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Veterans affairs

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https://www.readbyqxmd.com/read/29138051/sarcopenia-in-peripheral-arterial-disease-prevalence-and-impact-on-functional-status
#1
Odessa Addison, Steven J Prior, Rishi Kundi, Monica C Serra, Leslie I Katzel, Andrew W Gardner, Alice S Ryan
OBJECTIVES: To determine the prevalence of sarcopenia in older men with peripheral arterial disease (PAD) and to compare to a subset of the group to age, race, sex, and body mass index (BMI)-matched non-PAD control counterparts. We also sought to compare the functional status of those with PAD with and without sarcopenia. DESIGN: Cohort study. SETTING: A Veterans Affairs medical center. PARTICIPANTS: Sedentary, community dwelling men age 50+ years with a confirmed diagnosis of PAD (N=108; 44% black; BMI 27...
November 11, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/29137891/human-leukocyte-antigen-hla-and-gulf-war-illness-gwi-hla-drb1-13-02-spares-subcortical-atrophy-in-gulf-war-veterans
#2
Lisa M James, Peka Christova, Brian E Engdahl, Scott M Lewis, Adam F Carpenter, Apostolos P Georgopoulos
BACKGROUND: Gulf War Illness (GWI) is a multisystem disorder that has affected a substantial number of veterans who served in the 1990-91 Gulf War. The brain is prominently affected, as manifested by the presence of neurological, cognitive and mood symptoms. We reported previously on the protective role of six Human Leukocyte Antigen (HLA) alleles in GWI (Georgopoulos et al., 2016) and their association with regional brain function (James et al., 2016). More recently, we reported on the presence of subcortical brain atrophy in GWI (Christova et al...
November 9, 2017: EBioMedicine
https://www.readbyqxmd.com/read/29132630/evaluating-e-consultation-implementations-based-on-use-and-time-line-across-various-specialties
#3
Pratik J Parikh, Corinne Mowrey, Jennie Gallimore, Stephen Harrell, Brian Burke
BACKGROUND: Electronic Consultation (e-consults) can provide improved access, enhance patient and provider satisfaction, and reduce beneficiary travel expenses. We explored how e-consults were implemented across three specialty areas, diabetes (Diab), gastroenterology (GI), and neurosurgery (Neuro), at two Veterans Affairs hospitals in terms of strategies for use and time-lines. METHODS: We conducted observations and electronically shadowed patient e-consultations submitted to a specialty care service by primary care provider(s) at the two sites during a thirteen-month period...
December 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29130810/outcomes-after-angiography-with-sodium-bicarbonate-and-acetylcysteine
#4
Steven D Weisbord, Martin Gallagher, Hani Jneid, Santiago Garcia, Alan Cass, Soe-Soe Thwin, Todd A Conner, Glenn M Chertow, Deepak L Bhatt, Kendrick Shunk, Chirag R Parikh, Edward O McFalls, Mary Brophy, Ryan Ferguson, Hongsheng Wu, Maria Androsenko, John Myles, James Kaufman, Paul M Palevsky
Background Intravenous sodium bicarbonate and oral acetylcysteine are widely used to prevent acute kidney injury and associated adverse outcomes after angiography without definitive evidence of their efficacy. Methods Using a 2-by-2 factorial design, we randomly assigned 5177 patients at high risk for renal complications who were scheduled for angiography to receive intravenous 1.26% sodium bicarbonate or intravenous 0.9% sodium chloride and 5 days of oral acetylcysteine or oral placebo; of these patients, 4993 were included in the modified intention-to-treat analysis...
November 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29130272/effects-of-guideline-and-formulary-changes-on-statin-prescribing-in-the-veterans-affairs
#5
Adam A Markovitz, Rob G Holleman, Timothy P Hofer, Eve A Kerr, Mandi L Klamerus, Jeremy B Sussman
OBJECTIVE: To compare the effects of two sequential policy changes-the addition of a high-potency statin to the Department of Veterans Affairs (VA) formulary and the release of the American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines-on VA provider prescribing. DATA SOURCES/STUDY SETTING: Retrospective analysis of 1,100,682 VA patients, 2011-2016. STUDY DESIGN: Interrupted time-series analysis of changes in prescribing of moderate-to-high-intensity statins among high-risk patients and across high-risk subgroups...
