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https://www.readbyqxmd.com/read/28088603/hospital-readmissions-after-surgery-how-important-are-hospital-and-specialty-factors
#1
Robert H Hollis, Laura A Graham, Joshua S Richman, Melanie S Morris, Hillary J Mull, Tyler S Wahl, Edith Burns, Laurel A Copeland, Gordon L Telford, Amy K Rosen, Kamal F Itani, Jeffrey Whittle, Todd H Wagner, Mary T Hawn
BACKGROUND: Hospital readmission rates after surgery may represent an overall hospital effect or a combination of specialty and patient effects. We hypothesized that hospital readmission rates for procedures within specialties were more strongly correlated than rates across specialties within the same hospital. STUDY DESIGN: For general, orthopedic, and vascular specialties at Veterans Affairs hospitals during 2008-2014, 30-day risk-adjusted readmission rates were estimated for six high-volume procedures and each specialty...
January 11, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28088381/long-term-neurobehavioral-symptoms-and-return-to-productivity-in-operation-enduring-freedom-operation-iraqi-freedom-veterans-with-and-without-traumatic-brain-injury
#2
Marianne H Mortera, Stacy A Kinirons, Jessie Simantov, Heidi Klingbeil
OBJECTIVES: To describe Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who underwent the Comprehensive Traumatic Brain Injury Evaluation (CTBIE), differences between the traumatic brain injury (TBI) and non- traumatic brain injury (non-TBI) subgroups, and factors associated with return to productivity (RTP). DESIGN: Retrospective medical record review. SETTING: Veterans Affairs Medical Center, Polytrauma/TBI Network Site...
January 11, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28077205/impact-of-pharmacists-in-optimizing-geriatric-pharmacotherapy-in-primary-care-within-a-veterans-affairs-medical-center
#3
Taryn B Mondiello, Lauren A Stutzman
OBJECTIVE: To assess pharmacists' impact on optimizing pharmacotherapy among geriatric patients. DESIGN: Single-site, prospective, quality-improvement project. SETTING: Primary care at a Veterans Affairs medical center. PARTICIPANTS: Thirteen males 75 years of age and older were included. INTERVENTIONS: Recommendations were made by pharmacists to optimize prescribing. MAIN OUTCOME MEASURES: Differences between specific instances of suboptimal prescribing before and after pharmacists' recommendations, the percentage of pharmacists' recommendations accepted, and the top most commonly prescribed psychotropic medications and their most common indications...
January 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28076250/patient-reported-offers-of-alcohol-treatment-for-primary-care-patients-at-high-risk-for-an-alcohol-use-disorder
#4
Sean Grant, Katherine E Watkins, Andy Bogart, Susan M Paddock, Kimberly A Hepner
BACKGROUND: This study assessed patient-reported alcohol treatment offers by health care providers following routine annual screening for alcohol use in primary care. METHODS: A telephone interview within 30 days of the annual screen assessed demographics, alcohol and other drug use, mental health symptoms, and offers of formal treatment for alcohol by a Veterans Affairs health care provider. We included male patients (n = 349) at high risk for an alcohol use disorder (AUD) who had not received alcohol treatment in the past 3 months...
November 2016: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28073904/comparability-of-health-service-use-by-veterans-with-multisymptom-illness-and-those-with-chronic-diseases
#5
Stella M Gwini, Andrew B Forbes, Malcolm R Sim, Helen L Kelsall
OBJECTIVE: To compare health service utilization and disability claims among military personnel with multisymptom illness (MSI) (but no chronic diseases), those with chronic disease(s) and those without MSI or chronic diseases. MSI is also known as Gulf War illness. DESIGN: Cohort study. SETTING: Australia. PARTICIPANTS: In total, 1288 participants of a Gulf War veterans' study conducted in 2000-2003 (Wave-1) were followed up in 2011-2012 (Wave-2), aged on average 40 years...
January 9, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28073669/reoperation-rates-after-open-and-endovascular-abdominal-aortic-aneurysm-repairs
#6
Conor F Hynes, Kendal M Endicott, Sina Iranmanesh, Richard L Amdur, Robyn Macsata
OBJECTIVE: This study compared reoperation rates associated with open abdominal aortic aneurysm (AAA) repair (OR) outcomes vs endovascular AAA repair (EVAR). METHODS: A retrospective review of the Veterans Affairs Surgical Quality Improvement Project data was performed with inclusion criteria defined as all patients who underwent AAA repair from October 1, 2007, to October 1, 2013. The primary outcome was the incidence of reoperations. Reoperations included subsequent OR or EVAR procedures performed on the abdominal aorta or iliac arteries, surgical treatment of temporally related bowel obstruction, as well as treatment of abdominal or groin wound complications ≤6 months and treatment of bowel or lower limb ischemia ≤10 days...
