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

{"title":"Characterizing Opioid Response in Older Veterans in the Post-Acute Setting","authors":"Victoria D. Powell","doi":"10.12788/fp.0229","DOIUrl":"https://doi.org/10.12788/fp.0229","url":null,"abstract":"Background: Opioids often are used in post-acute care (PAC) settings, although there is a lack of evidence of sustained pain reduction and improved function. There are subgroups of individuals whose pain does not respond well to opioids yet report these agents as highly beneficial. We aimed to classify opioid responsiveness among veterans residing in a US Department of Veterans Affairs community living center PAC unit. Methods: This observational, cross-sectional study used barcode medication administration data followed by retrospective chart review. We determined opioid responsiveness along a continuum during 4 nonconsecutive days in 2016 and 2017. We defined opioid responsiveness as the mean change in pre- and postopioid pain ratings using the 0 to 10 scale over the 24-hour observation period (ie, mean ∆ score). The chart review identified correlates of opioid responsiveness adjusting for mean pre-opioid pain ratings. Results: Among the 41 residents who received opioids for at least moderate pain (≥ 4 of 10), the average response was highly variable (range, 0.5 - 6.3). Response did not correlate with demographic variables, indication for admission, or medical comorbidities, including cancer diagnosis. The presence of any psychiatric diagnosis ( P = .03), pain service consult ( P = .03), and higher opioid dosage ( P = .002) was significantly associated with poorer response. Conclusions: This pilot study classified opioid response on a continuum using a scalable administrative data source. Despite receiving higher dosages and more specialist consultations, some veterans’ pain responds poorly to opioids. Psychiatric comorbidity seems to increase this risk. Future studies in larger, more representative populations are necessary to confirm these findings to develop personalized pain management strategies that mitigate risks of opioids. its This article may discuss unlabeled or inves- tigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combina- tions—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77513052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Presentation of Subacute Combined Degeneration in a Patient With Chronic B12 Deficiency.","authors":"Nathan Kostick, Evan J Chen, Tabitha Eckert, Igor Sirotkin, E. Baldinger, A. Frontera","doi":"10.12788/fp.0228","DOIUrl":"https://doi.org/10.12788/fp.0228","url":null,"abstract":"Background\u0000Subacute combined degeneration (SCD) is a rare complication of chronic vitamin B12 deficiency that presents with a variety of neurologic findings, including decreased sensation in the extremities, increased falls, and visual changes. Treatment of SCD involves prompt replacement of vitamin B12 and addressing the underlying conditions that cause the deficiency. Given the prevalence of B12 deficiency in the older adult population, clinicians should remain alert to its possibility in patients who present with progressive neuropathy.\u0000\u0000\u0000Case Presentation\u0000This report presents a case of a patient with progressive SCD secondary to chronic B12 deficiency despite monthly intramuscular B12 injections.\u0000\u0000\u0000Conclusions\u0000Appropriate B12 replacement is aggressive and involves intramuscular B12 1000 mcg every other day for 2 to 3 weeks, followed by additional IM administration every 2 months before transitioning to oral therapy. Failure to adequately replenish B12 can lead to progression or lack of resolution of SCD symptoms.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"39 3 1","pages":"142-146"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46656765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pioneer in Women's Federal Practice.","authors":"C. Geppert","doi":"10.12788/fp.0242","DOIUrl":"https://doi.org/10.12788/fp.0242","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"39 3 1","pages":"104-105"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49493119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health Pharmacists: Increasing Necessary Mental Health Service Delivery.","authors":"Mikayla Romney, Renee F. Robinson, J. Boyle","doi":"10.12788/fp.0237","DOIUrl":"https://doi.org/10.12788/fp.0237","url":null,"abstract":"Background\u0000Pharmacists are well trained, readily accessible health care professionals (HCPs) who practice in a variety of inpatient and outpatient mental health settings.\u0000\u0000\u0000Observations\u0000As part of the interdisciplinary team, pharmacists can help address HCP shortages. Pharmacists currently are providing mental health collaborative practice services at US Department of Veterans Affairs (VA) facilities.\u0000\u0000\u0000Conclusions\u0000Collaborative practice services can be expanded within and outside the VA by using pharmacists to increase access to care and improve outcomes.