December 2017: Health Services Research
https://www.readbyqxmd.com/read/29126751/shift-to-community-onset-clostridium-difficile-infection-in-the-national-veterans-health-administration-2003-2014
#6
Kelly R Reveles, Mary Jo V Pugh, Kenneth A Lawson, Eric M Mortensen, Jim M Koeller, Jacqueline R Argamany, Christopher R Frei
BACKGROUND: Clostridium difficile infection (CDI) occurs frequently in inpatient settings; however, community-onset cases have been reported more frequently in recent years. This study evaluated hospital-onset and community-onset CDI in the national Veterans Health Administration (VHA) population over a 12-year period. METHODS: This was a retrospective cohort study of all adult VHA beneficiaries with CDI between October 1, 2002, and September 30, 2014. Data were obtained from the Veterans Affairs Informatics and Computing Infrastructure...
November 7, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/29125899/demographic-and-clinical-factors-associated-with-non-surgical-osteoarthritis-treatment-use-among-patients-in-outpatient-clinics
#7
Lauren M Abbate, Amy S Jeffreys, Cynthia J Coffman, Todd A Schwartz, Liubov Arbeeva, Leigh F Callahan, Nicole A Negbenebor, Wendy M Kohrt, Robert S Schwartz, Ernest Vina, Kelli D Allen
OBJECTIVE: To identify patient demographic and clinical characteristics associated with osteoarthritis (OA) treatment use. METHODS: This was a secondary data analysis of three clinical trials among patients with hip or knee OA conducted in 1) Duke Primary Care practices, 2) the Durham Veterans Affairs Health Care System (DVAHCS), and 3) the University of North Carolina-Chapel Hill (UNC). At baseline, participants reported socio-demographic characteristics, OA-related pain and function, and OA treatment use including oral analgesia, topical creams, joint injections and physical therapy...
November 10, 2017: Arthritis Care & Research
https://www.readbyqxmd.com/read/29122047/antipsychotic-polypharmacy-in-older-australians
#8
Lisa M Kalisch Ellett, Nicole L Pratt, Mhairi Kerr, Elizabeth E Roughead
BACKGROUND: Antipsychotics are commonly used, and the rate of use is highest, among those aged 65 years or over, where the risk of adverse events is also high. Up to 20% of younger adults use more than one antipsychotic concurrently; however there are few studies on the prevalence of antipsychotic polypharmacy in older people. We aimed to analyze antipsychotic use in elderly Australians, focusing on the prevalence of antipsychotic polypharmacy and the use of medicines to manage adverse events associated with antipsychotics...
November 10, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/29121097/sex-based-differences-in-veterans-with-pulmonary-hypertension-results-from-the-veterans-affairs-clinical-assessment-reporting-and-tracking-database
#9
Corey E Ventetuolo, Edward Hess, Eric D Austin, Anna E Barón, James R Klinger, Tim Lahm, Thomas M Maddox, Mary E Plomondon, Lauren Thompson, Roham T Zamanian, Gaurav Choudhary, Bradley A Maron
Women have an increased risk of pulmonary hypertension (PH) but better survival compared to men. Few studies have explored sex-based differences in population-based cohorts with PH. We sought to determine whether sex was associated with hemodynamics and survival in US veterans with PH (mean pulmonary artery pressure [mPAP] ≥ 25 mm Hg) from the Veterans Affairs Clinical Assessment, Reporting, and Tracking database. The relationship between sex and hemodynamics was assessed with multivariable linear mixed modeling...
2017: PloS One
https://www.readbyqxmd.com/read/29120955/improving-oral-hygiene-for-veterans-with-dementia-in-residential-long-term-care
#10
Eleanor S McConnell, Kyung Hee Lee, Lorraine Galkowski, Christine Downey, Mary Victoria Spainhour, Reginaldo Horwitz
Oral hygiene care is neglected in long-term care (LTC) due to patient-, staff-, and systems-level barriers. A dementia-specific oral hygiene program, implemented and evaluated in a Department of Veterans Affairs LTC unit, addressed barriers to oral care at multiple levels. Improved staff competency, access to oral care supplies, and standardized documentation systems were accompanied by reduced oral plaque and gingivitis, demonstrating the feasibility and benefits of direct care staff providing improved oral hygiene in LTC...