January 7, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28069657/obesity-and-heart-failure-predictors-of-failure-in-outpatient-skin-and-soft-tissue-infections
#7
Erin L Conway, John A Sellick, Kari Kurtzhalts, Kari A Mergenhagen
PURPOSE: The purpose of this study was to evaluate risk factors for failure of antibiotic treatment within 30 days for uncomplicated skin infections of outpatients treated in a Veteran's Affairs hospital. METHODS: A retrospective chart review of outpatients between January 2006 to July 2015 with an ICD-9 code of cellulitis or abscess were included in the analysis. The primary outcome was success versus failure of the antibiotic with failure defined as another antibiotic prescribed or hospitalization within 30 days for the original indication...
January 9, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28069650/evidence-to-support-continuation-of-statin-therapy-in-patients-with-staphylococcus-aureus-bacteremia
#8
Aisling R Caffrey, Tristan T Timbrook, Eunsun Noh, George Sakoulas, Steven M Opal, Victor Nizet, Kerry L LaPlante
In addition to cholesterol lowering capabilities, statins possess antiinflammatory and immunomodulatory effects. We sought to quantify the real-world impact of different statin exposure patterns on clinical outcomes in Staphylococcus aureus bacteremia. We conducted a retrospective cohort study among hospitalized patients with positive S. aureus blood cultures receiving appropriate antibiotics within 48 hours of culture collection (Veterans Affairs hospitals, 2002-2013). Three statin exposure groups were compared to non-users: pretreated statin users initiating therapy in the 30 days prior to culture and either (1) continuing statin therapy after culture, or (2) not continuing after culture, and (3) de novo users initiating at culture...
January 9, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28065327/eight-years-of-decreased-methicillin-resistant-staphylococcus-aureus-health-care-associated-infections-associated-with-a-veterans-affairs-prevention-initiative
#9
Martin E Evans, Stephen M Kralovic, Loretta A Simbartl, Rajiv Jain, Gary A Roselle
BACKGROUND: Declines in methicillin-resistant Staphylococcus aureus (MRSA) health care associated infections (HAIs) were previously reported in Veterans Affairs acute care (2012), spinal cord injury (SCIU) (2011), and long-term-care facilities (LTCFs) (2012). Here we report continuing declines in infection rates in these settings through September 2015. METHODS: Monthly data entered into a national database from 127 acute care facilities, 22 SCIUs, and 133 LTCFs were evaluated for trends using negative binomial regression...
January 1, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28060239/a-risk-factor-out-of-control-commentary-on-an-article-by-alon-ben-ari-md-et-al-preoperative-opioid-use-is-associated-with-early-revision-after-total-knee-arthroplasty-a-study-of-male-patients-treated-in-the-veterans-affairs-system
#10
https://www.readbyqxmd.com/read/28060227/preoperative-opioid-use-is-associated-with-early-revision-after-total-knee-arthroplasty-a-study-of-male-patients-treated-in-the-veterans-affairs-system
#11
Alon Ben-Ari, Howard Chansky, Irene Rozet
BACKGROUND: Opioid use is endemic in the U.S. and is associated with morbidity and mortality. The impact of long-term opioid use on joint-replacement outcomes remains unknown. We tested the hypothesis that use of opioids is associated with adverse outcomes after total knee arthroplasty (TKA). METHODS: We performed a retrospective analysis of patients who had had TKA within the U.S. Veterans Affairs (VA) system over a 6-year period and had been followed for 1 year postoperatively...
January 4, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28060203/predictors-of-employment-outcomes-in-veterans-with-traumatic-brain-injury-a-va-traumatic-brain-injury-model-systems-study
#12
Christina Dillahunt-Aspillaga, Risa Nakase-Richardson, Tessa Hart, Gail Powell-Cope, Laura E Dreer, Blessen C Eapen, Scott D Barnett, Dave Mellick, Adam Haskin, Marc A Silva
OBJECTIVES: To examine the length of time to return to work (RTW) among service members and veterans (SM/V) with traumatic brain injury (TBI) and to identify variables predictive of RTW. SETTING: Department of Veterans Affairs Polytrauma Rehabilitation Centers (VA PRC). PARTICIPANTS: SM/V enrolled in the VA PRC Traumatic Brain Injury Model Systems database who were of 18 to 60 years of age and admitted with the diagnosis of TBI. DESIGN: Prospective observational cohort study...
January 5, 2017: Journal of Head Trauma Rehabilitation
https://www.readbyqxmd.com/read/28055049/clinical-outcomes-of-metformin-use-in-populations-with-chronic-kidney-disease-congestive-heart-failure-or-chronic-liver-disease-a-systematic-review
#13
Matthew J Crowley, Clarissa J Diamantidis, Jennifer R McDuffie, C Blake Cameron, John W Stanifer, Clare K Mock, Xianwei Wang, Shuang Tang, Avishek Nagi, Andrzej S Kosinski, John W Williams
Background: Recent changes to the U.S. Food and Drug Administration boxed warning for metformin will increase its use in persons with historical contraindications or precautions. Prescribers must understand the clinical outcomes of metformin use in these populations. Purpose: To synthesize data addressing outcomes of metformin use in populations with type 2 diabetes and moderate to severe chronic kidney disease (CKD), congestive heart failure (CHF), or chronic liver disease (CLD) with hepatic impairment...