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"39 3 1","pages":"106-108"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47749432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Interventions and Adverse Events After Nonfatal Opioid Overdoses in Veterans.","authors":"E. Chen, Margaret Mendes, Colin D McGuire, S. Cheng","doi":"10.12788/fp.0236","DOIUrl":"https://doi.org/10.12788/fp.0236","url":null,"abstract":"Background\u0000Veterans are twice as likely to experience a fatal opioid overdose compared with their civilian counterparts. Recognition has increased that effective opioid overdose prevention likely requires a holistic approach that addresses the biopsychosocial factors contributing to opioid-related morbidity and mortality.\u0000\u0000\u0000Methods\u0000This retrospective descriptive study includes veterans who were administered naloxone for treatment of opioid overdose in the emergency department at Veterans Affairs San Diego Healthcare System from July 1, 2013 through April 1, 2017. Subjects were excluded if they received palliative/hospice care or were lost to follow-up, if there was documented lack of response to naloxone administration, and if overdose occurred secondary to inpatient administration of opioids. Data were collected via chart review.\u0000\u0000\u0000Results\u0000Thirty-five patients were included in this study. At the time of nonfatal opioid overdose, 29 (82.9%) had an active opioid prescription, and the mean morphine equivalent daily dose (MEDD) was 117 mg. Thirty-three (94.3%) had comorbid psychiatric disorders and 20 (57.1%) had substance use disorders. Within 6 months following overdose, subjects received care from mental health (45.5%), addiction treatment services (50.0%), and pain management (40.0%). Documented repeat overdose occurred in 4 patients.\u0000\u0000\u0000Conclusions\u0000This study may aid in the identification of potential areas for improvement in the prevention of opioid overdose and opioid-related mortality among veterans. Interventions designed to improve access to, engagement, and retention in effective care are pivotal for addressing the opioid epidemic as it evolves.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"39 3 1","pages":"136-141"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42357637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A First Look at the VA MISSION Act Veteran Health Administration Medical School Scholarship and Loan Repayment Programs.","authors":"John Byrne, Erin L Patel, P. Greenberg, Martin Eason, Anthony P Albanese, E. Bope, Sherri L Stephan, Patrick T Youngblood","doi":"10.12788/fp.0238","DOIUrl":"https://doi.org/10.12788/fp.0238","url":null,"abstract":"Background\u0000The US Department of Veterans Affairs (VA) is challenged by physician staffing shortages. The 2018 VA MISSION ACT authorized 2 scholarship and loan repayment programs. The Health Professions Scholarship Program (HPSP) created scholarships for physicians and dentists. The Education Debt Reduction Program (EDRP) increased the maximum debt reduction. The Specialty Education Loan Repayment Program (SELRP) authorized the repayment of educational loans for physicians in specialties deemed necessary for VA. The Veterans Healing Veterans (VHV) program was a 1-year pilot program specifically for veteran medical students.\u0000\u0000\u0000Observations\u0000For academic years 2020/2021 and 2021/2022, HPSP offered 54 scholarships with 51 accepted. In 2020, the VHV program offered 22 scholarships with 12 accepted by recipients at all 5 Teague-Cranston medical schools and 4 Historically Black Colleges and Universities. For SELRP, 14 applicants have been approved in family medicine, internal medicine, emergency medicine, and geriatrics. The average loan repayment is anticipated to be $110,000, which equates to 38.5 VA service years for the 14 applicants. Since 2018, 1546 physicians received EDRP awards with amounts increased from an average of $96,090 in 2018 to $148,302 in 2020.\u0000\u0000\u0000Conclusions\u0000The VA MISSION Act's scholarship and loan repayment programs provide VA with several ways to address physician workforce shortages. Ultimately, the success of the program will be determined by the recruitment of scholarship recipients to VA careers.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"39 3 1","pages":"110-113"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41599702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telescoping Stents to Maintain a 3-Way Patency of the Airway.","authors":"A. Zubair, M. Jagtiani, F. Oleszak, P. Belligund, M. Al-Ajam","doi":"10.12788/fp.0240","DOIUrl":"https://doi.org/10.12788/fp.0240","url":null,"abstract":"Background\u0000Central airway obstruction near the right upper lobe (RUL) airway orifice poses a dilemma for the clinician. Maintaining ventilation to the right middle and right lower lobes is of utmost importance. However, preserving ventilation to the RUL is desirable as well especially in patients with significant dyspnea.\u0000\u0000\u0000Case presentation\u0000In this case report, we describe telescoping 2 covered self-expanding hybrid stents to relieve airway obstruction while maintaining RUL ventilation.\u0000\u0000\u0000Conclusions\u0000Review of current literature revealed several additional documented approaches to overcome this challenge. The choice of intervention needs to be deliberated based on the available stents, delineation of the airway obstruction, and the patient's anatomy.