Federal practitioner : for the health care professionals of the VA, DoD, and PHS最新文献

{"title":"Gadolinium Intermediate Elimination and Persistent Symptoms After Magnetic Resonance Imaging Contrast Agent Exposure.","authors":"Brent Wagner, Olivia X Jastrzemski, Sasha R Vigil, Lien Tang, Shreeti Patel, Amy Cunningham, Joshua DeAguero, Karol Dokladny, G Patricia Escobar, Jing Yang, Frederick Gentry, Ian Henderson, Rachel Coyte, Martin L Kirk, James H Degnan, Bevan T Choate","doi":"10.12788/fp.0631","DOIUrl":"10.12788/fp.0631","url":null,"abstract":"<p><strong>Background: </strong>Gadolinium is the most widely used diagnostic heavy metal contrast agent in the Military Health System and Veterans Health Administration (VHA). Used for enhancing magnetic resonance imaging (MRI), gadolinium can also have toxic effects. From 1999 to 2025 use of contrast-enhanced MRI in VHA facilities has risen to a mean (SD) 2.6 (2.8) MRIs with gadolinium each for 939,928 patients.</p><p><strong>Case presentation: </strong>A 65-year-old Air Force veteran and retired mechanical technician sought nephrology consultation. His medical history included posttraumatic stress disorder, cervical spondylosis, ulnar nerve injury, bilateral sensorineural hearing loss, dyslipidemia, and hypertension. Twenty-five days before consultation, the patient started a contrast-enhanced MRI for elevated prostate-specific antigens. During the MRI, he experienced claustrophobia, sweating, shortness of breath, a metallic taste, and hot sensations in the groin, chest, \"kidneys,\" and lower back, and the MRI was halted. Some symptoms reappeared days later, resulting in a 4-day hospitalization. Serum gadolinium measured 0.1 ng/mL, and 24-hour urine gadolinium was 0.3 mcg. Back-extrapolation of gadolinium elimination rates suggested exposure to 0.5% to 8.0% of a standard contrast dose. At 107 days post-MRI, serum and urine gadolinium were undetectable, but the metallic taste persisted.</p><p><strong>Conclusions: </strong>Our findings suggest that detectable gadolinium in serum and urine may reflect subclinical exposure, even at doses below standard prescriptions. Clinicians must consider gadolinium as a potential cause of pleiotropic symptoms even when, as in this case, symptoms persist despite undetectable levels of gadolinium.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 11","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staff Perspectives on the VISN 20 Tele-Neuropsychology Program.","authors":"Ana C Messler, David D Hargrave, Christine E Gould, Chalise Carlson, Jeffrey A Sordahl","doi":"10.12788/fp.0652","DOIUrl":"10.12788/fp.0652","url":null,"abstract":"<p><strong>Background: </strong>The use of tele-neuropsychology (teleNP) is increasing within Veterans Integrated Service Network (VISN) 20. A quality improvement survey was conducted to better understand VISN 20 staff opinions of teleNP, how to improve the services, and whether it is preferred over face-to-face (F2F) neuropsychology evaluations in community-based settings.</p><p><strong>Methods: </strong>The authors surveyed US Department of Veterans Affairs (VA) VISN 20 staff from February 7, 2024, to June 15, 2024. Eighteen of 33 respondents had referred patients for neuropsychology services during the previous year.</p><p><strong>Results: </strong>The mean (SD) rating of teleNP usefulness was 1.5 (0.8) (between very much so and mostly useful on the scale) and the rating of non-VA F2F neuropsychology evaluation usefulness was 1.7 (0.9). A Wilcoxon signed rank-test of related samples indicated no differences between the pairs of ratings (<i>Z</i> = 1.50; <i>P</i> = .41). Respondents serving rural veterans were more likely to refer patients for teleNP services compared with those serving nonrural veterans (χ² = 5.7; <i>P =</i> .02). However, ratings of teleNP usefulness did not significantly differ for those serving rural compared with nonrural veterans (χ² = 1.4; <i>P =</i> .49).</p><p><strong>Conclusions: </strong>While response rate was low, the survey provides initial support for the acceptability and utility of teleNP among VA staff who responded to the survey, with favorable comparisons of teleNP to existing F2F neuropsychology resources.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 11","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Unanticipated Difficult Intubation Due to Posterior Tracheal Angulation.","authors":"Teresa H Jiang, Vivek Arora","doi":"10.12788/fp.0633","DOIUrl":"10.12788/fp.0633","url":null,"abstract":"<p><strong>Background: </strong>Lateral tracheal deviation from mechanical compression is well-known, but anterior-posterior (A-P) deviation has been rarely reported.