November 8, 2017: Journal of Nursing Care Quality
https://www.readbyqxmd.com/read/29120247/clinician-perceptions-related-to-the-use-of-the-cbt-i-coach-mobile-app
#11
Katherine E Miller, Eric Kuhn, Jason Owen, Katherine Taylor, Jessica Yu, Brandon J Weiss, Jill J Crowley, Mickey Trockel
OBJECTIVE: Clinicians' perceptions of CBT-I Coach, a patient-facing mobile app for cognitive-behavioral therapy for insomnia (CBT-I), are critical to its adoption and integration into practice. Diffusion of innovations theory emphasizes the influence of perceptions, including the relative advantage to current practice; the compatibility to clinician's needs; the complexity; the innovation's trialability; and observability. This study intended to evaluate the use and perceptions of CBT-I Coach among Veterans Affairs (VA)-trained CBT-I clinicians...
November 9, 2017: Behavioral Sleep Medicine
https://www.readbyqxmd.com/read/29120211/mental-health-treatment-related-stigma-and-professional-help-seeking-among-student-veterans
#12
Joseph M Currier, Ryon C McDermott, Wesley H McCormick
Record numbers of military veterans are enrolling at colleges/universities across the United States. Although a substantive subset might suffer from mental health problems, the majority of these students might not be amenable to utilizing services. The purpose of this study was to examine the role of treatment-related stigma in intentions to seek professional help among undergraduate student veterans at a university on the U.S. Gulf Coast. Focusing on 251 veterans and a gender-matched comparison group of 251 nonveterans, student veterans endorsed higher probabilities of seeking care from physicians (d = ...
November 2017: Psychological Services
https://www.readbyqxmd.com/read/29117314/assessment-of-fluorodeoxyglucose-f18-labeled-positron-emission-tomography-for-diagnosis-of-high-risk-lung-nodules
#13
Amelia W Maiga, Stephen A Deppen, Sarah Fletcher Mercaldo, Jeffrey D Blume, Chandler Montgomery, Laszlo T Vaszar, Christina Williamson, James M Isbell, Otis B Rickman, Rhonda Pinkerman, Eric S Lambright, Jonathan C Nesbitt, Eric L Grogan
Importance: Clinicians rely heavily on fluorodeoxyglucose F18-labeled positron emission tomography (FDG-PET) imaging to evaluate lung nodules suspicious for cancer. We evaluated the performance of FDG-PET for the diagnosis of malignancy in differing populations with varying cancer prevalence. Objective: To determine the performance of FDG-PET/computed tomography (CT) in diagnosing lung malignancy across different populations with varying cancer prevalence. Design, Setting, and Participants: Multicenter retrospective cohort study at 6 academic medical centers and 1 Veterans Affairs facility that comprised a total of 1188 patients with known or suspected lung cancer from 7 different cohorts from 2005 to 2015...
November 8, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/29116244/delivery-of-neostigmine-and-glycopyrrolate-by-iontophoresis-a-nonrandomized-study-in-individuals-with-spinal-cord-injury
#14
Mark A Korsten, Brian L Lyons, Miroslav Radulovic, Tradd M Cummings, Gautam Sikka, Kamaldeep Singh, Anton Sabiev, Ann M Spungen, William A Bauman
STUDY DESIGN: Phase I Clinical Trial. OBJECTIVES: In this proof-of-principle study, the effectiveness and safety of transdermal administration of neostigmine/glycopyrrolate to elicit a bowel movement was compared to intravenous administration in patients with spinal cord injury. SETTING: James J. Peters Veterans Affairs Medical Center (Bronx, NY). METHODS: Individuals were screened for responsiveness (Physical Response) to intravenous neostigmine (0...