January 3, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28055048/detecting-heterogeneous-treatment-effects-to-guide-personalized-blood-pressure-treatment-a-modeling-study-of-randomized-clinical-trials
#14
Sanjay Basu, Jeremy B Sussman, Rod A Hayward
Background: Two recent randomized trials produced discordant results when testing the benefits and harms of treatment to reduce blood pressure (BP) in patients with cardiovascular disease (CVD). Objective: To perform a theoretical modeling study to identify whether large, clinically important differences in benefit and harm among patients (heterogeneous treatment effects [HTEs]) can be hidden in, and explain discordant results between, treat-to-target BP trials...
January 3, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28051985/eye-care-productivity-and-access-in-the-veterans-affairs-health-care-system
#15
Mary G Lynch, April Maa, William Delaune, Joel Chasan, Glenn C Cockerham
OBJECTIVES: Eye care in the Veterans Affairs Health Care System is challenged with increasing demand and higher prevalence of patients with complex ocular conditions. Understanding factors that impact eye care productivity and access is necessary for appropriate allocation of resources. The purpose of this study was to determine the impact of various eye clinic personnel on eye care provider productivity and patient access. METHODS: Utilizing data from the Veterans Health Administration National Data Warehouse, workload and level of staffing were analyzed...
January 2017: Military Medicine
https://www.readbyqxmd.com/read/28050745/an-evolving-ecosystem-for-natural-language-processing-in-department-of-veterans-affairs
#16
Jennifer H Garvin, Megha Kalsy, Cynthia Brandt, Stephen L Luther, Guy Divita, Gregory Coronado, Doug Redd, Carrie Christensen, Brent Hill, Natalie Kelly, Qing Zeng Treitler
In an ideal clinical Natural Language Processing (NLP) ecosystem, researchers and developers would be able to collaborate with others, undertake validation of NLP systems, components, and related resources, and disseminate them. We captured requirements and formative evaluation data from the Veterans Affairs (VA) Clinical NLP Ecosystem stakeholders using semi-structured interviews and meeting discussions. We developed a coding rubric to code interviews. We assessed inter-coder reliability using percent agreement and the kappa statistic...
February 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28050717/improving-patient-safety-avoiding-unread-imaging-exams-in-the-national-va-enterprise-electronic-health-record
#17
Sarah Bastawrous, Benjamin Carney
In the current digital and filmless age of radiology, rates of unread radiology exams remain low, however, may still exist in unique environments. Veterans Affairs (VA) health care systems may experience higher rates of unread exams due to coexistence of Veterans Health Information Systems and Technology Architecture (VistA) imaging and commercial picture archiving and communication systems (PACS). The purpose of this patient safety initiative was to identify any unread exams and causes leading to unread exams...
January 3, 2017: Journal of Digital Imaging: the Official Journal of the Society for Computer Applications in Radiology
https://www.readbyqxmd.com/read/28046665/su-f-t-246-evaluation-of-healthcare-failure-mode-and-effect-analysis-for-risk-assessment
#18
T Harry, R Manger, L Cervino, T Pawlicki
PURPOSE: To evaluate the differences between the Veteran Affairs Healthcare Failure Modes and Effect Analysis (HFMEA) and the AAPM Task Group 100 Failure and Effect Analysis (FMEA) risk assessment techniques in the setting of a stereotactic radiosurgery (SRS) procedure were compared respectively. Understanding the differences in the techniques methodologies and outcomes will provide further insight into the applicability and utility of risk assessments exercises in radiation therapy. METHODS: HFMEA risk assessment analysis was performed on a stereotactic radiosurgery procedure...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28046080/the-annual-burden-of-seasonal-influenza-in-the-us-veterans-affairs-population
#19
Yinong Young-Xu, Robertus van Aalst, Ellyn Russo, Jason K H Lee, Ayman Chit
Seasonal influenza epidemics have a substantial public health and economic burden in the United States (US). On average, over 200,000 people are hospitalized and an estimated 23,000 people die from respiratory and circulatory complications associated with seasonal influenza virus infections each year. Annual direct medical costs and indirect productivity costs across the US have been found to average respectively at $10.4 billion and $16.3 billion. The objective of this study was to estimate the economic impact of severe influenza-induced illness on the US Veterans Affairs population...
2017: PloS One
https://www.readbyqxmd.com/read/28045351/primary-care-mental-health-integration-in-the-va-health-system-associations-between-provider-staffing-and-quality-of-depression-care
#20
Debra S Levine, John F McCarthy, Brittany Cornwell, Laurie Brockmann, Paul N Pfeiffer
OBJECTIVES: The study examined whether staffing of Primary Care-Mental Health Integration (PCMHI) services in the Department of Veterans Affairs (VA) health system is related to quality of depression care. METHODS: Site surveys and administrative data from 349 VA facilities for fiscal year 2013 were used to calculate PCMHI staffing (full-time equivalents) per 10,000 primary care patients and discipline-specific staffing proportions for PCMHI psychologists, social workers, nurses, and psychiatric medication prescribers...
January 3, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
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