</p><p><strong>Case presentation: </strong>A 50-year-old male with a history of chronic cerebral venous sinus thrombosis and taking enoxaparin presented to the emergency department for recurrent headaches. The patient experienced cardiac arrest and endotracheal tube (ETT) advancement was difficult secondary to unexpected posterior tracheal deviation encountered during cardiopulmonary resuscitation. Flexible fiber-optic bronchoscopy was performed to traverse the acute angulation and advance the ETT.</p><p><strong>Conclusions: </strong>Tracheal deviation in the A-P direction should be considered as a cause of difficult ETT advancement, and fiber-optic bronchoscopy should be performed early to diagnose such lesions.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 10","pages":"382-384"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Outcomes of a Telehealth-Based Physical Activity Program in Older Veterans Postdischarge.","authors":"Daniel Liebzeit, Samantha Bjornson, Kristin Phillips, Robert V Hogikyan, Christine Cigolle, Neil B Alexander","doi":"10.12788/fp.0632","DOIUrl":"10.12788/fp.0632","url":null,"abstract":"<p><strong>Background: </strong>Hospital-to-home transitions are influenced by hospitalization factors, associated posthospital syndromes, and postdischarge health care application. The objective of this study was to examine how these factors influenced outcomes of a pilot intervention using Veterans Affairs Video Connect (VVC) to enhance function and physical activity in older adults posthospital discharge.</p><p><strong>Methods: </strong>Twenty-four older adults (mean age, 74 years) participated in a 6-month pilot VVC physical activity intervention designed to enhance functional ability, physical performance, and physical activity.</p><p><strong>Results: </strong>Participants with mild to moderate cognitive impairment had less improvement in activities of daily living (median, 0; IQR, 0 to 1) than those with no impairment (median, 0; IQR, -0.75 to 0; effect size [ES], -1.1<i>; P</i> = .04). Participants with ≥ 1 readmission experienced a greater increase in Rosow-Breslau mobility disability score (median, 0; IQR, -0.5 to 1) than participants who were not readmitted (median, 0; IQR, -1.25 to 0.25; ES, 1.0<i>; P</i> = .03). Longer hospital length of stay was correlated with an increase in Nagi score (ρ, 0.45; 95% CI, 0.01 to 0.75), and higher number of medication changes was correlated with a decrease in Rosow-Breslau mobility disability score (ρ, -0.47; 95% CI, -0.76 to -0.02).</p><p><strong>Conclusions: </strong>In a cohort of older adults undergoing a 6-month pilot VVC-based physical activity intervention posthospital discharge, improvements in mobility and disability were most likely in those who had no cognitive impairment and were not readmitted. Larger sample and qualitative investigations are necessary to optimize outcomes for those who meet these clinical profiles.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 10","pages":"348-356"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"American Hunger Games: Food Insecurity Among the Military and Veterans.","authors":"Cynthia M A Geppert","doi":"10.12788/fp.0647","DOIUrl":"10.12788/fp.0647","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 10","pages":"363-364"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Integration of Extended Reality in Arthroplasty: Reviewing Technological Progress and Clinical Benefits.","authors":"Rini Desai, Michael Stickels, Harold Dossett","doi":"10.12788/fp.0629","DOIUrl":"10.12788/fp.0629","url":null,"abstract":"<p><strong>Background: </strong>Extended reality (XR) has shown promise in the operating room for enhancing surgical precision and improving patient outcomes. With the evolution of individualized planning in orthopedic surgery, precise implant alignment is integral to improving pain and function. XR encompasses augmented reality (AR), virtual reality (VR), and mixed reality (MR). Both AR and MR have been adapted for operating room use, while VR has been adapted for surgical planning and educational training.</p><p><strong>Methods: </strong>A literature search identified studies evaluating XR in arthroplasty and XR systems approved by the US Food and Drug Administration. This narrative report highlights the integration of XR in arthroplasty.