November 8, 2017: Spinal Cord
https://www.readbyqxmd.com/read/29114610/initiative-to-reduce-bone-scans-for-low-risk-prostate-cancer-patients-a-quasi-experimental-before-and-after-study-in-a-veterans-affairs-hospital
#15
Eric Ojerholm, Keith N Van Arsdalen, Robert E Roses, Patrick Tripp
Purpose: Bone scans (BS) are a low-value test for asymptomatic men with low-risk prostate cancer. We performed a quality improvement intervention aimed at reducing BS for these patients. Methods and materials: The intervention was a presentation that leveraged the behavioral science concepts of social comparison and normative appeals. Participants were multidisciplinary stakeholders from the Radiation Oncology and Urology services at a Veterans Affairs hospital...
July 2017: Advances in Radiation Oncology
https://www.readbyqxmd.com/read/29113634/pharmacy-diabetes-management-of-a-veteran-population-in-a-long-term-care-setting-a-program-evaluation
#16
Forest Hansen, Hilary Teeples, Jordan Csati, Suzanne M Gillespie
BACKGROUND: The benefits of an outpatient pharmacy diabetes clinic has been established, with improved patient outcomes and reduced total costs of care. We describe the benefits of an inpatient clinical pharmacy diabetes service within a Department of Veterans Affairs long-term care facility. METHODS: Patients were referred to the pharmacy diabetes monitoring program between February 2016 and August 2016. During this time, clinical pharmacy specialists managed all pharmacotherapy relating to diabetes care as well as all fingerstick monitoring frequencies and laboratory monitoring to achieve a prespecified, patient-specific A1C goal...
November 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/29109496/no-results-no-problem-why-we-are-publishing-methods-of-a-landmark-study-with-results-still-pending
#17
Brian E Lacy, Brennan Spiegel
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in both men and women in the United States, and screening for CRC is a national health-care priority. In this issue, investigators from the CONFIRM study group report on the aims and study design of a large, multicenter, randomized prospective study of whether screening colonoscopy is superior to an annual fecal immunochemical test (FIT). CONFRIM hopes to enroll 50,000 individuals, aged 50-75 years, from 46 Veterans Affairs Medical Centers and monitor them for 10 years...
November 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29101421/long-term-follow-up-of-intensive-glycaemic-control-on-renal-outcomes-in-the-veterans-affairs-diabetes-trial-vadt
#18
Lily Agrawal, Nasrin Azad, Gideon D Bahn, Ling Ge, Peter D Reaven, Rodney A Hayward, Domenic J Reda, Nicholas V Emanuele
AIMS/HYPOTHESIS: We conducted an analysis of data collected during the Veterans Affairs Diabetes Trial (VADT) and the follow-up study (VADT-F) to determine whether intensive (INT) compared with standard (STD) glycaemic control during the VADT resulted in better long-term kidney outcomes. METHODS: VADT randomly assigned 1791 veterans from 20 Veterans Affairs (VA) medical centres who had type 2 diabetes mellitus and a mean HbA1c of 9.4 ± 2% (79.2 mmol/mol) at baseline to receive either INT or STD glucose control for a median of 5...
November 3, 2017: Diabetologia
https://www.readbyqxmd.com/read/29100580/another-case-of-underprovision-of-mitral-valve-repair-surgery-lessons-from-the-veterans-affairs-health-system
#19
EDITORIAL
Anelechi C Anyanwu, David H Adams
No abstract text is available yet for this article.
September 28, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29100219/healthcare-utilization-by-frail-community-dwelling-older-veterans-a-1-year-follow-up-study
#20
Miriam Zylberglait Lisigurski, Yolin A Bueno, Chandana Karanam, Allen D Andrade, Sisir Akkineni, Victor Cevallos, Jorge G Ruiz
OBJECTIVES: Frailty is a prevalent clinical syndrome associated with a high risk of adverse health outcomes, including disability, morbidity, and mortality, that has become a major challenge for the healthcare system. The aim of this prospective study was to determine the level of healthcare utilization in prefrail and frail community-dwelling older military veterans. METHODS: We studied a cohort of community-dwelling older veterans aged 65 years and older 1 year at the Miami Veterans Affairs Medical Center to determine their levels of healthcare utilization...
November 2017: Southern Medical Journal
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