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"39 3 1","pages":"120-124"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44845644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Academic Hospitalist-Run Outpatient Paracentesis Clinic.","authors":"Lawrence D. Gerber, G. Sgro, Jessica E. Cyr, Sharon Conlin","doi":"10.12788/fp.0235","DOIUrl":"https://doi.org/10.12788/fp.0235","url":null,"abstract":"Background\u0000Patients needing large-volume paracenteses (LVPs) can occupy inpatient hospital beds and unnecessarily use inpatient resources.\u0000\u0000\u0000Methods\u0000We describe an outpatient paracentesis clinic that was part of a quality assurance initiative at the Veterans Affairs Pittsburgh Healthcare System in Pennsylvania. A retrospective review was conducted that included patient age, sex, etiology of ascites, amount of ascites removed, time of the procedure, complications, and results of ascites cell count and cultures abstracted from the electronic health record.\u0000\u0000\u0000Results\u0000Over 74 months, 506 paracenteses were performed on 82 patients. The mean volume removed was 7.9 L, and the mean time of the procedure was 33.3 minutes. There were 5 episodes of postprocedure hypotension that required admission for 3 patients. One episode of abdominal wall hematoma occurred that required admission. Two patients developed incarceration of an umbilical hernia after the paracentesis; both required surgical repair. Without the clinic, almost all the 506 outpatient LVPs we performed would have resulted in a hospital admission.\u0000\u0000\u0000Conclusion\u0000An outpatient paracentesis clinic run by academic hospitalists can safely and quickly remove large volumes of ascites and minimize hospitalizations.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"39 3 1","pages":"114-119"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47320139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Lithium on Suicidality in the Veteran Population.","authors":"Kelsie M Stark, Saadia A Basit, Brian G Mitchell","doi":"10.12788/fp.0241","DOIUrl":"10.12788/fp.0241","url":null,"abstract":"<p><strong>Background: </strong>Lithium has known antisuicidal properties making it an important agent to study in veterans with psychiatric conditions, a population at high risk for suicide.</p><p><strong>Methods: </strong>A single-site, retrospective chart review was conducted at a US Department of Veterans Affairs (VA) teaching hospital. Patients taking lithium for at least 6 months were identified using the VA Lithium Lab Monitoring Dashboard. The primary and secondary objectives were to evaluate the change in number of suicide attempts and suicidal ideation from 3 months prior to lithium initiation to 3 months after a 6-month duration of lithium.</p><p><strong>Results: </strong>The review included 98 patients; 47 (47.9%) received concomitant psychotherapy, 50 (51.0%) were taking an antipsychotic, and 29 (29.6%) an additional mood stabilizer. During the 6-month intervention period, 75 (76.5%) patients had a lithium level drawn and 28 were in the therapeutic range. Of the 98 patients, hospitalization for suicide attempt decreased from 4.1% before lithium use to 0% after lithium use for 6 months (<i>P</i> = .045). Hospitalization for suicidal ideation also decreased from 13.3% before lithium use to 1.0% after lithium use for 6 months (<i>P</i> = .0004).</p><p><strong>Conclusions: </strong>We observed a statistically significant reduction in hospitalization for suicide attempts and suicidal ideation in veterans prescribed lithium following nonfatal suicide behavior and suicidal ideation.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"39 3 1","pages":"130-135"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9014926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46775465","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":"Mild Grisel Syndrome: Expanding the Differential for Posttonsillectomy Adenoidectomy Symptoms.","authors":"Thomas W. Riney, D. Brillhart","doi":"10.12788/fp.0218","DOIUrl":"https://doi.org/10.12788/fp.0218","url":null,"abstract":"Background\u0000Tonsillectomy with or without adenoidectomy is the second most common pediatric surgical procedure in the United States with up to 97% performed as an outpatient.1,2 While it is largely a safe procedure, several complications have been described and are encountered in the emergency department and primary care setting.\u0000\u0000\u0000Presentation\u0000A 29-month child presented to the emergency department with neck stiffness 10 days after tonsillectomy and adenoidectomy. A computed tomography scan of the neck limited by motion artifact was unrevealing, but a consult to the pediatric otolaryngologist generated concern for Grisel syndrome, the atraumatic rotary subluxation of the atlantoaxial joint. While surgical intervention can be required, the patient had an uncomplicated clinical course and the anomalous neck posture resolved with time and antiinflammatories alone.\u0000\u0000\u0000Conclusions\u0000Keeping a broad differential for posttonsillectomy and adenoidectomy patient concerns is important for the clinician. Serious, life-threatening complications can arise from Grisel syndrome while good functional outcomes can be achieved with timely and appropriate treatment.","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"39 2 1","pages":"e6-e10"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47756620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}