</p><p><strong>Results: </strong>In total hip arthroplasty (THA), XR is most effective for maximizing alignment of the acetabular cup. Traditional techniques make ideal anteversion and inclination angles difficult to achieve, values critical for implant stability and the prevention of impingement and precocious wear. XR systems have been shown to improve the accuracy of inclination compared with traditional techniques in THA. For total knee arthroplasty (TKA), XR proves most useful in ensuring accurate alignment and resection for the tibial and femoral components. XR systems for TKA have been shown to increase the accuracy of distal femoral resection with a limited increase in surgery duration. Conventional techniques for total shoulder arthroplasty (TSA) are complicated by the difficulty faced in accessing and visualizing key structures with the shoulder, particularly with the recent trend towards minimally invasive techniques. Issues with implant positioning are more common in TSA than other joint arthroplasties, making XR particularly promising in this setting.</p><p><strong>Conclusions: </strong>XR technologies have shown significant potential in enhancing precision and patient outcomes in arthroplasty. There are some disadvantages to its use, however, including high cost and increased operative time. Integrating XR into surgical practice can improve implant alignment and accuracy, addressing challenges faced with conventional techniques.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 10","pages":"386-390"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updates in Multiple Sclerosis Imaging.","authors":"Zachery Rohm, Ahmad Toubasi, Carynn Koch, Mitchell Wallin, Francesca Bagnato","doi":"10.12788/fp.0620","DOIUrl":"10.12788/fp.0620","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS), one of the most common causes of neurological disability in young adults, is a chronic central nervous system disease characterized by immune-mediated inflammation, demyelination, and neurodegeneration. MS may be difficult to diagnose due to its protean neurological manifestations and the multitude of other neurologic conditions that can produce white matter lesions similar to MS demyelinating lesions. The wide clinical variability of the disease makes it challenging to provide an accurate prognosis in an individual with MS.</p><p><strong>Observations: </strong>Magnetic resonance imaging (MRI) biomarkers such as T2-lesions, chronic black holes, atrophy, paramagnetic rim lesions (PRL), and the central vein sign (CVS), may assist clinicians with the diagnosis and prognostication of MS. Underscoring their importance, PRL and CVS will be incorporated into the 2024 iteration of the McDonald Criteria for the diagnosis of MS. Quantitative MRI techniques, utilized in translational research, can quantify the degree of microstructural injury and guide the development of future therapies. This review discusses the impact, recent advances, and limitations of imaging biomarkers and quantitative MRI techniques with regard to routine MS clinical care and translational research.</p><p><strong>Conclusions: </strong>Clinicians caring for people with MS should have a basic understanding of imaging biomarkers and their implications for routine clinical care.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 10","pages":"365-371"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process Improvement for Engaging With Trauma-Focused Evidence-Based Psychotherapy for PTSD.","authors":"Nicholas Holder, Rachel M Ranney, Natalie Purcell, Gayle Y Iwamasa, Alejandra K Delgado, Adam Batten, Thomas C Neylan, Brian Shiner, Shira Maguen","doi":"10.12788/fp.0627","DOIUrl":"10.12788/fp.0627","url":null,"abstract":"<p><strong>Background: </strong>Initiation rates of trauma-focused evidence-based psychotherapy (TF-EBP) for posttraumatic stress disorder (PTSD) remain low despite large-scale dissemination efforts in the US Department of Veterans Affairs (VA). Through semistructured qualitative interviews, this study examined veterans' recommendations for process improvement in engaging in TF-EBP and mental health care.</p><p><strong>Methods: </strong>A qualitative analysis was conducted as part of a larger mixed-methods study. Thirty veterans who recently initiated TF-EBP were recruited to complete a semistructured qualitative interview about their experience. Rapid qualitative analysis procedures were used to analyze all interview content and identify themes focused on veteran experiences relevant to process improvement in TF-EBP and mental health care.