
March 27, 2018: AIDS
Judit Karacsonyi, Ehrin J Armstrong, Huu Tam D Truong, Ryan Tsuda, Damianos G Kokkinidis, Jose Roberto Martinez-Parachini, Aya J Alame, Barbara A Danek, Aris Karatasakis, Michele Roesle, Houman Khalili, Imre Ungi, Subhash Banerjee, Emmanouil S Brilakis, Bavana V Rangan
BACKGROUND: The contemporary use and outcomes of excimer laser coronary atherectomy (ELCA) in percutaneous coronary intervention (PCI) are not well described. METHODS: We examined the baseline clinical and angiographic characteristics and procedural outcomes of 130 target lesions in 121 consecutive PCIs (n = 116 patients) in which ELCA was performed at three United States Department of Veterans Affairs (VA) medical centers between 2008 and 2016. RESULTS: Mean age was 68...
March 15, 2018: Journal of Invasive Cardiology
Alicia R Gable, Claudia Der-Martirosian, Laura N Pinnock, Aram Dobalian
OBJECTIVE: To identify the communication preferences of homeless (H) and nonhomeless (NH) Veterans Affairs (VA) patients for receiving information about the impact of natural disasters on VA healthcare services. DESIGN: Probability-based sampling design stratified on age categories, urban/rural, coastal/noncoastal, and homelessness. SETTING: Northeast United States. PARTICIPANTS: Eligible NH and H participants included those who lived in and had at least one healthcare visit to a VA medical center/clinic in the region in the previous 24 months...
January 2018: Journal of Emergency Management: JEM
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
Tiffany A Radcliff, Karen Chu, Claudia Der-Martirosian, Aram Dobalian
INTRODUCTION: Although little research has examined impacts of disasters on scheduled ambulatory care services, routine care delivery is important for emergency planning and response because missed or delayed care can lead to more urgent care needs. This article presents potential measures of ambulatory care recovery and resilience and applies the measures to data around a recent disaster. METHODS: We conceptualize "ambulatory care recovery" as the change in median business days to complete appointments that were canceled, and "ambulatory care resiliency" as the change in percentage of completed appointments in time frames before, during, and after disasters...
March 2018: Journal of the American Board of Family Medicine: JABFM
Charles J Kahi, Heiko Pohl, Laura J Myers, Dalia Mobarek, Douglas J Robertson, Thomas F Imperiale
Background: Colonoscopy is widely used in the Veterans Affairs (VA) health care system for colorectal cancer (CRC) prevention, but its effect on CRC mortality is unknown. Objective: To determine whether colonoscopy is associated with decreased CRC mortality in veterans and whether its effect differs by anatomical location of CRC. Design: Case-control study. Setting: VA-Medicare administrative data. Participants: Case patients were veterans aged 52 years or older who were diagnosed with CRC between 2002 and 2008 and died of the disease by the end of 2010...
March 13, 2018: Annals of Internal Medicine
Patrick R Wood, Evan Manning, Joshua F Baker, Bryant England, Lisa Davis, Grant W Cannon, Ted R Mikuls, Liron Caplan
AIM: To determine the scope of acute hypoglycemic effects for certain anti-rheumatic medications in a large retrospective observational study. METHODS: Patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were selected who, during follow-up, initiated treatment with tumor necrosis factor inhibitors (TNFi's, including etanercept, adalimumab, infliximab, golimumab, or certolizumab), prednisone, or conventional disease-modifying anti-rheumatic drugs (DMARDs), and for whom proximate random blood glucose (RBG) measurements were available within a window 2-wk prior to, and 6 mo following, medication initiation...
February 15, 2018: World Journal of Diabetes
Jejo D Koola, Sharon E Davis, Omar Al-Nimri, Sharidan K Parr, Daniel Fabbri, Bradley A Malin, Samuel B Ho, Michael E Matheny
OBJECTIVE: Hepatorenal Syndrome (HRS) is a devastating form of acute kidney injury (AKI) in advanced liver disease patients with high morbidity and mortality, but phenotyping algorithms have not yet been developed using large electronic health record (EHR) databases. We evaluated and compared multiple phenotyping methods to achieve an accurate algorithm for HRS identification. MATERIALS AND METHODS: A national retrospective cohort of patients with cirrhosis and AKI admitted to 124 Veterans Affairs hospitals was assembled from electronic health record data collected from 2005 to 2013...
March 9, 2018: Journal of Biomedical Informatics
B Josea Kramer, Beth Creekmur, Michael N Mitchell, Debra Saliba
BACKGROUND/OBJECTIVES: Home-based primary care (HBPC) is a comprehensive, interdisciplinary program to meet the medical needs of community-dwelling populations needing long-term care (LTC). The U.S. Department of Veterans Affairs (VA) expanded its HBPC program to underserved rural communities, including American Indian reservations, providing a "natural laboratory" to study change in access to VA LTC benefits and utilization outcomes for rural populations that typically face challenges in accessing LTC medical support...
March 12, 2018: Journal of the American Geriatrics Society
Martha A Combs, Edan A Critchfield, Jason R Soble
OBJECTIVE: This preliminary, pilot study assessed the effectiveness of a group-based, mindfulness intervention in a residential, rehabilitation setting with specific focus on assessing participants' self-report of perceived benefit of the intervention on overall health, pain, sleep, mood/anxiety, attention, and self-awareness, as well as implementing modifications needed for successful intervention application among a diverse, clinical military population. METHOD/DESIGN: Participants were 19 veterans and active duty service members with a history of traumatic brain injury (TBI; 63% severe) who completed a mindfulness-based group intervention during inpatient admission at a Veterans Affairs Polytrauma Transitional Rehabilitation Program (PTRP)...