</p><p><strong>Results: </strong>Seven themes were identified: (1) veterans had a poor understanding of VA mental health care; (2) stigma remains a barrier to engaging in mental health treatment; (3) veterans emphasized the importance of therapy fundamentals (eg, rapport, flexibility) throughout their care; (4) shared decision-making was valued when used to select TF-EBP; (5) respect for preferences in treatment selection was associated with a positive outlook on TF-EBP; (6) veterans wanted clinicians to ask about relevant cultural identities early in their assessment/treatment; and (7) acknowledging culture and using culturally relevant examples strengthened TF-EBP engagement.</p><p><strong>Conclusions: </strong>Veterans identified 3 areas for continued process improvement: (1) providing information about the diverse range of mental health care services at the VA and the implications of this continuum of care; (2) consideration of veteran preferences in treatment decision-making, including the importance of perceived choice; and (3) incorporating cultural assessment and cultural responsiveness into case conceptualization and treatment.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 10","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Retroactive Application of Updated Surveillance Guidelines on Endoscopy Center Capacity at a Large VA Health Care System.","authors":"Yujie Sun, Michael J Kingsley, Richard M Wu, Ravy K Vajravelu, Asif Khalid","doi":"10.12788/fp.0628","DOIUrl":"10.12788/fp.0628","url":null,"abstract":"<p><strong>Background: </strong>In 2020, the US Multi-Society Task Force (USMSTF) on Colorectal Cancer revised its recommended interval for surveillance of 1 to 2 subcentimeter tubular adenomas from 5 to 10 years to 7 to 10 years. This study assessed the impact of retroactively applying these guidelines on endoscopy center capacity.</p><p><strong>Methods: </strong>Colonoscopy reports were reviewed for patients with an upcoming colonoscopy reminder at the Veterans Affairs Pittsburgh Healthcare System (VAPHS). Patients with incomplete records, high-risk indications, or inadequate bowel preparation were excluded. Previous surveillance recommendations were compared with the 2020 USMSTF guideline to determine whether colonoscopy intervals could be extended.</p><p><strong>Results: </strong>Of 583 patients, 331 (56.7%) had adequate data to determine extendibility. Using the 2020 USMSTF guidelines, colonoscopy interval could be extended by ≥ 1 year for 64 patients (11%) for a total of 153 years extended. For 36 patients, the ability to extend the colonoscopy interval was directly attributable to the updated 2020 USMSTF guideline.</p><p><strong>Conclusions: </strong>Retroactive application of USMSTF surveillance guidelines could modestly increase endoscopic capacity, but overall impact may be limited by fragmentation of care.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 10","pages":"378-381"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empowering Culture Change and Safety on the Journey to Zero Harm With Huddle Cards.","authors":"Michael T Finch, Brandon Mason, Nicole Volek, Brittany Phillips, Jennifer Shoaf, Debbie Brown, Ashley R McCormack, Jessica J Estell","doi":"10.12788/fp.0597","DOIUrl":"10.12788/fp.0597","url":null,"abstract":"<p><strong>Background: </strong>Safety event reporting plays an important role in improving patient safety. The US Department of Veterans Affairs has focused on minimizing or eliminating harm to patients.</p><p><strong>Observations: </strong>The patient safety (PS) and high reliability organization (HRO) teams at the Central Texas Veterans Health Care System (CTVHCS) developed an education model that integrates the Joint Patient Safety Reporting System (JPSR) into huddles. JPSR Huddle Cards provide frontline staff and management with guidance on the purpose of the JPSR, the difference between an adverse event and a near miss, what root causes are, the lifespan of a JPSR, how to celebrate reporting, and key fact checks. Six cards were presented to staff (1 per week) during morning safety huddles to support the CTVHCS journey to high reliability. Participants completed a survey on safety before and after receiving the cards.</p><p><strong>Conclusions: </strong>Posttest scores were consistently higher than pretest scores, with an average increase of around 2 standard deviations across all questions.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 9","pages":"336-340"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}