March 12, 2018: Rehabilitation Psychology
Paul S Pagel, Lonnie Dye, Brent T Boettcher, Julie K Freed
OBJECTIVE: Blood flow across the mitral valve during early left ventricular (LV) filling produces a 3-dimensional rotational fluid body, known as a vortex ring, that enhances LV filling efficiency. Diastolic dysfunction is common in elderly patients, but the influence of advanced age on vortex formation is unknown. The authors tested the hypothesis that advanced age is associated with a reduction in LV filling efficiency quantified using vortex formation time (VFT) in octogenarians undergoing coronary artery bypass graft (CABG) surgery...
March 7, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Dominick DePhilippis, Nancy M Petry, Marcel O Bonn-Miller, Sarah B Rosenbach, James R McKay
BACKGROUND: In 2011, the Department of Veterans Affairs launched an initiative to expand patients' access to contingency management (CM) for the treatment of substance use disorders, particularly stimulant use disorder. This study evaluates the uptake and effectiveness of the VA initiative by presenting data on participation in coaching, fidelity to key components of the CM protocol, and clinical outcomes (CM attendance and substance use). METHODS: Fifty-five months after the first VA stations began offering CM to patients in June 2011, 94 stations had made CM available to 2060 patients...
February 16, 2018: Drug and Alcohol Dependence
Leah L Zullig, Karen M Goldstein, Hayden B Bosworth, Sara M Andrews, Susanne Danus, George L Jackson, Dawn Provenzale, Morris Weinberger, Michael J Kelley, Corrine I Voils
BACKGROUND: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the US. CRC survivors may have complex healthcare needs requiring care from both specialists and primary care. Our objective was to understand how CRC survivors perceive their survivorship care, especially management of their cardiovascular-related chronic diseases. METHODS: We identified patients diagnosed with non-metastatic CRC between 10/1/2007 and 12/31/2015 at Veterans Affairs Medical Centers in North Carolina or Virginia...
March 9, 2018: BMC Health Services Research
Nabeel Khan, Chinmay Trivedi, Yash Shah, Dhruvan Patel, James Lewis, Yu-Xiao Yang
Aim: There is a paucity of data on the clinical course and the factors affecting the clinical course of herpes zoster (HZ) in inflammatory bowel disease (IBD). Our aim was to determine the impact of anti-TNF therapy and other factors on the clinical course of HZ in IBD patients. Methods: We conducted a retrospective cohort study among a cohort of nation-wide Veterans Affairs patients with IBD who developed incident HZ. The exposed group consisted of eligible study patients who were actively exposed to anti-TNF alone or anti-TNF plus thiopurines at the time of HZ onset...
March 7, 2018: Inflammatory Bowel Diseases
Thomas R Radomski, Felicia R Bixler, Susan L Zickmund, KatieLynn M Roman, Carolyn T Thorpe, Jennifer A Hale, Florentina E Sileanu, Leslie R M Hausmann, Joshua M Thorpe, Katie J Suda, Kevin T Stroupe, Adam J Gordon, Chester B Good, Michael J Fine, Walid F Gellad
BACKGROUND: The Department of Veterans Affairs (VA) has implemented robust strategies to monitor prescription opioid dispensing, but these strategies have not accounted for opioids prescribed by non-VA providers. State-based prescription drug monitoring programs (PDMPs) are a potential tool to identify VA patients' receipt of opioids from non-VA prescribers, and recent legislation requires their use within VA. OBJECTIVE: To evaluate VA physicians' perspectives and experiences regarding use of PDMPs to monitor Veterans' receipt of opioids from non-VA prescribers...
March 8, 2018: Journal of General Internal Medicine
John Frederick, Alexandria C Brown, Derek A Cummings, Charlotte A Gaydos, Cynthia L Gibert, Geoffrey J Gorse, Jenna G Los, Ann-Christine Nyquist, Trish M Perl, Connie S Price, Lewis J Radonovich, Nicholas G Reich, Maria C Rodriguez-Barradas, Mary T Bessesen, Michael S Simberkoff
OBJECTIVE To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP). DESIGN Retrospective observational cohort study. SETTING This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies. PARTICIPANTS The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites...
March 8, 2018: Infection Control and Hospital Epidemiology
Barbara G Bokhour, Gemmae M Fix, Nora M Mueller, Anna M Barker, Sherri L Lavela, Jennifer N Hill, Jeffrey L Solomon, Carol VanDeusen Lukas
BACKGROUND: Healthcare organizations increasingly are focused on providing care which is patient-centered rather than disease-focused. Yet little is known about how best to transform the culture of care in these organizations. We sought to understand key organizational factors for implementing patient-centered care cultural transformation through an examination of efforts in the US Department of Veterans Affairs. METHODS: We conducted multi-day site visits at four US Department of Veterans Affairs medical centers designated as leaders in providing patient-centered care...
March 7, 2018: BMC Health Services Research
Tessa L Walters, T Edward Kim, Edward R Mariano, Geoffrey Kenton Lighthall
BACKGROUND: The Perioperative Surgical Home (PSH) is an anesthesiologist-led, coordinated care model that may improve patient experience and safety. We hypothesized that PSH will decrease activation of the rapid response system for surgical inpatients. METHODS: This retrospective study was performed at an academic Veterans Affairs hospital with a PSH. Data from both medical and surgical cohorts admitted to a single ward were analyzed for the Pre-PSH (July 2006 to October 2010) and Post-PSH (November 2011 to May 2015) epochs...
March 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
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